Intimate partner violence and health-related quality of life in European men and women: findings from the DOVE study

Purpose: Little is known on the specific relation between being a perpetrator or both a victim and perpetrator of intimate partner violence (IPV) and health-related quality of life (HRQoL). We assessed the association between HRQoL and abuse, considering men and women as victims, perpetrators or reciprocally. Methods: Participants were adult men and women (n = 3,496), randomly selected from the general population of six European cities. The Revised-Conflict-Tactics-Scales and the Medical-Outcomes-Study 36-item Short-Form Health Survey (SF-36) were used to measure IPV and HRQoL. The age-, education-, and city-adjusted mean scores[standard error] of the physical and of the mental SF-36 component summaries were used to compare victims-only, perpetrators-only, and those involved in both (bidirectional or reciprocal cases) with those not involved in past-year and lifetime physical assault and/or sexual coercion. Results: The physical component summary was significantly lower in women involved in past-year bidirectional physical assault compared with non-abused women. The mental component summary in women not involved in IPV was significantly higher than in those physically abused, regardless of type of involvement. Women victims-only of past-year sexual coercion and victims or involved in bidirectional concomitant physical and sexual IPV also presented lower scores in the mental component summary than women not involved in IPV. In men, significantly lower scores in the mental component summary were found in the past-year bidirectional physically assaulted group and among those involved bidirectionally in both physical and sexual IPV compared with men not involved in IPV. Conclusion: Experiencing physical and sexual IPV is negatively associated with HRQoL. Lower scores in the mental component summary of the SF-36 are evident among female victims and among males and females involved in intimate partner violence as both victims and perpetrators when compared to females and males not involved in violence

The impact of intimate partner violence on forgone healthcare: a population-based, multicentre European study

Background: To examine the relationship between forgone healthcare and involvement in intimate partner violence (IPV) as victims, perpetrators or both. Methods:This cross-sectional multicentre study assessed community non-institutionalized residents (n = 3496, aged 18–64) randomly selected from six European cities: Athens, Budapest, London, Östersund, Porto, Stuttgart. A common questionnaire was used, including self-reports of IPV and forgone healthcare (‘Have you been in need of a certain care service in the past year, but did not seek any help?’). Odds ratios (ORs), 95% confidence intervals (CIs) were computed fitting logistic regression models adjusted for city, chronic disease, self-assessed health status and financial strain. Results: Participants experiencing past year IPV (vs. no violence) reported more often to forgone healthcare (n = 3279, 18.6% vs. 15.3%, P = 0.016). IPV experienced as both a victim and perpetrator was associated with forgone healthcare (adjusted OR, 95%CI: 1.32, 1.02–1.70). Conclusion: IPV was associated with forgone healthcare, particularly for those experiencing violence as both victims and perpetrators. Results suggest that preventing IPV among adults may improve timely healthcare uptake

Psychological abuse among older persons in Europe: a cross-sectional study

Purpose: Elder abuse is an issue of great concern world‐wide, not least in Europe. Older people are increasingly vulnerable to physical, psychological, financial maltreatment and sexual coercion. However, due to complexities of measurement, psychological abuse may be underestimated. The purpose of this study is to investigate the prevalence of psychological abuse toward older persons within a 12 month period. Design/methodology/approach: The study design was cross‐sectional and data were collected during January‐July 2009 in the survey “Elder abuse: a multinational prevalence survey, ABUEL”. The participants were 4,467 randomly selected persons aged 60‐84 years (2,559 women, 57.3 per cent) from seven EU countries (Germany, Greece, Italy, Lithuania, Portugal, Spain, Sweden). The sample size was adapted to each city according to their population of women and men aged 60‐84 years (albeit representative and proportional to sex‐age). The participants answered a structured questionnaire either through a face‐to‐face interview or a mix of interview/self‐response. The data were analysed using descriptive statistics and regression methods. Findings: The prevalence of overall psychological abuse was 29.7 per cent in Sweden, followed by 27.1 per cent in Germany; 24.6 per cent in Lithuania and 21.9 per cent in Portugal. The lowest prevalence was reported in Greece, Spain and Italy with 13.2 per cent, 11.5 per cent and 10.4 per cent, respectively. Similar tendencies were observed concerning minor/severe abuse. The Northern countries (Germany, Lithuania, Sweden) compared to Southern countries (Greece, Italy, Portugal, Spain) reported a higher mean prevalence (across countries) of minor/severe abuse (26.3 per cent/11.5 per cent and 12.9 per cent/5.9 per cent, respectively). Most perpetrators (71.2 per cent) were spouses/partners and other relatives (e.g. children). The regression analysis indicated that being from Greece, Italy, Portugal and Spain was associated with less risk of psychological abuse. Low social support, living in rented housing, alcohol use, frequent health care use, and high scores in anxiety and somatic complaints were associated with increased risk of psychological abuse. Social implications: Psychological abuse was more prevalent in Northern than Southern countries and factors such as low social support and high anxiety levels played an important role. Further studies are warranted to investigate the prevalence of psychological abuse and risk factors among older persons in other EU countries. Particular attention should be paid to severe abuse. Such research may help policy makers and health planers/providers in tailoring interventions to tackle the ever growing problem of elder abuse. Originality/value: The paper reports data from the ABUEL Survey, which collected population based data on elderly abuse

