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Anderson J, Trevella C, Burn AM. Interventions to improve the mental health of women experiencing homelessness: A systematic review of the literature. PLoS One 2024; 19:e0297865. [PMID: 38568910 PMCID: PMC10990227 DOI: 10.1371/journal.pone.0297865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/10/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Homelessness is a growing public health challenge in the United Kingdom and internationally, with major consequences for physical and mental health. Women represent a particularly vulnerable subgroup of the homeless population, with some evidence suggesting that they suffer worse mental health outcomes than their male counterparts. Interventions aimed at improving the lives of homeless women have the potential to enhance mental health and reduce the burden of mental illness in this population. This review synthesised the evidence on the effectiveness and acceptability of interventions which aim to improve mental health outcomes in homeless women. METHODS Five electronic bibliographic databases: MEDLINE, PsycInfo, CINAHL, ASSIA and EMBASE, were searched. Studies were included if they measured the effectiveness or acceptability of any intervention in improving mental health outcomes in homeless women. Study quality was assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool. A narrative summary of the study findings in relation to the research questions was produced. RESULTS Thirty-nine studies met inclusion criteria. Overall, there was moderate evidence of the effectiveness of interventions in improving mental health outcomes in homeless women, both immediately post-intervention and at later follow-up. The strongest evidence was for the effectiveness of psychotherapy interventions. There was also evidence that homeless women find interventions aimed at improving mental health outcomes acceptable and helpful. CONCLUSIONS Heterogeneity in intervention and study methodology limits the ability to draw definitive conclusions about the extent to which different categories of intervention improve mental health outcomes in homeless women. Future research should focus on lesser-studied intervention categories, subgroups of homeless women and mental health outcomes. More in-depth qualitative research of factors that enhance or diminish the acceptability of mental health interventions to homeless women is also required.
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Affiliation(s)
- Joanna Anderson
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Charlotte Trevella
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Anne-Marie Burn
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
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Dokkedahl S, Kristensen TR, Elklit A. Can Women Shelters Help Reduce Symptoms of PTSD and C-PTSD? Trajectories of PTSD Symptom Development Following Partner- and Family-Related Violence. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP22026-NP22046. [PMID: 34986313 DOI: 10.1177/08862605211066568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND To protect women from Intimate partner violence (IPV), women's shelters should not only provide emergency safety from IPV exposure, but also prolonged support that empowers women to build a life free from violence. The present study aims to investigate individual symptom development in association with residency at a women's shelter. METHOD Data were collected at four different timepoints, that is, enrolment (T1, N = 150), 3-months residency (T2, = 110), 6-months residency (T3, N = 68) and after relocation (T4, N = 63). Women were included from four Danish women's shelters. The International Trauma Questionnaire (ITQ) was applied to test for post-traumatic stress disorder (PTSD) and Complex-PTSD (C-PTSD) at all timepoints. A paired sample t-test was used to test the mean symptom development, and a Latent Class Growth Analysis (LCGA) was applied to test for different classes of PTSD-trajectories. Logistic regression was applied to predict class membership from shelter-related variables and symptom severity, that is, length of residency, psychological counselling, revictimization and key symptoms of C-PTSD. RESULTS The prevalence of PTSD (31%) and C-PTSD (37.9%) was high at enrolment. Although t-tests suggested a significant decline in symptoms at follow-up, the LCGA revealed different classes of symptom development. The two-class model was found to be the best representation of data with low-symptom- and high-symptom profiles, respectively. Overall, the largest decline in symptoms occurred within the first 3 months of residency. Revictimization was high and was further found to predict class membership. However, when included in a multiple regression only symptom severity predicted the high-symptoms profile class. DISCUSSION Psychological treatment focussing on PTSD and C-PTSD is important for the women's future well-being and safety. Reports on revictimization was alarmingly high, which emphasises a continuing need to protect women from psychological violence within the shelters. These findings should be replicated in larger samples before we can draw any conclusion.
