about domestic violence research paper

Domestic Violence

Affiliations.

• 1 University of Louisville
• 2 University of Tennessee
• PMID: 29763066
• Bookshelf ID: NBK499891

Family and domestic violence including child abuse, intimate partner abuse, and elder abuse is a common problem in the United States. Family and domestic health violence are estimated to affect 10 million people in the United States every year. It is a national public health problem, and virtually all healthcare professionals will at some point evaluate or treat a patient who is a victim of some form of domestic or family violence.

Unfortunately, each form of family violence begets interrelated forms of violence. The "cycle of abuse" is often continued from exposed children into their adult relationships and finally to the care of the elderly.

Domestic and family violence includes a range of abuse, including economic, physical, sexual, emotional, and psychological, toward children, adults, and elders.

Intimate partner violence includes stalking, sexual and physical violence, and psychological aggression by a current or former partner. In the United States, as many as one in four women and one in nine men are victims of domestic violence. Domestic violence is thought to be underreported. Domestic violence affects the victim, families, co-workers, and community. It causes diminished psychological and physical health, decreases the quality of life, and results in decreased productivity.

The national economic cost of domestic and family violence is estimated to be over 12 billion dollars per year. The number of individuals affected is expected to rise over the next 20 years, increasing the elderly population.

Domestic and family violence is difficult to identify, and many cases go unreported to health professionals or legal authorities. Due to the prevalence in our society, all healthcare professionals, including psychologists, nurses, pharmacists, dentists, physician assistants, nurse practitioners, and physicians, will evaluate and possibly treat a victim or perpetrator of domestic or family violence.

Definitions

Family and domestic violence are abusive behaviors in which one individual gains power over another individual.

Intimate partner violence typically includes sexual or physical violence, psychological aggression, and stalking. This may include former or current intimate partners.

Child abuse involves the emotional, sexual, physical, or neglect of a child under 18 by a parent, custodian, or caregiver that results in potential harm, harm, or a threat of harm.

Elder abuse is a failure to act or an intentional act by a caregiver that causes or creates a risk of harm to an elder.

Center for Disease Control and Prevention (CDC)

Domestic violence, spousal abuse, battering, or intimate partner violence, is typically the victimization of an individual with whom the abuser has an intimate or romantic relationship. The CDC defines domestic violence as "physical violence, sexual violence, stalking, and psychological aggression (including coercive acts) by a current or former intimate partner."

Domestic and family violence has no boundaries. This violence occurs in intimate relationships regardless of culture, race, religion, or socioeconomic status. All healthcare professionals must understand that domestic violence, whether in the form of emotional, psychological, sexual, or physical violence, is common in our society and should develop the ability to recognize it and make the appropriate referral.

Violence Abuse Types

The types of violence include stalking, economic, emotional or psychological, sexual, neglect, Munchausen by proxy, and physical. Domestic and family violence occurs in all races, ages, and sexes. It knows no cultural, socioeconomic, education, religious, or geographic limitation. It may occur in individuals with different sexual orientations.

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• Continuing Education Activity
• Introduction
• Epidemiology
• Pathophysiology
• History and Physical
• Treatment / Management
• Differential Diagnosis
• Pearls and Other Issues
• Enhancing Healthcare Team Outcomes
• Review Questions

Publication types

• Study Guide

EDITORIAL article

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Author Contributions

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

Conflict of Interest Statement

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

Acknowledgments

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

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

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

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

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

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

*Correspondence: Luca Rollè, [email protected]

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

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Peer-reviewed

Research Article

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

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

* E-mail: [email protected]

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

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

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

Roles Validation, Writing – review & editing

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

Roles Methodology, Supervision, Writing – review & editing

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

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

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

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

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

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

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

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

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

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

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

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

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

Introduction

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

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

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

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

Eligibility criteria

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

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

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

Information sources

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

Search strategy

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

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

Study selection

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

Data extraction

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

Risk of bias

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

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

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

Information about studies selected

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

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

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

Results/Key findings from the systematic review

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

Types of social support interventions for intimate partner violence survivor

Survivor- focused social support interventions..

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

Advocacy/ Case management interventions

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

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

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

Advocacy/Case management interventions with a psychotherapy component

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

Community-focused/ network social support interventions

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

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

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

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

Community focused/ network interventions with a psychotherapy component

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

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

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

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

Summary of key findings and recommendations

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

Limitations

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

Conclusions

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

Supporting information

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https://doi.org/10.1371/journal.pone.0235177.s001

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• Open access
• Published: 20 June 2023

A qualitative quantitative mixed methods study of domestic violence against women

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

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

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

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

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

Conclusions

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

Peer Review reports

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

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

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

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

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

Qualitative method

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

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

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

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

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

Quantitative method

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

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

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

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

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

Qualitative results

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

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

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

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

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

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

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

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

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

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

Themes of domestic violence against women

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

Husband’s criminal record

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

Inappropriate age for marriage

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

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

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

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

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

Overdependence

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

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

Bitter memories

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

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

Lack of commitment to different roles

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

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

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

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

Fear and silence

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

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

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

Shame from society

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

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

Hope and trust

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

Efforts for children

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

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

Child-bearing thoughts

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

Lack of effective communication

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

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

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

Harm to children

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

After divorce

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

Social harm

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

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

Non-acceptance in the family

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

Emotional harm

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

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

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

Inappropriate family support

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

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

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

Inefficiency of social systems

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

Undesired training and advice

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

Quantitative results

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Limitations

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

Data Availability

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

Abbreviations

Intimate Partner Violence

Human Immunodeficiency Virus

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Acknowledgements

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

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

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Contributions

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

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Correspondence to Mina Shayestefar .

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This article is resulted from a research approved by the Vice Chancellor for Research of Semnan University of Medical Sciences with ethics code of IR.SEMUMS.REC.1397.182 in the Social Determinants of Health Research Center. The authors confirmed that all methods were performed in accordance with the relevant guidelines and regulations. All participants accepted the participation in the present study. The researchers introduced themselves to the research units, explained the purpose of the research to them and then all participants signed the written informed consent. The research units were assured that the collected information was anonymous. The participant was informed that participating in the study was completely voluntary so that they can safely withdraw from the study at any time and also the availability of results upon their request.

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

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Effects of COVID-19 Shutdowns on Domestic Violence in the U.S.

This chapter examines the impact of COVID-19 shutdowns on domestic violence (DV) in the United States. Despite widespread concerns that pandemic shutdowns could increase DV, initial studies found mixed evidence that varied across data sources and locations. We review the evolving literature on the effects of the pandemic and highlight results from studies that examine multiple measures of DV across a common set of large cities. These studies show that the conflicting early results are due to opposite effects of pandemic shutdowns on two measures of DV in police data: an increase in domestic violence 911 calls and a decrease in DV crime reports. In theory, this divergence can come from either higher DV reporting rates, possibly because of additional media attention to DV and greater third-party calling, or from lower policing intensity for DV crimes. Prior evidence from police data and other sources supports the conclusion that the increase in calls came from greater reporting, while the incidence of criminal DV decreased. Finally, we present new evidence drawing on police and hospitals records from across the state of California to show that DV crimes and hospital emergency department (ED) visits were both lower during pandemic shutdowns.

