Angry wives, abusive husbands: relationship between domestic violence and psychosocial variables

Development and validation of a brief three-item form of the perceived social support questionnaire (F-SozU K-3)

Objective

The purpose of the present study was to develop and validate a brief screening instrument (F-SozU K-3) for the measurement of perceived social support in large scale surveys by shortening a well-established German questionnaire (F-SozU K-6).

Method

First, a brief three-item version of the F-SozU was developed based on a representative sample of N = 2482 respondents using exploratory and confirmatory factor analysis. Second, the newly developed brief three-item questionnaire was evaluated and standardized in an independent second representative population sample (N = 2501).

Results

A suitable three-item solution with a good internal consistency (α = 0.89, ω = 0.89) was identified. Full invariance across sex and partnership was established. Construct validity of the brief three-item form was established. Younger age, female sex, partnership status, and current employment were positively associated with higher social support scores. Norm values for the general sample and separately for sex and partnership status were reported.

Conclusions

The newly developed F-SozU K-3 is a reliable and valid screening instrument. It can be used as an economical alternative to previous longer instruments, especially in large scale surveys.

Factors Associated With Domestic Violence Against Women at Different Stages of Life: Findings From a 19-Year Longitudinal Dataset From the MINIMat Trial in Rural Bangladesh (2001-2020)

Despite the abundance of literature, longitudinal studies evaluating the factors associated with domestic violence (DV) at different stages and over longer periods of women's lives are rare. We evaluated factors associated with physical and sexual DV during pregnancy, at 10-year, and 18-year follow-ups after pregnancy and within a 19-year period of life using a cohort of women (n = 1,126) who participated in the Maternal and Infant Nutrition Interventions, Matlab trial in rural Bangladesh. Data on women's experience of DV, social and economic characteristics, empowerment, and family condition were recorded in a similar manner during pregnancy and at 10- and 18-year follow-ups, using standard questionnaires. Multivariate logistic regression models and generalized estimating equations were used to evaluate factors associated with women's experience of physical and sexual violence at each discrete time point and over a period of 19 years, respectively. During pregnancy, women were more likely to experience violence if they were members of microcredit programs/non-governmental organizations (NGOs), living in an extended family and had lower wealth status. At the 10- and 18-year follow-ups, higher levels of decision-making and higher wealth status were protective against the experience of violence. At the 18-year follow-up, women with larger age differences from their husbands were less likely to experience violence, while membership in microcredit programs/NGOs was associated with higher odds of experiencing violence among women. Within a period of 19 years, a higher level of education, living in an extended family, higher decision-making level and higher wealth index were protective against the experience of violence, while membership in microcredit programs/NGOs was a risk factor. In conclusion, this study showed that correlates of violence might change at different time points in women's life. Thus, policies and programs should consider the stage of women's lives while planning interventions for addressing violence against women.

Locating perpetrators of violence against women in India: An analysis of married men's characteristics associated with intimate partner violence

Intimate Partner Violence (IPV) against married women is widely prevalent in India. Using recent data from NFHS-5, we analyzed the association between husbands' characteristics and IPV. Separate logistic regression models were developed for three distinct "husband characteristic groups" namely demographic, social and economic groups, and one final model including only statistically significant variables. IPV has been found to be significantly associated with men's age, age gap between husband and wife, men's educational level, religion, caste, region, number of daughters, wife's decision-making autonomy, men's IPV justifying attitude, alcoholism and substance abuse among men, type of work and wealth. We suggest shifting the policy gaze from women and prioritizing men's education, control on substance abuse and alcoholism among men as well as employment opportunities to tackle the violence against women.

Social support and intimate partner violence in rural Pakistan: A longitudinal investigation of the bi-directional relationship

A large body of cross-sectional evidence finds strong and consistent associations between social support and intimate partner violence (IPV). However, the directionality of this relationship has not been firmly established due to a dearth of longitudinal evidence. Using cohort study data collected over a 3 year period from 945 women in rural Pakistan, we investigated the longitudinal relationship between IPV and social support. Friend and family social support was measured with the Multidimensional Perceived Social Support Scale, and IPV was measured with questions adopted from the World Health Organization's Violence Against Women Instrument, which was used to construct a measure of IPV severity. We estimated longitudinal associations in linear regression models that controlled for women's educational level, age at marriage, age, household composition, household assets, depressive symptoms, and Adverse Childhood Experiences. We found evidence of a bi-directional, mutually re-enforcing relationship that showed unique associations by type of social support. Specifically, we found that high social support from family, though not friends, decreased IPV severity 1 year later, and that higher IPV severity led to reductions in both friend and family social support 1 year later. Results suggest that interventions involving family members could be especially effective at reducing IPV in this context, and - given that low social support leads to many adverse health outcomes - results suggest that IPV can result in secondary harms due to diminished social support. In summary, our study confirms a bi-directional relationship between IPV and social support and suggests that IPV interventions that integrate social support may be especially effective at reducing IPV and mitigating secondary harms.

