Childhood emotional abuse and alcohol use disorders in a national Nepali women sample: The mediating role of borderline personality traits.

While many studies have found an association between childhood emotional abuse and alcohol use disorders (AUD) during adulthood, underlying psychological mechanisms linking the two remain inadequately understood. Drawing on the developmental psychopathology perspective, this study examined the relationship between childhood emotional abuse and AUD during adulthood with a national sample of women in Nepal (N = 1,100, M age = 37.73), focusing on the mediating role of borderline personality traits. Mediation analyses were performed using the Karlson-Holm-Breen (KHB) method and bootstrapping confidence intervals. Results indicated that Nepali women's borderline personality traits significantly mediated the relationship between childhood emotional abuse and AUD. Hence, emotional abuse in childhood increases the risk for AUD during adulthood for Nepali women by increasing the risk of borderline personality traits. Findings underscore the necessity of continued emphasis on developing and implementing early interventions for childhood emotional abuse and therapeutic interventions for borderline personality traits in reducing AUD among vulnerable women in Nepal.

In-law psychological aggression and its impacts on women's health.

Conflicts between couples and their parents-in-law are a common phenomenon in Chinese families. In this study, in-law psychological aggression (InPA) victimization and its association with intimate partner violence (IPV), women's health, and gender role valuation were examined. A household face-to-face survey with random sampling was conducted, and a total of 260 married Chinese women with parents-in-law were recruited. Among the participants, 11.2% and 43.1% had experienced InPA victimization and IPV victimization, respectively, and 7.3% had experienced both. Women's daily contact with parents-in-law, anxiety symptoms, demand to obey parents-in-law, and the low valuation of the male role significantly positively related to InPA victimization, whereas discussions of in-law conflict with husbands were significantly negatively related to InPA victimization. Therefore, in developing interventions for women experiencing InPA victimization, the role of the husband in InPA victimization and the risk of co-occurring InPA and IPV should be considered. These findings reflect the need to raise awareness about the influence of culture on gender roles, the harm caused by InPA victimization, and the urgent need to help Chinese women who are experiencing in-law conflict.

Parental Demandingness and Executive Functioning in Predicting Anxiety among Children in a Longitudinal Community Study.

Theoretical models and empirical studies of anxiety have predominately focused on the main effects of various predictors such as executive functioning deficits on anxiety. This study examined the moderating role of parental demandingness in the relationship between executive functioning deficits and anxiety in children. Ninety children (46.67% female) aged from 9 to 14 years completed several executive functioning tasks and a measure of anxiety. Parental demandingness was rated based on an observation of parent-child interactions. The children completed the anxiety measure again at one-year follow-up. The results showed that parental demandingness significantly moderated the prospective relationship between executive functioning deficits and anxiety, such that the association between executive functioning deficits and anxiety in children was weaker when parental demandingness was lower. These findings suggest that low parental demandingness may serve as a protective factor that buffers the detrimental effects of executive functioning deficits on anxiety.

Intimate partner violence victims' acceptance and refusal of on-site counseling in emergency departments: Predictors of help-seeking behavior explored through a 5-year medical chart review.

Healthcare services constitute the first formal support that many intimate partner violence (IPV) victims receive and a link to formal welfare and psychological support. The help-seeking behavior for psychosocial support, e.g., Accident and Emergency Departments (AED) onsite counseling, is key to developing effective support for IPV victims. This study aimed to strengthen the health-welfare support link to aid IPV prevention in AEDs by investigating the acceptance and refusal of on-site counseling by IPV victims. A retrospective cohort study retrieved and reviewed all records of IPV victims presenting at the AEDs of two Hong Kong hospitals between 2010 and 2014. A total of 157 male and 823 female IPV victims were identified, 295 of whom refused on-site counseling. Bivariate and multivariate analyses were performed to examine the association between help-seeking and demographic and violent injury-related factors. The odds of help-seeking via on-site counseling were significantly lower for victims with mental illness (aOR=0.49; 95% CI=0.27, 0.88). After controlling for all demographic characteristics, mental illness, and drug abuse information, sex remained an independent predictor of help-seeking (aOR=2.62; 95% CI=1.45, 4.74); victims who had experienced >2 abuse incidents were more likely to seek help than those who had experienced ≤2 abuse incidents (aOR=1.90; 95% CI=1.11, 3.26). The factors associated with help-seeking from on-site services by IPV victims reflect the need for multidisciplinary collaborative work aimed at IPV prevention. Healthcare professionals require training on how to promote help-seeking behavior targeted specifically for male and female IPV victims according to their needs and preferences.

