Family violence exposure and health outcomes among older African American women: do spirituality and social support play protective roles?

The pandemic within a pandemic: mental health and wellbeing of racially Minoritised women experiencing domestic abuse during the COVID-19 pandemic in the UK

BACKGROUND

The prevalence of domestic abuse is greater in times of humanitarian crisis, and the COVID-19 pandemic has been no different. Considerable evidence indicates that domestic abuse disproportionately impacts the mental health and wellbeing of racially Minoritised women. The present study aimed to explore racially Minoritised women's experiences of domestic abuse and mental health in the COVID-19 pandemic in the UK.

METHOD

An online cross-sectional survey was used with racially Minoritised women (n = 1202) in the UK during the third national lockdown.

RESULTS

Results demonstrate complex interplay of psychosocial factors, such as the roles of autonomy, resilience, self-silencing, family functioning, and social support as predictors of mental health and wellbeing during the 'shadow pandemic'.

CONCLUSION

Implications such as incorporating culturally competent mental health support, exploring the complex and multiple underpinnings of mental health in racially Minoritised victim-survivors of domestic abuse for future pandemic preparedness and support provision are discussed.

Resilience after adversity: an umbrella review of adversity protective factors and resilience-promoting interventions

Introduction

Resilience is the dynamic adaptive process of maintaining or recovering mental health from stressors, such as trauma, challenging life circumstances, critical transitions, or physical illnesses. Resilience after adversity can be fostered through protective factors and the implementation of interventions that promote resilience. Hence, it is essential to investigate both protective and vulnerable factors to reduce the negative effects of unfavorable life events and increase resilience through positive risk-response interventions.

Objective

To assess the effect of previous adversity, protecting factors, and resilience-promoting interventions to possess resilience after adversity in a global context.

Methods

The study included English language articles sourced from PubMed, Embase, Scopus, Web of Sciences, the Cochrane Database of Systematic Reviews, Scopus, and Google Scholar published before 15 April 2024. These articles reported the effect of adversity, protecting factors, and/or resilience-promoting interventions to possess resilience after adversity in a global context without a population age limitation. The quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews. A weighted inverse-variance random-effects model was applied to find the pooled estimates. The subgroup analysis, heterogeneity, publication bias, and sensitivity analysis were also assessed.

Results

A total of 44 articles (n = 556,920 participants) were included in this umbrella review. From the random-effects model analysis, the pooled effect of adversity on the development of resilience was 0.25 (p < 0.001). The pooled effects of adversity-protective factors and resilience-promoting interventions after adversity were 0.31 (p < 0.001) and 0.42 (p < 0.001), respectively. The pooled effects of specific adversity protective factors were 0.26, 0.09, 0.05, 0.34, 0.23, and 0.43 for the availability of support, cognitive ability, community cohesion, positive self-perception, religious involvement, and self-regulation, respectively. The pooled effects of specific resilience-promoting interventions were 0.30, 0.21, 0.51, and 0.52 for cognitive behavior therapy (CBT) interventions, mindfulness-based interventions, mixed interventions, and resilience-promoting interventions, respectively.

Conclusion

The findings of this umbrella review revealed that people who experienced early adversity can develop resilience later in life. The study highlights the need to consider adversity protective factors, such as availability of support (family, friends, and school), cognitive ability, community cohesion, positive self-perception, religious involvement, and self-regulation, and resilience-promoting interventions, including CBT interventions, mindfulness-based interventions, and mixed interventions, to enhance resilience promotion programs.

Effectiveness of INOSEL program consisting of Integrative Nursing and Omaha System for older women feeling loneliness: a randomised controlled trial

OBJECTIVES

To evaluate the effectiveness of an intervention combining Integrative Nursing and Omaha System on physical, mental, social, spiritual health of older women living with high level of loneliness. The second aim was to determine the effect of Omaha System interventions on knowledge, behaviour and status scores.

