Browsing by Subject "Intimate partner violence"

Now showing 1 - 11 of 11
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    Open Access
    Can mental health treatments help prevent or reduce intimate partner violence in low- and middle-income countries? A systematic review
    (BioMed Central, 2019-02-14) Tol, W A; Murray, S M; Lund, C.; Bolton, P; Murray, L K; Davies, T; Haushofer, J; Orkin, K; Witte, M; Salama, L; Patel, V; Thornicroft, G; Bass, J K
    Background Epidemiological research suggests an interrelationship between mental health problems and the (re)occurrence of intimate partner violence (IPV). However, little is known about the impact of mental health treatments on IPV victimization or perpetration, especially in low- and middle-income countries (LMIC). Methods We conducted a systematic review to identify prospective, controlled studies of mental health treatments in LMIC. We defined ‘mental health treatment’ as an intervention for individuals experiencing mental ill health (including substance misuse) including a substantial psychosocial or pharmacological component. Studies had to measure a mental health and IPV outcome. We searched across multi-disciplinary databases using a structured search strategy. Screening of title/abstracts and full-text eligibility assessments were conducted by two researchers independently, data were extracted using a piloted spreadsheet, and a narrative synthesis was generated. Results We identified seven studies reported in 11 papers conducted in five middle-income countries. With the exception of blinding, studies overall showed acceptable levels of risk of bias. Four of the seven studies focused on dedicated mental health treatments in various populations, including: common mental disorders in earthquake survivors; depression in primary care; alcohol misuse in men; and alcohol misuse in female adult sex workers. The dedicated mental health treatments targeting depression or alcohol misuse consistently reduced levels of these outcomes. The two studies targeting depression also reduced short-term IPV, but no IPV benefits were identified in the two alcohol-focused studies. The other three studies evaluated integrated interventions, in which a focus on substance misuse was part of efforts to reduce HIV/AIDS and violence against particularly vulnerable women. In contrast to the dedicated mental health interventions, the integrated interventions did not consistently reduce mental ill health or alcohol misuse compared to control conditions. Conclusions Too few studies have been conducted to judge whether mental health treatments may provide a beneficial strategy to prevent or reduce IPV in LMIC. Key future research questions include: whether promising initial evidence on the effects of depression interventions on reducing IPV hold more broadly, the required intensity of mental health components in integrated interventions, and the identification of mechanisms of IPV that are amenable to mental health intervention.
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    Domestic and intimate partner violence among pregnant women in a low resource setting in South Africa: a facility-based, mixed methods study
    (BioMed Central, 2018-07-04) Field, Sally; Onah, Michael; van Heyningen, Thandi; Honikman, Simone
    Background Rates of violence against women are reported to be highest in Africa compared to other continents. We aimed to determine associations between mental illness, demographic, psychosocial and economic factors with experience of intimate partner violence (IPV) among pregnant women in a low resource setting in Cape Town and to explore the contextual elements pertaining to domestic violence. Methods We recruited adult women attending antenatal services at a primary-level maternity facility. Demographic, socioeconomic and psychosocial data were collected by questionnaire. The Expanded Mini- International Neuropsychiatric Interview (MINI) Version 5.0.0 was used to assess mental health status and the Revised Conflict Tactic Scale (CTS2) used to assess IPV in the six months prior to the study. Non-parametric tests, Wilcoxon sum of rank test, Fisher Exact and two sample T test and multicollinearity tests were performed. Descriptive, bivariate and logistic regression analyses were conducted to identify associations between the outcome of interest and key predictors. A probability value of p ≤ 0.05 was selected. From counselling case notes, a thematic content analysis was conducted to describe contextual factors pertaining to forms of domestic violence (DV). Results The prevalence of IPV was 15% of a sample of 376 women. Women who were food insecure, unemployed, in stable but unmarried relationships, had experienced any form of past abuse and were not pleased about the current pregnancy were more likely to experience IPV. MINI-defined mental health problems and a history of mental illness were significantly associated with IPV. Qualitative analysis of 95 counselling case notes revealed that DV within the household was not limited to intimate partners and, DV in this context was often perceived as ‘normal’ behaviour by the participants. Conclusions This study contributes towards a greater understanding of the risk profile for IPV amongst pregnant women in low-income settings. Adversity, including food insecurity and mental ill-health are closely associated with IPV during the antenatal period. Advocates against violence against pregnant women are advised to consider that violence in the home may be perpetrated by non-intimate partners and may by enabled by a pervasive belief in the acceptability of the violence.
