Severe physical violence and Black women's health and well-being

Assessing the use of clinical guidelines against domestic violence in southern Sweden: A mixed-methods study

BACKGROUND AND AIM

Domestic violence is a prevalent public health issue. While clinical guidelines and care programs for its identification and handling have been formulated in all administrative regions of Sweden, their degree of implementation is largely unknown. This study aims to assess the implementation of one administrative region's care program, including how it is seen to align with and function in clinical practice, and any perceived barriers to or facilitators of its use.

METHODS

A survey was distributed to first-line managers for healthcare units with patient contact in the region (n = 807). The responses were analysed using descriptive statistics. Open responses were analysed thematically. Group interviews (n = 5) were held with caregivers (n = 15) working primarily with young patients and analysed thematically.

RESULTS

73% of the survey respondents reported previous awareness of the care program, and 27% reported knowledge of its content. The extent to which their staff knew about and followed the care program was assessed to be relatively low. The survey response rate was 19%. Among interview participants, knowledge of the care program was generally quite low. Survey responses and interview discussions pointed to the importance of developing routines, of collegial and managerial support and of training on domestic violence and the care program.

CONCLUSION

This study indicates that the knowledge and use of the regional care program is limited among healthcare staff, including among those working with young patients. This underscores the importance of information and training for furthering the implementation of clinical guidelines on domestic violence.

Interpersonal abuse and alcohol use among African American young women: the mediating role of emotion dysregulation

African American women experience a high prevalence of alcohol-related consequences, and no studies have explicitly examined the associations among lifetime interpersonal abuse, emotion dysregulation, and alcohol-related outcomes during the critical period of young adulthood within this population. This study used baseline data from a sample of African American young women (N = 560) who use alcohol, aged 18 to 24, enrolled in an HIV prevention intervention trial to examine whether emotion dysregulation mediated the relation between lifetime history of abuse and problematic alcohol use. Further, we sought to examine whether there were potential differential levels of problematic alcohol use based on the number of abuse types experienced. Multiple regression analyses showed that exposure to two or more forms of abuse was associated with problematic alcohol use, β = .24, p < .001, and heavy alcohol consumption, β = .23, p < .001, whereas history of a single form was not. Indirect effects of both single and multiple forms of abuse on problematic alcohol use (95% confidence interval [CI] [.16, 1.02]; [.46, 1.64]) and heavy alcohol consumption (95% CI [.02, .26]; [.05, .45]) via emotion dysregulation severity were found. Abuse and emotion dysregulation were associated with frequency of alcohol use and binge drinking, but not typical amount consumed. Hazardous alcohol consumption was prevalent among this sample of African American young women who use alcohol. This study provides preliminary evidence that emotion dysregulation may be an important mechanism buttressing the association between lifetime history of interpersonal abuse and problematic alcohol use among African American young women who use alcohol.

Association Between Women's Exposure to Intimate Partner Violence and Self-reported Health Outcomes in New Zealand

IMPORTANCE

Intimate partner violence (IPV) is increasingly recognized as a contributing factor for long-term health problems; however, few studies have assessed these health outcomes using consistent and comprehensive IPV measures or representative population-based samples.

OBJECTIVE

To examine associations between women's lifetime IPV exposure and self-reported health outcomes.

DESIGN, SETTING, AND PARTICIPANTS

The cross-sectional, retrospective 2019 New Zealand Family Violence Study, adapted from the World Health Organization's Multi-Country Study on Violence Against Women, assessed data from 1431 ever-partnered women (63.7% of eligible women contacted) in New Zealand. The survey was conducted from March 2017 to March 2019, across 3 regions, which accounted for approximately 40% of the New Zealand population. Data analysis was performed from March to June 2022.

EXPOSURES

Exposures were lifetime IPV by types (physical [severe/any], sexual, psychological, controlling behaviors, and economic abuse), any IPV (at least 1 type), and number of IPV types.

MAIN OUTCOMES AND MEASURES

Outcome measures were poor general health, recent pain or discomfort, recent pain medication use, frequent pain medication use, recent health care consultation, any diagnosed physical health condition, and any diagnosed mental health condition. Weighted proportions were used to describe the prevalence of IPV by sociodemographic characteristics; bivariate and multivariable logistic regressions were used for the odds of experiencing health outcomes by IPV exposure.

