Matters of the Heart and Mind: Interpersonal Violence and Cardiovascular Disease in Women

Decoding 2.3 million ECGs: interpretable deep learning for advancing cardiovascular diagnosis and mortality risk stratification

Aims

Electrocardiogram (ECG) is widely considered the primary test for evaluating cardiovascular diseases. However, the use of artificial intelligence (AI) to advance these medical practices and learn new clinical insights from ECGs remains largely unexplored. We hypothesize that AI models with a specific design can provide fine-grained interpretation of ECGs to advance cardiovascular diagnosis, stratify mortality risks, and identify new clinically useful information.

Methods and results

Utilizing a data set of 2 322 513 ECGs collected from 1 558 772 patients with 7 years follow-up, we developed a deep-learning model with state-of-the-art granularity for the interpretable diagnosis of cardiac abnormalities, gender identification, and hypertension screening solely from ECGs, which are then used to stratify the risk of mortality. The model achieved the area under the receiver operating characteristic curve (AUC) scores of 0.998 (95% confidence interval (CI), 0.995-0.999), 0.964 (95% CI, 0.963-0.965), and 0.839 (95% CI, 0.837-0.841) for the three diagnostic tasks separately. Using ECG-predicted results, we find high risks of mortality for subjects with sinus tachycardia (adjusted hazard ratio (HR) of 2.24, 1.96-2.57), and atrial fibrillation (adjusted HR of 2.22, 1.99-2.48). We further use salient morphologies produced by the deep-learning model to identify key ECG leads that achieved similar performance for the three diagnoses, and we find that the V1 ECG lead is important for hypertension screening and mortality risk stratification of hypertensive cohorts, with an AUC of 0.816 (0.814-0.818) and a univariate HR of 1.70 (1.61-1.79) for the two tasks separately.

Conclusion

Using ECGs alone, our developed model showed cardiologist-level accuracy in interpretable cardiac diagnosis and the advancement in mortality risk stratification. In addition, it demonstrated the potential to facilitate clinical knowledge discovery for gender and hypertension detection which are not readily available.

The Impact of COVID-19 Pandemic on Intimate Partner Violence (IPV) Against Women

Intimate partner violence (IPV) is a global public health crisis associated with adverse physical, psychological, economic, and social consequences. Studies on the impact of COVID-19 on IPV against women are scarce. This study aimed to understand the impact of COVID-19 on IPV against women. Google Scholar, PubMed, and the Cochrane Library were searched using the MeSH terms intimate partner violence, COVID-19, and women. Exclusion criteria were male-partner, elder, and child abuse and studies that targeted specific groups such as cancer, HIV, and substance abuse. Two independent reviewers completed the title, abstract screening, and review of selected articles. Thirteen out of 647 articles met the inclusion criteria. IPV against women increased in nine countries (Spain, United States, Nigeria, Ethiopia, Turkey, Peru, Bangladesh, Czech Republic, and the Democratic Republic of Congo); one country showed no change in gender-based violence among adolescent girls and young women (Kenya); and one study reported a decrease in IPV reporting by victims (United States). Policies made to mitigate the pandemic created unintended consequences that exacerbated risk factors for IPV against women. Lessons learned from COVID-19 must be used to develop policy-level support and response services to mitigate IPV against women amid a pandemic and other human crises.

Assessing the use of clinical guidelines against domestic violence in southern Sweden: A mixed-methods study

BACKGROUND AND AIM

Domestic violence is a prevalent public health issue. While clinical guidelines and care programs for its identification and handling have been formulated in all administrative regions of Sweden, their degree of implementation is largely unknown. This study aims to assess the implementation of one administrative region's care program, including how it is seen to align with and function in clinical practice, and any perceived barriers to or facilitators of its use.

METHODS

A survey was distributed to first-line managers for healthcare units with patient contact in the region (n = 807). The responses were analysed using descriptive statistics. Open responses were analysed thematically. Group interviews (n = 5) were held with caregivers (n = 15) working primarily with young patients and analysed thematically.

