Killing the beast within: woman battering and female suicidality

The Failure of All Mothers or the Mother of All Failures? Juror Perceptions of Failure to Protect Laws

Failure to protect laws have been an area of interest among legal scholars, child and domestic violence advocates, and the social work and psychology fields with varying focuses on the societal underpinnings of the laws and their application. Despite the pervasive legal literature on "mother blaming" and the revictimization of battered women that these laws engender, few studies have empirically examined if "mother blaming" occurs in these cases, or if battered women are treated more harshly. The aim of the present study was to investigate the impact of defendant sex and presence of domestic violence on mock juror decision making in a failure to protect case. The influences of juror sex on decision making were also examined. Jury eligible community members read a summary of a case in which the defendant was charged with failing to protect their child from a third-party abuser. The sex of the defendant and the presence of domestic violence were manipulated. Participants then rendered a verdict, provided sentencing recommendations, and responded to attitudinal questions about the defendant and perpetrator. Mock jurors were more likely to find the defendant guilty and view the defendant more negatively when the defendant had been the victim of domestic violence. Defendant sex did not affect outcome measures; however, female jurors were more punitive than male jurors. Results are discussed in terms of "victim blaming" and labeling theory of intimate partner violence.

Associations of Emotional Abuse Types with Suicide Ideation among Dating Couples

Numerous studies have demonstrated that coercive control is more strongly associated with suicidal ideation than other forms of intimate partner violence. However, a majority of these studies focused on samples of help-seeking women. This study examined whether coercive control remains the form of intimate partner violence most strongly associated with suicidal ideation within a sample of nonclinical dating couples. This cross-sectional, survey study on 104 dating couples examined the associations of coercive control (i.e., dominance/intimidation and restrictive engulfment) with suicidal ideation, while controlling for other forms of emotional abuse (i.e., hostile withdrawal and denigration), physical assault, and depressive symptoms. As expected, dominance/intimidation and depressive symptoms, but not denigration and physical assault, were associated with suicidal ideation. Contrary to our hypothesis, hostile withdrawal, but not restrictive engulfment, was associated with suicidal ideation. This study suggests that dominance/intimidation and hostile withdrawal are forms of emotional abuse that are pertinent to suicidal ideation in nonclinical dating couples.

Pregnancy-associated homicide and suicide in 37 US states with enhanced pregnancy surveillance

BACKGROUND

Pregnant and postpartum women may be at increased risk of violent death including homicide and suicide relative to nonpregnant women, but US national data have not been reported since the implementation of enhanced mortality surveillance.

OBJECTIVE

The objective of the study was to estimate homicide and suicide ratios among women who are pregnant or postpartum and to compare their risk of violent death with nonpregnant/nonpostpartum women.

STUDY DESIGN

Death certificates (n = 465,097) from US states with enhanced pregnancy mortality surveillance from 2005 through 2010 were used to compare mortality among 4 groups of women aged 10-54 years: pregnant, early postpartum (pregnant within 42 days of death), late postpartum (pregnant within 43 days to 1 year of death), and nonpregnant/nonpostpartum. We estimated pregnancy-associated mortality ratios and compared with nonpregnant/nonpostpartum mortality ratios to identify differences in risk after adjusting for potential levels of pregnancy misclassification as reported in the literature.

RESULTS

Pregnancy-associated homicide victims were most frequently young, black, and undereducated, whereas pregnancy-associated suicide occurred most frequently among older white women. After adjustments, pregnancy-associated homicide risk ranged from 2.2 to 6.2 per 100,000 live births, depending on the degree of misclassification estimated, compared with 2.5-2.6 per 100,000 nonpregnant/nonpostpartum women aged 10-54 years. Pregnancy-associated suicide risk ranged from 1.6-4.5 per 100,000 live births after adjustments compared with 5.3-5.5 per 100,000 women aged 10-54 years among nonpregnant/nonpostpartum women. Assuming the most conservative published estimate of misclassification, the risk of homicide among pregnant/postpartum women was 1.84 times that of nonpregnant/nonpostpartum women (95% confidence interval, 1.71-1.98), whereas risk of suicide was decreased (relative risk, 0.62, 95% confidence interval, 0.57-0.68).

CONCLUSION

Pregnancy and postpartum appear to be times of increased risk for homicide and decreased risk for suicide among women in the United States.

Abuse of Women With Disabilities

Women with disabilities are at increased risk for emotional, physical, and sexual abuse. They are also at risk for experiencing disability-related abuse from multiple sources. This problem is compounded by the social context of disability, including pervasive discrimination and stereotyping by society. This article highlights the problem of abuse of women with disabilities and examines the state of the science through a review of literature. An ecological model is presented that examines relevant individual, environmental, and cultural factors. The authors hope that this article will stimulate awareness of this problem and future research in this important arena.

