Intimate partner violence and miscarriage: examination of the role of physical and psychological abuse and posttraumatic stress disorder

Despite research documenting high rates of violence during pregnancy, few studies have examined the impact of physical abuse, psychological abuse, and posttraumatic stress disorder (PTSD) on miscarriage. Secondary analysis of data collected by the Chicago Women's Health Risk Study permitted an exploration of the relationships among physical abuse, psychological abuse, PTSD, and miscarriage among 118 primarily ethnic minority women. The interaction between maximum severity of abuse and age provided the best multivariate predictor of miscarriage rate, accounting for 26.9% of the variance between live birth and miscarriage outcome. Mean scores of psychological abuse, physical violence, forced sex, and PTSD were significantly higher in the miscarriage group than in the live birth group. Women who experience physical violence and psychological abuse during pregnancy may be at greater risk for miscarriage. Prospective studies can confirm findings and determine underlying mechanisms. Routine screening for traumatic stress and PTSD may reduce rates of miscarriage.     

Unemployment among women: examining the relationship of physical and psychological intimate partner violence and posttraumatic stress disorder

Prior research has demonstrated that intimate partner violence (IPV) is associated with employment instability among poor women. The current study assesses the broader relationship between IPV and women's workforce participation in a population-based sample of 6,698 California women. We examined past-year IPV by analyzing specific effects of physical violence, psychological violence, and posttraumatic stress disorder (PTSD) symptoms as predictors of unemployment. Results indicated substantial rates of unemployment among women who reported IPV, with rates of 20% among women who experienced psychological violence, 18% among women who experienced physical violence, and 19% among women with PTSD symptoms. When the relationship was adjusted for demographic characteristics and educational attainment, PTSD (adjusted odds ratio [AOR] = 1.60; 95% confidence interval [CI] = 1.22, 2.09) and psychological violence (AOR = 1.78; 95% CI = 1.36, 2.32), but not physical violence, were associated with unemployment. Implications for supported employment programs and workplace responses to IPV are discussed.     

Associations between expectancies of alcohol and drug use, severity of partner violence, and posttraumatic stress among women

Women who experience recurrent intimate partner violence (IPV) may use alcohol or drugs because they expect that these substances will help them cope with the negative physical and psychological sequelae of IPV. However, expectancies for alcohol and drug use have not been explored among this population of women. We used the Relaxation and Tension-Reduction Scale, Arousal and Aggression Scale, and Social Assertion Scale of the Alcohol Expectancy Questionnaire and modified its items to assess both alcohol and drug expectancies of 212 community-based, IPV-exposed women. Results of bivariate correlations showed that greater alcohol and drug expectancies were significantly correlated with greater alcohol problems and greater posttraumatic stress total and symptom severity scores. Results of a multivariate regression model showed that after controlling for demographic characteristics and history of childhood trauma, Relaxation and Tension- Reduction expectancies were associated with number of days of alcohol use, alcohol problems, physical and sexual IPV severity scores, and posttraumatic stress total and reexperiencing symptom severity scores. Expectancies do not significantly moderate the relationships between IPV, posttraumatic stress, and problematic alcohol and drug use. Given the strong relationships of expectancies with IPV severity, posttraumatic stress, and alcohol problems, expectancies may serve as targets for interventions to reduce alcohol use and problems and improve health-related outcomes in IPV-exposed women.     

Intimate partner violence and post-traumatic stress disorder symptoms in women: what we know and need to know

This article presents a review of knowledge regarding post-traumatic stress disorder (PTSD) in women experiencing intimate partner violence. Knowledge related to the prevalence and predictors of PTSD in battered women, the association between PTSD and physical health, and the emerging science regarding PTSD and physiological and immune parameters is addressed. Primary recommendations for future research includes the need for longitudinal and intervention research that incorporates a range of psychosocial and physiologic health outcomes.     

Adult violence with the mother and sibling as predictors of partner violence

The present study provides the first available evaluation of how violence with the mother and siblings during adulthood is associated with the occurrence of partner violence in young adults. Because a pattern of reciprocal partner violence is well documented, the authors hypothesized that reciprocal violence would also be found for adults and their mothers and for adults and their siblings. The authors also hypothesized that reciprocal violence with the mother and sisters would explain variance in partner violence even when controlling for other known predictors (poverty, poor family support, stress, anger, low self-esteem). Study participants included 377 college adults (114 men, 263 women; mean age = 24.4 years) who completed questionnaires to report their present violence to and from their mothers, sisters, brothers, and romantic partners. Violence is measured with a modified Conflict Tactics Scale. No sibling gender differences are found in violence reported as adults. Factor analysis confirms good fit for three clusters of reciprocal violence for adults: violence with the mother, violence with siblings, violence with the romantic partner. Violence with the mother and siblings significantly explains variance in partner violence even after controlling for other contextual variables, but only for women. One interpretation of present results is that because women receive less socialization than men to use violence, these two within-family models of violence have more significance for increasing their risk of partner violence. Partner violence prevention programs could include participation of mothers and siblings to enhance development of more peaceful conflict resolution patterns within and outside the family.     