RESULTS

The sample comprised 1431 ever-partnered women (mean [SD] age, 52.2 [17.1] years). The sample was closely comparable with New Zealand's ethnic and area deprivation composition, although younger women were slightly underrepresented. More than half of the women (54.7%) reported any lifetime IPV exposure, of whom 58.8% experienced 2 or more IPV types. Compared with all other sociodemographic subgroups, women who reported food insecurity had the highest IPV prevalence for any IPV (69.9%) and all specific types. Exposure to any IPV and specific IPV types was significantly associated with increased likelihood of reporting adverse health outcomes. Compared with those unexposed to IPV, women who experienced any IPV were more likely to report poor general health (adjusted odds ratio [AOR], 2.02; 95% CI, 1.46-2.78), recent pain or discomfort (AOR, 1.81; 95% CI, 1.34-2.46), recent health care consultation (AOR, 1.29; 95% CI, 1.01-1.65), any diagnosed physical health condition (AOR, 1.49; 95% CI, 1.13-1.96), and any mental health condition (AOR, 2.78; 95% CI, 2.05-3.77). Findings suggested a cumulative or dose-response association because women who experienced multiple IPV types were more likely to report poorer health outcomes.

CONCLUSIONS AND RELEVANCE

In this cross-sectional study of women in New Zealand, IPV exposure was prevalent and associated with an increased likelihood of experiencing adverse health. Health care systems need to be mobilized to address IPV as a priority health issue.

Coping and Protective Factors of Mental Health: An Examination of African American and US Caribbean Black Women Exposed to IPV from a Nationally Representative Sample

Existing research continues to highlight the harm that intimate partner violence (IPV) can pose to health and well-being. However, little is done to understand the effectiveness of coping and protective mechanisms in helping women manage under adverse circumstances. The current study addresses the mental health of US Black women and the role of coping and protective moderators. An analysis of data from the National Survey of American Life (2001-2003), the most comprehensive survey on the health of US Blacks, was conducted. The association between severe physical intimate partner violence and mental health outcomes were confirmed. Resilience moderated the relationship between severe intimate partner violence and mood disorder among US Black women, but this differed between African American and Caribbean Blacks. Resilience, emotional family support, and spirituality reduced the likelihood of having a mental health condition for some African American and Caribbean Black women, while the opposite was found for religiosity. Demographic factors were also associated with mental health conditions and behaviors. The study draws our attention to potential coping and protective mechanisms that could be incorporated into counseling and intervention practices while recognizing factors that may be harmful to the mental health of individuals.

The Effect of Intimate Partner Violence on the Physical Health and Health-Related Behaviors of Women: A Systematic Review of the Literature

AIM

The long-term effects of intimate partner violence (IPV) on physical health outcomes and health-related behaviors are underresearched in comparison to the effects on mental health and pregnancy. This systematic review examines the recent research in this area from 2012 through 2019.

METHODS

SCOPUS, PubMed, EBSCOhost, and gray literature were searched using the key words "intimate partner violence" and "health." To meet inclusion criteria, studies needed to be original research and focus on IPV during adulthood and its effects on the physical health or health-related behaviors of women. Fifty-two studies were qualitatively analyzed, with results grouped into broad categories of effects, including cardiovascular, endocrine, infectious diseases, and health screening.

RESULTS

IPV was shown to have negative effects on physical health outcomes for women, including worsening the symptoms of menopause and increasing the risk of developing diabetes, contracting sexually transmitted infections, engaging in risk-taking behaviors including the abuse of drugs and alcohol, and developing chronic diseases and pain. It also has significant effects on human immunodeficiency virus outcomes, worsening CD4+ cell depletion. Results varied regarding the effects of IPV on cardiovascular health outcomes.

CONCLUSION

The result of this review demonstrates that women who have experienced violence and abuse are at significantly increased risk of poor health outcomes in a variety of areas and so require specialized and tailored primary care. This review highlights significant gaps in this field of research, particularly in relation to cardiovascular disease, endocrine dysfunction, and neurological symptoms and conditions. It demonstrates a need for additional long-term studies in this field to better inform the health care of women who have experienced IPV and to establish the physiological mediators of these outcomes.

