Predicting re-victimization of battered women 3 years after exiting a shelter program

The Effect of Economic Reliance, Stress, and Women's Employment Status on Intimate Partner Violence Risk Among Partnered Women in Burkina Faso and Kenya

Economic factors, such as economic reliance on male partners, and economic stressors such as household income or employment loss, play an important role in the risk of intimate partner violence (IPV) within romantic partnerships. To investigate these relationships, we used survey data from IPUMS Performance Monitoring for Action that were collected in 2020 and 2021. We assessed the relationship between several economic factors-(1) women's economic reliance on their partners, (2) household income loss, and (3) respondent's employment status over the past year-and experience of IPV in the past year in Burkina Faso (N = 2,646) and Kenya (N = 3,416). Women who reported being economically reliant on their partners were less likely to experience physical or psychological violence in Burkina Faso (Prevalence ratio [PR]: 0.41, 95% confidence interval [CI]: 0.26-0.64 and PR: 0.75, 95% CI: 0.59-0.94, respectively), and physical violence in Kenya (PR: 0.69, 95% CI: 0.52-0.90) compared to women who reported not being economically reliant. In Kenya, women in households that experienced a complete loss of income were more likely to experience IPV compared to households that did not experience income loss-1.9 times more likely to experience psychological violence, and three times more likely to experience sexual violence. In Burkina Faso, no significant relationship was found between household income loss and IPV. Our findings indicate that both relative economic empowerment and overall economic stress may act as important risk factors for IPV, particularly where patriarchal and gender inequitable norms are relevant. These findings reinforce the need for a nuanced and intersectional understanding of IPV risk and intervention development, with the relationships between economic dynamics and IPV varying across countries and contexts.

Development and validation of the Informal Supporter Readiness Inventory (ISRI)

OBJECTIVE

This article outlines the development and validation of the Informal Supporter Readiness Inventory (ISRI), based on the model developed by the present authors in (Davies, 2023). This scale assesses the readiness of informal supporters to intervene or provide support in situations of intimate partner violence (IPV).

METHODS

The research followed a three-phased procedure of item development, scale development, and scale evaluation; adhering to best practice guidelines for psychometric development and validation. This process provided empirical substantiation for the domains of the Model of Informal Supporter Readiness (Davies, 2023).

RESULTS

The 57-item ISRI incorporates four primary factors: normative, individual, goodman-emotional, and situational-assessment. These factors demonstrated robust internal consistency and factor structures. Additionally, the ISRI evidenced strong test-retest reliability, and both convergent and divergent validity. Although aligning closely with the Model of Informal Supporter Readiness, the scale revealed a nuanced bifurcation of situational factors into situational-emotional and situational-assessment.

DISCUSSION

The ISRI offers an important advancement in IPV research by highlighting the multifaceted nature of informal supporter intervention. The findings have several implications, from tailoring individualised supportive interventions to strengthening support networks and empowering survivors. The present study's findings underscore the potential of adopting a social network-oriented approach to interventions in IPV scenarios. Applications for research and practice are discussed.

Supporting Intimate Partner Violence Survivors and Their Children in Pediatric Healthcare Settings

Intimate partner violence (IPV) is a pervasive public health epidemic that influences child health and thriving. In this article, we discuss how pediatric healthcare providers and systems can create healing-centered spaces to support IPV survivors and their children. We review the use of universal education and resource provision to share information about IPV during all clinical encounters as a healing-centered alternative to screening. We also review how to support survivors who may share experiences of IPV, focused on validation, affirmation, and connection to resources. Clinicians are provided key action items to implement in their clinical settings.

Sources of Well-Being for Hispanic Women Who Have Experienced Intimate Partner Violence: A Scoping Review

Purpose: This review sought to identify and integrate available evidence on various sources of Hispanic women's well-being following intimate partner violence (IPV). Methods: The review was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Four peer-reviewed databases were reviewed for studies published between 2007 and 2022. The inclusion criteria include being an original research, quantitative and/or qualitative data, Hispanic women as a separate group for analysis, well-being as an outcome variable (quantitative) or phenomenon of interest (qualitative), and published in English or Spanish. Results: A total of 2,292 records were identified, and nine articles were included in the final review. Findings revealed that ensuring safety and opportunities for women's children, separating from violent partners, and obtaining a job were related to increased well-being. Other findings revealed that peer support, self-empowerment, and leadership skills were associated with interpersonal, psychological, and community well-being, respectively. Economic and occupational well-being was linked to education and financial independence. Conclusions: This scoping review advances the exploration of well-being among Hispanic women who have experienced IPV. This knowledge can be used to inform post-IPV support for Hispanic women and highlight areas for intervention development to promote well-being.

Someone you can count on: Examining the mediating effect of social support on economic abuse and depression

The aim of this study was to examine whether social support mediated the relationship between economic abuse, a form of intimate partner violence, and mental health, specifically depression, among pregnant women. This cross-sectional study used a sample of 193 pregnant women living in the United States who participated in an online Qualtrics panel survey in January 2021. Hayes Process Macro was used to assess a mediation model. Economic abuse was associated with increased odds of depressive sympto ms and fewer perceived social supports. Social support mediated the relationship between economic abuse and depression. Implications for research, policy, and practice are discussed. Notably, research focused on economic abuse and efforts to respond to it need to pay particularly close attention to the role that social supports may play in survivor's overall well-being, as well as the impact that economic abuse may have on survivors' perceptions of social support. This may be particularly true for pregnant women experiencing economic abuse for whom social support-related interventions have yielded positive health outcomes.

The Role of Structural Factors in Support-Seeking Among Women Experiencing Intimate Partner Violence (IPV) in Mwanza, Tanzania: Findings From a Qualitative Study

In this qualitative study of women participating in an intimate partner violence (IPV) prevention trial, experiences of IPV and the context that shapes support-seeking were explored through in-depth interviews and focus groups discussions. Decisions to seek support were influenced by a range of factors including fear of further abuse, shame, acceptance of IPV as normal, belief that IPV is a private matter between the couple, economic dependence on male partners, and a poorly responsive legal and justice system. Gender empowerment programs need to intervene at the social, cultural, political, and economic levels that shape justification and meanings attached to IPV and women's decisions in seeking support.

Stay-Leave Decision-Making Among Women Victims of Domestic Violence in Israel: Background, Interactional, and Environmental Factors

The study examined the factors that contribute to stay-leave decision-making of women who are domestic violence victims, focusing on background factors (origin, education, and occupational status); interactional factors (severity of violence, previous separations, and previous stays in a shelter); and social factors (social support and woman's expectations of the shelter). In addition, it examined the contribution of the interaction of woman's expectations of the shelter × psychological violence to the woman's decision to leave/stay with her partner. Six months after returning to the community, 221 women who had stayed in a shelter for at least 3 months were located: 92 were Israeli-born Jews (41.6%), 49 were Israeli-born Arabs (22.2%), 51 were Former Soviet Union immigrants (23.1%), and 29 were Ethiopian immigrants (13.1%). Of them, 56.6% reported returning to their partners, and 43.4% reported leaving their partners. Education, occupational status, psychological violence severity, previous shelter stays, familial support, and expectations of having concrete needs fulfilled by the shelter made a significant contribution to the woman's leaving the abusive relationship. Furthermore, Israeli Arab women were more likely to stay with their partners. Finally, the interaction of the expectation that concrete needs would be met × psychological violence made a significant contribution to leaving the relationship. The study emphasizes the need to expand the resources of domestically abused women and also highlights specific groups requiring special attention upon shelter entry: Arab women, women who previously stayed in shelters, and women characterized by a lack of resources and a high degree of psychological violence.

