Intimate partner violence and new-onset depression: a longitudinal study of women's childhood and adult histories of abuse

Violence against older people and associations with mental health: A national probability sample survey of the general population in England

BACKGROUND

Official estimates of violence prevalence in England exclude older people. There are few studies of elder abuse and these excluded violence from acquaintances and strangers and lack comparability with younger adults.

OBJECTIVES

To estimate prevalence of past-year violence victimisation in older people, identify factors associated with violence in older age, quantify the extent to which experience of violence in older people was associated with common mental disorder (CMD).

STUDY DESIGN/METHODS

Analysis of a 2014 general population probability sample survey of 2570 adults aged 60+ and 4484 16-59 year olds. Modified version of the Conflict Tactics Scale measured domestic violence and List of Threatening Experiences captured bullying and serious assault. CMD were assessed using the revised Clinical Interview Schedule. Associations were examined using regression models adjusted for childhood victimisation and other adversities.

RESULTS

2.0 % (n = 52,CI:1.4-2.6) of older people experienced violence in the past year, with intimate partner violence the most prevalent form. Older people of non-white ethnicity, those who were socially isolated or lonely, and the formerly married were more likely to experience violence. Violence was associated with CMD in older people (adjusted odds ratio 2.2, CI:1.0-4.8), controlling for impairments, adversities and other factors.

CONCLUSION

Violence, especially from an intimate partner, is evident in later life and strongly associated with poor mental health. Better instruments for the identification of violence and abuse in older people in research and safe enquiry in practice settings are needed, with recognition of and attention to ethnic and other inequalities among older people in exposure.

Associations Between PTSD and Depressive Symptoms and Victimization Among Female College Students: A Latent Class Analysis

Research on subgroups of female college students who share similar experiences of childhood maltreatment (CM) and intimate partner violence (IPV) victimization is sparse. The primary aims of the current study are: (a) to identify subgroups of victims related to experience of psychological, physical, and sexual CM and IPV and (b) to test the association between subgroups and depressive and post-traumatic stress disorder (PTSD) symptom severity. Survey data was collected from 327 female students at a public university in the Northeast. Three distinct subgroups, that is, victimization classes, were found using Latent Class Analysis: A lifetime victimization class, comprised of females reporting high rates of CM and IPV across types (19.0% of the sample), a childhood victimization class (26.9%); and a low victimization class (54.1%). Depressive symptom severity was positively associated with lifetime and childhood, relative to low, victimization class membership. PTSD symptom severity was associated with the childhood victimization class relative to both lifetime and low victimization class. Subgroups of institutions of higher education (IHE) females who share CM and IPV victimization experiences are discernable. The co-occurrence of IPV and CM in female college students is not uncommon. PTSD symptom severity may be more related to CM than IPV in IHE female students.

Dissociative Symptoms in Women with Histories of Intimate Partner Victimization: A Focus on Coercive Control

Identifying and contrasting different patterns of intimate partner violence (IPV) (e.g. situational couple violence, coercive controlling violence) is useful for understanding IPV and its connections with health. Applying this approach to dissociation may be fruitful, given theoretical perspectives that predict a specific connection between coercive controlling violence and dissociative symptoms. To address this, community women with divorce histories (N = 188) completed measures to identify patterns of IPV victimization in prior relationships (no direct violence, situational couple violence, coercive controlling violence), and to quantify recent dissociative symptoms and number of depressed days, for comparison. Contrary to predictions, the predicted odds of recent dissociative symptoms did not differ between women who experienced situational couple violence versus coercive controlling violence. However, the latter group had greater odds of recent dissociative symptoms, but not depressed days, compared to women with no histories of direct violence. Further, a continuous measure of coercive control was uniquely associated with increased odds of dissociative symptoms. This study provides preliminary empirical support for a connection between coercive controlling violence and dissociative symptoms, compared to women without histories of direct violence. This deserves further attention given the strong theoretical rationale for this link, and the importance of dissociation for mental health.

Internet-based emotion regulation training aimed at reducing violent revictimization and depressive symptoms in victimized depressed patients: Results of a randomized controlled trial

BACKGROUND

Depressed patients who have become victim of violence are prone to revictimization. However, no evidence-based interventions aimed at reducing revictimization in this group exist.

METHODS

This multicenter randomized controlled trial evaluated the effectiveness of an internet-based emotion regulation training (iERT) added to TAU in reducing revictimization, emotion dysregulation, and depressive symptoms in recently victimized, depressed patients compared to TAU alone. Adult outpatients (N = 153) with a depressive disorder who had experienced threat, physical assault, or sexual assault within the previous three years were randomly allocated to TAU+iERT (n = 74) or TAU (n = 79). TAU involved psychotherapy (mainly cognitive behavioral therapy [77.8 %]). iERT comprised six guided online sessions focused on the acquisition of adaptive emotion regulation skills. The primary outcome measure was the number of revictimization incidents at 12 months after baseline, measured with the Safety Monitor. Analyses were performed according to the intention-to-treat principle.

RESULTS

Both groups showed a large decrease in victimization incidents. Mixed-model negative binomial regression analyses showed that TAU+iERT was not effective in reducing revictimization compared to TAU (IRR = 0.97; 95%CI = 0.64,1.46; p = .886). Linear mixed-model analyses demonstrated that TAU+iERT yielded a larger reduction of emotion dysregulation (B = -7.217; p = .046; Cohens d = 0.33), but not depressive symptoms (B = -1.041; p = .607) than TAU.

LIMITATIONS

The study was underpowered to detect small treatment effects. Additionally, uptake of iERT was quite low.

CONCLUSIONS

Although TAU+iERT resulted in a larger decrease of emotion dysregulation than TAU alone, it was not effective in reducing revictimization and depressive symptoms. Patients' revictimization risk substantially decreased during psychotherapy.

Health effects associated with exposure to intimate partner violence against women and childhood sexual abuse: a burden of proof study

The health impacts of intimate partner violence against women and childhood sexual abuse are not fully understood. Here we conducted a systematic review by comprehensively searching seven electronic databases for literature on intimate partner violence-associated and childhood sexual abuse-associated health effects. Following the burden of proof methodology, we evaluated the evidence strength linking intimate partner violence and/or childhood sexual abuse to health outcomes supported by at least three studies. Results indicated a moderate association of intimate partner violence with major depressive disorder and with maternal abortion and miscarriage (63% and 35% increased risk, respectively). HIV/AIDS, anxiety disorders and self-harm exhibited weak associations with intimate partner violence. Fifteen outcomes were evaluated for their relationship to childhood sexual abuse, which was shown to be moderately associated with alcohol use disorders and with self-harm (45% and 35% increased risk, respectively). Associations between childhood sexual abuse and 11 additional health outcomes, such as asthma and type 2 diabetes mellitus, were found to be weak. Although our understanding remains limited by data scarcity, these health impacts are larger in magnitude and more extensive than previously reported. Renewed efforts on violence prevention and evidence-based approaches that promote healing and ensure access to care are necessary.

