Körperliche und psychische Gewalterfahrungen in der deutschen Erwachsenenbevölkerung

Sexual and reproductive health outcomes of women who experienced violence in Germany: Analysis of the German health interview and examination survey for adults (DEGS1)

OBJECTIVES

Violence against women is a widespread public health concern with severe effects to women's sexual and reproductive health, including higher risks for miscarriage or stillbirth, unintended pregnancy and induced abortion. This study examined the association between women exposure to physical violence, psychological violence and sexual and reproductive health outcomes (contraceptive use, miscarriage or stillbirth and abortion) in Germany.

METHODS

This study used a cross-sectional research design to analyze data on violence against women and sexual and reproductive health (SRH) outcomes collected through the German Health Interview and Examination Survey for Adults, Wave 1, between 2008 and 2011 (n = 3149 women, aged 18-64 years). Multivariable logistic regression models were used to assess the association between experiences of violence among women and the presence of sexual and reproductive health outcomes, considering the influence of socio-demographic and health-related factors (age, marital status, socioeconomic status, social support, number of children, alcohol consumption, health status, chronic conditions).

RESULTS

Three associations remained significant (p<0.05) in fully-adjusted models: (i) exposure to physical violence by a parent or caregiver and birth control pill utilization (aOR, adjusted Odds Ratio, 95% CI: 1.36, 1.02-1.81) (ii) exposure to physical violence since the age of 16 and miscarriage or stillbirth (aOR, 95%CI: 1.89, 1.17-3.04); and (iii) exposure to psychological violence by a parent or caregiver and abortion (aOR, 95%CI: 1.87, 1.30-2.70).

CONCLUSIONS

The results suggest that adult German women who experienced physical or psychological violence since the age of 16, including violence perpetrated by a parent or caregiver, were more likely to report miscarriage or stillbirth and abortion. Direct assessment of violence experiences against women should be conducted by healthcare professionals in clinical encounters, particularly by obstetrics and gynaecological specialists, for the prevention of women´s adverse sexual and reproductive health outcomes. Furthermore, violence should be treated as a major public health concern and addressed through a multisectoral approach, involving the healthcare and educational sectors, researchers and relevant policymakers.

Not Always a "Buffer": Self-Compassion as Moderator of the Link Between Masculinity Ideologies and Help-Seeking Intentions After Experiences of Intimate Partner Violence

Many women and men experience intimate partner violence (IPV) during their lifetime. However, only relatively few people actually seek formal help after such an experience. The current study applied the mediated-moderation model of self-compassion and stigma that has previously been used to explain men's help-seeking behavior for depressive symptoms. The current study analyzed whether conformity to masculinity ideologies (CMI), self-stigma, and self-compassion were related to women's and men's intention to seek formal help after IPV experiences. A cross-sectional online questionnaire study was conducted with 491 German-speaking participants (65.8% women/34.2% men; age: M = 36.1 years; SD = 14.2). Participants read three vignettes about experienced IPV and then indicated how likely they would be to seek medical or psychological help if they were in the main character's situation. Additionally, the Conformity to Masculine Norms Inventory, Self-Stigma of Seeking Help Scale, and Self-Compassion Scale were used. Separate manifest path models for women and men revealed that strong CMI was linked to strong self-stigma in women and men. In turn, strong self-stigma was linked to weak intentions to seek formal help after IPV experiences. In men, strong self-compassion weakened (i.e., "buffered") the link between CMI and self-stigma. However, direct associations between strong CMI and weak intentions to seek formal help remained, especially for those participants with strong self-compassion. The current study adds to the existing literature on associations between CMI, self-compassion, and self-stigma by showing that those links are also relevant in women. However, self-compassion might not always act as a "buffer" and mediators that explain links between strong CMI and weak intentions to seek formal help in people with strong self-compassion need to be found in future studies.

