Sylvie Lo Fo Wong

Prevalence of intimate partner violence among migrant and native women attending general practice and the association between intimate partner violence and depression

OBJECTIVE To explore the prevalence of intimate partner violence (IPV) of women (aged >18 years) attending general practice and to assess the association between IPV and depression. METHODS A cross-sectional survey was conducted within 15 general practices across Rotterdam. The study population was all women older than 18 years of age attending general practice. Women were screened for sociodemographic factors, IPV and depression using the Composite Abuse Scale and the Beck Depression Inventory. RESULTS This study had a response rate of 63% (221 of 352 women). Two hundred and fourteen women were included in the study of whom 41% were migrants. Thirty per cent of the women attending general practise ever experienced IPV. Migrants experienced IPV 1.5 times more often compared to Dutch women. A significant association between IPV and depression was found. Half of the abused women were suffering from a depression. More than three-quarter of depressed women ever experienced IPV. CONCLUSIONS IPV is common in women attending general practice and it is significantly associated with depression. To improve recognition of abused women, doctors should ask depressed women if they ever experienced IPV.

Help-seeking behaviour of Serbian women who experienced intimate partner violence

OBJECTIVE This study aimed to identify whom women in Serbia approach for help in case of intimate partner violence (IPV), their reasons for seeking help and their satisfaction with the received help. METHODS A cross-sectional, population-based household survey of a random sample of women aged 15-49 years was conducted in Belgrade (WHO Multi-country Study on Womens Health and Domestic Violence against Women). A standard questionnaire was administered by trained interviewers through face-to-face interviews. RESULTS The questionnaire was completed by 1456 women and 1196 of them ever had an intimate partner. Almost one in four ever-partnered women reported experiencing either physical and/or sexual violence, at least once in their life. Among these abused women, ≈ 22% had ever sought help from formal institutions. Police and health services were most commonly approached (12% and 10% of abused women, respectively). Satisfaction with services was highest for health services and legal advice and lowest for police and social services. Women sought help especially when violence had a severe impact on them or when they saw that their children suffered. Women who did not seek help stated that they believed that the violence was bearable or had ended. Other reasons for not seeking help were fear of undesirable consequences of seeking help and lack of trust in institutions. CONCLUSIONS From the abused womens perspective, health care services are the institutions with the highest potential to help women in cases of IPV. Developing a comprehensive health sector response is of critical importance to ensure appropriate care and referral.

Why abused women do not seek professional help: a qualitative study

OBJECTIVE We aimed to gain insight into the process of help seeking of abused women visiting their family physician (FP). SETTING Family practice in Rotterdam, the Netherlands. METHOD We used a qualitative method with interviews in a sample of 14 abused women, identified in an earlier cross-sectional survey with the Composite Abuse Scale (CAS) and the Beck Depression Inventory (BDI). This qualitative method with semi-structured interviews was used to obtain information on the process of seeking help. RESULTS Unawareness of the impact of abuse on themselves and their children, unfamiliarity and negative experiences with professionals and fear for their partner hampers abused women to seek professional help. Our study reveals that abused women need informal support by family and friends to ask for professional support. Current health care does not fit into the needs of abused women during the abuse they want more practical support, after the abuse they need also psychological help. In our study, FPs and mothers pay less attention to the impact of witnessing violence on children. CONCLUSION When women are unaware of the negative consequences of IPV, the physical and mental well-being of themselves and their children they do not ask for professional support. Abused women view informal support is important in the changing process. FPs should be trained to pay more attention to informal support and be alert to childrens well-being.

Healthcare utilization by abused women: a case control study.

Abstract Background: Previous studies observed an association between intimate partner violence (IPV) and increased health problems. Early detection of IPV by general practitioners (GPs) is required to prevent further harm and provide appropriate support. In general practice, a limited number of studies are available on healthcare utilization of abused women. Objectives: The aim of the study was to investigate the healthcare utilization of abused women compared to non-abused. Methods: The study was designed as a matched case-control study in 16 general practices in deprived areas in Rotterdam (The Netherlands). Electronic medical files of 50 victims of IPV were analysed for consultation frequency, referrals, medical prescription and reasons for encounter over a period of five years. Controls (n = 50) were non-abused women matched for general practice, age, number of children, and country of origin and education level. Results: Abused women visited their GP almost twice as often than non-abused, in particular for social problems (OR = 3.5; 95%CI: 1.2–10.5; P = 0.01), substance abuse (OR = 4.6; 95%CI: 0.9–22.7; P = 0.05) and reproductive health problems (OR = 3.0; 95%CI: 1.3–6.8; P = 0.009). Victims of IPV were significantly more often referred for additional diagnostics (OR = 3.6; 95%CI: 1.1–12.2; P = 0.03), to mental healthcare (OR = 2.9; 95%CI: 1.2–7.1; P = 0.02) than non-victims. Abused women received 4.1 times more often a prescription for anti-depressants (95%CI: 1.5–11.6; P = 0.005) than non-abused women. Conclusion: As compared to non-abused women, female victims of IPV visited their GP more frequently and exhibited a typical pattern of healthcare utilization. This could alert GPs to inquire about partner abuse in the past.