Suicidality among pregnant women in Brazil: prevalence and risk factors

Suicide is one of the major causes of preventable death. We evaluated suicidality among pregnant women who participated in prenatal care in Brazil. A total of 255 patients were assessed using semi-structured interviews as well as the Edinburgh Postnatal Depression Scale (EPDS), Beck Depression Inventory (BDI), and Mini-International Neuropsychiatric Interview (MINI) Plus. Thereafter, Stata 12 was used to identify the significant predictors of current suicide risk (CSR) among participants using univariate and multivariate analyses (p < 0.05). According to MINI Plus module C, the lifetime suicide attempt rate was 12.55%. The overall CSR was 23.53%, distributed across risk levels of low (12.55%), moderate (1.18%), and high (9.80%). Our rates approximate those found in another Brazilian study (18.4%). Antenatal depression (AD), lifetime bipolar disorder, and any current anxiety disorder (as measured using the MINI) as well as BDI scores ≥15 and EPDS scores ≥11 were identified as positive risk factors in a univariate analysis (p < 0.001). These factors changed after a multivariate analysis was employed, and only years of education [odds ratio (OR) = 0.45; 95% confidence intervals (CIs) = 0.21-0.99], AD (OR = 3.42; 95% CIs = 1.37-8.53), and EPDS scores ≥11 (OR = 4.44; 95% CIs = 1.97-9.97) remained independent risk factors. AD and other psychiatric disorders were the primary risk factors for suicidality, although only the former remained an independent factor after a multivariate analysis. More than 10 years of education and EPDS scores ≥11 were also independent factors; the latter can be used as a screening tool for suicide risk.

Challenges of recognition of the psychiatric aspects of intimate partner violence

Background:

Even though intimate partner violence represents a major public health problem in Nigeria, much of its associated burden of psychiatric morbidity presenting in the clinical setting goes unrecognized and untreated.

Objectives:

The purpose of this paper is to clarify the psychiatric perspectives on intimate partner violence and highlight the barriers that militate against the detection of these problems in clinical contexts.

Method:

This paper utilized the framework of relevant case series and a focused review of the relevant literature to describe and annotate the psychiatric problems of the victims and perpetrators of intimate partner violence in southeast Nigeria.

Results:

The major barriers to detection of the psychiatric disorders occurring in the context of intimate partner violence include patients’ feelings of shame, reticence about the abuse experiences in the clinical encounter, and cloaking of their emotional distress in somatic complaints. Also, the poor interviewing skills of many doctors and their difficulty in processing psychosocial matters contributes to the non-detection of psychiatric problems occurring in the context of partner violence.

Conclusion:

Concerted efforts directed towards the improved detection, treatment and/or referral of patients presenting with these difficulties will enhance their wellbeing and quality of life.

Intimate partner abuse and suicidality: a systematic review

Research has demonstrated an association between intimate partner abuse and suicidality, presenting a serious mental health issue. However, studies have differed widely in the samples and methods employed, and in the depth of the investigation. Given the level of heterogeneity in the literature, this systematic review examines, for the first time, the nature of the relationship between intimate partner abuse and suicidality. The three main psychological and medical databases (PsychInfo 1887-March 2011; Medline, 1966-March 2011; Web of Knowledge 1981-March 2011) were searched. Thirty-seven papers on the topic of intimate partner abuse and suicidality were found. With only one exception, all of the studies found a strong and consistent association between intimate partner abuse and suicidality. Significantly, this relationship held irrespective of study design, sample and measurement of abuse and suicidality, thus demonstrating a consistently strong relationship between intimate partner abuse and suicidality. This review highlights that intimate partner abuse is a significant risk factor for suicidal thoughts and behaviours, which has important clinical implications.

Homicide and suicide during the perinatal period: findings from the National Violent Death Reporting System

OBJECTIVE

To estimate the rates of pregnancy-associated homicide and suicide in a multistate sample from the National Violent Death Reporting System, to compare these rates with other causes of maternal mortality, and to describe victims' demographic characteristics.

METHODS

We analyzed data from female victims of reproductive age from 2003 to 2007. We identified pregnancy-associated violent deaths as deaths attributable to homicide or suicide during pregnancy or within the first year postpartum, and we calculated the rates of pregnancy-associated homicide and suicide as the number of deaths per 100,000 live births in the sample population. We used descriptive statistics to report victims' demographic characteristics and prevalence of intimate-partner violence.

RESULTS

There were 94 counts of pregnancy-associated suicide and 139 counts of pregnancy-associated homicide, yielding pregnancy-associated suicide and homicide rates of 2.0 and 2.9 deaths per 100,000 live births, respectively. Victims of pregnancy-associated suicide were significantly more likely to be older and white or Native American as compared with all live births in National Violent Death Reporting System states. Pregnancy-associated homicide victims were significantly more likely to be at the extremes of the age range and African American. In our study, 54.3% of pregnancy-associated suicides involved intimate partner conflict that appeared to contribute to the suicide, and 45.3% of pregnancy-associated homicides were associated with intimate-partner violence.

