Double Jeopardy: Predictors of Elevated Lethality Risk Among IPV Victims Seen in Emergency Departments for Injuries from DV

Background and Purpose:

Intimate partner homicide, the most serious form of intimate partner violence (IPV), is a serious cause of death among women in the United States, many of whom are likely to be seen in emergency departments (EDs) for injuries related to IPV prior to their death. While previous research outlines correlates of intimate partner homicide generally, specific predictors of lethality risk for victims seen in EDs are not well understood. eHealth interventions targeting IPV and intimate partner homicide expand and improve provider information related to victim need and lethality risk and can inform a more nuanced scope of interventions provided to victims. We analyzed one such system, Domestic Violence Report and Referral (DVRR), which was implemented in an urban, high-traffic ED, and investigated the association between victim characteristics and lethality risk.

Methods

DVRR is an eHealth intervention designed to provide IPV-victimized ED patients with a warm handoff to services. The current study examined the relationship of children’s presence at home, pregnancy, age, and relationship to the abuser with increased IPV victim lethality risk. DVRR records were assessed for 327 female patients aged 16 and older seen at a level-2 trauma center ED for injuries caused by IPV. Risk of intimate partner homicide was measured both numerically and categorically (low, medium, high, very high) using the Lethality Assessment Score provided by the Lethality Risk Assessment for Intimate Partner Femicide, a quantitative measure of lethality risk designed specifically for IPV victims. Differences in score by victim characteristics were assessed using multiple linear regression models and t- and F-tests for means differences.

Results

The mean Lethality Assessment Score for this population indicated a high average lethality risk, with a third of respondents (33.1%) reporting very high Lethality Assessment Scores. Multiple linear regression models indicate that increasing victim age (b=0.2 per year, 95% CI: 0.11-0.29), the presence of children at home (b=2.68, 95% CI: 0.68-4.68), and a perpetrator identified as a boyfriend (p=4.50, 95% CI: 1.57-7.42) or ex-partner (p=4.52, 95% CI: 1.20-7.85) rather than a spouse, were significantly correlated with increased Lethality Assessment Scores (p<0.05). Pregnancy status was not significantly correlated with an increased Lethality Risk Score.

Discussion

In our sample, the mean risk of intimate partner homicide is high among victims of IPV seen in EDs for their injuries. The presence of children at home, increasing victim age, and a perpetrator identified as a boyfriend or ex-partner increase this risk. Interventions based on these risk factors could help hospital staff and IPV advocates channel resources toward patients with highest need, improving health outcomes for these high-risk patients without additional time or financial burden on hospitals

These results foreground the utility of the Lethality Assessment Score and eHealth interventions, such as DVRR, in addressing the needs of high-risk patients. These interventions add a valuable link between physicians and IPV advocacy into existing interventions, facilitating a well-coordinated system of potentially life-saving care.