More GP Consultations by Violence Victims: Results from the Representative German DEGS1 Study

Violence is a growing public health problem influencing physical and mental health. Victims tend to contact medical care in the first place, yet a discrepancy between patients' violence experiences (VE) and general practitioners' (GP) awareness is reported. The number of GP visits by victims is of interest. Using data of the nationally representative German Health Interview and Examination Survey for Adults (DEGS1), associations between the prevalence of ≥1 recent VE (last 12 months) and the number of GP contacts were analyzed with respect to age, gender, socio-economic status, and health conditions. The DEGS1 dataset comprised persons aged 18 to 64 years (n = 5938). The prevalence of a recent VE was 20.7%. Compared to non-victims, VE victims visited their GP significantly more often in the preceding 12 months (3.47 vs. 2.87, p < 0.001), which increased markedly in those who were strongly impaired by a recent physical VE (3.55 GP visits) or psychological VE (4.24). The high frequency of GP contacts in VE victims constitutes opportunities to professionally support this vulnerable patient group and underlines the necessity for GPs to integrate VE as a bio-psycho-social problem in a holistic treatment approach.

Lifetime Prevalence of Victimization and Perpetration as Related to Men's Health: Clinical Insights

Violence is a known risk factor for health problems. In this epidemiological study across 5,385 male patients, we investigate the prevalence of perpetrated violence, exposure to violence, their overlap and the relationship between violence, mental, and psychosomatic health, as well as adverse health behaviors, such as self-harming behavior and the consumption of drugs. Participants completed an anonymous questionnaire addressing violence experience (i.e., both expose and perpetration), age of victimization/perpetration, frequency, and perceived severity of violence exposure. We considered physical, psychological as well as sexual violence. Information on health status and adverse health behaviors complemented the data. Results showed that 48.4% of the sample reported having experienced violence (perpetration, victimization, or both). The victim-perpetrator overlap formed the largest group, in which the incidence of having experienced multiple types of violence was significantly higher compared to victims and perpetrators. The age-crime curve flattened more slowly with increasing age in this group. Although the perceived severity of exposure to violence is lower in the overlap group, its health status and adverse health behaviors were worse. Interventions should focus on this group since they constitute a burden for the healthcare system.

More GP contacts and poorer health of informal caregivers with low socioeconomic status in Germany: results from the population-based DEGS1 and the cross-sectional GPCare-1 study

OBJECTIVES

Informal caregivers are known to have poorer mental health. Risk factors for caregiver burden include low education, female gender, cohabitation with the care recipient and lack of resources. General practitioners (GPs) have an important role in supporting caregivers. Drawing on data from two surveys, associations between caregivers' socioeconomic status (SES), psychophysical health and GP contacts are analysed.

DESIGN

Cross-sectional study. The study draws on data from two surveys (German Health Interview and Examination Survey for Adults, DEGS1 and General Practice Care-1, GPCare-1).

SETTING

Germany.

PARTICIPANTS

DEGS1: German general population (18+ years) n=7987. GPCare-1: general practice patients (18+ years) n=813.

PRIMARY OUTCOME

Psychophysical health, GP contacts and communication.

METHODS

Using representative DEGS1 data, the prevalence of informal caregivers, caregivers' burden, chronic stress, various health conditions and frequency of GP contacts were evaluated stratified by SES. Data from the GPCare-1 study addressed caregivers' experiences and communication preferences with GPs.

RESULTS

In the DEGS1, the prevalence of caregivers was 6.5%. Compared with non-caregivers, caregivers scored significantly higher for chronic stress (15.45 vs 11.90), self-reported poor health (37.6% vs 23.7%) and GP visits last year (3.95 vs 3.11), while lifestyle and chronic diseases were similar. Compared with caregivers with medium/high SES, those with low SES had a significantly lower prevalence of high/medium caregiver burden (47.9% vs 67.7%) but poorer self-reported health (56.9% vs 33.0%), while other characteristics did not differ. In the GPCare-1 study, the prevalence of caregivers was 12.6%. The majority of them felt that their GP takes their problems seriously (63.6%) without difference by SES.

CONCLUSION

Caregivers with low SES constitute an especially high-risk group for psychological strain, requiring special GP attention to support their needs.

Austrian male patients' gender role conflict is associated with their wish for interpersonal violence to be addressed during patient-physician conversations: a questionnaire study

Background

Experiencing interpersonal violence and disclosing this experience to physicians can be associated with fear, shame, denial or emotional turmoil. Expressions of such feelings additionally conflict with masculine gender role ideologies and may be experienced as masculine gender role conflict. Masculine gender role conflict is often associated with men’s unwillingness to seek professional help. The current study analyzed the association between masculine gender role conflict and men’s wish for patient-physician conversations to include questions about interpersonal violence they might have experienced.

