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.     

Child maltreatment histories among female inmates reporting inmate on inmate sexual victimization in prison: the mediating role of emotion dysregulation

Despite data indicating that child maltreatment (CM) in various forms is associated with adult sexual victimization among community women, few studies have explicitly explored how types of CM might relate to prison sexual victimization. Because little is known about how CM might give rise to prison sexual victimization, the present study also examined emotion dysregulation emanating from early abuse experiences as a potential mediator in the link between early CM and inmate-on-inmate prison sexual victimization. Approximately 168 incarcerated women completed self-report inventories assessing various types of childhood maltreatment, emotion dysregulation, and coerced or forced sexual experiences in prison. Nearly 77% of the sample endorsed experiencing at least one form of CM, with 64% of inmates reporting that they experienced two or more forms of CM. Approximately 9% of inmates reported sexual coercion and 22% reported a forced sexual experience in prison. Each form of CM was associated with prison sexual coercion; however, fewer associations emerged between CM and forced prison sexual experiences. Emotion dysregulation was found to mediate links between CM, particularly co-occurring CM, and sexual coercion in prison, but it was unrelated to forced prison sexual experiences. Implications are discussed.     

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.     

Sexual violence and reproductive health among young people in three communities in Jamaica

A secondary analysis of data collected from 1,130 young people ages 15 to 24 in a population-based household survey to assess the reproductive health needs of young people in three communities in Jamaica was conducted to determine the relationships among three measures of sexual violence, background variables, three measures of sexual risk taking (early sexual debut, multiple partners, and no condom at last sex), and two reproductive health outcomes (genital discharge within the past 12 months and pregnancy). In the multivariate analyses, forced first sex increased the likelihood of genital discharge among males (odds ratio, OR = 5.33) and females (OR = 2.02) and pregnancy among females (OR = 2.05), controlling for background characteristics and sexual risk taking. Associations between sexual violence and reported genital discharge and pregnancy that were not mediated by our measures of sexual risk taking were found. More research into the causal mechanisms for this association is needed.     

Violence against women associated with arrests for sex trade but not drug charges

The current study was designed to examine associations between gender-based violence and arrests due to sex trade or drug-related charges among a statewide sample of incarcerated women in Rhode Island. Incarcerated women were asked to participate in brief pre- and posttest surveys of their experiences of violence, sexual risk and substance use behaviors, as part of a study on the effectiveness of a family planning program in a state correctional facility; data from pretest surveys (N=447) were used for current analyses. Logistic regression analyses adjusted for demographics were used to assess significant associations between gender-based violence variables (i.e., adolescent intimate partner violence (IPV), adult IPV, childhood sexual assault (SA), adolescent SA, and adult SA) and arrests due to sex trade or drug-related charges. Significant relationships were observed between arrests for sex trade and adult SA (OR=2.1, 95%CI=1.2-3.6), adolescent IPV (OR=2.5, 95%CI=1.5-4.1), and adult IPV (OR=1.7, 95%CI=1.1-2.6); no significant associations were observed for drug-related charges. Findings from the current study demonstrate that experiences of gender-based violence are associated with arrests for sex trade but not drug-related charges. Interventions for incarcerated women are needed to consider and address history of victimization from gender-based violence and its relation to women's historic and future sex trade involvement.     

Physically forced, alcohol-induced, and verbally coerced sexual victimization: Assessing risk factors among university women

Using survey responses from a sample of 185 college women enrolled at a large northwestern university, this study identified the various risk factors related to three different forms of verbally and physically coercive sexual victimization. Three logistic regression models were estimated and findings indicated that (1) more sexual partners and delays in responding to danger in sexual settings significantly increased the odds of experiencing unwanted sex as a result of verbal coercion, (2) an increased number of sex partners significantly increased the odds of experiencing alcohol-induced sexual assault, and (3) an increased number of sex partners and affiliation with the university Greek system significantly increased the odds of experiencing completed rape. Future research directions and policy implications are discussed.     

Examining the determinants of sexual violence among young, married women in Southern India

