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 adul ts. We used the Index of Spouse Abuse (ISA), a previously validated su rvey tool. The study was set in an inner-city ED with approximately 75 ,000 patients annually, most of them indigent. Patients 18 years or ol der who were able to give consent were included. Patients were exclude d if they had a language barrier, were a prisoner, or had never had a partner. All patients presenting during 31 randomly selected 4-hour sh ifts during July 1995 were considered for the study. DV was defined as either physical or nonphysical on the basis of ISA scoring. The preva lence was determined for present (in the preceding year) and past (mor e than 1 year ago) abuse. Four violence parameters were calculated for patients who had a partner at the time of presentation: present physi cal, present nonphysical, past physical, and past nonphysical. Only th e ''past'' parameters were calculated for patients who had had a partn er in the past but had no partner at the time of presentation. We used the chi(2) test to determine individually significant predictors of t he four parameters. Logistic-regression models were constructed to det ermine the significant predictors of DV. Associations among the presen t physical, present nonphysical, past physical, and past nonphysical a buse categories were determined with McNemar's test. Results: We enrol led 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 experie nced 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 rep orted present nonphysical violence (P=.20), and 20% men and 19% of wom en reported present physical violence (P=.71). Using logistic-regressi on models, we determined that women experienced significantly more pas t and present nonphysical violence but not physical violence than men. For all four parameters, the victim's suicidal ideation and alcohol u se were independently associated with DV. The victim's family history was strongly associated with past abuse. Using McNemar's test, we foun d that physical and nonphysical abuse were correlated in the past and present. Conclusion: Using a validated scale, we found that the preval ences of physical DV for men and women are high and that they are not statistically different in this population. Using chi(2) testing, we f ound that women had experienced significantly more past nonphysical vi olence than men; using logistic regression we found that they experien ced significantly more nonphysical Violence (both past and present) th an men. DV was frequently associated with suicidal ideation, alcohol u se, and family history of violence.