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Domestic abuse not just a big city problem
SCIENCE AND MEDICINE
NEWS
Domestic abuse not just a big city problem ccording to a new study, one in three US women surveyed in community-hospital emergency departments have been abused by a partner at some time in their lives. 3455 women, aged 18 years or older, visiting the emergency departments of 11 medium-sized hospitals—three in urban areas, four in suburban areas, and four in rural areas—in California and Pennsylvania completed a 16question survey about their experience of domestic abuse. The women
A
were asked whether they were currently in an abusive relationship; whether they had been physically, sexually and/or emotionally abused by a “husband, boyfriend, or partner” in the past year; or whether they had been so abused at any time in their life (JAMA 1998; 280: 433–38). 2·2% of the women reported they had come to the emergency department because they had been hurt by their partner; 14·4% reported that they had been physically or sexually abused in the past year; and 36·9%
Mistreatment linked to higher death rate in the elderly Old people who have been mistreated are three times more likely to die than are those who have not been mistreated, reports a US study. Researchers followed 2812 men and women participating in a long-term research project on ageing. All were more than 65 years old at the start of the study in 1982. During the next 9 years, 176 were found by investigators from elderly protective services to have been either: abused (10); neglected (30); exploited (8); or unable to care for themselves and so showed signs of self neglect (128). 13 years after the start of the study, only 9% of those who had been mistreated were still alive. By contrast, 17% of those who were unable to care for themselves were alive, and among those who had never been investigated by elderly protective services, 40% had survived (JAMA 1998; 280: 428–32).
reported they had been physically or sexually abused in their lifetime. The researchers identified four risk factors for reported physical or sexual abuse, or acute trauma from abuse: age, 18 to 39 years (odds ratio [OR] 2·2; 95% CI 1·7–3·0); monthly income less than US$1000 (OR 1·7; 95% CI 1·3–2·1); children younger than 18 years old living in the home (OR 2·0; 95% CI 1·5–2·6); and ending a relationship within the past year (OR 7·0; 95% CI 5·5–8·9). Partner abuse, write Stephen Dearwater (Allegheny University of the Health Sciences, Pittsburgh, PA, USA) and colleagues, is a common problem in community hospitals and not just a problem “limited to large, urban, or tertiary care” facilities. “Emergency care providers in all health care settings should understand the widespread prevalence of this problem and establish protocols that initiate appropriate screening” and interventions, they conclude. Michael McCarthy
Increase in teen boys’ suicidal behaviour linked with alcohol misuse
S
uicidal behaviours (ideas, attempts, or threats) are increasing in adolescent boys, and data suggest that “alcohol misuse is the causal factor”, says Eric Fombonne (Institute of Psychiatry, London, UK). If these time trends are confirmed in population-based studies, these findings suggest targets for suicide prevention, he adds. To investigate the underlying factors for increasing suicide rates, Fombonne studied a data set of all 6091 children aged 8–18 years referred to south London psychiatric services between 1970 and 1990. Suicidal behaviours—a strong risk factor for suicide—increased over the 21-year period in adolescent boys, but not in prepubertal boys or in girls of any age. Logistic regression analysis revealed that substance misuse increased contemporaneously in adolescent boys,
THE LANCET • Vol 352 • August 8, 1998
and was the only such factor predictive of suicidal behaviours (odds ratio [OR] 3·5, 95% CI 1·9–6·2). By contrast, depression was a strong correlate of suicidal
behaviours but did not increase over time, and family breakdown, which did increase markedly, was not predictive of suicidal behaviours (Br J Psych 1998; 173: 154–59). A review of randomly selected
case notes found that alcohol was the most frequently misused substance among the teenagers, and that “alcohol misuse was the only behaviour showing both an increase over the study period and a strong and positive association with suicidality”. Furthermore, severity of suicidal behaviours (attempts vs ideas or plans) was significantly associated with alcohol misuse (OR 4·2, 95% CI 1·3–13·3). When considered with other studies, these data suggest that alcohol misuse may be the underlying cause behind the increase in youth suicidal behaviours, says Fombonne, adding that psychiatrists should screen adolescent boys for substance use, and educate vulnerable patients about “the detrimental effects of alcohol misuse”. Kelly Morris
