Illness uncertainty and quality of life in patients with advanced cancer and their family caregivers: An actor-partner interdependence model analysis.

OBJECTIVE: The relationship between illness uncertainty and quality of life (QOL) has been examined for either the patient or caregiver, but not among the patient-caregiver dyads. This study examined relationships between illness uncertainty and QOL among patients with advanced cancer and family caregivers. METHODS: We conducted a secondary analysis of data from a randomized clinical trial that examined the effects of a dyadic-based intervention on psychological outcomes for patients with advanced cancer and family caregivers (N = 484 dyads). Illness uncertainty and QOL were measured using the shorten version of the Mishel Uncertainty in Illness Scale for Adult and the Functional Assessment of Cancer Therapy, respectively. The actor-partner interdependence model was used to examine whether an individual's uncertainty (either a patient's or caregiver's) was associated with their own QOL (i.e., an actor effect) and/or their partner's QOL (i.e., a partner effect). RESULTS: Significant actor effects included a negative association between patients' uncertainty and their own QOL (b = -0.422; p < 0.001) and a negative association between caregivers' uncertainty and their own QOL (b = -0.408; p < 0.001). In terms of partner effects, patients' uncertainty was negatively associated with caregivers' QOL (b = -0.095; p < 0.01). No partner effect was found for caregivers, suggesting that caregivers' uncertainty was not related to patients' QOL. CONCLUSIONS: Study findings support targeted interventions offered to both patients and their family caregivers to manage their illness uncertainty and improve their QOL.

Explanatory Theories of Intimate Partner Homicide Perpetration: A Systematic Review.

Theories play an important role in guiding intimate partner homicide (IPH) prevention research and practice. This study is the first systematic review of theories employed to explain why someone might kill their intimate partner. This review used rigorous methods to locate and synthesize literature that described explanatory theories of IPH perpetration. Using set search terms, we systematically searched 15 databases and repositories for theory-focused documents (i.e., theory papers or analyses) published in English from 2003 to 2018. Eighteen documents met these inclusion criteria and identified 22 individual theories that seek to explain why people might kill their intimate partners. These theories fell within four broader theoretical perspectives: feminist, evolutionary, sociological/criminological, and combined. Key tenets and focal populations of these 22 theories were identified and organized into a compendium of explanatory theories of IPH perpetration. Potential strengths and limitations of each of the four perspectives were described. Review findings underscored the likely importance of addressing gender as well as risk and protective factors at all levels of the social ecological model in efforts to understand IPH perpetration. The review findings highlighted the need for both integrated theories and a broader conceptual organizing framework to guide work aimed at IPH perpetration prevention to leverage the strengths of disparate theoretical perspectives. With the goal of informing future research, a preliminary iteration of such a framework is presented.

Disparities in potential years of life lost due to intimate partner violence: Data from 16 states for 2006-2015.

BACKGROUND: Intimate partner violence can lead to deaths of one or both partners and others (i.e., corollary victims). Prior studies do not enumerate the societal cost of intimate partner violence-related fatalities, exclude corollary victims from most analyses, and do not describe groups who bear the highest societal costs from intimate partner violence. OBJECTIVE: We examine racial/ethnic and gender-based disparities in potential years of life lost (PYLL) among intimate partners and corollary victims of intimate partner violence-related mortality. METHODS: We used 16 US states' 2006-2015 National Violent Death Reporting System data to estimate PYLL among intimate partners (n = 6,282) and corollary victims (n = 1,634) by victims' race/ethnicity and sex. We describe fatalities by sex, race/ethnicity, age, and victim-suspect relationships and used hierarchical linear models to examine PYLL per death differences by victims' sex and race/ethnicity. RESULTS: Nearly 290,000 years of potential life were lost by partner and corollary victims as a result of IPV in 16 states during the decade of study. Most partner victims were female (59%); most corollary victims were male (76%). Female intimate partners died 5.1 years earlier (95% CI: 4.4., 5.9) than males, and female corollary victims died 3.6 years (1.9, 5.5) earlier than males. Racial/ethnic minorities died nine or more years earlier than their White counterparts. White males had the lowest PYLL per death of all sex/race groups. IMPLICATIONS: Intimate partner violence-related fatalities exact a high societal cost, and the burden of that cost is disproportionately high among racial/ethnic minorities. Future interventions targeting specific sex and race/ethnic groups might help reduce disparities in intimate partner violence burden.

