Asking patients about violence: a survey of 510 women attending social and health services in Trieste,Italy

Violence against women is frequent, and has serious consequences for their physical and mental health. Until now, a common response of health services and professionals to victims has been the denial of the violence. The aims of this study were to estimate the prevalence of present and past violence among women attending social and health services in Trieste (Italy) for any reasons, and to evaluate the feasibility of asking them about violence. Five public health care facilities were involved: a hospital-based Emergency Department, two "Consultorio Familiare", and two community-based Social service centers. The final sample consisted of 510 women; the response rate among eligible women was 76% across all facilities. The study revealed a high prevalence of different kinds of violence, mostly perpetrated by men well known to the victim. Among the women interviewed, 10.2% had experienced physical/sexual violence in the last 12 months, regardless of perpetrator. Violence by a male partner or former partner, occurred in 6.4% of women; by other relatives, 1.6% of women; and by "other" persons 3.3% of women. The results demonstrated the feasibility of "asking about violence" in all cases; moreover, those women who had been abused were often eager to talk about it. A systematic approach to the issue of violence is a necessary condition for responding appropriately to the needs of women who have experienced or are experiencing violence. Nevertheless, to avoid the replication of a common bias against victims of violence, health and social personnel should be appropriately trained before "asking all cases" becomes a policy within health and social services.     

Physical and mental health effects of intimate partner violence for men and women

BACKGROUND: Few population-based studies have assessed the physical and mental health consequences of both psychological and physical intimate partner violence (IPV) among women or men victims. This study estimated IPV prevalence by type (physical, sexual, and psychological) and associated physical and mental health consequences among women and men. METHODS: The study analyzed data from the National Violence Against Women Survey (NVAWS) of women and men aged 18 to 65. This random-digit-dial telephone survey included questions about violent victimization and health status indicators. RESULTS: A total of 28.9% of 6790 women and 22.9% of 7122 men had experienced physical, sexual, or psychological IPV during their lifetime. Women were significantly more likely than men to experience physical or sexual IPV (relative risk [RR]=2.2, 95% confidence interval [CI]=2.1, 2.4) and abuse of power and control (RR=1.1, 95% CI=1.0, 1.2), but less likely than men to report verbal abuse alone (RR=0.8, 95% CI=0.7, 0.9). For both men and women, physical IPV victimization was associated with increased risk of current poor health; depressive symptoms; substance use; and developing a chronic disease, chronic mental illness, and injury. In general, abuse of power and control was more strongly associated with these health outcomes than was verbal abuse. When physical and psychological IPV scores were both included in logistic regression models, higher psychological IPV scores were more strongly associated with these health outcomes than were physical IPV scores. CONCLUSIONS: Both physical and psychological IPV are associated with significant physical and mental health consequences for both male and female victims.     

Voluntary abortion and domestic violence among women attended at a public maternity hospital of Salvador-BA

Quantitative study in order to study domestic violence in women with induced abortion. Interviews were conducted with 147 women hospitalized for induced abortion in a public maternity hospital in Salvador, Bahia. The subjects are characterized by mostly women, black, poorly educated, economically dependent on spouses, experienced psychological abuse, physical and sexual abuse committed by their spouses. Almost half of the women were victims of domestic violence during the current pregnancy, and that was the reason for inducing abortion for 67% of them. The study reveals an association between experience of domestic violence and induced abortion. As mental health consequences, they developed symptoms of post trauma stress disorder. It is necessary that the health professionals consider the cues to identify domestic violence as a health problem associated with induced abortion, which requires a transformation on the training model, including domestic violence as a health issue.     

Eating disturbance and sexual trauma in childhood and adulthood.

