An Evidence-Based Assessment Tool for Estimating Future Post-Traumatic Stress Disorder: A 7-Year Follow-Up Study.

Background: Intimate partner violence (IPV) affects up to one in three women across the world. Post-traumatic stress disorder (PTSD) is a common outcome. Many, but not all, women suffer long after they first sought help for IPV. Validated tools for estimating the likelihood of future PTSD are lacking. Materials and Methods: Women who sought IPV support services for the first time in 2011-2012 (N = 300) completed a seven-item screen for the presence or absence of clinically significant PTSD symptoms and the first assessment screening tool for post-traumatic stress disorder (FAST-PTSD), a tool designed to estimate future PTSD among women seeking help for IPV. Seven years later, in 2018, 271 (90%) women again completed the seven-item screen for clinically significant PTSD symptoms. A two-step binary logistic regression was conducted to determine the 7-year validity of the FAST for clinically significant symptoms of PTSD while controlling for baseline PTSD symptoms. Results: More than 25% of the women reported clinically significant PTSD at 7 years. Baseline moderate- and high-risk scores on the FAST-PTSD were associated with clinically significant levels of PTSD. Moderate risk was associated with nearly two and one-half times (odds ratio [OR] = 2.4) the risk of clinically significant symptoms of PTSD, and high risk with nearly eight times (OR = 7.8) the risk of PTSD at 7 years. Conclusions: PTSD is commonly associated with IPV and if untreated can compromise functioning of women and their children. The FAST-PTSD is a valid indicator of significant clinical PTSD symptoms 7 years following first contact with IPV support services. Using the FAST-PTSD to triage women at risk for sustained PTSD to early, preventive intervention may improve outcomes for women and their children.

Developing and Testing of an Economic Index Tool for Abused Women With Children.

Violence and poverty combine to severely compromise the safety, health, and functioning of women with major pass-through effects to their children. To reduce poverty and mitigate violence, measures are needed to assess economic status before and after intervention programs. The purpose of the study was to develop a new tool to assess women's various sources of income, to measure the degree to which the components of the tool are independent, and assess the usefulness of the tool to assess the connection of economic status and mental health functioning among abused women. RESULTS: Using content and face validity techniques and exploratory factor analysis, the 5-item Economic Index Tool was derived that assesses formal and informal employment wages, family and government cash assistance, and child support. Concurrent and predictive validity models for both the raw and weighted scores were significant, χ² (1) = 65.02, p <.001, Nalgelkerke R² =.285 and χ² (1) = 108.44, p <.001, Nalgelkerke R² =.443, respectively. Both the raw and weighted scores were associated with increased odds of being above poverty, Odds Ratios were 1.242 and 1.306, respectively, and all p values were < 0.001. The Economic Index Tool revealed a positive connection of higher economic status and better mental health. The Economic Index Tool offers a rapid assessment of abused women's economic status that can be used to guide multifaceted intervention programs and measure program effectiveness.

Child Brides, Forced Marriage, and Partner Violence in America: Tip of an Iceberg Revealed.

Forced marriage is a violation of human rights and thwarts personal safety and well-being. Child brides are at higher risk of intimate partner violence (IPV) and often are unable to effectively negotiate safe sex, leaving them vulnerable to sexually transmitted infections, including human immunodeficiency virus, and early pregnancy. The prevalence of forced marriage and child marriage in the United States is unknown. The intersection of forced marriage and child marriage and IPV is equally unknown. When 277 mothers who reported IPV to shelter or justice services were asked about a forced marriage attempt, frequency and severity of IPV, mental health status, and behavioral functioning of their child, 47 (17%) reported a forced marriage attempt with 45% of the women younger than 18 years of age at the time of the attempt. Among the 47 women, 11 (23%) reported death threats, 20 (43%) reported marriage to the person, and 28 (60%) reported a pregnancy. Women younger than 18 years reported more threats of isolation and economic deprivation associated with the attempt as well as pressure from parents to marry. Regardless of age, women experiencing a forced marriage attempt reported more intimate partner sexual abuse, somatization, and behavior problems for their children. Forced marriage attempts occurred to one in six women (17%) reporting IPV and are associated with worse functioning for mother and child. The frequent occurrence and associated effect of forced marriage attempts to maternal child functioning indicates routine assessment for a forced marriage attempt as part of comprehensive care for women reporting IPV.

Predicting Abused Women With Children Who Return to a Shelter: Development and Use of a Rapid Assessment Triage Tool.

To develop a tool to predict risk for return to a shelter, 150 women with children, exiting a domestic violence shelter, were evaluated every 4 months for 24 months to determine risk factors for returning to a shelter. The study identified four risk factors, including danger for murder, woman's age (i.e., older women), tangible support (i.e., access to money, transportation), and child witness to verbal abuse of the mother. An easy to use, quick triage tool with a weighted score was derived, which can identify with 90% accuracy abused women with children most likely to return to shelters.

A Risk Assessment Tool to Predict Sustained PTSD Symptoms Among Women Reporting Abuse.

