Risk and Protective Factors for Intimate Partner Violence Against Women: Systematic Review and Meta-analyses of Prospective-Longitudinal Studies

Impact of Intimate Partner Violence on Children

This review article highlights the longitudinal impact of intimate partner violence (IPV) on children, with a particular focus on in utero exposure and the mother-infant dyad. Research related to the identification of injuries and co-occurrence of child maltreatment in cases of IPV is summarized. Considerations around when and how to report to child protective services in the context of child exposure to IPV is discussed. Finally, universal education, home visiting, clinical programs, and factors associated with resiliency are examined as potential opportunities to support and empower survivor caregivers and their children.

"The questions made me realize how many times I could have been saved and removed from that situation": The experiences of patients attended to by paramedics for intimate partner violence, and actionable implementations for paramedicine

INTRODUCTION

Intimate partner violence (IPV) persists as a severe and prevalent criminal, social, and health issue, most commonly affecting women. Survivors of IPV frequently engage with the healthcare system to access treatment, support, and resources. Paramedics commonly encounter, either knowingly or unknowingly, patients experiencing IPV. There is little empirical research on how paramedics manage cases involving IPV.

OBJECTIVE

To examine how the perspectives and experiences of survivors of IPV who have been attended to by paramedics can inform our understanding of paramedic services.

METHODS

Using an interpretive description qualitative approach in the context of paramedicine, self-identified women (18+ years) who reported a history of IPV and being attended to by paramedics for IPV-caused reasons participated in semi-structured interviews. Interviews were transcribed verbatim and de-identified. De-identified transcripts were inductively analyzed (NVivo) for common patterns.

RESULTS

N = 9 survivors participated in interviews. Participants experienced cyclic and escalating physical, sexual, psychological, and coercive control forms of IPV. Participants primarily reported accessing paramedic services following instances of severe IPV and reported receiving minimal treatment and support. Challenges included bias and discrimination, poor individual paramedic conduct, undereducated and undertrained paramedics, insufficient infrastructure, inadequate transitions into healthcare and community services, perpetrator dynamics, and survivor dynamics. Corresponding solutions were safe and equitable paramedic behaviour, respectful conduct, mandatory education and training, develop functional infrastructure, develop functional transitions, and utilize techniques to engage with perpetrators and survivors.

CONCLUSION

Personal, situational, practitioner, paramedic service, and broad systemic infrastructure challenges cause survivors of IPV to be underserviced by paramedic services. Inadequate intervention efforts may be harmful or fatal for survivors. Survivor-derived solutions may guide paramedic service improvements. With improved service delivery, paramedics could evolve into reliable and useful resources for survivors of IPV.

Prevalence and factors associated with intimate partner violence among women in Tanzania: evidence from Tanzanian demographic and health survey 2022

BACKGROUND

Intimate partner violence (IPV) remains a pervasive issue in Tanzania, impacting the physical, mental, and emotional well-being of women across the country. Despite the existence of legal frameworks aimed at protecting women's rights, IPV persists in Tanzania. Understanding the magnitude and factors associated with IPV among women provides valuable insights that can be used to shape policies and interventions targeted at preventing and addressing IPV in the country. However, there is a paucity of evidence on the prevalence and factors associated with IPV nationwide. Therefore, this study is timely for addressing this gap in Tanzania.

METHODS

The study used a nationally representative secondary data that employed a cross-sectional design. Data for the current study were extracted from the 2022 Tanzania Demographic and Health Survey for women aged 15-49 years. A weighted sample of 4503 ever married or ever partnered women aged 15-49 years was used. The outcome variable was IPV status categorized into binary responses yes/no, while independent variables were socio-demographic and health related characteristics. Data were analysed using descriptive analysis, bivariable and multivariable logistic regression models. A threshold of p-value < 0.05 was used to determine statistically significant factor. The strength of the association was assessed using the adjusted odds ratio (aOR) along with its corresponding 95% confidence interval (CI).

RESULTS

The overall prevalence of IPV among women of reproductive age 15-49 years in Tanzania was 38.9%. The multivariable logistic regression results revealed that women who are working (aOR = 1.4,95%CI:1.2,1.7) and those whose husband/partner drinks alcohol (aOR = 2.9,95%CI: 2.4, 3.5) had higher odds of experiencing IPV compared to their counterparts. Conversely, protective factors include women's secondary and higher education level (aOR = 0.7,95%CI:0.5,0.9) and residing in the Southern zones (aOR = 0.4,95%CI:1.5,3.9).

CONCLUSION

The prevalence of IPV among women in Tanzania remains high compared to the global average of 30%. This was mostly associated with women's employment status, and women married/cohabiting with alcohol consumers. The government should implement community-based educational programs to raise awareness about IPV and dedicate more efforts like raising the tax on all alcoholic beverages to controlling alcohol consumption among men as a strategy to combat IPV in society.

Intimate partner violence and stress-related disorders: from epigenomics to resilience

Intimate Partner Violence (IPV) is a major public health problem to be addressed with innovative and interconnecting strategies for ensuring the psychophysical health of the surviving woman. According to the World Health Organization, 27% of women worldwide have experienced physical and sexual IPV in their lifetime. Most of the studies on gender-based violence focus on short-term effects, while long-term effects are often marginally included even though they represent the most serious and complex consequences. The molecular mechanisms underlying stress-related disorders in IPV victims are multiple and include dysregulation of the hypothalamic-pituitary-adrenal axis, inflammatory response, epigenetic modifications, neurotransmitter imbalances, structural changes in the brain, and oxidative stress. This review aims to explore the long-term health consequences of intimate partner violence (IPV), emphasizing the biological and psychological mechanisms underlying stress-related disorders and resilience. By integrating findings from epigenetics, microbiome research, and artificial intelligence (AI)-based data analysis, we highlight novel strategies for mitigating IPV-related trauma and improving recovery pathways. Genome-wide environment interaction studies, enhanced by AI-assisted data analysis, offer a promising public health approach for identifying factors that contribute to stress-related disorders and those that promote resilience, thus guiding more effective prevention and intervention strategies.

Causal and common risk pathways linking childhood maltreatment to later intimate partner violence victimization

Childhood maltreatment and intimate partner violence (IPV) victimization are major psychiatric risk factors. Maltreatment substantially increases the likelihood of subsequent IPV victimization, but what drives this association is poorly understood. We analyzed retrospective self-reports of maltreatment and IPV victimization in 12,794 participants (58% women, 42% men) from the Twins Early Development Study at ages 21 and 26 using quantitative genetic methods. We estimated the etiological influences common to maltreatment and IPV, and the effect of maltreatment on IPV beyond such common influences. Participants who reported childhood maltreatment ( ~ 7% of the sample) were 3 times more likely than their peers to also report IPV victimization at age 21, 4 times more likely at 26. The association between maltreatment and IPV was mostly due to environmental influences shared by co-twins (42-43%) and genetic influences (30-33%), as well as nonshared environmental influences (25-27%). The association between maltreatment and IPV was similar for women and men, but its etiology partly differed by sex. Maltreatment had a moderate effect on IPV in phenotypic models (β = 0.25-0.30), decreasing to a small-to-moderate range in causally informative models accounting for their common etiology (β = 0.15-0.21). Risk factors common to maltreatment and IPV victimization are largely familial in origin, environmental and genetic. Even considering common risk factors, experiencing maltreatment may be causally related to subsequent IPV victimization. Interventions promoting safe intimate relationships among young adults exposed to maltreatment are warranted and should address family-level environmental risk and individual-level risk shaped by genetics.

Intimate partner violence in southernouthern Tunisia: A retrospective study of the sociodemographic and medicolegal clinical profile

BACKGROUND

Intimate partner violence (IPV) is a significant public health issue that severely affects women's health and well-being in Tunisia. Understanding the socio-epidemiological profiles of IPV victims and perpetrators, along with the medico-legal implications, is essential for developing effective prevention measures.

METHODS

This was a cross-sectional, retrospective study that analyzed victims of intimate partner violence (IPV) in the Governorate of Sfax, Tunisia, from June 2022 to June 2023. Participants were interviewed face-to-face, and data were collected from medico-legal reports and police records based on the victims' complaints.

RESULTS

Our study included 374 suspected IPV victims, 96 % of whom were women with a mean age of 36. Most alleged perpetrators were male, with a significant proportion having a history of alcohol abuse and criminal activity. Physical assault combined with verbal abuse was the predominant form of IPV, often triggered by financial difficulties. The average duration of temporary total disability was 6 days, with 6.9 % of victims at risk for partial permanent disability.

CONCLUSION

This study provides insights into the socio-epidemiological profiles of IPV victims and perpetrators in southern Tunisia. While the findings may underestimate the true prevalence due to underreporting, the adoption of domestic violence legislation represents a significant step forward. By understanding these dynamics, we can develop effective strategies to mitigate the risk of IPV and promote healthier relationships.

