Determinants of Family Stress and Domestic Violence: Lessons from the COVID-19 Outbreak

Impact of COVID-19 on women living with HIV who are survivors of intimate partner violence

BACKGROUND

Women living with HIV (WLWH) experience higher rates of intimate partner violence (IPV) compared to women without HIV, but there has been minimal research to date on the impact of the COVID-19 pandemic on the lived experiences of WLWH who are IPV survivors.

METHODS

This is a secondary analysis of COVID-19 impact using baseline data from an ongoing, prospective, micro-longitudinal cohort study of HIV care engagement among WLWH who have experienced lifetime IPV. We measured the impact of COVID-19 along key domains (i.e., physical health, day-to-day life, sexual/relationship behavior, substance use, HIV care, mental health, financial status, and having conflict with partners). Using independent t-tests or Fisher's exact tests, and Pearson's chi-squared tests, we compared women with and without ongoing IPV across sociodemographic characteristics, psychiatric disorders, substance use, and COVID-19 impact domains. We then built separate multivariate linear regression models for each of the different COVID-19 impact domains; ongoing IPV exposure was the primary explanatory variable of interest.

RESULTS

Enrolled participants (n = 84) comprised a group of women (mean age 53.6y; SD = 9.9) who were living with HIV for a mean 23.3 years (SD = 10), all of whom had experienced lifetime IPV. Among 49 women who were currently partnered, 79.6% (n = 39) reported ongoing IPV. There were no statistically significant differences between those experiencing ongoing IPV and those who were not (or not partnered) in terms of demographic characteristics, substance use, or mental health. In multivariate models, ongoing IPV exposure was not associated with any COVID-19 impact domain. Anxiety and depression, however, were associated with COVID-19-related physical health, HIV care, and relationship conflict. Hispanic ethnicity was significantly associated with COVID-19-related physical health. More severe cocaine and opioid use were also significantly associated with COVID-19-related impact on day-to-day life.

CONCLUSIONS

Among this sample of WLWH who are all lifetime IPV-survivors, nearly half had ongoing IPV exposure. The COVID-19 public health emergency period affected WLWH in varied ways, but impacts were most profound for women experiencing concurrent mental health and substance use problems. Findings have important implications for future interventions to improve women's health and social outcomes.

A tale of two cities: Heterogeneous effects of COVID-19 quarantine on domestic violence in Brazil

Domestic violence calls to helplines surged worldwide immediately after COVID-19 lockdowns, but crime reporting, assaults, or homicides did not consistently rise. Using Brazilian data from health services and helplines, we analyze the impact of COVID-19 quarantine on domestic violence calls and assaults (health reports and hospitalizations). We use a difference-in-difference model to compare the evolution of domestic violence against women in municipalities that enacted the quarantine in March 2020 versus those that never did. Then, we estimate the difference in the quarantine effect between municipalities with and without protective services for women. Domestic violence calls increased by 11.8% in the first quarter of the quarantine, while health reports reduced by 12.6% a quarter later. These effects came from municipalities with protective services for women, where female hospitalizations due to assault decreased as well. In contrast, municipalities without such services saw a decrease in domestic violence calls and an increase in health reports in the first quarter. The supply of protective services for women could be a factor that explains why COVID-19-induced quarantine effects on domestic violence varied across populations. Our results suggest that when domestic violence calls increased, protective services actions prevented domestic violence from escalating into more severe cases, such as assaults.

The uprise of gun violence in the United States: consequences of a dual pandemic

PURPOSE OF REVIEW

The global coronavirus disease 2019 (COVID-19) viral outbreak and the rise of the anti-Black racism movement have produced a dual pandemic over the past few years, which has been associated with a dramatic rise in gun violence across the United States. This comprehensive review was performed to examine the current levels of gun violence in the context of these dual pandemics, delineate factors which have synergistically produced this surge in interpersonal violence, and propose future directions.

RECENT FINDINGS

Dual pandemics have mutually contributed to a worsening in many social determinants of health and thereby have had a particularly dramatic impact on many of our most vulnerable patients, including patients of minority races and ethnicities, in terms of interpersonal violence. Firearm injuries are at their highest rate in decades. The challenges in the trauma care of these patients have been compounded by staffing and resource shortages related to the COVID-19 pandemic and attrition of medical workers related to burnout.

SUMMARY

Consequences of the COVID-19 pandemic and the anti-Black racism movement have produced a social environment in the United States in recent years where interpersonal violence, especially firearm injuries, have surged. Particularly, during a time of challenged patient care delivery, the medical system struggles to support the increase in trauma volume. A broad approach to improving social determinants of health should be pursued in order to decrease the risk of gun violence from the recent near-historical high levels.

