When the Violence Comes Home - Pacific Standard

When the Violence Comes Home

Doctors consider how to respond to the domestic abuse of female veterans.
Author:
Publish date:
Social count:
0
Veterans Affairs medical center in Durham, North Carolina. (PHOTO: ILDAR SAGDEJEV/WIKIMEDIA COMMONS)

Veterans Affairs medical center in Durham, North Carolina. (PHOTO: ILDAR SAGDEJEV/WIKIMEDIA COMMONS)

A new study in the Journal of Family Violencestarts off with a strong, hard truth: “Female Veterans experience intimate partner violence (IPV) at alarming rates.” Women in military service, the authors say, are not only at risk of sexual assault while they are serving; they are also at a much greater risk of domestic violence at home than non-vets. The authors, led by Katherine M. Iverson at the National Center for Post Traumatic Stress Disorder, say that the Veterans Health Administration (VHA) needs to be much better equipped to detect and treat this persistent and troubling phenomenon than they are now.

Fifteen percent of active military personnel and 10 percent of veterans are now women, according to this study. But still, VHA doctors and nurses aren’t nearly as experienced in treating the physical and psychological problems particular to female veterans as they are with those of men.

The participants of this study’s survey, who were all primary care doctors and nurse practitioners in VHA facilities, agreed that they needed more training about specifically female needs. They also thought they could benefit from team-based approaches (for instance, doctors and social workers working together), rather than having each doctor tackle each individual case alone.

"I think it’s one of those subjects that if you don’t screen for it and start the conversation with the person, then you don’t detect and you don’t treat [it]."

Another problem seems to be a general lack of awareness of how big of a problem IPV really is, and “a perceived lack of time” during routine checkups. VHA doctors and nurses are already so busy screening for other issues that they know to be common to female veterans—substance abuse, depression, PTSD, and sexual trauma, for instance—that they may not think to screen for this one.

“It’s just really not on my radar,” said one doctor interviewed for the study. “It is so overshadowed by other mental health issues and substance abuse issues that, relative to those topics, IPV isn’t really up there.”

But the particular problem of intimate partner violence has to get on their radar, and soon, the authors said, because many female patients won’t bring it up if they aren’t asked. And routine yearly exams may be the only time these patients come in, too. It makes much more sense for the patients’ regular, familiar doctor to directly ask about it than to expect the patients to “spontaneously disclose” it, the authors argue.

“I think it’s one of those subjects that if you don’t screen for it and start the conversation with the person, then you don’t detect and you don’t treat [it],” said another health care provider the authors interviewed. “The downstream social consequences and medical complications are huge, so I think [IPV screening] has a lot of value.”

That’s where more education has to come in; doctors and nurses haven’t necessarily been trained about what to ask and how to say it, either. That lack of comfort, combined with the lack of time for each appointment, are why some health care providers say they avoid the topic altogether.

This study is admittedly small and focused, and it doesn’t take on the larger, and more difficult, question of why female veterans might be experiencing IPV more often than non-vets. According to the National Center for PTSD website, “among women Veterans, 39 percent report having experienced IPV at some point in their lives,” whereas the rate for American women overall is a lower rate, estimated to be somewhere between 22 and 31 percent.” Why the disparity? Research that investigated the source of the problem would be just as imperative as this discussion of the ways to treat it.

Related