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  • Open access
  • Published: 20 June 2023

A qualitative quantitative mixed methods study of domestic violence against women

  • Mina Shayestefar 1 ,
  • Mohadese Saffari 1 ,
  • Razieh Gholamhosseinzadeh 2 ,
  • Monir Nobahar 3 , 4 ,
  • Majid Mirmohammadkhani 4 ,
  • Seyed Hossein Shahcheragh 5 &
  • Zahra Khosravi 6  

BMC Women's Health volume  23 , Article number:  322 ( 2023 ) Cite this article

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Violence against women is one of the most widespread, persistent and detrimental violations of human rights in today’s world, which has not been reported in most cases due to impunity, silence, stigma and shame, even in the age of social communication. Domestic violence against women harms individuals, families, and society. The objective of this study was to investigate the prevalence and experiences of domestic violence against women in Semnan.

This study was conducted as mixed research (cross-sectional descriptive and phenomenological qualitative methods) to investigate domestic violence against women, and some related factors (quantitative) and experiences of such violence (qualitative) simultaneously in Semnan. In quantitative study, cluster sampling was conducted based on the areas covered by health centers from married women living in Semnan since March 2021 to March 2022 using Domestic Violence Questionnaire. Then, the obtained data were analyzed by descriptive and inferential statistics. In qualitative study by phenomenological approach and purposive sampling until data saturation, 9 women were selected who had referred to the counseling units of Semnan health centers due to domestic violence, since March 2021 to March 2022 and in-depth and semi-structured interviews were conducted. The conducted interviews were analyzed using Colaizzi’s 7-step method.

In qualitative study, seven themes were found including “Facilitators”, “Role failure”, “Repressors”, “Efforts to preserve the family”, “Inappropriate solving of family conflicts”, “Consequences”, and “Inefficient supportive systems”. In quantitative study, the variables of age, age difference and number of years of marriage had a positive and significant relationship, and the variable of the number of children had a negative and significant relationship with the total score and all fields of the questionnaire (p < 0.05). Also, increasing the level of female education and income both independently showed a significant relationship with increasing the score of violence.

Conclusions

Some of the variables of violence against women are known and the need for prevention and plans to take action before their occurrence is well felt. Also, supportive mechanisms with objective and taboo-breaking results should be implemented to minimize harm to women, and their children and families seriously.

Peer Review reports

Violence against women by husbands (physical, sexual and psychological violence) is one of the basic problems of public health and violation of women’s human rights. It is estimated that 35% of women and almost one out of every three women aged 15–49 experience physical or sexual violence by their spouse or non-spouse sexual violence in their lifetime [ 1 ]. This is a nationwide public health issue, and nearly every healthcare worker will encounter a patient who has suffered from some type of domestic or family violence. Unfortunately, different forms of family violence are often interconnected. The “cycle of abuse” frequently persists from children who witness it to their adult relationships, and ultimately to the care of the elderly [ 2 ]. This violence includes a range of physical, sexual and psychological actions, control, threats, aggression, abuse, and rape [ 3 ].

Violence against women is one of the most widespread, persistent, and detrimental violations of human rights in today’s world, which has not been reported in most cases due to impunity, silence, stigma and shame, even in the age of social communication [ 3 ]. In the United States of America, more than one in three women (35.6%) experience rape, physical violence, and intimate partner violence (IPV) during their lifetime. Compared to men, women are nearly twice as likely (13.8% vs. 24.3%) to experience severe physical violence such as choking, burns, and threats with knives or guns [ 4 ]. The higher prevalence of violence against women can be due to the situational deprivation of women in patriarchal societies [ 5 ]. The prevalence of domestic violence in Iran reported 22.9%. The maximum of prevalence estimated in Tehran and Zahedan, respectively [ 6 ]. Currently, Iran has high levels of violence against women, and the provinces with the highest rates of unemployment and poverty also have the highest levels of violence against women [ 7 ].

Domestic violence against women harms individuals, families, and society [ 8 ]. Violence against women leads to physical, sexual, psychological harm or suffering, including threats, coercion and arbitrary deprivation of their freedom in public and private life. Also, such violence is associated with harmful effects on women’s sexual reproductive health, including sexually transmitted infection such as Human Immunodeficiency Virus (HIV), abortion, unsafe childbirth, and risky sexual behaviors [ 9 ]. There are high levels of psychological, sexual and physical domestic abuse among pregnant women [ 10 ]. Also, women with postpartum depression are significantly more likely to experience domestic violence during pregnancy [ 11 ].

Prompt attention to women’s health and rights at all levels is necessary, which reduces this problem and its risk factors [ 12 ]. Because women prefer to remain silent about domestic violence and there is a need to introduce immediate prevention programs to end domestic violence [ 13 ]. violence against women, which is an important public health problem, and concerns about human rights require careful study and the application of appropriate policies [ 14 ]. Also, the efforts to change the circumstances in which women face domestic violence remain significantly insufficient [ 15 ]. Given that few clear studies on violence against women and at the same time interviews with these people regarding their life experiences are available, the authors attempted to planning this research aims to investigate the prevalence and experiences of domestic violence against women in Semnan with the research question of “What is the prevalence of domestic violence against women in Semnan, and what are their experiences of such violence?”, so that their results can be used in part of the future planning in the health system of the society.

This study is a combination of cross-sectional and phenomenology studies in order to investigate the amount of domestic violence against women and some related factors (quantitative) and their experience of this violence (qualitative) simultaneously in the Semnan city. This study has been approved by the ethics committee of Semnan University of Medical Sciences with ethic code of IR.SEMUMS.REC.1397.182. The researcher introduced herself to the research participants, explained the purpose of the study, and then obtained informed written consent. It was assured to the research units that the collected information will be anonymous and kept confidential. The participants were informed that participation in the study was entirely voluntary, so they can withdraw from the study at any time with confidence. The participants were notified that more than one interview session may be necessary. To increase the trustworthiness of the study, Guba and Lincoln’s criteria for rigor, including credibility, transferability, dependability, and confirmability [ 16 ], were applied throughout the research process. The COREQ checklist was used to assess the present study quality. The researchers used observational notes for reflexivity and it preserved in all phases of this qualitative research process.

Qualitative method

Based on the phenomenological approach and with the purposeful sampling method, nine women who had referred to the counseling units of healthcare centers in Semnan city due to domestic violence in February 2021 to March 2022 were participated in the present study. The inclusion criteria for the study included marriage, a history of visiting a health center consultant due to domestic violence, and consent to participate in the study and unwillingness to participate in the study was the exclusion criteria. Each participant invited to the study by a telephone conversation about study aims and researcher information. The interviews place selected through agreement of the participant and the researcher and a place with the least environmental disturbance. Before starting each interview, the informed consent and all of the ethical considerations, including the purpose of the research, voluntary participation, confidentiality of the information were completely explained and they were asked to sign the written consent form. The participants were interviewed by depth, semi-structured and face-to-face interviews based on the main research question. Interviews were conducted by a female health services researcher with a background in nursing (M.Sh.). Data collection was continued until the data saturation and no new data appeared. Only the participants and the researcher were present during the interviews. All interviews were recorded by a MP3 Player by permission of the participants before starting. Interviews were not repeated. No additional field notes were taken during or after the interview.

The age range of the participants was from 38 to 55 years and their average age was 40 years. The sociodemographic characteristics of the participants are summarized in table below (Table  1 ).

Five interviews in the courtyards of healthcare centers, 2 interviews in the park, and 2 interviews at the participants’ homes were conducted. The duration of the interviews varied from 45 min to one hour. The main research question was “What is your experience about domestic violence?“. According to the research progress some other questions were asked in line with the main question of the research.

The conducted interviews were analyzed by using the 7 steps Colizzi’s method [ 17 ]. In order to empathize with the participants, each interview was read several times and transcribed. Then two researchers (M.Sh. and M.N.) extracted the phrases that were directly related to the phenomenon of domestic violence against women independently and distinguished from other sentences by underlining them. Then these codes were organized into thematic clusters and the formulated concepts were sorted into specific thematic categories.

In the final stage, in order to make the data reliable, the researcher again referred to 2 participants and checked their agreement with their perceptions of the content. Also, possible important contents were discussed and clarified, and in this way, agreement and approval of the samples was obtained.

Quantitative method

The cross-sectional study was implemented from February 2021 to March 2022 with cluster sampling of married women in areas of 3 healthcare centers in Semnan city. Those participants who were married and agreed with the written and verbal informed consent about the ethical considerations were included to the study. The questionnaire was completed by the participants in paper and online form.

The instrument was the standard questionnaire of domestic violence against women by Mohseni Tabrizi et al. [ 18 ]. In the questionnaire, questions 1–10, 11–36, 37–65 and 66–71 related to sociodemographic information, types of spousal abuse (psychological, economical, physical and sexual violence), patriarchal beliefs and traditions and family upbringing and learning violence, respectively. In total, this questionnaire has 71 items.

The scoring of the questionnaire has two parts and the answers to them are based on the Likert scale. Questions 11–36 and 66–71 are answered with always [ 4 ] to never (0) and questions 37–65 with completely agree [ 4 ] to completely disagree (0). The minimum and maximum score is 0 and 300, respectively. The total score of 0–60, 61–120 and higher than 121 demonstrates low, moderate and severe domestic violence against women, respectively [ 18 ].

In the study by Tabrizi et al., to evaluate the validity and reliability of this questionnaire, researchers tried to measure the face validity of the scale by the previous research. Those items and questions which their accuracies were confirmed by social science professors and experts used in the research, finally. The total Cronbach’s alpha coefficient was 0.183, which confirmed that the reliability of the questions and items of the questionnaire is sufficient [ 18 ].

Descriptive data were reported using mean, standard deviation, frequency and percentage. Then, to measure the relationship between the variables, χ2 and Pearson tests also variance and regression analysis were performed. All analysis were performed by using SPSS version 26 and the significance level was considered as p < 0.05.

Qualitative results

According to the third step of Colaizzi’s 7-step method, the researcher attempted to conceptualize and formulate the extracted meanings. In this step, the primary codes were extracted from the important sentences related to the phenomenon of violence against women, which were marked by underlining, which are shown below as examples of this stage and coding.

The primary code of indifference to the father’s role was extracted from the following sentences. This is indifference in the role of the father in front of the children.

“Some time ago, I told him that our daughter is single-sided deaf. She has a doctor’s appointment; I have to take her to the doctor. He said that I don’t have money to give you. He doesn’t force himself to make money anyway” (p 2, 33 yrs).

“He didn’t value his own children. He didn’t think about his older children” (p 4, 54 yrs).

The primary code extracted here included lack of commitment in the role of head of the household. This is irresponsibility towards the family and meeting their needs.

“My husband was fired from work after 10 years due to disorder and laziness. Since then, he has not found a suitable job. Every time he went to work, he was fired after a month because of laziness” (p 7, 55 yrs).

“In the evening, he used to get dressed and go out, and he didn’t come back until late. Some nights, I was so afraid of being alone that I put a knife under my pillow when I slept” (p 2, 33 yrs).

A total of 246 primary codes were extracted from the interviews in the third step. In the fourth step, the researchers put the formulated concepts (primary codes) into 85 specific sub-categories.

Twenty-three categories were extracted from 85 sub-categories. In the sixth step, the concepts of the fifth step were integrated and formed seven themes (Table  2 ).

These themes included “Facilitators”, “Role failure”, “Repressors”, “Efforts to preserve the family”, “Inappropriate solving of family conflicts”, “Consequences”, and “Inefficient supportive systems” (Fig.  1 ).

figure 1

Themes of domestic violence against women

Some of the statements of the participants on the theme of “ Facilitators” are listed below:

Husband’s criminal record

“He got his death sentence for drugs. But, at last it was ended for 10 years” (p 4, 54 yrs).

Inappropriate age for marriage

“At the age of thirteen, I married a boy who was 25 years old” (p 8, 25 yrs).

“My first husband obeyed her parents. I was 12–13 years old” (p 3, 32 yrs).

“I couldn’t do anything. I was humiliated” (p 1, 38 yrs).

“A bridegroom came. The mother was against. She said, I am young. My older sister is not married yet, but I was eager to get married. I don’t know, maybe my father’s house was boring for me” (p 2, 33 yrs).

“My parents used to argue badly. They blamed each other and I always wanted to run away from these arguments. I didn’t have the patience to talk to mom or dad and calm them down” (p 5, 39 yrs).

Overdependence

“My husband’s parents don’t stop interfering, but my husband doesn’t say anything because he is a student of his father. My husband is self-employed and works with his father on a truck” (p 8, 25 yrs).

“Every time I argue with my husband because of lack of money, my mother-in-law supported her son and brought him up very spoiled and lazy” (p 7, 55 yrs).

Bitter memories

“After three years, my mother married her friend with my uncle’s insistence and went to Shiraz. But, his condition was that she did not have the right to bring his daughter with her. In fact, my mother also got married out of necessity” (p 8, 25 yrs).

Some of their other statements related to “ Role failure” are mentioned below:

Lack of commitment to different roles

“I got angry several times and went to my father’s house because of my husband’s bad financial status and the fact that he doesn’t feel responsible to work and always says that he cannot find a job” (p 6, 48 yrs).

“I saw that he does not want to change in any way” (p 4, 54 yrs).

“No matter how kind I am, it does not work” (p 1, 38 yrs).

Some of their other statements regarding “ Repressors” are listed below:

Fear and silence

“My mother always forced me to continue living with my husband. Finally, my father had been poor. She all said that you didn’t listen to me when you wanted to get married, so you don’t have the right to get angry and come to me, I’m miserable enough” (p 2, 33 yrs).

“Because I suffered a lot in my first marital life. I was very humiliated. I said I would be fine with that. To be kind” (p1, 38 yrs).

“Well, I tell myself that he gets angry sometimes” (p 3, 32 yrs).

Shame from society

“I don’t want my daughter-in-law to know. She is not a relative” (p 4, 54 yrs).

Some of the statements of the participants regarding the theme of “ Efforts to preserve the family” are listed below:

Hope and trust

“I always hope in God and I am patient” (p 2, 33 yrs).

