Housing interventions for women experiencing intimate partner violence: a systematic review

Addressing key risk factors for suicide at a societal level

A public health approach to suicide prevention recognises the powerful influence of social determinants. In this paper-the fifth in a Series on a public health approach to suicide prevention-we consider four major risk factors for suicide (alcohol use, gambling, domestic violence and abuse, and suicide bereavement) and examine how their influence on suicide is socially determined. Cultural factors and societal responses have an important role in all four risk factors. In the case of alcohol use and gambling, commercial entities are culpable. This Series paper describes a range of universal, selective, and indicated interventions that might address these risk factors, and focuses particularly on key universal interventions that are likely to yield substantial population-level benefits.

Females and Housing First: An analysis of 18-month outcomes in a randomized controlled trial

The main objective of this research was to qualitatively examine the impacts of Housing First (HF) specifically on those participants who identified themselves as female in response to question asking what their gender was. The data analyzed are from a larger, muti-site, randomized controlled trial. χ2 analysis was used to compare the life changes (coded as positive, neutral, or negative) experienced by 64 females (42 HF and 22 TAU). An in-depth qualitative analysis was conducted on 45 of these participants (23 HF and 22 TAU). Significantly more female HF participants reported making positive life changes from baseline to 18-month than those in TAU. Relative to females in TAU, female HF participants reported a number of specific positive changes, including enhanced safety, improved recovery in mental illness, greater reductions in drug use, and individual changes. The implications of findings for strengthening HF programs to meet the unique needs of female participants are discussed.

Machiavellianism and Intimate Partner Violence Perpetration: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis estimated the size of the relationship between Machiavellianism and intimate partner violence (IPV) perpetration. Further, we explored whether the strength of this relationship varied depending on IPV type (i.e., physical, psychological, sexual, and cyber), and perpetrator gender. Systematic searches of Medline Complete, PsycInfo, Scopus, and Web of Science databases were conducted on July 4, 2023. Studies were included if they were a peer-reviewed published paper or unpublished dissertation, in English, included a measure of Machiavellianism and IPV perpetration, and reported the relationship between these variables. Study quality was assessed using the AXIS tool. Nineteen studies (N = 9,464) were included in a random-effects meta-analysis revealing a significant, weak, positive correlation between Machiavellianism and IPV perpetration (r = .16, 95% CI [0.11, 0.21], p < .001). Machiavellianism had a significant, weak, positive relationship with cyber (r = .25, 95% CI [0.17, 0.32], p < .001), psychological (r = .20, 95% CI [0.15, 0.24], p < .001), and sexual IPV (r = .10, 95% CI [0.02, 0.19], p = .020). No significant relationship was found for physical IPV. There was no significant difference in the strength of the relationship between women and men. These findings are limited by the measures being self-report, heterogeneity across studies, and the cross-sectional nature of the included studies which limits the understanding of causal pathways. Nonetheless, this meta-analysis shows a link between Machiavellianism and IPV perpetration, and future research should examine how this knowledge may be used to reduce IPV perpetration.

Interventions targeting social determinants of mental disorders and the Sustainable Development Goals: a systematic review of reviews

Globally, mental disorders account for almost 20% of disease burden and there is growing evidence that mental disorders are socially determined. Tackling the United Nations Sustainable Development Goals (UN SDGs), which address social determinants of mental disorders, may be an effective way to reduce the global burden of mental disorders. We conducted a systematic review of reviews to examine the evidence base for interventions that map onto the UN SDGs and seek to improve mental health through targeting known social determinants of mental disorders. We included 101 reviews in the final review, covering demographic, economic, environmental events, neighborhood, and sociocultural domains. This review presents interventions with the strongest evidence base for the prevention of mental disorders and highlights synergies where addressing the UN SDGs can be beneficial for mental health.

Trends in outcomes used to measure the effectiveness of UK-based support interventions and services targeted at adults with experience of domestic and sexual violence and abuse: a scoping review

OBJECTIVES

In the UK, a range of support services and interventions are available to people who have experienced or perpetrated domestic and sexual violence and abuse (DSVA). However, it is currently not clear which outcomes and outcome measures are used to assess their effectiveness. The objective of this review is to summarise, map and identify trends in outcome measures in evaluations of DSVA services and interventions in the UK.

