Domestic violence: Prevalence among women in a primary care center - A pilot study

Background: Domestic violence is a prevalent problem with serious consequences, including the risk of death. The lifetime prevalence ranges from 21 to 34%, with 8-14% of them reporting abuse in the previous year. The incidence seen in primary care practice is about 8%. Despite this high rate, domestic violence is under-diagnosed in primary care. Objectives: To estimate the prevalence of domestic violence among women visiting a primary care center, to characterize them and to evaluate a screening tool. Methods: A brief anonymous questionnaire (in Hebrew and Russian) for self-completion was used as a screening tool. During October 1998 we distributed the questionnaires in a primary care clinic in Beer Sheva to all women aged 18-60 years whose health permitted their participation. A woman was considered at high risk for domestic violence when she gave a positive answer to at least on of the three questions related to violence. The risk factors for domestic violence were calculated by odds ratio with 95% confidence intervals. Results: The response rate was 95.7%. We found 41 women (30.8%) at high risk for violence. Women preferred talking about this issue with their family physician. Women at highest risk were older than 40 years, had emigrated from the former Soviet Union during the last 10 years, were living alone, and were unemployed. None of the women visited the Domestic Violence Center during the study period and 2 months thereafter. Only three women tore off the Center's address and phone number attached to the questionnaire. Conclusions: The anonymous questionnaire was well accepted and had a high compliance rats. Its disadvantages are that respondents must be literate and that it permits the woman to continue with her "secret-keeping" behavior. A high prevalence of domestic violence among women visiting a primary care clinic should convince family physicians to be more active in diagnosing the problem accurately among their patients, providing treatment and preventing further deterioration and possible danger. Further effort should be directed at improving the clinic staff's ability to detect domestic violence among patients, and at developing management programs in the health system to help combat domestic violence.