A qualitative study of abortion decision-making trajectories among pregnant women at their first antenatal care visit in Kampala, Uganda

Background

In Uganda, only about half of women who want to avoid pregnancy are using modern contraceptives, leading to high numbers of unintended pregnancies and elevated maternal and neonatal morbidity and mortality. In this study, we aimed to learn more about women's abortion decision-making before continuing to carry a pregnancy.

Methods

We utilised a qualitative study design and interviewed 31 purposively selected single and partnered pregnant women aged ≥18 years at their first antenatal care visit at Kawempe National Referral Hospital in Kampala, Uganda. We conducted the interviews in Luganda or English, transcribed them, and then translated them into English, as needed, for analysis. We analysed the data using thematic analysis. Deductive codes were based on social networks, social support, and health behaviour theories, and inductive codes were derived from interview transcripts.

Results

Almost half of the study participants (n = 13) considered an induced abortion before deciding to continue carrying their pregnancy. The most commonly stated reasons they considered abortion included anticipated interruptions to work and education, exhaustion related to child-rearing, and lack of social support. Other participants (n = 9) reported not considering abortion due to anticipated social support for their pregnancy, concerns about abortion-related morbidity and mortality, late confirmation of pregnancy, and religious beliefs. No participants discussed Uganda's restrictive abortion policies as a reason not to consider abortion.

Conclusions

Our results point to opportunities for continued reproductive health education and improved access to reproductive health services to allow pregnant women to meet their reproductive needs, seek out family planning, antenatal care, and safe abortion services when desired, and create support networks for pregnant women.

Intimate partner psychological violence and children's sleep difficulties up to 5 years of age: an ELFE birth cohort

To examine the association between intimate partner psychological violence (P-IPV) from before pregnancy to 2 years after the child's birth and child's sleep patterns, i.e. sleep onset difficulty (SOD), nighttime awakenings (NA), and nighttime sleep duration (NSD) between 2 and 5 years of child's age. Data come from the population-based French birth ELFE cohort launched in 2011. P-IPV was assessed before and during pregnancy, at 2 months and 2 years post-partum. Children's sleep patterns were measured at 2, 3, and 5 years of age. Group-based trajectory modelling was used to identify trajectories of P-IPV and each child's sleep patterns. Associations between P-IPV and children's sleep trajectories were assessed by weighted multivariate logistic regressions. Five P-IPV trajectories were identified: minimal (64%), prenatal (14%), decreasing (9%), increasing (8%), and persistent (5%). Two trajectories of SOD (few 65% and many 35%), three trajectories of NA (few 49%, decreasing 24%, and many 23%), and three trajectories of NSD (short 21%, medium 56%, and long 23%) were identified. About 9513, 9512, and 9499 children were included in comparative analyses, respectively, focused on SOD, NA, and NSD. Increasing and persistent P-IPV trajectories were both associated with the trajectory of many SODs [odds ratio (OR) = 1.53, 95% confident interval (CI) = 1.24-1.91; and OR = 1.71, 95% CI = 1.31-2.22, respectively] and the trajectory of many NA (OR = 1.66, 95% CI = 1.29-2.13); and (OR = 1.95, 95% CI = 1.42-2.69, respectively). Associations between persistent P-IPV and decreasing and many NA were significant among girls (OR = 1.76, 95% CI = 1.12-2.75 and OR = 2.27, 95% CI = 1.39-3.71, respectively), but not among boys. Family interventions in response to IPV should pay particular attention to sleep patterns of children exposed to IPV.

Concordance of Mother and Father Reports of Intimate Partner Violence and Observed Interactions in Unmarried Black Coparents Expecting Their First Child

Concordance between partner reports of Intimate Partner Violence (IPV) is generally low, but self-reporting of IPV and concordance between partners among expectant parents in marginalized communities has not been explored, nor have associations among each partner's reports of IPV and their behaviors in observed conflict discussions. This study will examine these gaps. One hundred and thirty-eight low-income, unmarried, Black, coparenting dyads expecting their first child together (136 mothers and 136 fathers) completed the Revised-Conflict Tactics Scale and a video recorded and coded conflict discussion. There was low concordance between parent's reports of IPV overall with moderate levels of concordance for coparents who were living together and had more harmonious relationships. Linear regression analyses indicated only mothers' reports of fathers' psychological and physical IPV but not fathers' reports of IPV were significantly associated with observed negative communication. Neither coparents' reports of psychological or physical IPV were associated with positive communication during a conflict discussion. These findings suggest that at the time of parenthood transitions, mothers' reports of fathers' IPV behaviors may be more robust in their association with negative/unhealthy couple communication patterns than fathers' reports and should be used when making safety determinations with families.

Disability and intimate partner violence experience among women in rural Samoa: A cross-sectional analysis

BACKGROUND

Women with disabilities experience higher rates of intimate partner violence (IPV). Evidence suggests this violence often manifests in more subtle and severe forms over longer periods of time. There is limited evidence on this association in the Pacific Islands region, despite facing one of the highest global prevalences of IPV.

OBJECTIVE

Examine the prevalence of disability and the association between disability and types of IPV experience among women in rural Samoa as part of the EVE Project.

METHODS

This study analysed cross-sectional data collected with nine communities in rural Samoa between December 2022 and February 2023. Enumerators collected data with 707 women on tablets using REDCap. IPV was measured using the standardised Demographic and Health Survey (DHS) domestic violence methodology. Disability was assessed using the Washington Group questions. Logistic regression was conducted to examine the association between disability and experiences of IPV (physical, sexual, emotional and economic violence) among women.

RESULTS

Having a disability was significantly associated with increased IPV experience among women in this study. When controlling for age and education, women with severe disability were significantly more likely to experience sexual (OR 4.31; p = 0.01) and emotional (OR 2.87; p = 0.02) IPV, when compared to women with no disability.

CONCLUSIONS

Our findings point towards a greater vulnerability of women with disabilities to IPV, and particularly sexual and emotional IPV, in rural Samoa. Qualitative research in partnership with women with disabilities is essential to inform the design of measurement tools and prevention programmes that are grounded in the context-specific experiences and needs of all women with disabilities.

Intimate partner violence among Nepalese women and associated factors in 2021-2022

Intimate partner violence (IPV) remains a significant public health challenge globally, impacting millions and contributing to preventable suffering and pain, both emotionally and physically. In Nepal, like many other nations, tackling IPV is a key priority on the path to achieving sustainable development goals. IPV prevalence and its correlates were studied using the deidentified data for secondary analysis from the 2022 Nepal Demographic and Health Survey (DHS), and changes in IPV at the urban, rural, and national levels from the 2016 Nepal DHS. These cross-sectional surveys employed a two-stage cluster sampling technique. In the Nepal DHS 2022, a total of 4,523 ever-partnered women were included and administered IPV-related questions. Various socio-demographic, attitudinal, and experiential attributes of 15-49 year old women were identified and used in the simple and multiple logistic regression models for computing the bivariate and multivariable associations with IPV. Over their lifetime, 27.27% women experienced IPV perpetrated by their current or most recent husband/intimate partner, with physical IPV being the most common type reported. The six statistically significant factors associated with IPV in the multivariable model included educational level of women and their partner, number of living children, use of alcohol by partner, knowing about father having ever beaten mother, and controlling behavior displayed by partner. While changes in IPV from 2016 to 2022 were not statistically significant. One in four women having experienced IPV in their lifetime in Nepal with no discernable change over the course of 6-years is a major public health challenge requiring investing in programs that encourage and ensure economic and social autonomy for women and change in the harmful gender norms.

Gender-based economic violence and the exploitation of women: A deep dive

Economic violence is a form of domestic violence that extends beyond physical harm, affecting victims' economic stability and independence. This situation perpetuates gender inequality and also reinforces the cycle of gender-based violence. With definitions of economic violence broadening to encompass a range of coercive and manipulative behaviors - from financial abuse in domestic violence scenarios to the economic harassment faced by stay-at-home moms - understanding this form of exploitation is crucial for crafting effective interventions. This article aims to delve into various facets of economic violence, including its definition, prevalence, and the stark realities it creates for its victims. Following the search of international databases: Social Work Abstracts (EBSCO), Psychology Abstracts, Family and Women Studies Worldwide, Psychiatry Online, Psych INFO (including Psych ARTICLES), PubMed, Wiley, and Scopus, 60 peer-reviewed articles that met all inclusion criteria were included in the paper. Our review clarifies that looking forward, the call for a comprehensive understanding of economic violence, enhanced legal frameworks, and the strengthening of supportive networks underscore the multidisciplinary approach required to combat this issue effectively.

Experiences of intimate partner violence among female cancer patients: a meta-synthesis of qualitative research

OBJECTIVES

This research systematically synthesized qualitative studies on intimate partner violence experiences among female cancer patients, aiming to inform the development of relevant psychosocial interventions.

