Posttraumatic stress disorder symptoms among low-income, African American women with a history of intimate partner violence and suicidal behaviors: self-esteem, social support, and religious coping

Resilience in Black Women: Lifeline or Double-Edged Sword?

Black women face many health disparities, many of which are tied to the stress of being a marginalized group member. Resilience, defined as the ability to bounce back from adversity and continue with life, has been introduced as a method to buffer the stress that Black women experience and improve their outcomes. However, there is not a universally agreed-upon definition of resilience in the literature. Thus, it is unclear how resilience works broadly, particularly for Black women. It is important to explore whether resilience is as positive as many scholars have perceived it to be. The current review analyzes 28 empirical articles that looked at stress, resilience, and health outcomes in Black women. The review revealed that there are many inconsistencies in how both stress and resilience are measured. Further, the positive effects of resilience seem to be largely context-dependent and vary depending on the demographic and health outcomes explored.

Do Religion and Spirituality Buffer the Effect of Childhood Trauma on Depressive Symptoms? Examination of a South Asian Cohort from the USA

Asian Americans have been identified as a racial group that is disproportionately affected by childhood trauma. The goal of this study was  to assess if religion/spirituality moderate the effects of childhood trauma on adult depressive symptoms among a sample of South Asians in the USA. Our analysis drew from the study on stress, spirituality, and health (SSSH) questionnaire fielded in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study (n = 990) during 2016-2018. A series of regression models with multiplicative interaction terms were conducted. Emotional neglect, emotional abuse, and physical neglect were associated with higher depressive symptoms. Higher religious attendance and negative religious coping techniques were found to exacerbate this relationship. There were two findings conditional on gender. Among men, gratitude and positive religious coping also exacerbated the relationship between childhood trauma and depressive symptoms. Negative religious coping also exacerbated the association between childhood trauma and depressive symptoms for women. This is the first community-based study of US South Asians to consider the association between various forms of childhood trauma and depressive symptom outcomes. South Asians remain an understudied group in the religion and health literature, and this study sheds light on the important differences in the function and effectiveness of religion/spirituality for those faced with early life trauma.

Adverse Childhood Experiences and Psychological Correlates of Substance Use Disorders Among Black Sexual Minority Women

This study examined the influence of adverse childhood experiences (ACEs) on Black sexual minority women's mental health and substance use disorders in adulthood. Secondary data analysis was conducted using N = 149 Black sexual minority women's reports from the Generations Study. Study variables included psychological distress, chronic strains, stressful life events, ACEs, and substance use disorders, including alcohol use disorder and drug use disorder. Quantitative data analysis consisted of descriptives and bivariate correlations. Participants' total ACE scores were positively significantly correlated with increased alcohol misuse, chronic life strains, and stressful life events. Exposure to household interpersonal violence and household mental illness during childhood were significantly correlated with alcohol misuse. Black sexual minority women with ACEs are at higher risk for mental health concerns throughout their lifespan and maladaptive coping strategies (e.g., substance use). Implications for counselors and therapists are provided.

Effects of Neighborhood Disconnection on Psychological Distress and Suicide Risk Associated with Interpersonal Violence Within Racial Groups

Negative mental health outcomes have been associated with adverse childhood experiences (ACEs) and intimate partner violence (IPV); however, few studies have identified risk and protective factors across levels of the social ecology that mitigate the onset of psychological distress and suicide risk associated with trauma. This study examines the relationship between ACEs, IPV, and mental health (i.e., psychological distress, suicidal ideation, and suicide attempts) within racial sub-populations of Black American, Latinx, and White adults. An online, cross-section survey was administered to a general population sample of adults in Baltimore and New York City. ACEs, IPV, and mental health outcomes were assessed within racial sub-populations of Black American (N = 390), Latinx (N = 178), and White (N = 339) adults, while accounting for within-group demographic differences. Moderating effects of social support and neighborhood disconnection on the relationship between ACEs, IPV, and mental health outcomes were also assessed. IPV was associated with psychological distress and suicidal ideation for Black and Latinx adults, but not for White adults. ACEs were associated with increased psychological distress for all three groups, and increased odds for suicidal ideation among Black and Latinx adults.. A significant negative interaction effect for neighborhood disconnection was found in the relationship between ACEs and psychological distress for Black adults. Findings highlight the significant mental health burdens of ACEs and IPV within racial and ethnic groups. Neighborhood disconnection may exacerbate psychological distress associated with ACEs among populations most impacted by interpersonal violence and mental health inequalities.

Does resilience mediate the association between mental health symptoms and linguistic markers of trauma processing? Analyzing the narratives of women survivors of intimate partner violence

Intimate partner violence (IPV) is a serious issue for women from all cultures and backgrounds. Studies on the negative consequences of violence suggest that women with a history of abuse are more likely to display depressive and PTSD symptoms. However, recent research has focused on the mechanisms underpinning resilience and the processing of traumatic memories, including linguistic markers and how they may reflect the mental health of traumatized individuals. In this study, we analyzed trauma narratives to investigate whether resilience mediates the impact of PTSD and depression symptoms on five trauma-processing mechanisms (cognitive processing, emotional processing, perceived threat to life, self-perspective, and integration of traumatic memories). Forty-three abused women (mean age = 38.74 years; SD = 9.41) wrote about their traumatic experiences and completed instruments assessing their levels of PTSD, depression, and resilience. We used LIWC software to analyze the women's narratives in terms of linguistic markers of psychological processing. Mediation analysis indicated that resilience fully mediated the impact of mental health symptoms on emotional processing, perceived threat to life, and integration of traumatic memories and partially mediated cognitive processing and self-perspective. We discuss the clinical implications of these findings, emphasizing the need to focus on the resources and strengths of women survivors of abuse in designing targeted psychological interventions.

