Coping variables that mediate the relation between intimate partner violence and mental health outcomes among low-income, African American women

Association of Daily Activities With Maternal-Child Bonding, Parenting Self-Efficacy, Social Support, and Parenting Behaviors Among Survivors Living in an Intimate Partner Violence Shelter: A Daily Diary Study

Following a traumatic event such as intimate partner violence (IPV), survivors often experience stress related to the violence. These high levels of stress related to IPV can be associated with the daily activities of survivors and their relationships with their children, such as maternal-child bonding. The purpose of the current study is to explore the relationship between daily activities, daily stress levels, parenting self-efficacy and behaviors, and maternal-child bonding among survivors living in an IPV shelter using an ecological momentary assessment (EMA) methodology. Twenty-five mothers living in an IPV shelter in two states in the Southern United States completed a baseline survey and completed electronic daily diaries for 14 days. Higher daily stress was associated with the number of times the mothers met with the case manager. Higher daily stress was also related to lower parenting self-efficacy. The number of case management appointments and legal appointments were positively correlated with a higher bonding score. More social support was associated with more positive parenting. IPV and post-traumatic stress disorder symptoms were not significantly associated with maternal-child bonding, parenting behaviors, or parenting self-efficacy. Findings suggest that screening for maternal support may be particularly important for positive bonding and positive parenting. Findings also lend preliminary insight into practical places where service providers could act to protect the bonding process or mitigate risks to impede it. Future research should include objective data about the mother's emotions and her interactive behavior with her child. There is also a need to consider how federal programs fund and incentivize service providers to focus on mother-child dyads and how they can tailor services that promote bonding.

"Being My Own Pillar of Support": How Palestinian-Arab Women Citizens of Israel Cope With IPV

Studies on the ways in which women implement coping strategies to recover from intimate partner violence have primarily focused on Western, non-collectivistic societies. To contribute to the scant literature on coping strategies among women in traditional-collectivistic societies, the current study applied the principles of Clinical Ethnographic Narrative Interview to analyze the experiences of 15 Palestinian-Arab citizens of Israel as these women confronted violence within marriage. This exploration is situated within the backdrop of entrenched collectivistic traditional norms and the broader context of the enduring Israeli-Arab conflict. An Interpretative Phenomenological Analysis revealed three themes that translated into a transformative three-phase coping model. The first theme covers navigating violent relationships through avoidance, emotional encapsulation, and cognitive reframing. The second theme describes strategies to mitigate violence and its consequences, including escapist and immediate departure, sustained fulfillment of duties, and maintaining hope amid adversity. The third theme characterizes strategies aimed at achieving self-care and self-empowerment. The findings highlight the importance of acknowledging women's definition of coping and recovery within their cultural constraints as they chart their coping trajectories.

Mental Health Professionals' Perspectives on Group Intervention for Women Survivors of Intimate Partner Violence: A Qualitative Study

Background

To examine the perspectives of mental health professionals on providing group intervention for female spouses of men with alcohol dependence who experienced intimate partner violence (IPV).

Methods

A qualitative research design was used, and a purposive sample technique was used to select the participants. Nine experts with more than five years of experience in handling partner violence cases provided insights through in-depth interviews. The transcripts were carefully examined several times, coded and re-coded. The codes were subsequently organized into thematic categories.

Results

Most of the experts were between the age of 35-45 years (66.7%), females (77.8%) and had more than five years of experience in mental health and IPV (55.6%). Most of the experts (66.7%) were working in teaching institutions related to mental health and IPV. The remaining one-third (33.3%) of the experts were legal and women empowerment practitioners. The thematic analysis generated six main themes and 19 subthemes, with 189 codes. The six mean themes were: psychosocial needs and concerns, psychosocial interventions, enhancing psychological well-being, enhancing the social support systems, challenges, and therapeutic strategies.

Conclusion

Experts emphasized the importance of a holistic approach to IPV intervention. Group intervention addresses multiple issues that contribute to violence. Survivors need safe housing, counseling, legal help, and financial assistance.

Challenges to Help-Seeking Among Women of Color Exposed to Intimate Partner Violence

Women exposed to intimate partner violence (IPV) often rely on support from their informal support networks to obtain resources that may mitigate IPV. This study explored the challenges women of color encounter in seeking advice and information from their informal support networks (i.e., family, friends, neighbors, community members) regarding IPV support services. In-depth interviews were conducted with 29 IPV survivors who self-identified as Black or Hispanic. Data were analyzed using grounded theory methodology. Results showed that participants lacked informational support, both in their communities and in their interpersonal relationships with family and friends. Communities treated IPV as normal and propagated the belief that women's responsibilities were to men and family. Family and friends discouraged IPV information seeking and advised that IPV should be kept private to avoid community shaming. The community environments also lacked information about resources for women experiencing IPV. The lack of information from their informal support networks appeared to delay participants' help-seeking. As the frequency and severity of violence escalated, some participants engaged in independent information searching, using social media and online information sources as well as conventional media like radio and newspapers. Others received information from first responders in the wake of a violent emergency. Participants described the information they received online or from first responders as empowering, encouraging them to engage in support services. Similarly, they felt empowered by the information they received from social workers, counselors, and victims' advocates, and they wished to use what they learned to help other women in similar circumstances. Women experiencing IPV and their communities need more information regarding IPV support services. Successful interventions for IPV survivors and their support networks may necessitate community-level education and altering biased perceptions of gender-appropriate behaviors.

Pre-COVID-19 predictors of low-income women's COVID-19 appraisal, coping, and changes in mental health during the pandemic

Study examined predictors and mental health consequences of appraisal (threat, support satisfaction) and coping (active, avoidant) in a sample of low-income women during coronavirus disease 2019 (COVID-19). Pre-COVID-19 contextual risk and individual resources and COVID-19-specific risk factors were examined as predictors of COVID-19 appraisal and coping, which, in turn, were tested as predictors of changes in depression and anxiety across the pandemic. Pre-COVID-19 resilience predicted more active coping, whereas pre-COVID-19 anxiety and depression predicted more avoidant coping and lower support satisfaction, respectively. Increases in anxiety were predicted by lower pre-COVID-19 self-compassion and higher concurrent threat appraisal and avoidant coping. Increases in depression were related to lower pre-COVID-19 self-compassion, active coping and support satisfaction, and higher COVID-19 hardships and health risk. Findings highlight contextual and individual factors and processes that contribute to mental health problems in a vulnerable population during community-level stressors, with implications for prevention and intervention.

Victimization and Distress in Indigenous Maya Women: A Qualitative Investigation of Gender-Based Violence and Mental Health Outcomes in Rural Guatemala

Purpose

There is currently scant research exploring Indigenous Guatemalan women's experiences of gender-based violence and mental health outcomes, but existing research suggests further exploration in this area is necessary. The current study aimed to address this gap by analyzing the experiences with violence and subsequent well-being of Indigenous Maya women in rural Guatemala.