METHODS

PubMed, Embase, Web of Science, Scopus, Medline, The Cochrane Library, CINAHL, CNKI, Wanfang, VIP, and Sinomed databases were searched for qualitative studies on intimate partner violence among female cancer patients. The search time frame was from the establishment of the database to April 8 2024. The quality of included studies was assessed using the list of qualitative studies in the Joanna Briggs Institute (JBI) Reviewer Manual. Meta-synthesis was integrated according to the meta-aggregation method proposed by the JBI and reported in accordance with the guidelines for Enhancing Transparency in Reporting Qualitative Research Synthesis (ENTREQ).

RESULTS

This study incorporated literature from seven sources, extracting 24 primary findings into 10 categories. These categories were further synthesized into four overarching results: cancer patients experienced multiple forms of violence; the multiple impacts of violence on cancer patients; patients' different ways of coping with violence; and multiple needs of cancer patients.

CONCLUSIONS

Intimate partner violence has emerged as a major, preventable global health issue, particularly affecting female cancer patients and significantly impacting their physical and mental health. Healthcare professionals must vigilantly monitor and address the psychological aspects of these patients, offering psychological counseling and treatment promptly as required.

The Association Between Food Insecurity and Intimate Partner Violence Among U.S. Army Soldiers

Food insecurity in the military ranges between 25% and 33%, significantly higher than the 10.5% for civilians reported by the U.S. Department of Agriculture. The primary objective of this study is to analyze the association between food insecurity and intimate partner violence (IPV) victimization among U.S. Army Soldiers. The secondary objective is to determine if there are any moderating effects in the relationship between food insecurity and IPV victimization by demographic, financial, and mental health covariates. A cross-sectional, online survey was administered by the U.S. Army Public Health Center at an Army installation in 2019; 56% of respondents reported that they were married or in a relationship (n = 2,740). The main predictor was the two-item food insecurity screener (Hunger Vital Signs), which measures marginal food insecurity (encompassing marginal, low, and very low food security). The main outcome was IPV victimization as measured by the Hurt, Insult, Threaten, Scream scale. Multiple logistic regression was used to assess the association between marginal food insecurity and IPV victimization, controlling for demographic, financial, and mental health covariates. In a multivariable model, marginally food insecure respondents had 2.05-fold greater adjusted odds of reporting any IPV victimization when compared to highly food secure respondents (95% confidence interval [1.40, 3.00]). The only interaction that was statistically significant was between anxiety and food insecurity on IPV victimization (p = .0034). Interactions by soldier's military rank, birth sex, and race and ethnicity were not statistically significant. IPV has implications for the emotional and physical health of survivors. In addition, service members who are food insecure may experience similar decrements in emotional and physical health due to suboptimal nutrient intake. By addressing both food insecurity and IPV, the military has the potential to increase the overall well-being of its service members and their dependents.

Burden of intimate partner violence, mental health issues, and help-seeking behaviors among women in Nepal

BACKGROUND

Intimate partner violence (IPV) is the most common form of violence, presenting a significant public health concern, especially for women and girls. Help-seeking can reduce future IPV and mitigate adverse health outcomes, including mental health issues.

OBJECTIVES

This study is the first national assessment on IPV, mental health consequences, and associated help-seeking behaviors in Nepal.

DESIGN

A cross-sectional descriptive study.

METHODS

Using secondary data from the 2022 Nepal Demographic and Health Survey, this study includes 5178 women aged 15-49 and employs multivariate regression analysis to explore the association between IPV and mental health problems, as well as factors influencing help-seeking behavior for both issues.

RESULTS

Among participants, 31.4% reported ever experiencing IPV, and most (29.4% of all women) in the past 12 months. Of those ever experiencing IPV, 72.0% had not sought help for IPV, and 92.2% of those who did, opted for informal support. A total of 27.6% (n = 1427) of female interviewees reported anxiety symptoms, 21.5% (n = 1110) depressive symptoms, and 7.1% (n = 368) suicidal ideation within the past 2 weeks. These rates were higher among women who had experienced IPV in the past 12 months, with 41.1% reporting anxiety, 33.2% depression symptoms, and 14.1% suicidal ideation. Of the 4194 respondents with symptoms of anxiety, depression, or suicidal ideation who were asked about help-seeking for mental health issues, 19.4% (n = 812) had sought help, primarily from informal sources (93.4%, n = 759). Emotional IPV in the past 12 months increased the odds of anxiety (adjusted odds ratio (aOR) 3.00, 95% confidence interval (CI) 2.08-4.31), depression (aOR 3.09, 95% CI 2.19-4.37), and suicidal ideation (aOR 1.91, 95% CI 1.20-3.04). Sexual IPV increased the odds of anxiety (aOR 2.88, 95% CI 1.67-4.95) and depression (aOR 2.12, 95% CI 1.32-3.41), while controlling behavior heightened the odds of depression (aOR 2.42, 95% CI 2.02-2.89) and suicidal ideation (aOR 2.24, 95% CI 1.25-4.02).

CONCLUSION

This nationwide study reveals a high prevalence of IPV and related mental health problems among women in Nepal and a low rate of help-seeking behavior, in particular to formal support structures. Stronger health system responses and empowering informal support are essential to improve referrals and raise awareness for violence survivors.

Intimate Partner Violence and Human Trafficking Screening and Services in Primary Care Across Underserved Communities in the United States-Initial Examination of Trends, 2020-2021

OBJECTIVES

The Health Resources and Services Administration (HRSA) began collecting data on intimate partner violence (IPV) and human trafficking (HT) in the 2020 Uniform Data System (UDS). We examined patients affected by IPV and HT served by HRSA-funded health centers in medically underserved US communities during the COVID-19 pandemic.

METHODS

We established a baseline and measured trends in patient care by analyzing data from the 2020 (N = 28 590 897) and 2021 (N = 30 193 278) UDS. We conducted longitudinal ordinal logistic regression analyses to assess the association of care trends and organization-level and patient characteristics using proportional odds ratios (PORs) and 95% CIs.

RESULTS

The number of clinical visits for patients affected by IPV and HT decreased by 29.4% and 88.3%, respectively, from 2020 to 2021. Health centers serving a higher (vs lower) percentage of pediatric patients were more likely to continuously serve patients affected by IPV (POR = 2.58; 95% CI, 1.01-6.61) and HT (POR = 6.14; 95% CI, 2.06-18.29). Health centers serving (vs not serving) patients affected by IPV were associated with a higher percentage of patients who had limited English proficiency (POR = 1.77; 95% CI, 1.02-3.05) and Medicaid beneficiaries (POR = 2.88; 95% CI, 1.48-5.62), whereas health centers serving (vs not serving) patients affected by HT were associated with a higher percentage of female patients of reproductive age (POR = 15.89; 95% CI, 1.61-157.38) and urban settings (POR = 1.74; 95% CI, 1.26-2.37).

CONCLUSIONS

The number of clinical visits for patients affected by IPV and HT during the COVID-19 pandemic declined. Delayed care will pose challenges for future health care needs of these populations.

Does domestic violence legislation reduce permissive attitudes about intimate partner violence? Longitudinal evidence from men and women from 61 countries

ABSTRACT

Introduction

Intimate partner violence (IPV) is highly prevalent and has substantial implication for women's health. Changing IPV attitudes is one pathway to reduce IPV. While evidence suggests that interventions targeting individuals may change IPV attitudes, the effect of wider-scale interventions, such as legislation, remains unknown.

Methods

We used individual-level IPV attitudes information collected between 1997 and 2020 by the Demographic and Health Surveys and the Multiple Indicator Cluster Surveys, which we linked with national-level domestic violence (DV) legislation information. We evaluated the effect of adoption of DV legislation on changes in IPV attitudes using a difference-in-differences study design that controlled for time-varying country-level confounding and accounted for staggered timing of legislation adoption.

Results

Our sample included harmonised information across 61 countries, composed of 2 184 047 women from 60 countries and 390 877 men from 40 countries. After controlling for country-level time-varying confounders, adoption of DV legislation reduced IPV acceptability among women (average treatment effect among treated=-0.07, 95% CI: -0.16, 0.06) and men (average treatment effect among treated=-0.11, 95% CI: -0.22, 0.03) although estimates were imprecise and included the null.

Conclusions

DV legislation may reduce permissive IPV attitudes, especially among men, although conclusions should be interpreted cautiously due to imprecise estimates.

