Representative Community Sample Research Articles

Why do eating disorders and obsessive–compulsive disorder co-occur?

The purpose of this study was to use an alternative, dimensionally based approach to understanding the reasons for comorbidity between eating disorders and obsessive–compulsive disorder. Participants from a representative community sample (N=407; 47% female) completed self-report measures of eating pathology, obsessive–compulsive symptoms, perfectionism, and neuroticism. Hierarchical multiple regression indicated that neuroticism and perfectionism completely mediated associations between most obsessive–compulsive and eating disorder symptoms. However, body dissatisfaction shared unique associations with checking, cleaning, and obsessive rituals that could not be explained by these personality traits. Results suggest that shared personality traits play a key role in the comorbidity between eating disorders characterized by binge eating and dietary restraint and obsessive–compulsive disorder. Future studies are needed to examine whether similar underlying neurocognitive processes that give rise to compulsive checking, cleaning, and obsessive rituals may also contribute to the development and maintenance of body checking in individuals diagnosed with eating disorders.

Three mutually informative ways to understand the genetic relationships among behavioral disinhibition, alcohol use, drug use, nicotine use/dependence, and their co-occurrence: twin biometry, GCTA, and genome-wide scoring.

Behavioral disinhibition is a trait hypothesized to represent a general vulnerability to the development of substance use disorders. We used a large community-representative sample (N = 7,188) to investigate the genetic and environmental relationships among measures of behavioral disinhibition, Nicotine Use/Dependence, Alcohol Consumption, Alcohol Dependence, and Drug Use. First, using a subsample of twins (N = 2,877), we used standard twin models to estimate the additive genetic, shared environmental, and non-shared environmental contributions to these five traits. Heritabilities ranged from .42 to .58 and shared environmental effects ranged from .12 to .24. Phenotypic correlations among the five traits were largely attributable to shared genetic effects. Second, we used Genome-wide Complex Trait Analysis (GCTA) to estimate as a random effect the aggregate genetic effect attributable to 515,384 common SNPs. The aggregated SNPs explained 10-30 % of the variance in the traits. Third, a genome-wide scoring approach summed the actual SNPs, creating a SNP-based genetic risk score for each individual. After tenfold internal cross-validation, the SNP sumscore correlated with the traits at .03 to .07 (p < .05), indicating small but detectable effects. SNP sumscores generated on one trait correlated at approximately the same magnitude with other traits, indicating detectable pleiotropic effects among these traits. Behavioral disinhibition thus shares genetic etiology with measures of substance use, and this relationship is detectable at the level of measured genomic variation.

Non-suicidal self-injury and suicidal behavior: prevalence, co-occurrence, and correlates of suicide among adolescents in Hong Kong

Despite increasing concern over the prevalence of non-suicidal self-injury (NSSI) among adolescents, there is debate about its classification as a stand-alone psychiatric diagnosis. This study investigated the patterns, co-occurrence, and correlates of NSSI and other suicidal behaviors among a representative community sample of in-school adolescents. A cross-sectional survey of 2,317 adolescents was conducted. Participants were asked to self-report NSSI, suicidal ideation, suicide attempt, and psychosocial conditions over the past 12months. Logistic regression and cumulative logit modeling analyses were conducted to investigate the different and similar correlates among these self-harm behaviors. The age-standardized prevalence rates of NSSI among male and female adolescents were estimated to be 13.4 and 19.7%, respectively, compared with 11.1 and 10.1% for male and female suicide attempt. Only a small proportion engaged in NSSI exclusively in the past year. NSSI by burning or reckless and risky behaviors, frequent drinking, and sexual experience were associated with increasing severity level of suicidal behaviors among individuals with NSSI. NSSI is prevalent among in-school adolescents in Hong Kong. However, it co-occurs with suicidal ideation and suicide attempt. High lethality of NSSI, frequent drinking habit, and lifetime sexual experience are suggested to be indicators for screening potential suicide attempters among those having NSSI.