Contextual determinants of Intimate Partner Violence: a multi-level analysis in six European cities

Objectives: To assess whether city-level characteristics influence the risk of intimate partner violence (IPV) victimization across six European cities. Methods: The DOVE Study included 3496 participants from Athens-Greece, Budapest-Hungary, London-UK, Östersund-Sweden, Porto-Portugal and Stuttgart-Germany. IPV victimization was assessed using the Revised Conflict Tactics Scales and several contextual variables were included: GINI coefficient, gender equality index, an index of social support, unemployment rate and proportion of residents with tertiary education. Multilevel models were fitted to estimate the associations (Odds ratio, 95% Confidence Intervals) between each type of victimization and contextual and individual-level variables. Results: 62.3% of the participants reported being a victim of IPV during the previous year, with large between-city differences (53.9%-72.4%). Contextual variables accounted for a substantial amount of this heterogeneity. Unemployment rates were associated with psychological (1.05, 1.01-1.08) and physical IPV (1.07, 1.01-1.13). GINI coefficient showed a positive association with any form of IPV (1.06, 1.01-1.11) and sexual coercion (1.13, 1.01-1.25). Conclusions: We found significant associations between contextual determinants and IPV, which emphasizes the importance of considering contextual socioeconomic conditions when policy measures are designed to address IPV

Healthcare and aging: do European Union countries differ?

Purpose The purpose of this paper is to evaluate socio-economic inequalities in the use, accessibility and satisfaction with health services amongst 60-84 year old people from seven European urban communities. Design/methodology/approach Data for this study were collected in 2009. The target population was people aged 60-84 years from Stuttgart (Germany), Athens (Greece), Ancona (Italy), Kaunas (Lithuania), Porto (Portugal), Granada (Spain) and Stockholm (Sweden). The total sample comprised 4,467 respondents with a mean response rate across these countries of 45.2 per cent. Findings The study demonstrated that the majority of respondents had contact with a health care provider within the last 12 months. The highest percentages were reported by respondents from Spain (97.8 per cent) and Portugal (97.7 per cent). The results suggest that 13.0 per cent of respondents had refrained from seeking care services. The highest rates were amongst seniors from Lithuania (24.0 per cent), Germany (16.2 per cent) and Portugal (15.4 per cent). Logistic regression suggests that seniors who refrained from seeking health care was statistically significant associated with those with higher levels of education (odds ratios (OR)=1.21; 95 per cent confidence intervals (CI)=1.01-1.25) and financial strain (OR=1.26; 95 per cent CI=1.16-1.37). Furthermore, the majority of respondents were satisfied with health care services. Originality/value The findings from the "Elder Abuse: a multinational prevalence survey" study indicate the existence of significant variations in use, accessibility and satisfaction with health services by country and for socio-economic factors related to organizing and financing of care systems

Male and female physical intimate partner violence and socioeconomic position: a cross-sectional international multicentre study in Europe

Objectives: This work explores the association between socioeconomic position (SEP) and intimate partner violence (IPV) considering the perspectives of men and women as victims, perpetrators and as both (bidirectional). Study Design: Cross-sectional international multicentre study. Methods: A sample of 3496 men and women, (aged 18-64 years), randomly selected from the general population of residents from six European cities was assessed: Athens, Budapest, London, Östersund, Porto and Stuttgart. Their education (primary, secondary and university), occupation (upper white-collar, lower white-collar and blue collar) and unemployment duration (never, ≤12 months and >12 months) were considered as SEP indicators and physical IPV was measured with the Revised Conflict Tactics Scales. Results: Past year physical IPV was declared by 17.7% of women (3.5% victims, 4.2% perpetrators and 10.0% bidirectional) and 19.8% of men (4.1% victims, 3.8% perpetrators and 11.9% bidirectional). Low educational level (primary vs. university) was associated with female victimization (adjusted Odds Ratio, 95% confidence interval: 3.2, 1.3-8.0) and with female bidirectional IPV (4.1, 2.4-7.1). Blue collar occupation (vs. upper white) was associated with female victimization (2.1, 1.1-4.0), female perpetration (3.0, 1.3-6.8) and female bidirectional IPV (4.0, 2.3-7.0). Unemployment duration was associated with male perpetration (> 12 months of unemployment vs. never unemployed: 3.8, 1.7-8.7) and with bidirectional IPV in both sex (women: 1.8, 1.2-2.7; men: 1.7, 1.0-2.8). Conclusions: In these European centers, physical IPV was associated with a disadvantaged socioeconomic position. A consistent socioeconomic gradient was observed in female bidirectional involvement, but victims or perpetrators-only presented gender specificities according to levels of education, occupation differentiation and unemployment duration potentially useful for designing interventions

