Intimate partner violence, depression, PTSD, and use of mental health resources among ethnically diverse black women

Interventions Targeting Depression and Posttraumatic Stress Disorder in United States Black Women Experiencing Intimate Partner Violence: A Systematic Review

There is a dearth of evidence indicating the effectiveness of psychological interventions targeting depression and/or posttraumatic stress disorder (PTSD) for Black women in the United States (US) exposed to intimate partner violence (IPV). We searched PubMed, MEDLINE, PsycINFO, EBSCOhost, Social Sciences, Social Sciences Full Text, Social Work Abstracts, and Cochrane databases between September 2021 and October 2022, for original studies of randomized control trials (RCTs) reporting depression and/or PTSD interventions delivered to US Black women with histories of IPV. Of the 1,276 articles, 46 were eligible and 8 RCTs were ultimately included in the review; interventions for depression (four interventions, n = 1,518) and PTSD (four interventions, n = 477). Among Depression and PTSD interventions (one intervention, n = 208), Beck's Depression Inventory II indicated M = 35.2, SD = 12.6 versus M = 29.5, SD = 13.1, <.01, and Davidson Trauma Scale indicated M = 79.4, SD = 31.5 versus M = 72.1, SD = 33.5, <.01, at pre- and post-intervention respectively. Also, some interventions reported severity of depression M = 13.9 (SD = 5.4) versus M = 7.9 (SD = 5.7) < 0.01, and PTSD (M = 8.08 vs. M = 14.13, F(1,117) = 9.93, p < .01) at pre- and post-intervention respectively. Publication bias was moderate and varied between 12 and 17 via the Downs and Black Checklist for Methodological Rigor for RCTs. Psychological interventions targeting depression and/or PTSD for Black women with histories of IPV reflect moderate improvement. Interventions that account for cultural nuances specific to Black women are fundamental for improving outcomes for survivors presenting with depression and/or PTSD.

Institutional Betrayal in the Criminal and Civil Legal Systems: Exploratory Factor Analysis with a Sample of Black and Hispanic Survivors of Intimate Partner Violence

Institutional betrayal (IB) is well-documented among survivors of gender-based violence seeking help and/or reporting incidents of violence in various settings, including college campuses and health care settings. Two of the most common institutions from which survivors seek help are the criminal and civil legal systems; however, less is known about the experiences of IB among survivors interfacing with those systems. Previous studies exploring IB have implemented the Institutional Betrayal Questionnaire (IBQ) and its various adaptations, but this scale has not yet been analyzed in the criminal or civil legal context, nor has it been analyzed among racially marginalized survivors. This paper explores the potential for utilizing the IBQ-Health among a sample of 199 Black and Hispanic survivors of intimate partner violence (IPV) who sought help from the criminal and/or civil legal system(s). An exploratory factor analysis was conducted to explore the fit of the measure to the data. Results suggest that the measure as it has previously been used does not demonstrate strong reliability or fit with this population or institution. Possible explanations and future directions are explored, including support for developing and piloting a new measure to assess IB among Black and Hispanic survivors of interpersonal violence who are seeking help from criminal and civil legal institutions.

Associations between different forms of intimate partner violence and posttraumatic stress among women who use drugs and alcohol in Kyrgyzstan

Survivors of intimate partner violence (IPV) have an increased risk of experiencing posttraumatic stress, and the subsequently associated symptoms can vary by form of IPV exposure (i.e., physical, sexual, or psychological IPV). Related research among socially marginalized populations, however, is limited, including among women who use and misuse substances. Drawing on baseline data from a pilot study conducted among 213 women in Kyrgyzstan who reported using drugs or engaging in hazardous alcohol use, we examined the associations between different forms of IPV and severe posttraumatic stress symptoms (PTSS). The vast majority of participants reported lifetime (93.9%, n = 200) and past 3-month (65.3%, n = 139) IPV, and two thirds of participants (65.3%, n = 139) reported experiencing PTSS in the prior month. Multivariable logistic regression analyses indicated statistically significant associations between only some forms of IPV and PTSS, including physical IPV, adjusted odds ratio (aOR) = 3.24, 95% confidence interval (CI) [1.15, 9.14], and injurious IPV, aOR = 2.71, 95% CI [1.10, 6.65]. Additionally, experiencing any form of IPV was associated with 4.95 higher odds of reporting PTSS, 95% CI [1.16, 21.15]; no other results were significant. These results not only underscore the need for future research on the mechanisms that might explain the unique associations between different forms of IPV and posttraumatic stress, but also highlight an urgent need for trauma-informed mental health and psychosocial support interventions for women who use drugs and alcohol.

Health Service Utilization of Black Immigrant Women Residing in the United States: A Systematic Review

Black immigrants constitute a rapidly growing population group in the U.S. A comprehensive understanding of health services used by Black immigrant women is necessary to support the complex needs of this population. We conducted a systematic review to (1) understand the types of health services used by Black immigrant women living in the U.S. and (2) examine barriers and motivators to using health services. Relevant studies were identified in the following databases: PubMed, PsychInfo, CINAHL, and Embase. Articles published until October 2022 were included in the review. From a total of 15,245 records, 47 articles that reported on health service utilization practices of Black immigrant women were included in the review. A variety of different health services were accessed by Black immigrant women, such as hepatitis screening, reproductive health services, cancer screenings, substance abuse treatment, mental health services, HIV services, dental services, genetic testing, cardiovascular risk testing, and general health services/ hospitalizations. Motivators for using health services included possession of health insurance, knowledge of health resources and conditions, and positive experiences with providers. Barriers to using health services included challenges navigating the health system, language barriers, and cultural beliefs. Factors that positively influence health service utilization must be expanded at the institutional, societal, and policy levels to improve access to health services for Black immigrant women.

