domestic violence research paper

EDITORIAL article

Editorial: new perspectives on domestic violence: from research to intervention.

$\r\nLuca Roll*$

1 Department of Psychology, University of Turin, Turin, Italy
2 School of Health and Social Work, University of Hertfordshire, Hertfordshire, United Kingdom

Editorial on the Research Topic New Perspectives on Domestic Violence: from Research to Intervention

In a document dated June 16th 2017, the United States Department of Justice stated that Domestic Violence (DV) has a significant impact not only on those abused, but also on family members, friends, and on the people within the social networks of both the abuser and the victim. In this sense, children who witness DV while growing up can be severely emotionally damaged. The European Commission (DG Justice) remarked in the Daphne III Program that 1 in 4 women in EU member states have been impacted by DV, and that the impact of DV on victims includes many critical consequences: lack of self-esteem, feeling shame and guilt, difficulties in expressing negative feelings, hopelessness and helplessness, which, in turn, lead to difficulties in using good coping strategies, self-management, and mutual support networks. In 2015 the EU Agency for Fundamental Rights affirmed that violence against women can be considered as a violation of human rights and dignity. Violence against women exists in each society and it can be related to any social, economic and cultural status and impact at the economic level. It includes physical, sexual, economic, religious, and psychological abuse.

Although men experience domestic violence by women, the rate of DV among women is much higher than that of men, especially in the category of being killed due to DV.

Recent studies have shown that between 13 and 61% of women (15–49 years old) report to have been physically abused at least once by an intimate partner. Domestic Violence takes place across different age groups, genders, sexual orientations, economic, or cultural statuses. However, DV remains largely under-reported due to fear of reprisal by the perpetrator, hope that DV will stop, shame, loss of social prestige due to negative media coverage, and the sense of being trapped with nowhere to go:

Hence, it is estimated that 90% of cases of DV continue to be identified as a non-denounced violence.

The aim of this Special Issue of Frontiers of Psychology is to gather updated scientific and multidisciplinary contributions about issues linked to domestic violence, including intimate partner violence (IPV). We encouraged contributions from a variety of areas including original qualitative and quantitative articles, reviews, meta-analyses, theories, and clinical case studies on biological, psycho-social and cultural correlates, risk and protective factors, and the associated factors related to the etiology, assessment, and treatment of both victims and perpetrators of DV.

We hope that this Special Issue will stimulate a better informed debate on Domestic Violence, in relation to its psychosocial impact (in and outside home, in school, and workplace), to DV prevention and intervention strategies (within the family and in society at large), in addition to specific types of DV, and to controversial issues in this field as well.

The Special Issue comprises both theoretical reviews and original research papers. 7 research papers, 6 reviews (policy and practice review, systematic review, review and mini-review) and 1 methodological paper are included.

The first section comprises 2 systematic review and 3 original research papers focused on factors associated with Domestic Violence/Intimate Partner Violence/feminicide. Velotti et al. conducted a systematic review focused on the role of the attachment style on IPV victimization and perpetration. Several studies included failed to identify significant associations. The authors suggest to consider other variables (e.g., socioeconomic condition) that in interaction with attachment styles could explain the differences found between the studies. Considering the clinical contribution that these findings can provide to the treatment of IPV victims and perpetrators, future studies are needed. From a systematic review conducted by Gerino et al. focused on IPV in the “golden age” (old age), economic and educational conditions, younger age (55–69), membership in ethnic minorities, cognitive and physical impairment, substance abuse, cultural and social values, sexism and racism, were found as risk factors; depression emerged as risk factor and consequence of IPV. However, social support was identified as main protective factor. Also help-seeking behaviors and local/national services had a positively impact the phenomenon. Furthermore, the role of the parental communication was highlighted ( Rios-González et al. ) In that mothers encourage daughters to engage in relationship with ethical men, while removing from their representation attractive features and enhancing the double standard of viewing ethical man as unattractive vs. violent and attractive man. Fathers' communication directed toward young boys supports the dominant traditional masculinity, objectifying girls and emphasizing chauvinist values. These communicative dynamics impact males' behavior and females' choice of the partner while increasing the attraction toward violent men, and thus influencing the risk to be involved in IPV episodes.

Furthermore, factors associated with multiple IPV victimization by different partners were identified. From the study of Herrero et al. , experiencing child abuse emerged as a main predictor (“conditional partner selection process”). Similarly, adult victimization perpetrated by other than the intimate partner influences multiple IPV episodes. Moreover, this phenomenon is more frequent among younger women and those with lower income satisfaction. Length of relationship and greater psychological consequences to previous IPV are positively associated with multiple IPV episodes, while previous physical abuse is negatively related with subsequent victimization. The risk of multiple IPV episodes is reduced in countries with greater human development, suggesting the role of structural factors.

Regarding reasons of feminicide, passion motives assume the main role, followed by family problems, antisocial reasons, predatory crimes that comprise sexual component, impulsivity and mental disorders. The risk of overkilling episodes is higher when the perpetrator is known by the victim and when the murder is committed for passion reasons ( Zara and Gino ).

The second section includes papers focused on IPV/DV in particular contexts (one research paper, two reviews). Within separated couples, where conflicts are common, both men and women experience psychological aggression. However, some particularities emerged: women started to suffer of several kinds of psychological violence that was aimed to control (complicating the separation process), dehumanize and criticize them. Men report only few forms of violence experienced (likely due to the men's social position that narrows their disclosure opportunity), which mainly concern the limitation of the possibility to meet children ( Cardinali et al. ). Regarding same-sex couples ( Rollè et al. ), both similarities and differences in comparison with heterosexual couples emerged. IPV among LGB people is comparable or even higher than heterosexual episodes. Unique features present in same-sex IPV concern identification and treatment aspects, mainly due to the absence of solutions useful in addressing obstacles to help-seeking behaviors (related to fear of discrimination within LGB community), and the limitation of treatment programs tailored to the particularities of the LGB experience. Similarly, within First Nation's communities in Canada, IPV is a widespread phenomenon. However, the lack of preventing programs and the presence of intervention solutions that fail to address its cultural origins, limit the reduction of the problem and the recovery of victims. Klingspohn suggests the development of interventions capable to guarantee cultural safety and consequently to reduce discrimination and marginalization that Aboriginal people experience with mainstream health care system and which limit help-seeking behaviors.

The third section comprises two reviews and one research paper concerned with the impact of Intimate Partner and Domestic Violence. The systematic review conducted by Onwumere et al. highlighted the financial and emotional burden that violence perpetrated by psychotic patients entails for their informal carers (mainly close family relatives). Moreover, the authors identified within the studies included positive association between victimization and trauma symptoms, fear, and feeling of powerless and frustration.

Among people who suffered of Domestic Violence with a romantic or non-romantic partner who became their stalker, stalking victimization entails physical and emotive consequences for both male and female victims. Females suffered more than males of depressive and anxiety symptoms (although for both genders symptoms were minimal), while males experienced more anger. Furthermore, both genders adopted at least one “moving away” strategy in coping with stalking episodes, and the increasing of stalking behaviors determined a reduction in coping strategies use. This latter finding is likely to be due to the distress experienced ( Acquadro Maran and Varetto ).

Children abuse—which occurs often in Domestic Violence—results in emotional trauma as well as physical and psychological consequences that can negatively impact the learning opportunities. The school staff's ability to identify abuse signals and to refer to professionals constitute their main role. However, lack of skills and confidence among teachers regarding this function emerged, and further training for the school staff to increase support provided to abused children is needed ( Lloyd ).

Lastly, the fourth section includes two papers (one review and one methodological paper) that provide information on intervention and prevention programs and one research paper which contributes to the development and validation of the Willingness to Intervene in Cases of Intimate Partner Violence Against Women (WI-IPVAW) Scale. Gracia et al. The instrument demonstrated—both in the long and in its short form—high reliability and construct validity. The development of WI-IPVAW can contribute to the evaluation of the t role that can be played by people who are aware of the violence and understand attitudes toward IPV that can influence perpetrator's behavior and victim disclosure. The origin of violence within intimate relationship during adolescence calls for the development of preventive programs able to limit the phenomenon. The mini-review conducted by Santoro et al. highlighted the necessity to consider the relational structure where women are involved (history of poly-victimization re-victimization), and the domination suffered according to the gender model structured by the patriarchal context. Moreover, considering that violence can occur after separation or divorce, requires in child custody cases the evaluation of parenting and co-parenting relationship. This process can provide an opportunity to assess and treat some kind of violent behavior (Conflict-Instigated Violence, Violent Resistance, Separation-Instigated Violence). According to these consideration, Gennari et al. elaborated a model for clinical intervention (relational-intergenerational model) useful to address these issues during child custody evaluation. The model is composed of three levels aimed at understanding intergenerational exchange and identify factors that contribute to safeguard family relationship. This assessment process allows parents to reflect on information emerged during the evaluation process and activate resources useful to promote a constructive change of conflict dynamics and violent behaviors.

Author Contributions

All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

We would like to thanks all the authors and the reviewers who contributed to the present article collection, for their dedication to our topics and to their readiness to share their knowledge, and thus to increase the research in this field; KathWoodward, Specialty Chief Editor of Gender, Sex, and Sexuality Studies that believed in our project, and to Dr. Tommaso Trombetta for his collaboration during last year.

Keywords: domestic violence, intimate partner abuse, intimate partner violence (IPV), gender violence against women, same sex intimate partner violence, systematic review, perpetrator and victim of violence, perpetrator

Citation: Rollè L, Ramon S and Brustia P (2019) Editorial: New Perspectives on Domestic Violence: From Research to Intervention. Front. Psychol. 10:641. doi: 10.3389/fpsyg.2019.00641

Received: 25 February 2019; Accepted: 07 March 2019; Published: 28 March 2019.

Edited and reviewed by: Kath Woodward , The Open University, United Kingdom

Copyright © 2019 Rollè, Ramon and Brustia. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Luca Rollè, [email protected]

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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Open Access

Peer-reviewed

Research Article

A systematic review of intimate partner violence interventions focused on improving social support and/ mental health outcomes of survivors

Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Resources, Software, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation International Centre for Reproductive Health, Ghent University, Ghent, Belgium

Roles Data curation, Formal analysis, Methodology, Writing – review & editing

Affiliation Georgia State University Alumna, Atlanta, Georgia, United States of America

Roles Validation, Writing – review & editing

Affiliation Médecins Sans Frontières-Operational Centre Brussels, Brussels, Belgium

Roles Methodology, Supervision, Writing – review & editing

Emilomo Ogbe,
Stacy Harmon,
Rafael Van den Bergh,
Olivier Degomme

Published: June 25, 2020
https://doi.org/10.1371/journal.pone.0235177
Reader Comments

Intimate partner violence (IPV) is a key public health issue, with a myriad of physical, sexual and emotional consequences for the survivors of violence. Social support has been found to be an important factor in mitigating and moderating the consequences of IPV and improving health outcomes. This study’s objective was to identify and assess network oriented and support mediated IPV interventions, focused on improving mental health outcomes among IPV survivors.

A systematic scoping review of the literature was done adhering to PRISMA guidelines. The search covered a period of 1980 to 2017 with no language restrictions across the following databases, Medline, Embase, Web of Science, PROQUEST, and Cochrane. Studies were included if they were primary studies of IPV interventions targeted at survivors focused on improving access to social support, mental health outcomes and access to resources for survivors.

