When crises collide: how intimate partner violence and poverty intersect to shape women's mental health and coping?

"It's a Valuable Service but a Hard Place to Be:" Women's Views About Violence Against Women Shelters

This mixed-methods secondary analysis examined VAW shelter use by 662 Canadian women abused by partners (50.5% Indigenous, 43.4% White, and 6.1% visible minority). Women who had never resided in shelters (n = 242) had less Severe Combined and Total IPV on the Composite Abuse Scale and fewer PTSD symptoms. More nonresidents worked full time and had higher incomes and no children. The 420 women residents mentioned strengths (70.4%) such as supportive staff and safety, and concerns (29.6%) about unsupportive staff and the shelter rules or facility. Some Indigenous women reported racist attitudes by shelter staff and child apprehensions. Practice implications are presented.

A policy review on the visibility of migrant women exposed to, and at risk of gender-based violence: Considerations for inclusive and equitable policies and programs in Canada

Gender based violence (GBV) has had distinct and disproportionate impact on the health and wellbeing of migrant women in Canada. Currently, there is dearth of documented information concerning the inclusion of migrant women in GBV-related public policies in Canada. The present study examines the extent to which Canadian public policies reflect and address the needs of migrant women who have experienced GBV. We conducted a policy review of publicly available documents at federal and provincial (British Columbia and Ontario) levels. Migrant women's visibility in the Canadian policy landscape remains limited, as their unique needs are often grouped into broader categories such as 'newcomers, or visible minorities'. This approach fails to acknowledge their distinct lived experiences. Regardless of the federal and provincial efforts in developing policies targeted at GBV prevention, several significant policy gaps came to light. These include the absence of well-defined protective measures for migrant women in precarious employment as well as the hurdles posed by immigration restrictions that pose a significant challenge for those seeking to leave abusive relationships, particularly in cases of dependent migration status. The highlighted policy gaps have negative impact on migrant women's social functioning, including limiting access to services and opportunities, and this has adverse effects on their overall health and wellbeing. To ensure the effectiveness and significance of GBV policies, it is imperative that policymakers acknowledge and target the distinct vulnerabilities and needs of migrant women who experience GBV. The inclusion of an intersectional perspective in the formulation and implementation of policies is essential, as it facilitates the recognition of the distinct needs of migrant women. Failure to acknowledge these varying needs and the real-life experiences of this diverse group can jeopardize the comprehensive and successful implementation of GBV response policies, not only in Canada but also worldwide. Prioritizing this aspect is crucial.

Intimate Partner Violence Survivors' Perspectives on Coping With Family Court Processes

Although intimate partner violence (IPV)-exposed mothers report distress during family court proceedings, no known research examines what helps them cope. We analyzed qualitative responses from 214 IPV-exposed mothers to the question of who/what helped during family court. Participants described (a) receiving social support, (b) accessing tools and resources, (c) modifying actions, thoughts, and emotions to adapt to a system that is not trauma-informed, (d) being believed/validated, and (e) managing post-separation family life as helpful. Participants also reported (f) barriers to navigating family law proceedings; a few expressed nothing helped. Findings support a trauma-informed, network-oriented approach to supporting family court-involved survivor mothers.

Supporting Intimate Partner Violence Survivors and Their Children in Pediatric Healthcare Settings

Intimate partner violence (IPV) is a pervasive public health epidemic that influences child health and thriving. In this article, we discuss how pediatric healthcare providers and systems can create healing-centered spaces to support IPV survivors and their children. We review the use of universal education and resource provision to share information about IPV during all clinical encounters as a healing-centered alternative to screening. We also review how to support survivors who may share experiences of IPV, focused on validation, affirmation, and connection to resources. Clinicians are provided key action items to implement in their clinical settings.

Trauma-Informed Yoga: A Capacity Building and Wellness Strengthening Intervention for Female Survivors of Intimate Partner Violence and Affiliative Staff

This evaluation examines the impacts of Exhale to Inhale's trauma-informed yoga (TIY) on stress, somatic complaints, and self-efficacy among female survivors of intimate partner violence (IPV) and affiliated staff in community-based domestic violence agencies. A two-phase study design was employed, the first of which collected data from in-person group classes and the second from remotely taught classes due to COVID-19 safety restrictions. Collected over 3 years, 526 female survivors (n = 361) and staff (n = 165) from 66 domestic violence agencies completed surveys revealing improved stress, somatic complaints, and self-efficacy following a single TIY session. TIY serves as a capacity-building intervention that is suitable and adaptable for survivors of IPV and the staff at domestic violence agencies.

Determinants of depression and anxiety in homeless people: A population survey of homeless people in Hong Kong

BACKGROUND

There are growing concerns about the homeless and mental health issues globally. This study aims to examine the mental health situation of homelessness and the determinants of anxiety and depression of them in Hong Kong.

METHOD

The data from the largest territory-wide study of the homeless population in 2021 was analyzed. Descriptive statistics and logistic regressions were used to investigate the association between mental health and socioeconomic variables, including demographic background, economic indicators, COVID-19 worries, government measures, and respect by others. The symptoms of depression and anxiety were assessed using Patient Health Questionnaire (PHQ) and General Anxiety Disorder (GAD).

RESULTS

The results showed that being female, food insecurity, and chronic diseases were the risk factors for anxiety and depression. A high level of respect by others was the protective factor for depression (adjusted OR 0.37, 95% CI [0.23, 0.61]) and anxiety (adjusted OR 0.40, 95% CI [0.24, 0.68]), compared to a low level of respect in the multivariate model.

CONCLUSIONS

Providing medical outreach services, additional resources for social services, implementation of homeless-friendly policies, and a progressive supply of public and transitional housing would help enhance the well-being of the homeless population.

Intimate Partner Violence among women living in families with children under the poverty line and its association with common mental disorders during COVID-19 pandemics in Ceará, Brazil

BACKGROUND

Intimate partner violence (IPV) is a pervasive public health issue that affects millions of women worldwide. Women living below the poverty line experience higher rates of violence and fewer resources to escape or cope with the abuse, and the COVID-19 pandemic has significantly impacted women's economic well-being worldwide. We conducted a cross-sectional study in Ceará, Brazil, on women in families with children living below the poverty line at the peak of the second wave of COVID to assess the prevalence of IPV and its association with common mental disorders(CMD).

METHODS

The study population comprised families with children up to six years of age who participated in the cash transfer program "Mais Infância". The families selected to participate in this program must meet a poverty criterion: families must live in rural areas, in addition to a monthly per capita income of less than US$16.50 per month. We applied specific instruments to evaluate IPV and CMD. To access IPV, we used the Partner Violence Screen (PVS). The Self-Reporting Questionnaire (SRQ-20) was used to assess CMD. To verify the association between IPV and the other evaluated factors with CMD, simple and hierarchical multiple logistic models were used.

RESULTS

Of the 479 participant women, 22% were positively screened for IPV (95% CI 18.2-26.2). After multivariate adjustment, the chances of CMD are 2.32 higher in women exposed to IPV than in those not exposed to IPV ((95%CI 1.30-4.13), p value = 0.004). CMD was also associated with job loss during the COVID-19 pandemic (ORa 2.13 (95% CI 1.09-4.35), p-value 0.029). In addition to these, separate or single marital status, as well as non-presence of the father at home and food insecurity were associated with CMD.

