Prevalence of and risk factors for intimate partner violence in China

OBJECTIVES: We estimated the prevalence of and risk factors for intimate partner violence in China. METHODS: Our cross-sectional, comparative prevalence study used a face-to-face survey of randomly selected women attending an urban outpatient gynecological clinic at a major teaching hospital in Fuzhou, China. Multiple logistic regression models were used to assess risk factors for intimate partner violence. RESULTS: Of the 600 women interviewed, the prevalence of lifetime intimate partner violence and violence taking place within the year before the interview was 43% and 26%, respectively. For lifetime intimate partner violence, partners who had extramarital affairs and who refused to give respondents money were the strongest independent predictors. For intimate partner violence taking place within the year before the interview, frequent quarreling was the strongest predictor. CONCLUSIONS: Intimate partner violence is prevalent in China, with strong associations with male patriarchal values and conflict resolutions. Efforts to reduce intimate partner violence should be given high priority in health care settings where women can be reached.     

Reproductive health and intimate partner violence

The article examines the relationship between reproductive health and intimate partner violence. Through the conference conducted by the Centers for Disease Control and Prevention, along with other government agencies and private organizations, it has been demonstrated that while there is an increased awareness of intimate partner violence as a public health issue, there has been limited research on the potential association of violence to women's reproductive health. Furthermore, there are few consistent findings that can be used to aid in the development and evaluation of effective interventions to reduce intimate partner violence as part of an overall strategy of improving women's reproductive health. Most recent information suggests potential associations between violence and a variety of reproductive health indicators, such as sexually transmitted diseases and HIV, birth outcomes, and unintended pregnancies. However, the nature of these associations remains unclear and requires further investigation.     

Childhood family violence history and women's risk for intimate partner violence and poor health

BACKGROUND: There is growing evidence for associations between generations in family violence and between family violence in both childhood and adulthood and women's health. Most studies focus on a subset of family violence (child abuse, witnessing intimate partner violence [IPV] as a child, and/or adult IPV), and few examine possible differences associated with the nature of abusive experiences, such as physical versus sexual abuse. METHODS: A population-based telephone survey, the 1999 and 2001 Washington State Behavioral Risk Factor Surveillance System, asked a representative sample of 3527 English-speaking, non-institutionalized adult women whether they had been physically or sexually assaulted or witnessed interparental violence in childhood, and whether they had experienced physical assault or emotional abuse from an intimate partner in the past year. The survey also asked about current general health and mental distress in the past month. RESULTS: The risks associated with childhood family violence experiences varied depending on the nature of those experiences. Women reporting childhood physical abuse or witnessing interparental violence were at a four- to six-fold increase in risk of physical IPV, and women reporting any of the experiences measured were at three- to four-fold increase in risk of partner emotional abuse. In contrast, women reporting childhood sexual abuse only were not at increased risk of physical IPV. Women reporting childhood physical abuse were at increased risk of poor physical health, and women reporting any type of childhood family violence were at increased risk of frequent mental distress. Approximately one third of women reporting poor general health and half of women reporting frequent mental distress also reported at least one of the childhood experiences measured. CONCLUSIONS: These findings underscore the role of childhood experiences of abuse and of witnessing family violence in women's current risk for IPV, poor physical health, and frequent mental distress.     

Barriers to screening for intimate partner violence

Background: Health care providers play a vital role in the detection of intimate partner violence among their patients. Despite the recommendations for routine intimate partner violence screening in various medical settings, health care providers do not routinely screen for intimate partner violence. The authors wanted to identify barriers to intimate partner violence screening and improve the understanding of intimate partner violence screening barriers among different health care providers. Methods: The authors conducted a systematic review to examine health care providers' perceived barriers to screening for intimate partner violence. By grouping the studies into two time periods, based on date of publication, they examined differences in the reported barriers to intimate partner violence screening over time. Results: The authors included a total of 22 studies in this review from all examined sources. Five categories of intimate partner violence screening barriers were identified: personal barriers, resource barriers, perceptions and attitudes, fears, and patient-related barriers. The most frequently reported barriers included personal discomfort with the issue, lack of knowledge, and time constraints. Provider-related barriers were reported more often than patient-related barriers. Conclusions: Barriers to screening for intimate partner violence are numerous among health care providers of various medical specialties. Increased education and training regarding intimate partner violence is necessary to address perceptions and attitudes to remove barriers that hinder intimate partner violence screening by health care providers.     