“Young people, adult worries”: RCT of an internet-based self-support method “Feel the ViBe” for children, adolescents and young adults exposed to family violence, a study protocol

BackgroundViolence in families affects children. Exposure to violence is seen as child abuse. Figures show that about one third of children exposed to violence become victim or perpetrator in their adult life: known as intergenerational transmission. Violence also affects sexual and reproductive health. To prevent problems in adult life, children need help and support. However, while trying to protect their parents, children often do not seek help, or perceive the threshold as too high. Since almost all children of the current generation have access to the internet, an online intervention will make help better available for this target group. In 2011, an internet-based self-support method for children, adolescents and young adults exposed to family violence was developed in the Netherlands: “Feel the ViBe”. The intervention was developed in close collaboration with the target group. This article describes the protocol of the RCT to study the effectiveness of this intervention.Methods/designThis study is a randomized controlled trial using the method of minimization to randomize the participants in two parallel groups with a 1:1 allocation ratio, being an intervention group, having access to “Feel the ViBe” and usual care (UC), and a control group, having access to minimally enhanced usual care (mEUC) followed by access to the intervention after twelve weeks. Outcomes are measured with questionnaires on PTSD symptoms, mental health and sexual and reproductive health. Routine Outcome Measurement (ROM) will be used to measure a direct effect of participating in the intervention. Data from a web evaluation questionnaire (WEQ), user statistics and qualitative analysis of online data will be used to support the findings. To compare results Cohen’s d effect sizes will be used.DiscussionA RCT and process evaluation will test effectiveness and provide information of how the effects can be explained, how the intervention meets the expectation of participants and which possible barriers and facilitators for implementation exist. A qualitative analysis of the data will add information to interpret the quantitative data. This makes “Feel the ViBe” unique in its field.Trial registrationThe Netherlands National Trial Register (NTR), trial ID NTR3692.

Implementing mentor mothers in family practice to support abused mothers: Study protocol

BackgroundIntimate partner violence is highly prevalent and mostly affects women with negative consequences for their physical and mental health. Children often witness the violence which has negative consequences for their well-being too. Care offered by family physicians is often rejected because abused women experience a too high threshold. Mentor mother support, a low threshold intervention for abused mothers in family practice, proved to be feasible and effective in Rotterdam, the Netherlands. The primary aim of this study is to investigate which factors facilitate or hinder the implementation of mentor mother support in family practice. Besides we evaluate the effect of mentor mother support in a different region.Methods/DesignAn observational study with pre- and posttests will be performed. Mothers with home living children or pregnant women who are victims of intimate partner violence will be offered mentor mother support by the participating family physicians. The implementation process evaluation consists of focus groups, interviews and questionnaires. In the effect evaluation intimate partner violence, the general health of the abused mother, the mother-child relationship, social support, and acceptance of professional help will be measured twice (t = 0 and t = 6 months) by questionnaires, reporting forms, medical records and interviews with the abused mothers. Qualitative coding will be used to analyze the data from the reporting forms, medical records, focus groups, interviews, and questionnaires. Quantitative data will be analyzed with descriptive statistics, chi square test and t-test matched pairs.DiscussionWhile other intervention studies only evaluate the feasibility and effectiveness of the intervention, our primary aim is to evaluate the implementation process and thereby investigate which factors facilitate or hinder implementation of mentor mother support in family practice.

