Mental and Physical Health and Intimate Partner Violence against Women: A Review of the Literature

"The Effects of Adolescent and Early Adulthood Intimate Partner Violence on Adult Socioeconomic Well-being"

Violent victimization disrupts lives and has the potential to undermine socioeconomic well-being. Intimate partner violence (IPV) is a particular concern because rates rise during adolescence to high rates in early adulthood. Prior literature has been hampered by specialized samples, short time-periods, and limited theoretical development. We draw from theorizing on victimization in the life course and the stress process model to analyze the Add Health data covering a twelve-year period. We find pathways from adolescent and early adult IPV are associated with reduced adult socioeconomic well-being. This provides evidence for the enduring effects of adversity on life course inequality.

Impacts of Male Intimate Partner Violence on Women: A Life Course Perspective

The nature and extent of the impacts of intimate partner violence (IPV) on victims are well documented, particularly male partner violence against women. However, less is known about how these impacts might change over time, including their legacy after women leave an abusive relationship and the lasting effects in their later lives. The purpose of this study was to examine women’s experiences of IPV at different stages over their life courses. Interviews with a cohort of 18 older women who had left an abusive relationship were analysed using thematic narrative analysis and the findings were presented according to trajectories, transitions, and turning points over their life courses. When in the relationship, the women experienced direct impacts on their physical, mental, social, and financial wellbeing. During separation, many experienced continued abuse and housing, legal, and financial stress. Life after separation was marked by loneliness, trauma, financial insecurity, and damaged relationships. Some women reached a turning point in their recovery through helping others. Understanding these impacts can inform interventions during each stage. Crisis support is critical when women are in an abusive relationship and during the dangerous phase of separation. Interventions can also assist women’s longer-term wellbeing and help them recover through post-traumatic growth.

Synergistic Effects of Psychological Intimate Partner Violence Exposure and Gender Discrimination on Postnatal Mental Health Trajectories

While the literature examining physical intimate partner violence (IPV) is extensive, the impact of psychological IPV on mental health during high-risk times such as the period following childbirth is not well understood. The current study examined associations between psychological IPV and the course and severity of women's postnatal mental health symptoms (depression, anxiety, and trauma symptoms). Both main effects of psychological IPV exposure and possible exacerbation by broader social victimization (i.e., gender discrimination) were considered. Participants were 76 mothers from a larger longitudinal study, who completed self-report measures of IPV, gender discrimination, and affective symptoms at 3, 6, 12, and 18 months postnatal. Hierarchical linear modeling revealed a main effect of psychological IPV on the course of trauma symptoms only. As hypothesized, gender discrimination moderated the effect of psychological IPV on all symptom trajectories in a synergistic manner. At moderate to high levels of gender discrimination only, psychological IPV predicted higher affective symptom severity and an escalating course of postnatal anxiety symptoms. These findings underscore the importance of expanding current conceptualizations of IPV impacts to incorporate relevant aspects of individuals' social-ecological context. Future directions and implications for prevention and intervention are discussed.

Strides Toward Recovery From Intimate Partner Violence: Elucidating Patient-Centered Outcomes to Optimize a Brief Counseling Intervention for Women

Women in the United States continue to experience intimate partner violence (IPV) at unprecedented rates, necessitating the development and implementation of personalized, effective healthcare-based interventions. Methods of developing patient-centered interventions for IPV should elicit the voice of the target population (i.e., women who experience IPV) while assuring that outcomes identified as important are incorporated into the refined intervention. This pilot study is part of a multiphase, larger study aiming to refine an IPV intervention and clinical outcome measurements prior to formal evaluation of the effectiveness of the intervention. Specifically, this study elucidates patient-centered outcomes identified by women who have experienced IPV. Women patients of the Veterans Health Administration (VHA) in New England participated in focus groups to provide feedback and desired outcomes of a new IPV intervention. Patient-centered outcomes were defined by the participants. Focus groups were transcribed and analyzed using conventional content analysis and matrix analysis. A total of 25 women participated in focus groups (n = 5) at two large VHA facilities. Participant feedback revealed five common themes related to desired outcomes. Women opined increased feelings of empowerment as a key outcome of engaging in an IPV intervention. Women desired increased social connectedness and support to be gained during treatment, citing providers and other survivors of IPV as exemplary sources. Self-esteem was viewed as critical to enhancing recovery, as was increased knowledge across domains of IPV (e.g., warning signs, the link between mental and physical health for self and children). Finally, women identified valued action and goal setting, such as achieving more independence, as an optimal outcome. Addressing IPV against women requires patient-centered interventions that specifically target the types of outcomes deemed important by the end users: women who experience IPV. Findings have implications for tailoring treatments for IPV and selecting measures that tap into women's desired outcomes.

Trends in Hospital Admissions for Intimate Partner Violence in Australian Mothers With Children Born From 1990 to 2009

This study aims to determine the prevalence, and trends over time, of Western Australian (WA) mothers who were victims of intimate partner violence (IPV) requiring hospital admission. The study investigated the prevalence of all mothers and the specific prevalence of Aboriginal and non-Aboriginal mothers. A population-based cohort study using de-identified linked health data of mothers of children born from 1990 to 2009 in WA was carried out. The prevalence of hospitalizations for IPV in mothers of children born in the period 1990-2009 (per 1,000 births) was calculated. Results indicate that the overall prevalence of hospital admissions for mothers assaulted 12 months prior to their child's birth month increased in the period 1990-2009, from 2.7 to 7.7 per 1,000 births. There was also an increase in the overall prevalence of hospital admissions of mothers who were assaulted 12 months prior to the birth month and 36 months after the birth month, from 8.9 per 1,000 births in 1990 to 19.4 per 1,000 births in 2009. In addition, being Aboriginal, having a mother <30 years of age, and being of low SES significantly increased the odds of having a mother with an IPV admission. This study highlights that while there has been an increase in the prevalence of IPV admissions for mothers of children born from 1990 to 2009 in WA, the level of prevalence has remained persistent for the last decade for the whole population. However, non-Aboriginal mothers have seen an increase in prevalence in the last decade. This increase is associated with the introduction of the Z63.0 code in International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM). This study highlights the importance of prioritizing groups for targeted early intervention and prevention as well as the need for culturally appropriate strategies to reduce the burden of interpersonal violence.

Tolerance of Violence against Women and the Risk of Psychosocial Distress in Humanitarian Settings in Northern Uganda

BACKGROUND

Violence against women (VAW) remains a public health concern, which can sometimes lead to mental or psychological stress among other negative consequences.

DATA AND METHODS

we fitted a binary logistic regression model on 657 respondents from host and refugee settings in three humanitarian districts (Adjumani, Obongi, and Lamwo) to examine the determinants of psychosocial stress.

RESULTS

experience of psychosocial distress is higher among refugees than host populations. Results indicate a higher proportion of respondents who ever experienced psychosocial stress in the 6 months preceding the survey among those who believed that a woman should tolerate violence (59% vs. 53%). Respondents who believed that a woman should tolerate violence had higher odds of experiencing psychosocial stress than their counterparts who believed a woman should not tolerate violence (OR = 6.86; 95%CI = 1.23-38.22). The likelihood to experience psychosocial stress was higher among females (OR = 6.94; 95%CI = 1.76-27.32), those with primary education (OR = 4.73; 95%CI = 1.24-18.00), and respondents with less than USD 2.7 as personal income one month before the survey (OR = 3.37; 95%CI = 1.32-8.62). Respondents who said that women should engage in income generation activities had higher odds to experience psychosocial stress (OR = 0.39; 95%CI = 0.17-0.89).

CONCLUSION

results suggest that income and positive attitudes toward female-led income generating activities act as protective measures against psychosocial distress. Given the associations between VAW and psychosocial distress, efforts aimed at prevention and response to VAW in humanitarian settings should integrate mental health and psychosocial support interventions.