Unperceived intimate partner violence and women's health

Objective

Women who experience intimate partner violence (IPV) often do not perceive themselves as abused. This study sought to estimate the health effects of unperceived IPV (uIPV), taking violence-free women as the reference, and to compare the effects of uIPV with those of perceived IPV (pIPV).

Method

We performed a cross-sectional population study through telephone interviews of 2835 women aged 18 to 70 years living in the region of Madrid and having an ongoing intimate partner relationship or contact with a former partner in the preceding year. Based on 26 questions from the Conflict Tactics Scale-1 and the Enquête Nacional sur les Violences envers les Femmes en France and the question “Do you feel abused by your partner?” a variable was constructed in three categories, namely, the absence of IPV, uIPV and pIPV. Using logistic regression, we analyzed the association between health problems, medication use, health-service utilization and IPV (perceived and unperceived) vis-à-vis the absence of IPV.

Results

There were 247 cases of uIPV and 96 of pIPV (prevalences of 8.8% and 3.4%, respectively). The multivariate analysis showed that a substantial number of the outcomes explored were associated with uIPV, pIPV, or both. The highest odds ratios (ORs) were obtained for depression (Patient Health Questionnaire-9 ≥ 10) (uIPV: OR 3.4, 95% CI 2.4-3.8; and pIPV: 4.1, 95%CI 2.5-6.8). In most problems, the ORs did not significantly differ between the two types of IPV.

Conclusions

uIPV is 2.6 times more frequent than pIPV and is associated with at least as many health problems as pIPV.     

Women's experience of intimate partner violence in Haiti

This study examined individual, partner, and community characteristics associated with the occurrence of intimate partner violence among ever-married women of reproductive age, using data from the 2000 Haiti Demographic and Health Survey. Separate logistic regressions were analyzed to assess women's risks of experiencing emotional, physical and sexual violence and multiple forms of intimate partner violence in the past 12 months. Twenty-nine percent of women in the sample experienced some form of intimate partner violence in the past 12 months, with 13 percent having experienced at least two different forms of violence. Significant positive associations with all forms of violence were found for lack of completion of primary school, history of violence exposure in women's families of origin either through witnessing violence between parents while growing up or direct experience of physical violence perpetrated by family members, partner's jealousy, partner's need for control, partner's history of drunkenness, and female-dominated financial decision-making. Significant positive associations were found between men's physical abuse of children at the community level and women's risk of experiencing emotional and physical violence. Neighborhood poverty and male unemployment, number of children living at home, women's attitudinal acceptance of wife beating, and male-dominated financial decision-making were additional risk factors for sexual violence. Women's economic independence was a protective factor for emotional and physical violence, while relationship quality was protective for all forms of violence and multiple victimizations.     

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.     

Narratives of intimate partner violence practiced against women

Research was conducted with women aged 15 to 49 living in an economically vulnerable area of the Brazilian state capital on the experience of victims of Intimate Partner Violence (IPV). The study adopted a qualitative technique called Collective Subject Discourse. During the interviews in their homes between February and July, 195 women reported incidents of violence throughout their lives. The discourses were grouped by similar violence using the CSD technique and organized into 7 major categories based on 395 key words; i) IPV Engineering (N = 114; 58.5%); ii) Rape of vulnerable sex (N = 77; 39.5%); iii) Silent or silenced violence (N = 43; 21%); iv) Years of Suffering (N = 43; 21%); v) New time despite the suffering (N = 39; 20%); vi) Talking about violence (N = 35; 18%); Violence is a language (N = 34; 17.4%). Three reports with the highest prevalence, entitled "IPV Engineering," are presented in full in this work. The narratives of violence revealed show the strength of vulnerability and abuse suffered by women and the existence of multiple dynamics of violence in intimate affective relationships.     

