Structural Pathways between Child Abuse, Poor Mental Health Outcomes and Male-Perpetrated Intimate Partner Violence (IPV)

Continuous chains: childhood maltreatment and intimate partner violence victimization among displaced women in a war context

BACKGROUND

Childhood victimization has been associated with long-term psychological effects and an increased risk of being victimized in later life. Previous research has primarily focused on sexual abuse during childhood, and a wide range of consequences have been identified. However, a significant gap remains in our understanding of the complex interaction between different forms of childhood abuse and violence in later life, particularly in the context of broader social stressors such as armed conflict and displacement.

METHODS

This study examines the association between exposure to different types of childhood maltreatment in the context of family and intimate partner violence (IPV) among displaced women living in refugee camps in northern Iraq. Structured interviews were conducted by trained female psychologists with 332 women aged between 20 and 62 years.

RESULTS

Results indicated that over one-third of the participating women reported experiencing at least one occurrence of IPV by their husbands within the past year. In addition, participants reported experiences of different types of maltreatment (physical, emotional, and sexual violence and physical and emotional neglect) perpetrated by family members in their childhood. While all forms of childhood maltreatment showed an association with IPV within the past year, only emotional childhood maltreatment was found to be a significant predictor of IPV in a multivariate analysis.

CONCLUSION

The study highlights the ongoing impact of child maltreatment and its contribution to increased vulnerability to IPV victimization in later life. In addition, this study describes the specific cultural and contextual elements that contribute to IPV in refugee camps.

Adverse childhood experiences and intimate partner violence: A meta-analysis

Intimate partner violence (IPV) represents a significant public health concern. Adverse childhood experiences (ACEs) represent one risk factor for IPV, however, the results of existing research on the association between ACEs and IPV demonstrate mixed findings. The present research sought to meta-analytically examine the association between ACEs and (a) IPV perpetration and (b) IPV victimization. Moderator analyses were conducted to determine factors that may impact the association between ACEs and IPV involvement. Electronic searches were conducted in MEDLINE, Embase, and PsycINFO in August of 2021. One-hundred and twenty-three records were screened for inclusion. All studies included a measure of ACEs and IPV victimization or perpetration. Among the 27 studies and 41 samples included in the meta-analysis, 65,330 participants were included. The results of the meta-analyses demonstrated that ACEs were positively associated with IPV perpetration and victimization. Significant methodological and measurement moderators further inform our understanding of ACEs and IPV involvement. The present meta-analyses demonstrates that trauma-informed approaches to IPV screening, prevention, and intervention may be useful, given that individuals who are involved with IPV may be more likely to possess a history of ACEs exposure.

Understanding the Effects of Trauma Exposure, Life Stress, Intimate Partner Violence, and Depression on Sexually Transmitted Infection Risk in Post-Conflict Liberia

In sub-Saharan Africa, sexually transmitted infections (STIs) are a public health concern. The impact of STIs are exacerbated in post-conflict low- and middle-income countries, such as Liberia, where exposure to traumatic events is prevalent and access to mental health services are limited. Following a syndemics framework, this study used regression analyses to explore the independent, additive, and multiplicative effects of four psychosocial conditions (exposure to war-related traumatic events, intimate partner violence [IPV], stressful life events, and depressive symptoms) on self-reported STIs. Data were collected from 379 youth aged 18-30 years (n = 170 women; n = 179 men) in Montserrado County, Liberia. Results revealed that psychosocial variables correlated with each other and STI risk. In multivariable analysis, stressful life events, depressive symptoms, and IPV were statistically significant predictors of STI risk. We found support for an additive effect between the number of psychosocial conditions reported and STI risk, as well as a multiplicative effect (interaction) between IPV and depressive symptoms on STI risk. Our results suggest a synergy between experiencing psychosocial conditions and STI risk and point to the potential benefit of multi-level sexual health approaches that simultaneously address mental health and IPV among youth in Liberia.

Experiences of intimate partner violence (IPV) among females with same-sex partners in South Africa: what is the role of age-disparity?

BACKGROUND

South African women have been exposed to epidemic proportions of intimate partner violence (IPV) amongst heterosexual relationships but not much is known about same-sex partnerships. Sexual minorities are excluded from research but are subject to intimate partner violence as much as heteronormative persons. The purpose of this study is to determine the association between age-disparity and IPV outcomes among females with same-sex partners in South Africa.

METHODS

A cross-sectional study of the nationally representative South African National HIV Prevalence, Incidence, Behaviour and Communication Survey (SABSSM 2017) is used. A weighted sample of 63,567 female respondents identified as having a same-sex partner are analysed. IPV is measured as ever been physically and/ or sexually abused. Any experience of IPV is included in the dependent variable of this study. Descriptive and inferential statistics are used to estimate the relationship between demographic, socioeconomic, age-disparity and IPV.

RESULTS

Almost 16% of females in same-sex relationships experienced IPV and about 22% from younger partners. In female same-sex partnerships, partner age-disparity (OR: 1.30, CI: 1.18 - 1.51), type of place of residence (OR: 2.27, CI: 1.79 - 3.79), highest level of education (OR: 1.07, CI: 0.97 - 1.17), marital status (OR: 1.60, CI: 1.37 - 1.88), and race (OR: 1.47, CI: 1.41 - 1.54) are associated with an increased likelihood of violence.

CONCLUSION

IPV programs that are specifically targeted for non-heteronormative orientations are needed. These programs should promote health equity and safety for non-confirmative sexual identities in the country.

Co-Occurring Intimate Partner Violence and Child Abuse in Eastern Democratic Republic of Congo: The Influence of Early Life Experiences of Abuse

Little is known about co-occurring intimate partner violence (IPV) against women and child abuse within families in humanitarian settings. Baseline data from 203 couples in eastern Democratic Republic of Congo were analyzed to assess associations between childhood experiences of abuse with present co-occurring violence. Over half of women (56.1%) and men (50.5%) reported co-occurring violence. Adjusted models demonstrate experiencing physical abuse as a child was associated with greatest odds of recent co-occurring violence while witnessing parental IPV had mixed influence. Programmatic approaches focused on reducing early childhood violence may be promising to prevent both IPV and child abuse.

Assessing the role of depression in reducing intimate partner violence perpetration among young men living in urban informal settlements using a mediation analysis of the Stepping Stones and Creating Futures intervention

BACKGROUND

Stepping Stones and Creating Futures (SS/CF) is a gender transformative and economic empowerment intervention that has effectively reduced the perpetration of intimate partner violence (IPV) by young men living in informal settlements in South Africa.

OBJECTIVE

This study examines whether depression mediated the association between SS/CF intervention and decreased IPV.

METHOD

Data from a two-arm cluster randomised community-based controlled trial that evaluated the effectiveness of SS/CF in lowering IPV were obtained from 674 young men aged 18-30 within urban informal settlements in South Africa. After being randomly assigned to either the experimental arm (SS/CF) or the control arm, the participants were followed up for 24 months. Logistic regression using mediation analysis was conducted to see whether changes in depressive symptoms mediated the association between the intervention and reduced IPV perpetration.

RESULTS

Findings from the mediation analysis indicated that those assigned to the SS/CF experimental group reported lower depression (β = -0.42, p < 0.05) at 12 months, and this was subsequently associated with reduced IPV (β = 0.43, p < 0.05) at 24 months. The direct path from SS/CF to IPV was originally (β = -0.46, p < 0.01), but reduced in the mediation model to (β = -0.13, p = 0.50). Depressive symptoms mediated the association between the SS/CF intervention and decreased IPV perpetration.

CONCLUSION

These findings suggest that one pathway through which SS/CF decreased IPV was through improvement in mental health (i.e. depression). Future IPV prevention interventions may consider incorporating components that focus on improving mental health as a way of also reducing IPV perpetration in disadvantaged settings.

Hospitalization for physical child abuse: Associated medical factors and medical history since birth

BACKGROUND

Physical abuse often begins at a very young age and sometimes results in serious or fatal injuries. It is crucial to diagnose physical abuse as early as possible to protect this vulnerable population.

OBJECTIVE

To study the factors associated with the first hospitalization for physical abuse from birth to the infant's first birthday in France.

PARTICIPANTS AND SETTING

We included all singleton children born in a hospital setting in France between 2009 and 2013, who were identified from the French national information system database (SNDS).

METHODS

To study factors associated with the first hospitalization for physical abuse during the first year after birth, we used the Fine and Gray regression model. Factors included in the multivariate model were the infant's sex, prematurity, neonatal conditions, the number of hospitalizations (at least two), medical consultations and complementary universal health insurance (proxy for family precariousness and socio-economic vulnerability).

RESULTS

Over the 2009-2013 period, among 3,432,921 newborn singletons, 903 (0.026 %) were hospitalized for physical abuse in the year following birth. Among the factors associated with physical abuse, such as prematurity (aHR = 2.2[1.8-2.7]), male sex (aHR = 1.3[1.2-1.5]), or having had at least two hospitalizations (aHR = 1.7[1.4-2.1]), we found that complementary universal health insurance coverage was the factor most associated (aHR = 4.1[3.5-4.7]) with being hospitalized for physical abuse.

CONCLUSION

These findings could help introduce preventative measures for infant protection in certain groups, such as parents of infants born prematurely, especially if they are in a precarious situation. This study also suggests that particular attention should be paid to infants who have been hospitalized at least two times in the first year of life, whatever the reason.

Cluster randomized controlled trial of Stepping Stones and Creating Futures to reduce mental health challenges among young men in informal settlements in KwaZulu-Natal Province, South Africa

BACKGROUND

Informal settlements are high density areas in and around cities, characterized by a lack of formal planning and basic amenities, being known in South Africa for high levels of mental disorder driven by violence, and complex social and economic challenges. In particular, young men's poor mental health goes untreated, with relatively few evidenced-based interventions available in this setting.

