Biomedical subjects
Therese Zink
Publications and source records attributed to Therese Zink.
The prevalence and incidence of intimate partner violence in older women in primary care practices.
OBJECTIVE: Identify the incidence and prevalence of intimate partner violence (IPV) in women over 55 years of age in primary care offices. DESIGN: Telephone survey conducted between March and June 2003 by trained female interviewers who gathered self-report information about health and abuse. PATIENTS: A total of 3,636 women over 55 years of age had at least 1 visit in the past 12 months to primary care offices affiliated with an academic center in Southwestern Ohio were contacted by phone; 995 were deemed competent and completed the interview. INTERVENTION/INSTRUMENT: Thirty-eight page instrument that explored health, history of psychological (controlling behavior and threat of physical harm), physical, and sexual abuse since age 55 years. Interviews lasted 20 to 45 min. MAIN RESULTS: The mean age was 69 years (SD 8.35). Physical abuse in intimate relationships was reported by 1.52% since age 55 years (prevalence) and 0.41% in the past year (incidence). Prevalence and incidence rates for sexual abuse were 2.14% and 1.12%, threat of physical harm 2.63% and 1.62%, respectively. Less than half of the victims told someone else about the abuse. The mean number of health conditions was 3.84 for victims and 3.21 for nonvictims (P<.055) with significantly larger percentages of IPV victims reporting problems with chronic pain and depression. CONCLUSIONS: Physical and sexual abuse by an intimate partner does occur in women over 55 years, but rates are lower than those of younger women. Health care providers are reminded to think about IPV in older women and to ask about abuse as disclosure is rare.
Physician knowledge and management of children exposed to domestic violence in Ohio: a comparison of pediatricians and family physicians.
Active members of the Ohio chapters of American Academy of Family Physicians (FP=1,498) and American Academy of Pediatrics (Ped=1,725) were surveyed about their knowledge and management regarding children exposed to domestic violence (DV). Characteristics of respondents were analyzed by use of Chi-square analysis. Logistic regression was performed to identify predictors of DV knowledge and management. The response rate was 33.3%. Family physicians were more likely to know their local DV agency and recognize the adult symptoms of DV, such as unexplained injury. Pediatricians were more likely to report the child who saw a fight between parents to child protective services. Continuing work to increase physicians' comfort and ability to assess for DV and manage exposed children is needed.
Intimate partner violence research in the health care setting: what are appropriate and feasible methodological standards?
The past 20 years of research has exposed the profound cost of intimate partner violence (IPV) in health care problems and health care dollars for victims and bystanders. As a result, professional organizations encourage clinicians to identify IPV victims and to refer them to community resources. To date there is little evidence to show the value of these efforts, and many completed studies are criticized for methodological weaknesses. IPV studies are challenging to design, and the double-blind randomized controlled trial may be an impossible standard. To move forward, funders and study committees are encouraged to reassess the standards for IPV research methodologies.
Second guessing the second opinion.
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Hidden victims: the healthcare needs and experiences of older women in abusive relationships.
BACKGROUND: Intimate partner violence (IPV) is a problem in older women, but older victims of IPV are often unidentified in the medical setting because providers think of IPV as a problem of younger women. The experiences of older women with IPV are unknown. This study reports on the healthcare experiences and needs of older victims of IPV. METHODS: Interviews were conducted with 38 women > 55 years who responded to an advertisement recruiting "women who had been in an abusive relationship since age 55." Interviews were audiotaped, transcribed, and analyzed for themes. RESULTS: The median age of participants was 58 years (range 55-90). The majority were Caucasian with annual incomes over dollar 40,000. The median relationship length was 24 years (range 2-67), and 39% remained in their abusive relationships. About half had discussed IPV with a healthcare provider. The themes that were identified included disclosure about IPV and both negative and positive experiences with healthcare providers. Reasons for nondisclosure were similar to those of younger women but were compounded by the generational mores of privacy about domestic affairs and society's lack of understanding and resources for IPV. Some of the women who disclosed IPV to their providers felt discounted and unsupported. Others reported receiving valuable help, including empathy, referrals to resources, assistance in naming the abuse, linking the stress of IPV to health, and respect for their decisions to continue their abusive relationships. CONCLUSIONS: Older women victims have difficulty initiating discussions about IPV with their providers. Providers are encouraged to identify signals of potential abuse and to create privacy with all patients to discuss difficult issues, such as IPV, and to be knowledgeable about appropriate referrals.
What are providers' reporting requirements for children who witness domestic violence?
Each year, 3.3 to 10 million children are exposed to domestic violence/abuse (DV). Providers' reporting obligations for these children are unclear. The child maltreatment statutes available on state's web sites (through August 2003) were reviewed. Only Alaska defines DV in the presence of a child as child abuse within its juvenile code. Within their child abuse definition and reporting statutes, many states include language such as "substantial risk" or "imminent danger" of "physical harm" or "mental injury." Although knowledge of the state law is an important first step, abiding by it may be challenging because most statutes are open to wide interpretation. As a result, providers are encouraged to seek advice from local child maltreatment specialists who understand the local legal interpretations and resources.
