"What Fresh Hell Is This?" Victims of Intimate Partner Violence Describe Their Experiences of Abuse, Pain, and Depression

Intimate Partner Violence Against Women and Labor Productivity: The Mediating Role of Morbidity

This study determines that morbidity presents a mediating impact between intimate partner violence against women and labor productivity in terms of absenteeism and presenteeism. Partial least squares structural equation modeling (PLS-SEM) was used on a nationwide representative sample of 357 female owners of micro-firms in Peru. The resulting data reveals that morbidity is a mediating variable between intimate partner violence against women and absenteeism (β = 0.213; p < .001), as well as between intimate partner violence against women and presenteeism (β = 0.336; p < .001). This finding allows us to understand how such intimate partner violence against women negatively affects the workplace productivity in the context of a micro-enterprise, a key element in many economies across the world.

Exploration of Black/African American College Survivors of IPV During COVID-19 Utilizing Descriptive Analysis

The last few decades have ushered in an increase in scholarship focused on campus-based violence, specifically sexual violence, sexual assault, and unwanted sexual experiences. This rise in sexual violence scholarship has promoted the examination of current campus-based interventions, resources, and response systems. However, there exists a dearth of research exploring the experience of intimate partner violence for college students within college/university settings. In this descriptive analysis, we capture the prevalence of intimate partner violence for a nationwide sample of 1,035 college students across diverse college and university campuses within the United States. Researchers utilized a sociodemographic questionnaire and the Intimate Partner Violence Screening Questionnaire to capture and measure college students' experiences of intimate partner violence during the COVID-19 pandemic. To analyze the data, the Statistical Package for Social Sciences (SPSS 28) was used. Univariate analyses and cross-tabulation analyses were conducted to examine the data. Specifically, due to the majority of research focusing on cisgender, White heterosexual women respondents, we focus our analysis on the experiences of Black and/or African American survivors of intimate partner violence on college campuses, in hopes of capturing the prevalence of intimate and relationship violence for Black/African American college students across colleges and universities. Results of this study revealed the prevalence of all types of intimate partner violence and abuse such as emotional/psychological, physical, and sexual violence within Black/African American college students. Findings from this database study produce implications for college/university campuses to consider capacity to address enduring psychological concerns and outcomes tied to intimate partner violence within college/university campuses, while also considering culturally responsive prevention and intervention efforts.

Trajectories of Depression, Post-Traumatic Stress, and Chronic Pain Among Women Who Have Separated From an Abusive Partner: A Longitudinal Analysis

This longitudinal study explored changes in women's health after separation from an abusive partner by characterizing the trajectories of their mental health (depression and post-traumatic stress disorder [PTSD]) and physical health (chronic pain) over a 4-year period. We examined how the severity of intimate partner violence (IPV) affected these trajectories, controlling for selected baseline factors using 5 waves of data collected from a community sample of 309 English-speaking, Canadian women. IPV severity was measured using the Index of Spouse Abuse where women were asked to consider the entire period of their partner relationship up to present at wave 1 and to rate their IPV experiences in the previous 12 months at waves 2-5. Mental health was measured using established self-report measures of depression (CESD) and PTSD (Davidson Trauma Scale), while chronic pain was measured using the Chronic Pain Grade Scale. Trajectories were estimated using MLM techniques with severity of IPV and selected co-variates (time since separation, age, financial strain) included. Our results show that women's health improved significantly over time, although significant levels of depression, PTSD symptoms and disabling chronic pain remained at the end of wave 5. Regardless of time since separation, more severe IPV was associated with higher levels of depression, PTSD, and disabling chronic pain, with IPV having a stronger effect on these health outcomes over time, suggesting cumulative effects of IPV on health. The results of this study contribute to quantifying the continuing mental and physical health burdens experienced by women after separation from an abusive partner. Increased attention to the long-term effects of violence on women's health beyond the crisis of leaving is critically needed to strengthen health and social services and better support women's recovery and healing.

Intimate Partner Violence in Same-Sex Relationships: Are We Aware of the Implications?

