Intimate partner violence in Nepal: Latent patterns and association with depressive symptoms

Concurrent Intimate Partner Violence: Survivors' Health and Help-Seeking

This study examined intimate partner violence patterns using the National Intimate Partner and Sexual Violence Survey, a nationally representative sample collected in 2010. The latent class analysis detected six distinctive patterns: Sexual Violence, Psychological Aggression, Multiple Violence, Coercive Control, Physical and Psychological Violence, and Stalking. Multiple Violence was the most common among males, while Coercive Control was the most common among females. Multiple Violence and Physical and Psychological Violence perpetrators inflicted more negative health consequences than the other types. Intervention and prevention approaches that consider perpetrator types as a part of survivor need assessments will improve services.

Mental health outcomes of physical, sexual, and psychological intimate partner violence among women in Turkey: A latent class study

Intimate partner violence (IPV) is a severe human right violation and a significant public health problem in Turkey. However, its complexity and stratified relationship with mental health problems are still uncovered in this under researched community, as violence is often approached as a uniform health and social problem. In this study, we collected data from 539 female adults in heterosexual relationships in Turkey using convenience and snowball sampling. The aim was to examine violence-related clusters and their association of these clusters with mental health outcomes, including depression, anxiety, and depression). We assessed whether participants experienced physical, sexual, and psychological violence in their intimate relationships and conducted a latent class analysis. We obtained five violence clusters: (1) no or low violence, (2) high psychological violence, (3) jealous control with physical violence, (4) moderate sexual and psychological violence, and (5) severe physical, sexual, and psychological violence. Analyses of variance showed that women who experienced multiple forms of IPV reported stronger depression, anxiety, and somatization compared with women in the no or low violence class. Additionally, they reported greater depression and anxiety compared with women who experienced only high psychological IPV. However, psychological violence amplified somatization as much as physical and sexual violence.

Patterns of Women's exposure to psychological violence: A global examination of low- and middle-income countries

Introduction

Under Sustainable Development Goal 5, prevalence of intimate partner violence (IPV) is a globally reportable indicator. There is a lack of consensus on how to measure and report psychological IPV, affecting prevalence estimates and cross-country comparability. We examine similarities and differences in the patterning of women's experiences of psychological abuse in low- and middle-income countries (LMICs) to inform common cut points.

Methods

Data include 13,452 ever-partnered women from six LMICs participating in the WHO multi-country study on women's health and domestic violence against women and 306,101 from 47 LMICs participating in the Demographic and Health Surveys. A confirmatory latent class analysis (LCA) approach was applied to identify the optimal class structure using the 3 DHS and 4 WHO psychological IPV items, assessed the impact of physical and sexual IPV on class structure, and tested class generalizability across countries. We validated the three-class solution by regressing the classes on physical IPV, sexual IPV, controlling behaviors, and injury due to domestic violence. We used item response theory (IRT) methods to assess item-level characteristics of the items.

Results

Analysis confirmed the three-class structure in most countries. Addition of physical and sexual IPV did not change overall class structure or improve discrimination or homogeneity of the items. The three-class structure was invariant within most WHO-classified regions. Operationalized classes informed by the LCA resulted in prevalences of roughly 90% low-to-no class, 7% moderate-intensity class, and 3% high-intensity class. Classes showed convergent validity with all outcomes tested. IRT analysis revealed good discriminations but substantial information overlaps over a narrow range of the latent psychological violence construct.

Conclusions

This study confirms the three-class pattern but suggests some differences across countries. and regions. We suggest cut points distinguishing violent from non-violent acts and demarcating levels of severity for future study. Findings offer evidence-based guidance to rectify challenges.

Profiles of Intimate Partner Violence Victimization: A Systematic Review

Person-centered approaches, such as latent class analysis (LCA) and latent profile analysis (LPA), aid the identification of subgroups within sample populations. These methods can identify the patterns of co-occurrence between different forms of intimate partner violence (IPV), providing valuable information for prevention and intervention efforts. The aim of this systematic review was to yield a summary and conduct a critical evaluation of the current research that utilizes LCA/LPA to investigate IPV victimization profiles. We provide an outline of 14 relevant studies, retrieved from searches conducted on PsycInfo, Scopus, and Eric databases. There was a large amount of variability in relation to the forms of IPV assessed, measures utilized, number of classes identified, and the sample populations recruited. However, broad similarities were revealed as there were some commonly identified classes, including the no/low violence class, the physical and psychological victimization class, and the multiple victimization class, yet the labels assigned to those classes differed across studies. A range of external criteria (risk factors and consequences) were also identified as being associated with class membership. We highlight the methodological features which may have impacted data collection and class enumeration, including the differences in sample population, the range of IPV indicators assessed, the time period from which IPV data were recorded, and whether data were collected regarding participants' current or previous relationships. Marginalized populations were underrepresented, and psychological abuse was most inconsistently operationalized. Recommendations for future research are provided, including recommendations with regard to labeling the classes for greater consistency across studies.

Intimate Partner Violence Polyvictimization and Health Outcomes

This study examines how gender interacts with polyvictimization patterns in survivors' health problems using 8,587 survivors of intimate partner violence from the National Intimate Partner and Sexual Violence Survey, a nationally representative sample collected in 2010. Polyvictimization included six categories that were created in our previous work: sexual violence, physical and psychological violence, coercive control, multiple violence, stalking, and psychological aggression. Multiple violence was associated with chronic pain, headache, difficulty sleeping, and poor health perception. Females experiencing coercive control were more likely to have chronic pain than males. The appropriate assessment of gendered patterns of polyvictimization, and relevant subsequent services and support will better address health problems among survivors.