RESULTS

73% of the survey respondents reported previous awareness of the care program, and 27% reported knowledge of its content. The extent to which their staff knew about and followed the care program was assessed to be relatively low. The survey response rate was 19%. Among interview participants, knowledge of the care program was generally quite low. Survey responses and interview discussions pointed to the importance of developing routines, of collegial and managerial support and of training on domestic violence and the care program.

CONCLUSION

This study indicates that the knowledge and use of the regional care program is limited among healthcare staff, including among those working with young patients. This underscores the importance of information and training for furthering the implementation of clinical guidelines on domestic violence.

Risk of interpersonal violence during and after pregnancy among people with schizophrenia: a population-based cohort study

BACKGROUND

Schizophrenia is associated with increased risk of experiencing interpersonal violence. Little is known about risk specifically around the time of pregnancy.

METHODS

This population-based cohort study included all individuals (aged 15-49 yr) listed as female on their health cards who had a singleton birth in Ontario, Canada, between 2004 and 2018. We compared those with and without schizophrenia on their risk of an emergency department (ED) visit for interpersonal violence in pregnancy or within 1 year postpartum. We adjusted relative risks (RRs) for demographics, prepregnancy history of substance use disorder and history of interpersonal violence. In a subcohort analysis, we used linked clinical registry data to evaluate interpersonal violence screening and self-reported interpersonal violence during pregnancy.

RESULTS

We included 1 802 645 pregnant people, 4470 of whom had a diagnosis of schizophrenia. Overall, 137 (3.1%) of those with schizophrenia had a perinatal ED visit for interpersonal violence, compared with 7598 (0.4%) of those without schizophrenia, for an RR of 6.88 (95% confidence interval [CI] 5.66-8.37) and an adjusted RR of 3.44 (95% CI 2.86-4.15). Results were similar when calculated separately for the pregnancy (adjusted RR 3.47, 95% CI 2.68-4.51) period and the first year postpartum (adjusted RR 3.45, 95% CI 2.75-4.33). Pregnant people with schizophrenia were equally likely to be screened for interpersonal violence (74.3% v. 73.8%; adjusted RR 0.99, 95% CI 0.95-1.04), but more likely to self-report it (10.2% v. 2.4%; adjusted RR 3.38, 95% CI 2.61-4.38), compared with those without schizophrenia. Among patients who did not self-report interpersonal violence, schizophrenia was associated with an increased risk for a perinatal ED visit for interpersonal violence (4.0% v. 0.4%; adjusted RR 6.28, 95% CI 3.94-10.00).

INTERPRETATION

Pregnancy and postpartum are periods of higher risk for interpersonal violence among people with schizophrenia compared with those without schizophrenia. Pregnancy is a key period for implementing violence prevention strategies in this population.

The prevalence of violence and its association with mental health among the Iranian population in one year after the outbreak of COVID-19 disease

BACKGROUND

COVID-19 spread between and across nearly every country, with considerable negative health consequences. The current study aimed to determine the prevalence of violence and its association with mental health among Iranians older than 15 years in 2020.

METHODS

Data was collected through National Mental Health Survey on 24,584 Iranians older than 15 years in 2020. were analyzed to determine the prevalence of violence and its association with mental health. Multi-stage sampling method was used, and data on demographic characteristics and domestic-social violence and mental health (GHQ-28) were collected. Data analysis was administered using descriptive statistics and a chi-square test at a 95% level.

RESULTS

The mean age of participants was 44.18 ± 16.4 years. The overall prevalence of domestic and social violence was 11.4% and 5.5%, respectively. Verbal violence was the most common type; with 61.8% and 66.8% for domestic and social violence, respectively. A suspected case of mental disorder, female gender, being younger than 25 years, living apart together, unemployment, low education, and history of COVID-19 infection presented a significant association with domestic and social violence (p > 0.05).

CONCLUSION

In comparison to the previous study in 2015, the prevalence of violence has increased. Therefore, domestic and social violence are the social concerns of Iranian society, indicating the necessity of appropriate interventions, particularly for those suspected of mental disorders and young women with low education levels.

Association Between Men's Exposure to Intimate Partner Violence and Self-reported Health Outcomes in New Zealand

Importance

Health implications of intimate partner violence (IPV) against men is relatively underexplored, although substantial evidence has identified associations between IPV and long-term physical health problems for women. Given the gendered differences in IPV exposure patterns, exploration of men's IPV exposure and health outcomes using population-based samples is needed.

