UNMC Researcher Participates in Landmark Study on
Domestic Violence
UNMC researcher Robert Muelleman, M.D., was one of the investigators
in a landmark study on domestic violence that appeared in the Dec. 16 edition
of the New England Journal of Medicine.
The article, which marked one of the rare times the journal has devoted
space to domestic violence, found that emergency room medical professionals
can play a significant role in the recognition and prevention of domestic
violence.
Most people see domestic violence as a criminal justice problem, a
sociological or psychological issue, Dr. Muelleman said. But the emergency
room medical professional can play a significant role in the recognition
and prevention of domestic violence. For example, our data really challenges
the standard response, Why dont these women just leave the guy? We found
that the most dangerous time for any abused woman is exactly when she is
threatening to leave or has just left the relationship.
The study, Risk Factors for Injury to Women from Domestic Violence
was accompanied by a major editorial. Dr. Muelleman is noted as one of
the sources for the data collected on the 256 intentionally injured women.
These women were part of a case-control study conducted at eight university-affiliated
emergency medicine departments. Dr. Muellemans participation came
while he was practicing emergency medicine at the University of Missouri
at Kansas Citys Truman Medical Center. He left that position to join the
staff at UNMC in 1998.
Dr. Muelleman is associate professor and chief, section of emergency
medicine. A 1984 UNMC graduate, Dr. Muelleman worked at Truman Medical
Center for five years. Prior to that, he worked five years in emergency
medicine at UNMC.
Its great that the New England Journal of Medicine devoted space to
our study, Dr. Muelleman said. I think its a tribute to the depth of
data gathered, and also an acknowledgement that domestic violence prevention
is now a national priority in the American medical community.
The federal Violence Against Women Act signed into law in 1994 called
for the creation of a research agenda on domestic violence. A priority
was to develop risk factors for domestic abuse. Our study is the
first ever to use case control methodology to study those risk factors.
The better we understand the risk factors, the better we can create
effective interventions.
One of the key results of the research is that most seriously injured
women had previous partners who abused them — that their abuse cycle was
long term and could have been identified at a much earlier stage, if effective
investigation tools had been in place. Today at NHS University Hospital,
for example, the YWCA sponsors trained domestic abuse counselors to stand
by in the emergency room during the evenings, seven days a week.
Dr. Muelleman said: Most at risk women do not visit the emergency room
for physical injuries directly received from the abusive partner. They
usually are coming in for some collateral issue, such as stress, or issues
involving their children. Now, we screen all women who visit the ER. If
their responses identify them as at risk for abuse, we direct them to the
abuse counselors, who then provide a number of other resources.
Simply put, we found that you have to ask these women about their lives,
first. Often, they arent going to just tell you.
Dr. Muelleman is continuing his work in the study of domestic violence
here. He currently is participating in a pilot project investigating
the association of problem gambling in the partner with risk of domestic
violence. This study involved 300 patients. Initial research has found
that the risk of domestic violence is as big from a partner with gambling
problems as from a partner with alcohol or drug problems.
A lot of women who have died from domestic violence had been seen in
their local emergency rooms at least two years before their deaths, Dr.
Muelleman said. In America, two to four million women are injured each
year and one to two million of those show up in emergency rooms. Of these,
easily 2,000 to 3,000 a year end up as homicides. Its clear that medical
professionals in the emergency room can be a great help in identifying
at risk women and directing many of them to supportive resources before
its too late.
UNMC is the only public, academic health science center in the state.
Through its commitment to research, education, outreach and patient care,
UNMC has established itself as one of the country’s leading centers for
cancer research and treatment and solid organ transplantation. Nearly $32
million in research grants and contracts were awarded to UNMC scientists
during the past fiscal year. In addition, UNMCs educational programs are
responsible for training more health professionals practicing in Nebraska
than any other institution.