"And then the person sort of just drops off the radar ": barriers in the transition from hospital to community-based care among survivors of intimate partner violence in Metropolitan Atlanta.

Introduction: Hospitals and community-based organizations (CBOs) provide the service-base for survivors of intimate partner violence (IPV), particularly those in acute crisis. Both settings face discrete challenges in meeting survivors' needs. In hospitals these challenges include the pressures of a fast-paced work setting, and a lack of trauma-informed and survivor-centered care. Connections to community care are often unmeasured, with relatively little known about best practices. Often IPV survivors who receive hospital care fail to connect with community-based services after discharge. Despite the critical role of CBOs in supporting IPV survivors, there is limited research examining the perspectives and insights of CBO staff on the challenges and opportunities for improving care coordination with hospitals. The purpose of this study was to address this knowledge gap by characterizing CBO staff perceptions of IPV care coordination between hospital and community-based organizations in Metropolitan Atlanta. Methods: We used a qualitative study design to conduct a cross-sectional examination of the perceptions and experiences of staff working at CBOs serving IPV survivors in Metropolitan Atlanta, Georgia. The adapted in-depth interview (IDI) guide was used to explore: (1) IPV survivor experiences; (2) Survivors' needs when transitioning from hospital to community-based care; (3) Barriers and facilitators to IPV care coordination; and (4) Ideas on how to improve care coordination. Data analysis consisted of a thematic analysis using MAXQDA Analytics Pro 2022. Results: Participants (N = 14) included 13 women and one man who were staff of CBOs serving IPV survivors in Metropolitan Atlanta. CBO staff perceived that: (1) IPV survivors face individual-, organizational-, and systems-level barriers during help seeking and service provision; (2) Care coordination between hospitals and CBOs is limited due to siloed care provision; and (3) Care coordination can be improved through increased bidirectional efforts. Conclusion: Our findings highlight the multi-level barriers IPV survivors face in accessing community-based care following medical care, the limitations of existing hospital-CBO coordination, and opportunities for improvement from the perspectives of CBO staff. Participants identified silos and inconsistent communication/relationships between hospital and CBOs as major barriers to care connections. They also suggested warm handoffs and a Family Justice Center to support care connection.

Prevalence, Pattern and Effect of Intimate Partner Violence against Women in Abeokuta, South West Nigeria.

BACKGROUND: The world over, women are victims of violence in close and intimate relationships where they are expected to be safe and protected. Intimate partner violence (IPV) significantly impacts the physical and mental well-being of those affected. This study assessed the prevalence, pattern and effects of IPV amongst women in Abeokuta South Local Government Area (LGA) of Ogun State, South West Nigeria. MATERIALS AND METHODS: This community-based cross-sectional study was carried out in Abeokuta - South LGA in Ogun State. Data were collected from 339 women in intimate relationships using a structured interviewer-administered questionnaire. Ethical approval (HPRS/381/471) was obtained from the Ogun State Ministry of Health Ethical Review Committee. Analysis was done using IBM® SPSS version 23, and results were presented in frequencies and proportions using tables and charts. RESULTS: About three-quarters (73.2%) of the 339 respondents had experienced one form of IPV. Psychological/emotional violence, 224 (66.1%), and physical violence, 161 (47.5%), were the study's most commonly reported forms of violence. Amongst those affected, 186 (54.9%) were 'insulted', 87 (25.7%) were 'embarrassed in public' and another 124 (36.6%) were slapped. The effects of IPV reported were bruises/lacerations, unwanted pregnancies, sexually transmitted infections and attempted suicide. CONCLUSION: The prevalence of IPV of all forms were high in the studied population. Therefore, the government needs to create more awareness of the problem and promote investments in women's empowerment to reverse this trend.

Continuous chains: childhood maltreatment and intimate partner violence victimization among displaced women in a war context.

BACKGROUND: Childhood victimization has been associated with long-term psychological effects and an increased risk of being victimized in later life. Previous research has primarily focused on sexual abuse during childhood, and a wide range of consequences have been identified. However, a significant gap remains in our understanding of the complex interaction between different forms of childhood abuse and violence in later life, particularly in the context of broader social stressors such as armed conflict and displacement. METHODS: This study examines the association between exposure to different types of childhood maltreatment in the context of family and intimate partner violence (IPV) among displaced women living in refugee camps in northern Iraq. Structured interviews were conducted by trained female psychologists with 332 women aged between 20 and 62 years. RESULTS: Results indicated that over one-third of the participating women reported experiencing at least one occurrence of IPV by their husbands within the past year. In addition, participants reported experiences of different types of maltreatment (physical, emotional, and sexual violence and physical and emotional neglect) perpetrated by family members in their childhood. While all forms of childhood maltreatment showed an association with IPV within the past year, only emotional childhood maltreatment was found to be a significant predictor of IPV in a multivariate analysis. CONCLUSION: The study highlights the ongoing impact of child maltreatment and its contribution to increased vulnerability to IPV victimization in later life. In addition, this study describes the specific cultural and contextual elements that contribute to IPV in refugee camps.