Predicting pain among female survivors of recent interpersonal violence: A proof-of-concept machine-learning approach

Interpersonal violence (IPV) is highly prevalent in the United States and is a major public health problem. The emergence and/or worsening of chronic pain are known sequelae of IPV; however, not all those who experience IPV develop chronic pain. To mitigate its development, it is critical to identify the factors that are associated with increased risk of pain after IPV. This proof-of-concept study used machine-learning strategies to predict pain severity and interference in 47 young women, ages 18 to 30, who experienced an incident of IPV (i.e., physical and/or sexual assault) within three months of their baseline assessment. Young women are more likely than men to experience IPV and to subsequently develop posttraumatic stress disorder (PTSD) and chronic pain. Women completed a comprehensive assessment of theory-driven cognitive and neurobiological predictors of pain severity and pain-related interference (e.g., pain, coping, disability, psychiatric diagnosis/symptoms, PTSD/trauma, executive function, neuroendocrine, and physiological stress response). Gradient boosting machine models were used to predict symptoms of pain severity and pain-related interference across time (Baseline, 1-,3-,6- follow-up assessments). Models showed excellent predictive performance for pain severity and adequate predictive performance for pain-related interference. This proof-of-concept study suggests that machine-learning approaches are a useful tool for identifying predictors of pain development in survivors of recent IPV. Baseline measures of pain, family life impairment, neuropsychological function, and trauma history were of greatest importance in predicting pain and pain-related interference across a 6-month follow-up period. Present findings support the use of machine-learning techniques in larger studies of post-IPV pain development and highlight theory-driven predictors that could inform the development of targeted early intervention programs. However, these results should be replicated in a larger dataset with lower levels of missing data.

Intimate partner violence is associated with poorer maternal mental health and breastfeeding practices in Bangladesh

Exposure to intimate partner violence (IPV) can have profound adverse consequences on maternal and child health. This study aimed to: (1) identify factors associated with IPV during pregnancy and postpartum in Bangladesh; and (2) assess the associations between IPV and maternal mental health and breastfeeding practices. We used data from a cross-sectional survey of 2000 mothers with children <6 months in four districts in Bangladesh. We applied multivariable logistic regression models to examine factors associated with IPV and structural equation modelling to assess the inter-relationships between IPV, maternal common mental disorders (CMD, measured by Self-reporting Questionnaire ≥7) and breastfeeding practices. Overall, 49.7% of mothers experienced violence during the last 12 months and 28% of mothers had high levels of CMD. Only 54% of women reported early initiation of breastfeeding and 64% reported exclusive breastfeeding. Women were more likely to experience IPV if living in food-insecure households, being of low socio-economic status, having low autonomy or experiencing inequality in education compared with husbands (OR ranged from 1.6 to 2.8). Women exposed to IPV were 2–2.3 times more likely to suffer from high levels of CMD and 28–34% less likely to breastfeed their babies exclusively. The indirect path (the indirect effects of IPV on breastfeeding through CMD) through maternal CMD accounted for 14% of the relationship between IPV on breastfeeding practice. In conclusion, IPV is pervasive in Bangladesh and is linked to increased risks of CMD and poor breastfeeding practices. Integrating effective interventions to mitigate IPV, along with routine maternal and child health services and involving men in counselling services, could help both to reduce exposure to IPV among women and to contribute to better health outcomes for women and children.

The Interplay Between Poly-Victimization and Sexual Assault in Late Life in the Context of Life Course Perspective

The aim of this article is to explore the interplay between poly-victimization and sexual assault against women in late life (SAWLL) according to the life-course perspective. Two themes emerged from qualitative interviews with 18 experienced welfare and health care professionals who intervened in cases of SAWLL: sexual assault by a spouse co-occurring with other types of abuse within marital relationships, and sexual assault and other types of abuse by two or more perpetrators along the life course. In many cases, SAWLL is an expression of a broader experience of poly-victimization, which relates to vulnerability in old age.

IPV and Health Consequences Among CPS-Involved Caregivers: A Fixed Effects Analysis Stratified by Race and Ethnicity

Intimate partner violence (IPV) is a public health dilemma that disproportionately affects minority women in the United States. The present study utilized data from the National Survey of Child and Adolescent Well-Being (NSCAW II) to examine the longitudinal course of IPV outcomes reported by minority women involved with Child Protective Services (CPS). Our findings highlight the heterogeneity of the relationship between IPV and mental or physical health based on race/ethnicity. Nonetheless, additional research is necessary to investigate the impact of IPV severity on physical and mental health outcomes to ultimately facilitate race-specific interventions for women involved with CPS.

Non-communicable diseases among women survivors of intimate partner violence: Critical review from a chronic stress framework

A neurobiological framework of chronic stress proposes that the stress-response system can be functionally altered by the repeated presentation of highly stressful situations over time. These functional alterations mainly affect brain processing and include the dysregulation of the hypothalamic-pituitary-adrenal axis and associated processes. In the present critical review, we translate these results to inform the clinical presentation of women survivors of intimate partner violence (IPV). We approach IPV as a scenario of chronic stress where women are repetitively exposed to threat and coping behaviours that progressively shape their neurobiological response to stress. The changes at the central and peripheral levels in turn correlate with the phenotypes of non-communicable diseases. The reviewed studies clarify the extent of the impact of IPV on women's health in large (N > 10,000) population-based designs, and provide observations on experimental neuroendocrine, immune, neurocognitive and neuroimaging research linking alterations of the stress-response system and disease. This evidence supports the prevention of violence against women as a fundamental action to reduce the prevalence of non-communicable diseases.

Addressing Intimate Partner Violence Using Gender-Transformative Approaches at a Community Level in Rural Tanzania: The UZIKWASA program

Intimate partner violence (IPV) is recognized as an important public health and social problem, with far-reaching consequences for women's physical and emotional health and social well-being, yet little is known about how behavior change campaigns (BCCs) affect this type of behavior and other related abuses in Tanzania and in other sub-Saharan African countries. UZIKWASA is a civil society organization based in Pangani District in coastal Tanzania and since 2009 has conducted BCCs focused on promoting gender justice and effective leadership. As with other complex programs there is a question about how such approaches affect norms and practice in relation to violence against women and girls. Drawing on longitudinal research utilizing more than 1000 community diary entries (hearsay ethnographies) and qualitative methods using 20 in-depth interviews and 16 focus group discussions with women and men, and adolescent girls and boys, this article explores the ways in which UZIKWASA's program effects change. The findings reveal personal and community narratives about gender-based and IPV as forms of retributive justice and assertion of authority by men. Drawing on gender performance as an explanation for violence, the research revealed changes in norms and practice in relation to violence against women and girls. Thus, we argue that UZIKWASA is gender-transformative by addressing gender norms and the critical awareness among leaders and the community of the social construction and reconstruction of gender that creates the context for real impact on changes in behavior.

"My Sister Is the One That Made Me Stay Above Water": How Social Supports Are Maintained and Strained When Survivors of Intimate Partner Violence Reside in Emergency Shelter Programs

While social support is critical in helping intimate partner violence (IPV) survivors heal and build hope, social isolation is a frequent experience for survivors. For survivors residing in domestic violence (DV) emergency shelters, the isolation from social supports is often exacerbated by shelter rules and policies. This study uses a 20th century feminist framework to understand the ways in which social support networks are maintained and/or strained when survivors reside in DV emergency shelters. Among this sample of 76 survivors, 40 participants identified family members as their support system, with siblings and mothers most frequently identified, and 14 participants identified friends as their social support. Prior to entering the DV shelter, survivors reported that their support networks provided encouragement and motivation along with emotional support, financial and material support, and support with children. Participants spoke about the process of informing their support systems of the transition into a DV shelter, the positive and negative impacts of the transition on their support system, and the roles that frequent telephone calls and texts played in maintaining their support networks. Participants reported positive impacts of residing in a DV shelter including improved emotional and physical health, strengthened emotional relationships, and improved physical and emotional resource provision. For those participants reporting negative experiences, they frequently identified logistical barriers, including the inability to receive visitors at the shelter, the distance between them and their friends and family, and strict rules around curfew and child care. Our findings invite researchers and practitioners to consider further examination of best practices around programming that supports survivors in maintaining social supports while residing in shelter programs.

