Intimate partner violence: a study in men and women from six European countries

Bidirectional Violence in Intimate Relationships: A Systematic Review

Intimate partner violence is a public health problem with significant consequences at different levels. Over the years, the literature has shown that most violence is not unidirectional and perpetrated by men against women but rather bidirectional, in which both couple elements may be victims, perpetrators, or both. In this systematic literature review, we aimed to systematize the empirical knowledge to assess the prevalence of bidirectional violence, the most reported types of violence, and the influence of sex and sexual orientation on this phenomenon. The search for this systematic review was conducted in four databases, and we included studies that showed the prevalence of bidirectional violence in samples aged over 18 years, in articles written in English or Portuguese, and published between 2012 and 2022. In the qualitative synthesis, 42 empirical studies were included. The results showed that bidirectional violence is the most common pattern of violence, with psychological violence being the most reported type of bidirectional violence; men and women reported bidirectional violence at similar rates, and homosexual couples reported higher percentages of bidirectional violence than heterosexual couples. These results contradict the patriarchalist view of violence that assigns the exclusivity role of the victim to women and of the perpetrator to men, demonstrating that violence occurs regardless of sex or sexual orientation. The practical implications and future directions at the level of public policies to give visibility to the phenomenon will be duly discussed.

Combinations of Parent-Related Risk Factors Explaining Family Violence Toward Children and Spouse

The purpose of the study was to investigate parent-related risk factor combinations that explain family violence (FV), which refers to intimate partner violence and child maltreatment (CM). The data were collected from parents with a 4-year-old child using a nationwide retrospective cross-sectional survey conducted in Finland (FinChildren) (N = 10,737). The research questions were as follows: (a) How are parent-related risk factors associated with FV against children and the spouse? (b) How does the accumulation of parent-related risk factors within three risk factor clusters explain FV? Analyses were carried out using cross-tabulations with χ2 tests, an exploratory factor analysis (EFA), and binary logistic regression analyses. The risk factor clusters built based on the EFA were as follows: parental well-being, parent's childhood adversities, and parent's health. Our results indicated that even a single risk factor predicted the likelihood of FV. In the well-being risk factor cluster, the odds for the occurrence of FV in parents with one well-being risk factor were double (odds ratios [OR] = 2.21; confidence intervals [CI]: [1.99, 2.45]) and in parents with at least four risk factors was six times (OR = 6.05; CI: [4.48, 8.18]) compared to those with no risk factor. We concluded that (a) the more different risk factors parents had, the more likely they were to report FV and (b) the accumulation of risk factors for well-being contributes most to the occurrence of the risk of FV. As a result, we emphasize the importance of identifying families with concurrent risk factors. However, any individual concerns must be addressed with parents and they must be supported in coping with their everyday life.

Development and Psychometric Evaluation of the IPV Internalized Stigma Scale

Self-stigma is the internalization of widespread and negative attitudes around a devalued attribute. Being a victim of intimate partner violence (IPV) is a stigmatized identity, with IPV self-stigma is a potential barrier to help seeking. The lack of an IPV self-stigma scale limits current measurement of this latent trait; this study sought to fill this gap. We developed the IPV Internalized Self-stigma Scale (IPVIS) by revising existing self-stigma and devaluation/discrimination measures and adding new items to fill perceived gaps. Using an online survey, a diverse sample (N = 455, M = 39.51, SD = 12.03) with various relationship types (e.g., heterosexual, same-sex), IPV circumstances (e.g., male or female perpetrators/victims) and different gender and sexual identities was recruited. Participants first completed the item pool (44-items), followed by measures of IPV, anxiety, depression, social health, and self-efficacy with data analyzed using a multi-model approach (e.g., factor analysis, item response theory [IRT]). Factor analyses revealed one dominant factor; IRT analyses further refined the unidimensional item set. The final 11 items had high internal consistency, ω = .90, 95% CI [0.89, 0.91], and were highly informative with moderate to high discrimination levels. The IPVIS demonstrated measurement invariance by demographics, showing no differential item functioning by age groups, sex, residence (urban/suburban/rural), ethnicity (European/Caucasian vs. others), or relationship status (partnered/unpartnered). Initial validity examination revealed significant correlations between the IPVIS and related measures (e.g., depression, anxiety, social health). The IPVIS is suitable for research and has widespread clinical applicability. To the best of our knowledge, the IPVIS is the first scale developed that assesses IPV self-stigma inclusive of a diverse range of clients/participants, relationship types, and IPV circumstances.

Are child maltreatment and intimate partner violence associated with adult disordered eating?

OBJECTIVE

Disordered eating is one of the most prevalent mental health concerns (Galmiche et al., 2019, Quick & Byrd-Bredbenner, 2013, Neumark-Sztainer et al., 2006). Studies show that child maltreatment increases the likelihood of disordered eating symptoms in adulthood (Caslini et al., 2016, Hazzard et al., 2019). However, these studies overlook abuse experiences later in life, such as intimate partner violence which may also be a significant contributing factor (Bundock et al., 2013). The proposed study will help identify whether childhood maltreatment and IPV are independent predictors and/or if the combination of the two are synergistic risk factors for adult disordered eating.

METHOD

We use data from 14,332 people from Wave III of the National Longitudinal Study of Adolescent to Adult Health (Add Health). Participants completed questionnaires assessing child maltreatment, intimate partner violence, and disordered eating symptoms. We will perform a series of logistic regression models to examine a) whether child maltreatment and intimate partner violence are independently associated with disordered eating and b) whether exposure to the combination of both child maltreatment and intimate partner violence is associated with worse outcomes for adult disordered eating compared to exposure to only one or none at all. We also propose a supplemental analysis to establish the robustness of these effects when accounting for the highest parental education, federal poverty percentage level, race/ethnicity, gender, and age.