OBJECTIVE: This study examined the relationship between sexual trauma and eating disorder behavior, taking into account the effects of developmental stage of the victim and the effects of multiple sexual assaults. METHOD: Four groups of adult women took part in this study. Subjects were either victims of childhood sexual abuse, victims of rape in adulthood, victims of both childhood sexual abuse and rape, and controls who were not traumatized sexually. All subjects were assessed with semistructured interviews and self-report inventories that assessed eating disorder behavior, general psychopathology, and impulsivity. RESULTS: Victims of childhood sexual abuse differed from controls on measures of eating disorder behavior and individuals who had experienced both childhood sexual abuse and rape in adulthood were most likely to display eating disorder-related psychopathology. Victims of childhood sexual abuse also distinguished themselves with high levels of eating disorder behavior plus multiple forms of impulsive self-destructive behavior. DISCUSSION: This study provides additional support for the association between childhood sexual abuse and eating disorder behavior. Childhood sexual abuse may be particularly linked to the presence of binge eating behavior and several other forms of impulsive self-destructive behavior.     

The impact of current and past interpersonal violence on women's mental health

Violence against women, and more particularly male partner violence, is frequent. Although there are many studies on the consequences of violence on women's mental health, a number of aspects are still unclear. The impact of violence is seldom studied in the context of other risk factors of mental distress, psychological abuse is rarely considered, and older women are generally excluded from the sample. This study aims to analyze the relationships between current and past violence and three indicators of current women's health--psychological distress, the use of psychoactive drugs and a subjective evaluation of health--controlling for demographic and social characteristics. We conducted a cross-sectional survey among patients of family practices in an Italian town and 444 women responded to a self-administrated questionnaire: 20% of them had experienced some kind of abuse in the last 12 months and 5.2% reported physical or sexual aggression, mostly (4%) inflicted by a partner or ex-partner. Current violence was strongly associated with psychological distress, the use of psychoactive drugs and a negative evaluation of health. Experiencing solely psychological abuse with no sexual or physical violence was also associated with impaired health. The relationship between current violence and health was independent of age. After controlling for age, education, children, marital and employment status, women victims of partner violence were around 6 times more likely to be depressed and to feel in bad health, and 4 times more likely to use psychoactive pills than other women. Moreover, there was a strong association between past and current violence. Compared to women who reported no violence, women who reported both types were 5.95 times, women who reported only current but no past violence were 4.81 times, and women who reported only past but no current violence were 3.01 times more likely to report psychological distress.     

Cumulative abuse experiences, physical health and health behaviors

PURPOSE: Our purpose was to investigate the complex relationship between a range of lifetime abuse experiences with current physical health and health behaviors. METHODS: Between October 1998 and May 1999, interviews were conducted with 557 ethnically diverse women seen at two urban primary care centers. Seven forms of abuse were measured: childhood physical and sexual abuse, past physical and sexual intimate partner violence (IPV), and recent emotional, physical, and sexual IPV. Severity was measured for six of these forms. Multiple non-specific physical symptoms were measured with a modified PRIME-MD, and four health behaviors were ascertained. RESULTS: Approximately 10% of women never experiencing abuse reported multiple non-specific physical symptoms, compared with 25.8% to 78.4% of women reporting a range of abuse experiences. Increases in recent IPV, past IPV, child abuse, and economic hardship were associated with increases in reported symptoms. Women who experienced IPV were more likely to report smoking cigarettes, binge drinking, and having poor nutritional habits. CONCLUSIONS: Recent IPV is associated with physical symptoms and risky health behaviors beyond the effects of child abuse, past IPV, and economic disadvantage. Understanding a person's IPV experiences may inform interventions for health behaviors, such as smoking cessation programs.     

