Disclosure Of Intimate Partner Violence Research Articles

Cochrane in CORR (®): Screening Women for Intimate Partner Violence in Healthcare Settings (Review).

Cochrane in CORR (®): Screening Women for Intimate Partner Violence in Healthcare Settings (Review).

Stigmatizing Reactions Versus General Negative Reactions to Partner Violence Disclosure as Predictors of Avoidance Coping and Depression.

Despite increased attention to the relation between negative social reactions to intimate partner violence (IPV) disclosure and poorer mental health outcomes for victims, research has yet to examine whether certain types of negative social reactions are associated with poorer mental health outcomes more so than others. Furthermore, research is scarce on potential mediators of this relationship. To fill these gaps, the current study examines whether stigmatizing reactions to IPV disclosure, such as victim-blaming responses and minimizing experiences of IPV, are a specific type of negative social reaction that exerts greater influence on women's depressive symptoms than general negative reactions, such as being angry at the perpetrators of IPV. We also examine avoidance coping as a key mediator of this relationship. A cross-sectional correlational study was conducted to examine these relationships. Participants were 212 women from an urban northeast community who indicated being physically victimized by their male partner in the past 6 months. Findings from a multiple regression analysis showed that stigmatizing reactions, not general negative reactions, predicted women's depressive symptoms. In addition, a multiple mediation analysis revealed that avoidance coping strategies, but not approach coping strategies, significantly accounted for the relationship between stigmatizing social reactions and women's depressive symptoms. Findings have implications for improving support from informal and formal sources and subsequently, IPV-exposed women's psychological well-being.

Midwives' experiences of routine enquiry for intimate partner violence in pregnancy.

Reducing violence against women is a national public health priority in Australia. Routine antenatal intimate partner violence screening by a skilled midwife is essential for assessment, support and appropriate referral, but can be challenging to implement. To explore midwives' experiences of routine enquiry, perceptions of facilitators and barriers, and suggested strategies to improve practice. A qualitative descriptive design was used. Participants were recruited from an e-mail bulletin by the Australian College of Midwives. In-depth telephone interviews were conducted with 21 midwives. Data were analysed using an inductive thematic analysis approach. Three themes were identified: The first theme; Asking the Question incorporated the belief that whilst asking women about intimate partner violence were within the role of the midwife, participants felt unsupported and unprepared. The second theme; The big fear factor represented concerns around positive disclosures of intimate partner violence, including a sense of responsibility, worries about encouraging women to disclose without clear processes and resources to support them. The third theme; Building a relationship incorporated the importance of continuity of care, trust and rapport-building. Continuity of care was identified as a positive enabler for routine enquiry. A perceived lack of support, time pressures, and presence of a partner at appointments were all considered barriers to routine enquiry. Routine enquiry about IPV is a valuable and important midwifery role. Midwives described frustration and fear when women disclosed violence. The perceived level of support from health services varied according to practice contexts and needs to be improved.

Reproductive Coercion by an Intimate Partner: Occurrence, Associations, and Interference with Sexual Health Decision Making

Reproductive coercion is a form of intimate partner violence (IPV) in which a variety of tactics can be used to force pregnancy on an intimate partner. This study investigated the occurrence of male-perpetrated reproductive coercion, its relationship to other forms of IPV, and interference with women’s sexual health decision making. Two data sets were collected, by conducting client–practitioner screenings (n = 2,108) and anonymous surveys (n = 84), from women seeking reproductive health services in a southwestern state and analyzed separately. Prevalence and correlates of reproductive coercion varied according to data-collection method, indicating that behaviorally based screening tools and anonymous screening may increase disclosure rates. In the screening sample, reproductive coercion was associated with forced sex, threats of physical harm, and verbal abuse. In the survey sample, reproductive coercion was associated with being nonwhite, fear of asking one’s partner to use a condom, and fear of refusing sex. Social workers should be aware that reproductive coercion is a form of coercive control that may be associated with increased fear and IPV and may interfere with sexual health decision making; however, disclosure of reproductive coercion or IPV is not necessary for intervention. The article concludes with a discussion of screening and intervention strategies.

