Obstacles and Limitations in the Use of Protocols Responding Intimate Partner Violence Against Women from the Health System in Spain

Intimate partner violence against women (IPVAW) is a public health problem that affects women worldwide. Consequently, victims frequently go to healthcare centers, usually with a cover reason. To address this problem, national and autonomic protocols to respond to IPVAW in health systems have been developed in Spain. In this regard, the role of primary care physicians (PCPs) will be essential for addressing IPVAW, but they could encounter obstacles in doing so. The purpose of this study was to explore how IPVAW is addressed in healthcare centers in Spain. This study synthesized the information available in the protocols to address IPVAW among health care workers in Spain and analyzed it according to World Health Organization (WHO) guidelines. Additionally, PCPs’ perspectives on these protocols and the nature of IPVAW attention from healthcare centers were explored through a focus group. The findings displayed that, although the protocols mostly conform to WHO guidelines, they are insufficient to address IPVAW. Generally, PCPs were unaware of the existence of the protocols and referred to the lack of training in IPVAW and protocol use as one of the main obstacles to intervening, along with a lack of time and feelings as well as cultural, educational, and political factors. The adoption of measures to ensure that PCPs apply these protocols correctly and to approach PCPs’ obstacles for addressing IPVAW in consultations will be crucial for the care of victims. (AU)

Disparities in Resource Availability, Psychological Intimate Partner Violence, and Depression Among Hispanic Women.

This study aims to analyze the relationship between the availability of resources, exposure to psychological intimate partner violence (P-IPV), and depression in Hispanic women in South Florida. This secondary data analysis used cross-sectional baseline data from SEPA (Salud, Educación, Prevención y Autocuidado) III. SEPA III was a randomized controlled trial that tested the SEPA intervention with 320 cisgender, sexually active Hispanic women. Descriptive analysis, logistic, and multiple regressions were conducted. Lower sexual relationship power and attending religious services were associated with higher odds of P-IPV. Reporting a history of P-IPV in the last 3 months predicted depression scores and higher depression scores were associated with higher odds of experiencing P-IPV. Participants with higher depressive scores reported less education, increased emergency room utilization, and less sexual relationship power. P-IPV is highly prevalent among Hispanic women living in South Florida. The availability of personal and community resources can buffer the risk of P-IPV and its mental health consequences. Nurses can strengthen women's resources to prevent Hispanic women from exposure to P-IPV.

Detecting intimate partner violence circumstance for suicide: development and validation of a tool using natural language processing and supervised machine learning in the National Violent Death Reporting System.

BACKGROUND: Intimate partner violence (IPV) victims and perpetrators often report suicidal ideation, yet there is no comprehensive national dataset that allows for an assessment of the connection between IPV and suicide. The National Violent Death Reporting System (NVDRS) captures IPV circumstances for homicide-suicides (<2% of suicides), but not single suicides (suicide unconnected to other violent deaths; >98% of suicides). OBJECTIVE: To facilitate a more comprehensive understanding of the co-occurrence of IPV and suicide, we developed and validated a tool that detects mentions of IPV circumstances (yes/no) for single suicides in NVDRS death narratives. METHODS: We used 10 000 hand-labelled single suicide cases from NVDRS (2010-2018) to train (n=8500) and validate (n=1500) a classification model using supervised machine learning. We used natural language processing to extract relevant information from the death narratives within a concept normalisation framework. We tested numerous models and present performance metrics for the best approach. RESULTS: Our final model had robust sensitivity (0.70), specificity (0.98), precision (0.72) and kappa values (0.69). False positives mostly described other family violence. False negatives used vague and heterogeneous language to describe IPV, and often included abusive suicide threats. IMPLICATIONS: It is possible to detect IPV circumstances among singles suicides in NVDRS, although vague language in death narratives limited our tool's sensitivity. More attention to the role of IPV in suicide is merited both during the initial death investigation processes and subsequent NVDRS reporting. This tool can support future research to inform targeted prevention.

Romantic attachment and cyber dating violence in adolescence: A dyadic approach.

