EpiWEAT: a new digital assessment tool for epigenetic studies.

ALTHOUGH THE RELATIONSHIP BETWEEN POSTTRAUmatic stress disorder (PTSD) and aggression is generally well established within the literature, research investigating the relationship between PTSD and male-perpetrated intimate partner violence (IPV) has only begun to emerge. Preliminary findings suggest a link between trauma exposure, PTSD symptomatology, and maleperpetrated IPV, which may have important clinical implications for batterer intervention programs. To the extent that IPV associated with PTSD has an etiology distinct from non–PTSD-related IPV, prevention and intervention programs may need to be tailored to address the potentially unique IPV risk factors among men with PTSD. Because of the lack of research on the association of PTSD and IPV perpetrated by women, this Commentary will focus on male-perpetrated IPV. Most US studies examining the relationship between PTSD and male-perpetrated IPV have been conducted with male veterans. Findings from these studies indicate that male veterans with greater PTSD symptomatology often self-report higher levels of anger, hostility, aggressiveness, anger reactivity, and IPV perpetration than veterans without significant PTSD symptomatology. The association between PTSD and IPV perpetration has also been found among civilian men. Rosenbaum and Leisring found that civilian male batterers referred to a group batterers treatment program who met diagnostic criteria for PTSD based on the PTSD Checklist-Civilian Version self-reported greater generalized aggressivity and significantly higher rates of IPV perpetration on the Conflict Tactics Scale than civilian male batterers without PTSD. In a study examining IPV rates within a nonclinical civilian male sample recruited from a college campus, Jakupcak and Tull reported similar findings, with higher self-reported rates of IPV perpetration, trait and internal anger, and hostility found among civilian men with PTSD symptomatology compared with civilian men without PTSD symptoms. Prior research investigating the relationship between PTSD and aggression has often included PTSD as a single construct. However, findings from a 3-wave longitudinal study examining the course of PTSD symptoms over a 12-month period in young adults who experienced community violence highlight the importance of considering how the 3 PTSD symptom clusters differentially change over time, influence other PTSD symptoms, and affect behavior, including aggression. Although debate exists as to the nature and number of factors, PTSD is currently characterized by 3 distinct symptom clusters consisting of (1) reexperiencing symptoms (eg, nightmares, flashbacks); (2) avoidance symptoms (eg, avoidance of trauma-related stimuli); and (3) hyperarousal symptoms (eg, hypervigilance, exaggerated startle response). These 3 symptom clusters have been examined as they relate to aggressive behavior. Overall, hyperarousal symptoms appear to play an especially prominent role in the initiation of aggressive behavior. For example, in a study examining the association between aggression and each of the 3 PTSD symptom clusters among male Vietnam veterans participating in a larger multisite psychophysiological project on PTSD, Taft et al found hyperarousal symptoms to have the strongest positive relationship with aggressive behavior in comparison with the other 2 PTSD symptom clusters. Additionally, the authors found that hyperarousal symptoms were both directly related to aggression and indirectly associated with aggression through alcohol problems, as measured by the CAGE questionnaire for assessing alcoholism. Conversely, findings from the same study show that reexperiencing symptoms may not directly influence aggressive behavior, but may indirectly affect aggression via their positive relationship on physiological reactivity (ie, heart rate and skin conductance) to trauma cues and negative affect on alcohol problems. Mixed findings exist regarding the role of PTSD avoidance symptoms and subsequent aggressive behavior. A study comparing male Vietnam veterans seeking inpatient PTSD treatment with a mixed diagnostic group of male inpatient Vietnam veterans without PTSD found a positive relationship between avoidance/numbing symptoms and aggression when assessing PTSD symptom clusters using the brief Mississippi Scale for Combat-Related PTSD. However, additional evidence from the study by Taft et al suggests a potential negative association between avoidance/numbing

Domestic Violence and Abuse Is Our Issue.