Intimate partner violence and women's presentations in general practice settings: Barriers to disclosure and implications for therapeutic interventions

BackgroundThere has been a small number of studies investigating the disclosure of intimate partner violence (IPV) in general practitioner settings in Australia, with the evidence being that partner violence is largely undisclosed. Drawing on previous research in this area, the main aim of this study was to investigate the rate of disclosure to general practitioners in women with known IPV backgrounds.MethodSubjects were recruited through two domestic violence services in metropolitan Adelaide. Women were interviewed about their relationship history, help‐seeking behaviour during the relationship, and assessed on the somatization, depression, and anxiety scales of the Symptom Checklist 90 Revised.ResultsOf the 87 women who sought medical help during their relationship, 43% reported disclosing a history of IPV to their general practitioner. Sixty‐nine-per cent of women were given a diagnosis of depression, with treatment being offered mostly in the form of medication, and 25% of women were referred for counselling.ConclusionsResults confirm that IPV remains largely undisclosed in general practice settings, with the potential for presentations to be misdiagnosed. Implications for clinical psychologists, where there may be similar rates of undisclosed partner abuse, include the need for better identification of abuse victims, and a sound determination of the most appropriate course of therapeutic interventions.

Cluster randomized controlled trial protocol: addressing reproductive coercion in health settings (ARCHES).

BackgroundWomen ages 16–29 utilizing family planning clinics for medical services experience higher rates of intimate partner violence (IPV) and reproductive coercion (RC) than their same-age peers, increasing risk for unintended pregnancy and related poor reproductive health outcomes. Brief interventions integrated into routine family planning care have shown promise in reducing risk for RC, but longer-term intervention effects on partner violence victimization, RC, and unintended pregnancy have not been examined.Methods/DesignThe ‘Addressing Reproductive Coercion in Health Settings (ARCHES)’ Intervention Study is a cluster randomized controlled trial evaluating the effectiveness of a brief, clinician-delivered universal education and counseling intervention to reduce IPV, RC and unintended pregnancy compared to standard-of-care in family planning clinic settings. The ARCHES intervention was refined based on formative research. Twenty five family planning clinics were randomized (in 17 clusters) to either a three hour training for all family planning clinic staff on how to deliver the ARCHES intervention or to a standard-of-care control condition. All women ages 16–29 seeking care in these family planning clinics were eligible to participate. Consenting clients use laptop computers to answer survey questions immediately prior to their clinic visit, a brief exit survey immediately after the clinic visit, a first follow up survey 12–20 weeks after the baseline visit (T2), and a final survey 12 months after the baseline (T3). Medical record chart review provides additional data about IPV and RC assessment and disclosure, sexual and reproductive health diagnoses, and health care utilization. Of 4009 women approached and determined to be eligible based on age (16–29 years old), 3687 (92 % participation) completed the baseline survey and were included in the sample.DiscussionThe ARCHES Intervention Study is a community-partnered study designed to provide arigorous assessment of the short (3-4 months) and long-term (12 months) effects of a brief, clinician-delivered universal education and counseling intervention to reduce IPC, RC and unintended pregnancy in family planning clinic settings. The trial features a cluster randomized controlled trial design, a comprehensive data collection schedule and a large sample size with excellent retention.Trial RegistrationClinicialTrials.gov NCT01459458. Registered 10 October 2011.

Intimate Partner Violence Detection and Care in the Veterans Health Administration: Patient and Provider Perspectives

BackgroundWomen veterans experience high rates of intimate partner violence (IPV), with associated negative health impacts. The Veterans Health Administration (VHA) has recently developed plans to implement routine IPV screening and provide IPV-related follow-up services for VHA patients. Previous research has examined barriers and facilitators to health care provider screening for IPV. The next step is to examine patients' disclosure of IPV experiences to health care providers and effective response to such disclosures. We sought to identify VHA patients' and providers' perspectives on how to facilitate effective IPV detection and care in VHA. MethodsWe conducted semistructured, qualitative interviews with 25 female veteran patients and 15 VHA health care providers. We used an inductive approach to analyzing interview transcripts and identifying themes that constituted study findings. ResultsThemes fell in to two broad categories: 1) barriers to disclosure and 2) barriers to an adequate response to disclosure and providing follow-up care. Barriers to disclosure of IPV to health care providers included lack of provider inquiry, lack of comfort, and concerns about the consequences of disclosure and lack of privacy. Patients and providers both indicated a need for expanded resources to respond to IPV in VHA. ConclusionsFindings support current plans for IPV program implementation in VHA and point to recommendations for practice and implications for further research.

