Posttraumatic stress symptoms and victimization among Japanese American women

Changes in Spousal Intimacy in Women Suffering Trauma Symptoms from Domestic Abuse: A Culturally Embedded Intervention Study in Pakistan

While emerging research is highlighting the significant effects of culture on marital and family relationships, studies investigating relationship intimacy and abuse in non-Western cultures are non-existent. This investigation assessed relationship intimacy in Pakistani women experiencing trauma symptoms (PTSD) from domestic abuse (DA) who received a culturally informed trauma intervention in a context that differs greatly in values and assumptions about marital relationships relative to Western traditions. Forty women meeting inclusion criteria were assessed on domestic violence type and characteristics (both victim and perpetrator characteristics), PTSD symptomology, and three aspects of relationship intimacy: engagement, communication, and shared friendships. PTSD symptomology and relationship intimacy were reassessed post-intervention. Results indicated significant changes in engagement and communication intimacy following the intervention, with engagement decreasing and communication increasing. The third aspect of intimacy, namely, shared friendships, showed no change. Engagement and overall intimacy showed significant negative correlations with physical abuse, though not with sexual or psychological/emotional abuse. These findings are interpreted within a cultural context where women have few options for leaving an abusive relationship. As such, the results highlight the importance of culture when studying facets of intimate relationships and the need to use culturally informed assessments to better understand the experience of intimacy within abusive relationships.

The psychological subtype of intimate partner violence and its effect on mental health: a systematic review with meta-analyses

PURPOSE

The present study examines the association between psychological violence and posttraumatic stress disorder (PTSD), depression, and anxiety, while comparing the specific subtypes of psychological violence and simultaneously focusing on methodological shortcomings.

METHOD

A systematic review and random-effects meta-analyses were applied on the three main outcomes: PTSD, depression, and anxiety. Four electronic databases were searched (PsycINFO, PubMed, EMBASE, and Web of Science), and a total of 194 studies were included (k = 149 for meta-analyses). GRADEpro was used to evaluate the certainty of the evidence from the meta-analyses.

RESULTS

Psychological violence had strong associations with the three main outcomes, with the strongest association for PTSD in both female and male victims. Coercive control was particularly associated with PTSD for female victims, while emotional/verbal and dominance/isolation had the strongest association with depression. Although the identified studies were characterized by gender bias, psychological violence appear to affect male mental health too.

DISCUSSION

Findings from the meta-analyses support the notion that psychological violence is a traumatic experience, which is strongly association with PTSD and other common mental health problems linked to trauma. GRADEpro rated the certainty of evince to be low, and thus, our confidence in the estimated effect is limited. Gender bias, the applied terminology, and other methodological shortcomings are discussed. Despite the substantial amount of research on this topic, more research is needed before we can draw any final conclusions on the effect of psychological violence on mental health.

Help-Seeking Among Battered Immigrant Filipina, Indian, and Pakistani Women in the United States: Perceived Barriers and Helpful Responses

This study examines the nature of helpful responses received and barriers to seeking help following the experience of intimate partner violence among women of Filipina, Indian, and Pakistani descent (N = 143) in the United States. Instead of aggregating women from diverse backgrounds, we investigated these groups of women separately. A content analysis found that while emotional support was the most helpful response, there were important variations by ethnicity and immigration position in the perceived helpfulness of various assistance resources as well as barriers to help-seeking. This study of disaggregated Asian immigrant groups enhances our understanding of both common and unique challenges faced by each immigrant group, which can inform development of socioculturally relevant intervention programs.

Possible Role for Imagery-Based Therapy in Managing PTSD in Pakistani Women Experiencing Domestic Abuse: A Pilot Study Using Eidetic Therapy

Domestic abuse of women is a serious problem worldwide that has economic, physical, and psychological consequences, yet in many countries and cultures, victims often have little access to psychological support. Using a pre-post design, we investigated the effects of psychological intervention using an imagery-based therapy in women showing post-traumatic stress disorder (PTSD) resulting from spousal domestic abuse. Forty women, referred from outpatient clinics in Pakistan and meeting inclusion criteria, underwent individual trauma counseling for 10-12 weeks using the principles of Eidetic Therapy, an imagery-based therapy that circumvents heavy reliance on verbal skills and narratives. Women showed significant reductions in PTSD by the end of treatment. Predictors of treatment gains included type of abuse, PTSD level at the outset of therapy, and years in the relationship. Neither economic resources or literacy, nor abuser or victim characteristics, predicted the amount of improvement. In conclusion, therapy was associated with a reduction in PTSD symptoms regardless of literacy level of participants. This reduction in PTSD was notable because, unlike many situations involving spousal abuse, these women were generally not in a position to leave their relationship, and hence the women might have experienced continued exposure to abuse. Context/cultural-based explanations for these findings are presented and discussed.