The Role of Positivity on Depressive Symptoms in Women Seeking Help for Intimate Partner Violence

Intimate partner violence (IPV) is a complex and pervasive global phenomenon. Despite extensive research on physical and sexual violence, there has been a relative lack of investigation into the detrimental and distinctive consequences of psychological violence against women. This is surprising given the profound impact it has on the psychological well-being of victims, notably in the form of depression, which is commonly observed as an outcome in cases of psychological IPV victimization. The present study analyzes the impact of psychological IPV on depressive symptoms, considering the moderating influence of personal positivity, defined as positive self-perceptions, optimistic life perspectives, and a hopeful view of the future in a sample of 171 Italian women seeking assistance from anti-violence centers in different localities of Italy. The findings show that in line with the hypothesis, the association between psychological violence and depressive symptoms is moderated by the levels of perceived positivity, even when controlling for instances of physical violence. These results and implications for interventions are discussed within the framework of existing literature on positive psychology and psychological well-being in the context of IPV.

[Adverse Childhood Experiences in Mothers and Intergenerational Family Violence]

For children, own adverse experiences, as well as their exposure to intimate partner violence poses a severe risk for health and development. In order to answer the question of intergenerational transmission of family violence, adverse childhood experiences in mothers are considered to be a significant risk factor for the occurrence of child maltreatment and intimate partner violence in families, which, however, has been little studied in Germany. Therefore, this paper uses cross-sectional data of 5.646 mothers that was taken fromthe representative study "Kinder in Deutschland - KiD 0-3". Multiple binary-logical regression models were calculated in order to examine the influence ofmaternal adverse childhood experiences on various forms of family violence. As a result, 823 mothers (9,3 %) reported adverse childhood experiences; 157 (2,8 %) admitted that their child had already been exposed to physical harm or harsh punishment, and 168 (3,0%) reported intimate partner violence since the birth of their child, respectively 493 (8,7 %) since any past relationship. Taking demographic and socioeconomic factors into account, the occurrence of all three forms of violence becamemore likely inmothers with adverse childhood experiences: physical harm of the child (OR = 2,78, p ≤ 0,001), current intimate partner violence of themother (OR = 3,76, p ≤ 0,001), as well as her lifetime experiences in general (OR = 3,67, p ≤ 0,001). Therefore, the support and guidance of families (e.g., by early childhood interventions) should take into account the connection between negative maternal childhood experiences, as well as familial forms of violence, and, if applicable, make generous preventative offers. In case of signs for familial violence, additional protective steps should be applied.

Decision-Making and Abuse, What Relationship in Victims of Violence?

Gender-Based violence is a worldwide persisting phenomenon: during their lifetime, 30% of women have experienced sexual and/or physical violence. The literature has investigated for several years the association between abuse and possible psychiatric and psychological consequences which may occur even after many years. The most common consequences involve mood and stress disorders (e.g., depression and PTSD). These disorders seem to have secondary long-term effects, such as decision-making and cognitive function impairments. Therefore, the present literature synthesis aimed to investigate whether and how the decision-making capacities of individuals experiencing violence can change because of abuse. We conducted a thematic synthesis using PRISMA guidelines: through a double-blind procedure, 4599 studies were screened; a total of 46 studies were selected for full-text reading, which was reduced to 13 by excluding papers with a wrong focus. To better understand the results of the thematic synthesis, two main focuses have been identified: "leave or stay decision making" and "multifactorial dimensions of decision making". Results showed that decision-making is an important process in avoiding secondary victimization.

Mental and Physical Health Changes Following an Abusive Intimate Relationship: A Systematic Review of Longitudinal Studies

Longitudinal studies are critical to understanding health changes following trauma. The present systematic review adopted a longitudinal perspective on intimate partner abuse (IPA) by examining characteristics and findings of studies that followed persons who recently left an abusive relationship or who were at a point where they might leave and reported on health over time. Web of Science, EBSCO, Published International Literature on Traumatic Stress, and PubMed databases were searched using combinations of terms reflecting IPA, longitudinal study design, and health outcomes. Quantitative studies that recruited adults or adolescents, had multiple time points, used a health indicator as an outcome, and where IPA was a predictor, independent variable, or inclusion criterion were included. These methods yielded 36 studies from 20 unique samples. The following domains were coded for each article: citation, demographics, risk of bias, sample setting, design, follow-up, relationship and IPA characteristics, outcomes, and analytic focus. Results showed that all samples were female, and most were help-seeking. Depression, post-traumatic stress, and physical symptoms decreased over time, while quality of life increased in most studies. Changes in anxiety symptoms over time were less consistent. Ongoing IPA and social support were the most consistent predictors of health changes over time, showing relations with indicators of poorer or better health, respectively. There was preliminary evidence that decreases in emotional and physical symptoms plateaued within 9 months of the baseline assessment. Sampling, study design, measurement, and analysis are considered, and recommendations for future research are provided.

Effects of Intimate Partner Violence Perpetrator and Victim Race on Protective Order Determinations

The legal granting of temporary and permanent protective orders prohibits a perpetrator from engaging in contact with the victim. Although protective orders reduce risk of re-abuse, very little research has explored factors that predict the likelihood that a victim is granted a protective order. Thus, we conducted an archival analysis on data previously collected from a Protection Order Assistance Office in a midwestern region of the United States, testing the influence of victim and perpetrator race on protective order allocations. Specifically, we coded data gathered from 490 petitioners (i.e., victims) seeking a protective order against a perpetrator of intimate partner violence, stalking, or sexual offending. Analyses revealed that racial minority victims were significantly less likely to receive a temporary protective order compared to White victims - effects that were exacerbated when the perpetrator was White (versus racial minority). These results are in line with existing research and theory regarding aversive racism. Implications for theory, policy, and practice are discussed.

Unique Effects of Psychological Distress in Victimization and Perpetration of Intimate Partner Violence

Introduction: Intimate partner violence (IPV) reliably co-occurs with psychological distress. However, understanding the precise nature of the association between these two classes of variables, as potential cause or effect, is complicated by the fact that victimization of IPV is not often studied controlling for simultaneous perpetration, and vice versa. It is therefore important to control for one form of IPV when testing predictors of the other to accurately understand the extent to which psychological distress may predispose people to these serious interpersonal problems. Method: Two national survey studies were conducted to test the unique associations between victimization and perpetration of IPV with psychological distress. In the first study, 773 adults completed survey measures of IPV (victimization and perpetration) and psychological distress (depression and stress). In the second study, 389 participants completed the same measures as in Study 1, but at two waves separated by three months (T1-T2 follow-up rate 73%). Results: In study 1, both depression and stress were concurrently associated with perpetrating IPV, when controlling for victimization. However, only depression was associated with victimization, after controlling for perpetration. Results of study 2 showed that both depression and stress are prospectively associated with IPV victimization. However, they are not prospectively associated with IPV perpetration, net the effect of IPV victimization. Discussion: These results are consistent with the interactional model of depression by showing that people with depression, and high levels of stress, are at heightened risk for experiencing IPV, even after controlling for their own propensity to enact IPV.

Associations Between Sexual Assault Victimization and Risky Drinking Within College Women's Personal Networks

Within a sample of college women, this study assessed if an individual's (i.e., ego) history of sexual assault was related to her connecting with risky drinkers, and if her social contacts (i.e., alters) who had experienced sexual assault were also people who engaged in risky drinking. Results suggest ego's history of sexual assault was associated with her connecting to risky drinkers. Generally, egos reported alters who experienced sexual assault were more likely to drink in higher quantities, except when the ego and alter both had experienced sexual assault. Findings highlight the importance of social connections for survivors of sexual assault.