Intimate Partner Violence, Legal Systems and Barriers for African American Women

Although many African American IPV survivors need services, they often do not access care. Hopelessness may partially explain low rates in help-seeking for this population and serve as a significant barrier to care for African American IPV survivors particularly those who have had prior legal system involvement. In a sample of 185 African American women, we first examined whether hopelessness mediated the relation between IPV and barriers to services. If such a mediation effect was found, we then would explore whether legal system involvement moderated the mediated effect of hopelessness on the relation between IPV and barriers to services. As anticipated, hopelessness partially served to explain (i.e., mediated) the relation between IPV and barriers to services. Further, this mediated effect was moderated by legal system involvement such that when legal system involvement was included as a moderator, hopelessness mediated the association between IPV and barriers to services only for those survivors who had been involved with the legal system. These results underscore the critical role of hopelessness as a barrier to accessing services for African American IPV survivors, especially those with prior involvement with the legal system. Recommendations are offered that underscore the importance of interventions that empower African American women who have survived violence instead of penalizing them.

Differential Associations between Guilt and Shame Proneness and Religious Coping Styles in a Diverse Sample of Young Adults

Positive religious coping is linked with better mental health outcomes following physical and sexual abuse while negative religious coping is associated with poorer outcomes. Religious coping styles may be linked with dispositional tendencies to experience guilt or shame. This study compared the associations between guilt and shame proneness and religious coping styles and tested whether abuse history moderated these relationships. We conducted a cross-sectional study with 425 college students (n = 145 with physical and/or sexual abuse history, n = 280 with no abuse history). Participants completed questionnaires assessing positive and negative religious coping style, as well as two dimensions of guilt proneness and shame proneness. Structural equation models were fitted to examine associations between guilt proneness and shame proneness, and positive and negative religious coping, respectively, accounting for abuse history as a binary moderator. Across the full sample, positive religious coping was positively associated with guilt repair (i.e., the tendency to engage in reparative behaviors following one's wrongdoing), guilt negative behavior evaluation (i.e., the tendency to feel bad about how one acted in a given scenario), and shame withdrawal (i.e., the tendency to try and avoid unpleasant situations in which one has done something wrong), and negatively associated with shame negative self-evaluation (i.e., the tendency to make internal, negative self-attributions about one's wrongdoing). Negative religious coping was positively associated with shame withdrawal and, for participants with no abuse history, shame negative self-evaluation. Results suggest that positive religious coping is more closely related to guilt proneness, and negative religious coping to shame proneness. Additional research with longitudinal designs and more defined abuse history subgroups is needed.

(Un)holy Smokes? Religion and Traditional and E-Cigarette Use in the United States

This study employed national cross-sectional survey data from the 2021 Crime, Health, and Politics Survey (n = 1578 to 1735) to model traditional cigarette and e-cigarette use as a function of religious affiliation, general religiosity, biblical literalism, religious struggles, and the sense of divine control. Although the odds of abstaining from cigarettes and e-cigarettes were comparable for conservative Protestants and non-affiliates, conservative Protestants were more likely to cut down on cigarettes and e-cigarettes during the pandemic. Religiosity increased the odds of abstaining from cigarettes (not e-cigarettes) and reduced pandemic consumption of cigarettes and e-cigarettes. Biblical literalism was unrelated to abstaining from cigarettes and pandemic changes in cigarette use; however, biblical literalists were more likely to cut e-cigarette use during the pandemic. While the sense of divine control was unrelated to abstaining from cigarettes and e-cigarettes, these beliefs increased the odds of cessation from traditional and e-cigarette use. Finally, our religious struggles index was unrelated to smoking behavior. Our study is among the first to report any association between religion and lower e-cigarette use.

Self-esteem in the context of intimate partner violence: A concept analysis

AIM

To explore the meaning of self-esteem in the context of intimate partner violence (IPV).

BACKGROUND

IPV is a preventable public health issue. The dynamic of IPV diminishes women's self-esteem. Defining self-esteem will guide the development of IPV interventions in healthcare settings.

DESIGN

Walker and Avant's eight-step approach was used.

DATA SOURCE

The search was conducted from Oxford Dictionary of English online, CINAHL, APA PsycInfo, PubMed, Women's Studies International, and Google Scholar.

REVIEW METHODS

No limits on the year of publication were applied.

RESULTS

Defining attributes of self-esteem are self-concept, self-affirmation, and self-respect. Antecedents of self-esteem are exposure to IPV and victim-blaming attitudes by healthcare professionals. Consequences include depression, substance abuse, and posttraumatic stress disorder. Empirical referents include self-worth, self-competence, self-blame, self-evaluation, self-confidence, and self-determination.

CONCLUSIONS

Current literature is limited in its definition of self-esteem in the context of IPV. Women experiencing IPV with low self-esteem might not seek help for IPV from nurses. Nurses could develop culturally appropriate IPV screening tools that assess the changes in self-esteem among women from different sociodemographic and cultural backgrounds. The defining attributes could contribute to developing comprehensive IPV screening tools in healthcare settings.

Which Aspects of Social Support Enhance Positive Mental Health in the Context of Intimate Partner Violence?

While there is evidence that social support can mitigate mental illness symptoms associated with intimate partner violence (IPV), there is a need to explore if social support can promote positive mental health. In this New Zealand (NZ) population-based study of women who had experienced physical and/or sexual violence (n = 453), structural equation modeling (SEM) showed that most facets of social support (friends, family, and neighbors) had a significant correlation with each dimension of positive mental health, as measured by Keyes' Mental Health Continuum Short Form (MHC-SF). Safety from IPV (no recent IPV experience) is a prerequisite before social support can assist women to attain positive mental health. Further work is required to ensure friends, family, and communities have the knowledge and resources to provide effective social support.

Needs and Support Perceived by Women for Coping with the Experience of Intimate Partner Violence in Andalusia (Spain): A Qualitative Study

There is a need to improve psychological interventions in women experiencing intimate partner violence (IPV) and reduce its long-term sequelae. The objective of this qualitative study was to explore the needs of female IPV survivors, the support they receive, and their strategies for coping with this experience over the long term. During 2017, 53 female IPV survivors participated in the study, of whom 38 (71.7%) were recruited from women's associations against gender violence from three Andalusia provinces (Southern Spain). In a semi-structured interview, the women responded to four open-ended questions about the effects of IPV on their life and how they coped with this situation. Four main themes were identified: (1) changes after the experience, (2) support during recovery, (3) perceived needs and obstacles, and (4) current situation. The survivors considered formal and informal social support to be critical to their recovery and emotional well-being. They also highlighted the need for continuity in support programs and for specialist interventions to address long-term psychological sequelae. These findings reinforce the need for psychological programs more tailored to the needs of these women.

