The impact of gender inequality on intimate partner violence in Spain

OBJECTIVE: To explore the geographical distribution of mortality due to intimate partner violence (IPV) and reports of IPV according to the gender development index (GDI) of Spanish provinces. METHODS: We performed an ecological study, based on GDI by provinces, of deaths from IPV and official complaints of IPV made by women between 1997 and 2004. The sources were the "Report on Human Capital and Human Development in Spain", the "Home Affairs Statistics Yearbook", and the web page of the Federation of Separated and Divorced Women. Provinces were divided into 2 groups according to whether their GDI score was above or below the mean GDI score for Spain (0.895). Mortality rates by age and rates of official complaints of IPV were calculated for the two groups of provinces (high and low GDI). Relative risks and their confidence intervals were calculated to analyze the risk of dying from or reporting IPV in low GDI provinces compared with that in high GDI provinces. RESULTS: The risk of death due to IPV was higher in women living in low GDI provinces than in those living in high GDI provinces (RR = 1.328; 95% CI, 1.253-1.406). Furthermore, the risk of reporting IPV was higher in low GDI provinces than in high GDI provinces (RR = 1.468; 95% CI, 1.462-1.474). CONCLUSION: Despite the trend to develop IPV strategies focused on individual causes, our results suggest that to tackle this problem, strategies for promoting gender equity in Spain are required.     

Intimate partner violence: social and health determinants and responses

The present study aims to review the problem of intimate partner violence, as well as its causes and consequences. It will also specifically analyze the role of health professionals. In opposition to the classical epidemiological view of risk factors, Heise proposes an ecological framework to study violence against women. This framework analyzes the interplay among the personal, situational and sociocultural factors that combine to cause abuse. Regarding the frequency of intimate partner violence in Spain, in January 2003 there were 2.519 formal complaints and 69 women died between January and November 2003. No geographical patterns in mortality or the incidence of formal complaints of intimate partner violence or among the provinces with the highest incidence of formal complains and those with highest mortality were observed. The only national survey published in Spain was performed by the Women's Institute in 1999, which reported a prevalence of domestic violence of 9.2%. A frequency of 22.8% was found in a primary health care center in Granada. Health services can play a key role in helping victims of domestic violence, since most women contact the health services at some time in their lives. Professionals in administrative or managerial positions can contribute to raising awareness of this health problem, which is one of the main causes of poor health and disability. Evidently, beyond consciousness-raising and early detection campaigns, public health strategies should be designed to prevent this serious health problem the causes of which can be changed.     

Mortality due to intimate partner violence in foreign women living in Spain (1999-2006)

OBJECTIVES: To describe the distribution of mortality due to intimate partner violence (IPV) in foreign women living in Spain and to explore the potentially greater risk of dying from IPV in this group. METHODS: We performed a retrospective ecological study of deaths from IPV registered by the Women's Institute of Spain (1999-2006). Mortality rates and Poisson models for relative risk and 95% confidence intervals were calculated. RESULTS: The average risk of dying from IPV in foreign women was 5.3 times greater than that in Spanish women. In the years studied, the increased risk in foreign women was 2 to 8 times greater than that in Spanish women. CONCLUSION: Foreign women living in Spain are especially vulnerable to death from IPV. Further research on the causes of this phenomena and strategies involving health services are needed.     

Intimate partner violence from the emergency medicine perspective

BACKGROUND: The incidence of acute cases of intimate partner violence (IPV) in the Emergency Department (ED) patients is between 2 and 7.2%. Ongoing IPV may be an immediate cause of presentation for medical care, or it may not be readily apparent. Over the last two decades efforts to improve identification of IPV in the ED have been successful. METHODS: A medline literature search from 1981-2001 was performed. A review of intimate partner violence from the emergency department provider perspective is performed. A discussion of the screening/detection of intimate partner violence and the barriers to improving detection rates is provided. RESULTS: The review of the current literature shows that IPV is a frequent cause of illness or injury in patients presenting in the ED. Screening programs for intimate partner violence have shown to increase the identification of patients experiencing acute episodes of abuse and seeking treatment. The difficulty has been in sustaining the programs and improving the screening of patients. Patient, provider and systems barriers prevent adequate recognition and management of the problem. CONCLUSION: Detection of IPV in patients presenting to the ED can be improved by providing educational programs and screening tools to health care providers. Sustaining the screening programs is more difficult and requires a health care system-wide effort.     

