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.     

Trajectory of intimate partner violence and healthcare seeking over the life course: study of Japanese women in the Tokyo metropolitan area,Japan

Objectives

To describe the trajectory of, and examine factors affecting, intimate partner violence (IPV) and IPV-specific healthcare seeking among Japanese women over the life course.

Study design

Life course study.

Method

One hundred and one women, aged 24–80 years, who had a lifetime history of IPV were interviewed in the Tokyo metropolitan area, Japan in 2005 and 2006. Life course data were collected according to the life history calendar method. Hierarchical linear modelling was used to examine IPV-specific healthcare seeking over the life course.

Results

Injury, formal or informal help seeking, public assistance, worse self-rated health status and smoking significantly increased the likelihood of IPV-specific healthcare seeking over the life course. There are significant cohort effects on healthcare seeking. The results suggest that women who experience IPV may seek healthcare services not only immediately after the first occurrence of IPV, but also later in life.

Conclusions

IPV is not always associated with immediate healthcare seeking. In particular, sexual IPV is not significantly associated with healthcare seeking. Pursuing formal and informal help is associated with healthcare seeking.     

The effects of intimate partner violence on health in young adulthood in the United States

This paper uses data on a national sample of adolescents from the United States followed through the transition into young adulthood to examine the association between intimate partner violence (IPV) and health outcomes, including depressive symptoms, self reported health status, and health care utilization. Researchers have shown an important IPV-health link in a number of settings but have often been limited by using cross-sectional data, convenience samples, and the inability to control for important risk factors and confounders. The findings from this study suggests that these limitations likely inflate the estimated link between IPV and health by as much as 60% but also show that IPV has important health impacts on a number of outcomes. The results also show no differential impact of IPV by gender or previous exposure to child abuse. The health effects of IPV are also typically larger for current exposure than previous exposure, but each exposure type is shown to reduce health.     

Formal and informal help-seeking associated with women's and men's experiences of intimate partner violence in Canada

While numerous studies have documented the prevalence, correlates, and consequences of intimate partner violence (IPV); most of this research has used a criminal justice framework that has focused on acts of physical violence. However, critics argue that this narrow conceptualization of IPV belies the heterogeneity in this experience with respect to the nature of coercive control in the relationship. Moreover, they contend that the different types of abusive and controlling relationships not only have a different etiology, health consequences, and help-seeking characteristics, they also have a different relationship by gender. This study examined the extent to which different patterns of violence, abuse, and control were differentially associated with formal and informal help-seeking in a national Canadian sample. Data from the 2004 General Social Survey were analyzed, which included 696 women and 471 men who reported physical or sexual violence by a current or ex-spouse or common-law partner. The most commonly reported formal sources for women and men were health professionals (i.e., doctors, nurses, counselors, psychologists) and the police. For women, informal sources (i.e., family, friends, neighbors) were commonly reported across all IPV subgroups. However, the importance of almost all of the formal sources (e.g., health professionals, police, lawyers, shelters, crisis centers) increased as the severity of the violence and control increased. Shelters and crisis centers were also reported by a notable proportion of women who experienced the most severe pattern of violence and control. For men, both formal and informal sources were more commonly reported by those who experienced moderate violence and control compared with those who experienced relatively less severe acts of physical aggression. The results suggest that research that more sensitively examines people's experiences of violence and control can help identify their health, social, and safety needs; and ultimately better inform the development of programs and services aimed at addressing these needs.     

Gender and psychotropic medication use: the role of intimate partner violence

OBJECTIVE: Women are known to use more psychotropic medications than men which may be linked to women's greater exposure to intimate partner violence (IPV). METHOD: The use of medications for sleep, depression and anxiety in adults in the 1999 Canadian General Social Survey was assessed. Rates of medication use by adults exposed to IPV (physical, sexual, emotional and financial) were compared to rates of those reporting no IPV. RESULTS: More women (14.9%) than men (9.6%) reported use of psychotropic medications in the preceding month. Rates were significantly higher in both women and men who reported IPV. This link was still present after key sociodemographic and health predictors of medication use were held constant. CONCLUSION: This random population based study provides the first data to support the idea that IPV may explain at least some of the increased psychotropic medication use by women. IPV should be included as a predictor variable in future studies investigating psychotropic medication use which itself can be added to the list of adverse health risks of IPV.     

