Original articleViolence Against Women from Different Relationship Contexts and Health Care Utilization in Spain
Introduction
Violence against women is a worldwide phenomenon and has been recognized as a significant contributor to women’s ill health (World Health Organization [WHO], 2002), with interpersonal violence being the most universal form of violence against women (Kranz & Garcia-Moreno, 2005).
International research has focused mainly on intimate partner violence (IPV), given its high prevalence and significant impact on health (Thompson et al., 2006). Prior studies consistently reported many adverse physical and mental outcomes linked to IPV (Golding, 1999, Campbell, 2002, Plichta, 2004, Ellsberg et al., 2008). These associations between IPV and negative health consequences have been reported regardless of the type of violence (physical, psychological, or sexual), current versus lifetime history, and clinic- or population-based recruitment strategies (Nicolaidis, Curry, McFarland, & Gerrity, 2004).
Women with a history of IPV also use health care services more than women without a history of IPV. This increased health care utilization for women with IPV has been found for inpatient hospitalization, primary and specialty care, and mental health care (Bergman, Brismar, & Nordin, 1999; Coker et al., 2004, Kernic et al., 2000). It may thus be deduced that IPV represents a problem for the health care system, by increasing already overstretched resources as well as both short- and long-term costs (Rivara et al., 2007, Snow Jones et al., 2006).
Research has documented that IPV is among the most serious forms of violence against women because of its significant impact on health and its greater chronicity. However, there are other types of interpersonal violence against women, besides IPV, implying direct abuse of the woman throughout her lifetime. Among these are physical, sexual, or psychological abuse within the family by someone other than a partner, sexual harassment in the workplace, in educational institutions, and in other social settings, as well as abuse suffered at the hands of unknown perpetrators (Koss et al., 1994, World Health Organization (WHO), 2002).
Despite considerable frequency of violence by a nonpartner, detected both in population-based studies (WHO, 2002; Fanslow and Robinson, 2004, Moracco et al., 2007) and in clinical samples (Eberhard-Gran et al., 2007, Schraibe et al., 2007) its impact on health has received less attention. Nevertheless, a wide range of health consequences, such as reproductive health problems, injuries, somatic disorders, substance abuse, and a tendency to be revictimized (Plichta & Falik, 2001) have been found to be associated with different forms of lifetime violence including child abuse, physical assault, and rape.
To our knowledge, no study has examined the effect on health care utilization related to violence inflicted by perpetrators from different relationship contexts, nor do we have information on the use of services by women who reported revictimization by a partner and by someone other than a partner throughout their life.
The objectives of this study are to 1) compare the sociodemographic characteristics and services used by ever abused women and never abused women; 2) analyze the effect of lifetime violence against women from different relationship context settings on services utilization (primary care, specialist services, emergency rooms and hospital admission); and 3) determine health care services utilization by women exposed to a combination of IPV and abuse by perpetrators other than a partner. Health care utilization was hypothesized to be higher for women who reported lifetime abuse, regardless of the perpetrator.
Section snippets
Study Sample and Data Collection
The study population consisted of adult women attending primary health care services who participated in a broader cross-sectional study to estimate national data of prevalence, risk factors and health effects of violence against women in Spain (Ruiz-Perez et al., 2010). It was developed in coordination with six research groups across the country and was approved by the corresponding ethics committees in each group.
Independent and representative samples were taken based on a multistage cluster
Results
Of the 10,815 female patients who completed the questionnaire, 3,538 (32.7%) reported a history of lifetime abuse; 1,868 (17.3%) reported that the abuse was perpetrated only by a partner, 1,079 (10.0%) by someone other than a partner, and for 591 (5.4%), the abuse was perpetrated by both partner and nonpartner. The most frequent abuse experienced by women by perpetrators other than a partner was by someone from their family context (421 [3.9%] Figure 1).
Abused women were slightly older, had a
Discussion
This study used a large, random sample of women seeking medical care for any reason in primary health care services around Spain. At least one act of physical, sexual, or psychological violence was reported by approximately one out of three female patients aged 18 and over. Our results confirmed what other authors have documented (Moracco et al., 2007) that a significant proportion of violence is directed at women, and that much of this violence occurs in the context of intimate relationships.
Acknowledgments
The authors thank all the physicians who voluntarily participated in this study, and also all the women who gave their time to complete the questionnaire and shared their violence experiences with us. Without them, this study would not have been possible. We gratefully acknowledge the research assistants who collaborated in this study, who all worked with immense dedication and commitment to ensure the successful completion of the study.
Isabel Montero, PhD in Medicine, Professor in Psychiatric Unit, University of Valencia. Expert on gender violence research, mental health and public health.
References (43)
- et al.
Intimate partner violence and women’s physical, mental, and social functioning
American Journal of Preventive Medicine
(2006) - et al.