PUBLIC SIGNIFICANCE

Disordered eating is a serious mental health concern, especially in an emerging adult population. Child maltreatment is consistently associated with disordered eating in adulthood. However, the independent or synergistic role of more recent abuse experiences, such as intimate partner violence, remains largely unknown. The proposed study provides insight into how both childhood abuse and intimate partner violence may be associated with disordered eating independently or in combination.

Intimate Partner Violence During COVID-19 Restrictions: A Study of 30 Countries From the I-SHARE Consortium

Intimate partner violence (IPV) causes substantial physical and psychological trauma. Restrictions introduced in response to the COVID-19 pandemic, including lockdowns and movement restrictions, may exacerbate IPV risk and reduce access to IPV support services. This cross-sectional study examines IPV during COVID-19 restrictions in 30 countries from the International Sexual HeAlth and REproductive Health (I-SHARE) study conducted from July 20th, 2020, to February, 15th, 2021. IPV was a primary outcome measure adapted from a World Health Organization multicountry survey. Mixed-effects modeling was used to determine IPV correlates among participants stratified by cohabitation status. The sample included 23,067 participants from 30 countries. A total of 1,070/15,336 (7.0%) participants stated that they experienced IPV during COVID-19 restrictions. A total of 1,486/15,336 (9.2%) participants stated that they had experienced either physical or sexual partner violence before the restrictions, which then decreased to 1,070 (7.0%) after the restrictions. In general, identifying as a sexual minority and experiencing greater economic vulnerability were associated with higher odds of experiencing IPV during COVID-19 restrictions, which were accentuated among participants who were living with their partners. Greater stringency of COVID-19 restrictions and living in urban or semi-urban areas were associated with lower odds of experiencing IPV in some settings. The I-SHARE data suggest a substantial burden of IPV during COVID-19 restrictions. However, the restrictions were correlated with reduced IPV in some settings. There is a need for investing in specific support systems for survivors of IPV during the implementation of restrictions designed to contain infectious disease outbreaks.

An Exploratory Study of Financial Health as an Antecedent of Economic Abuse Among Women Seeking Help for Intimate Partner Violence

Economic abuse is a common component of intimate partner violence (IPV). This study explored whether IPV victim and perpetrator financial health at relationship outset are associated with two types of economic abuse-restriction and exploitation-during the relationship. With a sample of 315 women seeking services for male-perpetrated IPV, the study showed increased use of economic restriction when perpetrators were advantaged in terms of assets or disadvantaged in terms of debt. There was increased use of economic exploitation when victims were advantaged in terms of assets or credit and when perpetrators were disadvantaged in terms of assets, debt, or credit. Implications for research and intervention are discussed.

Self-Esteem, Social Problem Solving and Intimate Partner Violence Victimization in Emerging Adulthood

Although there are many studies examining the psychosocial vulnerability factors of intimate partner violence (IPV) victimization in emerging adulthood, little is known about the life skills that may be involved, such as social problem solving (SPS) and self-esteem. The aim of the current study is to explore the relationships between SPS, self-esteem, and types (i.e., psychological, physical and sexual) and severity of IPV victimization in emerging adulthood. Based on a French online survey, 929 emerging adults (84.6% of whom were women with a mean age of 23.6) completed self-report questionnaires related to SPS (problem orientations and problem-solving styles), self-esteem and IPV victimization. The results showed that positive SPS skills and higher self-esteem were associated with lower severity of IPV. Multivariate analyses showed that the most associated factors of severe forms of IPV were avoidant and impulsive/carelessness styles. Minor sexual violence was positively associated with lower self-esteem and rational problem-solving skills, while minor psychological victimization was related to avoidant style. Upon completion of this study, it can be said that conflicts which escalate into IPV may be associated with dysfunctional conflict resolution styles, highlighting the importance of interventions that promote the development of life skills in order to prevent IPV.

(Un)Acknowledgment of Men as Victims of Intimate Partner Violence

Some victims of interpersonal violence do not acknowledge or label their experience as criminal. This study aims to explore men's experiences as victims of intimate partner violence and identify the key elements that contribute to their (un)acknowledgment and needs. We interviewed 10 Portuguese male victims in heterosexual relationships who requested formal help. A thematic analysis was performed using NVivo 11. Social gender discourses and expectations prevented men from acknowledging their intimate victimization and created barriers to seeking help. Participants struggled to achieve the social status of the victim and to gain access to intervention measures. These findings reflect the invisibility and insufficient social awareness of intimate partner violence against men and enhance our understanding of the need of those men.

Prevalence of Physical Violence in the Medical-Forensic Approach in the Years 2015-2020 in City and Neighboring Municipalities: Perspectives from Poland-Poznań Study

Forensic medical opinions serve the appropriate classification of a crime against health. Violence, a multifaceted phenomenon, requires forensic medical examination in the case of causing damage to health. Due to the effects caused by the perpetrator, the damage to health is divided into severe, medium, and light. This study analyzed 7689 incidents of violence from 2015-2020, taking place in the area subordinate to the Provincial Police Headquarters in Poznań, based on anonymized documentation of forensic medical examinations performed at the Department of Forensic Medicine in Poznań at the request of the Police and privately. The analysis took into account: units ordering the test, type of exposure, medical help, sex and age of the victim, places of the incident, classification and localization of injury, manner of impact, attitude of the perpetrator to the victim, profession of the victim, gender of the perpetrator, and remarks. In Poland, statistics on violence victims are underestimated, resulting from the low reporting of crimes committed to law enforcement authorities. There is a need for programs to educate the perpetrator of violence on methods of conflict resolution and programs to prevent violence, covering events taking place in public spaces.

