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1.  Responding to the Need for Sleep among Survivors of Interpersonal Violence: A Randomized Controlled Trial of a Cognitive-Behavioral Insomnia Intervention followed by PTSD Treatment 
Contemporary clinical trials  2015;45(0 0):252-260.
Sleep disturbance is a common feature of posttraumatic stress disorder (PTSD), but is not a focus of standard PTSD treatments. Psychological trauma exposure is associated with considerable physical and mental health morbidity, possibly due to the alterations in neuroendocrine function and inflammation observed in trauma exposed individuals. Although PTSD treatments are efficacious, they are associated with high drop-out rates in clinical trials and clinical practice. Finally, individuals with PTSD stemming from exposure to interpersonal violence represent an especially under-treated population with significant sleep disturbance. Community-based participatory research was utilized to design and prepare a clinical trial that randomizes recent survivors of interpersonal violence who have PTSD, depression, and insomnia to receive either: (1) Cognitive Behavioral Therapy for Insomnia (CBTi) followed by Cognitive Processing Therapy (CPT) for trauma, or (2) attention control followed by CPT. Outcome measures include subjective and objective measures of sleep, clinician-administered PTSD and depression scales, inflammatory cytokines, and salivary cortisol. Assessments are conducted at baseline, following the sleep or control intervention, and again following CPT. The design allows for: (1) the first test of a sleep intervention in this population; (2) the comparison of sequenced CBTi and CPT to attention control followed by CPT, and (3) assessing the roles of neuroendocrine function, inflammatory processes, and objective sleep markers in mediating treatment outcomes. The study’s overarching hypothesis is that treating insomnia will produce reduction in insomnia, PTSD, and depression severity, allowing patients to more fully engage in, and derive optimal benefits from, cognitive processing therapy.
doi:10.1016/j.cct.2015.08.019
PMCID: PMC4675039  PMID: 26343743
sleep; insomnia; posttraumatic stress disorder; depression; interpersonal violence; cognitive-behavioral therapy; community-based participatory research
2.  The Prevalence of Distress and Depression among Women in Rural Sichuan Province 
PLoS ONE  2016;11(8):e0161097.
Background
In this paper, we report findings regarding the prevalence of expressed distress and depressive conditions among women living in a rural region of Sichuan Province. As well, we know of no data among women in rural China that examine whether “depression,” as categorically defined in classifications such as the DSM, adequately captures the expressed distress and symptomatic complaints of women in rural China.
Methods
A multistage sampling method was employed to recruit the target population. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to measure distress symptoms, and MINI International Neuropsychiatric Interview (MINI) was employed to determine the prevalence of diagnosable depression and other disorders.
Results
Among 1898 rural women, 12.4% (236) scored ≥16 on the CES-D, indicative of distress, and a subset of 7.7% (146) had scores ≥21, highly suggestive of a clinically significant disorder. We found that 49.8% women with ≥16 CES-D score were identified as showing features consistent with a current major depressive episode (MDE) vs. 1.9% in a sample of randomly selected women with <16 CES-D score. Among respondents, 30 of 84 (35.7%) scoring 16–20 and 83 of 143 (58.0%) scoring ≥21 reported symptoms consistent with MDE. 25.1% of women with a positive CES-D score did not describe symptoms consistent with any DSM-IV disorder.
Conclusions
We found a higher portion of women reporting significant distress than previously described. Among them, there was a clear gradient, such that 41.7% of women with moderate distress did not have a psychiatric diagnosis, and even among those with more severe symptoms, 15.4% did not manifest a DSM-specific psychiatric condition.
doi:10.1371/journal.pone.0161097
PMCID: PMC4985145  PMID: 27526182
3.  Facilitating Intimate Partner Violence Education among Pharmacy Students: What Do Future Pharmacists Want to Know? 
This paper describes the first step toward creating training tools to improve pharmacy students’ and pharmacists’ ability to identify intimate partner violence (IPV) among patients and facilitate referrals. The paper’s objectives are to evaluate an IPV didactic session adapted for pharmacy students and describe student quantitative and qualitative feedback on the session. Almost 90% of students believed IPV was relevant to their pharmacy careers and that the session improved their ability to recognize IPV. Twenty one percent believed they had encountered a patient they suspected was a victim of IPV. Legal and liability issues, course logistics, skill development, greater specificity and student engagement were themes that emerged. Greater specificity toward pharmacy was recommended to understand the intricacies of legal and professional responsibilities, patient and personal safety risks, and maintaining strong provider/patient relationships. To overcome barriers to screening, assessment and referral, students need opportunities to engage in role-playing and practical application of the knowledge gained.
