The Unascended Pyramid the Limits of State Response to IPV in Rural Michoacán

Neighborhood Effects and Intimate Partner and Sexual Violence: Latest Results

Because a substantial proportion of sexual violence, stalking, and intimate partner violence is experienced at a young age, primary prevention of these forms of violence must begin early. Prevention efforts should take into consideration that female sexual violence and stalking victimization is perpetrated predominately by men and that a substantial proportion of male sexual violence and stalking victimization (including rape, unwanted sexual contact, noncontact unwanted sexual experiences, and stalking) also is perpetrated by men. CDC seeks to prevent these forms of violence with strategies that address known risk factors for perpetration and by changing social norms and behaviors by using bystander and other prevention strategies. In addition, primary prevention of intimate partner violence is focused on the promotion of healthy relationship behaviors and other protective factors, with the goal of helping adolescents develop these positive behaviors before their first relationships. The early promotion of healthy relationships while behaviors are still relatively modifiable makes it more likely that young persons can avoid violence in their relationships.

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

Intimate Partner Violence

The costs and consequences of intimate partner violence (IPV) and sexual violence (SV) are well-documented; however, little is known about how experiences of violence are connected to specific economic insecurities including food, healthcare, and housing insecurity among both men and women. This study investigates (1) the prevalence of food, healthcare, and housing insecurity across gender and racial groups exposed to IPV and SV and (2) associations between exposure to past-year IPV and SV and past-year food, healthcare, and housing insecurity controlling for confounding factors. A cross-sectional survey design was used in this study. Data from 2010 National Intimate Partner and Sexual Violence Survey (NISVS) were analyzed in a nationally representative sample of men (N = 8079) and women (N = 9970). Logistic regressions were used to model associations between past-year intimate partner and sexual violence and dependent variables of food, healthcare, and housing insecurity. Analyses were stratified by gender and included control variables of age, income, education, and race/ethnicity. Higher rates of food, housing, and healthcare insecurity were found among men and women of color exposed to violence, particularly among respondents who identified as Black/African American, Latinx, American Indian/Alaska Native, and other racial/ethnic minority groups. For men, IPV and SV was associated with higher odds for experiencing food (AOR = 2.40, p <.001), housing (AOR = 2.06, p <.001), and healthcare insecurity (AOR = 2.39, p <.001). For women, IPV and SV was also associated with higher odds for experiencing food (AOR = 2.16, p <.001), housing (AOR = 1.94, p <.001), and healthcare insecurity (AOR = 2.38, p <.001). Findings identify specific economic needs among survivors and suggest that the burdens of IPV and SV are not equitably shared across racial/ethnic populations. Findings can inform policy that aims to reduce inequalities in food, housing, and healthcare associated with IPV and SV.

The frequency and effects of intimate partner violence (IPV) on reproductive health in Kashmir among rural and urban women are investigated in this paper, together with evaluations of their knowledge, awareness, and practices (KAP). Six hundred women from three districts—Anantnag, Srinagar, and Baramulla who suffered with IPV, reproductive health issues, and their KAP was surveyed. The results show that, in rural women as opposed to urban women, where psychological violence is more widespread, IPV prevalence is higher. With rising STIs, reproductive pain, and medical consultations, results suggest that IPV has significant effects on reproductive health. Comparatively to rural women, urban women show better knowledge, awareness, and more proactive behaviours connected to reproductive health. Particularly in remote regions, the results suggest the need for context-specific treatments, including healthcare services that would integrate IPV screening and reproductive health support. Policies aiming at IPV prevention combined with community education initiatives aiming at raising KAP in rural settings could help reduce the health effects of IPV and promote reproductive health equity. The long-term and cumulative consequences of IPV on health must be investigated in future studies, including a conservative test of the literature on such socio-cultural settings.

BackgroundAccording to a WHO multi-country study, Tanzania is among the countries with a high prevalence of Intimate Partner Violence (IPV). The Demographic and Health Survey 2010 shows that there are...

