Psychological partner violence and women's vulnerability to depression, stress, and anxiety

Kelly P. Reducing Violence Against Women and Girls in the Arab League: A Systematic Review of Preventive Interventions

The UN's Sustainable Development Goal #5 (Gender Equity) includes violence against women and girls (VAWG), considering it as a violation of the rights of women and girls. The variety of risk factors for VAWG in Arab countries suggests the need to identify effective interventions to guide practitioners and policy makers. A systematic review of preventive interventions across the Arab League examined the outcomes of VAWG. Authors registered the study on the prospective register of systematic reviews database. Authors conducted the search for evidence up to 2023. Database searching identified 1,502 studies and after application of the eligibility criteria, 17 studies remained for inclusion. Quality appraisal used the Mixed Methods Appraisal Tool. Evidence emerged from eight Arab countries. Interventions occurred at the primary, secondary, and tertiary levels of prevention. However, only two studies employed interventions using more than one level of prevention, which considered systems strengthening and the development of community solidarity networks. The evidence revealed a lack of clear evaluation and evidence for the effectiveness of interventions and prevention alongside reactive approaches, with no evidence as to how systems may reduce or prevent VAWG. One main issue is patriarchal dominance in Arab countries creating the lack of a collective female voice in any of the evidence. However, Arab countries can change with support. Achieving the UN's Sustainable Development Goal #5 by 2030 means interventions and programs need to include more than one prevention level, consider systems and include the collective female voice.

Exposure to Psychological Intimate Partner Violence: Resilience to Depression is Related to Social Support and Learned Resourcefulness

Psychological violence is the most common form of intimate partner violence (IPV). Psychological IPV places women at significant risk for depressive symptoms. Accordingly, this study examined the moderator role of perceived social support and learned resourcefulness (LR) as personal resources in the relationship between psychological IPV and depression. This cross-sectional study was performed via an online survey platform. A total of 168 Turkish women, with a mean age of 33.8, completed a set of measurement tools. Data were assessed using linear regression and two-way and three-way interactions in moderated multiple regression analyses. The results of the study showed that as expected psychological IPV was directly associated with depression (β = .268, p < .001). To explore the moderator roles, two separate two-way interactions were conducted, and results demonstrated that neither social support nor LR separately moderated the relationship between psychological IPV and depression. However, there was a significant three-way interaction: togetherness of perceived social support with LR moderated the relationship between psychological IPV and depression (β = -.388, p < .05). More specifically, if women exposed to psychological IPV have high perceived social support and high LR, they are less likely to report depressive symptoms. This finding highlights the positive effect of the combination of personal resources on depression linked to psychological IPV's detrimental effects. The findings were discussed in the light of the relevant literature. Interventions focusing on strengthening social support and fostering LR skills may promote the psychological well-being of women exposed to psychological IPV.

Trajectories of intimate partner violence and their relationship to stress among young women in South Africa: An HPTN 068 study

BACKGROUND

One in four South African women will experience intimate partner violence (IPV) in their lifetime, potentially increasing their biological stress. In South Africa, limited IPV and stress research has utilized multiple timepoints or examined modifying factors. Cash transfers (CTs) are associated with reduced IPV and stress and may be an intervention target.

AIMS

We used data-driven methods to identify longitudinal IPV trajectory groups among South African adolescent girls and young women (AGYW), estimate each group's association with stress, and assess modification by a CT.

METHODS

A total of 2,183 South African AGYW ages 13 to 24 years from the HIV Prevention Trials Network 068 study were randomized to a CT or control group. Physical IPV was measured five times (2011-2017), and stress was captured once (2018-2019). Stress measures included the Cohen Stress Scale and stress biomarkers (C-reactive protein (CRP), cytomegalovirus (CMV), herpes simplex virus type-1 (HSV-1)). Group-based trajectory modeling identified IPV trajectories; ordinal logistic regression estimated the association between trajectory group and stress.

RESULTS

A two-group quadratic trajectory model was identified (higher trajectory group = 26.7% of AGYW; lower trajectory group = 73.3%). In both groups, the probability of IPV increased from ages 13 to 17 years before declining in early adulthood. However, the higher group's probability peaked later and declined gradually. The higher trajectory group was associated with an increased odds of elevated CRP (OR: 1.41, 95% CI [1.11, 1.80]), but not with other stress measures. The CT modified the relationship with CMV: a positive association was observed among the usual care arm (OR: 1.59, 95% CI [1.11, 2.28]) but not the CT arm (OR: 0.85, 95% CI [0.61, 1.19]).

