Johanna Becho

Differences in Social Network Structure and Support Among Women in Violent Relationships

Social support is critical for women in abusive relationships. While social support may decrease the risk of getting into a violent relationship, it can also allow battered women to remain in violent relationships by reducing the negative impact of intimate partner violence (IPV). In addition to the social isolation that women in abusive relationships may experience, her social contacts appear to be important. The purpose of this study was to compare the size, structure, and composition of the social networks of women in abusive relationships with those of a matched cohort of nonabused women. The authors enrolled women from primary care clinics who reported abuse within the prior month, and a demographically matched comparison group of women in nonabusive relationships. Participants completed a social network analysis, and investigators compared social networks of abused with nonabused women. The networks of women in abusive relationships were smaller in size, but more efficient in their ability to reach their members, than those of nonabused women. Proportionally, networks of abused women had more women but fewer in-laws than those of comparison women. The women in these abusive relationships had higher measures of centrality, suggesting that they were more critical in holding their networks together. Yet, they had fewer social contacts, and provided more support than they received with fewer reciprocated ties. Thus, social networks of women in violent relationships are small and offer less support than those of comparison women. However, previous work on networks with weak ties and structural holes suggests that access to resources may be available through these networks.

The role of physical activity and diabetes status as a moderator: functional disability among older Mexican Americans

PURPOSE we investigate the temporal association between the rate of change in physical function and the rate of change in disability across four comparison groups: Those with and without diabetes who report >30 min of physical activity per day, and those who report <30 min of physical activity per day. METHODS six waves of longitudinal data from the Hispanic Established Population for Epidemiologic Studies of the Elderly were utilised. At baseline, there were a total of 3,050 elder participants aged 65 years old or greater. The longitudinal rates of change in disability and physical function were compared by the diabetes status (ever versus none) and the physical activity status (less than or greater than or equal to 30 min per day). RESULTS disability and physical function data were analysed using a latent growth curve modelling approach adjusted for relevant demographic/health-related covariates. There were statistically significant longitudinal declines in physical function and disability (P < 0.001) in all groups. Most notable, the physical activity status was an important moderator. Those with >30 min of activity demonstrated better baseline function and less disability as well as better temporal trajectories than those reporting <30 min of physical activity per day. Comparisons between diabetes statuses within the same physical activity groups showed worse disability trajectories among those with diabetes. CONCLUSIONS a longitudinal decline in physical function and disability is moderated most notably by physical activity. The diabetes status further moderates decline in function and disability over time. Increased physical activity appears to be protective of disability in general and may lessen the influence of diabetes-related disability in older Mexican Americans, particularly at the end of life.

Complex Dynamics in Intimate Partner Violence: A Time Series Study of 16 Women

OBJECTIVE Three theories attempt to explain the dynamics of intimate partner violence, each representing a different dynamic pattern of violence: periodic, chaotic, and random. But few studies assess violence and its potential predictors in real time or permit assessment of the dynamics of violence. The purpose of this exploratory study was to estimate the degree of complexity in patterns of violence and identify predictors of violent events. METHOD This time series study was conducted between September 2006 and April 2007 among 16 adult women presenting to a university-affiliated family health center who had experienced violence within the past month. Women completed a daily telephone assessment of household environment and marital relationship for 2 months. To assess the degree of complexity, 3 different measures were used. Lyapunov exponents and saturation of correlation dimension were used to approximate dynamic patterns. Vector autoregression identified prior-week predictors of violence. Results were pooled across the 16 subjects who provided daily reports using meta-analytic techniques. RESULTS Most relationships exhibited complex dynamics, with all 3 distinct dynamic patterns found. The longer the relationship had lasted, the more predictable and periodic were its dynamics. The more frequent the violence, the more complex and sensitive to change were its dynamics. Comparing dynamic patterns, 3 distinct combinations of significant prior-day and prior-week associations were found. CONCLUSIONS Although complex dynamics were unrelated to duration of violence, there was a dynamic tension between (1) the duration of the relationship and its periodic temporal patterns and (2) the frequency of violence and its complex dynamics. Identification of dynamic patterns may aid understanding of the phenomena of intimate partner violence and lead to novel targeted screening, monitoring, and intervention/treatment approaches.

Dynamics of violence

RATIONALE, AIMS AND OBJECTIVES Three behavioural models suggest different dynamic patterns of intimate partner violence (IPV). However, few studies permit assessment of IPV dynamics. The purpose of this study was to estimate the degree of non-linearity in daily violence between partners over a 3-month period, identify their specific dynamic patterns and determine whether measures of violence severity and dynamics are interrelated. METHODS From six primary care clinics, we enrolled 200 adult women who experienced violence in the previous month and asked them to complete daily telephone assessments of household environment, marital relationship and violence using Interactive Verbal Response. To assess non-linearity of violence, algorithmic complexity was measured by LZ complexity and lack of regularity was measured by approximate entropy. Lyapunov exponents and correlation dimension saturation were used to approximate dynamic patterns. RESULTS Of the 9618 daily reports, women reported experiencing abuse on 39% of days, while perpetrating violence themselves on 23% of days. Most (59%) displayed random dynamics, 30% showed chaotic and 12% showed periodic dynamics. All three measures of non-linearity consistently demonstrated non-linear patterns of violence. Using multivariate analysis of variance, neither episode severity for men or women showed significant differences across dynamic types, but chaotic dynamics had the lowest frequencies of violence in men and women while random dynamics had the highest frequencies. Approximate entropy was positively correlated with violence frequency and burden in men and women, but Lyapunov exponent was inversely related to violence. LZ complexity correlated positively with wife-perpetrated violence only. CONCLUSIONS IPV is rarely a predictable, periodic phenomenon; no behavioural model describes the violence dynamics for all violent relationships. Yet, the measures of non-linearity and specific dynamic patterns correlate with different violent features of these relationships.

