Journal articles on the topic 'Domestic violence measurement'

Significant effort and money has been spent to change social and legal responses to domestic violence (DV) but, current statistics indicate relatively little decline in incidence rates and the literature contains conflicting findings, resulting in several controversies and heated political debates. Most of the rhetoric surrounding the controversial findings focus on theories and contextual issues related to survey instruments. However, this article seeks to raise another important issue that is common in criminological literature: poor measurement development and practices. Specifically, inconsistencies in scale development, psychometrics, and reporting practices for measurement lead to poor scale development and analytical confusion. We argue that poorly developed measures used repeatedly and slightly altered across varying studies contribute to the controversies in the literature. This article serves as an example of scale development to stimulate conversation regarding measurement issues amongst social scientists by focusing on one example regarding the measurement of DV beliefs. Exploratory and confirmatory factor analyses are used to explore the dimensionality of beliefs to develop the best measure for the data. Results highlight the need for more rigorous statistical estimation models and empirically supported psychometric techniques, and the need for further replication when developing composite measures of latent constructs.

The paper explores the role of the international right to the highest attainable standard of physical and mental health in the development of the legal framework in Lithuania to address violence against women. The right to the highest attainable standard of physical and mental health is entrenched under various international legal instruments. These have been ratified by Lithuania which, in 2011, also adopted a Law for the protection against domestic violence. Violence against women, including domestic violence, is undoubtedly a violation of the right to health; therefore the Lithuanian context provides an opportunity to evaluate the duties of the state in this regard more precisely. Indicators on human rights measurement have been instrumental in this evaluation.

Domestic violence experienced by children make them more prone to emotional, behavior, adaptation and mental health problems. Some researches show that children with high resiliency are able to develop a positive attitude, perspective and adaptability despite a history of violence. The purpose of this study was to determine the effect of CBT Art Therapy intervention to increase the resiliency of children expose to domestic violence. The method used in this research is single case single-subject experiment ABA design. Resilience measurement instruments used in this research are Quotient Test (RQT) and resilience behavior observation sheet. Data were analyzed through visual analysis and descriptive data analysis. The results showed an increasing score in RQT (27 points) as well as the intensity of resilience behavior and positive changes in the use of color, quality and theme of the artwork. Keywords: art therapy, resilience, child victims of domestic violence, single case single-subject experiment

This study examined forms, risk factors and health hazards of domestic violence among married secondary school teachers in Anambra State. Four research questions and four hypothesis guided the study. The study used a descriptive survey research design. The population of the study comprised 2600 married teachers (male and female) in all secondary schools owned by Anambra State. The sample consisted of 1080 married teachers in secondary schools in Anambra State. The instrument used for data collection was a structured questionnaire titled Domestic Violence Questionnaire (DVQ). The DVQ was validated by experts in measurement and evaluation as health education. The reliability coefficient of the instrument was 0.947. Mean and standard deviation statistics were used to answer the research questions. T-test and ANOVA were used to test null hypotheses at .05 level of significance. The findings revealed among others that forms of domestic violence such as physical injuries, depression, abortion and others exist among married secondary school teachers in Anambra State. Risk factors of domestic violence such as low self-esteem, economic stress, unhealthy family relationship, distrust, sexual dissatisfaction and others exist among married teachers in secondary schools in Anambra State. Based on the findings, it was recommended among others that, health educators should provide a platform to educate married teachers in various secondary schools on the need to avoid domestic violence so as to have a peaceful environment at home. Married teachers should endeavour to learn and understand each other as this will enable them avoid any form of violence at home. Keywords: Domestic violence, risk factors, health hazards, married secondary school teachers, Anambra State.

The effects of demographic, attitudinal, and situational variables on the domestic violence arrest decision were investigated using official data and officer attitudinal data. We examined some variables never before studied in this context (e.g., the demographic characteristics of officers) and improved on the measurement of many variables (e.g., victim cooperativeness, victim injury, and time of shift). Logit analyses clarified those factors that significantly impacted the arrest decision and identified how officers arrived at a determination of a victim's cooperativeness. The findings supported previous research that has highlighted the importance of situational variables in the arrest decision.