Theoretical Analysis of the Cycle of Intimate Partner Violence: A Systematic Review

Research on the intergenerational transmission of intimate partner violence (IPV), or the "cycle of violence," from childhood exposure (G1) to the perpetration of IPV in adulthood relationships (G2), has increased over the past decades. The link between childhood exposure to interparental violence and future IPV perpetration is largely explained by postulations from social and psychological theories, such as social learning theory. These theories provide claims regarding IPV transmission pathways and the mechanisms underpinning the transmission. However, evidence from extant theory-informed studies on the cycle of violence has generated several null and counter-predictive findings, which raises questions about the nature of the theory-informed research, as well as methodological questions. This systematic review sought to analyze how existing studies applied specific theories to research IPV transmission, and the mechanisms underpinning these transmissions. Following the PRISMA procedure for systematic reviews, we reviewed empirical articles from five databases (Scopus, Web of Science, CINAHL, Informit, and PubMed) published between 1990 and 2024. Results from the 30 included studies were synthesized under three theoretical categories, namely: social, psychological, and cultural theories. Under each theoretical category, we found inconsistent evidence, lack of empirical examination of theory-driven variables, and reductionist approaches, in terms of how claims from the theories are applied in research on IPV transmission. Research guided by a singular theoretical framework presented inconsistencies compared to those applying a multi-theory approach. As a result, we recommend an integrated theoretical model that considers the comprehensive and transactional process/factors that underpin IPV transmission.

Understanding the role of self-esteem and emotion dysregulation in victims of intimate partner violence

Self-esteem and emotion dysregulation appear to be important factors in the psychological well-being of trauma survivors. On the one hand, self-esteem may act as a shield against the psychological consequences of traumatic experiences; on the other hand, emotion regulation can affect the way individuals deal with post-traumatic affects (e.g., fear, terror, shame, and guilt). Consequently, the objective of this study was to investigate the role that emotion dysregulation and self-esteem play in the well-being of a sample of women after the traumatic experience of intimate partner violence (IPV). This study involved 282 women (mean age  = 41.55, SD = 10.52) who experienced IPV in the last year. Conditional process analyses and Johnson-Neyman analysis for regions of significance were performed. The results showed that emotion dysregulation mediated the relationship between post-trauma affectivity (i.e., fear, terror, shame and guilt) and survivors' well-being. Furthermore, self-esteem negatively predicted lack of well-being and acted as a moderator of the relationship between emotion dysregulation and lack of well-being. In this regard, through the Johnson-Neyman analysis for regions of significance, it was possible to identify a cut-off value above which the relationship between emotion dysregulation and lack of well-being became non-statistically significant. This study contributed to understanding the role that emotion dysregulation and self-esteem play in the well-being of IPV survivors. In this regard, clinical implications will be presented.

An Exploratory Study of Financial Health as an Antecedent of Economic Abuse Among Women Seeking Help for Intimate Partner Violence

Economic abuse is a common component of intimate partner violence (IPV). This study explored whether IPV victim and perpetrator financial health at relationship outset are associated with two types of economic abuse-restriction and exploitation-during the relationship. With a sample of 315 women seeking services for male-perpetrated IPV, the study showed increased use of economic restriction when perpetrators were advantaged in terms of assets or disadvantaged in terms of debt. There was increased use of economic exploitation when victims were advantaged in terms of assets or credit and when perpetrators were disadvantaged in terms of assets, debt, or credit. Implications for research and intervention are discussed.

Childhood Violence, High School Academic Environment, and Adult Alcohol Use Among Latinas and Black Women: A Structural Equation Modeling Study

OBJECTIVE

Young Latinas and Black women drink less than women of other racial/ethnic groups but experience more alcohol-related problems in midlife. This study aims to identify modifiable factors to prevent adult onset of alcohol use disorder (AUD) in this population.

METHODS

Data were collected at six time points as part of the Harlem Longitudinal Development Study from 365 Latinas (47%) and Black (53%) women (mean age at time 1 = 14, standard deviation 1.3). Structural equation modeling was used to test hypothesized pathways from childhood physical and sexual abuse to AUD via depressive mood, anxiety disorders, and somatic complaints in the 20s. We also tested the moderation effect of the high school academic environment by including in the structural equation model two latent variable interaction terms between the school environment and each of the abuse variables.

RESULTS

Childhood physical and sexual abuse was positively associated with depressive mood, anxiety disorders, and somatic complaints when participants were in the 20s. Depressive mood mediated childhood abuse and AUD when women were in the 30s. The high school academic environment attenuated the effect of physical, but not sexual abuse, on depressive mood (β = -0.59, B = -9.38, 95% CI [-14.00, -4.76]), anxiety symptoms (β = -0.61, B = -14.19, 95% CI [-21.76, -6.61]), appetite loss (β = -0.41, B = -10.52, 95% CI [-15.61, -5.42]), and sleeplessness (β = -0.50, B = -9.56, 95% CI [-13.95, -5.17]) in the early 20s.

CONCLUSIONS

Our findings underscore the need to invest in early violence prevention interventions and in education to ensure equitable access to quality, academically oriented, and safe schools.

Sexual Double Standards and Violence in Intimate Partner Relationships: The Role of Empathy in the Consumption of Online Sexual Content

The aim of this study was to evaluate the fit of an explanatory theoretical model of the relationship between sexual double standards (SDS) and violence in intimate partner relationships when empathy and online access to sexual material are taken into account. Cluster sampling was used to select 490 university students for participation in the study. The mean age of the participants was 21.89 years (SD = 3.52) and 70% were female. A battery of questionnaires was administered comprising the SDS scale, the sexuality on the internet and social networks questionnaire (CSRI-1), interpersonal reactivity index, and the intimate partner violence (IPV) questionnaire. The questionnaires were administered in a group-classroom setting. The results show that empathy acts as a protective and mediating variable because it reduces the impact of online sexual material on violent behavior. In addition, it was seen that the consumption of online sexual material has a direct impact on IPV and SDS. These findings point to the importance of taking empathy and the consumption of online sexual material into account in the development of prevention and intervention programs for tackling violence in young couples.

The Association Between Victimization and Perpetration of Physical Intimate Partner Violence and Unmet Healthcare Needs Among Married Women in South Korea

This study assessed physical intimate partner violence (IPV) experiences and examined their association with unmet healthcare needs among married women in South Korea. We analyzed data from a nationally representative longitudinal survey of 6,533 women at baseline. Participants were asked yes/no questions about their experiences of physical IPV victimization and perpetration over the past year. The responses were classified into four categories of IPV experience: "none," "victimization only," "perpetration only," and "both victimization and perpetration." At baseline, 0.9% reported being victimized only, and 25.9% reported both victimization and perpetration. The prevalence of unmet healthcare needs over the past year at baseline was 0.8%. Compared to women without any IPV experience, women in the IPV "victimization only" category had greater unmet healthcare needs (OR: 5.49, 95% CI [2.30, 13.12]) after adjusting for sociodemographic variables. Experiencing IPV perpetration only and both IPV victimization and perpetration were not statistically significantly associated with unmet healthcare needs. These results imply that physical IPV victims face difficulties accessing healthcare services which could exacerbate health inequalities over time. Moreover, this study suggests that it is necessary to distinguish IPV victims from those who experience IPV victimization only and those who experience both IPV victimization and perpetration.

Acceptability and feasibility of trauma- and violence-informed care for intimate partner violence

BACKGROUND/OBJECTIVES

Intimate partner violence (IPV) and child physical abuse frequently co-occur, yet IPV-exposed children are not routinely evaluated for abuse. Furthermore, IPV survivors often seek care for their children but not for themselves, making pediatric visits an opportunity to address IPV. We developed a trauma- and violence-informed care (TVIC)-based model that 1) evaluated IPV-exposed children and 2) linked survivor-caregivers to an IPV advocate. We aimed to assess the feasibility and acceptability of the model.

PARTICIPANTS

Children < 3 who were reported to Child Protective Services (CPS) for exposure to IPV and their survivor-caregiver.

METHODS

To examine feasibility, we calculated the percentage of 1) eligible children evaluated and 2) caregivers who met with an IPV advocate during the child's visit and followed up with the advocate. To assess acceptability, we conducted qualitative interviews with 30/41 caregivers about their perceptions of the model.

RESULTS

From 7/1/20-6/30/22, 49 (22.7 %) of 216 eligible children were evaluated. Of 41 caregivers, six already were receiving IPV services; Of the remaining 35, 24 (68.6 %) met with an IPV advocate, and 22 (91.7 %) had ≥1 follow-up visit with an advocate. We identified three themes: 1) Motivations for the visit, 2) Engagement with the model, and 3) Benefits. Caregivers attended the visit due to behavioral concerns about the child and a desire to comply with CPS. Engagement occurred as medical providers established rapport and provided support without judgment. Benefits included recognizing the impact of IPV on the child and immediate linkage to advocacy services.

CONCLUSION

A TVIC-based model is feasible and acceptable and could improve caregivers' engagement with the evaluation of IPV-exposed children for abuse and with IPV services, which have the potential to improve safety and promote well-being.