Effects of Neighborhood Disconnection on Psychological Distress and Suicide Risk Associated with Interpersonal Violence Within Racial Groups

Negative mental health outcomes have been associated with adverse childhood experiences (ACEs) and intimate partner violence (IPV); however, few studies have identified risk and protective factors across levels of the social ecology that mitigate the onset of psychological distress and suicide risk associated with trauma. This study examines the relationship between ACEs, IPV, and mental health (i.e., psychological distress, suicidal ideation, and suicide attempts) within racial sub-populations of Black American, Latinx, and White adults. An online, cross-section survey was administered to a general population sample of adults in Baltimore and New York City. ACEs, IPV, and mental health outcomes were assessed within racial sub-populations of Black American (N = 390), Latinx (N = 178), and White (N = 339) adults, while accounting for within-group demographic differences. Moderating effects of social support and neighborhood disconnection on the relationship between ACEs, IPV, and mental health outcomes were also assessed. IPV was associated with psychological distress and suicidal ideation for Black and Latinx adults, but not for White adults. ACEs were associated with increased psychological distress for all three groups, and increased odds for suicidal ideation among Black and Latinx adults.. A significant negative interaction effect for neighborhood disconnection was found in the relationship between ACEs and psychological distress for Black adults. Findings highlight the significant mental health burdens of ACEs and IPV within racial and ethnic groups. Neighborhood disconnection may exacerbate psychological distress associated with ACEs among populations most impacted by interpersonal violence and mental health inequalities.

Sarah Waller's Help-Seeking Model: Understanding African American Women Intimate Partner Violence Survivors' Help-seeking Process

African American women overwhelmingly experience the poorest outcomes resulting from intimate partner violence (IPV) victimization. Despite theoretical advancements, there remain a paucity of theories that explicate this marginalized population's comprehensive help-seeking process that includes the domestic violence service provision system and the Black church. We conducted 30 in-depth, semi-structured interviews with women who self-identified as African American. We utilized sensitizing concepts from the Transtheoretical Model of Change and Intersectionality theories, along with Agency framework and employed constructivist grounded theory methodology. Sarah's Help-Seeking Model emerged from the data and includes nine phases: (1) Awareness, (2) Acknowledgment, (3) Assessment, (4) Enough, (5) Enlist, (6) Escalate, (7) Reject, (8) Resolve, and (9) Restoration. This is the first theory that identifies how this vulnerable and underserved population's mental health and social support-seeking process is partially mediated by mistrust of law enforcement, disappointment in linkage to care and services, fear of death, and willingness to survive.

Intimate Partner Violence, Legal Systems and Barriers for African American Women

Although many African American IPV survivors need services, they often do not access care. Hopelessness may partially explain low rates in help-seeking for this population and serve as a significant barrier to care for African American IPV survivors particularly those who have had prior legal system involvement. In a sample of 185 African American women, we first examined whether hopelessness mediated the relation between IPV and barriers to services. If such a mediation effect was found, we then would explore whether legal system involvement moderated the mediated effect of hopelessness on the relation between IPV and barriers to services. As anticipated, hopelessness partially served to explain (i.e., mediated) the relation between IPV and barriers to services. Further, this mediated effect was moderated by legal system involvement such that when legal system involvement was included as a moderator, hopelessness mediated the association between IPV and barriers to services only for those survivors who had been involved with the legal system. These results underscore the critical role of hopelessness as a barrier to accessing services for African American IPV survivors, especially those with prior involvement with the legal system. Recommendations are offered that underscore the importance of interventions that empower African American women who have survived violence instead of penalizing them.

Risk Factors for Experiencing Gender Based Violence Across Racial Groups

BACKGROUND

College student interpersonal violence victimization is a major public health issue. Sexual assault and intimate partner violence have negative effects on mental and physical health, as well as an individual's ability to perform well academically and fully participate in the college experience. Because an individual's race impacts how they experience the world, it is important to consider racial differences in experiences of interpersonal violence.

STUDY QUESTION

This study sought to understand the particular characteristics of Black, White, and Hispanic students that increase their risk of experiencing interpersonal violence victimization.

METHOD AND SUBJECTS

Researchers performed a latent class analysis using the Spring 2013 data from the American College Health Association's National College Health Assessment II to determine whether the risk factors for victimization of college students vary based on race. Data was collected from 123,078 college students attending 153 institutions of higher learning.

FINDINGS

Results of this latent class analysis showed a 5 class solution where each class had unique risks that increased the potential for interpersonal violence victimization based on the race of the respondent.

IMPLICATIONS

Group based differences need to be considered when developing prevention strategies to reduce the risk of victimization on college campuses. Because different risks increase victimization for White, Black, and Hispanic students, it is important to consider how risk reduction strategies may differ for these groups; and ensure that all prevention strategies are culturally informed.

Is separate the new equal? A meta-analytic review of correlates of intimate partner violence victimization for Black and White women in the United States

Black women experience intimate partner violence (IPV) at higher rates than White women, and are more likely to experience more serious injuries, serious mental health diagnoses, or even death as consequences of IPV. Most research on factors associated with physical IPV does not primarily focus on Black women experiencing IPV. To be able to offer targeted intervention and prevention services, understanding unique correlates is critical. To address these discrepancies and better conceptualize factors associated with IPV for Black women, a meta-analysis was conducted to examine correlates for male physical IPV perpetration/female IPV victimization among predominantly Black samples. Next, strengths of correlates for male IPV perpetration/female IPV victimization were compared between Black and White samples. From an original pool of 759 articles examining correlates for IPV perpetration and victimization, 21 articles were usable that had a sufficient percentage (at least 75%) of Black participants and 80 articles that had a sufficient percentage (at least 75%) of White participants. Five significant correlates for male perpetration and seven significant correlates for female victimization in predominantly Black samples were identified. Comparisons for male perpetration/female victimization between predominantly White and Black samples were conducted for nine correlates, and one-third of these correlates (male emotional abuse perpetration, female post-traumatic stress symptoms, and female alcohol use) were significantly stronger correlates in Black populations compared to White populations. Research and clinical implications are discussed.

