The Shadow Pandemic: A Qualitative Exploration of the Impacts of COVID-19 on Service Providers and Women Survivors of Intimate Partner Violence and Brain Injury

"A whole ball of all-togetherness": The interwoven experiences of intimate partner violence, brain injury, and mental health

BACKGROUND

Intimate partner violence (IPV) is a global public health crisis, with physical violence leaving IPV survivors at high risk of brain injury (BI). Both BI and IPV have significant physical, psychological, cognitive, and social impacts, including a high risk of mental health concerns, yet there is limited exploration of IPV survivors' experiences with BI and mental health. This study aimed to explore the BI- and mental health-related needs and experiences of IPV survivors from the perspectives of survivors and service providers with the objective of developing knowledge translation materials to raise awareness and support survivors and service providers in addressing these concerns.

METHODS

This qualitative interpretive description study involved 19 semi-structured interviews and two focus group discussions (2-3 participants each) with 24 participants including IPV survivors experiencing BI and mental health concerns as well as IPV, mental health, and BI service providers between October 2020 and February 2021. Three screening questions were used to identify probable BI among survivors. Participants across groups were an average of 48.5±12.7 years old and were predominantly cisgender women (96%), of European origin (75%), with a university degree (71%). Interviews were recorded, transcribed, and thematically analyzed.

FINDINGS

Across interviews, participants spoke about IPV, BI, and mental health as being complex and interrelated experiences that have impacts across the survivor's life and extend well beyond the abusive relationship. Because of the underrecognized nature of BI in IPV, finding and accessing care requires persistence that survivors spoke of as being like "a full-time job." The benefit of making meaningful connections, particularly with other survivors, was highlighted.

CONCLUSIONS

Recognition of BI as a contributing factor shaping the lived experience of IPV survivors; acknowledgement that the impacts of IPV, BI, and mental health are far reaching and long lasting; and reducing barriers to finding and accessing appropriate care are critical to better supporting IPV survivors with BI and mental health concerns. Clinicians should consider BI and its lingering impacts among the IPV survivors with whom they work. Health and social policy that supports integration of care and the reduction of unnecessary barriers should be a priority.

"It definitely changed me": Exploring sexual and gender diverse people's experiences with intimate partner violence in Ontario, Canada

INTRODUCTION

Intimate partner violence (IPV) involves an individual committing acts intended to harm or intimidate a current or former romantic partner. The COVID-19 pandemic and subsequent stay-at-home orders often trapped victims with perpetrators and intensified IPV. Although sexual and gender diverse people disproportionately experience IPV compared to cisgender, heterosexual people, their experiences are not well documented in the Canadian context. This study aimed to explore the experiences of Two-Spirit, lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other sexual and gender diverse (2S/LGBTQIA+) people with IPV in Ontario and how the COVID-19 pandemic affected their IPV experiences.

METHODS

We conducted in-depth, semi-structured interviews with self-identified 2S/LGBTQIA+ people who experienced IPV on/after March 15, 2020. We audio-recorded and transcribed all interviews and coded the transcripts for content and themes using inductive and deductive techniques.

RESULTS

Our 20 participants experienced physical, psychological, sexual, and financial abuse. Technology-facilitated violence extended abuse geographically and temporally. IPV experiences were associated with negative mental health outcomes that were intensified by the COVID-19 pandemic. Participants struggled to see themselves as legitimate victims of IPV. Although participants regretted being victims of violence, many saw their abusive relationship(s) as a learning experience to inform future relationships.

DISCUSSION

Our findings suggest that 2S/LGBTQIA+ people may experience unique forms of identity abuse and may have difficulty recognizing their IPV experiences as abuse. Ensuring that comprehensive sexual health education is trauma-informed, anti-oppressive, and includes information about healthy relationship dynamics, 2S/LGBTQIA+ relationships, and IPV is critical.

Burden, trend and determinants of various forms of domestic violence among reproductive age-group women in India: findings from nationally representative surveys

BACKGROUND

Violence, a notable human rights concern, has a public health impact across the globe. The study aimed to determine the prevalence and determinants of domestic violence among ever-married women aged 18-49 years in India.

METHODS

Secondary data analysis with National Family Health Survey 5, 2019-21 data (NFHS-5) was conducted. The complex sampling design of the survey was accounted-for during analysis. The primary outcome was domestic violence. Prevalence was reported with 95% confidence interval (CI). Prevalence ratio was reported to provide the factors associated with domestic violence using Poisson regression.