Violent victimization and revictimization in patients with depressive disorders: context characteristics, disclosure rates, and gender differences

BACKGROUND

Depressed patients are prone to violent victimization, and patients who were victimized once are at increased risk to fall victim to violence again. However, knowledge on the context of victimization in depressed patients is lacking, and research identifying targets for prevention is urgently needed.

METHODS

This cross-sectional study explored context characteristics, disclosure rates and gender differences regarding violent victimization in 153 recently victimized depressed patients. Additionally, 12-month prevalence rates of repeat threat, physical assault, and sexual assault were examined, and gender differences were investigated using t-tests, Chi-square tests, and Fisher's exact tests. Furthermore, logistic regression analyses were used to identify factors associated with repeat victimization.

RESULTS

Overall, depressed men were most often victimized by a stranger in public, and women by their partner or ex-partner at home. Regarding sexual assault, no gender differences could be examined. Patients were sexually assaulted most often by an acquaintance (50.0%) or stranger (27.8%). In all patients, the most recent incidents of threat (67.6%) and physical assault (80.0%) were often preceded by a conflict, and only a minority had been intoxicated prior to the assault. Notably, less than half of patients had disclosed their recent experience of threat (40.6%) and physical assault (47.1%) to their mental health caregiver. For sexual assault, this was only 20%. Less than one third of patients had reported their recent experience of threat (27.9%), physical assault (30.0%) and sexual assault (11.1%) to the police. 48.4% of patients had been victimized repeatedly in the past year, with no gender differences found. Only depressive symptoms and unemployment were univariately associated with repeat victimization, but not in the multiple model.

CONCLUSIONS

The high prevalence of repeat victimization in depressed patients and their low disclosure rates stress the need to implement routine enquiry of victimization in mental health care, and to develop preventive interventions accounting for specific needs of men and women.

The Dark Tetrad, Intimate Partner Violence and the Mediating Role of Moral Disengagement

PURPOSE

Research suggests that physical, psychological, and/or sexual focussed Intimate Partner Violence (IPV) is related to the dark triad (DT) traits of Machiavellianism, psychopathy, and narcissism. This study extends these findings by considering the addition of everyday sadism into the four-dimension dark tetrad (DTET), testing the possibility that moral disengagement (MD) mediates the relationship between these variables. It was also examined whether the DTET provided incremental validity to the more general personality traits Honesty-Humility, Emotionality, Extraversion, Agreeableness, Conscientiousness, Openness (HEXACO) to predict IPV.

METHOD

Males and females (N = 416) from the general population completed five questionnaires in an online survey (HEXACO-60, MMEA, PMDS, CTS2S, SD4).

RESULTS

A principal component factor-analysis found that sexual IPV did not load as an individual factor and distinct form of violence on the CTS2S scale so was excluded from this study. Four hierarchical multiple regressions were conducted, using the demographics, HEXACO and either the DTET traits or an overall DTET variable as predictor variables, and either physical or psychological IPV as the dependent variables. Only psychopathy predicted physical and psychological IPV; MD mediated the relationship between psychopathy and psychological IPV. Although the DTET added incremental validity over HEXACO to predict physical IPV, HEXACO low Agreeableness was the strongest predictor of psychological IPV.

CONCLUSIONS

Those higher in psychopathy may show different offending trajectories for physical and psychological IPV dependent upon the use of MD processes. Despite the DTET adding incremental validity over the HEXACO dimensions, some HEXACO elements better explain the relationship between personality and psychological IPV than the DTET.

Childhood Physical Abuse and Antisocial Traits: Mediating Role of Posttraumatic Stress Symptom Clusters

Posttraumatic stress symptoms (PTSS) are associated with both childhood physical abuse (CPA) and antisocial (AS) traits, yet their potential as mediators of the CPA-AS traits link is understudied and the specific roles of individual symptom clusters in this relation is unknown. The current study aimed to examine the mediational role of PTSS in the relation between CPA and AS traits in a sample of low-income African American women with histories of intimate partner violence (IPV). It was hypothesized that avoidance would emerge as a significant mediator, whereas reexperiencing, numbing, and hyperarousal would not. Participants (N = 150) were recruited from a level-1 trauma public hospital and evaluated as part of a randomized controlled trial of a group therapy intervention for low-income, African American women suicide attempters with histories of IPV. The Childhood Trauma Questionnaire (CTQ), Posttraumatic Diagnostic Scale (PDS), and International Personality Disorder Examination-Screening Questionnaire (IPDE-SQ) were used to measure variables of interest. Using bootstrapping analyses, a parallel mediation model compared PTSS clusters as potential mediators of the CPA-AS traits relation, controlling for IPV. When reexperiencing, avoidance, numbing, and hyperarousal were entered simultaneously as potential mediators, only avoidance emerged as a significant mediator of the CPA-AS traits link. Avoidance symptoms may play a unique role in the link between early experiences of CPA and later AS traits among multiply traumatized African American women. Findings have implications for understanding AS traits in the context of early life trauma and suggest that targeting specific PTSS clusters (e.g., avoidance) may improve treatment outcomes for women in this population.

Mediating Roles of Intimate Partner Violence, Stress, and Social Support on Depressive Symptoms Among Thai Women

Prior research has shown that intimate partner violence (IPV), stress, and social support are associated with depressive symptoms. However, a possible mediating role of these variables linking depressive symptoms has not been fully investigated in Thailand. This study was conducted to assess the mediating roles of IPV, stress, and social support in the relationships between childhood abuse (CA), number of sexual partners (NSP), and depressive symptoms among 400 Thai women attending gynecology clinics. Results indicated that IPV was significantly positively correlated with stress and depressive symptoms but negatively correlated with social support. CA and NSP were significantly positively correlated with IPV, stress, and depressive symptoms, but negatively correlated with social support. Structural equation models (SEMs) showed that not only did IPV severity exhibit significantly indirect effect on depressive symptoms (β = .178; p < .05), but it also had a significant, positive total effect on depressive symptoms (β = .252; p < .05). In particular, IPV severity had the fully mediating effect on depressive symptoms through social support (β = -.204; p < .05) and stress (β = .158; p < .05). CA severity and NSP exhibited the significant indirect effect on depressive symptoms through IPV severity, stress, and social support. All the models analyzed showed that stress had an important mediator role (β = .583; p < .05) on depressive symptoms. The model fitted very well to the empirical data and explained 53% of variance. Findings affirmed the important role of these mediators as well as the need to design interventions for reducing stress or increasing support for women experiencing IPV. Utilizing an empowerment approach among female outpatients to decrease stress and depressive symptoms is recommended.

Ease of marital communication and depressive symptom severity among men and women in rural Uganda: cross-sectional, whole-population study

PURPOSE

Depression is a major contributor to the global burden of disease. The extent to which marital communication may influence depression in contexts with little mental health support is unknown.

