martes, 11 de noviembre de 2008

Physical violence against intimate partners and related exposures to violence among South African men

Nota de los editores: Inauguramos con este artículo la participación de médicos residentes de medicina de familia internacionales que han querido unirse al proyecto. Por esta razón algunos de los artículos serán en inglés.

This study seeked to investigate the dimension of the phenomenon of intimate partner violence in South Africa, and specifically of men inflicting violence against female partners.

The researchers resorted to data from a previous study, the South Africa Stress and Health Study, a cross-sectional national study about the prevalence of mental health problems, and gathered information about a sample of 834 men who had been previously married or had lived with a female partner. The authors then calculated the prevalence of physical violence against female partnersa and examined the association of physical violence with certain factors predisposing to to sexual violence.

The study found a prevalence of physical violence of 27,5%. The study also found out that physical violence was associated with witnessing parental violence and to having experienced physical violence in childhood, but that it was not associated with exposure to community violence.

The authors concluded that the prevalence of intimate partner violence in South Africa is high, and that men who experienced physical abuse during childhood were the most likely to perpetrate future acts of violence.

CMAJ 2008; 179(6):535-41

I would like to point out some methodological limitations of this study. The authors did not interview men directly. What they did was to resort to findings from a previous cross-sectional study, whose authors used a survey to gauge self-reported acts of violence against female partners as well as the presence of factors predisposing to sexual violence.

Self-reporting, particularly of sensitive issues such as admitting to have inflicted acts of violence, is a bias of the study, since many study participants may have provided an under-estimation of the true situation, and thus the real prevalence is likely to be higher.

Additionally, the design of this study (cross-sectional) also bears limitations, since it makes it more difficult to analyze the association between the aforementioned predisposing factors to sexual violence than if a longiditudinal study had been carried out, which would have analyzed the behaviour of the study participants across a particular span of time, rather than in an isolated moment in time.

Even though the authors of the study found an association between perpetration of sexual violence and the witnessing of parental violence as well as the experience of physical violence in childhood, they did not find an association between perpetration of sexual and exposure to community violence, unlike previous work conducted with adolescents in the United States. Since 75% of the participants reported having been exposed to community violence, this finding may have to do with the fact that violent crime in South Africa is so widespread, and is thus a difficult variable to analyze and “isolate”. Readers should also not discard the potential bias related to the fact that participants may have considered exposure to media coverage of community violence as actual exposure to community violence. Still another bias is that this study did not adequately address the difference between study participants having merely been exposed to community violence and/or havinf been directly involved with actively participating in community violence, so there’s room for further research on this.

Intimate partner violence is an important issue in Family Medicine, since the specialty has a leading role in studying family dynamics.

There is not a great deal of South African migrants in both Spain or Portugal, even though there has been a great influx of African immigration to Spain and Portugal over the past 20 years, with Spain receiving chiefly North African migrants, while Portugal has received mostly Lusophone Africa migrants. Thus, this article stresses the importance of carrying out research in African migrants in both Spain and Portugal, since at least in Portugal, we don’t know the prevalence of this phenomenon.

It also calls the attention of screening this population for factors predisposing to sexual violence, namely exposure to violence during childhood, perpetrating physical violence against an intimate partner, and exposure to community violence. In Portugal, violent crimes have been increasing, and many have been linked with inhabitants of poor, suburban neighbourhoods composed chiefly of African migrants.

Even though the piece may be more of interest to social researchers, anthropologists and public health health care professionals, it is important for the trainee to learn to suspect intimate partner violence when interviewing African migrants in the office, even though we currently lack evidence regarding the dimension of this problem in Southern Europe. Furthermore, this issue is more timely than ever, as both Portugal and Spain absorbed many African migrants over the past 2 decades. Finally, the availability of Electronic Health Records is a fundamental condition for the trainee to carry out research regarding this issue.

1 comentario:

Dr. Bonis dijo...

> It also calls the attention of screening this population for factors predisposing to sexual violence, namely exposure to violence during childhood, perpetrating physical violence against an intimate partner, and exposure to community violence.

I find specially difficult to ask about that sensible issues during the medical visit. More training in the management of those problems is needed, and more time per patient indeed.