Intimate Partner Violence

BackgroundDepression, post-traumatic stress disorder (PTSD), and binge drinking are among mental health effects of child abuse and intimate partner violence (IPV) experiences among women. Emerging data show the potential mediating role of mental ill health in the relationship of child abuse and IPV. There is evidence that PTSD, depression and alcohol abuse are comorbid common mental disorders and that a bidirectional relationship exists between depression and IPV in some settings. Furthermore, the temporal direction in the relationship of alcohol abuse and women’s IPV experiences from different studies is unclear. We undertook a study with women from the general population to investigate the associations of child abuse, mental ill health and IPV; and describe the underlying pathways between them.MethodsData is from a household survey employing a multi-stage random sampling approach with 511 women from Gauteng, South Africa. IPV was measured using the WHO Multi-country Study on Women's Health and Domestic Violence Questionnaire. Child abuse was measured using a short form of the Childhood Trauma Questionnaire. Depression was measured using the Centre for Epidemiologic Studies Depression Scale (CESD). PTSD symptoms were measured using the Harvard Trauma Questionnaire. Binge drinking was measured using the Alcohol Use Disorders Identification Test (AUDIT) scale. All data analyses were conducted in Stata 13. Regression modelling was used to test the association between variables. Structural equation modelling with full information maximum likelihood estimation accounting for missing data was done to analyse the underlying pathways between variables.ResultsFifty percent of women experienced IPV in their lifetime and 18% experienced IPV in the 12 months before the survey. Twenty three percent of women were depressed, 14% binge drank and 11.6% had PTSD symptoms. Eighty six percent of women had experienced some form of child abuse. Sociodemographic factors associated with recent IPV in multivariate models were younger age and foreign nationality. Depression, PTSD and binge drinking mediated the relationship of child abuse and recent IPV. Depression, PTSD and binge drinking were also effects of recent IPV. Other factors associated with recent IPV experience included relationship control, having a partner who regularly consumed alcohol and experiencing other life traumatic experiencesConclusionMental ill health plays a mediating role in the relationship of child abuse and recent IPV experiences among women. Conversely, IPV also negatively affects women’s mental health. Interventions to reducing the incidence of IPV could help alleviate the burden of mental ill health among women and vice versa. Effective integration of mental health services in primary health care, detection of symptoms, brief interventions and strengthened referral mechanisms for sustained community-based care are necessary in responding to victims of intimate partner violence. Response for abused children needs to take similar approaches and reduce the long-term mental health effects associated with violent exposures.

Despite research documenting high rates of violence during pregnancy, few studies have examined the impact of physical abuse, psychological abuse, and posttraumatic stress disorder (PTSD) on miscarriage. Secondary analysis of data collected by the Chicago Women's Health Risk Study permitted an exploration of the relationships among physical abuse, psychological abuse, PTSD, and miscarriage among 118 primarily ethnic minority women. The interaction between maximum severity of abuse and age provided the best multivariate predictor of miscarriage rate, accounting for 26.9% of the variance between live birth and miscarriage outcome. Mean scores of psychological abuse, physical violence, forced sex, and PTSD were significantly higher in the miscarriage group than in the live birth group. Women who experience physical violence and psychological abuse during pregnancy may be at greater risk for miscarriage. Prospective studies can confirm findings and determine underlying mechanisms. Routine screening for traumatic stress and PTSD may reduce rates of miscarriage.

Intimate partner violence outcomes in women with PTSD and substance use: A secondary analysis of NIDA Clinical Trials Network “Women and Trauma” Multi-site Study

Background: Posttraumatic stress disorder has been linked to women's ill health, including headaches. Intimate partner violence, which may result in posttraumatic stress disorder, is often reported by women with headaches. Prior studies of intimate partner violence and headache have estimated lifetime but not 12-month prevalence. The researchers in this study examined the relationship between headache and posttraumatic stress disorder in a novel population, and estimated 12-month and lifetime prevalence rates of intimate partner violence. Methods: Patients were recruited from a women's headache center (n = 92) during 2006–07 and completed the Migraine Disability Assessment measure of headache severity. Posttraumatic stress disorder was measured using a modified Breslau scale. Twelve-month and lifetime physical intimate partner violence were measured with the Partner Violence Screen and the STaT (“slapped, threatened and throw”) measure. Multivariable regression determined factors independently associated with headache severity. Results: Among all participants, 28.3% screened positive for posttraumatic stress disorder; 9.8% and 36.9% of women endorsed recent and lifetime intimate partner violence. Posttraumatic stress disorder was strongly associated with headache severity (β = 34.12, p = 0.01). Patients reporting lifetime intimate partner violence exhibited a trend of nine additional days of disability due to headache over 90 days. Conclusions: Posttraumatic stress disorder and intimate partner violence occur among a sizable proportion of women referred for headache. The authors' findings reaffirm that clinicians treating women with headaches must be aware of the possibility of posttraumatic stress disorder and intimate partner violence in such patients.

