Depression and Social Support Among Women Living with the Substance Abuse,Violence, and HIV/AIDS Syndemic: A Qualitative Exploration

BackgroundIntimate partner violence (IPV), HIV/AIDS, and substance use are described as the SAVA “syndemic” among low-income urban women because of their intersecting and synergistic presence in these women's lives. Depressive symptoms are significantly associated with these SAVA factors and although social support is potentially protective for depression, little is understood about its impact on depression associated with the SAVA syndemic.MethodsThis paper investigates how women living with SAVA experience and describe depressive symptoms, and examines how the types of social support they access impact their experiences of SAVA and depressive symptoms. Qualitative, in-depth interviews were conducted with 24 HIV-positive, low-income, urban women who experienced IPV and used cocaine or heroin in their lifetime. Interviews were analyzed based on study aims, principles of thematic content analysis, and grounded theory.ResultsWomen identified multiple SAVA factors as catalysts for depression and noted their synergistic effect on depressive symptoms, which were both a trigger for and a result of drug use. Women accessed varying sources of social support to address their SAVA factors and associated symptoms of depression, relying on informal sources for instrumental support related to IPV and formal sources for support related to HIV, drug use, and depression.ConclusionsThese findings have important implications for health providers who serve SAVA-affected women, and suggest that comprehensively addressing all SAVA factors (and IPV in particular) and improving their access to quality social support at critical times is essential to improve their mental health.     

“You Never Know What Could Happen”: Women’s Perspectives of Pre-Exposure Prophylaxis in the Context of Recent Intimate Partner Violence

BackgroundVulnerability to human immunodeficiency virus (HIV) infection is a significant public health issue for women experiencing intimate partner violence (IPV). Despite the increased risk of human immunodeficiency virus infection, women only represent 4.6% of pre-exposure prophylaxis (PrEP) users in the United States. IPV may present additional difficulties to PrEP access. In this qualitative study, we examined how IPV and the relational context shaped women's decisions, attitudes, and engagement in the PrEP care continuum.MethodsWe conducted semistructured interviews with 19 women residing in Connecticut who participated in a prospective cohort study. We purposively recruited our sample to include women who reported physical and/or sexual IPV in the past 6 months, and used a grounded theory approach to analyze the qualitative data.ResultsOur findings suggest multiple ways that the relational context can affect women's decisions, attitudes, and engagement in the PrEP care continuum. We identified five aspects of women's relationships that can shape women's interest, intentions, and access to PrEP: 1) relationship power struggles, 2) infidelity, 3) trust and monogamy, 4) male partner's reactions, and 5) “season of risk” (i.e., PrEP use only during times of perceived human immunodeficiency virus risk). Collectively, these findings suggest that women experiencing IPV might face additional relational challenges that need to be adequately addressed in settings administering PrEP.ConclusionsCommunication on sexual risk reduction strategies should address relational factors and promote women's autonomy. Future research on long-acting and invisible forms of PrEP may help to circumvent some of the relational barriers women experiencing IPV may face when considering PrEP care.     

The long-term effects of intimate partner violence on adolescent mothers' depressive symptoms

Adolescent mothers are at high risk of experiencing intimate partner violence (IPV) which may increase their likelihood of depressive symptoms in adulthood, yet little is known about the long-term effects of IPV on adolescent mothers' trajectories of depressive symptoms. The study reported here uses prospective data spanning 14 years from a study of 229 adolescent mothers from Washington State, USA to evaluate the effects of adolescent exposure to IPV on the trajectories of depressive symptoms over time, as well as the likelihood of depressive symptoms at age 28 years. After controlling for levels of economic insecurity, the results indicate that adolescent IPV and an early vulnerability to depression were significantly related to the intercept, but not the slope of the adult depressive symptom trajectories. Both cumulative and concurrent IPV predicted the likelihood of depressive symptoms at age 28 years. Follow-up analyses indicate that adolescent IPV is associated with greater levels of adult IPV, and that women who report both adolescent and adult IPV have the highest mean levels of depressive symptoms. These findings suggest that exposure to IPV in adolescence may alter the life course of young women, increasing their risk for continuing exposure to intimate partner violence in adulthood and its concomitant negative mental health effects. Efforts aimed at prevention and early intervention in IPV among adolescent mothers are important components of the clinical care of young mothers.     

