The effect of intimate partner violence and other forms of violence against women on health

Improving women's health and well-being by exploring the impact of emotional, physical, and sexual intimate partner violence

BACKGROUND

Over the past two decades, several studies have highlighted the harmful mental and physical effects of intimate partner violence (IPV) on its victims. However, more repeated measures research is needed to observe the long-term health and emotional effects of IPV. This includes how these impacts change when violence is reduced or ceases, such as when the perpetrator receives intervention. Further limitations of existing research include the lack of data on abuse frequency, severity, and impacts linked with specific forms of abuse.

OBJECTIVES

This research explores the impacts on IPV victims whose abusive (ex-)partners participate in perpetrator programs (PPs). It aims to identify distinct patterns of impacts associated with different IPV types and pinpoint the most damaging IPV behaviors through repeated measures data.

DESIGN

Longitudinal.

METHODS

In total, 349 heterosexual women, who were (ex-)partners of men enrolled in multiple European gender-based violence PPs, completed the Impact Outcome Monitoring Toolkit questionnaire.

RESULTS

The results showed that emotionally abusive behavior and-especially coercive control and online violence-were highly prevalent and had profound, alarming impacts, including self-harm and suicidal ideation. Over two-thirds of the sample reported experiencing sadness as a result of the violence endured, which was identified as a significant impact. Moreover, isolation had a common effect on emotional and physical violence. Recognizing threats and their damaging effects on victims has emerged as crucial because of their impact on victims. Finally, sexual violence, refusing to use contraception and forcing sex were the most damaging behaviors. Interestingly, our study found specific impacts of extreme abusive behavior depending on the type of abuse.

CONCLUSION

This study clearly supports the statement that the impact of abusive behavior can persist after it ends, as half of the victims no longer experiencing violence at the end of the PP reported at least one impact.

How Do Females Who Witnessed Interparental Violence in Childhood Make Sense of and Experience Romantic Relationships: A Qualitative Research in the Sample of Turkey

Witnessing violence between parents during childhood has an impact on individuals' attachment and romantic relationship behaviors. As a result, individuals have expectations according to the attitudes, beliefs, and values that constitute a healthy and unhealthy relationship, which they developed both their early and childhood experiences, and they can act accordingly. Therefore, this study aimed to qualitatively explore the way in which adult women who witnessing inter-parental intimate partner violence (IPV) in childhood, qualities characterize a romantic relationship in terms of being healthy and unhealthy, and their self-reflective statements about their relationships. The research was carried out according to a descriptive phenomenological design. The participants of the study consisted of 16 females aged between 23-58 (M = 40.62, SD = 11.67), 12 of whom were married and 4 of whom have a romantic relationship. According to the results of the analysis, the participants were able to reveal the characteristics that make up healthy and unhealthy relationships, but they stated problems with verbal and psychological violence in their relationships, open communication, and investment in the relationship. In addition, the participants expressed the conflict behaviors that they and their partners use. The findings are discussed with the literature studies and suggestions for future research are offered.

From the Bio-Psycho-Social Model to the Development of a Clinical-Forensic Assessment Tool for Chronic Pain in Victims of Violence: A Research Protocol

Violence against women impacts a minimum of 35% of the global female population, encompassing sexual, physical, and psychological forms. Perpetrators of this violence include partners, family members, or strangers. Its ramifications are substantial, evident in the prevalence of chronic pain reported by between 48% and 84% of women who have experienced abuse, with an odds ratio of 2.08. Notably associated diagnoses include pelvic/vaginal pain, fibromyalgia, irritable bowel syndrome/bowel symptoms, abdominal pain, migraine/headache, and back and neck pain. These diagnoses significantly limit a woman's ability to participate in daily activities, such as exercising or working, leading to genuine disability. Despite substantial evidence, the precise cause and etiology of these conditions remain unclear. Adhering to the bio-psycho-social model, it is conceivable that chronic pain in victims of violence cannot be attributed to a single factor alone, but rather to a combination of all three: biological, psychological, and social factors. Uncovering these factors could have significant clinical and legal implications. On one hand, it would be possible to conduct screenings to avoid developing chronic pain. and guide individuals toward the correct treatment. On the other hand, victims could seek compensation for chronic pain resulting from violence. Considering the limited knowledge about the causes of chronic pain and the absence of tools to identify risk factors or a set of tests for evaluating victims of violence, the goal of the research described in this project protocol is to pinpoint the specific contributing factors for chronic pain due to violence victimization. Additionally, it aims to devise a comprehensive protocol for assessing these factors in forensic science.

Impact of Intimate Partner Violence on mental health among married women in Sri Lanka: a study based on Women's Wellbeing Survey-2019

BACKGROUND

Sri Lankan married women have been reported to experience higher rates of intimate partner violence (IPV). However, research on its impact on mental health and how socio-demographic factors contribute to this association is limited. Therefore, this study aimed to examine the impact of IPV on the mental health of married women in Sri Lanka.

METHODS

In this study, data from 1611 married women who participated in the 2019 Sri Lankan Women's Wellbeing Survey were analyzed. Two binary outcomes were considered: married women's mental health and their suicidal ideation. Binary logistic regression models were used to assess the association between mental health and suicidal thoughts in relation to IPV while controlling for socio-demographic factors.

RESULTS

The results revealed that married women who experienced any form of violence by their spouse had a higher risk of having poor mental health conditions [AOR = 2.88 (2.20, 3.78)] and suicidal thoughts [AOR = 5.84 (4.10, 8.32)] compared to those who did not experience IPV.

CONCLUSIONS

IPV is a substantial contributor to poor mental health and suicidal thoughts among Sri Lankan married women. There is an urgent need for policy interventions, such as community awareness programs, counseling services and enhanced legal protections for victims.

Intimate partner violence and associated factors among women during the COVID-19 pandemic in Ethiopia: a systematic review and meta-analysis

Background

During the Coronavirus Disease 2019 (COVID-19) pandemic, intimate partner violence increased globally, but most notably in Africa. Conditions such as movement restrictions, staying home, and school closures increased the risk of domestic violence against women. Intimate partner violence is violence demonstrated by an intimate partner against women including physical, sexual, and psychological violence. Despite existing laws against intimate partner violence in Ethiopia, enforcement by law and the judicial system remains inadequate. Thus, this research aims to identify factors contributing to intimate partner violence among women during the COVID-19 pandemic, drawing insights from the current literature.

Method

We searched electronic databases, including PubMed, Google Scholar, CINAHL, Cochrane, and others. Two reviewers separately carried out the search, study selection, critical appraisal, and data extraction. A third party was involved in resolving disagreements among the reviewers. All 10 studies included in this study were published in English, with publication dates before 25 February 2024. Articles lacking an abstract and/or full-text, studies that did not identify the intended outcome, and qualitative studies were excluded from the analysis. A Microsoft Excel checklist was used to extract the data, which were then exported to STATA 11. I 2, funnel plots, and Egger's test were employed to measure heterogeneity and detect publication bias, respectively. A random-effects model was used to estimate the pooled prevalence of intimate partner violence and associated factors among women during the COVID-19 pandemic.

Result

The meta-analysis includes a sample size of 6,280 women from 10 articles. The pooled prevalence of intimate partner violence and associated factors among women during the COVID-19 pandemic was found to be 31.60% (95% CI: 21.10-42.11) and significant factors were partner alcohol use with a pooled odds ratio of 1.93 (95% CI: 1.60-2.23), income loss during the COVID-19 pandemic with a pooled odds ratio of 9.86 (95% CI: 6.35-15.70), partner's literacy level/education status with a pooled odds ratio of 2.03 (95% CI: 1.57-2.63), and decision-making in the household with a pooled odds ratio of 1.82 (95% CI: 1.33-2.50).

Conclusion

This systematic review and meta-analysis found preliminary evidence that intimate partner violence increased during the COVID-19 pandemic. A partner who has a history of alcohol use, women who had lost income during COVID-19, a partner who has no formal education, and household decisions made by the husband alone were statistically significant factors for intimate partner violence during the COVID-19 pandemic. This implies that the health sector must play a significant role in providing women who are victims of violence with comprehensive healthcare, advocating that violence against women should be viewed as unacceptable, and improving literacy to minimize the consequences of intimate partner violence among women.