We acknowledge financial support from the IZA COVID-19 Research Thrust and from the Bill and Melinda Gates Foundation, through the NBER Gender in the Economy Study Group Research Grants on Women, Victimization, and COVID-19. We have no competing interests to disclose. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.

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Domestic Risk Factors, Violence and Marital Dissolution: Evidence from Demographic and Health Survey of India

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The rising divorce rate in developing nations is a cause of concern among social scientists. Though women’s ability to dissolve marriages in response to domestic violence can be observed as an agency, it has long been perceived as undesirable for society. The paper examines the complex association between domestic risk factors, violence, and the likelihood of marital dissolution. Using the fourth round of Demographic and Health Survey data, we unravel these relations in India, where domestic violence is extremely high compared to the divorce rate. We find that divorce incidences are rising among Indian women as a protest against domestic violence towards them. Marital dissolution is more common among the victims of severe physical violence and sexual violence than those of emotional violence or less severe violence. Economic empowerment in terms of land ownership and employment has helped the process of dissolving abusive marriages.

L’augmentation du taux de divorce dans les pays en développement est une source de préoccupation parmi les scientifiques sociaux. Bien que la capacité des femmes à dissoudre les mariages en réponse à la violence domestique puisse être observée comme une agence, elle a longtemps été perçue comme indésirable pour la société. Le document examine l’association complexe entre les facteurs de risque domestiques, la violence et la probabilité de dissolution du mariage. En utilisant les données de la quatrième ronde de l’Enquête démographique et de santé, nous démêlons ces relations en Inde, où la violence domestique est extrêmement élevée par rapport au taux de divorce. Nous constatons que les incidents de divorce augmentent parmi les femmes indiennes en protestation contre la violence domestique à leur égard. La dissolution du mariage est plus courante parmi les victimes de violence physique grave et de violence sexuelle que parmi celles de violence émotionnelle ou de violence moins grave. L’autonomisation économique en termes de propriété foncière et d’emploi a aidé le processus de dissolution des mariages abusifs.

El creciente índice de divorcios en los países en desarrollo es motivo de preocupación entre los científicos sociales. Aunque la capacidad de las mujeres para disolver matrimonios en respuesta a la violencia doméstica puede ser observada como una agencia, ha sido percibida durante mucho tiempo como indeseable para la sociedad. El documento examina la compleja asociación entre los factores de riesgo domésticos, la violencia y la probabilidad de disolución del matrimonio. Utilizando la cuarta ronda de datos de la Encuesta Demográfica y de Salud, desentrañamos estas relaciones en India, donde la violencia doméstica es extremadamente alta en comparación con la tasa de divorcio. Encontramos que los incidentes de divorcio están aumentando entre las mujeres indias como protesta contra la violencia doméstica hacia ellas. La disolución del matrimonio es más común entre las víctimas de violencia física severa y violencia sexual que entre las de violencia emocional o violencia menos severa. El empoderamiento económico en términos de propiedad de tierras y empleo ha ayudado en el proceso de disolver matrimonios abusivos.

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Data Availability

This analysis was based on the National Family Health Survey data from India available in the public domain: https://dhsprogram.com/what-we-do/survey/survey-display-355.cfm .

We refer to both divorce and separation as divorce henceforth.

The United Nations ranked India 127th out of 160 countries in the Gender Inequality Index in 2017 (United Nations 2020b ) and 112th in the annual Gender Gap Index for 2020 among 153 countries (World Economic Forum 2020 ) based on economic participation and opportunity, educational attainment, health and survival, and political attainment.

Therefore, divorce and separation indicate a willingness to exit the marriage.

93% of the marriages in India are arranged. In contrast, only 3% of them are love marriages. Another 2% are love-cum-arranged marriages, meaning their families set up the relationship, and then the couple agreed to marry (Rukmini 2021 ).

Kelebek-Küçükarslan and Cankurtaran ( 2022 ) find that most divorce occurs within 5 years of marriage.

Among the women subjected to severe violence in India, 43.5% had bruises; 19% had eye injuries, dislocations, or burns; 14.8% had wounds, broken bones, or other serious injuries; 6.3% had severe burns. Almost 50% had gone through either of these due to their husbands’ actions (Author’s calculation from DHS-4 dataset).

By ‘opposing forces,’ we mean the factors that motivate abused women towards marital dissolution can be divided into two contradictory parts. Though it looks pretty simplistic that the victims of domestic violence are more likely to dissolve their marriages than their counterparts, the process is not very easy, especially in patriarchal societies. There are several cultural and psychological barriers to moving out of marriage, which we have discussed in detail. These barriers act as a counterforce that might discourage the victims from dissolving their abusive marriages and bearing with the violence.

Clubbing them together increases the sample of women who have been able to dissolve their marriages. It is important because the incidences of separation and divorce individually are still quite low in India.

Marriage in India often occurs among equals in terms of ethnicity, region of residence, household wealth, and household size. Therefore, we do not expect the divorced or separated women to be systematically different from those currently married in terms of the socio-economic parameters pre- and post-marriage. However, incidents of domestic violence and divorce might correlate with such characteristics.

The data agency (International Institute of Population Sciences) identifies the dataset to be a true representative only at the state level, though they have provided district identifiers. Moreover, there are 640 districts in the dataset, with some districts having less than 50 samples. In comparison, we have 36 states, and the sample size from each state is proportional to each state’s actual population; therefore, all states are adequately represented with proper weightage in the dataset. Hence, we consider state-fixed effects instead of district-fixed effects. Also, since most states are formed on the basis of differences in linguistics and culture, we presume controlling for state-fixed effects captures the unobserved heterogeneities in culture and norms surrounding domestic violence and marital dissolution.

We prefer to cluster the standard errors at the district level to control for any plausible inter-district heterogeneity. Clustering the standard errors at the smallest group identifier is also an established norm. Clustering the standard errors at a larger dimension—state increases the significance of domestic violence marginally without affecting the effect size. Since the coefficients of DV are already highly significant, we prefer to cluster the standard errors at the district level, which is a granular identifier than the state.

The regression is done using a Conditional Mixed Process (CMP) estimator package written and created by Roodman ( 2011 ). This estimator can be applied in models where the structure of the data shows a truly recursive data-generating process. The CMP approach assumes that the errors in all the equations follow a Gaussian distribution and that the system of Equations is perfectly recursive.

121 languages are spoken in India.

