Experiences of physical and emotional intimate partner violence during the COVID-19 pandemic: a comparison of prepandemic and pandemic data in a longitudinal study of Australian mothers.

OBJECTIVE: There is a lack of longitudinal population-based research comparing women's experiences of intimate partner violence (IPV) prior to and during the COVID-19 pandemic. Using data from the Mothers' and Young People's Study, the prevalence of physical and emotional IPV in the first year of the pandemic is compared with earlier waves of data. DESIGN: A prospective pregnancy cohort of first-time mothers in Melbourne, Australia was followed up over the first decade of motherhood, with a quick response study conducted during the COVID-19 pandemic. 422 women completed the primary exposure measure (IPV; Composite Abuse Scale) in the 1st, 4th and 10th year postpartum and the additional pandemic survey (June 2020-April 2021). OUTCOME MEASURES: Depressive symptoms; anxiety symptoms; IPV disclosure to a doctor, friends or family, or someone else. RESULTS: Maternal report of emotional IPV alone was higher during the pandemic (14.4%, 95% CI 11.4% to 18.2%) than in the 10th (9.5%, 95% CI 7.0% to 12.7%), 4th (9.2%, 95% CI 6.8% to 12.4%) and 1st year after the birth of their first child (5.9%, 95% CI 4.0% to 8.6%). Conversely, physical IPV was lowest during the pandemic (3.1%, 95% CI 1.8% to 5.0%). Of women experiencing IPV during the pandemic: 29.7% were reporting IPV for the first time, 52.7% reported concurrent depressive symptoms and just 6.8% had told their doctor. CONCLUSIONS: Findings suggest that the spike in IPV-related crime statistics following the onset of the pandemic (typically incidents of physical violence) is the tip of the iceberg for women's IPV experiences. There is a need to increase the capacity of health practitioners to recognise emotional as well as physical IPV, and IPV ought to be considered where women present with mental health problems.

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.

Training Australian general practitioners to counsel women experiencing intimate partner abuse (WEAVE): a pre-post training analysis.

BACKGROUND: Evaluations of Intimate Partner Abuse training for general practitioners is limited. The Women's Evaluation of Abuse and Violence Care study trialled in Australia was a primary care intervention that included delivering the Health Relationships training, a program that educates practitioners on how to provide supportive counselling and assistance to women afraid of an intimate partner. We report on effectiveness of the Healthy Relationships training program within a cluster-randomised controlled trial. METHODS: General practitioners filled out a baseline survey and surveys before and after training, including quantitative and open-text questions on barriers and enablers to supporting victim-survivors. The Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) tool, a validated measure, was included to assess practitioner knowledge, skills, confidence, and attitudes. General linear model repeated analysis of variance tested the difference between trial groups over time. RESULTS: Fifty-two general practitioners completed the baseline demographic survey, with 65% (19 intervention, 18 comparison) completing both pre-and-post-training surveys. There were no between-group differences in baseline characteristics. Post-training, the intervention group had significantly higher average scores than the comparison on perceived preparation to address abuse (p = .000), perceived knowledge (p = .000), actual knowledge (p = .03), and greater awareness of practice-related issues (p = .000). There were no between-group differences in PREMIS opinion domain scores on workplace issues, self-efficacy and understanding of victims. Post-training, the qualitative data indicated that the intervention practitioners (n = 24) reported increased knowledge, awareness, and confidence, while time pressures and lack of referral options impeded addressing abuse. CONCLUSION: The Healthy Relationships Training program for general practitioners increased aspects of practitioner knowledge, skills, and confidence. However, more support is needed to change opinions and support victim-survivors sustainably. TRIAL REGISTRATION: The WEAVE trial was registered on 21/01/2008 with the Australian New Zealand Clinical Trial Registry, number ACTRN12608000032358.

Lost in translation: a narrative review and synthesis of the published international literature on mental health research and translation priorities (2011-2023).

