May 16, 2006 -- Abused women are more likely than other women to report poorer health and depression, and the longer theyve been abused, the worse their health tends to be.

Those findings come from a survey of 3,429 English-speaking women aged 18-64 enrolled in a large health maintenance organization (HMO) in the Pacific Northwest.

More than four in 10 women -- 44% -- reported suffering some form of violence by at least one current or past intimate partner. Nearly 8% of the women reported suffering such violence in the past year.

Intimate partner violence was more common among younger women, women with low incomes and less education, single mothers, and those who had been abused as a child.

The results are due to appear in the American Journal of Preventive Medicine in June.

About the Survey

The surveys, conducted by telephone, included a random sample of women who had been members of the HMO -- called Group Health Cooperative -- for at least three years.

Topics included physical, sexual, or psychological violence by the womens current or past intimate partners of either sex, including spouses, nonmarital partners, or dates. The women also took depression surveys, talked about their community involvement, and rated their own health.

For safetys sake, the interviewers advised the women to say, I dont want vinyl siding and hang up if they felt afraid of being overheard while answering the questions.

Researchers from the Group Health Cooperatives Center for Health Studies -- including Robert Thompson, MD, and Amy Bonomi, PhD, MPH -- summed up the data in two reports.

Questions About Abuse

Here are some of the surveys questions that tracked abuse by intimate partners:

• Physical abuse: Has an intimate partner ever hit, slapped, shoved, choked, kicked, shaken, or otherwise physically hurt you?
• Sexual abuse: Has an intimate partner ever forced you to participate in a sex act (e.g., oral, vaginal, or anal penetration) against your will? Ever threatened, coerced, or physically forced you into any sexual contact that did not result in intercourse or penetration?
• Nonphysical abuse: Have you ever been frightened for your safety, or that of your family or friends, because of anger or threats of an intimate partner? Has an intimate partner ever put you down, or called you names repeatedly, or controlled your behavior?

Participants also rated how strongly they agreed or disagreed with statements including:

• I tried not to rock the boat because I was afraid of what my partner might do.
• My partner made me feel unsafe even in my own house.
• I felt ashamed of the things my partner did to me.
• I hid the truth from others because I was afraid not to.
• My partner could scare me without laying a hand on me.
• I felt owned and controlled by my partner.

Profile of Abused Women

Thompsons report gives an overview of the women. Among the findings:

• Between 11% and 21% reported abuse by more than one partner in their lifetime.
• 45% report having experienced more than one type of abuse by an intimate partner.
• Nearly 15% report suffering any type of violence by an intimate partner in the past five years.

Bonomis paper focuses on the health of abused women. It shows that compared to women who reported no history of violence by an intimate partner, women who reported experiencing physical and/or sexual violence by an intimate partner in the past five years were:

• More than four times as likely to have severe depressive symptoms
• More than twice as likely to have any depression symptoms
• Nearly three times as likely to report being in fair or poor health

Women who reported any type of abuse by an intimate partner more than five years ago were also more likely to report severe and minor depression, less community involvement, and a higher number of physical symptoms.

Talking About It

The researchers call for doctors to find ways of broaching the topic in an appropriate way with patients.

Thompson and colleagues write that the risk of not asking about a major underlying condition that affects nearly half of womens lives are far greater than the risk of asking. We ask the reader to consider, if there were a major risk factor for coronary heart disease that affected approximately 50% of the adult population, would you not want to know about it? As a clinician, of course you would!

Preventive strategies that consider the influence of the family, community, and sociocultural environment in which the women are situated are also needed, Bonomis team writes.

Because the study only included women with health insurance in a particular part of the country, its not clear if the results apply to other groups of women. Its also possible that some of the surveys werent perfectly accurate; the researchers didnt check the womens medical records.

Of course, men may also experience violence by an intimate partner. However, the survey only included women.

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SOURCES: Thompson, R. American Journal of Preventive Medicine, June 2006. Bonomi, A. American Journal of Preventive Medicine, June 2006. News release, Agency for Healthcare Research and Quality, Department of Health and Human Services.