AIM

This cluster randomized controlled trial investigated the effectiveness of Stepping Stones and Creating Futures (SS/CF), a participatory gender transformative and economic empowerment intervention, on the mental health of young men living in South African informal settlement.

METHODS

A total of 674 young men ages 18 to 30 years were recruited in 34 clusters in Durban's urban informal settlements. Clusters were randomly allocated (1:1) to either the experimental SS/CF or control arm and participants were followed-up over 24-months. Intention-to-treat analysis based on generalized estimating equations (GEE) were fitted to quantify the impact of SS/CF on the men's anxiety and post-traumatic stress (PTS) symptomatology.

RESULTS

At end of the 24 months follow-period, anxiety (adjusted odds ratio [aOR]: 0.62, p = .04, 95% CI [0.39, 0.99]) and PTS (aOR = 0.52, p = .03, 95% CI [0.29, 0.93]) were significantly lower for group assigned to the SS/CF compared to the control group.

CONCLUSION

SS/CF, a gender transformative and livelihoods strengthening intervention designed to address poverty and other socio-economic challenges in informal settlements reduced anxiety and PTS among men with mental health challenges living in informal settlements.

Breaking the Cycle of Family Violence: A Critique of Family Violence Interventions

As the intergenerational transmission of family violence is associated with numerous negative outcomes, interventions are needed to interrupt this cycle. Our aim is to review the family violence intervention literature and to assess whether and how interventions interrupt the intergenerational transmission of family violence. Papers about interventions were identified through database searches (PubMed, JSTOR, CINAHL, PsycINFO), supplemented by review of references and relevant review papers. Eligibility criteria included: empirical studies detailing interventions to interrupt or prevent child abuse/maltreatment and/or intimate partner violence, published between January 2000 and August 2020, and written in English. Of the 14 papers included in this narrative review, only 3 explicitly stated that they aimed to break the cycle of family violence; 12 papers came from high-income countries, and 10 focused on individuals, with half focusing on mothers. We identify effective intervention approaches, including long-term one-on-one coaching and home visits to improve parenting. Results demonstrate a dose-response relationship, suggesting the lasting value of increased intervention frequency and duration. We highlight gaps in the literature, including the need for interventions in low-income countries, and those geared toward fathers and neighborhoods/communities. We also examine the many methodological challenges of this work, such as possible biases related to the use of retrospective data, lack of objective outcome measures, and absence of long-term follow-up. Our recommendations for future research include incorporating trauma-informed frameworks, developing standardized definitions and measures to facilitate the comparison of intervention results, and designing more interventions specifically for fathers/husbands and for the prevention of intimate partner violence.

Integrating intimate partner violence prevention content into a digital parenting chatbot intervention during COVID-19: Intervention development and remote data collection

BACKGROUND

Intimate partner violence (IPV) is a serious public health issue which experienced a sharp incline during the onset of COVID-19. Increases in other forms of violence, such as violence against children (VAC), have also been linked to the pandemic, and there have been calls for greater prevention efforts that tackle both forms of violence concurrently. The COVID-19 crisis has highlighted the urgent need for evidence-based and scalable violence prevention interventions that target multiple forms of family violence. Parenting programmes have shown promising results in preventing various forms of family violence, including IPV and VAC, and have recently experienced an expansion in delivery, with digital intervention formats growing. This paper describes the development and evaluation of the IPV prevention content designed and integrated into ParentText, a chatbot parenting intervention adapted from Parenting for Lifelong Health programmes.

METHODS

The ParentText IPV prevention content was developed using the Six Steps in Quality Intervention Development (6SQuID) framework. This involved targeted literature searches for key studies to identify causal factors associated with IPV and determining those with greatest scope for change. Findings were used to develop the intervention content and theory of change. Consultations were held with academic researchers (n = 5), practitioners (n = 5), and local community organisations (n = 7), who reviewed the content. A formative evaluation was conducted with parents in relationships (n = 96) in Jamaica to better understand patterns in user engagement with the intervention and identify strategies to further improve engagement.

RESULTS

Using the 6SQuID model, five topics on IPV prevention were integrated into the ParentText chatbot. Text-messages covering each topic, including additional materials such as cartoons and videos, were also developed. The formative evaluation revealed an average user-engagement length of 14 days, 0.50 chatbot interactions per day, and over half of participants selected to view additional relationship content.

CONCLUSIONS

This article provides a unique contribution as the first to integrate IPV prevention content into a remotely delivered, digital parenting intervention for low-resource settings. The findings from this research and formative evaluation shed light on the promising potential of chatbots as scalable and accessible forms of violence prevention, targeting multiple types of family violence.

High levels of poor mental health among young men in urban informal settlements in South Africa: a community-based study of social determinants

Informal settlements (high population density areas at the outskirts of urban areas characterized by lack basic amenities) in South Africa are consequences of apartheid regime's discriminatory migrant labour and spatial policy and continue to grow. Living in informal settlements accompanies a mire of social/health challenges that threatens upward mobility, but few studies exist that document drivers of mental health challenges in these settings. We investigated the prevalence and social determinants of poor mental health for young men in informal settlements adjacent to one of the largest cities that is at the heart of HIV endemic in South Africa. This study involved a cross-sectional study with cluster sampling design of 674 young men aged 18-30 years residing in eThekwini informal settlement communities. We assessed the prevalence, and social determinants, of significant depressive (i.e., depression) and post-traumatic stress (i.e., PTS) symptoms using logistic regression. Given the complex survey design of the study, all analyses were adjusted for clustering. The prevalence of depression and PTS in the sample was 46.8% and 14.4% respectively. Results of the multivariable analyses indicated that severe food insecurity (aOR = 2.98, 95% CI:1.70-5.22), crime perpetration (aOR = 1.51, 95% CI:1.05-3.80), severe adverse childhood event (aOR = 2.00, 95% CI: 1.05-3.80), traumatic event exposures (aOR = 2.43, 95% CI:1.56-3.80) and problematic alcohol use (aOR = 1.73, 95% CI:1.20-2.49) were significantly associated with depression. While incomplete secondary education (aOR = 0.45, 95% CI:0.22-0.92), moderate food insecurity (aOR = 2.51, 95% CI:1.04-6.06), traumatic event exposures (aOR = 2.19, 95% CI:1.32-3.64) and problematic alcohol use (aOR = 2.15, 95% CI: 1.24-3.73) were significantly associated with PTS. Our study highlights the exceedingly high levels of poor mental health among young men in informal settlements, with depression and PTS being driven by economic/social conditions. Multilevel interventions that address the individual, interpersonal, and social variables that contribute to poor mental health are needed.

'I'm not the mother I wanted to be': Understanding the increased responsibility, decreased control, and double level of intentionality, experienced by abused mothers

A paucity of research has been conducted within South Africa on abused women's experiences of motherhood, even though abused women tend to be at increased risk of negative physical and mental health difficulties, which can interfere with their ability to take care of themselves and their children. The aim of this qualitative study was to explore women's experiences of mothering in the context of an abusive relationship. Data was collected via individual, telephonic, semi-structured, in-depth interviews with 16 mothers from three South African provinces, and analyzed according to the principles of grounded theory. Our findings highlight the mothers' experiences of: a simultaneous increased sense of responsibility with regards to their children and a loss of control over their mothering; as well as experiencing abuse aimed at either the mother or the child, which is simultaneously meant to affect the other; and lastly, mothers' assessing themselves negatively through normative paradigms of 'good mothering', regardless that they often mother in the best way they know how to, given challenging circumstances. Therefore, this study highlights that the motherhood institution continues to create 'good mothering' benchmarks against which women themselves evaluate their mothering, often leading to feelings of inadequacy. Our findings also emphasize that the environment created by men's abuse is in conflict with the great expectations placed upon mothers in abusive relationships. Thus, mothers may experience huge pressure, which may lead to feelings of failure, self-blame, and guilt. This study has demonstrated that the abuse mothers' encounter adversely impacted on their mothering. We therefore emphasize the need to better understand how mothering is influenced by and responsive to violence. This is important as understanding abused women's experiences can assist us to further develop appropriate support mechanisms needed to ensure minimal impact on both women and their children.

Pooled analysis of the association between mental health and violence against women: evidence from five settings in the Global South

OBJECTIVES

To describe associations between men's poor mental health (depressive and post-traumatic stress symptomatology) and their perpetration of intimate partner violence (IPV) and non-partner sexual violence (NPSV), and women's mental health and their experiences of IPV and NPSV in five settings in the Global South.

DESIGN

A pooled analysis of data from baseline interviews with men and women participating in five violence against women and girls prevention intervention evaluations.

SETTING

Three sub-Saharan African countries (South Africa, Ghana and Rwanda), and one Middle Eastern country, the occupied Palestinian territories.

PARTICIPANTS

7021 men and 4525 women 18+ years old from a mix of self-selecting and randomly selected household surveys.

MAIN OUTCOME MEASURES

All studies measured depression symptomatology using the Centre for Epidemiological Studies-Depression, and the Harvard Trauma Scale for post-traumatic stress disorder (PTSD) symptoms among men and women. IPV and NPSV were measured using items from modified WHO women's health and domestic violence and a UN multicountry study to assess perpetration among men, and experience among women.

FINDINGS

Overall men's poor mental health was associated with increased odds of perpetrating physical IPV and NPSV. Specifically, men who had more depressive symptoms had increased odds of reporting IPV (adjusted OR (aOR)=2.13; 95%CI 1.58 to 2.87) and NPSV (aOR=1.62; 95% CI 0.97 to 2.71) perpetration compared with those with fewer symptoms. Men reporting PTSD had higher odds of reporting IPV (aOR=1.87; 95% CI 1.44 to 2.43) and NPSV (aOR=2.13; 95% CI 1.49 to 3.05) perpetration compared with those without PTSD. Women who had experienced IPV (aOR=2.53; 95% CI 2.18 to 2.94) and NPSV (aOR=2.65; 95% CI 2.02 to 3.46) had increased odds of experiencing depressive symptoms compared with those who had not.