CONCLUSION

Our results indicate that pregnancy-associated homicide and suicide are important contributors to maternal mortality and confirm the need to evaluate the relationships between sociodemographic disparities and intimate-partner violence with pregnancy-associated violent death.

Violence against women is strongly associated with suicide attempts: evidence from the WHO multi-country study on women's health and domestic violence against women

Suicidal behaviours are one of the most important contributors to the global burden of disease among women, but little is known about prevalence and modifiable risk factors in low and middle income countries. We use data from the WHO multi-country study on women's health and domestic violence against women to examine the prevalence of suicidal thoughts and attempts, and relationships between suicide attempts and mental health status, child sexual abuse, partner violence and other variables. Population representative cross-sectional household surveys were conducted from 2000-2003 in 13 provincial (more rural) and city (urban) sites in Brazil, Ethiopia, Japan, Namibia, Peru, Samoa, Serbia, Thailand and Tanzania. 20967 women aged 15-49 years participated. Prevalence of lifetime suicide attempts, lifetime suicidal thoughts, and suicidal thoughts in the past four weeks were calculated, and multivariate logistic regression models were fit to examine factors associated with suicide attempts in each site. Prevalence of lifetime suicide attempts ranged from 0.8% (Tanzania) to 12.0% (Peru city); lifetime thoughts of suicide from 7.2% (Tanzania province) to 29.0% (Peru province), and thoughts in the past four weeks from 1.9% (Serbia) to 13.6% (Peru province). 25-50% of women with suicidal thoughts in the past four weeks had also visited a health worker in that time. The most consistent risk factors for suicide attempts after adjusting for probable common mental health disorders were: intimate partner violence, non-partner physical violence, ever being divorced, separated or widowed, childhood sexual abuse and having a mother who had experienced intimate partner violence. Mental health policies and services must recognise the consistent relationship between violence and suicidality in women in low and middle income countries. Training health sector workers to recognize and respond to the consequences of violence may substantially reduce the health burden associated with suicidal behaviour.

The burden of behavioral emergencies: need for specialist emergency services

Behavioral emergencies constitute an important component of medical emergencies. Psychiatric emergency services, which handle the bulk of behavioral emergencies, are inadequate to meet the burden. Strategies to deal with them are also hampered by the lack of adequate research and availability of data. Since behavioral emergencies may present differently in different groups, requiring differing management, consensus guidelines need to be arrived at for tackling behavioral emergencies. In addition, training professionals for psychiatric emergency services should form a part and parcel of emergency management services.

Pattern of domestic violence amongst non-fatal deliberate self-harm attempters: A study from primary care of West Bengal

OBJECTIVE

Evaluation of various clinico-demographic variables and pattern of domestic violence in non-fatal deliberate self-harm (DSH) attempters admitted in 3 Block Primary Health Centers (BPHC) of Sundarban region of West Bengal, India in the year 2002.

MATERIALS AND METHODS

A prospective study of 89 DSH cases admitted at 3 Sundarban BPHCs by using a specially designed DSH register and a questionnaire on domestic violence in Bengali along with detail clinical interview.

RESULTS

Among the total of 89 DSH cases (23 male and 66 female), young (less than 30 years), female sex, low education and married status constituted major part of the sample. Pesticide poisoning was the commonest mode of DSH attempt. Typical stressors found were marital conflict or conflict with in-laws or guardian. A majority of DSH attempters (69.6%) experienced more than one form of domestic violence. Poverty and unemployment in the family were strongly associated with domestic violence. Among female DSH attempters, the most common perpetrator was husband (48.48%) followed by in-laws (16.67%) and parent (34.78%) was the most common perpetrator among males.

CONCLUSION

Both DSH and domestic violence are serious socio-clinical issue of a major public health concern in the Sundarban region. Stressful life situations and various types of victimizations in the family intermixed with easy availability of lethal pesticides in this agriculture dependent community may facilitate the impulse of self-harm behavior, especially among the young housewives. Timely psychosocial intervention through community psychiatry program may mitigate the impact of psycho-cultural stressors and thus may help to reduce the morbidity and mortality from DSH.

Racial differences in the association between partner abuse and barriers to prenatal health care among Asian and native Hawaiian/other Pacific Islander women

OBJECTIVES

Prenatal health care (PNC) is associated with positive maternal and infant health outcomes. There is limited knowledge regarding Native Hawaiians/Other Pacific Islanders (NHOPI) and Asian women's access to PNC especially among those with partner abuse (PA) experience. The objectives of this paper were to (1) describe and examine factors associated with PNC access barriers among mothers, by race; and, (2) determine the association between PA and PNC access, by race.