doi:10.1016/j.cptl.2014.12.014
PMCID: PMC4415369  PMID: 25937853
intimate partner violence; pharmacy students; pharmacy education
4.  Finding the loopholes: a cross-sectional qualitative study of systemic barriers to treatment access for women drug court participants 
Health & justice  2015;3:12-.
Background
Therapeutic diversion courts seek to address justice-involved participants’ underlying problems leading to their legal system involvement, including substance use disorder, psychiatric illness, and intimate partner violence. The courts have not addressed systemic hurdles, which can contribute to a cycle of substance use disorder and recidivism, which in turn hinder health and wellness. The study purpose is to explore the systemic issues faced by women participants in drug treatment court from multiple perspectives to understand how these issues may relate to health and wellness in their lives.
Methods
Qualitative thematic framework analysis of five separate focus groups consisting of female drug treatment court participants, community providers, and court staff (n = 25). Themes were mapped across the socio-ecological framework and contextualized according to social determinants of health.
Results
Numerous systemic factors impacted women’s access to treatment. Laws and legal policies (governance) excluded those who could potentially have benefitted from therapeutic court and did not allow consideration of parenting issues. Macroeconomic policies limit housing options for those with convictions. Social policies limited transportation, education, and employment options. Public policies limited healthcare and social protection and ability to access available resources. Culture and societal values, including stigma, limited treatment options.
Conclusions
By understanding the social determinant of health for women in drug treatment court and stakeholder’s perceptions, the legal system can implement public policy to better address the health needs of women drug court participants.
doi:10.1186/s40352-015-0026-2
PMCID: PMC4607061  PMID: 26478853
Justice-involved women; Drug treatment court; Social determinants of health; And socio ecological model
5.  IMPROVING COORDINATED RESPONSES FOR VICTIMS OF INTIMATE PARTNER VIOLENCE: LAW ENFORCEMENT COMPLIANCE WITH STATE MANDATED INTIMATE PARTNER VIOLENCE DOCUMENTATION 
Violence against women  2015;21(7):897-907.
New York State law mandates specific IPV documentation under all circumstances meeting the enumerated relationship and crime criteria at the scene of a domestic dispute. Law enforcement compliance with this mandate is unknown. We reviewed law enforcement completion rates of Domestic Violence Incident Reports (DVIRs) and assessed correlations with individual or legal factors. Law enforcement officers filed DVIRs in 54% of the cases (n=191), more often when injury occurred (p<.01) and the defendant had prior court contact (p<.05). The discussion explores policy implications and potential means to rectify the gap between mandated processes and implementation.
doi:10.1177/1077801215584072
PMCID: PMC4629466  PMID: 25926052
Intimate Partner Violence; Abuse; Domestic Violence; Law Enforcement
6.  Finding the loopholes: a cross-sectional qualitative study of systemic barriers to treatment access for women drug court participants 
Health & Justice  2015;3:12.
Background
Therapeutic diversion courts seek to address justice-involved participants’ underlying problems leading to their legal system involvement, including substance use disorder, psychiatric illness, and intimate partner violence. The courts have not addressed systemic hurdles, which can contribute to a cycle of substance use disorder and recidivism, which in turn hinder health and wellness. The study purpose is to explore the systemic issues faced by women participants in drug treatment court from multiple perspectives to understand how these issues may relate to health and wellness in their lives.
Methods
Qualitative thematic framework analysis of five separate focus groups consisting of female drug treatment court participants, community providers, and court staff (n = 25). Themes were mapped across the socio-ecological framework and contextualized according to social determinants of health.
Results
Numerous systemic factors impacted women’s access to treatment. Laws and legal policies (governance) excluded those who could potentially have benefitted from therapeutic court and did not allow consideration of parenting issues. Macroeconomic policies limit housing options for those with convictions. Social policies limited transportation, education, and employment options. Public policies limited healthcare and social protection and ability to access available resources. Culture and societal values, including stigma, limited treatment options.