Intimate Partner Violence in Saudi Arabia: A Systematic Review

Intimate partner violence (IPV) is a serious public health issue at the global level, with cultural differences in its nature and prevalence. Most of the current evidence related to IPV comes from Western countries; however, there is a lack of evidence of IPV in developing countries such as Saudi Arabia. The issue of IPV has been investigated in Saudi Arabia only recently, and data have been inconsistent and inconclusive. Hence, we conducted a systematic review of the extant literature devoted to IPV prevalence, risk factors, and outcomes as well as Saudi women's help-seeking behaviors. Various databases, such as PubMed, CINAHL, Medline, PsycINFO, and reference lists of the reviewed studies, were searched to identify relevant studies by using different keywords. The review included 16 studies that met the inclusion criteria, which revealed several findings. There is no national representative prevalence study of IPV in the Saudi context. Various IPV definitions were used with limited evidence for the reliability and validity of the used IPV measures. IPV is a prevalent issue among Saudi women, but rates are comparable to those of other countries. There are various individual, relational, and sociocultural factors that increase women's vulnerability to IPV victimization. However, limited information is available regarding IPV protective factors. More importantly, IPV experiences negatively affect Saudi women's physical and mental health status. Saudi women rarely seek formal support for IPV. This review also highlights the lack of IPV data and inconsistencies in defining and measuring IPV. More rigorous research regarding IPV is needed to help develop relevant preventive and intervention programs.

Profiles of Emotion Regulation and Post-Traumatic Stress Severity among Female Victims of Intimate Partner Violence

Emotional dysregulation is a construct that has drawn substantial attention as a transdiagnostic contributing factor to the loss of health. Intimate partner violence (IPV) is a term used to describe physical, psychological, or sexual assault of a spouse or sexual partner. The aim of the study was to determine the variability of emotional dysregulation among women with different types of IPV revictimization and post-traumatic stress. The cross-sectional survey included 120 women attended by the Integrated Monitoring System of Gender Violence of Madrid, Spain, due to a gender violence complaint. The presence of post-traumatic stress disorder (DSM 5 criteria), emotional dysregulation (Emotional Processing Scale (EPS)), childhood trauma, and type of revictimization were evaluated. Cluster analysis found three profiles of emotional regulation: Emotionally Regulated, Avoidance/Non-Impoverished, and Emotional Overwhelm. The results showed that the Emotional Overwhelm group was characterized by a general dysregulation of emotional experiences and a greater intensity of post-traumatic stress symptoms. In addition, women who have suffered several episodes of IPV by different partners showed a differential pattern of emotional regulation than the rest of the victims that entailed greater psychopathology. Findings confirm that emotional dysregulation is a critical pathway to the decrease of health among IPV victims.

"There's no place like home": Examining the associations between state eviction defense protections and indicators of biopsychosocial stress among survivors of intimate partner violence

Housing instability is prevalent among intimate partner violence (IPV) survivors and a source of biopsychosocial stress among this population. Eviction policies play an important role in determining housing instability of IPV survivors. However, few studies have investigated whether state-level policies that prevent evictions lessen vulnerability to biopsychosocial stress among IPV survivors. This study examined the relationship between state eviction defense policy and indicators of biopsychosocial stress among 6577 IPV survivors. State-level data on IPV-related housing policies were from a compendium on homelessness and violence. Individual-level data were collected from the National Intimate Partner and Sexual Violence Survey (NISVS), a nationally representative study of noninstitutionalized U.S. women and men from Wave 1 (2010). Multilevel regression models were conducted to investigate associations between the presence of an eviction defense policy and indicators of biopsychosocial stress (i.e., headaches, sleeping, safety concerns and PTSD symptoms). Stratified multilevel modeling was conducted to examine differences in the policy-stress associations across racial and ethnic groups and gender. Nearly 26% of states had an eviction defense policy for IPV survivors. Overall, residing in a state with an eviction defense policy (vs. none) was associated with no reports of frequent headaches (B [95% CI] = -0.21 [-0.41, -0.01], p < .05). For non-Hispanic Black survivors, residing in a state with an eviction defense policy (vs. none) was associated with reduced likelihood of reporting safety concerns (B [95% CI] = -1.36 [-2.16, -0.56], p < .001) and PTSD symptoms (B [SE] = -1.91 [-2.82, -1.01], p < .000). Among men survivors, residing in a state with an eviction defense policy was associated with reduced likelihood of reporting safety concerns (B [95% CI] = -0.63 [-1.26, -0.01], p < .05). State housing policies are important protective policies for IPV survivors. For IPV survivors, the eviction defense policy may interrupt the psychological sequeale of IPV and housing instability.

Attitudinal Acceptance of Intimate Partner Violence and Mental Health Outcomes for Female Survivors in Sub-Saharan Africa

While current literature evidences a strong association between gender-based violence exposure and adverse mental health outcomes, few studies have explored how attitudinal acceptance of intimate partner violence (IPV) might impact this relationship. This analysis employed data from 13–24-year-old females as part of the Violence Against Children Surveys in Nigeria, Uganda, and Malawi. Mental health status, defined by the Kessler Screening Scale for Psychological Distress, and suicide ideation served as outcome measures. Predictors of interest included lifetime experiences of IPV and attitudinal acceptance of IPV. Country-stratified logistic and ordinary least squares regressions were used to predict outcomes and included interactions between violence exposure and attitudinal acceptance of IPV. Violence exposure was associated with increased symptoms of mental distress and increased suicide ideation in all countries. Among those who experienced IPV, exhibiting attitudinal acceptance of IPV was associated with improved mental health in Nigeria and Malawi. IPV tolerance conferred lower odds of suicide ideation following IPV exposure in Nigeria. The findings suggest that programs aiming to reduce attitudinal acceptance of IPV must consider how these changes may interact with women’s exposure to IPV.

Associations of Emotional, Physical, or Sexual Intimate Partner Violence and Depression Symptoms Among South African Women in a Prospective Cohort Study

Violence against women remains a significant public health problem globally. The majority of longitudinal studies documenting the negative impact of intimate partner violence (IPV) on the mental health of women come from high-income countries. The aim of this study was to investigate the longitudinal association between emotional, physical, or sexual IPV and depression symptoms among South African women in a prospective cohort study. Participants were 981 South African women enrolled in the Drakenstein Child Health Study-a cohort study investigating the early life determinants of child health. Interview data from four time-points (antenatal care visit, 6 months, 12 months, and 18 months postpartum) were included. The primary independent variable was self-reported emotional, physical, and sexual IPV in the past 12 months. Depressive symptoms were assessed at each time-point with the Edinburgh Postnatal Depression Scale (EPDS); a cutoff score of ⩾13 was used to define significant depression symptoms. We used pooled-multivariable logistic regression models to determine associations between the three different forms of IPV and significant depression symptoms while adjusting for time-fixed and time-updated covariates. The mean age of the sample at antenatal care visit was 27 years (standard deviation = 6.0). In the adjusted model including all forms of IPV and adjusting for sociodemographic and clinical characteristics, substance use, and childhood trauma, emotional (adjusted odds ratio [aOR] =1.55, 95% confidence interval (CI): [1.02, 2.34]; p = .039)] and sexual (aOR = 2.02, 95% CI: [1.10, 3.72]; p < .001) IPV were significantly associated with significant depression symptoms. The relationship between physical IPV and significant depression symptoms was not statistically significant (aOR = 0.68, 95% CI: [0.44, 1.05]; p = .485). Our study confirms findings from high-income countries of the association between IPV and depressive symptoms among women in South Africa. Routine screening for IPV, including emotional IPV and intervention programs for IPV among women, is needed in South Africa.

Nonverbal Response Cards Reduce Socially Desirable Reporting of Violence Among Adolescents in Rural Burkina Faso: A Randomized Controlled Trial

PURPOSE

Accurate measures of violence are difficult to obtain from self-reported data because of stigmatization and social undesirability of the topic. Most methods that attempt to reduce such biases require literacy and either remove the benefits of interviewer guidance or do not give individual-level results. We tested a low-tech nonverbal response card that avoids revealing interviewees' responses to interviewers while retaining interviewer support among adolescents in communities with very low educational attainment.

METHODS

As part of a broader health questionnaire, we asked a sample of 1,644 adolescents, aged 12-20 years, in northwestern Burkina Faso about their experiences of physical and sexual violence. We randomized participants to either a conventional verbal response arm or a nonverbal response card arm where respondents' answers were unspoken and not displayed to interviewers. We first evaluated response validity and reliability in each arm, then compared prevalence rates across arms and evaluated whether any differences varied by respondent characteristics using regression models.

RESULTS

The level of internal reliability of responses among nonverbal respondents was similar to or greater than that of verbal respondents. Nonverbal respondents reported similar patterns of physical assault and sexual debut as verbal respondents but significantly higher levels of sexual assault and forced sex. These differences were broadly similar across sample subgroups defined by age, gender, proneness to social desirability, and mental health.