Socialization processes within adolescents' relationships with parents and peers predicting couples' intimate partner violence in adulthood: A social learning perspective

Previous studies have established that individual characteristics such as violent behavior, substance use, and high-risk sexual behavior, as well as negative relationships with parents and friends, are all risk factors for intimate partner violence (IPV). In this longitudinal prospective study, we investigated whether violent behavior, substance use, and high-risk sexual behavior in early adulthood (ages 22-23 years) mediated the link between family conflict and coercive relationship talk with friends in adolescence (ages 16-17 years) and dyadic IPV in adulthood (ages 28-30 years). A total of 998 individuals participated in multimethod assessments, including observations of interactions with parents and friends. Data from multiple reporters were used for variables of interest including court records, parental and self-reports of violence, self-reports of high-sexual-risk behaviors and substance use, and self- and romantic partner-reports of IPV. Longitudinal mediation analyses showed that violent behavior during early adulthood mediated the link between coercive relationship talk with friends in adolescence and dyadic IPV in adulthood. No other mediation paths were found and there was no evidence of gender differences. Results are discussed with attention to the interpersonal socialization processes by which IPV emerges relative to individual risk factors.

Health associations for male survivors of unwanted and non-consensual sex

Literature has established that men with non-consensual sexual experiences exhibit a higher likelihood of engaging in high-risk sexual behaviors; however, previous research does not explore men with unwanted sexual experiences, nor their sexual and general health outcomes. Weighted data from the 2011-2017 National Survey of Family Growth included men aged 18-49 years who ever experienced oral, vaginal, or anal sex by partners of any gender (N = 10,763). The Pearson χ² test compared the sociodemographic of men with or without a history of unwanted or non-consensual sex. Logistic regressions were used to examine the association of this history to sexual health and general health outcomes, while controlling for age, race/ethnicity, and education level. Approximately 1 in 10 (10.3%) American men reported experiencing unwanted or non-consensual sex in their lifetime. Men with these experiences were more likely to rate their health as fair or poor (aOR = 1.5, 95% CI = [1.1, 2.0]) and have difficulty concentrating, remembering, or making decisions due to a physical, mental, or emotional condition (aOR = 2.1, 95% CI = [1.7, 2.7]). Men with forced sex experiences reported higher odds of gonorrhea (aOR = 5.4; 95% CI = [3.0, 10.0]) or chlamydia diagnoses (aOR = 2.5; 95% CI = [1.5, 4.4]) in the past year, and a diagnosis of genital herpes (aOR = 2.7; 95% CI = [1.6, 4.6]), genital warts (aOR = 1.7; 95% CI = [1.0, 5.6]), and syphilis (aOR = 2.4; 95% CI = [1.0, 5.6]) in their lifetime than men who did not report these experiences. The association of sexually transmitted infections and general health outcomes to unwanted and non-consensual sex validates the demand for clinicians to integrate trauma-informed care into their practice with male patients.

Trends and correlates of intimate partner violence (IPV) victimization in Rwanda: results from the 2015 and 2020 Rwanda Demographic Health Survey (RDHS 2015 and 2020)

Background

Intimate partner violence (IPV) is reported to be a public health issue given its magnitude and long-lasting consequences. Men are generally thought to be perpetrators of IPV, but they can also be victims. In Rwanda, the experience of men as victims has not yet been described and characterized. The aim of this study is to examine the trends and correlates of IPV victimization for men and women in Rwanda.

Methods

The data for this study were extracted from the Rwanda Demographic and Health Survey (RDHS) in 2014/15 (female: n = 8292, male: n = 3470) and 2019/2020 (female = 8574, male: n = 3590). The survey had used a structured measure of IPV (i.e. physical, sexual, or emotional) and its related demographic characteristics to collect data in a nationally representative sample of ever-married women aged 15–49 years and men aged 15–59 years. Multiple logistic regression was applied to examine the association between demographic characteristics and IPV in both women and men.

Result

The prevalence of IPV among women increased from 40% in 2015 to 46% in 2020, while it decreased from 21 to 18% in men during the same time period. The associated factors for women IPV victimization in 2015 were: uneducated husband (Adjusted Odds Ratios (AOR) = 5.570, 95% CI 1.29–24.02), woman from the poorest household (AOR = 2.834, 95% CI 1.9–93.12), husband aged from 30 to 39 years (AOR = 2.797, 95% CI 1.517–5.158), husband consuming alcohol (AOR = 3.021, 95% CI 1.517–5.158); women involved in decisions about their own earnings (AOR = 0.576, 95% CI 0.37–0.88); and purchases (AOR = 0.472, 95% CI 0.27–0.82). However, the factors such as uneducated husbands (AOR = 3.032, 95% CI 1.117–8.24); husbands consuming alcohol (AOR = 1.712, 95% CI 2.408–4.486); a woman's involvement in decisions on her personal health (AOR = 0.443, 95% CI 0.30–0.63) and visits from her family or relatives (AOR = 0.405, 95% = 0.41–0.22) were factors of IPV in 2020. On the other hand, the associated factors for men IPV victimization in 2015 were being from richer wealth index (AOR = 0.21, 95% CI 0.04–1.04), frequency of being hit in last 12 months by other than partner (AOR = 5.49, 95% CI 1.65–18.25), woman often consuming alcohol (AOR = 13.30, 95% CI 1.9–93.12); whereas its associated factor in 2020 were women consuming alcohol (3.91, 95% CI 0.55–9.87).

