Examining the measurement of severity of intimate partner violence and its association to mental health outcomes: a narrative synthesis

Introduction

The aims of this synthesis were to investigate the relationship between IPV severity and mental health outcomes and shed light to gaps and limitations in existing methodologies used to assess IPV severity and its association with mental health outcomes.

Methods

We conducted a two-stage narrative synthesis of 76 studies. First, we identified IPV measures used in at least five studies, focusing on their variations and severity score calculation. Then, we analyzed findings of studies correlating IPV severity with mental health outcomes, identifying features of measures and statistical methods influencing result consistency.

Results

Measures of intimate partner violence were often modified from their original, potentially impact on the reliability and validity of these measures. The operationalization of violence severity varied across studies, leading to inconsistencies in scoring whereby compromising the consistency of severity levels across studies. We found lack of consistency in applying validated methods for scoring instruments to determine abuse severity. In this review, we consistently found that the severity of IPV and its various subtypes were linked to different mental health outcomes across multiple studies. We discovered evidence suggesting that experiencing more types of IPV was associated with worse mental health outcomes. Generally, higher levels of overall IPV severity and its specific subtypes were correlated with poorer mental health outcomes. However, our analyses did not reveal consistent patterns that would allow for a definitive determination of how individual IPV subtypes differently affect mental health outcomes. Nevertheless, we observed that increasing severity of physical IPV tended to have a notable impact on post-traumatic stress disorder (PTSD). Conversely, increasing severity of psychological IPV was consistently associated with depression. While sexual IPV severity was explored in fewer studies, the evidence regarding its impact on various mental health outcomes was less conclusive.

Discussion

To achieve a comprehensive understanding of the mechanism by which IPV severity is related to mental health it may be time to take an alternative approach to measuring IPV severity. No IPV measures assessed the acceptability of the content to people who have experienced IPV. This is an important omission with significant consequences for the validity of the evidence base.

Aftermath of COVID-19: Exploring the Perception of Violence Against Women in the Middle East and North Africa

This article explores the perception of violence against women (VAW) in the Middle East and North Africa in the aftermath of the COVID-19 pandemic using Arab Barometer VI parts 1 and 3 (N = 12,548). Results showed that men and social conservatism were less likely to perceive that the VAW in the community had increased. For religious people, the odds of perceiving violence in the community were higher. Individuals whose jobs were interrupted because of the COVID-19 outbreak were more likely to perceive VAW in the community has increased compared to individuals whose jobs were not interrupted. The strongest predictor of the perception of increased VAW in the community because of COVID-19 was the current economic situation of the country. Those who perceived the economic situation of the country as bad were 1.6 times more likely to believe that VAW has increased. Government handling of the crisis and overall government performance increased the odds of perceiving that VAW has increased. Investigating correlates of VAW as the consequence of the COVID-19 pandemic is crucial because it helps governments, emergency services, and community leaders develop strategies of prevention for future disasters and improve community and institutional reactions.

Association of adversities and mental health among first- and second-generation Arab American young adults

The prevalence of mental health problems among young adults is widely recognized. However, limited research has examined the mental health of Arab American young adults specifically. To address this gap in the literature, this study aimed to investigate the effects of multiple stressors including adverse childhood experiences (ACEs), discrimination, and bullying victimization on the mental health of first- and second-generation Arab American young adults. The participants (N = 162) were recruited from a Midwest university using online and in-person methods. They were screened and completed a demographic questionnaire and self-report measures of ACEs, discrimination, bullying victimization, and mental health. Hierarchical multiple regression analysis was conducted to examine the effect of psychosocial stressors on mental health and the moderating effect of generation (first vs. second) on that relationship. Female gender, increased perceived discrimination, and more ACEs were associated with lower mental health scores (β = -0.316, p < 0.001, β = -0.308, p < 0.001, and β = -0.230, p = 0.002, respectively). There was a significant negative relationship between victimization and mental health for first-generation Arab Americans (β = -0.356, p = 0.010). However, that association all but disappeared for second-generation participants (β = 0.006, p = 0.953). The results highlight the impact of multiple adversities on Arab American young adults' mental health and indicate important nuances related to their generation in the association between bullying victimization and mental health. Implications for practice and future research are discussed.

Intimate partner violence prevention amongst Arab American young adults in Chicago: Implications for intervention development

AIMS

Intimate partner violence (IPV) rates in the Arab American community are high, and there are gaps in the understanding of young adults' perspectives on IPV and its prevention. The aims of this study are to describe Arab American young adults' perspectives on the design of IPV prevention programmes and to document and explore their understanding and experiences with IPV.

DESIGN

This exploratory study was part of a larger community-based participatory mixed-method study (QUAL-quan) amongst Arabs in Chicago and focused on young adult participants (18-25 years).