Methods

Data were collected in an ethnographic project on mental health in Panajachel, Guatemala, consisting of a cross-sectional survey on violence exposure and mental health history, followed by semi-structured interviews to elaborate on the experiences. Interviews with seven Kaqchikel Maya women who had been exposed to violence provided the qualitative basis for this study, supplemented by the survey results. Descriptive statistics of survey results and thematic analysis of interviews are presented.

Results

The survey results pointed to a deep relationship between violence victimization and mental health issues. Recurring themes in the interviews included symptoms of post-violence emotional distress including fear, sadness, physical ailments, and suicidal ideation; the role of the women as mothers; lack of legal and mental health support; and the importance of spirituality and religion.

Conclusions

These results highlight the importance of examining emotional distress as separate from diagnostic psychiatric disorders in addressing women's mental health post-violence. This exploratory study provides examples of violence exposure, mental health, and resource availability among Guatemalan Maya women and suggests possibilities for future investigation.

Coping and Protective Factors of Mental Health: An Examination of African American and US Caribbean Black Women Exposed to IPV from a Nationally Representative Sample

Existing research continues to highlight the harm that intimate partner violence (IPV) can pose to health and well-being. However, little is done to understand the effectiveness of coping and protective mechanisms in helping women manage under adverse circumstances. The current study addresses the mental health of US Black women and the role of coping and protective moderators. An analysis of data from the National Survey of American Life (2001-2003), the most comprehensive survey on the health of US Blacks, was conducted. The association between severe physical intimate partner violence and mental health outcomes were confirmed. Resilience moderated the relationship between severe intimate partner violence and mood disorder among US Black women, but this differed between African American and Caribbean Blacks. Resilience, emotional family support, and spirituality reduced the likelihood of having a mental health condition for some African American and Caribbean Black women, while the opposite was found for religiosity. Demographic factors were also associated with mental health conditions and behaviors. The study draws our attention to potential coping and protective mechanisms that could be incorporated into counseling and intervention practices while recognizing factors that may be harmful to the mental health of individuals.

The Protective Effects of Social Support on Hypertension Among African American Adolescents Exposed to Violence

African Americans develop hypertension earlier in life than Whites and the racial/ethnic disparities in blood pressure level can appear as early as adolescence. Violence victimization, a prevalent environmental stressor among inner-city youth, may play a role in such disparities. In a sample of inner-city youth in the United States, the current study examines the relationship between violence victimization and hypertension while investigating the role of social support in moderating that relationship. We analyzed eight waves of data from a longitudinal study of African American youth (n = 353, 56.7% female) from mid-adolescence (9th grade, mean age = 14.9 years old) to emerging adulthood (mean age = 23.1 years old) using probit regression. Higher levels of self-reported violence victimization during ages 14-18 was associated with more reports of hypertension during ages 20-23, after adjusting for sex, socioeconomic status, substance use, and mental distress. The relationship of violence victimization with hypertension was moderated by friends' support, but not parental support. The association between victimization and hypertension was weaker and non-significant among individuals with more peer support compared to those with less support. Researchers have reported many instances of associations of early violence exposure to later risk for hypertension; however, most have focused on childhood maltreatment or intimate partner violence. We extend these findings to violence victimization in an African American sample of youth from adolescence to early adulthood, while examining social support modifiers. The disparity in African American hypertension rates relative to Whites may partly be explained by differential exposure to violence. Our findings also suggest that having supportive friends when faced with violence can be beneficial for young adulthood health outcomes.

Prevalence and associated factors of suicidal behavior among pregnant mothers in southern Ethiopia: a cross-sectional study

Background

Suicidal behavior among pregnant mothers is one of the most common psychiatric emergencies that require a major public health concern by researchers and mental health task forces. Pregnant mothers experience suicidal attempt, which is a fatal problem to end life. Therefore, there was a need to assess the prevalence and associated factors of suicidal behavior among pregnant mothers to integrate mental health care, particularly suicide, with maternal management.

Methods

A cross-sectional study was conducted among 504 pregnant mothers in the Gedeo zone, southern Ethiopia. Suicidal behavior was assessed using revised suicidal behavior questionnaire (SBQ-R) with a total score of 3-18; those scoring ≥7 were considered as having Suicidal behavior. Data were entered into Epi-data 3.1 and analyzed using SPSS version 20. Bivariate and multivariate binary logistic regression analysis was performed to identify associated factors of suicidal behavior. Variables with a P-value less than 0.05 with 95% CI were considered statistically significant.

Results

In this study, the overall prevalence of suicidal behavior among pregnant mothers was 47(9.3%) with 95% CI (7.1- 11.9). Regarding the factors; being unmarried [AOR = 5.69, 95% CI, (1.19, 27.23)], gestation age greater than 27 weeks, [AOR = 4.92, 95% CI (1.67, 14.53)], history of having chronic medical illness [AOR = 4.47, 95% CI (1.35, 14.85)], depression [AOR = 4.20, 95% CI (1.90, 9.28], and intimate partner violence [AOR = 7.60, 95% CI (3.27, 17.67)] were significantly associated with suicidal behavior at P value less than 0.05 and corresponding 95% CI.

Conclusion

Pregnant mothers in the community had a high prevalence of suicidal behavior compared to studies conducted among general populations. It is better to include and implement the assessment of suicidal risk factors as a primary treatment package for pregnant mothers, training of health extension workers and other primary health workers on how to assess the risk of suicide among pregnant mothers is warranted.

Women's strategies for managing domestic violence during pregnancy: a qualitative study in Iran

BACKGROUND

Domestic violence during pregnancy is a severe public health problem. Abused pregnant women are confronted with the threats posed by domestic violence. Pregnancy and protection of the unborn child could affect maternal strategies for managing violence. The purpose of this study was to explore Iranian women's strategies for managing domestic violence during pregnancy.

METHODS

This qualitative study was conducted in October 2019 to June 2021 in Mashhad, Iran. Data were collected through individual semi structured interviews with 13 women who experienced perinatal domestic violence, two relatives and 24 related specialists as well as two focus group discussions with attendance of 20 abused mothers until the data saturation was achieved. Data were analyzed by the conventional content analysis approach of Graneheim and Lundman.

RESULTS

The main themes "escape strategies" and "situation improvement strategies" were emerged as the result of data analysis. Escape strategies was comprised of three categories including concealment, passive dysfunctional behaviors and neutral behaviors to control maternal emotional distress. Situation improvement strategies was comprised of three categories including active self-regulation, protecting family privacy and help seeking to control violence.

CONCLUSION

Understanding the experience of managing domestic violence among pregnant women is essential to design evidence based violence prevention programs, which enable supportive healthcare and social systems to encourage abused mothers to use more effective strategies and seeking help to overcome domestic violence.