Safely examining complex dynamics of intimate partner violence.

The overall goal of this study is to use complexity science to gain a deeper understanding of the nonlinear day-to-day dynamics of intimate partner violence, with implications for clinical interventions. This report describes research methods for gathering information about partner violence in real time and assesses recruitment and retention, adherence to study protocol, data validity, and participant safety. Research assistants enrolled 200 women in moderately violent intimate relationships and asked them to report about their relationships every day for 12 weeks. Daily, participants telephoned an Interactive Voice Response (IVR) system and responded to 34 survey questions. They also completed baseline and end-of-study surveys and maintained telephone contact with the study team weekly. Forty-two participants completed qualitative end-of-study interviews to describe their relationships and the impact of the study on their lives. Of 200 enrollees, 145 women provided enough data for nonlinear analyses, averaging 63.5 daily reports of 84 possible. Participants submitted 9,201 daily reports, documenting partners verbal or physical aggression on 39.4% of days, and their own aggression on 23.1%. Two women were withdrawn from the study for safety reasons; the remainder reported that study participation posed no additional threat. Eighty women sought assistance from community resources. Violence severity did not appear to change over the 12 weeks. The research team successfully and safely recruited and retained 145 women who provided valuable data for a study of complex dynamics of intimate partner violence.

Physician-assisted suicide attitudes of older Mexican-American and non-Hispanic white adults: does ethnicity make a difference?

Little is known about attitudes toward physician‐assisted suicide (PAS) in various ethnic groups. This study compares attitudes held by older Mexican Americans and non‐Hispanic whites and examines subject characteristics that may influence their responses. A convenience sample of 100 older Mexican Americans and 108 non‐Hispanic whites (n=208) aged 60 to 89 were recruited from four primary care community‐based practice sites in San Antonio, Texas. Interview items measured attitudes toward PAS, cognitive status, functional status, and religiosity.

Webs of causation in violent relationships

RATIONALE, AIMS AND OBJECTIVES Predictors of intimate partner violence (IPV) include husband, wife and relational characteristics. However, we know little about the proximal, day-to-day triggering of abusive events. The purpose of the study was to analyse the daily temporal relationships among environmental, relational and violence variables in violent marital relationships. METHOD Two hundred adult primary care women who experienced violence in the previous month were recruited from six primary care clinics. Women completed daily assessments of household environment, marital relationship and violence using telephone interactive verbal response for 12 weeks. Same-day correlates were sought using cross-correlations among the environmental, relational and violence factors. Prior-day and prior-week associations were sought using vector autoregressions. RESULTS Except for wifes alcohol intake, all household environment and relationship factors demonstrated significant same-day correlations with IPV. However, prior-day violence by the husband, hassles, lack of husbands alcohol intake, emotional upset and marital distance were significantly related to current husband-perpetrated violence. Wifes violence depended upon her prior-day violence and alcohol intake only. All factors were related to husband-perpetrated violence in the subsequent week. Only wifes alcohol intake and husbands seeking forgiveness did not feedforward. In addition to the presence of multiple interdependent factors, circular causality was noted for marital distance and feeling upset. CONCLUSIONS IPV was due to multiple interdependent factors, feedforward dynamics and circular causality as expected in complex systems. The complex dynamics imply that simple interventions may have little chance of success, but understanding couple-specific dynamics may allow women to recognize high-risk prior-day profiles and take preventive action.

Predictors of Perceived Need for and Actual Action Taking Among Women in Violent Relationships

Decision-making of women in violent relationships is poorly understood. The study seeks to identify predictors of need-for-action and actions taken by women in violent relationships. The participants were 143 women who experienced violence in previous month from 6 primary care clinics. The methods involved multiple times series using daily assessments of household environment, marital relationship, concerns, violence, and need-for-action collected via telephone interactive voice response for 8 weeks. Outcomes include daily need-for-action and reports of actions taken. Same-day correlates and prior-day associations using vector autoregressions were sought, combined across subjects using meta-analytic techniques. Need for help depended on stalking, concern for child safety, forgiveness, and low perceived control; actually seeking help depended on sense of control with same-day stress and need for help. Need for legal action depended on concern for child safety and finances with desire to keep family together; actually taking legal action, correlated only with prior-day stalking and concerns about child safety but less about effects of violence on child. Need to leave depended on his violence, with concern about its effect on child, her forgiveness, and a low desire to keep family together, while actually leaving was primed by a day of his drinking, and triggered by same-day stress and need to leave, but lower levels of her drinking or his seeking forgiveness. Once gone, prior-day stalking and his alcohol use correlated with returning to the relationship. Taking action depends upon few prior- and same-day factors unique to each action.