Relationships Between Childhood Interpersonal Trauma, Religious Coping, Post-traumatic Stress Symptoms, and Resilience

Positive and negative religious coping strategies have been linked to symptom trajectories following adult interpersonal trauma. However, the interactions between childhood interpersonal trauma, religious coping, and psychological outcomes are less clear. This study examined whether aspects of religious coping moderated the associations between cumulative childhood interpersonal trauma and mental health outcomes, such as post-traumatic stress symptoms (PTSS) and resilience. Participants included 525 undergraduates from two universities (M_age = 20.04, SD = 1.71; range = 18-24; 57.7% White; 82.1% female). In both the positive and negative religious coping models, cumulative childhood interpersonal trauma was related to PTSS (b = 6.66; b = 6.10, respectively). While positive religious coping was not associated with PTSS (b = .01), it was linked to resilience (b = .69). Negative religious coping was significantly related to PTSS (b = .75) but not resilience (b = -.20). No significant interactions were identified between aspects of religious coping and cumulative childhood interpersonal trauma. While religious coping was directly related to both positive and negative mental health outcomes, it may not be associated with the relationships between childhood interpersonal trauma exposure and clinical outcomes. Such findings offer valuable information on malleable factors that may contribute to adaptive and maladaptive functioning following childhood adversity.

"I Did It to Save My Children": Parenting Strengths and Fears of Women Exposed to Intimate Partner Violence

Intimate partner violence (IPV) is experienced by one in four women in the United States, and a wealth of quantitative research has underscored its detrimental effects on women's mental health and parenting practices. Little research, however, has considered ways in which women exposed to IPV retain and foster parenting strengths and ways in which motherhood serves as a source of resilience for these women. The objective of the current study was to conduct a thematic analysis of IPV-exposed women's parenting strengths and concerns as reported through focus groups conducted with IPV-exposed women (n = 22) and service providers (n = 31) in two urban areas in the Mid-West and Mid-South. Results of the thematic analysis indicated the emergence of three core themes: resilience and challenges of parenting in the context of IPV, leaving the violent partner, and intergenerational processes. Overall, service providers recognized far fewer strengths in parenting on all dimensions than did women, suggesting that service providers may be conceptualizing parenting in the context of IPV from a deficit model that underestimates the resilience demonstrated by these women. This has important consequences for the extent to which women may feel stigmatized or blamed when receiving resources and services critical to their families. Future research on parenting among women experiencing IPV would be enhanced by capturing the dynamic interplay between women's parenting strengths and challenges, and the ways in which these capacities are affected by resource access within and across social ecological contexts.

Trauma, Post-Traumatic Stress Disorder, and Treatment Among Middle-Aged and Older Women in the Nurses' Health Study II

OBJECTIVE

Trauma and post-traumatic stress disorder (PTSD) are common among women and associated with negative health outcomes across the life course. Relatively few studies, however, have examined the epidemiology of trauma, PTSD, and treatment among middle-aged and older civilian women, who are at elevated risk for adverse health outcomes. We aimed to characterize trauma, PTSD, and trauma-related treatment prevalence and correlates in a large cohort of middle-aged and older women.

DESIGN

Cross-sectional, nested substudy within the Nurses' Health Study II cohort.

SETTING

United States, 2018-2020.

PARTICIPANTS

33,327 current or former nurses, aged 53-74 years.

MEASUREMENTS

16-item modified version of the Brief Trauma Questionnaire; modified PTSD Checklist for the Diagnostic and Statistical Manual, Version 5.

RESULTS

The majority (82.2%) of women reported one or more lifetime traumas. The most common trauma types were unexpected death of a loved one (44.9%) and interpersonal violence (43.5%). Almost 30% reported occupational (nursing-related) trauma. Among the trauma-exposed, 10.5% met criteria for lifetime PTSD and 1.5% had past-month PTSD. One-third of lifetime PTSD cases were due to interpersonal violence event types. One-third of women with lifetime PTSD-and nearly half of those with PTSD from a nursing-related trauma-reported never receiving trauma-related treatment. Women aged 65 years and older with PTSD were less likely to be in treatment than those aged less than 65 years.

CONCLUSION

History of trauma and PTSD is prevalent in this population, and a treatment gap persists. Addressing this treatment gap is warranted, particularly among older women and those with nursing-related trauma.

Safer Sex Self-Efficacy Among Women With Experiences of Intimate Partner Violence

Women who have experienced intimate partner violence (IPV) are more likely to engage in risky sexual behaviors that increase the likelihood of adverse sexual health outcomes, including HIV acquisition. This study explored key predictors of safer sex self-efficacy in a sample of racially/ethnically diverse abused women. A total of 173 women were recruited from domestic violence agencies and completed a battery of measures that assessed risk factors associated with HIV risk. Both individual- and relationship-level predictors of safer sex self-efficacy were examined, including IPV, partner dependence, HIV knowledge, condom attitudes, self-esteem, and alcohol use. Hierarchical linear regression analysis results indicated several key predictors for safer sex self-efficacy, including IPV (B = -0.01, p < .05), partner dependence (B = -0.45, p < .001), condom attitudes (B = 0.63, p < .001), and alcohol use (B = - 0.24, p < .05). It is evident that a number of individual- and relationship-level factors affect the degree of safer sex self-efficacy among abused women. In work with this population, researchers and clinicians should intentionally attend to the identified predictors to most effectively address the needs of these women.