Intimate partner violence perpetration by court-ordered men: distinctions among subtypes of physical violence, sexual violence, psychological abuse, and stalking

This study continues previous work documenting the structure of violence perpetrated by males against their female intimate partners. It assesses the construct validity of a measurement model depicting associations among eight subtypes of perpetration: moderate physical violence, severe physical violence, forced or coerced sexual violence, sexual violence where consent was not possible, emotional/verbal psychological abuse, dominance/isolation psychological abuse, interactional contacts/surveillance related stalking, and stalking involving mediated contacts. Data were obtained from a sample of 340 men arrested for physical assault of a female spouse or partner, and court ordered into batterer intervention programs. Men were surveyed before starting the intervention. Confirmatory factor analyses (CFA) supported the validity of model as evidenced by good model to data fit and satisfaction of requirements for fit statistics. In addition, the eight factor solution was characterized by a slightly better model to data fit than a four factor higher order solution described in the author's previous work. Latent variable correlations across the broader categories of intimate partner violence (IPV) revealed that the violence subtypes were mostly moderately positively correlated and ranged from .381 (emotional/verbal psychological abuse with interactional contacts/surveillance related stalking) to .795 (dominance/isolation psychological with abuse with forced sex). Future studies should determine whether there are distinct risk factors and health outcomes associated with each of the eight IPV perpetration subtypes and identify possible patterns of co-occurrence.     

Intimate partner violence and HIV/STD risk among lesbian, gay, bisexual, and transgender individuals

To date, there has been little research examining HIV/STD risk among lesbian, gay, bisexual, and transgender (LGBT) individuals who are in abusive relationships. This article uses data collected from a community-based organization that provides counseling for LGBT victims of intimate partner violence (IPV). A total of 58 clients completed the survey, which inquired as to sexual violence and difficulties negotiating safer sex with their abusive partners. A large percentage of participants reported being forced by their partners to have sex (41%). Many stated that they felt unsafe to ask their abusive partners to use safer sex protection or that they feared their partners' response to safer sex (28%). In addition, many participants experienced sexual (19%), physical (21%), and/or verbal abuse (32%) as a direct consequence of asking their partner to use safer sex protection. Training counselors on issues of sexuality and safer sex will benefit victims of IPV.     

Ethnicity and risk for symptoms of posttraumatic stress following intimate partner violence: prevalence and predictors in European American and African American women

The present study uses a feminist theoretical framework to explore risk factors for the development of posttraumatic stress symptoms following intimate partner violence, with a community sample of 120 low-income European American and African American women. Hierarchical regression analyses were used to examine demographic, violence, and mental health variables that predict posttraumatic stress symptoms. The data reveal that African American women report lower levels of posttraumatic stress symptoms than do their European American peers. This difference was observed despite the presence of more empirically identified risk factors for African American women. Regression analyses show that symptoms of depression increase risk for posttraumatic stress for both groups. However, a difference was observed such that past victimization increase risk for only European American women, whereas amount of psychological violence in the previous year increases risk for only African American women. Potential explanations for observed ethnic differences are offered.     

Victimization, posttraumatic stress disorder symptomatology, and later nonsuicidal self-harm in a birth cohort

This longitudinal population-based study examined pathways to nonsuicidal self-harm (NSSH) in relation to childhood sexual abuse (CSA), assault victimization in early adulthood, posttraumatic stress disorder symptomatology (PTSD), and other mental disorders. At age 21, 476 men and 455 women completed interviews on assault victimization, PTSD, and other mental disorders. At age 26, they completed independent interviews on self-harm and childhood sexual abuse (CSA). Multivariate logistic regression analyses were conducted to determine predictors for NSSH at age 26. For men, anxiety and depressive disorders at age 21 were the only significant predictors of NSSH at age 26. For women, victimization, PTSD, and other anxiety disorders at age 21 all significantly predicted NSSH. CSA predicted later NSSH only indirectly, by increasing the risk of anxiety disorders among men and of assault victimization among women. In conclusion, pathways to nonsuicidal self-harm differed by sex. For women there were direct links with assault victimization and PTSD in early adulthood, whereas for men only internalizing disorders predicted future NSSH.     

