Profiles of Intimate Partner Violence Victimization, Substance Misuse, and Depression Among Female Caregivers Involved with Child Protective Services.

Intimate partner violence (IPV) victimization, substance misuse, and depression are highly prevalent among female caregivers involved with child protective services (CPS). Understanding heterogeneity in the occurrence of these problems is essential to improving pathways to intervention for women in this population. Latent class analysis was employed to determine whether there exist homogeneous subgroups of female caregivers who experience different patterns of IPV victimization, substance misuse, and depression. A restricted three-class solution best fit the data, suggesting high risk, moderate risk, and no risk subgroups. A substantial number of female caregivers comprise the high-risk subgroup (33%) in which caregivers reported very high rates of IPV victimization, substance misuse, and depression. Only a very small proportion comprised the no-risk subgroup (9%). Findings emphasize the heterogeneity among subgroups of female caregivers based on these risk factors, which may have implications for practitioners, such as CPS caseworkers, and researchers alike.

Psychological intimate partner violence and sexual risk behavior: examining the role of distinct posttraumatic stress disorder symptoms in the partner violence-sexual risk link.

BACKGROUND: Research has examined how physical and sexual intimate partner violence (IPV) victimization increases sexual risk behavior, yet research is lacking on 1) the effect of psychological IPV on sexual risk behavior and 2) factors through which psychological IPV may be linked to sexual risk behavior. METHODS: The current study examined the relationship between psychological IPV and sexual risk behavior controlling for other forms of IPV (i.e., physical and sexual) in a sample of 186 human immunodeficiency virus (HIV)-negative community women currently experiencing IPV. Further, this study examined the potential mediating effects of four posttraumatic stress disorder (PTSD) symptom severity clusters (i.e., re-experiencing, avoidance, numbing, and hyperarousal) on this relationship. FINDINGS: Results revealed that greater severity of psychological IPV was uniquely and directly related to greater sexual risk behavior. Additionally, of the four PTSD symptom severity clusters, only avoidance symptom severity mediated the relationship between psychological IPV and sexual risk behavior. CONCLUSION: Implications for addressing psychological IPV and PTSD to improve women's sexual health outcomes are discussed.

The Effects of Alcohol Problems, PTSD, and Combat Exposure on Nonphysical and Physical Aggression Among Iraq and Afghanistan War Veterans.

Aggression among combat veterans is of great concern. Although some studies have found an association between combat exposure and aggressive behavior following deployment, others conclude that aggression is more strongly associated with symptoms of posttraumatic stress disorder (PTSD), and that alcohol misuse may influence this association. Many of these studies have assessed aggression as a single construct, whereas the current study explored both nonphysical aggression only and physical aggression in a sample of Iraq and Afghanistan war veterans (N = 337; 91% male). We found that alcohol problems interacted with PTSD symptom severity to predict nonphysical aggression only. At low levels of PTSD symptoms, veterans with alcohol problems were more likely to perpetrate nonphysical aggression only, as compared with no aggression, than veterans without an alcohol problem. There was no difference in the likelihood of nonphysical aggression only between those with and without alcohol problems at high levels of PTSD symptoms. The likelihood of nonphysical aggression only, as compared with no aggression, was also greater among younger veterans. Greater combat exposure and PTSD symptom severity were associated with an increased likelihood of perpetrating physical aggression, as compared with no aggression. Ethnic minority status and younger age were also associated with physical aggression, as compared with no aggression. Findings suggest that a more detailed assessment of veterans' aggressive behavior, as well as their alcohol problems and PTSD symptoms, by researchers and clinicians is needed in order to determine how best to intervene.

The moderating effect of women's alcohol misuse on the relationship between intimate partner violence victimization and postpartum depression.

BACKGROUND AND OBJECTIVES: We examined the moderating effect of women's alcohol misuse on the relationship between intimate partner violence (IPV) victimization and postpartum depression. METHODS: Self-report data were collected from 122 women. Analyses controlled for women's baseline depression severity and partner alcohol misuse. RESULTS: Women's alcohol misuse moderated the relationship between psychological IPV victimization and postpartum depression only at high levels of the moderator. DISCUSSION AND CONCLUSIONS: Findings highlight the mental health risk posed by the combination of psychological IPV and alcohol misuse postpartum. SCIENTIFIC SIGNIFICANCE: Findings emphasize the need to investigate the understudied topic of women's postpartum alcohol misuse.

