Gender-based violence and trauma in marginalized populations of women: Role of biological embedding and toxic stress

Global Indigenous gender concepts, gender-based violence and resilience: A scoping review

BACKGROUND & OBJECTIVE

The legacy of colonialism includes ongoing trauma and disruption of traditional teachings on relationality, which has contributed to Indigenous populations being disproportionately exposed to gender-based violence (GBV). GBV in Indigenous populations is explored to consider gender-specific findings and points of resilience in relational networks.

PARTICIPANTS & SETTING

Included articles sampled Indigenous groups in Canada, US, Mexico, Guatemala, and Israel. All participants self-identified as Indigenous, and were either GBV survivors or service providers working in GBV contexts.

METHODS

A scoping review was conducted in OVID Medline, Embase, APA Psycinfo, and Informit Indigenous Collection, using keywords for Indigenous peoples, gender concepts, and GBV. Articles were screened and extracted by two reviewers; a third reviewer resolved conflicts.

RESULTS

Our search yielded one mixed-method study and seven qualitative studies, all published since 2016. North American studies identified colonial, patriarchal disruptions (e.g. residential schools) to positive pre-contact gender norms (e.g. non-hierarchical roles) that contribute to emerging GBV. Studies conducted in Guatemala and Israel also described local patriarchal cultures contributing to GBV. Lack of understanding of the Two-Spirit identity (i.e. supra-binary gender identity used by Indigenous persons) led to harmful attitudes and stigma. Interpersonal support and return to traditional matriarchal practices were identified as key resilience processes.

CONCLUSIONS

There is limited literature on Indigenous gender concepts and GBV, particularly regarding GBV against males and Two-Spirit persons. Colonization-related violence and/or patriarchal gender norms were identified as precursors for GBV. Decolonization processes should be further explored to address GBV in Indigenous populations.

Cumulative violence exposures among men who have sex with men living with HIV in India: Psychosocial correlates of HIV care continuum outcomes

Lifetime exposures to violence among men who have sex with men (MSM) are associated with multiple psychosocial health risks and can affect engagement and outcomes of HIV treatment. This study a) explored relationships between levels of exposures to violence and HIV care continuum outcomes among MSM living with HIV in India, and b) identified psychosocial correlates of HIV care continuum outcomes among MSM living with HIV and those with lifetime cumulative exposures to violence (CVE). CVE referred to exposures to violence in both childhood and adulthood. This cross-sectional analysis used survey data collected between August 2016 and May 2017 from 1763 men who have sex with men living with HIV across 10 cities in India, using respondent-driven sampling. We found that higher levels of violence exposure were significantly associated with lower awareness of HIV positive status, and lower likelihood of initiating antiretroviral therapy. Compared with MSM living with HIV that had no CVE, those with CVE were more likely to report perpetration of interpersonal violence, alcohol misuse, depressive symptoms, and HIV transmission risk behaviors and to have two to four co-occurring psychosocial problems. In multivariable analysis with the subset of MSM with CVE, psychosocial correlates significantly associated with at least one HIV care continuum outcome were HIV transmission risk behaviors, perpetration of interpersonal violence, depression, and alcohol misuse. The findings highlight the need for integrating care for lifetime violence exposures and associated behavioral problems in HIV care settings for men who have sex with men living with HIV in India.

Gender-Based Violence Interventions in Low- and Middle-Income Countries: A Systematic Review of Interventions at Structural, Community, Interpersonal, Individual, and Multiple Levels