337 articles were subjected to full text screening, of which 27 articles met screening criteria. The review included both quantitative and qualitative articles. As the focus of the review was on social support, we identified interventions that were i) focused on individual IPV survivors and improving their access to resources and coping strategies, and ii) interventions focused on both individual IPV survivors as well as their communities and networks. We categorized social support interventions identified by the review as Survivor focused , advocate/case management interventions (15 studies) , survivor focused, advocate/case management interventions with a psychotherapy component (3 studies), community-focused , social support interventions (6 studies) , community-focused , social support interventions with a psychotherapy component (3 studies) . Most of the studies, resulted in improvements in social support and/or mental health outcomes of survivors, with little evidence of their effect on IPV reduction or increase in healthcare utilization.

There is good evidence of the effect of IPV interventions focused on improving access to social support through the use of advocates with strong linkages with community based structures and networks, on better mental health outcomes of survivors, there is a need for more robust/ high quality research to assess in what contexts and for whom, these interventions work better compared to other forms of IPV interventions.

Citation: Ogbe E, Harmon S, Van den Bergh R, Degomme O (2020) A systematic review of intimate partner violence interventions focused on improving social support and/ mental health outcomes of survivors. PLoS ONE 15(6): e0235177. https://doi.org/10.1371/journal.pone.0235177

Editor: Nihaya Daoud, Ben-Gurion University of the Negev Faculty of Health Sciences, ISRAEL

Received: March 7, 2019; Accepted: June 9, 2020; Published: June 25, 2020

Copyright: © 2020 Ogbe et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information files.

Funding: E.O- University of Gent BOF startkrediet (BOF.STA.2016.0031.01) The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Introduction

The global prevalence of intimate partner violence (IPV) has been estimated at about 30% for women aged 15 and over [ 1 ]. We define IPV within this paper as ‘any acts of physical violence, sexual violence, stalking and psychological aggression (including coercive tactics) by a current or former intimate partner’ [ 2 ]. IPV affects men and women, and men or women can be perpetrators or survivors of violence. However, women are the most affected by IPV, and men tend to perpetrate violence more than women [ 3 ]. Survivors of violence are likely to first disclose experiences of intimate partner violence and expect informal support from a friend, family member, neighbour or other members of their social network, prior to seeking support from formal sources like health institutions and legal officers, however, the extent of disclosure differed with age, nature, ethnicity and gender [ 4 ].

IPV has been found to be associated with an increased risk of poor health, depressive symptoms, substance use, chronic disease, chronic mental illness and injury for both men and women [ 5 ]. Social support has been found to be an important factor for mediating, buffering and improving the outcomes of survivors of violence and improving mental health outcomes[ 6 ]. Conversely, social isolation and lack of social support have been found to be linked with poor health outcomes for survivors of violence. Liang et al [ 6 ] discussed the importance, perception of the abuse by the IPV survivor plays on their decision to ask for help and support. They mentioned how cultural factors including stigma and shame around disclosing IPV, perception of the incident as a personal problem and awareness of resources available, play a determining factor on types of resources accessed, especially for IPV survivors with a migrant background or of a low socioeconomic status. IPV survivors who perceive the abuse to be a personal problem were more likely to use placating and avoidant strategies before seeking external support [ 6 ].

In this study, we make use of Shumaker and Brownell’s definition of social support, and define it as any provision of assistance, which may be financial or emotional, that is recognized by both the beneficiary and provider as advantageous to the beneficiary’s welfare. ‘[ 7 ]. IPV interventions that involve the use of social support, have the potential to improve the health seeking behaviour, access to resources and mental health outcomes of IPV survivors. Commonly cited types of social support interventions include but are not limited to the use of peer support, family support and the use of ‘remote interventions like the use of internet or telephones as sources of social support from trained counsellors, as well as information about resources’ [ 8 ]. Goodman and Smyth [ 9 ] discussed the importance of using a ‘network oriented’ approach to provision of domestic violence services that takes into account the value of informal support, from social network members of IPV survivors, as this would promote the well-being of the survivor and sustain some of the benefits of the intervention over time. Given the existing gap in evidence on the effect of different IPV interventions on social support and/ mental health outcomes of IPV survivors, this study aimed to address the evidence gap, by assessing the effects of these different IPV interventions, and network oriented approaches on improving access to social support and improved mental health outcomes for IPV survivors. This is of added benefit, as access to social support improves the mental health outcome of survivors of violence. More evidence of different types of social support interventions targeted at different groups of people, that are effective in addressing mental health outcomes of survivors, are needed.

The systematic review was developed according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) guidelines. The methods used to screen the studies and define eligibility are described below:

Eligibility criteria

Studies meeting the following criteria were included: Primary research (original articles excluding systematic reviews), targeted at IPV survivors, describing interventions focused on improving access to resources and mental health outcomes for IPV survivors. The interventions had to use a social support or network-oriented approach. There were no restrictions on gender, but most of the studies identified focused on female survivors of violence (See Table 1 ). We defined ‘IPV as physical, sexual and psychological abuse directed against a person, by a current or ex-partner’ [ 10 ].

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https://doi.org/10.1371/journal.pone.0235177.t001

Studies had to address the following outcomes: intimate partner violence, social support, mental health outcomes and quality of life. Other outcomes that were also included were those associated with access to resources, utilisation of health services, and safety-promoting behaviours, if they were assessed in addition to the outcomes mentioned earlier. No restrictions were placed on study design or language, to allow for inclusion of all relevant studies.

Information sources

Between May and July 2017, we conducted a search across 5 databases: Medline, Embase, Web of Science, Cochrane and PROQUEST, for studies published between 1980 and 2017. We decided to include studies from the 1980’s because some of the pioneering publications on the use of advocacy and social support, for example, Sullivan et al’s work were published in the late 80’s and early 1990’s and we wanted our review to include some of these publications. Even though the review eventually included only primary studies, we included studies from COCHRANE to allow us to identify additional articles. We did not conduct a separate search for grey literature, as the PROQUEST database also included scholarly journals, newspapers, reports, working papers, and datasets along with e-books. Retrieved references were imported to Endnote and Mendeley and were then transferred to a systematic review software called Co-evidence [ 11 ]. In January 2019, another search was done to update and ensure new articles or information could be included in the review. Table 1 provides an overview and summary of the studies selected, as well as the evidence ranking of the studies.

Search strategy

The search strategy was developed in collaboration with a librarian, as well as a review of other existing systematic reviews on IPV or social support interventions. Search terms combined MeSH terms, and specific terms related to IPV and were adapted to each of the databases searched. This is presented in Table 2 .

https://doi.org/10.1371/journal.pone.0235177.t002

Study selection

Inclusion of retrieved studies and their eligibility were independently assessed by two reviewers, EO and SH, in a two-step process. First, the authors independently screened all study titles and abstracts using Co-evidence (the systematic review software), which notified each author of conflicts. When a conflict was identified, articles were again independently reviewed, and discordance was resolved through discussion, using the systematic review protocol as a guide. The same process was also used for the full text-screening phase of the study. While this process lengthened the screening process, it allowed for transparency and made it possible for both reviewers to continually reference the study protocol and ensure that the study objectives were adhered to, through the review process.

Data extraction

A standardized data collection form was developed by EO and SH, adapted from the Cochrane data collection grid. EO extracted all the data from the studies, SH and RB reviewed the data and it was agreed that OD would provide input if there was any disagreement about the data extracted.

Risk of bias

The quality and risk of bias in the studies were independently assessed by EO and SH, using the appropriate quality assessment tool. As the studies selected included quantitative and qualitative studies, there was an agreement to assess quantitative and qualitative studies separately. Quantitative studies were assessed using the Quality Assessment Tool for quantitative studies developed by the Effective Public Health Practice Project, see Table 3 for an overview of the components of this tool [ 12 ]. This tool had been used in another systematic review focused on interventions [ 13 ]. Qualitative studies were assessed, using the Critical Appraisal Skills Programme (CASP) Qualitative Research Checklist [ 14 ], the main components focused on assessing the methodological limitations, coherence, adequacy of data and relevance of research. See Table 4 for an overview.

https://doi.org/10.1371/journal.pone.0235177.t003

https://doi.org/10.1371/journal.pone.0235177.t004

Information about studies selected

The initial search across the different databases retrieved 3712 articles, of which 3364 articles were irrelevant based on the screening criteria. 337 articles were assessed at the full text screening stage, and 27 articles selected to be part of the systematic review, the overview is presented in Fig 1

From : Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). P referred R eporting I tems for S ystematic Reviews and M eta- A nalyses: The PRISMA Statement. PLoS Med 6(7): e1000097. doi: 10.1371/journal.pmed1000097 For more information, visit www.prisma-statement.org .

https://doi.org/10.1371/journal.pone.0235177.g001

Results/Key findings from the systematic review

The interventions were classified based on the methodology or type of social support provided to the survivors of violence. Most of the studies identified involved the use of an ‘advocate/ case manager’ or ‘interventionist’ (which referred to a nurse, psychologist or volunteer trained to administer the IPV intervention). The advocate was often responsible for offering the survivor information on resources and helping them identify safety strategies. The interventions usually consisted of weekly sessions or phone calls for a certain period of time. These interventions were mostly in the United States and from other countries like China, Canada, Denmark, Netherlands, Uganda and the United Kingdom. Other interventions involved the use of advocacy with an added psychotherapy component, and interventions that focused on community education, as well as empowerment of the IPV survivors. One of such community focused interventions used an empowerment model and encouraged survivors of violence to take photos of their safety strategies. These photos were used to educate the community about the consequences of intimate partner violence and advocate for community support to prevent intimate partner violence and encourage access to services. In our paper, the term ‘community focused’ included interventions targeted at the community which used participatory and non-participatory methods in the design and implementation of the programmes. The interventions identified in this systematic review had different target groups, pregnant women, survivors of violence resident in shelters, community members and IPV survivors, substance abusing women, and women with small children.

Types of social support interventions for intimate partner violence survivor

Survivor- focused social support interventions..

The interventions described below were all focused on providing social support and improving mental health outcomes for the survivors of violence, all of them involved the use of advocacy/case management approaches, through remote or ‘face to face’ methods. We also identified advocacy interventions with a strong therapeutic component, which we have discussed separately.

Advocacy/ Case management interventions

These interventions involved the use of community-based advocacy interventions focused on individuals that were survivors of violence, these interventions were focused on assisting the survivors identify and access resources, supportive relationships and cope with the effects of intimate partner violence. Fifteen of the studies reviewed (11 RCTs, 2 pre-post evaluation, 1 retrospective study, 1 quasi-experimental study with randomization) described experiences with social support interventions that provided some sort of advocacy service in combination with community support for survivors of violence, on an individual level [ 15 – 29 ].

Advocacy interventions may include ‘helping abused women to access services, guiding them through the process of safety planning, and improving abused women’s physical or psychological health’ [ 30 ]. For the review, interventions grouped under this category included mentor-mother interventions (these interventions involved the training of IPV survivors who were mothers as counsellors and mentors, for other IPV survivors), and use of home-based or in-clinic advocates. Most of the studies reported a decrease in depression, fear, post-traumatic stress disorder, and increased access to social support for the IPV survivors included in the study.