Structural Brain Alterations in Female Survivors of Intimate Partner Violence

Intimate partner violence (IPV) has been related to brain alterations in female survivors. Nonetheless, few studies have used an exploratory approach, focusing on brain regions that are traditionally studied in other populations with post-traumatic stress. Traumatic brain injury (TBI), strangulation, and childhood trauma are highly prevalent among this population, and have also been associated with brain alterations and functional deterioration. As such, it is difficult to determine how different brain regions are affected by the complex interplay of these factors in female survivors. The aim of this study is to assess (a) brain alterations in female survivors of IPV as compared to non-victim females and (b) the potential causal mechanisms associated with such alterations. We hypothesized that structural brain differences would be found between female survivors of IPV and non-victims, and that these differences would be related to IPV-related TBI, strangulation, IPV severity, depression, post-traumatic stress, generalized anxiety, and childhood adverse experiences. A total of 27 non-victims and 28 survivors completed structural magnetic resonance imaging and questionnaires to measure the potential causal mechanisms for brain alterations. Structural brain differences were found between groups, principally in volumetric analyses. The brain regions in which between-group differences were found were related to attempted strangulation, IPV-related TBI, severity of IPV, adverse childhood experiences, and post-traumatic stress. These results demonstrate that a wider range of brain regions may be impacted by IPV and that various factors are implicated in the structural brain alterations found in female survivors. This study demonstrates the importance of post-traumatic stress, childhood and adult trauma, and physical violence in assessing brain alterations in IPV survivors. Further, it serves as a critical first step in assessing an extensive list of potential causal mechanisms for structural brain alterations, using a more comprehensive a whole-brain structural analysis of IPV female victims, a largely understudied and vulnerable population.

Approach and avoidant coping among black transgender women who have experienced violence: A qualitative analysis

Black transgender women face nearly universal exposure to violence. Coping behaviors among cisgender women who have survived violence are well delineated; however, there are relatively few studies examining coping strategies for transgender women. The purpose of this qualitative study was to identify and characterize coping behaviors employed by Black transgender women (from Baltimore, MD and Washington, DC metropolitan areas) following an experience of violence. Secondary qualitative data analysis was conducted using framework analysis to explore narratives of 19 Black transgender women. Themes regarding avoidant and approach coping behaviors were developed within the context of existing literature. Approach coping behavior themes included: Help-Seeking, Seeking Guidance and Support, Self-Protecting Behavior, Positive Reappraisal, Self-Affirmation, Self-Care, Connection to a Higher Power, and Acceptance. Avoidant coping behavior themes included: Cognitive Avoidance, Substance, Alcohol, and Tobacco Use, Emotional Discharge, and Seeking Alternative Rewards. Participants employed similar coping behaviors as seen among cisgender women survivors of violence. However, several unique applications of approach coping mechanisms were identified including self-protecting behavior and self-affirming behavior. Culturally informed application of the identified coping behaviors can be taught and integrated into trauma-informed mental health interventions to promote strength and resilience among Black transgender women. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Criminalized Black Women's Experiences of Intimate Partner Violence in Canada

Canadian research examining the overlap between Black women's victimization and criminalization is sparse. This qualitative study addresses this gap by examining the ways in which criminalized Black women's intersecting identities of race, class, and gender influence how they perceive, experience, and respond to intimate partner violence (IPV). Semi-structured interviews were conducted with 25 Black women who experienced IPV. The findings focus on the women (15) who were also charged with an IPV-related offense. Critical race feminism was employed to analyze their narratives. This research has implications for policy, practice, and future research with Black women who are victimized and criminalized.

