Nancy Felipe Russo

Violence against women: Physical and mental health effects. Part I: Research findings*

Abstract Interpersonal violence is a ubiquitous source of fear, distress, and injury in the lives of women in the United States, crossing lines of age, race, ethnicity, and economic status ( Coley & Beckett, 1988 ; Frieze & Browne, 1989 ; Koss, 1988 ; Straus, Gelles, & Steinmetz, 1980 ). In recent years, the public health community has become increasingly aware that “this violence is a serious public health problem … [and that] nonfatal interpersonal violence has far-reaching consequences in terms of morbidity and quality of life” ( Center for Disease Control, 1985 , p. 739). This article reviews the physical and mental health effects on adult women of physical abuse and sexual assault, and describes their implications for mental health research and practice.

Abortion and Mental Health: Evaluating the Evidence.

The authors evaluated empirical research addressing the relationship between induced abortion and womens mental health. Two issues were addressed: (a) the relative risks associated with abortion compared with the risks associated with its alternatives and (b) sources of variability in womens responses following abortion. This article reflects and updates the report of the American Psychological Association Task Force on Mental Health and Abortion (2008). Major methodological problems pervaded most of the research reviewed. The most rigorous studies indicated that within the United States, the relative risk of mental health problems among adult women who have a single, legal, first-trimester abortion of an unwanted pregnancy is no greater than the risk among women who deliver an unwanted pregnancy. Evidence did not support the claim that observed associations between abortion and mental health problems are caused by abortion per se as opposed to other preexisting and co-occurring risk factors. Most adult women who terminate a pregnancy do not experience mental health problems. Some women do, however. It is important that womens varied experiences of abortion be recognized, validated, and understood.

Gender-based violence: concepts, methods, and findings

Abstract:  The United Nations has identified gender‐based violence against women as a global health and development issue, and a host of policies, public education, and action programs aimed at reducing gender‐based violence have been undertaken around the world. This article highlights new conceptualizations, methodological issues, and selected research findings that can inform such activities. In addition to describing recent research findings that document relationships between gender, power, sexuality, and intimate violence cross‐nationally, it identifies cultural factors, including linkages between sex and violence through media images that may increase womens risk for violence, and profiles a host of negative physical, mental, and behavioral health outcomes associated with victimization including unwanted pregnancy and abortion. More research is needed to identify the causes, dynamics, and outcomes of gender‐based violence, including media effects, and to articulate how different forms of such violence vary in outcomes depending on cultural context.

Male violence against women. Current research and future directions

This Psychology in the Public Forum section, authored by the American Psychological Associations Committee on Women in Psychologys Task Force on Male Violence Against Women and by Senator Joseph Biden, examines the prevalence, impact, and public policy dimensions of physical assault, sexual assault, and sexual harassment of women. This introduction reviews common themes that emerge from the articles that follow. It concludes by emphasizing that the problem of violence against women cannot be fully understood, let alone solved, by focusing exclusively on individual psychology. Only by changing the social and cultural institutions that have given rise to the problem can a lasting solution be achieved.

FAMILY AND WORK PREDICTORS OF PSYCHOLOGICAL WELL-BEING AMONG HISPANIC WOMEN PROFESSIONALS

This study examines the relative contributions of job- and gender-related variables to the mental health of Hispanic women professionals. Hispanic women professionals, managers and business owners (n = 303) were surveyed using the mailing list of a Hispanic professional womens organization. Results of multiple regression analyses indicate that income and Hispanic group were consistently related to mental health measures. Spouse support and ethnicity of spouse were associated with measures of stress in balancing roles and psychological distress symptoms. Marital status was related to personal life satisfaction (married women reported more satisfaction), and having young children was negatively associated with personal and professional satisfaction. Experience of discrimination, job stress and peer support were also significantly related to mental health measures. Although preliminary, this study underscores the importance of both job- and gender-related factors in research on the effects of employment on Hispanic womens mental health.

Depression and unwanted first pregnancy: longitudinal cohort study

Abstract Objective To examine the outcomes of an unwanted first pregnancy (abortion v live delivery) and risk of depression and to explain discrepancies with previous research that used the same dataset. Design Longitudinal cohort study. Setting Nationally representative sample of US men and women aged 14-24 in 1979. Participants 1247 women in the US national longitudinal survey of youth who aborted or delivered an unwanted first pregnancy. Main outcome measures Clinical cut-off and continuous scores on a 1992 measure of the Center for Epidemiological Studies depression scale. Results Terminating compared with delivering an unwanted first pregnancy was not directly related to risk of clinically significant depression (odds ratio 1.19, 95% confidence interval 0.85 to 1.66). No evidence was found of a relation between pregnancy outcome and depression in analyses of subgroups known to vary in under-reporting of abortion. In analyses of the characteristics of non-respondents, refusal to provide information on abortion did not explain the lack of detecting a relation between abortion and mental health. The abortion group had a significantly higher mean education and income and lower total family size, all of which were associated with a lower risk of depression. Conclusions Evidence that choosing to terminate rather than deliver an unwanted first pregnancy puts women at higher risk of depression is inconclusive. Discrepancies between current findings and those of previous research using the same dataset primarily reflect differences in coding of a first pregnancy.