Intimate partner violence after childbirth: an explanatory sequential mixed-methods study protocol.

BACKGROUND: Intimate partner violence (IPV) is the most common form of violence against women. Postpartum IPV refers to any type of IPV that occurs up to one year after childbirth and has many adverse impacts on mothers and their children. Considering the lack of sufficient information on the prevalence and factors related to IPV after childbirth in Iran, this study aimed to evaluate the frequency and severity of IPV, its different forms, and psychosocial factors related to IPV, as well as to explore how IPV is perceived among mothers one year after childbirth. METHODS: An explanatory sequential mixed-methods design was used to conduct this study in two phases. The first phase is a cross-sectional study that will be performed on postpartum mothers who have a one-year-old child referred to health care centers in the southern region of Tehran, Iran, with the aim of determining the prevalence of IPV and its related factors. The second phase is a qualitative conventional content analysis study with the purpose of exploring women's experiences and perceptions of IPV and its preventive or protective factors. Purposive sampling will be used. Based on the results of the quantitative phase, mothers who are at the two ends of the IPV spectrum (based on their total Conflict Tactics Scale (CTS-2) scores) will be selected, and in-depth and semistructured interviews will be conducted with them. Finally, the researchers will provide an interpretation of the quantitative results using qualitative data. DISCUSSION: This is the first study that uses a mixed methods approach to explain different dimensions of IPV, its related factors, and mothers' perceptions of it. By providing a better understanding of this phenomenon, it is hoped that the results of this research will be used by policymakers and officials of educational and cultural systems to plan and provide effective interventions, enact laws, and present educational and cultural programs to prevent IPV after childbirth. ETHICAL CODE: IR.TUMS.FNM.REC1400.200.

Intimate partner violence is the most common form of violence against women, with a higher prevalence in Asian and Eastern Mediterranean countries, including Iran. The period after childbirth is a stressful and anxiety-provoking event due to the increased physical, psychological, social, and economic needs of parents, leading to intimate partner violence. Studies show that women who experience violence after childbirth face many physical, sexual, and emotional problems. Additionally, it will have a negative impact on their baby. Many factors can lead to intimate partner violence, among which psychological factors are among the most important. Therefore, we decided to perform a study in two phases with the aim of determining the prevalence and factors related to intimate partner violence. In the first phase, we will study Iranian women who have a one-year child living in southern Tehran city and ask them to complete questionnaires related to intimate partner violence. In the second phase, we will conduct an interview with women who have experienced violence after childbirth to obtain more information about the factors involved.

Comparison of maternal-fetal attachment, anxiety, depression, and prevalence of intimate partner violence in Iranian women with intended and unintended pregnancy: a cross-sectional study.

BACKGROUND: Unintended pregnancies and intimate partner violence can adversely affect women, infants, and their psychological well-being. The study aimed to compare depression, anxiety, maternal-fetal attachment, and the prevalence of intimate partner violence between women with and without unintended pregnancies in Tabriz, Iran. The study sought to address the lack of research on this topic in the Iranian context. METHODS: This cross-sectional study was conducted on 486 pregnant women attending health centers in Tabriz City between 2022 and 2023. A cluster sampling method was utilized, and data were gathered through the administration of socio-demographic, Maternal Fetal Attachment, Edinburgh Postnatal Depression, World Health Organization Domestic Violence, and Pregnancy Anxiety instruments. A general linear model (GLM), controlling for potential confounding variables, was used to compare anxiety, depression, and maternal-fetal attachment between the two groups. Multivariable logistic regression analysis, also controlling for potential confounding variables, was employed to compare the prevalence of domestic violence between the two groups. RESULTS: The results of the adjusted GLM indicated that women with unintended pregnancies had significantly lower maternal-fetal attachment (Adjusted mean difference (AMD):-9.82, 95% CI:-12.4 to -7.15 ; p < 0.001)), higher levels of depression (AMD: 2.89; CI: 1.92 to 3.86 ; p < 0.001), and higher levels of anxiety (MD: 5.65; 95% CI: 3.84 to 7.45; p < 0.001) compared to women with intended pregnancies. During pregnancy, 40% of women with unintended pregnancies and 19.2% of women with intended pregnancies reported experiencing at least one form of physical, sexual, or emotional violence. The results of the adjusted multivariable logistic regression revealed that women with unintended pregnancies had a significantly higher odds of experiencing emotional violence (adjusted odds ratio [aOR]: 2.94; 95% CI: 1.64 to 5.26; p < 0.001), sexual violence, (aOR: 2.25; 95% CI: 1.32 to 3.85; p = 0.004), and physical violence (aOR: 2.38; 95% CI: 1.50 to 3.77; p < 0.001) compared to women with intended pregnancies. CONCLUSIONS: The study found that women with unintended pregnancies had lower levels of maternal-fetal attachment, higher levels of anxiety and depression, and a high prevalence of intimate partner violence, including physical, sexual, and emotional violence, compared to women with intended pregnancies. These results emphasize the importance of implementing policies aimed at reducing unintended pregnancies.

