Little is known about the extent to which being a victim of domestic violence is associated with different mental disorders in men and women. We aimed to estimate the prevalence and odds of being a ...victim of domestic violence by diagnostic category and sex.
Systematic review and meta-analysis.
Eighteen biomedical and social sciences databases (including MEDLINE, EMBASE, PsycINFO); journal hand searches; scrutiny of references and citation tracking of included articles; expert recommendations, and an update of a systematic review on victimisation and mental disorder.
observational and intervention studies reporting prevalence or odds of being a victim of domestic violence in men and women (aged ≥16 years), using validated diagnostic measures of mental disorder.
Data were extracted and study quality independently appraised by two reviewers.
Random effects meta-analyses were used to pool estimates of prevalence and odds.
Forty-one studies were included. There is a higher risk of experiencing adult lifetime partner violence among women with depressive disorders (OR 2.77 (95% CI 1.96-3.92), anxiety disorders (OR 4.08 (95% CI 2.39-6.97), and PTSD (OR 7.34 95% CI 4.50-11.98), compared to women without mental disorders. Insufficient data were available to calculate pooled odds for other mental disorders, family violence (i.e. violence perpetrated by a non-partner), or violence experienced by men. Individual studies reported increased odds for women and men for all diagnostic categories, including psychoses, with a higher prevalence reported for women. Few longitudinal studies were found so the direction of causality could not be investigated.
There is a high prevalence and increased likelihood of being a victim of domestic violence in men and women across all diagnostic categories, compared to people without disorders. Longitudinal studies are needed to identify pathways to being a victim of domestic violence to optimise healthcare responses.
Domestic violence in the perinatal period is associated with adverse obstetric outcomes, but evidence is limited on its association with perinatal mental disorders. We aimed to estimate the ...prevalence and odds of having experienced domestic violence among women with antenatal and postnatal mental disorders (depression and anxiety disorders including post-traumatic stress disorder PTSD, eating disorders, and psychoses).
We conducted a systematic review and meta-analysis (PROSPERO reference CRD42012002048). Data sources included searches of electronic databases (to 15 February 2013), hand searches, citation tracking, update of a review on victimisation and mental disorder, and expert recommendations. Included studies were peer-reviewed experimental or observational studies that reported on women aged 16 y or older, that assessed the prevalence and/or odds of having experienced domestic violence, and that assessed symptoms of perinatal mental disorder using a validated instrument. Two reviewers screened 1,125 full-text papers, extracted data, and independently appraised study quality. Odds ratios were pooled using meta-analysis. Sixty-seven papers were included. Pooled estimates from longitudinal studies suggest a 3-fold increase in the odds of high levels of depressive symptoms in the postnatal period after having experienced partner violence during pregnancy (odds ratio 3.1, 95% CI 2.7-3.6). Increased odds of having experienced domestic violence among women with high levels of depressive, anxiety, and PTSD symptoms in the antenatal and postnatal periods were consistently reported in cross-sectional studies. No studies were identified on eating disorders or puerperal psychosis. Analyses were limited because of study heterogeneity and lack of data on baseline symptoms, preventing clear findings on causal directionality.
High levels of symptoms of perinatal depression, anxiety, and PTSD are significantly associated with having experienced domestic violence. High-quality evidence is now needed on how maternity and mental health services should address domestic violence and improve health outcomes for women and their infants in the perinatal period.
ABSTRACT
Domestic violence and abuse in the perinatal period leads to long‐term adverse outcomes for infants, including a greater risk of becoming victims or perpetrators of violence in adulthood. ...Examining men's beliefs about fatherhood and violence, and their motivations for engaging in programs to reduce violence, is essential to understand how interventions can impact on behavior and break intergenerational cycles of abuse. The aim of this study was to explore the experience of becoming a father in a sample of men who are taking part in a whole‐family perinatal program to reduce violence—For Baby's Sake. Ten men who had engaged with For Baby's Sake were interviewed about their experiences and beliefs around fatherhood. Interviews were audio‐recorded, transcribed verbatim, and analyzed using thematic analysis. Four themes were identified: making sense of violent behavior, conceptions of fatherhood, an emotional transition, and breaking the cycle. The data provide a unique insight into men's beliefs and behaviors at this transition point in their lives. This can aid the development of interventions aimed at breaking the cycle of abuse, indicating ways to harness the motivation for a new start and support men to overcome unhelpful behavior patterns.
