Bakgrund Världshälsoorganisationen (WHO) klassar våld i nära relationer som ett folkhälsoproblem. Även om både män och kvinnor är utsatta så är det främst kvinnor som utsätts för den här typen av våld och enligt Nationellt centrum för kvinnofrid (NCK) är kvinnor nästan tre gånger mer utsatta än män. Hälso- och sjukvården behöver utveckla sitt arbete för att upptäcka våldsutsatta patienter men det finns begränsad forskning om hur fysioterapeuter arbetar med detta ämne. Syfte Att utforska fysioterapeuters upplevelser och erfarenheter av att möta kvinnor som blivit utsatta för våld i nära relation. Metod I studien användes en kvalitativ design med en semistrukturerad intervjuguide. Sex fysioterapeuter, som samtliga arbetade på antingen privat eller offentlig vårdcentral inom primärvården i Region Uppsala, intervjuades. Resultat Deltagarnas erfarenheter varierade i stor grad. Ingen av deltagarna ställde frågan om våldsutsatthet som en standardiserad fråga vid nybesök. Tvärtom uttryckte flera att de upplevde sig behöva skapa en relation med patienten innan de kunde ställa frågan. Deltagarna tog till olika åtgärder vid våldsutsatthet, framförallt hänvisade de vidare till kurator och/eller gav vidare information om kvinnofridslinjen. Samtliga upplevde ett behov av djupare kunskap och förståelse om ämnet. Konklusion Mer praktisk och teoretisk kunskap samt medvetenhet hos fysioterapeuter behövs för att de ska kunna arbeta mer effektivt med kvinnor som utsätts för våld i nära relation. / Background The World Health Organization (WHO) classifies intimate partner violence as a global health problem. Even if both men and women are affected, data from National Centre for Knowledge on Men’s Violence against Women (NCK) shows that almost three times more women than men have been affected. The Swedish health care needs to improve on how they work on finding these patients but there is little research of how physiotherapists work regarding this matter. Objective To explore how physiotherapists investigate and examine female patients who are or have been a victim of intimate partner violence. Methods This survey used a qualitative method with a semi structured interview guide. Six interviews were carried through with physiotherapists who worked in Uppsala’s primary care, either in public or private health centers. Results The survey showed various experiences within the partakers. None of the physiotherapists asked about intimate partner violence as a standardized question at all new visits. On the contrary, several informants expressed that they felt a need to create a relationship with the patients before asking such questions. The physiotherapist took different actions when detecting intimate partner violence; mainly referring the patients to a curator and/or giving information of the women’s peace line. All partakers felt the need of a deeper knowledge and understanding of this issue. Conclusion Physiotherapists need more awareness as well as practical and theoretical knowledge to be able to work more efficiently with women that are affected by intimate partner violence.

