Initial testing of components of the cultural determinants of trauma recovery (CDTR) theory amongst American Gender-Based violence survivors: Structural equation modelling.

AIM: We tested key hypotheses derived from the Cultural Determinants of Trauma Recovery Theory (CDTR) with an American sample. DESIGN: A cross-sectional study using anonymous online surveys. METHODS: This study was conducted with 225 American survivors of gender-based violence (GBV) between August to November 2019. Demographics, distress (depression: PHQ8; PTSD: PCL-5), mental health service utilization (counselling and medication), sense of coherence (SOC), internal barriers to help-seeking (shame, frozen and problem management subscales: BHS-TR Internal) and the GBV healing (GBV-Heal) were used. Structural equation modelling (SEM) was conducted to test the hypotheses. RESULTS: The final SEM model showed that the relationship between distress and mental health service utilization was not mediated by internal help-seeking barriers; the relationship between distress and trauma healing was partially mediated by internal help-seeking barriers; the relationship between internal help-seeking barriers and trauma healing was partially mediated by SOC; mental health service utilization was not significantly associated with trauma healing. Overall, the relationship between distress and trauma healing was partially mediated by internal help-seeking barriers and SOC. CONCLUSIONS: This study confirmed some hypothetical pathways between distress and trauma healing. Further research with larger and international samples should be necessary to test the overall CDTR and compare groups. IMPACT: This study can help us focus on psychological interventions that enhance meaning and mitigate internal help-seeking barriers to promote holistic trauma recovery. Public and public contribution: The sample was gathered from a clinical population registry that alerts patients of potential research opportunities.

Grisi Siknis: A cultural idiom of gender-based violence and structural inequalities in eastern Nicaragua.

For the Miskitu of Nicaragua, Grisi Siknis is a contagious illness that predominantly affects women. It is characterized by numerous psychosomatic symptoms, including headache, fear, aggressive behavior, loss of consciousness, and periods of rapid frenzy. Although Grisi Siknis has gained academic and public attention due to its unique cultural elements and perceived sexual aspects, little is known how the contextual and gender dimensions of Grisi Siknis are played out in relation to the socio-political context in the region. Based on 16 months of ethnographic work in the Nicaraguan Miskitu Coast, including semi-structured interviews (n = 20) and participant observation, this article documents a semantic shift in the embodied and symbolic language of a cultural idiom of distress. I show how duhindu (Miskitu spirit associated with illness and misfortune) and witchcraft are symbols that share cultural resonance in the Miskitu community, while gender violence discourse is a new language incorporated into the logic of this cultural idiom of distress. I argue that this semantic shift allows the individuals in this study to communicate local experiences of complex forms of structural inequalities (migration status, unemployment, ethnic identity) and gender-based violence that tend to be normalized as a ubiquitous cultural problem while preserving the broader socio-cultural meaning the Grisi Siknis represents. The ethnographic accounts of Grisi Siknis provide empirical data to unpack the unexplored contextual processes and local discourses that transform the meaning and logic of cultural idioms of distress at the individual level of experience.

Leaving A Mark, An Animal-Assisted Intervention Programme for Children Who Have Been Exposed to Gender-Based Violence: A Pilot Study.

Gender-based violence is one of the most serious social and health problems faced by women around the world. Importantly, it has a negative impact not only on the woman's physical and mental health, but also on all members of the family system in which it takes place. The aims of this study were to implement Leaving a Mark, an animal-assisted intervention (AAI) programme for children who have been exposed to gender-based violence, and to examine its effect on their associated clinical symptoms. The participants were 19 children (13 boys and 6 girls; Mage = 8.89, SD = 2.23) who had been exposed to domestic violence perpetrated either by their father or their mother's intimate partner. Clinical symptoms were assessed using the Child Behaviour Checklist (CBCL). After taking part in the AAI programme, the children showed a reduction in internalizing symptoms and in symptoms associated with post-traumatic stress disorder. However, no significant changes were observed in externalizing symptoms or in affective and behavioural dysregulation (CBCL-Dysregulation Profile). These results provide preliminary support for the use of the Leaving a Mark programme with children who have been exposed to domestic violence. However, further studies with a larger sample and more rigorous design are required.

