While previous research has explored women’s experiences of intimate partner violence (IPV), their help-seeking experiences and the barriers they encounter when seeking support, little research has explored the perspectives of women with disabilities regarding helpful IPV prevention, intervention and healing strategies. My qualitative research project sought to address two research questions: what have women with disabilities experienced when accessing support (from family, friends, and services) for IPV; and what do women with disabilities say would be helpful in the prevention or intervention of intimate partner violence. I undertook a secondary analysis of six interviews of women with disabilities who had been interviewed as part of a larger research study. My thematic analysis revealed many themes including experiences with sources of support—such as family, friends, counselling, and shelters—and strategies for prevention, including education and awareness; support system; affordable childcare and transportation; and self-care, spirituality, community, and social change. Barriers to support I identified include lack of education and awareness, lack of resources, lack of services, community size and dynamics, and potentially exclusive admission criteria. My intersectional analysis revealed the ways in which women’s social locations—such as their gender, cultural background, socio-economic situation, religion, disability and relationship status—influenced and shaped their help-seeking behaviours and their access to support systems. Several recommendations to address gaps in service provision are provided.

Premenstrual depressive symptoms and mood swings affect 3-8% of women in fertile age. The female hormones are believed to be the cause. Progesterone is well studied, but estrogen is not, and either are other causes such as intimate partner violence and chronic stress. The aim in this thesis was to investigate the influence of hormones as well as psychological aspects on the most common problems among women seeking care for premenstrual symptoms. In a cross-sectional study, four groups of women were included: ongoing users of oral contraceptives, with or without adverse mood symptoms and previous users, with or without experience of adverse mood. Depression and anxiety were significantly more common in both groups with reported adverse mood, in comparison with their control groups with no adverse mood. Self-reported PMS was significantly more common in those women who reported adverse mood, however, there was no difference in prospectively defined PMS or PMDD between the two groups of previous users. In a RCT with 25 women completing the study, GnRH treatment were tested in combination with two different HRT add-back doses of estradiol, in combination with progesterone and placebo. The higher dose of estrogen 1.5 mg in combination with progesterone induced significantly more pronounced symptoms than in combination with placebo. The lower dose, 0.5 mg gave less symptom recurrence in combination with progesterone. Exposure to violence was investigated among PMDD patients, healthy controls and gynecological patients. Among the participating women, gynecological patients, reported physical and/or emotional abuse significantly more often than did PMDD patients, as well as healthy controls. Chronic stress was investigated with diurnal cortisol, and low-dose dexamethasone test.  There was no difference in diurnal secretion of cortisol between PMDD patients and controls. No difference in the degree of dexamethasone suppression was found between PMDD patients and controls. According to the results from these studies, the main symptom provoking factor in women with PMDD appears to be the estradiol and progesterone fluctuations across the menstrual cycle, whereas chronic stress and intimate partner violence appears to be less relevant.

Male violence against women in intimate partner relationships is a global public health problem and a serious crime, but remains largely underreported. The overall ain of this thesis was, by means of an interdisciplinary approach and from the perspectives of gender, public health and law, to gain a deeper understanding of the situation of abused women, by studying, on one hand, their leaving processes and, on the other, the consequences of the violence for their health. On the basis of this information, a further aim was to increase knowledge of the quality and effect of gender relations in the practical application of the law. The point of departure was that the different perspectives should not be consodered separately but should be seen in context. The thesis describes the prcess for abused women, from the violent relationship and the break-up, the health consequences caused by the violence to the practical application of the law. The thesis consists of four studies (I-IV). An initial qualitative study (I) showed that the leaving process for abused women is fearful, complex and long-lasting. The analysis also revealed a gradual development of strong emotional bonds towards the men on the part of the women. Study II was a combination of qualitative in-depth interviews and quantitative measurements and confirmed former studies regarding the negative health consequences caused by the violence, in particular symptoms of complex PTSD. Study III, examining preliminary investiagtions concerning reported crimes of intimate partner violence, showed that there is still a lack of crminal justice for abused women even if the frequency of cases leading to prosecution was fairly high. In study IV court case records were examined by means of a qualitative method inspired by discourse analysis to determine whether gender is (re)constructed in court practice, and how the process works. The analysis of this particular sample indicated that the practical application of law is influenced by an old-fashioned and stereotypical view of violence, sexuality, men and women. the legal discourses retain and reproduce the gender order. The overall results of the separate studies reinforce the importance of gaining a broader understanding of men's violence against women in intimate partner relationships.