The summary statistics of the control variables and each of the detailed components of DV are presented in Online Appendix Tables A1 and A2, respectively.

Kernel density plots of the various constituent dimensions of DV are available in Fig. A1 in the Online Appendix.

An illustrative graph showing the incidence of at least one of the items in each constituent dimension is available in Fig. A2 in the Online Appendix.

Conducting several heterogeneity analyses (for detailed discussion, see Online Appendix), we identify secondary education and social mobility mediate divorce incidences. The likelihood of divorce is significant among abused women belonging to the advantaged caste group. The presence of a male child in the household reduces the likelihood of divorce among Indian women. The results are presented in Online Appendix Tables A3 and A4.

We have conducted an extensive sensitivity analysis and other robustness checks to validate these findings. These are discussed in Online Appendix.

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Acknowledgements

We thank the unknown reviewers and Professor Tanya Jakimow, editor of The European Journal of Development Research, for helpful comments on earlier versions of the paper. We thank the International Institute of Population Sciences (IIPS) and DHS forum for providing the DHS-4 dataset.

The author did not receive support from any organization for the submitted work.

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Maiti, S.N. Domestic Risk Factors, Violence and Marital Dissolution: Evidence from Demographic and Health Survey of India. Eur J Dev Res (2024). https://doi.org/10.1057/s41287-024-00628-x

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The Multicultural Community Liaison Officer (MCLO) Program is designed to combat domestic violence in the Australia.  This presentation briefly discusses the challenges and achievements of MCLO. 

http://digitalcommons.law.yale.edu/ylsd/3/

This thesis is born of the question: why do women suffer domestic violence disproportionately to any other group? Why does it continue, in the same form, with the same degree of pain, without rebate? And, if the same harm occurs over and over again, consistent through generations and uniform across borders, why then has the international community not yet developed effective means to address it? This thesis attempts to find a legal answer. This is prefaced, however, by the acknowledgement that the law is only one tool in an array of mechanisms, such as health, economics, and politics, which, if properly combined, could alleviate the pain and difficulties experienced by many victims of domestic violence. The area of law to which I look is international human rights law. My initial motivation for considering public international law arose from the repetition of similar forms of domestic violence around the globe. All over the world women suffer the same type of violence at the hands of their intimate partners and they endure the same feelings of helplessness and isolation when looking to the state for protection. If such violence is universal, it seems then, so too should be the solution. I propose in this thesis that international law, if properly fashioned, can be used effectively as part of this solution. In particular, I maintain that the authoritative enunciation of a norm against domestic violence in international law can improve the way states address domestic violence. I do not propose that individual abusers should be tried by international law. My focus instead is on the extent to which states fail consistently to alleviate domestic violence. This is important because many legal systems appreciate neither the exigency of extreme forms of domestic violence, nor the extent to which women as a group are disproportionately victims of this violence. The result of this lack of appreciation is an almost universal failure to police, prevent and punish domestic violence effectively.3 Due to the socialized normalcy of domestic violence, very few cases are reported or actually prosecuted. Where prosecutions do proceed, victims will often drop their complaints either because they have reconciled with, or because they fear recrimination from, their abuser. Given the disjuncture between the reality of domestic violence and the inefficacy of many legal systems to address it, a revision of the law vis-à-vis domestic violence is needed. Both national and international legal systems are in need of change. This thesis proposes that the international community should adopt a clear and authoritative articulation of a legal right against extreme and systemic forms of domestic violence and a corresponding duty of states to help remedy such violence. This proposition is made on the basis that international law currently does not contain an effective articulation of this right, and that adopting effective global standards in international law for addressing such violence would help improve state enforcement of this right. Under the current state of international law, it is difficult to convince states to prioritize its resources and infrastructures to protect abused women. Articulating clear and effective global standards in international law for addressing extreme forms of domestic violence would provide an important and practical benchmark against which domestic state legislation could be evaluated and re-shaped. Formulating such global standards could place pressure on states to take basic remedial steps against such violence, such as enacting legislation that allows for restraining orders to be made at the same time as a maintenance order, or creating accessible shelters, which will accommodate the divergent needs of women, including their children.

http://odhikar.org/fairness-creams-skin-colour-based-discrimination-and-violence-against-women-time-to-stop/

Ruma (not her real name), a school teacher by profession and a mother of two, living in Dhaka, married Mainul eight years ago. Soon after, Mainul started harassing her, calling her an ‘ugly’ woman – because of her dark complexion.  Her mother-in-law and other members of her husband’s family used to verbally abuse her almost every day, saying that her skin is ‘moyla’ (dirty); and expressed their anger and frustration, and thought that Mainul had bad luck as he was not able to marry a ‘beautiful’ woman–meaning a fair-complexioned woman. Ruma tried very hard to be seen as beautiful in the eyes of her husband and in-laws and experimented to see how she could look fairer. She started buying brand name fairness creams, hoping to make her skin lighter as she started to believe that fair meant lovely, as the advertisements say. She regularly watched fairness cream advertisements on television, read about them on bill boards and newspapers and wanted to be as fair as the models in the advertisements. Unfortunately, nothing really worked or showed much of a result. Her husband and in laws demanded a huge amount of dowry repeatedly – apparently as a retaliation for her darker skin.

http://www.civicresearchinstitute.com/online/issue.php?pid=18

*The full article is available through this link. This article may be available free of charge to those with university credentials.

The leading professional report devoted exclusively to innovative programs, legal developments, and current services and research in domestic violence law and prevention.

Domestic Violence Report  keeps you up-to-date on...

• Successful programs for prevention, protection, enforcement, prosecution, aftercare and corrections
• New legislation, court decisions, regulatory and policy developments
• Practical intervention strategies
• Criminal and civil litigation
• Medical and psychological treatment of victims, abusers and their children

http://odhikar.org/are-you-a-silent-observer-of-dowry-and-related-violence/

Every year many women in Bangladesh are killed and physically abused and many commit suicide because of the the vicious dowry practice and related violence. According to the rights organisation Odhikar, at least 2,800 women were killed, 1,833 were physically abused and 204 committed suicide because of dowry-related violence between 2001 and July 2014.