Elucidating posttraumatic stress symptom profiles and their correlates among women experiencing bidirectional intimate partner violence.

OBJECTIVE: This study employed latent class analysis to identify profiles of women experiencing intimate partner violence (IPV) based on the severity of posttraumatic stress disorder (PTSD) symptoms. METHOD: Self-report data from a sample of 369 women experiencing bidirectional IPV was used. RESULTS: A 3-class solution comprising low, moderate, and high PTSD severity profiles best fit the data. Profiles were differentially related to whether IPV victimization was considered traumatic (PTSD criterion A); whether functioning was impaired as a result of PTSD symptoms (PTSD criterion F); whether the woman met full diagnostic criteria for PTSD; depression symptom severity; and severity of psychological, physical, and sexual IPV victimization and use of IPV. An extremely high percentage of women in the high (96%) and moderate (88%) severity classes experienced functional impairment, although many did not meet full diagnostic criteria for PTSD. CONCLUSIONS: Findings support the need for interventions individually tailored to one's treatment needs based on the nature of one's traumatic stressor and the impact of PTSD on daily functioning.

Examining the Prevalence, Bidirectionality, and Co-Occurrence of Sexual Intimate Partner Violence among Women During Pregnancy and Postpartum.

OBJECTIVES: This longitudinal study examined the prevalence of women's sexual intimate partner violence (IPV) perpetration, the extent to which women experienced both sexual IPV victimization and perpetration, and the overlap between women's experiences of sexual IPV with psychological and physical IPV victimization and perpetration. METHODS: Data were collected via self-report survey from 180 women during the first 18 weeks of pregnancy and 122 participants completed follow-up assessments at six weeks postpartum. RESULTS: At both time points, the prevalence of sexual IPV victimization and perpetration were similar in this sample. Bidirectional sexual IPV was more common than sexual IPV victimization or perpetration only. The majority of participants who experienced sexual IPV victimization at baseline and follow-up also experienced psychological or physical IPV victimization. No participants at either time point reported sexual IPV perpetration only, those participants who perpetrated sexual IPV also perpetrated psychological or physical IPV. CONCLUSIONS: Future research should investigate women's sexual IPV victimization and perpetration as they relate to other areas of mental and physical health during this time period.

Posttraumatic stress disorder symptom clusters, alcohol misuse, and women's use of intimate partner violence.

Exploring how PTSD and alcohol misuse relate to women's use of intimate partner violence (IPV) is vital to develop our understanding of why some women may engage in IPV, which can serve to maximize intervention efforts for women. This study examined the extent to which posttraumatic stress disorder (PTSD) symptom clusters are directly and indirectly related to women's use of IPV through pathways involving alcohol misuse while controlling for severity of women's IPV victimization. The sample was comprised of substance-using, low socioeconomic status community women (N = 143) currently experiencing IPV victimization. The majority of the sample was African American (n = 115, 80.42%). This sample had an average annual household income of $14,368.68 (SD = $12,800.68) and the equivalent of a high school education (11.94 years, SD = 1.32). Path analyses indicated that the strongest statistical relationship emerged between women's use of IPV and women's IPV victimization. PTSD reexperiencing and numbing symptom severity was related to women's use of psychological, minor physical, and severe physical IPV; however, these relationships were indirect through alcohol misuse. Findings lend preliminary support for the application of the self-medication hypothesis to the study of PTSD, alcohol misuse, and IPV among women.

Women's intimate partner violence perpetration during pregnancy and postpartum.