Syfte: Att undersöka vårdpersonalens känslor i mötet med våldsutsatta kvinnor inom akutsjukvården. Metod: Kvalitativ studie med halvstrukturerad intervjumetod. Tretton sjuksköterskor och undersköterskor inom akutsjukvården blev intervjuade om mötet med våldsutsatta kvinnor genom tio halvstrukturerade frågor. Resultat: Vårdpersonalen saknade kunskap om våld i nära relationer och kände sig inte beredda att möta en kvinna utsatt för våld trots framtagna riktlinjer och handlingsplaner. Mötet med våldsutsatta kvinnor väckte många starka känslor som ilska och frustration, men också medkänsla och empati. Frågan om våldsutsatthet upplevdes som komplicerad att ställa av vårdpersonalen. Faktorer som tidsbrist och bristen på avskildhet försvårade arbetet. Vårdpersonalen ansåg att det var akutsjukvårdens ansvar att ställa frågan, men det var oklart vem som bar det yttersta ansvaret. Slutsats: För att kvinnor utsatta för våld ska få ett gott omhändertagande behöver vårdpersonalen inom akutsjukvården mer utbildning och tid. Det är av betydelse att arbetsledningen eftersträvar ett öppet klimat för diskussion kring dessa frågor och markerar att våld i nära relationer är en lika viktig fråga som andra medicinska tillstånd inom akutsjukvården. / Objective: To investigate health care professionals’ emotions in the meeting with women who experience intimate partner violence within emergency care. Methods: Qualitative study with semi-structured interview methodology. Thirteen nurses and nursing assistants within the emergency care shared their thoughts in interviews about the meeting with abused women through 10 semi-structured questions. Results: Health care professionals lacked knowledge about intimate partner violence and did not feel prepared to meet an abused woman despite developed guidelines and instructions. The meeting induced many strong emotions such as anger and frustration, but also compassion and empathy. The issue was perceived as complicated by the health care professionals. Factors such as lack of time and privacy hampered their work. They felt that it was the emergency care’s responsibility to address the issue, but with different views about whose obligation it was to raise the question. Conclusion: To provide good care for abused women, the health care professionals in the emergency care need more training and time. It is important that management encourages discussion and clarifies that intimate partner violence is just as essential as any other medical issues in the emergency care.

Treatment for perpetrators of Intimate partner violence (IPV) is most often provided by community based IPV perpetrator programmes. These programmes have become an integral part of the response to IPV despite the fact that they are plagued by high rates of attrition and researchers suggest their effectiveness may be limited. It has been suggested that the retention rates and effectiveness of the programmes may be improved by tailoring treatment to specific subgroups of IPV perpetrators. This study was an evaluation of a community based IPV perpetrator programme. Participants were twenty two male IPV perpetrators who were court and not court ordered to treatment for violence towards a female intimate partner. Only seven participants completed the programme. Their self reported incidents of violence, alcohol consumption, change readiness and levels of working alliance were measured up to four times during the 18 week programme. Results indicated that participants who completed the programme or the majority of it significantly reduced their violence towards intimate partners and their levels of alcohol consumption. Higher levels of violence were associated with alcohol abuse and non court ordered status. As expected, court ordered participants reported lower levels of readiness to change and working alliance, and higher levels of alcohol abuse. However they were more likely to complete the programme compared with non court ordered participants. Implications of these findings are discussed.

Diss. (sammanfattning) Umeå : Umeå universitet, 2010.

