Prevalence of children witnessed violence in a pediatric emergency department.

Witnessed violence is a form of child abuse with detrimental effects on child wellbeing and development, whose recognition relies on the assessment of their mother exposure to intimate partner violence (IPV). The aim of this study was to assess the frequency of witnessed violence in a population of children attending a pediatric emergency department (ED) in Italy, by searching for IPV in their mother, and to define the characteristics of the mother-child dyads. An observational cross-sectional study was conducted from February 2020 to January 2021. Participating mothers were provided a questionnaire, which included the Woman Abuse Screening Tool (WAST) and additional questions about their baseline data and health. Descriptive analysis was reported as frequency and percentage for the categorical variables and median and interquartile range (IQR) for quantitative variables. Mothers and children screened positive and negative for IPV and witnessed violence, respectively, were compared by the chi-square test or the exact Fisher test for categorical variables, and by the Wilcoxon-Mann-Whitney test for continuous variables. Out of 212 participating mothers, ninety-three (43.9%) displayed a positive WAST. Mothers tested positive were mainly Italian (71%, p 0.003), had a lower level of education (median age at school dropout 19, p 0.0002), and a higher frequency of unemployment (p 0.001) and poor personal health status (8.6%, p 0.001). The children of mothers tested positive showed a higher occurrence of abnormal psychological-emotional state (38.7%, p 0.002) and sleep disturbances (26.9%, p 0.04). CONCLUSION: IPV was common in a population of mothers seeking care for their children in a pediatric ED. WHAT IS KNOWN: • Witnessed violence is a form of child abuse, usually inferred by their mothers' exposure to IPV. The latter is suffered by one in three women worldwide. WHAT IS NEW: • This study shows a 43.9% prevalence of IPV among mothers attending an Italian pediatric ED. • Positive mother-child dyads displayed a higher frequency of poor mothers' health status and children's abnormal emotional state and sleep disturbances.

Psychological symptoms and intensity of partner violence: A study of women attending an anti-violence center in Italy.

Intimate partner violence (IPV) can seriously affect the health of victims. Our aims were to analyze the impact of IPV intensity on psychological symptoms in a sample of 151 victimized women (21-74 years old). We collected data through anonymous-auto-administrated questionnaires from a sample of women attending five Anti-violence centers in Italy, and assessed exposure to psychological, physical, sexual, verbal, and stalking partner violence in the last year. We used multiple logistic regression analysis to examine the probability of reporting psychological symptoms associated with IPV. After controlling for the potential confounders, the increase in the intensity of violence was associated with an increase in reported nightmares, panic attacks, and auditory hallucinations, with a dose-response effect. We think that understanding the impact of IPV on women's mental health is necessary to improve their psychological well-being, support their path to liberation, and prevent chronic and more serious suffering.

Mental distress and sexual harassment in Italian university students.

Only a few studies have analyzed the association between sexual harassment (SH) and mental health controlling for other types of violence. The aim of this study was to describe SH among male and female university students and analyze the association between harassment and mental distress controlling for sexual violence. An observational survey was conducted at Trieste University (Italy). Students answered an anonymous questionnaire about harassment that included three domains-sexual harassment, gender harassment, cyber harassment-and three psychological health indicators. The global harassment index was computed, with three levels: 0, no harassment; level 1, harassment in at least one of the three domains; and level 2, harassment in two or three domains. The symptoms of mental distress were measured by the 12-item General Health Questionnaire (GHQ) for depressive symptoms; a question about panic symptoms; and a question about general health. The sample included 759 students (412 women; 18 to 29 years old). After adjustment for age, birth country, couple relationship, employment status, mother's education, and previous sexual violence, the risk of mental distress was increased with harassment exposure. Men were affected in perceived health and depressive symptoms (GHQ score ≥ 6); women were affected in panic symptoms. Harassment has a strong negative impact on the mental health of victims; in some cases, men may be more affected than women. Clinicians should be aware of the negative impact of SH also on men.

Factors Associated With Exposure to Violent or Degrading Pornography Among High School Students.