Domestic abuse is a topic that is often discussed in the community. Experiential family counseling can be used to deal with domestic abuse. In terms of handling, it is vital to undertake a customer assessment. Standard domestic violance instruments that can be utilized in experiential family counseling have not been discovered as a result of library study. As a result, psychometric-based domestic violence tools are required. The creation of psychometric-based instruments results in instruments with high validity and reliability, such as test kits. The Delphi method, focus group discussion, factor analysis, and analysis of standard error of measurement were all used. According to the findings of the study, the application of this psychometric-based instrument has strong discriminating validity and no cross-loading, indicating good convergent validity. In terms of dependability, it also develops devices with a high level of dependability. So that psychometric analysis for evaluation in experiential family therapy can be used to build this instrument of domestic violance.

We report on the development of, and findings from, two scales measuring coercive control and space for action over a period of 3 years in a sample of 100 women who had accessed domestic violence services. We present statistical evidence to show a significant correlation between coercive control and space for action. However, dealing with violence is not a linear process, and support needs to extend beyond being enabled to separate. The scales advance measurement of women’s experience of coercive control and, through the space for action scale, document their ability to restore agency and freedom in contexts of relative safety.

Background: This study aimed to investigate the prevalence of domestic violence (DV) against women who are undergoing methadone maintenance therapy (MMT) and its related risk factors. Methods: This case-control study was conducted on 195 women who were under MMT and a control group consisting of 195 women who were not under it in the city of Zahedan from 22 May to 1 December 2019. Data were collected using a questionnaire for the measurement of violence against women and a sociodemographic questionnaire. In order to analyze the data, the t test, analysis of variance (ANOVA), Pearson’s correlation, and multiple regression analysis were used. Findings: In the case group, 67.2% of participants had experienced DV during the past year. In the control group, the prevalence was 78.5%. The rate of more than one occasion of DV was significantly higher in the group who were under MMT (P<0.05). The most common type of violence was mental abuse. Physical, sexual, and economic abuses were in the next ranks. Important predictors of DV, in order of importance, were: the women’s low educational level, smoking, income level, and polygamy (P<0.05). Conclusion: MMT is not a risk factor for DV. It seems that the rate of DV against women in Zahedan is very high. The prevalence of recurrent DV in women under MMT was higher than in the general population.

This article reviews the literature on the measurement of, impact of, and interventions for economic abuse within intimate partner relationships. Current assessment measures for economic abuse, along with estimates of the prevalence of economic abuse, are reviewed and critiqued. Research exploring the impact of economic abuse on the victim’s mental health and psychological well-being, family formations and parenting practices, and children’s behaviors and youth outcomes are presented. Recently developed interventions, including financial literacy program models, are discussed and emphasized as a critical service to increase victims’ economic self-efficacy, financial literacy, and financial behaviors. Finally, the review provides detailed recommendations on incorporating economic abuse as a central component of domestic violence research, practice, and policies.

Summary Client-centered practice, also termed survivor-centered practice in the context of domestic violence, has broad support as a set of strategies for working effectively with trauma survivors. However, research, evaluation and staff training are limited by a lack of measurement tools. This paper describes the process of developing an index of hotline caller reactions to practitioners’ client-centered practices. Findings The project was a collaborative effort between academic researchers and practitioners working in a community agency. To generate and refine the items, researchers consulted the scholarly literature and agency materials, had discussions with practitioners, and coded a group of 25 recorded calls to the agency’s hotline. The resulting tool separates two phases of the hotline calls and identifies 23 client reactions to advocate behaviors that indicate the client-centeredness of the interaction. Application The collaborative nature of the process ensured that the final product included multiple vantage points on client-centered practice. The tool developed in this study, the Client-Centered Hotline Assessment Tool (C-CHAT), may be used for research, evaluation, and training. Future research could explore the generalizability and, consequently, predictive utility of the tool in outcomes of interest to practitioners. In evaluation, the tool allows agencies, in assessing client experience, to go beyond client self-report of general satisfaction, and to improve services in response. Finally, in training, the tool allows supervisors to assess the level of fidelity to the client-centered model, and to pinpoint particular aspects of interactions that suggest strengths or growth areas for staff, ultimately improving the quality of services.

