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HITS: A short domestic violence screening tool for use in a family practice setting


Abstract and Figures

Domestic violence is an important problem that is often not recognized by physicians. We designed a short instrument for domestic violence screening that could be easily remembered and administered by family physicians. In phase one of the study, 160 adult female family practice office patients living with a partner for at least 12 months completed two questionnaires. One questionnaire was the verbal and physical aggression items of the Conflict Tactics Scale (CTS). The other was a new four-item questionnaire that asked respondents how often their partner physically Hurt, Insulted, Threatened with harm, and Screamed at them. These four items make the acronym HITS. In phase two, 99 women, who were self-identified victims of domestic violence, completed the HITS. For phase one, Cronbach's alpha was .80 for the HITS scale. The correlation of HITS and CTS scores was .85. For phase two, the mean HITS scores for office patients and abuse victims were 6.13 and 15.15, respectively. Optimal data analysis revealed that a cut score of 10.5 on the HITS reliably differentiated respondents in the two groups. Using this cut score, 91% of patients and 96% of abuse victims were accurately classified. The HITS scale showed good internal consistency and concurrent validity with the CTS verbal and physical aggression items. The HITS scale also showed good construct validity in its ability to differentiate family practice patients from abuse victims. The HITS scale is promising as a domestic violence screening mnemonic for family practice physicians and residents.
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July-August 1998
Family Medicine
In the United States, 8–12 million women are vic-
tims of domestic violence from current or former part-
Domestic violence is related to serious mor-
bidity and is a major public health problem in our
Recent research has found, however, that
only a small percentage of victims of domestic vio-
lence are identified in medical practice.
Screening for domestic violence by physicians is
done infrequently for a variety of reasons.
We be-
lieve that one of the main reasons is that existing in-
struments are time-consuming to administer and com-
plete. For example, the Wife Abuse Inventory
40 items, and the Conflict Tactics Scale (CTS)
multiple scoring protocols and requires the purchase
of a scoring manual. Hence, physicians may be de-
terred from using these instruments in busy clinical
settings. In the present study, we developed and tested
a short domestic violence screening tool that could
be suitable for use in office practice.
Instrument development began by assembling a
focus group of family physicians
to discuss the type
and wording of items that would comprise a useful
screening instrument. The group decided that the items
should be few in number and focused on verbal abuse
and physical violence. The group ultimately decided
on four items that would ask a patient to indicate how
often her partner physically Hurts, Insults, Threatens,
and Screams at her. Collectively, these items can be
remembered by the acronym “HITS.”
The research was conducted in two phases. In phase
one, the reliability (ie, internal consistency) and the
concurrent validity of the HITS instrument were as-
HITS: A Short Domestic Violence Screening Tool
for Use in a Family Practice Setting
Kevin M. Sherin, MD, MPH; James M. Sinacore, PhD; Xiao-Qiang Li, MD;
Robert E. Zitter, PhD; Amer Shakil, MD
From the Department of Family Medicine, University of Illinois at
Background and Objectives: Domestic violence is an important problem that is often not recog-
nized by physicians. We designed a short instrument for domestic violence screening that could be
easily remembered and administered by family physicians.
Methods: In phase one of the study,
160 adult female family practice office patients living with a partner for at least 12 months com-
pleted two questionnaires. One questionnaire was the verbal and physical aggression items of the
Conflict Tactics Scale (CTS). The other was a new four-item questionnaire that asked respondents
how often their partner physically Hurt, Insulted, Threatened with harm, and Screamed at them.
These four items make the acronym HITS. In phase two, 99 women, who were self-identified
victims of domestic violence, completed the HITS.
Results: For phase one, Cronbach’s alpha was
.80 for the HITS scale. The correlation of HITS and CTS scores was .85. For phase two, the mean
HITS scores for office patients and abuse victims were 6.13 and 15.15, respectively. Optimal data
analysis revealed that a cut score of 10.5 on the HITS reliably differentiated respondents in the two
groups. Using this cut score, 91% of patients and 96% of abuse victims were accurately classified.
Conclusions: The HITS scale showed good internal consistency and concurrent validity with the CTS
verbal and physical aggression items. The HITS scale also showed good construct validity in its
ability to differentiate family practice patients from abuse victims. The HITS scale is promising as
a domestic violence screening mnemonic for family practice physicians and residents.
(Fam Med 1998;30(7):508-12.)
Clinical Research and Methods
Vol. 30, No. 7
sessed with a group of female patients who were vis-
iting their family physician. The CTS was chosen to
establish concurrent validity because it is the instru-
ment most widely used to measure marital violence.
