Optimal methods to screen men and women for intimate partner violence: results from an internal medicine residency continuity clinic

Contradictory data exist regarding optimal methods and instruments for intimate partner violence (IPV) screening in primary care settings. The purpose of this study was to determine the optimal method and screening instrument for IPV among men and women in a primary-care resident clinic. We conducted a cross-sectional study at an urban, academic, internal medicine residency continuity clinic in Connecticut among English or Spanish speaking adult patients. One group of patients ( n = 340) received a self-administered questionnaire (SAQ) containing the partner violence screen (PVS) and the Hurt, Insulted, Threatened or Screamed at Questionnaire (HITS). A second group (n = 126) was screened with PVS and HITS by their primary care providers during face-to-face (FTF) clinical encounters. Multivariable logistic regression models were used to determine the association between IPV prevalence and screening method (SAQ or FTF) after adjusting for socio-demographic effects. The overall IPV prevalence was 17.3% using the SAQ and 9.0% with FTF screening (p = .008). Patients receiving the SAQ were more likely to report IPV than those who were screened FTF (adjusted odds ratio [AOR]: 2.6, 95% confidence interval [CI]: 1.2-5.6). This effect persisted for women, who had a higher odds of IPV when screened through a SAQ than when screened FTF (AOR: 3.5, 95% CI: 1.4-8.6). Men did not differ in reporting IPV between methods: 11% with SAQ versus 9.4% FTF (p = .69). In internal medicine residency continuity clinics, a SAQ for IPV may result in higher disclosure and completion rates among female patients compared to FTF screening. Unique screening instruments and methods may be needed for men.     

Associations between intimate partner violence and emotional distress among pregnant women in Durban, South Africa

Intimate partner violence (IPV) during pregnancy has been associated with multiple negative health outcomes including emotional distress during pregnancy. However, little is known about IPV during pregnancy and its association with emotional distress among South African women. The objectives of this study were to determine the prevalence of both emotional distress and IPV during pregnancy, to identify whether different exposures of violence were associated with emotional distress and to assess whether social support attenuated the relationship between IPV and emotional distress. Pregnant women enrolled in the South Africa HIV Antenatal and Posttest Support Study (SAHAPS) who completed the baseline survey were included in this cross sectional analysis. We used logistic regression models to explore bivariate and multivariate relationships between the proposed covariates and emotional distress. Nearly a quarter of women experienced some type of IPV during the current pregnancy, with psychological violence being the most prevalent. The odds of emotional distress was 1.41 times (95% CI: [1.26, 1.57]) higher for each additional episode of psychological violence and 2.01 times (95% CI: [1.16, 3.77]) higher for each additional episode of sexual violence during pregnancy, adjusting for other covariates. Physical violence was only marginally associated with increased odds of emotional distress. Finally, social support was marginally significant as a main effect but did not attenuate the relationship between IPV and emotional distress. The high prevalence of IPV among South African women and its association with emotional distress during pregnancy suggest that interventions that reduce violence during or prior to pregnancy are needed.     

Psychopathology in women arrested for domestic violence

This study examined the prevalence of psychopathology among women arrested for violence and whether the experience of intimate partner violence (IPV) was associated with Axis I psychopathology. Women who were arrested for domestic violence perpetration and court referred to violence intervention programs (N= 103) completed measures of IPV victimization, perpetration, and psychopathology. Results revealed high rates of posttraumatic stress disorder (PTSD), depression, generalized anxiety disorder (GAD), panic disorder, substance use disorders, borderline personality disorder, and antisocial personality disorder. Violence victimization was significantly associated with symptoms of psychopathology. Logistic regression analyses showed that sexual and psychological abuse by partners were associated with the presence of PTSD, depression, and GAD diagnoses. Results highlight the potential importance of the role of violence victimization in psychopathology. Results suggest that Axis I and Axis II psychopathology should routinely be assessed as part of violence intervention programs for women and that intervention programs could be improved by offering adjunct or integrated mental health treatment.     