METHODS

We conducted a whole-population study of married adult residents of eight villages in a rural region of southwestern Uganda. Depression symptom severity was measured using a modified version of the Hopkins Symptom Checklist for Depression, with > 1.75 classified as a positive screen for probable depression. Respondents were asked to report about ease of marital communication ('never easy', 'easy once in a while', 'easy most of the time' or 'always easy'). Sex-stratified, multivariable Poisson regression models were fit to estimate the association between depression symptom severity and marital communication.

RESULTS

Among 492 female and 447 male participants (response rate = 96%), 23 women and 5 men reported communication as 'never easy' and 154 women and 72 men reported it as 'easy once in a while'. Reporting communication as 'never easy' was associated with an increased risk of probable depression among women (adjusted relative risk [ARR], 2.06; 95% confidence interval [CI], 1.08-3.93, p = 0.028) and among men (ARR, 7.10; 95% CI 1.70-29.56, p = 0.007).

CONCLUSION

In this whole-population study of married adults in rural Uganda, difficulty of marital communication was associated with depression symptom severity. Additional research is needed to assess whether communication training facilitated by local leaders or incorporated into couples-based services might be a novel pathway to address mental health burden.

Collateral Benefits of Evidence-Based Substance Use Prevention Programming During Middle-School on Young Adult Romantic Relationship Functioning

The quality of romantic relationships formed during early adulthood has critical implications for physical and psychological wellbeing, future romantic relationships, and subsequent parenting of the next generation. The present study evaluates the cross-over effects of the PROSPER-delivered adolescent substance use prevention programming on young adult romantic relationship functioning through a long-term developmental cascade of adolescent skills and behaviors, along with subsequent family-of-origin functioning. Prospective, longitudinal, bivariate growth models were used to analyze the effects of the PROSPER-delivered interventions in a sample of 1008 youths living in rural and semi-rural communities in Iowa and Pennsylvania, starting in sixth grade (Age_M = 11.8; 62% female) who were in a steady romantic relationship at the young adult assessment (Age_M = 19.5). Findings indicated a cascading effect through which PROSPER promotes adolescent problem-solving skills during early-to-mid-adolescence; problem-solving skills were associated with better family functioning during mid-adolescence; and family functioning was associated with better romantic relationship quality, indicated by lower levels of relationship violence and more effective relationship problem-solving in young adulthood. PROSPER, which primarily targets adolescent substance misuse and conduct problem prevention, has lasting, collateral effects that benefit young adults in their romantic relationship functioning - which may have further downstream benefits for their own relationships and those of their children (i.e., intergenerational transmission effects). These findings add to the growing body of literature evidencing important cross-over effects of widely disseminated substance use prevention programs delivered during adolescence.

Social norms and the association between intimate partner violence and depression in rural Bangladesh-a multilevel analysis

BACKGROUND

Intimate partner violence (IPV) is highly prevalent globally and associated with adverse mental health outcomes among women. In IPV-endemic contexts like Bangladesh, previous research has found no association between low levels of IPV and depression. Although IPV and attitudes justifying IPV against women are highly prevalent in this context, nothing is known about how related contextual norms affect associations between individual-level IPV exposure and depression. The present study examines if village-level IPV norms, characterized using village-level (Level 2) prevalence of a) IPV-justifying attitudes (injunctive norms) and b) physical IPV (descriptive norms), modifies the individual-level (Level 1) associations between the severity of recent IPV and major depressive episode (MDE) among women in rural Bangladesh.

METHODS

Data were drawn from a nationally-representative sample consisting of 3290 women from 77 villages. Multilevel models tested cross-level interactions between village-level IPV norms and recently experienced individual-level IPV on the association with past 30-day MDE.

RESULTS

The prevalence of IPV was 44.4% (range: 9.6-76.2% across villages) and attitudes justifying IPV ranged from 1.6% to 49.8% across villages. The prevalence of MDE was 16.8%. The risk of MDE at low levels of IPV severity (versus none) was greater in villages with the least tolerant attitudes toward IPV compared to villages where IPV was more normative, e.g., interaction RR = 1.42 (95% CI: 0.64, 3.15) for low physical IPV frequency and injunctive norms.

CONCLUSIONS

The association between IPV and depression may be modified by contextual-level IPV norms, whereby it is exacerbated in low-normative contexts.

Health Correlates of Abuse History and Moderating Effect of Parenting Stress for Mothers with Mental Disorders

Parenting stress is common and may lead to worsening health, particularly in the context of other risk factors such as mental disorders or a history of abuse. This study investigated how parenting-related stress impacts the effect of abuse experiences on health among mothers with mental health disorders. Survey data was analyzed from 172 predominantly Hispanic mothers receiving outpatient behavioral health services. Most (80.2%) mothers had experienced abuse. Those reporting childhood abuse had 3.82 greater odds of experiencing abuse in adulthood. Findings demonstrated worse health outcomes among those experiencing abuse in both childhood and adulthood and those with a greater number of abuse experiences. Caregiving load intensified the relationship between abuse and anxiety and sleep disturbance. Parenting self-agency intensified the relationship between abuse and cigarette use. These findings have important implications for mental health nursing practice by identifying parenting-stress as an important target for interventions to improve health among women with histories of abuse and mental health disorders.

From Exposure to Family Violence During Childhood to Depression in Adulthood: A Path Analysis on the Mediating Effects of Intimate Partner Violence

Literature shows a link between adverse childhood experiences and subsequent depression, but there is a lack of concrete evidence on whether victimization of intimate partner violence (IPV) in adulthood plays significant roles in that link. This study aimed to test the mediating effect of adulthood IPV victimization in the associations between exposure to family violence in childhood and adulthood depression. Exposure to family violence in childhood was operationalized as one's experiences of child abuse and witnessing parental IPV in childhood. This study also tested the effects of other violence-related factors from the Personal and Relationships Profile, including one's antisocial personality, borderline personality, dominance, posttraumatic stress (PTS) symptoms, and violence approval, on the associations. A path analysis was conducted a cross-sectional survey study sample recruited between 2009 and 2010. The sample was 8,807 adults selected with a multistage stratified sampling procedure from six cities in China (43.4% male; M age = 40.61 years, SD = 8.93). The main outcome was participants' depressive symptoms during the past 2 weeks. As predicted, the path model suggests that IPV victimization significantly mediated the associations between exposure to family violence in childhood and adulthood depression. Violence approval and PTS symptoms, but not the other violence-related factors, significantly mediated the above associations. Findings warrant the need to identify individuals with exposure to family violence in early stages, and to provide them with suitable intervention programs to prevent subsequent IPV as well as to minimize the negative impacts of the exposure to family violence in childhood.

