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Gunarathne L, Nedeljkovic M, Apputhurai P, Bhowmik J. Impact of Intimate Partner Violence on mental health among married women in Sri Lanka: a study based on Women's Wellbeing Survey-2019. J Public Health (Oxf) 2024; 46:e410-e418. [PMID: 38852948 PMCID: PMC11358628 DOI: 10.1093/pubmed/fdae082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 05/13/2024] [Accepted: 05/22/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Sri Lankan married women have been reported to experience higher rates of intimate partner violence (IPV). However, research on its impact on mental health and how socio-demographic factors contribute to this association is limited. Therefore, this study aimed to examine the impact of IPV on the mental health of married women in Sri Lanka. METHODS In this study, data from 1611 married women who participated in the 2019 Sri Lankan Women's Wellbeing Survey were analyzed. Two binary outcomes were considered: married women's mental health and their suicidal ideation. Binary logistic regression models were used to assess the association between mental health and suicidal thoughts in relation to IPV while controlling for socio-demographic factors. RESULTS The results revealed that married women who experienced any form of violence by their spouse had a higher risk of having poor mental health conditions [AOR = 2.88 (2.20, 3.78)] and suicidal thoughts [AOR = 5.84 (4.10, 8.32)] compared to those who did not experience IPV. CONCLUSIONS IPV is a substantial contributor to poor mental health and suicidal thoughts among Sri Lankan married women. There is an urgent need for policy interventions, such as community awareness programs, counseling services and enhanced legal protections for victims.
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Affiliation(s)
- Lakma Gunarathne
- Department of Health Science and Biostatistics, Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
| | - Maja Nedeljkovic
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
| | - Pragalathan Apputhurai
- Department of Health Science and Biostatistics, Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
| | - Jahar Bhowmik
- Department of Health Science and Biostatistics, Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
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Arumugaperumal R, Ravichandhiran G, Agadi S, Muthuchamy V, D R, S S, Maruthupandian J. Evaluation of Intimate Partner Violence and Its Association With Depression Among Women in Chengalpattu District, India: A Cross-Sectional Study. Cureus 2024; 16:e59825. [PMID: 38846205 PMCID: PMC11154078 DOI: 10.7759/cureus.59825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2024] [Indexed: 06/09/2024] Open
Abstract
Background Intimate partner violence is one of the major problems experienced by women all over the world. Almost one in three women have experienced one or more forms of violence at least once in their lifetime. These estimates confirm that physical and sexual intimate partner violence remains pervasive in the lives of women across the globe. Intimate partner violence has been found to have a severe impact on mental health such as depression symptoms. This study aimed to assess the prevalence of intimate partner violence in terms of controlling behavior, sexual, and physical violence, and its association with depression in women of Chengalpattu district, India. Methods It is a community-based cross-sectional study conducted in 12 villages under the field practicing area of the rural health training center of Chettinad Health and Research Institute in Kelambakkam, India, by simple random sampling among 190 women participants ever married or partnered of age ≥18 years. A pre-tested, semi-structured questionnaire was used which included the WHO Violence Against Women Instrument (VAWI) in the English language and Patient Health Questionnaire 9 (PHQ 9). The collected data was entered in Microsoft Office Excel (Microsoft Corporation, Redmond, United States) and analyzed using IBM SPSS Statistics for Windows, Version 21 (Released 2012; IBM Corp., Armonk, New York, United States). A probability value (p-value) of less than 0.05 was considered statistically significant. Results The mean (SD) age of the study participants was 34 (±8) years. Among the 190 participants, 57.4% reported controlling behavior, 31.1% reported physical violence and 7.4% reported sexual violence by the intimate partner at least once in the past 12 months. About 34.7% were found to have mild depression and 21.6% with moderate depression. There was a significant association between intimate partner violence and depression in women (p < 0.001) Conclusion The present study found that there is a huge impact of intimate partner violence on the mental health of women whether it is psychological, physical, or sexual. There is a need for awareness and effective management of violence against women, especially in rural areas. Strategies focusing on women's education, leadership, empowerment, decision-making, and financial independence are very much needed.
