Interpersonal violence and women's psychological well-being

Do we have friendly services to meet the needs of young women exposed to intimate partner violence in the Madrid region?

Introduction

Women experiencing intimate partner violence (IPV) do not tend to go very frequently to formal support services. The objective of this study is to identify barriers related to the accessibility, acceptability, equity, appropriateness and effectiveness of IPV services from the perspective of the professionals working in the IPV public services.

Methods

A qualitative study was carried out in the Madrid region based on 13 semi‐structured interviews of young women who had survived IPV as well as 17 interviews with professionals. A thematic content analysis was performed, guided by the dimensions proposed by the World Health Organization (WHO) for friendly services for young people.

Results

From the perspective of the young women and professionals, barriers were identified for all the dimensions of the WHO's friendly services for young people: accessibility: lack of information and support from the social setting, scarce dissemination of the services, economic cost, non‐adapted schedules, inadequate locations or lack of services in settings close to young people; acceptability: lack of protocols to guarantee confidentiality, lack of speed in the provision of services or their referral, unwelcoming environments or unsympathetic professional malpractice; equity: discriminatory professional attitudes towards groups with different social status and lack of protocols to ensure the care of these groups; appropriateness: unmet needs and lack of multidisciplinary teams; and effectiveness: shortage of time, resources, competent professionals, protocols and coordination.

Conclusions

Strategies are needed to make the necessary changes to promote friendly services for the care of young people exposed to IPV. Additionally, it must be emphasized that resources are needed to raise awareness and disseminate IPV services, as well as to train professionals in this area.

Patient or Public Contribution

This paper is based on professionals' perspectives of public IPV‐related services of different areas such as Psychology, Social Work, Nursing, Psychiatry, Social Education and young women exposed to IPV. They either work in the public administration at the local, regional or state level or in NGOs in Spain.

Gender-Based Violence in Adolescent Dating from a Medical Perspective: A Qualitative Study of the Needs Felt in Primary Healthcare Centres

Violence in adolescent dating has become a worrying public health problem. Research carried out on the issue has focused on identifying the causes of this phenomenon. However, difficulties have been found in designing and implementing effective prevention programs. In this context, primary healthcare physicians are one of the most important figures in screening for and detecting this phenomenon, since, in many cases, they are the first to have contact with the victims. The present study focuses on the qualitative analysis of a series of interviews carried out with 95 primary healthcare physicians in Extremadura, Spain. These interviews addressed various questions related to the theoretical and practical knowledge that the physicians have about the topic. The analysis of their responses reveals some of the strengths and weaknesses of the Spanish public health system, at the same time as pointing to what is needed to be able to improve comprehensive intervention for the victims, from the moment they arrive for their first consultation until they are treated and referred to different health specialists.

Victimization Experiences and Well-Being in Adulthood: A Systematic Review and Meta-Analysis

Scientific research has explored the impact of violence during adulthood on psychopathology. Fewer efforts have been made from a positive theoretical framework, and no systematic evidence has been provided. This manuscript describes a literature review and meta-analysis on the relationship between victimization experiences and well-being in adulthood. A literature review was performed, and 27 studies met the inclusion criteria for the systematic review 16 for the meta-analysis. The meta-analysis yielded a medium and significant overall effect size (r = -0.309, p < .001), which indicated that greater victimization experiences partly explain lower well-being outcomes. A set of theoretical and methodological issues are discussed, specifically considering the conceptualization of victimization and well-being as well as the studies design, sample characteristics, measures, and data analysis. Derived from this integrative discussion, some recommendations are also provided for future research.

Prevalence, associated factors and health impact of intimate partner violence against women in different life stages

OBJECTIVES

The effect of age on intimate partner violence (IPV) against women has received little attention. The objective of this study is to analyze the prevalence, risk factors and health impact of current IPV in different life stages.