459
NEWS
Domestic abuse not just a big city problem ccording to a new study, one in three US women surveyed in community-hospital emergency departments have been abused by a partner at some time in their lives. 3455 women, aged 18 years or older, visiting the emergency departments of 11 medium-sized hospitals—three in urban areas, four in suburban areas, and four in rural areas—in California and Pennsylvania completed a 16question survey about their experience of domestic abuse. The women
A
were asked whether they were currently in an abusive relationship; whether they had been physically, sexually and/or emotionally abused by a “husband, boyfriend, or partner” in the past year; or whether they had been so abused at any time in their life (JAMA 1998; 280: 433–38). 2·2% of the women reported they had come to the emergency department because they had been hurt by their partner; 14·4% reported that they had been physically or sexually abused in the past year; and 36·9%
Mistreatment linked to higher death rate in the elderly Old people who have been mistreated are three times more likely to die than are those who have not been mistreated, reports a US study. Researchers followed 2812 men and women participating in a long-term research project on ageing. All were more than 65 years old at the start of the study in 1982. During the next 9 years, 176 were found by investigators from elderly protective services to have been either: abused (10); neglected (30); exploited (8); or unable to care for themselves and so showed signs of self neglect (128). 13 years after the start of the study, only 9% of those who had been mistreated were still alive. By contrast, 17% of those who were unable to care for themselves were alive, and among those who had never been investigated by elderly protective services, 40% had survived (JAMA 1998; 280: 428–32).
reported they had been physically or sexually abused in their lifetime. The researchers identified four risk factors for reported physical or sexual abuse, or acute trauma from abuse: age, 18 to 39 years (odds ratio [OR] 2·2; 95% CI 1·7–3·0); monthly income less than US$1000 (OR 1·7; 95% CI 1·3–2·1); children younger than 18 years old living in the home (OR 2·0; 95% CI 1·5–2·6); and ending a relationship within the past year (OR 7·0; 95% CI 5·5–8·9). Partner abuse, write Stephen Dearwater (Allegheny University of the Health Sciences, Pittsburgh, PA, USA) and colleagues, is a common problem in community hospitals and not just a problem “limited to large, urban, or tertiary care” facilities. “Emergency care providers in all health care settings should understand the widespread prevalence of this problem and establish protocols that initiate appropriate screening” and interventions, they conclude. Michael McCarthy
Increase in teen boys’ suicidal behaviour linked with alcohol misuse
S
uicidal behaviours (ideas, attempts, or threats) are increasing in adolescent boys, and data suggest that “alcohol misuse is the causal factor”, says Eric Fombonne (Institute of Psychiatry, London, UK). If these time trends are confirmed in population-based studies, these findings suggest targets for suicide prevention, he adds. To investigate the underlying factors for increasing suicide rates, Fombonne studied a data set of all 6091 children aged 8–18 years referred to south London psychiatric services between 1970 and 1990. Suicidal behaviours—a strong risk factor for suicide—increased over the 21-year period in adolescent boys, but not in prepubertal boys or in girls of any age. Logistic regression analysis revealed that substance misuse increased contemporaneously in adolescent boys,
THE LANCET • Vol 352 • August 8, 1998
and was the only such factor predictive of suicidal behaviours (odds ratio [OR] 3·5, 95% CI 1·9–6·2). By contrast, depression was a strong correlate of suicidal
behaviours but did not increase over time, and family breakdown, which did increase markedly, was not predictive of suicidal behaviours (Br J Psych 1998; 173: 154–59). A review of randomly selected
case notes found that alcohol was the most frequently misused substance among the teenagers, and that “alcohol misuse was the only behaviour showing both an increase over the study period and a strong and positive association with suicidality”. Furthermore, severity of suicidal behaviours (attempts vs ideas or plans) was significantly associated with alcohol misuse (OR 4·2, 95% CI 1·3–13·3). When considered with other studies, these data suggest that alcohol misuse may be the underlying cause behind the increase in youth suicidal behaviours, says Fombonne, adding that psychiatrists should screen adolescent boys for substance use, and educate vulnerable patients about “the detrimental effects of alcohol misuse”. Kelly Morris
459