Same-Day Correlates and Prior-Day Predictors of Couples' Violent Behaviors Based upon Partners' Daily Reports

Although previous research identified predictors of violent events within violent heterosexual couples, findings were limited to the woman's reports, to her perceptions; his assessments were not obtained. This exploratory study was conducted to gain understanding of proximal predictors of violence assessed in "real-time" from the perspective of both partners. Fifteen adult heterosexual couples in which the woman reported experiencing partner violence in the prior 30 days were enrolled in a primary care clinic. Each partner provided separate daily telephone reports for eight weeks via an automated Interactive Voice Response (IVR), concerning the previous day's violence, alcohol use, stressors, emotional reactions and concerns for children. Same-day correlates were determined by Pearson correlations while prior-day predictors were identified via vector autoregression. Same-day correlations show that men's violence was associated with almost every other variable while women's violence correlated with men's violence, men's drug use, women's alcohol use, anger, closeness, hassles, and all men's negative feelings. Using prior-day predictors, men's violence was related to feelings (primarily hers), but women's violence was more dependent upon feelings of both of them as well as women's prior-day violence and alcohol use. Men's violence was dependent upon their partners' prior-day feelings and the men's lack of concern about effects of violence on children. Women's violence was also dependent upon women's prior-day feelings, as well as women's violence, alcohol use, marital closeness, and men's concern for children. Although the co-occurrence of men's and women's violence has been seen before, in this study only women's violence was linked to alcohol use.

Influences of Extended Family on Intimate Partner Violence: Perceptions of Pakistanis in Pakistan and the United Kingdom

Limited research has been undertaken on the role of extended family members in Intimate Partner Violence (IPV). This study uniquely explores the perspective of Pakistani men and women about the role of a husband and wife's families in relation to marital conflict and IPV. For this qualitative study, data were collected through 41 individual interviews, including 20 from Pakistan and 21 from the United Kingdom. The findings are presented in four themes, including "privacy and personal space," "interference and instigation of problems," "conflicting and uncommunicated expectations," and "adjustment facilitation." A lack of privacy and personal space within a family home shared with extended family on the husband's side, interference in terms of mothers-in-law and sisters-in-law making complaints about the wife, and the couple's differing expectations of the husband's responsibility for his extended family could cause tension and conflict that could lead to IPV. The husband's family could also have a positive effect by minimizing conflict through offering the couple personal time and helping the wife to adjust to her new family. The wife's family was perceived as having a much more passive role in terms of not interfering, but instead allowing her to adjust to her new extended family. In conclusion, the husband's extended family can have a considerable impact on conflict within couples. Public health prevention initiatives for IPV in Pakistani people should address the role of the husband's extended family. The findings of the study are not only important for the population studied, which is part of an international diaspora, but also for other communities worldwide that value close family structure due to cultural and religious preferences.

Preparing for parenthood: developing a life-skills and socioemotional health program for young married couples in rural Pakistan

Background

Socioemotional life-skills to negotiate important life-transitions such as marriage and parenthood are critical for the wellbeing of young couples and their offspring, but programs addressing this issue are lacking in Low and Middle-Income Countries (LMICs).

Objective

This study describes the development of a ‘life-skills’ program for young married women, their husbands and families, living in rural settings in Pakistan.

Methods

Our methods included: a) a targeted review of relevant literature on life-skills and mental health in young people, b) a qualitative study and, c) intervention development workshops with experts and stakeholders. The review showed that common life-skills employed as part of psychosocial interventions in LMICs were communication skills, problem-solving, assessing relations, stress management, emotional regulation, identifying/eliciting affect, and self-awareness.

