The prevalence of Intimate Partner Violence at a Dutch emergency department

Intimate Partner Violence (IPV) is a big public health problem in our society
with high costs and negative consequences for the health. IPV is defined as
*violence caused by a partner in an intimate relationship and consists of
physical, mental and/or sexual abuse*. It is often poorly recognized by
doctors. A Dutch study revealed that 30% of the women attending their general
practitioner in Rotterdam ever experienced IPV. Migrants experienced IPV 1.5
times more often compared to native women. A study among women attending the
out-patient clinic obstretrics-gynaecology of the University Nijmegen Medical
Centre revealed that 23% ever experienced IPV. Studies abroad have proven that
the prevalence of Intimate Partner Violence at emergency departments (EDs) is
high (in the past 12 months: 7 - 21%, lifetime prevalence: 38 - 44%). However,
there is little known about the prevalence of IPV at Dutch ED*s. In an
unpublished study of 2011, over 15% of the patients attending the ED of the
Erasmus Medical Centre Rotterdam indicated having experienced violence in the
last 24 hours or the past twelve months before the ED visit. Men as often as
women indicated both being victimized the last 24 hours as in the last 12
months preceding the ED visit.

We expect to determine the prevalence of IPV at the ED of University Nijmegen
Medical Centre and to find specific characteristics of victims of IPV, like the
complaints they present themselves with and their educational and geographic
background and number of ED-visits last year. It*s important to know the
magnitude of IPV to raise awareness in doctors en nurses, so that they will
better recognize the presence of IPV and offer help.

Study design
A survey study is our choice of study design. A survey study fits our goal,
which is determining the prevalence of IPV among women attending a Dutch ED.

Variables and measurement instruments
The main variable we will measure is the dichotomous variable *having
experienced IPV*. We will obtain this data by using the Composite Abuse Scale
(CAS). The Composite Abuse Scale (CAS) is a widely used self report of
behaviours that women describe as abusive by their partners. It has recently
been published in the Centers for Disease Control and Prevention compendium of
intimate partner violence measures. It is an easily administered self- report
measure that provides standardized sub scale scores on four dimensions of
intimate partner abuse. It consists of 30 items presented in a six point format
requiring respondents to answer *never*, *only once*, *several times*,
*monthly*, *weekly* or *daily* in a twelve month period. The strength of the
scale is the ability to measure different types and severity of abuse, although
a limitation is the reduced number of sexual abuse items.

Other variables that we will include in our questionnaire are age, marital
status, children, living with a partner, education, country of origin, reason
for visiting the ED and numbers of visits to the ED. We also will ask whether,
when there has been violence, this took place in the past year of 24 hours. The
obtained data will be analyzed with SPSS 16.

Research population
The goal of our study is to determine the proportion of female patients that
attend the ED of the UMC St Radboud, that have experienced IPV in their
lifetime or at present*.
. We want to include as many patients as possible. We estimate a number of 300
is reachable and had sufficient power to draw statistic significant
conclusions. We will recruit these patients from the waiting room of the ED of
University Nijmegen Medical Centre, the Netherlands, during a period of 6
weeks. The target population consists of all women attending the ED, older than
18 years of age and ever had a relationship. Sufficient mastery of the Dutch,
English, Turkish or Arabic language is requisite. Exclusion criteria are:
presentation with reduced consciousness (Glasgow Coma Scale < 14) and patients
who visit the ED in presence of their partner (for safety). Patients referred
by their general practitioner to specific medical specialists will not be
included, for example a patient with myocardial infarction that is seen by a
cardiologist.

* NB The moment of the day/week in which the student-researcher should be
present at the ED is jet to determine.
Registration and security of data
The study will be presented as a survey on relationships and health The
receptionist will hand out an information letter to all female patients.
Subsequently, a patient is taken to a consulting room. Here, the
student-researcher will verify whether the patient meets the inclusion
criteria. Patients will be asked to cooperate, read extra information about the
survey and fill out the informed-consent form. Than the patients are asked to
fill in the questionnaire.Patients will be asked to fill out the questionnaire
in private to stimulate truthful answering and to improve the reliability of
the study. The questionnaire is anonymous and will be put in a box instantly
after completing it to guarantee anonymity. A student-researcher will be
present in the room when patients will be filling out the forms to clarify
ambiguities, to guarantee privacy and to stimulate patients to fill out the
forms as complete as possible. The patient is given the possibility to ask the
student-researcher to leave for 5-10 minutes. The student will stay close to
the room in case of any questions.
The questionnaire will contain:
a. set of demographic characteristics (age, marital status, having children,
education of patient/partner and country of origin)
b. CASquestions about reason for encounter and number of ED-visits last year

We expect that most women can fill in the questionnaire without any problems.
Some women might experience psychological distress because of answering the
CAS. At different points during answering the questions and reading the
information, women are offered to discuss possible difficulties with their
doctor or call the Domestic Violence Support Line. Women who come to the ED
accompanied by their partners are excluded from participation, because of
safety reasons.
For women, it can be difficult to face a questionnaire about intimate partner
violence since it is a subject which is not so easily discussed in our society.
But it's not an option not to do research in this field. Without research into
this target group we will not know enough about prevalence, demographic
characteristics and ED-visits. All these topics are important in raising
awareness amongst ED-personell, so that they notice the presence of IPV,
discuss it and offer help.