Coping Strategies Adopted by Women Who Experienced Intimate Partner Violence in the Context of Social Norms in Rural Areas in Zimbabwe

Intimate partner violence (IPV) has detrimental effects on the welfare of women. Research on the coping strategies employed by rural women in Zimbabwe is notably lacking, despite the fact that the majority of Zimbabwean women reside in rural areas. Therefore, this study sought to explore the strategies that women in rural areas used to manage and cope with IPV. The study adopted a qualitative research approach, and participants were recruited through the purposive sampling method in Chimanimani Rural District, Eastern Highlands, Zimbabwe. Face-to-face interviews using a narrative approach were conducted with 25 women between 19 and 49 years and seven key informants. The 25 women consisted of women who had left abusive relationships and were selected on the basis that they should have experienced IPV in their former relationships. Current IPV victims were excluded from the study. All the interviews were recorded, with participants' consent, to avoid loss of data. Data was analyzed by the author and an additional independent data analyst using thematic analysis. Findings from this study revealed that social norms influenced participants' covert coping behavior, which include acceptance of abuse and prayer. There is need to strengthen the existing coping strategies that are utilized by women as these could be the starting point for intervention efforts. This is important as it enables practitioners to develop context-specific and context-driven intervention strategies that will effectively serve the victims in their distinctive situation(s).

Postinjury Engagement With the Police and Access to Care Among Victims of Violent Street Crime: Does Criminal History Matter?

This study examines whether victims of violent street crimes who are known to the police as past offenders, when compared with victims with no arrest history, have different outcomes related to receipt of victim and health-related services, while taking into consideration whether or not police responded to the victimization incident. The sample is comprised of 103 men and women between the age of 18 and 40 living in one Mid-Atlantic city who were victims of street violence within the year before study recruitment. Logistic regression was used to assess the impact of police response to the victimization incident on receipt of victim services, and receipt of victim services on engagement with counseling and mental health services. The results show that prior arrests were not associated with receipt of services. However, having police officers respond to the victimization was associated with higher odds of receiving victim services, and in turn, victim services were associated with receiving mental health treatment. Police response appears to set victims on a path to accessing services. Although the number of arrests was not associated with service receipt, a small percentage of victims who did not receive services stated they were reluctant to cooperate with the police, thus limiting their opportunity for victim services. Because most victims who did not access victim services did not know that they existed, policies that promote more knowledge of and initial engagement with victim services could improve access to needed health and mental health services.

Postpartum Depressive Symptoms as a Mediator Between Intimate Partner Violence During Pregnancy and Maternal-Infant Bonding in Japan

Studies show that experiencing intimate partner violence (IPV) during pregnancy is related to poor maternal-infant bonding. However, the mechanisms underlying this relationship are unclear. This article aims to examine whether maternal postpartum depressive (PPD) symptoms mediate the association between pregnancy IPV and maternal-infant bonding, and whether the relationship differs by maternal-infant bonding subscales-lack of affection, anger/rejection. A survey was conducted among women who participated in a postpartum health check-up program in Aichi prefecture, Japan (N = 6,590) in 2012. We examined whether experiences of emotional and physical IPV were related to maternal-infant bonding and whether PPD symptoms mediated this relationship. Path analysis showed that emotional and physical IPV were associated with PPD symptoms, and PPD symptoms predicted poor bonding. The total effect of emotional IPV on poor bonding was significant, showing a marginally significant direct effect and statistically significant indirect effect. The total effect of physical IPV on poor bonding was not statistically significant. Emotional IPV was significantly associated with both lack of affection and anger/rejection bonding subscales, which were similarly mediated by PPD symptoms. Findings revealed a modest indirect association between IPV, emotional IPV in particular, and poor maternal-infant bonding, which was mediated by PPD symptoms. While prevention of IPV is the ultimate goal, the treatment of PPD symptoms among women who experience IPV during pregnancy may improve maternal-infant bonding and mitigate cross-generational effects of IPV. Identifying opportunities for detection of IPV and PPD symptoms, as well as prevention and early intervention, may improve maternal-infant bonding.

Socio-Demographic and Coping Correlates and Predictors of Depressive Symptoms Among Low-Income and Ethnic Minority Mothers At-Risk

This study identified coping and sociodemographic correlates and predictors of depressive symptoms in mothers at risk for clinical depression. A descriptive, cross-sectional design was employed. A convenience sample of 88 low-income or ethnic-minority mothers aged 21 to 45 completed a depression scale, demographic data sheet, and responded to an open-ended question. Content analysis, descriptive, and inferential statistics was used for data analysis. Exactly 42.5% of mothers reported high depressive symptoms (>16). Lower income levels (r = .342, p = .01) and head-of-household status (r = .220, p = .04) were significantly associated with higher depressive symptoms. Those who used social support coping had lower depressive symptoms than those who did not (t = 2.50, p = .014). Those using emotion-focused coping only had higher depressive symptoms than those using a mix of coping strategies (t = 2.60, p = .011). Healthcare providers can employ vigilant depression screening and encourage utilization of a mix of problem and emotion-focused coping strategies to reduce depressive symptoms and prevent clinical depression.

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.

Trauma History and Social Support Among American Indian/Alaska Native and Non-Native Survivors of Intimate Partner Violence

Social support (SS) is one of the most important protective factors against the deleterious effects of trauma exposure on mental health, but only a few studies have looked at predictors of SS among trauma-exposed populations. This study examines what predicts SS from friends, family, and other significant individuals in an ethnically diverse group of 61 women residing in Alaskan shelters for women who have experienced Intimate Partner Violence (IPV). Results from bivariate tests indicated that survivors who identified as American Indian or Alaska Native (AIAN) reported significantly higher SS from family (M = 5.04, SD = 1.74) in comparison with those who do not identify as AIAN (M = 3.80, SD = 2.31), t(56) = 2.24, p < .05. Income was positively correlated with higher SS from friends, r(59) = .33, p < .05. Lifetime history of interpersonal trauma was significantly and negatively related to variation in SS across multiple domains. When sociodemographic variables, trauma history, and violent relationship history were entered into a multiple regression, this model predicted 34% (p < .001) of the variance in Overall SS and 22% (p < .01), 32% (p < .001), and 17% (p < .05) of SS from family, friends, and other significant individuals, respectively. Taken together, these preliminary results suggest that income, race, lifetime interpersonal trauma history, and number of violent partners are important predictors of SS among women IPV survivors residing in shelters.

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.

Coping with domestic violence: women's voices in Bangladesh

Purpose

This paper aims offer a benchmark by providing an account of women's experiences with domestic violence in Bangladesh and develops illustrations on coping with abuse.