The association between violence against women and chronic pain: a systematic review and meta-analysis

Violence against women is a phenomenon that involves at least 35% of women worldwide. Violence can be sexual, physical, and/or psychological, perpetrated by the partner, another family member, or a stranger. Violence is a public health problem because its consequences include higher morbidity, higher mortality, and short and long-term physical and psychological health diseases. Most studies prove an association between any type of violence and some chronic pain diagnoses but no one has done a complete collection of this evidence. This systematic review and meta-analysis aimed to evaluate whether this association is statistically significant, including the largest number of studies. Through the inclusion of 37 articles, the association has been demonstrated. Compared with no history of violence, women who did experience violence showed 2 times greater odds of developing chronic pain. The impact of violence was significant also on fibromyalgia separately, but not on pelvic pain.PROSPERO registrationPROSPERO CRD42023425477.

Putting a price on pain: The monetary compensation needed to offset welfare losses due to violence

Efficiency calculations of violence prevention are likely to be severely biased if the hard-to-measure value of utility reductions due to victimization is not included. We measure the monetary compensation needed to offset the welfare loss associated with being subjected to violence, by applying the compensating-income-variation method to data from an Icelandic health-and-lifestyle survey carried out in 2017. We examine differences in the monetary compensation needed by (i) types of violence, (ii) duration since the exposure, and (iii) the relationship with the perpetrator. Our results show that the average compensation needed to offset the welfare loss due to psychological violence is $43,750 per year, $22,202 per year for sexual violence, and $10,938 per year for physical violence. Further, we find that the monetary compensation needed is highest when the perpetrator is a spouse or an ex-spouse, and when the violence happened recently.

Regional variations in the acceptance and experience of intimate partner violence in Nigeria: Revisiting cosmopolitan-success and conservative-failure hypothesis

This study investigates regional variations in the factors associated with acceptance and actual experience of intimate partner violence (IPV) among married women in northern and southern Nigeria - two regions with distinct socio-cultural and economic differences. Data from the 2018 demographic and health survey are analysed to compare these two regions. The sample comprised married/living-with-partner women within the reproductive age of 15-49. Overall, a positive association exists between IPV experience and IPV acceptance, regardless of which is used as the outcome variable. Contrary to the notion that IPV is prevalent where its acceptance is high, this study finds that the reverse is true. IPV acceptance is significantly higher in the north than in the south (39.4% versus 14.7%), but the reverse is the case for the actual experience of IPV (20.1% versus 24.7%). Being employed and having access to the internet reduce the odds of IPV victimisation for women in the south, but increases the chances for northern women. Muslims in the north have significantly higher odds of IPV acceptance than their Christian counterparts in the same region, but the reverse is the case in the south. Regional differences also exist in the influence of decision-making, educational difference between spouses, and media exposure. While the cosmopolitan-success and conservative-failure hypothesis explains the regional differences in the acceptance of IPV, it fails to explain differences in the actual experience of IPV. The study provides alternative explanations for the regional differences in the experience of IPV and acceptance of it in Nigeria, and it points to the need for differing intervention programmes across regions. Notably, the study found that the association between justification of IPV and actual experience of it is bi-directional and suggests caution in making causal inferences.

The Risk Factors of Chronic Pain in Victims of Violence: A Scoping Review

Violent situations are unfortunately very frequent in women and children all over the world. These experiences have long-term consequences for adult physical and psychological health. One of the most reported is chronic pain, defined in various sub-diagnoses and present in all types of violence. Unfortunately, the etiology of this condition is not clear and neither are the predisposing factors. The aim of this scoping review is to examine the literature trends about the probable risk factors of chronic pain in violence victims. Considering a bio-psycho-social model, it is possible to hypothesize the presence of all these aspects. The results will be discussed in the present article.

Determinants of spousal physical violence against women in Zambia: a multilevel analysis

BACKGROUND

Violence against women and girls is a major public health issue, a violation of human rights, and is linked to a number of harmful effects on one's physical, mental, sexual, and reproductive health. Studies conducted in other parts of sub-Saharan Africa (SSA) suggest that there is an association between contextual factors and experience of intimate partner violence. However, in Zambia, this association is not well documented. Thus, this study was conducted to examine how individual and community-level characteristics influence spousal violence against women in Zambia.

METHODS

Data from the most recent Zambia Demographic and Health Survey conducted in 2018 was used. A sample of 7,358 ever-married women aged 15-49 years was used in the analysis. Two level multilevel binary logistic regression models were employed to examine the association between individual and contextual-level factors and experience of spousal violence.

RESULTS

The prevalence of spousal physical violence against women in Zambia was 21.1% [95% CI, 19.8, 22.5]. Women aged 15-19 [aOR = 2.36, 95% CI = 1.34-4.14] and 20-24 [aOR = 2.11, 95% CI = 1.38-3.22], who did not own mobile phone [aOR = 1.36, 95% CI = 1.10-1.69], and had low decision making autonomy [aOR = 1.24, 95% CI = 1.01-1.54] were more likely experience spousal physical violence. Furthermore, communities which had a low proportion of women with decision making power [aOR = 1.66, 95% CI = 1.26-2.19] were more likely experience spousal physical violence. Additionally, women whose partners' drank alcohol [aOR = 2.81, 95% CI = 2.30-3.45] and those whose partners exhibited jealous behaviour [aOR = 2.38, 95% CI = 1.88-3.21] were more likely to experience spousal physical violence.

CONCLUSION

Both individual and community-level factors influenced spousal physical violence in Zambia. Integrating community level factors when designing interventions to address gender-based would be key to reduce women's vulnerability to gender based violence in the country. There is need to re-evaluate and re-strategize current strategies being implemented to address gender based violence in the country to make them context specific.

Intimate Partner Violence, Mental Health Symptoms, and Modifiable Health Factors in Women During the COVID-19 Pandemic in the US

Importance

During the COVID-19 pandemic, the prevalence and severity of intimate partner violence (IPV) increased. Associations between IPV and mental health symptoms and modifiable health factors early in the pandemic have yet to be explored.

Objective

To prospectively investigate the association of IPV with greater risk of mental health symptoms and adverse health factors during the COVID-19 pandemic in 3 cohorts of female participants.

Design, Setting, and Participants

This cohort study used observational data from 3 prospective, population-based, longitudinal cohorts in the US: the Nurses' Health Study II, Growing Up Today Study, and Nurses' Health Study 3. Data analyzed included baseline and follow-up survey responses about IPV experiences early in the pandemic (March-September 2020); mental health domains of depression, anxiety, and posttraumatic stress symptoms (PTSS); and modifiable health factors (May 2020-October 2021). Female participants (both health care professionals and non-health care workers) aged 21 to 60 years from the 3 cohorts were included in the full analytic sample.

Exposures

Experience of IPV measured by the Relationship Assessment Tool and fear of partner.

Main Outcomes and Measures

Mental health symptoms, including depression, anxiety, and PTSS, and modifiable health factors, including sleep duration, sleep quality, physical activity, alcohol use, and use of alcohol or other substances to cope with stress.

Results

The full analytic sample included 13 597 female participants with a mean (SD) age of 44 (10.6) years. Accounting for sociodemographic factors and prepandemic mental health symptoms and correcting for multiple testing, experiencing IPV was associated with higher endorsement of depression (odds ratio [OR], 1.44; 95% CI, 1.38-1.50), anxiety (OR, 1.31; 95% CI, 1.26-1.36), and PTSS (OR, 1.22; 95% CI, 1.15-1.29) in random-effects meta-analyses across the 3 cohorts. The IPV experience was also associated with poorer sleep quality (OR, 1.21; 95% CI, 1.16-1.26), shorter sleep duration (OR, 1.13; 95% CI, 1.08-1.19), increased use of alcohol (OR, 1.10; 95% CI, 1.06-1.14), and use of alcohol or other substances to cope with stress (OR, 1.13; 95% CI, 1.08-1.18) across all cohorts as well as decreased physical activity (OR, 1.17; 95% CI, 1.09-1.26) in the Nurses' Health Study II only.

Conclusions and Relevance

Results of the study showed that IPV experiences at the start of the pandemic were associated with worse mental health symptoms and modifiable health factors for female participants younger than 60 years. Screening and interventions for IPV and related health factors are needed to prevent severe, long-term health consequences.

Intimate partner violence against women of reproductive age and associated factors during COVID-19 pandemic in Northern Ethiopia, 2021: A community-based cross-sectional study

Background

Intimate partner violence (IPV) is a major public health concern that affects more than one-third of all women globally. Assessing the prevalence of intimate partner violence and associated factors during the COVID-19 pandemic in various localities is crucial for intervention actions. So far, a few studies have been done in Ethiopia during the current COVID-19 pandemic.

