Chapter 46: Social Violence

INTRODUCTION

Trauma care is, by definition, tertiary prevention or treatment. Understanding the root causes of the injury may aid in better comprehension and treatment of the trauma victim. Improvements in trauma care should incorporate consideration of the psychosocial aspects of such injuries as well as the needs of an impact on the larger health care system.

Patients who are victims of family and community violence may have relatively simple traumatic injuries but often have complex psychosocial issues that affect their response to injury. Simply treating the injuries and not intervening with the underlying causes makes recidivism of these patients the likely end result. Early detection and efforts at prevention of interpersonal violence must be part of the trauma center’s prevention program.

Violence may be defined as “the intentional use of physical force against another person or against oneself, which results in or has a high likelihood of resulting in injury or death.”¹ Its frequency is documented in the following facts.

• Suicides and homicides are the second and third leading causes of death among children and youth under the age of 21.²

• Overall injury and violence remain the leading cause of death for persons aged 1–44.²

• One person dies every 4 minutes as a result of intentional injury.³

• Intimate partner violence is the most common cause of injury to women in the United States causing nearly 2 million injuries a year.^4,5,6,7

The literature is replete with studies identifying risk factors for interpersonal violence.^2,8,9,10 Despite this potential knowledge base, physicians are often hesitant to utilize this information.^11,12,13 Early recognition and intervention may prevent future incidents and decrease rates of complications such as post-traumatic stress disorder.^13,14,15 The statistics on death and injury from intentional violence are only the tip of the iceberg. The cost to society of violent behavior also includes the price of legal battles, incarceration, and the economic effects on the health care system as a whole, as well as the psychological stress to victims and the families of victims.^3,4

The purpose of this chapter is to provide the practicing surgeon with some basic information on intentional violence with a focus on intimate partner and community violence, so that he or she may be a better provider of care for these patients with special needs.

INTIMATE PARTNER VIOLENCE

Intimate partner violence, or also known as domestic violence, refers to those acts of interpersonal violence resulting in physical or psychological injury to members of the same family or household or to intimate acquaintances in heterosexual or homosexual relationships. Another definition of domestic violence goes further, including “a pattern of coercive control consisting of physical, sexual, and/or psychological assault against former ...