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Affiliation(s)
- Rathibala Arumugaperumal
- Department of Community Medicine, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, IND
| | - Gowthamkarthic Ravichandhiran
- Department of Community Medicine, KLE Jagadguru Gangadhar Mahaswamigalu Moorsavirmath Medical College (JGMMMC), KLE Academy of Higher Education and Research, Hubballi, IND
| | - Soumya Agadi
- Department of Community Medicine, PSP Medical College Hospital and Research Institute, Oragadam, IND
| | - Vigneshsamy Muthuchamy
- Department of Community Medicine, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, IND
| | - Raja D
- Department of Community Medicine, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, IND
| | - Suganthi S
- Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, IND
| | - Jasmine Maruthupandian
- Department of Community Medicine, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, IND
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Gunarathne L, Bhowmik J, Apputhurai P, Nedeljkovic M. Factors and consequences associated with intimate partner violence against women in low- and middle-income countries: A systematic review. PLoS One 2023; 18:e0293295. [PMID: 37939106 PMCID: PMC10631698 DOI: 10.1371/journal.pone.0293295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023] Open
Abstract
Intimate Partner Violence (IPV) is a global public health issue, with notably high prevalence rates observed within Low-and Middle-Income Countries (LMICs). This systematic review aimed to examine the risk factors and consequences associated with IPV against women in LMICs. Following PRISMA guidelines, we conducted a systematic review using three databases: Web of Science, ProQuest Central, and Scopus, covering the period from January 2010 to January 2022. The study included only peer-reviewed journal articles in English that investigated IPV against women in LMICs. Out of 167 articles screened, 30 met the inclusion criteria, comprising both quantitative and mixed-method studies. Risk factors of IPV were categorised as: demographic risk factors (23 studies), family risk factors (9 studies), community-level factors (1 studies), and behavioural risk factors (14 studies), while consequences of IPV were categorised as mental health impacts (13 studies), physical impacts (5 studies), and societal impacts (4 studies). In this study, several risk factors were identified including lower levels of education, marriage at a young age, poor wealth indices, rural residential areas, and acceptance of gender norms that contribute to the prevalence of IPV in LMICs. It is essential to address these factors through effective preventive policies and programs. Moreover, this review highlights the necessity of large-scale, high-quality policy-driven research to further examine risk factors and consequences, ultimately guiding the development of interventions aimed at preventing IPV against women in LMICs.
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Affiliation(s)
- Lakma Gunarathne
- Department of Health Science and Biostatistics, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Jahar Bhowmik
- Department of Health Science and Biostatistics, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Pragalathan Apputhurai
- Department of Health Science and Biostatistics, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Maja Nedeljkovic
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
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Gayawan E, Uzobo E, Ononokpono DN, Aladeniyi OB, Dake FAA. Intimate partner violence and malnutrition among women of reproductive age in Western Africa: A geostatistical analysis. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002354. [PMID: 37939021 PMCID: PMC10631639 DOI: 10.1371/journal.pgph.0002354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/16/2023] [Indexed: 11/10/2023]
Abstract
Intimate partner violence (IPV) is a public health issue, and the experience varies among population sub-groups in Africa. In the West African sub-region, IPV perpetrated against women remains high and is exacerbated by the pertaining cultural milieu. It affects women's health, wellbeing, and nutritional status. We examined the association between women's lifetime experiences of physical, sexual, and emotional IPV and undernutrition by quantifying the association at smaller geographical settings in West African countries. We used a bivariate probit geostatistical technique to explore the association between IPV and undernutrition, combining data from the latest Demographic and Health Survey conducted in ten Western African countries. Bayesian inference relies on Markov chain Monte Carlo simulation. The findings demonstrate spatial clustering in the likelihood of experiencing IPV and being underweight in the regions of Mali, Sierra Leone, Liberia and neighboring Cote d'Ivoire, Ghana, Togo, Benin, Cameroon, and Nigeria. The pattern of clustering was somewhat similar when physical violence was combined with underweight and emotional violence combined with underweight. The findings also indicate protective effects of education, wealth status, employment status, urban residence, and exposure to mass media. Further, the likelihood of experiencing IPV and the likelihood of being underweight or thin declined with age and age-gap between the woman and her partner. The findings provide insight into the location-specific variations that can aid targeted interventions, and underscore the importance of empowering women holistically, in the domains of education, socio-economic and socio-cultural empowerment, in addressing women's vulnerability to IPV and malnutrition (underweight and thinness). Furthermore, IPV prevention programmes will need to address gender inequality and cultural factors such as male dominance that may heighten women's risk of experiencing IPV.
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Affiliation(s)
- Ezra Gayawan
- Department of Statistics, Federal University of Technology, Akure, Nigeria
| | - Endurance Uzobo
- Department of Sociology, Niger Delta University, Wilberforce Island, Amassoma, Nigeria
| | | | | | - Fidelia A. A. Dake
- Regional Institute for Population Studies, University of Ghana, Legon, Accra, Ghana
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Okedare OO. Intimate partner violence among unmarried young women (18-24 years) in urban communities, Ibadan, Nigeria. Int J Adolesc Med Health 2023; 0:ijamh-2023-0035. [PMID: 37347722 DOI: 10.1515/ijamh-2023-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 06/01/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVES Intimate partner violence (IPV) is a global health problem that affects more than one-third of women globally. Young women who experience IPV face the same consequences as older women. Previous studies on IPV have not studies young women exclusively, thus, we aimed to report the prevalence of IPV and predictors among young women in Ibadan, Nigeria. METHODS A community-based cross-sectional survey, using multistage cluster technique was conducted to determine the past-year prevalence of IPV among unmarried young women (n=736) from 20 communities in five Local Government Areas in Ibadan, Nigeria. The independent variables were respondents and their partners' background information. Dependent variables were experience of physical, sexual, psychological and any IPV. Data were analysed using descriptive statistics and binary logistic regression (α0.05). RESULTS Psychological IPV was the most prevalent form of IPV (50.1 %). Prevalence of any IPV was 56.3 %. At the bivariate level, having children, acceptance of IPV, ever had sex, age at first sex, experience at sexual debut, partners being with other women while being with the respondents, partners alcohol use, and partners witness of abuse as a child were significantly associated with IPV. However, only acceptance of IPV, experience at sexual debut, and partners being with other women while being with the respondents remained significant at the multivariate level. CONCLUSIONS IPV is a common occurrence among young women. Both individual and partners characteristics, especially acceptance of IPV contribute significantly to experience of IPV among young women. Hence, interventions targeted at reduction of IPV acceptance will greatly reduce the prevalence of IPV.