CONCLUSIONS

Sustained IPV risk during adolescence was associated with elevated CRP in young adulthood. The relationship between IPV and elevated CMV was attenuated among those receiving a CT, suggesting that CTs could possibly reduce biological stress due to IPV.

Depression, Anxiety, and Posttraumatic Stress Disorder Following Intimate Partner Violence: The Role of Self-Criticism, Guilt, and Gender Beliefs

Intimate partner violence (IPV) predicts anxiety, depression, and posttraumatic stress disorder (PTSD), yet the role of cognition in these pathways is poorly understood. This study explored whether self-criticism, guilt, and gender beliefs predicted psychological symptoms, using self-report data from 50 Colombian female IPV survivors with diverse socioeconomic statuses. Self-criticism and guilt were high and significantly associated with IPV. Self-criticism significantly predicted depression and PTSD, whilst only guilt predicted anxiety. Traditional gender role beliefs were associated with emotional abuse, but not with self-criticism, guilt, or symptoms. In conclusion, self-criticism and guilt are important treatment targets for female IPV survivors, regardless of gender beliefs.

Stressful life events, intimate partner violence, and perceived stress in the postpartum period: longitudinal findings in rural Pakistan

PURPOSE

While the association between intimate partner violence (IPV) and stress is well documented, the directionality of this relationship is unclear. We use an adjusted longitudinal study design to better understand if stressful life events in the home precipitate or exacerbate intimate partner violence (IPV) and if experiences of IPV, in turn, increase levels of perceived stress.

METHODS

Longitudinal data were collected among married women in rural Pakistan at 12 and 24 months postpartum (N = 815). Adjusted Poisson and linear regression models were used to examine stressful life events, past year IPV and severity (number and frequency of violent acts), and perceived stress (Cohen Perceived Stress Scale).

RESULTS

At 12 months postpartum, the prevalence of past year physical, psychological, and sexual IPV was 8.5%, 25.7%, and 25.1%, respectively, with 42.6% experiencing any IPV. After adjustment, stressful life events were associated with a subsequent increased likelihood of all IPV types and increased severity of all but physical IPV. Any past year IPV (versus none) and greater IPV severity were associated with 3.43 (95% CI 2.33-4.52) and 2.57 (95% CI 1.87-3.27) point subsequent increases in perceived stress. Physical, psychological, and sexual IPV and their respective severities were all independently associated with increased perceived stress.

CONCLUSIONS

Among postpartum women in Pakistan, stressful life events increase the likelihood of IPV and, in turn, experiences of IPV increase stress levels. Support to families undergoing stressful circumstances may be critical to reducing women's IPV exposure and resulting elevated stress.

COVID-19 and Mental Health of Minority Arab Higher-Education Students in Israel: Social, Economic, and Academic Factors

The mental health and well-being of higher-education students is a topic of growing interest. COVID-19 impacted higher education in many ways and the challenges were especially pronounced for minority students. This study examines the impact of COVID-19 on the mental health of Arab minority students in Israel in relation to social, academic, and financial factors. We recruited 420 Arab higher-education students enrolled in academic colleges or universities in Israel who completed a battery of online questionnaires. Mental health status was measured by the Depression, Anxiety, and Stress Scale 21 (DASS-21). Moderate to severe symptoms of depression, anxiety, and stress were reported by 49.3%, 45.2%, and 54% of Arab students, respectively. Analyses indicate that low quality of online learning, academic difficulties, and negative economic effects of COVID-19 predicted stress, anxiety, and depression. Women reported higher levels of depression and stress; job loss predicted depression and anxiety; low income predicted depression; and COVID-19-related health concerns predicted anxiety. This study highlights the unique and multiple challenges faced by minority students from disadvantaged backgrounds. Campus programs are needed to address the emotional needs of students. Longitudinal research is needed to more fully understand the impact of COVID-19 on higher-education students.