2575名在校大学生亲密伴侣暴力现况研究

目的 了解大学生恋爱中的性行为和亲密伴侣暴力行为情况,探讨亲密伴侣暴力与大学生其他部分心理行为的关系.方法 采取整群抽样的方法,对合肥和芜湖市3所高校2575名在校大学生进行问卷调查,内容包括恋爱情况、遭受亲密伴侣暴力情况、抑郁症状、自尊、学校生活满意度和自杀相关心理行为.x2检验和方差分析探讨不同恋爱经历大学生心理行为状况的差异.结果 2575名大学生中46.9%有过恋爱经历;男生高于女生,大二、三年级学生高于大一年级学生(x2值分别为44.13、161.84,P值均<0.05).目前正在恋爱的大学生中21.1%报告与现在的恋人发生过性行为,其中仅有21.8%(34/156)每次都使用安全套,11.5%(18/156)从不采用任何避孕措施,18.6%(29/156)与现在恋人(女友)发生性行为而怀孕,孕后到正规医院进行处理的比例仅占48.3%(14/29).有过恋爱经历的大学生中,遭受躯体暴力、心理暴力、性暴力、总暴力的报告率分别为18.0%、33.6%、5.1%、37.1%;男生遭受躯体暴力、心理暴力、总暴力的比例均高于女生,女生遭受性暴力的比例高于男生(x2值分别为70.21、13.25、14.04、5.77,P值均<0.05).在遭受过亲密伴侣暴力的大学生中,有74.2%(345/446)经历过3次以上亲密伴侣暴力.经历过亲密伴侣暴力的大学生抑郁症状得分最高,自尊和学校生活满意度得分最低(F值分别为4.00、16.39和8.76,P值均<0.05),自杀意念、自杀计划、自杀准备、自杀未遂的报告率均最高(x2值分别为13.80、9.72、8.52、11.96,P值均<0.05).结论 大学生恋人间性行为发生率较高,且保护意识缺乏;大学生亲密伴侣暴力现象较常见,且与其他不良心理行为关系密切.

Abstract：

Objective To investigate the prevalence of love affairs and intimate partner violence,and to explore the relationship between intimate partner violence and other mental health and risk behavior in college students.Methods Three universities were selected using cluster sampling method in Hefei and Wuhu.Totally.2575 college students completed an anonymous questionnaire.Intimate partner violence,depression,satisfaction of school life,self-esteem,suicidal psychology and behavior were evaluated to estimate the relationship between intimate partner violence and mental health/risk behavior.Results There were 46.9%students reported that they had intimate partner currently or in the past.The rate of having intimate partner in male students was higher than that in female students(x2=44.13,P<0.001).And the rates were higher in sophomores and juniors than in freshmen(x2=161.84,P<0.05).There were 21.1% students had sexual behavior with their intimate partners.But only 21.8%(34/156)intimate partners reported that they used condom every time.There were 11.5%(18/156)intimate partners reported that they never took any contraception.There were 18.6%(29/156)students reported that they were pregnant or led to their girlfriend becoming pregnant,but only less than 50.0% adolescents induced abortion in a legal hospitals.The rates of being the victim of physical assault,emotional abuse,sexual coercion,the total intimate partner violence were 18.0%,33.6%,5.1%.37.1%.The rates of being the victim of physical assault,emotional abuse,total intimate partner violence in male adolescents were higher than those in female adolescents,but the rate of sexual coercion was on the contrary(x2=70.21,13.25,14.04,5.77,P<0.05).Among the intimate partners who had suffered from intimate partner,74.2%(345/446)students had underwent more than 3 times.and 47.1% had underwent more than 2 types of intimate partner violence.The score of depression was highest in the victims of intimate partner violence,but the scores of self-esteem and school life satisfaction were on the contrary(F=4.00,16.39,8.76,P<0.05).The rates of suicidal ideation,suicidal plan,suicidal preparative and attempted suicide were highest in the victims of intimate partner violence(x2=13.80,9.72,8.52,11.96,P<0.05).Conclusion The rate of having sexual behavior with their intimate partners was high in college students,but their self-protection awareness was insufficient.In the present study,a high prevalence of intimate partner violence among university students was observed,and highlighted a need for attention to the other mental health and risk behavior in adolescents with intimate partner violence.     

