Physical health consequences of intimate partner violence in Spanish women

The effects of violence and related stress on asthma

In the United States, people living in deprived urban areas and persons in certain minoritized groups are often exposed to violence and affected with asthma, and epidemiologic studies have shown a link between exposure to violence (ETV) and asthma throughout the lifespan. Indeed, ETV at the individual, intrafamilial and community levels has been linked to asthma in children and adults. In this review, we discuss the evidence for a causal relation between ETV and asthma, emphasizing findings published in the last five years. Interpretation of the available evidence is limited by variable quality of the assessment of ETV or asthma, potential recall and selection bias, inability to estimate the relative contribution of various types of violence to the observed associations, lack of objective biomarkers of asthma or asthma endotypes, and inconsistent consideration of potential confounders or modifiers of the ETV-asthma link. Despite such limitations, the aggregate evidence from studies conducted in different locations and populations suggests that ETV affects asthma and asthma outcomes, and that this is explained by direct physiologic effects of violence-related distress and indirect effects (e.g., through risky health behaviors or co-morbidities). Thus, large prospective studies with careful assessment of specific types of ETV, key covariates and comorbidities (including mental illness), and asthma are needed to advance this field. Such research efforts should not preclude screening for maltreatment in children with asthma and ETV-related depression and anxiety in adolescents and adults with asthma. Further, vigorous policies are needed to curtail violence, as such policies could benefit patients with asthma while saving lives.

The impact of domestic violence: a prospective forensic study in the northeastern region of Algeria (Annaba)

Background

Violence against women is a global problem affecting different social and economic classes. The present study aimed to identify the impact of domestic violence on the health status of women abused by their intimate partner.

Methods

This is a cross-sectional descriptive study of a sample of women who were examined at the forensic exploration unit of Annaba Hospital over a period of 3 months (first quarter of 2018). In all, 200 women were recruited among those who had been abused by the intimate partner.

Results

One in ten women who consulted was a victim of domestic violence (9.36%). The average age was 33.91+/−9.02 years, with extremes from 19 to 65 years. There were multiple consequences, including physical injuries (bruises, fractures), many sequelae (neurosensory and functional deficits), and acute stress and anxiety disorders requiring appropriate care and social consequences (lack of resources, divorce). Forty percent of the interviewed victims had a general comorbidity, three quarters of whom had a worsening of their previous pathology. All forms of violence were present with varying frequencies, especially psychological violence with an extremely high frequency and sexual violence of remarkable severity. Many negative effects were identified; an association of suicide attempts and sexual violence (P = 0.0020) was rated.

Conclusions

The impact of this form of abuse is considerable and concerns mental, physical, and social health. We have to anticipate and raise the awareness of care providers of its consequences.

Reaching out to men in ending intimate partner violence: a qualitative study among male civil servants in Ibadan, Nigeria

PURPOSE

The aim of this study was to explore the perceptions of male civil servants in Ibadan, Nigeria about the perpetration of IPV and to document their suggested measures to prevent IPV in our communities in Nigeria.

METHODS

Four focus group discussions were conducted among 36 male civil servants selected from Oyo State Secretariat, Ibadan using purposive sampling technique. Data were transcribed and analysed using thematic approach.

RESULTS

Six major themes were identified; awareness of the forms of IPV, women and men as victims, causes, attitude, consequences as well as the suggested strategies for the prevention of IPV. Physical and psychological abuse were mentioned across the groups. The respondents pointed out that women experience IPV more than men, but that men also experience it. Some respondents stated that physical and psychological abuse against female intimate partners were acceptable in some circumstances according to the societal norms. The negative effects of IPV on physical, mental and social well-being of the individual, families and society were mentioned. Suggested ways of preventing IPV include tolerance and patience which will promote healthy, respectful and non-violent relationships among intimate partners.

CONCLUSION

Considering the perceptions and attitudes of these men to IPV, it is important to reach out to both genders for appropriate preventive and educational intervention in ending IPV among women and men.

Intimate Partner Violence and Sexual Agency in a Nationally Representative Sample of Women and Girls in the Philippines

This study examined the prevalence of intimate partner violence (Intimate Partner Violence) and its associations with sexual agency among women and adolescent girls in the Philippines. Data came from the 2017 Philippines National Demographic and Health Survey (DHS), a nationally representative, cross-sectional survey of women and girls ages 15-49. Participants included 11,727 women and girls who reported having a current male partner. Survey measures included three indicators of Intimate Partner Violence (physical, sexual, emotional), ability to refuse sex, ability to insist on condom use, perception that a husband/boyfriend can be justified in hitting or beating his wife/girlfriend, and sociodemographic characteristics. Descriptive and multivariable statistical analyses were conducted, with survey weightings used to account for the complex survey design. Overall, 23.9% reported Intimate Partner Violence in their current partnership (10.1% physical violence, 3.4% sexual violence, 19.0% emotional violence), 11.2% believed a husband or partner could be justified in hitting or beating their wife, 10.5% reported being unable to refuse sex with their partner, and 20.4% were unable to ask their partner to use a condom. In multivariable analyses, experiences of sexual (OR .68; 95% CI .50, .92), physical (OR .83; 95% CI .68, 1.02), and emotional violence (OR .69; 95% CI .58, .81) were associated with lower adjusted odds of being able to ask a partner to use a condom. When placed in the same model, emotional violence had the strongest association with lower odds of negotiating condom use with partner (OR .70; 95% CI .57, .85). Perception that a husband/boyfriend can be justified in hitting or beating his wife/girlfriend was associated with lower ability to refuse sex and ask a partner to use a condom. Findings indicate a need for further investment in interventions to prevent Intimate Partner Violence and support the sexual health and agency of women and girls who have experienced Intimate Partner Violence in the Philippines.

Risk Assessment Instruments for Intimate Partner Femicide: A Systematic Review

Intimate partner violence is a severe problem that has taken the lives of thousands of women worldwide, and it is bound to continue in the future. Numerous risk assessment instruments have been developed to identify and intervene in high-risk cases. However, a synthesis of specific instruments for severe violence against women by male partners has not been identified. This type of violence has specific characteristics compared to other forms of intimate partner violence, requiring individualized attention. A systematic review of the literature has been conducted to summarize the intimate partner homicide risk assessment instruments applied to this population. It has been carried out with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. The search strategy yielded a total of 1,156 studies, and only 33 studies met eligibility criteria and were included in the review. The data of these studies were extracted, analyzed, and presented on study characteristics (country and year, sample, data sources, purpose of the studies) and main findings (a brief description of the instruments, risk factor items, psychometric properties). The results indicate that the Danger Assessment, the Danger Assessment for Immigrants, the Danger Assessment for Law Enforcement, the Danger Assessment-5, the Taiwan Intimate Partner Violence Danger Assessment, the Severe Intimate Partner Risk Prediction Scale, The Lethality Screen, and the H-Scale are specific risk assessment instruments for predicting homicide and attempted homicide. There are differences in the number and content of risk assessment items, but most of them include the evidence's critical factors associated with homicide. Validity and reliability scores of these instruments vary, being consistency and accuracy medium-high for estimating homicide. Finally, implications for prediction and prevention are noted, and future research directions are discussed.

Trick or Treat: Does a Microfinance Loan Induce or Reduce the Chances of Spousal Violence against Women? Answers from India

It is a common belief that microfinance plays a dual role of poverty alleviation and socioeconomic upliftment of its women participants. However, there are enough researches that negates the positive impact of microfinance loans on spousal violence. Recognized as one of the most predominant social evils, violence against women is not only a violation of their human rights but also an act of exploitation and denial of freedom. In the present study, we have tried to investigate if microfinance loan takers experience more spousal violence as compared to their counterparts by analyzing the National Family Health Survey IV, 2015-16. Our results indicate that 40.8% of women microfinance participants experience spousal violence. Additionally, the likelihood of microfinance participants to experience spousal violence is much higher than the non-microfinance participants (odds ratio = 1.35, p value = .000). Microfinance programs are designed to increase the individual agencies of women participants, which, in turn, reduce the chances of them becoming victims of spousal violence. However, if the credit program participation induces the woman to be a victim of spousal violence together with becoming financially autonomous, then such hidden costs need to be taken into account while evaluating the effectiveness of the gendered policy design.

