Experience of intimate partner violence among women and men attending general practices in Dublin, Ireland: A cross-sectional survey

Abstract

This cross-sectional study examined women's and men's reported experience of intimate partner violence in general practice in the greater Dublin region. A high prevalence of reported experience of controlling behaviour and violent incidents was found. Although the reported prevalence of both was higher in men, women were more likely to have reported fear of a partner and a severe level of violence.

Conclusion: The findings demonstrate that intimate partner violence is a major problem among the men and women surveyed.

• General practice
• intimate partner violence
• men
• women

Introduction

Behaviour within an intimate relationship resulting in physical, psychological or sexual harm to those in the relationship is known as intimate partner violence [1]. Although both women and men are affected by intimate partner violence, previous studies have reported that the context and consequence of violence are more severe for female victims [2], [3]. A recent cross-sectional survey reported that over one third of women attending general practice had experienced physical violence perpetrated by a partner [4]. We used the methodology of Bradley et al. [4] to examine, for the first time, the experience of intimate partner violence amongst women and men attending general practices.

Methods

The survey was conducted over 3–5 consecutive days at six general practices during April 2003 and May 2003. The practices were selected to represent both affluent and deprived areas, male and female general practitioners, and single-handed or group practices. Women and men between ages 18 and 65 attending the practices were invited to participate. Potential participants were excluded if they were too ill or if they attended with their partner and/or sick children. Participants completed an anonymous questionnaire [4] that included a measure of violence encompassing three dimensions of abuse: controlling behaviour, violent incidents and related injuries (Appendix). Scores were calculated from the responses to produce the controlling behaviour and violent incident indices, which indicated the level of controlling behaviour or violent incidents experienced [4]. The Hospital Anxiety and Depression Score (HADS) was also incorporated in the questionnaire [5].

A sample size of 320 patients was calculated to give an 80% power to detect a 50% difference in the proportion of men reporting experiencing a violent incident compared with women. This calculation takes clustering into account, and is based on 54 patients being recruited from six practices and an intracluster correlation coefficient of 0.015 (calculated from data provided by Bradley et al. [4]). Due to time constraints, the maximum time limit for data collection was 10 appointment sessions (approximately 5 days) per general practice.

Results

Descriptive statistics were used to summarize the distributions of individual variables. The Pearson χ² test was used to compare proportions and evaluate possible associations in independent groups of categorical data. In total, 329 adults (180 women and 149 men) from six general practices were invited to participate in the survey. Fewer men were eligible for inclusion in the study during the maximum time limit for data collection. In each practice, on a maximum of three occasions, it was not feasible or ethical to invite consecutive clients to participate in the study as the surgery was too busy and so privacy could not be ensured.

The total response rate was 76%. One hundred and forty-one (79%) women and 108 (72%) men responded by completing the questionnaire. Ten men and two women did not complete the questionnaire fully and therefore were excluded from the analysis. The majority of participants were under 40 years of age, had been in an intimate relationship, lived with a partner and had children (Table I).

Table I.  Personal characteristics of the participants.

Variable	Total sample (n = 237) n %	Women (n=139) n %	Men (n=98) n %
Age group
18–39 yrs	170 (72)	102 (73)	68 (69)
40–65 yrs	59 (24)	35 (25)	24 (25)
Missing	8 (4)	2 (2)	6 (6)
Ever in an intimate relationship
Yes	235 (99)	138 (99)	97 (99)
No	1 (0.5)	1 (1)	0 (0)
Missing	1 (0.5)	0 (0)	1 (1)
Children
Yes	158 (67)	102 (74)	56 (57)
No	76 (32)	37 (26)	39 (40)
Missing	3 (1)	0 (0)	3 (3)
Living with
Partner	131 (55)	80 (58)	52 (52)
Alone	38 (16)	17 (12)	21 (22)
Parents	31 (13)	15 (11)	16 (16)
Children	15 (6)	14 (10)	1 (1)
Other	20 (9)	12 (8)	8 (8)
Missing	2 (1)	1 (1)	1 (1)

Sixty women (43%) and 52 (54%) men reported ever experiencing one or more violent incidents. Of those that experienced violence, a significantly higher proportion of women had high violent incident index scores than men. In this context, women sustained more injuries than men, but this was not statistically significant (Table II).

Table II.  Comparison of the experience of violent incidents and controlling behaviour among men and women attending general practice using bivariate analysis.

	Women		Men
	n (%)	95% CI	n (%)	95% CI	p value^a
Experienced ≥one violent incident	60/136 (43)	35–52	52/96 (54)	44–64	0.13
High violent incident index score^b (of respondents that experienced violence)	15/60 (25)	15–38	5/52 (10)	3–21	0.03
Injured as a result of violence (of respondents that experienced violence)	27/59 (46)	33–59	20/51 (39)	26–54	0.49
Experienced ≥one controlling behaviour	105/136 (77)	69–84	89/96 (93)	86–97	0.002
High controlling behaviour index score ^b (of respondents that experienced controlling behaviour)	11/105 (11)	5–18	10/89 (11)	6–20	0.23
Sometimes/often afraid of a partner	35/135 (26)	19–34	13/96 (14)	7–22	0.016

Denominators differ due to missing data.