Gender (A)Symmetry in Correlates of Perpetration of Intimate Partner Violence: Gender (A) Symmetry in IPV and the Role of Gender Attitudes

This study examined, using structural equation modeling (SEM), gender differences and similarities in correlates of the perpetration of emotional aggression against intimate partners among one of the largest groups of Asian Indians in the United States, Gujaratis. Although most of the correlates of emotional aggression (e.g., patriarchal attitudes, spousal disagreement, and alcohol use) were similar for men and women, higher support for gendered domestic roles was significantly related to higher perpetration of emotional aggression for men but not for women. Multigroup latent SEM served as a unique analytical strategy to investigate gender (a)symmetry, a controversial but critical debate in the field.

Long-term Trends in Depression among Women Separated from Abusive Partners

This study tested a cumulative adversity hypothesis, where differences in postseparation stressors among battered women were expected to lead to a widening gap in levels of women's depression over time. Ninety-four women separated from their abusive partners were interviewed six times over a 2-year period. Consistent with the hypothesis, inequalities grew over time. Women who were exposed to the greatest amount of violence and secondary stressors shortly after shelter exit experienced relatively higher levels of depression that either did not improve or significantly increased with time. Social support was the only resource to have the hypothesized decreasing effect on depression.

Interpersonal Violence and Mental Health Outcomes among Asian American and Native Hawaiian/Other Pacific Islander College Students

In a cross-sectional survey of college students (N = 614) we studied interpersonal violence victimization, perpetration, and mental health outcomes in an ethnoracially diverse rural-based sample of Asian Americans (27%), and Native Hawaiian/Other Pacific Islanders (25%), two groups vastly underrepresented in trauma research. High rates of interpersonal violence (34%), violence perpetration (13%), and probable psychiatric diagnoses (77%), including posttraumatic stress disorder, were found. Exposure to physical violence, sexual violence, and life stress all were predictive of psychopathology. Female participants were associated with higher likelihood of sexual violence victimization compared to male participants, and Asian American status (especially among males) was associated with lower likelihood of physical and sexual violence compared with European Americans. These data enhance our understanding of interpersonal violence and mental health outcomes among previously understudied minority groups.

Long Term Mental Health Effects of Partner Violence Patterns and Relationship Termination on Low-Income and Ethnically Diverse Community Women

Intimate partner violence (IPV) is associated with psychological distress; however, differences in the impact of unidirectional IPV, typically male-dominated, and bidirectional IPV have not been examined. To address this gap in the literature, we compared the effects of various IPV patterns on women's reports of dissociation, post-traumatic stress disorder, and stress in 6 interviews over eight years. We also examined whether differences by IPV pattern existed in women's mental health upon leaving a violent relationship. The 489 low-income women completing all interviews were African American (40%), Euro-American (30%), and Mexican American (30%), over half of whom (58%) were no longer with Wave 1 partners by Wave 6. In general, worse mental health was associated with relationship termination and bidirectional violence.

Post-traumatic stress disorder among Chinese women survivors of intimate partner violence: a review of the literature

Background

Post-traumatic stress disorder is one of the most prevalent mental health sequelae of intimate partner violence, and as a result, it has been extensively documented in Western literature. However, whether abused women from non-Western cultures experience similar post-traumatic responses to intimate partner violence is less documented.

Objectives

The objectives of this paper were (1) to review the literature for information about post-traumatic stress disorder among Chinese women survivors of intimate partner violence; (2) to provide a synthesis of the literature on post-traumatic stress disorder among abused Chinese women; and (3) to identify implications for practice and to suggest directions for research relating to post-traumatic stress disorder among abused Chinese women.

Design

A systematic review of the literature.

Data Sources

Following a systematic search for relevant literature in computerized databases and manual searches of English and Chinese language publications, five papers reporting on four studies conducted in China, Taiwan, Malaysia, and the United States were included in the review.

Review Methods

Abstracts meeting the inclusion criteria were reviewed independently by two of the authors and any discrepancies were resolved by discussion. Full papers for selected abstracts were then retrieved and assessed independently by the same reviewers.