Modelling the effects of intimate partner violence and access to resources on women's health in the early years after leaving an abusive partner

Although the negative health effects of intimate partner violence (IPV) are well documented, little is known about the mechanisms or determinants of health outcomes for women who had left their abusive partners. Using data collected from a community sample of 309 Canadian women who left an abusive partner, we examined whether women's personal, social and economic resources mediate the relationships between the severity of past IPV and current health using structural equation modelling. A good fit was found between the model and data for hypothesized models of mental and physical health. In the mental health model, both the direct and total indirect effects of IPV were significant. In the physical health model, the direct effect of IPV on physical health was about four times as large as the total indirect effects. In both models, more severe past IPV was associated with lower health and women's personal, social, and economic resources, when combined, mediated the relationship between IPV and health. These findings demonstrate that the health outcomes of IPV for women who have left an abusive partner must be understood in context of women's resources.     

Prevalence of Intimate Partner Violence Among Women Visiting Health Care Centers in Palestine Refugee Camps in Jordan

This study was conducted to investigate the prevalence of intimate partner violence (IPV) among a sample of women visiting health care centers in Palestine refugee camps in Jordan. We found that different types of IPV, including physical, emotional, sexual, economic, and control behaviors by the partners were experienced by the participants. This study was among a number of studies that investigated this phenomenon in residents of Palestinian camps. It adds to existing studies in this field, however, as it focuses on the prevalence of the top five types of IPV in these women. Cooccurrence of IPV, that is, experiencing two or more types of partner violence at the same time, was noticed in these women. Experiencing control by one's partner and the presence of different attitudes between men and women toward the use of violence were factors contributing to the occurrence of this phenomenon in these women. National efforts aiming at breaking the cycle of violence should be fostered through media and public awareness campaigns. Changing people's attitudes concerning men's use and women's acceptance of violence should be the aim of these efforts.     

Social Support and Employment Status Modify the Effect of Intimate Partner Violence on Depression Symptom Severity in Women: Results from the 2006 Behavioral Risk Factor Surveillance System Survey

BackgroundDepression and intimate partner violence (IPV) are significant health issues for U.S. women. Interaction effects between IPV and other psychosocial factors on the severity of depressive symptoms have not been fully explored. This study assessed effect modification, that is, how IPV interacts with sociodemographics, psychosocial factors and health risk behaviors, on the severity of depressive symptoms in women.MethodsWe utilized cross-sectional data from female respondents (n = 16,106) of the 2006 Behavioral Risk Factors Surveillance Survey. Sociodemographics, psychosocial variables, and health risk behaviors determined to be significantly associated with depression were tested for interaction effects with IPV. Weighted ordinal logistic regression and predicted probabilities illustrated the effect of IPV status on depressive symptom severity, stratified by interaction effects.ResultsRecent and lifetime IPV exposure were associated with more severe depressive symptoms compared with no IPV exposure. IPV history interacted with employment status and social support on the severity of depressive symptoms in women. Overall, any IPV exposure was associated with more severe depressive symptoms among women with low social support and unemployment, although the effect of recent (versus lifetime) IPV was most pronounced among women with high social support or employed women.ConclusionsSocial support and employment status interact with IPV on the severity of depressive symptoms in women. Therefore, social support or workplace interventions designed to improve depressive symptoms should examine IPV history.     

Disability and intimate partner violence: A cross-sectional study from Mwanza,Tanzania

BackgroundWomen with disabilities are at heightened risk of experiencing intimate partner violence [IPV], although the mechanisms through which disability acts as a risk factor for IPV are not clear.ObjectiveWe analyzed cross-sectional data (n = 867) from Wave 3 of the MAISHA longitudinal study, conducted in Mwanza, Tanzania, to i) describe the levels of disability and IPV amongst women, and ii) to assess the association between level and type of disability and IPV experience.MethodsIPV was assessed using the WHO Multi-Country study instrument. Levels of disability (none, mild and severe) were categorized based on responses to the Washington Group Short Set questions. We fitted logistic regression models to determine the risk of experiencing each type of IPV according to disability level and type of disability.ResultsWe found significant associations between mild and severe disability and different types of IPV. For example, in multivariate analyses controlling for socio-demographic variables, women reporting severe disability were significantly more likely to report physical and/or sexual IPV, sexual IPV. controlling behaviors, economic IPV, and severe IPV, whereas for mild disability compared to no disability, physical and/or sexual IPV, sexual IPV, and economic IPV were significantly more likely to be reported. Cognitive disability was a significant correlate of all forms of IPV apart from physical IPV.ConclusionsOur findings that specific types of disability and not others were associated with an elevated risk of IPV exposure indicate the need for nuanced measurement and analysis of the association between disability and IPV.     