Association between education and domestic violence among women being offered an HIV test in urban and rural areas in Kenya

The objective of this study was to examine the association between education and domestic violence among women being offered an HIV test in urban and rural areas in Kenya. A sample selection of women who experienced physical (n = 4,308), sexual (n = 4,309), and emotional violence (n = 4,312) aged 15 to 49 allowed for the estimation of the association between education and domestic violence with further analysis stratified by urban and rural residence. The main outcome of interest was a three-factor (physical, sexual, and emotional) measure for violence with the main predictor being education. Nearly half of all domestic violence, physical (46%), sexual (45%), and emotional (45%) occurred among women aged 15 to 29. After adjusting for confounding variables, women who resided in urban areas and had a postprimary/vocational/secondary and college/university education were 26% (OR = 0.74, 95% CI: [0.64, 0.86]), p < .001 and 22% (OR = 0.78, 95% CI: [0.66, 0.92]), p < .01 less likely to have experienced physical violence compared to those who had a primary education respectively. This was 17% (OR = 0.83, 95% CI: [0.73, 0.94]), p < .01 and 17% (OR = 0.83, 95% CI: [0.72, 0.96]), p < .05 less likely among women who resided in rural areas. A surprising finding was that women residing in rural areas with less than a primary education were 35% less likely to have experienced sexual violence (OR = 0.65, 95% CI: [0.43, 0.99]), p < .01 compared to those who had a primary education. These findings suggest that physical, sexual, and emotional violence were prevalent in Kenya among married and formerly married women. This study indicates that more research is needed to understand factors for HIV/AIDS among Kenyan women who have specifically tested positive for HIV or identified as AIDS-positive and the implications for women's health.     

Depressive symptoms among female college students experiencing gender-based violence in Awassa, Ethiopia

Little epidemiologic research has focused on the mental health effects of gender-based violence among sub-Saharan African women. The objective of this study was to assess risk of depression and depressive symptoms among 1,102 female undergraduate students who were victims of gender-based violence. Students who reported experience of any gender-based violence were nearly twice as likely to be classified as having moderate depression during the academic year (OR = 1.98, 95% CI = 1.39-2.82) as compared with nonabused students. Compared with nonabused students, those who had experienced both physical and sexual abuse were 4 times more likely to report either moderately severe (OR = 4.32, 95% CI = 2.00-9.31) or severe depressive symptoms (OR = 4.19, 95% CI = 1.01-17.43). Our findings, consistent with previous studies, support the thesis that women's mental health status is adversely affected by exposure to gender-based violence.     

Adulthood animal abuse among women court-referred to batterer intervention programs

The substantial increase in the enrollment of women in batterer intervention programs (BIPs) over the past 30 years has greatly outpaced research on women who perpetrate intimate partner violence (IPV). As a result, it is unknown whether existing programs, which were originally designed to treat male perpetrators, are effective at preventing recidivism among women. Recent research shows that men who perpetrate IPV may also aggress against nonintimate partners, children, and animals, and that the reach of their aggressive tendencies has implications for treatment. Conducting similar investigations on women who perpetrate IPV may help to inform treatment delivery in BIPs. This study examined the prevalence of adulthood animal abuse perpetration and its association with psychological and physical IPV perpetration in a sample of women arrested for domestic violence (N = 87). Seventeen percent (n = 15) of the women committed at least one act of animal abuse since the age of 18, in contrast to the 0.28% prevalence rate reported in the general population. The overrepresentation of animal abuse in this sample was consistent with that of men arrested for domestic violence. Furthermore, women who reported committing animal abuse as an adult showed moderately higher rates of psychological aggression and physical assault perpetration against their partners, relative to women who did not report animal abuse. Implications for future research are discussed.     