The purpose of this study was to analyze pornography exposure in a sample of 702 Italian adolescents (46% males; mean age = 18.2, SD = 0.8). Among male students, 11% were not exposed, 44.5% were exposed to nonviolent material, and 44.5% were exposed to violent/degrading material. Among female students, 60.8% were not exposed, 20.4% were exposed to nonviolent material, and 18.8% were exposed to violent/degrading material. Among males, adjusted odds ratio (AdjOR) of exposure to violent/degrading pornography were higher if using alcohol, having friends who sell/buy sex, and taking sexual pictures. Females who were victims of family violence, attending technical/vocational schools, and taking sexual pictures had higher AdjOR of watching violent pornography; smoking and having friends who sell/buy sex were associated with both nonviolent and violent/degrading exposure. Exposure to violent/degrading pornography is common among adolescents, associated with at-risk behaviors, and, for females, it correlates with a history of victimization. School nurses have a pivotal role in including discussions about pornography in interventions about relationships, sexuality, or violence.

Longitudinal study of depression and health status in pregnant women: incidence, course and predictive factors.

The aim of this study was to determine the effect of isolated psychological intimate partner violence and psychosocial factors (social support and alcohol or drug use by a partner/family member) on psychological well-being (depression or poor self-perceived health status) at 5 and 12 months post-partum. A longitudinal cohort study was carried out with a consecutive sample of 1,400 women in their first trimester of pregnancy, who attended the prenatal programme in the Valencia Region (Spain) in 2008 and were followed up at 5 months and 12 months post-partum. A logistic regression model was fitted using generalized estimating equations, to assess the effect of isolated psychological intimate partner violence, social support, alcohol consumption and illicit drug use problems by a partner or family member on subsequent psychological well-being at follow-up. We observed a decrease in the incidence of poorer psychological well-being (post-partum depression and poor self-perceived health status) at 12 months post-partum. The strongest predictor of poor psychological well-being was depression (AOR = 6.83, 95 % CI: 3.44-13.58) or poor self-perceived health status (AOR = 5.34, 95 % CI: 2.37-12.02) during pregnancy. Isolated psychological IPV increased the risk of a deterioration in psychological well-being. Having a tangible social network was also a predictor of both post-partum depression and poor self-perceived health status. The effect of functional social support varied according to the type of psychological well-being indicator being used. Problems of alcohol consumption or illicit drug use by a partner or family member were a predictor of post-partum depression only. Psychological well-being during the first year after birth is highly affected by isolated psychological IPV and psychosocial factors.

Social context and drivers of intimate partner violence in rural Kenya: implications for the health of pregnant women.

More than half of rural Kenyan women experience intimate partner violence (IPV) in their lifetime. Beyond physical consequences, IPV indirectly worsens maternal health because pregnant women avoid antenatal care or HIV testing when they fear violent reprisal from partners. To develop an intervention to mitigate violence towards pregnant women, we conducted qualitative research in rural Kenya. Through eight focus group discussions, four with pregnant women and four with male partners, and in-depth interviews with service providers, we explored the social context of IPV using an ecological model. We found that women experienced physical and sexual IPV, but also economic violence such as forced exile from the marital home or losing material support. Relationship triggers of IPV included perceived sexual infidelity or transgressing gender norms. Women described hiding antenatal HIV testing from partners, as testing was perceived as a sign of infidelity. Extended families were sometimes supportive, but often encouraged silence to protect the family image. The broader community viewed IPV as an intractable, common issue, which seemed to normalise its use. These results resonate with global IPV research showing that factors beyond the individual - gender roles in intimate partnerships, family dynamics and community norms - shape high rates of violence.

Maternal health-related quality of life at 1 year after a preterm birth: role of socioeconomic status at birth.