In addition, the CTS assesses both the severity and
chronicity of that violence. Moreover, the CTS has
been used in three nationally normed studies
has a high level of internal consistency, concurrent
and content and construct validity.
CTS also has been found to correlate well with spouse
reports of domestic violence.
In phase two, the construct validity of the HITS
was tested by comparing the responses of the partici-
pants in phase one (general patients visiting their phy-
sician) with the responses of self-identified victims
of domestic violence. If the HITS is a useful screen-
ing tool, victims of violence should score higher than
the general population of patients. Moreover, it should
be possible to find a cut score that reliably differenti-
ates victims of violence from patients in general.
The CTS. The CTS contains 15 items that measure
perception of verbal and physical violence; all 15 of
these items were used in this study. The CTS’s four
remaining “reasoning” items were not included be-
cause they are not directly related to domestic violence.
Using the response format of the original instru-
ment, patients were asked to estimate how often within
the previous year their partner committed acts toward
them such as: sulked and/or refused to talk, stomped
out of the house or room; threatened to hit or throw
something; slapped; kicked, bit, or hit with a fist; and
threatened with a knife or gun. Respondents made
their estimates using a 7-point frequency scale of
never, once, twice, 3–5 times, 6–10 times, 11–20
times, and more than 20 times. Score values could
range from a minimum of 15 to a maximum of 105.
To ensure that the verbal and physical violence items
from the CTS continued to be a meaningful scale
without the reasoning items, we conducted an inter-
nal consistency analysis; the data was collected from
the patients in the study. Cronbach’s alpha was .87
for the 15 items.
The HITS Scale. The HITS scale is a paper-and-pen-
cil instrument that was comprised of the following
four items: “How often does your partner: physically
hurt you, insult you or talk down to you, threaten you
with harm, and scream or curse at you?” Patients re-
sponded to each of these items with a 5-point fre-
quency format: never, rarely, sometimes, fairly of-
ten, and frequently. Score values could range from a
minimum of 4 to a maximum of 20.
For phase one of the study (reliability and concur-
rent validity testing), 160 female patients visiting a
family practice clinic during April, May, and June
1996 participated in this study. For inclusion, partici-
pants had to be over age 21 and had to have lived
with the same partner for at least 12 months. All par-
ticipants were patients in the Family Practice Center
of Christ Hospital Medical Center (Advocate), which
serves a population of urban/suburban patients in the
southwest Chicago area of Oak Lawn.
For phase two of the study (measuring construct
validity), 99 women, who were self-identified as vic-
tims of domestic violence, participated. Some par-
ticipants were residents of domestic violence crisis
shelters (n=54), and others presented to an emergency
room (n=45).
Instrument Administration
In phase one, the CTS and HITS were each printed
on a separate page and stapled together. To control
for presentation effects, the sequencing of the scales
was counterbalanced so that half of the participants
completed the CTS followed by the HITS, and the
other half completed the instruments in the reverse
Following approval from our institution’s Medical
Investigations Committee, female patients in the fam-
ily practice population were asked by nursing staff to
participate in the present study during a normal of-
fice visit. Volunteers completed forms privately in
exam rooms, and forms were collected before leav-
ing the office. To maintain confidentiality, no identi-
fying information was recorded.
In phase two, copies of the HITS were sent to each
of the crisis shelters and the agency that attended
women who presented in the emergency room. Staff
coordinators at each site were asked to solicit partici-
pation by clients and to distribute and collect the forms
at a time that did not disrupt counseling sessions or
other important therapeutic events.
Data Analysis
Phase One: Reliability and Concurrent Validity.
For this part of the study, frequency distributions were
constructed for total scores on the CTS and HITS.
Descriptive statistics for the HITS also were com-
puted. The internal consistency (ie, reliability) of the
HITS was determined with Cronbach’s coefficient
alpha. A scatter plot of the total scores for the CTS
and HITS was constructed, and the scores were then
correlated to establish the concurrent validity of the
HITS. In addition, subscores for items that assessed
verbal abuse and physical abuse were computed sepa-
rately and correlated across instruments.
Clinical Research and Methods
July-August 1998
Family Medicine
Tests for presentation effects were conducted by
comparing the total score for participants who com-
pleted an instrument first in the set with those who
completed it second. The Mann-Whitney U test was
used for this comparison because the distribution of
scores for both instruments was clearly not normal.