Domestic violence and abuse, health status, and social functioning

BACKGROUND: Current and past history of domestic violence (DV), including physical, sexual, and emotional abuse is common among women patients seen in health care settings and is associated with a higher frequency of many health problems. However, the association of DV with self-assessed social functioning is less well known. METHODS: We administered a telephone survey to a random sample of 391 women HMO members seen for a routine annual check-up. The survey included questions about current and past physical, sexual, and emotional violence and self-assessed social functioning and health status from the SF-36. We included questions about attitudes toward routine DV screening, likelihood of disclosure, and the health care setting as a resource. RESULTS: Seven percent of the women reported recent DV and 34% reported lifetime abuse. Abuse was related to limitations in social functioning (adjusted OR = 2.26). Among women with no recent history of abuse, those with a history of past physical (adjusted OR = 1.90), sexual (adjusted OR = 2.04), or emotional (adjusted OR = 2.20) abuse reported significantly poorer social functioning. Emotional abuse, even in the absence of a history of physical or sexual abuse, was strongly associated with limitations in social functioning (adjusted OR = 4.95). Most women believed it appropriate for clinicians to inquire routinely about DV (87%) and 83% believed that the health care setting was a source of help. CONCLUSIONS: Current and past DV, including emotional abuse, adversely affect social functioning. Therefore, clinicians in the health care setting have a unique and important opportunity to assist women victims of DV and abuse.     

Gender-based violence and HIV sexual risk behavior: Alcohol use and mental health problems as mediators among women in drinking venues, Cape Town

Gender-based violence is a key determinant of HIV infection among women in South Africa as elsewhere. However, research has not examined potential mediating processes to explain the link between experiencing abuse and engaging in HIV sexual risk behavior. Previous studies suggest that alcohol use and mental health problems may explain how gender-based violence predicts sexual risk. In a prospective study, we examined whether lifetime history of gender-based violence indirectly affects future sexual risk behavior through alcohol use, depression and post-traumatic stress disorder (PTSD) in a high-risk socio-environmental context. We recruited a cohort of 560 women from alcohol drinking venues in a Cape Town, South African township. Participants completed computerized interviews at baseline and 4 months later. We tested prospective mediating associations between gender-based violence, alcohol use, depression, PTSD, and sexual risk behavior. There was a significant indirect effect of gender-based violence on sexual risk behavior through alcohol use, but not mental health problems. Women who were physically and sexually abused drank more, which in turn predicted more unprotected sex. We did not find a mediated relationship between alcohol use and sexual risk behavior through the experience of recent abuse or mental health problems. Alcohol use explains the link between gender-based violence and sexual risk behavior among women attending drinking venues in Cape Town, South Africa. Efforts to reduce HIV risk in South Africa by addressing gender-based violence must also address alcohol use.     

Childhood Abuse as a Risk Factor for Adolescent Pregnancy in El Salvador

PURPOSE: To determine whether having been abused as a child increases the risk of adolescent pregnancy in El Salvador and whether intimate partner violence during adolescence affects the association. METHODS: Using data from 3753 women between the ages of 15 and 24 from a nationally representative household health survey of Salvadoran women (FESAL 2002/2003), the association between history of childhood abuse (emotional, physical, or sexual abuse, and witnessing abuse of one's mother) and adolescent pregnancy was explored using multiple logistic regression analyses. The effect of intimate partner violence during adolescence on the relationship was explored among a subgroup of 15-19-year-olds. RESULTS: The risk of adolescent pregnancy was significantly higher among women abused as children. Women who were sexually abused, physically abused, or who experienced any type of abuse had a 48%, 42%, and 31% higher risk, respectively, of adolescent pregnancy than those without a history of abuse, after adjusting for confounding factors. Intimate partner violence during adolescence was also strongly and significantly linked with adolescent pregnancy risk. CONCLUSIONS: This is the first study from a Latin American country to demonstrate a relationship between childhood abuse and adolescent pregnancy. Greater efforts are needed to promote detection of abuse, expand knowledge about sexual and reproductive health, protect vulnerable youth, and to advocate for greater rights and social protections to Salvadoran children and adolescents.     

Intimate partner violence among men and women--South Carolina, 1998

Few studies provide population-based estimates of intimate partner violence (IPV) for men and women, especially at the state level. IPV may result in adverse health effects for victims and perpetrators (1-3). To estimate the lifetime incidence of IPV by type of violence (e.g., physical, sexual, and perceived emotional abuse) and to explore demographic correlates of reporting IPV among men and women, the South Carolina Department of Health and Environmental Control and the University of South Carolina conducted a population-based random-digit-dialed telephone survey of adults in the state. This report summarizes the results of the survey, which indicated that approximately 25% of women and 13% of men have experienced some type of IPV during their lifetime. Although women were significantly more likely to report physical and sexual IPV, men were as likely as women to report emotional abuse without concurrent physical or sexual IPV.     