Gender-based violence (GBV) disproportionately impacts women and girls in low- and middle-income countries (LMIC). This review described the characteristics of structural, community, interpersonal, individual, and multilevel GBV interventions in LMIC and examined components of interventions implemented at different socio-ecological levels. We conducted a systematic search of peer-reviewed literature on GBV intervention evaluation studies in LMIC using the following databases: PubMed, CINAHL, Embase, Cochrane, Academic Search Ultimate, PsycInfo, and Web of Science. The search resulted in 3,256 articles, with 60 articles meeting the eligibility criteria. Thirty-eight articles reported positive GBV outcomes with significant differences between intervention and control arms on at least one GBV outcome. Very few interventions were found to be stand-alone GBV interventions. The key components of interventions effective in addressing victimization and perpetration across levels were education or psychoeducation, psychotherapy, skills development, gender transformative activities, community engagement, focus on men and/or partners, and health promotion activities such as HIV or STI prevention. Most interventions were multilevel, with positive outcomes for victimization. Fewer evidence-based interventions existed for addressing perpetration. There is need for additional research using rigorous methods to establish an evidence base for effective interventions in under-researched regions in LMIC as well as for interventions that address perpetration of GBV.

Psychosocial effects of gender-based violence among women in Vhembe district: A qualitative study

Background

The phenomenon of gender-based violence is a pertinent social problem in South Africa. The fear of reporting gender-based violence contributes to its continuation, marginalisation and silencing of victims.

Objectives

The study sought to explore the psychosocial effects of gender-based violence among women in Vhembe district.

Methods

An exploratory phenomenological research design was used and sampling was performed purposively from a population of women who experienced gender-based violence in a low-resource, rural setting of Vhembe district. Semi-structured telephonic interviews were used as the main method of data collection after permissions and informed consent were sought for conducting the study. Thematic content analysis was applied to convert the participants' statements into a meaningful framework to derive the findings.

Results

A total of 15 participants aged from 19 to 35 years participated in the study. Their psychosocial experiences of gender-based violence were depression, worthlessness, social isolation and anger directed towards children.

Conclusion

This research confirms that gender-based violence remains one of the most challenging problems associated with mental health problems in Vhembe district. It affirms the need to focus on awareness in rural areas afflicted by patriarchal attitudes, norms and stereotypes. Gender-based violence should to be viewed as human rights violation for victims' protection.

Contribution

The study contributes to the body of knowledge on the experiences of gender-based violence among marginalised women from rural areas.

Childhood and adolescent nutrition outcomes among girls exposed to gender-based violence: A rapid evidence assessment of quantitative research

BACKGROUND

An emerging evidence base has explored the nutritional consequences of gender-based violence (GBV) perpetrated against girls during childhood/adolescence. We conducted a rapid evidence assessment of quantitative studies describing associations between GBV and girls' nutrition.

METHODS

We adapted systematic review methods and included empirical, peer-reviewed studies, published after 2000 (until November, 2022), that were written in Spanish or English and reported quantitative associations between girls' exposure to GBV and nutrition outcomes. A variety of GBV forms were considered: childhood sexual abuse (CSA), child marriage, preferential feeding of boys, sexual IPV and dating violence. Nutrition outcomes included anemia, underweight, overweight, stunting, micronutrient deficiencies, meal frequency, and dietary diversity.

RESULTS

In total, 18 studies were included, 13 of which were conducted in high-income countries. Most sources utilized longitudinal or cross-sectional data to quantify associations between CSA, sexual assault, and intimate partner/dating violence and elevated BMI/overweight/obesity/adiposity. Findings suggest that CSA perpetrated by parents/caregivers is associated with elevated BMI/overweight/obesity/adiposity via cortisol reactivity and depression; this relationship may be compounded by additional intimate partner/dating violence in adolescence. The effects of sexual violence on BMI are likely to emerge during a sensitive period of development between late adolescence and young adulthood. Emerging evidence was found regarding the relationship between child marriage (and the related exposure: age at first pregnancy) and undernutrition. The association between sexual abuse and reduced height and leg length was inconclusive.

CONCLUSION

Given that only 18 studies were included, the relationship between girls' direct exposure to GBV and malnutrition has received little empirical attention, especially with respect to studies conducted in LMIC and fragile settings. Most studies focused on CSA and overweight/obesity, where significant associations were found. Future research should test the moderation and mediation effects of intermediary variables (depression, PTSD, cortisol reactivity, impulsivity, emotional eating) and consider sensitive periods of development. Research should also explore the nutritional consequences of child marriage.