None of the participants had any missing data on
the HITS. However, 10 participants (6% of 160) did
not provide complete data on the CTS. Nine partici-
pants had one missing item, and one participant had
two missing items. To use all subjects in the analysis,
missing values were imputed with the mean value of
the existing CTS items.
Phase Two: Construct Validity. To measure the con-
struct validity of the HITS, scores for the respondents
at the shelters and emergency room were compared
with scores of the 160 female patients in phase one.
If the screening tool is efficacious, HITS scores of
self-identified victims of domestic violence should
be significantly higher than those of general patients
who are visiting their physician. HITS scores were
therefore compared using Student’s t test for inde-
pendent samples.
In addition, the Optimal Data Analysis® program
(ODA 1.0, Optimal Data Analysis for DOS, Chicago,
Optimal Data Analysis, Inc) was used to find a cut
score that reliably differentiated the two groups of
participants. The intent of this was to find a score
above which domestic violence probably has occurred.
In evaluating the cut score to distinguish victim-
ized and non-victimized respondents, a leave-one-out
validation method was used. To do this, one score
was held out while the other 258 (ie, 160 subjects in
phase one plus 99 subjects in phase two, minus one)
were used to find the cut score. This cut score was
then used to classify the holdout score in terms of it
belonging to the office or victimized group. After this
was done for all 259 scores, the results were merged
to examine the overall percentage accuracy classifi-
cation. The leave-one-out methodology allows one
to classify HITS scores that are not used to derive the
cut score, thus rendering an unbiased account of clas-
sification accuracy.
Phase One: Reliability and Concurrent Validity
The frequency distributions for the CTS and HITS
scores from phase one are shown in Figure 1. As can
be seen, both distributions are L-shaped, indicating
that the majority of respondents scored in the low
(non-victim) range of the scale. The lowest and high-
est HITS scores were 4 and 18, respectively. The mean
was 6.13, the median was 5, and the standard devia-
tion was 2.75. Cronbach’s alpha was .80 for the four-
item scale. The analysis further showed that deleting
the item about being physically hurt would leave al-
pha unchanged. However, alpha would notably de-
crease if any of the other items were dropped from
the scale.
Figure 2 shows the scatterplot of HITS and CTS
scores. The lower left portion shows a higher density
of points due to the L-shaped nature of the score dis-
tributions. However, the relationship is positive and
linear. A correlation of .85 was found between HITS
and CTS total scores. Subscores on both instruments
that measured respondents’ experience of physical vio-
lence showed a correlation of r= .82. The same was true
for items that measured verbal violence, r=.81.
Figure 1
Frequency Distributions of CTS and HITS Scores
CTS—Conflict Tactics Scale
HITS—acronym for Hurts, Insults, Threatens, and Screams
Vol. 30, No. 7
Presentation Effects. Presentation effects were not
found. The median total HITS score was 5 for those
who completed the instrument first, as well as for
those who completed it second, z=.23, P=.815. The
median CTS scores were 19.64 and 20 for those com-
pleting the instrument first and second, respectively,
z=.26, P=.794.
Phase Two: Construct Validity
The mean HITS scores for the victimized and of-
fice groups were 15.12 and 6.13, respectively. This
difference was statistically significant, t=24.12, P<
.0005. Computations showed that 69% of the vari-
ance in HITS scores was attributable to group mem-
analysis revealed that the score of 10.5 re-
liably discriminated the two study groups
(P<.05).Table 1 shows the cut score classification per-
formance summary. In terms of actual group mem-
bership, 96% (95/99) of the victimized participants
and 91% (146/160) of the office participants were
classified correctly using this cut score. This is analo-
gous to sensitivity and specificity, respectively. In
terms of making predictions, 87% (95/109) of those
predicted to be victimized by domestic violence and
97% (146/150) of those predicted to be office patients
were accurate. This is analogous to the positive and
negative predictive values, respectively.
The HITS scale is not the first short domestic vio-
lence screening tool to be developed for outpatient
clinical settings. Other short instruments, such as the
Abuse Assessment Screen,
have been developed for
the same purpose, but the HITS instrument is shorter
than others.
HITS has only four items, two each
that address verbal and physical aggression. The brev-
ity of the HITS is rivaled only by the three-item Part-
ner Violence Screen developed by Feldhaus et al.
However, the latter was designed for use in an emer-
gency room, and the items do not form an easily re-
membered acronym.
The results from phase one indicate that the HITS
has good internal consistency and concurrent valid-
ity with the CTS. Although the four reasoning items
were not used in the CTS, there is no reason to be-
lieve that this affected the ability of the scale to mea-
sure perception of physical and verbal violence. An
internal consistency analysis of the 15-item CTS with
our office sample revealed an alpha of .87.