Assessing attitudes towards violence against women and girls, their determinants and health-seeking behaviour among women and men in South Sudan: a cross-sectional national survey.

OBJECTIVE: Investigating attitudes accepting two categories of violence against women and girls (VAWG) (intimate partner violence-IPV-and other expressions of VAWG) and their association with seven demographic/social determinants and health-seeking behaviours in South Sudan. DESIGN: Cross-sectional study using data from the South Sudan National Household Survey 2020. SETTING: South Sudan. PARTICIPANTS AND METHODS: 1741 South Sudanese women and 1739 men aged 15-49 years; data captured between November 2020 and February 2021 and analysed using binary logistic regression. RESULTS: People with secondary or higher education displayed attitudes rejecting acceptance of IPV (OR 0.631, 95% CI 0.508 to 0.783). Women and men living in states with more numerous internally displaced people (IDP) or political/military violence had attitudes accepting IPV more than residents of less violence-affected regions (OR 1.853, 95% CI 1.587 to 2.164). Women had a higher odd of having attitudes accepting IPV than men (OR 1.195, 95% CI 1.014 to 1.409). People knowing where to receive gender-based violence healthcare and psychological support (OR 0.703, 95% CI 0.596 to 0.830) and with primary (OR 0.613, 95% CI 0.515 to 0.729), secondary or higher education (OR 0.596, 95% CI 0.481 to 0.740) displayed attitudes rejecting acceptance of other expressions of VAWG. People residing in states with proportionately more IDP and who accepted IPV were more likely to have attitudes accepting other expressions of VAWG (OR 1.699, 95% CI 1.459 to 1.978; OR 3.195, 95% CI 2.703 to 3.775, respectively). CONCLUSION: Attitudes towards accepting VAWG in South Sudan are associated with women's and men's education, gender, residence and knowledge about health-seeking behaviour. Prioritising women's empowerment and gender transformative programming in the most conflict-affected areas where rates of VAWG are higher should be prioritised along with increasing girls' access to education. A less feasible strategy to decrease gender inequalities is reducing insecurity, military conflict, and displacement, and increasing economic stability.

Uncovering community needs regarding violence against women and girls in southern Ethiopia: An explorative study.

BACKGROUND: Violence against women and girls (VAWG) is a significant global public health problem and a violation of human rights experienced by one in three women worldwide. This study explores community perceptions of and responses to VAWG and challenges in accessing support services among female violence survivors in Arbaminch City. METHODS: We adopted a phenomenological explorative qualitative study design. A total of 62 participants including female violence survivors, religious leaders, service providers, police, women, and men in participated in interviews, focus group discussions, and observations in August 2022. Participants were selected purposively, and the findings were analyzed thematically. We applied data source and respondent triangulation to increase the findings' trustworthiness. RESULTS: Community perceptions of VAWG, specifically of intimate partner violence (IPV) and non-partner sexual violence (NPSV), varied depending on gender, age, and social position. IPV and NPSV were normalized through tolerance and denial by young and married men, while resistance to all forms of violence was common among women. Survivors of violence responded to the act of violence by leaving their homes, separating from their husbands, or taking harsh actions against their husbands, such as murder. Support for VAWG survivors was available through health care, free legal services, and a temporary shelter. Yet factors ranging from individual to societal levels, such as fear, lack of knowledge, lack of family and community support, and social and legal injustice, were barriers to accessing existing services. Nonetheless, violence survivors desired to speak about their experiences and seek psychosocial support. CONCLUSIONS: Our qualitative evidence gathered here can inform tailored VAWG prevention and response services such as interventions to shift social norms and the perception towards VAWG among different population group through raising awareness in schools, health care settings, faith-based venues, and using social media.

Is household food insecurity associated with social attitudes accepting of physical intimate partner violence against women in Nigeria? A population-level cross-sectional study.