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    Forensic medicine in South Africa: associations between medical practice and legal case progression and outcomes in female murders
    (Public Library of Science, 2011) Abrahams, Naeemah; Jewkes, Rachel; Martin, Lorna J; Mathews, Shanaaz
    BACKGROUND: Forensic medicine has been largely by-passed by the tide of health systems research and evidence based medicine. Murder victims form a central part of forensic medical examiners' case load, and women murdered by intimate partners are an important subgroup, representing the most severe form and consequence of intimate partner violence. Our aim was to describe the epidemiology of female murder in South Africa (by intimate and non-intimate partners); and to describe and compare autopsy findings, forensic medical management of cases and the contribution of these to legal outcomes. METHODS: We did a retrospective national study in a proportionate random sample of 25 medico-legal laboratories to identify all homicides in 1999 of women aged 14 years and over. Data were abstracted from the mortuary file and autopsy report, and collected from a police interview. FINDINGS: In 21.5% of cases the perpetrator was convicted. Factors associated with a conviction for the female murders included having a history of intimate partner violence 1.18 (95%CI: 0.16-2.20), weapon recovered 1.36 (95% CI:0.58-2.15) and a detective visiting the crime scene 1.57 (95% CI:0.14-3.00). None of the forensic medical activities increased the likelihood of a conviction. CONCLUSION: The findings raise important questions about the role of forensic medicine in these cases.
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    Gender inequitable masculinity and sexual entitlement in rape perpetration South Africa: findings of a cross-sectional study
    (Public Library of Science, 2011) Jewkes, Rachel; Sikweyiya, Yandisa; Morrell, Robert; Dunkle, Kristin
    Objective To describe the prevalence and patterns of rape perpetration in a randomly selected sample of men from the general adult population, to explore factors associated with rape and to describe how men explained their acts of rape. Design Cross-sectional household study with a two- stage randomly selected sample of men. METHODS: 1737 South African men aged 18-49 completed a questionnaire administered using an Audio-enhanced Personal Digital Assistant. Multivariable logistic regression models were built to identify factors associated with rape perpetration. RESULTS: In all 27.6% (466/1686) of men had raped a woman, whether an intimate partner, stranger or acquaintance, and whether perpetrated alone or with accomplices, and 4.7% had raped in the last 12 months. First rapes for 75% were perpetrated before age 20, and 53.9% (251) of those raping, did so on multiple occasions. The logistic regression model showed that having raped was associated with greater adversity in childhood, having been raped by a man and higher maternal education. It was associated with less equitable views on gender relations, having had more partners, and many more gender inequitable practices including transactional sex and physical partner violence. Also drug use, gang membership and a higher score on the dimensions of psychopathic personality, namely blame externalisation and Machiavellian egocentricity. Asked about why they did it, the most common motivations stemmed from ideas of sexual entitlement. CONCLUSIONS: Perpetration of rape is so prevalent that population-based measures of prevention are essential to complement criminal justice system responses. Our findings show the importance of measures to build gender equity and change dominant ideas of masculinity and gender relations as part of rape prevention. Reducing men's exposure to trauma in childhood is also critically important.
