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

Associations between interpersonal and community-level violence experiences and HIV outcomes: implications for violence screening in Ryan White Clinics

Violence experience, interpersonal and community-level, is commonly reported by people living with HIV (PLWH). Understanding the impact of the various forms of violence on HIV outcomes is critical for prioritizing violence screening and support resources in care settings. From February 2021 to December 2022, among 285 PLWH purposively sampled to attain diversity by gender, race/ethnicity, and HIV care retention status in Atlanta, Georgia, we examined interpersonal and community violence experiences and proxy measures of violence (post-traumatic stress disorder (PTSD), anxiety, depression) and their associations with HIV outcomes (engagement and retention in care and HIV viral suppression) using multivariable analysis. Participants commonly reported lifetime intimate partner violence (89%), non-partner violence (97%), hate crimes (93%), and moderate-to-severe adverse childhood events (59%). Lifetime violence experiences were not significantly linked to HIV care engagement, retention, nor durable viral suppression, but were each individually associated with PTSD, which in turn, was significantly associated lower odds of durable viral suppression (AOR 0.35, CI 0.14-0.86). Thus, the high prevalence and multiplicity of interpersonal and community-level violence experienced among PLWH in Atlanta underscores the need for universal trauma-informed approaches and supports implementation of PTSD screening to identify patients at greatest need for trauma support services.

"This Is My Future?": Understanding the Lives of Emerging Adult Women Living with Chronic Pain Through a Narrative Inquiry

Chronic pain disproportionately affects women yet is often underestimated by medical professionals. In Canada, chronic pain rates have risen significantly, particularly among those aged 20 to 29 without other health conditions. However, limited qualitative research focuses on chronic pain exclusively in women under 30. By focusing on gender, this narrative inquiry study examined how societal narratives and stereotypes uniquely affect emerging adult women's experiences of chronic pain, contributing to their dismissal and invisibility in both personal and institutional contexts. Two key narrative threads were co-created with participants through analysis of their stories: silenced, invisible, and locating self with pain, and resisting singular stories of people living with chronic pain. Participants' shared family narratives of dismissal, stories of being silenced in health care, and dominant narratives in the context of age and gender that shaped the participants' stories to live by. This study demonstrates the importance of recognizing people in the midst of living with chronic pain. Understanding unique pain experiences during emerging adulthood can improve treatment options and long-term outcomes for this demographic.

Development and Psychometric Evaluation of a Questionnaire to Assess Attitudes Towards Invisible Gender-Based Violence (Q-AIGV)

Objective: To develop and psychometrically evaluate a questionnaire to assess attitudes towards invisible gender-based violence (Q-AIGV). Background: Invisible gender-based violence is defined as discriminatory attitudes and beliefs towards women that are culturally accepted and normalised in society. Methodology: This is a cross-sectional descriptive observational study. The development of the initial version of the questionnaire, a pilot study (N = 63) and a final validation study (N = 1264) were carried out. Reliability, validity, stability and readability were tested. Results: Exploratory factor analysis revealed that the Q-AIGV is composed of 15 items distributed in three factors. Known-groups analysis detected significant differences in two groups with different characteristics (age and relationship duration). Criterion validity indicated the existence of a moderate and significant correlation (r = 0.469; p < 0.001) between the mean score of the Q-AIGV and the 'Scale of Attitudes towards Gender-based Violence'. The Q-AIGV's content validity index (CVI-t = 0.96) and internal consistency (α = 0.906) were excellent. Conclusion: The Q-AIGV showed very good results for reliability, validity, stability and readability. This suggests that the Q-AIGV could be a good tool for assessing attitudes towards invisible gender-based violence.

