Intimate partner violence (Spousal abuse) - for such a prevalent problem, why do we know so little?

How time flies!   This is the 200^th posting for DrPHealth.  There just seems to be an endless supply of public health issues to comment on.  Thanks for your continuing support, and please forward the link to your friends and colleagues and follow on Twitter @DrPHealth.  

Speaking out on tough issues like spousal abuse is the first step to reducing the problem. Raise your voice by sharing information widely 


Over the past five years,  just over 1 Million Canadians are victims of intimate partner violence (IPV).  Roughly half of these are still within the relationship in which the violence occurred.  IPV affects both genders equally, however females tend to be more physically and sexually victimized, and more likely to leave the abusive relationship.  

In a January 2011 report, Statistics Canada released an updated fairly comprehensive report on Family Violence that includes a significant chapter on IPV  Stats Can Family Violence report.  It is a subreport of the General Social Survey undertaken every 5 years with the last cycle in 2009.  The Family Violence report provides some trending suggesting that rates of IPV decreased between 1999 and 2004, but remained constant through the 2009 cycle. 

Other points of note about current partner violence is it is more likely to occur in younger age groups, common-law relationships (versus legal marriage), and relationships involving previously married persons.   The correlation with socioeconomic status is not clear.  Reporting is more prevalent in lower income situations, but there is not a gradient associated with education of either the victim or the perpetrator. 

Only a fraction of incidents are reported to the police, and less still result in definitive action to prevent recurrence.  Incidence of violence represent only about a third of partner abuse, with some 17% of the Canadian population reporting some form of abuse, the majority being emotional in nature. 

On any given day nearly 5000 women are in one of the almost 600 shelters across the country.  Even among shelter residents, only 40% had reported the abuse to the police. 

A recent Cochrane evidence review prompted a Health-Evidence summary statement on interventions to prevent intimate partner abuse  Health evidence summary statement on IPA .  It is disappointing that many of the promising practices of providing brief or intensive support  have not stood the test of effectiveness under trial conditions or still require better study.  Only intensive advocacy in shelters demonstrating reduced physical violence outcomes in the 1-2 year time frame, and possibly brief advocacy in the emergency department on using safety behaviours have sufficient evidence to warrant inclusion in current programming.  

 

The US Preventative Task Force reviewed screening recommendations for IPV in July this year and concluded as well that there is some evidence that screening followed by intervention has value, but that there are major gaps in the evidence to develop definitive conclusions.  US Prevention Task Force IPV screening 

For such a prevalent and disconcerting health and social problem, while our knowledge is increasing, we should be just as concerned about of lack of understanding about why IPV persists, how to prevent it, and how to manage it with the least consequence to victims and children who are caught in the wake of the relationship dysfunction.