literature review of domestic violence research

Exploring the knowledge translation of domestic violence research: A literature review

Affiliations.

• 1 Department of Social Work, The University of Melbourne, Melbourne, Vic, Australia.
• 2 School of Health and Society, University of Wollongong, Wollongong, NSW, Australia.
• 3 School of Health Studies, University of Western Ontario, London, Canada.
• 4 Department of General Practice, The University of Melbourne, Melbourne, Vic, Australia.
• 5 Royal Women's Hospital, Melbourne, Vic, Australia.
• PMID: 32614128
• DOI: 10.1111/hsc.13070

There is growing recognition of the links between knowledge translation, policy and practice, particularly in the domestic violence research area. A literature review applying a systematic approach with a realist lens was the preferred methodology. The review answered the following question: What are the mechanisms of change in research networks which 'work' to support knowledge translation? A search of eight electronic databases for articles published between 1960 and 2018 was completed, with 2,999 records retrieved, 2,869 records excluded and 130 full-text articles screened for final inclusion in the review. The inclusion criteria were purposefully broad, including any study design or data source (including grey literature) with a focus on domestic violence knowledge translation. The analysis of included studies using a realist lens identified the mechanisms of change to support knowledge translation. A disaggregation of the included studies identified five theories focused on the following outcomes: (1) develop key messages, (2) flexible evidence use, (3) strengthen partnerships, (4) capacity building and (5) research utilisation. This review adds to our understanding of knowledge translation of domestic violence research. The mechanisms of change identified may support knowledge translation of research networks. Further research will focus on exploring the potential application of these program theories with a research network.

Keywords: domestic violence; family violence; knowledge translation; literature review; realist informed.

© 2020 John Wiley & Sons Ltd.

Publication types

• Research Support, Non-U.S. Gov't
• Capacity Building / organization & administration
• Domestic Violence / statistics & numerical data*
• Evidence-Based Medicine*
• Knowledge Management
• Research Design
• Translational Research, Biomedical*

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Domestic Violence Against Women: Systematic Review of Prevalence Studies

• Original Article
• Published: 15 December 2009
• Volume 25 , pages 369–382, ( 2010 )

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• Samia Alhabib 1 ,
• Ula Nur 2 &
• Roger Jones 3  

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To systematically review the worldwide evidence on the prevalence of domestic violence against women, to evaluate the quality of studies, and to account for variation in prevalence between studies, using consistent definitions and explicit, rigorous methods. Systematic review of prevalence studies on domestic violence against women. Literature searches of 6 databases were undertaken for the period 1995 to 2006. Medline, Embase, Cinahl, ASSIA, ISI, and International Bibliography of the Social Sciences were searched, supplemented by hand searching of the reference lists from studies retrieved and specialized interdisciplinary journals on violence. A total of 134 studies in English on the prevalence of domestic violence against women, including women aged 18 to 65 years, but excluding women with specific disabilities or diseases, containing primary, empirical research data, were included in the systematic review. Studies were scored on eight pre-determined criteria and stratified according to the total quality score. The majority of the sudies were conducted in North America (41%), followed by Europe (20%). 56% of studies were population-based, and 17% were carried out either in primary or community health care settings. There was considerable heterogeneity both between and within geographical locations, health care settings, and study quality The prevalence of lifetime domestic violence varies from 1.9% in Washington, US, to 70% in Hispanic Latinas in Southeast US. Only 12% scored a maximum of 8 on our quality criteria, with 27% studies scored 7, and 17% scored 6. The mean lifetime prevalence of all types of violence was found to be highest in studies conducted in psychiatric and obstetric/gynecology clinics. Results of this review emphasize that violence against women has reached epidemic proportions in many societies. Accurate measurement of the prevalence of domestic violence remains problematic and further culturally sensitive research is required to develop more effective preventive policies and programs.

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Acknowledgements

We would like to acknowledge the advice given by Dr. Kalwant Sidhu, Director of the MSc Programme at King’s College London, Martin Hewitt, who provided advice on literature searching, Dr. Paul Seed, who provided statistical advice, Prof. Gene Feder and Prof. Tony Ades for commenting on the paper before submission for publication and to Jeremy Nagle in the British Library, who helped to track down references.

Contributorship

Samia Alhabib had the original idea for the study which was refined by Roger Jones. Data collection, critical appraisal of studies and general data analysis were undertaken by Samia Alhabib. Meta-analysis and sensitivity analysis were undertaken by Ula Nur. Samia Alhabib and Roger Jones drafted and finalized the manuscript.

Potential Conflict of Interest

None declared.

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Academic Unit of Primary Health Care, University of Bristol, 25 Belgrave Road, Bristol, BS8 2AA, UK

Samia Alhabib

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Department of General Practice & Primary Care, King’s College London, London, UK

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Correspondence to Samia Alhabib .

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Alhabib, S., Nur, U. & Jones, R. Domestic Violence Against Women: Systematic Review of Prevalence Studies. J Fam Viol 25 , 369–382 (2010). https://doi.org/10.1007/s10896-009-9298-4

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DOI : https://doi.org/10.1007/s10896-009-9298-4

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Domestic Violence: A Literature Review

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Expert Commentary

Domestic violence and abusive relationships: Research review

Research review of data and studies relating to intimate partner violence and abusive relationships.

Republish this article

This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License .

by John Wihbey, The Journalist's Resource August 17, 2015

This <a target="_blank" href="https://journalistsresource.org/criminal-justice/domestic-violence-abusive-relationships-research-review/">article</a> first appeared on <a target="_blank" href="https://journalistsresource.org">The Journalist's Resource</a> and is republished here under a Creative Commons license.<img src="https://journalistsresource.org/wp-content/uploads/2020/11/cropped-jr-favicon-150x150.png" style="width:1em;height:1em;margin-left:10px;">

The controversy over NFL star Ray Rice and the instance of domestic violence he perpetrated, which was caught on video camera, stirred wide discussion about sports culture, domestic violence and even the psychology of victims and their complex responses to abuse . In 2015, domestic violence drew a national spotlight again when the South Carolina newspaper, the Post and Courier , won a Pulitzer Prize for its investigation of women who were abused by men and had been dying at a rate of one every 12 days.

The research on domestic violence, referred to more precisely in academic literature as “intimate partner violence” (IPV), has grown substantially over the past few decades. Although knowledge of the problem and its scope have deepened, the issue remains a major health and social problem afflicting women. In November 2014 the World Health Organization estimated that 35% of all women have experienced either intimate partner violence or sexual violence by a non-partner during their lifetimes. This figure is supported by the findings of a 2013 peer-reviewed metastudy — the most rigorous form of research analysis — published in the leading academic journal Science . That metastudy found that “in 2010, 30.0% [95% confidence interval (CI) 27.8 to 32.2%] of women aged 15 and over have experienced, during their lifetime, physical and/or sexual intimate partner violence.” The prevalence found among high-income regions in North America was 21.3%. Of course, under-reporting remains a substantial problem in this research area.

In 2010, the National Intimate Partner and Sexual Violence Survey, conducted by the U.S. Centers for Disease Control and Prevention, found that “more than 1 in 3 women (35.6%) … in the United States have experienced rape, physical violence, and/or stalking by an intimate partner in their lifetime.” That survey was subsequently updated in September 2014. The findings, based on telephone surveys with more than 12,000 people in 2011, include:

The lifetime prevalence of physical violence by an intimate partner was an estimated 31.5% among women and in the 12 months before taking the survey, an estimated 4.0% of women experienced some form of physical violence by an intimate partner. An estimated 22.3% of women experienced at least one act of severe physical violence by an intimate partner during their lifetimes. With respect to individual severe physical violence behaviors, being slammed against something was experienced by an estimated 15.4% of women, and being hit with a fist or something hard was experienced by 13.2% of women. In the 12 months before taking the survey, an estimated 2.3% of women experienced at least one form of severe physical violence by an intimate partner.

