Paige Hall Smith

Physical and mental health effects of intimate partner violence for men and women.

BACKGROUND Few population-based studies have assessed the physical and mental health consequences of both psychological and physical intimate partner violence (IPV) among women or men victims. This study estimated IPV prevalence by type (physical, sexual, and psychological) and associated physical and mental health consequences among women and men. METHODS The study analyzed data from the National Violence Against Women Survey (NVAWS) of women and men aged 18 to 65. This random-digit-dial telephone survey included questions about violent victimization and health status indicators. RESULTS A total of 28.9% of 6790 women and 22.9% of 7122 men had experienced physical, sexual, or psychological IPV during their lifetime. Women were significantly more likely than men to experience physical or sexual IPV (relative risk [RR]=2.2, 95% confidence interval [CI]=2.1, 2.4) and abuse of power and control (RR=1.1, 95% CI=1.0, 1.2), but less likely than men to report verbal abuse alone (RR=0.8, 95% CI=0.7, 0.9). For both men and women, physical IPV victimization was associated with increased risk of current poor health; depressive symptoms; substance use; and developing a chronic disease, chronic mental illness, and injury. In general, abuse of power and control was more strongly associated with these health outcomes than was verbal abuse. When physical and psychological IPV scores were both included in logistic regression models, higher psychological IPV scores were more strongly associated with these health outcomes than were physical IPV scores. CONCLUSIONS Both physical and psychological IPV are associated with significant physical and mental health consequences for both male and female victims.

A Longitudinal Perspective on Dating Violence Among Adolescent and College-Age Women

OBJECTIVES We investigated physical assault in dating relationships and its co-occurrence with sexual assault from high school through college. METHODS Two classes of university women (n = 1569) completed 5 surveys during their 4 years in college. RESULTS Women who were physically assaulted as adolescents were at greater risk for revictimization during their freshman year (relative risk = 2.96); each subsequent year, women who have experienced violence remained at greater risk for revictimization than those who have not. Across all years, women who were physically assaulted in any year were significantly more likely to be sexually assaulted that same year. Adolescent victimization was a better predictor of college victimization than was childhood victimization. CONCLUSIONS There is a need for dating violence prevention/intervention programs in high school and college and for research on factors that reduce revictimization.

Social Support Protects against the Negative Effects of Partner Violence on Mental Health

OBJECTIVES Social support for abused women may reduce the impact of abuse on mental health, yet few studies have addressed this issue. We wish to determine associations between intimate partner violence (IPV) and mental health outcomes and to assess the protective role of abuse disclosure and support on mental health among abused women. METHODS A cross-sectional survey was conducted of 1152 women, ages 18-65, recruited from family practice clinics from 1997 through 1999. They were screened for IPV during a brief in-clinic interview, and physical and mental health status was assessed in a follow-up interview. RESULTS IPV, defined as sexual, physical, or psychological abuse, was associated with poor perceived mental and physical health, substance abuse, symptoms of posttraumatic stress disorder (PTSD), current depression, anxiety, and suicide ideation/actions. Among women experiencing IPV and controlling for IPV frequency, higher social support scores were associated with a significantly reduced risk of poor perceived mental health (adjusted relative risk [aRR] 0.5, 95% confidence interval [CI] 0.3, 0.6) and physical health (aRR 0.6, 95% CI 0.5, 0.8), anxiety (aRR 0.3, 95% CI 0.2, 0.4), current depression (aRR 0.6, 95% CI 0.5, 0.8), PTSD symptoms (aRR 0.5, 95% CI 0.4, 0.8), and suicide attempts (aRR 0.6, 95% CI 0.4, 0.9). CONCLUSIONS Healthcare providers can be instrumental in identifying IPV and helping women develop skills, resources, and support networks to address IPV. Physicians, family, or friends may provide needed social support.

Social support reduces the impact of partner violence on health: application of structural equation models.

BACKGROUND Intimate partner violence (IPV) is associated with poorer health, yet pathways through which IPV affects either mental or physical health are not well characterized. METHODS Structural equation modeling was used to test a model in which physical-IPV and battering were considered as separate independent variables. The sample included 191 women currently experiencing either physical IPV or battering. Emotional support provided to women experiencing IPV was hypothesized to mediate the impact of IPV on current mental and physical health (dependent variables). RESULTS Higher scores on emotional support were associated with better physical (beta = -0.23, P < 0.01) and mental health (beta = -0.27, P < 0.001). Physical IPV was directly associated with poorer mental health (beta = 0.023, P < 0.01) and indirectly associated with poorer physical health (beta = 0.18, P < 0.001) and mental health (beta = -0.04, P < 0.05), primarily through battering. Higher battering scores were directly associated with less emotional support (beta = -0.33, P < 0.001) and indirectly associated with poorer physical (beta = 0.12, P < 0.01) and mental health (beta = 0.09, P < 0.01), primarily through emotional support. Model diagnostics indicated a good fit (chi(2) = 20.44, P = 0.37, GFI = 0.98, CFI = 0.99, RMSEA = 0.02). CONCLUSIONS Higher levels of emotional support may modify the effect of IPV on health. Interventions to increase social and emotional support to abused women may reduce mental and physical health consequences.