BACKGROUND: Priority setting in mental health research is arguably lost in translation. Decades of effort has led to persistent repetition in what the research priorities of people with lived-experience of mental ill-health are. AIM: This was a narrative review and synthesis of published literature reporting mental health research priorities (2011-2023). METHODS: A narrative framework was established with the questions: (1) who has been involved in priority setting? With whom have priorities been set? Which priorities have been established and for whom? What progress has been made? And, whose priorities are being progressed? RESULTS: Seven papers were identified. Two were Australian, one Welsh, one English, one was from Chile and another Brazilian and one reported on a European exercise across 28 countries (ROAMER). Hundreds of priorities were listed in all exercises. Prioritisation mostly occured from survey rankings and/or workshops (using dots, or post-it note voting). Most were dominated by clinicians, academics and government rather than people with lived-experience of mental ill-health and carer, family and kinship group members. CONCLUSION: One lived-experience research led survey was identified. Few studies reported lived-experience design and development involvement. Five of the seven papers reported responses, but no further progress on priorities being met was reported.

This review followed PRISMA guidance for search strategy development and systematic review and reporting. This was not a systematic review with or without meta-analysis and the method did not fit for registration with PROSPERO.

Should we be concerned? A qualitative study of educators' perceptions of medical student wellbeing in domestic violence training.

INTRODUCTION: Domestic violence (DV) is common in the Australian community so it is likely that there will be medical students who are affected personally by DV. Some of these students may find DV training confronting or even re-traumatising. A trauma-informed medical education (TIME) framework utilising trauma-informed care principles may minimise this risk to students. We aimed to explore educators' perceptions of student well-being in Australian medical school DV training. METHOD: This descriptive qualitative study interviewed 13 educators with experience teaching DV in Australian medical schools using an interpretivist methodology and a TIME framework. Interview data was thematically analysed to identify themes. RESULTS: Four key themes included (1) educators thrown in at the deep end; (2) keeping students emotionally safe; (3) a trauma-informed learning environment and; (4) challenges of student DV disclosures. Few of the participants had received training in DV. Educators used methods such as trigger warnings and ground rules to improve student's emotional safety. Experienced educators dealt with disclosures of DV by students which led to role confusion. DISCUSSION: There is a need for increased training of medical educators that includes awareness and implementation of TIME principles when training medical students in DV as well as increased supports and resources for educators.

Identifying the barriers faced by obstetricians and registrars in screening or enquiry of intimate partner violence in pregnancy: A systematic review of the primary evidence.

INTRODUCTION: Intimate partner violence (IPV) disproportionally affects women compared to men. The impact of IPV is amplified during pregnancy. Screening or enquiry in the antenatal outpatient setting regarding IPV has been fraught with barriers that prevent recognition and the ability to intervene. AIMS: The aim of this systematic review was to determine the barriers that face obstetricians/gynaecologists regarding enquiry of IPV in antenatal outpatient settings. The secondary objective was to determine facilitators. METHODS: Primary evidence was searched using Ovid MEDLINE, Ovid Maternity and Infant Care, PubMed and Proquest from 1993 to May 2023. The included studies comprised empirical studies published in English language targeting a population of doctors providing antenatal outpatient care. The review was PROSPERO-registered (CRD42020188994). Independent screening and review was performed by two authors. The findings were analysed thematically. RESULTS: Nine studies addressing barriers and two studies addressing facilitators were included: three focus-group or semi-structured interviews, six surveys and two randomised controlled trials. Barriers for providers centred at the system level (time, training), provider level (personal beliefs, cultural bias, experience) and provider-perceived patient level (fear of offending, patient readiness to disclose). Increased experience and the use of validated tools were strong facilitators. CONCLUSION: Barriers to screening reflect multi-level obstruction to the identification of women exposed to IPV. Although the antenatal outpatient clinic setting addresses a particular population vulnerable to IPV, the barriers for obstetricians are not unique. The use of validated cueing tools provides an evidence-based method to facilitate enquiry of IPV among antenatal women, assisting in identification by clinicians. Together with education and human resources, such aids build capacity in women and obstetric providers.

Women Higher Education Students' Experiences of Sexual Violence: A Scoping Review and Thematic Synthesis of Qualitative Studies.

Sexual violence (SV) against women is common in higher education settings, causing serious harm to the health, well-being, and academic outcomes of victim/survivors. There have been numerous systematic reviews of the quantitative evidence on this topic, highlighting the prevalence, health impacts, and barriers and facilitators to help-seeking after SV. To date, however, qualitative research exploring the lived experience of women higher education students has not been synthesized. This scoping review and thematic synthesis of qualitative studies aims to map the global evidence on women higher education students' experiences of SV and explore how they understand and make sense of their experiences. We searched five databases (CinAHL, Academic Search Complete, Medline, PsychInfo, and SocIndex) in January 2023 for relevant articles. Eligible articles needed to be published in English and describe qualitative or mixed-methods primary research on the lived experiences of women higher education students who were victim/survivors of SV. In all, 34 articles describing 32 studies met these inclusion criteria. Thematic analysis of data extracted from the included studies suggests that, for women higher education students, the experience of SV is characterized by profound shame, with often-irreversible impacts on hopes and plans for the future. Yet, at the same time, SV is normalized and expected as a part of the "student experience." Furthermore, an imagined "specter" of "real violence" is held up as a constant comparison that serves to minimize and trivialize their experiences. These findings have important implications for higher education providers seeking to improve programs to address SV.

