Fears of disclosure and misconceptions regarding domestic violence reporting amongst patients in two US emergency departments

The Extremely High Risk Category Model for Nonfatal Strangulation

AIMS

This study investigates the risk factors and prevalence of nonfatal strangulation (NFS) within the contexts of intimate partner violence and sexual assault, with a particular focus on the demographic and relational dynamics that influence its occurrence.

DESIGN/METHODS

A comprehensive literature review was undertaken, encompassing both quantitative and qualitative data from existing research on NFS.

RESULTS

The Extremely High Risk Category Conceptual Model for NFS emerged as an innovative, investigator-developed framework that synthesizes the current literature on factors associated with NFS risk.

CONCLUSION

Frameworks that integrate current evidence on NFS risk factors, such as the Extremely High Risk Category model, have the potential to inform the practices of healthcare, social services, and law enforcement professionals. By identifying higher risk individuals, these professionals can implement targeted safety planning and support services. There is an urgent need for focused research and intervention strategies to address the complexities of NFS within intimate partner violence and sexual assault contexts. Expanding research to include diverse populations across genders and ages is crucial for the development of comprehensive prevention and support measures.

Women's experiences of gender-based violence supports through an intersectional lens: a global scoping review

ABSTRACT

Objective

To apply an intersectional lens to explore how the interconnected social identities of women across global settings impact access experiences for gender-based violence (GBV) supports.

Design

A scoping review.

Data sources

We systematically searched seven databases to identify studies published in English from the database inception to January 2023.

Inclusion criteria

We included peer-reviewed studies with a primary objective of examining the access experiences of populations who self-identify as women (aged 15 years or older) who have experienced GBV, have intersecting identities (ie, racialisation, poverty, etc) that can further contribute to marginalisation and utilised or sought support services.

Methods

Two reviewers independently completed title/abstract, full-text screening and data charting. Integrating intersectionality theory and the McIntyre access framework, we analysed support service access and utilisation across social identities, axes of marginalisation and geographic contexts.

Results

210 papers (195 distinct studies) met the inclusion criteria. Most studies (60%) were published since 2015 and used qualitative methods (63%). Findings reflected intersectional differences in women's experiences of accessing GBV services across contexts and lived experiences. Common findings indicate that seeking GBV support was motivated and enabled by informal supports and positive prior experiences in accessing services. However, findings highlight that structural and systemic constraints in existing support systems (in all study settings) impact access to necessary support services and their alignment with women's needs. Few studies examined health and non-health outcomes associated with unhindered access to care.

Conclusions

Women's experiences with GBV support systems in different geopolitical contexts highlight barriers across axes of racialisation, poverty, multidimensional violence and other systemic factors, which are often eclipsed in generic one-size-fits-all models of support. This research can inform transformational policy development and tailored interventions to improve outcomes for all women who experience GBV and thus advance gender equality and equity goals.

What ethical conflicts do internists in Spain, México and Argentina encounter? An international cross-sectional observational study based on a self-administrated survey

BACKGROUND

The differences in clinical bioethics between the Mediterranean and Latin American cultures have not been analyzed. The objective of the study is to compare the ethical conflicts that internists in Spain, Mexico and Argentina have.

METHODS

Cross-sectional observational study through a survey directed at internists from Spain, Argentina and Mexico. The survey was administered to affiliated members of the National Societies of Internal Medicine across three countries via an online platform.

RESULTS

762 internists participated, 261 from Spain, 154 from Argentina and 347 from Mexico. The main ethical conflicts that internists in Spain, Argentina and Mexico have are related (in order) to the end of life, to the clinical relationship and to the patient's autonomy. Withholding and withdrawing life-sustaining treatment is the most frequent conflict in Spain and Argentina and the second in Mexico.

CONCLUSIONS

Internists from Spain and Argentina identify very similar ethical conflicts. Furthermore, they consider them more frequent and difficult than in Mexico. In Argentina they are less satisfied with the way they are resolved. To explain these differences, socio-cultural factors are postulated, among others: paternalism, individualism, masculinity, organization of the health system, formal training in bioethics and assessment of death.

Mental Health and Quality of Life in Ecuadorian Women Exposed to Gender-Based Violence

Violence Against Women is a global problem that affects millions of women around the world. The main objective of this study was to evaluate the Mental Health and Quality of Life of Ecuadorian women exposed or not exposed to Gender Violence mediated by sociodemographic factors. A total of 433 Ecuadorian women, 18 to 64 years of age, most of whom (69%) reported being exposed to gender violence. Most of the women lived in the province of Pichincha and were selected through a type of nonprobabilistic sampling based on a survey about gender violence. Women exposed to gender violence showed a greater impact on personality profiles, clinical tests, and quality of life in the physical, psychological, social, and environmental domains compared to women not exposed to violence. In addition, these effects were mediated by age, economic level, education, marital status, and exposure to physical violence and psychological or sexual abuse within the socio-family or work contexts. The results of this study could contribute to improving public health systems, showing improvements in care programs for victims of violence.

In their own words: Perspectives of IPV survivors on obtaining support within the healthcare system

BACKGROUND

Almost half of all women in the US experience intimate partner violence (IPV) in their lifetime. The US Preventive Services Task Force recommends IPV screening paired with intervention for women of reproductive age. We aim to understand clinical practices and policies that are beneficial, detrimental, or insufficient to support survivors of IPV in a safety-net healthcare system.

METHODS

We sampled 45 women who were 18-64 years old, had experienced IPV within the prior year and were patients in the San Francisco Health Network. We conducted in-depth, semi-structured interviews to elicit their perspectives on disclosing IPV and obtaining support within the healthcare system. We analyzed our data using thematic analysis and grounded theory practices informed by ecological systems theory.

FINDINGS

We identified four themes regarding factors that impeded or facilitated discussing and addressing IPV across interpersonal and systemic levels relating to relationship-building, respect, autonomy and resources. (1) Interpersonal barriers included insufficient attention to relationship-building, lack of respect or concern for survivor circumstances, and feeling pressured to disclose IPV or to comply with clinicians' recommended interventions. (2) Interpersonal facilitators consisted of patient-centered IPV inquiry, attentive listening, strength-based counseling and transparency regarding confidentiality. (3) Systemic barriers such as visit time limitations, clinician turn-over and feared loss of autonomy from involvement of governmental systems leading to separation from children or harm to partners, negatively affected interpersonal dynamics. (4) Systemic facilitators involved provision of resources through IPV universal education, on-site access to IPV services, and community partnerships.

CONCLUSIONS

Women experiencing IPV in our study reported that relationship-building, respect, autonomy, and IPV-related resources were essential components to providing support, promoting safety, and enabling healing in the healthcare setting. Successful trauma-informed transformation of healthcare systems must optimize interpersonal and systemic factors that improve survivor wellbeing while eliminating barriers.