METHODS

We analyzed 2004-2007 data from Hawai'i's Pregnancy Risk Assessment Monitoring System (n = 7,158). The outcome is > or = 1 experience with a PNC access barrier. PA is experience with physical violence from a partner. Descriptive statistics, and bivariate and multivariate logistic regression analyses stratified by race were conducted.

RESULTS

The respondents included 35.7% NHOPI, 37.4% Asian, 20.1% White and 6.6% Other. More than 6% experienced PA, and 25.9% reported > or = 1 PNC access barrier. Experience with PA was significantly associated with NHOPI and Asians reporting > or = 1 barrier to accessing PNC, but was non-significant with Whites.

CONCLUSIONS

Programs should address barriers to accessing PNC, and target NHOPI and Asian mothers with PA experience to reduce the healthcare disparity and improve quality of life.

Prevalence of violence against pregnant women in Abeokuta, Nigeria

AIM

To determine the prevalence of violence to pregnant women within 12 months prior to and during the current pregnancy.

METHODS

Cross-sectional study of 534 pregnant women attending three secondary and one tertiary health facility in Abeokuta, Nigeria using semistructured interviewer-administered questionnaires.

RESULTS

Prevalence of violence within 12 months prior to pregnancy was 14.2%. Polygamous union, low level of education in both woman and partner and consumption of alcohol by partners were significant (P < 0.05) risk factors of violence prior to pregnancy. Verbal abuse was the most common (66.2%) type of abuse. Others included flogging (10.8%), slaps (9.5%), threats of violence (6.8%) and forced sexual intercourse (2.7%). The perpetrators were often husbands (65.8%) and the parents (15.8%). Some 2.3% of pregnant women had experienced violence during current pregnancy. Low level of education was significantly (P < 0.05) associated with experiencing violence during pregnancy. Although almost 25% of the pregnancies were unplanned, this was not significantly associated with experiencing violence (P > 0.05). There were similarities in the perpetrators and forms of violence experienced before and during pregnancy, with partners being the most common perpetrators.

CONCLUSION

Gender-based violence is common in our environment. Health-care providers should routinely screen for gender-based violence during antenatal visits in order to protect the health of both mother and child.

Incidence and prevalence of intimate partner violence by and against women with severe mental illness

Although a significant body of research has focused on the victimization of severely mentally ill persons and their perpetration of violence against others, relatively little attention has specifically addressed partner violence inflicted against and committed by severely mentally ill women. We conducted a review of the existing research to examine these issues. The published literature suggests that severely mentally ill women are at increased risk of being victimized by their partners and that a high proportion of severely mentally ill individuals may assault their intimate partners. Directions for future research and suggestions for clinical practice are presented.

Relationships of depression to child and adult abuse and bodily pain among women who have experienced intimate partner violence

This study investigates whether depression in women who experienced intimate partner violence is associated with having also experienced childhood sexual and physical abuse, psychological abuse by an intimate partner, recent involvement with the abusive partner, and bodily pain. Fifty-seven women who had left a violent relationship with an intimate partner completed measures assessing their demographic characteristics, experiences of abuse in childhood and in their relationship with their intimate partner, and depressive symptoms. Multiple regression analysis showed that women's depression was significantly greater among those who had experienced childhood physical and sexual abuse, more severe psychological abuse, and greater bodily pain (p<.001), adjusted R(2)=.32. These results suggest characteristics that can help to identify abused women who are most at risk for depression, and they suggest specific issues that may need to be addressed in this population.

Pregnancy-associated violent deaths: the role of intimate partner violence

This literature review examines intimate partner violence in relation to pregnancy-associated femicide and suicide. Empirical publications were eligible for review if they included information on intimate partner violence and examined females who were pregnant/postpartum and who were victims of femicide/attempted femicide and/or suicide/attempted suicide. Nine publications met the inclusion criteria and were reviewed. Results suggest that intimate partners perpetrate one- to two-thirds of the pregnancy-associated femicides in the United States and that pregnant women make up 5% of urban intimate partner femicides. Intimate partner abuse during pregnancy appears to be a risk factor for severe intimate partner violence, including attempted/completed femicide. So little information exists concerning intimate partner violence in pregnancy-associated suicides that it is impossible to draw conclusions regarding this topic; however, a hospital-based study suggests that intimate partner violence may be a risk factor for attempting suicide while pregnant. More research is needed concerning intimate partner pregnancy-associated femicide and suicide so that evidenced-based preventive/therapeutic interventions may be developed.

