Objectives-This longitudinal study examined the influence of Intimate Partner Violence (IPV) expe... more Objectives-This longitudinal study examined the influence of Intimate Partner Violence (IPV) experience of pregnant women participating in the Domestic Violence Enhanced Home Visitation Program (DOVE) on the language and neurological and development of infants and toddlers. Methods-A total of 210 infants and toddlers born to women reporting low, moderate, and high levels of IPV were included in the analysis. Logistic regression analysis was used to determine the bivariate association between maternal IPV and risk of language and neurological delay of infants and toddlers and between covariates and language and neurological delay. Generalized Estimating Equation models with logit link was used to predict the risk for neurological and language delay of infants and toddlers as a result of maternal IPV. Results-Infants and toddlers born to women exposed to moderate levels of IPV had increased odds of language delay compared to infants and toddlers of women who experienced low levels of violence (OR=5.31, 95% CI=2.94, 9.50, p<0.001). Infants and toddlers born to women who experienced moderate and high levels of IPV were at higher risk of neurological delay respectively, compared to infants and toddlers of women who experienced low levels of IPV (OR=5.42, 95% CI=2.99, 9.82, p<0.001 & OR=2.57, 95% CI=1.11, 5.61, p=0.026). Conclusions-Maternal IPV is associated with increased risk of language and neurological delay of infants and toddlers. These findings have implications for health care for women and infants exposed to IPV. Clinicians including pediatricians working with pregnant women should screen for IPV throughout pregnancy to identify women and children at risk. Interventions to reduce maternal IPV and early intervention services for infants and toddlers exposed to IPV are necessary for optimal maternal and child health.
The International Journal of Diversity in Organizations, Communities, and Nations: Annual Review, 2009
Around the world, inequalities exist around boundaries of race, social class, gender, disability,... more Around the world, inequalities exist around boundaries of race, social class, gender, disability, religious beliefs and sexual orientation, often resulting from past and current discriminatory practices. Governments have taken certain measures, including enacting policies such as positive action, to remedy such discrimination. This paper provides a comparative analysis of perceptions of the impact of positive action in seven EU and three non-EU countries. The study adopted participatory methods including consensus workshops, interviews and policy analysis to obtain data from designers of positive action. Findings are discussed, conclusions drawn and wide-ranging recommendations are made at the EC, individual countries and organisational levels.
Journal of Clinical and Translational Science, 2019
OBJECTIVES/SPECIFIC AIMS: To examine maternal morbidity and its related social determinants among... more OBJECTIVES/SPECIFIC AIMS: To examine maternal morbidity and its related social determinants among women experiencing homelessness during pregnancy. METHODS/STUDY POPULATION: This study will use an exploratory sequential mixed method design to explore and examine the structural, interpersonal and individual factors contributing to maternal morbidity among a convenience sample of 150 English speaking women experiencing homelessness during a pregnancy within the last 3 years in Baltimore. In the qualitative phase of the study, we will conduct semi-structured interviews with 15 women purposively sampled to refine the relationships between resilience, social determinants of health and multilevel factors that impact maternal morbidities. Factors of interest include prenatal care received, barriers and facilitators to receiving prenatal care, maternal morbidities, social support, and strategies used to manage their condition during this time. Using the findings from the qualitative phase, ...
The Domestic Violence Enhanced Home Visitation (DOVE) intervention used in the Perinatal Nurse Ho... more The Domestic Violence Enhanced Home Visitation (DOVE) intervention used in the Perinatal Nurse Home Visiting Intervention Enhanced With mHealth Technology (RCT: R01HD071771) is a nurse-lead evidenced-based intervention that has been shown to decrease violence overtime. This summative mixed-methods impact evaluation is intended to provide insight to enhance the DOVE IPV protocol for screening and intervention by (a) identifying which core aspects of DOVE facilitated or inhibited its success and what was most critical to optimal IPV (intimate partner violence) screening and intervention practices, (b) informing how DOVE IPV screening and intervention were influenced by the experiences of home visitor (HV), and (c) identifying policy considerations and best practice recommendations for the DOVE protocol. Participants were HVs and managers ( N = 13) in rural/urban home visiting programs delivering DOVE across three states. The sample had a mean age of 48.76. Three fourths were baccalaur...
