Health professionals' intervention in the context of domestic violence against women: exploring perceptions and experiences of providing healthcare

Domestic violence against women is a complex social phenomenon and a widely recognised issue of public health, which requires that all sectors of society, including the health sector, take the necessary action to prevent and address it. This paper aims to contribute to the discussion on the role of the primary health care in addressing domestic violence against women, by analysing health professionals' perceptions of their practice as well as the difficulties they experience in providing healthcare to victims. To fulfil this aim, a qualitative approach was chosen, using focus groups with health professionals working in the area of primary health care in an inland region of Portugal. The main findings point to the lack of a specific protocol and insufficient information and skills to respond to domestic violence situations, which hinders health professionals' confidence to intervene and tends to orientate them towards a more medical response. Resulting from these findings, implications for practice are discussed: the need for clear and specific orientations to guide health professionals' intervention; the need to offer training that enables them to provide appropriate healthcare to women experiencing domestic violence; and the need to position themselves in the context of an integrated, multi-sectoral intervention.

A longitudinal analysis on determinants of problem drinking among Korean women: focusing on a gender perspective

Background

In recent years, female drinking has been on the rise worldwide, and this trend can be observed in Korea as well. Accordingly, this study aimed to examine the heterogeneous longitudinal changes in drinking patterns among Korean women, while also exploring the determinants of these changes. In particular, the study identified the gender perspective-related determinants of the classified patterns of problem drinking.

Methods

Data on 4615 adult women who participated in the Korea Welfare Panel Study (KOWEPS) for 3 years (2018–2020) were analyzed longitudinally using SPSS Statistics 22.0 and M-plus 7.0. The changes in female drinking patterns were analyzed using latent class growth analysis. Subsequently, multinomial logistic regression analysis was performed to identify the predictive factors affecting the changes in drinking patterns.

Results

Latent class analysis yielded three classes: “low problem drinking/decreased,” “moderate problem drinking/maintained,” and “high problem drinking/increased.” Of the participants, 80.4% were in the first class, 14.5% in the second, and 5.1% in the third. After controlling for sociodemographic and psychosocial factors, we found: i) domestic violence, work–family balance stress, and gender role perception were not statistically significant for the “moderate problem drinking/maintained” class; lower levels of depression (odds ratio; OR = .750, p < .05) and higher levels of satisfaction with social relationships (OR = 1.257, p < .05) increased the probability of belonging to the “moderate problem drinking/maintained” group compared to the low problem drinking/decreased class; ii) in the “high problem drinking/increased” class, relative to the low problem drinking/decreased class, experience of domestic violence (OR = 1.857, p < .05), work–family balance stress (OR = 1.309, p < .05), and gender role perception (OR = .705, p < .05) were significant predictors of drinking behavior.

Conclusions

Problem drinking in Korean women demonstrated heterogeneous patterns of change, with gender-specific factors being the main predictors of this change. Therefore, this study developed a strategy for reducing the harmful effects of female drinking, which considers the characteristics of the changes in women’s drinking patterns as well as factors from the gender perspective.

Gender, employment, and continuous pandemic as predictors of alcohol and drug consumption during the COVID-19

AIMS

This study aims to assess the impacts of the continuous pandemic state, gender and employment status on changes in substance use during the COVID-19 outbreak.

METHODS

A sample of 828 Israelis participated in an online survey and answered questions on demographic characteristics, ranking their substance consumption, and perceived increase in alcohol/drug consumption. The age range was 18-65 (Mean = 30.10, S.D. = 11.99), and the majority (72.9 %) were female. We gathered the data in two waves: 1) during and following the early first lockdown; 2) following the second lockdown.

RESULTS

Men reported higher beer, hard liquor, and illegal drug consumption than women. Continuous COVID-19 was associated with higher consumption of all alcohol, and cannabis, and higher perceived increases in substance consumption than short-term COVID-19. Significant interactions were found between gender and employment regarding all-drug consumption measurements and interactions between gender, employment, and pandemic duration (short/continuous) were found regarding cannabis consumption.

