The psychological subtype of intimate partner violence and its effect on mental health: a systematic review with meta-analyses

Geographic pattern of the prevalence of intimate partner violence against women in Zanjan (Iran)

Introduction

Intimate partner violence (IPV) against women is a serious public health issue and refers to physically, sexually and psychologically harmful behaviors as well as emotionally controlling behaviors and financial abuse that occur in the form of marriage or cohabitation. Knowing the current situation of the IPV prevalence against women and high-risk areas in the Zanjan city, Iran, can help policymakers to establish better health programs for risk reduction.

Methods

This population-based cross-sectional study consisted of married women aged 18-55 years living in Zanjan city in 2021. 760 married women covered by 19 urban comprehensive health service centers (UCHSCs) were selected by the stratified systematic random sampling method. The prevalence of IPV against women was measured in four types: psychological, physical, sexual, and economic.

Results

Mean (SD) age of the women was 35.49 (8.76) years. 606 women (79.7%) experienced one type of IPV. The highest and lowest IPV prevalence against women were psychological (76.6%) and economic (12%), respectively. The highest and lowest prevalence of psychological violence were observed in CUHSCs 2 and 17, physical violence in CUHSCs 1 and 14, sexual violence in CUHSCs 2 and 17, and economic violence in CUHSCs 2 and 8, respectively. The severity of violence was higher among self-employment or workers husbands, with low monthly household income, and among younger women.

Discussion

The IPV rate in the target population is high, and the highest rate is related to psychological violence. These results highlight the need to intervention in the society and high-risk women for policymakers of the health system.

Examining the Content Validity of the Measure of Psychologically Abusive Behaviors: A Qualitative Approach

The content validity of the Measure of Psychologically Abusive Behaviors (MPAB) was examined via qualitative content analysis of interviews conducted with 262 women who experienced intimate partner violence. Data were coded using MPAB categories and items. Approximately 73.4% of the data were represented by the MPAB at both the category and severity levels; half of the data mapped onto "severe" items. At the category level, 12.3% of the data did not map onto the MPAB; 15.5% of the data mapped onto a category but did not match a severity level. Results support the content validity of the MPAB.

The association between intimate partner violence type and mental health in migrant women living in Spain: findings from a cross-sectional study

Introduction

The association between intimate partner violence (IPV) and mental health has been clearly established in the literature, however the differential associations between IPV type and mental health are less well understood, particularly in migrant groups who are at increased risk of both IPV and poor mental health. Under-studied and emerging forms of violence such as economic abuse and technology-facilitated abuse must be considered alongside more traditionally studied forms of IPV in order to fully understand the complex nature of violence. This study makes a novel contribution to the literature by assessing multiple forms of IPV including psychological, physical, sexual, economic and technology-facilitated IPV and their relationship with symptoms of depression and anxiety in migrant women, disaggregated by IPV type.

Methods

A cross-sectional survey of migrant women living in the Valencian Community of Spain was conducted, to assess experiences of IPV and symptoms of mental health. Regression analysis from the Bayesian perspective was performed.

Results

1,998 women accessed the survey. They had an average age of 37, and came predominantly from Europe (49%), namely Western Europe, followed by Latin America (38%). The majority had been in Spain between 1 and 3 years, and 80% had resident status. A total of 1,156 responded to questions on violence and mental health. Results showed that the prevalence of IPV was high, with 59% of women reporting any experience of violence. Economic abuse was the most commonly reported form of violence, and showed the strongest relationship with symptoms of depression. Sexual violence was the strongest predictor of anxiety. In both cases, in the presence of violence, the odds of having more severe symptoms of depression and anxiety increases by over 2.25. Technology-facilitated abuse was as detrimental to women's mental health as face-to-face violence.

Discussion

The findings from the study are relevant to researchers, policy-makers and service providers. They highlight the complex nature of IPV experiences faced by migrant women and the importance of understanding how different types of IPV can impact migrant mental health, in order to ensure survivors receive adequate care.