METHODS

A randomised controlled trial was conducted with 69 older women feeling loneliness (INOSEL n = 36, control n = 33 groups). INOSEL group received group-based and person-centered intervention and control group received routine care.

RESULTS

INOSEL and control groups showed an improvement in loneliness score. The decrease in loneliness score and level was higher in the INOSEL group. The physical activity, health status perception, social support, social inclusion, well-being, and spirituality scores increased in the INOSEL group. INOSEL group experienced an increase in the knowledge, behaviour and status.

DISCUSSION

INOSEL program, a theoretical structure, reduced loneliness and positively affected women's health.

IMPLICATIONS FOR PRACTICE

Health professionals can use this program based on Integrative Nursing and Omaha System in nursing caring.

CLINICAL TRIAL REGISTRATION

NCT03695133.

Contextualizing the experiences of Black pregnant women during the COVID-19 pandemic: 'It's been a lonely ride'

The emergence of the COVID-19 pandemic significantly changed the prenatal care experience, specifically regarding medical appointments and social opportunities. It is critical to capture this change through the narratives of pregnant people, particularly those of marginalized populations, whose voices may often be underrepresented in the literature. This mixed-methods paper summarizes the experiences of 40 pregnant Black/African American (AA) women during the COVID-19 pandemic. A cross-sectional, online survey was administered between 2020 and 2021 to assess prenatal health and the impacts of the COVID-19 pandemic on patients' pregnancy experience. Coping behaviors during the pandemic were self-reported using the COPE-IS. Univariate analyses were conducted. An additional analysis of participants (n = 4) was explored through a week-long qualitative exercise using a photo documentation procedure. Photo-Elicitation Interviews (PEI) were conducted to capture and center their pandemic pregnancy experiences. Sources of stress during the pandemic varied, with the most common being financial concerns (n = 19, 47.5%). Over half of the sample (n = 18, 54.5%) self-reported increases in their positive coping behaviors during the pandemic, such as communicating with friends and family, talking to healthcare providers, listening to music, and engaging in spiritual practices-such as prayer. The four PEI study participants reflected on the impacts of social distancing on their prenatal experience and mentioned hospital and provider-related weariness due to their race. The findings of this study suggest that during the COVID-19 pandemic, Black/AA pregnant women in Charlotte, NC used social support, mindfulness practices, self-advocacy, and health literacy to navigate challenges present during their prenatal health experience. This paper highlights the personal, social, and structural experiences of pregnant women during a public health crisis so that responsive and effective programs or policies can be planned in the future.

Domestic Violence Survivorship Among a Sample of Older African American Women: An Interpretative Phenomenological Analysis

African American women experience domestic violence at a rate that is 35% higher than the domestic violence rate of White women. Moreover, African American women encompass 8% of the US population but account for 22% of domestic violence-related homicide victims. African American women are at greater risk for facing economic difficulties, homelessness, unemployment, and health and educational disparities due to domestic violence. However, little attention has been given to the lived experiences of older women who are domestic violence survivors. Theories of phenomenology and hermeneutics provided the theoretical framework for this study. An interpretative phenomenological analysis framework guided the research design and data analysis process. Overall, the findings pointed toward the need for generating more culturally sensitive and culturally tailored programs and services to address domestic violence in the African American community. Additionally, services are needed that include faith-based education, training, and prevention programs to enable churches and social workers to address the unique cultural needs of African American women who have endured domestic violence.

The Impact of Traumatic Events on Mental Health Among Older African American and Black Caribbean Adults

Objectives: This study examined the frequency and impact of traumatic events on the mental health of older African American and Black Caribbean adults. Methods: The current study used data from the National Survey of American Life of 1,135 African American and 426 Black Caribbean adults aged 50 and older. Analysis examined the impact of traumatic events on both positive (i.e., happiness and life satisfaction) and negative (i.e., depressive symptoms, psychological distress, and 12-month anti-depressant use) domains of mental health. Results: Findings indicate that approximately 80% of older African Americans and Black Caribbeans reported experiencing a traumatic event at some point in their lifetime. Among African Americans assaultive violence was associated with more depressive symptoms, lower levels of life satisfaction, and lower levels of happiness. This was not the case among Black Caribbeans. Conclusions: These findings provide preliminary insight in mental health outcomes for older African American and Black Caribbean adults.

