Remission of PTSD after victims of intimate partner violence leave a shelter

Unveiling the traumatic impact of cyber dating abuse and offline intimate partner violence: exploring the mediating role of adult attachment

Cyber Dating Abuse (CDA) corresponds to a traumatic experience involving controlling and harassing behavior by a partner through modern technologies. This study aimed to assess the frequency of CDA, explore its connection to offline violence (specifically Intimate Partner Violence-IPV), and investigate attachment's mediating role in the relationship between various violence forms (cyber and offline) and trauma symptoms. Two groups were recruited for the study: one comprising 342 individuals who reported encountering offline IPV within the previous year and another group of 334 individuals who did not have such experiences. Both groups exhibited CDA, with the IPV-experienced group showing statistically significant higher prevalence. This supports literature indicating a relationship between online and offline violence. Additionally, attachment anxiety mediated CDA controlling, offline IPV, and subsequent PTSD symptoms, while attachment avoidance mediated only between offline IPV and PTSD symptoms. The findings seemed to validate the importance of acknowledging attachment as a mediator for PTSD, both in clinical practice and research.

Posttraumatic Growth, Centrality of Event, Trauma Symptoms and Resilience: Profiles of Women Survivors of Intimate Partner Violence

The current study used a person-oriented approach to investigate (a) potential distinctive groups of women survivors of IPV based on their posttraumatic growth (PTG), centrality of event, resilience, and posttraumatic stress symptoms (PTSS) patterns, and (b) examine the role of sociodemographic (age, education, work status) and violence related (physical and emotional violence, time since last violence episode, psychological help) factors in distinguishing these groups. The study sample consisted of 421 women survivors of IPV, and latent profile analysis revealed four profiles: "negative impact" (11% of the sample), "positive growth" (46%), "low impact" (18%), and "distressed growth" (25%). Women age, education, received psychological help, frequency of physical and emotional violence, and time since last violence incident significantly distinguished some of the indicated profiles from each other. Findings of this study contribute to the existing literature by identifying different responses to IPV and investigating some of the theoretical assumptions that had not been comprehensively analyzed in the IPV literature. Limitations of the study and implications for future research are discussed.

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

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

"Knitting Together the Lines Broken Apart": Recovery Process to Integration among Japanese Survivors of Intimate Partner Violence

OBJECTIVE

This study used narrative interviewing and grounded theory analysis to discover the phases of trauma integration for Japanese women who had experienced intimate partner violence (IPV).

METHOD

We interviewed 23 Japanese women who had experienced IPV using the Clinical Ethnographic Narrative Interviews (CENI) from November 2017 to September 2018 in Tokyo, Japan. The data from 11 participants who had achieved trauma integration using the Trauma Recovery Rubric were analyzed using a modified grounded theory approach.

RESULTS

Six phases of the trauma integration journey after IPV were discovered: (1) Chaos, (2) Burning out, (3) Focusing, (4) Challenging, (5) Deepening insights, and (6) Re-building. The survivors described the processes of exploration of themselves and their reactions to their concurrent challenges. They focused on finding ways to protect, re-discover, and re-embrace themselves by healing from physical, psychological, and spiritual distresses. They also rebuilt relationships with others and acquired knowledge and skills to achieve a new life. Notably, the primary components of their recovery processes were changes in self-perception and self-interpretation of the trauma itself and its impacts on one's life and within oneself from multiple angles. In addition, traditional Japanese norms and gender roles, such as beliefs concerning the "ideal life of a woman" and fear of not behaving differently from others, profoundly influenced their recovery process.

CONCLUSION

This study highlights the importance of incorporating individuals' cultures and their phase, needs, and personal self-development timeframes when developing trauma integration interventions.