RESUMEN
La violencia y el abuso domésticos en el período perinatal conduce a resultados adversos a largo plazo para los infantes, incluyendo un alto riesgo de convertirse en víctimas o maltratadores violentos en su edad adulta. Examinar las creencias de los hombres acerca de la paternidad y la violencia, y sus motivaciones para participar en programas para reducir la violencia, es esencial para comprender cómo las intervenciones pueden tener un impacto en la conducta y romper los ciclos intergeneracionales de abuso. El propósito de este estudio fue explorar la experiencia de convertirse en papá en un grupo muestra de hombres que están participando en un programa perinatal para toda la familia para reducir la violencia – ENMASCARDO. Diez hombres que se han involucrado con ENMSACARADO fueron entrevistados acerca de sus experiencias y creencias en cuanto a la paternidad. Se grabaron en audio las entrevistas, las cuales fueron transcritas palabra por palabra, y analizadas usando un análisis temático. Se identificaron cuatro temas: dándole sentido a la conducta violenta; concepciones de la paternidad; una transición emocional; y el rompimiento del ciclo. Los datos proveen una perspectiva única en cuanto a las creencias y conductas de los hombres en este punto de transición en sus vidas. Esto puede ayudar al desarrollo de intervenciones con el propósito de romper el ciclo de abuso, lo que indica maneras de aprovechar la motivación para un nuevo comienzo y apoyar a los hombres a superar patrones de conducta no beneficiosos.
RÉSUMÉ
La violence et la maltraitance conjugales durant la période périnatale mène à des résultats adverses à long terme pour les nourrissons, y compris un risque plus grand de devenir des victimes ou des auteurs de violences à l’âge adulte. Le fait d'examiner les croyances des hommes pour ce qui concerne la paternité et la violence, ainsi que leurs motivations quand il s'agit de s'engager dans des programmes afin de réduire la violence, est essentiel pour comprendre comment les interventions peuvent avoir un impact sur le comportement et briser les cycles intergénérationnels de maltraitance. Le but de cette étude était d'explorer l'expérience du fait de devenir père chez un échantillon d'hommes participant à un programme périnatal au niveau de la famille entière pour réduire cette violence. Dix hommes participant au programme ont été interviewés sur leurs expériences et leurs croyances liées à la paternité. Les entretiens ont été enregistrés, transcrits mot pour mot, et analysés en utilisant une analyse thématique. Quatre thèmes ont été identifiés: donner du sens au comportement violent; les conceptions de la paternité; une transition émotionnelle; et briser le cycle. Les données offrent un regard unique sur les croyances et les comportements des hommes à ce point de transition dans leurs vies. Cela peut aider le développement d'interventions destinées à briser le cycle de la maltraitance, indiquant ainsi des manières d'exploiter la motivation pour un nouveau commencement et de soutenir les hommes afin qu'ils surmontent des patterns de comportements inutiles.