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    Integrating intimate partner violence prevention content into a digital parenting chatbot intervention during COVID-19: Intervention development and remote data collection
    (BioMed Central, 2023-09-04) Schafer, Moa; Lachman, Jamie M.; Gardner, Frances; Zinser, Paula; Calderon, Francisco; Han, Qing; Facciola, Chiara; Clements, Lily
    Background Intimate partner violence (IPV) is a serious public health issue which experienced a sharp incline during the onset of COVID-19. Increases in other forms of violence, such as violence against children (VAC), have also been linked to the pandemic, and there have been calls for greater prevention efforts that tackle both forms of violence concurrently. The COVID-19 crisis has highlighted the urgent need for evidence-based and scalable violence prevention interventions that target multiple forms of family violence. Parenting programmes have shown promising results in preventing various forms of family violence, including IPV and VAC, and have recently experienced an expansion in delivery, with digital intervention formats growing. This paper describes the development and evaluation of the IPV prevention content designed and integrated into ParentText, a chatbot parenting intervention adapted from Parenting for Lifelong Health programmes. Methods The ParentText IPV prevention content was developed using the Six Steps in Quality Intervention Development (6SQuID) framework. This involved targeted literature searches for key studies to identify causal factors associated with IPV and determining those with greatest scope for change. Findings were used to develop the intervention content and theory of change. Consultations were held with academic researchers (n = 5), practitioners (n = 5), and local community organisations (n = 7), who reviewed the content. A formative evaluation was conducted with parents in relationships (n = 96) in Jamaica to better understand patterns in user engagement with the intervention and identify strategies to further improve engagement. Results Using the 6SQuID model, five topics on IPV prevention were integrated into the ParentText chatbot. Text-messages covering each topic, including additional materials such as cartoons and videos, were also developed. The formative evaluation revealed an average user-engagement length of 14 days, 0.50 chatbot interactions per day, and over half of participants selected to view additional relationship content. Conclusions This article provides a unique contribution as the first to integrate IPV prevention content into a remotely delivered, digital parenting intervention for low-resource settings. The findings from this research and formative evaluation shed light on the promising potential of chatbots as scalable and accessible forms of violence prevention, targeting multiple types of family violence.
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    Men, prostitution and the provider role: understanding the intersections of economic exchange, sex, crime and violence in South Africa
    (Public Library of Science, 2012) Jewkes, Rachel; Morrell, Robert; Sikweyiya, Yandisa; Dunkle, Kristin; Penn-Kekana, Loveday
    BACKGROUND: South African policy makers are reviewing legislation of prostitution, concerned that criminalisation hampers HIV prevention. They seek to understand the relationship between transactional sex, prostitution, and the nature of the involved men. METHODS: 1645 randomly-selected adult South African men participated in a household study, disclosing whether they had sex with a woman in prostitution or had had a provider relationship (or sex), participation in crime and violence and completing psychological measures. These became outcomes in multivariable regression models, where the former were exposure variables. RESULTS: 51% of men had had a provider relationship and expected sex in return, 3% had had sex with a woman in prostitution, 15% men had done both of these and 31% neither. Provider role men, and those who had just had sex with a woman in prostitution, were socially conservative and quite violent. Yet the men who had done both (75% of those having sex with a woman in prostitution) were significantly more misogynist, highly scoring on dimensions of psychopathy, more sexually and physically violent to women, and extensively engaged in crime. They had often bullied at school, suggesting that this instrumental, self-seeking masculinity was manifest in childhood. The men who had not engaged in sex for economic exchange expressed a much less violent, more law abiding and gender equitable masculinity; challenging assumptions about the inevitability of intersections of age, poverty, crime and misogyny. CONCLUSIONS: Provider role relationships (or sex) are normative for low income men, but not having sex with a woman in prostitution. Men who do the latter operate extensively outside the law and their violence poses a substantial threat to women. Those drafting legislation and policy on the sex industry in South Africa need to distinguish between these two groups to avoid criminalising the normal, and consider measures to protect women.