Severity of neurocognitive impairment in women who have experienced intimate partner violence in Spain

This study examines neuropsychological impairment in women who have experienced intimate partner violence using DSM 5 criteria for mild and severe cognitive impairment. A total of 108 females in Spain were included in one of three groups: psychological abuse (n = 24), physical and psychological abuse (n = 45), and no-abuse (n = 39). There were differences between the control and IPV groups in attention and executive functioning. Furthermore, approximately 25% of women experiencing IPV suffer mild neuropsychological alterations and 5% severe, mostly in memory and executive function domains. This evidence supports the growth in research that suggests psychological violence on its own to be as strongly related to poor health outcomes as physical violence in intimate partner relationships.     

Community violence and PTSD in selected South African townships

Given the high rates of crime in South Africa's townships, nonpolitical violence out-side the home and its psychological impact on women were investigated within two samples, the primary a help-seeking sample and the secondary a community sample. In the help-seeking sample, two thirds of the women reported having experienced several traumatic events outside the home. Those women displayed a median of 9 PTSD (post-traumatic stress disorder) symptoms, with nearly half meeting all criteria for PTSD. In the community sample, 40 women of color were interviewed at a community festival for women, and again two thirds reported having experienced several traumatic events outside the home during the previous year. These women displayed a median of 8.8 PTSD symptoms, with none meeting all criteria for PTSD. South Africa's distinctive culture of violence is discussed as context for understanding issues of community violence and PTSD among women in its minority townships.     

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.     

The Association Between Different Types of Intimate Partner Violence Experienced by Women

Those who experience intimate partner violence (IPV) are often subjected to multiple types of victimization such as physical violence, sexual violence, psychological aggression, and stalking. However, relatively few studies have used a national population-based sample and multivariate methods to analyze the associations between these different types of violence. This study uses multivariate methods to analyze a national population-based sample of women in order to document empirically the extent to which different types of IPV overlap, while controlling for personal and behavioral characteristics. Results indicated significant levels of overlap, with victims often experiencing more than one type of victimization by an intimate partner. Findings also indicated that women who had experienced violence by non-intimate partners were often more likely to experience violence by intimates. Finally, women who had experienced stalking by an intimate were more likely to experience more forms of IPV on average than those who had experienced physical violence, sexual violence, or emotional aggression.     

Examining the Impact of Posttraumatic Stress Disorder Related to Intimate Partner Violence on Antenatal,Intrapartum and Postpartum Women: A Scoping Review

We undertook a comprehensive scoping review of published academic articles to examine the extent, range and nature of research related to the effects of posttraumatic stress disorder (PTSD) among childbearing women who have experienced intimate partner violence (IPV). Fifty-five sources were identified from the electronic databases and two additional sources were identified after searching reference lists. Among the 57 articles, five met the inclusion criteria of childbearing women who have experienced IPV and PTSD. Numerical analysis revealed considerable heterogeneity among articles, with various aims, methodological approaches, patient populations and outcomes of interest. Inductive thematic content analysis revealed three themes: (1) context; (2) outcomes; and (3) changes in practice. The findings from this first attempt at summarizing literature via a scoping review demonstrate the need for additional research related to: identification of, treatment interventions for, and understanding the mechanisms of impact for IPV related PTSD among childbearing women.     

Pregnancy and Intimate Partner Violence in Canada: a Comparison of Victims Who Were and Were Not Abused During Pregnancy

The purpose of this study was to examine risk factors, indicators of severity, and differences in post-violence health effects for victims who experienced intimate partner violence (IPV) during pregnancy compared to victims who experienced IPV outside the pregnancy period. Data were from Statistics Canada’s 2009 General Social Survey. Among IPV victims, 10.5 % experienced physical and/or sexual violence during pregnancy. Victims who had experienced violence during pregnancy were more likely than victims who were not abused during pregnancy to experience both less severe and more severe forms of violence. In fully adjusted models, younger age, separated or divorced marital status, as well as partners’ patriarchal domination, destruction of property, and drinking were significant predictors of pregnancy violence. Measures indicative of more severe violence and of a number of adverse post-violence health effects were significantly elevated among victims who experienced pregnancy violence relative to victims who were not abused during pregnancy. Implications of these findings are discussed.     