CONCLUSIONS

Nonverbal response cards offer a practical and beneficial method for reducing underreporting of stigmatized and traumatic experiences while maintaining data quality in low-literacy populations.

Intimate Partner Violence, Police Involvement, and Women's Trauma Symptoms

This study examined whether police involvement in intimate partner violence (IPV) incidents is associated with women's trauma symptoms. Participants were 95 women recruited from domestic violence shelters. Women reported on their trauma symptoms, the frequency of IPV victimization, the use of a weapon during IPV, and police involvement over the year following shelter departure. Police involvement in IPV was associated with higher levels of reexperiencing trauma symptoms 1 year after shelter departure, even after controlling for baseline trauma symptoms, the frequency of IPV, and the use of a weapon during IPV. Women's race and ethnicity did not moderate the results. These findings suggest police involvement in IPV incidents may be associated with higher levels of trauma symptoms experienced by women. Further investigation into law enforcement practices and policies to help reduce women's distress is needed.

Sleep and Interpersonal Violence: A Systematic Review

Sleep disturbance is a significant public health issue that disproportionately affects survivors of interpersonal violence (IPV). This systematic review presents data on the relationship of IPV and sleep. Inclusion criteria for this review were studies that included subjects 18 years of age or older, used an IPV measure and sleep disturbance measure, and were published in a peer-reviewed journal in English. A total of 23 articles met full inclusion criteria and were included in the present review. Studies were largely cross sectional, were conducted in a wide range of clinical and nonclinical samples, and utilized a variety of measures to assess IPV (sexual violence, physical violence, or psychological aggression perpetrated by an intimate partner or sexual or physical violence by any perpetrator in childhood or adulthood) and sleep disturbances (both general sleep disturbance excluding specific sleep disorders and the two specific sleep disorders of insomnia and nightmares). The findings examined the prevalence and association of sleep disturbance in IPV samples from population and community studies, the prevalence and association of sleep disturbance in IPV studies, and the associations between post-traumatic stress disorder and sleep disturbance in IPV samples. All studies identified a relationship between IPV and sleep disturbance. The results of this review provide important information for clinicians, researchers, and policy makers on the prevalence of and relationship between IPV and sleep disturbance.

Exploring Intimate Partner Violence Before, During, and After Pregnancy in Bangladesh

Intimate partner violence (IPV) against pregnant or postpartum women is known to have multiple detrimental effects on women and their children. Although results from past research suggest much continuity in trajectories of IPV, it is unclear whether pregnancy interrupts or augments these patterns. Little is known about how physical, sexual, and psychological IPV change and overlap throughout a woman's transition to parenthood. Relying on population-based data, this study examines the prevalence, co-occurring nature, and the changing patterns of physical, sexual, and psychological IPV before, during, and after pregnancy in Bangladesh. Cross-sectional survey data were collected between October 2015 and January 2016 in the Chandpur District of Bangladesh from 426 new mothers, aged 15 to 49 years, who were in the first 6 months postpartum. IPV was assessed with a validated set of survey items. The frequencies of different types of IPV victimization according to the period of occurrence were calculated separately and in a cumulative, co-occurring manner. The prevalence of physical IPV before, during, and after pregnancy was 52.8%, 35.2%, and 32.2%, respectively. The comparative figures for psychological IPV were 67.4%, 65%, and 60.8%, and for sexual IPV were 21.1%, 18.5%, and 15.5%, respectively. The results demonstrate a notable continuity in IPV victimization before, during, and after pregnancy. Psychological IPV is the only type to exhibit a significant reduction during and after pregnancy, compared with before pregnancy, but it commonly overlaps with physical IPV, which shows a significant change during pregnancy and little change in the postpartum period. At the same time, pregnancy and childbirth offer little protection against IPV for women in relationships characterized by psychological or sexual victimization, both of which commonly overlap with physical IPV. Results reinforce the need to conduct routine screening during pregnancy to identify women with a history of IPV and to offer necessary help and support.

Empowering Through Psychodrama: A Qualitative Study at Domestic Violence Shelters

Psychodrama is a therapeutic method in which the stage is used to enact and reenact life events with the aim of instilling, among other positive changes, hope and empowerment in a wide range of populations suffering from psychological duress. The therapeutic process in psychodrama moves away from the classic treatment of the individual in isolation to treatment of the individual in the context of a group. In domestic violence situations, in which abusive men seek to socially isolate their victims from family and friends, the social support that psychodrama provides can positively influence the psychological health and well-being of the participants. This qualitative study examines the manner in which psychodramatic treatment can empower abused women residing in domestic violence shelters and help them regain control of their lives. An action research study of domestic violence survivors living in a women's shelter in Israel, over a 12-month period, demonstrates the role of psychodrama therapy in promoting the reduction of anxiety, stress, guilt, and self-blame, while reinforcing perceptions of self-worth and confidence. These findings contribute to our understanding of the potential of psychodrama in helping reshape life roles and reframe experiences within a creative process, with the aim of facilitating a transition from powerlessness to powerfulness among vulnerable populations.

Modelling collective action to change social norms around domestic violence: social dilemmas and the role of altruism

Interventions promoting collective action have been used to prevent domestic violence in a range of settings, but their mechanisms of operation remain unclear. We formalise and combine feminist theoretical approaches to domestic violence into a game-theoretic model of women's collective action to change gendered social norms and outcomes. We show that social norms create a social dilemma in which it is individually rational for women to abstain from action to prevent domestic violence among neighbours, but all women suffer negative consequences if none take action. Promoting altruism among women can overcome the social dilemma. Discouraging women from tolerating domestic violence, imposing additional external punishment on men for perpetrating violence, or lowering costs to women of taking action against violence may not work or even backfire. We invite researchers on community mobilisation to use our framework to frame their understandings of collective action to prevent domestic violence.

The syndemic effects of mental ill health, household hunger, and intimate partner violence on adherence to antiretroviral therapy among pregnant women living with HIV in Yaoundé, Cameroon

Background

This research advances understanding of interrelationships among three barriers to adherence to antiretroviral therapy (ART) among pregnant women living with HIV (WLWH) in Cameroon: probable common mental disorders (CMD), intimate partner violence (IPV), and hunger.

Methods

The sample included 220 pregnant WLWH in Cameroon. Multivariable modified Poisson regression was conducted to assess the relationship between IPV, hunger, and CMD on ART adherence.

Results

Almost half (44%) of participants recently missed/mistimed an ART dose. Probable CMD was associated with greater risk of missed/mistimed ART dose (aRR 1.5 [95% CI 1.1, 1.9]). Hunger was associated with greater risk of missed/mistimed ART dose among those who reported IPV (aRR 1.9 [95% CI 1.2, 2.8]), but not among those who did not (aRR 0.8 [95% CI 0.2, 2.3]).

Conclusion

Suboptimal ART adherence, CMD, and IPV were common among pregnant WLWH in Cameroon. Pregnant WLWH experiencing IPV and hunger may be especially vulnerable to suboptimal ART adherence.

Investigating the prevalence of intimate partner violence victimisation in women presenting to the emergency department in suicidal crisis

OBJECTIVE

To investigate the prevalence of intimate partner violence (IPV) and frequency of victimisation questioning by hospital staff in women presenting to EDs for suicide-related complaints and injuries.

METHODS

A cross-sectional survey design was used to assess IPV and ED experiences among women with a recent (<18 months) suicide-related presentation to EDs within six Local Health Districts across New South Wales. Women aged 16 years and over, residing in participating health districts were recruited in-person by hospital staff, or via Facebook advertisements. Variables assessed included demographic characteristics, psychosocial assessment coverage and exposure to IPV (Composite Abuse Scale [Revised]-Short-Form). Binary logistic regression was used to test for independent associations between variables on victimisation questioning by hospital staff.

RESULTS

A total of 563 women completed questionnaires following presentation to the ED for a suicide attempt (n = 329; 58%) or suicide crisis (n = 234; 42%). Of these, 200 women (36%) reported IPV exposure in the 18 months prior and 141 women (25%) reported earlier lifetime victimisation. Of the 341 women with a history of IPV, 155 women (45%) were asked about victimisation by hospital staff. Younger age and lower socio-economic status were significantly associated with questioning (P = 0.03).

CONCLUSION

Findings suggest a large proportion of women seeking support for suicide in the ED are affected by IPV, although few are asked about abuse experiences. Victimisation is associated with complex health issues and heightened mortality risk, which carry important implications for patient-care. Findings support routine ED screening and can be applied to stratify risk within IPV responses.