Intimate partner violence and asthma in pediatric and adult populations

OBJECTIVE

To evaluate the relationship between intimate partner violence (IPV) and adult and childhood asthma outcomes.

DATA SOURCES

We conducted a systematic literature review using 4 databases (PubMed, Ovid MEDLINE, Ovid Embase, and Ovid PsycINFO) with asthma and IPV-associated terms.

STUDY SELECTIONS

We included published studies, available in English, to October 2021, which included IPV as an exposure and asthma as an outcome. Both adult and pediatric populations were included in the following settings: community, health care, and home.

RESULTS

There were 37 articles identified. There was evidence among multiple studies to support increased prevalence of asthma in adults exposed to IPV and prevalence and incidence in children with parental IPV exposure. There were fewer studies evaluating IPV exposure and adult asthma morbidity, but they found statistically significant associations between IPV and increased rate of asthma exacerbations and worsened asthma control. There was sparse evidence evaluating a relationship between IPV and adult asthma mortality. There were no studies identified evaluating IPV and childhood asthma morbidity or mortality.

CONCLUSION

The association between IPV and increased asthma prevalence, incidence, and worsened morbidity merits recognition and further investigation into potential mechanisms. Health care providers can implement practical strategies to help mitigate the negative effects of IPV on health and asthma. These include addressing potential impactful biopsychosocial factors and comorbidities, implementing routine screening and referrals, and partnering with community advocacy organizations. Given their positions of respect and power in society, health care providers can have lasting impacts on the lives of pediatric and adult patients affected by IPV.

Signs and symptoms of intimate partner violence in women attending primary care in Europe, North America and Australia: a systematic review and meta-analysis

BACKGROUND

Intimate partner violence (IPV) is a prevalent yet underdiagnosed health issue, and primary care practitioners are in a unique front-line position to provide care and counsel for the victims.

OBJECTIVE

To identify the signs and symptoms of women exposed to IPV who attended primary care, regardless motive of consultation.

METHODS

Systematic review and meta-analysis on Cochrane, PubMed, Embase and CINAHL between 1946 and 2020. Eligible studies had to be original quantitative research, on women aged >15 years, attending primary care settings in Europe, North America and Australia and interviewed on their status as victims of IPV and on their signs and symptoms.

RESULTS

Of 1791 articles identified, 57 were selected. Associations were found between IPV and signs and symptoms of depression [19 studies: overall odds ratio (OR) = 3.59, 95% confidence interval (CI; 2.7-4.7, I2 = 94.6%)], anxiety [9 studies: overall OR = 2.19, 95% CI (1.75-2.73, I2 = 84%)], gynaecological and/or sexually transmitted infections [6 studies: overall OR = 2.82, 95% CI (2.1-3.8, I2 = 41%)] and combination of somatic symptoms [5 studies: standard mean deviation = 0.795, 95% CI (0.62-0.97, I2 = 0%)].

CONCLUSIONS

Women exposed to IPV may present with clinical symptoms and signs other than bodily injury. Policy implications knowing these symptoms presented by women victims of IPV can help GPs identify and treat them.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018089857.

Can Justice System Interventions Prevent Intimate Partner Homicide? An Analysis of Rates of Help Seeking Prior to Fatality

When women are killed, they are more likely to be killed by an intimate partner than anyone else, and a substantial number of women who are killed by an intimate were abused by that intimate partner before their death. The proportion of men killed by an intimate partner is much lower and prior research indicates that male intimate partner homicide victims are likely to abuse their partners prior to their deaths. However, limited research has examined the criminal and civil justice help seeking of intimate partner homicide victims. This study examines administrative data from one large urban police jurisdiction to understand rates of help seeking by homicide victims in the 1 to 3 years prior to the homicide. Over 4 years (2010-2014), 197 women and 776 men were killed. The proportion of women killed by an intimate or ex-intimate partner was 39.6%, and the proportion of men killed by an intimate or ex-intimate partner was 3.9%. Police had been in contact with the victim of intimate partner femicides for a domestic violence complaint in 91% of cases in the 3 years prior to the femicide (44.9% resulted in arrest), with an average of 6.2 visits per contacted victim. Among male intimate partner homicide victims, 73.3% had been the complainant on a domestic violence case (38.1% resulted in arrest). Few (<10%) victims sought protection orders before the homicide. Over the 3 years prior to their deaths, 36.7% of male homicide victims and 9.0% of femicide victims had been the suspect in a domestic violence case. Results indicate high rates of engagement of police officers with intimate partner homicide victims before their deaths, and highlight the opportunity for homicide prevention through integration of risk assessment (to identify high-risk cases) and enhanced criminal justice and social service interventions in high-risk cases.

Exploring Intimate Partner Violence Among Women Attending Malaysian Primary Care Clinics

Victims of intimate partner violence (IPV) are frequent attendees at health care facilities. Although most literature on this subject focuses on developed or Western countries, there is a dearth of information from Asian countries. This study aims to estimate the prevalence of IPV among women attending urban primary care services in Malaysia and to identify the risk factors associated with IPV. Six out of 15 available public primary care clinics in the federal territory of Kuala Lumpur, Malaysia, were randomly selected. The sampling size for each clinic was conducted proportionate to the clinic's average daily patient attendance. A total of 882 women participated in this study via a self-administered questionnaire. We administered the women's experience with battering scale (WEB-scale) to estimate the prevalence of psychological violence and included a screening question for physical and sexual assault. The results showed that 22.0% of the women surveyed reported experiencing IPV. Ethnicity appears to be a significant predictor, with Chinese and Indian women reporting IPV at a higher rate than Malay women. Women with IPV are more likely to come from lower income households, have witnessed parental IPV, receive less social support, and have poorer psychological well-being. Our findings indicate that the prevalence of IPV among women attending urban public primary care clinics is high. Health care providers should pay close attention during clinical encounters for any sign of IPV, particularly among those presenting with risk factors.

Exposure to Intimate Partner Violence and Hypertension Outcomes among Young Women in South Africa

Hypertension and intimate partner violence is affecting longevity and quality of life among women worldwide. In this study, intimate partner violence is identified as a risk factor for hypertension outcomes among young women in South Africa. Using a nationally representative sample of 216 (N) young women (15-34 years old) from the South African Demographic and Health Survey, this study uses cross-tabulations and logistic regression methods to identify the odds of hypertension outcomes. Results show that between 20 and 41% of 15-34-year-old women have hypertension. Further, 68% of women with hypertension experienced physical intimate partner violence. Finally, the odds of hypertension are increased if young women experience physical (OR: 4.07; CI: 1.04726-15.82438) or sexual (OR: 2.56; CI: 1.18198-5.55834) intimate partner violence. Efforts to reduce hypertension outcomes in the country should include intimate partner violence awareness and assistance.

Possible Role for Imagery-Based Therapy in Managing PTSD in Pakistani Women Experiencing Domestic Abuse: A Pilot Study Using Eidetic Therapy

Domestic abuse of women is a serious problem worldwide that has economic, physical, and psychological consequences, yet in many countries and cultures, victims often have little access to psychological support. Using a pre-post design, we investigated the effects of psychological intervention using an imagery-based therapy in women showing post-traumatic stress disorder (PTSD) resulting from spousal domestic abuse. Forty women, referred from outpatient clinics in Pakistan and meeting inclusion criteria, underwent individual trauma counseling for 10-12 weeks using the principles of Eidetic Therapy, an imagery-based therapy that circumvents heavy reliance on verbal skills and narratives. Women showed significant reductions in PTSD by the end of treatment. Predictors of treatment gains included type of abuse, PTSD level at the outset of therapy, and years in the relationship. Neither economic resources or literacy, nor abuser or victim characteristics, predicted the amount of improvement. In conclusion, therapy was associated with a reduction in PTSD symptoms regardless of literacy level of participants. This reduction in PTSD was notable because, unlike many situations involving spousal abuse, these women were generally not in a position to leave their relationship, and hence the women might have experienced continued exposure to abuse. Context/cultural-based explanations for these findings are presented and discussed.

