Systematic review and data synthesis on the treatment of sexual violence victimization by an intimate partner.

This study aims to conduct a systematic review and synthesis on the treatment of sexual violence victimization by an intimate partner evaluating specifically the impact of treatment on mental health outcomes of female sexual intimate partner violence (IPV) survivors. We followed the Cochrane Handbook for Systemic Reviews of Interventions guidelines for the process of conducting systematic reviews. We were unable to conduct meta-analyses due to the substantial heterogeneity of the interventions for IPV. A qualitative summary of 6 controlled studies identified no benefit to the treatment of sexual coercion, posttraumatic stress disorder, depression, or anxiety for female sexual IPV survivors. However, we are limited by a paucity of data for each outcome on this subject. In conclusion, sexual coercion is a complex issue that has adverse effects on mental health and the well-being of the survivors. More research is needed that investigates what kind of interventions are effective for this specific population.

Systematic Investigation of Meta-Analysis Data on Treatment Effectiveness for Physical, Psychological, and Sexual Intimate Partner Violence Perpetration.

Intimate partner violence can lead to physical, economical, mental, and sexual well-being issues, and even death, and it is most commonly experienced by women. There exist a number of treatment models for the prevention and treatment of intimate partner violence (IPV). In this study, we provided a comprehensive meta-regression analysis of the effectiveness of batterer treatment programs, with a view to characterizing the interplay between different forms of IPV (physical, psychological, and sexual). Using meta-regression, we explore the effect sizes and whether IPV treatment methods have distinct impacts on the outcomes. We use the difference normalized by pretreatment mean and variance foldchange to uncover the relationship between different violence subtypes and how they drive each other. Specifically, our study found that studies with more pre-treatment psychological and/or sexual violence, lead to less favorable outcomes while the studies that start with more physical violence are able to demonstrate their effects more effectively. Results of this study can be used to help the clinician effectively select the treatment for the perpetrator based on the violence type and severity of violence in order to more effectively treat the needs for each specific relationship.

La violencia de pareja puede llegar a afectar al bienestar físico, económico, mental y sexual e incluso llevar a la muerte, siendo experimentada con más frecuencia por las mujeres. Hay diversos modelos de prevención y tratamiento de la violencia de pareja (VP). En este estudio se lleva a cabo un análisis global de meta-regresión de la eficacia de los programas de tratamiento para maltratadores centrado en caracterizar la interacción entre diferentes formas de VP (física, psicológica y sexual). Mediante meta-regresión se explora el tamaño del efecto y si los distintos métodos de tratamiento de la VP influyen de modo distinto en los resultados. Se utiliza la diferencia normalizada por la media y la reducción de la heterogeneidad (varianza) del pretratamiento para analizar la relación entre los distintos tipos de violencia y cómo se influyen mutuamente. En concreto en este trabajo encontramos que los estudios con más violencia psicológica y/o sexual en el pretratamiento tienen resultados menos favorables, mientras que los que comienzan con más violencia física pueden demostrar sus efectos de un modo más eficaz. Los resultados de este estudio pueden ser de ayuda para que el profesional seleccione de modo más eficaz el tratamiento para el agresor teniendo en cuenta el tipo de violencia y su gravedad, con el fin de tratar de forma más adecuada las necesidades de cada relación específica.

Characterizing Disparities in the Treatment of Intimate Partner Violence.

Exposure to Intimate Partner Violence (IPV) has lasting adverse effects on the physical, behavioral, cognitive, and emotional health of survivors. To this end, it is critical to understand the effectiveness of IPV treatment strategies in reducing IPV and its debilitating effects. Meta-analyses designed to comprehensively describe the effectiveness of treatments offer unique advantages. However, the heterogeneity within and between studies poses challenges in interpreting findings. Meta-analyses are therefore unlikely to identify the factors that underlie disparities in treatment efficacy. To characterize the effect of demographic and social factors on treatment effectiveness, we develop a comprehensive computational and statistical framework that uses Meta-regression to characterize the effect of demographic and social variables on treatment outcomes. The innovations in our methodology include (i) standardization of outcome variables to enable meaningful comparisons among studies, and (ii) two parallel meta-regression pipelines to reliably handle missing data.