The results from phase two of the study provide
two important findings to demonstrate the construct
validity of the HITS. First, the group of self-identi-
fied victims of abuse scored significantly higher than
family practice patients. Second, ODA
revealed that
the score of 10.5 reliably differentiated the two groups
of respondents. These findings are consistent with an
effective screening tool.
Figure 2
Scatter Plot of HITS and CTS Scores
Table 1
Cut Score Classification Performance Summary
Predicted Group
Victimized Office Total Accuracy
Victimized 95 4 99 96%
Office 14 146 160 91%
Total 109 150
Accuracy 87% 97%
Note: A HITS score of >10.5 classified someone as a victimized
HITS—acronym for Hurts, Insults, Threatens, and Screams
Actual Group
CTS—Conflict Tactics Scale
HITS—acronym for Hurts, Insults, Threatens, and Screams
Clinical Research and Methods
July-August 1998
Family Medicine
In practice, the cut score of 10.5 is not directly us-
able because the HITS scoring procedure does not
allow for fractions of points. We, therefore, suggest
that clinicians suspect domestic violence when their
patients have a HITS score greater than 10.
Despite the statistical findings of the HITS cutoff,
physicians should investigate domestic violence
whenever they believe such a problem might exist.
The HITS is not used, nor should it be used, in lieu of
good clinical judgment. One must keep in mind that
our sample of office patients was compared with a
group of women for whom the experience of domes-
tic violence led them to seek professional help. We
suspect that there are many more women who cope
with a violent home life, yet, for whatever reason, do
not want to bring up the issue with a health care pro-
fessional. As always, clinical acumen should outweigh
test scores if there appears to be a discrepancy be-
tween the two.
Hopefully, a verbal form of the HITS with a yes-
no response format would have similar accuracy as
the written instrument used in this study. If so, physi-
cians could screen for domestic violence during a
conversation with a patient, thus obviating the need
for a paper-and-pencil instrument (albeit a short one).
Given the positive results from this study, additional
work should be done to explore the characteristics of
the HITS. For example, concurrent validity with other
normed instruments, such as the Index of Spouse
should be examined. HITS scores also could
be correlated with the incidence of violence that is
reported in medical records.
In addition, the utility
of the HITS should be studied with other women who
are known to be at high risk of violence.
Acknowledgments: This research was supported by a grant from the Med
Fund of Christ Hospital Medical Center (Advocate). The Med Fund has
sole rights for the reprint or use of the HITS questionnaire herein de-
scribed. The authors extend their appreciation to the following individu-
als and organizations that participated in this study: Sr. Cathleen Moore
and Pat Meneghini from Good Shepherd, Jenny Miller from Crisis Cen-
ter Advocates, Sharon Harold from South Suburban Family Shelter, and
Theresa DuBoise from Family Rescue. A portion of this work was pre-
sented at the 1997 Society of Teachers of Family Medicine (STFM) An-
nual Spring Conference in Boston and the 1998 STFM Annual Spring
Conference in Chicago. The work also was presented at the 1997 Ameri-
can Academy of Family Physicians Scientific Assembly in Chicago.
Corresponding Author: Address correspondence to Dr Sherin, Univer-
sity of Illinois at Chicago, Christ Family Medicine Residency Program,
4400 W 95 Street, Suite 207, Oak Lawn, IL 60453. 708-346-5324. Fax:
708-346-2003. E-mail:
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... The HITS has been previously validated in pediatric and adult populations. [18][19][20][21] This study explores the psychometric properties of the TeenHITSS among adolescents who are at-risk versus adolescents who are not at-risk. ...
... This study utilized data from 251 adolescents to establish the accuracy and psychometric properties of the TeenHITSS, a 5-item tool for detecting physical, psychological, and sexual abuse of adolescents in clinical settings. As with other versions, [18][19][20][21] the TeenHITSS was found to be a reliable, valid, and accurate tool for identifying abuse. ...