Intimate partner violence (IPV) against women is a significant health issue in the United States and worldwide. The majority of studies on IPV have been conducted in urban populations. The objectives of this study are to determine if prevalence, frequency, and severity of IPV differ by rurality and to identify variance in geographic access to IPV resources. A cross-sectional clinic-based survey of 1478 women was conducted to measure the 1-year prevalence of physical, sexual, and psychologic IPV. IPV intervention programs in the state were inventoried and mapped, and the distance to the closest program was estimated for each participant based on an innovative algorithm developed for use when only ZIP code location is available. Women in small rural and isolated areas reported the highest prevalence of IPV (22.5% and 17.9%, respectively) compared to 15.5% for urban women. Rural women reported significantly higher severity of physical abuse than their urban counterparts. The mean distance to the nearest IPV resource was three times greater for rural women than for urban women, and rural IPV programs served more counties and had fewer on-site shelter services. Over 25% of women in small rural and isolated areas lived >40 miles from the closest program, compared with <1% of women living in urban areas. Rural women experience higher rates of IPV and greater frequency and severity of physical abuse yet live much farther away from available resources. More IPV resources and interventions targeting rural women are needed.

Intimate partner violence (IPV) is a serious public health concern linked with adverse health consequences such as posttraumatic stress disorder, depression, and anxiety. Although substance use disorders (SUDs) have been associated with IPV, there is limited research on IPV screening and disclosure among health care patients with SUDs, particularly veterans. To examine the rates of IPV screening and disclosure among veterans with alcohol use disorder (AUD) and opioid use disorder (OUD) and to identify IPV subtypes and lethality risks, disaggregated by sex and SUD type. This study analyzed IPV screening and disclosure rates among veterans in the Veterans Health Administration (VHA) diagnosed with AUD and/or OUD from January 2016 to December 2021. 790,384 veterans diagnosed with AUD, OUD, or both in VHA electronic health records. Data included rates of IPV screening, rates of positive IPV screens (IPV+), IPV subtypes (psychological, physical, sexual), and risk of IPV-related lethality (escalation, strangulation, belief of being killed). In our sample, 22.36% (n = 176,739) were screened for IPV, with 12.24% (n = 16,086) of those with a valid administration, screening positive. Female veterans had higher rates of being screened for IPV and positive IPV disclosures than males. Veterans with co-occurring AUD and OUD were more likely to screen positive for IPV than those with only AUD or OUD. Female veterans, particularly those with co-occurring AUD and OUD, were more likely to report high-lethality IPV compared to male veterans with AUD only. Approximately 1 in 5 veterans in the cohort were screened for IPV. Female veterans with co-occurring AUD and OUD had the highest screen positive rate and severity of IPV. These findings highlight the need for routine IPV screening in VHA, tailored interventions, and integrated treatments addressing both SUD and IPV to improve health outcomes.

Informing Intimate Partner Violence Prevention Efforts: Dyadic, Developmental, and Contextual Considerations

BackgroundWomen who experience intimate partner violence (IPV) are likely to experience reduced sexual and reproductive health (SRH). This paper aims to describe the prevalence of IPV and family planning use, and explore how IPV intersects with SRH among young Kiribati women; including met and unmet need for family planning, and use of contraception.MethodsData for this paper were drawn from the Kiribati Social Development Indicator Survey [1], conducted in 2018–2019. Chi-square tests for independence were conducted, with 95% confidence intervals to identify the strength of association. Associations were considered statistically significant at p < .05.ResultsOf the n = 3,106 women who had been intimately partnered or sexually active in the last year, 20% had unmet need for either spacing or limiting, the greatest unmet need being observed in women aged 15–24 years (28.8%). Half (51%) of ever-partnered Kiribati women experienced physical IPV from an ex/partner in their lifetime, one quarter experienced sexual IPV (24%) and 46% psychological IPV. Women aged 15–24 years reported higher rates of physical and/or sexual IPV over their lifetime and within the last year. Women who had experienced IPV from their partner in the last 12 months were significantly less likely to show unmet need for spacing or limiting (46.5%) than women who had not experienced any IPV (53.5%) and were more likely to be using a modern method of contraception (31%) than women who had not experienced IPV (26%). Women who experienced lifetime IPV were more also more likely to report met need for family planning.ConclusionsThis study shows women in Kiribati experience elevated rates of IPV and unmet need for family planning. Inclusion of young women (including single women) and rural women, especially women living with IPV must be prioritised as an international goal if the SRH needs are to be met for all. In order to overcome the difficulties faced by young women, women in remote areas and those experiencing IPV, health-care providers would benefit from further training and information on the issues around IPV.

Economic Insecurity and Intimate Partner and Sexual Violence Victimization

Men Are Also Victims of Intimate Partner Violence

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.

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