Rates of intimate partner violence in the United States

The Epidemiology of Violence Exposure in Children

Exposure to violence remains a significant issue for children in the United States. The COVID-19 pandemic exacerbated many of these exposures. Violence unequally impacts children of color and lesbian, gay, bisexual, transgender, and questioning youth. Pediatricians can and must continue to advocate and intervene to decrease pediatric violence exposure and its effects.

Responsivity to Interviewer during Interview-Based Assessment of Physical Intimate Partner Violence

Objective

Interview assessments of intimate partner violence (IPV) may provide more accurate behavior frequency estimates than self-report questionnaires. However, concerns have been raised about whether participants underreport IPV during interviews due to an emotional response to the interviewer.

Method

Participants were 42 mixed gender community couples (83 individuals) in which at least one partner endorsed physical IPV perpetration or victimization in their relationship. We examined whether participants were emotionally responsive to the interviewer during an interview about physical IPV. Responsivity was defined as the extent to which participants' emotional arousal, indexed by vocal fundamental frequency (f0), was predicted by interviewers' emotional arousal at the previous talk turn on a moment-by-moment basis. We then examined whether participants' responsivity predicted interview-based reporting of IPV relative to their own self-report on an IPV measure and to the highest other available report (including partner report).

Results

Repeated measures actor-partner interdependence models conducted in a multi-level modeling framework indicated that, on average, participants were responsive to interviewers' emotional arousal, even when controlling for responsivity to their own arousal, and that responsivity varied across participants. However, participants' responsivity to interviewer arousal did not significantly predict reporting of IPV perpetration or victimization during the interview relative to their own self-report or to the highest other available report.

Conclusions

Participants are emotionally responsive to interviewer arousal, but this responsivity does not appear to reduce interview-based reporting of IPV relative to self-report, supporting the utility of IPV interviews in clinical and research settings.

Overlap of relationship distress and intimate partner violence in community samples

Mixed-gender couples presenting for couple therapy are at 2-3 times higher risk for physical intimate partner violence (IPV) than community couples. However, it is unclear if this elevation of relative risk is the same in the general population because relationship distress and treatment-seeking are often confounded. We used archival data from three representative U.S. civilian samples and one representative U.S. Air Force sample to test the hypothesis that clinically significant relationship distress is associated with increased risk of various forms of IPV. In these community samples, those in mixed-gender distressed relationships were at 2-3 times higher risk than those in nondistressed relationships for any physical IPV during the past year and at 3-6 times higher risk for clinically significant psychological and physical IPV during the past year. Given that the increase in IPV risk is similar for individuals in distressed community relationships and therapy-seeking relationships, the prior findings of the elevated rates of IPV in clinical samples are unlikely to be due to therapy-seeking. Although epidemiological risk involves statistical, not causal, associations, the increased co-occurrence of IPV in distressed mixed-gender couples fits with numerous theories of IPV and has implications for both screening and future research. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Head Trauma in a Community-Based Sample of Victims of Intimate Partner Violence: Prevalence, Mechanisms of Injury and Symptom Presentation

OBJECTIVE

The present study aimed to explore the prevalence of subconcussive head trauma, traumatic brain injury (TBI), potential hypoxic events, and hypoxic brain injury (HBI) in victims of physical intimate partner violence (IPV). The study also aimed to characterize the injury presentation and mechanisms of injury in this population.

METHOD

A group of 47 female participants with a history of at least one relationship that included physical violence completed a structured interview assessing for subconcussive hits, TBI, and HBI. Participants ranged in age from 19 to 55, and had an average of 15.3 years of education. Forty-four participants completed the structured interview in person and three participants completed the interview over the phone.

RESULTS

The majority of participants reported sustaining at least one impact to the head and approximately half of the participants sustained at least one impact that resulted in a mild TBI. Approximately half of the participants experienced at least one incident of having difficulty breathing due to a violent act from their partner, and approximately one-third of participants reported symptoms consistent with mild HBI. The most common mechanisms of injury were being hit with a closed fist and being strangled.

CONCLUSIONS

The high levels of head trauma observed in this study highlight the need for clinical and community providers to screen victims of physical IPV for head trauma. The unique characteristics of this population (female sex, high frequency of injuries, and presence of HBIs) indicate that research evaluating the cognitive effects of injuries in this population is needed.

REPRINT OF: Physical and Mental Health Effects of Intimate Partner Violence for Men and Women

EDITOR'S NOTE

This article is a reprint of a previously published article. For citation purposes, please use the original publication details: Coker AL, Davis KE, Arias I, et al. Physical and mental health effects of intimate partner violence for men and women. Am J Prev Med. 1985;1(6):1-8.

BACKGROUND

Few population-based studies have assessed the physical and mental health consequences of both psychological and physical intimate partner violence (IPV) among women or men victims. This study estimated IPV prevalence by type (physical, sexual, and psychological) and associated physical and mental health consequences among women and men.

METHODS

The study analyzed data from the National Violence Against Women Survey (NVAWS) of women and men aged 18 to 65. This random-digit-dial telephone survey included questions about violent victimization and health status indicators.

RESULTS

A total of 28.9% of 6790 women and 22.9% of 7122 men had experienced physical, sexual, or psychological IPV during their lifetime. Women were significantly more likely than men to experience physical or sexual IPV (relative risk [RR]=2.2, 95% confidence interval [CI]=2.1, 2.4) and abuse of power and control (RR=1.1, 95% CI=1.0, 1.2), but less likely than men to report verbal abuse alone (RR=0.8, 95% CI=0.7, 0.9). For both men and women, physical IPV victimization was associated with increased risk of current poor health; depressive symptoms; substance use; and developing a chronic disease, chronic mental illness, and injury. In general, abuse of power and control was more strongly associated with these health outcomes than was verbal abuse. When physical and psychological IPV scores were both included in logistic regression models, higher psychological IPV scores were more strongly associated with these health outcomes than were physical IPV scores.

CONCLUSIONS

Both physical and psychological IPV are associated with significant physical and mental health consequences for both male and female victims.

