Early family adversity trajectories and mental health in emerging adulthood: Differential impacts of contextual insecurity and relational adversity.

Intimate partner violence (IPV) victimization is a prominent risk factor for depression among mothers. Less is known about the long-term relationship between IPV and maternal depression, impacts of IPV exposure on children, and mechanisms linking IPV with long-term mental health problems. IPV threatens stable housing for survivors, which increases likelihood of surveillance and sanctioning by formal systems - in particular, child welfare and criminal justice. The present study investigates whether housing insecurity and system contacts mediate the relationship between maternal IPV victimization and depression among both mothers and children 10 years later. Data comes from the Fragile Families and Child Well-being Study, a longitudinal survey of at-risk families with children. Structural equation modeling investigates pathways from IPV victimization of mothers to maternal and child depression via housing insecurity and contact with the child welfare and criminal justice systems. Results show IPV victimization is directly associated with housing insecurity, child welfare contact, and adolescent depression. Further, housing insecurity leading to both types of system contact mediates the link from IPV to maternal depression; in contrast, housing insecurity alone mediates the link from IPV to depression among children when they are 15 years old. Findings suggest IPV toward mothers has enduring, multigenerational effects on mental health that unfold over a long period following victimization. Complex pathways suggest housing insecurity and contact with punitive social systems that disproportionately impact low-income families explain in part the link from IPV to depression. Lack of housing options may deter survivors from leaving violent relationships, and housing insecurity in the wake of victimization may contribute to interactions with punitive social systems. Efforts to address housing, stigma, and psychological needs of IPV survivors are crucial to stabilize families.

Back to table of contents Previous article Next article Professional NewsFull AccessFree WPA Curriculum Available on Intimate Partner, Sexual ViolenceMark MoranMark MoranSearch for more papers by this authorPublished Online:17 Oct 2016https://doi.org/10.1176/appi.pn.2016.10b1AbstractThe curriculum is designed for training medical students, psychiatrists in residency programs, and practicing psychiatrists, with increasing levels of competency at each level.A new competency-based curriculum focusing on intimate partner violence and sexual violence against women, issued by the World Psychiatric Association (WPA), seeks to educate medical students, trainees, and practicing psychiatrists about interviewing, assessing, and treating women victims of intimate partner or sexual violence. The WPA’s International Competency-Based Curriculum for Mental Health Care Providers on Intimate Partner Violence/Sexual Violence Against Women, issued in July, is a 55-page document freely accessible on the WPA website. It outlines a wide range of teaching tools—didactic material, PowerPoint slides, case vignettes, and videos. “We owe it to our trainees to help them be up to speed on inter-viewing, assessing, and treating women exposed to intimate partner violence and sexual violence.” —Donna Stewart, M.D.The curriculum was developed by a steering committee of the WPA Section on Women’s Mental Health. Donna Stewart, M.D., co-chair of the committee and University Professor and chair of Women’s Health at the University of Toronto, said that psychiatric educators are welcome to use the resources in whole or in part with attribution.In an interview with Psychiatric News, Stewart said research indicates that few women who experience abuse or violence ever tell a health professional, and few physicians ask about intimate partner or sexual victimization. She said that’s true in mental health settings as well. The major barriers offered by psychiatrists for failing to discuss intimate partner or sexual violence include lack of adequate training about how to ask or respond, lack of knowledge regarding prevalence, skepticism about treatment effectiveness, concern about legal involvement, uncertainty about appropriate referrals, physician discomfort with the issues, time constraints, fear of offending or losing patients, and fear of safety for the women or oneself. “Worldwide the prevalence of intimate partner violence is at least 30 percent,” Stewart continued. “And we know that intimate partner violence and sexual violence dramatically affect mental health.” She added that while it is recognized that men can be victims of intimate partner violence, it is women who are disproportionately on the receiving end of such violence and tend to suffer greater injury.The curriculum is built around observable “competencies”—similar to the core competencies set by the Accreditation Council for Graduate Medical Education—that should be mastered in successive stages. The nine competencies described in the curriculum, each of which is divided into subtopics, require learners to be able to do the following: Define physical, psychological, and sexual intimate partner violence. Discuss prevalence.Be aware of myths and preconceptions.Have knowledge of sequelae. Assess for presence in a clinical setting.Provide psychological first aid.Have knowledge of resources.Communicate and document details of assessment.Manage violence-related psychological trauma.The curriculum offers five forms of resources. These include the World Health Organization’s Guidance on Health for Women subjected to intimate partner violence or sexual violence; links and abstracts of key papers, books, manual, and toolkits; a number of PowerPoint slides on intimate partner and sexual violence; case vignettes and teaching points; and video-based learning vignettes accessible on YouTube.One case vignette, for instance, is on “Treatment of Posttraumatic Stress Disorder After Sexual Violence (or Intimate Partner Violence)”: A family doctor refers a 25-year-old woman who was raped six months ago by an ex-partner to a community psychiatrist for intrusive memories of the assault, distressing dreams, flashbacks, avoidance of being alone, sadness, anxiety, trouble concentrating, hypervigilance, and inability to work. The woman was previously well and has no psychiatric history. The vignette is accompanied by teaching points about diagnosis, the range of treatment options, and documentation. Stewart said that the WPA’s Section on Women’s Mental Health began work on the curriculum three years ago, when the steering committee was selected from international leaders with expertise in intimate partner violence and sexual violence. It was cited as a priority by WPA President Dineesh Buhgra, M.D., Ph.D., of the United Kingdom. The co-chair of the curriculum steering committee is Prabha Chandra, M.D., professor and chair of the Department of Psychiatry at the National Institute of Mental Health and Neurosciences in Bangalore, India. Past APA President Michelle Riba, M.D., a member of the WPA Section on Women’s Mental Health and secretary of scientific publications for the WPA, said the curriculum is being disseminated at psychiatric meetings around the world, including APA’s, and a number of universities and training programs have already begun using it. The curriculum is accompanied by the Position Statement on Intimate Partner Violence and Sexual Violence Against Women, also issued in July, that declares the WPA’s support for public and professional awareness of violence against women as a critical women’s mental health determinant and for research to develop and evaluate the best treatments for women who have been victimized. “As many as 30 percent of our female patients will have experienced intimate partner violence, so we owe it to our trainees to help them be up to speed on interviewing, assessing, and treating women exposed to intimate partner violence and sexual violence,” Stewart said. “And practicing psychiatrists owe it to themselves and their patients to be current as well.” ■The International Competency-Based Curriculum for Mental Health Care Providers on Intimate Partner Violence/Sexual Violence Against Women can be accessed here. The WPA Position Statement on Intimate Partner Violence and Sexual Violence Against Women is available here. ISSUES NewArchived