Coping and Protective Factors of Mental Health: An Examination of African American and US Caribbean Black Women Exposed to IPV from a Nationally Representative Sample

Existing research continues to highlight the harm that intimate partner violence (IPV) can pose to health and well-being. However, little is done to understand the effectiveness of coping and protective mechanisms in helping women manage under adverse circumstances. The current study addresses the mental health of US Black women and the role of coping and protective moderators. An analysis of data from the National Survey of American Life (2001-2003), the most comprehensive survey on the health of US Blacks, was conducted. The association between severe physical intimate partner violence and mental health outcomes were confirmed. Resilience moderated the relationship between severe intimate partner violence and mood disorder among US Black women, but this differed between African American and Caribbean Blacks. Resilience, emotional family support, and spirituality reduced the likelihood of having a mental health condition for some African American and Caribbean Black women, while the opposite was found for religiosity. Demographic factors were also associated with mental health conditions and behaviors. The study draws our attention to potential coping and protective mechanisms that could be incorporated into counseling and intervention practices while recognizing factors that may be harmful to the mental health of individuals.

Using Mindfulness to Improve Mental Health Outcomes of Immigrant Women with Experiences of Intimate Partner Violence

Immigrant women are disproportionately affected by intimate partner violence (IPV), which poses risk for mental health problems, such as PTSD and depression. Post-migration barriers limit immigrant women's access to supportive services, which can further debilitate their mental health symptoms and their safety. The Being safe, Healthy, and Positively Empowered (BSHAPE) digital intervention was designed to address physical safety and healthcare needs of immigrant women through a multi-component approach that integrated mindfulness-based stress reduction (MBSR) practices. This paper reports qualitative feedback findings from eighteen Black immigrant women with recent IPV exposure and co-occurring mental health symptoms, who participated in the mindfulness sessions of BSHAPE. We identified elements of mindfulness that women perceived as beneficial in their healing. Women's feedback indicated healing and empowerment through positive appraisals and coping strategies. The benefits were noted for mindfulness elements promoting self-compassion, self-actualization, intentionality of moving forward in life, and developing positivity or a sense of optimism. Other helpful elements were relaxation, self-care and reflection, self-awareness, self-control and focused thinking. Our findings show that incorporating mindfulness practices in interventions can be beneficial for promoting the healing and empowerment of immigrant women in abusive relationships.

Caught in the Crossroad: An Intersectional Examination of African American Women Intimate Partner Violence Survivors' Help Seeking

OBJECTIVES

African American women are disproportionately impacted by intimate partner violence (IPV)-related homicide. They reflect the second highest prevalence rates and experience the highest rates of murder resulting from IPV victimization. Although most survivors note that they have experienced rejection and anticipatory stigma as barriers to their help seeking, African American women additionally experience racism and racial discrimination as obstacles that may further preclude their help seeking. This systematic review highlights African American women's experiences of rejection from providers and the effects that it may have upon their ability to secure urgent aid.

METHOD

A dearth of literature examines the subtle ways that African American women survivors experience rejection resulting from the interlocking nature of race, class, and gender oppression. Fundamental to developing more culturally salient interventions is more fully understanding their help-seeking experiences. A systematic review was conducted to provide a critical examination of the literature to understand the intersections of IPV and help-seeking behavior among African American women. A total of 85 empirical studies were identified and 21 were included in the systematic review. The review illuminates both the formal and semiformal help-seeking pathways.

RESULTS

We recommend integrating anti-Blackness racist praxis, incorporating African American women's ways of knowing and centralizing their needs in an effort to improve the health and well-being of this population.

CONCLUSIONS

Eliminating barriers to more immediately accessing the domestic violence service provision system is key to enhance social work practice, policy, and research with African American female survivors of IPV.

The psychological subtype of intimate partner violence and its effect on mental health: a systematic review with meta-analyses

PURPOSE

The present study examines the association between psychological violence and posttraumatic stress disorder (PTSD), depression, and anxiety, while comparing the specific subtypes of psychological violence and simultaneously focusing on methodological shortcomings.

METHOD

A systematic review and random-effects meta-analyses were applied on the three main outcomes: PTSD, depression, and anxiety. Four electronic databases were searched (PsycINFO, PubMed, EMBASE, and Web of Science), and a total of 194 studies were included (k = 149 for meta-analyses). GRADEpro was used to evaluate the certainty of the evidence from the meta-analyses.

RESULTS

Psychological violence had strong associations with the three main outcomes, with the strongest association for PTSD in both female and male victims. Coercive control was particularly associated with PTSD for female victims, while emotional/verbal and dominance/isolation had the strongest association with depression. Although the identified studies were characterized by gender bias, psychological violence appear to affect male mental health too.

DISCUSSION

Findings from the meta-analyses support the notion that psychological violence is a traumatic experience, which is strongly association with PTSD and other common mental health problems linked to trauma. GRADEpro rated the certainty of evince to be low, and thus, our confidence in the estimated effect is limited. Gender bias, the applied terminology, and other methodological shortcomings are discussed. Despite the substantial amount of research on this topic, more research is needed before we can draw any final conclusions on the effect of psychological violence on mental health.