The ethics of researching intimate partner violence in global health: A case study from global health research

There has been an increase in attention to intimate partner violence (IPV) as a health issue that contributes to the spread of HIV, physical and emotional stress, depression, substance use, serious injuries, and higher rates of mortality in low-income settings. This paper explores the ethical implications raised by research on IPV by global health scholars. Drawing on Hedgecoe’s work on critical bioethics to analyse a qualitative study of IPV in Rwanda, this paper discusses the risks and benefits of conducting research on IPV as part of the global health agenda. We discuss ethical issues that have become evident through our work in this area, including: raising IPV as an issue of concern in women’s lives in settings where economic support for women experiencing IPV may not exist; recording interviews and focus group discussions in contexts with significant government surveillance; ethical tensions in appropriating local voices in ways that position women as ‘victims’ of violence; and the risks associated with framing IPV as a global health issue separate from feminist advocacy. We recommend more tailored approaches to ethics in IPV research, which considers the specificity of the social, cultural and economic context.     

Disability,sexual orientation,and the mental health outcomes of intimate partner violence: A comparative study of women in the U.S.

Background

Research on disabled non-heterosexual women's post-intimate partner violence mental health outcomes—such as anxiety, depression, suicidal ideation, and alcohol use—is lacking.

Associations between intimate partner violence,violence-related policies,and HIV diagnosis rate among women in the United States

PurposeTo assess the association between state-level intimate partner violence (IPV) prevalence and HIV diagnosis rates among women in the United States and investigate the modifying effect of state IPV health care policies.MethodsData on HIV diagnosis rates were collected from HIV surveillance data from 2010 to 2015, and IPV prevalence data were collected from the National Intimate Partner and Sexual Violence Survey from 2010 to 2012. States were coded for IPV health care policies on training, screening, reporting, and insurance discrimination.ResultsStates with higher IPV prevalence was associated with higher HIV diagnoses among women (B = 0.02; 95% confidence interval [CI] = 0.003, 0.04; P = .02). State policies were a significant effect modifier (B = −0.05; 95% CI = −0.07, −0.02; P < .001). Simple slopes revealed that the association between IPV and HIV diagnosis rates was stronger in states with low IPV protective health care policies (B = 0.09; CI = 0.06, 0.13; P < .001) and moderate IPV protective policies (B = 0.05; 95% CI = 0.02, 0.07, P < .001), but not in states with high IPV protective policies (B = −0.009; 95% CI = −0.04, 0.02; P = .59).ConclusionsHIV prevention programs should target IPV and link to community resources. IPV-related policies in the health care system may protect the sexual health of women experiencing IPV.     

Looking at COVID-19 effects on intimate partner and sexual violence organizations in Canada through a feminist political economy lens: a qualitative study

ObjectivesIntimate partner violence and sexual violence organizations such as women’s shelters play a crucial role in advancing gender equality in Canada. COVID-19 has challenged how such organizations operate. This study explored how intimate partner violence and sexual violence organizations in Canada have been affected by COVID-19 and the consequences on service delivery.MethodsWe interviewed 17 frontline and management staff from intimate partner violence and sexual violence organizations and programs across Canada, and analyzed the data using thematic analysis and applying a feminist political economy lens.ResultsWe identified the following themes: (1) Adapting; (2) Struggling financially; (3) Resourcefulness; (4) Troubles connecting; (5) Narrowing scope of work; and (6) Burden of care.ConclusionA feminist political economy framework considers the gendered impact of the pandemic and related measures on the workforce. Both the pandemic and measures to control it have affected intimate partner violence and sexual violence organizations in Canada, the staff working in these organizations, and the quality of relationships between staff and clients. Intimate partner and sexual violence organizations in Canada have been chronically underfunded and their predominantly female staff underpaid, affecting their ability to meet the needs of women. The onset of COVID-19 not only worsened these issues but converged with a shift in focus to more pandemic-related tasks, further limiting the scope and reach of organizations. Whether the adaptations, innovations, and perseverance demonstrated by such organizations and staff can tip the balance in favour of more equitable policy and outcomes remains to be seen.     