Comprehensive Analysis of Electronic Health Records to Characterize The Association Between Intimate Partner Violence and Mental Health.

Intimate partner violence (IPV) involves physical, emotional, and sexual harm to the survivor. To characterize the relationship between mental health and IPV, we utilized electronic health records (EHR) data from IBM Explorys. Focusing on 15 mental health conditions and IPV, we queried cohorts of patients with these conditions to discover additional medical terms, including symptoms, findings, and diagnoses that are prevalent in these cohorts. We then systematically assessed the (i) direct association (co-occurrence, i.e., relative prevalence of a medical term in a cohort compared to the background population) and (ii) indirect association (the similarity between co-occurrence profiles) between all pairs of these mental health conditions. Our results showed that direct and indirect measures of association provide complementary insights into the relationship between pairs of conditions. Using this framework, we discovered several patterns of association among 16 different mental health related conditions.

Systematic Investigation of Meta-Analysis Data on Treatment Effectiveness for Physical, Psychological, and Sexual Intimate Partner Violence Perpetration / [Investigación sistemática de los datos de meta-análisis sobre la eficacia del tratamiento de la agresión de pareja física, psicológica y sexual]

Intimate partner violence can lead to physical, economical, mental, and sexual well-being issues, and even death, and it is most commonly experienced by women. There exist a number of treatment models for the prevention and treatment of intimate partner violence (IPV). In this study, we provided a comprehensive meta-regression analysis of the effectiveness of batterer treatment programs, with a view to characterizing the interplay between different forms of IPV (physical, psychological, and sexual). Using meta-regression, we explore the effect sizes and whether IPV treatment methods have distinct impacts on the outcomes. We use the difference normalized by pretreatment mean and variance foldchange to uncover the relationship between different violence subtypes and how they drive each other. Specifically, our study found that studies with more pre-treatment psychological and/or sexual violence, lead to less favorable outcomes while the studies that start with more physical violence are able to demonstrate their effects more effectively. Results of this study can be used to help the clinician effectively select the treatment for the perpetrator based on the violence type and severity of violence in order to more effectively treat the needs for each specific relationship.(AU)

La violencia de pareja puede llegar a afectar al bienestar físico, económico, mental y sexual e incluso llevar a la muerte, siendo experimentada con más frecuencia por las mujeres. Hay diversos modelos de prevención y tratamiento de la violencia de pareja (VP). En este estudio se lleva a cabo un análisis global de meta-regresión de la eficacia de los programas de tratamiento para maltratadores centrado en caracterizar la interacción entre diferentes formas de VP (física, psicológica y sexual). Mediante meta-regresión se explora el tamaño del efecto y si los distintos métodos de tratamiento de la VP influyen de modo distinto en los resultados. Se utiliza la diferencia normalizada por la media y la reducción de la heterogeneidad (varianza) del pretratamiento para analizar la relación entre los distintos tipos de violencia y cómo se influyen mutuamente. En concreto en este trabajo encontramos que los estudios con más violencia psicológica y/o sexual en el pretratamiento tienen resultados menos favorables, mientras que los que comienzan con más violencia física pueden demostrar sus efectos de un modo más eficaz. Los resultados de este estudio pueden ser de ayuda para que el profesional seleccione de modo más eficaz el tratamiento para el agresor teniendo en cuenta el tipo de violencia y su gravedad, con el fin de tratar de forma más adecuada las necesidades de cada relación específica.(AU)

Adverse health correlates of intimate partner violence against older women: Mining electronic health records.

