Intimate partner violence and women's cancer quality of life

Perceived Appropriateness of Assessing for Health-related Socioeconomic Risks Among Adult Patients with Cancer

Cancer treatment can trigger or exacerbate health-related socioeconomic risks (HRSR; food/housing insecurity, transportation/utilities difficulties, and interpersonal violence). The American Cancer Society and National Cancer Institute recommend HRSR screening and referral, but little research has examined the perceptions of patients with cancer on the appropriateness of HRSR screening in healthcare settings. We examined whether HRSR status, desire for assistance with HRSRs, and sociodemographic and health care-related factors were associated with perceived appropriateness of HRSR screening in health care settings and comfort with HRSR documentation in electronic health records (EHR). A convenience sample of adult patients with cancer at two outpatient clinics completed self-administered surveys. We used χ 2 and Fisher exact tests to test for significant associations. The sample included 154 patients (72% female, 90% ages 45 years or older). Thirty-six percent reported ≥1 HRSRs and 27% desired assistance with HRSRs. Overall, 80% thought it was appropriate to assess for HRSRs in health care settings. The distributions of HRSR status and sociodemographic characteristics were similar among people who perceived screening to be appropriate and those who did not. Participants who perceived screening as appropriate were three times as likely to report prior experience with HRSR screening (31% vs. 10%, P = 0.01). Moreover, 60% felt comfortable having HRSRs documented in the EHR. Comfort with EHR documentation of HRSRs was significantly higher among patients desiring assistance with HRSRs (78%) compared with those who did not (53%, P < 0.01). While initiatives for HRSR screening are likely to be seen by patients with cancer as appropriate, concerns may remain over electronic documentation of HRSRs.

Significance

National organizations recommend addressing HRSRs such as food/housing insecurity, transportation/utilities difficulties, and interpersonal violence among patients with cancer. In our study, most patients with cancer perceived screening for HRSRs in clinical settings as appropriate. Meanwhile, concerns may remain over the documentation of HRSRs in EHRs.

Blaming in Women with Breast Cancer Subjected to Intimate Partner Violence: A Hermeneutic Phenomenological Study

Objective

The present study was conducted to determine the blaming experiences of women with breast cancer subjected to intimate partner violence (IPV).

Methods

This hermeneutic phenomenological study explored blaming experiences of women with breast cancer subjected to IPV. Nine women with a mean age of 47.5 years referred to oncology hospitals in Tabriz (Iran) were interviewed using semi-structured in-depth interviews. Data analysis was performed based on Van Manen's thematic analysis method.

Results

The main theme emerged from the data is "blaming as a shifting cognitive judgment" with three subthemes of patient blaming partner, partner blaming patient, and self-blame.

Conclusions

The findings of the present study revealed that cognitive judgment shifting could be emerged as different types of blaming in the patients with breast cancer exposed to IPV. It is suggested that oncology nurses heed the psychological needs of women with breast cancer through holistic nursing considering couple and family-centered care.

Stressful life events, intimate partner violence, and perceived stress in the postpartum period: longitudinal findings in rural Pakistan

PURPOSE

While the association between intimate partner violence (IPV) and stress is well documented, the directionality of this relationship is unclear. We use an adjusted longitudinal study design to better understand if stressful life events in the home precipitate or exacerbate intimate partner violence (IPV) and if experiences of IPV, in turn, increase levels of perceived stress.

METHODS

Longitudinal data were collected among married women in rural Pakistan at 12 and 24 months postpartum (N = 815). Adjusted Poisson and linear regression models were used to examine stressful life events, past year IPV and severity (number and frequency of violent acts), and perceived stress (Cohen Perceived Stress Scale).

RESULTS

At 12 months postpartum, the prevalence of past year physical, psychological, and sexual IPV was 8.5%, 25.7%, and 25.1%, respectively, with 42.6% experiencing any IPV. After adjustment, stressful life events were associated with a subsequent increased likelihood of all IPV types and increased severity of all but physical IPV. Any past year IPV (versus none) and greater IPV severity were associated with 3.43 (95% CI 2.33-4.52) and 2.57 (95% CI 1.87-3.27) point subsequent increases in perceived stress. Physical, psychological, and sexual IPV and their respective severities were all independently associated with increased perceived stress.

CONCLUSIONS

Among postpartum women in Pakistan, stressful life events increase the likelihood of IPV and, in turn, experiences of IPV increase stress levels. Support to families undergoing stressful circumstances may be critical to reducing women's IPV exposure and resulting elevated stress.