DESIGN

Scoping review.

DATA SOURCES

MEDLINE, EMBASE, PsycINFO, Social Policy and Practice, ASSIA, IBSS, Sociological abstracts and SSCI electronic databases were searched from inception until 21 June 2022. Grey literature sources were identified and searched.

ELIGIBILITY

We included randomised controlled trials, non-randomised comparative studies, pre-post studies and service evaluations, with at least one outcome relating to the effectiveness of the support intervention or service for people who have experienced and/or perpetrated DSVA. Outcomes had to be assessed at baseline and at least one more time point, or compared with a comparison group.

CHARTING METHODS

Outcome measures were extracted, iteratively thematically grouped into categories, domains and subdomains, and trends were explored.

RESULTS

80 studies reporting 87 DSVA interventions or services were included. A total of 426 outcome measures were extracted, of which 200 were used more than once. The most commonly reported outcome subdomain was DSVA perpetration. Cessation of abuse according to the Severity of Abuse Grid was the most common individual outcome. Analysis of temporal trends showed that the number of studies and outcomes used has increased since the 1990s.

CONCLUSIONS

Our findings highlight inconsistencies between studies in outcome measurement. The increase in the number of studies and variety of measures suggests that as evaluation of DSVA services and interventions matures, there is an increased need for a core of common, reliable metrics to aid comparability.

PROTOCOL REGISTRATION

https://osf.io/frh2e.

Examining second-stage shelters: insights into housing instability and tailored support for IPV survivors

BACKGROUND

Intimate Partner Violence (IPV) exposes women and children to a wide range of challenges across housing, employment, social connections, and child well-being and is a public health issue. IPV survivors are at heightened risk of housing insecurity and homelessness. Emergency shelters have historically offered respite and support, but the emergence of second-stage shelters provides longer-term solutions. Despite their significance, there has been a lack of comprehensive research on second-stage shelters. This study focuses on understanding the needs of IPV survivors accessing second-stage shelters, aiming to illuminate unexplored aspects of support. To examine the current published peer-reviewed literature and gray literature on second-stage shelters, a scoping review was conducted.

METHODS

This scoping review used the method suggested by Arksey & O'Malley (2005) and considered all studies that focused on women who had experienced IPV and were accessing transitional housing/second-stage shelters.

RESULTS

Sixteen articles, mainly from the USA and published between 1985 and 2022, were included in the analysis. The findings highlighted themes of (1) a safe(r) place, with the subtheme of 'gated' communities, and (2) programming and services, with the subtheme of does one size fit all? and (3) insider support, with subthemes of paid insider support and peer insider support.

CONCLUSIONS

Housing instability was evident, and the need for multiple and individualized tailored options of programming and support along with housing security was identified. Second-stage housing policy and practice implications are addressed which illuminate unexplored aspects of support.

Children of a syndemic: co-occurring and mutually reinforcing adverse child health exposures in a prospective cohort of HIV-affected mother-infant dyads in Cape Town, South Africa

INTRODUCTION

Several HIV-related syndemics have been described among adults. We investigated syndemic vulnerability to hazardous drinking (HD), intimate partner violence (IPV) and household food insecurity (HFIS) in breastfed children born without HIV in urban South Africa. We compared those who were perinatally HIV exposed (CHEU) to those who were not (CHU), under conditions of universal maternal antiretroviral therapy (ART) and breastfeeding.

METHODS

A prospective cohort of pregnant women living with HIV (WLHIV), and without HIV, were enrolled and followed with their infants for 12 months postpartum (2013-2017). All WLHIV initiated antenatal efavirenz-based ART. Measurements of growth (∼3 monthly), infectious cause hospitalisation, ambulatory childhood illness (2-week recall) and neurodevelopment (BSID-III, measured at ∼12 months' age) were compared across bio-social strata using generalised linear regression models, with interaction terms; maternal data included interview-based measures for HD (AUDIT-C), IPV (WHO VAW) and HFIS.