METHODS

We analyzed a sub-sample of 8,935 ever-partnered women aged 16 years and older from the Spanish Macrosurvey on Gender Violence of 2014. Main outcomes: current physical/ sexual IPV and current psychological-only IPV. The impact of IPV on health was analyzed using the variables self-perceived health, mental health and activity limitations. Risk factors were assessed using the prevalence ratio (PR) from Poisson regression models with robust variance. Analyses were stratified by age (young people, adults, and elderly people).

RESULTS

Abuse in childhood increases the likelihood of IPV in any life stage. A higher education level decreases the probability of physical/sexual IPV across all ages. Unemployment increases the probability of IPV in adult women (physical/sexual-IPV, PR:1.7; psychological-IPV, PR:1.3). Being an immigrant increases the likelihood of physical/sexual IPV in adult women (PRwomen:1.91). Women exposed to current physical/sexual IPV have a greater likelihood of reporting poor self-perceived health (PRyoungpeople:2.59; PRadults:1.68; PRelderly:1.28), poor mental health (PRyoungpeople:3.10; PRadults:2.61; PRedlerly:2.17) and activity limitations (PRyoungpeople:2.44; PRadults:1.98). For psychological IPV only, there is an increase in the probability of poor self-perceived health (PRadults:1.37; PRelderly:1.19), poor mental health (PRyoungpeople:2.24; PRadults:2.16; PRelderly:1.69), and activity limitations (PRadults:1.30; PRelderly:1.18).

CONCLUSIONS

We found both common factors and differential factors when looking at IPV by age group. This shows the need to link gender violence prevention with the social circumstances of the population across different life stages.

To Stay in or Leave an Abusive Relationship: Losses and Gains Experienced by Battered Filipino Women

The present study aimed to describe and analyze the losses and gains experienced by battered Filipino women as a result of their decision to stay in or leave an abusive relationship. In-depth, semistructured interviews were conducted with 60 battered women, 30 of the women were still living with their abusive husbands/partners and 30 have left their abusive husbands/partners. Results from the phenomenological data analysis of the qualitative data revealed that the women who stayed in and left their abusive partners experienced both losses and gains. For the women who stayed in an abusive relationship, they lost a sense of self, the opportunity for a better life, peace of mind, psychological well-being, and love for their partners. However, these women had the benefits of having a complete family and a partner to help raise their children. In contrast, despite not having a complete family or a partner to help them raise their children, women who left an abusive relationship gained back their sense of self, peace of mind, freedom, inner strength, and hope. Implications for counseling practice were discussed.

Interpersonal Violence and Health in Female University Students in Spain

BACKGROUND

Most studies address the health impact of violence by an intimate partner; therefore, violence exerted by someone other than a partner in university students and its health effects are less known.

PURPOSE

This study aims to analyze the effect of different forms of interpersonal violence on female university students' health.

DESIGN

Women 18 to 25 years of age enrolled at two schools of the University of Valencia in the academic year 2013-2014 (N = 540) were selected, with a participation rate of 82%. Students were grouped as follows: no lifetime violence, violence by an intimate partner (IPV), other personal violence (OPV), and by both (IPV and OPV). Adjusted logistical regression analysis was performed to assess the effects of the different forms of violence on students' health.

RESULTS

As many as 92 students (20.6%) experienced violence at least once in their lives: 46 (10.3%) by an intimate partner, 24 (5.4%) by someone other than a partner, and 22 (4.9%) by both. Abused students are more likely to suffer psychological distress and poor health perception, and more regularly used psychoactive drugs than nonabused students, although the use of medication is higher for those abused by a partner and others. Women who experienced only IPV are more likely to suffer psychological distress (adjusted odds ratio [aOR] = 1.78, p < .05, 95% confidence interval [CI; 1.10-2.86]), while those who experienced only OPV are more than twice as likely to perceive their health as poor (aOR = 2.68, p < .05, 95% CI [1.38-5.22]).