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Affiliation(s)
- Omowumi O Okedare
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
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Dikmen HA, Çankaya S. The effects of exposure to physical and emotional violence from partners on psychological resilience, forgiveness, happiness, life satisfaction, and depression level in Turkish women. Dev Psychobiol 2023; 65:e22389. [PMID: 37073585 DOI: 10.1002/dev.22389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/18/2023] [Accepted: 03/16/2023] [Indexed: 04/09/2023]
Abstract
The data of this descriptive and correlational study were collected from 583 women between October 2021 and December 2021 with information form, Brief Resilience Scale, Oxford Happiness Scale-Short Form, Epidemiological Research Center Depression Scale, Heartland Forgiveness Scale, and Life Satisfaction Scale. There is a statistically significant difference between the resilience, happiness, and life satisfaction levels of women exposed to physical violence from their partners and the presence of depression (p < .001). A statistically significant difference was found between the presence of depression and resilience, happiness, and life satisfaction (p < .001) and forgiveness (p = .004) in women who were exposed to emotional violence from their partners. While resilience, happiness, and life satisfaction levels decreased in women who were exposed to physical violence from their partners, the incidence of depression increased. While the presence of depression increased in women who were exposed to emotional violence from their partners, the level of resilience, happiness, life satisfaction, and forgiveness decreased.
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Affiliation(s)
- Hacer Alan Dikmen
- Department of Midwifery, Faculty of Health Sciences Selcuk University Konya Turkey
| | - Seyhan Çankaya
- Department of Midwifery, Faculty of Health Sciences Selcuk University Konya Turkey
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Mittal M, Paden McCormick A, Palit M, Trabold N, Spencer C. A Meta-Analysis and Systematic Review of Community-Based Intimate Partner Violence Interventions in India. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5277. [PMID: 37047893 PMCID: PMC10093839 DOI: 10.3390/ijerph20075277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/07/2023] [Accepted: 03/10/2023] [Indexed: 06/19/2023]
Abstract
Intimate partner violence (IPV) in India remains an entrenched and prevalent public health issue. Despite ample evidence of the widespread problem of IPV in India and associated mental and physical morbidities, far less is known about intervention models to reduce IPV in India. The aims of this meta-analysis and systematic review are to assess the effectiveness of community-based interventions to reduce IPV in India and to provide a narrative synthesis of these intervention approaches. A total of 9 databases were searched to identify peer-reviewed, English-language articles published between January 2000 and September 2022. The search identified 10 studies that met study inclusion criteria, including 3 randomized control trials, 4 quasi-experimental, 2 pre/post, and 1 time-series evaluation. Eight studies were included in the meta-analysis. There was notable variation in the interventions and approaches employed to reduce IPV and varying measurement of IPV outcomes. The results of the meta-analysis show that participating in community-based IPV interventions produced a significant reduction in IPV among women. When considering different types of IPV, study participants were less likely to report physical and psychological IPV victimization. In addition, participants were also less likely to report approving of IPV after participating in community-based IPV interventions. Community-based interventions and research addressing IPV are still evolving in India. Missing descriptions of theoretical frameworks, sampling, intervention design, and inadequately reported effectiveness of intervention (both quantitative and qualitative reporting) need to be addressed. Moreover, long-term evaluations of the pilot interventions are needed to provide a clear picture of the long-term effectiveness, sustainability, and replicability of the community-based IPV interventions. The findings have implications for researchers, practitioners (community health workers, clinicians, and social workers), and policymakers keen on IPV reduction in India and globally.
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Affiliation(s)
- Mona Mittal
- Department of Family Science, University of Maryland School of Public Health, College Park, MD 20742, USA
| | - Anna Paden McCormick
- Department of Family Science, University of Maryland School of Public Health, College Park, MD 20742, USA
| | - Manjushree Palit
- Jindal School of Psychology and Counseling, Jindal Global University, Sonipat 131001, India
| | - Nicole Trabold
- College of Health Science and Technology, Rochester Institute of Technology, Rochester, NY 14623, USA
| | - Chelsea Spencer
- Department of Applied Human Sciences, Kansas State University, Manhattan, KS 66506, USA;
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Gupta G, Sachdeva A, Kumar M, Singh M. Spectrum of intimate partner violence in patients with psychiatric illness-From victimization to perpetration. Int J Psychiatry Med 2023; 58:20-36. [PMID: 35048727 DOI: 10.1177/00912174211053726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Persons with psychiatric illness are vulnerable to be the victims of intimate partner violence (IPV) and at risk of perpetrating IPV. OBJECTIVES To estimate the prevalence and association of IPV in patients with psychiatric disorders, both as victims and as perpetrators. METHODOLOGY We conducted a questionnaire based, cross-sectional study using systematic random sampling at psychiatric Outpatient Department (OPD) in a tertiary care hospital, in Haryana, India. A total of 500 participants diagnosed with psychiatric disorder were assessed using Operational WHO Criteria for IPV Victimization assessment and IPV Perpetration Assessment scale by Rhodes et al. RESULTS The prevalence of IPV victimization was 16% during the last year and 26% during lifetime. IPV victimization was found significantly more in females (especially sexual), young and unemployed participants, during the initial 10 years of marriage and 10 years of the illness. Sexual IPV was the most common. The prevalence of IPV perpetration by the participants was 6% during last year and 10.6% in lifetime. Perpetrators were more likely to be males of higher age (40-50 years), unemployed, having lower income, belonging to joint family, and residing in rural areas. Diagnosis of a psychiatric illness, especially psychosis increased chances of perpetration. As the duration of illness increased, prevalence of IPV perpetration increased. CONCLUSION Intimate partner violence among persons with psychiatric disorders is common and they are more vulnerable to being victims of IPV, rather than perpetrating IPV. Vulnerability and risk factors for IPV should be taken into account and optimized strategies should be devised for prevention.
