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.
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.
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.
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.
Mental health court; Gender and justice; Criminogenic factors; Healthcare utilization
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.
Intimate partner violence; social support; coping
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.
Intimate partner violence; help-seeking; ethnicity
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.
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.
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.
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.
Disaster Mental Health; training; train-the-trainer; dissemination
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.
DEAF; ABUSE; DOMESTIC VIOLENCE; SIGN LANGUAGE
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.
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.
Upstate New York
English and Spanish speaking respondents under 65 years of age answering four questions to assess DV/SA.
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.
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.
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.
Community Pharmacy; Domestic Violence; Sexual Assault
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.
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.
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).
Following an educational intervention, providers demonstrate more knowledge and efficacy regarding routine inquiry and referral for IPV. Barriers to universal implementation still warrant attention.
Intimate Partner Violence; Abuse; Domestic Violence; Medical Education
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.
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.
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.
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.
Battered women; legal intervention; domestic violence
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.
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.
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.
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.
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.
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.
266 offenders were screened for ten common Axis I psychiatric disorders along with current SI and past-year IVV.
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.
The findings support a connection between IVV and SI in criminal offenders.
suicide; suicidal ideation; violence; victimization; offenders
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.
domestic violence; trauma; physical and mental health comorbidities
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.
Domestic violence; Intimate partner violence; Latin America; Honduras; Rural; Community health
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.
dating violence; domestic violence; sexuality; youth violence
To explore the associations among dating violence (DV), aggression, relationship power, and depressive symptoms.
A cross-sectional survey secondary analysis.
An urban, school based health center, October, 2009 through May, 2009.
Low income, adolescent girls (n= 155), ages 14–18.
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.
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.
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.
dating violence; depression; relationship power; adolescent; aggression
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.
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).
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.
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.
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.
To describe the co-occurrence of intimate partner violence (IPV) and mental health burden among perinatal mothers attending well-baby visits with their infants in the first year of life. We compare rates of depression, anxiety disorder, and substance abuse diagnoses between mothers who reported IPV within the past year to those who did not.
This cross-sectional study of 188 mothers of infants (under 14 months) was conducted in an urban hospital pediatric clinic. Participants reported demographics and IPV and completed a semistructured psychiatric diagnostic interview.
Mothers reporting IPV were more likely to be diagnosed with mood and/or anxiety diagnoses (p<0.05, Fisher's exact test), specifically current depressive diagnoses (p<0.01, Fisher's exact test) and panic disorder (p<0.05, Fisher's exact test). There was a trend for more posttraumatic stress disorder (PTSD) (p<0.06) among abused mothers. Substance abuse and dependence, age, race, insurance status, employment, education, and family arrangements did not differ between groups. Prior major or minor depression increases the odds for perinatal depression threefold (OD 3.18).
These findings have implications for practitioners who encounter perinatal women. Findings suggest providers should explore signs and symptoms of depression and anxiety disorders among women reporting IPV. Similarly, when perinatal mothers report symptoms of depression, PTSD, or panic disorder, practitioners should be alert to the possible contributory role of IPV.
While victims of intimate partner violence (IPV) present to health care settings for a variety of complaints; rates and predictors of case identification and intervention are unknown.
Examine emergency department (ED) case finding and response within a known population of abused women.
Retrospective longitudinal cohort study.
Police-involved female victims of IPV in a semi-rural Midwestern county.
We linked police, prosecutor, and medical record data to examine characteristics of ED identification and response from 1999–2002; bivariate analyses and logistic regression analyses accounted for the nesting of subjects’ with multiple visits.
IPV victims (N = 993) generated 3,426 IPV-related police incidents (mean 3.61, median 3, range 1–17) over the 4-year study period; 785 (79%) generated 4,306 ED visits (mean 7.17, median 5, range 1–87), which occurred after the date of a documented IPV assault. Only 384 (9%) ED visits occurred within a week of a police-reported IPV incident. IPV identification in the ED was associated with higher violence severity, being childless and underinsured, more police incidents (mean: 4.2 vs 3.3), and more ED visits (mean: 10.6 vs 5.5) over the 4 years. The majority of ED visits occurring after a documented IPV incident were for medical complaints (3,378, 78.4%), and 72% of this cohort were never identified as victims of abuse. IPV identification was associated with the day of a police incident, transportation by police, self-disclosure of “domestic assault,” and chart documentation of mental health and substance abuse issues. When IPV was identified, ED staff provided legally useful documentation (86%), police contact (50%), and social worker involvement (45%), but only assessed safety in 33% of the women and referred them to victim services 25% of the time.
The majority of police-identified IPV victims frequently use the ED for health care, but are unlikely to be identified or receive any intervention in that setting.
intimate partner violence; police incidents; health care screening; risk identification; interventions; emergency departments
Intimate partner violence (IPV) victims frequently seek medical treatment though rarely for IPV. Recommendations for health care providers (HCPs) include: IPV screening, counseling, and safety referral.
