Risk Predictors for Health Disparities in Victims Exposed to Intimate Partner Violence (IPV)

Background: Intimate partner violence (IPV) is a global public health epidemic. Mandated reporting of IPV is limited to children and the elderly but not victims ages 18- 64. Exposure of IPV is associated with increased prevalence of health disparities affecting a victim’s lifespan.¹ Studies have shown a strong statistical association between IPV and adverse health outcomes; i.e. heart disease (CVD) and chronic stress. Little is known about the mechanistic pathways linking IPV to these health problems.¹ In TN, Afro-American women are 3.4X more likely to be victims of IPV and suffer a significantly greater amount of health disparities as compared with their Caucasian cohorts. IPV is a frequent cause of facial injuries: 75% to the head, neck, face.² The OMFS is in a pivotal position to identify victims, their associated health disparities and act as a “gate keeper” in interdisciplinary collaborative to decrease risk/future injuries to victims of IPV.²

Purpose: To describe  an association among facial injuries, health disparities and exposure to IPV in female patients that visit the oral surgery clinic at Meharry Medical College School of Dentistry (MMCSOD), a community dental school that treats mainly Afro-American women in Nashville, TN. Specific Aims: 1. To estimate the prevalence of IPV in women who visit the clinic and 2.To compare the association of IPV exposure, oral injuries and health disparities between Afro-American and non-Afro-American women. All victims would benefit by the healthcare providers awareness of exposure to this harsh life event and its effect on their health.

Materials and Methods: The MMC IRB approved this study (14-08-254).A cross-sectional study was implemented by enrolling female patients, ages 18-64, who visit the oral surgery clinic at MMCSOD). Inclusion criteria: AxOx3 and English speaking .Exclusion criteria: Incapable of communication/refuse to consent. The predictor variables included injury location (Head, Neck, Face or other) and 2 questionnaires with predictor variables that included the Partner Violence Screen (PVS) and the Partner Abuse Symptom Scale (PASS).^1,2 Both were administered by verbal communication. The outcome variable was self-reported injury etiology categorized as IPV or other. Other demographic variables were Age, economic status, substance abuse, health history. Descriptive statistics, univariate and bivariate analyses were computed. Sensitivity, specificity, positive and negative predictive values were also computed and graphically depicted (SPSS, Chicago, IL; with P < or = .05 being considered statistically significant).

Results: The sample (N= 44) had a mean age of 41.9 ± 14.2.Self-reported prevalence of IPV was 36.4% (16/44) as compared with 25% (Questionnaires vs. Standard Operating Procedure (SOP); p<0.05). HNF injuries were see in all 16 (p<0.0001). Among the variables of the questionnaires, 6 were statistically significant: Anxiety, Stress/PTSD, Depression, Heart palpitations and PVS positivity (P<0.01). Chest pain and memory loss were significantly associated with positivity of the PVS (p<0.05). Stress/PTSD and Depression are significantly greater in Afro-American females when compared with their non-Afro-American cohorts (p<0.01).

Conclusions: This is the first study to identify the prevalence of IPV in patients who frequent the oral surgery clinic at MMCSOD. HNF injuries and PVS were statistically significant as predictors of a present/past IPV injury etiology (p<0.001).² Anxiety, Depression, PTSD/Stress, Palpitations/Chest pain/memory loss are statistically significant/associated with IPV exposure. Afro-American females when compared to non-Afro-American cohorts  have a statistically significant increase in stress/PTSD and Depression. Although the sample is small, with greater numbers we expect that the use of these predictor variables will help to decipher the mechanistic pathway(s) of how IPV exposure precipitates/exacerbates chronic health disparities affecting a victim’s lifespan. The OMFS can provide a Segway for community healthcare awareness to decrease the burden of health disparities due to IPV and save billions of dollars in healthcare cost.