INTRODUCTION: Little research has documented cyber dating violence (DV)-a type of teen DV with unique characteristics that has been associated with negative consequences. Attachment is central to understanding negative behaviors in the context of relationships and has been associated with other forms of DV in teens. This study used an actor-partner interdependence model (APIM) to examine how cyber-DV victimization and perpetration (direct aggression and control) relate to attachment anxiety and avoidance. METHODS: An online questionnaire was completed by 126 adolescent couples (n = 252; mean age = 17.7) from Quebec, Canada. RESULTS: In almost all couples (96%), at least one partner reported an incident of cyber-control in the previous year, while cyber-aggression was reported in 34% of couples. APIM results revealed that girls' and boys' victimization and perpetration of direct cyber-aggression are associated similarly with both their own high levels of attachment anxiety and their partner's. Concerning cyber-control, results show that boys' and girls' victimization is associated more with their partner's higher level of anxious attachment than their own. Girls' perpetration of cyber-control is associated with both their own high levels of attachment anxiety and their partner's, while for boys' perpetration, their own high levels of anxious attachment were found to play a significantly greater role than their girlfriend's. No significant associations were found for the dimension of avoidant attachment for both cyber-aggression and cyber-control whether perpetration or victimization. CONCLUSION: These findings, which identify potential risk factors for victimization and perpetration of cyber-DV, have implications for research, intervention, and prevention.

The Nature, Patterns and Consequences of Technology-Facilitated Domestic Abuse: A Scoping Review.

Women are increasingly at risk of gender-based violence through technology and digital tools. Some digital devices and apps such as GPS location tracking, spyware, mobile phones and social media platforms have become new tools for perpetrators to monitor, harass and abuse victims. However, the nature and impacts of technology on intimate partner violence (IPV) have remained perplexing and ambiguous. Hence, this scoping review was conducted to explore the nature, patterns and consequences of technology-facilitated domestic abuse (TFDA). All journal articles and grey literature exploring the TFDA phenomenon, its nature and impacts on victims and services providers were scanned, and twenty-two papers were included in this scoping review. Overall, findings showed that digital devices, online applications and social media accounts facilitated IPV and exacerbated the consequences of abuse. Yet, many victims and frontline workers found understanding the nature and impacts of TFDA difficult. They faced many challenges addressing this form of abuse. Thus, several strategies are needed to adequately tackle TFDA, including conducting further research on the issue, developing appropriate policy and addressing gender inequality in the online environment.

Stories of Backlash in Interviews With Survivors of Intimate Partner Violence Against Women in Sweden.

Despite high gender equality ratings, Sweden shows a high prevalence of intimate partner violence against women (IPVAW). Suggested factors underlying this apparent paradox include backlash effects against women's empowerment. This study explores stories of backlash in interviews with 23 IPVAW survivors in Sweden. Thematic analysis identified categories of narrative segments referring to phenomena provoking violence; the victims' resources, agency, breaking with gender norms and resistance, and the partner's feelings of subordination, while case-centered narrative analysis pointed to divergences between how these categories appear in the stories. The study underscores the complexity of links between gender (in)equality and IPVAW in Sweden.

Barriers Faced by American Indian Women in Urban Wisconsin in Seeking Help Following an Experience of Intimate Partner Violence.

American Indian1 (AI) women experience high rates of intimate partner violence (IPV) and face many barriers when help-seeking. This study aims to understand better the context of IPV and help-seeking behaviors for urban AI women after experiences with IPV. Postcolonial and Indigenous feminist frameworks framed this critical ethnography study. Semistructured interviews with 34 AI IPV survivors2 living in Wisconsin urban areas were conducted. Our findings highlight context-specific structural barriers to help-seeking after experiences of IPV heightened by the COVID-19 pandemic. Context-specific and survivor-led interventions are necessary to address and reduce barriers that urban AI women face.

Intimate Partner Violence, Economic Insecurity, and Health Outcomes Among American Indian and Alaska Native Men and Women: Findings From a National Sample.

