The role of emotional abuse in intimate partner violence and health among women in Yokohama, Japan

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.

Predicting the Risk of Intimate Partner Violence: The Chinese Risk Assessment Tool for Victims

The present study reports the development and validation of the Chinese Risk Assessment Tool for Victims (CRAT-V), an actuarial instrument for the prediction of intimate partner violence (IPV) victimization in a Chinese population. Data were collected from a representative sample of 2,708 Chinese women who were married or cohabiting in Hong Kong. All participants were interviewed with a questionnaire assessing their experience of IPV victimization and personal or family factors related to IPV. As measured by the Revised Conflict Tactics Scale (CTS 2), the base rates of preceding-year physical and sexual IPV victimization were 4.6 % and 3.6 %, respectively. Using a cross-validation procedure, the present study developed a 5-factor instrument with one half of the randomly split sample and validated the resulting tool with the other half. The CRAT-V had a sensitivity of 74.0 %, a specificity of 68.3 %, an overall accuracy of 68.7 %, and an area under the receiver operating characteristic (ROC) curve of 0.75 when administered on the second half of sample. Overall, the CRAT-V may serve as a straightforward, systematic, and easy-to-administer instrument tailor-made for Chinese populations for the assessment of risk of IPV victimization against women.

Intimate partner violence and prescription of potentially addictive drugs: prospective cohort study of women in the Oslo Health Study

OBJECTIVES

To investigate the prescription of potentially addictive drugs, including analgesics and central nervous system depressants, to women who had experienced intimate partner violence (IPV).

DESIGN

Prospective population-based cohort study.

SETTING

Information about IPV from the Oslo Health Study 2000/2001 was linked with prescription data from the Norwegian Prescription Database from 1 January 2004 through 31 December 2009.

PARTICIPANTS

The study included 6081 women aged 30-60 years.

MAIN OUTCOME MEASURES

Prescription rate ratios (RRs) for potentially addictive drugs derived from negative binomial models, adjusted for age, education, paid employment, marital status, chronic musculoskeletal pain, mental distress and sleep problems.

RESULTS

Altogether 819 (13.5%) of 6081 women reported ever experiencing IPV: 454 (7.5%) comprised physical and/or sexual IPV and 365 (6.0%) psychological IPV alone. Prescription rates for potentially addictive drugs were clearly higher among women who had experienced IPV: crude RRs were 3.57 (95% CI 2.89 to 4.40) for physical/sexual IPV and 2.13 (95% CI 1.69 to 2.69) for psychological IPV alone. After full adjustment RRs were 1.83 (1.50 to 2.22) for physical/sexual IPV, and 1.97 (1.59 to 2.45) for psychological IPV alone. Prescription rates were increased both for potentially addictive analgesics and central nervous system depressants. Furthermore, women who reported IPV were more likely to receive potentially addictive drugs from multiple physicians.

CONCLUSIONS

Women who had experienced IPV, including psychological violence alone, more often received prescriptions for potentially addictive drugs. Researchers and clinicians should address the possible adverse health and psychosocial impact of such prescription and focus on developing evidence-based healthcare for women who have experienced IPV.

Relationship between domestic violence and postnatal depression among pregnant Chinese women

OBJECTIVE

To investigate the prevalence of domestic violence during pregnancy and postnatal depression, and to explore the relationship between domestic violence and postnatal depression among Chinese women.

METHODS

In a cross-sectional survey, 846 pregnant women were screened with the Abuse Assessment Screen; 215 women completed the postnatal follow-up. All participants underwent psychosocial assessment, with the Edinburgh Postpartum Depression Scale being used for the evaluation of postnatal depression.

RESULTS

The overall prevalence of domestic violence during pregnancy was 11.3%, and the most common form of domestic violence was psychologic abuse. The follow-up interviews showed a higher prevalence of postnatal depression among women who had been abused during pregnancy (25.1%) than among those who had not (6.0%). Psychologic abuse during pregnancy, an unexpected pregnancy, an attitude of acceptance toward violence, and concern over the newborn's health were related with postnatal depression.

CONCLUSION

Domestic violence during pregnancy and related factors contributed to postnatal depression in a population of Chinese women. The findings emphasize the importance of intervention among vulnerable populations in low-income countries.

The prevalence of exposure to domestic violence and the factors associated with co-occurrence of psychological and physical violence exposure: a sample from primary care patients

Background

Since many health problems are associated with abuse and neglect at all ages, domestic violence victims may be considered as a group of primary care patients in need of special attention.

Methods

The aim of this multi-centre study was to assess the prevalence of domestic violence in primary care patients, and to identify those factors which influence the co-occurrence of psychological and physical violence exposure and their consequences (physical, sexual and reproductive and psychological) as obtained from medical records.

