Abused women disclose partner interference with health care: an unrecognized form of battering

The association between emotional and physical intimate partner violence and COVID-19 vaccine uptake in a community-based U.S. Cohort

Objective

To estimate risk of being unvaccinated against COVID-19 by experience of intimate partner violence (IPV).

Methods

Among 3,343 partnered individuals in a community-based U.S. cohort, we quantified emotional and physical IPV experienced between March and December 2020 and estimated risk of being unvaccinated against COVID-19 through June 2021 by experience of IPV. Experience of recent IPV was defined as endorsement of more frequent or severe IPV since the start of the pandemic or report of any past-month IPV in at least one of four follow-up surveys conducted by the end of December 2020. We created a three-level composite variable - no experience of IPV, experience of emotional but not physical IPV, and experience of physical IPV.

Results

Cisgender women, non-binary, or transgender individuals who reported experiencing emotional, but not physical, IPV and those who reported experiencing physical IPV were both at significantly higher risk of being unvaccinated for COVID-19 compared to those who reported experiencing no IPV (ARRemotional violence: 1.28 [95 % CI: 1.09 - 1.51]; ARRphysical violence: 1.70 [95 % CI: 1.41 - 2.05]). Cisgender men who reported experiencing physical IPV were also at significantly higher risk of being unvaccinated for COVID-19 (ARRphysical violence: 1.52 [95 % CI: 1.15 - 2.02]).

Conclusions

IPV may increase the risk of low vaccine uptake. Results highlight the need to incorporate IPV prevention and support into public health responses, with targeted resources and consideration for reducing barriers to public health interventions among those impacted.

Barriers and facilitators of the reporting by family doctors of cases of domestic violence - a qualitative study across Portugal

BACKGROUND

Domestic violence (DV) is a serious and prevalent public health problem with devastating consequences for the victims and their families. Whilst the number of cases reported to the authorities has risen in recent years, many victims still chose not to present a complaint. In Portugal, to address this, DV became a public crime. As victims of DV present multiple health problems and frequently seek professional help, family doctors are in a privileged position to detect and report cases of DV to the authorities. However, little is known about what motivates these professionals to report or not the DV cases they encounter in their practice to the authorities.

METHODS

We conducted semi-structured interviews with family doctors from all regional health administrations of continental Portugal. Interviews occurred between July 2020 and September 2022, were conducted in person or remotely, audio recorded, transcribed, and analysed using thematic analysis. Content analysis was conducted to assess the agreement or disagreement regarding mandatory reporting in each of the themes and subthemes.

RESULTS

Fifty-four family doctors took part in this study (n = 39 women, n = 15 men). The main themes that arose from the analysis were: "Barriers related to the physician's activity," "Barriers related to the victim or aggressor," "Facilitators related to the physician's activity," "Facilitators related to the victim or aggressor." Although different barriers were described, most doctors agreed with the mandatory reporting of DV cases.

CONCLUSIONS

Family doctors encounter multiple barriers and facilitators when considering reporting a DV case to the authorities. The results of this study can help develop new interventions to address the barriers described by the doctors, increasing their compliance with mandatory reporting, the protection of victims and the just persecution of the aggressor.

Adverse Childhood Experiences, Interpersonal Violence, and Racial Disparities in Early Prenatal Care in North Dakota (ND PRAMS 2017-2019)

In North Dakota (ND), American Indian women are more likely to be exposed to adverse childhood experiences (ACEs) and interpersonal violence, and receive late prenatal care (PNC) compared to other racial groups. In a sample of 1,849 (weighted n = 26,348) women from the 2017 to 2019 North Dakota Pregnancy Risk Assessment Monitoring System, we performed a series of logistic regression models to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for AI and Other Racial Identity women compared to White women regarding risk of late PNC (initiated after week 13) and dissatisfaction of PNC timing. Models were adjusted for interpersonal violence (from husband/partner, family member, someone outside of family, ex-husband/partner, or any) to determine if violence accounts for racial/ethnic disparities in PNC. AI women experienced two-fold higher risk of late PNC (OR: 2.25, 95% CI: 1.55, 3.26) and dissatisfaction of PNC timing (OR: 2.34, 95% CI: 1.61, 3.40) than White women. In the analyses for the association between joint ACEs (Higher: ≥4; Lower: <4)/Race and PNC outcomes, odds of late PNC were two-fold among AI women with Higher ACEs (OR: 2.35, 95% CI: 1.41, 3.94) and Lower ACEs (OR: 2.73, 95% CI: 1.69, 4.41), compared to White women with Lower ACEs. Results were similar for dissatisfaction of PNC timing. Accounting for violence did not significantly change odds ratios in any analyses. Thus, interpersonal violence surrounding pregnancy does not explain racial disparities in PNC in ND. To understand disparities in PNC among AI women, risk factors like historic trauma and systemic oppression should be examined.

The neuropathology of intimate partner violence

Lifelong brain health consequences of traumatic brain injury (TBI) include the risk of neurodegenerative disease. Up to one-third of women experience intimate partner violence (IPV) in their lifetime, often with TBI, yet remarkably little is known about the range of autopsy neuropathologies encountered in IPV. We report a prospectively accrued case series from a single institution, the New York City Office of Chief Medical Examiner, evaluated in partnership with the Brain Injury Research Center of Mount Sinai, using a multimodal protocol comprising clinical history review, ex vivo imaging in a small subset, and comprehensive neuropathological assessment by established consensus protocols. Fourteen brains were obtained over 2 years from women with documented IPV (aged 3rd-8th decade; median, 4th) and complex histories including prior TBI in 6, nonfatal strangulation in 4, cerebrovascular, neurological, and/or psychiatric conditions in 13, and epilepsy in 7. At autopsy, all had TBI stigmata (old and/or recent). In addition, white matter regions vulnerable to diffuse axonal injury showed perivascular and parenchymal iron deposition and microgliosis in some subjects. Six cases had evidence of cerebrovascular disease (lacunes and/or chronic infarcts). Regarding neurodegenerative disease pathologies, Alzheimer disease neuropathologic change was present in a single case (8th decade), with no chronic traumatic encephalopathy neuropathologic change (CTE-NC) identified in any. Findings from this initial series then prompted similar exploration in an expanded case series of 70 archival IPV cases (aged 2nd-9th decade; median, 4th) accrued from multiple international institutions. In this secondary case series, we again found evidence of vascular and white matter pathologies. However, only limited neurodegenerative proteinopathies were encountered in the oldest subjects, none meeting consensus criteria for CTE-NC. These observations from this descriptive exploratory study reinforce a need to consider broad co-morbid and neuropathological substrates contributing to brain health outcomes in the context of IPV, some of which may be potentially modifiable.

Physical intimate partner violence and prenatal oral health experiences in the United States

BACKGROUND

Intimate partner violence (IPV) is a significant public health issue, and when experienced during pregnancy, IPV substantially harms maternal health. Still, limited research has examined how IPV may influence prenatal oral health and dental care utilization. This study investigates the relationship between IPV during pregnancy and women's oral health experiences.

DATA

Data are from 31 states from 2016-2019 in the United States that participated in the Pregnancy Risk Assessment Monitoring System (N = 85,289)-a population-based surveillance system of live births conducted annually by the Centers for Disease Control and Prevention and state health departments. Multivariable logistic regression analyses were used to examine the association between physical IPV during pregnancy (measured by being pushed, hit, slapped, kicked, choked, or physically hurt any other way by a current or ex-husband/partner) and various oral health experiences.

