Juncal Plazaola-Castaño

Intimate partner violence and mental health consequences in women attending family practice in Spain.

Objective: Despite the abundant literature on the consequences of intimate partner violence (IPV) on mental health, psychological abuse has rarely been considered, and the separate effects of the different types of IPV have been understudied. The aim of this study was to analyze the association between physical, psychological, and sexual IPV and women’s mental health. Methods: The sample included 1402 randomly selected women attending general practice in Spain. Information about IPV, use of psychoactive drugs, psychological distress (measured with the 12-item General Health Questionnaire), and self-perceived health status was obtained through a self-administered structured questionnaire. Results: Lifetime IPV prevalence was 32%. All types of abuse were significantly associated with psychological distress, tranquilizers, and antidepressants use. Compared with never-abused women, those referring psychological abuse solely were more likely to present negative mental health indicators. Women reporting physical abuse presented worse self-perceived health than never-abused women (odds ratio [OR] = 1.74; 95% confidence interval [CI] = 1.04–2.91 for combined physical and psychological abuse; OR = 2.91; 95% CI = 1.73–4.91 for combined physical, psychological, and sexual abuse). Women referring the 3 types of abuse were the most likely to present impaired mental health. Increased intensity and duration of some abusive experiences also led to increased levels of association with poor mental health. Conclusions: This study underlines that different types of IPV can affect mental health differently. Results also show that IPV can be present even when there are no physical injuries and highlight the need for clinicians to screen for psychological, as well as physical and sexual, IPV. IPV = intimate partner violence; PTSD = posttraumatic stress disorder; OR = odds ratio; CI = confidence interval; US = United States; GHQ = General Health Questionnaire.

Methodological issues in the study of violence against women

The objective of this paper is to review the methodological issues that arise when studying violence against women as a public health problem, focusing on intimate partner violence (IPV), since this is the form of violence that has the greatest consequences at a social and political level. The paper focuses first on the problems of defining what is meant by IPV. Secondly, the paper describes the difficulties in assessing the magnitude of the problem. Obtaining reliable data on this type of violence is a complex task, because of the methodological issues derived from the very nature of the phenomenon, such as the private, intimate context in which this violence often takes place, which means the problem cannot be directly observed. Finally, the paper examines the limitations and bias in research on violence, including the lack of consensus with regard to measuring events that may or may not represent a risk factor for violence against women or the methodological problem related to the type of sampling used in both aetiological and prevalence studies.

Women’s Response to Intimate Partner Violence:

The responses of women to a situation of abuse by their partner has hardly been addressed in the literature. Using a self-administered, anonymous questionnaire, 400 women attending three practices in a primary health care center in Granada (Spain) were studied. The women’s response to abuse was used as a dependent variable. Sociodemographics, intensity, duration, and combination of the types of abuse were used as independent variables. Lifetime prevalence of any type of partner abuse was 22.8%. Of abused women, 68% showed an active response, attempting to resolve the situation mainly through separation (58.2%). The factors independently associated with a woman’s active response were being separated, widowed, or divorced; reporting a greater intensity of abuse; and being younger than age 35 years. The results of this study show that a large majority of abused women in Spain try to resolve their situation, and that they are not passive victims.

Partner Violence and Psychological Well-Being: Buffer or Indirect Effect of Social Support

Objectives: To determine the effect of two kinds of intimate partner violence (IPV) (physical and psychological) in the previous 12 months (current) and before the previous 12 months (past) on psychological well-being among women aged 18 to 70 years who attend primary healthcare centers in Spain; and to analyze the effect of the duration of lifetime IPV and social support on psychological well-being. Methods: A cross-sectional survey was carried out among 10,322 women randomly recruited in primary healthcare centers in Spain. Outcome variables were three indicators of psychological well-being (psychological distress, psychotropic drug use, and self-perceived health). Predictor variables were the different types of IPV, IPV timing (current and past), duration of lifetime IPV, and social support. Logistic regression models were fitted. Results: Both types of IPV increased the probability of worse psychological well-being in both IPV timings (current and past). Longer duration of lifetime IPV, friends network size, and tangible support were independently associated with worse psychological well-being. However, an interaction between current IPV and family network size was found. The probability of poor self-perceived health status was reduced by 29% among women exposed to current IPV who had a large family network (odds ratio, 0.71; 95% confidence interval, 0.54-0.94). Conclusions: Psychological well-being was independently affected by IPV (types and duration) and social support (friends network size, tangible support). Only family network size mitigates the negative consequences of IPV on self-perceived health status. IPV = intimate partner violence; ISA = Index of Spouse Abuse.