Results

The qualitative study indicated that areas of particular need included interpersonal communication skills with significant others, coping with the pressures of parenthood, and mental well-being. Existing helpful practices included social support by family members and elders. Lack of empowerment in young married women and poor engagement of husbands were identified as a barrier to accessing a potential intervention. Our proposed intervention called ‘Preparing for Parenthood’ consisted of 10 core sessions and 10 follow-up sessions designed to be delivered by lay health workers. It synergistically combined evidence-based socioemotional life-skills (awareness, communication skills, assertiveness, decision-making skills, goal-setting, critical thinking, problem-solving, and coping with stress), with cognitive behavioural strategies (gently challenging existing thoughts and attitudes, behaviour activation and problem solving). The intervention focuses on engagement of the entire family, including husbands.

Conclusions

The intervention can supplement existing sexual and reproductive health programs by providing skills to prospective parents to effectively negotiate stressful life-transitions and life-events. We envisage the intervention would improve mental as well as sexual and reproductive health of young couples and plan to test this in future randomised trials.

Culturally adapted trauma-focused CBT-based guided self-help (CatCBT GSH) for female victims of domestic violence in Pakistan: feasibility randomized controlled trial

BACKGROUND

Cognitive behaviour therapy (CBT), self-help and guided self-help interventions have been found to be efficacious and cost effective for victims of trauma, but there are limited data from low- and middle-income countries on culturally adapted interventions for trauma.

AIMS

To investigate the feasibility and acceptability of culturally adapted trauma-focused CBT-based guided self-help (CatCBT GSH) for female victims of domestic violence in Pakistan.

METHOD

This randomized controlled trial (RCT) recruited 50 participants from shelter homes in Karachi and randomized them to two equal groups. The intervention group received GSH in nine sessions over 12 weeks. The control group was a waitlist control. The primary outcomes were feasibility and acceptability. Secondary outcomes included Impact of Event Scale-Revised (IES-R), Hospital Anxiety and Depression Scale (HADS) and the WHO Disability Assessment Schedule 2 (WHO DAS 2). Assessments were carried out at baseline and at 12 weeks.

RESULTS

Out of 60 clients who met DSM-5 criteria for post-traumatic stress disorder (PTSD), 56 (93.3%) agreed to participate in the study. Retention to the intervention group was excellent, with 92% (23/25) attending more than six sessions. Statistically significant differences were noted post-intervention in secondary outcomes in favour of the intervention.

CONCLUSIONS

A trial of CatCBT GSH was feasible and the intervention was acceptable to Pakistani women who had experienced domestic violence. Furthermore, it may be helpful in improving symptoms of PTSD, depression, anxiety and overall functioning in this population. The results provide a rationale for a larger, confirmatory RCT of CatCBT GSH.

The association between intimate partner violence, psychiatric morbidity amongst pregnant women and partner alcohol use in southern Nigeria

BACKGROUND

Intimate partner violence (IPV) against women is common, although prevalence and correlates amongst pregnant women in developing countries are poorly researched.

AIM

To identify the magnitude of IPV, and its relationship with psychiatric morbidity and partner alcohol use.

SETTING

This study was conducted among women receiving routine ante-natal care at a secondary level healthcare facility in southern Nigeria.

METHODS

A cross-sectional descriptive study was conducted by recruiting pregnant women (n = 395) attending the Ante-Natal Clinic of the Central Hospital, Benin-City, Edo State, Nigeria, between August 2015 and February 2016 and undertaking face-to-face interviews utilising a socio-demographic questionnaire, the Composite Abuse Scale and the 20-item Self-reporting Questionnaire.

RESULTS

Past 12-month prevalence of IPV was 24.8%, with emotional abuse being the commonest type (89.8%). Forty-six participants (11.6%) screened positive for probable psychiatric morbidity. Predictors of IPV included partner alcohol use in the past 12 months (adjusted odds ratio [aOR]: 2.67; 95% confidence interval [CI]: 1.16-6.16; p 0.02), having a psychiatric morbidity (aOR: 2.53; 95% CI: 1.27-5.04; p 0.01), being single (aOR: 2.12; 95% CI: 1.25-3.58; p 0.01) and multiparous (aOR: 2.5; 95% CI: 1.43-4.38; p 0.001).

CONCLUSION

Intimate partner violence was common amongst pregnant women in Nigeria. Identified modifiable risk factors can be targets for screening and intervention for women in these settings.

Is Readiness to Take Action Among Women in Violent Relationships a Catastrophic Phenomenon?