This work aims to shed light on the differential diagnosis of complex post-traumatic stress disorder (cPTSD), post-traumatic stress disorder (PTSD), and borderline personality disorder (BPD) within the context of intimate partner violence (IPV), which represents a highly innovative field of clinical research. To this end, a critical review of the literature was conducted to identify and compare the clinical patterns and symptomatic overlaps among cPTSD, PTSD, and BPD, with an emphasis on their manifestation in both IPV victims and offenders. The results show that despite some symptomatic similarities, cPTSD, PTSD, and BPD have distinct clinical patterns of interpersonal violence. Specifically, disturbances in self-organization (DSO) are more commonly found in offenders, while the diagnosis of cPTSD seems more aligned with the psychological functioning of victims. In addition, cPTSD and specific characteristics of BPD, such as fear of rejection and instability of identity, constitute risk factors for IPV victimization. cPTSD is shown as a predisposing factor not only for IPV victims but also for offenders, while PTSD emerges as a consequential factor. The specific pathways linking PTSD, cPTSD, and BPD with IPV have significant implications for clinical practice. Further research is needed to understand these profiles and the mechanisms linking trauma-related features to IPV, which is crucial for implementing effective violence prevention programs.

BackgroundOver the years, researchers have relied on data from women victims to understand the profile on male perpetrators of intimate partner violence (IPV). IPV studies with male participants in the general population are still emerging in Africa. The contribution of mental ill health to IPV perpetration in the general population that has been documented elsewhere is emergent. Notwithstanding, research with male perpetrators is essential to informing effective prevention programmes and interventions. To contribute to the emerging literature on male perpetrators, we conducted a study to estimate the prevalence and factors associated with IPV perpetration by men in heterosexual relationships. We also modelled pathways to IPV perpetration using data from Zimbabwe.MethodsData were collected through a nationwide survey employing a random and multi-staged sampling method. We recruited and administered a structured questionnaire to 2838 men aged 18 years and above. IPV was measured using an adapted WHO Domestic Violence Questionnaire. Determinants of IPV measured included child abuse, alcohol abuse, post-traumatic stress disorder (PTSD), depressive symptoms, personal gender attitudes and risky sexual behaviours. Multivariate regression modelling was used to assess factors associated with IPV perpetration. Structural equation modelling was used to explore the underlying pathways to recent IPV perpetration.ResultsForty one percent of men had perpetrated IPV in their lifetime and 8.8% percent of men perpetrated IPV in the 12 months before the survey. Older, more educated men, men who binge drank, men who were abused as children or experienced other life traumatic experiences were more likely to perpetrate IPV in lifetime. Depressive symptoms and sexual relationship power (were also associated with lifetime IPV perpetration. IPV perpetration in the last 12 months was associated with binge drinking, PTSD and sexual relationship power. The pathways to IPV perpetration in the last 12 months from child abuse to recent IPV were mediated by comorbid PTSD symptoms, depression binge drinking and sexual relationship power.ConclusionsIPV perpetration was associated with child abuse history, mental ill health, sexual relationship power and personal gender attitudes. Interventions to reduce IPV need to engage men to address gender inequality, mental ill health and reduce alcohol consumption.