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    Problem solving therapy (PST) tailored for intimate partner violence (IPV) versus standard PST and enhanced usual care for pregnant women experiencing IPV in rural Ethiopia: protocol for a randomised controlled feasibility trial
    (2020-06-01) Keynejad, Roxanne C; Bitew, Tesera; Sorsdahl, Katherine; Myers, Bronwyn; Honikman, Simone; Medhin, Girmay; Deyessa, Negussie; Sevdalis, Nick; Tol, Wietse A; Howard, Louise; Hanlon, Charlotte
    Background In rural Ethiopia, 72% of women are exposed to lifetime intimate partner violence (IPV); IPV is most prevalent during pregnancy. As well as adversely affecting women’s physical and mental health, IPV also increases the risk of child morbidity and mortality associated with maternal depression, thus making antenatal care an important opportunity for intervention. Adapting generic, task-shared, brief psychological interventions for perinatal depression and anxiety to address the needs and experiences of women affected by IPV may improve acceptability to women and feasibility for health workers. This randomised controlled feasibility trial will compare brief problem solving therapy (PST) specifically adapted for pregnant women experiencing IPV (PST-IPV) with standard PST and enhanced usual care to determine the feasibility of a future fully powered randomised controlled trial. Methods Seventy-five pregnant women scoring five or more on the Patient Health Questionnaire, endorsing a tenth question about functional impact and reporting past-year IPV, will be recruited from antenatal care clinics in predominantly rural districts in Ethiopia. Consenting participants will be randomised to either four sessions of PST-IPV, four sessions of standard PST or information about sources of support (enhanced usual care) in a three-arm design. The interventions will be delivered by trained, supervised antenatal care staff using a task-sharing model. Assessments will be made at baseline and after 9 weeks by masked outcome assessors and will include measures of depression symptoms (primary outcome), post-traumatic stress, anxiety symptoms, functional impact, past-month IPV and hypothesised mediators (secondary outcomes). A mixed-method process evaluation will determine the feasibility of a future randomised controlled trial, assess the feasibility, acceptability, fidelity and quality of implementation of PST-IPV, generate testable hypotheses about causal mechanisms, and identify potential contextual factors influencing outcomes. Discussion Despite mental health being a critical concern for women experiencing IPV, there is limited evidence for brief, task-shared psychological interventions adapted for their needs in low- and middle-income countries. Contextually tailored interventions for pregnant women experiencing IPV in low- and middle-income countries require development and process evaluation. This randomised controlled feasibility trial will yield results on the feasibility of conducting a fully powered trial, relevant to researchers, primary and antenatal care clinicians in resource-limited settings. Trial registration Pan-African clinical trials registry: PACTR202002513482084. Prospectively registered on 13 December 2019.
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    The relationship between intimate partner violence, rape and HIV amongst South African men: a cross-sectional study
    (Public Library of Science, 2011) Jewkes, Rachel; Sikweyiya, Yandisa; Morrell, Robert; Dunkle, Kristin
    Objective: To investigate the associations between intimate partner violence, rape and HIV among South African men. Design Cross-sectional study involving a randomly-selected sample of men. METHODS: We tested hypotheses that perpetration of physical intimate partner violence and rape were associated with prevalent HIV infections in a cross-sectional household study of 1229 South African men aged 18-49. Violence perpetration was elicited in response to a questionnaire administered using an Audio-enhanced Personal Digital Assistant and blood samples were tested for HIV. A multivariable logistic regression model was built to identify factors associated with HIV. RESULTS: 18.3% of men had HIV. 29.6% (358/1211) of men disclosed rape perpetration, 5.2% (63/1208) rape in the past year and 30.7% (362/1180) of had been physically violent towards an intimate partner more than once. Overall rape perpetration was not associated with HIV. The model of factors associated with having HIV showed men under 25 years who had been physically violent towards partners were more likely to have HIV than men under 25 who had not (aOR 2.08 95% CI 1.07-4.06, p = 0.03). We failed to detect any association in older men. CONCLUSIONS: Perpetration of physical IPV is associated with HIV sero-prevalence in young men, after adjusting for other risk factors. This contributes to our understanding of why women who experience violence have a higher HIV prevalence. Rape perpetration was not associated, but the HIV prevalence among men who had raped was very high. HIV prevention in young men must seek to change ideals of masculinity in which male partner violence is rooted.
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    Spousal age difference and associated predictors of intimate partner violence in Nigeria
    (BioMed Central, 2018-02-02) Adebowale, Ayo Stephen
    Background: The growth in Intimate Partner Violence (IPV) cases among couples in Nigeria has been significant in recent years. Victims, which are often females, face numerous health challenges, including early death. I examined the linkages between spousal age differences and IPV in Nigeria. Method: The couples recode data section of the 2013 Nigeria Demographic Health and Survey was used (n = 6765). Intimate partner violence was measured using 13-item questions. Data were analyzed using the logistic regression model (α = .05). Results: The mean spousal age difference was 8.20 ± 5.0 years. About 23.5, 18.0, 13.5 and 4.7% of couples surveyed had experienced some form of IPV, emotional, physical and sexual violence respectively. Also, IPV prevalence was 27.0, 23.7, 22.0 and 18.7% among couples with age differences of 0–4, 5–9, 10–14 and ≥15 years respectively; this pattern was exhibited across all domains of IPV. Among women who experienced physical violence, 20.5% had only bruises, 8.0% had at least one case of eye injuries, sprains and/or dislocations, and 3.7% had either one or more cases of wounds, broken bones or broken teeth. The identified predictors of IPV were: family size, ethnicity, household wealth, education, number of marital unions and husband drinks alcohol. The unadjusted likelihood of IPV was 1.60 (C.I = 1.30–1.98, p < 0.001) and 1.35 (C.I = 1.10–1.64, p < 0.01) higher in households where the spousal age difference was 0–4 and 5–9 years respectively, than the likelihoods among those with a spousal age difference ≥ 15 years, but the strength of the association weakens when other variables were included in the model. Conclusion: The level of IPV was generally high in Nigeria, but it reduced with increasing spousal age difference. This study underscores the need for men to reach a certain level of maturity before marriage, as this is likely to reduce the level of IPV in Nigeria.
