Assessing incarcerated women's physical and mental health status and needs in a Swiss prison: a cross-sectional study.

BACKGROUND: Women make up 5% of the European prison population on average. Almost invisible in prison and health research, and suffering the stigma associated with female offending, incarcerated women are often forgotten, and their specific healthcare needs remain much ignored. Combining face-to-face survey interviews and medical chart data, we aim to assess the health status, healthcare needs, and access to preventive medicine of women incarcerated in Switzerland. RESULTS: Sixty incarcerated adult women participated in a cross-sectional study to assess their life and incarceration histories, physical and mental health problems, medication, and use of medical services. Eligibility criteria were (a) an incarceration of at least four weeks and (b) the ability to provide written informed consent. Exclusion criteria were psychiatric instability and insufficient language competence. Women's average age was 34.3 years old (SD = 9.8); 45.0% of them were born in Switzerland, 33.3% in Europe and 15.0% on the African continent. Overall, 61.7% of women self-reported physical or mental health problems and 13.3% indicated they were once diagnosed with a sexually transmitted infection. Further, 78.3% of women were active cigarette smokers; more than one in three women reported alcohol use problems and almost one in two women had used at least one illicit drug in the year before incarceration. Depression and perceived stress scores were above clinical cut-off points for more than half of interviewed women. When asked how they rated their health, 68.3% of women felt it had worsened since incarceration. All but four women had accessed prison medical services; however, our study does not indicate whether women's use of healthcare was indeed adequate to their needs. CONCLUSIONS: This study demonstrated incarcerated women's poor health and health-risk behaviours. Structural changes and gender-responsive health promotion interventions have the potential to improve the health of incarcerated women and help them return to the community in better health.

A latent profile analysis of intimate partner victimization and aggression and examination of between-class differences in psychopathology symptoms and risky behaviors.

OBJECTIVE: Intimate partner violence (IPV) is associated with heightened psychopathology symptoms and risky behaviors. However, extant investigations are limited by their focus on IPV victimization, despite evidence to suggest that victimization and aggression frequently co-occur. Further, research on these correlates often has not accounted for the heterogeneity of women who experience victimization. METHOD: The present study utilized latent profile analysis to identify patterns of physical, psychological, and sexual victimization and aggression in a convenience sample of 212 community women experiencing victimization (Mage = 36.63, 70.8% African American), as well as examined differences in psychopathology symptoms (i.e., posttraumatic stress symptoms [PTSS] and depressive symptoms) and risky behaviors (i.e., drug problems, alcohol problems, deliberate self-harm (DSH), HIV-risk behaviors) across these classes. RESULTS: Four classes of women differentiated by severities of victimization and aggression were identified. Greater psychopathology symptoms were found among classes defined by greater victimization and aggression, regardless of IPV type. Risky behaviors were more prevalent among classes defined by greater sexual victimization and aggression in particular. CONCLUSIONS: Findings highlight the importance of developing interventions that target the particular needs of subgroups of women who experience victimization. (PsycINFO Database Record

Anxiety and posttraumatic stress symptom pathways to substance use problems among community women experiencing intimate partner violence.

BACKGROUND AND OBJECTIVES: Although intimate partner violence (IPV) has demonstrated strong associations with anxiety and posttraumatic stress, these constructs have rarely been examined simultaneously in IPV research. Gaps in knowledge remain as to their differential associations to substance use problems among IPV-victimized women. DESIGN: A sample of 143 community women self-reported on their current IPV victimization, mental health and substance use problems. METHOD: Hierarchical entry multiple regressions were used to test for the direct and indirect effects of psychological, physical, and sexual IPV to alcohol and drug problems through anxiety and posttraumatic stress. RESULTS: Higher anxiety symptom severity and higher physical IPV severity were associated with greater alcohol and drug problems. Higher posttraumatic stress symptom severity was associated with greater alcohol and drug problems. Mediation analyses indicated (i) significant indirect pathways of IPV types to alcohol problems through posttraumatic stress symptom severity controlling for anxiety symptom severity and (ii) significant indirect pathways of IPV types to drug problems through anxiety symptom severity controlling for posttraumatic stress symptom severity. CONCLUSIONS: In examining the indirect pathways of psychological, physical, and sexual IPV to substance use problems this study highlights that anxiety and posttraumatic stress symptom severity have unique effects on alcohol and drug problems among IPV-victimized women.

The mediating role of avoidance coping between intimate partner violence (IPV) victimization, mental health, and substance abuse among women experiencing bidirectional IPV.