The Validity and Reliability of Available Intimate Partner Homicide and Reassault Risk Assessment Tools: A Systematic Review.

At least one in seven homicides around the world is perpetrated by intimate partners. The danger of intimate partner homicide (IPH) associated with intimate partner violence (IPV) has led to the development of numerous IPV reassault and IPH risk assessment tools. Using 18 electronic databases and research repositories, we conducted a systematic review of IPH or IPV reassault risk assessment instruments. After review, 43 studies reported in 42 articles met inclusion criteria. We systematically extracted, analyzed, and synthesized data on tools studied, sample details, data collection location, study design, analysis methods, validity, reliability, and feasibility of use. Findings indicate that researchers in eight countries have tested 18 distinct IPH or IPV reassault risk assessment tools. The tools are designed for various professionals including law enforcement, first responders, and social workers. Twenty-six studies focused on assessing the risk of male perpetrators, although eight included female perpetrators. Eighteen studies tested tools with people in mixed-sex relationships, though many studies did not explicitly report the gender of both the perpetrators and victims/survivors. The majority of studies were administered or coded by researchers rather than administered in real-world settings. Reliable and valid instruments that accurately and feasibly assess the risk of IPH and IPV reassault in community settings are necessary for improving public safety and reducing violent deaths. Although researchers have developed several instruments assessing different risk factors, systematic research on the feasibility of using these instruments in practice settings is lacking.

Traumatic Experience, Polytraumatization, and Perinatal Depression in a Diverse Sample of Adolescent Mothers.

This study examines the prevalence of trauma subtypes, polytraumatization, and perinatal depression (PND) in a diverse sample of adolescent mothers to help inform PND prevention, screening, and treatment efforts. We conducted a secondary analysis of a sample (N = 210) of adolescent mothers aged 14 to 20 years from a prospective longitudinal study of PND. Participants were recruited from a county-based, public health prenatal clinic, and data were collected in the prenatal and postpartum periods. In this sample, 81% of adolescent mothers reported at least one trauma experience and 75% reported lifetime experience of intimate partner violence (IPV). The most prevalent trauma types among adolescent mothers reporting PND were sexual trauma prior to age 13 (11.9%), loss of a caregiver or sibling (28.3%), emotional adversity (17.1%), and polytraumatization (43%). Trauma is alarmingly prevalent among adolescent mothers. Results suggest standards of care for adolescent mothers should include screening adolescent mothers for trauma history and provision of appropriate referrals for IPV. Findings support the need for trauma-informed treatment in perinatal public health clinics to decrease potential health risks to both mother and baby.

Intimate Partner Violence Among Same-Sex Couples in College: A Propensity Score Analysis.

Intimate partner violence (IPV) is a pervasive social issue with numerous detrimental effects on individuals, families, and society. Existing research and a social-ecological minority stress framework suggest, as compared with mixed-sex couples, those in same-sex relationships may be at heightened risk for perpetrating and experiencing IPV. Using a U.S. sample of college students ( N = 4,081), this secondary data analysis contrasted the prevalence of five forms of IPV (i.e., physical, sexual, psychological, injury, any type) between those in mixed-sex ( n = 3,960) and those in same-sex ( n = 121) intimate partnerships. Comparative analyses were supplemented with propensity score weighting to help balance members of mixed-sex and same-sex relationships across eight potentially confounding variables (e.g., biological sex, age). Prior to the application of propensity score weighting, results suggested those in same-sex relationships are significantly more likely to perpetrate and/or experience IPV resulting in physical injury. Results from post-weighting analyses retained the significance and magnitude of model estimates. Taken together, results suggest, as compared with mixed-sex couples, U.S. college students in same-sex couples have greater odds of experiencing IPV perpetration and victimization resulting in physical injury, even after accounting for the influence of several potentially confounding variables. Findings support the utility and future application of propensity score analytic techniques in this type of research as well as the importance of recognizing the unique IPV risk and service needs of people in same-sex relationships.