Still, the overall rates of IPV in the United States have been generally falling over the past two decades, and in 2013 the federal government reauthorized an enhanced Violence Against Women Act , adding further legal protections and broadening the groups covered to include LGBT persons and Native American women. (For research on the relatively higher violence rates among gay men, see the 2012 study “Intimate Partner Violence and Social Pressure among Gay Men in Six Countries.” )

A 2013 study published in the Journal of Marriage and Family , “Women’s Education, Marital Violence, and Divorce: A Social Exchange Perspective,” analyzes a nationally representative sample of more than 900 young U.S. women to look at factors that make females more likely to leave abusive relationships. The researchers, Derek A. Kreager, Richard B. Felson, Cody Warner and Marin R. Wenger, are all at Pennsylvania State University. They note that traditional “social exchange theory” would suggest that as women have more resources, they become less dependent on men and have more opportunities outside relationships, and therefore have more ability to divorce. The study sets out to “determine whether the relationship between a woman’s education and divorce is different in violent marriages.” The researchers also hypothesize that women who have higher levels of education are less likely to get divorced in general — prior academic work they cite supports this — but they aim to see how the introduction of intimate partner violence changes this dynamic.

The study’s findings include:

• The data provide “support for our primary hypotheses that women’s education typically protects against divorce but that this association weakens in abusive marriages. In addition, we found a similar pattern for wives’ proportional income, net of education. Together, these patterns suggest that educational and financial resources benefit women by increasing marital stability in nonabusive marriages and promoting divorce in abusive marriages.”
• Further, the “greater tendency for educated women to leave abusive marriages was substantial. For example, in highly violent marriages, women with a college degree had over a 10% greater probability of divorce in the observed time period than women without a college degree.”
• The study also finds that “women with economic resources were likely to leave unhappy marriages, regardless of whether they involve abuse. Similarly, degree-earning women were more likely than less educated women to leave violent marriages, regardless of their feelings of dissatisfaction.”

The researchers note that, across the U.S. population, more women are attaining college degrees, and given the study’s findings, this suggests “increases in women’s education should reduce rates of domestic violence. In a population with many educated women, violent marriages are likely to break up.” They caution that it is also possible “that our observed patterns reflect husbands’ perceptions and decisions. Perhaps abusive men feel threatened by successful wives, which then increases divorce risk. Nonabusive men may not feel threatened and thus stay with successful women.” On this point, more research is required.

Related research: A 2015 study titled “When War Comes Home: The Effect of Combat Service on Domestic Violence” suggests that multiple deployments and longer deployment lengths may increase the chance of family violence. A June 2014 study published in the  Journal of Interpersonal Violence , “Intimate Partner Violence Before and During Pregnancy: Related Demographic and Psychosocial Factors and Postpartum Depressive Symptoms Among Mexican American Women,”  provides a snapshot of domestic violence in a community sample of low-income Hispanic women. A March 2013 report from the U.S. Department of Justice’s Bureau of Justice Statistics, “Female Victims of Sexual Violence, 1994-2010,” provides a broad picture of such crimes across American society, examining the demographics of both victims and offenders. Regarding the issue of IPV prevention, a 2003 metastudy published in the Journal of the American Medical Association (JAMA) , “Interventions for Violence Against Women: Scientific Review,” found that “information about evidence-based approaches in the primary care setting for preventing IPV is seriously lacking…. Specifically, the effectiveness of routine primary care screening remains unclear, since screening studies have not evaluated outcomes beyond the ability of the screening test to identify abused women. Similarly, specific treatment interventions for women exposed to violence, including women’s shelters, have not been adequately evaluated.” Subsequent research continues to find problems with current techniques for screening and detection.

Tags: gender, women and work, crime, sex crimes

About The Author

John Wihbey

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

From the Editorial Board of the Peer-Reviewed Journal, Partner Abuse www.springerpub.com/pa and the Advisory Board of the Association of Domestic Violence Intervention Programs www.battererintervention.org *  www.domesticviolenceintervention.net

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

61-Page Author Overview

Domestic Violence Facts and Statistics at-a-Glance

PASK Researchers

PASK Video Summary by John Hamel, LCSW

• Introduction
• Implications for Policy and Treatment
• Domestic Violence Politics

17 Full PASK Manuscripts and tables of Summarized Studies

INTERNATIONAL RESEARCH

THE PARTNER ABUSE STATE OF KNOWLEDGE PROJECT

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.

Contact: [email protected]

DOMESTIC VIOLENCE TRAININGS

Online CEU Courses - Click Here for More Information

Also see VIDEOS and ADDITIONAL RESEARCH sections below.

Other domestic violence trainings are available at: www.domesticviolenceintervention.net , courtesy of the Association of Domestic Violence Intervention Providers (ADVIP)

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

Click here for all reports

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

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Burden of Mental Disorders and Suicide Attributable to Childhood Maltreatment

• 1 The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia
• 2 Department of Clinical, Educational, and Health Psychology, Division of Psychology and Language Sciences, University College London, London, United Kingdom
• 3 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York

Question   What proportion of mental health conditions and burden in Australia is attributable to childhood maltreatment?

Findings   This meta-analysis found, after controlling for genetic and environmental confounding, that childhood maltreatment accounts for 21% to 41% of common mental health conditions in Australia, with the highest attributable proportion for suicide attempts and self-harm. More than 1.8 million cases of depressive, anxiety, and substance use disorders, 66 143 years of life lost, and 184 636 disability-adjusted life-years could be prevented if childhood maltreatment was eradicated in Australia.

Meaning   Efforts to prevent child maltreatment exposure have the potential to improve mental health at a population level in Australia.

Importance   The proportion of mental disorders and burden causally attributable to childhood maltreatment is unknown.

Objective   To determine the contribution of child maltreatment to mental health conditions in Australia, accounting for genetic and environmental confounding.

Design, Setting, and Participants   This meta-analysis involved an epidemiological assessment accounting for genetic and environmental confounding between maltreatment and mental health and 3 cross-sectional national surveys: the Australian Child Maltreatment Study (ACMS) 2023, National Study of Mental Health and Well-being 2020-2022, and Australian Burden of Disease Study 2023. Causal estimates were derived on the association between childhood maltreatment and mental health conditions from a meta-analysis of quasi-experimental studies. This was combined with the prevalence of maltreatment from the ACMS to calculate the population attributable fraction (PAF). The PAF was applied to the number and burden of mental health conditions in Australia, sourced from 2 population-based, nationally representative surveys of Australians aged 16 to 85 years, to generate the number and associated burden of mental disorders attributable to child maltreatment.

Exposure   Physical abuse, sexual abuse, emotional abuse, or neglect prior to age 18 years.

Main Outcomes and Measures   Proportion and number of cases, years of life lost, years lived with disability, and disability-adjusted life-years of mental health conditions (anxiety, depression, harmful alcohol and drug use, self-harm, and suicide attempt) attributable to childhood maltreatment.

Results   Meta-analytic estimates were generated from 34 studies and 54 646 participants and applied to prevalence estimates of childhood maltreatment generated from 8503 Australians. Childhood maltreatment accounted for a substantial proportion of mental health conditions, ranging from 21% (95% CI, 13%-28%) for depression to 41% (95% CI, 27%-54%) of suicide attempts. More than 1.8 million cases of depressive, anxiety, and substance use disorders could be prevented if childhood maltreatment was eradicated. Maltreatment accounted for 66 143 years of life lost (95% CI, 43 313-87 314), primarily through suicide, and 184 636 disability-adjusted life-years (95% CI, 109 321-252 887).