The Impact of the COVID-19 Pandemic on the Needs and Lived Experiences of Intimate Partner Violence Survivors in the United States: Advocate Perspectives

We explored the challenges and lived experiences of intimate partner violence (IPV) survivors during the COVID-19 pandemic by interviewing 53 U.S.-based IPV advocates between June and November 2020. Advocates described how the COVID-19 pandemic limited survivors' abilities to meet their basic needs. The pandemic was also described as being used by abusive partners to perpetrate control and has created unique safety and harm reduction challenges. IPV survivors experienced compounding challenges due to structural inequities. IPV must be considered by local, state, and federal governments when developing disaster planning policies and practices, including in the context of pandemics.

PTSD and Depression Symptoms Increase Women's Risk for Experiencing Future Intimate Partner Violence

Psychological distress may impact women's risk for future intimate partner violence (IPV). Yet, limited research has utilized longitudinal research designs and there is a scarcity of research looking at the three most commonly implicated mental health factors-posttraumatic stress disorder (PTSD), depression, and alcohol use-within the same study. Research is especially scarce for women veterans, who experience substantial risk for these mental health concerns and experiencing IPV. This study examined the role of PTSD symptoms, depression symptoms, and alcohol use in increasing risk for experiencing future IPV while simultaneously accounting for the impact of recent IPV experience on subsequent mental health. This study included a sample of 1921 women veterans (M_age = 36.5), who were asked to complete three mail surveys over the course of 8 months as part of a larger longitudinal survey study of US veterans' health and well-being. The survey assessed experiences of IPV, PTSD symptoms (PCL-5), depression symptoms (PHQ-9), and alcohol use (AUDIT-C) at each of the three time points. Results from separate path analysis models provided support for the role of PTSD symptoms and depression symptoms (but not alcohol use) in increasing risk for IPV experience over time. However, the path analysis models provided little support, with the exception of PTSD, for the impact of IPV experience on subsequent mental health symptoms. Findings point to the importance of better understanding the mechanisms by which PTSD and depression symptoms can increase risk for IPV to inform theory and prevention and treatment efforts. Detection and treatment of PTSD and depression symptoms among women may help reduce risk for future violence in intimate relationships.

Improving Quality of Life Among Latina Intimate Partner Violence Survivors Through Economic Empowerment

This study examined the relationship between (1) quality of life and forms of intimate partner violence (IPV) (i.e., psychological abuse, physical violence, sexual violence, and types of economic abuse), and (2) quality of life and economic empowerment among Latina IPV survivors. The authors used data from the Moving Ahead financial literacy program evaluation (n = 200). Nested random-effects models were conducted. Findings indicated that psychological abuse and economic control were significantly and negatively associated with quality of life. Economic empowerment (i.e., financial knowledge, economic self-efficacy, and economic self-sufficiency) was significantly and positively related to Latinas' quality of life. Financial strain was inversely associated with Latina's quality of life. These findings highlight the importance of identifying strategies for increasing the overall well-being of Latina IPV survivors. Economic empowerment interventions can be an effective mechanism for improving their quality of life. As such, domestic violence organizations should include economic empowerment as part of the services offered to survivors.

"Staying alive" in the context of intimate partner abuse

Females are disproportionately affected by intimate partner abuse that can result in severe physical and mental harm. Benenson et al. provide little exploration of how female-evolved traits enhance females' survival in abusive relationships. Discussion centres on "why" females do not "just leave" an abusive relationship and the effectiveness of female-evolved traits in navigating intimate partner abuse over time.

Responding to Violence Against Women in Sport: Challenges Facing Sport Organizations in Victoria, Australia

Purpose: Violence against women is a global epidemic. Such violence occurs in sport, although previous research has focused on child/youth sexual abuse or elite sport. Despite sport being identified as having a role in preventing violence against women, little is known about how sport organizations respond to violence against adult women in community sport. Methods: Twenty-two individual participants from 12 sports organizations based in Victoria, Australia participated in this empirical and applied Concept Mapping study to explore the perceived challenges sports organizations face in responding to violence against women. Concept Mapping is a mixed-method participatory approach and we analyzed the results using a socio-ecological framework. Results: Sports administrators considered training-related challenges as the most important but most difficult to address. Challenges related to organizational capacity/social environment were perceived as easier but less important to address. Conclusions: Key initiatives can be developed to support sport organizations to respond to violence against women in sport, but they will need assistance to prioritize initiatives addressing the most important challenges given a perceived lack of capacity to do so.

Examining the impact of economic abuse on survivors of intimate partner violence: a scoping review

Background

Economic abuse is a unique form of intimate partner violence (IPV) and includes behaviors that control a survivor’s ability to acquire, use, and maintain resources. These tactics can result in someone becoming economically dependent on their partner and may limit their ability to leave the relationship and establish independence. The aim of this study was to conduct a scoping review focused on the impact of economic abuse on survivors of IPV.

Methods

A total of 14 databases were reviewed, which resulted in 35 peer-reviewed manuscripts for inclusion in the study. Manuscripts were included if they were: written in English, published since the year 2000, focused specifically on the impact of economic abuse perpetrated by an intimate partner, economic abuse was measured as an independent variable, and if economic abuse was looked at separately from other forms of IPV. Both convenience and population-based samples were included in the review. Information was extracted using a data charting form. The data were analyzed using a combination of grouping techniques and constant comparison methods to identify key findings.

Results

Studies found significant associations between economic abuse and a range of outcomes, such as mental and physical health, financial impacts, parent-child interactions, and quality of life. The most frequently examined were mental health, followed by financial issues.

Conclusions

Limitations of these studies included a lack of longitudinal research and a focus on heterosexual relationships with male-perpetrated violence toward female survivors. Study findings highlight the wide-ranging potential impacts of economic abuse on survivors and the need for additional research to better understand potential outcomes and implement and evaluate interventions to address them.