Limited data are available on experiences of intimate partner violence (IPV) and sexual violence (SV) and health outcomes among American Indian and Alaska Native (AIAN) populations. This study explores the relationship between IPV and SV, food insecurity, housing insecurity, healthcare access, and self-reported physical and mental health status in a nationally representative sample of AIAN adults (N = 3,634). IPV and SV were associated with poorer physical and mental health at the bivariate level, but not in multivariate analyses. Economic inequalities are a salient predictor of health and may be compounded by demographic and geographic contexts.

Intimate partner physical violence and inadequate weight gain in pregnancy / Violência física entre parceiros íntimos e ganho de peso inadequado durante a gestação

Abstract Objectives: to evaluate the association between intimate partner physical violence (IPPV) and inadequate gestational weight gain (GWG). Methods: cross-sectional study composed of 554 women who attended four Basic Health Units in the city of Rio de Janeiro between 2005 and 2009. The GWG was calculated through the difference between the final weight of pregnancy and pre-gestational weight. For the measurement of IPPV, the Portuguese version of the Conflict Tactics Scales (CTS-1) was used. Data analysis was based on multinomial logistic regression models, estimating odds ratios and respective 95% confidence intervals for associations between the variables of interest. Results: the prevalence of minor and severe IPPV was 31.6% and 16.3%, respectively. Almost two-thirds of the women had insufficient or excessive GWG. After adjusting the model, it was observed that the presence of IPPV increased by 1.66 (CI95%=1.05-2.64) times the chances of insufficient GWG, compared to couples who did not experience this type of violence. Concerning the excessive GWG, the associations with IPPV were not statistically significant. Conclusion: women who experience IPPV in their relationships are more likely to have insufficient GWG during pregnancy. From this perspective, prenatal care becomes an essential service for screening domestic violence and its possible repercussions.

Resumo Objetivos: avaliar a associação entre violência física entre parceiros íntimos (VFPI) e o ganho de peso gestacional (GPG) inadequado. Métodos: estudo seccional composto por 554 mulheres que compareceram a quatro Unidades Básicas de Saúde do município do Rio de Janeiro, entre 2005 e 2009. O GPG foi calculado através da diferença entre o peso final da gestação e o peso pré-gestacional. Para a mensuração da VFPI foi utilizada a versão em português da Conflict Tactics Scales (CTS-1). A análise dos dados se baseou em modelos de regressão logística multinomial, estimando-se razões de chance e respectivos intervalos de 95% de confiança para as associações entre as variáveis de interesse. Resultados: a prevalência de VFPI menor e grave foi 31,6% e 16,3%, respectivamente. Quase dois terços das mulheres apresentaram GPG insuficiente ou excessivo. Após o ajuste do modelo, observou-se que a presença de VFPI aumentou em 1,66 (IC95%=1,05-2,64) vezes as chances de GPG insuficiente, em comparação aos casais que não vivenciaram este tipo de violência. Em relação ao GPG excessivo as associações com VFPI não foram estatisticamente significantes. Conclusões: mulheres que vivenciam a VFPI têm maiores chances de apresentarem GPG insuficiente. Nessa perspectiva, o pré-natal passa a ser um serviço fundamental para o rastreamento de violência doméstica e suas possíveis repercussões.

Características da violência por parceiro íntimo em Mato Grosso do Sul, 2009-2018 / Características de la violencia por compañero íntimo en Mato Grosso do Sul, Brasil, 2009-2018 / Characteristics of intimate partner violence in Mato Grosso do Sul state, Brazil, 2009-2018

Objective: to analyze intimate partner violence (IPV) in Mato Grosso do Sul state, Brazil, with emphasis on physical violence. Methods: this was a cross-sectional study applying multiple correspondence analysis (MCA) to records retrieved from the Notifiable Health Conditions Information System covering the period from 2009 to 2018. Results: of the 9,950 notifications registered, 91.8% were notifications of physical violence; higher rates were found in young females (189.2/100,000), who had up to incomplete high school education (139.6/100,000), had a partner (202.7/100,000), were Indigenous (488.8/100,000), and were living on the border with other countries (223,1/100,000); the aggressors were mostly current partners (76.9%) and male (95.5%); MCA revealed that physical violence was predominant at weekends, at night, with use of physical force and when the aggressor was under the influence of alcohol; most IPV did not occur at home, but was committed by current partners and was not a repeated event. Conclusion: IPV stood out among young victims, those who had a partner, low education, Indigenous women and occurred notably in the border region.