Objective

This study aimed to assess the prevalence of intimate partner violence in women of reproductive age and associated factors during the COVID-19 pandemic in Debre Berhan town, Ethiopia, 2021.

Methodology

A community-based cross-sectional study was done. A total of 809 ever-partnered women of reproductive age were selected randomly via a multistage sampling method. Crude and adjusted odds ratios (AOR) with the resulting 95% confidence interval (CI) were used to verify the strength of associations. Significant associations were declared at p-values <0.05.

Result

Among the 796 women who successfully participated in the study, 337 (42.3%) experienced at least one type of intimate partner violence. Prevalence of psychological, physical, and sexual violence was 35.3% (281), 15.3% (122), and 15.2% (121), respectively. Multivariate analysis revealed that women with no formal education [AOR (95% CI): 3.66 (1.91-6.98)], having no own income [AOR (95% CI): 1.78 (1.24-2.56)], and attitude of IPV were acceptable [AOR (95% CI): 4.02 (1.33-12.14)]; a male partner with no formal education [AOR (95% CI): 3.06 (1.53-6.14)], with "level of religious beliefs" [weak-AOR (95% CI): 4.17 (1.45-12.03); and medium-AOR (95% CI): 1.64 (1.13-2.39)], who is alcoholic [AOR (95% CI): 5.91 (4.03-8.67)], and with smoking habits [AOR (95% CI): 2.04 (1.10-3.77)] and >5 [AOR (95% CI): 1.83 (1.01-3.39)] was significantly associated with the presence of intimate partner violence.

Conclusion and recommendation

This study revealed a high prevalence of IPV in the study participants. The high intimate partner violence prevalence was due to multiple factors, thus demanding empowering women and tailored health education for male partners.

Does sexual Intimate Partner Violence (IPV) increase risk of multiple high-risk fertility behaviours in India: evidence from National Family Health Survey 2015–16

Background

One in three women from lower and middle-income countries are subjected to physical and/or sexual intimate partner violence (IPV) in their life span. Prior studies have highlighted a range of adverse health impacts of sexual IPV. However, less is known about the link between multiple high-risk fertility behaviours and sexual intimate partner violence. The present study examines the statistical association between multiple high-risk fertility behaviours and sexual intimate partner violence among women in India.

Methods

The present study used a nationally representative dataset, the National Family Health Survey (NFHS-4) 2015–16. A total of 23,597 women were included in the study; a subsample of married women of reproductive age who have had at least one child 5 years prior to the survey and who had valid information about sexual IPV. Logistic regression models were employed alongside descriptive statistics.

Results

Approximately 7% of women who are or had been married face sexual IPV. The prevalence of sexual violence was higher among women who had short birth intervals and women who had given birth more than three times (12%). Around 11% of women who had experienced any high-risk fertility behaviours also experienced sexual violence. The unadjusted association suggested that multiple high-risk fertility behaviours were 32% (UORs = 1.32, 95% CI: 1.16–1.50) higher for those women who experienced sexual violence. After adjusting for other sociodemographic variables, except for women’s education and wealth quantile, the odds of multiple high-risk fertility behaviours were 16% (AOR = 1.16; 95% CI: 1.02–1.34) higher among women who faced sexual violence. The inclusion of women’s educational attainment and wealth status in the model made the association between sexual IPV and high-risk fertility behaviours insignificant.

Conclusion

Sexual intimate partner violence is statistically associated with high-risk fertility behaviours among women in India. Programs and strategies designed to improve women’s reproductive health should investigate the different dimensions of sexual IPV in India.

Trick or Treat: Does a Microfinance Loan Induce or Reduce the Chances of Spousal Violence against Women? Answers from India

It is a common belief that microfinance plays a dual role of poverty alleviation and socioeconomic upliftment of its women participants. However, there are enough researches that negates the positive impact of microfinance loans on spousal violence. Recognized as one of the most predominant social evils, violence against women is not only a violation of their human rights but also an act of exploitation and denial of freedom. In the present study, we have tried to investigate if microfinance loan takers experience more spousal violence as compared to their counterparts by analyzing the National Family Health Survey IV, 2015-16. Our results indicate that 40.8% of women microfinance participants experience spousal violence. Additionally, the likelihood of microfinance participants to experience spousal violence is much higher than the non-microfinance participants (odds ratio = 1.35, p value = .000). Microfinance programs are designed to increase the individual agencies of women participants, which, in turn, reduce the chances of them becoming victims of spousal violence. However, if the credit program participation induces the woman to be a victim of spousal violence together with becoming financially autonomous, then such hidden costs need to be taken into account while evaluating the effectiveness of the gendered policy design.

The Experiences of Persistent Pain Among Women With a History of Intimate Partner Violence: A Systematic Review

Women experience persistent pain at higher rates than men; however, women are less likely to be provided with adequate or appropriate care and more likely to have their pain experiences dismissed. The purpose of this review is to consider the complex interaction of the biopsychosocial factors in the experience of persistent pain in order to inform improved models of care. Given persistent pain is among the most frequently reported health consequences of intimate partner violence (IPV), this review focused on studies exploring the association between persistent pain and IPV. Three reviewers independently and systematically searched seven databases. Qualitative and quantitative studies describing the association between IPV and persistent pain published between January 2000 and June 2018 were included. Twelve studies met the inclusion criteria. The included studies demonstrated that a history of IPV places an additional burden on women who experience persistent pain that cannot be explained by an underlying psychological condition. Health care practitioners should be aware of this phenomena to ensure diagnosis, assessment, and treatment plans are targeted accordingly. Future policy directives and research should account for and seek to elucidate this additional burden.

Sexual Violence and Risk of Hypertension in Women in the Nurses' Health Study II: A 7-Year Prospective Analysis

Background Hypertension is a prevalent condition in women and an important modifiable risk factor for cardiovascular disease. Despite women's experiences of sexual violence being common, no prospective studies have examined lifetime sexual assault and workplace sexual harassment in relationship to hypertension in large civilian samples with extended follow-up. Here, we examined whether these experiences were prospectively associated with greater risk of developing hypertension over 7 years. Methods and Results Data are from a substudy of the Nurses' Health Study II and include women free of hypertension at the time of sexual assault and workplace sexual harassment assessment in 2008 (n=33 127). Hypertension was defined as self-reported doctor diagnosis or initiating antihypertensive medication use, assessed biennially through 2015. We performed Cox proportional hazards regression models to predict time to developing hypertension associated with sexual violence exposure, adjusting for relevant covariates. Over follow-up, 7096 women developed hypertension. Sexual assault and workplace sexual harassment were prevalent (23% and 12%, respectively; 6% of women experienced both). Compared with women with no exposure, women who experienced both sexual assault and workplace sexual harassment had the highest risk of developing hypertension (hazard ratio [HR], 1.21; 95% CI, 1.09-1.35), followed by women who experienced workplace sexual harassment (HR, 1.15; 95% CI, 1.05-1.25) and then by women who experienced sexual assault (HR, 1.11; 95% CI, 1.03-1.19), after adjusting for relevant covariates. Conclusions Sexual assault and workplace sexual harassment are prospectively associated with greater risk of hypertension. Reducing such violence is important in its own right and may also improve women's cardiovascular health.

He hurts her womb: Physical-sexual violence and pregnancy complications among women in Afghanistan

Background: Though some studies show the association between intimate partner violence and pregnancy complications in developed countries, the association remains understudied in less developed and low-income settings. This study examines the association of physical and sexual violence with pregnancy complications among women in Afghanistan.

Methods: This study used the data from the 2015 Afghanistan Demographic and Health Survey (AfDHS). The analysis included 7229 women aged between 15 and 49 and used logistic regression to show the association of physical and sexual violence with pregnancy compilations. The analysis controlled for some potential variables and followed complex survey design factors such as strata, clusters, and survey weights.

Results: Fully adjusted regression model shows that the women who experienced physical violence were 21% (adjusted odds ratio [OR]=1.21; confidence interval [CI]=0.98, 1.50; P <0.1) more likely to endure pregnancy complications compared to those who did not face the violence. Likewise, the women experiencing sexual violence were 89% (adjusted OR=1.89; CI=1.37, 2.62; P <0.01) higher to face pregnancy complications than those who did not face any of sexual violence. More specifically, physically and sexually violated women were highly prey to the complications that increased with the increment of the violence.

Conclusion: This study adds that policymakers may formulate policies for ensuring 3C (caring couple counselling) by readdressing couple relationships, raising gender rights and awareness, providing reproductive health literacy, and increasing mental health awareness during pregnancy.