Social Structure, Social Learning, and the Severity of Physical Intimate Partner Violence Against Women in Nigeria

Using the Nigerian Demographic and Health Survey (NDHS) of 2013, this study applies the social structure (feminist) and social learning perspective in understanding the severity of physical intimate partner violence (IPV) in Nigeria. About 26,403 married women were analyzed from the 2013 NDHS data. Multinomial regression was used to analyze variables that capture the social structural and social learning perspectives in relation to women's experience of minor and severe physical IPV. The study revealed that primary and secondary educational attainment, and being employed predicted severe physical IPV victimization. Alcohol consumption by the respondents' spouses, being a victim of childhood abuse, and witnessing IPV between parents predicted severe physical IPV. The finding of this study implies that experiences of IPV take place within a sociocultural context that shapes the social realities of the average Nigerian woman.

Physical and mental health of women exposed to intimate partner violence in the 10 years after having their first child: an Australian prospective cohort study of first-time mothers

OBJECTIVE

To investigate mental and physical health of mothers exposed to recent and early postpartum intimate partner violence (IPV) in the 10 years after having their first child.

DESIGN

Prospective pregnancy cohort study.

SETTING

Women were recruited at six metropolitan public maternity hospitals in Melbourne, Australia and followed up at 1, 4 and 10 years post partum.

STUDY MEASURES

Exposure to physical and/or emotional IPV was measured using the Composite Abuse Scale at 1, 4 and 10 years. At 10-year follow-up, mothers reported on physical and mental health, and functional health status.

PARTICIPANTS

1507 first-time mothers enrolled at mean of 15 weeks' gestation.

RESULTS

One in three women experienced IPV during the 10 years after having their first child. Women experiencing recent IPV (19.1%) reported worse physical and mental health than women not reporting IPV. Compared with women not reporting IPV, women experiencing recent IPV had higher odds of poor functional health status (Adj OR=4.5, 95% CI 3.2 to 6.3), back pain (Adj OR=2.0, 95% CI 1.4 to 2.9), incontinence (Adj OR=1.8, 95% CI 1.2 to 2.6), depressive symptoms (Adj OR=4.9, 95% CI 3.2 to 7.5), anxiety (Adj OR=5.1, 95% CI 3.0 to 8.6) and post-traumatic stress symptoms (Adj OR=7.2, 95% CI 4.6 to 11.1) at 10 years. Women with past IPV at 1 and/or 4 years (15.7% of the cohort) also had higher odds of physical and mental health problems. There was evidence of a gradient in health outcomes by recency of exposure to IPV.

CONCLUSIONS

Both recent and past exposure to IPV are associated with poor maternal physical and mental health 10 years after a first birth. Health services and advocacy organisations providing support to women need to be aware of the consistent relationship between IPV and a range of physical and mental health conditions, which may persist even after IPV appears to have ceased.

Barriers to women's disclosure of domestic violence in health services in Palestine: qualitative interview-based study

Background

Domestic violence (DV) damages health and requires a global public health response and engagement of clinical services. Recent surveys show that 27% of married Palestinian women experienced some form of violence from their husbands over a 12 months' period, but only 5% had sought formal help, and rarely from health services. Across the globe, barriers to disclosure of DV have been recorded, including self-blame, fear of the consequences and lack of knowledge of services. This is the first qualitative study to address barriers to disclosure within health services for Palestinian women.

Methods

In-depth interviews were carried out with 20 women who had experienced DV. They were recruited from a non-governmental organisation offering social and legal support. Interviews were recorded, transcribed and translated into English and the data were analysed thematically.

Results

Women encountered barriers at individual, health care service and societal levels. Lack of knowledge of available services, concern about the health care primary focus on physical issues, lack of privacy in health consultations, lack of trust in confidentiality, fear of being labelled ‘mentally ill’ and losing access to their children were all highlighted. Women wished for health professionals to take the initiative in enquiring about DV. Wider issues concerned women’s social and economic dependency on their husbands which led to fears about transgressing social and cultural norms by speaking out. Women feared being blamed and ostracised by family members and others, or experiencing an escalation of violence.

Conclusions

Palestinian women’s agency to be proactive in help-seeking for DV is clearly limited. Our findings can inform training of health professionals in Palestine to address these barriers, to increase awareness of the link between DV and many common presentations such as depression, to ask sensitively about DV in private, reassure women about confidentiality, and increase awareness among women of the role that health services can play in DV.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-09907-8.

Prevalence and factors associated with intimate partner violence against women in The Gambia: a population-based analysis

Although intimate partner violence (IPV) against women is prevalent in sub-Saharan Africa, studies that investigated factors associated with IPV among Gambian women are limited. In this study, we examined the prevalence and factors associated with the different forms of IPV against Gambian women. We used a sample of 3,116 currently married women age (15 ~ 49 years) from The Gambia Demographic and Health Survey 2013. Logistic regression models were used to examine factors associated with Physical Violence (PV), Sexual Violence (SV), and Emotional Violence (EV). Over 40% (n = 1,248) of women reported at least one form of IPV. The prevalence of PV, SV and EV was 20.6%, 4.3%, and 15.1% respectively. Women married at age 18 ~ 24 (adjusted Odds Ratio [aOR]_SV = 1.55), lived with 3 ~ 4 (aOR_PV = 1.69; aOR_EV = 2.10) and ≥5 (aOR_PV = 1.77; aOR_EV = 2.64) children, witnessed parental violence (aOR_PV = 1.66; aOR_SV = 2.75; aOR_EV = 2.25), partner's primary education (aOR_PV = 1.76), accused of unfaithfulness (aOR_PV = 2.42; aOR_SV = 3.62; aOR_EV4.10), and partner's alcohol consumption (aOR_PV = 2.56; OR_SV = 3.91; aOR_EV = 2.82) are more likely to report IPV. Conversely, women who lived in Kerewan area (aOR_PV = 0.43; aOR_SV = 0.38; aOR_EV = 0.50), had high income (aOR_PV = 0.65), Wolof (aOR_PV = 0.68) and Jola (aOR_PV = 0.65) ethnicity and unemployed (aOR_PV = 0.59; aOR_SV = 0.56) were less likely to report IPV. Interventions to prevent IPV should focus on education on its effects, and programs that reject sociocultural practices as determinants of IPV.

Psychosocial interventions for intimate partner violence in low and middle income countries: A meta-analysis of randomised controlled trials

Background

Intimate partner violence (IPV) is prevalent worldwide and presents pernicious consequences for women in developing countries or humanitarian settings. We examined the efficacy of psychosocial interventions for IPV among women in low- and middle-income countries (LMICs).

Methods

Seven databases were systematically searched for randomised controlled trials (RCTs) examining psychosocial interventions for IPV in LMICs. Thirteen RCTs were included in random-effects meta-analyses. Risk ratios (RR) and risk difference were calculated as pooled effect sizes. Risk of bias was assessed using an adapted version of the Cochrane tool accounting for cluster RCTs. Sensitivity analyses were conducted for risk of bias and design characteristics. Publication bias and heterogeneity were assessed.

Results

Psychosocial interventions reduced any form of IPV by 27% at shortest (relative risk (RR) = 0.73) and 25% at longest (RR = 0.75) follow up. Physical IPV was reduced by 22% at shortest (RR = 0.78) and 27% at longest (RR = 0.73) follow up. Sexual IPV was reduced by 23% at longest follow up (RR = 0.77) but showed no significant effect at shortest follow-up. Sensitivity analyses for risk of bias led to an increase in magnitude of the effect for any form of IPV and physical IPV. The effect on sexual IPV was no longer significant. Heterogeneity was moderate to high in the majority of comparisons.

Conclusions

Psychosocial interventions may reduce the impact of IPV in humanitarian or low and middle income settings. We acknowledge heterogeneity and limited availability of RCTs demonstrating minimal risk of bias as limitations.

Quality of life, psychological distress and violence among women in close relationships: a population-based study in Finland

BACKGROUND

The aim of this study was to examine associations between exposure to violence, quality of life, and psychological distress. Women aged 19-54 years who had been exposed to violence by someone in a close relationship were compared with women unexposed to violence in Finland. We also aimed to investigate associations between different forms of violence (physical, sexual, emotional, or any combination of these) with quality of life and psychological distress.

METHODS

We selected a sample of 22,398 women who had returned self-completed questionnaires from a Finnish population-based health survey between 2013 and 2016. Exposure to violence during the past year was assessed through specific questions from the survey. The EUROHIS-QOL 8-item index was used to measure quality of life, and ordinary least square regressions were fitted. The mental health inventory (MHI-5) was used to measure psychological distress. We investigated associations with multivariate logistic regression analysis.