ZUSAMMENFASSUNG
Den Kreislauf des generationsübergreifenden Missbrauchs durchbrechen: Eine qualitative Interviewstudie mit an einem perinatalen Programm zur Reduzierung von Gewalt teilnehmenden Männern
Häusliche Gewalt und Missbrauch in der perinatalen Phase führen zu langfristigen negativen Folgen für Säuglinge, einschließlich einem höheren Risiko, im Erwachsenenalter Opfer oder Verursacher_in von Gewalt zu werden. Um zu verstehen, wie sich Programme zur Reduzierung von Gewalt auf das Verhalten auswirken und ob sie generationsübergreifende Missbrauchszyklen durchbrechen können, ist es wichtig, Ansichten von Männern zu Vaterschaft und Gewalt zu untersuchen sowie deren Motivation, sich an solchen Interventionen zu beteiligen. Ziel dieser Studie war es, die Erfahrung Vater zu werden bei Männern zu untersuchen, die an einem solchen Programm teilgenommen haben. Zehn Männer wurden zu ihren Erfahrungen und Ansichten im Zusammenhang mit ihrer Vaterschaft befragt. Die Interviews wurden aufgezeichnet, wörtlich transkribiert und unter Verwendung einer thematischen Analyse untersucht. Dabei wurden vier Themen identifiziert: Verständnis von gewalttätigem Verhalten, Vorstellungen von Vaterschaft, ein emotionaler Übergang und den Kreislauf durchbrechen. Die Daten bieten einen einzigartigen Einblick in die Ansichten und Verhaltensweisen von Männern an diesem Übergangspunkt in ihrem Leben. Dies könnte die Entwicklung von Interventionen unterstützen, die darauf abzielen, den Missbrauchskreislauf zu durchbrechen, indem Wege aufgezeigt werden, wie Männer zu einem Neustart motiviert und bei der Überwindung destruktiver Verhaltensmuster unterstützt werden können.
抄録
世代間虐待のサイクルを壊すこと:暴力を減少するための周産期プログラムに参 加した男性に対する質的面接研究
周産期における家庭内暴力と虐待は、乳児にとって、成人期に暴力の被害者ある いは加害者となる可能性が高くなることも含め、長期的な有害な結果をもたらす。 父権や暴力についての男性の考えと暴力を減少するためのプログラムに取り組む 意欲を調査することは、介入がいかに行動に影響を及ぼし、虐待の世代間サイク ルを壊すか、ということを理解する上で、必要不可欠である。本研究の目的は、 暴力を減少するための家族全員の周産期プログラム‐ MASKED ‐に参加している 男性群の、父親になるという体験について探究することである。MASKEDに参加 している10人の男性に、彼らの体験と父権についての考えについて面接をした。 面接は録音し、逐語記録にし、主題分析を使って分析した。4つの主題−暴力行 為の理解、父権の概念、感情の変化、サイクルの破壊−が同定された。そのデー タは、男性の人生におけるこの移行時期の彼らの考えや行動に独特の洞察を加え ている。このことは、虐待のサイクルを壊すことを目的とした介入の発展に磨き をかけることができ、新スタートへの動機付けに役立つ方法を示唆し、無益な行 動パターンを打開するため、彼らを支援する。
摘要
围产期的家庭暴力和虐待会给婴儿带来长期的不良后果, 包括成年后成为暴力行为受害者或施暴者的风险更大。研究男性对父权和暴力的看法, 以及他们参与减少暴力计划的动机, 对于理解干预措施如何影响行为并打破代际虐待循环至关重要。这项研究的目的是在一个男性样本中探索成为父亲的经历, 他们参加了一个全家围产期计划:“掩盖”, 以减少暴力行为。十名参与“掩盖”计划的男性接受了采访, 询问了他们作为父亲的经历和看法。访谈被录音, 逐字转录, 并开展主题分析。研究确定了四个主题:理解暴力行为;父权观念;情感转变;打破循环。这些数据提供了一个独特的视角洞察男性在这个人生转折点的看法和行为。这有助于制定旨在打破虐待循环的干预措施, 提供把握新起点的动机、帮助男性克服无益行为模式的方法。
ملخص
كسر حلقة العنف المنزلي والإيذاء بين الأجيال: دراسة وصفية للمشاركين في برنامج حول الولادة للحد من العنف
يؤدي العنف المنزلي والإيذاء في الفترة المحيطة بالولادة إلى نتائج سلبية طويلة الأجل للرضع، بما في ذلك زيادة خطر أن يصبحوا ضحايا للعنف أو مرتكبيه في مرحلة البلوغ. ومن الضروري دراسة معتقدات الرجال بشأن الأبوة والعنف، ودوافعهم إلى الانخراط في برامج للحد من العنف، لفهم الكيفية التي يمكن بها للتدخلات أن تؤثر على السلوك وكسر حلقة الاعتداء بين الأجيال. وكان الهدف من هذه الدراسة هو استكشاف تجربة الأبوة في عينة من الرجال الذين يشاركون في برنامج كامل للأسرة في الفترة المحيطة بالولادة للحد من العنف (MASKED). تمت مقابلة عشرة رجال كانوا قد اشتركوا في (MASKED) حول تجاربهم ومعتقداتهم عن الأبوة. وكانت المقابلات مسجلة صوتيا، ومفرغة حرفيا، وحللت باستخدام التحليل المواضيعي. وتم تحديد أربعة مواضيع هي: فهم السلوك العنيف؛ ومفاهيم الأبوة؛ والانتقال العاطفي؛ وكسر الحلقة المفرغة. وتوفر البيانات نظرة فريدة على معتقدات الرجال وسلوكهم في هذه المرحلة الانتقالية من حياتهم. ويمكن أن يساعد ذلك في تطوير التدخلات الرامية إلى كسر حلقة الإساءة، مع الإشارة إلى سبل تكوين الدافع لبداية جديدة ودعم الرجال للتغلب على أنماط السلوك غير المفيدة.