From Isolation to Connection: The Practices and Promise of Open Domestic Violence Shelters

Antidomestic violence advocates have begun to question two essential policies that have long defined domestic violence shelters-strict secrecy regarding shelter location and prohibitions on shelter access to all except staff and residents-both of which serve to increase survivors' social isolation and entail coercive rules that resonate painfully with broader oppressive dynamics. In response a growing number of communities have begun experimenting with open shelters, which break from tradition by making their locations public, and allowing visitors. Although this innovation is a sharp departure from tradition, virtually no research exists to explore its philosophical underpinnings, benefits, and challenges. This study addresses this gap. Study Questions: We used a qualitative descriptive approach to explore the experiences and perspectives of open shelter directors. Participants included 14 open shelter directors from 11 states. We conducted semistructured phone interviews with each participant, focusing on their shelter's (a) nature and history; (b) rationale; (c) policies and programs related to secrecy and openness; (d) benefits and challenges; (e) effects on specific survivor subgroups; and (f) practices used to build or strengthen survivors' relationships. Open shelters: (a) promote physical safety using a broad array of measures; (b) adopt a range of policies that promote varying degrees of location disclosure and visitor accessibility; (c) face challenges, such as the need to gain buy-in from multiple constituents; and (d) Improve survivor outcomes, including decreased shame; improved advocacy relationships; increased access to services and community involvement in shelter life; and deepened relationships with network members; in turn increasing prospects for physical and psychological well-being long after survivors' shelter stays are over. Findings suggest a new path for shelters interested in promoting survivor safety and healing in the context of a web of meaningful relationships.

Coordinated Community Responses to Domestic Violence: A Systematic Review of the Literature

Coordinated community responses (CCRs) are a commonly used intervention in the field of domestic violence (DV), yet research findings on CCRs to DV have been inconsistent. The aim of this study was to examine the current state of CCRs to DV, with a specific focus on those responses that involve law enforcement officers as key players. A systematic review of 31 databases resulted in 18 peer-reviewed manuscripts for inclusion in this study. Manuscripts were included if they were written in English and published in 1999 or later; focused specifically on DV and criminal justice and/or community responses; research outcomes were specific to cases, victims, or offenders; the intervention was clearly described and evaluated using an experimental or quasi-experimental design; and was implemented in the United States. Findings suggest that there is a great deal of variability across CCR studies involving law enforcement officers with regard to (a) whether studies used the term "coordinated community response" to describe the intervention being evaluated, (b) the types of cases included, (c) the nature of the CCR being evaluated, (d) the outcomes that were examined, and (e) how these outcomes were operationalized. These variations make it difficult for scholars to draw broader conclusions about the effectiveness of CCR interventions. Future research should include the identification of core outcomes that can be used across studies to allow for comparison studies and meta-analyses. There is also a need for studies to focus on identifying which components of CCR interventions are most critical to producing positive outcomes.

Structural and construct validity of the Quality of Life Scale among Canadian women with histories of intimate partner violence

OBJECTIVES

To evaluate the structural and construct validity, and internal consistency of the Quality of Life Scale among Canadian women with histories of intimate partner violence.

METHODS

Consistent with COSMIN Guidelines, a secondary analysis was conducted using data from a community sample of 250 adult (over 18 years) Canadian women with histories of partner violence and who participated in Wave 5 of the longitudinal Women's Health Effects Study. Data were collected 4 years after baseline using structured interviews that included the Quality of Life Scale and two mental symptom scales (Center for Epidemiological Depression Scale and Davidson Trauma Scale) used to assess construct validity of the Quality of Life Scale.

RESULTS

Confirmatory factor analysis in MPLUS 8 with maximum likelihood estimation supported the hypothesized unidimensional structure of the 9-item Quality of Life Scale based on acceptable fit indices. Internal consistency, estimated using Cronbach's alpha and composite reliability, were .91 and .92, respectively, with item-total correlations ranging from .46 to .84. Inter-item correlation coefficients (range = .30-.79), suggesting that all items contribute to the total score. As hypothesized, the quality of life total score was negatively related to the total scores on both the Center for Epidemiologic Studies-Depression (r = -.739) and Davidson Trauma Scale (r = -.537), providing evidence of construct validity of the Quality of Life Scale.

CONCLUSION

The Quality of Life Scale is a brief, reliable, valid, unidimensional self-report measure appropriate for use with women who have experienced partner violence. By addressing an important measurement gap, results of this study have potential to advance research on women's quality of life in the context of partner violence, including improving the evaluation of a growing body of advocacy and health interventions designed to support women's healing and well-being.

Beyond Domestic Violence Shelter: Factors Associated With Housing Placements for Survivors Exiting Emergency Shelters

Domestic violence (DV) shelters are a critical resource for many survivors facing housing instability. Although DV shelter programs may address an array of survivor needs, DV survivors often identify the most pressing concerns as the need for safe housing and the financial resources to maintain housing. This study examines the factors associated with housing placements for DV survivors residing in emergency shelters. Data for this study came from program data collected by one organization operating six DV emergency shelters in an urban northeastern city. Among the sample of 347 DV survivors, findings revealed that there were significant associations between sociodemographic variables, services received, and post-discharge variables and post-shelter housing. Among this sample, three out of four residents (74.9%) left the DV shelter with housing in place. However, the findings suggest that there are areas for improved services and policy efforts to further support survivors in accessing safe and affordable housing. Our findings invite researchers and practitioners to consider further examination of best practices around program and policy options that support survivors in gaining economic independence and securing safe and affordable housing.

The Efficacy of a Health Promotion Intervention for Indigenous Women: Reclaiming Our Spirits

Indigenous women globally are subjected to high rates of multiple forms of violence, including intimate partner violence (IPV), yet there is often a mismatch between available services and Indigenous women's needs and there are few evidence-based interventions specifically designed for this group. Building on an IPV-specific intervention (Intervention for Health Enhancement After Leaving [iHEAL]), "Reclaiming Our Spirits" (ROS) is a health promotion intervention developed to address this gap. Offered over 6 to 8 months in a partnership between nurses and Indigenous Elders, nurses worked individually with women focusing on six areas for health promotion and integrated health-related workshops within weekly Circles led by an Indigenous Elder. The efficacy of ROS in improving women's quality of life and health was examined in a community sample of 152 Indigenous women living in highly marginalizing conditions in two Canadian cities. Participants completed standard self-report measures of primary (quality of life, trauma symptoms) and secondary outcomes (depressive symptoms, social support, mastery, personal agency, interpersonal agency, chronic pain disability) at three points: preintervention (T1), postintervention (T2), and 6 months later (T3). In an intention-to-treat (ITT) analysis, Generalized Estimating Equations (GEE) were used to examine hypothesized changes in outcomes over time. As hypothesized, women's quality of life and trauma symptoms improved significantly pre- to postintervention and these changes were maintained 6 months later. Similar patterns of improvement were noted for five of six secondary outcomes, although improvements in interpersonal agency were not maintained at T3. Chronic pain disability did not change over time. Within a context of extreme poverty, structural violence, and high levels of trauma and substance use, some women enrolled but were unable to participate. Despite the challenging circumstances in the women's lives, these findings suggest that this intervention has promise and can be effectively tailored to the specific needs of Indigenous women.

A comprehensive review of prioritised interventions to improve the health and wellbeing of persons with lived experience of homelessness

Background

Homelessness has emerged as a public health priority, with growing numbers of vulnerable populations despite advances in social welfare. In February 2020, the United Nations passed a historic resolution, identifying the need to adopt social-protection systems and ensure access to safe and affordable housing for all. The establishment of housing stability is a critical outcome that intersects with other social inequities. Prior research has shown that in comparison to the general population, people experiencing homelessness have higher rates of infectious diseases, chronic illnesses, and mental-health disorders, along with disproportionately poorer outcomes. Hence, there is an urgent need to identify effective interventions to improve the lives of people living with homelessness.