DNA methylation and exposure to violence among African American young adult males

Exposure to violence (ETV) has been linked to epigenomics mechanisms such as DNA methylation (DNAm). We used epigenetic profiling of blood collected from 32 African American young adult males who lived in Washington DC to determine if changes in DNAm at CpG sites affiliated with nervous and immune system were associated with exposure to violence. Pathway analysis of differentially methylated regions comparing high and low ETV groups revealed an enrichment of gene sets annotated to nervous system and immune ontologies. Many of these genes are known to interact with each other which suggests DNAm alters gene function in the nervous and immune system in response to ETV. Using data from a unique age group, young African American adult males, we provide evidence that lifetime ETV could impact DNA methylation in genes impacted at Central Nervous System and Immune Function sites.

METHOD

Methylation analysis was performed on DNA collected from the blood of participants classified with either high or low lifetime ETV. Illumina®MethylationEPIC Beadchips (~850k CpG sites) were processed on the iScan System to examine whole-genome methylation differences. Differentially methylated CpG-sites between high (n ​= ​19) and low (n ​= ​13) groups were identified using linear regression with violence and substance abuse as model covariates. Gene ontology analysis was used to identify enrichment categories from probes annotated to the nearest gene.

RESULTS

A total of 595 probes (279 hypermethylated; 316 hypomethylated) annotated to 383 genes were considered differentially methylated in association with ETV. Males with high ETV showed elevated methylation in several signaling pathways but were most impacted at Central Nervous System and Immune Function affiliated sites. Eight candidate genes were identified that play important biological roles in stress response to violence with HDAC4 (10%), NR4A3 (11%), NR4A2 (12%), DSCAML1(12%), and ELAVL3 (13%) exhibiting higher levels in the low ETV group and DLGAP1 (10%), SHANK2 (10%), and NRG1(11%) having increased methylation in the high ETV group. These findings suggest that individuals subjected to high ETV may be at risk for poor health outcomes that have not been reported previously.

Association between elder abuse and telomere shortening in older adults: A 2-year prospective study

BACKGROUNDS

Elder abuse is a public health issue associated with increased morbidity and mortality. Its impact on victims' health at the cellular level, however, remains unknown. This study assessed the association between abuse exposure and shortening of telomere length (TL), a promising molecular marker for biological aging, in older victims.

SETTING

The geriatric departments of three Grade-A hospitals in the People's Republic of China (PRC).

PARTICIPANTS

Six hundred Chinese older adults, including 300 abused victims and 300 non-abused controls were randomly drawn respectively from a larger sample of 467 abused and 518 non-abused older adults recruited at baseline. Participants were assessed for physical and psychological abuse exposure at baseline between September 2015 and February 2016 and assessed for TL 2 years after the abuse assessment.

MEASUREMENTS

TL was quantified using a quantitative PCR method and expressed as T/S ratio (the ratio of telomere repeat copy numbers to single-copy gene numbers). Physical and psychological abuse was measured using the Revised Conflicts Tactics Scale.

RESULTS

Adjusting for demographic, medical, and behavioral confounders, physical and psychological abuse exposure at baseline were independently associated with shorter TL at follow-up. The association was the most significant between multiple forms of abuse (physical and psychological) exposure and shorter TL.

CONCLUSION

This study provides the first evidence on the relationship between abuse and shortened TL in older victims, implying the potential effect of elder abuse on accelerated cellular aging. The findings suggest the importance of routinely assessing and intervening abuse in older adults by healthcare professionals, to promote and maintain physical health in older adults.