Objective

To assess the association between men's lifetime IPV exposure and self-reported health outcomes.

Design, Setting, and Participants

This cross-sectional study analyzed data from the 2019 New Zealand Family Violence Study, which was conducted across 3 regions of New Zealand. The representative sample included ever-partnered men aged 16 years or older. Data analysis was performed between May and September 2022.

Exposures

Lifetime IPV against men by types (physical [severe or any], sexual, psychological, controlling behaviors, and economic abuse), any IPV (at least 1 type), and number of IPV types experienced.

Main Outcomes and Measures

The 7 health outcomes were poor general health, recent pain or discomfort, recent use of pain medication, frequent use of pain medication, recent health care consultation, any diagnosed physical health condition, and any diagnosed mental health condition.

Results

The sample comprised 1355 ever-partnered men (mean [SD] age, 51.3 [16.9] years), who predominantly identified as heterosexual (96.9%; 95% CI, 95.7%-97.8%). Half of the sample (49.9%) reported experiencing any lifetime IPV, of whom 62.1% reported at least 2 types. Of all sociodemographic subgroups, unemployed men had the greatest prevalence of reporting exposure to any IPV (69.2%) and all IPV types. After adjustment for sociodemographic factors, men's exposure to any lifetime IPV was associated with an increased likelihood of reporting 4 of the 7 assessed health outcomes: poor general health (adjusted odds ratio [AOR], 1.78; 95% CI, 1.34-2.38), recent pain or discomfort (AOR, 1.65; 95% CI, 1.21-2.25), recent use of pain medication (AOR, 1.27; 95% CI, 1.00-1.62), and any diagnosed mental health condition (AOR, 1.66; 95% CI, 1.11-2.49). Specific IPV types were inconsistently associated with poor health outcomes. Any physical IPV exposure was associated with poor general health (AOR, 1.80; 95% CI, 1.33-2.43), recent pain or discomfort (AOR, 2.23; 95% CI, 1.64-3.04), and frequent use of pain medication (AOR, 1.69; 95% CI, 1.08-2.63), which appeared to be associated with exposure to severe physical IPV. Exposure to sexual IPV, controlling behaviors, and economic abuse was not associated with any assessed outcomes after sociodemographic adjustment. Experience of a higher number of IPV types did not show a clear stepwise association with number of health outcomes.

Conclusions and Relevance

Results of this study indicate that exposure to IPV can adversely affect men's health but is not consistently a factor in men's poor health at the population level. These findings do not warrant routine inquiry for IPV against men in clinical settings, although appropriate care is needed if IPV against men is identified.

Consequences of the Lockdown: Domestic Violence During the COVID-19 Pandemic

BACKGROUND

The global pandemic of the coronavirus disease 2019 (COVID-19) has presented many unique challenges to health systems. The hidden impact of COVID-19 and its associated lockdown have been an increased prevalence of domestic violence.

OBJECTIVE

To increase our understanding of the connection between COVID-19 containment measures, domestic violence, and mental health in Germany, we conducted an online self-assessment survey of 98 domestic violence victims and 276 controls. All participants answered questions concerning domestic violence, emotional regulation skills, limitations due to and acceptance of containment measures, and quality of their contact experiences.

RESULTS

There was no significant effect of "gender" x "domestic violence." Among victims of domestic violence, the number of women was considerably higher than the number of men. In addition, the factors "negative contact quality," "emotional regulation," and "resilience" differed significantly between the victims of domestic violence and the control group.

CONCLUSIONS

The COVID-19 outbreak and associated containment and quarantine measures resulted in a "hidden pandemic" of domestic violence for which prevention programs and early victim assistance through the expansion of digital technologies are urgently needed. Prospective studies should expand empirical data to focus on the long-term psychological effects of domestic violence and biomarkers that can serve as warning signs of stress-related disorders.