BACKGROUND: Maternal problems in the postpartum period may lead to suboptimal long-term health for women and could affect mother-child attachment. Social disadvantage is a risk factor for preterm birth, which carries its own burden of health issues and stress. The main aim of this study was to investigate the role for social factors in mothers' physical and emotional health-related quality of life (HRQoL) at 1 year after a preterm birth. METHODS: EPIPAGE-2 is a French nationwide, prospective, population-based cohort of preterm children born before 35 weeks' gestation (N=3614 women). At birth, detailed data on the family's social status were collected. At 1 year after birth, mothers completed a mailed questionnaire to report information on their HRQoL, assessed by the Medical Outcomes Study 12-item Short Form. We used multivariate linear regression models to assess the association between social factors and maternal HRQoL. RESULTS: At 1 year after childbirth, the emotional HRQoL of mothers of preterm children was worse than their physical HRQoL, even in women without any previous signs of psychological distress at the infant's discharge from hospital. Baseline social characteristics were the most important factors influencing the physical component of HRQoL. None of the studied social factors had any clear association with the mental component of HRQoL. CONCLUSION: Our study underlines the importance of social disadvantage during pregnancy as risk factors for poor physical HRQoL at 1 year after a preterm birth.

Are there differences in the impact of partner violence on reproductive health between postpartum women and women who had an elective abortion?

The aim of this study was to determine if the effects of intimate partner violence (IPV) in the previous 12 months (current IPV) on newborn's health, pregnancy outcomes and couple's reproductive behaviours were different for postpartum (PP) women as compared to women who had undergone an elective abortion (EA) in Trieste (Italy). This study is part of an unmatched case-control study. The major findings are that current IPV was positively associated with previous stillbirth among both groups of women, but the association was only marginally significant. Among EA women only, current IPV was significantly associated with previous miscarriages (adjusted odds ratio, 2.41; 95 %CI, 1.13-5.14). In both groups of women, current IPV was associated with a lack of joint couple decision making about contraception; however, the magnitude of this effect was higher among PP women. This study reveals that IPV was associated with poor obstetrical history among both groups of women. But the associations of current IPV with previous EA and couple reproductive behaviours were stronger among PP women.

Intimate Partner Violence Against Women During the COVID-19 Lockdown in Italy: A Multicenter Survey Involving Anti-Violence Centers.

This study explores intimate partner violence (IPV) evolution during the lockdown with a sample of 238 women (44% cohabitating and 56% not cohabitating with the perpetrator), attending five antiviolence centers in Italy (June-September 2020). Questions included 12 items on IPV and, for each item, a question about whether violence increased/stayed the same/decreased during lockdown; an indicator of IPV modifications was constructed. Two distinct patterns, confirmed after adjustment for socio-demographic factors, emerged: IPV increased for 28% of cohabitating and decreased for 56% of non-cohabitating women. Such results suggest the efficacy of physical distancing-strictly controlled by the State-in the prevention of IPV.

Violence and women's psychological distress after birth: an exploratory study in Italy.

Our aim in conducting this study was to analyze the relationships between violence and maternal psychological distress 8 months after a birth, taking into account other important psychosocial factors, known to be associated both with violence and with new mothers' mental health. A total of 352 women responded to a questionnaire after the birth at a maternity hospital in northern Italy, and 292 also participated in a telephone interview 8 months later. We evaluated psychological distress with the General Health Questionnaire (GHQ), and partner and family violence with a 28-item scale. Eight months postpartum, 5% of women showed high psychological distress; 10% were currently experiencing violence from the partner or another family member. After adjustment for covariates, the odds ratio for depressive symptoms was 13.74 for women experiencing violence. We believe that these results provide support for the important role of violence in postpartum maternal psychological distress.

Freeing Oneself From Intimate Partner Violence: A Follow-Up of Women Who Contacted an Anti-violence Center in Italy.

This study examines the situation of women ( N = 124) who had presented themselves to an anti-violence center in Italy in the previous 3-5 years. At follow-up, 37.3% had no contact with the perpetrator, 22.7% had stayed with him, and 39.8% had "forced" contact. Almost half of the sample was still subjected to intimate partner violence (IPV). Compared to women with "no contact," the risk of IPV was 5.9 times higher for women who stayed with the perpetrator, and 10.5 times higher for women with "forced" contact. These results confirm that ending IPV does not depend exclusively on women's choices.

Disordered Eating Behaviors and Sexual Harassment in Italian Male and Female University Students.

