Positive IPV Screen Significantly Associated with Health Outcomes and Healthcare Use among Women Veterans Over 45
Intimate partner violence (IPV)—psychological, physical, or sexual aggression by a current or former intimate partner—is experienced by an estimated 5.3 million women in the U.S. annually. Few studies have examined IPV among women older than childbearing age, leading the U.S. Preventive Services Task Force to find insufficient evidence to recommend IPV screening to women in this age group, although VA has been routinely screening women of all ages since 2014. This study examined the proportion of women older than childbearing age who screen positive when routinely screened for past-year IPV at VA clinics, as well as associations of a positive screen with health conditions and use of healthcare services. Using VA data, investigators identified 4,481 female VA patients aged ≥45 years who were screened for IPV between April 2014 and April 2016 at one of 13 VA facilities in 11 states. In addition to examining health conditions and healthcare use, investigators also assessed patients’ sociodemographics, combat exposure, and history of military sexual trauma (MST).
- Of the study cohort, 255 middle-aged (45-59 years; 9%) and 79 older (60 years and older, 5%) women screened positive for past-year IPV. A positive screen was significantly associated with negative mental and physical health outcomes, as well as increased use of healthcare services.
- Those screening IPV+ in both the middle-aged and older groups were more likely than those screening IPV- to be diagnosed with each category of mental health condition (i.e., anxiety, PTSD, depression). Middle-aged women screening positive had more than twice the odds of having a diagnosis of depression, anxiety, PTSD, and substance use, and four times the odds of suicidal behaviors or self-harm, while older women screening positive had more than three times the odds of having a depression diagnosis.
- For middle-aged women, significant associations also were seen for nausea/vomiting, other GI disorders and non-infectious genitourinary disorders. For older women, significant associations were seen for headache, injuries and burns, and skin ulcers or infection.
- Middle-aged women screening IPV+ had more than double the rate of psychosocial visits in the subsequent 20 months, and older women had a near doubling. Middle-aged women who screened IPV+ also had increased rates of primary care and ED visits, as well as higher odds of having any inpatient admission. These associations were not seen for the older women.
- Screening for IPV in middle-aged and older women may improve detection and service delivery in this underserved population.
- Investigators studied "older" female patients, but the mean age of the older group was still relatively young (67 years) and may not represent the experience of women in their 70s, 80s, and older.
This study was funded by HSR&D (IIR 15-142). All authors are part of HSR&D’s Center for Health Equity, Research and Promotion (CHERP) in Pittsburgh and Philadelphia, PA.
Makaroun L, Brignone E, Rosland A-M, and Dichter M. Association of Health Conditions and Health Services Utilization with Intimate Partner Violence Identified via Routine Screening in Middle-Aged and Older Women. JAMA Network Open. April 21, 2020.