Using Social Media to Explore the Consequences of Domestic Violence on Mental Health

A great deal of research has focused on the negative consequences of domestic violence (DV) on mental health. However, current studies cannot provide direct and reliable evidence on the impacts of DV on mental health in a short term as it is not feasible to measure mental health shortly before and after an unpredictable event like DV. This study aims to explore the short-term outcomes of DV on individuals' mental health. We collected a sample of 232 victims (77% female) and 232 nonvictims (gender and location matched with 232 victims) on Sina Weibo. In both the victim and nonvictim groups, we measured their mental health status during the 4 weeks before the first DV incident and during the 4 weeks after the DV incident. We used our proposed Online Ecological Recognition (OER) system, which is based on several predictive models to identify individuals' mental health statuses. Mental health statuses were measured based on individuals' Weibo profiles and messages, which included "Depression," "Suicide Probability," and "Satisfaction With Life." The results showed that mental health in the victim group was impacted by DV while individuals in the nonvictim group were not. Furthermore, the victim group demonstrated an increase in depression symptoms, higher suicide risks, and decreased life satisfaction after their DV experience. In addition, the effect of DV on individuals' mental health could appear in the conditions of child abuse, intimate partner violence, and exposure to DV. These findings inform that DV significantly impacts individuals' mental health over the short term, as in 4 weeks. Our proposed new data collection and analyses approach, OER, has implications for employing "big data" from social networks to identify individuals' mental health.

Social Determinants of Domestic Violence Among Saudi Married Women in Riyadh, Kingdom of Saudi Arabia

Intimate partner violence is a worldwide public health problem. The objectives of this study were to measure the prevalence and types of domestic violence, and to explore the association between social determinants (sociodemographic factors, husband-related factors, and social support) and violence against women by their intimate partner (husband). We conducted a cross-sectional survey in 18 randomly selected primary health care centers and 13 private institutions (teaching institutes, government offices, social welfare organizations) in Riyadh, Saudi Arabia. Female data collectors took interview from 1,883 married Saudi females aged 30 to 75 years. Interviews included sociodemographic information, reproductive health variables, and social support questionnaire. Violence was measured using modified Intimate Partner Violence Against Women questionnaire developed by the World Health Organization. Multivariate logistic regression analysis was conducted. The lifetime prevalence for any type of violence was 43.0% (n = 810). The most frequent type was controlling behavior (36.8%), followed by emotional violence (22%), sexual violence (12.7%), and physical violence (9.0%). Multivariate logistic regression analysis revealed that the following were associated with greater odds of reporting domestic violence: younger age 30 to 40 years (adjusted odds ratio [aOR] = 1.9, 95% confidence interval [CI] = [1.3, 3.0]), 41 to 50 years (aOR = 1.6, 95% CI = [1.1, 2.5]); lack of emotional support (aOR = 1.7, 95% CI = [1.2, 2.5]); lack of tangible support (aOR = 1.4, 95% CI = [1.1, 1.9]); and perceived poor self-health (aOR = 1.7, 95% CI = [1.0, 3.0]), husbands' poor health (aOR = 1.9, 95% CI = [1.2, 2.0]), and polygamy (aOR = 1.6, 95% CI = [1.5, 2.6]). Domestic violence occurs frequently in Saudi Arabia. Both social conditions and social relations are significantly associated with domestic violence against Saudi women. Furthermore, improvement in implementation of the local policies and multisectoral protection services can prevent women from domestic violence.

Moderating Effects of Resilience on Depression, Psychological Distress, and Suicidal Ideation Associated With Interpersonal Violence

Resilience has been found to attenuate the effects of negative mental health symptomology associated with interpersonal victimization; however, existing research has largely focused on resilience traits, such as individual cognitive and environmental factors that promote resilience. In addition, empirical knowledge on the extent to which resilience mitigates suicidal symptomology associated with interpersonal violence victimization is particularly limited. This study assesses whether the relationship between interpersonal violence (i.e., IPV and nonpartner sexual violence) and mental health symptomology (i.e., depression, psychological distress, and suicidal ideation) is moderated by resilience using a general population sample of women (N = 932). A cross-sectional, observational survey was administered in four U.S. cities (Baltimore, New York City, Philadelphia, and Washington, D.C.). Bivariate results indicated that women exposed to interpersonal violence reported significantly higher rates of suicidal ideation, depression, and psychological distress compared with women without exposure to interpersonal violence. Regression models revealed significant positive associations between interpersonal violence and depression, distress, and suicidal ideation, adjusting for sociodemographics. Resilience did not significantly moderate the relationship between interpersonal violence victimization and any associated mental health outcomes. However, subgroup analyses reveal significant interaction effects between resilience and IPV within specific racial and ethnic minority subgroups, suggesting that attenuating effects of resilience on mental health symptoms (i.e., depression and psychological distress) associated with IPV likely vary across race and ethnicity. Implications for future research and clinical interventions focused on resilience among survivors of interpersonal violence are discussed.

Posttraumatic stress and depression among women in Kenya's informal settlements: risk and protective factors

Background: Approximately 56% of Kenya´s population resides in informal settlements (UN-Habitat, 2016). Female residents experience a range of psychosocial stressors including chronic poverty and high rates of interpersonal violence. Despite evidence that this population has some of the worst physical health outcomes in the country (APHRC, 2014), few studies have evaluated their mental health status and its correlates. Objective: The purpose of this study was to identify risk and protective factors associated with mental health problems (posttraumatic stress & depression) among women living in informal settlements in Kenya. Hypothesized risk factors included economic stress, a history of experiencing childhood abuse and sexual violence, as well as partner-perpetrated psychological and physical abuse. Hypothesized protective factors were supportive relationships with family members and friends and having a sense community connection. Method: Local community health workers were trained to collect data via individual interviews using validated measures. Participants were recruited using systematic random sampling in two informal settlements in Nakuru County. We used path analysis to test the hypothesized model among a sample of 301 women. Results: The model had an excellent fit (χ2 = 13.391, df = 8, p =.099; GFI =.99; CFI =.99; RMSEA =.05) and explained 25% of the variance in PTSS and 28% of the variance in depression. All predictor variables except support from friends were statistically significant in the expected direction. Specifically, economic stress, childhood abuse, sexual violence, as well as physical and psychological abuse from one´s partner had significant positive associations with PTSS and depression. Having supportive family members and a sense of being part of the community had significant negative associations with symptoms. Conclusions: Results highlight the importance of addressing intimate partner and other forms of interpersonal violence in these settings and hold implications for tailoring interventions for this marginalized population.

Intimate Partner Violence against Women with Disabilities in Spain: A Public Health Problem

Violence against women with disabilities is a social problem with important consequences for their physical and mental health. The World Health Organization (WHO) declared violence against women as a public health priority issue in 1996 and the fact that violence is used by the intimate partner and upon women with disabilities exacerbates the situation. Therefore, this is an issue that must be addressed from a public health viewpoint. Violence is studied from various aspects: Physical, psychological, sexual, or social control, and its multiple consequences in women's health and the use of health services. In this perspective, with the data from the VI Violence against Women Macro-survey 2019 (VWM-2019) and adjusted to Spain, this study examines the incidence of intimate partner violence and its consequences in the health of women with disabilities and its impact on health services. Using binary logistic regression, the greater vulnerability of this group to these attacks is stated and the need to address this issue to improve the health of these people is brought to light.

Firearm exposure and the health of high-risk intimate partner violence victims

RATIONALE

The negative physical and mental health consequences of intimate partner violence (IPV) have been well-documented, as those who are exposed to trauma experience more physical health issues. Further, an abuser's direct access to a firearm drastically increases the risk for fatality, which can exacerbate ongoing stress and trauma in an abusive relationship. However, very little research has investigated the intersection of exposure to firearms and adverse health outcomes in the context of IPV.

OBJECTIVE

This study investigates the sensitivity of firearm exposure in IPV contexts by examining if abusive partner firearm ownership-regardless of actual use of a gun in the abuse-is associated with negative health outcomes.

METHODS

The research team administered questionnaires to IPV victims (N = 215) from six domestic violence shelters across rural and urban locations in a single state.