Community cohesion and violence against women in Ghana, Pakistan, and South Sudan: A secondary data analysis

Background:

Much knowledge has been accumulated on individual-level risks and protective factors of violence against women. However, the influence of factors operating at the community level, such as community cohesion, remains unclear, especially in low- and middle-income countries. This study examined whether community cohesion, a combined measure of mutual trust and tolerance, affects women’s likelihood of experiencing intimate partner violence, violence perpetrated by a family member, and violence occurring in public spaces.

Methods:

Data on 4785 women aged between 18 and 60 years in Ghana, Pakistan, and South Sudan, initially collected by the ‘What Works to Prevent Violence Against Women and Girls’ Research and Innovation Programme, were used for this study. Binary logistic regression analyses were used to assess the association between a composite measure of community cohesion and recent experience of physical, sexual, and psychological violence while controlling for different individual-, community-, and state-level variables.

Results:

Multivariate analyses revealed that community cohesion was associated with lower risks of public spaces violence (adjusted odds ratio = 0.396, 95% confidence interval = 0.312–0.503, P < 0.001) and family member violence (adjusted odds ratio = 0.839, 95% confidence interval = 0.754–0.934, P < 0.001). There was no statistically significant association between intimate partner violence and community cohesion, but adjusted models showed that women with more developed social networks were at higher risks of experiencing intimate partner violence (adjusted odds ratio = 1.104, 95% confidence interval = 1.062–1.148, P < 0.001).

Conclusion:

Our findings suggest that community cohesion may have a protective effect against the most visible forms of violence against women. However, this effect may be attenuated or even eliminated by other individual- or household-level mechanisms in the case of violence between intimates or family members.

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.

Communicating a History of Sexual Trauma: Partner Responses to Women's Disclosure

The study aimed to understand how women who experienced sexual trauma but are now in a healthy relationship perceive their partners' responses to their disclosure of sexual trauma. Forty-one women completed an in-depth semi-structured phone interview. Responses were analyzed using reflexive thematic analysis, identifying two overarching themes and six subthemes. The results provide a voice to the needs and preferences of women who experienced sexual trauma, but are navigating communication in a healthy relationship. Given that most women disclosed their experiences with partners, this sample provides valuable insight for clinicians, interventionists, and partners of survivors to navigate supportive interactions.

Challenges to Detecting and Addressing Intimate Partner Violence Among Roma Women in Spain: Perspectives of Primary Care Providers

The objective of this study is to identify challenges and facilitators for detecting and addressing cases of intimate partner violence (IPV) against Roma women, from the perspectives of health personnel and representatives of Roma organizations, and to compare both perspectives. A total of 28 semi-structured interviews were carried out between November 2014 and February 2015 in different Spanish cities. A thematic analysis was carried out, guided by Aday and Andersen's model regarding barriers to access to health services. Both groups signaled the following as principal challenges: (a) consideration of IPV as a private problem among the Roma population, (b) little use of primary care providers for prevention, (c) distrust of Roma women toward primary care professionals as resources for seeking help, (d) the inexistence of Roma professionals in health services, (e) health professionals' lack of cultural sensitivity related to Roma people, and (f) the focus of health protocols for action against IPV on filing a police report. Potential facilitating factors included Roma women's trust in nurses, social workers, and pediatricians and ethnic heterogeneity. There is need to promote action to address the identified challenges through a health equity approach that includes greater training and awareness raising among health professionals about Roma culture and the specific needs of Roma women.

The Consequences of Disdainful Hook-Ups for Later Egalitarian Relationships of Girls

Introduction: There is extensive research about the consequences that toxic relationships with dominant masculinities have on different areas of women’s lives, including how they can influence future relationships they establish. Some of these women reproduce toxic relationships with dominant masculinities in their following relationships, and some women start to establish sexual-affective relationships with non-dominant masculinity models. However, less is known about the specific consequences in non-dominant masculinities who establish relationships with women who have not overcome the false memory of excitement regarding their toxic relationships. Methodology: In order to shed light on the consequences for non-dominant masculinities, eight communicative interviews were conducted with four women and four men. Results: The main findings indicate that those female participants who have kept an exciting memory of toxic relationships, when in an equal relationship, have attitudes of disdain towards non-dominant masculinities. They may ridicule them, not value their personal or intellectual abilities, talk down to them, and even negatively value their sexual aptitudes. Discussion: The application of the previous literature to our results leads to establishing the work on memories of relationships that have led to socialization in violent relationships as a preventive approach. Conclusion: The previously mentioned attitudes could generate health problems for non-dominant masculinities engaged in these relationships.

Cardiovascular Risk and Outcomes in Women Who Have Experienced Intimate Partner Violence: An Integrative Review

BACKGROUND

Cardiovascular disease (CVD) and intimate partner violence (IPV) are 2 major chronic problems that prevalently affect women's health and quality of life in the United States. However, whether female IPV survivors are at risk for developing adverse cardiovascular outcomes has not been clearly understood.

OBJECTIVE

This integrative review was conducted to bridge the literature gap by examining cardiovascular health in female adults with a history of IPV experience.

METHODS

Three electronic databases including PubMed, CINAHL, and Web of Science were used to search for studies published between 1998 and 2019. The search process followed the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines.

RESULTS

Of the 229 records retrieved from the literature, 19 met the criteria for review. All included studies were quantitative research. Although the overall findings showed a mixed relationship between IPV and CVD, women who experienced abuse were more likely to engage in unhealthy behaviors, have higher levels of CVD biomarkers, experience cardiovascular symptoms, and exhibit long-term cardiovascular complications when compared with nonabused women.

CONCLUSIONS

Intimate partner violence is a stressor that directly and indirectly influences women's cardiovascular health. Therefore, it is essential for healthcare providers to routinely screen IPV status in clinical practice. Targeted interventions, such as assessing women's coping strategies and evaluating their cardiovascular health using a total risk factor approach, are recommended to prevent or reduce the deleterious effects of violence on this large, vulnerable group of women.

Individual and community-level risk factors of women's acceptance of intimate partner violence in Ethiopia: multilevel analysis of 2011 Ethiopian Demographic Health Survey

BACKGROUND

The prevalence of Intimate partner violence (IPV) is higher in societies with higher acceptance of norms that support IPV. In Ethiopia, the proportion of women's acceptance of IPV was 69%, posing a central challenge in preventing IPV. The main objective of this study was to assess the individual and community-level factors associated with women's acceptance of IPV.

METHODS

Two-level mixed-effects logistic regression was applied to the 2011 Ethiopia Demographic and Health Survey data. A total of 16,366 women nested in the 596 clusters were included in the analysis.

RESULTS

The acceptability of the IPV was estimated to be 69%. Among the individual-level factors: women's education with secondary and above (AOR = 0.38; 95% CI 0.29-0.52), partner's education secondary and above (AOR = 0.71; 95% CI 0.54-0.82), women aged 35-49 years (AOR = 0.67; 95% CI 0.54-0.82), fully empowered in household level decision making (AOR = 0.67; 95% CI0.54-0.81), literate (AOR = 0.76; 95% CI 0.62-0.92), and perceived existence of law that prevents IPV (AOR = 0.56; 95% CI 0.50-0.63) were significantly associated with women's acceptance of IPV. Similarly, rural residence (AOR = 1.93; 95% CI 1.53-2.43) and living in the State region (AOR = 2.37; 95% CI 1.81-3.10) were significantly associated with the women's acceptance of IPV among the community-level factors.

CONCLUSION

Both individual and community-level factors were significant risk factors for the acceptability of intimate partner violence. Women's education, women's age, women's empowerment, partner education level, perceived existence of the law, and literacy were among individual factors. State region and residence were among community-level risk factors significantly associated women's acceptance of IPV.

Tolerance of Violence against Women and the Risk of Psychosocial Distress in Humanitarian Settings in Northern Uganda

BACKGROUND

Violence against women (VAW) remains a public health concern, which can sometimes lead to mental or psychological stress among other negative consequences.

DATA AND METHODS

we fitted a binary logistic regression model on 657 respondents from host and refugee settings in three humanitarian districts (Adjumani, Obongi, and Lamwo) to examine the determinants of psychosocial stress.

