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 a Theory of Economic Solvency for Women Who Have Experienced Intimate Partner Violence.

Poverty and intimate partner violence create a cycle that is difficult for women to escape. To create programs to help women escape the cycle, a full understanding of economic solvency is needed. A Model of Economic Solvency has been created, and this Grounded Theory study serves to validate the model and give more details so that it can be effectively used in research and interventions. The revised model defines economic solvency as a woman's human capital, social capital, sustainable employment, independence, and assets. These factors are affected by opportunities and threats in her relationships, community, and society.

Attitude towards gender roles and violence against women and girls (VAWG): baseline findings from an RCT of 1752 youths in Pakistan.

BACKGROUND: Violence against women is driven by gender norms that normalize and justify gender inequality and violence. Gender norms are substantially shaped during adolescence. Programs offered through schools offer an opportunity to influence gender attitudes toward gender equity if we understand these to be partly shaped by peers and the school environment. OBJECTIVE: We present an analysis of the baseline research conducted for a randomized controlled trial with 1752 grade 6 boys and girls and their attitudes toward gender roles, VAWG, and associated factors. METHODS: We used baseline data from a  cluster randomised control study. Interviews were conducted in 40 public schools in Hyderabad, with 25-65 children per school. Questions were asked about attitudes toward gender roles, peer-to-peer perpetration, and victimization experiences, and family life, including father- or in-law-to- mother violence and food security. Multiple regression models were built of factors associated with gender attitudes for boys and girls. RESULTS: Our result have shown youth attitudes endorsing patriarchal gender beliefs were higher for boys, compared to girls. The multiple regression model showed that for boys, patriarchal gender attitudes were positively associated with hunger, depression, being promised already in marriage, and being a victim and/or perpetrator of peer violence. For girls gender attitudes were associated with hunger, experiencing corporal punishment at home, and being a perpetrator (for some, and victim) of peer violence. CONCLUSION: Youth patriarchal attitudes are closely related to their experience of violence at school and for girl's physical punishment, at home and for boys being promised in early marriage. We suggest that these variables are indicators of gender norms among peers and in the family. The significance of peer norms is that it provides the possibility that school-based interventions which work with school peers have the potential to positively impact youth patriarchal gender attitudes and foster attitudes of gender equality and respect, and potentially to decrease youth victimization and perpetration.

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.

Interrupting Intimate Partner Violence During Pregnancy With an Effective Screening and Assessment Program.

Intimate partner violence is a public health problem that affects many women during pregnancy and can compromise the health and safety of mothers and infants. Identification and routine assessment of intimate partner violence during pregnancy is essential, and health care providers must be afforded training and resources that support an effective screening and assessment program. The essential components of an intimate partner violence assessment program for women who are abused during pregnancy are explored.

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.

Economic solvency in the context of violence against women: a concept analysis.

The aim of this concept analysis is to define economic solvency in the context of violence against women. Poverty, or lack of resources, is often discussed as a risk factor for intimate partner violence. The concept of economic solvency, which may be a protective factor for women, is less often discussed and not well defined. Databases searched for the analysis included EBSCOhost, CINAHL, PubMed and Gender Watch. The Rodgers evolutionary method was used to perform the concept analysis. A total of 134 articles were retrieved, using the specified search terms 'economic solvency and women', 'economic self-reliance and women' and 'economic self-sufficiency and women'. Articles were included if they were peer reviewed, contained the keywords with sufficient context to determine the author's intended meaning, and focused on women only or contrasted men to women. Thirty-five articles were used in the concept analysis. The definition of economic solvency drawn from the concept analysis is: a long-term state that occurs when there is societal structure that supports gender equity and external resources are available and can be used by a woman who has necessary human capital, sustainable employment and independence. Just as poverty and violence are cyclical, so are economic solvency and empowerment of women. To decrease women's risk of intimate partner violence around the world and further improve the status of women, we recommend continued research on economic solvency, including the individual, family, community and societal resources required to obtain economic solvency and the human capital characteristics needed for sustainability.

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.

Violence against women in Pakistan: contributing factors and new interventions.