Conclusions
By understanding the social determinant of health for women in drug treatment court and stakeholder’s perceptions, the legal system can implement public policy to better address the health needs of women drug court participants.
doi:10.1186/s40352-015-0026-2
PMCID: PMC4607061  PMID: 26478853
Justice-involved women; Drug treatment court; Social determinants of health; And socio ecological model
7.  Depression, social support and associated factors among women living in rural China: a cross-sectional study 
BMC Women's Health  2015;15:28.
Background
Few studies have focused on depression and social support in Eastern populations, especially women in rural China. Our research investigated depression among women in rural China, and studied the relationships between social support and depression.
Methods
We recruited women ages 16 years and older from north Sichuan. Participants completed socio-demographic measures, the Center for Epidemiologic Studies Depression Scale, and the Duke Social Support Index. The analysis method included descriptive statistics and logistic regression.
Results
The final sample included 1,898 participants with a mean age of 48.6 years, and the prevalence of significant depressive symptoms was 12.4%. Results suggest being unemployed, having poorer perceived health/economic status, and lower social support were positively associated with depression. Younger age and greater social support were negatively associated with depression.
Conclusions
This study provides insights on the psychological health of women in rural China and potential directions for future research. These issues are especially pertinent during this time of rapid economic transformation and outmigration in rural China.
doi:10.1186/s12905-015-0180-7
PMCID: PMC4392745  PMID: 25879808
Depressive mood; Social support; Females in rural China; Mental health
9.  Does gender matter? Exploring mental health recovery court legal and health outcomes 
Health & justice  2014;2(1):12-.
Background
Based upon therapeutic justice principles, mental health courts use legal leverage to improve access and compliance to treatment for defendants who are mentally ill. Justice-involved women have a higher prevalence of mental illness than men, and it plays a greater role in their criminal behavior. Despite this, studies examining whether women respond differently than men to mental health courts are lacking. Study goals were to examine gender-related differences in mental health court participation, and in criminal justice, psychiatric and health-related outcomes.
Methods
This study utilized a quasi-experimental pre-posttest design without a control group. The data were abstracted from administrative records of Kalamazoo Community Mental Health and Substance Abuse agency, the county jail and both county hospitals, 2008 through 2011. Generalized estimating equation regression was used to assess gender-differences in pre-post program outcomes (jail days, psychiatric and medical hospitalization days, emergency department visits) for the 30 women and 63 men with a final mental health court disposition.
Results
Program-eligible females were more likely than males to become enrolled in mental health court. Otherwise they were similar on all measured program-participation characteristics: treatment compliance, WRAP participation and graduation rate.
All participants showed significant reductions in emergency department visits, but women-completers had significantly steeper drops than males: from 6.7 emergency department visits to 1.3 for women, and from 4.1 to 2.4 for men. A similar gender pattern emerged with medical-hospitalization-days: from 2.2 medical hospital days down to 0.1 for women, and from 0.9 days up to 1.8 for men. While women had fewer psychiatric hospitalization days than men regardless of program involvement (2.5 and 4.6, respectively), both genders experienced fewer days after MHRC compared to before. Women and men showed equal gains from successful program completion in reduced jail days.
Conclusions
Despite similar participation characteristics, findings point to greater health gains by female compared to male participants, and to lower overall psychiatric acuity. Mental-health-court participation was associated with decreased psychiatric hospitalization days and emergency department visits. Successful program completion correlated to fewer jail days for both women and men.
doi:10.1186/s40352-014-0012-0
PMCID: PMC4269165  PMID: 25530934
Mental health court; Gender and justice; Criminogenic factors; Healthcare utilization
10.  Does gender matter? Exploring mental health recovery court legal and health outcomes 
Health & Justice  2014;2:12.
Background
Based upon therapeutic justice principles, mental health courts use legal leverage to improve access and compliance to treatment for defendants who are mentally ill. Justice-involved women have a higher prevalence of mental illness than men, and it plays a greater role in their criminal behavior. Despite this, studies examining whether women respond differently than men to mental health courts are lacking. Study goals were to examine gender-related differences in mental health court participation, and in criminal justice, psychiatric and health-related outcomes.