By analysing the overall dowry situation, reported statistics indicate that it is only the tip of the iceberg. Majority of the victims continue to tolerate abuse, if they are not killed, all through their married life and never report it. The main reasons behind tolerating or not reporting such abuse is that they are either financially incapable of going away and protecting themselves from their abusive husbands or they are not welcome by their poverty-stricken or stigmatised parental families.

http://www.ncbi.nlm.nih.gov/pubmed/24777256

Exposure to intimate partner violence (IPV) has negative consequences for children's well-being and behavior. Much of the research on parenting in the context of IPV has focused on whether and how IPV victimization may negatively shape maternal parenting, and how parenting may in turn negatively influence child behavior, resulting in a deficit model of mothering in the context of IPV. However, extant research has yet to untangle the interrelationships among the constructs and test whether the negative effects of IPV on child behavior are indeed attributable to IPV affecting mothers' parenting. The current study employed path analysis to examine the relationships among IPV, mothers' parenting practices, and their children's externalizing behaviors over three waves of data collection among a sample of 160 women with physically abusive partners. Findings indicate that women who reported higher levels of IPV also reported higher levels of behavior problems in their children at the next time point. When parenting practices were examined individually as mediators of the relationship between IPV and child behavior over time, one type of parenting was significant, such that higher IPV led to higher authoritative parenting and lower child behavior problems [corrected]. On the other hand, there was no evidence that higher levels of IPV contributed to more child behavior problems due to maternal parenting. Instead, IPV had a significant cumulative indirect effect on child behavior via the stability of both IPV and behavior over time. Implications for promoting women's and children's well-being in the context of IPV are discussed.

http://www.pearsonhighered.com/educator/product/Heavy-Hands-An-Introduct...

Heavy Hands, Fifth Edition, provides an authentic introduction to the crimes of family violence, covering offenders and offenses, impact on victims, and responses of the criminal justice system. This established text is essential reading for those considering careers in criminal justice, victim advocacy, social work, and counseling. Gosselin draws on extensive field experience and uses real-life examples to provide sharp insight into how and why abuse occurs and its effects on abuse survivors. The text’s accessible language and effective learning tools keep students engaged and motivated, while its practical, real-world focus helps students connect text material to the world around them. 

http://dhsprogram.com/publications/publication-DHSQMP-DHS-Questionnaires...

**Go to the publication " DHS6_Module_Domestic_Violence_6Aug2014_DHSQMP"

This document is part of the Demographic and Health Survey’s DHS Toolkit of methodology for the MEASURE DHS Phase III project, implemented from 2008-2013.

This publication was produced for review by the United States Agency for International Development (USAID). It was prepared by MEASURE DHS/ICF International.

http://www.pulp.up.ac.za/edited-collections/strengthening-the-protection...

Strengthening the protection of sexual and reproductive health and rights in the African region through human rights uses rights-based frameworks to address some of the serious sexual and reproductive health challenges that the African region is currently facing. More importantly, the book provides insightful human rights approaches on how these challenges can be overcome. The book is the first of its kind. It is an important addition to the resources available to researchers, academics, policymakers, civil society organisations, human rights defenders, learners and other persons interested in the subject of sexual and reproductive health and rights as they apply to the African region. Human rights issues addressed by the book include: access to safe abortion and emergency obstetric care; HIV/AIDS; adolescent sexual health and rights; early marriage; and gender-based sexual violence.

Myanmar Activists Demand Law to Ban Violence Against Women

This article from The New York Times explores Myanmar's lack of infrastructure to combat violence against women and children. 

http://euromedrights.org/publication/violence-against-women-in-the-conte...

On the occasion of International Women’s Day (8th of March), the Euro Mediterranean Human Rights Network (EMHRN) published today its regional report “Violence against women in the context of political transformations and economic crisis in the Euro-Mediterranean region; trends and recommendations towards equality and justice”.

This report alerts that violence against women has dramatically increased in the Euro-Mediterranean region during the recent years,  showcasing key patterns of violence against women, through case studies from Egypt, Syria, Tunisia, Libya, France, Cyprus and Spain.

The report also underlines the alarming increase and severity of sexual violence in countries such as Libya, Syria and Egypt mounting to sexual terrorism.  In Egypt, women protestors were subjected to systematic and seemingly planned harassment and gang rapes in Tahrir Square. In Syria, women and are subjected to trafficking and sexual exploitation girls in refugee camps.

Subject : This research memorandum presents key findings from desk research conducted in January and February 2014, on the barriers to instituting appropriate VAW laws against domestic violence (DV), and to effectively implementing them in three countries in Asia (China, Pakistan, and Sri Lanka).

Background and Cross-Cutting Findings: China, Pakistan, and Sri Lanka have all ratified CEDAW; however, both China and Pakistan have not passed the Optional Protocol to CEDAW. Research found four cross-cutting barriers impeding the institutionalization of appropriate VAW laws against DV in these three countries:

1)  The predominant public discourse on DV is fragmented. As a result, an overall sense of urgency and severity of the problem is not felt among key stakeholders in all 3 countries.

2)  Other national policies regarding housing, marriage, fertility, migration, etc. undermine both the international (CEDAW) legal framework, and the national policies set up for service provision and protection across all three countries.

3)  There is an overall lack of appropriate resource allocation among all 3 countries for comprehensively implementing appropriate VAW laws against DV. A large body of evidence suggests multiple root causes for VAW-DV, and States disagree on where and how to allocate resources to VAW-DV (prevention, intervention, prosecution, and protection).

4)  Incomparable and unreliable data is the 4 th major barrier to instituting appropriate VAW laws against DV both internationally through CEDAW, and nationally within all 3 countries. Transparency of data collection methodologies is also a noted concern. 

Violence against Women (VAW) is a pervasive, global human rights violation. This research memo discusses the current state of VAW in Australia, and the Australian Governments proposed National Action Plan (NAP) addressing VAW across Australia’s diverse community. Noting that women’s rights are not fully protected by the Commonwealth and revealing the current appalling statistics around domestic and sexual violence against Australian women, the memo then provides insight on Indigenous women and VAW, followed by a deeper look at NAP. Finally, after a brief look at the recent study tour of Australia by the Special Rapporteur on Violence against Women, Australia’s commitment to addressing VAW is discussed with reference to reporting for CEDAW and UPR. The memo then considers the Special Rapporteur’s study tour in light of the election of a new federal government. It then concludes that if the state shows genuine commitment to its people, and to its obligations under human rights treaties, the onus ultimately rests on it to work with civil society to make use of the human rights mechanisms and seek to honestly and with purpose examine their human rights status and develop and adopt sustainable positive change. 

https://www.ncbi.nlm.nih.gov/pubmed/24164531

Intimate partner violence (IPV) has detrimental consequences for women's mental health. To effectively intervene, it is essential to understand the process through which IPV influences women's mental health. The current study used data from 5 waves of the Women's Employment Study, a prospective study of single mothers receiving Temporary Assistance for Needy Families (TANF), to empirically investigate the extent to which job stability mediates the relationship between IPV and adverse mental health outcomes. The findings indicate that IPV significantly negatively affects women's job stability and mental health. Further, job stability is at least partly responsible for the damaging mental health consequences of abuse, and the effects can last up to 3 years after the IPV ends. This study demonstrates the need for interventions that effectively address barriers to employment as a means of enhancing the mental health of low-income women with abusive partners.

http://jbp.sagepub.com/content/40/6/563

Racial microaggressions are often unintentional and subtle forms of racism that manifest in interpersonal communications, behaviors, or environments. The purpose of this study was to explore the presence of racial microaggressions within domestic violence shelters and to understand how women respond to them. Using a phenomenological approach to data collection and analysis, 14 Black women from 3 different shelters were interviewed. Twelve women reported experiencing at least one racial microaggression, although few identified the experience as racist. Additional themes were also examined to understand why women did not identify their experiences of racial microaggressions as racist. Implications for research and practice are discussed.

http://www.unwomen.org/en/digital-library/publications/2010/1/ending-vio...