Gendered Worlds of Pain: Women, Marginalization, and Chronic Pain

The importance of gender is undertheorized in chronic pain research, meaning extant research cannot sufficiently shed light on how chronic pain experience and treatment are connected to institutions and societal structures. Much literature on gender and pain is not critical in orientation, making it difficult to translate data into recommendations for improved treatment and care. Our study takes a critical approach informed by social theory to understand chronic pain among women who experience socioeconomic marginalization. Drawing on a gender-based subanalysis of interview data collected in Canada as part of an institutional ethnography of chronic pain among people who are socioeconomically marginalized, from women's narratives, we identified 4 themes that speak to gender, chronic pain, and marginalization. These are 1) gendered minimization of women's health concerns, 2) managing intergenerational poverty, 3) living with violence and trauma, and 4) gendered organization of family care. Together, these themes highlight how women's experiences of chronic pain and marginalization amplify gendered vulnerabilities in health care, social services, and society in general. Our findings depict a deeply gendered experience of chronic pain that is inseparable from the daily struggle of managing one's life with pain with heavy responsibilities, the baggage of past trauma, and responsibility for others with few resources. We emphasize the importance of chronic pain care and health and social services that are both gender- and trauma-informed. PERSPECTIVE: This article draws on an institutional ethnography (a holistic qualitative methodology) of chronic pain and socioeconomic marginalization to demonstrate the importance of chronic pain care and health and social services that are both gender- and trauma-informed.

Twelve-Month Sustainment of IPV Screening and Response Programs in Primary Care: Contextual Factors Impacting Implementation Success

PURPOSE

The Veterans Health Administration (VHA) employed implementation facilitation (IF) as a strategy to boost uptake of intimate partner violence (IPV) screening programs in primary care. This study examined the sustainment of screening uptake 1 year after IF and identified factors impacting sustainment success.

METHODS

A mixed-methods evaluation using quantitative and qualitative data was conducted. IPV screening rates from the conclusion of the IF period (i.e., initial adoption) through the 1-year sustainment period served as the primary outcome. We categorized sites into four groups of screening adoption and sustainment success (high adoption and high sustainment, moderate adoption and moderate sustainment, low adoption and low sustainment, and no adoption and/or no sustainment). Qualitative analysis of key informant interviews was used to identify contextual factors affecting screening 12 months post-IF. A mixed sustainment analysis matrix integrated quantitative and qualitative findings and enabled the identification of cross-site patterns.

MAIN FINDINGS

Seven of the nine sites sustained IPV screening at the most basic level (saw static or increased screening rates). High adopting and high sustaining sites (n = 3) were marked by consistently supportive medical center leadership, ongoing training for clinicians, clear protocols for responding to positive screens, and robust referral options for women experiencing IPV. Nonsustaining sites (n = 2) were marked by a host of barriers including staffing shortages, competing priorities, and inconsistent messaging from leadership regarding the importance of IPV screening.

CONCLUSIONS

Knowing barriers and facilitators to successful IPV screening sustainment can inform health care systems to tailor IF and other implementation strategies to sustain IPV screening in primary care. Sustainment of IPV screening requires attention to a combination of facilitators (e.g., consistent leadership support and robust referral options) as well as addressing key barriers (e.g., staff turnover and competing priorities).

Tentative Causes of Brain and Neuropsychological Alterations in Women Victims of Intimate Partner Violence

Victims of Intimate Partner Violence Against Women (IPVAW) experience neuropsychological and cerebral changes, which have been linked to several tentative causal mechanisms, including elevated cortisol levels, psychopathological disorders, traumatic brain injury (TBI), hypoxic/ischemic brain damage, and medical conditions related to IPVAW. While these mechanisms and their effects on brain function and neuropsychological health are well-documented in other clinical populations, they manifest with unique characteristics in women affected by IPVAW. Specifically, IPVAW is chronic and repeated in nature, and mechanisms are often cumulative and may interact with other comorbid conditions. Thus, in light of existing literature on neuropsychological alterations in other populations, and recognizing the distinct features in women who experience IPVAW, we propose a new theoretical model-the Neuro-IPVAW model. This framework aims to explain the complex interplay between these mechanisms and their impact on cognitive and brain health in IPVAW victims. We anticipate that this theoretical model will be valuable for enhancing our understanding of neuropsychological and brain changes related to intimate partner violence, identifying research gaps in these mechanisms, and guiding future research directions in this area.