Methods
This study utilized a quasi-experimental pre-posttest design without a control group. The data were abstracted from administrative records of Kalamazoo Community Mental Health and Substance Abuse agency, the county jail and both county hospitals, 2008 through 2011. Generalized estimating equation regression was used to assess gender-differences in pre-post program outcomes (jail days, psychiatric and medical hospitalization days, emergency department visits) for the 30 women and 63 men with a final mental health court disposition.
Results
Program-eligible females were more likely than males to become enrolled in mental health court. Otherwise they were similar on all measured program-participation characteristics: treatment compliance, WRAP participation and graduation rate.
All participants showed significant reductions in emergency department visits, but women-completers had significantly steeper drops than males: from 6.7 emergency department visits to 1.3 for women, and from 4.1 to 2.4 for men. A similar gender pattern emerged with medical-hospitalization-days: from 2.2 medical hospital days down to 0.1 for women, and from 0.9 days up to 1.8 for men. While women had fewer psychiatric hospitalization days than men regardless of program involvement (2.5 and 4.6, respectively), both genders experienced fewer days after MHRC compared to before. Women and men showed equal gains from successful program completion in reduced jail days.
Conclusions
Despite similar participation characteristics, findings point to greater health gains by female compared to male participants, and to lower overall psychiatric acuity. Mental-health-court participation was associated with decreased psychiatric hospitalization days and emergency department visits. Successful program completion correlated to fewer jail days for both women and men.
Electronic supplementary material
The online version of this article (doi:10.1186/s40352-014-0012-0) contains supplementary material, which is available to authorized users.
doi:10.1186/s40352-014-0012-0
PMCID: PMC4269165  PMID: 25530934
Mental health court; Gender and justice; Criminogenic factors; Healthcare utilization
11.  DEPRESSIVE AND POSTTRAUMATIC SYMPTOMS AMONG WOMEN SEEKING PROTECTION ORDERS AGAINST INTIMATE PARTNERS: RELATIONS TO COPING STRATEGIES AND PERCEIVED RESPONSES TO ABUSE DISCLOSURE 
Violence against women  2012;18(4):420-436.
This investigation examined the relationship of abuse-specific coping strategies and perceived responses to abuse disclosure to symptoms of depression and posttraumatic stress among 131 women seeking a protection order against an intimate partner. Disengagement, denial, and self-blame coping strategies, as well as blaming of the participant by others, were associated with greater depressive and posttraumatic symptoms. None of the strategies of coping or responses to abuse disclosure were negatively related to depressive or posttraumatic stress symptoms. Findings suggest that mental health providers may find it useful to address these negative styles of coping while public education campaigns should target victim-blaming.
doi:10.1177/1077801212448897
PMCID: PMC4196262  PMID: 22735315
Intimate partner violence; social support; coping
12.  CONCOMITANT FORMS OF ABUSE AND HELP-SEEKING BEHAVIOR AMONG WHITE, AFRICAN AMERICAN, AND LATINA WOMEN WHO EXPERIENCE INTIMATE PARTNER VIOLENCE 
Violence against women  2011;17(8):1067-1085.
This study uses National Violence against Women Survey data to investigate the differential impact of concomitant forms of violence (sexual abuse, stalking, and psychological abuse) and ethnicity on help-seeking behaviors of women physically abused by an intimate partner (n=1,756). Controlling for severity of the physical abuse, women who experienced concomitant sexual abuse were less likely to seek help, women who experienced concomitant stalking were more likely to seek help, whereas concomitant psychological abuse was not associated with help-seeking. Ethnic differences were found in help-seeking from friends, mental health professionals, police and orders of protection. Implications for service outreach are discussed.
doi:10.1177/1077801211414846
PMCID: PMC4196266  PMID: 21821618
Intimate partner violence; help-seeking; ethnicity
13.  Predicting Dissemination of a Disaster Mental Health “Train-the-trainer” Program 
Objective
Disaster mental health (DMH) is vital to comprehensive disaster preparedness for communities. A train-the-trainer (TTT) model is frequently used in public health to disseminate knowledge and skills to communities, although few studies have examined its success. We report on the development and implementation of a DMH TTT program and examine variables that predict dissemination.