Journal of medical Internet research, Jan 17, 2016
Intimate partner violence (IPV) is common during pregnancy and the postpartum. Perinatal home vis... more Intimate partner violence (IPV) is common during pregnancy and the postpartum. Perinatal home visitation provides favorable conditions in which to identify and support women affected by IPV. However, the use of mHealth for delivering IPV interventions in perinatal home visiting has not been explored. Our objective was to conduct a nested qualitative interpretive study to explore perinatal home visitors' and women's perceptions and experiences of the Domestic Violence Enhanced Home Visitation Program (DOVE) using mHealth technology (ie, a computer tablet) or a home visitor-administered, paper-based method. We used purposive sampling, using maximum variation, to select women enrolled in a US-based randomized controlled trial of the DOVE intervention for semistructured interviews. Selection criteria were discussed with the trial research team and 32 women were invited to participate. We invited 45 home visitors at the 8 study sites to participate in an interview, along with the...
Introduction-This article presents an integrative review of the literature examining the relation... more Introduction-This article presents an integrative review of the literature examining the relationship between racial discrimination and adverse birth outcomes. Methods-Searches for research studies published from 2009 to 2015 were conducted using PubMed, CINAHL, Scopus, PsycINFO, Web of Science, and Embase. Articles were assessed for potential inclusion using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 2009 framework. Results-Fifteen studies met criteria for review. The majority of the studies found a significant relationship between racial discrimination and low birth weight, preterm birth, and small for gestational age. Each of the studies that examined more proximal variables related to birth outcomes such as entry into prenatal care, employment opportunities, neighborhood characteristics, or inflammatory markers found significant associations between the specific variables examined and racial discrimination. Participants in qualitative studies discussed experiences of institutional racism with regard to several components of prenatal care including access and quality of care. Discussion-Racial discrimination is a significant risk factor for adverse birth outcomes. To best understand the mechanisms by which racial discrimination impacts birth outcomes, and to inform the development of effective interventions that eliminate its harmful effects on health, longitudinal research that incorporates comprehensive measures of racial discrimination is needed. Health care providers must fully acknowledge and address the psychosocial factors that impact health outcomes in minority racial/ethnic women.
Dating violence is a serious and prevalent public health problem that is associated with numerous... more Dating violence is a serious and prevalent public health problem that is associated with numerous negative physical and psychological health outcomes, and yet there has been limited evaluation of prevention programs on college campuses. A recent innovation in campus prevention focuses on mobilizing bystanders to take action. To date, bystander programs have mainly been compared with no treatment control groups raising questions about what value is added to dating violence prevention by focusing on bystanders. This study compared a single 90-min bystander education program for dating violence prevention with a traditional awareness education program, as well as with a no education control group. Using a quasi-experimental pre-test/post-test design with follow-up at 2 months, a sample of predominately freshmen college students was randomized to either the bystander (n = 369) or traditional awareness (n = 376) dating violence education program. A non-randomized control group of freshme...
In an effort to move research related to women and children experiencing violence from the univer... more In an effort to move research related to women and children experiencing violence from the university setting to the field, the DOVE study has been implemented to test the effectiveness of a structured intervention for pregnant women experiencing IPV. Using existing home health professionals, the DOVE program is directed at empowering new mothers in order to prevent their children’s exposure to IPV. A town (community) and gown (academic institution) partnership was developed to assist prenatal home visiting nurses to intervene with pregnant women experiencing IPV but barriers to working together were noted. Methods and Design: Quantitative and qualitative data from surveys and focus group discussions were gathered from the home visitors during a two-day workshop. Results: Thirty-five percent of the home visitors had or were experiencing abuse. Correlation results show that HVs reports of self- or friend-experienced IPV was moderately associated with working with more abused women in...
Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing / Sigma Theta Tau, Jan 15, 2015
This study aimed to determine gender and race variations in regards to the influence of religious... more This study aimed to determine gender and race variations in regards to the influence of religious involvement (RI) as a moderator of the effects of early traumatic stress (ETS) on health-related quality of life among adult survivors of child abuse. A cross-sectional predictive design was used to study Seventh-day Adventist adults in North America (N = 10,283). A secondary analysis of data collected via questionnaires was done using multiple regression. Data revealed that women had a significantly higher prevalence of any or all ETS subtypes, except for physical abuse prevalence, which was the same for both genders. Blacks reported a significantly higher prevalence of at least one ETS subtype than did Whites, except for neglect, where Whites had a higher prevalence. Exposure to at least one ETS subtype was associated with worse negative effect on mental health (B = -2.08, p < .0001 vs. B = -1.54, p < .0001) and physical health (B = -2.01, p < .0001 vs. B = -1.11, p < .000...
Journal of National Black Nurses' Association : JNBNA, 2012
This qualitative study examined the experiences of HIV-positive African-American and African Cari... more This qualitative study examined the experiences of HIV-positive African-American and African Caribbean childbearing women related to decisions about HIV testing, status disclosure, adhering to treatment, decisions about childbearing, and experiences in violent intimate relationships. Twenty-three women completed a 60-minute in-depth interview. Six themes emerged: perceived vulnerability to HIV infection; feelings about getting tested for HIV; knowledge, attitudes, and behaviors after HIV diagnosis; disclosure of HIV status; living with HIV (positivity, strength, and prayer); and, experiences with physical and sexual violence. Three women (13%) reported perinatal abuse and 10 women (n = 23, 43.4%) reported lifetime abuse. Positive experiences and resilience were gained from faith and prayer. Most important to the women were the perceived benefits of protecting the health of their baby. Findings suggest that policies supporting early identification of HIV-positive childbearing women a...
Posttraumatic stress disorder (PTSD) is an anxiety disorder that occurs after a traumatic event a... more Posttraumatic stress disorder (PTSD) is an anxiety disorder that occurs after a traumatic event and has been linked to psychiatric and physical health declines. Rates of PTSD are far higher in individuals with low incomes and who reside in urban areas compared to the general population. In this study, 250 urban health care-seeking women were interviewed for a diagnosis of PTSD, major depressive disorder, and also the experience of traumatic events. Multivariate logistic regressions were used to determine the associations between traumatic events and PTSD development. Survival analysis was used to determine if PTSD developed from assaultive and nonassaultive events differed in symptom duration. Eighty-six percent of women reported at least one traumatic event, 14.8% of women were diagnosed with current PTSD, and 19.6% with past PTSD. More than half of women with PTSD had comorbid depression. Assaultive traumatic events were most predictive of PTSD development. More than two thirds of the women who developed PTSD developed chronic PTSD. Women who developed PTSD from assaultive events experienced PTSD for at least twice the duration of women who developed PTSD from nonassaultive events. In conclusion, PTSD was very prevalent in urban health care-seeking women. Assaultive violence was most predictive of PTSD development and also nonremittance.