Prevalence of Childhood Sexual Abuse Among Women Using the Childhood Trauma Questionnaire: A Worldwide Meta-Analysis

Childhood sexual abuse (CSA) is a common form of childhood maltreatment. Several studies have shown that CSA adversely affects the physical and mental health. Numerous studies have evaluated the prevalence of CSA among females using various instruments. In this meta-analysis, we estimated the rate of CSA among women using the short form of the Childhood Trauma Questionnaire for the first time. Four databases (PsycINFO, PubMed, Cochrane Library, and Embase) were systematically searched for studies published as of April 2, 2018. Forty-eight articles (53 groups of samples) covering 22,224 individuals, including women, from 16 countries were selected. Using the random-effects model, the pooled overall rate of CSA was 24% (95% confidence interval [21%, 27%]). On subgroup analyses, the rate of female CSA in people with mental illness was higher than that in the general group; this result showed variability among different geographical regions.

"We Can Be Oppressed but That Does Not Mean We Cannot Fight Oppression": Narratives of Resilience and Advocacy From Survivors of Intimate Partner Violence

Helping others has been identified as an important component in recovery and resilience for women following intimate partner violence (IPV). However, little is known about the experiences of women who are IPV survivors and who also engage in formal and informal violence against women (VAW) advocacy work, such as supporting IPV survivors in a social work role or volunteering on VAW advocacy committees. Using in-depth semistructured interviews with nine "survivor-advocates" who were part of a larger study on IPV and resilience, this study extends the existing literature to examine the multidirectional relationship between IPV, advocacy work, and resilience using narrative analysis. Three distinct narratives were identified in survivor-advocates' accounts of their experiences of abuse and advocacy work. The working through the abuse narrative focused on using the knowledge and experience from advocacy work that began prior to IPV to critically reflect on the abuse and its meaning for women. The second narrative, helping others, focused on using personal experiences of abuse to help other IPV survivors. The third narrative, personal strength, focused on a personal identity as a lifelong advocate and inner strength and determination as central to resilience. The findings of this study demonstrate the multitude of ways that engaging in advocacy work interacts with abuse experiences and women's recovery and resilience processes. The findings of this study can inform approaches for promoting resilience and recovery for IPV survivors and highlight the importance of cultivating a critical understanding of abuse to support resilience and recovery following IPV.

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

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

A mutual process of healing self and healing the community: A qualitative study of coping with and healing from stress, adversity, and trauma among diverse residents of a midwestern city

Residents of urban American neighborhoods facing economic hardship often experience individual and collective adversities at high levels. This study explores how racially diverse adults experience stress, adversity, and trauma, and how they cope and heal in the context of their environment. Following a critical realist grounded theory methodology, four focus groups were conducted with African American, White and Latinx participants (N = 21) within an employment service program. Participants identified key stressors ranging from financial and job challenges, violence, and trauma. To cope with and heal from adversity, they practiced positivity, named trauma and its effects, sought social connection, envisioned community-based resources, and addressed structural and systemic barriers. The data generated a theory of "a mutual process of healing self and healing the community" through intrapersonal, interpersonal, and structural change. The results of this study indicate a need for peer-led, community-engaged initiatives and holistic, trauma-informed, healing-centered practices.

Couple Reports on Intimate Partner Violence and their Health Impact: Evidence From a Population-Based Survey in Japan

Recent studies have shown that couples' reports of intimate partner violence (IPV) are not necessarily consistent. This study investigated the associations between patterns of partner victimization and perpetration reports and health and perceived wellbeing. Using household survey data from a probabilistic urban sample of adults aged 25 to 50 years and their partners, we identified 1,467 heterosexual pairs who completed the modified Japanese version of the Conflict Tactics Scale 2 Short Form. We classified responses into four categories: congruent report of no IPV, incongruent respondent victimization report, incongruent partner perpetration report, and congruent report of IPV. We used analysis of covariance to compare physical and mental health (measured by the SF-8 Health Survey Questionnaire) and life satisfaction among the four groups. The results showed that 22.4% of respondents were involved in IPV, and approximately 75% of them had incongruent reports. Compared with congruent reports of no IPV, respondents with an incongruent victimization report and an incongruent partner perpetration report scored significantly lower on physical health (-0.96, p = .03 and -1.16, p = .04, respectively). Those with an incongruent victimization report and congruent report of IPV had lower mental health scores (-2.32, p = .00 and -2.21, p = .00, respectively) and lower life satisfaction (-0.32, p = .00 and -0.21, p = .01, respectively). The results indicated that the respondent's victimization report was associated with worse mental health regardless of their partner's perpetration report, and physical health was worse only in cases with incongruent reports. Cases with a partner perpetration report but no respondent victimization report showed worse physical health but no negative effects on mental health and perceived wellbeing. These results indicate that research and practice regarding IPV should consider both partners' experiences of violence when assessing the impact of health and wellbeing on victims.

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.

"I forgive myself": The association between self-criticism, self-acceptance, and PTSD in women victims of IPV, and the buffering role of self-efficacy

The effects of intimate partner violence (IPV) concerning specifically posttraumatic stress disorder (PTSD) symptomatology have been widely demonstrated, but the consequences of abuse are not the same for all victims. We know little about the psychological processes that limit these adverse consequences. Therefore, we explored the association between self-criticism felt by abused women and their PTSD, and we investigated self-acceptance as the underlying process explaining this relationship. We also examined self-efficacy as the protective (moderating) factor. The results indicated that self-criticism was indirectly associated with greater PTSD via lower self-acceptance. Critically, the indirect effect only emerged for individuals low in self-efficacy.

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

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

Differential effect of childhood emotional abuse on present social support in borderline disorder and depression: a cross-sectional study

BACKGROUND

Perceived social support (PSS) is a crucial factor in physical and mental health. Previous studies found a negative association between childhood maltreatment (CM) and current PSS.

OBJECTIVE

In this paper, we investigate whether psychopathology moderates this association in a sample of patients with Depressive Disorder (DD) and Borderline Personality Disorder (BPD).

METHOD

Sixty-nine patients with DD and 110 patients with BPD were recruited to inpatient/day clinic treatment programmes for either DD or BPD. All participants completed the Childhood Trauma Questionnaire (CTQ) and the Social Support Questionnaire (F-SozU). Our hypothesis was tested with a moderator analysis in a multiple linear regression model.