In Tiwari et al’s study, where an advocacy intervention was compared to the usual community services, the reduction in depression and other mental outcomes, was not significant but the reduction in ‘partner aggression’ and increase in access to social support in the intervention arm was significant [ 15 ]. Two of the studies, an in-clinic advocacy intervention by Coker et al [ 23 ] and a home-based advocate intervention by Sharps et al [ 20 ] resulted in a significant reduction in the experience of intimate partner violence by the survivors (decrease in experience of IPV in the intervention arm compared to the control group). The two mentor mothers’ studies included in this review, showed an increase in uptake of support services and mental health services. Prosman et al’s study [ 18 ] specifically showed evidence that the mentor mother intervention led to a decrease of in experience of IPV (decreased Composite Abuse Scale (CAS) mean score by 37.7 (SD 25.7) after 16 weeks), as well as in depression scores. This study had a component that focused on uptake of therapy, which may have influenced the outcomes. Four of these studies compared ‘face to face’ case management/ advocacy services to remote modes of care and assessed the impact on social support and IPV. Gilbert et al’s study [ 24 ] compared online and case manager implemented screening, assessment, and referral to treatment intervention for IPV survivors who were substance abusing, the intervention was guided by social cognitive theory, and focused on short screening, an intervention and referral to treatment (SBIRT) model. There were no significant differences between both groups in terms of impact of the interventions, the study found both groups has an increase in access to social support, IPV self-efficacy (ability to protect themselves from IPV) and abstinence from substance use, irrespective of the type of intervention they received. McFarlane et al [ 26 ] assessed the differences between nurse case management and a referral card on reduction of violence and use of community resources among IPV survivors, and found no differences in outcome between both groups, but found compared to baseline, participants who received either intervention (nurse case management or referral card) had a significant reduction in experiences of violence (threats of abuse, assaults, risks of homicide and work harassment) between baseline and 24 months post-intervention. There were no significant differences in outcome for participants who were in the referral card or case management intervention arm. Other outcomes like improved safety behaviors and a reduction in the utilization of community resources were also found across both groups. Stevens et al’s [ 27 ] study focused on using telephone based support/referral services for IPV survivors compared to enhanced usual care (, the intervention was based on a social support and empowerment model. The study found no significant difference in outcomes between the intervention arm (telephone-based arm) and the control arm (enhanced usual care- community services provided by the community center including health, social, educational, and recreational services). Research participants reported a decrease in experiences of IPV across both groups, associated with ‘higher levels of social support’ at baseline and at 3 months post-intervention. However, the reduced levels of violence did not influence the capacity to obtain or utilize community resources among the research participants. Constantino et al’s [ 29 ] study compared an advocacy based intervention across different methods (online and face to face) and found the intervention reduced depression, anxiety and increased personal and social support among the online group compared to the control group. The intervention included a module that addressed interpersonal relationships, thoughts and emotions as well as access to referral services like legal aid. Another study by Constantino [ 28 ] involved a nurse led intervention focused on providing information on resources and services for IPV survivors living in a domestic violence shelter. The intervention was compared to usual care in the shelter. The intervention group had reduced psychological distress, increased levels of social support and reduced reporting of health care issues. Most of the studies we found in this category showed moderate levels of quality of evidence.

Advocacy/Case management interventions with a psychotherapy component

3 of the studies (3 RCTs) [ 31 – 33 ] were focused on interventions that included specific types of psychotherapy, sometimes delivered remotely or through individual or group sessions. Zlotnick et al [ 31 ] described the use of interpersonal psychotherapy among pregnant women focused at improving social support among the survivors of violence during individual psychotherapy sessions. Though there was a moderate change in depression and PTSD scores (reduction) between the control and intervention groups at post-intake (5–6 weeks), this difference was not sustained at the post-partum period. Hansen et al [ 33 ] describes the use of psychotherapy using either the ‘Trauma Recovery Group’ (TRG) method developed by ‘a private Danish organization called ‘‘The Mothers’ Aid”‘ or regular trauma therapy for individual or groups of women who were survivors of IPV. The study reported significant changes in PTSD, depression and anxiety symptoms and increased levels of social support (high effect sizes); however, our assessment with the EPHPP grading revealed that the study design was weak. Miller et al’s [ 32 ] study shows the effect of a ‘mom empowerment programme’ focused on improving mental health outcomes and ability to access resources among IPV survivors participating in the programme, with resulting improvement in PTSD, depression and anxiety symptoms.

Community-focused/ network social support interventions

These group of studies, distinct from the ones described above focused on community education and change, so the focus of the studies was not just the individual survivor of violence, but the community as a whole. 9 (3 RCTs, 3 pre-post evaluations, 3 qualitative research) of the studies we reviewed consisted of interventions described as being community-based [ 34 – 42 ]. The definitions of community-focused interventions used for classifying the studies followed the typology by McLeroy et al [ 43 ], which refers to interventions where:

The setting of the intervention is the community
The target population of the intervention is the community
The intervention uses community members as a resource
The community serves as an agent for the intervention (i.e. interventions working with already existing structures within the community)

We have focused on interventions in this category where the focus of the intervention is the community. The interventions described include community participatory research, like those described by Ragavan et al’s systematic review on community participatory research on domestic violence [ 44 ], as well as interventions that are ‘community placed’, where the community is a target of the intervention, and might not have been involved in the design of the intervention, in a participatory way.

All the interventions were focused on IPV reduction and improving social support and mental health outcomes for survivors of violence. Interventions like SASA [ 34 , 39 ], used community members as a resource for the intervention. In the SASA intervention, community activists in the intervention sites were trained on GBV prevention, power inequalities and gender norms. After training, they carried out advocacy activities, engaging different stakeholders and members of their social networks to address harmful social norms around GBV. At the end of the intervention, there were reported lower rates of IPV among the intervention community. Other interventions like the ‘Framing Safety project’ [ 35 ], which focused on promoting agency and self-empowerment among survivors of violence, found that by providing means through which survivors of violence could tell their own stories and take ownership of this process, there was a resulting feeling of empowerment among the women. Other interventions used group therapy sessions that were community-based and culturally tailored to the specific target population. Wuest et al [ 41 ] described a collaborative partnership with different stakeholders (academic, NGOs and community members) to develop a comprehensive intervention to IPV, ‘Intervention for Health Enhancement After Leaving (iHEAL), a primary health care intervention for women recently separated from violent/abusive partners’. The post evaluation revealed significant reduction in depression and PTSD from baseline to 6 months post-intervention, these improvements in mental health outcomes, were present at 12 months post-intervention. Other outcomes, like social support, showed some initial improvement from baseline to 6 months post-intervention but these changes were not sustained till 12 months post-intervention.

Community focused/ network interventions with a psychotherapy component

Three of the nine studies (1 RCT and 2 pre-post study) by Kelly et al [ 36 ], McWhirter et al [ 37 ], and Nicolaidis et al [ 38 ] described group therapy interventions that were designed in collaboration with the target population in a participatory way. These studies reported significant reductions in severity of mental health conditions like depression and PTSD, as well as an increase in social support and self-efficacy for the women who were involved in the study.

The focus of this systematic review was to assess the existing evidence available on IPV interventions focused on improving social support and/or mental health outcomes. To ensure that we included all relevant studies, we included both quantitative and qualitative articles. 27 articles were included in the systematic review out of 337 full text articles assessed. The following interventions were identified via the review: Survivor focused interventions (18 studies: 15 of these studies were focused on advocacy/case management services; 3 of these on advocacy/case management services with a psychotherapy component), community-based social support interventions (9 studies:4 out of these were community coordinated interventions with a psychotherapy component). The heterogeneity of the studies made it difficult to conduct a meta-analysis because of the variability in outcome measures, study design and processes and duration of interventions implemented. Survivor focused advocacy/case management IPV interventions made up most of the interventions identified (18 out of 27). The studies showed good to moderate evidence of the positive impact of these interventions on mental health outcomes and also access to social support for the IPV survivors included in the study, and in a few studies, a reduction in partner aggression or experience of IPV (IPV scores) [ 15 – 23 ]. In one study, by De Prince et al [ 42 ], where a community-based advocacy intervention was compared to an advocacy intervention that was focused on referral, both groups showed improvement in mental health outcomes, but the community-based advocacy intervention group (outreach) had slightly better mental health outcomes. A specific approach of the intervention was that it was community-led/ coordinated, the community based organisation reached out directly to the survivors of violence based on information from the systems based advocate, hence removing the need for survivors to seek out services themselves based on the referrals received from the system based advocate. This study might have important lessons for future advocacy interventions, as just provision of referrals might not ensure uptake of services, and a community coordinated follow up of IPV survivors might be more effective in ensuring uptake. However, it must be noted that only few of the advocate-based studies and 1 of the community-focused interventions reported an impact on IPV, with good level of evidence [ 15 , 20 – 23 , 34 ], similar to what has been found in other reviews of advocate-based interventions on intimate partner violence [ 45 ]. Tiwari et al’s study, which focused on the use of an empowerment, social support and advocacy-focused telephone intervention, found improved mental health outcomes among the intervention group. In comparison, Cripe et al’s [ 46 ] study also compared the effect of an empowerment-based intervention in comparison to usual care among abused pregnant women and found higher scores of improved safety behaviours among the intervention group compared to the control group but ‘no statistically significant difference in health-related quality of life, adoption of safety behaviours, and use of community resources between women in the intervention and control groups’. These differences we attribute to the study design, context and characteristics of the study participant. Goodman et al has described the importance of integrating a ‘social network’ approach into IPV interventions, and linking interventions with social networks of IPV survivors to ensure sustained access to social support for the survivors [ 9 , 47 ]. Many of the advocacy/case management interventions described above have created these linkages by assisting IPV survivors identify sources of support within their existing networks and also engage in forming new social relationships [ 16 , 18 , 48 ]. However, more IPV interventions should integrate this approach in a coordinated systemic manner, as engaging with social network members of the IPV survivors ensures sustainability of the programme’s effects over time [ 9 ].

Several of the studies focused on psychotherapy interventions, which were individual, or group based. We classified these interventions separately as these interventions combined community-based advocacy with a therapeutic component, as opposed to advocacy/case management alone or community focused interventions. These interventions either used interpersonal therapy [ 31 ], traumatic treatment therapy [ 33 ], empowerment based group therapy [ 32 ], and a multicomponent intervention that combined therapeutic education sessions with information on resources and legal help remotely or ‘face to face’ [ 29 ]. All the interventions showed some impact on mental health outcomes and social support, with a weaker level of evidence of an impact on IPV. Although Zlotnick et al’s study[ 31 ] on a therapeutic intervention for pregnant IPV survivors, described an improvement of mental health outcomes (moderate effect on PTSD and depression), this finding was not sustained in the postpartum period, drawing attention to the need to assess the efficacy of interventions in this particular group, taking into account time dependent factors and participant attributes. A review done by Trabold et al [ 49 ], found that clinically focused interventions and group-based cognitive or cognitive behavioural interventions had a significant effect on depression and PTSD, as well as the uses of Interpersonal therapy (time dependent). However, as our review focused on therapies focused on improving social support and mental health outcomes, we included fewer studies. Although we found a similar trend as described by Trabold et al, among community-based interventions (including those that were psychotherapy focused), we could not assign the effect specifically to the type of psychotherapy method, but rather to the length, associated support services and context of the intervention. Sullivan et al [ 50 ] discussed the positive effect of trauma informed practice on mental health outcomes of IPV survivors in Shelters, showing evidence of the importance of IPV interventions to include a comprehensive ‘therapeutic or mental health component’. They also discussed the six components of what ‘trauma informed practice’ which includes: (a) reflecting and understanding of trauma and its many impacts on health and behaviour, (b) addressing both physical and psychological safety concerns, (c) using a culturally informed strengths-based approach, (d) helping to illuminate the nature and impact of trauma on survivors’ everyday experience, and (e) providing opportunities for clients to regain control over their lives’. These components were useful for advocacy/case management interventions for IPV survivors, to ensure a focus on improving mental health outcomes, intersectional collaboration between stakeholders, and that the intervention is survivor-centred and addresses cultural factors.