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

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

Living in an Intimate Partner Violence Shelter During a Pandemic: Perspectives from Advocates and Survivors

PURPOSE

With state-wide quarantine policies during the COVID-19 pandemic like those implemented in the state of Texas, intimate partner violence (IPV) shelter staff were forced to incorporate new safety measures to keep survivors and advocates safe. To understand the impact of these adaptations fully, authors interviewed shelter staff and residents to capture both of their experiences living and working in the same shelter during the height of the coronavirus pandemic (summer 2020) to understand how changes in policy and procedure in shelters impacted survivors and advocates.

MATERIALS AND METHODS

A qualitative phenomenological design was utilized to collect and analyze data from 10 staff and 10 survivors to develop both a textual and a structural description of participant experiences living in an IPV shelter.

RESULTS

The current study captured the survivors' and advocates' perspectives related to the 1) vacillating views of shelter social distancing and quarantine policies, 2) shelter occupancy and staffing unpredictability, 3) the broader challenges related to environmental stressors and 4) mobility challenges.

DISCUSSION

Results of this study highlight factors related to interpersonal relationships within the shelter and structural factors of shelter which contributed to stress for participants.

CONCLUSION

The coronavirus is continuing to present challenges for shelters. Implications can be drawn from provider and client experiences that can inform policies and procedures for future health crises, including the need to mitigate environmental stress and transportation challenges, as well as considerations for maintaining social support should social distancing be necessary in future epidemics.

Associations between different forms of intimate partner violence and posttraumatic stress among women who use drugs and alcohol in Kyrgyzstan

Survivors of intimate partner violence (IPV) have an increased risk of experiencing posttraumatic stress, and the subsequently associated symptoms can vary by form of IPV exposure (i.e., physical, sexual, or psychological IPV). Related research among socially marginalized populations, however, is limited, including among women who use and misuse substances. Drawing on baseline data from a pilot study conducted among 213 women in Kyrgyzstan who reported using drugs or engaging in hazardous alcohol use, we examined the associations between different forms of IPV and severe posttraumatic stress symptoms (PTSS). The vast majority of participants reported lifetime (93.9%, n = 200) and past 3-month (65.3%, n = 139) IPV, and two thirds of participants (65.3%, n = 139) reported experiencing PTSS in the prior month. Multivariable logistic regression analyses indicated statistically significant associations between only some forms of IPV and PTSS, including physical IPV, adjusted odds ratio (aOR) = 3.24, 95% confidence interval (CI) [1.15, 9.14], and injurious IPV, aOR = 2.71, 95% CI [1.10, 6.65]. Additionally, experiencing any form of IPV was associated with 4.95 higher odds of reporting PTSS, 95% CI [1.16, 21.15]; no other results were significant. These results not only underscore the need for future research on the mechanisms that might explain the unique associations between different forms of IPV and posttraumatic stress, but also highlight an urgent need for trauma-informed mental health and psychosocial support interventions for women who use drugs and alcohol.

Attending to Marginalization in The Chronic Pain Literature: A Scoping Review

Background

There has been a recent and, for many within the chronic pain space, long-overdue increase in literature that focuses on equity, diversity, inclusion, and decolonization (EDI-D) to understand chronic pain among people who are historically and structurally marginalized.

Aims

In light of this growing attention in chronic pain research, we undertook a scoping review of studies that focus on people living with chronic pain and marginalization to map how these studies were carried out, how marginalization was conceptualized and operationalized by researchers, and identify suggestions for moving forward with marginalization and EDI-D in mind to better support people living with chronic pain.

Methods

We conducted this scoping review using critical analysis in a manner that aligns with dominant scoping review frameworks and recent developments made to scoping review methodology as well as reporting guidelines.

Results

Drawing on 67 studies, we begin with a descriptive review of the literature followed by a critical review that aims to identify fissures within the field through the following themes: (1) varying considerations of sociopolitical and socioeconomic contexts, (2) conceptual conflations between sex and gender, and (3) differing approaches to how people living with chronic pain and marginalization are described.