Can be found under the 'View Online' portion of the site

Ending violence against women is at the heart of the mandate of the United Nations Development Fund for Women (UNIFEM). The international community has an unprecedented opportunity to make meaningful progress in tackling this universal human rights violation. Within this context, UNIFEM has developed its Strategy 2008-2013 to end violence against women and girls, an overview of which is presented here. 

http://www.larepublica.ec/blog/internacional/2013/02/15/bolivia-enfrenta...

La Paz, 15 feb (EFE).- Bolivia ha asumido el reto de frenar la hasta ahora reinante impunidad en los crímenes contra las mujeres con una ley que castigará con dureza la violencia machista, tras el asesinato esta semana de una periodista a manos de su esposo policía.

http://www.echr.coe.int/sites/search_eng/pages/search.aspx#{"fulltext":["factsheet: Violence against women"],"subcategory":["factsheets"]}

Document summaries the court’s case law in relation to domestic violence, genital mutilations, rape, violence and social exclusion, violence at the hands of state authorities and violence in public places.

12 cases dealing with domestic violence refer to the violation of different articles of the European Convention of human rights, namely of the article 2 on the right to life, article 13 on the right to an effective remedy, article 8 on the right to respect for family life, prohibition of inhuman or degrading treatment and article 14 on prohibition of discrimination. Both cases relating genital mutilation against Austria and Ireland were declared inadmissible for the reasons of insufficient protection of the young Nigerian girls that should be provided by their parents. 5 cases dealing with rape reaffirmed the violation of articles 3 on the prohibition of inhuman or degrading treatment or punishment, article 8 and artcile 13 mentioned above. The case of violence and social exclusion confirmed violation of the article 3 whereas the violence at the hands of state authorities brought forward violation of the article 3, artcile 14 and article 11 on freedom of assembly. The last case presented in the factsheet deals with the violence in public places giving declaring the violation of the article 3 and article 8.

http://www.statcan.gc.ca/pub/85-002-x/2013001/article/11766-eng.htm

For the past three decades, Federal-Provincial-Territorial (FPT) Ministers responsible for the Status of Women have shared a common vision to end violence against women in all its forms. Violence against women inCanada is a serious, pervasive problem that crosses every social boundary and affects communities across the country. It remains a significant barrier to women's equality and has devastating impacts on the lives of women, children, families and Canadian society as a whole.

This report marks the third time that the FPT Status of Women Forum has worked with Statistics Canada to add to the body of evidence on gender-based violence. Assessing Violence Against Women: A Statistical Profile was released in 2002 and was followed by Measuring Violence Against Women: Statistical Trends 2006. The 2006 report expanded the analysis into new areas, presenting information on Aboriginal women and women living in Canada's territories. The current report maintains this important focus and also includes information on dating violence, violence against girls and violence that occurs outside of the intimate partner/family context. It also shows trends over time and provides data at national, provincial/territorial, and census metropolitan area levels. A study on the economic impacts of one form of violence against women, spousal violence, is also presented.

http://mptf.undp.org/document/search?fund=WAV00&document_areas=fund,proj...

Please enter "Consolidated Report China" into the search engine in order to find this document.

The United Nations Trust Fund in Support of Actions to Eliminate Violence against Women (UN Trust Fund to EVAW) is a leading multilateral grant-making mechanism devoted to supporting national and local efforts to end violence against women and girls. Established in 1996 by a UN General Assembly Resolution, the UN Trust Fund to EVAW is now administered by UN WOMEN. In 2008, the UN Trust Fund to EVAW began awarding grants on a competitive basis for Joint Programmes submitted by UN Country Teams. 

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NCDVTMH’s research utilizes qualitative, quantitative, and survivor-centered methods to build knowledge on the complex connections among domestic and sexual violence (DSV), trauma, mental health, and substance use.

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Many survivors experience coercion specifically related to their mental health or use of substances as part of a broader pattern of abuse and control, tactics known as mental health and substance use coercion. Beginning with its 2014 report on experiences of Mental Health and Substance Use Coercion among National Domestic Violence Hotline callers, NCDVTMH has been at the forefront of expanding the knowledge and understanding of these pervasive forms of abuse.

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• Iran J Psychiatry
• v.16(1); 2021 Jan

Population-Based Approaches to Prevent Domestic Violence against Women Using a Systematic Review

Ebrahim babaee.

1 Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Community and Family Medicine Department, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.

Arash Tehrani-Banihashem

Mehran asadi-aliabadi, arghavan sheykholeslami, majid purabdollah.

2 Department of Nursing, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran.

Arezou Ashari

Marzieh nojomi.

3 Department of Sociology and Anthropology, Nipissing University, North Bay, Ontario, Canada.

Objective: In this systematic review, we aimed to evaluate the existing strategies and interventions in domestic violence prevention to assess their effectiveness.

Method : To select studies, Pubmed, ISI, CINAHL, PsycINFO, Cochrane, Scopus, Embase, Ovid, Science Direct, ProQuest, and Elsevier databases were searched. Two authors reviewed all papers using established inclusion/ exclusion criteria. Finally, 18 articles were selected and met the inclusion criteria for assessment. Following the Cochrane quality assessment tool and AHRQ Standards, the studies were classified for quality rating based on design and performance quality. Two authors separately reviewed the studies and categorized them as good, fair, and poor quality.

Results: Most of the selected papers had fair- or poor-quality rating in terms of methodology quality. Different intervention methods had been used in these studies. Four studies focused on empowering women; 3, 4, and 2 studies were internet-based interventions, financial interventions, and relatively social interventions, respectively. Four interventions were also implemented in specific groups. All authors stated that interventions were effective.

Conclusion: Intervention methods should be fully in line with the characteristics of the participants. Environmental and cultural conditions and the role of the cause of violence are important elements in choosing the type of intervention. Interventions are not superior to each other because of their different applications.

Domestic violence (DV) can be a major health problem ( 1 ) and one of the causes of death and disability in women that depends on the local culture where the woman lives ( 2 ). Violence against women as a health concern is increasing ( 3 ). This issue will increase the demand for health services ( 4 ). DV can be physical, sexual, economic, and psychological ( 5 ). Scientific evidence suggests that DV causes physical injuries, gastrointestinal disorders, chronic pain syndrome, depression, anxiety, suicidal behaviors, and pregnancy problems, such as unwanted pregnancy, illegal abortion, and preterm labor ( 6 ).