Protocol for a randomised controlled trial of a healthy relationship tool for men who use intimate partner violence (BETTER MAN).

BACKGROUND: Intimate partner violence (IPV) is common globally, but there is a lack of research on how to intervene early with men who might be using IPV. Building on evidence supporting the benefits of online interventions for women victim/survivors, this study aims to test whether a healthy relationship website (BETTER MAN) is effective at improving men's help seeking, their recognition of behaviours as IPV and their readiness to change their behaviours. METHODS/DESIGN: In this two-group, pragmatic randomised controlled trial, men aged 18-50 years residing in Australia who have been in an adult intimate relationship (female, male or non-binary partner) in the past 12 months are eligible. Men who report being worried about their behaviour or have had others express concerns about their behaviour towards a partner in the past 12 months will be randomised with a 1:1 allocation ratio to receive the BETTER MAN website or a comparator website (basic healthy relationships information). The BETTER MAN intervention includes self-directed, interactive reflection activities spread across three modules: Better Relationships, Better Values and Better Communication, with a final "action plan" of strategies and resources. Using an intention to treat approach, the primary analysis will estimate between-group difference in the proportion of men who report undertaking help-seeking behaviours for relationship issues in the last 6 months, at 6 months post-baseline. Analysis of secondary outcomes will estimate between-group differences in: (i) mean score of awareness of behaviours in relationships as abusive immediately post-use of website; (ii) mean score on readiness to change immediately post-use of website and 3 months after baseline; and (iii) cost-effectiveness. DISCUSSION: This trial will evaluate the effectiveness of an online healthy relationship tool for men who may use IPV. BETTER MAN could be incorporated into practice in community and health settings, providing an evidence-informed website to assist men to seek help to promote healthy relationships and reduce use of IPV. TRIAL REGISTRATION: ACTRN12622000786796 with the Australian New Zealand Clinical Trials Registry: 2 June 2022. Version: 1 (28 September 2023).

Psychosocial interventions for survivors of rape and sexual assault experienced during adulthood.