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Affiliation(s)
- Geetanjali Gupta
- Department of Psychiatry, 425957ESIC Medical College and Hospital, Faridabad, India
| | - Ankur Sachdeva
- Department of Psychiatry, 425957ESIC Medical College and Hospital, Faridabad, India
| | - Manoj Kumar
- Department of Psychiatry, 425957ESIC Medical College and Hospital, Faridabad, India
| | - Mitasha Singh
- Department of Community Medicine, 425957ESIC Medical College and Hospital, Faridabad, India
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Kebede AA, Gessesse DN, Tsega NT, Aklil MB, Temesgan WZ, Abegaz MY, Anteneh TA, Tibebu NS, Alemu HN, Haile TT, Seyoum AT, Tiguh AE, Yismaw AE, Mihret MS, Nenko G, Wondie KY, Taye BT. Prevalence and factors associated with maternal loneliness during the postpartum period in Gondar city. Heliyon 2022; 8:e09891. [PMID: 35847616 PMCID: PMC9284384 DOI: 10.1016/j.heliyon.2022.e09891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/11/2022] [Accepted: 07/01/2022] [Indexed: 11/21/2022] Open
Abstract
Background Mental health problems have increased worldwide, particularly in developing countries. Currently, loneliness is widely understood as a painful subjective experience when the social connections a person has do not meet their interpersonal needs in respect to the quality or quantity of friendship or social interaction. It has been linked to unpleasant health consequences for both the mother and child. Therefore, this study aimed to assess maternal loneliness during the postpartum period and associated factors in Gondar city. Methods A community-based cross-sectional study was conducted from July 1st to August 30th, 2021 in Gondar city. A cluster sampling technique was employed to select 858 postpartum women. Data were entered into epidemiological data (EPI data) version 4.6 and exported to SPSS 25 for further cleaning and analysis. The multivariable logistic regression analysis was fitted to identify factors associated with maternal loneliness during the postpartum period. The adjusted odds ratio (AOR) with its 95 % confidence interval (CI) was performed and the level of significance was claimed based on a p-value of ≤0.05. Results A total of 858 women were included in the analysis, giving a response rate of 98.4%. Two-fifths (40.9%) of the study participants have experienced loneliness during the postpartum period (95% CI: 37.6, 44.2). Low household decision-making power (AOR = 11.2; 95% CI: 7.59, 16.4) and poor social support (AOR = 2.44; 95 CI: 1.58, 3.76) were significantly associated with maternal loneliness. Conclusion In this study, 4 out of 10 women have experienced loneliness during the postpartum period. Thus, it highlights the potential risks of the mother’s loneliness on her postnatal well-being, particularly if the woman has poor social support and low household decision-making power. Encouraging women to be involved in all aspects of the household decision-making and promoting the need for social support for all women during the postpartum period may be optimal initial targets to reduce the impact of loneliness.