CONCLUSIONS

Interventions aimed at preventing IPV and NPSV perpetration and experience must account for the mental health of men as a risk factor, and women's experience.

Knowledge of evidence-based practices for PTSD among mental health court judges

Mental health courts offer access to community-based care for defendants with psychiatric disorders, including posttraumatic stress disorder (PTSD). However, limited information is available on how judges make treatment decisions about evidence-based practices. In this qualitative study, we interviewed mental health court judges to evaluate: (1) perspectives toward the role of PTSD in criminal behavior; (2) knowledge about evidence-based practice for PTSD; (3) treatment decisions for defendants with PTSD; and (4) treatment decisions for defendants at risk for suicide, a common comorbidity with PTSD. We hypothesized that mental health court judges would report low familiarity with evidence-based practices for PTSD despite wide recognition of the impact of trauma on criminal behavior. Methods: Mental health court judges (N = 11, 60% women, 60% between 50-59 years) were recruited from 7 states in the US and completed a demographics questionnaire and semi-structured qualitative interview that was transcribed and double-coded. Results: Judges in mental health court unanimously agreed that PTSD is highly prevalent among their defendants, but that they had not having received formal education about evidence-based practices for PTSD. They reported relying on their team members to provide recommendations for treatment planning and viewed their role as the enforcer of the treatment teams' suggestions. Finally, judges also reported that suicide prevention is an important consideration and that there is a need for universal suicide risk assessments. Conclusions: These findings have implications for continuing education among judges in mental health court, and we recommend mandated training to increase awareness of evidence-based practices for PTSD and suicide prevention.

High-Risk Contexts for Violence Against Women: Using Latent Class Analysis to Understand Structural and Contextual Drivers of Intimate Partner Violence at the National Level

Introduction: Intimate partner violence (IPV) affects 1 in 3 women and poses a major human rights threat and public health burden, yet there is great variation in risk globally. Whilst individual risk factors are well-studied, less research has focussed on the structural and contextual drivers of IPV and how these co-occur to create contexts of high risk. Methods: We compiled IPV drivers from freely-accessible global country-level data sources and combined gender inequality, natural disasters, conflict, colonialism, socioeconomic development and inequality, homicide and social discrimination in a latent class analysis, and identified underlying 'risk contexts' based on fit statistics and theoretical plausibility (N=5,732 country-years; 190 countries). We used multinomial regression to compare risk contexts according to: proportion of population with disability, HIV/AIDS, refugee status, and mental health disorders; proportion of men with drug use disorders; men's alcohol consumption; and population median age (N=1,654-5,725 country-years). Finally, we compared prevalence of physical and/or sexual IPV experienced by women in the past 12 months across risk contexts (N=3,175 country-years). Results: Three distinct risk contexts were identified: 1) non-patriarchal egalitarian, low rates of homicide; 2) patriarchal post-colonial, high rates of homicide; 3) patriarchal post-colonial conflict and disaster-affected. Compared to non-patriarchal egalitarian contexts, patriarchal post-colonial contexts had a younger age distribution and a higher prevalence of drug use disorders, but a lower prevalence of mental health disorders and a smaller refugee population. IPV risk was highest in the two patriarchal post-colonial contexts and associated with country income classification. Conclusions: Whilst our findings support the importance of gender norms in shaping women's risk of experiencing IPV, they also point towards an association with a history of colonialism. To effectively address IPV for women in high prevalence contexts, structural interventions and policies are needed that address not only gender norms, but also broader structural inequalities arising from colonialism.

Correlates of co-occurring physical child punishment and physical intimate partner violence in Colombia, Mexico and Peru

Background

Violent discipline of children and intimate partner violence (IPV) against women are global public health and human rights problems. To address calls for more evidence on intersections, this study aimed to expand knowledge about correlates of physical child punishment, physical IPV against women and their co-occurrence (both) in the same household. 

Methods

Using national, population-based survey datasets from Colombia, Mexico and Peru, multinomial logistic regressions examined correlates of three mutually exclusive patterns of violence in the household: physical child punishment (only), physical IPV ever (only) and co-occurrence (both), each compared with no violence, after adjusting for other factors. Logistic regression was used to analyse odds ratios of physical child punishment in households affected by IPV past year and before past year compared with never, after adjusting for other factors.

Results

In all countries, adjusted odds ratios (aOR) of co-occurrence were significantly higher among women with lower education, more than one child, a child aged 2–5, a partner who tried to socially isolate her, and a history of childhood violence (caregiver violence and/or IPV exposure). They were significantly lower among women who reported collaborative partnerships (joint decision-making and/or shared chores). Co-occurrence was also significantly correlated with a history of child marriage/early motherhood in Colombia and Mexico, partner’s excess drinking in Mexico and Peru, agreement that physical child punishment was necessary in Peru and partner’s history of childhood violence in Colombia and Mexico. Evidence of shared risk factors was strongest for social isolation and caregiver histories of childhood violence and of shared protective factors for collaborative partnership dynamics. In all countries, associations between physical child punishment and physical IPV remained significant after adjusting for other factors, suggesting that correlations could not be explained by shared risk factors alone.

Conclusions

These findings are consistent with several theories relevant for violence prevention: 1) more collaborative, gender equitable partnerships may protect both children and women from violence; 2) violence between intimate partners may ‘spill over’ into violence against children (as correlations could not be explained by shared risk factors alone); and 3) there appears to be strong evidence of intergenerational transmission of violence.

Intimate partner violence perpetration and sexual risk behaviour: Identifying shared determinants among young men in Tanzania

In this study we examined factors that predict involvement in different patterns of sexual risk behavior and IPV perpetration among young men in Tanzania (n = 979), with a focus on identifying factors that distinguish men who engage in both behaviours from those who do not. Risk factors were drawn from three domains thought to be upstream drivers of both IPV and sexual risk: poverty, adverse childhood experiences, and inequitable gender norms. A three-step latent class analysis was used to assess whether and how factors from each domain distinguished subgroups of men whose behaviour patterns were characterised as comorbid (involvement in IPV and sexual risk behaviour), IPV-only, sexual risk only, and normative (low risk). Consistent with expectations, greater food insecurity, adverse childhood experiences, and inequitable gender norms related to violence and sexual behaviour predicted increased risk of membership in the comorbid group compared to other sub-groups. Findings support the promise of integrated prevention programmes targeting the common causes of IPV perpetration and sexual risk behaviour.

The Influence of Adverse Childhood Experiences on Perpetration of Intimate Partner Violence Among Black Men: The Moderating Role of Alcohol Use

This study examined the moderating role of alcohol use on the association between adverse childhood experiences (ACEs) and intimate partner violence (IPV) perpetration among Black men in the United States. We conducted bivariate and logistic regression analyses using data from Wave 2 of the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC). Bivariate results revealed significant relationships between eight of the 10 ACE factors physical neglect; emotional, physical and sexual abuse; witnessing a mother being abused; and having a parent guardian with an alcohol and drug problem and who was incarcerated and IPV perpetration. Similarly, examination of the relationship between ACEs and alcohol use in adulthood also revealed significant associations, with the exception of exposure to emotional neglect, emotional and sexual abuse, and witnessing a mother being abused. Findings from the logistic regression models revealed that alcohol use significantly moderated the relationship between ACEs and IPV perpetration, but only for men exposed to 1, 2, and ≥4 adversities in childhood. However, alcohol use appeared to exacerbate the relationship between ACEs and IPV perpetration for men without childhood adversity. Implications for practice, policy, and areas for further research are discussed.

Intimate Partner Violence Perpetration Among Military Spouses

Military spouses are an understudied population with respect to intimate partner violence (IPV) perpetration. Due to the unique demands of service members' jobs, military couples are documented to experience particular individual, couple, and family-level risk factors that may lead to IPV perpetration. Using the frustration-aggression hypothesis and considering the possibility of mutual violence, we examined (a) the direct effects of stressful events, marital discord, and work-family conflict on IPV perpetration among military spouses and (b) the indirect effect of anger arousal between stressful events, marital discord, and work-family conflict on IPV perpetration. This study is a secondary analysis of data drawn from a survey of army spouses conducted by the Walter Reed Army Institute of Research in 2012. The sample consists of 314 female spouses of active-duty members (white 75%, enlisted 80%). After controlling for covariates (including spouse race, rank, household size, age, living distance from military installation), the direct effects of marital discord and anger on IPV perpetration were statistically significant. Also, the direct effects of marital discord and work-family conflict on anger were significant. The path model demonstrated that the indirect effects of marital discord and work-family conflict on IPV perpetration via anger were significant. Finally, most physical and verbal violence was reported to occur in the form of mutual violence with their partners. Study findings suggest that the pathway of risk factors impacting IPV might differ depending on the sources of stress. The Family Advocacy Program, military social work practitioners, and other behavioral health providers should consider domains of risk and provide support to military spouses that is specifically tailored to these risk factors. Furthermore, considering the mediating role of anger arousal in the relationship between marital discord, work-family conflict and IPV, programs to address anger might be helpful to reduce IPV among military spouse perpetrators.

Effects of Adolescent-Focused Integrated Social Protection on Depression: A Pragmatic Cluster-Randomized Controlled Trial of Tanzania's Cash Plus Intervention

We assessed the impacts of Tanzania's adolescent-focused Cash Plus intervention on depression. In this pragmatic cluster-randomized controlled trial, 130 villages were randomly allocated to an intervention or control arm (1:1). Youth aged 14-19 years living in households receiving governmental cash transfers were invited to participate. The intervention included an intensive period (a 12-session course) and an aftercare period (9 months of mentoring, productive grants, and strengthened health services). We examined intervention impacts on a depressive symptoms scale (10-item Center for Epidemiologic Studies Depression Scale score (range, 0-30)) and rates of depressive symptomatology (score ≥10 points on the scale), recorded at study baseline (April-June 2017), midline (May-July 2018), and endline (June-August 2019). Using intention-to-treat methodology, we employed logistic and generalized linear models to estimate effects for binary and continuous outcomes, respectively. Quantile regression was used to estimate effects across the scale. From 2,458 baseline participants, 941 intervention and 992 control adolescents were reinterviewed at both follow-ups. At endline, the intervention reduced the odds of depressive symptomatology (adjusted odds ratio = 0.67, 95% confidence interval: 0.52, 0.86), with an undetectable mean scale difference (risk difference = -0.36, 95% confidence interval: -0.84, 0.11). Quantile regression results demonstrated an intervention effect along the upper distribution of the scale. Integration of multisectoral initiatives within existing social protection systems shows potential to improve mental health among youth in low-resource settings.