Psychological Well-Being during the COVID-19 Lockdown: Labour Market and Gender Implications

In the Spring of 2020, a great number of countries introduced different restrictive measures in order to cope with the COVID-19 pandemic. This article examines the labour market transitions of individuals brought about by some of those measures, and the effect of such transitions on psychological well-being. The fact that it has been possible to distinguish between unemployment transitions before the pandemic began and those resulting from the lockdowns is worth highlighting. Evidence is provided showing that unemployment due to the lockdown had a greater negative impact on psychological well-being than furloughs and teleworking. Gender differences confirm that women experienced greater adverse effects as compared to men. Specifically, women working at home exhibited greater negative effects when compared with those on furlough, probably due to a combination of work disruption and increased family obligations. Finally, on the contrary to men, women living in areas with more rigorous restrictions show a reduced probability of worse PWB when compared to those residing in areas without restrictions. This finding suggests that women are willing to sacrifice freedom of movement as long as restrictions protect their at-risk relatives.

Increases in Intimate Partner Violence During COVID-19: Prevalence and Correlates

Measures to contain the global COVID-19 pandemic led to stay-at-home orders across the world, accompanied by fears of a global surge in intimate partner violence (IPV). We administered an online general-population survey to 1169 women and transgender/nonbinary individuals throughout the state of Michigan in June-August 2020 to assess changes in the prevalence, severity, and correlates of IPV during the COVID-19 pandemic. Quota sampling was used to match the racial/ethnic and urban/rural distribution of the state. More than one in seven (15.1%) participants reported physical, sexual, psychological, or technology-facilitated IPV since COVID, similar to the prevalence in the 3 months before COVID (16.2%). However, there were indications that IPV severity increased and that novel cases of IPV are occurring in relationships that previously had no abuse. A majority (64.2%) of individuals who experienced IPV since COVID reported that the IPV was new to the relationship (34.1%) or of increased severity during COVID-19 (26.6%), representing 9.7% of the overall sample. New or increased IPV was significantly more prevalent among those who were essential workers, pregnant, unable to afford rent, unemployed/underemployed or had recent changes to their job, had partners with recent changes to employment, and those who had gotten tested or tested positive for COVID-19. Urban residence, trans/nonbinary identity, and having a toddler were more strongly associated with IPV during COVID as compared to before COVID. While findings do not support significant changes in the overall prevalence of IPV, the majority of survivors reported incident IPV in relationships that had not previously been abusive, or IPV that became more severe since the start of the pandemic. Cases of new or increased IPV were more concentrated in marginalized groups. Potential touchpoints for outreach and services during future lockdowns include prenatal and pediatric settings, daycares, employers of essential workers, and COVID-19 testing centers. Policies providing rental, childcare, and unemployment support may mitigate increases in IPV during COVID-19.

The Differential Impact of COVID-19 on Labour Market Outcomes of Immigrants in Canada

Based on Canadian Labour Force Survey data, we estimate the differential effect of the COVID-19 pandemic on seven labour market outcomes, and separate between recent and established immigrants relative to domestic-born Canadians. We also use Recentered Influence Function (RIF) unconditional quantile regressions to estimate the differential effects across the distribution of outcomes. We find that the pandemic had an adverse effect on the labour market outcomes for all workers, and that the adverse effects were generally larger for immigrants and especially recent immigrants as well as for immigrants at the bottom of the outcome distributions. The adverse effects were generally larger at the earliest waves of the pandemic, and for recent immigrants who were female, less educated, and those with child responsibilities, and for jobs at greater risk of contact with the pandemic.

The short-term economic consequences of COVID-19: Occupation tasks and mental health in Canada

In this paper, we study the effect of COVID-19 on the labour market and reported mental health of Canadians. To better understand the effect of the pandemic on the labour market, we build indexes for whether workers: (i) are relatively more exposed to disease, (ii) work in proximity to co-workers, (iii) are essential workers and (iv) can easily work remotely. Our estimates suggest that the impact of COVID-19 was significantly more severe for workers that work in proximity to co-workers and those more exposed to disease who are not in the health sector, while the effects are less severe for essential workers and workers that can work remotely. Last, using the Canadian Perspective Survey Series, we observe that reported mental health is significantly lower among some of the most affected workers such as women and less-educated workers. We also document that those who were absent from work because of COVID-19 are more concerned with meeting their financial obligations and with losing their job than those who continue working outside their home.

Depression, anxiety, and stress in Korean general population during the COVID-19 pandemic

OBJECTIVES

The aim of this study was to investigate the prevalence and risk factors of poor mental health in the general Korean population during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

This cross-sectional, population-based, online survey-based study was conducted from November 5 to 20, 2020 and included adults aged 20-49 years in Chungnam Province, Korea. A total of 549 adults were included.