A health inequalities perspective on violence against women

The present paper argues that the physical and mental health consequences of gender-based violence constitute a major public health problem in the UK and a source of significant health inequality. The concept of violence against women is explored alongside brief examples of the mental and physical health impact of this violence. While the impact on women's health is relatively uncontested, the extent to which social divisions such as poverty, class and minority ethnic status create specific vulnerabilities to violence are more controversial. A widely held view within the movement to support survivors within the UK has been that violence against women cuts across class and ethnicity, and is found in all communities and classes. A more nuanced discussion of the way in which poverty and ethnic background may create particular vulnerabilities is explored. Disentangling cause and consequence, and also the barriers to help-seeking for minority ethnic women are discussed. The role of social workers in addressing the way in which violence against women is both ubiquitous but marginal in their caseloads is discussed, and appropriate interventions to respond to health inequality issues are proposed.

Violence a global public health problem

This article is a version of the Introduction to the World Report on Violence and Health, published by the World Health Organization (WHO). It presents a general description about this phenomenon and points some basic questions: concepts and definitions about the theme; the state of knowledge about it; nature and typology on violence; proposal of a quantitative and qualitative approach of an ecological model; responsibilities and functions of the public health sector and its potentiality to prevent and reduce violence in the world; the responsibilities of the nations and the policy makers in a intersetorial point of view; difficulties and obstacles for actuation and challenges for the health sector.

Violência: um problema global de saúde pública

Este artigo é uma versão do que foi publicado no Informe Mundial sobre Violência e Saúde, da Organização Mundial de Saúde (OMS), como introdução ao tema. Apresenta uma descrição geral da problemática e a posição da OMS. Nele, os autores se dedicam a responder algumas questões básicas: o estado do conhecimento sobre o assunto; os conceitos e definições com os quais a OMS trabalha; a natureza e a tipologia sobre violência; as formas de abordagem quantitativa e qualitativa em um modelo ecológico; o lugar e o papel da saúde pública e sua potencialidade com vistas a contribuir para prevenir e diminuir a violência no mundo; as responsabilidades das nações e dos gestores em todos os níveis; os obstáculos para atuação e os desafios para o setor.

Suicide risk and mental health indicators: Do they differ by abuse and HIV status?

PURPOSE

This study examines the association between women's HIV serostatus, intimate partner violence (IPV) experience, and risk of suicide and other mental health indicators. Using data from Project WAVE (Women, AIDS, and the Violence Epidemic), we 1) describe the rates of suicidal thoughts and attempts, anxiety, and depression; 2) examine whether and to what extent these outcomes differ by women's HIV and IPV status.

METHODS

A one-time interview was conducted with a sample 611 women living in an urban area, one-half of whom were HIV-positive.

RESULTS

Having thought about suicide was reported by 31% of the sample and 16% reported having attempted suicide. Among HIV-positive women, thoughts of suicide occurred more frequently among those who were recently diagnosed. One-half of the sample reported problems with depression, and 26% reported problems with anxiety; of women reporting these problems, 56% received mental health treatment. Rates varied significantly by HIV and IPV status, with women who were both HIV-positive and abused consistently faring worse. Relative to HIV-negative non-abused women, HIV-positive abused women were 7.0 times as likely to report problems with depression, 4.9 times as likely to report problems with anxiety, 3.6 times as likely to have thought about suicide, and 12.5 times as likely to have ever attempted suicide. Our findings that abused HIV-negative women were also at significantly elevated risk for all of these outcomes lends support to the conclusion that it is the experience of abuse that is associated with the negative outcomes.

CONCLUSIONS

Health care and service providers interacting with women who may be HIV-positive and/or in abusive relationships should routinely assess for mental health status, especially suicide risk, which may need crisis intervention.

Intimate partner violence and depression among Whites, Blacks, and Hispanics

PURPOSE

To examine the relationship between intimate partner violence and depression.

METHODS

A household probability sample of Whites (n=616), Blacks (n=377), and Hispanics (n=592) age 18 or older was interviewed in 1995. The response rate was 85%. Logistic analysis is used to identify predictors of depression.

RESULTS

Among men, Black (OR=.29; 95% CI, 0.13-.65) and Hispanic (OR=0.4; 95% CI, 0.2-0.8) ethnicity were protective against depression. Factors of risk for men included victimization by female to male partner violence (OR=4.04; 95% CI, 1.15-14.11), unemployment (OR=7.65; 95% CI, 1.59-16.39), and living in a high-unemployment neighborhood (OR=4.6; 95% CI, 1.86-11.37). Among women, the predictors are perpetration of moderate (OR=4.08; 95% CI, 1.33-12.47) or severe (OR=6.57; 95% CI, 1.76-24.52) female to male partner violence, and impulsivity (OR=1.82; 95% CI, 3.87-20.71).

CONCLUSIONS

Knowledge from surveys using general population samples is important for developing prevention interventions in the community. Because predictors of depression in these samples are both individual and contextual at neighborhood level, prevention interventions to be effective must address not only individual factors of risk but also structural conditions in the environment where individuals live.

