Severe Intimate Partner Violence Research Articles

Intimate partner violence (IPV) among sexual minority men (SMM) during the COVID-19 pandemic: A scoping review and a call for research

There is a dearth of literature documenting the impact of the COVID-19 pandemic on intimate partner violence (IPV) victimization among sexual minority men (SMM). This review examines studies conducted since the onset of the COVID-19 pandemic, focusing on the experiences and changes in IPV experiences among SMM. We conducted a comprehensive search, and article screening and selection adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Only 7 studies were identified and met the eligibility, all of which utilized cross-sectional design. Studies were conducted in the U.S (n = 4), Spain (n = 1), China (n = 1), and a study using global samples (n = 1). Measurements and assessment tools for IPV victimization vary across these studies. SMM were observed to experience a relatively high rate of IPV victimization, and some reported experiencing more severe and frequent IPV victimization since the pandemic. IPV victimization was associated with multilevel factors such as younger age, substance use, mental illness, economic and structural vulnerabilities. None of the studies had examined the impact of the pandemic on help-seeking. There is a need to explore the long-term effects of the ongoing pandemic on IPV victimization among this vulnerable population. Developing safe intervention strategies and ensuring confidential access to health and supportive services are particularly urged.

The Implementation of the Advocacy Intervention for Midlife and Older Women Who Have Experienced Intimate Partner Violence: Protocol for a Randomized Controlled Trial.

Midlife and older women who experience intimate partner violence (IPV) often have less access to supports and services than younger women. There is far less focus on research and supports for midlife and older women compared to younger women experiencing IPV, and often, neither elder abuse nor IPV services meet their needs. Few interventions are available to meet the needs of midlife and older women. The goal of this randomized controlled trial is to test the effectiveness of an advocacy intervention for midlife and older women who experience IPV and to learn from the experiences of those who implement and participate in the program. This trial is a 2-arm, unblinded, parallel, pragmatic randomized controlled trial with a qualitative component. Eligible participants will be women who live in the Maritime provinces of Canada (New Brunswick, Nova Scotia, and Prince Edward Island), who are in midlife and older (aged approximately ≥50 years), and who are currently in a relationship with an abusive partner or have recently left an abusive partner. Facilitators will be trained to deliver the intervention. The intervention will be entirely virtual and will consist of 2 components: (1) an empowerment component, which will involve sharing resources and information with the women; and (2) a social support component, which will include providing support and encouragement to women for 12 weeks. Quantitative effectiveness data will be collected from all trial participants at baseline, 3 months after the intervention, and 9 months after the intervention about the incidence and severity of IPV, physical and mental health, and safety behaviors and strategies. Qualitative interviews will be conducted with the facilitators and intervention group participants. Control group participants will receive a static, nontailored version of the advocacy intervention for midlife and older women (AIM) intervention materials after baseline data collection. A total of 12 facilitators have been trained to deliver the AIM intervention to trial participants. Participant recruitment and data collection will be completed in January 2025. Data analysis will continue throughout the data collection period, and the results will be disseminated by December 2025. This research will result in the adaptation and testing of a program to support and empower midlife and older women in the Maritime provinces of Canada who experience IPV. International Standard Randomized Controlled Trial Registry ISRCTN30646991; https://doi.org/10.1186/ISRCTN30646991. DERR1-10.2196/57886.

Examining the measurement of severity of intimate partner violence and its association to mental health outcomes: a narrative synthesis.

