Rathnayake Jayamini Chathurika, Mat Pozian Nadirah, Carroll Julie-Anne, King Julie
School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove Campus, Victoria Park Road, Kelvin Grove, QLD 5069, Australia.
Healthcare (Basel). 2023 Sep 7;11(18):2486. doi: 10.3390/healthcare11182486.
Despite the Australian Government's attempts to reduce domestic violence (DV) incidences, impediments within the social and health systems and current interventions designed to identify DV victims may be contributing to female victims' reluctance to disclose DV experiences to their primary healthcare providers. This scoping review aimed to provide the state of evidence regarding reluctance to disclose DV incidents, symptoms and comorbidities that patients present to healthcare providers, current detection systems and interventions in clinical settings, and recommendations to generate more effective responses to DV. Findings revealed that female victims are reluctant to disclose DV because they do not trust or believe that general practitioners can help them to solve their issues, and they do not acknowledge that they are in an abusive relationship, and are unaware that they are in one, or have been victims of DV. The most common symptoms and comorbidities victims present with are sleep difficulties, substance use and anxiety. Not all GPs are equipped with knowledge about comorbidities signalling cases of DV. These DV screening programs are the most prominent intervention types within Australian primary health services and are currently not sufficiently nuanced nor sensitive to screen with accuracy. Finally, this scoping review provides formative evidence that in order for more accurate and reliable data regarding disclosure in healthcare settings to be collected, gender power imbalances in the health workforce should be redressed, and advocacy of gender equality and the change of social structures in both Australia and New Zealand remain the focus for reducing DV in these countries.
尽管澳大利亚政府试图减少家庭暴力(DV)发生率,但社会和卫生系统中的障碍以及当前旨在识别DV受害者的干预措施,可能导致女性受害者不愿向其初级医疗服务提供者透露DV经历。本范围综述旨在提供有关患者向医疗服务提供者隐瞒DV事件、症状和合并症的证据现状,临床环境中当前的检测系统和干预措施,以及提出更有效应对DV的建议。研究结果显示,女性受害者不愿透露DV情况,原因在于她们不信任或不相信全科医生能够帮助她们解决问题,她们不承认自己处于虐待关系中,没有意识到自己身处其中,或者曾是DV的受害者。受害者出现的最常见症状和合并症是睡眠困难、药物使用和焦虑。并非所有全科医生都具备识别DV合并症的知识。这些DV筛查项目是澳大利亚初级卫生服务中最突出的干预类型,目前在筛查准确性方面不够细致入微且不够敏感。最后,本范围综述提供了形成性证据,即要收集关于医疗环境中披露情况的更准确可靠数据,就应纠正卫生人力中的性别权力不平衡,倡导性别平等以及改变澳大利亚和新西兰的社会结构仍然是这些国家减少DV的重点。