BACKGROUND: Exposure to rape, sexual assault and sexual abuse has lifelong impacts for mental health and well-being. Prolonged Exposure (PE), Cognitive Processing Therapy (CPT) and Eye Movement Desensitisation and Reprocessing (EMDR) are among the most common interventions offered to survivors to alleviate post-traumatic stress disorder (PTSD) and other psychological impacts. Beyond such trauma-focused cognitive and behavioural approaches, there is a range of low-intensity interventions along with new and emerging non-exposure based approaches (trauma-sensitive yoga, Reconsolidation of Traumatic Memories and Lifespan Integration). This review presents a timely assessment of international evidence on any type of psychosocial intervention offered to individuals who experienced rape, sexual assault or sexual abuse as adults. OBJECTIVES: To assess the effects of psychosocial interventions on mental health and well-being for survivors of rape, sexual assault or sexual abuse experienced during adulthood. SEARCH METHODS: In January 2022, we searched CENTRAL, MEDLINE, Embase, 12 other databases and three trials registers. We also checked reference lists of included studies, contacted authors and experts, and ran forward citation searches. SELECTION CRITERIA: Any study that allocated individuals or clusters of individuals by a random or quasi-random method to a psychosocial intervention that promoted recovery and healing following exposure to rape, sexual assault or sexual abuse in those aged 18 years and above compared with no or minimal intervention, usual care, wait-list, pharmacological only or active comparison(s). We classified psychosocial interventions according to Cochrane Common Mental Disorders Group's psychological therapies list. DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by Cochrane. MAIN RESULTS: We included 36 studies (1991 to 2021) with 3992 participants randomly assigned to 60 experimental groups (3014; 76%) and 23 inactive comparator conditions (978, 24%). The experimental groups consisted of: 32 Cognitive Behavioural Therapy (CBT); 10 behavioural interventions; three integrative therapies; three humanist; five other psychologically oriented interventions; and seven other psychosocial interventions. Delivery involved 1 to 20 (median 11) sessions of traditional face-to-face (41) or other individual formats (four); groups (nine); or involved computer-only interaction (six). Most studies were conducted in the USA (n = 26); two were from South Africa; two from the Democratic Republic of the Congo; with single studies from Australia, Canada, the Netherlands, Spain, Sweden and the UK. Five studies did not disclose a funding source, and all disclosed sources were public funding. Participants were invited from a range of settings: from the community, through the media, from universities and in places where people might seek help for their mental health (e.g. war veterans), in the aftermath of sexual trauma (sexual assault centres and emergency departments) or for problems that accompany the experience of sexual violence (e.g. sexual health/primary care clinics). Participants randomised were 99% women (3965 participants) with just 27 men. Half were Black, African or African-American (1889 participants); 40% White/Caucasian (1530 participants); and 10% represented a range of other ethnic backgrounds (396 participants). The weighted mean age was 35.9 years (standard deviation (SD) 9.6). Eighty-two per cent had experienced rape or sexual assault in adulthood (3260/3992). Twenty-two studies (61%) required fulfilling a measured PTSD diagnostic threshold for inclusion; however, 94% of participants (2239/2370) were reported as having clinically relevant PTSD symptoms at entry. The comparison of psychosocial interventions with inactive controls detected that there may be a beneficial effect at post-treatment favouring psychosocial interventions in reducing PTSD (standardised mean difference (SMD) -0.83, 95% confidence interval (CI) -1.22 to -0.44; 16 studies, 1130 participants; low-certainty evidence; large effect size based on Cohen's D); and depression (SMD -0.82, 95% CI -1.17 to -0.48; 12 studies, 901 participants; low-certainty evidence; large effect size). Psychosocial interventions, however, may not increase the risk of dropout from treatment compared to controls, with a risk ratio of 0.85 (95% CI 0.51 to 1.44; 5 studies, 242 participants; low-certainty evidence). Seven of the 23 studies (with 801 participants) comparing a psychosocial intervention to an inactive control reported on adverse events, with 21 events indicated. Psychosocial interventions may not increase the risk of adverse events compared to controls, with a risk ratio of 1.92 (95% CI 0.30 to 12.41; 6 studies; 622 participants; very low-certainty evidence). We conducted an assessment of risk of bias using the RoB 2 tool on a total of 49 reported results. A high risk of bias affected 43% of PTSD results; 59% for depression symptoms; 40% for treatment dropout; and one-third for adverse events. The greatest sources of bias were problems with randomisation and missing outcome data. Heterogeneity was also high, ranging from I2 = 30% (adverse events) to I2 = 87% (PTSD). AUTHORS' CONCLUSIONS: Our review suggests that survivors of rape, sexual violence and sexual abuse during adulthood may experience a large reduction in post-treatment PTSD symptoms and depressive symptoms after experiencing a psychosocial intervention, relative to comparison groups. Psychosocial interventions do not seem to increase dropout from treatment or adverse events/effects compared to controls. However, the number of dropouts and study attrition were generally high, potentially missing harms of exposure to interventions and/or research participation. Also, the differential effects of specific intervention types needs further investigation. We conclude that a range of behavioural and CBT-based interventions may improve the mental health of survivors of rape, sexual assault and sexual abuse in the short term. Therefore, the needs and preferences of individuals must be considered in selecting suitable approaches to therapy and support. The primary outcome in this review focused on the post-treatment period and the question about whether benefits are sustained over time persists. However, attaining such evidence from studies that lack an active comparison may be impractical and even unethical. Thus, we suggest that studies undertake head-to-head comparisons of different intervention types; in particular, of novel, emerging therapies, with one-year plus follow-up periods. Additionally, researchers should focus on the therapeutic benefits and costs for subpopulations such as male survivors and those living with complex PTSD.

Social and emotional wellbeing of Aboriginal and Torres Strait Islander peoples in Aboriginal controlled social housing.