Conclusions and Relevance   This study provides the first estimates of the causal contribution of child maltreatment to mental health in Australia. Results highlight the urgency of preventing child maltreatment to reduce the population prevalence and burden of mental disorders.

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Grummitt L , Baldwin JR , Lafoa’i J , Keyes KM , Barrett EL. Burden of Mental Disorders and Suicide Attributable to Childhood Maltreatment. JAMA Psychiatry. Published online May 08, 2024. doi:10.1001/jamapsychiatry.2024.0804

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“I see it as a partnership.” Faculty support survivors of domestic violence through comprehensive research. 

• Published April 8, 2024
• Faculty Research Profiles , Research News

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Lexington, KY – In an era where domestic violence remains a critical and pervasive issue, the University of Kentucky College of Social Work (CoSW) stands out for its unwavering commitment to combatting this societal challenge.  

The first statewide report on Domestic Violence released by Team Kentucky in June 2023 underscored the alarming prevalence of this issue, with over 45% of women and 35.5% of men in the commonwealth experiencing intimate partner violence (IPV) in their lifetimes.  

Drs. Kathryn Showalter and Laneshia Conner , alongside doctoral candidates Stephanie Ratliff and Rujeko Machinga-Asaolu were invited to lead multiple sessions during the National Network to End Domestic Violence (NNEDV) 7 th Annual Economic Justice Summit. 

“We were invited to share findings on often-overlooked IPV factors, such as co-occurring substance misuse, the economic impact of domestic violence, the vulnerability of older adults, psychological abuse, and workplace violence protection orders,” said Showalter. “It was an extremely rewarding and fruitful effort after years of building positive relationships at NNEDV.”  

Dr. Kathryn Showalter, a leading researcher at UK , has secured two pilot grants from the University of Kentucky’s Center for Research on Violence Against Women (CRVAW) and the Center for Clinical and Translational Sciences (CTTS). 

Dr. Laneshia Conner is an assistant professor at COSW, a second-year CTTS DREAM Scholar and a recipient of the University’s BIRWHC grant.  

Stephanie Ratliff, CoSW Director of Social Work Field Education and doctoral candidate, shared that she sees the role of peer-reviewed research on IPV as a collaborative tool to empower domestic violence programs and shelters. 

“Limited or inaccurate data can have a detrimental impact on services for survivors and critical funding decisions,” Ratliff explains. “Research is pivotal in bridging the gap between empirical evidence and practical application, enhancing services and guiding targeted investments. I see our research as a partnership.”  

The group’s collaborative research particularly emphasizes the economic impact wrought by IPV, including perpetrators’ financial sabotage and employment interference. This can leave survivors financially dependent and struggling to secure economic independence.  

“Abusive partners strategically sabotage their victims immediate financial security as well as their ability to maintain careers into the future” Showalter said. “These findings are especially relevant for female dominated sectors, like nursing in which their is opportunity to advance and thus opportunity to control.” 

Shelters and domestic violence programs often lack the resources to conduct peer-reviewed research, focusing their efforts on providing survivors with immediate needs like housing, food, transportation, and childcare.  

This team’s research not only addresses economic sabotage and employment interference by perpetrators but also strengthens domestic violence programs through empirical evidence crucial for securing funding. Their research focuses on empowering these programs to offer comprehensive services, including harm reduction strategies and policy changes to combat discriminatory practices, thus supporting IPV survivors’ journey towards safety and stability. 

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For 85 years, the University of Kentucky College of Social Work (CoSW) has been a leader in social work education. As a college, we promote community and individual well-being through translational research and scholarship, exemplary teaching, and vital community engagement. We are committed to the people and social institutions throughout Kentucky, the nation, and the world. Like the University, CoSW is an organization that cultivates a diverse academic community characterized by interpersonal fairness and social justice. We are fiercely committed to developing outstanding social work professionals — leaders who will serve individuals, families, and communities through innovative and effective practices that are guided by cultural competency, systematic ethical analysis, and a keen and pragmatic understanding of the human condition.  

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Highfill defends dissertation on military domestic abuse policies

Thursday, May 16, 2024 • Jaelon Jackson :

By Jaelon Jackson School of Social Work

In her remarkable academic journey at The University of Texas at Arlington, Christine Highfill was supported by a dedicated team of mentors and collaborators. 

Her dissertation committee, chaired by Social Work Associate Professor Dr. Rachel Voth Schrag and Social Work Assistant Professor Dr. Donna Schuman, provided invaluable guidance and expertise throughout her research process. Other esteemed members of her committee included Social Work Assistant Professor Dr. Rebecca Mauldin, Social Work Associate Professor Dr. Ling Xu, and Sociology and Anthropology Professor Dr. Beth Anne Shelton.

Highfill's dissertation, under the guidance of her committee, examines the historical changes in laws regarding domestic violence, particularly within the military context. She investigates the current policies within the military and their real-world impact on individuals and families affected by domestic abuse. 

Drawing from her own experiences surviving domestic abuse within the military, Highfill's research is deeply personal and driven by a passion to make a difference in the lives of others facing similar challenges.

"Dr. Highfill's work highlights the importance of considering the unique needs of military families in domestic violence research. She is working to translate what we have learned in civilian survivorship research into the context of military connected families. 

“Her approach can serve as a crucial foundation to build and tailor effective interventions for military connected survivors of intimate partner violence in both civilian and military contexts," Voth Schrag said.

Her dedication to research is evident in her extensive publication record. Highfill has authored 11 articles and two reports, with one article recently accepted for publication and four others currently under review. 

Highfill has also registered six scoping review protocols and is contracted with Oxford Press to write the Encyclopedia of Social Work entry on scoping reviews—a methodology she has mastered to systematically analyze literature on diverse topics.

In addition to her academic pursuits, Highfill is a Licensed Master Social Worker actively engaged in community service. She serves as the data and evaluation coordinator for a local nonprofit agency, facilitating communication between the agency and a national program evaluation firm. 

Moreover, Highfill provides mental health therapy services to community members in North Texas, contributing to the well-being of those she serves.

Highfill reflects on her journey. 

She said Antwan Williams, the School of Social Work’s assistant director of communications, marketing and recruiting and an adjunct assistant professor, was the first person she talked to when looking at if social work was right for her before deciding to start the Master of Social Work program here at UTA. Now she has not only earned her MSW degree but also a Ph.D. in Social Work from UTA.

“You start as one person and end up changed, with the Ph.D. title it represents not just academic success but personal growth," Highfill said.

Schuman says she has worked with Highfill on several research projects focused on improving health and well-being outcomes in military-connected populations. 

“She is a dedicated and intrepid researcher whose passion and commitment to her work shine through in every project she tackles. 

“I look forward to the next chapter of her professional journey and the outstanding contributions she will make toward improving the lives of our military and veteran families," Schuman said.

Highfill's expertise in military-connected domestic violence and abuse has earned her national recognition from The Institute for Military and Veteran Family Wellness. Her commitment to improving policies and support systems for survivors underscores her dedication to creating positive change in both academic and real-world contexts.

In addition to earning her MSW and PhD in Social Work degrees from UTA, Highfill received a Bachelor of Arts degree from Southwest Baptist University majoring in psychology, and a master's degree in human services counseling: military resilience cognate from Liberty University.

Dr. Highfill officially graduated on May 10, marking the culmination of her academic journey and the next step of what surely will be an impactful career.