Bruised Inside Out: The Adverse and Abusive Life Histories of Incarcerated Women as Pathways to PTSD and Illicit Drug Use

The majority of incarcerated women who suffer from diverse traumatic life histories including abusive home lives and intimate partner violence (IPV), develop post-traumatic stress disorder (PTSD) and struggle with heavy illicit drug use. While many have offered examinations of these relationships, the current study is among the first to utilize an integrated feminist pathways and general strain theory (GST) approach to explain them. Using data from a stratified random sample of all incarcerated women in Oklahoma (N = 334), we explore the links between, adverse childhood experiences, including physical, sexual, emotional, and childhood neglect, IPV, PTSD, and heavy illicit drug use. Our findings indicate that the effects of IPV on heavy illicit drug use are mediated by PTSD symptoms suggesting that PTSD plays a significant role in the pathway to illicit drug use among Oklahoma women prisoners. Implications for the importance of utilizing an integrated feminist pathways and GST approach in future research are offered.     

Intimate partner violence and unintended pregnancy among bangladeshi women

This study examined the relationship between intimate partner violence (IPV) and unintended pregnancy using data from women reporting IPV in the 2007 Bangladesh Demographic Health Survey. The analysis included 4,695 married women, aged 15 to 40 years, who had at least one birth in the last 5 years. Bivariate and multiple logistic regression analyses were performed to assess the relationship between IPV and pregnancy. About one third (30.4%) of women were abused physically and/or sexually and about one third (30.9%) of their births in the last 5 years were unintended. Compared with women who suffered no IPV, women who were abused sexually had a 1.64-fold increased risk of unintended pregnancy, which is higher than those who suffered physical abuse only (odds ratio: 1.35). The prevalence of unintended pregnancy among those who experienced severe physical violence was 1.60 times higher than those who reported no abuse. The findings indicate a significant relationship between IPV and unintended pregnancy among Bangladeshi women.     

Seeking for risk factors of Intimate Partner Violence (IPV) in a Greek national sample: the role of self-esteem

The objective of this article is to gain a better understanding of the magnitude of intimate partner violence (IPV) in Greece and to explore factors associated with increased risk of IPV prevalence. A cross-sectional study was undertaken among 1,122 men and women, aged 18 to 65, who are residents of urban areas of Greece. The questionnaire used included 3 sections and 39 items that examined the sociodemographic characteristics of the participants, rate of IPV victimization and perpetration (physical, sexual, emotional), childhood experience of violence, and level of self-esteem. Statistical analysis showed self-esteem to be significantly associated with physical violence victimization and perpetration (odds ratio [OR] = .975, confidence interval [CI] = .955-.996; OR = .972, CI = .951-.993, respectively), whereas experience of abuse during childhood was shown to be a strong predictor in all six models of IPV victimization and perpetration (p < .001). Finally, gender, age and years of cohabitation were some sociodemographic and background characteristics found to increase the risk of specific forms of IPV. Conclusions drawn from the current study should be taken into account in attempts aiming at preventing or ameliorating the problem.     

Severity of intimate partner violence and occurrence and frequency of police calls

This article evaluates whether female victims of severe physical, psychological, or sexual intimate partner violence (IPV) call police more often than other abused women. Abused women (431) reported frequency of contacting police (dependent variable), nature and severity of IPV experienced, and characteristics of themselves and their perpetrator (explanatory variables). A two-part regression model estimated likelihood of police contact among all participants and rate of contact among callers. Women with severe physical or psychological IPV or injury were more likely to call police than were other abused women. Among callers, women made 96% more calls if a weapon was involved, 58% more if they were severely sexually abused, and 40% more if they were severely physically abused. Women with children at home made 32% more calls. These results delineate the level and types of IPV and other characteristics of homes that make single and repeat calls to police.     

