Intimate partner violence against women during pregnancy: a systematic review and meta-analysis protocol for producing global and regional estimates

BACKGROUND: Intimate partner violence is a devastating human rights violation and public health problem with high prevalence rates globally. Intimate partner violence during pregnancy is associated with devastating maternal, perinatal, and neonatal health effects. We present the protocol for a systematic review and meta-analysis to estimate the global lifetime prevalence of intimate partner violence during pregnancy. METHODS: This review aims to systematically synthesize the evidence on the global prevalence of violence against women by intimate partners during pregnancy using available population-based data. A comprehensive search of MEDLINE, EMBASE, Global Health, PsychInfo, and Web of Science databases will be conducted to identify all relevant articles. Manual searches will be conducted in Demographic and Health Survey (DHS) data reports and websites of national statistics and/or other offices. DHS data analysis will also be conducted. Based on inclusion and exclusion criteria, titles and abstracts will be screened for eligibility. Then, full-text articles will be assessed for eligibility. The following data will be extracted from included articles: study characteristics, population characteristics (e.g., ever-partnered, currently partnered, or any women, and age range), violence characteristics (e.g., type of violence, and perpetrator), estimate type (e.g., intimate partner violence during any pregnancy or during last pregnancy), subpopulation type (e.g., by age, marital status, urban/rural), prevalence estimate, and key quality indicators. A hierarchical Bayesian meta-regression framework will be used. This multilevel modelling approach will use survey-specific, country-specific, and region-specific random effects to pool observations. This modelling technique will be used to estimate global and regional prevalence. DISCUSSION: This systematic review and meta-analysis will provide estimates on the global and regional prevalence of intimate partner violence during pregnancy and contribute to monitoring progress towards Sustainable Development Goal (SDG) Target 5.2 on eliminating violence against women and to SDG Targets 3.1 and 3.2 on reducing maternal mortality and neonatal mortality. Given the significant health impacts of intimate partner violence during pregnancy, potential for intervention, and urgency to address violence and improve health, this review will provide critical evidence to governments, non-governmental organizations, and policymakers on the magnitude of violence during pregnancy. It will also inform effective policies and programs to prevent and respond to intimate partner violence during pregnancy. SYSTEMATIC REVIEW REGISTRATION: PROSPERO ID CRD42022332592

A framework to model global, regional, and national estimates of intimate partner violence

BACKGROUND: Accurate and reliable estimates of violence against women form the backbone of global and regional monitoring efforts to eliminate this human right violation and public health problem. Estimating the prevalence of intimate partner violence (IPV) is challenging due to variations in case definition and recall period, surveyed populations, partner definition, level of age disaggregation, and survey representativeness, among others. In this paper, we aim to develop a sound and flexible statistical modeling framework for global, regional, and national IPV statistics. METHODS: We modeled IPV within a Bayesian multilevel modeling framework, accounting for heterogeneity of age groups using age-standardization, and age patterns and time trends using splines functions. Survey comparability is achieved using adjustment factors which are estimated using exact matching and their uncertainty accounted for. Both in-sample and out-of-sample comparisons are used for model validation, including posterior predictive checks. Post-processing of models’ outputs is performed to aggregate estimates at different geographic levels and age groups. RESULTS: A total of 307 unique studies conducted between 2000–2018, from 154 countries/areas, and totaling nearly 1.8 million unique women responses informed lifetime IPV. Past year IPV had a similar number of studies (n = 332), countries/areas represented (n = 159), and individual responses (n = 1.8 million). Roughly half of IPV observations required some adjustments. Posterior predictive checks suggest good model fit to data and out-of-sample comparisons provided reassuring results with small median prediction errors and appropriate coverage of predictions’ intervals. CONCLUSIONS: The proposed modeling framework can pool both national and sub-national surveys, account for heterogeneous age groups and age trends, accommodate different surveyed populations, adjust for differences in survey instruments, and efficiently propagate uncertainty to model outputs. Describing this model to reproducible levels of detail enables the accurate interpretation and responsible use of estimates to inform effective violence against women prevention policy and programs, and global monitoring of elimination efforts as part of the Sustainable Development Goals. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12874-022-01634-5

Domestic violence and mental health: a cross-sectional survey of women seeking help from domestic violence support services.

BACKGROUND: Domestic violence and abuse (DVA) are associated with an increased risk of mental illness, but we know little about the mental health of female DVA survivors seeking support from domestic violence services. OBJECTIVE: Domestic violence and abuse (DVA) are associated with an increased risk of mental illness, but we know little about the mental health of female DVA survivors seeking support from domestic violence services. DESIGN: Baseline data on 260 women enrolled in a randomized controlled trial of a psychological intervention for DVA survivors was analyzed. We report prevalence of and associations between mental health status and severity of abuse at the time of recruitment. We used logistic and normal regression models for binary and continuous outcomes, respectively. Mental health measures used were: Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM), Patient Health Questionnaire, Generalized Anxiety Disorder Assessment, and the Posttraumatic Diagnostic Scale (PDS) to measure posttraumatic stress disorder. The Composite Abuse Scale (CAS) measured abuse. RESULTS: Exposure to DVA was high, with a mean CAS score of 56 (SD 34). The mean CORE-OM score was 18 (SD 8) with 76% above the clinical threshold (95% confidence interval: 70-81%). Depression and anxiety levels were high, with means close to clinical thresholds, and all respondents recorded PTSD scores above the clinical threshold. Symptoms of mental illness increased stepwise with increasing severity of DVA. CONCLUSIONS: Exposure to DVA was high, with a mean CAS score of 56 (SD 34). The mean CORE-OM score was 18 (SD 8) with 76% above the clinical threshold (95% confidence interval: 70-81%). Depression and anxiety levels were high, with means close to clinical thresholds, and all respondents recorded PTSD scores above the clinical threshold. Symptoms of mental illness increased stepwise with increasing severity of DVA