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Affiliation(s)
- Azmeraw Ambachew Kebede
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dereje Nibret Gessesse
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nuhamin Tesfa Tsega
- Department of Women's and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mastewal Belayneh Aklil
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Wubedle Zelalem Temesgan
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Marta Yimam Abegaz
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tazeb Alemu Anteneh
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nebiyu Solomon Tibebu
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Haymanot Nigatu Alemu
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tsion Tadesse Haile
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asmra Tesfahun Seyoum
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Agumas Eskezia Tiguh
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ayenew Engida Yismaw
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Muhabaw Shumye Mihret
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Goshu Nenko
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kindu Yinges Wondie
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Birhan Tsegaw Taye
- School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
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Agarwal N, Abdalla SM, Cohen GH. Marital rape and its impact on the mental health of women in India: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000601. [PMID: 36962419 PMCID: PMC10021972 DOI: 10.1371/journal.pgph.0000601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 05/16/2022] [Indexed: 11/18/2022]
Abstract
This systematic review aims to describe the prevalence of marital rape in India, the analytic methods employed in its study, and its implications on mental health of victims. Online databases, PubMed, Embase, Web of Science and APA Psych, were systematically searched for articles published up until November 2020. Selected articles included those published from or studies conducted in India where the primary exposure was marital rape. The primary outcomes of interest are Post Traumatic Stress Disorder (PTSD) and Depression. Secondary outcomes related to PTSD and depression (e.g., suicidality) included in identified studies were also described. 11 studies were included after excluding studies based on our selection criteria: 9 quantitative studies and 2 qualitative studies. Sexual coercion by intimate partner was highly prevalent, ranging from 9%-80% and marital rape ranged from 2%-56%. Many of the studies reported statistically significant associations between marital rape and mental health outcomes, including clinical depression (7 of 8); PTSD (1 of 3). Quantitative studies were assessed for quality and risk of bias using the NIH Quality Assessment Scale and the modified Newcastle Ottawa Scale for cross-sectional and observational cohort studies, and most exhibited a low risk of bias. Qualitative studies identified a broad range of exposures and psychological sequlae of marital rape not captured by quantitative studies. Included publications exhibit a low to moderate association between marital rape and adverse mental health outcomes. Qualitative data also supplements these findings and provide relevant context. Further research on marital rape, its prevalence and consequences, is needed to advance policy, and health infrastructure on the subject.
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Affiliation(s)
- Nandini Agarwal
- Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Salma M Abdalla
- Epidemiology Department, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Gregory H Cohen
- Epidemiology Department, Boston University School of Public Health, Boston, Massachusetts, United States of America
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11
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Shri N, Muhammad T. Association of intimate partner violence and other risk factors with HIV infection among married women in India: evidence from National Family Health Survey 2015-16. BMC Public Health 2021; 21:2105. [PMID: 34789185 PMCID: PMC8597306 DOI: 10.1186/s12889-021-12100-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 10/19/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) infection remains an important public health concern in many countries. It is fuelled by gender inequality and disparity, which has resulted in a fundamental violation of women's human rights. This study aims to find out the association of intimate partner violence (IPV) and other risk factors with the prevalence of HIV infection among married women in India. METHODS This study is based on data from the India National Family Health Survey (2015-16). Bivariate analysis has been performed to estimate the prevalence of HIV. Logistic regression analysis is conducted to find out the association between IPV, factors such as having alcoholic husband and lifetime partner, and HIV infection among currently married women. RESULTS Married women who had faced physical, sexual, and emotional violence from their husbands/partners were almost twice more likely to have tested HIV positive compared to married women who did not face violence [OR: 2.14, CI: 1.08-4.50]. The odds of testing for HIV positive was significantly higher among the married women experiencing IPV and having alcoholic husband [OR: 4.48, CI: 1.87-10.70] than those who did not experience IPV and had non-alcoholic husband. The use of condom did not show any significant association with HIV infection. Again, having more than one lifetime partner had a positive association with HIV infection compared to those with one partner [OR: 2.45, CI: 1.21-4.16]. CONCLUSIONS The study revealed that factors such as experiencing all types of IPV, having an alcoholic husband, increased number of lifetime partners, being sexually inactive, belonging to vulnerable social groups, and urban place of residence are important risk factors of HIV infection among married women in India. The results also suggest that gender-based violence and an alcoholic husband may represent a significant factor of HIV infection among married women and interventions should on focus such vulnerable populations.
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Affiliation(s)
- Neha Shri
- International Institute for Population Sciences, Mumbai, Maharashtra India 400088
| | - T. Muhammad
- International Institute for Population Sciences, Mumbai, Maharashtra India 400088
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Ler P, Sivakami M, Monárrez-Espino J. Prevalence and Factors Associated With Intimate Partner Violence Among Young Women Aged 15 to 24 Years in India: A Social-Ecological Approach. JOURNAL OF INTERPERSONAL VIOLENCE 2020; 35:4083-4116. [PMID: 29294780 DOI: 10.1177/0886260517710484] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Intimate partner violence (IPV) is a critical public health issue that has reached epidemic proportions. Research investigating IPV among young women in India using large-scale population data is lacking. This study examined the prevalence and factors associated with IPV among women aged 15 to 24 years in India through a social-ecological approach. This cross-sectional study analyzed data from the National Family Health Survey, a population-based survey conducted in India from 2005 to 2006. The past-year prevalence of emotional, physical, and sexual forms of IPV, among ever-married women aged 15 to 24 years were computed. Multivariate logistic regression was conducted to evaluate the association of factors at various levels of the social-ecological framework with the past-year experience of emotional, physical, sexual, and any form of IPV. The past-year prevalence of IPV among women aged 15 to 24 years (n = 16,285) was 29%. Physical IPV was the most common, affecting 23% in the past year. The past-year prevalence of sexual IPV among women aged 15 to 24 years at 9.5% was higher than older women. Individual factors significantly associated with the past-year experience of all forms of IPV were the young age at first marriage, parental IPV, and ever had a terminated pregnancy. At the relationship level, husband's controlling behaviors, his consumption of alcohol, and experience of violence from other family members were positively associated with all forms of IPV in the past year. Poverty and acceptance of IPV increased the women's odds of experiencing IPV. IPV was associated with multiple factors occurring at all levels of the social-ecological framework. Actions to prevent and eliminate IPV in India demand multidisciplinary and collaborative efforts that are tailored specifically for adolescents and young women. It is imperative to protect the girls and young women from IPV; it protects the future of India.