METHODS

Participants (n = 44) completed an IPV survey about IPV perpetration and victimization, dating violence norms, conflict management skills, gender stereotyping, and belief in the need for help. From four focus groups (22 participants), we explored Arab American young adults' perspectives on IPV prevention programme development.

RESULTS

Participants supported the adaptation and development of a youth-centred IPV prevention intervention that is community-based, culturally informed, and inclusive of multiple Arab community stakeholders. The survey results indicated multiple experiences with psychological and physical dating violence victimization (76.3% and 47.2%) and perpetration (62.2% and 27%).

CONCLUSION

Arab American young adults in Chicago are exposed to high rates of IPV. Community-based participatory approaches are needed to develop IPV prevention interventions that centre community needs.

IMPACT

Intimate partner violence is a significant public health problem; nearly 1 in 4 women have experienced IPV at some point in their life, and about 70% of those experiencing IPV, experience their first victimization before the age of 25. Arab American young adults experience high rates of IPV victimization and perpetration, requiring urgent attention. Participants proposed various community-based strategies to develop IPV prevention programmes that include multiple community stakeholders. Community-based organizations and researchers, schools and religious institutions could establish collaborations to ensure the adaptation and development of community-informed IPV prevention programmes.

Domestic Violence Against Women in North African and Middle Eastern Countries: A Scoping Review

This scoping review aimed to identify the scope of the current literature on the prevalence, consequences, and risk factors of domestic violence (DV) against women by their husbands or male partners in North African and Middle Eastern countries. The methodology for this scoping review was based on the framework outlined by Arksey and O'Malley. Studies published on DV against women over the age of 15 by partner or husband and published in peer-reviewed scientific journals between January 1970 and April 2018 were included in the review. The databases MEDLINE, PsychINFO, CINAHL, HealthSTAR, EMBASE, Scopus, African Journals Online, Turkish Journal Database, and gray literature sources were searched. On completion of the review process, 151 full-text articles were identified for charting. This review demonstrated that women's age, women's education level, duration of marriage, history of childhood abuse/witnessing family violence, living in the rural region, and family income level were negatively associated with DV, indicating that younger women, women with lower education, a longer marriage duration, and a lower income level had a higher risk of exposure to DV in this region. Anxiety, depression/insomnia, and physical injury were the most common health problems reported by victims in the region. The highest proportion of women with no response to violence was reported in Jordan, Saudi Arabia, and Turkey. The findings of this scoping review represent the first attempt to summarize the literature from North African and Middle Eastern countries and demonstrate the similarity in DV-related behaviors among women despite the cultural and regional diversity of the studies.

Depression, Stress and the Mediating Role of Intimate Partner Violence (IPV) Among Israeli Women of Childbearing Age in the Shadow of the COVID-19 Pandemic

Dealing with the outbreak of the new coronavirus has generated unprecedented challenges around the world, including in Israel. Women of childbearing age may be forced to live under particularly difficult circumstances during the pandemic. The current study among Israeli women of childbearing age has three main objectives related to the specific period of the COVID-19 pandemic: to study the prevalence and predictors of intimate partner violence (IPV); to investigate the prevalence and predictors of depression; to examine whether IPV mediates the association between general stress, fear of COVID-19 and depression as an outcome. In a cross-sectional study, 722 married women, Jewish and Arab residents of Israel, were recruited to answer an online self-completion questionnaire during the first wave of the COVID-19 pandemic. The questionnaire included an assessment of their degree of general stress and depression, fear of COVID-19, experiences of IPV and demographic variables. The results of the current study show that a high percentage of women reported IPV (with Muslim women reporting higher IPV than Jewish women), perceived stress (PSS), perceived COVID-19 stress and depression. The findings also show that IPV and its three dimensions mediate the relationship between COVID-19 stress and depression, such that higher stress was related to higher IPV, raising the odds for depression. Moreover, the total scores for IPV and emotional violence were found to mediate the relationship between stress and depression. That is, domestic violence explains part of the association between stress and depression during the COVID-19 pandemic. Indeed, the current pandemic has resulted in an increase in IPV and depression, and especially in the specific stress associated with the disease itself. Based on the findings of the current study, preventing violence will reduce stress-related depression. The Muslim population, and especially those who are more religious, is in particular need of intervention.

A Qualitative Study of Arab-American Perspectives on Intimate Partner Violence in Dearborn, Michigan

Few studies explore how intimate partner violence (IPV) affects Arab Americans. Through focus groups with stakeholders from an Arab-centered health organization and semistructured interviews with Arab-American female clients (18-65 years), we explore how IPV affects Arab-American women and factors that impede and facilitate their access to support services. We find that IPV is a critical concern among Arab Americans and that generational status, educational attainment, and support from family, friends, or religious leaders were perceived to influence access to IPV support services. This study has implications for developing culturally sensitive IPV interventions for Arab-American women.

