The Psychology of Health and Illness: The Mental Health and Physiological Effects of Intimate Partner Violence on Women

Violence against women is a global public health problem with about one in three women experiencing either physical and or sexual intimate partner violence during their lifetime. Globally as many as 38% of homicides committed against women are by a male intimate partner. Violence against women may have negative effects on their mental, physical, and reproductive health (WHO fact sheet, 2016). Untreated individuals who have experienced violence or life-threatening situations may develop posttraumatic stress disorder (PTSD). This disorder has the potential to be life-changing and cause negative psychological and medical issues (Rokach, Ahmed, & Patel, 2017). This potentially life-changing nature and consequence of violence affecting women world-wide deserves greater attention to ensure elimination of risk factors, financial support of investigational studies to promote detection of victims, and research to increase therapeutic efficacy of remediation. These efforts should be bolstered by all physicians, mental health experts, social service specialists, and public health advocates.     

Children's response to community violence: What do we know?

This article presents a framework for understanding the developmental significance of violence-related trauma in the lives of young children. It emphasizes the importance of the distinction between acute and chronic trauma. Acute trauma is more readily dealt with through “psychological first aid” and a “therapy of reassurance.” Chronic trauma requires a more systematic reconstruction of the child's “social map” of the world. The socioeconomic and demographic correlates of violent trauma predict an accumulation of risk factors in the child's life that compounds the problem of developmental disability. The problem community violence poses for the child must be understood in the larger context of greater risk for family disruption (including less than secure attachment) as well as domestic violence, poverty, and minority group status. The increasing incidence and prevalence of community violence poses a major challenge to the mental health of children.     

The Protective Functions of Social Support and Coping for Women Experiencing Intimate Partner Abuse

This study evaluated two alternate models exploring protective factors in the relationship between intimate partner abuse and health: one in which social support was proposed to mediate the violence-health relation, and a second in which coping was proposed to mediate this relation, while social support would moderate the abuse-coping relation. Women were administered questionnaires measuring coping, social support, violence, and health status. Relationship violence predicted mental health status only, although mental health did predict physical health. Coping was found to serve as a mediator between abuse and health. Implications for future research and clinical applications are discussed.     

Family Support and Mental Health in Pregnant Women Experiencing Interpersonal Partner Violence: An Analysis of Ethnic Differences

This study investigated the relationship between family support and mental health in a community sample of pregnant women experiencing interpersonal partner violence (IPV). This study also examined how family support may differentially affect mental health in Black and White women experiencing IPV. A total of 110 participants (32 Black and 78 White) were obtained from the first time period of a longitudinal study examining the effects of domestic violence on women. The model was supported (χ² = 142.55; df = 72, p > .001, RMSEA = .07). Black women had better mental health than White women. However, ethnicity was not a significant predictor of family support. Implications from this study highlight the need for further research on the role of family support in the lives of physically abused women as well as the need to incorporate cross cultural perspectives when examining this issue.     

Profiles of Children’s Thinking About Violence in Families Exposed to Intimate Partner Violence

Intimate partner violence remains a pervasive and common social problem. Evidence indicates that children witness many instances of intimate partner violence. However, the structure of children’s thinking about family violence is still not well understood. This research employed latent profile analysis to identify underlying latent profiles of children’s thinking about violence using the Attitudes and Beliefs About Violence Scale. The analysis identified two latent profiles mostly differentiated by children’s beliefs about whether or not victims of violence deserve to have violence inflicted upon them. Several covariates differentiated members of the two profiles. Suggestions for intervention and practice are included.     

Exploring Violence Exposure, Stress, Protective Factors and Behavioral Problems Among Inner-City Youth

This study examined relationships between violence exposure, other stressors, family support, and self-concept on self-reported behavioral problems among 320 urban adolescents (aged 11–18) referred for mental health treatment. Overall, participants reported high levels of violence exposure, with a median of six past encounters with violence as a witness, victim, or through the experiences of associates. All forms of violence exposure (witnessing, being a victim, knowing of victims) were correlated with internalizing and externalizing behavioral problems for males and females. Total violence exposure predicted behavioral problems among participants, even after controlling for the effects of other risk, demographic and protective factors. Family support and self-concept moderated the influence of life stress and cumulative risk on problem behavior outcomes, but these protective variables did not significantly moderate violence exposure.     