Methods

In structured closed-ended interviews conducted at an Austrian hospital 129 male patients (M_age = 59.4, SD = 14.7) were asked what forms of interpersonal violence they had experienced. Additionally, a study-specific questionnaire was used to find out whether male patients wanted future physician-patient conversations to include questions about interpersonal violence they might have experienced. Men’s gender role conflict was assessed with the Gender Role Conflict Scale-Short Form.

Results

Half of the male patients (50%) reported having experienced at least one form of interpersonal violence. Nearly half of the men (48%) wanted their physician to ask them in future about any violence they might have experienced. One pattern of gender role conflict was positively associated with men’s wish to be asked in patient-physician conversations about potential interpersonal violence. Namely, men who reported conflicts between work and family relations were more likely to state that they wanted such conversations (OR = 1.6, 95%CI = 1.1–2.4) than were men who did not often experience this pattern of gender role conflict.

Conclusions

Experiences of interpersonal violence should be an important part of physician-patient conversations with male patients. Overall, male patients would welcome their physician initiating a potential conversation about violence. Using an approach that takes consideration of masculine gender role ideologies may further increase some men’s willingness to approach the topic of interpersonal violence. Men who adhere to the norm of being preoccupied with work may be more willing to talk about this subject if healthcare situations are framed in a way that men perceive the possibility to uphold masculine gender role ideologies of self-sufficiency or of being in control.

Domestic Violence Against Men-Prevalence and Risk Factors

BACKGROUND

According to the World Health Organization (WHO), intimate partner violence is among the major risks to women's health around the world. Men, too, can be victims of domestic violence; like female victims, they tend to present initially with their injuries to a family physician or an emergency room. Domestic violence against men is thus a relevant issue for physicians of all specialties.

METHODS

This review is based on publications retrieved by a comprehensive, selective search in the PubMed database and with the Google Scholar search service, as well as on a retrospective analysis of data on the injured persons, the aggressors, and the nature of the violence that was experienced and the injuries that were sustained.

RESULTS

The studies identified by the search yielded prevalence rates of 3.4% to 20.3% for domestic physical violence against men. Most of the affected men had been violent toward their partners themselves. 10.6-40% of them reported having been abused or maltreated as children. Alcohol abuse, jealousy, mental illness, physical impairment, and short relationship duration are all associated with a higher risk of being a victim of domestic violence. The reported consequences of violence include mostly minor physical injuries, impaired physical health, mental health problems such as anxiety or a disruptive disorder, and increased consumption of alcohol and/or illegal drugs.

CONCLUSION

The prevalence of violence against men and the risk factors for it have been little studied to date. It would be desirable for preventive measures to be further developed and for special help to be made available to the affected men.

Physical Violence and Associated Factors among Housemaids Living in Debre-Tabor Town, Northwest Ethiopia: Does Employer Alcohol Intake Increase Housemaid Violence?

Background

Violence against women and girls continues to be a global epidemic, including Ethiopia. Housemaids are a neglected segment of the population, and there are no sufficient findings in our country. This study aimed to assess the magnitude of physical violence and associated factors among housemaids aged 15 years and above living in Debre Tabor town, northwest Ethiopia.

Methods

A community-based cross-sectional study was conducted in Debre Tabor town, northwest Ethiopia from April 1 to 30, 2018. A total of 634 housemaids were selected using cluster sampling method. Data were entered into Epi info version 7.2.2.6 and analyzed with SPSS version 20 using descriptive and analytic statistics. Binary logistic regression analysis was carried out to identify independent significant factors. Adjusted odds ratio (AOR) with 95% confidence interval (CI) was used to report the strength of associations.

Results

From 634 housemaids that participated in the study, 235 (37.1%, 95% CI: 33.1−41.0) of them experienced at least one type of physical violence in their lifetime. Housemaids who previously lived in rural areas (AOR = 2.82, 95% CI: 1.61, 4.94), had high working experience (AOR = 2.17, 95% CI: 1.27, 3.71), not having parents (AOR = 2.02, 95% CI: 1.18, 3.46), being divorced (AOR = 2.23, 95% CI: 1.31, 4.20), employer alcohol consumption (AOR = 4.97, 95% CI: 2.81, 8.79), and presence of extended family with employers (AOR = 2.26, 95% CI: 1.42, 3.59) were independently associated with the probability of housemaid physical violence.

