"Counteract the gaslighting" - a thematic analysis of open-ended responses about what women survivors of intimate partner sexual violence need from service providers.

BACKGROUND: Intimate partner sexual violence (IPSV) is a prevalent but misunderstood form of gender-based violence with significant impacts women's health and well-being. Research suggests that IPSV has a specific context and unique impacts, but little is known about how to tailor service responses. To address this gap, we explored help-seeking experiences and needs among IPSV survivors after disclosure. METHODS: This study draws on qualitative data from a subsample of women who participated in a cross-sectional survey about the service needs of intimate partner violence survivors. Women who reported IPSV and provided information about IPSV-specific help-seeking needs after disclosure were included in the analysis. Open-ended text responses of 37 IPSV survivors were analysed using thematic analysis. RESULTS: IPSV was invisible and silenced in service responses. Three themes suggest potential ways forward. In the first theme, 'Don't dismiss it', women needed providers to take their disclosures seriously and listen to the significant impacts of IPSV on their well-being and safety. In the second theme, 'See the bigger picture', women needed service providers to understand that IPSV fits into broader patterns of abuse, and that psychological abuse and coercive control impacts women's ability to consent. In the third theme, 'counteract the gaslighting', women needed providers to educate them about the continuum of IPSV and help them label IPSV as a form of violence. CONCLUSIONS: Our exploratory findings extend the limited evidence base on IPSV and highlight a need for further in-depth research to explore a tailored approach to supporting IPSV survivors. To avoid contributing to the silencing of IPSV survivors, service responses should recognise the harmful and sexualised nature of IPSV, challenge cultural stereotypes that minimise IPSV, and understand that co-occurring psychological abuse may exacerbate shame and prevent women from articulating the source of their distress.

"You can't swim well if there is a weight dragging you down": cross-sectional study of intimate partner violence, sexual assault and child abuse prevalence against Australian nurses, midwives and carers.

BACKGROUND: Domestic and family violence (DFV), including intimate partner violence (IPV), sexual assault and child abuse are prevalent health and social issues, often precipitating contact with health services. Nurses, midwives and carers are frontline responders to women and children who have experienced violence, with some research suggesting that health professionals themselves may report a higher incidence of IPV in their personal lives compared to the community. This paper reports the largest study of DFV against health professionals to date. METHOD: An online descriptive, cross-sectional survey of 10,674 women and 772 men members of the Australian Nursing and Midwifery Federation (ANMF) (Victorian Branch). The primary outcome measures were 12-month and adult lifetime IPV prevalence (Composite Abuse Scale); secondary outcomes included sexual assault and child abuse (Australian Bureau of Statistics Personal Safety Survey) and prevalence of IPV perpetration (bespoke). RESULTS: Response rate was 15.2% of women/11.2% of men who were sent an invitation email, and 38.4% of women/28.3% of men who opened the email. In the last 12-months, 22.1% of women and 24.0% of men had experienced IPV, while across the adult lifetime, 45.1% of women and 35.0% of men had experienced IPV. These figures are higher than an Australian community sample. Non-partner sexual assault had been experienced by 18.6% of women and 7.1% of men, which was similar to national community sample. IPV survivors were 2-3 times more likely to have experienced physical, sexual or emotional abuse in childhood compared to those without a history of IPV (women OR 2.7, 95% CI 2.4 to 2.9; men OR 2.8, 95% CI 2.0 to 4.1). Since the age of sixteen, 11.7% of men and 1.7% of women had behaved in a way that had made a partner or ex-partner feel afraid of them. CONCLUSIONS: The high prevalence of intimate partner violence and child abuse in this group of nurses, midwives and carers suggests the need for workplace support programs. The findings support the theory that childhood adversity may be related to entering the nursing profession and has implications for the training and support of this group.

"It happens to clinicians too": an Australian prevalence study of intimate partner and family violence against health professionals.

BACKGROUND: The purpose of this study was to measure the prevalence of intimate partner and family violence amongst a population of Australian female nurses, doctors and allied health professionals. METHODS: We conducted a descriptive, cross-sectional survey in a large Australian tertiary maternity hospital with 471 participating female health professionals (45.0% response rate). The primary outcome measures were 12 month and lifetime prevalence of intimate partner violence (Composite Abuse Scale) and family violence. RESULTS: In the last 12 months, one in ten (43, 11.5%) participants reported intimate partner violence: 4.2% (16) combined physical, emotional and/or sexual abuse; 6.7% (25) emotional abuse and/or harassment; 5.1% (22) were afraid of their partner; and 1.7% (7) had been raped by their partner. Since the age of sixteen, one third (125, 29.7%) of participants reported intimate partner violence: 18.3% (77) had experienced combined physical, emotional and/or sexual abuse; 8.1% (34) emotional abuse and/or harassment; 25.6% (111) had been afraid of their partner; and 12.1% (51) had been raped by their partner. Overall, 45.2% (212) of participants reported violence by a partner and/or family member during their lifetime, with 12.8% (60) reporting both. CONCLUSION: Intimate partner and family violence may be common traumas in the lives of female health professionals, and this should be considered in health workplace policies and protocols, as health professionals are increasingly urged to work with patients who have experienced intimate partner and family violence. Implications include the need for workplace manager training, special leave provision, counselling services and other resources for staff.