FINDINGS

Women who experienced prenatal physical IPV reported worse oral health experiences during pregnancy, including being more likely to report not knowing it was important to care for their teeth, not talking about dental health with a provider, needing to see a dentist for a problem, going to see a dentist for a problem, as well as having more unmet dental care needs.

CONCLUSIONS

Together, these findings indicate that women who experience physical IPV during pregnancy have lower knowledge of prenatal oral health care, more oral health problems, and greater unmet dental care needs. Given the risk of IPV and oral health problems for maternal and infant health, the study findings point to greater attention toward the oral health needs of IPV-exposed pregnant women.

Intimate Partner Violence and Prenatal Oral Health Experiences

Background

Intimate partner violence (IPV) is a significant public health issue, and when experienced during pregnancy, IPV poses substantial harms for maternal health. Still, limited research has examined how IPV may influence prenatal oral health and dental care utilization. This study aims to investigate the relationship between IPV during pregnancy and women's oral health experiences.

Data

Data are from the Pregnancy Risk Assessment Monitoring System from 2016 through 2019 (N = 85,289). Multivariable logistic regression analyses were used to examine the association between physical IPV during pregnancy and various oral health experiences.

Findings

Women who experienced prenatal physical IPV reported worse oral health experiences during pregnancy, including being more likely to report not knowing it was important to care for their teeth, not talking about dental health with a provider, needing to see a dentist for a problem, going to see a dentist for a problem, as well as having more unmet dental care needs.

Conclusions

Together, these findings indicate that women who experience physical IPV during pregnancy have lower knowledge of prenatal oral health care, more oral health problems, and greater unmet dental care needs. Given the risk associated with IPV and oral health problems for maternal and infant health, the study findings point to greater attention toward the oral health needs of IPV-exposed pregnant women.

Domestic Violence During the COVID-19 Pandemic: A Systematic Review

BACKGROUND

COVID-19 outbreak and the followed confinement measures have raised concerns to specialists worldwide regarding the imminent increase in domestic violence cases. The present systematic review aims to identify the international trends in domestic violence during the COVID-19 epidemic and to examine the possible differences among all population groups and different geographic areas worldwide.

METHOD

The following databases were accessed: DOAJ, ERIC, Google Scholar, ProQuest, Pubmed, PsycNet, and SCOPUS, up to July 22, 2020.

RESULTS

A total of 32 studies were considered eligible. Data from North America, Europe, Asia-Pacific Area, Africa, and worldwide researches were retrieved. COVID-19 has caused an increase in domestic violence cases, especially during the first week of the COVID-19 lockdown in each country. In children, however, although the specialists' estimations suggested an increase in child maltreatment and abuse cases, the rate of police and social services' reports has declined during the COVID-19 pandemic. School closures that isolated students at home seemed to have contributed to this decrease.

CONCLUSIONS

Domestic violence has been a considerable issue imposed by the COVID-19 epidemic to a worldwide context. The home confinement led to constant contact between perpetrators and victims, resulting in increased violence and decreased reports. In order to minimize such issues, prevention measures and supporting programs are necessary.

Intimate partner violence and barriers to prenatal care

RATIONALE

Past research has shown that intimate partner violence (IPV) is associated with less adequate access to prenatal care. However, less is known about why IPV creates challenges for accessing prenatal care, including how IPV is related to unique barriers to prenatal care.

OBJECTIVE

The aim of this study is to examine the association between physical IPV around the time of pregnancy (preconception IPV, prenatal IPV, or both preconception and prenatal IPV) and (1) adequacy of prenatal care, and (2) barriers to prenatal care.

METHODS

Data are from 35 sites (34 states and New York City) from the Pregnancy Risk Assessment Monitoring System (PRAMS) for years 2009-2016 (n = 166,840). Adequacy of prenatal care is examined using multinomial logistic regression and measures of barriers to prenatal care are assessed using negative binomial regression and logistic regression.

RESULTS

The findings reveal that women with IPV exposure-especially those who experience IPV both before and during pregnancy-are more likely to experience inadequate prenatal care. In addition, women with IPV exposure incur a higher rate of barriers to prenatal care, as well as several specific barriers to prenatal care including not having transportation, not being able to get time off work, being too busy, being unable to find child care, and keeping a pregnancy a secret.

CONCLUSIONS

Considering the adverse consequences of both IPV and inadequate access to prenatal care for maternal and child health, the findings of this study highlight the need for public health interventions that both reduce the prevalence of IPV and remove barriers to prenatal care for IPV-exposed women.

Intimate partner violence screening during COVID-19

OBJECTIVES

Emergency Department (ED) screening for intimate partner violence (IPV) is typically nursing-initiated, often with visitors present. Since the onset of the COVID-19 pandemic, we have seen both an increase in societal stress, a known exacerbator of IPV, and the implementation of visitor restriction policies. This combination presents the need for enhanced IPV screening and the opportunity to perform screening in a controlled, patient-only environment. Our goal was to evaluate the frequency of nurse-initiated screening for IPV prior to and during the early months of the COVID-19 pandemic as well as the frequency of positive screens for IPV.

METHODS

We conducted a retrospective cross-sectional study evaluating all adults (age >18 years) presenting to a tertiary care center ED. Patients were identified as presenting prior to the COVID-19 pandemic (June 1, 2019 to August 31, 2019) and after the COVID-19 visitor restriction policies (June 1, 2020 to August 31, 2020). Descriptive statistics were performed using chi-square and t-tests compared the demographic variables. Chi-square was used for a bivariate analysis of our primary outcomes (IPV screening performed and screening positive for IPV). Further analysis was done using a binary logistic regression model adjusting for the demographic characteristics.

RESULTS

Both the odds of nursing-initiated IPV screening and the odds of verbally screening positive for IPV significantly increased (OR 1.509, 95% CI 1.432-1.600) and (OR 1.375, 95% CI 1.126-1.681) respectively following the implementation of COVID-19 visitor restriction policies.

CONCLUSIONS

These findings suggest that nurse-initiated IPV screening should continue to be performed with the patient privately, even after COVID-19 related ED visitor restrictions are removed. These findings also support the hypothesis that the stress related to COVID-19 is contributing to a rise in IPV.

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.

Intimate Partner Violence and its Mental Health Implications Amid COVID-19 Lockdown: Findings Among Nigerian Couples

Intimate partner violence (IPV) has been identified as a global health problem with increasing mental health consequences. During the COVID-19 pandemic lockdown in Nigeria, couples were compelled to spend more time together, regardless of their pre-existing challenges. Our study aims to determine the prevalence of IPV, its forms, and mental health implications among Nigerian households amid the COVID-19 lockdown. A cross-sectional study was implemented which used the snowball sampling technique to recruit 474 participants across 31 states in Nigeria. A semi-structured online questionnaire was distributed using the WhatsApp platform. The relationship between IPV, its forms, and associated factors were analyzed using descriptive analysis and logistic regression with significant value at p ≤ .05 and confidence interval of 95%. Majority (98.1%) of the participants had at least a college degree and 90.1% were employed. Overall prevalence of IPV ranged from 7.2% to 13.5%. Using the lockdown as the landmark, higher prevalence was found before than during the lockdown across physical, emotional, financial, and sexual forms of IPV. Emotional form had the highest prevalence both before and during the lockdown with 11.4% and 3.8% respectively. Furthermore, 22.6% of participants reported that the lockdown affected their mental health. Hopelessness, feelings of failure, being irritable, and constantly under strain were psychological symptoms significantly associated with IPV amid the lockdown. Decreased prevalence of IPV were found in the early phase of the pandemic, suggesting that couples can experience less partner violence during periods of confinement. Our study supports existing evidence that forms of IPV have negative mental health consequences on abused partners.