The aims of this synthesis were to investigate the relationship between IPV severity and mental health outcomes and shed light to gaps and limitations in existing methodologies used to assess IPV severity and its association with mental health outcomes. We conducted a two-stage narrative synthesis of 76 studies. First, we identified IPV measures used in at least five studies, focusing on their variations and severity score calculation. Then, we analyzed findings of studies correlating IPV severity with mental health outcomes, identifying features of measures and statistical methods influencing result consistency. Measures of intimate partner violence were often modified from their original, potentially impact on the reliability and validity of these measures. The operationalization of violence severity varied across studies, leading to inconsistencies in scoring whereby compromising the consistency of severity levels across studies. We found lack of consistency in applying validated methods for scoring instruments to determine abuse severity. In this review, we consistently found that the severity of IPV and its various subtypes were linked to different mental health outcomes across multiple studies. We discovered evidence suggesting that experiencing more types of IPV was associated with worse mental health outcomes. Generally, higher levels of overall IPV severity and its specific subtypes were correlated with poorer mental health outcomes. However, our analyses did not reveal consistent patterns that would allow for a definitive determination of how individual IPV subtypes differently affect mental health outcomes. Nevertheless, we observed that increasing severity of physical IPV tended to have a notable impact on post-traumatic stress disorder (PTSD). Conversely, increasing severity of psychological IPV was consistently associated with depression. While sexual IPV severity was explored in fewer studies, the evidence regarding its impact on various mental health outcomes was less conclusive. To achieve a comprehensive understanding of the mechanism by which IPV severity is related to mental health it may be time to take an alternative approach to measuring IPV severity. No IPV measures assessed the acceptability of the content to people who have experienced IPV. This is an important omission with significant consequences for the validity of the evidence base.

Depression, anxiety, and posttraumatic stress in women with and without brain injuries due to intimate partner violence: Psychometric evaluation of measurement approaches and group comparisons.

The current study examined the psychometric properties of common mental health questionnaires among women survivors of intimate partner violence (IPV) with and without brain injuries due to IPV and evaluated whether women with and without IPV-related brain injuries differed in depression, anxiety, and posttraumatic stress disorder (PTSD) symptom severity. Women survivors of IPV with and without IPV-related brain injuries were recruited online through Prolific (N = 205, M = 39.8 ± 11.9 years old, 83.9% non-Hispanic White, 42.4% college-educated). They completed the eight-item Patient Health Questionnaire (PHQ-8), seven-item Generalized Anxiety Disorder scale (GAD-7), and PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders (fifth edition) (PCL-5). Model fit and internal consistency were estimated for each scale. Groups were compared on mental health symptom severity, with and without controlling for age, education, and IPV severity. Both one-factor and multifactor models showed excellent fit for all scales. PHQ-8 (ω = .91), GAD-7 (ω = .94), and PCL-5 total scores (ω = .95) had strong reliability, and all subscale scores had acceptable-to-strong reliability (ω range = .79-.94). Women with IPV-related brain injuries reported greater physical IPV severity, higher rates of depression, and higher somatic anxiety and PTSD symptom severity. No group differences in mental health symptoms were significant after controlling for IPV severity. The PHQ-8, GAD-7, and PCL-5 showed evidence for reliability and validity among women survivors of IPV. Women with IPV-related brain injuries had higher PTSD symptom severity, attributable to greater physical violence exposure in general. Brain injury screening among survivors appears warranted for women with extensive physical IPV experiences. Interventions addressing PTSD, violence prevention, and brain injury recovery may best serve this population. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Cigarette Smoking in Women Victims of Police-Reported Intimate Partner Violence: The Role of Childhood Maltreatment, Type of Partner Abuse, and Psychological Distress Symptoms

ABSTRACT Existing research on the relationship between intimate partner violence (IPV) and cigarette smoking primarily involves low-risk, physical IVP-focused studies on community women. As a result, the risks associated with cigarette smoking in women victims of severe IPV have not been fully explored. This study examined the association between exposure to different forms of childhood maltreatment, exposure to physical, psychological, and sexual IPV, and current psychological distress symptoms with cigarette smoking in a high-risk sample of women victims of police-reported severe IPV. Participants included 162 women victims of police-reported severe IPV recruited in shelters for domestic violence and Child Protective Services in Portugal. Participants provided self-reports on childhood maltreatment physical, psychological, and sexual violence), physical, psychological, and sexual IPV, psychological distress symptoms (anxiety, depressive, somatic, and posttraumatic stress disorder symptoms), and daily cigarette consumption. Results revealed significant associations between daily cigarette consumption and exposure to IPV, physical abuse during childhood, psychological IPV, and anxiety symptoms in women experiencing police-reported severe IPV. Childhood maltreatment may increase vulnerability for emotion dysregulation, promoting addictive behaviors to regulate distress. Smoking can be an unhealthy regulating strategy to reduce the distress related to chronic exposure to psychological IPV. Future effective health promotion interventions in women facing severe forms of IPV may target emotional regulation and incorporate a trauma-focused approach.