Is the cluster risk model of parental adversities better than the cumulative risk model as an indicator of childhood physical abuse?: findings from two representative community surveys

Screening strategies for childhood physical abuse (CPA) need to be improved in order to identify those most at risk. This study uses two regionally representative community samples to examine whether a cluster or cumulative model of risk indicators (i.e. parental divorce, parental unemployment, and parental addictions) explains a larger proportion of the variation in CPA. Data were drawn from Statistics Canada's National Population Health Survey (1994-1995) and Canadian Community Health Survey 3.1 (2005). Response rates were greater than 80% in both samples. Each survey had approximately 13,000 respondents aged 18 and over who answered questions about the above adverse childhood experiences. A gradient was shown with similar outcomes in each data set. Only 3.4% of adults who experienced none of the three risk indicators reported they had been physically abused during childhood or adolescence. The prevalence of CPA was greater among those who experienced parental divorce alone (8.3%-10.7%), parental unemployment alone (8.9%-9.7%) or parental addictions alone (18.0%-19.5%). When all three risk indicators were present, the prevalence of CPA ranged from 36.0%-41.0% and the age-sex-race adjusted odds were greater than 15 times that of individuals with none of the three risk indicators. The cluster model explained a statistically significantly larger proportion of the variation than the cumulative model although the difference between the two models was modest. For the purposes of parsimony, the cumulative model may be the better alternative. Adults who were exposed to two or more childhood risk indicators were much more likely to report that they were physically abused during their childhood than those with only one or no risk factors. Medical professionals may use this information on cumulative risk factors to more effectively target screening for potential CPA. Future research should include prospective studies.

The association between self‐reported daily hassles and cortisol levels in depression and anxiety in community living older adults

The aim of this study was to assess whether the association, in a naturalistic setting, between daily hassles and diurnal salivary cortisol differs in the presence of depression and anxiety in older adults. Data were assessed in a large representative community sample of older adults (n = 1760). A multinomial analysis was used to study as an outcome variable: no disorder, depression only, anxiety only and depression and anxiety, as a function of daily hassles and cortisol levels controlling for age, gender and time of saliva collection. Multivariate regression analyses were also carried out to test the association between daily hassles and cortisol levels stratified by depression and anxiety status. A significant positive association was observed between the number of daily hassles reported and cortisol levels in participants with no depression and no anxiety and in participants with anxiety. Participants without depression and anxiety, and those with depression only, had significant lower cortisol levels later in the day. This was not observed in respondents with anxiety. Stressors such as daily hassles are associated with cortisol secretion in depression and anxiety in older adults in a large epidemiologic setting.

Quality of life in patients with muscle invasive and non-muscle invasive bladder cancer

Compared to the literature on other malignancies, data on quality of life (QoL) in bladder cancer are sparse. This study sought answers to the following questions: In what QoL domains do patients with bladder cancer differ from the general population? Do patients with radical cystectomy differ in QoL compared to those who received conservative treatment? Do patients with neobladder generally have better QoL compared to patients with other diversion methods? At the beginning of inpatient rehabilitation, N = 823 patients with bladder cancer were assessed. Data of a representative community sample (N = 2037) were used for comparison. The questionnaire EORTC QLQ-C30 was used to measure QoL. Multivariate linear regression models were computed to investigate differences between groups. Patients with both non-muscle invasive and muscle invasive bladder cancer reported significantly more problems and worse functioning than the general population. Radiotherapy is associated with clinically relevant more pain, dyspnoea, constipation, appetite loss and decreased social functioning while chemotherapy is associated more with dyspnoea. Cystectomy patients reported more fatigue, appetite loss and decreased role functioning. Male patients ≥70 years with conduit experienced more sleep and emotional problems. These effects of urinary diversion were not observed in women and younger patients. Patients with bladder cancer experience various QoL concerns at the beginning of inpatient rehabilitation. These problems can partly be explained by the type of treatment the patients receive. Type of urinary diversion is relevant for QoL in subgroups of patients.

Personality disorder symptoms are differentially related to divorce frequency.

Divorce is associated with a multitude of outcomes related to health and well-being. Data from a representative community sample (N = 1,241) of St. Louis residents (ages 55-64) were used to examine associations between personality pathology and divorce in late midlife. Symptoms of the 10 DSM-IV personality disorders were assessed with the Structured Interview for DSM-IV Personality and the Multisource Assessment of Personality Pathology (both self and informant versions). Multiple regression analyses showed Paranoid and Histrionic personality disorder symptoms to be consistently and positively associated with number of divorces across all three sources of personality assessment. Conversely, Avoidant personality disorder symptoms were negatively associated with number of divorces. The present paper provides new information about the relationship between divorce and personality pathology at a developmental stage that is understudied in both domains.