Dating violence, quality of life and mental health in sexual minority populations: a path analysis.

PURPOSE: Theories explaining the impact of intimate partner violence (IPV) on mental health have focused on heterosexual relationships. It is unclear whether mental health disparities between heterosexual and sexual minority people are due to IPV or factors related to sexual orientation. The present study aimed to investigate pathways of how sexual orientation influenced quality of life and mental health. METHODS: The present cross-sectional study was conducted in 1076 young adults in a university population (934 heterosexual and 142 sexual minority groups). Structural equation modelling was used to examine the pathways of sexual orientation, dating violence, sexual orientation concealment, quality of life and mental health (perceived stress, anxiety and depression). RESULTS: After adjusting for sociodemographic factors, quality of life in sexual minority people was poorer [estimate -2.82, 95 % confidence interval (CI) -4.77 to -0.86, p = 0.005], and stress (estimate 2.77, 95 % CI 1.64-3.92, p < 0.0001), anxiety (estimate 1.84, 95 % CI 1.13-2.56, p < 0.0001) and depression levels (estimate 0.62, 95 % CI 0.05-1.2, p < 0.0001) were higher than in heterosexual people. Dating violence and sexual orientation concealment were mediators, with the models showing a good fit. CONCLUSION: Our study has progressed investigation of the link between sexual orientation and quality of life and mental health in the Chinese context. It has helped identify health disparities between heterosexual and sexual minority people and determined specific factors affecting their quality of life and mental health.

A comparison of intimate partner violence and associated physical injuries between cohabitating and married women: a 5-year medical chart review.

BACKGROUND: Cohabitation, referring to a co-residential romantic relationship between two intimate partners without a marriage license, has become widely accepted in contemporary societies. It has been found that cohabitating women have a higher risk of experiencing intimate partner violence (IPV) than married women. However, as yet, no studies have investigated the level and pattern of IPV-associated physical injuries and its mental health impact on cohabitating women. Therefore, we aim to compare IPV-associated physical injuries between cohabitating and married women by conducting a review of 5-year medical records from the emergency departments of two major public hospitals in Hong Kong. METHODS: This is a retrospective cohort study. Using two computerized systems, we identified the medical charts of 1011 women who had experienced IPV and presented at emergency departments between 2010 and 2014, of which, 132 were cohabitating and 833 were married. RESULTS: Cohabitating women were significantly younger (p-value < .0001) and had obtained a higher educational level (p-value = .008) than married women. After adjusting for those two variables, the logistic regression models showed that cohabitating women were approximately 2.1 times more likely than married women to present with head, neck, or facial injuries (OR = 2.1, 95% CI = 1.30-3.40, p = .002), and the risk of having multiple injuries in different locations (head, neck, face, torso, limbs) was almost twice that for cohabitating women compared with married women (OR = 1.82, 95% CI = 1.25-2.65, p = .001). Furthermore, cohabitating women were almost two times as likely as married women to experience more than one method of physical violence (OR = 1.72, 95% CI = 1.18-2.51, p = .005). There were no significant differences regarding mental health, police reporting, and discharge plans. CONCLUSIONS: Owing to recent social changes to the family structure, including the growing acceptance of cohabitation, it is essential that a screening program for IPV is established for cohabitating women, as well as the inclusion of IPV content in medical and nursing curriculums and in-service training.

Injury Patterns and Help-seeking Behavior in Hong Kong Male Intimate Partner Violence Victims.