SenseMaker® as a monitoring and evaluation tool to provide new insights on gender-based violence programs and services in Lebanon.

Monitoring and evaluation (M&E) of gender-based violence (GBV) programs is challenging in humanitarian settings. To address these challenges, we used SenseMaker® as a mixed methods M&E tool for GBV services and programs in Lebanon. Over a three-month period in 2018, a total of 198 self-interpreted stories were collected from women and girls accessing GBV programs from six service providers across five locations. The resultant mixed-methods analysis provided holistic and nuanced insights on how perceived benefits differed by type of GBV program, how motivations for accessing programs differed by location, and how feelings while accessing programs differed by participant nationality. SenseMaker reinforced the intersectionality between events leading up to the accessed services, the experiences of accessing the services, and subsequent outcomes as a result of having accessed the services, helping to contextualize the findings within the broader experiences of participating women and girls. Limited literacy and technology skills among participants proved to be a challenge and future work should investigate how technology might facilitate use of the tool among participants with lower literacy and technology skills in addition to exploring the feasibility and added value of SenseMaker as an M&E tool in acute humanitarian settings.

The experiential expertise of primary care midwives in the detection of gender violence during pregnancy. Qualitative study. / El saber experiencial de las matronas de Atención Primaria en la detección de violencia de género durante el embarazo. Estudio cualitativo.

AIM: To use the reflections of primary care midwives to find out the barriers and facilitators for detecting IPV during pregnancy. The second aim is to determine proposals for measures to improve detection of IPV. METHOD: Qualitative methodology with a interpretative phenomenological approach. In-depth interviews were conducted with 12midwives, working in the sexual and reproductive health care centres of Hospitalet de Llobregat (Barcelona). RESULTS: The difficulties in detection relate to the system of visits, the situation of women and barriers of practitioners themselves, such as fear. Follow-up of pregnancy and the relationship of trust with the midwife stand out as facilitators. The proposals for improvement were to increase training and use safe and reliable health care procedures. CONCLUSIONS: The complexity of IPV makes it likely that IPV during pregnancy is undetected. It would be desirable to implement actions such as expanding training and agreeing on an internal work circuit that includes objective instruments to detect IPV, coordination with other services and ethical and legally appropriate way of recording in the clinical record.

Narrative storytelling as mental health support for women experiencing gender-based violence in Afghanistan.

RATIONALE: Experiencing gender-based violence (GBV) can have serious consequences for women's mental health. However, little is known about how to address the health consequences of GBV against women in high-prevalence settings where GBV is widely accepted as normal. OBJECTIVE: This study examines the potential for narrative storytelling to support women's mental health and alleviate the suffering caused by GBV in high-prevalence settings. It adopts a symbolic interactionist perspective to explore the perceptions and lived experiences of women living in safe houses for GBV in Afghanistan. METHOD: In-depth semi-structured interviews were carried out with women (n = 20) in two Afghanistan safe houses between March and May 2017. The data were analysed both inductively and deductively using thematic network analysis. RESULTS: The findings reveal the stigmatising and traumatic experiences many women have had when telling their stories of GBV in this context. In contrast, storytelling under supportive conditions was perceived to be a highly valuable experience that could help formulate positive social identities and challenge broader social structures. The supportive conditions that contributed to a positive storytelling experience included the presence of a sympathetic non-judgemental listener and a supportive social environment. CONCLUSIONS: These findings offer an alternative to biomedical models of mental health support for women experiencing GBV in high-prevalence settings. They raise the importance of tackling broader social changes that challenge patriarchal social structures, and highlight the potential role that narrative storytelling approaches can play in high-prevalence settings like Afghanistan.