RESULTS

We found a significant interaction between diagnosis and CM for the CTQ total score and the emotional abuse subscale. Post hoc analyses revealed a significant negative correlation between CM and PSS only for patients suffering from BPD and not for patients with DD.

CONCLUSION

Our results suggest that the negative association between CM and PSS might be more pronounced in certain patient groups, particularly patients with BPD.

Construct Validity and Dimensionality of the Rosenberg Self-Esteem Scale and Its Association with Spiritual Values Within Irish Population

Until this research, correlation of Rosenberg's (1965) self-esteem scale (RSES), with religious and spiritual values, was never investigated using the measure as a twofold construct instead of the monolithic form. This research paper explores the prediction of RSES by spiritual values using a twofold structure of: self-esteem-positive (SEP) and self-esteem-negative (SEN), to specify individual and fragmented correlations with spirituality, which until now was unobtainable. Confirmatory factor analysis and structural equation modelling were applied to analyse the data. The survey was conducted among two-hundred and sixty-eight participants from the Republic of Ireland. The research finds that spirituality influences peoples' self-esteem, but clear and linear correlation between spirituality and self-esteem is difficult to be concluded. People respond oppositely and differently to positive and to negative items in the RSES which indicates that the measure is a combination of two statistically consistent constructs: SEP and SEN. The results of the study confirm that there are many spiritual areas that affect self-esteem.

The effect of intimate partner violence on women's mental distress: a prospective cohort study of 3010 rural Indian women

PURPOSE

Intimate partner violence (IPV) encompasses physical, sexual, and psychological abuse, as well as controlling behavior. Most research focuses on physical and sexual abuse, and other aspects of IPV are rarely investigated. We estimated the effect of these neglected aspects of IPV on women's mental distress.

METHODS

We used data from 3010 women living in rural tribal communities in Rajasthan, India. Women completed baseline interviews and were re-interviewed approximately 1.5 years later. We measured IPV with questions adopted from the Demographic and Health Survey's Domestic Violence Module, which asked seven questions about physical abuse, three questions about psychological abuse, and five questions about partner controlling behavior. Mental distress was measured with the 12-item General Health Questionnaire (score range 0-12). We used Poisson regression models to estimate the relation between changes in IPV and mental distress, accounting for time-fixed characteristics of individuals using individual fixed effects.

RESULTS

Women reported an average of 2.1 distress symptoms during baseline interviews. In models that controlled for time-varying confounding (e.g., wealth, other types of abuse), experiencing psychological abuse was associated with an increase of 0.65 distress symptoms (95% CI 0.32, 0.98), and experiencing controlling behavior was associated with an increase of 0.31 distress symptoms (95% CI 0.18, 0.44). However, experiencing physical abuse was not associated with an increase in distress symptoms (mean difference = - 0.15, 95% CI - 0.45, 0.15).

CONCLUSIONS

Psychological abuse and controlling behavior may be important drivers of the relation between IPV and women's mental health.

Social Networks and Its Impact on Women's Awareness, Interest, and Uptake of HIV Pre-exposure Prophylaxis (PrEP): Implications for Women Experiencing Intimate Partner Violence

BACKGROUND

In the United States, women represent less than 5% of all pre-exposure prophylaxis (PrEP) users. Social networks may promote and/or inhibit women's PrEP awareness, which could influence PrEP intentions. Furthermore, women experiencing intimate partner violence (IPV) may have smaller, less supportive networks, which could deter or have no impact on PrEP care engagement. This study examined associations between network characteristics and women's PrEP awareness, interest, uptake, and perceived candidacy and analyzed IPV as an effect modifier.

SETTING/METHODS

From 2017 to 2018, data were collected from a prospective cohort study of 218 PrEP-eligible women with (n = 94) and without (n = 124) IPV experiences in Connecticut. Women completed surveys on demographics, IPV, social networks, and PrEP care continuum outcomes.

RESULTS

Adjusted analyses showed that PrEP awareness related to having more PrEP-aware alters. PrEP intentions related to having more alters with favorable opinions of women's potential PrEP use and a smaller network size. Viewing oneself as an appropriate PrEP candidate related to having more PrEP-aware alters and more alters with favorable opinions of women's potential PrEP use. IPV modified associations between network characteristics and PrEP care. Having members who were aware of and/or used PrEP was positively associated with PrEP care engagement for women without IPV experiences but had either no effect or the opposite effect for women experiencing IPV.

CONCLUSION

Improving PrEP attitudes might improve its utilization among women. Social network interventions might be one way to increase PrEP uptake among many US women but may not be as effective for women experiencing IPV.

Coping as a mediator between locus of control, competence beliefs, and mental health: A systematic review and structural equation modelling meta-analysis

OBJECTIVE

This systematic review and two-staged structural equation modelling meta-analysis (TSSEM) aimed to examine whether coping mediates the associations between locus of control, competence beliefs, and mental health in the general population and clinical samples.

METHODS

Eligible studies published until May 2017 were identified through systematic searches of PubMED and EMBASE. The review included 19 studies and the meta-analysis 15 studies.

RESULTS

The review supports the assumption that coping mediates the associations between locus of control and competence beliefs, and mental health. TSSEM using a pooled sample of 3986 respondents and 225 cross-sectional effect sizes indicated that maladaptive coping mediates the association between maladaptive locus of control and mental health problems. On the contrary, adaptive coping did not mediate this association and was only significantly associated with competence beliefs and adaptive locus of control but, unexpectedly, not with mental health. Both maladaptive and adaptive locus of control but not competence beliefs had direct links to mental health problems that were independent of coping.

CONCLUSION

Interventions should not only focus on enhancing adaptive coping as it might be more promising to diminish maladaptive locus of control, which may result in reduced maladaptive coping and, finally, improved mental health.