BACKGROUND: Few studies have focused on the characteristics of male victims of intimate partner violence (IPV). Providers of care lack knowledge on the pathognomonic features to identify male IPV victims, who tend to be hidden. OBJECTIVES: This study investigated the injury patterns of male IPV victims and their help-seeking characteristics. METHODS: A retrospective cohort study was carried out in two regional hospitals in Hong Kong. Data were collected from the hospital computer databases (i.e., the Accident & Emergency Information System and the Clinical Data Analysis and Reporting System) and the medical charts completed by physicians. RESULTS: Medical records were retrieved from August 1, 2009 to December 31, 2011 for all IPV victims presenting at the accident and emergency departments. There were 372 cases in total, including 54 male and 318 female cases. Male victims were more likely to have abrasions/scrapes (66.7%), human bites (20.4%), and laceration/cutting (18.5%) than female victims (31.4%, 1.3%, 6.9%; p < 0.001, p < 0.01, p < 0.001, respectively). More male victims received dressing (38.9%) and injection (13.0%) than female victims (14.5%, 3.5%; p < 0.001, p < 0.01, respectively). Fewer male victims attended consultation by the medical social worker (MSW; 5.6%) than female victims (21.7%). CONCLUSION: Abrasion wounds are the most common in male victims of IPV. Male victims have lower rates of seeking help from MSWs, and most are aged 40 years or above. This study has identified important characteristics of male victims to aid the development of a comprehensive program for early IPV detection and management.

Transcultural and psychometric validation of the Dispositional Resilience Scale (DRS-15) in Chinese adult women.

PURPOSE: The aim of this study was to report translation and transcultural adaptation of the 15-item Dispositional Resilience Scale in traditional Chinese (C-DRS-15) and evaluate its psychometric properties. METHODS: The DRS is a self-report instrument that measures psychological hardiness. We followed an international standard of cross-cultural translation and validation of patient-reported outcome measures to create the Chinese version. Then, the translated C-DRS-15 was validated on 542 Chinese women from a population-based sample in Hong Kong. RESULTS: The internal consistency and criterion-related validity were investigated. Exploratory and confirmatory factor analysis revealed that the C-DRS-15 was supported by a modified three-factor structure in our Chinese sample (RMSEA = .06, CFI = .94, TLI = .92, and SRMR = .06). The reliability (Cronbach's α coefficient = .78) and validity were satisfactory. Total resilience score was negatively correlated with depression (p < .001), with non-depressed women scoring higher on the C-DRS-15. CONCLUSIONS: The C-DRS-15 was demonstrated to be a reliable and valid measurement to assess hardiness in Chinese women.

Patterns, aetiology and risk factors of intimate partner violence-related injuries to head, neck and face in Chinese women.

BACKGROUND: Intimate partner violence (IPV) related injuries have been recognized among health care professionals. However, few studies have provided detailed information on injuries to the head, neck and face regions in Chinese women. As abused Chinese women are generally unwilling to disclose IPV and there are differences in socio-demographic characteristics, societal norms and behaviours, the women may exhibit different patterns, aetiology and risk factors of IPV-related HNF injuries. This study aims to examine the patterns of head, neck and face injuries presenting to Accident and Emergency departments, including the anatomical regions, types, severity, aetiology and demographic and non-demographic risk factors of injuries inflicted by intimate partners in Chinese context. METHODS: Medical charts of 223 women presented to the Accident and Emergency departments of two regional hospitals in Hong Kong between January 2010 and December 2011 were reviewed independently by two reviewers. RESULTS: Head, neck and face injuries remained the most common injuries found in abused Chinese women (77.6%), and punching with a fist was the most common aetiology (60.2%). In particular, punching with a fist was significantly associated on the upper third of the maxillofacial region (p = .01) and the back part of the head (p = .03). Moreover, cohabiting and separated women were more likely to have multiple injuries than those who were married (OR = 3.3, 95% CI = 1.4, 7.8; OR = 2.1, 95% CI = .4, 11.9). CONCLUSIONS: The findings enhance the understanding of head, neck and face injuries and inform clinicians about the linkage among injuries and risks in abused Chinese women.