RESULTS

About 63 796 ever-married women aged 18-49 years covered under domestic violence module of NFHS-5 survey were included. Prevalence of domestic violence (12 months preceding the survey) was 31.9% (95% CI: 30.9-32.9%). Physical violence (28.3%) was the most common form followed by emotional (14.1%) and sexual violence (6.1%). Women with low education, being employed, husband being uneducated or with coercive behavior had significantly higher prevalence of domestic violence.

CONCLUSIONS

One-third of the reproductive age-group women were facing some form of domestic violence. Target group interventions like violence awareness campaigns, women supportive services and stringent law enforcement should be implemented to eliminate domestic violence by year 2030.

Challenges to the Provision of Services for Sexual and Intimate Partner Violence in Canada During the COVID-19 Pandemic: Results of a Nationwide Web-Based Survey

The COVID-19 pandemic increased women's vulnerability to intimate partner and sexual violence (IPV/SV), as well as challenging organizations' ability to respond. This research is based on a 2021 nationwide survey about the impacts of COVID-19 on IPV/SV services across Canada. Nationwide, organizations adopted several measures to reduce the risk of COVID-19 transmission, including scaling back services, reducing or stopping their volunteers, and reducing the number of in-shelter clients. Organizations detailed several financial challenges including increased costs and cancelation of fundraising events. Organizations also reported many staffing challenges, from increased workloads to staff leaves of absence due to childcare responsibilities, mental health reasons, or contracting COVID-19. Policies ensuring adequate financial support to IPV/SV services in nonemergency times could help minimize disruption to service delivery during crisis situations.

Characterizing Intimate Partner Violence in the United States During the COVID-19 Pandemic: A Systematic Review

Intimate partner violence (IPV) is a significant global health concern. Numerous research studies document increases in IPV since the onset of the COVID-19 pandemic in March 2020. Despite this widespread recognition, research around the nature of this violence is still growing. This systematic review summarizes the existing literature documenting the prevalence and characteristics of IPV during the COVID-19 pandemic. Inclusion criteria are as follows: reported original data empirical study, assessed for IPV among adult population in the United States, and was published in English between December 2019 and March 2022. A total of 53 articles were then independently reviewed and sorted into four thematic subcategories: victimization, perpetration, articles addressing victimization and perpetration, and provider perspectives. Studies document consistent increases in the prevalence of IPV victimization and perpetration. Providers within agencies providing support to individuals impacted by IPV also documented increased strain on the agencies.

A Systematic Review of Women's Experiences of Interpersonal Violence During the COVID-19 Pandemic

OBJECTIVE

To explore and synthesize women's experiences of interpersonal violence during the COVID-19 pandemic.

DATA SOURCES

The MEDLINE, Ovid, Embase, Cochrane, Web of Science, and CINAHL databases were searched to identify articles published between December 2019 and November 2022.

STUDY SELECTION

Seventeen peer-reviewed studies were included, for a total of 2,046 women.

DATA EXTRACTION

Data were extracted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.

DATA SYNTHESIS

COVID-19 brought many challenges for women experiencing interpersonal violence. Women reported worsening of abuse during the pandemic. The pandemic led to severe economic challenges, which eventually precipitated more abuse. Additionally, women experienced mental health distress from social isolation and increased surveillance and control from their abusive partners. Several factors affected their ability to access health care and support services; these included limited availability of services, fear of contracting the virus, and an abusive partner who restricted their movement outside the home.

CONCLUSION

The pandemic presented multiple challenges and additional stressors for women who experienced interpersonal violence during pandemic-related restrictions on services, gatherings, and work and school outside of the home. The findings from this review signify the need to raise public awareness about violence against women and to plan for coordinated efforts to decrease violence against women and address victims' needs in the event of future pandemics or other public health emergencies.

"The pandemic only gave visibility to what is invisible": a qualitative analysis of structural violence during COVID-19 and impacts on gender-based violence in Brazil

BACKGROUND

The COVID-19 pandemic produced alarming rates of disease and mortality globally, yet few nations were as severely impacted as Brazil. The pandemic also exposed and exacerbated persistent forms of structural violence across Brazil, which complicated gender-based violence (GBV) prevention and response efforts. While structural violence is not new, the systemic pressure and uncertainty introduced by COVID-19 intensified the detrimental impact of structural violence on the lives of Brazilians impacted by GBV. This work qualitatively investigated how the COVID-19 pandemic amplified structural violence and GBV in Brazil.