Journal of Obstetric, Gynecologic & Neonatal Nursing, 2012
Objective-To examine and describe the influence of maternal depressive symptoms on maternal-fetal... more Objective-To examine and describe the influence of maternal depressive symptoms on maternal-fetal attachment (MFA) in predominantly low-income women. Design-Mixed method. Setting-Three urban obstetric/gynecologic (OB/GYN) clinics serving predominantly lowincome women. Participants-A convenience sample of 166 women participated in the quantitative component and a purposeful sub-sample of 12 women participated in the qualitative component; all women were between 24-28 weeks gestation at the time of data collection. Methods-Linear regression models were used to examine the influence of depressive symptoms and social support on MFA. Individual in-depth interviews were conducted among a sub-sample of women to explore the influence of maternal depressive symptoms on MFA. Results-Fifty-nine percent (n=98) of participants had scores that were clinically significant for depressive symptoms. In the final model of social support and depressive symptoms regressed on MFA, social support (b = 0.23, 95% CI [0.09, .37], p = .002) and depressive symptoms (b = −1.02, 95% CI [−1.32, −.73], p < 0.001) were significant predictors. This multivariate linear regression model with two variables accounted for 65.2% of the total variance in overall MFA. Qualitative participants discussed the importance of social support in contributing to their mood state and MFA. Conclusions-Findings from this study highlight the importance of assessing for depressive symptoms during pregnancy given its influence on MFA. By understanding how important it was
To examine in-depth the lives of women whose partners attempted to kill them, and to identify pat... more To examine in-depth the lives of women whose partners attempted to kill them, and to identify patterns that may aid in the clinician's ability to predict, prevent, or counsel about femicide or attempted femicide. DESIGN: Qualitative analysis of 30 in-depth interviews. SETTING: Six U.S. cities. PARTICIPANTS: Thirty women, aged 17-54 years, who survived an attempted homicide by an intimate partner. RESULTS: All but 2 of the participants had previously experienced physical violence, controlling behavior, or both from the partner who attempted to kill them. The intensity of the violence, control, and threats varied greatly, as did the number of risk factors measured by the Danger Assessment, defining a wide spectrum of prior abuse. Approximately half (14/30) of the participants did not recognize that their lives were in danger. Women often focused more on relationship problems involving money, alcohol, drugs, possessiveness, or infidelity, than on the risk to themselves from the violence. The majority of the attempts (22/30) happened around the time of a relationship change, but the relationship was often ending because of problems other than violence. CONCLUSIONS: Clinicians should not be falsely reassured by a woman's sense of safety, by the lack of a history of severe violence, or by the presence of few classic risk factors for homicide. Efforts to reduce femicide risk that are targeted only at those women seeking help for violence-related problems may miss potential victims.
The current study explored the views of women experiencing interpersonal violence (IPV) and their... more The current study explored the views of women experiencing interpersonal violence (IPV) and their relationship with their mothers or other supportive adult, and determines how this relationship affected perinatal depressive symptoms. The sample consisted of 30 urban and rural pregnant women enrolled in a larger ongoing randomized controlled trial. Data from quantitative instruments that measured depressive symptoms were examined in combination with qualitative interview data collected at baseline and six months post-natal. Women describing positive relationships with their mothers or another supportive adult reported statistically significant lower depressive symptoms scores (p < .05). For women who experience intimate partner violence (IPV) before, during, and after pregnancy, the risk of perinatal depression escalates with rates as high as 47.6% (Golding, 1999; Rodriguez et al., 2010). IPV during pregnancy has been associated with
The authors conducted thirty-two in-depth interviews with 20 rural, low-income, women residing in... more The authors conducted thirty-two in-depth interviews with 20 rural, low-income, women residing in the United States, who were pregnant (n =12) or three months postpartum (n =8) and had experienced intimate partner violence (IPV). Using purposive sampling and the grounded theory method, the authors generated a conceptual model of coping. The urge to protect the unborn baby was the primary influence for participants' decisions about separating from or permanently leaving an abusive relationship. Implications include universal screening for IPV in child-bearing women, inquiry into maternal identity development during pregnancy, and improved resource access for rural, low-income women.
Objectives. This 11-city study sought to identify risk factors for femicide in abusive relationsh... more Objectives. This 11-city study sought to identify risk factors for femicide in abusive relationships. Methods. Proxies of 220 intimate partner femicide victims identified from police or medical examiner records were interviewed, along with 343 abused control women. Results. Preincident risk factors associated in multivariate analyses with increased risk of intimate partner femicide included perpetrator’s access to a gun and previous threat with a weapon, perpetrator’s stepchild in the home, and estrangement, especially from a controlling partner. Never living together and prior domestic violence arrest were associated with lowered risks. Significant incident factors included the victim having left for another partner and the perpetrator’s use of a gun. Other significant bivariate-level risks included stalking, forced sex, and abuse during pregnancy. Conclusions. There are identifiable risk factors for intimate partner femicides.