Design/methodology/approach

A case study design was adopted, applying an emic perspective in employing a qualitative research approach to explore and describe women's experiences with and perceptions about domestic violence and their ways of coping in Sherpur District, Bangladesh. In total 25 recently married women participants were purposively sampled by snowballing. In-depth interview data facilitated a latent thematic content analysis.

Findings

The findings indicate that women adopt a range of responses to domestic violence. Two key aspects of coping surfaced in the narratives: (1) emotion-driven and (2) problem-driven approaches to abusive situations. Findings point to a range of research issues that require further study such as domestic violence and taboo; somatization; structural gender inequalities; male perpetrators; family dynamics and the intersections of these issues and contexts.

Originality/value

A more proactive way of coping resulted in resilience amidst an abusive environment, whereas passive ways of coping led to a life in distress. It is important however, to understand ways of coping as a continuum rather than a dichotomy.

Depression and Intimate Partner Violence Among African American Women Living in Impoverished Inner-City Neighborhoods

Mental health correlates of intimate partner violence (IPV) victimization including negative physical and mental health outcomes are well documented. However, certain subgroups of African American women, such as those living in impoverished, urban communities, are underrepresented in most studies and may experience IPV at higher rates. Furthermore, the circumstances of this women including poverty makes them at risk to IPV and its consequences. The present study estimated the prevalence of IPV victimization and its association with depression in a sample of low-income African American women participating in the Mobile Youth and Poverty Study. Participants in this study were caregivers of adolescents living in extremely impoverished conditions and were part of the Mobile Youth Survey, a community-based, longitudinal, multiple cohort survey conducted between the years 1998 and 2011. Data for the current study were collected between the years 2001 and 2010. The dependent variable was depressive symptoms as measured by the Center for Epidemiological Studies-Depression Scale (CES-D). The independent variable was IPV measured using a subsample of items from the Conflict Tactics Scale. Nearly three quarters (73.6%, n = 489) of the sample experienced some form of IPV and 49.1% (n = 326) had a CES-D depression score of 16 or greater indicating mild to severe depression symptoms. The highest proportion of women who met the CES-D criteria for depression were those experiencing the most severe IPV irrespective of category (i.e., physical, psychological, or combined). Logistic regression analyses showed that women reporting the most severe abuse, irrespective of category, were significantly more likely to meet the CES-D criteria for depression. In addition, low education and receipt of economic assistance were significantly associated with depressive symptoms. The combination of poor economic conditions and IPV may predispose African American women living in impoverished, urban communities to mental health outcomes such as depression.

The Effects of Child and Adult Victimization on Psychological Distress: A Mediated Structural Equation Modeling Analysis

Justice-involved women experience significantly higher rates of victimization and psychological distress, and these experiences place women at greater risk of initial and ongoing involvement in the criminal justice system. This research explored the relationship between victimization, the hypothesized mediators (social support and coping), and psychological distress among a sample of 406 victimized women on probation/parole. Results of the Structural Equation Modeling (SEM) were significant and indicated a partial mediation model (74%) with both direct and indirect effects. Based upon the results of this research, implications and future research are explored regarding gender-responsive practices for this population.

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.

The Role of Depression in the Relationship Between Psychological and Physical Intimate Partner Violence

Physical and psychological intimate partner violence (IPV) are significant public health concerns often associated with negative consequences for individuals, families, and society. Because IPV occurs within an interpersonal relationship, it is important to better understand how each partner's depressive symptoms, marital satisfaction, and psychological and physical IPV are interlinked. The purpose of this study was to identify actor and partner effects in a dyadic data analysis association between marital satisfaction and depressive symptoms, its links to psychological IPV, and then to physical IPV. Guided by the social information processing model, this study has implications for understanding the processes leading to various types of IPV in people seeking couples therapy. Using cross-sectional data from 126 heterosexual couples, we conducted an actor-partner interdependence model (APIM) to test actor and partner effects. Indirect actor and partner effects were also assessed. More depressive symptoms were associated with lower marital satisfaction. More depressive symptoms were generally linked with increased perpetration of psychological and physical IPV. Psychological IPV was associated with an individual's use of physical IPV. Effect sizes were moderate to large in magnitude. Four specific indirect effects were identified from depressive symptoms to psychological IPV to physical IPV. Depressive symptoms may be an important factor related to psychological and physical IPV for males and females. Implications include assessing for and treating depression in both partners, and discussing preferred ways of supporting each other that do not include psychological or physical IPV.

The psychobiology of stress and intimate partner violence

Exposure to intimate partner violence (IPV) negatively affects health outcomes, however, the biopsychosocial pathways underlying this relationship are not well understood. We conducted a systematic review of research published from 2000 through 2018 on biological and psychological stress-related correlates and consequences of IPV exposure. Fifty-three publications were included. The biological and psychological literatures have evolved separately and remain distinct. The biological literature provides emerging evidence of stress-related endocrine and immune-inflammatory dysregulations that are in line with patterns typically observed among chronically stressed individuals. The psychological literature provides strong evidence that IPV is associated with psychological stress, and that psychological stress follows new instances of IPV. Larger scale, integrative studies using prospective study designs are needed to more carefully map out how IPV influences victims both biologically and psychologically, and how these biopsychological changes, in turn, affect the health of victims over time.

A realist review of which advocacy interventions work for which abused women under what circumstances

BACKGROUND

Intimate partner abuse (including coercive control, physical, sexual, economic, emotional and economic abuse) is common worldwide. Advocacy may help women who are in, or have left, an abusive intimate relationship, to stop or reduce repeat victimisation and overcome consequences of the abuse. Advocacy primarily involves education, safety planning support and increasing access to different services. It may be stand-alone or part of other services and interventions, and may be provided within healthcare, criminal justice, social, government or specialist domestic violence services. We focus on the abuse of women, as interventions for abused men require different considerations.

OBJECTIVES

To assess advocacy interventions for intimate partner abuse in women, in terms of which interventions work for whom, why and in what circumstances.

SEARCH METHODS

In January 2019 we searched CENTRAL, MEDLINE, 12 other databases, two trials registers and two relevant websites. The search had three phases: scoping of articles to identify candidate theories; iterative recursive search for studies to explore and fill gaps in these theories; and systematic search for studies to test, confirm or refute our explanatory theory.

SELECTION CRITERIA

Empirical studies of any advocacy or multi-component intervention including advocacy, intended for women aged 15 years and over who were experiencing or had experienced any form of intimate partner abuse, or of advocates delivering such interventions, or experiences of women who were receiving or had received such an intervention. Partner abuse encompasses coercive control in the absence of physical abuse. For theory development, we included studies that did not strictly fit our original criteria but provided information useful for theory development.

DATA COLLECTION AND ANALYSIS

Four review authors independently extracted data, with double assessment of 10% of the data, and assessed risk of bias and quality of the evidence. We adopted RAMESES (Realist and meta-narrative evidence syntheses: evolving standards) standards for reporting results. We applied a realist approach to the analysis.

