Lifeguard Pharmacy: the co-development of a new community pharmacy response service for people in danger from domestic abuse or suicidal ideation.

BACKGROUND: Domestic abuse (DA) and suicidal ideation (SI) are prevalent and often co-occur. Numerous practical and psychosocial barriers inhibit help-seeking, including accessibility and confidentiality concerns. Pharmacies are accessible and may be perceived as a discreet venue for a DA and SI response service. OBJECTIVE: To co-develop a community pharmacy response service for people experiencing domestic abuse or suicidal ideation. METHODS: Overall, 36 unique individuals contributed at least once to a series of focus groups, interviews or workshops to co-develop the service components. Participants had lived experience of DA/SI or were professionals from DA/SI support services or pharmacies. Audio recordings and field notes from events were thematically analysed. Specific themes were identified and informed the development of the service components. KEY FINDINGS: Participants supported the development of this new service and considered community pharmacies to be an ideal setting. They thought of the service as a lifeline, that would offer hope. Under this main concept of hope, five main themes were identified: Safety, Empathy, Empowerment, Equity, and Discretion. Participants' practical considerations were incorporated into the service design, including the name choice of "Lifeguard Pharmacy", the strapline "Bringing Hope to Life", and the development of a "Client Flowchart" outlining how to welcome a client, arrange for a consultation, and then guide clients out of the pharmacy afterwards. CONCLUSIONS: Overall, the findings supported the development and introduction of this pharmacy-based intervention, which may help overcome barriers to help-seeking for DA or SI due to its sense of hope, accessibility, and discretion.

Characterizing Physical Intimate Partner Violence-Associated Injuries Among Adults in Low- and Middle-Income Countries: A Systematic Review.

Forty-two percent of women who experienced intimate partner violence (IPV) reported that their experience of IPV resulted in an injury. This review aims to review the existing literature from low- and middle-income countries (LMICs) on IPV-related injuries as well as identify IPV-related injury patterns and locations. A systematic electronic database search was conducted between August and September 2021 (Prospero ID: CRD42021281519). Five databases yielded 408 articles; 328 remained for title and abstract screening after duplicates were removed. Of the 59 eligible for full-text review, 19 articles were eligible for extraction. After quality assessment, 18 articles were included in the study. Most (56%) studies were observational studies. Studies represented 15 different countries. The majority of the studies (89%) had authors whose institutional affiliation was located in the country where the study took place. Soft tissue injuries were the most commonly reported injury type followed by fractures and burns. The most common injury locations were the head, neck, and face followed by both upper and lower limbs. The most commonly cited injury mechanism was bodily force. The findings of this study echo what has been written in the literature regarding IPV-related injury patterns from high-income countries (HICs). One limitation of this study is that the search only included literature published in English. The injury patterns identified in this article confirm the need for awareness and action on the part of both medical and surgical providers in order to best address IPV in LMICs.

Acute Health System-Level Interventions for Identification and Management of Domestic Abuse: Preliminary Interrupted Time Series Evaluation.

This preliminary interrupted time series analysis evaluated different interventions to improve identification of victim-survivors of domestic abuse in one U.K. National Health Service trust, focusing on emergency department, sexual health services and HIV care, and obstetrics and gynecology. This analysis demonstrated that while system-level interventions can improve identification of domestic abuse in clinical contexts, the exact nature of interventions most likely to be effective may vary in different clinical contexts. For example, none of the modeled interventions generated significant impacts in emergency department contexts, and estimates were close to the null in all cases, but routine inquiry demonstrated effectiveness in sexual health services, while implementation generated improved effectiveness in the obstetrics and gynecology setting.

Harnessing Health Information Technology in Domestic Violence in the United States: A Scoping Review.

Objectives: The following scoping review aims to identify and map the existing evidence for HIT interventions among women with DV experiences in the United States. And provide guidance for future research, and facilitate clinical and technical applications for healthcare professionals. Methods: Five databases, PubMed, EBSCOhost CINAHL, Ovid APA PsycINFO, Scopus and Google Scholar, were searched from date of inception to May 2023. Reviewers extracted classification of the intervention, descriptive details, and intervention outcomes, including physical safety, psychological, and technical outcomes, based on representations in the included studies. Results: A total of 24 studies were included, identifying seven web-based interventions and four types of abuse. A total of five studies reported safety outcomes related to physical health. Three studies reported depression, anxiety, and post-traumatic stress disorder as psychological health outcomes. The effectiveness of technology interventions was assessed in eight studies. Conclusion: Domestic violence is a major public health issue, and research has demonstrated the tremendous potential of health information technology, the use of which can support individuals, families, and communities of domestic violence survivors.

