Severe Intimate Partner Violence, Sources of Stress and the Mental Health of U.S. Black Women

Pregnancy-Associated Firearm Mortality in the U.S., 2008-2019

INTRODUCTION

This study analyzed the contribution of firearms to pregnancy-associated mortality from homicide and suicide.

METHODS

This was a retrospective cohort study using the Centers for Disease Control and Prevention's National Violent Death Reporting System from 2008 to 2019. Women aged 15-44 years who died by suicide (intentional self-harm) and homicide where a firearm was involved were included. Persons without known pregnancy status were excluded. Pregnancy-associated deaths were defined as those that occurred during pregnancy or within 1 year of pregnancy (early and late postpartum). Sociodemographic characteristics and social and circumstantial differences were compared between pregnancy-associated and nonpregnant-associated deaths. Data analysis was conducted in 2022-2023.

RESULTS

A total of 1,803 homicide and 1,929 suicide deaths from firearms were included. Twenty-two percent (n=388) and 11% (n=212) of firearm homicides and suicides, respectively, were pregnancy associated. Victims of pregnancy associated homicide were predominantly Black (54.8%), were single (76%), and had high school diploma or equivalent degree (41.2%). Victims of pregnancy-associated suicide were predominantly White (80.5%). Among pregnancy-associated homicides and suicides, deaths occurred more frequently during pregnancy (63.4% and 40.3%). Pregnancy-associated homicides more frequently occurred in the victim's home than nonpregnancy-associated homicides (51.5% vs 46.7%, p=0.02) and was related to ongoing conflict or violence between a current or former partner (61.6% vs 51.9%, p<0.001). Pregnancy-associated suicides more frequently occurred in those who experienced intimate partner violence within a month of death than non-pregnancy-associated suicide (4.2% vs 1.3%, p=0.005).

CONCLUSIONS

Although there are differences in demographic characteristics between victims, interpersonal violence is associated with both pregnancy-associated homicides and suicides where a firearm was involved.

Saliva as a diagnostic tool to measure polycyclic aromatic hydrocarbon exposure in dental patients exposed to intimate partner violence (IPV)

BACKGROUND

Social habits such as tobacco use, alcohol consumption, and chemically contaminated diet contribute to poor oral health. Intimate Partner Violence (IPV) is a global public health epidemic which can exacerbate the prevalence of health conditions affecting a victim's lifespan. This study investigates using saliva as a biomarker for detecting levels of benzo(a)pyrene [B(a)P]; a toxicant present in cigarette smoke and barbecued meat in a population of IPV + female patients.

METHODS

A cross-sectional IRB-approved study utilized 63 female participants (37 African Americans [AA], and 26 non-African Americans [NAA]), who provided consent for the study. Participants submitted samples of saliva, as well as questionnaires about demographics, health history, and a well-validated (IPV) screen.

RESULTS

The prevalence of IPV was greater in AA compared to NAA. While the concentrations of PAHs/B(a)P detected in saliva of IPV samples in NAA were generally within the range of B(a)P reported for saliva from elsewhere, the concentrations were high in some IPV positive samples. Among the B(a)P metabolites, the concentrations of B(a)P 7,8-diol, B(a)P 3,6- and 6,12-dione metabolites were greater than the other metabolite in both AA and non-AA groups who were positive.

CONCLUSION

Our study supports the use of saliva as a potential "diagnostic rheostat" to identify toxicants that may exacerbate/precipitate systemic disease in female victims of IPV. In addition, our study is the first to report that IPV may precipitate the accumulation of B(a)P in oral cavity that can alter inflammatory cascades and increase risk of poor health outcomes in this population of patients.

Race/Ethnicity, Nativity, and Gender Disparities in Mental Health Trajectories from Mid- to Later-Life: A Life Course-Intersectional Approach

BACKGROUND

Numerous studies have highlighted mental health disparities based on race/ethnicity, nativity, and gender across different life stages. However, few have investigated how the intersectionality of these factors influences mental health trajectories during midlife to late life. This study fills this gap by adopting a life course-intersectional approach, viewing mental health trajectories as dynamic processes shaped by the combined influences of race/ethnicity, nativity, and gender. It explores social, psychological, and physiological pathways contributing to these disparities.

DESIGN

Using data from the Health and Retirement Study (2006-2018; N = 38,049 observations) and growth curve models, this study examines how intra-individual trends in depressive symptoms (measured as CES-D scale, 07) are influenced by the intersection of race/ethnicity, nativity, and gender. It also investigates the impact of objective and subjective social isolation and physical health on group disparities in mental health trajectories.