Objectives

The objective of this systematic review is to identify, appraise, and synthesise the best available evidence on the benefits and cost-effectiveness of interventions to improve the health and social outcomes of people experiencing homelessness.

Search Methods

In consultation with an information scientist, we searched nine bibliographic databases, including Medline, EMBASE, and Cochrane CENTRAL, from database inception to February 10, 2020 using keywords and MeSH terms. We conducted a focused grey literature search and consulted experts for additional studies.

Selection Criteria

Teams of two reviewers independently screened studies against our inclusion criteria. We included randomised control trials (RCTs) and quasi-experimental studies conducted among populations experiencing homelessness in high-income countries. Eligible interventions included permanent supportive housing (PSH), income assistance, standard case management (SCM), peer support, mental health interventions such as assertive community treatment (ACT), intensive case management (ICM), critical time intervention (CTI) and injectable antipsychotics, and substance-use interventions, including supervised consumption facilities (SCFs), managed alcohol programmes and opioid agonist therapy. Outcomes of interest were housing stability, mental health, quality of life, substance use, hospitalisations, employment and income.

Data Collection and Analysis

Teams of two reviewers extracted data in duplicate and independently. We assessed risk of bias using the Cochrane Risk of Bias tool. We performed our statistical analyses using RevMan 5.3. For dichotomous data, we used odds ratios and risk ratios with 95% confidence intervals. For continuous data, we used the mean difference (MD) with a 95% CI if the outcomes were measured in the same way between trials. We used the standardised mean difference with a 95% CI to combine trials that measured the same outcome but used different methods of measurement. Whenever possible, we pooled effect estimates using a random-effects model.

Main Results

The search resulted in 15,889 citations. We included 86 studies (128 citations) that examined the effectiveness and/or cost-effectiveness of interventions for people with lived experience of homelessness. Studies were conducted in the United States (73), Canada (8), United Kingdom (2), the Netherlands (2) and Australia (1). The studies were of low to moderate certainty, with several concerns regarding the risk of bias. PSH was found to have significant benefits on housing stability as compared to usual care. These benefits impacted both high- and moderate-needs populations with significant cimorbid mental illness and substance-use disorders. PSH may also reduce emergency department visits and days spent hospitalised. Most studies found no significant benefit of PSH on mental-health or substance-use outcomes. The effect on quality of life was also mixed and unclear. In one study, PSH resulted in lower odds of obtaining employment. The effect on income showed no significant differences. Income assistance appeared to have some benefits in improving housing stability, particularly in the form of rental subsidies. Although short-term improvement in depression and perceived stress levels were reported, no evidence of the long-term effect on mental health measures was found. No consistent impact on the outcomes of quality of life, substance use, hospitalisations, employment status, or earned income could be detected when compared with usual services. SCM interventions may have a small beneficial effect on housing stability, though results were mixed. Results for peer support interventions were also mixed, though no benefit was noted in housing stability specifically. Mental health interventions (ICM, ACT, CTI) appeared to reduce the number of days homeless and had varied effects on psychiatric symptoms, quality of life, and substance use over time. Cost analyses of PSH interventions reported mixed results. Seven studies showed that PSH interventions were associated with increased cost to payers and that the cost of the interventions were only partially offset by savings in medical- and social-services costs. Six studies revealed that PSH interventions saved the payers money. Two studies focused on the cost-effectiveness of income-assistance interventions. For each additional day housed, clients who received income assistance incurred additional costs of US$45 (95% CI, -$19, -$108) from the societal perspective. In addition, the benefits gained from temporary financial assistance were found to outweigh the costs, with a net savings of US$20,548. The economic implications of case management interventions (SCM, ICM, ACT, CTI) was highly uncertain. SCM clients were found to incur higher costs than those receiving the usual care. For ICM, all included studies suggested that the intervention may be cost-offset or cost-effective. Regarding ACT, included studies consistently revealed that ACT saved payers money and improved health outcomes than usual care. Despite having comparable costs (US$52,574 vs. US$51,749), CTI led to greater nonhomeless nights (508 vs. 450 nights) compared to usual services.

Authors' Conclusions

PSH interventions improved housing stability for people living with homelessness. High-intensity case management and income-assistance interventions may also benefit housing stability. The majority of included interventions inconsistently detected benefits for mental health, quality of life, substance use, employment and income. These results have important implications for public health, social policy, and community programme implementation. The COVID-19 pandemic has highlighted the urgent need to tackle systemic inequality and address social determinants of health. Our review provides timely evidence on PSH, income assistance, and mental health interventions as a means of improving housing stability. PSH has major cost and policy implications and this approach could play a key role in ending homelessness. Evidence-based reviews like this one can guide practice and outcome research and contribute to advancing international networks committed to solving homelessness.

Effect of pilates exercise on cognitive distortion, stress coping and psychological endurance of women victim violence

BACKGROUND

The lack of examine studies that the effect of pilates exercises on mood of female victims of violence staying in women's shelters is the reasson to conduct this study Aim, the examine the effect of 8-week pilates exercises on stress coping styles, cognitive distortions and psychological endurance of female victims of violence staying in women's shelters.

METHODS

The purpose of the study was explained to the female victims of violence staying in women's shelters. The Cognitive Distortions Scale, the Stress Coping Styles Scale and the Psychological Endurance Scale were administered as pretests to 22 women voluntarily participating in the study. 1.5-hour pilates exercises were performed two days a week in a gym. The study started with 22 women and ended with the administration of the post-tests to 15 women remaining at the end of 8 weeks due to separations from women's shelters.

RESULTS

Pilates exercises were found to be significantly effective in terms of the preoccupation with danger, hopelessness, self-blame and sense of self sub-scales of the psychological endurance and cognitive distortions scales and in terms of the submissive approach, optimistic approach and helpless approach sub-scales of the stress coping styles scale.

CONCLUSIONS

İt was seen that application of pilates exercises enabled female victims of violence to cope with stress, eliminated cognitive distortions, which are the basis of many psychological problems, and increased psychological endurance. It is suggested that pilates exercises should be aplied at Women's shelters to cope with stress and to increase psychological endurance.

Second-Order Sexual Harassment: Violence Against the Silence Breakers Who Support the Victims

Second-order sexual harassment (SOSH) is the harassment suffered by those who stand with and support victims of violence against women (VAW)¹. Because the vast majority of programs currently focus on promoting bystander intervention, for such programs to be successful, knowledge about and actions against SOSH are necessary. Through narratives, this article provides unprecedented clues about SOSH. Working on safety strategies for individuals who support victims, promoting solidarity networks that also address SOSH, and ensuring that institutional policies are enforced are found to be central factors that can help prevent and/or transcend SOSH.

