Ann Malecha

Intimate partner sexual assault against women: frequency, health consequences, and treatment outcomes.

OBJECTIVE: To describe the characteristics and consequences of sexual assault within intimate relationships specific to racial or ethnic group, compare the findings to a similar group of physically assaulted–only women, and measure the risk of reassault after victim contact with justice and health services METHODS: A personal interview survey of 148 African-American, Hispanic, and white English- and Spanish-speaking abused women seeking a protection order. Extent of sexual assault, prevalence of rape-related sexually transmitted diseases and pregnancy, symptoms of posttraumatic stress disorder (PTSD) and depression, and risk of reassault after treatment were measured RESULTS: Sixty-eight percent of the physically abused women reported sexual assault. Fifteen percent of the women attributed 1 or more sexually-transmitted diseases to sexual assault, and 20% of the women experienced a rape-related pregnancy. Sexually assaulted women reported significantly (P = .02) more PTSD symptoms compared with nonsexually assaulted women. One significant (P = .003) difference occurred between ethnic groups and PTSD scores. Regardless of sexual assault or no assault, Hispanic women reported significantly higher mean PTSD scores compared with African-American women (P = .005) and White women (P = .012). The risk of sexual reassault was decreased by 59% and 70% for women who contacted the police, or applied for a protection order, after the first sexual assault. Receiving medical care decreased the womans risk of further sexual assault by 32% CONCLUSION: Sexual assault is experienced by most physically abused women and associated with significantly higher levels of PTSD compared with women physically abused only. The risk of reassault is decreased if contact is made with health or justice agencies. LEVEL OF EVIDENCE: III

Protection orders and intimate partner violence: an 18-month study of 150 black, Hispanic, and white women

OBJECTIVES We compared types and frequencies of intimate partner violence experienced by women before and after receipt of a 2-year protection order. METHODS Participants were 150 urban English- and Spanish-speaking Black, Hispanic, and White women who qualified for a 2-year protection order against an intimate partner. RESULTS One woman committed suicide 6 weeks into the study. The remaining 149 women completed all interviews. Results showed significant reductions in threats of assault, physical assault, stalking, and worksite harassment over time among all women, regardless of receipt or nonreceipt of a protection order. CONCLUSIONS Abused women who apply and qualify for a 2-year protection order, irrespective of whether or not they are granted the order, report significantly lower levels of violence during the subsequent 18 months.

An intervention to increase safety behaviors of abused women: Results of a randomized clinical trial

BackgroundAlthough intimate partner violence is recognized as a major threat to women’s health, few interventions have been developed or tested. ObjectiveTo test an intervention administered to abused women in order to increase safety-seeking behaviors. MethodA two-group clinical trial randomized 75 abused women to receive six telephone intervention sessions on safety behaviors. A control group of 75 women received standard care. Women in both groups were re-interviewed at 3 months and 6 months post-initial measurement. ResultsUsing repeated measures analysis of variance (ANOVA), we found significantly [F (2,146) 5.11, p = .007] more adopted safety behaviors reported by women in the intervention group than by women in the control group at both the 3-month [F (91,74) = 19.70, p < .001] and 6-month [F (1,74) = 15.90, p < .001] interviews. The effect size (ES) of the intervention was large at 3 months (ES = 1.5) and remained substantial at 6 months (ES = 0.56). DiscussionThese findings demonstrate that an intervention to increase safety behaviors of abused women is highly effective when offered following an abusive incident and remains effective for 6 months.

INTIMATE PARTNER SEXUAL ASSAULT AGAINST WOMEN AND ASSOCIATED VICTIM SUBSTANCE USE, SUICIDALITY, AND RISK FACTORS FOR FEMICIDE

In order to establish the frequency of substance use, following and attributed to sexual assault, and describe the danger for femicide and suicidality for women physically and sexually abused compared to physically-abused only women, a personal interview of 148 African-American, Hispanic, and white English and Spanish-speaking abused women was completed. Women who reported more than one sexual assault were 3.5 (95% CI, 0.9, 13.4) times more likely to report beginning or increasing substance use compared to women who reported only one sexual assault. Sexually assaulted women reported significantly (p = .002) more risk factors for femicide compared to physically- abused only women. Specific to suicide, women reporting sexual assault were 5.3 (95% CI, 1.3, 21.5) times more likely to report threatening or attempted suicide within a 90-day period compared to physically-abused only women. The health assessment and intervention of intimate partner violence must extend beyond injury to include behavior risk sequelae of substance abuse and suicidality.

Increasing the Safety-Promoting Behaviors of Abused Women: In this study, a telephone intervention for victims of intimate-partner violence showed efficacy for 18 months.