OBJECTIVES: Although prior research suggests that household food insecurity (HFI) is associated with intimate partner violence against women (IPVAW), there is a paucity of research regarding its impact on attitudes accepting of IPVAW. We examined whether individuals experiencing HFI are more likely to accept physical IPVAW, whether the association varies by gender and whether it persists when models are adjusted for other confounders. DESIGN: Population-level cross-sectional analysis. SETTING: This study used the round 6 of the UNICEF-supported Multiple Indicator Cluster Survey (MICS) conducted in Nigeria. PARTICIPANTS: The sample included 23 200 women and 7087 men, aged 15-49 years, who were currently married or in union and responded to the attitudes towards domestic violence and HFI modules in the MICS. OUTCOME MEASURES AND STATISTICAL ANALYSIS: Attitudinal acceptance of physical IPVAW (specific forms and overall). We conducted weighted multivariable logistic regression to estimate the OR and their corresponding 95% CIs of the associations of food insecurity (FI) with attitudinal acceptance of physical IPVAW, adjusting for potential confounders. RESULTS: Multivariable results indicate that severe HFI was positively associated with attitudinal acceptance physical IPVAW in at least one of the scenarios presented (aOR=1.11; 95% CI: 1.01 to 1.22). Individuals experiencing severe HFI had higher odds of physical IPVAW acceptance when wife neglects the children (aOR=1.15; 95% CI: 1.02 to 1.31). The likelihood of physical IPVAW acceptance if wife burns the food was lower for women experiencing moderate HFI (aOR=0.86; 95% CI: 0.74 to 0.99). Stratified analyses indicated heterogeneity in the association between HFI and attitudinal acceptance of physical IPVAW by gender. CONCLUSION: Our findings indicate that, depending on the severity, FI status may be associated with attitudinal acceptance of physical IPVAW, with potential variations based on gender. The public health implications are discussed.

Attitudes of women towards intimate partner violence in Guyana: A cross-sectional analytical study.

BACKGROUND: To assess the attitudes of women towards intimate partner violence (IPV) in Guyana. METHODS: We used national data from the publicly available Multiple Indicator Cluster Survey (MICS) conducted in Guyana in 2019 for women aged 15 to 49 years. The prevalence of women who agreed that a husband is justified in beating his wife was analyzed. Respondent reasons included if she: "goes out without telling him", "neglects the children", "argues with him", "refuses sex with him", "burns the food", "has another partner", "stays out late/partying", "refuses to cook or clean", "overspends", and/or "he doesn't have access to her cellphone". Descriptive analyses were carried for all the variables. Logistic regression was used to identify factors associated with these 10 respondent reasons, separately and in combination. RESULTS: The overall prevalence of women's attitudes justifying IPV against women if there was a 'yes' response to any of the 10 reasons was 17.9% (95%CI: 16.6-19.3%), and varied from 2.7% if she "goes out without telling him", "burns the food", or "overspends" to 10.0% if she "has another partner". This prevalence ranged from 10.2% in urban areas to 19.3% in rural areas (p<0.001), and from 16.1% in coastal to 30.1% in interior areas (p<0.001). Similarly, 25.9% of women from the poorest household agreed that a husband has the right in beating his wife for any of the 10 reasons compared to 11.6% of the richest women (11.6%) (p<0.001). Rural place of residence, ethnicity, geographic region, level of education, wealth quintile, ever used of a computer, and frequency of listening to the radio were significant factors associated with women's attitudes justifying IPV against women (p<0.05). CONCLUSION: Over one-sixth of the respondents agreed that a husband was justified in committing IPV against women in Guyana. Public health programs focusing on geographic locations, ethnicity, and economic status must be implemented to change attitudes justifying IPV and reduce this significant public health challenge.

Effectiveness of a community-based participatory health promotion intervention to address knowledge, attitudes and practices related to intimate partner violence: a quasi-experimental study.

BACKGROUND: Intimate partner violence is the most common form of violence experienced by women. It has detrimental consequences. A range of determinants cause intimate partner violence and to reduce it, effective interventions are required to address the determinants. Health promotion interventions have been recommended as effective to enable people to control over the determinants and to improve health. Hence, a community based participatory health promotion intervention was developed and tested in a selected study setting. The objective was to evaluate the effectiveness of a health promotion intervention in terms of addressing knowledge, attitudes and practices related to intimate partner violence. METHODS: A quasi-experimental study was conducted by recruiting ninety women aged 15 to 49 years separately from two health administrative areas identified as the intervention area and the control area from the Kandy district of Sri Lanka. A pretested interviewer-administered questionnaire was used in both pre- and post-assessments. Selected groups of women from the intervention area were facilitated with a health promotion intervention to improve knowledge, attitudes and practices related to intimate partner violence. To evaluate the effectiveness of the intervention descriptive summaries and bivariate analysis were used. RESULTS: The response rate was 90.9% (N = 90) during the pre-assessment and 87.9% (n = 87) and 82.8% (n = 82) from the intervention and control areas, respectively, during the post-assessment. Statistically significant improvement was reported in the total mean score comprising knowledge, attitudes, practices and identification of determinants from 59.6 to 80.8 in the intervention area [Pre-assessment: Mean = 59.6 (standard deviation-SD) = 17.5; Post-assessment: Mean = 80.8, SD = 19.0; p < 0.001) compared to the improvement in the control area from 62.2 to 63.0 (Pre-assessment: Mean = 62.2, SD = 17.3; Post-assessment: Mean = 63.0, SD = 18.9; p = 0.654). CONCLUSIONS: The intervention was effective to improve knowledge, attitudes and practices related to intimate partner violence. Hence, the present approach can be used in similar contexts to address the knowledge, attitudes and certain practices related to intimate partner violence.