Adverse Childhood Experiences and Diabetes: Testing Violence and Distress Mediational Pathways in Family Medicine Patients

Type 2 diabetes mellitus (diabetes) is increasing in frequency and creating a significant burden on the United States healthcare system. Adverse childhood experiences (ACE) and interpersonal violence (IV) have been shown to have detrimental effects on mental and physical health. How ACE can influence IV as an adult and how this can influence the management of diabetes is not known. The purpose of the current study is to understand the relationship between violence and social determinants of health (SDoH), and its effect on patients with type 2 diabetes mellitus. A practiced-based research network (PBRN) of family medicine residency programs was utilized to collect cross-sectional data from seven family medicine residency program primary care clinics. In total, 581 participants with type 2 diabetes were recruited. A serial/parallel mediation model were analyzed. The majority of participants (58.3%) had a Hemoglobin A1c (HbA1c) that was not controlled. ACE was associated with an increase in Hurt-Insult-Threaten-Scream (HITS) scores, which in turn was positively associated with an increase in emotional burden, and finally, emotional burden decreased the likelihood that one's HbA1c was controlled (Effect = -.054, SE = .026 CI [-.115, -.013]). This indirect pathway remained significant even after controlling for several SDoH and gender. The impact of ACE persists into adulthood by altering behaviors that make adults more prone to experiencing family/partner violence. This in turn makes one more emotionally distressed about their diabetes, which influences how people manage their chronic condition. Family physicians should consider screening for both ACE and family/partner violence in those patients with poorly controlled diabetes.

Biology, Bias, or Both? The Contribution of Sex and Gender to the Disparity in Cardiovascular Outcomes Between Women and Men

Purpose of Review

Cardiovascular disease (CVD) is the leading cause of mortality and morbidity worldwide for both men and women. However, CVD is understudied, underdiagnosed, and undertreated in women. This bias has resulted in women being disproportionately affected by CVD when compared to men. The aim of this narrative review is to explore the contribution of sex and gender on CVD outcomes in men and women and offer recommendations for researchers and clinicians.

Recent Findings

Evidence demonstrates that there are sex differences (e.g., menopause and pregnancy complications) and gender differences (e.g., socialization of gender) that contribute to the inequality in risk, presentation, and treatment of CVD in women.

Summary

To start addressing the CVD issues that disproportionately impact women, it is essential that these sex and gender differences are addressed through educating health care professionals on gender bias; offering patient-centered care and programs tailored to women’s needs; and conducting inclusive health research.

Domestic violence and associated factors during COVID-19 epidemic: an online population-based study in Iran

Background

The novel coronavirus disease 2019 has severely affected communities around the world. Fear and stress of being infected, along with pressure caused by lockdown, prevention protocols, and the economic downturn, increased tension among people, which consequently led to the rise of domestic violence (DV). Therefore, this study was conducted to determine the rate of change in DV and its associated factors during the COVID-19 epidemic in Shiraz, Iran.

Methods

In this cross-sectional study, 653 individuals with the age of over 15 years from Shiraz were participated through snowball sampling and filled out an online questionnaire through the WhatsApp platform. A 51-item, self-administered and multidimensional (knowledge, attitude, and practice) questionnaire was designed and assessed 653 participants. The gathered data was analyzed using SPSS software (version 25), and variables with a p-value of less than 0.05 were considered statistically significant.

Results

In this study, 64.2% of the respondents were within the age range of 31–50 years, and 72.6% of the subjects were female. Furthermore, 73.8 and 73.0% of the individuals were married and educated for over 12 years, respectively. The DV increased by 37.5% during the quarantine period, compared to before the pandemic. The emotional type was the most common type of violence; the sexual type was the least frequent. Multivariate analysis indicated that infection with COVID-19, drug use, high level of co-living observation of anti-COVID prevention protocols, and lower level of physical activity during the quarantine period had a positive and significant association with the occurrence of DV.

Conclusion

Based on the obtained results, it is required to implement effective harm-reduction policies and measures in the community due to the increasing rate of DV during the COVID-19 epidemic.