^aFrom Pearson χ² test of association.

^bTo examine the spectrum of intimate partner violence, scales of severity were constructed for two aspects: “violent incidents” (18 questions) and “controlling behaviour” (seven questions). Questions relating to children were excluded from the index scores. For each question, never having experienced violence or a given controlling behaviour was scored zero. Having experienced either rarely, sometimes or often was scored 1, 2 or 3, respectively. The violent incident scale thus has a minimum score of zero and a maximum score of 54, while the controlling behaviour score ranged from zero to 21. For controlling behaviour, a score of 15 or more was classified as high, and for violent incident a score of 21 or more was classified as high.

A significantly higher proportion of men than women reported ever experiencing one or more controlling behaviours. Equal proportions of women and men had high controlling behaviour index scores. Thirty-five women (26%) and 13 men (14%) reported “often” or “sometimes” feeling afraid of a partner (Table II).

According to the HADS, 11 women (8%) and nine men (9%) were classified as depressed. Thirty-eight women (28%) women and 24 men (25%) were classified as anxious. Both women and men who sustained one or more injuries as a result of intimate partner violence were significantly more likely to be depressed and anxious than those without that experience.

One hundred and nine women (82%) and 66 men (70%) said that it would be acceptable for their general practitioner to ask about abuse and violence in their relationships (p=0.05).

Discussion

Men as well as women attending general practice experience intimate partner violence, though patterns differ. A higher proportion of men than women attending the general practices reported experiencing controlling behaviour, though women were more likely to have a high violent incident index score and to report fear of a partner. This corresponds with previous findings that male- and female-perpetrated violence within intimate relationships differs in both meaning and consequence [2]. An association between women experiencing violence and depression is well documented [4], [6]. This study has revealed such an association in men experiencing intimate partner violence.

The proportion of women experiencing violence was consistent with previous findings [4]. The majority of men and women said that it would be acceptable to be asked about intimate partner violence during a consultation. According to Bradley and colleagues [4], “the purpose of such questioning is to destigmatise the issue by naming and accepting it”.

Unfortunately, the sample size in this study did not allow for detailed subgroup analysis. However, given the main finding that there are high levels of intimate partner violence among attendees at general practice, next steps would include exploring the extent of mutual intimate partner violence, triggers for such violence, differences between how women and men perceive such violence, and the consequences of this for individual and family life. It would also be appropriate to explore and test interventions to reduce the incidence and limit the effects of intimate partner violence, and inappropriate to continue to address this issue as solely a women's problem.

We thank the late Dr Fiona Bradley for inspiring us to design and conduct this study. We thank the participants who took time to fill in the study questionnaire and the general practices that facilitated us, especially the reception staff. Thank you to Alan Kelly of the Department of Community Health and General Practice, TCD, for statistical advice.

JL and SS tendered for funding. GP, SS and JL developed the protocol. GP did the fieldwork. GP, SS and JL contributed to the analysis plan. GP carried out the analysis with SS. GP drafted the paper with contributions from SS and JL. GP is guarantor for the paper.

The Irish College of General Practitioners Manne Berber Research Fellowship funded the study.

There are no competing interests to declare.

Ethical approval for the study was obtained from the Ethics Committee attached to the Department of Public Health and Primary Care, University of Dublin.

Appendix

Controlling behaviour Participants were asked whether a partner has ever done any of the following:

• Threatened you

• Shouted, screamed or swore at you

• Checked your movements

• Restricted your social life

• Kept you short of money

• Criticized you

• Put you down in front of others

• Shouted at or threatened the kids (in ways that might hurt them)

Violent incidents Participants were asked whether a partner has ever done any of the following:

• Stopped you from moving or leaving the room

• Choked you or held a hand over your mouth

• Punched you in the face

• Forced you to do something against your will

• Slapped you on the body, arms or legs

• Pushed, grabbed or shoved you

• Punched/kicked you on body, arms or legs

• Used an object to hurt you

• Threw things at you or about the room

• Punched or kicked walls or furniture

• Demanded sex when you didn't want it

• Shouted or threatened the kids

• Hit or hurt the kids

• Forced you to have sex

• Tried to strangle, burn or drown you

• Threatened you with an object or weapon

• Kicked you in the face

• Threatened to kill you

• Twisted your arm or pulled you by the hair

• Threatened you with a fist, hand or foot

Violent injuries Participants were asked if they had ever had any of the following injuries as a result of intimate partner violence:

• Cuts, bruises or marks anywhere on your face

• Cuts anywhere on your body

• Bruises anywhere on your body

• Burns anywhere on your body

• Broken arm, leg or ribs

• Miscarriage

• Blackout or unconsciousness

• Black eye

• Internal injury

• Lost or broken teeth or split lip

• Sickness or vomiting

• Sprained wrist or ankle

• Broken nose, jaw or cheekbone

• Bleeding on face, body, arms or legs

• Burst eardrum or deafness