Pregnancy and domestic violence: a review of the literature

Pregnancy-related violence is a serious public health issue. Although there is a growing body of research on this subject, there are still many unanswered questions regarding the prevalence of this type of victimization, the risk factors, and the consequences. The purpose of this literature review is to organize and synthesize the interdisciplinary empirical research on pregnancy-related violence and to provide direction for both researchers and practitioners for future work in this area.

Primary care and victims of domestic violence

Providing quality health care involves integrating routine inquiry about domestic violence into ongoing clinical practice. This means asking all women patients, and others who may be at risk, about abuse in their lives. Whether or not a woman chooses to use services or leave her partner, our intervention is very important. Some women return to violent partners several times before they feel safe enough to leave, feel they can survive on their own, or can accept that the person they love will not change. Make sure that she has follow-up for her medical problems and appropriate referrals for mental health and substance abuse problems when indicated.

Abuse, addiction, and depression as pathways to sexual risk in women and men with a history of substance abuse

PURPOSE

In this paper, we develop and test a model for predicting sexual risk for HIV and other STDs.

METHODS

Researchers interviewed 528 women and men with a history of substance abuse about their past experiences of physical and sexual abuse, symptoms, and sexual risk behavior (number of partners, trading sex for drugs or money, unprotected intercourse, and sexual orientation). The model explores direct and indirect associations of physical abuse and sexual abuse with sexual risk.

RESULTS

Depression and severity of problems with drugs and alcohol were expected to mediate associations between abuse and sexual risk. However, analyses did not substantiate any indirect effects. Being female, more severe drug problems and, among men, past sexual abuse were significant predictors of sexual risk.

CONCLUSION

Prevention interventions would do well to address not only drug addiction, but also past sexual abuse in men and depression in women.

Suicide in women

This article reviews research into suicide in women during the last 25 years. National rates vary between the extremes of 19/10(5) per year in Sri Lanka and < 1/10(5) per year in the Philippines and Egypt, but almost everywhere rates for women are much lower than male rates, with a median ratio of 2.8/1. The exceptions are in India and China, which report higher rates in young married women. The reproductive process has some influence. While menstruation, hormonal treatment, pregnancy and the puerperium have no major effect, unwanted pregnancy may still lead to suicide under certain circumstances, and severe labour can occasionally do so. Having children protects, but the relative risk is no more than 2.0 in nulliparous women. Social factors also have a limited effect. There are higher rates of suicide in divorced women, but the evidence on widowhood is equivocal. Prosperity and employment have no effect. Sexual abuse, rape and domestic violence undoubtedly lead to suicide attempts, but the evidence on completed suicide is lacking. There are many unanswered questions, especially why rates of completed suicide for women (with a greater prevalence of overt depression) are lower than for men, and why Chinese and Indian women have higher rates. More research is required, especially from developing nations.

Addressing barriers to community care of battered women in rural environments: creating a policy of social inclusion

Given domestic violence continues to be a serious social problem, recently acknowledged as a national public health epidemic as well, the need to examine existing formal helping services and address the barriers to service utilization among battered women is warranted. Social exclusion is the process by which multi-dimensionally disadvantaged individuals are prohibited from obtaining formal helping services. Although not a policy per se, many community helpers and organizations inadvertently contribute to erecting barriers which exclude battered women from using such services, particularly in rural environments. Suggestions to transform a process of social exclusion to social inclusion for battered women is offered.

Prevalence and determinants of intimate partner abuse among public hospital primary care patients

OBJECTIVE

To determine the prevalence, sociodemographic determinants, and depression correlates of intimate partner abuse among an ethnically diverse population of women patients.

DESIGN

Cross-sectional telephone survey in English and Spanish of a random sample of women patients aged 18 to 46 years.

SETTING

Three public hospital primary care clinics (general internal medicine, family medicine, and obstetrics/gynecology) in San Francisco, Calif.

PARTICIPANTS

We interviewed 734 (74%) of the 992 eligible participants. Thirty-one percent were non-Latina white, 31% African American, and 36% Latina.

MEASUREMENTS AND MAIN RESULTS

Using questions adapted from the Abuse Assessment Screen, we determined recent and lifetime history of physical, sexual, and psychological abuse. Overall, 15% reported recent abuse by an intimate partner (in the preceding 12 months); lifetime prevalence was 51%. Recent abuse was more common among women aged 18 to 29 years (adjusted odds ratio [OR] 2.1; 95% confidence interval [CI], 1.2 to 3.7), non-Latinas (adjusted OR, 1.7; 95% CI, 1.0 to 2.9), and unmarried women (adjusted OR, 1.65; 95% CI, 1.0 to 2.7). The prevalence of abuse did not differ by education, employment, or medical insurance status of the women. Compared with women with no history of abuse, a greater proportion of recently abused women reported symptoms of depression (adjusted OR, 3.5; 95% CI, 2.2 to 5.5).