CONCLUSIONS

The discussion addresses the results in the context of continuous COVID-19 and traditional gender roles. Policymakers should develop prevention and harm reduction interventions for substance use and abuse, focusing on unemployed men as an at-risk group.

Integration of Primary Health-Care Services in Women's Shelters: A Scoping Review

Women who have experienced intimate partner violence (IPV) have significant detrimental physical and mental health consequences associated with the violence as well as numerous barriers to health-care and social service utilization. Service integration offers a solution to help support women who have experienced violence overcome negative health consequences as well as barriers to system navigation and use. The purpose of this scoping review was to examine research activity pertaining to IPV and primary health-care and women's shelters integration. Namely, the aim was to determine the extent, range, and nature of research related to the effects of integrating primary health-care services and women's shelters. Nineteen sources were identified as potentially relevant from four electronic databases, with four articles meeting the inclusion criteria of integration of primary health-care and women's shelter services where outcomes were presented related to the efficacy of primary health-care received and integration. Numerical analysis revealed considerable homogeneity among articles in terms of methodological approaches, patient populations, and type of integration. Inductive thematic content analysis revealed three themes that resulted from integration: (1) increased access to and acceptability of services, (2) bridge back to health-care, and (3) decreasing future health-care burden. The findings from this scoping review represent a first attempt to summarize the literature, indicate a need for additional research, and suggest implications for practice.

Childhood maltreatment and intimate partner violence victimization: A meta-analysis

BACKGROUND

Intimate partner violence (IPV) victimization is a serious public health problem in the world. It is imperative to examine risk factors for IPV victimization.

OBJECTIVE

This meta-analysis aimed to explore the relationship between childhood maltreatment (CM) and IPV victimization and investigate the moderating effects of gender and marital status.

PARTICIPANTS AND SETTING

Examination of the literature produced a sample of 56 effect sizes (N = 23,127) for review.

METHODS

PsycINFO, PsycArticles, EBSCO-ERIC, Medline, Google Scholar, and ProQuest Dissertations & Theses databases were systematically searched until March 31, 2018. Forty-six eligible studies were included in the meta-analysis. Random effects model was used for meta-analysis of the studies.

RESULTS

Results indicated a significant association between total CM and IPV victimization (r = .18, p < .001). Further subgroup analyses revealed that all four types of CM (childhood physical abuse, psychological abuse, sexual abuse, and neglect) were positively related to IPV victimization (r = .19, .18, .17, and .12, respectively). Moreover, the moderation analyses revealed that the association between CM and IPV victimization was stronger for dating couples than for married ones. However, this relation did not show significant difference between males and females.

CONCLUSIONS

There is an association between CM and IPV victimization, and it is moderated by marital status.

Symptoms of post-traumatic stress disorder among battered women in Lebanon: an exploratory study

Intimate partner violence against women is common in Lebanon and can lead to major health problems. However, the incidence of symptoms of post-traumatic stress disorder (PTSD) in battered women has not been extensively explored in the Lebanese cultural context. The objectives of this study were as follows: (a) to determine the prevalence of PTSD symptoms among women in Lebanon who have been physically abused by their partners, (b) to assess whether the rate of PTSD symptoms varied according to sociodemographic variables, and (c) to reveal other attributes that might be risk factors for developing symptoms of PTSD. Of the 95 physically abused women who met inclusion criteria, 85 completed a questionnaire including sociodemographic questions, the physical abuse subscale of the Composite Abuse Scale (CAS), and the PTSD Checklist-Civilian Version (PCL-C). Results showed a high prevalence of PTSD symptoms (97%), positively correlated with physical violence (r = .719). Lower education level and recent abuse were correlated with symptom severity, as were the number of problematic habitual behaviors in the abusive partner and the use of psychotherapy. Increased involvement of health care professionals in the detection of women at risk, with referral to appropriate resources, is suggested to improve prevention and management efforts.