Interventions that compared remote and ‘face to face’ methods of support and advocacy mostly resulted in a reduction in IPV victimization and increased access to social support. In cases where different modes of intervention delivery were tested, for example a comparison between remotely delivered interventions (telephone or online) and ‘face to face’ interventions, no difference was noted between both modes of intervention. Krasnoff and Moscati’s study [ 51 ] discussed a multi-component referral, support and case management intervention that reported similar reduction in perceived IPV victimization as seen in studies included in our review. There were some differences in the telephone support interventions included, Stevens et al’s study [ 27 ] reported no difference in mental health outcomes compared to Tiwari et al’s study[ 15 ] which found an improvement in mental health outcomes among the intervention group. We postulate differences in outcome could be attributable to the fact that Tiwari’s intervention was more advocacy, empowerment and support focused than the intervention described in Stevens et al study, which was more information and referral focused.

Summary of key findings and recommendations

Most of the interventions that used advocacy with strong community linkages and a focus on community networks showed significant effects on mental health outcomes and access to social support, we assume a reason for this could be that because these interventions were rooted in the community, there were more sources of support that allowed the survivors of violence to develop better coping strategies, for example in the SASA study that included a strong community engagement component, community responses to cases of IPV were supportive of the survivor, and this had an effect on incidence of IPV. Future research and interventions on IPV should focus on ensuring stronger community linkages and outreach programmes to enhance the impact of the interventions on IPV survivors.
This review found that when remote modes of intervention delivery were compared to ‘in person’ delivery of an intervention, there were no significant differences in outcome. This finding is of specific importance to hard-to-reach and vulnerable populations whom might be unwilling to access care at hospitals and registered clinics. More research focused on the use of remote support interventions among vulnerable populations (specifically IPV survivors), should be encouraged.
There was a lot of heterogeneity in outcome measurements, especially measures of social support, drawing attention to the need for research and discussions around standardization and synthesis of evidence-based research on social support and IPV.
In some of the studies, the ‘dosage of the intervention’, as well as some participant characteristics like age or ethnicity are often cited as potential moderators of some of the outcomes, more research on IPV intervention should examine the time dependent nature of interventions and their effect on outcomes similar to what was done by Bybee et al[ 16 ].

Limitations

Although there were no language restrictions included in our search strategy, most of the studies retrieved and subsequently reviewed were in English, which could have influenced some of our conclusions.

Conclusions

This systematic review presented the findings from IPV interventions focused on social support and mental health outcomes for IPV survivors. Advocacy/case management interventions that had strong linkages with communities, and were community focused seemed to have significant effects on mental health outcomes and access to resources for IPV survivors. However, all IPV survivors are not the same, and culture, socioeconomic background and the perception of abuse by the IPV survivor, have a mediating effect on their decision to access social support and utilize referral services. ‘An intersectional trauma informed practice’[ 50 ] [ 52 ] that addresses psychological and physical effects of IPV, is culturally appropriate and is empowering for the survivor, in addition to a ‘social network oriented approach’ might provide a way to ensure that IPV interventions are responsive to the needs of the IPV survivor[ 47 ]. This will ensure the interventions are targeted at ensuring survivors are able to access social support from their existing networks or new social relationships, and might also promote community education about IPV and promote community support for IPV prevention and mitigation. Future studies on IPV interventions should assess how these approaches impact the incidence of IPV, social and mental health outcomes across different populations’ of IPV survivors.

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Domestic Violence and Its Effects on Women, Children, and Families

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1 Department of Pediatrics, Maimonides Children's Hospital of Brooklyn, 4802 Tenth Avenue, Brooklyn, NY 11219, USA. Electronic address: [email protected].
2 Department of Pediatrics, Maimonides Children's Hospital of Brooklyn, 4802 Tenth Avenue, Brooklyn, NY 11219, USA.
3 City University of New York (CUNY) - Graduate School of Public Health and Health Policy, 235 West 102nd Street, New York, NY 10025, USA.
PMID: 33678299
DOI: 10.1016/j.pcl.2020.12.011

Men and women experience severe domestic violence (DV) and intimate partner violence (IPV); however, women and children remain especially vulnerable. Violence along the DV/IPV continuum has been recognized as a type of child maltreatment and a child's awareness that a caregiver is being harmed or at risk of harm is sufficient to induce harmful sequelae. Consequences of these abusive behaviors are associated with mental and physical health consequences. Health care professionals can screen, identify, and manage this pathology in affected families while educating communities to these pernicious effects.

Keywords: Child abuse; Domestic violence; Intimate partner violence; Pandemic preparedness.

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Domestic Violence Facts and Statistics * Domestic Violence Video Presentations * Online CEU Courses

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Resources for researchers, policy-makers, intervention providers, victim advocates, law enforcement, judges, attorneys, family court mediators, educators, and anyone interested in family violence

PASK FINDINGS

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INTERNATIONAL RESEARCH

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The world's largest domestic violence research data base, 2,657 pages, with summaries of 1700 peer-reviewed studies.

Courtesy of the scholarly journal, Partner Abuse www.springerpub.com/pa and the Association of Domestic Violence Intervention Providers www.domesticviolenceintervention.net

Over the years, research on partner abuse has become unnecessarily fragmented and politicized. The purpose of The Partner Abuse State of Knowledge Project (PASK) is to bring together in a rigorously evidence-based, transparent and methodical manner existing knowledge about partner abuse with reliable, up-to-date research that can easily be accessed both by researchers and the general public.

Family violence scholars from the United States, Canada and the U.K. were invited to conduct an extensive and thorough review of the empirical literature, in 17 broad topic areas. They were asked to conduct a formal search for published, peer-reviewed studies through standard, widely-used search programs, and then catalogue and summarize all known research studies relevant to each major topic and its sub-topics. In the interest of thoroughness and transparency, the researchers agreed to summarize all quantitative studies published in peer-reviewed journals after 1990, as well as any major studies published prior to that time, and to clearly specify exclusion criteria. Included studies are organized in extended tables, each table containing summaries of studies relevant to its particular sub-topic.

In this unprecedented undertaking, a total of 42 scholars and 70 research assistants at 20 universities and research institutions spent two years or more researching their topics and writing the results. Approximately 12,000 studies were considered and more than 1,700 were summarized and organized into tables. The 17 manuscripts, which provide a review of findings on each of the topics, for a total of 2,657 pages, appear in 5 consecutive special issues of the peer-reviewed journal Partner Abuse . All conclusions, including the extent to which the research evidence supports or undermines current theories, are based strictly on the data collected.

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Click here for video presentations from the 6-hour ADVIP 2020 International Conference on evidence-based treatment.

NISVS: The National Intimate Partner and Sexual Violence Survey

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CLASSIC VIDEO PRESENTATIONS Murray Straus, Ph.D. * Erin Pizzey * Don Dutton, Ph.D. Click Here

Video: the uncomfortable facts on ipv, tonia nicholls, ph.d., video: batterer intervention groups: moving forward with evidence-based practice, john hamel, ph.d., additional research.

From Other Renowned Scholars and Clinicians. Click on any name below for research, trainings and expert witness/consultation services

PREVALENCE RATES

Arthur Cantos, Ph.D. University of Texas

Denise Hines, Ph.D. Clark University

Zeev Winstok, Ph.D. University of Haifa (Israel)

CONTEXT OF ABUSE

Don Dutton, Ph.D University of British Columbia (Canada)

K. Daniel O'Leary State University of New York at Stony Brook

Jennifer Langhinrichsen-Rohling, Ph.D. University of South Alabama

ABUSE WORLDWIDE ETHNIC/LGBT GROUPS

Fred Buttell, Ph.D. Tulane University

Clare Cannon, Ph.D. University of California, Davis

Vallerie Coleman, Ph.D. Private Practice, Santa Monica, CA

Chiara Sabina, Ph.D. Penn State Harrisburg

Esteban Eugenio Santovena, Ph.D. Universidad Autonoma de Ciudad Juarez, Mexico

Christauria Welland, Ph.D. Private Practice, San Diego, CA

RISK FACTORS

Louise Dixon, Ph.D. University of Birmingham (U.K.)

Sandra Stith, Ph.D. Kansas State University

Gregory Stuart, Ph.D. University of Tennessee Knoxville

IMPACT ON VICTIMS AND FAMILIES

Deborah Capaldi, Ph.D. Oregon Social Learning Center

Patrick Davies, Ph.D. University of Rochester

Miriam Ehrensaft, Ph.D. Columbia University Medical Ctr.

Amy Slep, Ph.D. State University of New York at Stony Brook

VICTIM ISSUES

Carol Crabsen, MSW Valley Oasis, Lancaster, CA

Emily Douglas, Ph.D. Bridgewater State University

Leila Dutton, Ph.D. University of New Haven

Margaux Helm WEAVE, Sacramento, CA

Linda Mills, Ph.D. New York University

Brenda Russell, Ph.D. Penn State Berks

CRIMINAL JUSTICE RESPONSES

Ken Corvo, Ph.D. Syracuse University

Jeffrey Fagan, Ph.D. Columbia University

Brenda Russell, Ph.D, Penn State Berks

Stan Shernock, Ph.D. Norwich University

PREVENTION AND TREATMENT

Julia Babcock, Ph.D. University of Houston

Fred Buttell, Ph.D.Tulane University

Michelle Carney, Ph.D. University of Georgia

Christopher Eckhardt, Ph.D. Purdue Univerity

Kimberly Flemke, Ph.D. Drexel University

Nicola Graham-Kevan, Ph.D. Univ. Central Lancashire (U.K.)

Peter Lehmann, Ph.D. University of Texas at Arlingon

Penny Leisring, Ph.D. Quinnipiac University

Christopher Murphy, Ph.D. University of Maryland

Ronald Potter-Efron, Ph.D. Private Practice, Eleva, WI

Daniel Sonkin, Ph.D. Private Practice, Sausalito, CA.

Lynn Stewart, Ph.D. Correctional Service, Canada

Casey Taft, Ph.D Boston University School of Medicine

Jeff Temple, Ph.D. University of Texas Medical Branch

Domestic Violence Awareness

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SAFETY ALERT: If you are in danger, please use a safer computer and consider calling 911. The National Domestic Violence Hotline at 1-800-799-7233 / TTY 1-800-787-3224 or the StrongHearts Native Helpline at 1−844-762-8483 (call or text) are available to assist you.