Beyond the Measurement Trap A Reconstructed Conceptualization and Measurement of Woman Battering

Many areas of womens health, including battering, suffer from conceptual and methodological deficits. This article uses the “measurement trap” (Graham & Campbell, 1991), a set of conditions defined by lack of information resulting from a narrow conceptualization of the problem, poor existing data sources, inappropriate outcome indicators, and limited measurement techniques, as a framework for describing how current approaches to conceptualizing and measuring battering hamper research and program efforts in the field of domestic violence. We then describe an alternative conceptualization-and-measurement approach that is based on battered womens experiences. We argue that an experiential approach, which grounds measurement in womens lived experiences, improves our ability to conduct research that correctly identifies, monitors, and explains the epidemiology of this phenomenon and provides a solid basis for policy and program development.

Women's Experiences with Battering: A Conceptualization from Qualitative Research

Battering of women by their male partners affects an estimated 3 -4 million women each year in the United States. Prevalence studies indicate that between one-third and one-fifth of all women will be physically assaulted by a male partner. Battering generally consists of mens continuous use of physical, and often sexual, assaults along with verbally and emotionally abusive behaviors that may become more severe and damaging over time. In addition to assaulting their partners, batterers also threaten, intimidate, and humiliate them; isolate them from family and friends; restrict their access to money and other resources; threaten the safety of children and others in their families; and control their activities outside the home. Sex is also a weapon batterers use to gain power over their partners; this manifests itself as both rape and withholding sexual affection. Evidence is growing that the physical, psychological, and sexual violence battered women are subjected to contributes to the development of many serious health problems including injury, depression, anxiety, posttraumatic stress disorder, chronic pain, gastrointestinal disorders, substance abuse, suicide, and homicide.

A Population-Based Study of the Prevalence and Distinctiveness of Battering, Physical Assault, and Sexual Assault in Intimate Relationships

The types of violence subsumed under the term intimate partner violence include physical assault, sexual assault, psychological abuse, and battering. This study is the first to estimate the prevalence of intimate partner violence by type (battering, physical assaults, and sexual assaults) in a population-based sample of women aged 18 to 45. The authors describe the prevalence of partner violence by type as well as the demographic, health behavior, and health status correlates of intimate partner violence by type. Findings support the empirical distinction of battering and assault. Battering as measured by the Womens Experiences With Battering (WEB) Scale provided the most comprehensive measure of intimate partner violence.

Sexual Assault Perpetration and Reperpetration: From Adolescence to Young Adulthood

Three incoming freshmen classes of men provided data in a 5-year longitudinal study of the relationship between childhood victimization experiences and sexually coercive behaviors during adolescence and 4 years of college. A key finding of this study was that men who were physically punished, sexually abused, or who witnessed domestic violence in childhood were at greater risk for sexual perpetration in high school. Furthermore, men who perpetrated in high school were at greater risk for sexual perpetration in college; and after controlling for perpetration in high school, those who were abused or witnessed violence in childhood were not at greater risk for college perpetration. The findings have a number of implications for research and practice: We need to identify high-risk populations and direct more targeted interventions toward them. These groups include those who witness or experience abuse as a child and young men who perpetrate violence in adolescence, regardless of childhood abuse experiences.

Intimate Partner Aggression—What Have We Learned? Comment on Archer (2000)

This commentary on J. Archer (2000) identifies limitations at the level of the primary data, the formal meta-analysis, and the interpretations of the results. Highlighted are concerns with the conceptual dichotomy that is the foundation of the analysis, how aggression was conceptualized and defined, and the methodological problems in the studies included in the database that were not neutralized by the meta-analysis. These include inadequate measurement of contextual factors and injury outcomes, scaling issues, and sampling concerns. The authors question the degree to which the field is advanced by this meta-analysis when the results are placed in the context of these limitations. Following American Association for the Advancement of Science directives (I. Lerch, 1999), the authors believe that inadequate attention was paid to the policy implications of the conclusions raising the potential to undermine societal efforts to eradicate violence against women.

Physical Partner Violence and Medicaid Utilization and Expenditures

Objectives. Little research has addressed differences in health care expenditures among women who are currently experiencing intimate partner violence (IPV) compared with those who are not. The purpose of this work is to provide estimates of direct medical expenditure for physician, drug, and hospital utilization among Medicaid-eligible women who screened as currently experiencing IPV compared with those who are not currently experiencing IPV. Methods. In this family practice-based cross-sectional study, women were screened for current IPV using a 15-item Index of Spouse Abuse–Physical (ISA-P) between 1997 and 1998. Consents were obtained from study subjects to review Medicaid expenditure and utilization data for the same time period. Results. Mean physician, hospital, and total expenditures were higher for those women with higher IPV scores compared with those who scored as not currently experiencing IPV, after adjusting for confounders. Higher IPV scores were associated with a three-fold increased risk of having a total expenditure over