RESULTS

experience of psychosocial distress is higher among refugees than host populations. Results indicate a higher proportion of respondents who ever experienced psychosocial stress in the 6 months preceding the survey among those who believed that a woman should tolerate violence (59% vs. 53%). Respondents who believed that a woman should tolerate violence had higher odds of experiencing psychosocial stress than their counterparts who believed a woman should not tolerate violence (OR = 6.86; 95%CI = 1.23-38.22). The likelihood to experience psychosocial stress was higher among females (OR = 6.94; 95%CI = 1.76-27.32), those with primary education (OR = 4.73; 95%CI = 1.24-18.00), and respondents with less than USD 2.7 as personal income one month before the survey (OR = 3.37; 95%CI = 1.32-8.62). Respondents who said that women should engage in income generation activities had higher odds to experience psychosocial stress (OR = 0.39; 95%CI = 0.17-0.89).

CONCLUSION

results suggest that income and positive attitudes toward female-led income generating activities act as protective measures against psychosocial distress. Given the associations between VAW and psychosocial distress, efforts aimed at prevention and response to VAW in humanitarian settings should integrate mental health and psychosocial support interventions.

Health Correlates of Abuse History and Moderating Effect of Parenting Stress for Mothers with Mental Disorders

Parenting stress is common and may lead to worsening health, particularly in the context of other risk factors such as mental disorders or a history of abuse. This study investigated how parenting-related stress impacts the effect of abuse experiences on health among mothers with mental health disorders. Survey data was analyzed from 172 predominantly Hispanic mothers receiving outpatient behavioral health services. Most (80.2%) mothers had experienced abuse. Those reporting childhood abuse had 3.82 greater odds of experiencing abuse in adulthood. Findings demonstrated worse health outcomes among those experiencing abuse in both childhood and adulthood and those with a greater number of abuse experiences. Caregiving load intensified the relationship between abuse and anxiety and sleep disturbance. Parenting self-agency intensified the relationship between abuse and cigarette use. These findings have important implications for mental health nursing practice by identifying parenting-stress as an important target for interventions to improve health among women with histories of abuse and mental health disorders.

The association between exposure to domestic abuse in women and the development of syndromes indicating central nervous system sensitization: A retrospective cohort study using UK primary care records

BACKGROUND

Domestic abuse is a global public health issue. The association between the development of central sensitivity syndromes (CSS) and previous exposure to domestic abuse has been poorly understood particularly within European populations.

METHODS

A retrospective cohort study using the 'The Health Improvement Network,' (UK primary care medical records) between 1st January 1995-31st December 2018. 22,604 adult women exposed to domestic abuse were age matched to 44,671 unexposed women. The average age at cohort entry was 36 years and the median follow-up was 2.5 years. The outcomes of interest were the development of a variety of syndromes which demonstrate central nervous system sensitization. Fibromyalgia, chronic fatigue syndrome and temporomandibular joint disorder outcomes have been reported previously. Outcomes were adjusted for the presence of mental ill health.

RESULTS

During the study period, women exposed to domestic abuse experienced an increased risk of developing chronic lower back pain (adjusted incidence rate ratio [aIRR] 2.28; 95% CI 1.85-2.80), chronic headaches (aIRR 3.15; 95% CI 1.07-9.23), irritable bowel syndrome (aIRR 1.41; 95% CI 1.25-1.60) and restless legs syndrome (aIRR 1.89; 95% CI 1.44-2.48). However, no positive association was seen with the development of interstitial cystitis (aIRR 0.52; 95% CI 0.14-1.93), vulvodynia (aIRR 0.42; 95% CI 0.14-1.25) and myofascial pain syndrome (aIRR 1.01; 95% CI 0.28-3.61).

CONCLUSION

This study demonstrates the need to consider a past history of domestic abuse in patients presenting with CSS; and also consider preventative approaches in mitigating the risk of developing CSS following exposure to domestic abuse.

SIGNIFICANCE

Domestic abuse is a global public health issue, with a poorly understood relationship with the development of complex pain syndromes. Using a large UK primary care database, we were able to conduct the first global cohort study to explore this further. We found a strong pain morbidity burden associated with domestic abuse, suggesting the need for urgent public health intervention to not only prevent domestic abuse but also the associated negative pain consequences.

Sexual Assault and Carotid Plaque Among Midlife Women

Background Sexual assault is a risk factor for poor mental health, yet its relationship to cardiovascular disease risk is not understood. We tested whether women with a sexual assault history had greater carotid atherosclerosis levels and progression over midlife. Methods and Results A total of 169 non-smoking, cardiovascular disease-free women aged 40 to 60 years were assessed twice over 5 years. At each point, women completed questionnaires, physical measures, phlebotomy, and carotid ultrasounds. Associations between sexual assault and carotid plaque level (score 0, 1, ≥2) and progression (score change) were assessed in multinomial logistic and linear regression models, adjusted for age, race/ethnicity, education, body mass index, blood pressure, lipids, insulin resistance, and additionally depression/post-traumatic stress symptoms; 28% of the women reported a sexual assault history. Relative to non-exposed women, women with a sexual assault history had an over 4-fold odds of a plaque score of ≥2 at baseline (≥2, odds ratio [OR] [95% CI]=4.35 [1.48-12.79], P=0.008; 1, OR [95% CI]=0.49 [0.12-1.97], P=0.32, versus no plaque; multivariable); and an over 3-fold odds of plaque ≥2 at follow-up (≥2, OR [95% CI]=3.65 [1.40-9.51], P=0.008; 1, OR [95% CI]=1.52 [0.46-4.99], P=0.49, versus no plaque; multivariable). Women with a sexual assault history also had an over 3-folds greater odds of a plaque score progression of ≥2 (OR [95% CI]=3.48[1.11-10.93], P=0.033, multivariable). Neither depression nor post-traumatic symptoms were related to plaque. Conclusions Sexual assault is associated with greater carotid atherosclerosis level and progression over midlife. Associations were not explained by standard cardiovascular disease risk factors. Future work should consider whether sexual assault prevention reduces women's cardiovascular disease risk.

Adolescent Perceptions of Dating Violence: A Qualitative Study

Scholars have identified dating violence as a public health issue among adolescents. Yet, minimal research has detailed adolescents' perceptions of dating violence, specifically gender differences in perceptions. Research suggests that in order for dating violence prevention and intervention to be effective, services need to be delivered in a manner that is understood by adolescents. Therefore, this study used a qualitative phenomenology study to investigate adolescents' perceptions of dating violence, including gender differences in adolescents' perceptions. Thirty adolescents between the ages of 14 and 19 from a Midwest public high school participated in focus groups. Focus group participants were asked semistructured interview questions regarding the definition of dating violence, risk and protective factors for dating violence, support for victims and perpetrators, and prevention efforts. Data were analyzed using qualitative content analysis methods, and common themes were identified. Adolescents' language revealed gender differences in perceptions toward dating violence. Males perceive dating violence through action, perpetration, and physical consequences. Females discuss dating violence by relating to the victim and the victim's emotions. Although gender differences existed in participants' perceptions, both males and females explained that dating violence is more often perpetrated by females, despite the view from society that males are more likely to perpetrate dating violence. Findings suggest that schools, practitioners, and policy makers are not meeting the needs of adolescents in regard to dating violence prevention and intervention. Prevention and intervention efforts could be improved by delivering education and services using language that adolescents find relevant. Findings also suggest that adolescents may benefit from prevention and intervention with gender specific components.

Developing an SMS text message intervention on sexual and reproductive health with adolescents and youth in Peru

Background

Improved access to sexual and reproductive health (SRH) services and information is essential for supporting adolescents and youth in making informed decisions and optimizing each young person’s outcomes related to their SRH, health and well-being and countries’ current and future social and economic development. Mobile phones offer opportunities for young people to privately access SRH content and to be linked to SRH services. The objective of this study was to develop the content for an SMS (short message service or “text message”) platform jointly with adolescents and youth in three regions in Peru (Lima, Ayacucho and Loreto) as part of the ARMADILLO (Adolescent/Youth Reproductive Mobile Access and Delivery Initiative for Love and Life Outcomes) Study.

Methods

Content development was done in three stages. During Stage 1, we held community consultations with 13–17 year old adolescents, 18–24 year old youth and professionals who work with young people through the education and health sectors (“adult advisers”) to identify and rate SRH topics of interest through group free- and guided-brainstorming activities and an individual written sharing activity. During Stage 2, the team developed the preliminary domains, sub-domains and content for the SMS platform. During Stage 3, we held focus groups with adolescents to validate the SMS content, including both individual scoring of and group feedback for each SMS. Group feedback asked about their general impressions and understanding and their thoughts about the language and usefulness of the SMS.