A psychometric evaluation of the PTSD Checklist for DSM-5 among women experiencing intimate partner violence.

Recent national estimates suggest that 1 in 2 women will experience intimate partner violence (IPV) in their lifetime. Given the high prevalence of posttraumatic stress disorder (PTSD) among women experiencing IPV, it is necessary to consider whether PTSD assessments function adequately for this population. Thus, the present study aimed to evaluate the psychometric properties of the past-month version of the PTSD Checklist for DSM-5 (PCL-5), one of the most widely used self-report measures of PTSD symptoms, in a sample of community women experiencing IPV. Participants were 158 women who had experienced IPV in the past 6 months (Mage = 40.14 years, 39.9% White). The PCL-5 demonstrated good internal consistency, Cronbach's α =.97, and scores were significantly positively correlated with theoretically related constructs (i.e., PTSD symptom count on the SCID-5, IPV severity, substance use, depression, anxiety, and emotion dysregulation); however, it demonstrated poor 30-day stability, r =.38, ICC =.55. The ability of the PCL-5 to discriminate with respect to a PTSD diagnosis was acceptable, AUC =.74. A cutoff score of 21 maximized sensitivity (82.5%) and specificity (55.4%); this is lower than typical cutoffs (i.e., 31-33). Although the PCL-5 has generally demonstrated adequate psychometric properties, findings suggest that it does not function optimally for women experiencing IPV relative to its functioning for other trauma-exposed populations. The lower-than-typical cutoff suggests that the PCL-5 may underestimate PTSD prevalence among women experiencing IPV.

Prevalence and severity of physical intimate partner violence during pregnancy among adolescents in eight sub-Saharan Africa countries: A cross-sectional study.

Globally, intimate partner violence (IPV) is highly prevalent, with adolescents being particularly vulnerable, especially during pregnancy. This study examines the prevalence and severity of physical IPV among pregnant adolescents in sub-Saharan Africa (SSA). We analyzed data from Demographic Health Surveys collected between 2017-2021 from eight SSA countries, involving 2,289 ever-pregnant adolescents aged 15-19. Physical IPV during pregnancy was defined as experiencing physical harm while pregnant by a husband, former partner, current boyfriend, or former boyfriend. Severity of physical IPV included experiences such as kicking, choking, weapon threats, and serious injuries. Logistic regression analysis was conducted, with results presented as unadjusted and adjusted odds ratios with 95% confidence intervals. The prevalence of physical IPV during pregnancy among adolescents in the eight SSA countries ranged from 2.9% to 12.6%, with 5.6% experiencing severe lifetime physical IPV and 6.3% severe physical injuries. We found a strong association between physical IPV during pregnancy and severe lifetime physical IPV (aOR: 6.8, 95% CI: 4.5-10.4) and severe injuries (aOR: 9.2, 95% CI: 6.0-14.2), even after adjusting for covariates. Physical IPV during pregnancy is common among adolescents in SSA and is associated with severe physical lifetime IPV. Addressing this issue in low-resource settings requires collaborative efforts among community stakeholders, health system practitioners, and policymakers to protect vulnerable adolescent girls during pregnancy.

Anxiety, Depression, and Comorbid Symptomatology: Different Forms and Severity of Intimate Partner Violence Perpetrated by Men Seeking Help.