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Domestic violence against women in India: A systematic review of a decade of quantitative studies

Ameeta kalokhe.

a Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA

b Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA

Carlos del Rio

Kristin dunkle.

c Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA, USA

Rob Stephenson

d Center for Sexuality and Health Disparities, University of Michigan School of Public Health and School of Nursing, Ann Arbor, MI, USA

Nicholas Metheny

Anuradha paranjape.

e General Internal Medicine, Temple University School of Medicine, Philadelphia, PA, USA

Seema Sahay

f Department of Social and Behavioral Sciences, National AIDS Research Institute, Pune, India

Associated Data

Domestic violence (DV) is prevalent among women in India and has been associated with poor mental and physical health. We performed a systematic review of 137 quantitative studies published in the prior decade that directly evaluated the DV experiences of Indian women to summarise the breadth of recent work and identify gaps in the literature. Among studies surveying at least two forms of abuse, a median 41% of women reported experiencing DV during their lifetime and 30% in the past year. We noted substantial inter-study variance in DV prevalence estimates, attributable in part to different study populations and settings, but also to a lack of standardisation, validation, and cultural adaptation of DV survey instruments. There was paucity of studies evaluating the DV experiences of women over age 50, residing in live-in relationships, same-sex relationships, tribal villages, and of women from the northern regions of India. Additionally, our review highlighted a gap in research evaluating the impact of DV on physical health. We conclude with a research agenda calling for additional qualitative and longitudinal quantitative studies to explore the DV correlates proposed by this quantitative literature to inform the development of a culturally tailored DV scale and prevention strategies.

Introduction

Domestic violence (DV), defined by the Protection of Women from Domestic Violence Act 2005 as physical, sexual, verbal, emotional, and economic abuse against women by a partner or family member residing in a joint family, plagues the lives of many women in India. National statistics that utilise a modified version of the Conflict Tactics Scale (CTS) to measure the prevalence of lifetime physical, sexual, and/or emotional DV estimate that 40% of women experience abuse at the hands of a partner ( Yoshikawa, Agrawal, Poudel, & Jimba, 2012 ). Data from a recent systematic review by the World Health Organization (WHO) provides similar regional estimates and suggests that women in South-East Asia (defined as India, Maldives, Sri Lanka, Thailand, Bangladesh, and Timor-Leste) are at a higher likelihood for experiencing partner abuse during their lifetime than women from Europe, the Western Pacific, and potentially the Americas ( WHO, 2013 ).

Among the different proposed causes for the high DV frequency in India are deep-rooted male patriarchal roles ( Visaria, 2000 ) and long-standing cultural norms that propagate the view of women as subordinates throughout their lifespan ( Fernandez, 1997 ; Gundappa & Rathod, 2012 ). Even before a child is born, many families have a clear preference for male children, which may result in their preferential care, and worse, sex-selective abortions, female infanticide and abandonment of the girl-child ( Gundappa & Rathod, 2012 ). During childhood, less importance is given to the education of female children; further, early marriage as occurs in 45% of young, married women, according to 2005–2006 National Family Health Survey (NFHS-3) data ( Raj, Saggurti, Balaiah, & Silverman, 2009 ), may also heighten susceptibility to DV ( Ackerson, Kawachi, Barbeau, & Subramanian, 2008 ; Raj, Saggurti, Lawrence, Balaiah, & Silverman, 2010 ; Santhya et al., 2010 ; Speizer & Pearson, 2011 ). In reproductive years, mothers pregnant with and/or those who give birth to only female children may be more susceptible to abuse ( Mahapatro, Gupta, Gupta, & Kundu, 2011 ) and financial, medical, and nutritional neglect. Later in life, culturally bred views of dishonour associated with widowhood may also influence susceptibility to DV by other family members ( Saravanan, 2000 ).

In addition to being prevalent in India, DV has also been linked to numerous deleterious health behaviours and poor mental and physical health. These includes tobacco use ( Ackerson, Kawachi, Barbeau, & Subramanian, 2007 ), lack of contraceptive and condom use ( Stephenson, Koenig, Acharya, & Roy, 2008 ), diminished utilisation of health care ( Sudha & Morrison, 2011 ; Sudha, Morrison, & Zhu, 2007 ), higher frequencies of depression, post-traumatic stress disorder (PTSD), and attempted suicide ( Chandra, Satyanarayana, & Carey, 2009 ; Chowdhury, Brahma, Banerjee, & Biswas, 2009 ; Maselko & Patel, 2008 ; Shahmanesh, Wayal, Cowan, et al., 2009 ; Shidhaye & Patel, 2010 ; Verma et al., 2006 ), sexually transmitted infections (STI) ( Chowdhary & Patel, 2008 ; Sudha & Morrison, 2011 ; Weiss et al., 2008 ), HIV( Gupta et al., 2008 ; Silverman, Decker, Saggurti, Balaiah, & Raj, 2008 ), asthma ( Subramanian, Ackerson, Subramanyam, & Wright, 2007 ), anaemia ( Ackerson & Subramanian, 2008 ), and chronic fatigue ( Patel et al., 2005 ). Furthermore, maternal intimate partner violence (IPV) experiences have been associated with more terminated, unintended pregnancies ( Begum, Dwivedi, Pandey, & Mittal, 2010 ; Yoshikawa et al., 2012 ), less breastfeeding ( Shroff et al., 2011 ), perinatal care ( Koski, Stephenson, & Koenig, 2011 ), and poor child outcomes ( Ackerson & Subramanian, 2009 ). These negative health repercussions and high DV frequency speak to the need for the development of effective DV prevention and management strategies. And, the development of effective DV interventions first requires valid measures of occurrence and an in-depth understanding of its epidemiology.

While many aspects of DV are similar across cultures, recent qualitative studies describe how some aspects of the DV experienced by women in India may be unique. These studies highlight the role of non-partner DV perpetrators for those living in both nuclear and joint-families ( Fernandez, 1997 ; Kaur & Garg, 2010 ; Raj et al., 2011 ). (These families are patrilineal where male descendants live with their wives, offspring, parents, and unmarried sisters.) They discuss the high frequency and near normalisation of control, psychological abuse, neglect, and isolation, the occurrence of DV to women at both extremes of age (young and old), dowry harassments, control over reproductive choices and family planning, and demonstrate the use of different tools to inflict abuse (i.e. kerosene burning, stones, and broomsticks as opposed to gun and knife violence more commonly seen in industrialised nations) ( Bunting, 2005 ; Go et al., 2003 ; Hampton, 2010 ; Jutla & Heimbach, 2004 ; Kaur & Garg, 2010 ; Kermode et al., 2007 ; Kumar & Kanth, 2004 ; Peck, 2012 ; Rastogi & Therly, 2006 ; Sharma, Harish, Gupta, & Singh, 2005 ; Stephenson et al., 2008 ; Wilson-Williams, Stephenson, Juvekar, & Andes, 2008 ).

This paper presents a systematic review of the quantitative studies conducted over the past decade that estimate and assess DV experienced by women in India, and evaluates their scope and capacity to measure the DV themes highlighted by recent qualitative studies. It aims to examine the distribution of the prevalence estimates provided by the recent literature of DV occurrence in India, improve understanding of the factors that may affect these prevalence estimates, and identify gaps in current studies. This enhanced knowledge will help inform future research including new interventions for the prevention and management of DV in India.