Sexual violence among a cohort of injection drug users

The objective of this study was to determine the prevalence of, and factors associated with, sexual violence in childhood, adolescence and adulthood, among injection drug using men and women. The Vancouver Injection Drug User Study is a prospective cohort of injection drug users (IDU) begun in 1996. The analysis included all individuals who completed the baseline questionnaire who responded to a question about sexual assault. Multivariate modeling was used to determine and to what extent a history of sexual violence at different ages is predictive of HIV risk and other health risk behaviors. HIV prevalence was calculated as the total current number of HIV-positive individuals in the cohort. Of the 1437 eligible individuals, 36% reported a lifetime history of sexual violence; 68% of women, and 19% of men (p<0.001). After adjusting for fixed sociodemographics, these individuals were more likely to have ever been in the sex trade, to knowingly share needles/rigs with HIV-positive people, to have attempted suicide, to have ever accidentally overdosed, to binge on alcohol, and to have been diagnosed with a mental disorder/disability. The prevalence of child sexual abuse in this cohort is 21%; 33% for women, and 13% for men. The data show a dose-response relationship between age at first sexual violence and most risk behaviors examined. These relationships are further mediated by gender. The prevalence of HIV among individuals who ever experienced sexual violence was 25%, compared to 19% among those who never experienced sexual violence (p=0.006). Sexual violence, and especially child sexual abuse, is highly prevalent among this cohort, particularly among women. Child sexual abuse has worse consequences for both genders than sexual violence later in life. Nevertheless, women and men are affected differently by sexual violence at different ages, and this has significant implications for health promotion programs, and specifically HIV prevention.     

Recommendations of the Polish Gynecological Society concerning child sexual abuse

The World Health Organisation defines child sexual abuse as the involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared and cannot give consent, or that violates the laws or social taboos of society. Child sexual abuse is evidenced by this activity between a child and an adult or another child who by age or development is in a relationship of responsibility, trust or power, the activity being intended to gratify or satisfy the needs of the other person. It is estimated that in the world on average one in 3-4 women and one in 6-10 men were victims of sexual abuse in childhood. In Poland, according to the estimates of the Child's Rights Protection Committee, approximately 20% of girls and 5-6% of boys under the age of 15 years has suffered sexual abuse. In 2007 there was an increase in violence victims in all age categories, but the most alarming data concerned minors under 13 years. Girls fall victim to sexual abuse three times more frequently than boys. Sexual abuse of boys frequently involves violence. Data show that there are fewer women than men who execute such actions against a minor. Most victims (49-84%) know the perpetrator, and approximately 14-20% of acts of violence take place within the family. This article presents recommendations of the Polish Gynecological Society concerning procedures in cases of suspected sexual abuse of children.     

Domestic violence and sexually transmitted diseases: the experience of prenatal care patients.

OBJECTIVES: The authors analyzed interview responses of patients at a prenatal care clinic to explore whether women who had been victims of sexual and physical abuse were more likely than non-victimized women to have experienced a sexually transmitted disease (STD). METHODS: A consecutive sample of 774 prenatal patients of a large health department in North Carolina were interviewed concerning a variety of health issues, including violence and STDs. Logistic regression analysis was used to model the women's STD status as a function of their experiences of sexual and physical abuse, controlling for several potentially confounding factors. RESULTS: Thirty percent of the women reported having experienced at least one STD, with the most common infections being chlamydia and gonorrhea. Twenty-eight percent of the women reported having been victims of abuse; 16% reported physical abuse only, while 12% reported both physical and sexual abuse. The majority of violence was domestic in nature, perpetrated by the victims' husbands, boyfriends, male friends, and relatives. After controlling for confounding variables, the authors found that women who reported both physical and sexual abuse were significantly more likely to have experienced STDs than non-victims (odds ratio [OR] = 2.25; 95% confidence interval [CI] 1.37, 3.69). The logistic regression analysis also showed a relationship of borderline statistical significance between non-sexual physical abuse and STDs. CONCLUSIONS: Health care providers should routinely screen patients for both abuse and STDs, and they should assist identified women in accessing appropriate health, social, and legal services.     