Intimate partner violence (IPV) is a serious public health issue associated with numerous deleterious outcomes. Previous studies highlighted the relevance of documenting psychological predictors of IPV to identify prevention strategies. This study examined the links between anxious and depressive symptomatology and perpetrated physical, psychological, and sexual violence among 494 French-Canadian men seeking help for IPV-related difficulties. Differences in the frequency of perpetrated IPV were examined across four groups: (a) no anxious or depressive symptoms reaching a cutoff of high distress, (b) symptoms of anxiety, (c) symptoms of depression, and (d) comorbid symptoms. Results highlighted that men with comorbid symptoms perpetrated significantly more severe violent acts compared to the other groups. This study underscores the importance of targeting the reduction of psychological distress when treating men who perpetrated IPV.

Positive and Negative Gender Role Beliefs and Intimate Partner Violence.

An ethnically diverse sample of 384 male and female undergraduates was assessed for their gender role beliefs based on positive (family responsibility) vs. negative (male dominance and female submissiveness) aspects derived from Hispanic cultural traditions. Negative male and female gender role beliefs were significantly positively correlated with reported victimization by and perpetration of severe intimate partner violence (IPV) for both men and women. Positive male gender role beliefs were negatively correlated with reported victimization by and perpetration of IPV for both men and women, with women also providing some evidence that positive female gender role beliefs were associated with less IPV.

An Exploration of Type of Animal Abuse and Intimate Partner Violence

ABSTRACT Prior research has identified a relationship between animal abuse and intimate partner violence (IPV). However, there is a gap in the literature regarding the relationship between IPV and type of animal abused. From a sample of 851 participants, this study explored, using unadjusted odds ratios, the bivariate relationships between types of IPV victimization (e.g., psychological, physical, and severe IPV) and partners’ abuse of cats, dogs, small pets, and horses. The strongest association was between the partner’s abuse of cats and severe IPV victimization. The partner’s cat abuse was associated with a 1,232% increase in the likelihood of severe IPV for women and a 945% increase for men. Cat abuse and dog abuse were significantly associated with all types of IPV, abuse of small pets was associated with physical and severe IPV, and horse abuse was not significantly related to IPV. Additionally, this study examined the relationship between types of animal abuse (e.g., neglect, emotional abuse, threats, physical abuse, and severe physical abuse) for cats and dogs and IPV. Cat neglect was most strongly associated with severe IPV and increased the likelihood of it by approximately 3,700%. Dog neglect increased the likelihood of severe IPV by approximately 1,600%. Results from the study indicate that there are differences between type of animal abused in relationship to IPV and highlights the need for future research to examine types of animal abuse separately.

The association between emotional and physical intimate partner violence and COVID-19 vaccine uptake in a community-based U.S. Cohort

ObjectiveTo estimate risk of being unvaccinated against COVID-19 by experience of intimate partner violence (IPV). MethodsAmong 3,343 partnered individuals in a community-based U.S. cohort, we quantified emotional and physical IPV experienced between March and December 2020 and estimated risk of being unvaccinated against COVID-19 through June 2021 by experience of IPV. Experience of recent IPV was defined as endorsement of more frequent or severe IPV since the start of the pandemic or report of any past-month IPV in at least one of four follow-up surveys conducted by the end of December 2020. We created a three-level composite variable – no experience of IPV, experience of emotional but not physical IPV, and experience of physical IPV. ResultsCisgender women, non-binary, or transgender individuals who reported experiencing emotional, but not physical, IPV and those who reported experiencing physical IPV were both at significantly higher risk of being unvaccinated for COVID-19 compared to those who reported experiencing no IPV (ARRemotional violence: 1.28 [95 % CI: 1.09 – 1.51]; ARRphysical violence: 1.70 [95 % CI: 1.41 – 2.05]). Cisgender men who reported experiencing physical IPV were also at significantly higher risk of being unvaccinated for COVID-19 (ARRphysical violence: 1.52 [95 % CI: 1.15 – 2.02]). ConclusionsIPV may increase the risk of low vaccine uptake. Results highlight the need to incorporate IPV prevention and support into public health responses, with targeted resources and consideration for reducing barriers to public health interventions among those impacted.

Considerations in cultural adaptation of parent-child interventions for African American mothers and children exposed to intimate partner violence.