Mexican American Women’s Definitions of Rape and Sexual Abuse

Focus group approach was used to explore concepts related to rape and sexual abuse among 17 Mexican immigrant women living in rural Arizona. The women discussed definitions of various forms of unwanted sexual experiences, their personal knowledge of someone who had been raped or sexually abused, and their perceptions of the roots of sexual abuse. Distinctions between rapto and violación, child versus adult rape (including marital rape), motivations for rape, and social factors contributing to victim silencing were identified. The meaning and perceived impact of rape reflected the gender relations of the culture. Keeping silent was a consistent theme, underscoring the difficulties of accurately assessing rape prevalence in Latinas. Research, prevention, intervention, and treatment programs need to recognize the social context and impact of rape and be designed accordingly. Participants reported many rape experiences, suggesting that underreporting is a major problem in estimating rape prevalence for Latinas.

Abortion and anxiety: What's the relationship?

Using data from the United States National Survey of Family Growth (NSFG) and the National Comorbidity Survey (NCS), we conducted secondary data analyses to examine the relationship of abortion, including multiple abortions, to anxiety after first pregnancy outcome in two studies. First, when analyzing the NSFG, we found that pre-pregnancy anxiety symptoms, rape history, age at first pregnancy outcome (abortion vs. delivery), race, marital status, income, education, subsequent abortions, and subsequent deliveries accounted for a significant association initially found between first pregnancy outcome and experiencing subsequent anxiety symptoms. We then tested the relationship of abortion to clinically diagnosed generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), and social anxiety disorder, using NCS data. Contrary to findings from our analyses of the NSFG, in the NCS analyses we did not find a significant relationship between first pregnancy outcome and subsequent rates of GAD, social anxiety, or PTSD. However, multiple abortions were found to be associated with much higher rates of PTSD and social anxiety; this relationship was largely explained by pre-pregnancy mental health disorders and their association with higher rates of violence. Researchers and clinicians need to learn more about the relations of violence exposure, mental health, and pregnancy outcome to avoid attributing poor mental health solely to pregnancy outcomes.

Is There an “Abortion Trauma Syndrome”? Critiquing the Evidence

&NA; The objective of this review is to identify and illustrate methodological issues in studies used to support claims that induced abortion results in an “abortion trauma syndrome” or a psychiatric disorder. After identifying key methodological issues to consider when evaluating such research, we illustrate these issues by critically examining recent empirical studies that are widely cited in legislative and judicial testimony in support of the existence of adverse psychiatric sequelae of induced abortion. Recent studies that have been used to assert a causal connection between abortion and subsequent mental disorders are marked by methodological problems that include, but not limited to: poor sample and comparison group selection; inadequate conceptualization and control of relevant variables; poor quality and lack of clinical significance of outcome measures; inappropriateness of statistical analyses; and errors of interpretation, including misattribution of causal effects. By way of contrast, we review some recent major studies that avoid these methodological errors. The most consistent predictor of mental disorders after abortion remains preexisting disorders, which, in turn, are strongly associated with exposure to sexual abuse and intimate violence. Educating researchers, clinicians, and policymakers how to appropriately assess the methodological quality of research about abortion outcomes is crucial. Further, methodologically sound research is needed to evaluate not only psychological outcomes of abortion, but also the impact of existing legislation and the effects of social attitudes and behaviors on women who have abortions.

Hispanic Women and Mental Health: An Overview of Contemporary Issues in Research and Practice.

We would like to thank Patricia Arredondo, Manual Barrera, Deborah Belle, Martha Bernal, Sanford Braver, Laura Brown, Glorisa Canino, Lillian Comas-Diaz, Oliva Espin, Irene Frieze, Angela Ginorio, Sara Gutierres, Christine Iijima Hall, Jean Hamilton, Nancy Henley, Alexandra Kaplan, Rita Mae Kelly, Brenda Major, Vivian Makosy, Angela McBride, D. Allen Meyer, Carol Nadelson, Anne Petersen, Kathleen Pottick, Lenore Radloff, R. E. Roberts, Gloria Romero, Banisa Saint-Damian, Elaine Soto, Cynthia Telles, Carol Valentine, Melba Vasquez, Ena Vasquez-Nuttall, and Maxine Baca Zinn, who provided extensive comments on the manuscripts that were submitted. Every manuscript that was included received an outside review and underwent an extensive revision process. In addition to the manuscripts published here, several are in the process of revision for later publication in Psychology of Women Quarterly. We are pleased that our goal of serving as a catalyst for the publication of research on the psychology of Hispanic women is being met, and want to express our appreciation to Editor Janet Shibley Hyde for her support and patience in the process. A special acknowledgement goes to Beth Roberts, of Cambridge University Press, for expediting the publication process. We would also like to thank Karen Applegate, Beth Walker-Corkery, Ria Hermann, and Lynn Virdin for assembling background materials for the issue, and Jan Lamoreaux for her secretarial assistance in processing the manuscript submissions. This work was partially supported by Amaro’s Research Fellowship from the Hispanic Health Research Consortium funded by the National Coalition of Hispanic Health and Human Services Organizations, and the Minigrant Program of the College of Liberal Arts and Sciences of Arizona State University. This project was a joint venture, with order of authorship for this overview determined alphabetically. Requests for reprints should be sent to: Hortensia Amaro, School of Public Health, Boston University, 85 E. Newton St., Boston, MA 02118.