A public health perspective on "The ethics of asking and not asking about abuse."

Comments on the article by K. Becker-Blease and J. Freyd (see record 2006-03947-003), which provides a thought-provoking and important perspective regarding the ethics of researchers asking or not asking adults about abuse they experienced as children. Many of these authors' concerns with research on abuse during childhood apply equally to abuse and violence experienced at all life stages. Focusing on intimate partner violence (IPV), we wish to amplify upon and respond to their observations from the perspective of public health scientists involved in large-scale telephone survey research on violence (including family violence, IPV, sexual violence, and suicide). We strongly agree with Becker-Blease and Freyd that decisions not to ask about abuse play directly into the social forces that perpetuate IPV and other forms of violence as pervasive and pernicious social and public health problems. From a public health perspective, the question is not whether to ask but how to ask about participants' experiences with violence and abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intimate partner violence among female sex workers in two Mexico–U.S. Border cities: Partner characteristics and HIV risk behaviors as correlates of abuse.

Intimate partner violence (IPV) has been associated with greater vulnerability to HIV infection among women. We examined prevalence and correlates of IPV among female sex workers (FSWs) in Tijuana and Ciudad Juarez, two large Mexico–U.S. border cities in which HIV prevalence is rising. Participants were 300 FSWs with a current spouse or a steady partner. Participants' mean age was 33 years, and mean number of years as a sex worker was 6. The prevalence of IPV in the past 6 months among participants was 35%. Using multivariate logistic regression, factors independently associated with IPV included having experienced abuse as a child, a partner who had sex with someone else, and lower sexual relationship power. Our findings suggest the need for previous abuse screening and violence prevention services for FSWs in the Mexico–U.S. border region. Careful consideration of relationship dynamics such as infidelity and relationship power is warranted when assessing for IPV risk. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevalences of intimate partner violence in a representative U.S. Air Force sample.

Objective: Intimate partner violence (IPV) is a serious health concern, but little is known about prevalence of IPV in the armed forces, as military members cope with the pressures of long-standing operations. Furthermore, previous prevalence studies have been plagued by definitional issues; most studies have focused on acts of aggression without consideration of impact (clinically significant [CS] IPV). This is the first large-scale study to examine prevalences of IPV, CS-IPV, and clinically significant emotional abuse (CS-EA) for men and women. Method: A United States Air Force-wide anonymous survey was administered across 82 bases in 2006 (N = 42,744) to assess IPV, CS-IPV, and CS-EA. Results: The adjusted prevalence of CS-IPV perpetration was 4.66% for men and 3.54% for women. Prevalences of IPV perpetration were 12.90% for men and 15.14% for women. CS-EA victimization was 6.00% for men and 8.50% for women. Sociodemographic differences in risk for violence were found for gender, race/ethnicity, pay grade, religious faith, marital status, and career type even after controlling for other demographic variables. Conclusions: Partner maltreatment is widespread in military (and civilian) samples. Men were more likely to perpetrate CS-IPV, whereas women were more likely to perpetrate IPV. Specific demographic risk factors were identified for different types of partner maltreatment (e.g., lower rank predicted higher risk for both perpetration and victimization across men and women). Other sociodemographic differences varied across severity (IPV vs. CS-IPV) and across gender. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Relation of low-severity violence to women's health