Telemedicine and virtual healthcare for survivors of sexual assault and intimate partner violence: A qualitative study.

BACKGROUND: Survivors of sexual assault and intimate partner violence often face many challenges in seeking/receiving healthcare and are often lost to follow up. OBJECTIVES: Our study objectives are to evaluate the feasibility, acceptability, and satisfaction of using telemedicine technology among sexual assault and intimate partner violence patients who present to a Canadian Emergency Department. DESIGN: Qualitative research was conducted using a thematic approach. METHODS: Patients were identified from a case registry of all sexual assault and intimate partner violence cases seen between 1 April 2020 and 31 March 2022 from an emergency department of a large Canadian hospital. Qualitative trauma-informed interviews were conducted with consenting participants. Thematic qualitative analyses were performed to investigate barriers and drivers of telemedicine for follow-up care. RESULTS: Of the 1007 sexual assault and intimate partner violence patients seen during the study timeframe, 180 (8%) consented to be contacted for future research, and 10 completed an interview regarding telemedicine for follow-up care. All participants were cisgendered women, 5 (50%) experienced sexual assault, 6 (60%) physical assault, and 3 (30%) verbal assault. All knew their assailant, and 6 (60%) were assaulted by a current or former intimate partner. Three themes emerged as drivers of telemedicine use: increased comfort, increased convenience, and less time required for the appointment. Three thematic barriers to telemedicine use included lack of privacy from others, lack of safety from their assailant, and pressure to balance competing tasks during the appointment. CONCLUSION: This study illustrated that telemedicine for sexual assault and intimate partner violence follow-up care is feasible, acceptable, and can improve patient satisfaction with follow-up care. Ensuring safety and privacy are key considerations when offering telemedicine as an appropriate option for survivors.

A qualitative analysis of telemedicine and virtual healthcare for survivors of sexual assault and intimate partner violenceWhy was the study done? Sexual assault and intimate partner violence are prevalent issues in our society. More than 3/10 Canadian women have been sexually assaulted at least once since the age of 15 years and more than 4/10 Canadian women have experienced IPV in their lifetime. Survivors face many obstacles to receiving care after sexual assault and intimate partner violence and are often lost to follow up.What did the researchers do?The researchers studied the acceptability, feasibility, and satisfaction of using telemedicine technology among sexual assault and intimate partner violence survivors who presented to a Canadian Emergency Department. Sexual assault and intimate partner violence survivors were interviewed individually about their experience receiving follow-up care via telemedicine. The interviews were done using a trauma-informed approach, and data analyses were done to explore the barriers and drivers of telemedicine for follow-up care.What did the researchers find?The total number of interviews was 10, and all participants were cisgendered women. All knew their assailant and six were assaulted by a current or former intimate partner. Survivors found that telemedicine was an accessible way to have a follow-up appointment and were mostly satisfied with their experience. Three major drivers to using telemedicine included increased comfort being at home in their own space, increased convenience as they did not have to leave their house to have the appointment, and less time required for the appointment. Three major barriers to using telemedicine included lack of privacy from others during the appointment, pressure to balance competing tasks during the appointment, and lack of safety from their assailant.What do the findings mean?This study has shown that follow-up care for sexual assault and intimate partner violence survivors using telemedicine can be feasible, acceptable, and can improve patient satisfaction. However, it is important to consider factors such as safety and privacy on an individual basis when offering telemedicine as an option for follow-up care for survivors.

A global review of the impact on women from men's alcohol drinking: the need for responding with a gendered lens.

BACKGROUND: Global evidence shows that men's harmful alcohol use contributes to intimate partner violence (IPV) and other harms. Yet, interventions that target alcohol-related harms to women are scarce. Quantitative analyses demonstrate links with physical and verbal aggression; however, the specific harms to women from men's drinking have not been well articulated, particularly from an international perspective. AIM: To document the breadth and nature of harms and impact of men's drinking on women. METHODS: A narrative review, using inductive analysis, was conducted of peer-reviewed qualitative studies that: (a) focused on alcohol (men's drinking), (b) featured women as primary victims, (c) encompassed direct/indirect harms, and (d) explicitly featured alcohol in the qualitative results. Papers were selected following a non-time-limited systematic search of key scholarly databases. RESULTS: Thirty papers were included in this review. The majority of studies were conducted in low- to middle-income countries. The harms in the studies were collated and organised under three main themes: (i) harmful alcohol-related actions by men (e.g. violence, sexual coercion, economic abuse), (ii) impact on women (e.g. physical and mental health harm, relationship functioning, social harm), and (iii) how partner alcohol use was framed by women in the studies. CONCLUSION: Men's drinking results in a multitude of direct, indirect and hidden harms to women that are cumulative, intersecting and entrench women's disempowerment. An explicit gendered lens is needed in prevention efforts to target men's drinking and the impact on women, to improve health and social outcomes for women worldwide.