Intimate Partner Violence and Female Nurses’ Employment: Disclosure and Consequences

The study examined the relationship between women's disclosure of intimate partner violence and their experience of employment interference, work-related consequences, and work participation in 140 nurses. Participants reported experiencing at least one employment interference tactic and 40 % of them disclosed their experience. Employment interference, work-related consequences, and work participation did not differ between nurses who disclosed violence/employment interference and those who did not. Further, our participants may have chosen to disclose employment interference in order to express their discomfort rather than to seek assistance or advice. Distribution of power governed by gender is an obstacle facing women in Jordan, limiting the extent to which they can be protected from experiencing IPV in the workplace. Language: en

Workplace domestic violence leave laws: implementation, use, implications

Purpose – Intimate partner violence (IPV), affecting 30 percent of women worldwide, may affect employment and workplace safety. In all, 16 US states adopted laws providing leave for employed survivors. These qualitative findings are from an evaluation of Oregon’s state leave law. The paper aims to discuss these issues. Design/methodology/approach – The authors interviewed Oregon government employees (n=17) with past year IPV and Oregon supervisors (n=10) of past year IPV survivors. Interviews were transcribed, analyzed and coded. Findings – Participants agreed that IPV has an effect on work. They reported positive workplace reactions to IPV disclosure (93 percent positive, 52 percent negative), but also negative reactions (lack of information, confidentiality, supervisor support). Several implications for supervisors were named (workload, being untrained, being a mandatory reporter, workplace safety and confidentiality). Three years after implementation, 74 percent of participants did not know the leave existed, 65 percent of survivors would have used it if known. The main barriers to usage were fear for job, lack of payment, and stigma. The main barriers of implementation were untrained supervisors and lack of awareness. Participants (85 percent) suggested workplace training on IPV, the law and supervisor role. Practical implications – Effective implementation and support of the IPV leave law is important to avoid negative consequences for survivors and the workplace. Participants called for an increase in IPV awareness and supervisor training. Originality/value – These results provide important recommendations to policymakers, authorities and advocates on development, implementation and evaluation of laws adopted to support employed IPV survivors.

Disclosure experiences of sexual minority college student victims of intimate partner violence.

Although research on disclosure following intimate partner violence (IPV) victimization is burgeoning, sexual minority young adults' (lesbian, gay, bisexual, queer, questioning, etc.; LGBQ+) experiences have not received equal attention. The current study employed the minority stress framework to examine disclosure experiences of LGBQ+ college students across the United States reporting physical IPV victimization within their current relationship (n = 77). Participants completed measures assessing minority stress and IPV disclosure, and answered open-ended questions regarding the most and least helpful persons/responses to disclosure or reasons for non-disclosure. Results indicated that approximately one-third (35 %) of victims disclosed to at least one person, with friends being the most common recipients. Thematic analyses indicated that talking or listening to the victim was considered the most helpful response and not understanding the situation least helpful. Reasons for non-disclosure centered on themes of the victims' perception that the IPV was not a big deal. Quantitative findings regarding physical IPV disclosure indicated that non-disclosers experienced greater minority stress than disclosers. The current study suggests the presence of differences between sexual minority (i.e., LGBQ +persons) and non-sexual minority persons, as well as between LGBQ+ young adults/college students and older adults and presents a theoretical structure (i.e., minority stress framework) through which these differences may be understood.

Disclosure of intimate partner violence in current marital/partner relationships among female university students and among women at an emergency department.