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

PURPOSE

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

METHOD

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

RESULTS

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

DISCUSSION

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

Psychological impacts during the COVID-19 outbreak among adult population in Jordan: A cross-sectional study

In response to the initial outbreak of the Coronavirus Disease 2019 (COVID-19) pandemic and the pandemic-related restraints and preventive measures implemented, the global population has been experiencing a wide range of immediate psychological reactions, such as fear and psychological distress. The present study aimed to assess the psychological impacts of the COVID-19 pandemic among a sample of adults during the national lockdown implemented in Jordan. A quantitative, descriptive, correlational, cross-sectional design was used. An anonymous online questionnaire was used to collect data on the participants' sociodemographic characteristics, the changes in daily life they had experienced, their fear of COVID-19, and their depression, anxiety, and stress levels. A total of 725 Jordanian adults aged 18-65 years (mean = 33.7, SD = 9.3) were included in this study, with most of the participants being female (n = 409, 56.4%). The majority of the participants reported changes in their daily routines and activities during the COVID-19 lockdown, with 62.8% of the participants reporting weight changes, 92% reporting increased social media use, and 86.5% reporting increased mobile phone use and checking. Further, 41.4% of the participants reported high levels of fear of COVID-19, while 41.8%, 24.5%, and 22.8% reported mild to extremely severe depression, anxiety, and stress symptoms, respectively. Female participants had significantly higher levels of fear of COVID-19 and stress than did males. Fear of COVID-19 was significantly positively correlated with depression, anxiety, and stress scores. Anxiety, stress, gender, having physical disorders, and having mental disorders were identified as being significant predictive factors of fear of COVID-19. The findings of this study highlight the urgent need to pay further attention towards maintaining the psychological well-being of the public during this global crisis. The findings may guide the development of appropriate public health strategies aimed at promoting healthy living, improving mental health, and reducing fear and other psychological problems among at-risk groups during the COVID-19 pandemic. Additionally, the findings may guide further qualitative, longitudinal, and experimental studies both during and after the lockdown.

Psychometric Properties of the Arabic Version of the Fear of COVID-19 Scale (FCV-19S) Among Jordanian Adults

There is an urgent need to assess the impacts of the Coronavirus-19 disease (COVID-19) outbreak on mental health among the general population such as the Fear of COVID-19. The current study aimed to provide further validation of the Arabic version of the Fear of COVID-19 Scale (FCV-19S) for use among Jordanian adults. A cross-sectional study was conducted using an anonymous online survey between 1 and 12 May 2020. The forward-backward translation method was adopted to translate the FCV-19S into Arabic. The study sample included 725 Jordanian adults. The internal consistency (Cronbach’s α) was 0.91 indicating excellent internal consistency. As for convergent validity, a significant positive correlation was found between the Fear of COVID-19 Scale (FCV-19S) and the three subscales of the Depression, Anxiety, and Stress Scale-21 (DASS-21), with the highest correlation being between the FCV-19S and the anxiety subscale (r = 0.54, p < .05), followed by the stress subscale (r = 0.51, p < .05), and lastly, the depression subscale (r = 0.46, p < .05). Construct validity was assessed using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and item response theory (IRT). The unidimensional factor structure of the FCV-19S was confirmed on the study sample. The Arabic version of the FCV-19S is a reliable and valid instrument with good psychometric properties. The use of this scale for assessing the severity of fear related to the COVID-19 pandemic among Arabic-speaking populations is recommended. The findings may guide future COVID-19-related research and further validation testing.

Investigating the Complex Relationship Between Intimate Partner Violence Victimization and Perpetration Among System-Involved Women in Heterosexual Relationships: An Exploratory Analysis

Research indicates women who perpetrate intimate partner violence (IPV) experience both more frequent and more severe IPV victimization. However, the IPV field needs additional research to understand the complex relationship between various forms of IPV victimization (e.g., psychological, physical, sexual) and IPV perpetration by women. In particular, the field needs a better understanding of the unique interplay of various forms of IPV victimization and perpetration among female system-involved survivors (i.e., female survivors involved with child protective services and/or the court system and mandated to services). Such understanding would aid extant efforts to ensure that mandated services address the experiences and meet the needs of these system-involved women. To address this knowledge gap, we conducted an exploratory, secondary data analysis using cross-sectional baseline data collected as part of a larger evaluation study of a psychoeducational therapeutic IPV and parenting program for system-involved IPV survivors mandated to services (N = 73). Results from multiple regression analyses revealed that both psychological and physical IPV victimization were uniquely associated with the perpetration of psychological and physical abuse by system-involved female IPV survivors. Furthermore, our examination of the interaction between physical and psychological victimization and its impact on perpetration revealed that higher levels of both physical and psychological IPV victimization were associated with significantly higher levels of psychological perpetration (p < .01) and increased likelihood of physical perpetration (p < .05). Results are discussed in the context of service provision within systems, agencies, and programs targeting system-involved women mandated to services for IPV.