Health care interventions for intimate partner violence: What women want?
Women’s Health Issues
(2005) - et al.
Intimate partner violence and women’s physical and mental health in the WHO multi-country study on women’s health and domestic violence: An observational study
Lancet
(2008) - et al.
A global overview of gender-based violence
Internal Journal of Gynaecology and Obstetrics
(2002) - et al.
Cumulative abuse experiences, physical health and health behaviours
Annals of Epidemiology
(2002) - et al.
Women experience with violence: A national study
Women’s Health Issues
(2007) - et al.
Differences in physical and mental health symptoms and mental health utilization associated with intimate partner violence versus childhood abuse
Psychosomatics
(2009) - et al.
Prevalence of violence and its implications for women’s health
Women’s Health Issues
(2001) - et al.
Healthcare Utilization and Costs for Women with a history of Intimate Partner Violence
American Journal of Preventive Medicine
(2007) - et al.
Geographical variability in violence against women in Spain
Gaceta Sanitaria
(2010)
Long-term costs of intimate partner violence in a sample of female HMO enrollees
Women’s Health Issues
Intimate partner violence prevalence, types, and chronicity in adult women
American Journal of Preventive Medicine
Utilisation of medical care by abused women
British Medical Journal
A single-item measure of social support as a predictor of morbidity
Journal of Family Practice
Health care utilization and cost associated with physical and non-physical-only intimate partner violence
Heal Care Research
Health consequences of intimate partner violence
Lancet
Violence against women as a public health issue
Annals of New York Academy of Sciences
Physical partner violence and Medicaid utilization and expenditures
Public Health Report
Somatic symptoms and diseases are more common in women exposed to violence
Journal of General Internal Medicine
Violence against women in New Zealand: Prevalence and health consequences
New Zealand Medical Journal
Intimate partner violence as a risk factor for mental disorders: A meta-analysis
Journal of Family Violence
Cited by (20)
Women's intimate partner violence versus community violence: Comparing injuries as presented in Iceland's largest emergency department
2022, International Emergency NursingCitation Excerpt :IPV abuse contributes to significantly higher mental-health service utilization compared to never-abused women [10], and women subjected to IPV are more likely to have suicidal ideation and suicidal behaviour [11], post-traumatic stress disorder (PTSD) and anxiety [12] than non-abused women. Abuse increases women’s health care utilization, such as primary and emergency care, speciality services and hospital admissions [13]. Findings show that the hospital admission ratio is approximately 3–5% amongst IPV patients [14,15], and a U.S. study revealed that around a third of all of women’s assault-related emergency visits were a consequence of IPV [16].
Primary health care attributes and responses to intimate partner violence in Spain
2017, Gaceta SanitariaCitation Excerpt :Men's intimate partner violence (IPV) against women, is a global public health problem and has devastating effects on the health and wellbeing of women and children.1–3 Health care services, and especially primary health care facilities, can play a key role in alleviating the effects of IPV, since they are the gatekeepers of the health system and therefore the public institutions most frequently accessed by women exposed to IPV, even if not all of them will disclose this situation.1,4–7 In this study IPV was defined as “any behaviour within an intimate relationship that causes physical, sexual or psychological harm, including acts of physical aggression, sexual coercion, psychological abuse and controlling behaviours”,3 and it was explicitly stated that the focus was on IPV exerted by men against women.
Health status and intimate partner violence
2014, Gaceta SanitariaFamily Violence Associated with Self-Rated Health, Satisfaction With Life, and Health Service Use in Primary Care Older Adults
2022, Journal of Interpersonal Violence
Isabel Montero, PhD in Medicine, Professor in Psychiatric Unit, University of Valencia. Expert on gender violence research, mental health and public health.
Isabel Ruiz-Perez, PhD in Medicine, Specialist in Preventive Medicine and Public Health and Master of Public Health, Professor of Research Methodology (IVESP and EASP), Andalusian School of Public Health. Currently, Director of Research at the EASP.
David Martín-Baena, Bachelor of Statistics, University of Valencia. CIBERESP technical researcher and professor in the School of Nursing La Fe, who are highly experienced in creating, debugging and operation (descriptive and multivariate analysis) of health databases.
Marta Talavera, PhD in Biology, Professor in the Department of Experimental and Social Sciences, School of Magistario, University of Valencia. His current research is violence against women, health and gender.
Vicenta Escribà-Agüir, PhD in Medicine, a researcher in the Department of Health Disparities in Centre for Public Health Research (CSISP) and professor in the School of Nursing La Fe. Great experience in gender research, women's health and violence.
Carmen Vives-Cases, PhD in Sociology. Professor in the Department of Preventive Medicine and Public Health, University of Alicante. Expert on gender violence research and public health.
Supported with funding from the Health Institute Carlos III (1/06-36, PI05/0676) (Ministry of Health, Spain).