Analysis of the impact of fibromyalgia on quality of life: associated factors

We analysed the impact of fibromyalgia (FM) on the functional capacity of patients suffering this syndrome and identified factors that are associated with greater disease impact. We performed a cross-sectional descriptive telephone survey on all patients diagnosed with fibromyalgia during 2003 in a university hospital in Spain. Variables studied were socio-demographic, job, clinical, health and psycho-social characteristics of patients diagnosed with FM and impact of FM on them. Disease impact was measured by means of the Fibromyalgia Impact Questionnaire (FIQ). The rest of variables were collected by means of an expressly designed questionnaire. The relation between FIQ score and the other variables was performed with a bivariate analysis, using several tests depending on the variables involved. To analyse the factors associated with greatest disease impact, a multivariate linear regression model was designed. The average FIQ score for the sample was 63.6. Having a larger number of children, being tired and being in a depressed mood were the symptoms that most affected activities of daily living. A diagnosis of any mental illness, reference to repercussion on the family environment, a lower self-rated health and having consulted more specialists before FM diagnosis were associated with a higher impact after adjusting according to all the variables in the model. It can be confirmed that the FIQ is a useful instrument for measuring the impact of FM on quality of life. Identifying factors that determine the extent of its impact will enable more effective therapeutic strategies to be designed.

Variabilidad geográfica de la violencia contra las mujeres en España

OBJECTIVES To describe the prevalence of intimate partner violence and non-partner violence against women in Spain overall and by autonomous regions, as well as the characteristics of this violence, and to study the association between the prevalence of intimate partner violence and the frequency of formal complaints and deaths. METHODS A cross-sectional survey was performed through a self-administered questionnaire in 11,475 women attending primary care from 2006 to 2007. Multistage stratified sampling was carried out in a representative sample in each autonomous region. Data on intimate partner and non-intimate partner violence, formal complaints to the police and deaths due to intimate partner violence were gathered. A descriptive analysis was conducted. Correlations between the prevalence of intimate partner violence and police reports and deaths from this cause were determined through Pearsons correlation coefficient. RESULTS A total of 24.8% (23.4%-26.3%) of the sample reported having experienced intimate partner violence at some time. The highest prevalence of intimate partner violence was found in Ceuta and Melilla (40.2%) and the Balearic Islands (32.5%) and the lowest in Cantabria (18%). Fifteen percent of the sample reported having experienced non-partner violence at some time, and the most frequent type was that committed by a relative. Again, the highest prevalence of non-partner violence was found in Ceuta and Melilla and the Balearic Islands and the lowest in Cantabria. A significant positive linear correlation was found between intimate partner violence in the previous year and the rate of reports of intimate partner violence in the autonomous regions (r=0.398; p=0.005). CONCLUSIONS The prevalence of intimate partner violence varies from one autonomous region to another. The reasons for this variation should be further explored in future studies.

La violencia contra la mujer en la pareja: un estudio en el ámbito de la atención primaria

Objetivos: Determinar la prevalencia de violencia contra la mujer en la pareja en una muestra de mujeres asistentes por cualquier motivo a centros de atencion primaria, y analizar las caracteristicas de esta violencia. Metodos: Estudio transversal en 23 consultas de atencion primaria de Andalucia, Madrid y Valencia. La muestra incluye 1.402 mujeres entre 18 y 65 anos de edad elegidas aleatoriamente en estas consultas. Entre las variables recogidas mediante cuestionario autoadministrado se incluyeron la existencia de maltrato fisico, emocional o sexual, su temporalidad, su frecuencia y su duracion. Resultados: El 32% del total de mujeres en la muestra tuvo algun tipo de maltrato a lo largo de su vida. El 7% presento en algun momento de su vida maltrato fisico y emocional a la vez, el 14% maltrato emocional, el 3% maltrato emocional y sexual conjuntamente y el 6% los 3 tipos de maltrato. El 52% de las mujeres que refirieron los 3 tipos de maltrato lo habian sufrido durante mas de 5 anos. Hay una mayor probabilidad de padecer maltrato en la actualidad habiendolo sufrido con una pareja anterior en el pasado (odds ratio = 3,30; intervalo de confianza del 95%, 2,10-5,18). Conclusiones: Estos resultados ponen de manifiesto la magnitud de la violencia contra la mujer en la pareja en nuestro ambito. Los profesionales de la salud se encuentran en una situacion privilegiada para abordar este grave problema de salud publica.