Objectives-This longitudinal study examined the influence of Intimate Partner Violence (IPV) expe... more Objectives-This longitudinal study examined the influence of Intimate Partner Violence (IPV) experience of pregnant women participating in the Domestic Violence Enhanced Home Visitation Program (DOVE) on the language and neurological and development of infants and toddlers. Methods-A total of 210 infants and toddlers born to women reporting low, moderate, and high levels of IPV were included in the analysis. Logistic regression analysis was used to determine the bivariate association between maternal IPV and risk of language and neurological delay of infants and toddlers and between covariates and language and neurological delay. Generalized Estimating Equation models with logit link was used to predict the risk for neurological and language delay of infants and toddlers as a result of maternal IPV. Results-Infants and toddlers born to women exposed to moderate levels of IPV had increased odds of language delay compared to infants and toddlers of women who experienced low levels of violence (OR=5.31, 95% CI=2.94, 9.50, p<0.001). Infants and toddlers born to women who experienced moderate and high levels of IPV were at higher risk of neurological delay respectively, compared to infants and toddlers of women who experienced low levels of IPV (OR=5.42, 95% CI=2.99, 9.82, p<0.001 & OR=2.57, 95% CI=1.11, 5.61, p=0.026). Conclusions-Maternal IPV is associated with increased risk of language and neurological delay of infants and toddlers. These findings have implications for health care for women and infants exposed to IPV. Clinicians including pediatricians working with pregnant women should screen for IPV throughout pregnancy to identify women and children at risk. Interventions to reduce maternal IPV and early intervention services for infants and toddlers exposed to IPV are necessary for optimal maternal and child health.
The International Journal of Diversity in Organizations, Communities, and Nations: Annual Review, 2009
Around the world, inequalities exist around boundaries of race, social class, gender, disability,... more Around the world, inequalities exist around boundaries of race, social class, gender, disability, religious beliefs and sexual orientation, often resulting from past and current discriminatory practices. Governments have taken certain measures, including enacting policies such as positive action, to remedy such discrimination. This paper provides a comparative analysis of perceptions of the impact of positive action in seven EU and three non-EU countries. The study adopted participatory methods including consensus workshops, interviews and policy analysis to obtain data from designers of positive action. Findings are discussed, conclusions drawn and wide-ranging recommendations are made at the EC, individual countries and organisational levels.
Journal of Clinical and Translational Science, 2019
OBJECTIVES/SPECIFIC AIMS: To examine maternal morbidity and its related social determinants among... more OBJECTIVES/SPECIFIC AIMS: To examine maternal morbidity and its related social determinants among women experiencing homelessness during pregnancy. METHODS/STUDY POPULATION: This study will use an exploratory sequential mixed method design to explore and examine the structural, interpersonal and individual factors contributing to maternal morbidity among a convenience sample of 150 English speaking women experiencing homelessness during a pregnancy within the last 3 years in Baltimore. In the qualitative phase of the study, we will conduct semi-structured interviews with 15 women purposively sampled to refine the relationships between resilience, social determinants of health and multilevel factors that impact maternal morbidities. Factors of interest include prenatal care received, barriers and facilitators to receiving prenatal care, maternal morbidities, social support, and strategies used to manage their condition during this time. Using the findings from the qualitative phase, ...
The Domestic Violence Enhanced Home Visitation (DOVE) intervention used in the Perinatal Nurse Ho... more The Domestic Violence Enhanced Home Visitation (DOVE) intervention used in the Perinatal Nurse Home Visiting Intervention Enhanced With mHealth Technology (RCT: R01HD071771) is a nurse-lead evidenced-based intervention that has been shown to decrease violence overtime. This summative mixed-methods impact evaluation is intended to provide insight to enhance the DOVE IPV protocol for screening and intervention by (a) identifying which core aspects of DOVE facilitated or inhibited its success and what was most critical to optimal IPV (intimate partner violence) screening and intervention practices, (b) informing how DOVE IPV screening and intervention were influenced by the experiences of home visitor (HV), and (c) identifying policy considerations and best practice recommendations for the DOVE protocol. Participants were HVs and managers ( N = 13) in rural/urban home visiting programs delivering DOVE across three states. The sample had a mean age of 48.76. Three fourths were baccalaur...