Effects of ePREP and OurRelationship on Low-Income Couples' Mental Health and Health Behaviors: a Randomized Controlled Trial

Relationship distress is a pervasive problem in the USA that disproportionally impacts couples with low-income levels. The goal of the present study was to evaluate the effectiveness of two online relationship interventions, OurRelationship and ePREP, both of which were supported by a paraprofessional coach, in improving mental health and physical health behaviors with low-income couples. Couples (N = 742) were randomized to either intervention or a 6-month waitlist control group and assessed pre-, mid-, and post-intervention as well at 4 and 6 months after randomization. Results from multilevel models indicated that during treatment, compared to couples in the waitlist group, couples in the intervention groups reported significantly greater improvements in mental health that were small to moderate in magnitude (psychological distress, anger, problematic alcohol use, and perceived stress) as well as improvements in physical health/health behaviors (perceived health, insomnia, and exercise) that were small in magnitude. Furthermore, the differences between intervention and waitlist groups were maintained over follow-up. Treatment gains in both mental health and physical health behaviors were generally stronger for those who began treatment with greater difficulties in those areas. Implications of these findings with regard to intervention and policy are discussed.

Attachment, Emotion Dysregulation, and Physical IPV in Predominantly Hispanic, Young Adult Couples

Insecure attachment has been found to be a risk factor for perpetrating physical intimate partner violence (IPV). However, this association is likely exacerbated by additional factors, such as conflicting insecure attachment in one’s partner and difficulties with overall emotion regulation and impulse control. The present study aimed to examine the associations between insecure attachment and physical IPV perpetration in male and female partners, as well as to examine whether these associations are exacerbated by involvement with a partner with opposing attachment needs and overall emotion dysregulation and impulsivity. Additionally, this study examined whether partners’ emotion dysregulation interacted to predict IPV. Two hundred eight heterosexual couples primarily recruited from a Hispanic-serving university completed questionnaires on attachment, emotion dysregulation, and one’s own and one’s partner’s perpetration. Results revealed that attachment anxiety, impulsivity, and an interaction effect between attachment avoidance and partner’s attachment anxiety were associated with self-reported, but not partner-reported, male perpetration. For females, attachment anxiety was associated with female IPV (self-reported and partner-reported), and impulsivity was associated with self-reported female IPV. Overall, results underscore how relationships between known risk factors and IPV perpetration may differ depending on if IPV perpetration is measured using self-reported or partner-reported data. Additional results and implications are discussed.

Using Technology to Conduct Focus Groups With a Hard-to-Reach Population: A Methodological Approach Concerning Male Victims of Partner Abuse in Four English-Speaking Countries

Research shows that the experiences of male victims of partner abuse (PA) are often denied by the public and the professionals who are charged to support PA victims. Recruiting female victims for research on PA victimization is relatively easy because there are existing structures to serve this group of victims. Thus, male victims are considered a hard-to-reach (HTR) population, and studying them can be difficult. This article focuses on the use of technology to collect qualitative data from male PA victims in an international study focusing on male victims. The researchers used their own professional networks to recruit and screen a convenience sample of male victims of female-to-male PA, in four different English-speaking countries: Australia, Canada, England, and the United States. Four web-based, video-enabled, focus groups were held for each country-for a total of 12 groups and 41 male participants. This article addresses recruitment methods, the use of technology in data collection, protecting the confidentiality of male victims, methods for informed consent, and lessons learned to facilitate future research.

Couple Reports on Intimate Partner Violence and their Health Impact: Evidence From a Population-Based Survey in Japan

Recent studies have shown that couples' reports of intimate partner violence (IPV) are not necessarily consistent. This study investigated the associations between patterns of partner victimization and perpetration reports and health and perceived wellbeing. Using household survey data from a probabilistic urban sample of adults aged 25 to 50 years and their partners, we identified 1,467 heterosexual pairs who completed the modified Japanese version of the Conflict Tactics Scale 2 Short Form. We classified responses into four categories: congruent report of no IPV, incongruent respondent victimization report, incongruent partner perpetration report, and congruent report of IPV. We used analysis of covariance to compare physical and mental health (measured by the SF-8 Health Survey Questionnaire) and life satisfaction among the four groups. The results showed that 22.4% of respondents were involved in IPV, and approximately 75% of them had incongruent reports. Compared with congruent reports of no IPV, respondents with an incongruent victimization report and an incongruent partner perpetration report scored significantly lower on physical health (-0.96, p = .03 and -1.16, p = .04, respectively). Those with an incongruent victimization report and congruent report of IPV had lower mental health scores (-2.32, p = .00 and -2.21, p = .00, respectively) and lower life satisfaction (-0.32, p = .00 and -0.21, p = .01, respectively). The results indicated that the respondent's victimization report was associated with worse mental health regardless of their partner's perpetration report, and physical health was worse only in cases with incongruent reports. Cases with a partner perpetration report but no respondent victimization report showed worse physical health but no negative effects on mental health and perceived wellbeing. These results indicate that research and practice regarding IPV should consider both partners' experiences of violence when assessing the impact of health and wellbeing on victims.

Sexual Violence Perpetration Within Intimate Relationships: An I3 Model Analysis of the Effects of Sexual Violence Victimization and Psychological Flexibility

The I³ Model posits that intimate partner violence (IPV) is determined by the relative strength of instigatory, impellance, and inhibitory factors. Although much research has examined nonsexual IPV, few studies have used the I³ Model to examine sexual IPV. This study investigated the effects of sexual IPV victimization (an impellor) and psychological flexibility (an inhibitor) on sexual IPV perpetration within a dyadic framework. Participants nested within 617 intimate couples completed measures of psychological flexibility and sexual IPV perpetration and victimization. Results showed that Actor IPV victimization was positively and Actor psychological flexibility was negatively associated with Actor IPV perpetration. Among those who experienced low levels of IPV victimization, psychological flexibility inhibited IPV perpetration. This inhibiting effect did not extend to Actors who experienced high levels of IPV victimization. Findings highlight the complex interactions between I³ factors and support continued dyadic examination of IPV perpetration etiology.

The Relationship between Women's Resources and Health-Related Quality of Life in a Sample of Female Victims of Intimate Partner Violence

While it is known that resource inadequacy increases the risk of exposure to intimate partner violence (IPV) and that women's health is significantly impacted by IPV, scant research has documented diminished resources as a primary determinant of women's health. Fifty female victims of moderate to severe IPV completed assessments of their physical, sexual and psychological experiences of IPV, resource profile, symptoms of posttraumatic stress disorder (PTSD) and depression and mental and physical health-related quality of life (HRQoL). Women's resources, controlling for age, income, psychological abuse and sexual coercion, were unique predictors of symptoms of PTSD, symptoms of depression; and mental HRQoL. The public health implications of the adequacy of women's resources are discussed in the context of IPV prevention and intervention. Future studies should evaluate the efficacy of economic empowerment programs regarding the impact on IPV survivors' mental and physical health and safety.