Perceptions of Dental Medicine Students on Equity within Healthcare Systems in Romania: A Pilot Study

The scope of this paper is to evaluate the opinion of future dentists on equity within healthcare systems from a social and medical perspective.

MATERIAL AND METHODS

We conducted an observational study based on a survey among year five students from the "Carol Davila" Faculty of Dental Medicine Bucharest using an online questionnaire composed of graded answers to 14 statements on the theme of equity within healthcare systems before taking this course.

RESULTS

The questionnaire was sent to 300 students, of whom 151 (50.3%) responded; 79.47% of these were female and 20.53% were male; 9.3% had a rural background and 90.7% had an urban background. The majority of respondents expressed strong agreement that equity in public healthcare and acknowledging disadvantaged populations was important. The majority of students also strongly agreed that inequity came about from a lack of accessibility to medical care, lack of financial resources, and the absence of a second medical opinion. There were no statistically significant differences specific to the gender and background environment of the respondents.

CONCLUSIONS

The notion of equity is known to future dentists. However, contextual clarifications of the concept itself and its adequate quantification are necessary.

Intimate partner violence and asthma in pediatric and adult populations

OBJECTIVE

To evaluate the relationship between intimate partner violence (IPV) and adult and childhood asthma outcomes.

DATA SOURCES

We conducted a systematic literature review using 4 databases (PubMed, Ovid MEDLINE, Ovid Embase, and Ovid PsycINFO) with asthma and IPV-associated terms.

STUDY SELECTIONS

We included published studies, available in English, to October 2021, which included IPV as an exposure and asthma as an outcome. Both adult and pediatric populations were included in the following settings: community, health care, and home.

RESULTS

There were 37 articles identified. There was evidence among multiple studies to support increased prevalence of asthma in adults exposed to IPV and prevalence and incidence in children with parental IPV exposure. There were fewer studies evaluating IPV exposure and adult asthma morbidity, but they found statistically significant associations between IPV and increased rate of asthma exacerbations and worsened asthma control. There was sparse evidence evaluating a relationship between IPV and adult asthma mortality. There were no studies identified evaluating IPV and childhood asthma morbidity or mortality.

CONCLUSION

The association between IPV and increased asthma prevalence, incidence, and worsened morbidity merits recognition and further investigation into potential mechanisms. Health care providers can implement practical strategies to help mitigate the negative effects of IPV on health and asthma. These include addressing potential impactful biopsychosocial factors and comorbidities, implementing routine screening and referrals, and partnering with community advocacy organizations. Given their positions of respect and power in society, health care providers can have lasting impacts on the lives of pediatric and adult patients affected by IPV.

Designing and validation of a reproductive health need assessment tool for women experienced domestic violence

Background

Violence as a serious health problem and one of the main manifestations of gender inequality brings about adverse health effects for women. Therefore, it is of utmost importance to recognize the reproductive health status of women subjected to violence in order to provide the health services they need. Considering that one of the ways to determine reproductive health status is the use of valid questionnaires in this field, this study aimed to determine the components of reproductive health in domestic violated women and design a valid and reliable assessment tool.

Methods

The present study was conducted based on a mixed-method design. The first part of the study (qualitative section) was conducted based on conventional content analysis. In this part, unstructured in-depth interviews were conducted with 18 violated women and 9 experts. In the next stage, the item pool was formed and the Reproductive Health Needs of Violated Women Scale was designed based on the review of the literature and the results of the qualitative section with 39 items using the Waltz approach. For psychometric assessment of the above instrument, face and content validity, item analysis, and construct validity were examined using exploratory factor analysis.

Results

Based on the results of factor analysis, the four following factors were extracted with a total variance of 47.62: "men's participation", "self-care", "support and health services", as well as "sexual and marital relationships. The internal consistency of the instrument was calculated at α = 0.70–0.89 and α = 0.94 for different constructs and the whole instrument, respectively. Moreover, intra-cluster correlation coefficients were obtained at ICC = 0.96–0.99 and ICC = 0.98 for constructs and the whole instruments, respectively.

Conclusions

Based on the results of the current study, the present scale is a tool that specifically assesses the reproductive health needs of violated women and has appropriate validity and reliability. The results of the assessment using the aforementioned instruments can be of great help in promoting the reproductive health of women subjected to violence.

Intimate Partner Violence Among Women Accessing HIV-Care Services at Tertiary Hospitals in Ogun State, Nigeria: Implications for Policy and Practice

Intimate partner violence is both a predisposing factor for and sequelae of HIV infection. It is more likely for HIV-positive women to experience intimate partner violence compared with HIV-negative women. Previous researches have described the other risk factors for intimate partner violence. This cross-sectional study identified the correlates of intimate partner violence among HIV-positive women accessing HIV-care. We interviewed 458 women accessing HIV-care at the three tertiary hospitals in Ogun State, Nigeria. Trained research assistants conducted 10-min structured interviews with validated questionnaires. We carried out descriptive, bivariate, and regression analyses. We used the backward elimination technique to build a model to predict the experience of intimate partner violence (IPV) within the preceding 12 months. We set the level of significance at .05. A total of 23 (5.02%) participants reported IPV within the preceding 12 months, while the prevalence of lifetime intimate partner violence was 24.02%. Younger age, the experience of IPV in previous relationships, and having multiple sex partners were related to the experience of IPV within the preceding 12 months (p < .05). Also, the partners' age, alcohol intake, and current smoking status were associated with the experience of IPV within the preceding 12 months (p < .05). After regression analysis, participants' age (adjusted odds ratio [AOR] = 0.892, 95% confidence interval [CI] = [0.831, 0.957]), experience of IPV in previous relationship (AOR = 12.841, 95% CI = [4.303, 38.318]), and partners' current smoking status (AOR = 4.874, 95% CI = [1.252, 18.969]) retained association with the experience of IPV within the preceding 12 months. IPV among HIV-positive women accessing HIV-care occurs in a complicated, context-specific way. Routine HIV strategies and services should include interventions that involve men and address gender power imbalances. For effectiveness, specific interventions must consider women's' specific context and characteristics.

Should domestic violence be or not a public crime?

BACKGROUND

Domestic violence has been addressed in public policies and law reforms in many countries to target its identification and provide increased support to those affected. In some countries, reporting domestic violence is mandatory, which means that anyone not only 'can' but also 'must' file a report, which is enough to progress the criminal proceedings, even against the victim's will. This article provides an overview about the importance of the clinicians' duty of care, debating whether or not domestic violence should be a public crime.

METHODS

A narrative review on the subject of mandatory reporting of domestic violence, conducting a search of PubMed.

RESULTS

Twenty studies were retrieved. Commonly victims agree with mandatory reporting. However, there are still several concerns voiced by both victims and health care workers that need to be further addressed.

CONCLUSION

This article addresses the importance and limitations of mandatory reporting while acknowledging the impact of these measures in both the victim and the accused.