CONCLUSION

We conclude that the prevalence of intimate partner violence in families with children up to six years of age living below the poverty line in Ceará is high and is associated with greater chances of common mental disorders in mothers. Also, job loss and reduced access to food caused by the Covid 19 pandemic exacerbated both phenomena, constituting a double burden generator factor on mothers.

Development of an Economic and Relationship-Strengthening Intervention for Alcohol Drinkers Living with HIV in Malawi

Heavy alcohol use among people with HIV in sub-Saharan Africa is driven by household economics such as poverty and unemployment and has negative impacts on couple relationships. Multilevel interventions have the potential to reduce alcohol use and improve relationship outcomes by addressing the web of co-occurring economic, social, and dyadic factors. This objective of this study was to develop an economic and relationship-strengthening intervention for couples in Malawi, consisting of matched savings accounts with financial literacy training and a couples counseling component to build relationship skills. Informed by the ADAPT-ITT framework, we collected multiple rounds of focus group data with key stakeholders and couples to gain input on the concept, session content, and procedures, held team meetings with field staff and an international team of researchers to tailor the intervention to couples in Malawi, and refined the intervention manual and components. The results describe a rigorous adaptation process based on the eight steps of ADAPT-ITT, insights gained from formative data and modifications made, and a description of the final intervention to be evaluated in a pilot randomized clinical trial. The economic and relationship-strengthening intervention shows great promise of being feasible, acceptable, and efficacious for couples affected by HIV and heavy alcohol use in Malawi.

Risk factors for intimate partner emotional violence among women in union in Uganda

Introduction

Despite the growing evidence of the prevalence of gender-based violence in Uganda, less is known about the factors influencing intimate partner emotional violence (IPEV) among married women in the country. This study investigated the social demographic factors associated with IPEV among married women aged 15 years and older.

Data and methods

The study used the 2016 Uganda Demographic Healthy Survey (UDHS) data. A weighted sample of 5,642 women who had been in a union was selected. A binary logistic regression model was fitted to analyze the predictors of IPEV.

Results

Almost four in 10 (38%) married women experienced IPEV. Witnessing parental violence (OR = 1.37, CI = 0.59-0.92), partner's controlling behavior (OR = 4.26, CI = 3.29-5.52), and attaining age 35+ (OR = 1.44, CI = 1.06-1.95) increased the odds of IPEV. Residing in rural areas (OR = 0.004, CI = 0.48-0.99) and having higher education (OR = 0.51, CI = 0.26-1.00) decreased the odds of IPEV.

Conclusion and implications

Witnessing parental violence, alcohol consumption, age, place of residence, partner's controlling behavior, and level of education influence IPEV among married women in Uganda. The findings have several implications including strengthening IPEV-prevention campaigns, women empowerment, and alcohol consumption regulations.

Intimate Partner Violence and Barriers to Help-Seeking Among Black, Asian, Minority Ethnic and Immigrant Women: A Qualitative Metasynthesis of Global Research

It is well known that victims of intimate partner violence experience numerous barriers to leaving abusive relationships. For ethnic minority and immigrant women these barriers are significantly exacerbated. This metasynthesis explored barriers to help-seeking as experienced by Black, Asian, minority ethnic and immigrant women with experience of intimate partner violence. A review of worldwide literature published in English in peer-reviewed journals on this topic from 2000 to July 2020 produced 2597 relevant articles. After removing duplicates and applying the exclusion criteria, a total of 47 articles were selected for inclusion in the review. The synthesis found that these women faced additional barriers as a result of institutional racism, immigration laws, culture and religion, and issues of cultural competence, and lack of diversity within frontline services. Such barriers, from a range of formal and informal resources, services and other mechanisms of support, served to exacerbate feelings of fear, threat, isolation and powerlessness. The barriers were also further weaponised by perpetrators in order to extend their reign of terror and control. As a result, women were caught in a double-bind - stay in an abusive relationship or face further threats and consequences if they attempted to leave. Whilst our search criteria focused on barriers to help-seeking, many of the papers included in our synthesis also explored facilitators to help-seeking, which are included in our findings and overwhelmingly relate to informal support from females.

Cultural collectivism, intimate partner violence, and women's mental health: An analysis of data from 151 countries

Culture, defined as the distinctive, learned beliefs and patterns of behavior that are particular to a given group or community, is a key determinant of mental health. The cultural dimension of individualism-collectivism, which measures the extent to which a given society accords importance to individuals as opposed to larger groups, has been associated with cross-national variations in mental health outcomes such as depression and suicide. However, this cultural dimension is also associated with variations in the frequency of intimate partner violence (IPV), which has a significant and sustained adverse impact on women's mental health. This study examines the relationships between individualism-collectivism, the frequency of IPV, and rates of depression and suicide in women, based on data from 151 countries. In this data set, IPV was significantly associated with age-standardized rates of depression and suicide in women, even after adjusting for demographic variables. Cultural collectivism was positively correlated with IPV, but this relationship was significantly influenced by national income and women's educational attainment. In multivariate analyses, IPV, but not cultural collectivism, remained significantly associated with depression in women. These results highlight the importance of screening for and addressing IPV in women seeking mental health care, particularly in low- and middle-income countries where cultural and economic factors may both increase the risk of IPV and delay or impede its reporting.

Informal Help-Seeking in Moments of Acute Danger: Intimate Partner Violence Survivors' Emergency Outreach Efforts and the Forces That Shape Them

Heightened attention to police brutality has created momentum for alternative, community-based responses to violence, including that inflicted by an intimate partner. But to build effective alternatives, we must know what survivors already do in moments of acute danger when they do not call the police. This study sought to explore these moments from an ecological perspective. Using a qualitative descriptive methodology, we conducted 25 interviews with a diverse sample of intimate partner violence (IPV) survivors. Each described the first, the worst, and the most recent IPV incident, whom they reached out to and why, the outcomes of their help-seeking, and the individual, interpersonal, and psychosocial influences on the process. Even in the face of severe violence, what participants most wanted was someone who would listen without judgment. Direct interpersonal factors that influenced their help-seeking included their partner's controlling behavior, as well as their network members' capacities, perspectives on IPV, and feelings about the survivor. Broader influential factors included the radiating effects of IPV and other forms of trauma in survivors' networks. Participants offered recommendations on how domestic violence (DV) programs could both strengthen survivors' networks and provide them with targeted community support in moments of grave danger. As we continue to develop community-based alternatives to police intervention, DV programs have a critical opportunity to build on survivors' own recommendations. This process must address the ongoing effects of trauma that hamper the ability of so many network members to support survivors in crisis.

Intimate partner violence and barriers to prenatal care

RATIONALE

Past research has shown that intimate partner violence (IPV) is associated with less adequate access to prenatal care. However, less is known about why IPV creates challenges for accessing prenatal care, including how IPV is related to unique barriers to prenatal care.

OBJECTIVE

The aim of this study is to examine the association between physical IPV around the time of pregnancy (preconception IPV, prenatal IPV, or both preconception and prenatal IPV) and (1) adequacy of prenatal care, and (2) barriers to prenatal care.