Revisiting the effects of self-protective behaviors on the risk of injury in assaults against women

Using data from the National Crime Victimization Survey (NCVS; 1992-2005), we closely examined the effects of victims' self-protective actions on the risk of injury among female nonsexual assault victims. Building on previous research, we focused on 3 important methodological and conceptual issues: (a) gradational coding of the 16 different NCVS self-protective actions, (b) separate analyses of serious injuries, and (c) the victim-offender relationship. Our analyses demonstrated that the risk of injury was strongly and positively associated with the degree of forcefulness of self-protective actions. Furthermore, the likelihood of victim injury was inversely related to the relational distance between the victim and the offender.

Drinking in the Context of Life Stressors: A Multidimensional Coping Strategy Among South African Women

This study explored narratives of drinking as a coping strategy among female drinkers in a South African township. In 2010-2011, we conducted qualitative in-depth interviews with 54 women recruited from 12 alcohol-serving venues. Most women drank heavily and linked their drinking to stressors. They were motivated to use drinking to manage their emotions, facilitate social engagement, and achieve a sense of empowerment, even while recognizing the limitations of this strategy. This study helps to contextualize heavy drinking behavior among women in this setting. Multifaceted interventions that help female drinkers to more effectively manage stressors may aid in reducing hazardous drinking.

Partner Violence and Substance Abuse Are Intertwined

Research shows that co-occurring partner violence and substance abuse are problems for many women. However, less is known about women’s varied experiences with partner violence and substance abuse. This exploratory, qualitative study investigates these two issues among a sample of 15 women in substance abuse treatment who experienced partner violence. Overall, findings show participants’ experience of violence–substance connections varied in important ways; complicating factors exacerbate both problems; and domestic violence services and substance abuse treatments should account for these variations and complications. We discuss directions for providers, researchers, and policymakers concerned with partner violence or substance abuse.

One dozen considerations when working with women in substance abuse groups

Women and men have different histories, presentations, and behaviors in substance abuse groups. Twelve considerations are offered for the beginning group leader when encountering women with substance abuse issues. These include understanding sexism, what brings women to treatment, and how women behave in group treatment. Implications for clinical practice with women in single-gender and mixed-gender groups are included.

The Impact of Comprehensive Services in Substance Abuse Treatment for Women With a History of Intimate Partner Violence

This study examines the impact of comprehensive services on posttreatment substance use among women with a history of intimate partner violence. The sample includes 1,123 women from 50 treatment facilities derived from the National Treatment Improvement Evaluation Study (NTIES). Generalized linear mixed modeling was used to determine whether a history of intimate partner violence moderates the association between service receipt and posttreatment substance use. Significant interactions were found between history of intimate partner violence and concrete ( p = .016) and family services ( p = .023) in predicting substance use.

Intimate partner violence and initiation of smoking and drinking: A population-based study of women in Yokohama, Japan

Intimate Partner Violence (IPV) is prevalent in the lives of women across the globe and has been found to be associated with substance use among women. As part of the World Health Organization's (WHO) cross-national research effort, this study examined the relationship between the experience of IPV and use of alcohol and tobacco among a probability sample of women aged 18-49 in Yokohama, Japan. Using retrospective data for 2000-2001, we employed methods of survival analysis that allowed an examination of the probability of initiating smoking and drinking subsequent to the experience of IPV. Experiencing IPV was associated with current smoking as well as initiation of smoking and current patterns of drinking. Women who had experienced IPV were more likely to be smoking at the time of the interview and tended to initiate smoking at earlier ages compared to those who had not experienced IPV. At any time point, the risk of starting to smoke was more than twice as high for women who had previously experienced IPV than for women who had not. In addition, women who had experienced IPV were more likely to drink heavily. The present study's findings clearly point to the need to enhance coordination between IPV prevention and substance abuse programs in order to improve the safety and wellbeing of women who have experienced IPV.

Sexual Assault and Current Mental Health: The Role of Help-Seeking and Police Response

We examine the extent to which seeking help from social service agencies, family and friends, reporting to the police, or responses by the police might buffer or exacerbate the impact of sexual assault on mental health outcomes among sexual assault victims.The trend in many cases was for help-seeking and police response to exacerbate the impact of sexual assault victimization. With respect to depression, we found that the association of rape penetration was greater among those seeking help from social services and those reporting their victimization to the police. Although arresting the offender appears to be associated with higher levels of depression, it actually results in a lower probability of heavy episodic drinking.