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Affiliation(s)
- Sarah Dokkedahl
- Danish National Center of Psychotraumatology, Odense, Denmark
- 6174University of Southern Denmark, Odense, Denmark
- Dannercenterfonden
| | - Trine Rønde Kristensen
- Centre for Persons Subjected to Violence, Center of Social Medicine, Copenhagen University Hospital, 53146Bispebjerg and Frederiksberg Hospital, Kobenhavn, Denmark
| | - Ask Elklit
- Danish National Center of Psychotraumatology, Odense, Denmark
- 6174University of Southern Denmark, Odense, Denmark
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Patton SC, Szabo YZ, Newton TL. Mental and Physical Health Changes Following an Abusive Intimate Relationship: A Systematic Review of Longitudinal Studies. TRAUMA, VIOLENCE & ABUSE 2022; 23:1079-1092. [PMID: 33468040 DOI: 10.1177/1524838020985554] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Longitudinal studies are critical to understanding health changes following trauma. The present systematic review adopted a longitudinal perspective on intimate partner abuse (IPA) by examining characteristics and findings of studies that followed persons who recently left an abusive relationship or who were at a point where they might leave and reported on health over time. Web of Science, EBSCO, Published International Literature on Traumatic Stress, and PubMed databases were searched using combinations of terms reflecting IPA, longitudinal study design, and health outcomes. Quantitative studies that recruited adults or adolescents, had multiple time points, used a health indicator as an outcome, and where IPA was a predictor, independent variable, or inclusion criterion were included. These methods yielded 36 studies from 20 unique samples. The following domains were coded for each article: citation, demographics, risk of bias, sample setting, design, follow-up, relationship and IPA characteristics, outcomes, and analytic focus. Results showed that all samples were female, and most were help-seeking. Depression, post-traumatic stress, and physical symptoms decreased over time, while quality of life increased in most studies. Changes in anxiety symptoms over time were less consistent. Ongoing IPA and social support were the most consistent predictors of health changes over time, showing relations with indicators of poorer or better health, respectively. There was preliminary evidence that decreases in emotional and physical symptoms plateaued within 9 months of the baseline assessment. Sampling, study design, measurement, and analysis are considered, and recommendations for future research are provided.
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Affiliation(s)
- Samantha C Patton
- Department of Psychological and Brain Sciences, 12239University of Louisville, Louisville, KY, USA
| | - Yvette Z Szabo
- Department of Psychological and Brain Sciences, 12239University of Louisville, Louisville, KY, USA
- Department of Veterans Affairs, VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA
| | - Tamara L Newton
- Department of Psychological and Brain Sciences, 12239University of Louisville, Louisville, KY, USA
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Symes L, McFarlane J, Maddoux J, Levine LB, Landrum KS, McFarlane CD. Establishing Concurrent Validity for a Brief PTSD Screen Among Women in a Domestic Violence Shelter. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP3646-NP3660. [PMID: 29911485 DOI: 10.1177/0886260518779595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
There is a particular need for valid scales to screen for posttraumatic stress disorder (PTSD) among women who seek safe shelter from intimate partner violence. Screening to identify women who are at risk for PTSD can lead to early intervention that reduces the risk for PTSD-related outcomes such as poor decision making, inconsistent parenting, and behavior dysfunction among their children. The gold standard for diagnosing PTSD is the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) (CAPS-5). A seven-item PTSD screen has been used for in this population and has a well-established cutoff score but has not been validated against the DSM-5 diagnostic criteria for PTSD. The study purpose was to establish concurrent validity for a seven-item screen for PTSD with the CAPS-5. Participants were 75 women, 18 years or older, who were residents of a 120-bed shelter in the southern United States. They spoke English or Spanish. They reported intimate partner physical or sexual violence within 4 months of their entry into the study. Following informed consent, data were collected in individual interviews, conducted in either English or Spanish. In addition to demographic data, the seven-item PTSD screen and the CAPS-5 were administered. A receiver operating characteristic (ROC) curve analysis was conducted to assess the concurrent validity of the seven-item PTSD screen with the CAPS-5. The seven-item PTSD screen results were significantly correlated with the CAPS-5 results in this sample (area under the curve [AUC] = .640, z = 2.670, p = .008). Sensitivity was 96.2, and observed specificity was 31.8. The seven-item PTSD screen demonstrates excellent sensitivity (e.g., 96% of true PTSD cases) and acceptable specificity (32% of non-PTSD cases) and can be used to quickly and accurately identify individuals for diagnostic assessment and intervention.
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Symes L, McFarlane J, Maddoux J, Fredland N. Evaluating an Intergenerational Model to Explain the Path From Violence Against Mothers to Child Behavior and Academic Outcomes. Violence Against Women 2019; 26:730-749. [PMID: 31032712 DOI: 10.1177/1077801219841444] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
An intergenerational model to explain the long-term effect of partner violence against mothers on child behavior was evaluated 48 months after 278 mothers first sought safe shelter or justice services. Twelve percent reported recent abuse, and six mothers reported severe or extreme danger. Self-efficacy (-.58, p < .05), social support (-28, p < .05), and financial support (-.25) were inversely associated with mental health concerns. Higher maternal mental health concerns (.55, p < .05) and child witnessing abuse (.70, p < .05) were associated with child behavioral problems. Child behavioral problems were inversely associated with child academic functioning (-.22, p < .05). To improve child outcomes, interventions that establish safety for mothers and children and promote maternal mental health are needed.