Intimate partner violence. A survey conducted in the primary care setting

OBJECTIVES: To determine the prevalence of intimate partner violence (IPV) in a sample of women attending primary care centers for any reason and to analyze the characteristics of this violence. METHODS: A cross sectional study was performed in 23 primary care centers in three regions of Spain (Andalusia, Madrid and Valencia). The sample included 1,402 randomly selected adult women aged between 18 and 65 years attending these centers. Among the variables collected through a self-administered questionnaire were the existence of physical, emotional or sexual abuse, and its timing, duration, and frequency. RESULTS: Overall, 32% had experienced some type of IPV. By type, 7% had experienced both physical and emotional IPV, 14% had experienced emotional IPV, 3% had experienced emotional and sexual IPV, and 6% had suffered all 3 types of IPV. Among the latter, 52% had experienced abuse for more than 5 years. Women who experienced abuse in a previous relationship had a greater probability of being abused by a new intimate partner (OR = 3.30; 95% CI, 2.10-5.18). CONCLUSIONS: These results show the scale of IPV in Spain. Health professionals play an important role in IPV, as they are in a privileged position to tackle this serious public health problem.     

Intimate partner violence among men prevalence, chronicity, and health effects

CONTEXT: The breadth and depth of intimate partner violence (IPV) experienced by men have not been fully documented. OBJECTIVES: To describe the prevalence, chronicity, and severity of IPV, and the health outcomes associated with IPV, in adult men with healthcare insurance. DESIGN: A retrospective telephone cohort study conducted from 2003 to 2005. The setting was an integrated healthcare system in Washington State and Idaho. PARTICIPANTS: English-speaking men aged 18 and older (N=420) enrolled in the healthcare system for 3 or more years. MAIN OUTCOME MEASURES: Physical, psychological, and sexual IPV were assessed using five questions from the Behavioral Risk Factor Surveillance Survey. Health was measured using the Short Form-36, version 2 (SF-36v2) survey, the Center for Epidemiological Studies Depression Scale, and the National Institute of Mental Health Presence of Symptoms Survey. RESULTS: Men experienced IPV at a rate of 4.6% in the past year, 10.4% in the past 5 years, and 28.8% over their lifetimes. While overall rates of physical and nonphysical IPV were similar, men aged 18-55 were twice as likely to be recently abused (14.2%, SE=2.6%) than were men aged 55 and older (5.3%, SE=1.6%). Abuse was typically nonviolent or mildly violent, occurred on multiple occasions, and was initiated by only one intimate partner. Compared to men with no IPV, older men who experienced IPV had more depressive symptoms (prevalence ratios=2.61 and 2.80 for nonphysical and physical abuse) and had lower SF-36v2 mental health subscales (range=-3.21 to -5.86). CONCLUSIONS: Men experience IPV at moderate rates, and poor mental health outcomes are associated with such experiences.     

Trends in infectious diseases mortality in Spain]

OBJECTIVE: The aim of this study was to describe the trend and geographical distribution of mortality by infectious diseases in Spain between 1980 and 1993. METHODS: Deaths caused by infectious diseases ocurred in Spain between 1980-1993 were studied. Data were obtained from the national mortality registry from the Instituto Nacional de Estadística. Deaths included in the International Diseases Classification (ICD-9) in group I were included, and also deaths by infectious diseases included in other groups. The trend in mortality risk was evaluated by means of a log-lineal Poisson model. Standardized mortality rates (SMR) by age for each Spanish province in 1980-83 and 1990-93, were calculated to identify geographical differences in mortality. These SMR were compared using Spearman correlation coefficient. RESULTS: Between 1980 and 1993, the adjusted mortality rate by infectious diseases decreased around 1.4% each year. In 1980 and also in 1993 respiratory tract infections were the first cause of death, 29.6 and 20.3 deaths for 105 inhabitants, respectively. The second cause of death was tuberculosis in 1980, 3.9 * 105 and HIV infection in 1993, 10.7 * 105. This decrease in infectious diseases mortality during the studied period was shown in all age groups, except for the 25 to 44 age group, were mortality rate increased by seven times. The geographical distribution showed that the provinces with the highest mortality rate were the same in 1980-83 and in 1990-93 (Spearman coefficient: 0.49; p < 0.001). CONCLUSIONS: Because deaths by infectious diseases are distributed in different groups in the ICD-9, their impact on mortality is underestimated, although they are the fourth cause of death in Spain. However, between 1980 and 1993 it has been shown a decrease in mortality by these diseases, except for the 25-44 age group where an impressive increase ocurred due to HIV infection. No differences between provinces have been shown.     

