Attachment, Mental Health, and Alcohol Use by Men: The Mediating Role of Cumulative Lifetime Violence Severity.

Cumulative lifetime violence (CLV) encompasses many different types and contexts of violence that occur across the lifespan and is associated with negative mental health outcomes in men; however, little attention has been paid to other factors that can influence these relationships such as attachment style. In this analysis, our focus is to understand how attachment styles directly and indirectly through CLV affect men's mental health, specifically depression, anxiety, posttraumatic stress disorder (PTSD), and alcohol use. Data from 597 Canadian men with lifetime experiences of violence who participated in our national online survey focusing on violence and health were used for mediation analysis. Results indicated that CLV severity mediated the relationship between attachment anxiety (but not attachment avoidance) and depression, anxiety, PTSD, and alcohol use. Although attachment anxiety and attachment avoidance each directly affected depression, anxiety, and PTSD, neither directly affected alcohol use. Importantly, these findings provide the first evidence that the mechanism by which anxious attachment affects alcohol use is through CLV severity. These findings highlight the importance of anxious attachment on mental health outcomes for men who have experienced CLV.

Cumulative lifetime violence, social determinants of health, and cannabis use disorder post-cannabis legalization in a community sample of men: An intersectional perspective.

Despite Canada having the highest disease burden globally for cannabis use disorder (CUD) and violence being ubiquitous in men's lives, little is known about how intersections among social determinants of health (SDOH) and cumulative lifetime violence severity (CLVS) influence CUD in men post-cannabis legalization. Using data collected in a survey with a national community sample of 597 men who self-identified as having experienced violence, we conducted a latent profile analysis using 11 subscales of the CLVS-44 scale and explored differential associations between CLVS profiles and CUD considering SDOH covariates. Four profiles were distinguished by intersections among CLVS-44 subscale severity and roles as target and perpetrator. CLVS profiles were significantly associated with CUD in the unadjusted model and in the adjusted model where age, adverse housing, and education were significant covariate controls. In the adjusted model, CUD was differentially associated with CLVS profiles and significantly higher in Profile 4 (highest severity target and perpetrator) than in Profile 1 (lowest severity target, no perpetration). Chi-square tests showed significant intersection between adverse housing, younger age, Profile 4 CLVS, and moderate to severe CUD among cannabis users. These results reveal the importance of understanding simultaneous intersections among indicators of CLVS in determining profiles of lifetime violence. Also critical are intersections among CLVS profiles and significant covariates as a basis for trauma- and violence-informed care for CUD that prioritizes men most disadvantaged by this convergence and attends to individual and structural health disparities at practice and policy levels.

Cumulative Lifetime Violence, Gender, Social Determinants of Health and Mental Health in Canadian Men: A Latent Class Analysis.

Purpose: Among men, violence is pervasive and associated with poor mental health, but little is known about which men are most vulnerable. Our purpose is to address this gap by exploring mental health and social determinants of health (SDOH) including gender role conflict (GRC) in heterogenous groups of men with distinct patterns of cumulative lifetime violence (CLV) as target and perpetrator. Methods: Latent class analysis was conducted using means of 64 indicators of CLV severity collected from a community sample of 685 eastern Canadian men, ages 19 to 65 years. Class differences by SDOH, and depression, anxiety, and posttraumatic stress disorder (PTSD) were explored with Chi-square and analysis of variance. Results: A 4-class solution was optimal. Class 1 had the lowest CLV severity; were more likely to be better educated, employed, and have little difficulty living on their incomes; and had better mental health than other classes. Class 2, characterized by moderate psychological violence as both target and perpetrator, had mean depression and PTSD scores at clinical levels, and more difficulty living on income than Class 1. Classes 3 and 4 were typified by high severity CLV as target but differentiated by Class 4 having the highest perpetration severity, higher GRC, and being older. In both classes, mean mental health scores were above cut-offs for clinical symptomology and higher than Classes 1 and 2. Conclusion: This is the first evidence that distinct patterns of CLV severity among men intersect with GRC and SDOH and are uniquely associated with mental health.

Longitudinal effectiveness of a woman-led, nurse delivered health promotion intervention for women who have experienced intimate partner violence: iHEAL randomized controlled trial.