Objetivo: analizar la violencia por compañero íntimo (VPI) en Mato Grosso do Sul, Brasil, con énfasis en la violencia física. Métodos: estudio transversal, con análisis de correspondencia (AC) de registros en el Sistema de Información de Agravamientos de Notificación, entre 2009 y 2018. Resultados: de las 9.950 notificaciones registradas, el 91,8% era de violencia física; las mayores tasas fueron encontradas en mujeres jóvenes (189,2/100.000), con escolaridad hasta secundaria completa (139,6/100.000), con pareja (202,7/100.000), indígenas (488.8/100,000) y residentes en la frontera (223,1/100.000); los agresores fueron, en su mayoría, de compañeros actuales (76,9%) y hombres (95,5%); sobre la violencia física, la AC reveló predominio de los fines de semana, en la noche, con uso de fuerza física y el agresor bajo los efectos de alcohol; sin embargo, ocurrieron fuera de la residencia, cometidos por compañeros actuales y no constituyeron hechos de repetición. Conclusión: se destacaron víctimas jóvenes, con pareja, baja escolaridad, mujeres indígenas y expresivos sucesos en la región fronteriza.

Objetivo: analisar a violência por parceiros íntimos (VPI) em Mato Grosso do Sul, Brasil, com destaque para violência física. Métodos: estudo transversal, com análise de correspondências (AC) dos registros no Sistema de Informação de Agravos de Notificação, em 2009-2018. Resultados: de 9.950 notificações registradas, 91,8% foram de violência física; maiores taxas foram encontradas em jovens do sexo feminino (189,2/100 mil), com escolaridade até o ensino médio incompleto (139,6/100 mil), com companheiro (202,7/100 mil), indígenas (488,8/100 mil) e residentes na fronteira (223,1/100 mil); os agressores eram majoritariamente parceiros atuais (76,9%) e homens (95,5%); sobre a violência física, a AC revelou predominância em fins de semana, à noite, com utilização de força corporal e agressor sob efeito de álcool; entretanto, ocorreu principalmente fora da residência, cometida por parceiro atual e não constituiu evento de repetição. Conclusão: destacaram-se vítimas jovens, com companheiro, baixa escolaridade, mulheres indígenas e ocorrência expressiva em região de fronteira.

Investigating the associations between intimate partner violence and nutritional status of women in Zimbabwe.

BACKGROUND: Intimate partner violence (IPV) against women and poor nutritional status are growing health problems in low and middle-income countries (LMICs). Moreover, violence against women has been shown to be associated with poor nutrition. This study investigated the relationship between IPV and nutritional status (i.e., underweight, overweight, and obesity) among women of reproductive age (15-49 years) in Zimbabwe. METHODS: Pooled data from the 2005/2006, 2010/2011, and 2015 Zimbabwe Demographic Health Surveys (ZDHS) on 13,008 married/cohabiting women were analysed. Multinomial logistic regression models were used to examine the associations between the various forms of IPV and the nutritional status of women. We further estimated the prevalence of BMI ≥ 25.0 kg/m2 (overweight and obesity) by intimate partner violence type. RESULTS: The mean BMI of women was 24.3 kg/m2, more than one-fifth (24%) were overweight and about 12% were obese. Forty-three percent (43%) of women reported to have ever experienced at least one form of intimate partner violence. More than one-third (35%) of women who reported to have ever experienced at least one form of intimate partner violence had a BMI ≥ 25.0 kg/m2 (p< 0.01). Relative to normal weight, women who had ever experienced at least one form of IPV (i.e., physical, emotional, or sexual) were more likely to be obese (aOR = 2.59; 95% CI = 1.05-6.39). Women's exposure to any form of intimate partner violence was not significantly associated with the likelihood of being underweight or overweight relative to normal weight. CONCLUSIONS: The study findings show that women of reproductive age in Zimbabwe are at high risk of both IPV and excess weight. Moreover, we found a positive relationship between exposure to at least one form IPV and obesity. Public health interventions that target the well-being, empowerment and development of women are needed to address the complex issue of IPV and adverse health outcomes, including obesity.