Safety Planning With Marginalized Survivors of Intimate Partner Violence: Challenges of Conducting Safety Planning Intervention Research With Marginalized Women

Intimate partner violence (IPV) disproportionately affects marginalized women in the United States. This calls for effective safety planning strategies to reduce the risk for future revictimization and address safety needs of survivors from marginalized groups. This review identified types of interventions that incorporated safety planning and were successful in reducing the risk for future revictimization among IPV survivors from diverse groups, examined elements of safety planning in effective interventions, and described challenges or limitations in safety planning intervention research with marginalized women. A systematic search of five databases was performed. The search resulted in inclusion of 17 studies for synthesis. The included studies were quantitative, U.S.-based, evaluated interventions with a safety planning component, and had an outcome of change in IPV. Effective interventions that incorporated safety planning were empowerment and advocacy focused. Elements included were comprehensive assessments of survivors' unique needs and situations, educating them about IPV, helping them identify threats to safety, developing a concrete safety plan, facilitating linkage with resources, providing advocacy services as needed, and conducting periodic safety check-ins. For survivors with mental and behavioral health issues, effective interventions included psychotherapeutic approaches along with safety planning to address survivors' co-occurring health care needs. Although most studies reported positive findings, there were limitations related to designs, methods, adequate inclusion, and representation of marginalized women and cultural considerations. This calls for additional research using rigorous and culturally informed approaches to establish an evidence base for effective interventions that specifically address the safety planning needs of marginalized survivors of IPV.

Using Mindfulness to Improve Mental Health Outcomes of Immigrant Women with Experiences of Intimate Partner Violence

Immigrant women are disproportionately affected by intimate partner violence (IPV), which poses risk for mental health problems, such as PTSD and depression. Post-migration barriers limit immigrant women's access to supportive services, which can further debilitate their mental health symptoms and their safety. The Being safe, Healthy, and Positively Empowered (BSHAPE) digital intervention was designed to address physical safety and healthcare needs of immigrant women through a multi-component approach that integrated mindfulness-based stress reduction (MBSR) practices. This paper reports qualitative feedback findings from eighteen Black immigrant women with recent IPV exposure and co-occurring mental health symptoms, who participated in the mindfulness sessions of BSHAPE. We identified elements of mindfulness that women perceived as beneficial in their healing. Women's feedback indicated healing and empowerment through positive appraisals and coping strategies. The benefits were noted for mindfulness elements promoting self-compassion, self-actualization, intentionality of moving forward in life, and developing positivity or a sense of optimism. Other helpful elements were relaxation, self-care and reflection, self-awareness, self-control and focused thinking. Our findings show that incorporating mindfulness practices in interventions can be beneficial for promoting the healing and empowerment of immigrant women in abusive relationships.

Glucocorticoids and Aggression: A Tripartite Interaction

The effects of glucocorticoids on aggression can be conceptualized based on its mechanisms of action. These hormones can affect cell function non-genomically within minutes, primarily by affecting the cell membrane. Overall, such effects are activating and promote both metabolic preparations for the fight and aggressive behavior per se. Chronic increases in glucocorticoids activate genomic mechanisms and are depressing overall, including the inhibition of aggressive behavior. Finally, excessive stressors trigger epigenetic phenomena that have a large impact on brain programming and may also induce the reprogramming of neural functions. These induce qualitative changes in aggression that are deemed abnormal in animals, and psychopathological and criminal in humans. This review aims at deciphering the roles of glucocorticoids in aggression control by taking in view the three mechanisms of action often categorized as acute, chronic, and toxic stress based on the duration and the consequences of the stress response. It is argued that the tripartite way of influencing aggression can be recognized in all three animal, psychopathological, and criminal aggression and constitute a framework of mechanisms by which aggressive behavior adapts to short-term and log-term changes in the environment.