Journal of medical Internet research, Jan 17, 2016
Intimate partner violence (IPV) is common during pregnancy and the postpartum. Perinatal home vis... more Intimate partner violence (IPV) is common during pregnancy and the postpartum. Perinatal home visitation provides favorable conditions in which to identify and support women affected by IPV. However, the use of mHealth for delivering IPV interventions in perinatal home visiting has not been explored. Our objective was to conduct a nested qualitative interpretive study to explore perinatal home visitors' and women's perceptions and experiences of the Domestic Violence Enhanced Home Visitation Program (DOVE) using mHealth technology (ie, a computer tablet) or a home visitor-administered, paper-based method. We used purposive sampling, using maximum variation, to select women enrolled in a US-based randomized controlled trial of the DOVE intervention for semistructured interviews. Selection criteria were discussed with the trial research team and 32 women were invited to participate. We invited 45 home visitors at the 8 study sites to participate in an interview, along with the...
Introduction-This article presents an integrative review of the literature examining the relation... more Introduction-This article presents an integrative review of the literature examining the relationship between racial discrimination and adverse birth outcomes. Methods-Searches for research studies published from 2009 to 2015 were conducted using PubMed, CINAHL, Scopus, PsycINFO, Web of Science, and Embase. Articles were assessed for potential inclusion using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 2009 framework. Results-Fifteen studies met criteria for review. The majority of the studies found a significant relationship between racial discrimination and low birth weight, preterm birth, and small for gestational age. Each of the studies that examined more proximal variables related to birth outcomes such as entry into prenatal care, employment opportunities, neighborhood characteristics, or inflammatory markers found significant associations between the specific variables examined and racial discrimination. Participants in qualitative studies discussed experiences of institutional racism with regard to several components of prenatal care including access and quality of care. Discussion-Racial discrimination is a significant risk factor for adverse birth outcomes. To best understand the mechanisms by which racial discrimination impacts birth outcomes, and to inform the development of effective interventions that eliminate its harmful effects on health, longitudinal research that incorporates comprehensive measures of racial discrimination is needed. Health care providers must fully acknowledge and address the psychosocial factors that impact health outcomes in minority racial/ethnic women.
Dating violence is a serious and prevalent public health problem that is associated with numerous... more Dating violence is a serious and prevalent public health problem that is associated with numerous negative physical and psychological health outcomes, and yet there has been limited evaluation of prevention programs on college campuses. A recent innovation in campus prevention focuses on mobilizing bystanders to take action. To date, bystander programs have mainly been compared with no treatment control groups raising questions about what value is added to dating violence prevention by focusing on bystanders. This study compared a single 90-min bystander education program for dating violence prevention with a traditional awareness education program, as well as with a no education control group. Using a quasi-experimental pre-test/post-test design with follow-up at 2 months, a sample of predominately freshmen college students was randomized to either the bystander (n = 369) or traditional awareness (n = 376) dating violence education program. A non-randomized control group of freshme...
In an effort to move research related to women and children experiencing violence from the univer... more In an effort to move research related to women and children experiencing violence from the university setting to the field, the DOVE study has been implemented to test the effectiveness of a structured intervention for pregnant women experiencing IPV. Using existing home health professionals, the DOVE program is directed at empowering new mothers in order to prevent their children’s exposure to IPV. A town (community) and gown (academic institution) partnership was developed to assist prenatal home visiting nurses to intervene with pregnant women experiencing IPV but barriers to working together were noted. Methods and Design: Quantitative and qualitative data from surveys and focus group discussions were gathered from the home visitors during a two-day workshop. Results: Thirty-five percent of the home visitors had or were experiencing abuse. Correlation results show that HVs reports of self- or friend-experienced IPV was moderately associated with working with more abused women in...
Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing / Sigma Theta Tau, Jan 15, 2015
This study aimed to determine gender and race variations in regards to the influence of religious... more This study aimed to determine gender and race variations in regards to the influence of religious involvement (RI) as a moderator of the effects of early traumatic stress (ETS) on health-related quality of life among adult survivors of child abuse. A cross-sectional predictive design was used to study Seventh-day Adventist adults in North America (N = 10,283). A secondary analysis of data collected via questionnaires was done using multiple regression. Data revealed that women had a significantly higher prevalence of any or all ETS subtypes, except for physical abuse prevalence, which was the same for both genders. Blacks reported a significantly higher prevalence of at least one ETS subtype than did Whites, except for neglect, where Whites had a higher prevalence. Exposure to at least one ETS subtype was associated with worse negative effect on mental health (B = -2.08, p < .0001 vs. B = -1.54, p < .0001) and physical health (B = -2.01, p < .0001 vs. B = -1.11, p < .000...
Journal of National Black Nurses' Association : JNBNA, 2012
This qualitative study examined the experiences of HIV-positive African-American and African Cari... more This qualitative study examined the experiences of HIV-positive African-American and African Caribbean childbearing women related to decisions about HIV testing, status disclosure, adhering to treatment, decisions about childbearing, and experiences in violent intimate relationships. Twenty-three women completed a 60-minute in-depth interview. Six themes emerged: perceived vulnerability to HIV infection; feelings about getting tested for HIV; knowledge, attitudes, and behaviors after HIV diagnosis; disclosure of HIV status; living with HIV (positivity, strength, and prayer); and, experiences with physical and sexual violence. Three women (13%) reported perinatal abuse and 10 women (n = 23, 43.4%) reported lifetime abuse. Positive experiences and resilience were gained from faith and prayer. Most important to the women were the perceived benefits of protecting the health of their baby. Findings suggest that policies supporting early identification of HIV-positive childbearing women a...
Posttraumatic stress disorder (PTSD) is an anxiety disorder that occurs after a traumatic event a... more Posttraumatic stress disorder (PTSD) is an anxiety disorder that occurs after a traumatic event and has been linked to psychiatric and physical health declines. Rates of PTSD are far higher in individuals with low incomes and who reside in urban areas compared to the general population. In this study, 250 urban health care-seeking women were interviewed for a diagnosis of PTSD, major depressive disorder, and also the experience of traumatic events. Multivariate logistic regressions were used to determine the associations between traumatic events and PTSD development. Survival analysis was used to determine if PTSD developed from assaultive and nonassaultive events differed in symptom duration. Eighty-six percent of women reported at least one traumatic event, 14.8% of women were diagnosed with current PTSD, and 19.6% with past PTSD. More than half of women with PTSD had comorbid depression. Assaultive traumatic events were most predictive of PTSD development. More than two thirds of the women who developed PTSD developed chronic PTSD. Women who developed PTSD from assaultive events experienced PTSD for at least twice the duration of women who developed PTSD from nonassaultive events. In conclusion, PTSD was very prevalent in urban health care-seeking women. Assaultive violence was most predictive of PTSD development and also nonremittance.