Intimate partner violence (IPV) is often studied as a problem that predominantly affects younger women. However, studies show that older women are also frequently victims of abuse even though the physical effects of abuse are harder to detect. In this study, we mined the electronic health records (EHR) available through IBM Explorys to identify health correlates of IPV that are specific to older women. Our analyses suggested that diagnostic terms that are co-morbid with IPV in older women are dominated by substance abuse and associated toxicities. When we considered differential co-morbidity, i.e., terms that are significantly more associated with IPV in older women compared to younger women, we identified terms spanning mental health issues, musculoskeletal issues, neoplasms, and disorders of various organ systems including skin, ears, nose and throat. Our findings provide pointers for further investigation in understanding the health effects of IPV among older women, as well as potential markers that can be used for screening IPV.

Treatments for Female Victims of Intimate Partner Violence: Systematic Review and Meta-Analysis.

Intimate partner violence (IPV) is an important problem that has significant detrimental effects on the wellbeing of female victims. The chronic physical and psychological effects of intimate partner violence (IPV) are complex, long-lasting, chronic, and require treatments focusing on improving mental health issues, safety, and support. Various psycho-social intervention programs are being implemented to improve survivor wellbeing. However, little is known about the effectiveness of different treatments on IPV survivors' wellbeing. For this purpose, we conducted a systematic review and meta-analysis to assess the effectiveness of interventions on improving outcomes that describe the wellbeing of adult female survivors of IPV. We searched PubMed, PsycINFO, and Cochrane Library. We explored the effectiveness of available interventions on multiple outcomes that are critical for the wellbeing of adult female victims of IPV. To provide a broad and comprehensive view of survivors' wellbeing, we considered outcomes including mental health, physical health, diminishing further violence, social support, safety, self-efficacy, and quality of life. We reviewed 2,770 citations. Among these 25 randomized-controlled-study with a total of 4,683 participants met inclusion criteria. Findings of meta-analyses on interventions indicated promising results in improving anxiety [standardized mean difference (SMD) -7.15, 95% confidence interval (CI) -8.39 to -5.92], depression (SMD -0.26, CI -0.56 to -0.05), safety (SMD = 0.43, CI 0.4 to -0.83), violence prevention (SMD = -0.92, CI -1.66 to -0.17), health (SMD = 0.39, CI 0.12 to 0.66), self-esteem (SMD = 1.33, CI -0.73 to 3.39), social support (SMD =0.40, CI 0.20 to 0.61), and stress management (SMD = -8.94, CI -10.48 to -7.40) at the post-test. We found that empowerment plays a vital role, especially when treating depression and Post-Traumatic Stress Disorder (PTSD), which are difficult to improve across interventions. We found mixed findings on self-efficacy and quality of life. The effects of IPV are long-lasting and require treatments targeting co-morbid issues including improving safety and mental health issues.

Brain Injury and Mental Health Among the Victims of Intimate Partner Violence: A Case-Series Exploratory Study.

Intimate partner violence (IPV) survivors frequently report face, head, and neck as their injury site. Many mild traumatic brain injuries (TBIs) are undiagnosed or underreported among IPV survivors while these injuries may be linked to changes in brain function or pathology. TBI sustained due to IPV often occurs over time and ranges in severity. The aim of this case-series study was to explore risk factors, symptoms, and brain changes unique to survivors of intimate partner violence with suspicion of TBI. This case-series exploratory study examines the potential relationships among IPV, mental health issues, and TBI. Participants of this study included six women: 3 women with a history of IPV without any experience of concussive blunt force to the head, and 3 women with a history of IPV with concussive head trauma. Participants completed 7T MRI of the brain, self-report psychological questionnaires regarding their mental health, relationships, and IPV, and the Structured Clinical Interview. MRI scans were analyzed for cerebral hemorrhage, white matter disturbance, and cortical thinning. Results indicated significant differences in resting-state connectivity among survivors of partner violence as well as differences in relationship dynamics and mental health symptoms. White matter hyperintensities are also observed among the survivors. Developing guidelines and recommendations for TBI-risk screening, referrals, and appropriate service provision is crucial for the effective treatment of TBI-associated IPV. Early and accurate characterization of TBI in survivors of IPV may relieve certain neuropsychological consequences.

