Domestic violence in an inner-city ED.

STUDY OBJECTIVE: To determine the prevalence of domestic violence (DV) for male and female ED patients and to determine the demographics of DV.

METHODS: The study design was a descriptive written survey of adults. We used the Index of Spouse Abuse (ISA), a previously validated survey tool. The study was set in an inner-city ED with approximately 75,000 patients annually, most of them indigent. Patients 18 years or older who were able to give consent were included. Patients were excluded if they had a language barrier, were a prisoner, or had never had a partner. All patients presenting during 31 randomly selected 4-hour shifts during July 1995 were considered for the study. DV was defined as either physical or nonphysical on the basis of ISA scoring. The prevalence was determined for present (in the preceding year) and past (more than 1 year ago) abuse. Four violence parameters were calculated for patients who had a partner at the time of presentation: present physical, present nonphysical, past physical, and past nonphysical. Only the "past" parameters were calculated for patients who had had a partner in the past but had no partner at the time of presentation. We used the chi2 test to determine individually significant predictors of the four parameters. Logistic-regression models were constructed to determine the significant predictors of DV. Associations among the present physical, present nonphysical, past physical, and past nonphysical abuse categories were determined with McNemar's test.

RESULTS: We enrolled 516 patients, 233 men and 283 women. On the basis of ISA scoring, 14% of men and 22% of women had experienced past nonphysical violence (P=.02, men versus women), and 28% of men and 33% of women had experienced past physical violence (P=.35). Of the 157 men and 207 women with partners at the time of presentation, 11% of men and 15% of women reported present nonphysical violence (P=.20), and 20% men and 19% of women reported present physical violence (P=.71). Using logistic-regression models, we determined that women experienced significantly more past and present nonphysical violence but not physical violence than men. For all four parameters, the victim's suicidal ideation and alcohol use were independently associated with DV. The victim's family history was strongly associated with past abuse. Using McNemar's test, we found that physical and nonphysical abuse were correlated in the past and present.

CONCLUSION: Using a validated scale, we found that the prevalences of physical DV for men and women are high and that they are not statistically different in this population. Using chi 2 testing, we found that women had experienced significantly more past nonphysical violence than men; using logistic regression we found that they experienced significantly more nonphysical violence (both past and present) than men. DV was frequently associated with suicidal ideation, alcohol use, and family history of violence.