Rates of intimate partner violence (IPV) and HIV in South Africa are among the highest globally. IPV is associated with a range of adverse mental health and HIV outcomes. The Common Elements Treatment Approach (CETA) is a transdiagnostic, evidence-based intervention delivered by lay providers. To compare the effectiveness of CETA to active attention control in reducing IPV, depression, Post-Traumatic Stress Disorder (PTSD), and substance use among women at risk of poor HIV outcomes who have experienced IPV. Women living with HIV with an unsuppressed viral load or at risk for poor adherence and experienced past 12-month IPV were recruited from Johannesburg-area clinics and randomised 1:1 to CETA or control (SMS HIV appointment reminders plus safety checks and planning). The primary trial outcome was HIV retention and viral suppression, reported elsewhere. This paper reports secondary outcomes, evaluated at three and 12 months: IPV, depression, PTSD, and substance use. Participants were enrolled between November 11, 2021 to July 19, 2023 and randomised to CETA (N=202) or control (N=197). In the intent to treat analysis, the Cohen's d treatment effect for depression at three months was 0.24 (difference in mean change -3.1; 95% CI: -6.1, 0.1) and 0.48 at 12 months (-6.2; 95% CI: -9.5, -2.8). The PTSD treatment effect was 0.39 at three (-0.3; 95% CI: -0.5, -0.1) and 0.47 at 12 months (-0.3; 95% CI: -0.5, -0.2). Effect sizes were larger in a subgroup of participants with the top 50% of baseline symptom scores (depression: d=0.50, d=0.74; PTSD: d=0.58, d=0.94, at three and 12 months, respectively). There were no statistically significant differences in change for substance use or IPV. At baseline, only 12% of participants had past 3-month substance use and 32% had past 3-month or ongoing experiences of IPV, which made these outcomes challenging to evaluate. CETA was effective for reducing depression and PTSD including among high severity participants and at an extended follow-up. Future studies with increased power for substance use and IPV outcomes are warranted. CETA is a recommended treatment for depression and PTSD among this population. Clinicaltrials.gov NCT04242992 , registered January 27, 2020. What is already known about this topic?: Intimate partner violence (IPV) and related mental health problems are common in South Africa and can lead to poor HIV outcomes, such as low retention in care and viral non-suppression. There is a lack of evidence-based mental healthcare options for women living with HIV who have experienced IPV.What this study adds: Among women living with HIV and past-year IPV experiences, we found that Common Elements Treatment Approach (CETA) was an effective treatment for depression and PTSD compared to a control condition.How this study might affect research, practice, or policy: CETA is recommended to treat common mental health problems among women with HIV and experiences of IPV.

HIV has an impact on the presence and severity of both intimate partner violence (IPV) and posttraumatic stress disorder (PTSD) in infected women. However, the relationship of type and severity of IPV with PTSD in this population has not been adequately explored. We focus on the association between the type and severity of IPV and HIV status and PTSD in a sample of South African women. One hundred and sixty-nine women (114 HIV-positive and 55 HIV-negative controls), matched for geographical area, education, and socio-economic status, were recruited from HIV clinics. Clinical and demographic data were collected, including data on childhood trauma, other traumatic life events, IPV, posttraumatic stress symptoms, problematic alcohol use, and depressive symptoms. HIV-positive women had significantly more depressive symptoms, alcohol abuse, and childhood trauma exposure as well as significantly higher rates of PTSD (25.4%) when compared with uninfected women (10.9%). No significant group differences in the rate, pattern, and severity of physical, sexual, psychological, injury, and negotiation IPV were found. In logistic regression analysis, the rate and severity category of IPV did not significantly predict PTSD in HIV-positive women when childhood trauma and life events were controlled for. Our results indicate the need for screening for alcohol abuse, PTSD and depressive symptoms at HIV wellness, and ARV clinics. The high rates of PTSD in HIV-positive women indicate the need for specialized programs to manage PTSD and minimize negative sequelae in this population. These results also highlight the need for improved screening and prevention of childhood trauma and IPV both in infected and uninfected women.

Intimate partner violence (IPV) research on immigrant women who are unauthorized is particularly scarce, despite unique vulnerabilities associated with their documentation status that may impact help-seeking and health outcomes. The purpose of this study was to document the frequency of lifetime IPV and related help-seeking behaviors, and examine the relationship between IPV, major depressive disorder (MDD), post-traumatic stress disorder (PTSD), and health-related quality of life (HRQL) among a community health center-based sample of unauthorized, Spanish-speaking immigrant women in Philadelphia. A clinic-based sample of unauthorized Spanish-speaking women (N = 200, ages 18-65) completed an anonymous, cross-sectional survey on IPV experiences, help-seeking behaviors, and self-reported health in 2013-2014. Chi-square tests assessed associations between sociodemographic variables and IPV. Multivariable logistic regression investigated whether IPV predicted mental health outcomes. Approximately one in three (34.5%) women reported lifetime IPV experiences. Of these, half (56.6%) sought help (formal n = 22; informal n = 25) because of the violence. Women identified not knowing where to go, believing that help was not necessary, and embarrassment as barriers to help-seeking. Symptoms consistent with MDD and PTSD were reported by 40.5% and 16% of the sample, respectively. In unadjusted logistic regression models, IPV survivors were more likely to endorse MDD and PTSD, and report low mental health HRQL scores than counterparts without IPV. In fully adjusted models, only the association between IPV and PTSD remained significant (OR: 3.80, p =.01). Study findings document high frequencies of IPV, MDD, and PTSD among this clinic-based sample of unauthorized immigrant women. Women who reported IPV also had a greater likelihood of reporting symptoms consistent with PTSD. Findings highlight the need for clinic-based mental health and trauma-informed services tailored to unauthorized immigrant women as well as interventions to decrease IPV.