Physical Intimate Partner Violence, Childhood Physical Abuse and Mental Health of U.S. Caribbean Women: The Interrelationship of Social, Contextual, and Migratory Influences

The literature has shown an increased risk for mental health conditions among victims of domestic violence. Few studies have examined the relationship between mental health disorders and domestic violence among Caribbean women, and how the association might be influenced by migratory and contextual factors. This study addresses the mental well-being of U.S. Caribbean Black women victims of domestic violence, and the relationships between acculturation, discrimination, and demographic influences. An analysis of data from the 2001-2003 National Survey of American Life (NSAL) re-interview, the first and most complete study on U.S. Caribbean Blacks, was conducted. Bivariate analysis revealed an association between acts of physical domestic violence and mental health conditions, with generally higher risk among women who reported both severe physical intimate partner violence and childhood physical abuse. Multivariate logistic regression indicates an association between specific mental disorders and acts of domestic violence. Acculturation, length of residence in the United States, age, education, poverty, and country of origin were also associated with mental health. The study highlights future directions for exploration including additional investigation of the influence of acculturation on the physical health of victims of domestic violence.

Associations Between Reproductive Coercion, Partner Violence, and Mental Health Symptoms Among Young Black Women in Baltimore, Maryland

This study examined the associations of reproductive coercion (RC) with mental health of Black adolescent and young adult women. We tested RC as a predictor of depression and post-traumatic stress disorder (PTSD) symptoms. We also explored the interaction of exposure to RC and physical and sexual intimate partner violence (IPV) as they relate to depression and PTSD symptoms. A primarily community-based convenience sample of 188 self-identified Black women, aged 18 to 25 years, in Baltimore, Maryland, completed computer-based cross-sectional surveys. Lifetime RC (37.8%) and IPV (48.9%) were prevalent in this sample. Nearly 10% of the young women reported experiencing RC without IPV; 38% of the sample reported experiencing both types of violence. Depression (69%) and PTSD (47.1%) symptoms were more prevalent among women with RC than among women without RC. Adjusted results revealed RC and IPV were independently associated with depression (adjusted odds ratioRC = 2.86, 95% CI = [1.38, 5.94] and adjusted odds ratioIPV = 5.15, 95% CI = [2.47, 10.76]). Similarly, RC and IPV were independently associated with PTSD (adjusted odds ratioRC = 2.41, 95% CI = [1.15, 5.08] and adjusted odds ratioIPV = 3.04, 95% CI = [1.39, 6.63]). Findings suggest that RC and IPV independently contribute to mental health morbidities among this population of women. Current policies in health care practice increasingly recommend provision of screening for IPV, including RC. These practices should extend to women receiving services in community-based settings, thus strengthening the linkage to referral for further mental health treatment and victim service support. In the context of the social burdens affecting young Black women's health, a comprehensive approach that integrates mental health and reproductive/sexual health care is essential for women reporting RC experiences.

Psychological Distress and Attitudes Toward Seeking Professional Psychological Services Among Black Women: the Role of Past Mental Health Treatment

Black women are one of the most underserved and undertreated minority groups in the USA. While Black women generally do not seek professional psychological services to manage psychological distress, recent findings suggest an openness to mental health treatment as a form of self-care. This study investigated the relationship among symptoms of anxiety, depression, and post-traumatic stress as a predictor of attitudes toward professional psychological help (i.e., psychological openness, help-seeking propensity, and indifference to stigma) in a sample of 205 Black women. We also examined if past mental health treatment (i.e., counseling or therapy) moderated these relationships. Results indicated that symptoms of anxiety, depression, and post-traumatic stress were all negatively associated with help-seeking propensity and indifference to stigma. Only symptoms of post-traumatic stress were negatively associated with psychological openness. Findings also demonstrated that past mental health treatment moderated the relationship among depressive symptoms and help-seeking propensity and indifference to stigma, respectively. Specifically, as depressive symptoms increased, help-seeking propensity significantly decreased among participants who had not reported past mental health treatment. Additionally, indifference to stigma decreased with increased symptoms of depression, though the decline in indifference to stigma was greater among those who did not report past mental health treatment. We also found similar results for symptoms of post-traumatic stress with regard to indifference to stigma. Findings suggest that Black women's past mental health treatment may be relevant to understanding attitudes toward seeking professional psychological services when experiencing high psychological distress.

Help-Seeking Behaviors and Barriers Among Black Women Exposed to Severe Intimate Partner Violence: Findings From a Nationally Representative Sample

This article examined general help-seeking utilization and barriers among U.S. Black women reporting severe physical intimate partner violence (IPV). Data from the National Survey of American Life (NSAL), the largest and most detailed survey on Blacks residing in the United States, were analyzed. Among U.S. Black women reporting severe physical IPV, many sought the help of a psychiatrist (13.8%) or other mental health professionals (14.0%). Multivariate findings revealed associations between help-seeking utilization and sociodemographic factors. Queries from open responses suggested potential cultural and ethnic differences between African American and Caribbean Black women reporting intimate partner violence in relation to barriers to help-seeking.

Intimate Partner Violence and Help-Seeking Behaviour: A Systematic Review of Cross-Cultural Differences

Intimate partner violence (IPV) is an issue that affects women across all cultures. It is essential to understand how women could be assisted to prevent and reduce the effects of violence. This systematic review examined studies that made cross-cultural comparisons of differences in help-seeking behaviour of women who have experienced IPV. Databases including the Cochrane Library, PsychInfo and others were searched for literature published between 1988 and 2016. Seventeen articles with a total of 40,904 participants met the inclusion criteria. This review found some differences in the procurement of support across cultural groups. While Caucasian women were more likely to seek assistance from formal services such as mental health and social services, Latina/Hispanic and African-American women were more likely to utilize other types of formal supports such as hospital and law enforcement services. The findings regarding utilization of informal support systems showed mixed results. Overall, the findings of this systematic review suggest that women from culturally diverse minority backgrounds should be educated and encouraged to access support before and after experiencing IPV. Further, potential barriers to help-seeking need to be identified and addressed across women from all cultures.

