No Differences in Health Outcomes After Routine Inquiry About Violence Victimization in Young Women: A Randomized Controlled Study in Swedish Youth Health Centers

Youth is a period in life when the risk of violence victimization is high and association between victimization and ill health is well established. Youth rarely reveal violence victimization to health professionals if not directly asked but favor health professionals asking about victimization. The study’s primary aim was to examine health outcomes in young women being routinely asked about violence victimization and offered subsequent support, compared with controls, at 12-month follow-up. Secondary aims were to examine to what extent routine inquiry altered the consultation and re-victimization rates during the study period. A randomized controlled intervention study was conducted at Swedish youth health centers. Participants assigned to the intervention group were asked structured questions about violence. Victimized participants received empowering strategies and were offered further counseling. Participants in the control group completed questionnaires about victimization after the visit. Both groups answered questions about sociodemographics and health, constructed from validated instruments. A questionnaire was administered to all participants 12 months after baseline. Of 1,445 eligible young women, 1,051 (73%) participated, with 54% of the participants completing the 12-month follow-up. Lifetime violence victimization was reported by 53% in the intervention group and 60% in the control group, ns. There were no significant differences in health outcomes, between baseline and 12-month follow-up, within either group or between groups. Re-victimization rates were 16% in the intervention group and 12% in the control group, ns. Of victimized young women in the intervention group, 14% wanted and received further counseling. Routine inquiry about violence victimization and empowering strategies were feasible within ordinary consultations at youth health centers but did not demonstrate improved health outcomes at 12-month follow-up compared with controls. Questions about violence led to a high degree of disclosure, and 14% of victimized young women in the intervention group received further counseling as a result.

Subjectively Evaluated Effects of Domestic Violence on Well-Being in Clinical Populations

Effects of domestic violence are reflected in victims' physical, psychological, and sexual health as well as in victims' subjective evaluations of health or subjective well-being. The principal aim of this study was to study the extent to which the consequences of domestic violence are reflected in patients' subjectively evaluated well-being, life management, and sense of security in an emergency department, a maternity department, and a reception unit of a psychiatric hospital. A questionnaire on the effects of domestic violence was administered to 530 patients. 61 patients reported either current or previous domestic violence that affected their current well-being and life management. Domestic violence was reported to have an effect on subjective well-being and sense of security: the more recent or frequent the experience of violence was, the greater was considered its impact on well-being and sense of security. Routine inquiry can uncover hidden cases of abuse and hence would be of great benefit in the healthcare context. Early identification of abuse victims can prevent further harm caused by violence.

Fathering Agency Staff Members’ Perspectives on Domestic Violence Perpetration

Purpose: To describe the perspectives of fathering staff regarding domestic violence (DV) perpetration. Materials and methods: A cross-sectional survey of 85 fathering staff members was conducted to identify behaviors and barriers regarding inquiry about DV perpetration. Results: Almost half (47.1%) of the surveyed staff reported never having identified DV perpetration. Routine inquiry was less likely if staff perceived low prevalence rates among their clients (odds ratio [OR] = 0.11, p = .001), did not have standard ways of asking (OR = 0.11, p < .001), or if they had never identified family violence before (OR = 0.07, p < .001). Increased years as a provider (OR = 6.62, p = .001) and DV training (OR = 7.29, p = .003) increased rates of DV perpetration inquiry. Conclusions: Staff of fathering agencies do not routinely screen for DV perpetration likely due to the interplay between individual and agency-level barriers. Appropriate training interventions can address identified barriers.

Directions in research on spiritual and religious issues for improving palliative care

Spiritual and religious issues are often important to people with serious illnesses. Spiritual beliefs and religious ceremonies may help patients near the end of life find meaning and comfort. Comprehensive palliative care ought to address patients' spiritual and religious needs and concerns as well as their physical distress. Puchalski et al. (2003) document the paucity of studies that collect empirical data on spiritual and religious issues in palliative care. They argue convincingly that more studies are essential in order to develop evidence-based standards for appropriate ways to address patients' spiritual and religious needs at the end of life. Such research would help us better understand how spiritual and religious concerns, beliefs, practices, and interventions might impact outcomes of end-of-life care. For instance, routine inquiry by physicians about patients' spiritual and religious concerns might lead to such outcomes as better relief of physical symptoms or improved quality of life. Puchalski et al. (2003) call for more empirical research on these important topics and also the development of better measures. For example, they point out the need for measurements of religiousness that account for more than a patient's denomination. They also found that very few of the available scales had undergone evaluation for internal consistency or test–retest reliability. Moreover, many existing instruments concerning spirituality are not validated for patients near the end of life.

Childhood Sexual and Physical Abuse and Adult Self-Harm and Suicidal Behaviour: A Literature Review

This article reviews the link between childhood sexual and/or physical abuse and adult self-harm, suicidal ideation, and suicidal attempt from 1988 to 1998 in the clinical literature. Despite the methodological and definitional concerns, empirical studies have generally demonstrated more reports of self-harm, suicidal ideation, and suicidal behaviour in clinical and community populations of adults who report sexual and/or physical abuse in childhood than in comparison groups who do not report abuse. Implications for practice include the identification of populations at risk for self-harm or suicide and routine inquiry of abuse histories on admission. Further research into universal definitions of the key terms, standardized measurements of the variables, and longitudinal studies is required.