BACKGROUND: Little is known about the wellbeing and aspirations of Aboriginal and Torres Strait Islander peoples living in social housing. Aboriginal and Torres Strait Islander peoples living in social housing face common social housing challenges of low income, higher incidence of mental health issues and poorer health along with specific challenges due to the impacts of colonisation and its ongoing manifestations in racism and inequity. A greater understanding of social and emotional wellbeing needs and aspirations is essential in informing the provision of appropriate support. METHODS: Surveys of social and emotional wellbeing (SEWB) were completed by 95 Aboriginal people aged 16 years and older living in Aboriginal Housing Victoria social housing in 2021. The survey addressed a range of domains reflecting social and emotional wellbeing, as defined by Aboriginal and Torres Strait Islander peoples. RESULTS: Most respondents demonstrated a strong sense of identity and connection to family however 26% reported having 6 or more health conditions. Ill health and disability were reported to be employment barriers for almost a third of people (32%). Improving health and wellbeing (78%) was the most cited aspiration. Experiences of racism and ill health influenced engagement with organisations and correspondingly education and employment. CONCLUSION: Strong connections to identity, family and culture in Aboriginal peoples living in social housing coexist along with disrupted connections to mind, body and community. Culturally safe and appropriate pathways to community services and facilities can enhance these connections. Research aimed at evaluating the impact of strengths-based interventions that focus on existing strong connections will be important in understanding whether this approach is effective in improving SEWB in this population. TRIAL REGISTRATION: This trial was retrospectively registered with the ISRCTN Register on the 12/7/21 with the study ID:ISRCTN33665735.

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

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

'Family court sucks out your soul': Australian general practitioners' experiences supporting domestic violence survivors through family court.

BACKGROUND: Domestic violence is a significant public health issue with survivors experiencing short- and long-term physical, sexual and psychological health issues. Given this, survivors of domestic violence use healthcare services at an increased rate compared to the general population. Therefore, general practitioners (GPs) are well placed to support survivors of domestic violence. However, many practitioners do not feel ready to address this complex issue of domestic violence. Further, there is no research exploring GPs' role in supporting families through family court in the context of domestic violence. METHODS: This study used qualitative methods. Fifteen GPs participated in individual in-depth interviews. The interviews were audio recorded with consent, transcribed verbatim and thematically analysed. RESULTS: The majority of participants were female GPs working in metropolitan settings. Four themes were generated from the data: on different planets, witnessing legal systems abuse, weaponizing mental health in family court and swinging allegiances. Participants had negative perceptions of family court and felt that it operated on a different paradigm to that of general practice which caused difficulties when supporting patients. Participants supported survivors through instances where the court was used by perpetrators to further their abusive behaviour or where the court acted abusively against survivors. In particular, perpetrators and the family court used survivors' mental health against them in court proceedings, which resulted in survivors being reluctant to receive treatment for their mental health. Participants struggled with their allegiances within their patient family and usually opted to support either the mother, the father, or the children. CONCLUSIONS: Implications of these findings for GP training are evident, including curriculum that discusses the intersection of mental health diagnoses and legal proceedings. There may also be a place for health justice partnerships within general practice.

"Help Me Realize What I'm Becoming": Men's Views on Digital Interventions as a Way to Promote Early Help-Seeking for Use of Violence in Relationships.

Intimate partner violence (IPV) is a major global issue with huge impacts on individuals, families, and communities. It is also a gendered problem, with the vast majority of IPV perpetrated by men. To date, interventions have primarily focused on victim/survivors; however, it is increasingly recognized that men's use of violence must also be addressed. Despite this, there remain limited options for doing this in practice. In most high-income countries, men's behavior change programs (MBCPs) or their equivalent are the typical referral pathway, with men often mandated to attend by the criminal justice system. Yet, these programs have limited evidence for their effectiveness and recidivism and dropouts are major challenges. Moreover, an entire subset of men-those uninvolved with criminal justice settings-remain under-serviced. It is clear that a critical gap remains around early engagement with men using violence in relationships. This study explores the potential for digital interventions (websites or apps) to fill this gap through qualitative analysis of data from focus groups with 21 men attending MBCPs in Victoria, Australia. Overall, we interpreted men's perceptions of digital interventions as being able to facilitate connection with the "better man inside," with four sub-themes: (a) Don't jump down my throat straight away; (b) Help me realize what I'm becoming; (c) Seeing a change in my future; and (d) Make it simple and accessible. The findings of this study suggest that there is strong potential for digital interventions to engage early with men using IPV, but also some key challenges. Websites or apps can provide a safe, private space for men to reflect on their behavior and its consequences; however, the lack of interpersonal interaction can make it challenging to balance non-judgmental engagement with accountability. These issues should be considered when designing digital interventions for men using violence in relationships.

