The impact of intimate partner violence on forgone healthcare: a population-based, multicentre European study

Bidirectional Violence in Intimate Relationships: A Systematic Review

Intimate partner violence is a public health problem with significant consequences at different levels. Over the years, the literature has shown that most violence is not unidirectional and perpetrated by men against women but rather bidirectional, in which both couple elements may be victims, perpetrators, or both. In this systematic literature review, we aimed to systematize the empirical knowledge to assess the prevalence of bidirectional violence, the most reported types of violence, and the influence of sex and sexual orientation on this phenomenon. The search for this systematic review was conducted in four databases, and we included studies that showed the prevalence of bidirectional violence in samples aged over 18 years, in articles written in English or Portuguese, and published between 2012 and 2022. In the qualitative synthesis, 42 empirical studies were included. The results showed that bidirectional violence is the most common pattern of violence, with psychological violence being the most reported type of bidirectional violence; men and women reported bidirectional violence at similar rates, and homosexual couples reported higher percentages of bidirectional violence than heterosexual couples. These results contradict the patriarchalist view of violence that assigns the exclusivity role of the victim to women and of the perpetrator to men, demonstrating that violence occurs regardless of sex or sexual orientation. The practical implications and future directions at the level of public policies to give visibility to the phenomenon will be duly discussed.

Intimate partner violence during COVID-19: systematic review and meta-analysis according to methodological choices

BACKGROUND

Intimate Partner Violence (IPV) is the most common form of interpersonal violence and a major public health problem. The COVID-19 pandemic might have contributed to an increase in IPV experiences. To evaluate changes in IPV prevalence during the pandemic, it is important to consider studies' methodological characteristics such as the assessment tools used, samples addressed, or administration modes (e.g., face-to-face, telephone or online interviews), since they may influence disclosure and were likely affected by pandemic-imposed mobility restrictions.

METHODS

Systematic review and meta-analysis of empirical studies addressing IPV against women, men, or both, during the COVID-19 period. We searched six electronic databases until December 2021, including articles in English, German, Spanish, French or Portuguese languages. We extracted and synthesised characteristics of studies related to sampling (clinical, community, convenience), type assessment tool (standardised questionnaire, specifically created questions), method of administration (online, telephone, face-to-face), and estimates of different forms of IPV (physical, sexual, psychological). IPV estimates were pooled stratified by study characteristics using random-effects models.

RESULTS

Of 3581 publications, we included 103 studies. Fifty-five studies used a standardized instrument (or some adaptations) to assess IPV, with the World Health Organisation Questionnaire and the Revised Conflicts Tactics Scales being the most frequent. For 34 studies, the authors created specific questions to assess IPV. Sixty-one studies were conducted online, 16 contacted participants face-to-face and 11 by telephone. The pooled prevalence estimate for any type of violence against women (VAW) was 21% (95% Confidence Interval, 95%CI = 18%-23%). The pooled estimate observed for studies assessing VAW using the telephone was 19% (95%CI = 10%-28%). For online studies it was 16% (95%CI = 13%-19%), and for face-to-face studies, it was 38% (95%CI = 28%-49%). According to the type of sample, a pooled estimate of 17% (95%CI = 9%-25%) was observed for studies on VAW using a clinical sample. This value was 21% (95%CI = 18%-24%) and 22% (95%CI = 16%-28%) for studies assessing VAW using a convenience sample and a general population or community sample, respectively. According to the type of instrument, studies on VAW using a standardized tool revealed a pooled estimate of 21% (95%CI = 18%-25%), and an estimate of 17% (95%CI = 13%-21%) was found for studies using specifically created questions.

CONCLUSIONS

During the pandemic, IPV prevalence studies showed great methodological variation. Most studies were conducted online, reflecting adaptation to pandemic measures implemented worldwide. Prevalence estimates were higher in face-to-face studies and in studies using a standardized tool. However, estimates of the different forms of IPV during the pandemic do not suggest a marked change in prevalence compared to pre-pandemic global prevalence estimates, suggesting that one in five women experienced IPV during this period.

Austrian male patients' gender role conflict is associated with their wish for interpersonal violence to be addressed during patient-physician conversations: a questionnaire study

Background

Experiencing interpersonal violence and disclosing this experience to physicians can be associated with fear, shame, denial or emotional turmoil. Expressions of such feelings additionally conflict with masculine gender role ideologies and may be experienced as masculine gender role conflict. Masculine gender role conflict is often associated with men’s unwillingness to seek professional help. The current study analyzed the association between masculine gender role conflict and men’s wish for patient-physician conversations to include questions about interpersonal violence they might have experienced.