Young People’s Voices and Science for Overcoming Toxic Relationships Represented in Sex Education

The scientific literature has presented evidence of how fiction series impact the socialisation of young people’s relationships. However, there is a gap in the evidence on how dialogic interactions overcome the negative impact of the fiction series on the socialisation of toxic relationships. This research analyses dialogic interactions based on scientific evidence related to toxic relationships that contribute to overcoming this type of relationship. First, we developed a communicative content analysis of eight episodes of one of the most-watched fiction series by young people, Sex Education. After that, we conducted four communicative interviews with the young audience to collect their voices about the impact of these toxic relationships represented in this fiction series in their daily conversations. The results indicate that in such cases, there is a need to promote dialogic interactions about this fiction series, focusing the dialogue on which type of masculinity develops a toxic relationship and which, on the contrary, promotes healthy relationships.

Impact of Sources of Strengths on Coping and Safety of Immigrant Survivors of Intimate Partner Violence

Intimate partner violence (IPV) is a national and international public health and human rights concern. Immigrant women are disproportionately affected by IPV that includes homicides. This study explored the perspectives of survivors of IPV, who are immigrants to the United States, regarding their sources of strength that enhance their safety and promote coping in abusive relationships. Data for this qualitative study were collected from ethnically diverse immigrant women residing in Massachusetts, Arizona, Virginia, Washington, D.C., New York, Minnesota, and California, using purposive and snowball sampling techniques. Eighty-three in-depth interviews were conducted with adult immigrant survivors of IPV who self-identified as Asian (n = 30), Latina (n = 30), and African (n = 23). Data were analyzed using thematic analysis. Women identified both external (e.g., community support, support from social service agencies) and internal (e.g., optimism, faith, beliefs) sources of strength. The study highlights how these sources can adequately address needs of survivors and offers areas for improvement in services for survivors. The findings are informative for practitioners serving immigrant survivors of IPV in legal, social service, and physical and mental health settings.

Development, feasibility, acceptability and preliminary evaluation of the internet and mobile phone-based BSHAPE intervention for Immigrant survivors of cumulative trauma

BACKGROUND

Cumulative trauma exposures can have a profound effect on women's health and well-being. Black immigrant women are disproportionately affected by cumulative trauma experiences that place them at risk for multiple health issues such as reproductive sexual health problems and HIV, or mental health problems such as PTSD. The trauma-informed internet and mobile phone-based Being Safe, Healthy, and Positively Empowered (BSHAPE) intervention was designed to comprehensively assess for cumulative traumatic experiences, for current safety, and to address women's co-occurring healthcare needs through educational, psychoeducational, and mindfulness-based stress-reduction components.

PURPOSE

This paper describes the development, feasibility, acceptability, and preliminary evaluation of the computer and phone delivered BSHAPE intervention among adult Black immigrant women survivors of cumulative trauma.

METHOD

Seventy women participated in the feasibility, acceptability, and preliminary evaluation of BSHAPE, with outcomes assessed at post-intervention. The feasibility and acceptability outcomes assessed were enrollment, adherence, and perceptions of the intervention. Preliminary evaluation outcomes included perceived stress, stress management, trauma coping self-efficacy, mindfulness, mental health (MH), HIV/STI risk, general empowerment, and empowerment related to safety.

CONCLUSIONS

Findings suggest that a BSHAPE intervention is feasible and acceptable. Overall, women reported satisfaction with BSHAPE and provided suggestions for improvement. Women showed significant reduction in perceptions of stress, improved stress-management, enhanced self-efficacy, reduced HIV/STI risk, and improved MH, overall empowerment, as well as empowerment related to safety. The findings of this study will be useful in further refining BSHAPE and testing it in a full-scale randomized controlled trial.

TRIAL REGISTRATION

NCT03664362.