RESULTS

Among women in Finland, the prevalence of exposure to violence in any type of close relationship during the past year was 7.6%. Women who had been exposed to violence had significantly worse scores of the EUROHIS-QOL 8-item index, and psychological distress was significantly worse (p < 0.001), compared with unexposed women. Strong associations were found between combinations of violence and both quality of life (coefficient - 0.51, p < 0.001) and mental health (odds ratio 4.16, 95% confidence interval 3.44-5.03). Compared with women who had been exposed to violence by a stranger, women who had been exposed to violence by someone in a close relationship had significantly lower quality-of-life scores (p < 0.001).

CONCLUSIONS

This study found that experience of close relationship violence had a negative influence on both quality of life and psychological distress among women in the general Finnish population. Comparison with victims of violence by strangers shows that some of the lower quality-of-life scores among victims are driven by the perpetrator and victim being in a close relationship. Preventive policies in primary care settings aimed at screening and educating young people should be considered as an early form of intervention to reduce the negative mental health consequences of violence.

Domestic Violence and Healthcare Utilization in Turkey

This study aims to analyze the prevalence of domestic violence, the level, and determinants of healthcare utilization of women exposed to violence and the satisfaction from the behaviors of health personnel. The data source of this study is the 2014 Research on Domestic Violence against Women in Turkey which was carried out with Hacettepe University Institute of Population Studies and Ministry of Family and Social Policies in Turkey. The research has a nationally representative sample of 7462 women aged 15-59. Logistic regression analysis was performed to determine the effect of the basic characteristics of women on receiving healthcare due to violence. In this study, the rate of women receiving healthcare was 63%. Women who were unemployed have no health insurance, live in low wealth level, in rural areas, and the Eastern region had used healthcare services at a lower level.

Risk of Cardiometabolic Disease and All-Cause Mortality in Female Survivors of Domestic Abuse

Background Domestic abuse (DA) against women is a global public health problem. Although the possible health burden could be substantial, the associations between DA and subsequent cardiometabolic disease (cardiovascular disease, hypertension, and type 2 diabetes mellitus) and all-cause mortality are poorly understood. Methods and Results This retrospective cohort study consisted of UK-based primary care patients between January 1, 1995, to December 1, 2017. Overall, 18 547 women exposed to DA were matched to 72 231 unexposed women by age and lifestyle factors. The main outcomes, presented as adjusted incidence rate ratios (IRRs), were the risk of developing cardiovascular disease, hypertension, type 2 diabetes mellitus, and all-cause mortality. In total, 181 exposed women experienced a cardiovascular disease event compared with 644 of the unexposed control group, relating to an increased adjusted IRR of 1.31 (95% CI, 1.11-1.55; P=0.001). There was also an increased risk of subsequent type 2 diabetes mellitus (adjusted IRR: 1.51; 95% CI, 1.30-1.76; P<0.001) and all-cause mortality (adjusted IRR: 1.44; 95% CI, 1.24-1.67; P<0.001) following exposure to DA. This observation was not seen with hypertension (adjusted IRR: 0.99; 95% CI, 0.88-1.12; P=0.873). Conclusions There is an increased risk of subsequent cardiovascular disease, type 2 diabetes mellitus, and all-cause mortality in female survivors of DA. However, there is no association with the development of hypertension in this group, in keeping with previous literature. Considering the high prevalence of DA, clinicians should be made aware of the disproportionally increased risk and thus are encouraged to manage modifiable risk factors actively in this group.

Hand therapists' attitudes, environmental supports, and self-efficacy regarding intimate partner violence in their practice

STUDY DESIGN

Descriptive, cross-sectional.

INTRODUCTION

Intimate partner violence (IPV) may involve physical, psychological, or sexual abuse. Although hand injuries are reported as common sequelae of IPV, there is limited attention to this issue in hand therapy research reports or practice recommendations.

PURPOSE OF THE STUDY

The primary aim is to describe the attitudes and beliefs of hand therapists (HTs) about IPV issues.

METHODS

A sample of 189 HT completed a standardized survey investigating perceptions regarding issues pertaining to IPV. Areas addressed included self-efficacy (in dealing with IPV), perceived systemic support, victim blaming, professional role responsibility, and safety. Data were analyzed using descriptive statistics while between-group comparisons evaluating the impact of prior IPV experience and demographic variables of gender, country, certified hand therapy, and occupation on questionnaire scores used Mann-Whitney U analysis.

RESULTS

The majority of therapists (66%) had some prior experience with IPV. HTs reported neutral perceptions about self-efficacy (M = 2.9/5), client or personal safety (M = 3/5), and support systems available when addressing IPV in practice (M = 3/5). However, therapists considered intervening as part of their professional role (M = 3.8/5) and reported low levels of victim-blaming attitudes (M = 4.4/5). Those with firsthand IPV experience reported lower victim blaming (mdn = 4.9/5 vs 4.6/5, P = .02). Additionally, females were less likely to blame victims of IPV than males (mdn = 4.7/5 vs 4.3/5, P = .003).

DISCUSSION

Although Hand Therapists believe their professional role includes addressing IPV, confidence to deal with IPV, access/awareness of resources and perceived safety were substantive barriers.

CONCLUSION

Continuing research should identify effective tools to educate and assist therapists to identify and support victims of IPV in hand therapy.

A Cross-Sectional Study to Explore Intimate Partner Violence and Barriers to Empowerment of Women in Armenia

BACKGROUND

Intimate partner violence is a major problem worldwide and it is one of the most social issues in Armenia. Empowerment is one of the important factors that helps women to break the cycle of violence by their husband/partner. The aim of this research is to explore the impact of intimate partner violence on empowerment of Armenian women of reproductive age group.

METHODS

This cross-sectional study used data Armenia Demography and Health Survey Data 2015-16. A total 6116 women were selected from 8749 households at both urban and rural places of Armenia for interview using multistage cluster sampling technique. Data analysis was performed using SPSS version 24.

RESULTS

The respondents aged between 35 and 49 years are more likely to face violence compared to other age group (p≤0.001). The respondents who have no decision-making power, about 89% of them, are experiencing intimate partner violence, whereas only 11% are facing intimate partner violence among those who have decision-making power (p≤0.001). The logistic regression analysis reveals that age of the respondents, number of children in the households, wealth index, and empowerment status are significantly associated with intimate partner violence.

CONCLUSION

Intimate partner violence has significant impact on the empowerment of women in Armenia. This study revealed that women with no empowerment are more likely to experience intimate partner violence compared to those women who are empowered in Armenian society.

Association between intelligence quotient and violence perpetration in the English general population

BACKGROUND

Data on the relationship between intelligence quotient (IQ) and violence perpetration are scarce and nationally representative data from the UK adult population is lacking. Therefore, our goal was to examine the relationship between IQ and violence perpetration using nationally representative community-based data from the UK.

METHODS

We analyzed cross-sectional data from the 2007 Adult Psychiatric Morbidity Survey. IQ was estimated using the National Adult Reading Test (NART). Violence perpetration referred to being in a physical fight or having deliberately hit anyone in the past 5 years. We conducted logistic regression analysis to assess the association between IQ (exposure variable) and violence perpetration (outcome variable).

RESULTS

There were 6872 participants aged ⩾16 years included in this study. The prevalence of violence perpetration decreased linearly with increasing IQ [16.3% (IQ 70-79) v. 2.9% (IQ 120-129)]. After adjusting for demographic and behavioral factors, childhood adversity, and psychiatric morbidity, compared with those with IQ 120-129, IQ scores of 110-119, 100-109, 90-99, 80-89, and 70-79 were associated with 1.07 [95% confidence interval (CI) 0.63-1.84], 1.90 (95% CI 1.12-3.22), 1.80 (95% CI 1.05-3.13), 2.36 (95% CI 1.32-4.22), and 2.25 (95% CI 1.26-4.01) times higher odds for violence perpetration, respectively.

CONCLUSIONS

Lower IQ was associated with violence perpetration in the UK general population. Further studies are warranted to assess how low IQ can lead to violence perpetration, and whether interventions are possible for this high-risk group.