Data-driven identification of subtypes of intimate partner violence.

Intimate partner violence (IPV) is a complex problem with multiple layers of heterogeneity. We took a data-driven approach to characterize this heterogeneity. We integrated data from different studies, representing 640 individuals from various backgrounds. We used hierarchical clustering to systematically group cases in terms of their similarities according to violence variables. Results suggested that the cases can be clustered into 12 hierarchically organized subgroups, with verbal abuse and negotiation being the main discriminatory factors at higher levels. The presence of physical assault, injury, and sexual coercion was discriminative at lower levels of the hierarchy. Subgroups also exhibited significant differences in terms of relationship dynamics and individual factors. This study represents an attempt toward using integrative data analysis to understand the etiology of violence. These results can be useful in informing treatment efforts. The integrative data analysis framework we develop can also be applied to various other problems.

Co-occurrence Patterns of Intimate Partner Violence.

Intimate partner violence (IPV) is an important social and public health problem, affecting millions of women worldwide. Violence in a relationship can occur in multiple ways, including physical violence, psychological aggression, and sexual violence. In this study, utilizing data from the National Intimate Partner and Sexual Violence Survey (NISVS), we comprehensively investigate the interplay between physical, psychological, and sexual violence, in terms of their co-occurrence patterns, their relation to trauma symptoms and overall health of victims. For this purpose, we perform network analysis and develop a visualization technique that enables in-depth navigation of the three-dimensional (physical, psychological, sexual) space of violence. Our findings show that physical violence tends to significantly co-occur with psychological abuse, and violence intensifies when both are present. We also find that sexual violence tends to overlap less with other types of violence, particularly with physical violence. Milder forms of psychological abuse are prominent in the population and seem to represent a separate type of abuse (micro-aggression) in terms of its occurrence patterns. Finally, we observe that trauma symptoms and health problems tend to be reported more by survivors at the presence of intense psychological aggression. Our findings can be useful in developing treatments that target different patterns of IPV.

Interplay between traumatic brain injury and intimate partner violence: data driven analysis utilizing electronic health records.

BACKGROUND: It is estimated that a majority of intimate partner violence (IPV) victims suffer from blunt force to the head, neck and the face area. Injuries to head and neck are among the major causes for traumatic brain injury (TBI). METHODS: In this interdisciplinary study, we aimed to characterize the key associations between IPV and TBI by mining de-identified electronic health records data with more than 12 M records between 1999 to 2017 from the IBM Explorys platform. For this purpose, we formulated a data-driven analytical framework to identify significant health correlates among IPV, TBI and six control cohorts. Using this framework, we assessed the co-morbidity, shared prevalence, and synergy between pairs of conditions. RESULTS: Our findings suggested that health effects attributed to malnutrition, acquired thrombocytopenia, post-traumatic wound infection, local infection of wound, poisoning by cardiovascular drug, alcoholic cirrhosis, alcoholic fatty liver, and drug-induced cirrhosis were highly significant at the joint presence of IPV and TBI. CONCLUSION: To develop a better understanding of how IPV is related to negative health effects, it is potentially useful to determine the interactions and relationships between symptom categories. Our results can potentially improve the accuracy and confidence of existing clinical screening techniques on determining IPV-induced TBI diagnoses.

Identifying health correlates of intimate partner violence against pregnant women.

