History Of Domestic Abuse Research Articles

Trauma-specific mindfulness-based cognitive therapy for women with post-traumatic stress disorder and a history of domestic abuse: intervention refinement and a randomised feasibility trial (coMforT study)

BackgroundWomen who have experienced domestic violence and abuse (DVA) are at increased risk of developing post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD). In 2014–2015, we developed a prototype trauma-specific mindfulness-based cognitive therapy curriculum (TS-MBCT) for the treatment of PTSD in a DVA population. This study aimed to refine the prototype TS-MBCT and evaluate the feasibility of conducting a randomised controlled trial (RCT) testing its effectiveness and cost-effectiveness.MethodsIntervention refinement phase was informed by evidence synthesis from a literature review, qualitative interviews with professionals and DVA survivors, and a consensus exercise with experts in trauma and mindfulness. We tested the refined TS-MBCT intervention in an individually randomised parallel group feasibility trial with pre-specified progression criteria, a traffic light system, and embedded process and health economics evaluations.ResultsThe TS-MBCT intervention consisted of eight group sessions and home practice. We screened 109 women in a DVA agency and recruited 20 (15 TS-MBCT, 5 self-referral to National Health Service (NHS) psychological treatment), with 80% follow-up at 6 months. Our TS-MBCT intervention had 73% uptake, 100% retention, and high acceptability. Participants suggested recruitment via multiple agencies, and additional safety measures. Randomisation into the NHS control arm did not work due to long waiting lists and previous negative experiences. Three self-administered PTSD/CPTSD questionnaires produced differing outcomes thus a clinician administered measure might work better. We met six out of nine feasibility progression criteria at green and three at amber targets demonstrating that it is possible to conduct a full-size RCT of the TS-MBCT intervention after making minor amendments to recruitment and randomisation procedures, the control intervention, primary outcomes measures, and intervention content. At 6 months, none of the PTSD/CPTSD outcomes ruled out a clinically important difference between trial arms indicating that it is reasonable to proceed to a full-size RCT to estimate these outcomes with greater precision.ConclusionsA future RCT of the coMforT TS-MBCT intervention should have an internal pilot, recruit from multiple DVA agencies, NHS and non-NHS settings, have an active control psychological treatment, use robust randomisation and safety procedures, and clinician-administered measures for PTSD/CPTSD.Trial registrationISRCTN64458065 11/01/2019.

Patient views on the routine use of a two-item screening tool for domestic abuse in general practice: a UK-based cross-sectional study.

Domestic abuse (DA) is underdiagnosed by the medical community. The National Institute for Health and Care Excellence (NICE) does not recommend DA screening in primary care. The enduring use of remote consultations since COVID-19, coupled with the sensitive nature and increasing prevalence of DA, necessitates review of the NICE guideline, which was developed pre-pandemic primarily for face-to-face consultations. To explore NHS patient experiences and views on routine DA screening in primary care. Data were collected from 6967 NHS patients using an anonymous 29-item eSurvey that included information on accessible support services. Logistic regression analysis from 4253 responders explored the association between the validated WAST-short questions and previous exposure to abuse. Almost half of the responders confirmed having experienced DA, whereas 6.1% declined disclosure. About two-thirds of responders agreed it would be beneficial to routinely screen DA in general practice using a short, validated tool. Logistic regression analysis adjusted for age, sex, and ethnicity suggested those with a history of abuse had 11.52 times higher odds of having tension in the relationship and 9.72 times higher odds of having difficulty working out arguments compared with those with no history of DA. Similarly, those who answered 'would rather not say' had 6.42 times higher odds of having tension in the relationship, and 4.31 times higher odds of having difficulty working out arguments. The routine use of the already established WAST-short in primary care could help identify and potentially tackle DA. Training health and social care professionals in administering the brief, non-threatening DA screening questionnaire would help raise awareness, and identify and support victims.