Intimate partner violence (IPV) has been a significant public health problem in same-sex relationships. However, health policies across the globe do not address IPV causing a massive gap in health and economic burden. In the last decade, crucial missing links have been established, and researchers tried to connect the dots of this severe health disparity. This intersectionality has found the impact of race, gender, class, physical ability, and legal framework of IPV in lesbian, gay, and bisexual (LGB) relationships. However, preventive strategies, training programs, and dialogues in the clinical field about IPV are from heteronormative lenses. This particular bias can perpetuate the issue and will remain one of the leading causes of health burden in the LGB population. This article reviews the lacunae in health policies regarding same-sex IPV, highlights its impact on minority mental health, and calls for attention to train health-care professionals regarding the same.

Does Domestic Violence Against Women Increase Teacher-Student School Violence? The Mediating Roles of Morbidity and Diminished Workplace Performance

This research reveals how domestic gender violence suffered by female teachers affects teacher-student school violence in the classroom. Based on a representative survey of 1,542 female professors in 95 public schools in the Callao metropolitan region of Peru using variance structural equation modelling, there is a strong positive relation found between both types of violence (β = 0.34), accompanied by the existence of mediating effects of morbidity and diminished workplace performance. These results demonstrate that in order to reduce the incidence of school violence we must not only address violence between educators and students, but also violence suffered by teachers at the hands of their domestic partner.

Psychological and Physical Intimate Partner Violence, Measured by the New York City Community Health Survey - New York City, 2018

Purpose

Intimate partner violence (IPV) can damage long-term physical and mental health, yet IPV prevalence in New York City (NYC) is unknown. We described prevalence and health correlates of psychological and physical IPV in NYC.

Method

The 2018 NYC Community Health Survey, a representative telephone survey among adult residents, asked about lifetime psychological or physical IPV experiences. We estimated age-adjusted physical and psychological prevalence, stratified by demographic variables, and created log-linear multivariable models with 95% CIs to measure the association of each IPV type with health conditions and behaviors.

Results

Overall, 10,076 surveys were completed. We excluded responses with missing IPV values. Of 9,945 adults, 16.7% reported ever having experienced psychological IPV; higher prevalence among females (18.6%; CI:17.0-20.2) than males (14.5%; CI:13.1-16.2). Prevalence of not getting needed mental health treatment (PR: 4.5; CI:3.3-6.1) and current depression (PR:2.6 CI:2.1-3.1) was higher among adults who had ever experienced psychological IPV, compared with those who had not. Of 9,964 adults, 9.8% reported ever having experienced physical IPV; higher prevalence among females (12.4%; CI:11.1-13.8) than males (6.8%; CI:5.8-8.0). Prevalence of not getting needed mental health treatment (PR:3.9, CI:2.8-5.4) and current depression (PR:2.6, CI:2.1-3.2) was higher among adults who had ever experienced physical IPV, compared with those who had not.

Conclusions

One in six (16.7%) and one in 10 (9.8%) NYC adults reported ever experiencing psychological IPV and ever experiencing physical IPV, respectively. Key implications suggest that IPV potentially underlies public health priority health conditions and behaviors.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10896-022-00442-1.

Access to domestic violence advocacy by race, ethnicity and gender: The impact of a digital warm handoff from the emergency department

Background

Racial/ethnic minority survivors of domestic violence (DV) referred from emergency departments (EDs) face barriers connecting with advocacy services due to systemic inequities. This study assesses the impact of Domestic Violence Report and Referral (DVRR), a digital mandatory reporting compliance system with integrated direct-to-advocacy referrals sent with patient consent, on survivors’ likelihood of receiving advocacy by race/ethnicity and gender.

Methods

We assessed ED charts between 2014–2018 in an urban, Level 1 trauma center for DV-related positive screening, chief concern, or documentation in medical/social work notes. We matched these visits by name to local DV advocacy agency records. Using logistic regression, we assessed survivor odds of reaching advocacy by DVRR receipt, race/ethnicity and gender. We used predicted probabilities to identify between-group differences in advocacy services received.