Perspectives and Values of Dental Medicine Students Regarding Domestic Violence

Background and Objectives: The purpose of this study is to evaluate dental medical students' opinions concerning domestic violence from a social and medical standpoint and from the perspective of the moral values of the physician-patient relationship. Materials and Methods: We performed an observational study with 4- and 5-year dental medical students at the UMF "Carol Davila" in Bucharest from October 2020-May 2021, using a questionnaire containing 20 items on domestic violence (DV). The questionnaire was uploaded online on the e-learning platform where the students have access. To collect the data, we used Microsoft Excel 365, and the statistical analysis was performed using Jamovi. Results: Of the 600 students enrolled, 415 answered the questionnaire, the answering rate being 69.16%. A total of 215 (53.1%) personally knew victims of DV, 4 (1.0%) considered that violence within a couple is necessary for certain situations, 401 (99.0%) considered that domestic violence is a fundamental problem in today's society, and 170 (41.5%) felt that in domestic violence situations, the blame lies solely with the partner who resorts to physical violence. Regarding the role of the physician, 220 (56%) considered that the physician should breach confidentiality and report cases when patients state they are a victim of DV, 337 (88.2%) thought that free medical treatment should be provided for DV victims who have a dire financial situation, and 212 (56.7%) considered that victims of DV are non-compliant patients. Conclusions: Domestic violence is a phenomenon well-known to stomatology students, which creates the premise of an excellent physician-patient relationship with them, aiding in proper management of ethical issues such as a potential need to breach confidentiality or evaluate the potential conflicts between autonomy and beneficence.

Comparison of mental burden across different types of cancer patients in Nepal: a special focus on cervical cancer patients

Purpose

The purpose of the study is to assess the differential impact of gender and cancer sites on mental burden across different types of cancer and control patients.

Design/methodology/approach

The paper is based on a primary survey undertaken in 2015–2016 of 600 cancer and 200 control patients across five hospitals of Nepal. The data was analyzed using propensity score matching methods and treatment effect weighting estimators.

Findings

The authors find that of all the types of patients covered under this study, cervical cancer patients suffered from a greater intensity of anxiety and lack of functional wellbeing. On an average, all other female, male cancer patients, and control patients experience significantly lower intensity of mental burden in the range of 1.83, 2.63 and 3.31, respectively when compared to patients of cervical cancer. The results are robust across all the four treatment effect estimators and through all the measures of mental burden. The implications of suffering from cervical cancer, as a unique gynecological cancer was studied in-depth. An effect size analysis pointed out to the dysfunctional familial relationship as additional causes of concern for cervical cancer patients.

Originality/value

An important finding that emerged is that female cancer patients especially those who have cervical cancer should be given special attention because they appear to be the most vulnerable group. Further work is needed to delineate the reasons behind a cervical cancer patient facing higher amount of stress.

Intimate Partner Violence and Controlling Behaviors Experienced by Emergency Department Patients: Differences by Sexual Orientation and Gender Identification

The objective of this study was to estimate the prevalence of intimate partner violence (IPV) in an emergency department (ED) by sexual orientation and gender identification. We conducted a cross-sectional survey of adult patients (n = 1,136) presenting to a Level I Trauma Center ED from November 2015 to November 2016. Multivariable logistic regression analysis was used to estimate the adjusted odds ratio (aOR) of reporting any IPV or IPV subtypes (physical or sexual IPV or battering) by sexual orientation and gender identification, controlling for confounders. Overall, 11.6% (132 / 1,136) of those surveyed were IPV positive. The prevalence of IPV was significantly higher in lesbian, gay, bisexual, transgender, and questioning (LGBTQ) patients than in heterosexuals (18.3% vs. 10.8%, p = .0151); prevalence was highest among bisexuals (21.6%) and gay men (18.5%). IPV prevalence did not differ significantly in females versus males (13.5% vs. 9.2%, p = .0872). After controlling for age, the odds of reporting any IPV was highest among females (aOR = 1.67; 95% confidence interval [CI] = [1.10, 2.53]); no significant differences were found by sexual orientation. Gay patients (aOR = 5.50; 95% CI = [1.60, 18.94]) and females (aOR = 2.70; 95% CI = [1.46, 9.99]) had significantly higher odds of reporting physical or sexual IPV than heterosexuals and males, respectively. The study is among the first to report IPV prevalence by sexual orientation in an ED patient population. The reported IPV was higher among LGBTQ patients than heterosexual patients although this relationship diminished when controlling for covariates. These data begin to define the scope of IPV among LGBTQ ED patients and may be used to inform brief interventions to reduce the IPV-related morbidity experienced by ED patients.

Expert Perspectives on Intimate Partner Violence Power and Control in Pediatric Healthcare Settings

OBJECTIVE

Childhood exposure to intimate partner violence (IPV) is a pervasive public health epidemic with profound impact on child health. While past work has demonstrated how abusive partners exert control over IPV survivors in a variety of settings (eg workplace, courts, home), scant research has examined how IPV power and control behaviors manifest themselves in pediatric healthcare settings. In this study, we explore the perspectives of pediatric IPV experts about: (1) behaviors used by abusive partners to control IPV survivors in pediatric healthcare settings; (2) how controlling behaviors impact healthcare access and quality; and (3) recommendations for the pediatric healthcare team.

METHODS

Individual semi-structured interviews were conducted with pediatric IPV experts recruited through snowball sampling. Interviews were individually coded by two research team members and analyzed using thematic analysis.

RESULTS

Twenty-eight pediatric IPV experts participated. Participants described several types of controlling behaviors including limiting healthcare access, dominating conversations during medical visits, controlling medical decision making, and manipulating perceptions of the healthcare team. Participants acknowledged the challenges of recognizing controlling behaviors and provided several recommendations to addressing behaviors such as leveraging the expertise of multidisciplinary teams.

CONCLUSIONS

Participants described how abusive partners may attempt to control or discredit their partners in pediatric healthcare settings, using subtle behaviors that may be easily missed by the healthcare team. These results set the stage for further research and clinical practice innovation including triangulating the findings with IPV survivors, examining how frequently these behaviors occur, and developing multidisciplinary IPV training for the pediatric healthcare team.

Violence against women: An observational study in an Italian emergency department

Violence against women is a pervasive phenomenon affecting one in three women aged ≥15 in the world that are more likely to visit an emergency department (ED) for the serious physical and psychological consequences of the abuse. The aim of this observational single-centre study is to describe the socio-demographic and clinical variables associated with violence against women. We enrolled 425 female patients who attended an Italian ED for trauma on 2019 and the patients' information was collected and analyzed with descriptive statistics. The average age of the patients was 41.5 (standard deviation = 14.2) years. 74.6% of the women were Italians, and 86.6% were of metropolitan origin. The reasons for the ED visit included aggression (67.5%), accidental trauma (29.0%) and unknown reasons (3.5%). Multivariate analysis confirmed that three factors were independently associated with violence: nationality (odds ratio [OR] = 0.27; 95% confidence interval [CI], 0.09-0.77), head/face/neck injuries (OR = 7.32; 95% CI, 3.76-14.27) and multiple injuries (OR = 8.52; 95% CI, 1.03-70.47). Age over 25 was a protective factor. The study confirmed that being a foreigner and having head/face/neck injuries or multiple injuries are associated with violence against women.

The impact of the Covid-19 pandemic in the precipitation of intimate partner violence

Intimate Partner Violence (IPV) is a global pandemic and many have been victims of it long before Covid-19. International organizations have documented an increase in IPV reports during the current pandemic, raising awareness of the potential causes for such an increase. Reflecting on risk factors associated with IPV, and the underlying need of the perpetrators to exert control over the victims, it becomes increasingly important to understand how the current policies of social distancing, self-isolation, and lockdown can precipitate episodes of IPV. Furthermore, access to specialized services and health care can be compromised, and health care professionals face new challenges and demands imposed by the pandemic while managing IPV cases. This article begins by examining the main risk factors more commonly associated with IPV in the literature. It proceeds by reflecting on how these risk factors may be exacerbated during the Covid-19 pandemic, which can explain the increased number of reports. Finally, it emphasizes the new challenges faced by health care professionals, while assisting IPV victims during the pandemic and provides possible recommendations on actions to implement during and beyond the Covid-19 pandemic to prevent such cases.