CONCLUSIONS

Because a substantial proportion of women patients in primary care settings are abused, screening for partner abuse and depression is indicated. In contrast to other studies, lower socioeconomic status was not associated with partner abuse history.

Rates and relative risk of hospital admission among women in violent intimate partner relationships

OBJECTIVES

This study assessed the history of hospitalization among women involved in violent intimate relationships.

METHODS

In this 1-year retrospective cohort study, female residents of King County, Washington, who were aged 18 to 44 years and who had filed for a protection order were compared with nonabused women in the same age group. Outcome measures included overall and diagnosis-specific hospital admission rates and relative risk of hospitalization associated with abuse.

RESULTS

Women known to be exposed to a violent intimate relationship were significantly more likely to be hospitalized with any diagnosis (age-specific relative risks [RRs] ranging from 1.2 to 2.1), psychiatric diagnoses (RR = 3.6, 95% confidence interval [CI] = 2.8, 4.6), injury and poisoning diagnoses (RR = 1.8, 95% CI = 1.2, 2.8), digestive system diseases (RR = 1.9, 95% CI = 1.3, 2.9), and diagnoses of assault (RR = 4.9, 95% CI = 1.1, 22.1) or attempted suicide (RR = 3.7, 95% CI = 1.6, 9.2) in the year before filing a protection order.

CONCLUSIONS

This study showed an increased relative risk of both overall and diagnosis-specific hospitalizations among abused women. Intimate partner violence has a significant impact on women's health and use of health care.

Intimate partner abuse among women diagnosed with depression

Domestic violence is a pervasive problem for women, and depression is the most prevalent negative mental health consequence of domestic violence. This study investigates the extent to which domestic violence is part of the history of women diagnosed with depression. Eighty two women with a diagnosis of depression were surveyed. A 61.0% lifetime prevalence of domestic violence was found. Lifetime prevalence for forced sex was 29.3%. Demographics of abused and nonabused women were not significantly different. Abused women were found to be less healthy. Prevalence of headaches, chronic pain, rape or marital rape, and sleep problems or nightmares were significantly higher. Severity of abuse was significantly correlated (p < .01) to severity of depression. Implications for mental health practice and training of peer support group leaders for women with depression are described, as well as directions for future research.

Domestic violence and out-of-hospital providers: a potential resource to protect battered women

OBJECTIVE

The primary objective was to determine the prevalence of domestic violence (DV) in a subset of women presenting to the Boston emergency medical services (EMS) system and to evaluate documentation. A secondary objective was to determine the rate of refusal of transport to the hospital for DV-positive patients, compared with the general population.

METHODS

A retrospective chart review of ambulance run sheets from a nonconsecutive, convenience sample between July and December 1995 was performed. Women presenting with injury, obstetric/ gynecologic complaints, or psychiatric complaints were included. Records were reviewed, and labeled as positive, probable, suggestive, or negative for DV, based on a previously used classification system. A weighted kappa test was performed, and data were analyzed using chi-square and t-test.

RESULTS

Among 1,251 charts reviewed, 876 met criteria for inclusion. The percentage of positive cases was 5.4% (95% CI = 3.9% to 6.9%), probable 10.8% (8.8% to 12.9%), suggestive 2.6% (1.6% to 3.7%), and negative 81.2% (78.6% to 83.6%). Among DV-positive patients, the refusal to transport rate was 23.4% (11.3% to 35.5%), compared with a 7.1% (5.8% to 9.3%) rate for the entire study population (n = 876), and 4.7% for the general Boston EMS population during the same year. More DV patients presented during the night shift compared with other shifts.

CONCLUSIONS

Domestic violence is common in this high-risk population. A substantial proportion of women in this population refuse transport to the hospital. Out-of-hospital personnel should be trained with the tools to identify and document DV, assess patient safety, offer timely resources, and empower victims to make choices.

Negative life experiences, depression, and immune function in abused and nonabused women

Abuse of women by their intimate partner is a staggering national problem. Abused women have a higher number of medically unexplained somatic symptoms, more functional disability, a lower self-rating of general health, and higher health care utilization when compared to nonabused women. The authors' purpose in this study was to examine differences in occurrences of negative life experiences, level of depression, and T-cell function between abused and nonabused women. The sample consisted of abused women (n = 12) and nonabused women (n = 12). Hypotheses tested were (1) abused women will have more negative life experiences than nonabused women, (2) abused women will have higher levels of depression than nonabused women, and (3) abused women will have reduced T-cell function compared to nonabused women. A cross-sectional cohort design was used to compare differences in negative life experiences, levels of depression, and T-cell function. Independent sample t-tests were performed comparing the abused versus nonabused women on the dependent measures. Significant differences were found between the groups for negative life experiences (LES; t = 2.29, p < 0.05), level of depression (BDI; t = 3.48, p < 0.01), and T-cell function (TMR; t = -5.62, p < 0.01). These findings are descriptive and do not establish causal links. However, this is an inquiry into the psychological and biobehavioral responses of women experiencing abuse and their potential health problems. The study shows that abused women reported more negative life experiences, experienced higher levels of depression, and experienced lower T-cell function when compared with nonabused women.