Efforts for children

“My divorce took a month. We got a divorce. I forgave my dowry and took my children instead” (p 2, 33 yrs).

Some of their other statements regarding the “ Inappropriate solving of family conflicts” are listed below:

Child-bearing thoughts

“My husband wanted to take me to a doctor to treat me. But my father-in-law refused and said that instead of doing this and spending money, marry again. Marriage in the clans was much easier than any other work” (p 8, 25 yrs).

Lack of effective communication

“I was nervous about him, but I didn’t say anything” (p 5, 39 yrs).

“Now I am satisfied with my life and thank God it is better to listen to people’s words. Now there is someone above me so that people don’t talk behind me” (p 2, 33 yrs).

Some of their other statements regarding the “ Consequences” are listed below:

Harm to children

“My eldest daughter, who was about 7–8 years old, behaved differently. Oh, I was angry. My children are mentally depressed and argue” (p 5, 39 yrs).

After divorce

“Even though I got a divorce, my mother and I came to a remote area due to the fear of what my family would say” (p 2, 33 yrs).

Social harm

“I work at a retirement center for living expenses” (p 2, 33 yrs).

“I had to go to clean the houses” (p 5, 39 yrs).

Non-acceptance in the family

“The children’s relationship with their father became bad. Because every time they saw their father sitting at home smoking, they got angry” (p 7, 55 yrs).

Emotional harm

“When I look back, I regret why I was not careful in my choice” (p 7, 55 yrs).

“I felt very bad. For being married to a man who is not bound by the family and is capricious” (p 9, 36 yrs).

Some of their other statements regarding “ Inefficient supportive systems” are listed below:

Inappropriate family support

“We didn’t have children. I was at my father’s house for about a month. After a month, when I came home, I saw that my husband had married again. I cried a lot that day. He said, God, I had to. I love you. My heart is broken, I have no one to share my words” (p 8, 25 yrs).

“My brother-in-law was like himself. His parents had also died. His sister did not listen at all” (p 4, 54 yrs).

“I didn’t have anyone and I was alone” (p 1, 38 yrs).

Inefficiency of social systems

“That day he argued with me, picked me up and threw me down some stairs in the middle of the yard. He came closer, sat on my stomach, grabbed my neck with both of his hands and wanted to strangle me. Until a long time later, I had kidney problems and my neck was bruised by her hand. Given that my aunt and her family were with us in a building, but she had no desire to testify and was afraid” (p 3, 32 yrs).

Undesired training and advice

“I told my mother, you just said no, how old I was? You never insisted on me and you didn’t listen to me that this man is not good for you” (p 9, 36 yrs).

Quantitative results

In the present study, 376 married women living in Semnan city participated in this study. The mean age of participants was 38.52 ± 10.38 years. The youngest participant was 18 and the oldest was 73 years old. The maximum age difference was 16 years. The years of marriage varied from one year to 40 years. Also, the number of children varied from no children to 7. The majority of them had 2 children (109, 29%). The sociodemographic characteristics of the participants are summarized in the table below (Table  3 ).

The frequency distribution (number and percentage) of the participants in terms of the level of violence was as follows. 89 participants (23.7%) had experienced low violence, 59 participants (15.7%) had experienced moderate violence, and 228 participants (60.6%) had experienced severe violence.

Cronbach’s alpha for the reliability of the questionnaire was 0.988. The mean and standard deviation of the total score of the questionnaire was 143.60 ± 74.70 with a range of 3-244. The relationship between the total score of the questionnaire and its fields, and some demographic variables is summarized in the table below (Table  4 ).

As shown in the table above, the variables of age, age difference and number of years of marriage have a positive and significant relationship, and the variable of number of children has a negative and significant relationship with the total score and all fields of the questionnaire (p < 0.05). However, the variable of education level difference showed no significant relationship with the total score and any of the fields. Also, the highest average score is related to patriarchal beliefs compared to other fields.

The comparison of the average total scores separately according to each variable showed the significant average difference in the variables of the previous marriage history of the woman, the result of the previous marriage of the woman, the education of the woman, the education of the man, the income of the woman, the income of the man, and the physical disease of the man (p < 0.05).

In the regression model, two variables remained in the final model, indicating the relationship between the variables and violence score and the importance of these two variables. An increase in women’s education and income level both independently show a significant relationship with an increase in violence score (Table  5 ).

The results of analysis of variance to compare the scores of each field of violence in the subgroups of the participants also showed that the experience and result of the woman’s previous marriage has a significant relationship with physical violence and tradition and family upbringing, the experience of the man’s previous marriage has a significant relationship with patriarchal belief, the education level of the woman has a significant relationship with all fields and the level of education of the man has a significant relationship with all fields except tradition and family upbringing (p < 0.05).

According to the results of both quantitative and qualitative studies, variables such as the young age of the woman and a large age difference are very important factors leading to an increase in violence. At a younger age, girls are afraid of the stigma of society and family, and being forced to remain silent can lead to an increase in domestic violence. As Gandhi et al. (2021) stated in their study in the same field, a lower marriage age leads to many vulnerabilities in women. Early marriage is a global problem associated with a wide range of health and social consequences, including violence for adolescent girls and women [ 12 ]. Also, Ahmadi et al. (2017) found similar findings, reporting a significant association among IPV and women age ≤ 40 years [ 19 ].

Two others categories of “Facilitators” in the present study were “Husband’s criminal record” and “Overdependence” which had a sub-category of “Forced cohabitation”. Ahmadi et al. (2017) reported in their population-based study in Iran that husband’s addiction and rented-householders have a significant association with IPV [ 19 ].

The patriarchal beliefs, which are rooted in the tradition and culture of society and family upbringing, scored the highest in relation to domestic violence in this study. On the other hand, in qualitative study, “Normalcy” of men’s anger and harassment of women in society is one of the “Repressors” of women to express violence. In the quantitative study, the increase in the women’s education and income level were predictors of the increase in violence. Although domestic violence is more common in some sections of society, women with a wide range of ages, different levels of education, and at different levels of society face this problem, most of which are not reported. Bukuluki et al. (2021) showed that women who agreed that it is good for a man to control his partner were more likely to experience physical violence [ 20 ].

Domestic violence leads to “Consequences” such as “Harm to children”, “Emotional harm”, “Social harm” to women and even “Non-acceptance in their own family”. Because divorce is a taboo in Iranian culture and the fear of humiliating women forces them to remain silent against domestic violence. Balsarkar (2021) stated that the fear of violence can prevent women from continuing their studies, working or exercising their political rights [ 8 ]. Also, Walker-Descarte et al. (2021) recognized domestic violence as a type of child maltreatment, and these abusive behaviors are associated with mental and physical health consequences [ 21 ].

On the other hand and based on the “Lack of effective communication” category, ignoring the role of the counselor in solving family conflicts and challenges in the life of couples in the present study was expressed by women with reasons such as lack of knowledge and family resistance to counseling. Several pathologies are needed to investigate increased domestic violence in situations such as during women’s pregnancy or infertility. Because the use of counseling for couples as a suitable solution should be considered along with their life challenges. Lin et al. (2022) stated that pregnant women were exposed to domestic violence for low birth weight in full term delivery. Spouse violence screening in the perinatal health care system should be considered important, especially for women who have had full-term low birth weight infants [ 22 ].

Also, lack of knowledge and low level of education have been found as other factors of violence in this study, which is very prominent in both qualitative and quantitative studies. Because the social systems and information about the existing laws should be followed properly in society to act as a deterrent. Psychological training and especially anger control and resilience skills during education at a younger age for girls and boys should be included in educational materials to determine the positive results in society in the long term. Manouchehri et al. (2022) stated that it seems necessary to train men about the negative impact of domestic violence on the current and future status of the family [ 23 ]. Balsarkar (2021) also stated that men and women who have not had the opportunity to question gender roles, attitudes and beliefs cannot change such things. Women who are unaware of their rights cannot claim. Governments and organizations cannot adequately address these issues without access to standards, guidelines and tools [ 8 ]. Machado et al. (2021) also stated that gender socialization reinforces gender inequalities and affects the behavior of men and women. So, highlighting this problem in different fields, especially in primary health care services, is a way to prevent IPV against women [ 24 ].

There was a sub-category of “Inefficiency of social systems” in the participants experiences. Perhaps the reason for this is due to insufficient education and knowledge, or fear of seeking help. Holmes et al. (2022) suggested the importance of ascertaining strategies to improve victims’ experiences with the court, especially when victims’ requests are not met, to increase future engagement with the system [ 25 ]. Sigurdsson (2019) revealed that despite high prevalence numbers, IPV is still a hidden and underdiagnosed problem and neither general practitioner nor our communities are as well prepared as they should be [ 26 ]. Moreira and Pinto da Costa (2021) found that while victims of domestic violence often agree with mandatory reporting, various concerns are still expressed by both victims and healthcare professionals that require further attention and resolution [ 27 ]. It appears that legal and ethical issues in this regard require comprehensive evaluation from the perspectives of victims, their families, healthcare workers, and legal experts. By doing so, better practical solutions can be found to address domestic violence, leading to a downward trend in its occurrence.

Some of the variables of violence against women have been identified and emphasized in many studies, highlighting the necessity of policymaking and social pathology in society to prevent and use operational plans to take action before their occurrence. Breaking the taboo of domestic violence and promoting divorce as a viable solution after counseling to receive objective results should be implemented seriously to minimize harm to women, children, and their families.

Limitations

Domestic violence against women is an important issue in Iranian society that women resist showing and expressing, making researchers take a long-term process of sampling in both qualitative and quantitative studies. The location of the interview and the women’s fear of their husbands finding out about their participation in this study have been other challenges of the researchers, which, of course, they attempted to minimize by fully respecting ethical considerations. Despite the researchers’ efforts, their personal and professional experiences, as well as the studies reviewed in the literature review section, may have influenced the study results.

Data Availability

Data and materials will be available upon email to the corresponding author.

Abbreviations

Intimate Partner Violence

Human Immunodeficiency Virus

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Acknowledgements

The authors of this study appreciate the Deputy for Research and Technology of Semnan University of Medical Sciences, Social Determinants of Health Research Center of Semnan University of Medical Sciences and all the participants in this study.

Research deputy of Semnan University of Medical Sciences financially supported this project.

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Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran

Monir Nobahar & Majid Mirmohammadkhani

Clinical Research Development Unit, Kowsar Educational, Research and Therapeutic Hospital, Semnan University of Medical Sciences, Semnan, Iran

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M.Sh. contributed to the first conception and design of this research; M.Sh., Z.Kh., M.S., R.Gh. and S.H.Sh. contributed to collect data; M.N. and M.Sh. contributed to the analysis of the qualitative data; M.M. and M.Sh. contributed to the analysis of the quantitative data; M.SH., M.N. and M.M. contributed to the interpretation of the data; M.Sh., M.S. and S.H.Sh. wrote the manuscript. M.Sh. prepared the final version of manuscript for submission. All authors reviewed the manuscript meticulously and approved it. All names of the authors were listed in the title page.

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Shayestefar, M., Saffari, M., Gholamhosseinzadeh, R. et al. A qualitative quantitative mixed methods study of domestic violence against women. BMC Women's Health 23 , 322 (2023). https://doi.org/10.1186/s12905-023-02483-0

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Diverse Intimate Partner Violence Survivors' Experiences Seeking Help from the Police: A Qualitative Research Synthesis

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  • 1 Boise State University, ID, USA.
  • 2 Old Dominion University, Norfolk, VA, USA.
  • 3 University of Houston-Downtown, TX, USA.
  • 4 Department of the Air Force, Washington, D.C, USA.
  • PMID: 39150320
  • DOI: 10.1177/15248380241270083

Intimate partner violence (IPV), inclusive of all forms of abuse, is an ongoing public health and criminal-legal issue that transcends social boundaries. However, there is a lack of equitable representation of diverse populations who experience IPV in the literature. To garner a holistic knowledge of diverse IPV survivor populations' experiences with seeking help from the police, the current review utilized a qualitative research synthesis methodology to explore police interactions among six IPV survivor populations that are underrepresented in the current literature: women with substance use issues, immigrant women, women in rural localities, heterosexual men, racially/ethnically minoritized women, and sexual minority women. Seven electronic databases were searched to identify peer-reviewed articles on IPV survivors' narrative descriptions (qualitative or mixed-methods) of their encounters with law enforcement. The final analysis included 28 studies that were then coded with an iterative coding strategy. The analysis uncovered the following themes: (a) revictimization by the police, (b) police negligence, (c) discrimination, (d) cultural differences, and (e) positive experiences. These themes demonstrated that while some experiences with law enforcement were shared between under-researched survivor groups, some experiences were explicitly tied to some aspects of survivors' identities. Recognizing the potential law enforcement has to support survivors, the findings of the current review reiterate the need for ongoing efforts to improve law enforcement knowledge and overall response to IPV, especially for diverse populations of IPV survivors.

Keywords: diverse populations; domestic violence; help-seeking; intimate partner violence; police response; qualitative synthesis; survivor experiences.

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Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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New Perspectives on Domestic Violence: from Research to Intervention

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INTERNATIONAL RESEARCH

FACTS AND STATISTICS ON DOMESTIC VIOLENCE AT-A-GLANCE

Sponsored by the peer-reviewed journal partner abuse https://www.springerpub.com/partner-abuse.html  , and the association of domestic violence intervention providers https://domesticviolenceintervention.net/, facts and statistics on  prevalence of partner abuse, victimization.