Stress Management and Health Promotion in a Sample of Women With Intimate Partner Violence: A Randomized Controlled Trial

The aim of the present study was to investigate the effectiveness of a stress management program regarding mitigating psychological repercussions in women who experience intimate partner violence (IPV). This randomized controlled trial took place from January 2015 to June 2015, in Attica, Greece. A total of 60 women were randomly assigned into an intervention and control group, with the intervention group ( n = 30) receiving stress management and a lifestyle program. Self-reported measures were used to assess stress, depression and anxiety levels, daily routine, severity of abuse, self-esteem, health locus of control, and self-efficacy. Statistical analysis showed a significant improvement in measures of stress, depression, anxiety, self-esteem, and self-efficacy in the intervention group. Daily routine and physical exercise also improved. Based on these findings, we strongly encourage health professionals to advise women experiencing current and past IPV to adopt stress management techniques to their daily program, as a further means of empowerment.

Intimate partner violence and depression in rural Bangladesh: Accounting for violence severity in a high prevalence setting

Intimate partner violence (IPV) against women is highly prevalent globally, and is associated with adverse health outcomes, including depression. Though women living in low- and middle-income countries (LMICs) face a larger burden of IPV, little is known about whether IPV increases the risk of depression among non-pregnant women and in contexts of high prevalence. Within the setting of rural Bangladesh, this study examined the relationship between the severity of marital IPV against women and the risk of depression. Data were drawn from a nationally-representative study focused on individual and contextual determinants of IPV among married women aged 16-37 years in rural Bangladesh, collected through a multistage, stratified sample in 77 villages in 2014 (n=3290). Multivariable log-binomial regression models were used to estimate the association between the severity of IPV (operationalized as the frequency of different acts of psychological, physical, and sexual abuse, as well as injury due to IPV) and risk of major depressive episode (MDE) using the Edinburgh Postnatal Depression Scale (EPDS). One in six women (16.8%) met the criteria for MDE. Past year IPV was endemic; psychological (77.2%) was most common, followed by sexual (58.8%) and physical (44.4%). Nearly a third of women experienced IPV-related injury. There was a positive dose-response relationship between severity of each type of IPV and MDE above the lowest level of exposure. In adjusted models, the highest levels of psychological (RR=2.27, 95% CI: 1.62, 3.17), physical (RR=2.44, 95% CI: 1.94, 3.08), and sexual (RR=1.65, 95% CI: 1.08, 2.52) IPV severity remained significantly associated with MDE, as well as experiencing IPV-related injury (RR=1.72, 95% CI: 1.23, 2.40). In rural Bangladesh, the severity of all types of marital IPV against women is strongly related to increased risk of MDE. Results suggest the limited utility of standard dichotomous IPV indicators in high prevalence settings.

Lifetime Spousal Violence Victimization and Perpetration, Physical Illness, and Health Risk Behaviours among Women in India

The aim of this study was to assess the association between lifetime spousal violence victimization, spousal violence perpetration, and physical health outcomes and behaviours among women in India. In the 2015⁻2016 National Family Health Survey, a sample of ever-married women (15⁻49 years) (N = 66,013) were interviewed about spousal violence. Results indicate that 29.9% of women reported lifetime spousal physical violence victimization and 7.1% lifetime spousal sexual violence victimization (31.1% physical and/or sexual violence victimization), and 3.5% lifetime spousal physical violence perpetration. Lifetime spousal violence victimization and lifetime spousal violence perpetration were significantly positively correlated with asthma, genital discharge, genital sores or ulcers, sexually transmitted infections (STIs), tobacco use, alcohol use, and termination of pregnancy, and negatively associated with daily consumption of dark vegetables. In addition, lifetime spousal violence victimization was positively associated with being underweight, high random blood glucose levels, and anaemia, and negatively correlated with being overweight or obese. Lifetime spousal violence perpetration was marginally significantly associated with hypertension. The study found in a national sample of women in India a decrease of lifetime physical and/or sexual spousal violence victimization and an increase of lifetime spousal physical violence perpetration from 2005/5 to 2015/6. The results support other studies that found that, among women, lifetime spousal physical and/or sexual spousal violence victimization and lifetime spousal physical violence perpetration increase the odds of chronic conditions, physical illnesses, and health risk behaviours.

[Domestic violence against women patients seen with chest pain in the emergency department]

OBJECTIVES

1) To determine the prevalence of intimate partner violence (IPV) in patients seen in the emergency department with chest pain. 2)To analyse the possible association between IPV and presence/control of vascular risk factors (VRF), psychic manifestations of stress, delay in requesting care, care received, and prognosis.

METHODS

The study was conducted on 125 women, and included a targeted interview, the Partner Violence Screen (PVS) test, a 30-day follow-up telephone interview, and a one-year follow-up clinical history review.

RESULTS

A total of 27 patients (21.6%) had a history of IPV, which was present in 4 of them. Women with a history of IPV were younger (53.7±15.0 vs. 64.0±18.4; P=.020), had more anxiety or a depressive syndrome (57.7% vs 13.5%; P<0.001), and consulted later (35.0±65.2days vs 7.9±25.0days; P=.047). Among older women (≥65years), there was more dyslipidaemia (100% vs 60.4%; P=.039) and worse blood pressure control (good control 20% vs 78.4%; P=.007) in those with a history of IPV. There were no differences in the diagnoses, tests, length of stay, admissions or prognosis among patients with or without a history of IPV, and there were no differences according to chronology of IPV.

CONCLUSIONS

The current or previous existence of IPV in patients who consult for chest pain in the emergency department is high. The existence of IPV is associated with a delay in consultation and greater anxiety, and may contribute to poor control of VRF, but does not affect the prognosis in the medium term.

Validation and adaptation of the danger assessment-5: A brief intimate partner violence risk assessment

AIMS

The aim of this study was to assess the predictive validity of the DA-5 with the addition of a strangulation item in evaluating the risk of an intimate partner violence (IPV) victim being nearly killed by an intimate partner.

BACKGROUND

The DA-5 was developed as a short form of the Danger Assessment for use in healthcare settings, including emergency and urgent care settings. Analyzing data from a sample of IPV survivors who had called the police for domestic violence, the DA-5 was tested with and without an item on strangulation, a potentially fatal and medically damaging IPV tactic used commonly by dangerous abusers.

DESIGN

Researchers interviewed a heterogeneous sample of 1,081 women recruited by police between 2009-2013 at the scene of a domestic violence call; 619 (57.3%) were contacted and re-interviewed after an average of 7 months.

METHODS

The predictive validity of the DA-5 was assessed for the outcome of severe or near lethal IPV re-assault using sensitivity, specificity and ROC curve analysis techniques.

RESULTS

The original DA-5 was found to be accurate (AUC = .68), equally accurate with the strangulation item from the original DA substituted (AUC = .68) and slightly more accurate (but not a statistically significant difference) if multiple strangulation is assessed.

CONCLUSION

We recommend that the DA-5 with the strangulation item be used for a quick assessment of homicide or near homicide risk among IPV survivors. A protocol for immediate referral and examination for further injury from strangulation should be adopted for IPV survivors at high risk.

Is a Health Interview Survey an appropriate tool to assess domestic violence?

Background

The aim of this study is to assess if a Health Interview Survey (HIS) targeting the general population is an appropriate tool to collect valid data on domestic violence. Studying item non-response on the question on domestic violence and its association with socio-demographic and health characteristics compared with victims of domestic violence can contribute to this.

Methods

Cross-sectional data from the Belgian HIS 2013 were analysed. A question whether the perpetrator of a violent event was a member of the respondents' household was embedded in a general topic on violence in the self-administered questionnaire. This study is limited to people aged 15+ that at least completed the first question of this topic. Socio-demographic characteristics of item non-respondents and of victims of domestic violence were explored and the association with health status was assessed through ORs calculated via logistic regression.

Results

The year prevalence of domestic violence is 1.1%. Although the question on domestic violence yields a high level of non-response (62%), this does not hinder the further completion of the questionnaire. When compared with victims of domestic violence, those not responding on the question on the perpetrator have better (mental) health. When compared with those not being victim of domestic violence, victims report poorer physical and mental health.

Conclusion

An HIS can be an appropriate tool to assess domestic violence in the general population and its association with health. However, a solution should be found for the high item non-response on the question on the perpetrator of the violent event.