Importance for forest plant communities of refuges protecting from deer browsing

There is growing evidence that the increase of wild ungulates worldwide is responsible of strong deleterious impacts on various component of forest biodiversity (tree and shrub regeneration, insects, songbirds). Plant communities are particularly affected by overbrowsing, and overabundant deer are increasingly recognized as a major factor of decline in understory plant diversity in temperate and boreal forest ecosystems.In grassland ecosystems, refuges from herbivores have been shown to provide suitable habitat for plants sensitive to browsing and grazing, and to allow the conservation of rare plant species. In the present study we analyze if such refuges can maintain representative samples of forest plant communities exposed to strong browsing pressure by deer. For this we used the unique situation offered by the presence, side by side, on the Haida Gwaii archipelago of forested islands colonized or not by introduced deer.We compared plant assemblages on rocky outcrop to assemblages found in the adjacent field-layer in order (1) to assess, on islands without deer, the potential of refuges to be representative of the local field-layer communities and (2), on islands colonized by deer for over 60years, to analyze how far plant assemblages on rocky outcrops are representative of un-browsed field-layer communities and can serve as bioassays for field-layer plant communities in the absence of unbrowsed reference sites. We did this for forest-interior field-layer plant communities as well as for the forest edge plant communities found along the shorelines. We used refuges on treefall mounds to assess the role refuges can play as sources of propagules in two understory shrubs and ferns.Our results indicate that, in presence of deer, plant species density and plant cover are dramatically higher in refuges than in the adjacent field-layer plots. The comparison of these refuge communities to the reference state provided by the field-layer on islands without deer indicated that refuges maintain a representative part of the unbrowsed plant community, although with differences in the cover percentage in some plants. Some typical plants are more abundant in the refuges and, more sobering, six field-layer species are only poorly present in the rocky habitat. Despite these differences and their small size, refuges shelter a representative part of the understory and forest edge vegetation of the studied sites and could serve as a bioassay of deer overbrowsing in situations lacking a reference state.

Perceptions of the use of indigenous leaves as packaging materials in the ready-to-eat cornmeals

Although alternative food packaging materials are available, Ghanaians still use leaves to package some ready-to-eat cornmeal products. This study examines the perceptions of a representative community sample of 70 producers, 40 sellers and 120 consumers of ready-to-eat leaves-packaged cornmeal products in Kumasi using questionnaires. Fante Kenkey (packaged in dried leaves of either musa paradisiaca or sterculia tragacanta) and Ga kenkey (packaged in dried sheaths of zea mays) are the most preferred products, accounting together for 80% of all leaves-packaged cornmeals processed by producers, for 76% of products offered by sellers and for 96% of products purchased by consumers. Reasons producers cited for the continued utilization of leaves as packaging materials include medicinal via the infusion of the cornmeal with beneficial phytonutrients that also imparts distinctive aroma and taste (61%), environmental friendliness (17%), availability (4%), relatively low cost (4%), lack of toxicity and renewability (14%). Despite consumers concerns of unhygienic (7%), short shelf lives (18%) and loss of moisture leading to hardening of Ga Kenkey (60%), 87% of consumers declined a suggestion for use of alternative packaging materials for ready-to-eat cornmeals. Data provided by this study can be used to examine food packaging trends for research and policy analyses in Ghana. Keywords : Kenkey, musa paradisiaca, sterculia tragacanta, zea mays, phytochemical, leaf-package

Community variation in adolescent alcohol use in Australia and the Netherlands

To investigate the cross-national relevance of community health promotion, this paper compared community variation in alcohol use and risk and protective factors for adolescents in Australia (State of Victoria, 2009) and the Netherlands (2007/2008). Multi-level analyses examined community variation in heavy episodic (binge) alcohol use [≥5 drinks in a session ≥once in the prior fortnight (>63 ml of ethanol)] and associations with predictors. Representative community samples of adolescents (12-17 years) were recruited. The participants were 7812 students from 36 Australian communities and 15 082 adolescents from 124 Dutch communities. Predictors included adolescent reports of family, school, peer and neighbourhood environments and community predictors (rural, disadvantage). The overall prevalence of alcohol use prevalence was similar in both nations. Australia had higher use at younger ages and no difference between genders. In the Netherlands older adolescents and males used alcohol at significantly higher rates. Although individual predictors were mostly similar, binge drinking was more strongly associated with poor family management, friends' use of drugs and community disorganization in Australia. Significant community variation in adolescent heavy alcohol use was observed in both countries, but was higher in the Netherlands [inter class correlation 6.1%, (95% CI: 4.5-8.3%)] than Australia (ICC 2.4%, 1.3-4.5%). Youth from rural areas drank at a higher level, especially in the Netherlands. Targeting community level adolescent alcohol use appears feasible in both countries. Although behavioural patterns and risk and protective influences are similar in the Netherlands and Australia, important differences should be taken into account in tailoring community interventions.