Journal of Obstetric, Gynecologic & Neonatal Nursing, 2012
Objective-To examine and describe the influence of maternal depressive symptoms on maternal-fetal... more Objective-To examine and describe the influence of maternal depressive symptoms on maternal-fetal attachment (MFA) in predominantly low-income women. Design-Mixed method. Setting-Three urban obstetric/gynecologic (OB/GYN) clinics serving predominantly lowincome women. Participants-A convenience sample of 166 women participated in the quantitative component and a purposeful sub-sample of 12 women participated in the qualitative component; all women were between 24-28 weeks gestation at the time of data collection. Methods-Linear regression models were used to examine the influence of depressive symptoms and social support on MFA. Individual in-depth interviews were conducted among a sub-sample of women to explore the influence of maternal depressive symptoms on MFA. Results-Fifty-nine percent (n=98) of participants had scores that were clinically significant for depressive symptoms. In the final model of social support and depressive symptoms regressed on MFA, social support (b = 0.23, 95% CI [0.09, .37], p = .002) and depressive symptoms (b = −1.02, 95% CI [−1.32, −.73], p < 0.001) were significant predictors. This multivariate linear regression model with two variables accounted for 65.2% of the total variance in overall MFA. Qualitative participants discussed the importance of social support in contributing to their mood state and MFA. Conclusions-Findings from this study highlight the importance of assessing for depressive symptoms during pregnancy given its influence on MFA. By understanding how important it was
To examine in-depth the lives of women whose partners attempted to kill them, and to identify pat... more To examine in-depth the lives of women whose partners attempted to kill them, and to identify patterns that may aid in the clinician's ability to predict, prevent, or counsel about femicide or attempted femicide. DESIGN: Qualitative analysis of 30 in-depth interviews. SETTING: Six U.S. cities. PARTICIPANTS: Thirty women, aged 17-54 years, who survived an attempted homicide by an intimate partner. RESULTS: All but 2 of the participants had previously experienced physical violence, controlling behavior, or both from the partner who attempted to kill them. The intensity of the violence, control, and threats varied greatly, as did the number of risk factors measured by the Danger Assessment, defining a wide spectrum of prior abuse. Approximately half (14/30) of the participants did not recognize that their lives were in danger. Women often focused more on relationship problems involving money, alcohol, drugs, possessiveness, or infidelity, than on the risk to themselves from the violence. The majority of the attempts (22/30) happened around the time of a relationship change, but the relationship was often ending because of problems other than violence. CONCLUSIONS: Clinicians should not be falsely reassured by a woman's sense of safety, by the lack of a history of severe violence, or by the presence of few classic risk factors for homicide. Efforts to reduce femicide risk that are targeted only at those women seeking help for violence-related problems may miss potential victims.
The current study explored the views of women experiencing interpersonal violence (IPV) and their... more The current study explored the views of women experiencing interpersonal violence (IPV) and their relationship with their mothers or other supportive adult, and determines how this relationship affected perinatal depressive symptoms. The sample consisted of 30 urban and rural pregnant women enrolled in a larger ongoing randomized controlled trial. Data from quantitative instruments that measured depressive symptoms were examined in combination with qualitative interview data collected at baseline and six months post-natal. Women describing positive relationships with their mothers or another supportive adult reported statistically significant lower depressive symptoms scores (p < .05). For women who experience intimate partner violence (IPV) before, during, and after pregnancy, the risk of perinatal depression escalates with rates as high as 47.6% (Golding, 1999; Rodriguez et al., 2010). IPV during pregnancy has been associated with
The authors conducted thirty-two in-depth interviews with 20 rural, low-income, women residing in... more The authors conducted thirty-two in-depth interviews with 20 rural, low-income, women residing in the United States, who were pregnant (n =12) or three months postpartum (n =8) and had experienced intimate partner violence (IPV). Using purposive sampling and the grounded theory method, the authors generated a conceptual model of coping. The urge to protect the unborn baby was the primary influence for participants' decisions about separating from or permanently leaving an abusive relationship. Implications include universal screening for IPV in child-bearing women, inquiry into maternal identity development during pregnancy, and improved resource access for rural, low-income women.
Objectives. This 11-city study sought to identify risk factors for femicide in abusive relationsh... more Objectives. This 11-city study sought to identify risk factors for femicide in abusive relationships. Methods. Proxies of 220 intimate partner femicide victims identified from police or medical examiner records were interviewed, along with 343 abused control women. Results. Preincident risk factors associated in multivariate analyses with increased risk of intimate partner femicide included perpetrator’s access to a gun and previous threat with a weapon, perpetrator’s stepchild in the home, and estrangement, especially from a controlling partner. Never living together and prior domestic violence arrest were associated with lowered risks. Significant incident factors included the victim having left for another partner and the perpetrator’s use of a gun. Other significant bivariate-level risks included stalking, forced sex, and abuse during pregnancy. Conclusions. There are identifiable risk factors for intimate partner femicides.
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