Violence Against Women and Its Consequences on Women's Reproductive Health and Depression: A Jordanian Sample

The aims of this study were to investigate the women's current reproductive health (RH) status, depression levels, and to clarify the relationships between the violence against women and depression and the RH components. Three hundred women participated in the study. Data were collected from the Women Health Center (WHC) in Prince Faisal hospital in Rusaifa, Jordan. The findings revealed that around 25.9%, 13.1%, 83.2%, and 65.1% of the participant women had been exposed to physical, sexual, control, and psychological violence, respectively. Around 77.7% of women were using contraceptives; oral contraceptives and intrauterine devices (IUDs) were the most common family planning methods used. In addition, the results revealed that 50% of women were suffering from significant levels of depression. A positive relationship between exposure to all violence types and women's depression levels was found but not for all RH components.

Gender-based violence and its association with mental health among Somali women in a Kenyan refugee camp: a latent class analysis

BACKGROUND

In conflict-affected settings, women and girls are vulnerable to gender-based violence (GBV). GBV is associated with poor long-term mental health such as anxiety, depression and post-traumatic stress disorder (PTSD). Understanding the interaction between current violence and past conflict-related violence with ongoing mental health is essential for improving mental health service provision in refugee camps.

METHODS

Using data collected from 209 women attending GBV case management centres in the Dadaab refugee camps, Kenya, we grouped women by recent experience of GBV using latent class analysis and modelled the relationship between the groups and symptomatic scores for anxiety, depression and PTSD using linear regression.

RESULTS

Women with past-year experience of intimate partner violence alone may have a higher risk of depression than women with past-year experience of non-partner violence alone (Coef. 1.68, 95% CI 0.25 to 3.11). Conflict-related violence was an important risk factor for poor mental health among women who accessed GBV services, despite time since occurrence (average time in camp was 11.5 years) and even for those with a past-year experience of GBV (Anxiety: 3.48, 1.85-5.10; Depression: 2.26, 0.51-4.02; PTSD: 6.83, 4.21-9.44).

CONCLUSION

Refugee women who experienced past-year intimate partner violence or conflict-related violence may be at increased risk of depression, anxiety or PTSD. Service providers should be aware that compared to the general refugee population, women who have experienced violence may require additional psychological support and recognise the enduring impact of violence that occurred before, during and after periods of conflict and tailor outreach and treatment services accordingly.

Physical violence in college women: Psychometric evaluation of the safe dates-physical violence victimization scale

Researchers examined psychometric characteristics of the Safe Dates-Physical Violence Victimization scale in 97 Jordanian college women. Reliability coefficient and Principal Components Analysis were used. Construct validity was examined using independent samples t-test. Cronbach's alpha of 0.80 was yielded. Two dimensions (injury-causing tactics and threatening tactics) were identified. Using construct validity analysis, researchers indicated significant differences in the mean depression, anxiety, stress, and childhood victimization scores among women reporting physical violence, compared to their counterparts. College women possess psychological stressors due to academic and social responsibilities. Such stressors influence their decision to leave the partner which adversely impacts their psychological health.

Prevalence of intimate partner violence against women in the Arab world: a systematic review

Background

Violence against women has particular importance for women’s health and wellbeing in the Arab world, where women face persistent barriers to social, political and economic equality. This review aims to summarize what is known about the prevalence of physical, sexual and emotional/psychological intimate partner violence (IPV) against women in the 22 countries of the Arab League, including geographic coverage, quality and comparability of the evidence.

Methods

A systematic review of IPV prevalence in Arab countries was carried out among peer-reviewed journal articles and national, population-based survey reports published by international research programmes and/or governments. Following PRISMA guidelines, Medline and the Social Sciences Citation Index were searched with Medical Subject Headings terms and key words related to IPV and the names of Arab countries. Eligible sources were published between January 2000 and January 2016, in any language. United Nations databases and similar sources were searched for national surveys. Study characteristics, operational definitions and prevalence data were extracted into a database using Open Data Kit Software. Risk of bias was assessed with a structured checklist.