African American women are at disproportionate risk of experiencing intimate partner violence (IPV) and consistently report more severe and recurrent IPV victimization in comparison to their White and Hispanic counterparts. IPV is more likely to occur in families with children than in couples without children. Parenting in the wake of IPV is a challenging reality faced by many African American women in the United States. Despite the urgent need to support mothers who have survived IPV, there is currently no culturally adapted parenting intervention for African American mothers following exposure to IPV. The aim of this review is to summarize and integrate two disparate literatures, hitherto unintegrated; namely the literature base on parenting interventions for women and children exposed to IPV and the literature base on parenting interventions through the lens of African American racial and cultural factors. Our review identified 7 questions that researchers may consider in adapting IPV parenting interventions for African American women and children. These questions are discussed as a possible roadmap for the adaptation of more culturally sensitive IPV parenting programs.

Empowerment Moderates the Relationship Between Partner Abuse and Suicidal Ideation for Immigrant Women.

Research shows strong associations between intimate partner violence (IPV) among women and suicidal ideation but this topic is understudied among immigrant women in abusive relationships in the United States. Empowerment may play a significant role in protecting abused immigrant women from suicidal ideation but has not been studied with quantitative data. The current study used convenience sampling. Immigrant women who experienced IPV were asked about IPV severity, empowerment, and where they were born. Bivariate associations among variables were assessed; empowerment was tested as a moderator of the relationship between IPV and suicidal ideation. The sample comprised 293 immigrant women, with 62.8% reporting suicidal ideation with a significantly greater proportion of women from South America than elsewhere reporting suicidal ideation. Empowerment buffered the effect of IPV on suicidal ideation. Prevalence of suicidal ideation among immigrant women experiencing IPV is concerning. Severity of IPV, region of the world where women were born, and empowerment were all related to suicidal ideation, showing directions for future research. Empowerment nursing interventions are needed to address IPV and resulting mental health problems among immigrant women. [Journal of Psychosocial Nursing and Mental Health Services, 62(9), 19-28.].

Examining strength at home couples to prevent intimate partner violence on a military installation: A randomized controlled trial.

In this study, the effectiveness of a couples-based group intervention to prevent intimate partner violence (IPV), Strength at Home Couples (SAH-C), was examined on a military installation relative to a comparison intervention, Supportive Prevention (SP). It was expected that greater reductions in use of physical, psychological, and sexual IPV behaviors, as well as reduced suicidality, would be found among service members and their partners in SAH-C relative to SP. Participants included 138 couples randomized to SAH-C and SP through a clinical controlled trial embedded in a hybrid effectiveness implementation study which took place on a military installation. The Revised Conflict Tactics Scales and Multidimensional Measure of Emotional Abuse were used to measure IPV, and 13 Military Suicide Research Consortium common data elements were used to assess suicidality. Service members randomized to SAH-C evidenced greater reductions based on effect sizes across the assessment time points for all IPV variables, including use of overall physical IPV, severe physical IPV, sexual IPV, psychological IPV, and coercive control IPV relative to those randomized to SP. Partners of service members demonstrated a similar general pattern for reductions in use of IPV, but findings were not as robust as for service members. Both service members and partners demonstrated greater reductions in suicidality based on effect sizes when randomized to SAH-C relative to SP. Findings extend prior work demonstrating the promising effects of SAH-C delivered in the military context and highlight the possible benefits of SAH-C in preventing self-harm thoughts and behaviors. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Profiles of Intimate Partner Violence and Their Differential Association With Gender Hostility Among Men Seeking Help