Methods

In structured closed-ended interviews conducted at an Austrian hospital 129 male patients (M_age = 59.4, SD = 14.7) were asked what forms of interpersonal violence they had experienced. Additionally, a study-specific questionnaire was used to find out whether male patients wanted future physician-patient conversations to include questions about interpersonal violence they might have experienced. Men’s gender role conflict was assessed with the Gender Role Conflict Scale-Short Form.

Results

Half of the male patients (50%) reported having experienced at least one form of interpersonal violence. Nearly half of the men (48%) wanted their physician to ask them in future about any violence they might have experienced. One pattern of gender role conflict was positively associated with men’s wish to be asked in patient-physician conversations about potential interpersonal violence. Namely, men who reported conflicts between work and family relations were more likely to state that they wanted such conversations (OR = 1.6, 95%CI = 1.1–2.4) than were men who did not often experience this pattern of gender role conflict.

Conclusions

Experiences of interpersonal violence should be an important part of physician-patient conversations with male patients. Overall, male patients would welcome their physician initiating a potential conversation about violence. Using an approach that takes consideration of masculine gender role ideologies may further increase some men’s willingness to approach the topic of interpersonal violence. Men who adhere to the norm of being preoccupied with work may be more willing to talk about this subject if healthcare situations are framed in a way that men perceive the possibility to uphold masculine gender role ideologies of self-sufficiency or of being in control.

Intimate Partner Violence and Use of Primary and Emergency Care: The Role of Informal Social Support

Social support may encourage victims to disclose their experiences of intimate partner violence (IPV), but also to seek the appropriate help and care in the social and health services. Using data from a multicenter European project, DOVE (Domestic Violence Against women/men in Europe-prevalence, determinants, effects, and policies/practices), the present study aimed at measuring the frequency of primary care and emergency use according to IPV types of victimization, and to investigate whether victims receiving different levels of informal social support are using health care differently. Results suggested a significant association between IPV types and use of emergency services, and no association was found regarding primary care services. Victims of physical abuse and sexual coercion went to the emergency department (ED) more frequently (more than once a year). Also, victims of physical abuse receiving low social support visited an ED more frequently than those with high social support, whereas victims of sexual coercion with high informal social support went more often to the ED compared with victims of sexual coercion with low social support, even after controlling for other covariates. These results seem to suggest that social support has a significant role in the decision to use health care among victims of IPV.

Intimate partner violence: A key correlate of women's physical and mental health in informal settlements in Nairobi, Kenya

Globally, one billion people live in informal settlements, and that number is expected to triple by 2050. Studies suggests that health in informal settlements is a serious and growing concern, yet there is a paucity of research focused on health outcomes and the correlates of health in these settlements. Studies cite individual, environmental and social correlates to health in informal settlements, but they often lack empirical evidence. In particular, research suggests that high rates of violence against women (VAW) in informal settlements may be associated with detrimental effects on women's health, but few studies have investigated this link. The purpose of this study was to fill this gap by empirically exploring associations between women's experiences of intimate partner violence (IPV) and their physical and mental health. Data for this study were collected in August 2018 in Mathare Valley Informal Settlement in Nairobi, Kenya. A total of 550 randomly-selected women participated in surveys; however, analyses for this study were run on a subpopulation of the women (n = 361). Multivariate logistic regressions were used to investigate the link between psychological, sexual, and emotional IPV and women's mental and physical health. Results suggest that while some socioeconomic, demographic, and environmental variables were significantly associated with women's mental and physical health outcomes, all types of IPV emerged key correlates in this context. In particular, women's experiences of IPV were associated with lower odds of normal-high physical health component scores (based on SF-36); higher odds of gynecological and reproductive health issues, psychological distress (based on K-10), depression, suicidality, and substance use. Findings from this study suggest that policies and interventions focused on prevention and response to VAW in informal settlements may make critical contributions to improving health for women in these rapidly growing settlements.

Hunting to Feel Human, the Process of Women's Help-Seeking for Suicidality After Intimate Partner Violence: A Feminist Grounded Theory and Photovoice Study

Women reach out to health care providers for a multitude of health problems in the aftermath of intimate partner violence, including suicidality; however, little is known about how they seek help. The purpose of this study was to explore how women seek help for suicidality after intimate partner violence using a feminist grounded theory and photovoice multiple qualitative research design. Interviews were conducted with 32 women from New Brunswick, Canada, and seven from this sample also participated in five photovoice meetings where they critically reflected on self-generated photos of their help-seeking experiences. Data were analyzed using the constant comparative analysis of grounded theory. Hunting to Feel Human involves fighting for a sense of belonging and personal value by perceiving validation from health care providers. Women battled System Entrapment, a feeling of being dehumanized, by Gauging for Validation and Taking the Path of Least Entrapment. Implications for health care providers include prioritizing validating interactions and adopting a relational approach to practice.