Timing of Physical and Emotional Intimate Partner Violence Exposure and Women's Health in an Australian Longitudinal Cohort Study.

Drawing on data from a prospective pregnancy cohort (N = 1,507), this study examines the relationship between exposure to physical and emotional intimate partner violence (IPV) across the first 10 years of motherhood and women's mental and physical health. A measure of IPV (Composite Abuse Scale) was included at 1, 4, and 10 years postpartum. Past year and prior experiences of IPV were associated with mental and physical health issues at 10 years, both for mothers who had experienced combined IPV and emotional IPV alone. Awareness of the health issues associated with different types of IPV can assist in tailoring responses for women who experience IPV.

"He'd Tell Me I was Frigid and Ugly and Force me to Have Sex with Him Anyway": Women's Experiences of Co-Occurring Sexual Violence and Psychological Abuse in Heterosexual Relationships.

Intimate partner sexual violence (IPSV) is a common yet hidden form of violence. It is primarily perpetrated against women by their male partners and is associated with a range of serious mental and physical health outcomes. Despite these harms, it is chronically under-researched. In particular, the overlaps between IPSV and psychological abuse in relationships are poorly understood. Extant literature has focused primarily on the relationship between IPSV and physical violence, neglecting the fact that IPSV often involves verbal or emotional coercion, threats or blackmail rather than the use of 'force'. In this paper, we draw on reflexive thematic analysis of qualitative interviews with n = 38 victim/survivors of IPSV to explore how they understood the relationship between sexual and psychological abuse in their heterosexual relationships. Four themes were developed from this analysis: 1. I felt like I couldn't say Nno'; 2. I felt degraded and worthless; 3. Letting me know who's boss; and 4. Making me feel crazy. These themes broadly correspond to four distinct patterns or interactions between IPSV and psychological abuse. Our findings strongly suggest that the relationship between sexual and psychological abuse in relationships is far more complex than previous research would indicate. Psychological abuse is not simply a tool to obtain sex and sexual violence is not only used as a mechanism of psychological control. Instead, the two forms of abuse interact in ways that can be unidirectional, bi-directional or simultaneous to develop and maintain an environment of fear and control and erode women's self-worth.

Health Care Providers Views on Identifying and Responding to South Asian Women Experiencing Family Violence: A Qualitative Meta Synthesis.

Family violence (FV) is a universal public health problem in South Asia with negative-health outcomes for South Asian women. Health care providers (HCPs) play a pivotal role in identifying and supporting women experiencing FV, but little is known about their experiences with South Asian women. A systematic review was conducted to explore and address health care providers' views on identification and response to South Asian women experiencing FV. Nine online databases, reference lists were searched, and a priori inclusion and exclusion criteria were applied independently by two reviewers. A meta-synthesis approach was utilized to integrate findings from qualitative studies. Eight studies involving 250 participants met the inclusion criteria. Studies were published between 2007 and 2020 within South Asian countries (Pakistan, India, and Sri Lanka) and one study from the USA and UK. The meta-synthesis identified three themes: Context of societal norms and attitudes towards women in South Asia; Influence of family honor, Privacy and shame; and Concern about health care provider's personal safety. Findings revealed that FV is often perceived as a normal routine issue and is considered a "private issue" in South Asian society. Family honor and values play a pivotal role in silencing women experiencing FV as disclosure is considered shameful and disgrace to family honor. Furthermore, health care providers avoid intervening in FV cases due to risk for their personal safety. Finally, this review provides the evidence to support a specific framework for FV interventions among south Asian women for policy makers and practitioners.

Visualising Patterns in Women's Experiences of Intimate Partner Violence in the First 10 years of Motherhood.