Clinical outcomes in patients with unintended pregnancy after liver transplantation: A multicenter registry cohort study

The consequences of unintended pregnancy in recipients of liver transplants (LTs), a growing part of the high-risk obstetric population, remain unknown. To fill this gap, we conducted a retrospective registry cohort study to describe the risk factors, obstetric and neonatal morbidity, and graft outcomes associated with unintended pregnancy after LT. This study utilized the Transplant Pregnancy Registry International and included 565 pregnancies of recipients of LT between 1967 and 2019 from 289 hospitals, primarily in North America. The primary outcome of acute cellular rejection and secondary outcomes of graft loss, severe maternal morbidity, and neonatal composite morbidity were compared by pregnancy intention. The study population included 60.9% with intended pregnancies and 39.1% with unintended pregnancies. Recipients with unintended pregnancy were more likely to self-report as Black race, to be younger, nulliparous, and to have exposure to teratogenic immunosuppression. Acute cellular rejection was more common with unintended pregnancy (3.7% vs. 1.2%, p =0.047). Unintended pregnancies had lower median birth weight (2806.6 vs. 2948.4 g, p =0.033). Unintended pregnancy was not associated with increased neonatal morbidity or severe maternal morbidity. These findings underscore the importance of family planning counseling, access to safe and effective contraceptive options, as well as multidisciplinary prenatal care in the growing population of recipients of reproductive-aged LT.

Prevalence and Factor Influencing Intimate Partner Violence against Women during COVID-19 Pandemic: A Systematic Review and Meta-Analysis

Background

It seems that the prevalence of intimate partner violence increased during the COVID-19 pandemic. To investigate the prevalence of different types of IPV and its contributing factors on a global scale during the COVID-19 pandemic.

Methods

This is a systematic review and meta-analysis study. This study followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist. All original studies, written in English that reported the overall prevalence of IPV or at least one type of IPV against women during the COVID-19 pandemic were included in this study. PubMed, Embase, Scopus, and Web of Science databases were searched in July 2023. Our general keywords included "Intimate Partner Violence", "Spouse Abuse", "Domestic Violence", "COVID-19", and "SARS-CoV-2". We used the Joanna Briggs Institute Checklist to assess the quality of all included studies. We conducted a random effect model for meta-analysis using the Mantel-Haenszel method in comprehensive meta-analysis software Version 3. Each type of IPV is calculated as an event rate with a 95% CI for each variable. The I2 statistic test was used to assess the Heterogeneity.

Results

Forty-one studies encompassing 14,615 participants met our eligibility criteria and were included in our study. The overall prevalence of IPV was 31% (95% CI: [24.2, 38.8], P < 0.001). Based on type, the highest rate of IPV in the included studies was reported for psychological type (33%, 95% CI: [23.4, 44.3], P = 0.004). The rates of IPV for economic, physical, and sexual types were 19.1% (95% CI: [12.2, 28.6], P < 0.001), 9.5% (95% CI: [6.8, 13.1], P < 0.001), and 8.5% (95% CI: [6.2, 11.7], P < 0.001), respectively. Age, education level, being pregnant, and marital duration were among the most frequent influencing factors.

Conclusion

About one-third of women experienced IPV during the COVID-19 pandemic. Psychological IPV emerged as the most prevalent type in the included studies. The most important factors were environmental, social, economic, cultural, and political factors. Age, education level, marital duration, being pregnant, and marital duration were among the most frequent influencing factors.

Interventions for intimate partner violence during the perinatal period: A scoping review: A systematic review

Background

Intimate partner violence (IPV) is a prevalent global health problem. IPV that occurs before pregnancy often continues during the perinatal period, resulting in ongoing violence and many adverse maternal, obstetrical, and neonatal outcomes.

Objectives

This scoping review is designed to broadly capture all potential interventions for perinatal IPV and describe their core components and measured outcomes.

Search Methods

We conducted a search for empirical studies describing IPV interventions in the perinatal population in June 2022. The search was conducted in MEDLINE, EMBASE, PsycInfo, CINAHL, Cochrane Central Register of Controlled Trials, Web of Science, Applied Social Sciences Index & Abstracts, ClinicalTrials.gov and MedRxiv. Hand searching of references from select articles was also performed.

Selection Criteria

Included studies described an intervention for those experiencing IPV during the perinatal period, including 12 months before pregnancy, while pregnant or in the 12 months post-partum. The search encompassed January 2000 to June 2022 and only peer-reviewed studies written in either English or French were included. Included interventions focused on the survivor exposed to IPV, rather than healthcare professionals administering the intervention. Interventions designed to reduce IPV revictimization or any adverse maternal, obstetrical, or neonatal health outcomes as well as social outcomes related to IPV victimization were included.

Data Collections and Analysis

We used standard methodological procedures expected by The Campbell Collaboration.

Main Results

In total, 10,079 titles and abstracts were screened and 226 proceeded to full text screening. A total of 67 studies included perinatal IPV interventions and were included in the final sample. These studies included a total of 27,327 participants. Included studies originated from 19 countries, and the majority were randomized controlled trials (n = 43). Most studies were of moderate or low quality. Interventions included home visitation, educational modules, counseling, and cash transfer programs and occurred primarily in community obstetrician and gynecologist clinics, hospitals, or in participants' homes. Most interventions focused on reducing revictimization of IPV (n = 38), improving survivor knowledge or acceptance of violence, knowledge of community resources, and actions to reduce violence (n = 28), and improving maternal mental health outcomes (n = 26). Few studies evaluated the effect of perinatal IPV interventions on obstetrical, neonatal or child health outcomes.

Authors' Conclusions

The majority of intervention studies for perinatal IPV focus on reducing revictimization and improving mental health outcomes, very few included obstetrical, neonatal, and other physical health outcomes. Future interventions should place a larger emphasis on targeting maternal and neonatal outcomes to have the largest possible impact on the lives and families of IPV survivors and their infants.

"Breaking through the Brokenness": An Arts-Based Qualitative Exploration of Pregnant Women's Experience of Intimate Partner Violence while Receiving Trauma- and Violence-Informed Antenatal Care

Intimate partner violence (IPV) is a pervasive, worldwide public health concern. Risk of IPV may elevate during the perinatal period, increasing maternal and fetal health risks. Trauma- and violence-informed care shows promise among interventions addressing associated mental health sequelae. As a secondary analysis, the purpose of this study was to employ a qualitative arts-based exploration to better understand pregnant women's experiences of trauma and violence-informed perinatal care in the context of IPV. Using an arts-based qualitative methodology, different art forms were used to analyze, interpret, and report data, resulting in a layered exploration to represent phenomena. From this, four themes were reflected in four poetic pieces: Black Deep Corners, Triggering my Thoughts, Breaking through the Brokenness, and Now Perfectly Imperfect. Nine pieces of visual art were created reflecting these themes, creating a layered, embodied, artistic way to empathically explore and translate phenomena.

No Escape: Mass Incarceration and the Social Ecology of Intimate Partner Violence Against Women

Women in heavily policed and incarcerated communities face extremely high rates of intimate partner violence (IPV)-but how criminal legal system contact affects such violence remains poorly understood. This study explores the social ecology of IPV by fitting structural equation models to longitudinal, dyadic data from households in contact with the criminal legal system (N = 2,224) and their local communities. Results suggest that a complex of factors at multiple social-ecological levels-including adverse local conditions, dysfunctional couple conflict, and men's behavioral health and perceptions of their neighborhoods-may put women at heightened risk of IPV victimization in a time of mass incarceration.

Intimate Partner Violence Risk Factors: A Vulnerability-Adaptation Stress Model Approach

Intimate partner violence (IPV) disproportionally affects women. Using the vulnerability-adaptation stress model, we examined adverse childhood experiences (ACEs), self-esteem, and hope as vulnerability indicators and relationship status and length, positive and negative affect, and socioeconomic status (SES) as stressors to ascertain the risk for IPV. Women (N = 491, M = 37.15, standard deviation = 12.51) completed an online survey comprised of the Positive and Negative Affect Scale, Rosenberg's Self-esteem Scale, Snyder's Hope Scale, ACE questionnaire, Composite Abuse Scale Revised-Short Form, and demographic questions. Factor analysis identified four ACE factors of sexual abuse, physical or psychological abuse, witnessing domestic violence, and household dysfunction. A five-step hierarchical multiple regression identified that greater exposure to physical or psychological child abuse was associated with an increased risk of IPV (Step 2), B = 0.73 [0.16, 1.34]. Lower self-esteem, B = -0.30 [-0.47, -0.14] predicted IPV (Step 3). Age B = 0.07 [0.01, 0.13], negative affect, B = 0.39 [0.19, 0.59], and relationship length, B = -1.24 [-2.16, 0.41] were associated with a higher risk of IPV (Step 4). In Step 5, previous variables attenuated to non-significance while age, B = 0.07 [0.01, 0.13], negative affect, B = 0.39 [0.19, 0.59], and relationship length B = -1.25 [-2.16, 0.41] remained significant. While the key findings of this study were inconsistent with some commonly reported findings (e.g., ACEs, self-esteem, hope, relationship status, SES, age), these inconsistencies are important to highlight given the factorial approach to examining ACEs, the comprehensive analyses conducted, and our examination of these variables' direct relationship to IPV. The study was limited by its cross-sectional nature, higher prevalence of IPV victims, and not examining IPV sub-types. Similar studies need to be conducted for other relationship types and victimized individuals (e.g., same-sex relationships and male victims) to provide a complete picture of risk factors for IPV.

