Service utilization, perceived changes of self, and life satisfaction among women who experienced intimate partner abuse: the mediation effect of empowerment

Swedish women reaching post-traumatic growth after an intimate partner violence relationship: A study of formal help and growth after trauma

AIMS

This study examined whether women in Sweden who had been in an intimate partner violence (IPV) relationship reached post-traumatic growth (PTG) and if the level of PTG differed for women who had received formal help compared with women who had not received formal help. The study also examined whether there was a difference in the level of PTG depending on which type of formal help the women had received.

METHODS

The data were collected through an online self-report survey. A total of 166 women took part in the study.

RESULTS

The results showed that 69.3% (n = 115) of the women reported a pre-determined or higher level of PTG attainment and that those who had received formal help reported a higher level of PTG than those who had not received formal help. There was no difference in the level of PTG depending on which type of formal help the women had received.

CONCLUSIONS

The majority of the Swedish women in this study who had lived in an IPV relationship attained PTG. Although formal help appeared to help the women attain PTG, the type of the formal help did not seem to have a crucial role in attaining different levels of PTG. These findings are discussed in the light of the future research directions and public health measures to better support women who experience IPV.

Intimate Partner Violence (IPV) in Bhutan: Understanding Women's Responses to IPV Using the Transtheoretical Model of Behavior Change

Intimate partner violence is highly prevalent in Asian region. It is largely committed by male against their female intimate partner. This is often associated with the region's unique social and cultural norms which subordinate women throughout their lives. IPV is an ongoing concern in Bhutan. The country's age-old traditions and customs are closely related to culture of silence among women experiencing IPV. This study examined women's responses to intimate partner violence (IPV) in Bhutan. Semi-structured interviews were conducted to explore sensitising concepts such as how and when women recognised IPV and how they responded to it. Fifteen women who had sought supportive services at the institution `RENEW' (Respect, Educate, Nurture, Empower Women) as a result of IPV participated in the interview. The Trans-theoretical model of behaviour change (TTM) was used as a theoretical framework to understand women's cognitive, affective and behavioural change processes. The interviews were audio-recorded and transcribed. Thematic analysis was used to identify the patterns of women's responses. From the analysis, women's experiences of IPV and their responses were located within the four stages of change, including contemplation, preparation, action and maintenance. Women used nine traditional processes of change among which consciousness raising and helping relationships were critical and appeared across all four stages of change. This study provides important insights of Bhutanese women's cognitive and behavioural responses to IPV. The appearance of consciousness raising and helping relationships across all the stages of change represents a potential opportunity for intervention to initiate and promote changes in women's response to IPV in the early stages.

Burden and Growth during COVID-19: Comparing Parents of Children with and without Disabilities

The COVID-19 pandemic and the measures taken to contain it have had a disproportionate impact on families with young children, especially with disabilities. This study examined factors associated with burden and growth among parents of young children in Israel, while comparing parents of children with and without disabilities. We hypothesized that the association between family functioning, informal social support, and perceived adequacy of educational services and burden and growth would be moderated by disabilities. An online questionnaire was completed by 675 parents of young children, 95 of them with disability. The moderating effect of disability on burden and growth was examined using PROCESS. Compared to parents of children without disabilities, greater burden was found among parents of children with disabilities, but levels of growth were similar. External support was lacking for both parent groups. Educational services were perceived as severely inadequate. Lower perceived adequate educational services were associated with greater burden. On the other hand, higher levels of family functioning (i.e., family cohesion and adaptability) and greater adequacy of educational services were associated with growth. The results show that while burden was greater for parents of children with disabilities, growth during the COVID-19 period was possible for parents of both groups. The findings also pointed to the importance of the family system for sustaining the wellbeing of its members in lockdown situations. Put together, the findings highlight the importance of planning for such national and global emergencies.

[Posttraumatic growth in survivors of intimate partner violence: A French pilot study]

OBJECTIVE

This study aimed to: (1) evaluate posttraumatic growth in survivors of intimate partner violence, (2) compare and characterize this posttraumatic growth with the one measured in survivors of other types of violence, and (3) evaluate post-traumatic stress disorder and its relationship with posttraumatic growth in our clinical population.