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Research & Evidence

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NRCDV works to strengthen researcher/practitioner collaborations that advance the field’s knowledge of, access to, and input in research that informs policy and practice at all levels. We also identify and develop guidance and tools to help domestic violence programs and coalitions better evaluate their work, including by using participatory action research approaches that directly tap the diverse expertise of a community to frame and guide evaluation efforts.

Safety & Privacy in a Digital World

Immigrant Survivors of Domestic Violence

Teen Dating Violence

Housing and Domestic Violence

Preventing and Responding to Domestic Violence in Lesbian, Gay, Bisexual, Transgender, or Queer (LGBTQ) Communities

Domestic Violence in LGBTQ Communities

Trans and Non-Binary Survivors

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For an extensive list of research & evidence materials check out the research & statistics section on VAWnet

The Domestic Violence Evidence Project (DVEP) is a multi-faceted, multi-year and highly collaborative effort designed to assist state coalitions, local domestic violence programs, researchers, and other allied individuals and organizations better respond to the growing emphasis on identifying and integrating evidence-based practice into their work. DVEP brings together research, evaluation, practice and theory to inform critical thinking and enhance the field's knowledge to better serve survivors and their families.

The Community Based Participatory Research Toolkit (CBPR) is for researchers and practitioners across disciplines and social locations who are working in academic, policy, community, or practice-based settings. In particular, the toolkit provides support to emerging researchers as they consider whether and how to take a CBPR approach and what it might mean in the context of their professional roles and settings. Domestic violence advocates will also find useful information on the CBPR approach and how it can help answer important questions about your work.

For over two decades, the National Resource Center on Domestic Violence has operated VAWnet , an online library focused on violence against women and other forms of gender-based violence. VAWnet.org has long been identified as an unparalleled, comprehensive, go-to source of information and resources for anti-violence advocates, human service professionals, educators, faith leaders, and others interested in ending domestic and sexual violence.

Safe Housing Partnerships , the website of the Domestic Violence and Housing Technical Assistance Consortium , includes the latest research and evidence on the intersection of domestic and sexual violence, housing, and homelessness. You can also find new research exploring different aspects of efforts to expand housing options for domestic and sexual violence survivors, including the use of flexible funding approaches, DV Housing First and rapid rehousing, DV Transitional Housing, and mobile advocacy.

Open access
Published: 20 June 2023

A qualitative quantitative mixed methods study of domestic violence against women

Mina Shayestefar 1 ,
Mohadese Saffari 1 ,
Razieh Gholamhosseinzadeh 2 ,
Monir Nobahar 3 , 4 ,
Majid Mirmohammadkhani 4 ,
Seyed Hossein Shahcheragh 5 &
Zahra Khosravi 6

BMC Women's Health volume 23 , Article number: 322 ( 2023 ) Cite this article

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Violence against women is one of the most widespread, persistent and detrimental violations of human rights in today’s world, which has not been reported in most cases due to impunity, silence, stigma and shame, even in the age of social communication. Domestic violence against women harms individuals, families, and society. The objective of this study was to investigate the prevalence and experiences of domestic violence against women in Semnan.

This study was conducted as mixed research (cross-sectional descriptive and phenomenological qualitative methods) to investigate domestic violence against women, and some related factors (quantitative) and experiences of such violence (qualitative) simultaneously in Semnan. In quantitative study, cluster sampling was conducted based on the areas covered by health centers from married women living in Semnan since March 2021 to March 2022 using Domestic Violence Questionnaire. Then, the obtained data were analyzed by descriptive and inferential statistics. In qualitative study by phenomenological approach and purposive sampling until data saturation, 9 women were selected who had referred to the counseling units of Semnan health centers due to domestic violence, since March 2021 to March 2022 and in-depth and semi-structured interviews were conducted. The conducted interviews were analyzed using Colaizzi’s 7-step method.

In qualitative study, seven themes were found including “Facilitators”, “Role failure”, “Repressors”, “Efforts to preserve the family”, “Inappropriate solving of family conflicts”, “Consequences”, and “Inefficient supportive systems”. In quantitative study, the variables of age, age difference and number of years of marriage had a positive and significant relationship, and the variable of the number of children had a negative and significant relationship with the total score and all fields of the questionnaire (p < 0.05). Also, increasing the level of female education and income both independently showed a significant relationship with increasing the score of violence.

Conclusions

Some of the variables of violence against women are known and the need for prevention and plans to take action before their occurrence is well felt. Also, supportive mechanisms with objective and taboo-breaking results should be implemented to minimize harm to women, and their children and families seriously.

Peer Review reports

Violence against women by husbands (physical, sexual and psychological violence) is one of the basic problems of public health and violation of women’s human rights. It is estimated that 35% of women and almost one out of every three women aged 15–49 experience physical or sexual violence by their spouse or non-spouse sexual violence in their lifetime [ 1 ]. This is a nationwide public health issue, and nearly every healthcare worker will encounter a patient who has suffered from some type of domestic or family violence. Unfortunately, different forms of family violence are often interconnected. The “cycle of abuse” frequently persists from children who witness it to their adult relationships, and ultimately to the care of the elderly [ 2 ]. This violence includes a range of physical, sexual and psychological actions, control, threats, aggression, abuse, and rape [ 3 ].

Violence against women is one of the most widespread, persistent, and detrimental violations of human rights in today’s world, which has not been reported in most cases due to impunity, silence, stigma and shame, even in the age of social communication [ 3 ]. In the United States of America, more than one in three women (35.6%) experience rape, physical violence, and intimate partner violence (IPV) during their lifetime. Compared to men, women are nearly twice as likely (13.8% vs. 24.3%) to experience severe physical violence such as choking, burns, and threats with knives or guns [ 4 ]. The higher prevalence of violence against women can be due to the situational deprivation of women in patriarchal societies [ 5 ]. The prevalence of domestic violence in Iran reported 22.9%. The maximum of prevalence estimated in Tehran and Zahedan, respectively [ 6 ]. Currently, Iran has high levels of violence against women, and the provinces with the highest rates of unemployment and poverty also have the highest levels of violence against women [ 7 ].

Domestic violence against women harms individuals, families, and society [ 8 ]. Violence against women leads to physical, sexual, psychological harm or suffering, including threats, coercion and arbitrary deprivation of their freedom in public and private life. Also, such violence is associated with harmful effects on women’s sexual reproductive health, including sexually transmitted infection such as Human Immunodeficiency Virus (HIV), abortion, unsafe childbirth, and risky sexual behaviors [ 9 ]. There are high levels of psychological, sexual and physical domestic abuse among pregnant women [ 10 ]. Also, women with postpartum depression are significantly more likely to experience domestic violence during pregnancy [ 11 ].

Prompt attention to women’s health and rights at all levels is necessary, which reduces this problem and its risk factors [ 12 ]. Because women prefer to remain silent about domestic violence and there is a need to introduce immediate prevention programs to end domestic violence [ 13 ]. violence against women, which is an important public health problem, and concerns about human rights require careful study and the application of appropriate policies [ 14 ]. Also, the efforts to change the circumstances in which women face domestic violence remain significantly insufficient [ 15 ]. Given that few clear studies on violence against women and at the same time interviews with these people regarding their life experiences are available, the authors attempted to planning this research aims to investigate the prevalence and experiences of domestic violence against women in Semnan with the research question of “What is the prevalence of domestic violence against women in Semnan, and what are their experiences of such violence?”, so that their results can be used in part of the future planning in the health system of the society.

This study is a combination of cross-sectional and phenomenology studies in order to investigate the amount of domestic violence against women and some related factors (quantitative) and their experience of this violence (qualitative) simultaneously in the Semnan city. This study has been approved by the ethics committee of Semnan University of Medical Sciences with ethic code of IR.SEMUMS.REC.1397.182. The researcher introduced herself to the research participants, explained the purpose of the study, and then obtained informed written consent. It was assured to the research units that the collected information will be anonymous and kept confidential. The participants were informed that participation in the study was entirely voluntary, so they can withdraw from the study at any time with confidence. The participants were notified that more than one interview session may be necessary. To increase the trustworthiness of the study, Guba and Lincoln’s criteria for rigor, including credibility, transferability, dependability, and confirmability [ 16 ], were applied throughout the research process. The COREQ checklist was used to assess the present study quality. The researchers used observational notes for reflexivity and it preserved in all phases of this qualitative research process.

Qualitative method

Based on the phenomenological approach and with the purposeful sampling method, nine women who had referred to the counseling units of healthcare centers in Semnan city due to domestic violence in February 2021 to March 2022 were participated in the present study. The inclusion criteria for the study included marriage, a history of visiting a health center consultant due to domestic violence, and consent to participate in the study and unwillingness to participate in the study was the exclusion criteria. Each participant invited to the study by a telephone conversation about study aims and researcher information. The interviews place selected through agreement of the participant and the researcher and a place with the least environmental disturbance. Before starting each interview, the informed consent and all of the ethical considerations, including the purpose of the research, voluntary participation, confidentiality of the information were completely explained and they were asked to sign the written consent form. The participants were interviewed by depth, semi-structured and face-to-face interviews based on the main research question. Interviews were conducted by a female health services researcher with a background in nursing (M.Sh.). Data collection was continued until the data saturation and no new data appeared. Only the participants and the researcher were present during the interviews. All interviews were recorded by a MP3 Player by permission of the participants before starting. Interviews were not repeated. No additional field notes were taken during or after the interview.

The age range of the participants was from 38 to 55 years and their average age was 40 years. The sociodemographic characteristics of the participants are summarized in table below (Table 1 ).

Five interviews in the courtyards of healthcare centers, 2 interviews in the park, and 2 interviews at the participants’ homes were conducted. The duration of the interviews varied from 45 min to one hour. The main research question was “What is your experience about domestic violence?“. According to the research progress some other questions were asked in line with the main question of the research.

The conducted interviews were analyzed by using the 7 steps Colizzi’s method [ 17 ]. In order to empathize with the participants, each interview was read several times and transcribed. Then two researchers (M.Sh. and M.N.) extracted the phrases that were directly related to the phenomenon of domestic violence against women independently and distinguished from other sentences by underlining them. Then these codes were organized into thematic clusters and the formulated concepts were sorted into specific thematic categories.

In the final stage, in order to make the data reliable, the researcher again referred to 2 participants and checked their agreement with their perceptions of the content. Also, possible important contents were discussed and clarified, and in this way, agreement and approval of the samples was obtained.

Quantitative method

The cross-sectional study was implemented from February 2021 to March 2022 with cluster sampling of married women in areas of 3 healthcare centers in Semnan city. Those participants who were married and agreed with the written and verbal informed consent about the ethical considerations were included to the study. The questionnaire was completed by the participants in paper and online form.

The instrument was the standard questionnaire of domestic violence against women by Mohseni Tabrizi et al. [ 18 ]. In the questionnaire, questions 1–10, 11–36, 37–65 and 66–71 related to sociodemographic information, types of spousal abuse (psychological, economical, physical and sexual violence), patriarchal beliefs and traditions and family upbringing and learning violence, respectively. In total, this questionnaire has 71 items.

The scoring of the questionnaire has two parts and the answers to them are based on the Likert scale. Questions 11–36 and 66–71 are answered with always [ 4 ] to never (0) and questions 37–65 with completely agree [ 4 ] to completely disagree (0). The minimum and maximum score is 0 and 300, respectively. The total score of 0–60, 61–120 and higher than 121 demonstrates low, moderate and severe domestic violence against women, respectively [ 18 ].