How Trauma, Depression, and Gender Roles Lead to Intimate Partner Violence Perpetration Among a Sample of Predominately Low-Income Black, Indigenous, Men of Color: A Mixed Methods Study

Despite decades of research and significant efforts by practitioners and advocates, intimate partner violence (IPV) in the United States remains a public health issue that disproportionately affects racial/ethnic minorities. The lack of mixed methods and qualitative studies, particularly with Black, Indigenous, Men of Color (BIMOC), limits the field's ability to tease apart the complex, multifaceted aspects of IPV perpetration and minimizes diverse perspectives of how childhood trauma and key proximal factors culminate in IPV perpetration. An explanatory design, follow-up explanations model, was used with a sample of predominately low-income BIMOC in a batterer intervention program (BIP). Associations between IPV and theoretically supported factors (e.g., trauma symptoms, depression, gender roles) were examined using a cross-sectional survey (N = 67) with ordinary least squares regression. Following up, processes explaining how these factors might lead to IPV perpetration were explored using semistructured interviews (N = 11) with narrative analysis. Results indicate that depressive and posttraumatic stress disorder (PTSD) symptoms together predict men's IPV perpetration. Participants' collective narrative explains how key factors-such as adverse childhood experiences, PTSD, depression, social isolation, anger, and restricted emotionality-work together to culminate in IPV perpetration. Findings shed light on potential trajectories and antecedents that manifest in IPV perpetration, providing implications for practice techniques and program development with low-income BIMOC in BIPs.

Adverse Childhood Experiences (ACEs), Alcohol Use in Adulthood, and Intimate Partner Violence (IPV) Perpetration by Black Men: A Systematic Review

Intimate partner violence (IPV) is a serious social and public health problem in the United States. Adverse childhood experiences (ACEs) and alcohol use have been found to be associated with IPV perpetration; however, limited studies have examined the interrelationships of these variables among Black men. This is the first known study to systematically review and synthesize studies on the interrelationships of ACEs, alcohol use, and IPV perpetration among Black men. Comprehensive literature searches were conducted in PubMed and six EBSCOhost databases by a research librarian and two researchers. Twenty studies met inclusion criteria: empirical; available in English; included ACEs, alcohol use/substance abuse, and IPV perpetration variables in the analyses; and samples included Black/African American male IPV perpetrators aged ≥ 18 years. ACEs were found to be associated with IPV perpetration among Black men, but findings were mixed regarding the role of alcohol in relation to ACEs and IPV. Numerous ACE factors (1-6) were used across studies. However, findings regarding the co-occurrence of ACE factors are inconclusive because none of the studies examined the cumulative effects of exposure to more than one type of ACE on subsequent IPV perpetration. Implications for policy, practice, and research related to the interrelationships of ACEs, alcohol use, and IPV perpetration are provided. Future work is needed to better explicate the interrelationships among these constructs.

Intimate Partner Violence Predicts Posttraumatic Stress Disorder Severity Independent of Early Life and Deployment-Related Trauma in Deployed Men and Women Veterans

Intimate partner violence (IPV) refers to emotional, physical, and/or sexual abuse perpetrated by a current or former partner. IPV affects both genders, though little is known about its effects on men as victims. The aims of this study were to determine if IPV is a factor contributing to posttraumatic stress disorder (PTSD) severity independently of deployment-related trauma, and to determine if there are gender differences in these associations. Participants were 46 female and 471 male post-9/11 veterans. Four sequential regressions were employed to examine the independent contribution of IPV among multiple trauma types on PTSD severity in men and women at two epochs, post-deployment (participants were anchored to deployment-related PTSD symptoms) and current (within the past month). Models were significant for both epochs in men (ps < .001) but not in women (ps > .230). In men, IPV independently predicted PTSD severity in both epochs (β > .093). However, in women, early life trauma (β = .284), but not IPV was a significant and independent predictor for current PTSD. Thus, there are distinct gender differences in how trauma type contributes to PTSD symptom severity. Although the statistical models were not significant in women, we observed similar patterns of results as in men and, in some cases, the β was actually higher in women than in men, suggesting a lack of power in our analyses. More research is clearly needed to follow-up these results; however, our findings indicate that IPV is a contributing factor to PTSD severity in veterans.

Intimate Partner Violence Among Women Accessing HIV-Care Services at Tertiary Hospitals in Ogun State, Nigeria: Implications for Policy and Practice

Intimate partner violence is both a predisposing factor for and sequelae of HIV infection. It is more likely for HIV-positive women to experience intimate partner violence compared with HIV-negative women. Previous researches have described the other risk factors for intimate partner violence. This cross-sectional study identified the correlates of intimate partner violence among HIV-positive women accessing HIV-care. We interviewed 458 women accessing HIV-care at the three tertiary hospitals in Ogun State, Nigeria. Trained research assistants conducted 10-min structured interviews with validated questionnaires. We carried out descriptive, bivariate, and regression analyses. We used the backward elimination technique to build a model to predict the experience of intimate partner violence (IPV) within the preceding 12 months. We set the level of significance at .05. A total of 23 (5.02%) participants reported IPV within the preceding 12 months, while the prevalence of lifetime intimate partner violence was 24.02%. Younger age, the experience of IPV in previous relationships, and having multiple sex partners were related to the experience of IPV within the preceding 12 months (p < .05). Also, the partners' age, alcohol intake, and current smoking status were associated with the experience of IPV within the preceding 12 months (p < .05). After regression analysis, participants' age (adjusted odds ratio [AOR] = 0.892, 95% confidence interval [CI] = [0.831, 0.957]), experience of IPV in previous relationship (AOR = 12.841, 95% CI = [4.303, 38.318]), and partners' current smoking status (AOR = 4.874, 95% CI = [1.252, 18.969]) retained association with the experience of IPV within the preceding 12 months. IPV among HIV-positive women accessing HIV-care occurs in a complicated, context-specific way. Routine HIV strategies and services should include interventions that involve men and address gender power imbalances. For effectiveness, specific interventions must consider women's' specific context and characteristics.

Stepping Stones and Creating Futures: A group-based approach to addressing violence against women through working with men

In low- and middle-income countries, group-based interventions to address intimate partner violence (IPV) working with men, whether or not they are violent themselves, are increasingly common. Stepping Stones and Creating Futures (SSCF) is one intervention demonstrating reductions in men's perpetration of IPV through working with men around gender inequalities and livelihoods. Using a case study of Thembani, a young man living in an urban informal settlement in South Africa who was a participant within a large randomized controlled trial evaluating SSCF, we discuss how his use of violence changed. This reduction occurred through recognition that his situation was not a personal failing, but similar to others, thus reducing the shame he felt, learning to control his anger, and starting to understand how others felt when he used his power over others. This case study provides some initial evidence about how group-based interventions working with men may start to transform men's practices.

Characteristics of Childhood Family Violence Experiences in Spanish Batterers

Intimate Partner Violence (IPV) constitutes a major public health problem worldwide. The existing links between childhood family violence experiences and perpetration of IPV during adulthood suggest that violence is transmitted across generations. The aims of this study were to provide new insights into characteristics of the history of childhood family violence in a sample of Spanish convicted male batterers and to examine what typology of batterer (specialist or generalist) is more likely to have had different types of childhood experiences of violence in the family context. Participants were 740 men convicted of IPV whose ages ranged from 18 to 71 years old (M = 39.74; SD = 10.01). Of them, 305 men were classified as specialist batterers, and 391 men were classified as generalist batterers. Participants completed a questionnaire made ad hoc regarding family of origin violence and sociodemographic aspects. Results showed that, in comparison with generalist batterers, specialist batterers had higher likelihood of having experienced child abuse or maltreatment during their childhood, having experienced physical punishment and child neglect, having their father as the aggressor of such experienced situations of abuse, or maltreatment. Likewise, specialist batterers had higher likelihood of having been witnesses of family violence, having witnessed physical and psychological violence in the family, having witnessed their mother and siblings being the victims and their father being the aggressor when family violence occurred. This study emphasized the need for identifying children exposed to direct and indirect family violence because they could be a vulnerable group for future IPV perpetration. Moreover, variables related to childhood family violence must be considered when developing intervention treatment programs focused on male specialist batterers.

Opportunities for technologically driven dialogical health communication for participatory interventions: Perspectives from male peer navigators in rural South Africa

There is increasing interest in the potential to deliver participatory dialogical HIV and intimate partner violence (IPV) prevention interventions via digital platforms, though the majority of mHealth interventions have been didactic in approach. We undertook 10 in-depth interviews with male Peer Navigators (PNs) who had been extensively trained and working on a larger intervention promoting young people's sexual and reproductive rights, in rural KwaZulu-Natal. Interviews focused on their, and their peers', use of technology in their everyday lives. Data were transcribed and translated, and subjected to thematic analysis. PNs described structural barriers to the use of technology, including poor connectivity, high data costs, and erratic electricity. They primarily used Facebook and WhatsApp for communication and highlighted how reading messages asynchronously was important to overcome connectivity challenges. PNs shared how groups were primarily for information sharing, they also discussed ‘sensitive’ issues online. Privacy was a concern, especially for conversations, and there was recognition of how confidentiality could be breached. It was also felt that WhatsApp could potentially support greater openness in discussions. We reflect on the potential for online interventions to support dialogical health communication, highlighting how dialogical health communication may be enabled through information provision, the asynchronous communication enhancing the potential for reflection, and greater participation in discussion by those who are shyer. Despite this potential there remain important risks around privacy of discussions and how to implement these approaches online.