Prevalence and Risk Factors of Domestic Violence Against Women Attending a Primary Care Center in Riyadh, Saudi Arabia

Domestic violence (DV) against women can negatively affect the physical, mental, sexual, and reproductive health of the women as well as the well-being of their children. The objective was to estimate among Saudi women the prevalence of different types of DV, to identify its associated risk factors, and to determine the immediate victims' reactions to such violence. A cross-sectional study was carried between March and July, 2011. Self-administrated questionnaire was administered to ever-married Saudi women attending Al-Wazarat primary health care center, in Riyadh, Saudi Arabia. Out of the 720 women studied, 144 (20%) reported exposure to DV over the last year. The most common DV types were emotional (69%), social (34%), economic (26%), physical (20%), and sexual violence (10%). In multivariate logistic regression analysis, the following characteristics were independently associated with DV: younger women age, longer duration of marriage, higher women education, lower husband education, working husbands, military occupation, fewer children, husbands with multiple wives, smoking husbands, aggressive husbands, presence of chronic disease in women or husbands, and non-sufficient family income. The most common impacts of DV on women were medical or behavioral problems (72%) and psychiatric problems (58%). The most common reactions to DV were seeking separation (56%) and doing nothing (41%). More than 90% of children of abused women suffered psychological or behavioral problems. In conclusion, DV against Saudi women is considerable and the response is generally passive. Promoting a culture non-tolerant to DV and providing accessible, effective, and trustful social services to abused women are critically needed.

Prevalence of intimate partner violence in Spain: A national cross-sectional survey in primary care

OBJECTIVES

(1) To analyze the prevalence of Intimate Partner Violence by types. (2) To examine the relationship between sociodemographic characteristics and Intimate Partner Violence.

DESIGN

Cross-sectional study using a self-administered questionnaire.

SETTING

Primary Healthcare centers in Spain.

PARTICIPANTS

10,322 women (18-70 years) attending Primary Healthcare centers.

MAIN MEASUREMENTS

A compound index was calculated based on frequency, types, and duration of Intimate Partner Violence. Multivariable adjusted logistic regression models were used to identify the sociodemographic factors, which were independently associated with each Intimate Partner Violence category.

RESULTS

The prevalence of Intimate Partner Violence was 24.8%. For the physical only category, no differences were observed regarding education or employment status, and women with the highest income have less risk. For the psychological only category, no differences were observed according to the income level. The risk increases as the education level decreases, and the greatest frequency of only psychological Intimate Partner Violence was observed in women who were unemployed or students. For both the physical and psychological category of Intimate Partner Violence, a clear risk increase is observed as income and education levels decrease. Retired women showed the highest frequency of this violence category.

CONCLUSION

The results show that Intimate Partner Violence affects women of all social strata, but the frequency and Intimate Partner Violence category will vary according to the socio-economic.

The Lethality Screen: The Predictive Validity of an Intimate Partner Violence Risk Assessment for Use by First Responders

This research is an examination of the predictive validity of the Lethality Screen, a tool used in conjunction with the Lethality Assessment Program (LAP). This intimate partner violence (IPV) risk assessment is an 11-item version of the Danger Assessment (DA) that was designed to be user-friendly for first responders and to maximize sensitivity. Participants ( N = 254) were recruited into the study at the scene of police-involved IPV incidents in one Southwestern state and subsequently participated in two structured telephone interviews approximately 7 months apart. These analyses provide evidence that the Lethality Screen has considerable sensitivity (92%-93%) and a high negative predictive value (93%-96%) for near lethal and severe violence. However, specificity was low (21%). The Lethality Screen also has good agreement with the DA and IPV survivors' perception of risk. The high sensitivity and low specificity should be considered carefully when determining whether the Lethality Screen is appropriate for particular areas of practice with IPV survivors and/or perpetrators.

The Consequences of Intimate Partner Violence on Health: A Further Disaggregation of Psychological Violence-Evidence From Spain

Using a nationally representative sample of 10,171 women, this study examines the association between current and previous intimate partner violence and current health status. Current physical or sexual violence was associated with the highest likelihood of reporting health outcomes, followed by current emotional or economic abuse. Current controlling behavior increased the odds of reporting poor health whereas previous controlling behavior has less effect on current health. Controlling behavior alone often is the first expression of mistreatment. If health professionals could identify violence at this early stage, long-term effects on women's health could be minimized. The implications for health of the cumulative effects of violence and of its timing are discussed.

Domestic violence against women as a risk factor for depressive and anxiety disorders: findings from domestic violence household survey in Tehran, Iran

Domestic violence (DV) especially intimate partner violence is a global health problem responsible for significant part of burden of diseases in women. Mental health problems such as depression and anxiety are possibly results and resulted in IPV. To investigate correlation between IPV and depression and anxiety among married women, in a household survey of married women in Tehran, Iran, at summer 2011, we recruited 615 samples with cluster sampling method and they are directly asked about experience of 23 different types of physical and non-physical IPV during marital life and last 12 months. Depression and anxiety were assessed by Beck depression inventory II (BDI) and Beck Anxiety inventory (BAI). Multinominal regression model was used to assess the independent relationship of factor on IPV. Mean (±SE) age and duration of marriage were 42.6 ± 0.9 and 22 ± 0.8, respectively. Non-physical violence and physical violence during marital life reported in 77.2 and 35.1 %. Clinically significant depression and anxiety was reported in 15.3 and 32.7 % of women, respectively. The odds ratio (95 % CI) of clinically significant depression and anxiety in DV victims were 5.8 (2.3-14.6) and 2.6 (1.6-4.3). DV as a social factor is significantly correlated factor with depression and anxiety. Comprehensive view and collaborative work to detect and address social determinants of mental illness like DV is a crucial point in mental health promotion programs.

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

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

Violence and Abuse Against Women Who Have Attempted Suicide by Deliberate Self-Poisoning: A 2-Year Follow-Up Study in Iran

Sources of data about the occurrence of domestic violence are scarce in Iran. The aim of this study was to evaluate the behavioral effects of different types of domestic violence on women who had attempted suicide by deliberate self-poisoning (DSP). A total of 195 women who had attempted suicide by DSP in response to "violence and abuse" were followed up for 2 years. The most common type of violence, as mentioned by the women themselves as the motive of self-poisoning, was physical abuse (92%) followed by verbal abuse (2.1%), multi-abuses (2.1%), emotional abuse (1.6%), and sexual abuse (1.1%). Suicidal ideation and attempt were more common in those who were consulted sometime after they had initially presented to the hospital with DSP or those who had suffered repeated domestic abuse. It was concluded that invention of methods other than the current consultation system is necessary to prevent repeated suicide attempts among abused women in Iran.

Violent injuries and regional correlates among women in China: results from 21 cities study in China

BACKGROUND

Ecological models depict violent injuries against women being influenced by both individual and environmental characteristics. However, only few studies examined the association between regional variables and the likelihood of violent injuries. Our study is a preliminary assessment of the impact of regional variables on the likelihood that a woman has experienced violent injuries.

METHODS

Participants were 16 866 urban residents, who were identified through a multi-stage sampling process conducted in 21 Chinese cities. Out of the sampled population, 8071 respondents were female. Subsequent analyses focused solely on the female sample. Multilevel logistic regression analyses were performed to examine regional variation in violent injuries.

RESULTS

Prevalence of violent injuries against women is 10.7% (95% CI: 7.8%, 15.5%). After controlling for individual-level characteristics, higher regional male-female ratio (OR: 1.97, P < 0.05), population growth rate (OR: 4.12, P < 0.01) and unemployment rate (OR: 2.45, P < 0.01) were all associated with an elevated risk of violent injuries among Chinese women caused by physical attack.

CONCLUSIONS

The results suggest violent injuries among Chinese women caused by physical attack have become an important social and public health problem. The findings point to the importance of developing effective health policies, laws and interventions that focuses on the unequal economic development between different regions.

Prevalence and Risk Factors of Domestic Violence Against Women by Their Husbands in Iran

OBJECTIVE

Domestic violence against women is a health problem. Research on domestic violence in order to clarify the relationship between the different forms of violence and health outcomes is needed. This study aimed to determine the frequency and risk factors of domestic violence in women. It also assessed the association between risk factors and psychological, physical, and sexual violence against women by their intimate partners.

MATERIALS & METHODS

This cross-sectional study was done on married women 16-80 years of age living in jahrom south of Iran between August 2013 and December 2014. This research was implemented through questionnaires including the demographic characteristic. The form of partner violence including emotional abuse, physical violence and sexual violence was assessed with a validated questionnaire. Odds ratios and 95% confidence intervals were calculated to measure the association between violence and factors.