Conclusion

High prevalence of housemaid physical violence has been reported. Socio-demographic characteristics of both employers and employees and the behavioral characteristics of employers contributed to physical violence. It is important to give special attention to housemaids who came from rural areas and do not have parents. It is also important to make work experience of housemaids as short as possible.

[Social problems in primary health care - prevalence, responses, course of action, and the need for support from a general practitioners' point of view]

BACKGROUND

Very often patients utilize primary care services for health conditions related to social problems. These problems, which are not primarily medical, can severely influence the course of an illness and its treatment. Little is known about the extent to which problems like unemployment or loneliness occur in a general practice setting.

OBJECTIVES

What are the most frequent health-related social problems perceived by general practitioners (GPs)? How are these problems associated with GP- or practice characteristics? How do general practitioners deal with the social problems they perceive and what kind of support do they need?

MATERIALS AND METHODS

Cross-sectional, postal questionnaire survey with questions derived from "Chapter Z social problems" of the International Classification of Primary Care - 2^nd edition. The questionnaire was mailed to available GP addresses in the federal states of Hamburg (n=1,602) and Schleswig-Holstein (n=1,242).

RESULTS

N=489 questionnaires (17.2 %) were analyzed. At least three times a week, GPs were consulted by patients with poverty/financial problems (53.4 %), work/unemployment problems (43.7 %), patients with loneliness (38.7 %) as well as partnership issues (25.5 %). Only rarely did GPs report having perceived assault/harmful event problems (0.8 %). The highest frequency of problems was encountered by practices with a high proportion of a migrant population.

CONCLUSIONS

Social problems are a common issue in routine primary care. GPs in Northwestern Germany usually try to find internal solutions for social problems but also indicated further interest in institutionalized support. A possible approach to solving these issues are community-based, locally organized networks.

[Gender-inclusive care of victims of violence : The model project "Gender Gewaltkonzept" at the University Hospital Aachen]

Violence is a topic of great social relevance, frequently causing tremendous health consequences for those affected and high consequential costs for health care and the national economy. The established consulting and assistance services are usually restricted to offers for ambulant supply, mainly from private agencies or societies. As a result, there is no identification and care for patients who have experienced violence and who are treated in hospital. Another deficiency is the identification and care of male victims of violence. Despite wide-ranging offers of assistance, only very few gender-specific consulting and support services have been available to date.Therefore, the model project "Gender Gewaltkonzept" was initiated at Aachen University Hospital to assess the prevalence of violence and the potential consequences of the violence experienced on the patients' health. In addition, we investigated whether males and females are in need of different supply requirements.Based on the results of the project "Gender Gewaltkonzept" so far, and on prevalence estimates proving that there is a high rate of violent experiences in both males and females, this overview is aimed at presenting the aid and protection concepts available for victims of violence, in addition to the existing deficiencies of the care system. We present approaches to resolving these deficiencies to be able to establish all-encompassing gender-appropriate support for victims of violence.

[Prevalence of experience of physical and psychological violence in the general population in the past 12 months. Results of the German Health Interview and Examination Survey for Adults (DEGS1)]

Experiences of violence may have considerable psychosocial and health implications. A violence screening tool was implemented in the German Health Interview and Examination Survey for Adults (DEGS1) to depict the perpetrators' and victims' point of view. The study participants were between 18 and 64 years old (n = 5939). The aim of this article is to assess the percentage of people who experienced physical and psychological violence in the last 12 months or who suffered negative effects on their quality of life as a consequence or who were perpetrators of multiple acts of violence. The characteristics of victims, offenders, and their conflict partners are described. Furthermore, specific constellations of violence experience with regard to health-related quality of life are described. Finally, the association between being a victim of violence and different factors is estimated. In total, 2.7% of women and 4.3% of men reported multiple experiences of physical violence in the last 12 months or having their lives negatively impacted as a consequence of violence. Experience of psychological violence was reported by 18.9% of women and 15.4% of men. Women are more likely than men to be both perpetrator and victim within the family. Men are more likely than women to be both the perpetrator and victim outside of the family environment. Regardless of whether they are the victim or perpetrator of violence, the psychological well-being is significantly worse than those of people who did not experience violence. Experience of violence in childhood and adolescence increases the risk of becoming victim or perpetrator of violence later on in life. The findings presented here describe the psychological and physical experience of violence as one part of violence committed in the whole population. Some prevention advice is also presented.