Alcohol use and coping in a cross-sectional study of African American homicide survivors

The loss of a loved one to homicide is associated with considerable distress, often in the form of posttraumatic stress disorder (PTSD) and complicated grief (CG), and alcohol misuse. Yet alcohol-related problems and loss from a homicide are issues that disproportionally affect African Americans. The present study investigated alcohol use in a sample of 54 African American homicide survivors. Although there was a low prevalence of hazardous drinking, alcohol use was associated with higher levels of PTSD, complicated grief, and depression severity. In addition, scores on the Alcohol Use Disorders Identification Test (AUDIT) were correlated with active emotional coping and avoidant emotional coping. In analyses of PTSD symptom clusters, emotional numbing and hyperarousal symptoms were significantly correlated with AUDIT total score.

Positive and negative religious coping as predictors of distress among minority older adults

OBJECTIVES

The study replicated and extended previous findings by investigating relationships between positive and negative religious coping and psychological distress in minority older adults.

METHODS

Older adults were evaluated during screening and baseline procedures of a psychotherapy clinical trial for late-life worry and anxiety. Participants were age 50 years or older and recruited from low-income and predominantly minority neighborhoods. Participants screening positive for worry (PSWQ-A ≥ 23) with no significant cognitive impairment (Six-Item Screener for cognitive impairment ≤2) completed a diagnostic interview and baseline assessments. Positive and negative religious coping were assessed with the positive and negative coping subscales of the Brief Religious Coping scale. Psychological distress was assessed with measures of depression, anxiety, and worry. A set of multiple linear regression models were used to evaluate the relationship between religious coping and each measure of psychological distress.

RESULTS

Negative religious coping was associated with greater anxiety, worry, and depression. Positive and negative religious coping interacted such that positive religious coping buffered the effects of negative religious coping on anxiety and depression. Significant main effects and interactions remained after controlling for age, gender, race, years of education, and study.

CONCLUSIONS

The findings of this study are consistent with prior work showing that negative religious coping is associated with greater psychological distress. This study replicates previous findings that positive religious coping may buffer the harmful effects of negative religious coping and extends understandings of the specific psychological impacts that positive and negative religious coping may have on older, minority adults.

Race, psychosocial vulnerability and social support differences in inner-city women's symptoms of posttraumatic stress disorder

BACKGROUND/OBJECTIVES

Inner-city Black women may be more susceptible to posttraumatic stress disorder (PTSD) than White women, although mechanisms underlying this association are unclear. Living in urban neighborhoods distinguished by higher chronic stress may contribute to racial differences in women's cognitive, affective, and social vulnerabilities, leading to greater trauma-related distress including PTSD. Yet social support could buffer the negative effects of psychosocial vulnerabilities on women's health.

METHODS/DESIGN

Mediation and moderated mediation models were tested with 371 inner-city women, including psychosocial vulnerability (i.e., catastrophizing, anger, social undermining) mediating the pathway between race and PTSD, and social support moderating psychosocial vulnerability and PTSD.

RESULTS

Despite comparable rates of trauma, Black women reported higher vulnerability and PTSD symptoms, and lower support compared to White Hispanic and non-Hispanic women. Psychosocial vulnerability mediated the pathway between race and PTSD, and social support moderated vulnerability, reducing negative effects on PTSD. When examining associations by race, the moderation effect remained significant for Black women only.

CONCLUSIONS

Altogether these psychosocial vulnerabilities represent one potential mechanism explaining Black women's greater risk of PTSD, although cumulative psychosocial vulnerability may be buffered by social support. Despite higher support, inner-city White women's psychosocial vulnerability may actually outweigh support's benefits for reducing trauma-related distress.

Examining Associations Between Strangulation and Depressive Symptoms in Women With Intimate Partner Violence Histories

Intimate partner violence (IPV) is associated with poor mental health outcomes among women. Studies on IPV and mental health show that experiencing more than one type of IPV often enhances women's depression or depressive symptoms. However, most of these studies conceptualize IPV as physical, psychological, or sexual violence. Little is known about specific experiences of severe IPV, such as strangulation, that put victims at greater risk of lethality and serious injury and their association with women's depression. This study examined associations between IPV, strangulation, and depression among women using secondary data collected for a randomized clinical trial testing an integrated HIV-IPV prevention intervention for abused women. Women were recruited from healthcare service delivery organizations, Department of Health and Human Services, and family court. Women (n = 175) completed assessments on IPV, strangulation, mental health, social support, and self-esteem. The majority reported strangulation (n = 103) and depressive symptoms (n = 101). Women who experienced strangulation also reported more severe physical (p < .001), sexual (p < .001), and psychological (p < .001) abuse. However, in multivariate logistic regression with sociodemographics, violence variables, and strangulation, none of these variables were associated with a higher risk for depressive symptoms. Social support had a protective effect on depressive symptoms. Findings suggest strangulation is prevalent among abused women seeking services, warranting screening, assessment, and referral in these settings.

Childhood Abuse, Religious Involvement, and Lifetime Substance Use Disorders among Latinas Nationwide

BACKGROUND

Childhood abuse is a major behavioral health concern and imposes lasting sequelae on mental and physical health, including lifetime substance use disorders (LT-SUD). Yet, gender-specific research examining this early trauma and substance use in Latina-Americans (Latinas) is scarce. No study has explored the relationship between collectivist cultural factors and LT-SUD in this largest minority-female subgroup of the United States' population.

OBJECTIVES

Based on coping theory, this study investigated the association between childhood abuse, cultural factors, and LT-SUD among Latinas nationwide.

METHODS

Using the National Latino and Asian American Study we performed three-step logistic regressions to investigate LT-SUD for 1,427 Latinas, following three preplanned steps: (1) childhood physical and sexual abuse (CPA and CSA) with LT-SUD; (2) known correlates as controls; and (3) cultural strength factors.

RESULTS

The prevalence rates of CPA and CSA were 28.0% and 18.4%, and that of LT-SUD was 4.8%. Religious attendance at a weekly level was negatively related to LT-SUD. Alongside English proficiency, discrimination, and social support, however, CPA and religious coping were positively associated with LT-SUD. Conclusion/Importance: Childhood physical abuse is an early risk factor for long-term substance use, viewed as a negative coping strategy. Religious attendance may have potential protection for Latinas. The victimization history may lead to coexisting positive (e.g., pursing social support, religious coping) and negative (e.g., SUD) coping behaviors within Latino communities.