Gender and Educational Differences in Perception of Domestic Violence Against Women Among Libyan Migrants in Manchester

Domestic violence against women (DVAW) is a worldwide phenomenon and refers to any act committed against women that results in physical and psychological harm, and coercion, loss of liberty, and deprivation. There is a dearth of research and information about the extent and prevalence of domestic violence among Libyan communities. The aim of the study was to explore community knowledge of, and attitudes toward, DVAW and to improve our understanding of the factors that influence knowledge, attitudes, and responses, particularly educational and gender differences. Using snowball sampling, we analyzed 20 semistructured interviews with Libyans living in Manchester, United Kingdom. We found gender and education-influenced participants' perception of DVAW. Men in general did not recognize DVAW as a serious social problem; noticeably, they saw it as a personal and family issue. Knowing attitudes toward DVAW is necessary for government and communities' prevention policies as attitudes influence perpetration of DVAW.

Patterns of Intimate Partner Violence Victimization and Survivors' Help-Seeking

Intimate partner violence (IPV) survivors often do not seek critically needed help. A good understanding of the relationship between the pattern of violence and help-seeking is critical to developing adequate services for the survivors, as well as for reaching out to those who do not seek help. This study used the National Intimate Partner and Sexual Violence Survey to examine how IPV survivor's help-seeking varies, depending on the characteristics of the survivors and the pattern of victimization. Logistic regression analyses were conducted, with the survivors' help-seeking and use of formal or informal help as the dependent variables. The study results show that women are the primary victims of IPV, that the pattern of victimization is associated with both whether survivors seek help or not, and which help sources they utilize, if any. IPV consequences are also associated with survivors' help-seeking, as are demographic factors such as age, gender, race, and immigration status.

Patterns of Service Utilization Among Women Who Are Victims of Domestic Violence: The Contribution of Cultural Background, Characteristics of Violence, and Psychological Distress

The study examined patterns of utilization of various services among female victims of domestic violence in Israel. The study looked at how cultural background, characteristics of violence, attempts at separation from partner, and women's emotional distress contributed to patterns of service utilization. The sample of participants included 499 women who arrived at 12 shelters in Israel. Of those participants, 142 were Jewish, 156 were Arab, 125 had been born in the former Soviet Union (FSU), and 76 had been born in Ethiopia. Latent class analysis procedure was applied to identified patterns of service utilization. The procedure identified three patterns of service utilization: substantial use, frequent use of welfare and criminal justice services, and minimal use. Among Arab women, the likelihood of making substantial use of services was greater than the likelihood of making minimal use. Moreover, among the entire sample, the higher the levels of sexual abuse, violence, and posttraumatic stress disorder (PTSD), the greater the likelihood of substantial versus minimal use of services. In addition, being employed, enduring higher levels of violence, and making attempts to separate increased the likelihood of utilization of welfare and criminal justice services versus minimal use. The study highlights the factors that motivate women to make use of services and the distinct strategies they use in the help-seeking process. At the practice level, the study emphasizes the need to take into account both the woman's cultural context and the stage of help seeking she is at. In this way, professionals can provide differential treatment accordingly.

The Contested Whiteness of Arab Identity in the United States: Implications for Health Disparities Research

In response to the Institute on Minority Health and Health Disparities' (NIMHD) new health disparities research framework, we call on the National Institutes of Health (NIH) to acknowledge Arabs in the United States as a health disparity population. Arab classification as White leads to their cultural invisibility and perpetuates a cycle of undocumented health disparities.We provide examples of how this contested identity reinforces challenges associated with identifying this population and contributes to enactments of structural violence and undocumented health disparities. Decades of research with Arabs in the United States provides consistent evidence that their health does not fit the health profile of White Americans and that Arabs do not benefit from Whiteness and White privilege associated with their White racial categorization. On the contrary, Arabs in the United States experience discrimination and health disparities that require urgent attention; this can be achieved only by identifying the population with a racial category other than White.We conclude with recommendations to NIH and NIMHD to revise their definition of health disparity populations to include Arabs in the United States.

Predicting Depression Among Jewish and Arab Israeli Women Who Are Victims of Intimate Partner Violence

This study examined whether there were differences in levels of depression between Arab and Jewish Israeli female victims of intimate partner violence (IPV) and how various personal and environmental variables contributed to depression. A total of 303 women were selected. T tests were conducted, and no significant differences were revealed. Hierarchical regressions were also conducted. Background variables (violence in childhood and employment status) and psychiatric treatment contributed significantly to the variance in depression, and a negative contribution was made by personal and environmental variables (sense of mastery and social support). The interaction between ethnic origin and psychiatric treatment was also found to be significant. The discussion highlights the theoretical contribution and implications for practice in the field.