OBJECTIVE: To determine if women who experience low-severity violence differ in numbers of physical symptoms, psychological distress, or substance abuse from women who have never been abused and from women who experience high-severity violence. DESIGN: Cross-sectional, self-administered, anonymous survey. SETTING: Four community-based, primary care, internal medicine practices. PATIENTS: Survey respondents were 1,931 women aged 18 years or older. SURVEY DESIGN: Survey included questions on violence; a checklist of 22 physical symptoms; the Symptom Checklist-22 (SCL-22) to measure depression, anxiety, somatization, and self-esteem; CAGE questions for alcohol use; and questions about past medical history. Low-severity violence patients had been "pushed or grabbed" or had someone "threaten to hurt them or someone they love" in the year prior to presentation. High-severity violence patients had been hit, slapped, kicked, burned, choked, or threatened or hurt with a weapon. MAIN RESULTS: Of the 1,931 women, 47 met criteria for current low-severity violence without prior abuse, and 79 met criteria for current high-severity violence without prior abuse, and 1,257 had never experienced violence. The remaining patients reported either childhood violence or past adult abuse. When adjusted for socioeconomic characteristics, the number of physical symptoms increased with increasing severity of violence (4.3 for no violence, 5.3 for low-severity violence, 6.4 for high-severity violence, p < .0001). Psychological distress also increased with increasing severity of violence (mean total SCL22 scores 32.6 for no violence, 35.7 for low-severity violence, 39.5 for high-severity violence, p < .0001). Women with any current violence were more likely to have a history of substance abuse (prevalence ratio [PR] 1.8 for low-severity, 1.9 for high-severity violence) and to have a substance-abusing partner (PR 2.4 for both violence groups). CONCLUSIONS: In this study, even low-severity violence was associated with physical and psychological health problems in women. The data suggest a dose-response relation between the severity of violence and the degree of physical and psychological distress.     

Effects of domestic violence on children's behavior problems and depression.

The Children's Depression Inventory, Child Behavior Checklist, and Youth Self-Report were completed by mothers, fathers, and their 8–12 yr old children to assess the effects of various types of domestic violence on children's behavior problems and depression. 110 Israeli children from lower-class families were identified through social service records. 33 of the children had been physically abused by their parents within the last 6 mo, 16 had witnessed spouse abuse, 30 had been both victims and witnesses of domestic violence, and 31 had experienced no known domestic violence. Overall, domestic violence had effects on child development that varied in magnitude and nature depending on the type of domestic violence and who reported the information about the child's adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The possibility for treating certain forms of endometrial and ovarian carcinomas with GnRH agonists]

The purpose of this study was to quantify the proportion of men and women seen in a university emergency department (ED) for treatment of injuries resulting from intimate partner violence (IPV) that require reports to law enforcement authorities. A total of 1,516 adult ED patients were asked to complete a written survey instrument; 1,003 patients (66.2%) completed the survey. Two percent of patients reported they presented to the ED for treatment of injuries resulting from IPV. Three percent reported IPV within the last year, and 10% reported that they had ever been physically abused by a partner. Six percent of respondents reported that they had ever been threatened with a gun or knife by a partner, 2% within the past year. Only the lifetime prevalence of IPV was significantly greater among female patients, 15% versus 6% (P < .001). Approximately 2% of our ED patients require law enforcement intervention for IPV.     

Additional adverse events among women exposed to intimate partner violence: Frequency and impact.

Objective: To assess additional adverse life events that women exposed to intimate partner violence (IPV) may have endured and to ascertain whether, and in what ways, problems in adjustment are related more to IPV or to IPV plus other adverse life events. Method: Predictors of the effects of exposure to adversities were investigated in this study of 104 women exposed to severe IPV who reported conflict tactics, adverse life events, as well as symptoms of distress. Results: The majority of participants experienced additional adversities (86%). Significant differences were found between those exposed to IPV-only and those exposed to IPV plus other adverse events in terms of IPV frequency and current symptoms of distress. Women with IPV plus other adverse events had twice as many physical assaults and 4 times as many sexual assaults from an intimate partner compared to IPV-only women. The number of adverse events contributed significantly to variance in trauma symptoms over and above that of exposure to IPV alone. Women exposed to additional events had approximately twice as many avoidance and physiological arousal symptoms as IPV-only women. Conclusions: The results of this study suggest a variety of implications for IPV treatment and interventions. Specifically, the role that additional interpersonal violence, especially sexual violence, plays in the expression of distress may relate to the type of service offered to the survivor. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Interventions for intimate partner violence: Review and implications for evidence-based practice.