Co-Design Workshops to Develop a Psychosocial Support Service Model for Refugees in Sweden Affected by Gender-Based Violence

BACKGROUND

Experiencing gender-based violence (GBV) is common among refugees. Intersecting systems of oppression can increase the risk of GBV and of suffering detrimental consequences, while concurrently creating barriers to meaningful support. Despite this, refugees with lived experience of GBV are rarely involved in the development, planning and adaptation of services and policies.

METHODS

This article reports on a formative research process that aimed to involve public contributors (refugee victim-survivors of GBV) and relevant stakeholders in co-designing a service model aimed at improving psychosocial support in Sweden. Led by a partnership of public contributors and academic researchers, the research process consisted of iterative cycles of co-design workshops, complemented by scoping of existing literature.

RESULTS

The co-design process resulted in a characterisation of the psychosocial service system needs, as perceived by the survivor co-researchers and stakeholders, and a two-level empowerment and support service model. The model included (i) a community-based intervention to promote help-seeking and (ii) psychosocial group support delivered in specialist clinics. Outcomes of the project included perceived benefits for those involved, service-led direct changes and acquisition of funding for continued research on the co-designed model.

CONCLUSION

Improving psychosocial support for refugees in Sweden affected by GBV requires safe spaces to connect with peers and familiarise with available services, laws and rights in the society. Further, strengthened collaborations across sectors are necessary to meet the variety of needs. Co-design workshops were an effective way to initiate changes in the service delivery model for psychosocial support for refugees in Sweden affected by GBV.

PATIENT OR PUBLIC CONTRIBUTIONS

This is a participatory reflection on a participatory process. The survivor co-researchers contributed to designing and carrying out the PPI process and have co-authored this manuscript.

Intimate Partner Violence and Antenatal Depression Among Underserved Pregnant Women

Introduction: Few studies have examined the associations of intimate partner violence (IPV) exposure during pregnancy and types of IPV with antenatal depression among underserved pregnant women. Methods: Data came from participants from a Healthy Start program in South Carolina between 2015 and 2019 (n = 1,629). The first two questions in the Woman Abuse Screening Tool (WAST) were used to measure IPV exposure, that is, having a problematic relationship with their partner. Those who had IPV exposure were assessed with six additional questions of the WAST. Principal component analysis was conducted on the 8-item WAST data to identify underlying types of IPV exposure. Antenatal depression was defined as the Center for Epidemiologic Studies Depression scores ≥16. Results: Participants were racially diverse (71% black, 21% white) with 85% Medicaid recipients. Nearly 12% of participants reported IPV exposure and 30% reported antenatal depression. The odds of having IPV exposure were higher among unmarried women, those with less than a high school education, and those who lacked family support. The odds of having antenatal depression were 2.5 times higher (95% CI: 1.9-3.5) among women with IPV exposure. After controlling for covariates, a one-point increase in the scores for psychological IPV (Factor 1) or a problematic relationship (Factor 3) was associated with increased odds of antenatal depression. Conclusion: This is one of the first studies to estimate the prevalence of IPV exposure using a proxy measure (a problematic relationship) among underserved U.S. pregnant women. Its positive association with antenatal depression suggests the utility of screening for a problematic relationship using a two-item WAST and providing assistance to those with IPV exposure.

Risk and Protective Factors Associated With Intimate Partner Violence with Gay Men: A Scoping Review

Intimate partner violence (IPV) is a complex, multidimensional phenomenon and may involve different risk and protective factors, as well as people of different sexual orientations, including gay men. Despite scientific evidence of the high prevalence of victimization and perpetration of this phenomenon, IPV in gay men is still largely invisible. The aim of this study was to map the risk and protective factors related to IPV among gay cis men based on a literature review. The Scopus, PsycNET, Pubmed, BVS-Psi, and SciELO databases were searched to retrieve articles published between 2018 and 2022. Thematic analysis was used to map the risk and protective factors of the 29 articles that met the inclusion criteria. Among the results, most studies investigated the risk factors for victimization of IPV, despite showing the high prevalence of bidirectionality in IPV among gay men. In addition, multiple risk and protective factors (individual, relational, and socio-community) have been shown to be associated with IPV among gay men. Mapping risk and protective factors for IPV at different ecological levels makes it possible to identify a more accurate profile of gay men's vulnerabilities, in addition to enabling the construction of more systemic interventions, which are multisectoral with specific prevention strategies, for IPV among gay men.

Intimate Partner Violence and HIV Outcomes Among Women Living with HIV in Durban, South Africa

We examined the impact of past-year intimate partner violence (IPV) on HIV outcomes among women living with HIV (WLHIV) in Durban, South Africa. We assessed past-year IPV using the WHO Violence Against Women Questionnaire. We conducted logistic regression to assess associations between demographic variables and IPV at baseline, and between IPV at baseline and longitudinal HIV outcomes. Among 235 WLHIV, 17% reported past-year emotional, physical, or sexual IPV. At baseline, HIV-disclosure to partner was associated with 4.35-fold odds of past-year IPV (95% CI 1.17-16.10) after controlling for children, education, and harmful alcohol use. In the prospective analysis, IPV was associated with not achieving the co-primary outcome of retention in care and viral suppression in univariate (OR = 2.32, 95% CI 1.04-5.18), but not in the multivariate model. In the context of rapid treatment scale-up, the high burden of IPV among WLHIV needs to be prioritized, with an emphasis on disclosure support.

Causal and common risk pathways linking childhood maltreatment to later intimate partner violence victimization

Childhood maltreatment and intimate partner violence (IPV) victimization are major psychiatric risk factors. Maltreatment substantially increases the likelihood of subsequent IPV victimization, but what drives this association is poorly understood. We analyzed retrospective self-reports of maltreatment and IPV in 12794 participants (58% women, 42% men) from the Twins Early Development Study at ages 21 and 26 using quantitative genetic methods. We estimated the etiological influences common to maltreatment and IPV, and the direct causal effect of maltreatment on IPV beyond such common influences. Participants exposed to maltreatment (~7% of the sample) were 3 times more likely to experience IPV victimization than their peers at age 21, 4 times more likely at 26. The association between maltreatment and IPV was mostly due to environmental influences shared by co-twins (42-43%) and genetic influences (30-33%). The association between maltreatment and IPV was similar for women and men, but its etiology partly differed by sex. Maltreatment had a moderate-to-large effect on IPV in phenotypic models (β = 0.23-0.34), decreasing to a small-to-moderate range in causal models accounting for their common etiology (β = 0.15-0.21). Risk factors common to maltreatment and IPV victimization are largely familial in origin, environmental and genetic. Even considering common risk factors, experiencing maltreatment is causally related to subsequent IPV victimization. Interventions promoting safe intimate relationships among young adults exposed to maltreatment are warranted and should address family-level environmental risk and individual-level risk shaped by genetics.

Perceived social support and the experience of intimate partner violence among married and cohabiting young women in urban slums, Ibadan, Nigeria: a descriptive study

Background

Social support is an important factor for improving the outcome of intimate partner violence (IPV) among abused women. Gaps exist on the role of social support among young women who have experienced IPV in Nigeria. Therefore, this study examined the influence of social support on the experience of IPV married and cohabiting young women in urban slums of Ibadan, Nigeria.

Methods

This study was a community-based household survey conducted in ten slum communities in the five local government areas of Ibadan municipality among 314 young women. Outcome variable was the experience of physical, psychological and any IPV. Socio-demographic characteristics were summarised using frequency and percentage. Level of statistical significance was set at α0.05.

Results

The mean age of respondents was 22.25±1.75 years and the mean spousal age difference was 7.15±3.87 years. Majority of the respondents were married (62.1%), and have been in a union for 0-4 years (68.8%). More than half (56.4%) justified IPV perpetration. Majority of the respondents reported having experienced psychological IPV (66.6%) and at least one form of IPV (86.3%) but have never told anyone about their IPV experience (58.1%). Social support was a predictor of psychological and any IPV, but not physical IPV. Type of union and duration of union significantly predicted all forms of IPV.

Conclusion

Prevalence of IPV is higher among women in cohabiting relationships. Social support from family and friends helps abused women cope with the experience of IPV. Thus, IPV prevention should target the social support system available to abused women.

Does Alcohol Use Influence Hospitalization Outcomes in Adults Suffering Craniomaxillofacial Fractures From Street Fighting?

Study Design

This retrospective cohort study utilized the National Inpatient Sample (NIS) database for the years 2016-2018. Incidences of street fighting were identified using the corresponding ICD-10 codes.