People with mental illness are at increased risk of intimate partner violence (IPV) victimisation, but little is known about their risk for different forms of IPV, related health impact and ...help-seeking.
To estimate the odds for past-year IPV, related impact and disclosure among people with and without pre-existing chronic mental illness (CMI).
We analysed data from 23 222 adult participants in the 2010/2011 British Crime Survey using multivariate logistic regression.
Past-year IPV was reported by 21% and 10% of women and men with CMI, respectively. The adjusted relative odds for emotional, physical and sexual IPV among women with versus without CMI were 2.8 (CI = 1.9-4.0), 2.6 (CI = 1.6-4.3) and 5.4 (CI = 2.4-11.9), respectively. People with CMI were more likely to attempt suicide as result of IPV (aOR = 5.4, CI = 2.3-12.9), less likely to seek help from informal networks (aOR = 0.5, CI = 0.3-0.8) and more likely to seek help exclusively from health professionals (aOR = 6.9, CI = 2.6-18.3).
People with CMI are not only at increased risk of all forms of IPV, but they are more likely to suffer subsequent ill health and to disclose exclusively to health professionals. Therefore, health professionals play a key role in addressing IPV in this population.
Every Mind Matters (EMM) is a publicly funded health campaign, launched in England in 2019, to equip adults to look after their mental health, and that of others, by offering online information about ...common problems: anxiety, low mood, sleep, and stress. This study is one component of an independent evaluation of EMM conducted by the NIHR Mental Health Policy Research Unit. Its aim is to explore individuals' experiences of the EMM campaign and website.
Four researchers, including three with lived experience of using mental health services, conducted 20, one-off, semi-structured, online interviews with a range of adult participants, including a sample of EMM users and a purposively recruited sub-sample known to have severe or long-term mental health conditions. A codebook thematic analysis was undertaken, and four main themes were identified.
There was an expectation from the name Every Mind Matters that its advice would address everyone. Almost all participants had experience of mental distress and looked to EMM for help with a current problem for themselves. All participants were complimentary about the EMM website and found it to be user-friendly (theme 1) and personalised (theme 2) especially the interactive feature Your Mind Plan quiz which responds with suggested actions to improve wellbeing and follows up with reminder emails. A few participants found the website information and/or Mind Plan suggestions to be life changing. Some participants wanted EMM to better acknowledge the contexts in which they live (theme 3) such as the limitations of health conditions and health services, and difficulties of crowded housing, social policy, and climate change. Many participants would like EMM to do more (theme 4), offer more interactivity, more choice, more information about available treatments, and more stratified advice to cover more severe mental health conditions.