What Do Domestic Violence and Sexual Assault Service Providers Need to Know About Survivors to Deliver Services?

Using survey data, we investigate perspectives of 80 program directors of domestic violence and/or sexual assault agencies regarding whether gathering specific information at intake is helpful in determining survivors' needs for five service areas: legal advocacy, medical advocacy, support group, counseling, and shelter. We explore whether directors' opinions of information-type usefulness differ by type of service agency (single- or dual-focus). Findings show directors perceive the information most helpful to early service provision includes survivors' goals, experiences of violence and trauma, and health status. MANOVA results show no significant differences among directors from single- or dual-focus agencies.

Measuring Substance Use Among System-Involved IPV Survivors: A Research Note.

This research note presents findings from a qualitative study exploring female, system-involved intimate partner violence (IPV) survivors' perspectives on substance use disclosure in the context of research studies. The study sample includes 22 women who completed a court- and/or child protective services (CPS)-mandated IPV parenting program. Analyses revealed three key areas of participants' perspectives on substance use assessment and disclosure: (a) administration setting/format and measurement clarity, (b) administrator characteristics, and (c) repercussions due to breach of confidentiality. Findings from the current study offer insights into barriers for survivors reporting their substance use and suggestions for researchers seeking to assess substance use among this population.

Pregnant adolescent women's perceptions of depression and psychiatric services in the United States.

PROBLEM: Adolescent mothers and their children are at high-risk for depression and the associated negative educational, social, health, and economic outcomes. BACKGROUND: However, few pregnant adolescent women with depression receive psychiatric services, especially low-income or racial/ethnic minority adolescent women. AIM: This qualitative study explores perceptions of depression, psychiatric services, and barriers to accessing services in a sample of low-income, pregnant racial/ethnic minority adolescent women. Our goal was to better understand the experiences of depression during pregnancy for these vulnerable adolescent women, and thereby improve their engagement and retention in services for perinatal depression. METHODS: We recruited 20 pregnant adolescent women who screened positive for depression from 2 public health prenatal clinics in the southeastern United States. Participants were low-income and primarily racial/ethnic minority women between 14 and 20 years old. Data were collected through individual in-depth, ethnographically informed interviews. FINDINGS: Generally, participants lacked experience with psychiatric services and did not recognize their symptoms as depression. However, participants perceived a need for mood improvement and were interested in engaging in services that incorporated their perspective and openly addressed stigma. DISCUSSION: Participants reported practical and psychological barriers to service engagement, but identified few cultural barriers. Family perceptions of psychiatric services served as both a barrier and support. CONCLUSION: Adolescent women are more likely to engage in psychiatric services if those services reduce practical and psychological barriers, promise relief from the symptoms perceived as most meaningful, and address underlying causes of depression. Culture may affect Latina adolescent women's perceptions of depression and services.

Research With Children Exposed to Partner Violence: Perspectives of Service-Mandated, CPS- and Court-Involved Survivors on Research With Their Children.

Rapidly growing numbers of female survivors of intimate partner violence (IPV) who are the primary caregivers for their children are being mandated to services by child protective services (CPS) and/or the court system. Research is needed to better understand the experiences of these children; however, such research is hindered by the dearth of empirical evidence to guide researchers in how best to recruit and collect data about and from IPV-exposed children whose families are mandated to services. From a qualitative study with 21 CPS- and/or court-involved mothers, this article reports findings about participants' perspectives regarding research with their IPV-exposed children. Our analyses determined three key findings: (a) mothers' reasons or motivations for allowing their children to participate in research, (b) mothers' reasons for refusing consent for their children to participate, and (c) strategies for increasing research participation among this population. Based on these findings, we offer recommendations for enhancing research participation among IPV-exposed children from CPS- and/or court-involved families mandated to services, including specific recruitment and data collection strategies. These recommendations and strategies also hold value for research with other vulnerable families and children struggling with violence.