Intimate partner violence (IPV), including physical, psychological, and sexual violence towards a partner, is a human rights violation that is associated with the development of a multitude of short- and long-term physical and mental health problems (WHO, 2013). IPV survivors are at greater risk of developing mood, anxiety, and trauma- and stressor-related disorders (García-Moreno et al., 2005). Public health guidelines recommend screening for IPV in mental health settings (WHO, 2013). However, most mental health practitioners do not routinely assess for IPV in their practice (Howard et al., 2010). Lack of training in how to assess for and respond to IPV has been identified as an important barrier for IPV assessment in mental health settings (Trevillion et al., 2016). IPV-related training has been linked to positive outcomes for clinicians, including higher ratings of perceived knowledge and confidence in addressing IPV (Forsdike et al., 2019). Yet, studies suggest that approximately one quarter to one half of mental health professionals have never received IPV-related training (Murray et al., 2016; Nyame et al., 2013). To address this gap, the WHO advanced a series of evidence-based training recommendations (WHO, 2013). At present, there is a dearth of research exploring the degree to which global mental health providers’ experiences of training resemble WHO guidelines. Furthermore, few studies have investigated factors that contribute to clinicians’ likelihood of participating in IPV-related training, and reasons for obtaining training are not well understood. There has also been no previous research into the relationship between mental health professionals’ experiences of training and their accuracy in correctly identifying IPV. The present thesis, consisting of two studies, sought to assess global mental health providers’ IPV-related training experiences, including factors that influence the probability of participating in training and the relationship between training and diagnostic accuracy. In study 1, mental health professionals’ IPV-related training experiences were surveyed, and factors that may contribute to the likelihood of participating in training were explored (e.g., IPV prevalence, norms, and legislation, and professional experience with IPV). The relationship between IPV-related training and knowledge and experience of relationship problems was also examined; 321 specialized mental health professionals (psychologists and psychiatrists) from 24 countries participated in an online survey. Participants responded to a series of questions regarding the content, duration, and frequency of their IPV-related training based on WHO recommendations, and rated their level of knowledge and experience with relationship problems. Descriptive analyses showed that nearly half of participants (46.9%) had never received IPV-related training. Approximately half of those who received training (49.4%) indicated that their training followed WHO recommendations. Logistic regressions revealed that participants who were from countries with relatively better implemented laws addressing IPV and participants who encountered IPV more often in clinical practice were more likely to have received training. Furthermore, participants who received training were more likely than those without training to report higher knowledge and experience of relationship problems. Findings highlight global challenges with regards to IPV-related training. They suggest that clinicians’ likelihood of participating in training is related to their clinical contact with IPV and the institutional context in which they practice. Study 2 investigated the relationship between IPV-related training and clinicians’ diagnostic accuracy in the context of relationship problems, using the same sample as study 1. Chi-square analyses evaluated relationships between IPV-related training and clinicians’ performance while assessing for clinically significant relationship problems (RPM) in case-controlled vignettes across two study conditions: RPM present (i.e., when the task was to correctly identify RPM) and RPM absent (i.e., when the task was to correctly identify that there was no RPM; normative relationship problems were presented). Results showed that participants who received IPV-related training were more likely to perform better than those without training in the RPM present condition, but not in the RPM absent condition. In the RPM present condition, participants were more likely to respond correctly when their training was more recent and more closely resembled WHO recommendations for training. In the RPM absent condition, a similar percentage of participants with training (60-78%) and without training (45-76%) misclassified normative relationship problems as clinically significant RPM. Overall, findings suggest that IPV-related training is related to improved diagnostic accuracy in the context of relationship problems. WHO recommendations for training are supported.

Thesis advisor: Lisa A. Goodman / Recent research suggests that half or more of today’s domestic violence (DV) advocates are survivors of intimate partner violence (IPV) or other forms of abuse, consistent with the survivor-led early stages of the DV movement. Advocates who are themselves survivors (survivor-advocates) are at risk of experiencing vicarious trauma and other negative outcomes in response to their challenging work. Emerging research has also identified the possibility of deriving personal growth and healing from the work of advocacy, which bolster survivor-advocates against the stressors in their work. However, the processes by which survivor-advocates navigate their work and cope with its challenges are poorly understood. To date, only one qualitative study has asked survivor-advocates about their experiences. This study began illustrating some of the ways that survivor-advocates approach and experience their work; however, it is vital that we develop a richer understanding of how survivor-advocates experience their work as both healing and harmful, in order to maintain the sustainability and effectiveness of the services they provide. This study used grounded theory methodology to explore how survivor-advocates apply their survivorship to their work, and how their work influenced their well-being and recovery. The theoretical model that emerged was anchored by a central process called bringing my whole self to work, which participants described as consisting of four interrelated components: 1) constructing a personal narrative about how their identity connects to their work, 2) applying those connections to shape their work in numerous ways, 3) experiencing healing as an outcome of the previous two components and 4) the organizational contexts that shaped the process through validating or invalidating the survivor identity. Successfully engaging in this process helped survivor-advocates feel a greater sense of connection and integrity to their survivor identity and work, as well as possibly enhanced well-being. This process suggests numerous ways for DV organizations to encourage and support survivor-advocates to engage more openly, meaningfully, and effectively in their work and points toward new directions in understanding vicarious trauma. / Thesis (PhD) — Boston College, 2019. / Submitted to: Boston College. Lynch School of Education. / Discipline: Counseling, Developmental and Educational Psychology.