The aim of this study is to describe sexual harassment among Italian university students and analyze the relationship between harassment and disordered eating behaviors. An observational survey was conducted among university students at Trieste University (Italy) in spring 2014. Students answered an anonymous self-administered questionnaire about sexual harassment, including three domains-sexual harassment, unwanted comments on physical appearance, cyber-harassment-and disordered eating behaviors. The global sexual harassment index was computed with three levels: Level 0, no harassment; Level 1, harassment in at least one of the three domains; and Level 2, harassment in two or three domains. Disordered eating behaviors were classified by at least one of the following: (a) eating without being able to stop or vomiting at least once or twice a month, (b) using laxatives or diuretics at least once or twice a week, (c) monitoring weight every day, and (d) dieting at least very often. The sample included 759 students (347 men and 412 women; 18-29 years old). Experiencing sexual harassment was related to eating disorder symptoms for both genders with a regular gradient: the higher the harassment score, the more frequent the disordered eating behavior symptoms, even after adjusting for age and previous sexual violence. The association was stronger for males than females. Sexual harassment and disordered eating behaviors have long been considered mainly a female problem. Men are not exempt from these problems and in some cases may be more affected than women. The topics should be assessed in men and women.

Does violence affect one gender more than the other? The mental health impact of violence among male and female university students.

The impact of violence on health has been studied mostly among women. While the studies including men show that violence is detrimental for them also, knowledge concerning gender differences is scarce. This study explores whether violence has a different impact on males and females in a sample of 502 Italian university students, responding to a self-administered questionnaire. We considered violence by family members, witnessed family violence, peers/school violence, intimate partner violence, and sexual violence. Mental health outcomes included: depression, panic attacks, heavy alcohol use, eating problems, suicidal ideation and attempts, and self-evaluation of health. Both males and females reported similar rates of experienced and witnessed family violence as well as of intimate partner violence, to which women reacted more negatively than men. Peers/school violence was more common among men. Sexual violence was more common and more severe among females. Among mental health effects, panic attacks were more common among females, and alcohol problems among males. We considered the cumulative impact of violence, calculating the odds ratios (ORs) for reporting each health outcome after having experienced zero, one, two, three or four/five types of violence. For both men and women, the more violence, the higher the risk of health problems; however, the real jump in the risk of mental suffering occurred between three and four /five types of violence, the latter category more often female. Moreover, we obtained ORs for the relationships between health outcome and each type of violence, after adjustment for the other types of violence. For experienced and witnessed family violence, the health impact was similar for males and females; for intimate partner violence, sexual violence, and peer/school violence it was larger for females. In the literature, women report more violence-related health problems than men. Results of the present study imply that the excess health problems among women may result from more intense or more frequent experiences of violence.

Women's psychological health according to their maternal status: a study in France.

This study explored the extent to which the psychological distress of women is related to their motherhood status. A representative sample of 6970 women, aged 20-59, living in France, was interviewed. This analysis was restricted to the 2799 women aged between 25 and 39, 307 of whom had had a baby in the last year. Several indicators of psychological distress were used, including the 12-item General Health Questionnaire, psychotropic drug use and suicide attempts. Women with babies under the age of 12 months presented no more psychological problems than the other women. The proportion of respondents with scores above 5 for the GHQ was 8.7% for mothers with young babies, 11.4% for mothers of an older child and 12.0% for childless women. Adjusting for age, education, employment and couple status, no differences were observed between the three groups of women, except for a lower level of psychotropic drug use among the mothers of young babies. Overall, regardless of maternal status, a high proportion of women showed symptoms of anxiety and depression. Thus, research and clinical efforts should focus on risk factors for psychological distress in women and on preventive measures beyond the post-partum period.

Intimate partner violence and forced migration during pregnancy: Structural constraints to women's agency.

Little is known about migration during pregnancy related to intimate partner violence (IPV). In this paper, we examine issues of agency in relation to pregnant women's migrations in a high HIV prevalence area of Kenya. We qualitatively explored forced migration among pregnant women, using data from in-depth interviews, focus groups and IPV screening forms. To quantitatively examine migration during pregnancy, we analysed data from a prospective study of 614 pregnant women. The qualitative data revealed that women had varied responses to violence in pregnancy, with some being able to leave the marital home voluntarily as a strategy to escape violence. Others were 'sent packing' from their marital homes when they dared to exercise autonomy, in some cases related to HIV status. Quantitative analyses revealed that pregnant women who migrated were more educated, less likely to be living with a partner and had fewer children than other women. Migration among pregnant women in Kenya illustrates the complexity of understanding women's agency in the context of IPV. The findings indicate that there is not a dichotomy between 'victim' and 'agent', but rather a complex dynamic between and within pregnant women, who may sequentially or simultaneously experience aspects of victimhood and/or agentic response.