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Using Baseline Data to Predict Chronic PTSD 48-months After Mothers Report Intimate Partner Violence: Outcomes for Mothers and the Intergenerational Impact on Child Behavioral Functioning. Arch Psychiatr Nurs 2018; 32:475-482. [PMID: 29784233 DOI: 10.1016/j.apnu.2018.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 02/08/2018] [Accepted: 02/11/2018] [Indexed: 11/20/2022]
Abstract
Worldwide one in three women report intimate partner violence. Many of these women report long term mental health problems, especially PTSD, which is associated with negative problem solving, isolation, somatization, depression, and anxiety. Children are impacted by their exposure to domestic violence and experience internal (i.e., depression, anxiety) and external (i.e., hostility, delinquency) behavioral clinical problems. To predict which women will experience chronic PTSD symptoms, a PTSD predictor tool was developed and applied to PTSD symptom scores four years after 300 mothers with children (age 18 months to 16 years) received assistance for the violence. At four years, 266 (89%) of the 300 mother child dyads were retained. Of those, 245 met inclusion criteria for this study and 53% had scores above the clinical threshold for PTSD. The predictor tool performed well. There was a significant association, χ2 (4) = 11.83, p = .019, Cramer's V = 0.229, between mothers predicted at low/some risk for chronic PTSD and scoring below the cut-off score for diagnostic PTSD symptoms at four years. Mothers predicted to be at extreme risk for chronic PTSD reported PTSD symptoms at or above the diagnostic level at 48 months. Children whose mothers had PTSD were at greater risk for Borderline/Clinical range behavioral problems compared to children whose mothers did not have PTSD. Relative risk values ranged from 2.07 (Externalizing) to 2.30 (Internalizing). When appropriate interventions are available, the PTSD predictor tool can assist with triage and guided referral of women at risk for chronic PTSD.
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Gupta J, Falb KL, Ponta O, Xuan Z, Campos PA, Gomez AA, Valades J, Cariño G, Olavarrieta CD. A nurse-delivered, clinic-based intervention to address intimate partner violence among low-income women in Mexico City: findings from a cluster randomized controlled trial. BMC Med 2017; 15:128. [PMID: 28697769 PMCID: PMC5506677 DOI: 10.1186/s12916-017-0880-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 05/19/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Rigorous evaluations of health sector interventions addressing intimate partner violence (IPV) in low- and middle-income countries are lacking. We aimed to assess whether an enhanced nurse-delivered intervention would reduce IPV and improve levels of safety planning behaviors, use of community resources, reproductive coercion, and mental quality of life. METHODS We randomized 42 public health clinics in Mexico City to treatment or control arms. In treatment clinics, women received the nurse-delivered session (IPV screening, supportive referrals, health/safety risk assessments) at baseline (T1), and a booster counselling session after 3 months (T2). In control clinics, women received screening and a referral card from nurses. Surveys were conducted at T1, T2, and T3 (15 months from baseline). Our main outcome was past-year physical and sexual IPV. Intent-to-treat analyses were conducted via three-level random intercepts models to evaluate the interaction term for treatment status by time. RESULTS Between April and October 2013, 950 women (480 in control clinics, 470 in treatment clinics) with recent IPV experiences enrolled in the study. While reductions in IPV were observed for both women enrolled in treatment (OR, 0.40; 95% CI, 0.28-0.55; P < 0.01) and control (OR, 0.51; 95% CI, 0.36-0.72; P < 0.01) clinics at T3 (July to December 2014), no significant treatment effects were observed (OR, 0.78; 95% CI, 0.49-1.24; P = 0.30). At T2 (July to December 2013), women in treatment clinics reported significant improvements, compared to women in control clinics, in mental quality of life (β, 1.45; 95% CI, 0.14-2.75; P = 0.03) and safety planning behaviors (β, 0.41; 95% CI, 0.02-0.79; P = 0.04). CONCLUSION While reductions in IPV levels were seen among women in both treatment and control clinics, the enhanced nurse intervention was no more effective in reducing IPV. The enhanced nursing intervention may offer short-term improvements in addressing safety planning and mental quality of life. Nurses can play a supportive role in assisting women with IPV experiences. TRIAL REGISTRATION Clinicaltrials.gov ( NCT01661504 ). Registration Date: August 2, 2012.