Objective

To determine whether alcohol use (measured by blood alcohol content (BAC)) in patients sustaining maxillofacial trauma from hand-to-hand fighting influence hospitalization outcomes.

Methods

The primary predictor variable was BAC stratified into six categories of increasing magnitude. The primary outcome variable was mean length of hospital stay (days). The secondary outcome variable was total hospital charges (US dollars).

Results

Our final sample consisted of 3038 craniomaxillofacial fractures. Each additional year in age added +$545 in hospital charges (P < .01). Non-elective admissions added $14 210 in hospital charges (P < .05). Patients admitted in 2018 experienced approximately $7537 more in hospital charges (P < .01). Le Fort fractures (+$61 921; P < .01), mandible fractures (+$13 227, P < .01), and skull base fractures (+$22 170; P < .05) were all independently associated with increased hospital charges. Skull base fractures added +7.6 days to the hospital stay (P < .01) and each additional year in patient age added +.1 days to the length of the hospital stay (P < .01).

Conclusions

BAC levels did not increase length of stay or hospitalization charges. Le Fort fractures, mandible fractures, and skull base fracture each independently increased hospital charges. This reflects the necessary care (ie, ICU) and treatment (ie, ORIF) of such fractures. Older adults and elderly patients are associated with increased length of stay and hospital charges-they are likely to struggle in navigating the healthcare system and face socioeconomic barriers to discharge.

Prognostic factors of first intimate partner violence among ever-married women in Sub-Saharan Africa: Gompertz gamma shared frailty modeling

BACKGROUND

Violence against women, particularly intimate partner violence, is a significant Concern for public health as well as a violation of the human rights of women especially in low and middle-income countries. However, there was limited evidence how soon an ever-married women experience intimate partner violence in Africa. Therefore, this study aimed to investigate the timing of first intimate partner violence (FIPV) among ever-married women in 30 SSA countries and to identify the risk factors of the timing.

METHODS

The present study has utilized 125,731 weighted samples, who participated in the domestic violence module of the survey from Demographic and Health Surveys of 30 SSA countries. The Gompertz gamma shared frailty model was fitted to determine the predictors. For model evaluation, the theta value, Akaike Information Criteria (AIC), Bayesian Information Criteria (BIC), and deviance were used. The Adjusted Hazard Ratio (AHR) with a 95% Confidence Interval (CI) was reported in the multivariable Gompertz gamma shared frailty model to highlight the strength and statistical significance of the associations.

RESULT

One-third (31.02%) of ever-married women had reported experiencing IPV. The overall incidence rate of FIPV was 57.68 persons per 1000 person-years (95% CI = 50.61-65.76). Age at marriage, age difference, educational status, employment, residence, women's decision-making autonomy, husband who drink alcohol and wealth status were significantly associated with the timing of FIPV.

CONCLUSION

The findings show that ever-married women are at high and increasing risk of violence. Thus, we recommend establishing effective health and legal response services for IPV, strengthening laws governing the sale and purchase of alcohol, empowering women, raising the educational attainment of women, and putting policies in place to combat the culture of societal tolerance for IPV all contribute to the empowerment of women.

Risk factors associated with intimate partner violence (IPV) against Jordanian married women: A social ecological perspective

This paper seeks to gain insights into complex and multiple influences which may behind the different components of intimate partner violence (IPV) against Jordanian wives. Drawing on a quantitative approach, the paper explores and presents findings of the determinants of domestic violence sustained by female partners during the year preceding a nationally representative survey. The survey is based on national multi-stage random sampling data from the 2012 Jordan Demographic Health Survey (JDHS). The paper applies the social-ecological framework. A method of Leastwise deletion techniques is used to remove missing data. Doing this resulted in 6213 married women used in the data analysis. Logistic regression models are used to estimate/predict different forms of IPV against domestic female partners. The findings of the study suggest that wives are victimized at all levels of the framework. Specifically, family, community, and social levels were the most vital factors affecting victims experiencing IPV. More specifically, wives witnessing their fathers beat their mothers and wives who are scared of their husbands are more prone to sustain violence inflicted by their partners. Furthermore, wives' education, working status, and age at marriage do not predict IPV. Another key finding is that wife empowerment in family relationships is a protective factor against domestic violence against her. The implication is that the patriarchal explanation of domestic violence against wives is valid in the Jordanian cultural context. This study underscores the need to reevaluate the effectiveness of Jordan's general human development programs and women empowerment programs as an essential measure for alleviating IPV inflicted on married women in Jordan.

Factors associated with domestic violence in pregnant women during the COVID-19 pandemic: Araraquara Cohort study

AIMS AND METHOD

This cross-sectional study, carried out from 2021 to 2022, investigated the factors associated with domestic violence in 400 Brazilian pregnant women during the COVID-19 pandemic. Violence was assessed with the World Health Organization's Violence Against Women questionnaire and the Abuse Assessment Screen. Demographic, socioeconomic, obstetric, lifestyle and mental health data were collected.

RESULTS

Violence at any time in their lives was reported by 52.2% of the women, and psychological violence was the most prevalent type (19.5%). Violence was associated with being single and mental health changes. Pregnant women exposed to any lifetime violence and psychological violence were, respectively, 4.67 and 5.93 times more likely to show mental health changes compared with women with no reported violence.

CLINICAL IMPLICATIONS

Training health professionals involved in prenatal care in the early detection of single women and women with mental health changes could be important in preventing domestic violence.

Intimate partner violence and its correlates in middle-aged and older adults during the COVID-19 pandemic: A multi-country secondary analysis

Intimate partner violence (IPV) may have been exacerbated during the COVID-19 pandemic. Middle-aged and older adults, ages 45 years or older, are at higher risk of COVID-19 mortality and social isolation. However, most studies on IPV during the pandemic do not focus on this important subpopulation. Informed by the social-ecological theory, this study examines individual, household, community, and country-level correlates of IPV among middle-aged and older adults in multiple countries using a cross-sectional online survey. Data from 2867 participants aged 45 or older in the International Sexual Health and Reproductive Health (I-SHARE) survey from July 2020 to February 2021 were described using univariate analysis. IPV was defined using four validated WHO measures. Individual characteristics included self-isolation and food security. At the country-level, we examined social distancing stringency. Logistic regression models with a random intercept for country were conducted to explore IPV correlates among 1730 eligible individuals from 20 countries with complete data. Most participants were heterosexual (2469/2867), cisgender (2531/2867) females (1589/2867) between the ages of 45-54 (1539/2867). 12.1% (346/2867) of participants experienced IPV during social distancing measures. After adjustment, participants who self-isolated experienced 1.4 (95% CI 1.0, 2.0, p = 0.04) times the odds of IPV compared to those who had not isolated. Those who reported an increase in food insecurity compared to pre-pandemic experienced 2.2 times the odds (95% CI 1.6, 3.0, p<0.0001) of IPV compared to those who did not report increased food insecurity. People in countries with more stringent social distancing policies were less likely to experience IPV compared to people in countries with lower levels of stringency (aOR = 0.6, 95% CI 0.4, 0.9, p = 0.04). IPV was common among middle-aged and older adults during the COVID-19 pandemic. Our data suggest the need for further crisis management and social protection measures for middle-aged and older adults who have intersecting vulnerabilities to IPV to mitigate COVID-19 impact.

Violence Against Women as a Global Public Health Issue

Violence against women, especially intimate partner violence, is recognized as a global public health issue due to its prevalence and global reach. This article outlines the scope of the issue, with respect to its prevalence, health outcomes, and risk factors, and identifies key milestones that led to its global recognition: methodological and data advances, acknowledgment as a criminal justice and health issue, support by the global women's movement, and the robust evidence demonstrating that intimate partner violence is preventable. Key issues for the future include recognition and consideration of intersectionality in research, improvements in the measurement of other forms of violence against women, and the need to scale up prevention efforts that have documented success. Violence against women is an urgent priority as it affects individuals, their families and surroundings, and the entire global health community.

Intimate Partner Violence Among Rwandan Women With HIV: A Cross-Sectional Study

ABSTRACT

In Rwanda, women have higher incidence of HIV and intimate partner violence (IPV). This study aimed to estimate the prevalence of IPV among women living with HIV (WWH) in Rwanda and measure the difference in psychological outcomes, demographic data, and HIV-related outcomes using a cross-sectional, descriptive, observational design. A convenience sample of 162 Rwandan WWH were purposefully recruited to participate. The study collected demographic data and data about IPV, depression, HIV-related stigma, coping, self-esteem, and hope. The prevalence of any form of IPV in the sample was 27% with psychological IPV being the most prevalent. Demographic data had no statistical significance with the prevalence of IPV. WWH who experienced IPV had higher HIV stigma, lower coping self-efficacy, lower self-esteem, and less hope and worse HIV psychological outcomes. Further studies are needed to look into the correlation between the two and interventions addressing IPV prevention.