"Stop Giving Us What You Think We Need. Come to Us and Ask Us What We Need": Justice Perceptions Among Survivors of Domestic Abuse.

Justice is typically thought of as a product of the criminal legal system. However, prior research has found that survivors of domestic and sexual abuse may also value other factors outside of the legal system. This study explores perceptions of justice held by 96 survivors of domestic abuse. Responses to an online survey indicate that perceptions of justice are complex and multifaceted. Survivors often spoke of justice as accountability, restoration, postabuse support, and validation. The findings highlight the many justice considerations, and solely emphasizing criminal legal system outcomes may be misguided. Implications for additional research and practice are provided.

A Realist Evaluation of a "Whole Health" Response to Domestic Violence and Abuse in the UK.

Health Pathfinder is a multilevel system change intervention initiated to transform the health response to domestic violence and abuse in eight sites in England. The current study drew upon interviews with health professionals (n = 27) and victim-survivors (n = 20) to provide a realist account of how this intervention achieved its goals. Findings show that five change mechanisms explain why Health Pathfinder was effective as an ecological intervention: awareness, expertise, relationships, empowerment, and evidence. Positive progress in respect of each mechanism had meaningful impacts on victim-survivor experiences of enquiry, disclosure, and uptake of services and had the potential to meaningfully impact health inequities.

Did the First COVID-19 National Lockdown Lead to an Increase in Domestic Abuse in the U.K.'s Capital City of London?

On March 23, 2020, the United Kingdom went into national lockdown to stop the spread of COVID-19. In this paper, we examine whether a policy aimed at minimizing the health consequences of the pandemic had unintended negative consequences for domestic abuse. Using data from the Metropolitan Police in England we estimate the impact of lockdown on domestic abuse in the 32 boroughs that make up the London metropolitan area. Using a before and after approach, and controlling for other factors, we show an increase in the probability of being a victim of domestic abuse during lockdown similar in magnitude to the increase experienced over the Christmas holidays. However, the overall picture masks inequalities across groups: with women, younger and older people, and people of Asian, Arab, and Middle Eastern ethnicity subject to the highest increases, reflecting vulnerabilities and existing inequalities. Of the domestic abuse-related crimes, it is the most violent crimes that saw the greatest increases during lockdown. Once lockdown restrictions are eased, rates decline but remain slightly higher than prior to lockdown up to 3 months later. The results present a clear message for policy makers: a policy adopted to alleviate one problem, even in times of crisis, must factor in the impact this may have in other areas. Failure to do so in this situation, despite existing evidence linking domestic abuse to stress, confinement, and crisis situations prior to lockdown, has resulted in an increase in domestic violence in the U.K.'s capital city, during lockdown and beyond.

The Relation Between Domestic Violence and Professional, Contact Sports: It's Complicated.

Learning theories provide explanations for domestic violence; they can also aid in our understanding of the relation between contact sports and domestic violence. Notably, language used during sporting events and athletes' behaviors being rewarded both on and off the field can influence the behaviors of viewers. Adubato (2016) found a statistically significant relation between an increase in domestic violence arrests and the kick-off times of Philadelphia Eagles football games. Here, we replicate and extend this work to Chicago and Boston. We examine quantitative, hourly data from the Chicago and Boston Police Departments and compare mean domestic violence arrests in an 8-hour period from the average Bears' and Patriots' (football) kick-off times, respectively, to the same time period on non-football Sundays, major holidays, and days of rival Blackhawks' and Bruins' (hockey) games, respectively. Results show a significant difference in average domestic violence arrests between hockey games and non-football Sundays in Chicago only. This work highlights the importance of context in examining domestic violence nationally and has implications for domestic violence policies in professional sports' organizations.

Violence against older people and associations with mental health: A national probability sample survey of the general population in England.

BACKGROUND: Official estimates of violence prevalence in England exclude older people. There are few studies of elder abuse and these excluded violence from acquaintances and strangers and lack comparability with younger adults. OBJECTIVES: To estimate prevalence of past-year violence victimisation in older people, identify factors associated with violence in older age, quantify the extent to which experience of violence in older people was associated with common mental disorder (CMD). STUDY DESIGN/METHODS: Analysis of a 2014 general population probability sample survey of 2570 adults aged 60+ and 4484 16-59 year olds. Modified version of the Conflict Tactics Scale measured domestic violence and List of Threatening Experiences captured bullying and serious assault. CMD were assessed using the revised Clinical Interview Schedule. Associations were examined using regression models adjusted for childhood victimisation and other adversities. RESULTS: 2.0 % (n = 52,CI:1.4-2.6) of older people experienced violence in the past year, with intimate partner violence the most prevalent form. Older people of non-white ethnicity, those who were socially isolated or lonely, and the formerly married were more likely to experience violence. Violence was associated with CMD in older people (adjusted odds ratio 2.2, CI:1.0-4.8), controlling for impairments, adversities and other factors. CONCLUSION: Violence, especially from an intimate partner, is evident in later life and strongly associated with poor mental health. Better instruments for the identification of violence and abuse in older people in research and safe enquiry in practice settings are needed, with recognition of and attention to ethnic and other inequalities among older people in exposure.