CONCLUSIONS

The high prevalence of violence and its consistent association with a wide range of female university students' health problems suggest that violence seriously compromises women's health.

CLINICAL RELEVANCE

Prevention programs that promote harmonious social relationships among university students should be implemented.

Violence against young women attending primary care services in Spain: prevalence and health consequences

BACKGROUND

There are a significant number of studies assessing the negative health consequences of violence against women. However, a limited number of studies analyse the health consequences of violence committed against young women by different types of aggressors.

OBJECTIVES

The goal of this study is to assess the prevalence of interpersonal violence against young women in Spain and analyse its impact on the physical and mental health of the victims.

METHODS

A total of 1076 women aged 18-25 years attending Spanish primary care services were selected. We estimated the prevalence of interpersonal violence and compared the health data and demographic characteristics of abused and non-abused young women, multi-logistic regression models were fitted. The Wald test was used to assess whether there were differences in the negative health consequences of intimate partner (IPV) versus non-IPV.

RESULTS

As many as 27.6% young women reported a history of abuse, of whom 42.7% had been assaulted by their partner, 41.1% by someone other than their partner and 16.2% both by their partner and another person. The distribution of social and demographic characteristics was similar for IPV and non-IPV victims. Young abused women were three times more likely to suffer psychological distress and have somatic complaints, and they were four times more likely to use medication as compared to non-abused women.

CONCLUSION

Our results suggest that all forms of violence compromise young women's health seriously. Including patients' history of abuse in their health record may help make more informed clinical decisions and provide a more integrated care.

Intimate partner violence in older women in Spain: prevalence, health consequences, and service utilization

The purpose of this study is to estimate the prevalence of lifetime intimate partner violence (IPV) in older women and to analyze its effect on women's health and Healthcare Services utilization. Women aged 55 years and over (1,676) randomly sampled from Primary Healthcare Services around Spain were included. Lifetime IPV prevalence, types, and duration were calculated. Descriptive and multivariate procedures using logistic and multiple lineal regression models were used. Of the women studied, 29.4% experienced IPV with an average duration of 21 years. Regardless of the type of IPV experienced, abused women showed significantly poorer health and higher healthcare services utilization compared to women who had never been abused. The high prevalence detected long standing duration, negative health impact, and high healthcare services utilization, calling attention to a need for increased efforts aimed at addressing IPV in older women.

Intimate partner violence: how clinicians can be an asset to their patients

Intimate partner violence (IPV) has emerged as a public health concern. It does not consist of physical violence alone, but includes psychological and emotional issues as well. IPV cuts across all cultures, age groups, and socioeconomic classes and necessitates numerous health care visits. It is often difficult to identify those who are affected by IPV when assessing during health care services. This difficulty may be overcome as health care providers become aware of the need to integrate screening as part of the initial assessment. Although it can be difficult to measure the impact of IPV, several organizations have been able to determine that the economic cost to society is significantly increased when IPV is present. Because nurses are the largest class of health care providers, their ability to perform screening activities is paramount to early detection and management of IPV.

Personal and psychosocial predictors of psychological abuse by partners during and after pregnancy: a longitudinal cohort study in a community sample

OBJECTIVE

To describe the incidence and risk factors of psychological intimate partner violence (IPV) during pregnancy and the first year after childbirth.

DESIGN

Longitudinal cohort study.

SETTING

Nine primary care centers in the Valencia Region (Spain).

POPULATION

A consecutive sample of 1400 women in the first trimester of pregnancy, attending the prenatal programme in the Valencia Region of Spain in 2008, with follow-up in the third trimester of pregnancy, and at 5 and 12 months postpartum. A total of 888 women (66.5%) participated in all four phases.

METHODS

A logistic regression model was fitted using generalised estimating equations to assess the effects of previous partner violence, consumption of alcohol or illicit drugs and social support on subsequent psychological partner violence.

MAIN OUTCOME MEASURE

Psychological IPV during follow-up.