Conclusion

The present study revealed a significant increase in IPV against women, and slight decrease of IPV against men in Rwanda from 2015 to 2020, as well as its associated risks and protective factors over time. This increase needs further exploration given that government and partners have invested in policies and strategies to mitigate the IPV with limited impact. Since there is a relationship between IPV prevalence and education, the existing laws on domestic violence need to be known by the citizens. Findings from this study evidenced also visits from extended families to be a protective factor and therefore suggesting the necessity of a family and community-based approach in managing IPV in Rwanda. Future studies to assess the effectiveness of community-based approach in preventing IPV.

Ugandan Men Exposed to Intimate Partner Violence: A Cross-Sectional Survey of Nationally Representative Data

Although women typically constitute the largest proportion of the population who experience the deleterious effects of intimate partner violence (IPV), understanding the bidirectional nature of IPV is important for developing nuanced prevention initiatives. This study examines data from the 2016 Ugandan Demographic and Health Survey. Participants were selected from households in all the 15 regions in Uganda using a two stage sampling design. A total of 2858 men who were in a heterosexual union or separated/divorced were included in the analysis. Univariate and multivariable logistic regression analyses were performed with the aim of identifying associations between selected demographic variables and male exposure to all forms of IPV combined, psychological violence, physical violence and sexual violence. The prevalence of lifetime IPV and during the 12 months preceeding the survey respectively was 43.6 and 30.5% in all forms, with 35.9 and 24.8% reporting psychological, 20.2 and 11.9% for physical and 8.2 and 5.7% sexual violence. The key factors associated with all forms of IPV were being afraid of their wife/partner most of the time (OR = 5.10, 95% CI 2.91, 8.96) controlling behaviour of the intimate partner (OR = 3.80, 95% CI 2.84, 5.07), bi-directional violence against the partner (OR = 3.20, 95% CI 2.49, 4.12), alcohol consumption by the intimate partner (OR = 1.85, 95% CI 1.40, 2.45). The factors associated with males who experience IPV appear to be modifiable and may warrant consideration for inclusion in programs supporting both males and females who experience IPV.

The Prevalence, Directionality, and Dyadic Perpetration Types of Intimate Partner Violence in a Community Sample in Portugal: a Gender-Inclusive Inquiry

Intimate partner violence (IPV) is a major concern across the world, and its prevalence assessment has been a priority in numerous countries. However, data about IPV prevalence in Portugal is scarce and not up-to-date. This study aims to estimate IPV prevalence in Portugal. A community sample of 1392 adults (77.4% female, mean age = 34.95 years, SD = 12.80) was collected through a web-based survey, between March and June of 2020. Participants completed a sociodemographic questionnaire and the Conflict Tactic Scales-2 (CTS-2). Accounting for all forms of IPV, a past-year prevalence of 64.4% and 64.6% were found, for victimization and perpetration, respectively. Regarding gender or sexual orientation, no significant differences were found in the past-year or the lifetime prevalence, neither concerning frequency. Directionality and dyadic concordance types were analyzed and showed that most violence was bidirectional. Having perpetrated violence in previous intimate relationships was the most influential factor when predicting past-year perpetration or victimization. Other significant predictors were age, being victimized before 15 years old, cohabitation with the intimate partner, and drug use, but the last two were only significant for victimization. Findings support the idea that IPV is a relevant phenomenon, regardless of gender and sexual orientation. It is the first nationwide, gender-inclusive study to do so in Portugal. Studies based on different samples might provide important evidence to prevent hasty conclusions about IPV prevalence and patterns and to guide empirically driven policies.

Intimate Partner Violence and Risk for Mortality and Incident Dementia in Older Women

The aim of this study was to assess the long-term risk for mortality and incident dementia associated with exposure to intimate partner violence (IPV) at any time over the life course. Data were taken from the Australian Longitudinal Study of Women's Health, a population-based cohort study initiated in 1996. Analysis is based on 12,085 community-dwelling women aged 70 to 75 years at baseline from all states and territories. Self-reported exposure to violence was separated into historical (any time before baseline), current (past 12 months), or both. Date of death was obtained from the National Death Index, and dementia status was self-reported or obtained from administrative data. We modeled mortality risk using Cox regression, and risk for incident dementia using Fine-Gray proportional hazards modeling with death as a competing risk. Follow up continued to December 2017. At baseline, 728 women (6.0%) reported historical IPV, 121 (1.0%) reported current violence, and 38 reported both (0.3%). Historical IPV increased 20-year mortality risk after controlling for demographic, socioeconomic, and lifestyle variables (hazard ratio 1.10, 95% confidence interval = [1.00, 1.20]). There was no relationship between current violence and mortality (hazard ratio 1.04, 95% confidence interval = [0.85, 1.29]). There was also no association between IPV and risk for incident dementia (hazard ratio 1.02, 95% confidence interval = [0.89, 1.17]). Older women who self-report exposure to IPV over the lifespan die significantly earlier than women who do not. Further research that considers the mediating role of psychological trauma is needed to examine the relationship between IPV and dementia.