The objective of this article was to survey available intimate partner violence (IPV) treatment studies with (a) randomized case assignment, and (b) at least 20 participants per group. Studies were classified into 4 categories according to primary treatment focus: perpetrator, victim, couples, or child-witness interventions. The results suggest that extant interventions have limited effect on repeat violence, with most treatments reporting minimal benefit above arrest alone. There is a lack of research evidence for the effectiveness of the most common treatments provided for victims and perpetrators of IPV, including the Duluth model for perpetrators and shelter–advocacy approaches for victims. Rates of recidivism in most perpetrator- and partner-focused treatments are approximately 30% within 6 months, regardless of intervention strategy used. Couples treatment approaches that simultaneously address problems with substance abuse and aggression yield the lowest recidivism rates, and manualized child trauma treatments are effective in reducing child symptoms secondary to IPV. This review shows the benefit of integrating empirically validated substance abuse and trauma treatments into IPV interventions and highlights the need for more work in this area. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Making sense of family conflict: Intimate partner violence and preschoolers’ externalizing problems.

This research examines relations among parental intimate partner violence (IPV), preschoolers’ narrative coherence about family conflict situations, and preschoolers’ externalizing problems. Participants were 57 mothers and their 4- to 5-year-old children. Mothers provided data on IPV and children’s externalizing problems. Narrative coherence was coded from children’s play narratives in response to story stems from the MacArthur Story Stem Battery. Results are consistent with theory suggesting that exposure to IPV may adversely affect preschoolers’ ability to understand family conflict situations in an organized manner, which in turn may contribute to their externalizing problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceived benefit from child sexual abuse

People often report perceptions of benefit from adverse life experiences. In this study, adult perceptions of benefit from child sexual abuse were examined in a sample of 154 low-income women who were sexually abused as children. Almost half reported some perceived benefit. The benefits fell into 4 main categories: protecting children from abuse, self-protection, increased knowledge of child sexual abuse, and having a stronger personality. Degree of perceived benefit was associated with several indicators of adult adjustment. In addition, those who perceived themselves as stronger had higher self-esteem, and those who perceived increased sexual abuse knowledge viewed others more favorably and were more comfortable getting close to others, when compared with other respondents.     

Prostitution, violence, and posttraumatic stress disorder

One hundred and thirty people working as prostitutes in San Francisco were interviewed regarding the extent of violence in their lives and symptoms of posttraumatic stress disorder (PTSD). Fifty-seven percent reported that they had been sexually assaulted as children and 49% reported that they had been physically assaulted as children. As adults in prostitution, 82% had been physically assaulted; 83% had been threatened with a weapon; 68% had been raped while working as prostitutes; and 84% reported current or past homelessness. We differentiated the types of lifetime violence as childhood sexual assault; childhood physical abuse; rape in prostitution; and other (non-rape) physical assault in prostitution. PTSD severity was significantly associated with the total number of types of lifetime violence (r = .21, p = .02); with childhood physical abuse (t = 2.97, p = .004); rape in adult prostitution (Student's t = 2.77, p = .01); and the total number of times raped in prostitution (Kruskal-Wallace chi square = 13.51, p = .01). Of the 130 people interviewed, 68% met DSM III-R criteria for a diagnosis of PTSD. Eighty-eight percent of these respondents stated that they wanted to leave prostitution, and described what they needed in order to escape.     

Editorial.

The papers collected in this special issue of CJBS reflect a growing interest in the field of family violence among Canadian investigators. The purpose of this collection is twofold: first, to focus attention on the problem of family violence as a research issue by introducing some examples of current research to those unfamiliar with the issue; and second, to encourage researchers to continue and expand their efforts in this field. This collection of papers mirrors the diversity of focus among family violence research programs, the range of research techniques used, and the differences in state-of-the-art in the various sub-fields of child abuse, sexual victimization of children, and wife assault. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive–behavioral therapy for PTSD and depression symptoms reduces risk for future intimate partner violence among interpersonal trauma survivors.