Pakistan ranks 125th out of 169 countries on the Gender Development Index and has high prevalence rates of Violence against Women (VAW). Contributing factors toward gender based violence at the micro, meso and macro levels include the acceptability of violence amongst both men and women, internalization of deservability, economic disempowerment, lack of formal education, joint family systems, entrenched patriarchal norms and values, and a lack of awareness of legal and other support systems. These factors have a long-lasting impact on the health of women and children. The gender disparities in the experience of women seeking health care in Pakistan are well-recognized and documented. In the past, common government policy responses to these disparities have included developing the role of community health workers (CHWs) and lady health visitors (LHVs). Despite being commendable initiatives, these too have been unsuccessful in addressing these multi-faceted disparities. Within this complex scenario, new interventions to address VAW and its impact on health in Pakistan include Group Counselling, Economic Skills Building, Health-Based Microfinance, and Family-Based models that increase male involvement, especially at the primary health care level. The purpose of this article is to outline key contributing factors to VAW, explore tested and new interventions, and highlight the opportunities that exist in implementing them.

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.

Meeting the 2015 Millennium Development Goals with new interventions for abused women.

In a developing country such as Pakistan, where illiteracy, poverty, gender differences, and health issues are prevalent, violence against women is a commonly observed phenomenon. The rising incidences of abuse among women indicate a need to introduce evidence-based community-derived interventions for meeting Millennium Developmental Goals by 2015. This article discusses the application of counseling, economic skills building, and microcredit programs as practical and effective interventions to improve the health outcomes of abused women and, therefore, improving maternal and child health in the Pakistani society.

Connecting the dots of heart disease, poor mental health, and abuse to understand gender disparities and promote women's health: a prospective cohort analysis.

Heart disease, poor mental health, and abuse are epidemic among women worldwide. Our purpose was to identify a group of women with heart disease and explore the relationship between a history of abuse and existing symptoms of depression and post-traumatic stress disorder (PTSD) and analyze the relationships over time. A prospective cohort analysis design with mental health measures repeated at 3 and 6 months postintake was followed. Abused women (n = 25) reported significantly more symptoms of depression (p = .004) and PTSD (p = .003) compared with nonabused women (n = 14). To promote global mental health among women with heart disease, interventions must address a history of abuse.

Development of an economic skill building intervention to promote women's safety and child development in Karachi, Pakistan.

Violence against women is a global epidemic phenomenon that can result in major mental health problems. Not only are women affected but also the health and well-being of their children are in jeopardy. To prevent violence and promote women's safety, several strategies have been tested in various cultural contexts. This article describes the process of developing and validating an economic skill building intervention for women of an urban slum area of Karachi, Pakistan. The purpose of the intervention is to increase women's economic independence, promote women's safety, and improve the behavioral functioning of their children.

Risk factors for femicide-suicide in abusive relationships: results from a multisite case control study.

The killing of women by men who then take their own lives (femicide-suicide) is the most common form of homicide-suicide. This study identified femicide-suicide risk factors in an 11-city case-control study of femicide in the United States. Perpetrator, victim, relationship, and incident characteristics were analyzed for femicide-suicide cases (n = 67) and controls (n = 356, women living in the community with nonfatal physical abuse) using logistic regression modeling. Two risk factors emerged that were unique to femicide-suicides cases compared to overall femicide risk analyses: prior perpetrator suicide threats and victims having ever been married to the perpetrator.

Intimate partner sexual assault against women: frequency, health consequences, and treatment outcomes.

OBJECTIVE: To describe the characteristics and consequences of sexual assault within intimate relationships specific to racial or ethnic group, compare the findings to a similar group of physically assaulted-only women, and measure the risk of reassault after victim contact with justice and health services. METHODS: A personal interview survey of 148 African-American, Hispanic, and white English- and Spanish-speaking abused women seeking a protection order. Extent of sexual assault, prevalence of rape-related sexually transmitted diseases and pregnancy, symptoms of posttraumatic stress disorder (PTSD) and depression, and risk of reassault after treatment were measured. RESULTS: Sixty-eight percent of the physically abused women reported sexual assault. Fifteen percent of the women attributed 1 or more sexually-transmitted diseases to sexual assault, and 20% of the women experienced a rape-related pregnancy. Sexually assaulted women reported significantly (P = .02) more PTSD symptoms compared with nonsexually assaulted women. One significant (P = .003) difference occurred between ethnic groups and PTSD scores. Regardless of sexual assault or no assault, Hispanic women reported significantly higher mean PTSD scores compared with African-American women (P = .005) and White women (P = .012). The risk of sexual reassault was decreased by 59% and 70% for women who contacted the police, or applied for a protection order, after the first sexual assault. Receiving medical care decreased the woman's risk of further sexual assault by 32%. CONCLUSION: Sexual assault is experienced by most physically abused women and associated with significantly higher levels of PTSD compared with women physically abused only. The risk of reassault is decreased if contact is made with health or justice agencies.