Shutdowns caused by the coronavirus disease 2019 (COVID-19) pandemic raised concerns among advocates that a potential increase in intimate partner violence (IPV) may occur. With a COVID-19 surge now firmly in place, many victims of IPV are at home with their abusers, and they may not feel able to safely connect with domestic violence hotlines.

The pandemic has reinforced the idea that social determinants of health may be magnified during a crisis, and sheltering in place may be more difficult for some populations. This ideology has been described in the New England Journal of Medicine.1

According to a survey from the Centers for Disease Control and Prevention, 1 in 4 women and 1 in 10 men experience IPV, which can be physical, emotional, sexual, or psychological abuse.2 Although anyone can be a victim to IPV, the majority of violence occurs in communities of color and other marginalized groups. According to the authors, “IPV cannot be addressed without also addressing social factors, especially in the context of a pandemic that is causing substantial isolation.”

Many victims of IPV often are financially dependent on their abuser, and a global pandemic can exacerbate these financial entanglements due to increased job loss and unemployment. The efforts to stop the spread of the virus have also reduced access to shelters and safe havens. Though some establishments have reopened, many still remain shut or unable to accommodate additional persons within.


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School closures have added to stresses in the home; virtual learning requires a hands-on approach from a parent or caregiver, and parents who work may not be able to assist their child(ren) in their schooling. This added stress of balancing work, child care, and education has led to a rise in child abuse, and school teachers, counselors, and child care providers have less opportunities to assess, recognize and report signs of child abuse than they did before the pandemic.

Additional barriers now exist in reporting IPV, especially within the police and court report processing systems. Victims of IPV who would visit a medical center or hospital now may not be able to see a provider due to the risk of COVID-19. Certain medical offices have moved to telemedicine platforms, making screening patients for IPV more difficult. Patients may live in areas with unreliable internet or cellular service, and abusers may be monitoring the victim’s internet and phone history, leaving patients unable to disclose their abuse while at home.

Certain steps could promote more equitable access to services as a second wave of COVID-19 becomes a reality, noted the authors. Communities could ensure equal access to broadband internet access in homes; this would allow for more access to telehealth services and permit victims of IPV to search for resources and maintain social connections.

Providers can and should continue to screen for IPV and discuss safety planning with patients during telemedicine appointments, according to the study authors. Clinicians can also educate themselves about the available community resources to provide to the patient. Clinicians should help the victim review safety practices such as deleting internet browsing history or text messages, saving hotline information under other listings, and creating a new, confidential email account for receiving information about resources or communicating with their clinician team.

Governing bodies should consider these social determinants of health when developing crisis standards of care. “As state mandates relax and people begin to live a new version of normal, clinicians, public health, officials, and policymakers cannot stop addressing the layers of social inequities in our communities and the ways in which they affect people’s access to care,” stated the authors. The pandemic has highlighted how much work needs to be done to ensure that people who experience abuse can continue to obtain access to support, refuge, and medical care when another public health disaster hits.”

References

1. Evans ML, Lindauer M, Farrell ME. A pandemic within a pandemic—intimate partner violence during COVID-19. N Engl J Med. Published online September 16, 2020. doi: 10.1056/NEJMp2024046

2. Smith SG, Zhang X, Basile KC, et al. National Intimate Partner and Sexual Violence survey: 2015 data brief—updated release. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. Published November 2018. Accessed November 2, 2020. https://www.cdc.gov/violenceprevention/pdf/2015data-brief508.pdf.