Hand therapists' attitudes, environmental supports, and self-efficacy regarding intimate partner violence in their practice

STUDY DESIGN

Descriptive, cross-sectional.

INTRODUCTION

Intimate partner violence (IPV) may involve physical, psychological, or sexual abuse. Although hand injuries are reported as common sequelae of IPV, there is limited attention to this issue in hand therapy research reports or practice recommendations.

PURPOSE OF THE STUDY

The primary aim is to describe the attitudes and beliefs of hand therapists (HTs) about IPV issues.

METHODS

A sample of 189 HT completed a standardized survey investigating perceptions regarding issues pertaining to IPV. Areas addressed included self-efficacy (in dealing with IPV), perceived systemic support, victim blaming, professional role responsibility, and safety. Data were analyzed using descriptive statistics while between-group comparisons evaluating the impact of prior IPV experience and demographic variables of gender, country, certified hand therapy, and occupation on questionnaire scores used Mann-Whitney U analysis.

RESULTS

The majority of therapists (66%) had some prior experience with IPV. HTs reported neutral perceptions about self-efficacy (M = 2.9/5), client or personal safety (M = 3/5), and support systems available when addressing IPV in practice (M = 3/5). However, therapists considered intervening as part of their professional role (M = 3.8/5) and reported low levels of victim-blaming attitudes (M = 4.4/5). Those with firsthand IPV experience reported lower victim blaming (mdn = 4.9/5 vs 4.6/5, P = .02). Additionally, females were less likely to blame victims of IPV than males (mdn = 4.7/5 vs 4.3/5, P = .003).

DISCUSSION

Although Hand Therapists believe their professional role includes addressing IPV, confidence to deal with IPV, access/awareness of resources and perceived safety were substantive barriers.

CONCLUSION

Continuing research should identify effective tools to educate and assist therapists to identify and support victims of IPV in hand therapy.

Telling Medical Professionals About Victimization by Intimate Partner: Analysis of Women Surviving Intimate Partner Violence

This study investigated factors in women’s disclosure of intimate partner violence (IPV) to medical professionals. Its sample of 3,226 women surviving IPV was extracted from the National Intimate Partner and Sexual Violence Survey public-use dataset, dated 2010. The dichotomous outcome variable was told medical professional about IPV. Explanatory variables were physical violence experienced in the past year, need for medical services for IPV, injury, fear, poor physical health, number of health problems, poor mental health, African American, Latina, other ethnic minority, education, family income, inability to afford seeing doctor, age, and being married. Logistic regression results showed likelihood of IPV disclosure increased with 31 or more physical IPV episodes in preceding year, needed medical services for IPV, IPV-related injury, 2 or more health problems, fear of partner, poor mental health, inability to afford seeing doctor, and age 55 and over. Disclosure likelihood was decreased by other ethnic minority and absence of high school graduation. Our findings support standardized protocols identifying recent IPV, IPV injury, and multiple health problems, along with corresponding response training for medical professionals. Our findings also support making victim advocates and behavioral health specialists available in medical facilities to address patients’ fears and mental health.

Psychological treatments for depression among women experiencing intimate partner violence: findings from a randomized controlled trial for behavioral activation in Goa, India

Intimate partner violence (IPV) strongly predicts depression, but it is unknown if women experiencing IPV can benefit from depression treatments in contexts where depression and IPV are prevalent. This study explored whether women experiencing IPV in Goa, India, can benefit from the Healthy Activity Program (HAP), a culturally adapted behavioral activation treatment, compared with enhanced usual care (EUC). Cross-sectional and longitudinal analyses were performed on data from a clinical trial. Measures assessed at baseline and 3 and 12 months included depressive symptoms. Measures assessed at 3 and 12 months included activation and IPV. Independent t tests were conducted to assess if participants experiencing IPV had higher depressive symptoms and lower activation at 3 and 12 months; hierarchical linear regression was conducted to determine if 3-month IPV predicted 12-month depressive symptoms across trial arms (Hypothesis 1). Hierarchical linear regression was then conducted to examine if the relationship between 3-month activation and 12-month depressive symptoms was moderated by 3-month IPV within each trial arm (Hypothesis 2). As expected, participants experiencing IPV had significantly lower activation levels and higher depressive symptoms compared with participants who did not experience IPV at 3 and 12 months in cross-sectional analyses. Similarly, IPV endorsed at 3 months significantly predicted depressive symptoms at 12 months. However, activation was significantly associated with less severe depressive symptoms at 12 months, irrespective of IPV endorsement among HAP participants. For EUC participants, IPV remained the only significant predictor of depressive symptoms at 12 months. Results suggest that women experiencing IPV can still benefit from behavioral activation.

Intimate Partner Violence Experiences Among Men Living with HIV in Rural Appalachia

There has been limited study of the syndemic link between HIV and intimate partner violence (IPV) among rural populations in the United States. We utilized the Revised Conflict Tactics Scale-2 to examine the past year prevalence, type (psychological aggression, physical assault, and sexual assault), and the impact of IPV on HIV clinical outcomes among men living with HIV in rural Appalachia. Approximately 39% of participants experienced some type of IPV in the preceding year, with 67% of those individuals experiencing more than 1 type of IPV. Approximately 77% of participants endorsing IPV exposure experienced psychological aggression. Most participants exposed to psychological aggression (70%) and/or physical assault (57%) were both victims and perpetrators, and those experiencing sexual assault reported being exclusively victims (65%). There were no significant differences in clinical outcomes including viral load and CD4 count, which may be secondary to small sample size derived from a clinic population with a high rate of virologic suppression (94%). This study demonstrates the need to assess IPV exposure in men living with HIV and further highlights the intricacies of relationship violence in these individuals.

Health and Health Care From the Perspective of Intimate Partner Violence Adult Female Victims in Shelters: Impact of IPV, Unmet Needs, Barriers, Experiences, and Preferences

Intimate partner violence (IPV) predicts poor health for victims and their children, but little is known about the perspective of victims. This study reports the perspectives of adult female IPV victims about the impact of IPV on their health and barriers of health care access for themselves and their children. The majority rated their health as good to excellent (69%). However, 83.5% indicated that IPV negatively affected their health; 53.5% had unmet health care needs. Mental health care was the most common unmet need for women; children's unmet needs were immunizations and preventive care. Transportation difficulties posed the biggest barrier to health care access.

Establishing the Prevalence of Intimate Partner Violence Among Hair Salon Clients

This study determined prevalence of intimate partner violence (IPV) victimization among female clients at three hair salons in Connecticut using an anonymous tablet based screening tool. While many may assume that women receive services at hair salons, victims of IPV are often isolated by their partners and unable to access help. Of the 203 clients who participated, 40 (20%) had experienced IPV in her lifetime. In identifying the prevalence of IPV within the salon setting, this study provides support for community-based programs and supports their legitimacy as an important locus for identifying women experiencing IPV and connecting them to resources.