METHODS

Data are from 35 sites (34 states and New York City) from the Pregnancy Risk Assessment Monitoring System (PRAMS) for years 2009-2016 (n = 166,840). Adequacy of prenatal care is examined using multinomial logistic regression and measures of barriers to prenatal care are assessed using negative binomial regression and logistic regression.

RESULTS

The findings reveal that women with IPV exposure-especially those who experience IPV both before and during pregnancy-are more likely to experience inadequate prenatal care. In addition, women with IPV exposure incur a higher rate of barriers to prenatal care, as well as several specific barriers to prenatal care including not having transportation, not being able to get time off work, being too busy, being unable to find child care, and keeping a pregnancy a secret.

CONCLUSIONS

Considering the adverse consequences of both IPV and inadequate access to prenatal care for maternal and child health, the findings of this study highlight the need for public health interventions that both reduce the prevalence of IPV and remove barriers to prenatal care for IPV-exposed women.

Exploring Factors Associated with Intimate Partner Violence Survivors' Use of Financial Safety Planning Strategies

The purpose of this study was to explore financial strategies that intimate partner violence (IPV) survivors undertake when engaging in safety planning and to examine the relationship between these strategies and various survivor characteristics. As part of the cross-sectional study, a total of 425 female survivors of IPV were surveyed. To examine the relationship between financial safety planning strategies and participants' demographic characteristics, abuse experiences, and financial knowledge, binomial logistic regression analyses were conducted. Factors associated with financial safety planning varied by strategy; ethnicity and nativity were often significantly associated. Implications for practice and areas for future research are discussed.

Racial and Gender Inequalities in Food, Housing, and Healthcare Insecurity Associated with Intimate Partner and Sexual Violence

The costs and consequences of intimate partner violence (IPV) and sexual violence (SV) are well-documented; however, little is known about how experiences of violence are connected to specific economic insecurities including food, healthcare, and housing insecurity among both men and women. This study investigates (1) the prevalence of food, healthcare, and housing insecurity across gender and racial groups exposed to IPV and SV and (2) associations between exposure to past-year IPV and SV and past-year food, healthcare, and housing insecurity controlling for confounding factors. A cross-sectional survey design was used in this study. Data from 2010 National Intimate Partner and Sexual Violence Survey (NISVS) were analyzed in a nationally representative sample of men (N = 8079) and women (N = 9970). Logistic regressions were used to model associations between past-year intimate partner and sexual violence and dependent variables of food, healthcare, and housing insecurity. Analyses were stratified by gender and included control variables of age, income, education, and race/ethnicity. Higher rates of food, housing, and healthcare insecurity were found among men and women of color exposed to violence, particularly among respondents who identified as Black/African American, Latinx, American Indian/Alaska Native, and other racial/ethnic minority groups. For men, IPV and SV was associated with higher odds for experiencing food (AOR = 2.40, p <.001), housing (AOR = 2.06, p <.001), and healthcare insecurity (AOR = 2.39, p <.001). For women, IPV and SV was also associated with higher odds for experiencing food (AOR = 2.16, p <.001), housing (AOR = 1.94, p <.001), and healthcare insecurity (AOR = 2.38, p <.001). Findings identify specific economic needs among survivors and suggest that the burdens of IPV and SV are not equitably shared across racial/ethnic populations. Findings can inform policy that aims to reduce inequalities in food, housing, and healthcare associated with IPV and SV.

Understanding the interconnected relationships between intimate partner violence and child maltreatment: The role of maternal material hardship

BACKGROUND

Evidence indicates an association between intimate partner violence (IPV) and child maltreatment (CM). Although research shows mothers' IPV victimization is a risk factor for CM, the specific elements within IPV and CM are not well understood. Some studies suggest material hardship plays a role in the relationships between IPV and CM. However, the relationship between different typologies of IPV and CM considering material hardship has rarely been examined.

OBJECTIVE

This study fills this gap by assessing the direct effects of IPV victimization on material hardship and CM, direct effects of material hardship on CM, and indirect effects of IPV victimization on CM via material hardship with attention to typologies of IPV and CM.

METHODS

Data included responses by 3086 mothers in the Fragile Families Child Wellbeing Study.

RESULTS

Structural equation modeling showed that material hardship predicted higher risk of CM regardless of the presence of IPV or what type (child physical assault: β = 0.11, p < 0.001; child psychological aggression: β = 0.12, p < 0.001; child neglect: β = 0.06, p < 0.01). However, mothers who experienced controlling and emotional IPV had a higher risk of material hardship, and this increased their children's risk of CM (child physical assault: β = 0.02, p < 0.01; child psychological aggression: β = 0.02, p < 0.01; child neglect: β = 0.01, p < 0.05). This was the only type of IPV associated with CM through its association with material hardship.

CONCLUSIONS

The varied findings suggest that intervention efforts in families with co-occurring IPV and CM should mobilize economic support to IPV survivors with consideration of the varied effects of different types of IPV.

Intimate partner violence against women with intellectual disability: A relational framework for inclusive, trauma-informed social services

Women with intellectual disability experience intimate partner violence at higher rates and tend to remain in abusive relationships longer than non-disabled women. The purpose of this inquiry was to generate a preliminary set of principles and delineate domains of support as a general guide for social service workers supporting women with intellectual disability through the difficult, often stop-start process of ending an abusive relationship and creating a desired future. Taking a pragmatic inquiry approach, guiding principles and domains of support were generated through a triangulated engagement with relational theory, relevant published research, and original data gathered through interviews with five experienced social service workers. The results comprise a relational framework for inclusive, trauma-informed services aimed at fostering the relational autonomy of women with intellectual disability. Enacting relational principles of reflexivity, recognition, solidarity and safety, social service workers can support women with intellectual disability with safety planning, securing basic life needs, strengthening social relationships, acquiring new skills and nurturing self-affective attitudes of self-respect, self-efficacy and self-esteem.

The Impact of the COVID-19 Pandemic on the Needs and Lived Experiences of Intimate Partner Violence Survivors in the United States: Advocate Perspectives

We explored the challenges and lived experiences of intimate partner violence (IPV) survivors during the COVID-19 pandemic by interviewing 53 U.S.-based IPV advocates between June and November 2020. Advocates described how the COVID-19 pandemic limited survivors' abilities to meet their basic needs. The pandemic was also described as being used by abusive partners to perpetrate control and has created unique safety and harm reduction challenges. IPV survivors experienced compounding challenges due to structural inequities. IPV must be considered by local, state, and federal governments when developing disaster planning policies and practices, including in the context of pandemics.