Applying the planned care model to intimate partner violence

PURPOSE: This article presents the steps for organizing a health organization's response to intimate partner violence (IPV) according to the Planned Care Model (PCM). IPV is common and costly and results in poor physical and mental health outcomes for victims and their families. Because most care is not acute, a planned approach that crosses systems may result in more comprehensive and higher quality care. Community collaboration with IPV agencies is especially critical. The health care organization must make IPV a priority and set policies and systems to identify and manage patients, train staff, and measure, monitor, and provide feedback on outcomes. Other key PCM components include: practice design--design systems to identify and track victims, stratify risk, and coordinate care; evidence-based decision support--choose validated IPV screening questions and guidelines for identification, management, and referral and make them available in a systematic way with ongoing assessment and feedback to providers and other members of the health care team; patient self-management--self-man-agement materials should be selected and disseminated to those working with IPV victims; and data information systems--these should support a confidential patient registry and efforts to audit and provide feedback about identification and referral efforts. Process and outcome measures based on the management guidelines and protocols should be developed and monitored, and the results disseminated. CONCLUSION: Adapting PCM for the management of IPV stretches the traditional acute approach to IPV of screen-identify-refer. It expands the PCM into new realms, including embracing new partners, trying innovative ways to measure return on investment, grappling with ethical dilemmas, and designing a multifactorial evaluation across systems.     

儿童期虐待与亲密伴侣暴力关系

目的通过研究儿童期不同形式虐待与其成人后亲密伴侣暴力的关系，为家庭暴力的心理干预提供科学的理论依据。方法采用自编《新婚夫妇婚前暴力调查表》和《儿童期虐待问卷》对湖南省长沙市2个社区领取结婚证愿意接受婚前暴力调查研究的291对新婚夫妇进行调查。结果受虐组的情感虐待因子分、躯体虐待因子分及量表总分高于非受虐组；女性受虐组的躯体虐待因子分和性虐待因子分高于非受虐组；男性受虐组的情感虐待因子分、躯体虐待因子分和情感忽视因子分均高于非受虐组。但差异无统计学意义（P〉0．05）。2组间在受教育程度、职业、婚前有无同居史上差异有统计学意义（x^2=10．433，P=0．034；x^2=15．525。P=0．008；x^2=8．843。P=0．003）。结论儿童期情感虐待和躯体虐待对其成人后受虐有影响；女性儿童期躯体虐待和性虐待对其成人后受虐有影响；男性儿童期虐待对其成人后受虐无影响。亲密伴侣暴力（IPV）与受教育程度、职业、婚前同居史相关。     

Sexual infidelity as trigger for intimate partner violence

Abstract Background: We conducted a qualitative study to examine acute, situational factors and chronic stressors that triggered severe intimate partner violence (IPV) in women. Methods: Our sample consisted of 17 heterosexual couples, where the male was in detention for IPV and made telephone calls to his female victim. We used up to 4 hours of telephone conversational data for each couple to examine the couple's understanding of (1) acute triggers for the violent event and (2) chronic stressors that created the underlying context for violence. Grounded theory guided our robust, iterative data analysis involving audiotape review, narrative summation, and thematic organization. Results: Consistently across couples, violence was acutely triggered by accusations of infidelity, typically within the context of alcohol or drug use. Victims sustained significant injury, including severe head trauma (some resulting in hospitalization/surgery), bite wounds, strangulation complications, and lost pregnancy. Chronic relationship stressors evident across couples included ongoing anxiety about infidelity, preoccupation with heterosexual gender roles and religious expectations, drug and alcohol use, and mental health concerns (depression, anxiety, and suicide ideation/attempts). Conclusions: Disseminated models feature jealousy as a strategy used by perpetrators to control IPV victims and as a red flag for homicidal behavior. Our findings significantly extend this notion by indicating that infidelity concerns, a specific form of jealousy, were the immediate trigger for both the acute violent episode and resulting injuries to victims and were persistently raised by both perpetrators and victims as an ongoing relationship stressor.