We utilised PubMed, OVID, Cochrane Reviews, PsycINFO, and CINAHL as search engines to identify articles published between 1 April 2004 and 1 January 2015 that focused on the DV experiences of women in India ( Figure 1 ). Our specific search terms included ‘domestic violence’, ‘intimate partner violence’, ‘spouse abuse’, ‘partner violence’, ‘gender-based violence’, ‘sexual violence’, ‘physical violence’, ‘wife battering’, ‘wife beating’, ‘domestic abuse’, ‘violence’, and ‘India’. We first removed duplicate articles and then filtered the articles based on our inclusion criteria: quantitative studies evaluating original data that had been published in English and directly surveyed the DV experiences of women. While we recognise that in cultures where DV is commonplace the reporting of DV perpetration by men may be as high as the frequency of experiencing DV reported by women ( Koenig, Stephenson, Ahmed, Jejeebhoy, & Campbell, 2006 ), we restricted our eligibility criteria to studies directly surveying women about their DV experiences to reduce further inter-study variation and allow for more accurate cross-study comparisons. We excluded reviews, case reports, meta-analyses, and qualitative studies. A single author (ASK or NM) reviewed each individual article to determine whether it met inclusion criteria. If questions arose regarding its inclusion into the review, they were discussed with a second author (SS) until concordance was reached regarding whether or not the paper was to be included.

Adapted PRISMA Flow Diagram demonstrating study selection methodologies and filter results.

Note: An initial PubMed search of articles published between 1 April 2004 and 1 January 2015 focusing on the DV experiences of women in India is depicted. This figure illustrates the search terms, search engines, applied inclusion and exclusion filters, the process by which articles were chosen to be included in the study, and the results of the selection process.

We collected data from each study regarding study population; study setting; use of a validated scale; forms of, perpetrators of, and time frame during which DV was measured; whether an attempt was made to measure severity of DV; whether potential DV correlates were evaluated; and whether DV prevalence was estimated. We subcategorised the forms of violence into physical, sexual, psychological, control, and neglect based on descriptions of questions provided in the studies. Emotional and verbal forms of abuse were classified as psychological abuse and deprivation was classified as neglect. If the study asked participants about agency or autonomy, this was noted in the summary tables. In publications where information about the DV assessment tool and its validation was not provided, we contacted the authors for more information. If authors reported having conducted formative fieldwork to generate questions, pre-tested the items, and/or conducted some assessment of the measurement tool’s expert or face validity, we reported the validation as ‘limited’. If we did not hear back from the authors, we stated the data were ‘not reported’.

Article yield of systematic search

Our initial search of DV articles published in PubMed, OVID, Cochrane Reviews, PsycINFO, and CINAHL between 1 April 2004 and 1 January 2015 yielded 3843 articles ( Figure 1 ). We identified 628 articles using search terms ‘domestic violence’ and ‘India’, 283 articles using ‘intimate partner violence’ and ‘India’, 98 articles using ‘spouse abuse’ and ‘India’, 221 articles using ‘partner violence and India’, 54 articles using ‘gender-based violence’ and ‘India’, 199 articles using ‘sexual violence’ and ‘India’, 120 articles using ‘physical violence’ and ‘India’, 1 article using ‘wife battering’ and ‘India’, 51 articles using ‘wife beating’ and ‘India’, 10 articles using ‘domestic abuse’ and ‘India’, and 2022 articles using ‘violence’ and ‘India’. Of the 3843 articles, 3705 articles were removed because they (1) were duplicated in the search, (2) focused on extraneous topics, (3) lacked Indian context, (4) were not based on original quantitative data, or (5) were based on study data that were not directly obtained through surveying women about their personal DV experiences. Thus, the selection criteria yielded a total of 137 studies examining the DV experiences of women in India: 14 international studies (see Table 1 in supplementary material ), 50 multi-state India studies (see Table 2 in supplementary material ), and 73 single-state India studies (see Table 3 in supplementary material ).

The scope and breadth of recent studies: study populations

Collectively, the reviewed studies provide information on the DV experienced by young and middle-aged women in traditional heterosexual marriages from both urban and rural environments, joint and nuclear families, across Indian states ( Figure 2 ). Among the studies specifying age limits, the vast majority (88% or 92/104) evaluated DV experienced by women age 15–50, with only 11% (11/104) of studies surveying DV suffered by women above age 50 and 1% (1/104) evaluating DV experienced by young adolescents (wed before age 15). Only one study assessed DV experienced by women in HIV discordant. No studies surveyed DV in non-traditional relationships, such as same-sex relationships or live-in relationships. Less than one-third (29% or 40/137) collected data differentiating DV experienced by women in joint versus nuclear families. Thirty-seven per cent (51/137) evaluated domestic abuse suffered by women living in urban settings, 18% (24/137) in rural, and the remainder (44% or 60/137) in both rural and urban environments. Only one examined DV experienced by women residing in tribes. Twenty-three per cent (32/137) and 3% (4/137) utilised a nationally representative and sub-nationally representative study population, respectively. Southern Indian states were by far the most surveyed in the literature (Maharashtra 66 studies, Tamil Nadu 59 studies, and Karnataka 51 studies) and Northern Indian states the least (Uttaranchal, Sikkim, Punjab, Haryana, Chhattisgarh, and Assam each with 33 studies).

A summary of the distribution of recent Indian DV literature by region, state, surveyed perpetrator, and family type.

Note: (a) demonstrates the distribution of studies by rural versus urban region, (b) by state, (c) by the perpetrator surveyed, and (d) whether the survey collected data differentiating DV in joint versus nuclear family households.

Prevalence of DV in India

Collectively, the reviewed studies demonstrate that DV occurs among Indian women with high frequency but there is substantial variation in the reported prevalence estimates across all forms of DV ( Figure 3 ). For example, the median and range of lifetime estimates of psychological abuse was 22% (range 2–99%), physical abuse was 29% (2–99%), sexual abuse was 12% (0–75%), and multiple forms of DV was 41% (18–75%). The outliers at the upper extremes were contributed by a study of in low-income slum communities with high prevalence of substance abuse( Solomon et al., 2009 ) and a second study conducted in a tertiary care centre where surveys were self-administered and thus participants may have felt increased comfort in reporting DV( Sharma & Vatsa, 2011 ). The median and range of past-year estimates of psychological abuse was 22% (11–48%), physical abuse was 22% (9–90%), sexual abuse was 7% (0–50%), and multiple forms of DV was 30% (4–56%). The outlier of 90% for physical abuse was contributed by a study of women whose husbands were alcoholics in treatment ( Stanley, 2012 ). As expected, higher DV prevalence was noted when multiple forms of DV were assessed. Of all forms of DV, physical abuse was measured most frequently, with psychological abuse, sexual abuse, and control or neglect receiving substantially less attention. Further statistical analysis beyond these descriptive statistics was not conducted due to the large inter-study heterogeneity of designs and populations limiting comparability across studies.

A summary of the lifetime and past 12-month prevalence estimates of the various forms of DV as documented by each individual study.

Note: Circles, squares, upright triangles, and inverted triangles represent prevalence estimates of psychological, physical, sexual, and multiple forms of DV, respectively, as provided by each individual study. While medians and ranges are provided, further analysis was not carried out due to the limited homogeneity between studies impeding accurate comparison.

The scope and breadth of recent studies: study design

The past decade of quantitative India DV research has included a breadth of large regional and international studies as well as smaller scale, single-state studies. However, the capacity to draw causal inferences from this literature has been limited by the nearly exclusive use of cross-sectional design. The country and regional-level studies utilised larger, often nationally or sub-nationally representative samples (average sample size: 25,857 women, range: 111–124,385), to provide inter-country or regional epidemiologic comparisons. The single-state studies tended to use smaller sample sizes (average: 1109 women, range: 30–9639) to provide a more in-depth evaluation of DV experienced in a particular population of women.