Association between intimate partner violence and nutritional status among Indian women: a latent class analysis approach

BACKGROUND

Intimate partner violence (IPV) is an unabating public health issue that has numerous negative repercussions for women's health. Its detrimental impact on women's nutritional outcomes has been documented in a few studies from low- and middle-income countries; however, there is a lack of granular understanding in terms of the typology of IPV experiences and their association with nutritional outcomes. This study explores the distinct classes of IPV experience among women in India and examines how these classes are associated with their nutritional outcomes.

METHODS

Using data of 60,622 ever-married women aged 15-49 years from the 2019-21 National Family Health Survey (NFHS-5), latent class analysis (LCA) was performed to identify distinct groups of women based on their IPV experiences. BMI was used to assess women's nutritional status, and it was classified as: <18.5 kg/m2 (underweight), 18.5-24.9 kg/m2 (normal) and ≥ 25.0 kg/m2 (overweight). Further, multinomial logistic regression analyses were used to estimate the odds of being underweight or overweight by latent classes of IPV experiences.

RESULTS

LCA model identified four distinct IPV experience groups of women: Low Physical and Low Sexual IPV (LPLS-IPV) class (72%); High Physical and Low Sexual IPV (HPLS-IPV) (12.5%); High Sexual and Low Physical IPV (HSLP-IPV) (12%); and High Physical and High Sexual (HPHS-IPV) class (3.5%). The likelihood of being underweight was higher among women in the HPHS-IPV class (aOR: 1.24, 95% CI: 1.08-1.44), followed by those in the HPLS-IPV class (aOR: 1.11, 95% CI: 1.04-1.20).

CONCLUSION

The latent class groups found that high physical IPV experiences were associated with women's nutritional outcomes. The experiences of women having both high physical and sexual violence affect women's nutritional outcomes to a greater extent and they are more likely to be undernourished.

Women's experiences of economic coercion and depressive symptoms in Matlab, Bangladesh

Prior studies of the association between intimate partner violence (IPV) and depressive symptoms have typically excluded economic coercion (EC), a prevalent form of IPV worldwide. Here, we used structural equation models (SEM) to estimate the association of EC with depressive symptoms, with and without adjustment for physical/psychological/sexual IPV, among women in rural Matlab, Bangladesh. Data were collected from cross-sectional surveys with married women 15-49 years, conducted between November 2018 and January 2019. Prior-week depressive symptoms were measured using the 10-item Centre for Epidemiologic Studies Depression short-form. Lifetime EC was assessed using a bi-dimensional, 36-item scale developed in Matlab. Lifetime physical/sexual/psychological IPV was assessed using the 20-item WHO Domestic Violence module. Covariates were age, age at marriage, and schooling; partner's schooling; and household wealth. Among 929 women, lifetime experience of EC ranged from 41.9% (control over access to work, schooling, and training) to 50.0% (control over use/maintenance of economic resources), while any lifetime physical/psychological/sexual IPV was 89.5%. Coercion involving the use and maintenance of economic resources had a significant, adjusted association with depressive symptoms (standardized coefficient = 0.491, p<0.001, R2=0.221). The standardized association of any physical/psychological/sexual IPV with depressive symptoms, adjusted for covariates and cluster sampling, was 0.346 (p <0.001, R2=0.143). When further adjusted for the two measures of EC, the association was attenuated and non-significant (0.049, p = 0.817). These findings suggest that EC is prevalent, significantly associated with depressive symptoms, and attenuates the association of other forms of IPV with depressive symptoms. Addressing EC with other forms of IPV may be necessary to reduce depressive symptoms in exposed women.

Impact of the Change Starts at Home Trial on Women's experience of intimate partner violence in Nepal

Intimate partner violence (IPV) affects 1 in 3 women worldwide. Research in low- and middle-income countries suggests that multicomponent interventions incorporating media, group work, and community mobilization may be effective at changing social norms that enable such violence. Our study aimed to evaluate the impact of a radio programme plus community engagement versus radio programming alone on the 12-month prevalence of IPV. Using a cluster randomized, repeat cross-sectional, single-blinded approach, thirty-six village communities were pair-matched within three districts in Nepal and randomly assigned to either control or intervention. Both groups were exposed to social behaviour change communication through radio programming. In addition, weekly listening and discussion groups (LDGs) were formed in intervention communities to meet and discuss radio programming over the 40-week intervention period. Participants were also exposed to other community mobilization activities such as street theatre and messaging from local leaders who were engaged in intervention programming. IPV was measured at baseline, 12 months post-baseline at program conclusion, and 28 months post-baseline using a simple random sample of 40 married women per cluster (n = approximately 1440 at each time point) along with 382 women who participated in the LDGs. Although control and intervention groups were demographically similar, baseline rates of IPV were higher in control areas. The trend in IPV for both groups was nonlinear, largely declining at midline (control condition) and rising again at endline (control and intervention conditions), possibly reflecting greater reporting due to awareness-raising activities. Significant differences between the two groups were largely absent at endline. Higher LDG attendance was associated with decreases in several forms of IPV, some of which persisted to endline. These findings suggest that intensive community engagement over longer timespans or social network measurement may be necessary to detect significant changes at the community level (NCT02942433).