Taking action among women in violent relationships appears to involve sudden changes and reversals after periods of building stress, suggesting that decision making is a "catastrophic" phenomenon. This study sought to determine whether readiness-to-change is best modeled as a cusp catastrophic (CCM) phenomenon among women in violent relationships. A total of 143 women who experienced violence in the previous month completed baseline and end-of-study interviews assessing her hope, coping strategies, social network, and readiness-for-action (seeking help, taking legal action, and leaving) concerning the violence. Daily assessments of his violent behavior, forgiveness sought and given, and her perceived need-for-action were collected via telephone Interactive Voice Response for 8 weeks. Using regression analysis, the impact of factor-analyzed asymmetry (violence burden) and bifurcation (hope and cope, support, forgiveness, and number of children) variables on the outcomes (readiness-for-help, legal action, and leaving) was modeled, comparing the CCM against linear models to determine which model accounts for the most variance in each outcome. Cusp catastrophe models for all three actions accounted for more variance than either linear model comparison, but violence burden was only relevant to readiness-for-help and different bifurcation variables were at work for each action. While forgiveness was an important bifurcation factor in readiness-for-help and number of children served as the bifurcation factor for readiness-for-legal-action, readiness-to-leave was more complex with both number of children and hope-and-cope as bifurcation factors. Not only should we expect sudden changes in readiness but efforts to facilitate decision making should focus on addressing the bifurcation factors that may distort her interpretation of reality.

Empowerment and Intimate Partner Violence in Pakistan: Results From a Nationally Representative Survey

Using empowerment theory, the current study examines antecedents of lifetime experience of intimate partner violence, intimate partner violence experienced in the last 12 months, emotional violence, and husbands' controlling behaviors toward their wives in Pakistan. Using data from a subsample of 658 women from the nationally representative Pakistan Demographic and Health Survey 2012-2013, this study examined whether empowerment variables, such as household decision-making power, economic decision-making power, and adherence to patriarchy, operationalized as justification of wife beating, contribute to intimate partner violence using logistic regression analyses. Results indicate that adherence to patriarchal norms, household decision-making power, and higher education was found to be associated with lifetime prevalence of intimate partner violence. Adherence to patriarchal norms, economic decision-making power, and higher education was found significantly associated with intimate partner violence in the past 12 months. Adherence to patriarchal norms was significantly associated with experiencing emotional violence as well as controlling behaviors by husbands. In conclusion, women's adherence to patriarchal norms is a reflection of the patriarchal society in which they live; indeed, this was found to be the most important predictor of women's experience of intimate partner violence, when different types of violence were assessed. Implications for social work practice are discussed.

Not Managing Expectations: A Grounded Theory of Intimate Partner Violence From the Perspective of Pakistani People

Intimate partner violence (IPV) is a major social and public health problem affecting people from different cultures and societies. Much research has been undertaken to understand the phenomenon, its determinants, and its consequences in numerous countries. However, there is a paucity of research on IPV in many areas of the world including Pakistan. The present study aimed to develop a theory of the meaning and process of IPV from the perspective of Pakistani men and women living in and outside Pakistan.

Predictors of Perceived Need for and Actual Action Taking Among Women in Violent Relationships

Decision-making of women in violent relationships is poorly understood. The study seeks to identify predictors of need-for-action and actions taken by women in violent relationships. The participants were 143 women who experienced violence in previous month from 6 primary care clinics. The methods involved multiple times series using daily assessments of household environment, marital relationship, concerns, violence, and need-for-action collected via telephone interactive voice response for 8 weeks. Outcomes include daily need-for-action and reports of actions taken. Same-day correlates and prior-day associations using vector autoregressions were sought, combined across subjects using meta-analytic techniques. Need for help depended on stalking, concern for child safety, forgiveness, and low perceived control; actually seeking help depended on sense of control with same-day stress and need for help. Need for legal action depended on concern for child safety and finances with desire to keep family together; actually taking legal action, correlated only with prior-day stalking and concerns about child safety but less about effects of violence on child. Need to leave depended on his violence, with concern about its effect on child, her forgiveness, and a low desire to keep family together, while actually leaving was primed by a day of his drinking, and triggered by same-day stress and need to leave, but lower levels of her drinking or his seeking forgiveness. Once gone, prior-day stalking and his alcohol use correlated with returning to the relationship. Taking action depends upon few prior- and same-day factors unique to each action.