Patterns of abuse among South Asian women experiencing domestic violence in the United States

This qualitative study was conducted with a convenience sample of 20 South Asian women experiencing domestic violence in the United States. The results explore the patterns of abuse and factors and circumstances (i.e. turning points) that motivated South Asian women to change in the context of the stage that they were in as per the Landenburger's model (binding, enduring, disengaging, and recovery). The four themes that emerged from the interviews and analysis are (1) 'Timing and Frequency of abuse', (2) 'Methods of control - financial, isolation and suspicion', (3) 'Cycle of Abuse', and (4)' Turning Points - motivation to change'. Implications for practice and policy-level changes for abused South Asian women in the United States are discussed.

Perceived stress and mental health: The mediating roles of social support and resilience among black women exposed to sexual violence

BACKGROUND

Black women disproportionately suffer from violence and its subsequent mental health outcomes. Increasing levels of perceived stress are associated with greater symptoms of depression and post-traumatic stress disorder (PTSD). Social support and resilience can potentially mediate the negative consequences of perceived stress on women's mental health. This study assesses the association between perceived stress and mental health outcomes among Black women. In addition, this study examines social support and resilience as mediators of association between perceived stress and mental health.

METHODS

Black women residing in Baltimore, MD (n = 310) were recruited from STD clinics into a retrospective cohort study (2013-2018) on sexual assault and HIV risk. Social support and resilience served as coping variables and were assessed as mediators in the associations between perceived stress and mental health. Analyses were stratified by exposure to sexual violence in adulthood.

RESULTS

Almost half of our sample (46%) experienced severe depression and about one-third (27%) experienced severe PTSD. Resilience partially mediated the association between perceived stress and severe depressive symptoms among exposed women. Social support partially mediated the association between perceived stress and severe PTSD symptoms among exposed women.

LIMITATIONS

Since this is a cross-sectional analysis, we are unable to determine the temporal relationship between outcome and exposure variables. The CES-D-10 and NSESSS are scales that measure the severity of depressive and PTSD symptoms, respectively, and are not clinical diagnoses.

CONCLUSION

There is a critical need to develop interventions focused on reducing the burden of stress on mental health.

Intimate Partner Violence and Depression among Black Transgender Women in the USA: The Potential Suppressive Effect of Perceived Social Support

Depression among Black transgender women (BTW) in the USA is an often understudied mental health concern with far-reaching consequences for overall physical and mental health at both the individual and community levels. Intimate partner violence (IPV) among BTW is also a frequently understudied and important social determinant of health in need of further exploration. This study sought to address the gap in research on the relationship between IPV and depression among BTW using a time- and location-based community sample of BTW from six US cities. In addition, it sought to explore the potential protective or suppressive effect of perceived social support on this relationship. Generalized structural equation models were used to assess conditional direct and indirect effects of IPV on depression via the suppression effect of perceived social support. Evidence was found of a statistically significant conditional direct effect of IPV on depression as well as a statistically significant suppression effect for perceived social support. Specifically, there was a 20% lower likelihood of increased depressive symptomatology for every 1-unit increase in perceived social support reported by participants. These findings indicated that perceived social support may be an important intervention point for helping to improve the mental health and well-being of BTW.

Intimate Partner Violence and Depression among Black Transgender Women in the USA: The Potential Suppressive Effect of Perceived Social Support

Depression among Black transgender women (BTW) in the USA is an often understudied mental health concern with far-reaching consequences for overall physical and mental health at both the individual and community levels. Intimate partner violence (IPV) among BTW is also a frequently understudied and important social determinant of health in need of further exploration. This study sought to address the gap in research on the relationship between IPV and depression among BTW using a time- and location-based community sample of BTW from six US cities. In addition, it sought to explore the potential protective or suppressive effect of perceived social support on this relationship. Generalized structural equation models were used to assess conditional direct and indirect effects of IPV on depression via the suppression effect of perceived social support. Evidence was found of a statistically significant conditional direct effect of IPV on depression as well as a statistically significant suppression effect for perceived social support. Specifically, there was a 20% lower likelihood of increased depressive symptomatology for every 1-unit increase in perceived social support reported by participants. These findings indicated that perceived social support may be an important intervention point for helping to improve the mental health and well-being of BTW.

Psychosocial Mediators Between Intimate Partner Violence and Alcohol Abuse in Low-Income African American Women

Intimate partner violence (IPV) exposure can increase alcohol use. Although African Americans use less alcohol compared with European Americans, African American women experience disparate rates of IPV, potentially intensifying their alcohol abuse. We used data from 171 African American women to test if IPV was related to alcohol abuse and if psychosocial factors-loneliness, embarrassment, fear of harm, hope, social support, childcare needs, and finances-mediated this link. IPV and alcohol abuse were related, and several factors were related to either IPV or alcohol abuse. Social support was related to both, and it mediated the IPV-alcohol abuse link, explaining women's alcohol abuse relating to IPV.