Methods
This secondary analysis examines 140 community-based mental health providers’ participation in a TTT DMH program in 2005–06. Instructors’ dissemination of the training was followed for 12-months. Bivariate and multivariate analyses were conducted to predict dissemination of the training program.
Results
Sixty percent of the trainees in the DMH TTT program conducted trainings in the 12-month period following training. The likelihood of conducting trainings was predicted by a self-report measure of Perceptions of Transfer of Training. The number of individuals subsequently trained (559) was predicted by prior DMH training and gender. No other variables predicted dissemination of DMH training.
Conclusion
The TTT model was moderately successful in disseminating DMH training. Intervention at the organizational and individual level, as well as training modifications, may increase cost-effective dissemination of DMH training.
doi:10.1001/dmp.2010.6
PMCID: PMC4175412  PMID: 21149237
Disaster Mental Health; training; train-the-trainer; dissemination
14.  Intimate Partner Violence Reported by Two Samples of Deaf Adults via a Computerized American Sign Language Survey 
Journal of interpersonal violence  2013;29(5):948-965.
A computerized sign language survey was administered to two large samples of deaf adults. Six questions regarding intimate partner violence (IPV) were included, querying lifetime and past-year experiences of emotional abuse, physical abuse, and forced sex. Comparison data were available from a telephone survey of local households. Deaf respondents reported high rates of emotional abuse and much higher rates of forced sex than general population respondents. Physical abuse rates were comparable between groups. More men than women in both deaf samples reported past-year physical and sexual abuse. Past-year IPV was associated with higher utilization of hospital emergency services. Implications for IPV research, education, and intervention in the Deaf community are discussed.
doi:10.1177/0886260513505703
PMCID: PMC4161008  PMID: 24142445
DEAF; ABUSE; DOMESTIC VIOLENCE; SIGN LANGUAGE
15.  Does the Health Status of Intimate Partner Violence Victims Warrant Pharmacies as Portals for Public Health Promotion? 
Objectives
To explore whether the health status of intimate partner violence (IPV) victims warrants pharmacies to be portals for public health promotion. Specific objectives included: 1) Identify prevalence of IPV including Domestic Violence and Sexual Assault (DV/SA) in a community sample; 2) Describe characteristics and correlates of DV/SA relative to those who did not report DV/SA; and 3) Explore whether DV/SA status is related to mental health medication use.
Design
A secondary analysis of a countywide random telephone survey, the Monroe County Adult Health Survey 2006 (MCAHS), which collects prevalence data on health behaviors and health status indicators.
Setting
Upstate New York
Participants
English and Spanish speaking respondents under 65 years of age answering four questions to assess DV/SA.
Interventions
None
Main Outcome Measure
To determine whether those reporting DV/SA are at increased odds for mental health medication use controlling for other socio-demographic and health related variables.
Results
The survey response rate was 30.3% with 1,881 respondents fitting inclusion. Those reporting DV/SA were almost twice as likely to utilize mental health medications. However, when controlling for other variables, only poor mental and physical health were significant in increasing the odds of mental health medication use.
Conclusion
Analyses suggest DV/SA victims in a community sample do utilize mental health medications. When controlling for other variables, they report worse physical and mental health. If pharmacies are suitable portals for DV/SA outreach, curricula would need to provide the knowledge and skills needed to take an active role in this public health promotion.
doi:10.1331/JAPhA.2010.09094
PMCID: PMC4161009  PMID: 20199963
Community Pharmacy; Domestic Violence; Sexual Assault
16.  Instructional Curriculum Improves Medical Staff Knowledge and Efficacy for Patients Experiencing Intimate Partner Violence 
Military medicine  2011;176(11):1260-1264.
Study Objectives
This study assesses VA mental health providers’ understanding of intimate partner violence (IPV) and the perception of patient benefit of routine inquiry and service referral. The impact of an instructional curriculum was also examined following an interactive training.
Methods
An evidence-based curriculum was offered to VA mental health providers. The curriculum utilized didactic methods, case scenarios, and resources regarding referrals and statutes regarding crimes related to violence and abuse. The participants completed pre- and post-training surveys to assess their perceptions about IPV and to evaluate the training.