  • Overall, 22% of individuals assaulted by a partner at least once in their lifetime (23% for females and 19.3% for  males)
  • Higher overall rates among dating students
  • Higher victimization for male than female high school students
  • Lifetime rates higher among women than men
  • Past year rates somewhat higher among men
  • Higher rates of intimate partner violence (IPV) among younger, dating populations “highlights the need for school-based IPV prevention and intervention efforts”

Perpetration

  • Overall, 25.3% of individuals have perpetrated IPV
  • Rates of female-perpetrated violence higher than male-perpetrated (28.3% vs. 21.6%)
  • Wide range in perpetration rates:  1.0% to 61.6% for males; 2.4% to 68.9% for women,
  • Range of findings due to variety of samples and operational definitions of PV

Emotional Abuse and Control

  • 80% of individuals have perpetrated emotional abuse
  • Emotional abuse categorized as either expressive (in response to a provocation) or coercive (intended to monitor, control and/or threaten)
  • Across studies, 40% of women and 32% of men reported expressive abuse; 41% of women and 43% of men reported coercive abuse
  • According to national samples, 0.2% of men and 4.5% of women have been forced to have sexual intercourse by a partner
  • 4.1% to 8% of women and 0.5% to 2% of men report at least one incident of stalking during their lifetime
  • Intimate stalkers comprise somewhere between one-third and one half of all stalkers.
  • Within studies of stalking and obsessive behaviors, gender differences are much less when all types of obsessive pursuit behaviors are considered, but more skewed toward female victims when the focus is on physical stalking

Facts and Statistics on Context

Bi-directional vs. uni-directional.

  • Among large population samples, 57.9% of IPV reported was bi-directional, 42% unidirectional; 13.8% of the unidirectional violence was male to female (MFPV), 28.3% was female to male (FMPV)
  • Among school and college samples, percentage of  bidirectional violence was 51.9%; 16.2% was MFPV and 31.9% was FMPV
  • Among respondents reporting IPV in legal or female-oriented clinical/treatment seeking samples not associated with the military, 72.3% was bi-directional; 13.3% was MFPV, 14.4% was FMPV
  • Within military and male treatment samples, only 39% of IPV was bi-directional; 43.4% was MFPV and 17.3% FMPV
  • Unweighted rates:  bidirectional rates ranged from 49.2% (legal/female treatment) to 69.7% (legal/male treatment)
  • Extent of bi-directionality in IPV comparable between heterosexual and LGBT populations
  • 50.9% of IPV among Whites bilateral; 49% among Latinos; 61.8% among African-Americans
  • Male and female IPV perpetrated from similar motives – primarily to get back at a partner for emotionally hurting them, because of stress or jealousy, to express anger and other feelings that they could not put into words or communicate, and to get their partner’s attention.
  • Eight studies directly compared men and women in the power/control motive and subjected their findings to statistical analyses. Three reported no significant gender differences and one had mixed findings. One paper found that women were more motivated to perpetrate violence as a result of power/control than were men, and three found that men were more motivated; however, gender differences were weak
  • Of the ten papers containing gender-specific statistical analyses, five indicated that women were significantly more likely to report self-defense as a motive for perpetration than men. Four papers did not find statistically significant gender differences, and one paper reported that men were more likely to report this motive than women.  Authors point out that it might be particularly difficult for highly masculine males to admit to perpetrating violence in self-defense, as this admission implies vulnerability.
  • Self-defense was endorsed in most samples by only a minority of respondents, male and female.  For non-perpetrator samples, the rates of self-defense reported by men ranged from 0% to 21%, and for women the range was 5% to 35%.  The highest rates of reported self-defense motives (50% for men, 65.4% for women) came from samples of perpetrators, who may have reasons to overestimate this motive.
  • None of the studies reported that anger/retaliation was significantly more of a motive for men than women’s violence; instead, two papers indicated that anger was more likely to be a motive for women’s violence as compared to men.
  • Jealousy/partner cheating seems to be a motive to perpetrate violence for both men and women.

Facts and Statistics on Risk Factors

  • Demographic risk factors predictive of IPV:  younger age, low income/unemployment, minority group membership
  • Low to moderate correlations between childhood-of-origin exposure to abuse and IPV
  • Protective factors against dating violence:  Positive, involved parenting during adolescence, encouragement of nonviolent behavior; supportive peers
  • Negative peer involvement predictive of teen dating violence
  • Conduct disorder/anti-social personality risk factors for IPV
  • Weak association between depression and IPV, strongest for women
  • Weak association overall between alcohol and IPV, but stronger association for drug use
  • Alcohol use more strongly associated with female-perpetrated than male-perpetrated IPV
  • Married couples at lower risk than dating couples; separated women the most vulnerable
  • Low relationship satisfaction and high conflict predictive of IPV, especially high conflict
  • With few exception, IPV risk factors the same for men and women

Facts and Statistics on Impact on Victims, Children and Families

Impact on partners.

  • Victims of physical abuse experience more physical injuries, poorer physical functioning and health outcomes, higher rates of psychological symptoms and disorders, and poorer cognitive functioning compared to non-victims.  These findings were consistent regardless of the nature of the sample, and, with some exceptions were generally greater for female victims compared to male victims.
  • Physical abuse significantly decreases female victims’ psychological well-being, increases the probability of suffering from depression, anxiety, post-traumatic stress disorder (PTSD) and substance abuse; and victimized women more likely to report visits to mental health professionals and to take medications including painkillers and tranquilizers.
  • Few studies have examined the consequences of physical victimization in men, and the studies that have been conducted have focused primarily on sex differences in injury rates.
  • When severe aggression has been perpetrated (e.g., punching, kicking, using a weapon), rates of injury are much higher among female victims than male victims, and those injuries are more likely to be life-threatening and require a visit to an emergency room or hospital. However, when mild-to-moderate aggression is perpetrated (e.g., shoving, pushing, slapping), men and women tend to report similar rates of injury.
  • Physically abused women have been found to engage in poorer health behaviors and risky sexual behaviors. They are more likely to miss work, have fewer social and emotional support networks are also less likely to be able to take care of their children and perform household duties.
  • Similarly, psychological victimization among women is significantly associated with poorer occupational functioning and social functioning.
  • Psychological victimization is strongly associated with symptoms of depression and suicidal ideation, anxiety, self-reported fear and increased perceived stress, insomnia and poor self-esteem
  • Psychological victimization is at least as strongly related as physical victimization to depression, PTSD, and alcohol use as is physical victimization, and effects of psychological victimization remain even after accounting for the effects of physical victimization.
  • Because research on the psychological consequences of abuse on male victims is very limited and has yielded mixed findings (some studies find comparable effects of psychological abuse across gender, while others do not) it is premature to draw any firm conclusions about this issue.

Effects of Partner Violence and Conflict on Children

  • Significant correlation between witnessing mutual PV and both internalizing (e.g., anxiety, depression) and externalizing outcomes (e.g., school problems, aggression) for children and adolescents
  • Exposure to male-perpetrated PV:  Worse outcomes in internalizing and externalizing problems, including higher rates of aggression toward family members and dating partners, compared to no exposure
  • Children and teens exposed to female-perpetrated PV significantly more likely to aggress against peers, family members and dating partners compared to those not so exposed
  • Results mixed regarding additive effect of exposure to PV and experiencing direct child abuse
  • Witnessing PV in childhood correlated with trauma symptoms and depression in adulthood
  • Child abuse correlated with family violence perpetration in adulthood
  • Children more impacted by exposure to conflict characterized by contempt, hostility and withdrawal compared to those characterized only by anger
  • Greater impact when topic discussed concerns the child (e.g., disagreements over child rearing, blaming the child)
  • High inter-parental conflict/emotional abuse leads to a decrease in parental sensitivity, warmth and consistent discipline; and an increase in harsh discipline and psychological control
  • Neurobiological and physical functioning mediate relationship between inter-parental conflict and negative child outcomes
  • Maternal behaviors somewhat more affected than paternal behaviors, but findings are equivocal, given difficulty in disaggregating male and female perpetrated conflict from couple level operationalizations
  • Greater effects found for mother-child relationships and child outcomes through the toddler years; greater effects found for father-child relationships and child outcomes during the school-age years
  • Family systems theory useful in understanding how discord in one part of the family can impact functioning in the family as a whole, even if it poses some methodological and explanatory challenges

Facts and Statistics on Partner Abuse in Other Populations

Partner abuse in ethnic minority and lgbt populations.

  • African-Americans:  Older studies found higher rates of male-to-female partner violence (MFPV); recent studies have found higher rates of female-to-male partner violence (FMPV)
  • Psychological aggression reported at significantly higher rates than physical aggression
  • As with White populations, minor/moderate aggression far more prevalent among Black couples than severe aggression
  • In dating studies, no gender differences found in rates of physical or psychological victimization, but women reported higher rates of physical aggression than men
  • Latinos:  Mutual and minor/moderate PV most prevalent, but not as much as psychological aggression
  • No gender differences for physical or psychological aggression, except among migrant farm workers where MFPV was highest
  • Asian Americans:  The one general population study found percentage of mutual violence perpetration to be one-third of total
  • Overall rates of PV comparable across gender in large population, community and dating samples
  • Lowest rates found among Vietnamese, compared to respondents who identified as Filipino, Chinese or others of Asian descent
  • Native Americans:  Only three studies found; women reported higher rates of victimization than men, and reported higher levels of injuries incurred
  • Risk factors for ethnic minority PV include:  substance abuse, low SES, and violence exposure and victimization in childhood
  • LGBT populations:  Higher overall rates compared to heterosexual populations
  • Inconsistent findings regarding PV differences between same-sex subgroups
  • Risk factors for LGBT groups include discrimination and internalized homophobia

Partner Abuse Worldwide

  • A total of 162 articles reporting on over 200 studies met the inclusion criteria and were summarized in the online tables for Asia, the Middle East, Africa, Latin America and the Caribbean, and Europe and the Caucasus.
  • A total of 40 articles (73 studies) in 49 countries contained data on both male and female IPV, with a total of 117 direct comparisons across gender for physical PV.
  • Rates of physical PV were higher for female perpetration /male victimization compared to male perpetration/female victimization, or were the same, in 73 of those comparisons, or 62%.
  • There were 54 comparisons made for psychological abuse including controlling behaviors and dominance, with higher rates found for female perpetration /male victimization, in 36 comparisons (67%).
  • Of the 19 direct comparisons made for sexual PV, rates were found to be higher for female perpetration /male victimization in 7comparisons (37%).
  • When only adult samples from large population and community surveys were considered, the overall percentage of partner abuse that was higher for female perpetration /male victimization compared to male perpetration/female victimization, or were the same, was found to be 44% for adult IPV, although in many comparisons, the differences were slight.
  • Studies reporting on female victimization only found the lowest rates for physical abuse victimization in a large population study in Georgia (2%, past year), and the highest in a community survey in Ethiopia (72.5% past year) On the higher end, rates of physical PV far exceed the average found in the United States.
  • The lowest rates of psychological victimization were found in large population study in Haiti (10.8% past year); highest was 98.7% in Bangkok, Thailand (past year).
  • Unlike physical IPV, the highest rates of psychological abuse throughout the world are about the same as those found in the United States (80%).
  • Rates of sexual abuse victimization differed widely across regions, with rates as low as 1% in Georgia (past year); highest rates were found in a study of secondary school students in Ethiopia (68%, lifetime)
  • Physical injuries were compared across gender in two studies.  As expected, abused women were found to experience higher rates of physical injuries compared to men.
  • Far more frequently mentioned were the psychological and behavioral effects of abuse, and these included PTSD symptomology, stress, depression, irritability, feelings of shame and guilt, poor self-esteem, flashbacks, sexual dissatisfaction and unwanted sexual behavior, changes in eating behavior, and aggression.
  • Two studies compared mental health symptoms across gender.  In Botswana, women were found to evidence significantly more of these than men; whereas in a clinical study in Pakistan male and female IPV victims suffered equally (60% of men and women reported depression, 67% anxiety.)
  • A variety of health-related outcomes were also found to be associated with IPV victimization, including overall poor physical health, more long-term illnesses, having to take a larger number of prescribed drugs, STDs, and disturbed sleeping patterns.  Abused mothers experienced poorer reproductive health, respiratory infections, induced abortion and complications during pregnancy; and in a few studies their children were found to experience diarrhea, fever and prolonged coughing.
  • The most common risk factors found in this review of IPV in Asia, Africa, the Middle East, Latin America and Europe have also been found to be significant risk factors in the U.S. and other English-speaking industrialized nations.
  • Most often cited are the risk factors related to low income household income and victim/perpetrator unemployment, at 36.  An almost equally high number of studies (35) reported victim’s low education level.  Alcohol and substance abuse by the perpetrator was a risk factor in 26 studies.  Family of origin abuse, whether directly experienced or witnessed, was cited in 18 studies.  Victim’s younger age was also a major risk factor, mentioned in 17 studies, and perpetrator’s low education level was mentioned in 16.
  • In contrast to the U.S., there is a much higher tolerance by both men and women for IPV in other parts of the world, with rates of approval depending on the country and the type of justification.
  • Regression analyses indicated that a country’s level of human development (as measured by HDI)  was not a significant predictor of male or female physical partner abuse perpetration.
  • Additional regression analyses indicated that a nation’s gender inequality level, as measured by the Gender Inequality Index (GII), was not predictive of either male or female perpetrated physical partner abuse or female-only victimization in studies conducted with general population or community samples.
  • Separate regression analyses on data from the IDVS with dating samples indicate that higher gender inequality levels significantly predict higher prevalence of male and female physical partner abuse perpetration. GII level explained the variance for 17% of male partner abuse and 19% of female partner abuse perpetration.
  • A final analysis examined the association between dominance by one partner and partner violence perpetrated against a partner in dating samples using data from the IDVS. Male dominance scores were not found to be predictive of male partner violence perpetration; however, female dominance scores explained 47% of the variance of female partner violence perpetration.

Facts and Statistics on The Role of Law Enforcement and the Criminal Justice System

The crime control effects of criminal sanctions.