Strengthening domestic violence theories: intersections of race, class, sexual orientation, and gender

Current family therapy theories and practices of domestic violence place an important emphasis on gender. Employing the notion of intersectionality, this article demonstrates how the relevance and applicability of contemporary theories and practices may be enhanced through the inclusion of primary dimensions of social life, including but not limited to race, class, and sexual orientation. Theoretical in nature, this article suggests future directions for theory construction and clinical practice, drawing on literature not easily accessible to most marital and family therapists.

The cultural context model: therapy for couples with domestic violence

This article offers a brief analysis of heterosexual dominance within various cultures toward a larger understanding of domestic violence. It then describes the Cultural Context Model, developed over 15 years of experience treating domestic violence in its broader context, utilizing separate "culture circles" for men and women before and during couple therapy. It then identifies guidelines for assessment and intervention with a discussion of the special issues raised when substance abuse is involved.

Guns, Alcohol, and Intimate Partner Violence: The Epidemiology of Female Suicide in New Mexico

Suicide is among the leading causes of death in the United States, and in women the second leading cause of injury death overall. Previous studies have suggested links between intimate partner violence and suicide in women. We examined female suicide deaths to identify and describe associated risk factors. We reviewed all reports from the New Mexico Office of the Medical Investigator for female suicide deaths occurring in New Mexico from 1990 to 1994. Information abstracted included demographics, mechanism of death, presence of alcohol/drugs, clinical depression, intimate partner violence, health problems, and other variables. Annual rates were calculated based on the 1990 census. The New Mexico female suicide death rate was 8.2/100,000 persons per year (n = 313), nearly twice the U. S. rate of 4.5/100,000. Non-Hispanic whites were overrepresented compared to Hispanics and American Indians. Decedents ranged in age from 14 to 93 years (median = 43 years). Firearms accounted for 45.7% of the suicide deaths, followed by ingested poisons (29.1%), hanging (10.5%), other (7.7%), and inhaled poisons (7.0%). Intimate partner violence was documented in 5.1% of female suicide deaths; in an additional 22.1% of cases, a male intimate partner fought with or separated from the decedent immediately preceding the suicide. Nearly two-thirds (65.5%) of the decedents had alcohol or drugs present in their blood at autopsy. Among decedents who had alcohol present (34.5%), blood alcohol levels were far higher among American Indians compared to Hispanics and non-Hispanic Whites (p = .01). Interpersonal conflict was documented in over 25% of cases, indicating that studies of the mortality of intimate partner violence should include victims of both suicide and homicide deaths to fully characterize the mortality patterns of intimate partner violence.

Gender violence and reproductive health

The available literature reflects the growing interest in gender violence and reproductive health. Violence is generally studied by identifying pathologies, measuring their demands on services and evaluating their repercussions on fetal outcome. Institutional violence, however, has received little attention and is mainly concerned with the consequences of inappropriate use of technologies. Data from the Sexuality and Health Feminist Collective shows that among patients, 20.5% stated that they have never talked about their sexual life with their partners; 38.3% stated that they have had sexual intercourse against their will, including situations ranging from sexual harassment to rape which was referred by 12.3% of them. One of the most relevant issues arising from the anamnesis and interviews of these women was the violence to which they were submitted by health services. The high prevalence of violent situations indicates the urgency of incorporating an approach which deals with gender violence and promotes the empowerment of women into the routine of reproductive health services.

A narrative analysis: a black woman's perceptions of breast cancer risks and early breast cancer detection

The oncology nurse's role in breast cancer management is enhanced by knowledge of the patient's perceptions of risks. This case study elucidates the process by which perceived risks of breast cancer are embedded in sequences of biographic experiences including childhood sexual abuse, childhood injuries, and an abusive marriage. The case study shows that risk perceptions and subsequent delayed breast cancer detection is related to (a) a belief that breast cancer results from "bad luck, or fate"; (b) lack of cancer-related symptoms; (c) belief that a higher power determines ill health; (d) reluctance to turn to others for help while in an abusive marriage; (e) family history of cancer invulnerability since generations of family members died of diabetes, heart disease, and pregnancy-related illnesses; and (f) fear of gynecologic exams resulting from childhood sexual abuse. Furthermore, nonapplicability of traditional breast cancer risk factors such as heredity, age older than 30 years at first full-term pregnancy, early menarche, and late menopause prohibit an accurate assessment of self-risk. This case study suggests that breast cancer risk perception often differs from that of biomedical factors, and that an understanding of risk judgments is essential for appropriate therapeutic responses.