The purpose of this longitudinal study was to examine the prevalence of women's psychological, minor physical, and severe physical intimate partner violence (IPV) perpetration during the first 18 weeks of pregnancy and at 6 weeks postpartum and to compare women who used each type of IPV to those who did not. Women who increased their IPV perpetration over time were also compared to women who decreased or did not change their IPV perpetration over time. A sample of 180 women participated in a larger study of the well-being of pregnant women. Data were collected via self-report survey and 122 participants were retained at follow-up. At both time points, more women in the sample reported IPV perpetration (baseline n = 132; follow-up n = 73) than IPV victimization (baseline n = 114; follow-up n = 66). Women who perpetrated IPV reported higher levels of IPV victimization, reported partner alcohol misuse, stress, depression, and lower dyadic adjustment compared to women who did not. Women's IPV perpetration was associated with several negative outcomes. Findings suggest that IPV screening during pregnancy and postpartum should include women's IPV perpetration and should be conducted at multiple time points, since women's IPV experiences may change over time.

Posttraumatic stress and depression symptoms as correlates of deliberate self-harm among community women experiencing intimate partnerviolence.

Deliberate self-harm (DSH) among women in the general population is correlated separately with posttraumatic stress, depression, and abuse during childhood and adulthood. The prevalence of these DSH correlates is particularly high among women exposed to intimate partner violence (IPV), yet few studies have examined DSH among this high-risk population and none have examined these correlates simultaneously. Two hundred and twelve IPV-victimized women in the community participated in a 2-h retrospective interview. One-third reported current or past DSH. Discriminant analysis was used to examine which posttraumatic stress and depression symptoms and types of current IPV and childhood abuse were uniquely associated with current DSH. Findings show that women who currently use DSH reported greater severity of posttraumatic stress numbing symptoms and more severe sexual IPV compared to women who used DSH only in the past. Examining factors that are associated with women's current DSH in this population is critical so that a focus on DSH can be integrated into the treatment plans of women who are receiving mental health care, but also so that women who are not receiving such care can be referred to adequate mental health services.

Risk factors for intimate partner violence during pregnancy and postpartum.

This longitudinal investigation examined potential risk factors for intimate partner violence (IPV) among women during pregnancy and 6 weeks postpartum. A sample of 180 pregnant women was collected in order to investigate (1) whether associations between partner alcohol misuse, partner jealousy, partner suspicion of infidelity, and stress were associated with IPV victimization; (2) the indirect effects of alcohol misuse on these relationships; and (3) factors related to changes in IPV victimization over time. At baseline, partner alcohol misuse was associated with each type of IPV victimization and the combination of partner alcohol misuse, partner jealousy, and partner suspicion of infidelity was most strongly associated with severe physical victimization. Partner alcohol misuse mediated the relationship between partner jealousy and psychological and severe physical victimization. At follow-up, partner jealousy and stress were related to women's psychological victimization and partner alcohol misuse was related to women's severe physical victimization. Findings suggest that partner alcohol misuse is a risk factor for women's IPV victimization during pregnancy and jealousy and that stress may increase risk for some types of IPV. Findings also suggest that intervention should target parents early in pregnancy in order to reduce the risk for future IPV.

Methods for Assessing and Addressing Participant Protection Concerns in Intimate Partner Violence Research.

Research on intimate partner violence (IPV) is highly sensitive and may put some participants at increased psychological, emotional, and physical risk. Still, we know little about the risks posed by most social science methods and have minimal guidance regarding appropriate practices for carrying out various forms of research. This study collected data from 59 IPV researchers regarding the most commonly used participant protection methods, the efficacy of those methods, number and nature of adverse events (AE) experienced, and experiences with institutional review boards (IRBs). Participants were invited via e-mail to complete an anonymous online survey. Findings indicate an overall low incidence of AEs as well as a minimal relationship between AEs and IPV inquiry. These findings may provide researchers with preliminary data on the effectiveness of various participant protection methods. Results may also facilitate more innovative and effective participant protections measures, help researchers prevent and cope with AE, and create more mutually beneficial relationships with IRBs.

Modeling PTSD symptom clusters, alcohol misuse, anger, and depression as they relate to aggression and suicidality in returning U.S. veterans.