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Affiliation(s)
- Peggy Ler
- Karolinska Institutet, Stockholm, Sweden
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Kumari S, Kiran M, Chaudhury S. Severity of violence and quality of life of women with psychiatric disorders as compared to normal controls. Ind Psychiatry J 2020; 29:213-221. [PMID: 34158704 PMCID: PMC8188912 DOI: 10.4103/ipj.ipj_33_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 12/11/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Despite the fact that violence against women is a significant public health problem, there is a paucity of research into this area, and little is known about the extent to which women with psychiatric disorders are affected. AIM The aim of the study was to assess and compare the severity of violence and quality of life of women with psychiatric disorders and normal controls. MATERIALS AND METHODS Based on purposive sampling technique, a sample consisting of 120 participants was selected from in-patient (female section) and outpatient services of the Ranchi Institute of Neuro-Psychiatry and Allied Sciences and Kanke Area. Both groups were matched on sociodemographic details. Normal controls were screened using General Health Questionnaire-12. The severity of violence against women scale and the revised Conflict Tactics Scale were used to assess the severity of violence, and World Health Organization Quality of Life (WHOQOL)-BREF scale was used for the assessment of the quality of life. Scales were scored as per their test manuals. Results were tabulated and compared using appropriate statistical tests. RESULTS Women with psychiatric illness as well as normal controls faced various forms of symbolic violence equally. Women with psychiatric disorders faced significantly higher severity of physical assault, sexual coercion, and injury as compared to normal controls. Women with psychiatric disorders had significantly lower scores on WHOQOL BREF compared to normal participants. CONCLUSION Women with psychiatric disorders suffered significantly higher severity of both physical and sexual violence and had significantly worse quality of life compared to normal controls.
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Affiliation(s)
- Sapna Kumari
- Department of Psychiatric Social Work, Ranchi Institute of Neuropsychiatry and Allied Sciences, Ranchi, Jharkhand, India
| | - Manisha Kiran
- Department of Psychiatric Social Work, Ranchi Institute of Neuropsychiatry and Allied Sciences, Ranchi, Jharkhand, India
| | - Suprakash Chaudhury
- Department of Psychiatry, Dr D Y Patil Medical College, Hospital and Research Center, Pune, Maharashtra, India
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Factors Associated With Depressive Symptoms in Female Victims of Intimate Partner Violence in Southern Taiwan. J Nurs Res 2020; 27:e33. [PMID: 30664041 PMCID: PMC6641094 DOI: 10.1097/jnr.0000000000000303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Intimate partner violence (IPV) is known to cause physical suffering and psychological problems, which burden society. In addition, IPV-related psychological problems such as depressive symptoms may lead to disabilities, chronic mental illness, and an increased risk of suicide. PURPOSE This study was designed to explore the factors associated with depressive symptoms in women who were physically abused by intimate partners. METHODS This cross-sectional study recruited 72 physically abused women from two domestic violence prevention centers in southern Taiwan. The questionnaires that were used to collect data included the Eysenck Personality Questionnaire, the Conflict Tactic Scale, and the Center for Epidemiologic Studies Depression Scale. RESULTS Sixty-six of the participants (91.67%) met the inclusion criteria and completed all questionnaires. Fifty-five (83.3%) of the participants were found to have depressive symptoms. Depressive symptoms were positively associated in this sample with younger age, a lower level of extraversion, and a higher level of neuroticism. These three factors explained 59.5% of the total variance in depressive symptoms. CONCLUSIONS/IMPLICATIONS FOR PRACTICE Youth and neuroticism were found to be significant risk factors for developing depressive symptoms in female victims of IPV, whereas extraversion was found to be a related protective factor. The results of this study indicate that clinical workers should provide female victims of IPV, especially relatively young victims, with services that help ameliorate neuroticism to reduce the risk of depressive symptoms.
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Kamimura A, Nourian MM, Assasnik N, Nourian K, Franchek-Roa K. Childhood Abuse and Intimate Partner Violence Victimization Among Filipina and South Asian Women in the United States. ACTA ACUST UNITED AC 2020; 1:2-10. [PMID: 33786467 PMCID: PMC7784723 DOI: 10.1089/whr.2019.0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Intimate partner violence (IPV) is a common form of interpersonal violence and impacts the health and well-being of victims over their lifetime. Many victims of IPV experience multiple types of victimization throughout their lives, often starting in childhood. The prevalence of IPV victimization of women varies among different race/ethnic groups. The purpose of this project is to examine childhood abuse among Filipina and South Asian women living in the United States who had experienced IPV. Methods: Data were extracted from Lifecourse Experiences of Intimate Partner Violence and Help-Seeking among Filipina, Indian, and Pakistani Women: Implications for Justice System Responses 2007-2009 (San Francisco, CA) (ICPSR 29682). Data were collected from 143 women (87 Filipina and 56 South Asian (i.e., Indian or Pakistani) aged between 18 and 60 years who had been a victim of IPV and lived in the United States. Results: Although both Filipina and South Asian women who had experienced IPV reported a high prevalence of childhood abuse, Filipina women reported a higher prevalence than South Asian women. South Asian women were more likely to have first experienced IPV at a younger age and sought some form of IPV services as compared with Filipina women. The factors associated with experiencing all the types of IPV victimization included younger age at the first physical IPV victimization experience and higher educational attainment. Conclusions: Future research should examine the cumulative victimization of childhood abuse and IPV among Asian populations and its impact on health.