Partner Abuse Among Treatment-Seeking Individuals with Chronic Pain: Prevalence, Characteristics, and Association with Pain-Related Outcomes

OBJECTIVE

This study assessed the prevalence of abusive partner relationships among individuals presenting for chronic pain treatment. In addition, this study examined the association between partner abuse histories and pain-relevant outcome variables.

DESIGN

Cross-sectional.

SETTING

This study took place at a specialty pain rehabilitation treatment center in the Midwestern United States.

SUBJECTS

Participants in this study (N = 108) included adults (Mage = 45.73 [15.95] years) presenting for chronic pain treatment who consented to participate in a research study on stress, relationships, and chronic pain.

METHODS

Participants completed self-report measures about relationship and abuse histories, physical and mental health, and demographic information. Participants were categorized into the following groups: no intimate partner violence (IPV), past IPV (>12 months ago), or current/recent IPV (≤12 months ago).

RESULTS

Results indicated that over half (56%) of the sample endorsed a history of partner abuse and around one-third (29%) of the sample had experienced abuse within the past year. Psychological/emotional abuse was the most common form of abuse reported. Those with current/recent abuse histories reported greater impairment in pain interference, post-traumatic stress symptoms, mental health functioning, and pain self-efficacy compared with those who had not experienced abuse in the past year.

CONCLUSIONS

Partner abuse appears common among individuals with chronic pain and is associated with pain-relevant outcomes, warranting additional clinical attention and research in this area.

Alcohol Use, Hostile Sexism, and Religious Self-Regulation: Investigating Risk and Protective Factors of IPV Perpetration

Research suggests that the relationship between alcohol use and intimate partner violence (IPV) is moderated by a range of other factors. Therefore, we investigated the relationship between alcohol use, hostile sexism, and religious self-regulation with perpetration. Using a national sample of 255 men, we found that hostile sexism was associated with physical violence toward a partner and alcohol use was positively associated with psychological abuse toward a partner. With regard to religious self-regulation, we found that introjected religious self-regulation was positively associated with hostile sexism and positively associated with perpetrating physical IPV. Identified religious self-regulation was negatively associated with physical violence perpetration. We also found significant interactions among our independent measures on physical IPV perpetration. These analyses suggest that increased alcohol consumption elevates the risk for physical violence perpetration among men who are high in introjected religious self-regulation and low in hostile sexism, while reducing the risk for perpetration in men who are high in identified religious self-regulation and low in hostile sexism. Implications and limitations of the findings are discussed.

Domestic Violence Against Men-Prevalence and Risk Factors

BACKGROUND

According to the World Health Organization (WHO), intimate partner violence is among the major risks to women's health around the world. Men, too, can be victims of domestic violence; like female victims, they tend to present initially with their injuries to a family physician or an emergency room. Domestic violence against men is thus a relevant issue for physicians of all specialties.

METHODS

This review is based on publications retrieved by a comprehensive, selective search in the PubMed database and with the Google Scholar search service, as well as on a retrospective analysis of data on the injured persons, the aggressors, and the nature of the violence that was experienced and the injuries that were sustained.

RESULTS

The studies identified by the search yielded prevalence rates of 3.4% to 20.3% for domestic physical violence against men. Most of the affected men had been violent toward their partners themselves. 10.6-40% of them reported having been abused or maltreated as children. Alcohol abuse, jealousy, mental illness, physical impairment, and short relationship duration are all associated with a higher risk of being a victim of domestic violence. The reported consequences of violence include mostly minor physical injuries, impaired physical health, mental health problems such as anxiety or a disruptive disorder, and increased consumption of alcohol and/or illegal drugs.

CONCLUSION

The prevalence of violence against men and the risk factors for it have been little studied to date. It would be desirable for preventive measures to be further developed and for special help to be made available to the affected men.

Co-Occurrence of Multiple Risk Factors and Intimate Partner Violence in an Urban Emergency Department

INTRODUCTION

Urban emergency departments (ED) provide care to populations with multiple health-related and overlapping risk factors, many of which are associated with intimate partner violence (IPV). We examine the 12-month rate of physical IPV and its association with multiple joint risk factors in an urban ED.

METHODS

Research assistants surveyed patients regarding IPV exposure, associated risk factors, and other sociodemographic features. The joint occurrence of seven risk factors was measured by a variable scored 0-7 with the following risk factors: depression; adverse childhood experiences; drug use; impulsivity; post-traumatic stress disorder; at-risk drinking; and partner's score on the Alcohol Use Disorders Identification Test. The survey (N = 1037) achieved an 87.5% participation rate.

RESULTS

About 23% of the sample reported an IPV event in the prior 12 months. Logistic regression showed that IPV risk increased in a stepwise fashion with the number of present risk factors, as follows: one risk factor (adjusted odds ratio [AOR] [3.09]; 95% confidence interval [CI], 1.47-6.50; p<.01); two risk factors (AOR [6.26]; 95% CI, 3.04-12.87; p<.01); three risk factors (AOR = 9.44; 95% CI, 4.44-20.08; p<.001); four to seven risk factors (AOR [18.62]; 95% CI, 9.00-38.52; p<001). Ordered logistic regression showed that IPV severity increased in a similar way, as follows: one risk factor (AOR [3.17]; 95% CI, 1.39-7.20; p<.01); two risk factors (AOR [6.73]; 95% CI, 3.04-14.90; p<.001); three risk factors (AOR [10.36]; 95%CI, 4.52-23.76; p<.001); four to seven risk factors (AOR [20.61]; 95% CI, 9.11-46.64; p<001).

CONCLUSION

Among patients in an urban ED, IPV likelihood and IPV severity increase with the number of reported risk factors. The best approach to identify IPV and avoid false negatives is, therefore, multi-risk assessment.