  • Possible causal mechanisms for the effectiveness of arrest and prosecution:  fear of sanctions and victim empowerment; however, because none of the reviewed studies adequately measure such mechanisms, review assumes a general crime control effect that is neutral about causal mechanisms
  • “Based upon the analyses and conclusions produced by these studies, we find that the most frequent outcome reported is that sanctions that follow an arrest for IPV have no effect on the prevalence of subsequent offending.  Among the minority of reported analyses that do report a statistically significant effect, two-thirds of the published findings show sanctions are associated with reductions in repeat offending and one third show sanctions are associated with increased repeat offending.”
  • Wide range of recidivism from 3.1% to 65.5% , due to high variability in measures of repeat offending (e.g., follow-up time frame)
  • Studies unclear about then exact nature of the sentence imposed, and what constitutes a “prosecution” or “conviction”
  • Diversity of analytic methods hinder analysis of effect sizes
  • Sample selection bias:  None of the studies address this issue; for instance, if a small number of low-risk cases are prosecuted, prosecuted offenders are more likely to re-offend compared to those not prosecuted, because of the selection process
  • Missing data:  Often leads to cases being dropped from a study, which in turns creates sample bias

Gender and Racial/Ethnic Differences in Criminal Justice Decision Making

  • Female arrests affected by high SES, presence of weapons and witnesses
  • Women more likely than men to be cited rather than be taken into custody, but the gender discrepancy is less when a decision is made on whether to file charges as misdemeanors or felonies
  • Men are more likely than women to be convicted and to be given harsher sentences
  • “Males were consistently treated more severely at every stage of the prosecution process, particularly regarding the decision to prosecute, even when controlling for other variables (e.g., the presence of physical injuries) and when examined under different conditions.”
  • No conclusive evidence of discrimination against ethnic minority groups in either arrest, prosecution and sentencing
  • Dual arrests were more likely in same-sex couples compared to heterosexual couples, perhaps due to incorrect assumption by police that same-sex couples more likely to engage in mutual violence.
  • Protective orders far more likely to be granted, and with more restrictions to women than to men (particularly in cases involving less severe abuse histories)
  • Mock juries more likely to assign blame responsibility to male perpetrators in contrast to female perpetrators, even when presented with identical scenarios

Effectiveness, Victim Safety, Characteristics and Enforcement of Protective Orders

  • A large percentage of women who are issued protective orders (POs) tend to be unemployed or under-employed as income ranged between $10,000 to $15,000, and almost 50% of women are financially dependent on their partners.
  • At least half of women obtaining POs are married, and married women are more likely to stay with their abusers and be pregnant.
  • Women who are issued POs tend to have more mental health issues (i.e., depression, PTSD) and rural women tend to experience more abuse and mental health issues than urban women
  • Only a few studies have examined characteristics of men seeking a PO
  •  “Effectiveness” defined as violations of protective orders (POs) and/or re-victimization
  • Some studies have found POs to reduce violence against victims, with an almost 80% reduction in violence reported to police
  • Victims report feeling safer and having greater psychological well-being after obtaining a protective order; still, POs violated at a rate of between 44% to 70%
  • Nearly 60% of women who had secured a PO reported to have subsequently been stalked
  • Severity of criminal charges on the offender, as well as previous violations, best predictors of new PO violations
  • Although there is no significant difference in the amount of abuse suffered by married and unmarried victims, married victims less likely to seek final protective orders, perhaps because they are more likely to be re-victimized
  • Women granted POs at significantly higher rates than men, especially in cases involving lower level violence
  • No gender differences in the enforcement of POs, and no differences in rates of recidivism  

Facts and Statistics on Assessment and Treatment

Risk assessment.

  • Little agreement in the literature with regard to the most appropriate approach (actuarial, structured clinical judgment) nor which specific measure has the strongest empirical validation behind it, leaving clinicians and policy makers with little clear guidance
  • Review yielded studies reporting on the validity and reliability of eight IPV specific actuarial instruments and three general actuarial risk assessment measures.
  • Range of area under the curve (AUC) values reported for the validity of the Ontario Domestic Assault Risk Assessment (ODARA) predicting recidivism was good to excellent (0.64 – 0.77)
  • The single study that reported on the Domestic Violence Risk Appraisal Guide (DVRAG) reported an AUC = 0.70 (p < .001). The inter-rater reliability for both instruments was excellent
  • The Domestic Violence Screening Inventory (DVSI) and Domestic Violence Screening Inventory – Revised (DVSI-R) were found to be good predictors of new family violence incidents and IPV recurrence (AUC range 0.61 – 0.71)
  • Three studies examined the Psychopathy Checklist – Revised (PCL-R) and Violence Risk Appraisal Guide (VRAG), neither of which are IPV specific, reporting AUCs ranging from 0.66 – 0.71 and 0.67 – 0.75, respectively.
  • The Level of Service Inventory – Revised (LSI-R) and Level of Service Inventory – Ontario Revision (LSI-OR) were discussed in four articles, reporting two AUC values of 0.50 and 0.73, both of which were predicting IPV recidivism
  • Two structured professional judgment instruments were included in the review, the Spousal Assault Risk Assessment guide (SARA) and the Brief Spousal Assault Form for the Evaluation of Risk (B-SAFER. The SARA research reports nine AUCs ranging from 0.52-0.65. The interrater reliability (IRR) for the SARA was excellent for total scores, good for the summary risk ratings, and poor for the critical items. Although neither of the articles examining the B-SAFER reported the predictive validity of the instrument one did report the IRR based on 12 cases with a mean interclass coefficient (ICC) of 0.57.
  • The Danger Assessment (DA) has the largest body of literature behind it, but there are limitations in the research that inhibit a clear determination of the psychometric properties of the measure, thus far. Victim appraisals of the risk of future IPV show some evidence of predictive accuracy; however, further research is needed to determine the best means with which to collect the victim’s reports and determining the conditions (e.g., stalking) and characteristics of victims that should be considered (e.g., PTSD, substance use).
  • Overall, the literature reveals moderate postdictive/predictive accuracy across measures with little evidence to support one as being highly superior to others, particularly given the heterogeneity of perpetrators and victims, study limitations, and the small body of empirical literature to date.
  • Several themes emerged when we examined the synthesized literature: (1) There is a relatively small body of empirical evidence evaluating IPV violence risk assessment measures. (2) The need for continued advancements in the methodological rigor of the research including prospective studies, research that compares multiple measures within single studies, and research that uses large samples and appropriate outcome indicators. In terms of clinical implications, the review demonstrates the considerable promise of several IPV risk assessment measures but generally reveals modest postdictive/predictive accuracy for most measures.
  • Victim appraisals, while the research has a considerable ways to go, were found to have clinical relevance. However, preliminary evidence suggests that clinicians may want to be particularly cautious when working with some sub-groups when taking into account victims’ perceptions (e.g., PTSD symptoms, substance use, stalking and severe abuse experienced) and supplement the woman’s input with an additional structured assessment.
  • When clinicians and administrators are faced with the challenge of determining which measure(s) to use to assess risk of IPV they should carefully consider the purpose of the assessment (Heilbrun, 2009). Assessors also should take into account the context, setting, and resources when evaluating which measure best suits their needs.
  • Consideration must be given to the characteristics of the population to be assessed (e.g., age, gender, ethnicity, socio-economic status) and the extent to which a measure has been cross-validated in similar samples is required
  • Assessors need to be clear about the outcome of concern (verbal abuse, physical abuse, severe violence, stalking, femicide) and knowledgeable about relevant base rates
  • Based on the available literature, we are also unable to provide guidance on the clinical relevance and utility of these instruments with female perpetrators, male victims, and in same-sex relationships due to the lack of studies using relevant populations.

Effectiveness of Primary Prevention Efforts

  • All studies incorporated a curriculum-based intervention, with the primary goal of lowering rates of PV
  • Schools provided the setting for two-thirds of the interventions; the rest were conducted in community settings
  • Of the five most methodologically-sound school based studies, only one, the Safe Dates Program, found a clear-cut positive outcome on PV behavior (emotional abuse, mild physical abuse and sexual coercion)
  • In contrast, each of the five most methodologically-sound community-based studies was deemed effective in reducing PV; among them were two interventions targeting couples and one family-based intervention involving parents and their adolescent children
  • Although outcomes are mixed, especially for the school-based studies, and no studies were replicated, the authors suggest that “because prevention is generally cost-effective, programming is badly needed to prevent IPV before it begins.”

Effectiveness of Intervention Programs for Perpetrators and Victims

  • Authors reviewed studies all utilized either a randomized or quasi-experimental design
  • Mixed evidence for the effectiveness of perpetrator interventions
  • Evidence that group or couples format can be effective, but many studies flawed
  • More promising results for programs with alternative content (e.g., programs that encourage a strong therapist-client relationship and group cohesion, use some form of Motivational Interviewing technique)
  • Inconsistent effects for brief interventions
  • Structured interventions found to reduce rates of re-victimization compared to no-treatment controls when they include supportive advocacy
  • Cognitive-behavioral treatment (CBT) most effective in reducing the deleterious effects of PV on victims and enhancing their emotional functioning
  • Little evidence to indicate the superiority of one type of intervention over another. Thus, there is no empirical justification for agencies, state organizations, judges, mental health professionals, or others involved in improving the lives of those impacted by IPV to limit the type of services offered to clients, or to restrict the theoretical and ideological underpinnings of such methods.

Full References for PASK Manuscripts

  • Capaldi, D.M., Knoble, N.B.,Shortt, J.W., & Kim, H.K. (2012). A systematic review of risk factors for intimate partner violence. Partner Abuse , 3(2), 231-280.
  • Carney, M., & Barner, J. (2012.  Prevalence of partner abuse:  Rates of emotional abuse and control.  Partner Abuse , 3(3), 286-335.
  • Desmarais, S.L., Reeves, K.A.,Nicholls, T.L.,Telford, R. & Fiebert, M.S. (2012). Prevalence of physical violence in intimate Relationships – Part 1: Rates of male and female victimization. Partner Abuse , 3(2), 140-169.
  • Desmarais, S.L., Reeves, K.A.,Nicholls, T.L.,Telford, R. & Fiebert, M.S. (2012). Prevalence of physical violence in intimate relationships – Part 2: Rates of male and female perpetration  Partner Abuse , 3(2), 170-198.
  • Eckhardt, C.I., Murphy, C.M., Whitaker, D.J., Sprunger, J., Dykstra, R., & Woodard, K. (2013). The effectiveness of intervention programs for perpetrators and victims of intimate partner violence. Partner Abuse , 4(2),
  • Langhinrichsen-Rohling, J., & McCullars, A.  (2012). Motivations for men and women’s intimate partner violence perpetration: A comprehensive review.  Partner Abuse , 3(4),
  • Langhinrichsen-Rohling, J., Misra, T.A., Selwyn, C. & Rohling, M.L. (2012). Rates of bi-directional versus unidirectional intimate partner violence across samples, sexual orientations, and race/ethnicities: A comprehensive review. Partner Abuse , 3(2), 199-230
  • Lawrence, E., Oringo, A., & Brock, R. (2012).  The impact of partner abuse on partners. Partner Abuse , 3(4),
  • MacDonnel, K. Watson (2012).  The combined and independent impact of witnessed interparental violence and child maltreatment.  Partner Abuse , 3(3), 358-378.
  • Maxwell, C., & Garner, J. (2012).  The crime control effects of criminal sanctions for intimate partner violence Partner Abuse , 3(4),
  • Nicholls, T., Pritchard, M., Reeves, K., & Hilterman, E. (2013).  Risk assessment in intimate partner violence:  A review of contemporary approaches.  Partner Abuse , 4(1),
  • Russell, B. (2012).  Effectiveness, victim safety, characteristics and enforcement of protective orders.  Partner Abuse , 3(4),
  • Santovena, E,  Lambert, T., & Hamel, J. (2013). Partner abuse worldwide.  Partner Abuse , 4(1)
  • Shernock, S., & Rusell, B. (2012). Gender and racial/ethnic differences in criminal justice decision making in intimate partner violence cases. Partner Abuse , 3(4),
  • Sturge-Apple, M.L., Skibo, M.A., & Davies, P.T. (2012).  Impact of parental conflict and emotional abuse on children and families.  Partner Abuse , 3(3), 379-400.
  • West, C. (2012).  Partner abuse in ethnic minority and gay, lesbian bisexual, and transgender populations.  Partner Abuse , 3(3), 336-357.
  • Whitaker, D.J., Murphy, C.M., Eckhardt, C.I., Hodges, A.E., & Cowart, M. (2013). Effectiveness of primary prevention efforts for intimate partner violence  Partner Abuse , 4(2)

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Domestic violence research topics.

The list of domestic violence research paper topics below will show that domestic violence takes on many forms. Through recent scientific study, it is now known that domestic violence occurs within different types of households. The purpose of creating this list is for students to have available a comprehensive, state-of-the-research, easy-to-read compilation of a wide variety of domestic violence topics and provide research paper examples on those topics.

Domestic violence research paper topics can be divided into seven categories:

  • Victims of domestic violence,
  • Theoretical perspectives and correlates to domestic violence,
  • Cross-cultural and religious perspectives,
  • Understudied areas within domestic violence research,
  • Domestic violence and the law,
  • Child abuse and elder abuse, and
  • Special topics in domestic violence.

100+ Domestic Violence Research Topics

Victims of domestic violence.

Initial research recognized wives as victims of domestic violence. Thereafter, it was acknowledged that unmarried women were also falling victim to violence at the hands of their boyfriends. Subsequently, the term ‘‘battered women’’ became synonymous with ‘‘battered wives.’’ Legitimizing female victimization served as the catalyst in introducing other types of intimate partner violence.

  • Battered Husbands
  • Battered Wives
  • Battered Women: Held in Captivity
  • Battered Women Who Kill: An Examination
  • Cohabiting Violence
  • Dating Violence
  • Domestic Violence in Workplace
  • Intimate Partner Homicide
  • Intimate Partner Violence, Forms of
  • Marital Rape
  • Mutual Battering
  • Spousal Prostitution

Read more about victims of domestic violence .

Part 2: Research Paper Topics on

Theoretical Perspectives and Correlates to Domestic Violence

There is no single causal factor related to domestic violence. Rather, scholars have concluded that there are numerous factors that contribute to domestic violence. Feminists found that women were beaten at the hands of their partners. Drawing on feminist theory, they helped explain the relationship between patriarchy and domestic violence. Researchers have examined other theoretical perspectives such as attachment theory, exchange theory, identity theory, the cycle of violence, social learning theory, and victim-blaming theory in explaining domestic violence. However, factors exist that may not fall into a single theoretical perspective. Correlates have shown that certain factors such as pregnancy, social class, level of education, animal abuse, and substance abuse may influence the likelihood for victimization.