Impact of mild traumatic brain injury on physical, mental and cognitive functioning of abused women admitted to emergency units.

Limited studies exist on women's mild traumatic brain injury received from episode of intimate partner violence. This study aims to identify the occurrence of intimate partner violence-related mild traumatic brain injury in Chinese women admitted to emergency units; and examine the physical, mental, and cognitive functioning of abused women with mild traumatic brain injury related to violent episodes. Eighty-six Chinese abused women presenting at emergency units in four major local hospitals in Hong Kong between January 2014 and December 2016 were recruited. They were admitted for the treatment of intimate partner violence-related physical injuries and were screened for traumatic brain injury by the emergency unit nurses at triage. Participants were assessed for traumatic brain injury based on the definition from US Center for Disease Control and Prevention, post-concussion physical symptoms, anxiety and depression, health-related quality of life, and cognitive functioning. Structured multiphase regression was used to examine the impact of intimate partner violence-related mild traumatic brain injury on physical, mental, and cognitive functioning of participants. We found that 24.4% of participants had intimate partner violence-related mild traumatic brain injury. There were significantly more severe post-concussion physical symptoms in abused women with intimate partner violence-related mild traumatic brain injury than those without mild traumatic brain injury (estimate = 18.7, 95% CI = 10.9 to 26.6, p < 0.001). The Mental Component Summary was also significantly associated with intimate partner violence-related mild traumatic brain injury (estimate = -7.9, 95% CI = -13.8 to -2.1, p = 0.009). Regarding cognitive functioning, the mean total test scores indicated that both groups were cognitively abnormal and there was no significant impact from mild traumatic brain injury. This study provides evidence on the impact of mild traumatic brain injury and implications in screening for mild traumatic brain injury and early intervention for improving quality of life in abused women.

Understanding Forgiveness After Leaving an Abusive Relationship: The Voices of Chinese Female Intimate Partner Violence Survivors.

Forgiveness is known to play an important role in recovery studies of female intimate partner violence (IPV) survivors. However, survivors' understanding of forgiveness remains unclear. This study explored forgiveness through semi-structured interviews with 25 Chinese women. The results indicate that forgiveness is an unintended process that comprises the alleviation of a grudge held against former partners and a reframed understanding of them. It does not involve reconciliation. Moreover, establishment of clear boundaries is a precondition for forgiveness. The findings supplement knowledge on forgiveness and the importance of cognitive reframing, emotion regulation, and establishing clear boundaries in forgiveness and recovery.

Striving to Avoid Inferiority and Procrastination among University Students: The Mediating Roles of Stress and Self-Control.

The current study intended to examine whether the relationship between university students' striving to avoid inferiority (SAI) and procrastination was serially mediated by stress and self-control. The sample consisted of 154 Hong Kong university students. Their levels of striving to avoid inferiority, stress, self-control, and procrastination were measured by the Striving to Avoid Inferiority Scale (SAIS), the stress subscale of the Depression Anxiety Stress Scales (DASS-21), the Short Self-Regulation Questionnaire (SSRQ), and the General Procrastination Scale (GPS), respectively. The results of structural equation modeling revealed that SAI positively predicted stress, stress negatively predicted self-control, and self-control negatively predicted procrastination. SAI did not directly predict procrastination. The results of bootstrapping analyses supported the hypotheses that the effect of stress on procrastination was mediated by self-control, the effect of SAI on self-control was mediated by stress, and more importantly, the effect of SAI on procrastination was serially mediated by stress and self-control. Further research is suggested to investigate the thoughts and feelings pertinent to procrastination and the actual duration of procrastination among university students.

Intimate Partner Violence Victimization, Social Support, and Resilience: Effects on the Anxiety Levels of Young Mothers.