Results

A total of 172 adolescents and youth ages 13–24 and 20 adult advisers participated. Adolescents and youth brainstormed and rated SRH topics and sub-topics that led to the initial structure for the SMS platform, with 9 domains, 25 sub-domains and 146 draft SMS. Adolescents provided high scores for the SMS, with all sub-domains receiving average scores of 3.0 or higher (out of 4.0) for the SMS included. Adolescents also provided suggestions to optimize content, including improvements to unclear messages, resulting in SMS with adolescent-friendly content in simple, straightforward language. This process also revealed that adolescents lacked knowledge and had misconceptions related to contraceptive methods.

Conclusion

This study details the systematic process used to develop relevant and accessible SRH information through a participatory approach. We document critical information about what young people know and how they think, enabling us to understand their perspective and literally speak their language. Results also provide future directions for programmatic, research and policy efforts with young people, in particular around gender norms, interpersonal violence, and access to SRH information and services, in similar settings.

The Interaction of Dopamine Genes and Financial Stressors to Predict Adulthood Intimate Partner Violence Perpetration

Three dopamine genes (DAT1, DRD2, and DRD4) have been associated with interpersonal delinquency, aggression, and violence when individuals experience adverse environmental exposures. Guided by the catalyst model of aggression, risk alleles identified in previous studies were hypothesized to be associated with intimate partner violence (IPV) perpetration in the presence of financial stressors, a possible environmental trigger. This hypothesis was tested using weighted, clustered logistic regression with data from the National Longitudinal Study of Adolescent to Adult Health. The direct effects DAT1, DRD2, and DRD4 on IPV perpetration, and the interaction of DAT1, DRD2, and DRD4 and financial stressors on IPV perpetration were assessed. Due to cell size, only White men and women were included in this analysis. Increasing number of financial stressors was associated with increased odds of IPV perpetration, regardless of DAT1, DRD2, and DRD4 alleles. As predicted, increasing number of financial stressors was more strongly associated with IPV perpetration among individuals with high-risk DAT1 alleles, than individuals with low-risk alleles. However, this relationship was inverted for DRD2. Although there was still a significant interaction between DRD2 and financial stressors, individuals with low-risk alleles had higher odds of IPV perpetration in the presence of financial stressors. A similar, nonsignificant relationship was found for DRD4. These findings indicate that these genes may interact differently with environmental exposures and types of violent behavior. In addition, the findings may, if replicated, suggest dopamine plays a different role in IPV perpetration compared with other forms of aggression and violence.

Analysing training in gender-based violence for undergraduate nursing students in Spain: A mixed-methods study

BACKGROUND

Health-care professionals, and nurses especially among them, play an essential role in the health sector's response to gender-based violence. To be able to successfully address this major public health issue they need specific training in the topic.

OBJECTIVE

To analyse training on gender-based violence that nursing students receive at universities in Spain.

DESIGN

Mixed-methods approach.

SETTING

Spain.

METHODS

Systematic review of public documents followed by in-depth interviews with university lecturers.

RESULTS

Eighty per cent (92/115) of nursing training programmes included content regarding gender-based violence. There was great variability in the topics included in the training. Health consequences due to gender-based violence exposure and the role of the health sector in addressing these health consequences were the most frequently included topics. Ethical issues and legislation were the least frequent ones, as these were only dealt with in one and 18 training programmes, respectively. In the qualitative analysis of the interviews, two categories were identified: 'Supportive legislation and supportive lecturers are essential for integrating gender-based violence training' and 'Approach to gender-based violence shapes the contents and the subject in which it is incorporated'. The first category refers to the main drivers for training integration, while the second category refers to how lecturers' perceptions influenced the way in which training was implemented.

CONCLUSIONS

As many as 80% of the nursing education programmes included specific training in gender-based violence, although with great variability in the contents among the universities. For this study's participants, enacted legislation, and lecturers interested in the topic and in decision-making positions were key drivers for this extensive implementation. The variability observed across universities might be explained by lecturers' different approaches to gender-based violence and the nursing profession.

The Level of Hopelessness and Psychological Distress among Abused Women in A Women's Shelter in Turkey

Hopelessness prevents abused women from participating in social life and increases the risk of suicide. The aim of this study was to determine the level of hopelessness and psychological distress among abused women admitted to shelter in a conservative country. The sample included 40 abused women. A questionnaire, Beck Hopelessness Scale and the General Health Questionnaire were used to collect data. Chi-square, the Pearson correlation analysis test, and variance analysis were performed. Half of the women experienced moderate and severe hopelessness. Higher levels of hopelessness were found to be associated with higher psychological distress. Women had problems with decision-making, concentrating on a job, felt unhappiness, and depression. The results of the study would be useful in designing training programs for nurses, social workers and counselors as well as policy makers who assist women facing domestic violence to provide better physiological and psychological care for sheltered women in conservative countries.

Association of Sexual Harassment and Sexual Assault With Midlife Women's Mental and Physical Health

IMPORTANCE

Sexual harassment and sexual assault are prevalent experiences among women. However, their association with health indices is less well understood.

OBJECTIVE

To investigate the association of history of sexual harassment and sexual assault with blood pressure, mood, anxiety, and sleep among midlife women.

DESIGN, SETTING, AND PARTICIPANTS

Nonsmoking women without cardiovascular disease were recruited from the community to undergo physical measurements (blood pressure, height, weight), medical history, and questionnaire psychosocial assessments (workplace sexual harassment, sexual assault, depression, anxiety, sleep).

EXPOSURES

Sexual harassment and sexual assault.

MAIN OUTCOMES AND MEASURES

Blood pressure, depressive symptoms, anxiety, and sleep characteristics.

RESULTS

Among the 304 nonsmoking women aged 40 to 60 years who participated in the study, all were free of clinical cardiovascular disease, and the mean (SD) age was 54.05 (3.99) years. A total of 19% reported a history of workplace sexual harassment (n = 58), and 22% reported a history of sexual assault (n = 67). Sexual harassment was related to significantly greater odds of stage 1 or 2 hypertension among women not taking antihypertensives (odds ratio [OR], 2.36; 95% CI, 1.10-5.06; P = .03) as well as clinically poor sleep (OR, 1.89; 95% CI, 1.05-3.42; P = .03), after adjusting for covariates. Sexual assault was associated with significantly greater odds of clinically elevated depressive symptoms (OR, 2.86; 95% CI, 1.42-5.77; multivariable P = .003), clinically relevant anxiety (OR, 2.26; 95% CI, 1.26-4.06; P = .006), and clinically poor sleep (OR, 2.15; 95% CI, 1.23-3.77; multivariable P = .007), after adjusting for covariates.

CONCLUSIONS AND RELEVANCE

Sexual harassment and sexual assault are prevalent experiences among midlife women. Sexual harassment was associated with higher blood pressure and poorer sleep. Sexual assault was associated with poorer mental health and sleep. Efforts to improve women's health should target sexual harassment and assault prevention.

Violência provocada pelo parceiro íntimo entre usuárias da Atenção Primária à Saúde: prevalência e fatores associados

RESUMO A violência provocada por parceiro íntimo é reconhecida mundialmente como um problema de saúde pública. Investigaram-se a prevalência e os fatores associados a esse tipo de violência em 470 mulheres usuárias da Atenção Primária à Saúde, em um município da Região Metropolitana de Belo Horizonte, Minas Gerais. Trata-se de estudo transversal, utilizando distribuições de frequência e teste Qui-quadrado de inúmeras variáveis e regressão logística final. Os resultados apontam que a violência contra a mulher é um fenômeno de alta frequência e pode estar associado à baixa escolaridade e ao consumo de álcool. A Atenção Primária à Saúde é um dos locais mais procurados pelas mulheres em situação de violência. Assim, é fundamental que os profissionais de saúde se envolvam no combate à violência contra a mulher.

[Domestic violence against women patients seen with chest pain in the emergency department]

OBJECTIVES

1) To determine the prevalence of intimate partner violence (IPV) in patients seen in the emergency department with chest pain. 2)To analyse the possible association between IPV and presence/control of vascular risk factors (VRF), psychic manifestations of stress, delay in requesting care, care received, and prognosis.

METHODS

The study was conducted on 125 women, and included a targeted interview, the Partner Violence Screen (PVS) test, a 30-day follow-up telephone interview, and a one-year follow-up clinical history review.