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Qualitative research with young men showed high levels of cellphone usage.

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Emphasizes the importance of sharing information and personal discussions online.

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Suggests potential opportunities for discussion and reflection via WhatsApp.

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Recognises limitations of WhatsApp communication for health communication.

Evaluating the effects of two alcohol reduction counseling interventions on intimate partner violence perpetration: secondary analysis of a three-arm randomized controlled trial among Vietnamese men with HIV

BACKGROUND AND AIMS

Evidence suggests that alcohol reduction interventions decrease intimate partner violence (IPV) perpetration, although this remains untested in low- and middle-income countries and among men with human immunodeficiency virus (HIV). This study evaluates the effectiveness of alcohol reduction counseling interventions on IPV perpetration among men on anti-retroviral therapy (ART) and tests whether alcohol use explains the intervention effects.

DESIGN

Secondary analysis of data from a three-arm randomized controlled trial among ART patients with hazardous alcohol use. Participants were recruited from March 2016 to May 2017.

SETTING

Thai Nguyen, Vietnam.

PARTICIPANTS, INTERVENTIONS AND COMPARATORS

Male participants (n = 426). Participants received a two-session brief intervention (BI), a six-session combined intervention (CoI) or the standard of care (SOC), comprising alcohol treatment referrals. Alcohol reduction counseling interventions were guided by cognitive-behavioral therapy and motivational enhancement therapy delivered by psychosocial counselors over 3 months.

MEASUREMENTS

IPV perpetration was measured using the shortened Conflict Tactics Scale 2 and alcohol use was measured using timeline followback.

FINDINGS

BI and CoI participants reported reduced IPV perpetration at 3 months compared with SOC participants [BI: adjusted odds ratio (aOR) = 0.27, 95% confidence interval (CI) = 0.11, 0.65; CoI: aOR = 0.50, 95% CI = 0.22, 1.13]; the association was only significant for the BI group. Intervention effects were not sustained at 6 and 12 months. There was little evidence that alcohol use acted as a mediator (indirect effect, BI: aOR = 0.84, 95% CI = 0.63, 1.04; indirect effect, CoI: aOR = 0.86, 95% CI = 0.66, 1.03).

CONCLUSIONS

Among Vietnamese men receiving anti-retroviral therapy, alcohol reduction counseling interventions appeared to reduce intimate partner violence perpetration immediately post-intervention, but reductions were not sustained at 6 and 12 months and were not explained by alcohol reduction.

Prevalence and factors associated with experience of corporal punishment in public schools in South Africa

Background

Corporal punishment (CP) is still a common practice in schools globally. Although illegal, studies in South Africa report its continued use, but only a few have explored factors associated with school CP. Moreover, extant studies have not shown the interrelationships between explanatory factors. This study aimed to determine the prevalence and factors associated with learners’ experiences, and to examine pathways to the learners’ experiences of CP at school.

Method

3743 grade 8 learners (2118 girls and 1625 boys) from 24 selected public schools in Tshwane, South Africa, enrolled in a cluster randomised controlled trial evaluating a multi-component school-based intervention to prevent intimate partner violence, and completed self-administered questionnaires. We carried out descriptive analysis, simple linear and structural equation modelling to examine factors and pathways to the learners’ experience of CP at school.

Results

About 52% of learners had experienced CP at school in the last 6 months. It was higher among boys compared to girls. Experience of CP at school amongst learners was associated with learner behavior, home environment, and school environment. Learners from households with low-socio economic status (SES) had an increased risk of CP experience at school. Amongst boys, low family SES status was associated with a negative home environment and had a direct negative impact on a learner’s mental health, directly associated with misbehavior.

Conclusion

CP in public schools in South Africa continues despite legislation prohibiting its use. While addressing learner behaviour is critical, evidence-based interventions addressing home and school environment are needed to change the culture among teachers of using corporal punishment to discipline adolescents and inculcate one that promotes positive discipline.

The Relationship Between Exposure to Violence in the Family of Origin During Childhood, Psychological Distress, and Perpetrating Violence in Intimate Relationships Among Male University Students

Witnessing or experiencing violence early in childhood is a significant risk factor for later perpetration of intimate partner violence (IPV) by men against women. Despite a large body of research on the topic, there is a need for more specific information about how differing patterns of family violence might pose distinct risks of later mental health problems and violence perpetration. Using a self-administered questionnaire, a cross-sectional survey was conducted among 745 male university students in Israel (age = 21-43, M = 25.56, SD = 3.172) to examine the effects of their exposure to family violence (i.e., parent-to-child psychological aggression [PA] and physical violence [PV] and witnessing interparental PA and PV) on their use of IPV. This study also examined whether psychological distress mediates the relationship between family violence exposure (witnessing or experiencing) and later IPV perpetration. Results indicate that experiencing PA and PV in childhood and current psychological distress predict significantly current IPV perpetration. Results also revealed that psychological distress mediates only the relations between participants experiencing parental violence and their PA against intimate partners. However, results showed that higher rates of participants witnessing interparental violence correlate significantly with lower rates of their PV against intimate partners; this relationship was not mediated by their psychological distress. It was also found that experiencing parental violence has significant direct and indirect positive effect on participants' PV against intimate partners. The limitations of the study and the implications of its results are discussed.

The mediating role of emotion regulation strategies in the relationship between family of origin violence and intimate partner violence

The effects of family of origin violence and intimate partner violence have been extensively documented; however, very few studies have examined the interaction with emotion regulation strategies. Thus, the objective of this research was to analyze whether different types of emotion regulation strategies, both adaptive and maladaptive, mediate the relationship between family of origin violence and intimate partner violence in the Mexican population. A total of 838 participants (45.9% men and 54.1% women) responded to instruments addressing family of origin violence, emotion regulation strategies, and intimate partner violence. The results revealed that both structural models were significant. For women, the model showed an adequate fit X2 (11, N = 838) = 22.75, p = .288, GFI = .95, AGFI = .91, NFI = .98, CFI = .97, RMSEA = .05. Likewise, we found similar indexes for men X2 (11, N = 838) = 28.20, p = .348, GFI = .97, AGFI = .93, NFI = .97, CFI = .95, RMSEA = .04. Specifically, the direct effects of adaptive strategies on intimate partner violence were statistically significant. Meanwhile, the direct effects of family of origin violence on maladaptive emotion regulation strategies were significant, as were the direct effects of maladaptive strategies on intimate partner violence. In turn, the indirect effects of family of-origin violence were significantly related to intimate partner violence via maladaptive emotion regulation strategies. In addition, the results clearly showed that men reported higher levels of aggression against women. Finally, regarding the selection of emotion regulation strategies, while women employed more adaptive emotion regulation, men showed a more definite tendency to use maladaptive emotion regulation.

From Exposure to Family Violence During Childhood to Depression in Adulthood: A Path Analysis on the Mediating Effects of Intimate Partner Violence

Literature shows a link between adverse childhood experiences and subsequent depression, but there is a lack of concrete evidence on whether victimization of intimate partner violence (IPV) in adulthood plays significant roles in that link. This study aimed to test the mediating effect of adulthood IPV victimization in the associations between exposure to family violence in childhood and adulthood depression. Exposure to family violence in childhood was operationalized as one's experiences of child abuse and witnessing parental IPV in childhood. This study also tested the effects of other violence-related factors from the Personal and Relationships Profile, including one's antisocial personality, borderline personality, dominance, posttraumatic stress (PTS) symptoms, and violence approval, on the associations. A path analysis was conducted a cross-sectional survey study sample recruited between 2009 and 2010. The sample was 8,807 adults selected with a multistage stratified sampling procedure from six cities in China (43.4% male; M age = 40.61 years, SD = 8.93). The main outcome was participants' depressive symptoms during the past 2 weeks. As predicted, the path model suggests that IPV victimization significantly mediated the associations between exposure to family violence in childhood and adulthood depression. Violence approval and PTS symptoms, but not the other violence-related factors, significantly mediated the above associations. Findings warrant the need to identify individuals with exposure to family violence in early stages, and to provide them with suitable intervention programs to prevent subsequent IPV as well as to minimize the negative impacts of the exposure to family violence in childhood.

Understanding How Relational Health Effects Intimate Partner Violence Perpetration among Low-Income, Black, Indigenous, Men of Color Exposed to Adverse Childhood Experiences: An Exploratory Study

Relational health has emerged as a consistent factor that can mitigate the effects of trauma among children; however, less is known about relational health with adults, particularly related to intimate partner violence (IPV) perpetration among racially and socioeconomically marginalized men. The Exploratory Sequential Design, Taxonomy Development Model was used. Semi-structured interviews (N = 11) and narrative analysis were conducted in Phase I. In Phase II, variables approximating the key themes that emerged in Phase I were selected from an existing dataset (N = 67), and relationships were examined using bivariate associations. The sample consisted of low-income Black, Indigenous, men of color (BIMOC) in a batterer intervention program (BIP). Adverse life experiences shaped participants' world view via mistrust in others, stifling emotions and vulnerability, and a sense of personal guilt and shame. These orientations were then carried into adult relationships where men coped using social isolation to manage challenges, negatively affecting intimate relationships. For some men, mental health exacerbated these circumstances. Significant bivariate and multivariate associations supported this narrative. This study lays the foundation for future research to examine the potential effects of social support on IPV perpetration. BIPs should consider augmenting programming to enhance men's social networks to support their use of nonviolence after program completion.