OVERVIEWDespite an epidemic of intimate-partner violence against women, and general agreement that women should be screened for it, few assessment and intervention protocols have been evaluated in controlled studies. To test a telephone intervention intended to increase the “safety-promoting behavior” of abused women, 75 women received six telephone calls over a period of eight weeks in which safety-promoting behaviors were discussed. A control group of 75 women received usual care. Women in both groups received follow-up calls to assess safety-promoting behaviors at three, six, 12, and 18 months after intake. Analysis showed that the women in the intervention group practiced significantly (P < 0.01) more safety-promoting behaviors than women in the control group at each assessment. On average, women in the intervention group practiced almost two more safety-promoting behaviors than they had at time of intake and nearly two more than women in the control group; the additional behaviors were practiced for 18 months. This nursing intervention requires only 54 minutes to complete (six nine-minute telephone calls) and can be integrated into any health care setting. Because less than one hour of professional nursing time is involved, the cost of the intervention is minimal. Future research should determine whether the adoption of safety-promoting behaviors by abused women averts trauma and its subsequent health care costs.

Intimate Partner Violence A Gender Comparison

To compare the severity of violence reported by women and men filing assault charges against an intimate partner, 100 complainants (90 women and 10 men) were interviewed. Measurement instruments included the Severity of Violence Against Women Scales, Danger Assessment Scale, Stalking Victimization Survey, and a quality of life index. Using independent t tests, no significant differences existed between male and female demographic characteristics. The majority of victims were African American, employed, and in current relationships with the abuser. Similarly, no significant differences existed between genders for any of the measurement instruments, including quality of life indices. Although incidence reports of intimate partner, nonlethal violence is consistently and appreciably higher for females, this study indicates that the severity and extent of the violence does not differ by gender, and neither do the associated quality of life indices. Clearly, violence against intimates is an equally serious issue for both men and women.

Women Filing Assault Charges on an Intimate Partner Criminal Justice Outcome and Future Violence Experienced

To describe the criminal justice outcomes and violence experienced after women seek to file assault charges against an intimate partner, 90 women were interviewed and followed for six months. Threats of violence, physical assault, stalking, and danger were measured by interview questionnaires at the time of filing charges and at 3 and 6 months later. Among the 90 women, 48% had insufficient evidence for charges; of the 52% making charges, 11% dropped charges, 37% of the perpetrators were arrested, and 4% remained fugitives. With the exception of danger at 3 months for one group of women, levels of violence did not differ by charges accepted or perpetrator arrested at 3 and 6 months. The act of women attempting to file assault charges, whether the charges were accepted or the perpetrator arrested, resulted in equally lower levels of future violence.

Severity of Violence Against Women by Intimate Partners and Associated Use of Alcohol and/or Illicit Drugs by the Perpetrator

One hundred eighty abused women presenting for protective orders or to file assault charges were interviewed. The Severity of Violence Against Women Scale measured threats of abuse and actual physical violence. A questionnaire measured stalking. Additionally, the women were asked if the perpetrator was drunk daily and/or used illicit drugs. Perpetrators were divided into four groups: no alcohol or drug use (33%); alcohol only (19%); drugs only (18%); and alcohol and drugs (30%). Using multivariate analysis and controlling for demographic variables, physical abuse was significantly (p = .005) higher for women with perpetrators who used drugs only (x = 60.4) compared with perpetrators who used alcohol only (x = 47.7). Stalking was significantly (p = .001) higher for perpetrators who used alcohol and drugs (x = 8.2) compared with perpetrators who did not use alcohol or drugs (x = 5.6). To enable abused women to promote their safety, an understanding of the association between substance use and specific types of intimate partner violence is required.

TESTING THERAPEUTIC LIFE REVIEW OFFERED BY HOME CARE WORKERS TO DECREASE DEPRESSION AMONG HOME-DWELLING OLDER WOMEN

The purpose of the study was to test a psychosocial intervention, therapeutic life review, offered by home care workers to decrease depression among home-dwelling older women. A quasi-experimental, one-group time-series design measured the effect of a once-a-week, 40-minute therapeutic life review intervention, delivered for six weeks by home care workers, on the depression scores of women 65 years and older, compared to their scores during the ten weeks prior to the intervention. Over time, depression scores improved with a significant decrease in depression immediately following the six-week intervention. Based on these findings, we concluded that home care workers can deliver a community-based psychosocial intervention that decreases depression in their home-dwelling clients.

Applying For and Dropping a Protection Order: A Study With 150 Women

A total of 150 women who qualified for a protection order against an intimate partner wereinterviewed on the day of application and 3 months later to study factors associated with the receipt or dropping of a protection order. At 3 months, 54% of the women received protection orders, 28% dropped the process, and 18% did not receive protection orders. Differences (p < .05) in relationship status existed at intake between the women that received or dropped the protection order. Women who dropped were more likely in current relationships with the perpetrator, whereas protection order recipients considered the perpetrator a former partner. At intake and 3 months later, women in current relationships, irrespective of protection receipt or drop, reported significantly (p < .005) more physical assaults. Relationship status is a significant correlate of abused women’s receipt or dropping of a protection order as well as the level of assault experienced.