  • Animal Abuse: The Link to Family Violence
  • Assessing Risk in Domestic Violence Cases
  • Attachment Theory and Domestic Violence
  • Battered Woman Syndrome
  • Batterer Typology
  • Bullying and the Family
  • Coercive Control
  • Control Balance Theory and Domestic Violence
  • Cycle of Violence
  • Depression and Domestic Violence
  • Education as a Risk Factor for Domestic Violence
  • Exchange Theory
  • Feminist Theory
  • Identity Theory and Domestic Violence
  • Intergenerational Transfer of Intimate Partner Violence
  • Popular Culture and Domestic Violence
  • Post-Incest Syndrome
  • Pregnancy-Related Violence
  • Social Class and Domestic Violence
  • Social Learning Theory and Family Violence
  • Stockholm Syndrome in Battered Women
  • Substance Use/Abuse and Intimate Partner Violence
  • The Impact of Homelessness on Family Violence
  • Victim-Blaming Theory

Read more about domestic violence theories .

Part 3: Research Paper Topics on

Cross-Cultural and Religious Perspectives on Domestic Violence

It was essential to acknowledge that domestic violence crosses cultural boundaries and religious affiliations. There is no one particular society or religious group exempt from victimization. A variety of developed and developing countries were examined in understanding the prevalence of domestic violence within their societies as well as their coping strategies in handling these volatile issues. It is often misunderstood that one religious group is more tolerant of family violence than another. As Christianity, Islam, and Judaism represent the three major religions of the world, their ideologies were explored in relation to the acceptance and prevalence of domestic violence.

  • Africa: Domestic Violence and the Law
  • Africa: The Criminal Justice System and the Problem of Domestic Violence in West Africa
  • Asian Americans and Domestic Violence: Cultural Dimensions
  • Child Abuse: A Global Perspective
  • Christianity and Domestic Violence
  • Cross-Cultural Examination of Domestic Violence in China and Pakistan
  • Cross-Cultural Examination of Domestic Violence in Latin America
  • Cross-Cultural Perspectives on Domestic Violence
  • Cross-Cultural Perspectives on How to Deal with Batterers
  • Dating Violence among African American Couples
  • Domestic Violence among Native Americans
  • Domestic Violence in African American Community
  • Domestic Violence in Greece
  • Domestic Violence in Rural Communities
  • Domestic Violence in South Africa
  • Domestic Violence in Spain
  • Domestic Violence in Trinidad and Tobago
  • Domestic Violence within the Jewish Community
  • Human Rights, Refugee Laws, and Asylum Protection for People Fleeing Domestic Violence
  • Introduction to Minorities and Families in America
  • Medical Neglect Related to Religion and Culture
  • Multicultural Programs for Domestic Batterers
  • Qur’anic Perspectives on Wife Abuse
  • Religious Attitudes toward Corporal Punishment
  • Rule of Thumb
  • Same-Sex Domestic Violence: Comparing Venezuela and the United States
  • Worldwide Sociolegal Precedents Supporting Domestic Violence from Ancient to Modern Times

Part 4: Research Paper Topics on

Understudied Areas within Domestic Violence Research

Domestic violence has typically examined traditional relationships, such as husband–wife, boyfriend–girlfriend, and parent–child. Consequently, scholars have historically ignored non-traditional relationships. In fact, certain entries have limited cross-references based on the fact that there were limited, if any, scholarly publications on that topic. Only since the 1990s have scholars admitted that violence exists among lesbians and gay males. There are other ignored populations that are addressed within this encyclopedia including violence within military and police families, violence within pseudo-family environments, and violence against women and children with disabilities.

  • Caregiver Violence against People with Disabilities
  • Community Response to Gay and Lesbian Domestic Violence
  • Compassionate Homicide and Spousal Violence
  • Domestic Violence against Women with Disabilities
  • Domestic Violence by Law Enforcement Officers
  • Domestic Violence within Military Families
  • Factors Influencing Reporting Behavior by Male Domestic Violence Victims
  • Gay and Bisexual Male Domestic Violence
  • Gender Socialization and Gay Male Domestic Violence
  • Inmate Mothers: Treatment and Policy Implications
  • Intimate Partner Violence and Mental Retardation
  • Intimate Partner Violence in Queer, Transgender, and Bisexual Communities
  • Lesbian Battering
  • Male Victims of Domestic Violence and Reasons They Stay with Their Abusers
  • Medicalization of Domestic Violence
  • Police Attitudes and Behaviors toward Gay Domestic Violence
  • Pseudo-Family Abuse
  • Sexual Aggression Perpetrated by Females
  • Sexual Orientation and Gender Identity: The Need for Education in Servicing Victims of Trauma

Part 5: Research Paper Topics on

Domestic Violence and the Law

The Violence against Women Act (VAWA) of 1994 helped pave domestic violence concerns into legislative matters. Historically, family violence was handled through informal measures often resulting in mishandling of cases. Through VAWA, victims were given the opportunity to have their cases legally remedied. This legitimized the separation of specialized domestic and family violence courts from criminal courts. The law has recognized that victims of domestic violence deserve recognition and resolution. Law enforcement agencies may be held civilly accountable for their actions in domestic violence incidents. Mandatory arrest policies have been initiated helping reduce discretionary power of police officers. Courts have also begun to focus on the offenders of domestic violence. Currently, there are batterer intervention programs and mediation programs available for offenders within certain jurisdictions. Its goals are to reduce the rate of recidivism among batterers.

  • Battered Woman Syndrome as a Legal Defense in Cases of Spousal Homicide
  • Batterer Intervention Programs
  • Clemency for Battered Women
  • Divorce, Child Custody, and Domestic Violence
  • Domestic Violence Courts
  • Electronic Monitoring of Abusers
  • Expert Testimony in Domestic Violence Cases
  • Judicial Perspectives on Domestic Violence
  • Lautenberg Law
  • Legal Issues for Battered Women
  • Mandatory Arrest Policies
  • Mediation in Domestic Violence
  • Police Civil Liability in Domestic Violence Incidents
  • Police Decision-Making Factors in Domestic Violence Cases
  • Police Response to Domestic Violence Incidents
  • Prosecution of Child Abuse and Neglect
  • Protective and Restraining Orders
  • Shelter Movement
  • Training Practices for Law Enforcement in Domestic Violence Cases
  • Violence against Women Act

Read more about Domestic Violence Law .

Part 6: Research Paper Topics on

Child Abuse and Elder Abuse

Scholars began to address child abuse over the last third of the twentieth century. It is now recognized that child abuse falls within a wide spectrum. In the past, it was based on visible bruises and scars. Today, researchers have acknowledged that psychological abuse, where there are no visible injuries, is just as damaging as its counterpart. One of the greatest controversies in child abuse literature is that of Munchausen by Proxy. Some scholars have recognized that it is a syndrome while others would deny a syndrome exists. Regardless of the term ‘‘syndrome,’’ Munchausen by Proxy does exist and needs to be further examined. Another form of violence that needs to be further examined is elder abuse. Elder abuse literature typically focused on abuse perpetrated by children and caregivers. With increased life expectancies, it is now understood that there is greater probability for violence among elderly intimate couples. Shelters and hospitals need to better understand this unique population in order to better serve its victims.

  • Assessing the Risks of Elder Abuse
  • Child Abuse and Juvenile Delinquency
  • Child Abuse and Neglect in the United States: An Overview
  • Child Maltreatment, Interviewing Suspected Victims of
  • Child Neglect
  • Child Sexual Abuse
  • Children Witnessing Parental Violence
  • Consequences of Elder Abuse
  • Elder Abuse and Neglect: Training Issues for Professionals
  • Elder Abuse by Intimate Partners
  • Elder Abuse Perpetrated by Adult Children
  • Filicide and Children with Disabilities
  • Mothers Who Kill
  • Munchausen by Proxy Syndrome
  • Parental Abduction
  • Postpartum Depression, Psychosis, and Infanticide
  • Ritual Abuse–Torture in Families
  • Shaken Baby Syndrome
  • Sibling Abuse

Part 7: Research Paper Topics on

Special Topics  in Domestic Violence

Within this list, there are topics that may not fit clearly into one of the aforementioned categories. Therefore, they are be listed in a separate special topics designation. Analyzing Incidents of Domestic Violence: The National Incident-Based Reporting System

  • Community Response to Domestic Violence
  • Conflict Tactics Scales
  • Dissociation in Domestic Violence, The Role of
  • Domestic Homicide in Urban Centers: New York City
  • Fatality Reviews in Cases of Adult Domestic Homicide and Suicide
  • Female Suicide and Domestic Violence
  • Healthcare Professionals’ Roles in Identifying and Responding to Domestic Violence
  • Measuring Domestic Violence
  • Neurological and Physiological Impact of Abuse
  • Social, Economic, and Psychological Costs of Violence
  • Stages of Leaving Abusive Relationships
  • The Physical and Psychological Impact of Spousal Abuse

Domestic violence remains a relatively new field of study among social scientists but it is already a popular research paper subject within college and university students. Only within the past 4 decades have scholars recognized domestic violence as a social problem. Initially, domestic violence research focused on child abuse. Thereafter, researchers focused on wife abuse and used this concept interchangeably with domestic violence. Within the past 20 years, researchers have acknowledged that other forms of violent relationships exist, including dating violence, battered males, and gay domestic violence. Moreover, academicians have recognized a subcategory within the field of criminal justice: victimology (the scientific study of victims). Throughout the United States, colleges and universities have been creating victimology courses, and even more specifically, family violence and interpersonal violence courses.

The media have informed us that domestic violence is so commonplace that the public has unfortunately grown accustomed to reading and hearing about husbands killing their wives, mothers killing their children, or parents neglecting their children. While it is understood that these offenses take place, the explanations as to what factors contributed to them remain unclear. In order to prevent future violence, it is imperative to understand its roots. There is no one causal explanation for domestic violence; however, there are numerous factors which may help explain these unjustified acts of violence. Highly publicized cases such as the O.J. Simpson and Scott Peterson trials have shown the world that alleged murderers may not resemble the deranged sociopath depicted in horror films. Rather, they can be handsome, charming, and well-liked by society. In addition, court-centered programming on television continuously publicizes cases of violence within the home informing the public that we are potentially at risk by our caregivers and other loved ones. There is the case of the au pair Elizabeth Woodward convicted of shaking and killing Matthew Eappen, the child entrusted to her care. Some of the most highly publicized cases have also focused on mothers who kill. America was stunned as it heard the cases of Susan Smith and Andrea Yates. Both women were convicted of brutally killing their own children. Many asked how loving mothers could turn into cold-blooded killers.

Browse other criminal justice research topics .

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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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StatPearls [Internet].

Domestic violence.

Martin R. Huecker ; Kevin C. King ; Gary A. Jordan ; William Smock .

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Last Update: April 9, 2023 .

  • Continuing Education Activity

Family and domestic violence is a common problem in the United States, affecting an estimated 10 million people every year; as many as one in four women and one in nine men are victims of domestic violence. Virtually all healthcare professionals will at some point evaluate or treat a patient who is a victim of domestic or family violence. Domestic and family violence includes economic, physical, sexual, emotional, and psychological abuse of children, adults, or elders. Domestic violence causes worsened psychological and physical health, decreased quality of life, decreased productivity, and in some cases, mortality. Domestic and family violence can be difficult to identify. Many cases are not reported to health professionals or legal authorities. This activity describes the evaluation, reporting, and management strategies for victims of domestic abuse and stresses the role of team-based interprofessional care for these victims.

  • Identify the epidemiology of domestic violence.
  • Describe the types of domestic violence.
  • Explain challenges associated with reporting domestic violence.
  • Review some interprofessional team strategies for improving care coordination and communication to identify domestic violence and improve outcomes for its victims.
  • Introduction

Family and domestic violence including child abuse, intimate partner abuse, and elder abuse is a common problem in the United States. Family and domestic health violence are estimated to affect 10 million people in the United States every year. It is a national public health problem, and virtually all healthcare professionals will at some point evaluate or treat a patient who is a victim of some form of domestic or family violence. [1] [2] [3] [4] [5]

Unfortunately, each form of family violence begets interrelated forms of violence. The "cycle of abuse" is often continued from exposed children into their adult relationships and finally to the care of the elderly.

Domestic and family violence includes a range of abuse, including economic, physical, sexual, emotional, and psychological, toward children, adults, and elders.

Intimate partner violence includes stalking, sexual and physical violence, and psychological aggression by a current or former partner. In the United States, as many as one in four women and one in nine men are victims of domestic violence. Domestic violence is thought to be underreported. Domestic violence affects the victim, families, co-workers, and community. It causes diminished psychological and physical health, decreases the quality of life, and results in decreased productivity.

The national economic cost of domestic and family violence is estimated to be over 12 billion dollars per year. The number of individuals affected is expected to rise over the next 20 years, increasing the elderly population.

Domestic and family violence is difficult to identify, and many cases go unreported to health professionals or legal authorities. Due to the prevalence in our society, all healthcare professionals, including psychologists, nurses, pharmacists, dentists, physician assistants, nurse practitioners, and physicians, will evaluate and possibly treat a victim or perpetrator of domestic or family violence. [6] [7]

Definitions

Family and domestic violence are abusive behaviors in which one individual gains power over another individual.

  • Intimate partner violence typically includes sexual or physical violence, psychological aggression, and stalking. This may include former or current intimate partners.
  • Child abuse involves the emotional, sexual, physical, or neglect of a child under 18 by a parent, custodian, or caregiver that results in potential harm, harm, or a threat of harm.
  • Elder abuse is a failure to act or an intentional act by a caregiver that causes or creates a risk of harm to an elder.

Center for Disease Control and Prevention (CDC)

Domestic violence, spousal abuse, battering, or intimate partner violence, is typically the victimization of an individual with whom the abuser has an intimate or romantic relationship. The CDC defines domestic violence as "physical violence, sexual violence, stalking, and psychological aggression (including coercive acts) by a current or former intimate partner."