RESULTS

Among 872 breastfeeding mother-infant pairs (n = 461 CHEU, n = 411 CHU), WLHIV (vs. HIV negative) reported more unemployment (279/461, 60% vs. 217/411, 53%; p = 0.02), incomplete secondary education (347/461, 75% vs. 227/411, 55%; p < 0.0001), HD (25%, 117/459 vs. 7%, 30/411; p < 0.0001) and IPV (22%, 101/457 vs. 8%, 32/411; p < 0.0001) at enrolment; and HFIS at 12 months (45%, 172/386 vs. 30%, 105/352; p > 0.0001). There were positive interactions between maternal HIV and other characteristics. Compared to food secure CHU, the mean difference (95% CI) in weight-for-age Z-score (WAZ) was 0.06 (-0.14; 0.25) for food insecure CHU; -0.26 (-0.42; -0.10) for food secure CHEU; and -0.43 (-0.61; -0.25), for food insecure CHEU. Results were similar for underweight (WAZ < -2), infectious-cause hospitalisation, cognitive and motor delay. HIV-IPV interactions were evident for ambulatory diarrhoea and motor delay. There were HIV-HD interactions for odds of underweight, stunting, cognitive and motor delay. Compared to HD-unexposed CHU, the odds ratios (95% CI) of underweight were 2.31 (1.11; 4.82) for HD-exposed CHU; 3.57 (0.84; 15.13) for HD-unexposed CHEU and 6.01 (2.22; 16.22) for HD-exposed CHEU.

CONCLUSIONS

These data suggest that maternal HIV-related syndemics may partly drive excess CHEU health risks, highlighting an urgent need for holistic maternal and family care and support alongside ART to optimise the health of CHEU.

'Sometimes, we don't know if we're getting abused': discussions of intimate partner violence and HIV risk among transgender women

Transgender women are among the populations at highest risk for HIV in the USA and have elevated risk for intimate partner violence (IPV). There is an urgent need for integrated HIV-IPV prevention interventions for transgender women. Using qualitative methods, we explored transgender women's lived experiences of IPV and the relationship between IPV and HIV risk. Using thematic analysis, we identified four key concepts that warrant inclusion in the development of models for IPV and HIV interventions: (1) considering the boundaries of IPV; (2) normalising expectations of chronic violence; (3) relationship safety; (4) calls for trans-affirming and empowering services.

Feel-Own-Move: a psychomotor therapy program for victims of intimate partner violence living in shelter homes. Feasibility and effects on mental health, bodily dissociation, and quality of life

Introduction

Intimate partner violence (IPV) is a worldwide concern, impacting victims' mental health, physical health, and quality of life. High rates of posttraumatic stress disorder (PTSD), depression, anxiety, bodily dissociation, and somatic symptoms have been found in victims of IPV, with an important impact on the chronicity of impairments and on the outcomes of psychological interventions. Therapeutic interventions available in shelter homes for victims are scarce in addressing their body-mind needs therefore asking for better empirical research. Thus, the aim of this study was to evaluate the feasibility and effects of Feel-Own-Move (FOM), an 8-week psychomotor therapy program for victims of IPV, on their mental health, levels of bodily dissociation, and general quality of life.

Methods

A within-subject repeated measures design was used to evaluate the intervention effects, and feasibility results were analyzed.

Results

Seventeen women completed the program (mean age 42.8 years, range 21-64). Results showed a significant decrease in levels of bodily dissociation, with FOM having a large effect size. The intervention also had a large effect size at increasing the environment domain of quality of life, although no statistically significant differences were found. FOM ended with excellent rates of reach, adherence, acceptability, and satisfaction. A positive retention rate was also found.

Discussion

In conclusion, FOM seems to be a feasible psychomotor therapy intervention for female victims of IPV living in shelters. Importantly, this program showed to be effective in reducing bodily dissociation among participants, which is suggested to prospectively contribute to their mental health and quality of life.