BACKGROUND: Intimate partner violence (IPV) threatens the safety, health and quality of life of women worldwide. Comprehensive IPV interventions that are tailored, take a long-term view of women's needs, including health concerns, and maximize choice and control, have the potential to effectively address heath and safety concerns. Few such interventions have been tested, including in the Canadian context. METHODS: A parallel randomized controlled trial of adult (age 19 + years), English-speaking, Canadian women with histories of IPV randomized either to iHEAL, a tailored health promotion intervention delivered by Registered Nurses over 6-7 months, or to community service information (usual care control). Primary (Quality of Life, PTSD symptoms) and secondary outcomes (Depression, Confidence in Managing Daily Life, Chronic Pain, IPV Severity) were measured at baseline and 6, 12 and 18 months post-intervention via an online survey. Generalized estimating equations were used to test for differences by study arm in intention-to-treat (full sample) and per protocol (1 + iHEAL visit) analyses focussing on short-term (immediately post-intervention) and longer-term (1 year post-intervention) effects. Selected process evaluation data were summarized using descriptive statistics. RESULTS: Of 331 women enrolled, 175 were randomized to iHEAL (135 who engaged in 1 + visits) and 156 to control. Women who received iHEAL showed significantly greater short-term improvement in Quality of Life compared to the control group, with these effects maintained 1 year later. Changes in PTSD Symptoms also differed significantly by group, with weaker initial effects that were stronger 1 year post-intervention. Significant moderate, short- and longer-term group effects were also observed for Depression and Confidence in Managing Daily Life. IPV Severity decreased for both groups, with significant immediate effects in favour of the intervention group that grew stronger 1 year post-intervention. There were no changes in Chronic Pain. CONCLUSION: iHEAL is an effective, acceptable and safe intervention for diverse groups of women with histories of IPV. Trial results provide a foundation for implementation and ongoing evaluation in health care settings and systems. Delayed effects noted for PTSD Symptoms and IPV Severity suggest that longer-term assessment of these outcomes may be needed in trials of IPV interventions. TRIAL REGISTRATION: Clinicaltrials.gov ID NCT03573778 (Registered on June 29, 2018).

Cumulative Lifetime Violence, Gender Role Conflict, and Cardiovascular Disease Risk in Eastern Canadian Men.

Despite violence being a chronic stressor that negatively affects health through allostatic overload and potentially harmful coping behaviors, the relationship between cumulative lifetime violence severity (CLVS) and cardiovascular disease (CVD) risk in men has received little attention and the role of gender has not been considered. Using survey and health assessment data from a community sample of 177 of eastern Canadian men with CLVS as target and/or perpetrator, we developed a profile of CVD risk measured by the Framingham 30-year risk score. We tested the hypothesis that CLVS measured by the CLVS-44 scale has direct and specific indirect effects through gender role conflict (GRC) on 30-year CVD risk using parallel multiple mediation analysis. Overall, the full sample had 30-year risk scores 1.5 times higher than their age-based Framingham reference normal risk scores. Men classified as having elevated 30-year CVD risk (n = 77) had risk scores 1.7 times higher than reference normal. Although the direct effects of CLVS on 30-year CVD risk were not significant, indirect effects of CLVS through GRC, specifically Restrictive Affectionate Behavior Between Men, were significant. These novel results reinforce the critical role of chronic toxic stress, particularly from CLVS but also from GRC, in influencing CVD risk. Our findings highlight the need for providers to consider CLVS and GRC as potential antecedents to CVD and to routinely use trauma- and violence-informed approaches in the care of men.

What About the Men? A Critical Review of Men's Experiences of Intimate Partner Violence.

Intimate partner violence (IPV) is a health problem affecting people of all genders and other social locations. While IPV victimization of cis-gendered women has been widely researched, how men conceptualized or experience IPV victimization, and the variations in their experiences of IPV, has not been thoroughly examined. In this critical review of men's experiences of IPV, an extensive search of peer reviewed literature was conducted using multiple database (Cochrane database, MEDLINE, CINAHL, Embase, PsycgINFO, and Google Scholar) as well as the gray literature. We critically reviewed examining the conceptual foundations of IPV victimization among men. The influence or gender roles and societal expectation on men's experiences and perceptions of IPV victimization and their help-seeking behavior are explored. Current knowledge about types, tactics, and patterns of IPV against men and the health and social consequences of IPV are addresses. Additionally, the conceptual and empirical limitations of current research are discussed, including the tendency to compare only the prevalence rates of discrete incidents of abuse among women versus men; the use of IPV measures not designed to capture men's conceptualizations of IPV; and the lack of attention given to sex and gender identity of both the victim and perpetrator. Future research priorities that address these limitations and seek to strengthen and deepen knowledge about IPV among men are identified.

Cumulative lifetime violence severity, social determinants and anxiety in a national sample of Canadian men.