Domestic and family violence has no boundaries. This violence occurs in intimate relationships regardless of culture, race, religion, or socioeconomic status. All healthcare professionals must understand that domestic violence, whether in the form of emotional, psychological, sexual, or physical violence, is common in our society and should develop the ability to recognize it and make the appropriate referral.

Violence Abuse Types

The types of violence include stalking, economic, emotional or psychological, sexual, neglect, Munchausen by proxy, and physical. Domestic and family violence occurs in all races, ages, and sexes. It knows no cultural, socioeconomic, education, religious, or geographic limitation. It may occur in individuals with different sexual orientations.

Reason Abusers Need to Control [8] [9] [10]

  • Anger management issues
  • Low self-esteem
  • Feeling inferior 
  • Cultural beliefs they have the right to control their partner
  • Personality disorder or psychological disorder
  • Learned behavior from growing up in a family where domestic violence was accepted
  • Alcohol and drugs, as an impaired individual may be less likely to control violent impulses

Risk Factors

Risk factors for domestic and family violence include individual, relationship, community, and societal issues. There is an inverse relationship between education and domestic violence. Lower education levels correlate with more likely domestic violence. Childhood abuse is commonly associated with becoming a perpetrator of domestic violence as an adult. Perpetrators of domestic violence commonly repeat acts of violence with new partners. Drug and alcohol abuse greatly increases the incidence of domestic violence.

Children who are victims or witness domestic and family violence may believe that violence is a reasonable way to resolve a conflict. Males who learn that females are not equally respected are more likely to abuse females in adulthood. Females who witness domestic violence as children are more likely to be victimized by their spouses. While females are often the victim of domestic violence, gender roles can be reversed.

Domination may include emotional, physical, or sexual abuse that may be caused by an interaction of situational and individual factors. This means the abuser learns violent behavior from their family, community, or culture. They see violence and are victims of violence.

  • Epidemiology

Domestic violence is a serious and challenging public health problem. Approximately 1 in 3 women and 1 in 10 men 18 years of age or older experience domestic violence. Annually, domestic violence is responsible for over 1500 deaths in the United States. [11] [12] [13]

Domestic violence victims typically experience severe physical injuries requiring care at a hospital or clinic. The cost to individuals and society is significant. The national annual cost of medical and mental health care services related to acute domestic violence is estimated at over $8 billion. If the injury results in a long-term or chronic condition, the cost is considerably higher.

Financial hardship and unemployment are contributors to domestic violence. An economic downturn is associated with increased calls to the National Domestic Violence Hotline.

Fortunately, the national rate of nonfatal domestic violence is declining. This is thought to be due to a decline in the marriage rate, decreased domesticity, better access to domestic violence shelters, improvements in female economic status, and an increase in the average age of the population.

  • Most perpetrators and victims do not seek help.
  • Healthcare professionals are usually the first individuals with an opportunity to identify domestic violence.
  • Nurses are usually the first healthcare providers victims encounter.
  • Domestic violence may be perpetrated on women, men, parents, and children.
  • Fifty percent of women seen in emergency departments report a history of abuse, and approximately 40% of those killed by their abuser sought help in the 2 years before death.
  • Only one-third of police-identified victims of domestic violence are identified in the emergency department.
  • Healthcare professionals who work in acute care need to maintain a high index of suspicion for domestic violence as supportive family members may, in fact, be abusers.

Child Abuse

Age, family income, and ethnicity are all risk factors for both sexual abuse and physical abuse. Gender is a risk factor for sexual abuse but not for physical abuse.

Each year there are over 3 million referrals to child protective authorities. Despite often being the first to examine the victims, only about 10% of the referrals were from medical personnel. The fatality rate is approximately two deaths per 100,000 children. Women account for a little over half of the perpetrators.

Intimate Partner Violence

According to the CDC, 1 in 4 women and 1 in 7 men will experience physical violence by their intimate partner at some point during their lifetimes. About 1 in 3 women and nearly 1 in 6 men experience some form of sexual violence during their lifetimes. Intimate partner violence, sexual violence, and stalking are high, with intimate partner violence occurring in over 10 million people each year.

One in 6 women and 1 in 19 men have experienced stalking during their lifetimes. The majority are stalked by someone they know. An intimate partner stalks about 6 in 10 female victims and 4 in 10 male victims.

At least 5 million acts of domestic violence occur annually to women aged 18 years and older, with over 3 million involving men. While most events are minor, for example grabbing, shoving, pushing, slapping, and hitting, serious and sometimes fatal injuries do occur. Approximately 1.5 million intimate partner female rapes and physical assaults are perpetrated annually, and approximately 800,000 male assaults occur. About 1 in 5 women have experienced completed or attempted rape at some point in their lives. About 1% to 2% of men have experienced completed or attempted rape.

The incidence of intimate partner violence has declined by over 60%, from about ten victimizations per 1000 persons age 12 or older to approximately 4 per 1000.

Due to underreporting and difficulty sampling, obtaining accurate incidence information on elder abuse and neglect is difficult. Elderly abuse is thought to occur in 3% to 10% of the population of elders.

Elderly patients may not report due to fear, guilt, ignorance, or shame. Clinicians underreport elder abuse due to poor recognition of the problem, lack of understanding of reporting methods and requirements, and concerns about physician-patient confidentiality.

  • Pathophysiology

There may be some pathologic findings in both the victims and perpetrators of domestic violence. Certain medical conditions and lifestyles make family and domestic violence more likely. [13] [14] [15]

Perpetrators

While the research is not definitive, a number of characteristics are thought to be present in perpetrators of domestic violence. Abusers tend to:

  • Have a higher consumption of alcohol and illicit drugs and assessment should include questions that explore drinking habits and violence
  • Be possessive, jealous, suspicious, and paranoid.
  • Be controlling of everyday family activity, including control of finances and social activities.
  • Suffer low self-esteem
  • Have emotional dependence, which tends to occur in both partners, but more so in the abuser

Domestic violence at home results in emotional damage, which exerts continued effects as the victim matures.

  • Approximately 45 million children will be exposed to violence during childhood.
  • Approximately 10% of children are exposed to domestic violence annually, and 25% are exposed to at least 1 event during their childhood.
  • Ninety percent are direct eyewitnesses of violence.
  • Males who batter their wives batter the children 30% to 60% of the time.
  • Children who witness domestic violence are at increased risk of dating violence and have a more difficult time with partnerships and parenting.
  • Children who witness domestic violence are at an increased risk for post-traumatic stress disorder, aggressive behavior, anxiety, impaired development, difficulty interacting with peers, academic problems, and they have a higher incidence of substance abuse.
  • Children exposed to domestic violence often become victims of violence.
  • Children who witness and experience domestic violence are at a greater risk for adverse psychosocial outcomes.
  • Eighty to 90% of domestic violence victims abuse or neglect their children.
  • Abused teens may not report abuse. Individuals 12 to 19 years of age report only about one-third of crimes against them, compared with one-half in older age groups

Pregnant and Females

The American College of Obstetricians and Gynecologists (ACOG) recommends all women be assessed for signs and symptoms of domestic violence during regular and prenatal visits. Providers should offer support and referral information.

  • Domestic violence affects approximately 325,000 pregnant women each year.
  • The average reported prevalence during pregnancy is approximately 30% emotional abuse, 15% physical abuse, and 8% sexual abuse.
  • Domestic violence is more common among pregnant women than preeclampsia and gestational diabetes.
  • Reproductive abuse may occur and includes impregnating against a partner's wishes by stopping a partner from using birth control.
  • Since most pregnant women receive prenatal care, this is an excellent time to assess for domestic violence.

The danger of domestic violence is particularly acute as both mother and fetus are at risk. Healthcare professionals should be aware of the psychological consequences of domestic abuse during pregnancy. There is more stress, depression, and addiction to alcohol in abused pregnant women. These conditions may harm the fetus.

Gay, Lesbian, Bisexual, and Transgender

Domestic violence occurs in gay, lesbian, bisexual, and transgender couples, and the rates are thought to be similar to a heterosexual woman, approximately 25%.

  • There are more cases of domestic violence among males living with male partners than among males who live with female partners.
  • Females living with female partners experience less domestic violence than females living with males.
  • Transgender individuals have a higher risk of domestic violence. Transgender victims are approximately two times more likely to experience physical violence.

Gay, lesbian, bisexual, and transgender victims may be reticent to report domestic violence. Part of the challenge may be that support services such as shelters, support groups, and hotlines are not regularly available. This results in isolated and unsupported victims. Healthcare professionals should strive to be helpful when working with gay, lesbian, bisexual, and transgender patients.

Usually, domestic violence is perpetrated by men against women; however, females may exhibit violent behavior against their male partners.

  • Approximately 5% of males are killed by their intimate partners.
  • Each year, approximately 500,000 women are physically assaulted or raped by an intimate partner compared to 100,000 men.
  • Three out of 10 women at some point are stalked, physically assaulted, or raped by an intimate partner, compared to 1 out of every 10 men.
  • Rape is primarily perpetrated by other men, while women engage in other forms of violence against men.

Although women are the most common victims of domestic violence, healthcare professionals should remember that men may also be victims and should be evaluated if there are indications present.

The elderly are often mistreated by their spouses, children, or relatives.

  • Annually, approximately 2% of the elderly experience physical abuse, 1% sexual abuse, 5% neglect, 5% financial abuse, and 5% suffer emotional abuse.
  • The annual incidence of elder abuse is estimated to be 2% to 10%, with only about 1 in 15 cases reported to the authorities.
  • Approximately one-third of nursing homes disclosed at least 1 incident of physical abuse per year.
  • Ten percent of nursing home staff self-report physical abuse against an elderly resident.

Elder domestic violence may be financial or physical. The elderly may be controlled financially. Elders are often hesitant to report this abuse if it is their only available caregiver. Victims are often dependent, infirm, isolated, or mentally impaired. Healthcare professionals should be aware of the high incidence of abuse in this population.

  • History and Physical

The history and physical exam should be tailored to the age of the victim.

The most common injuries are fractures, contusions, bruises, and internal bleeding. Unexpected injuries to pre-walking infants should be investigated. The caregiver should explain unusual injuries to the ears, neck, or torso; otherwise, these injuries should be investigated.

Children who are abused may be unkempt and/or malnourished. They may display inappropriate behavior such as aggression, or maybe shy, withdrawn, and have poor communication skills. Others may be disruptive or hyperactive. School attendance is usually poor.

Intimate Partner Abuse

Approximately one-third of women and one-fifth of men will be victims of abuse. The most common sites of injuries are the head, neck, and face. Clothes may cover injuries to the body, breasts, genitals, rectum, and buttocks. One should be suspicious if the history is not consistent with the injury. Defensive injuries may be present on the forearms and hands. The patient may have psychological signs and symptoms such as anxiety, depression, and fatigue.

Medical complaints may be specific or vague such as headaches, palpitations, chest pain, painful intercourse, or chronic pain.

Intimate Partner Abuse: Pregnancy and Female

Abuse during pregnancy may cause as much as 10% of pregnant hospital admissions. There are a number of historical and physical findings that may help the provider identify individuals at risk.

If the examiner encounters signs or symptoms, she should make every effort to examine the patient in private, explaining confidentiality to the patient. Be sure to ask caring, empathetic questions and listen politely without interruption to answers.

Intimate Partner Abuse: Same-Sex

Same-sex partner abuse is common and may be difficult to identify. Over 35% of heterosexual women, 40% of lesbians, 60% of bisexual women experience domestic violence. For men, the incidence is slightly lower. In addition to common findings of abuse, perpetrators may try to control their partners by threatening to make their sexual preferences public.

The provider should be aware there are fewer resources available to help victims; further, the perpetrator and victim may have the same friends or support groups.

Intimate Partner Abuse: Men

Men represent as much as 15% of all cases of domestic partner violence. Male victims are also less likely to seek medical care, so that the incidence may be underreported. These victims may have a history of child abuse.

Elderly Abuse

Health professionals should ask geriatric patients about abuse, even if signs are absent.

  • Pathologic characteristics of perpetrators including dementia, mental illness, and drug and alcohol abuse
  • A shared living situation with the abuser
  • Social isolation

Establishing that injuries are related to domestic abuse is a challenging task. Life and limb-threatening injuries are the priority. After stabilization and physical evaluation, laboratory tests, x-rays, CT, or MRI may be indicated. It is important that healthcare professionals first attend to the underlying issue that brought the victim to the emergency department. [1] [16] [17] [18]

  • The evaluation should start with a detailed history and physical examination. Clinicians should screen all females for domestic violence and refer females who screen positive. This includes females who do not have signs or symptoms of abuse. All healthcare facilities should have a plan in place that provides for assessing, screening, and referring patients for intimate partner violence. Protocols should include referral, documentation, and follow-up.
  • Health professionals and administrators should be aware of challenges such as barriers to screening for domestic violence: lack of training, time constraints, the sensitive nature of issues, and a lack of privacy to address the issues.
  • Although professional and public awareness has increased, many patients and providers are still hesitant to discuss abuse.
  • Patients with signs and symptoms of domestic violence should be evaluated. The obvious cues are physical: bruises, bites, cuts, broken bones, concussions, burns, knife or gunshot wounds.
  • Typical domestic injury patterns include contusions to the head, face, neck, breast, chest, abdomen, and musculoskeletal injuries. Accidental injuries more commonly involve the extremities of the body. Abuse victims tend to have multiple injuries in various stages of healing, from acute to chronic.
  • Domestic violence victims may have emotional and psychological issues such as anxiety and depression. Complaints may include backaches, stomachaches, headaches, fatigue, restlessness, decreased appetite, and insomnia. Women are more likely to experience asthma, irritable bowel syndrome, and diabetes.

Assuming the patient is stable and not in pain, a detailed assessment of victims should occur after disclosure of abuse. Assessing safety is the priority. A list of standard prepared questions can help alleviate the uncertainty in the patient's evaluation. If there are signs of immediate danger, refer to advocate support, shelter, a hotline for victims, or legal authorities.

