Primary care-based interventions for intimate partner violence: a systematic review.

CONTEXT: Primary care providers are uniquely positioned to respond to patients' disclosure of intimate partner violence (IPV). However, the research on primary care-based IPV interventions has not been systematically synthesized, making it difficult for providers, policymakers, and researchers to understand how to effectively intervene in the primary care setting. This systematic review summarizes primary care-based interventions for patients experiencing IPV. EVIDENCE ACQUISITION: PubMed, PsycINFO, and CINAHL were searched from their start through September 2012; this search was augmented by bibliographic review and consultation with experts. Eligible studies included English-language, peer-reviewed articles that assessed patient-level impact of IPV interventions that originated from patients' visits to a primary care provider. EVIDENCE SYNTHESIS: Of 80 potentially eligible studies, 17 met eligibility criteria. The majority of interventions recruited women from reproductive care sites. Interventions tended to be brief, delivered by nonphysicians, and focused on empowerment, empathetic listening, discussion of the cycle of violence and safety, and referral to community-based resources. Thirteen studies demonstrated at least one intervention-related benefit. Six of 11 articles measuring IPV persistence found reductions in future violence; two of five measuring safety-promoting behaviors found increases; and six of ten measuring IPV/community resource referrals found enhanced use. Some studies also documented health improvements. CONCLUSIONS: The majority of studies demonstrated patient-level benefit subsequent to primary care IPV interventions, with IPV/community referrals the most common positively affected outcome.

Academy on Violence and Abuse: highlights of proceedings from the 2011 conference, "toward a new understanding".

In April 2011, the Academy on Violence Abuse (http://www.avahealth.org/) convened a network of experts for its second annual conference, "Developing the Science of Violence and Abuse: Toward a New Understanding." The conference served as a forum for highlighting the growing body of research regarding the biological consequences and adverse health consequences of abuse. In doing so, it underscored an important scientific premise: By evaluating the impact of violence and abuse from birth to death, one can better evaluate the social, behavioral, psychological, and biological context and pathways that result in the morbidity, mortality, and quality of life of all affected individuals and communities. In this article, we summarize content presented by the conference's keynote speakers and provide citations that speakers have submitted to support their statements.

Cognitive and emotional processing in narratives of women abused by intimate partners.

This study examined relationships between cognitive and emotional processing with changes in pain and depression among intimate partner violence survivors. Twenty-five women who wrote about their most traumatic experiences completed measures of pain and depressive symptoms before the first writing session and again 4 months following the last writing session. Reduced pain was significantly associated with less use of positive and negative emotion words. Relationships between cognitive and emotional aspects of writing with changes in depressive symptoms fell short of statistical significance. The results suggest that emotional processing in narrative writing predicts changes in pain in intimate partner violence survivors.

Relationships of depression to child and adult abuse and bodily pain among women who have experienced intimate partner violence.

This study investigates whether depression in women who experienced intimate partner violence is associated with having also experienced childhood sexual and physical abuse, psychological abuse by an intimate partner, recent involvement with the abusive partner, and bodily pain. Fifty-seven women who had left a violent relationship with an intimate partner completed measures assessing their demographic characteristics, experiences of abuse in childhood and in their relationship with their intimate partner, and depressive symptoms. Multiple regression analysis showed that women's depression was significantly greater among those who had experienced childhood physical and sexual abuse, more severe psychological abuse, and greater bodily pain (p<.001), adjusted R(2)=.32. These results suggest characteristics that can help to identify abused women who are most at risk for depression, and they suggest specific issues that may need to be addressed in this population.

The effects of expressive writing on pain, depression and posttraumatic stress disorder symptoms in survivors of intimate partner violence.

This study examined the effects of expressive writing on depression, posttraumatic stress disorder (PTSD) and pain symptoms among women who have survived intimate partner violence (IPV). Forty-seven women completed baseline and four-month follow-up assessments and were randomly assigned to four writing sessions of either expressive writing focused on traumatic life events or writing about a neutral topic. Main effects were not significant for changes in depression, pain or PTSD symptoms. However, among depressed women, those assigned to expressive writing showed a significantly greater drop in depression. For depressed women with IPV histories, expressive writing may lead to reduced depression.