MAIN RESULTS

We included 98 studies (147 articles). There were 88 core studies: 37 focused on advocates (4 survey-based, 3 instrument development, 30 qualitative focus) and seven on abused women (6 qualitative studies, 1 survey); 44 were experimental intervention studies (some including qualitative evaluations). Ten further studies (3 randomised controlled trials (RCTs), 1 intervention process evaluation, 1 qualitative study, 2 mixed methods studies, 2 surveys of women, and 1 mixed methods study of women and staff) did not fit the original criteria but added useful information, as befitting a realist approach. Two studies are awaiting classification and three are ongoing.Advocacy interventions varied considerably in contact hours, profession delivering and setting.We constructed a conceptual model from six essential principles based on context-mechanism-outcome (CMO) patterns.We have moderate and high confidence in evidence for the importance of considering both women's vulnerabilities and intersectionalities and the trade-offs of abuse-related decisions in the contexts of individual women's lives. Decisions should consider the risks to the woman's safety from the abuse. Whether actions resulting from advocacy increase or decrease abuse depends on contextual factors (e.g. severity and type of abuse), and the outcomes the particular advocacy intervention is designed to address (e.g. increasing successful court orders versus decreasing depression).We have low confidence in evidence regarding the significance of physical dependencies, being pregnant or having children. There were links between setting (high confidence), and potentially also theoretical underpinnings of interventions, type, duration and intensity of advocacy, advocate discipline and outcomes (moderate and low confidence). A good therapeutic alliance was important (high confidence); this alliance might be improved when advocates are matched with abused women on ethnicity or abuse experience, exercise cultural humility, and remove structural barriers to resource access by marginalised women. We identified significant challenges for advocates in inter-organisational working, vicarious traumatisation, and lack of clarity on how much support to give a woman (moderate and high confidence). To work effectively, advocates need ongoing training, role clarity, access to resources, and peer and institutional support.Our provisional model highlights the complex way that factors combine and interact for effective advocacy. We confirmed the core ingredients of advocacy according to both women and advocates, supported by studies and theoretical considerations: education and information on abuse; rights and resources; active referral and liaising with other services; risk assessment and safety planning. We were unable to confirm the impact of complexity of the intervention (low confidence). Our low confidence in the evidence was driven mostly by a lack of relevant studies, rather than poor-quality studies, despite the size of the review.

AUTHORS' CONCLUSIONS

Results confirm the core ingredients of advocacy and suggest its use rests on sound theoretical underpinnings. We determined the elements of a good therapeutic alliance and how it might be improved, with a need for particular considerations of the factors affecting marginalised women. Women's goals from advocacy should be considered in the contexts of their personal lives. Women's safety was not necessarily at greatest risk from staying with the abuser. Potentially, if undertaken for long enough, advocacy should benefit an abused woman in terms of at least one outcome providing the goals are matched to each woman's needs. Some outcomes may take months to be determined. Where abuse is severe, some interventions may increase abuse. Advocates have a challenging role and must be supported emotionally, through provision of resources and through professional training, by organisations and peers.Future research should consider the different principles identified in this review, and study outcomes should be considered in relation to the mechanisms and contexts elucidated. More longitudinal evidence is needed. Single-subject research designs may help determine exactly when effect no longer increases, to determine the duration of longitudinal work, which will likely differ for vulnerable and marginalised women. Further work is needed to ascertain how to tailor advocacy interventions to cultural variations and rural and resource-poor settings. The methods used in the included studies may, in some cases, limit the applicability and completeness of the data reported. Economic analyses are required to ascertain if resources devoted to advocacy interventions are cost-effective in healthcare and community settings.

Longitudinal Investigation of Depression, Intimate Partner Violence, and Supports Among Vulnerable Families

Intimate partner violence (IPV) affects nearly 12 million individuals and their families each year in the United States. Many negative outcomes are associated with IPV, with depression being one of the most prevalent mental health problems. Most previous studies on IPV have used cross-sectional designs to examine the potential protective effects of support on depression. The current study fills this gap by conducting a longitudinal investigation of the roles of social support and family resources on depression among caregivers of young children. The study sample consisted of 548 female caregivers. Findings suggest that among those with an IPV history, those with higher social support reported lower depressive symptoms than those with less social support. No significant interaction was found for family resources and IPV. Rather, family resources had a main effect on depressive symptoms with no differential impact based on IPV status. Findings suggest the importance of connecting vulnerable families to supports such as social support and family resources to help mitigate depressive symptoms. Future research should consider the underlying mechanisms of social support as a protective factor among IPV victims with depression.

Spiritual Well-Being and Psychological Adjustment: Mediated by Interpersonal Needs?

Spiritual well-being has been shown to reduce suicidal behavior, depressive symptoms, and hopelessness. Thwarted interpersonal needs have been shown to increase risk of suicidal behavior. This paper aims to explore the interrelationships among spiritual well-being, thwarted interpersonal needs, and negative outcomes including suicidal ideation, hopelessness, and depressive symptoms among African American women. Sixty-six African American women (M = 36.18; SD = 11.70), from a larger study of women who had experienced interpersonal violence within the past year, completed self-report questionnaires. Mediation analyses revealed that thwarted belongingness, but not perceived burdensomeness, significantly mediated the relations between spiritual well-being and the three outcomes. This study provides the first examination of the role of thwarted interpersonal needs on the link between spiritual well-being and negative psychological outcomes. Spiritual well-being serves a protective role against feelings of social isolation, which may reduce one's risk of negative psychological outcomes. Treatments that bolster a sense of spirituality and social connectedness may reduce suicidal ideation, hopelessness, and depressive symptoms.

Strategizing Safety: Theoretical Frameworks to Understand Women's Decision Making in the Face of Partner Violence and Social Inequities

Women in physically and psychologically abusive relationships face numerous decisions related to their safety: decisions that historically have been viewed by researchers and human service practitioners as related to individual or interpersonal factors, such as how they feel about their partner, what they (or those they are close to) think is best for their children, or whether they have a safe place to go to. Social and structural factors, such as poverty, sexism, and barriers related to disability, are either left out or viewed at their individual-level consequence, such as a woman's employment status. Using interview data and case studies from a larger study on housing instability, partner violence, and health, the authors apply ecological and macro-level theoretical models that go beyond the individual level to the stories of women who struggled with partner violence, arguing that it is critical to examine the large social and structural forces that impact women's lives if we are to understand the decisions women make when facing a violent partner.