The vast majority of all reviewed studies utilised cross-sectional design, with only 12% (17/137) using a prospective design to draw causal inferences. Six of these 13 utilised the NFHS-2 and four-year follow-up data from the rural regions of four states to evaluate the effect of DV on mental health disorders ( Shidhaye & Patel, 2010 ), a woman’s adoption of contraception, occurrence of unwanted pregnancy ( Stephenson et al., 2008 ), uptake of prenatal care ( Koski et al., 2011 ), early childhood mortality ( Koenig et al., 2010 ), functional autonomy and reproduction ( Bourey, Stephenson, & Hindin, 2013 ), and contraceptive adoption ( Stephenson, Jadhav, & Hindin, 2013 ), while one used the data to evaluate the effect of autonomy on experience of physical violence ( Nongrum, Thomas, Lionel, & Jacob, 2014 ; Sabarwal, Santhya, & Jejeebhoy, 2014 ). Only one study employed a case-control study to evaluate the link between DV and child mortality ( Varghese, Prasad, & Jacob, 2013 ) and another utilised a randomised control design to evaluate the effect of a mixed individual and group women’s behavioural intervention in reducing DV and marital conflict over time ( Saggurti et al., 2014 ). The remainder of prospective studies evaluated the causal association between DV and incident STIs and/or attempted suicide ( Chowdhary & Patel, 2008 ; Maselko & Patel, 2008 ; Weiss et al., 2008 ), DV and maternal and neonatal health outcomes ( Nongrum et al., 2014 ), the effect of the type of interviewing (face-to-face versus audio computer-assisted self-interviews) on DV reporting ( Rathod, Minnis, Subbiah, & Krishnan, 2011 ), trends in DV occurrence over time ( Simister & Mehta, 2010 ), and the effect of change in a woman or her spouse’s employment status on her experience of DV ( Krishnan et al., 2010 ).

The scope and breadth of recent studies: DV measures

Only 61% (84/137) of studies reported use of a validated scale or made attempts to validate the instrument they ultimately used. When use of a validated instrument was reported, most (82% or 69/84) had been developed for the cultural context of North America and Europe (i.e. modified CTS, Abuse Assessment Screen, Index of Spouse Abuse, Woman Abuse Screening Tool, Partner Violence Screen, Composite Abuse Scale, and Sexual Experience Scale). In fact, only 15 of the studies reporting use of a validated questionnaire adapted or developed their instrument to the Indian context by surveying themes raised by the prior qualitative literature (i.e. use of belts, sticks, and burning to inflict physical abuse, restricting return to natal family home, not allowing natal family to visit marital home). As expected, these studies reported higher frequencies of DV. In personal communication, some authors who chose not to use validated, widely used DV scales (i.e. CTS) stated they did so because of space limitations and inadequacy of existing tools for measuring DV in the Indian cultural context.

Two-thirds of studies (64% or 87/137) assessed two or fewer forms of DV. Of all forms of DV, physical abuse was evaluated most frequently (96% or 131/137), followed by sexual abuse (58% or 79/137), psychological abuse (44% or 60/137), neglect and control (4% or 7/137). Only 11% (15/137) of studies evaluated DV perpetrated by non-partner family members. For these studies evaluating DV perpetrated by partners and non-partner family members, available estimates of lifetime sexual and psychological abuse were always higher than the median prevalence estimates of reviewed studies; available estimates of lifetime physical abuse were often, but not universally, higher. Only 20% (109/137) attempted to evaluate different levels of DV severity. While many (43% or 59/137) studies evaluated lifetime violence, a considerable number assessed recent DV (42% or 58/137 past-12 month DV, 5% or 7/137 past-6 month DV, 4% or 5/137 past-3 month DV, and 4% or 6/137 the time period of current or research partnerships). Additionally, 10% (14/137) evaluated DV occurrence during pregnancy or the peri-partum period.

The scope and breadth of recent studies: measured outcomes

Figure 4 provides a framework for synthesising the potential DV correlates measured to date. It demonstrates that the focus of the quantitative literature has largely been on the mental health and gynecologic consequences of DV but has only begun to evaluate repercussions on physical health and health behaviour. Twelve per cent (16/137) of the studies evaluated one or multiple mental health disorder as outcomes of DV, including PTSD, depression, and suicide, but not anxiety. The literature provided a comprehensive evaluation of the association between DV and gynaecologic health including sexual (15% or 21/137) and maternal health (8% or 11/137). However, only six studies were dedicated to evaluating physical health outcomes (oral health, nutrition, chronic fatigue, asthma, direct injury, and blindness during pregnancy). And while 17 studies were dedicated to evaluating the association between DV and uptake of health behaviours, 11 of the 15 were focused on behaviours related to sexual and maternal health. Thus, the association between health behaviours like the woman’s substance abuse and adherence to medical and clinical care remains largely understudied, as does the link between DV and physical health outcomes such as cardiovascular and gastrointestinal disease, chronic pain syndromes (including migraines), and urinary tract infections.

A framework for conceptualising the reviewed studies.

Note: The proposed framework provides structure for interpreting and synthesising the prior decade’s quantitative research evaluating the domestic violence experienced by women in India.

The past 10 years have been an incredible period of growth in DV research in India and South Asia. Our systematic review contributes to the growing body of evidence by providing an important summary of the epidemiologic studies during this critical period and draws attention to the magnitude and severity of the ongoing epidemic in India. Comprehensively, the reviewed literature estimates that 4 in 10 Indian women (when surveyed about multiple forms of abuse) report experiencing DV in their lifetime and 3 in 10 report experiencing DV in the past year. This is concordant with the WHO lifetime estimate of 37.7% (95% CI: 30.9%43.1%) in South-East Asia (defined as India, Maldives, Sri Lanka, Thailand, Bangladesh, and Timor-Leste) and is higher than the regional estimates provided by the WHO for the Europe, the Western Pacific, and potentially the Americas. In addition to highlighting the high frequency of occurrence, the studies in this review emphasise the toll DV takes on the lives of many Indian women through its impact on mental, physical, sexual, and reproductive health.

Perhaps the most striking finding of our review was the large inter-study variance in DV prevalence estimates ( Figure 3 ). While this variability speaks to the capacity of the India literature to capture the breadth of DV experiences in different populations and settings, it also underscores the need for standardising aspects of study design in the investigator’s control to make effective inter-study and cross-population comparisons. Standardisation of the instruments used to measure DV should be a priority. To optimise the yield of such an instrument in capturing the DV experiences of Indian women, it should build upon currently available, well-validated instruments, but also be culturally tailored. Thus, it should account for the culturally prominent forms of DV identified by the Indian qualitative literature and social media, survey abuse inflicted by non-partner perpetrators, survey multiple forms abuse (i.e. physical, sexual, psychological, and control), and ideally, include a measure of DV severity (i.e. based on frequency of affirmative responses, frequency of abuse, or resultant injury). Our review demonstrates that current studies fall short, with only 61% reporting use of validated questions (rarely developed or adapted to Indian culture), 11% surveying DV perpetrated by non-partner family members, 64% assessing more than two different forms of abuse, and 20% evaluating level of DV severity. Our review also suggests that when questions assessing DV are culturally adapted and validated, evaluate multiple forms of abuse, and survey abusive behaviours by non-partner family members in addition to partners, reporting of DV increases.