The Relationship between Women's Resources and Health-Related Quality of Life in a Sample of Female Victims of Intimate Partner Violence

While it is known that resource inadequacy increases the risk of exposure to intimate partner violence (IPV) and that women's health is significantly impacted by IPV, scant research has documented diminished resources as a primary determinant of women's health. Fifty female victims of moderate to severe IPV completed assessments of their physical, sexual and psychological experiences of IPV, resource profile, symptoms of posttraumatic stress disorder (PTSD) and depression and mental and physical health-related quality of life (HRQoL). Women's resources, controlling for age, income, psychological abuse and sexual coercion, were unique predictors of symptoms of PTSD, symptoms of depression; and mental HRQoL. The public health implications of the adequacy of women's resources are discussed in the context of IPV prevention and intervention. Future studies should evaluate the efficacy of economic empowerment programs regarding the impact on IPV survivors' mental and physical health and safety.

Transitioning Out of an Urban Domestic Violence Emergency Shelter: Voices of Survivors

Domestic violence (DV) shelters play a critical role for survivors and lead to a range of positive outcomes for families. However, transitioning in and out of temporary homelessness involves a range of stressors and research indicates that survivors transitioning out of DV shelters continue to have a multitude of needs. The focus of this study is to utilize an empowerment-based feminist lens to understand the process of transitioning out of a DV emergency shelter among 27 shelter residents in urban emergency shelters. Participants described the successes, challenges, and lessons learned while transitioning from the emergency shelter setting. The findings indicate that survivors transitioning out of DV shelters face a multitude of risks, challenges, and stressors. Our findings invite researchers and practitioners to further examine best practices that support families transitioning from shelter.

Is the 'Nordic Paradox' an illusion? Measuring intimate partner violence against women in Europe

OBJECTIVES

Recent studies suggest that intimate partner violence (IPV) against women in Europe is highest among some of the most gender egalitarian countries in the world, like Sweden, Finland and Denmark. This paper aims at disentangling the so-called Nordic Paradox.

METHODS

We have decomposed traditional IPV indicators into a 'previous partner' and 'current partner' components and presented new IPV indicators that are sensitive to the frequency of victimization. The new indicators are based on aggregated data from Agency for Fundamental Rights Survey on violence against women for the 28 EU Member States.

RESULTS

The country rankings in terms of IPV levels change substantially when overall prevalence measures are substituted by their 'previous partner' and 'current partner' components and, especially, when considering the frequency of victimization. When comparing the traditional IPV prevalence ranking with the current partner violence repetition-sensitive indicator ranking, the Nordic countries fall several positions.

CONCLUSIONS

Our findings suggest that the prevalence of IPV tends to be higher in more gender egalitarian countries because union formation and dissolution occur more often, but not because men are necessarily more violent against their partners.

The Social Network of Victims of Domestic Violence: A Network-Based Intervention Model to Improve Relational Autonomy

This study aims to understand when and how domestic violence victims' relational autonomy changes and to propose an intervention model stemming from the findings. Using qualitative and social network analysis, we study the actions of network members, as well as changing features of victims' networks. Results show that victims base their decisions on their expectations toward others, and on a desire to preserve their autonomy. Their relational autonomy tends to increase when they leave abusive partners and stay in shelters, but maintaining relational diversity proves challenging once they exit shelters. A network-based model of intervention that aims to improve the victims' relational autonomy is proposed.

Actions Taken by Women in Response to Intimate Partner Violence and Intimate Partner Violence Status at 1-Year Follow-Up

BACKGROUND

Intimate partner violence (IPV) is a pervasive public health issue with significant physical and mental health sequelae. A longer duration and greater severity of abuse are associated with adverse health outcomes and increased risk of revictimization. Current research has identified a variety of strategies used by women in response to abuse, but has not established whether the use of these strategies is associated with decreased IPV over time. For this study, we analyzed the associations between the use of specific actions in response to abuse-placating, resistance, informal or formal network help-seeking, safety planning, and substance use-and IPV victimization at the 1-year follow-up.

METHODS

Ninety-five women with past-year IPV at baseline participated in a 1-year follow-up survey measuring their use of specific actions in response to IPV and subsequent IPV status. IPV victimization at the 1-year follow-up was analyzed as a function of types of actions taken and sociodemographic variables.

RESULTS

Among women with past-year IPV at baseline (N = 95), 53% reported no further IPV victimization at the 1-year follow-up. In bivariate analysis, social support was associated with decreased risk of IPV victimization (odds ratio, 0.43; 95% confidence interval [CI], 0.18-0.99). In multivariable analyses, high use of placating (adjusted odds ratio, 9.40; 95% CI, 2.53-34.9), formal network help-seeking (adjusted odds ratio, 7.26; 95% CI, 1.97-26.74), and safety planning (adjusted odds ratio, 2.98; 95% CI, 1.02-8.69) strategies were associated with an increased risk of IPV victimization at the 1-year follow-up.

CONCLUSIONS

Our data demonstrate that IPV exposure can change over time and that the use of specific actions in response to IPV can be indicators of risk of subsequent victimization. Abuse severity is an important potential confounder of action efficacy.

Intimate Partner Violence and Use of Primary and Emergency Care: The Role of Informal Social Support

Social support may encourage victims to disclose their experiences of intimate partner violence (IPV), but also to seek the appropriate help and care in the social and health services. Using data from a multicenter European project, DOVE (Domestic Violence Against women/men in Europe-prevalence, determinants, effects, and policies/practices), the present study aimed at measuring the frequency of primary care and emergency use according to IPV types of victimization, and to investigate whether victims receiving different levels of informal social support are using health care differently. Results suggested a significant association between IPV types and use of emergency services, and no association was found regarding primary care services. Victims of physical abuse and sexual coercion went to the emergency department (ED) more frequently (more than once a year). Also, victims of physical abuse receiving low social support visited an ED more frequently than those with high social support, whereas victims of sexual coercion with high informal social support went more often to the ED compared with victims of sexual coercion with low social support, even after controlling for other covariates. These results seem to suggest that social support has a significant role in the decision to use health care among victims of IPV.

Beaten Into Submissiveness? An Investigation Into the Protective Strategies Used by Survivors of Domestic Abuse

The aim of the study was to identify the prevalence and perceived helpfulness of a variety of protective strategies that were used by female survivors of domestic abuse and to explore factors that may have influenced strategy usage. Forty participants were recruited from a voluntary sector domestic abuse service, commissioned by an outer London local authority in the United Kingdom, in early 2014. The measurement tools used were the Intimate Partner Violence Strategies Index (IPVSI) and the Coordinated Action Against Domestic Abuse (CAADA) Domestic Abuse, Stalking and "Honour"-Based Violence (DASH) Risk Assessment Checklist. The average age was 33 years (SD = 7.9, range = 20-57); half reported to be of Asian ethnicity, 37.5% White, and 12.5% Black or Mixed ethnicity. The average DASH score was 9.8 (SD = 13.2, range = 0-18), and an average of 18 (SD = 6.7, range = 1-29) protective strategies were utilized by each participant. All of the most commonly used strategies were from the placating category. Although safety planning strategies were rated as the most helpful by all participants, placating strategies were also rated as helpful by two thirds of participants. Stepwise multiple regression showed that placating was the only significant predictor of DASH score (β = .375, p < .05) and accounted for 14% of the variance of DASH score. Findings showed that women utilized a diverse range of protective strategies with placating strategies being most intensely used and rated as helpful. However, placating strategy usage could be a risk factor as opposed to a protective factor. This study has also demonstrated that greater placating strategies were used by White than South Asian women, and women who were employed used more formal strategies. This research has extended the knowledge base of protective strategies that professionals can draw from to underpin decisions and interventions when working with domestic abuse survivors.