Detecting intimate partner violence (IPV) might empower women to start working on the impact that the abuse experience has had on their lives. Little, however, is known about disclosure of abuse in community and in clinical settings. The purpose of this study was to explore whether there was a difference in the disclosure of abuse experience among women who were attending the emergency department (ED) at Landspitali University Hospital or were located at a university site, that is, at the University Square at the University of Iceland. A cross-sectional research design was used. Data were collected at the same time in 2009 over a period of 9 months from N = 306 women ranging in age from 18 to 67 years (n = 166 at the University Square and n = 140 at the ED). A significantly higher proportion of the women at the ED reported that they were victims of IPV in their current marital/partner relationship and scored higher on the Women Abuse Screening Tool total scale than the women at the university site. This gave a clear indication that the women at the ED experienced significantly more frequent and more severe IPV in their current marital/partner relationship compared with the women at the university site. Identifying IPV in primary and clinical settings might, therefore, function as a protective factor if these women are offered appropriate first response and interventions.

Intimate Partner Violence Programs in a Children's Hospital: Comprehensive Assessment Utilizing a Delphi Instrument.

The purpose of this study was to conduct a baseline assessment of intimate partner violence (IPV) practices in a pediatric hospital system. The Delphi Instrument for Hospital-based Domestic Violence Programs was used to assess the structure and components of the hospital system's IPV practices. Through key stakeholder interviews, we also assessed IPV practices in individual patient care areas. Qualitative analysis of interview data used a grounded theory approach. The hospital scored 17 of 100 points on the Delphi instrument assessment. Key areas of weakness identified by the Delphi instrument and interviews included lack of coordinated provider training and evaluation of IPV-related processes and no standards for IPV screening, safety assessment, and documentation. Most interviewees supported addressing IPV; all identified barriers to IPV screening at individual provider and institutional levels. Institutional barriers included lack of a standardized response to IPV disclosure, need for individualized screening protocols for different patient care settings, lack of standardized provider training, concerns about overextending social work resources, and lack of resources for hospital staff experiencing vicarious trauma. Individual barriers included concern that screening may harm physician-patient-family relationships and the perception that physicians are unwilling to address psychosocial issues. The Delphi Instrument for Hospital-based Domestic Violence Programs identified weaknesses and key areas for improvement in IPV practices. Deficiencies revealed by the Delphi instrument were affirmed by individual interview results. Institutional and individual provider level barriers must be addressed to optimize IPV practices in a pediatric hospital system.

Prevalence of intimate partner violence disclosed during routine screening in a large general practice

Domestic violence in its myriad shapes and forms is a crime affecting every level of society. Gaining a true understanding of intimate partner violence (IPV) victimology allows for the meaningful provision of intervention services. To explore the prevalence of IPV disclosure during routine screening in a large general practice in provincial New Zealand. Data were collected from 13 October 2008 to 30 June 2014 from 6827 individuals screened for IPV on 10 062 occasions and were analysed relative to age, ethnicity, gender, screening outcome, screener and health centre enrolled status. Analysis indicated an overall ever-positive disclosure rate of IPV of 11.1%, lower than New Zealand studies that place ever-positive prevalence as high as 78%. Maori women disclosed an ever-positive rate of 21.6%, Pacific women 13.2%, compared to 8.9% for NZ European/Other women. Casual patients positively disclosed in 13.7% of instances as opposed to enrolled patients in 10.5%. Disclosure of past abuse was made 1.3 times more often than that of a current abusive situation. Those aged between 16 and 65 years disclosed an ever-positive rate ≥10%. While nurses screened 5.5 times more patients than doctors, the doctors facilitated a higher percentage of positive disclosures than the nurses. Disclosure rates from a general practice setting do not mirror those of population studies or administrative datasets due to differences in samples and data collection methods. Routine annual screening is effective, with both doctors and nurses providing support for approximately equal numbers of patients in immediate danger.

Accounting for Intimate Partner Violence: A Biographical Analysis of Narrative Strategies Used by Men Experiencing IPV From Their Female Partners.