Purpose: The purpose of this study is to establish the psychometric properties and diagnostic accuracy of the Teen Hurt-Insult-Threaten-Scream-Sex (TeenHITSS), a 5-item measure used to screen adolescents for family violence in clinical settings. Methods: Study participants included 251 adolescent participants (n=197 not at-risk subsample; n=56 at-risk subsample), recruited from ambulatory care clinics, a medical center at-risk referral clinic, and area shelters. Participants completed a cross-sectional survey, including the TeenHITSS and Parent-Child Conflict Tactics Scales (CTSPC) questionnaires. We calculated internal reliability, validity, and sensitivity and specificity for the full sample and both subsamples for each screening instrument. Results: Concurrent validity between the TeenHITSS and CTSPC was strong (r=.71, P<.000). We determined an optimal cutpoint based on sensitivity and specificity for correctly identifying abuse victims as a score of one or greater on the TeenHITSS. The TeenHITSS also proved slightly superior to the CTSPC in differentiating between victims and nonvictims of adolescent abuse (AUC=.79 vs .73, respectively). Conclusions: The TeenHITSS screening tool performed as well as the CTSPC in correctly classifying at-risk and not-at-risk teenagers and offers much greater utility to providers by supplying an actionable cut score. The findings of this study suggest that TeenHITSS is a valid and reliable tool to screen for physical and sexual abuse in children ages 13 years and older in clinical settings and can help health care providers detect adolescent abuse and initiate intervention and prevention of future abuse.
... The HITS scale is a short screening tool for domestic violence which is contained of four questions about partner violence. Score values could range from 4 to 20 ( score more than10 indicate existence of IPV) (41). Participants included 23 abused women (11 pregnant and 12 postpartum) who experienced perinatal intimate partner violence. ...
Full-text available
Background Perinatal intimate partner violence is a hidden under reported and difficult to identify problem which has negative effects on mother and child. The present study aimed to explore women's experiences with perinatal intimate partner violence disclosure. Methods This qualitative study was carried out from October 2019 to January 2021 in Mashhad, Iran. Participants included 23 abused women (11 pregnant and 12 postpartum) which were selected via purposive sampling. Semi-structured in-depth interviews and focus group discussion were conducted until the data saturation was achieved. The data analysis was performed based on conventional content analysis adopted by Graneheim & Lundman. Results The main themes "barriers to disclosure" and "facilitators of disclosure" were emerged as the result of data analysis. Barriers to disclosure included negative disclosure consequences. Facilitators of disclosure included maternal self-efficacy, intensity of violence, and formal and informal supportive networks. Conclusions Most abused women did not disclose violence despite routine screening for perinatal intimate partner violence in antenatal care. Recognizing the barriers to and facilitators of violence disclosure play an important role in eliminating barriers, strengthen facilitators, providing effective supportive services for abused women, and reducing perinatal violence. Focus on the barriers to and facilitators of disclosure will be useful to policymakers, health program planners, and health care providers to identify and manage intimate partner violence, appropriately.
... Health literacy is assessed using the standard DHS panel of 8 items across 4 domains (capacity to interpret, obtain, understand, and make appropriate health decisions) [41]. Intimate partner violence (IPV) is assessed using the Hit, Insult, Threaten, Scream scale [42]. Symptoms of depression are assessed using the Edinburgh Postpartum Depression Scale and the Patient Health Questionnaire 9, which has been validated in Kenya [43]. ...
Background Cisgender women in Kenya are at elevated risk of HIV acquisition during pregnancy and post partum. Acute HIV infection during pregnancy and breastfeeding accounts for approximately one-third of all vertical HIV transmissions. The World Health Organization recommends offering oral tenofovir-based pre-exposure prophylaxis (PrEP) to pregnant and postpartum women who are HIV negative but at substantial and ongoing risk for HIV acquisition. PrEP delivery for pregnant and postpartum women is expanding within routine maternal child health clinics in Kenya. However, approximately half of pregnant women discontinue PrEP within 30 days of initiation. Therefore, it is crucial to develop PrEP adherence strategies that enhance support for adherence when peripartum events and health issues pose challenges to sustaining PrEP adherence. Objective We are conducting a randomized controlled trial to determine the effect of a bidirectional communication platform named Mobile Solutions for Women’s and Children’s Health (mWACh), which utilizes two-way SMS text messaging between patients and remote nurses to support PrEP adherence and address maternal health concerns in real time during the peripartum period. Methods The mWACh-PrEP study is a randomized trial designed to support PrEP adherence during the peripartum period by comparing mWACh-PrEP to the standard of care (ie, in-clinic adherence counseling) among women who are HIV negative and initiating PrEP. Purposive sampling was used to select 5 facilities offering PrEP in antenatal clinics in Kisumu and Siaya Counties, and block randomization will be used to divide participants into groups. Participants in the intervention arm will receive a customized messaging curriculum via SMS text messages targeted toward their particular perinatal stage. The primary outcome, PrEP adherence at 6 months post partum, will be evaluated using a log-binomial regression model, adjusting for imbalanced baseline characteristics. Based on a previous study of directly observed dosing conditions, we will use a hair tenofovir concentration cutoff of 0.038 ng/mg (corresponding to 7 doses/week) as the primary adherence outcome measured at 6 months post partum (binary outcome). Qualitative interviews and cost-effective analyses will be conducted to understand the feasibility, acceptability, and economic impact of the intervention. Results Enrollment began in March 2022 and is projected to continue until July 2023, with follow-up through March 2024. The study results are expected to be reported in 2025. Conclusions This trial will provide insights into using mobile health to enhance PrEP adherence among pregnant and postpartum mothers. Additionally, the findings will have implications for the use of mobile health technology to improve adherence to other daily medications during the peripartum period. Trial Registration NCT04472884; International Registered Report Identifier (IRRID) DERR1-10.2196/41170
... Among this sample, respondents had an average M = 5.24 (SD = 2.43). Consistent with prior literature (Sherin, Sinacore, Li, Zitter, & Shakil, 1998), the sample demonstrated adequate internal consistency with Cronbach's alpha of 0.85. ...