Objective This study explored the mediational roles of parental depression and coparenting to the effects of parental material hardship on child social skills by considering the interdependent relationship between father and mother. Background The family stress model (FSM) represents a common framework for examining the effects of financial stressors on child development outcomes. However, previous studies have overlooked the role of coparenting and the dyadic family system, which incorporates reports from both fathers and mothers, in understanding the effects of material hardship through the FSM. Method Longitudinal data from the Future of Family and Child Wellbeing study were analyzed using an actor–partner interdependent model. A total of 3,003 children, along with their fathers and mothers, were included. Maternal and paternal material hardship was reported when the child was aged 3 years. Maternal and paternal depression and coparenting were reported when the child was aged 5 years. Child social skills were reported when the child was aged 9 years. Results The indirect effect of maternal material hardship on child social skills was mediated by maternal depression and mother perceived coparenting. An interdependent relationship between father and mother regarding material hardship and coparenting was found. Conclusion This study supports the FSM in the family system though maternal coparenting and depression and emphasizes the importance of material hardship on parent and child adjustment. Implications The findings underscore interventions designed to foster parental collaboration and reduce the psychological burden associated with economic hardship.

Maternal Depression and Child Development: Clues to Causal Mechanisms From Potential Confounders.

The mediating effect of parenting stress and couple relationship quality on the association between material hardship trajectories and maternal mental health status

Associations between state-level restorative justice policies and mental health among women survivors of intimate partner violence

This study aims to understand the direct and indirect effects of poverty trajectories on maternal depression trajectories mediated by material hardship trajectories. A latent growth mediation model was tested using a predominantly low-income and mostly unmarried sample of mothers from the Fragile Families and Child Wellbeing Study, a national birth cohort of racially diverse mothers (N = 3999). Measures included family poverty, material hardship, and maternal depression from 5 waves of data which tracked mothers starting 1year after childbirth until the child reached 15years of age. The results revealed that (1) family poverty was associated with material hardship and maternal depression, and material hardship was related to maternal depression at the trajectory level and the rate of change, with the exception of the relationships between the rate of change in family poverty and the rate of change in maternal depression; (2) material hardship mediated the relationship between family poverty and maternal depression at the initial trajectory levels, and the rate of change in material hardship fully mediated the relationship between the rate of change in poverty and the rate of change in maternal depression. This study provides further evidence that alleviating material hardship might be a promising avenue to reducing maternal depression.

Impact of Intimate Partner Violence on Unmet Need for Mental Health Care: Results From the NSDUH

Intimate partner violence as a risk factor for children's use of the emergency room and injuries