Main findings: Women experience a multitude of direct, indirect and hidden harms from a male intimate partner's alcohol drinking, particularly in LMIC settings.Added knowledge: This review consolidates global qualitative evidence from diverse women's lived experience and adds a broader understanding of harm from men's alcohol drinking, beyond physical and verbal abuse shown in quantitative evidence.Global health impact for policy and action: Policy and intervention efforts that take an explicit gendered and intersectional lens on men's harmful drinking have potential to greatly improve health and social outcomes for women globally.

Patterns of intimate partner violence exposure across the first 10 years of life and children's emotional-behavioural outcomes at 10 years.

BACKGROUND: Childhood exposure to intimate partner violence (IPV) is associated with emotional-behavioural problems. However, little is known about children's emotional-behavioural outcomes following exposure to different long-term patterns of IPV. OBJECTIVE: The current study aimed to investigate the emotional-behavioural functioning of children at 10 years of age following exposure to different patterns of IPV across the first 10 years of life. PARTICIPANTS AND SETTING: Data for this study was drawn from the Mothers' and Young People's Study- a longitudinal study of 1507 first time mothers and their first born child. METHODS: Women were recruited during pregnancy from six public hospitals in Victoria, Australia. Data was collected during pregnancy, and at one, four and ten years postpartum. Four patterns of IPV exposure were previously identified: (a) minimal IPV exposure; (b) early IPV; (c) Increasing IPV; and (d) persistent IPV. Logistic regression was used to assess associations between IPV exposure and emotional-behavioural outcomes. RESULTS: Exposure to early, increasing, or persistent IPV was associated with increased odds of experiencing emotional-behavioural difficulties (OR 2.15-2.97). Children exposed to a persistent pattern of IPV experienced over 6 times the odds of conduct problems (OR = 6.15 CI = 2.3-16.44). CONCLUSIONS: Children exposed to early, increasing, or persistent IPV experienced increased odds of emotional-behavioural problems at age 10, regardless of the duration or type of violence they were exposed to. However, children exposed to persistent IPV across childhood appeared to experience the highest odds of emotional-behavioural difficulties.

Professional's Views on the 'Nordic Paradox' in a Low Intimate Partner Violence Prevalence Country.

The apparently contradictory co-existence of high levels of gender equality and intimate partner violence against women (IPVAW) found in Nordic countries has been termed the Nordic Paradox. The aim of this study was to examine how the Nordic Paradox is discussed and explained by Spanish professionals working in the IPVAW field. Five focus groups (n = 19) and interviews with key informants (n = 10) were conducted. Four main categories of possible explanations for the Nordic Paradox were identified: Macro-micro disconnect (i.e., discordance between individual beliefs and behaviors and macro-social norms of gender equality), IPVAW as multicausal (i.e., IPVAW defined as a multicausal phenomenon that does not necessarily have to be associated with gender equality), cultural patterns of social relationships (i.e., the role of social relationships and the way people relate to each other in the Nordic countries), and backlash effect (i.e., men's reaction to greater equality for women). Although this study does not provide a final explanation for the Nordic paradox, its results provide us with a better understanding of the phenomenon and can help to advance research in this field.

Impacts of an abbreviated personal agency training with refugee women and their male partners on economic empowerment, gender-based violence, and mental health: a randomized controlled trial in Rwanda.