Results

Of the 1366 visits, 740 received the DVRR intervention; 323 received advocacy services Without DVRR, compared to white, female survivors (n = 87), male survivors (n = 132) had 0.20 (95% CI: 0.07–0.56) times the odds of reaching advocacy compared to female survivors; Latinx survivors (n = 136) had 2.53 (95% CI: 1.58–4.07) times the odds of reaching advocacy compared to white survivors. With DVRR, the odds and predicted probabilities of reaching advocacy increased significantly for all survivors. White, female survivors (n = 74) who received DVRR experienced 2.60 (95% CI: 1.66–4.07) times the odds of connecting with advocacy. Compared to this reference group, Black survivors (n = 480) who received DVRR experienced 4.66 additional times the odds of reaching advocacy services (95% CI: 3.09–7.04) and male survivors (n = 84) experienced 8.96 additional times the odds (95% CI: 2.81–28.56). Overall, we predict 43% (95% CI: 38–53%) of Latinx survivors (n = 177), 36% (95% CI: 31–40%) of Black survivors (n = 480) and 23% (95% CI: 14–32%) of white survivors (n = 83); 37% (95% CI: 33–40%) of women (n = 656) and 29% (95% CI: 18–42%) of men (n = 84) received advocacy services with DVRR.

Conclusion

Direct-to-advocacy ED referrals facilitated by eHealth technology improve access to advocacy care for all survivors in this sample; marginalized racial and ethnic groups most often victimized by DV appear to have the highest rates of connection to advocacy.

Examination of the Transient Changes in Affect Resulting From Participation in Research Addressing Intimate Partner Violence

As a result of the proliferation of data examining intimate partner violence (IPV), there has been an emerging interest in how this research emotionally affects participants, particularly those with a history of personal experience with IPV. While a large body of IPV research suggests that only a small proportion of individuals experience transient emotional distress as the result of participation, this research is limited by examining only the emotional responses at the conclusion of the research, rather than examining changes in affect during the research. Therefore, this research sought to examine negative affect among participants throughout the research to better examine the trajectory of affect during participation in research on IPV. We recruited a sample of 914 college students who completed a measure of negative affect at the beginning, after being exposed to violence questionnaires, and at the conclusion of the research. The findings suggested that among the total sample, negative affect generally declined over the course of the research, although there was a significant interaction for victims of both psychological and physical IPV, such that their negative affect remained stable over participation in the research. Negative affect was significantly correlated with measures of reactions to the research globally, and not significantly related to perceptions of the overall benefits of the research. These data suggest that participation in research on IPV does not increase negative affect, even among those with a history of IPV. Implications of these data for future research on IPV are discussed.

The association between life satisfaction, emotional support, and perceived health among women who experienced intimate Partner violence (IPV) - 2007 behavioral risk factor surveillance system

BACKGROUND

Intimate partner violence (IPV) is a pressing phenomenon whose consequences are associated with severe physical and mental health outcomes. Every minute, around 24 people in the United States are raped, physically injured, or emotionally abused by their intimate partner. Although having experienced IPV is not modifiable, emotional support is a protective factor to prevent victims from committing suicide. The psychological state of IPV victims is critical in post-traumatic events and this is evidenced in numerous qualitative interviews. Therefore, the objective of this study is to explore the association between IPV with emotional support, life satisfaction, and perceived health status in the United States.

METHODS

This study analyzed the data from the 2007 Behavioral Risk Factor Surveillance System. Univariate analyses, multivariable logistic regression analyses, and ordinal logistic regression analyses were used to estimate the adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs) for factors associated with IPV. Analyses were conducted using SPSS version 25.

RESULTS

The analyses show that there is a strong association between IPV experience and emotional support (AOR:1.810; 95% CI = 1.626-2.015). Participants who had either physical violence or unwanted sex with an intimate partner in the past 12 months have 2.28 higher odds to receive less emotional support and 2.05 higher odds to perceive poor life satisfaction. Also, participants who reported experiencing IPV were associated with (AOR: 3.12; 95% CI =2.68-3.62) times the odds of having ≥6 days more mentally unhealthy days in a month. For perceived health outcomes, people who had been threatened with violence by a sex partner have 1.74 (95% CI =1.54-1.96) times the odds of having poor perceived general health status. IPV survivors have 3.12 (95% CI =2.68-3.62) times the odds of having ≥6 days more mentally unhealthy days in a month.