Effects of religious and spiritual variables on outcomes in violent relationships

Objective Religious and spiritual factors in intimate partner violence have received increasing attention. But are such factors related to outcomes in violent relationships? The purpose of this study was to assess the relative impact of spiritual symptoms and religious coping on attitudinal/behavioral and clinical outcomes among women in violent relationships. Methods Adult women with a recent history of husband-to-wife physical abuse were recruited from six primary care clinics. Once enrolled, 200 subjects completed a baseline interview and daily assessment of level of violence, using the Interactive Verbal Response for 12 weeks. At the completion of the study, contact with each participant was attempted to determine whether she had either sought professional help or left the relationship. Three religious/spiritual variables were assessed at baseline—number of visits to a religious/spiritual counselor, religious coping, and severity of spiritual symptoms. Stepped multiple linear regression was used to explain factor-analyzed outcomes (coping and appraisals, hope and support, symptomatology, functional status, readiness for change, and medical utilization), adjusting for demographic, marital, childhood, mental health, and violence variables. Results After controlling for duration, severity and dynamics of violence, the use of spiritual resources, and the level of spiritual symptoms were associated with most attitudinal/behavioral and clinical outcomes, while religious coping was only associated with staying in the relationship. Conclusions Religious and spiritual factors were associated with most outcomes. Spiritual symptoms had a consistently negative effect on outcomes while use of spiritual resources had variable effects. Religious coping was only associated with refraining from leaving the relationship.

Multi‐day recurrences of intimate partner violence and alcohol intake across dynamic patterns of violence

Rationale, aims and objectives Consistent links exist between male alcohol intake and male-perpetrated intimate partner violence (IPV) as well as female alcohol intake and female-perpetrated IPV. However, the nature of the relationship remains unclear. This study attempted to identify unique alcohol–violence patterns within three different types of relationship dynamics to better understand the alcohol–violence relationship and its role in violence dynamics. Method Two hundred women in abusive relationships were recruited from six primary care clinics. Subjects completed daily assessments of their relationship using interactive verbal response via telephone for 12 weeks. Dynamic patterns (periodic, chaotic, random) were determined by positive versus negative Lyapunov exponents and measures of correlation dimension saturation. To identify recurrent day-to-day activities, we used orbital decomposition (based on symbolic dynamics). Results Periodic dynamics included daily reports with mutual abuse and alcohol intake while random dynamics included a variety of patterns, especially those involving unequal mutual abuse. Unique strings for each dynamic pattern were examined. Periodic dynamics involved heavy alcohol intake by the husband or mutual moderate-severe violence. Random dynamics uniquely involved mutual verbal abuse with husbands alcohol intake on same or different days as well as husband-perpetrated moderate-severe violence with or without husband-perpetrated minor violence. Chaotic dynamics uniquely involved combinations from wife-perpetrated minor violence alone to combinations of husbands heavy alcohol intake (with or without husband-perpetrated minor violence), mutual verbal abuse, and husband-perpetrated verbal abuse (with or without husbands heavy alcohol intake). Conclusion Recurrent 4-day patterns were observed. Each dynamic pattern was characterized by recurrent strings unique to that pattern.RATIONALE, AIMS AND OBJECTIVES Consistent links exist between male alcohol intake and male-perpetrated intimate partner violence (IPV) as well as female alcohol intake and female-perpetrated IPV. However, the nature of the relationship remains unclear. This study attempted to identify unique alcohol-violence patterns within three different types of relationship dynamics to better understand the alcohol-violence relationship and its role in violence dynamics. METHOD Two hundred women in abusive relationships were recruited from six primary care clinics. Subjects completed daily assessments of their relationship using interactive verbal response via telephone for 12 weeks. Dynamic patterns (periodic, chaotic, random) were determined by positive versus negative Lyapunov exponents and measures of correlation dimension saturation. To identify recurrent day-to-day activities, we used orbital decomposition (based on symbolic dynamics). RESULTS Periodic dynamics included daily reports with mutual abuse and alcohol intake while random dynamics included a variety of patterns, especially those involving unequal mutual abuse. Unique strings for each dynamic pattern were examined. Periodic dynamics involved heavy alcohol intake by the husband or mutual moderate-severe violence. Random dynamics uniquely involved mutual verbal abuse with husbands alcohol intake on same or different days as well as husband-perpetrated moderate-severe violence with or without husband-perpetrated minor violence. Chaotic dynamics uniquely involved combinations from wife-perpetrated minor violence alone to combinations of husbands heavy alcohol intake (with or without husband-perpetrated minor violence), mutual verbal abuse, and husband-perpetrated verbal abuse (with or without husbands heavy alcohol intake). CONCLUSION Recurrent 4-day patterns were observed. Each dynamic pattern was characterized by recurrent strings unique to that pattern.