The prevalence of sexual violence is increasingly being studied in India. Yet the determinants of sexual violence, irrespective of physical violence, remain largely unexplored. Here the authors identify the determinants of sexual violence, and additionally, explore how the presence of physical violence modifies these determinants. A cross-sectional analysis is conducted using baseline data from a longitudinal study involving young married women attending reproductive health clinics in Southern India. A multivariable logistic regression analysis is conducted to first identify determinants of sexual violence and then repeated after stratifying elements based on presence or absence of physical violence identified from participants' reports. 36% and 50% of the participants report experiencing sexual and physical violence, respectively. After adjusting for other covariates, women's partners' characteristics are found most significantly associated with their odds of experiencing sexual violence. These characteristics include husbands' primary education, employment as drivers, alcohol consumption, and having multiple sex partners. Women's contribution to household income also increases their odds of experiencing sexual violence by almost twofold; however, if they are solely responsible for "all" household income, the relationship is found to be protective. Physical violence modifies the determinants of sexual violence, and among women not experiencing physical violence, husbands' primary education and employment as drivers increase women's odds of experiencing sexual violence nearly threefold, and women who contribute "all" the household income (n = 62) do not experience sexual violence. These relationships are not significant among women experiencing physical violence. Study findings improve the understanding of the determinants of sexual violence. Future research is needed to examine the risk factors for different types of GBV independently and to tease apart the differences in risk factors depending on women's experiences. The significance of male partners' characteristics warrants in-depth research, and in order to promote gender-equitable norms, future interventions need to focus on male behaviors and men's day-to-day survival challenges, all of which likely influence conflicts in marital relationships.     

Mental disorders and charges of violent offences. A study of male adolescent remand prisoners

This study describes associations between mental disorders and charges of violence among remanded adolescents. 100 15-17 year old boys from East Denmark, consecutively remanded during one year, were interviewed with SCAN, K-SADS and SCID-II to obtain past year ICD-10 diagnoses. There was no statistically significant association between the occurrence of a violent charge and mental disorders in general (OR=1.02, 95% confidence interval (CI) [0.24; 4.38]). An association was found between violent charge and non-Danish ethnicity (OR=7.58, [1.60; 35.92]). Previously reported association between violence and mental disorder among adults were not replicated in this male adolescent remand population. A developmental hypothesis is proposed.     

Beyond Traditional Definitions of Assault: Expanding Our Focus to Include Sexually Coercive Experiences

Traditionally, studies examining sexual assault have not considered experiences of coerced consensual sex. This study sought to compare women who endorsed experiences of coerced sexual intercourse with women who reported more traditionally defined experiences of sexual assault and with a group of women who had experienced neither sexual assault nor coercion. The authors hypothesized that women who had experienced sexual coercion would show symptom elevations on a measure of interpersonal trauma-related symptoms that were more consistent with sexual assault victims than with non-victims. Among a sample of undergraduate college women (N=300), women who endorsed coerced sexual intercourse (8.7%) were compared to women endorsing experiences meeting the legal definition of rape (21%), women endorsing childhood sexual abuse (11.7%), women reporting both rape and childhood sexual abuse (6.0%), and women reporting no victimization experiences (52.7%). Analysis of the Trauma Symptom Inventory (TSI; Briere, 1995) clinical subscales confirmed that women who reported coerced sexual intercourse endorsed symptoms levels more consistent with the adult rape group than with the non-victim group.     

Relationships among alcohol outlet density, alcohol use, and intimate partner violence victimization among young women in the United States

Greater access to alcohol has been widely found to be associated with many negative outcomes including violence perpetration. This study examines the relationship between alcohol outlet density, alcohol use, and intimate partner violence (IPV) victimization among young women in the United States. A direct association between alcohol outlet density in one's neighborhood and the likelihood of IPV victimization was examined. Data were from Wave III of the National Longitudinal Study of Adolescent Health (Add Health), which followed a nationally representative sample of adolescents into adulthood. Participants were young adult females age 18 to 26 at Wave III. Of the 4,571 female respondents who reported a current heterosexual relationship and had IPV data, 13.2% reported having been the victim of physical violence only and 6.5% experienced sexual only or physical and sexual violence in the relationship during the past year. In the regression models tested, there was no significant direct association between neighborhood alcohol outlet density and IPV victimization nor was there an association between outlet density and drinking behaviors, thus eliminating the possibility of an indirect association. Results of fully adjusted models indicate females who drank heavily, whether infrequently or frequently, were at significant risk for experiencing sexual only IPV or sexual and physical IPV. Asians and Native Americans were at significantly greater odds of experiencing sexual only or sexual and physical IPV compared with non-Hispanic Whites, while non-Hispanic Blacks were at significantly greater odds for physical only IPV. We conclude that a continuous measure of alcohol outlet density was not associated with IPV in models controlling for individual and other neighborhood characteristics. Young women who drink heavily, whether infrequently or frequently, have greater odds of experiencing sexual only or sexual and physical compared to abstainers. Similar to previous study findings, young women living with or married to their partner were at far greater risk of experiencing physical only and/or sexual only or sexual and physical IPV. The study adds to the growing body of literature that examines how community characteristics such as outlet density influence the likelihood of IPV.     

