A Predictive Model to Help Identify Intimate Partner Violence Based on Diagnoses and Phone Calls
ABSTRACT Intimate partner violence (IPV) is a significant health problem but goes largely undiagnosed, undisclosed, and clinically undocumented.
To use historical data on diagnoses and telephone advice calls to develop a predictive model that identifies clinical profiles of women at high risk for undisclosed IPV.
A case-control study was conducted in women aged 18-44 years enrolled at Kaiser Permanente Northern California (KPNC) in 2005-2006 using symptoms reported by telephone and clinical diagnosis from electronic medical records. Analysis was conducted in 2007-2010. Overall, 1276 cases were identified using ICD-9 codes for IPV and were matched with 5 controls each. A full multivariate model was developed to identify those with IPV, as well as a reduced model and a summed-score model whose performance characteristics were assessed.
Predictors most highly associated with IPV were history of remote IPV (OR=7.8); calls or diagnoses for psychiatric problems (OR=2.4); calls for HIV concerns (OR=2.4); and clinical diagnoses of prenatal complications (OR=2.1). Using the summed-score model for a population with IPV prevalence of 7%, and using a threshold score of 3 for predicting IPV with a sensitivity of 75%, 9.7 women would need to be assessed to diagnose one case of IPV.
Diagnosed IPV was associated with a clinical profile based on both telephone call data and clinical diagnoses. The simple predictive model can prompt focused clinical inquiry and improve diagnosis of IPV in any clinical setting.
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ABSTRACT: We conducted a qualitative study to examine acute, situational factors and chronic stressors that triggered severe intimate partner violence (IPV) in women. Our sample consisted of 17 heterosexual couples, where the male was in detention for IPV and made telephone calls to his female victim. We used up to 4 hours of telephone conversational data for each couple to examine the couple's understanding of (1) acute triggers for the violent event and (2) chronic stressors that created the underlying context for violence. Grounded theory guided our robust, iterative data analysis involving audiotape review, narrative summation, and thematic organization. Consistently across couples, violence was acutely triggered by accusations of infidelity, typically within the context of alcohol or drug use. Victims sustained significant injury, including severe head trauma (some resulting in hospitalization/surgery), bite wounds, strangulation complications, and lost pregnancy. Chronic relationship stressors evident across couples included ongoing anxiety about infidelity, preoccupation with heterosexual gender roles and religious expectations, drug and alcohol use, and mental health concerns (depression, anxiety, and suicide ideation/attempts). Disseminated models feature jealousy as a strategy used by perpetrators to control IPV victims and as a red flag for homicidal behavior. Our findings significantly extend this notion by indicating that infidelity concerns, a specific form of jealousy, were the immediate trigger for both the acute violent episode and resulting injuries to victims and were persistently raised by both perpetrators and victims as an ongoing relationship stressor.Journal of Women's Health 06/2012; 21(9):942-9. DOI:10.1089/jwh.2011.3328 · 1.90 Impact Factor
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ABSTRACT: The Institute of Medicine, United States Preventive Services Task Force (USPSTF), and national healthcare organizations recommend screening and counseling for intimate partner violence (IPV) within the US healthcare setting. The Affordable Care Act includes screening and brief counseling for IPV as part of required free preventive services for women. Thus, IPV screening and counseling must be implemented safely and effectively throughout the healthcare delivery system. Health professional education is one strategy for increasing screening and counseling in healthcare settings, but studies on improving screening and counseling for other health conditions highlight the critical role of making changes within the healthcare delivery system to drive desired improvements in clinician screening practices and health outcomes. This article outlines a systems approach to the implementation of IPV screening and counseling, with a focus on integrated health and advocacy service delivery to support identification and interventions, use of electronic health record (EHR) tools, and cross-sector partnerships. Practice and policy recommendations include (1) ensuring staff and clinician training in effective, client-centered IPV assessment that connects patients to support and services regardless of disclosure; (2) supporting enhancement of EHRs to prompt appropriate clinical care for IPV and facilitate capturing more detailed and standardized IPV data; and (3) integrating IPV care into quality and meaningful use measures. Research directions include studies across various health settings and populations, development of quality measures and patient-centered outcomes, and tests of multilevel approaches to improve the uptake and consistent implementation of evidence-informed IPV screening and counseling guidelines.Journal of Women's Health 01/2015; 24(1):92-9. DOI:10.1089/jwh.2014.4870 · 1.90 Impact Factor
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ABSTRACT: The purpose of the present study was to investigate risk and protective factors for intimate partner violence (IPV) victimization in a high-risk sample of predominantly minority young adults from low-income urban communities. Participants were 1,130 individuals (57.9% women) ages 21 to 26 who participated in a telephone interview assessing IPV victimization, violence-related behaviors, and sexual behaviors. Results indicated that about 20.9% of participants reported experiencing one or more IPV incidents in their lifetime. Based on previous research, we examined lifetime violence, lifetime number of sexual partners, number of children, education, and religious service attendance as predictors of IPV. Results from a multivariate logistic regression showed that lifetime violence-related behaviors, number of lifetime sexual partners, and number of children were significant risk factors for IPV. The link between children and IPV risk: (a) was moderated by education for women and men and (b) was stronger for women(vs. men). These findings suggest that training for coping with stress and anger, endorsement of safe sex practices, and greater support for education may be effective strategies for preventing and reducing IPV among high-risk populations.Journal of Interpersonal Violence 06/2013; 28(15). DOI:10.1177/0886260513488684 · 1.64 Impact Factor