Primary Care Providers with More Experience and Stronger Self-Efficacy Beliefs Regarding Women Veterans Screen More Frequently for Interpersonal Violence

BackgroundMilitary sexual trauma (MST) and/or intimate partner violence (IPV) are common experiences in the growing group of women veterans using the Veterans Health Administration health care system. And even though MST screening is closely monitored at the facility level, little is known about individual primary care provider (PCP) behavior with regard to screening women for MST and IPV.ObjectivesTo understand how PCP experiences and beliefs regarding women's health care influence PCP-reported screening for MST and IPV.Research Design and ParticipantsWe administered a cross-sectional online survey from September 2014 through April 2015 (supplemented by a mailed survey between April and May 2015) to 281 PCPs in 12 Veterans Health Administration medical centers.Measures and AnalysisSurveys measured PCP-reported screening frequency for MST and IPV, experience with women veterans, self-efficacy, gender-sensitive beliefs, and perceived barriers to providing comprehensive care for women. We used multivariable ordered logistic regression analysis to identify correlates of screening, weighted for nonresponse and adjusted for clustering.ResultsNinety-four PCPs (34%) completed the survey. Being a designated women's health provider (p < .05) and stronger self-efficacy beliefs about screening women for MST (p < .001) were associated with reporting more frequent screening for MST. Being a designated women's health provider (p < .01), seeing women patients at least once per week (p < .001), and self-efficacy beliefs about screening women for IPV (p < .001) were associated with reporting more frequent screening for IPV.ConclusionsVeterans Health Administration initiatives to enhance PCP opportunities to screen women veterans for trauma and to strengthen self-efficacy beliefs about comprehensive women's health care may increase screening of women veterans for MST and IPV.     

Intimate Partner Violence/Abuse and Depressive Symptoms among Female Health Care Workers: Longitudinal Findings

Intimate partner violence and abuse (IPV/A) have been shown to have a major impact on mental health functioning. This study assessed the longitudinal association between recent IPV/A and depressive symptoms to identify potential targets for preventive interventions for women. Random effects models were used to examine four waves of data collected at 6-month intervals from a cohort of 1,438 female health care workers. IPV/A (e.g., sexual and physical violence, psychological abuse) in the past 5 years was associated with higher Center for Epidemiologic Studies Depression Scale (CES-D) 10 scores across four waves after adjustment for age, time, marital status, and childhood trauma. Women who reported IPV/A in the past 5 years had higher CES-D 10 scores (β, 1.31; 95% confidence interval, 0.79–1.82; p < .0001) than nonabused women. This association was generally constant with time, suggestive of a cross-sectional association across all four waves of data. Additionally, recent IPV/A was associated with change in depressive symptoms over time among the full cohort and those with CES-D 10 scores below 10 (the threshold for likely depression) at baseline. Recent IPV/A was independently associated with depressive symptoms both cross-sectionally and longitudinally. The longitudinal association was stronger among those not depressed at baseline. Implications for health care settings and workplace policies addressing IPV/A are discussed.     

Traumatic physical health consequences of intimate partner violence against women: what is the role of community-level factors?

Background

Intimate partner violence (IPV) against women is a serious public health issue with recognizable direct health consequences. This study assessed the association between IPV and traumatic physical health consequences on women in Nigeria, given that communities exert significant influence on the individuals that are embedded within them, with the nature of influence varying between communities.

Methods

Cross-sectional nationally-representative data of women aged 15 - 49 years in the 2008 Nigeria Demographic and Health Survey was used in this study. Multilevel logistic regression analysis was used to assess the association between IPV and several forms of physical health consequences.

Results

Bruises were the most common form of traumatic physical health consequences. In the adjusted models, the likelihood of sustaining bruises (OR = 1.91, 95% CI = 1.05 - 3.46), wounds (OR = 2.54, 95% CI = 1.31 - 4.95), and severe burns (OR = 3.20, 95% CI = 1.63 - 6.28) was significantly higher for women exposed to IPV compared to those not exposed to IPV. However, after adjusting for individual- and community-level factors, women with husbands/partners with controlling behavior, those with primary or no education, and those resident in communities with high tolerance for wife beating had a higher likelihood of experiencing IPV, whilst mean community-level education and women 24 years or younger were at lower likelihood of experiencing IPV.