Intimate Partner Violence and Mental Health Among Transgender/Gender Nonconforming Adults

There is significant evidence to suggest that intimate partner violence (IPV) is associated with mental health problems including anxiety and depression. However, this research has almost exclusively been conducted through heteronormative and cisgender lenses. The current study is an exploratory, quantitative analysis of the relationship between experiences of IPV and mental health among transgender/gender nonconforming (TGNC) adults. A national sample of 78 TGNC individuals completed a survey online measuring participants' experiences with IPV and depression, anxiety, and satisfaction with life. Of the sample, 72% reported at least one form of IPV victimization in their lifetime: 32% reported experiencing sexual IPV, 71% psychological IPV, 42% physical IPV, and 29% IPV assault with injury. All four types of IPV were positively associated with anxiety, and all but physical abuse was significantly associated with depression. None of the four types of IPV was associated with satisfaction with life. In a canonical correlation, IPV victimization and mental health had 31% overlapping variance, a large-sized effect. Sexual IPV and anxiety were the highest loading variables, suggesting that TGNC individuals who have experienced sexual IPV specifically tended to have higher levels of anxiety. These findings support previous qualitative, small-sample studies suggesting that IPV is a pervasive problem in the TGNC community. TGNC individuals who have experienced IPV may be at increased risk for mental health problems, and therefore, IPV history may trigger appropriate mental health screenings and referrals for this population in health care settings.

Reducing youth suicide: systems modelling and simulation to guide targeted investments across the determinants

BACKGROUND

Reducing suicidal behaviour (SB) is a critical public health issue globally. The complex interplay of social determinants, service system factors, population demographics, and behavioural dynamics makes it extraordinarily difficult for decision makers to determine the nature and balance of investments required to have the greatest impacts on SB. Real-world experimentation to establish the optimal targeting, timing, scale, frequency, and intensity of investments required across the determinants is unfeasible. Therefore, this study harnesses systems modelling and simulation to guide population-level decision making that represent best strategic allocation of limited resources.

METHODS

Using a participatory approach, and informed by a range of national, state, and local datasets, a system dynamics model was developed, tested, and validated for a regional population catchment. The model incorporated defined pathways from social determinants of mental health to psychological distress, mental health care, and SB. Intervention scenarios were investigated to forecast their impact on SB over a 20-year period.

RESULTS

A combination of social connectedness programs, technology-enabled coordinated care, post-attempt assertive aftercare, reductions in childhood adversity, and increasing youth employment projected the greatest impacts on SB, particularly in a youth population, reducing self-harm hospitalisations (suicide attempts) by 28.5% (95% interval 26.3-30.8%) and suicide deaths by 29.3% (95% interval 27.1-31.5%). Introducing additional interventions beyond the best performing suite of interventions produced only marginal improvement in population level impacts, highlighting that 'more is not necessarily better.'

CONCLUSION

Results indicate that targeted investments in addressing the social determinants and in mental health services provides the best opportunity to reduce SB and suicide. Systems modelling and simulation offers a robust approach to leveraging best available research, data, and expert knowledge in a way that helps decision makers respond to the unique characteristics and drivers of SB in their catchments and more effectively focus limited health resources.

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.

Spirituality and Parenting among Women Experiencing Intimate Partner Violence

PURPOSE

While spirituality and parenting have been examined among caregivers experiencing adversity, less research has explored these factors among mother survivors of intimate partner violence (IPV). Given the potentially protective role of spirituality, understanding how parenting is associated with spirituality is important.

METHOD

The current study explored parenting practices, parent-child communication, and spirituality among 175 women caregivers who had experienced recent IPV. Hierarchical linear regression was used to examine associations between maternal age, education, HIV status, and illicit substance use (model 1); child age and gender (model 2); parent-child comfort communicating about sexual practices, IPV, HIV/AIDS, and substance use (model 3); and positive and negative parenting practices (model 4) with spirituality.

RESULTS

Findings suggested positive parenting practices, greater comfort talking about IPV, and greater discomfort talking about substance use were associated with higher spirituality.

CONCLUSIONS

Results highlight the value of parenting and communication strategies among women caregivers experiencing recent adversity.

Prevalence and correlates of major depressive disorder: a systematic review

OBJECTIVES

Major depressive disorder (MDD) is one of the most disabling mental illnesses and it has a significant impact on society. This review aims to provide updated scientific evidence about the epidemiology of MDD.

METHODS

A systematic literature review of the PubMed and MEDLINE databases was performed to identify articles on the prevalence of MDD and its correlates. The search was restricted to manuscripts published between January 2001 and December 2018.

RESULTS

Sixty-three articles were included in the review. The lifetime prevalence of MDD ranged from 2 to 21%, with the highest rates found in some European countries and the lowest in some Asian countries. The main sociodemographic correlates were separated/divorced marital status and female gender. Child abuse, intimate partner violence, and comorbidity with other physical and mental disorders also were consistently associated with MDD across the reviewed studies.

CONCLUSIONS

MDD is a highly prevalent condition worldwide. There are remarkable interregional differences in the disorder's prevalence, as well as in certain sociodemographic correlates. MDD is also highly comorbid with physical and mental health problems.

Sex Trafficking in the United States: A Scoping Review

PURPOSE

Human trafficking is a public health social work issue. This review aimed to present the current state (nature and extent) of sex trafficking research, categorize best practices, and identify recommendations for professionals.

METHODS

Comprehensive literature searches of online databases were conducted to identify eligible articles from January 2000 to March 2019.

RESULTS

The search yielded 467 studies, 87 met the predetermined criteria for inclusion. Seven themes identified: awareness, identification, at-risk populations, health issues, implementation of trafficking legislation, service and program implementation, and exploiters.

DISCUSSION AND IMPLICATIONS FOR PRACTICE

Findings indicate the need for additional research to determine the most effective practices to increase awareness and identification, widespread TVPA implementation, reduce risk factors and resulting health disparities, offer services to survivors and prevention of potential victims.

CONCLUSION

There should be significant efforts to enhance all sex trafficking research in the United States to implement effective, sustainable and evidence-based interdisciplinary interventions.

Prevalence and correlates of major depressive disorder: a systematic review

OBJECTIVES

Major depressive disorder (MDD) is one of the most disabling mental illnesses and it has a significant impact on society. This review aims to provide updated scientific evidence about the epidemiology of MDD.

METHODS

A systematic literature review of the PubMed and MEDLINE databases was performed to identify articles on the prevalence of MDD and its correlates. The search was restricted to manuscripts published between January 2001 and December 2018.

RESULTS

Sixty-three articles were included in the review. The lifetime prevalence of MDD ranged from 2 to 21%, with the highest rates found in some European countries and the lowest in some Asian countries. The main sociodemographic correlates were separated/divorced marital status and female gender. Child abuse, intimate partner violence, and comorbidity with other physical and mental disorders also were consistently associated with MDD across the reviewed studies.

CONCLUSIONS

MDD is a highly prevalent condition worldwide. There are remarkable interregional differences in the disorder's prevalence, as well as in certain sociodemographic correlates. MDD is also highly comorbid with physical and mental health problems.

Sexual Revictimization: A Routine Activity Theory Explanation

Research has shown that victims of sexual assault are at a significant risk of revictimization. We use routine activity theory to predict how sexual victimization in adolescence relates to depression, substance use, and ultimately revictimization as a young adult. We frame our research within routine activity theory and predict that sexual victimization increases substance use and depressive symptoms, both of which increase the likelihood of revictimization. We test the hypotheses with three waves of data from the Longitudinal Study of Violence Against Women. Using structural equation modeling, we examine the direct and indirect effects of previous sexual victimization, depressive symptoms, and substance use on the odds of victimization during the sophomore year of college. Results suggest that sexual victimization during the sophomore year of college is predicted directly by previous sexual victimization and also indirectly through depressive symptomology, though not substance use. Although understudied in the literature, depression is shown to mediate the relationship between victimization and revictimization, and this finding is consistent with routine activity theory, as well as the state dependence perspective on revictimization. Our findings suggest that depressive symptoms, a long acknowledged consequence of sexual victimization, should also be understood as a source of revictimization risk, indicating the importance of depression screening and intervention for decreasing sexual victimization.