Drinking and Intimate Partner Violence Severity Levels Among U.S. Ethnic Groups in an Urban Emergency Department

BACKGROUND

Emergency departments (EDs) provide care to ethnically diverse populations with multiple health-related risk factors, many of which are associated with intimate partner violence (IPV). This paper examines ethnic-specific 12-month rates of physical IPV by severity and their association with drinking and other sociodemographic and personality correlates in an urban ED sample.

METHODS

Research assistants surveyed patients at an urban ED regarding IPV exposure as well as patterns of alcohol and drug use, psychological distress, adverse childhood experiences (ACEs), and other sociodemographic features.

RESULTS

The survey (N = 1,037) achieved an 87.5% participation rate. About 23% of the sample reported an IPV event in the past 12 months. Rates were higher (p < 0.001) among blacks (34%), whites (31%), and multiethnic (46%) respondents than those among Asians (13%) and Hispanics (15%). Modeled results showed that black respondents were more likely than Hispanics (reference) to report IPV (adjusted odds ratio [AOR] = 1.69, 95% confidence interval [CI] = 1.98-2.66, p < 0.05) and that respondents' partner drinking was associated with IPV (AOR = 1.85, 95% CI = 1.25-2.73, p < 0.01) but respondents' drinking was not. Use of illicit drugs, younger age, impulsivity, depression, partner problem drinking, ACEs, and food insufficiency were all positively associated with IPV.

CONCLUSIONS

There was considerable variation in IPV rates across ethnic groups in the sample. The null results for the association between respondents' drinking and IPV was surprising and may stem from the relatively moderate levels of drinking in the sample. Results for ethnicity, showing blacks as more likely than Hispanics to report IPV, support prior literature.

Why do couples seek relationship help online? Description and comparison to in-person interventions

Couples are increasingly utilizing newly developed online adaptations of couple therapy; however, different presenting problems could drive couples to seek either online or in-person services. This study compared the presenting problems of 151 couples seeking an online couple intervention for relationship distress (OurRelationship) with responses from 147 couples seeking in-person couple therapy. Presenting problems were generally consistent across gender and whether or not the respondent was the initial help-seeker. Online and in-person samples frequently endorsed difficulties with communication and emotional intimacy; however, they differentially endorsed trust, time together, and child/parenting difficulties. Therefore, while basing online interventions on existing couple therapies is generally supported, efforts should be made to tailor online services to meet the unique needs of this population.

Partner Disagreement on the Occurrence of Intimate Partner Violence Among a National Sample of Heterosexual Young-Adult Couples

To assess the extent and patterns of partner disagreement on the occurrence of intimate partner violence (IPV) among a young-adult couple sample, the Add Health Romantic Pairs data are used (N = 1,183 heterosexual couples). Among young-adult couples in which IPV is reported, substantial partner disagreement is the norm. Moreover, women are more likely to report their own perpetration of minor and physical IPV than men. For injurious and sexual IPV, no gendered patterns are observed. In conclusion, IPV prevalence rates vary depending on which partner's self-reports are being considered. Prior research may have suffered from a reporting bias and to obtain accurate estimates of IPV both partners of a couple should be included in future research.

A Randomized, Controlled Trial of the Impact of the Couple CARE for Parents of Newborns Program on the Prevention of Intimate Partner Violence and Relationship Problems

Effective, accessible prevention programs are needed for adults at heightened risk for intimate partner violence (IPV). This parallel group randomized controlled trial examines whether such couples receiving the American version of Couple CARE for Parents of Newborns (CCP; Halford et al. 2009) following the birth of a child, compared with controls, report fewer first occurrences of clinically significant IPV, less frequent physical and psychological IPV, and improved relationship functioning. Further, we test whether intervention effects are moderated by level of risk for IPV. Couples at elevated risk for IPV (N = 368) recruited from maternity units were randomized to CCP (n = 188) or a 24-month waitlist (n = 180) and completed measures of IPV and relationship functioning at baseline, post-program (when child was 8 months old), and two follow-ups (at 15 and 24 months). Intervention effects were tested using intent to treat (ITT) as well as complier average causal effect (CACE; Jo and Muthén 2001) structural equation models. CCP did not significantly prevent clinically significant IPV nor were there significant main effects of CCP on clinically significant IPV, frequency of IPV, or most relationship outcomes in the CACE or ITT analyses. Risk moderated the effect of CCP on male-to-female physical IPV at post-program, with couples with a planned pregnancy declining, but those with unplanned pregnancies increasing. This study adds to previous findings that prevention programs for at-risk couples are not often effective and may even be iatrogenic for some couples.

Intimate partner violence: Wounds are deeper

Intimate partner violence claims millions of victims worldwide leading to infringement of fundamental human rights, serious physical and mental heath consequences and leading behind in its wake broken relationships and affected children. Despite its prevalence, its is not a well understood phenomenon. Through this article, we briefly review the literature on this subject; emphasizing on epidemiology and typologies of IPV, perpetuating factors and outcomes, the relevant legislations in India and the screening and intervention steps.

Coping and violence perpetration in a residential substance use disorder treatment sample

Background: Individuals in substance use disorder treatment report high rates of violence against partners and non-partners. There is growing interest in integrated coping-oriented treatment approaches for violence and substance use concerns, yet little is known about the relationship between specific coping responses and perpetration of partner and non-partner violence. Objective: This cross-sectional study evaluated relationships between coping responses and partner and non-partner physical assault perpetration in a substance use disorder treatment sample. Methods: Participants included 343 men (76%) and women (24%) who completed self-report survey measures of coping responses, violence perpetration, and substance use as part of screening for a randomized trial. Negative binomial regression was used to examine relationships between coping strategies and partner and non-partner violence perpetration, when accounting for substance use and demographic factors. Results: About one-third of participants reported partner violence perpetration (30%) and non-partner violence perpetration (34%). Frequency of partner violence and non-partner violence were both associated with more use of avoidant and emotion-focused strategies and less use of problem-focused coping in adjusted models. Discussion: Continued research is warranted to determine whether coping-oriented interventions decrease violence among people in substance use disorder treatment.