Conclusion

By identifying strengths and limitations in the research literature, we aim to highlight opportunities for researchers to contribute to a more comprehensive understanding of marginalization in chronic pain experiences.

Longitudinal effectiveness of a woman-led, nurse delivered health promotion intervention for women who have experienced intimate partner violence: iHEAL randomized controlled trial

BACKGROUND

Intimate partner violence (IPV) threatens the safety, health and quality of life of women worldwide. Comprehensive IPV interventions that are tailored, take a long-term view of women's needs, including health concerns, and maximize choice and control, have the potential to effectively address heath and safety concerns. Few such interventions have been tested, including in the Canadian context.

METHODS

A parallel randomized controlled trial of adult (age 19 + years), English-speaking, Canadian women with histories of IPV randomized either to iHEAL, a tailored health promotion intervention delivered by Registered Nurses over 6-7 months, or to community service information (usual care control). Primary (Quality of Life, PTSD symptoms) and secondary outcomes (Depression, Confidence in Managing Daily Life, Chronic Pain, IPV Severity) were measured at baseline and 6, 12 and 18 months post-intervention via an online survey. Generalized estimating equations were used to test for differences by study arm in intention-to-treat (full sample) and per protocol (1 + iHEAL visit) analyses focussing on short-term (immediately post-intervention) and longer-term (1 year post-intervention) effects. Selected process evaluation data were summarized using descriptive statistics.

RESULTS

Of 331 women enrolled, 175 were randomized to iHEAL (135 who engaged in 1 + visits) and 156 to control. Women who received iHEAL showed significantly greater short-term improvement in Quality of Life compared to the control group, with these effects maintained 1 year later. Changes in PTSD Symptoms also differed significantly by group, with weaker initial effects that were stronger 1 year post-intervention. Significant moderate, short- and longer-term group effects were also observed for Depression and Confidence in Managing Daily Life. IPV Severity decreased for both groups, with significant immediate effects in favour of the intervention group that grew stronger 1 year post-intervention. There were no changes in Chronic Pain.

CONCLUSION

iHEAL is an effective, acceptable and safe intervention for diverse groups of women with histories of IPV. Trial results provide a foundation for implementation and ongoing evaluation in health care settings and systems. Delayed effects noted for PTSD Symptoms and IPV Severity suggest that longer-term assessment of these outcomes may be needed in trials of IPV interventions.

TRIAL REGISTRATION

Clinicaltrials.gov ID NCT03573778 (Registered on June 29, 2018).

Intangible Identity Theft and Intimate Partner Violence

While tougher domestic violence laws and protective orders are frequently credited with attenuating intimate partner violence (IPV), one unexplored explanation for this observed reduction is that intimate partner abusers are shifting their abusive behavior to intangible identity theft to thwart legal mechanisms traditionally used to deter IPV. Unlike the monetary motive associated with document identity theft, intangible identity theft is committed by someone with a preexisting grievance against the victim because the theft's primary purpose is to tarnish the victim's reputation. Results from a multilevel analysis show that a woman has a lower probability of being a victim of an intimate rather than nonintimate partner crime in cities with a higher intangible identity theft rate. Such a finding suggests that intangible identity theft may be a form of intimate partner abuse with few adverse consequences for offenders because identity thieves are rarely arrested and prosecuted. Nevertheless, the current study is only preliminary. Further research is needed before our findings and conclusions can be universally accepted.