RESULTS

The prevalence of physical, sexual and emotional domestic violence was respectively 16.4%, 18.6% and 44.4%.and was associated with Age (p=0.002), Husband's Age (p=0.001), Length of marriage (p=0.002), Woman's low educational level women's education (OR=4.67 95%.CI=1.97-11.07), husband's low education (OR=9.22 95%. CI=0.69-12.16), were the most important risk factors for violence.

CONCLUSION

Prevalence of physical, emotional or sexual violence was very high. Men's violence against women in intimate relationships is commonly occurring in Iran. Considering the factors contributing to violence against women, raising the level of education of men and women is one of the ways to prevent violence.

Violence and cardiovascular health: a systematic review

CONTEXT

Violence, experienced in either childhood or adulthood, has been associated with physical health outcomes, including cardiovascular disease. However, the consistency of the existing literature has not been evaluated.

EVIDENCE ACQUISITION

In 2013, the authors conducted a PubMed and Web of Science review of peer-reviewed articles published prior to August 2013 on the relation between violence exposure, experienced in either childhood or adulthood, and cardiovascular outcomes. To meet inclusion criteria, articles had to present estimates for the relation between violence exposure and cardiovascular outcomes (e.g., hypertension, blood pressure, stroke, coronary disease, or myocardial infarction) adjusted for demographic factors. Articles focusing on violence from television, video games, natural disasters, terrorism, or war were excluded.

EVIDENCE SYNTHESIS

The initial search yielded 2,273 articles; after removing duplicates and applying inclusion and exclusion criteria, 30 articles were selected for review. A consistent positive relation was noted on the association between violence experienced during childhood and cardiovascular outcomes in adulthood (i.e., hypertension, coronary heart disease, and myocardial infarction). Associations across genders with varying types of violence exposure were also noted. By contrast, findings were mixed on the relation between adult violence exposure and cardiovascular outcome.

CONCLUSIONS

Despite varying definitions of violence exposure and cardiovascular endpoints, a consistent relation exists between childhood violence exposure, largely assessed retrospectively, and cardiovascular endpoints. Findings are mixed for the adult violence-cardiovascular health relation. The cross-sectional nature of most adult studies and the reliance of self-reported outcomes can potentially be attributed to the lack of findings among adult violence exposure studies.

Preconception care: screening and management of chronic disease and promoting psychological health

INTRODUCTION

A large proportion of women around the world suffer from chronic diseases including mental health diseases. In the United States alone, over 12% of women of reproductive age suffer from a chronic medical condition, especially diabetes and hypertension. Chronic diseases significantly increase the odds for poor maternal and newborn outcomes in pregnant women.

METHODS

A systematic review and meta-analysis of the evidence was conducted to ascertain the possible impact of preconception care for preventing and managing chronic diseases and promoting psychological health on maternal, newborn and child health outcomes. A comprehensive strategy was used to search electronic reference libraries, and both observational and clinical controlled trials were included. Cross-referencing and a separate search strategy for each preconception risk and intervention ensured wider study capture.

RESULTS

Maternal prepregnancy diabetic care is a significant intervention that reduces the occurrence of congenital malformations by 70% (95% Confidence Interval (CI): 59-78%) and perinatal mortality by 69% (95% CI: 47-81%). Furthermore, preconception management of epilepsy and phenylketonuria are essential and can optimize maternal, fetal and neonatal outcomes if given before conception. Ideally changes in antiepileptic drug therapy should be made at least 6 months before planned conception. Interventions specifically targeting women of reproductive age suffering from a psychiatric condition show that group-counseling and interventions leading to empowerment of women have reported non-significant reduction in depression (economic skill building: Mean Difference (MD) -7.53; 95% CI: -17.24, 2.18; counseling: MD-2.92; 95% CI: -13.17, 7.33).

CONCLUSION

While prevention and management of the chronic diseases like diabetes and hypertension, through counseling, and other dietary and pharmacological intervention, is important, delivering solutions to prevent and respond to women's psychological health problems are urgently needed to combat this leading cause of morbidity.

Preconception care: delivery strategies and packages for care

The notion of preconception care aims to target the existing risks before pregnancy, whereby resources may be used to improve reproductive health and optimize knowledge before conceiving. The preconception period provides an opportunity to intervene earlier to optimize the health of potential mothers (and fathers) and to prevent harmful exposures from affecting the developing fetus. These interventions include birth spacing and preventing teenage pregnancy, promotion of contraceptive use, optimization of weight and micronutrient status, prevention and management of infectious diseases, and screening for and managing chronic conditions. Given existing interventions and the need to organize services to optimize delivery of care in a logical and effective manner, interventions are frequently co-packaged or bundled together. This paper highlights packages of preconception interventions that can be combined and co-delivered to women through various delivery channels and provides a logical framework for development of such packages in varying contexts.

Victims' barriers to discussing domestic violence in clinical consultations: a qualitative enquiry

Victims of domestic violence frequently attend health care facilities. In many cases, their abusive experience is neither disclosed nor discussed during clinical consultations. This study examined the barriers faced by women when discussing abuse with health care providers, specifically in cases involving Malaysian women with a history of domestic violence. A qualitative study using in-depth interviews was conducted with 10 women with a history of domestic violence residing at a shelter. Purposive sampling was conducted until data saturation. Using the grounded theory approach of analysis, themes that emerged from these interviews were then further analyzed to examine the barriers faced by these women. Women who experienced domestic violence faced multiple barriers while discussing their accounts of abuse with others. Values placed on the privacy of domestic violence; upholding the traditional gender roles; preserving the family unity; minimizing the abuse, the feeling of shame, self-blame; and fearing their abuser generally create internal barriers when discussing their encounters of abuse with health care providers. The perceived unknown role of health care professionals when dealing with patients experiencing domestic violence as well as the previous negative experiences in clinical consultations acted as external barriers for discussing abuse with health care providers. Women with domestic violence experiences faced internal and external barriers to discussing their abuse during clinical consultations. Physicians and health care providers must consider domestic violence in consultations with female patients. A good doctor-patient relationship that encompasses empathy, confidence, trust, support, assurance, confidentiality, and guidance can help patients with abusive backgrounds overcome these barriers, leading to the disclosure and discussion of their abusive encounters. Proper education, guidelines, and support for health care providers are required to help them assist women with histories of domestic violence.

The relationship of violence and traumatic stress to changes in weight and waist circumference: longitudinal analyses from the study of women's health across the nation

This article investigates the associations of violence and traumatic stress with changes in weight and waist circumference, hypothesizing that violence in midlife would be associated with increases or decreases in weight and waist circumference. The longitudinal cohort of the Study of Women's Health Across the Nation comprised the study sample, which included an ethnically/racially and socially diverse group of 2,870 women between the ages of 42 and 52 years at baseline. Women were followed annually for 10 years, and assessments included weight and waist circumference measures and data on violence, health outcomes, and confounders. At baseline, 8.6% Caucasian, 10.8% African American, 9.2% Chinese, and 5.0% Japanese women reported violence and traumatic stress. Reporting violence and traumatic stress during follow-up was significantly associated with weight gain (odds ratio [OR] = 2.39, 95% confidence interval [CI] = [1.28-4.47]), weight loss (OR = 3.54, 95% CI = [1.73-7.22]), and gain (OR = 2.44, 95% CI = [1.37-4.37]) or loss (OR = 2.66, 95% CI = [1.23-5.77]) in waist circumference, adjusting for age, race/ethnicity, education, marital status, and smoking. Violence and traumatic stress against midlife women were associated with gains or losses in weight and waist circumference.