Identifying pregnant women experiencing domestic violence in an urban emergency department

The article describes characteristics of pregnant women presenting to the Emergency Department (ED) who are experiencing current violence and presented a screening tool to identify pregnant women experiencing violence. Women completed an in-person interview regarding violence, sociodemo-graphic factors, health status, and drug use. Fifteen percent of women reported at least one episode of violence during the pregnancy. Young age (OR = 3.37, 95% CI: 1.79-6.36), current alcohol use (OR = 1.53, 95% CI: 1.06-2.19), current marijuana use (OR = 1.96, 95% CI: 1.32-2.92), less than a high school education (OR = 1.46, 95% CI: 1.01-2.12), and a prior diagnosis of trichomonas (OR = 1.81, 95% CI: 1.20-2.72) were significantly related to experiencing current violence. Screening patients using these five characteristics identified 8 out of 10 women reporting violence (sensitivity = 75.6%). These results identify a set of predictors that may be helpful in identifying pregnant women who are experiencing current domestic violence.     

The impact of mental health services on arrests of offenders with a serious mental illness

This study examines the impact of mental health services on arrests of offenders with a serious mental Illness (SMI) by assessing changes in associations between receipt of outpatient and emergency room/inpatient services and arrests one, two, and three quarters later. A variety of data sets were used for identifying 3,769 offenders who were in the Pinellas County Florida jail between 7/1/2003 and 6/30/ 2004, and 7,755 offenders who were in the Harris County Texas jail between 10/1/2005 and 9/30/2006. Arrests, out-patient and emergency room/inpatient services were assigned to one of 16 ninety-day periods between 7/1/2002 and 6/10/2006 in Pinellas County and one of 12 such periods between 10/1/2004 and 9/15/2007 in Harris County. Generalized estimating equations were used. Covariates were age, gender, race, diagnosis, and homelessness. The results were also adjusted for exposure to arrests. In Pinellas County, outpatient services significantly reduced the risks of arrests 1 quarter later by 17% (odds ratio [OR] = 0.83, 95% confidence interval [CI]: 0.78-0.87, p < .001), two quarters later by 11% (OR = 0.89, 95% CI: 0.84-0.94, p < .001), and three quarters later by 9% (OR = 0.91, 95% CI: 0.86-0.96, p = .001). In Harris County, these services reduced the risk of arrest 1 quarter later by 5% (OR = 0.95, 95% CI: 0.91-0.99, p = .028), but not two and three quarters later. In Pinellas County, ER/inpatient services increased the risk of arrests by 22% (OR = 1.23, 95% CI: 1.15-1.30, p < .001), 8% (OR = 1.08, 95% CI: 1.02-1.15, p = .010) and 11% (OR = 1.11, 95% CI: 1.02-1.16, p = .001) one, two, and three quarters later. In Harris County, these services increased the risk of arrest only 1 quarter later (OR = 1.16, 95% CI: 1.11-1.22, p < .001). Results suggest that service receipt and its timing may have had some impact on the arrests of adults with a SMI and criminal justice involvement.     

Somatic morbidity and criminality: the Northern Finland 1966 Birth Cohort Study

OBJECTIVE: The aim of this study was to investigate the association between adverse physical disorders and violent/non-violent criminal behaviour. DESIGN: The study material consisted of the large, prospectively followed, unselected and genetically homogeneous Northern Finland 1966 Birth Cohort, the Finnish Hospital Discharge Registers and the National Crime Register (n=10934). MAIN RESULTS: The results of the logistic regression analyses showed that male offenders had statistically significantly more injuries (adj. OR=1.81, 95% CI=1.51-2.17), when compared with males without a criminal history. Violent male offenders exhibited greater morbidity to the diseases of the respiratory system (adj. OR=1.64, 95% CI=1.03-2.60) when compared with non-violent criminals. Female offenders suffered more commonly from poisonings (adj. OR=3.84, 95% CI=1.69-8.72), injuries (adj. OR=2.79, 95% CI=1.67-4.66), infections (adj. OR=1.87, 95% CI=1.16-2.99) and indefinite symptoms (adj. OR=2.02, 95% CI=1.20-3.40) than non-offending females. CONCLUSIONS: At epidemiological level, criminal behaviour seems to be associated especially with an increased risk of injuries for both sexes. The observed increase of the diseases of the respiratory system among violent but not among non-violent males calls for further investigations.     

Comparative analysis of differences by gender in sudden infant death syndrome in Hungary and Japan

We examined the sex ratio in sudden infant death syndrome (SIDS) cases in Hungary, in Tokyo and Japan between 1985 and 1996. From all the infant death cases in Hungary 395 (240 male, 155 female) were SIDS (odds ratio (OR)=1.179, with 95% confidence interval (CI)=0.961, 1.446), in Japan 4348 (2550 male, 1798 female) were SIDS (OR=1.145, with 95% CI=1.076, 1.218) and in Tokyo 307 (178 male, 129 female) were SIDS (OR=1.128, with 95% CI=0.894, 1.423). Male infants showed a significantly higher birth rate than females. The male infants are more vulnerable (p<0.005), however, higher mortality among male infants should not be considered a characteristic feature for SIDS.     