The Domestic Violence during the COVID-19 Pandemic: Scoping Review

Introduction The Covid-19 pandemic had brought unexpected challenges in all sectors of life, from the social, economic to health sectors, particularly public health. One of the most worrying effects of Covid-19 is the increase in cases of domestic violence. Aim : This scoping review was to determine trends in domestic violence during the Covid-19 pandemic and strategies for handling it   Method The method used in this paper is the Scoping Review study. We searched for relevant articles on 4 databases (PubMed, ScienceDirect, ProQuest and EBSco), in English, published in 2019-2021. Of the 434 articles identified, there were 6 articles that met the inclusion criteria.   Result There were 6 themes we got related to domestic violence during the Covid-19 pandemic, namely: 1) The number of cases of domestic violence during the Covid-19 pandemic; 2) Risk factors for domestic violence; 3) Victims and perpetrators of domestic violence; 4) Types of domestic violence; 5) Impact of domestic violence; 6) Strategies for handling domestic violence during the Covid-19 pandemic.   Conclusion The Covid-19 pandemic had an impact on domestic violence cases, where the majority of victims were women and most of whom experienced recurrent domestic violence. The majority of the articles in this scoping review were quantitative research, we recommend that future research can be examined deeper into the understanding, experiences and needs of victims and perpetrators of domestic violence during the Covid-19 pandemic including the roles of cross-sectors and obstacles experienced in handling domestic violence in the future. the covid-19 pandemic. The results of this study are expected to provide input in making policies related to the prevention and reduction of domestic violence cases during the Covid-19 pandemic.  

Women's Mental Health in the Time of Covid-19 Pandemic

Even if the fatality rate has been twice higher for men than for women, the Covid-19 pandemic has affected women more than men, both as frontline workers and at home. The aim of our article was to analyze the differences observed in mental health and violence between men and women in the COVID outbreak. For this purpose, we have used all papers available in PubMed between January and July 2020 as well as data from non-governmental associations. We have thus successively analyzed the situation of pregnancy during the pandemic; the specific psychological and psychiatric risks faced by women both as patients and as workers in the health sector, the increased risk of violence against women at home and at workplace and, finally the risk run by children within their families. In conclusion, research on the subject of mental health issues during the Covid-19 pandemic is still scarce, especially in women. We hope that this pandemic will help to recognize the major role of women at home and at the workplace.

Interpersonal violence: Serious sequelae for heart disease in women

Experiencing various forms of violence in either childhood or adulthood has been associated with cardiovascular disease, both shortly after the event and during follow-up, particularly in women. The coronavirus disease 2019 pandemic has heightened the risk of domestic violence with serious sequelae for mental and cardiovascular health in women, possibly due to several contributing factors, ranging from lockdown, stay at home regulations, job losses, anxiety, and stress. Accordingly, it remains paramount to enforce proactive preventive strategies, at both the family and individual level, maintain a high level of attention to recognize all forms of violence or abuse, and guarantee a multidisciplinary team approach for victims of interpersonal or domestic violence in order to address physical, sexual, and emotional domains and offer a personalized care.

Domestic Violence and Mental Health During the COVID-19 Pandemic in Bangladesh

BACKGROUND

The COVID-19 lockdown, the advent of working from home, and other unprecedent events have resulted in multilayer and multidimensional impacts on our personal, social, and occupational lives. Mental health conditions are deteriorating, financial crises are increasing in prevalence, and the need to stay at home has resulted in the increased prevalence of domestic violence. In Bangladesh, where domestic violence is already prevalent, the lockdown period and stay-at-home orders could result in more opportunities and increased scope for perpetrators of domestic violence.

OBJECTIVE

In this study, we aimed to determine the prevalence and pattern of domestic violence during the initial COVID-19 lockdown period in Bangladesh and the perceptions of domestic violence survivors with regard to mental health care.

METHODS

We conducted this cross-sectional web-based study among the Bangladeshi population and used a semistructured self-reported questionnaire to understand the patterns of domestic violence and perceptions on mental health care from August to September 2020. The questionnaire was disseminated on different organizational websites and social media pages (ie, those of organizations that provide mental health and domestic violence services). Data were analyzed by using IBM SPSS (version 22.0; IBM Corporation).

RESULTS

We found that 36.8% (50/136) of respondents had faced domestic violence at some point in their lives; psychological abuse was the most common type of violence. However, the prevalence of the economical abuse domestic violence type increased after the COVID-19 lockdown was enforced. Although 96.3% (102/136) of the participants believed that domestic violence survivors need mental health support, only 25% (34/136) of the respondents had an idea about the mental health services that are available for domestic violence survivors in Bangladesh and how and where they could avail mental health services.