Aggression in Women: Behavior, Brain and Hormones

We review the literature on aggression in women with an emphasis on laboratory experimentation and hormonal and brain mechanisms. Women tend to engage in more indirect forms of aggression (e.g., spreading rumors) than other types of aggression. In laboratory studies, women are less aggressive than men, but provocation attenuates this difference. In the real world, women are just as likely to aggress against their romantic partner as men are, but men cause more serious physical and psychological harm. A very small minority of women are also sexually violent. Women are susceptible to alcohol-related aggression, but this type of aggression may be limited to women high in trait aggression. Fear of being harmed is a robust inhibitor of direct aggression in women. There are too few studies and most are underpowered to detect unique neural mechanisms associated with aggression in women. Testosterone shows the same small, positive relationship with aggression in women as in men. The role of cortisol is unclear, although some evidence suggests that women who are high in testosterone and low in cortisol show heightened aggression. Under some circumstances, oxytocin may increase aggression by enhancing reactivity to provocation and simultaneously lowering perceptions of danger that normally inhibit many women from retaliating. There is some evidence that high levels of estradiol and progesterone are associated with low levels of aggression. We highlight that more gender-specific theory-driven hypothesis testing is needed with larger samples of women and aggression paradigms relevant to women.

The Intimate Partner Flooding Scale

Dysfunctional conflict resolution behaviors in couples have been long recognized as markers of relationship maladjustment and are, consequently, frequent targets of couple therapy. The process of flooding may play a role. Flooding is the subjective sense of being overwhelmed by the partner's negative affect, which is perceived as unexpected and intense, and feeling as though one's information processing is impaired. It has been theorized that flooding is so aversive as to lead to maladaptive conflict behaviors (e.g., conflict escalation or withdrawal) as attempts to terminate the offending input (i.e., partner anger). Despite strong theory describing the construct, there has been a lack of valid measures to assess it. In the present study, we evaluated the psychometric properties of a 15-item measure in a sample of 453 couples. Reasonable unifactoriality, excellent internal consistency, and high test-retest reliability were demonstrated. Furthermore, using a dyadic latent variable model, the IPFS showed strong structural validity and concurrent validity with measures of relationship satisfaction, intimate partner violence, anger, depressive symptoms, and observed negative conflict behaviors. The IPFS appears to be a promising, economical instrument to assess flooding, a process relevant for understanding dysfunctional couple conflict behaviors.

New data on intimate partner violence and intimate relationships: Implications for gun laws and federal data collection

Age at first marriage has risen substantially and birth rates are at a record low; people are spending more time in relationships that, by comparison, have fewer emotional, financial, and legal commitments. Little research has examined intimate partner violence (IPV) prevalence in current and former adult (vs. adolescent) dating relationships. Such information is relevant to federal firearms policies that are based on the nature of an intimate relationship. We examined assaultive behaviors by the type and status of the relationship - current spouse, former spouse, current boyfriend or girlfriend, and former boyfriend or girlfriend - in 31,206 IPV incidents responded to by Philadelphia police in 2013. Over 80% of the IPV incidents involved individuals in non-marital relationships. Incidents involving current boyfriends or girlfriends had the highest percentage of violent behaviors (e.g., punch, strangle). They also were more likely than current spouses to use bodily weapons (hands, fists, or feet) or non-gun weapons (knives, bats, etc.) (AOR = 1.19 and 1.43, respectively), to injure their victims (AOR = 1.37), and to be arrested (AOR = 1.46). Former unmarried partners had the highest odds of stalking their intimate (AOR = 3.37) and violating a restraining order (AOR = 2.61). Gun use was similar across relationship type. A growing portion of the population is not protected by federal policies designed to keep guns out of the hands of abusers. Current boyfriends and girlfriends are a risk to their intimates. Federal data collection practices and firearm policies merit updating to more fully take into account dating, same-sex marriage, and other partnerships.

Ambivalent Sexism, Alcohol Use, and Intimate Partner Violence Perpetration

Research on risk factors for men's perpetration of intimate partner violence (IPV) has shown a high correlation with problem alcohol use. Additional studies, however, indicate that the alcohol-IPV link is neither simple nor necessarily direct and that a range of factors may moderate this relationship. Using a national, community-based sample of 255 men, the present study examined the moderating effects of ambivalent sexism (i.e., hostile and benevolent sexism) on the relationship between alcohol use and IPV perpetration. The findings show that both greater alcohol consumption and high hostile sexism are positively associated with IPV perpetration, and that hostile sexism moderates the alcohol-IPV relationship for perpetration of physical IPV, but not for psychological IPV. Moreover, high levels of alcohol consumption have a greater impact on physical IPV perpetration for men low in hostile sexism than for men high in hostile sexism, lending support to the multiple threshold model of the alcohol-IPV link. Implications of the findings for prevention, intervention, and future research are discussed.

A longitudinal study of socioeconomic status, family processes, and child adjustment from preschool until early elementary school: the role of social competence

OBJECTIVE

Using a short-term longitudinal design, this study examined the concurrent and longitudinal relationships among familial socioeconomic status (SES; i.e., family income and maternal and paternal education levels), marital conflict (i.e., constructive and destructive marital conflict), parenting practices (i.e., positive and negative parenting practices), child social competence (i.e., social skills), and child behavioral adjustment (i.e., internalizing and externalizing problems) in a comprehensive model.

METHODS

The sample included a total of 1604 preschoolers aged 5 years at Time 1 and first graders aged 6 years at Time 2 (51.5% male). Parents completed a self-reported questionnaire regarding their SES, marital conflict, parenting practices, and their children's behavioral adjustment. Teachers also evaluated the children's social competence.

RESULTS

The path analysis results revealed that Time 1 family income and maternal and paternal education levels were respectively related to Time 1 social skills and Time 2 internalizing and externalizing problems, both directly and indirectly, through their influence on destructive and constructive marital conflict, as well as negative and positive parenting practices. Notably, after controlling for Time 1 behavioral problems as mediating mechanisms in the link between family factors (i.e., SES, marital conflict, and parenting practices) and behavioral adjustment, Time 1 social skills significantly and inversely influenced both the internalization and externalization of problems at Time 2.

CONCLUSIONS

The merit of examining SES, marital conflict, and parenting practices as multidimensional constructs is discussed in relation to an understanding of processes and pathways within families that affect child mental health functioning. The results suggest social competence, which is influenced by the multidimensional constructs of family factors, may prove protective in reducing the risk of child maladjustment, especially for children who are socioeconomically disadvantaged.