Evidence of Gender Violence Negative Impact on Health as a Lever to Change Adolescents' Attitudes and Preferences towards Dominant Traditional Masculinities

Women and girls experience gender violence from a young age. Scientific research has presented evidence of the negative impact of toxic relationships and toxic stress on physical and psychological health. However, less is known on how this evidence can have a preventive effect. Knowing these impacts can be important for women and girls to decide the type of affective-sexual relationships they want to have, and even transform their attraction towards different types of masculinity. This study presents results from the MEMO4LOVE project. Researchers use mixed-methods approaches, including a questionnaire (n = 141) to study adolescents' peer groups' interactions that promoted healthy or toxic affective-sexual relationships, and five communicative focus groups with boys and girls to analyze how these interactions can be transformed by sharing scientific knowledge on the effects of violent relationships with adolescents. The results showed the impact of sharing with adolescents the evidence of the adverse effects of toxic relationships with violent masculinities on health. The peer group's transformation occurred: non-violent boys gained self-confidence, and girls redirected or reinforced their attraction to non-violent boys. These results suggest the potential positive effects of knowing the impacts of toxic relationships on girls' health.

The Impact of Adverse Childhood Experiences on Cognition in African American Older Adults: An Integrated Literature Review

The current integrative literature review examined the existing evidence on the connection between adverse childhood experiences (ACEs) and cognitive changes in African American older adults. Using the Covidence platform, several databases were searched, resulting in 266 publications dated 2008-2020. Ten articles met inclusion criteria and were reviewed. Findings indicate that four ACEs (physical, sexual, and verbal abuse, and low socioeconomic status) are associated with impaired cognition in African American older adults. Four gaps were identified: lack of (a) older adult participants in research investigating original and expanded ACEs; (b) exclusively African American samples of participants in studies examining the relationship between ACEs and cognition; (c) consensus about what specific ACEs contribute to changes in cognition in older adults; and (d) information about successful interventions created to prevent and mitigate the effects of ACEs in older adults. This review provides a synthesis of the limited evidence on the effects of ACEs on cognition among other outcomes. Findings on the effects of ACEs on African American older adults' cognition are limited, thus making a compelling case for further investigating the role of childhood adversity in the disparity of cognitive changes in African American communities. [Research in Gerontological Nursing, 14(5), 265-272.].

Contextual factors associated with gender-based violence and related homicides perpetrated by partners and in-laws: A study of women survivors in India

Gender based violence (GBV) is a significant public health concern for women globally, including countries such as India. The researchers investigated factors related to GBV and GBV-related homicides perpetrated by both husbands and in-laws using a qualitative approach. Data were collected from 27 women in India. Analysis revealed factors at the societal/cultural (e.g. dowry), community (e.g. inadequate resources), relationship (e.g. in-laws abuse) and individual (e.g. internalized powerlessness) levels. Findings highlight the need for culturally appropriate risk assessment and safety planning procedures, as well as policies and programs across different ecological levels to reduce risk for GBV and GBV-related homicides.

A patient-oriented research approach to assessing patients' and primary care physicians' opinions on trauma-informed care

OBJECTIVE

To gather patients' and primary care physicians' (PCP) opinions on trauma-informed Care (TIC) and to investigate the acceptability of recommendations developed by patient, family, and physician advisors.

DESIGN

Cross-sectional research survey design and patient engagement.

SETTING

Canada, 2017 to 2019.

PARTICIPANTS

English-speaking adults and licensed PCPs residing in Canada.

MAIN OUTCOME MEASURES

Participants were given a series of questionnaires including a list of physician actions and a list of recommendations consistent with TIC.

RESULTS

Patients and PCPs viewed TIC as important. Both patients and PCPs rated the following recommendations as helpful and likely to positively impact patient care: physician training, online trauma resource centres, information pamphlets, the ability to extend appointment times, and clinical pathways for responding to trauma. PCPs' responses were significantly more positive than patients' responses.

CONCLUSION

TIC is important to patients and PCPs. Patients and PCPs believe changes to physician training, patient engagement, and systemic factors would be helpful and likely to positively impact patient care. Future research needs to be conducted to investigate whether these recommendations improve patient care.