Screening for Intimate Partner Violence Experience and Use in the Veterans Health Administration

Importance

The practice of screening women for intimate partner violence (IPV) in health care settings has been a critical part of responding to this major public health problem. Yet, IPV prevention would be enhanced with detection efforts that extend beyond screening for IPV experiences to identifying those who use violence in relationships as well.

Objective

To determine rates of IPV experiences and use (ie, among perpetrators of IPV) and factors associated with disclosures among adult patients seeking mental health services at the Veterans Health Administration.

Design, Setting, and Participants

This cross-sectional study used electronic medical record data drawn from a quality improvement initiative at 5 Veterans Health Administration medical centers conducted between November 2021 and February 2022 to examine IPV disclosures following concurrent screening for IPV experience and use. Participants included patients engaged in mental health services. Data were analyzed in April and May 2023.

Exposure

Mental health clinicians were trained to screen for IPV experience and use concurrently and instructed to screen all patients encountered through routine mental health care visits during a 3-month period.

Main Outcomes and Measures

Outcomes of interest were past-year prevalence of IPV use and experience, sociodemographic characteristics, and clinical diagnoses among screened patients.

Results

A total of 200 patients were offered IPV screening. Of 155 participants (mean [SD] age, 52.45 [15.65] years; 124 [80.0%] men) with completed screenings, 74 (47.7%) denied past-year IPV experience and use, 76 (49.0%) endorsed past-year IPV experience, and 72 (46.4%) endorsed past-year IPV use, including 67 participants (43.2%) who reported IPV experience and use concurrently; only 9 participants (5.8%) endorsed unidirectional IPV experiences and 5 participants (3.2%) endorsed unidirectional IPV use. Patients who reported past-year IPV experience and use were younger than those who denied IPV (experience: mean difference, -7.34 [95% CI, 2.51-12.17] years; use: mean difference, -7.20 [95% CI, 2.40-12.00] years). Patients with a posttraumatic stress disorder diagnosis were more likely to report IPV use (43 patients [59.7%]) than those without a posttraumatic stress disorder diagnosis (29 patients [40.3%]; odds ratio, 2.14; [95% CI, 1.12-4.06]). No other demographic characteristics or clinical diagnoses were associated with IPV use or experience.

Conclusions and Relevance

In this cross-sectional study of IPV rates and associated factors, screening for IPV found high rates of both IPV experience and use among patients receiving mental health care. These findings highlight the benefit of screening for IPV experience and use concurrently across gender and age. Additionally, the associations found between PTSD and IPV use underscore the importance of strengthening and developing additional targeted treatment for IPV.

Prevalence and risk factors for nonconsensual distribution of intimate images among Italian young adults: Implications for prevention and intervention

Nonconsensual distribution of intimate images (NCII), also known as revenge porn, has become a significant social issue in recent years, with severe consequences for victims. The present study aimed to investigate the prevalence and predictors of NCII victimization among young Italian adults, focusing on the role of sexting, intimate partner violence (IPV), impulsivity, and self-disclosure. An online survey was conducted among a sample of 2047 Italian young adults (F = 29.3 %, M = 53.4 %, Not Indicated=16.9 %; mean age = 24.4, SD = 4.4) using a convenience sample recruited through internet. The survey included questions on NCII victimization, sexting behavior, sextortion, and IPV. Our findings showed that 33.9 % of respondents reported engaging in sexting behavior, with females being three times more likely to engage in sexting than males. Furthermore, 3.3 % of participants reported being victims of NCII, with over one-third of victims experiencing three or more types of NCII victimization. Multiple regression analysis revealed that sexting and IPV were significant predictors of NCII victimization, and the interaction effect between self-disclosure and impulsivity was also a significant predictor. This study contributes to the understanding of NCII in Italy and highlights the need for interventions and prevention strategies to address both NCII and IPV, given their strong continuity. The results also suggest that the relationship between self-disclosure, impulsivity, IPV, and NCII victimization is complex and requires further investigation, suggesting a scenario where the climate of violence may impair the victim's decision-making.