METHODS

We realized a monocentric pilot study in Poitiers (Vienne, France) recruiting 17 survivors of intimate partner violence and 42 survivors of other types of violence from two medical departments: the Unit of Forensic Medicine, where victims are oriented following complaints, and the Psychotrauma Center. Participants were administrated questionnaires comprising socio-demographics data and specific scales, namely the PTGI and PCL-5.

RESULTS

We found a higher prevalence of posttraumatic growth in survivors of intimate partner violence (82 %), when compared with survivors of sexual assault and other interpersonal types of violence (52 % and 53 %, respectively). Posttraumatic growth was low to moderate, and faster as it was detected in victims recruited in the Unit of Forensic Medicine. All domains of posttraumatic growth were positively affected, i.e. higher scores from the PTGI were recorded in survivors of intimate partner violence. No difference was found when results were compared between groups from the Psychotrauma Center. We were unable to identify socio-demographic predictors of posttraumatic growth. À posttraumatic stress disorder was found in survivors of intimate partner violence, and negatively related to posttraumatic growth.

DISCUSSION

To our knowledge, this is the first study comparing post-traumatic growth across such conditions and using specific and recognized scales. Our pilot study demonstrated that survivors of intimate partner violence were able to develop low to moderate posttraumatic growth faster than survivors of other types of violence. All domains of posttraumatic growth were affected, demonstrating the ability of survivors to withstand adversity. Scientific data regarding the link between posttraumatic growth and posttraumatic stress disorder is unclear, probably depending on the trauma, the circumstances, the timing of the measurement. In our study, we found a clear negative correlation between the two parameters. Our results underline the necessity to provide overall and rapid intervention in survivors of intimate partner violence, comprising legal, psychological, social and medical approaches, to facilitate the development of posttraumatic growth.

[Post-traumatic growth: Some conceptual considerations]

OBJECTIVE

Post-traumatic growth (PTG) is a quite new concept of positive psychology proposed in the mid-1990s which is still rather confidential in France. This article aims to propose a full description of this concept from an historical view to epidemiological data through underlying mechanisms and evaluation.

METHODS

A literature search identifying relevant results was performed through the Pubmed database.

RESULTS

PTG refers to positive psychological changes experienced as a result of a traumatic life event in order to rise to a higher level of functioning. That is to say that people experiencing psychological struggle following adversity may often see positive outcomes in the aftermath of trauma. Domains of PTG include appreciation of life, relationships with others, new possibilities in life, personal strength and spiritual change. A self-report scale, the Post-Traumatic Growth Inventory (PTGI), has been developed. PTG has been demonstrated after various traumatic events such as transport accidents, natural disasters, interpersonal violence or medical problems, with a prevalence ranging from 3 to 98 % depending on the type of trauma.

DISCUSSION

The concept of resilience and some evaluation bias may have been deleterious for the development of the PTG concept in the French-speaking world. There is a need to consolidate data to understand the pathway leading to PTG, noticeably to identify factors contributing to PTG that can help to promote the growth as a new therapy for trauma.

A realist review of which advocacy interventions work for which abused women under what circumstances

BACKGROUND

Intimate partner abuse (including coercive control, physical, sexual, economic, emotional and economic abuse) is common worldwide. Advocacy may help women who are in, or have left, an abusive intimate relationship, to stop or reduce repeat victimisation and overcome consequences of the abuse. Advocacy primarily involves education, safety planning support and increasing access to different services. It may be stand-alone or part of other services and interventions, and may be provided within healthcare, criminal justice, social, government or specialist domestic violence services. We focus on the abuse of women, as interventions for abused men require different considerations.

OBJECTIVES

To assess advocacy interventions for intimate partner abuse in women, in terms of which interventions work for whom, why and in what circumstances.

SEARCH METHODS

In January 2019 we searched CENTRAL, MEDLINE, 12 other databases, two trials registers and two relevant websites. The search had three phases: scoping of articles to identify candidate theories; iterative recursive search for studies to explore and fill gaps in these theories; and systematic search for studies to test, confirm or refute our explanatory theory.

SELECTION CRITERIA

Empirical studies of any advocacy or multi-component intervention including advocacy, intended for women aged 15 years and over who were experiencing or had experienced any form of intimate partner abuse, or of advocates delivering such interventions, or experiences of women who were receiving or had received such an intervention. Partner abuse encompasses coercive control in the absence of physical abuse. For theory development, we included studies that did not strictly fit our original criteria but provided information useful for theory development.