Emotional intimate partner violence experienced by men in same-sex relationships

Intimate partner violence research has focused almost exclusively on physical and sexual intimate partner violence in opposite-sex relationships, paying little attention to the intimate partner violence experienced by men in same-sex relationships. Emerging research focusing on intimate partner violence among male-male couples has focused largely on physical and sexual violence, with little consideration of the unique forms of emotional violence experienced by gay men. Ten focus-group discussions with gay and bisexual men were conducted to examine perceived typologies, antecedents and experiences of emotional violence that occur between male partners. Participants described emotional violence as the most threatening form of intimate partner violence, driven largely by factors including power differentials, gender roles and internalised homophobia. Results indicate that gay and bisexual men perceive emotional intimate partner violence to be commonplace. A better understanding of emotional violence within male-male relationships is vital to inform intimate partner violence prevention efforts and the more accurate measurement of intimate partner violence for gay men.

Risk Factors of Physical and Sexual Abuse for Women in Mali: Findings From a Nationally Representative Sample

Mali is a developing country that has marked inequalities between genders. Using the 2012-2013 Mali Demographic and Health Survey, a nationally representative sample of Malian women ( N = 2,527), the study examined the effect of controlling behaviors, childhood exposure to and experience of violence, husband's alcohol use, woman's use of violence, and sociocultural factors on the likelihood of experiencing physical and sexual abuse. Findings indicated that controlling behavior, childhood exposure to violence, and husband's use of alcohol were predictors of physical and sexual abuse. Respondent's use of violence increased risk of physical abuse. Implications for programming in Mali are discussed.

Acculturation, Drinking, and Intimate Partner Violence among Hispanic Couples in the United States: A Longitudinal Study

This article examines the 5-year association between acculturation, drinking, and maleto-female partner violence and female-to-male partner violence among Hispanic couples in the United States. A national representative sample of Hispanic couples 18 years of age or older was interviewed in 1995 and 2000. Both members of the couple were independently interviewed. Differences in prevalence rates of male-to-female partner violence and female-to-male partner violence, incidence, and recurrence across acculturation groups are not significant. Drinking is associated with acculturation among women. Couples with mixed acculturation level (high-medium) are less at risk for maleto-female partner violence. An increase of five standard drinks per week in men’s drinking decreases the risk of female-to-male partner violence by 10%. Acculturation level at Time 1 is not associated with male-to-female partner violence and female-to-male partner violence status 5 years later.

Detecting and Documenting Intimate Partner Violence

The objective of this research was to assess rates of clinician screening for intimate partner violence (IPV) and to evaluate documentation of cases. The authors reviewed 527 charts of women aged 18 to 65 seen in the emergency department of an academic medical center. Of the 527 charts reviewed, 150 charts (29%) indicated patients were screened; 23 patients (15%) were positive for IPV. Prevalence of lifetime exposure to IPV was 4.4%, and prevalence of current IPV was 2.8%. Few aspects of patient safety (whether the patient felt safe going home, whether a gun was in the home) were charted. Screening and documentation rates in emergency departments are far from optimal.

Violence Against Immigrant Women

Intimate partner violence against immigrant women is at epidemic proportions, but research has only recently begun to address the concern. A review of the legal, medical, and social science research literature reveals little data, but that which exist demonstrate that immigrant women's cultures, contexts, and legal status (a) increase vulnerability for abuse, (b) are used by batterers to control and abuse immigrant women, and (c) create barriers to women seeking and receiving help. Data also reveal that immigrant culture and context offer resiliency factors through which programs and policy can be used to better serve these populations.

Sexual Violence Against Adolescent Girls

This study investigates associations between immigration and acculturation with sexual assault among a large, representative sample of high school girls. The analysis utilized data from the Massachusetts Youth Risk Behavior Surveys conducted in 1999, 2001, and 2003 ( N = 5,919). Adjusted logistic regression analyses were conducted among the full sample and a sexually active subsample. Being an immigrant was associated with recurring sexual assault victimization; this effect was not consistent across age and racial/ethnic groups. Immigrant status conferred risk among adolescent girls aged 15 and younger, Black adolescent girls, and sexually active Hispanic girls. No differences were detected in sexual assault victimization based on acculturation.

Borderline personality disorder and related constructs as risk factors for intimate partner violence perpetration

In this manuscript we systematically reviewed 29 articles from 2010 to 2014 that addressed the association between borderline personality disorder (BPD) and intimate partner violence (IPV) perpetration, with particular attention paid to the role of perpetrator sex. Our primary objective was to provide a summary of (1) the operationalization and measurement of BPD and IPV, (2) mechanisms of the BPD-IPV association, and (3)the current understanding of the role of perpetrator sex related to BPD and IPV. We observed three distinct operational definitions of BPD which are measured in a variety of ways. IPV measurement tends to be more consistent. Further, emotion perception, impulsivity, attachment, and substance use are proposed mechanisms to explain the BPD IPV relation. The findings regarding potential perpetrator sex differences in the BPD-IPV association are mixed. Finally, we also provide recommendations for future research and clinical practice.

Intimate Partner Violence Among Hong Kong Young Adults: Prevalence, Risk Factors, and Associated Health Problems

Intimate partner violence is a serious social problem and public health issue affecting the well-being of the young adults. However, there is very little epidemiological evidence on the incidence and associated health problems in contemporary Chinese society. Using a representative community sample of 1,223 young adults aged 18 to 27 years conducted by Hong Kong Family Planning Association in 2011, this study aimed to estimate the prevalence, risk factors, and possible health consequences of intimate partner violence among young adults in Hong Kong. It is found that the prevalence of lifetime and preceding 1-year intimate partner violence by former or current partners was 8.6% and 4.9% respectively. Male youths who were older were less likely to experience past-year intimate partner violence (odds ratio [OR] = 0.21, p < .05) and those who had a university degree or were unemployed were more likely to experience past-year intimate partner violence (OR = 8.48, p < .01 and OR = 8.14, p < .05 respectively). Female youths who had a full-time job were less likely to experience the lifetime violence (OR = 0.15, p < .05) and those who were ever pregnant with current partner were more likely to experience both lifetime intimate partner violence (OR = 5.00, p < .05) and past-year violence (OR = 5.63, p < .05). Both female and male victims were more likely to be subjected to mental health problems and only female victims felt fear for the violent partner.