Acculturation stress, drinking, and intimate partner violence among Hispanic couples in the U.S

This article examines the cross-sectional association between acculturation, acculturation stress, drinking, and intimate partner violence (IPV) among Hispanic couples in the U.S. The data being analyzed come from a multicluster random household sample of couples interviewed as part of the second wave of a 5-year national longitudinal study. The overall survey response rate for the second wave is 72%. Participants are Hispanic couples 18 years of age or older (N = 387). Results show that, among men, lower acculturation is positively associated with higher acculturation stress, which is directly related to a greater likelihood of involvement in IPV. These associations are also present among women. However, data for women show an additional path linking higher levels of acculturation directly to IPV. Drinking is not associated with IPV, independent of gender. Acculturation, directly or through acculturation stress, increases the likelihood of IPV.     

Community violence victimization and symptoms of posttraumatic stress disorder: the moderating effects of coping and social support

This study tested the relationship of community violence (CV) victimization to severity of posttraumatic stress disorder (PTSD), and the roles of coping style and perceived social support in moderating that relationship. Three-hundred seventy-two men and women (age 18 to 22 years) self-reported on CV exposure, traumatic experiences, PTSD symptoms, perceived support from family and friends, and coping strategies. Results indicated that high CV victimization, high disengagement coping (i.e., avoidant styles), and low perceived social support from family and friends significantly predicted increased PTSD scores. Significant moderating effects indicated that the relationship between victimization and heightened PTSD severity was stronger at high levels of perceived friend support and disengagement. Thus, the protective function of friend support seemed to break down at increasing levels of victimization, whereas, as expected, avoidant styles of coping increased the risk for negative outcome. Findings are discussed in terms of event controllability, negative social reactions, and coping resources.     

Treating low-income and minority women with posttraumatic stress disorder: a pilot study comparing prolonged exposure and treatment as usual conducted by community therapists

Twenty-one female psychiatric outpatients with chronic posttraumatic stress disorder (PTSD) are randomly assigned to prolonged exposure (PE; n = 9) for PTSD or treatment as usual (TAU; n = 12). Participants are predominantly low income and African American with complex trauma and psychiatric histories. Treatment is delivered by community therapists with no prior training in behavior therapy for anxiety disorders. Clients who completed PE show a greater improvement in PTSD symptoms, general anxiety, and depression than clients who completed TAU. These findings provide preliminary evidence suggesting that PE is an effective treatment for core PTSD symptoms, even when delivered by community therapists in a front-line services clinic.     

Relationship between type of trauma exposure and posttraumatic stress disorder among urban children and adolescents

This study examines the association between trauma exposure and posttraumatic stress disorder (PTSD) among 157 help-seeking children (aged 8-17). Structured clinical interviews are carried out, and linear and logistic regression analyses are conducted to examine the relationship between PTSD and type of trauma exposure controlling for age, gender, and ethnicity. Confrontation with traumatic news, witnessing domestic violence, physical abuse, and sexual abuse are each significantly associated with PTSD. Witnessing a crime, being the victim of a crime, and exposure to accidents, fire, or disaster are not associated with PTSD. These findings underscore the association between interpersonal violence and childhood PTSD.     

Relationships of depression to child and adult abuse and bodily pain among women who have experienced intimate partner violence

This study investigates whether depression in women who experienced intimate partner violence is associated with having also experienced childhood sexual and physical abuse, psychological abuse by an intimate partner, recent involvement with the abusive partner, and bodily pain. Fifty-seven women who had left a violent relationship with an intimate partner completed measures assessing their demographic characteristics, experiences of abuse in childhood and in their relationship with their intimate partner, and depressive symptoms. Multiple regression analysis showed that women's depression was significantly greater among those who had experienced childhood physical and sexual abuse, more severe psychological abuse, and greater bodily pain (p<.001), adjusted R(2)=.32. These results suggest characteristics that can help to identify abused women who are most at risk for depression, and they suggest specific issues that may need to be addressed in this population.     

Suicidal behavior among low-income, African American female victims of intimate terrorism and situational couple violence

This study examined risk of suicidal behavior among low-income, African American women (N = 369) in three types of male intimate relationships- intimate terrorism (IT) (i.e., physical violence used within a general pattern of coercive control), situational couple violence (SCV; i.e., episodic physical violence that is not part of a general pattern of coercive control), and nonviolent (NV; i.e., no physical violence). IT victims had more than double the odds of suicidal behavior compared to SCV victims and this association remained significant after controlling for physical violence severity, depression symptoms, and alcohol and drug abuse. Risk of suicidal behavior was not significantly different for SCV victims compared to women in NV relationships. Findings emphasize the need for researchers and practitioners to distinguish between types of male partner violence when examining its context and consequences for female victims.     