DATA COLLECTION AND ANALYSIS

Four review authors independently extracted data, with double assessment of 10% of the data, and assessed risk of bias and quality of the evidence. We adopted RAMESES (Realist and meta-narrative evidence syntheses: evolving standards) standards for reporting results. We applied a realist approach to the analysis.

MAIN RESULTS

We included 98 studies (147 articles). There were 88 core studies: 37 focused on advocates (4 survey-based, 3 instrument development, 30 qualitative focus) and seven on abused women (6 qualitative studies, 1 survey); 44 were experimental intervention studies (some including qualitative evaluations). Ten further studies (3 randomised controlled trials (RCTs), 1 intervention process evaluation, 1 qualitative study, 2 mixed methods studies, 2 surveys of women, and 1 mixed methods study of women and staff) did not fit the original criteria but added useful information, as befitting a realist approach. Two studies are awaiting classification and three are ongoing.Advocacy interventions varied considerably in contact hours, profession delivering and setting.We constructed a conceptual model from six essential principles based on context-mechanism-outcome (CMO) patterns.We have moderate and high confidence in evidence for the importance of considering both women's vulnerabilities and intersectionalities and the trade-offs of abuse-related decisions in the contexts of individual women's lives. Decisions should consider the risks to the woman's safety from the abuse. Whether actions resulting from advocacy increase or decrease abuse depends on contextual factors (e.g. severity and type of abuse), and the outcomes the particular advocacy intervention is designed to address (e.g. increasing successful court orders versus decreasing depression).We have low confidence in evidence regarding the significance of physical dependencies, being pregnant or having children. There were links between setting (high confidence), and potentially also theoretical underpinnings of interventions, type, duration and intensity of advocacy, advocate discipline and outcomes (moderate and low confidence). A good therapeutic alliance was important (high confidence); this alliance might be improved when advocates are matched with abused women on ethnicity or abuse experience, exercise cultural humility, and remove structural barriers to resource access by marginalised women. We identified significant challenges for advocates in inter-organisational working, vicarious traumatisation, and lack of clarity on how much support to give a woman (moderate and high confidence). To work effectively, advocates need ongoing training, role clarity, access to resources, and peer and institutional support.Our provisional model highlights the complex way that factors combine and interact for effective advocacy. We confirmed the core ingredients of advocacy according to both women and advocates, supported by studies and theoretical considerations: education and information on abuse; rights and resources; active referral and liaising with other services; risk assessment and safety planning. We were unable to confirm the impact of complexity of the intervention (low confidence). Our low confidence in the evidence was driven mostly by a lack of relevant studies, rather than poor-quality studies, despite the size of the review.

AUTHORS' CONCLUSIONS

Results confirm the core ingredients of advocacy and suggest its use rests on sound theoretical underpinnings. We determined the elements of a good therapeutic alliance and how it might be improved, with a need for particular considerations of the factors affecting marginalised women. Women's goals from advocacy should be considered in the contexts of their personal lives. Women's safety was not necessarily at greatest risk from staying with the abuser. Potentially, if undertaken for long enough, advocacy should benefit an abused woman in terms of at least one outcome providing the goals are matched to each woman's needs. Some outcomes may take months to be determined. Where abuse is severe, some interventions may increase abuse. Advocates have a challenging role and must be supported emotionally, through provision of resources and through professional training, by organisations and peers.Future research should consider the different principles identified in this review, and study outcomes should be considered in relation to the mechanisms and contexts elucidated. More longitudinal evidence is needed. Single-subject research designs may help determine exactly when effect no longer increases, to determine the duration of longitudinal work, which will likely differ for vulnerable and marginalised women. Further work is needed to ascertain how to tailor advocacy interventions to cultural variations and rural and resource-poor settings. The methods used in the included studies may, in some cases, limit the applicability and completeness of the data reported. Economic analyses are required to ascertain if resources devoted to advocacy interventions are cost-effective in healthcare and community settings.

Family Functioning, Self-Concept and Cybervictimization: An Analysis Based on Gender

The aim of this study was to analyze the relationships between cybervictimization, family functioning, and self-concept in adolescents, while taking the gender perspective into account. A study was conducted with a sample of 8115 adolescents, aged between 11 and 16 years (M = 13.34; SD = 1.04) from the State of Nuevo Leon, Mexico. A MANOVA 3x2 was performed to analyze the data. The results showed that family functioning, family self-concept, and academic self-concept were higher when cybervictimization was low. It was also observed that, in situations of cybervictimization, the girls had lower family self-concept, lower academic self-concept, and lower family functioning than the boys. The results that were obtained and their implications are discussed in the final section.