Housing Instability and Evictions Linked to Elevated Intimate Partner and Workplace Violence Among Women Sex Workers in Vancouver, Canada: Findings of a Prospective, Community-Based Cohort, 2010-2019

Objectives. To model the relationship of unstable housing and evictions with physical and sexual violence perpetrated against women sex workers in intimate and workplace settings. Methods. We used bivariate and multivariable logistic regression with generalized estimating equations to model the association of unstable housing exposure and evictions with intimate partner violence (IPV) and workplace violence among a community-based longitudinal cohort of cisgender and transgender women sex workers in Vancouver, Canada, from 2010 through 2019. Results. Of 946 women, 85.9% experienced unstable housing, 11.1% eviction, 26.2% IPV, and 31.8% workplace violence. In multivariable generalized estimating equation models, recent exposure to unstable housing (adjusted odds ratio [AOR] = 2.04; 95% confidence interval [CI] = 1.45, 2.87) and evictions (AOR = 2.45; 95% CI = 0.99, 6.07) were associated with IPV, and exposure to unstable housing was associated with workplace violence (AOR = 1.46; 95% CI = 1.06, 2.00). Conclusions. Women sex workers face a high burden of unstable housing and evictions, which are linked to increased odds of intimate partner and workplace violence. Increased access to safe, women-centered, and nondiscriminatory housing is urgently needed. (Am J Public Health. 2023;113(4):442-452. https://doi.org/10.2105/AJPH.2022.307207).

Association of sex work and social-structural factors with non-fatal overdose among women who use drugs in Vancouver, Canada

BACKGROUND

Women who use drugs (WWUD) and engage in sex work experience disproportionate sex- and drug-related harms, such as HIV, however comparatively little is known about their overdose risk. Therefore, we examined the association between sex work and overdose and secondarily explored the association of social-structural factors, such as policing and gendered violence, with overdose.

METHODS

Data were derived from two community cohort studies based in Vancouver, Canada between 2005 to 2018. We used logistic regression with GEE to examine the associations between a) sex work and nonfatal overdose and b) social-structural and individual variables with overdose among WWUD who engaged in sex work during the study. Sex work, overdose, and other variables were time-updated, captured every six months.

RESULTS

Among 857 WWUD included, 56% engaged in sex work during the study. Forty-three percent of WWUD engaged in sex work had at least one overdose compared to 26% of WWUD who did not. Sex work was not significantly associated with an increased odds of overdose (AOR = 1.14, 95% CI: 0.93-1.40). In the exploratory analysis amongst 476 WWUD engaged in sex work, social-structural variables associated with overdose in the multivariable model included exposure to: punitive policing (OR = 1.97, 95% CI: 1.30-2.96) and physical or sexual violence (OR = 2.55, 95% CI: 1.88-3.46).

CONCLUSIONS

WWUD engaged in sex work had an increased overdose burden that may be driven by social-structural factors rather than sex work itself. Interventions that address policing and gendered violence represent potential targets for effective overdose prevention.

Prevalence, Correlates, and Trends of Intimate Partner Violence Against Women in Gambia: Results From 2 National Cross-Sectional Health Surveys

No country is immune from intimate partner violence (IPV). The objectives of this study were to analyze the prevalence, correlates and trends of this global public health menace perpetrated by men against women using the most recent nationally representative Gambia Demographic and Health Survey (GDHS) 2019-20; with analysis of levels and trends of IPV perpetrated by current/former husbands/partners from ever-married women, from GDHS conducted in 2013, at the 8 subnational regions. IPV association with 12 covariates entailing socio-demographic, experiential and attitudinal characteristics was analyzed in bivariate and multivariable models, using simple and multiple logistic regression. Physical, emotional, and sexual IPV was reported by 29.09%, 24.03%, and 5.52% respectively. While prevalence of having experienced any type of IPV was39.23%. Statistically significant association of IPV with various covariates computed in univariate analysis were used in the multivariable logistic regression model. Women's and husband's educational attainment, wealth status, having witnessed father physically beat mother, and marital control exhibited by the husband were statistically significantly associated with IPV, in the final model. Physical, emotional, and sexual IPV increased from 2023 to 2019-20 in all 8 regions, with the exception of sexual IPV in Kanifing region. However, not all these changes were not statistically significant. Physical and sexual IPV prevalence in Gambia was slightly lower compared with the African region. The disturbing finding of increase in all 3 types of violence in all regions-with one exception-paints a dire scenario that augurs the imperative of women empowerment and revisiting of cultural norms for protecting women.