Sexual and physical abuse: a threat to reproductive and sexual health

According to the cross-cultural data, violence has two fundamental certainties: 1) that the overwhelming majority of perpetrators are men; and 2) that the targets are usually women. Sexual and physical abuse subsume a wide variety of violent behaviors, some of which are legally recognized as criminal acts. Evidence indicates that the most invisible of all is child sexual abuse, in which nonreporting of crime is prevalent. Although there appears to be no simplistic response to the question as to why men are violent towards women, it is noted that it involves several contributing factors. These include inequalities between women and men at the societal level, and cultural norms and expectations about behaviors of women and men at another level. In terms of the identity of the perpetrators, research has found that a large majority of perpetrators are socialized for violence. The effects of violence on the sexual and reproductive health of the victim are multiple and long lasting. For example, physical consequences of rape include sexually transmitted diseases and HIV infection, as well as unwanted pregnancy, miscarriage, unsafe abortion, homicide, and suicide. With respect to the psychological consequences, the most common symptoms are anxiety, depression, sexual dysfunction, and difficulties with interpersonal relationships. In view of this, there is a need for a long-term management of victims of sexual abuse.     

性暴力与生殖健康研究

目的:了解未婚人工流产(人流)女青少年中的性暴力发生现状及其对生殖健康的影响。方法:于2002年10月~2003年2月在北京、郑州、深圳、南宁市8所医院对2002名自愿要求人流的未婚女青少年进行了自填式问卷调查和妇科检查以及有关性传播疾病(STDs)的实验室检测。结果:2002名未婚人流女青少年中有282名报告曾遭受了性暴力,其发生率为14·08%。在首次性行为和近1年中曾遭受了性暴力的比例分别为7·99%和8·39%。性暴力施暴者中最常见的是男朋友(76·24%)。在性暴力受害者中,有46·10%的人被证实目前患有STDs(包括滴虫性阴道炎、念珠菌性阴道炎、沙眼衣原体感染、淋病、尖锐湿疣、生殖器疱疹)。性暴力受害者更可能首次性行为年龄<18岁、有多个性伴侣、在月经期有性行为、受教育程度低和有吸烟、饮酒嗜好。单因素分析显示,性暴力受害者中有STDs感染史和目前有STDs感染的比例明显高于无性暴力的女青少年,差异有极显著性(P<0·01);多因素分析表明,性暴力经历、首次性交年龄<18岁、性伴侣数≥2个、不使用避孕方法、父母关系不良是未婚人流女青少年是否感染性传播疾病的预测因子。与未遭受性暴力的女青少年相比,性暴力受害者目前有STDs感染的风险增加了1·3倍。结论:未婚人流女青少年中有较高的性暴力发生率和性传播疾病患病率,对未婚人流女青少年的生殖健康造成了明显的影响。     

Risk for post-traumatic stress disorder associated with different forms of interpersonal violence in South Africa

The South African population is exposed to multiple forms of violence. Using nationally representative data from 4351 South African adults, this study examined the relative risk for post-traumatic stress disorder (PTSD) associated with political, domestic, criminal, sexual and other (miscellaneous) forms of assault in the South African population. Violence exposure was assessed using the 'worst event' list from the WHO's Composite International Diagnostic Interview (CIDI) and a separate questionnaire assessing experiences of human rights abuses, and lifetime PTSD was assessed according to the APA's Diagnostic and Statistical Manual of Mental Disorders criteria using the CIDI. Findings indicated that over a third of the South African population has been exposed to some form of violence. The most common forms of violence experienced by men were criminal and miscellaneous assaults, while physical abuse by an intimate partner, childhood physical abuse and criminal assaults were most common for women. Among men, political detention and torture were the forms of violence most strongly associated with a lifetime diagnosis of PTSD, while rape had the strongest association with PTSD among women. At a population level, criminal assault and childhood abuse were associated with the greatest number of PTSD cases among men, while intimate partner violence was associated with the greatest number of PTSD cases among women. Recommendations for mental health service provision in South Africa and for future research on the relative risk for PTSD are offered.     