Adverse mental health outcomes associated with emotional abuse in young rural South African women: a cross-sectional study

There is a lack of data on the prevalence of emotional abuse in youth. The aim of this study was thus to estimate the prevalence of emotional abuse in intimate partnerships among young women in rural South Africa and to measure the association between lifetime experience of emotional abuse (with and without the combined experience of physical and/or sexual abuse) and adverse health outcomes. Between 2002 and 2003, young women from 70 villages were recruited to participate in the cluster randomized controlled trial of an HIV behavioral intervention, Stepping Stones. Data was obtained through the administration of a questionnaire at baseline. Of the 1,293 women who had ever been partnered, 189 (14.6%) had experienced only emotional abuse in their lifetimes. Three hundred sixty-six women (28.3%) experienced emotional abuse with physical and/or sexual abuse in their lifetimes, and one hundred forty-four women (11.1%) experienced physical and/or sexual abuse without emotional abuse. Hazardous drinking was associated with the experience of physical and/or sexual abuse, with (OR 6.0, 95% CI [1.0, 36.6]) and without emotional abuse (OR 5.8, 95% CI [1.1, 29.4]). Illicit drug use (OR 5.6, 95% CI [2.4, 12.6]), having depressive symptoms (OR 2.9, 95% CI [1.2, 4.2]), having psychological distress (OR 1.9, 95% CI [1.4, 2.6]), and suicidality (OR 79.0, 95% CI [17.3, 359.6]) was associated with the experience of emotional abuse with physical and/or sexual abuse. Suicidality was also strongly associated with having experienced emotional abuse alone (OR 79.5, 95% CI [16.7, 377.4]). This study showed that emotionally abused young women had a greater risk of suicidality than those experiencing no abuse and that the combined experience of emotional with physical and/or sexual abuse was strongly associated with poor mental health outcomes.     

Depression Among Mexican Women: The Impact of Nonviolent Coercive Control,Intimate Partner Violence and Employment Status

There is significant empirical evidence documenting the link between intimate partner violence (IPV) and incidence of depression symptoms. This study explores the impact of intimate partner violence, nonviolent spousal coercive control, and women’s employment status on the incidence of depression symptoms in a sample of Mexican women. Results from regression models suggest different types of abusive relationships have differential impacts on incidence of depression. Specifically, a woman’s employment status contributed to the risk of depression in the context of prevalent nonviolent spousal controlling behaviors. On the other hand, employment status did not contribute to the risk of developing depression symptoms when women were in relationships where physical violence was not coupled with controlling behaviors. Results of the study are discussed in the context of the Mexican culture, as well as implications for the treatment of IPV among Mexican women.     

Posttraumatic stress disorder following ethnoreligious conflict in Jos, Nigeria

In September 2001, ethnoreligious rioting occurred in Jos, Nigeria. Using a multistage cluster sampling technique, 290 respondents were recruited in Jos 7 to 9 months after the riot. Data were collected regarding demographics, exposure to traumatic events, and psychological symptoms. Resting pulse and blood pressure were recorded. A total of 145 (52.5%) witnessed or were victims of personal attacks, 165 (59.6%) lost their possessions, 56 (20.7%) had their homes burned, 44 (16.2%) witnessed relatives' deaths, and 8 (2.9%) were robbed. A total of 252 (89.7%) of the respondents met reexperiencing criteria, 138 (49.1%) met avoidance criteria, and 236 (84.0%) met arousal criteria for posttraumatic stress disorder (PTSD). A total of 116 (41%, 95% confidence interval [CI] = 36% to 47%) met all three categories for PTSD. Only personal attacks (adjusted odds ratio = 2.8, 95% CI = 1.7 to 4.7) and a heart rate of 90 beats/min or more (adjusted odds ratio = 2.8, 95% CI = 1.4 to 5.8) were significantly related to PTSD in a multivariate model.     

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.