Gender Differences in Average Cost of IPV (Arias & Corso, 2005)

Study purpose and context

  • Article: Violence and Victims, Volume 20, Number 4, August 2005
  • Topic: Average cost per person victimized by an intimate partner of the opposite gender, comparing men and women
  • Research gap: Prior work documented differences in prevalence, injury, and service use between female and male IPV victims, but no robust estimates of costs for men’s IPV victimization
  • Objective: Explore gender differences in intensity of service utilization for physical IPV injuries and estimate the average cost per person victimized by an opposite-gender partner, focusing on female-to-male IPV versus male-to-female IPV
  • Key finding preview: Women show higher prevalence of physical IPV and injuries; women also use mental health and medical services more; total average cost per victim is higher for women, but male-to-female IPV still represents a significant economic burden

Background: IPV, gender differences, and costs

  • IPV definition used: use of actual or threatened physical, sexual, or psychological violence by current or former intimate partners
  • Historical focus: IPV research predominantly on men’s violence against women; justified by perceived gender-based disadvantage for women victims
  • Early debates: Steinmetz (1978) highlighted women’s IPV against men; later literature examined gender symmetry in physical IPV, especially in low-severity, nonclinical samples
  • Nationally representative findings: Some studies (e.g., Archer, 2000; Straus, 1980) show comparable rates of physical IPV in heterosexual couples in some contexts, but symmetry is typically observed only for low-severity acts and often not for severe violence
  • Severity and outcomes: Women generally experience more severe injuries, greater likelihood of medical care, hospitalization, mental health issues, and productivity losses
  • Economic impact context: IPV costs include medical treatment, mental health services, productivity losses, and lost work time; prior CDC estimates: direct health care costs ≈ $4.1B (1995) and productivity losses ≈ $1.8B (1995)
  • Research aim: Determine whether cost symmetry exists when considering both women’s and men’s IPV victimization, by estimating costs per person victimized by the opposite gender

Data source and sample

  • Data source: National Violence Against Women Survey (NVAWS), a national telephone survey of violence experiences
  • Time frame: November 1995 – May 1996
  • Sample size: approximately 8,000 women and 8,000 men
  • Population: adults aged 18+ in all 50 states and DC; random-digit dialing; one adult per household (selected by most recent birthday)
  • Response rates: Men 68.9% participation; Women 72.1% participation
  • Focus: heterosexual relationships only for this analysis; excludes respondents with current or past same-gender partnerships
  • Exclusions: 65 men with current/past male partners; 79 women with current/past female partners
  • Descriptive sample: Table 1 provides demographics for Men (N≈7,934) and Women (N≈7,920)
    • Key demographics (overall): predominantly White, mid-40s, married, employed full-time, high school education or higher
    • Differences: few significant gaps across demographic modalities except for certain variables (age shows significance; most others do as well)

Measures

  • IPV Victimization measure
    • Based on 12 items from the Conflict Tactics Scales (CTS; Straus, 1979) covering physical aggression (e.g., pushed, slapped, beaten, choked, etc.)
    • Respondents reported whether anyone had engaged in each tactic and identified the perpetrator’s relationship
    • Classification: victims if they experienced at least one physical assault by an intimate partner (current/former spouse, live-in partner, boyfriend/girlfriend, or date)
    • Reliability: Cronbach’s alpha for IPV scale =
    • Men:
    • Women:
  • Injury assessment
    • Among those with IPV history, detailed questions about the most recent incident and injury types
    • Injury severity categories captured (brain/spinal, broken bones/burns, lacerations/knife wounds, scratches/bruises/welts, etc.)
  • Service utilization and productivity loss measures
    • Mental health services: number of visits to mental health professionals; days off from work; days off from childcare/household chores; days off from school/volunteer/social activities
    • Medical services (injury-related): emergency department (ED) visits, outpatient hospital visits, inpatient hospital days, physician visits, dental visits, ambulance, physical therapy, home care/visiting nurse
  • Costs and economic inputs
    • Unit costs: derived from CDC (Costs of Intimate Partner Violence Against Women in the United States, 2003)
    • Productivity costs: daily wage loss = 99;otherproductivitylosses=99; other productivity losses =68 per day
    • All cost estimates presented in 1995 dollars: 1995extdollars1995 ext{ dollars}
  • Analysis approach
    • Cost per person victimized by the opposite gender calculated by combining unit costs with average service use and the proportion of victims using each service
    • Separate cost components: mental health, productivity losses (work and non-work activities), and medical services
    • Statistical tests: t-tests for mean differences; chi-square tests for proportions
    • Population-level context: IPV victims’ experiences across gender lines, with a focus on physical IPV only (due to data limitations on sexual IPV among men)