Women's Economic Abuse Experiences: Results from the UN Multi-Country Study on Men and Violence in Asia and the Pacific

Economic abuse is a poorly understood form of intimate partner violence but may have far-reaching implications for the financial health of the survivor. Additionally, very little is known about whether depressive symptoms, education, employment, or attitudes about relations between men and women mediate or moderate the relationship between economic abuse and their financial circumstances. The purpose of this study was to answer these two research questions: (a) Is there a relationship between the experience of economic abuse and food insecurity (as a measure of poverty)? (b) Is the relationship between economic abuse and food insecurity impacted by women's education, women's and men's employment, women's attitudes towards gender relations, or women's depressive symptoms? We used quantitative data from the "UN Multi-Country Study on Men and Violence," analyzing data on 3,105 women aged 18-49 years who were interviewed. Initial logistic regressions were conducted followed by introducing moderators and mediators to the model using path analyses to test the relationship between economic abuse and food insecurity in the household. Significant predictors of food insecurity included several types of abuse and partners' employment, women's own employment, and education. The only type of IPV not associated with food insecurity was physical abuse. Experiences of economic abuse were associated with a 1.69 times greater likelihood of reporting food insecurity which was higher than experiences of psychological or sexual abuse. Additionally, women's experiences of economic abuse over their lifetime were significantly associated with an increase in depressive symptoms which in turn was associated with greater likelihood of experiencing food insecurity. Such relationships warrant attention to economic abuse and depressive symptoms as part of the interventions used when working with survivors. Additional research could also help further our understanding of how these variables interact together and how best to address its impact on survivors.

Eviction, intimate partner violence and HIV: Expanding concepts and assessing the pathways through which sexual partnership dynamics impact health

Over 2 million renters in the United States are legally evicted annually, and even more renters experience other landlord-related forced moves each year. While past research has documented an association between legal eviction and HIV risk, no studies have examined the relationship between forced moves and sexual partnership dynamics longitudinally, or the pathways through which forced moves impact such risk. Addressing this gap is imperative, particularly given inequities that place Black renters and women at disproportionate risk of eviction. This study leverages data from a longitudinal cohort study of 282 adults in New Haven to examine whether landlord-related forced moves reported at baseline (including, but not limited to, legal eviction) is associated with HIV sexual risk reported six months later. We use bootstrapped path analyses to examine intimate partner violence (IPV) victimization and perpetration as potential mediators. One-fifth of participants (21.2%) had experienced a landlord-related forced move at baseline. At follow up, nearly two-thirds (63.8%) reported at least one HIV sexual risk factor, one in seven (14.2%) reported IPV victimization, and one in ten (10.3%) reported IPV perpetration. Individuals who reported landlord-related forced moves were more likely to report IPV victimization (standardized β = 0.19, SE = 0.08, p = .02) and IPV perpetration (β = 0.25, SE = 0.09, p = .003). Both IPV victimization and perpetration mediated the association between landlord-related forced moves and HIV sexual risk (indirect victimization effect, β = 0.09, SE = 0.05, p = .06; indirect perpetration effect, β = 0.16, SE = 0.07, p = .02), though IPV victimization was only marginally significant. In conclusion, IPV is itself a negative consequence of forced moves that also contributes to other negative health effects, like HIV risk. Therefore, providers should offer violence screening and referral for clients who have recently faced a forced move. Simultaneously, policy-level solutions to prevent eviction and increase housing affordability are urgently needed to address the rising burden - and inequitable distribution - of evictions among low-income renters.

Community-based system dynamics modelling of stigmatized public health issues: Increasing diverse representation of individuals with personal experiences

Utility of community-based system dynamics (CBSD) models on stigmatized public health issues and health disparities depends upon how representative the model is to real-world experience within the community. "Personal experience" participants (PEP), especially from marginalized groups, are essential model contributors, but are often underrepresented in modeling groups due to multiple barriers. This study details a method to increase PEP representation for models on stigmatized issues. We use a case study from a CBSD project on health disparities within the association between alcohol misuse (AM) and intimate partner violence (IPV) for Northern Plains Indigenous women. Short group model building sessions were held at three community organizations providing relevant resources. Each model contributed unique system components, and there were few similarities between models. A consolidated model provided a rich picture of the complex system. Adding brief PEP-based group modeling sessions can enhance PEP representation in model development for stigmatized public health issues.

IPV Experiences and Financial Strain Over Time: Insights from the Blinder-Oaxaca Decomposition Analysis

Financial strain is one hardship faced by female survivors of intimate partner violence (IPV) that is often overlooked. This paper examined the relationships between multiple forms of abuse-with a focus on economic abuse-and financial strain. Guided by stress process model, this study tested two hypotheses: (1) economic abuse is associated with financial strain more than other types of IPV; and (2) decreased economic abuse relates to financial strain over time. The study sample consists of 229 female IPV survivors who participated in a longitudinal, randomized controlled study evaluating an economic empowerment curriculum. Results from regression models suggest that physical abuse and economic abuse were significantly and positively associated with the magnitude of financial strain. Oaxaca-Blinder decomposition was used to partition the mean differences of financial strain over time that was mainly attributed to the decrease in economic and physical abuse (78%). Particularly, the decrease of economic abuse contributed to over half (58%) of the decrease in financial strain over time. Advocates should assess survivors' risk of economic abuse, evaluate financial strain, and utilize financial safety planning skills to help survivors build economic security and independence. In addition, policy makers should address issues concerning economic security among female IPV survivors.

Crisis Work Embedded in a Global Crisis: The Early Phase Impact of COVID-19 on Survivors of Intimate Partner Violence and Service Provisions

COVID-19, as a global pandemic, was a public health inflection point for individuals affected by intimate partner violence (IPV) and those who provide IPV services. Public health guidelines that were intended to reduce risk of exposure to the virus impacted vulnerability factors for IPV survivors and associated systems of services. We aimed to (1) explore the effect of COVID-19 on survivors of IPV; (2) assess the effect of COVID-19 on IPV-related service provisions and service providers; and (3) explore challenges and opportunities in the wake of COVID-19 on broader IPV services and advocacy.

METHOD

Twelve directors of IPV shelter, criminal justice, and other advocacy services within a diverse, Midwestern metropolitan area were recruited to participate in in-depth, semi-structured interviews in June-August 2020. Interviews were transcribed verbatim and analyzed using Dedoose. Data were coded and analyzed through thematic analysis.

RESULTS

Four major themes, contextualized by COVID-19 and racial injustice, emerged from the data analysis: (1) IPV-related trends; (2) impact on IPV survivors, services, and agency morale; (3) inter-agency collaborations; and (4) future opportunities for innovative service delivery. Gaps and opportunities for developing culturally congruent, trauma-informed services were identified.

CONCLUSION

Findings suggest that responsive and accessible IPV resources and associated advocacy services can make the difference between life and death for survivors.

Seeking safety from male partner violence in Turkey: Toward a context-informed perspective on women's decisions and actions

Women's stay/leave decision-making in violent relationships has become a subject of investigation in psychology over the last few decades. Despite making significant contributions to the understanding of how women's psychological processes shape their responses to violence, much of this research has lacked a contextualized approach. The present study aimed to provide a feminist context-informed examination of women's decision-making and safety-seeking processes. Twelve women who had experiences of violence in their marital relationships were interviewed individually. The study was carried out in Istanbul, Turkey, and all participants were socioeconomically disadvantaged women. A constructivist grounded theory approach was used for the data analysis. The results indicated that women's helplessness, beyond being a psychological construct, was a reality shaped by the conditions of marginalization in their lives. More than being related to the experience of psychological trauma, the women's narratives revealed the disempowering barriers associated with the lack of socioeconomic and institutional resources. Under these circumstances, regardless of their decisions to stay or leave, the women underlined their ongoing strategic efforts to ensure their safety, as mainly strengthened by the relational support available to them.