Predictors of HIV-related risk perception and PrEP acceptability among young adult female family planning patients

HIV pre-exposure prophylaxis (PrEP) presents new opportunities for HIV prevention. While women comprise approximately 20% of new HIV infections in the US, significant questions remain about how to most effectively facilitate PrEP uptake for this population. Family planning clinics are a dominant source of health care for young women and support an estimated 4.5 million women annually. We explore characteristics associated with HIV risk perception and PrEP acceptability among young adult women seeking reproductive health services in a high-prevalence setting. A cross-sectional, clinic-based survey was conducted with women ages 18-35 (n = 146) seeking health care at two family planning clinics in the greater Baltimore, Maryland area, from January to April 2014. An estimated 22% of women reported being worried about HIV risk, and 60% reported they would consider taking a pill daily to prevent HIV. In adjusted models, HIV-related worry was associated with having no college education, being single or dating more than one person, practicing consistent condom use during vaginal sex, and having ever traded sex. PrEP acceptability was significantly associated with being Black (71% vs. 49%, AOR 2.23, CI: 1.89-2.64) and having ever traded sex (83% vs. 58%, AOR 4.94, CI: 2.00-12.22). For women with a history of intimate partner violence (IPV), PrEP acceptability was significantly lower (57% vs. 62%, AOR .71, CI: .59-.85) relative to their non-abused counterparts. Results suggest that family planning clinics may be a natural setting for PrEP discussion and roll-out. They should be considered in the context of integrating HIV prevention with reproductive health services. Women with a trauma history may need additional support for implementing HIV prevention in the form of PrEP.

What is the role of health systems in responding to domestic violence? An evidence review

Objective The aim of the present study was to review and analyse academic literature and program evaluations to identify promising evidence for health system responses to domestic violence in Australia and internationally. Methods English-language literature published between January 2005 and March 2016 was retrieved from search results using the terms ‘domestic violence’ or ‘intimate partner violence’ in different combinations with other relevant terms, resulting in 1671 documents, of which 59 were systematic reviews. Electronic databases (Medline (Ovid), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Psycinfo, Social work Abstracts, Informit, Violence and Abuse Abstracts, Family Studies Abstracts, Cochrane Library of Systematic Reviews and EMBASE) were searched and narrative analysis undertaken. Results This review details the evidence base for the following interventions by health services responding to domestic violence: first-line responses, routine screening, risk assessment and safety planning, counselling with women, mother–child interventions, responses to perpetrators, child protection notifications, training and system-level responses. Conclusions There is growing evidence for the effectiveness of health service interventions to reduce the extent of harm caused by domestic violence. What is known about the topic? Domestic violence is a significant problem globally with enormous human, social and economic costs. Although women who have experienced abuse make extensive use of healthcare services, health services have lagged behind the policing, criminal justice and other human service domains in responding to domestic violence. What does this paper add? The present comprehensive review identifies best-practice health system responses to domestic violence. What are the implications for practitioners? Health systems can play a key role in identifying and responding to domestic violence for women who often do not access other services. There is growing evidence for the effectiveness of health service interventions to reduce the extent of harm caused by domestic violence, in particular for specialist counselling, structured risk assessment and safety planning, training for first-line responses and interventions for mothers and children affected by domestic violence.

An intimate partner violence informational program in a hospital fracture clinic: a pre-test post-test intervention study

Background:

Many organizations have conducted Intimate Partner Violence (IPV) informational campaigns, but the extent to which such cost-effective, simple changes to the clinic environment can improve patient perceptions about IPV is largely unknown. Our primary objective was to determine how an IPV informational program affects patients’ perceptions about discussing IPV in a fracture clinic setting.

Methods:

We conducted a pre-post intervention study to evaluate the impacts of an IPV informational program on patients’ perceptions and willingness to discuss IPV in an orthopaedic fracture clinic setting. During the intervention phase, there were posters and brochures in each bed area and several places in the waiting area, and the surgeons received a button to wear on their lab coat stating their openness to discuss IPV and a set of instructions on how to ask patients about IPV and refer them to resources.

Results:

A total of 160 patients (80 pre-intervention and 80 post-intervention) have participated in this study. Overall perception of the clinic as an open place in which to discuss IPV did not change as a result of the informational program compared to the control setting. However, more patients exposed to posters and information about IPV believed the clinic staff possessed resources to help IPV victims compared to the control group; however, this difference did not reach statistical significance (62% vs. 53%, respectively, p=0.29).

Conclusions:

Passive interventions may serve an adjunctive role in facilitating active interventions in a clinic environment, but should not be considered in isolation as an effective approach.

Altered Eating Behaviors in Female Victims of Intimate Partner Violence

Little is known about altered eating behaviors that are associated with the experience of intimate partner violence (IPV) victimization. Our aim was to explore the experiences and perspectives of IPV victims regarding their eating behaviors and their attitudes toward and use of food. We conducted focus groups and individual interviews with 25 IPV victims identified at a domestic violence agency and asked them about their eating behaviors and how, if at all, these behaviors related to their experience of IPV. Qualitative analysis of the transcribed encounters identified themes explicating the relationship between their eating behaviors and experiences of IPV. All women described altered eating behaviors related to IPV that were categorized into several major themes: (a) somatization (victims experience significant somatic symptoms as a result of abuse); (b) avoiding abuse (victims modify their eating behaviors to avoid abuse); (c) coping (victims use food to handle the psychological effects of abuse); (d) self-harm (victims use food to hurt themselves as a reaction to the abuse); and (e) challenging abusive partners (victims use their eating behaviors to retaliate against their abusers). IPV can provoke altered eating behaviors in victims that may be harmful, comforting, or a source of strength in their abusive relationships. Understanding the complex relationship between IPV and victims' altered eating behaviors is important in promoting healthy eating among victims.

Screening at hair salons: The feasibility of using community resources to screen for intimate partner violence

BACKGROUND

Intimate partner violence (IPV) is a source of severe health consequences, and therefore, health care organizations have recommended routine IPV screening. Implementing health-related screenings outside of health care facilities is common public health practice, but to date, IPV screening in hair salons has not been reported. The objective of this study was to determine the prevalence of IPV among women at hair salons. We hypothesized that women would disclose IPV in this setting and that rates of abuse would reflect national averages.

METHODS

We recruited a convenience sample of hair salons in Connecticut in 2014. Hair stylists were trained on how to recognize and refer IPV victims. Self-reported IPV of salon clients was measured by a tablet-based validated screening tool, the Patient Satisfaction and Safety Survey.

RESULTS

Overall, reported past-year prevalence of physical abuse was 3.6%, past-year prevalence of sexual abuse was 2.7%, lifetime prevalence of emotional or physical abuse was 34.2%, and 5.3% of the sample reported that they had been hurt that day by their current or former partner. Past-year physical abuse was more common among women 30 years to 39 years old (9.1%), black (9%), and single women (7.5%). Past-year sexual abuse was more common among women 20 years to 29 years old (13.8%), other races (6.7%), and single women (5.4%). Lifetime abuse was more common among women 50 years to 59 years old (13.8%), black (36.1%), and divorced women (69.7%). Hurt-today abuse was more common among women younger than 20 years (12.5%), other races (13.3%), and women in common law relationships (25%).

CONCLUSION

Women in our study reported IPV prevalence rates consistent with national data. Documentation of IPV prevalence in hair salons will provide much-needed support for novel interventions such as CUT IT OUT, a national program designed to train hair stylists on how to recognize and refer IPV victims.