An ecological study on the association between early childhood caries and intimate partner violence in 20 low- and middle-income countries: 2007-2017

Background: Women are the worst affected by intimate partner violence (IPV), and this impacts negatively on the health of the children they care for. This study aimed to determine the associations between IPV and the prevalence of early childhood caries (ECC) in 3-5-year-olds. Methods: This was an ecological study using IPV (physical, sexual, emotional) data extracted from the Demographic Health Survey of 20 low- and middle-income countries and ECC data for 3-5-year-olds of the same countries for the period 2007-2017. Linear regression analysis was used to assess the relationship between the percentage of 3-5-year-olds with ECC (outcome variable) and IPV indicators (physical, sexual, emotional). The model was adjusted for the country's gross national income and the percentage of women with secondary or higher education. Partial eta squared (ηp ²), regression coefficients, confidence intervals and p-values were calculated. Results: Data on ECC in 3-5-year-olds and IPV were available for six low-income-countries, 10 lower-middle-income-countries and four upper-middle-income-countries. The most prevalent form of IPV was physical violence (10.09%). The Democratic Republic of Congo had the highest prevalence of physical violence (45.8%), sexual violence (25.4%), and ECC (80.0%). The strongest association was between the prevalence of ECC and emotional violence (ηp ²=0.01), followed by physical violence (ηp ²=0.005), and sexual violence (ηp ²=0.003). For every 1% higher prevalence of emotional violence, there was 0.28% higher prevalence of ECC, and for every 1% higher percentage of physical violence, there was 0.21% higher prevalence of ECC. On the contrary, for every 1% higher prevalence of sexual violence, there was 0.35% lower prevalence of ECC prevalence. Conclusions: Emotional and sexual violence where the two types of IPV associated with the prevalence of ECC. The associations were minor and the directions of their effects were difference. These findings need to be studied further.

An ecological study on the association between early childhood caries and intimate partner violence in 20 low- and middle-income countries: 2007-2017

Background: Women are the worst affected by intimate partner violence (IPV), and this impacts negatively on the health of the children they care for. This study aimed to determine the associations between IPV and the prevalence of early childhood caries (ECC) in 3-5-year-olds. Methods: This was an ecological study using IPV (physical, sexual, emotional) data extracted from the Demographic Health Survey of 20 low- and middle-income countries and ECC data for 3-5-year-olds of the same countries for the period 2007-2017. Linear regression analysis was used to assess the relationship between the percentage of 3-5-year-olds with ECC (outcome variable) and IPV indicators (physical, sexual, emotional). The model was adjusted for the country's gross national income and the percentage of women with secondary or higher education. Partial eta squared (ηp 2), regression coefficients, confidence intervals and p-values were calculated. Results: Data on ECC in 3-5-year-olds and IPV were available for six low-income-countries, 10 lower-middle-income-countries and four upper-middle-income-countries. The most prevalent form of IPV was physical violence (10.09%). The Democratic Republic of Congo had the highest prevalence of physical violence (45.8%), sexual violence (25.4%), and ECC (80.0%). The strongest association was between the prevalence of ECC and emotional violence (ηp 2=0.01), followed by physical violence (ηp 2=0.005), and sexual violence (ηp 2=0.003). For every 1% higher prevalence of emotional violence, there was 0.28% higher prevalence of ECC, and for every 1% higher percentage of physical violence, there was 0.21% higher prevalence of ECC. On the contrary, for every 1% higher prevalence of sexual violence, there was 0.35% lower prevalence of ECC prevalence. Conclusions: Emotional and sexual violence where the two types of IPV associated with the prevalence of ECC. The associations were minor and the directions of their effects were difference. These findings need to be studied further.

Intimate partner violence among ever-married Afghan women: patterns, associations and attitudinal acceptance

Intimate partner violence (IPV) is one of the most prevalent forms of violence that women suffer globally. Women in Afghanistan have been exposed to high levels of IPV which coincided with high levels of conflict during more than four decades. We cross-sectionally examined the Afghanistan Demographic and Health Survey responses of 21,234 ever-married Afghan women. We first performed the frequency distribution analysis to determine the prevalence of IPV and the basic socio-demographic characteristics of the participants. Subsequently we examined the relationship between the independent and dependent variables followed by the bivariate and survey versions of logistic regression analyses. We report odds ratios in order to depict the strength and direction of the associations between the IPV and selected independent variables. P-values less than 0.05 were considered statistically significant. The analyses showed that 55.54% of Afghan women experienced some form of physical, emotional, or sexual violence by their intimate partners during the recall period partners. The most common form of IPV found was physical violence (50.52%). Factors such as being exposed to inter-parental violence (respondent woman's father physically abused her mother) (adjusted OR= 3.69, CI= 3.31-4.10) and respondent's acceptance of IPV (aOR= 1.85, 1.51-2.26) were associated with increased exposure to IPV. Having a spouse with at least a primary education (aOR= 0.76, CI= 0.64-0.91) or a respondent with at least a primary education (aOR= 0.82, CI= 0.68-0.98) was associated with lower exposure to reported IPV. The lifetime experience of IPV occurs to a high extent among Afghan women, and several socio-demographic factors have predisposing attributes. IPV policy formulation and strategizing may benefit from considering these factors.

VULNERABILITY ELEMENTS FOR PERMANENCE IN MARITAL VIOLENCE: SPEECHES OF WOMEN WHO CONSUME ALCOHOL/DRUGS

ABSTRACT Purpose to identify elements of vulnerabilities for the permanence of women who consume alcohol/drugs in marital violence. Method an exploratory, descriptive and qualitative study conducted with 16 women over the age of 18 years old, with a history of alcohol and/or other drug use and marital violence, registered in two Family Health Units in the urban area of a municipality of Bahia, Brazil. Women whose signs suggested alcohol use or abstinence and those emotionally unstable were excluded. Data collection took place from October 2016 to February 2017, through in-depth interviews. The data were systematized, based on the Collective Subject Discourse. Results economic dependence; the hope that the partner will change; the transgenerationality of marital violence and the non-resoluteness of the care network emerged as elements that make women who consume alcohol/drugs vulnerable to remain in marital relationships permeated by violence. Conclusion by pointing to elements that make women who consume alcohol and/or other drugs vulnerable to remain in marital relationships permeated by violence, the findings signal to the need for inter-sectoral articulations. This articulation among the various sectors should promote the implementation and/or deployment of effective actions that provoke reflections on social construction anchored in gender inequality and still assist the demands of women, culminating in the reach of female empowerment.