Besides, this phenomenon can affect children in the future. Studies show that the risk of behavioral problems and emotional injuries in children who experience violence increases in the future ( 7 ).

According to a recent WHO report, 37% of Eastern Mediterranean countries have the highest rate of violence against women ( 8 ). Surveys show that the prevalence of violence against women varies from 27% to 83% between different communities, and this diversity may be due to cultural differences ( 9 , 10 ).

Recent studies in Iran show that about 66% of married women during the first year of their marriage have experienced some form of violence by their current or ex-spouse ( 9 ).

Although the problem of DV is very serious, it can be well screened for routine symptoms of DV during general health services ( 11 ). The ultimate goal is to stop the violence before it begins. For this purpose, it is important to understand the factors that trigger violence. Studies show that traditional misconceptions, low literacy levels, poor knowledge about women's rights, and lack of social support for abused women can lead to various forms of violence against women ( 1 ). Violence tracking is the first step in controlling DV ( 11 ). In contrast, any delay in the early detection of this phenomenon can cause serious harm to the well-being of women and children. Based on previous systematic review studies in Iran, various interventions and prevention methods have been used to control DV and overcome this social dilemma.

Despite recent information about the epidemiology of violence based on recent studies, there is still less evidence-based approaches in primary health care services for the prevention and control of DV against women. The assessment of different interventions to improve the well-being of affected women is still a key research priority ( 12 ). Thus, there is an urgent need to design complementary research with very robust and comprehensive research methods to evaluate the effectiveness of existing intimate partner violence (IPV) interventions. According to the available documentation, serval interventions have been designed to combat violence against women. Some of these interventions are specific to a particular type of violence. But nowadays, according to the documentation, there is a need for implementation of social support programs and interventions for women, children, and their partners. Also, it seems few randomized control trials (RCT) as a robust design have been performed in this field, and studies have reported that the results of the intervention were effective, but the quality of these studies should be assessed.

Finally, methods should be selected and designed to be effective, simple, accessible, and practicable for different demographic groups and health care settings. According to the mentioned evidence-based facts, in this research project, we aimed to evaluate the existing strategies and interventions in DV prevention, using a systematic review, to assess their effectiveness to choose the best applicable and effective methods.

Materials and Methods

Search Strategy and Study Screening Process

This systematic review was conducted in 2019. To select appropriate studies, an extensive search was conducted. Pubmed, ISI, CINAHL, PsycINFO, Cochrane, Scopus, Embase, Ovid, Science Direct, ProQuest, and Elsevier databases were searched to cover published articles from 2000 to 2019.To select studies, we used the keywords such as Domestic Violence Family, Violence Partner Abuse, Intimate Partner Violence, Abused, and Women. The type of included studies was intervention clinical trial, randomized controlled trial, and prevention trials. Therefore, these terms were used as keywords as well. Also, references of the selected articles were searched manually. Two researchers conducted the resource search process separately and eventually coordinated the selected studies. In the first searching phase, 921 articles were selected. Using manual searching, 58 related articles were found. Finally, 979 articles were selected. Duplicating articles were detected by one researcher and supervised by a subsequent researcher using EndNote (X8) software. The number of articles after this process reached 927. Then, the title and abstract of articles were evaluated based on inclusion criteria. Consequently, 78 articles met the inclusion criteria. By reviewing the full-texts of articles, 44 were excluded due to inappropriate content. Out of the remaining 34 articles, 16 were excluded considering their designs. Finally, 18 eligible studies were reviewed. Finding and Screening Flowchart were plotted using the PRISMA Flow Diagram Tool ( 13 ), which is reported in Figure 1.

Inclusion and Exclusion Criteria

We considered all studies with a RCT design, as eligible for inclusion if they examined PICO as a tool ( Table1 ) for developing a search strategy for identifying potentially relevant studies in any topic about DV with prevention approach. We applied other restrictions in this review, such as studies related to the English language and their publication time was from 2000 to 2019. Also, articles whose full texts were not accessible were excluded.

Description of PICO Criteria Applied to the Selecting Studies

Quality Evaluation of Selected Articles (Risk of Bias Assessment)

The Cochrane Risk-of-Bias Tool was used for the qualitative evaluation of the articles, considering the design of the papers that had the RCT methods ( 14 ). This tool has 7 criteria to assess the quality of articles in terms of bias. Articles were evaluated by 2 researchers using this tool separately. There was a 25% inconsistency between both researchers. To resolve the disagreement, a third-person re-evaluated and judged the disputes. Using the instructions of the Cochrane quality assessment tool, the studies were classified for quality rating, based on design and performance quality according to the AHRQ Standards. Therefore, the studies were categorized into 3 subgroups: good, fair, and poor quality ( 14 ). Table 2 illustrates these subgroups. Thereafter, data were entered into Review Manager Software (version: 5.3). The results are presented as the risk of bias graph (Figure 2) and the summary of the risk of bias graph (Figure 3).

Summary of Characteristics Domestic Violence Intervention Studies

PRISMA Flowchart Screening and Selection of Studies

Assessment of Methodological Quality of Selected Studies (Risk of Bias Graph)

Assessment of Methodological Quality of Selected Studies (Risk of Bias Summery)

As noted, after a comprehensive search and qualitative evaluation of studies, finally 18 articles were selected for evaluatation. Based on the included articles, to prevent and control the violence against women in different countries, different models have been applied to various groups. In included articles, DV against women has been considered physical, emotional, sexual, financial, etc, by the wife or partner of the woman. The results of the studies show various screening tools for violence. For example, some of these tools were used in primary health care ( 15 ), some for pregnant women ( 16 ), and some for men ( 17 ). Of the final selected papers, the oldest was in 2003 and the newest in 2018. All final selected articles had an RCT design. Based on selecting the population to perform the interventions, there were various target groups and intervention methods. Most studies focused on empowering women. In 3 studies, the internet sites had been applied to conduct interventions. Four studies had also evaluated economic interventions and financially empowerment methods in couples. Two studies had used kinds of social intervention. Follow-up times were different between studies, and in some studies, the follow-up period was 4 years. In all selected studies based on the study goal, a preventive intervention method was considered for the study target group. The control group consisted of those who either did not receive any intervention or received another intervention to compare the efficacy of the method applied to the intervention group or were under routine care and treatment. Also, it was found that to assess the effectiveness of interventional methods, the amount of inflicted violence on women was either self-reported or measured using standard measurement tools. Evaluation of the design and quality of these studies based on the relevant evaluation checklists indicated that all studies had strengths and weaknesses in the method of implementation and process of the research. Most of the papers were at the fair or poor-quality level in terms of methodology quality rating. The summary of the characteristics of reviewed studies in this project that met the inclusion criteria was reported in Table 2 .