近10年亲密伴侣暴力国际研究热点的文献计量学分析

目的 从文献计量的角度系统地分析世界各国近10年有关亲密伴侣暴力(intimate partner violence,IPV)的研究热点问题的分布及变化趋势,旨在为我国开展相关研究提供参考依据。方法 检索PubMed数据库2005-2014年收录的相关文献采用书目信息共现挖掘系统(BICOMS)进行文献计量分析,并利用SPSS 20.0软件绘制系统聚类关系图及χ²检验分析热点变化趋势。结果 统计分析表明,国际上在IPV领域发布的科研论文共3 257篇,数量上整体呈上升态势,尤以近3年更为明显。近10年相关研究主题词主要集中在4各方面:IPV的相关损害及疾病、流行病学调查方法、社会支持、IPV及所引起的疾病预防干预知识及措施。分析结果显示,相对前5年,近5年发表的文献侧重于IPV与HIV感染关系的研究(2.0% vs. 1.0%,χ²=4.471,P=0.034),并将研究对象拓展到孕产妇(1.2% vs. 0.4%,χ²=4.805,P=0.028)等人群。结论 近10年IPV领域的研究总体围绕4个方面,近5年的研究热点开始转向其与HIV感染,目标人群开始拓展到普通女性以外其他人群,中国在该领域的研究还处于起步阶段,期待有所突破的研究。     

'Health's a difficult beast': the interrelationships between domestic violence, women's health and the health sector. An Australian case study

This paper reports on the Australian component of a five nation study undertaken in Australia, Canada, Thailand, Bangladesh and Afghanistan examining policy networks that address women's health and domestic violence. It examines the relationship between health and domestic violence in Western Australia and analyses the secondary role assumed by health. The study adopted a qualitative research paradigm and semi-structured interviews. Snowball sampling was used to identify relevant and significant stakeholders and resulted in a final sample of 30 individuals representing three key areas: the 'health policy community', the 'domestic violence prevention community' and 'other interested stakeholders', that is, those who have an interest in, but who are not involved in, domestic violence prevention work. Results suggest that the secondary positioning of health is associated with the historical 'championing' of the issue in the women's movement; limited linkages between the health policy community and the domestic violence prevention community and within the health policy community itself; the 'fit' between domestic violence and the Western Australian Health Department mandate; and the mis-match between domestic violence and the medical model. The conclusion indicates a need for collaboration based on effective links across the domestic violence community and the health policy community.     

Primary health care attributes and responses to intimate partner violence in Spain

Objective

This study provides an overview of the perceptions of primary care professionals on how the current primary health care (PHC) attributes in Spain could influence health-related responses to intimate partner violence (IPV).

Exploring the associations between intimate partner violence and women’s mental health: Evidence from a population-based study in Paraguay

Using a nationally representative sample from the 2008 Paraguayan National Survey of Demography and Sexual and Reproductive Health, we examine the association between emotional, physical, and sexual intimate partner violence (IPV) and mental health among women aged 15–44 years who have ever been married or in a consensual union. The results from multivariate logistic regression models demonstrate that controlling for women’s socioeconomic and marital status and history of childhood abuse and their male partners’ unemployment and alcohol consumption, IPV is independently associated with an increased risk for common mental disorders (CMD) and suicidal ideation measured by the Self Reporting Questionnaire (SRQ-20). IPV variables substantially improve the explanatory power of the models, particularly for suicidal ideation. Emotional abuse, regardless of when it occurred, is associated with the greatest increased risk for CMD whereas recent physical abuse is associated with the greatest increased risk for suicidal ideation. These findings suggest that efforts to identify women with mental health problems, particularly suicidal ideation, should include screening for the types and history of IPV victimization.     