Intimate Partner Violence and the Role of Child Maltreatment and Neighborhood Violence: A Retrospective Study of African American and US Caribbean Black Women

Background: Research suggests that intimate partner violence (IPV) is associated with childhood maltreatment and violence exposure within the neighborhood context. This study examined the role of child maltreatment and violence exposure on intimate partner violence, with the moderating effects of mental disorders (IPV) among US Black women. Methods: Data from the National Survey of American Life (NSAL), the largest and most complete sample on the mental health of US Blacks, and the first representative sample of Caribbean Blacks residing in the United States was used to address the study objectives. Descriptive statistics, chi-square test of independence, t-test, and logistic regression procedures were used to analyze the data. Results: Bivariate results indicate an association between child abuse and intimate partner victimization among US Black women. Witnessing violence as a child as well as neighborhood violence exposure was also related to IPV but shown to differ between African American and Caribbean Black women. Multivariate findings confirmed the influence of mental disorders and social conditions on US Black women's risk for IPV. Moderating effects of child maltreatment and mental disorders in association with adult IPV were not found. Conclusions: The study addressed the short and long-term impact of child maltreatment and the contribution to the cycle of intimate violence among US Black women including African American and Caribbean Blacks. The study suggests the need for prevention and intervention efforts to improve structural conditions for at-risk populations and communities predisposed to violence and other negative outcomes. Possibilities for future research are also discussed.

Health Promotion Behaviors among Urban Black Women

Health-promotion behaviors among urban Black women are the forefront of US health policy regarding health disparities. This cross-sectional study explored factors such as health literacy, self-efficacy, and readiness for change with health-promotion behaviors of urban Black women. Although these variables are relevant, urban Black women have identified that spirituality and history of domestic violence were also relevant. The sample consists of 152 participants from outpatient clinics, community events, and grocery stores in one Northeastern US city. The anonymous online survey contained the following Instruments: Newest Vital Sign, New General Self-efficacy Scale, Health Risk Instrument, Daily Spiritual Assessment Scale, FAST Survey, and Health-Promoting Lifestyle Profile II. Univariate statistics and bivariate/simultaneous linear regression identified significant relationships between health-promotion behaviors and the following: eeadiness for change, self-efficacy, and spirituality. Participants who engaged in health-promotion behaviors were ready to change, but these behaviors were negatively associated with spirituality, self-efficacy, and a history of domestic violence.

Exploring Psychosocial Mediators of the Associations of Lifetime Trauma and Body Mass Index in African American Women

Purpose: This study sought to examine the association between lifetime trauma (i.e., childhood, adulthood, and cumulative) and body mass index (BMI) and if this association was mediated by psychosocial factors (i.e., depressive symptoms and stress) in a sample of African American women.

Methods: We examined lifetime trauma among African American women in the Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure Study (InterGEN) study. We conducted mediation analyses with bootstrapping to assess the direct and indirect effects of increasing forms of trauma across the lifespan on BMI. Depressive symptoms and stress were examined as mediators of these associations.

Results: The analytic sample included 138 women with a mean age of 31.9 years. Approximately half of women reported any childhood trauma (47.8%) and more than half (73.2%) reported any adulthood trauma. The direct effects of all forms of trauma were associated with greater depressive symptoms. Only lifetime trauma was associated with higher stress overload (B=2.40, standard error [SE]=1.12, p<0.05). Higher depressive symptoms were associated with higher BMI in all models. The indirect effects of adulthood trauma (B=0.60, SE=0.20, p<0.01) and lifetime trauma (B=0.53, SE=0.20, p<0.01) on BMI were partially mediated by depressive symptoms.

Conclusion: These findings indicate that depressive symptoms mediate the associations between adulthood and lifetime trauma with BMI. Interventions aimed at reducing elevated BMI in African American women should account for the influence of depressive symptoms. Future research should replicate these analyses in other samples of African American women.

Intimate partner violence, associations with perceived need for help and health care utilization: a population-based sample of women in Sweden

Aim: To assess the association between physical intimate partner violence (physical IPV) in the past 5 years, perceived need for help and primary health care utilization due to mental health problems in a general population-based sample of women in Sweden. Methods: We performed structured follow-up interviews with 616 women between 1995 and 2015. Associations between physical IPV in the past 5 years and (i) perceived need for help and (ii) primary health care utilization due to mental health problems, were estimated by logistic regression analyses with crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Results: Of the women who had experienced physical IPV in the past 5 years, 45.1% perceived a need for help but refrained from seeking care. After adjusting for sociodemographic factors, exposure to physical IPV in the past 5 years remained associated with perceived need for help (OR 3.54; CI 1.77–7.11). After adjusting for sociodemographic factors, the association between exposure to physical IPV and primary health care utilization did not remain statistically significant. Conclusions: Women exposed to physical IPV were more likely to perceive the need for help compared with unexposed women. A large proportion of IPV-exposed women in the general population may refrain from seeking care although they perceive a need for help. Future studies need to investigate potential barriers to mental health care seeking among women exposed to IPV. Routine questioning about IPV should be implemented in primary health care with improved referral to available support services.