While our search yielded many well-designed cross-sectional studies providing insight into the epidemiology of DV in India (i.e. patterns of occurrence, socio-demographic, and health correlates), it also revealed many gaps and thus, a potential research agenda. Future qualitative studies are needed to examine the link between DV and correlates identified by the cross-sectional literature, to inform the development of future prevention strategies, and to enhance delivery of DV supportive services by examining survivor preferences and needs. Additional longitudinal quantitative studies are also needed to better understand predictors of DV and to explore the direction of causality between DV and the physical health associations identified in the reviewed studies. They are also needed to assess the link between DV and other physical health outcomes like injury, cardiovascular disease, irritable bowel syndrome, immune effects, and psychosomatic syndromes as well as non-sexual health behaviours such as substance abuse and medication adherence. This is particularly paramount in India, where physical injury and cardiovascular disease together account for over a quarter of disability-adjusted life years lost ( National Commission on Macroeconomics and Health, 2005 ).

Additionally, our review also exposed gaps in the current understanding of DV in some populations and regions of India. For example, most studies focused on women of age 15–50. Only 11 reported on the DV experiences of women over 50, a stage where frailty, financial and physical dependence, and culturally engendered shame and disgrace associated with widowhood may heighten their risk of experiencing DV, neglect, and control by various family members ( Solotaroff & Pande, 2014 ). And, while 43% of Indian women aged 20–24 marry before the age of 18, we encountered few studies evaluating DV experienced by pre-adolescents or young adolescents married as children ( UNICEF, 2014 ). An additional gap is in evaluating the DV experiences of women engaging in live-in relationships as opposed to marital relationships, divorced or widowed women, women involved in same-sex relationships, and in HIV serodiscordant and concordant relationships, settings in which social and family support systems are already weakened ( Kohli et al., 2012 ). Next, beyond the national and multi-state data sets, there is little representation of the northern states of India (i.e. Uttaranchal, Sikkim, Punjab, Haryana, Chhattisgarh, and Assam) and of women residing in tribal villages ( Sethuraman, Lansdown, & Sullivan, 2006 ). The vast cultural, religious, and socio-economic inter-regional differences in India highlight the need for more in-depth study of the DV experiences of women in these areas.

The high prevalence of DV and its association with deleterious behaviours and poor health outcomes further speak to the need for multi-faceted, culturally tailored preventive strategies that target potential victims and perpetrators of violence. The recent Five Year Strategic Plan (2011–2016) released by the Ministry of Women and Child Development discusses a plan to pilot ‘one-stop crisis centres for women’ survivors of violence, which would include medical, legal, law enforcement, counselling, and shelter support for themselves and their children. The significant differences in women’s empowerment and DV experience by region and population within India ( Kishor & Gupta, 2004 ) underscore the need to culturally- and regionally tailor the screening and support services provided at such centres. For example, in resource-limited states where sexual forms of DV predominate, priority should be given to the allocation of health-care providers to evaluate, document, and treat associated injuries and/or transmitted diseases. In settings where financial control and neglect are common, legal, financial, and educational empowerment may need to be given precedence.

Our review is not without limitations. First, our analysis relied solely on data directly provided in the publications. We did not further contact the authors if information was not provided. Second, a single author (ASK or NM) reviewed the individual papers for inclusion into the review, which may have introduced a selection bias. We tried to limit this bias through discussion of the papers in which eligibility was not clear-cut with a second author (SS) until agreement about the inclusion status was reached. Next, we included studies whose main intent was to evaluate the DV experiences of Indian women as well as studies whose main aim may not have been related to DV at all, but included DV as a covariate in the analysis. Thus, many of the studies that solely included DV as a covariate may not have had the intent or resources to fully examine the DV experience. While this may be viewed as a limitation, our goal was not to critically evaluate each individual study, but to comprehensively review the information currently provided in the Indian DV literature. Lastly, inclusion of multiple studies that utilise the same data set (e.g. NFHS) may have skewed the overall median estimate of DV prevalence and the remainder of our analysis. We felt, however, that the substantial differences in DV assessment (e.g. measurement time frames, forms of DV assessed, whether DV severity was assessed, and measured health correlates) between these studies legitimised their need to be included as separate entities in the review.

In conclusion, our literature review underscores the need for further studies within India evaluating the DV experiences of older women, women in same-sex relationships, and live-in relationships, extending the assessment of DV perpetrated by individuals besides intimate partners and spouses, and assessing the multiple forms and levels of abuse. It further stresses the necessity for the development and validation (in multiple regions and study populations within India) of a culturally tailored DV scale and interventions geared towards the prevention and management of DV.

Supplementary Material

Tables and table references, acknowledgments.

This work was supported by the US Department of Health and Human Services, National Institutes of Health, Fogarty International Center [grant number 1 R25 TW009337-01 K01 TW009664].

Supplemental data for this article can be accessed at http://dx.doi.org/10.1080/17441692.2015.1119293

Disclosure statement

No potential conflict of interest was reported by the authors.

Ameeta Kalokhe , http://orcid.org/0000-0002-3556-1786

Seema Sahay , http://orcid.org/0000-0001-6064-827X

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Population Health

News | Video

Voids in Scientific Evidence Slow Efforts to Curb Firearm Violence

A penn ldi virtual seminar parses what works and what doesn’t in gun control.

• Hoag Levins
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Efforts to address the rising public health crisis of firearm violence are being stymied by the lack of scientific evidence about which current laws and proposed policies are–or are not–effective interventions. That’s according to a May 3 virtual seminar of top experts convened by the University of Pennsylvania’s Leonard David Institute of Health Economics (LDI) and co-sponsored by the Penn Injury Science Center.

As she opened the session, Therese Richmond , PhD, RN , moderator, LDI Senior Fellow, Penn School of Nursing Professor, and Research Core Director at the Penn Injury Science Center cited the latest annual count of U.S. firearm carnage: more than 26,000 suicides by gun, 20,000 homicides, 549 unintentional shootings, and 995 other firearm deaths. That’s roughly 1 person killed by gun every 11 minutes around the clock, every day.

Primary Cause of Children’s Death

And there are some particularly tragic inequities within these statistics. Rates of firearm homicides are 11-fold greater for Black males than white males. And more children and adolescents aged 1-19 years die annually from firearm injuries than from any other single cause.

Scientists have been investigating gun violence as a public health hazard for a long time but that suddenly stopped in 1996 as the gun lobby partnered with its supporters in Congress to pass the Dickey Amendment that blocked the Centers for Disease Control and Prevention (CDC) from funding any research “to advocate or promote gun control.”

Twenty-three years later, in 2019, Congress lifted those prohibitions and from 2020 to 2022, the CDC and National Institutes of Health (NIH) awarded more than $149 million in research grants related to firearm injury prevention research. And while this new infusion of money and research effort is moving forward, there are still very large evidence voids in the scientific understanding of how any given law or potential intervention actually works to decrease or not decrease gun violence.

Richmond, a board member of the Research Society for the Prevention of Firearm-Related Harms, discussed current research evidentiary needs with three seminar panelists who are also board members in that same Society. They are Andrew Morral , PhD , Senior Behavioral Scientist and Director of the National Collaborative on Gun Violence Research at the RAND Corporation; Joseph Richardson, Jr. , PhD , who leads the Prevent Gun Violence: Research, Empowerment, Strategies & Solutions (PROGRESS) initiative and is Executive Director of the Transformative Research and Applied Violence Intervention Lab at the University of Maryland; and Ali Rowhani-Rahbar , MD, PhD , Director of the Firearm Injury & Policy Research Program at the University of Washington.

Convoluted Gun Laws

The world of state guns laws is convoluted. The number of laws is so extensive and varied that no one appears able to estimate it. There are around 20 major classes of state firearm laws, with numerous subcategories within each class. Examples of these classes include background check laws, child-access prevention laws, concealed-carry laws, and laws regulating the storage and use of firearms. Regulations vary significantly by state as they cover aspects such as permits for purchase and possession, firearm registration, concealed and open carry regulations, restrictions on certain types of firearms and magazines, and various self-defense laws like the “castle doctrine” or “stand-your-ground” laws.