Willingness to participate in HIV vaccine efficacy trials in a population of fishing communities, Uganda

Background With a number of preventive HIV vaccine candidates under pre-clinical and early-phase human studies, it is critical to intensify efforts to identify and prepare populations for potential efficacy trials. Willingness to participate (WTP) in HIV vaccine trials in most at risk populations for HIV infection is unknown especially in Sub-Saharan Africa. We assessed WTP in a potential HIV-1 vaccine efficacy trial population of fishing communities in Uganda. Methods A community-representative random sample of 2,200 individuals, 18-49 years was selected at baseline from 8 fishing communities around Lake Victoria. After consent, data on HIV risk behaviors and WTP in future HIV vaccine trials were collected using a semi-structured questionnaire; venous blood was collected for HIV serology using rapid HIV tests as per the Uganda National algorithm. Results Fifty percent of respondents were females and a majority (91%) had attained some level of education. Almost all respondents, 89% (1,953/2,192) expressed WTP in future HIV vaccine trials. Males were more willing to participate than females (p<0.01). WTP was associated with awareness of ongoing HIV vaccine research (p<0.01). Unwillingness to participate was attributed mainly to perceived fear of side effects (42%) and fear that the study vaccine may cause HIV/AIDS (26.3%). The overall HIV prevalence was 26.7%, lower among those who responded positively to WTP (26.8%) than those who did not (27.7%). Conclusion WTP in HIV vaccine trials in this population is high but extensive education on HIV vaccine safety particularly on vaccine induced side effects and false positivity will be required in preparation for these trials. Because of the high HIV prevalence, this population should be targeted for future HIV vaccine trials.

The Longitudinal Prediction of Alcohol Consumption-Related Harms Among Young Adults

This study explores the longitudinal pathways by which risk and protective factors influence the development of alcohol-related harms in a representative community sample of 941 young adults (19–20 years) from Victoria, Australia, focusing on the role of concurrent risky drinking. Impulsivity at 15–16 years, alcohol-related harms at 15–16 years and 17–18 years, frequency of intoxication at 17–18 years, and antisocial behavior, friends’ drinking and living arrangements at 19–20 years were directly related to alcohol-related harms, as well as indirectly related to harms through increased risky drinking. Paternal drinking at 17–18 years was directly related to alcohol-related harms. Friends’ drinking at 19–20 years and alcohol-related harms at age 17–18 interacted with risky drinking to increase the likelihood of alcohol-related harms. Implications for intervention efforts are discussed.

The impact of depression on self-care activities and health care utilization among people with diabetes in Taiwan

Using cross-sectional analyses of a nationally representative community sample (n=1260), we found that in people with diabetes, depression was associated with lower rates of reducing or quitting smoking and alcohol, less exercise, less regular lifestyle, but more health care utilization and a higher rate of foot care.

Psychosocial adversities at work are associated with poorer quality marriage-like relationships

The characteristics of work have an impact on individuals’ personal lives, including on health and close personal relationships. Previous research into the negative spillover effects from work to marital quality has predominantly examined structural job characteristics, such as job hours and shift work. This study used data from a large representative community sample of midlife (aged 40–44 at baseline) employed persons in marriage-like relationships (n = 2,054) to investigate the relationship between psychosocial job characteristics and relationship quality. Data from three waves of the Personality and Total Health (PATH) Through Life Survey were analysed. The results show that all psychosocial job adversities (high job demands, low job control, and job insecurity) were independently associated with lower levels of positive support from partners for both men and women. In addition, there was a linear relationship between the number of psychosocial adversities reported and lower levels of positive support from partners. These findings are relevant to policy makers in the areas of employment and family services. They identify the potential broader social costs of adverse psychosocial characteristics at work. This study sets the scene for further longitudinal research to examine the causal links between psychosocial job quality and relationship quality.