Violence in the Great Recession.

Substantial evidence suggests that economic hardship causes violence. However, a large majority of this research relies on observational studies that use traditional violence surveillance systems that suffer from selection bias and over-represent vulnerable populations, such as people of color. To overcome limitations of prior work, we employed a quasi-experimental design to assess the impact of the Great Recession on explicit violence diagnoses (injuries identified to be caused by a violent event) and proxy violence diagnoses (injuries highly correlated with violence) for child maltreatment, intimate partner violence, elder abuse, and their combination. We used Minnesota hospital data (2004-2014), conducting a difference-in-differences analysis at the county level (n = 86) using linear regression to compare changes in violence rates from before the recession (2004-2007) to after the recession (2008-2014) in counties most affected by the recession, versus changes over the same time period in counties less affected by the recession. The findings suggested that the Great Recession had little or no impact on explicitly identified violence; however, it affected proxy-identified violence. Counties that were more highly affected by the Great Recession saw a greater increase in the average rate of proxy-identified child abuse, elder abuse, intimate partner violence, and combined violence when compared with less-affected counties.

Maltrato en la gestante adolescente y su efecto en el peso del recién nacido en la altura geográfica peruana, Huancayo, Perú / Abuse in adolescent pregnant women and its effect on newborn weight in the Peruvian geographical altitude, Huancayo, Peru

INTRODUCCIÓN: La violencia en la gestante está asociada a muchos factores del recién nacido, pero esto casi no se ha reportado en la altura geográfica. OBJETIVO: Determinar si existe asociación entre el maltrato en la gestante adolescente y su efecto en el peso del recién nacido en la altura geográfica peruana. MÉTODO: Estudio de cohorte retrospectiva. Se tomó la información de 855 gestantes. La variable exposición fue que hubieran sufrido violencia, lo cual se asoció al peso y otros datos del recién nacido en la ciudad de Huancayo, Perú. RESULTADOS: Según el análisis multivariado, hubo más riesgo de que el niño tuviera un peso inadecuado cuando hubo violencia física (riesgo relativo ajustado [RRa]: 1,42; intervalo de confianza del 95% [IC95%]: 1,01-2,00; p = 0,045), cuando se tuvo un parto pretérmino según Capurro (RRa: 4,90; IC95%: 2,85-8,45; p < 0,001), cuando hubo complicaciones en el parto (RRa: 2,11; IC95%: 1,25-3,61; p = 0,006) y si el abuso inició en el primer trimestre (RRa: 14,74; IC95%: 4,70-46,27; p < 0,001), el segundo (RRa: 18,72; IC95%: 5,78-60,63; p < 0,001) o el tercero (RRa: 18,87; IC95%: 4,71-75,60; p < 0,001). CONCLUSIONES: Existe asociación entre sufrir violencia física durante la gestación y el bajo peso al nacer, y también se encontró asociación con otras variables.

INTRODUCTION: Violence in the pregnant woman is associated with many newborn factors, but this has hardly been reported in the geographical altitude. OBJECTIVE: To determine whether there is an association between adolescent pregnancy abuse and its effect on newborn birth weight in high altitude Peru. METHOD: Retrospective cohort study. Information was taken from 855 pregnant women. The exposure variable was whether they had suffered gender-based violence, the exposure variable was that they had suffered violence, which was associated with the weight and other data of the newborn in Huancayo city, Peru. RESULTS: In the multivariatee analysis it was found that there was a higher risk of the child having an inadequate weight when there was physical violence (adjusted relative risk [RRa]: 1.42; 95% confidence interval [95% CI]: 1.01-2.00; p = 0.045), when there was a preterm birth according to Capurro (RRa: 4.90; 95% CI: 2.85-8.45; p < 0.001), when there were complications in childbirth (RRa: 2.11; 95% CI: 1.25-3.61; p = 0.006) and if the abuse started in the first trimester (RRa: 14.74; 95% CI: 4.70-46.27; p < 0.001), second (RRa: 18.72; 95% CI: 5.78-60.63; p < 0.001) or third (RRa: 18.87; 95% CI: 4.71-75.60; p < 0.001). CONCLUSIONS: There is an association between suffering physical violence during gestation and low birth weight, and association was also found with other variables.