The aim of the study was to identify the prevalence and perceived helpfulness of a variety of protective strategies that were used by female survivors of domestic abuse and to explore factors that may have influenced strategy usage. Forty participants were recruited from a voluntary sector domestic abuse service, commissioned by an outer London local authority in the United Kingdom, in early 2014. The measurement tools used were the Intimate Partner Violence Strategies Index (IPVSI) and the Coordinated Action Against Domestic Abuse (CAADA) Domestic Abuse, Stalking and “Honour”-Based Violence (DASH) Risk Assessment Checklist. The average age was 33 years ( SD = 7.9, range = 20-57); half reported to be of Asian ethnicity, 37.5% White, and 12.5% Black or Mixed ethnicity. The average DASH score was 9.8 ( SD = 13.2, range = 0-18), and an average of 18 ( SD = 6.7, range = 1-29) protective strategies were utilized by each participant. All of the most commonly used strategies were from the placating category. Although safety planning strategies were rated as the most helpful by all participants, placating strategies were also rated as helpful by two thirds of participants. Stepwise multiple regression showed that placating was the only significant predictor of DASH score (β = .375, p < .05) and accounted for 14% of the variance of DASH score. Findings showed that women utilized a diverse range of protective strategies with placating strategies being most intensely used and rated as helpful. However, placating strategy usage could be a risk factor as opposed to a protective factor. This study has also demonstrated that greater placating strategies were used by White than South Asian women, and women who were employed used more formal strategies. This research has extended the knowledge base of protective strategies that professionals can draw from to underpin decisions and interventions when working with domestic abuse survivors.

Introduction. The research is focused on the issue of domestic violence against women. It deals with the definition of violence, concepts and models of individual areas by summarising the research findings and the possibilities of methodological tools for measurement of significant factors of violence against women. Aim. The primary goal of the research is to define significant factors which determine violence against women. Materialand Methods. Methods of research – survey, document analysis and database statistical analysis. Results. Primary results of quantitative research reveal that women of all ages and educational groups are at risk. Mostly women aged 26–45, living in rural areas with middle school education without maturity exam (final exam). Violence in families involves men of all age groups with emphasis on increased incidence in specific categories: mostly men aged 36–45, living in rural areas with secondary (high school or comprehensive school) education. Another field of interest represents analysis of negative family situations, impact of violence against woman on her psychological conditions, and reasons why victims carry on marriage and/or partnership. Conclusions. It can be concluded that the most frequent negative phenomena during aggressor's and/or victim's childhood were physical violence of father against mother, alcohol – possibly father's alcoholism, poverty, physical punishment of children, and patriarchal model of the family. Two thirds of victims continue marriage/partnership in order to maintain the family, to keep the father for children, and for financial reasons. There is a frequent social criminality in poor biological families of aggressors, i.e., a commission of crime because of lack of finances.

The aim of the article is to discuss the main methodological issues concerning the measurement of social benefits resulting from legal and civic counselling. A critical resumption of the existing practice of macroeconomic valuation of the counselling effects was conducted and a preliminary analysis of the demand-driven benefits for Poland was carried out in the article. Methodological considerations were illustrated by a case of domestic violence, specifying all possible paths of reactions to the problem along with financial consequences of such reactions. The first attempt was made to present the measurement of the legal counselling benefits using an algorithm, pointing to all the circumstances that should be considered when quantifying such benefits. On the basis of the existing — not free from certain shortcomings indicated in the article — estimates of benefits and costs of free legal counselling systems, it can be clearly stated that social benefits significantly outweigh the costs connected with the functioning of such systems.

The goal is to adapt and analyze the psychometric properties of the Copenhagen Burnout Inventory (CBI) in workers of the national domestic violence helpline (Peru). Two measurements were taken in the same population (n=160). Translation-back translation was applied. Internal consistency was assessed with Cronbach’s alpha, corrected Item-Total Correlation and omega coefficient. Test-retest was performed in the second measurement. Convergent validity was examined with Pearson correlations with the Secondary Traumatic Stress Scale, the Perceived Stress Scale, and the Fear of Covid-19 Scale. Confirmatory Factor Analysis confirmed that the three-correlated factor model has the best fit. Regarding reliability, adequate coefficients were found (alpha: >.82, omega: >.91 and intraclass correlation: > .66). The CBI scales are correlated with the Secondary Traumatic Stress Scale, the Perceived Stress Scale, and the Fear of Covid-19 Scale, and they are also significantly associated with self-reported health status, but only work-related burnout is associated with self-reported workload. As a result, the CBI shows excellent psychometric properties.

This study describes the initial development of a scale of measurement of psychological maltreatment of women by their male partners. The initial version of the scale was administered to 407 men and 207 women at intake into a domestic violence program. All 58 items of the scale were endorsed by a large enough number of subjects to warrant inclusion in the final instrument. Factor analysis revealed a similar factor structure for the men and women, with dominance-isolation and emotional-verbal abuse factors emerging from the analysis. Intracouple reliability for each item of the scale was examined for the subset of men and women who were cohabiting couples (n = 28). Unsurprisingly, the agreement of men’s and women’s reports was low, though the scores on the domination-isolation subscale were significantly correlated.