To have and to hold: Emotional distress, divorce denial, and the politics of interspousal torts

Abstract While domestic abuse can manifest itself in many forms, one example of abuse within the divorce process is the denial of the religious divorce. In Jewish law, the parties must transact a bill of divorce (known as a get) before they are divorced. If a spouse refuses to cooperate with this process, they limit their former partner’s ability to date and remarry within the community, effectively maintaining coercive control post-divorce. This article will examine whether or not victims of get refusal would be able to recover monetary awards under the tort doctrine of Intentional Infliction of Emotional Distress (IIED). This article will argue that while the facts of get refusal meet the central elements of the tort of IIED, these cases are unlikely to succeed in most states due to the court system’s reluctance to apply IIED to interspousal torts. The reasons behind this hesitation draw on the complex history of domestic abuse and tort law, and historical legal prioritizations of family privacy over abuse victims’ safety. Additionally, I will explore the history of the IIED tort as a vehicle for social change and examine how IIED can still play that role today. Ultimately, I will argue for the necessity of courts’ abandoning lasting vestiges of the marital privacy doctrine and providing redress to victims of this insidious form of domestic abuse.

“She was accused of colluding with the mother”; the training and support needs of parent‐and‐child foster carers: A qualitative study

AbstractParent‐and‐child foster placements are used to accommodate parents with their children, either when the mother is a looked‐after child or as a setting for a parenting assessment. Despite this being a specialized role with significant potential for affecting outcomes for disadvantaged families, there is currently a lack of accessible learning opportunities for foster carers on the physical and mental well‐being of women with complex needs such as a history of domestic abuse, substance abuse, perinatal mental ill‐health, or having a learning disability. Parent‐and‐child carers experience some unique stresses and value the support of others with similar experiences; this kind of peer support is currently largely absent. This qualitative study has used ten focus groups with foster carers, eight interviews with mothers, and nine interviews with supervising social workers, to inform the development of an online learning resource and a social media‐based peer support network for parent‐and‐child foster carers.

Assessment of postnatal depression and some associated risk factors among mothers attending the immunisation outpatient department in a tertiary health care centre: a cross sectional study

Background: Postpartum depression is a significant and common health problem that causes a considerable amount of impact to both the mother and baby and distress on the family and society. The objective of this study is to find out prevalence of postnatal depression among mothers attending immunization outpatient department (OPD) for immunization of their baby in a tertiary health care center and to study some risk factors responsible for it.Methods: This cross sectional study was conducted in a tertiary care teaching hospital of Maharashtra state during period September to February 2019. Total 188 mothers were screened for postpartum depression using local version of EPDS (Edinburgh Postnatal Depression Scale).Results: 24 (12.76%) mothers were found to have a score of 10–12 indicating moderate depressive symptoms, and 18 mothers had a score of 13 and above. (9.57%). Risk factors found to be significantly associated with postnatal depression rural residence of mother, lack of support during and after pregnancy, history of domestic abuse, and stressful life events in the past year.Conclusions: Since the prevalence of EPDS score >13 was found to be high in the current study, we recommend routine screening for PPD in our population.

Prevalence and correlates of depression among male medical students and interns in Albaha University, Saudi Arabia.

Background:Depression in medical students and interns appear higher than the general population, with evidence of mental health deterioration over a period of medical training.Objectives:To estimate the prevalence and evaluate the predictors of depression among male medical students and interns, Albaha University, Saudi Arabia.Subjects and Methods:A cross-sectional analytic study was conducted which includes a representative stratified random sample with the proportional allocation of male medical students and interns, College of Medicine, Albaha University (2017–2018). A questionnaire included sociodemographic characteristics of the participants as well as a medical and family history of depression, medical or psychiatric illness, abuse or violence, and the major traumatic event was utilized. In addition, the validated reliable Arabic version of Becks Depression Inventory (BDI) questionnaire was used to screen for depression.Results:The study included 161 medical students and 21 interns. Their age ranged between 19 and 26 years with a mean of 22.03 ± 1.94 years. Majority of the participants (98.9%) were Saudis and singles (84.6%). The prevalence of depression, based on the BDI scale, was 53.8%; it was mild in 25.8% and severe or extreme in 4.4% of the participants. No factor was significantly associated with depression. However, severe or extreme depression was more reported among students/interns with a history of domestic abuse or violence and those who had a history of major trauma or psychiatric event, P < 0.001.Conclusion:Depression is a common problem among male medical students and interns in AlBaha University, with no difference according to demographics, smoking history, family history of depression, history of chronic medical or psychiatric illness, history of domestic/violence abuse, and history of major trauma or psychiatric event.