Physical violence against women by their intimate partner during pregnancy and its relationship with breastfeeding / Violência física contra a mulher pelo parceiro durante a gravidez e sua relação com o aleitamento materno

Abstract Objectives: to estimate the association between physical violence against women by their intimate partner during pregnancy and breastfeeding. Methods: the data source is the 2010 National Demographic and Health Survey (DHS) conducted in Colombia, and 11,416 mother-child dyads were analysed. The relationship between physical violence against women by their partner during pregnancy and breastfeeding indicators was carried out using the weighted propensity score from the Inverse Probability of Treatment Weighting (IPTW). Variables for adjustment were selected through the Directed Acyclic Diagram (DAG) and performed a sensitivity analysis to identify the strength of hidden bias. Results: according to the data, 6.4% (730) of the women suffered physical violence by their partner during their pregnancy. The median time of exclusive breastfeeding was 1.0 month. No statistically significant relationship was observed with any of the breastfeeding indicators analysed: exclusive breastfeeding (OR=1.17; CI95%=0.82-1.67); breastfeeding at any time (OR=1.61; CI95%=0.58-2.60); and initiation of breastfeeding (OR=1.07; CI95%=0.74-1.2) Conclusion: although the association between violence against women committed during pregnancy and breastfeeding indicators was not found, the suboptimal breastfeeding practices and high prevalence of violence against women by the partner are two major public health issues in Colombia. Prenatal care professionals can change this scenario by identifying women exposed to intimate partner violence and offering tailored support for breastfeeding practices.

Resumo Objetivos: estimar a associação entre a violência física contra a mulher durante a gravidez pelo parceiro íntimo e o aleitamento materno. Métodos: o estudo analisou os dados de 11.416 díades mãe-filho na Pesquisa Nacional de Demografa e Saúde (ENDS) realizada na Colômbia em 2010. Utilizou-se o escore de propensão com o Inverso da Probabilidade Ponderada do Tratamento (IPTW) para estimar o efeito da violência física contra a mulher pelo parceiro durante a gravidez e o aleitamento materno. Através de um Diagrama Acíclico Direcionado (DAG) foram selecionadas as variáveis para ajuste do modelo.Análise de sensibilidade foi realizada para identificar a presença de viés oculto. Resultados: segundo os dados analisados, 6,4% das mulheres sofreram violência física pelo parceiro durante a gravidez. O tempo mediano de aleitamento materno exclusivo foi de 1 mês. Não houve relação estatisticamente significante entre a violência física contra a mulher com os indicadores de aleitamento materno analisados: aleitamento materno exclusivo (OR= 1,17; IC95%= 0,82 - 1,67), aleitamento materno em algum momento (OR=1,61; IC95%= 0,58 - 2,60) e início do aleitamento materno (OR=1,07; IC95%= 0,74 - 1,2) Conclusão: embora não se tenha encontrado associação entre a violência física contra a mulher pelo parceiro durante a gravidez e o aleitamento materno, práticas insuficientes de aleitamento materno e a existência da violência contra a mulher pelo parceiro ainda permanecem como problemas de saúde pública na Colômbia. Os profissionais da assistência pré-natal podem mudar esse cenário, identificando mulheres expostas à violência praticada pelo parceiro íntimo e oferecendo suporte individualizado para as práticas de aleitamento materno.

Social determinants of antenatal depression and anxiety among women in South Asia: A systematic review & meta-analysis.