Results

The search identified 74 records with population or facility-based IPV prevalence data from eleven Arab countries, based on 56 individual datasets. These included 46 separate survey datasets from peer-reviewed journals and 11 national surveys published by international research programmes and/or governments. Seven countries had national, population-based IPV estimates. Reported IPV prevalence (ever) ranged from 6% to more than half (59%) (physical); from 3 to 40% (sexual); and from 5 to 91% (emotional/ psychological). Methods and operational definitions of violence varied widely, especially for emotional/psychological IPV, limiting comparability.

Conclusions

IPV against women in Arab countries represents a public health and human rights problem, with substantial levels of physical, sexual and emotional/psychological IPV documented in many settings. The evidence base is fragmented, however, suggesting a need for more comparable, high quality research on IPV in the region and greater adherence to international scientific and ethical guidelines. There is a particular need for national, population-based data to inform prevention and responses to violence against women, and to help Arab countries monitor progress towards the Sustainable Development Goals.

The Role of Depression in the Relationship Between Psychological and Physical Intimate Partner Violence

Physical and psychological intimate partner violence (IPV) are significant public health concerns often associated with negative consequences for individuals, families, and society. Because IPV occurs within an interpersonal relationship, it is important to better understand how each partner's depressive symptoms, marital satisfaction, and psychological and physical IPV are interlinked. The purpose of this study was to identify actor and partner effects in a dyadic data analysis association between marital satisfaction and depressive symptoms, its links to psychological IPV, and then to physical IPV. Guided by the social information processing model, this study has implications for understanding the processes leading to various types of IPV in people seeking couples therapy. Using cross-sectional data from 126 heterosexual couples, we conducted an actor-partner interdependence model (APIM) to test actor and partner effects. Indirect actor and partner effects were also assessed. More depressive symptoms were associated with lower marital satisfaction. More depressive symptoms were generally linked with increased perpetration of psychological and physical IPV. Psychological IPV was associated with an individual's use of physical IPV. Effect sizes were moderate to large in magnitude. Four specific indirect effects were identified from depressive symptoms to psychological IPV to physical IPV. Depressive symptoms may be an important factor related to psychological and physical IPV for males and females. Implications include assessing for and treating depression in both partners, and discussing preferred ways of supporting each other that do not include psychological or physical IPV.

The psychobiology of stress and intimate partner violence

Exposure to intimate partner violence (IPV) negatively affects health outcomes, however, the biopsychosocial pathways underlying this relationship are not well understood. We conducted a systematic review of research published from 2000 through 2018 on biological and psychological stress-related correlates and consequences of IPV exposure. Fifty-three publications were included. The biological and psychological literatures have evolved separately and remain distinct. The biological literature provides emerging evidence of stress-related endocrine and immune-inflammatory dysregulations that are in line with patterns typically observed among chronically stressed individuals. The psychological literature provides strong evidence that IPV is associated with psychological stress, and that psychological stress follows new instances of IPV. Larger scale, integrative studies using prospective study designs are needed to more carefully map out how IPV influences victims both biologically and psychologically, and how these biopsychological changes, in turn, affect the health of victims over time.

Factors Influencing the Quality of Life of Healthy Pregnant Women in North Jordan

Background and Objectives: Quality of life (QOL) assessment during pregnancy contributes to determining women's unmet needs and preventing negative health outcomes. In this study, we aimed to identify the effects of participants' characteristics, perceived stress, and perceived social support on their QOL. We also aimed to determine the differences in QOL according to these factors. Materials and Methods: A cross-sectional study was carried out in a city in Jordan. Purposive sampling was used to select 218 participants. Data was collected by the quality of life Short Form- 36(SF-36) survey, perceived stress scale (PSS), and The Multidimensional perceived Social Support Scale (MSPSS). Results: We found that only parity had a significant effect on the QOL. High-parity women had lower QOL scores than low-parity women. The participants reported high social support, specifically from their families and significant others. The 36-Item Short-Form Health Survey was a reliable tool for measuring the QOL in pregnancy. Conclusions: Parity factor and social support should be recognized in any health promotion intervention and during providing antenatal care. Further research is needed toassess the QOL during pregnancy.