“Being Unfilial Condemns You to Hell”: Integrative Treatment for Social Anxiety Shaped by Domestic Abuse, Confucian Values, and Taoist Beliefs

Social anxiety is a common and treatable condition but less is known about how to adapt evidence-based approaches in a culture-sensitive way to Asian clients. We present the case of “Sally,” a 25-year-old Chinese Singaporean female who suffered from severe and long-standing social anxiety disorder (SAD), and secondary low mood. Contributing factors included a history of domestic abuse, as well as culturally influenced authoritarian parenting emphasizing the Confucian value of filial piety and reinforced by Taoist beliefs of karmic retribution and supernatural punishment. Treatment was based on Clark and Wells’s cognitive model of SAD with a focus on behavioral experiments, and was enhanced using a schema mode formulation and imagery rescripting to address relevant early memories that were at the origin of the social anxiety. Sally received a total of 42 sessions over the course of 21 weeks, during which she made steady progress toward recovery. Her self-reported depression and social phobia fell from the “severe clinical” range pretreatment to the “non-clinical” range posttreatment; these gains were maintained at 6 months follow-up. Sally’s functioning fully recovered, and she returned to work and school. While behavioral experiments for dropping safety behaviors were useful for overcoming the social anxiety, schema formulation was important for providing Sally with insight to her thought process, and imagery rescripting was crucial for weakening her self-criticism and internalized black and white thinking on filial piety. The significance of culture and religion in SAD, and the potential of adapting cognitive therapy in a culture-sensitive way is discussed.

PSYCHOSOCIAL CORRELATES OF POST-TRAUMATIC STRESS DISORDER IN PATIENTS WITH FIRE BURNS

ABSTRACTOBJECTIVE: to elucidate the psychosocial correlates of post-traumatic stress disorder (PTSD) in the burn victims of Pakistan.METHODOLOGY: A total of 200 burn victims were included in the sample. The standardized measures were used to assess the symptom levels of PTSD. The detailed demographic profile of the patients was also received for gleaning the demographics’ association with PTSD symptoms. The screening of PTSD symptoms for further clinical management had also been catered through this data collection strategy. For analysis SPSS Version 22.0 was employed. RESULT: Mean age of the respondents was 30.56+10.3 years. Most of the respondents were males (n=111, 55.5%), panjabi speaking (n=120; 60%), followers of Islam (n=146; 73%), lower socioeconomic class (n=93; 45.5%), illiterate (n=114; 57%), Unemployed/Housewife (n=155; 77.5%) and were married (n=143; 71.5%). Most of the respondents had high PTSD levels (n=169; 84.5%). Panjabi natives (n=105/120; 87.5%), married persons (n=120/143), urban background (n= 110/118; 93.2%), persons currently living with children (n=102/123; 82.9%), Unemployed/Housewife (n=140/155; 90.3%), illiterate (n=109/114; 95.6%), respondents who experienced domestic violence (n=150/151; 99.3%) and those experienced burn injuries less than one-year duration (n=140/151; 92.7%) had higher PTSD levels than their counterparts. Fifty-one (25.5 %) respondents had suicidal ideation.CONCLUSION: Being male, married, illiterate, urban background, having history of domestic abuse, unemployed/housewives, having lower education level and experienced burn injuries less than one-year duration are significant psychosocial correlates of PTSD in patients with fire burns. KEY WORDS: Post-traumatic stress disorder (PTSD) (MeSH); Stress Disorder (MeSH); Burns (MeSH); Psychosocial factors (non-MeSH).

SOCIOECONOMIC FACTORS OF DEPRESSION AMONG FEMALES VISITING OUTPATIENT CLINIC IN DISTRICT GHIZAR, GILGIT-BALTISTAN, PAKISTAN: A PILOT STUDY

