At first glance, the numbers are promising: from 1999 to 2000, the violent crime rate in the United States declined 15 percent, according to the National Crime Victimization Survey of the US Department of Justice. Homicide rates have dropped to levels not seen since the 1960s. However, in Massachusetts and other states, while the homicide rate of men killing other men has decreased, the rate of men murdering women has remained the same. In the more than 20 percent of murders in the country in which men kill women, more than 60 percent are at the hands of an "intimate" partner.

"Every year, there are new articles documenting the health burden women carry as a result of domestic violence," said Laura McCloskey, an associate professor in the Department of Maternal and Child Health. "New spheres of health problems continue to surface."

Along with the obvious physical injuries, abused women are at higher risk for mental health problems, such as depression, and suicide. They are more likely to have sexually transmitted diseases, the hypothesis being that men in these women’s lives come with their own health risks and engage in risky sexual behavior. Abused women are more likely to experience complications when giving birth (probably because of diminished prenatal care), and new research by Rosalind Wright, instructor in medicine at HMS, indicates there may be a link between abuse and the severity of asthma attacks.

McCloskey is conducting a study, funded by the Agency for Health Research Quality, to see how abused women use–or do not use–services available to them through the health care system and how help is given to them. In the study, McCloskey and her colleagues have distributed a "Women’s Stress and Health Questionnaire" in the waiting rooms of community health centers, clinics and hospitals in Greater Boston. The survey asks questions such as, "In the past year, has your partner hit or slapped you?"

The researchers call women who have been abused to see if they received any advice or care related to intimate partner violence. McCloskey and her colleagues will follow the women’s health records over time.

"Presumably, the study will show that health problems are reduced after support is given," said McCloskey. "The idea is to show that responses in health care settings should result in a cost savings to the health care system while improving the lives of abused women."

McCloskey is also deeply involved in studying the effects of intimate partner abuse on children’s health. Studies have shown that a disproportionate number of abused women have children, who may witness the violence or, worse, become victims of it themselves. In 1990, McCloskey started a longitudinal study of 300 families in the southwestern United States to investigate the effects of abuse on the mental health of children and to trace the cycle of violence. Some of her findings have been surprising.

"There definitely is an effect on children from intimate partner violence, but it is not as powerful in the way people traditionally think about it," said McCloskey. "The common model is that boys who are abused will become abusers. We found a slight risk for increased aggression if a boy came from a violent family, but we also discovered there are many pathways to that aggression, such as neglect, substance abuse and mental health problems in the family. They don’t all have to do with violence."

She also found that many boys from violent homes in her study sought refuge elsewhere, particularly in religion.

Girls from violent homes had a range of problems, one of the most striking of which was that they were much more likely than boys to be in a violent dating relationship and at earlier ages.

"The impact of seeing their mothers being beaten is incredibly damaging, and that damage surfaces early on," said McCloskey. "The girls’ self-esteem plummets."

McCloskey identified a cycle of sexual abuse in her study. Women who had been sexually abused as children were more likely to be victims of violence as adults. Their children were also more likely to become victims of sexual abuse, usually at the hands of the same men who had abused the mother. These abusers tended to be male relatives.

The women do not have a psychological need to re-live their abuse through their children, as some experts have suggested. Instead, said McCloskey, she noticed the profound isolation these women feel. Their partners have often forced them to give up friendships and to ignore the outreach of neighbors. McCloskey knows of cases where no telephones were in homes or, in at least one instance, she knows of a husband who took the phone with him whenever he left the house.

"The physical abuse is terrible, but I think there is a secondary problem that is more serious–the social isolation these women face," said McCloskey. "They are so cut off from social networks. If they leave their violent partners, they return to their families that may have been abusive or neglectful. If they stay with their partners, a wedge is created between the women and their children, who blame their mothers for not protecting them from abuse."

McCloskey would like to see more research into costs and benefits of intervening on behalf of abused women and their children.

"Interventions are incredibly cheap when compared to what it costs to keep a woman in the emergency room even for just one afternoon," said McCloskey.

Scientists are objective by training, something that is not always easy to sustain. Laura McCloskey and her staff know that working with study participants who are in extremely stressed situations creates special challenges in the conduct of research (see article above).

McCloskey has interviewed hundreds of abused women and their children. She recognizes how difficult it is to perform interviews with family members who are in a state of crisis and suffering.

She explained that she and her staff provided some help, when warranted, to research participants in their study. They hired a counselor who worked onsite and provided direct counseling as needed. They also trained survey takers to screen women for problems that needed to be referred to the counselor. McCloskey and her staff were careful to include their interventions as variables in their study report so as not to skew the results.

"Our study was not about interventions," said McCloskey. "It was about the natural course of the cycle of violence in families, but at times, we felt we had to do something."

She said that sometimes people ask her how she avoids becoming depressed after hearing so many unhappy stories.

"One of the reasons we do this work, and why it’s not depressing, is that we’re not just reading about abuse in the newspaper. We’re actually collecting information that we hope will someday help these women or others in similar situations," said McCloskey.