RESULTS

Having an abusive partner who owned a firearm was associated with significantly worse physical health-above and beyond IPV experienced in the relationship. Even so, IPV involving firearms was not significantly associated with physical health beyond partner firearm ownership. The relationship between partner firearm ownership and negative health outcomes was primarily attenuated by sleep disturbances among victims.

CONCLUSIONS

The results provide initial information about the role that firearms play in adverse victim health beyond injuries (e.g., gunshot wounds) and fatalities.

Breaking the Taboo: Sexual Assault in Late Life as a Multifaceted Phenomenon-Toward an Integrative Theoretical Framework

Sexual assault (SA) in late life has been receiving growing attention over the past two decades. It is directed primarily against older women and has been the least frequently reported form of abuse. Despite the growing awareness and body of knowledge on this phenomenon, the theoretical framework is still limited. Therefore, the aim of the present article is to suggest a theoretical conceptualization of the multifaceted phenomenon of sexual assault against women in late life (SAWLL). This conceptualization has been developed through several stages: (a) identification of three grounded fields of inquiry that are relevant to SAWLL: SA, elder mistreatment, and intimate partner violence; (b) classification of SAWLL along four paths: (1) ongoing SA in the context of lifelong IPV; (2) SA beginning in old age in the family within the community, involving spouses, family members, caregivers, dating mates, and so on; (3) ongoing SA, continuing in institutions, perpetrated by family members; and (4) SA in institutions, beginning in old age, relating to staff, residents, and family members; (c) We suggest three additional theoretical perspectives: trauma, a life-course perspective, and social constructionism, which provide further in-depth knowledge for understanding SAWLL. The combination of the three abovementioned stages composes an integrative theoretical framework, addressing SAWLL as a multifaceted phenomenon.

Intimate Partner Violence and Women's Mental Health: The Mediating Role of Coping Strategies Among Women Seeking Help From the Police

Many variables explain the link between intimate partner violence (IPV) and its impact on women's mental health. This proposition is mostly from samples drawn from battered women's shelters, batterer intervention programs (BIPs), emergency rooms, and medical clinics. We know little about the psychological well-being of women who report abuse to police departments. This study used data from case records of women who experience IPV and sought help from a city police station located in the southwest United States. These case records were examined to identify how sociodemographic characteristics of age, ethnicity, marital status, financial dependence, resources of social support, and coping strategies related with type and number of IPV incidents as well as mental health symptoms. The sample consisted of 154 women, majority of whom experienced physical violence (70.1%), sexual violence (9.1%), emotional violence/stalking (14.9%), and combined, that is, reporting more than one (5.8%). Approximately 67.5% of the women reported some mental health symptoms. Social support and coping strategies significantly distinguished women's experience of mental health symptoms. Unexpectedly, the current data indicate that women who scored higher in perceived social support significantly reported more mental health symptoms. Coping strategies mediated the relationship between IPV and mental health symptoms. The findings suggest that availability of coping resources may mitigate repeated IPV and modify the impact of mental health. In discussing prevention and intervention efforts with women who have experienced or are at risk of experiencing IPV, practitioners can help women employ empowering coping strategies that are built on their resilience. In addition, mental health professionals working with the police, especially in community policing setting, can achieve promising outcomes for women experiencing violence.

Complex PTSD in survivors of intimate partner violence: risk factors related to symptoms and diagnoses

BACKGROUND

In 2018, the World Health Organization proposed a new diagnosis entitled Complex Posttraumatic Stress Disorder (CPTSD) in the ICD-11. It is a diagnosis that encompasses the classic symptoms of PTSD, along with symptoms of disturbances in self-organization (DSO). Although this disorder has been studied in several countries and populations, research on the population of women survivors of intimate partner violence (IPV) is scarce.

OBJECTIVES

1) To analyse the prevalence of CPTSD and PTSD according to ICD-11 criteria; 2) To analyse the associations between CPTSD symptomatology and severity of violence, level of fear, resilience and strategies of emotion regulation; 3) To analyse which risk factors (severity of violence, level of fear, resilience and strategies of emotion regulation) may differ between female survivors with CPTSD or PTSD.

METHOD

162 women IPV survivors who completed a socio-demographic and violence-related interview, as well as questionnaires to assess PTSD and CPTSD, severity of violence, resilience and emotion regulation strategies.

RESULTS

The results showed a higher prevalence of CPTSD (39.50%), compared to PTSD (17.90%). Moreover, a high level of fear was related to re-experiencing in the here and now, avoidance, current sense of threat and disturbances in relationships. Low levels of resilience and maladaptive emotion regulation strategies such as expressive suppression were related to affective dysregulation, negative self-concept and disturbances in relationships. Finally, the results showed that maladaptive emotion regulation strategies differentiated between meeting CPTSD and PTSD criteria in women survivors of IPV.

CONCLUSION

The findings of this study indicated that CPTSD was twice as prevalent as PTSD within the sample. Moreover, maladaptive emotion regulation strategy as expressive suppression was the main variable related to experiencing CPTSD, in contrast to PTSD. These findings may have important implications for the design of specific treatments aimed at women survivors of IPV, who also suffer CPTSD.

Violence against women in heterosexual couples: A review of psychological and medico-legal considerations

Intimate partner violence against women (IPVAW) is the most pervasive violation of women's rights worldwide, causing devastating lifelong damage. Victims can suffer physical, emotional or mental health problems, and experience detrimental effects in social, psychological and relational health with their families, especially children. Due to the complexity regarding violence against women in heterosexual couples, it is important to make a clear distinction between psychological and physical mistreatment, which also includes psychological violence. This differentiation is important in determining different emotional and psychological aspects of mistreatment in order to understand the reasons why some women stay in such relationships and to explain the personality profiles of victims and perpetrators. In this short narrative review, we have combined perspectives of depth psychology and attachment theory from studies on trauma, traumatic bonds and the perpetrator/victim complex in gender violence. We have also considered the growing literature on IPVAW as it relates to the medico-legal field. Our search strategy included intimate partner violence, attachment styles, risk factors and the victim/perpetrator relationship. Distinguishing the different types of IPVAW is a necessary step in understanding the complexity, causes, correlations and consequences of this issue. Above all, it enables the implementation of effective prevention and intervention strategies.

Exploring the Prevalence and Correlates Associated With Intimate Partner Violence During Pregnancy in Bangladesh

Intimate partner violence (IPV) during pregnancy is known to have multiple detrimental consequences for the woman and potentially for her unborn child. However, little is known about the nature and extent of IPV during pregnancy, particularly in developing countries, which compromises efforts to address the problem. Relying on population-based data, this article examines the extent, patterns, and correlates associated with physical, sexual, and psychological IPV during pregnancy in Bangladesh. Cross-sectional survey data were collected between October 2015 and January 2016 from 426 new mothers, aged 15 to 49 years, who were in the first 6 months postpartum. IPV was assessed with a validated set of survey items. Multivariate logistic regression analyses were conducted to evaluate correlates associated with different types of IPV. Overall, 66.4% of women experienced any IPV during pregnancy. The prevalence of physical, sexual, and psychological IPV was 35.2%, 18.5%, and 65%, respectively. These forms of IPV often overlap, particularly physical and psychological IPV. Pregnant women who report limited social support and have controlling husbands are at significantly increased risk for all three types of IPV during pregnancy. Women who cling to traditional gender roles and those with low self-esteem exhibit increased risk for physical and psychological IPV during pregnancy. Psychological IPV during pregnancy is also correlated with low decision-making autonomy and childhood exposure to violence. Women whose husband's demand a dowry at marriage are at increased risk of sexual IPV during pregnancy. Results reinforce the need to conduct routine screening during pregnancy to identify women with a history of IPV and to be able to offer help and support. The findings also reinforce calls for gender equity and women's equal access to family and social resources thereby increasing women's social support networks, their self-esteem, and autonomy, and reducing their risk of IPV during pregnancy.

Expected years lived with intimate partner violence: a new approach for public health

BACKGROUND

Intimate Partner Violence against women (IPV) is a major public health problem. However, mainstream indicators used in public health are not designed to fully capture the pervasive and enduring impact of IPV.

OBJECTIVE

We propose a new indicator that considers the burden of IPV in women during their middle life years, estimating the number of years that women are expected to live under IPV, and provide estimates for 151 countries.