Native American (NA) women experience higher rates of intimate partner violence (IPV) compared to other U.S. racial/ethnic groups, yet previous research has not sufficiently examined the complex determinants shaping their IPV experiences. This research explores the interplay of family networks and legal systems influencing NA women's IPV experiences. Data were collected through in-depth individual and group interviews with 42 NA survivors and 41 health/social service providers from July 2016 to June 2017 in NA communities from three different U.S. regions. We used Grounded Theory to develop emergent themes from the data, focusing on system-level risk and protective factors of women's of IPV experiences. In terms of family systems, participants indicated that NA communities were comprised of highly influential and interwoven family systems, making them powerful sources of support for both survivors and their partners who use violence. Participants described how intergenerational violence exposures contributed to the normalization of violence. In terms of legal systems, participants described inconsistent consequences for abusers of NA women, insufficient protection from legal systems, and manipulation of jurisdictional complexities. Interactions between family and legal systems influenced decision-making and outcomes. Family and community-based approaches, and the incorporation of traditional language and cultures, are needed to promote healing. Our findings reflect the complex ways that family and legal systems shape NA women's IPV experiences. Results provide insight into how NA women interact with and navigate these systems when experiencing IPV and how these systems impact decision-making and the ability to be safe from IPV. Research is needed to advance understanding of the inter-relationships between intergenerational trauma, family systems, and legal systems on IPV survivors' mental health and wellness. To make meaningful change, further research examining IPV from an interdisciplinary perspective that explores the interplay of social determinants of health inequities is needed.

Childhood intimate partner violence (IPV) exposure increases the likelihood of internalizing and externalizing problems. There is substantial variability in children's outcomes following IPV exposure, but the reasons behind this are unclear, particularly among preschool-age children. The current study aimed to examine the direct and indirect effects of IPV on preschoolers' mental health through parent factors (parenting and parental depression), exploring child temperament as a potential moderator of the relation between IPV and child outcomes. Participants were 186 children (85 girls) and their parents living in the United States. Data were initially collected when children were age three, with follow-up at ages four and six. Both parents' baseline IPV perpetration had adverse effects on child outcomes. Mothers' IPV was associated with greater paternal depression, paternal overractivity, and maternal laxness, whereas fathers' IPV was associated with more paternal overreactivity. Only paternal depression mediated the effect of mothers' IPV on child outcomes. Parenting did not mediate nor did child temperament moderate the relation between IPV and child outcomes. Results shed insight into the need to address parental mental health in families experiencing IPV and underline the need for a further exploration of individual- and family-level mechanisms of adjustment following IPV exposure.

Understanding the interconnected relationships between intimate partner violence and child maltreatment: The role of maternal material hardship

A Longitudinal Investigation of Intimate Partner Violence Among Mothers With Mental Illness

Severe mental illness, substance use, and intimate partner violence have emerged as major intersecting public health problems that adversely and disproportionately impact the lives of women in the United States. This longitudinal study investigated the demographic and clinical correlates of intimate partner violence in a sample of 324 mothers with severe mental illness. A secondary analysis of longitudinal data was conducted by using multiple logistic regression. Participants were part of a longitudinal, community-based study of mothers with severe mental illness, which was aimed at understanding how these mothers viewed motherhood. The women were interviewed initially at baseline (interviews were conducted between 1995 and 1996) and then about 20 months later at follow-up (interviews were conducted between 1997 and 1998). At follow-up the prevalence rate of intimate partner violence was 19%. Multiple logistic regression analyses showed a significant positive relationship between alcohol and drug misuse at baseline and intimate partner violence at follow-up, indicating that women with a co-occurring diagnosis of a substance use disorder (dual diagnosis) were more likely than women without such a diagnosis to report intimate partner violence. The number of lifetime psychiatric hospitalizations and the number of symptoms related to psychiatric disability exhibited at baseline were positively associated with intimate partner violence at follow-up, and age was inversely associated with intimate partner violence. Mental health professionals serving mothers with mental health problems need to be aware of and prepared to assess the significant correlation between these intersecting public health problems in order to influence successful interventions. Particular attention must be given to the special treatment needs related to dual diagnosis and victimization and the impact of these factors on this vulnerable population.

Due to their high rates of parental maltreatment and violence exposure, youth in the foster care system are considered particularly vulnerable to experiencing intimate partner violence (IPV) in adolescence and young adulthood. Those who have emancipated from foster care may be at a heightened risk, as they are significantly more likely to struggle in a variety of critical domains (i.e., mental health, substance use, and delinquency). This longitudinal study is the first to explore the impact of demographic, individual, family, and foster care system factors on IPV involvement for foster care alumni at age 23/24. Analyses were conducted on three waves of quantitative data from the Midwest Evaluation of the Adult Functioning of Former Foster Youth (the Midwest Study). We find that approximately 21% of the young adults in our sample were involved in some type of IPV at age 23/24, with bidirectional violence the most commonly reported form. Males were more likely than females to report IPV victimization, whereas females were more likely than males to report IPV perpetration and bidirectional violence. Young adults who reported parental IPV prior to foster care entry were more likely to be involved in bidirectionally violent partnerships than nonviolent partnerships in young adulthood, as were young adults who reported neglect by a foster caregiver and those who reported greater placement instability while in the foster care system. Anxiety at baseline increased the odds of IPV perpetration at age 23/24, and posttraumatic stress disorder (PTSD) at baseline decreased the odds of IPV perpetration at age 23/24. Understanding the characteristics and experiences that place these young adults at risk for IPV will allow for more effective and targeted prevention efforts.