INTRODUCTION: We assessed the impact of a personal agency-based training for refugee women and their male partners on their economic and social empowerment, rates of intimate partner violence (IPV), and non-partner violence (NPV). METHODS: We conducted an individually randomized controlled trial with 1061 partnered women (aged 18-45) living in a refugee camp in Rwanda. Women received two days of training, and their partners received one day of training. The follow-up survey where all relevant outcomes were assessed was carried out at 6-9 months post-intervention. RESULTS: At follow up, women in the intervention arm were more likely to report partaking in income generating activities (aIRR 1.27 (1.04-1.54), p < 0.05) and skill learning (aIRR 1.59 (1.39-1.82), p < 0.001) and reported a reduction in experience of physical or sexual NPV in the past six months (aIRR 0.65 (0.39-1.07), p < 0.09). While improved, no statistically significant impacts were seen on physical or sexual IPV (aIRR 0.80 (0.58-1.09), p = 0.16), food insecurity (ß 0.98 (0.93 to 1.03), p = 0.396), or clean cookstove uptake (aIRR 0.95 (0.88 to 1.01), p = 0.113) in the past six months. We found statistically significant reduction in physical and sexual IPV amongst those experiencing IPV at baseline (aIRR 0.72 (0.50 to 1.02), p < 0.07). Small improvements in self-efficacy scores and our indicator of adapting to stress were seen in the intervention arm. Some challenges were also seen, such as higher prevalence of probable depression and/or anxiety (aIRR 1.79 (1.00-3.22), p = 0.05) and PTSD (aIRR 2.07 (1.10-3.91), p < 0.05) in the intervention arm compared to the control arm. CONCLUSION: Our findings echo previous research showing personal agency training can support economic well-being of women. We also find potentially promising impacts on gender-based violence. However, there is some evidence that integration of evidence-based mental health support is important when enhancing agency amongst conflict-affected populations. TRIAL REGISTRATION NUMBER: The trial was registered with ClinicalTrials.gov, Identifier: NCT04081441 on 09/09/2019.

Modeling determinants of time-to-premarital cohabitation among Ethiopian women using parametric shared frailty models.

BACKGROUND: Premarital cohabitation is rampant and currently practiced worldwide, particularly in sub-Saharan Africa. It is a known cause of marital instability and divorce. It is also associated with intimate partner violence and harms the psychology of children in later life. However, in Ethiopia, there has been limited attention given to premarital cohabitation. OBJECTIVE: The main goal of this study was to identify the determinants of time-to-premarital cohabitation among Ethiopian women. METHODS: The 2016 EDHS data was used to achieve the study's goal. The survival information of 15683 women was analyzed based on their age at premarital cohabitation. The regional states of the women were used as a clustering effect in the models. Exponential, Weibull, and Log-logistic baseline models were used to identify factors associated with age at premarital cohabitation utilizing socioeconomic and demographic characteristics. RESULTS: The median age of premarital cohabitation was found to be 18 years. Surprisingly, 72.7% of participants were cohabitated in the study area. According to the Log-logistic-Gamma shared frailty model, place of residence, occupation, educational status, and being pregnant were found to be factors determining the time to premarital cohabitation. CONCLUSION: Premarital cohabitation among Ethiopian women was higher compared to women in the sub-Saharan Africa and East Africa. Place of residence, occupation, educational status, and being pregnant were found to be factors determining the time for premarital cohabitation. Therefore, we recommend the concerned bodies set out strategies to educate women about the influencing factors and dangers of premarital cohabitation.

Violence Exposure and Disability in Colombian Female Survivors of Intimate Partner Violence: the Mediating Role of Depressive Symptoms.

BACKGROUND: Violence is an important public health problem and one of the main causes of deaths worldwide. The mental health consequences of surviving intimate partner violence (IPV) include depression, anxiety and post-traumatic stress disorder. Previous studies have identified that there is a relationship between depression and level of disability in female survivors of IPV. Estimating the direct, indirect or total effect of an exposure on an outcome makes it possible to identify mediating effects between a group of variables. Detecting mediation effects is useful for identifying casual pathways that generate a final outcome and provides a rationale for designing interventions to target the mediator, which in turn positively affects the outcome. The objective was to identify the mediating role of depressive symptoms on the relationship between IPV and disability. METHODS: This was a cross-sectional study of 94 women over the age of 18 who were survivors of IPV by men. They were recruited from two public hospitals in Cali and Tuluá in southwest Colombia. An analysis of casual relationships was performed using structural equation modelling that was made up of: four exogenous observed variables (age, current relationship status [in a relationship or single], level of schooling, and history of an impairment), intermediate endogenous variables (violence and depressive symptoms), and the main endogenous variable (disability). The analyses were carried out in Stata14.2. RESULTS: The direct effect of IPV severity on the level of disability was not statistically significant (ß=0.09; P=0.63). However, the indirect effect of IPV severity on disability mediated by depressive symptoms was (ß=0.39; P<0.01). The total effect of IPV severity on the level of disability was even greater (ß=0.48; P=0.01). CONCLUSIONS: This study found a complete mediating role of depressive symptoms on the relationship between the severity of IPV and the level of disability for the female participants in this study. The results of this research contribute to defining strategies to prevent and address intimate partner violence, depressive symptoms and disability in this population.

Beyond the Initial Assault: Characterizing Revictimization in Intimate Partner Violence and Its Implications for Women's Health.