Health risks and behaviour of out–of–school 16–year–olds in New South Wales

Abstract: This study describes the health risks and health behaviour of a sample of 283 out–of–school 16–year–olds in New South Wales. We sampled study participants through the Commonwealth Employment Service offices in 1994 using a multistage sampling procedure. Of those surveyed, 129 responded to a letter inviting them to participate and 154 were recruited opportunistically. This paper describes the study methods and results for self–reported binge drinking, weekly use of tobacco and marijuana, sexual abuse, physical abuse, drink–driving, violence, and use of health services, by sex and method of recruitment. High rates of substance use were observed. Reported substance use in the out–of–school group was consistently higher than for 16–year–olds in school, except for binge drinking for girls recruited by letter. Of the out–of–school group, 34 per cent reported weekly use of tobacco, marijuana and also binge drinking. Boys were more likely to report drink–driving than girls (28 per cent and 13 per cent respectively). Having been in trouble with police ranged from 32 per cent for girls recruited by letter to 75 per cent for boys recruited opportunistically. A high proportion of girls reported sexual abuse (34 per cent of the 'letter' group and 41 per cent of the 'opportunistic' group). Overall, 87 per cent of respondents had used health services in the previous year. The results indicate that this is a disadvantaged group of young people who are an important target for health service provision and interventions.     

Help-seeking for intimate partner violence and forced sex in South Carolina

PURPOSE: In this population-based, random-digit-dial, cross-sectional survey, we assessed the lifetime victimization of intimate partner violence (IPV) and forced or coerced sex among 556 women and men in South Carolina, and the help-seeking behaviors of victims. RESULTS: Among women, 25.3% experienced IPV (sexual, physical, or emotional violence) compared with 13.2% of men. Although women were significantly more likely to report physical or sexual IPV (17.8%) than were men (4.9%), men (8.3%) were as likely as women (7.4%) to report perceived emotional abuse without physical or sexual IPV. One half of men and women with annual incomes <$15, 000 reported IPV. Among women experiencing physical or sexual IPV, 53% sought community-based or professional services for IPV; women with higher education levels and those experiencing more severe violence were most likely to seek services. CONCLUSIONS: These data show that IPV is common and that most victims do not receive services to address this violence.     

Childhood physical and sexual abuse experiences associated with post-traumatic stress disorder among pregnant women

PurposeWe sought to evaluate the extent to which childhood physical and/or sexual abuse history is associated with post-traumatic stress disorder (PTSD) during early pregnancy and to explore the extent to which the childhood abuse-PTSD association is mediated through, or modified by, adult experiences of intimate partner violence (IPV).MethodsIn-person interviews collected information regarding history of childhood abuse and IPV from 2,928 women aged 18-49 years old prior to 16 weeks of gestation. PTSD was assessed using the PTSD Checklist-Civilian Version. Multivariate logistic regressions were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).ResultsCompared to women with no childhood abuse, the odds of PTSD were increased 4.31-fold for those who reported physical abuse only (95% CI, 2.18–8.49), 5.33-fold for sexual abuse only (95% CI, 2.38–11.98), and 8.03-fold for those who reported physical and sexual abuse (95% CI, 4.10–15.74). Mediation analysis showed 13% of the childhood abuse-PTSD association was mediated by IPV. Furthermore, high odds of PTSD were noted among women with histories of childhood abuse and IPV compared with women who were not exposed to either (OR = 20.20; 95% CI, 8.18–49.85).ConclusionsChildhood abuse is associated with increased odds of PTSD during early pregnancy. The odds of PTSD were particularly elevated among women with a history of childhood abuse and IPV. Efforts should be made to prevent childhood abuse and mitigate its effects on women's mental health.