An Investigation of Posttraumatic Stress Disorder and Depressive Symptomatology among Female Victims of Interpersonal Trauma

This study examined factors associated with PTSD-depression comorbidity among a sample of 162 adult female rape or assault victims with PTSD, as well as potential differential predictors of PTSD and depression severity. PTSD-only participants reported higher levels of childhood sexual abuse than those with comorbid PTSD and depression, and the PTSD/MDD group reported relatively more distorted trauma-related beliefs, dissociation, PTSD severity, and depression severity. Distorted trauma-related beliefs and dissociation were the strongest unique predictors of higher PTSD and depressive symptoms. Rates of PTSD and depression comorbidity did not appear to be a function of symptom overlap. Study findings suggest possible explanations for the high PTSD and depression comorbidity rates commonly found among victims of interpersonal violence.

An examination of women's alcohol use and partner victimization experiences among women with protective orders

This study examined associations of women's alcohol use with self-reported experiences of male-perpetrated intimate partner violence among a sample of women with protective orders. Participants were 676 women with a protective order against a male intimate partner from three rural areas and one urban area. Multivariate analyses indicated that women's substance use was associated with psychological abuse tactics and severity of physical and sexual victimization in the last year of the relationship. Women's alcohol use was associated with the severity of physical violence within the last year of the relationship, whereas illegal drug use had associations with the number of verbal abuse, degradation and jealousy/control tactics. There was a significant interaction of women's alcohol and drug use with the severity of sexual assault.

Domestic violence and alcohol use: trauma-related symptoms and motives for drinking

Alcohol use is frequently associated with posttraumatic stress disorder (PTSD), especially in the face of chronic traumatic experiences. However, the relationship between alcohol use and symptoms associated with chronic trauma exposure has not been evaluated. This study examined alcohol use in recently battered women (N=369). Differences were found in trauma symptoms between abstainers, moderate drinkers, and heavy drinkers, with heavy drinkers reporting more severe symptoms. Mediational analyses suggest that the relationship between drinking and trauma symptoms is mediated by drinking to cope, which has not been previously demonstrated in a battered population. Results suggest the importance of assessing trauma symptoms and motives for drinking in understanding alcohol use in recent survivors of domestic violence.

Substance use among women in shelters for abused women and children. Programming opportunities

OBJECTIVE

This study explores changes in the use of alcohol and other substances by women in British Columbia as they moved into shelters for abused women and again three months later. We see this time as a key life transition, and potentially a rich opportunity for influencing women's substance use behaviour. The purpose of this study was to document changes in the level of use of alcohol and other substances and the levels of stress among women as they moved through shelters for abused women.

METHODS

Standardized questionnaires augmented by qualitative interviews were employed to measure alcohol and substance use, experiences of abuse, and levels and types of stressors facing women in this situation.

FINDINGS

Significant reductions in women's use of alcohol and stimulants were observed from Interview I to Interview II, but there was no significant reduction in use of other depressants or tobacco use. Levels of stress decreased and sources of stress changed for the women after the shelter experience. Stress connected to relationship with partners had the most significant decrease, followed by mental health, housing, and legal issues. Women reported barriers to accessing financial aid and services for substance use outside of the shelter.

CONCLUSIONS

Women's experiences of violence and substance use were found to be interconnected in complex ways and changes in substance use were affected by a range of influences, such as financial concerns, mothering, relationships, levels of social support, and physical and mental health issues. Substance-using women who have experienced violence are an underserved population and a multi-sectoral response designed to address psychosocial, relational, and structural issues could better help them improve their overall health.

Alcohol and domestic violence: women's views

Alcohol's role in men's violence to women is a controversial issue. In the United Kingdom, little research has been conducted on the link between the two, and no in-depth studies have sought the views of the women who suffer such violence. This article reports on in-depth research with 20 women that aimed to hear their views on the role of alcohol in men's violence to them. The results of the research show that women do not blame alcohol for their partner's violence; they hold the men, not their alcohol consumption, responsible for their actions.