Prevalence and Risk Factors of Domestic Violence against Iranian Women: A Cross-Sectional Study

Background

Violence against women in families is the most common form of violence against them. The purpose of this study was to determine the prevalence of domestic violence and its effects on married women of Ilam.

Methods

In this descriptive-sectional research, 334 married women referred to medical health centers in Ilam were selected to participate using a random sampling method. After obtaining their consent to participate in the study, participants responded to a 46 items questionnaire and responses were analyzed using IBM SPSS for Windows ver. 20.0 (IBM Co., Armonk, NY, USA).

Results

The majority of the participants reported experiencing domestic violence and emotional violence was more prevalent than other kinds of violence. Logistic regression analysis showed that lower education level, marriage at a younger age, shorter duration of marriage, fewer children, being a housewife, and husband's unemployment had a significant relationship with domestic violence against women.

Conclusion

The high prevalence of wife abuse in Ilam especially emotional violence due to lower education levels and marriage at younger age could be a serious threat for women's health as well as for other members of the family. This could be a grounding factor for other social harms such as suicide and this issue must be studied from legal, religious, and cultural standpoints.

Instruments to Assess Intimate Partner Violence: A Scoping Review of the Literature

A scoping review was conducted to map existing evidence on strategies to measure male and female intimate partner violence (IPV). PubMed, ISI Web of Knowledge, and Scopus databases were searched from inception to 2014. There were 1,098 studies analyzed. To assess IPV, the most commonly followed strategy was the creation of study-specific questions (30.3%). The Conflict Tactics Scales (CTS) were the most frequent choice among generic instruments, whereas for clinical samples, the preferred tool was the Abuse Assessment Screen. Prevalence estimates were generally higher when the original versions of the CTS were used. This review provides a guiding frame of what exists in the IPV measurement literature, showing trends in the choice for a particular instrument according to administration methods and settings.

Intimate Partner Violence in Pakistan: A Systematic Review

Intimate partner violence (IPV) is a major social and public health problem affecting people in various cultures and societies. Though the issue of IPV in Pakistan has been researched since the 1990 s, no attempt has been made systematically to review the available evidence on IPV in Pakistan. This article presents findings of a systematic review of available empirical literature related to IPV in Pakistan. Using various key words, MEDLINE, CINAHL, and PsycINFO were searched to identify relevant studies. This resulted in the identification of 55 potential studies for inclusion. After application of exclusion criteria 23 studies were identified, 20 of which used quantitative research designs, two used qualitative designs and one adopted a mixed method case study approach. All studies reported men as the perpetrators of IPV and women as its victims. Findings are presented and discussed for IPV for its forms, predictors, effects and victims' responses. Pakistani peoples' perceived reasons for and their attitudes towards IPV are also presented and discussed.

A brief form of the Perceived Social Support Questionnaire (F-SozU) was developed, validated, and standardized

OBJECTIVES

Development of a brief instrument (F-SozU K-6) for the measurement of perceived social support in epidemiologic contexts by shortening a well-established German questionnaire (F-SozU K-14).

STUDY DESIGN AND SETTING

The development of the F-SozU K-6 consisted of two phases; phase 1: the F-SozU K-14 was presented to a general population sample representative for the Federal Republic of Germany (N = 2,007; age: 14-92 years). Six items for the short form were selected based on the maximization of coefficient alpha. Phase 2: the new short form (F-SozU K-6) was evaluated and standardized in an independent second population survey (N = 2,508, age: 14-92 years).

RESULTS

The F-SozU K-6 showed very good reliability and excellent model fit indices for the one-dimensional factorial structure of the scale. Furthermore, strict measurement invariance was detected allowing unbiased comparison of means and correlation coefficients and path coefficients between both sexes across the full lifespan from adolescence (14-92 years). Well-established associations of perceived social support with depression and somatic symptoms could be replicated using the short form.

CONCLUSION

The F-SozU K-6 presents a reliable, valid, and economical instrument to assess perceived social support and can thus be effectively applied within the frameworks of clinical epidemiologic studies or related areas.