Exploring the Experience of Arab American and Arab Immigrant Women With Intimate Partner Violence

This article describes a study resulting from of a university-community partnership. The faculty of the university and the executive director of local community agency serving the local Arab American and Arab immigrant community had a shared interest in looking at the unique experiences and needs of Arab women survivors of intimate partner violence (IPV). This led to a qualitative research project in which 25 Arab American women were interviewed about their experience with IPV. Contextual themes emerged related to cultural context, community response, and survival resilience. Implications for practice and direction for future research are discussed.

The Health of Arab Americans in the United States: An Updated Comprehensive Literature Review

Background: Arab Americans are a historically understudied minority group in the United States and their health needs and risks have been poorly documented. We aim to provide an updated comprehensive review of the literature on Arab American physical and mental health and provide suggestions for future work in this field.

Methods: A comprehensive review of the English language medical and public health literature published prior to 2017 identified through multiple database searches was conducted with search terms describing Arab Americans and health outcomes and behaviors. The literature was qualitatively summarized by health behavior (vaccination, tobacco use, drug and alcohol use, and physical activity), health outcome (diabetes, mental health, cardiovascular disease, cancer, women's, and child health), and populations at increased risk of poor health outcomes (adolescents and the elderly).

Results: The majority of studies identified exploring Arab American health have been published since 2009 with an increase in the number of longitudinal and intervention studies done with this population. The majority of research is being undertaken among individuals living in ethnic enclaves due to the lack of an ethnic or racial identifier that may help identify Arab Americans from population-based studies. Studies highlight the conflicting evidence in the prevalence of diabetes and cardiovascular disease based on study sample, an increased understanding of cancer incidence and barriers to identification, and an increased level of knowledge regarding mental health and sexual health needs in the population. Information on health behaviors has also increased, with a better understanding of physical activity, alcohol and drug use, and vaccination.

Conclusion: More research on Arab American health is needed to identify risks and needs of this marginalized population given the current social and political climate in the United States, especially with regard to acculturation status and immigrant generation status. We provide recommendations on approaches that may help improve our understanding of Arab American health.

Beliefs of Palestinian Women From Israel About the Responsibility and Punishment of Violent Husbands and About Helping Battered Women

This article presents a study that examined beliefs about violent husbands and about helping battered women among Palestinian women living in Israel from the perspective of patriarchal ideology. A convenience sample of 701 married women was obtained, and a self-report questionnaire was administered. The findings reveal that the majority of participants held violent husbands accountable for their behavior; however, the majority of them did not support punishing violent husbands through formal agencies (i.e., the police) or through informal social institutions (i.e., the family). In addition, contrary to expectations, the majority of women perceived wife beating as a social problem rather than as a private one that should be dealt with within the family. Regression and multiple regression analysis revealed that women's endorsement of patriarchal ideology was found to influence all three above-mentioned beliefs about violent husbands and battered women, over and above the amount of variance in each of these beliefs that could be attributed to the women's sociodemographic characteristics. The limitations of the study and its implications for future research are discussed.

Depression Among Arab American and Arab Immigrant Women in the United States

The difficult and tense political climate Arab populations are currently facing may be exacerbating mental health issues, reducing forms of social support in friend circles, and decreasing the desire to seek health care. There is room to better understand the mental health needs of Arab women residing in the United States and to develop policies and interventions that keep these women safe and in care. This column reviews two recent studies; the first examines barriers to reporting intimate partner violence and depression among Arab American women and the second highlights stressors and social support for Arab women immigrants throughout their immigration experience.

Mental health consequences of violence against women and girls

PURPOSE OF REVIEW

Recent studies on mental health consequences of violence against women and girls were reviewed in a range of situations.

RECENT FINDINGS

Although several studies continued to show cross-sectional associations between child sexual abuse (CSA) and mental health outcomes, a few prospective studies showed a robust association between CSA and depression. Studies on the impact of dating violence are still at a nascent stage and focus on antecedents of violence rather than its consequences. Women at higher risk, such as adolescents, migrants, the homeless, and women in the perinatal period have been studied and specific vulnerabilities identified. Women reporting bidirectional violence had higher rates of depression and post-traumatic stress disorder (PTSD). Cumulative violence, severity of violence, and recent violence are associated with higher morbidity. Studies among women in conflict zones have emphasized the role of different forms of sexual and physical violence on mental health.

SUMMARY

Newer emerging areas that need more research include mental health consequences of women in conflict zones and among same sex relationships. There are also few studies on the violence experience of both older women and adolescents. The need to better delineate the psychopathology of complex manifestations of PTSD is underscored.