... Four other screening instruments were used, according to the same terms, to assess mental health in the study participants. Validated French versions of the Multidimensional Anxiety Scale for Children (MASC) [11], the Child Depression Inventory (CDI) [12], the Coopersmith Self-Esteem Inventory (SEI) [13], the Hurt, Insult, Threaten, and Scream tool (HITS) [14] and the DEP-ADO tool [15] were used to assess anxiety, depression, selfesteem, gender-based violence and psychoactive substance use respectively, among the study participants. ...
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Introduction. – Adolescents living with HIV are more likely to experience mental health challenges compared to their peers who do not have HIV. However, there is a lack of data regarding the mental health of adolescents living with HIV in Cameroon. Understanding risk factors and protective factors that influence mental health amongst adolescents is critical for effective programming. The purpose of this study was to estimate the prevalence and the factors associated with depression in adolescents infected with HIV and receiving ART in a Cameroonian referral hospital. Methods. – This was a cross-sectional study which enrolled adolescents perinatally infected with HIV, aged 10−19 years, on antiretroviral treatment and cared for at “Centre M�ere et Enfant de la Fondation Chantal Biya”, Yaounde, Cameroon. Structured questionnaires, including validated French versions of the Coopersmith Child Depression Inventory (CDI), the Multidimensional Anxiety Scale for Children (MASC) and the Coopersmith Self Esteem Inventory (SEI), were administered to the study participants by the healthcare providers. Results. – All in all, 302 adolescents were recruited in the study at a median age of 15.2 years (interquartile range : 12.0 − 17.5), including 159 (52.7 %) girls. Both parents had died for 57 (18.9 %) adolescents ; only the father was alive for 64 (21.2 %) ; only the mother was alive for 48 (15.9 %), both parents were alive for 133 (44.0 %). This study found prevalence of 26.5 % for severe depression, 36.4 % for suicidal ideation, 29.1 % for high/very high anxiety, and 20.5 % for low self-esteem. No factor was found significantly associated with severe depression but there was a trend towards decreased risk of severe depression among adolescents whose mother was alive [OR= 0.4 (0.1−1.0), p = 0.084]. Conclusion. – This study found that elevated depression, anxiety, and low self-esteem symptoms were prevalent among Cameroonian adolescents perinatally infected with HIV. Services and systems should go beyond clinical management of HIV and address the psychosocial and mental health of adolescents. The indicators of mental health among adolescents infected with HIV should be included in HIV program reporting.
Intimate partner violence (IPV) is a public health problem of epidemic proportions. IPV often starts early in adolescence and continues throughout an individual's lifespan. IPV is defined as abuse or aggression occurring in the context of a romantic relationship that is perpetrated by a current or former partner. IPV victims often experience severe psychological trauma, physical injury, and even death. The direct recipient of the violence is often not the only individual impacted. Children are often peripheral victims of IPV. It is vital that pediatric health care providers, including pediatric nurse practitioners, recognize that IPV is indeed a pediatric health care crisis requiring strategies for both identification and intervention. This continuing education article will discuss IPV and its impact on children from conception to adolescence while exploring implications for practice.
