Prevalence of Intimate Partner Violence and Beliefs About Partner Violence Screening Among Young Men

DISCUSSION

Though primary care physicians may face barriers to identifying or responding to IPV among men,¹⁵ approximately 9 in 10 young men in the United States supported being asked by a health care clinician about IPV perpetration or victimization. Although nearly 1 in 5 young men reported any use of IPV towards their partners and over 1 in 4 young men reported use of IPV by their partners towards them, only about 1 in 10 had been asked by a health care clinician about perpetration or victimization. These gaps demonstrate missed opportunities for IPV identification, as well as needed interventions and referrals. Education, race/ethnicity, and history of involvement in physical IPV as perpetrator or victim were linked to beliefs about or experiences with being asked by a health care clinician about IPV among this nationally representative sample of young men. Understanding these associations may aid primary care physicians in identifying male patients who have been perpetrators or victims of IPV and addressing their needs for mental and behavioral health services or referral to IPV advocacy organizations for intervention.

Young men aged 18-35 years tend to be healthy, raising questions about how often they would be seen in a primary care practice and how much opportunity a physician would have to screen them for IPV. In the current sample, 60% of men reported having at least 1 regular doctor. While men are more likely than women, and younger adults are more likely than older adults, to seek health care on an as needed rather than preventative basis,^16–18 our data show that 60% of young men have a regular doctor. When young men seek health care with that primary care physician, those health care encounters offer opportunities to identify IPV.

Primary care physicians can be mindful of distinct patient needs and resultant opportunities to address IPV among a broad range of male patients. A larger age distribution might reveal cohort effects and reflect shifting social norms about gender roles and relationships.

This study focused on young men, known to have higher rates of past year violence than older men,^19,20 and examined the opportunity for primary care physicians to intervene early with men who experience and/or perpetrate IPV to prevent continuing or subsequent violence.

Further research with sufficiently large sample sizes in each group is needed to examine potential variation in characteristics associated with experiences and beliefs about health care clinician identification of IPV among men who are victims only, perpetrators only, or both victims and perpetrators of IPV. It is particularly important that future research examine group differences given that extant research has shown that victim-perpetrators are at significantly higher risk for negative health outcomes compared to victims only or perpetrators only.²¹

Given that 16.6% of the young men in our sample reported experiencing both perpetration and victimization, and given that the majority of young men who disclosed IPV involvement reported both perpetration and victimization, assessment for both perpetration and victimization is needed for primary care physicians to determine the different service needs of male patients with IPV. The current study demonstrates that asking men about IPV perpetration and victimization is feasible and acceptable, and this finding raises the question of effective responses. Responses may include counseling, brief interventions, and referrals, though these interventions have not been tested in a primary care setting.¹⁵

Brief motivational interviewing interventions focused on IPV perpetration have been shown to be effective in hospital and emergency department settings,^22,23 but these interventions have not been examined in primary care settings. Further exploration is needed to identify effective treatments in primary care settings.

Routine identification may improve management of IPV,²⁴ but tailored identification and intervention methods may be needed to sensitively address beliefs among specific groups of men. Young men who disclosed IPV perpetration endorsed less support for male patients being asked about IPV, and this may reflect barriers to communication or lack of effective resources to address IPV perpetration.¹⁵ Further research is needed to assess best strategies for primary care physicians to use when identifying and responding to IPV among male patients. Primary care physicians have a unique position as community-based clinicians who can partner with local IPV services such as batterer intervention programs and advocacy organizations to respond to the needs of male patients identified with IPV perpetration or victimization.

Because our data are cross-sectional, only associations with, and not causation of, beliefs and experiences regarding IPV identification in health care settings can be determined. Data were collected in 2014, and additional research is needed to ascertain whether experiences and beliefs about partner violence screening among young men are changing over time. In this study we measured involvement in physical IPV only; other forms of IPV including emotional abuse or sexual violence may be associated with other health care beliefs and experiences regarding IPV identification. IPV perpetration and victimization were measured by self-report of physical acts only and not about the context of these acts. The sample was overwhelmingly in heterosexual relationships. Additional research is needed to examine experiences and beliefs about partner violence screening among young men in non-heterosexual relationships.

Despite some limitations, our findings offer a first look at young men’s beliefs regarding screening for IPV perpetration or victimization in health care settings and characteristics associated with beliefs and experiences being asked by a health care clinician about IPV. A substantial majority of this nationally representative sample of young men support health care clinician identification of both IPV perpetration and victimization, yet both are infrequently assessed in clinical practice. Given the potential to intervene in numerous negative health outcomes associated with IPV, primary care physicians can work to identify IPV perpetration and victimization among male patients and consider brief interventions or referrals for men identified with IPV.