Injury outcomes: prevalence and injuries by gender

  • Lifetime physical IPV prevalence (not living with a partner of same gender):
    • Men: 7.3 ext{ ext{%}} (N = 580 reporting lifetime IPV)
    • Women: 21.9 ext{ ext{%}} (N = 1,733 reporting lifetime IPV)
  • Proportion with at least one injury from the most recent incident among those with IPV history:
    • Men: 20.7 ext{%} (N = 120)
    • Women: 39.2 ext{%} (N = 679)
  • Injury type distribution among injured victims
    • General pattern: women more likely than men to report injuries across most categories
    • Exceptions: men more likely to report lacerations, knife wounds, or cuts
    • Specific percentages among those reporting injuries:
    • Brain/spinal cord injuries, internal injuries: Men 6.6 ext{ ext{%}}; Women 8.5 ext{ ext{%}}
    • Broken bones, burns, chipped/knocked-out teeth: Men 8.5 ext{ ext{%}}; Women 11.2 ext{ ext{%}}
    • Lacerations/knife wounds/cuts: Men 24.5 ext{ ext{%}}; Women 6.7 ext{ ext{%}}
    • Scratches/bruises/welts/swelling/sore muscles/sprains: Men 60.4 ext{ ext{%}}; Women 73.7 ext{ ext{%}}

Medical service utilization and productivity losses (overall, not injury-specific)

  • Mental health services utilization
    • Proportion reporting use: Men 16.9 ext{ ext{%}}; Women 21.7 ext{ ext{%}}
    • Average visits (among those who used services): Men 6.0extvisits6.0 ext{ visits} (range 0–27); Women 12.1extvisits12.1 ext{ visits} (0–97)
  • Productivity losses (total days, all activities)
    • Work days lost: Men 8.9extdays8.9 ext{ days}; Women 7.2extdays7.2 ext{ days}
    • Household chores/childcare: Men 8.4extdays8.4 ext{ days}; Women 8.3extdays8.3 ext{ days}
    • School: Men 6.3extdays6.3 ext{ days}; Women 6.2extdays6.2 ext{ days}
    • Volunteer activities: Men 4.7extdays4.7 ext{ days}; Women 9.3extdays9.3 ext{ days}
    • Social/recreational activities: Men 12.0extdays12.0 ext{ days}; Women 10.1extdays10.1 ext{ days}
  • Medical service utilization among IPV victims (injured vs. not injured in most recent incident)
    • ED visits (injured): Men average 1.1extvisits1.1 ext{ visits}; Women average 2.0extvisits2.0 ext{ visits}
    • Outpatient hospital visits (injured): Men 2.8extvisits2.8 ext{ visits}; Women 2.5extvisits2.5 ext{ visits}
    • Inpatient hospital days (injured): Men 0.6extdays0.6 ext{ days}; Women 1.7extdays1.7 ext{ days}
    • Physician visits (injured): Men 1.6extvisits1.6 ext{ visits}; Women 3.5extvisits3.5 ext{ visits}
    • Dental visits (injured): Men 0.3extvisits0.3 ext{ visits}; Women 5.2extvisits5.2 ext{ visits}
    • Ambulance trips (injured): Men 1.0exttrip1.0 ext{ trip}; Women 1.2exttrips1.2 ext{ trips}
    • Physical therapy visits (injured): Men 2.5extvisits2.5 ext{ visits}; Women 19.7extvisits19.7 ext{ visits}
    • Home care visits (injured): Men 0.0extvisits0.0 ext{ visits}; Women 2.0extvisits2.0 ext{ visits}
  • Interpretation: No significant gender differences in mean visits/days among those injured, suggesting similar care patterns for equivalent injuries; broader burden differences arise from variation in injury rates and incidence

Cost estimation methods and key results

  • How costs were computed
    • Medical services costs: unit costs from CDC (1995 dollars) multiplied by mean utilization and the proportion of victims using each service
    • Mental health costs: per-visit unit costs times visits; productivity costs: daily wage-loss components
    • Productivity losses: extWorkdaysimes99+extOtherdaysimes68ext{Work days} imes 99 + ext{Other days} imes 68 per person
  • Key unit-cost findings (per person, by victim gender and IPV direction)
    • Men victimized by a female partner (female-to-male IPV)
    • Mental health services: 80.1180.11 (approximately) per man
    • Productivity losses: 224.07224.07 per man
    • Medical services: 83.0083.00 total per man
      • Inpatient: 77.0077.00; Outpatient: 5.005.00
    • Women victimized by a male partner (male-to-female IPV)
    • Mental health services: 207.43207.43 per woman
    • Productivity losses: 257.34257.34 per woman
    • Medical services: 483.23483.23 total per woman
      • Inpatient: 429.73429.73; Outpatient: 54.0054.00
  • Total average cost per person with at least one physical IPV victimization
    • Men: 387.10ext(1995dollars)387.10 ext{ (1995 dollars)}
    • Women: 948.00ext(1995dollars)948.00 ext{ (1995 dollars)}
  • Overall conclusion on costs
    • The total average cost per person is higher for women than men, driven by higher IPV prevalence, greater injury rates, and more extensive service use among women
    • However, male victims, particularly in the context of female-to-male IPV, still incur meaningful costs, underscoring the need for inclusive definitions and services