ABSTRACTOBJECTIVE: This pilot study was conducted to find out the socioeconomic factors leading to depression in married females of district Ghizar, Gilgit Baltistan, Pakistan.METHODS: The study was conducted at District Headquarter Hospital Gahkuch, Ghizar from November 2015 to February 2016. Depression was diagnosed using Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criterion and socioeconomic status was assessed by a self-designed questionnaire. Analysis was performed with SPSS version-23.RESULTS: Out of 73 females, 53 (72.6%) were depressed according to DSM-IV. Majority of women were uneducated (n=23; 31.5%). Most females were married (n=50; 68.5%) followed by divorced females (n=8; 11%). Sixty-one (83%) women had arranged marriage. Majority of women (n=43; 58.9%) were housewives. Most females (n=37; 50.7%) had non-cordial relations with in-laws. Domestic violence was reported by (n=41; 56.2%) women. Sixty-one (83.5%) women had land ownership of some kind. Women who were married within the family (OR 1.386, CI .837-2.292), presence of depression in husband (OR 3.530, CI .933-13.359), non-cordial relation of women with in-laws (OR 3.657, CI 1.979-6.755) and domestic violence (OR 3.584, CI 0.717-17.921) were significantly associated with depression.CONCLUSION: Majority of the females had no cordial relations with in-laws, more than half had history of domestic abuse. Marriages outside family had inverse relation with depression. Depression in husband and bad relationship of women with in-laws were strong predictors for depression in married females of district Ghizar, Gilgit Baltistan. Small sample size and hospital-based study were the main limitations of the study.KEY WORDS: Depression (MeSH); Socioeconomic Factors (MeSH); Domestic Violence (MeSH).

Older adults and violence: an analysis of Domestic Homicide Reviews in England involving adults over 60 years of age

ABSTRACTDomestic Homicide Reviews (DHRs) are conducted when an individual aged 16 or over appears to have died from violence, abuse or neglect by a person to whom they are related or with whom they are in an intimate relationship or who is a member of the same household. DHRs aim to identify lessons to be learned, to improve service responses to domestic abuse and to contribute to prevention of domestic abuse/homicide. We submitted Freedom of Information requests to English Local Authorities to identify DHRs where victim, perpetrator or both were aged over 60. Collected Reports and/or Executive Summaries were thematically analysed. Analysis identified four key themes in the context of the key relationship and caring: major mental illness of the perpetrator; drug and/or alcohol abuse; financial issues; and a history of domestic abuse in key or family relationships. We analysed 14 adult family homicides, 16 intimate partner homicides and five homicide–suicides. Age per se did not emerge as a significant factor in our analysis. Terminology needs to be standardised, and training/education regarding risk assessment needs to be improved in relation to age, myths around ageing/dementia and stresses of caring. Management of mental illness is a key factor. A central repository of DHR Reports accessible for research and subject to regular review would contribute to maximising learning and improving practice.

The Effects of Abuse, Emotion Regulation and Family Member’s Gambling Problem on Problem Gamblers: Developmental Perspective

The goal of this study was to identify the moderated mediating effect of family member's gambling problem on the connection between abuse, emotion regulation and problem gambling. To this end, a research model was tested among 642 adults (men: 473, women: 169) who gambled at least once a year and had been categorized as problem gamblers based on the CPGI score (8 and above). The study results were as follows: for men, abuse was identified to have a direct effect on problem gambling and an indirect influence on problem gambling by lowering their emotion regulation. In addition, men who experienced much abuse and had a family member with a gambling problem were found to suffer with a gambling problem of higher severity. This indicates that family member’s gambling problem moderates the connection between abuse and gambling problem. As for women, history of domestic abuse affected emotion regulation, but emotion regulation did not mediate the connection between abuse and gambling problem. This study has its significance as it identifies the mechanism of family member’s gambling problem from the perspective of developmental psychopathology, in addition to the mechanism of emotion regulation and gambling problem on the developmental path that negative childhood experience can lead to adjustment problem in adulthood.

PTU-082 Clinical Outcomes after Transplantation for Paracetamol Overdose: Evaluation of Predictors of Outcome, Adherence and Pre-Transplant Psychiatric History