Intimate partner violence and job instability.
OBJECTIVE: Research has shown that intimate partner violence (IPV) affects the physical and mental health of victims. It can also compromise work performance, leading to job loss. We explored the potential link between job loss and IPV as part of a larger study on IPV and health care. METHODS: Thirty-two mothers in Midwestern IPV shelters or support groups were interviewed to gather information about their abuse histories, health care experiences, and demographic characteristics. Interviews were audio taped, transcribed, and reviewed for themes. RESULTS: Half of participants had lost jobs because of IPV. Reasons included: the abuser told the victim to quit, in order to be safe, excessive absences because of covering up the abuse, and health issues exacerbated by IPV. CONCLUSION: Job instability was common among IPV victims in this study. Although this study did not address cause and effect, evidence of job instability may be another "red flag symptom" indicating that providers should screen for IPV.
How children affect the mother/victim's process in intimate partner violence.
BACKGROUND: Witnessing intimate partner violence (IPV) causes physical and mental health problems for children. Children are one of multiple factors that a victim weighs as she manages the abusive relationship. Little has been written about how children affect the mother's decisions about the abuse or what assistance a mother wants from the children's physician in creating a nonabusive home. OBJECTIVE: To consider the role children play in their mothers' management of abusive partners. METHODS: Thirty-two mothers living in midwestern IPV shelters or participating in support groups were interviewed about their abuse stories, perceptions about the effects of the abuse on their children, and desires about IPV management in the health care setting. The interviews were audiotaped, transcribed, and analyzed by a team of researchers using thematic analysis. RESULTS: Children were an integral factor in the mothers' management of their abusive relationships. For more than half of the participants, something the children did or said catalyzed their seeking help. For some, the children's attachment to the abuser was a reason to delay seeking assistance. Based on these findings, we explored what mothers wanted from their children's physicians regarding their abusive relationships. Mothers talked about the delicate balance between education and blame, between offering help and becoming too intrusive, and between wanting the best for their children and fearing the involvement of child protective services. CONCLUSIONS: Children play an important role in mothers' management of their abusive relationships. From their children's physicians, participants wanted IPV screening and IPV resources. Some wanted the physician to educate them about how the IPV affected the children in a nonblaming manner.
Medical management of intimate partner violence considering the stages of change: precontemplation and contemplation.
BACKGROUND: We undertook a study to understand how women who are victims of intimate partner violence (IPV) want physicians to manage these abusive relationships in the primary care office. METHODS: Thirty-two mothers in IPV shelters or support groups in southwestern Ohio were interviewed to explore their abuse experiences and health care encounters retrospectively. The interviews were taped and transcribed. Using thematic analysis techniques, transcripts were read for indications of the stages of change and for participants' desires concerning appropriate physician management. RESULTS: Participants believed that physicians should screen women for IPV both on a routine basis and when symptoms indicating possible abuse are present, even if the victim does not disclose the abuse. Screening is an important tool to capture those women early in the process of victimization. When a victim does not recognize her relationship as abusive, participants recommended that physicians raise the issue by asking, but they also warned that doing more may alienate the victim. Participants also encouraged physicians to explore clues that victims might give about the abuse. In later contemplation, victims are willing to disclose the abuse and are exploring options. Physicians were encouraged to affirm the abuse, know local resources for IPV victims, make appropriate referrals, educate victims about how the abuse affects their health, and document the abuse. Participants identified a variety of internal and external factors that had affected their processes. CONCLUSIONS: In hindsight, IPV victims recommended desired actions from physicians that could help them during early stages of coming to terms with their abusive relationships. Stage-matched interventions may help physicians manage IPV more effectively and avoid overloading the victim with information for which she is not ready.
Intimate partner violence: what are physicians' perceptions?
BACKGROUND: Intimate partner violence (IPV) is common in primary care; 11% to 22% of women experienced physical abuse in the past year. Older women experience IPV as well, but it is often undetected. This study examined primary care providers' awareness about IPV in older women, including their screening practices and management. METHODS: Interviews and focus groups were conducted with 44 primary care providers. Thematic analysis was used to identify common themes. RESULTS: Providers fell along a continuum of thoroughness for identifying and managing IPV in older women, ranging from suboptimal to thorough identification of IPV and suboptimal to thorough management of the patient. In addition to the barriers commonly reported about IPV screening in younger women, providers described limited understanding of the diagnoses commonly associated with IPV, frustration with older women's unwillingness to disclose problems and ask for help, and limited community services that accommodate older women with IPV. Providers recommended that communities sponsor public awareness campaigns about IPV as a problem for all women and that aging and IPV agencies work together. CONCLUSIONS: Continued provider training about IPV should include information on identifying older victims and appropriate management options. Participants stressed the importance of community efforts to raise awareness and improve resources available for older women who are victims of IPV.