Adverse Childhood Experiences and Early Maladaptive Schemas as Predictors of Cyber Dating Abuse: An Actor-Partner Interdependence Mediation Model Approach

The increasing role that new technologies play in intimate relationships has led to the emergence of a new form of couple violence, cyber dating abuse, especially among adolescents and young adults. Although this phenomenon has received increased attention, no research has investigated predictors of cyber dating abuse taking into account the interdependence of the two partners. The study examines adverse childhood experiences (abuse, neglect, and witnessed intimate partner violence) and early maladaptive schemas (emotional deprivation and abandonment) as possible predictors of young adults' perpetrated and suffered cyber dating abuse. Adopting a dyadic approach, mediational models in which adverse childhood experiences were assumed to be related to individual and partner's cyber dating abuse through individual early maladaptive schemas were tested. 134 couples completed online self-reports of the variables of interest, including a bidimensional measure of cyber dating abuse assessing pressure-aggression and control-monitoring. Actor-partner interdependence mediation model analyses were conducted. Results indicated that the emotional deprivation schema mediated the association between adverse childhood experiences and cyber dating abuse, whereas the abandonment schema did not. Specifically, more frequent experiences of emotional abuse and physical neglect during childhood were indirectly related to increased likelihood of perpetrating cyber dating pressure-aggression as well as of perpetrating and suffering cyber dating control-monitoring in both males and females. These associations were mediated by a stronger internalization of the emotional deprivation schema and were supported by both self-reported and partner-reported data. Also, a strong and direct association was found between childhood exposure to intimate partner violence by the opposite-sex parent and cyber dating pressure-aggression by females or control-monitoring by both males and females. These findings help to clarify the potential negative effects of specific adverse childhood experiences and early maladaptive schemas on the tendency to perpetrate and suffer cyber abuse in romantic relationships. The implications for prevention and treatment programs are noted and avenues for future research are described.

Traumatic Experiences and PTSD Symptoms in the Chinese Male Intrafamilial Physical Violence Perpetrators: A Comparative and Structural Equation Modeling Study

We aimed to compare traumatic experiences among the groups of perpetrators with or without violent pedigree, and establish a structural model of posttraumatic stress disorder (PTSD) symptoms as mediators of traumatic experiences and severe intrafamilial physical violence among Chinese male perpetrators. A cross-sectional survey and a face-to-face interview were conducted to examine intimate partner violence (IPV) perpetration and violent pedigree, childhood maltreatment, other traumatic events, PTSD symptoms, and severe intrafamilial physical violence in a community sample of 229 abusive men and 303 controlled men in China. Using structural equation modeling (SEM) techniques, the scores of the questionnaires were entered into the theoretical model and calculated. Findings demonstrated that the numbers of the traumatic events in four groups were significantly different with a declining trend, and the SEM data had an adequate fit. The loadings of pathways from childhood witness domestic violence (DV) to severe physical violence (SPV) were more salience than other pathways, and the indirect effect of every pathway, except for the childhood witness DV to PTSD symptoms, on severe intrafamilial physical violence in the model was significant. The results suggest that PTSD symptoms cluster as mediator of the intergenerational transmission of SPV perpetration in Chinese abusive men. Childhood witness IPV has effects on adulthood perpetration of IPV.

Alcohol use, depressive symptoms, and intimate partner violence perpetration: A longitudinal analysis among men with HIV in northern Vietnam

Background

While the link between alcohol use and male-perpetrated intimate partner violence (IPV) has been well-established, research is needed to test whether psychosocial factors interact with alcohol use to exacerbate IPV perpetration. We tested whether depressive symptoms influenced the strength and/or direction of the alcohol-IPV relationship among men with HIV in Vietnam.

Methods

This study is a secondary analysis using data from a randomized controlled trial conducted in Thai Nguyen, Vietnam. Participants were clinic patients with HIV and hazardous alcohol use. Questionnaires were administered at baseline, three, six, and 12 months. Alcohol use was assessed as proportion of days alcohol abstinent. Analyses were restricted to males who reported being married/cohabitating at baseline (N = 313). Multilevel growth models were used to test whether time-varying depressive symptoms modified the time-varying effect of alcohol use on IPV perpetration.

Results

Time-varying depressive symptoms modified the effect of proportion of days alcohol abstinent on IPV perpetration. However, the pattern of effect modification was not as expected, as reporting depressive symptoms weakened the alcohol-IPV relationship. At times when participants screened negative for depressive symptoms, those who reported higher proportion of days alcohol abstinent than usual had significantly lower odds of IPV perpetration (Odds Ratio [OR] = 0.17, 95% Confidence Interval 0.06, 0.45, p = 0.0004). At times when participants screened positive for depressive symptoms, there was no observed effect of alcohol use on IPV perpetration (OR = 4.28, 95% CI 0.80, 22.78, p = 0.09).

Conclusion

The findings highlight the complex nature of the alcohol-IPV relationship and the need to investigate the intersection between hazardous drinking, mental health, and IPV. Men who concurrently report depressive symptoms and heightened alcohol use may be socially isolated from an intimate partner or experiencing fatigue, leading to less alcohol-related IPV perpetration. Mental health interventions addressing depression and alcohol misuse integrated into HIV services may reduce IPV perpetration.

Perpetration of Intimate Partner Violence Among Men Living with HIV in Northern Vietnam

We examined the prevalence of intimate partner violence (IPV) perpetration and characteristics of HIV-infected male perpetrators. The cross-sectional study was conducted in Vietnam with male antiretroviral treatment clients (N = 1099; mean age = 40.2 years). Bivariable associations were tested between psychological or physical/sexual IPV perpetration in the last 12 months and sociodemographic, psychosocial, and sexual behavioral factors using prevalence ratios. Factors significant at p < 0.10 were entered in multivariable models for each IPV outcome using a modified Poisson approach. Results showed 15.6% (N = 171/1099) reported perpetrating psychological IPV and 7.6% (N = 84/1099) perpetrating physical/sexual IPV in the last 12 months. HIV risk behaviors, including hazardous drinking and multiple sexual partners, having witnessed interparental violence as a child, and depressive symptoms were associated with perpetrating IPV. HIV interventions targeting HIV-infected men in Vietnam should intervene on IPV perpetration by addressing the co-occurring factors of sexual risk, depression, alcohol use, and child maltreatment that are correlated with IPV.

Exploring adversities among parents convicted of killing their children

Experiencing adversities has been associated with the use of violence but this has not been explored with filicide offenders in South Africa. Individual, semi-structured interviews were conducted with 22 parents/stepparents/caregivers convicted of child homicide in South Africa, resulting in 49 in-depth interviews. Data were analyzed by means of grounded theory. Using an ecological framework, this study alludes to the widespread and cumulative nature of violence and trauma experiences within multiple domains of the participants' lives. The study highlighted the absence of support in the aftermath of experiencing trauma, possibly resulting in these parents lacking resources to mitigate the sequelae of adverse experiences. This study calls for trauma related, mental health components to be integrated into violence interventions and for these to address the impact of trauma at the individual, family, and societal levels, to prevent the transition from victim to offender.

Longitudinal analysis of alcohol use and intimate partner violence perpetration among men with HIV in northern Vietnam

BACKGROUND

Alcohol use is a known risk factor for male-perpetrated intimate partner violence (IPV), although few studies have been conducted globally and among men with HIV (MWH). We estimated the longitudinal effects of alcohol use on IPV perpetration among MWH.

METHODS

This study is a secondary analysis of randomized controlled trial data among male and female antiretroviral treatment patients with hazardous alcohol use in Thai Nguyen, Vietnam. Analyses were restricted to male participants who were married/cohabitating (N = 313). Alcohol use was assessed as proportion days alcohol abstinent, heavy drinking, and alcohol use disorder (AUD) using the Timeline Followback and Mini International Neuropsychiatric Interview questionnaire. Multilevel modeling was used to estimate the effects of higher versus lower average alcohol use on IPV perpetration (between-person effects) and the effects of time-specific deviations in alcohol use on IPV perpetration (within-person effects).

RESULTS

Participants with higher average proportion days alcohol abstinent had decreased odds of IPV perpetration (adjusted Odds Ratio [aOR] = 0.43, p = 0.03) and those with higher average heavy drinking and AUD had increased odds of IPV perpetration (Heavy drinking: aOR = 1.05, p = 0.002; AUD: aOR = 4.74, p < 0.0001). Time-specific increases in proportion days alcohol abstinent were associated with decreased odds of IPV perpetration (aOR = 0.39, p = 0.02) and time-specific increases in AUD were associated with increased odds of IPV perpetration (aOR = 2.95, p = 0.001). Within-person effects for heavy drinking were non-significant.

CONCLUSIONS

Alcohol use is associated with IPV perpetration among Vietnamese men with HIV. In this context, AUD and frequent drinking are stronger correlates of IPV perpetration as compared to heavy drinking.

Correlates of intimate partner violence among urban women in sub-Saharan Africa

Introduction

The dynamics of intimate partner violence (IPV)—one of the world’s leading public health problems—in urban Africa remain poorly understood. Yet, urban areas are key to the future of women’s health in Africa.

Study objectives

We explored survivor-, partner-, and household-level correlates of prevalence rates for types of IPV in urban SSA women.

Method

The study uses DHS data from 42,143 urban women aged 15–49 in 27 SSA countries. Associations at the bivariate level were examined using the Pearson Chi-square test. The modified Poisson regression test estimated the relative prevalence of IPV subtypes in the study population at the multivariate level.