Suicidal ideation and aggression are common correlates of posttraumatic stress disorder (PTSD) among U.S. Iraq and Afghanistan war veterans. The existing literature has established a strong link between these factors, but a more nuanced understanding of how PTSD influences them is needed. The current study examined the direct and indirect relationships between PTSD symptom clusters and suicidal ideation in general aggression (without a specified target) regarding depression, alcohol misuse, and trait anger. Participants were 359 (92% male) U.S. Iraq/Afghanistan war veterans. Path analysis results suggested that the PTSD numbing cluster was directly (ß = .28, p < .01) and indirectly (ß = .17, p = .001) related through depression. The PTSD hyperarousal cluster was indirectly related to suicidal ideation through depression (ß = .13, p < .001). The PTSD reexperiencing cluster was directly related to aggression (ß = .17, p < .05), whereas the PTSD numbing and hyperarousal clusters were indirectly related to aggression through trait anger (ß = .05, p < .05; ß = .20, p < .001). These findings indicate that adjunct treatments aimed at stabilizing anger, depression, and alcohol misuse may help clinicians ameliorate the maladaptive patterns often observed in veterans. These results also point to specific manifestations of PTSD and co-occurring conditions that may inform clinicians in their attempts to identify at risk veterans and facilitate preventative interventions.

The reward probability index: design and validation of a scale measuring access to environmental reward.

Behavioral models of depression implicate decreased response-contingent positive reinforcement (RCPR) as critical toward the development and maintenance of depression (Lewinsohn, 1974). Given the absence of a psychometrically sound self-report measure of RCPR, the Reward Probability Index (RPI) was developed to measure access to environmental reward and to approximate actual RCPR. In Study 1 (n=269), exploratory factor analysis supported a 20-item two-factor model (Reward Probability, Environmental Suppressors) with strong internal consistency (α=.90). In Study 2 (n=281), confirmatory factor analysis supported this two-factor structure and convergent validity was established through strong correlations between the RPI and measures of activity, avoidance, reinforcement, and depression (r=.65 to .81). Discriminant validity was supported via smaller correlations between the RPI and measures of social support and somatic anxiety (r=-.29 to -.40). Two-week test-retest reliability was strong (r=.69). In Study 3 (n=33), controlling for depression symptoms, hierarchical regression supported the incremental validity of the RPI in predicting daily diary reports of environmental reward. The RPI represents a parsimonious, reliable, and valid measure that may facilitate understanding of the etiology of depression and its relationship to overt behaviors.

Emotion regulation and intimate partner violence in newlyweds.

Is the inability to regulate negative emotions a risk factor for intimate partner violence (IPV)? To address this question, the authors asked 72 newlywed couples to report their levels of negative affect every day for 7 days and examined whether variability in those reports was associated with the IPV self-reported to have been perpetrated over the previous year. Although main effects of variability in both husbands' and wives' negative affect did not reach statistical significance, variability in husbands' negative affect significantly interacted with wives' reports of IPV to account for husbands' IPV, even after overall levels of husbands' negative affect, marital satisfaction, and chronic stress were controlled. Specifically, whereas variability in negative affect was unrelated to IPV among husbands with wives who reported no IPV, such variability was positively associated with the IPV perpetrated by husbands with wives who also reported having perpetrated IPV during the previous year. Although preliminary, these results support theories suggesting that the ability to regulate negative emotions may help intimates avoid perpetrating IPV, particularly when faced with a partner's IPV perpetration.

Reduction of intimate partner violence in a gay couple following alcohol treatment.

Although intimate partner violence among heterosexual couples is a growing topic of investigation, there remains a critical deficiency in the amount of research on violence and relationship functioning in gay men. This article presents baseline and follow-up data on a case study examining the effects of partial hospital alcohol treatment on one gay couple. This information may be helpful in understanding the relationship between alcohol use, violence, and relationship functioning in this population. On the basis of past research involving heterosexual couples as participants, we predicted that subsequent to one patient receiving alcohol treatment: 1) alcohol consumption would be reduced; 2) there would be a reduction in the amount of psychological aggression between partners; 3) there would be a reduction in the frequency of physically violent episodes; and 4) an overall improvement in relationship satisfaction would be evident. The couple was followed-up 6 and 12 months following the patient's alcohol treatment. The results indicate a decrease in alcohol use as well as reduced physical and psychological aggression, but no increase in relationship satisfaction. This case illustration may provide insight into the context surrounding intimate partner violence and relationship functioning in gay couples, with implications for further research and treatment.