BACKGROUND: Pregnancy is a time of major psychological changes making pregnant women more susceptible to depression and anxiety. Prevalence is higher among women living in Bangladesh, India and Pakistan, compared to high-income countries, due to poor understanding and lack of mental health integration within antenatal care. Antenatal depression/anxiety is associated with adverse outcomes including postnatal depression, low birth weight and impaired fetal development. Existing systematic reviews provided only limited information on the social determinants of antenatal depression/anxiety in these South Asian countries. OBJECTIVE: This review aimed to identify, synthesise and appraise the evidence on the social determinants associated with antenatal depression and anxiety in women living in Bangladesh, India and Pakistan. METHODS: We searched five databases (MEDLINE, Embase, PsycINFO, Scopus, Web of Science) and PROSPERO. Observational studies published between 1st January 2000 and 4th January 2021 were included if they were in the English language, used validated tools for measuring depression/anxiety in pregnant women and reported statistical associations or raw numbers. Summary estimates were obtained using random-effects model. Heterogeneity and publication bias was measured using the I2 statistic and Egger's test, respectively. This review was registered on PROSPERO (reference: CRD42020167903). RESULTS: We included 34 studies (with 27,379 women). Meta-analysis of Adjusted Odds Ratios (AOR) found that Intimate partner violence (AOR 2.48, 95% CI 1.41-4.33), unplanned pregnancy (AOR 1.53, 95% CI 1.28-1.83), male gender preference (AOR 3.06, 95% CI 1.40-6.72) and poor relationship with in-laws (AOR 2.69, 95% CI 1.25-5.80) were significantly associated with antenatal depression/anxiety. CONCLUSION: The review identified a complex range of social determinants of antenatal depression and anxiety in Bangladesh, India and Pakistan. Screening tools to identify pregnant women at high risk should be integrated within antenatal care to prevent adverse outcomes. Knowledge of these social determinants will inform the development of such screening tools and interventions.

Global, regional, and national prevalence estimates of physical or sexual, or both, intimate partner violence against women in 2018.

BACKGROUND: Intimate partner violence against women is a global public health problem with many short-term and long-term effects on the physical and mental health of women and their children. The Sustainable Development Goals (SDGs) call for its elimination in target 5.2. To monitor governments' progress towards SDG target 5.2, this study aimed to provide global, regional, and country baseline estimates of physical or sexual, or both, violence against women by male intimate partners. METHODS: This study developed global, regional, and country estimates, based on data from the WHO Global Database on Prevalence of Violence Against Women. These data were identified through a systematic literature review searching MEDLINE, Global Health, Embase, Social Policy, and Web of Science, and comprehensive searches of national statistics and other websites. A country consultation process identified additional studies. Included studies were conducted between 2000 and 2018, representative at the national or sub-national level, included women aged 15 years or older, and used act-based measures of physical or sexual, or both, intimate partner violence. Non-population-based data, including administrative data, studies not generalisable to the whole population, studies with outcomes that only provided the combined prevalence of physical or sexual, or both, intimate partner violence with other forms of violence, and studies with insufficient data to allow extrapolation or imputation were excluded. We developed a Bayesian multilevel model to jointly estimate lifetime and past year intimate partner violence by age, year, and country. This framework adjusted for heterogeneous age groups and differences in outcome definition, and weighted surveys depending on whether they were nationally or sub-nationally representative. This study is registered with PROSPERO (number CRD42017054100). FINDINGS: The database comprises 366 eligible studies, capturing the responses of 2 million women. Data were obtained from 161 countries and areas, covering 90% of the global population of women and girls (15 years or older). Globally, 27% (uncertainty interval [UI] 23-31%) of ever-partnered women aged 15-49 years are estimated to have experienced physical or sexual, or both, intimate partner violence in their lifetime, with 13% (10-16%) experiencing it in the past year before they were surveyed. This violence starts early, affecting adolescent girls and young women, with 24% (UI 21-28%) of women aged 15-19 years and 26% (23-30%) of women aged 19-24 years having already experienced this violence at least once since the age of 15 years. Regional variations exist, with low-income countries reporting higher lifetime and, even more pronouncedly, higher past year prevalence compared with high-income countries. INTERPRETATION: These findings show that intimate partner violence against women was already highly prevalent across the globe before the COVID-19 pandemic. Governments are not on track to meet the SDG targets on the elimination of violence against women and girls, despite robust evidence that intimate partner violence can be prevented. There is an urgent need to invest in effective multisectoral interventions, strengthen the public health response to intimate partner violence, and ensure it is addressed in post-COVID-19 reconstruction efforts. FUNDING: UK Department for International Development through the UN Women-WHO Joint Programme on Strengthening Violence against Women Data, and UNDP-UN Population Fund-UNICEF-WHO-World Bank Special Programme of Research, Development, and Research Training in Human Reproduction, a cosponsored programme executed by WHO.