Intimate partner violence (IPV) perpetrated by men has been associated with men’s hostility toward women (HTW). However, no study that has examined HTW has considered every main form of IPV as well as the severity of the acts perpetrated. The purpose of the present study was to identify distinct profiles of IPV perpetration based on the severity of physical, psychological, and sexual IPV and coercive control acts and to examine potential differences in HTW between the resulting profiles in a sample of 969 men seeking help for anger management or domestic violence. In addition, given the association previously found between HTW and IPV perpetration in women, we also investigated whether hostility toward men (HTM) could also be linked to men’s profiles of IPV perpetration. The results of the latent profile analysis suggested four profiles of IPV perpetrators: minor psychological IPV and severe control, severe IPV and control, minor IPV and control, and no/minor psychological IPV. Results also indicated significant differences between the profiles in terms of both HTW and HTM. Specifically, greater HTW was observed among the profiles characterized by the highest proportion of physical IPV perpetration, whereas greater HTM was observed among the profiles characterized by the highest proportions of severe coercive IPV. Findings will contribute to guide intervention strategies tailored to these different subgroups of men.

The Neurobehavioral Symptom Inventory: Psychometric Properties and Symptom Comparisons in Women With and Without Brain Injuries Due to Intimate Partner Violence.

This study psychometrically evaluated the Neurobehavioral Symptom Inventory (NSI) among women survivors of intimate partner violence (IPV) and compared symptoms between women with no brain injury history (n = 93) and women with IPV-related brain injury history (n = 112). Women completed the NSI and questionnaires on traumatic brain injury (TBI), hypoxic-ischemic brain injury (HI-BI), and lifetime IPV history. A four-factor NSI model, including affective, somatosensory, cognitive, and vestibular factors, had the best fit (comparative fit index = 0.970, root mean square error of approximation = 0.064), with strong reliability for the total score (ω = .93) and subscale scores (ω range = .72-.89). In group comparisons, women with IPV-related brain injuries reported greater total, affective, and cognitive symptom severity after adjusting for age and education; however, no group differences were observed after adjusting for IPV severity. When examining lifetime number of brain injuries, HI-BI count was independently predictive of total, cognitive, and vestibular symptom severity after adjusting for age, education, and IPV severity; whereas TBI count did not independently predict any NSI scores after adjusting for these covariates. The NSI had acceptable psychometric properties for measuring neurobehavioral symptoms among women survivors of IPV. The association between HI-BI count and cognitive and vestibular symptoms may indicate the importance of studying repetitive nonfatal strangulation as an injury mechanism in this population.

Intimate Partner Violence and Formal Help-Seeking in Spain: Comparing Experiences of Spanish and Immigrant Women

In Spain, 17.23% of the population is immigrant. In Madrid area, it rises to 20.96%, being Latin American and Romanian origin the most prevalent. Data indicate that intimate partner violence (IPV) is higher in immigrant than in Spanish women, although they seem to make less use of specialized services. This study aims to identify the characteristics of knowledge and use of specialized IPV services and related variables between Spanish, Romanian, and Latin American women with lifetime IPV in Spain. An anonymous, self-administered survey was applied to a stratified sample of residents aged over 16 in Coslada (Madrid, Spain), where there is a large immigrant population (18.78%). Data from 280 women showed higher recognized lifetime IPV for immigrants (62.1%) than for natives (48%) (p < .05). However, not even half (48.7%) of them used any of the services assessed (without significant differences by origin); Romanians showed more judicialized processes. Use of services was related to having children or IPV severity, among other variables. Results point out the need to consider the influence of the context of immigrant women on their help-seeking behavior and increase awareness and training among professionals. Further research is required about the specific needs of women from different countries.

The Exosystem Impact: An Analysis of Male- and Female Physical Intimate Partner Violence Victimization in Heterosexual Relationships.

