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Screening for Intimate Partner Violence Experience and Use in the Veterans Health Administration

October 13, 2023

A first-of-its-kind study by Yale School of Medicine researchers revealed high numbers of intimate partner violence (IPV) among adult patients seeking mental health services at veterans’ health care facilities in the United States.

The research, published in JAMA Network Open, found that 49 percent of patients screened reported having experienced IPV sometime in the past year and 46 percent said they had engaged in IPV during the same period.

Especially notable was how little unidirectional [intimate partner violence] was reported, as well as the lack of gender differences among those experiencing and/or using IPV.

Galina A. Portnoy, PhD

Most notably, 43 percent of patients reported having both experienced and perpetrated IPV, indicating that mutual violence in relationships was quite common among this sample. Patients with a post-traumatic stress disorder diagnosis were more likely to report IPV use than those without a PTSD diagnosis.

“This study advances our understanding of relationship violence among those engaged in health care. Especially notable was how little unidirectional IPV was reported, as well as the lack of gender differences among those experiencing and/or using IPV, both findings consistent with other research we’ve been conducting across studies. ” said Galina A. Portnoy, PhD, assistant professor of psychiatry and the study’s first author.

“These findings can help integrated health care systems, like the (Veterans Health Administration, or VHA), plan for implementation of comprehensive IPV screening that includes identifying both IPV use and experience concurrently, to identify, and respond to a potentially high-risk population that presents for care,” she said.

The scientists led a pilot program to implement IPV screening for experience and use concurrently during routine mental health care visits. Then they extracted electronic health care data from patients across the five VHA facilities in the United States (including one in the Northeast, three in the Midwest, and one in the South) that participated in the implementation pilot.

VHA is the largest comprehensive and integrated health care system in the U.S., making it ideally positioned to implement comprehensive screening for IPV.

The 155 patients screened were from a pool of 1,720 patients with clinical visits who were eligible for screening during the implementation pilot period. Two hundred patients were offered screening for IPV experience and use, but 45 either declined or failed environmental safety checks. The sample included 124 men and 31 women.

There was significant overlap among patients who reported experiencing IPV and engaging in it. The study revealed that PTSD was the only mental or physical health condition significantly associated with IPV disclosures.

Other Yale and VHA researchers contributing to the study were Mark Relyea, PhD; Candice Presseau, PhD; Skye Orazietti, MSW; LeAnn E. Bruce, PhD, LCSW; Cynthia A Brandt, MD, MPH; and senior author Steve Martino, PhD, professor of psychiatry.

Funding was provided by Health Services Research and Development, U.S. Department of Veterans Affairs, and Office of Care Management and Social Work’s Intimate Partner Violence Assistance Program.

Submitted by Christopher Gardner on October 13, 2023