  • If there is no immediate danger, the assessment should focus on mental and physical health and establish the history of current or past abuse. These responses determine the appropriate intervention.
  • During the initial assessment, a practitioner must be sensitive to the patient’s cultural beliefs. Incorporating a cultural sensitivity assessment with a history of being victims of domestic violence may allow more effective treatment.
  • Patients that have suffered domestic violence may or may not want a referral. Many are fearful of their lives and financial well-being. They hence may be weighing the tradeoff in leaving the abuser leading to loss of support and perhaps the responsibility of caring for children alone. The healthcare provider needs to assure the patient that the decision is voluntary and that the provider will help regardless of the decision. The goal is to make resources accessible, safe, and enhance support.
  • If the patient elects to leave their current situation, information for referral to a local domestic violence shelter to assist the victim should be given.
  • If there is a risk to life or limb, or evidence of injury, the patient should be referred to local law enforcement officials.
  • Counselors often include social workers, psychiatrists, and psychologists that specialize in the care of battered partners and children.

A detailed history and careful physical exam should be performed. If head trauma is suspected, consider an ophthalmology consultation to obtain indirect ophthalmoscopy.

Laboratory studies are often important for forensic evaluation and criminal prosecution. On occasion, certain diseases may mimic findings similar to child abuse. As a consequence, they must be ruled out.

  • A urine test may be used as a screen for sexually transmitted disease, bladder or kidney trauma, and toxicology screening. 

If bruises or contusions are present, there is no need to evaluate for a bleeding disorder if the injuries are consistent with an abuse history. Some tests can be falsely elevated, so a child abuse-specialist pediatrician or hematologist should review or follow-up these tests.

Gastrointestinal and Chest Trauma

  • Consider liver and pancreas screening tests such as AST, ALT, and lipase. If the AST or ALT is greater than 80 IU/L, or lipase greater than 100 IU/L, consider an abdomen and pelvis CT with intravenous contrast.
  • The highest-risk are those with abusive head trauma, fractures, nausea, vomiting, or an abnormal Glasgow Coma Scale score of less than 15.

The evaluation of the pediatric skeleton can prove challenging for a non-specialist as there are subtle differences from adults, such as cranial sutures and incomplete bone growth. A fracture can be misinterpreted. If there is a concern for abuse, consider consulting a radiologist.

Imaging: Skeletal Survey

A skeletal survey is indicated in children younger than 2 years with suspected physical abuse. The incidence of occult fractures is as high as 1 in 4 in physically abused children younger than 2 years. The clinician should consider screening all siblings younger than 2 years.

The skeletal survey should include 2 views of each extremity; anteroposterior and lateral skull; and lateral chest, spine, abdomen, pelvis, hands, and feet. A radiologist should review the films for classic metaphyseal lesions and healing fractures, most often involving the posterior ribs. A “babygram” that includes only 1 film of the entire body is not an adequate skeletal survey.

Skeletal fractures will remodel at different rates, which are dependent on the age, location, and nutritional status of the patient.

Imaging: CT

If abuse or head trauma is suspected, a CT scan of the head should be performed on all children aged six months or younger or children younger than 24 months if intracranial trauma is suspected. Clinicians should have a low threshold to obtain a CT scan of the head when abuse is suspected, especially in an infant younger than 12 months.

CT of the abdomen and pelvis with intravenous contrast is indicated in unconscious children, have traumatic abdominal findings such as abrasions, bruises, tenderness, absent or decreased bowel sounds, abdominal pain, nausea, or vomiting, or have elevation of the AST, an ALT greater than 80 IU/L, or lipase greater than 100 IU/L.

Special Documentation

Photographs should be taken before treatment of injuries.

Intimate Partner and Elder

Evaluate for evidence of dehydration, electrolyte abnormalities, infection, substance abuse, improper medication administration, and malnutrition. 

  • X-rays of bruised of tender body parts to detect fractures
  • Head CT scan to evaluate for intracranial bleeding as a result of abuse or the causes of altered mental status
  • Pelvic examination with evidence collection if sexual assault

Evidence Collection

Domestic and family violence commonly results in the legal prosecution of the perpetrator. Preferably, a team specializing in domestic violence is called in to assist with evidence collection.

Each health facility should have a written procedure for how to package and label specimens and maintain a chain of custody. Law enforcement personnel will often assist with evidence collection and provide specific kits.

It is important to avoid destroying evidence. Evidence includes tissue specimens, blood, urine, saliva, and vaginal and rectal specimens. Saliva from bites can be collected; the bite mark is swabbed with a water-moistened cotton-tipped swab.

Clothing stained with blood, saliva, semen, and vomit should be retained for forensic analysis.

  • Treatment / Management

The priority is the ABCs and appropriate treatment of the presenting complaints. However, once the patient is stabilized, emergency medical services personnel may identify problems associated with violence. [19] [20] [21]

Emergency Department and Office Care

Interventions to consider include:

  • Make sure a safe environment is provided.
  • Diagnose physical injuries and other medical or surgical problems.
  • Treat acute physical or life-threatening injuries.
  • Identify possible sources of domestic violence.
  • Establish domestic violence as a diagnosis.
  • Reassure the patient that he is not at fault.
  • Evaluate the emotional status and treat.
  • Document the history, physical, and interventions.
  • Determine the risks to the victim and assess safety options.
  • Counsel the patient that violence may escalate.
  • Determine if legal intervention is needed and report abuse when appropriate or mandated.
  • Develop a follow-up plan.
  • Offer shelter options, legal services, counseling, and facilitate such referral.

Medical Record

The medical record is often evidence used to convict an abuser. A poorly document chart may result in an abuser going free and assaulting again.

Charting should include detailed documentation of evaluation, treatment, and referrals.

  • Describe the abusive event and current complaints using the patient's own words.
  • Include the behavior of the patient in the record.
  • Include health problems related to the abuse.
  • Include the alleged perpetrator's name, relationship, and address.
  • The physical exam should include a description of the patient's injuries including location, color, size, amount, and degree of age bruises and contusions.
  • Document injuries with anatomical diagrams and photographs.
  • Include the name of the patient, medical record number, date, and time of the photograph, and witnesses on the back of each photograph.
  • Torn and damaged clothing should also be photographed.
  • Document injuries not shown clearly by photographs with line drawings.
  • With sexual assault, follow protocols for physical examination and evidence collection.

Disposition

If the patient does not want to go to a shelter, provide telephone numbers for domestic violence or crisis hotlines and support services for potential later use. Provide the patient with instructions but be mindful that written materials may pose a danger once the patient returns home.

  • A referral should be made to primary care or another appropriate resource.
  • Advise the patient to have a safety plan and provide examples.
  • Forty percent of domestic violence victims never contact the police.
  • Of female victims of domestic homicide, 44% had visited a hospital emergency department within 2 years of their murder.
  • Health professionals provide an opportunity for victims of domestic violence to obtain help.
  • Differential Diagnosis

The differential diagnosis varies with the injury type of injury and age.

Head Traum a

  • Accidental injury
  • Arteriovenous malformations
  • Bacterial meningitis
  • Birth trauma
  • Cerebral sinovenous thrombosis
  • Solid brain tumors

Bruises and Contusions

  • Accidental bruises
  • Bleeding disorder
  • Congenital dermal melanocytosis (Mongolian spots)
  • Erythema multiforme
  • Accidental burns
  • Atopic dermatitis
  • Contact dermatitis
  • Inflammatory skin conditions
  • Congenital syphilis
  • Osteogenesis imperfecta
  • Osteomyelitis
  • Toddler’s fracture

Without proper social service and mental health intervention, all forms of abuse can be recurrent and escalating problems, and the prognosis for recovery is poor. Without treatment, domestic and family violence usually recurs and escalates in both frequency and severity. [3] [22] [23]

  • Of those injured by domestic violence, over 75% continue to experience abuse.
  • Over half of battered women who attempt suicide will try again; often they are successful with the second attempt.

In children, the potential for poor outcomes is particularly high as abuse inflicts lifelong effects. In addition to dealing with the sequelae of physical injury, the mental consequences may be catastrophic. Studies indicate a significant association between child sexual abuse and increased risk of psychiatric disorders in later life. The potential for the cycle of violence to continued from childhood is very high.

Children raised in families of sexual abuse may develop:

  • Attention deficit hyperactivity disorder (ADHD)
  • Conduct disorder
  • Bipolar disorder
  • Panic disorder
  • Sleep disorders
  • Suicide attempts
  • Post-traumatic stress disorder (PTSD)

Health Outcomes

There are multiple known and suspected negative health outcomes of family and domestic violence. There are long-term consequences to broken bones, traumatic brain injuries, and internal injuries.

Patients may also develop multiple comorbidities such as:

  • Fibromyalgia
  • High blood pressure
  • Chronic pain
  • Gastrointestinal disorders
  • Gynecologic disorders
  • Panic attacks
  • Pearls and Other Issues

Screening: Tools

  • The American Academy of Pediatricians has free guides for the history, physical, diagnostic testing, documentation, treatment, and legal issues in cases of suspected child abuse.
  • The Center for Disease Control and Prevention (CDC) provides several scales assessing family relationships, including child abuse risks.
  • The physical examination is still the most significant diagnostic tool to detect abuse. A child or adult with suspected abuse should be undressed, and a comprehensive physical exam should be performed. The skin should be examined for bruises, bites, burns, and injuries in different stages of healing. Examine for retinal hemorrhages, subdural hemorrhages, tympanic membrane rupture, soft tissue swelling, oral bruising, fractured teeth, and organ injury.

Screening: Recommendations

  • Evaluate for organic conditions and medications that mimic abuse.
  • Evaluate patients and caregivers separately
  • Clinicians should regularly screen for family and domestic violence and elder abuse
  • The Elder Abuse Suspicion Index can be used to assess for elder abuse
  • Screen for cognitive impairment before screening for abuse in the elderly
  • Pattern injury is more suspicious
  • Failure to report child abuse is illegal in most states.
  • Failure to report intimate partner and elder abuse is illegal in many states.

It is important to be aware of federal and state statutes governing domestic and family abuse. Remember that reporting domestic and family violence to law enforcement does not obviate detailed documentation in the medical record.

  • Battering is a crime, and the patient should be made aware that help is available. If the patient wants legal help, the local police should be called.
  • In some jurisdictions, domestic violence reporting is mandated. The legal obligation to report abuse should be explained to the patient.
  • The patient should be informed how local authorities typically respond to such reports and provide follow-up procedures. Address the risk of reprisal, need for shelter, and possibly an emergency protective order (available in every state and the District of Columbia).
  • If there is a possibility the patient’s safety will be jeopardized, the clinician should work with the patient and authorities to best protect the patient while meeting legal reporting obligations.
  • The clinical role in managing an abused patient goes beyond obeying the laws that mandate reporting; there is a primary obligation to protect the life of the patient.
  • The clinician must help mitigate the potential harm that results from reporting, provide appropriate ongoing care, and preserve the safety of the patient.
  • If the patient desires, and it is acceptable to the police, a health professional should remain during the interview.
  • The medical record should reflect the incident as described by the patient and any physical exam findings. Include the date and time the report was taken and the officer's name and badge number.

National Statutes

Federal Child Abuse Prevention and Treatment Act (CAPTA)

Each state has specific child abuse statutes. Federal legislation provides guidelines for defining acts that constitute child abuse. The guidelines suggest that child abuse includes an act or failure recent act that presents an imminent risk of serious harm. This includes any recent act or failure to act on the part of a parent or caretaker that results in death, physical or emotional harm, sexual abuse, or exploitation.

Elder Justice Act

The Elder Justice Act provides strategies to decrease the likelihood of elder abuse, neglect, and exploitation. The Act utilizes three significant approaches:

Patient Safety and Abuse Act

The Violence Against Woman Act makes it a federal crime to cross state lines to stalk, harass, or physically injure a partner; or enter or leave the country violating a protective order. It is a violation to possess a firearm or ammunition while subject to a protective order or if convicted of a qualifying crime of domestic violence.

  • Enhancing Healthcare Team Outcomes

Domestic violence may be difficult to uncover when the victim is frightened, especially when he or she presents to an emergency department or healthcare practitioner's office. The key is to establish an assessment protocol and maintain an awareness of the possibility that domestic and family violence may be the cause of the patient’s signs and symptoms.

Over 80% of victims of domestic and family violence seek care in a hospital; others may seek care in health professional offices, including dentists, therapists, and other medical offices. Routine screening should be conducted by all healthcare practitioners including nurses, physicians, physician assistants, dentists, nurse practitioners, and pharmacists. Interprofessional coordination of screening is a critical component of protecting victims and minimizing negative health outcomes. Health professional team interventions reduce the incidence of morbidity and mortality associated with domestic violence. Documentation is vital and a legal obligation.

  • Healthcare professionals including the nurse should document all findings and recommendations in the medical record, including statements made denying abuse
  • If domestic violence is admitted, documentation should include the history, physical examination findings, laboratory and radiographic finds, any interventions, and the referrals made.
  • If there are significant findings that can be recorded, pictures should be included.
  • The medical record may become a court document; be objective and accurate.
  • Healthcare professionals should provide a follow-up appointment.
  • Reassurance that additional assistance is available at any time is critical to protect the patient from harm and break the cycle of abuse.
  • Involve the social worker early
  • Do not discharge the patient until a safe haven has been established.

The following agencies provide national assistance for victims of domestic and family violence:

  • Centers for Disease Control and Prevention (800-CDC-INFO (232-4636)/TTY: 888-232-6348
  • Childhelp: National Child Abuse Hotline: (800-4-A-CHILD (2-24453))
  • The coalition of Labor Union Women (cluw.org): 202-466-4615
  • Corporate Alliance to End Partner Violence: 309-664-0667
  • Employers Against Domestic Violence: 508-894-6322
  • Futures without Violence: 415-678-5500/TTY 800-595-4889
  • Love Is Respect: National Teen Dating Abuse Helpline: 866-331-9474 /TTY: 866-331-8453
  • National Center on Domestic and Sexual Violence
  • National Center on Elder Abuse
  • National Coalition Against Domestic Violence (www.ncadv.org)
  • National Network to End Domestic Violence: 202-543-5566
  • National Organization for Victim Assistance
  • National Resource Center on Domestic Violence: 800-537-2238 
  • National Sexual Violence Resource Center: 717-909-0710
  • Review Questions
  • Access free multiple choice questions on this topic.
  • Comment on this article.