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The purpose of this review is to provide an overview of the current state of knowledge regarding the experience of intimate partner violence (IPV) during pregnancy. Pregnancy IPV is a significant problem worldwide, with rates varying significantly by country and maternal risk factors. Pregnancy IPV is associated with adverse newborn outcomes, including low birth weight and preterm birth. Many mechanisms for how IPV may impact birth outcomes have been proposed and include direct health, mental health, and behavioral effects, which all may interact. Screening for IPV during pregnancy is essential, yet due to time constraints and few clear recommendations for assessment, many prenatal providers do not routinely inquire about IPV, or even believe they should. More training is needed to assist health care providers in identifying and managing pregnancy IPV, with additional research needed to inform effective interventions to reduce the rates of pregnancy IPV and resultant outcomes.

Although physical abuse during pregnancy has been linked to poor birth outcomes, the role of psychological abuse is less well understood. Associations between birth outcomes and types of psychological abuse during pregnancy (being threatened, screamed at, or insulted) were examined in 489 women with no history of physical abuse. Being threatened was significantly associated with adverse birth outcomes, with women reporting any instance during pregnancy twice as likely to deliver a low birth weight baby. These results remained after controlling for background factors. Finally, most of the variance between threats and birth weight was accounted for by mediating health behaviors (specifically prenatal care utilization and pregnancy weight gain), suggesting pathways for the negative effects of being threatened by an intimate partner during pregnancy.

Intimate Partner Violence and COVID-19 Erin G. Siegel, BA, Rachel K. Carpenter, MS, & Jill D. Stinson, PhD Department of Psychology, College of Arts & Sciences, East Tennessee State University, Johnson City, TN Intimate partner violence includes physical, sexual, or psychological harm by a current or former partner or spouse. In the US, a decline in reported rates over the past two decades may have been reversed by the onset of the COVID-19 pandemic, particularly during the initial lockdown in March 2020. A majority of Americans were isolated at home, potentially increasing the occurrence of IPV assaults. Few studies have evaluated changes in IPV rates throughout the pandemic. This study aims to estimate and compare the rates of intimate partner assaults during the COVID-19 pandemic to previous years, while also examining the influence of geographic location (e.g., rurality versus urban areas), age of the victim, and nature of the assault type. The hypotheses are as follows: 1) an increase in cases of IPV during the first quartile of the pandemic, followed by a decline in the later recent quartiles (i.e., end of 2020); 2) an increase in IPV during the COVID-19 pandemic being more pronounced in counties with greater rurality; 3) an increase in IPV in persons over 18 during the first quartile of the pandemic compared to those under 18 age (who are less likely to live with a partner); and 4) predominant assault type rates (e.g., forcible rape versus murder) may have changed during the pandemic. Data for this project were obtained from the Tennessee Incident-Based Reporting System (TIBRS) for secondary data analysis. From 2016 to 2020 there were 371,196 reported IPV assaults. Variables of interest include all 95 Tennessee counties, age of victim (e.g., over or under 18), and the type of assault (forcible rape, forcible fondling, forcible sodomy, sexual assault with an object, simple assault, aggravated assault, homicide, intimidation, and stalking). Data describing county rurality were obtained from the online County Health Rankings and Roadmaps. County-level rates of IPV are separated by quartile during the pandemic months (Q1, Q2, Q3, Q4). Descriptive analyses will determine the yearly rates of IPV assaults from 2016-2020, with a specific examination of rates during the pandemic quartiles, age distribution, variability among types of assaults, and which counties demonstrate the highest reports. Percent change analyses will evaluate the previous years and determine if there was a significant change in IPV rates throughout the pandemic. Subsequent analyses will compare rates of IPV in rural and urban counties. This project aims to examine how the COVID-19 pandemic has affected rates of IPV, which may inform current prevention and intervention efforts. Additionally, data from urban and rural communities will potentially highlight treatment disparities, providing valuable information pertaining to resource allocation.