The Impacts of Intervention Practices With Abused Women in Domestic Violence Shelters: An Integrative Review of the Literature.

This article presents the results of an integrative review of the literature on domestic violence shelter practices, drawing upon 23 studies conducted in five countries from 25 peer-reviewed articles published between 2005 and 2020. The purpose of the review was to understand the impacts of intervention practices on abused women during their stay at a domestic violence shelter. Seven inclusion criteria were used to assess the studies included in the review. A thematic analysis revealed seven themes, divided into two main categories: formal interventions and practices related to shelter culture. These results highlight important implications for policy, research, and practices in domestic violence shelters that are discussed in this article.

Tools for the identification of victims of domestic abuse and modern slavery in remote services: A systematic review.

OBJECTIVE: To explore the technology-based tools available for supporting the identification of victims of domestic abuse and modern slavery in remote services and consider the benefits and challenges posed by the existing tools. METHODS: We searched six academic databases. Studies were considered for inclusion if they were published in English between 2000 and 2023. The QuADS quality appraisal tool was used to assess the methodological quality of included studies. A narrative synthesis was conducted using the convergent integrated approach. RESULTS: Twenty-four studies were included, of which two were professional guidelines; each reported on a distinct technology-based tool for remote services. All tools related to domestic abuse and 21 focused on screening for intimate partner violence among young and mid-life women (18-65) in high-income countries. The review did not identify tools that support the identification of victims of modern slavery. We identified eight common themes of tool strengths, highlighting that the remote approach to screening was practical, acceptable to victims, and, in some circumstances, elicited better outcomes than face-to-face approaches. Five themes pointed to tool challenges, such as concerns around privacy and safety, and the inability of computerised tools to provide empathy and emotional support. CONCLUSIONS: Available technology-based tools may support the identification of victims of domestic abuse by health and social care practitioners in remote services. However, it is important to be mindful of the limitations of such tools and the effects individuals' screening preferences can have on outcomes. Future research should focus on developing tools to support the identification of victims of modern slavery, as well as empirically validating tools for screening during remote consultations.

Recognising and responding to non-fatal strangulation in domestic abuse.

Victims/survivors (the authors use this term throughout the article but acknowledge that individuals may use various terms to describe their experiences) of non-fatal strangulation associated with domestic abuse are at risk of further serious harm or death, but often do not disclose the assault. In addition, some of the signs and symptoms are not immediately apparent or obvious. Nurses have a professional responsibility to respond to suspicions about and/or disclosure of any type of domestic abuse by initiating safeguarding and protection procedures and must provide effective care. This article discusses non-fatal strangulation in domestic abuse, including the presenting signs and symptoms and barriers to disclosure, and describes the role of the nurse. The authors include a fictional case study to demonstrate the type of situation nurses may experience when they encounter a victim/survivor of non-fatal strangulation.

Judicial Actors' Understanding of the Mental Health Impacts of Intimate Partner Violence: A Scoping Review.

Intimate partner violence (IPV) is a global public health issue that has grave physical and mental health consequences for millions of women. The judicial system plays a critical role in responding to IPV principally through the criminal justice system, family law, and/or child welfare jurisdictions. However, victims/survivors who interact with the legal system report negative experiences. An under-researched area of scholarship is the degree to which judicial actors understand the mental health impacts of IPV on victims/survivors and how they apply that knowledge in practice. This scoping review aimed to identify and synthesize existing scholarship on judicial actors' understanding of the mental health impacts of IPV on women survivors. We searched 10 databases (Medline, Scopus, PubMed, PsycINFO, EMBASE, Westlaw, HeinOnline, the Cochrane Library, and the Joanna Briggs Library databases) for studies published between 2000 and 2023. A total of 27 studies were included in the review. We identified five main themes, including: awareness of survivors' experiences, gap in judicial actors' knowledge, understanding of perpetrator tactics and risk factors, disclosing mental health problems, training, and guidance. The review highlights significant gaps in judicial actors' understanding of this issue and recommends strategies to increase the awareness and understanding of IPV among judicial actors. The findings can be used to justify future research to better understand the training and development needs of judicial actors to improve their level of awareness of the dynamics and impact of IPV and to make policy and practice recommendations to build the capacity of the judicial workforce.

