Doctors should increase domestic-violence screening

A few weeks ago, a 7-year-old overweight boy came in for a "well-child check." His mother was concerned because he was "always getting into trouble" in his new school and his teacher thought he should be evaluated for attention deficit disorder (ADHD). At home, he was more withdrawn, twitchy, and continually fighting with his older sister.

I had a hunch about what was wrong.

That same day in the mail I received the 2011 report from the Women Against Abuse shelter, the largest of its kind in Philadelphia, with 85 beds and 15 cribs.

Amid all the report's statistics, one number jumped off the page: 7,705. That was the number of requests for shelter denied in 2011 because of lack of space.

Experts say domestic violence rises in bad economies because that's when household stress levels rise. Last year, the national domestic violence hotline (1-800-799-SAFE) logged a 21 percent spike in calls. Shelters across Pennsylvania have been packed for months.

In 2009, Philadelphia police responded to 137,913 domestic-violence incidents. Domestic violence claimed 37 lives in Philadelphia during 2009 and 30 in 2010. The likelihood that someone will suffer domestic violence at some point in life is 25 percent for women and 7 percent for men.

The research is undisputed. Besides the physical wounds of domestic violence, mothers are more likely to be depressed; to have unplanned and premature pregnancies; to go to fewer prenatal visits; and to miss more well-child visits for their children.

Before having a baby, more than 325,000 pregnant women are battered by their partners yearly; yet we screen for domestic violence less than for sugar diabetes in pregnancy or preeclampsia, which is less common.

Two significant risk factors for domestic violence are poverty and being unmarried. In the First Congressional District, which surrounds St. Christopher's Hospital for Children, 45 percent of children live in poverty (third-highest in the nation) and 67 percent live in single-parent households (second-highest in the nation). Behind closed doors, muffled by raised volumes on TV sets, our district, and our city, are brewing a potent concoction for domestic violence.

Forty-three percent of adult domestic-violence victims live with children. Up to half of these children are abused or neglected, as well. They bear silent witness, hands over their ears, hiding. They are bathed by their own stress hormones, such as cortisol and adrenaline, which their developing brains and immune systems cannot defend against, causing health damage that can last a lifetime.

In Philadelphia, abuse affects more than 5,000 children annually. These children are more likely to suffer from physical health problems such as premature birth, poor asthma control, obesity, and child abuse and neglect.

Teens in households with domestic violence have more unplanned pregnancies and sexually transmitted infections. Depression, anxiety, traumatic stress disorder, academic under-performance, and bullying are more likely.

The longer the domestic violence goes on and the more severe it is, the more damage it does to children. When they reach adulthood, the cycle of violence is more apt to continue.

All told, domestic violence leads to $5.8 billion in increased health-care costs a year. This is a public-health crisis of a staggering magnitude.

A survey of mothers in pediatric clinics found that 4 percent are current domestic-violence victims and 15 percent had a history of domestic violence. In four different studies of abuse survivors, 70 percent to 81 percent reported they would like health providers to ask them privately about intimate-partner violence.

Yet a study in the Journal of the American Medical Association found that only 10 percent of primary-care physicians routinely screen for intimate-partner violence during new-patient visits. Only 9 percent routinely screen during periodic checkups.

We must make domestic-violence screening a routine part of our practices because it crosses all racial, ethnic, and socio-economic boundaries. We must stop the hurt.

Using a laminated domestic-violence screening card stashed alongside the poison-control hotline stickers, I asked the mother of the 7-year-old privately about her exposure to domestic violence. She shook her head, but the expression on her face told me otherwise. She wasn't ready yet, but a door was opened for her.

I explained what domestic violence does to children and how widespread it is. Then I offered her the domestic-violence resource card in case she "knew of anyone who might need these services." She took the card without hesitation.

be reached at Daniel.Taylor@Drexelmed.edu.