Research into Intimate Partner Violence
Violence within the context of an intimate relationship, or intimate partner violence (IPV)—is a serious public health problem that affects millions of Americans. According to the Centers for Disease Control & Prevention (CDC) IPV is defined as “physical violence, sexual violence, stalking and psychological aggression (including coercive acts) by a current or former intimate partner” 1. Intimate partners are generally considered individuals who share a close personal relationship.
The CDC has defined four main types of IPV 2:
- Physical violence. Considered the intentional use of physical force with the potential for causing death, disability, injury, or harm.
- Sexual violence. Sexual violence is comprised of several categories: Rape, unwanted physical contact, and unwanted contact-free sexual experiences, and reproductive coercion. The CDC’s description of each category, and what they entail, can be found here.
- This is considered a pattern of repeated, unwanted attention and contact that causes fear or concern for one’s own safety or the safety of someone else (e.g., family member or friend).
- Psychological aggression. The use of verbal and non-verbal communication with the intent to harm another person mentally or emotionally, and/or to exert control over another.
According to the CDC’s most recently available estimates,3 IPV impacts one in four women, and one in nine men, and approximately 23 million women and 1.7 million men have been the victims of rape or attempted rape at some point in their lives. The consequences of IPV are wide-ranging, and can impact everything from physical and mental health to housing stability and employment.
Military service has unique psychological, social, and environmental factors that may contribute to an increased risk for IPV among active duty service members and Veterans. In addition, multiple deployments, family separation and reintegration, traumatic brain injury, or substance abuse can all contribute to partner conflict—further elevating the already-existing risk for IPV among Veterans.4
Because Veterans’ military service puts them at elevated risk for IPV, research to both detect and treat the consequences of IPV is critical. HSR&D investigators conduct a variety of studies around IPV. The following are just a few of these newly-funded, ongoing, and recently completed studies.
VA has begun implementing intimate partner violence (IPV) screening for women using VA care; however, despite strong evidence that screening increases detection of IPV, existing primary care-based interventions result in minimal effects on IPV experiencers’ health and wellbeing. In order to support VA’s ongoing IPV screening and support efforts, and route women Veterans into effective counseling, HSR&D has recently funded the Recovering from IPV through Strengths and Empowerment (RISE) study. In this three-year, multisite study, investigators will evaluate an approach to IPV recovery that is designed to be delivered in, or aligned with primary care and based on empowerment—a highly relevant intervention model for women who experience IPV.
Investigators will work with two of HSR&D’s Women’s Health Practice-Based Research Network sites, and will focus on the following:
- Tailoring and refining RISE to accommodate differences in service structures and personnel in different primary care settings through input from a Stakeholder Advisory Board, focus groups with women Veterans, and interviews with VA primary care providers.
- Conducting a formative open trial of RISE with women Veterans to inform the development of a user-friendly, tailored implementation protocol and intervention manual informed by both qualitative interviews and quantitative data.
- Examining the effects of RISE on women Veterans’ individual psychosocial outcomes (empowerment, self-efficacy, health, and service use) through a randomized, controlled clinical trial.
Implications: Women Veterans are already at increased risk for IPV, and investigators expect results from this study to have wide-reaching implications. Through thorough evaluation of a patient-centered IPV intervention tailored to women Veterans’ needs, preferences, and circumstances, study findings should provide a rigorous evidence -base that RISE is an effective, reproducible intervention that leads to improved health and psychosocial outcomes for women Veterans. It is also expected that study results will provide information on how RISE can be widely implemented throughout VA.
Through effective detection—and subsequent provision of both treatment and support services—healthcare systems like VA may help mitigate the risk of intimate partner violence (IPV). VA has been providing IPV screenings as part of routine care since 2014— the largest national healthcare-based IPV identification and response program in the country.
In this study, investigators are looking at three aspects of VA’s IPV screening program:
- The rate at which women Veterans using VA healthcare screen positive for past-year IPV and access VHA IPV services, as well as the demographic and clinical characteristics associated with both;
- Patients’ health and safety following disclosure of IPV, and associations with service use and safety-related empowerment; and
- Patients' experiences with violence and service access, and perspectives on how interventions impact their health and safety.
