One out of every six men who present to trauma centers is a survivor of some form of violence, with one in 20 having experienced both intimate partner and sexual violence (IPSV), according to a study by researchers at the University of Miami Miller School of Medicine and four other institutions.
In addition, men affected by penetrating trauma were slightly more likely than women to screen positive for IPSV, which in turn was associated with increases in rates of mental illness, substance abuse and trauma recidivism.
The findings were reported in a recent article in The Journal of Trauma and Acute Care Surgery.
Tanya L. Zakrison, M.D., M.H.Sc., M.P.H., associate professor in the DeWitt Daughtry Family Department of Surgery’s Division of Trauma and Surgical Critical Care at the Miller School, was the instigator of the research and first author of the study.
“I remember taking care of a young man several years back,” she said. “He was in his early 20s, but he looked so small and so very sad. This patient had just had a dispute with his girlfriend, who had ended their relationship. He came to our trauma center because of a self-inflicted stab wound. I remember wondering how often we saw trauma patients — both male and female — as a direct or indirect result of intimate partner violence.”
Zakrison and her colleagues, with the support of on-staff social workers, then began universal screening of all patients — regardless of gender, age, background or mechanism of presenting injury — to understand how often they had experienced intimate partner violence. They quickly expanded their questioning to include a screen for sexual violence.
“We were blown away by the results,” said Zakrison. “We found that 14 percent of our overall sample of trauma patients at Jackson Memorial Hospital’s Ryder Trauma Center screened positive for intimate partner violence, with 8 percent screening positive for sexual violence, with no statistically significant difference in the rate between men and women. We quickly decided to expand to a multi-center trial, adding trauma centers in California, Florida, Georgia and Texas, and found similar results — that intimate partner and sexual violence is prevalent in all trauma patients.”
Those findings were reported in an article in the same journal in 2017.
For the most recent study, the researchers focused on men as a subgroup.
“We are not aware of any male-only studies in the United States on intimate partner violence in the trauma population, or the associated sequela of such violence,” said Zakrison. “Our objective was to perform a subgroup analysis of our affected male cohort, as this remains an understudied and neglected group in the trauma literature. One reason is that IPSV is generally underreported by men due to issues of shame. A 52-year-old male survivor of sexual violence in our study told us, ‘Not even my wife knows.’”
The researchers compiled and analyzed statistics related to the 1,281 men of the 2,034 patients who were admitted to four participating level-1 trauma centers over the course of 12 months. Of this cohort, 9.3 percent screened positive for intimate partner violence, 14.1 percent for IPSV, and 6.5 percent for sexual violence in the previous 12 months. A categorical analysis of the HITS (Hurts, Insults, Threatens, Screams) screen found the percentage of men who were physically hurt was actually higher than for women at 4.8 percent, compared with 4.3 percent, respectively. The total proportion of men who presented with any history of intimate partner violence, sexual violence or both (IPSV) was 15.8 percent, or more than one out of every six men.
“We know that intimate partner violence is bidirectional, at times affecting both partners in a relationship,” said Zakrison. “We postulate, however, with regards to the association with penetrating trauma, that it is possible that men who experience shaming, in particular, tend to have this rebound engagement in perceived hyper-masculine activities such as firearm-related violence, leading to societal-level violence. We feel it may lead to multidirectional violence, not just bidirectional.”
Both studies were supported by EAST, the Eastern Association for the Surgery of Trauma, the largest trauma surgery organization in the United States. Earlier this year, prior to the current paper’s publication, Zakrison won the Cox-Templeton Injury Prevention Paper Competition at EAST’s 31st Scientific Assembly in Lake Buena Vista, Fla., for this novel work.
Zakrison’s Miller School co-authors were Rishi Rattan, M.D., Xiomara Ruiz, M.D., David Turay, M.D., Ph.D., Nicholas Namias, M.D., M.B.A., Dante Yeh, M.D., and Daniel Pust, M.D. Additional co-authors were investigators at Hospital Universitario General Calixto García and Instituto de Ciencias Medicas at la Universidad de la Habana in Cuba, Emory University School of Medicine in Atlanta, Loma Linda University and Medical Center in Loma Linda, Calif., and UT Southwestern Medical Center and Parkland Memorial Hospital in Dallas.
Future studies will explore the connection between male intimate partner violence and homicide, shaming, toxic masculinity and firearm-related violence.