Background: In 2015, 17,000 reports were made of about assault cases in Sweden. In 46% of the reports the perpetrator was in a close relationship with the victim. When the victims of violence seek care, healthcare staff lacks routines and resources to pay attention to and respond to women adequately, despite the fact that the healthcare system has legal responsibility to prevent, detect and identify violence. Hence the interest in how healthcare professionals meet these women and what routines and resources are available in health care to support women with violence. Aim: The literature review’s aims was to map the encounter of women who are exposed to violence in close relationships with a male partner. Method: A general literature review based on qualitative and quantitative articles. Result: Healthcare professionals pay attention to and rarely respond to vulnerable women in healthcare due to lack of knowledge and education. Lack of routines and resources prevents healthcare professionals from responding to and providing adequate support to women with violence. Conclusions: The conclusion that can be drawn is that the predominantly affected person's lack of treatment and the lack of routines and resources of the healthcare system is the woman who is the victim of violence. Suggestions for Continuing Research: To research how healthcare is working with the shortcomings that presents in the encounter of women who experience intimate partner violence / Bakgrund: År 2015 gjordes 17 000 anmälningar om misshandelsbrott i Sverige. I 46% av anmälningarna var gärningsmannen i en nära relation med offret. När de våldsutsatta kvinnorna söker vård saknar vårdpersonal rutiner och resurser för att uppmärksamma och bemöta kvinnorna på adekvat sätt, trots att hälso- och sjukvården har lagstadgat ansvar att förebygga, upptäcka och identifiera våld. Därav intresset för hur vårdpersonal bemöter dessa kvinnor och vilka rutiner och resurser som finns inom hälso- och sjukvården att ge stöd till våldsutsatta kvinnor. Syfte: Litteraturöversikten syftade till att kartlägga hälso- och sjukvårdens bemötande av kvinnor som utsätts för våld i nära relation av en manlig partner. Metod: En allmän litteraturöversikt baserad på kvalitativa och kvantitativa artiklar. Resultat: Vårdpersonal inom hälso- och sjukvården uppmärksammade och bemötte sällan våldsutsatta kvinnor i vården på grund av bristande kunskap och utbildning. Brister i rutiner och resurser hindra vårdpersonalen från att bemöta och ge adekvat stöd till våldsutsatta kvinnor. Slutsatser: Slutsatsen som kan dras är att den som främst drabbas av vårdpersonalens bristande bemötande samt hälso- och sjukvårdens bristande rutiner och resurser, är den våldsutsatta kvinnan. Förslag på fortsatt forskning: Efterforska vidare hur hälso- och sjukvården arbetar med bristerna som framkommer i bemötandet med våldsutsatta kvinnor.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / O primeiro objetivo da Tese consistiu na identificação e caracterização dos instrumentos de aferição epidemiológicos que vêm sendo propostos para a abordagem de IA domiciliar, bem como na síntese de suas propriedades psicométricas. Para tal, realizou-se busca sistemática em três bases de dados eletrônicas: MEDLINE, LILACS e SciELO. Não houve delimitação do período de publicação. Os resultados são apresentados no artigo intitulado Household food insecurity: a systematic review of the measuring instruments used in epidemiological studies. Foram identificados 24 instrumentos, todos breves e de fácil aplicação. A maioria foi desenvolvida nos Estados Unidos. O instrumento HFSSM apresentou o maior número de estudos de utilização e psicométricos, podendo ser recomendado sem hesitação. O segundo e principal objetivo desta Tese foi avaliar se a ocorrência de violência psicológica e física entre parceiros íntimos pode ser considerada um fator de risco para a ocorrência de Insegurança Alimentar (IA) domiciliar. As informações que subjazem a pesquisa originaram-se de um inquérito domiciliar realizado no Distrito de Campos Elíseos, Município de Duque de Caxias, entre abril a novembro de 2010. A população de estudo foi selecionada por meio de amostragem por conglomerados em três estágios (setor censitário, domicílio, indivíduo) com técnicas de amostragem inversa para a seleção dos domicílios. A amostra do estudo incluiu 849 mulheres que no período da entrevista relataram possuir algum relacionamento amoroso nos 12 meses anteriores. As informações foram obtidas por meio de entrevista utilizando-se um questionário estruturado, contendo instrumentos previamente validados, como a Revised Conflict Tatics Scales (CTS2) para a mensuração das violências e a Escala Brasileira de Insegurança Alimentar (EBIA) para a IA domiciliar. Utilizou-se a análise de caminhos (Path Analysis) na análise de dados o que permitiu explorar as relações entre as violências, entre estas e o Transtorno Mental Comum (TMC), este último e a IA, bem como as relações mais distais do modelo teórico. Os resultados são apresentados no artigo intitulado Violência entre parceiros íntimos, transtornos mentais comuns e insegurança alimentar: modelagem de equações estruturais. A hipótese central deste estudo foi corroborada, na medida em que tanto a violência psicológica, como a violência física se mostraram importantes fatores de risco para a IA, via a ocorrência de TMC. Contrariamente ao esperado, notou-se um maior efeito da violência psicológica do que da violência física na ocorrência do desfecho. Espera-se que a divulgação dos resultados desta Tese auxilie os profissionais e gestores na área de segurança alimentar e