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    Symptoms of posttraumatic stress partially mediate the relationship between gender-based violence and alcohol misuse among South African women
    (BioMed Central, 2023-06-22) Nguyen, Kim A.; Myers, Bronwyn; Abrahams, Naeemah; Jewkes, Rachel; Mhlongo, Shibe; Seedat, Soraya; Lombard, Carl; Garcia-Moreno, Claudia; Chirwa, Esnat; Kengne, Andre P.; Peer, Nasheeta
    Abstract Background The association of traumatic experiences with problematic alcohol use has been described, but data on possible mediation effects of mental distress are sparse. We examined whether mental ill-health mediated the association between trauma exposure across the lifespan and alcohol use. Method We analysed cross-sectional data from a sample of rape-exposed and non-rape-exposed women, living in KwaZulu-Natal, with self-reported data on alcohol misuse (AUDIT-C cut-off ≥ 3) and exposure to childhood maltreatment (CM), intimate partner violence (IPV), non-partner sexual violence (NPSV), other traumatic events, and mental ill-health. Logistic regression and multiple mediation models were used to test the mediation effects of symptoms of depression and PTSS on the association between abuse/trauma and alcohol misuse. Results Of 1615 women, 31% (n = 498) reported alcohol misuse. Exposure to any CM (adjusted odds ratio (aOR): 1.59, 95% confidence interval (CI): 1.27–1.99), as well as to sexual, physical and emotional CM, were independently associated with alcohol misuse. Lifetime exposure to any IPV (aOR:2.01, 95%CI:1.59–2.54), as well as to physical, emotional and economic IPV, NPSV (aOR: 1.75, 95%CI: 1.32–2.33), and other trauma (aOR:2.08, 95%CI:1.62–2.66), was associated with alcohol misuse. Exposure to an increasing number of abuse types, and other traumatic events, was independently associated with alcohol misuse. PTSS partially mediated the associations of CM, IPV, NPSV and other trauma exposures with alcohol misuse (ps ≤ 0.04 for indirect effects), but depression symptoms did not. Conclusions These findings highlight the need for trauma-informed interventions to address alcohol misuse that are tailored to the needs of women who have experienced violence.
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    The neural correlates of intimate partner violence in women
    (2011) Flegar, S; Fouche, J P; Jordaan, E; Marais, S; Spottiswoode, B; Stein, Dan J; Vythilingum, B
    Objective: To examine hippocampal volume and white matter tracts in women with and without intimate partner violence (IPV). Method: Nineteen women with IPV exposure in the last year, and 21 women without IPV exposure in the last year underwent structural magnetic resonance imaging (MRI) including diffusion tensor imaging (DTI) sequences. Additional data on alcohol use and presence of psychiatric disorder was collected. Differences in fractional anisotropy (FA) between the two groups were examined, using a statistical model that included demographic measures, alcohol use and psychiatric disorder. Results: IPV subjects did not demonstrate significantly different hippocampal volumes compared to subjects without recent IPV. FA was, however, significantly reduced in the body of the corpus callosum of IPV subjects. Adjusting for age, alcohol use, smoking and psychiatric diagnosis did not change the significance of the result. Conclusion: Data on hippocampal volume in IPV are inconsistent, perhaps reflecting the fact that multiple factors influence this measure. Reduced FA in the body of the corpus callosum in IPV suggests altered integrity of this white matter tract; additional work is needed to address the underlying mechanisms and clinical correlates of this finding.