Results
Seventy-three individuals completed the training. Fifty-four of the participants were female, and thirty-three were over the age of 45. Fifty-one individuals completed both surveys. There were no differences between participants’ views of the seriousness of IPV in the community or their practices before or after the training. However, participants scored significantly higher on the knowledge and efficacy measures after the training (p<.001).
Conclusion
Following an educational intervention, providers demonstrate more knowledge and efficacy regarding routine inquiry and referral for IPV. Barriers to universal implementation still warrant attention.
PMCID: PMC4161012  PMID: 22165653
Intimate Partner Violence; Abuse; Domestic Violence; Medical Education
17.  Protection Orders Protect Against Assault and Injury: A Longitudinal Study of Police-Involved Women Victims of Intimate Partner Violence 
Journal of interpersonal violence  2012;27(14):2845-2868.
Objective
To measure the efficacy of protection orders (POs) in reducing assault and injury-related outcomes using a matched comparison group and tracking outcomes over time.
Methods
This study was a retrospective review of police, emergency department, family court and prosecutor administrative records for a cohort of police-involved female IPV victims; all events over a four-year study period were abstracted. Victims who obtained protection orders (POs) were compared to a propensity-score-based match group without POs over three time periods: Before, during, and after the issuance of a PO.
Results
Having a PO in place was associated with significantly more calls to police for non-assaultive incidents, and more police charging requests that were multiple-count and felony-level. Comparing outcomes, PO victims had police incident rates that were more than double the matched group prior to the PO, but dropped to the level of the matched group during and after the order. ED visits dropped over time for both groups.
Conclusion
This study confirmed the protective effect of POs, which are associated with reduced police incidents and emergency department visits both during and after the order, and reduced police incidents compared to a matched comparison group.
doi:10.1177/0886260512438284
PMCID: PMC4151113  PMID: 22491224
Battered women; legal intervention; domestic violence
18.  Increased Risk for Postpartum Psychiatric Disorders Among Women with Past Pregnancy Loss 
Journal of Women's Health  2013;22(9):760-768.
Abstract
Background
Scant literature exists on whether prior pregnancy loss (miscarriage, stillbirth, and/or induced abortion) increases the risk of postpartum psychiatric disorders—specifically depression and anxiety—after subsequent births. This study compares: (1) risk factors for depression and/or anxiety disorders in the postpartum year among women with and without prior pregnancy loss; and (2) rates of these disorders in women with one versus multiple pregnancy losses.
Methods
One-hundred-ninety-two women recruited at first-year pediatric well-child care visits from an urban pediatric clinic provided demographic information, reproductive and health histories. They also completed depression screening tools and a standard semi-structured psychiatric diagnostic interview.
Results
Almost half of the participants (49%) reported a previous pregnancy loss (miscarriage, stillbirth, or induced abortion). More than half of those with a history of pregnancy loss reported more than one loss (52%). Women with prior pregnancy loss were more likely to be diagnosed with major depression (p=0.002) than women without a history of loss. Women with multiple losses were more likely to be diagnosed with major depression (p=0.047) and/or post-traumatic stress disorder (Fisher's exact [FET]=0.028) than women with a history of one pregnancy loss. Loss type was not related to depression, although number of losses was related to the presence of depression and anxiety.
Conclusions
Low-income urban mothers have high rates of pregnancy loss and often have experienced more than one loss and/or more than one type of loss. Women with a history of pregnancy loss are at increased risk for depression and anxiety, including post-traumatic stress disorder (PTSD), after the birth of a child. Future research is needed to understand the reasons that previous pregnancy loss is associated with subsequent postpartum depression and anxiety among this population of women.
doi:10.1089/jwh.2012.4011
PMCID: PMC3768229  PMID: 24007380
19.  Interpersonal Violence Victimization and Suicidal Ideation 
Crisis  2011;32(5):240-245.
Background
Offenders are at elevated risk for interpersonal violence victimization (IVV), which is a risk factor for suicide-related outcomes in some populations, suggesting the importance of examining risk associated with IVV in offenders.