Alexithymia among Jordanian university students: Its prevalence and correlates with depression, anxiety, stress, and demographics

PURPOSE

The aim of the article is to identify the prevalence, levels, and associated factors of alexithymia among Jordanian university students.

DESIGN AND METHODS

Using stratified cluster random sampling, data were collected from 492 students using Toronto Alexithymia Scale (TAS-20), and Depression, Anxiety, and Stress Scale (DASS-21).

FINDINGS

The prevalence of alexithymia, depression, anxiety, and stress were 24.6, 28.5, 38.4, and 22.6%, respectively, and were all higher among females. Alexithymia correlated with five factors: depression, anxiety, stress, female gender, and satisfaction with life.

PRACTICAL IMPLICATIONS

There is a need for screening and interventional programs that prevent or alleviate the symptoms of alexithymia, depression, anxiety, and stress among university students.

Nursing students' alternative beliefs regarding care for patients suffering from depression

Depression is an illness that constitutes a major challenge for Public Health worldwide. Therefore, there is a clear need to receive training to care for this type of patient. This study sets out to identify alternative non-scientific beliefs among nursing students regarding the topic of depression after studying the module of Psychopathology. This study enrolled 102 third year undergraduate nursing students. The students resolved a case on an individual basis in written form which was analysed qualitatively. In this study, we have found that, despite having undergone information-transfer educational training in relation to the physiopathology of depression, nursing students persist in holding unscientific beliefs about this condition. On the basis that the opinions of nurses about depression can influence the care of their future patients, it is important to consider these alternative beliefs as learning difficulties in order to design an effective teaching instruction.

Lethal hopelessness: Understanding and responding to asylum seeker distress and mental deterioration

The mental deterioration of the so called 'legacy caseload' (asylum seekers who arrived in Australia by boat between August 2012-December 2013) has become a national concern and is garnering international attention. Prolonged uncertainty is contributing to mental deterioration and despair. There have been at least 11 deaths by suicide since June 2014. Social support services have been limited and legal assistance in short supply; this is associated with lengthy delays with visa applications. Thwarted belongingness, purpose and identity, a shortage of available services, and barriers to legal support for processes attendant upon Refugee Status Determination increase the likelihood that the mental health of asylum seekers will deteriorate further, potentially developing into worsening decline, which will lead to increased self-harm and suicide. This article summarises recent suicide deaths in Australia, positing practical assistance and support for asylum seekers living in the community. Therapeutic engagement should be trauma-informed wherever possible, helping asylum seekers to reframe their sense of lethal hopelessness.

The comparison of socioeconomic status, perceived social support and mental status in women of reproductive age experiencing and not experiencing domestic violence in Iran

BACKGROUND

Given the significant health effects of domestic violence against women, the present study was conducted in 2016, in Tehran, Iran in order to compare the socioeconomic status, perceived social support and mental status in women of reproductive age experiencing and not experiencing domestic violence.

METHODS

This descriptive-analytical cross-sectional study was conducted on 500 women. The data collection tools used included questionnaires: demographic information, Socioeconomic, Beck's Depression, Spielberger's Anxiety, Cohen's Perceived Stress, Sarason's Perceived Social Support and WHO's Domestic Violence Inventory.

RESULTS

The results showed that 43.2% of women said they had experienced at least one case of domestic violence, among which 16.4%, 15% and 36.6% of women had experienced physical, sexual and emotional-verbal types of violence, respectively. The mean age (p less than 0.001) and educational level (p=0/018) of violated women and their spouses (p less than 0.001) were lower than those of non-violated women. Furthermore, violated women experienced lower socioeconomic status (p less than 0.05), higher perceived stress (p less than 0.008), higher depression (p less than 0.001), and higher overt anxiety (0.002. They also perceived lower levels of social support (p less than 0.001).

CONCLUSIONS

The issue of domestic violence was rather prevalent in the participants of the present study, particularly the younger, less educated and more socioeconomically deprived communities and families.

Depression, Perceived Health, and Right-of-Return Hopefulness of Palestinian Refugees

PURPOSE

Displacement is traumatic and often an unwanted social change that can lead to a loss of identity and socioeconomic, physical, and psychological livelihood. The purpose of the study was to describe the association of perceived health and right-of-return hopefulness to depressive symptom severity in Palestinian refugees, taking into consideration gender and poverty.