Childhood Victimization, Attachment, Coping, and Substance Use Among Victimized Women on Probation and Parole

Justice-involved women report high rates of victimization across their life span, and these experiences contribute to their involvement in the criminal justice (CJ) system. Within this population, research has identified an overlap among victimization and substance use, a high-risk coping mechanism. Furthermore, research indicates attachment style is related to coping and high-risk behaviors. Research is needed to understand the relationship among these mechanisms as they relate to intimate partner violence (IPV). To address this gap, this study investigated the relationship between attachment, coping, childhood victimization, substance use, and IPV among 406 victimized women on probation/parole. Results of 6 multivariate regression analyses were statistically significant, accounting for 8%-13% of the variance in IPV. Particularly, childhood sexual victimization and negative coping were significant in all analyses. Findings provide practitioners, administrators, and policymakers information about the specific needs of justice-involved women.

Strategies for coping with individual PTSD symptoms: Experiences of African American victims of intimate partner violence

OBJECTIVE

Understanding how populations at particular risk for posttraumatic stress disorder (PTSD) and its deleterious outcomes cope with individual PTSD symptoms is critical to developing interventions that promote resilience, support recovery, and ultimately empower traumatized populations. Therefore, the purpose of this study was to identify specific strategies women use to cope with individual PTSD symptoms among a population at particular risk for experiencing trauma and its negative sequelae-African American victims of intimate partner violence (IPV) who use substances.

METHOD

This 30-day study included 107 African American women who reported experiencing current IPV and using a substance. During their follow-up interviews, women participated in a structured interview to retrospectively report on the strategies they typically used to cope with various PTSD symptoms during the 30-day period.

RESULTS

Results of content analysis revealed that women used 19 different strategies to cope with symptoms (e.g., social support, substance use, electronic media, religious or spiritual coping), which varied as a function of the PTSD symptom experienced. Aggregating symptoms to the cluster level obscured the variability in strategies used to cope with individual symptoms.

CONCLUSIONS

Findings are discussed in the context of the larger literature on coping and PTSD, specifically regarding (a) coping strategies that may be adaptive or maladaptive and (b) directions for future research that attend to experiences of individual PTSD symptoms. (PsycINFO Database Record

Violence Victimization, Social Support, and Papanicolaou Smear Outcomes: A Longitudinal Study from Adolescence to Young Adulthood

BACKGROUND

African American youth are among those at greatest risk for experiencing violence victimization. Notably, the mortality rate of cervical cancer for African American women is also twice that of white women. To date, we know of no literature using longitudinal data to examine how violence victimization relates to Papanicolaou (Pap) smear results or cervical cancer in this population. Our study examines how violence victimization during adolescence (age 15 to 18) influences psychological distress, perceived social support, heavy substance abuse, and sexual risk behaviors during emerging adulthood (age 20 to 23), and subsequent Pap smear outcomes during young adulthood (age 29 to 32).

METHOD

This study is based on 12 waves of data collected in a longitudinal study of 360 African American women from mid-adolescence (ninth grade, mean age = 14.8 years) to young adulthood (mean age = 32.0 years). We used structural equation modeling analysis to examine the hypothesized model.

RESULT

Violence victimization during adolescence had a direct effect on decreased social support, increased psychological distress, and increased heavy cigarette use during emerging adulthood. Better social support was also associated with fewer sexual partners during emerging adulthood and lower odds of abnormal Pap smear results during young adulthood. The effect of violence victimization on abnormal Pap smear was mediated by social support.

CONCLUSION

Our results show that violence victimization during adolescence has long-term negative effects through multiple pathways that persist into adulthood. Our findings also suggest that social support may help to compensate against other risk factors. Interventions designed to address the perceived support may help victims cope with their experience.

Reducing violence in poor urban areas of Honduras by building community resilience through community-based interventions

OBJECTIVES

To examine the impact of a 3 year community-based violence prevention intervention on risk of violence and social capital in two poor urban communities in Honduras in 2011-2014.

METHODS

A quasi-experimental design pre and post implementation of the intervention was conducted based on data from two randomly selected samples using the same structured questionnaire in 2011 and in 2014.

RESULTS

Community members had a 42 % lower risk of violence in 2014 compared to 2011. There was a positive relation between participation in the intervention and structural social capital, and participants had more than twice the likelihood of engaging in citizenship activities compared to the general population.

CONCLUSIONS

The intervention contributed to decreasing violence and increasing community resilience in two urban areas in Honduras. Citizenship activities and active community participation in the violence prevention agenda rather than social trust and cohesion characteristics was affected by the intervention. This research introduces important lessons learned to future researchers aiming to retrieve very sensitive data in a similarly violent setting, and provides strong research opportunities within areas, which to this date remain undiscovered.

Rurality and Self-Reported Health in Women with a History of Intimate Partner Violence

OBJECTIVE

To investigate differences in self-reported health among Australian women with a history of intimate partner violence (IPV) in relation to rurality of residence.

METHODS

Data were drawn from six survey waves of the Australian Longitudinal Study on Women's Health 1973-78 birth cohort. Self-reported general and mental health scores derived from the SF-36 scale were compared for women with a history of IPV living in metropolitan, regional and rural areas. Multivariable generalised estimating equations were constructed adjusting for income hardship, number of children, education, social support, age and marital status.

RESULTS

Women with a history of IPV living in regional and rural areas had no significant differences in self-reported general health scores compared to their metropolitan counterparts. Rural women affected by IPV had slightly better self-reported mental health than equivalent women living in metropolitan or regional areas. The socio-demographic factors with the strongest association with self-reported health were income, education, social support, and number of children.

CONCLUSIONS

Women in regional and rural areas were no more disadvantaged, in terms of self-reported general health or mental health, than IPV affected women living in major cities in Australia.

Coping with Depression in Single Black Mothers

Very little information exists in the literature about what black women do when they experience symptoms of depression. The purpose of this descriptive study was to analyze the responses of 208 community-residing black single mothers, aged 18 to 45, to an open-ended question asking, "What do you do to feel better when you are feeling down in the dumps?" The theoretical bases of the Ways of Coping Checklist, were used to facilitate categorizing their responses into a coping scale and then a particular coping profile. Percentages were used to categorize the frequency of the responses into the respective coping scale and to categorize the frequency of the combined responses of each woman into a respective coping profile. Of the 333 responses that the women provided, 327 were useable. Findings indicated that a majority of responses fell into the Escape-Avoidance category (n = 206; 63%), followed by the Seeking Social Support (n = 60, 18.3%), Positive Reappraisal (n = 40; 12.2%), Planful Problem Solving (n = 12; 3.7%), Distancing (n = 3; 1%), and Self-Controlling (n = 6; 1.8%) categories. No responses fit the Confrontive Coping or Accepting Responsibility categories and none of the responses indicated that the women sought professional help. Of the 176 women who provided answers to the study question, more than half (64.2%; n = 113) gave only emotion-focused responses, 2.8% (n = 5) gave only problem-focused responses, 2.8% (n = 5) gave mixed responses, and 30.2% (n = 53) reported social support seeking. Implications for future research, cultural theory, and nursing practice are addressed.