METHODS

Prevalence rates of physical and sexual IPV for a given year are taken from the Global Database on the Prevalence of Violence Against Women. Annual period life tables are constructed using data from the World Population Prospects. We use Sullivan's method to estimate partial life expectancy between the ages of 15 and 49 lived suffering from physical and sexual IPV in each country. The final indicator measures the number of years 15 to 49-year-old women are expected to live with IPV (YLIPV) in a given year.

RESULTS

Based on data from surveys representative of 92.0% of the global female population aged between 15 to 49, we find that ever-partnered women aged between 15 to 49 are expected to live 4.1 years (Low Bound: 2.3; Upper Bound: 7.1) suffering from violence during this age range. By regions, women are expected to suffer from IPV during 6.0 years (3.7-9.2) in Africa; 4.3 years (2.4-7.8) in Asia; 3.4 years (2.1-5.6) in Oceania; 2.6 years (1.5-4.2) in the Americas; and 1.7 years (0.9-3.1) in Europe.

CONCLUSIONS

YLIPV is a useful indicator to display the burden of IPV. Similarly to the mainstream public health indicators rationale, YLIPV accounts for the time women are exposed to IPV during their lifespan and it is standardized by age exposure.

Rape survivors in South Africa: analysis of the baseline socio-demographic and health characteristics of a rape cohort

BACKGROUND

Little is known about women who have experienced a recent rape, and how they differ from women without this exposure. Identifying factors linked to rape is important for preventing rape and developing effective responses in countries like South Africa with high levels of sexual violence.

OBJECTIVE

To describe the socio-demographic and health profile of women recently exposed to rape and to compare them with a non-rape-exposed group.

METHODS

The Rape Impact Cohort Evaluation Study (RICE) enrolled 852 women age 16-40 years exposed to rape from post-rape care centres in Durban (South Africa) and a control group of 853 women of the same age range who have never been exposed to rape recruited from public health services. Descriptive analyses include logistic regression modelling of socio-demographic characteristics associated with recent rape exposure.

RESULTS

Women with recent rape reported poorer health and more intimate partner violence than those who were not raped. They had a lower likelihood of having completed school (Odds Ratio [OR] 0.46 95% Confidence Interval (CI): 0.24-0.87) and dependence on a government grant as a main source of income (OR 0.61: 95%CI 0.49-0.77). They were more likely to live in informal housing (OR 1.88 95%CI: 1.43-2.46) or rural areas (OR 2.24: 95%CI 1.61-3.07) than formal housing areas - however they were also more likely to report full-time employment (OR 4.24: 95%CI 2.73-6.57).

CONCLUSION

The study shows that structural factors, such as lower levels of education, poverty, and living in areas of poor infrastructure are associated with women's vulnerability to rape. It also shows possible protection from rape afforded by the national financial safety net. It highlights the importance of safe transportation in commuting to work. Preventing rape is critical for enabling women's full social and economic development, and structural interventions are key for reducing women's vulnerability.

Physical and mental health of women exposed to intimate partner violence in the 10 years after having their first child: an Australian prospective cohort study of first-time mothers

OBJECTIVE

To investigate mental and physical health of mothers exposed to recent and early postpartum intimate partner violence (IPV) in the 10 years after having their first child.

DESIGN

Prospective pregnancy cohort study.

SETTING

Women were recruited at six metropolitan public maternity hospitals in Melbourne, Australia and followed up at 1, 4 and 10 years post partum.

STUDY MEASURES

Exposure to physical and/or emotional IPV was measured using the Composite Abuse Scale at 1, 4 and 10 years. At 10-year follow-up, mothers reported on physical and mental health, and functional health status.

PARTICIPANTS

1507 first-time mothers enrolled at mean of 15 weeks' gestation.

RESULTS

One in three women experienced IPV during the 10 years after having their first child. Women experiencing recent IPV (19.1%) reported worse physical and mental health than women not reporting IPV. Compared with women not reporting IPV, women experiencing recent IPV had higher odds of poor functional health status (Adj OR=4.5, 95% CI 3.2 to 6.3), back pain (Adj OR=2.0, 95% CI 1.4 to 2.9), incontinence (Adj OR=1.8, 95% CI 1.2 to 2.6), depressive symptoms (Adj OR=4.9, 95% CI 3.2 to 7.5), anxiety (Adj OR=5.1, 95% CI 3.0 to 8.6) and post-traumatic stress symptoms (Adj OR=7.2, 95% CI 4.6 to 11.1) at 10 years. Women with past IPV at 1 and/or 4 years (15.7% of the cohort) also had higher odds of physical and mental health problems. There was evidence of a gradient in health outcomes by recency of exposure to IPV.

CONCLUSIONS

Both recent and past exposure to IPV are associated with poor maternal physical and mental health 10 years after a first birth. Health services and advocacy organisations providing support to women need to be aware of the consistent relationship between IPV and a range of physical and mental health conditions, which may persist even after IPV appears to have ceased.

Prevalence, associated factors, and disclosure of intimate partner violence among mothers in rural Bangladesh

BACKGROUND

The purpose of this study is to assess the prevalence and associated factors of physical and sexual intimate partner violence (IPV) among married women of reproductive age in a rural population in northeast Bangladesh. In addition, we examined women's sharing and disclosure of violence experience with others.

METHODS

This cross-sectional study uses data from a household survey of 3966 women conducted in 2014 in the Sylhet District of Bangladesh. Interviews were completed in respondent's homes by trained local female interviewers.

RESULTS

Twenty-nine percent (28.8%, 95% CI 27.4-30.3%) of the women reported ever experiencing physical or sexual IPV by their spouse; 13.2% (95% CI 12.1-14.3%) reported physical or sexual IPV in the past year. Of the 13.2%, 10.1% (95% CI 9.2-11.1%) reported experiencing physical IPV and 4.6% (95% CI 4.0-5.3%) reported sexual IPV. In a combined model, the adjusted odds of having experienced physical or sexual IPV in the past year were higher for women who were raised in households with history of IPV (AOR = 4.35, 95% CI 3.26-5.80); women with no formal education (AOR = 1.76, 95% CI 1.30-2.37); women whose husbands had no formal education (AOR = 1.63, 95% CI 1.22-2.17); Muslim (AOR = 1.63, 95% CI 1.03-2.57); women younger than age 30 (AOR = 1.53, 95% CI 1.11-2.12); and women who were members of an NGO or microcredit financial organization (AOR = 1.38, 95% CI 1.04-1.82). Wealth, parity, number of household members, and pregnancy status (pregnant, postpartum, neither pregnant nor postpartum) were not associated with physical or sexual IPV after adjusting for other factors. Data on disclosure was available for women who reported experiencing physical violence in the last year; only 31.8% of victims told someone about the violence they had experienced and 1% reported to police, clerics, health workers, or a counselor altogether.

CONCLUSIONS

In rural northeast Bangladesh, a high proportion of women of reproductive age experience physical or sexual IPV. Women do not often speak of these experiences, especially to anyone outside of family. Interventions aimed at preventing future IPV and addressing current IPV should focus on women who witnessed IPV in childhood, as well as younger women and less educated couples.

TRIAL REGISTRATION

This study was registered as a Clinical Trial (Identifier: NCT01702402). https://clinicaltrials.gov/ct2/show/NCT01702402.

Childhood Trauma Exposure Exacerbates the Impact of Concurrent Exposure to Intimate Partner Violence on Women's Posttraumatic Symptoms

Although it is well established that intimate partner violence (IPV) is detrimental to women's mental health, it remains unclear to what extent symptoms can be attributed to the proximal effects of IPV exposure itself as opposed to more stable scarring effects or co-occurring risk factors. Heterogeneity in the magnitude of IPV effects further suggests that IPV-exposed individuals are differentially susceptible to disorder, and an investigation of moderating factors that may make women more vulnerable is warranted. We used a prospective longitudinal study of low-income mothers followed from 3 to 18 months postpartum to distinguish the concurrent mental health effects of IPV exposure from overall person-level IPV-mental health associations, as well as to test the moderating role of prior relational traumatic experiences in the form of childhood maltreatment. Multilevel modeling results demonstrated a unique concurrent association between increasing IPV and women's posttraumatic symptoms over time, even after controlling for an overall association between mean IPV and symptom levels. The effects of concurrent IPV were heightened in women who reported a history of childhood maltreatment. Model effects were medium to large, R² = .27-.35. The implications of these findings for the identification of and intervention with women at the highest risk for relational trauma-related mental health difficulties are discussed.