Evidence of Gender Asymmetry in Intimate Partner Violence Experience at the Population-Level

Claims of "gender symmetry" in intimate partner violence (IPV) prevalence are contested, with resolution of the issue complicated by methodological and measurement challenges. This study explores gendered differences in the distribution of IPV exposure at the population-level, considering multiple types of IPV exposure. The subjects comprised of 1,431 ever-partnered women and 1,355 ever-partnered men. Data from a nationally representative population-based cross-sectional survey were used to compare men and women's IPV experiences. Twenty-three IPV acts were assessed across IPV types (moderate physical, severe physical, sexual, psychological, controlling behaviors, economic). Proportions were presented by gender for the number of individual IPV acts experienced per IPV type, and the frequency of these acts (none, once, few times, or many times). A composite exposure score was developed to assess the number of acts and their frequency within types by comparing scores in tertiles and across types by correlations. Women reported greater overall prevalence of 20 of the 23 individual IPV acts assessed. Across all assessed acts, women comprised a substantially greater proportion of those who reported experiencing individual acts "many times." Women experienced more severe and more frequent IPV than men based on self-reported experience of IPV acts, and by the frequency with which acts were experienced. Significant differences between men and women's exposure scores were observed for all six assessed types, with greater proportions of women scoring in the upper tertiles. This study provides evidence of gender asymmetry in experiences of IPV at the population level. While men do experience IPV victimization, there remains need for directed and substantial resource allocation for intervention and therapeutic responses to women's exposure to IPV, and for primary prevention with men. Going forward, IPV measurement tools that consider frequency, severity, or co-occurring types of IPV are needed.

Panorama of Intimate Partner Violence Against Women in Brazil and its Association With Self-Perception of Health: Findings From a National Representative Survey

Intimate partner violence (IPV) is a challenge in Brazil. The country holds one of the highest rates of femicide in the world, most of which are preceded by IPV. We conducted a cross-sectional study with 34,334 women, aged 18 to 59 years, from the 2019 Brazilian National Health Survey to analyze the prevalence of IPV and its subtypes among the Brazilian adult women in the last 12 months, encompassing their health consequences and the use of health services resulting from IPV. We also used logistic regression models to estimate the association of sociodemographic characteristics and self-perceived health status with IPV. The prevalence of IPV among Brazilian adult women in the last 12 months was 7.6% (95% confidence interval [CI] [7.0, 8.2]). Women aged 18 to 39 years, not married, and with income of up to 1 minimum wage (MW), had higher odds of suffering IPV. Among those who reported health consequences due to IPV, 69% reported psychological consequences, and 13.9% sought health care, mostly in primary or secondary health care services in the Brazilian Unified Health System (41.9%). Regarding the self-perceived health variables, women who reported eating problems (odds ratio [OR]  =  1.29; [1.01, 1.65]), lack of interest/absence of pleasure (OR  =  1.41; [1.11, 1.79]), depressive feelings (OR  =  1.39; [1.03, 1.88]), feeling of failure (OR = 1.75; [1.36, 2.24]), and suicidal thoughts (OR = 1.73; [1.25, 2.41]) had greater odds of reporting IPV compared to those who did not report these same perceptions. The results show that younger, divorced or single, low-income women with eating problems and mental health disorders were more likely to suffer IPV. IPV often led to health problems, and many abused women sought support from public health services. Health professionals must be trained to identify and care for these women, thereby acting as allies in preventing and reducing IPV.