CONCLUSIONS

Domestic violence is one of the most well-known stressors that have direct impacts on physical and mental health. However, the burden of domestic violence is often underreported, and its impact on mental health is neglected in Bangladesh. The burden of this problem has increased during the COVID-19 crisis, and the cry for mental health support is obvious in the country. However, it is necessary to provide information about available support services; telepsychiatry can be good option for providing immediate mental health support in a convenient and cost-effective manner.

Sexist Myths Emergency Healthcare Professionals and Factors Associated with the Detection of Intimate Partner Violence in Women

This study analysed the capacity of emergency physicians and nurses working in the city of Granada (Spain) to respond to intimate partner violence (IPV) against women, and the mediating role of certain factors and opinions towards certain sexist myths in the detection of cases. This is a cross-sectional study employing the physician readiness to manage intimate partner violence survey (PREMIS) between October 2020 and January 2021, with 164 surveys analysed. Descriptive and analytical statistics were applied, designing three multivariate regression models by considering opinions about different sexist myths. Odds ratios and 95% confidence intervals (CIs) were considered for the detection of cases. In the past six months, 34.8% of professionals reported that they had identified some cases of IPV, particularly physicians (OR = 2.47, 95% CI = 1.14–5.16; OR = 2.65, 95% CI = 1.26–5.56). Those who did not express opinions towards sexist myths related to the understanding of the victim or the consideration of alcohol/drug abuse as the main causes of violence and showed a greater probability of detecting a case (NS) (OR = 1.26 and OR = 1.65, respectively). In order to confirm the indicia found, further research is required, although there tends to be a common opinion towards the certain sexual myth of emergency department professionals not having an influence on IPV against women.

Protection against Sexual Violence in the Colombian Legal Framework: Obstacles and Consequences for Women Victims

Sexual violence is a type of gender-based violence (GBV), as it is one of the different types of violence that is exerted against women. Sexual violence infringes fundamental human rights, and denies women’s dignity and self-determination, personal development, and well-being. Despite international treaties and a regulatory framework that legally protects Colombian women against sexual violence, it is necessary to know the effectiveness of this regulatory framework in Colombia. Therefore, the main objective of this research is to examine criminal legislation on crimes of sexual violence in Colombia with a dual purpose: first, to analyze procedural guarantees for women victims of sexual violence; second, to determine obstacles for victims of sexual violence in accordance with the legal framework. We used a legal interpretation method to perform an analysis and interpret the law. The results found that, although sexual violence is considered a type of crime, procedural guarantees are not effective as victims encounter serious obstacles with negative consequences, such as the violation of fundamental human rights.

Domestic Violence during the COVID-19 Pandemic in Portugal

The measures implemented to combat the COVID-19 pandemic led populations to confinement at home, with increased risk of domestic violence due to extended shared time between victims and offenders. Evidence on domestic violence in times of pandemic is lacking. This study examines the occurrence of domestic violence, associated factors and help seeking during the COVID-19 pandemic. An online survey was conducted in Portugal between April and October 2020 by NOVA National School of Public Health. The survey was disseminated through partner networks, media, and institutions working within the scope of violence. Data were collected on the experience of domestic violence, and help seeking during the pandemic. In a total of 1,062 respondents, 146 (13.7%) reported having suffered domestic violence during the pandemic, including psychological (13.0%, <i>n</i> = 138), sexual (1.0%, <i>n</i> = 11), and physical (0.9%, <i>n</i> = 10) abuse. Overall, the lower the age, the more the reported domestic violence. Also, a higher proportion of participants who perceived difficulties to make ends meet during the pandemic reported domestic violence. Differences between women and men and across educational levels on reported domestic violence were not statistically significant. Bivariate logistic analyses showed that, among women, reported domestic violence was more likely among those with up to secondary education compared to higher education. Most of the victims did not seek help (62.3%), the main reasons being considering it unnecessary, that help would not change anything, and feeling embarrassed about what had happened. Only 4.3% of the victims sought police help. The most common reasons for not coming forward to form a complaint were considering the abuse was not severe and believing the police would not do anything. Our findings indicate that domestic violence during the COVID-19 pandemic was experienced by both sexes and across different age groups. There is a need for investing in specific support systems for victims of domestic violence to be applied to pandemic contexts, especially targeting those in more vulnerable situations and potentially underserved.