Prevalence of intimate partner violence at an out-patient clinic obstetrics-gynecology in the Netherlands

Intimate partner violence (IPV) is a highly prevalent problem among women. Our aim was to investigate the prevalence of IPV among patients of an out-patient clinic obstetrics–gynecology, association with level of education, and womens opinion on asking about IPV by physicians. We conducted a survey among women between 18 and 60 years in a waiting room of an out-patient clinic obstetrics–gynecology. We used the Composite Abuse Scale to measure type and severity of IPV. Two hundred women of whom 82 (41%) were pregnant, were included in the study (response 57%). Twenty-three percent of the women ever experienced IPV and 9% currently. IPV is more prevalent among women with a lower educated partner. Four of the pregnant women (5%) experienced current IPV. Seventy-eight percent of the respondents find it important for physicians to ask about IPV. IPV proved to be a highly prevalent problem in an out-patient clinic obstetrics–gynecology with almost one-quarter of the patients ever having been victim of various forms of IPV, and almost one in 10 currently. Awareness of the possibility of IPV and early recognition by physicians might reduce mental and physical sequels and strengthen womens feeling of being supported.

'I am stronger, I'm no longer afraid…', An evaluation of a home-visiting mentor mother support programme for abused women in primary care

OBJECTIVE We aimed to investigate which factors make a mentor mother support programme for abused women successful. METHOD We used semi-structured interviews with abused women and focus group discussions with the mentor mothers to evaluate their experiences and needs within a mentor support programme (MeMoSA). Fourteen abused women were interviewed 6 months after the support programme ended. Mentor mothers participated in two focus group discussions. RESULTS Abused women emphasised that nonjudgmental listening, equivalence, involvement and bonding are important factors for successful support. Mentor mothers described that empathy, availability, persistence and advocacy fitted the needs of women best to empower them and help them to cope with their violent situation at home. A safe place to meet each other was also an important factor. CONCLUSION A good relationship, tailored support provided by home visiting, advocacy and safety are required to effectively help abused women. MeMoSA, a home-visiting support programme, is a promising valuable new support programme in primary care for abused women.

Support by trained mentor mothers for abused women: a promising intervention in primary care

BACKGROUND Intimate partner violence (IPV) against women is a major health problem and negatively affects the victims mental and physical health. Evidence-based interventions in family practice are scarce. OBJECTIVE We aimed to evaluate a low threshold home-visiting intervention for abused women provided by trained mentor mothers in family practice. The aim was to reduce exposure to IPV, symptoms of depression as well as to improve social support, participation in society and acceptance of mental health care. METHODS A pre-post study of a 16-week mentoring intervention with identified abused women with children was conducted. After referral by a family doctor, a mentor mother visited the abused woman weekly. Primary outcomes are IPV assessed with the Composite Abuse Scale (CAS), depressive symptoms using the Symptom Checklist (SCL 90) and social support by the Utrecht Coping List. Secondary outcomes are analysed qualitatively: participation in society defined as employment and education and the acceptance of mental health care. RESULTS At baseline, 63 out of 66 abused women were referred to mentor support. Forty-three participants completed the intervention programme. IPV decreased from CASt otal 46.7 (SD 24.7) to 9.0 (SD 9.1) (P ≤ 0.001) after the mentor mother support programme. Symptoms of depression decreased from 53.3 (SD 13.7) to 34.8 (SD 11.5) (P ≤ 0.001) and social support increased from 13.2 (SD 4.0) to 15.2 (SD 3.5) (P ≤ 0.001). Participation in society and the acceptance of mental health for mother and child improved. CONCLUSIONS Sixteen weekly visits by trained mentor mothers are a promising intervention to decrease exposure to IPV and symptoms of depression, as well as to improve social support, participation in society and the acceptance of professional help for abused women and their children.

Vroegtijdige herkenning partnergeweld

SamenvattingVan Rosmalen-Nooijens K, Lo Fo Wong S. Vroegtijdige herkenning partnergeweld. Tijdschr praktijkonderst 2011;6(5):129-33.Partnergeweld treft meestal vrouwen en kinderen. Naar schatting komt partnergeweld voor bij 30-41% van de patiënten in de wachtkamer van de huisarts. Wanneer er kinderen zijn in een gezin waar geweld plaatsvindt, zijn zij vrijwel altijd getuige hiervan. De kans is groot dat zij zelf als volwassene weer dader of slachtoffer worden: intergenerationele overdracht.Partnergeweld blijft vaak verborgen. Vrouwen die ermee maken hebben komen veelal bij de huisarts met lichamelijk onverklaarbare klachten. Het is belangrijk om signalen van partnergeweld te herkennen en het actief aan te kaarten. Huisartsen, praktijkondersteuners en doktersassistenten hebben daarvoor training nodig. Bestaande hulpverlening voor slachtoffers van partnergeweld is vaak te hoogdrempelig of er zijn lange wachtlijsten. Er zijn enkele veelbelovende projecten om deze slachtoffers te ondersteunen vanuit de eerste lijn.