ELEMENTOS DE VULNERABILIDADE PARA PERMANÊNCIA NA VIOLÊNCIA CONJUGAL: DISCURSO DE MULHERES QUE CONSOMEM ÁLCOOL/DROGAS

RESUMO Objetivo identificar elementos de vulnerabilidades para permanência de mulheres que consomem álcool/drogas na violência conjugal. Método estudo exploratório, descritivo e de abordagem qualitativa, realizado com 16 mulheres com idade acima de 18 anos, história de consumo de álcool e/ou outras drogas e violência conjugal, cadastradas em duas Unidades de Saúde da Família da zona urbana de um município da Bahia, Brasil. Foram excluídas as mulheres cujos sinais sugeriam uso ou abstinência do álcool e aquelas emocionalmente instáveis. A coleta de dados ocorreu de outubro de 2016 a fevereiro de 2017, por meio da entrevista em profundidade. Os dados foram sistematizados, baseando-se no Discurso do Sujeito Coletivo. Resultados a dependência econômica; a esperança de que o companheiro mude; a transgeracionalidade da violência conjugal e a não resolutividade da rede de atendimento emergiram como elementos que vulnerabilizam mulheres que consomem álcool/drogas a permanecerem em relações conjugais permeadas pela violência. Conclusão os achados, ao apontar elementos que vulnerabilizam mulheres que consomem álcool e/ou outras drogas a permanecer em relações conjugais permeadas pela violência, sinaliza para a necessidade de articulações intersetoriais. Esta articulação entre os diversos setores deve promover a implantação e/ou implementação de ações eficazes que provoquem reflexões acerca da construção social ancorada na desigualdade de gênero e ainda assistam as demandas das mulheres, culminando no alcance do empoderamento feminino.

[Domestic Violence and Intimate Partner Violence - a Challenge within the Health Care Sector - Result of a Survey Among Physicians]

Domestic violence evidently endangers health. Since physicians are seen as primary contact persons by victims of violence it is necessary to understand their perception of their role. 1346 of all physicians and dentists registered in 2015 with the Saxony Board of Physicians filled in a questionnaire on contact with victims, knowledge on support structures and willingness to take part on specific medical education. Frequency of contact was estimated to be low, while readiness to approach patients in case of suspicion was high. There was uncertainty about where to refer, as well as a limited level of awareness of existing support structures. Most indicated a high request in further education. In conclusion, motivation and readiness contrast with uncertainty and lack of awareness. Education focusing on key players and major network interfaces should endorse physicians in their significant role within the care and prevention system of violence.

An ecological study on the association between early childhood caries and intimate partner violence in 20 low- and middle-income countries: 2007-2017

Background: Women are the worst affected by intimate partner violence (IPV), and this impacts negatively on the health of the children they care for. This study aimed to determine the relationship between IPV and the prevalence of early childhood caries (ECC) in 3-5-year-olds. Methods: This was an ecological study using IPV (physical, sexual, emotional) data extracted from the Demographic Health Survey of 20 low- and middle-income countries and ECC data for 3-5-year-olds of the same countries for the period 2007-2017. Linear regression analysis was used to assess the relationship between the percentage of 3-5-year-olds with ECC (outcome variable) and IPV indicators (physical, sexual, emotional). The model was adjusted for the country’s gross national income and the percentage of women with secondary or higher education. Partial eta squared (ηp2), regression coefficients, confidence intervals and p-values were calculated. Results: Data on ECC in 3-5-year-olds and IPV were available for six low-income-countries, 10 lower-middle-income-countries and four upper-middle-income-countries. The most prevalent form of IPV was physical violence (10.09%). The Democratic Republic of Congo had the highest prevalence of physical violence (45.8%), sexual violence (25.4%), and ECC (80.0%). The strongest association was between the prevalence of ECC and emotional violence (ηp2=0.01), followed by physical violence (ηp2=0.005), and sexual violence (ηp2=0.003). For every 1% higher prevalence of emotional violence, there was 0.28% higher prevalence of ECC, and for every 1% higher percentage of physical violence, there was 0.21% higher prevalence of ECC. On the contrary, for every 1% higher prevalence of sexual violence, there was 0.35% lower prevalence of ECC prevalence. Conclusions: The association between IPV and the prevalence of ECC in 3-5-year-olds is minor, with the strongest direct association effect being with emotional violence; and there was an inverse association between sexual violence and the prevalence of ECC. These findings need to be studied further.

Intimate partner violence in Greece: a study of 664 consecutive forensic clinical examinations

BACKGROUND

Intimate partner violence (IPV) is a well-known phenomenon, which affects mostly women. While IPV victims may attend emergency departments (EDs) seeking medical care, not all of them will make an allegation against their abusers.

OBJECTIVE

The aim of this study was to examine the prevalence and the characteristics of the victims, who had made an allegation about the violent incident and had been examined by a forensic pathologist for judicial purposes, and had attended EDs seeking medical care, before the forensic examination.

METHODS

We reviewed the archives of clinical examinations that were conducted at the Department of Forensic Medicine and Toxicology of National and Kapodistrian University of Athens during a 5-year period (2012-16).

RESULTS

Six hundred sixty-four clinical examinations were conducted at our Department for IPV allegations. According to our findings, women were more likely to seek medical care than men. Victims who have attended EDs were more likely to have sustained injuries located at least on the head or on the lower limbs.

CONCLUSION

The majority of IPV victims in the broader region of Attica (Greece) were women, usually married, and aged between 30 and 49 years old. Despite the fact that the majority of IPV incidents are not reported to police, every person who is engaged in the process of dealing with IPV victims has to be educated and adequately informed about this phenomenon, its implications and the possible ways to deal with it. Furthermore, victims need to be educated and informed adequately in waiting rooms of EDs.