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Affiliation(s)
- Akiko Kamimura
- Department of Sociology, University of Utah, Salt Lake City, Utah
| | - Maziar M Nourian
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Kimiya Nourian
- School of Medicine, University of Utah, Salt Lake City, Utah
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Sankar S, Parker N, Nichols E, Carolan M, Escobar-Chew AR. Addressing Couple Violence in Therapy Training Clinics: A Human-Centered Approach to Systems Intervention Design. JOURNAL OF COUPLE & RELATIONSHIP THERAPY 2019. [DOI: 10.1080/15332691.2019.1609383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Sudha Sankar
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - Nicole Parker
- School of Social Work, Michigan State University, East Lansing, Michigan, USA
| | - Emily Nichols
- School of Social Work, Grand Valley State University, Grand Rapids, Michigan, USA
| | - Marsha Carolan
- School of Social Work, Michigan State University, East Lansing, Michigan, USA
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Caudillo Ortega L, Valdez Montero C, Flores Arias ML, Ahumada Cortez JG, Gámez Medina ME, Ramos Frausto VM. Relación entre la violencia contra la mujer y el índice de masa corporal: revisión integradora. AVANCES EN ENFERMERÍA 2018. [DOI: 10.15446/av.enferm.v36n2.66009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objetivo: el propósito de esta revisión es conocer la evidencia científica existente de la relación entre la violencia contra la mujer (VCM) y su índice de masa corporal (IMC) (alto y bajo).Síntesis del contenido: se realizó una revisión integradora de las publicaciones científicas que abordaran y relacionaran la VCM y el IMC en diferentes bases de datos. Se consideraron los siete pasos de Cooper. Se analizaron por título, año de publicación, autores y fuente; finalmente, se estudiaron los aspectos metodológicos. Se identificaron 85 artículos y se excluyeron 67 por no cumplir con los criterios de inclusión. De los artículos incluidos en la revisión, 5 reportaron correlación positiva y significativa entre la VCM con el índice de masa corporal alto (sobrepeso/obesidad). Asimismo, 6 de los artículos refieren una relación positiva entre la VCM y el IMC bajo; es decir, a mayor violencia, se reporta un IMC alto. Pero, también, 1 reporta una relación negativa y significativa; es decir, a menor violencia, menor el IMC de las mujeres.Conclusión: los resultados encontrados muestran la existencia escasa literatura científica que aborde la temática de la VCM y el IMC. Algunos estudios muestran la relación entre la VCM y el IMC alto y bajo. Los resultados no son concluyentes, por lo que se requiere generar líneas de acción y atención a las mujeres receptoras de los diferentes tipos de violencia.
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Rowan K, Mumford E, Clark CJ. Is Women's Empowerment Associated With Help-Seeking for Spousal Violence in India? JOURNAL OF INTERPERSONAL VIOLENCE 2018; 33:1519-1548. [PMID: 26663611 PMCID: PMC5081269 DOI: 10.1177/0886260515618945] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Violence against women by their husbands is a problem for women worldwide. However, the majority of women do not seek help. This article presents findings from a national survey in India on empowerment-related correlates of help-seeking behaviors for currently married women who experienced spousal violence. We examined individual-, relationship-, and state-level measures of empowerment on help-seeking from informal and formal sources. Findings indicate that help-seeking is largely not associated with typical measures of empowerment or socio-economic development, whereas state-level indicators of empowerment may influence help-seeking. Although not a target of this study, we also note that injury from violence and the severity of the violence were among the strongest factors related to seeking help. Taken together, the low prevalence of help-seeking and lack of strong individual-level correlates, apart from severe harm, suggests widespread barriers to seeking help. Interventions that affect social norms and reach women and men across social classes in society are needed in addition to any individual-level efforts to promote seeking help for spousal violence.
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Kalokhe AS, Iyer SR, Kolhe AR, Dhayarkar S, Paranjape A, del Rio C, Stephenson R, Sahay S. Correlates of domestic violence experience among recently-married women residing in slums in Pune, India. PLoS One 2018; 13:e0195152. [PMID: 29608581 PMCID: PMC5880392 DOI: 10.1371/journal.pone.0195152] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 03/16/2018] [Indexed: 12/03/2022] Open
Abstract
The high risk of experiencing domestic violence (DV) among married women in India who reside in slum communities underscores the need for effective, evidence-based, and culturally-tailored primary prevention. To inform such DV primary prevention strategies for this population, we herein aimed to identify correlates of DV experience in early marriage. Utilizing a cross-sectional design, potential correlates of DV experience were explored among a geographically-clustered random sample of 100 recently-married women residing in slums in Pune, India. In multivariable regression, DV experience was associated with less educational attainment by the participant’s spouse (standardized β = -0.281, p = 0.004), less satisfaction of the spouse’s family with the maanpaan (wedding-related gifts provided by the bride’s family) they received at the time of marriage (standardized β = -0.298, p<0.001), poorer conflict negotiation skills (standardized β = -0.308, p<0.001), and greater acknowledgement of DV occurrence in family and friends (standardized β = 0.436, p<0.001). These correlates suggest strategies that could be incorporated into future DV primary prevention interventions for this vulnerable population (i.e. promoting completion of formal education of boys alongside girls, mitigating causes of familial dowry harassment, improving conflict negotiation skills, and challenging norms surrounding DV).