Summary of Included Studies

Women Empowerment Interventions

In 4 included studies in this systematic review, women empowerment interventions were used to combat DV. The first study in this field was done in 2012 in china ( 18 ). Women aged 18 years or older with a positive screening for DV (n = 200) and small children were recruited to participate. The intervention was a community-based advocacy program, consisting of 2 components: empowerment and telephone social support. The intervention aimed to increase abused women’s safety and enhance their problem-solving ability. After the intervention, in the treatment group, the mean of safety behavior was increased almost a 5-fold significantly. The other study by Hannah in 2018, reported the reducing IPV in Spanish-Latinas speaking women ( 19 ). Inclusion criteria were having a history of IPV in the past 2 years and having a child of 4 to 12 years. The intervention was a community-based Moms’ Empowerment Program (MEP). MEP was used as an interpersonal relationship to empower women to increase women’s self-efficacy and reduce their self-blame. Although the sample size was not significant (intervention group = 55, control group = 40), the intervention ( 36 ) was significantly effective in the treatment group, especially physical violence. Because of the selection of specific groups of participants, the generalizability of the results was controversial. In a study by Jhumka Gupta, women over 18 years with at least 1-year marriage duration were involved ( 20 ). The intervention in this study was relatively different from the 2 previous studies. The control arm (n = 421) received VSLA (village savings and loan associations) and the treatment arm (n = 513) received VSLA and an 8-session gender dialogue group (GDG). The GDGs were developed between men and women to address household gender inequities and communication. Despite some methodological limitations, the results of this study were also effective in the VSLA-GDG group, but it was not significant. Another community-based intervention to empower women was in 2015 by Sandra ( 21 ). The intervention was a 10 session community- based therapeutic group program. The study included women who had a physical conflict and their children aged 6 and 12 years. Participants were categorized into 3 groups: mother-plus-child (n = 61), child-only (n = 62), and comparison group (n = 58). The intervention focused on enhancing women's skills, strengthening them in connecting to social support, and also empowering children to improve children's attitudes about DV to manage this health problem. This intervention with good methodological status like previously ( 37 ) had a moderate change in IPV prevention.

Interventions for Specific Groups

Out of 18 selected articles, in 5 the interventions were applied to specific groups. The applied interventions were also specific. In one study, the name of the intervention was the Green Dot program ( 22 ). In this method, male and female students (n = 89 707) were involved and received training about the types of violence (most sexual violence). These students had to train their friends as leaders. Although the study had a methodological limitation, at the end of the study, the different types of violence (especially sexual violence) and alcohol or drug-facilitated sex in schools reduced significantly. In the next study by Louisa Gilbert, drug user women were target groups ( 23 ). The aim was to assess the impact of RPRS (Relapse Prevention and Relationship Safety) to reduce IPV and prevent drug use in addicted women. According to experts, RPRS is suitable for women who experience different levels of violence and have multiple partners. The RPRS enables participants to avoid IPV and drug use by behavior changes and training suitable negotiation methods. After the intervention, in the RPRS group, about 5.3 times reduction in physical and sexual violence and 6 times in psychological violence was obtained. Another interesting study was applying religious methods (Happy Muslim Family Activities) to reduce DV. The study was conducted by Kasetchai Laeheem in 2017( 24 ). In this study, certain religious norms and practices have been used as an intervention in Thailand's Muslim population to control violence against women. This method used Islamic methods and teachings to change the behavior of the couples, improve their attitude, and reinforce their morality. Despite the limitations, violence in this study was also reduced significantly in the intervention group. In the fourth study, Jennifer et al in 2012 examined the effect of BALL intervention (Building A Lasting Love Intervention) to reduce violence on young African American pregnant girls (n = 72)( 25 ). This program focused on the signs of healthy versus unhealthy romantic relationships, personal relationship skill, and problem-solving techniques. Findings indicated that the program had some impact on IPV reduction in the treatment arm. In the last study, Jamila Mejdoubi evaluated the effect of nursing home care intervention to IPV control on 237 pregnant women ( 26 ). Women received approximately 50 nurse home visits during pregnancy, first-year, and second-year life of the child by trained nurses. During each home visit, the health status of the mother and child, mitigation of risk factors for IPV, and informing about consequences of IPV were intended. At the end of the study, about 50% reduction in violence (sexual, physical, and psychological) was obtained in the intervention group.

Internet Based Interventions

In 3 included studies, the internet-based interventions were applied. In the study of Jane Koziol-McLain conducted on 186 women aged 16 years and over, the study aimed to test the efficacy of a web-based safety decision aid to reduce IPV exposure by improving women's mental health ( 27 ). Participants were followed up for 1 year, and the study discovered that intervention was effective in reducing violence and depression symptoms. The next study in 2017 by Nancy E. Glass was conducted using the same methodology and yielded similar results ( 29 ). Other online intervention (KOCH) in 2017 by Joon Choi was designed to examine the impact of a short intervention for preventing and addressing IPV ( 28 ). About 55 Korean-American religious leaders were included in the study. The KOCH aimed to increase self-efficacy, knowledge of IPV, and improve attitudes that support IPV. After the 3-month follow-up, findings indicated that the intervention was effective and knowledge of clergy and their attitudes against IPV increased significantly.

Financial Interventions

Four studies have used financial interventions to reduce IPV. The first intervention (IMAGE) by Paul M Pronyk in 2005 aimed to assess a structural intervention on women aged 14-35 years in 8 matched villages ( 30 ). There were 3 groups: women who applied for loans (n = 843), women who were also living with loans applied women (n = 1455), and randomly selected women from that area (n = 2858). The intervention consisted of income-generating activities, gender roles, cultural beliefs, relationships, and IPV facts training curriculum. At the end of the study, the experience of IPV either physical or sexual reduced by 55%, and household economic wellbeing along social capital increased. The small number of clusters, short duration of follow-up, and biased reporting were several limitations of the study. The next intervention (Mashinani) by Clea Sarnquist was a woman empowering program through a combination of formal business training, microfinance, and IPV reduction activities ( 31 ). Women aged 18 years or older who were victims of DV were included. Women received their first loan and began their business activities according to their job plan. After 4 to 5 months of follow-up, the results showed that interventions affected increasing daily profits and decreasing DV. Another study by Kathryn L in 2015 was slightly different in terms of intervention and subjects ( 32 ). Researchers hypothesized that interventions on reducing IPV and economic abuse are not more effective on women married as child brides (<17 years). Women aged 18 years and older with no previous microfinance experience were eligible. The intervention aimed at the reduction of IPV and economic abuse using gender equality promotion activities. After the intervention, most forms of IPV were lower among women married as adults, and the study showed that interventions were less effective in women who are married at an early age. The last study by Anita Raja (CHARM intervention) in 2017 has particularly focused on women's economic empowerment ( 33 ). This research involved longitudinal examinations of women's financial independence and its associations with consequent incident IPV. The intervention was economic programs and gender equity training sessions. Eligible couples were women over 15 years with husbands aged 18-30 years. Finally, findings indicated that women's economic conflict with owning a bank account and involvement of married women with their husbands in business can reduce the occurrence and recurrence of IPV.