Childhood adversity and psychosis: a systematic review of bio-psycho-social mediators and moderators

The association between childhood adversity (CA) and psychosis has been extensively investigated in recent years. An increasing body of research has also focused on the mediating or moderating role of biological and psychological mechanisms, as well as other risk factors that might account for the link between CA and psychosis. We conducted a systematic search of the PsychINFO, Embase, Ovid, and Web of Science databases for original articles investigating the role of genetic vulnerabilities, environmental factors, psychological and psychopathological mechanisms in the association between CA and psychosis up to August 2019. We included studies with individuals at different stages of the psychosis continuum, from subclinical psychotic experiences to diagnosed disorders. From the 28 944 records identified, a total of 121 studies were included in this review. Only 26% of the studies identified met the criteria for methodological robustness. Overall, the current evidence suggests that CA may be associated with psychosis largely independently of genetic vulnerabilities. More consistent and robust evidence supports interaction between early and recent adversities, as well as the mediating role of attachment and mood symptoms, which is suggestive of an affective pathway between CA and psychosis across the continuum from subclinical experiences to diagnosable disorder. This review highlighted numerous methodological issues with the existing literature, including selection bias, heterogeneity of measurement instruments utilised, and lack of control for potential confounders. Future research should address these limitations to more accurately estimate mediation and moderation effects on the CA-psychosis association to inform the development of preventive interventions.

Intimate partner violence and subsequent depression and anxiety disorders

PURPOSE

The current longitudinal study examines the temporal association between different types of intimate partner violence (IPV) at early adulthood (21 years) and subsequent depression and anxiety disorders in young adulthood (30 years).

METHODS

Participants were from the Mater-University of Queensland Study of Pregnancy. A cohort of 1529 was available for analysis. IPV was measured using the Composite Abuse Scale at 21 years. At the 21 and 30-year follow-ups, major depression disorder and anxiety disorders were measured using the Composite International Diagnostic Interview.

RESULTS

We found a temporal relationship between almost all forms of IPV at 21 years and females' new cases of major depression disorder at 30 years. This association was not found for females who had previously been diagnosed with depression disorder. IPV did not predict the onset of new anxiety disorders, but it had a robust association with anxiety disorders in females with a previous anxiety diagnosis. We observed no significant link between IPV and males' subsequent major depression disorder. Interestingly, the experience of emotional abuse was a robust predictor of new cases of anxiety disorders but only for males.

CONCLUSION

Our results suggest the need for sex-specific and integrated interventions addressing both IPV and mental health problems simultaneously. IPV interventions should be informed by the extend to which pre-existing anxiety and depression may lead to different psychological responses to the IPV experience. Increased risk of anxiety disorders predicted by emotional abuse experienced by males challenges beliefs about invulnerability of men in the abusive relationships and demands further attention.

Mental health care in the context of intimate partner violence: Survivor perspectives

Experience of violence or abuse from an intimate partner (intimate partner violence, IPV) can result in a variety of psychological and mental health impacts for which survivors may seek psychotherapy or other mental health services. Individuals experiencing IPV may have specific needs and preferences related to mental health care, yet the question of how to best provide client-centered mental health care in the context of IPV has received little attention in the literature. In this article, we report on findings from qualitative interviews with 50 women reporting past-year IPV who received care through the Veterans Health Administration regarding experiences with and recommendations for mental health services. Participants described client-centered mental health care in the context of recent or ongoing IPV as being characterized by flexibility and responsiveness around discussion of IPV; respect for the complexity of clients' lives and support for self-determination; and promoting safety and access to internal and external resources for healthy coping. We discuss findings in terms of their implications for the mental health field, highlighting the need for flexibility in application of evidence-based treatments, improved coordination between therapeutic and advocacy services, and training to enhance competencies around understanding and responding to IPV. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Exposure to Violence and Posttreatment Substance Use Among Patients With Opioid Use Disorder

Exposure to violence can lead to a dramatic increase in the likelihood of the development of a substance use disorder (SUD). Given the overlap between the two, substance use for survivors of violence, then, can be a coping mechanism to manage the traumatic effects of abuse and persistent use can evolve into a diagnosable SUD. This study was designed to examine the posttreatment substance use among adults who have a history of exposure to violence and sought treatment for opioid use disorder. Data for this study were drawn from the Comprehensive Addiction Treatment Outcome Research system. Among the 13,105 patients included in the study, 444 (3.4%) received a formal diagnosis for opioid use disorder. Female victims of violence are at a greater risk of suffering injuries related to violence, resulting in increased levels of medical care utilization, which may prompt the initiation and prolonged use of prescription pain relief medication. Related to this important finding is another indicating that exposure to violence at multiple points in the past was associated with more severe indicators of substance use. These data show that there is a relationship between exposure to violence, SUDs, and relapse among patients seeking treatment. Not only must patients and treatment providers address these past violent experiences as important psychological factors in recovery, but in the context of opioid use disorder, physical injuries contributing to chronic pain may also trigger persistent substance use.

Acute mental health symptoms among individuals receiving a sexual assault medical forensic exam: the role of previous intimate partner violence victimization

Sexual assault and intimate partner violence (IPV) are common in the USA, and they often co-occur. Individuals with multiple victimization experiences have more severe mental health outcomes compared to those with one victimization. The current study examined mental health symptoms and their association with IPV victimization history among a sample of individuals who experienced a recent sexual assault and received a sexual assault medical forensic examination. A total of 82 participants (92.70% female) completed a post-sexual assault survey as part of clinical care to coordinate follow-up services. IPV history and prior sexual assault were assessed as well as mental health symptoms including acute stress and depressive symptoms. It was found that individuals with an IPV history reported more acute stress and depressive symptoms compared to those without an IPV history. No differences were found based on prior sexual assault history. These findings highlight the importance of screening for IPV history during the sexual assault medical forensic examination to coordinate care.

Armed Conflict, Intimate Partner Violence, and Mental Distress of Women in Northeastern Uganda: A Mixed Methods Study

As global mental health research and programming proliferate, research that prioritizes women's voices and examines marginalized women's mental health outcomes in relation to exposure to violence at community and relational levels of the socioecological model is needed. In a mixed methods, transnational study, we examined armed conflict exposure, intimate partner violence (IPV), and depressive symptoms among 605 women in Northeastern Uganda. We used analysis of variance to test between groups of women who had experienced no IPV or armed conflict, IPV only, armed conflict only, and both; and linear regression to predict depressive symptoms. We used rapid ethnographic methods with a subsample (n = 21) to identify problem prioritization; and, to characterize women's mental health experiences, we conducted follow up in-depth interviews (n = 15), which we analyzed with grounded theory methods. Thirty percent of the sample met the cut-off for probable major depressive disorder; women exposed to both IPV and armed conflict had significantly higher rates of depression than all other groups. While women attributed psychological symptoms primarily to IPV exposure, both past-year IPV and exposure to armed conflict were significantly associated with depressive symptoms. Women identified socioeconomic neglect as having the most impact and described three interrelated mental health experiences that contribute to thoughts of escape, including escape through suicide. Policy efforts should be interprofessional, and specialists should collaborate to advance multi-pronged interventions and gender-informed implementation strategies for women's wellbeing.