The roles of victim and perpetrator alcohol use in intimate partner violence outcomes

Alcohol use increases the risk of intimate partner violence (IPV), yet little research has examined its role in victimization outcomes (e.g., physical injury, police reporting). This study examined the roles of perpetrator and victim incident-specific alcohol use in IPV outcomes. The sample included 501 men and 1,756 women who had experienced an IPV physical assault. Logistic regression analyses showed that after controlling for relevant covariates, women whose partners had been drinking were significantly more likely to be injured than were women whose partners had not been drinking. A woman's own alcohol use was unrelated to victimization outcomes. Men were significantly more likely to report the incident if their partners had been drinking but were marginally less likely to report if they had been drinking. Findings suggest that perpetrators' incident-specific alcohol use is important in understanding which victims are most likely to be injured and report the incident to the police.

Age at first sexual assault and current substance use and depression

This article explores how the association between sexual violence and substance use and mental health differs by race and life course stage. Analyses are based on data (n = 8,000) from the Violence and Threats of Violence against Women and Men in the United States Survey, 1994-1996 (NVAWS). Although sexual violence does not heighten the risk of problem drinking for White women, minority women victimized in adulthood are significantly more likely to engage in problem drinking and use illicit drugs. This suggests that for minority women the effects of recent victimization experiences result in immediate and potentially long-lasting consequences. The findings with respect to the association between sexual violence and depression are consistent with the child and adolescent development literature. It is Hispanic women who are more likely to suffer depression as a consequence of child sexual assault.

Addressing the service linkage problem. Increasing substance abuse treatment engagement using personalized feedback interventions in heavy-using female domestic violence shelter residents

Two personalized substance abuse assessment and feedback interventions were tested for effectiveness in engaging female domestic violence shelter residents in substance abuse treatment. One hundred forty-seven residents were assessed for quantity andfrequency of substance use, negative consequences due to use, motivation to change substance use behavior, and psychopathological symptoms related to substance abuse. Assessment identified (33) 22% of participants as heavy substance users. Twenty of the 33 heavy-using residents received one of two personalized substance use feedback interventions:face-to-face feedback or writtenfeedbackplaced in shelter mailboxes. Treatment engagement was defined as attending at least one substance abuse treatment session within 30 days after the intervention. Results showed a significant difference in treatment engagement rates in favor of the face-to-face feedback group (60% vs. 0%). The results provide preliminary data suggesting that substance abuse assessment can be effectively accomplished in the shelter environment and that the face-to-face feedback procedure may be an effective intervention to bridge the service linkage problem between domestic violence services and substance abuse treatment.

Victimization and Substance Abuse among Women: Contributing Factors, Interventions, and Implications

Although the literature indicates that there is an association of victimization with substance abuse, there has been limited research focused on understanding and synthesizing the factors that have been identified as contributing to victimization and substance abuse and on interventions designed to address these contributing factors. The purposes of this article are to (a) review the literature on factors related to victimization and substance abuse, (b) review interventions and outcomes, and (c) discuss clinical implications for interventions and research. Results suggest that there is a high rate of co-occurrence of victimization and substance abuse among women, that the factors contributing to victimization and substance abuse are complex, and that there is a lack of treatment models addressing victimization and substance abuse.

Adolescent victimization and problem drinking

This study explores the connection between violent victimization in adolescence and subsequent problem drinking. Using national data we estimate the effects of adolescent victimization on a 3-category problem drinking measure (Abstainers, Moderate, and Binge Drinkers). We also examine the differences in the social and personal consequences of drinking across victims and non-victims. These consequences include harm to friendships, health, outlook on life, marriage, work, studies, and financial position. Victims of adolescent violence are more likely to engage in subsequent binge drinking and experience negative drinking consequences, particularly negative financial consequences. The findings are consistent with the adolescent development literature, which has highlighted the importance of violent victimization in the transition to adult roles and responsibilities. Additional research, particularly longitudinal data on violent victimization and substance abuse on a nationally representative sample of young people and adults is needed to further explore the connection between violent victimization and subsequent problem drinking.