Women's Experiences Accessing Mental Health Care in Australia After Sexual Violence in Adulthood.

In Australia, at least one in every five women has experienced sexual violence since age 15. Research consistently links sexual violence with poor mental health, persisting long after the crisis period. Trauma-informed mental health support is therefore critical. This article draws on interviews with 29 women who had experienced sexual violence to understand their experiences accessing mental health services in Australia. Our findings suggest that, constrained by a biomedical model of care, mental health practitioners' understanding of trauma generally, and sexual violence particularly, may be lacking. Further, women struggle to navigate a "maze" of services.

Healthcare Professionals' Own Experiences of Domestic Violence and Abuse: A Meta-Analysis of Prevalence and Systematic Review of Risk Markers and Consequences.

Background: Globally, healthcare professionals (HCPs) are increasingly asked to identify and respond to domestic violence and abuse (DVA) among patients. However, their own experiences of DVA have been largely ignored.Aim: To determine the prevalence of current and lifetime DVA victimisation among HCPs globally, and identify risk markers, consequences and support-seeking for DVA.Method: PubMed, EMBASE, PsycINFO, CINAHL ASSIA and ProQuest were searched. Studies about HCPs' personal experience of any type of DVA from any health service/country were included. Meta-analysis and narrative synthesis were adopted.Results: Fifty-one reports were included. Pooled lifetime prevalence was 31.3% (95% CI [24.7%, 38.7%] p < .001)) and past-year prevalence was 10.4% (95% CI [5.8%, 17.9%] p <.001). Pooled lifetime prevalence significantly differed (Qb=6.96, p < .01) between men (14.8%) and women (41.8%), and between HCPs in low-middle income (64.0%) and high-income countries (20.7%) (Qb = 31.41, p <.001). Risk markers were similar to those in the general population, but aspects of the HCP role posed additional and unique risks/vulnerabilities. Direct and indirect consequences of DVA meant HCP-survivors were less able to work to their best ability. While HCP-survivors were more likely than other HCPs to identify and respond to DVA among patients, doing so could be distressing. HCP-survivors faced unique barriers to seeking support. Being unable to access support - which is crucial for leaving or ending relationships with abusive people - leaves HCP-survivors entrapped.Conclusion: Specialised DVA interventions for HCPs are urgently needed, with adaptations for different groups and country settings. Future research should focus on developing interventions with HCP-survivors.

Is a clinician's personal history of domestic violence associated with their clinical care of patients: a cross-sectional study.

OBJECTIVE: To investigate whether domestic violence (DV) impacts on health professionals' clinical care of DV survivor patients. DESIGN, SETTING: Descriptive, cross-sectional study at an Australian tertiary maternity hospital. PARTICIPANTS: 471 participating female health professionals (45.0% response rate). OUTCOME MEASURES: Using logistic and linear regression, we examined whether health professionals' exposure to lifetime DV was associated with their clinical care on specific measures of training, attitudes, identification and intervention. RESULTS: DV survivor health professionals report greater preparedness to intervene with survivor patients in a way that is consistent with ideal clinical care. This indicates that personal DV experience is not a barrier, and may be a facilitator, to clinical care of survivor patients. CONCLUSIONS: Health professionals are at the front line of identifying and responding to patients who have experienced DV. These findings provide evidence that survivor health professionals may be a strength to the healthcare organisations in which they work since among the participants in this study, they appear to be doing more of the work seen as better clinical care of survivor patients. We discuss the need for greater workplace supports aimed at promoting safety and recovery from violence and strengthening clinical practice with patients.

Listening to mental health workers' experiences: factors influencing their work with women who disclose sexual assault.

Women are overrepresented within mental health service-use statistics, and a disproportionate number of them have experienced sexual assault. While mental health workers are often the first point of contact between these women and the mental health system, within the research to date, women have often reported a negative experience of disclosing sexual assault to these workers. This article presents findings from an exploratory Australian study. The aim of the study was to explore factors that influenced how mental health Crisis Assessment and Treatment Service (CATS) workers respond to women who disclose sexual assault in crisis service settings. Fifteen CATS workers were surveyed and the predominantly qualitative data were then analysed using thematic analysis. This article presents two key findings: (i) the majority of participants had not experienced adequate sexual assault training, and seven of the 15 did not feel well equipped to respond to a disclosure of sexual assault; and (ii) they rarely consulted or referred women to specialist sexual assault services, despite recognizing the significant impact of sexual assault on mental health functioning. Recommendations are made for training and increased communication between mental health and sexual assault service systems to ensure better outcomes for women.