The impact of age and BMI on impairment due to disordered eating in a large female community sample

The impact of age and BMI on functional impairment in eating disorders was assessed by the Clinical Impairment Assessment (CIA) scale in a representative community sample. The CIA was administered to 1080 women aged 16–50years (M=36.2, SD=9.5) with a range of BMI from 13.5 to 55.0 (M=24.6, SD=4.9) randomly selected from the Norwegian National Population Register. The average global CIA score was 5.3 (SD=8.5). Impairment tended to decrease with age (rs=−.20, p<.01), yet increased with greater BMI (rs=.31, p<.01). Approximately 30% of the participants with obesity scored in the clinical range compared to 7% of the underweight and normal-weight participants. Data supported the utility and feasibility of the CIA as a measure of functional impairment secondary to weight, shape, and eating concerns. It is recommended that age and BMI be considered during the interpretation of CIA data.

The interplay of genes and adolescent development in substance use disorders: leveraging findings from GWAS meta-analyses to test developmental hypotheses about nicotine consumption.

The present study evaluated gene by development interaction in cigarettes smoked per day (CPD) in a longitudinal community-representative sample (N=3,231) of Caucasian twins measured at ages 14, 17, 20, and 24. Biometric heritability analyses show strong heritabilities and shared environmental influences, as well as cross-age genetic and shared environmental correlations. Single nucleotide polymorphisms (SNPs) previously associated with CPD according to meta-analysis were summed to create a SNP score. At best, the SNP score accounted for 1% of the variance in CPD. The results suggest developmental moderation with a larger significant SNP score effect on CPD at ages 20 and 24, and smaller non-significant effect at ages 14 and 17. These results are consistent with the notion that nicotine-specific genetic substance use risk is less important at younger ages, and becomes more important as individuals age into adulthood. In a complementary analysis, the same nicotine-relevant SNP score was unrelated to the frequency of alcohol use at ages 14, 17, 20, or 24. These results indicate that the SNP score is specific to nicotine in this small sample and that increased exposure to nicotine at ages 20 and 24 does not influence the extent of concurrent or later alcohol use. Increased sample sizes and replication or meta-analysis are necessary to confirm these results. The methods and results illustrate the importance and difficulty of considering developmental processes in understanding the interplay of genes and environment.

The power of habits: Unhealthy snacking behaviour is primarily predicted by habit strength

Although increasing evidence shows the importance of habits in explaining health behaviour, many studies still rely solely on predictors that emphasize the role of conscious intentions. The present study was designed to test the importance of habit strength in explaining unhealthy snacking behaviour in a large representative community sample (N= 1,103). To test our hypothesis that habits are crucial when explaining unhealthy snacking behaviour, their role was compared to the 'Power of Food', a related construct that addresses sensitivity to food cues in the environment. Moreover, the relation between Power of Food and unhealthy snacking habits was assessed. A prospective design was used to determine the impact of habits in relation to intention, Power of Food and a number of demographic variables. One month after filling out the questionnaire, including measures of habit strength and Power of Food, participants reported their unhealthy snacking behaviour by means of a 7-day snack diary. Results showed that habit strength was the most important predictor, outperforming all other variables in explaining unhealthy snack intake. The findings demonstrate that snacking habits provide a unique contribution in explaining unhealthy snacking behaviour, stressing the importance of addressing habit strength in further research and interventions concerning unhealthy snacking behaviour.

Evidence That Psychotic Symptoms Are Prevalent in Disorders of Anxiety and Depression, Impacting on Illness Onset, Risk, and Severity--Implications for Diagnosis and Ultra-High Risk Research