Richmond noted that the news media and public debate about gun violence tend to focus on federal policy even though few of the individual states’ gun laws have been evaluated. She asked Morral to provide a synopsis of RAND’s extensive reviews of state laws as well as the academic literature about them.

“There’s a lot of correlational evidence of some association between the laws states pass and the outcomes they achieve in terms of firearm homicide, suicides, and injuries,” said Morral. “You can say, ‘Hawaii, California, New York, and New Jersey have particularly low firearm suicides and homicide rates and they also happen to be the states that have particularly restrictive gun laws.’ But that’s not good enough to make a claim about what is driving those outcomes. They’re different from other states in a lot of ways. They’re blue states and they’re wealthy states. How do you know it’s not just the wealth that’s leading to this difference? My group at RAND’s Gun Policy in America project has been working for eight years to tease apart what can be attributed to the law versus what might be attributable to other aspects of a state.”

Latest Analysis

“For the most part,” Morral continued, “state laws haven’t been studied carefully but that has been changing, and we have been updating our systematic review, going through thousands of articles to identify those that use more rigorous methods of identifying the effects of gun laws. We have sorted the policies that have been studied into these different categories of levels of evidence, our highest level being what we call ‘supportive evidence’ that is comprised of multiple studies demonstrating a particular effect.”

He indicated that RAND rates three types of state gun laws as having supportive evidence for various kinds of results in the scientific literature:

• Child-Access Prevention (CAP) Laws that seem to be associated with future reductions in firearm injuries, suicides, assaults, and homicides among young people. A lesser level of evidence suggests they are also associated with reductions in adult suicides.
• More Restrictive Concealed-Carry Laws that provide the police and state with some discretion over who gets a concealed carry permit. The more restrictive versions of these laws are associated with reductions in total firearm homicides. But this legal approach was disrupted a year and a half ago as the U.S. Supreme Court made more restrictive concealed carry laws illegal across the country.
• Stand-Your-Ground Laws that remove the duty to retreat from a conflict if safe retreat is possible. These laws appear to be clearly associated with increases in firearm homicides and are a concern, given that nearly half the states have adopted them.

RAND’s second, lower-quality level of evidentiary ratings indicate that background checks, minimum age purchase laws, and firearms surrender laws help to reduce firearm homicides–this last particularly so in domestic violence cases.

However, Morral emphasized that states that have laws like firearm surrender statutes often don’t enforce them. Technically, judges may be required by law to ask whether a domestic offender has firearms but fail to do so. He pointed to a recent study in North Carolina suggesting that in a large proportion of cases, that despite being required by law to do it, judges there simply don’t inquire about an offender’s firearms.

“So,” Morral said, “you wouldn’t expect a firearms surrender law to have as much effect in North Carolina as it does in another state where the judges are doing what they’re supposed to do. And this is hard to study because getting data on implementation fidelity is really hard. That is an information collection effort where you send people out into the field to collect that data, and that’s expensive.”

Social Determinants and Firearm Violence

Looking beyond just the legal language and politics of gun control laws, Richmond asked if firearm violence was looked at as one of the social determinants of health, how could other kinds of public policies affect firearm violence rates?

Rowhani-Rahbar said there was a recent scoping review of the literature that found very few studies that have empirically looked at the relationship between societal and structural level determinants of these firearm violence outcomes. A couple of studies of redlining showed how those historic racist policies are associated with those very same neighborhoods that are now experiencing higher levels of gun violence.

He noted that several studies have focused on state social policies’ impact on total crime or total violence and suicide but not explicitly with firearm-related outcomes.

“I think that’s really important because while different forms of violence are interconnected and have shared risk and protective factors, the pathways for firearm-related violence are not necessarily identical to those for non-firearm-related violence. There is obviously a need to examine the impact of state social policies on firearm-related outcomes,” Rowhani-Rahbar said.

“We did a scoping review of income support policies on firearm-related death, and we found four studies globally on that, one from Brazil and three from the United States,” Rowhani-Rahbar said. “Most of these are cash transfer programs. Some of the evidence is that there seems to be an association between those policies and reduction in firearm-related death and injury. A recent study looked at state minimum wage policies and firearm-related homicide that showed an association between minimum wage and reduction in firearm homicide. Another looked at state social spending and food insecurity in relation to firearm related suicide. They showed significant reductions in firearm-related suicide.”

Hospital-Based Violence Intervention

Panelist Richardson is heavily involved in a related area of research focused on how community-based violence intervention (CVI) programs and hospital-based violence intervention programs (HVIPs) can be used in ways that reduce firearm-related harms in a community.

Richardson explained, “My mentor, Carnell Cooper , MD FACS , who started one of the first HVIPs programs at the University of Maryland, conducted one of the first studies to test the effectiveness of the concept and found that among the treatment group, the reinjury rate was 5% compared to the non-treatment group, which was 36%. So at least in his study, he was able to show that these programs are effective in terms of providing behavioral health and social services primarily for young Black men who are disproportionately impacted by gun violence. The program provided the patients with behavioral health and social services, including cognitive behavioral therapy, to not only reduce their rate of trauma recidivism, but also criminal recidivism as well, and get them back into employment and educational opportunities.”

“My colleague and I, Daniel Webster , ScD , have conducted a systematic review of HVIPs,” Richardson continued. “And what we found is that there were really no conclusive results. There are pieces of programs that are effective, but in total, we did not find conclusively that there were enough studies to say that these programs are totally effective in reducing trauma, recidivism, and other metrics that we use to gauge success.”

“I think part of that involves the lack of experimental designs for HVIPs,” said Richardson. “Also, there are challenges with increasing the sample size. For example, in the study conducted by Dr. Cooper at the University of Maryland, there were 100 participants in that study, but it took 33 months to get those 100 participants. So, we often find challenges with recruitment and retention. Then there’s also the challenge of determining what aspects of the programs actually work because not all HVIPs are the same. For my program—we were the first fully operational program in the Washington, D.C. metro area—we had 116 participants over a three-year period. And over that period, we had one person come back to the hospital for a violent injury. So, numerically, we were successful, but we still cannot prove what aspects of the program contributed to that significant reduction in trauma recidivism. We need more research to understand what that looks like, and also the ways that HVIPs programs connect with street outreach programs.”

Looking Ahead

As the session ended, Richmond asked the panelists for a final comment identifying one promising policy area that they want to see move forward, or see new evidence emerge in that reduces firearm violence? These are their answers:

• Morral : “The low hanging fruit politically and possibly empirically, is removing firearms from people who are prohibited possessors . There’s a huge number of people in the country who are prohibited possessors and have firearms but there’s no general mechanisms for identifying them or having them give up their firearms. We know that most firearm crime is committed by people who are prohibited possessors. Many gun owners say we don’t need more gun laws, we just need to enforce the laws, and this would, I think, fit into that enforcement framework.”

• Rowhani-Rahbar : “I propose policies that strengthen our communities in terms of overcoming economic stress and hardship that could, in the long term, have some sizable impact in those communities.”

• Richardson : “Change the policies related to felony disenfranchisement and the collateral consequences. We’ve seen the impact a felony has on the outcomes of people who are coming back from prison and trying to penetrate the legal labor market. Their felony record punishes them for a lifetime. Often, these are young men who are disadvantaged by that record and revert back to crimes of economic survival, which probably contributed to their engaging in firearm violence from the outset.”

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