Objective: Women who develop symptoms of posttraumatic stress disorder (PTSD) and depression subsequent to interpersonal trauma are at heightened risk for future intimate partner violence (IPV) victimization. Cognitive–behavioral therapy (CBT) is effective in reducing PTSD and depression symptoms, yet limited research has investigated the effectiveness of CBT in reducing risk for future IPV among interpersonal trauma survivors. Method: This study examined the effect of CBT for PTSD and depressive symptoms on the risk of future IPV victimization in a sample of women survivors of interpersonal violence. The current sample included 150 women diagnosed with PTSD secondary to an array of interpersonal traumatic events; they were participating in a randomized clinical trial of different forms of cognitive processing therapy for the treatment of PTSD. Participants were assessed at 9 time points as part of the larger trial: pretreatment, 6 times during treatment, posttreatment, and 6-month follow-up. Results: As hypothesized, reductions in PTSD and in depressive symptoms during treatment were associated with a decreased likelihood of IPV victimization at a 6-month follow-up even after controlling for recent IPV (i.e., IPV from a current partner within the year prior to beginning the study) and prior interpersonal traumas. Conclusions: These findings highlight the importance of identifying and treating PTSD and depressive symptoms among interpersonal trauma survivors as a method for reducing risk for future IPV. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Warzone violence in Vietnam: an examination of premilitary, military, and postmilitary factors in PTSD in-patients

The impact of childhood victimization and other premilitary factors on warzone abusive violence was examined with 177 Vietnam combat veteran inpatients. Premilitary and military variables were also examined in relationship to postmilitary variables, including violence and PTSD. Statistical analyses showed that none of the premilitary variables predicted warzone violence. High combat exposure did, however, predict warzone abusive violence and PTSD. In addition, participation in warzone violence predicted postmilitary violence to self, spouse, and others. Although high rates of childhood victimization and high levels of combat exposure were found, neither predicted postmilitary violence, criminal activities, drug/alcohol problems, or suicide attempts. Low childhood adjustment ratings and school suspensions predicted adult alcohol abuse and drug abuse, respectively. These findings and their implication for treatment are discussed.     

Relationship of childhood sexual, physical, and combined sexual and physical abuse to adult victimization and posttraumatic stress disorder

OBJECTIVE: Prior research has suggested that women who experience childhood sexual abuse are at increased risk for sexual victimization and Posttraumatic Stress Disorder (PTSD) in adulthood. However, previous studies have paid insufficient attention to the overlap of childhood sexual and physical abuse. In the present study we disentangled the separate and combined effects of childhood sexual and physical abuse by comparing groups of participants who reported contact childhood sexual abuse only (SA), sequelae of childhood physical abuse only (PA), combined childhood sexual and physical abuse (CA), or no child abuse (NA). METHOD: A sample of 475 female college students completed measures of sexual and physical abuse in childhood (before age 15) and adulthood (after age 15), PTSD and trauma symptoms, and demographic variables. Of these participants, 27 were assigned to the SA group, 53 to the PA group, 31 to the CA group, and 211 to the NA group. RESULTS: The highest rate of adult sexual and/or physical victimization was reported by the CA group, followed by the PA group, with lower rates reported by the SA and NA groups. Using adult victimization as a covariate, the analyses revealed that the CA group reported significantly higher rates of PTSD and trauma symptoms compared to the NA group. CONCLUSIONS: The results suggest that prior reports of differences in rates of adult victimization and PTSD between women who experienced childhood sexual abuse and women who did not may be attributable to the inclusion of participants with a history of combined childhood sexual and physical abuse in childhood sexual abuse groups. The importance of separating physical and combined forms of victimization from sexual abuse is discussed.     

Predictors of domestically violent men's aggression toward children: A prospective study.