Adjustment Profiles of Low-Income Caregivers from the United States and South Africa: Contrasts and Commonalities

Although low-income parents living in under-resourced communities in the United States and around the world face challenges, many do well while others struggle in one or more areas of functioning. The present study examined patterns of adjustment among maternal caregivers living in the United States (US) (N?=?320) and South Africa (SA) (N?=?324). Cluster analyses across four domains of functioning representing both positive and negative adjustment and conducted within country revealed similar patterns of adjustment, with a majority of caregivers (37.8% in the US; 47.5% in SA) landing in a “holding steady” pattern, exhibiting good but not exceptional adjustment. Other patterns of adjustment (three additional in the US sample; two additional in the SA sample) showed elevated impairment in somatic complaints, problems with alcohol, or life satisfaction. In both the US and SA, support from family, friends, and neighbors differentiated the adjustment profiles. Further, both current stressors within and outside of the family and previous stressors including direct and indirect exposure to violence discriminated caregivers who were “holding steady” from those who were struggling in one or more domains. Additionally, across both countries, caregivers who were “holding steady” evidenced less avoidant coping. Implications of this work for fostering resilience among caregivers and their children are discussed.     

Melancholia and the Violent Regulation of Gender Variance: Reply to Commentaries

In this reply to James Herzog and Gayle Salamon, the “in”/“out” boundary of gender and the psychotherapeutic address of gender is considered. Particular emphasis is paid to the ways in which gender is constituted through aggressive and often violent forms of social regulation. Matters of social justice are considered as psychoanalysts and mental health workers take up normative violence in the form of policy speech. Clinical dilemmas with respect to gender melancholia, trauma, and shame are also considered.     

Help-Seeking and Internal Obstacles to Receiving Support in the Wake of Community Violence Exposure: The Case of Arab and Jewish Adolescents in Israel

We examined help-seeking and internal obstacles to receiving psychosocial support in the wake of community violence exposure in a sample of 1,835 Arab and Jewish adolescents living in Israel. Paper and pencil surveys conducted in schools examined adolescents’ personal victimization and witnessing of community violence in the past year, and then queried adolescents about their help-seeking after violence exposure. Our findings indicated widespread exposure to community violence, particularly for the Arab respondents. Only one in three Arab and one in four Jewish adolescents reported seeking help from anyone to cope with such experiences following their violence exposure, and only rarely did adolescents seek help from a mental health professional (one in twenty for Jewish and one in nine for Arab adolescents). Adolescents across both samples indicated a variety of internal obstacles that might explain their lack of seeking help to cope with violence exposure, including cognitive minimization of the event, deliberately maintaining the secrecy of the event, wishing to maintain their autonomy, and failing to believe in the efficacy of seeking help from others. Such findings shed light on the difficult challenges to providing professional support to adolescents when they are exposed to community violence, and suggest that such challenges, while varying to a degree across cultures, are also prevalent across cultures.     

Family consequences of refugee trauma

OBJECTIVE: To construct a model on the consequences of political violence for refugee families based upon a qualitative investigation. METHODS: This study used a grounded-theory approach to analyze qualitative evidence from the CAFES multi-family support and education groups with Bosnian refugee families in Chicago. Textual coding and analysis was conducted using ATLAS/ti for Windows. RESULTS: A grounded-theory model of Family Consequences of Refugee Trauma (FAMCORT) was constructed that describes Displaced Families of War across four realms of family life: (1) changes in family roles and obligations, (2) changes in family memories and communications, (3) changes in family relationships with other family members; and (4) changes in family connections with the ethnic community and nation state. In each realm, the model also specifies family strategies, called Families Rebuilding Lives, for managing those consequences. CONCLUSIONS: Political violence leads to changes in multiple dimensions of family life and also to strategies for managing those changes. Qualitative family research is useful in better understanding refugee families and in helping them through family-oriented mental health services.     

