re: Jonathan Majors
tw: strangulation/IPV
My graduate public health practicum comprised an educational intervention to increase emergency medicine resident physician screening rates for intimate partner violence (IPV) at my alma mater, Stony Brook University Medical Center (SBUMC), where I was a senior research associate for Professor and Interim Chair Adam J. Singer, M.D. over 2 years and 6 academic semesters. Prior, I completed an internship for the Bellevue-NYU Program for Survivors of Torture (PSOT) during my studies at Stuyvesant High School.
I mention this because as a public health professional trained in healthcare management (MPH/MBA) and research interest in the subject over two decades, I wish to communicate the following data, indicators, and statistics on the trending topic from a sufficiently competent perspective, given the maddening, saddening tendency for viral tweets, unqualified hot takes, and blatant misinformation continuing to bury the lede: objective, relevant peer-reviewed science and evidence-based compassionate care.
ELI5 DEFINITIONS
strangulation: neck compression which obstructs airflow and/or bloodflow
intimate partner violence (IPV): domestic violence by current of former partner within intimate relationship (interpersonal relationship involving physical or emotional intimacy)
SIMPLIFIED GENERAL OUTCOMES
asphyxia: deficient oxygen due to abnormal breathing
hypoxia: resultant deficient oxygen at the tissue level
ABBREVIATED SYSTEMIC OUTCOMES
cardiovascular (carotid artery dissection, embolism, thrombosis, etc.) neurological (aphasia, cerebral ischemia, hemorrhage, stroke, etc.) physical (abrasions, bruises, hyoid fracture, internal bleeding, petechia, etc.) psychological (amnesia, anxiety, depression, PTSD, suicidal ideation, etc.) respiratory (pneumonia, acute respiratory distress syndrome [ARDS], etc.)
SELECTED STATISTICS (SOURCES CITED)
as few as 5–10 seconds until loss of consciousness, death within minutes⁴
9% of IPV strangulation victims are pregnant at the time of their assault⁷
25–33% of women experience intimate partner violence (IPV) in lifetime¹
31% increased suicidal ideation in survivors, lowest hope score in all IPV³
up to 38% report losing consciousness (high indicator of delayed fatality)⁶
43% of children in IPV households witnessed mothers being strangled⁹
(and of those children, 9% are also strangled by the same perpetrator)⁹
50% of strangulation victims have visible injuries (15% visible in photos)⁵
>50% LEOs killed in LOD are killed by IPV strangulation perpetrators¹²
up to 58% of IPV strangulation victims also suffer sexual assault/abuse⁸
68–80% women at high risk experience near-fatal strangulation by partner²
up to 92% of IPV victims estimated to suffer traumatic brain injury (TBI)⁷
100% US states (+22 tribes & 2 territories) passed felony strangulation law¹³
750% likelihood in strangulations victims for homicide by perpetrator¹¹
Admittedly, a quarter century of Law and Order: SVU binging does not not an attorney make, nor does one summer semester of MBA business law admit one to the bar. Though I know the basics: due process, probable cause, reasonable doubt, innocent before proven guilty, perhaps even some passing profiency with the Latin habeus corpus ad litem quid pro quo certiorari — amidst ever-changing, ongoing developments beyond the reporting of this past weekend, I’ll leave the legalities to the lawyers, and the theatrics to the tabloids and Twitter. Let’s strive to center victims and survivors, underrepresented demographics and vulnerable populations, in an elevated rational discourse, rooted firmly within the arenas of civility, decency, and empathy.
Sources
1 Breiding, et al (2011). Prevalence and Characteristics of Sexual Violence, Stalking, and Intimate Partner Violence Victimization — National Intimate Partner and Sexual Violence Survey, United States. MMWR 2014; 63(SS-8):1–18.
2 Taliaferro, et al (2009). Strangulation in Intimate Partner Violence. Intimate Partner Violence: A Health-Based Perspective. Oxford University Press, Inc., 217–235; Messing, et al (2018). Differentiating Among Attempted Completed and Multiple Non-Fatal Strangulation in Women Experiencing Intimate Partner Violence. Women’s Health Issues, 28(3), 104–111.; Wilbur, et al (2001). Survey results of women who have been strangulated while in an abusive relationship. 21J. Emergency Medicine 297.
3 Gwinn, et al (2018). Hope Rising: How the Science of Hope Can Change Your Life, 113; Wilbur, et al (2001). Survey results of women who have been strangulated while in an abusive relationship. 21J. Emergency Medicine 297.
4 Patch, et al (2022). Emergency Evaluation of Nonfatal Strangulation Patients: A Commentary on Controversy and Care Priorities. Journal of Emergency Nursing, 48(3), 243–247.
5 Strack, et al (2001). A review of 300 attempted strangulation cases: Part I: Criminal Legal Issues. Journal of Emergency Medicine, 21(3), 303–309; Brady, et al (2021). How Victims of Strangulation Survived. Violence Against Women, 1(26).
6 Shields, et al (2010). Living victims of strangulation: A 10-year review of cases in a metropolitan community. American Journal of Forensic Medical Pathology, 31, 320–325.
7 Campbell, et al, (2018) The Effects of IPV and Probable Traumatic Brain Injury on Central Nervous System, Journal of Women’s Health, 27(6).
8 Zilkens, et al (2016). Non-Fatal Strangulation in Sexual Assault, Journal of Forensic and Legal Medicine, 43, 1–7.
9 Fitzgerald, et al (2022). The Prosecution of Non-Fatal Strangulation cases: An Examination of Finalised Prosecution cases in Queensland, 2017–2020; The University of Melbourne and The University of Queensland.
10 Thomas, et al (2014). Do You Know What It Feels Like to Drown. Psychology of Women Quaterly, 38, 124–137.
11 Glass, et al (2008). Non-fatal strangulation is an important risk factor for homicide of women. The Journal of Emergency Medicine, 35(3), 329–335.
12 Gwinn, et al (2018). Hope Rising: How the Science of Hope Can Change Your Life, 90.
13 Training Institute on Strangulation Prevention (2023). https://www.strangulationtraininginstitute.com/resources/legislation-map
14 Bergin, et al (2022). Describing Non-Fatal Intimate Partner Strangulation Presentation and Evaluation in a Community-Based Hospital. Journal of Head Trauma Rehabilitation, 37(1),5–14.
15 DiPaolo, et al (2009). Unexpected Delayed Death After Manual Strangulation, Monaldi Arch Chest Cis, 71(3), 132–134; Luke (1966). Strangulation as a Method of Homicide, Arch Path, Vol. 83.
Acknowledgement
I gratefully acknowledge Alliance for HOPE International, Family Justice Center Alliance, and the Strangulation Training Institute for allowing me to reproduce, in part or in whole, data and statistics cited in their Strangulation in Intimate Partner Violence Infographic v1.11.2023.
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