Coping Strategies Adopted by Women Who Experienced Intimate Partner Violence in the Context of Social Norms in Rural Areas in Zimbabwe

Intimate partner violence (IPV) has detrimental effects on the welfare of women. Research on the coping strategies employed by rural women in Zimbabwe is notably lacking, despite the fact that the majority of Zimbabwean women reside in rural areas. Therefore, this study sought to explore the strategies that women in rural areas used to manage and cope with IPV. The study adopted a qualitative research approach, and participants were recruited through the purposive sampling method in Chimanimani Rural District, Eastern Highlands, Zimbabwe. Face-to-face interviews using a narrative approach were conducted with 25 women between 19 and 49 years and seven key informants. The 25 women consisted of women who had left abusive relationships and were selected on the basis that they should have experienced IPV in their former relationships. Current IPV victims were excluded from the study. All the interviews were recorded, with participants' consent, to avoid loss of data. Data was analyzed by the author and an additional independent data analyst using thematic analysis. Findings from this study revealed that social norms influenced participants' covert coping behavior, which include acceptance of abuse and prayer. There is need to strengthen the existing coping strategies that are utilized by women as these could be the starting point for intervention efforts. This is important as it enables practitioners to develop context-specific and context-driven intervention strategies that will effectively serve the victims in their distinctive situation(s).

Maternal Intimate Partner Violence Exposure and Autonomic Reactivity: Associations With Positive Parenting

Intimate partner violence (IPV) can negatively impact parenting, posing a threat both to the wellbeing of mothers and their young children. Parenting may also be influenced by emotion regulation (ER), which can support parents' ability to navigate relational challenges or buffer against the influence of adverse experiences on parenting. Changes in maternal respiratory sinus arrhythmia (RSA) during parent-child interactions have been conceptualized as a psychophysiological index of ER. Competing theoretical models posit that RSA response may mediate or moderate the relation between IPV and parenting or may be independently associated with parenting, however, there is little prior evidence concerning these hypothesized associations. This study examined these associations in a sample of 125 low-income maltreating and comparison mothers and their 3- to 5-year-old children. Dyads completed a moderately challenging laboratory task, and positive parenting and maternal RSA were measured during the task. Maternal verbal IPV exposure, but not physical IPV, was associated with less positive parenting, while greater maternal RSA activation over the task was associated with more positive parenting. Maternal RSA activation did not mediate or moderate the relationship between IPV exposure and parenting, and this association did not differ by whether or not the mother had perpetrated child maltreatment. Consequently, verbal IPV exposure and greater RSA activation independently predicted positive parenting. Results suggest that interventions for IPV-exposed mothers of young children may benefit from ensuring psychological safety and improving maternal ER to promote positive parenting for at-risk children.

An Analysis of Comparative Perspectives on Economic Empowerment among Employment-Seeking Survivors of Intimate Partner Violence (IPV) and Service Providers

Purpose: The purpose of this study is to compare perspectives on economic empowerment in the context of employment seeking among intimate partner violence (IPV) survivors and service providers specializing in IPV-related trauma. This study addressed the following question is: How do employment-seeking IPV survivors and service providers conceptualize and understand empowerment? Insights into how each group conceives of economic empowerment and its attainment following IPV experiences can help to inform an effective service curriculum that can be used to facilitate optimal employment outcomes among survivors. Methods: A constructivist grounded theory method was used to develop a theoretical framework for conceptualizing how economic empowerment is understood by employment-seeking survivors of IPV, and IPV service providers. Twenty-six participants were recruited (survivors, n = 16; service providers, n = 10) in a large northeastern U.S. city. Interview questions focused on how IPV survivors and service providers identify and conceptualize economic empowerment, and how support services respond to survivors’ needs around empowerment, particularly through help with employment seeking. Results: Data were coded and analyzed following data analysis stages: (a) initial coding; (b) constant comparison; and, (c) focused coding. Three main themes emerged from the narrative data: (1) structural characteristics shape individual experiences and perspectives of empowerment; (2) peer support as an integral component to empowerment; and (3) employment attainment as economic empowerment. Though perspectives on economic empowerment were often aligned, some key differences emerged. Whereas providers tended toward a more restricted, micro-level view of empowerment as primarily an attribute of the individual, survivors were inclined toward a structuralist perspective that considers how individuals’ experiences of empowerment are shaped by broader, institutional-level factors. Conclusions: Findings from this study build on prior research on the experiences of IPV survivors. The focus on experiences of empowerment in the context of employment-seeking can inform work on building more effective support services for survivors that avoid reductionist approaches that could be perceived by survivors as “victim-blaming” by incorporating a sensitivity to empowerment as derived from structural factors that shape individual experience.

Understanding the association between material hardship and posttraumatic stress disorder: a test of the social selection and social causation hypotheses and an exploration of gender differences

PURPOSE

There is a well-established association between poverty and posttraumatic stress disorder (PTSD); however, little research has tested the temporality of the association.

METHODS

Using data from Waves IV (2008; N = 14,800) and V (2016-2018; N = 10,685) of the National Longitudinal Study of Adolescent to Adult Health, we examined temporal associations between material hardship (a specific operationalization of poverty) and PTSD, as well as assessed for potential gender differences in associations. We conducted logistic regression and generalized structural equation modeling to examine associations between material hardship and PTSD and assess for mediation and moderation by gender.

RESULTS

Prior PTSD diagnoses were associated with an increased likelihood of material hardship (OR = 1.64; 95% CI 1.21, 2.21). The indirect effect of gender on material hardship through PTSD diagnoses was significant. Prior material hardship was associated with an increased likelihood of PTSD diagnoses (OR = 1.81; 95% CI 1.35, 2.42). The indirect effect of gender on PTSD diagnoses through material hardship was significant. There was no evidence of moderation by gender for either association.

CONCLUSION

Results suggest reciprocal associations between material hardship and PTSD. Economic policies, as well as improved access to evidence-based PTSD treatments, may reduce the burden of both material hardships and PTSD.

Survivors' Experiences of Intimate Partner Violence and Shelter Utilization During COVID-19

This paper examines the effects of COVID-19 on service-engaged female survivors of IPV and makes recommendations for service providers based on these survivors' voices. The researchers adopted an exploratory, descriptive, and qualitative approach to inquiry due to the novelty of the research questions during the early days of the COVID-19 in March 2020. Semi-structured interviews with service-engaged survivors were analyzed using inductive and deductive coding processes. Two categories arose from our qualitative questions. The first category, related to experiences with service providers, included the themes of varying levels of support and isolation. Within the theme of isolation, survivors discussed both positive and negative aspects of isolation. The second category refers to the impact of COVID-19 on survivors' daily lives and focused on the theme of escalation. The theme of escalation had two subthemes 1) escalation of life-generated risks and 2) escalation of partner-generated risks. Given that the pandemic will continue until vaccines are fully distributed and that future public health emergencies may mirror many of the challenges identified in the current context, survivors residing at home will continue to need services, and agencies will continue to need additional resources to provide them. Therefore, we discuss recommendations that can have a bearing on services offered in the future.