Intimate partner violence (IPV) is a serious social issue which affects the medium- and long-term health outcomes of many individuals worldwide. The cost of IPV on the physical and psychological well-being of individuals, in addition to its wider economic costs in responding to abused persons, is significant. Presently, there is a lack of understanding about the nature of female-initiated IPV and how men account for their experiences of it. This study examined male victims' life stories of their IPV experiences from their intimate partners. Using the biographical narrative interpretive method, three cases were analyzed from a social constructionist perspective to examine what narrative strategies men used to account for their experiences of being abused by their female partners. Three dominant narrative strategies were used by respondents: the fatherhood narrative, the good husband narrative, and the abuse narrative. The abuse narrative had a unique narrative form, which reflected respondents' disassociation between their identities as men and also as abused persons. Dominant conflicting discourses of masculinity and intimate partner abuse disadvantaged men in identifying IPV and secondly in responding appropriately. This study found that men prefer to use dominant discursive identities as legitimate means from which to disclose IPV experiences. The findings from this study illustrate that broad questioning by professionals regarding fatherhood may be most helpful in promoting disclosures of IPV if this is suspected.

Intimate partner violence: an underappreciated etiology of orbital floor fractures.

To evaluate the prevalence of intimate partner violence (IPV) in a large population of female orbital floor fracture patients and provide recommendations on effectively identifying and referring IPV survivors. Retrospective review of facial fracture patients examined at the University of Iowa Hospitals and Clinics between January 1995 and April 2013. International Classification of Diseases, Ninth Revision, codes and medical record review were used to determine the prevalence of IPV victimization and clinical outcomes. A total of 1,354 women and 4,296 men sustained facial fractures. Of these, 405 women and 1,246 men sustained orbital floor fractures. Leading mechanisms of orbital floor fractures in women were motor vehicle collisions (29.9%) and falls (24.7%). Twenty percent had no etiology documented. Intimate partner violence-associated assault was the third leading documented cause of orbital floor fractures in women (7.6%) followed by non-IPV-associated assault (7.2%). Among women with orbital floor fractures due to assault, leading patterns of injury included the following: isolated orbital floor fractures (38.7%, 12/31 in IPV patients; 55.2%, 16/29 in non-IPV patients), zygomaticomaxillary complex fractures (35.5%, 11/31 in IPV patients; 17.2%, 5/29 in non-IPV patients), and orbital floor plus medial wall fractures (16.1%, 5/31 in IPV patients; 24.1%, 7/29 in non-IPV patients). Involvement of ancillary services was documented in 20.0% (7 law enforcement and 5 social service agencies, 12/60) of assault-related orbital floor fracture cases. Ascertainment of patient safety was documented in 1.7% (1/60) of these cases. Ophthalmologists treating orbital floor fracture patients should maintain a high index of suspicion for IPV and screen accordingly. Following IPV disclosure, patient safety should be assessed and referral provided.

Effects of a Systems Change Model to Respond to Patients Experiencing Partner Violence in Primary Care Medical Settings

Using an 18-month longitudinal follow-up of women receiving healthcare at intervention clinics compared to control clinics, the present study tested four hypotheses related to the effectiveness of a systems change intervention on intimate partner violence (IPV) inquiry, violence reduction and the health and wellbeing of women patients in family medicine clinics. The study also examined participants’ views of the benefits and harms of IPV inquiry. Results showed that the intervention increased IPV inquiry, discussion, and disclosure compared to usual care. Women in intervention clinics made fewer doctor visits, but also received more prescriptions over time. The groups did not differ in change in physical violence, use of safety plans and strategies, connection to the community, patient satisfaction, or quality of health. Over the course of the study, both the intervention and usual care groups adopted more safety behaviors and experienced less violence, suggesting that participating in research interviews may have constituted an unintentional intervention. Small sample size (N = 34), low participation rate (32 %) and attrition (35 %) call for caution in interpreting these results.

Effect of face-to-face interview versus computer-assisted self-interview on disclosure of intimate partner violence among African American women in WIC clinics.

African American women in the United States report intimate partner violence (IPV) more often than the general population of women. Overall, women underreport IPV because of shame, embarrassment, fear of retribution, or low expectation of legal support. African American women may be especially unlikely to report IPV because of poverty, low social support, and past experiences of discrimination. The purpose of this article is to determine the context in which low-income African American women disclose IPV. Consenting African American women receiving Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) services in WIC clinics were randomized to complete an IPV screening (Revised Conflict Tactics Scales-Short Form) via computer-assisted self-interview (CASI) or face-to-face interview (FTFI). Women (n = 368) reported high rates of lifetime and prior-year verbal (48%, 34%), physical (12%, 7%), sexual (10%, 7%), and any (49%, 36%) IPV, as well as IPV-related injury (13%, 7%). Mode of screening, but not interviewer race, affected disclosure. Women screened via FTFI reported significantly more lifetime and prior-year negotiation (adjusted odds ratio [aOR] = 10.54, 3.97) and more prior-year verbal (aOR = 2.10), sexual (aOR = 4.31), and any (aOR = 2.02) IPV than CASI-screened women. African American women in a WIC setting disclosed IPV more often in face-to-face than computer screening, and race-matching of client and interviewer did not affect disclosure. Findings highlight the potential value of face-to-face screening to identify women at risk of IPV. Programs should weigh the costs and benefits of training staff versus using computer-based technologies to screen for IPV in WIC settings.

