Can Women Shelters Help Reduce Symptoms of PTSD and C-PTSD? Trajectories of PTSD Symptom Development Following Partner- and Family-Related Violence.

BACKGROUND: To protect women from Intimate partner violence (IPV), women's shelters should not only provide emergency safety from IPV exposure, but also prolonged support that empowers women to build a life free from violence. The present study aims to investigate individual symptom development in association with residency at a women's shelter. METHOD: Data were collected at four different timepoints, that is, enrolment (T1, N = 150), 3-months residency (T2, = 110), 6-months residency (T3, N = 68) and after relocation (T4, N = 63). Women were included from four Danish women's shelters. The International Trauma Questionnaire (ITQ) was applied to test for post-traumatic stress disorder (PTSD) and Complex-PTSD (C-PTSD) at all timepoints. A paired sample t-test was used to test the mean symptom development, and a Latent Class Growth Analysis (LCGA) was applied to test for different classes of PTSD-trajectories. Logistic regression was applied to predict class membership from shelter-related variables and symptom severity, that is, length of residency, psychological counselling, revictimization and key symptoms of C-PTSD. RESULTS: The prevalence of PTSD (31%) and C-PTSD (37.9%) was high at enrolment. Although t-tests suggested a significant decline in symptoms at follow-up, the LCGA revealed different classes of symptom development. The two-class model was found to be the best representation of data with low-symptom- and high-symptom profiles, respectively. Overall, the largest decline in symptoms occurred within the first 3 months of residency. Revictimization was high and was further found to predict class membership. However, when included in a multiple regression only symptom severity predicted the high-symptoms profile class. DISCUSSION: Psychological treatment focussing on PTSD and C-PTSD is important for the women's future well-being and safety. Reports on revictimization was alarmingly high, which emphasises a continuing need to protect women from psychological violence within the shelters. These findings should be replicated in larger samples before we can draw any conclusion.

The complex trauma of psychological violence: cross-sectional findings from a Cohort of four Danish Women Shelters.

Background: Psychological trauma has only recently been considered a traumatic event. Therefore, research on Posttraumatic Stress Disorder (PTSD) and Complex-PTSD following exposure to psychological violence, is less studied compared with physical and sexual violence. Objectives: This study aimed to establish the prevalence of PTSD and C-PTSD of among female victims of partner violence (IPV) and examine the unique association between different subtypes of IPV (i.e. physical, psychological and sexual IPV) and the traumatic response. Methods: The study includes a shelter-based sample of female victims of IPV (N = 147). Validated measures were used to estimate IPV exposure and mental health outcomes. Partial Correlation and Hierarchical Regression was used to examine the association between IPV and PTSD and C-PTSD, respectively. Results: The study found a high prevalence of both PTSD (56.5%) and C-PTSD (21.1%) in the sample. Overall, when controlling for the other types of violence, psychological violence correlated with PTSD, C-PTSD, negative affect and somatization. When controlling for psychological violence, neither physical nor sexual violence correlated with any of the mental health outcomes. Hierarchical regression models helped explain 23.5% and 29.7% of the variance in symptoms of PTSD and C-PTSD, respectively. Conclusion: A relatively large subgroup of the women had symptoms of C-PTSD, which demonstrate a potentially unmet need for trauma-informed treatment services in Danish Women Shelters. Psychological violence was found to be the strongest risk factor for all mental health outcomes and thus, it is important to acknowledge the severity of this IPV subtype.

Antecedentes: El trauma psicológico sólo recientemente ha sido considerado un evento traumático. Por lo tanto, la investigación sobre el Trastorno de Estrés Postraumático (TEPT) y el TEPT Complejo tras la exposición a la violencia psicológica, está menos estudiada en comparación con la violencia física y sexual.Objetivos: El objetivo de este estudio fue establecer la prevalencia del TEPT y el TEP-C entre las mujeres víctimas de la violencia de pareja (IVP, en siglas en inglés) y examinar la asociación distintiva entre los diferentes subtipos de IVP (es decir, IVP físico, psicológico y sexual) y la respuesta traumática.Métodos: El estudio incluye una muestra basada en refugios para mujeres víctimas de IVP (N = 147). Se utilizaron medidas validadas para estimar la exposición a la IVP y los resultados de salud mental. Se utilizó la correlación parcial y la regresión jerárquica para examinar la asociación entre la IVP y el TEPT y el TEPT-C, respectivamente.Resultados: El estudio encontró una alta prevalencia tanto de TEPT (56,5%) como de TEPC (21,1%) en la muestra. En general, al controlar los otros tipos de violencia, la violencia psicológica se correlacionó con el TEPT, el TEPT-C, el afecto negativo y la somatización. Al controlar la violencia psicológica, ni la violencia física ni la sexual se correlacionaron con ninguno de los resultados de salud mental. Los modelos de regresión jerárquica ayudaron a explicar el 23,5% y el 29,7% de la variación en los síntomas del TEPT y el TEPT-C, respectivamente.Conclusión: Un subgrupo relativamente grande de mujeres tenía síntomas de TEPTC, lo que demuestra una necesidad potencialmente no cubierta de servicios de tratamiento con información en traumas en los refugios de mujeres danesas. Se comprobó que la violencia psicológica era el factor de riesgo más fuerte para todos los resultados de salud mental y, por lo tanto, es importante reconocer la gravedad de este subtipo de IVP.

The psychological subtype of intimate partner violence and its effect on mental health: protocol for a systematic review and meta-analysis.

BACKGROUND/AIM: Psychological violence is estimated to be the most common form of intimate partner violence (IPV). Despite this, research on the independent effect of psychological violence on mental health is scarce. Moreover, the lack of a clear and consistent definition of psychological violence has made results difficult to compare. The present study therefore aims to consolidate knowledge on psychological violence by conducting a systematic review and random-effects meta-analysis on the association between psychological violence and mental health problems, when controlling for other types of violence (e.g. physical and sexual) and taking into account severity, frequency, and duration of psychological violence. METHOD: The present study is registered in the International Prospective Register for Systematic Reviews (PROSPERO; #CRD42018116026) and the study design follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA; Additional file 1). A dual search will be conducted in the electronic databases PsycINFO, PubMed, EMBASE, and Web of Science. Data will be extracted using Endnote and Covidence and a meta-analysis will be conducted using Metafor-package in the programming language R. The Quality Assessment Tool for Quantitative Studies developed by the Effective Public Health Practice Project will be used to assess the quality of the included studies (i.e. weak, moderate and strong). RESULTS AND DISCUSSION: The present review will help consolidate knowledge on psychological violence by evaluating whether frequency, severity or actual "type" of psychological violence produces the most harm. A thorough quality assessment will help overcome potential limitations regarding expected variations in terminology and assessment of psychological violence. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018116026 .

[Barriers to communication between clinicians and immigrants]. / Barrierer i lægesamtalen med indvandrerpatienten.

Clinicians lack cultural competencies and communication skills relevant to clinical decision-making in cases of language and cultural barriers. Life course perspectives and basic understanding of life in exile are not integrated in diagnostics, treatment or follow-up resulting in low patient compliance, mistrust, complications, diagnostic errors and delays. Stereotyping and generalizations put patients in a position where they are forced to protect themselves by withholding important information. When in doubt clinicians should ask, listen and avoid guessing.