Examining the Role of Antisocial Personality Disorder in Intimate Partner Violence Among Substance Use Disorder Treatment Seekers With Clinically Significant Trauma Histories

This study examined the associations among posttraumatic stress disorder (PTSD) symptom severity, antisocial personality disorder (ASPD) diagnosis, and intimate partner violence (IPV) in a sample of 145 substance abuse treatment-seeking men and women with positive trauma histories; sex was examined as a moderator. ASPD diagnosis significantly predicted both verbal and physical aggression; sex moderated the association between ASPD diagnosis and physical violence. PTSD symptom severity significantly predicted engaging in verbal, but not physical, aggression. Overall, these results suggest that an ASPD diagnosis may be an important risk factor for engaging in IPV among women seeking treatment for a substance use disorder.

Dating Violence among Youth Couples: Dyadic Analysis of the Prevalence and Agreement

Although dating violence takes place within the context of a couple, there are few studies exploring how the prevalence data change when violence is reported by one partner or both, and to what extent partners agree about the existence of violence. The aim of this study is therefore to analyze and compare the reports about the prevalence of violence obtained from participants and their partners, together with interpartner agreement concerning victimization and perpetration of threats, physical, verbal-emotional and sexual violence. A total of 105 young heterosexual couples answered a questionnaire about victimization and the perpetration of violence in their relationship during the previous year. The results indicated that prevalence rates varied, depending on who reported the violence -the man, the woman or the couple- perhaps because interpartner agreement was low, except for the occurrence of verbal-emotional violence and the absence of physical violence. These findings suggest the need to develop more systematic research, especially through the use of reports from both members of the couple.

Identifying unique and shared risk factors for physical intimate partner violence and clinically-significant physical intimate partner violence

Intimate partner violence (IPV) is a significant public health concern. To date, risk factor research has not differentiated physical violence that leads to injury and/or fear (i.e., clinically significant IPV; CS-IPV) from general physical IPV. Isolating risk relations is necessary to best inform prevention and treatment efforts. The current study used an ecological framework and evaluated relations of likely risk factors within individual, family, workplace, and community levels with both CS-IPV and general IPV to determine whether they were related to one type of IPV, both, or neither for both men and women. Probable risk and promotive factors from multiple ecological levels of influence were selected from the literature and assessed, along with CS-IPV and general IPV, via an anonymous, web-based survey. The sample comprised US Air Force (AF) active duty members and civilian spouses (total N = 36,861 men; 24,331 women) from 82 sites worldwide. Relationship satisfaction, age, and alcohol problems were identified as unique risk factors (in the context of the 23 other risk factors examined) across IPV and CS-IPV for men and women. Other unique risk factors were identified that differed in prediction of IPV and CS-IPV. The results suggest a variety of both established and novel potential foci for indirectly targeting partner aggression and clinically-significant IPV by improving people's risk profiles at the individual, family, workplace, and community levels. Aggr. Behav. 41:227-241, 2015. © 2014 Wiley Periodicals, Inc.

Enhanced definitions of intimate partner violence for DSM-5 and ICD-11 may promote improved screening and treatment

Nuanced, multifaceted, and content valid diagnostic criteria for intimate partner violence (IPV) have been created and can be used reliably in the field even by those with little-to-no clinical training/background. The use of such criteria such as these would likely lead to more reliable decision making in the field and more consistency across studies. Further, interrater agreement was higher than that usually reported for individual mental disorders. This paper will provide an overview of (a) IPV's scope and impact; (b) the reliable and valid diagnostic criteria that have been used and the adaptation of these criteria inserted in the latest Diagnostic and Statistical Manual of Mental Disorders (DSM) and another adaptation proposed for the forthcoming International Statistical Classification of Diseases and Related Health Problems (ICD); (c) suggestions for screening of IPV in primary care settings; (d) interventions for IPV; and (e) suggested steps toward globally accepted programs.

Alcohol outlet density, drinking contexts and intimate partner violence: a review of environmental risk factors

Alcohol use is a robust predictor of intimate partner violence (IPV). A critical barrier to progress in preventing alcohol-related IPV is that little is known about how an individual's specific drinking contexts (where, how often, and with whom one drinks) are related to IPV, or how these contexts are affected by environmental characteristics, such as alcohol outlet density and neighborhood disadvantage. The putative mechanism is the social environment in which drinking occurs that may promote or strengthen aggressive norms. Once these contexts are known, specific prevention measures can be put in place, including policy-oriented (e.g., regulating outlet density) and individually oriented (e.g., brief interventions to reduce risk for spousal aggression) measures targeting at-risk populations. This paper reviews applicable theories and empirical research evidence that links IPV to drinking contexts and alcohol outlet density, highlights research gaps, and makes recommendations for future research.

Social desirability and partner agreement of men's reporting of intimate partner violence in substance abuse treatment settings

Estimates indicate that intimate partner violence (IPV) occurs in approximately 30% of relationships and up to 85% of the relationships of men in substance abuse treatment. However, partners consistently display poor agreement in reporting the presence of IPV. Social desirability is frequently offered as the primary reason for under-reporting of IPV by perpetrators. The goal of the current study was to explicitly test the social desirability hypothesis using both partners' reports of negotiation, psychological aggression, physical aggression, sexual aggression, and injuries in a substance abuse treatment sample. A total of 54 males and their female partners were recruited from a residential adult substance use treatment facility. Consistent with prior literature, partners displayed poor agreement about the presence of different types of IPV. The male partner's social desirability was not associated with his reporting of male-to-female physical aggression, psychological aggression, or injuries. Men who engaged in higher levels of self-deceptive enhancement and lower levels of impression management were more likely to under-report male-to-female sexual coercion. Overall, the findings question the generalized importance of social desirability in IPV reporting in substance abuse treatment populations.

Safety-related moderators of a parent-based HIV prevention intervention in South Africa

Our study examined factors influencing the effectiveness of a parent-based HIV prevention intervention implemented in Cape Town, South Africa. Caregiver-youth dyads (N = 99) were randomized into intervention or control conditions and assessed longitudinally. The intervention improved a parenting skill associated with youth sexual risk, parent-child communication about sex and HIV. Analyses revealed that over time, intervention participants (female caregivers) who experienced recent intimate partner violence (IPV) or unsafe neighborhoods discussed fewer sex topics with their adolescent children than caregivers in safer neighborhoods or who did not report IPV. Participants with low or moderate decision-making power in their intimate relationships discussed more topics over time only if they received the intervention. The effectiveness of our intervention was challenged by female caregivers' experience with IPV and unsafe neighborhoods, highlighting the importance of safety-related contextual factors when implementing behavioral interventions for women and young people in high-risk environments. Moderation effects did not occur for youth-reported communication outcomes. Implications for cross-cultural adaptations of parent-based HIV prevention interventions are discussed.