Results

Approximately 36% of women in urban SSA experienced at least one form of IPV; 12.8% experienced two types; and 4.6% experienced all three types. SSA urban women who had only primary-level education, had 3 or more living children, were informally employed, were in polygynous unions, or who approved of wife-beating similarly displayed higher adjusted prevalence rates for all three forms of IPV compared respectively to their counterparts without formal education, without a living child, were unemployed, in monogamous unions, or who do not approve of wife-beating. On the other hand, the region’s urban women who began cohabiting between ages 25 and 35 years or who lived in higher wealth households showed consistently lower adjusted prevalence rates for all three forms of IPV relative to their counterparts who began cohabiting before 18 years or who lived in lower wealth households. Compared to their counterparts without formal education, without a living child, or whose partners did not have formal education, women with secondary and higher education, with 1–2 living children, or whose partners had only primary level schooling displayed higher adjusted prevalence rates for both IPEV and IPPV, but not for IPSV. However, relative to their counterparts whose partners were aged 25 years or below, living with a partner aged 40 years and above was associated with statistically significant reduced prevalence rates for IPPV and IPSV, but not for IPEV. Only for IPPV did women with partners educated at secondary and above levels display statistically significant higher adjusted prevalence rates relative to their counterparts with uneducated partners. Also, solely for IPPV did women who began cohabiting between ages 18 and 24 years or whose partners were employed (whether formally or informally) show decreased adjusted prevalence rates relative to their counterparts who started cohabiting before 18 years or whose partners were unemployed. In addition, only for IPSV did women aged 40 years and above or living in middle wealth households show statistically significant reduced adjusted prevalence rates relative to their counterparts aged less than 25 years or living in lower wealth households.

Discussion and conclusion

By 2030, the majority of SSA women will be urban dwellers. Complexities surround IPV in urban SSA, highlighting the unique dynamics of the problem in this setting. While affirming the link between IPV and marital power inequities and dynamics, findings suggest that the specific correlates of prevalence rates for different IPV sub-types in urban SSA women can, at once, be both similar and unique. The contextual drivers of the differences and similarities in the correlates of the prevalence rates of IPV sub-types among the region’s urban women need further interrogation.

Emerging partner violence among young adolescents in a low-income country: Perpetration, victimization and adversity

Background

Intimate partner violence (IPV) is prevalent in high- as well as low-income contexts. It results in a substantial public health burden and significant negative socioeconomic and health outcomes throughout the life-course. However, limited knowledge exists about IPV during early adolescence. This period is critical during the transition to adulthood for at least two reasons: it is when the majority of adolescents in low-income countries first encounter dating, sexuality and partnerships, often with older adolescents or adults, and it is also the period when lifelong patterns of violence and norms about acceptable IPV are formed. The current study is one of the first to measure IPV prevalence among young adolescents in a low-income setting, examine the potential etiology, and investigate relationships with gender ideology, poverty, mental health and childhood adversity.

Methods

We surveyed 2,089 adolescents aged 10–16 in Malawi using standardized instruments. We estimated the prevalence of IPV, and use multivariate logistic regression to test potential correlates.

Results

More than a quarter (27%) of ever-partnered adolescents in Malawi report being victimized. A substantial proportion of both male and female adolescents (15%) report committing violence against their partner. Girls were more likely than boys to report being a victim of sexual IPV (24% versus 8%), and boys more likely to perpetrate such (9% versus 1%). Almost 10% of the sample had both committed and been a victim of IPV. Cumulative childhood adversity (e.g., physical abuse, witnessing domestic violence) was a consistent and strong correlate of IPV victimization (adjusted odds ratio (aOR) 1.30) and of perpetration (aOR 1.35). Depression and PTSD were likewise associated with IPV victimization in the overall sample. Notably, gender ideology was not predictive of either victimization or perpetration, even among boys.

Conclusions

IPV is common for both male and female young Malawian adolescents, and includes both victimization and perpetration. IPV compounds other adversities experienced by adolescents in this low-income setting, and it is rarely alleviated through help from the health system or other formal support. These findings underscore the need to intervene early when interventions can still break destructive pathways and help foster healthier relationships. This focus on early adolescence is particularly critical in low-income countries given the early onset and rapid pace of the transition to adulthood, with sexual activity, dating and partnership thus being common already in young adolescence. Promising interventions would be those that reduce violence against or around children, as well as those that reduce the impacts of such trauma on mental health during adolescence.

Associations Between Lifetime Traumatic Experiences and HIV-Risk Behaviors Among Young Men Living in Informal Settlements in South Africa: A Cross-Sectional Analysis and Structural Equation Model

Supplemental Digital Content is Available in the Text.

Background:

Qualitative research emphasizes men's experiences of trauma increase HIV risk. We seek to understand associations between experience of traumatic events and HIV-risk behaviors among heterosexual men in 2 trials in urban informal settlements in South Africa.

Methods:

Cross-sectional surveys among men in Johannesburg and Durban, South Africa, enrolled in intervention trials. Adjusted logistic regression and structural equation modeling assessed associations between men's experiences of poverty and traumatic events, and HIV-risk behaviors (inconsistent condom use, transactional sex, and number of sex partners). We explored mediated pathways from trauma to HIV risk through mental health and alcohol, and gender attitudes.

Results:

Among 2394 men, in adjusted logistic regression, transactional sex and 4 or more sex partners were associated with witnessing the murder of a family member, witnessing a murder of a stranger, experiencing excessive pain, been kidnapped, and witnessing a rape. More consistent condom use was associated with witnessing the murder of a family member, being kidnapped, and witnessing a rape. In 3 separate structural equation modeling pathways were consistent, trauma directly increased transactional sex, and past year sexual partners, and increased consistent condom use. Risk was increased through mental health pathways, and gender inequitable attitudes and practices.

Conclusion:

Men's HIV-risk behaviors in this population emerge at the confluence of poverty, traumatic experiences, and gender inequalities. Effective HIV-prevention interventions needs to reduce men's experiences of poverty and trauma, transform gender norms, and reduce the mental health impact of trauma.

Violence against children and intimate partner violence against women: overlap and common contributing factors among caregiver-adolescent dyads

BACKGROUND

Intimate partner violence against women (IPV) and violence against children (VAC) are both global epidemics with long-term health consequences. The vast majority of research to date focuses on either IPV or VAC, however the intersections between these types of violence are a growing area of global attention. A significant need exists for empirical research on the overlap of IPV and VAC, especially in contexts with particularly high rates of both types of violence.

METHODS

This exploratory study includes secondary analysis of data from a cluster randomized controlled trial in Ugandan schools. Using baseline reports from a random sample of early adolescents attending school and their caregivers, this study uses a probability sample across all eligible schools of adolescent-caregiver dyads (n = 535). We categorized adolescent-caregiver dyads into four groups: those reporting VAC 'only', IPV 'only', both VAC and IPV, or 'no violence'. Two separate multinomial logistic regression models for male and female caregivers explored adolescent and caregiver characteristics associated with the VAC 'only', the IPV 'only', or the both VAC and IPV dyads, each compared to the 'no violence' dyad.

RESULTS

One third of dyads reported both IPV and VAC and nearly 75% of dyads reported VAC or IPV. Dyads reporting IPV were more likely to also report VAC. Common contributing factors for female caregiver-adolescent dyads with both VAC and IPV include lower SES, less caregiver education, higher caregiver mental distress, more frequent caregiver alcohol use, and caregivers who report less emotional attachment to their intimate partner. Male caregiver-adolescent dyads with both VAC and IPV included caregivers with less emotional attachment to their intimate partner and more attitudes accepting VAC.

CONCLUSIONS

Findings reveal a significant overlap of IPV and VAC and the importance for violence prevention and response programming to consider coordinated or integrated programming. Unique results for female and male caregivers highlight the importance of a gendered approach to addressing IPV and VAC intersections.

TRIAL REGISTRATION

The trial was registered at clinicaltrials.gov, NCT01678846, on September 5, 2012.

Violence against children and intimate partner violence against women: overlap and common contributing factors among caregiver-adolescent dyads

BACKGROUND

Intimate partner violence against women (IPV) and violence against children (VAC) are both global epidemics with long-term health consequences. The vast majority of research to date focuses on either IPV or VAC, however the intersections between these types of violence are a growing area of global attention. A significant need exists for empirical research on the overlap of IPV and VAC, especially in contexts with particularly high rates of both types of violence.

METHODS

This exploratory study includes secondary analysis of data from a cluster randomized controlled trial in Ugandan schools. Using baseline reports from a random sample of early adolescents attending school and their caregivers, this study uses a probability sample across all eligible schools of adolescent-caregiver dyads (n = 535). We categorized adolescent-caregiver dyads into four groups: those reporting VAC 'only', IPV 'only', both VAC and IPV, or 'no violence'. Two separate multinomial logistic regression models for male and female caregivers explored adolescent and caregiver characteristics associated with the VAC 'only', the IPV 'only', or the both VAC and IPV dyads, each compared to the 'no violence' dyad.

RESULTS

One third of dyads reported both IPV and VAC and nearly 75% of dyads reported VAC or IPV. Dyads reporting IPV were more likely to also report VAC. Common contributing factors for female caregiver-adolescent dyads with both VAC and IPV include lower SES, less caregiver education, higher caregiver mental distress, more frequent caregiver alcohol use, and caregivers who report less emotional attachment to their intimate partner. Male caregiver-adolescent dyads with both VAC and IPV included caregivers with less emotional attachment to their intimate partner and more attitudes accepting VAC.

CONCLUSIONS

Findings reveal a significant overlap of IPV and VAC and the importance for violence prevention and response programming to consider coordinated or integrated programming. Unique results for female and male caregivers highlight the importance of a gendered approach to addressing IPV and VAC intersections.

TRIAL REGISTRATION

The trial was registered at clinicaltrials.gov, NCT01678846, on September 5, 2012.

Intimate partner violence and incidence of depression in married women: A longitudinal study of a nationally representative sample

BACKGROUND

Intimate partner violence (IPV) has a serious detrimental effect on mental health outcomes. We aimed to investigate the association of verbal or physical IPV with incidence of depressive symptoms in both married women and men according to the victim-perpetrator role. The potential mediating role of verbal or physical IPV in the association between satisfaction level with family relationships or childhood adversity and the incidence of depressive symptoms in married adults was also explored.