An Integrative Review of the Methods Used to Research the Prevalence of Violence against Women in Pakistan

This paper is a report of an integrative review conducted to assess the methodological and ethical strategies used to protect participants and researchers in conducting violence against women (VAW) studies in Pakistan. The measurement of the prevalence of violence against women in Pakistan is challenging for researchers given the cultural norms and the traditional role of women. Lack of methodological rigor in addressing the concerns can result in underreporting of violence, create physical and emotional risk for the participants, interviewers, and researchers, and impose threats to internal and external validity of VAW studies. Using Whittemore and Knafl’s process for conducting an integrative review, 11 studies published between 1999 and 2012, reporting on prevalence, experiences, and factors associated with violence in a marital relationship were analyzed. Overall, studies reveal an underreporting of exposure to violence and threats to women and interviewers’ safety in the conduct of such studies, both of which present threats to study rigor. The utilization of WHO ethical and safety recommendations to guide VAW studies in this context should be considered.

Violence against women by their intimate partners in Shahroud in northeastern region of Iran

BACKGROUND

Violence against women is one of the worst consequences of cultural, political, and socio-economic inequalities between men and women. Intimate Partner Violence (IPV) has been identified as an important cause of morbidity from multiple mental, physical, sexual, and reproductive health outcomes. Nonetheless, the prevalence and related factors of this international problem have not been investigated extensively in some parts of the world. The aims of this research were to determine the prevalence of physical and mental violence perpetrated by men against their intimate partners and to assess the associated factors of partner violence among women in Shahroud in northeastern region of Iran in 2010.

METHODS

This Cross-Sectional study was conducted in Shahroud, in northeast of Iran in 2010. Cluster sampling was done from primary health service institutions, universities, public schools and governmental organizations throughout the city and six hundred married women completed the study. A structured questionnaire with 34 items was designed in three parts to assess the physically (10 items) and mentally (15 items) violent acts by a current intimate male partner and identify collative behaviors (9 items) of victims. The Logistic regression analysis was applied to determine the net effect of background variables on the IPV occurrence within the past year.

RESULTS

About 20% of the participants experienced at least one type of physical violence. Increased risk of physical violence was positively associated with the younger age of the couple (OR=3.08, P<0.05), lower education (OR=2.28, P<0.01) and having a semi-manual skilled occupation of husband (OR=3.62, P<0.05), husband's heavy cigarette smoking (OR=2.62, P<0.01), and his drug abuse (OR=2.1, P<0.05). About 85% of the women had experienced mental harassment within the past twelve months. Logistic Regression Analysis found that lower education (OR=3.06, P<0.01) and having semi-manual skilled occupation (OR=3.8, P<0.05) of husband, increasing years of marriage (OR=2.8, P<0.01), husband's heavy cigarette smoking (OR=2.3, P<0.01) and his abusing the use of drugs (OR=3.4, P<0.01) had significant associations with women's experience of mental violence.

CONCLUSIONS

Some socioeconomic characteristics such as educational level, occupational status of men, heavy smoking and drug abusing are associated with the occurrence of violence against one's intimate partner. Since IPV is usually unreported, healthcare providers should be aware of the risk factors associated with domestic violence to be able to design preventive measures against its negative health outcomes in women.

Spousal violence against women and its association with women's mental health in Pakistan

In Pakistan, the issue of spousal violence is under-researched and still not considered a public health problem. To assess the association of spousal violence with women's mental health, a hospital-based cross-sectional survey was conducted through a structured interview schedule with 373 randomly selected ever-married women of reproductive age in eight randomly selected hospitals in the cities of Lahore and Sialkot, Pakistan. After controlling for sociodemographic variables, women's experiences of past and current psychological, physical, and sexual violence remained significantly associated with women's poor mental health. The situation warrants urgent action to mitigate the violence-induced damages done to women's mental health.

Differences in social network structure and support among women in violent relationships

Social support is critical for women in abusive relationships. While social support may decrease the risk of getting into a violent relationship, it can also allow battered women to remain in violent relationships by reducing the negative impact of intimate partner violence (IPV). In addition to the social isolation that women in abusive relationships may experience, her social contacts appear to be important. The purpose of this study was to compare the size, structure, and composition of the social networks of women in abusive relationships with those of a matched cohort of nonabused women. The authors enrolled women from primary care clinics who reported abuse within the prior month, and a demographically matched comparison group of women in nonabusive relationships. Participants completed a social network analysis, and investigators compared social networks of abused with nonabused women. The networks of women in abusive relationships were smaller in size, but more efficient in their ability to reach their members, than those of nonabused women. Proportionally, networks of abused women had more women but fewer in-laws than those of comparison women. The women in these abusive relationships had higher measures of centrality, suggesting that they were more critical in holding their networks together. Yet, they had fewer social contacts, and provided more support than they received with fewer reciprocated ties. Thus, social networks of women in violent relationships are small and offer less support than those of comparison women. However, previous work on networks with weak ties and structural holes suggests that access to resources may be available through these networks.