RESULTS

A total of 27 patients (21.6%) had a history of IPV, which was present in 4 of them. Women with a history of IPV were younger (53.7±15.0 vs. 64.0±18.4; P=.020), had more anxiety or a depressive syndrome (57.7% vs 13.5%; P<0.001), and consulted later (35.0±65.2days vs 7.9±25.0days; P=.047). Among older women (≥65years), there was more dyslipidaemia (100% vs 60.4%; P=.039) and worse blood pressure control (good control 20% vs 78.4%; P=.007) in those with a history of IPV. There were no differences in the diagnoses, tests, length of stay, admissions or prognosis among patients with or without a history of IPV, and there were no differences according to chronology of IPV.

CONCLUSIONS

The current or previous existence of IPV in patients who consult for chest pain in the emergency department is high. The existence of IPV is associated with a delay in consultation and greater anxiety, and may contribute to poor control of VRF, but does not affect the prognosis in the medium term.

Disparities in Intimate Partner Violence among Currently Married Women from Food Secure and Insecure Urban Households in South Ethiopia: A Community Based Comparative Cross-Sectional Study

Intimate partner violence (IPV) against women and food insecurity are an ever growing public health concerns in Ethiopia. However, the connection between the two is not yet well investigated. Therefore, this study compares IPV by household food security status and examines the association between IPV and food insecurity and among currently married women in childbearing age in Arba Minch town, South Ethiopia. A community based comparative cross-sectional study was conducted among 696 currently married women (15-49). A quantitative data was collected using a pretested and structured questionnaire on randomly selected women. Logistic regression was done using IBM SPSS version 20. Statistical significance was declared at p-value of less than 0.05 and odds ratio with its 95% confidence interval was used to show the degree of association. Lifetime and current IPV were 62.4% and 50%, respectively. Sixty-three (23.6%) and 285 (66.4%) women who experienced current IPV were from food secured and insecure households, respectively (P-value<0.001). The odds of experiencing current IPV were higher among women from food insecure households (AOR=6.59,95% CI(4.54,9.57)) and who were in the age range of 30-39 (AOR=2.16, 95% CI(1.34,3.56)) and it was lower among women with 10 and more years age difference with their husband (AOR=0.52, 95% CI (0.31,0.88)) and with high decision-making power (AOR=0.61, 95% CI (0.38.0.96)) than their reference groups. The prevalence of current IPV was significantly higher among women from food insecure households as compared to their counterparts. The odds of experiencing current IPV were higher among women from food insecure households. Policy makers and programme planners should consider improving urban women's household food security status in order to improve gender inequality and empower women. Multisectorial effort is needed to improve women education and other behavioral factors.

Development of an Innovative Treatment Paradigm for Intimate Partner Violence Victims With Depression and Pain Using Community-Based Participatory Research

Intimate partner violence (IPV) is a public health issue with complex physical health, mental health and social consequences that can exacerbate survivors' barriers to health care engagement and support. Furthermore, health care professionals are often unaware of or feel ill-equipped to address survivors' complex needs. Depression and chronic pain are particularly prevalent co-occurring problems for survivors and can impede engagement and outcomes in traditional health care. This study's purpose was to understand what interventions might be more responsive to survivors' myriad needs, particularlly those with depression and pain. Survivors were involved with the design, execution, analysis, and interpretation of results, based on community-based participatory research principles. Intervention development happened in two phases: the first consisted of focus groups with survivors to inform the intervention and the second included intervention design, informed by a community advisory board (CAB). Thirty-one survivors participated in Phase 1, and they reported preferring a range of support including formal help-seeking, informal coping strategies, and spirituality. In Phase 2, the CAB (comprised of survivors, health care professionals, and researchers) identified three distinct aspects of a comprehensive IPV intervention: (a) education regarding both the complex health issues and available local resources; (b) an integrated consultation service for providers to seek recommendations for responding to the full spectrum of survivors' needs; and (c) a trauma-informed, accessible clinic. Academic medical centers could not have designed this intervention in isolation; survivors and providers played an integral part of this process, and continue to inform our current work.

Health-Sector Responses to Intimate Partner Violence: Fitting the Response Into the Biomedical Health System or Adapting the System to Meet the Response?

This study aims to analyze how middle-level health systems' managers understand the integration of a health care response to intimate partner violence (IPV) within the Spanish health system. Data were obtained through 26 individual interviews with professionals in charge of coordinating the health care response to IPV within the 17 regional health systems in Spain. The transcripts were analyzed following grounded theory in accordance with the constructivist approach described by Charmaz. Three categories emerged, showing the efforts and challenges to integrate a health care response to IPV within the Spanish health system: "IPV is a complex issue that generates activism and/or resistance," "The mandate to integrate a health sector response to IPV: a priority not always prioritized," and "The Spanish health system: respectful with professionals' autonomy and firmly biomedical." The core category, "Developing diverse responses to IPV integration," crosscut the three categories and encompassed the range of different responses that emerge when a strong mandate to integrate a health care response to IPV is enacted. Such responses ranged from refraining to deal with the issue to offering a women-centered response. Attempting to integrate a response to nonbiomedical health problems as IPV into health systems that remain strongly biomedicalized is challenging and strongly dependent both on the motivation of professionals and on organizational factors. Implementing and sustaining changes in the structure and culture of the health care system are needed if a health care response to IPV that fulfills the World Health Organization guidelines is to be ensured.

Screening, management, and treatment of intimate partner violence among women in low-resource settings

The prevention of intimate partner violence continues to be a high priority for health practitioners and researchers around the world. Screening practices and intervention efforts utilized within high- and/or middle-income areas may not translate effectively to low-resource areas due to differences in financial, social, and physical context. However, little is known about the evidence-base of intervention efforts in such areas. Using the Arksey and O'Malley framework for scoping reviews, the purpose of this review was to synthesize what is known about intimate partner violence screening, management, and treatment in low-resource areas. A total of 31 programs reported across 34 articles were included in this scoping review. The programs incorporated a range of intervention activities, including group-based education and skill-development combined with microfinance to screening and referral to community resources. Slightly less than half of the studies (n = 14) were randomized controlled trials or clustered randomized controlled trials. Many barriers were common across the programs, including limited financial support, lack of community support, and lack of coordination across programs. Despite considerable barriers related to the limited available resources, the literature base had many strengths, such as strong evaluation methodologies, inclusion of a theoretical or conceptual framework to guide the intervention, and community engagement before and during the intervention implementation. However, insufficient statistical power and barriers related to cultural differences or inadequate cultural sensitivity were also common. With a variety of barriers to program implementation noted within the articles, it is important for researchers and practitioners to consider the geographic, social, cultural, and economic contexts when implementing intimate partner violence programs in low-resource areas. Given the significant differences in context across low-resource areas, additional research to establish effective protocols for tailoring and implementing evidence-based programs using a community-engaged framework would be beneficial to future research and practice.

Non-partner sexual violence against women in Spain: lifetime prevalence, perpetrators and consequences on mental health

Background

Research on sexual violence by non-partners based on representative samples is scarce. The objectives of the study were (i) to analyse the prevalence of different forms of non-partner sexual violence in Spain and their perpetrators, (ii) to analyse the consequences of non-partner sexual violence on mental health and (iii) to estimate the percentage of rapes that are reported to the police.

Methods

Data from the 2015 Spanish Survey on Violence against Women, a nationally representative sample of 10 171 women, were used. Three mutually exclusive categories of non-partner sexual violence were created to measure the effects of violence on health. Logistic regression models were fitted.

Results

The lifetime prevalence of non-partner sexual violence was 7.2%. All the categories of non-partner sexual violence were strongly associated with the different health outcomes. Rape increased the likelihood of reporting anxiety [odds ratio, OR: 3.77 (2.65-5.37)], sadness because of feelings of worthlessness [OR: 3.31 (2.32-4.73)] and the desire to cry without reason [OR: 3.46 (2.45-4.89)] more than 3-fold. The relationship of the victim with the perpetrator varied by the type of sexual victimization. Less than 6% of rapes were reported to the police in 2014.

Conclusions

All forms of non-partner sexual violence, from unwanted sexual touching to rape, can lead to a multitude of mental health consequences. A public health approach to addressing this violence is needed.

Professionals' perception of intimate partner violence in young people: a qualitative study in northern Spain

BACKGROUND

Intimate partner violence (IPV) is a public health problem with devastating effects on young women's health. These negative effects increase when the exposure to IPV lasts for a long time and exposure at an early age increases the risk of adult IPV. Despite efforts made in the last few decades, data show little progress has been made towards its reduction. Thus, the aim of the study reported here is to explore professionals' perceptions regarding intimate partner violence (IPV) among young people, focusing on the characteristics of the phenomenon and their perceptions about existing programmes and campaigns aimed at addressing it.