Recovering from Intimate Partner Violence through Strengths and Empowerment (RISE): Initial Evaluation of the Clinical Effects of RISE Administered in Routine Care in the US Veterans Health Administration

Intimate partner violence (IPV) is a common concern among military Veterans that negatively impacts health. The United States' Veterans Health Administration (VHA) has launched a national IPV Assistance Program (IPVAP) to provide comprehensive services to Veterans, their families and caregivers, and VHA employees who use or experience IPV. Grounded in a holistic, Veteran-centered psychosocial rehabilitation framework that guides all facets of the program, the IPVAP initiated the pilot implementation of a novel intervention called Recovering from IPV through Strengths and Empowerment (RISE). This evidence-based, person-centered, trauma-informed, and empowerment-oriented brief counseling intervention is designed to support those who experience IPV and to improve their psychosocial wellbeing. This program evaluation study describes clinical outcomes from patients who participated in a pilot implementation of RISE in routine care. We examined changes in general self-efficacy, depression, and valued living, as well as treatment satisfaction among patients who received RISE and completed program evaluation measures at VHA facilities during the pilot. Results from 45 patients (84% women) indicate that RISE was associated with significant pretreatment to posttreatment improvements in self-efficacy, depression, and valued living (Cohen's d s of 0.97, 1.09, and 0.51, respectively). Patients reported high satisfaction with treatment. Though preliminary results were similar across gender and IPV types, findings from the evaluation of the pilot implementation of RISE demonstrate the intervention's feasibility, acceptability, and clinical utility in routine VHA care and inform the scalability of RISE. Additionally, findings provide preliminary support for the effectiveness and acceptability of RISE with men. Modification to RISE and its implementation are discussed, which may be useful to other settings implementing IPV interventions.

Psychological Trauma in the Context of Intimate Partner Violence: A Concept Analysis

A comprehensive understanding of psychological trauma in the context of intimate partner violence (IPV) is relevant for nurses and other healthcare providers to provide better care for individuals and families confronting this issue. A concept analysis based on Walker and Avant was conducted to fully understand this concept and its impact on physical and mental health. This concept analysis demonstrates that psychological trauma in the IPV context is an intricate multi-faceted concept that can have a significant long-term effect on individuals who have experienced IPV. The concept's attributes, antecedents, and consequences identified in this concept analysis will contribute to guiding practice, research, education, and policy development aimed to address the trauma affecting individuals and families in the context of IPV.

Intimate Partners Violence against Women during a COVID-19 Lockdown Period: Results of an Online Survey in 7 Provinces of the Democratic Republic of Congo

Intimate Partners’ Violence (IPV) is a public health problem with long-lasting mental and physical health consequences for victims and their families. As evidence has been increasing that COVID-19 lockdown measures may exacerbate IPV, our study sought to describe the magnitude of IPV in women and identify associated determinants. An online survey was conducted in the Democratic Republic of Congo (DRC) from 24 August to 8 September 2020. Of the 4160 respondents, 2002 eligible women were included in the data analysis. Their mean age was 36.3 (SD: 8.2). Most women (65.8%) were younger than 40 years old. Prevalence of any form of IPV was 11.7%. Being in the 30–39 and >50 years’ age groups (OR = 0.66, CI: 0.46–0.95; p = 0.026 and OR = 0.23, CI: 0.11–048; p < 0.001, respectively), living in urban setting (OR = 0.63, CI: 0.41–0.99; p = 0.047), and belonging to the middle socioeconomic class (OR = 0.48, CI: 0.29–0.79; p = 0.003) significantly decreased the odds for experiencing IPV. Lower socioeconomic status (OR = 1.84, CI: 1.04–3.24; p = 0.035) and being pregnant (OR = 1.63, CI: 1.16–2.29; p = 0.005) or uncertain of pregnancy status (OR = 2.01, CI: 1.17–3.44; p = 0.011) significantly increased the odds for reporting IPV. Additional qualitative research is needed to identify the underlying reasons and mechanisms of IPV in order to develop and implement prevention interventions.