Effect of partner violence in adolescence and young adulthood on blood pressure and incident hypertension

Intimate partner violence has adverse health consequences, but little is known about its association with hypertension. This study investigates sex differences in the relationship between intimate partner violence and blood pressure outcomes. Data included 9,699 participants from waves 3 (2001-02) and 4 (2008-09) of the National Longitudinal Study of Adolescent Health (51% female). Systolic (SBP) and diastolic (DBP) blood pressure and incident hypertension (SBP≥140 mmHg, DBP≥90 mmHg, or taking antihypertensive medication) were ascertained at wave 4. Intimate partner violence was measured at wave 3 with 8 items from the revised Conflict Tactics Scales. Separate victimization and perpetration scores were calculated. Sex-specific indicators of severe victimization and perpetration were created using the 66th percentile among those exposed as a cut point. Sex-specific, linear and logistic regression models were developed adjusting for age, race, financial stress, and education. Thirty-three percent of men and 47% of women reported any intimate partner violence exposure; participants were categorized as having: no exposure, moderate victimization and / or perpetration only, severe victimization, severe perpetration, and severe victimization and perpetration. Men experiencing severe perpetration and victimization had a 2.66 mmHg (95% CI: 0.05, 5.28) higher SBP and a 59% increased odds (OR: 1.59, 95% CI: 1.07, 2.37) of incident hypertension compared to men not exposed to intimate partner violence. No other category of violence was associated with blood pressure outcomes in men. Intimate partner violence was not associated with blood pressure outcomes in women. Intimate partner violence may have long-term consequences for men's hemodynamic health. Screening men for victimization and perpetration may assist clinicians to identify individuals at increased risk of hypertension.

A cross-sectional study identifying the pattern of factors related to psychological intimate partner violence exposure in Slovenian family practice attendees: what hurt them the most

BACKGROUND

Intimate partner violence (IPV) is yet to be fully acknowledged as a public health problem in Slovenia. This study aimed to explore the health and other patient characteristics associated with psychological IPV exposure and gender-related specificity in family clinic attendees.

METHODS

In a multi-centre cross-sectional study, 960 family practice attendees aged 18 years and above were recruited. In 689 interviews with currently- or previously-partnered patients, the short form of A Domestic Violence Exposure Questionnaire and additional questions about behavioural patterns of exposure to psychological abuse in the past year were given. General practitioners (GPs) reviewed the medical charts of 470 patients who met the IPV exposure criteria. The Domestic Violence Exposure Medical Chart Check List was used, collecting data on the patients' lives and physical, sexual and reproductive, and psychological health status, as well as sick leave, hospitalisation, visits to family practices and referrals to other clinical specialists in the past year. In multivariate logistic regression modelling the factors associated with past year psychological IPV exposure were identified, with P<0.05 set as the level of statistical significance.

RESULTS

Of the participants (n=470), 12.1% (n=57) were exposed to psychological IPV in the previous year (46 women and 11 men). They expressed more complaints regarding sexual and reproductive (p=0.011), and psychological and behavioural status (p<0.001), in the year prior to the survey. Unemployment or working part-time, a college degree, an intimate relationship of six years or more and a history of disputes in the intimate relationship, increased the odds of psychological IPV exposure in the sample, explaining 41% of the variance. In females, unemployment and a history of disputes in the intimate relationship explained 43% of the variance.

CONCLUSIONS

The prevalence of psychological IPV above 10% during the past year was similar to earlier studies in Slovenia, although the predominance of better-educated people might be associated with lower tolerance toward psychological abuse. GPs should pay special attention to unemployed patients and those complaining about family disputes, to increase early detection.

Violence against women by male partners and against children within the family: prevalence, associated factors, and intergenerational transmission in Romania, a cross-sectional study

Background

Domestic violence is a public health problem with negative consequences. We aimed to determine the prevalence of violence between parents and by parents against children, types of intimate partner violence against women, the intergenerational transmission of violence, and to identify a profile of beliefs and judgements regarding violent behaviour.

Methods

The data used for this article were sourced from three cross-sectional studies performed in Romania in 2009–2011. We sampled 869 respondents (male and female) with a homogenous distribution between environment, gender, educational level, and age group (18 to 75). From a 96-item questionnaire regarding family and reproductive health, this article refers to four items: (1) feelings relating to the family in which they were raised; (2) whether they witnessed violence between parents or were victims of violence by parents or other family members during childhood or the teenage years; (3) opinions relating to 10 statements on violence from Maudsley Violence Questionnaire; (4) the manifestation of psychological, emotional, and sexual abuse from the partner in the family of procreation (FOP). The data were analysed by Pearson chi-square tests and latent class analysis.

Results

During childhood, 35% of respondents witnessed parental violence and 53.7% were victims of family violence. Psychological abuse by men against women was the most common type of violence reported in the FOP (45.1%). Violence in childhood and adolescence correlated with the perception of the family of origin as a hostile environment and of violence against women as a corrective measure, and that insults, swearing, and humiliation by their partner within the FOP is acceptable (p < 0.05). A profile of beliefs and judgements about violent behaviour indicated that the Impulsive reactive cluster is represented by men in rural areas, and by subjects who witnessed parental violence or were victims of violence during childhood (p < 0.001).

Conclusions

In Romania, the use of violence as a form of discipline or instruction of children and women remains a significant problem, with a higher rate of intimate partner violence than in other developed countries. Furthermore, implementing intervention mechanisms for psychological abuse is urgently required, as are education and intervention in high-risk populations.

The association between protective actions and homicide risk: findings from the Oklahoma Lethality Assessment Study

This study focuses on the relationship between women's risk of homicide as measured by the Danger Assessment and 13 protective actions. Participants (N = 432) experienced an incident of police involved intimate partner violence (IPV) and subsequently completed a structured telephone interview. Most women in this sample experienced severe violence and were classified as being at high risk for homicide. Participants engaged in an average of 3.81 (SD = 2.73) protective actions. With the exception of the use of formal domestic violence services, women in the high-risk category were significantly more likely than women in the lower risk category to have used each of the protective actions examined. Implications for research and practice are discussed.

Intimate partner violence influence on deliveries assisted by skilled health personnel

OBJECTIVE

Millennium Development Goal 5 calls for increasing proportions of deliveries assisted by skilled health personnel to reduce maternal mortality. This study aims to identifying the implication of exposure to intimate partner violence on these proportions.

METHODOLOGY

This study used domestic violence modules data of Demographic and Health Surveys of six countries from 2005 to 2007. Proportions of assisted deliveries were examined by sociodemographic characteristics and exposure to intimate partner violence in the studied countries. Influence on the proportion was examined against exposure to intimate partner violence through odds ratio and 95% of logistic regression analysis after controlling for women age, residence (urban/rural), household wealth level, economic level of country, educational level and working status of women and their husbands/partners.

RESULTS

Data sets of 18,507 participants over 20 years of age showed that almost three-quarters (73%) of women had deliveries assisted by skilled health personnel. One-third of the women were ever exposed to intimate partner violence (37%) and 9% of them to the severe level. Exposure to intimate partner violence statistically significantly lowered this proportion to 69% (odds ratio: 0.73; 95% confidence interval: 0.67-0.78) meanwhile severe violence lowered it to 65% (odds ratio 0.64; 95% confidence interval: 0.58-0.72). When running multiple regression analysis, exposure to intimate partner violence retained its statistically significant decreasing influence on proportions and was not biased by the other stronger socioeconomic characteristics.

CONCLUSION AND RECOMMENDATIONS

Intimate partner violence has an independent influence on reducing assisted deliveries by skilled health personnel. Programs working for increasing proportions of assisted deliveries by skilled health personnel are recommended to integrate protection women from violence.

[Health status and intimate partner violence]

OBJECTIVE

To describe the prevalence of intimate partner violence (IPV) in Spain in the last year and at some point during the lifetime, to determine health status in women according to whether they had experienced IPV or not, and to analyze the individual variables associated with IPV in Spain.

METHODS

A cross-sectional study was performed of the database, Macrosurvey on Gender Violence in Spain 2011. This database includes data on 7,898 women older than 18 years old. The dependent variables were IPV-last year, IPV-ever in life. Covariates consisted of sociodemographic characteristics, socioeconomic status, maternal experience of IPV, social support, and self-care. The measure of association used was the OR with its 95% confidence interval (95% CI).

RESULTS

A total of 3.6% of women had experienced IPV-last year and 12.2% ever in life. Female victims of IPV had poorer health than women who had not experienced IPV. Immigrant women living in Spain for 6 years or more were more likely to experience IPV-ever in life than Spanish women [OR (95% CI): 1.95 (1.50, 2.53)]. An interaction was found between nationality and the existence of children under 18 years old. Among women with children under 18 years old, immigrant women were more likely to experience IPV-last year than Spanish women [OR (95% CI): 1.99 (1.25, 3.17)]. Other variables associated with IPV were age, low socioeconomic status, low social support and having a mother who had experienced IPV.

CONCLUSIONS

In Spain, some women have a higher probability of experiencing IPV. The variables associated with greater vulnerability to IPV should be taken into account when implementing measures to prevent or alleviate IPV.