Trauma Recovery of Greek Women Who Have Experienced Gender-Based Violence: A Narrative Research

In a society where women still suffer from oppression and injustice, research on gender-based violence (GBV) and trauma recovery path is considered a priority. Specifically, it was to be researched how the social and cultural obstacles can affect the help-seeking behavior of Greek women who experienced GBV. The data of this qualitative research were collected through narrative interviews and the analysis was carried out with the thematic analysis. The significant findings of the research were that the feelings of the women changed through the violent relationship, with the feelings of betrayal, guilt, and shame dominating. Moreover, the relative network was not notably utilized, while it seems that the women who utilized their social network were helped to evolve. Additionally, the feelings of guilt and shame stood out as an obstacle to help-seeking behavior and the functionality of the women was reduced on multiple levels during the period in which they experienced gender-based violence. Finally, the physical symptoms of the women during that period, such as musculoskeletal pain, numbing, and gastrointestinal problems, evoke great interest.

Profiles of Emotion Regulation and Post-Traumatic Stress Severity among Female Victims of Intimate Partner Violence

Emotional dysregulation is a construct that has drawn substantial attention as a transdiagnostic contributing factor to the loss of health. Intimate partner violence (IPV) is a term used to describe physical, psychological, or sexual assault of a spouse or sexual partner. The aim of the study was to determine the variability of emotional dysregulation among women with different types of IPV revictimization and post-traumatic stress. The cross-sectional survey included 120 women attended by the Integrated Monitoring System of Gender Violence of Madrid, Spain, due to a gender violence complaint. The presence of post-traumatic stress disorder (DSM 5 criteria), emotional dysregulation (Emotional Processing Scale (EPS)), childhood trauma, and type of revictimization were evaluated. Cluster analysis found three profiles of emotional regulation: Emotionally Regulated, Avoidance/Non-Impoverished, and Emotional Overwhelm. The results showed that the Emotional Overwhelm group was characterized by a general dysregulation of emotional experiences and a greater intensity of post-traumatic stress symptoms. In addition, women who have suffered several episodes of IPV by different partners showed a differential pattern of emotional regulation than the rest of the victims that entailed greater psychopathology. Findings confirm that emotional dysregulation is a critical pathway to the decrease of health among IPV victims.

Exploring African Immigrant Women's Pre- and Post-Migration Exposures to Stress and Violence, Sources of Resilience, and Psychosocial Outcomes

This qualitative study seeks to identify pre- and post-migration stressors experienced by African women who had immigrated to the United States along with the vulnerability and resilience factors that exacerbate or mitigate the negative health effects of these experiences. Seventeen interviews and six focus groups were conducted with 39 African immigrant women. Participants reported encountering experiences of political instability and armed conflict pre-migration and intimate partner violence pre- and post-migration. Religious faith was an important source of resilience for women. Findings support the design of culturally appropriate interventions to improve the mental health of vulnerable African immigrant women.

Intimate partner violence during pregnancy in Vietnam: role of husbands

Intimate partner violence (IPV) perpetrators are often husbands. Understanding factors pertaining to women's male partners is essential for programming interventions against IPV. The objective of the study was to describe husband-related social and behavioural risk factors and assess how they are associated with IPV during pregnancy. Cross-sectional data were collected among 1309 pregnant women with husbands in Dong Anh district, Vietnam. Information on sociodemographic characteristics of husbands, the husband's behaviour and the husband's involvement in pregnancy care was indirectly collected via women's report at first antenatal care visit. Data on exposure to intimate partner violence during pregnancy were collected when the women returned for antenatal care in 30-34 gestational weeks. Logistic regression analyses were used to measure the relationships between IPV during pregnancy and risk factors from the husband. Pregnant women who had husbands who were younger or blue-collar worker/farmer/unemployed had more likelihood to be exposed to IPV. Women with husbands who drank alcohol before sexual intercourse and gambled were more likely to be exposed to IPV repeated times. Those with husbands who had intentions of having a child had over three times increased OR to be exposed to IPV once (AOR = 3.2, 95% CI 1.1-9.7). If the husband had a preference for sons, the woman had 1.5 times increased OR (AOR = 1.5; 95% CI 1.1-1.9) to be exposed to IPV repeated times during pregnancy. This study highlights significant associations between IPV and maternal perceptions of husbands' behaviours and involvement in pregnancy. Findings may help to identify at-risk pregnant women to IPV and guide the development of targeted interventions to prevent IPV from husbands.