Help-Seeking Behaviors and Barriers Among Black Women Exposed to Severe Intimate Partner Violence: Findings From a Nationally Representative Sample

This article examined general help-seeking utilization and barriers among U.S. Black women reporting severe physical intimate partner violence (IPV). Data from the National Survey of American Life (NSAL), the largest and most detailed survey on Blacks residing in the United States, were analyzed. Among U.S. Black women reporting severe physical IPV, many sought the help of a psychiatrist (13.8%) or other mental health professionals (14.0%). Multivariate findings revealed associations between help-seeking utilization and sociodemographic factors. Queries from open responses suggested potential cultural and ethnic differences between African American and Caribbean Black women reporting intimate partner violence in relation to barriers to help-seeking.

Marital Violence affecting female nurses and its physical and mental health consequences

THE AIM

To investigate the relationship between marital violence and Jordanian nurses' physical and mental health.

BACKGROUND

Despite the negative impact of marital violence on female nurses' health, few studies have investigated its physical and mental aspects.

METHOD

A descriptive correlational design was used to investigate the relationship between marital violence and the physical and mental health of female Jordanian nurses. One hundred ninety-eight female Jordanian nurses from five governmental hospitals were recruited. The Women Abuse Screening Test was used to measure forms of violence, and the SF-36 V2 instrument was used to examine physical and mental health. The prevalence of violence was calculated, and the linear relationship between violence and physical and mental health was measured using Pearson correlation.

RESULTS

Female nurses reported a high percentage of different forms of violence. The study results revealed a negative relationship between violence and mental health and physical health.

CONCLUSION

Jordanian female nurses suffered hazardous physical and mental health consequences of violence that adversely affect their entire life.

IMPLICATIONS FOR NURSING POLICY AND EDUCATION

Nursing educators should establish clear guidelines and training policies on marital violence for nurses through creation of an effective and cooperative networking and resources. Also, nursing/health policymakers should create responsive healthcare environment through raising the awareness on marital violence against nurses and providing counselling services for emergency and concurrent cases.

Exploring women's health care experiences through an equity lens: Findings from a community clinic serving marginalised women

AIMS AND OBJECTIVES

To explore how marginalised women perceive and rate equity-oriented health care at a primary care clinic using items that evaluate patients' experiences of care.

BACKGROUND

Despite an increased recognition of the importance of health care that is equity-oriented, and that understands the patient within the context of the broader social determinants of health, inequities in health remain prevalent around the world.

DESIGN

Items from the "EQUIP Primary Health Care" research programme were used to explore patients' experiences of equity-oriented health care. Women were invited to complete the questionnaire with the explicit aim of gaining their input to improve quality of care at the clinic. The Strengthening the Reporting of Observational Studies in Epidemiology Statement was followed for the study.

METHODS

Sixty-seven women who experienced significant health and social inequities, and were seeking care at a women's only nurse practitioner primary health care clinic in Canada, were invited to complete the questionnaire. For quality improvement purposes, correlational analyses were used to explore women's experiences of care.

RESULTS

Women's responses showed that Promote Emotional Safety and Trust and Overall Quality of Care were the most highly correlated domains, indicating the importance of the health care team in establishing trusting relationships, particularly for women who experience stigma and negative judgement when seeking care.

CONCLUSION

Seeking feedback from patients on their experiences of care using items developed to explicitly tap into equity issues is useful in understanding how patients experience equity-oriented health care. Responses from the women highlight the importance of understanding not only the what of equity-oriented care but also the how.

