A Systematic Review of Intimate Partner Violence Interventions Impacting South Asian Women in the United States

Cross-lagged relationships between exposure to intimate partner violence, depressive symptoms and suicidal thoughts among adolescent and young married women

BACKGROUND

High rates of depression and suicidal ideation are found in women experiencing intimate partner violence (IPV), but their temporal relationship is unclear. This study explores the bidirectional causality between IPV victimization, depressive symptoms, and suicidal thoughts among adolescent and young married women in India.

METHODS

Data sourced from the UDAYA longitudinal survey in India, comprising 3,965 women aged 15-22. Employing Pearson's correlation coefficient, we analyzed the relationship between variables. Additionally, a two-wave cross-lagged autoregressive panel model explored the bidirectional link between IPV, depressive symptoms, and suicidal ideation.

RESULTS

Approximately 25 % and 45 % of the participants reported some form of partner violence at baseline and at follow-up after three years, respectively. Exposure to IPV at baseline was significantly associated with depressive symptoms at follow-up [β = 0.10, p < 0.001], and the association between depressive symptoms at baseline and IPV at follow-up was statistically not significant [β = -0.02, 95 % CI: -0.06-0.02]. Similarly, exposure to IPV at baseline was significantly associated with suicidal thoughts at follow-up [β = 0.24, p < 0.001], and the association between suicidal thoughts at baseline and IPV at follow-up was statistically not significant [β = 0.003, 95 % CI: -0.001-006].

CONCLUSIONS

The findings suggest that exposure to IPV is consistently and strongly associated with depressive symptoms and suicidal thoughts in adolescent and young married women. However, the reciprocal relationships did not hold true in this study, implying that reducing IPV during adolescence could potentially minimize the prevalence of depressive symptoms and suicidal thoughts during young adulthood.

South Asians and the Role of Bystanders in Domestic Violence Prevention: Results from a Pilot Study

PURPOSE

Domestic violence manifests in unique ways in South Asian immigrant communities. Given the need to uphold family honor, formal help-seeking remains minimal within this community. Individuals experiencing victimization rely on friends and family members as informal sources of support. These friends and family members may also be bystanders who witness victimization. Therefore, the goal of this study was to examine differences in participant responses to an online interactive bystander intervention developed for South Asians.

METHODS

To get community response to the intervention, B.R.A.K.E. The Cycle, a Qualtrics link with all the intervention scenarios was posted on 21 sub-Reddit pages. Screeners to ensure that participants were of South Asian origin, 18 or older and currently residing in the United States (US) were added. True to the study purpose, to examine differences across gender and generational position, we conducted descriptive analysis and chi-square tests.

RESULTS

There were differences in scenarios by gender and immigration position. Some of the main findings point to the need to report domestic violence, seek help (formal or informal) as well as surprisingly some responses justified the use of force by a male partner. We discuss these in-depth by scenarios.

DISCUSSION

This is the first study to examine differences in bystander preference and response to using an intervention that was developed specifically for the South Asian community. Social workers can utilize this intervention to create dialogue around domestic violence prevention and the role of bystander within the South Asian and potentially other immigrant communities.

Posttraumatic Stress Disorder Symptoms and Sleep Disturbances Among Asian Indians: A Systematic Review

Substantial comorbidity exists between posttraumatic stress disorder and sleep disturbances/disorders. Such comorbidities are understudied in minority groups, including Asian Indians residing in countries outside India. Thus, we synthesized the existing literature specific to this group of Asian Indians to determine (a) prevalence estimates of posttraumatic stress disorder (PTSD) and sleep disturbances/disorders; and (b) PTSD-sleep comorbidity estimates. For this systematic review, we searched four databases (PubMed, PsycInfo, PTSDpubs, Web of Science) using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Of 3,796 screened articles, 9 articles (10 studies) met inclusion criteria. Study sample sizes ranged from 11 to 2,112 Asian Indians; studies were conducted in Singapore or Malaysia. No reviewed study examined PTSD. All studies examined sleep disturbances/disorders among Asian Indians; prevalence estimates were: 8.3% to 70.4% for short sleep duration, 2.0% to 22.9% for long sleep duration, 25.9% to 56.3% for poor sleep quality, 3.4% to 67.5% for insomnia diagnosis or probable insomnia, 7.7% for excessive daytime sleepiness, 3.8% to 54.6% for obstructive sleep apnea (OSA) diagnosis or high OSA risk, and 5.1% to 11.1% for sleep-disordered breathing. Specific to Asian Indians residing in countries outside India, this review advances PTSD-sleep literature by (a) suggesting substantial prevalence of sleep disturbances/disorders; (b) highlighting the need for culturally relevant sleep interventions; and (c) highlighting research gaps (e.g., no PTSD-focused research).