Women's Experiences of Intimate Partner Violence While Incarcerated: The Measurement Structure, Reliability, and Validity of a Novel Instrument

While incarcerated, women may continue to experience intimate partner violence (IPV), perpetrated by partners who reside in the outside community. Power and control dynamics of abusive relationships may intensify as the abuser exploits their partners' incarceration. The current study assessed IPV experiences of 832 incarcerated women (50% white, 76% mothers), testing a novel instrument. Results validated a two-factor structure: (a) general abuse (i.e., verbal, physical) and (b) deny or threaten to deny (i.e., leveraging the women's incarceration to intimidate or control). This study introduces a novel instrument to measure IPV while incarcerated and provides implications for research and practice.

Witnessing inter-parental violence in childhood and help-seeking behaviours in violence against women in Peru

BACKGROUND

Violence against women (VAW) severely impacts their physical and mental health. In some cultures, women can normalize certain types of violence if they were linked to home models in childhood and, eventually, do not seek for help in adulthood. We aimed to determine, in Peruvian women, (1) the association between witnessing violence in their family of origin and VAW experienced in adulthood, (2) the extent to which women who have experienced VAW seek some help, and (3) identify VAW prevalence by Peruvian region.

METHODS

Cross-sectional study of secondary data obtained from the 2019 National Demographic and Family Health Survey (ENDES). The outcome was VAW (psychological, physical and sexual violence), whereas the exposure was witnessing violence in the home of origin. Help-seeking behavior was a secondary outcome, for which VAW was the exposure. Prevalence ratios (PR) were estimated to assess both associations, unadjusted and adjusted for covariates (aPR).

RESULTS

Data from 14,256 women aged 15 to 49 years were analysed. 51.5% reported having experienced VAW and 43.8% witnessed violence in the home of origin during childhood. Witnessing inter-parental violence in childhood was associated with psychological violence aPR = 1.25 (95% CI: 1.17-1.33), physical aPR = 1.52 (95% CI: 1.38-1.67), and sexual aPR = 1.99 (95% CI: 1.57-2.52). Women who have experienced both types of violence (physical and sexual) were more likely to help-seeking (aPR = 1.30, 95% CI: 1.14-1.50) than women suffering only one type of violence.

CONCLUSION

Women who reported having witnessed home violence in their childhood are more likely to experience Violence Against Women (VAW) by their current partner. Physical and sexual violence with a current partner was more associated with witnessing inter-parental violence in childhood, and when physical and sexual violence jointly occurred women were more help-seeking. The southern region of Peru is identified as an area of high vulnerability for women. It is crucial to promote educative and community-based programs aimed at the prevention and early recognition of VAW.

The Association Between Witnessing Interparental Violence and Adolescents' Anger Expression Styles

The purpose of this research was to determine the association between witnessing interparental violence and anger expression styles in adolescents. Previous studies have generally focused on the attitudes to violence of individuals witnessing it. However, the present research specifically investigated the association between witnessing interparental violence and anger. The research was performed as a descriptive and correlational study. The research sample consisted of 1,000 adolescents aged 15 to 19 contacted via social media platforms using the convenience sample method. An online data collection form containing questions was prepared to determine adolescents' sociodemographic characteristics and contained questions from the Witnessing Interparental Violence Scale and Trait Anger Expression Inventory. Statistical analysis was performed on SPSS 21.0 software. In all, 446 (44.6%) adolescents had witnessed interparental violence. Trait, externalized, and internalized anger scores were higher among adolescents who had witnessed interparental violence compared to those who had not. This research shows that witnessing interparental violence has significant effects on the individual's trait anger and anger expression styles. We recommend that the effects of exposure to violence and witnessing interparental violence be compared and that witnessing violence in different cultural environments be evaluated in future studies.

Health-Related Costs of Intimate Partner Violence: Using Linked Police and Health Registers

This study aims to estimate direct health-related costs for victims of intimate partner violence (IPV) using nationwide linked data based on police reports and two healthcare registers in Finland from 2015 to 2020 (N = 21,073). We used a unique register dataset to identify IPV victims from the data based on police reports and estimated the attributable costs by applying econometric models to individual-level data. We used exact matching to create a reference group who had not been exposed to IPV. The mean, unadjusted, attributable healthcare cost for victims of IPV was €6,910 per individual over the 5-year period after being first identified as a victim. When adjusting for gender, age, education, occupation, and mental-health- and pregnancy-related diagnoses, the mean attributable health-related cost for the 5 years was €3,280. The annual attributable costs of the victims were consistently higher than those for nonvictims during the entire study period. Thus, our results suggest that the adverse health consequences of IPV persist and are associated with excess health service use for 5 years after exposure to IPV. Most victims of IPV were women, but men were also exposed to IPV, although the estimates were statistically significant only for female victims. Victims of IPV were over-represented among individuals outside the labor force and lower among those who were educated. The total healthcare costs of victims of IPV varied according to the socioeconomic factors. This study highlights the need for using linked register data to understand the characteristics of IPV and to assess its healthcare costs. The study results suggest that there is a significant socioeconomic gradient in victimization, which could also be useful to address future IPV prevention and resource allocation.

Path Analysis of Adverse Childhood Experiences, Early Marriage, Early Pregnancy, and Exposure to Intimate Partner Violence Among Young Women in Honduras

Purpose

The pathways by which adverse childhood experiences (ACEs) are associated with early marriage and early pregnancy are poorly understood. Early marriage and early pregnancy may be risk factors for adulthood intimate partner violence (IPV). The aim of this study was to assess the relationships among ACEs, early marriage, early pregnancy, and IPV among women in Honduras.

Method

We used weighted data from 1,436 women aged 18-24 years from the nationally representative 2017 Honduras Violence Against Children and Youth Survey. We used path analysis to estimate relationships and accounted for sample design, non-response, and within-country clustering.

Results

We found that ACEs had differential relationships with outcomes of interest. For example, witnessing violence in the community was directly associated with increased probability of early pregnancy (10 percentage points (PP); 95% CI: 0.04, 0.15) and IPV (6 PP; 95% CI: 0.01, 0.10), while emotional violence was not directly or indirectly associated with any outcome. Early marriage and early pregnancy had no direct or indirect effect on IPV, but the total effect of early marriage on IPV was significant.

Conclusions

Understanding the relationship between ACEs, early marriage, early pregnancy, and IPV may help inform prevention efforts. For example, programs aiming to reduce early pregnancy may consider addressing sexual violence experienced in childhood.

Screening for Intimate Partner Violence

More than a decade has passed since the Affordable Care Act (ACA) required screening for intimate partner violence (IPV) and related counseling with no co-payment and eliminated insurers' ability to deny coverage based on preexisting conditions, including IPV. While screening for IPV and coverage of services became more feasible after implementation of the ACA, in theory, gaps remain. Nearly half of women in the United States report that they have experienced IPV in their lifetime, but the true number is likely even higher. In this column, I review screening recommendations for IPV and related policies, gaps in research on groups at higher risk, systems-level approaches to increase screening, and recommendations from professional organizations on screening and supporting IPV survivors.

Polygenic risk for major depression, attention deficit hyperactivity disorder, neuroticism, and schizophrenia are correlated with experience of intimate partner violence

Research has suggested that mental illness may be a risk factor for, as well as a sequela of, experiencing intimate partner violence (IPV). The association between IPV and mental illness may also be due in part to gene-environment correlations. Using polygenic risk scores for six psychiatric disorders - attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), bipolar disorder (BPD), major depressive disorder (MDD), neuroticism, and schizophrenia-and a combined measure of overall genetic risk for mental illness, we tested whether women's genetic risk for mental illness was associated with the experience of three types of intimate partner violence. In this cohort of women of European ancestry (N = 11,095), participants in the highest quintile of genetic risk for ADHD (OR range: 1.38-1.49), MDD (OR range: 1.28-1.43), neuroticism (OR range: (1.18-1.25), schizophrenia (OR range: 1.30-1.34), and overall genetic risk (OR range: 1.30-1.41) were at higher risk for experiencing more severe emotional and physical abuse, and, except schizophrenia, more severe sexual abuse, as well as more types of abuse and chronic abuse. In addition, participants in the highest quintile of genetic risk for neuroticism (OR = 1.43 95% CI: 1.18, 1.72), schizophrenia (OR = 1.33 95% CI: 1.10, 1.62), and the overall genetic risk (OR = 1.40 95% CI: 1.15, 1.71) were at higher risk for experiencing intimate partner intimidation and control. Participants in the highest quintile of genetic risk for ADHD, ASD, MDD, schizophrenia, and overall genetic risk, compared to the lowest quintile, were at increased risk for experiencing harassment from a partner (OR range: 1.22-1.92). No associations were found between genetic risk for BPD with IPV. A better understanding of the salience of the multiple possible pathways linking genetic risk for mental illness with risk for IPV may aid in preventing IPV victimization or re-victimization.