Intimate partner violence and ways of coping with stress: cross-sectional survey of female patients in Russian general practice

BACKGROUND

Despite World Health Organization guidelines on health service responses to intimate partner violence (IPV) against women general practitioners (GPs) often overlook the problem. Training on IPV addresses GPs' barriers to asking women patients about abuse and responding appropriately. One of the barriers is stereotype of women as passive victims. Little is known about coping behaviour of women patients with a history of IPV.

OBJECTIVES

The objectives are (i) to compare problem- and emotion-focused coping used by patients who have experienced IPV with those who have not; (ii) to examine whether greater coping resources (health, education, employment and income) would be associated with more problem-focused coping.

METHODS

The Russian Ways of Coping Questionnaire was administered to every fifth woman who participated in a cross-sectional survey on IPV prevalence in 24 St Petersburg general practices. Linear regression was used (n = 159) to test associations between life-time IPV, coping resources and ways of coping.

RESULTS

Mean problem-focused coping scores were 0.2-4.7 units higher in those patients who have experienced IPV compared with those who have not [95% confidence interval (CI): -4.2, 11.9; P = 0.16-0.92], while mean emotion-focused coping scores were 2.5-4.2 units higher (95% CI: -3.0, 11.0; P = 0.12-0.57). After adjustment for coping resources there was no evidence for an association between IPV and problem-focused coping.

CONCLUSIONS

Patients who have experienced IPV use as much problem-focused and emotion-focused coping, as those patients who have not experienced IPV. These findings should be incorporated into training on IPV to address GPs' stereotypes towards patients who have experienced IPV.

Is John Henryism a resilience factor in women experiencing intimate partner violence?

BACKGROUND

Research suggests that posttraumatic stress disorder (PTSD) and depression are two common mental health problems in intimate partner violence (IPV) survivors. Research has found that while Black women consistently report higher rates of victimization than White women, they also report less severe PTSD and depressive symptoms, suggesting that Black IPV survivors might be more resilient to PTSD and depression than are White survivors.

DESIGN

We implemented a correlational study with 81 Black and 100 White female survivors of IPV to determine if John Henryism (JH; i.e., a predisposed active coping mechanism) contributes to the resilience observed in Black IPV survivors.

METHODS

Participants completed the John Henryism Active Coping Scale, Center for Epidemiological Studies Depression Scale, Davidson Trauma Scale, and the Abusive Behavior Inventory.

RESULTS

Results demonstrated that White woman endorsed more severe depressive symptoms as compared to Black women. Severity of PTSD symptoms and JH was not significantly different between races. JH did not moderate the relationship between race and depression; however, for PTSD, JH was found to be protective of PTSD in White women, while demonstrating little impact on Black women.

CONCLUSIONS

The implications of these findings are discussed in terms of the minority stress model.

Mediators of the childhood emotional abuse-hopelessness association in African American women

Although there is an association between experiencing childhood emotional abuse and feeling hopeless as an adult, it is critical to understand the factors that may be protective in this relationship. The goal of this study was to determine if two protective factors, namely spiritual well-being, including both religious and existential well-being, and positive self-esteem, served to mediate the association between childhood emotional abuse and adult hopelessness. The sample for this investigation was low-income African American women suicide attempters who were abused by a partner in the prior year (N=121). A path analysis revealed that in this sample, the childhood emotional abuse-hopelessness link was mediated by existential well-being and positive self-esteem, as well as by the two-mediator path of emotional abuse on existential well-being on self-esteem on hopelessness. Results suggested that existential well-being may be a more salient protective factor for hopelessness than religious well-being among abused, suicidal African American women who experienced childhood emotional abuse. Findings highlight the value of culturally relevant strategies for enhancing existential well-being and self-esteem in this at-risk population to reduce their vulnerability to feelings of hopelessness.

Effects of an intervention program for female victims of intimate partner violence on psychological symptoms and perceived social support

BACKGROUND

Research has documented severe mental health problems in female victims of intimate partner violence (IPV). Therefore, providing effective treatment is pivotal. Few studies have investigated the effects of intervention programs on reducing the harmful consequences of IPV.

OBJECTIVE

The present study examined the effects of a specific three-phase intervention program for female victims of IPV on psychological symptoms (PTSD, anxiety, and depression) and perceived social support. Given that many of the women dropped out before and during the intervention program, potential differences in initial levels of psychological symptoms, perceived social support, as well as descriptive variables were explored between the women who completed the whole program and the groups of women who dropped out prematurely.

METHOD

The initial sample consisted of 212 female victims of IPV. Symptoms of PTSD, depression, anxiety, and level of perceived social support were measured with validated scales before the start of the intervention and after completion of each treatment phase.

RESULTS

Results showed a significant effect of the intervention program on reducing psychological symptoms and increasing levels of perceived social support. Effect sizes ranged from medium to very high. Significant positive effects were found for each of the treatment phases. There were no significant differences between the women who completed the whole program and those women who dropped out prematurely in terms of initial level of symptoms and perceived social support as well as descriptive characteristics.

CONCLUSIONS

Specifically developed intervention programs for female victims of IPV are effective in reducing the harmful personal consequences of IPV. Future studies should consider employing controlled study designs and address the issue of high drop out rates found in intervention studies.

Mediators of a culturally-sensitive intervention for suicidal African American women

This study explored intervention outcomes and mechanisms that could help explain why low-income, African American women with a history of intimate partner abuse and suicide attempt improve in response to a culturally-informed intervention, the Grady Nia Project. Specifically, the investigation examined whether or not the intervention had effects on the women and whether or not spiritual well-being and coping mediated the effects of the intervention on suicidal ideation and depressive symptoms. In this randomized controlled clinical trial, data from 89 women who completed both pre- and post-intervention assessments were analyzed. During the post-intervention follow-up, women in the active intervention group reported lower levels of suicidal ideation and depressive symptoms and higher levels of existential well-being and adaptive coping skills than those women randomized to the treatment as usual group. However, only existential well-being was found to mediate treatment effects on suicidal ideation and depressive symptoms. Religious well-being, as well as adaptive and maladaptive coping, did not serve a mediational function. These findings highlight the importance of designing and implementing culturally-sensitive and evidence-based strategies that enhance existential well-being in this population.

The Mediating Effects of Empowerment, Interpersonal Conflict, and Social Support on the Violence–PTSD Process among Single Mothers

In this study, data from 181 income-assisted single mothers residing in Ontario, Canada, is used to examine the process through which childhood abuse and intimate partner violence (IPV) affect current post-traumatic stress disorder (PTSD) symptom levels. Structural equation modelling is used to examine the mediating effects of empowerment, social support, and interpersonal conflict on the trauma–PTSD process. Empowerment and social support are highlighted as key protective factors that may be compromised by exposure to abuse/violence and interpersonal conflict. Implications include understanding the ways in which women’s empowerment may be enhanced particularly in the post-trauma period.