Mental health trajectories of women experiencing differing patterns of intimate partner violence across the first 10 years of motherhood

Intimate partner violence is commonly experienced by women and associated with poor mental health outcomes. Evidence regarding the patterns of IPV across time, and the associated long term course of depressive symptoms is lacking. The current study aimed to (a) identify patterns of physical and emotional IPV experienced by women over the 10 years since having their first child, and (b) identify trajectories depressive symptoms across the 10-year period for each pattern of IPV exposure. Data was drawn from the Mothers' and Young People's Study (MYPS), a longitudinal study of 1507 mothers and their first born child. Data was collected during pregnancy and at one, four, and ten years postpartum. Using Latent Class Analysis, four distinct classes of IPV were identified: (1) Minimal IPV, (2) Early IPV exposure, (3) Increasing IPV, and (4) Persistent IPV. Latent growth modelling revealed that all classes characterised by some IPV exposure experienced elevated trajectories of depressive symptoms in comparison to the minimal IPV class. Those experiencing increasing and persistent IPV experienced the most severe course of depressive symptoms.

Examining the Role of Interpersonal Violence in Racial Disparities in Breastfeeding in North Dakota (ND PRAMS 2017-2019)

BACKGROUND

The 2019 overall breastfeeding initiation rate in the US was 84.1%, yet only 76.6% of American Indian (AI) women initiated breastfeeding. In North Dakota (ND), AI women have greater exposure to interpersonal violence than other racial/ethnic groups. Stress associated with interpersonal violence may interfere with processes important to breastfeeding. We explored whether interpersonal violence partially explains racial/ethnic disparities in breastfeeding in ND.

METHODS

Data for 2161 women were drawn from the 2017-2019 ND Pregnancy Risk Assessment Monitoring System. Breastfeeding questions in PRAMS have been tested among diverse populations. Breastfeeding initiation was self-report to "Did you ever breastfeed or pump breast milk to feed your new baby, even for a short period?" (yes/no). Breastfeeding duration (2 months; 6 months) was self-reported how many weeks or months of breastmilk feeding. Interpersonal violence for both 12 months before and during pregnancy based on self-report (yes/no) of violence from a husband/partner, family member, someone else, or ex-husband/partner. An "Any violence" variable was created if participants reported "yes" to any violence. Logistic regression models estimated crude and adjusted odds ratios (OR) and 95% confidence intervals (95% CI) for breastfeeding outcomes among AI and Other Race women compared to White women. Sequential models were adjusted for interpersonal violence (husband/partner, family member, someone else, ex-husband/partner, or any).

RESULTS

AI women had 45% reduced odds of initiating breastfeeding (OR: 0.55, 95% CI: 0.36, 0.82) compared to white women. Including interpersonal violence during pregnancy did not change results. Similar patterns were observed for all breastfeeding outcomes and all interpersonal violence exposures.

DISCUSSION

Interpersonal violence does not explain the disparity in breastfeeding in ND. Considering cultural ties to the tradition of breastfeeding and the role of colonization may provide a better understanding of breastfeeding among AI populations.

Association Between Women's Exposure to Intimate Partner Violence and Self-reported Health Outcomes in New Zealand

IMPORTANCE

Intimate partner violence (IPV) is increasingly recognized as a contributing factor for long-term health problems; however, few studies have assessed these health outcomes using consistent and comprehensive IPV measures or representative population-based samples.

OBJECTIVE

To examine associations between women's lifetime IPV exposure and self-reported health outcomes.

DESIGN, SETTING, AND PARTICIPANTS

The cross-sectional, retrospective 2019 New Zealand Family Violence Study, adapted from the World Health Organization's Multi-Country Study on Violence Against Women, assessed data from 1431 ever-partnered women (63.7% of eligible women contacted) in New Zealand. The survey was conducted from March 2017 to March 2019, across 3 regions, which accounted for approximately 40% of the New Zealand population. Data analysis was performed from March to June 2022.

EXPOSURES

Exposures were lifetime IPV by types (physical [severe/any], sexual, psychological, controlling behaviors, and economic abuse), any IPV (at least 1 type), and number of IPV types.