A comparative study of machine learning algorithms for predicting domestic violence vulnerability in Liberian women

Domestic violence against women is a prevalent in Liberia, with nearly half of women reporting physical violence. However, research on the biosocial factors contributing to this issue remains limited. This study aims to predict women's vulnerability to domestic violence using a machine learning approach, leveraging data from the Liberian Demographic and Health Survey (LDHS) conducted in 2019-2020. We employed seven machine learning algorithms to achieve this goal, including ANN, KNN, RF, DT, XGBoost, LightGBM, and CatBoost. Our analysis revealed that the LightGBM and RF models achieved the highest accuracy in predicting women's vulnerability to domestic violence in Liberia, with 81% and 82% accuracy rates, respectively. One of the key features identified across multiple algorithms was the number of people who had experienced emotional violence. These findings offer important insights into the underlying characteristics and risk factors associated with domestic violence against women in Liberia. By utilizing machine learning techniques, we can better predict and understand this complex issue, ultimately contributing to the development of more effective prevention and intervention strategies.

A Systematic Review of Interventions to Reduce Gender-Based Violence Among Women and Girls in Sub-Saharan Africa

Sub-Saharan Africa (SSA) is disproportionately affected by gender-based violence (GBV). We systematically reviewed English language, peer-reviewed, quantitative evaluations of interventions to reduce violence against women and girls (VAWG) in SSA that involved a comparison group and reported GBV incidence, or GBV-related attitudes, norms and symptoms as an outcome. We identified 53 studies published between January 2000 and April 2020 and classified these programmes from an empowerment perspective using the following categories: social, economic, combined social and economic and psychological empowerment interventions. Our review found social empowerment interventions effective for transforming gender attitudes and norms and reducing GBV, and psychological empowerment interventions effective for managing GBV-related symptoms. The evidence for economic empowerment interventions was equivocal. Key elements of successful interventions included participatory group learning, engaging male partners, engaging the community, longer duration and utilising existing platforms. Promising approaches for further research included gender specific programmes, psychological empowerment interventions delivered by lay workers and psychological empowerment interventions focused on GBV reduction.

Intimate partner violence, substance use, and health comorbidities among women: A narrative review

Exposure to intimate partner violence (IPV), including physical, sexual, and psychological violence, aggression, and/or stalking, impacts overall health and can have lasting mental and physical health consequences. Substance misuse is common among individuals exposed to IPV, and IPV-exposed women (IPV-EW) are at-risk for transitioning from substance misuse to substance use disorder (SUD) and demonstrate greater SUD symptom severity; this too can have lasting mental and physical health consequences. Moreover, brain injury is highly prevalent in IPV-EW and is also associated with risk of substance misuse and SUD. Substance misuse, mental health diagnoses, and brain injury, which are highly comorbid, can increase risk of revictimization. Determining the interaction between these factors on the health outcomes and quality of life of IPV-EW remains a critical need. This narrative review uses a multidisciplinary perspective to foster further discussion and research in this area by examining how substance use patterns can cloud identification of and treatment for brain injury and IPV. We draw on past research and the knowledge of our multidisciplinary team of researchers to provide recommendations to facilitate access to resources and treatment strategies and highlight intervention strategies capable of addressing the varied and complex needs of IPV-EW.

Trajectories of Depression, Post-Traumatic Stress, and Chronic Pain Among Women Who Have Separated From an Abusive Partner: A Longitudinal Analysis

This longitudinal study explored changes in women's health after separation from an abusive partner by characterizing the trajectories of their mental health (depression and post-traumatic stress disorder [PTSD]) and physical health (chronic pain) over a 4-year period. We examined how the severity of intimate partner violence (IPV) affected these trajectories, controlling for selected baseline factors using 5 waves of data collected from a community sample of 309 English-speaking, Canadian women. IPV severity was measured using the Index of Spouse Abuse where women were asked to consider the entire period of their partner relationship up to present at wave 1 and to rate their IPV experiences in the previous 12 months at waves 2-5. Mental health was measured using established self-report measures of depression (CESD) and PTSD (Davidson Trauma Scale), while chronic pain was measured using the Chronic Pain Grade Scale. Trajectories were estimated using MLM techniques with severity of IPV and selected co-variates (time since separation, age, financial strain) included. Our results show that women's health improved significantly over time, although significant levels of depression, PTSD symptoms and disabling chronic pain remained at the end of wave 5. Regardless of time since separation, more severe IPV was associated with higher levels of depression, PTSD, and disabling chronic pain, with IPV having a stronger effect on these health outcomes over time, suggesting cumulative effects of IPV on health. The results of this study contribute to quantifying the continuing mental and physical health burdens experienced by women after separation from an abusive partner. Increased attention to the long-term effects of violence on women's health beyond the crisis of leaving is critically needed to strengthen health and social services and better support women's recovery and healing.

