Damage: The Health Effects of Abuse

For a woman fleeing a violent relationship, success means living to see another sunrise and sunset with no beatings in between. Survival is all that matters. Only after she finds shelter and secures her long-term safety can the victim start to focus on other aspects of her life.

“One of the reasons women live in shelters is to build new lives for themselves and their children,” explains Elizabeth Holman, a registered nurse and director of the Community Health Services Clinic run by the College of Nursing at Arizona State University. “To do this takes energy and good health.”

“And yet, due to the abusive environment, their health has often been neglected or compromised,” adds Chris Lyons, senior nurse at the clinic. “Some of these women have not received routine care simply because their husbands wouldn’t allow it.”

Domestic violence shelters have limited resources available to address the health needs of their residents.

Holman says that shelter staff had expressed that their residents had health needs but no access to services. “Most of the shelters are very small. They’re homes. Some will just have crisis shelter beds,” says Holman.

Even if shelter staff had access to more resources, little is known about the unique needs of abused women and their children.

That’s why nurses from ASU’s clinic decided to create a health needs survey for women in local domestic violence shelters. They wanted to find out the specific health issues affecting abused women and children.

Holman and Lyons surveyed 213 women living in domestic violence shelters in Maricopa County. The surveys asked about health and lifestyle, health care access and insurance status, pregnancy and family planning, and children’s health.

The researchers worked with the shelters to protect the women’s confidentiality, and to reassure each woman that no identifying information would be recorded.

“Safety is their utmost concern when they come into the shelter,” explains Lyons. “We tried not to ask more than necessary to determine areas of need without prying.”

Musculoskeletal problems, mental health issues, and gynecological problems topped the list of current health problems. Forty percent of all survey respondents with current health problems related those problems to their abuse. Those with chronic problems most often mentioned mental health issues, musculoskeletal, endocrine, and pulmonary ailments.

More than half of the women surveyed had no health insurance. Some of the uninsured women may qualify for the Arizona’s state health program, AHCCCS, and mothers can receive assistance for their children through the state’s Kids Care program.

“The shelters work very hard to help the women get enrolled in the available assistance programs, but not everyone qualifies,” says Lyons.

These uninsured women often rely on hospital emergency rooms for non-emergency illnesses. They also head to the emergency rooms to get treatment for problems that could have been avoided with timely health care.

“That’s expensive, and it only addresses the immediate problem,” notes Lyons.

Dental problems affected 61 percent of the women, and nearly one-third of them related these problems to their abuse. Vision problems affected 64 percent, and 17 percent related those to abuse as well. Although only 19 percent of the women reported hearing problems, more than half said the problems were abuse-related.

“I don’t think it’s unusual to have a lot of dental, vision, or even hearing problems among this population because of the incidence of trauma to the head,” speculates Lyons. Thirty-eight percent of the women said they had received six or more blows to the head during adulthood.

Children’s health is also affected when a mother is abused. More than one-third of the 33 pregnant women completing the survey had received no prenatal care. Among mothers whose children had health problems, 18 percent said those problems were a direct or indirect result of abuse.

As a result of their findings, the ASU researchers have submitted a proposal to fund two advanced practice nurses to rotate among the shelters. These nurses would provide direct services, coordinate the use of community resources, and seek additional resources for the unmet needs of the shelter residents.

Holman says that researchers have only scratched the surface in terms of understanding the health needs of abused women. The ASU nurses recommend continued data collection from the shelters. They are working to share their findings with local, state, and national agencies to raise awareness about the issue.—Diane Boudreau

Editor's note: The Community Health Services Clinic is an autonomous, nonprofit clinic managed by the ASU College of Nursing. The domestic violence study was funded by St. Luke’s Health Initiatives. For more information, contact Elizabeth Holman, R.N., or Chris Lyons, R.N., at 480.941.9283.