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.     

Perceived conflict patterns and relationship quality associated with verbal sexual coercion by male dating partners

The study of verbal sexual coercion in heterosexual relationships is controversial because nonphysical coercive tactics are often viewed as socially acceptable. It was hypothesized that, within couples, verbal sexual coercion will occur within a larger context of destructive conflict tactics and diminished relationship quality. Female undergraduates in consensually sexual dating relationships (N = 193) provided self-report data on male partner verbal sexual coercion perceived conflict behaviors, and relationship quality. About 21% reported current partner verbal sexual coercion. Results reveal positive associations between feeling pressured into unwanted sex and perceptions of partner psychological abuse and destructive verbal conflict patterns. Also as expected, partner verbal sexual coercion is negatively associated with relationship satisfaction and sexual functioning. The authors conclude that women's experiences of verbal sexual coercion in heterosexual relationships may reflect broader problems in the dyadic context.     

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.     

"The red zone": temporal risk for unwanted sex among college students

The "red zone" usually refers to the first few weeks of the first semester at college, when female students are believed to be at greatest risk for experiencing unwanted sex. We tested this notion using data from a survey study of 207 first-and second-year students (121 women, 84 men) at a small, liberal arts university. Results demonstrated only one significant elevation in incidence rates of first- and second-year women's unwanted sexual experiences (sexual touching, attempted and completed anal, oral, and vaginal sex), between the end of the first month and fall break (mid-October) during the second year at school. Previous research and local information about the relevant behaviors of sorority and fraternity members is discussed in light of these findings to provide heuristic material for further empirical testing. Because risk may involve both temporal and situational factors, systematic collection and dissemination of local data are recommended.     

Risk factors and consequences of unwanted sex among university students: hooking up, alcohol, and stress response

This is the first study of unwanted sexual experiences in the collegiate "hooking-up" culture. In a representative sample of 178 students at a small liberal arts university. Twenty-three percent of women and 7% of men surveyed reported one or more experiences of unwanted sexual intercourse. Seventy-eight percent of unwanted vaginal, anal, and oral incidents took place while--"hooking up,"--whereas 78% of unwanted fondling incidents occurred at parties or bars. The most frequently endorsed reason for unwanted sexual intercourse was impaired judgment due to alcohol. The most frequently endorsed reason for unwanted fondling was that it happened before the perpetrator could be stopped. Of those affected by unwanted sexual intercourse or unwanted fondling, 46.7% and 19.2% reported unwanted memories, 50% and 32.7% reported avoidance and numbing responses, and 30% and 26.9% reported hyperarousal responses, respectively. A preliminary model of unwanted sex and collegiate social dynamics is proposed to provide a heuristic for further research.     

Reducing intimate and paying partner violence against women who exchange sex in Mongolia: results from a randomized clinical trial

Women who exchange sex for money or other goods, that is, female sex workers, are at increased risk of experiencing physical and sexual violence from both paying and intimate partners. Exposure to violence can be exacerbated by alcohol use and HIV/STI risk. The purpose of this study is to examine the efficacy of a HIV/STI risk reduction and enhanced HIV/STI risk reduction intervention at decreasing paying and intimate partner violence against Mongolian women who exchange sex and engage in harmful alcohol use. Women are recruited and randomized to either (a) four sessions of a relationship-based HIV/STI risk reduction intervention (n = 49), (b) the same HIV/STI risk reduction intervention plus two additional motivational interviewing sessions (n = 58), or (c) a four session control condition focused on wellness promotion (n = 59). All the respondents complete assessments at baseline (preintervention) as well as at immediate posttest, 3 and 6 months postintervention. A multilevel logistic model finds that women who participated in the HIV/STI risk reduction group (OR = 0.14, p < .00), HIV/STI risk reduction and motivational interview group (OR = 0.46, p = .02), and wellness (OR = 0.20, p < .00) group reduced their exposure to physical and sexual violence in the past 90 days. No significant differences in effects are observed between conditions. This study demonstrates the efficacy of a relationship-based HIV/STI risk reduction intervention, a relationship-based HIV/STI risk reduction intervention combined with motivational interviewing, and a wellness promotion intervention in reducing intimate and paying partner violence against women who exchange sex in Mongolia. The findings have significant implications for the impact of minimal intervention and the potential role of peer networks and social support in reducing women's experiences of violence in resource poor settings.