Background and objective: Addressing adverse social determinants of health is an upstream approach to potentially improve child health outcomes and health equity. We aimed to determine if systematically screening and referring for social needs in hospitalized pediatric patients increased families' enrollment in publicly available resources. Methods: Randomized controlled trial at a large urban children's hospital enrolled English-speaking caregivers of patients 0 to 36 months of age on the general pediatrics service from June 2016 to July 2017. The intervention arm received the WE CARE Houston social needs intervention (screener and resource referrals based on screening results and receptiveness to help); the control arm received standard of care. Baseline social risk data were collected for all participants. Caregivers who screened positive for mental health need, substance abuse, or domestic violence received additional support, including from social workers. The primary outcome was enrollment in resources at 6 months postdischarge. Univariate and multivariable analysis was performed to identify associations. Results: Our study sample consisted of 413 caregivers from diverse sociodemographic/socioeconomic backgrounds. Overall, 85% of study participants had ≥1 social risk (median 2, range 0-9). WE CARE Houston identified caregiver employment, health insurance, primary care physician, depression, childcare, smoking, and food resources as the most prevalent social needs. Among these, caregivers were most receptive to resources for childcare, mental health, health insurance, and primary care. There was no significant difference in enrollment in new resources by study arm. Conclusion: Screening for social needs in the hospital is feasible and can result in the identification of social needs, but further work is needed to successfully address these needs.
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Background Domestic violence threatens maternal physical, psychological and emotional safety. Abused pregnant women required several interventions based on their actual needs with the purpose of reducing domestic violence and its negative consequences. The present study aimed to explore the exclusive needs of abused pregnant women in Iran. Methods This qualitative study was performed from September 2019 to August 2021 in Mashhad, Iran. Semi-structured interviews with 14 abused women (8 pregnant and 6 after birth) who were the victims of domestic violence, and 11 key informants with various discipline specialties until the data saturation was achieved. Participants were selected through purposive sampling. Qualitative data were analyzed based on the conventional content analysis adopted by Graneheim & Lundman. Findings "Family and society empowerment" was the main concept emerged from the data analysis comprising of three categories such as "need to empower couples to reduce domestic violence during pregnancy", "demand for improved health care services", and "need to strengthen inter-sectoral, legal and social supports". Conclusion Abused pregnant women experienced several individual, interpersonal and inter sectoral needs. Family and society empowerment constituted the actual needs of abused pregnant women. Awareness of policymakers and health system managers of these needs could be the basis for designing a supportive care program according to abused women’s actual needs. In addition to the educational and skill empowerment of couples, it is essential that supportive organizations cooperate with each other to provide integrated and coordinated services to abused pregnant women and strengthen and facilitate maternal access to supportive resources.
Objective: This study aimed to determine the prevalence of intimate partner violence (IPV) victimization and the factors associated with IPV during pregnancy and the early postnatal period in Korean community samples. Methods: We enrolled 5,953 pregnant mothers and mothers with young children registered in the Early Life Health Management Program provided by 30 public health centers in Korea between 2020 and 2021. We used the Korean HITS questionnaire to measure IPV. Sociodemographic, social support, and psychosocial variables were collected using self-administered questionnaires. Chi-square tests and multiple logistic regression analyses were conducted with SAS. Results: Using a cutoff score of 6 with the Korean HITS, the prevalence of IPV was 7.6%. According to multivariable logistic analyses, "have seen domestic violence during childhood or adolescence" (odds ratio [OR], 2.61; 95% confidence interval [CI], 1.95-3.50), unplanned pregnancy (2.18, 1.73-2.75), depression during pregnancy (2.17, 1.69-2.79), history of receiving treatment for emotional problems (1.53, 1.07-2.20), and living in a rural area (1.52, 1.01-2.29). "Having someone who talk to" was protective of IPV (OR for "Not having someone to talk to,' 2.24; 95% CI, 1.49-3.35). Conclusion: Policies to prevent and address IPV during the perinatal period are urgently needed in Korea.