An increasing body of sociological research explores the complexity of intimate partner violence (IPV) in heterosexual relationships. However, early research in this area concentrated exclusively on male perpetration, thereby necessitating a better understanding of the contexts behind female-perpetrated and bidirectional IPV. Using the two most recent cycles of the Canadian General Social Survey (2014 and 2019), our study employs a multinomial logistic regression model to examine the prevalence and severity of female and male physical IPV victimization among a large sample of married and common-law heterosexual couples. Framing our analysis through one concentric level of Dutton's (1990) nested ecological model, the exosystem, we aim to understand whether these indicators serve as protective markers against severe and nonsevere physical IPV. We investigate the impact of eight exosystem indicators (financial stress, number of children, length of relationship, religiosity, employment, social support, education, and income). Our findings suggest that social support, employment, and household income serve as protective markers against male and female physical IPV victimization. Other protective factors include the length of the relationship and the partner's religiosity for female-perpetrated violence. At the same time, the presence of children in the household reduces the likelihood of male-perpetrated IPV despite being a risk marker for female perpetration. Risk factors for both men and women include education and their partner's employment. Future research should undertake a more in-depth exploration of the impact of exosystem and macrosystem factors on instances of IPV to generate a better understanding of predictive and preventative measures.

Mental Health Conditions and Utilisation of Mental Health Services by Survivors of Physical Intimate Partner Violence in Portugal: Results from the WHO World Mental Health Survey

The aim of this article is to study mental health conditions among survivors of severe physical intimate partner violence (IPV) and their utilisation of mental health services. This study is an integrated part of the World Mental Health Survey Initiative-Portugal, for which data was collected from a nationally representative adult sample using well-validated scales. Logistic regression models were used in the analysis. The most common statistically significant mental health conditions among IPV survivors were suicide ideation, PTSD, major depressive episode, and generalised anxiety disorder. More than one in three survivors developed PTSD. Suicide ideation was likely to occur after first experiencing IPV. Almost a half of survivors received specialised mental health treatment; in most cases, delivered by a psychiatrist. Over 60% addressed their mental health issues consulting general physicians or other healthcare professionals. Those who experienced family violence in childhood had greater odds of also experiencing IPV; survivors of IPV with this experience were more likely to receive mental health treatment. The need to promote greater awareness and competencies of not only mental health professionals but also of general physicians and other healthcare professionals to provide support more effectively to survivors of any type of IPV deserves to be emphasised.

Risk for Severe Intimate Partner Violence in Nairobi's Informal Settlements: Tailoring the Danger Assessment to Kenya.

Understanding the risk for severe intimate partner violence (IPV) can help women and providers assess danger. The validated, widely used Danger Assessment (DA) developed for this purpose has not been tested in a low- and middle-income country (LMIC). We tailored the DA to Nairobi, Kenya, and prospectively evaluated baseline danger against severe IPV at 3-month follow-up. We used data from the myPlan Kenya trial conducted in 3 informal settlements in Nairobi, Kenya, from 2017 to 2018. DA items were refined through formative and pilot phases, yielding minor wording modifications. Quantitative analyses prospectively evaluated baseline DA against severe IPV at 3-month follow-up to understand the predictive effect of the (1) original 20-item DA, (2) 16-item Kenya-DA (highest relative risk ratios [RRR] with severe IPV), and (3) 16-item Kenya-DA weighted (weighting based on strength of RRRs). Diagnostic criteria, including C-statistics, sensitivity, specificity, receiver operating characteristic curve, and area under the curve, were examined; logistic regressions quantified the odds of each metric predicting severe IPV at follow-up. The original 20-item DA produced the highest specificity (75.41%) and lowest sensitivity (57.14%), resulting in the overall lowest C-statistic. Compared to the 16-item Kenya-DA, the Kenya-DA weighted produced slightly higher sensitivity (66.67% vs. 64.29%) and specificity (77.05% vs. 72.13%), resulting in the highest C-statistic (0.78 vs. 0.75). All versions successfully predicted severe IPV at 3-month follow-up (original DA: odds ratio [OR]=1.26, 95% confidence interval [CI]=1.12, 1.41, P<.001; Kenya-DA: OR=1.33, 95% CI=1.16, 1.53, P<.001; Kenya-DA weighted: OR=1.19, 95% CI=1.10, 1.28, P<.001). Several factors identified as homicide risk factors in other settings were not prospectively associated with severe IPV. Within a high-danger LMIC context, all 3 DA configurations performed well diagnostically. We recommend the 16-item Kenya-DA given the value for simplicity and field implementation, whereas the Kenya-DA weighted can add accuracy for research purposes.