Violence permeating daily life: a qualitative study investigating perspectives on violence among women in Karachi, Pakistan

Background:

This study explored how married women perceive situations which create family conflicts and lead to different forms of violence in urban Pakistan. In addition, it examines perceptions of consequences of violence, their adverse health effects, and how women resist violence within marital life.

Methods:

Five focus group discussions were conducted with 28 women in Karachi. Purposive sampling, aiming for variety in age, employment status, education, and socioeconomic status, was employed. The focus group discussions were conducted in Urdu and translated into English. Manifest and latent content analysis were applied.

Results:

One major theme emerged during the analysis, ie, family violence through the eyes of females. This theme was subdivided into three main categories. The first category, ie, situations provoking violence and their manifestations, elaborates on circumstances that provoke violence and situations that sustain violence. The second category, ie, actions and reactions to exposure to violence, describes consequences of ongoing violence within the family, including those that result in suicidal thoughts and actions. The final category, ie, resisting violence, describes how violence is avoided through women’s awareness and actions.

Conclusion:

The current study highlights how female victims of abuse are trapped in a society where violence from a partner and family members is viewed as acceptable, where divorce is unavailable to the majority, and where societal support of women is limited. There is an urgent need to raise the subject of violence against women and tackle this human rights problem at all levels of society by targeting the individual, family, community, and societal levels concurrently.

Intimate partner violence and its association with women's reproductive health in Pakistan

OBJECTIVE

To determine the prevalence of intimate partner violence in Pakistan and its association with reproductive health outcomes.

METHODS

A cross-sectional survey was conducted in 8 hospitals in Lahore and Sialkot between October 2008 and January 2009. Information from randomly selected ever-married women of reproductive age was collected via a structured interview. Psychologic, physical, and sexual violence was categorized as "no" or "severe" violence. Associations between reproductive health outcomes and violence were assessed by multivariate logistic regression.

RESULTS

Among 373 women interviewed, 75.9% reported severe psychologic, 34.6% reported severe sexual, and 31.9% reported severe physical violence at least once in marital life. Women who experienced severe physical violence were more likely to have their husband's noncooperation in using contraceptives (adjusted odds ratio [AOR], 3.31; 95% confidence interval [CI], 1.93-5.68), poor prenatal care (AOR, 2.11; 95% CI, 1.23-3.69), unplanned pregnancies (AOR, 2.29; 95% CI, 1.39-3.76), and poor self-reported reproductive health (AOR, 2.95; 95% CI, 1.71-4.91) as compared with non-abused women. Similar associations existed for other types of violence.

CONCLUSION

The results highlight the magnitude of violence and its association with reproductive health of women. Urgent action is needed to mitigate the violence and its consequential damage to health.

Urdu translation of the ICD-10 chapter V (F), research diagnostic criteria (RDC): process and principles of translation

Although there is some literature on translation and cultural adaptation of measurement scales, none is available on the translation of diagnostic guidelines, such as the International Classification of Diseases Tenth Edition (ICD-10). Our group translated ICD-10, Research Diagnostics Criteria (RDC) into Urdu, which is the official language of Pakistan but is also spoken in some states in India. Significant diasporas of Urdu speakers also exist in Western Countries. We describe the translation process and the principles that guided our work. The translation process consisted of preparation, forward-translation, external translation, synthesis, focus group discussions with laypersons to clarify terminology, and review by mental health professionals and laypersons. Translation also included a wider consultation process in which the final version was sent to Pakistani mental health professionals in Pakistan and abroad.