Avoidance coping is consistently linked with negative mental health outcomes among women experiencing intimate partner violence (IPV). This study extended the literature examining the potentially mediating role of avoidance coping strategies on both mental health and substance use problems to a highly generalizable, yet previously unexamined population (i.e., women experiencing bidirectional IPV) and examined multiple forms of IPV (i.e., psychological, physical, and sexual) simultaneously. Among a sample of 362 women experiencing bidirectional IPV, four separate path models were examined, one for each outcome variable. Avoidance coping mediated the relationships between psychological and sexual IPV victimization and the outcomes of PTSD symptom severity, depression severity, and drug use problems. Findings indicate nuanced associations among IPV victimization, avoidance coping, and mental health and substance use outcomes.

Elucidating posttraumatic stress symptom profiles and their correlates among women experiencing bidirectional intimate partner violence.

OBJECTIVE: This study employed latent class analysis to identify profiles of women experiencing intimate partner violence (IPV) based on the severity of posttraumatic stress disorder (PTSD) symptoms. METHOD: Self-report data from a sample of 369 women experiencing bidirectional IPV was used. RESULTS: A 3-class solution comprising low, moderate, and high PTSD severity profiles best fit the data. Profiles were differentially related to whether IPV victimization was considered traumatic (PTSD criterion A); whether functioning was impaired as a result of PTSD symptoms (PTSD criterion F); whether the woman met full diagnostic criteria for PTSD; depression symptom severity; and severity of psychological, physical, and sexual IPV victimization and use of IPV. An extremely high percentage of women in the high (96%) and moderate (88%) severity classes experienced functional impairment, although many did not meet full diagnostic criteria for PTSD. CONCLUSIONS: Findings support the need for interventions individually tailored to one's treatment needs based on the nature of one's traumatic stressor and the impact of PTSD on daily functioning.

Fear of past abusive partner(s) impacts current posttraumatic stress among women experiencing partner violence.

This study examines the impact of fear of past abusive partner(s) on posttraumatic stress among 212 community-recruited women currently exposed to intimate partner violence (IPV). The path analysis model tested explained 60% of the variation in IPV-related posttraumatic stress. Findings revealed that fear of past abusive partner(s) was uniquely associated with the severity of current posttraumatic stress symptoms over and above the impact of current IPV or childhood abuse and neglect. Future research should continue examining women's subjective emotional experience of past and current victimization so as to further inform both clinical practice and intervention planning.

Examining the Prevalence, Bidirectionality, and Co-Occurrence of Sexual Intimate Partner Violence among Women During Pregnancy and Postpartum.

OBJECTIVES: This longitudinal study examined the prevalence of women's sexual intimate partner violence (IPV) perpetration, the extent to which women experienced both sexual IPV victimization and perpetration, and the overlap between women's experiences of sexual IPV with psychological and physical IPV victimization and perpetration. METHODS: Data were collected via self-report survey from 180 women during the first 18 weeks of pregnancy and 122 participants completed follow-up assessments at six weeks postpartum. RESULTS: At both time points, the prevalence of sexual IPV victimization and perpetration were similar in this sample. Bidirectional sexual IPV was more common than sexual IPV victimization or perpetration only. The majority of participants who experienced sexual IPV victimization at baseline and follow-up also experienced psychological or physical IPV victimization. No participants at either time point reported sexual IPV perpetration only, those participants who perpetrated sexual IPV also perpetrated psychological or physical IPV. CONCLUSIONS: Future research should investigate women's sexual IPV victimization and perpetration as they relate to other areas of mental and physical health during this time period.

Posttraumatic stress disorder symptom clusters, alcohol misuse, and women's use of intimate partner violence.

Exploring how PTSD and alcohol misuse relate to women's use of intimate partner violence (IPV) is vital to develop our understanding of why some women may engage in IPV, which can serve to maximize intervention efforts for women. This study examined the extent to which posttraumatic stress disorder (PTSD) symptom clusters are directly and indirectly related to women's use of IPV through pathways involving alcohol misuse while controlling for severity of women's IPV victimization. The sample was comprised of substance-using, low socioeconomic status community women (N = 143) currently experiencing IPV victimization. The majority of the sample was African American (n = 115, 80.42%). This sample had an average annual household income of $14,368.68 (SD = $12,800.68) and the equivalent of a high school education (11.94 years, SD = 1.32). Path analyses indicated that the strongest statistical relationship emerged between women's use of IPV and women's IPV victimization. PTSD reexperiencing and numbing symptom severity was related to women's use of psychological, minor physical, and severe physical IPV; however, these relationships were indirect through alcohol misuse. Findings lend preliminary support for the application of the self-medication hypothesis to the study of PTSD, alcohol misuse, and IPV among women.