The impact of intimate partner violence, depressive symptoms, alcohol dependence, and perceived stress on 30-year cardiovascular disease risk among young adult women: A multiple mediation analysis

Intimate partner violence (IPV), the physical, sexual, psychological abuse or control by a former or current intimate partner, affects almost one-third of women in the United States. IPV exposure can result in many negative outcomes including physical injury, increased stress, and depression. Currently, there is a small, but, growing body of literature examining the link between IPV victimization and increased cardiovascular disease (CVD) risk among young adult women. To better prevent this negative outcome, it is imperative to understand what factors associated with IPV victimization may be increasing this risk. A secondary analysis of Wave IV of the Add Health study was conducted to examine possible factors mediating past year IPV exposure and 30-year CVD risk score including perceived stress, depressive symptoms, and alcohol dependence among a representative sample of young adult women in the United States. Multiple mediation analyses were run to examine the possible mediating factors in the relationship between IPV and CVD risk. In a multiple mediation model, the indirect effect of perceived stress became insignificant when depressive symptoms were introduced. The findings of this study reveal that 30-year CVD risk in the context of IPV victimization should continue to be examined among this population. The mediation models suggested the importance of stress and depression in the context of IPV and heart health. Screening for depression among women exposed to IPV should be considered as an important intervention point, not only to mitigate mental health issues, but to also help prevent the development of cardiovascular disease.

The weWomen and ourCircle randomized controlled trial protocol: A web-based intervention for immigrant, refugee and indigenous women with intimate partner violence experiences

Intimate partner violence (IPV), including homicides is a widespread and significant public health problem, disproportionately affecting immigrant, refugee and indigenous women in the United States (US). This paper describes the protocol of a randomized control trial testing the utility of administering culturally tailored versions of the danger assessment (DA, measure to assess risk of homicide, near lethality and potentially lethal injury by an intimate partner) along with culturally adapted versions of the safety planning (myPlan) intervention: a) weWomen (designed for immigrant and refugee women) and b) ourCircle (designed for indigenous women). Safety planning is tailored to women's priorities, culture and levels of danger. Many abused women from immigrant, refugee and indigenous groups never access services [WHY?] and research is needed to support interventions that are most effective and suited to the needs of abused women from these populations in the US. In this two-arm trial, 1250 women are being recruited and randomized to either the web-based weWomen or ourCircle intervention or a usual safety planning control website. Data on outcomes (i.e., safety, mental health and empowerment) are collected at baseline and at 3, 6, and 12 months post- baseline. It is anticipated that the findings will result in an evidence-based culturally tailored intervention for use by healthcare and domestic violence providers serving immigrant, refugee and indigenous survivors of IPV. The intervention may not only reduce risk for violence victimization, but also empower abused women and improve their mental health outcomes.

Gender-based violence and trauma in marginalized populations of women: Role of biological embedding and toxic stress

Gender-based violence (GBV) and trauma can dysregulate and recalibrate environmentally sensitive physiological (i.e. central nervous, endocrine, and immune) systems placing survivors at risk for multiple health problems. The researchers build the case that the effects of GBV are likely to be particularly high impact and contribute to health disparities for marginalized survivors of GBV. Further, the researchers underscore a need for a multi-level bio-socio-ecological model that deciphers, characterizes, and explains individual differences in these effects and the need to establish an evidence base from which to derive interventions that address biological effects of toxic stress among marginalized survivors of GBV.

Intimate partner violence, trauma, and mental health need among female community college students

OBJECTIVE

The impact of interpersonal violence on college students has received considerable attention, yet no studies have been conducted among community college students, who comprise 40% of all American college students, and have unique risk factors and needs. Community College students are more likely to be women, people of color, working, parenting, and first generation college students.

PARTICIPANTS

Data were collected from a simple random sample from four community colleges (n=435).

METHODS

A cross-sectional quantitative survey was used to assess the extent of intimate partner violence, trauma exposure, sexual violence, and associated mental health consequences among female students.

RESULTS

Over 27% of participants reported IPV in the past year, while 25% reported sexual assault and 34% reported other uncomfortable sexual experiences in their lifetime. Nearly 20%of participants were currently reporting PTSD symptoms.

CONCLUSIONS

Community Colleges should work with service providers to build their capacity to respond to students' needs.

Types of non-psychotic mental disorders in adult women who suffered intimate partner violence: an integrative review

OBJECTIVE

Identifying the types of non-psychotic mental disorders in adult women who suffered intimate partner violence in the literature.

METHOD

An integrative review carried out in the MEDLINE, CINAHL, LILACS, Web of Science and SCOPUS databases.

RESULTS

We selected 19 articles published in international journals in English, with a predominance of cross-sectional study studies (78.9%). The most common types of non-psychotic mental disorders were: depression (73.7%) and post-traumatic stress disorder (52.6%). It was observed that 78.9% of the articles presented a 2C level of evidence.

CONCLUSION

Studies have shown that adult women who are victims of intimate partner violence mostly suffer from depression and post-traumatic stress disorder, as well as other morbidities; a fact that highlights how devastating violence by an intimate partner can impact on the mental health of those who experience it.

Intimate Partner Violence, Cumulative Violence Exposure, and Mental Health Service Use

Intimate partner violence (IPV) leaves victims with serious mental healthconsequences; some victims do not seek help even though they suffer from adverse mental health symptoms. Victims' use of mental health services seems to be affected by sociocultural factors and their history of experiences with violence. This study used the collaborative psychiatric epidemiology surveys to examine the effects of cumulative violence on IPV victims' mental health service use. The results showed that victims' mental health needs were the most prominent predictor of their use of mental health services, and that cumulative violence exposure also predicted mental health service use.

Multiple Intimate Partner Violence Experiences: Knowledge, Access, Utilization and Barriers to Utilization of Resources by Women of the African Diaspora

OBJECTIVE

This study examined knowledge, access, utilization, and barriers to use of resources among Black women exposed to multiple types of intimate partner violence in Baltimore, Maryland and the U.S. Virgin Islands (USVI).

METHODS

We analyzed quantitative survey data collected by 163 women recruited from primary care, prenatal or family planning clinics in Baltimore and the USVI. In addition we analyzed qualitative data from in-depth interviews with 11 women. Quantitative data were analyzed using descriptive statistics and qualitative data were analyzed using thematic analysis.