Aims
The present study examined the association between IVV and suicidal ideation (SI) among criminal offenders in a pretrial jail diversion program in the United States.
Methods
266 offenders were screened for ten common Axis I psychiatric disorders along with current SI and past-year IVV.
Results
Past-year IVV was significantly associated with current SI, and the association remained significant after adjusting for symptoms of ten Axis I psychiatric disorders, respectively and simultaneously. Gender did not moderate the IVV-SI association.
Conclusions
The findings support a connection between IVV and SI in criminal offenders.
doi:10.1027/0227-5910/a000080
PMCID: PMC4150083  PMID: 21940254
suicide; suicidal ideation; violence; victimization; offenders
20.  “What Fresh Hell Is This?” Victims of Intimate Partner Violence Describe Their Experiences of Abuse, Pain, and Depression 
Journal of family violence  2012;27(8):773-781.
Traditionally, professionals working with intimate partner violence (IPV) survivors view a victim through a disciplinary lens, examining health and safety in isolation. Using focus groups with survivors, this study explored the need to address IPV consequences with an integrated model and begin to understand the interconnectedness between violence, health, and safety. Focus group findings revealed that the inscription of pain on the body serves as a reminder of abuse, in turn triggering emotional and psychological pain and disrupting social relationships. In many cases, the physical abuse had stopped but the abuser was relentless by reminding and retraumatizing the victim repeatedly through shared parenting, prolonged court cases, etc. This increased participants’ exhaustion and frustration, making the act of daily living overwhelming.
doi:10.1007/s10896-012-9469-6
PMCID: PMC3512568  PMID: 23226694
domestic violence; trauma; physical and mental health comorbidities
21.  Bridging Prevention and Health: Exploring Community Perceptions of Intimate Partner Violence in Rural Honduras 
Journal of family violence  2012;27(7):707-714.
This qualitative study rooted in community-based participatory research principles utilized semi-structured interviews with 2 focus groups (n=9) with female healthcare volunteers (FCVs) and 3 male key informants who were community leaders (MCLs). The study aimed to examine how a rural Honduran community defines and responds to intimate partner violence (IPV) in order to lay the foundation for future interventions. Based on grounded theory, the authors assessed for common themes across transcripts. Authors found that a number of participants denied the existence of IPV. Perspectives on the causes and definitions of IPV varied between FCVs and MCLs. All participants affirmed the need for intervention and many participants mentioned healthcare and legal systems as potential venues to ameliorate IPV. The results highlight potentially important differences between FCV and MCL perspectives that may inform future interventions. Findings suggest health-care workers can play a role in IPV prevention and intervention in rural Honduras.
doi:10.1007/s10896-012-9454-0
PMCID: PMC3520440  PMID: 23243337
Domestic violence; Intimate partner violence; Latin America; Honduras; Rural; Community health
22.  Age Got to Do With It? Partner Age Difference, Power, Intimate Partner Violence, and Sexual Risk in Urban Adolescents 
Journal of interpersonal violence  2013;28(10):2068-2087.
Adolescent girls with older male main partners are at greater risk for adverse sexual health outcomes than other adolescent girls. One explanation for this finding is that low relationship power occurs with partner age difference. Using a cross-sectional, descriptive design, we investigated the effect of partner age difference between an adolescent girl and her male partner on sexual risk behavior through the mediators of sexual relationship power, and physical intimate partner violence (IPV), and psychological IPV severity. We chose Blanc’s framework to guide this study as it depicts the links among demographic, social, economic, relationship, family and community characteristics, and reproductive health outcomes with gender-based relationship power and violence. Urban adolescent girls (N = 155) completed an anonymous computer-assisted self-interview survey to examine partner and relationship factors’ effect on consistent condom use. Our sample had an average age of 16.1 years with a mean partner age of 17.8 years. Partners were predominantly African American (75%), non-Hispanic (74%), and low-income (81%); 24% of participants reported consistent condom use in the last 3 months. Descriptive, correlation, and multiple mediation analyses were conducted. Partner age difference was negatively associated with consistent condom use (−.4292, p < .01); however, the indirect effects through three proposed mediators (relationship power, physical IPV, or psychological IPV severity) were not statistically significant. Further studies are needed to explore alternative rationale explaining the relationship between partner age differences and sexual risk factors within adolescent sexual relationships. Nonetheless, for clinicians and researchers, these findings underscore the heightened risk associated with partner age differences and impact of relationship dynamics on sexual risk behavior.
doi:10.1177/0886260512471082
PMCID: PMC3706999  PMID: 23345572
dating violence; domestic violence; sexuality; youth violence
23.  Associations among Depressive Symptoms, Dating Violence, and Relationship Power in Urban, Adolescent Girls 
Objective
To explore the associations among dating violence (DV), aggression, relationship power, and depressive symptoms.