Attitudes Toward Wife Beating in Pakistan: Over-Time Comparative Trends by Gender

We investigate the determinants and over time patterns of perceptions toward wife beating from 2012 to 2018 in Pakistan. We use two waves of the Pakistan Demographic and Health Survey that include ever-married women and men aged 15 to 49 (12,607 women and 3052 men in 2012 and 11,543 women and 3055 men in 2018). Education, employment, wealth, and region influence attitudes toward wife beating. While women are generally more tolerant toward wife beating than men, the presence of a family member during the interview further increased their tolerance toward wife beating. Wife beating support has increased over time among women whose interviews were overheard and men. Additionally, households with joint decision-making have a lower tolerance toward wife beating, even lower than households where the wife is the main decision-maker.

Asian Indians in the United States and Posttraumatic Stress Disorder Interventions: A Narrative Literature Review

Topic. Limited research has examined trauma and posttraumatic stress disorder (PTSD) among Asian Indians in the U.S. Thus, we (1) synthesize literature on trauma, PTSD, disparities in treatment for PTSD, the burden of untreated PTSD, and culturally-adapted (CA) PTSD interventions; and (2) discuss recommendations for clinicians/researchers working with this population.Method. We searched two databases using keywords related to Asian Indians, PTSD, and interventions. Of 238 identified articles, we used content from 26 articles to inform our review.Findings. Asian Indians report traumatic experiences before, during, or after immigration to the U.S. and consequential PTSD symptoms. Further, Asian Indians in the U.S. are disproportionately impacted by socio-cultural and economic determinants of poor mental health (e.g., shame/stigma associated with seeking mental health services, few culturally-responsive services), which may contribute to the under-reporting of PTSD and (interpersonal) traumas and less willingness to seek treatment. Additionally, CA PTSD interventions tailored to Asian Indians in the U.S. have not been developed. Socio-cultural considerations that can inform CA PTSD interventions for Asian Indians include: causal conditions (e.g., culturally-rooted beliefs about trauma/PTSD), intervening conditions/barriers (e.g., emotional inhibition), and mitigating/coping strategies (e.g., religious/spiritual practices, cultural idioms of distress). These considerations influence clinician/treatment preferences (e.g., solution-oriented and structured therapy, less emotional exposure). Lastly, we outline recommendations for clinicians/researchers: (1) need for national studies on trauma, PTSD, treatment utilization, and the burden of untreated PTSD; (2) consideration of immigration-related experiences influencing PTSD; (3) consideration of socio-cultural elements for CA PTSD interventions; and (4) need for culturally-valid PTSD assessments.

'We don't get money in our own hands': evidence from focus group discussions on economic abuse against women in two states of India

INTRODUCTION

Violence against women is a serious human rights violation. While much attention has been given to the prevalence and prevention of physical, sexual and emotional violence, one crucial dimension is to date less well understood: economic abuse against women. This paper presents rich qualitative data on economic abuse against women in India to improve the understanding of economic abuse in a lower-middle income setting and to assess how economic abuse interacts with socio-cultural factors such as patrilocality, patriarchal gender norms and limited acceptance of female employment.

METHODS

We conducted 13 focus group discussions (FGDs) in the states Maharashtra and Rajasthan. FGDs were conducted with married working (for income) and non-working women, husbands and mothers-in-law. Discussions were recorded, transcribed verbatim and translated to English. Transcripts were coded using thematic analysis and emerging themes were discussed among all authors.

RESULTS

Women suffered from four distinct forms of economic abuse. Economic control emerged as the most prevalent theme, amplified by women's marginalisation from financial decision-making in the household. Discussions further alluded to employment sabotage, which husbands commonly justified by not wanting their wives to neglect their duties at home. A third category was women's economic exploitation, expressed by husbands taking their salaries, accumulating debt in their wife's name, and using their wife's wedding endowments for own purposes. A last category was husbands' refusal to financially contribute to necessary household expenses, which hindered investments in children's education and adequate coping with health emergencies. We identified important linkages with other forms of domestic abuse.

CONCLUSION

Economic abuse has the potential to trap women in abusive relationships. Effective interventions to reduce economic abuse and economically empower women such as financial inclusion programmes are urgently needed. Stricter penalisation of dowry-related violence and spousal abuse is also required.

Impacts of Culture on Perceptions of Intimate Partner Violence Among Fijian Indian Women in the United States

INTRODUCTION

South Asian women are at a higher risk for experiencing intimate partner violence (IPV) in the United States. Fijian Indian (FI) women are part of the diverse South Asian diaspora; however, there are no published data on their experience with IPV. This phenomenological study (a) examined if FI culture influences how women define, experience, and seek help for IPV and (b) identified impacts these themes have on FI women's IPV-related help-seeking, behaviors in regard to U.S. health systems and law enforcement.