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Objective to map assessment tools for elder abuse and determine the psychometric properties of each one. Method scoping review developed according to recommendations of the JBI Institute Reviewer’s Manual in databases and gray literature. Results seventeen tools were identified for measuring situations of elder abuse. They were categorized into 1) Tools for assessment of risk for abuse, and 2) Tools for identification of abuse. According to risk for abuse, Vulnerability to Abuse Screening Scale was the most prevalent in the literature, with factorial analysis acceptable through four domains, and good internal reliability (0,74). Therefore, Assessment Tool for Domestic Elder Abuse comprises the assessment of six types of elder abuse; however, the study shows psychometric limitation since the internal structure was not evaluated by validity evidences. Conclusion seventeen tools to determine the occurrence or risk for elder abuse were identified with different psychometric properties. We recommend the use of more than one of the tools identified for an appropriate measurement of elder abuse situations given the complexity of the phenomenon and the lack of a single instrument that contemplates all its consequences and forms of expression. Keywords Violence; Aged; Validation Studies; Elder Abuse; Forensic Nursing
This article compares the rate of physical abuse of children and spouses from a 1975 study with the rates from a 1985 replication. Both studies used nationally representative samples (2,143 families in 1975 and 3,520 in 1985), and both found an extremely high incidence of severe physical violence against children ("child abuse") and a high incidence of violence against spouses. However, the 1985 rates, although high, were substantially lower than in 1975: the child abuse rate was 47% lower, and the wife abuse rate was 27% lower. Possible reasons for the lower rates in 1985 are examined and evaluated, including: (a) differences in the methods of the studies, (b) increased reluctance to report, (c) reductions in intrafamily violence due to ten years of prevention and treatment effort, and (d) reductions due to changes in American society and family patterns that would have produced lower rates of intrafamily violence even without ameliorative programs. The policy implications of the decreases and of the continued high rate of child abuse and spouse abuse are discussed.
Development of research on intrafamily conflict and violence requires both conceptual clarity and measures of the concepts. The introduction to this paper therefore seeks to clarify and distinguish the concepts of "conflict," "conflict of interest," "hostility," and "violence." The main part of the paper describes the Conflict Tactics (CT) Scales. The CT Scales are designed to measure the use of Reasoning, Verbal Aggression, and Violence within the family. Information is presented on the following aspects of this instrument: theoretical rational, acceptability to respondents, scoring, factor structure, reliability, validity, and norms for a nationally representative sample of 2,143 couples.
Reports on the development, psychometric evaluation, and applications of a wife-abuse inventory (WAI) for females, a screening device designed to predict which respondents are at risk of being abused by their spouses. Preliminary reliability and validity data from administration of the WAI to 50 women are presented. Potential applications of the WAI include its adoption in social agencies, use as an evaluation tool, and employment as a criterion measure. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
"The Eleventh Mental Measurements Yearbook" [provides] test users with descriptive information, references, and critical reviews of commercially published English-language tests. The contents [of this volume] include: (a) a bibliography of 477 commercially available tests, new or revised, published as separates for use with English-speaking Ss; (b) 703 critical test reviews by well-qualified professional people who were selected by the editors on the basis of their expertise in measurement and, often, the content of the test being reviewed; [and] (c) bibliographies of references for specific tests related to the construction, validity, or use of the tests in various settings. The volume is organized like an encyclopedia, with tests being ordered alphabetically by title. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
To assess the occurrence, frequency, and severity of physical abuse during pregnancy and associated initiation of prenatal care. Stratified, prospective cohort analysis. Public prenatal clinics in Houston, Tex, and Baltimore, Md. Total population-based sample of 691 black, Hispanic, and white pregnant women. All of the women were urban residents and most of the Hispanic women were Mexican American. All participants were invited into the study at the first prenatal visit and were followed up until delivery. Identification of abuse status. A three-question Abuse Assessment Screen detected a 17% (1/6) prevalence of physical or sexual abuse during pregnancy, which is more than double all previous published reports. When evaluated against nationally tested research instruments, the three-question screen that was asked at the first prenatal visit was sensitive and specific to abuse status. Abuse was recurrent, with 60% of abused women reporting two or more episodes of assault. Location of abuse focused on the head. Frequency and severity of abuse and potential danger of homicide was appreciably worse for white women. Abused women were twice as likely as nonabused women to begin prenatal care during the third trimester. A simple clinical assessment screen completed by the health care provider in a private setting and with the male partner absent is as effective as research instruments in identifying abused women. Straightforward, routine clinical assessment is recommended as essential in preventing potential trauma, interrupting existing abuse, and protecting health.
National surveys show that each year in the United States approximately 2 million women are battered by their husbands. Only a small percentage of these women are identified by physicians. The objective of this research was to determine the incidence and prevalence of spouse abuse among women seeking health care in a family practice clinic (or setting). During a two-month period, all adult women seeking health care from a family practice clinic in a medium-sized Midwestern community were asked to complete an anonymous questionnaire about whether they had ever been physically assaulted by their partners. Of 476 consecutive women seen in practice, 394 (82.7%) agreed to participate. Of these, 22.7% had been physically assaulted by their partners within the last year. The lifetime rate of physical abuse was 38.8%. Only six women in the sample had ever been asked about abuse by their physician in a recent visit [corrected]. Although spouse abuse is common, physicians rarely ask about it. Physicians should be trained to detect and assess abuse among female patients.