RELEVANCE TO CLINICAL PRACTICE

The results of this study illustrate the importance of establishing trusting relationships, tailoring care, and using a nondiscriminatory approach when working with women who experience negative judgements when seeking care.

Building Nehemiah's Wall: The North Minneapolis Faith Community's Role in the Prevention of Intimate Partner Violence

African American women who are victims of intimate partner violence (IPV) often rely on faith when exposed to IPV; however, the role of the faith community in the lives of IPV victims is less clear. This study uses a community-based approach to examine the role of the faith community in addressing IPV in heterosexual relationships in North Minneapolis where rates of poverty and IPV among African Americans are disproportionately high compared to other cities in Minnesota. Five focus group discussions (FGDs) were held with 34 lay and secular leaders of mixed genders in the North Minneapolis community. FGDs were evaluated using a grounded theory method of analysis. Discussions revealed that some faith leaders effectively identified IPV as a community issue and intervened but that many remained silent or were not well trained to address the issue safely. Faith-based solutions were identified to address IPV in the African American community and included the faith community speaking openly about IPV, developing programs for unmarried and adolescent couples, and coordinating services with secular IPV support organizations.

Severe Physical Intimate Partner Violence and the Mental and Physical Health of U.S. Caribbean Black Women

BACKGROUND

Intimate partner violence is a threat to women's health. Relative to other racial/ethnic groups, African American and immigrant women are at an increased risk for violence. However, despite the growing presence of Caribbean Black immigrants in this country, few studies have examined the association between severe physical intimate partner violence (SPIPV) and the health of Caribbean Black women currently residing in the United States. This study examined the mental and physical health of U.S. Caribbean Black women with and without a history of SPIPV. We also explored the role of generational status-first, second, or third-in association with the physical and mental health of abused Caribbean Black women.

METHODS

Data from the National Survey of American Life, the largest and the only known representative study on Caribbeans residing in the United States, were analyzed. The World Health Organization (WHO) World Mental Health Composite International Diagnostic Interview (WMH-CIDI) was used to determine DSM-IV mental disorders. The presence of physical health conditions was based on respondents' self-reports of physician diagnoses.

RESULTS

The findings indicate an association between SPIPV and the mental and physical health status of U.S. Caribbean Black women. Rates of physical conditions and mental health disorders were generally higher among women with a history of SPIPV than those without a history. Generational status also played a role in women's health outcomes.

CONCLUSIONS

The study has interventions and preventive implications for both detecting and addressing the health needs of U.S. Caribbean Black women who experience severe physical abuse by an intimate partner.

Prevalence and Factors Associated With Severe Physical Intimate Partner Violence Among U.S. Black Women: A Comparison of African American and Caribbean Blacks

This study explored prevalence rates and factors associated with lifetime severe physical intimate partner violence among U.S. Black women. Data from the National Survey of American Life were examined. Rates of severe physical intimate partner violence were higher among African American women compared with U.S. Caribbean Black women. Risk factors associated with reported abuse were similar to those found in earlier studies but differed by ethnic backgrounds. Demographic, resource, and situational factors were associated with severe physical intimate partner violence among U.S. Black women in general but made unique contributions by ethnic group. Implications and suggestions for future studies were discussed.

Substance use, mental disorders and physical health of Caribbeans at-home compared to those residing in the United States

This study compares the health conditions of domestic Caribbeans with those living in the United States to explore how national context and migration experiences might influence substance use (i.e., alcohol or drug) and other mental and physical health conditions. The study is based upon probability samples of non-institutionalized Caribbeans living in the United States (1621), Jamaica (1216) and Guyana (2068) 18 years of age and over. Employing descriptive statistics and multivariate analytic procedures, the results revealed that substance use and other physical health conditions and major depressive disorder and mania vary by national context, with higher rates among Caribbeans living in the United States. Context and generation status influenced health outcomes. Among first generation black Caribbeans, residing in the United States for a longer length of time is linked to poorer health outcomes. There were different socio-demographic correlates of health among at-home and abroad Caribbeans. The results of this study support the need for additional research to explain how national context, migratory experiences and generation status contribute to understanding substance use and mental disorders and physical health outcomes among Caribbean first generation and descendants within the United States, compared to those remaining in the Caribbean region.