Establishing Concurrent Validity for a Brief PTSD Screen Among Women in a Domestic Violence Shelter

There is a particular need for valid scales to screen for posttraumatic stress disorder (PTSD) among women who seek safe shelter from intimate partner violence. Screening to identify women who are at risk for PTSD can lead to early intervention that reduces the risk for PTSD-related outcomes such as poor decision making, inconsistent parenting, and behavior dysfunction among their children. The gold standard for diagnosing PTSD is the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) (CAPS-5). A seven-item PTSD screen has been used for in this population and has a well-established cutoff score but has not been validated against the DSM-5 diagnostic criteria for PTSD. The study purpose was to establish concurrent validity for a seven-item screen for PTSD with the CAPS-5. Participants were 75 women, 18 years or older, who were residents of a 120-bed shelter in the southern United States. They spoke English or Spanish. They reported intimate partner physical or sexual violence within 4 months of their entry into the study. Following informed consent, data were collected in individual interviews, conducted in either English or Spanish. In addition to demographic data, the seven-item PTSD screen and the CAPS-5 were administered. A receiver operating characteristic (ROC) curve analysis was conducted to assess the concurrent validity of the seven-item PTSD screen with the CAPS-5. The seven-item PTSD screen results were significantly correlated with the CAPS-5 results in this sample (area under the curve [AUC] = .640, z = 2.670, p = .008). Sensitivity was 96.2, and observed specificity was 31.8. The seven-item PTSD screen demonstrates excellent sensitivity (e.g., 96% of true PTSD cases) and acceptable specificity (32% of non-PTSD cases) and can be used to quickly and accurately identify individuals for diagnostic assessment and intervention.

"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.

The coMforT study of a trauma-informed mindfulness intervention for women who have experienced domestic violence and abuse: a protocol for an intervention refinement and individually randomized parallel feasibility trial

Background

Domestic violence and abuse (DVA) is common and destructive to health. Post-traumatic stress disorder (PTSD) is a major mental health consequence of DVA. People who have experienced DVA have specific needs, arising from the repeated and complex nature of the trauma. The National Institute for Health and Care Excellence recommends more research on the effectiveness of psychological interventions for people who have experienced DVA. There is growing evidence that mindfulness-based interventions may help trauma symptoms.

Methods

Intervention refinement and randomized controlled feasibility trial. A prototype trauma-informed mindfulness-based cognitive therapy (TI-MBCT) intervention will be co-produced following qualitative interviews and consensus exercise with stakeholders. Participants in the feasibility trial will be recruited from DVA agencies in two geographical regions and randomized to receive either TI-MBCT or usual care (self-referral to the Improving Access to Psychological Therapies (IAPT) service). TI-MBCT will be delivered as a group-based eight-week program. It will not be possible to blind the participants or the assessors to the study allocation. The following factors will inform the feasibility of progressing to a fully powered trial: recruitment, retention, intervention fidelity, and the acceptability of the intervention and trial design to participants. We will also test the feasibility of measuring the following participant outcomes before and 6 months post-randomization: PTSD, dissociative symptoms, depression, anxiety, DVA re-victimization, self-compassion, and mother-reported child health. Process evaluation and economic analysis will be embedded within the feasibility trial.

Discussion

This study will lead to the development of a TI-MBCT intervention for DVA survivors with PTSD and inform the feasibility and design of a fully powered randomized controlled trial (RCT). The full trial will aim to determine the effectiveness and cost-effectiveness of a TI-MBCT intervention in improving the clinically important symptoms of PTSD in DVA survivors.

Trial registration

ISRCTN, ISRCTN64458065, Registered 11 January 2019.

Evaluating an Intergenerational Model to Explain the Path From Violence Against Mothers to Child Behavior and Academic Outcomes

An intergenerational model to explain the long-term effect of partner violence against mothers on child behavior was evaluated 48 months after 278 mothers first sought safe shelter or justice services. Twelve percent reported recent abuse, and six mothers reported severe or extreme danger. Self-efficacy (-.58, p < .05), social support (-28, p < .05), and financial support (-.25) were inversely associated with mental health concerns. Higher maternal mental health concerns (.55, p < .05) and child witnessing abuse (.70, p < .05) were associated with child behavioral problems. Child behavioral problems were inversely associated with child academic functioning (-.22, p < .05). To improve child outcomes, interventions that establish safety for mothers and children and promote maternal mental health are needed.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Using Baseline Data to Predict Chronic PTSD 48-months After Mothers Report Intimate Partner Violence: Outcomes for Mothers and the Intergenerational Impact on Child Behavioral Functioning