Factors mediating the impacts of child abuse and intimate partner violence on chronic pain: a cross-sectional study

BACKGROUND

Most research on the health impacts of intimate partner violence (IPV) and child abuse has been conducted in Western countries and may not be generalizable to women living in different contexts, such as Saudi Arabia. Chronic pain, a disabling health issue associated with experiences of both child abuse and IPV among women, negatively impacts women's well-being, quality of life, and level of functioning. Yet, the psychosocial mechanisms that explain how abuse relates to chronic pain are poorly understood. We developed and tested a theoretical model that explains how both IPV and child abuse are related to chronic pain.

METHODS

We recruited a convenience sample of 299 Saudi women, who had experienced IPV in the past 12 months, from nine primary health care centers in Saudi Arabia between June and August 2015. Women completed a structured interview comprised of self-report measures of IPV, child abuse, PTSD, depressive symptoms, chronic pain, and social support. Using Structural equation modeling (SEM), we analyzed the proposed model twice with different mental health indicators as mediators: PTSD symptoms (Model 1) and depressive symptoms (Model 2).

RESULTS

Both models were found to fit the data, accounting for 31.6% (Model 1) and 32.4% (Model 2) of the variance in chronic pain severity. In both models, mental health problems (PTSD and depressive symptoms) fully mediated the relationship between severity of IPV and child abuse and chronic pain severity. Perceived family support partially mediated the relationship between abuse severity and depressive symptoms.

CONCLUSIONS

These results underscore the significance of considering lifetime abuse, women's mental health (depressive and PTSD symptoms) and their social resources in chronic pain management and treatment.

Factors Related To Depression and Post-Traumatic Stress Disorder in Shelter-Based Abused Women

In this study, linear mixed-effects regression analyses were used to examine whether sociodemographic variables, abuse-related variables, and well-being variables were associated with symptoms of depression and post-traumatic stress disorder (PTSD) in abused women residing in shelters. Results pointed out that symptoms of depression severity were positively associated with migration background and the experience of physical abuse and negatively associated with self-esteem and social support. PTSD symptoms were positively associated with the experience of sexual abuse and negatively associated with self-esteem. Within women’s shelters, staff could be sensitive to improving the social integration of women, especially those with a non-Dutch background, and strengthening the women’s social networks and their self-esteem.

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.

Religiosity, Gender, and Natural Disasters: A Qualitative Study of Disaster-Stricken Regions in Iran

While religiosity is emerging as one of the more important subjects in disaster management, identifying gender differences in using religion as a coping method has attracted very little attention. The aim of this study was to explore the effects of religiosity on disaster-affected women and men in the setting of Iran. A field-based investigation using a qualitative approach was carried out to achieve the study's purpose. Data were collected using in-depth unstructured interviews with 25 participants who had been damaged by recent disasters. Two themes, negative and positive effects of religiosity, and five categories were extracted from the data. Women may be influenced by religion more than men, and thus, they can play key roles in strengthening the positive effects of religiosity.

Rates of traumatization and psychopathology in criminal justice-involved women

Prior research has consistently found disproportionate rates of traumatization and psychopathology in criminal justice-involved women. The current study aimed to characterize rates of traumatization, psychopathology, and diagnostic comorbidity in women involved with the justice system. Furthermore, this study examined the role of posttraumatic stress symptoms in the association between traumatic events and levels of self-esteem. Participants were 185 women from the Chicagoland area with current or previous (past 2 years) involvement with the criminal justice system. Results confirmed disproportionate rates of trauma experiences and psychopathology in this population, and logistic regression analyses indicated that rates of traumatization predicted diagnostic comorbidity. Analyses indicated an indirect effect of posttraumatic stress in the association between traumatic experiences and self-esteem. Findings highlight the importance of assessing and targeting both trauma experiences and posttraumatic stress in justice-involved women to optimize prevention and intervention efforts.

Cross-Cultural Validation and Psychometric Properties of the Arabic Brief Religious Coping Scale (A-BRCS)

The aim of this study was to translate and validate the psychometric properties of an Arabic Brief Religious Coping Scale. A descriptive correlational design was used to conduct the study among participants of 403 Iraqi secondary school students. The A-BRCS and both the subscales, positive and negative, had Cronbach's alphas of .70, .86 and .82, respectively. All inter-item and item-to-total correlations for each subscale were above the recommended criteria of .30. Factor loadings of the positive subscale using oblique (oblimin) and orthogonal (varimax) rotations ranged from .72 to .86 and from .71 to .86, respectively. Factor loadings of the negative subscale using oblimin and varimax rotations ranged from .64 to .83 and from .63 to .83, respectively. The A-BRCS was found to be a valid and reliable instrument to measure religious coping among Iraqi secondary school students.

Effects of religious and spiritual variables on outcomes in violent relationships

OBJECTIVE

Religious and spiritual factors in intimate partner violence have received increasing attention. But are such factors related to outcomes in violent relationships? The purpose of this study was to assess the relative impact of spiritual symptoms and religious coping on attitudinal/behavioral and clinical outcomes among women in violent relationships.

METHODS

Adult women with a recent history of husband-to-wife physical abuse were recruited from six primary care clinics. Once enrolled, 200 subjects completed a baseline interview and daily assessment of level of violence, using the Interactive Verbal Response for 12 weeks. At the completion of the study, contact with each participant was attempted to determine whether she had either sought professional help or left the relationship. Three religious/spiritual variables were assessed at baseline-number of visits to a religious/spiritual counselor, religious coping, and severity of spiritual symptoms. Stepped multiple linear regression was used to explain factor-analyzed outcomes (coping and appraisals, hope and support, symptomatology, functional status, readiness for change, and medical utilization), adjusting for demographic, marital, childhood, mental health, and violence variables.

RESULTS

After controlling for duration, severity and dynamics of violence, the use of spiritual resources, and the level of spiritual symptoms were associated with most attitudinal/behavioral and clinical outcomes, while religious coping was only associated with staying in the relationship.