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Affiliation(s)
- Jhumka Gupta
- Department of Global and Community Health, George Mason University, MS 5B7, 4400 University Drive, Fairfax, VA, 22030, USA.
| | - Kathryn L Falb
- International Rescue Committee, 122 East 42nd Street, New York, NY, 10168, USA
| | - Oriana Ponta
- Innovations for Poverty Action, Manuel María Contreras 133, Mezzanine 2 Col. Cuauhtemoc, Mexico City, 06500, Mexico
| | - Ziming Xuan
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118, USA
| | - Paola Abril Campos
- Innovations for Poverty Action, Manuel María Contreras 133, Mezzanine 2 Col. Cuauhtemoc, Mexico City, 06500, Mexico
| | - Annabel Arellano Gomez
- Mexico City Ministry of Health, Xocongo # 225, Col. Transito, Mexico City, 068020, Mexico
| | - Jimena Valades
- International Planned Parenthood Federation, 125 Maiden Lane, New York, NY, 10038, USA
| | - Gisele Cariño
- International Planned Parenthood Federation, 125 Maiden Lane, New York, NY, 10038, USA
| | - Claudia Diaz Olavarrieta
- Population Council, Av. Insurgentes Sur No. 2453 Torre Murano, Piso 9, Local 903, Col. Tizapán, Delegación Álvaro Obregón, Mexico City, 01090, Mexico
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Page RL, Chilton J, Montalvo-Liendo N, Matthews D, Nava A. Empowerment in Latina Immigrant Women Recovering From Interpersonal Violence: A Concept Analysis. J Transcult Nurs 2017; 28:531-539. [PMID: 28826380 DOI: 10.1177/1043659617707014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Latina immigrant women are vulnerable and may experience higher levels of interpersonal or intimate partner violence (IPV) due to their immigrant status and cultural emphasis on familism. The concept of empowerment within the cultural context of Latina immigrant women experiencing IPV was analyzed using a modified version of Walker and Avant's concept analysis technique. The technique considers usage and definitions in the literature, antecedents, attributes, empirical referents, and the inclusion of a model and contrary case. This analysis encompasses a comparative approach and includes a discussion of how the definition of empowerment compares across the nursing literature. Defining attributes include reciprocal relationships, autonomy, and accountability. Antecedents comprise willingness to learn and motivation to create change. Consequences encompass self-esteem, self-efficacy, and competence for making life decisions. Empowerment has the potential to improve total well-being, having a positive and profound impact on the lives of women experiencing IPV.
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Affiliation(s)
- Robin L Page
- 1 Texas A&M University College of Nursing, Bryan, TX, USA
| | | | | | - Debra Matthews
- 1 Texas A&M University College of Nursing, Bryan, TX, USA
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Symes L, McFarlane J, Fredland N, Maddoux J, Zhou W. Parenting in the Wake of Abuse: Exploring the Mediating Role of PTSD Symptoms on the Relationship Between Parenting and Child Functioning. Arch Psychiatr Nurs 2016; 30:90-5. [PMID: 26804508 DOI: 10.1016/j.apnu.2015.08.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/25/2015] [Accepted: 08/25/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND Children whose mothers report partner violence and symptoms of posttraumatic stress disorder (PTSD) are at risk for behavior dysfunctions. AIM To examine the mediating effects of maternal PTSD symptoms on the relationship of parenting behaviors to child internalizing and externalizing behavior dysfunctions. FINDINGS Maternal PTSD symptoms have a partial mediating effect on the relationship between inconsistent discipline and child internalizing and externalizing behaviors. Maternal PTSD symptoms have a fully mediating effect on the relationship between poor supervision and child internalizing behaviors. CONCLUSIONS There is a need to identify women who report partner violence and are at high risk for PTSD and intervene early to prevent problematic parenting and resulting child behavior problems.
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Symes L, Maddoux J, McFarlane J, Pennings J. A Risk Assessment Tool to Predict Sustained PTSD Symptoms Among Women Reporting Abuse. J Womens Health (Larchmt) 2015; 25:340-7. [PMID: 26267645 PMCID: PMC4834525 DOI: 10.1089/jwh.2015.5287] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Nationally and worldwide, 30% or more of women are likely to have experienced intimate partner violence. Maternal mental health symptoms predict child function. When mothers have sustained posttraumatic stress disorder (PTSD), their children at are risk for growth and developmental delays and poor behavioral outcomes that may adversely affect the course of their lives. While many who experience trauma will recover without intervention, a significant proportion will experience PTSD, with negative consequences for their personal lives and the lives of their families. Early identification of those at high risk for PTSD symptoms will support early interventions to prevent PTSD and its negative consequences. METHODS This paper describes the development of a tool that can predict PTSD symptoms at 8 months in mothers who are primarily of low socioeconomic status and primarily members of underrepresented groups. The tool consists of four key measures. CONCLUSIONS Using this tool to identify mothers at high risk for sustained PTSD and entering them into early intervention programs may protect mothers and their children from negative outcomes and promote their health and wellbeing.
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Affiliation(s)
- Lene Symes
- 1 College of Nursing, Office of Research and Sponsored Programs, Texas Woman's University , Houston, Texas
| | - John Maddoux
- 1 College of Nursing, Office of Research and Sponsored Programs, Texas Woman's University , Houston, Texas
| | - Judith McFarlane
- 1 College of Nursing, Office of Research and Sponsored Programs, Texas Woman's University , Houston, Texas
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