MAIN OUTCOMES AND MEASURES

Outcome measures were poor general health, recent pain or discomfort, recent pain medication use, frequent pain medication use, recent health care consultation, any diagnosed physical health condition, and any diagnosed mental health condition. Weighted proportions were used to describe the prevalence of IPV by sociodemographic characteristics; bivariate and multivariable logistic regressions were used for the odds of experiencing health outcomes by IPV exposure.

RESULTS

The sample comprised 1431 ever-partnered women (mean [SD] age, 52.2 [17.1] years). The sample was closely comparable with New Zealand's ethnic and area deprivation composition, although younger women were slightly underrepresented. More than half of the women (54.7%) reported any lifetime IPV exposure, of whom 58.8% experienced 2 or more IPV types. Compared with all other sociodemographic subgroups, women who reported food insecurity had the highest IPV prevalence for any IPV (69.9%) and all specific types. Exposure to any IPV and specific IPV types was significantly associated with increased likelihood of reporting adverse health outcomes. Compared with those unexposed to IPV, women who experienced any IPV were more likely to report poor general health (adjusted odds ratio [AOR], 2.02; 95% CI, 1.46-2.78), recent pain or discomfort (AOR, 1.81; 95% CI, 1.34-2.46), recent health care consultation (AOR, 1.29; 95% CI, 1.01-1.65), any diagnosed physical health condition (AOR, 1.49; 95% CI, 1.13-1.96), and any mental health condition (AOR, 2.78; 95% CI, 2.05-3.77). Findings suggested a cumulative or dose-response association because women who experienced multiple IPV types were more likely to report poorer health outcomes.

CONCLUSIONS AND RELEVANCE

In this cross-sectional study of women in New Zealand, IPV exposure was prevalent and associated with an increased likelihood of experiencing adverse health. Health care systems need to be mobilized to address IPV as a priority health issue.

Relationship between Sexual Violence and the Health of Spanish Women-A National Population-Based Study

BACKGROUND

Health consequences are likely to be different when sexual violence is analysed independently from other types of violence. It is also likely that different health consequences will result in the cases of partner or ex-partner sexual violence, non-partner sexual violence and sexual harassment.

METHODS

This study is based on the 2019 Macro-survey of Violence against Women conducted by the Spanish Ministry of Equality on a sample of 9568 women aged 16 years or older. Odds ratios were calculated, and multinomial logistic regression analyses were performed.

RESULTS

The present study estimates that 4 out of 10 surveyed women had experienced some form of sexual violence in their lifetime. Sexual harassment is the most frequently reported form of this violence, while intimate partner sexual violence is the form with the most unfavourable sociodemographic characteristics and the worst health impact indicators, such as a greater likelihood of suicidal behaviour.

CONCLUSIONS

Sexual violence is a widespread, under-studied problem with negative health impacts. Women exposed to intimate partner violence are the most vulnerable and at risk. It is advised that responses and comprehensive care plans be developed that place special emphasis on the protection of victims' mental health.

Association Between Men's Exposure to Intimate Partner Violence and Self-reported Health Outcomes in New Zealand

Importance

Health implications of intimate partner violence (IPV) against men is relatively underexplored, although substantial evidence has identified associations between IPV and long-term physical health problems for women. Given the gendered differences in IPV exposure patterns, exploration of men's IPV exposure and health outcomes using population-based samples is needed.

Objective

To assess the association between men's lifetime IPV exposure and self-reported health outcomes.

Design, Setting, and Participants

This cross-sectional study analyzed data from the 2019 New Zealand Family Violence Study, which was conducted across 3 regions of New Zealand. The representative sample included ever-partnered men aged 16 years or older. Data analysis was performed between May and September 2022.

Exposures

Lifetime IPV against men by types (physical [severe or any], sexual, psychological, controlling behaviors, and economic abuse), any IPV (at least 1 type), and number of IPV types experienced.