CONCLUSIONS

Religious and spiritual factors were associated with most outcomes. Spiritual symptoms had a consistently negative effect on outcomes while use of spiritual resources had variable effects. Religious coping was only associated with refraining from leaving the relationship.

Gender and Race Variations in the Intersection of Religious Involvement, Early Trauma, and Adult Health

PURPOSE

This study aimed to determine gender and race variations in regards to the influence of religious involvement (RI) as a moderator of the effects of early traumatic stress (ETS) on health-related quality of life among adult survivors of child abuse.

DESIGN

A cross-sectional predictive design was used to study Seventh-day Adventist adults in North America (N = 10,283).

METHODS

A secondary analysis of data collected via questionnaires was done using multiple regression.

RESULTS

Data revealed that women had a significantly higher prevalence of any or all ETS subtypes, except for physical abuse prevalence, which was the same for both genders. Blacks reported a significantly higher prevalence of at least one ETS subtype than did Whites, except for neglect, where Whites had a higher prevalence. Exposure to at least one ETS subtype was associated with worse negative effect on mental health (B = -2.08, p < .0001 vs. B = -1.54, p < .0001) and physical health (B = -2.01, p < .0001 vs. B = -1.11, p < .0001) for women compared to men. Among those exposed to all ETS subtypes (n = 447), Whites had significant worse physical health, with White women having almost two times the negative effect on physical health (B = -4.50, p < .0001) than White men (B = -2.87, p < .05). As for RI moderation, based on tests of three-way interactions of race-RI-ETS, there were no associated differences. However, tests of three-way interactions of gender-RI-ETS showed a significant buffering effect. Among those with high levels of negative religious coping (RC), women exposed to ETS had significantly worse physical health (B = -1.28) than men.

CONCLUSIONS

Results give evidence of gender and racial differences on the magnitude of the ETS-health effect, as well as gender differences in ETS-health buffering by RC.

CLINICAL RELEVANCE

Findings suggest gender and racial differences must be considered when devising holistic nursing interventions for improving health outcomes of early trauma survivors.

Childhood Maltreatment and PTSD: Spiritual Well-Being and Intimate Partner Violence as Mediators

Childhood maltreatment places individuals, including African American women who are undereducated and economically disadvantaged, at risk for developing posttraumatic stress disorder (PTSD) symptoms. Participants were 192 African American women with a history in the prior year of both a suicide attempt and intimate partner violence (IPV) exposure. They were recruited from a public hospital that provides medical and mental health treatment to mostly low-income patients. A simple mediator model was used to examine if (1) existential well-being (sense of purpose) and/or religious well-being (relationship with God) mediated the link between childhood maltreatment and adult PTSD symptoms. Sequential multiple mediator models determined if physical and nonphysical IPV enhanced our understanding of the mediational association among the aforementioned variables. Findings suggest that existential well-being mediated the association between childhood maltreatment and adult PTSD symptoms in a simple mediator model, and existential well-being and recent nonphysical IPV served as sequential multiple mediators of this link. However, religious well-being and physical IPV were not significant mediators. Findings underscore the importance of enhancing existential well-being in the treatment of suicidal African American women with a history of childhood maltreatment and IPV.

Depression and social support among women living with the substance abuse, violence, and HIV/AIDS syndemic: a qualitative exploration

BACKGROUND

Intimate partner violence (IPV), HIV/AIDS, and substance use are described as the SAVA "syndemic" among low-income urban women because of their intersecting and synergistic presence in these women's lives. Depressive symptoms are significantly associated with these SAVA factors and although social support is potentially protective for depression, little is understood about its impact on depression associated with the SAVA syndemic.

METHODS

This paper investigates how women living with SAVA experience and describe depressive symptoms, and examines how the types of social support they access impact their experiences of SAVA and depressive symptoms. Qualitative, in-depth interviews were conducted with 24 HIV-positive, low-income, urban women who experienced IPV and used cocaine or heroin in their lifetime. Interviews were analyzed based on study aims, principles of thematic content analysis, and grounded theory.

RESULTS

Women identified multiple SAVA factors as catalysts for depression and noted their synergistic effect on depressive symptoms, which were both a trigger for and a result of drug use. Women accessed varying sources of social support to address their SAVA factors and associated symptoms of depression, relying on informal sources for instrumental support related to IPV and formal sources for support related to HIV, drug use, and depression.

CONCLUSIONS

These findings have important implications for health providers who serve SAVA-affected women, and suggest that comprehensively addressing all SAVA factors (and IPV in particular) and improving their access to quality social support at critical times is essential to improve their mental health.

Intimate Partner Violence and its Health Impact on Ethnic Minority Women [corrected]

In the United States, intimate partner violence (IPV) against women disproportionately affects ethnic minorities. Further, disparities related to socioeconomic and foreign-born status impact the adverse physical and mental health outcomes as a result of IPV, further exacerbating these health consequences. This article reviews 36 U.S. studies on the physical (e.g., multiple injuries, disordered eating patterns), mental (e.g., depression, post-traumatic stress disorder), and sexual and reproductive health conditions (e.g., HIV/STIs, unintended pregnancy) resulting from IPV victimization among ethnic minority (i.e., Black/African American, Hispanic/Latina, Native American/Alaska Native, Asian American) women, some of whom are immigrants. Most studies either did not have a sufficient sample size of ethnic minority women or did not use adequate statistical techniques to examine differences among different racial/ethnic groups. Few studies focused on Native American/Alaska Native and immigrant ethnic minority women and many of the intra-ethnic group studies have confounded race/ethnicity with income and other social determinants of health. Nonetheless, of the available data, there is evidence of health inequities associated with both minority ethnicity and IPV. To appropriately respond to the health needs of these groups of women, it is necessary to consider social, cultural, structural, and political barriers (e.g., medical mistrust, historical racism and trauma, perceived discrimination, immigration status) to patient-provider communication and help-seeking behaviors related to IPV, which can influence health outcomes. This comprehensive approach will mitigate the racial/ethnic and socioeconomic disparities related to IPV and associated health outcomes and behaviors.