PURPOSE: Violence against women during pregnancy is a serious public health concern due to its significant adverse health consequences for both the mother and the baby. This study aims to systematically identify common health problems and synergistic health correlates of intimate partner violence (IPV) that specifically affect pregnant women. METHODS: We mine large-scale electronic health record (EHR) data from the IBM Explorys database to identify health problems that are prevalent in both IPV and pregnancy populations, as well those that are synergistically associated with the presence of IPV during pregnancy. For this purpose, we develop methods that enhance the statistical reliability of identified patterns by constructing confidence intervals that take into account systematic bias and measurement errors in addition to the variance in estimation. RESULTS: We identify with high confidence 668 and 2750 terms that are respectively prevalent in respectively IPV and pregnancy populations. Of these terms, 279 are common. We also identify 16 synergistic health correlates with high confidence. Our results suggest that mental health, substance abuse, and genitourinary complications are prevalent among pregnant women exposed to IPV. The synergistic terms we identify reveal potential conditions that can be direct consequences of trauma (e.g., tibial fracture), long-term health consequences (e.g., chronic rhinitis), markers associated with the demograhics of affected populations (e.g., acne), and risk factors that potentially increase vulnerability during pregnancy (e.g., disorders of attention and motor control). CONCLUSIONS: Our results indicate that IPV significantly affects the well-being of pregnant women in multiple ways. The findings of this study can be useful for screening of IPV in pregnant women. Finally, the methodology presented here can also be useful for investigating the synergy between other medical conditions using EHR databases with privacy constraints.

Disaster Training Needs and Expectations Among Turkish Emergency Medicine Physicians - A National Survey.

OBJECTIVES: Earthquakes, landslides, and floods are the most frequent natural disasters in Turkey. The country has also recently experienced an increased number of terrorist attacks. The purpose of this study is to understand the expectations and training of Turkish emergency medicine attending physicians in disaster medicine. METHODS: An online questionnaire was administered to the 937 members of the Emergency Medicine Association of Turkey, of which 191 completed the survey (20%). RESULTS: Most participants (68%) worked at a Training and Research Hospital (TRH) or a University Hospital (UH), and 69% had practiced as an attending for 5 years or less. Mass immigration, refugee problems, and war/terror attacks were considered to be the highest perceived risk topics. Most (95%) agreed that disaster medicine trainings should occur during residency training. Regular disaster drills and exercises and weekly or monthly trainings were the most preferred educational modalities. Most respondents (85%) were interested in advanced training in disaster medicine, and this was highest for those working less than 5 years as an attending. UH and TRH residency training programs were not considered in themselves to be sufficient for learning disaster medicine. CONCLUSIONS: Turkish emergency medicine residency training should include more disaster medicine education and training.

Meta-analysis and systematic review for the treatment of perpetrators of intimate partner violence.

Aim of this study is to investigate the effectiveness of different batterer intervention programs in reducing violence for male IPV perpetrators. The Cochrane Handbook for Systemic Reviews of Interventions guidelines for the process of conducting systematic reviews and meta-analysis were followed. Pooled together, overall these various intervention programs are effective in reducing violence for male perpetrators of IPV comparing post to pre-intervention [(pooled estimate = -0.85; 95% Confidence Interval (CI) (-1.02 to -0.69)]. Exploratory subgroup analysis revealed that incorporating substance abuse or trauma components to the interventions yielded better results (substance abuse: CI = -3.20 to -1.08 and trauma: CI = -2.63 to -0.30) as compared to programs that did not have these components. Gender-role based batterer intervention programs yielded mixed results. Analysis of the three controlled studies with 223 participants comparing batterer programs to a minimal control group showed mixed effects. In conclusion, treatment strategies that are addressing highly comorbid issues such as substance abuse and trauma issues may work more effectively in preventing violence.

Adult Attachment Security and Different Types of Relational Violence Victimization Among College-Age Couples.

This study aims to understand the associations between adult attachment security and different types of intimate partner violence victimization including that of emotional abuse, physical violence, and sexual coercion among heterosexual couples. Participants included 87 couples with the mean age 22.3 years. An actor-partner interdependence model was fit to the data. Findings indicated that adult attachment security accounted for 15% of the variance in the emotional abuse victimization of females, 9% of the variance in the sexual coercion victimization of females, and 7% of the variance in minor physical victimization of males. This may significantly impact risk factor assessment, and contribute to improved therapeutic intervention and increased understanding of the development and progression of relationship violence.