CONCLUSIONS

People reported with any IPV experience are more likely to receive less emotional support, perceive dissatisfaction in life, and poor health outcomes. This study shows the need for policies centered on the development of interventions that focus on mental health for those who have experienced IPV.

Quantitative Methods for Analyzing Intimate Partner Violence in Microblogs: Observational Study

Background

Social media is a rich, virtually untapped source of data on the dynamics of intimate partner violence, one that is both global in scale and intimate in detail.

Objective

The aim of this study is to use machine learning and other computational methods to analyze social media data for the reasons victims give for staying in or leaving abusive relationships.

Methods

Human annotation, part-of-speech tagging, and machine learning predictive models, including support vector machines, were used on a Twitter data set of 8767 #WhyIStayed and #WhyILeft tweets each.

Results

Our methods explored whether we can analyze micronarratives that include details about victims, abusers, and other stakeholders, the actions that constitute abuse, and how the stakeholders respond.

Conclusions

Our findings are consistent across various machine learning methods, which correspond to observations in the clinical literature, and affirm the relevance of natural language processing and machine learning for exploring issues of societal importance in social media.

What barriers prevent health professionals screening women for domestic abuse? A literature review

BACKGROUND

Domestic abuse is known to affect one in four women (although it is difficult to quantify) and has significant short- and long-term health implications. As people who often have regular contact with women in a variety of circumstances, including routine appointments, health professionals, particularly nurses and midwives, are in an ideal position to screen women for domestic abuse. However, it is recognised that there is a reluctance by some health professionals to undertake this important role.

AIM

To identify the potential barriers preventing health professionals from screening women for domestic abuse and to consider how these barriers could be overcome.

METHOD

A literature review of electronic databases using predetermined search terms and inclusion/exclusion criteria was undertaken. Seven studies were identified for review, consisting of five qualitative and two quantitative pieces of research.

CONCLUSION

Several barriers to screening by health professionals were identified, including lack of training, education, time, privacy, guidelines, policies and support from the employer, with the most prevalent of these being a lack of training and education. Further research is required, specifically within the UK, to provide more details about how these barriers might be addressed.

Conceptual Foreknowings: Integrative Review of Feeling Overwhelmed

Feeling overwhelmed is a universal humanuniverse living experience of living quality. From the humanbecoming perspective, all individuals choose to feel overwhelmed or not as they make choices moment to moment. Thus, it is of importance to understand feeling overwhelmed from divergent perspectives. To achieve this, the author in this article reviews the extant literature on feeling overwhelmed from the disciplines of nursing, business, psychology, philosophy, theology, social work, education, and sociology. Three themes that emerged from the extant literature were (a) feeling overwhelmed arises as an engulfing turbulence, (b) feeling overwhelmed surfaces with disquiet isolation, and (c) feeling overwhelmed emerges with reaching for relief.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Development of an Innovative Treatment Paradigm for Intimate Partner Violence Victims With Depression and Pain Using Community-Based Participatory Research

Intimate partner violence (IPV) is a public health issue with complex physical health, mental health and social consequences that can exacerbate survivors' barriers to health care engagement and support. Furthermore, health care professionals are often unaware of or feel ill-equipped to address survivors' complex needs. Depression and chronic pain are particularly prevalent co-occurring problems for survivors and can impede engagement and outcomes in traditional health care. This study's purpose was to understand what interventions might be more responsive to survivors' myriad needs, particularlly those with depression and pain. Survivors were involved with the design, execution, analysis, and interpretation of results, based on community-based participatory research principles. Intervention development happened in two phases: the first consisted of focus groups with survivors to inform the intervention and the second included intervention design, informed by a community advisory board (CAB). Thirty-one survivors participated in Phase 1, and they reported preferring a range of support including formal help-seeking, informal coping strategies, and spirituality. In Phase 2, the CAB (comprised of survivors, health care professionals, and researchers) identified three distinct aspects of a comprehensive IPV intervention: (a) education regarding both the complex health issues and available local resources; (b) an integrated consultation service for providers to seek recommendations for responding to the full spectrum of survivors' needs; and (c) a trauma-informed, accessible clinic. Academic medical centers could not have designed this intervention in isolation; survivors and providers played an integral part of this process, and continue to inform our current work.