It is commonly assumed that there are clear lines of demarcation between anxiety and depressive disorders on the one hand and psychosis on the other. Recent evidence, however, suggests that this principle may be in need of updating. Depressive and/or anxiety disorders, with no previous history of psychotic disorder, were examined for the presence of psychotic symptoms in a representative community sample of adolescents and young adults (Early Developmental Stages of Psychopathology study; n = 3021). Associations and consequences of psychotic symptomatology in the course of these disorders were examined in terms of demographic distribution, illness severity, onset of service use, and risk factors. Around 27% of those with disorders of anxiety and depression displayed one or more psychotic symptoms, vs 14% in those without these disorders (OR 2.23, 95% CI 1.89-2.66, P < .001). Presence as compared with nonpresence of psychotic symptomatology was associated with younger age (P < .0001), male sex (P < .0058), and poorer illness course (P < .0002). In addition, there was greater persistence of schizotypal (P < .0001) and negative symptoms (P < .0170), more observable illness behavior (P < .0001), greater likelihood of service use (P < .0069), as well as more evidence of familial liability for mental illness (P < .0100), exposure to trauma (P < .0150), recent and more distant life events (P < .0006-.0244), cannabis use (P < .0009), and any drug use (P < .0008). Copresence of psychotic symptomatology in disorders of anxiety and depression is common and a functionally and etiologically highly relevant feature, reinforcing the view that psychopathology is represented by a network or overlapping and reciprocally impacting dimensional liabilities.

Availability of validated instruments for the study of religiousness in Brazilian samples

Brazil is a country of continental dimensions and its plural cultural matrix reflects on diverse religious practices. In fact, a population survey indicates that more than 80% of Brazilian people attribute an important meaning for religion2. Most studies clearly indicate that religiousness has an independent protector effect for physical and mental health3. The last two decades mark an explosion in studies addressing the relationships between religiousness and mental health4. Nevertheless, there is a predominance of investigations derived from North American samples (mainly Protestant)5. In Brazil, the study of the influence of religiousness on mental health is still in its infancy. Noteworthy, advances in this research field had been challenged by criticisms toward the scientific rigor and the actual validity of measuring religiousness3. Critics have argued that there is an extrapolation in the conclusion of many studies, where the protector effect of an aspect of religiousness are sometimes interpreted to mean the religion “in general” is positive3. The measurement of religiousness in health is a relatively recent scientific achievement which dates to pioneering investigations in the post-war5,6. King and Hunt early found that religiousness in a multidimensional construct6. Currently, there are over 100 instruments available to tap different religiousness dimension3. However, few instruments are validated for use in Brazilian samples. Lucchetti et al. developed the Duke Religiousness Index (DUREL), which is a brief instrument which measures three religiousness facets, namely: organizational religiousness (OR), non-organizational religiousness (NOR) and intrinsic religiousness (IR)7. The Brazilian Portuguese version of the DUREL (P-DUREL) was initially validated by Lucchetti et al. in a low-income community sample7. In this study, the P-DUREL had adequate internal consistency as well as convergent-discriminant validity. Posteriorly, our research group extended these observations and found adequate internal consistency, test-retest reliability and convergent-discriminant validity in a two different samples (i.e., university students and psychiatric outpatients)8. The study by Martinez et al.1. validated the P-DUREL in a sample of postgraduate students. These authors found psychometric properties similar to the study by Taunay et al. Altogether, these three validation studies provide support for the use of the P-DUREL for the study of religiousness in our milieu. Despite these initial efforts, there is a need for new advances in this research field. There is just another validated instrument for the study of religiousness in Brazilian sample, namely the Intrinsic Religiousness Inventory (IRI)9. There are other validated instruments which measure related constructs, such as the Spiritual Well-Being Scale10 and the Religious-Spiritual Coping scale11. Future studies should determine the psychometric properties of the P-DUREL in distinct samples (e.g., a more representative community sample and clinical samples). The development and validation of instruments to measure religiousness is crucial step for the advance of this research field. The Revista de Psiquiatria Clinica had published in the last few years several studies relating religiousness to mental health for a growing audience.

A Systematic Review of Risk Factors for Intimate Partner Violence.

A systematic review of risk factors for intimate partner violence was conducted. Inclusion criteria included publication in a peer-reviewed journal, a representative community sample or a clinical sample with a control-group comparison, a response rate of at least 50%, use of a physical or sexual violence outcome measure, and control of confounding factors in the analyses. A total of 228 articles were included (170 articles with adult and 58 with adolescent samples). Organized by levels of a dynamic developmental systems perspective, risk factors included: (a) contextual characteristics of partners (demographic, neighborhood, community and school factors), (b) developmental characteristics and behaviors of the partners (e.g., family, peer, psychological/behavioral, and cognitive factors), and (c) relationship influences and interactional patterns. Comparisons to a prior review highlight developments in the field in the past 10 years. Recommendations for intervention and policy along with future directions for intimate partner violence (IPV) risk factor research are presented.