Conclusions

Evidence from this study shows that exposure to IPV is associated with increased likelihood of traumatic physical consequences for women in Nigeria. Education and justification of wife beating were significant community-level factors associated with traumatic physical consequences, suggesting the importance of increasing women's levels of education and changing community norms that justify controlling behavior and IPV.     

The Syndemic Effects of Intimate Partner Violence, HIV/AIDS, and Substance Abuse on Depression among Low-Income Urban Women

Intimate partner violence (IPV), HIV/AIDS, and substance use are epidemics among low-income urban women that have been described together as the “SAVA syndemic” because of their co-occurring nature. This study examines the synergistic or “syndemic” effect of these three health issues on depression among urban women and evaluates social support as a protective factor that might reduce depressive symptoms associated with the Substance Abuse, Violence, and AIDS (SAVA) syndemic. Data from 445 urban women were collected through in-person interviews. All women were over the age of 18, not pregnant, English speaking, and reported having a main partner in the past year. Twenty-five percent had experienced all three factors of the SAVA syndemic (were HIV-positive, had experienced IPV in the past year, and had used cocaine or heroin in their lifetime). HIV-positive status, hard drug use, IPV, and low levels of social support were all individually associated with greater depressive symptoms. When controlling for demographics and other SAVA factors, IPV and hard drug use in the past 30 days remained associated with depressive symptoms, as did low social support. However, social support did not modify the effect of the SAVA factors on depression. Compared to women who experienced no SAVA factors, women who had experienced all three factors were 6.77 times more likely to have depressive symptoms. These findings confirm that IPV is significantly associated with depressive symptoms and that the syndemic impact of IPV, substance use, and HIV could have even more extreme effects on depression outcomes.     

Principles of care for women experiencing intimate partner violence: Views of expert Japanese health professionals and advocates

In Japan, interventions for Intimate Partner Violence (IPV) in the health care setting are rare, partly due to Japanese cultural norms that marginalize women's IPV experiences. A thematic analysis of narratives of eight Japanese health professionals who are experts in IPV care identified shared core values and practices that have guided their development of culturally relevant IPV interventions: supporting women's autonomy to define what is at stake for her, appreciating unique trajectories and timing for recovery, and practicing shared decision-making. These shared practices may be essential for training health professionals to respond to IPV in Japan and elsewhere.     

Intimate Partner Violence and the Utilization of Maternal Health Care Services in Nigeria

Our aim in this study is to examine the association between women's lifetime experiences of physical, sexual, and emotional intimate partner violence (IPV) and the use of maternal health care services. We used data from the 2008 Nigeria Demographic and Health Survey. Analysis was based on responses from 17,476 women (for antenatal care [ANC]) and 17,412 (for delivery assisted by a skilled health provider) who had had deliveries in the 5 years preceding the survey. We found an overall IPV prevalence rate of 33.4%. Physical IPV was associated with low use of ANC. Emotionally abused women were less likely to use delivery assistance from skilled health care providers. Based on our findings, we suggest the importance of designing interventions to address the health care needs of women who have experienced violence from their partners.     

Early childhood exposure to intimate partner violence and teen depression symptoms in the U.S.

Among the various negative outcomes of intimate partner violence (IPV) exposure to children, depression symptoms are worthy of attention given the effects on well-being and long-term achievement. This study examined the effects of early childhood exposure to IPV between ages 1 and 3 on depression symptoms at age 15 and investigated whether maternal physical punishment at age 5 and peer bullying victimisation at age 9 affected the association. Data came from five waves of the Fragile Families and Child Wellbeing Study. The study was based on 20 U.S. cities with populations of over 200,000 people. The most recent wave of data collection occurs during the period between 2014 and 2017. The final analytic sample was 1,690 children. Structural equation modeling was utilised to examine the effects of exposure to IPV on physical punishment, bullying victimisation, and depression symptoms. Early exposure to IPV was associated with experiencing physical punishment at Year 5, which subsequently increased peer bullying victimisation at Year 9 and then depression symptoms at Year 15. Early exposure to IPV had a direct effect on depression symptoms at Year 15. Early exposure to IPV also had indirect effects on Year 15 depression symptoms through its effects on physical punishment and bullying victimisation. The total standardised effect of early exposure on depression symptoms was 0.06. Consistent with trauma theory and the ecobiodevelopmental framework, the results indicate that exposure to IPV appeared to have a long-term effect on children, manifested in teen depression symptoms.     