Psychological advocacy toward healing (PATH): study protocol for a randomized controlled trial.

BACKGROUND: Domestic violence and abuse (DVA), defined as threatening behavior or abuse by adults who are intimate partners or family members, is a key public health and clinical priority. The prevalence of DVA in the United Kingdom and worldwide is high, and its impact on physical and mental health is detrimental and persistent. There is currently little support within healthcare settings for women experiencing DVA. Psychological problems in particular may be difficult to manage outside specialist services, as conventional forms of therapy such as counseling that do not address the violence may be ineffective or even harmful. The aim of this study is to assess the overall effectiveness and cost-effectiveness of a novel psychological intervention tailored specifically for survivors of DVA and delivered by domestic violence advocates based in third-sector organizations. METHODS AND STUDY DESIGN: This study is an open, pragmatic, parallel group, individually randomized controlled trial. Women ages 16 years and older experiencing domestic violence are being enrolled and randomly allocated to receive usual DVA agency advocacy support (control) or usual DVA agency support plus psychological intervention (intervention). Those in the intervention group will receive eight specialist psychological advocacy (SPA) sessions weekly or fortnightly, with two follow-up sessions, 1 month and then 3 months later. This will be in addition to any advocacy support sessions each woman receives. Women in the control group will receive usual DVA agency support but no additional SPA sessions. The aim is to recruit 250 women to reach the target sample size. The primary outcomes are psychological well-being and depression severity at 1 yr from baseline, as measured by the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) and the Patient Health Questionnaire (PHQ-9), respectively. Secondary outcome measures include anxiety, posttraumatic stress, severity and frequency of abuse, quality of life and cost-effectiveness of the intervention. Data from a subsample of women in both groups will contribute to a nested qualitative study with repeat interviews during the year of follow-up. DISCUSSION: This study will contribute to the evidence base for management of the psychological needs of women experiencing DVA. The findings will have important implications for healthcare commissioners and providers, as well as third sector specialist DVA agencies providing services to this client group. TRIAL REGISTRATION: ISRCTN58561170

Domestic violence and mental health:a cross-sectional survey of women seeking help from domestic violence support services

BACKGROUND: Domestic violence and abuse (DVA) are associated with increased risk of mental illness, but we know little about the mental health of female DVA survivors seeking support from domestic violence services. OBJECTIVE: Our goal was to characterise the demography and mental health of women who access specialist DVA services in the United Kingdom and to investigate associations between severity of abuse and measures of mental health and health state utility, accounting for important confounders and moderators. DESIGN: Baseline data on 260 women enrolled in a randomized controlled trial of a psychological intervention for DVA survivors were analysed. We report the prevalence of and associations between mental health status and severity of abuse at the time of recruitment. We used logistic and normal regression models for binary and continuous outcomes, respectively. The following mental health measures were used: Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM), Patient Health Questionnaire, Generalised Anxiety Disorder Assessment, and the Posttraumatic Diagnostic Scale to measure posttraumatic stress disorder (PTSD). The Composite Abuse Scale (CAS) measured abuse. RESULTS: Exposure to DVA was high, with a mean CAS score of 56 (SD 34). The mean CORE-OM score was 18 (SD 8) with 76% above the clinical threshold (95% confidence interval: 70-81%). Depression and anxiety levels were high, with means close to clinical thresholds, and more than three-quarters of respondents recorded PTSD scores above the clinical threshold. Symptoms of mental illness increased stepwise with increasing severity of DVA. CONCLUSIONS: Women DVA survivors who seek support from DVA services have recently experienced high levels of abuse, depression, anxiety, and especially PTSD. Clinicians need to be aware that patients presenting with mental health conditions or symptoms of depression or anxiety may be experiencing or have experienced DVA. The high psychological morbidity in this population means that trauma-informed psychological support is needed for survivors who seek support from DVA services

A framework to model global, regional, and national estimates of intimate partner violence