Increased Risk of Death Triggered by Domestic Violence, Hunger, Suicide, Exhausted Health System during COVID-19 Pandemic: Why, How and Solutions

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, just like many other public health emergencies, is a well-established global health burden that has resulted in several changes in routines and lifestyles of people globally. The coronavirus disease (COVID-19) pandemic, caused by SARS-CoV-2, has directly or indirectly involved in the loss of lives of more than 3.24 million as of 6th May, 2021. The increasing threats posed by this pandemic were subsided by the swift and drastic measures put in place by different countries. As other causes of death before the emergence of COVID-19 still exist, the pandemic has further worsened their impact. The increased risks of COVID-19 deaths are not only due to the health burden it possesses, but also due to some other factors. These factors include domestic violence that becomes rampant, especially during lockdowns; hunger due to low economic development, unemployment, and loss of jobs; suicide due to depression; exhausted health system due to high level of COVID-19 cases and inability to contain it. As we move from the response phase into recovery, the pandemic's direct and broader impacts on individuals, households, and communities will influence the capacity to recover. An understanding of these impacts is therefore required to develop priorities to support recovery. This paper identifies other causes of death amidst the pandemic, such as domestic violence, hunger, suicide, and exhausted health system, and how to minimize their effects.

Interpersonal Violence during the COVID-19 Lockdown Period in Nepal: A Descriptive Cross-sectional Study

INTRODUCTION

The government issued a country-wide lockdown in Nepal as a measure to curb the spread of COVID-19 pandemic. This has resulted in various difficult experiences which includes financial loss, separation from loved ones, grief, uncertainty over disease status and loss of freedom. During these stressful situations, interpersonal violence is likely to be aggravated. To avoid the occurrence of adverse events such as impulsive acts, homicide, or suicide, it is important to identify high-risk individuals.

METHODS

This is a descriptive cross-sectional, questionnaire-based, online survey by convenience sampling. The prevalence of different types of interpersonal violence with socio-demographic factors, substance use, and overall mental wellbeing was assessed by using descriptive statistical tests.

RESULTS

Out of total 556 participants included in the analysis, 50.9% (283) were male and 48.7% (271) were female. There were 100 (18.0%) participants who reported being a victim of interpersonal violence and 101 (18.2%) participants who reported being a perpetrator during the lockdown. The victims of violence were more likely to be living with their spouse alone. The victims and perpetrators were also more likely to have increased alcohol and tobacco use. More number of victims and perpetrators had lower mental wellbeing scores on the WHO wellbeing index.

CONCLUSIONS

There was prevalence of interpersonal violence during the COVID-19 lockdown. In addition to the fear regarding pandemic, victims have to face domestic violence placing them at a double injustice. Identification of vulnerable groups and proper management of survivors must be prioritized given the unanimous consensus on the rise of interpersonal violence during periods of heightened stress.

COVID-19, Lockdown, and Intimate Partner Violence: Some Data from an Italian Service and Suggestions for Future Approaches

Intimate partner violence (IPV)-defined as physical, psychological, sexual, and/or economic violence typically experienced by women at home and perpetrated by their partners or expartners-is a pervasive form of violence that destroys women's feelings of love, trust, and self-esteem, with important negative consequences on physical and psychological health. Many reports from several countries have underlined a remarkable increase in the cases of IPV during the COVID-19 emergency. In this opinion article, we discussed the hypothesis that such an increase may be related to the restrictive measures enacted to contain the pandemic, including women's forced cohabitation with the abusive partner, as well as the exacerbation of partners' pre-existing psychological disorders during the lockdown. In addition, we retrospectively analyzed some data derived from our practice in a public Italian referral center for sexual and domestic violence (Service for Sexual and Domestic Violence [SVSeD]). These data interestingly revealed an opposite trend, that is, a decrease in the number of women who sought assistance since the beginning of the COVID-19 outbreak. Such a reduction should be interpreted as a negative consequence of the pandemic-related restrictive measures. Although necessary, these measures reduced women's possibilities of seeking help from antiviolence centers and/or emergency services. Owing to the COVID-19 outbreak, there is an urgent need for developing and implementing alternative treatment options for IPV victims (such as online and phone counseling and telemedicine), as well as training programs for health care professionals, especially those employed in emergency departments, to facilitate early detection of IPV.