Introduction Paracetamol hepatoxicity is the most common cause of fulminant hepatic failure in the UK 1 and NHSBT criteria for super-urgent liver transplantation in these patients are well described. 2 While potentially life-saving, transplanted patients must live with the consequences of immunosuppression and life-long follow up. Patients transplanted for paracetamol overdose have an increased risk of post-transplant death compared to patients transplanted for other indications, particularly due to suicide, trauma & non-adherence to treatment. 3 Outcome after transplantation may be adversely affected by persisting physical/psychological/psychiatric/social & addiction circumstances that may make adherence unmanageable, even with full social support. Given the shortage of organ donors, rationing is inevitable and not all patients who fulfil the NHSBT criteria are listed for transplantation, despite a predicted poor/fatal outcome without. There is currently no clear way of pre-operatively predicting the risk of poor outcomes after transplant for paracetamol overdose. Our aim was to identify factors in the presenting history that could suggest that these patients might be unlikely to fully benefit from undergoing liver transplantation. Methods We retrospectively analysed all patients transplanted for fulminant liver failure due to paracetamol overdose at University Hospitals Birmingham from 2000–2014, using standard clinical and transplant databases. Survival and graft related outcomes were assessed using Kaplan-Meier survival curves, with log-rank tests used to make comparisons across factors. Patients with DNAs and non-compliance were then compared to compliant patients using Mann-Whitney tests, for continuous variables, and Fisher’s exact test, for categorical variables. Results 59 patients were transplanted for POD during this period with median follow up of 6 years, mean age of 35 (range 17–57 years). 59% of patients were female. 57% of patients had a pre-existing psychiatric diagnosis however only 36% had a history of previous overdose. 12 patients died before discharge from hospital (main causes of death were multi-organ failure & sepsis) with a further 6 patients dying after initial discharge (all associated with non-compliance and 33% were due to suicide). Overall 5 year survival was 69%, which rose to 87% if the patient survived to discharge from hospital. Having a history of domestic abuse was associated with a higher risk of death (p = 0.001). Of 36 patients under long-term follow up at our centre, 15 have had at least one episode of biopsy proven rejection (41.7%) with a 5 year rejection rate of 46%. To date this has resulted in two patient deaths and two re-grafts. Patients aged 16–35 were significantly more likely to experience rejection than the older cohort (p = 0.04). 73% of patients with rejection had a history of non-compliance with medication compared to 27% in compliant patients (p = 0.031). In the 2007–2015 patient cohort, both staggered and mixed overdosed were found to give significantly increased risk of rejection (p = 0.027 and 0.011 respectively). Conclusion Patients transplanted for paracetamol overdose have poorer long term survival and graft function than other transplant patients. There remains no clear way of predicting post-operative mortality/graft dysfunction from pre-admission factors. However, domestic abuse may be associated with increased patient mortality and patients under 35, staggered and mixed overdoses are at higher risk of graft rejection. These results are unlikely to change the decision to list for transplantation, but could help identify those at higher risk post-discharge and aid in tailoring follow up. References 1 Riordan S, Williams R. Cause and prognosis in acute liver failure. Liver Transpl 2003; 5 (1):86–89. 2 Mitchell I, Bihari D, Chang R, Wendon J, Williams R. Earlier Identification of patients at risk from acetominophen-induced acute liver failure. Cri Care Med 1998; 26 (2):279–284. 3 Germani G, Theocharidou E, Adam R, Karam V, Wendon J, et al . Liver transplantation for acute liver failure in Europe: outcomes over 20 years from the ELTR database. J Hepatol 2012; 57 :288–296. Disclosure of Interest None Declared

No Ground on Which to Stand: Revise Stand Your Ground Laws So Survivors of Domestic Violence are No Longer Incarcerated for Defending Their Lives

No Ground on Which to Stand: Revise Stand Your Ground Laws So Survivors of Domestic Violence are No Longer Incarcerated for Defending Their Lives

Screening for Postnatal Depression in a Tertiary Care Hospital

To determine the need to screen postpartum women for postpartum depression. This study was designed to determine the prevalence of an Edinburgh postnatal depression scale (EPDS) score of≥13 in postpartum mothers and to evaluate the association of different sociodemographic and obstetric factors with postpartum depression. Prospective cohort study. 1600 postpartum women who delivered a live born at St. John's Hospital were recruited into the study. Participants were screened for postnatal depression using the EPDS. A risk factor questionnaire that covered key sociodemographic and obstetric factors was also completed by all the subjects. Prevalence of a score of 13 or higher, on the EPDS. The prevalence of an EPDS score of≥13 in our population was 7.5% (120/1600). Participants with a family history of psychiatric illness, history of domestic abuse, delayed initiation of breastfeeding, and those who gave birth to a female infant were at a significantly higher risk for an EPDS score of 13 or higher, indicating probable postnatal depression. The mode of delivery, NICU admission of the newborn, and history of antenatal complications were not significant risk factors. Since the prevalence of an EPDS score≥13 (which is suggestive of PPD) was found in a significant proportion of women, screening for PPD is indicated in all postpartum women to identify and promptly treat these women. Identification of a clear correlation between certain risk factors and PPD will lead to a more prompt diagnosis of PPD.