Disclosure: Martin Huecker declares no relevant financial relationships with ineligible companies.

Disclosure: Kevin King declares no relevant financial relationships with ineligible companies.

Disclosure: Gary Jordan declares no relevant financial relationships with ineligible companies.

Disclosure: William Smock declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

  • Cite this Page Huecker MR, King KC, Jordan GA, et al. Domestic Violence. [Updated 2023 Apr 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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Employing Research To Understand Violence Against Women

National Institute of Justice Journal

Fifty years ago, violence against women, and domestic violence in particular, was not considered a criminal justice concern in this country. It was largely viewed as a personal matter, best dealt with privately within families.

With a sweeping reinvestment in criminal justice reform in the 1960s, the women’s movement of the 1960s and 1970s, and efforts in the late 1980s and 1990s that led to passage of the Violence Against Women Act in 1994, violence against women entered the public consciousness in the United States. It began to be recognized as a serious public health and public safety problem that warranted criminal justice system intervention.

Over the past 50 years, NIJ has established and expanded a strong program that addresses violence against women. Its portfolio has funded more than $130 million in research on intimate partner violence, sexual violence, stalking, teen dating violence, and other related topics. NIJ-funded initiatives have also helped finance the testing of previously unsubmitted sexual assault kits and establish best practices in testing these kits.

Kristina Rose, a former NIJ acting director who worked on violence against women issues throughout her 19 years with the U.S. Department of Justice, summed up NIJ’s influence: “When it comes to violence against women, NIJ has been brave and pioneering across the spectrum of issues to help people understand what we know about violence against women, including what the criminal justice response should look like.”

Minneapolis Domestic Violence Experiment

In the wake of national attention surrounding violence against women in the 1970s and early 1980s, NIJ funded a randomized controlled trial experiment in Minneapolis that examined various law enforcement responses to domestic violence. [1] In 1984, the results of the Minneapolis Domestic Violence Experiment indicated that spending a night in jail significantly reduced the risk that a person would commit a future act of domestic violence. As a result, many police departments across the country implemented pro-arrest or mandatory arrest policies in domestic violence situations.

Given the findings and the implications for law enforcement, NIJ funded six replication studies, beginning in 1986. These studies showed contradictory results, which underscored the importance of replicating research studies. Replication ensures that results are valid, reliable, and generalizable.

Although replications found mixed results, the Minneapolis Domestic Violence Experiment marked a significant change in how law enforcement approached intimate partner violence.

“This was the first time there was a shift in how the criminal justice system thought about and responded to domestic violence,” says Angela Moore, senior science advisor and social scientist at NIJ.

Nearly 40 years later, the Minneapolis Domestic Violence Experiment is still frequently cited as a pivotal study.

The Violence Against Women Act

The Violence Against Women Act (VAWA) of 1994 was landmark legislation that created legal protections for victims of domestic and sexual violence and established funding streams for responding to these crimes. Filling critical resource gaps in every state, VAWA grant programs support law enforcement agencies, prosecutors’ offices, courts, domestic violence shelters, and rape crisis centers in serving victims and holding persons who commit violent acts against women accountable. VAWA also expanded the scope and scale of U.S. research on violence against women and led to a significant expansion of NIJ’s major research and evaluation efforts in the field.

“VAWA was an impetus,” says Moore. “We did some work on violence against women before the Act, but the funding NIJ received as a result of VAWA helped us spring forward and gave rise to the program we have today.”

VAWA was reauthorized in 2000, 2005, and 2013, and separate legislation in 2002 established the Office on Violence Against Women (OVW), a Department of Justice agency responsible for leading the implementation of VAWA grant programs.

“Thanks to funding administered by OVW, communities have developed coordinated responses to crimes of violence against women,” says OVW Acting Director Katharine Sullivan. “Justice system professionals, victim services providers, and other community partners have used these grants to work together to ensure that victims get the help they need and that dangerous persons are stopped from committing more crimes. These coordinated community responses have transformed how domestic violence is treated in the criminal and civil justice systems and sparked innovative prevention efforts like Maryland’s Lethality Assessment Program to reduce domestic violence homicides.”

In 1998, NIJ began receiving designated VAWA funds for research on violence against women. Funding allocations varied by year — ranging from $7 million in 1998 to $1.88 million in 2008 and 2009 — with a current allocation of $3 million to $5 million each fiscal year. This steady stream of funds from OVW has helped NIJ study the nature and scope of violence against women and the effectiveness of strategies for combatting these crimes. Knowledge generated through NIJ’s Violence Against Women program informs efforts within the Department of Justice and in communities across the nation to protect victims and bring those who commit violent acts against women to justice.

Collecting Representative Data

Despite the considerable number of studies on violence against women that were conducted in the 1980s and 1990s, there remained a critical need to understand the magnitude and nature of intimate partner violence, sexual violence, and stalking in a way that would provide accurate and reliable data. Surveys that frame questions within the context of crime do not necessarily provide representative data on respondents’ experiences with violence against women, in part because people do not always self-identify as victims of crime.

To address this research gap, in 2000 NIJ partnered with the Centers for Disease Control and Prevention (CDC) on the National Violence Against Women Survey (NVAWS). [2] The survey revealed that more than half of the surveyed women reported being physically assaulted at some point in their lives, and nearly two-thirds of women who reported being raped, physically assaulted, or stalked were victimized by intimate partners.

For two reasons, this survey has been consistently cited as a more reliable representation of rates of violence against women than surveys that frame victimization within the context of crime. First, the NVAWS did not rely solely on reported offenses because the vast majority of crimes go unreported. Second, the survey was designed to ask detailed, behavior-specific questions about respondents’ victimization experiences. By asking questions that avoid legal terms (for example, “rape”) and instead asking about a suspect’s specific behaviors (for example, “slapped,” “pushed,” and “shoved”), the survey avoided attributing blame or labeling respondents as victims.

The NVAWS was one of many NIJ-CDC collaborations to address violence against women. As a result, NIJ was able to bring a public health perspective to its work, alongside its inherent focus on public safety. NIJ again collaborated with CDC, as well as the U.S. Department of Defense Family Advocacy Program, to develop the National Intimate Partner and Sexual Violence Survey (NISVS); the first survey report was produced in 2011. [3] CDC continues to administer the NISVS to capture data about violence against women and men, and the survey has become one of the most frequently cited data sets in the National Archive of Criminal Justice Data.

Research After VAWA

VAWA mandated that the Department of Justice work in partnership with the National Academy of Sciences (NAS) to develop a research agenda for violence against women. The 1996 NAS report Understanding Violence Against Women was instrumental in shaping the direction of NIJ’s violence against women research portfolio. Subsequent NAS reports, along with strategic planning workshops and other input, have also informed program goals and direction.

Intimate Partner Violence

Through grants, cooperative agreements, and contracts supported by VAWA funding, NIJ has supported more than 200 studies on intimate partner violence — accounting for nearly half of the agency’s total funding allocations for violence against women research since 1993. Over this period, rates of intimate partner homicides have dropped nearly 30 percent as public awareness of intimate partner violence and policy responses have grown. [4] In 2016, NIJ hosted a meeting with prominent researchers and criminal justice practitioners to inform the Institute’s research agenda moving forward.

NIJ-funded studies on intimate partner violence have focused on definition and measurement, victims and those who commit the violent act, impacts on children, contexts and consequences, civil and criminal justice interventions, and processes used to respond to these crimes. This research has found links between intimate partner violence and early parenthood, severe poverty, and unemployment and has shown that understanding the demographic differences among victims and person who abuse their partner helps predict which interventions will be successful in specific groups.

Violence Against Women in Special Populations

Violence against women is a multifaceted issue that affects populations on many levels. NIJ’s broad name for its violence against women program — the Violence Against Women and Family Violence Research and Evaluation Program [5] — helped make it possible for NIJ to fund research on a wide range of topics related to violence against women, including trauma and the impact on children exposed to violence. This work also gave rise to a focus on teen dating violence and the maltreatment of elderly adults.

“There’s a lot of research that talks about the intergenerational aspects of violence against women,” says Moore. “It’s important to study these other facets of violence because they can have a tremendous impact within families, communities, and society as a whole.”

Building on a long history of research in the area of intimate partner violence, NIJ’s teen dating violence research portfolio grew out of a recognition that the field needed to explore how to prevent dating violence in populations younger than adults. NIJ has funded nearly three dozen studies on teen dating violence since the portfolio was established in 2005. NIJ also sponsored an interagency working group on teen dating violence in 2006. [6]

VAWA reauthorizations in 2005 and 2013 called for NIJ, in consultation with OVW, to conduct analyses and research on violence against American Indian and Alaska Native women in Indian Country. NIJ focused subsequent research on dating violence, domestic violence, sexual assault, sex trafficking, stalking, and murder in these communities. NIJ-funded research also evaluated the effectiveness of federal, state, tribal, and local responses to violence against American Indian and Alaska Native women. As part of the NIJ-CDC partnership, NIJ funded an oversampling of American Indian and Alaska Native women and men in 2010. The data revealed that four out of five American Indian and Alaska Native women in the United States have experienced violence in their lifetimes, and that these women find it much more difficult than other populations to access victim services. [7]

NIJ has funded dozens of additional studies to examine violence against women in specific populations, including disabled, elderly, and homeless persons; recipients of welfare; immigrants; incarcerated individuals; and various racial, cultural, and ethnic groups.

Sexual Violence

NIJ supported its first sexual violence research project in 1973, but the agency’s research on sexual violence dramatically expanded in the 1990s after the passage of VAWA. The first solicitation that focused exclusively on sexual violence was issued in 2002, when NIJ-funded research provided the first comprehensive national look at rape and sexual assault on college campuses.

NIJ has also done groundbreaking work to assist in the processing of sexual assault evidence nationally. In 2011, NIJ funded action-research projects in Houston, Texas, and Wayne County, Michigan, to help understand the nature and scope of untested sexual assault kits and to identify effective, sustainable, victim-centric responses to sexual assault. Additionally, through an NIJ-FBI partnership, the FBI laboratory in Quantico, Virginia, tested thousands of previously untested sexual assault kits from across the country, and NIJ convened the NIJ Sexual Assault Forensic Evidence Reporting (SAFER) working group. Information gleaned from these efforts contributed to the creation of the publication National Best Practices for Sexual Assault Kits: A Multidisciplinary Approach, which NIJ released in 2017. [8]

NIJ is also evaluating the Bureau of Justice Assistance’s Sexual Assault Kit Initiative (SAKI). The action-research projects in Houston, Wayne County, and other jurisdictions helped inform and establish the multidisciplinary nature of SAKI and underscored the need for collaboration between multiple components of the criminal justice system on sexual assault kit testing.

NIJ’s preliminary research in this area examined the stalking of members of Congress and celebrities in the 1980s. In 1993, NIJ was directed to develop a model anti-stalking code. NIJ has funded five projects on stalking, but this remains the least funded research topic in NIJ’s violence against women program, in part because of the difficulty of measuring and capturing reliable data on the subject.

Disseminating Results

NIJ-funded researchers have published scholarly articles related to violence against women in more than 50 different journals. The NIJ Journal has been an additional platform to disseminate research results, and a special issue of the Violence Against Women journal in 2013 highlighted NIJ’s programs. [9] NIJ’s Compendium of Research on Violence Against Women spans nearly 300 pages and includes summary information on all research related to violence against women from 1993 to the present, with links to study reports and manuscripts. [10]

NIJ releases an annual solicitation and has more than 50 active research projects on violence against women.

“All of NIJ’s work aims to respond to the needs and questions of the criminal justice field,” says Moore. “NIJ has funded work that has transformed the evidence base around what we know in regard to violence against women. We have come a long way since the Minneapolis Domestic Violence Experiment and the early days of our violence against women work. What hasn’t changed over the past 50 years is our commitment to funding research to better understand violence against women and how best to combat it moving forward.”

About This Article

This article was published as part of NIJ Journal issue number 281 , released May 2019.

[note 1] In this article, the terms “domestic violence” and “intimate partner violence” can be considered synonyms. NIJ now uses the more inclusive term “intimate partner violence,” which does not imply that this violence occurs exclusively within a domestic setting.

[note 2] National Institute of Justice, Full Report of the Prevalence, Incidence, and Consequences of Violence Against Women: Findings From the National Violence Against Women Survey , Washington, DC: U.S. Department of Justice, National Institute of Justice, November 2000, NCJ 183781.

[note 3] “ The National Intimate Partner and Sexual Violence Survey (NISVS) ,” Centers for Disease Control and Prevention, updated September 19, 2018.

[note 4] See Intimate Partner Violence: Interventions .

[note 5] See Violence Against Women and Family Violence Program .

[note 6] For more information on the NIJ teen dating violence research portfolio, see Teen Dating Violence .

[note 7] André B. Rosay, Violence Against American Indian and Alaska Native Women and Men: 2010 Findings From the National Intimate Partner and Sexual Violence Survey , Washington, DC: U.S. Department of Justice, National Institute of Justice, May 2016, NCJ 249736.

[note 8] National Institute of Justice, National Best Practices for Sexual Assault Kits: A Multidisciplinary Approach , Washington, DC: U.S. Department of Justice, National Institute of Justice, 2017, NCJ 250384.

[note 9] Bernard Auchter, ed., “The Violence Against Women Research and Evaluation Program at the National Institute of Justice,” special issue, Violence Against Women 19 no. 6 (2013).

[note 10] National Institute of Justice, Violence and Victimization Research Division's Compendium of Research on Violence Against Women, 1993-2016 , Washington, DC: U.S. Department of Justice, National Institute of Justice, August 2017, NCJ 223572.

About the author

Rianna P. Starheim is a writer and former contractor with Leidos.

Cite this Article

Read more about:, related publications.

  • Violence and Victimization Research Division's Compendium of Research on Violence Against Women, 1993-2018
  • NIJ Journal Issue No. 281

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