Heather M. Foran

Alcohol and intimate partner violence: A meta-analytic review

The link between alcohol use/abuse and partner violence attracted increasing research attention in the past decade. Some studies reported a null or weak association between alcohol use and intimate partner violence, whereas other studies reported a moderate or large association. Using a meta-analytic approach, the link between alcohol use/abuse and male-to-female partner violence as well as female-to-male partner violence was examined herein. The results indicate that there is a small to moderate effect size for the association between alcohol use/abuse and male-to-female partner violence and a small effect size for the association between alcohol use/abuse and female-to-male partner violence. For men only, several moderators were also examined and the magnitude of the effect sizes varied significantly as a function of the type of sample and type of alcohol measure selected. Specifically, there was a larger association of alcohol and aggression in clinical versus non-clinical samples and when measures assessed more severe alcohol problems.

Marital functioning, chronic pain, and psychological distress

&NA; This study examined whether marital functioning variables related uniquely to psychological distress and diagnoses of depressive disorder independent of pain severity and physical disability. Participants were 110 chronic musculoskeletal pain patients. Hierarchical regression results showed that marital variables (i.e. marital satisfaction, negative spouse responses to pain) contributed significantly to depressive and anxiety symptoms over and above the effects of pain severity and physical disability. In contrast, marital variables were not significantly related to diagnoses of depressive disorder (i.e. major depression, dysthymia, or both) after controlling for pain variables. In multivariate analyses, physical disability and marital satisfaction were uniquely related to depressive symptoms whereas physical disability, pain severity, and negative spouse responses to pain were uniquely related to anxiety symptoms. Only physical disability was uniquely related to major depression. The results suggest that models of psychological distress in chronic pain patients might be enhanced by attributing greater importance to interpersonal functioning and increasing attention to anxiety.

Problem Drinking, Jealousy, and Anger Control: Variables Predicting Physical Aggression Against a Partner

Alcohol use and intimate partner violence (IPV) are significantly related, but only a subset of individuals who drink are aggressive and relatively little is known about what moderates this relationship in community samples. Two risk factors, anger control and jealousy, were hypothesized to moderate the relationship between IPV and problem drinking in a sample of 453 community couples. A significant three-way interaction indicated that men with jealousy problems, but not anger control problems, were most likely to show the strongest association between problem drinking and IPV. In accord with the multiple threshold model of IPV, specific combinations of risk factors appeared to represent different thresholds in which problem drinking influenced the likelihood of IPV.

Risk for suicidal ideation in the U.S. Air Force: An ecological perspective

OBJECTIVE Suicidal members of the U.S. military often fail to disclose their suicidal urges and behaviors. Military suicide prevention efforts may therefore be enhanced if they also target less stigmatized psychosocial factors that may decrease risk of suicidality. In keeping with Bronfenbrenners (1977, 1994) model, this study simultaneously examined 4 ecological levels (i.e., individual, family, workplace, and community) of factors variously associated with increased or decreased risk for suicidal ideation. METHOD Active-duty U.S. Air Force members (N = 52,780; 79.3% male; 79.2% non-Hispanic White; mean age = 31.78 years, SD = 7.38) completed the 2006 Community Assessment survey (a biennial, anonymous survey conducted at 82 U.S. Air Force bases worldwide), including the Centers for Disease Control and Preventions (2008) 5-item measure of past-year suicidality along with scales assessing an array of potential predictors. RESULTS The 1-year rate of suicidal ideation, defined as (a) more than rarely thinking about suicide or (b) ever seriously considering suicide, was approximately 4%. In multivariate models, for men and women, individual- (depressive symptoms and alcohol problems), family- (relationship satisfaction and intimate partner victimization), workplace- (hours worked), and community-level (social support) variables were retained in the final model. However, some sex differences in retained predictors were noted (e.g., men: dissatisfaction with the U.S. Air Force way of life; women: workplace relationship satisfaction and financial stressors). CONCLUSIONS Addressing depressive symptoms and alcohol use, facilitating healthy relationship functioning, and increasing job satisfaction and social support may aid military suicide prevention efforts. These findings illustrate the importance of attending to multiple levels of potential influence when designing integrated suicide prevention and intervention programs.

Alcohol Problems, Aggression, and Other Externalizing Behaviors After Return From Deployment: Understanding the Role of Combat Exposure, Internalizing Symptoms, and Social Environment

OBJECTIVES The study examined whether elevated rates of externalizing behaviors following deployment could be explained by internalizing symptoms (depression, anxiety, and PTSD symptoms), and health of the social environment (unit leadership, organizational support, and stigma/barriers to care). DESIGN A model of combat exposure, social environment, internalizing symptoms, and externalizing behaviors was tested in a military unit following a fifteen-month deployment to Iraq. The sample included 1,397 soldiers assessed four month post-deployment; 589 of these soldiers were assessed again nine months post-deployment. RESULTS Externalizing behaviors were highly stable over the five-month post-deployment period. Both social environment and internalizing symptoms were significantly associated with level of externalizing behaviors at four months and nine months post-deployment, but combat exposure alone significantly predicted change in externalizing behaviors over the follow-up period. CONCLUSIONS Results suggest the need to broaden the scope of interventions targeted to combat veterans and have implications for care providers and military leaders.

Prevalences of Intimate Partner Violence in a Representative U.S. Air Force Sample.