The Relational Context of Social Support in Young Adults: Links with Stress and Well-Being

This study examined the roles of relationship-specific social support and gender in the associations between perceived stress and well-being. Three sources of support (family, friends, and romantic partners) and three well-being indicators (loneliness, depressive symptoms, and physical health) were assessed in 628 young adults attending college (M _age = 19.72; range of 18–24). Stress directly predicted all well-being indicators, and indirectly predicted well-being through social support in relationship-specific ways. Family support mediated the relationship between stress and physical health, friend support mediated the association between stress and loneliness, and romantic partner support mediated the relationships of stress with both loneliness and depressive symptoms. With regard to loneliness and physical health, women were more strongly impacted when they had less support from friends.     

Supporting the Need for an Integrated System of Care for Youth with Co-occurring Traumatic Stress and Substance Abuse Problems

Adolescents are at high risk for violence exposure and initiation of drug use. Co-occurring substance use and trauma exposure are associated with increased risk of mental health disorders, school underachievement, and involvement with multiple systems of care. Coordination and integration of systems of care are of utmost importance for these vulnerable youth. This study delineates the negative sequelae and increased service utilization patterns of adolescents with a history of trauma, substance abuse, and co-occurring trauma and substance abuse to support the need for integrated mental health and substance abuse services for youth. Data from two national sources, the National Child Traumatic Stress Network and Center for Substance Abuse Treatment demonstrate the increased clinical severity (measured by reports of emotional and behavioral problems), dysfunction, and service utilization patterns for youth with co-occurring trauma exposure and substance abuse. We conclude with recommendations for an integrated system of care that includes trauma-informed mental health treatment and substance abuse services aimed at reducing the morbidity and relapse probability of this high-risk group.     

Impact of Exposure to Community Violence on Anxiety: A Longitudinal Study of Family Social Support as a Protective Factor for Urban Children

In a longitudinal study, we examined the relationship between exposure to community violence and anxiety, and the extent to which family social support moderated this relationship within a predominantly African American sample of 385 children in an urban public school system. Children reported notably lower anxiety levels compared to normative data for African American children. A high percentage reported witnessing a variety of violent acts. Cross-sectional results indicated that among girls exposure to violence was significantly correlated with total, physiological, and concentration anxiety. Among boys violence exposure was not associated with anxiety. Hierarchical regression analyses indicated that after controlling for gender, exposure to violence at Time 1 did not significantly predict changes in anxiety. A significant interaction was found for gender and exposure to violence on concentration anxiety; girls who reported higher initial violence exposure reported greater increases in subsequent concentration anxiety than boys. Whereas findings from our study did not support a moderating relationship of family social support on children's exposure to violence and anxiety, a strong negative relationship was found between anxiety and family support. Among children with initially low worry anxiety, those with low family social support showed greater increases in subsequent worry anxiety.     

Risk and resilience: The moderating role of social coping for maternal mental health in a setting of political conflict

Violence can threaten individual wellbeing and tear at the social fabric of communities. At the same time, suffering can mobilize social coping and mutual support. Thus, the backdrop of political violence increases risk factors and stimulates resilience. The current study examined the moderating role of social coping as reflective of risk and resiliency in Northern Ireland, a setting of protracted conflict. Specifically, structural equation modeling was used to investigate whether social coping protects from or exacerbates the negative impact of sectarian crime and nonsectarian crime on maternal mental health (N = 631). Nonsectarian crime predicted greater psychological distress for mothers in Belfast. Mixed support was found for the buffering and depletion moderation hypotheses; social coping functioned differently for nonsectarian crime and sectarian crime. Greater social coping buffered mothers’ psychological distress from the negative effects of nonsectarian crime, but exacerbated maternal mental health problems when facing sectarian crime. Results suggest that social coping is a complex phenomenon, particularly in settings of protracted political violence. Implications for interventions aimed at alleviating psychological distress by enhancing mothers’ social coping in contexts of intergroup conflict are discussed.     