METHODS

We analyzed key informant interviews (KII) conducted with 12 service providers working in sectors related GBV prevention and response in Roraima, Boa Vista, and Rio de Janeiro. Interviews were audio-recorded, transcribed, and translated from Portuguese or Spanish into English, before applying deductive and inductive coding approaches through a collaborative data reduction process. The theoretical lens of structural violence outlined by Farmer and Rylko-Bauer guided the thematic development.

RESULTS

Analyses identified three themes. First, structural violence manifests as policies of inaction and erasure, which reduce the opportunity for upward social mobility among GBV survivors including Black women, trans persons, and people who live in the favelas. Policies of inaction and erasure fail to acknowledge/adequately respond to the significant health and safety needs of these communities. Second, structural violence is a fundamental cause of violence against women and children. Finally, service providers described community driven responses that address the dire survival needs (i.e., food insecurity) imposed by COVID-19, within a context of structural violence. These community driven responses were innovative, agile, and based on dire needs expressed to, and observed by, the service providers interviewed.

CONCLUSION

This analysis highlights how the COVID-19 pandemic exacerbated existing forms of structural violence prevalent throughout Brazil. Findings stress the urgency with which the Brazilian government and international organization must act to support community driven programs that strive to address the most basic human needs.

Exploring the intersection of brain injury and mental health in survivors of intimate partner violence: A scoping review

Rationale

Intimate partner violence (IPV) is the most commonly occurring form of violence against women. The most common site of injury in IPV is the head, face, and neck, resulting in possible brain injury (BI). Independently, mental health (MH) concerns are highly prevalent among both IPV survivors and individuals with BI; however, no systematic review exists on the combined experience of BI and MH in IPV.

Objective

The aim of this review was to describe the identification of and relationships between BI, MH, and IPV in the literature and the implications for health policy and practice.

Methods

A search strategy including text words and subject headings related to BI, IPV, and MH was developed for MEDLINE and translated to EMBASE, PsycINFO, CINAHL, Cochrane, Scopus, and Web of Science. Two reviewers independently assessed articles for inclusion. Articles discussing MH, BI, and IPV in relation to one another were included in the review.

Results

Twenty-eight articles were identified for inclusion. Methods for identifying IPV, BI, and MH were highly variable across studies. Fourteen studies reported significantly higher MH scores in IPV survivors with BI than in those without BI. Articles predominantly focused on cis gender women in heterosexual relationships and the impact of race and ethnicity were largely overlooked. Healthcare access was explored by eight articles, though none discussed the implications of co-occurring BI and MH.

Conclusion

Brain injury and MH are highly prevalent among IPV survivors; however, little research discusses the implication for healthcare. Future research should explore healthcare-related needs and experiences to inform policy and practice and better represent the diversity of IPV survivors.

Impact of COVID-19 on the Health Response to Family Violence in Aotearoa New Zealand: A Qualitative Study

COVID-19 pandemic planning and response has resulted in unprecedented upheaval within health systems internationally. With a concern for increasing frequency and escalation of family violence, the so called "shadow pandemic," we wondered how health system violence intervention programs were operating during this time. In Aotearoa New Zealand, the Ministry of Health Violence Intervention Program (VIP), using a systems approach, seeks to reduce and prevent the health impacts of family violence and abuse through early identification, assessment, and referral of victims presenting to designated health services. In this qualitative descriptive study, we explored how the VIP program was impacted during the first year of the COVID-19 pandemic. Forty-one VIP coordinators and managers representing 15 of the 20 New Zealand District Health Boards and the National VIP Team participated. Across 12 focus groups (8 face to face and 4 via Zoom) and 7 individual interviews (all via Zoom) participants shared their experience navigating systems to support frontline health providers' responsiveness to people impacted by family violence during the pandemic. In our reflexive thematic analysis, we generated 3 themes: Responding to the moment, valuing relationships, and reflecting on the status quo. Our findings demonstrate the dynamic environment in which participants found creative ways to adapt to the uncertainty and engage with communities to re-shape interventions and ensure continued implementation of the program. At the same time, challenges within the system prior to the pandemic were brought into view and highlighted the need for action. These included, for example, the need for improved engagement with Māori (Indigenous people of Aotearoa New Zealand) to address long-standing health inequities. Having quality essential services for those impacted by family violence that engages with local knowledge and networks and routinely copes with uncertainty will strengthen our systems to minimize risk of harm during emergencies.