METHODS

Twelve professionals from education, health and municipal social services were interviewed. All but one of the interviews were recorded and transcribed verbatim. Data were analysed according to the methodology of inductive thematic analysis, with the support of Atlas.ti software. The transcripts were read several times and coded line by line. Afterwards, codes were grouped into themes. The developed themes were refined into two phases with the participation of all the authors.

RESULTS

From the analysis, the following three themes were identified: "A false sense of gender equity", "IPV among young people: subtle, daily and normalized", and "Mass media campaigns do not fit young people's needs". According to the participants, psychological abuse in the form of controlling behaviour by their partners is the most common type of IPV young women are exposed to, although exposure to other types of IPV was also acknowledged. This violence was described as something subtle, daily and normalized and, consequently, not something that is easy to recognize for the girls that are exposed to it, nor for adults working with young people.

CONCLUSIONS

The study participants showed good knowledge of the characteristics IPV has among young people. This knowledge was reflected in locally implemented IPV prevention projects, which they considered successful in addressing young people's needs. However, these interventions lacked formal evaluation, political support and continuation. The study participants did not believe that nationwide mass media campaigns realistically reflected the specific characteristics of IPV among young people. Thus, participants perceived these campaigns to be ineffective.

Viewing Gendered Violence in Guatemala Through Photovoice

This research examined rural and urban women’s experiences of gender-based violence in Chimaltenango, Guatemala. Photovoice methodology was used to describe and analyze local realities and vulnerabilities, and ethnographic techniques added cultural and contextual factors. While the initial focus was on intimate partner violence, results showed that violence for women exists from childhood to senior years. Participants noted gaps in services and participated in a public strategy workshop to address these. Challenges and opportunities are presented around the enduring and complex global crisis of gendered violence. Photovoice is a powerful method for organizations to better understand and respond to local issues.

Pattern of oral-maxillofacial trauma from violence against women and its associated factors

BACKGROUND/AIM

Violence against women is a global public health problem. The aim of this study was to characterize the profile of women victims of violence and identify factors associated with maxillofacial injuries.

MATERIAL AND METHODS

A cross-sectional study was performed based on an evaluation of 884 medico-legal and social records of women victims of physical aggression treated at the Center of Forensic Medicine and Dentistry in Brazil. The variables investigated were related to the sociodemographic characteristics of victims, circumstances of aggressions, and patterns of trauma. Descriptive and multivariate statistics using decision tree analysis by the Chi-squared automatic interaction detector (CHAID) algorithm, as well as univariate and multivariate Poisson regression analyses were performed.

RESULTS

The occurrence of maxillofacial trauma was 46.4%. The mean age of victims was 29.38 (SD=12.55 years). Based on decision tree, the profile of violence against women can be explained by the aggressor's gender (P<.001) and sociodemographic characteristics of victims, such as marital status (P=.001), place of residence (P=.019), and educational level (P=.014). Based on the final Poisson regression model, women living in suburban areas were more likely to suffer maxillofacial trauma (PR=1.752; CI 95%=1.153-2.662; P=.009) compared to those living in rural areas. Moreover, aggression using a weapon resulted in a lower occurrence of maxillofacial trauma (PR=0.476; CI 95%=0.284-0.799; P=.005) compared to cases of aggression using physical force.

CONCLUSIONS

The prevalence of oral-maxillofacial trauma was high, and the main associated factors were place of residence and mechanism of aggression.

Intimate partner violence is associated with increased maternal hair cortisol in mother-child dyads

BACKGROUND

The chronic consequences of intimate partner violence (IPV) on HPA activation are a topic of debate. The current study investigated hair cortisol concentrations in female victims of IPV and their children.

METHODS

A total of 52 mother-child dyads were divided into two groups depending on exposure to IPV: IPV group (n=27 dyads) and control group (n=25 dyads). Hair cortisol concentration was measured in 1-cm-long hair strands, representing 30days of exposure before assessment. PTSD and depression symptoms were assessed in the mother and child.

RESULTS

Women reporting IPV presented with higher hair cortisol levels, depression and PTSD symptoms severity in comparison to control women. Children who witnessed IPV reported more severe PTSD symptoms, but depressive symptoms and hair cortisol were not statistically different than those in control children. Correlation analyses revealed a positive association between the number of injury events and the level of hair cortisol in children. No associations between the hair cortisol levels in mothers and those in their children were found.

CONCLUSION

Higher hair cortisol levels detected in women exposed to IPV reflected long-lasting changes in HPA axis functioning associated with chronic stress exposure. Children whose parents recurrently engage in violent conflicts with intimate partners may often feel threatened and consequently reporting more PTSD-related symptoms. Given that experiencing and witnessing violence during childhood and adolescence are predictive of intimate partner violence in adulthood, the need of early interventions is crucial.

History of violence and subjective health of mother and child

OBJECTIVE

To study the self-reported prevalence of experienced violence among a cohort of women about two years after giving birth, their health during pregnancy, pregnancy outcomes and their experience of their child's health.

SETTING AND SUBJECTS

In 2011, a total of 657 women participated in phase III of the Childbirth and Health Cohort Study in Icelandic Primary Health Care, 18 to 24 months after delivery. The women had previously participated in phase I around pregnancy week 16 and phase II 5-6 months after delivery. Data were collected by postal questionnaires.

MAIN OUTCOME MEASURES

Women's reported history of experienced violence, sociodemographic and obstetric background, self-perceived health, the use of medications and their child's perceived health.

RESULTS

In phase III, 16% of women reported experiencing violence. These women felt less support from their current partner (p < 0.001), compared to those who did not report violence. Their pregnancies were more frequently unplanned (p < 0.001), deliveries more often by caesarean section (p < 0.05), and their self-perceived health was worse (p < 0.001). They reported more mental and somatic health complaints, and their use of antidepressant drugs was higher (p < 0.001). Furthermore, women with a history of violence considered their child's general health as worse (p = 0.008).

CONCLUSIONS

Our study confirms that a history of violence is common among women. A history of violence is associated with various maternal health problems during and after pregnancy, a higher rate of caesarean sections and maternal reports of health problems in their child 18-24 months after birth. KEY POINTS   Violence is a major concern worldwide. Understanding the impact of violence on human health and developing effective preventive measures are important elements of any public health agenda.   • The reported prevalence of experiencing violence was 16% among women attending antenatal care in the primary health care setting in Iceland.   • Women with a history of violence reported worse health in general during pregnancy and delivered more often by caesarean section, compared to women with no such history.   • Mothers with a history of violence also evaluated the general health of their child as worse than women with no such history.   • The findings of this study support the importance of recognizing and addressing experienced violence among women in primary care.

The Consequences of Intimate Partner Violence on Health: A Further Disaggregation of Psychological Violence-Evidence From Spain

Using a nationally representative sample of 10,171 women, this study examines the association between current and previous intimate partner violence and current health status. Current physical or sexual violence was associated with the highest likelihood of reporting health outcomes, followed by current emotional or economic abuse. Current controlling behavior increased the odds of reporting poor health whereas previous controlling behavior has less effect on current health. Controlling behavior alone often is the first expression of mistreatment. If health professionals could identify violence at this early stage, long-term effects on women's health could be minimized. The implications for health of the cumulative effects of violence and of its timing are discussed.

Dating violence and physical health: A longitudinal lens on the significance of relationship dynamics and anti-social lifestyle characteristics

BACKGROUND

Scholars have documented the significant physical health consequences of intimate partner violence. Yet, because existing research draws primarily on clinical samples of adult women, it is unclear whether exposure to dating violence is related to health detriments among young men and women. Furthermore, data limitations largely have precluded consideration of the mechanisms underlying these previously observed associations.

AIMS

We sought to examine the direct association between dating violence and self-rated physical health during adolescence and across the transition to adulthood. We also directed attention to potential mediating and confounding factors, including negative relationship dynamics, anti-social lifestyle characteristics and physical health correlates.

METHODS

Drawing on five waves of data from the Toledo Adolescent Relationships Study (n = 3746 person-periods), we used growth curve analyses to examine these associations among a sample of young men and women in dating relationships.

RESULTS

Longitudinal analyses revealed that dating violence was associated with declines in self-rated physical health across the period from adolescence to young adulthood. This effect, however, was attenuated with the inclusion of negative relationship dynamics.

CONCLUSIONS

Findings suggest the need to further examine the physical health consequences of dating violence, with a particular focus on the relationship context and other potential confounding forces. Copyright © 2016 John Wiley & Sons, Ltd.