A Sample of Predominately African American Domestic Violence Victims' Responses to Objective Risk Assessments

One area of significant concern for researchers of domestic violence is identifying the utility of objective risk assessment tools on diverse samples. This study included a sample of predominately African American women (n = 57) living in a domestic violence shelter. The study compared the Danger Assessment (DA) and the Ontario Domestic Assault Risk Assessment (ODARA) to evaluate their responses of their risk for re-abuse. Results revealed a moderate to strong correlation between the DA and ODARA (r = .73). Offender's age, habitation, and pregnancy status were not related to the victim's perceptions of risk for future abuse. Implications of these findings are discussed.

The Role of Stressful Life Events and Cultural Factors on Criminal Thinking among African American Women Involved in the Criminal Justice System

African American women are positioned at the intersection of multiple disadvantaged statuses and disproportionately impacted by criminal justice policies, as evinced by their increased likelihood of incarceration. Yet, they continue to be overlooked in mainstream criminological research. Using data from 418 African American women in the B-WISE (Black Women in a Study of Epidemics) project, the current study investigates the relationship between several prominent stressors occurring in five social contexts and criminal thinking as a coping strategy. Findings indicate that criminal thinking may be one maladaptive coping mechanism to manage stressors, such as gendered racism, financial stress, and network loss, that occur across these multiple social contexts for African American women in prison and on probation. Spirituality, on the other hand, seems to operate as a buffer. Implications for practice include promoting programs that strengthen a sense of collective identity in the community, as well as hiring more African American women who could provide additional culturally-competent behavioral health services in criminal justice professions.

Factors associated with two types of child custody loss among a sample of African American mothers: A novel approach

African American families are overrepresented in the Child Welfare System; however, extant research on this phenomenon has (1) focused mostly on Caucasian or mixed-race samples and (2) has not examined informal custody arrangements alongside official child custody loss. This research addresses these gaps in the literature by examining factors associated with both official and informal child custody loss among a sample of African American mothers. Multinomial regression results show that having ever been incarcerated following a conviction increases the odds of experiencing both types of custody loss relative to no loss. Additionally, mother's experiences of childhood victimization increase the likelihood of informal custody loss relative to no loss, while being older, past year homelessness, number of minor children, being lesbian or bisexual, crack/cocaine use, and more family social support increase the odds of official loss versus no loss. Finally, increases in social support from friends decrease the odds of official loss. Implications are discussed.

[The role of religion in the promotion of health, in the prevention of violence and in the rehabilitation of individuals involved in criminal activity: literature review]

This is a review of the literature on the role of religion in the promotion of health, the prevention of violence and the rehabilitation of individuals involved in criminal activities. Research was conducted in the Medline through PubMed, Lilacs, Scopus, Social Index with full text, Sociological abstracts and Social services abstracts databases. Twenty-nine essays in Portuguese, English and Spanish were selected and analyzed between 1990 and 2011. The results indicate the function of the religious group and the role of religion in the rehabilitation of individuals, the prevention of criminal involvement, corrective orientations and in social iniquity environments. A debate is presented on the main themes revealed, highlighting the multiplicity of religious roles, their influence over prisoners, as a social control and support base and its influence on mental health promotion and quality of life. The relation between religion and the public sphere is discussed, emphasizing the role of religious groups and the fragility of the State in providing basic public policies. Despite revealing the successful role of religion in violence prevention and in rehabilitation, some studies question this relation and highlight the conflicts between the concepts employed and the final results.

Defining the Meaning of Spirituality Through a Qualitative Case Study of Sheltered Homeless Women

The primary purpose of this case study was to assess the meaning of spirituality in a convenience sample of women located in an urban city in the southwest United States. The secondary purpose was to describe their lived experiences associated with spirituality. From these interviews five themes emerged: Belief in God or a Higher Power, Distinction Between Religion and Spirituality, Belief That There Is a Plan for Their Lives, Spirituality Providing Guidance for What Is Right/Wrong, and Belief That Their Lives Will Improve. These findings support the perceived fundamental importance of spirituality in the lives of homeless women. Nurses and other clinicians can use this information to develop interventions to help support women using spirituality practices and to help improve the outlook of homelessness for these women.