nutricional, bem como pesquisadores da área na tomada de decisões em relação ao instrumento de aferição a ser utilizado para a caracterização das situações e ampliem o olhar sobre o problema, incorporando outros fatores de risco, tais como as violências entre parceiros íntimos, aqueles estritamente econômicos, habitualmente considerados no debate sobre os determinantes e estratégias de enfrentamento da IA. / The first goal of the Thesis that consisted of identifying and characterizing the epidemiological measurement instruments that have been proposed for addressing HFI and synthesis of its psychometric properties. To this end, we performed a systematic search of three electronic databases: MEDLINE, LILACS and SciELO. There was no definition of the publication period. The results are presented in the article entitled "Household food insecurity: a systematic review of the measuring instruments used in epidemiological studies". Twenty-four instruments were identified; all brief and of easy application. The majority were devised in the United States. The HFSSM instrument had the largest number of use studies and psychometric and can be recommended without hesitation. The second and main objective of this Thesis was to evaluate the occurrence of physical intimate partner violence (IPV) of psychological type and can be considered a risk factor for the occurrence of household food insecurity (HFI). The information underlying the research originated from a household survey conducted in the District of Campos Elíseos, in the city of Duque de Caxias, between April and November 2010. The study population was selected using cluster sampling in three stages (census tract, household, individual) with inverse sampling techniques to the selection of households. The study sample included 849 women (82.03% of the interviews for the study background) than during the interview reported having a romantic relationship in the last 12 months. Information was obtained through interviews using a structured questionnaire containing previously validated instruments such as the Revised Conflict Tactics Scales (CTS2) to measure the IPV and Brazilian Food Insecurity Scale (EBIA) for HFI. The results are presented in the article titled "Intimate partner violence, common mental disorders and food insecurity: a survey- based structural equation modeling analysis". The central hypothesis of this study was corroborated, and IPV psychological presented both as direct kick in the occurrence of HFI effect, while the physical type of IPV only had indirect effect via CMD . It is hoped that the dissemination of the results of this thesis assists professionals and managers in the area of food security as well as researchers in the field in making decisions regarding the measurement instrument to be used for the characterization of situations and broaden the look about the problem, incorporating other risk factors such as intimate partner violence, strictly economic ones usually considered in the debate on the determinants and coping strategies of food insecurity.

O objetivo principal desta Dissertação foi avaliar as relações entre a Violência Física entre Parceiros Íntimos (VFPI) e o estado nutricional em mulheres adultas. As informações que subjazem a pesquisa originaram-se de um inquérito domiciliar realizado no Distrito de Campos Elíseos, Município de Duque da Caxias, entre abril e novembro de 2010. A população de estudo foi selecionada por meio de amostragem por conglomerados em três estágios (setor censitário, domicílio, indivíduo) com técnicas de amostragem inversa para a seleção dos domicílios. A amostra incluiu 625 mulheres com idade entre 20 e 59 anos, em que no período da entrevista relataram possuir algum relacionamento amoroso nos últimos 12 meses e apresentaram critérios elegíveis para a realização da antropometria. As informações foram obtidas por meio de entrevista com mulher utilizando-se um questionário estruturado, contendo escalas previamente validadas, como a Revised Conflict Tatics Scales (CTS2) para a mensuração da VFPI e também por meio da aferição do peso e estatura para o cálculo do IMC (kg/m2).Os resultados da dissertação são apresentados no artigo intitulado Violência física entre parceiros íntimos: um fator de risco para o excesso de peso entre mulheres adultas?. As análises sugerem que amostra estudada seja representativa de uma população de baixa/média renda. A prevalência de sobrepeso foi de 36,5% [IC95%: 30,9-42,1%], de obesidade 29,9% [IC95%: 23,3-36,4%] e 27,1% [IC95%: 19,6-34,7%] das mulheres relataram alguma forma de VFPI. Refutando a hipótese central desta dissertação, após o controle das variáveis escolaridade da mulher, idade, cor da pele, estado civil, gravidez anterior, mal uso de álcool pelo companheiro e apoio social, a ocorrência de VFPI reduziu a probabilidade de sobrepeso (OR: 0,54; p-valor 0,093) e obesidade (OR: 0,35; p-valor 0,001), indicando que há uma tendência ao menor peso entre as mulheres que referiram a VFPI nos últimos doze meses. Estes resultados corroboram estudos anteriores que afirmam que tanto a violência entre parceiros íntimos, como o excesso de peso, são importantes problemas de saúde pública no Brasil, merecendo ser prontamente enfrentados. Os achados sobre as repercussões da VFPI no estado nutricional obtidos nesta pesquisa vão na mesma direção de duas pesquisas que estudaram as consequências do abuso físico na Índia, mas divergem dos encontrados no Egito e nos EUA que não encontraram esta associação. Em função da falta de consenso entre os achados e do reduzido número de estudos sobre o tema, sugere-se que novas pesquisas sejam realizadas.