Investigators used VA administrative data to identify 8,885 women who had completed screening for experience of past-year IPV during clinic visits between April 2014 and April 2016. Data were collected from 13 VA healthcare facilities nationwide. Of the group identified, 8.7% of patients screened positive for past-year IPV. Odds of screening positive for IPV were higher among women who were under age 35; married; served in the most recent conflict era (OEF/OIF/OND); experienced sexual assault or harassment during military service; or had not served in the military (non-Veterans).
Implications. Investigators expect that study findings will inform VA’s approach to IPV interventions by illuminating demand for and impact of services. Investigators also expect study results to offer VA more comprehensive characterization of patients' experiences and perspectives, with the goal of identifying subgroups that may be in greater need of assistance. Study findings—particularly regarding patients' experiences with violence and recovery over time—may also be relevant to healthcare systems outside of VA.
Dichter ME, Haywood TN, Butler AE, Bellamy SL, Iverson KM. Intimate Partner Violence Screening in the Veterans Health Administration: Demographic and Military Service Characteristics. American Journal of Preventive Medicine. 2017 Jun 1; 52(6):761-768.
Women Veterans face particularly high rates of homelessness, which may be associated with psychosocial experiences including unhealthy alcohol use and experience of intimate partner violence (IPV). In this study, investigators examined clinical social health screening data to assess the association between housing instability and experience of past-year IPV victimization, as well as unhealthy alcohol use among 554 women receiving VA primary care.
Study results show that approximately 12% of patients screened reported housing instability. Experience of past-year IPV was associated with increased risk of housing instability, with one in five women screening positive for IPV also reporting housing concern. There was no statistically significant association between current unhealthy alcohol use and housing instability.
Implications: Findings will help address potential housing concerns among women Veterans using VA care who screen positive for IPV.
Dichter ME, Wagner C, Borrero S, et al. Intimate partner violence, unhealthy alcohol use, and housing instability among women Veterans in the Veterans Health Administration. Psychological Services. 2017;14(2), 246-249.
The US Preventive Services Task Force recommends screening women of childbearing age for current intimate partner violence (IPV) experiences, as early intervention may help reduce the impact of IPV. VA began implementing routine IPV screening in 2014, and identifying the prevalence of past-year IPV among women can inform the further implementation and development of screening, intervention, and support services.
This retrospective cohort study sought to identify the prevalence of past-year IPV among women Veterans utilizing VA primary care, and to document associated demographic, military, and primary care characteristics. Investigators used data from the WOMAN (Women's Overall Mental Health Assessment of Needs) survey—a telephone survey conducted in 2012 with a national sample of 6,046 women Veterans. The primary measure was past-year IPV; other measures included patient demographics and military characteristics (i.e., combat exposure). Investigators used self-report and VA data to assess primary care use (VA and non-VA).
- The prevalence of past-year IPV among women Veterans who used VA primary care services was 19%, with higher rates (22% to 26%) among women up to age 55. Most women (77%) who experienced IPV identified a VA provider as their usual healthcare provider.
- Women who were not employed full-time, received public assistance, had been homeless within the past year, or had an annual income of less than $25,000 were more likely to have experienced IPV.
- Women who identified as lesbian or bisexual also were more likely to report IPV than heterosexual women, as were those who were the parent/guardian of a child younger than 18 years old.
- Age-adjusted military correlates included service during Vietnam to post-Vietnam eras, less than 10 years of service, and experiences of military sexual trauma (MST).
Implications: The high prevalence of past-year IPV among women beyond childbearing years, the majority of whom primarily rely on VA as a source of healthcare, reinforces the importance of screening all women for IPV in VA primary care settings.
Kimerling R, Iverson K, Dichter M, et al. Prevalence of intimate partner violence among women Veterans who utilize Veterans Health Administration primary care. Journal of General Internal Medicine. August 2016;31(8):888-94.
1 Centers for Disease Control and Prevention website, “Intimate Partner Violence: Definitions” https://www.cdc.gov/violenceprevention/intimatepartnerviolence/definitions.html
3 3 National Intimate Partner and Sexual Violence Survey, Centers for Disease Control and Prevention. https://www.cdc.gov/violenceprevention/nisvs/index.html
4 Gierisch JM, Shapiro A, Grant NN, King HA, McDuffie JR, Williams JW. Intimate Partner Violence: Prevalence Among U.S. Military Veterans and Active Duty Servicemembers and a Review of Intervention Approaches. VA Evidence-based Synthesis Program Reports. Washington (DC): Department of Veterans Affairs; 2013 Aug.