METHODS

Ten FI women in California, 18 years and older, who either were born in Fiji or had parents born in Fiji, were recruited through convenience and snowball sampling. Semistructured interviews took place either face-to-face or via Zoom. Transcribed interview data underwent reflective thematic analysis by two members of the research team.

RESULTS

Normalizing and silencing of IPV events are bolstered by cultural practices of (a) familism/collectivism that ask women to prioritize family intactness over their own emotional and physical safety, (b) traditional patriarchal gender roles, (c) threats of shame and judgment within the community, and (d) the gendered hierarchy tenets of some forms of Hinduism. FI women are more inclined to seek help for IPV from within versus outside the family, with healthcare providers and law enforcement described as women's last choices for assistance.

CONCLUSIONS

Although a small and regionalized immigrant community, this study of FI women reflects the importance of health and human service providers' understanding of the histories and cultural nuances of the local immigrant populations they serve.

Health Care Providers Views on Identifying and Responding to South Asian Women Experiencing Family Violence: A Qualitative Meta Synthesis

Family violence (FV) is a universal public health problem in South Asia with negative-health outcomes for South Asian women. Health care providers (HCPs) play a pivotal role in identifying and supporting women experiencing FV, but little is known about their experiences with South Asian women. A systematic review was conducted to explore and address health care providers' views on identification and response to South Asian women experiencing FV. Nine online databases, reference lists were searched, and a priori inclusion and exclusion criteria were applied independently by two reviewers. A meta-synthesis approach was utilized to integrate findings from qualitative studies. Eight studies involving 250 participants met the inclusion criteria. Studies were published between 2007 and 2020 within South Asian countries (Pakistan, India, and Sri Lanka) and one study from the USA and UK. The meta-synthesis identified three themes: Context of societal norms and attitudes towards women in South Asia; Influence of family honor, Privacy and shame; and Concern about health care provider's personal safety. Findings revealed that FV is often perceived as a normal routine issue and is considered a "private issue" in South Asian society. Family honor and values play a pivotal role in silencing women experiencing FV as disclosure is considered shameful and disgrace to family honor. Furthermore, health care providers avoid intervening in FV cases due to risk for their personal safety. Finally, this review provides the evidence to support a specific framework for FV interventions among south Asian women for policy makers and practitioners.

COVID-19 related distress and sleep health among trauma-exposed South Asians: Does generational status matter?

The COVID-19 pandemic has resulted in substantial changes in individual and socio-economic factors that may negatively impact sleep health. We examined associations between COVID-19 related distress and sleep among trauma-exposed South Asian adults in the United States. Since a health advantage among foreign-born individuals has been previously noted in the literature (the 'immigrant paradox'), we also explored if generational status (number of generations one's family has been in the U.S.) moderated associations between COVID-19 related distress and sleep health. Participants were 196 trauma-exposed South Asian adults residing in the U.S. (54% male, 63% U.S.-born citizens, average age = 34.51 years), who completed measures of generational status, COVID-19 related distress, trauma exposure, sleep-related impairment (SRI), and sleep disturbances. Greater COVID-19 distress was associated with more sleep disturbances (b = 0.15, p < 0.001) and SRI (b = 0.24, p < 0.001). Generational status was not associated with sleep, nor did it modify associations between COVID-19 distress and sleep. Findings highlight the potential importance of developing interventions to reduce stress and sleep difficulties during the pandemic. Our results did not support the immigration paradox. Future studies are needed to better understand the role of generational status on sleep health across immigrant subgroups.

Intimate partner violence: A loop of abuse, depression and victimization

Intimate partner violence has been recognized as a serious public health issue. Exposure to violence contributes to the genesis of, and exacerbates, mental health conditions, and existing mental health problems increase vulnerability to partner violence, a loop that imprisons victims and perpetuates the abuse. A recently described phenomenon is when male violence against females occurs within intimate relationships during youth, and it is termed adolescent or teen dating violence. In this narrative review, factors associated with intimate partner violence and consequences of exposure of children to parental domestic violence are discussed, along with possible intensification of violence against women with the spread of coronavirus disease 2019 pandemic and subsequent lockdown. Intervention programs with a multicomponent approach involving many health care settings and research have a pivotal role in developing additional strategies for addressing violence and to provide tailored interventions to victims. Prevention policy with a particular attention on healthy child and adolescent development is mandatory in the struggle against all forms of violence.