In the study by Tabrizi et al., to evaluate the validity and reliability of this questionnaire, researchers tried to measure the face validity of the scale by the previous research. Those items and questions which their accuracies were confirmed by social science professors and experts used in the research, finally. The total Cronbach’s alpha coefficient was 0.183, which confirmed that the reliability of the questions and items of the questionnaire is sufficient [ 18 ].

Descriptive data were reported using mean, standard deviation, frequency and percentage. Then, to measure the relationship between the variables, χ2 and Pearson tests also variance and regression analysis were performed. All analysis were performed by using SPSS version 26 and the significance level was considered as p < 0.05.

Qualitative results

According to the third step of Colaizzi’s 7-step method, the researcher attempted to conceptualize and formulate the extracted meanings. In this step, the primary codes were extracted from the important sentences related to the phenomenon of violence against women, which were marked by underlining, which are shown below as examples of this stage and coding.

The primary code of indifference to the father’s role was extracted from the following sentences. This is indifference in the role of the father in front of the children.

“Some time ago, I told him that our daughter is single-sided deaf. She has a doctor’s appointment; I have to take her to the doctor. He said that I don’t have money to give you. He doesn’t force himself to make money anyway” (p 2, 33 yrs).

“He didn’t value his own children. He didn’t think about his older children” (p 4, 54 yrs).

The primary code extracted here included lack of commitment in the role of head of the household. This is irresponsibility towards the family and meeting their needs.

“My husband was fired from work after 10 years due to disorder and laziness. Since then, he has not found a suitable job. Every time he went to work, he was fired after a month because of laziness” (p 7, 55 yrs).

“In the evening, he used to get dressed and go out, and he didn’t come back until late. Some nights, I was so afraid of being alone that I put a knife under my pillow when I slept” (p 2, 33 yrs).

A total of 246 primary codes were extracted from the interviews in the third step. In the fourth step, the researchers put the formulated concepts (primary codes) into 85 specific sub-categories.

Twenty-three categories were extracted from 85 sub-categories. In the sixth step, the concepts of the fifth step were integrated and formed seven themes (Table 2 ).

These themes included “Facilitators”, “Role failure”, “Repressors”, “Efforts to preserve the family”, “Inappropriate solving of family conflicts”, “Consequences”, and “Inefficient supportive systems” (Fig. 1 ).

Themes of domestic violence against women

Some of the statements of the participants on the theme of “ Facilitators” are listed below:

Husband’s criminal record

“He got his death sentence for drugs. But, at last it was ended for 10 years” (p 4, 54 yrs).

Inappropriate age for marriage

“At the age of thirteen, I married a boy who was 25 years old” (p 8, 25 yrs).

“My first husband obeyed her parents. I was 12–13 years old” (p 3, 32 yrs).

“I couldn’t do anything. I was humiliated” (p 1, 38 yrs).

“A bridegroom came. The mother was against. She said, I am young. My older sister is not married yet, but I was eager to get married. I don’t know, maybe my father’s house was boring for me” (p 2, 33 yrs).

“My parents used to argue badly. They blamed each other and I always wanted to run away from these arguments. I didn’t have the patience to talk to mom or dad and calm them down” (p 5, 39 yrs).

Overdependence

“My husband’s parents don’t stop interfering, but my husband doesn’t say anything because he is a student of his father. My husband is self-employed and works with his father on a truck” (p 8, 25 yrs).

“Every time I argue with my husband because of lack of money, my mother-in-law supported her son and brought him up very spoiled and lazy” (p 7, 55 yrs).

Bitter memories

“After three years, my mother married her friend with my uncle’s insistence and went to Shiraz. But, his condition was that she did not have the right to bring his daughter with her. In fact, my mother also got married out of necessity” (p 8, 25 yrs).

Some of their other statements related to “ Role failure” are mentioned below:

Lack of commitment to different roles

“I got angry several times and went to my father’s house because of my husband’s bad financial status and the fact that he doesn’t feel responsible to work and always says that he cannot find a job” (p 6, 48 yrs).

“I saw that he does not want to change in any way” (p 4, 54 yrs).

“No matter how kind I am, it does not work” (p 1, 38 yrs).

Some of their other statements regarding “ Repressors” are listed below:

Fear and silence

“My mother always forced me to continue living with my husband. Finally, my father had been poor. She all said that you didn’t listen to me when you wanted to get married, so you don’t have the right to get angry and come to me, I’m miserable enough” (p 2, 33 yrs).

“Because I suffered a lot in my first marital life. I was very humiliated. I said I would be fine with that. To be kind” (p1, 38 yrs).

“Well, I tell myself that he gets angry sometimes” (p 3, 32 yrs).

Shame from society

“I don’t want my daughter-in-law to know. She is not a relative” (p 4, 54 yrs).

Some of the statements of the participants regarding the theme of “ Efforts to preserve the family” are listed below:

Hope and trust

“I always hope in God and I am patient” (p 2, 33 yrs).

Efforts for children

“My divorce took a month. We got a divorce. I forgave my dowry and took my children instead” (p 2, 33 yrs).

Some of their other statements regarding the “ Inappropriate solving of family conflicts” are listed below:

Child-bearing thoughts

“My husband wanted to take me to a doctor to treat me. But my father-in-law refused and said that instead of doing this and spending money, marry again. Marriage in the clans was much easier than any other work” (p 8, 25 yrs).

Lack of effective communication

“I was nervous about him, but I didn’t say anything” (p 5, 39 yrs).

“Now I am satisfied with my life and thank God it is better to listen to people’s words. Now there is someone above me so that people don’t talk behind me” (p 2, 33 yrs).

Some of their other statements regarding the “ Consequences” are listed below:

Harm to children

“My eldest daughter, who was about 7–8 years old, behaved differently. Oh, I was angry. My children are mentally depressed and argue” (p 5, 39 yrs).

After divorce

“Even though I got a divorce, my mother and I came to a remote area due to the fear of what my family would say” (p 2, 33 yrs).

Social harm

“I work at a retirement center for living expenses” (p 2, 33 yrs).

“I had to go to clean the houses” (p 5, 39 yrs).

Non-acceptance in the family

“The children’s relationship with their father became bad. Because every time they saw their father sitting at home smoking, they got angry” (p 7, 55 yrs).

Emotional harm

“When I look back, I regret why I was not careful in my choice” (p 7, 55 yrs).

“I felt very bad. For being married to a man who is not bound by the family and is capricious” (p 9, 36 yrs).

Some of their other statements regarding “ Inefficient supportive systems” are listed below:

Inappropriate family support

“We didn’t have children. I was at my father’s house for about a month. After a month, when I came home, I saw that my husband had married again. I cried a lot that day. He said, God, I had to. I love you. My heart is broken, I have no one to share my words” (p 8, 25 yrs).

“My brother-in-law was like himself. His parents had also died. His sister did not listen at all” (p 4, 54 yrs).

“I didn’t have anyone and I was alone” (p 1, 38 yrs).

Inefficiency of social systems

“That day he argued with me, picked me up and threw me down some stairs in the middle of the yard. He came closer, sat on my stomach, grabbed my neck with both of his hands and wanted to strangle me. Until a long time later, I had kidney problems and my neck was bruised by her hand. Given that my aunt and her family were with us in a building, but she had no desire to testify and was afraid” (p 3, 32 yrs).

Undesired training and advice

“I told my mother, you just said no, how old I was? You never insisted on me and you didn’t listen to me that this man is not good for you” (p 9, 36 yrs).

Quantitative results

In the present study, 376 married women living in Semnan city participated in this study. The mean age of participants was 38.52 ± 10.38 years. The youngest participant was 18 and the oldest was 73 years old. The maximum age difference was 16 years. The years of marriage varied from one year to 40 years. Also, the number of children varied from no children to 7. The majority of them had 2 children (109, 29%). The sociodemographic characteristics of the participants are summarized in the table below (Table 3 ).

The frequency distribution (number and percentage) of the participants in terms of the level of violence was as follows. 89 participants (23.7%) had experienced low violence, 59 participants (15.7%) had experienced moderate violence, and 228 participants (60.6%) had experienced severe violence.

Cronbach’s alpha for the reliability of the questionnaire was 0.988. The mean and standard deviation of the total score of the questionnaire was 143.60 ± 74.70 with a range of 3-244. The relationship between the total score of the questionnaire and its fields, and some demographic variables is summarized in the table below (Table 4 ).

As shown in the table above, the variables of age, age difference and number of years of marriage have a positive and significant relationship, and the variable of number of children has a negative and significant relationship with the total score and all fields of the questionnaire (p < 0.05). However, the variable of education level difference showed no significant relationship with the total score and any of the fields. Also, the highest average score is related to patriarchal beliefs compared to other fields.

The comparison of the average total scores separately according to each variable showed the significant average difference in the variables of the previous marriage history of the woman, the result of the previous marriage of the woman, the education of the woman, the education of the man, the income of the woman, the income of the man, and the physical disease of the man (p < 0.05).

In the regression model, two variables remained in the final model, indicating the relationship between the variables and violence score and the importance of these two variables. An increase in women’s education and income level both independently show a significant relationship with an increase in violence score (Table 5 ).

The results of analysis of variance to compare the scores of each field of violence in the subgroups of the participants also showed that the experience and result of the woman’s previous marriage has a significant relationship with physical violence and tradition and family upbringing, the experience of the man’s previous marriage has a significant relationship with patriarchal belief, the education level of the woman has a significant relationship with all fields and the level of education of the man has a significant relationship with all fields except tradition and family upbringing (p < 0.05).

According to the results of both quantitative and qualitative studies, variables such as the young age of the woman and a large age difference are very important factors leading to an increase in violence. At a younger age, girls are afraid of the stigma of society and family, and being forced to remain silent can lead to an increase in domestic violence. As Gandhi et al. (2021) stated in their study in the same field, a lower marriage age leads to many vulnerabilities in women. Early marriage is a global problem associated with a wide range of health and social consequences, including violence for adolescent girls and women [ 12 ]. Also, Ahmadi et al. (2017) found similar findings, reporting a significant association among IPV and women age ≤ 40 years [ 19 ].

Two others categories of “Facilitators” in the present study were “Husband’s criminal record” and “Overdependence” which had a sub-category of “Forced cohabitation”. Ahmadi et al. (2017) reported in their population-based study in Iran that husband’s addiction and rented-householders have a significant association with IPV [ 19 ].

The patriarchal beliefs, which are rooted in the tradition and culture of society and family upbringing, scored the highest in relation to domestic violence in this study. On the other hand, in qualitative study, “Normalcy” of men’s anger and harassment of women in society is one of the “Repressors” of women to express violence. In the quantitative study, the increase in the women’s education and income level were predictors of the increase in violence. Although domestic violence is more common in some sections of society, women with a wide range of ages, different levels of education, and at different levels of society face this problem, most of which are not reported. Bukuluki et al. (2021) showed that women who agreed that it is good for a man to control his partner were more likely to experience physical violence [ 20 ].