The Potential of Pre-Exposure Prophylaxis for Women in Violent Relationships

HIV and intimate partner violence (IPV) are significant intersecting threats to women's health. Women in violent relationships have few feasible HIV risk reduction options as traditional prevention methods are largely dependent on a partner's cooperation. The purpose of this review is to explore potential benefits and drawbacks of pre-exposure prophylaxis (PrEP) use among women in the United States experiencing IPV. Advantages of PrEP use in this population include the potential for covert or autonomous use, coital independence, dual protection against sexual and injection risk, and facilitated connections to social services. A number of barriers, however, may interfere with the effective use of PrEP, including partner resistance, cost, frequent medical visits, gendered norms regarding sexuality, and stigma. To realize its potential for women in violent relationships, it will be necessary to incorporate PrEP into behavioral and structural interventions that encourage uptake, facilitate adherence, ensure women's safety, and challenge existing gender norms.

The Clinical and Radiological Examination of Acute Intimate Partner Violence Injuries: A Retrospective Analysis of an Italian Cohort of Women

BACKGROUND

Intimate partner violence (IPV) is the most frequent type of violence against women. We compared clinical and radiological IPV characteristics to stranger assault (SA).

METHODS

We retrospectively identified 123 women with IPV from court reports and matched them to 124 SA. Clinical and radiological characteristics were evaluated by testing their sensitivity, specificity, positive and negative predictive value for IPV, and the strength of their association with IPV.

RESULTS

IPV women referred with more delay to the emergency department (ED), had more ED accesses, and showed more mismatch between reports to the triage and disclosures to the ED physician. They also displayed more head, neck, and face injuries, and new-plus-old fractures.

CONCLUSION

The identification of specific features may help ED physicians to suspect IPV.

Racial Disparities in Intimate Partner Violence and in Seeking Help With Mental Health

Applying Aday and Andersen's health services utilization model, this examination of racial disparities in women's experience of intimate partner violence also looked at racial disparities in mental disorders and in use of mental health professionals' help. We conducted a secondary data analysis of 6,589 women completing the National Violence Against Women Survey. Per our linear regression results, minority women, versus White, tended proportionally to seek less help from mental health professionals. Help seeking by African American women was less likely if they were using illegal drugs; among Hispanic women, additional threats from partner curtailed help seeking from mental health professionals. "Other ethnic minority" women's help seeking decreased with their use of stimulants. Implications for intervention are discussed.

Intimate partner violence: prevalence, health consequences, and intervention

Intimate partner violence (IPV) can be defined in many ways and encompasses many different types of physical and emotional abuse. IPV affects the health, safety, and quality of life for women, men, and children worldwide, regardless of race, sexual orientation, or socioeconomic status. The health effects include acute trauma; a wide range of physical and mental sequelae; and, for some, death. Because of the serious consequences of IPV, both the Centers for Disease Control and the World Health Organization identify IPV as a significant public health issue.

Domestic Violence and Treatment Seeking: A Longitudinal Study of Low-Income Women and Mental Health/Substance Abuse Care

A study with 591 low-income women examined domestic violence's role in treatment seeking for mental health or substance abuse problems. (The women resided in one of two California counties.) Following Aday's behavioral model of health services utilization, the secondary data analysis considered the women's need, enabling, and predisposing factors. Generalized estimating equations analyzed the women's longitudinal records of treatment seeking. Results showed that those in the sample who were likely to seek treatment had experienced three or more controlling behaviors and only one abusive behavior. Multivariate data analysis showed treatment-seeking women were likely to be white and older; responsible for few dependent children; not graduates of high school; employed; not participating in Medicaid; diagnosed; and perceiving a need for treatment. The implications of these results for services and policies are discussed.

Women's intimate partner violence perpetration during pregnancy and postpartum

The purpose of this longitudinal study was to examine the prevalence of women's psychological, minor physical, and severe physical intimate partner violence (IPV) perpetration during the first 18 weeks of pregnancy and at 6 weeks postpartum and to compare women who used each type of IPV to those who did not. Women who increased their IPV perpetration over time were also compared to women who decreased or did not change their IPV perpetration over time. A sample of 180 women participated in a larger study of the well-being of pregnant women. Data were collected via self-report survey and 122 participants were retained at follow-up. At both time points, more women in the sample reported IPV perpetration (baseline n = 132; follow-up n = 73) than IPV victimization (baseline n = 114; follow-up n = 66). Women who perpetrated IPV reported higher levels of IPV victimization, reported partner alcohol misuse, stress, depression, and lower dyadic adjustment compared to women who did not. Women's IPV perpetration was associated with several negative outcomes. Findings suggest that IPV screening during pregnancy and postpartum should include women's IPV perpetration and should be conducted at multiple time points, since women's IPV experiences may change over time.

Prevalence of Intimate Partner Violence Across Medical and Surgical Health Care Settings

Intimate partner violence (IPV) is a serious health problem and a leading cause of nonfatal injury in North American females. Prevalence of IPV has ranged from less than 20% to more than 50% across primary care, emergency medicine, and family medicine. We conducted a systematic review and meta-analysis of the literature to examine best estimates of IPV prevalence as opportunities for targeted interventions in health care specialties. We included 37 articles in this study. Based on our pooled data, best estimates of the lifetime prevalence of any type of IPV were 38% in family medicine and 40% in emergency medicine.

Predictors of change in mental health and distress among women attending a women's shelter

BACKGROUND

Intimate partner violence (IPV) is detrimental to mental health. The Domestic Violence Survivor Assessment (DVSA), which includes a mental health assessment, is often used to evaluate abuse survivors in a counseling situation. The DVSA seeks to outline the cognitive state of women as per the stages of change as they attempt to move toward a life with no IPV.

OBJECTIVE

The objective of this study was to explore predictors of change in mental health and distress among women who entered a women's shelter more than once.

METHODS

Women entering a women's shelter more than once over a 3-year period were assessed by a trained social worker using the DVSA. A logistic regression analysis examined relationships between the chosen characteristics and the participants' mental health through the DVSA stages of change.

RESULTS

We analyzed complete data for 94 women who entered the shelter a mean of 3.3 times (range 2-8) over a mean period of 16.1 days (range: 1-391). Thirty-six women (36/94; 38.3%) progressed through the stages. The average number of visits among women who progressed through the stages was 4. Our multivariable logistic regression showed women who had more visits to the shelter were almost twice as likely to progress through the stages compared to women who entered the shelter fewer times (OR=1.928; 95% CI=1.292-2.877; p=0.001). In the univariate analysis, only increased number of visits was significantly associated with progressing through the stages of change (OR=1.694; 95% CI=1.237-2.322; p=0.001). The other factors were not significantly associated with a change in mental health and distress (p>0.05).

CONCLUSION

Women who enter women's shelters more frequently may be more likely to progress through the DVSA mental health stages compared to other women. Women's shelters may be helpful in assisting progression through the stages of change, thereby improving their mental health after abuse.

How many Slovenian family practice attendees are victims of intimate partner violence? A re-evaluation cross-sectional study report

Background

Intimate partner violence (IPV) can be considered a leading public health problem affecting approximately 50% of women during the course of their lifetimes. This study was carried out with the aim of re-testing the prevalence data and providing sufficient grounds for decision-makers in family medicine in Slovenia to adopt much-needed protocols for IPV management in the field.

Methods

In January 2012, every tenth general practitioner (GP) registered in Slovenia, of a total of 958, was invited to participate in a multi-centre cross-sectional study, and 9.4% of them, working in 90 family practices, agreed to participate. From February 1 to March 1, 2012, they asked every fifth family practice attendee aged 18 years and above, regardless of gender, to participate in the study. The short version of Domestic Violence Exposure Questionnaire was administered to 2572 patients.