This research examines predictors of domestically violent men's aggression toward children after the children and their mothers sought help at an emergency shelter for domestic violence victims. Participants were 62 women who had sought refuge at a domestic violence shelter and who had at least one child between 4 and 9 years old. During their shelter stay, women provided data on partner–child aggression that occurred before shelter entry. After leaving the shelter, they also provided data on postshelter partner–mother intimate partner violence (IPV), children's postshelter contacts with their mothers' partners, and postshelter partner–child aggression on 5 occasions after their shelter departure (4, 8, 12, 16, and 20 months postshelter). Consistent with our hypotheses, the level of partner–child aggression before the family entered the shelter, the level of partner–mother IPV after shelter departure, and the frequency of children's contacts with the partners after shelter departure each predicted postshelter partner–child aggression. Clinical and policy implications are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Emotional attachments in abusive relationships: a test of traumatic bonding theory

An empirical test of traumatic bonding theory, the notion that strong emotional attachments are formed by intermittent abuse, is reported. In-depth assessments (interviews plus questionnaires) were conducted on 75 women who had recently left abusive relationships (50 where physical violence had occurred). The study found support for the effect of relationship dynamic factors such as extremity of intermittent maltreatment and power differentials on long-term felt attachment for a former partner, experienced trauma symptoms, and self-esteem, immediately after separation from an abusive partner and again after a six month interim. All three of these measures were significantly intercorrelated within each time period. Each measure at Time 1 correlated significantly with each corresponding measure at Time 2. After six months attachment had decreased by about 27%. Relationship variables (total abuse, intermittency of abuse and power differentials) accounted for 55% of the variance in the attachment measure at Time 2 indicating prolonged effects of abuse suffered in the relationship.     

The mediating role of parenting stress in the relation between intimate partner violence and child adjustment.

This study examined the role of maternal parenting stress in the relation between intimate partner violence (IPV) and children's emotional and behavioral problems among 139 African American children between the ages of 8 and 12 years. Structural equation modeling was used to investigate a mediational model examining maternal reports of IPV and parenting stress and both mother and child reports of child adjustment. Results suggest that parenting stress helps explain the link between IPV and child emotional and behavioral problems. Findings from this study highlight the importance of parenting stress in outcomes of children from low-income African American families who experience IPV. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The complexities of domestic violence.

Comments on the article by Robert Bornstein, "The complex relationship between dependency and domestic violence: Converging psychological factors and social forces," (see record 2006-11202-003). Although a more focused examination of the psychological factors involved in domestic violence is welcome, there are some factual errors in Bornstein's article that need attention and represent a general problem in reports of domestic violence. Bornstein wrote, "Studies indicate that more than 95% of abuse perpetrators are men" (p. 595) and then proceeded to assess dependency in male perpetrators and female victims of intimate partner violence (IPV). The study indicating that more than 95% of IPV perpetrators are men was not cited and is, in fact, fictitious. The best empirical evidence indicates an entirely different finding. Clinical predictions of dangerousness made in psychiatric emergency rooms often underestimate female dangerousness. Risk of harm to children has often been based on wife abuse-child abuse incidence co-occurrence estimates from shelter house samples of women and erroneously generalized to community samples. For these reasons, regeneration of the gender paradigm by Bornstein, or others, serves to misinform the profession. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Incidence of child neglect and child abuse in the region of Copenhagen

The aim of the study was to evaluate the incidence of physical violence, neglect and sexual abuse against children as reported to the local authorities, in the county of Copenhagen during the year 1993. A questionnaire was mailed to the local authorities in the 18 districts in the county and to 18 schools and 18 general practitioners (GP's). They were asked whether, and how many new, verified and suspected cases of physical, emotional and sexual abuse had come to their attention in 1993. A total of 300 cases of child abuse were identified in the area with a total population of 675.000 i.e. a total incidence of 2.7 cases per 1000 children aged 0-17 years (2.7%), with 0.7% for physical violence, 0.5% for sexual abuse and 1.5% for emotional neglect. Some 180 cases were considered verified and 120 cases were suspected. A considerable variation between the different districts was noted, i.e. the local incidence varied from 0-5.4%. A statistically significant inverse correlation between the average local tax-income and the incidence of child abuse and neglect was found. There were several examples of schools having knowledge of more cases than the local authorities. Very few cases came to be attention of the GP.