Domestic violence leads to “Consequences” such as “Harm to children”, “Emotional harm”, “Social harm” to women and even “Non-acceptance in their own family”. Because divorce is a taboo in Iranian culture and the fear of humiliating women forces them to remain silent against domestic violence. Balsarkar (2021) stated that the fear of violence can prevent women from continuing their studies, working or exercising their political rights [ 8 ]. Also, Walker-Descarte et al. (2021) recognized domestic violence as a type of child maltreatment, and these abusive behaviors are associated with mental and physical health consequences [ 21 ].

On the other hand and based on the “Lack of effective communication” category, ignoring the role of the counselor in solving family conflicts and challenges in the life of couples in the present study was expressed by women with reasons such as lack of knowledge and family resistance to counseling. Several pathologies are needed to investigate increased domestic violence in situations such as during women’s pregnancy or infertility. Because the use of counseling for couples as a suitable solution should be considered along with their life challenges. Lin et al. (2022) stated that pregnant women were exposed to domestic violence for low birth weight in full term delivery. Spouse violence screening in the perinatal health care system should be considered important, especially for women who have had full-term low birth weight infants [ 22 ].

Also, lack of knowledge and low level of education have been found as other factors of violence in this study, which is very prominent in both qualitative and quantitative studies. Because the social systems and information about the existing laws should be followed properly in society to act as a deterrent. Psychological training and especially anger control and resilience skills during education at a younger age for girls and boys should be included in educational materials to determine the positive results in society in the long term. Manouchehri et al. (2022) stated that it seems necessary to train men about the negative impact of domestic violence on the current and future status of the family [ 23 ]. Balsarkar (2021) also stated that men and women who have not had the opportunity to question gender roles, attitudes and beliefs cannot change such things. Women who are unaware of their rights cannot claim. Governments and organizations cannot adequately address these issues without access to standards, guidelines and tools [ 8 ]. Machado et al. (2021) also stated that gender socialization reinforces gender inequalities and affects the behavior of men and women. So, highlighting this problem in different fields, especially in primary health care services, is a way to prevent IPV against women [ 24 ].

There was a sub-category of “Inefficiency of social systems” in the participants experiences. Perhaps the reason for this is due to insufficient education and knowledge, or fear of seeking help. Holmes et al. (2022) suggested the importance of ascertaining strategies to improve victims’ experiences with the court, especially when victims’ requests are not met, to increase future engagement with the system [ 25 ]. Sigurdsson (2019) revealed that despite high prevalence numbers, IPV is still a hidden and underdiagnosed problem and neither general practitioner nor our communities are as well prepared as they should be [ 26 ]. Moreira and Pinto da Costa (2021) found that while victims of domestic violence often agree with mandatory reporting, various concerns are still expressed by both victims and healthcare professionals that require further attention and resolution [ 27 ]. It appears that legal and ethical issues in this regard require comprehensive evaluation from the perspectives of victims, their families, healthcare workers, and legal experts. By doing so, better practical solutions can be found to address domestic violence, leading to a downward trend in its occurrence.

Some of the variables of violence against women have been identified and emphasized in many studies, highlighting the necessity of policymaking and social pathology in society to prevent and use operational plans to take action before their occurrence. Breaking the taboo of domestic violence and promoting divorce as a viable solution after counseling to receive objective results should be implemented seriously to minimize harm to women, children, and their families.

Limitations

Domestic violence against women is an important issue in Iranian society that women resist showing and expressing, making researchers take a long-term process of sampling in both qualitative and quantitative studies. The location of the interview and the women’s fear of their husbands finding out about their participation in this study have been other challenges of the researchers, which, of course, they attempted to minimize by fully respecting ethical considerations. Despite the researchers’ efforts, their personal and professional experiences, as well as the studies reviewed in the literature review section, may have influenced the study results.

Data Availability

Data and materials will be available upon email to the corresponding author.

Abbreviations

Intimate Partner Violence

Human Immunodeficiency Virus

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Acknowledgements

The authors of this study appreciate the Deputy for Research and Technology of Semnan University of Medical Sciences, Social Determinants of Health Research Center of Semnan University of Medical Sciences and all the participants in this study.

Research deputy of Semnan University of Medical Sciences financially supported this project.

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Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran

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Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran

Monir Nobahar & Majid Mirmohammadkhani

Clinical Research Development Unit, Kowsar Educational, Research and Therapeutic Hospital, Semnan University of Medical Sciences, Semnan, Iran

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M.Sh. contributed to the first conception and design of this research; M.Sh., Z.Kh., M.S., R.Gh. and S.H.Sh. contributed to collect data; M.N. and M.Sh. contributed to the analysis of the qualitative data; M.M. and M.Sh. contributed to the analysis of the quantitative data; M.SH., M.N. and M.M. contributed to the interpretation of the data; M.Sh., M.S. and S.H.Sh. wrote the manuscript. M.Sh. prepared the final version of manuscript for submission. All authors reviewed the manuscript meticulously and approved it. All names of the authors were listed in the title page.

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Correspondence to Mina Shayestefar .

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Shayestefar, M., Saffari, M., Gholamhosseinzadeh, R. et al. A qualitative quantitative mixed methods study of domestic violence against women. BMC Women's Health 23 , 322 (2023). https://doi.org/10.1186/s12905-023-02483-0

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Indian J Community Med
v.35(2); 2010 Apr

A Study on Domestic Violence Against Adult and Adolescent Females in a Rural Area of West Bengal

Madhutandra sarkar.

Department of Community Medicine, Nilratan Sircar Medical College and Hospital, Kolkata, India

Background:

Globally, domestic violence against females is common across culture, religion, class and ethnicity. There are various reasons for domestic violence and it might have serious health outcomes.

Objectives:

The study was undertaken to determine the prevalence, characteristics, reasons and the socio-demographic correlates of domestic violence, if any, and to find out the perceptions of the females to cope with the act of violence and to overcome the situation.

Materials and Methods:

A cross-sectional observational study was undertaken by interviewing 141 adult and adolescent females residing in a village of West Bengal, with the help of a pre-designed and pre-tested questionnaire. Data were analyzed statistically by simple proportions and tests of significance (Chi-square test).

Out of 141 respondents, 33 (23.4%) adult and adolescent females in this village were exposed to domestic violence in the past year. Among the demographic characteristics, statistically significant maximum prevalence was observed among 30-39 years age group, illiterate and unmarried females. For most of the females who were exposed to domestic violence, their husbands acted as the perpetrators (72.73%) and they reported slapping as the specific act of physical assault (72.73%). Majority of the respondents reported that opportunity of education (31.9%), being economically productive (31.9%) and better family income (23.4%) would help them to overcome the situation.

Conclusion:

This study emphasizes the need for justified female empowerment and this calls for multidisciplinary approach to develop public health measures, which would most effectively address the problem of domestic violence.

Introduction

The most prevalent form of violence against females worldwide is domestic violence. Domestic violence against females is a serious public health concern in every community and culture. It has drawn attention from the medical community because it has a negative and harmful impact on the mental, physical and social health of females.

World Health Organization (WHO) has defined domestic violence as “the range of sexually, psychologically and physically coercive acts used against adult and adolescent women by current or former male intimate partners”.( 1 , 2 ) Violence is often not restricted to the current husband, but may extend to boy friends, former husbands and other family members such as parents, siblings and in-laws.

Domestic violence against women is highly prevalent in India and the women usually try to hide it. Particularly wife beating or physical mistreatment is a very common phenomenon in many Indian homes. The percentage of women who are exposed to violence by their husbands is 45% in India.( 3 ) Despite this widespread prevalence, such violence is not customarily acknowledged and has remained invisible. Background conditions of females are found to play a significant role in domestic violence.

It is often difficult to conduct research on violence against females, since most females are reluctant to disclose information they consider confidential and intimate. For eliminating domestic violence against females, it is critical to understand the context of violence and social constructs, which support its perpetuation. There is little empirical data on prevalence of domestic violence and its determinants in India, which needs urgent attention. Particularly, it is important to understand this serious problem in a rural low socio-economic condition with poor educational and economic background of the females.

With the above background, this study was undertaken with the following objectives:

To determine the prevalence, characteristics and reasons of domestic violence reported against adult and adolescent females.
To determine the socio-demographic correlates of domestic violence, if any.
To find out the perceptions of the females to cope with the act of violence and to overcome the situation.

Materials and Methods

Type of study: Community-based cross-sectional observational study.

Place of study: This study was conducted in Dearah village of Singur block, Hooghly district, West Bengal. This village is the field practice area of the Rural Health Unit and Training Center, Singur.

Duration of study: Three months, from August 16, 2006 to November 15, 2006.

Study population: All adult and adolescent females residing in Dearah village.

Inclusion criteria: Adult and adolescent females (aged 10 years and above) who gave consent for the study and who were the permanent residents of the village.

Sampling: Total female population of Dearah village is 1117 and total number of households is ≥50 (according to the records of the Rural Health Unit and Training Center, Singur and Nasibpur Union Health Centre, Dearah). Proportion of female population of >10 years age is 75% (Source: National Family Health Survey-2). Hence, the estimated female population of >10 years age in the village was 838. With an aim to cover 1/5th of the study population, every 5 th household was taken by systematic random sampling. Therefore, the estimated number of study population to be covered was 168 and the estimated number of households to be visited was 110.

However, total number of respondents was found to be 141 during the study period.

Study tool: A pre-designed, pre-tested and structured questionnaire.

Study technique: Interview method.

Methodology: After taking permission from the appropriate authorities, a house-to-house visit was conducted and informed verbal consent to participate in this study was obtained by all the participants. The females were interviewed face-to-face in their homes by the author herself. During the interview, the female was alone with the interviewer. The anonymity of the responses was guaranteed. The operational definition of domestic violence adopted for this study was maltreatment of the adult and adolescent females by the husbands, parents or other family members including minor to major physical harassment. The reference period considered was last one year from the date of interview. The females were asked about their demographic profile, characteristics and reasons of violence and their perceptions towards this.

Analysis of data: Data obtained were collated and analyzed statistically by simple proportions and tests of significance (Chi-square test).

Table 1 shows that, out of 141 respondents, 33 (23.4%) adult and adolescent females in this village were exposed to domestic violence in the last one year. Statistically significant association is present between the number of females exposed to violence and the demographic characteristics, in case of age, educational and marital status. Maximum prevalence was observed among the females in the age group of 30-39 years (50%), followed by 10-19 years age group (42.86%), whereas minimum prevalence was observed among the females in the age group of 20-29 years (10.53%). Prevalence was highest among the females who were illiterates (46.15%), followed by just literates/below primary schooling (20%). Prevalence was higher among the unmarried females (30%) than married (26.67%) or widowed/divorced females (none).