Intimate partner violence (IPV) can involve patterns of physical, sexual and emotional abuse. Women typically experience physical IPV in combination with emotional IPV, while emotional IPV is often experienced in the absence of other types of IPV. There is very little known about women's experiences of these different types of IPV over time. The primary aim of this paper is to describe patterns in women's individual experiences of physical and/or emotional IPV across the first 10 years of motherhood. Data were drawn from a prospective pregnancy cohort of 1507 first-time mothers in Melbourne, Australia. Emotional, physical, and combined physical and emotional IPV were reported in the first, fourth and tenth year of motherhood using the Composite Abuse Scale. The overall prevalence of each type of IPV remained consistent across the three time-points, with emotional IPV alone being the most prevalent. There was substantial variability in women's experiences of IPV over time and there was no common progression from one type of IPV to another. Women were more likely to report IPV at more than one time-point if they experienced combined physical and emotional IPV, while for women who reported emotional or physical IPV alone this was more likely to be at a single time-point. A number of socio-demographic characteristics in early pregnancy were associated with a higher risk of reporting IPV at all three time-points, including being unemployed (RRR = 3.6; 95% CI: 2.1, 6.2) and being aged 18-24 years (RRR = 3.1; 95% CI: 1.8, 5.4). Knowledge of the variability and persistence of IPV in the first 10 years of motherhood, and factors associated with these experiences, can help tailor effective health and social service responses.

Translation and cross-cultural adaptation of the Composite Abuse Scale into Brazilian Portuguese.

OBJECTIVE: To perform the translation and cross-cultural adaptation from English into Brazilian Portuguese of the Composite Abuse Scale, an instrument that identifies and quantifies intimate partner violence. METHODS: This study is based on the strict implementation of its previously published protocol, which consists of ten steps: (a) conceptual analysis; (b) double-blind translation; (c) comparison and first reconciled version of the two translations; (d) back-translation; (e) review of the back-translation by the developer and second reconciled version; (f) expert committee review (n = 6); (g) comparison of expert reviews and third reconciled version; (h) cognitive interviews with women from the Casa da Mulher Brasileira in Curitiba (n = 15); (i) assessments of user perceptions and final reconciliation; and (j) submission of the final version of the questionnaire to the developer. RESULTS: The implementation of the 10 steps of the protocol allowed the idiomatic, semantic, conceptual and experiential equivalences of the Composite Abuse Scale, incorporating suggestions and criticisms from the different participants of the process. Participants included the developer, professional translators, researchers specialized on the subject, women in situation of intimate partner violence, and professionals who provide care to them. Experts and cognitive interviews with women were instrumental in ensuring equivalence, and facilitating the understanding, including: (1) adaptation of the term "intimate relation" to "affective or conjugal relation"; (2) substitution of enclisis for proclisis cases in 20 items; (3) adoption of gender-neutral language, allowing its use in heterosexual, bisexual, and same-sex relations; (4) materialization of an instrument of scientific rigor and self-applicable, which may help women to visualize the situations of abuse in their relations. CONCLUSIONS: The translation and cross-cultural adaptation process of the Composite Abuse Scale resulted in the Composite Abuse Scale Brazilian Portuguese Version, a 30-item self-applicable instrument, capable to identify and quantify intimate partner violence, its frequency, severity and typologies (physical, emotional, harassment and severe combined violence).

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

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

Women's experiences and expectations of intimate partner abuse identification in healthcare settings: a qualitative evidence synthesis.

OBJECTIVES: To explore women's experiences and expectations of intimate partner abuse (IPA) disclosure and identification in healthcare settings, focusing on the process of disclosure/identification rather than the healthcare responses that come afterwards. DESIGN: Systematic review and meta-synthesis of qualitative studies DATA SOURCES: Relevant studies were sourced by using keywords to search the databases MEDLINE, EMBASE, CINAHL, PsychINFO, SocINDEX and ASSIA in September 2021. ELIGIBILITY CRITERIA: Studies needed to focus on women's views about IPA disclosure and identification in healthcare settings, use qualitative methods and have been published in the last 5 years. DATA EXTRACTION AND SYNTHESIS: Relevant data were extracted into a customised template. The Critical Appraisal Skills Programme checklist for qualitative research was used to assess the methodological quality of included studies. A thematic synthesis approach was applied to the data, and confidence in the findings was appraised using The Confidence in the Evidence from Reviews of Qualitative research methods. RESULTS: Thirty-four studies were included from a range of healthcare settings and countries. Three key themes were generated through analysing their data: (1) Provide universal education, (2) Create a safe and supportive environment for disclosure and (3) It is about how you ask. Included papers were rated overall as being of moderate quality, and moderate-high confidence was placed in the review findings. CONCLUSIONS: Women in the included studies articulated a desire to routinely receive information about IPA, lending support to a universal education approach that equips all women with an understanding of IPA and options for assistance, regardless of disclosure. Women's suggestions for how to promote an environment conducive to disclosure and how to enquire about IPA have clear implications for clinical practice.PROSPERO registration numberCRD42018091523.