"This Is About Me": Feasibility Findings From the Children's Component of an IPV Intervention for Justice-Involved Families.

Two community-based agencies collaborated to create a program for justice-involved female intimate partner violence (IPV) survivors and their children. Our research team conducted a feasibility study of the children's program using an exploratory, multimethod qualitative design with child participants (n = 8), adult participants (n = 18), and providers (n = 7). Analyses determined four key findings: (a) importance of attendance; (b) the need for a flexible, child-driven curriculum; (c) improvement through expression and peer bonding; and (d) the value of specific program content. The findings point to indispensable program elements and enhancement recommendations. Implications for other communities and providers serving IPV-exposed children are described.

Characteristics, needs, and help seeking of partner violence victims mandated to community services by courts and child protective services.

The rapid growth of a subpopulation of women victimized by intimate partner violence (IPV) garnered the attention of 2 human service agencies in 1 Southeastern United States city. These agencies noted a shift in their clientele from female IPV victims who voluntarily sought agency services to victims who were mandated to agency services by child protective services (CPS), the court system, or both. Court-referred victims had been arrested for perpetrating IPV against their male partners. CPS-referred victims were experiencing concerning levels of IPV in their families, whether or not the victim had ever perpetrated IPV. Moreover, this subpopulation of women tended to be primary caregivers of children. In response to the growth of this subpopulation, the agencies collaborated to design and implement a program targeting female IPV victims who were primary caregivers for their children and who had been mandated to the agencies' services. The research team partnered with the agencies to conduct an investigation of this community-developed program and its participants. This article presents an exploratory, descriptive study that investigates (a) the characteristics of service-mandated, parenting IPV victims; (b) the needs of service-mandated, parenting IPV victims; and (c) the types of help-seeking behavior these women had engaged in before their service referral. Study findings indicate that, although the participants showed parenting strengths and active help-seeking efforts, this sample of women was characterized by severe IPV experiences and serious mental health needs.

Directors' opinions about domestic violence and sexual assault service strategies that help survivors.

Little evidence is available regarding recommended practices for domestic violence and sexual assault services. Although there is a literature concerned with these services, few studies have investigated recommended practices from the perspective of community providers. In addition, researchers have not yet investigated the utility of specific domestic violence and sexual assault service delivery strategies. To help address these knowledge needs, the authors investigated agency directors' perspectives on six types of services typically offered by domestic violence and sexual assault agencies including crisis, legal advocacy, medical advocacy, support group, individual counseling, and shelter. The authors also examined the extent to which directors' opinions about service delivery practices differed based on key agency's characteristics, specifically the services offered (i.e., domestic violence, sexual assault, or both) and agency location (i.e., rural, suburban, or urban). A sample of 97 (94% response rate) North Carolina agency directors completed a survey on recommended service delivery practices. The authors conducted descriptive analyses to identify directors' overall opinions about service delivery practices and used multivariate analysis of variance to examine whether directors' opinions about service delivery practices differed according to agency characteristics. Findings showed differences in directors' opinions about service delivery practices based on their agency's service location. Practice recommendations were garnered from the study's results.

Domestic violence and sexual assault service goal priorities.

We investigated agency directors' perspectives about how service goals should be prioritized for domestic violence and sexual assault service subtypes, including crisis, legal advocacy, medical advocacy, counseling, support group, and shelter services. A sample of 97 (94% response rate) North Carolina domestic violence and/or sexual assault agency directors completed a survey asking participants to rank the importance of service goals. Overall, participants considered emotional support provision to be a critical service goal priority across all service types. Social support and self-care service strategies were deemed less important. However, prioritization of other service goals varied depending on the service type. Statistically significant differences on service goal prioritization based on key agency characteristics were also examined, and agency characteristics were found to relate to differences in service goal prioritization.