The Effect of Intimate Partner Violence on the Physical Health and Health-Related Behaviors of Women: A Systematic Review of the Literature

AIM

The long-term effects of intimate partner violence (IPV) on physical health outcomes and health-related behaviors are underresearched in comparison to the effects on mental health and pregnancy. This systematic review examines the recent research in this area from 2012 through 2019.

METHODS

SCOPUS, PubMed, EBSCOhost, and gray literature were searched using the key words "intimate partner violence" and "health." To meet inclusion criteria, studies needed to be original research and focus on IPV during adulthood and its effects on the physical health or health-related behaviors of women. Fifty-two studies were qualitatively analyzed, with results grouped into broad categories of effects, including cardiovascular, endocrine, infectious diseases, and health screening.

RESULTS

IPV was shown to have negative effects on physical health outcomes for women, including worsening the symptoms of menopause and increasing the risk of developing diabetes, contracting sexually transmitted infections, engaging in risk-taking behaviors including the abuse of drugs and alcohol, and developing chronic diseases and pain. It also has significant effects on human immunodeficiency virus outcomes, worsening CD4+ cell depletion. Results varied regarding the effects of IPV on cardiovascular health outcomes.

CONCLUSION

The result of this review demonstrates that women who have experienced violence and abuse are at significantly increased risk of poor health outcomes in a variety of areas and so require specialized and tailored primary care. This review highlights significant gaps in this field of research, particularly in relation to cardiovascular disease, endocrine dysfunction, and neurological symptoms and conditions. It demonstrates a need for additional long-term studies in this field to better inform the health care of women who have experienced IPV and to establish the physiological mediators of these outcomes.

Qualidade de vida de mulheres e homens idosos em situação de violência por parceiro íntimo

Resumo Este artigo buscou investigar a associação entre a violência por parceiro íntimo (VPI) e os níveis de qualidade de vida (QV) e seus domínios (controle e autonomia; realização pessoal e prazer), em pessoas idosas. Realizou-se estudo transversal de base populacional da segunda onda (2013/2014) do Estudo EpiFloripa, com pessoas idosas (n=649), residentes em Florianópolis, SC, Sul do Brasil. As médias de QV e seus domínios foram descritas segundo as variáveis de ajuste (idade, renda, deficit cognitivo, sintomas depressivos e dependência de atividades de vida diária), estratificadas por sexo. Analisou-se a associação entre VPI e QV por meio de regressão linear múltipla, com significância estatística de 5%. Os escores médios de QV, bem como realização pessoal e prazer foram semelhantes entre os sexos, enquanto o controle e autonomia das mulheres foram significativamente inferiores em comparação aos homens (p=0,04). Observou- se menores escores de QV nas mulheres expostas à situação de violência, nas três direcionalidades analisadas: perpetrada (-3,15; IC95%: -4,84; -1,45), bidirecional (-2,59; IC95%: -4,10; -1,09) e sofrida (-1,62; IC95%: -3,06; -0,17) e as mais prejudicadas foram aquelas que cometeram agressões. O controle e autonomia foi afetado para as perpetradoras e envolvidas na violência bidirecional, enquanto menores escores de realização pessoal e prazer foram verificados entre as idosas, em quaisquer situações de violência. Os homens não tiveram sua QV prejudicada por estarem em situação de VPI, tanto vítimas como perpetradores dessa violência. Concluiu-se que a VPI possui impacto assimétrico sobre a QV de pessoas idosas em relação ao sexo, prejudicando com maior intensidade as mulheres.

Exposição à violência comunitária e familiar e autoavaliação de saúde na população brasileira