The association between impulsivity, trait anger, and the perpetration of intimate partner and general violence among women arrested for domestic violence

The problem of domestic violence is widespread, with research indicating men and women both perpetrate a substantial amount of aggression. However, aggression perpetrated by women is a relatively understudied area compared to aggression perpetrated by men. Additionally, research is needed to determine the correlates of aggression perpetration among women, as this can inform more effective treatment programs. Thus, the current study sought to examine the association between trait anger and impulsivity and the perpetration of physical and psychological intimate partner violence (IPV) and general aggression among women arrested for domestic violence (N = 80). Findings indicated that both trait anger and impulsivity were significantly associated with aggression perpetration and trait anger mediated the relationship between impulsivity and aggression perpetration. Directions for future research and violence intervention programs are discussed.     

Maternal depression and adolescent behavior problems: an examination of mediation among immigrant Latino mothers and their adolescent children exposed to community violence

This study examines the psychological and behavioral effects of exposure to community violence of 47 Latino mothers and their young adolescent children. Using data gathered from multiple sources, this study tests the associations between lifetime exposure to community violence, maternal depression, and child behavior problems. More than 80% of the youngsters ranging from age 11 to 14 years and 68% of the mothers reported being exposed to at least one act of community violence either as a victim or as a witness. Analyses reveal that maternal depression is a mediator of child behavior problems, reducing the direct effect of community violence exposure by more than 50%. Findings suggest that maternal depression is a factor more important than child's community violence exposure in contributing to young adolescents' behavioral problems.     

The 5-year course of intimate partner violence among White, Black, and Hispanic couples in the United States

This article examines the 5-year incidence, prevalence, and recurrence of intimate partner violence (IPV) among White, Black, and Hispanic intact couples in the United States. A national multistage household probability sample of couples, age 18 years or older, was interviewed in 1995 with a response rate of 85%, and reinterviewed in 2000 with a response rate of 72%. Results indicate that the incidence and recurrence of IPV are higher for Blacks and Hispanics than for Whites. Compared to Whites, Hispanics are 2.5 times more likely to initiate IPV between baseline and follow-up and Blacks are 3.7 times more likely to report IPV at baseline and follow-up. Couples reporting severe IPV in 1995 are more likely than others to report severe IPV at follow-up. The rate of recurrence for severe IPV among Black and Hispanic couples is 6 and 4 times higher, respectively, than the rate among Whites. The results suggest that Blacks and Hispanics may be more affected by IPV.     

Spousal violence among Anglos,Blacks, and Mexican Americans: The role of demographic variables,psychosocial predictors,and alcohol consumption

Racial/ethnic differences in the prevalence and correlates of self-reported spousal violence in a community sample of Anglo, Black, and Mexican American adults are examined. Females, the formerly married, and Black females in particular (up to 60% of formerly married) were most likely to report both being beaten by and beating a spouse. Multivariate analyses controlling for demographic variables, financial stress, social desirability, sex role traditionalism and drinking quantity (and spouse's drinking among the currently married) did not eliminate the greater likelihood of reports of both beating and being beaten among married Black females. There was little consistent evidence to suggest greater violence propensity among Mexican American than Anglo respondents. The findings raise questions about simplistic socioeconomic status or financial stress explanations of observed racial/ethnic differences in spousal violence. Further, curvilinear effects of alcohol quantity and spouse drinking upon reported violence question simple disinhibition arguments and suggest the need for data regarding couple dynamics.     

Retrospective reports of parental partner abuse: Relationships to depression,trauma symptoms and self-esteem among college students

This study tested whether retrospective reports of childhood exposure to parental partner abuse were associated with internalizing aspects of adult adjustment. Participants were 550 men and women college students. Among women, childhood exposure to partner abuse was related to depression, trauma-related symptoms, and low self-esteem; among men, exposure was associated with trauma-related symptoms. These relationships were statistically independent of reported parental alcohol abuse and divorce. Relationships of parental partner abuse to low self-esteem and depression among women were also independent of variation in retrospective reports of child sexual and physical abuse. However, the relationship of partner abuse to trauma-related symptoms depended, in part, on the co-occurrence of child abuse. The discussion addressed implications of the findings for future research and for clinical practice.