Patterns of resource utilization and mental health symptoms among women exposed to multiple types of victimization: a latent class analysis.

Although the value of resources aimed to support women who experience intimate partner violence (IPV) is clear, few studies have investigated how exposure to multiple types of victimization influences women's resource utilization. We applied latent class analysis (LCA) to a sample of 412 women who used IPV in their current relationships to test whether women's resource utilization is associated with different patterns of victimization, including current IPV victimization, past IPV victimization, and childhood victimization. Three classes of women were identified: the Low Cumulative IPV class (n = 121) included women with a low prevalence of past IPV victimization and low severity of current IPV victimization; The High Past/ Low Current IPV class (n = 258) included women with a high prevalence of past IPV victimization but low severity of current IPV victimization; and the High Cumulative IPV class (n = 33) included women with a high prevalence of past IPV victimization and severe current IPV victimization. Multiple types of childhood victimization were highly prevalent among women in all three classes. Women in the High Cumulative IPV class used a greater variety of resources, experienced a greater number of posttraumatic stress and depression symptoms, drug problems, and used more severe IPV aggression compared to women in other classes. These findings highlight the heterogeneity of resource utilization among women in relationships characterized by bidirectional IPV and underscore the potential clinical utility of adapting services to meet the specific needs of women with unique profiles of victimization.

Posttraumatic stress and depression symptoms as correlates of deliberate self-harm among community women experiencing intimate partnerviolence.

Deliberate self-harm (DSH) among women in the general population is correlated separately with posttraumatic stress, depression, and abuse during childhood and adulthood. The prevalence of these DSH correlates is particularly high among women exposed to intimate partner violence (IPV), yet few studies have examined DSH among this high-risk population and none have examined these correlates simultaneously. Two hundred and twelve IPV-victimized women in the community participated in a 2-h retrospective interview. One-third reported current or past DSH. Discriminant analysis was used to examine which posttraumatic stress and depression symptoms and types of current IPV and childhood abuse were uniquely associated with current DSH. Findings show that women who currently use DSH reported greater severity of posttraumatic stress numbing symptoms and more severe sexual IPV compared to women who used DSH only in the past. Examining factors that are associated with women's current DSH in this population is critical so that a focus on DSH can be integrated into the treatment plans of women who are receiving mental health care, but also so that women who are not receiving such care can be referred to adequate mental health services.

Risk factors for alcohol-related problems among victims of partner violence.

Despite the high prevalence of alcohol-related problems and disorders among women who experience intimate partner violence (IPV), factors related to current alcohol use are understudied. We examined current risk factors for alcohol-related problems among 143 substance-using, IPV-exposed women recruited from an urban community from 2007 to 2010. Posttraumatic stress disorder (PTSD) symptom severity was associated with alcohol-related problems and a positive alcohol screen; physical IPV severity was related to alcohol dependence. Post hoc analyses revealed that PTSD symptom severity mediated relationships between physical IPV severity and hazardous, harmful, and dependent drinking. Focusing on managing PTSD symptoms and physical IPV in community-based interventions may halt the progression from alcohol use to dependence.

IS IT THE EXCEPTION OR THE RULE? DAILY CO-OCCURRENCE OF PHYSICAL, SEXUAL, AND PSYCHOLOGICAL PARTNER VIOLENCE IN A 90-DAY STUDY OF SUBSTANCE-USING, COMMUNITY WOMEN.

OBJECTIVE: This study aims to describe the daily co-occurrence of physical, sexual, and psychological intimate partner violence (IPV) among substance-using, community-based women currently experiencing IPV. METHODS: A micro-longitudinal study design was used to collect data daily from 49 women for 90 days. RESULTS: On the majority of days (62%), no IPV occurred; 27% of days were characterized by psychological IPV alone, followed by the co-occurrence of psychological and physical IPV (6% of IPV days). Results of person-level analyses showed comparable sized correlations between the proportion of days with physical and sexual IPV and the proportion of days with physical and psychological IPV. However, results of day-level analyses revealed that the association between physical and psychological IPV was much stronger than the association between physical and sexual IPV; Physical IPV was 64 times more likely to occur on days when psychological IPV occurred. CONCLUSIONS: Results revealed new information about physical, sexual, and psychological IPV experiences and demonstrate the utility of a micro-longitudinal design among this high risk population. Implications for practice, future research, and the development of preventive interventions are noted, underscoring the importance of psychological IPV and the range of IPV experiences among women.