METHODS

The Korea Welfare Panel Study (KOWEPS) in 2006 and 2007 dataset was analyzed for 9217 married respondents aged 19 years or older. Physical and verbal IPV was assessed according to victim-perpetrator role in 2006. Depressive symptoms were evaluated by the Center for Epidemiologic Studies Depression Scale, 11-item version in 2006 and 2007. Association of IPV with incidental depressive symptoms was investigated with logistic regression analysis fully-adjusted for all potential confounding factors.

RESULTS

The bidirectional role of verbal IPV and victimization by physical IPV led to incidence of depressive symptoms in married women. Verbal IPV significantly mediated the association between satisfaction level with the family relationship and incidental depressive symptoms in women.

LIMITATIONS

We did not investigate the influence of premorbid depressive symptoms on new-onset IPV.

CONCLUSIONS

This study is the first to demonstrate that gender and the victim-perpetrator role are critical moderating factors in the association between IPV and depressive symptom incidence using a nationally representative sample.

Associations between poverty, mental health and substance use, gender power, and intimate partner violence amongst young (18-30) women and men in urban informal settlements in South Africa: A cross-sectional study and structural equation model

Research suggests that poverty is a key driver of intimate partner violence (IPV), however detailed analysis suggests that this relationship is not clear, either for women’s experience or men’s perpetration of IPV. We explored associations between poverty and IPV using cross-sectional data from the Stepping Stones and Creating Futures cluster randomized control trial, in urban informal settlements in Durban, South Africa, with young (18–30) people. Using logistic regression and structural equation modelling we assess associations between poverty and women’s experience and men’s perpetration of physical and/or sexual IPV in the past 12 months. 680 women and 677 men were recruited into the study between September 2015 and September 2016. The analyses highlight how specific forms or measures of poverty intersecting with gender identities shape IPV. For men we found indicators of economic provision were associated with IPV perpetration, while for women food-insecurity was key to IPV experience. We also found similarities between women and men. First, food-insecurity and childhood traumas shaped pathways to substance misuse and poor mental health that increased IPV. Second, there was a resilience pathway in both models, whereby those with more education had increased gender equitable attitudes and fewer controlling behaviours, which reduced IPV. Interventions to reduce IPV need to work to reduce household food insecurity, but these need to be combined with gender transformative interventions. Interventions should also focus on reducing the impact of mental health and substance misuse. Finally, working to increase educational attainment is a long-term critical intervention to reduce IPV.

Trial registration:NCT03022370. Registered 13 January 2017, retrospectively registered.

Intimate partner violence during pregnancy in relation to non-psychotic mental health disorders in Rwanda: a cross-sectional population-based study

OBJECTIVES

To investigate the prevalence of non-psychotic mental health disorders (MHDs) and the association between exposure to all forms of intimate partner violence (IPV) during pregnancy and MHDs.

DESIGN

Cross-sectional population-based study conducted in the Northern Province of Rwanda and Kigali city.

PARTICIPANTS AND SETTINGS

Totally, 921 women who gave birth ≤13 months before being interviewed were included. Simple random sampling was done to select villages, households and participants. Community health workers helped to identify eligible participants and clinical psychologists, nurses or midwives conducted face-to-face interviews. The collected data were analysed using descriptive statistics and bivariable and multivariable logistic regression modelling RESULTS: The prevalence rates of generalised anxiety disorder, suicide ideation and post-traumatic stress disorder (PTSD) were 19.7%, 10.8% and 8.0%, respectively. Exposure to the four forms of IPV during pregnancy was highly associated with the likelihood of meeting diagnostic criteria for each of the non-psychotic MHDs investigated. Physical, psychological and sexual violence, showed the strongest association with PTSD, with adjusted ORs (aORs) of 4.5, 6.2 and 6.3, respectively. Controlling behaviour had the strongest association with major depressive episode in earlier periods with an aOR of 9.2.

CONCLUSION

IPV and MHDs should be integrated into guidelines for perinatal care. Moreover, community-based services aimed at increasing awareness and early identification of violence and MHDs should be instituted in all villages and health centres in Rwanda. Finally, healthcare providers need to be educated and trained in a consistent manner to manage the most challenging cases quickly, discreetly and efficiently.

Mental ill health and factors associated with men's use of intimate partner violence in Zimbabwe

Background

Over the years, researchers have relied on data from women victims to understand the profile on male perpetrators of intimate partner violence (IPV). IPV studies with male participants in the general population are still emerging in Africa. The contribution of mental ill health to IPV perpetration in the general population that has been documented elsewhere is emergent. Notwithstanding, research with male perpetrators is essential to informing effective prevention programmes and interventions. To contribute to the emerging literature on male perpetrators, we conducted a study to estimate the prevalence and factors associated with IPV perpetration by men in heterosexual relationships. We also modelled pathways to IPV perpetration using data from Zimbabwe.

Methods

Data were collected through a nationwide survey employing a random and multi-staged sampling method. We recruited and administered a structured questionnaire to 2838 men aged 18 years and above. IPV was measured using an adapted WHO Domestic Violence Questionnaire. Determinants of IPV measured included child abuse, alcohol abuse, post-traumatic stress disorder (PTSD), depressive symptoms, personal gender attitudes and risky sexual behaviours. Multivariate regression modelling was used to assess factors associated with IPV perpetration. Structural equation modelling was used to explore the underlying pathways to recent IPV perpetration.

Results

Forty one percent of men had perpetrated IPV in their lifetime and 8.8% percent of men perpetrated IPV in the 12 months before the survey. Older, more educated men, men who binge drank, men who were abused as children or experienced other life traumatic experiences were more likely to perpetrate IPV in lifetime. Depressive symptoms and sexual relationship power (were also associated with lifetime IPV perpetration. IPV perpetration in the last 12 months was associated with binge drinking, PTSD and sexual relationship power. The pathways to IPV perpetration in the last 12 months from child abuse to recent IPV were mediated by comorbid PTSD symptoms, depression binge drinking and sexual relationship power.

Conclusions

IPV perpetration was associated with child abuse history, mental ill health, sexual relationship power and personal gender attitudes. Interventions to reduce IPV need to engage men to address gender inequality, mental ill health and reduce alcohol consumption.

Prevalence and risk factors of physical or sexual intimate violence perpetration amongst men in four districts in the central region of Ghana: Baseline findings from a cluster randomised controlled trial

BACKGROUND

Evidence-based interventions are essential in the prevention of violence against women (VAW). An understanding of risk factors for male perpetration of VAW using population-based research is crucial for developing such interventions. This study is a baseline assessment of a two-arm unmatched cluster randomised controlled trial (C-RCT), set up to assess the impact of a Rural Response System (RRS) intervention for preventing violence against women and girls in Ghana. This study aims at assessing past year prevalence and risk factors for sexual or physical intimate partner violence (IPV) perpetration among men.

METHODS

The population-based survey involved 2126 men aged 18 and above living in selected communities in 4 districts in the central region of Ghana. Logistic regression techniques were used to determine risk factors for sexual or physical IPV perpetration. All models adjusted for age of respondent and took into account the study design.

RESULTS

Half of the men had perpetrated at least one form of violence against their intimate partners in their lifetime while 41% had perpetrated sexual or physical IPV. Majority (93%) of the men had been in relationships in the 12 months preceding the survey, and of these, 23% had perpetrated sexual or physical IPV. Childhood factors associated with sexual or physical IPV included witnessing abuse of mother (aOR:1.40(1.06-1.86)), and neglect (aOR:1.81(1.30-2.50)). Other major risk factors for IPV perpetration were: having multiple partners (aOR:1.76(1.36-2.26)), (involvement in transactional sex (aOR:1.76(1.36-2.26)), substance use (aOR:1.74(1.25-2.43)) and gender inequitable attitudes (aOR:0.94(0.91-0.97)).

CONCLUSION

Childhood violence experience and witnessing, risky behaviour (multiple partners, transactional sex, substance use) and gender inequitable attitudes are major risk factors for sexual or physical IPV perpetration. Perpetration of sexual or physical IPV tend to co-occur with non-partner violence and emotional IPV perpetration. Interventions targeting these factors are critical in reducing IPV.

Children bereaved by fatal intimate partner violence: A population-based study into demographics, family characteristics and homicide exposure

BACKGROUND

In the context of violence against women, intimate partner homicide increasingly receives research and policy attention. Although the impact of losing a parent due to intimate partner homicide is intuitively obvious, little is known about the children involved. We aimed to identify all children bereaved by parental intimate partner homicide in the Netherlands in the period 2003-2012, describe their demographics and family circumstances, and assess their exposure to prior violence at home and to the homicide itself.

METHODS AND FINDINGS

We cross-examined 8 national data sources and extracted data about children's demographics and circumstances prior to, and during the homicide. Our primary outcomes were prior violence at home (child maltreatment, neglect or domestic violence) and homicide witness status (ranging from being at a different location altogether to being present at the scene). During the decade under study, 256 children lost a biological parent due to 137 cases of intimate partner homicide. On average, the children were 7.4 years old at the time of the homicide (51.1% were boys; 95% CI 47.3-54.7) and most lost their mother (87.1%; full population data). Immigrant children were overrepresented (59.4%; 95% CI 52.8-66.0). Of the children for whom information about previous violence at home was gathered, 67.7% (95% CI 59.7-73.7) were certainly exposed and 16.7% (95% CI 11.3-22.2) probably. Of the children who had certainly been exposed, 43.1% (95% CI 41.1-60.9) had not received social services or mental health care. The majority of the children (58.7%; 95% CI 52.1-65.3) were present at the location of the homicide when the killing took place, with varying levels of exposure. Homicide weapons mostly involved cutting weapons and firearms, leading to graphic crime scenes.

CONCLUSIONS

Care providers need capacity not only to help children cope with the sudden loss of a parent but also with unaddressed histories of domestic violence and exposure to graphic homicide scenes, in a culture-sensitive way. Future directions include longitudinal monitoring of children's mental health outcomes and replication in other countries.