A study was carried out in 28 family practices in Slovenia in 2009. Twenty-eight family physicians approached every fifth family practice attendee, regardless of gender, to be interviewed about their exposure to domestic violence and asked to specify the perpetrator and the frequency. Out of 840 patients asked, 829 individuals, 61.0% women (n = 506) and 39.0% men (n = 323) were assessed (98.7% response rate). They represented a randomised sample of general practice attendees, aged 18 years and above, who had visited their physician for health problems and who were given a physical examination. Visits for administrative purposes were excluded.

Multivariate binary logistic regression analysis was used to determine the factors associated with exposure to both psychological and physical violence.

Results

Of 829 patients, 15.3% reported some type of domestic violence experienced during the previous five years; 5.9% reported physical and 9.4% psychological violence; of these 19.2% of men and 80.8% of women had been exposed to psychological violence, while 22.4% of men and 77.6% of women had been exposed to physical violence. The domestic violence victims were mostly women (p < 0.001) aged up to 35 years (p = 0.001). Exposure to psychological violence was more prevalent than exposure to physical violence. Of the women, 20.0% were exposed to either type of violence, compared to 8.0% of male participants, who reported they were rarely exposed to physical violence, while women reported often or constant exposure to physical violence. Their partners were mostly the perpetrators of domestic violence towards women, while amongst men the perpetrators were mostly other family members.

In univariate analysis female gender was shown to be a risk factor for domestic violence exposure. Regression modelling, explaining 40% of the variance, extracted two factors associated with psychological and physical violence exposure: the abuse of alcohol in the patient (OR 4.7; 95% CI 1.54-14.45) and their unemployment (OR 13.3; 95% CI 1.53-116.45).

Conclusions

As far as the study design permits, the identified factors associated with both psychological and physical violence exposure could serve as determinants to raise family physicians' awareness when exploring the prevalence of domestic violence. The results of previous research, showing at least 15% prevalence of exposure to domestic violence among primary care patients in Slovenia, and the female gender as a risk factor, were confirmed.

Violence against women is strongly associated with suicide attempts: evidence from the WHO multi-country study on women's health and domestic violence against women

Suicidal behaviours are one of the most important contributors to the global burden of disease among women, but little is known about prevalence and modifiable risk factors in low and middle income countries. We use data from the WHO multi-country study on women's health and domestic violence against women to examine the prevalence of suicidal thoughts and attempts, and relationships between suicide attempts and mental health status, child sexual abuse, partner violence and other variables. Population representative cross-sectional household surveys were conducted from 2000-2003 in 13 provincial (more rural) and city (urban) sites in Brazil, Ethiopia, Japan, Namibia, Peru, Samoa, Serbia, Thailand and Tanzania. 20967 women aged 15-49 years participated. Prevalence of lifetime suicide attempts, lifetime suicidal thoughts, and suicidal thoughts in the past four weeks were calculated, and multivariate logistic regression models were fit to examine factors associated with suicide attempts in each site. Prevalence of lifetime suicide attempts ranged from 0.8% (Tanzania) to 12.0% (Peru city); lifetime thoughts of suicide from 7.2% (Tanzania province) to 29.0% (Peru province), and thoughts in the past four weeks from 1.9% (Serbia) to 13.6% (Peru province). 25-50% of women with suicidal thoughts in the past four weeks had also visited a health worker in that time. The most consistent risk factors for suicide attempts after adjusting for probable common mental health disorders were: intimate partner violence, non-partner physical violence, ever being divorced, separated or widowed, childhood sexual abuse and having a mother who had experienced intimate partner violence. Mental health policies and services must recognise the consistent relationship between violence and suicidality in women in low and middle income countries. Training health sector workers to recognize and respond to the consequences of violence may substantially reduce the health burden associated with suicidal behaviour.

Relationships Between Physical and Non-Physical Forms of Intimate Partner Violence and Depression among Urban Minority Adolescent Females

BACKGROUND: Little is known about intimate partner violence (IPV) and depression among low income, urban African American and Hispanic adolescent females. METHOD: Interviews with 102 urban African American and Hispanic adolescent females examined physical abuse, emotional/verbal abuse, and threats, and their unique and combined associations with depression. RESULTS: One-quarter of the sample experienced all three types of abuse. Non-physical forms of IPV were significantly associated with depression. CONCLUSIONS: Some urban adolescent females from lower income households experience high rates of IPV. Physical and non-physical forms of IPV are important in understanding and responding to depression in this population.

Interpersonal violence and women's psychological well-being

BACKGROUND

The health impact of violence against women by perpetrators other than intimate partners has received little attention. This study aims to analyze the effect of different forms of interpersonal violence on women's health.

METHODS

Adult women (10,815) randomly sampled from primary healthcare services around Spain were included. Women were grouped as follows: (1) no history of violence, (2) history of intimate partner violence only (IPV), (3) history of non-IPV only, and (4) history of both IPV and non-IPV. Lifetime prevalence of violence by IPV, non-IPV, and both was calculated. Adjusted multivariable regression analysis was performed to assess the effects of the different forms of violence on women's health status.

