Women Veterans Screening Positive for Intimate Partner Violence More Likely to Receive Mental Illness Diagnosis
BACKGROUND:
Intimate partner violence (IPV) has a particularly strong association with mental health symptoms, and women Veterans are at particularly high risk for both IPV and mental health morbidity. For example, a recent study showed that nearly 1 in 5 women Veterans receiving VA primary care reported past-year IPV. This cross-sectional study is the first large-scale investigation into the associations between IPV and mental health using IPV clinical screening and mental health diagnosis data from VA medical records. Study investigators identified all female VA patients (both Veterans and dependents) with a documented IPV screen between April 8, 2014 (earliest recorded screen date) and April 2016, which included 8,888 women who received care from 13 VAMCs. Investigators also assessed patient demographics and military service characteristics, in addition to mental health diagnoses.
FINDINGS:
- Female VA patients who screened positive for past-year IPV were more than twice as likely to have a mental health diagnosis – or more than two mental health diagnoses – compared to those who screened negative. More than half (54%) of the women who screened positive for IPV had a mental health diagnosis, compared with less than one-third (33%) of those who screened negative for IPV.
- Each category of IPV exposure (psychological, physical, and sexual violence) was significantly associated with having a mental health diagnosis or comorbidity. Associations remained after adjusting for military sexual trauma and combat trauma.
IMPLICATIONS:
- Mental health providers should be trained and prepared to assess and comprehensively respond to patients' experiences of intimate partner violence.
- IPV assessment and response needs to address all forms of IPV, including psychological violence in the absence of physical or sexual violence, and the particularly strong associations between mental health and experiences of sexual intimate partner violence.
LIMITATIONS:
- Diagnoses were based on medical record documentation and, thus, excluded mental health conditions not documented within VA records. Also, the IPV measure was extracted from clinical screening data and given known barriers to patient disclosure of IPV to healthcare providers, the IPV+ group examined in this study is likely an underestimate of the true number of women VA patients who have experienced IPV.
- The cross-sectional nature of this study prohibits conclusions about the causal influence of IPV on mental health. It is also possible that mental health symptoms contribute to increased risk for IPV.
AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (IIR 15-142). Drs. Dichter and Sorrentino are part of HSR&D's Center for Health Equity Research & Promotion (CHERP), Philadelphia, PA, and the National Center for PTSD in Boston, MA.
Dichter M, Sorrentino A, Bellamy S, et al. Disproportionate Mental Health Burden associated with Past-Year Intimate Partner Violence among Women Receiving Care in the Veterans Health Administration. Journal of Traumatic Stress. December 2017;30(6):555-63.