Contextual determinants of intimate partner violence: a multi-level analysis in six European cities

OBJECTIVES

To assess whether city-level characteristics influence the risk of intimate partner violence (IPV) victimization across six European cities.

METHODS

The DOVE study included 3496 participants from Athens-Greece, Budapest-Hungary, London-UK, Östersund-Sweden, Porto-Portugal and Stuttgart-Germany. IPV victimization was assessed using the Revised Conflict Tactics Scales, and several contextual variables were included: GINI coefficient, gender equality index, an index of social support, unemployment rate and proportion of residents with tertiary education. Multilevel models were fitted to estimate the associations (odds ratio, 95% confidence intervals) between each type of victimization and contextual and individual-level variables.

RESULTS

62.3% of the participants reported being a victim of IPV during the previous year, with large between-city differences (53.9%-72.4%). Contextual variables accounted for a substantial amount of this heterogeneity. Unemployment rates were associated with psychological (1.05, 1.01-1.08) and physical IPV (1.07, 1.01-1.13). GINI coefficient showed a positive association with any form of IPV (1.06, 1.01-1.11) and sexual coercion (1.13, 1.01-1.25).

CONCLUSIONS

We found significant associations between contextual determinants and IPV, which emphasizes the importance of considering contextual socioeconomic conditions when policy measures are designed to address IPV.

Male Victims of Female-Perpetrated Partner Violence: A Qualitative Analysis of Men's Experiences, the Impact of Violence, and Perceptions of Their Worth

There has been a recent increase in the amount of research on male victims of female-perpetrated partner violence (PV) but research needs to be conducted to understand how the patterns of abuse persist in these relationships. In the current study, the experiences of 59 male PV victims in the USA, recruited through online advertisements in professional networks and websites (e.g., agencies that specialize in male victims of PV), were explored through a thematic analysis. Analyses suggested that the help seeking process of male PV victims is complex and heterogeneous and can often lead to further negative consequences due to various structural, cultural, social, and organizational factors. The findings also highlight the potential societal issues that male victims perceived as contributing to male victimization and lack of available resources for them. The results are discussed in terms of its implications for agencies, service providers, and general societal attitudes that are relevant to raising awareness about this phenomenon.

The impact of intimate partner violence on forgone healthcare: a population-based, multicentre European study

BACKGROUND

To examine the relationship between forgone healthcare and involvement in intimate partner violence (IPV) as victims, perpetrators or both.

METHODS

This cross-sectional multicentre study assessed community non-institutionalized residents (n = 3496, aged 18-64) randomly selected from six European cities: Athens, Budapest, London, Östersund, Porto, Stuttgart. A common questionnaire was used, including self-reports of IPV and forgone healthcare ('Have you been in need of a certain care service in the past year, but did not seek any help?'). Odds ratios (ORs), 95% confidence intervals (CIs) were computed fitting logistic regression models adjusted for city, chronic disease, self-assessed health status and financial strain.

RESULTS

Participants experiencing past year IPV (vs. no violence) reported more often to forgone healthcare (n = 3279, 18.6% vs. 15.3%, P = 0.016). IPV experienced as both a victim and perpetrator was associated with forgone healthcare (adjusted OR, 95%CI: 1.32, 1.02-1.70).

CONCLUSION

IPV was associated with forgone healthcare, particularly for those experiencing violence as both victims and perpetrators. Results suggest that preventing IPV among adults may improve timely healthcare uptake.

Social support and the intimate partner violence victimization among adults from six European countries

BACKGROUND

Social support may buffer the negative effects of violence on physical and mental health. Family medicine providers play an essential role in identifying the available social support and intervening in intimate partner violence (IPV).

OBJECTIVE

This study aimed at assessing the association between social support and the IPV victimization among adults from six European countries.

METHODS

This is a cross-sectional multi-centre study that included individuals from Athens (Greece), Budapest (Hungary), London (UK), Östersund (Sweden), Porto (Portugal) and Stuttgart (Germany). Data collection was carried out between September 2010 and May 2011. The sample consisted of 3496 adults aged 18-64 years randomly selected from the general population in each city. The revised Conflict Tactics Scales was used to assess IPV victimization. Social support was assessed with the Multidimensional Scale of Perceived Social Support.

RESULTS

Participants reporting physical assault victimization experienced lower social support (mean ± SD) than their counterparts, 66.1 ± 13.96 versus 71.7 ± 12.90, P < 0.001, for women; and 67.1 ± 13.69 versus 69.5 ± 13.52, P = 0.002 for men. Similar results were found regarding sexual coercion victimization, 69.1 ± 14.03 versus 71.3 ± 12.97, P = 0.005 for women and 68.0 ± 13.29 versus 69.3 ± 13.62, P = 0.021 for men. This study revealed lower levels of social support among participants reporting lifetime and past year victimization, independent of demographic, social and health-related factors.

CONCLUSION

Results showed a statistically significant association between low social support and IPV victimization. Although the specific mechanisms linking social support with experiences of violence need further investigation, it seems that both informal and formal networks may be associated with lower levels of abusive situations.