How did UK social distancing restrictions affect the lives of women experiencing intimate partner violence during the COVID-19 pandemic? A qualitative exploration of survivor views

BACKGROUND

Increased numbers of domestic abuse cases were reported at the start of the COVID-19 pandemic. Many people experiencing abuse faced barriers to seeking support with service closures affecting the sector. Available evidence suggests women are overrepresented in the reported cases of intimate partner violence (IPV) and we aimed to learn more about how their lives were impacted by social distancing restrictions.

METHODS

We conducted an online qualitative interview study, using reflexive thematic analysis. Interviews were conducted between April 2021 and March 2022. 18 women in the UK with past experiences of IPV provided informed consent and participated in this study.

RESULTS

During the analysis, we identified five themes relating to the impact of lockdown restrictions on participants' lives, including: (1) Lockdown meant being confined to a place where abuse was escalating, (2) Barriers to accessing support, including "cancelled" services and missed opportunities to intervene during interactions in lockdown with frontline workers. (3) Increased feelings of fear, isolation, and loss of control, particularly during the early stages of the pandemic from the combination of abuse and pandemic-related changes to daily life. (4) Some forms of support were more accessible during the pandemic, such as provision of online psychological support and social groups. Participants also accessed new forms of support for the first time during the pandemic, in some cases sparked by posts and content on social media about abuse awareness. (5) For some, psychosocial wellbeing transformed during the pandemic, with several participants using the word "freedom" when reflecting on their experience of simultaneously escaping abuse and living through the COVID-19 pandemic.

CONCLUSIONS

In this study, we explored the views of female survivors of IPV in the UK during the COVID-19 pandemic. Our results highlight the importance of combined public awareness campaigns and community intervention points for victims to safely seek help during social distancing restrictions. Having the time and space to reflect on healing after escaping abuse was described by women in our study as a benefit from their lives in lockdown, which is a factor that could be incorporated into future initiatives developed to support people subjected to violence and abuse.

"At the Root of COVID Grew a More Complicated Situation": A Qualitative Analysis of the Guatemalan Gender-Based Violence Prevention and Response System during the COVID-19 Pandemic

A growing body of literature has documented an increased risk of gender-based violence (GBV) within the context of COVID-19 and service providers' reduced capacity to address this vulnerability. Less examined are the system-level impacts of the pandemic on the GBV sector in low- and middle-income countries. Drawing on the perspectives of 18 service providers working across various GBV-related sectors in Guatemala, we explored how the Guatemalan GBV prevention and response system operated during the COVID-19 pandemic. Findings highlight that the pandemic reinforced survivors' existing adversities (inadequate transportation access, food insecurity, digital divides), which subsequently reduced access to reporting, justice, and support. Consequently, the GBV prevention and response system had to absorb the responsibility of securing survivors' essential social determinants of health, further limiting already inflexible budgets. The pandemic also imposed new challenges, such as service gridlocks, that negatively affected survivors' system navigation and impaired service providers' abilities to efficiently receive reports and mobilize harm reduction and prevention programming. The findings underscore the systemic challenges faced by GBV service providers and the need to incorporate gender mainstreaming across public service sectors-namely, transportation and information/communication-to improve lifesaving GBV service delivery for Guatemalan survivors, particularly survivors in rural/remote regions.

Experiences of Women Accessing Violence Against Women Outreach Services in Canada During the COVID-19 Pandemic: a Brief Report

The COVID-19 pandemic has had significant impacts on violence against women (VAW), including increased prevalence and severity, and on VAW service delivery. The purpose of this research was to study women's experiences with VAW services in the first stages of the pandemic and describe their fears and concerns. This cross-sectional study was conducted from May through October 2020. Our VAW agency partners across Ontario, Canada invited women using outreach services to participate in a study about their experiences during the pandemic. In total, 49 women from 9 agencies completed an online survey. Quantitative data were analyzed with descriptive statistics and open-ended responses are presented to supplement findings. Women's experiences with VAW services during the pandemic varied greatly; some found technology-facilitated services (phone, video, text) more accessible, while others hoped to return to in-person care. Over half of women reported poorer wellbeing, access to health care, and access to informal supports. Many women reported increased relationship-related fears, some due specifically to COVID-19 factors. Our results support providing a variety of technology-based options for women accessing VAW services when in-person care options are reduced. This research also adds to the scant literature examining how some perpetrators capitalized on the pandemic by using new COVID-19-specific forms of coercive control. Although the impacts of the pandemic on women varied, our findings highlight how layers of difficulty, such as less accessible formal and informal support, as well as increased fear - can compound to make life for women experiencing abuse exceptionally difficult.