Intimate partner violence, depression, PTSD, and use of mental health resources among ethnically diverse black women

This study examined exposure to violence and risk for lethality in intimate partner relationships as factors related to co-occurring MH problems and use of mental health (MH) resources among women of African descent. Black women with intimate partner violence (IPV) experiences (n = 431) were recruited from primary care, prenatal or family planning clinics in the United States and the U.S. Virgin Islands. Severity of IPV was significantly associated with co-occurring MH problems, but was not associated with the use of MH resources among African-American women. Risk for lethality and co-occurring problems were also not significantly related to the use of resources. African Caribbean women with severe physical abuse experiences were significantly less likely to use resources. In contrast, severity of physical abuse was positively associated with the use of resources among Black women with mixed ethnicity. Severe IPV experiences are risk factors for co-occurring MH problems, which in turn, increases the need for MH services. However, Black women may not seek help for MH problems. Thus, social work practitioners in health care settings must thoroughly assess women for their IPV experiences and develop tailored treatment plans that address their abuse histories and MH needs.

The Prevalence of Mental Health Disorders in a Community Sample of Female Victims of Intimate Partner Violence

Intimate partner violence (IPV) is a serious, devastating, and prevalent problem. IPV places women at risk for negative health consequences, including increased mental health disorders. The majority of research to date has focused on mental health disorders among women in domestic violence shelters, and research is needed that examines mental health disorders among a broader range of women experiencing IPV. Therefore, the present study examined the prevalence of posttraumatic stress disorder (PTSD), depression, and substance abuse disorders in a community sample of IPV victims (N = 94) using diagnostic interviews. Results showed that the majority of women met diagnostic criteria for a mental health disorder, with PTSD being the most common mental health disorder. Furthermore, psychological abuse was a significant predictor of both PTSD and depression, whereas physical aggression did not predict these outcomes. Implications of these findings for treatment and intervention work with battered women are discussed.

Co-occurring intimate partner violence and mental health diagnoses in perinatal women

OBJECTIVES

To describe the co-occurrence of intimate partner violence (IPV) and mental health burden among perinatal mothers attending well-baby visits with their infants in the first year of life. We compare rates of depression, anxiety disorder, and substance abuse diagnoses between mothers who reported IPV within the past year to those who did not.

METHODS

This cross-sectional study of 188 mothers of infants (under 14 months) was conducted in an urban hospital pediatric clinic. Participants reported demographics and IPV and completed a semistructured psychiatric diagnostic interview.

RESULTS

Mothers reporting IPV were more likely to be diagnosed with mood and/or anxiety diagnoses (p<0.05, Fisher's exact test), specifically current depressive diagnoses (p<0.01, Fisher's exact test) and panic disorder (p<0.05, Fisher's exact test). There was a trend for more posttraumatic stress disorder (PTSD) (p<0.06) among abused mothers. Substance abuse and dependence, age, race, insurance status, employment, education, and family arrangements did not differ between groups. Prior major or minor depression increases the odds for perinatal depression threefold (OD 3.18).

CONCLUSION

These findings have implications for practitioners who encounter perinatal women. Findings suggest providers should explore signs and symptoms of depression and anxiety disorders among women reporting IPV. Similarly, when perinatal mothers report symptoms of depression, PTSD, or panic disorder, practitioners should be alert to the possible contributory role of IPV.

Women's perceptions of their community's social norms towards assisting women who have experienced intimate partner violence

The role of social norms has played an often unrecognized role in the perception of and action to assist low-income urban women who are in violent relationships. Two forms of social norms will be assessed, including descriptive norms--what people typically do to assist women in a violent relationship--and injunctive norms--defined as what people should do to assist women. This study will present our initial findings into the development of measures to assess women's perception of their community's social norms toward assisting women who have experienced intimate partner violence (IPV) and how these norms are related to women's perception of the community, reasons for community assistance toward women experiencing IPV, and women's own experience of IPV. Systematic measurement development processes were applied to reliably and validly develop the social norms measures. A three-phase approach was used to develop eight paired items measuring descriptive and injunctive norms. A total of 176 low-income urban women were interviewed and the scale responses were compared to length of time at the residence, perceptions of their neighborhood, perceived reasons for community involvement and non-involvement in assisting women experiencing IPV, and IPV experienced as an adult. The two developed social norms scales were found to have high internal consistency alpha coefficients of 0.84 for descriptive norms and 0.93 for injunctive norms. Paired t tests were statistically significant, denoting higher injunctive than descriptive social norms. Lowered descriptive norms were found among younger women, women who reported that they did not think their neighborhood was a good place to live, women who had ever experienced intimate partner violence as an adult, and perceived lower reasons for neighbor involvement and higher reasons for neighbor non-involvement toward assisting women experiencing IPV. Higher levels of injunctive social norms were statistically associated with living in a good place and increased perceived reasons for neighbor involvement toward assisting women experiencing IPV. Significant differences between descriptive and injunctive norms suggest that women, especially those who are currently experiencing IPV, would prefer greater support from community neighbors than they are currently providing. The descriptive and injunctive social norms scales demonstrated a high level of internal reliability and significantly associated with other influencing factors thought to be associated with social norms. Overall, the performance of the injunctive and descriptive norms scales support their use as a tool to investigate social norms toward neighbors taking action to assist women experiencing IPV.

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Defensive Functioning Scale: a validity study

OBJECTIVE

We assess the convergent and predictive validity of the Defensive Functioning Scale (DFS) with measures of life events, including childhood abuse and adult partner victimization; dimensions of psychopathology, including axis I (depressive) and axis II (borderline personality disorder) symptoms; and quality of object relations.

METHOD

One hundred and ten women from a university-based urban primary care clinic completed a research interview from which defense mechanisms were assessed. The quality of object relations was also assessed from interview data. The women completed self-report measures assessing depression, borderline personality disorder symptoms, childhood physical and sexual abuse, and adult partner physical and sexual victimization.

RESULTS

Inter-rater reliability of the scoring of the DFS levels was good. High adaptive defenses were positively correlated with the quality of object relations and pathological defenses were positively correlated with childhood and adult victimization and symptom measures. Although major image distorting defenses were infrequently used, they were robustly correlated with all study variables. In a stepwise multiple regression analysis, major image distorting defenses, depressive symptoms, and minor image distorting defenses significantly predict childhood victimization, accounting for 37% of the variance. In a second stepwise multiple regression analysis, borderline personality disorder symptoms and disavowal defenses combined to significantly predict adult victimization, accounting for 16% of the variance.

CONCLUSIONS

The DFS demonstrates good convergent validity with axis I and axis II symptoms, as well as with measures of childhood and adult victimization and object relations. The DFS levels add nonredundant information to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition beyond axis I and axis II.