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Background: Women who are victims of domestic violence frequently seek care in an emergency department. However, it is challenging to hold sensitive conversations in this environment.Objective: To describe communication about domestic violence between emergency providers and female patients.Design: Analysis of audiotapes made during a randomized, controlled trial of computerized screening for domestic violence.Setting: 2 socioeconomically diverse emergency departments: one urban and academic, the other suburban and community-based.Participants: 1281 English-speaking women age 16 to 69 years and 80 providers (30 attending physicians, 46 residents, and 4 nurse practitioners).Results: 871 audiotapes, including 293 that included provider screening for domestic violence, were analyzed. Providers typically asked about domestic violence in a perfunctory manner during the social history. Provider communication behaviors associated with women disclosing abuse included probing (defined as asking > or =1 additional topically related question), providing open-ended opportunities to talk, and being generally responsive to patient clues (any mention of a psychosocial issue). Chart documentation of domestic violence was present in one third of cases.Limitations: Nonverbal communication was not examined. Providers were aware that they were being audiotaped and may have tried to perform their best.Conclusion: Although hectic clinical environments present many obstacles to meaningful discussions about domestic violence, several provider communication behaviors seemed to facilitate patient disclosure of experiences with abuse. Illustrative examples highlight common pitfalls and exemplary practices in screening for abuse and response to disclosures of abuse. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To assess physical and mental functional health status as associated with the severity of intimate partner violence (IPV) and perceived danger. METHODS: Prospective cross-sectional survey of all patients aged 18-55 in an urban emergency department during a convenience sample of shifts. Instruments included the George Washington Universal Violence Prevention Screening protocol, administered by computer during the initial visit, the Short-Form 12 Health Survey (SF-12), the Conflict Tactics Scale (CTS2), and the Revised Danger Assessment (DA), administered by interview at 1 week follow-up. RESULTS: In total, 548 (20%) participants screened disclosed IPV victimization. Of those, 216 (40%) completed the follow-up assessment 1 week later. This cohort was 91% African American, 70% single, and 63% female, with a mean age of 35 (SD 10.41). Both physical and mental health functioning scores were lower than normative levels (50) compared with national averages: Physical Component Summary (PCS) scale 43.64 (SD 10.86) and Mental Component Summary (MCS) scale 37.46 (SD 12.29). As physical assault, psychological aggression, and reported injury increased on the CTS2, mental health functioning diminished (p < 0.01). Increased physical assault and psychological aggression were also associated with diminished physical health functioning (p < 0.05). As victim-perceived danger increased on the DA, both physical and mental health functioning decreased (p < 0.01, p < 0.001, respectively). Greater self-advocacy activities were associated with lower mental (but not physical) health functioning as well. Females experienced worsening mental health functioning as both physical assault and psychological aggression increased, whereas male victims experienced worsening mental health functioning only as psychological aggression increased. CONCLUSIONS: These findings suggest that IPV takes a greater mental than physical toll (for both sexes) and that as IPV severity increases, mental health functioning diminishes and self-advocacy behaviors increase. Additionally, as perceived danger increases, both physical and mental health status worsens. This has important implications for clinicians to assess and consider IPV victims' perceptions of their situations relative to danger, not just the levels of abuse they are experiencing. [ABSTRACT FROM AUTHOR]