RESULTS

Of the women, 32.7% experienced lifetime violence. Poor self-perceived health, psychological distress, co-occurring somatic complaints, and use of antidepressant or tranquilizer medication were significantly higher for women with a history of violence than for women with no history of violence. Women who reported both types of violence, IPV and non-IPV, were almost five times more likely to suffer psychological distress and co-occurring somatic complaints and > six times more likely to use medication than women with no history of violence.

CONCLUSIONS

The high prevalence of violence and its consistent association with a wide range of women's health problems suggest that violence seriously compromises women's health. Health providers should ask their female patients specifically about their history of violence, both IPV and non-IPV. Including this in patient's assessment would lead to more informed clinical decisions and more integrated care.

Domestic violence screening: prevalence and outcomes in a Canadian HIV population

There is a strong association between domestic violence victimization and HIV infection. This may lead to poor health outcomes including mental health disorders and reduced access to care. A standardized domestic violence screening interview was incorporated into ongoing care in the large and diverse population living with HIV in Southern Alberta, Canada. Results from May through December 2009 are reported, including the prevalence and outcomes of abuse. Thirty-four percent of 853 patients screened reported abuse. Of these, 16% reported abuse in their current relationship, 58% in a previous relationship, and 57% reported a history of childhood abuse. High-risk groups for abuse included females (43%), gay/bisexual males (35%), and Aboriginals (61%). We found an association between a history of domestic violence and delayed access to care (p < 0.05), missed appointments (p < 0.001), and an increased use of clinic resources such as social work (p < 0.0001) and psychiatry (p < 0.001). Mental health conditions prior to HIV diagnosis, including depression (p < 0.0001), suicidal ideation (p < 0.0001), and anxiety disorder (p < 0.0001) were associated with abuse at any time, while a history of adjustment disorder was associated with childhood abuse (p < 0.05). A simple domestic violence screening tool was helpful for identifying patients experiencing abuse in our diverse HIV-infected population. This high prevalence of domestic violence among our HIV patients was associated with poor outcomes and an increased use of medical resources. HIV caregivers should be aware of domestic violence in order to optimize care and refer patients to appropriate support professionals as needed.

Intimate partner violence and initiation of smoking and drinking: A population-based study of women in Yokohama, Japan

Intimate Partner Violence (IPV) is prevalent in the lives of women across the globe and has been found to be associated with substance use among women. As part of the World Health Organization's (WHO) cross-national research effort, this study examined the relationship between the experience of IPV and use of alcohol and tobacco among a probability sample of women aged 18-49 in Yokohama, Japan. Using retrospective data for 2000-2001, we employed methods of survival analysis that allowed an examination of the probability of initiating smoking and drinking subsequent to the experience of IPV. Experiencing IPV was associated with current smoking as well as initiation of smoking and current patterns of drinking. Women who had experienced IPV were more likely to be smoking at the time of the interview and tended to initiate smoking at earlier ages compared to those who had not experienced IPV. At any time point, the risk of starting to smoke was more than twice as high for women who had previously experienced IPV than for women who had not. In addition, women who had experienced IPV were more likely to drink heavily. The present study's findings clearly point to the need to enhance coordination between IPV prevention and substance abuse programs in order to improve the safety and wellbeing of women who have experienced IPV.

Partner violence and psychological well-being: buffer or indirect effect of social support

OBJECTIVES

To determine the effect of two kinds of intimate partner violence (IPV) (physical and psychological) in the previous 12 months (current) and before the previous 12 months (past) on psychological well-being among women aged 18 to 70 years who attend primary healthcare centers in Spain; and to analyze the effect of the duration of lifetime IPV and social support on psychological well-being.

METHODS

A cross-sectional survey was carried out among 10,322 women randomly recruited in primary healthcare centers in Spain. Outcome variables were three indicators of psychological well-being (psychological distress, psychotropic drug use, and self-perceived health). Predictor variables were the different types of IPV, IPV timing (current and past), duration of lifetime IPV, and social support. Logistic regression models were fitted.

RESULTS

Both types of IPV increased the probability of worse psychological well-being in both IPV timings (current and past). Longer duration of lifetime IPV, friends network size, and tangible support were independently associated with worse psychological well-being. However, an interaction between current IPV and family network size was found. The probability of poor self-perceived health status was reduced by 29% among women exposed to current IPV who had a large family network (odds ratio, 0.71; 95% confidence interval, 0.54-0.94).

CONCLUSIONS

Psychological well-being was independently affected by IPV (types and duration) and social support (friends network size, tangible support). Only family network size mitigates the negative consequences of IPV on self-perceived health status.