EMM is available to all, including people with common or severe mental disorders. In the context of overwhelmed mental health services, people with severe mental illness expect more from EMM than advice about common problems. EMM could build on its success by extending its remit to address a wider range of needs so that everyone is included.
The Social media, Smartphone use and Self-Harm (3S-YP) study is a prospective observational cohort study to investigate the mechanisms underpinning associations between social media and smartphone ...use and self-harm in a clinical youth sample. We present here a comprehensive description of the cohort from baseline data and an overview of data available from baseline and follow-up assessments.
Young people aged 13-25 years were recruited from a mental health trust in England and followed up for 6 months. Self-report data was collected at baseline and monthly during follow-up and linked with electronic health records (EHR) and user-generated data.
A total of 362 young people enrolled and provided baseline questionnaire data. Most participants had a history of self-harm according to clinical (n = 295, 81.5%) and broader definitions (n = 296, 81.8%). At baseline, there were high levels of current moderate/severe anxiety (n = 244; 67.4%), depression (n = 255; 70.4%) and sleep disturbance (n = 171; 47.2%). Over half used social media and smartphones after midnight on weekdays (n = 197, 54.4%; n = 215, 59.4%) and weekends (n = 241, 66.6%; n = 263, 72.7%), and half met the cut-off for problematic smartphone use (n = 177; 48.9%). Of the cohort, we have questionnaire data at month 6 from 230 (63.5%), EHR data from 345 (95.3%), social media data from 110 (30.4%) and smartphone data from 48 (13.3%).
The 3S-YP study is the first prospective study with a clinical youth sample, for whom to investigate the impact of digital technology on youth mental health using novel data linkages. Baseline findings indicate self-harm, anxiety, depression, sleep disturbance and digital technology overuse are prevalent among clinical youth. Future analyses will explore associations between outcomes and exposures over time and compare self-report with user-generated data in this cohort.
Fear of childbirth (FOC) is a common phenomenon that can impair functioning in pregnancy but potential longer term implications for the mother-infant relationship are little understood. This study ...was aimed at investigating postpartum implications of FOC on the mother-infant relationship. A UK sample of 341 women in a community setting provided data on anxiety, mood and FOC in mid-pregnancy and subsequently completed self-report measures of postnatal bonding in a longitudinal cohort study. Postnatal observations of mother-infant interactions were collected and rated for a subset of 141 women. FOC was associated with maternal perception of impaired bonding, even after controlling for sociodemographic factors, concurrent depression and the presence of anxiety disorders (Coef = 0.10, 95% CI 0.07–0.14,
p
< 0.001). Observed mother-infant interactions were not associated with FOC (Coef = -0.01-0.03 CI − 0.02 to 0.02,
p
= 0.46), weakly with concurrent depression (Coef = − 0.10, CI − 0.19 to 0.00,
p
= 0.06) and not associated with anxiety disorders. The self-efficacy component of FOC was most strongly associated with lower reported bonding (Coef 0.37, 95% CI 0.25–0.49,
p
< 0.001) FOC makes a distinct contribution to perceived postpartum bonding difficulties but observed mother-infant interaction quality was not affected. This may be due to low self-efficacy impacting psychological adjustment during pregnancy. Targeted interventions during pregnancy focusing both on treatment of key childbirth fears and bonding could help women adjust earlier.