Estado de salud y violencia contra la mujer en la pareja

Objective

To describe the prevalence of intimate partner violence (IPV) in Spain in the last year and at some point during the lifetime, to determine health status in women according to whether they had experienced IPV or not, and to analyze the individual variables associated with IPV in Spain.

Methods

A cross-sectional study was performed of the database, Macrosurvey on Gender Violence in Spain 2011. This database includes data on 7,898 women older than 18 years old. The dependent variables were IPV-last year, IPV-ever in life. Covariates consisted of sociodemographic characteristics, socioeconomic status, maternal experience of IPV, social support, and self-care. The measure of association used was the OR with its 95% confidence interval (95% CI).

Results

A total of 3.6% of women had experienced IPV-last year and 12.2% ever in life. Female victims of IPV had poorer health than women who had not experienced IPV. Immigrant women living in Spain for 6 years or more were more likely to experience IPV-ever in life than Spanish women [OR (95% CI): 1.95 (1.50, 2.53)]. An interaction was found between nationality and the existence of children under 18 years old. Among women with children under 18 years old, immigrant women were more likely to experience IPV-last year than Spanish women [OR (95% CI): 1.99 (1.25, 3.17)]. Other variables associated with IPV were age, low socioeconomic status, low social support and having a mother who had experienced IPV.

Conclusions

In Spain, some women have a higher probability of experiencing IPV. The variables associated with greater vulnerability to IPV should be taken into account when implementing measures to prevent or alleviate IPV.     

Factors associated with HIV sero-status in young rural South African women: connections between intimate partner violence and HIV

BACKGROUND: This paper aims to describe factors associated with HIV sero-status in young, rural South African women and the relationship between intimate partner violence (IPV) and HIV. METHODS: A total of 1295 sexually active female volunteers, aged 15-26, from 70 villages were recruited to participate in a cluster randomized controlled trial of an HIV behavioural intervention. The main measures were HIV sero-status, and IPV and sexual practices measured using a questionnaire administered during baseline interviews. RESULTS: About 12.4% of women had HIV and 26.6% had experienced more than one episode of physical or sexual IPV. After adjusting for age, HIV infection was associated with having three or more past year partners [odds ratio (OR) 2.39; 95% confidence interval (95% CI) 1.48-3.85], sex in past 3 months (OR 3.33; 95% CI 1.87-5.94), a partner three or more years older (OR 1.69; 95% CI 1.16-2.48), and a more educated partner (OR 1.91; 95% CI 1.30-2.78). IPV was associated with HIV in two-way analyses (OR 1.56; 95% CI 1.08-2.23), but the effect was non-significant after adjusting for HIV risk behaviours. The experience of IPV was strongly associated with past year partner numbers, time of last sex, and partner's education; it was also marginally associated with partner age difference. Adverse experiences in childhood, including sexual abuse, increased the likelihood of having more past year partners (OR 1.43; 95% CI 1.21-1.69). CONCLUSIONS: IPV was strongly associated with most of the identified HIV risk factors. Our findings provide further evidence of links between IPV and HIV among women and the importance of joint prevention.     

Household and neighborhood contexts of intimate partner violence

OBJECTIVES: Two sources of contextual risk on the prevalence and severity of intimate partner violence (IPV) are investigated: household economic condition and neighborhood disadvantage. There is debate about whether each context is an independent source of IPV risk and whether risks cumulate over contexts. METHODS: Data from the second wave of the National Survey of Families and Households are combined with tract level data from the 1990 U.S. Census. A sub-sample of co-resident couples with a child aged 5-17 in the household was selected for analysis (n=2,273). IPV is measured in three ways: as any physical violence reported by either partner in the year prior to the survey, as gendered violence in which both partners are identified as aggressors, and as severe violence in terms of injury and frequency. RESULTS: Regardless of how IPV is assessed, couples with IPV are more likely to present a vulnerable economic risk profile and to live in neighborhoods of high disadvantage. When economically vulnerable couples living in advantaged versus disadvantaged neighborhoods are compared, there are no significant differences in rates of IPV, regardless of the measure of IPV that is used. Neighborhood context matters, however, in comparisons among economically advantaged couples: rates of IPV are significantly higher among those in disadvantaged neighborhoods. CONCLUSIONS: The consistency of effect for economic vulnerability and its invariance across neighborhood settings suggests that reducing economic vulnerability is likely to have beneficial effects in both disadvantaged and non-disadvantaged neighborhoods.     