DESIGN

The descriptive, correlational study was framed within a socioecological lens. Data collection occurred between October 2015 and November 2015 in Amman, Jordan, which hosts the most Palestinian refugees in the world. The participants in the sample (N = 177) had a mean age of 36.9 years.

METHODS

Participants responded to the Patient Health Questionnaire for depressive symptom severity, the RAND-36 perceived health item, and a statement about hopefulness to return to Palestine. Descriptive, correlation, and logistic and linear regression analyses were computed.

FINDINGS

Results showed that 43% of participants had moderate to severe depressive symptoms, 42% lived in poverty, and 20% had fair or poor health; yet, 60% were hopeful about returning to Palestine. Participants who had better perceived health and right-of-return hopefulness were less likely to have symptoms of major depression. Perceived health was the only factor-not gender, poverty, or right-of-return hopefulness-that explained the variance in depressive symptoms.

CONCLUSIONS

Palestinian adult refugees in Jordan exhibited symptoms of major depression that were associated with poorer perceived health and less hopefulness about repatriation to Palestine.

CLINICAL RELEVANCE

Nurses with community or mental health specialization can play a major role by systematically screening refugees for depression using worldwide, evidence-based tools and by advocating for policies that can improve the health and living conditions of refugees.

Disclosure of Spousal Violence: Viewpoints From the Jordanian Society

The objectives of this study were to identify reasons behind not disclosing spousal violence and examine relationships between these reasons and women's demographic profile including the experience of spousal violence. Jordanian women ( N = 709) aged 16 to 66 years ( M = 32.6, SD = 8.7) attending health care centers were recruited. Results indicated that women's intentions to maintain the family unit and use of patience with abuser represented the top two reasons for not disclosing violence. Non-significant relationships were, generally, identified between not disclosing spousal violence and women's demographic profile. Women's justification of spousal violence and witnessing parental violence were the proposed reasons for women's lack of disclosure of violence. Implications for this study include health professionals' use of evidence-based knowledge and skills to deal with victims of violence. Researchers' roles include creating physical and emotional environment that urges disclosure of violence. Furthermore, they can contribute with health professionals in the implementation of health education programs directing victims and perpetrators in the places where they can be located. Proper collaboration between health professionals, researchers, and policy makers may significantly limit suffering of victims of violence.

Depressive Symptoms in College Women: Examining the Cumulative Effect of Childhood and Adulthood Domestic Violence

The purpose of this study was to examine the cumulative effect of childhood and adulthood violence on depressive symptoms in a sample of Jordanian college women. Snowball sampling technique was used to recruit the participants. The participants were heterosexual college-aged women between the ages of 18 and 25. The participants were asked about their experiences of childhood violence (including physical violence, sexual violence, psychological violence, and witnessing parental violence), partner violence (including physical partner violence and sexual partner violence), experiences of depressive symptoms, and about other demographic and familial factors as possible predictors for their complaints of depressive symptoms. Multiple linear regression analysis was implemented to identify demographic- and violence-related predictors of their complainants of depressive symptoms. Logistic regression analysis was further performed to identify possible type(s) of violence associated with the increased risk of depressive symptoms. The prevalence of depressive symptoms in this sample was 47.4%. For the violence experience, witnessing parental violence was the most common during childhood, experienced by 40 (41.2%) women, and physical partner violence was the most common in adulthood, experienced by 35 (36.1%) women. Results of logistic regression analysis indicated that experiencing two types of violence (regardless of the time of occurrence) was significant in predicting depressive symptoms (odds ratio [OR] = 3.45, p < .05). Among college women's demographic characteristics, marital status (single vs. engaged), mothers' level of education, income, and smoking were significant in predicting depressive symptoms. Assessment of physical violence and depressive symptoms including the cumulative impact of longer periods of violence on depressive symptoms is recommended to be explored in future studies.

Violence against Congolese refugee women in Rwanda and mental health: a cross-sectional study using latent class analysis

OBJECTIVE

To examine patterns of conflict-related violence and intimate partner violence (IPV) and their associations with emotional distress among Congolese refugee women living in Rwanda.

DESIGN

Cross-sectional study.

SETTING

Two Congolese refugee camps in Rwanda.

PARTICIPANTS

548 ever-married Congolese refugee women of reproductive age (15-49 years) residing in Rwanda.