Child-to-Parent Violence and Abuse: A Scoping Review.

Child-to-parent violence and abuse (CPVA) is a pattern of behavior where a parent or carer is abused by a child they are caring for. The main body of work on CPVA is relatively recent and evolving at pace. This scoping review explores the characteristics of parents, carers, children, and young people in cases of CPVA, the characteristics of CPVA, and barriers to and facilitators of help-seeking in cases of CPVA. The scoping review did not exclude any studies on the basis of geographical location or date of the study. The databases Scopus, CINAHL, Web of Science, Medline, and PubMed were searched in August 2023, along with hand searches of key journals. A total of 145 reports were included in the review, selected for their relevance to the scoping review questions. The main findings were: (a) the field of CPVA is rapidly growing, doubling in the last decade but with a predominance of quantitative studies; (b) there is no agreed universal definition; (c) children and young people with disabilities; who identify as trans or nonbinary gender, or who are adopted or fostered, are almost completely absent from the existing research; (d) there is very limited research focusing on protective factors or on help-seeking.

Randomised pilot and feasibility trial of a group intervention for men who perpetrate intimate partner violence against women.

BACKGROUND: There is a need for robust evidence on the effectiveness and cost-effectiveness of domestic abuse perpetrator programmes in reducing abusive behaviour and improving wellbeing for victim/survivors. While any randomised controlled trial can present difficulties in terms of recruitment and retention, conducting such a trial with domestic abuse perpetrators is particularly challenging. This paper reports the pilot and feasibility trial of a voluntary domestic abuse perpetrator group programme in the United Kingdom. METHODS: This was a pragmatic individually randomised pilot and feasibility trial with an integrated qualitative study in one site (covering three local-authority areas) in England. Male perpetrators were randomised to either the intervention or usual care. The intervention was a 23-week group programme for male perpetrators in heterosexual relationships, with an average of three one-to-one sessions, and one-to-one support for female current- or ex-partners delivered by third sector organisations. There was no active control treatment for men, and partners of control men were signposted towards domestic abuse support services. Data were collected at three-monthly intervals for nine months from male and female participants. The main objectives assessed were recruitment, randomisation, retention, data completeness, fidelity to the intervention model, and acceptability of the trial design. RESULTS: This study recruited 36 men (22 randomly allocated to attend the intervention group programme, 14 to usual care), and 15 current- or ex-partners (39% of eligible partners). Retention and completeness of data were high: 67% of male (24/36), and 80% (12/15) of female participants completed the self-reported questionnaire at nine months. A framework for assessing fidelity to the intervention was developed. In interviews, men who completed all or most of the intervention gave positive feedback and reported changes in their own behaviour. Partners were also largely supportive of the trial and were positive about the intervention. Participants who were not allocated to the intervention group reported feeling disappointed but understood the rationale for the trial. CONCLUSIONS: It was feasible to recruit, randomise and retain male perpetrators and female victim/survivors of abuse and collect self-reported outcome data. Participants were engaged in the intervention and reported positive benefits. The trial design was seen as acceptable. TRIAL REGISTRATION: ISRCTN71797549, submitted 03/08/2017, retrospectively registered 27/05/2022.

Whose Expertise Counts? Women Survivors' Experiences With Psychologists.

Many women who experience intimate partner violence seek the expertise of psychologists to support their healing. However, there is a gap in the research about what women want from their psychologists. We interviewed 20 women survivors who had seen psychologists. Using reflexive thematic analysis, we constructed three themes: see all of me, see me for my expertise, and don't impose an agenda on me. We found that often psychologists acted as experts imposing their own agendas, rather than supporting survivors to make their own decisions. We discuss this in relation to the link between knowledge and power through dominant social science discourses and explore how resistance to this dominant discourse was taken up by many women.

Harmonising outcome measurement for child focused domestic abuse interventions. Reflections on the development and implementation of a core outcome set.

There is appetite in the UK to better measure the impact of domestic violence and abuse (DVA) interventions on children. The spread of outcomes-based commissioning means outcome measurement is no longer just the territory of academic researchers but is now firmly within the purview of practitioners and policy makers. However, outcomes measured in trials only partially represent the views of those delivering and using services with respect to how success should be defined and captured. Even within trials there is huge inconsistency in the definition and measurement of important endpoints. This yields a body of evidence that is difficult to make sense of, defeating the ends for which it was produced - to improve the response to children and families who have experienced abuse. Development of Core Outcome Sets (COS) is seen as a solution to this problem, by establishing consensus across key stakeholder groups regarding a minimum standard for outcome measurement in trials, and increasingly in service delivery contexts. To date COS development has addressed outcomes relating to health conditions or interventions, with limited application to public health challenges. We reflect on our efforts to develop a COS to evaluate psychosocial interventions for children and families experiencing DVA. We highlight the value of COS development as a mechanism for improving evidence quality and the response to families experiencing abuse. Finally, we make recommendations to researchers and COS guideline developers to support this broader application of COS methodology.