Psychological Intimate Partner Violence and Sexual Risk Behavior: Examining the Role of Distinct Posttraumatic Stress Disorder Symptoms in the Partner Violence–Sexual Risk Link

BackgroundResearch has examined how physical and sexual intimate partner violence (IPV) victimization increases sexual risk behavior, yet research is lacking on 1) the effect of psychological IPV on sexual risk behavior and 2) factors through which psychological IPV may be linked to sexual risk behavior.MethodsThe current study examined the relationship between psychological IPV and sexual risk behavior controlling for other forms of IPV (i.e., physical and sexual) in a sample of 186 human immunodeficiency virus (HIV)-negative community women currently experiencing IPV. Further, this study examined the potential mediating effects of four posttraumatic stress disorder (PTSD) symptom severity clusters (i.e., re-experiencing, avoidance, numbing, and hyperarousal) on this relationship.FindingsResults revealed that greater severity of psychological IPV was uniquely and directly related to greater sexual risk behavior. Additionally, of the four PTSD symptom severity clusters, only avoidance symptom severity mediated the relationship between psychological IPV and sexual risk behavior.ConclusionImplications for addressing psychological IPV and PTSD to improve women's sexual health outcomes are discussed.     

Women's Substance Use and Mental Health During the COVID-19 Pandemic

PurposeWomen are experiencing greater unemployment and increased stress from childcare responsibilities than men during the COVID-19 pandemic. Women with these experiences may be at particular risk for mental illness and increased substance use during the COVID-19 pandemic. The purpose of the study was to assess women's substance use, mental health, and experiences of COVID-19 pandemic impacts.MethodsA national online survey was administered to adult women from September to November 2020. The survey included questionnaires assessing mental health, loneliness, intolerance for uncertainty, social support, substance use, and intimate partner violence (IPV).ResultsA total of 499 women responded; most were White, college educated, and in their mid-30s. Of the 20.24% who acknowledged at least one IPV problem, 29.7% stated that their IPV problems have gotten worse since the pandemic began, and 16.83% said that they have increased their drug or alcohol use to cope with their relationship problems. Anxiety, perceived daily impact of COVID-19, and lower self-efficacy were significant predictors of COVID-19 anxiety. Those with risky alcohol use had significantly higher anxiety (p = .028) and depression (p = .032) than those with low-risk alcohol use.ConclusionsGreater anxiety about COVID-19, greater reported changes in daily life due to the pandemic, and high-risk alcohol use are related to greater mental health–related distress among women. For some, IPV has gotten worse during the pandemic and drug or alcohol use is a coping mechanism.     

Experiences of Discrimination and Depression Trajectories over Pregnancy

IntroductionResearch on risk factors for prenatal depression is critical to improve the understanding, prevention, and treatment of women's psychopathology. The current study examines the relation between experiences of racial discrimination and trajectories of depression symptoms over the course of pregnancy.MethodParticipants completed standardized measures regarding symptoms of depression at four timepoints during pregnancy and reported on experiences of racial discrimination at one timepoint. Latent growth curve modeling was used to examine the relation between discrimination and initial levels (intercept) and trajectories (slope) of depression symptoms over pregnancy.ResultsParticipants were 129 pregnant individuals recruited from obstetric clinics and oversampled for elevated depression symptoms. Thirty-six percent of the participants were living at or below 200% of the federal poverty line. Fifty-four percent of the sample identified as non-Latinx White, 26% as Latinx, and 13% as non-Latinx Black. An unconditional latent growth curve modeling revealed a negative quadratic trajectory of depression symptoms during pregnancy. When women's report of discrimination was added as a predictor of depression trajectories, discrimination predicted the initial value (intercept) of depression symptoms, but not change over the course of pregnancy (slope). Specifically, higher levels of experiences of discrimination were associated with higher levels of depression symptoms. When sociodemographic and contextual covariates were included in the model, a low family income-to-needs ratio was also related to higher levels of depression symptoms.ConclusionsThese findings provide evidence that women's experiences of racial discrimination and family financial strain are risk factors for prenatal depression, with implications for screening, treatment, and policy.