Prevalence and effects of violence against women in a rural community in Minia governorate, Egypt

This study was carried out to investigate prevalence and the characteristics of domestic violence (DV) against women in a rural area in Minia governorate, Egypt, as well as its physical and psychological consequences. Seven hundred and seventy-two women were interviewed. Sociodemographic data were collected; the WHO questionnaire was used to identify the abuse; the Structured Clinical Interview for DSM IIIR (SCID) to detect psychiatric disorders. Abused females constituted 57.4% of the total sample. There were significant relationships between DV and low education, low income, higher number of children, and husband's education. Psychiatric disorders occurred in 18% of the sample. There were statistically significant relationships between psychological and physical abuse of women and the occurrence of psychiatric disorders. In conclusion, DV against women was related to various negative health outcomes, and it is recommended to be given its real importance in both Forensic Medicine Council and in psychiatric assessment.

Prevalence and psychosocial risk factors of PTSD: 18 months after Kashmir earthquake in Pakistan

BACKGROUND

On average in a year 939 earthquakes of a magnitude between 5 and 8 on the Richter scale occur around the world. In earthquakes developing countries are prone to large-scale destruction because of poor structural quality of buildings, and preparedness for earthquakes. On 8th October 2005, a major earthquake hit the remote and mountainous region of northern Pakistan and Kashmir. We wanted to find out the rate of PTSD in a randomly selected sample of participants living in earthquake area and the correlates of the PTSD.

METHOD

The study was conducted 18 months after the earthquake. We selected a sample of men and women living in the houses and tents for interviews. Using well established instruments for PTSD and general psychiatric morbidity we gathered information from over 1200 people in face to face interviews. We gathered information about trauma exposure and loss as well.

RESULTS

55.2% women and 33.4% men suffered from PTSD. Living in a joint family was protective against the symptoms of PTSD. Dose of exposure to trauma was associated with the symptoms of PTSD. Living in a tent was associated with general psychiatric morbidity but not with PTSD.

LIMITATIONS

We used questionnaire instead of interviews to detect the symptoms of psychiatric disorders.

CONCLUSIONS

The symptoms of PTSD are common 18 months after the earthquake and they are specifically associated with the dose of trauma exposure. This may have implications for rehabilitation of this population.

The role of the extended family in women's risk of intimate partner violence in Jordan

The extended family as a potential cause of and protection against intimate partner violence (IPV) remains relatively unstudied. This mixed-methods study used focus group discussions (FGDs) and a clinic-based survey to investigate several family-based risk and protective factors associated with women's risk of IPV in Jordan. Seventeen FGDs (total number of participants = 105) were conducted with women in Amman. Each transcript was coded for categories using open coding methodology and mapping. Relevant categories and subcategories were family support, family interference, family abuse, exposure to violence in childhood, and place of residence. For the survey, systematic probability proportionate to size methodology was used to select a sample of 517 literate, ever married, women from seven reproductive health clinics located throughout the country (response rate = < or = 70%); due to missing data, the analytic sample was restricted to 418 women. Measures assessed the categories mentioned above. Bivariate and multivariate logistic regression models were constructed to examine the relationship between IPV and the main predictors of interest (residence, family interference, family violence, exposure to violence as a child, and family support). The combined results of the FGDs and the survey demonstrated that the respondent's husband's exposure to violence in childhood and violence perpetrated by other family members were risk factors for IPV. Family interference was also significantly related to IPV but only when the respondent identified the interference as harmful to her relationship. Residence with the respondent's in-laws demonstrated mixed effects. A supportive family was protective against IPV, although the FGDs revealed that families were not always an effective source of assistance. Findings demonstrate the continued role of the wife's and husband's kin in women's risk of IPV in Jordan, highlighting the importance of a broader view of the context of IPV.

Psychiatric morbidity and domestic violence: a survey of married women in Lahore

OBJECTIVE

A number of studies have looked at the prevalence rates of psychiatric disorders in the community in Pakistan over the last two decades. However, a very little information is available on psychiatric morbidity in primary health care. We therefore decided to measure prevalence of psychiatric disorders and their correlates among women from primary health care facilities in Lahore.

METHODS

We interviewed 650 women in primary health care settings in Lahore. We used a semi-structured interview and questionnaires to collect information during face-to-face interviews.

RESULTS

Nearly two-third of the women (64.3%) in our study were diagnosed to have a psychiatric problem, while one-third (30.4%) suffered with Major Depressive Disorder. Stressful life events, verbal violence and battering were positively correlated with psychiatric morbidity and social support, using reasoning to resolve conflicts and education were negatively correlated with psychiatric morbidity.

CONCLUSION

The prevalence of psychiatric disorders is in line with the prevalence figures found in community studies. Domestic violence is an important correlate which can be the focus of interventions.