The Social and Individual Characteristics of Women Associated With Engagement With Multiple Intimate Violent Partners

Intimate partner violence (IPV) is a serious public health problem with known negative physical and mental health outcomes for women exposed. Studies have shown that with increased violence exposure, there are increased risks of negative outcomes for women. Likewise, chronicity of IPV across multiple partners is linked to more profound psychological suffering than acute exposure. However, little is known about the social- and individual-level characteristics of women that are correlated with engagement with multiple abusive partners. The current study (N = 164) identifies the characteristics of women that are associated with the number of violent partners with which they have been involved, with 35% of the sample reporting multiple IPV relationships. Participants reported on the number of violent partners, demographic characteristics, trauma history, current trauma and depressive symptoms, and exposure to IPV, including physical, sexual, and psychological violence. Results of multiple regression analysis indicate that trauma history (childhood sexual abuse, being held hostage, and torture) and current psychological violence were associated with women's engagement with multiple violent partners. Additional findings reveal that identification as African American and White was associated with greater re-engagement compared with identification as Latina. Finally, current exposure to sexual violence was associated with fewer violent partners. The clinical implications of these findings for treatment for women at risk for engagement with multiple partners in IPV relationships are discussed.

Substance Use as a Coping Mechanism for Survivors of Intimate Partner Violence: Implications for Safety and Service Accessibility

This study examined substance use disorder (SUD) and mental health (MH) among survivors of intimate partner violence, with data collected from 102 participants. Both survivors and service providers emphasized SUD and MH as top priorities and reported a high prevalence of post-traumatic stress disorder (PTSD), depression, anxiety, and low self-esteem coupled with increasing rates of heroin, methamphetamine, and pharmaceutical abuse. Emergent themes included (a) trauma impacts functioning, (b) substances as coping strategy, (c) weighing safety against need, (d) lacking SUD and MH services, and (e) need for comprehensive and culturally specific resources. Scarcity of funding demands cross-sector collaboration to support survivors.

Modeling lifetime abuse and cardiovascular disease risk among women

BACKGROUND

Cardiovascular disease (CVD) is one of the most significant health challenges facing women today. Abuse is a serious gendered issue also affecting the health of women. Despite beginning evidence that abuse may increase the risk of CVD among women, causal pathways linking abuse to CVD have received little attention. Our purpose was to test Scott-Storey's conceptual model showing direct and indirect pathways through which lifetime abuse severity may affect women's CVD risk.

METHODS

Using data collected from a community sample of 227 Canadian women who had left an abusive partner, we conducted structural equation modeling with latent growth curve analysis using a phantom variable approach to test the direct effects of severity of lifetime abuse on CVD risk (indicated by measures of systolic and diastolic blood pressure) as well as its indirect effects through CVD risk behaviors and through women's initial level of depressive symptoms and the observed rate of change in their depressive symptoms over time.

RESULTS

Women in this sample had above average CVD risk factors (i.e., smoking, overweight/obesity, depressive symptoms, high blood pressure) in comparison to women in the general population. Further, CVD risk behaviors increased with severity of lifetime abuse and remained present long after leaving the abusive relationship. Results of the tested model provide preliminary evidence supporting many of the hypothesized pathways by which severity of lifetime abuse can increase CVD risk among women; the model fit the data reasonably well explaining 41% of the variance in CVD risk.

CONCLUSIONS

Findings support the growing recognition of the long-term effects of lifetime abuse on cardiovascular health, suggest important implications for clinicians working with women, and provide a novel approach for studying the concept of cumulative lifetime abuse through the use of a phantom variable.

The association between five forms of child maltreatment and depressive and anxiety disorders: A systematic review and meta-analysis

BACKGROUND

Child maltreatment is a global public health issue that encompasses physical abuse, sexual abuse, emotional abuse, neglect, and exposure to intimate partner violence (IPV). This systematic review and meta-analysis summarises the association between these five forms of child maltreatment and depressive and anxiety disorders.

METHODS

Published cohort and case-control studies were included if they reported associations between any form of child maltreatment (and/or a combination of), and depressive and anxiety disorders. A total of 604 studies were assessed for eligibility, 106 met inclusion criteria, and 96 were included in meta-analyses. The data were pooled in random effects meta-analyses, giving odds ratios (ORs) with corresponding 95% confidence intervals (CIs) for each form of child maltreatment.

RESULTS

All forms of child maltreatment were associated with depressive disorders (any child maltreatment [OR = 2.48, 2.14-2.87]; sexual abuse [OR = 2.11, 1.83-2.44]; physical abuse [OR = 1.78, 1.57-2.01]; emotional abuse [OR = 2.35, 1.74-3.18]; neglect [OR = 1.65, 1.35-2.02]; and exposure to IPV [OR = 1.68, 1.34-2.10]). Several forms of child maltreatment were significantly associated with anxiety disorders ('any child maltreatment' [OR = 1.68, 1.33-2.4]; sexual abuse [OR = 1.90, 1.6-2.25]; physical abuse [OR = 1.56, 1.39-1.76]; and neglect [OR = 1.34, 1.09-1.65]). Significant associations were also found between several forms of child maltreatment and post-traumatic stress disorder (PTSD).

CONCLUSIONS

There is a robust association between five forms of child maltreatment and the development of mental disorders. The Global Burden of Disease Study (GBD) includes only sexual abuse as a risk factor for depressive and anxiety disorders. These findings support the inclusion of additional forms of child maltreatment as risk factors in GBD.

Intimate Partner Violence and Depression among Black Transgender Women in the USA: The Potential Suppressive Effect of Perceived Social Support

Depression among Black transgender women (BTW) in the USA is an often understudied mental health concern with far-reaching consequences for overall physical and mental health at both the individual and community levels. Intimate partner violence (IPV) among BTW is also a frequently understudied and important social determinant of health in need of further exploration. This study sought to address the gap in research on the relationship between IPV and depression among BTW using a time- and location-based community sample of BTW from six US cities. In addition, it sought to explore the potential protective or suppressive effect of perceived social support on this relationship. Generalized structural equation models were used to assess conditional direct and indirect effects of IPV on depression via the suppression effect of perceived social support. Evidence was found of a statistically significant conditional direct effect of IPV on depression as well as a statistically significant suppression effect for perceived social support. Specifically, there was a 20% lower likelihood of increased depressive symptomatology for every 1-unit increase in perceived social support reported by participants. These findings indicated that perceived social support may be an important intervention point for helping to improve the mental health and well-being of BTW.