Long-Term Recovery from Intimate Partner Violence: Recovery and Hope

Recovery is a preferred outcome for assessing intervention effectiveness in the context of intimate partner violence (IPV), but measurement tools are in nascent form. It is therefore unclear what the recovery potential of survivors may be. A national online survey explored the self-rated recovery progress of Australian women (n = 1116), using visual analog scales (VAS) for recovery, hope, and other demographic variables. Findings show that many women rated themselves as completely recovered (14% of the eligible sample and 22% of the women who had left their partner > 10 years previously). However, most women experienced recovery as an ongoing process of healing (81%) and some women made little recovery progress (5%). Nevertheless, 77% of women who had separated >10 years ago rated their recovery as significant (scores of >70/100). Surprisingly, hope and recovery scores were only moderately correlated. This requires further investigation to determine what impacts on hope in long-term recovery, and how subjective and objective measures of hope and recovery vary in the context of IPV. The VAS was an efficient unidimensional measure for an online survey and is proposed for use in clinical and service contexts requiring subjective measures.

Intimate partner violence: psycho-physio-pathological sequelae for defining a holistic enriched treatment

Intimate partner violence (IPV) is a health priority, which worldwide, mainly affects women. The consequences of IPV include several psychophysiological effects. These range from altered levels of hormones and neurotrophins to difficulties in emotion regulation and cognitive impairment. Mounting evidence from preclinical studies has shown that environmental enrichment, a form of sensory-motor, cognitive, and social stimulation, can induce a wide range of neuroplastic processes in the brain which consistently improve recovery from a wide variety of somatic and psychiatric diseases. To support IPV survivors, it is essential to ensure a safe housing environment, which can serve as a foundation for environmental enrichment-based interventions. However, some concerns have been raised when supportive housing interventions focus on the economic aspects of survivors’ lives instead of the emotional ones. We thus propose a holistic intervention in which supportive housing is integrated with evidenced-based psychotherapies which could constitute an enriched therapeutic approach for IPV survivors.

Sexual relationship power equity is associated with consistent condom use and fewer experiences of recent violence among women living with HIV in Canada

BACKGROUND

Sexual relationship power (SRP) inequities, including having a controlling partner, have not been widely examined among women living with HIV (WLWH). We measured prevalence, and key outcomes of relationship control among WLWH in Canada.

METHODS

Baseline data from WLWH (≥16 years), reporting consensual sex in the last month enrolled in a Canadian community-collaborative cohort study in British Columbia, Ontario, and Quebec, included Pulerwitz's (2000) SRP relationship control sub-scale. Scale scores were dichotomized into medium/low [score=1-2.82] vs. high relationship control [score=2.82-4], high scores=greater SRP equity. Cronbach's alpha assessed scale reliability. Bivariate analyses compared women with high vs. medium/low relationship control. Crude and adjusted multinomial regression examined associations between relationship control and condom use (consistent [ref], inconsistent, never), any sexual, physical and/or emotional violence, and physical and/or sexual violence (never [ref], recent [≤3 months ago], and previous [>3 months ago]).

RESULTS

Overall, 473 sexually active WLWH (33% of cohort), median age=39 (IQR=33-46), 81% on antiretroviral therapy and 78% with viral loads <50copies/mL were included. The sub-scale demonstrated good reliability (Cronbach's alpha=0.92). WLWH with high relationship control (80%) were more likely (p<0.05) to: be in a relationship; have no children; have greater resilience; and report less socio-structural inequities. In adjusted models, high relationship control was associated with lower odds of: inconsistent vs. consistent condom use (aOR:0.39[95%CI:0.18-0.85]); any recent (aOR:0.14[0.04-0.47]); as well as recent physical and/or sexual (aOR=0.05[0.02,0.17]) but not previous violence (vs. never).

DISCUSSION

Prioritizing relationship equity and support for WLWH is critical for addressing violence and promoting positive health outcomes.