Use of contraception and abortion in Greece: A review

Greece has one of the highest rates of abortions in Europe and a very low prevalence of contraceptive use apart from withdrawal and condoms. Based on limited data from the post 30 years, this paper describes the context in which Greek women make reproductive decisions, and the history of family planning and abortion policies and services in Greece. It shows that in spite of the persistence of the traditional importance placed on marriage and motherhood, the fertility rote in Greece is very low. Sex education is still not included in the school curriculum, and the lack of accurate information on contraception and the prevention of unwanted pregnancy, especially in adolescence, still have critical repercussions for women’s life choices. Although the public sector has been required to provide family planning services since 1980, only 2% of women of reproductive age were accessing these services in 1990, based mainly in urban centres. In 2001, one in four women of reproductive age had had at least one unwanted pregnancy ending in abortion; the rate was one in ten in the 16-24 age group and one in three in the 35-45 age group. With an almost complete lack of preventive policies in Greece, women continue to have to rely on abortion to control births. (c) 2004 Reproductive Health Matters. All rights reserved

Physical intimate partner violence in Europe: results from a population-based multi-center study in six countries

INTRODUCTION: The prevalence, determinants and health consequences of physical intimate partner violence (IPV) in Western Europe has never been considered in a cross-cultural perspective, taking men and women involvement in the three patterns of violence: victims, perpetrators or both. METHODS: We assessed a representative sample of adults (18-64 years; N=3496) living in Athens-Greece, Porto-Portugal, Budapest-Hungary, London-United Kingdom, {\"O}stersund-Sweden and Stuttgart-Germany. Past-year physical IPV was assessed using the Revised-Conflict-Tactics-Scales. The association between IPV and child abuse, socioeconomics (education, occupation, unemployment duration), behavioral (alcohol) and health factors (chronic diseases, anxiety and depressive symptoms), by sex and IPV pattern, was estimated using age- and city-adjusted logistic regression odds ratios (AOR, 95\% confidence intervals). RESULTS: Physical IPV was reported by 17.7\% (16.0-19.4\%) of women (3.5\% victims-only, 4.2\% perpetrators-only and 10.0\% both victims and perpetrators) and by 19.8\% (17.8-22.0\%) of men (4.1\%, 3.8\% and 11.9\%, respectively). In general, Greek presented the highest and Portuguese the lowest estimates. History of child abuse increased the risk of all IPV patterns. In women, unemployment duration and blue collar occupation were associated with increased likelihood of all IPV patterns. In men, only unemployment duration was associated with increased perpetration and lower occupation with victimization. Heavy alcohol use, chronic diseases and self-assessment of health as poor or fair were significantly associated with female involvement in IPV, both as victim and perpetrator. Anxiety and depressive symptoms severity was higher in male and female declaring both victimization and perpetration. CONCLUSIONS: In these European men and women IPV was frequently experienced and child abuse a common determinant of victimization, perpetration or bi-directional violence. Irrespective of IPV pattern, socioeconomic inequalities were evident in females but less consistent in males. These findings confirm IPV as a major public health concern, and for those involved it significantly increases the burden of disease

Forgone healthcare and intimate partner violence: a study in six European urban centres

Background: Victims of intimate partner violence (IPV) are known to refrain from seeking care when in need. Whether the impact on forgone care differs according to the victim-perpetrator role remains unexplored. We aimed to describe the relation between past-year IPV and forgone healthcare according to victims, perpetrators or both (bidirectional). Methods: Adult men and women (n=3496, aged 18-64), randomly sampled from the general population of Athens, Porto, London, Budapest, Östersund and Stuttgart were assessed using a common questionnaire. IPV was ascertained with the Revised-Conflict-Tactics-Scales. The association between IPV and forgone healthcare (“Have you been in need of a certain care service in the past year, but did not seek any help?”), sociodemographics (sex, age, education, city) and health factors (self-assessed health, public or private healthcare sector use), in victims, perpetrators and both was estimated using adjusted logistic regression odds ratios (AOR, 95% confidence intervals). Results: Forgone healthcare ranged from 12.6% (Budapest) to 22.4% (Stuttgart) and was associated with bidirectional involvement in IPV (AOR, 95%CI= 1.37, 1.05-1.78). A lower educational level was associated with forgone care in multivariate models fitted for victims of and for bidirectional involvement in IPV. A fair/poor self-assessed health (contrasting to a good/very good/excellent health) was significantly associated with forgone care in victims (AOR, 95%CI=2.61, 1.96-3.47), in bidirectional IPV (AOR, 95%CI=2.94, 2.27-3.82) and for perpetrators (AOR, 95%CI=2.58, 1.96-3.40). Conclusion: Beside the known barriers identified for inequalities and access to healthcare, the role of IPV in forgone healthcare should be considered