Intimate Partner Violence and Depression among Black Transgender Women in the USA: The Potential Suppressive Effect of Perceived Social Support

Depression among Black transgender women (BTW) in the USA is an often understudied mental health concern with far-reaching consequences for overall physical and mental health at both the individual and community levels. Intimate partner violence (IPV) among BTW is also a frequently understudied and important social determinant of health in need of further exploration. This study sought to address the gap in research on the relationship between IPV and depression among BTW using a time- and location-based community sample of BTW from six US cities. In addition, it sought to explore the potential protective or suppressive effect of perceived social support on this relationship. Generalized structural equation models were used to assess conditional direct and indirect effects of IPV on depression via the suppression effect of perceived social support. Evidence was found of a statistically significant conditional direct effect of IPV on depression as well as a statistically significant suppression effect for perceived social support. Specifically, there was a 20% lower likelihood of increased depressive symptomatology for every 1-unit increase in perceived social support reported by participants. These findings indicated that perceived social support may be an important intervention point for helping to improve the mental health and well-being of BTW.

Intimate partner violence and incidence of depression in married women: A longitudinal study of a nationally representative sample

BACKGROUND

Intimate partner violence (IPV) has a serious detrimental effect on mental health outcomes. We aimed to investigate the association of verbal or physical IPV with incidence of depressive symptoms in both married women and men according to the victim-perpetrator role. The potential mediating role of verbal or physical IPV in the association between satisfaction level with family relationships or childhood adversity and the incidence of depressive symptoms in married adults was also explored.

METHODS

The Korea Welfare Panel Study (KOWEPS) in 2006 and 2007 dataset was analyzed for 9217 married respondents aged 19 years or older. Physical and verbal IPV was assessed according to victim-perpetrator role in 2006. Depressive symptoms were evaluated by the Center for Epidemiologic Studies Depression Scale, 11-item version in 2006 and 2007. Association of IPV with incidental depressive symptoms was investigated with logistic regression analysis fully-adjusted for all potential confounding factors.

RESULTS

The bidirectional role of verbal IPV and victimization by physical IPV led to incidence of depressive symptoms in married women. Verbal IPV significantly mediated the association between satisfaction level with the family relationship and incidental depressive symptoms in women.

LIMITATIONS

We did not investigate the influence of premorbid depressive symptoms on new-onset IPV.

CONCLUSIONS

This study is the first to demonstrate that gender and the victim-perpetrator role are critical moderating factors in the association between IPV and depressive symptom incidence using a nationally representative sample.

Does a history of childhood abuse moderate the association between symptoms of posttraumatic stress disorder and borderline personality disorder in survivors of intimate partner violence?

OBJECTIVE

This study examined whether a history of childhood abuse (CA) strengthened the association between borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) in the aftermath of intimate partner violence (IPV). This hypothesis arises from clinical literature but has not been examined empirically. We predicted that a history of CA would enhance associations between BPD features and PTSD symptoms.

METHOD

Dimensional assessment of both PTSD and BPD was made in a sample of 211 women who sought mental health services following IPV. Two analyses were conducted using clinician-assessed DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th ed.) PTSD symptoms: (a) total score and (b) symptom clusters.

RESULTS

Using path analysis, results indicated significant associations between BPD features and PTSD symptoms, but no significant interaction between BPD and CA in either analysis.

CONCLUSIONS

Results are discussed given current understanding of comorbidities involving PTSD, with particular attention to potential implications for clinical practice. Areas for future research are proposed.

The relation of abuse to physical and psychological health in adults with developmental disabilities

BACKGROUND

People with developmental disabilities are at disproportionately high risk of abuse. Although considerable evidence exists on the health-related consequences of abuse in the general population, little is known about those consequences in people with developmental disabilities.

OBJECTIVE

To examine the relation of abuse with psychological and physical health outcomes in adults with developmental disabilities.

METHODS

We used an accessible audio computer-assisted self-interview to collect anonymous data on demographic and disability characteristics, childhood and adult abuse experiences, and physical and psychological health from 350 women and men with developmental disabilities. Abuse experience was reflected by five factor scores consisting of three child abuse factors (childhood sexual abuse, childhood physical abuse, childhood disability-related abuse) and two adult abuse factors (adult sexual abuse, adult mixed abuse). We examined each of four health outcomes (depression, post trraumatic stress disorder, physical health symptoms, secondary health conditions) separately to determine the extent to which childhood and adult abuse experiences uniquely predicted psychological and physical health outcomes above and beyond demographic and disability-related characteristics.

RESULTS

All five abuse factor scores were significantly related to all four health outcomes. When examined simultaneously, childhood disability-related abuse and adult mixed abuse accounted for unique variance in outcomes. Exploratory analyses revealed no difference in the impact of abuse by gender.

CONCLUSIONS

In this study, childhood disability-related abuse and adult mixed abuse significantly predicted lower levels of psychological and physical health in a sample of adults with developmental disabilities. Our findings highlight the importance of addressing abuse and its sequalae in the developmental disabilities community.

Gender discrimination, victimisation and women's mental health

Gender inequality and discrimination, as well as violence and victimisation towards women, have recently hit the headlines creating a media furore. We provide a timely discussion surrounding the impact of these issues on women's mental health and a discussion of the role of psychiatry in this context.Declaration of interestK.B. is the editor for the British Journal of Psychiatry but has not played a role in the decision to accept this editorial for publication in this journal. G.H. has no conflict of interest to declare.

Prevalence and risk factors of intimate partner violence among women in four districts of the central region of Ghana: Baseline findings from a cluster randomised controlled trial

Intimate partner violence (IPV) is a significant global public health problem. Understanding risk factors is crucial for developing prevention programmes. Yet, little evidence exists on population-based prevalence and risk factors for IPV in West Africa. Our objective was to measure both lifetime and past year prevalence of IPV and to determine factors associated with past year physical or sexual IPV experience. This population-based survey involved 2000 randomly selected women aged 18 to 49 years living in 40 localities within four districts of the Central Region of Ghana. Questionnaires were interviewer-administered from February to May 2016. Respondents were currently or ever-partnered, and resident in study area ≥12months preceding the survey. Data collected included: socio-demographics; sexual behavior; mental health and substance use; employment status; 12-month and lifetime experience of violence; household food insecurity; gender norms/attitudes; partner characteristics and childhood trauma. Logistic regression modelling was used to determine factors associated with sexual or physical IPV, adjusting for age and survey design. About 34% of respondents had experienced IPV in the past year, with 21.4% reporting sexual and or physical forms. Past year experience of emotional and economic IPV were 24.6% and 7.4% respectively. Senior high school education or higher was protective of IPV (AOR = 0.51[0.30-0.86]). Depression (AOR = 1.06[1.04-1.08], disability (AOR = 2.30[1.57-3.35]), witnessing abuse of mother (AOR = 2.1.98[1.44-2.72]), experience of childhood sexual abuse (AOR = 1.46[1.07-1.99]), having had multiple sexual partners in past year (AOR = 2.60[1.49-4.53]), control by male partner (AOR = 1.03[1.00-1.06]), male partner alcohol use in past year (AOR = 2.65[2.12-3.31]) and male partner infidelity (AOR = 2.31[1.72-3.09]) were significantly associated with increased odds of past year physical or sexual IPV experience. Male perpetrated IPV remains a significant public health issue in Ghana. Evidence-based interventions targeting women's mental health, disabilities, exposure to violence in childhood, risky sexual behavior and unequal power in relationships will be critical in reducing IPV in this setting.