Trauma and Health Symptoms in a Community Sample: Examining the Influences of Gender and Daily Stress.

Although there is a rich body of literature on trauma and health, limited research has investigated the variables of gender, trauma symptoms, physical health, mental health, and daily stress together in a community sample. Considering the deleterious effects of trauma on health, our overarching inquiry was whether trauma symptoms can predict overall mental and physical health with attention to gender and daily stress as potential moderators. Participants (n = 103; 50.5% women) completed self-report measures of trauma symptoms, mental health, physical health, and daily stress, along with demographic information. Trauma symptoms predicted 25.2% of the variance in general health symptoms. Gender significantly added to the variance accounted for, but daily stress was not significant in the model. Trauma symptoms predicted 37.1% of the variance in mental health symptoms. Daily stress significantly added to the model, but gender did not. Results are interpreted through the integration of family stress theory and feminist frameworks, adding to the literature by further illuminating the relationships between gender, daily stress, health symptoms, and trauma in a community sample.

Mining Electronic Health Records Data: Domestic Violence and Adverse Health Effects.

Intimate partner violence (IPV) often culminates in acute physical injury, sexual assault, and mental health issues. It is crucial to understand the healthcare habits of victims to develop interventions that can drastically improve a victim's quality of life and prevent future abuse. The objective of this study is to mine de-identified and aggregated Electronic Health Record data to identify women's health issues that are potentially associated with IPV. In this study we compared health issues of female domestic abuse victims to female non-domestic abuse victims. The Domestic abuse population contained 5870 patients, while the Non-Domestic Abuse population contained 14,315,140 patients. Explorys provides National Big Data from the entire USA. Statistical analysis identified 2429 terms as significantly more prevalent among victims of domestic abuse, compared to the general population. These terms were classified into broad categories, including acute injury, chronic conditions, substance abuse, mental health, disorders, gynecological and pregnancy related problems.

NETWORK MAP OF ADVERSE HEALTH EFFECTS AMONG VICTIMS OF INTIMATE PARTNER VIOLENCE.

Intimate partner violence (IPV) is a serious problem with devastating health consequences. Screening procedures may overlook relationships between IPV and negative health effects. To identify IPV-associated women's health issues, we mined national, aggregated de-identified electronic health record data and compared female health issues of domestic abuse (DA) versus non-DA records, identifying terms significantly more frequent for the DA group. After coding these terms into 28 broad categories, we developed a network map to determine strength of relationships between categories in the context of DA, finding that acute conditions are strongly connected to cardiovascular, gastrointestinal, gynecological, and neurological conditions among victims.

Secure Base Narrative Representations and Intimate Partner Violence: A Dyadic Perspective.

This study aimed to understand the relationship between secure base phenomena and dating violence among couples. Within a relationship, a secure base can be defined as a balancing act of proximity-seeking and exploration at various times and contexts with the assurance of a caregiver's availability and responsiveness in emotionally distressing situations. Participants were 87 heterosexual couples. The Actor-Partner Interdependence Model was used to examine the relationship between each partner's scores on secure base representational knowledge and intimate partner violence. Findings demonstrated that women's secure base representational knowledge had a significant direct negative effect on the victimization of both men and women, while men's secure base representational knowledge did not have any significant partner or actor effects. Therefore, findings suggest that women with insecure attachments may be more vulnerable to being both the victims and the perpetrators of.

Couples Therapy for Intimate Partner Violence: A Systematic Review and Meta-Analysis.

Intimate partner violence is a serious public health problem accompanied by substantial morbidity and mortality. Despite its documented impact on health, there is no widely recognized treatment of choice. Some studies indicate that couples suffering from situational violence may benefit from couples therapy, but professionals are cautious to risk the possibility of violent retaliation between partners. After a comprehensive literature search of 1,733 citations, this systematic review and meta-analysis compiles the results of six studies to investigate the effectiveness of couples therapy as a treatment for violence. Preliminary data suggest that couples therapy is a viable treatment in select situations.