RESULTS

The findings reveal that, during mid- to early late-life, most Black and Hispanic Americans experience higher levels of depressive symptoms compared to their White counterparts (disparities ranging from 0.184 to 0.463 for men and 0.117 to 0.439 for women). However, this disadvantage diminishes for US-born Hispanic men and US-born Black women (0.014-0.031 faster decrease rates compared to US-born White), while it intensifies for Hispanic immigrants (0.017-0.018 slower decrease rates compared to US-born White) in advanced ages. Mediation analysis demonstrates that both social isolation and physical health contribute to these disparities, with physical health explaining a larger portion, particularly in differences between immigrant Hispanic women and US-born Whites.

CONCLUSION

This study underscores the importance of a life course-intersectional approach in understanding mental health disparities. It emphasizes the need for improved social welfare systems and community-level interventions targeting the specific challenges faced by older Hispanic immigrants, especially women who encounter multiple forms of oppression.

Optimizing the Construction of Outcome Measures for Impact Evaluations of Intimate Partner Violence Prevention Interventions

Most impact evaluations of intimate partner violence (IPV) prevention interventions use binary measures of "any" versus "no" physical and/or sexual IPV as their primary outcome measure, missing opportunities to capture nuance. In this study, we reanalyzed secondary data from six randomized controlled trials conducted in low- and middle-income countries-Bandebereho (Rwanda), Becoming One (Uganda), Indashyikirwa (Rwanda), MAISHA CRT01, MAISHA CRT02 (Tanzania), Stepping Stones Creating Futures (South Africa), and Unite for a Better Life (Ethiopia), to assess how different conceptualizations and coding of IPV variables can influence interpretations of the impact of an intervention. We compared the standard outcome measures to new measures that reflect the severity and intensity of violence and whether interventions prevent new cases of IPV or reduce or stop ongoing violence. Results indicate that traditional binary indicators masked some of the more subtle intervention effects, and the use of the new indicators allowed for a better understanding of the impacts of the interventions. Conclusions on whether a program is perceived "to work" are highly influenced by the IPV outcomes that the investigators choose to report, and how they are measured and coded. Lack of attention to outcome choice and measurement could lead to prematurely abandoning strategies useful for violence reduction or missing essential insights into how programs may or may not affect IPV. While these results must be interpreted cautiously, given differences in intervention types, the underlying prevalence of violence, sociodemographic factors, sample sizes, and other contextual differences across the trial sites, they can help us move toward a new approach to reporting multiple outcomes that allow us to unpack the "impact" of an intervention by assessing intervention effect by the severity of violence and type of prevention, whether primary and secondary.

The Effects of Polyvictimization by Intimate Partners on Suicidality Among Salvadoran Women

Intimate partner violence (IPV) victims tend to suffer from various mental health issues. Mental health issues, including suicidal thoughts and attempts caused by IPV victimization, might be more severe among women in El Salvador, where violence against women is prevalent overall. Although polyvictimization, which is defined as experiencing more than one type of violence by one or multiple partners, is associated with more severe mental health consequences than victimization by just a single form of violence due to accumulative trauma, not enough attention has been paid to this phenomenon among Salvadoran women. Thus, guided by trauma theory, this study aimed to examine the impact of polyvictimization from different types of violence (i.e., physical, sexual, emotional, and economic) on suicidal thoughts and attempts among Salvadoran women using the 2017 Violence Against Women National Survey. A nationally representative sample of 3,074 Salvadoran women aged 15 years or older and who had experienced an intimate relationship in their lifetime, recruited through a multistage random sampling design, was analyzed in this study using logistic regression analyses. We found that psychological and economic violence, along with physical and sexual violence, had statistically significant associations with suicidal thoughts and attempts, and polyvictimization increased suicidal thoughts and attempts. Based on this study's findings, we recommend effective research and practice or intervention implementation for addressing IPV and associated mental health problems among Salvadoran women.

Evidence of Help-Seeking Behaviors Among Black Women Under Community Supervision in New York City: A Plea for Culturally Tailored Intimate Partner Violence Interventions

BACKGROUND

Black women involved in the legal system disproportionately experience intimate partner violence (IPV); however, current research does not satisfactorily describe the risk and protective factors associated with IPV among Black women under community supervision.