If You Can't Say Something Nice: A Latent Profile Analysis of Social Reactions to Intimate Partner Violence Disclosure and Associations With Mental Health Symptoms

The social reactions that victims receive when disclosing intimate partner violence (IPV) have important implications for recovery and well-being. Women from the community (n = 172) reported IPV, reactions to IPV disclosure, and mental health symptoms in individual interviews. Latent profile analyses revealed three subgroups of victims with varied experiences of reactions. The group characterized by high negative/low positive reactions reported the highest depression and posttraumatic stress disorder (PTSD) symptom severity; symptom severity was high regardless of IPV severity. However, symptoms were only severe at high IPV severity among individuals classified into groups characterized by high positive reactions, and by low negative and low positive reactions.

Testing Psychometrics of Healthcare Empowerment Questionnaires (HCEQ) among Iranian Reproductive Age Women: Persian Version

BACKGROUND

Producing high quality data needs an accurate measurement in any fields of study. This study aimed to test psychometrics of the Persian version Healthcare Empowerment Questionnaire (HCEQ) in relation to personal care among Iranian reproductive age women and to validate the instrument for future use.

METHODS

A cross-sectional study was conducted on 549 reproductive age women in a health centers affiliated to Tehran University of Medical Sciences producing a response rate of 100%. Content validity was established using translation and backtranslation procedures, pilot testing, and getting views of expert panel. Construct validity was measured using explanatory factor analysis. Cronbach's alpha was used to measure internal consistency, and intra-class correlation coefficients were used to confirm stability.

RESULTS

The results indicated that explanatory factor analysis of 10 items in three dimensions explained 63.2% of the total variance. Validity and reliability of the 10-items of HCEQ with two response scales (perception of control and motivation of being empowered) assessed for internal quality showed the reliability of internal consistency (α=0.70; range=0.62-0.76). The correlation between convert (10 items) and apparent (3 factors) variables was 0.5 times higher than the revealed convergent validity.

CONCLUSION

The findings of this study supported the reliability and validity of the Persian version of HCEQ to assess the degree of individual empowerment in relation to personal healthcare and services among reproductive age women. Therefore, the HCEQ-Persian version could be a useful, comprehensive, and culturally sensitive scale for assessing healthcare empowerment among reproductive age women.

Overcoming Abuse: A Phenomenological Investigation of the Journey to Recovery From Past Intimate Partner Violence

To date, minimal research has focused on the recovery process for survivors of intimate partner violence (IPV). This study utilized a phenomenological methodology to understand the lived experiences of survivors of IPV ( N = 123) who had overcome abusive relationships and created violence-free and meaningful lives. The researchers aimed to understand key factors involved in their recovery processes. Results indicated two main processes in the IPV recovery process: intrapersonal processes and interpersonal processes. Intrapersonal processes included (a) regaining and recreating one's identity, (b) embracing the freedom and power to direct one's own life, (c) healing from the mental and physical health symptoms of the abuse, (d) fostering acceptance and forgiveness with self and abuser, (e) education and examination of abusive relationships, (f) determining whether and how to enter new intimate relationships, and (g) acknowledging the long-term process of overcoming abuse. Interpersonal processes included themes of (a) building positive social support and relationships and (b) using ones' experiences with abuse to help others. Results of the present study are presented, and implications for practitioners are discussed.

Negative attitudes related to violence against women: gender and ethnic differences among youth living in Serbia

OBJECTIVES

This study aimed to identify to what extent negative attitudes towards intimate partner violence against women are present among young women and men living in Serbia, in Roma and non-Roma settlements.

METHODS

We used the data from the 2010 Multiple Indicator Cluster Survey conducted in Serbia, for the respondents who were 15-24 years old. Regression analyses were used to examine the association between judgmental attitudes, socio-demographic factors and life satisfaction.

RESULTS

In Roma settlements, 34.8% of men and 23.6% of women believed that under certain circumstances men are justified to be violent towards wives, while among non-Roma it was 5.6 and 4.0%, respectively. These negative attitudes were significantly associated with lower educational level, lower socio-economic status and being married. In multivariate model, in both Roma and non-Roma population women who were not married were less judgmental, while the richest Roma men were least judgmental (OR 0.40, 95% CI 0.18-0.87).