OBJECTIVE Intimate partner violence (IPV) is a serious health concern, but little is known about prevalence of IPV in the armed forces, as military members cope with the pressures of long-standing operations. Furthermore, previous prevalence studies have been plagued by definitional issues; most studies have focused on acts of aggression without consideration of impact (clinically significant [CS] IPV). This is the first large-scale study to examine prevalences of IPV, CS-IPV, and clinically significant emotional abuse (CS-EA) for men and women. METHOD A United States Air Force-wide anonymous survey was administered across 82 bases in 2006 (N = 42,744) to assess IPV, CS-IPV, and CS-EA. RESULTS The adjusted prevalence of CS-IPV perpetration was 4.66% for men and 3.54% for women. Prevalences of IPV perpetration were 12.90% for men and 15.14% for women. CS-EA victimization was 6.00% for men and 8.50% for women. Sociodemographic differences in risk for violence were found for gender, race/ethnicity, pay grade, religious faith, marital status, and career type even after controlling for other demographic variables. CONCLUSIONS Partner maltreatment is widespread in military (and civilian) samples. Men were more likely to perpetrate CS-IPV, whereas women were more likely to perpetrate IPV. Specific demographic risk factors were identified for different types of partner maltreatment (e.g., lower rank predicted higher risk for both perpetration and victimization across men and women). Other sociodemographic differences varied across severity (IPV vs. CS-IPV) and across gender.

The Role of Relationships in Understanding the Alexithymia–Depression Link

Alexithymia is associated with increased depressive symptoms in both clinical and community samples. One way that alexithymia may lead to depression is through its impact on interpersonal relationships. Individuals with alexithymia report lower perceived social support, intimacy, and relationship satisfaction. Furthermore, poor relationship functioning is a clear risk factor for depressive symptoms. Given the established alexithymia–depression link and marital dysfunction–depression link, a logical next step is to examine whether relationship dysfunction (low social support, intimacy, negative relationship behaviours, and relationship dissatisfaction) mediates the association between alexithymia and depressive symptoms. The hypothesized mediation model was assessed in a sample of 104 community couples with two analytical approaches—first with cross–sectional measures using path analysis and second with daily diary measures collected over a seven–day period using a multilevel modelling approach. Poor relationship functioning mediated the association between alexithymia and depressed mood in the daily diary data and partially mediated that association with the cross–sectional measures. These results identify alexithymia as an important variable in understanding the marital functioning–depression association, and this finding has implications for treatment. Copyright

Validation of a Self-Report Measure of Unrealistic Relationship Expectations

Cognitive models of intimate partner aggression implicate maladaptive relationship beliefs as antecedents to aggression and targets for intervention. However, existing self-report measures of relationship beliefs have failed to differentiate aggressive and nonaggressive individuals, raising questions about their assessment of and role in understanding aggression. To address these concerns, the authors developed and tested a new measure of unrealistic relationship beliefs in a sample of 453 community couples. Structural validity, concurrent validity, discriminant validity, internal consistency, and temporal stability of the new measure were examined. The final scale demonstrated adequate internal consistency (alphas=.83-.84), test-retest reliability (rs=.68-.74), and concurrent validity (small to moderate associations with predicted variables). Unrealistic relationship beliefs significantly differentiated aggressive and nonaggressive men, and this association remained significant after the authors controlled for other related variables.

Hazardous Alcohol Use and Intimate Partner Violence in the Military: Understanding Protective Factors

Hazardous alcohol use is a well-established risk factor for mens intimate partner violence (IPV), with dozens of studies demonstrating the association. The current study extends understanding of the hazardous alcohol use-IPV link by examining what factors moderate this association in a more systematic and broader way that has been done in past studies. Individual, family, workplace, community, and developmental factors were tested as moderators of the hazardous alcohol use and IPV link in a large, representative sample of active duty service members (the 2006 Community Assessment), and the results were tested for replicability in a hold-out sample. Two family variables (relationship satisfaction and parent-child satisfaction), 1 community variable (community safety), and 3 developmental variables (years in the military, marital length, and family income/pay grade) cross-validated as significant moderators of the association between mens hazardous alcohol use and IPV. Across the significant moderators, the association between hazardous alcohol use and mens IPV was weakened by maturation/development, improved community safety, and better relationship functioning. No individual or workplace variables were significant moderators for men, and there were no significant moderators found for women. The results support the importance of a developmental and relational perspective to understanding the hazardous alcohol use-IPV link, rather than solely an individual coping perspective.

Enhanced definitions of intimate partner violence for DSM-5 and ICD-11 may promote improved screening and treatment

Nuanced, multifaceted, and content valid diagnostic criteria for intimate partner violence (IPV) have been created and can be used reliably in the field even by those with little-to-no clinical training/background. The use of such criteria such as these would likely lead to more reliable decision making in the field and more consistency across studies. Further, interrater agreement was higher than that usually reported for individual mental disorders. This paper will provide an overview of (a) IPVs scope and impact; (b) the reliable and valid diagnostic criteria that have been used and the adaptation of these criteria inserted in the latest Diagnostic and Statistical Manual of Mental Disorders (DSM) and another adaptation proposed for the forthcoming International Statistical Classification of Diseases and Related Health Problems (ICD); (c) suggestions for screening of IPV in primary care settings; (d) interventions for IPV; and (e) suggested steps toward globally accepted programs.