Duxbury Fiona
Health Services Research Unit, Institute of Health Sciences, Oxford.
Br J Gen Pract. 2006 Apr;56(525):294-300.
This discussion paper reviews the health impacts, physical and mental, of domestic violence and explores the link between domestic violence and psychological symptoms. This paper focuses more on posttraumatic stress disorder (PTSD) than depression and low self-esteem because doctors are less familiar with PTSD. The barriers preventing health workers from detecting domestic violence are reviewed and the fear of health professionals that asking about trauma can harm patients is explored. The article then outlines practical strategies to improve detection of domestic violence using patients' presenting psychological symptoms and the diagnoses frequently associated with domestic violence namely, PTSD, depression and low self-esteem. It is argued that it is inadvisable to try to implement a policy of screening for domestic violence in general practice when the public health model is currently inappropriate. The paper discusses why the diagnostic frameworks of depression and PTSD are helpful in general practice, not only in detecting domestic violence but in working with the patient to establish trust and ways forward that can be tailored to meet the needs of the patient and their children. Patients' and professionals' dilemmas about what to do once domestic violence is detected are briefly explored.
本讨论文件回顾了家庭暴力对身心健康的影响，并探讨了家庭暴力与心理症状之间的联系。由于医生对创伤后应激障碍（PTSD）不如对抑郁症和自卑熟悉，因此本文更多地关注创伤后应激障碍而非抑郁症和自卑。文中回顾了阻碍医护人员发现家庭暴力的障碍，并探讨了医疗专业人员担心询问创伤情况会伤害患者的问题。然后，本文概述了利用患者呈现的心理症状以及与家庭暴力经常相关的诊断（即创伤后应激障碍、抑郁症和自卑）来改善家庭暴力发现情况的实用策略。有人认为，在公共卫生模式目前不合适的情况下，试图在全科医疗中实施家庭暴力筛查政策是不可取的。本文讨论了抑郁症和创伤后应激障碍的诊断框架为何在全科医疗中有用，这不仅有助于发现家庭暴力，还能与患者建立信任并找到适合患者及其子女需求的前进方向。文中简要探讨了患者和专业人员在发现家庭暴力后该如何应对的困境。