The social anatomy of adverse childhood experiences and aggression in a representative sample of young adults in the U.S

Objective The current study assesses the effect of adverse childhood experiences on later aggression and violence across young adult relationships contexts, including intimate partners, friends, or strangers. Method Surveys were conducted with a nationally representative sample of young adults ages 18-32, drawn from the AmeriSpeak panel, a probability-based panel with coverage of 97% of U.S. households. The weighted study sample is 2284 young adult respondents, of whom 1561 reported being in an intimate partnership. Results Rates of verbal aggression perpetrated by young adults declined with the intimacy of the relationship, such that aggression against a partner (72%) exceeded aggression directed at friends (43%) and strangers (34%). Similar rates of physical violence (about 9%) were reportedly perpetrated against partners, friends, and strangers. Adjusting for a range of personal characteristics, both adverse childhood experiences and recent stressors in these young adult lives exhibited direct associations with verbal and physically aggressive outcomes. Conclusions In models of verbal and physical aggression across relationship contexts, childhood adversity exhibits lasting effects unaccounted for by important proximal life circumstances, including recent life stressors, mental health, and substance use behaviors. These results provide empirical insights for clinical treatment of young adults prone to aggressive conflicts as well as input to positive youth development programming to foster healthy approaches to conflict.

Typologies of intimate partner violence-maternal parenting and children's externalizing problems: The moderating effect of the exposure to other forms of family violence

Typologies of IPV and parenting practices in mothers who experienced police-reported IPV remain surprisingly unexplored, in addition to how those typologies are linked with children's externalizing problems. Using data from 162 Portuguese mother-child dyads with a police or child protection services referral of IPV, this study aimed to: (a) identify IPV-parenting typologies; (b) test the associations between typologies and children's externalizing problems, and (c) examine the moderating effect of children's exposure to other forms of family violence in those associations. Using a person-centered approach, two IPV-parenting typologies were found: a spillover typology, with high levels of physical, psychological, and sexual violence and high levels of harsh and inconsistent parenting practices; and a compartmentalized typology, with high levels of physical, psychological, and sexual violence and lower ineffective parenting practices. Results also showed that externalizing symptoms (reported by mothers and teachers) were significantly lower in children of mothers in the compartmentalized typology compared to those in the spillover typology. Children's direct exposure to other forms of family violence moderated this association. Findings suggested that children with a high exposure to other forms of family violence showed the highest levels of externalizing problems when their mothers were classified into the spillover typology, and they exhibited the lowest levels of externalizing problems when their mothers were classified in the compartmentalized typology.

Intimate Partner Violence and Psychological Distress Among Young Couples: The Role of the Pattern of Violence

The objective of this study was to assess whether the psychological distress of young men and women involved in intimate partner violence (IPV) is predicted by their reported role in the pattern of violence. Dyadic structural equation modeling (SEM) analyses were performed on a sample of 205 young couples, controlling for income, cohabitation, children, and the length of the relationship. Findings revealed that the most common reported pattern of IPV was mutual in nature. Reported bidirectional violence within the couple was related to distress for both sexes. The couple's income and the length of their relationship were negatively associated with psychological distress, namely for young women. Findings point to the importance of considering therapy in a couple-context.

Relationship of Physical Intimate Partner Violence with Mental Health Diagnoses in the Nationwide Emergency Department Sample

OBJECTIVES

We examined associations of physical intimate partner violence (PIPV) with selected mental health disorders using a nationally representative sample of emergency department (ED) discharges corresponding to men and women (18-64 years) from the 2010 Nationwide Emergency Department Sample.

METHODS

PIPV was determined using International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) external cause of injury code E967.3 (battering by spouse or partner). ICD-9-CM clinical classification of discharge diagnoses was used to identify mental health disorders. Multivariable logistic regression models were constructed to estimate adjusted odds ratios (OR_adj) and their 95% confidence intervals (CIs).

RESULTS

PIPV prevalence was estimated at 0.36 per 1000 ED discharges. The strongest correlates of PIPV were alcohol-related (OR_adj = 3.02, 95% CI: 2.62-3.50), adjustment (OR_adj = 2.37, 95% CI: 1.56-3.58), intentional self-harm (OR_adj = 1.41, 95% CI: 1.05-1.89), anxiety (OR_adj = 1.23, 95% CI: 1.07-1.40), drug-related (OR_adj = 1.22, 95% CI: 1.01-1.47), and mood (OR_adj = 1.16, 95% CI: 1.04-1.31) disorders. PIPV's association with alcohol-related disorders was stronger among women (OR_adj = 3.22, 95% CI: 2.79-3.72) versus men (OR_adj = 1.98, 95% CI: 1.42-2.77). Similarly, drug-related disorders were stronger correlates of PIPV among women (OR_adj = 1.32, 95% CI: 1.09-1.60) versus men (OR_adj = 0.59, 95% CI: 0.31-1.16).

CONCLUSIONS

In EDs, PIPV was linked to several mental health disorders, with women experiencing comorbid PIPV and substance use more frequently than men.

The prevalence of lifetime abuse among older adults in seven European countries

OBJECTIVES

To investigate the lifetime prevalence rate of abuse among older persons and to scrutinize the associated factors (e.g. demographics).

METHODS

This cross-sectional population-based study had 4467 participants, aged 60-84, from seven European cities. Abuse (psychological, physical, sexual, financial and injuries) was measured based on The Revised Conflict Tactics Scale, and the UK survey of abuse/neglect of older people.

RESULTS

Over 34 % of participants reported experiencing lifetime psychological, 11.5 % physical, 18.5 % financial and 5 % sexual abuse and 4.3 % reported injuries. Lifetime psychological abuse was associated with country, younger age, education and alcohol consumption; physical abuse with country, age, not living in partnership; injuries with country, female sex, age, education, not living in partnership; financial abuse with country, age, not living in partnership, education, benefiting social/partner income, drinking alcohol; and sexual abuse with country, female sex and financial strain.

CONCLUSIONS

High lifetime prevalence rates confirm that elder abuse is a considerable public health problem warranting further longitudinal studies. Country of residence is an independent factor associated with all types of elder abuse which highlights the importance of national interventions alongside international collaborations.