The Nonlinear Effect of Informal Social Control on Repeat Intimate Partner Violence Victimization

Prior research has examined the effects of neighborhood context on intimate partner violence (IPV) with mixed results. While most studies find that neighborhood disadvantage is positively associated with risk of IPV, the effects are less consistent for characteristics such as social ties and informal social control. One possible explanation for these mixed findings draws from theoretical and empirical literature arguing that a high level of collective efficacy can aid in the control of criminal behavior, but it can also deter residents from acting against crime committed by neighbors. This suggests the possibility of a nonlinear effect of collective efficacy where the risk of IPV may be high in areas with very low levels of collective efficacy because of the inability of neighborhoods to collectively control residents, but it may also be high in areas with very high levels of collective efficacy where residents are less willing to report on the criminal behavior of fellow residents. We test this possibility using survey data for female victims of IPV in Chicago merged with neighborhood characteristics. Findings suggest that the risk of repeat victimization is highest in areas with either very high or very low levels of informal social control.

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

BACKGROUND

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

OBJECTIVES

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

SEARCH METHODS

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

SELECTION CRITERIA

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

DATA COLLECTION AND ANALYSIS

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

MAIN RESULTS

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

AUTHORS' CONCLUSIONS

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

To Stay in or Leave an Abusive Relationship: Losses and Gains Experienced by Battered Filipino Women

The present study aimed to describe and analyze the losses and gains experienced by battered Filipino women as a result of their decision to stay in or leave an abusive relationship. In-depth, semistructured interviews were conducted with 60 battered women, 30 of the women were still living with their abusive husbands/partners and 30 have left their abusive husbands/partners. Results from the phenomenological data analysis of the qualitative data revealed that the women who stayed in and left their abusive partners experienced both losses and gains. For the women who stayed in an abusive relationship, they lost a sense of self, the opportunity for a better life, peace of mind, psychological well-being, and love for their partners. However, these women had the benefits of having a complete family and a partner to help raise their children. In contrast, despite not having a complete family or a partner to help them raise their children, women who left an abusive relationship gained back their sense of self, peace of mind, freedom, inner strength, and hope. Implications for counseling practice were discussed.

Women Victims of Intimate Partner Violence in Shelters: Correlates of Length of Stay and Subsequent Reentries

The purpose of this study was to examine which variables are associated with the length of stay at a shelter and the likelihood of reentering the shelter after a first stay in a sample of 777 women victims of intimate partner violence. The results showed that the women's health, having been previously abused, and having children with them at the shelter were the best set of correlates for length of shelter stay; lack of social support, having been previously abused, and the abusers' being unemployed increased the risk of repeated use of shelters. The implications for intervention are discussed.

Longitudinal Changes in Self-Efficacy, Mental Health, Abuse, and Stages of Change, for Women Fearful of a Partner: Findings From a Primary Care Trial (WEAVE)

Women seeking healthcare while experiencing intimate partner violence (IPV) often report a mismatch between healthcare received and desired. An increase in detection of women experiencing IPV through routine screening has not consistently shown a parallel increase in uptake of referrals or decreased abuse. This study investigates relationships between women's stage of change (SOC), mental health, abuse, social support, and self-efficacy. This study used data from a randomized-controlled trial (RCT) of an intervention to improve outcomes for women afraid of their partners ( n = 225; WEAVE). Women's progress toward change was categorized into pre-contemplation/contemplation (pre-change SOC) or preparation/action/maintenance of change (change-related SOC). Characteristics of women ending the 2-year study in pre-change SOC were compared with those always in change-related and those ending in change-related SOC. Variables were analyzed using multinomial logistic regressions at baseline, 6, 12, and 24 months. Compared with women in pre-change SOC, women always in change-related SOC or ending in change-related SOC are significantly more likely to have higher levels of self-efficacy at 6 (AdjOR = 1.19, confidence interval [CI] = [1.08, 1.30]) and 24 months (AdjOR = 1.21, CI = [1.04, 1.40]). Women always in change-related SOC are always significantly less likely to live with an intimate partner. Women ending in change-related SOC are less likely to live with a partner at 12 (AdjOR = 0.30, CI = [0.12, 0.75]) and 24 (AdjOR = 0.22, CI = [0.06, 0.80]) months. Clinicians should focus on enhancing abused women's self-efficacy, supporting them to create and maintain positive changes.

Freeing Oneself From Intimate Partner Violence: A Follow-Up of Women Who Contacted an Anti-violence Center in Italy

This study examines the situation of women ( N = 124) who had presented themselves to an anti-violence center in Italy in the previous 3-5 years. At follow-up, 37.3% had no contact with the perpetrator, 22.7% had stayed with him, and 39.8% had "forced" contact. Almost half of the sample was still subjected to intimate partner violence (IPV). Compared to women with "no contact," the risk of IPV was 5.9 times higher for women who stayed with the perpetrator, and 10.5 times higher for women with "forced" contact. These results confirm that ending IPV does not depend exclusively on women's choices.

Intimate Partner Violence, Cumulative Violence Exposure, and Mental Health Service Use

Intimate partner violence (IPV) leaves victims with serious mental healthconsequences; some victims do not seek help even though they suffer from adverse mental health symptoms. Victims' use of mental health services seems to be affected by sociocultural factors and their history of experiences with violence. This study used the collaborative psychiatric epidemiology surveys to examine the effects of cumulative violence on IPV victims' mental health service use. The results showed that victims' mental health needs were the most prominent predictor of their use of mental health services, and that cumulative violence exposure also predicted mental health service use.

Intimate partner violence: treating abuser and abused

Intimate partner violence is associated with significant psychiatric comorbidity. Treatment has focused on male perpetrators but recent studies indicate that this is of limited success in reducing male violence. This article reviews the current available treatments from three perspectives: that of the victim, the perpetrator, and the couple who wish to remain together. It also provides guidelines to assist the general psychiatrist in determining what treatment to offer patients who present with intimate partner violence. Guidelines emphasise the need for assessment of risk factors that indicate a potentially lethal relationship and the importance of the diagnosis and treatment of comorbidity, especially alcohol misuse and dependence.

Sexual exploitation of unaccompanied migrant and refugee boys in Greece: Approaches to prevention

In this essay, Julie Freccero and colleagues discuss resources to prevent the sexual exploitation of unaccompanied and separated refugee boys in Greece.