The objective is to test the efficacy of cognitive-narrative therapy in the treatment of depression, post-traumatic stress disorder (PTSD), complex posttraumatic stress disorder (CPTSD) and borderline symptoms on a sample of women who suffered from intimate partner violence (IPV). Trial design is a longitudinal randomized controlled trial with a sample of 19 battered women allocated in two groups, a control group and treatment group, assessed twice at baseline before intervention, and at follow-up. The outcome measures were the Patient Health Questionnaire, International Trauma Questionnaire, PTSD and CPTSD Diagnostic Interview Schedule for International Classification of Diseases (ICD)-11, Conjugal Violence Exposure Scale (CVES), Life Events Checklist and Intervention Program Satisfaction Assessment Instrument. The treatment group received a four-session cognitive-narrative manualized intervention. There were no statistically significant differences between groups at baseline and follow-up, however, positive effect sizes ranging between 0.04 and 0.43 were found in depression, PTSD, and borderline, as well in some CPTSD dimensions when analyzing baseline-follow-up deltas between groups. There was also a negative effect size of -0.28 in the CPTSD total. This intervention is effective in the treatment of depression, PTSD and borderline and is an important tool in the treatment of these disorders.

Both intimate partner violence and neighborhood crime have been associated with worse mental health outcomes, but less is known about cumulative effects. This association was studied in a sample of pregnant women who were enrolled in a study of disaster exposure, prenatal care, and mental and physical health outcomes between 2010 and 2012. Women were interviewed about their exposure to intimate partner violence and perceptions of neighborhood safety, crime, and disorder. Main study outcomes included symptoms of poor mental health; including depression, pregnancy-specific anxiety (PA), and posttraumatic stress disorder (PTSD). Logistic regression was used to examine predictors of mental health with adjustment for confounders. Women who experienced high levels of intimate partner violence and perceived neighborhood violence had increased odds of probable depression in individual models. Weighted high cumulative (intimate partner and neighborhood) experiences of violence were also associated with increased odds of having probable depression when compared with those with low violence. Weighed high cumulative violence was also associated with increased odds of PTSD. This study provides additional evidence that cumulative exposure to violence is associated with poorer mental health in pregnant women.

Apart from being a consequence of intimate partner violence (IPV), posttraumatic stress disorder (PTSD) can also be a risk factor for IPV revictimization. The current study examined how each of 4 PTSD symptom clusters (reexperiencing, arousal, avoidance, and numbing) related to revictimization in a sample of 156 female help-seeking victims of IPV, recruited from various victim support services in the Netherlands. In addition, we hypothesized that victim-perpetrated IPV would mediate the relation between PTSD symptomatology and IPV revictimization. Our results show that victims' PTSD reexperiencing symptoms predict revictimization of partner violence (d = .45 for physical IPV revictimization; d = .35 for psychological IPV revictimization); the other 3 PTSD symptom clusters were not related to IPV revictimization. Furthermore, victim-perpetrated psychological IPV was found to partially mediate the relation between victims' PTSD reexperiencing symptoms and IPV revictimization (Z = 2.339, SE = 0.044, p = .019 for physical IPV revictimization, and Z = 2.197, SE = 0.038, p = .028 for psychological IPV revictimization). Findings indicate that IPV victims with higher levels of PTSD reexperiencing symptoms may be more likely to perpetrate psychological IPV themselves, which may put them at greater risk for receiving IPV in return. Based on these results, a focus on individual PTSD symptom clusters and victim behaviors seems relevant for practice and may contribute to a decrease in victims' risk for future IPV.