Worldwide one in three women report intimate partner violence. Many of these women report long term mental health problems, especially PTSD, which is associated with negative problem solving, isolation, somatization, depression, and anxiety. Children are impacted by their exposure to domestic violence and experience internal (i.e., depression, anxiety) and external (i.e., hostility, delinquency) behavioral clinical problems. To predict which women will experience chronic PTSD symptoms, a PTSD predictor tool was developed and applied to PTSD symptom scores four years after 300 mothers with children (age 18 months to 16 years) received assistance for the violence. At four years, 266 (89%) of the 300 mother child dyads were retained. Of those, 245 met inclusion criteria for this study and 53% had scores above the clinical threshold for PTSD. The predictor tool performed well. There was a significant association, χ² (4) = 11.83, p = .019, Cramer's V = 0.229, between mothers predicted at low/some risk for chronic PTSD and scoring below the cut-off score for diagnostic PTSD symptoms at four years. Mothers predicted to be at extreme risk for chronic PTSD reported PTSD symptoms at or above the diagnostic level at 48 months. Children whose mothers had PTSD were at greater risk for Borderline/Clinical range behavioral problems compared to children whose mothers did not have PTSD. Relative risk values ranged from 2.07 (Externalizing) to 2.30 (Internalizing). When appropriate interventions are available, the PTSD predictor tool can assist with triage and guided referral of women at risk for chronic PTSD.

Parenting in the Wake of Abuse: Exploring the Mediating Role of PTSD Symptoms on the Relationship Between Parenting and Child Functioning

BACKGROUND

Children whose mothers report partner violence and symptoms of posttraumatic stress disorder (PTSD) are at risk for behavior dysfunctions.

AIM

To examine the mediating effects of maternal PTSD symptoms on the relationship of parenting behaviors to child internalizing and externalizing behavior dysfunctions.

FINDINGS

Maternal PTSD symptoms have a partial mediating effect on the relationship between inconsistent discipline and child internalizing and externalizing behaviors. Maternal PTSD symptoms have a fully mediating effect on the relationship between poor supervision and child internalizing behaviors.

CONCLUSIONS

There is a need to identify women who report partner violence and are at high risk for PTSD and intervene early to prevent problematic parenting and resulting child behavior problems.

A Risk Assessment Tool to Predict Sustained PTSD Symptoms Among Women Reporting Abuse

BACKGROUND

Nationally and worldwide, 30% or more of women are likely to have experienced intimate partner violence. Maternal mental health symptoms predict child function. When mothers have sustained posttraumatic stress disorder (PTSD), their children at are risk for growth and developmental delays and poor behavioral outcomes that may adversely affect the course of their lives. While many who experience trauma will recover without intervention, a significant proportion will experience PTSD, with negative consequences for their personal lives and the lives of their families. Early identification of those at high risk for PTSD symptoms will support early interventions to prevent PTSD and its negative consequences.

METHODS

This paper describes the development of a tool that can predict PTSD symptoms at 8 months in mothers who are primarily of low socioeconomic status and primarily members of underrepresented groups. The tool consists of four key measures.

CONCLUSIONS

Using this tool to identify mothers at high risk for sustained PTSD and entering them into early intervention programs may protect mothers and their children from negative outcomes and promote their health and wellbeing.

Is length of shelter stay and receipt of a protection order associated with less violence and better functioning for abused women? Outcome data 4 months after receiving services

To provide differential effectiveness on length of stay at a shelter and receipt versus non-receipt of a protection order (PO), and outcomes of violence, functioning, and resiliency, in 300 abused women (150 first-time users of a shelter and 150 first-time applicants for a PO) who participate in a 7-year study with outcomes measured every 4 months. Four months after a shelter stay or application for a PO, abused women staying 21 days or less at a shelter reported similar outcomes compared with women staying longer than 21 days. Similarly, women receiving and not receiving a PO reported overall equivalent outcomes. Seeking shelter or justice services results in similar improved outcomes for abused women 4 months later, regardless of length of stay at the shelter or receipt or no receipt of the PO. Contact with shelter and justice services results in positive outcomes for abused women and indicates the urgent need to increase availability, accessibility, and acceptability of shelter and justice services.