Intimate Partner Violence Associated with Postpartum Depression, Regardless of Socioeconomic Status

Objective This study examined whether socioeconomic status moderated the association between intimate partner violence (IPV) and postpartum depression among a community-based sample of women. Defining the role of poverty in the risk of postpartum depression for IPV victims enables prioritization of health promotion efforts to maximize the effectiveness of existing maternal-infant resources. Methods This cross-sectional telephone-survey study interviewed 301 postpartum women 2 months after delivery, screening them for IPV and depression [using Edinburgh Postnatal Depression Scale (EPDS)]. Socioeconomic status was defined by insurance (Medicaid-paid-delivery or not). This analysis controlled for the following covariates, collected through interview and medical-record review: demographics, obstetric history, prenatal health and additional psychosocial risk factors. After adjusting for significant covariates, multiple linear regression was conducted to test whether socioeconomic status confounded or moderated IPV's relationship with EPDS-score. Results Ten percent of participants screened positive for postpartum depression, 21.3 % screened positive for current or previous adult emotional or physical abuse by a partner, and 32.2 % met poverty criteria. IPV and poverty were positively associated with each other (χ(2) (1) = 11.76, p < .001) and with EPDS score (IPV: beta 3.2 (CI 2.0, 4.5) p < .001, poverty: beta 1.3 (CI 0.2, 2.4) p = .017). In the multiple linear regression, IPV remained significantly associated, but poverty did not (IPV: adjusted beta 3.1 (CI 1.8, 4.3) p < .001, poverty: adjusted beta 0.8 (CI -0.3, 1.9) p = .141), and no statistically significant interaction between IPV and poverty was found. Conclusions Study findings illustrated that IPV was strongly associated with postpartum depression, outweighing the influence of socioeconomic status upon depression for postpartum women.

Reclaiming Our Spirits: Development and Pilot Testing of a Health Promotion Intervention for Indigenous Women Who Have Experienced Intimate Partner Violence

Indigenous women are subjected to high rates of multiple forms of violence, including intimate partner violence (IPV), in the context of ongoing colonization and neo‐colonization. Health promotion interventions for women who experience violence have not been tailored specifically for Indigenous women. Reclaiming Our Spirits (ROS) is a health promotion intervention designed for Indigenous women living in an urban context in Canada. In this paper, we describe the development of the intervention, results of a pilot study, and the revised subsequent intervention. Building on a theory‐based health promotion intervention (iHEAL) showing promising results in feasibility studies, ROS was developed using a series of related approaches including (a) guidance from Indigenous women with research expertise specific to IPV and Indigenous women's experiences; (b) articulation of an Indigenous lens, including using Cree (one of the largest Indigenous language groups in North America) concepts to identify key aspects; and (c) interviews with Elders (n = 10) living in the study setting. Offered over 6–8 months, ROS consists of a Circle, led by an Indigenous Elder, and 1:1 visits with a Registered Nurse, focused on six areas for health promotion derived from previous research. Pilot testing with Indigenous women (n = 21) produced signs of improvement in most measures of health from pre‐ to post‐intervention. Women found the pilot intervention acceptable and helpful but also offered valuable suggestions for improvement. A revised intervention, with greater structure within the Circle and nurses with stronger knowledge of Indigenous women's experience and community health, is currently undergoing testing. © 2017 The Authors. Research in Nursing & Health Published by Wiley Periodicals, Inc.

Stalking: A Multidimensional Framework for Assessment and Safety Planning

Despite the high prevalence of stalking and the risk of harm it poses to victims, arrest rates, prosecutions, and convictions for stalking continue to be low in the United States. The overall goal of this article is to introduce a multidimensional framework of stalking that adds to the current literature by (1) providing a conceptual framework consistent with legal elements of many stalking statutes to facilitate assessment, communication, documentation, and safety planning for stalking several victims; (2) introducing a more systematic way of assessing course of conduct and the context of fear in stalking situations in order to increase the understanding of cumulative fear for stalking victims; (3) emphasizing the aspects of stalking harm that go beyond violence and that show how harm from stalking accumulates over time including life sabotage; and (4) discussing 12 risk factors derived from the overall multidimensional framework that can be used to describe the big picture of stalking and to facilitate safety planning for victims. Implications for future research are discussed.

Intimate Partner Violence Victims Seeking a Temporary Restraining Order: Social Support and Resilience Attenuating Psychological Distress

Social support has been found in many studies to be a protective factor for those exposed to intimate partner violence (IPV), but personal resilience has received far less attention. The present study concerns 136 female IPV victims seeking a temporary restraining order (TRO) from a Family Justice Center (FJC). The relationships between IPV victimization, social support, resilience, and psychological distress were examined. Hierarchical regressions found that both perceived social support and self-reported resilience were inversely associated with distress symptoms. Higher social support was associated with lower trauma symptoms, controlling for abuse history, demographics, and resilience. Higher resilience was associated with lower mood symptoms and lower perceived stress, controlling for abuse history, demographics, and social support. No significant associations were recorded for anger symptoms. These findings suggest that fostering resilience can have important health benefits for IPV victims, above and beyond the well-known benefits of social support. Ways that resilience might be cultivated in this population and other implications for practice are discussed.

Health Advocacy Project: Evaluating the Benefits of Service Learning to Nursing Students and Low Income Individuals Involved in a Community-Based Mental Health Promotion Project

Poverty, along with other factors such as unemployment, work and life stressors, interpersonal violence, and lack of access to high quality health and/or social services all play a role in determining who develops a mental illness and for whom those symptoms persist or worsen. Senior nursing student preparing to enter the field and working in a service learning capacity may be able to influence early recovery and symptom abatement among those most vulnerable to mental illness. A consortium of community stakeholders and researchers collaboratively designed a 10-week mental health promotion project called the Health Advocacy Project (HAP). The project combines case management and system navigation support delivered by trained and highly supervised nursing students to individuals experiencing major depressive disorder (MDD) and/or post-traumatic stress disorder (PTSD). In this article, we present the findings of a qualitative fidelity evaluation that examines the effectiveness of nursing students in delivering the health advocacy intervention at the level and with the intensity originally intended. The findings demonstrate how the services of senior nursing students may be optimized to benefit our healthcare system and populations most at risk for developing MDD and PTSD.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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.

What Works to Reduce Victimization? Synthesizing What We Know and Where to Go From Here

While some attention has been paid to "what works" to reduce crime, little is known about the effectiveness of programs designed to reduce victimization. This study systematically reviews 83 program evaluations to identify what works to (a) reduce victimization, (b) enhance beliefs/attitudes about victims, and (c) improve knowledge/awareness of victimization issues. Evidence-based findings are organized around 4 major forms of victimization, including bullying, intimate partner violence, sexual abuse, and other general forms of victimization. Determining whether certain types of programs can reduce the risk of victimization has important implications for improving people's quality of life. Based on our findings, we offer several promising directions for the next generation of research on evaluating victimization programs. The goal of this study is to improve the strength of future program evaluations, replications, and other systematic reviews as researchers and practitioners continue to learn what works to reduce victimization.