Main Outcomes and Measures

The 7 health outcomes were poor general health, recent pain or discomfort, recent use of pain medication, frequent use of pain medication, recent health care consultation, any diagnosed physical health condition, and any diagnosed mental health condition.

Results

The sample comprised 1355 ever-partnered men (mean [SD] age, 51.3 [16.9] years), who predominantly identified as heterosexual (96.9%; 95% CI, 95.7%-97.8%). Half of the sample (49.9%) reported experiencing any lifetime IPV, of whom 62.1% reported at least 2 types. Of all sociodemographic subgroups, unemployed men had the greatest prevalence of reporting exposure to any IPV (69.2%) and all IPV types. After adjustment for sociodemographic factors, men's exposure to any lifetime IPV was associated with an increased likelihood of reporting 4 of the 7 assessed health outcomes: poor general health (adjusted odds ratio [AOR], 1.78; 95% CI, 1.34-2.38), recent pain or discomfort (AOR, 1.65; 95% CI, 1.21-2.25), recent use of pain medication (AOR, 1.27; 95% CI, 1.00-1.62), and any diagnosed mental health condition (AOR, 1.66; 95% CI, 1.11-2.49). Specific IPV types were inconsistently associated with poor health outcomes. Any physical IPV exposure was associated with poor general health (AOR, 1.80; 95% CI, 1.33-2.43), recent pain or discomfort (AOR, 2.23; 95% CI, 1.64-3.04), and frequent use of pain medication (AOR, 1.69; 95% CI, 1.08-2.63), which appeared to be associated with exposure to severe physical IPV. Exposure to sexual IPV, controlling behaviors, and economic abuse was not associated with any assessed outcomes after sociodemographic adjustment. Experience of a higher number of IPV types did not show a clear stepwise association with number of health outcomes.

Conclusions and Relevance

Results of this study indicate that exposure to IPV can adversely affect men's health but is not consistently a factor in men's poor health at the population level. These findings do not warrant routine inquiry for IPV against men in clinical settings, although appropriate care is needed if IPV against men is identified.

Can Women Shelters Help Reduce Symptoms of PTSD and C-PTSD? Trajectories of PTSD Symptom Development Following Partner- and Family-Related Violence

BACKGROUND

To protect women from Intimate partner violence (IPV), women's shelters should not only provide emergency safety from IPV exposure, but also prolonged support that empowers women to build a life free from violence. The present study aims to investigate individual symptom development in association with residency at a women's shelter.

METHOD

Data were collected at four different timepoints, that is, enrolment (T1, N = 150), 3-months residency (T2, = 110), 6-months residency (T3, N = 68) and after relocation (T4, N = 63). Women were included from four Danish women's shelters. The International Trauma Questionnaire (ITQ) was applied to test for post-traumatic stress disorder (PTSD) and Complex-PTSD (C-PTSD) at all timepoints. A paired sample t-test was used to test the mean symptom development, and a Latent Class Growth Analysis (LCGA) was applied to test for different classes of PTSD-trajectories. Logistic regression was applied to predict class membership from shelter-related variables and symptom severity, that is, length of residency, psychological counselling, revictimization and key symptoms of C-PTSD.

RESULTS

The prevalence of PTSD (31%) and C-PTSD (37.9%) was high at enrolment. Although t-tests suggested a significant decline in symptoms at follow-up, the LCGA revealed different classes of symptom development. The two-class model was found to be the best representation of data with low-symptom- and high-symptom profiles, respectively. Overall, the largest decline in symptoms occurred within the first 3 months of residency. Revictimization was high and was further found to predict class membership. However, when included in a multiple regression only symptom severity predicted the high-symptoms profile class.

DISCUSSION

Psychological treatment focussing on PTSD and C-PTSD is important for the women's future well-being and safety. Reports on revictimization was alarmingly high, which emphasises a continuing need to protect women from psychological violence within the shelters. These findings should be replicated in larger samples before we can draw any conclusion.