METHODS

We conducted a subgroup analysis of Black women (N = 128) using data from a randomized controlled trial that evaluated the feasibility and efficacy of two IPV screening and prevention programs for women under community supervision. Participants in the original study were randomized into two IPV prevention conditions-computerized or case manager Women Initiating New Goals of Safety (WINGS). In this study, we examine the effects of that study's two conditions on linkage to IPV services and secondary outcomes, specifically among Black participants who experienced physical, sexual, and psychological IPV.

RESULTS

Both conditions showed significant reductions in days of substance use abstinence over the 3-month period among Black women who experienced sexual or verbal IPV. Participants in the case manager arm were 14 times more likely to receive IPV services in the past 90 days-from baseline to the 3-month follow-up (adjusted odds ratio = 14.45, 95% confidence interval [CI] = 1.25 to 166.51, p = 0.032). Participants in the computerized arm were significantly more likely to report receiving social support from baseline to the 3-month follow-up assessment (regression coefficient [b] = 2.27, 95% CI = 0.43 to 4.11, p = 0.015).

CONCLUSIONS

Although both conditions showed significant reductions in the number of days of abstinence from substance use among this subgroup of Black women, the findings showed differential effectiveness between the computerized WINGS arm and the case manager WINGS arm in improving social support and linkage to services. These findings may indicate that different modalities of WINGS may work better for specific activities and point to the need for a hybrid format that optimizes the use of distinct modalities for delivering activities.

Meta-analysis of the effect of racial discrimination on suicidality

Racial discrimination (RD) is unfair treatment of individuals based on race or ethnicity. It is a pervasive and increasing phenomenon in the lives of many individuals with deleterious effects on mental health. Research implicates RD in diminished well-being, lower life satisfaction and self-esteem, and mental health disorders. Furthermore, there have been reports that minorities and marginalized groups exposed to RD are at a higher risk of suicide. Given that RD negatively impacts mental health and that suicide is a major public health concern, we meta-analytically reviewed the literature to investigate whether RD is associated with suicidal ideation (SI) and suicide attempt (SA). We identified 43 eligible articles investigating the association between RD and suicidality through PubMed, Embase, PsycINFO and Scopus, from which we pooled 39 effect sizes for SI (58,629 individuals) and 15 for SA (30,088 individuals). Results demonstrated that RD has a small but significant effect both on SI (r = 0.16, 95% CI: 0.12 to 0.19; p < 0.0001) and on SA (r = 0.13, 95% CI: 0.02 to 0.23; p = 0.018). We found no indication of publication bias, and fail-safe tests confirmed the robustness of the results. Furthermore, we tested the moderating effects of several study characteristics (e.g., age, race, RD and SI time frame assessment, and categorization of RD measures). The only study characteristic to moderate the effect of RD on SI was SI time frame assessment (r = 0.07; 95% CI: 0.015 to 0.12; p = 0.01). Our findings suggest that SI and SA are phenomena that may be influenced by exposure to RD. Thus, individuals that are discriminated based on race may develop more suicidal thoughts and an increased likelihood of attempting suicide. These findings underscore the need for more prevention and intervention efforts to attenuate the effect of RD on suicidality.

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We conducted a meta-analysis of 62,349 individuals.

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We pooled effect sizes from 43 studies from seven countries.

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Racial discrimination has a statistically significant effect on suicidal ideation (r = 0.16, p < 0.0001).

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Racial discrimination has a statistically significant effect on suicide attempt (r = 0.13, p = 0.018).

Adults Suffering from Violence Are at Risk of Poor Prognosis in Taiwan, 2000-2015

Objective: To understand the risk of developing a poor prognosis in adulthood after violent injury in Taiwan. Methods: This study used the data of outpatients, from emergency departments, and from hospitalization of 2 million people under National Health Insurance from 2000 to 2015. The ICD-9 diagnostic code N-code was defined as the case of this study and was 995.8 (abused adult) or E-code was E960-E969 (homicide and intentional injury by others) The first violent injury of 18−64-year-old adults (the study group) was analyzed. Patients who had not suffered violent abuse were the control group. The groups were matched in a 1:4 ratio, and the paired variables were gender, age ±1 year, Charlson Comorbidity index (CCI) before exposure, and year of medical treatment. SAS 9.4 statistical software was used, and the Cox regression method was used for data analysis. Results: During the 15-year period, a total of 8726 people suffered from violence (34,904 controls). The incidences of common poor prognoses among the victims of violence were sleep disorder, anxiety, and depression, in 33.9%, 21.6%, and 13.2% of people, respectively. The risk (Adults, Overall) of developing Post-Traumatic Stress Disorder (PTSD), bipolar disorder, and manic disorder after being violently injured (average 9 years) was 34.86, 4.4, and 4.1 times higher than those who had not suffered violence (all p values < 0.01). The risk (Adults, Males) of developing PTSD, bipolar disorder, and manic disorder after being violently injured (average 9 years) was 30.0, 3.81, and 2.85 times higher, respectively, than those who had not suffered violence (all p values < 0.01). The risk (Adults, Females) of developing PTSD, manic disorder, and bipolar disorder after being violently injured (average 9 years) was 36.8, 6.71, and 5.65 times higher, respectively, than of those who had not suffered violence (all p values < 0.01). Conclusion: The risks of poor prognosis are higher in adults who have suffered violent abuse than in those who have not. Therefore, police, social workers, and medical personnel should pay attention to the mental state of victims of violence. They should aim to support prompt treatment, to avoid PTSD, bipolar disorder, manic disorder, etc.