RESUMO: Introdução: Os impactos negativos isolados da violência comunitária e da violência familiar na autoavaliação de saúde (AAS) dos indivíduos são conhecidos, mas existe pouca evidência sobre o efeito combinado desses dois tipos de violência interpessoal. Objetivo: Analisar a associação entre a exposição à violência comunitária/por desconhecidos e à violência familiar/por conhecidos e a AAS negativa, distinguindo o tipo de violência sofrido e também considerando sua exposição cumulativa. Métodos: Estudo epidemiológico de corte transversal desenvolvido com os dados da Pesquisa Nacional de Saúde (PNS) 2013. Foram realizados modelos de regressão logística multinominal brutos e ajustados para teste de associação das variáveis. Resultados: Todos os tipos de violência analisados se associaram à AAS negativa. A violência interpessoal comunitária/por desconhecidos isolada esteve associada à AAS como regular (odds ratio - OR=1,38) e ruim (OR = 1,79). A exposição à violência familiar/por conhecidos mostrou-se associada à autoavaliação regular (OR = 1,52) e ruim (OR = 2,70). A exposição concomitante às duas violências mostrou-se associada à avaliação regular (OR = 4,00) e ruim da saúde (OR = 7,81), sendo essa associação de maior magnitude que aquelas para as violências isoladas. Conclusão: O efeito cumulativo da exposição à violência familiar/por conhecido e comunitária/por desconhecido potencializa a avaliação negativa do estado de saúde. Os profissionais de saúde devem estar atentos à polivitimização e ao seu impacto na saúde de vítimas que acessam os serviços de saúde.

The psychobiology of stress and intimate partner violence

Exposure to intimate partner violence (IPV) negatively affects health outcomes, however, the biopsychosocial pathways underlying this relationship are not well understood. We conducted a systematic review of research published from 2000 through 2018 on biological and psychological stress-related correlates and consequences of IPV exposure. Fifty-three publications were included. The biological and psychological literatures have evolved separately and remain distinct. The biological literature provides emerging evidence of stress-related endocrine and immune-inflammatory dysregulations that are in line with patterns typically observed among chronically stressed individuals. The psychological literature provides strong evidence that IPV is associated with psychological stress, and that psychological stress follows new instances of IPV. Larger scale, integrative studies using prospective study designs are needed to more carefully map out how IPV influences victims both biologically and psychologically, and how these biopsychological changes, in turn, affect the health of victims over time.

Exposure to violence in breast cancer patients: systematic review

RESULTS

The nine studies included were reviewed under two titles as descriptive and qualitative. Based on the results of six descriptive studies, it was determined that the majority of these studies focused on violence and abuse in childhood; depression is high among breast cancer patients exposed to violence; healing is unfavorably influenced among breast cancer patients exposed to spouse violence or abuse/violence in childhood; physical, emotional and functional welfare/comforts are restricted and quality of life is low during disease process; there is positive correlation between advanced-stage cancer and history of violence; they hesitate to ask the clinical staff for support. Although breast cancer women underreport the violence they have been exposed to, a study stated that 55% of women are exposed to violence after being diagnosed with breast cancer. Results of the three qualitative study revealed that violence is the field of "taboo" among breast cancer patients and they reconsider the "life", "relationship-origin stress", "social support" and "importance of breast for herself" over the disease process.

CONCLUSION

In conclusion, it is underlined that giving care becomes difficult, maintenance of treatment fails, and quality of life is decreased in breast cancer patients exposed to violence.

Disparities in women's cancer-related quality of life by Southern Appalachian residence

PURPOSE

The purpose was to determine whether Appalachian residence alone or in combination with violence was linked to poorer quality of life (QOL).

METHODS

Women recently diagnosed and included in either the Kentucky or North Carolina Cancer Registries were interviewed by phone between 2009 and 2015 (n = 3320; mean age = 56.74). Response rates were similar by state (40.1 in Kentucky and 40.9% in North Carolina). Appalachian (N = 990) versus non-Appalachian residents (N = 2330) were hypothesized to have poorer QOL defined as (a) lower Functional Assessment of Cancer Therapy-General (FACT-G) scores and (b) more symptoms of depression, stress, or comorbid physical conditions. Lifetime intimate partner or sexual violence was first investigated as a moderator then mediator of regional differences. Multiple analyses of covariance (MANCOVA) models were used.

RESULTS

Violence modified the effect of Appalachian residence on poorer QOL outcomes; FACT-G total scores (p = .02) were lowest for women living in Appalachia who had additionally experienced violence. Socioeconomic indicators appeared to mediate or explain differences in QOL outcomes by Appalachian residence such that when adjusting for income, education and insurance, Appalachian residence remained associated only with poorer physical QOL outcomes (p < .05).

CONCLUSIONS

While violence rates did not differ by residence, the combined effect of living in Appalachia and experiencing violence resulted in significantly greater impact on poorer QOL among women recently diagnosed with cancer. Clinical consideration of patients' residence, socioeconomic status and violence experienced may help identify and mitigate the longer-term impact of these identifiable factors associated with poorer QOL.