Men who experienced relationship violence were more likely than women to be missed in follow-up screening for risk of death by homicide caused by that abuse, according to a new Yale School of Medicine (YSM) study.
The same study revealed that when men and women were screened to determine the likelihood of death caused by intimate partner violence (IPV), women were nearly two times more likely to experience IPV-related lethality risk in the past year.
The study, published in JAMA Network Open, relied on electronic health records of 1.3 million patients screened for IPV at 135 Veterans Health Administration medical centers in the U.S.
Researchers from the Department of Psychiatry at YSM and Yale School of Public Health and colleagues at four other universities found that among 67,379 IPV-positive patients, 17.7% were not administered a secondary lethality risk screen to determine the likelihood of death caused by IPV, as directed by the screening protocol. This oversight occurred significantly more frequently among men, with 1 in 5 men not getting screened when they should have been.
Of those who were assessed for IPV-related lethality risk, 9,354 patients (16.9%) screened positive, with women at significantly higher risk than men, according to the study.
“Men experiencing relationship violence often encounter stigma and barriers to help-seeking,” says Galina Portnoy, PhD, assistant professor of psychiatry at YSM; director and founder of the IPV Center for Implementation, Research, and Evaluation; and the study’s first author.
“The reasons for clinicians missing lethality risk screening, particularly with men, are unclear and has led to further exploration in our follow-up qualitative work,” she says. “Enhancing clinician training to improve recognition of IPV is important to ensuring that clinicians are not relying solely on their judgment, which may be influenced by biases around gender and violence.”
The study revealed that women were more than five times more likely to experience strangulation, more than three times more likely to believe their partner might kill them, and 1.6 times more likely to report recent increases in violence frequency or severity. These findings echo decades of research indicating that, while rates of IPV may be similar across genders in some studies, the impact is often greater for women who experience more severe forms of violence and more health-related outcomes compared to men.
A person who screens positive for lethality risk can be offered potentially life-saving services like safety planning, same day consultations, education, and referral to care, as needed. Accurate IPV screening is crucial for saving lives and connecting high-risk patients to essential care. This latest study highlights the need for equitable screening practices to ensure all patients receive the support they need.
Additional study authors include Elizabeth C. Coppola, PhD; Katherine M. Iverson, PhD; Melissa E. Dichter, PhD; Jacquelyn C. Campbell, PhD, RN; LeAnn E. Bruce, PhD, LCSW; Cynthia A. Brandt, MD, MPH; and Mark R. Relyea, PhD.