Young mothers face considerable challenges that can affect their mental health, with anxiety being one of the most common mental health problems observed in this population. Furthermore, pregnancy is one of the risk factors for intimate partner violence (IPV). There is thus an urgent need to explore the IPV risk faced by young mothers and its association with their mental health, anxiety in particular. The study aimed to investigate the correlation between IPV victimization and anxiety in young mothers, as well as the protective effects of social support and resilience. A total of 79 young Chinese mothers aged 16 to 25 were recruited from a special service project for young parents in Hong Kong. Just more than half (50.6%) were found to have experienced psychological aggression by their current partner, with 26.6% and 13.9%, respectively, having experienced physical assault and sexual abuse. Roughly a quarter (25.3%) perceived themselves to suffer from moderate or severe generalized anxiety disorder. Logistic regression further showed the young mothers who had experienced physical assault and/or sexual abuse by their current partners to be at least six times likelier to have moderate or severe anxiety disorder (adjusted odds ratio [aOR] = 4.51, p < .05) than those who had experienced no such violence. Young mothers with less perceived social support (aOR = 0.77, p < .01), a lower secondary level of education or below (aOR = 12.99, p < .05), and in receipt of social security assistance (aOR = 5.69, p < .05) were also likelier to have moderate or severe anxiety disorder. The results indicate the importance of social support during the critical period of young motherhood. Health care professionals need to remain alert to the impacts of IPV victimization and the risk of anxiety in young mothers with a low level of education and/or receiving financial support.

Clinical Features of Heterosexual Intimate Partner Violence Victims With Escalating Injury Severity.

Intimate partner violence (IPV) is largely recognized to have a cyclical pattern and violence escalation in terms of frequency and intensity over time. However, there is a lack of systematic investigation of the profiles of victims and quantification of the patterns of injury of the victims associated with the first time versus repeated violence episodes. This study aimed to fill this knowledge gap by medical chart review of 878 victims in a 5-year period from 2010 to 2014 in Accident and Emergency Department (AED) of two public general hospitals in Hong Kong. The differences in injury patterns between the first IPV episode (FE) and recurrent IPV episodes (REs) experienced by male and female victims in heterosexual relationship were evaluated. The results indicated the violence escalation occurred in recurrent IPV in both genders. In female victims, there was significant increase in the number of injury locations (mean [M] = 2.0 vs. 2.2, p < .05), number of causes of injury (M = 1.7 vs. 2.2, p < .001) and police escort (15.2% vs. 22.1%, p < .05) in RE compared to FE. In male victims, however, only the increase in the number of causes of injury was significant (M = 1.6 vs. 2.1, p < .05) in RE compared to FE. In summary, our results highlight the escalation in the severity of harm of IPV victims in heterosexual relationship, and the gender differences in severity aggression and injury and help-seeking behavior change in recurrent IPV. Preventive measures are indicated to intervene the IPV occurrence and recurrence with rising morbidity and a potential of mortality.

Impact of COVID-19 on Child Maltreatment: Income Instability and Parenting Issues.

Introduction: Children are widely recognized as a vulnerable population during disasters and emergencies. The COVID-19 pandemic, like a natural disaster, brought uncertainties and instability to the economic development of the society and social distancing, which might lead to child maltreatment. This study aims to investigate whether job loss, income reduction and parenting affect child maltreatment. Methods: We conducted a cross-sectional online survey of 600 randomly sampled parents aged 18 years or older who had and lived with a child under 10 years old in Hong Kong between 29 May to 16 June 2020. Participants were recruited from a random list of mobile phone numbers of a panel of parents. Of 779 recruited target parents, 600 parents completed the survey successfully via a web-based system after obtaining their online consent for participating in the survey. Results: Income reduction was found significantly associated with severe (OR = 3.29, 95% CI = 1.06, 10.25) and very severe physical assaults (OR = 7.69, 95% CI = 2.24, 26.41) towards children. Job loss or large income reduction were also significantly associated with severe (OR= 3.68, 95% CI = 1.33, 10.19) and very severe physical assaults (OR = 4.05, 95% CI = 1.17, 14.08) towards children. However, income reduction (OR = 0.29, 95% CI = 0.15, 0.53) and job loss (OR = 0.47, 95% CI = 0.28, 0.76) were significantly associated with less psychological aggression. Exposure to intimate partner violence between parents is a very strong and significant factor associated with all types of child maltreatment. Having higher levels of difficulty in discussing COVID-19 with children was significantly associated with more corporal punishment (OR = 1.19, 95% CI = 1.05, 1.34), whereas having higher level of confidence in managing preventive COVID-19 behaviors with children was negatively associated with corporal punishment (OR = 0.87, 95% CI = 0.76, 0.99) and very severe physical assaults (OR = 0.74, 95% CI = 0.58, 0.93). Conclusions: Income instability such as income reduction and job loss amplified the risk of severe and very severe child physical assaults but protected children from psychological aggression. Also, confidence in teaching COVID-19 and managing preventive COVID-19 behaviors with children was significantly negatively associated with corporal punishment during pandemic.