Neuroticism, marital violence, and the moderating role of stress and behavioral skills.

Do high levels of neuroticism predict intimate partner violence (IPV)? Although neuroticism may predispose partners to increased risks of IPV perpetration, the extent to which it predicts such perpetration is likely to depend on the broader context of the relationship. Consistent with this prediction, the current longitudinal study of 169 community couples revealed that the effects of neuroticism on IPV perpetration over the first 4 years of marriage were moderated by observations of problem-solving behavior and objective ratings of chronic stress. Specifically, although husbands and wives who scored higher on a measure of neuroticism at the outset of marriage engaged in more IPV throughout the marriage on average, those who possessed more effective problem-solving skills or experienced lower levels of stress were significantly less likely to engage in IPV. Results highlight the importance of considering the broader relationship context when examining predictors of specific interpersonal processes.

The role of drug use in a conceptual model of intimate partner violence in men and women arrested for domestic violence.

In a previous study, alcohol problems in perpetrators and their partners contributed directly and indirectly to intimate partner violence (IPV), even after including other correlates of violence in the model (G. L. Stuart et al., 2006). The present study extends these findings by examining the role of illicit drug use. We recruited 271 men and 135 women arrested for IPV and used structural equation modeling to examine the data. Results showed that drug use, as reported by the perpetrators, was a stronger predictor of IPV than were alcohol problems in perpetrators and their partners. Arrested males' marijuana use and stimulant use (i.e., cocaine and amphetamines) were associated with perpetration of IPV, and their report of their female partners' stimulant use was associated with her violence perpetration. In arrested women, specific substances used did not predict violence perpetration beyond other model variables; however, female perpetrators' report of male partners' stimulant use predicted male psychological and physical aggression, after controlling for other variables. These results provide further evidence that drug problems by both partners may be important in the evolution of aggression. Implications for batterer intervention programs are discussed.

Drug abuse and aggression between intimate partners: a meta-analytic review.

The present investigation employed meta-analytic procedures to quantitatively evaluate the empirical evidence on the relationship between drug abuse and aggression between intimate partners. Data from 96 studies yielding 547 effect sizes indicated that increases in drug use and drug-related problems were significantly associated with increases in aggression between intimate partners (d= .27). Cocaine emerged as the illicit substance with the strongest relationship to psychological, physical, and sexual aggression (ds= .39 to .62). Marijuana was also identified as having a significant association with partner aggression. Results showed comparable effect sizes for men and women, regardless of the sex of the drug user and/or perpetrator of partner aggression, with female reports of aggression having yielded larger effect sizes than male reports. Moderator analyses revealed that relative to other groups, married or cohabiting couples and Black participants evidenced significantly stronger effect sizes. The findings are discussed in relation to possible mechanisms linking drugs to partner aggression, and implications for future research are discussed in terms of focusing on conducting studies that assess the interaction of context and temporal sequencing of drugs and partner aggression.

Reasons for intimate partner violence perpetration among arrested women.

There are limited empirical data regarding the reasons or motives for the perpetration of intimate partner violence among women arrested for domestic violence and court referred to violence intervention programs. The present study examined arrested women's self-report reasons for partner violence perpetration and investigated whether women who were victims of severe intimate partner violence were more likely than were women who were victims of minor partner violence to report self-defense as a reason for their behavior. In all, 87 women in violence intervention programs completed a measure of violence perpetration and victimization and a questionnaire assessing 29 reasons for violence perpetration. Self-defense, poor emotion regulation, provocation by the partner, and retaliation for past abuse were the most common reasons for violence perpetration. Victims of severe partner violence were significantly more likely than were victims of minor partner violence to report self-defense as a reason for their violence perpetration. The clinical implications of these findings are discussed.