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.

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.

Adolescents who experienced sexual abuse: fears, needs and impediments to disclosure.

OBJECTIVE: Understanding the impediments that prevented sexually abused adolescents from disclosure to their family or to professionals, and analyzing the responses they received when they did disclose. METHODS: In depth anonymous interviews were conducted in Italy through a toll-free telephone line with 36 young people who experienced sexual abuse in adolescence. A qualitative analysis was carried out of the adolescents' feelings, fears and needs, and of the help received, if any. RESULTS: The main impediments to disclose to a family member were fear of not being believed, shame, and fear of causing trouble to the family. The main impediments for not seeking services were ignorance of the existence/functioning of protective agencies, wish to keep the secret, lack of awareness of being abused, mistrust of adults and professionals, and fear of the consequences of disclosure. When they did disclose to professionals, the teens received very limited support. CONCLUSION: Adolescents need to receive proper information about the risk of being sexually abused and about the help they can receive from their social network and protective agencies. There is a crucial need for appropriate training of professionals.

Adult outcomes in women who experienced parental violence during childhood.

OBJECTIVE: The aims of this work are to analyze the associations between violence suffered at the hands of fathers and mothers in childhood and adolescence and three outcomes in adulthood--having or not having children, marital status, and occupational status--controlling for the possible impact of partner violence. METHOD: This cross-sectional study examined a sample of 510 women, attending various health care and social services facilities in a Northern Italian city. Both quantitative and qualitative data were collected. RESULTS: Almost one quarter of the respondents reported some kind of abuse by one or both parents, and 18.2% had experienced physical and/or sexual violence by a partner or ex-partner; women abused by parents were more likely to experience partner violence. Irrespective of whether they experienced partner violence, women abused by parents were more likely to be childless, divorced or never married, and in a precarious occupational situation. CONCLUSIONS: This study is the first one carried out in Italy on this subject: results largely confirmed the trends found in studies in other countries. However, two of the associations which emerged, namely between parents' abuse and being divorced or never married and between parents' abuse and being childless, are worth noting, since they could be interpreted as failures or, on the contrary, as active and positive choices made by abused women in a difficult context. Qualitative data from case histories provided insights into the violence some women have suffered and its consequences, but also into women's great resilience and strengths.

Responses to and resources for intimate partner violence: qualitative findings from women, men, and service providers in rural Kenya.

Intimate partner violence (IPV) is reported by one in three women globally, but the prevalence is much higher in East Africa. Though some formal and informal resources do exist for women experiencing IPV, data suggest that disclosure, help seeking, and subsequent utilization of these resources are often hindered by sociocultural, economic, and institutional factors. This article explores actions taken by victims, available support services, and barriers to the utilization of available IPV resources by pregnant women in rural Nyanza, Kenya. Qualitative data were collected through nine focus group discussions and 20 in-depth interviews with pregnant women, partners or male relatives of pregnant women, and service providers. Data were managed in NVivo 8 using a descriptive analytical approach that harnessed thematic content coding and in-depth grounded analysis. We found that while formal resources for IPV were scarce, women utilized many informal resources (family, pastors, local leaders) as well as the health facility. In rare occasions, women escalated their response to formal services (police, judiciary). The community was sometimes responsive to women experiencing IPV but often viewed it as a "normal" part of local culture. Further barriers to women accessing services included logistical challenges and providers who were undertrained or uncommitted to responding to IPV appropriately. Moreover, the very sanctions meant to address violence (such as fines or jail) were often inhibiting for women who depended on their partners for financial resources. The results suggest that future IPV interventions should address community views around IPV and build upon locally available resources-including the health clinic-to address violence among women of childbearing age.