Domestic violence and substance abuse during COVID19: A systematic review

INTRODUCTION

As COVID-19 develops around the world, numerous publications have described the psychiatric consequences of this pandemic. Although clinicians and healthcare systems are mainly focused on managing critically ill patients in an attempt to limit the number of casualties, psychiatric disease burden is increasing significantly. In this scenario, increased domestic violence and substance abuse have been recently reported.

OBJECTIVE

The objective of this study is to perform a systematic review of the literature regarding the consequences of severe acute respiratory syndrome-CoV-2 infection in terms of domestic violence and substance abuse, and compare incidences found.

MATERIALS AND METHODS

We conducted a literature search using the preferred reporting items for systematic reviews and meta-analyses guidelines. The keywords included "domestic violence," "substance abuse" AND "COVID-19," including multiple variants from December 2019 through June 2020. An extensive bibliographic search was carried out in different medical databases: Pubmed, EMBASE, LILACS, medRxiv, and bioRxiv. Titles and abstracts were reviewed according to the eligibility criteria. The risk of bias in the retrieved articles was assessed by the Joanna Briggs Institute's critical assessment instrument.

RESULTS

A total of 1505 papers were initially retrieved after consulting the selected databases. After browsing through titles and abstracts, 94 articles were initially included considering the predefined eligibility criteria. After a more detailed analysis, only six scientific articles remained in our selection. Of these, three were evaluating domestic violence against children, while the other three were about substance abuse.

CONCLUSION

There is not enough evidence to support the concept that COVID-19 has led to an increase in the rates of domestic violence and substance abuse. The initial decrease in violence reports might not translate into a real reduction in incidence but in accessibility. Apparently, there has been a slight increase in alcohol and tobacco abuse, especially by regular users, which also requires confirmatory studies. The inconsistency between expert opinon articles and the actual published data could be a result of the limited time since the beginnging of the crisis, the fact that psychitaric patients have been chronically exposed to stressful situatons, and a possible stimulated increase in demand for psychatric consultations.

Danger in danger: Interpersonal violence during COVID-19 quarantine

BACKGROUND

Intimate partner violence (IPV) is defined as physical or sexual violence, emotional abuse and stalking. It is typically experienced by women but can also be experienced by men. During quarantine due to the COVID-19, home risks to become a very dangerous place for victims of domestic violence.

METHOD

Very recent studies focusing on abusive situations during COVID emergence were identified in PubMed/Medline, Scopus, Embase.

RESULTS

During the COVID-19 outbreak people have encountered an invisible and dark enemy and an experience of impotence. Due to the feelings of frustration and agitation, aggression arises with possible transgenerational transmission of trauma and violence.

CONCLUSIONS

Especially during quarantine and COVID emergence around the world there is a need of programs aimed to prevent acts of domestic violence and to achieve accurate assessment of multiple domains of abuse (psychological, physical, sexual) provided by trained multidisciplinary staffs (including psychiatrists, psychologists, social and legal services).

What about heart and mind in the COVID-19 era?

From the time of Hippocratic medicine, heart-brain interactions have been recognized and contributed to both mental and physical health. Heart-brain interactions are complex and multifaceted and appear to be bidirectional. Exposure to chronic and daily stressors such as quarantine, or severe psychological trauma like a significant person in danger of life can affect the cardiovascular system and the emotional experience of the individual, leading to an increased risk of developing a cardiovascular disease or mental illness. Subjects with comorbidities between mental disorders and heart diseases are obviously more susceptible to be influenced by emotional burden due to the spread of COVID-19, with emotional responses characterized by fear, panic, anger, frustration. Psychological services and crisis interventions are needed at an early stage to reduce anxiety, depression and post-traumatic stress disorder in such a stressful period, with a special attention to special groups of patients, such as women, children, or the elderly.