Psychoanalytically Based Treatment for Traumatized Children and Families

A psychoanalytic orientation provides an important perspective for developing community-based prevention and intervention programs for traumatized children and their families. In New Orleans, the Violence Intervention Program for Children and Families is designed to reduce the risk of exposure to violence, mental health problems following exposure, interference with normal developmental progression, academic performance, family functioning, onset of behavioral and conduct disturbances, later psychopathology, and subsequent violence. The program includes an unusual focus on work with police officers as first responders to increase their sensitivity and responsiveness to traumatized children. A psychoanalytic perspective helps a therapist or interventionist understand a person's strengths and weaknesses, frustrations, and conflicts as well as those within a chaotic environment and social situation. The psychoanalytic approach allows for more effective therapeutic approaches as well as more flexible problem-solving strategies.     

Intrafamilial physical victimization and externalizing behavior problems: Who remain the ‘forgotten’ children?

Over the past few decades, researchers have documented positive associations between direct child maltreatment and exposure to interpersonal violence (including intimate partner violence, community violence, school violence, and media violence) and children's externalizing behavior problems. However, current family violence literature largely ignores the effects of child abuse on other children in the family. A handful of studies have focused on exposure to child abuse and documented the behavioral effects on siblings, and these studies lend support for broadening scholarship focused on this type of family violence. This article presents empirical research and theories that focus on the relationships between child physical abuse and exposure to intimate partner violence and children's externalizing behavior problems. Using this literature as a foundation, an argument is made for the need to focus on children's exposure to child physical abuse. This article presents information from the few studies that have focused on children who were exposed to the physical abuse of a sibling and offers theoretical frameworks, including social learning theory and psychological proximity, as a foundation for future research. The article concludes with a discussion of services that may be necessary for children who have been exposed to the physical abuse of a sibling, including services focused on safety and mental health.     

What’s Love Got to Do with It: Relationship Functioning and Mental and Physical Quality of Life Among Pregnant Adolescent Couples

The study objective was to describe relationship adjustment and its association with mental and physical quality of life for young couples expecting a baby. 296 young pregnant couples recruited from urban obstetric clinics reported on relationship strengths (e.g., equity, romantic love, and attractiveness), relationship risks (e.g., attachment, intimate partner violence), external family support, relationship adjustment, and mental and physical quality of life. Using the Actor Partner Interdependence Model we assessed both actor and partner effects of relationship variables on relationship adjustment and quality of life. Sixty-one percent of couples had at least one member with moderate or severe relationship distress. Lower attachment avoidance, lower attachment anxiety, higher relationship equity, lack of intimate partner violence, feelings of love, perceived partner attractiveness, and family support of the relationship related to better relationship adjustment. Associations were fairly consistent across gender. Better relationship adjustment related to more positive mental and physical quality of life for both young women and men. Our results highlight the potential importance of strong relationships on the well-being of expecting parents. Our results suggest that secure attachments, equitable relationships, feelings of love, and a lack of violence may be particularly important in having strong relationships and improved mental and physical health during pregnancy.     

Children growing up in a violent community: The role of the family

This review evaluates empirical reports of relations among exposure to violence in the community, dimensions that characterize families and parenting, and the distress and maladjustment of children and adolescents. Family functioning variables that have been examined in relation to community violence exposure include family conflict and violence, social support, structure and cohesion, parenting practices, maternal distress, and sociodemographic characteristics. Evidence is reviewed for three hypotheses regarding family dimensions: (1) that they are associated with children's community violence exposure in bivariate relations, (2) that they moderate relations between community violence exposure and child outcomes, and (3) that they mediate relations between community violence exposure and child outcomes. Following the empirical review, theoretical and methodological gaps in the literature are identified; guidelines are proposed for ecologically valid family-based research on community violence.     

Exposure,Loss, and Support Predicting the Dimensions of Posttsunami Trauma

This study examined whether exposure, resource loss, and social support predicted the posttsunami trauma of PTSD, depression, negative affect, and physical health problems of the 2004 tsunami survivors. Four hundred sixteen survivors were interviewed in Tamil Nadu (India) 14 months posttsunami. Loss of life followed by loss of property and disaster exposure positively predicted the dimensions of trauma. Survivors having lower social status and income received less material and informational support than their equally affected counterparts, which furthered stress and distress. The survivors’ trauma can be arrested, minimizing the exposure and tangible resource loss, and improving the delivery of social support.