A Violência entre Parceiros Íntimos (VPI) tem sido reconhecida como um importante problema de saúde pública e um fator de risco para agravos a saúde de mulheres e crianças. Os serviços de saúde desempenham importante papel na detecção precoce da VPI, especialmente em momentos da vida nos quais se preconiza o atendimento sistematizado, como na gestação e primeira infância. Esta dissertação tem como objetivo principal estimar a probabilidade de ocorrência de Violência Física entre Parceiros Íntimos (VFPI) durante a gestação e/ou pós-parto em população atendida em Unidades Básicas de Saúde (UBS), segundo diferentes características sócio-econômicas e demográficas da clientela. Trata-se de um estudo transversal, realizado com usuárias de 5 UBS da cidade do Rio de Janeiro no ano de 2007. Foram entrevistadas 811 mães de crianças de até cinco meses de idade, que não possuíam nenhuma contra-indicação formal para a amamentação e que relataram ter tido pelo menos uma relação amorosa um mês ou mais durante a gestação ou no período do pós-parto. Condições socioeconômicas e demográficas e relativas aos hábitos de vida do casal foram consideradas como potenciais preditores de violência. Utilizou-se a versão em português da CTS2 para identificar as situações de VPI. A variável de desfecho foi analisada em três níveis: ausência de VFPI, presença de VFPI no período da gestação ou do pós-parto e presença de VFPI em ambos os períodos. Utilizou-se um modelo logito-multinomial para as projeções de prevalências segundo os descritores selecionados. Os fatores que mais aumentaram a probabilidade de ocorrência de violência durante a gestação e/ou nos primeiros cinco meses de vida da criança foram: idade materna < 20 anos, escolaridade materna inferior ao 2 grau completo, ter 2 ou mais filhos menores de cinco anos, tabagismo materno, uso inadequado de álcool pela mãe e/ou companheiro, uso de drogas pela mãe e/ou companheiro e percepção materna sobre a saúde do bebê aquém da esperada. Entre mães com todas estas características, a estimativa de prevalência projetada de VFPI na gestação e/ou no pós-parto chegou a 96,4%, sendo 59,4% a estimativa de ocorrência em apenas um dos dois períodos e 37% em ambos. Por outro lado, a probabilidade de ocorrência de VFPI cai a 3,6% em famílias sem estas características. Os resultados indicam que a presença de certas características da criança e de sua família aumenta enormemente a probabilidade de ocorrência de VFPI, devendo ser levadas em consideração ao se estabelecer estratégias de intervenção que visem à detecção precoce e uma efetiva intervenção. / Intimate partner violence (IPV) has been recognized as an important public health problem and a risk factor for health problems of women and children. Health services play an important role in early detection of IPV. This issue is especially important in moments of life when systematized care is recommended, such as the pregnancy and early childhood. The main objective of this research was to estimate the probability of physical intimate partners violence (PIPV) during pregnancy or postpartum period. This is a cross-sectional study carried out in 5 primary health care units in Rio de Janeiro during the year 2007. Eight hundred and eleven interviews with mothers of children up to five months of age were carried out. Mothers presenting any formal contraindication for breastfeeding were considered ineligible, as well as women not reporting at least one month of amorous relationship during the pregnancy or postpartum period. Socioeconomic, demographic and life habits of the couple were considered as potential predictors. The outcome variable was assessed at three levels: no PIPV; PIPV during the pregnancy or postpartum; and PIPV in both periods. A multinomial logit model was used for projecting the respective prevalence according to a range of selected descriptors. The risk factors significantly associated with a greater risk of PIPV were: maternal age < 20; women with less than twelve years of schooling; women with 2 or more children under five years old; alcohol misuse by mother or partner; illicit drug abuse by the women or partner; and mothers perception of infants health lower than expected. Between mothers with all those characteristics, the projected prevalence of PIPV during pregnancy and/or postpartum was 96.4%, and as much as 59.4% accounted for the occurrence in one of the periods and 37% for the occurrence in both periods. In the absence of all of those factors, estimates reached only 3.6% during pregnancy and/or postpartum Summarizing, this study disclosed that some characteristics of children and their family increases the probability of PIPV during the pregnancy and postpartum period. This information is valuable for achieving early identification and effective resolution of the problem.