RESULTS

A substantial proportion of Black women with multiple types of violence experiences lacked knowledge of, did not have access to, and did not use resources. Barriers to resource use were identified at the individual, relationship, and community levels.

CONCLUSION

There is need for programs to develop awareness, promote access and utilization of resources, and eliminate barriers to resource use among abused Black women.

A Qualitative Study of Survival Strategies Used by Low-Income Black Women Who Experience Intimate Partner Violence

Women who experience intimate partner violence (IPV) are often portrayed as helpless victims. Yet many women who experience IPV implement strategies to help them survive the abuse. This qualitative study sought to explore the survivor strategies used by low-income black women who experience IPV. Authors used a semistructured interview guide to survey 26 survivors who reported being in an IPV relationship in the past two years. Thematic analysis revealed three types of survivor strategies used by low-income black women: (1) internal (use of religion and becoming self-reliant), (2) interpersonal (leave the abuser or fight back), and (3) external (reliance on informal, formal, or both kinds of sources of support). This article informs social work practitioners of the strategies used by low-income black women in surviving IPV so that practitioners can develop interventions that support these strategies.

Racial Disparities in Intimate Partner Violence Examined Through the Multiple Disadvantage Model

This research adopted the perspective of the multiple disadvantage model to explore racial disparities in intimate partner violence (IPV) against women and IPV's links to social structural factors, social relationships, substance use, and health/mental health and access to related services. The study used data from 6,588 women who completed the National Violence Against Women Survey; linear regression was conducted separately for four ethnic groups. Results consistently showed physical assaults to increase with posttraumatic stress disorder symptoms. For African Americans, increases in assaults were linked to injury, disclosing IPV to friends/family as well as medical professionals, Medicaid use, and drug use; decreases, in turn, were linked to past assault by ex-partners. For Latinas, increases in assaults were associated with eight factors: being married, number of ex-partners, depression, disclosing IPV to friends/family and disclosing to mental-health professionals, drug use, alcohol abstinence, and partner's frequent alcohol use. For European Americans, increases in assaults were linked to number of ex-partners, injury, low income, Medicaid use, disclosing IPV to friends/family as well as mental-health professionals, and alcohol abstinence; decreases were associated with age and with other health insurance coverages. For women of other ethnicity, increases were linked to number of ex-partners, disclosing IPV to mental-health professionals, Medicaid use, drug use, and woman's own as well as partner's alcohol abstinence; decreases in this ethnicity category were linked to past assault by ex-partners. Intervention and policy implications are discussed.

Cumulative Violence Exposures: Black Women's Responses and Sources of Strength

Black women with cumulative violence exposures (CVE) may have unique needs for health care and safety. Qualitative data was analyzed from interviews with nine Black women with CVE to explore factors that motivated women to leave abusive relationships, women's sources of strengths, and their responses to abuse. Quantitative data (N = 163) was analyzed to examine relationships between CVEs by intimate partner and health among Black women to further characterize the challenges these women face in making changes and finding their sources of strengths. Findings highlight the need to assess for CVE and identify multiple motivators for change, sources of strengths and coping strategies that could be potential points of intervention for women with CVE.

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.

Impact of Intimate Partner Forced Sex on HIV Risk Factors in Physically Abused African American and African Caribbean Women

We examined associations between intimate partner forced sex (IPFS) and HIV sexual risk behaviors among physically abused Black women. Women aged 18-55 in intimate relationships were interviewed in health clinics in Baltimore, MD and St. Thomas and St. Croix, US Virgin Islands (USVI). Of 426 physically abused women, 38% experienced IPFS; (Baltimore = 44 and USVI = 116). USVI women experiencing IPFS were more likely to have 3+ past-year sex partners (AOR 2.06, 95% CI 1.03-4.14), casual sex partners (AOR 2.71, 95% CI 1.42-5.17), and concurrent sex partners (AOR 1.94, 95% CI 1.01-3.73) compared to their counterparts. Baltimore women reporting IPFS were more likely to have exchanged sex (AOR 3.57, 95% CI 1.19-10.75). Women experiencing IPFS were more likely to report their abuser having other sexual partners in Baltimore (AOR 3.30, 95% CI 1.22-8.88) and USVI (AOR 2.03, 95% CI 1.20-3.44). Clinicians should consider the influence of IPFS on individual and partnership HIV sexual risk behaviors.

Intimate Partner Violence and its Health Impact on Ethnic Minority Women [corrected]

In the United States, intimate partner violence (IPV) against women disproportionately affects ethnic minorities. Further, disparities related to socioeconomic and foreign-born status impact the adverse physical and mental health outcomes as a result of IPV, further exacerbating these health consequences. This article reviews 36 U.S. studies on the physical (e.g., multiple injuries, disordered eating patterns), mental (e.g., depression, post-traumatic stress disorder), and sexual and reproductive health conditions (e.g., HIV/STIs, unintended pregnancy) resulting from IPV victimization among ethnic minority (i.e., Black/African American, Hispanic/Latina, Native American/Alaska Native, Asian American) women, some of whom are immigrants. Most studies either did not have a sufficient sample size of ethnic minority women or did not use adequate statistical techniques to examine differences among different racial/ethnic groups. Few studies focused on Native American/Alaska Native and immigrant ethnic minority women and many of the intra-ethnic group studies have confounded race/ethnicity with income and other social determinants of health. Nonetheless, of the available data, there is evidence of health inequities associated with both minority ethnicity and IPV. To appropriately respond to the health needs of these groups of women, it is necessary to consider social, cultural, structural, and political barriers (e.g., medical mistrust, historical racism and trauma, perceived discrimination, immigration status) to patient-provider communication and help-seeking behaviors related to IPV, which can influence health outcomes. This comprehensive approach will mitigate the racial/ethnic and socioeconomic disparities related to IPV and associated health outcomes and behaviors.