Child Maltreatment, Youth Violence, Intimate Partner Violence, and Elder Mistreatment: A Review and Theoretical Analysis of Research on Violence Across the Life Course

This article reports the results of a scoping review of the literature on life-course patterns of violence that span the developmental periods of childhood, adolescence, and early and middle adulthood. We also assess the evidence on elder mistreatment and its relation to earlier forms of violence. Additionally, we draw on theories and empirical studies to help explain the transmission of violence over time and relational contexts and the factors that appear to mitigate risks and promote resilience in individuals exposed to violence. Results suggest that encounters with violence beginning in childhood elevate the risk for violence in subsequent developmental periods. The strongest connections are between child maltreatment (physical abuse, emotional abuse, sexual abuse, and neglect) and violence in adolescence and between violence in adolescence and violence in early and middle adulthood. Persistence of violence into older adulthood leading to elder mistreatment is less well-documented, but probable, based on available research. We conclude that more attention should be paid to studying developmental patterns and intersecting forms of violence that extend into old age. To eradicate violence in all its forms, considerably more must be done to increase awareness of the repetition of violence; to connect research to actionable steps for prevention and intervention across the life course; and to better integrate systems that serve vulnerable children, youth, and adults. Primary prevention is essential to breaking the cycle of violence within families and to alleviating the risks to children caused by poverty and other external factors such as social disconnection within communities.

"Don't Know where to Go for Help": Safety and Economic Needs among Violence Survivors during the COVID-19 Pandemic

The COVID-19 pandemic and related quarantine has created additional problems for survivors of interpersonal violence. The purpose of this study is to gain a preliminary understanding of the health, safety, and economic impacts of the COVID-19 pandemic on people that are experiencing or have previously experienced violence, stalking, threats, and/or abuse. An online survey, open from April to June 2020, was taken by people with safety concerns from interpersonal violence. Participants were recruited from IPV and sexual assault-focused agencies, state coalitions, and social media. Quantitative data were summarized using descriptive methods in SPSS and coding methods from thematic and content analysis was used to analyze qualitative data from open-ended questions. A total of 53 participants were recruited for the survey. Individuals with safety concerns have experienced increased challenges with health and work concerns, stress from economic instability, difficulties staying safe, and access resources and support. Over 40% of participants reported safety had decreased. Use of social media and avoidance strategies were the most common safety approaches used. Participants reported mixed experiences with virtual services. The COVID-19 pandemic has exacerbated existing structural concerns for survivors of violence like IPV and sexual assault. Increased support and economic resource access, coupled with modified safety planning and improved virtual approaches, would better help meet survivor needs.

Prevalence and factors associated with intimate partner violence against adult women in Brazil: National Survey of Health, 2019

OBJECTIVE

To estimate the prevalence and factors associated with intimate partner violence against adult women in Brazil.

METHODS

Quantitative cross-sectional epidemiological study using the database of the National Survey of Health 2019. The prevalence in the last 12 months and crude and adjusted prevalence ratios of intimate partner violence were calculated, stratified by sociodemographic characteristics.

RESULTS

Intimate partner violence was reported by 7.60% of Brazilian women aged from 18 to 59 years, with higher prevalence among younger women (8.96%), black women (9.05%), those with lower education level (8.55%) and low income (8.68%). After adjusted analysis, the age groups of 18-24 years old (PRadj: 1.41) and 25-39 years old (PRadj: 1.42) and income lower than one minimum wage (PRadj: 1.55) remained associated with intimate partner violence.

CONCLUSIONS

Intimate partner violence was associated with younger and poorest women. This result points to the need to develop intersectoral policies, especially those aimed at reducing social inequalities and at the coping with intimate partner violence among adult women.

Exploring factors associated with pregnant women's experiences of material hardship during COVID-19: a cross-sectional Qualtrics survey in the United States

BACKGROUND

The COVID-19 pandemic has exacerbated the financial insecurity of women and their families globally. Some studies have explored the impact of financial strain among pregnant women, in particular, during the pandemic. However, less is known about the factors associated with pregnant women's experiences of material hardship.

METHODS

This cross-sectional study used a non-probability sample to examine the factors associated with pregnant women's experiences of material hardship during the COVID-19 pandemic. In January 2021, 183 pregnant women living in the United States participated in an online Qualtrics panel survey. In addition to socio-demographic characteristics, individuals were asked about their finances and predictors of financial well-being, mental health symptoms, and intimate partner violence (IPV) experiences. Chi-square analysis and one-way ANOVA were used to examine whether women's experiences with material hardship and associated factors differed by income level (i.e., less than $20,000; $20,000 to $60,000; more than $60,000). Ordinary least squares regression was used to calculate unadjusted and adjusted estimates.

RESULTS

Study findings showed that the majority of women in the sample experienced at least one form of material hardship in the past year. Individuals with an annual household income less than $20,000 reported the highest average number of material hardships experienced (M = 3.7, SD = 2.8). Compared to women with household incomes less than $20,000, women with incomes of more than $60,000 reported significantly fewer material hardships, less financial strain, and higher levels of financial support, economic self-efficacy, and economic-self-sufficiency. Women with incomes of $60,000 or more also reported significantly lower levels of psychological abuse, and a smaller percentage met the cut-off for anxiety. Economic self-sufficiency, financial strain, posttraumatic stress disorder, and economic abuse were all significantly associated with material hardship.

CONCLUSIONS

A contribution of this study is that it highlights the significant, positive association between economic abuse, a unique form of IPV, and material hardship among pregnant women during the pandemic. These findings suggest the need for policy and practice interventions that help to ameliorate the financial insecurity experienced by some pregnant women, as well as respond to associated bidirectional vulnerabilities (e.g., mental health symptoms, experiences of IPV).

Material hardship is associated with posttraumatic stress disorder symptoms among low-income Black women

The link between socioeconomic status and posttraumatic stress disorder (PTSD) symptoms is well established. Given that Black women are disproportionately burdened by both poverty and PTSD symptoms, research focusing on these constructs among this population is needed. The current study assessed the association between material hardship (i.e., difficulty meeting basic needs) and PTSD symptoms among 227 low-income Black women in the United States. We explored several potential explanations for the association between poverty and PTSD symptoms (e.g., individuals living in poverty may experience higher levels of trauma exposure; individuals living in poverty may have less access to relevant protective resources, like social support; poverty itself may represent a traumatic stressor). Using robust negative binomial regression, a positive association between material hardship and PTSD symptoms emerged, B = 0.10, p = .009, SMD = 0.08. When trauma exposure was added to the model, it was positively associated with PTSD symptoms, B = 0.18, p < .001, SMD = 0.16, and material hardship remained positively associated with PTSD symptoms, B = 0.10, p =.019, SMD = 0.08. When social support indicators were added to the model, they were not associated with PTSD symptoms; however, material hardship remained significantly associated, B = 0.10, p = .021, SMD = 0.08. In the model with material hardship and trauma exposure, a significant interaction between material hardship and trauma exposure on PTSD symptoms emerged, B = -0.04, p = .027. These results demonstrate the importance of including material hardship in trauma research, assessment, and treatment.

