Counterintuitive Findings for Domestic Violence During COVID-19

Batya Swift Yasgur, MA, LSW

September 15, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Intimate partner violence (IPV) has not increased during the COVD-19 pandemic, at least during the early stages of the pandemic, new research suggests.

In April 2020, investigators surveyed over 1750 individuals in intimate partner relationships. The survey was drawn from social media and e-mail distribution lists. The researchers found that of the roughly one fifth who screened positive for IPV, half stated that the degree of victimization had remained the same since the COVID-19 outbreak; 17% reported that it had worsened; and one third reported that it had gotten better.

Those who reported worsening victimization said that sexual and physical violence, in particular, were exacerbated early in the pandemic's course.

"I was surprised by this finding, and we certainly were not expecting it — in fact, I expected that the vast majority of victims would report that victimization got worse during stay-at-home policies, but that wasn't the case," lead author Katelyn Jetelina, PhD, MPH, assistant professor, Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center, School of Public Health, Dallas, Texas, told Medscape Medical News.

"I think the biggest take-home message is that some victims got better, but the vast majority stayed the same. These victims, men and women, were isolated with their perpetrator during COVID-19, so we need to be creative in how to reach isolated victims during events like the pandemic," she added.

The study was published online September 1 in Injury Prevention.

"Shadow Pandemic?"

The World Health Organization called upon healthcare organizations to be prepared to curb a potential IPV "shadow pandemic" during the COVID-19 pandemic.

However, no study has specifically evaluated whether self-reported victimization, particularly with regard to the severity and type of abuse, changed during the early period after COVID-19 social distancing polices were mandated.

"We scrambled right away when the pandemic hit because it was a unique opportunity to examine how behaviors change due to early stay-at-home policies; and, as a violence and injury epidemiologist, I am always curious about IPV, and this was a small subanalysis of that larger question," Jetelina said.

The researchers recruited participants through their university and private social media accounts as well as professional distribution lists. Of those who completed the survey, 1759 (mean age, 42 years [SD, 13 years]) reported that they currently had an intimate partner. These participants were included in the study.

IPV was determined using the five-item Extended Hurt, Insulted, Threatened and Scream (E-HITS) construct. Respondents were asked how often their partner physically hurt them, insulted them, threatened them with harm, screamed or cursed at them, or forced them to engage in sexual activities.

Each item was answered using a 5-point Likert scale. Scores ranged from 1, indicating never, to 5, indicating frequently. Participants who scored ≥7 were considered IPV-positive.

Participants were also asked whether IPV severity had gotten much/somewhat better, had remained the same, or had gotten somewhat/much worse.

First Peek

Of the total sample, 18% screened positive for IPV. Of these, 54% reported that the victimization had remained the same, 17% reported that it had worsened, and 30% said it had improved.

The majority of IPV victims experienced being insulted (97%) or being screamed at (86%).

Among those who reported worsening of IPV, the risk for physical violence was 4.38 times higher than the risk for nonphysical victimization. The risk for sexual victimization was 2.31 times higher than the risk for nonsexual victimization.

Among those who reported that IPV had gotten better, the improvement was 3.47 times higher with regard to physical victimization compared to nonphysical victimization. Jetelina acknowledged that the findings cannot be generalized to the broader population.

"This was a convenience sample, but it is the first peek into what is happening behind closed doors and a first step to hearing collecting data from the victims themselves to better understand this 'shadow pandemic' and inform creative efforts to create better services for them while they are in isolation," she said.

Lethality Indicators

Commenting on the study for Medscape Medical News, Peter Cronholm, MD, MD, MSCE, associate professor of family medicine and community health at the Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, questioned the use of a score of 7 on the E-HITS screen to determine the presence of IPV.

"I think there are other thresholds that might be important, and even low levels of sexual violence may be different than higher levels of emotional violence," said Cronholm, who was not involved with the study.

"Someone may have been sexually assaulted frequently but not cross the threshold, so I think it would have been helpful for the researchers to look at different types of violence," he said.

Also commenting on the study for Medscape Medical News, Jessica Palardy, LSW, program supervisor at STOP Intimate Partner Violence, Philadelphia, Pennsylvania, said, the findings "solidify a trend we sensed was happening but couldn't confirm."

She said her agency's clients "have had a wide variety of experiences, in terms of increases or decreases in victimization."

Some clients were able to use the quarantine as an excuse to stay with family or friends and so could avoid seeing their partners. "Others indicated that because their partners were distracted by figuring out a new method of work, the tension shifted away from the victim," said Palardy, who was not involved in the research.

"For those who saw an increase in victimization, we noticed that this increase also came with an increase in lethality indicators, such as strangulation, physical violence, use of weapons and substances, etc," she said.

She emphasized that it is critical to screen people for IPV to ensure their safety.

"The goal is to connect people with resources before they are in a more lethal situation so that they can increase their safety and know their options," Palardy said.

The National Domestic Violence Hotline and the Crisis Text Line are two sources of support for IPV victims.

Jetelina and coauthors, Cronholm, and Palardy report no relevant financial relationships.

Inj Prev. Published online September 1, 2020. Full text

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