Impact of adding Level II and III trauma centers on volume and disease severity at a nearby Level I trauma center

BACKGROUND

As emergency care becomes increasingly regionalized, systems planners must determine how system expansion impacts existing system assets. We hypothesized that accrediting new Level II and III trauma centers impacted the trauma patient census and severity at a nearby Level I trauma center and estimated the magnitude of the impact.

METHODS

We conducted an interrupted time series analysis using monthly patient counts during the past 10 years for five trauma centers located near one another in Pennsylvania. The Level I center (TC-A) operated for the entire period. A Level II center 39 miles away was accredited after 70 months (TC-B), one Level III center 46 miles away was accredited after 95 months but lost accreditation after 11 months (TC-C), and two other Level III centers 40 miles and 45 miles away were accredited after 107 months (TC-D and TC-E).

RESULTS

Monthly patient volume at the Level I center, which increased gradually over the study and summed to 25,120 patients, decreased by 10.8% (p < 0.05) when TC-B was accredited and decreased by an additional 12.9% (p < 0.05) when TC-D and TC-E were accredited simultaneously. No change stemmed from temporarily accrediting TC-C. Ultimately, the Level I center treated 1,903 fewer patients than expected over 51 months, an 11.9% volume reduction, and patient severity remained consistent but mortality decreased.

CONCLUSION

Accrediting Level II and Level III trauma centers reduced patient volume and reduced overall mortality at a nearby Level I center. Strategic planning of statewide trauma systems can help balance rapid access to care with maintenance of adequate annual patient volumes of critically injured patients.

LEVEL OF EVIDENCE

Epidemiologic study, Level IV.

Conditional inference trees: a method for predicting intimate partner violence

A number of different methodologies have been employed to investigate the complex relationship between psychological and physical aggression. Herein, a method of unbiased recursive partitioning (conditional inference trees) was applied to a longitudinal sample to identify cutoffs of psychological aggression at baseline that differentiate between individuals who do and do not perpetrate physical aggression at follow-up. The algorithm categorized men into low- and high-risk groups, and women into mild-, moderate-, or high-risk categories of perpetration. Couples responded anonymously to a self-report measure of psychological and physical aggression (CTS2) at baseline and a 12-month follow-up. Sensitivity analyses for predicting physical aggression reached as high as 59% for women and 60% for men.

A systematic review of the epidemiology of nonfatal strangulation, a human rights and health concern

We reviewed the literature on the epidemiology of nonfatal strangulation (also, albeit incorrectly, called choking) by an intimate partner. We searched 6 electronic databases to identify cross-sectional, primary research studies from 1960 to 2014 that reported national prevalence estimates of nonfatal strangulation by an intimate partner among community-residing adults. Of 7260 identified references, 23 articles based on 11 self-reported surveys in 9 countries met the inclusion criteria. The percentage of women who reported ever having been strangled by an intimate partner ranged from 3.0% to 9.7%; past-year prevalence ranged from 0.4% to 2.4%, with 1.0% being typical. Although many epidemiological surveys inquire about strangulation, evidence regarding its prevalence is scarce. Modifying or adding a question to ongoing national surveys, particularly the Demographic and Health Surveys, would remedy the lack of data for low- and middle-income countries. In addition, when questions about strangulation are asked, findings should be reported rather than only combined with other questions to form broader categories (e.g., severe violence). Such action is merited because of the multiple negative short- and long-term sequelae of strangulation.

Genetic associations with intimate partner violence in a sample of hazardous drinking men in batterer intervention programs

The etiology of intimate partner violence (IPV) is multifactorial. However, etiological theories of IPV have rarely included potential genetic factors. The purpose of the present study was to examine whether a cumulative genetic score (CGS) containing the monoamine oxidase A (MAOA) and the human serotonin transporter gene linked polymorphism (5-HTTLPR) was associated with IPV perpetration after accounting for the effects of alcohol problems, drug problems, age, and length of relationship. We obtained DNA from 97 men in batterer intervention programs in the state of Rhode Island. In the full sample, the CGS was significantly associated with physical and psychological aggression and injuries caused to one's partner, even after controlling for the effects of alcohol problems, drug problems, age, and length of relationship. Two of the men in the sample likely had Klinefelter's syndrome, and analyses were repeated excluding these two individuals, leading to similar results. The implications of the genetic findings for the etiology and treatment of IPV among men in batterer intervention programs are briefly discussed.

Child abuse and neglect and intimate partner violence victimization and perpetration: a prospective investigation

This paper describes the extent to which abused and neglected children report intimate partner violence (IPV) victimization and perpetration when followed up into middle adulthood. Using data from a prospective cohort design study, children (ages 0-11) with documented histories of physical and sexual abuse and/or neglect (n=497) were matched with children without such histories (n=395) and assessed in adulthood (Mage=39.5). Prevalence, number, and variety of four types of IPV (psychological abuse, physical violence, sexual violence, and injury) were measured. Over 80% of both groups - childhood abuse and neglect (CAN) and controls - reported some form of IPV victimization during the past year (most commonly psychological abuse) and about 75% of both groups reported perpetration of IPV toward their partner. Controlling for age, sex, and race, overall CAN [adjusted odds ratio (AOR)=1.60, 95% CI [1.03, 2.49]], physical abuse (AOR=2.52, 95% CI [1.17, 5.40]), and neglect (AOR=1.64, 95% CI [1.04, 2.59]) predicted increased risk for being victimized by a partner via physical injury. CAN and neglect also predicted being victimized by a greater number and variety of IPV acts. CAN and control groups did not differ in reports of perpetration of IPV, although neglect predicted greater likelihood of perpetrating physical injury to a partner, compared to controls. Abused/neglected females were more likely to report being injured by their partner, whereas maltreated males did not. This study found that child maltreatment increases risk for the most serious form of IPV involving physical injury. Increased attention should be paid to IPV (victimization and perpetration) in individuals with histories of neglect.