Increasing Financial Empowerment among Survivors of Intimate Partner Violence: A Growth Curve Analysis

Financial empowerment interventions are often used with survivors of intimate partner violence (IPV) to improve their financial well-being. However, few evaluations actually measure financial empowerment as an outcome. Thus, the purpose of this study was to develop and test a conceptual model for financial empowerment and then use the model to evaluate the effectiveness of a financial literacy intervention at increasing financial empowerment for survivors. The conceptual model was guided by Christens' nomological network for psychological empowerment and included four components: emotional, cognitive, relational, and behavioral. The analyses used data from a randomized controlled trial evaluating Moving Ahead, a financial literacy program developed for IPV survivors (n = 449). To determine whether this intervention was effective at increasing financial empowerment for survivors over time, confirmatory factor analyses were run to test for longitudinal measurement invariance, followed by a curve-of-factors growth model (CFM) with assignment as a time-invariant predictor of change. Strict partial longitudinal measurement invariance was achieved and CFM results found assignment to be significantly associated with both initial status (.054, p = .042) and change over time (.114, p = .000). Results suggest that this conceptual model for financial empowerment fit the data well and the intervention was effective.

Beyond Domestic Violence Shelter: Factors Associated With Housing Placements for Survivors Exiting Emergency Shelters

Domestic violence (DV) shelters are a critical resource for many survivors facing housing instability. Although DV shelter programs may address an array of survivor needs, DV survivors often identify the most pressing concerns as the need for safe housing and the financial resources to maintain housing. This study examines the factors associated with housing placements for DV survivors residing in emergency shelters. Data for this study came from program data collected by one organization operating six DV emergency shelters in an urban northeastern city. Among the sample of 347 DV survivors, findings revealed that there were significant associations between sociodemographic variables, services received, and post-discharge variables and post-shelter housing. Among this sample, three out of four residents (74.9%) left the DV shelter with housing in place. However, the findings suggest that there are areas for improved services and policy efforts to further support survivors in accessing safe and affordable housing. Our findings invite researchers and practitioners to consider further examination of best practices around program and policy options that support survivors in gaining economic independence and securing safe and affordable housing.

Exploring Intimate Partner Violence Among Women Attending Malaysian Primary Care Clinics

Victims of intimate partner violence (IPV) are frequent attendees at health care facilities. Although most literature on this subject focuses on developed or Western countries, there is a dearth of information from Asian countries. This study aims to estimate the prevalence of IPV among women attending urban primary care services in Malaysia and to identify the risk factors associated with IPV. Six out of 15 available public primary care clinics in the federal territory of Kuala Lumpur, Malaysia, were randomly selected. The sampling size for each clinic was conducted proportionate to the clinic's average daily patient attendance. A total of 882 women participated in this study via a self-administered questionnaire. We administered the women's experience with battering scale (WEB-scale) to estimate the prevalence of psychological violence and included a screening question for physical and sexual assault. The results showed that 22.0% of the women surveyed reported experiencing IPV. Ethnicity appears to be a significant predictor, with Chinese and Indian women reporting IPV at a higher rate than Malay women. Women with IPV are more likely to come from lower income households, have witnessed parental IPV, receive less social support, and have poorer psychological well-being. Our findings indicate that the prevalence of IPV among women attending urban public primary care clinics is high. Health care providers should pay close attention during clinical encounters for any sign of IPV, particularly among those presenting with risk factors.

Synergistic Effects of Psychological Intimate Partner Violence Exposure and Gender Discrimination on Postnatal Mental Health Trajectories

While the literature examining physical intimate partner violence (IPV) is extensive, the impact of psychological IPV on mental health during high-risk times such as the period following childbirth is not well understood. The current study examined associations between psychological IPV and the course and severity of women's postnatal mental health symptoms (depression, anxiety, and trauma symptoms). Both main effects of psychological IPV exposure and possible exacerbation by broader social victimization (i.e., gender discrimination) were considered. Participants were 76 mothers from a larger longitudinal study, who completed self-report measures of IPV, gender discrimination, and affective symptoms at 3, 6, 12, and 18 months postnatal. Hierarchical linear modeling revealed a main effect of psychological IPV on the course of trauma symptoms only. As hypothesized, gender discrimination moderated the effect of psychological IPV on all symptom trajectories in a synergistic manner. At moderate to high levels of gender discrimination only, psychological IPV predicted higher affective symptom severity and an escalating course of postnatal anxiety symptoms. These findings underscore the importance of expanding current conceptualizations of IPV impacts to incorporate relevant aspects of individuals' social-ecological context. Future directions and implications for prevention and intervention are discussed.

Violence With Femicide Risk: Its Effects on Women and Their Children

The objective of this study is to assess the effects that a specific type of severe violence-violence with femicide risk (VFR)-has on women's physical and mental health, as well as the physical health of their children. I focus on Peru, a country in which 7 out of 10 women have been victims of some form of intimate partner violence. In Latin America, Peru is one of the countries with the highest rates of violence against women. Methodological gaps in the existing literature (sampling size, selection bias, and reverse causality) are covered using an important nationally representative sample (Demographic and Health Survey: N = 84,136) and the use of propensity score matching. Results show that VFR increases symptoms of depression, as well as alcohol and tobacco consumption. The children of victims of VFR had significantly more recent episodes of bloody stool, diarrhea, fever, and coughing. These effects are heterogeneous. They vary based on violence characteristics (history of sexual violence) and on victims' socioeconomic status. According to the relevant literature, these effects can be understood to stem from somatization, stress, substance use (as a facilitator of violence), and neurological damage due to exposure to this type of violence. Results suggest VFR may have life-course altering effects given victims' distinct coping strategies.

Intimate Partner Violence and the Role of Child Maltreatment and Neighborhood Violence: A Retrospective Study of African American and US Caribbean Black Women

Background: Research suggests that intimate partner violence (IPV) is associated with childhood maltreatment and violence exposure within the neighborhood context. This study examined the role of child maltreatment and violence exposure on intimate partner violence, with the moderating effects of mental disorders (IPV) among US Black women. Methods: Data from the National Survey of American Life (NSAL), the largest and most complete sample on the mental health of US Blacks, and the first representative sample of Caribbean Blacks residing in the United States was used to address the study objectives. Descriptive statistics, chi-square test of independence, t-test, and logistic regression procedures were used to analyze the data. Results: Bivariate results indicate an association between child abuse and intimate partner victimization among US Black women. Witnessing violence as a child as well as neighborhood violence exposure was also related to IPV but shown to differ between African American and Caribbean Black women. Multivariate findings confirmed the influence of mental disorders and social conditions on US Black women's risk for IPV. Moderating effects of child maltreatment and mental disorders in association with adult IPV were not found. Conclusions: The study addressed the short and long-term impact of child maltreatment and the contribution to the cycle of intimate violence among US Black women including African American and Caribbean Blacks. The study suggests the need for prevention and intervention efforts to improve structural conditions for at-risk populations and communities predisposed to violence and other negative outcomes. Possibilities for future research are also discussed.

Intersectional and Trauma-Informed Approaches to Employment Services: Insights From Intimate Partner Violence (IPV) Service Providers

This article presents qualitative findings from a constructivist grounded theory study that examines intimate partner violence and employment-seeking from the perspectives of 10 service providers. Three distinct themes emerge through analysis: (a) understanding the intersecting barriers to employment faced by survivors, (b) integrated approaches to employment services, and (c) barriers to providing employment services. Findings have important theoretical implications on the intersectional nature of employment-seeking and provide insight into IPV service responses.