BACKGROUND: Despite anxiety disorders being the ninth leading cause of disability and associated with social inequities, little attention has been given to how intersections among social determinants of health and chronic stressors such as cumulative lifetime violence affect the likelihood of experiencing anxiety disorders. Our purpose was to explore the relationships among cumulative lifetime violence severity as target and perpetrator, social determinants of health and generalized anxiety disorder in Canadian men. METHODS: Using a community sample of 592 Canadian men who self-identified as having experienced violence, we developed and tested an evidence-based model of generalized anxiety disorder including indicators of cumulative lifetime violence, gender, social location, socio-economic disparity, personal resources and other chronic stressors using logistic regression. RESULTS: Most men (76.4%, n = 452) reported experiences as both target and perpetrator. The model accounted for 50.8% of the variance in anxiety severity χ2 (8) = 264.43, p = .000). The prevalence of probable generalized anxiety disorder was 30.9%, a rate higher than that found among Canadian men in general in the same period. Remarkably, the likelihood of generalized anxiety disorder increased by a factor of 5.30 for each increase of 1 in cumulative lifetime violence severity, and six-fold for feeling overwhelmed by demands of everyday life (aOR = 6.26). Masculine discrepancy stress, having been born in Canada, unemployment, and food insecurity also contributed significantly to increasing the likelihood of generalized anxiety disorder. Both social support and mastery had significant aORs < 1, suggesting possible protective effects. Together these findings delineate characteristics and social determinants that may heighten vulnerability to generalized anxiety disorder and influence its progression among men who have experienced lifetime violence. CONCLUSIONS: These findings are the first evidence that Canadian men with lifetime violence histories are a sub-group disproportionately affected by chronic stressors and socio-economic disparities and that together the presence and/or severity of these factors increases their vulnerability to generalized anxiety disorder. Our results highlight the importance of strengths-based trauma- and violence-informed approaches to care, including practical resources to reduce the stress of everyday life, improve social support, and reinforce personal control and choice.

Cumulative Lifetime Violence Severity and Chronic Pain in a Community Sample of Canadian Men.

OBJECTIVE: To create a descriptive profile of chronic pain severity in men with lifetime cumulative violence histories, as a target and/or a perpetrator, and investigate how chronic pain severity is associated with and predicted by lifetime cumulative violence severity and known determinants of chronic pain. METHODS: Analysis of variance and binary logistic regression were performed on data collected in an online survey with a community convenience sample of 653 men who reported experiences of lifetime violence. RESULTS: The prevalence of high-intensity / high-disability pain in men with lifetime violence was 35.8%. Total Cumulative Lifetime Violence Severity-44 (CLVS-44) scores were significantly associated with high-intensity / high-disability chronic pain measured by the Chronic Pain Grade Scale (odds ratio= 8.40). In a model with 10 CLVS-44 subscale scores, only psychological workplace violence as a target (adjusted odds ratio [aOR]= 1.44) and lifetime family physical violence as a target (aOR= 1.42) significantly predicted chronic pain severity. In a multivariate model, chronic pain severity was predicted by CLVS-44 total score (aOR= 2.69), age (aOR= 1.02), injury with temporary impairment (aOR= 1.99), number of chronic conditions (aOR= 1.37), and depressive symptoms (aOR= 1.03). CONCLUSION: The association between lifetime cumulative violence severity and chronic pain severity in men is important new information suggesting the need for trauma- and violence-informed approaches to assessment and intervention with men. This is the first analysis using CLVS-44 subscales to understand which configurations of lifetime cumulative violence may be most predictive of chronic pain severity; further investigation is needed to confirm these findings.

Cumulative lifetime violence severity scale: development and initial testing among men.