Persistence, Impairment, Disability and Unmet Treatment of Lifetime and 12-Month Anxiety Disorders in Black Men and Women, 50 Years of Age and Older

Objectives: To examine anxiety disorders in aging Black adults. Methods: Using nationally representative data from the National Survey of American Life, we estimated lifetime/12-month prevalence of anxiety disorders in Black men and women, age 50+ (N = 1561). Disorder-specific persistence and severity, functional impairment, and mental health service utilization were investigated using multivariate regressions. Results: Black men and women who met criteria for anxiety disorders (lifetime prevalence=12.4%/18.3% in men/women) also demonstrated persistent disorders (percent meeting criteria = 40.3%-61.2%). Those with a 12-month anxiety disorder (6.2%/10.5% of men/women) typically reported severe task interference (38.3%-85.7%). Those with any 12-month anxiety disorder, compared to those without, experienced greater impairment in days out of role, work, family burden, cognition and, in women, mobility (p's < .05). Only 47.0%/65.2% of Black men/women with any lifetime anxiety disorder used mental health services. Discussion: Despite low prevalence, older Blacks with anxiety disorders experience substantial mental health burden in middle age and later.

Prevalence, Severity and Burden of Post-Traumatic Stress Disorder in Black Men and Women Across the Adult Life span

Objectives: To examine post-traumatic stress disorder (PTSD) among Black adults in younger, middle, and older ages. Methods: Using nationally representative data from the National Survey of American Life, we estimated lifetime and 12-month prevalence of PTSD in Black men and women ages 18-34, 35-49, and 50+. We determined PTSD persistence and severity by age group, then associations of PTSD with socio-economic status, chronic stress, and racial discrimination in middle age. Results: The lifetime prevalence of PTSD was higher in Black women/men ages 18-34 (prevalence=14.0%/6.3%) and 35-49 (12.8%/4.6%) versus 50 and older (8.7%/5.1%). Those ages 35-49 were more likely than younger/older Black adults to have severe interference in work, relationships, and activities domains. In middle age, PTSD was associated with unemployment, lower education, poverty, and stress in Black men, and unemployment, divorce, poverty, stress, and discrimination in Black women. Discussion: Black women experience a disproportionate burden of PTSD in middle age.

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.

Lifetime and Twelve-Month Prevalence, Persistence, and Unmet Treatment Needs of Mood, Anxiety, and Substance Use Disorders in African American and U.S. versus Foreign-Born Caribbean Women

There is growing diversity within the Black population in the U.S., but limited understanding of ethnic and nativity differences in the mental health treatment needs of Black women. This study examined differences in the prevalence of psychiatric disorders, their persistence, and unmet treatment needs among Black women in the U.S. Data were from the National Survey of American Life, a nationally representative survey that assessed lifetime and twelve-month mood, anxiety, and substance use disorders according to the Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV) criteria, and mental health service use among those meeting disorder criteria. One in three African American women met criteria for a lifetime disorder, compared to one in three Caribbean women born within the U.S. and one in five Caribbean women born outside the U.S. About half of African American women with a lifetime disorder had a persistent psychiatric disorder, compared to two in five Caribbean women born within the U.S. and two in three Caribbean women born outside the U.S. African Americans had more persisting dysthymia and panic disorder and less persisting social phobia compared to foreign-born Caribbean women. Of the three groups, Caribbean women born within the U.S. were most likely to seek mental health treatment during their lifetime. These results demonstrate, despite a lower prevalence of psychiatric disorders in Black women, that there is a great likelihood their disorders will be marked by persistence and underscores the need for culturally specific treatment approaches. As Black immigrants in the United States are increasing in number, adequate mental health services are needed.