Prevalence and risk factors of postpartum depression in sub-Himalayan region.

Background: Postpartum depression (PPD) is a common problem faced by women after childbirth. The adverse effects of PPD upon the maternal-infant relationship and child development reinforce the need for early identification and effective treatment models. This study intends to add to the existing knowledge about the prevalence of PPD and its associated risk factors in the hilly region in Himachal Pradesh. Methods: A hospital-based cross-sectional study was conducted on 426 women presenting for a postpartum visit at 6 weeks postpartum. Sociodemographic characteristics were recorded on a pretested questionnaire. Women were screened for postpartum depression using a validated EPDS (Edinburgh postnatal depression scale) prestructured questionnaire with 10 questions. Women were divided into two groups based on screening results. Results: The overall prevalence of PPD in the study was 17.4%. Out of sociodemographic factors, age (0.010) and family structure (0.008) were found to be significant. Nuclear family women were more prone to PPD. Domestic abuse (<0.001) is also a leading factor for PPD. By comparing obstetric and gender issues, it was found that the total number of previous living children (p-value <0.001), gender of previous living children (<0.001), and gender of newborns (<0.001) are the major determining factors of PPD. Another factor that was significantly related to PPD was an unwanted pregnancy. Conclusions: We have found a high prevalence of PPD in our region that does not have screening protocols for the screening of such patients. We, therefore, propose routine screening for postpartum depression at 6 weeks postpartum.

Mental health conditions and utilisation of mental health services by survivors of physical intimate partner violence in Portugal: Results from the WHO world mental health survey.

The aim of this article is to study mental health conditions among survivors of severe physical intimate partner violence (IPV) and their utilisation of mental health services. This study is an integrated part of the World Mental Health Survey Initiative-Portugal, for which data was collected from a nationally representative adult sample using well-validated scales. Logistic regression models were used in the analysis. The most common statistically significant mental health conditions among IPV survivors were suicide ideation, PTSD, major depressive episode, and generalised anxiety disorder. More than one in three survivors developed PTSD. Suicide ideation was likely to occur after first experiencing IPV. Almost a half of survivors received specialised mental health treatment; in most cases, delivered by a psychiatrist. Over 60 % addressed their mental health issues consulting general physicians or other healthcare professionals. Those who experienced family violence in childhood had greater odds of also experiencing IPV; survivors of IPV with this experience were more likely to receive mental health treatment. The need to promote greater awareness and competencies of not only mental health professionals but also of general physicians and other healthcare professionals to provide support more effectively to survivors of any type of IPV deserves to be emphasised.

Power and control, resistance and survival: A systematic review and meta-synthesis of the qualitative literature on intimate partner violence against transgender individuals.

Transgender (trans) individuals experience intimate partner violence (IPV) at elevated levels compared to cisgender individuals. Traditional theoretical understandings of IPV as men's patriarchal domination of women, and later, broader theories in which IPV is conceptualized as the relatively privileged partner enacting domination over the relatively oppressed partner, do not fully capture the totality of IPV experiences, including how IPV is perpetrated against trans individuals. We conducted a systematic review and qualitative meta-synthesis of the qualitative and theoretical literatures on IPV against trans individuals (N = 37 articles and books) to generate novel IPV theory inclusive of trans individuals' experiences. We identified five major themes: (1) societal context of IPV, (2) IPV tactics and types, (3) help-seeking, (4) consequences of IPV, and (5) proposed interventions for victims. Synthesizing across themes, we offer a novel theoretical model that demonstrates how abusers can leverage structural discrimination and vulnerabilities against trans victims, regardless of the abuser's own identities. We identify individual power and control tactics abusers use, including identifying a category of IPV that we term leveraging vulnerability, which involves abusers weaponizing their own vulnerabilities to avoid accountability. Reducing IPV in trans communities requires expanding current IPV theory to include trans victims, recognition of a wider range of abuse tactics, and structural interventions that promote the respectful treatment of trans individuals. Our theoretical model of IPV "centers the margins" to make trans victims' experiences, and indeed all victims whose experiences fall outside normative scripts, more legible.