Survivor-Defined Practice in Domestic Violence Work: Measure Development and Preliminary Evidence of Link to Empowerment

Survivor-defined practice, characterized by an emphasis on client choice, partnership, and sensitivity to the unique needs, contexts, and coping strategies of individual survivors, is an aspirational goal of the domestic violence (DV) movement, assumed to be a key contributor to empowerment and other positive outcomes among survivors. Despite its central role in DV program philosophy, training, and practice, however, our ability to assess its presence and its presumed link to well-being has been hampered by the absence of a way to measure it from survivors' perspectives. As part of a larger university-community collaboration, this study had two aims: (a) to develop a measure of survivor-defined practice from the perspective of participants, and (b) to assess its relationship to safety-related empowerment after controlling for other contributors to survivor well-being (e.g., financial stability and social support). Results supported the reliability and validity of the Survivor-Defined Practice Scale (SDPS), a nine-item measure that assesses participants' perception of the degree to which their advocates help them achieve goals they set for themselves, facilitate a spirit of partnership, and show sensitivity to their individual needs and styles. The items combined to form one factor indicating that the three theoretical aspects of survivor-defined practice may be different manifestations of one underlying construct. Results also support the hypothesized link between survivor-defined practice and safety-related empowerment. The SDPS offers DV programs a mechanism for process evaluation that is rigorous and rooted in the feminist empowerment philosophy that so many programs espouse.

Advocacy interventions to reduce or eliminate violence and promote the physical and psychosocial well-being of women who experience intimate partner abuse

BACKGROUND

Intimate partner abuse is common worldwide, damaging the short- and long-term physical, mental, and emotional health of survivors and children. Advocacy may contribute to reducing abuse, empowering women to improve their situation by providing informal counselling and support for safety planning and increasing access to different services. Advocacy may be a stand-alone service, accepting referrals from healthcare providers, or part of a multi-component (and possibly multi-agency) intervention provided by service staff or others.

OBJECTIVES

To assess the effects of advocacy interventions within or outside healthcare settings in women who have experienced intimate partner abuse.

SEARCH METHODS

In April 2015, we searched CENTRAL, Ovid MEDLINE, EMBASE, and 10 other databases. We also searched WHO ICTRP, mRCT, and UK Clinical Research Network (UKCRN), and examined relevant websites and reference lists with forward citation tracking of included studies. For the original review we handsearched six key journals. We also contacted first authors of eligible papers and experts in the field.

SELECTION CRITERIA

Randomised or quasi-randomised controlled trials comparing advocacy interventions for women with experience of intimate partner abuse versus no intervention or usual care (if advocacy was minimal and fewer than 20% of women received it).

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed risk of bias and undertook data extraction. We contacted authors for missing information needed to calculate statistics for the review and looked for adverse events.

MAIN RESULTS

We included 13 trials involving 2141 participants aged 15 to 65 years, frequently having low socioeconomic status.The studies were quite heterogeneous in terms of methodology, study processes and design, including with regard to the duration of follow-up (postintervention to three years), although this was not associated with differences in effect. The studies also had considerable clinical heterogeneity in relation to staff delivering advocacy; setting (community, shelter, antenatal, healthcare); advocacy intensity (from 30 minutes to 80 hours); and abuse severity. Three trials evaluated advocacy within multi-component interventions. Eleven measured some form of abuse (eight scales), six assessed quality of life (three scales), and six measured depression (three scales). Countries and ethnic groups varied (one or more minority ethnic groups in the USA or UK, and local populations in Hong Kong and Peru). Setting was associated with intensity and duration of advocacy.Risk of bias was high in five studies, moderate in five, and low in three. The quality of evidence (considering multiple factors such as risk of bias, study size, missing data) was moderate to low for brief advocacy and very low for intensive advocacy. Incidence of abuse Physical abuseModerate quality pooled data from two healthcare studies (moderate risk of bias) and one community study (low risk of bias), all with 12-month follow-up data, showed no effect on physical abuse for brief (< 12 hours) advocacy interventions (standardised mean difference (SMD) 0.00, 95% confidence interval (CI) - 0.17 to 0.16; n = 558). One antenatal study (low risk of bias) showed an association between brief advocacy and reduced minor physical abuse at one year (mean difference (MD) change - 1.00, 95% CI - 1.82 to - 0.18; n = 110). An antenatal, multi-component study showed a greater likelihood of physical abuse ending (odds ratio (OR) 0.42, 95% CI 0.23 to 0.75) immediately after advocacy (number needed to treat (NNT) = 8); we cannot exclude impact from other components.Low to very low quality evidence from two intensive advocacy trials (12 hours plus duration) showed reduced severe physical abuse in women leaving a shelter at 24 months (OR 0.39, 95% CI 0.20 to 0.77; NNT = 8), but not at 12 or 36 months. Sexual abuseMeta-analysis of two studies (n = 239) showed no effect of advocacy on sexual abuse (SMD - 0.12, 95% CI - 0.37 to 0.14), agreeing with the change score (MD - 0.07, 95% CI - 0.30 to 0.16) from a third study and the OR (0.96, 95% CI 0.44 to 2.12) from a fourth antenatal, multi-component study. Emotional abuseOne study in antenatal care, rated at low risk of bias, showed reduced emotional abuse at ≤ 12-month follow-up (MD (change score) - 4.24, 95% CI - 6.42 to - 2.06; n = 110). Psychosocial health Quality of lifeMeta-analysis of two studies (high risk of bias) showed intensive advocacy slightly improved overall quality of life of women recruited from shelters (MD 0.23, 95% CI 0.00 to 0.46; n = 343) at 12-month follow-up, with greater improvement in perceived physical quality of life from a primary care study (high risk of bias; MD 4.90, 95% CI 0.98 to 8.82) immediately postintervention. Depression Meta-analysis of two studies in healthcare settings, one at high risk of bias and one at moderate risk, showed that fewer women developed depression (OR 0.31, 95% CI 0.15 to 0.65; n = 149; NNT = 4) with brief advocacy. One study at high risk of bias reported a slight reduction in depression in pregnant women immediately after the intervention (OR 0.51, 95% CI 0.20 to 1.29; n = 103; NNT = 8).There was no evidence that intensive advocacy reduced depression at ≤ 12-month follow-up (MD - 0.14, 95% CI - 0.33 to 0.05; 3 studies; n = 446) or at two years (SMD - 0.12, 95% CI - 0.36 to 0.12; 1 study; n = 265). Adverse effectsTwo women died, one who was murdered by her partner and one who committed suicide. No evidence links either death to study participation.

AUTHORS' CONCLUSIONS

Results suggest some benefits from advocacy. However, most studies were underpowered. Clinical and methodological heterogeneity largely precluded pooling of trials. Therefore, there is uncertainty about the magnitude of benefit, the impact of abuse severity, and the setting.Based on the evidence reviewed, intensive advocacy may improve short-term quality of life and reduce physical abuse one to two years after the intervention for women recruited from domestic violence shelters or refuges. Brief advocacy may provide small short-term mental health benefits and reduce abuse, particularly in pregnant women and for less severe abuse.

Within the Bounds: The Role of Relocation on Intimate Partner Violence Help-Seeking for Immigrant and Native Women With Histories of Homelessness

Our study examines the effects of abused women's relocation and recentness to an area on informal and formal help-seeking, and how access to personal and social resources affect these relationships. Secondary data analysis was conducted using a sample of 572 women with histories of abuse and homelessness who were interviewed at shelters in the state of Florida. Findings from nested linear regressions demonstrate that relocation affects formal help-seeking while recentness to an area affects informal help-seeking. Access to personal resources also predicts women's use of both informal and formal resources. Implications for intimate partner violence help-seeking are discussed.