Overview of Intimate Partner Violence: Current State of Knowledge in Regard to Women Veterans
Intimate partner violence (IPV) is a serious public health challenge. Approximately 29% of women and 10% of men in the U.S. have experienced rape, physical violence, and/or stalking by an intimate partner, and research suggests that IPV is common in women Veterans, particularly those who access VA healthcare services. This article provides an overview of the risk and impact of experiencing IPV among women Veterans, who currently make up 10% of the Veteran population, and who appear particularly likely to report IPV (research has shown prevalence ranges from 24% - 29% of past-year IPV). Investigators also discuss evidence-based treatment for IPV and identify future priorities for research and clinical programming.
- Risk factors or risk markers for IPV include pre-military trauma, military sexual trauma, PTSD, and depression. For example, women who have experienced IPV exhibit rates of PTSD that range from 31% to 84%, and the prevalence of depression among women who have experienced IPV is estimated to be 48%.
- Common comorbidities associated with IPV include traumatic brain injury (TBI) and homelessness. Women Veterans are up to four times more likely to be homeless than non-Veteran women and may become homeless as a consequence of experiencing IPV.
- The literature shows that women Veterans who experienced both sexual and physical assault were more likely to report chronic health conditions and significantly lower health-related quality of life for 10 or more years after military service.
- The authors suggest that treatment programs should be designed and developed with the understanding that IPV is an adverse health exposure – not a psychiatric diagnosis. Also, because PTSD is among the most common comorbidities in women who experience IPV, first-line treatments should be trauma-focused, consistent with VA clinical practice guidelines for PTSD.
- Future research can help identify the mechanisms and circumstances that increase women Veterans' risk of IPV. Future work also should evaluate interventions aimed at identifying and addressing IPV and related health needs.
- Recently, both the U.S. Preventive Services Task Force and the Institute of Medicine issued recommendations supporting the screening and identification of women at risk for IPV. Currently, VA has not yet enacted such policy or procedures. However, recent research has established the clinical utility of the four-item HITS (Hurt/Insult/Threaten/Scream) tool in a sample of women VA patients, creating a validated and promising means of identifying IPV among women Veterans.
This study was partly supported by HSR&D (SDR 10-012). Drs. Iverson and Dichter were supported by HSR&D Career Development Awards. Dr. Iverson is part of the VA New England Healthcare System National Center for PTSD. Dr. Dichter is part of HSR&D's Center for Health Equity Research and Promotion, Philadelphia, PA. Dr. Gerber is Women's Health Fellowship Director, VA Boston Healthcare System, and Dr. Klap is part of HSR&D's Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles.
Gerber M, Iverson K, Dichter M, Klap R, and Latta R. Women Veterans and Intimate Partner Violence: Current State of Knowledge and Future Directions. Journal of Women’s Health February 7, 2014;e-pub ahead of print.