AbstractBackgroundAccurate and reliable estimates of violence against women statistics form the backbone of monitoring efforts to eliminate these human right violations and public health concerns. Estimating the prevalence of intimate partner violence (IPV) is challenging due to variations in case definition and recall period, surveyed populations, partner definition, level of age disaggregation, and survey representativeness, among others. In this paper, we aim to develop a sound and flexible statistical modeling framework for global, regional, and national IPV statistics.MethodsWe modeled IPV within a Bayesian multilevel modeling framework, accounting for heterogeneity of age groups using age-standardization, and age patterns and time trends using splines functions. Survey comparability is achieved using adjustment factors which are estimated using exact matching and their uncertainty accounted for. Both in-sample and out-of-sample comparisons are used for model validation, including posterior predictive checks. Post-processing of models’ outputs is performed to aggregate estimates at different geographic levels and age groups.ResultsA total of 307 unique studies conducted between 2000-2018, from 154 countries/territories/areas, and totaling nearly 1.8 million unique women responses informed lifetime IPV. Past year IPV had similar number of studies (n=332), countries represented (n=159), and individual responses (n=1.8 million). Roughly half of IPV observations required some adjustments. Posterior predictive checks suggest good model fit to data and out-of-sample comparisons provided reassuring results with small median prediction errors and appropriate coverage of predictions’ intervals.ConclusionsThe proposed modeling framework can pool both national and sub-national surveys, account for heterogeneous age groups and age trends, accommodate different surveyed population, adjust for differences in survey instruments, and efficiently propagate uncertainty to model outputs. By describing this model to reproducible levels of details, the accurate interpretation and responsible use of estimates for global monitoring of violence against women elimination efforts are supported, as part of the Sustainable Development Goals.</jats:sec

Randomised pilot and feasibility trial of a group intervention for men who perpetrate intimate partner violence against women

Background: There is a need for robust evidence on the effectiveness and cost-effectiveness of domestic abuse perpetrator programmes in reducing abusive behaviour and improving wellbeing for victim/survivors. While any randomised controlled trial can present difficulties in terms of recruitment and retention, conducting such a trial with domestic abuse perpetrators is particularly challenging. This paper reports the pilot and feasibility trial of a voluntary domestic abuse perpetrator group programme in the United Kingdom. Methods: This was a pragmatic individually randomised pilot and feasibility trial with an integrated qualitative study in one site (covering three local-authority areas) in England. Male perpetrators were randomised to either the intervention or usual care. The intervention was a 23-week group programme for male perpetrators in heterosexual relationships, with an average of three one-to-one sessions, and one-to-one support for female current- or ex-partners delivered by third sector organisations. There was no active control treatment for men, and partners of control men were signposted towards domestic abuse support services. Data were collected at three-monthly intervals for nine months from male and female participants. The main objectives assessed were recruitment, randomisation, retention, data completeness, fidelity to the intervention model, and acceptability of the trial design. Results: This study recruited 36 men (22 randomly allocated to attend the intervention group programme, 14 to usual care), and 15 current- or ex-partners (39% of eligible partners). Retention and completeness of data were high: 67% of male (24/36), and 80% (12/15) of female participants completed the self-reported questionnaire at nine months. A framework for assessing fidelity to the intervention was developed. In interviews, men who completed all or most of the intervention gave positive feedback and reported changes in their own behaviour. Partners were also largely supportive of the trial and were positive about the intervention. Participants who were not allocated to the intervention group reported feeling disappointed but understood the rationale for the trial. Conclusions: It was feasible to recruit, randomise and retain male perpetrators and female victim/survivors of abuse and collect self-reported outcome data. Participants were engaged in the intervention and reported positive benefits. The trial design was seen as acceptable. Trial registration: ISRCTN71797549, submitted 03/08/2017, retrospectively registered 27/05/2022

Young people’s attitudes to domestic violence and the role of schools in primary prevention : the Indian context

This thesis examines young people's attitudes to domestic violence in Mumbai, India and explores the under-researched potential of school-based interventions in changing attitudes that justify domestic violence in particular and violence against women in general. While young people's attitudes to violence in intimate relationships and the role of schools in imparting prevention education are currently receiving more attention in countries like Canada, and the UK, school- based preventative work still remains largely unexplored ill India. The empirical research is a mixed methods model using a combination of survey- based and qualitative interview-based methods. A survey was conducted in 14 secondary schools in Mumbai with 2229 school-going young people between the ages of 12 and 15 years (Classes VIII and IX). The quantitative analyses develop multivariate models of individual/household socio-demographic determinants of young peoples' definitions of domestic violence, attitudes to victim blame and attitudes to girls/women provoking violence. Furthermore, these analyses examine the influences of school-related factors, in particular single-sex and coeducational schools, in shaping young people's attitudes to domestic violence. To gain an insight into teachers' awareness/knowledge of domestic violence, and their opinions on the potential preventative role of schools and education both in increasing young people'S awareness of domestic violence and in influencing young people's negative attitudes to domestic violence, the qualitative analyses drew upon data generated by semi-structured iriterviews with 28 school teachers and Principals (head teachers) from the 14 sampled schools. The implications of these findings are discussed in relation to the role of schools in challenging attitudes that condone domestic violence on the one hand and reinforcing gender-stereotypes and reflecting the gender inequalities of wider society on the other. The findings of this study also seek to inform the development of school- based primary prevention programmes in India by identifying factors significantly associated with attitudes that justify domestic violence.EThOS - Electronic Theses Online ServiceGBUnited Kingdo