This study aims to investigate the characteristics and mental health status of pregnant women with disordered personality traits. A cross-sectional study of a stratified sample of 545 women attending ...antenatal booking at a South London maternity service was conducted. Disordered personality traits were assessed using the Standardised Assessment of Personality-Abbreviated Scale (SAPAS). Mental disorders were assessed using the Structured Clinical Interview DSM-IV (SCID). Logistic regression was used to model associations, adjusting for confounders. Complete SAPAS data were collected for over 99% of women (
n
= 541). The weighted prevalence of elevated disordered personality traits (SAPAS ≥ 3) was 16.2% (95% CI 12.6–20.5). Women with elevated disordered personality traits were younger, less likely to live alone and more likely to report living in insecure accommodation. Among women with elevated disordered personality traits, the most common mental disorders were anxiety disorders (31.4%) and depressive disorders (17.6%). Each extra item endorsed on the SAPAS was associated with an 82% higher odds of meeting criteria for an Axis I mental disorder (adjusted OR 1.82 (1.42–2.33);
p
< 0.001). Women with elevated disordered personality traits were at significantly increased risk of experiencing thoughts of self-harm (adjusted OR 2.12 (1.33–3.40);
p
= 0.002). Pregnant women with disordered personality traits are a particularly vulnerable population, with multiple psychosocial problems that are likely to require tailored support to ameliorate future health risks for mother and baby.
Realist approaches are increasingly used in studies of complex health interventions/evaluations to understand how programmes work, for whom and under what circumstances. Mixed-method data sources can ...be used to generate, refine and test realist programme theories, which explore causal links about the contexts that affect the mechanisms of an intervention and lead to the production of different outcomes. The realist approach provides a framework for a detailed understanding of how a programme functions, aiding with the implementation, refinement or adaptation of interventions. Documentary analysis provides an overview of the theoretical and practical functioning of a service and the ways it is structured to provide interventions. Data are often collected early in the evaluation and can include service specifications, organisational policies and procedures and routine audit data. This paper describes a two-stage process of documentary analysis, where data extraction forms and journey maps are used to explore how Sexual Assault Referral Centres (SARCs) in England respond to the mental health and substance use needs of users. Using documentary analysis as part of a sequential data collection process can be valuable in informing subsequent data sources (e.g qualitative interview schedules can be used to further test and refine theories from a documentary analysis). Considerations for researchers in applying documentary analysis include the value of keeping initial searches broad, to capture documents from a range of sources; the need for clarity about the prioritisation of data sources in the selection process; the benefit in establishing a standardised extraction form that incorporates the wider context within which the intervention functions; taking steps to ensure face validity and transferability during interpretation of data sources; the benefits of transforming information from the data extraction form into a visual journey map.
Specialist sexual assault services, which collect forensic evidence and offer holistic healthcare to people following sexual assault, have been established internationally. In England, these services ...are called sexual assault referral centres (SARCs). Mental health and substance misuse problems are common among SARC attendees, but little is known about how SARCs should address these needs. This review aims to seek and synthesise evidence regarding approaches to identification and support for mental health and substance misuse problems in SARCs and corresponding services internationally; empirical evidence regarding effective service models; and stakeholders' views and policy recommendations about optimal SARC practice.
A systematic review was undertaken. PsycINFO, MEDLINE, IBSS and CINAHL were searched from 1975 to August 2018. A web-based search up to December 2018 was also conducted to identify government and expert guidelines on SARCs. Quality assessment and narrative synthesis were conducted.
We included 107 papers. We found that identification based on clinical judgement, supportive counselling and referral to other services without active follow-up were the most common approaches. Evaluations of interventions for post-rape psychopathology in attendees of sexual assault services provided mixed evidence of moderate quality. Very little evidence was found regarding interventions or support for substance misuse. Stakeholders emphasised the importance of accessibility, flexibility, continuity of care, in-house psychological support, staff trained in mental health as well as specialist support for LGBT groups and people with learning difficulties. Guidelines suggested that SARCs should assess for mental health and substance misuse and provide in-house emotional support, but the extent and nature of support were not clarified. Both stakeholders and guidelines recommended close partnership between sexual assault services and local counselling services.
This review suggests that there is big variation in the mental health and substance misuse provision both across and within different sexual assault service models. We found no robust evidence about how sexual assault services can achieve good mental health and substance misuse outcomes for service users. Clearer guidance for service planners and commissioners, informed by robust evidence about optimal service organisations and pathways, is required. PROSPERO registration number: CRD42018119706.
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