Intimate partner violence and academic performance: the role of physical,mental, behavioral,and financial health

Undergraduate students of all gender identities are at risk of experiencing intimate partner violence (IPV) victimization. It is known that IPV negatively affects academic performance, yet little is known about the role of health. This study examined if past-year IPV victimization was associated with an increase in students’ self-perception of health interfering with academic performance. Data were drawn from the 2011–2014 National College Health Assessment (N = 84,734). Structural equation modeling was used to examine the relationship between a latent variable of IPV and health impediments to academic performance. The model was a good fit for the data (RMSEA = .012, CFI = .994, TLI = .981). Undergraduate survivors of past-year IPV – and transgender students – were more likely to report impediments to their academic performance: physical assault (0.66, p < .001), sexual assault (0.57, p < .001), sexually transmitted infections (0.42, p < .001), pregnancy (0.38, p < .001), depression (0.38, p < .001), disordered eating (0.36, p < .001), financial problems (0.33, p < .001), anxiety (0.32, p < .001), sleep problems (0.32, p < .001), chronic health problems (0.29, p < .001), drug use (0.29, p < .001), injury (0.25, p < .001), and alcohol use (0.25, p < .001). This demonstrates that IPV has a spiral effect, such that IPV’s impact on health is perceived by students as detrimental to their academics.     

Together to end violence against women in Tanzania: Results of a pilot cluster randomized controlled trial to evaluate preliminary effectiveness of interpersonal and community level interventions to address intimate partner violence

ABSTRACT

In Tanzania, women suffer high rates of intimate partner violence (IPV). We conducted a pilot cluster randomised controlled trial to test the feasibility, acceptability and preliminary effectiveness of IPV prevention interventions targeting men and communities in nine villages randomly assigned to one of three study arms (n = 450 couples). In the Control Group, women participated in savings groups while male partners received no intervention. In Intervention Group 1, women participated in savings groups and men participated in peer-groups addressing gender relations and IPV prevention. In Intervention Group 2, women participated in savings groups, men participated in peer-groups, and community leaders facilitated dialogues on similar topics. Recruitment was completed within one month with 95% retained in the intervention and 81% retained in the endline survey. Acceptability was high, with men participating in 82% of peer-group session hours. More men in Interventions 1 (24%) and 2 (19%) disagreed with wife-beating compared to men in the Control (13%); and more men reported non-perpetration of IPV in Interventions 1 (16%) and 2 (14%) compared to the Control (?2%). Findings suggest a fully powered RCT may detect significant reductions in men’s justification and use of IPV, paving the way for evidence-based violence prevention programming.

Trial registration: ClinicalTrials.gov identifier: NCT02434796.     

Community influences on intimate partner violence in India: Women's education, attitudes towards mistreatment and standards of living

Intimate partner violence (IPV) directed towards women is a serious public health problem. Women's education may offer protection against IPV, but uncertainty exists over how it might reduce risk for IPV at the community and individual levels. The objectives of this study are to: (1) disentangle community from individual-level influences of women's education on risk for IPV; (2) quantify the moderating influence of communities on individual-level associations between women's education and IPV; (3) determine if women's attitudes towards mistreatment and living standards at the community and individual levels account for the protective influence of women's education; and (4) determine if the protective influence of education against IPV is muted among women living in communities exhibiting attitudes more accepting of mistreatment.Study information came from 68,466 married female participants in the National Family Health Survey conducted throughout India in 1998–1999. Multilevel logistic regression was used to address the study objectives. IPV showed substantial clustering at both the state (10.2%) and community levels (11.5%). At the individual level, there was a strong non-linear association between women's education and IPV, partially accounted for by household living standards. The strength of association between women's education and IPV varied from one community to the next with evidence that the acceptance of mistreatment at the community level mutes the protective influence of higher education. Furthermore, women's attitudes towards mistreatment and their standards of living accounted for community-level associations between women's education and IPV.Place of residence accounted for substantial variation in risk of IPV and also modified individual-level associations between IPV and women's education. At the community level, women's education appeared to exert much of its protective influence by altering population attitudes towards the acceptability of mistreatment. However, there was no residual association between women's education and IPV at the community level once living standards are taken into account. While women's education provides strong, independent leverage for reducing the risk of IPV, planners must keep in mind important community factors that modify its protective influence.