Domestic violence disclosure scheme: a guide to Clare's Law for district nurses.

The Government is rolling out a national Domestic Violence Disclosure Scheme from March 2014 that will allow people who are worried that they may be at risk of violence from their new partner to ask police whether they have a past history of domestic abuse. This article considers the value of the scheme and the role that district nurses must take in promoting the scheme as part of their intervention and support in domestic violence cases.

Women prisoners, mental health, violence and abuse

This article examines the specific experiences of women in prison, focusing on previous (and continuing) physical and mental abuse, the consequent health care requirements of women prisoners, the policy response and the availability of suitable health care in prisons across the EU. It draws from an extensive review of the literature on women prisoners across Europe that was part of an on-going European Project funded by the DAPHNE programme of the European Commission, entitled ‘DAPHNE Strong’. It also uses the field research from the project collected via surveys and in-depth interviews with key personnel in organisations that work with women prisoners or ex-prisoners and staff with a strategic overview of activity from the ministries of justice, police, prison service and women's support organisations.There are probably many more women prisoners with a history of domestic abuse than is officially recognised. Many of the women prison population who have experienced violence and abuse mask this by problematic drug or alcohol use as well as self-injury. These are key areas that training for prison staff needs to address.The availability of services for this group of women is inconsistent within and between countries of the EU. The political will to address the situation of women in prison, as distinct from the norms applied to men, is variable and it seems to take the determined efforts of active lobby groups to make inroads into an area of latent inertia.

The Collaborative Role of the Psychologist and Physician on an Interdisciplinary Pain Rehabilitation Team

Pain is the most common reason individuals seek medical attention. Pain can be classified as either acute or chronic. Patients suffering from chronic pain deal with a mixture of physical, emotional, and social issues that makes the management of these patients very complex. Because of this complexity, a team treatment approach is imperative. One of these types of cases is described here, within the context of an interdisciplinary pain rehabilitation program. The collaborative role of the psychologist and physician in treatment planning is highlighted in this case presentation. The described case focuses on an individual dealing with a chronic painful condition, who also has a history of domestic abuse. Literature has shown that self-reported abuse may be an important prediction of chronic pain and supports the idea that abuse may indirectly or directly be implicated in the “chronification” of pain. Implications related to treatment are further explored in the case presentation and discussion.

Domestic abuse in the emergency department: can a risk profile be defined?

The main purpose of this study was to determine whether any clinical or demographic characteristics could identify adult female patients presenting to the emergency department (ED) with a history of domestic abuse. A second objective was to describe the frequency, types, and severity of this abuse. This study was a crosssectional survey of 611 women conducted in an academically-affiliated, urban ED. Domestic abuse was described as "recent" (within the preceding 12 months) or "lifetime" (recent or past). This included emotional, physical, and sexual abuse. Recent (7.9%, n = 48) and lifetime (38%, n = 232) domestic abuse was reported. For recently abused women, violence had been severe (87.5%, n = 42) and was associated with 1) trauma (OR 5.4, 95% CI = 2.6 to 11.6), 2) obstetrical and gynecological syndromes (OR 5.6, 95% CI = 2.4 to 13.2), and 3) psychiatric symptoms and substance use (OR 7.3, 95% CI = 2.4 to 22.0). The sensitivities and positive predictive values of these risk factors individually (<27.1% and <25.0%, respectively) and in aggregate (56.3% and 20.9%, respectively) were low. These indicators predicted only 27 (56.3%) of recently abused women. Lifetime domestic violence was more likely in homeless women (OR 5.8, 95% CI = 2.2 to 15.0), although less likely in immigrants (OR 0.4, 95% CI = 0.3 to 0.7). Clinical presentations and demographic characteristics of women presenting to the ED may not be sensitive or predictive indicators of domestic abuse. In the absence of typical clinical or demographic findings, asking all women in the ED about domestic abuse remains a necessary priority.