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Affiliation(s)
- Ameeta S. Kalokhe
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, United States of America
- Emory University Rollins School of Public Health, Department of Global Health, Atlanta, Georgia, United States of America
- * E-mail: (ASK); (SS)
| | - Sandhya R. Iyer
- National AIDS Research Institute, Department of Social and Behavioral Research, Pune, India
| | - Ambika R. Kolhe
- National AIDS Research Institute, Department of Social and Behavioral Research, Pune, India
| | - Sampada Dhayarkar
- National AIDS Research Institute, Department of Epidemiology and Biostatistics, Pune, India
| | - Anuradha Paranjape
- Temple University Lewis Katz School of Medicine, Department of Medicine, General Internal Medicine, Philadelphia, Pennsylvania, United States of America
| | - Carlos del Rio
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, United States of America
- Emory University Rollins School of Public Health, Department of Global Health, Atlanta, Georgia, United States of America
| | - Rob Stephenson
- Emory University Rollins School of Public Health, Department of Global Health, Atlanta, Georgia, United States of America
- University of Michigan, School of Nursing, Department of Health Behavior and Biological Sciences, Ann Arbor, Michigan, United States of America
| | - Seema Sahay
- National AIDS Research Institute, Department of Social and Behavioral Research, Pune, India
- * E-mail: (ASK); (SS)
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Kamimura A, Ganta V, Myers K, Thomas T. Intimate Partner Violence, Childhood Abuse, and In-Law Abuse Among Women Utilizing Community Health Services in Gujarat, India. JOURNAL OF INTERPERSONAL VIOLENCE 2017; 32:3778-3796. [PMID: 26345222 DOI: 10.1177/0886260515603973] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Previous studies in India suggest high prevalence of intimate partner violence (IPV), childhood abuse, and abuse from in-laws. Yet few studies examined IPV, childhood abuse, and abuse from in-laws together. The purpose of this study is to examine the association between IPV, childhood abuse, and abuse from in-laws, and types of abuse (physical, sexual, and emotional abuse) among women utilizing community health services for the economically disadvantaged in India. This study contributes to expanding the literature on abuse experience and providing knowledge for developing intervention programs and research projects to improve health and safety of economically disadvantaged women. The data were collected from women aged 18 years old or older at 18 community health centers that are primarily for the economically disadvantaged in Gujarat, India, in October and November 2013. Of the 219 women who completed a self-administered survey, 167 participants, who had ever been married and indicated whether they had been abused by their spouse or not, were included in analysis. More than 60% of the participants experienced IPV, childhood abuse, and/or abuse from in-laws, often with multiple types of abuse. Physical abuse is a major issue for IPV, childhood abuse, and in-law abuse. Emotional abuse potentially happens along with physical and/or sexual abuse. Abuse from in-laws requires greater attention because all types of abuse from in-laws were associated with IPV. Community health centers should provide abuse prevention and intervention programs that have involvement of family members as well as women who are at risk of being abused.
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Affiliation(s)
| | - Vikas Ganta
- 2 The Catholic Health Association of India, Telengana State, India
| | - Kyl Myers
- 1 University of Utah, Salt Lake City, UT, USA
| | - Tomi Thomas
- 2 The Catholic Health Association of India, Telengana State, India
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Depression and intimate partner violence among college students in Iran. Asian J Psychiatr 2016; 23:51-55. [PMID: 27969079 DOI: 10.1016/j.ajp.2016.07.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 04/26/2016] [Accepted: 07/14/2016] [Indexed: 11/23/2022]
Abstract
Intimate partner violence (IPV) is a significant public health threat and causes mental as well as physical health problems. Depression is a common mental health consequence of IPV. While Iran has a high prevalence of IPV and depression, the association between IPV and depression has not been well examined. The Iranian data from the International Dating Violence Study (IDVS) 2001-2006 (ICPSR 29583) were analyzed. Twenty-three male and 75 female college students were selected in the IDVS Iranian data. Nearly all of the participants, male and female, reported being victims and perpetrators of IPV. Female participants were more likely to report depression compared to male participants. Participants who had experienced sexual IPV reported significantly higher levels of depression compared to those who did not experience sexual IPV. However, when substance abuse and partner conflict were analyzed, the contribution of sexual IPV on depression was no longer significant. This study suggests that IPV prevention and intervention programs should take into consideration that college-aged men and women frequently experience and use violence in dating relationships. Depression interventions should be included for female students. Substance abuse and partner conflict are important risk factors for depression.
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