Results

In the sample, there were more women (62.9% (n = 1617)). The average age of all the participants was 49.0 ± 16.1 years. Of 2572 participants (95.3% response rate), 17.1% people had been exposed to either emotional or both physical and emotional abuse. The prevalence of psychological violence was 10.3%, and that of concurrent physical and psychological abuse 6.8%, with all the patients exposed to physical IPV disclosing concurrent psychological violence. Female gender and previous formal divorce were risk factors identified in all three multivariate logistic regression models. The odds of concurrent physical and psychological and either type of IPV exposure in patients were lessened by an age of 65 years or above. The odds for either type of IPV were also lower in single people, while in concurrent physical and psychological IPV exposure, living in urban settings acted as a protective factor.

Conclusions

In Slovenian family practice attendees, an IPV exposure prevalence of approximately 17% should be considered a valid estimation.

Barriers to and facilitators for screening women for intimate partner violence in surgical fracture clinics: a qualitative descriptive approach

Background

Intimate Partner Violence (IPV) is a major health issue that involves any physical, sexual or psychological harm inflicted by a current or former partner. Musculoskeletal injuries represent the second most prevalent clinical manifestation of IPV. Health care professionals, however, rarely screen women for IPV. Using qualitative methods, this study aimed to explore the perceived barriers to IPV screening and potential facilitators for overcoming these barriers among orthopaedic surgeons and surgical trainees.

Methods

We conducted three focus groups with orthopaedic surgeons, senior surgical trainees, and junior surgical trainees. A semi-structured focus group guide was used to structure the discussions. Transcripts and field notes from the focus groups were analyzed using the qualitative software program N’Vivo (version 10.0; QSR International, Melbourne, Australia). To further inform our focus group findings and discuss policy changes, we conducted interviews with two opinion leaders in the field of orthopaedics. Similar to the focus groups, the interviews were digitally recorded and transcribed, and then analyzed.

Results

In the analysis, four categories of barriers were identified: surgeon perception barriers; perceived patient barriers; fracture clinic barriers and orthopaedic health care professional barriers. Some of the facilitators identified included availability of a crisis team; development of a screening form; presence of IPV posters or buttons in the fracture clinic; and the need for established policy or government support for IPV screening. The interviewees identified the need for: the introduction of evidence-based policy aiming to increase awareness about IPV among health care professionals working within the fracture clinic setting, fostering local and national champions for IPV screening, and the need to generate change on a local level.

Conclusions

There are a number of perceived barriers to screening women in the fracture clinic for IPV, many of which can be addressed through increased education and training, and additional resources in the fracture clinic. Orthopaedic health care professionals are supportive of implementing an IPV screening program in the orthopaedic fracture clinic.

Prospective association of intimate partner violence with receipt of clinical preventive services in women of reproductive age

BACKGROUND

Women who experience intimate partner violence (IPV) have a greater risk for adverse health outcomes, suggesting the importance of preventive services in this group. Little prior research has explored how IPV exposure impacts receipt of relevant preventive services. We assess the prospective association of IPV exposure with receiving specific preventive services.

METHODS

Women in the Central Pennsylvania Women's Health Study's longitudinal cohort study (conducted 2004-2007; n = 1,420) identified past-year exposure to IPV at baseline and receipt of IPV-relevant preventive services (counseling for safety and violence concerns, tests for sexually transmitted infections [STIs], counseling for STIs, Pap testing, counseling for smoking/tobacco use, alcohol/drug use, and birth control) at 2-year follow-up. Multiple logistic regression analysis assessed the impact of IPV on service receipt, controlling for relevant covariates.

FINDINGS

Women exposed to IPV had greater odds of receiving safety and violence counseling (adjusted odds ratio [AOR], 2.40; 95% confidence interval [CI], 1.25-4.61), and tests for STIs (AOR, 2.46; 95% CI, 1.41-4.28) compared with women who had not been exposed to IPV. Independent of other predictors, including IPV, women who saw an obstetrician-gynecologist were more likely to receive Pap tests, STI/HIV testing and counseling, and birth control counseling, compared with women who had not seen an obstetrician-gynecologist.

CONCLUSION

Overall rates of preventive service receipt for all women in the sample were low. Women exposed to IPV were more likely to receive safety and violence counseling and STI testing, and seeing an obstetrician-gynecologist increased the odds of receiving several preventive services.

Intimate partner violence and welfare participation: a longitudinal causal analysis

This longitudinal study examined the temporal-ordered causal relationship between intimate partner violence (IPV), five mental disorders (depression, generalized anxiety disorder, social phobia, panic attack, posttraumatic stress disorder [PTSD]), alcohol abuse/dependence, drug abuse/dependence, treatment seeking (from physician, counselor, and self-help group), employment, child support, and welfare participation. It was a secondary data analysis of records of 571 women; the records were extracted from the study "Violence Against Women and the Role of Welfare Reform" (VAWRWR). Results from generalized estimating equations (GEE) showed that experiencing controlling behaviors reduced likelihood of welfare participation whereas experiencing physical abuse increased it. Significant impact on welfare participation was wielded by panic attack, drug abuse/dependence, and employment; treatment seeking and child support made no significant impact. The study found no significant mediating effect wielded by panic attack, drug abuse/dependence, employment, or child support on welfare participation's relationship to controlling behaviors or physically abusive behaviors experienced. Implications for intervention are discussed.

Barriers to recommended gynecologic care in an urban United States HIV clinic

BACKGROUND

Despite an increased risk for cervical cytologic abnormalities, HIV-infected women frequently miss their gynecology appointments. We examined barriers to adherence with gynecologic care in an urban HIV clinic.

METHODS

We conducted a cross-sectional survey of 200 women receiving gynecologic services in an urban HIV clinic, followed by focus groups. Primary outcomes included (1) missed gynecology appointments and (2) receipt of a Pap smear in the previous year. Independent variables included sociodemographic characteristics, child care responsibilities, substance use, depressive symptoms, social support, interpersonal violence, CD4 count, and HIV-1 RNA. We conducted multivariable logistic regression to examine associations between independent variables and outcomes. We then held two focus groups designed to gather opinions on and increase our understanding of the key findings from the survey.

RESULTS

Of 200 women, 69% missed at least one gynecology appointment, and 22% had no Pap smear in the past year. In logistic regression, moderate (odds ratio [OR] 3.1, 95% confidence interval [CI] 1.4-6.7) and severe (OR 3.1, 95% CI 1.3-7.5) depressive symptoms and past-month substance use (OR 2.3, 95% CI 1.0-5.3) were associated with missing an appointment in the prior year. An education level of less than high school (OR 0.3, 95% CI 0.1-0.6) compared with high school diploma or greater was associated with not having a Pap smear in the previous year. When analyses were limited to women with a cervix (n = 166), moderate (OR 2.5, 95% CI 1.1-5.7) and severe (OR 2.5, 95% CI 1.0-6.3) depressive systems remained significantly associated with missing a gynecology appointment in the previous year and age >50 (OR 0.3, 95% CI 0.1-0.9), an HIV-1 RNA > 50 (OR 0.4, 95% CI 0.2-0.9), and education level less than high school (OR 0.2, 95% CI 0.1-0.5) were associated with not having a Pap smear in the past 12 months. Qualitative analysis of the focus group data suggested that fear, inclement weather, and forgetting appointments may contribute to missed gynecology appointments.

CONCLUSION

Gynecologic healthcare is underused among HIV-infected women. We found that depressive symptoms, substance use, fear of the gynecologic examination, and simply forgetting about the appointment may be barriers to gynecologic care. Interventions targeting these barriers may improve use of gynecologic care among this population.