Deaf Victims' Experiences With Intimate Partner Violence: The Need for Integration and Innovation

While in recent years, intimate partner violence (IPV) has attracted considerable research attention, the experiences of IPV affecting the Deaf community have been understudied. As a linguistic and cultural minority, Deaf victims of IPV encounter significant barriers in accessing information and services designed to address the medical and legal consequences of victimization. The number of Deaf Americans who communicate via American Sign Language (ASL) may well exceed a half-million, yet little is known about Deaf IPV victims' experiences and the characteristics of persons who perpetrate IPV with ASL users. This study addressed both topics. The current study is based on interviews in ASL with 14 Deaf IPV victims (participants). We explored: the types of abuse participants experienced; characteristics of victims and perpetrators; participants' help-seeking behaviors; and the availability, use, and helpfulness of various resources. These findings were compared to what is known about IPV in the hearing community. Our findings include that lack of information regarding IPV and lack of access to specialized IPV services were pervasive problems affecting Deaf victims. For some victims, the close-knit nature of the Deaf community was a barrier for discussing IPV and accessing information and support. It was common for Deaf victims to receive services or information about IPV from providers who were not IPV specialists. Communication abuse was prevalent in our study. The nature of communication abuse is unique for Deaf victims compared to hearing victims.

The Use of the Clinical Ethnographic Narrative Interview to Understand and Support Help Seeking After Gender-Based Violence

Gender-based violence (GBV), characterized by the abduction or rape of women and girls to humiliate, intimidate, and traumatize them and their communities, is a profoundly disturbing tactic in international conflict. Long after armed conflict has ended, survivors continue to experience physical injuries, psychological trauma, and social and cultural stigma. Guilt, shame, and continued interpersonal violence can become a normalized part of daily life, significantly challenging the road to healing and recovery. Research about self-disclosure and narrative after GBV has shown that help seeking rates are shockingly low, with estimates ranging from 4-27%. From a feminist and a humanistic perspective, studying trauma history and related help seeking is delicate work that must use interview processes that ensure the survivor can tell her story without revictimization, while also aiming to restore personal mastery, empowerment, and self-understanding. Based on theories about benefits and challenges of the narrative after GBV and trauma, we propose that the Clinical Ethnographic Narrative Interview (CENI) allows researchers and practitioners a safe container to examine the complex interplay between suffering, culture, and help seeking. Using this interview, the interviewer and the participant work as partners to define, compare, and contrast the socio-cultural barriers and facilitators of help seeking. This paper explains the narrative theory and the challenges and benefits of the narrative approach after trauma. Then we provide support for the use of the CENI for an understanding of the help seeking process and facilitating a health-promoting narrative interview for survivors. We then address implications for research, practice, and policy.

Influence of Intimate Partner Violence and Depression on Undergraduate Nursing Students: A Literature Review

BACKGROUND

Intimate partner violence (IPV) and dating violence is a significant problem among college-age students. IPV has an associative outcome of depression and lower academic performance, but it is unknown how it relates to undergraduate nursing students.

METHOD

Two literature searches were performed for IPV and depression from a combination of 87 databases including EBSCO, Proquest, Nursing at OVID, Medline, PubMed, CINAHL, PsycARTICLES, JSTOR, SAGE journals, and Google Scholar.

RESULTS

Initial results yielded 24,675 research studies on IPV, dating violence, and depression. Forty-eight level-three studies were identified using the John Hopkins School of Nursing evidence-based practice model, including 42 nonexperimental studies, three meta-syntheses, and three governmental studies.

CONCLUSION

Relevant data on the prevalence rates of IPV and depression among nursing students are lacking. IPV and dating violence among college students places them at a higher risk for failure and poor academic performance. [J Nurs Educ. 2017;56(7):397-403.].

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.