Co-occurring intimate partner violence, mental health, and substance use problems: a scoping review

Background

Intimate partner violence (IPV) is a pervasive, serious problem detrimental to the health of untold numbers of women. In addition to physical injuries that may be sustained, IPV has been significantly associated with mental health challenges including substance use problems. The problems are complex, highly correlated with each other, and bidirectional in nature. Although as many as 50% of women in mental health and between 25% and 50% of women in substance abuse treatment programs report IPV, frontline workers in all three sectors state they lack the training to address these co-occurring problems.

Objective

To determine what frontline IPV, mental health, and substance use workers need to know in order to provide appropriate care to women experiencing co-occurring IPV, mental health and/or substance use problems.

Design

Using Scholars Portal OVID, Medline and OVID PsycINFO and combinations of significant terms, we conducted a scoping review of articles published between 2005 and 2014.

Results

An initial 4017 records were retrieved (3484 from Scholars Portal, 272 from Medline, 261 from PsycINFO). After applying inclusion and exclusion criteria, 35 articles were reviewed. Of these, 14 examined the relationships among IPV, mental health, and substance use; 7 focused on IPV and mental health; 14 looked at IPV and substance use.

Conclusions

Although education and training frequently figured among the recommendations in the reviewed articles, specific content for proposed education or training was lacking. The most frequently occurring recommendations focused on the need to develop better collaboration, coordination, and integration across IPV, mental health and addiction treatment services.

Psychosocial correlates of gender-based violence among HIV-infected and HIV-uninfected women in three US cities

Gender-based violence (GBV) is common among women with and at risk for HIV, yet little is known about the GBV associated psychological factors that could be modifiable through behavioral interventions. The current study examined the associations between some of these psychological factors (i.e., hopelessness, consideration of future consequences, self esteem), mental health symptoms, substance abuse, and GBV among a sample of 736 HIV-infected and sociodemographically similar uninfected participants in the Women's Interagency HIV Study (WIHS). Results indicated high rates of lifetime GBV among the sample (58%), as well as high rates of childhood sexual abuse (CSA) (22.2%). HIV-infected women were more likely to be hopeless and to experience lower consideration of future consequences as compared to uninfected women. Multivariable analysis indicated that current non-injection drug use and a history of injection drug use were the main correlates of GBV and CSA, even when other psychosocial variables were included in analytic models. Being born outside of the US reduced the likelihood of GBV and CSA. Future research directions and intervention implications are discussed.

Racial and ethnic differences in factors related to workplace violence victimization

Workplace violence (WPV) is a significant public health concern affecting all racial or ethnic groups. This study examined whether different racial/ethnic groups differed in vulnerability to WPV exposure and utilization of resources at the workplace. This cross-sectional research focused on White, Black, and Asian nursing employees (N = 2,033) employed in four health care institutions in a mid-Atlantic U.S. metropolitan area. Whereas childhood physical abuse was significantly related to risk of WPV among workers from all racial/ethnic backgrounds, intimate partner abuse was a significant factor for Asians and Whites. Blacks and Asians were found to be less likely than Whites to be knowledgeable about WPV resources or use resources to address WPV. Services to address past trauma, and education and training opportunities for new workers may reduce risk of WPV and promote resource utilization among minority workers.

PTSD, comorbid depression, and the cortisol waking response in victims of intimate partner violence: preliminary evidence

Posttraumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD) are two highly comorbid and debilitating disorders experienced by more than half of intimate partner violence victims (IPV). Hypothalamic-pituitary-adrenal (HPA) abnormalities are common in both disorders, though the direction of abnormalities often differs. The present study examined the relationship between comorbid PTSD and MDD, and the (salivary) cortisol waking response in 104 recently abused IPV victims. Waking cortisol levels, area under the waking curve with respect to ground (AUCg), and AUC with respect to increase (AUCi) were examined to determine the relation of HPA dynamics to comorbidity for basal versus more dynamic measures. Prior to accounting for comorbidity, women with PTSD or MDD showed significantly greater AUCi than women without the respective disorder. Accounting for comorbidity, PTSD only did not differ from other groups, while MDD only and PTSD + MDD showed greater AUCi than women with neither disorder. Results were nonsignificant for waking cortisol levels or AUCg. Results suggest that MDD drives elevated waking cortisol response, but not basal cortisol activity in recently abused IPV victims. Results demonstrate the importance of examining comorbid diagnoses and HPA activity from a dynamic perspective. Therapeutic implications are discussed.

Victimization experiences, substance misuse, and mental health problems in relation to risk for lethality among African American and African Caribbean women

The purpose of this study was to investigate the association of intimate partner victimization experiences, mental health (MH), and substance misuse problems with the risk for lethality among women of African descent. Data for this cross-sectional study were derived from a large case-control study examining the relationship between abuse status and health consequences. Women were recruited from primary care, prenatal, or family planning clinics in Baltimore and the U.S. Virgin Islands. Logistic regression was used to generate the study findings. Among 543 abused women, physical and psychological abuse by intimate partners, comorbid posttraumatic stress disorder (PTSD) and depression symptoms, and PTSD-only problems significantly increased the likelihood of lethality risk. However, victims' substance misuse and depression-only problems were not associated with the risk for lethality. In addition, PTSD symptoms mediated the relationship between severe victimization experiences and risk for lethality. Practitioners should pay attention to victimization experiences and MH issues when developing treatment and safety plans. Policies to fund integrated services for African American and African Caribbean women with victimization and related MH issues, and training of providers to identify at-risk women may help reduce the risk for lethality in intimate partner relationships.