BACKGROUND: Knowledge of the relationship between men's health and violence is flawed by narrow and faulty conceptualization and measurement of violence that often results in attribution of health problems to one form or type of violence without consideration of other exposures. Our purpose is to describe the development and initial testing of the Cumulative Lifetime Violence Severity scale designed for use in health research to measure men's perceptions of the severity of their cumulative lifetime violence. METHODS: We framed the dimensions of violence severity as: type (physical, psychological, sexual), timing (childhood, adulthood), focus (perpetrator, target), context, frequency, and degree of distress. Items reflecting these dimensions were vetted by local experts including individuals who identified as men, with particular attention to meaningful language for men. The measure was pretested, revised to 64 items, and tested for test-retest reliability prior to use in a study of 685 English-speaking Eastern Canadian men, ages 19 to 65 years. We used Principal Components Analysis to illuminate the underlying dimensionality of the items. RESULTS: Principal Components Analysis yielded a 44-item 11 component solution that accounted for 64.06% of variance with good model fit and a Cronbach's alpha of .92. All dimensions of our conceptualization of violence severity were reflected in the components, except Adult Target Sexual Violence. Convergent validity between the Cumulative Lifetime Violence Severity-44 Scale and a global lifetime violence rating scale was r = .750 (p < .001) and concurrent validity was moderate and significant between the Cumulative Lifetime Violence Severity-44 scale and measures of mental health problems commonly experienced by people with violence histories. CONCLUSIONS: The Cumulative Lifetime Violence Severity-44 scale shows promise as the first comprehensive measure of cumulative lifetime violence for health research that considers gender, individual distress and experiences as both perpetrator and target. Next steps include further exploratory analysis with a more diverse sample of men and confirmatory factor analysis.

Patterns and correlates of cannabis use by cumulative lifetime violence severity as target and/or perpetrator in a community sample of eastern Canadian men.

BACKGROUND: Recent Canadian legalization of cannabis for non-medical use underscores the need to understand patterns and correlates of cannabis use among men who may be more likely than women to become problematic cannabis users. Evidence supporting an association between substance use and violence is accumulating. Current knowledge of relationships among patterns of cannabis use, violence, gender and health is limited by dichotomous measurement of cannabis use and a focus on individual types of violence rather than lifetime cumulative violence. METHODS: We collected online survey data between April 2016 and Septermber 2017 from a community convenience sample of 589 Eastern Canadian men ages 19 to 65 years and explored how socio-demographic characteristics, gender, and health varied by past-year patterns of cannabis use (i.e., daily, sometimes, never) in the total sample and by higher and lower cumulative lifetime violence severity (CLVS) measured by a 64-item CLVS scale score (1 to 4). RESULTS: Overall prevalence of cannabis use was 46.6% and differed significantly between lower (38.1%) and higher (55.3%) CLVS groups (χ2 (1) = 17.42, p = .000). Daily cannabis use was more likely in the higher (25.1%) than the lower group (11.9%, χ2 (2) = 31.53, p < .001). In the total sample, daily use was significantly associated with being single, less education, lower income, some gender norms, health problems, and use of other substances. Significant associations were found for sometimes cannabis use with age group 19 to 24 years, being single, some gender norms, and hazardous and binge drinking. Never use was associated with being married, more education, higher income, being older, not using other substances, and not having mental health problems. Associations between cannabis use patterns and many variables were found in both CLVS groups but effect sizes were frequently larger in the higher group. CONCLUSIONS: These results add substantively to knowledge of relationships among lifetime cumulative violence, patterns of cannabis use, gender, socio-demographic indicators and health problems and may inform theoretical models for future testing. Additionally, findings provide critical information for the design of health promotion strategies targeted towards those most at risk in the current climate of cannabis legalization.

Gender and Workplace Bullying: Men's Experiences of Surviving Bullying at Work.

Although men are targets of workplace bullying, there is limited research focused on their experiences. To address this gap, we used a qualitative grounded theory approach and interviewed a community sample of 20 Atlantic Canadian men to explore and explain their experiences of, and responses to, bullying. The main problem identified by men was a lack of workplace support to address and resolve the bullying, a challenge named abandonment. Men addressed this problem by surviving, a process that involved efforts to manage persistent bullying and the associated consequences. Men experienced physical, emotional, and social health consequences and, contrary to prevailing assumptions related to men's help-seeking behaviors, men want support and many sought help to address the problem and its consequences. Responses to abandonment and the associated consequences varied according to a number of factors including gender and highlight the need for research aimed at understanding the gendered nature of bullying.

A theoretical understanding of sickness absence among women who have experienced workplace bullying.

Historically, we have assumed that workplaces, where employed individuals spend approximately one third of their days, provide safe and supportive environments and opportunities to enhance women's capacities. Unfortunately, workplace bullying and consequent sickness absence are prevalent and costly realities that significantly influence women's health. In this study, sickness absence among 18 Canadian women who were targets of workplace bullying was explored using a grounded theory secondary analysis. Findings show that although sickness absence is critical in attenuating the health consequences of being bullied, it is a partial solution because rehabilitation and successful return to work is challenged when working conditions remain unchanged. This problem is addressed using is a three-stage process of discerning a path that involves gaining space, making sense, and moving forward. Organizational support is critical to all stages of the process; it can reduce the risk of declines in health and sickness absence, and is essential for successful return to work.