Demographic characteristics of the respondents ( n = 141)

Characteristics	No. (%) of respondents		Significance
	Total	Exposed to violence
Age group (years)
10‐19	21 (100)	9 (42.86)	χ =18.78, d.f = 4.
20‐29	57 (100)	6(10.53)	Significant,
30‐39	18 (100)	9(50)	< 0.001
40‐49	21 (100)	6 (28.57)
≥50	24 (100)	3(12.5)
Religion
Hindus	93 (100)	18 (19.35)	Not Significant,
Muslims	48 (100)	15 (31.25)	< 0.05
Education
Illiterate	39 (100)	18 (46.15)	χ = 15.9, d.f = 4,
Just literate/Below	15 (100)	3(20)	Significant,
Primary			< 0.01
Primary	45 (100)	6(13.33)
Middle	18 (100)	3(16.67)
Secondary and above	24 (100)	3 (12.5)
Marital status
Unmarried	30(100)	9(30)	χ = 7.68, d.f = 2,
Married	90 (100)	24 (26.67)	Significant,
Widowed/Divorced	21 (100)	‐	> 0.05
No. of children
0	42 (100)	12 (28.57)	Not Significant,
1‐2	51 (100)	12 (23.53)	< 0.05
3‐4	24 (100)	3(12.5)
≥5	24 (100)	6(25)
Type of family
Nuclear	63 (100)	12 (19.05)	Not Significant,
Joint	78 (100)	21 (26.92)	< 0.05
PCI of family (Rs. per month)
>500	105 (100)	21 (20)	Not Significant,
500‐999	27 (100)	9 (33.33)	> 0.05
≥1000	9 (100)	3 (33.33)
Overall	141 (100)	33 (23.4)

This table also shows that the prevalence of domestic violence was found to be higher among the Muslims than the Hindus (31.25 vs. 19.35%). Prevalence was highest among the females who were unmarried or who did not give birth to a child (28.57%), followed by females with 5 or more children (25%). Prevalence was higher among the females who lived in joint families than who lived in nuclear families (26.92 vs. 19.05%). Prevalence was also higher among the females with per capita income (PCI) of the family ≥Rs. 500 per month than females with per capita income of the family < Rs. 500 per month (33.33 vs. 20%). No respondent in this study had contribution to her family income.

Table 2 shows the characteristics of violence reported by the respondents. It was observed that, among 33 respondents, maximum number of females (81.82%) reported that they were exposed to domestic violence few times in the last year. Others reported the frequency of violence in last one year as few times in a week and few times in a month (9.09% or three females each). Maximum number of females (72.73%) reported that they had been physically assaulted by their husbands. Fathers acted as perpetrators in case of 27.27% females. Twenty-one females (63.64%) reported that the perpetrators were not intoxicated during the act of violence. Most of the females reported slapping as the specific act of physical assault (72.73%), followed by fist blow and beating with a stick or rod (18.18% each). Only three females reported kicking.

Characteristics of violence reported by the respondents ( n = 33)

Characteristics	No. (%) of females reporting
Frequency of violence in last one year
Few times in a week	3 (9.09)
Few times in a month	3 (9.09)
Few times in a year	27 (81.82)
Perpetrators of violence
Husband	24 (72.73)
Father	9 (27.27)
Perpetrators intoxicated during the act
Yes	12 (36.36)
No	21 (63.64)
Specific acts of physical assault
Slapping	24 (72.73)
Kicking	3 (9.09)
Fist blow	6 (18.18)
Beating with a stick or rod	6 (18.18)

Table 3 depicting the reasons of violence reported by respondents shows that, among 33 respondents, most of the females said the underlying reasons of violence as disobeying elders/perpetrators (27.27%), followed by not having a male child and unemployment of perpetrator (18.18% each). Other reasons were reported as insufficient dowry, relationship with another woman, poor family income and not approving relationship with wives’ parents (9.09% or three females each). Thirty females (90.9%) reported the reason causing immediate provocation of violent attack as not obeying or arguing back. Only three females reported that this was for refusing sex.

Reasons of violence reported by the respondents ( n = 33)

Reasons	No. (%) of females reporting
Underlying
Insufficient dowry	3 (9.09)
Not having a male child	6 (18.18)
Relationship with another woman	3 (9.09)
Disobeying elders/perpetrators	9 (27.27)
Unemployment of perpetrator	6 (18.18)
Poor family income	3 (9.09)
Not approving relationship with wives’ parents	3 (9.09)
Causing immediate provocation
Not obeying or arguing back	30 (90.9)
Refusing sex	3 (9.09)

Regarding the perceptions of respondents Table 4 , it was observed that, out of 141 respondents, maximum number of females (44.68%) reported that they should revolt to cope with the act of violence. Fifty-seven females (40.43%) reported that they should tolerate it. Others reported that they should try to convince the assaulter (8.5%) and seek help outside e.g. relatives, neighbors or social organizations (4.3%). Only three females reported that obeying elders might be a solution to cope with the act of violence.

Perceptions of the respondents ( n =141)

Perceptions	No. (%) of respondents
	Total	Exposed to violence
To cope with the act of violence
Revolt	63 (44.68)	12 (36.36)
Tolerate	57 (40.43)	15 (45.45)
Try to convince assaulter	12 (8.5)	6 (18.18)
Seek help outside	6 (4.3)	-
Obeying elders	3 (2.13)	-
To overcome the situation
Opportunity of education	45 (31.9)	12 (36.36)
Being economically productive	45 (31.9)	9 (27.27)
Better family income	33 (23.4)	15 (45.45)
De-addiction of assailant	12 (8.5)	-
Changing herself	15 (10.64)	6 (18.18)
Changing herself	15 (10.64)	6 (18.18)
Can’t say	6 (4.26)	-
Overall	141 (100)	33 (100)

This table also shows that most of the females reported that opportunity of education (31.9%), being economically productive (31.9%) and better family income (23.4%) would help them to overcome the situation. Others reported that de-addiction of assailant and changing herself would be helpful. Six females (4.26%) could not say anything.

This study shows the prevalence of domestic violence as 23.4% in the past year. Similar study conducted by Kocacik and Dogan reported that the prevalence of physical violence was 38.3% in the Sivas province of Turkey.( 4 ) Another study conducted in rural Bangladesh by Bates et al . showed that 67% of the women had ever experienced domestic violence and 35% had done so in the past year.( 5 )

Among the socio-demographic variables, age, educational and marital status are significantly associated with the domestic violence in this study. It was observed that the females in 30-39 years age group (50%) and 10-19 years age group (42.86%) were highly exposed to domestic violence. Maximum prevalence was observed among the illiterates (46.15%), followed by just literates/below primary schooling (20%). Unmarried females (30%) were more exposed to domestic violence than married (26.67%) or widowed/divorced females (none). No association is found with other socio-demographic variables like religion, number of children, type of the family and per capita monthly income of the family. No female in this study was economically independent. In a similar study done in the Sivas province of Turkey, families with low-income level showed a higher rate of violence and the rate of domestic violence decreased as the annual income level increased,( 4 ) whereas the present study does not support this finding. Low level of education was found to be a risk factor for domestic violence,( 4 ) the finding as corroborated by the present study.

It was observed in this study that the most frequent rate of violence reported by the females (81.82%) was few times in the last year. However, the study by Kocacik and Dogan showed that 45.2% of the women had been exposed to violence several times in a month.( 4 )

The present study shows that the husbands were the perpetrators in case of most of the females (72.73%). Twelve (36.36%) females reported that the perpetrators were intoxicated during the act of violence. Slapping was reported by most of the females as the specific act of physical assault (72.73%). Another study conducted by Nair et al . in rural Gujarat showed that slapping (80%), kicking/punching/hitting with an object (74%), pulling by the hair/dragging (27%) and forced sex (27%) were the types of reported physical abuse. The victims were mostly wives (78%) and the perpetrators were their husbands. Frequent physical violence was much less reported than verbal and psychological harassments.( 6 )

Economic, cultural and psychological factors were reported as the most prevalent causes of violence in the present study. In the study by Kocacik and Dogan, economic problems were reported as the most important reason for domestic violence (31.4%).( 4 )

In this study, 44.68% females reported that they should revolt to cope with the act of violence and 40.43% reported that they should tolerate this. Another study conducted by Nair et al . in rural Gujarat showed that women also shared the notion that husbands have the right to ‘discipline’ their wives by using force. Majority of the men (72%) as well as women (79%) said that the wife should always follow her husband’s and in-laws’ instructions and be obedient.( 6 )

Most of the females in this study reported that opportunity of education, being economically productive and better family income would help them to overcome the situation.

The above findings can be explained by the concept of violence in Indian culture, where violence against women is tolerated and considered as a means of discipline or punishment. It is a common thing for most men to speak rudely and act aggressively. Most probably, women do not protest or retaliate against the harassments, out of their concerns for social prestige, lack of economic and social support and for the sake of their children. Lack of education and economic independence often make them less confident to disclose their problems freely without any hesitation.

Conclusions

The reasons of violence are various factors such as power, employment and education level. Domestic violence is associated with illiteracy of the females. Most of the females are not aware of their rights. They tend to accept violence as something normal. This might be related to the fact that men culturally possess women; that manhood is associated with violence and that violence is widely accepted as a form of behavior. Husbands justify this act that they have all rights to beat his wife. And, it is told to the girl before marriage that she should adjust to whatever happens after marriage. The Indian culture, which prescribes obedience for women, may also contribute to this, since women consider opposing their husband as a sin. Besides that, domestic affairs are something that is usually kept a secret. The mind set of projecting husbands as the sole authority of the household needs to be changed and this is to be more emphasized by the parents.

This study indicates that justified female empowerment and enlightenment in the form of education, culture and economic productivity may help reduce this social as well as public health problem. In order to effectively address this problem, multidisciplinary approach to formulate fundamentally sound public health measures is essential. There is a need for sustained educational campaign to bring change in the community’s attitudes, particularly those of females themselves. Similarly, educational programs to target boys and girls are necessary to prevent violence from being perpetuated generation after generation. There is also a need for organizations that would support and help adult and adolescent females who are victims of domestic violence in the community with shelter, legal aid and awareness increase. Economic and social empowerment of females will enable them to fight for rights and rebuild their life. Panchayat members, village elders, health workers, school teachers, existing women’s organizations and mass media exposure in the villages should play a more active role in preventing and reducing domestic violence.

Acknowledgments

The author is grateful to Profs. R. Biswas and A. Dasgupta, Department of Preventive and Social Medicine, All India Institute of Hygiene and Public Health, Kolkata for their support and valuable suggestions. The author is also thankful to Dr. Anil Kumar, Rural Health Unit and Training Center, Singur and the health staff of Nasibpur Union Health Center, Dearah for their assistance.

Source of Support: Nil

Conflict of Interest: None declared.

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EDITORIAL article

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A systematic review of intimate partner violence interventions focused on improving social support and/ mental health outcomes of survivors

Introduction

Eligibility criteria

Information sources

Search strategy

Study selection

Data extraction

Risk of bias

Information about studies selected

Results/Key findings from the systematic review

Types of social support interventions for intimate partner violence survivor

Advocacy/ Case management interventions

Advocacy/Case management interventions with a psychotherapy component

Community-focused/ network social support interventions

Community focused/ network interventions with a psychotherapy component

Summary of key findings and recommendations

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Domestic Violence and Its Effects on Women, Children, and Families

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Research & Evidence

A qualitative quantitative mixed methods study of domestic violence against women

Conclusions

Qualitative method

Quantitative method

Qualitative results

Husband’s criminal record

Inappropriate age for marriage

Overdependence

Bitter memories

Lack of commitment to different roles

Fear and silence

Shame from society

Hope and trust

Efforts for children

Child-bearing thoughts

Lack of effective communication

Harm to children

After divorce

Social harm

Non-acceptance in the family

Emotional harm

Inappropriate family support

Inefficiency of social systems

Undesired training and advice

Quantitative results

Limitations

Data Availability

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