Development and Psychometric Assessment of a Questionnaire for the Detection of Invisible Violence against Women

BACKGROUND

Invisible violence against women (IVAW) can be understood as the set of attitudes, behaviors, and subtle beliefs that men use to subordinate women and that are culturally accepted. These behaviors can be a risk factor for intimate partner violence (IPV), so it is important to design tools that allow us to detect it early. The aim of this study was to design and psychometrically assess a questionnaire for the detection of invisible violence against women (Q-IVAW).

METHODOLOGY

A descriptive cross-sectional methodological study carried out in three phases: (1) development of the initial version; (2) pilot study (N = 51); and (3) final validation study (N = 990). The tool's reliability, validity, and legibility were assessed. To assess reliability, the internal consistency (Cronbach's α) was analyzed. The validity assessment included an analysis of content, criterion, and construct validity.

RESULTS

The EFA revealed that the Q-IVAW was comprised of five factors that explained 55.85% of the total variance found. The Q-IVAW showed very high reliability (α = 0.937), excellent content validity, and good construct validity. The criterion validity analysis showed a moderate correlation between A-IPVAW and Q-IVAW (r = 0.30; p < 0.001).

CONCLUSION

The psychometric assessment of the Q-IVAW yielded good results, which could support the tool's ability to assess how often women are subjected to inviable violent behaviors by their partners.

Women’s experiences of navigating chronic pain within the context of living with an episodic disability

Objectives:

Of the 6.2 million Canadians aged 15 years or older who live with disability, 61% have disabilities that are not static or continuous. These dynamic conditions are known as episodic disabilities and many disproportionately experienced by women. Chronic pain is also a common feature associated with many episodic disabilities. The purpose of this article is to explore the experience of chronic pain for women living with episodic disabilities.

Methods:

This qualitative study draws on the tenets of interpretive description. Thirty women, with one or more episodic disabilities and chronic pain, participated in a semi-structured interview and answered questions about their chronic pain levels, using Von Korff et al.’s graded chronic pain scale.

Results:

Women experienced gendered treatment within the healthcare system and reported that they were frequently dismissed by their healthcare providers, most often physicians. Healthcare professionals’ practices around pain assessment were another common challenge for women. Women who were able to access financial support from government disability programs were more likely to access allied health professionals. Many of the holistic strategies that women researched and used to treat chronic pain were self-enacted. While diet, exercise, and other self-care activities are general health promotion strategies for all, they were seen as essential aspects of living that helped women have control over chronic pain and modifying the course of their episodic disability.

Conclusion:

Living with chronic pain and an episodic disability is complex. The findings of this study present the impact that gendered treatment in the healthcare system has on women who live with an episodic disability and experience chronic pain. It is evident that the current system did not meet the needs of the women in our study and system changes could result in better experiences, more disclosure of alternative therapies, and increase women’s agency in their care.

Intimate Partner Violence and Trauma-Informed Care in Pregnancy

Intimate partner violence is defined as any behavior within an intimate relationship that causes physical, psychological, or sexual harm to those in the relationship. Globally, women are disproportionately victims of intimate partner violence. The risk increases during pregnancy, with rates estimated as high as 20% among pregnant persons. Intimate partner violence is associated with adverse perinatal outcomes, including perinatal and maternal death. As pregnancy is a period of frequent interaction with the healthcare system, it is an opportune time to screen and intervene for intimate partner violence. Universal screening at the first prenatal visit and subsequently every trimester is recommended, with either written or verbal validated tools. Pregnant persons experiencing intimate partner violence need nonjudgmental, compassionate, confidential and trauma-informed care. The goal of this review is to outline pregnancy-specific care considerations.