CONCLUSIONS

Violence prevention activities have to be focused on promoting gender equality among youth in vulnerable population groups such as Roma, especially through social support, strengthening their education and employment.

Common ground, complementary approaches: adapting the Housing First model for domestic violence survivors

The Housing First model has been shown to be a highly effective approach to achieving permanent housing for chronically homeless individuals with serious mental illness and chemical dependency. There are numerous components of the model that lend themselves toward achieving similar goals for homeless domestic violence (DV) survivors and their children. A leading cause of homelessness for women, many of whom are mothers, is DV. This article describes the commonalities between the Housing First model and the tenets of DV victim advocacy work and explores how Housing First can be adapted to effectively achieve safe and stable housing for DV survivors and their children. Preliminary evidence for the adapted model - termed Domestic Violence Housing First - is provided, and policy implications are discussed.

A Systematic Review of Posttraumatic Growth in Survivors of Interpersonal Violence in Adulthood

This review critically evaluates the literature on posttraumatic growth in survivors of interpersonal violence, integrating the findings from 12 quantitative and 4 qualitative studies. The following databases were searched using predetermined terms: AMED, EMBASE, MEDLINE, PsycINFO, BNI, CINAHL, and Web of Knowledge. The review's findings suggest that the mean prevalence of growth in interpersonal violence survivors is around 71% (range 58-99%). The highest level of growth was consistently experienced in the "appreciation of life" domain. However, survivors reported growth in the four remaining domains: "personal strength," "new possibilities," "experience of relationships with others," and "outlook on life." The nature of the relationship between growth and distress was inconsistent across studies. A combination of pretrauma, peritrauma, and posttrauma variables were found to be related to the degree of growth survivors experienced. Methodological weaknesses of the quantitative studies included the predominant use of retrospective, cross-sectional, correlational designs, discrepancy in the measurement of growth, insufficient sample sizes for power calculations in five studies and limited external validity. Qualitative findings were limited by sampling methods, insufficient information about interview schedules, the lack of credibility checks, and evidence of reflexivity demonstrated by some studies. Implications for practice, policy, and future research are discussed.

A Patient-Centered Decision-Support Tool Informed by History of Interpersonal Violence: "Will This Treatment Work for Me?"

The Probability of Treatment Benefit (PTB) chart is a decision-support tool that quantifies, in absolute terms, the probability that an individual patient will benefit from a psychological treatment based on the individual's pre-treatment characteristics. The demand for such a tool has increased with the growing emphasis on personalized medicine and the need for selecting a treatment from an expanding list of evidence-based models. This method has the potential to provide clinicians and mental health consumers with a practical and interpretable means of comparing treatment options for individuals whose benefit from a particular treatment may differ substantially. We provide a practice update and demonstrate how to develop a PTB chart using data from a randomized controlled trial examining the efficacy of two approaches for treating posttraumatic stress disorder based on patients' pre-treatment exposure to multiple types of interpersonal violence. Step-by-step instructions for applying the PTB method are provided.

Professional versus personal resource utilization in survivors of intimate partner violence

Although many women are affected by intimate partner violence (IPV) across the life span, rates of help seeking for IPV-related concerns are low. The current project examined predictors of personal and professional resource use in a sample of female IPV survivors, with the purpose of identifying engagement strategies for IPV services and resources. The study is notable for is concurrent examination of demographic variables, abuse characteristics, beliefs about cause of violence, beliefs about helpfulness of resources, coping style, and PTSD symptoms as predictors of resource use. Interviews and self-report measures were completed by 372 women recruited from community agencies. The average age was 34.41 years (SD = 8.09), and 66% of the sample was African American, followed by 28% Caucasian, 1.4% Latino, and 1.4% Native American. Results indicated that professional help seeking was significantly related to psychological aggression, age, controllability of cause of violence, engaged coping, helpfulness of resource, and PTSD severity (p < .001), and that personal resource use was related to relationship length, stability of cause of violence, disengaged coping, and helpfulness of resource (p < .001). These findings point to the importance of cognitions and coping style in the decision to seek help for IPV. In particular, beliefs about the helpfulness of potential resources as well as beliefs about the controllability and stability of the violence appear to be important targets for increasing engagement of IPV survivors in available services. (PsycINFO Database Record

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.