Intimate partner violence and hair cortisol concentration: A biomarker for HPA axis function

Intimate partner violence (IPV) is associated with various health issues, which may be explained by hypothalamic-pituitary-adrenal (HPA) axis dysfunction. There is a lack of research examining hair cortisol concentrations as a biomarker of HPA function alterations in the context of IPV with consideration to women's resilience. The study assessed whether IPV severity and resilience are associated with hair cortisol concentrations among Saudi women. This cross-sectional explanatory design used a convenience sample of 156 Saudi women from health care settings. A structured interview that included self-reported responses was performed, and hair samples were collected. The samples were analyzed using a salivary ELISA kit. The result showed a significant difference in hair cortisol concentration between women who have experienced IPV and women who have not experienced IPV. As well, controlling for depressive and post-traumatic stress disorder, IPV severity (β = -.281, 95 % CI = -.046 to -.003) and resilience (β = -.225, 95 % CI = -.038 to -.005) were significant predictors of lower hair cortisol concentrations. The effect of IPV severity on cortisol levels as a biomarker of HPA axis function could explain the poor health conditions among IPV survivors. This study highlights that IPV victimization leads to physiological changes and that hair cortisol is an indicator of women's health status.

Relationships between Trait Emotional Intelligence, mood states, and future orientation among female Italian victims of Intimate Partner Violence

Objective

Trait Emotional Intelligence (EI) has been associated with psychological outcomes in many conditions; however, it has received little attention in the field of Intimate Partner Violence (IPV). We explored the relationship between trait EI, mood states, and future orientation in a sample of Italian women victims of IPV.

Method

We recruited 409 help-seeking women who were victims of IPV. They completed the Trait Emotional Intelligence Questionnaire, Positive Affect-Negative Affect Schedule, Long-Term Personal Direction Scale, and Achievability of Future Goals Scale.

Results

The results showed that trait EI was associated with the future orientation of IPV victims both directly and indirectly through the mood states.

Conclusions

Our findings suggest potential paths for developing future psychoeducation methodologies designed at improving the quality of life of women IPV victims.

Prevalence and Correlates of Intimate Partner Violence Experience Among Partners of Naval Personnel in Lagos, Nigeria

BACKGROUND

Military personnel are one of the high risk groups recognized as perpetrators of intimate partner violence (IPV). Little is known about IPV experience of partners of naval personnel. This study determined the prevalence and correlates of IPV experience among partners of naval personnel.

METHODS

A cross-sectional survey of 435 male and female partners of naval personnel selected using the multistage sampling technique from the Navy Barracks in Lagos, Nigeria was conducted. Data were collected using a 40 item interviewer-administered questionnaire between August and September 2017. Univariate, bivariate and multivariate analysis was done to identify the predictors of partners' experience of IPV. Analysis was done at p-value ≤0.05.

RESULTS

The mean age of the respondents was 32.7 ± 7.86yrs and 72% were females. The lifetime prevalence of any IPV experience was 40.7% (with 74.4% of this experienced by females, CI: 0.81-1.91). The prevalence of controlling behaviour, psychological, sexual, economic and physical IPV were 31.5%, 16.3% 12.4%, 12.0% and 8.5% respectively. There was a positive association between experience of IPV and respondents' occupational status (p < 0.0001), lifetime experience of physical (p < 0.0001), sexual abuse (<0.0001), and history of childhood abuse (p < 0.0001). After adjustment for confounders, age (AOR = 2.11, CI = 1.07-4.16), occupational status (AOR = 4.56, CI = 2.30-9.02), history of childhood abuse (AOR = 2.10, CI = 1.26-3.49,) and partners' alcohol use (AOR = 3.41, CI = 1.38-8.39) remained significant factors influencing experience of IPV.

CONCLUSION

The prevalence of IPV experience among partners of naval personnel was high. Being unemployed, experience of abuse in childhood and having a partner who consumed alcohol increased partners' vulnerability to IPV. Naval personnel would benefit from marital counseling and training on non-violence conflict resolution strategies.

The association between intimate partner violence and low birth weight and preterm delivery in eastern Ethiopia: Findings from a facility-based study

OBJECTIVE

To determine the associations between intimate partner violence during pregnancy and low birth weight and preterm birth among women who gave birth in public hospitals in Harari region, eastern Ethiopia.

DESIGN

A cross-sectional study was conducted among women who gave birth in public hospitals in Harari region.

PARTICIPANTS

Women aged 16-45 years who gave birth in hospitals from November 2018 to April 2019.

SETTING

Two public hospitals in Harari regional state, eastern Ethiopia MEASUREMENT: Intimate partner violence was measured using a questionnaire adapted from the World Health Organization Multi-Country Study on Women's Health and Domestic Violence against Women. Binary and multiple logistic regression was performed to establish the association between intimate partner violence and low birth weight and preterm birth. Both crude and adjusted odds ratios with 95% confidence intervals were calculated. The level of significance was set at a p-value of <0.05.

RESULTS

In this study, 39% of women reported experiencing partner violence during their most recent pregnancy. The prevalence of preterm birth and low birth weight were found to be 18.9% and 12.01%, respectively. After adjusting for potential confounders, women who experienced any intimate partner violence during pregnancy were 1.62 times (AOR = 1.62, 95%CI= 1.22, 2.78) more likely to give birth prematurely and 1.37 times (AOR= 1.37, 95%CI=1.73, 2.57) more likely to have a low birth weight infant relative to women who did not experience intimate partner violence during pregnancy.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

The results underscore the need for including intimate partner violence prevention as an important strategy to reduce child mortality and morbidity. Screening pregnant women for intimate partner violence and providing support for women who have experienced violence might be helpful in tackling prematurity and low birth weight.

A Prospective Study of Exposure to Gender-Based Violence and Risk of Sexually Transmitted Infection Acquisition in the Women's Interagency HIV Study, 1995-2018

Background: Our objectives were to estimate the association of gender-based violence (GBV) experience with the risk of sexually transmitted infection (STI) acquisition in HIV-seropositive and HIV-seronegative women, to compare the STI risks associated with recent and lifetime GBV exposures, and to quantify whether these associations differ by HIV status. Methods: We conducted a multicenter, prospective cohort study in the Women's Interagency HIV Study, 1994-2018. Poisson models were fitted using generalized estimating equations to estimate the association of past 6-month GBV experience (physical, sexual, or intimate partner psychological violence) with subsequent self-reported STI diagnosis (gonorrhea, syphilis, chlamydia, pelvic inflammatory disease, or trichomoniasis). Results: Data from 2868 women who reported recent sexual activity comprised 12,069 person-years. Higher STI risk was observed among HIV-seropositive women (incidence rate [IR] 5.5 per 100 person-years) compared with HIV-seronegative women (IR 4.3 per 100 person-years). Recent GBV experience was associated with a 1.28-fold (95% confidence interval [CI] 0.99, 1.65) risk after adjustment for HIV status and relevant demographic, socioeconomic, and sexual risk variables. Other important risk factors for STI acquisition included unstable housing (adjusted incidence rate ratio [AIRR] 1.81, 95% CI 1.32-2.46), unemployment (AIRR 1.42, 95% CI 1.14-1.76), transactional sex (AIRR 2.06, 95% CI 1.52-2.80), and drug use (AIRR 1.44, 95% CI 1.19-1.75). Recent physical violence contributed the highest risk of STI acquisition among HIV-seronegative women (AIRR 2.27, 95% CI 1.18-4.35), whereas lifetime GBV experience contributed the highest risk among HIV-seropositive women (AIRR 1.59, 95% CI 1.20-2.10). Conclusions: GBV prevention remains an important public health goal with direct relevance to women's sexual health.

Trauma-Informed Practices to Address Intersections Between HIV and Intimate Partner Violence Among Women: Perspective of Community Service Providers

The current study aimed to document intervention practices, challenges, and training needs concerning the intersections between HIV and intimate partner violence (IPV) among community service providers (n = 12). A direct content analysis using the Trauma-Informed Approach was performed. Results revealed that community service providers need to create a safe, trusting, and mutually collaborative environment in which the intersections between HIV and IPV trauma are recognized, screened, and discussed with women. These results also highlight the need to consolidate partnerships between HIV and IPV organizations to provide relevant services that consider traumatic experiences. Overall, these findings support the urgent need to develop, implement, and evaluate targeted community interventions that jointly address HIV and IPV.