BACKGROUND: Nationally and worldwide, 30% or more of women are likely to have experienced intimate partner violence. Maternal mental health symptoms predict child function. When mothers have sustained posttraumatic stress disorder (PTSD), their children at are risk for growth and developmental delays and poor behavioral outcomes that may adversely affect the course of their lives. While many who experience trauma will recover without intervention, a significant proportion will experience PTSD, with negative consequences for their personal lives and the lives of their families. Early identification of those at high risk for PTSD symptoms will support early interventions to prevent PTSD and its negative consequences. METHODS: This paper describes the development of a tool that can predict PTSD symptoms at 8 months in mothers who are primarily of low socioeconomic status and primarily members of underrepresented groups. The tool consists of four key measures. CONCLUSIONS: Using this tool to identify mothers at high risk for sustained PTSD and entering them into early intervention programs may protect mothers and their children from negative outcomes and promote their health and wellbeing.

Community resource use among abused immigrant women: baseline data analysis for a 7-year prospective study.

PURPOSE: To determine the community resources most often used, most needed, and most difficult to use for immigrants. DESIGN: A naturalistic study using principles of community-based participatory research. METHOD: A group of 106 abused immigrant women were interviewed in person with the Community Agency Use, Frequency, Helpfulness, and Difficulty form as part of a 7-year prospective study. RESULTS: The most frequently noted service needed most was counseling (n = 34, 33.0%) followed by legal services (n = 23, 22.3%) and social services (n = 13, 12.6%). Law enforcement was the most commonly used service (n = 63, 59.4%) and the most difficult to receive (n = 16, 48.5%). Counseling (n = 6, 18.2%) and legal services (n = 5, 15.2%) were also reported as difficult. DISCUSSION: Law enforcement is often called on to help in partner violence, but immigrant women report difficulty in using this service. CONCLUSIONS: Abused immigrant women have risk factors for abuse, and they face barriers in accessing the services they need. IMPLICATIONS FOR PRACTICE: It is important for service providers in the community to be aware of the unique challenges of abused immigrant women and to address their needs accordingly.

Rapid assessment to identify and quantify the risk of intimate partner violence during pregnancy.

BACKGROUND: Abuse during pregnancy is common and affects upwards of one in six pregnant women worldwide. The objective of this study is to describe the demographics, frequency, and severity of abuse, and the risk of murder for women who report abuse during pregnancy compared with women who do not report abuse. METHODS: A total of 300 women seeking assistance for partner abuse were recruited to participate in a 7-year prospective study. Of the 300 women, 50 reported they had been pregnant within the last 4 months; 25 of the women (50%) reported they were "beaten" during the pregnancy; and 25 women (50%) reported they had not been "beaten." Analysis was completed on differential severity for abuse and risk for murder between the two groups. RESULTS: Women reporting abuse during pregnancy had statistically significant (p < 0.001) higher scores for Threat of abuse, F(1, 49) = 14.37, p < 0.001; Physical abuse, F(1, 49) = 21.21, p < 0.001; and Danger for murder weighted F(1, 49) = 22.99, p < 0.001. All effects sizes were large. CONCLUSION: Women abused during pregnancy are at greater risk for further abuse and in severe danger for murder. To ensure the safety of pregnant women, screening policies are essential.

Acculturation and associated effects on abused immigrant women's safety and mental functioning: results of entry data for a 7-year prospective study.

Intimate partner violence has negative effects on women's safety and wellbeing. When immigrant women are victimized the danger and poor health may intensify. The purpose was to determine the impact of acculturation on severity of violence, danger for murder, mental health functioning, and safety behaviors of abused immigrant women. Entry data of a 7-year prospective study of 106 abused immigrant women who were first time users of safe shelter or justice services is presented. The interview included the Severity of Violence Against Women Scale, Danger Assessment, Brief Symptom Inventory (BSI), Safety Behavior Checklist, and Acculturation for Hispanics instruments. A significant (p < 0.05) positive correlation between acculturation and safety behaviors and BSI scores was established. Higher acculturation scores were associated with significantly more practiced safety behaviors and higher levels of depression. Understanding the specific needs of abuse immigrant women associated with acculturation is imperative to develop interventions to interrupt abuse and promote safety and mental well-being.

U.S.-born compared to non-U.S.-born abused women: analysis of baseline data.

It is evident from recent studies that a woman's citizenship status does not exempt her from exposure to partner violence. The purpose of this article was to examine if social support, self-efficacy, and marginalization of abused women differ based on U.S. born compared to non-U.S. born with and without documentation. The findings suggest that women who were born in the United States had significantly higher self-efficacy scores compared to non-U.S.-born women without documents. There were no significant differences in social support among abused women who are U.S. born compared to non-U.S. born with and without documentation. In addition, women who were not born in the United States and did not have documents had higher marginalization.

Testing two global models to prevent violence against women and children: methods and baseline data analysis of a seven-year prospective study.

Worldwide, two models of care are offered most often to abused women-safe shelter and justice services. No evidence exists on the differential effectiveness of the models. To provide evidence for best practice and policy, 300 abused women, 150 first-time users of a shelter and 150 first time-applicants for a protection order, participated in a seven-year study. Safety, abuse, and the emotional and physical functioning of the women and their children were measured. The procedural logistics, sampling process, metrics, and baseline descriptors for these 300 women and 300 children is presented along with implications for practice and policy.