Other Interventions

Intervention in 2 studies was nearly social. The first study (SASA) by Tanya Abramsky in 2012 emphasized prevention violence and HIV/AIDS in women in African countries ( 34 ). SASA intervention used a community mobilization approach by changing the community attitudes, norms, behaviors, and ending of gender inequality and societal misconceptions to prevent violence against women. Participants in the study were men and women aged 18 to 49 years. After 4 years, in the intervention group, attitudes improved toward violence, and social support responses to helping affected women increased. The ESID intervention was another social method by Cris M. Sullivan in 2003 ( 35 ). In this intervention, the role of social professionals by making innovations was crucial. Female undergraduate students were used to conduct the intervention on shelter women after community psychological training. Training courses were about empathy and active listening skills, IPV facts, managing dangerous situations, and accessing community resources. This intervention was also effective, and results indicated that women in the treatment arm were significantly less likely to be abused again, and they also reported a higher quality of life and fewer difficulties in obtaining community resources.

In this systematic review, we examined the effectiveness of applied interventions and existing strategies to prevent IPV in 18 selected RCT articles. Reviewing the studies revealed that different interventions and therapeutic methods have been developed to control and reduce violence against women in different regions and countries. Included studies were also reviewed methodologically. Almost all articles received a fair- or poor-quality rating based on the Cochrane quality assessment tool. These limitations in the studies can preclude drawing any conclusions about the effectiveness of interventions.

Reviewing the papers also revealed that the selection of suitable screening tools, determining the amount of inflicted violence, and selecting effective methods to outcome assessment of interventions should be considered widely by researchers. The results of the studies showed that there are various screening tools for violence. For example, some of these tools were used in primary health care ( 15 ), some for pregnant women ( 16 ), and some for men. Based on included articles, very few studies to date have evaluated the effectiveness of screening programs to reduce violence or to improve women’s health. Also, data about the potential harms associated with these programs are lacking. Selecting the appropriate tool to assess outcomes of interventions is also controversial. Based on evidence, there is no complete consensus that the measurement of the recurrence of violence against individuals can be used as an appropriate tool to assess the effectiveness of interventional methods. Many researchers believe that most women do not have any control on re-violence over themselves ( 16 ). Furthermore, some insist on self-reporting by women, and there is great evidence that women underreport the violence and abuse against themselves ( 15 ).

In all reviewed articles, all authors stated that interventions were efficient, and there was no article declaring that the intervention was not effective. Likewise, most of the interventions were on women. Therefore, the results should be interpreted with caution.

Some studies have used the internet to intervene as an innovation. The researchers suggest that the online intervention provides a vehicle for creating awareness and action for change in a private space ( 27 , 38 ). Based on the evidence, online data collection may help reduce some biases, and online training can eliminate general barriers to participation ( 39 ). Although this method may apply to certain groups, many abused women seek information online, and available information typically is not tailored to their circumstances.

Reviewing selected studies revealed that social factors are very efficient in designing and implementing interventions. Considering this, the many goals on IPV prevention programs can be achieved by changing gender inequality behaviors and societal misconceptions. Due to cultural resistance, these changes may be slow. Based on the evidence, one of the causes of disability in women depends on the local culture in which they live ( 32 ). According to WHO, one of the most important roles of public health in controlling DV is addressing social and cultural norms related to gender that support IPV ( 40 ).

Results of papers also showed that the role of social education and individual skills in enhancing women's social capital and reducing violence is important. Education plays both direct and indirect roles in the prevention of IPV ( 41 ). Based on studies, a positive attitude toward male dominance, belief about women as a lower rank in the creation, and many other cultural gender inequities rationalize violence against women ( 42 ). Thus, it seems that social scientists should play an active role in creating positive societal change in women with abusive partners who needed access to a variety of community resources.

In several studies, children had participated in the interventions, and the methods were effective likewise. Children as witnesses of parental violence learn that violence is a way to deal with marital problems, and when they grow up, they will commit violence against their own families ( 43 ). This matter should be widely considered in future works that children need to understand the facts of violence and learn how to manage it.

There have been some economic empowerment programs that have yielded somewhat conflicting results to reduce IPV and decrease its health harms ( 44 ). Studies state that women's revenue formation or their higher-earning than men are associated with increased rather than a reduced chance for IPV ( 45 ). Experts emphasize that the financial empowerment of women can reduce the risk for IPV, especially if sponsored with attempting to improve gender equity norms ( 46 ). Based on the evidence, when norms do not accept women's employment well, these programs may not be effective in controlling IPV ( 47 ).

Religious leaders can be effective in reducing violence against women in some countries. Some studies have emphasized the use of the process of Islamic socialization to prevent IPV. Related specialists believe that promoting Muslims to participate in activities that develop their potential with emphasis on Islamic morality and ethics can prevent and solve the problem of aggressive behavior ( 48 ). It is recommended that such interventions be performed for other religions as well.

Appraising included studies also showed that more vulnerable groups, such as students, pregnant and addicted women, should be considered separately and receive appropriate intervention programs to prevent violence. The Nurse-Family Partnership (NFP) ( 49 ) and Bystander intervention programs were specifically effective interventions conducted on young high-risk pregnant women and students to reduce the probability of violence respectively ( 50 , 51 ).

In the ongoing systematic review, we had some potential weaknesses. We limited this systematic review to English-language articles with available full-text. These constraints can lead to potential publication bias. Also, the search process restricted to selecting papers with an RCT design, and very effective interventions may have been made with different designs in other languages. Finally, it seems that a scoping review or narrative review be the most appropriate method instead of the systematic review approach for assessing or responding to such a wide study objective. Despite these limitations, we believe that conducting extensive search and selecting a variety of interventional studies in sufficient numbers can be one of the strengths of our study.

Most of the selected papers had fair- or poor-quality rating in terms of methodology quality. Evaluating the included articles revealed that the intervention methods should be fully in line with the characteristics of the participants and the role of the cause of violence in the choice of intervention should not be ignored. Interventions are not superior to each other, because they are selected based on the type of violence and the target group. Further research using rigorous designs should be done to assess the effectiveness of existing methods to facilitate reductions in IPV exposure.

Acknowledgment

The research reported in this publication was supported by the Elite Researcher Grant Committee under award number 971358 from the National Institutes for Medical Research Development (NIMAD), Tehran, Iran.

Conflict of Interest

The corresponding author reports grants from the National Institutes for Medical Research Development (NIMAD) during this study. Other authors report no conflict of interest.