Discussion and interpretation

  • Gender asymmetry in physical IPV outcomes
    • Lifetime IPV prevalence higher among women; injury rates higher among women; care-seeking and productivity losses greater among women
    • When considering rate of injury, gender differences in total costs become significant
  • Mental health service utilization as a key differentiator
    • Women reported more mental health service use and higher average visits, which contributes substantially to cost differentials
    • Possible reasons for higher female mental health utilization:
    • Higher victimization rate and injury burden
    • Economic factors (e.g., greater economic dependence)
    • Greater willingness to seek mental health care or lower treatment barriers
  • Economic and policy implications
    • Findings support including men in IPV prevention and treatment planning; avoid a double standard in recognizing and addressing IPV victimization regardless of gender
    • Economic burden includes direct medical costs and productivity losses; policy should address both direct care and societal productivity implications
  • Theoretical and practical implications
    • Results challenge a simple symmetry view; differences in consequences and functional impact suggest IPV is a gendered phenomenon in outcomes, not merely in perpetration rates
    • Calls for comprehensive definitions of IPV that encompass perpetration and victimization across genders to fully capture social and economic burden

Limitations and strengths

  • Key limitations
    • Small sample size of men victimized by physical IPV may limit precision in cost estimates and detection of gender differences in some cost components
    • Focus only on physical IPV due to limited data on sexual IPV among men; costs of other IPV forms not captured
    • Some costs not included or potentially underreported (e.g., intangible costs like pain, suffering; home care costs were infrequent and may be unreliable)
    • Reliance on self-reported victimization, injuries, and service use; potential reporting bias
    • Costs were computed based on the most recent IPV incident, which may not reflect all past episodes
    • Indirect health effects not captured (e.g., somatic symptoms not directly linked to IPV) may underestimate total costs
  • Strengths
    • Population-based, random sample for both women and men; first to assess costs of men’s IPV victimization in a broad, national sample
    • Inclusive approach to examining both directions of physical IPV (female-to-male and male-to-female)
    • Uses standardized measures (CTS) and CDC-unit cost inputs to enable comparability with other IPV cost studies
    • Highlights the importance of evaluating economic burden beyond prevalence and injury rates, incorporating mental health and productivity implications

Conclusions and practical implications

  • main takeaway: IPV costs are markedly asymmetric by gender, driven by higher prevalence and injury rates among women; male victims still incur meaningful costs, particularly in the context of female-to-male IPV
  • Recommendations for practitioners and policymakers
    • Develop and fund services that are responsive to male IPV victims in addition to female victims
    • Ensure prevention programs address both directions of IPV and tailor interventions to gender-specific needs and pathways to care
    • Consider the broader economic burden when designing IPV interventions, including productivity losses and mental health service needs
  • Final ethical note
    • Avoid minimizing the importance of any IPV victimization based on gender; both male-to-female and female-to-male IPV carry significant consequences and require appropriate support and prevention efforts

Appendix: Key numbers and references (Table summaries)

  • Table 1: Sample descriptives for Men (N ≈ 7,934) and Women (N ≈ 7,920)
    • Age: Men ~42.5; Women ~44.2
    • Marital status and employment patterns show high levels of marriage and full-time employment across groups; most are White and have at least high school education
    • Notable gender differences in some demographics were statistically significant
  • Table 2: Utilization of services and productivity losses (IPV victims, physical IPV)
    • Mental health service uptake higher among women; mean visits higher for women
    • Work and non-work productivity losses show gender differences across domains, with some domains showing larger losses for either gender depending on the activity
    • Medical service utilization higher among women for ED visits, inpatient admissions, and physician visits among those injured
  • Table 3: Average costs per person by gender and IPV direction (1995 dollars)
    • Men (N = 580) vs Women (N = 1,733): components of costs broken down into Mental health, Productivity losses, Medical services
    • Mental health: Men ≈ 80.11;Women≈80.11; Women ≈207.43
      a
    • Productivity losses: Men ≈ 224.07;Women≈224.07; Women ≈257.34
    • Medical services: Men ≈ 83.00(Inpatient83.00 (Inpatient77.00, Outpatient 5.00);Women≈5.00); Women ≈483.23 (Inpatient 429.73,Outpatient429.73, Outpatient54.00)
    • Total costs: Men ≈ 386.76;Women≈386.76; Women ≈948.00
  • References (selected): Archer (2000); Cantos, Neidig, & O'Leary (1994); CDC (2003); Steinmetz (1978); Tjaden & Thoennes (1998, 2000); Hyde (1986); O'Leary (2000); etc.
  • Note: All costs reported reflect 1995 dollars; unit costs and productivity multipliers were drawn from cited sources and methodologies described in the article