Negative Emotions as Risk Factors for Self-Directed Violence and Intimate Partner Violence in Chinese College Students.

In this study, we examined the unique contributions of negative emotions (i.e., anger, depression, and shame) for two different types of self-directed violence (i.e., nonsuicidal self-injury [NSSI] and suicidality) and three different types of intimate partner violence perpetration (i.e., physical, sexual, and psychological violence) in a college sample. We investigated the moderating role of gender in any link between the negative emotions and the violent behaviors. We also examined an association between self-directed violence and intimate partner violence perpetration. We collected the survey data from a convenience sample of 752 Chinese college students (408 women and 344 men) ranging from 18 to 23 years of age. The questionnaires were filled out during class time. Analyses revealed that anger was associated with increased intimate partner physical, sexual, and psychological violence perpetration but not self-directed violence, underscoring its relevance for engaging in violence directed toward others. Our analyses also showed that, conversely, shame was associated with increased NSSI and suicidality but not intimate partner violence. Depression was associated with increased risk of engaging in self-directed violence as well as intimate partner physical and psychological violence. Moderation analysis showed that gender moderates the relationship of shame with NSSI. Women appear more susceptible to NSSI influenced by shame. Furthermore, the results found self-directed violence and intimate partner physical violence perpetration to be associated. The findings highlight the importance of targeting negative emotions in treatment with high-risk individuals. Integrated violence prevention programs would make it possible to treat co-occurring violence against self and intimate others in a more effective way.

Dating CAFE Ambassador Programme: Chinese College Students to Help Peers in Dating Violence.

Dating violence prevention programs have been understudied in Asia, including China. The current study sought to evaluate the feasibility of the Dating Compassion, Assessment, reFerral, and Education (CAFE) Ambassador Programme in China. This program is designed to enhance the behavioral intentions of Chinese students to help peers who are experiencing dating violence and to compare students' attitudes toward dating violence, students' subjective norms about helping peers, and students' perceived behavioral control in helping peers before and after attending the 7.5 hour program. A quasi-experimental design was used, including two student groups (n = 85) assessed at baseline and 3-month follow-up. Quantitative pre- and postintervention measurements, in conjunction with qualitative focus group interviews, were used to evaluate the program's effectiveness. The findings indicated a significant enhancement in the behavioral intentions of participants in the intervention group to help peers experiencing dating violence, a stronger subjective norm regarding helping others, and an enhanced sense of perceived behavioral control to help, compared with the control group, over time. Focus group data revealed that students who participated in the program developed a more comprehensive definition of dating violence, increased awareness of dating violence in peers, a shift in their focus concerning the role of intention in dating violence and felt more responsible for helping their peers. The findings support the effectiveness of the Dating CAFE Ambassador Programme.

Using the Woman Abuse Screening Tool to Screen for and Assess Dating Violence in College Students.

The study aimed to evaluate the measurement properties of the Woman Abuse Screening Tool (WAST) in Chinese college students. A cross-sectional survey was conducted in Hong Kong. A cutoff score of 10 was found to be able to discriminate between abused and nonabused Chinese young adults. The total score was significantly correlated with total scores for anxiety and depression on the Chinese version of the Hospital Anxiety and Depression Scale. Two-factor structure of the WAST was supported by exploratory and confirmatory factor analyses. The Chinese WAST was found to be valid in screening for and assessing intimate partner violence.