Globally, an estimated one in four women have experienced intimate partner violence (IPV) in their lifetimes. IPV has enormous physical, mental, and social consequences across ecological levels of human experience. These consequences extend to the children of adult women survivors of IPV and are worsened by intersecting experiences of racism, classism, sexism, and xenophobia. Service systems purporting to help, such as child protective services (CPS) and health service systems, can either create additional harm for women and their children or offer services that women may have difficulty accessing due to cost, isolation, and other factors. These harms can be especially pronounced among (a) Black women who have used drugs, who have children, and who are in community supervision programs (CSPs) in the U.S. and (b) Syrian refugee women with children living outside camps in Jordan. These populations of women face particular challenges getting basic needs met while navigating safety for themselves and their children – both due to IPV and from systems themselves (e.g., risk of losing custody of their children, sociocultural risk of interference in family life). Yet, limited research exists on the relationship between experiencing IPV and service involvement within these two populations. The following dissertation aims to address these research gaps in three papers, using descriptive and bivariate data as well as logistic regression analyses of E-WORTH and Women ASPIRE studies, as informed by ecological theory.
The first paper (E-WORTH), guided by ecological theory, aims to determine the prevalence of and test hypothesized associations between psychological, physical, and sexual IPV and CPS involvement among Black women who have used drugs, who ever had children, and who are in CSPs in New York City (N=247). I hypothesized that women who ever had children, were in CSPs, and had ever experienced psychological, physical, and/or sexual IPV by male partners would have higher odds of being involved with CPS in their lifetime than women who ever had children, were in CSPs, and had not experienced IPV by male partners. Using self-reported data from Black women who have used drugs and were recruited from CSPs in New York City, I found that 70.85% of women who ever had children and who were in CSPs reported ever experiencing psychological IPV by a male partner, 70.04% reported ever experiencing physical IPV by a male partner, 48.58% reported ever experiencing sexual IPV by a male partner, and 40.89% reported ever experiencing psychological, physical, and sexual IPV by a male partner. Further, I found that 55.87% of women reported ever having had an open case with CPS. Multivariable logistic regression analyses revealed that women who had experienced lifetime sexual IPV had significantly higher odds of ever being involved with CPS than women in the study who had never experienced sexual IPV (OR: 1.81; 95% CI: 1.09, 3.01). Similarly, women who experienced multiple forms of IPV (psychological, physical, and sexual) also had significantly higher odds of being involved with CPS (OR: 1.81; 95% CI: 1.07, 3.04). However, these associations did not hold in adjusted models.
Paper 2 (Women ASPIRE) aims to (1) compare the prevalence of mental health symptomology (anxiety, depression, and PTSD) among Syrian refugee women with children under age 18 living outside camps in Jordan who have and who have not experienced physical and/or sexual IPV in the past year; and (2) examine the relationship between IPV and mental health symptomology among Syrian refugee women with children living outside camps in Jordan. Based on ecological theory as my conceptual framework, I hypothesized that Syrian refugee women with children who had experienced IPV in the past year would have significantly higher odds of meeting screening criteria for anxiety, depression, and PTSD as compared to Syrian refugee women with children who had not experienced IPV in the past year. I found high rates of IPV, anxiety, depression, and PTSD among women in the sample (N=412). Furthermore, using multivariable logistic regression models from the Women ASPIRE dataset, I found that women with children who had experienced physical and/or sexual IPV in the past year had significantly higher odds of meeting screening criteria for all three mental health conditions – anxiety (aOR: 3.68, CI: 2.28-5.94, p<0.001), depression (aOR: 3.03, CI: 1.83-4.99, p<0.001), and PTSD (aOR: 6.94, CI: 3.75-12.84, p<0.001) – than women with children who had not experienced IPV in the past year. Despite these findings, at least one-fifth of women with children reported an unmet need for mental health or protective services, and less than one-third of women were aware of the availability of these services in their local communities.
The third paper (Women ASPIRE) aims to (a) examine the prevalence of physical and sexual IPV among health service-seeking Syrian refugee women with children in non-camp settings in Jordan and (b) compare the differences in health service use between women with children who had and who had not experienced IPV (N=412). Informed by experiences across levels of ecological theory, I hypothesized that women with children who had ever experienced IPV would have lower odds of using each type of health service (i.e., general, specialist, reproductive, mental health, and emergency health services) – and would have higher odds of using limited numbers of services – than women with children who had never experienced IPV. I tested my hypothesis using binary logistic regression models and an independent samples t-test. I found that nearly 60% of Syrian refugee women with children living outside camps in Jordan had ever experienced physical and/or sexual IPV by their current or most recent husband. Contrary to my hypotheses, I found that women with children who had ever experienced IPV had over three times the odds of using mental health services and were significantly more likely to use a greater variety of health services (including mental health services) than women who had not experienced IPV (aOR: 3.10, 95% CI: 1.92-5.00, p<0.001; mean 3.26 vs. 2.84 types of services respectively, t [410] = 03.71, p<0.001).
Findings affirm that IPV is a serious public health issue among the affected populations and that access to needed services remains crucial to affected populations. Results fill gaps in existing literature by confirming that women with children in each study population have high odds of system involvement, particularly with CPS and mental health service systems, thereby offering social workers within those systems opportunities to intervene effectively. Thus, this dissertation can help social work practitioners and clinicians offer more responsive, accessible, and relevant services to clients within the study populations. Policymakers and administrators can fund development and testing of interventions across multiple ecological levels to promote the safety, health, and well-being of women and their children. Researchers can build on these findings through quantitative and qualitative studies on intervention effectiveness and accessibility among women engaged with system.
Identifer | oai:union.ndltd.org:columbia.edu/oai:academiccommons.columbia.edu:10.7916/84np-y972 |
Date | January 2023 |
Creators | Hartmann, Jennifer |
Source Sets | Columbia University |
Language | English |
Detected Language | English |
Type | Theses |
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