Results

The present literature review revealed a paucity of information relating to post-traumatic stress disorder symptoms or diagnoses in abused Chinese women. Nevertheless, a link between post-traumatic stress disorder and intimate partner violence was demonstrated by the reviewed papers.

Conclusions

Caution should be exercised when making comparison of the findings across the four studies because of the inherent methodological differences. Also, as the assessment tools have not been validated for culture-bound interpretation of trauma and symptom manifestation, comparisons of findings for Chinese women to women in Western literature should be undertaken with due consideration. Implications for practice and recommendations for future research are discussed.

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

OBJECTIVES

As part of the World Health Organization's cross-national research effort, we investigated the relationship between various health indicators and the experience of intimate partner violence (IPV), which included emotional, physical, and sexual abuse, among women in Yokohama, Japan.

METHODS

We used multivariate logistic and negative binomial regression to examine the relationship between health status and IPV in a stratified cluster sample of 1371 women aged 18 to 49 years.

RESULTS

In 9 of 11 health indicators examined, the odds of experiencing health-related problems were significantly higher (P < .05) among those that reported emotional abuse plus physical or sexual violence than among those that reported no IPV, after we controlled for sociodemographic factors, childhood sexual abuse, and adulthood sexual violence perpetrated by someone other than an intimate partner. For most health indicators, there were no significant differences between those that reported emotional abuse only and those that reported emotional abuse plus physical or sexual violence.

CONCLUSIONS

The similarity of outcomes among those that reported emotional abuse only and those that reported emotional abuse plus physical or sexual violence suggests the need for increased training of health care providers about the effects of emotional abuse.

Heterogeneity among violence-exposed women: applying person-oriented research methods

Variability of experience and outcomes among violence-exposed people pose considerable challenges toward developing effective prevention and treatment protocols. To address these needs, the authors present an approach to research and a class of methodologies referred to as person oriented. Person-oriented tools support assessment of meaningful patterns among people that distinguish one group from another, subgroups for whom different interventions are indicated. The authors review the conceptual base of person-oriented methods, outline their distinction from more familiar variable-oriented methods, present descriptions of selected methods as well as empirical applications of person-oriented methods germane to violence exposure, and conclude with discussion of implications for future research and translation between research and practice. The authors focus on violence against women as a population, drawing on stress and coping theory as a theoretical framework. However, person-oriented methods hold utility for investigating diversity among violence-exposed people's experiences and needs across populations and theoretical foundations.

Relationship between emotional numbing and arousal symptoms in American women of Japanese descent who experienced interpersonal victimization

In recent years, studies of veterans and others who experienced various types of trauma have found a strong relationship between emotional numbing and arousal symptoms, challenging the current DSM-IV diagnostic criteria, which combines emotional numbing and avoidance symptoms in a single criterion. In this paper, we investigate emotional numbing symptoms in a community-based random sample of women of Japanese descent who had experienced interpersonal victimization, such as childhood abuse, intimate partner violence, and violence perpetrated by non-intimates (n = 202). Controlling for age, place of birth, and timing and severity of victimization, emotional numbing symptom counts were associated more strongly with arousal than avoidance symptoms, consistent with previous studies of veterans and assaulted women. In addition, emotional numbing symptom counts were significantly associated with age and, to a lesser degree, country of birth. Implications for research and practice are discussed.

Violence against women: outcome complexity and implications for assessment and treatment

This article reviews the major forms of violence against women, including sexual assault, intimate-relationship violence, and stalking and outlines the known psychological effects of such victimization. Also discussed are a number of variables that combine to determine the effects of such victimization, including type and characteristics of the assault; victim variables such as demographics, psychological reactions at the time of the trauma, previous victimization history, current or previous psychological difficulties, and general coping style; and sociocultural factors such as poverty, social inequality, and inadequate social support. The implications of this complexity are explored in terms of psychological assessment and the frequent need for multitarget, multimodal treatment approaches.

The relationship between intimate partner violence and PTSD: an application of Cox regression with time-varying covariates

This study uses Cox regression with time-varying covariates to examine the relationship between intimate partner violence and posttraumatic stress disorder (PTSD) in a random sample of Japanese American women and immigrant women from Japan (N = 211). Because applications of survival analysis in trauma research are scarce, this paper presents the utility of this analytical approach by contrasting it with other common methods of analysis (chi-square tests and Cox regression with covariates that do not change over time).