RESULTS

We observed an increase in the incidence of psychological IPV after birth, particularly at 5 months postpartum. The strongest predictor of psychological IPV was having experienced abuse 12 months before pregnancy (OR 10.46, 95%CI 2.40-45.61). Other predictors were consumption of alcohol or illicit drugs by the partner or a family member (OR3.50, 95%CI 1.38-8.85) and lack of affective social support (OR2.83, 95%CI 1.31-6.11).

CONCLUSIONS

Previous abuse and psychosocial risk factors predict partner psychological abuse after birth. Monitoring psychological IPV and effective interventions are needed not only during pregnancy but also during the postpartum period.

Psychological/verbal abuse and utilization of mental health care in perinatal women seeking treatment for depression

Research on psychological violence has suggested it is common among perinatal women and is predictive of later physical violence. Psychological violence is also a strong correlate of negative mental and physical health outcomes and may influence engagement in health services. Both physical and mental health care are of critical importance for perinatal women who may be especially vulnerable to psychological violence and its deleterious effects. This study examined the clinical records of 299 perinatal patients who received treatment in a psychiatric partial hospital program to determine whether there were differences in utilization of care between those women with and without current interpersonal psychological abuse. More women than expected who reported current psychological abuse left treatment early compared to those without such reports.

Nurses' preparedness to care for women exposed to Intimate Partner Violence: a quantitative study in primary health care

BACKGROUND

Intimate partner violence (IPV) has a deep impact on women's health. Nurses working in primary health care need to be prepared to identify victims and offer appropriate interventions, since IPV is often seen in primary health care. The aim of the study was to assess nurses' preparedness to identify and provide nursing care to women exposed to IPV who attend primary health care.

METHOD

Data was collected using a questionnaire to nurses at the primary health care centres. The response rate was 69.3%. Logistic regression analysis was used to test relationships among variables.

RESULTS

Shortcomings were found regarding preparedness among nurses. They lacked organisational support e.g. guidelines, collaboration with others and knowledge regarding the extensiveness of IPV. Only half of them always asked women about violence and mostly when a woman was physically injured. They felt difficulties to know how to ask and if they identified violence they mostly offered the women a doctor's appointment. Feeling prepared was connected to obtaining knowledge by themselves and also to identifying women exposed to IPV.

CONCLUSION

The majority of the nurses were found to be quiet unprepared to provide nursing care to women exposed to IPV. Consequences might be treatment of symptoms but unidentified abuse and more and unnecessary suffering for these women. Improvements are needed on both at the level of the organisation and individual.

Violence against women from different relationship contexts and health care utilization in Spain

BACKGROUND

Studies reported an excess of health services utilization among women with violence by an intimate partner (IPV). However, little is known about health utilization by women victims of other forms of interpersonal violence than IPV. This study aimed to determine the effect of violence from different relationship contexts on health care utilization.

METHODS

A cross-sectional study following a multistage cluster sampling scheme was conducted. Women aged 18 to 70 years were randomly selected according to their scheduled health care visit. The number of women invited to participate was 16,419 and 73% accepted. After exclusion, the final sample consisted of 10,815 women. The outcome variables were health care utilization (primary care, specialty services, emergency rooms, and hospital admissions) and the predictor variable was interpersonal violence from different relationship contexts. Multivariable adjusted logistic regression models were conducted to assess the independent effect of each violence relationship context on health care utilization.

MAIN FINDINGS

Compared with never abused women, use of health services was significantly higher for abused women, although the rates varied depending on the violence relationship context. The greatest probability of service use was among women whose abuse was perpetrated by both a partner and others. Comparing the magnitude of effect of each violence category by perpetrators other than a partner, this effect was stronger for violence in a social context in the case of emergency rooms only.

CONCLUSION

Regardless of the perpetrator, lifetime violence increased health services utilization. Violence affects women's behavior in terms of how they use health services.