Informal social reactions to college women's disclosure of intimate partner violence: associations with psychological and relational variables.

This researchers assessed informal (e.g., friends, family) social reactions to college women's (N = 139) disclosure of intimate partner violence (IPV) within their current romantic relationships and associated psychological (i.e., posttraumatic stress symptoms [PTSS] and global psychological distress symptoms) and relational (i.e., intentions to leave the abusive relationship) variables. Women completed confidential surveys, which assessed current partner abuse, psychological and relational variables, and three types of social reactions from informal supports to disclosure of IPV: positive (e.g., believing, validating the victim), negative (e.g., disbelieving, blaming the victim), and leaving (i.e., being told to end the relationship) reactions. At the bivariate level, negative social reactions to women's disclosure were related to increases in global psychological distress, PTSS, and leaving intentions; positive social reactions to disclosure related only to increases in PTSS; and being told to leave the relationship related to increases in PTSS and leaving intentions. In the regression analyses, after controlling for abuse severity, negative social reactions were significantly related to global psychological distress and PTSS, and being told to leave significantly related to leaving intentions and PTSS. Mechanisms for these relationships and implications are discussed.

Primary Care–Based Interventions for Intimate Partner Violence

Primary care providers are uniquely positioned to respond to patients' disclosure of intimate partner violence (IPV). However, the research on primary care-based IPV interventions has not been systematically synthesized, making it difficult for providers, policymakers, and researchers to understand how to effectively intervene in the primary care setting. This systematic review summarizes primary care-based interventions for patients experiencing IPV. PubMed, PsycINFO, and CINAHL were searched from their start through September 2012; this search was augmented by bibliographic review and consultation with experts. Eligible studies included English-language, peer-reviewed articles that assessed patient-level impact of IPV interventions that originated from patients' visits to a primary care provider. Of 80 potentially eligible studies, 17 met eligibility criteria. The majority of interventions recruited women from reproductive care sites. Interventions tended to be brief, delivered by nonphysicians, and focused on empowerment, empathetic listening, discussion of the cycle of violence and safety, and referral to community-based resources. Thirteen studies demonstrated at least one intervention-related benefit. Six of 11 articles measuring IPV persistence found reductions in future violence; two of five measuring safety-promoting behaviors found increases; and six of ten measuring IPV/community resource referrals found enhanced use. Some studies also documented health improvements. The majority of studies demonstrated patient-level benefit subsequent to primary care IPV interventions, with IPV/community referrals the most common positively affected outcome.

Beyond assessment: Examining providers’ responses to disclosures of violence

Intimate partner violence (IPV) and sexual assault (SA) are significant public health issues. In spite of gains made in research and support for screening, little is known about how healthcare providers respond to disclosures of violence. The purpose of this analysis was to examine providers' documented responses to women's disclosure of IPV or SA. This qualitative analysis of healthcare providers' responses to the disclosure of violence was part of a larger retrospective review of 2000 medical records from four family planning clinics in the northeastern United States. Findings from this analysis reveal that although screening for IPV and past experiences of violence is consistent, providers' responses to disclosures of violence are often inconsistent. The majority of documented responses to the disclosure of violence (81.5%) were only descriptive in nature and 13% of the medical records contained no documentation of the violence. As universal violence assessment has increased, providers need to be aware of not only how to screen for violence, but how to respond in a way that is helpful, sincere, nonjudgmental, and legally adequate. This will require providers to move beyond a description of violence toward a response that is action-oriented and includes safety planning and referrals.