Design
A cross-sectional survey secondary analysis.
Setting
An urban, school based health center, October, 2009 through May, 2009.
Participants
Low income, adolescent girls (n= 155), ages 14–18.
Methods
Descriptive and bivariate analyses were conducted to illustrate patterns and associations among variables. Key variables included depressive symptoms, DV victimization and aggression, and relationship power. We used mediation analyses to determine the direct and indirect effects among variables.
Results
Both DV victimization and aggression were reported frequently. Furthermore, DV victimization had a significant direct effect on depression and an indirect effect through relationship power. Depressive symptoms and relationship power were associated with DV aggression. Although relationship power did have a significant inverse effect on depressive symptoms, it was not through DV aggression.
Conclusions
Complex associations remain between mental health and DV; however, relationship power partially accounts for DV victimization's effect on depressive symptoms. Depressive symptoms are associated with DV victimization and aggression; therefore, nurses should address relationship power in clinical and community interventions.
doi:10.1111/j.1552-6909.2012.01384.x
PMCID: PMC3707001  PMID: 22697267
dating violence; depression; relationship power; adolescent; aggression
24.  Assessing Danger: What Judges Need To Know 
Family court review  2012;50(1):150-158.
Every day, judges are faced with decisions regarding intimate partner violence (IPV) victims' requests for protection orders, custody arrangements, and visitation schedules. To make informed decisions, judges must understand victims' risk for future violence. This mixed method study explores the extent to which protection order petitions (n=169) communicate victims' current danger and future risk of violence. Methods included interviews coupled with an archival review of court petitions. Findings suggest judges are inadequately prepared to render decisions to improve victim safety in the absence of standardized risk assessments. The Danger Assessment provides an evidence-based solution to routinize intake interviews with victims petitioning the court.
doi:10.1111/j.1744-1617.2011.01436.x
PMCID: PMC3364605  PMID: 22661908
25.  Sleep Disturbances and Their Association With Mental Health Among Women Exposed to Intimate Partner Violence 
Journal of Women's Health  2011;20(12):1923-1929.
Abstract
Background
Intimate partner violence puts the victim at risk for substantial medical and psychiatric morbidity. As with other stress- and trauma-related experiences, intimate partner violence is associated with sleep disturbance, particularly insomnia and nightmares. This association, however, has not been well characterized in terms of general prevalence or its further relationship with depression, suicidality, and posttraumatic stress disorder (PTSD).
Methods
The present study used validated instruments to characterize insomnia and nightmares among 121 women exposed to intimate partner violence. Participants with and without depression were compared on demographic, abuse, and sleep characteristics as were those with and without suicidality. Logistic regression models were constructed to test sleep variables as independent predictors of depression controlling for demographic factors, abuse severity, and PTSD severity.
Results
Clinically significant insomnia and nightmares were observed in 46% and 32% of participants, respectively. Depressed women had more severe PTSD and were more likely to have insomnia and to have nightmares than nondepressed women. In models controlling for PTSD severity, the presence of insomnia was associated with an approximately eightfold greater risk of being depressed; nightmares were associated with a twofold increase in risk.
Conclusions
Sleep disturbances were prevalent among women experiencing intimate partner violence, with both insomnia and nightmares predicting the presence of depression even after controlling for PTSD severity. In addition to the need to address common mental health issues such as depression, given that sleep problems are modifiable and potentially less stigmatizing than mental health problems, assessing and addressing insomnia and nightmares in survivors of interpersonal violence warrants strong clinical consideration and further investigation.
doi:10.1089/jwh.2011.2781
PMCID: PMC3236986  PMID: 21988551

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