More than one in three women and more than one in four men fall prey to stalking, rape or other physical or psychological violence by a partner at some time in their lives. Despite these grim statistics and evidence that victims can end up suffering mental and physical health problems such as post-traumatic stress disorder, health professionals have yet to nail down the best way to stop the abuse—which they call “intimate partner violence”—and to care for those affected by it.
One of the obstacles is that detecting victims can be difficult. Women experience such violence more frequently than men, but focusing only on women who are in sexual relationships with men will miss many cases. Intimate partner violence strains relationships between heterosexual and same-sex partners alike as well as couples who are not sexually intimate. Victims also come from all backgrounds—affluent and educated communities included, says Allison Bressler, a co-founder of A Partnership for Change, a nonprofit dedicated to ending family abuse and intimate partner violence. Too often, doctors with affluent patients will not suspect abuse. Furthermore, victims who are not being physically assaulted often do not define their relationship as abusive, she says, but any person who is made to fear one’s partner is in fact being mistreated.
A related problem is that family doctors—to whom people who do want help often turn first—are often ill equipped to identify and provide help to victims, even though some studies suggest that screening by health professionals could be helpful. Many doctors do stock waiting rooms with leaflets and pamphlets, but that passive offer of help may not be enough. A 2012 review found that the most common barriers to screening included the doctors’ personal discomfort and lack of knowledge and time.
What is more, even if doctors found abused patients and wanted to help, they would not necessarily know the best course of action. Relatively few clinical trials have assessed whether one form of treatment works better than another. A further obstacle to therapy’s success if figuring out what exactly constitutes successful treatment. Children, finances and other factors complicate individuals’ situations—for some people who are suffering intimate partner violence, the end of an abusive relationship is not victory.
A recent study by researchers based in Australia demonstrates exactly how challenging it is to design a program addressing intimate partner violence. The team was led by Kelsey Hegarty, an associate professor in the General Practice and Primary Health Care Academic Center at the University of Melbourne. Hegarty and her colleagues created a screening and counseling program to identify and help women with signs of intimate partner violence. “Our aim was to see if screening delivered by doctors can make a difference,” she says.
The researchers recruited 52 practicing clinicians and mailed all their female patients from the past year a lifestyle questionnaire. Of the 5742 women who completed and returned the survey, 731 gave responses that showed fear of their partners. The doctors and 254 women who provided contact information and enrolled in the study were assigned randomly to either a control group (the women received a list of resources and normal physicians’ care if needed; the doctors received a basic education packet on intimate partner violence) or an experimental group. The doctors in the latter group took a short training course on how to help women who showed fear of partner. The training included six hours of distance learning and two one-hour role-play sessions. The women in the experimental group were sent mail offering between one and six free counseling sessions, depending on their need.
After the counseling, participants were asked to complete a survey that assessed their quality of life. The survey included questions that asked whether the women felt healthy, whether they enjoyed their lives, how safe they felt, how satisfied they were in their personal relationships and how often they had felt depressed or anxious in the past four weeks.
The team compared responses with a survey given at the beginning of the study. The intervention group did not show marked improvement when compared with the control group for most of the questions. The counseling. However, did decrease feelings of depression for the women. Additionally, doctors in the experimental group also inquired after the health of women and their children more often. The results were published online in April in The Lancet.
Hegarty explains that the study does not support the use of a mailed invitation to partake in counseling. It doesn’t even show that screening within the context of health care is effective. However, she says the results do show that training doctors can make a difference because of the improvement in depression. An accompanying commentary in the same journal agrees that it may be wise for doctors to ask about intimate partner violence under certain circumstances—for example, if the patient has mental health issues.
A longer training program may show more striking results, Hegarty says. A big question is why many of the women who showed fear of their partner in the initial screen did not accept the offer for counseling. “This [loss] is typical of a lot of studies in this area,” says Heidi Nelson, a research professor in medical informatics, clinical epidemiology and medicine at Oregon Health & Science University who was not involved in the study. The study was well done, she says, but teasing out effective treatments for social and medical problems is different from conducting a drug trial. She does not want doctors to conclude from this research that they can do nothing, she says, noting that their awareness of the problem is important.
Different health care systems and cultures further complicate finding a good program to identify intimate partner violence. A successful program should empower victims and doctors alike. It will likely involve multiple opportunities for people suffering abuse to seek help offer places where such services are clearly available, Nelson says. The physician’s office is one place to expose violence that all too often goes on behind closed doors, but until more effective treatment programs are designed, many men and women will still live in fear.