Examining the Impact of Maternal Health, Race, and Socioeconomic Status on Daughter's Self-Rated Health Over Three Decades

This study examines the role of mother's health and socioeconomic status on daughter's self-rated health using data spanning three decades from the National Longitudinal Surveys of Mature Women and Young Women (N = 1,848 matched mother-daughter pairs; 1,201 White and 647 African American). Using nested growth curve models, we investigated whether mother's self-rated health affected the daughter's self-rated health and whether socioeconomic status mediated this relationship. Mother's health significantly influenced daughters' self-rated health, but the findings were mediated by mother's socioeconomic status. African American daughters reported lower self-rated health and experienced more decline over time compared with White daughters, accounting for mother's and daughter's covariates. Our findings reveal maternal health and resources as a significant predictor of daughters' self-rated health and confirm the role of socioeconomic status and racial disparities over time.

Neighborhood disorder, spiritual well-being, and parenting stress in African American women

Using a culturally informed risk-protective framework, the purpose of this study was to examine spiritual well-being (existential, religious) as a moderator (protective factor) in the relation between neighborhood disorder (risk factor) and parenting stress in a high-risk sample of low-socioeconomic status (SES) African American women (N = 144). These women, who were primary caregivers of children between 8 and 12 years old, reported on disorder in their existential and religious well-being, neighborhoods, and 3 types of parenting stress. Women who perceived more disorder in their neighborhood had more parenting stress, and women who reported more existential and religious well-being had less parenting stress. Existential (characterized by a sense of purpose in life), but not religious (characterized by a sense of life in relation with God) well-being moderated the relation between neighborhood disorder and all types of parenting stress, such that women with medium or high levels of existential well-being had low levels of parenting stress at low levels of neighborhood disorder, but higher levels of parenting stress at higher levels of neighborhood disorder. No moderation effects were found at low levels of existential well-being. Results are framed in a context that emphasizes their relevance to incorporating family interventions that bolster culturally relevant resilience factors, such as spirituality, pertinent to low-SES African American families.

Mediators of the childhood emotional abuse-hopelessness association in African American women

Although there is an association between experiencing childhood emotional abuse and feeling hopeless as an adult, it is critical to understand the factors that may be protective in this relationship. The goal of this study was to determine if two protective factors, namely spiritual well-being, including both religious and existential well-being, and positive self-esteem, served to mediate the association between childhood emotional abuse and adult hopelessness. The sample for this investigation was low-income African American women suicide attempters who were abused by a partner in the prior year (N=121). A path analysis revealed that in this sample, the childhood emotional abuse-hopelessness link was mediated by existential well-being and positive self-esteem, as well as by the two-mediator path of emotional abuse on existential well-being on self-esteem on hopelessness. Results suggested that existential well-being may be a more salient protective factor for hopelessness than religious well-being among abused, suicidal African American women who experienced childhood emotional abuse. Findings highlight the value of culturally relevant strategies for enhancing existential well-being and self-esteem in this at-risk population to reduce their vulnerability to feelings of hopelessness.

Examining Cultural Correlates of Active Coping Among African American Female Trauma Survivors

African American women are at a greater risk for exposure to multiple traumatic events and are less likely to seek mental health services than White women. Many women report avoidant and passive coping strategies placing them at an increased risk for lower psychological adjustment. Thus, the purpose of the current study is to examine the role of culturally relevant factors such as spirituality, self-esteem, and social support as significant correlates of John Henryism Active Coping among African American female trauma survivors. The study utilized secondary data from the B-WISE project (Black Women in a Study of Epidemics) with a sample of 161 community-based African American women with a self-reported history of trauma. Results indicate that participants with higher self-esteem and existential well-being were more likely to cope actively with daily life stressors. However, socio-demographics were not significant correlates of John Henryism Active Coping at the multivariate level. Implications for clinical practice are discussed along with the Strong Black Woman (SBW) ideology, which may explain over-reporting of positive attributes such as self-esteem and existential well-being. Limitations of the study and directions of future research are also discussed.