Propensity score analysis of psychological intimate partner violence and preterm birth.

Psychological intimate partner violence (IPV), a global public health problem, affects mothers during pregnancy. We evaluated its relationship with preterm birth. We established a cohort of 779 consecutive mothers receiving antenatal care and giving birth in 15 public hospitals in Spain. Trained midwives collected IPV data using the Index of Spouse Abuse validated in the Spanish language. Preterm was defined as birth before 37 completed weeks of gestation. Gestational age was estimated by early ultrasound. With multivariate logistic regression we estimated the relative association of IPV with preterm birth as adjusted odds ratios (AOR), with 95% confidence intervals (CI). In propensity score analysis, using weighting by inverse probability of exposure to IPV, the whole sample was used for estimating the absolute difference in probability of preterm amongst offspring born to mothers with and without IPV. Socio-demographic and other pregnancy characteristics served as covariates in both analyses. Preterm occurred in 57 (7.3%) pregnancies. Psychological IPV, experienced by 151 (21%) mothers, was associated with preterm birth (11.9% vs 6.5%; AOR = 2.4; 95% CI = 1.1-5.0; p = 0.01). The absolute preterm difference in psychological IPV compared to normal was 0.08 (95% CI = 0.01-0.16; p = 0.04). The probability of preterm birth was 8% higher on average in women with psychological IPV during pregnancy. As our analysis controlled for selection bias, our findings give credence to a causal inference. Screening and management for psychological IPV during pregnancy is an important step in antenatal care to prevent preterm birth.

Can Women Shelters Help Reduce Symptoms of PTSD and C-PTSD? Trajectories of PTSD Symptom Development Following Partner- and Family-Related Violence.

BACKGROUND: To protect women from Intimate partner violence (IPV), women's shelters should not only provide emergency safety from IPV exposure, but also prolonged support that empowers women to build a life free from violence. The present study aims to investigate individual symptom development in association with residency at a women's shelter. METHOD: Data were collected at four different timepoints, that is, enrolment (T1, N = 150), 3-months residency (T2, = 110), 6-months residency (T3, N = 68) and after relocation (T4, N = 63). Women were included from four Danish women's shelters. The International Trauma Questionnaire (ITQ) was applied to test for post-traumatic stress disorder (PTSD) and Complex-PTSD (C-PTSD) at all timepoints. A paired sample t-test was used to test the mean symptom development, and a Latent Class Growth Analysis (LCGA) was applied to test for different classes of PTSD-trajectories. Logistic regression was applied to predict class membership from shelter-related variables and symptom severity, that is, length of residency, psychological counselling, revictimization and key symptoms of C-PTSD. RESULTS: The prevalence of PTSD (31%) and C-PTSD (37.9%) was high at enrolment. Although t-tests suggested a significant decline in symptoms at follow-up, the LCGA revealed different classes of symptom development. The two-class model was found to be the best representation of data with low-symptom- and high-symptom profiles, respectively. Overall, the largest decline in symptoms occurred within the first 3 months of residency. Revictimization was high and was further found to predict class membership. However, when included in a multiple regression only symptom severity predicted the high-symptoms profile class. DISCUSSION: Psychological treatment focussing on PTSD and C-PTSD is important for the women's future well-being and safety. Reports on revictimization was alarmingly high, which emphasises a continuing need to protect women from psychological violence within the shelters. These findings should be replicated in larger samples before we can draw any conclusion.