RESULTS

In total, 18.8% of the participants had symptoms of depression, 10.6% had symptoms of anxiety, and 5.1% had a high level of perceived stress during the COVID-19 pandemic. Higher levels of stress (odds ratio [OR], 3.13; 95% confidence interval [CI], 1.13 to 8.67), anxiety (OR, 2.33; 95% CI, 1.09 to 4.49), and depression (OR, 3.00; 95% CI, 1.64 to 5.50) were found among never married, widowed, divorced, and separated people than among married/cohabiting/partnered participants. Participants who felt increased stress at home during the COVID-19 outbreak reported more depression (OR, 2.45; 95% CI, 1.49 to 4.05) and anxiety (OR, 2.42; 95% CI, 1.31 to 4.50). Women had higher risks of anxiety (OR, 1.97; 95% CI, 1.09 to 3.58) and stress (OR, 6.40; 95% CI, 2.30 to 17.85) than men. Participants with the highest household income were less likely to report symptoms of stress than those with the lowest household income (OR, 0.24; 95% CI, 0.06 to 0.96).

CONCLUSIONS

The participants in this study exhibited poor mental health index scores, suggesting that some people are at risk for mental health problems during the COVID-19 pandemic. Being married was independently and significantly associated with a lower likelihood of depression, anxiety, and stress.

Transitioning to virtual interaction during the COVID-19 pandemic: Impact on the family connects postpartum home visiting program activity

In this paper, we analyze program activity for Family Connects (FC), an evidence-based postpartum home-visiting intervention, during the COVID-19 pandemic. When the pandemic began, FC transitioned to a virtual protocol which maintains key psychosocial components of the in-person protocol and adjusts health assessments to address the lack of in-person contact. Program performance is contrasted for periods before the pandemic onset (April 2019-March 2020) and after the onset (April 2020-March 2021), involving 10,280 scheduled visits and 6696 visited families (46% non-Hispanic white; 20% non-Hispanic Black; 23% Hispanic; and 10% other race). Post-pandemic onset, FC program participation rates were at 89.8% of pre-pandemic levels. Home visitors observed post-onset increases in families' concerns about home safety but declines in families' needs related to infant care. Community connections were facilitated for 42.9% of visited families post-pandemic onset compared to 51.1% pre-pandemic onset. We conclude that post-pandemic onset virtual delivery rates of FC declined but are high enough to merit continued implementation during a period when some families will decline in-person visits. When in-person visits are deemed safe per public health guidelines, the findings suggest a hybrid approach that could maximize program outreach by prioritizing in-person contact and offering virtual delivery as a second choice.

Adherence to COVID-19 policy measures: Behavioral insights from The Netherlands and Belgium

BACKGROUND

Since the start of the global COVID-19 pandemic, countries have been mirroring each other's policies to mitigate the spread of the virus. Whether current measures alone will lead to behavioral change such as social distancing, washing hands, and wearing a facemask is not well understood. The objective of this study is to better understand individual variation in behavioral responses to COVID-19 by exploring the influence of beliefs, motivations and policy measures on public health behaviors. We do so by comparing The Netherlands and Flanders, the Dutch speaking part of Belgium.

METHODS AND FINDINGS

Our final sample included 2,637 respondents from The Netherlands and 1,678 from Flanders. The data was nationally representative along three dimensions: age, gender, and household income in both countries. Our key outcome variables of interest were beliefs about policy effectiveness; stated reasons for complying with public rules; and changes in behavior. For control variables, we included a number of measures of how severe the respondent believed Covid-19 to be and a number of negative side effects that the person may have experienced: loneliness, boredom, anxiety, and conflicts with friends and neighbors. Finally, we controlled for socio-demographic factors: age, gender, income (categorical), education (categorical) and the presence of Covid-19 risk factors (diabetes, high blood pressure, heart disease, asthma, allergies). The dependent variable for each of the estimation models is dichotomous, so we used Probit models to predict the probability of engaging in a given behavior. We found that motivations, beliefs about the effectiveness of measures, and pre-pandemic behavior play an important role. The Dutch were more likely to wash their hands than the Flemish (15.4%, p<0.01), visit family (15.5%, p < .01), run errands (12.0%, p<0.05) or go to large closed spaces such as a shopping mall (21.2%, p<0.01). The Dutch were significantly less likely to wear a mask (87.6%, p<0.01). We also found that beliefs about the virus, psychological effects of the virus, as well as pre-pandemic behavior play a role in adherence to recommendations.

CONCLUSIONS

Our results suggest that policymakers should consider behavioral motivations specific to their country in their COVID-19 strategies. In addition, the belief that a policy is effective significantly increased the probability of the behavior, so policy measures should be accompanied by public health campaigns to increase adherence.