The Implementation of an Interpersonal Violence Screening Program in Primary Care Settings: Lessons Learned

BACKGROUND

Interpersonal violence (IPV) is a public health issue that disproportionately affects women. IPV screening improves likelihood of survivor disclosure and access to additional support. To enhance primary care IPV screening, Technology Enhanced Screening and Supportive Assistance (TESSA) uses integrated technological systems to deliver bidirectional, evidence-informed health navigation, health management, and safety interventions. This study evaluates TESSA implementation in primary care clinics using the Consolidated Framework for Implementation Research (CFIR).

METHOD

CFIR is a metatheoretical framework used for evaluating clinical intervention implementation. Salient constructs within CFIR's five domains (intervention characteristics, outer setting, inner setting, characteristics of individuals, and process) were identified (23 constructs), and pertinent implementation details were examined.

RESULTS

Key lessons learned included intervention characteristic constructs like intervention source (e.g., selecting tablets that can screen for items integral to the program's aims) and adaptability (e.g., ensuring tablets worked with electronic medical records for each clinic), process constructs like engaging champions (e.g., garnering buy-in from key clinic stakeholders and staff), outer setting constructs like patient needs and resources (e.g., addressing pertinent patient resource needs) and external policies and incentives (e.g., incentivizing clinics by addressing clinic needs), and inner setting constructs like leadership engagement (e.g., ensuring buy-in from organizational leaders as leadership changed frequently).

CONCLUSIONS

CFIR identifies important implementation factors for programs like TESSA that screen for high-risk populations and implement in primary care settings. The TESSA program implementation permits increased IPV screening among primary health care populations, thus promoting access to resources for otherwise hard-to-reach populations.

Associations of intimate partner violence and financial adversity with familial homelessness in pregnant and postpartum women: A 7-year prospective study of the ALSPAC cohort

OBJECTIVE

To determine whether emotional and physical intimate partner violence (IPV) and financial adversity increase risk of incident homelessness in pregnancy and the post-partum period.

STUDY DESIGN

Data were drawn from the Avon Longitudinal Study of Parents and Children, which starting in 1990 mailed questionnaires to 14,735 mothers in the UK, over 7 years from pregnancy onwards. Marginal structural models and multiple imputation were used to address time-varying confounding of the primary variables, testing for interaction between concurrent emotional/physical IPV and financial adversity, and adjusted for baseline age, ethnicity, education, partner's alcohol use, parity, depression, and social class.

RESULTS

Emotional IPV (HR 1.44 (1.13,1.84)), physical IPV (HR 2.05 (1.21,3.49)), and financial adversity (HR 1.59 (1.44,1.77)) each predicted a multiplicative increase in the discrete-time hazard of incident homelessness. We identified joint effects for concurrent emotional IPV and financial adversity (HR 2.09 (1.35,3.22)) and concurrent physical IPV and financial adversity (HR 2.79 (1.21,6.44)). We further identified a temporary decline in self-reported physical IPV among mothers during pregnancy and up to 8 months post-partum.

CONCLUSIONS

Emotional and physical IPV and financial adversity independently and jointly increase the risk of incident homelessness. The effects of emotional and physical IPV are comparable to or greater than the risk of financial adversity. Homelessness prevention policies should consider IPV victims as high-risk, regardless of financial status. Furthermore, self-reported physical IPV declines temporarily during pregnancy and up to 8 months post-partum. Screening for IPV in this period may miss high-risk individuals.

Coping With the Experiences of Intimate Partner Violence Among South African Women: Systematic Review and Meta-Synthesis

Background: Intimate partner violence (IPV) continues to be a serious problem worldwide. South Africa has a high prevalence of women experiencing IPV. Although much research reports on the prevalence rates, risk factors, and consequences of IPV, fewer studies report on how women deal with the experiences of IPV. Objective: This systematic review of the empirical literature aimed to identify and synthesize the best available evidence on women's experiences of coping with IPV in South Africa. Methods: A four-level search and retrieval strategy using PRISMA and JBI guidelines was conducted, which included critical appraisal, study selection, data extraction, and data synthesis. Ten studies met the eligibility criteria and were included in the review. They were assessed to meet a set threshold (7/10) based on the JBI Critical Appraisal Checklist for Qualitative Research. All studies were conducted between 2010 and 2020, conducted in South Africa, and used qualitative methodologies to accomplish the overall aim of investigating IPV experiences of women and their responses to it. Results: The total number of women included in the studies was 159. The data extraction yielded 49 findings of which 47 were aggregated into 14 categories and three themes: (1) help- and support-seeking coping, (2) emotional regulation coping, and (3) problem avoidance and distraction coping. Help- and support-seeking coping refers to women's responses when they seek instrumental aid, advice, comfort, and/or understanding from others. Emotional regulation includes responses of women in which their emotions were expressed or regulated. Problem avoidance and distraction coping represent responses of women in which they take efforts to avoid thinking about the problem situation and rather reshift their focus. Conclusion: Overall, this review found that a variety of coping responses are used by South African women experiencing IPV. The findings point to the need for understanding IPV and responses to it within a broader social context rather than just at the personal level. Approaching IPV at many levels may lead to a change in societal norms, better access to and delivery of services to IPV survivors, more functional family affairs, and personal well-being and improved quality of life.

Administering the U.S. Family Violence Option: The role of stigma in waiver recommendations

The Family Violence Option (FVO) was designed to help survivors of domestic violence (DV) more easily secure income support in the United States (U.S.), without placing them at risk of further abuse. The objective of this study is to determine whether the decision-making of advocates responsible for determining waiver recommendations under the FVO is influenced by the relationship status of DV survivors. Recursive partitioning was used to analyse data from a sample of 237 survivor risk assessments from four New Jersey counties to determine which women receive waiver recommendations and which do not. Advocates completed risk assessments for the women and were instructed to make recommendations on waivers based on their assessment. Workers' decision-making was examined using classification and regression trees (CART) to determine what case factors made it more or less likely for survivors to be recommended waivers. The CART results were supplemented with logistic regression analyses to ensure validity. For two of three waivers, survivors who reported currently residing with their abuser or who had ended the relationship recently were less likely to receive waiver recommendations than those who had been out of the relationship for a longer period of time (OR = 0.09-0.21), even when accounting for the type and severity of DV and the impacts of the violence on survivors' mental health. The results indicate that DV advocates' decision-making is complicated by factors independent of survivors' case characteristics. This can affect the safety and well-being of women attempting to leave violent relationships by affecting their access to resources.

Poverty, depression, and anxiety: Causal evidence and mechanisms

Why are people who live in poverty disproportionately affected by mental illness? We review the interdisciplinary evidence of the bidirectional causal relationship between poverty and common mental illnesses-depression and anxiety-and the underlying mechanisms. Research shows that mental illness reduces employment and therefore income, and that psychological interventions generate economic gains. Similarly, negative economic shocks cause mental illness, and antipoverty programs such as cash transfers improve mental health. A crucial step toward the design of effective policies is to better understand the mechanisms underlying these causal effects.