Recent research has emphasized the importance of addressing specific victim-related factors to reduce victims' vulnerability and prevent future revictimization experiences. This study aimed to analyze the vulnerability profiles of women who were victims of intimate partner violence, including those who had experienced a single incident of violence and those who had endured revictimization. Participants were 338 women with active judicial protection measures registered in the system of support for victims of gender violence (VioGén) in Madrid, Spain. The analysis considered sociodemographic characteristics, victimization history, perceived triggers of violence, women's responses and feelings, as well as clinical outcomes linked to revictimization history. The study revealed that many victims faced socioeconomic vulnerability. Furthermore, the findings underscored the intricate link between the likelihood of enduring chronic violence and women's awareness of early indicators of violence risk, their initial responses to aggression, communication skills, and recurrent behaviors in the context of an established violent dynamic. This study offers valuable insights for law enforcement to identify the risk of revictimization. Furthermore, findings raise awareness about the particularly vulnerable situation of some women to repeated victimization experiences and provide relevant information for clinical intervention.

Impact of COVID-19 on women living with HIV who are survivors of intimate partner violence.

BACKGROUND: Women living with HIV (WLWH) experience higher rates of intimate partner violence (IPV) compared to women without HIV, but there has been minimal research to date on the impact of the COVID-19 pandemic on the lived experiences of WLWH who are IPV survivors. METHODS: This is a secondary analysis of COVID-19 impact using baseline data from an ongoing, prospective, micro-longitudinal cohort study of HIV care engagement among WLWH who have experienced lifetime IPV. We measured the impact of COVID-19 along key domains (i.e., physical health, day-to-day life, sexual/relationship behavior, substance use, HIV care, mental health, financial status, and having conflict with partners). Using independent t-tests or Fisher's exact tests, and Pearson's chi-squared tests, we compared women with and without ongoing IPV across sociodemographic characteristics, psychiatric disorders, substance use, and COVID-19 impact domains. We then built separate multivariate linear regression models for each of the different COVID-19 impact domains; ongoing IPV exposure was the primary explanatory variable of interest. RESULTS: Enrolled participants (n = 84) comprised a group of women (mean age 53.6y; SD = 9.9) who were living with HIV for a mean 23.3 years (SD = 10), all of whom had experienced lifetime IPV. Among 49 women who were currently partnered, 79.6% (n = 39) reported ongoing IPV. There were no statistically significant differences between those experiencing ongoing IPV and those who were not (or not partnered) in terms of demographic characteristics, substance use, or mental health. In multivariate models, ongoing IPV exposure was not associated with any COVID-19 impact domain. Anxiety and depression, however, were associated with COVID-19-related physical health, HIV care, and relationship conflict. Hispanic ethnicity was significantly associated with COVID-19-related physical health. More severe cocaine and opioid use were also significantly associated with COVID-19-related impact on day-to-day life. CONCLUSIONS: Among this sample of WLWH who are all lifetime IPV-survivors, nearly half had ongoing IPV exposure. The COVID-19 public health emergency period affected WLWH in varied ways, but impacts were most profound for women experiencing concurrent mental health and substance use problems. Findings have important implications for future interventions to improve women's health and social outcomes.

Intimate partner violence, depression, hazardous alcohol use, and social support among people with HIV initiating HIV care in Cameroon.

Intimate partner violence (IPV) has been associated with poor mental health among people with HIV (PWH) globally. Social support may be a strategy to foster mental health among PWH. Little is known about whether the relationship between IPV and mental health differs by IPV type or level of social support. Interviews were conducted with 426 PWH initiating HIV care in Cameroon. Log binomial regression analyses were used to estimate the association between four types of IPV (controlling behavior and emotional, physical, and sexual IPV) and symptoms of depression or hazardous alcohol use, separately by IPV type and level of social support. Over half (54.8%) of respondents experienced moderate/high levels of controlling behavior, 42.0% experienced emotional IPV, 28.2% experienced physical IPV and 23.7% experienced sexual IPV. Controlling behavior was associated with greater prevalence of depressive symptoms. This relationship did not vary meaningfully by level of social support (low: aPR 2.4 [95% CI 1.2, 4.9]; high: 1.7 [95% CI 1.0, 2.7]). Emotional and physical IPV were associated with greater prevalence of depressive symptoms among those with low social support (emotional IPV: aPR 1.9 [95% CI 1.0, 3.4]; physical IPV: aPR 1.8 [95% CI 1.2, 2.8]), but not among those with high social support (emotional IPV: aPR 1.0 [95% CI 0.7, 1.6]; physical IPV: aPR 1.0 [95% CI 0.6, 1.6]). Controlling behavior, emotional IPV, and physical IPV were associated with a greater prevalence of hazardous alcohol use, with moderately larger effect estimates among those with high compared to low social support. Sexual IPV was not associated with depressive symptoms or hazardous alcohol use. Services to screen and care for people experiencing IPV are urgently needed among PWH in Cameroon. Future research to identify barriers, feasibility, acceptability, and organizational readiness to integrate IPV and mental health services into HIV care settings is needed.