Report women’s experiences discussing IPV with HCPs.
Structured interviews with women reporting IPV HCP discussions; descriptive analyses; bivariate and multivariate analyses and association with patient demographics and substance abuse.
Women from family court, community-based, inner-city primary care practice, and tertiary care-based outpatient psychiatric practice.
A total 142 women participated: family court (N=44; 31%), primary care practice (N=62; 43.7%), and psychiatric practice (N=36; 25.4%) Fifty-one percent (n=72) reported HCPs knew of their IPV. Of those, 85% (n=61) told a primary care provider. Regarding IPV attitudes, 85% (n=61) found their HCP open, and 74% (n=53) knowledgeable. Regarding approaches, 71% (n= 51) believed their HCP advocated leaving the relationship. While 31% (n=22) received safety information, only 8% (n=6) received safety information and perceived their HCP as not advocating leaving the abusive relationship.
Half of participants disclosed IPV to their HCP’s but if they did, most perceived their provider advocated them leaving the relationship. Only 31% reported HCPs provided safety planning despite increased risks associated with leaving. We suggest healthcare providers improve safety planning with patients disclosing IPV.
domestic violence; patient-physician communication; women’s health
Although there has been much research examining the relationship between pregnancy and abuse, this study is one of the few to investigate whether perinatal status (defined as pregnancy or early postpartum) impacts the help seeking of abused women.
We retrospectively reviewed 3 years of prosecutor administrative records, police incident reports, and hospital medical records for a countywide population of adult females (n = 964) assaulted by an intimate partner in 2000. Perinatal and nonperinatal victims were compared using chi-square and a series of logistic regression models, controlling for all demographic and incident-related factors.
Compared with women across the county, abused women were twice as likely to become pregnant (p < 0.001). Perinatal status did not change the rate of help seeking from police (OR 1.1, p = 0.67) or emergency departments (ED) (OR 1.1, p = 0.94), but it did change the pattern of help seeking with higher ED use in the 6 months prior to the assault (p < 0.01) and a trend toward seeking help with fewer injuries (p = 0.10).
Abused women are more likely to become pregnant. Perinatal status impacts how victims seek help from criminal justice agencies and EDs.
To assess physical and mental functional health status as associated with the severity of intimate partner violence (IPV) and perceived danger.
Prospective cross-sectional survey of all patients aged 18–55 in an urban emergency department during a convenience sample of shifts. Instruments included the George Washington Universal Violence Prevention Screening protocol, administered by computer during the initial visit, the Short-Form 12 Health Survey (SF-12), the Conflict Tactics Scale (CTS2), and the Revised Danger Assessment (DA), administered by interview at 1 week follow-up.
In total, 548 (20%) participants screened disclosed IPV victimization. Of those, 216 (40%) completed the follow-up assessment 1 week later. This cohort was 91% African American, 70% single, and 63% female, with a mean age of 35 (SD 10.41). Both physical and mental health functioning scores were lower than normative levels (50) compared with national averages: Physical Component Summary (PCS) scale 43.64 (SD 10.86) and Mental Component Summary (MCS) scale 37.46 (SD 12.29). As physical assault, psychological aggression, and reported injury increased on the CTS2, mental health functioning diminished (p < 0.01). Increased physical assault and psychological aggression were also associated with diminished physical health functioning (p < 0.05). As victim-perceived danger increased on the DA, both physical and mental health functioning decreased (p < 0.01, p < 0.001, respectively). Greater self-advocacy activities were associated with lower mental (but not physical) health functioning as well. Females experienced worsening mental health functioning as both physical assault and psychological aggression increased, whereas male victims experienced worsening mental health functioning only as psychological aggression increased.
These findings suggest that IPV takes a greater mental than physical toll (for both sexes) and that as IPV severity increases, mental health functioning diminishes and self-advocacy behaviors increase. Additionally, as perceived danger increases, both physical and mental health status worsens. This has important implications for clinicians to assess and consider IPV victims' perceptions of their situations relative to danger, not just the levels of abuse they are experiencing.
Measurements of intimate partner violence (IPV) based on acts of violence have repeatedly found substantial bilateral violence between intimates. However, the context of this violence is not well defined by acts alone. The objective of this research was to compare differences in women and men within each IPV status category (victim, perpetrator, and both) with respect to levels of battering as defined by their scores on the Women’s Experience With Battering Scale (WEB), which asks gender-neutral questions about the abuse of power and control and fear in an intimate relationship. In our study, women disclosed higher levels of battering on the WEB, despite IPV status (victimization or both victimization and perpetration). In addition, female IPV victims were 5 times more likely than their male counterparts to disclose high rates of battering on the WEB. Depressive symptoms, symptoms of posttraumatic stress disorder, African American race, and IPV victimization were independently associated with higher WEB scores.
intimate partner violence; victim; perpetrator; battering; mental health; Women’s Experience With Battering Scale