04:59pm Monday 18 December 2017

Emergency Department Counseling Program Fails to Reduce Intimate Partner Violence or Heavy Drinking Among At-Risk Women, Penn Medicine Study Finds

PHILADELPHIA – A large randomized clinical trial of an emergency department (ED)-based program aimed at reducing incidents of excessive drinking and partner violence in women did not result in significant improvements in either risk factor, according to a new study from researchers at the Perelman School of Medicine at the University of Pennsylvania. Contrary to previous studies which found brief interventions in the ED setting to be effective for reducing alcohol consumption to safe levels and preventing subsequent injury among patients with hazardous drinking, the new study did not find a positive result among women drinkers involved in abusive relationships. Results are available in the August 4th issue of JAMA. 

“Concerns have been raised that brief motivational interventions for heavy drinking are less effective in women and in victims of violence; our results support those concerns,” said lead author Karin Rhodes, MD, director of the Center of Emergency Care Policy & Research in the department of Emergency Medicine at Penn. “Hopefully our results will serve as a catalyst for further testing to see if a more intensive version of the intervention, provided in a different setting, for a longer period of time might be effective. Relationship violence and heavy drinking are two risk factors that commonly occur together, and have highly negative consequences for individuals, as well as their families and communities. We have to keep working on solutions to these problems.”

For the program to be assessed as having had a positive effect, those who participated in the intervention would have achieved statistically better results on the variables being measured than those who did not receive the intervention. However, similar to other research with women who are involved in violent and abusive relationships, the new study – which involved 20-30 minute motivational intervention sessions, delivered by master’s-level therapists with a follow-up phone call – found that both excessive drinking (defined as greater than or equal to four drinks per day) and incidents of partner violence (as either a victim or perpetrator) declined in both the intervention group that received the program and a control group whose members just received referrals to social service resources.

Specifically, twelve weeks after the intervention, the number of women with any episodes of past-week partner violence declined from 57 percent to 43 percent in the intervention group, and from 63 percent to 41 percent in the control group. Past-week heavy drinking decreased from 51 percent to 43 percent in the intervention group, and from 46 percent to 41 percent in the control group.

The study also found that over time, both victimization and perpetration of partner violence and days of heavy drinking decreased significantly across intervention and control groups alike. At 12 months after the enrolling in the study, over 45 percent of women reported no incidents of partner violence in the previous three months and 22 percent had reduced their alcohol consumption to safe drinking levels. However, there was no evidence that these outcomes were influenced by the intervention. Nor was there any evidence that frequent assessments served as an intervention compared to baseline screening and referral alone.

The all-Penn team of researchers found that 86 percent of study participants were also assessed as clinically depressed, the majority lived at or below the poverty level, 43 percent had histories of childhood sexual abuse, and 40 percent had post-traumatic stress disorder. “Clearly the population we studied had a very difficult set of psychosocial problems,” said Rhodes. “Broadening the intervention to address multiple co-occurring risk factors in the context of violence exposure may require a more in-depth and longer approach than can be feasibly provided in an ED setting.”

In addition to Rhodes, other Penn co-authors are Melissa Rodgers (project manager at the Center for Emergency Care Policy & Research), Marilyn Sommers, Alexandra Hanlon, and Jesse Chittams from the Penn School of Nursing, Andrea Doyle from Penn’s School of Social Policy and Practice, Elizabeth Datner from the department of Emergency Medicine, and senior author, Paul Crits-Christoph, from the department of Psychiatry.

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Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation’s first medical school) and the University of Pennsylvania Health System, which together form a $4.9 billion enterprise.

The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 17 years, according to U.S. News & World Report’s survey of research-oriented medical schools. The School is consistently among the nation’s top recipients of funding from the National Institutes of Health, with $409 million awarded in the 2014 fiscal year.

The University of Pennsylvania Health System’s patient care facilities include: The Hospital of the University of Pennsylvania — recognized as one of the nation’s top “Honor Roll” hospitals by U.S. News & World Report; Penn Presbyterian Medical Center; Chester County Hospital; Penn Wissahickon Hospice; and Pennsylvania Hospital — the nation’s first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Chestnut Hill Hospital and Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2014, Penn Medicine provided $771 million to benefit our community.


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