Association between intimate partner violence and mentally unhealthy days in women in the U.S

Background

In the United States (U.S.), intimate partner violence (IPV) is a serious public health concern, mainly affecting the health and well-being of women. The objective of this study was to identify the IPV and socio-demographic factors associated with mentally unhealthy days among women in the U.S. of ages ≥18 years.

Methods

Data for this study were obtained from the 2007 Behavioral Risk Factor Surveillance System. Multivariable analyses were used to estimate adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs) for factors associated with IPV and 14 or more mentally unhealthy days per month. Analyses were conducted using SAS 9.3.

Results

The analyses show that the following factors increase the likelihood of self-reported 14 or more mentally unhealthy days: having a high school level of education or less (AOR: 1.732; 95% CI: 1.415–2.119) and having an income < $50,000. In addition, experiencing IPV such as: ever being threatened by a sex partner (AOR: 1.499; 95% CI: 1.264–1.779); having a sex partner ever attempt violence (AOR: 1.461; 95% CI: 1.224–1.743); having a sex partner ever become violent (AOR: 1.541; 95% CI: 1.303–1.823); and ever having unwanted sex with a partner (AOR: 1.929; 95% CI: 1.584–2.350) also increased the likelihood of self-reported 14 or more mentally unhealthy days per month.

Conclusions

The results indicate that, for women in the U.S., IPV and socio-demographic factors have an effect on self-reported 14 or more mentally unhealthy days. Improving access to services that offer protection and guidance for women abused by their intimate partner could decrease the likelihood of selfreported 14 or more mentally unhealthy days and long-term negative mental health outcomes among women.

To ask, or not to ask: the hesitation process described by district nurses encountering women exposed to intimate partner violence

AIMS AND OBJECTIVES

To improve the understanding of district nurses' experiences of encountering women exposed to intimate partner violence.

BACKGROUND

Intimate partner violence is a public health issue that influences all aspects of affected women's lives; it is thus of great relevance to identify intimate partner violence. District nurses in primary health care in Sweden encounter women of all ages and are therefore in a unique position to identify intimate partner violence and provide nursing care. However, studies indicate that several barriers have kept nurses from identifying intimate partner violence. Consequently deeper understanding of district nurses' encounters with women exposed to intimate partner violence is needed.

DESIGN

A qualitative study using grounded theory method.

METHODS

Interviews with 11 district nurses in primary health care in Sweden.

RESULTS

The hesitation process is central in these encounters. Several barriers to asking and factors that facilitated asking impacted the hesitation process. Under the influence of these factors, district nurses moved from being unaware that identifying intimate partner violence was their professional responsibility, to becoming ambivalent about asking, to starting to prepare themselves to ask about intimate partner violence. The presence of factors that facilitated asking finally made district nurses feel prepared, and then they decided to ask women about intimate partner violence.

CONCLUSIONS

The concept of managing the hesitation process could be used to be incorporated in continuing education and training. Barriers and facilitators concerning organisational factors found in this study may be specific to the Swedish health care system, but the concept of the hesitation process is applicable in similar contexts and perhaps to other issues about which it is difficult to ask.

RELEVANCE TO CLINICAL PRACTICE

This study illuminates the importance of a supportive work environment in reducing district nurses' hesitation to ask about intimate partner violence and to propose continuing education, training and supervision for district nurses regarding intimate partner violence.

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

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

Cyber aggression within adolescents' romantic relationships: linkages to parental and partner attachment

Extensive research has examined face-to-face aggression within adolescents' romantic relationships, but little attention has been given to the role of electronic technologies in adolescents' perpetuation of these behaviors. Thus, this study examined the relationship of anxious and avoidant partner attachments to partner-directed cyber aggression, assessed 1 year later among 600 adolescents (54% female). After accounting for gender and previous behaviors, anxious partner attachment was related to later partner-directed cyber aggression. In addition, insecure parental attachment from adolescents' mothers was related positively to insecure partner attachment and had an indirect effect on their partner-directed cyber aggression through the mediation of anxious partner attachment. This study provides insight into the impact of electronic technologies on adolescents' romantic relationships.