Identifying sociodemographic differences in Intimate Partner Violence among immigrant and native women in Spain: A cross-sectional study

OBJECTIVES To analyze whether sociodemographics and social support have a different or similar effect on the likelihood of Intimate Partner Violence in immigrants and natives, and to estimate prevalences and associations between different types of IPV depending on womens birthplace. METHODS Cross-sectional study of 10,048 women (18-70 years) attending primary healthcare in Spain (2006-2007). OUTCOME Current Intimate Partner Violence (psychological, physical and both). Sociodemographics and social support were considered first as explicative and later as control variables. RESULTS Similar Intimate Partner Violence sociodemographic and social support factors were observed among immigrants and natives. However, these associations were stronger among immigrants, except in the case of poor social support (adjusted odds ratio natives 4.36 and adjusted odds ratio immigrants 4.09). When these two groups were compared, immigrants showed a higher likelihood of IPV than natives (adjusted odds ratios 1.58). CONCLUSION Immigrant women are in a disadvantaged Intimate Partner Violence situation. It is necessary that interventions take these inequalities into account.

Validation of the Spanish version of the Index of Spouse Abuse

BACKGROUND Partner violence against women is a major public health problem. Although there are currently a number of validated screening and diagnostic tools that can be used to evaluate this type of violence, such tools are not available in Spain. The aim of this study is to analyze the validity and reliability of the Spanish version of the Index of Spouse Abuse (ISA). METHODS A cross-sectional study was carried out in 2005 in two health centers in Granada, Spain, in 390 women between 18 and 70 years old. Analyses of the factorial structure, internal consistency, test-retest reliability, and construct validity were conducted. Cutoff points for each subscale were also defined. For the construct validity analysis, the SF-36 perceived general health dimension, the Rosenberg Self-Esteem Scale and the Goldberg 12-item General Health Questionnaire were included. RESULTS The psychometric analysis shows that the instrument has good internal consistency, reproducibility, and construct validity. CONCLUSIONS The scale is useful for the analysis of partner violence against women in both a research setting and a healthcare setting.

Risk factors for fibromyalgia: the role of violence against women

The objectives of the study were to analyse the association between fibromyalgia (FM) and violence against women and to explore the association between FM and sociodemographic factors, social support and psychological distress. A case-control study was conducted in a Spanish hospital. Cases were women diagnosed with FM, with no signs of any other type of inflammatory rheumatic disorder, who were seen at the Rheumatology Department of the hospital. Controls were women not diagnosed with FM who were seen at the Ear, Nose and Throat Department of the same hospital. A self-administered anonymous questionnaire was used to gather data on sociodemographic characteristics, violence, social support and psychological distress. Uni-, bi- and multivariate logistic regression analyses were conducted; 287 cases and 287 controls were recruited. The multivariate analysis showed that the probability of presenting FM increased with age (odds ratios (OR) = 1.06; CI95% = 1.03–1.09); that employed women and housewives were more likely to have the syndrome than unemployed women or students (OR = 4.97; CI95% = 1.45–17.02, and OR = 3.47; CI95% = 0.98–12.22, respectively); that the lower the educational level, the higher the probability of having FM; and that psychological distress was positively associated with the syndrome (OR = 4.62; CI95% = 2.68–7.97). Although abuse was more prevalent in cases than in controls, the differences were not statistically significant. However, frequency of abuse was positively and significantly correlated with FM. Although the aetiology of FM is still uncertain, it seems that certain psychosocial factors may be associated with the syndrome. Therefore, an interdisciplinary approach to the treatment of patients affected with this syndrome should be considered.