Use of medical care, police assistance, and restraining orders by women reporting intimate partner violence--Massachusetts, 1996-1997

Approximately 1.5 million women in the United States are physically or sexually assaulted by an intimate partner (IP) each year (1). The Woman Abuse Tracking in Clinics and Hospitals (WATCH) Project at the Massachusetts Department of Public Health analyzed data from the 1996 and 1997 Behavioral Risk Factor Surveillance System (BRFSS) in Massachusetts to 1) estimate the percentage of women aged 18-59 years experiencing intimate partner violence (IPV) who used medical care, police assistance, and restraining orders during the preceding 5 years, 2) determine where women experiencing IPV went for medical care, and 3) examine the overlap in use of these three services. This report describes the results of these analyses, which indicate that a higher percentage of women aged 18-59 years use police assistance rather than obtain a restraining order or seek medical care.     

Intimate partner violence incidence and continuation in a primary care screening program

There are few longitudinal estimates of intimate partner violence (IPV) incidence and continuation. This report provides estimates of IPV incidence and continuation in women receiving health care in clinics participating in an IPV assessment and services intervention study. The Women's Experience with Battering Scale was used in combination with questions addressing physical and sexual assault to annually screen women for IPV. Between April 2002 and August 2005, 657 women in rural South Carolina consented and were screened at least twice. Among those with a current partner (n = 530), the majority (86.2%) had never experienced IPV. Among prevalent victims, IPV continued over time for 37%. IPV continuation rates were higher among older women and those who considered abuse as a problem in their relationship. Of those women who were IPV negative at time 1, IPV incidence at time 2 was 4.2%. A higher score on the Women's Experience with Battering Scale at time 1, a marker of psychological abuse, was a strong predictor of physical IPV incidence (p(trend) = 0.0001). These data suggest that the incidence of IPV over a short follow-up period is relatively low and that the majority of IPV desists over this short follow-up period.     

Intimate partner violence: prevalence, types, and chronicity in adult women

BACKGROUND: Most intimate partner violence (IPV) prevalence studies do not examine the relationships between IPV types and the chronicity and severity of abuse. OBJECTIVES: Delineate prevalence, chronicity, and severity of IPV among adult women. DESIGN: Retrospective cohort study conducted by telephone survey. Data were collected in 2003 to 2005 and analyzed contemporaneously. PARTICIPANTS: English-speaking women (n=3568) aged 18 to 64 years enrolled in a U.S. health maintenance organization for 3 or more years. Response rate was 56.4%. MAIN EXPOSURE: Physical, psychological, and sexual IPV were assessed using five questions from the Behavioral Risk Factor Surveillance Survey and ten items from the Women's Experience with Battering (WEB) scale. RESULTS: Most (3429) of the respondents had at least one intimate partnership as an adult. Of these, 14.7% reported IPV of any type in the past 5 years, and 45.1% of abused women experienced more than one type. Prevalence was 7.9% in the past year, while during a woman's adult lifetime, it was 44.0%. Depending on IPV type, 10.7% to 21.0% were abused by more than one partner; duration was <1 year to 5 median years; while in 5% to 13% of the instances, IPV persisted for >20 years. IPV rates were higher for younger women, women with lower income and less education, single mothers, and those who had been abused as a child. CONCLUSIONS: The high prevalence of IPV across women's lifetimes in the previous 5 years and the previous year are documented. The present investigation provides new information of IPV chronicity, severity, and the overlap of IPV types over a woman's adult life span.     

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.     

Examining the effect of residential change on intimate partner violence risk

OBJECTIVES: To examine the relationship between residential change and a woman's subsequent risk of intimate partner violence (IPV), whether by a past or a new offender, a relationship that has not been prospectively examined to date. DESIGN: A dynamic cohort of women who recently changed residence (movers) was compared with those who did not (non-movers) for 12-month risk of IPV by a past offender and of IPV by a new offender. PARTICIPANTS AND METHODS: Secondary analysis of a linked, longitudinal National Crime Victimization Survey dataset including 10 754 recent movers and 10 236 non-movers among women aged 18-44 years. RESULTS: The risk of IPV by either a past or a new offender was almost double for women who had recently moved compared with those who had not moved. This increased risk proved to be robust, as it persisted when the data were weighted and unweighted, and when the main effect was adjusted by measured covariates. CONCLUSIONS: The apparent increase in IPV risk after residential change may be a marker of a pre-existing problem or a precursor of subsequent problems. Unlike past research that has considered residential change after abuse or as a simultaneous exposure, this study focused solely on empirically measuring the risk of IPV after a recent move. This decision has important public health ramifications: determination of IPV exposure is not always possible, whereas soliciting a woman's history of residence may be more feasible. If transience puts a woman at greater risk for victimisation by an intimate partner, increased awareness may have a vital role in protecting women who move.