The association between protective actions and homicide risk: findings from the Oklahoma Lethality Assessment Study

This study focuses on the relationship between women's risk of homicide as measured by the Danger Assessment and 13 protective actions. Participants (N = 432) experienced an incident of police involved intimate partner violence (IPV) and subsequently completed a structured telephone interview. Most women in this sample experienced severe violence and were classified as being at high risk for homicide. Participants engaged in an average of 3.81 (SD = 2.73) protective actions. With the exception of the use of formal domestic violence services, women in the high-risk category were significantly more likely than women in the lower risk category to have used each of the protective actions examined. Implications for research and practice are discussed.

Mediators of a culturally-sensitive intervention for suicidal African American women

This study explored intervention outcomes and mechanisms that could help explain why low-income, African American women with a history of intimate partner abuse and suicide attempt improve in response to a culturally-informed intervention, the Grady Nia Project. Specifically, the investigation examined whether or not the intervention had effects on the women and whether or not spiritual well-being and coping mediated the effects of the intervention on suicidal ideation and depressive symptoms. In this randomized controlled clinical trial, data from 89 women who completed both pre- and post-intervention assessments were analyzed. During the post-intervention follow-up, women in the active intervention group reported lower levels of suicidal ideation and depressive symptoms and higher levels of existential well-being and adaptive coping skills than those women randomized to the treatment as usual group. However, only existential well-being was found to mediate treatment effects on suicidal ideation and depressive symptoms. Religious well-being, as well as adaptive and maladaptive coping, did not serve a mediational function. These findings highlight the importance of designing and implementing culturally-sensitive and evidence-based strategies that enhance existential well-being in this population.

The roles of spirituality in the relationship between traumatic life events, mental health, and drug use among African American women from one southern state

This study examines the role of spirituality as a moderator of the relationship between traumatic life experiences, mental health, and drug use in a sample of African American women. It was hypothesized that there would be an inverse relationship overall between spirituality and mental health and drug use among this sample of African American women. Secondly, was expected that spirituality would moderate the relationship between traumatic life events and mental health and drug use. African American women (n = 206) were recruited from the community and from probation officers in three urban areas of a southern state, and face-to-face interviews were completed. Findings indicated that there was a main effect for spirituality (as measured by existential well-being on the Spiritual Well-Being Scale) and traumatic life events, mental health, and alcohol use. In addition, spirituality was a significant moderator of the relationship between traumatic life events and cocaine use. Discussion and implications for African American women are included.

Differential Associations Between Partner Violence and Physical Health Symptoms Among Caucasian and African American Help-Seeking Women

The relationship between partner violence and physical health symptoms is well-established. Although some researchers have theorized that the physical health effects of partner violence may be worse for ethnic minority women, there is little research addressing this topic. The current study examined whether African American women demonstrate a differential association in this relationship than Caucasian women. This study included 323 women (232 African American, 91 Caucasian) who participated in a larger investigation of the psychological and psychophysiological correlates of recent partner violence among women seeking help for the abuse. Race was examined as a moderator of the relationship between partner violence frequency and physical health symptoms. Although mean levels of partner violence frequency and physical health symptoms did not significantly differ between African American and Caucasian women, linear regression analyses demonstrated a significant positive relationship between partner violence frequency and physical health symptoms for African American women; whereas there was no association observed between these variables for Caucasian women. Post hoc analyses revealed that posttraumatic stress disorder symptoms partially mediated the association between partner violence frequency and physical health symptoms for the African American women. The current findings underscore the importance of considering race when studying the effect of partner violence on women's health.