PRIMARY OUTCOME MEASURE

Our primary outcome was emotional distress as measured using the Self-Report Questionnaire-20 (SRQ-20). For analysis, we considered participants with scores greater than 10 to be experiencing emotional distress and participants with scores of 10 or less not to be experiencing emotional distress.

RESULTS

Almost half of women (49%) reported experiencing physical, emotional or sexual violence during the conflict, and less than 10% of women reported experiencing of any type of violence after fleeing the conflict. Lifetime IPV was reported by approximately 22% of women. Latent class analysis derived four distinct classes of violence experiences, including the Low All Violence class, the High Violence During Conflict class, the High IPV class and the High Violence During and After Conflict class. In multivariate regression models, latent class was strongly associated with emotional distress. Compared with women in the Low All Violence class, women in the High Violence During and After Conflict class and women in the High Violence During Conflict had 2.7 times (95% CI 1.11 to 6.74) and 2.3 times (95% CI 1.30 to 4.07) the odds of experiencing emotional distress in the past 4 weeks, respectively. Furthermore, women in the High IPV class had a 4.7 times (95% CI 2.53 to 8.59) greater odds of experiencing emotional distress compared with women in the Low All Violence class.

CONCLUSIONS

Experiences of IPV do not consistently correlate with experiences of conflict-related violence, and women who experience high levels of IPV may have the greatest likelihood for poor mental health in conflict-affected settings.

Sexual Coercion and Psychological Aggression Victimization: Unique Constructs and Predictors of Depression

Sexual coercion of women is a common problem in couples that is often conceptualized as a facet of sexual assault or as a form of psychological aggression. Because psychological aggression is consistently linked to depressive symptoms, the researchers evaluated the unique contribution of sexual coercion victimization in the prediction of depressive symptoms beyond the variance explained by psychological aggression victimization. Sample 1 consisted of women living with a partner for at least a year and parenting a young child, whereas Sample 2 consisted of undergraduate students in relationships of at least 6 months. Overall, 27.4% of the women in Sample 1 and 22.8% of the women in Sample 2 reported experiencing sexual coercion victimization. Across both samples, depressive symptoms and psychological aggression victimization were significantly greater in women who experienced sexual coercion victimization. In addition, sexual coercion victimization and psychological aggression victimization each contributed significantly and uniquely to the prediction of depressive symptoms. Thus, although related to psychological aggression victimization, sexual coercion in an intimate relationship is a distinct construct. Implications for assessment, prevention, and couple therapy are discussed.

Prevalence of intimate partner violence among women visiting health care centers in Palestine refugee camps in Jordan

This study was conducted to investigate the prevalence of intimate partner violence (IPV) among a sample of women visiting health care centers in Palestine refugee camps in Jordan. We found that different types of IPV, including physical, emotional, sexual, economic, and control behaviors by the partners were experienced by the participants. This study was among a number of studies that investigated this phenomenon in residents of Palestinian camps. It adds to existing studies in this field, however, as it focuses on the prevalence of the top five types of IPV in these women. Co-occurrence of IPV, that is, experiencing two or more types of partner violence at the same time, was noticed in these women. Experiencing control by one's partner and the presence of different attitudes between men and women toward the use of violence were factors contributing to the occurrence of this phenomenon in these women. National efforts aiming at breaking the cycle of violence should be fostered through media and public awareness campaigns. Changing people's attitudes concerning men's use and women's acceptance of violence should be the aim of these efforts.

Mental health status of women in Jordan: a comparative study between attendees of governmental and UN relief and works agency's health care centers

This study aimed at investigating differences in mental health problems between attendees of governmental and United Nations Relief and Works Agency for Palestine Refugees health care centers in Jordan. Further, predictors of mental health problems based on women's demographic profile were investigated. A convenience sample of 620 women attending governmental and United Nations Relief and Works Agency for Palestine Refugees health care centers in Jordan was recruited for this purpose. Independent samples t-tests were used to identify differences in mental health, and multiple linear regression was implemented to identify significant predictors of women's mental health problems. Results indicated an absence of significant differences in mental health problems between attendees of the two types of health care centers. Further, among the demographic indicators that were tested, income, spousal violence, and general health were the predictors of at least three different mental health problems in women. This study highlights opportunities for health professionals to decrease women's propensity for mental health problems by addressing these factors when treating women attending primary care centers in different Jordanian towns, villages, and refugee camps.