This study examined how type of perpetrator (family only [FO] vs. generally violent [GV]), readiness to change, and stake in conformity function separately and together in predicting completion of a partner abuse intervention program (PAIP). Data were collected from 192 male perpetrators of intimate partner violence (IPV) who were court mandated to attend a PAIP. Participants were categorized as FO violent or GV based on a combination of their self-report and official records of violence. Stake in conformity has been defined as the degree to which an individual is invested in the values and institutions of a society. A composite stake in conformity score was computed for each participant based on his education level, and marital and employment status. Each participant was also assigned a stage of change score based on his responses on a validated measure of stage of change for domestic violence perpetrators. Analyses indicated that stage of change was not related to program completion or attendance. Type of perpetrator and stake in conformity composite score were significantly related to program completion. Perpetrators with higher stake in conformity scores and individuals categorized as FO attended more PAIP sessions and were more likely to complete the program. When both predictors were examined together, only stake in conformity composite score uniquely predicted program attendance and completion. These findings provide additional evidence that subtype of IPV perpetrator has implications for treatment responsiveness and provide preliminary evidence for the value of improved measurement of investment in societal institutions.

Background and Aims.Research on child maltreatment has largely overlooked the under-five age group and focuses primarily on quantitative measurement. This mixed-methods study of maltreated children (N=92) entering care (age 6–60 months) combines a quantitative focus on the associations between care journey characteristics and mental health outcomes with a qualitative exploration of maltreatment in four different families.Methods.Care journey data was obtained from social care records; mental health and attachment assessments were carried out following entry to care; qualitative data comprised semistructured interviews with professionals, foster carers, and parents.Results.Significant associations were found between suspected sexual abuse and increased DAI inhibited attachment symptoms (p=0.001) and between reported domestic violence and decreased DAI inhibited (p=0.016) and disinhibited (p=0.004) attachment symptoms. Qualitative results: two themes demonstrate the complexity of assessing maltreatment: (1) overlapping maltreatment factors occur in most cases and (2) maltreatment effects may be particularly challenging to isolate. Conclusions.Qualitative exploration has underscored the complexity of assessing maltreatment, indicating why expected associations were not found in this study and posing questions for the quantitative measurement of maltreatment in general. We therefore suggest a new categorisation of maltreatment and call for the complimentary research lenses of further mixed-methods approaches.

Background: The autonomy associated with the essence of decision-making in the field of reproductive health, including about fertility, pregnancy, and the utilization of health services. The research has shown that autonomy occurred in poor countries and growing. This literature is intended to explore autonomy measures and policies related to reproductive health programs. Methods: Review of the literature search some databases such as the Online Public Access Catalog (OPAC) and Pubmed Medical Center (PMC). Twenty-two articles that met the criteria for discussion included articles dominated by South and Southeast Asia and parts of Africa, as well as one European region. Most of the literature defines women's autonomy using theories from previous literature. Results: the study proves that there is a link between autonomy and utilization of health services, family planning and fertility. Autonomy measurement is done by using direct and indirect dimensions. Dimensions direct connect participation in decision making related to the economy, household and mobility. The other dimension is to assess women's attitudes toward domestic violence. Dimensions are indirectly related to proxies that affect women's status such as employment, education or media exposure. Conclusion: Potential policies and programs related to reproductive health in developing countries basically recommend the integration of women's empowerment in health programs.

Globally, domestic violence affects women across their life span. Domestic violence against women and children during COVID-19 is a critical and substantial public health issue. This review article was aimed to determine the prevalence and its associated factors toward domestic violence against women and children during COVID-19. Several studies showed that the prevalence of domestic violence against women and children has been alarmingly enlarged during this COVID-19. Domestic violence is a significant and essential problem that is occurring all over the world for many years now, but this condition has been augmented during the lockdown situation because of this pandemic. Women and children of the worldwide are facing twin health emergencies that are COVID-19 and domestic violence. The pandemic was found as a threat to commit domestic violence against women and children. This is because, even though the measurements taken to avoid COVID-19 spread are supportive strategies and also the only opportunity to do so, reducing the risk of COVID-19 was found to raise the risk of domestic violence against women and children. Factors associated with domestic violence against women and children were; being housewives, age < 30 years, marriage, husband’s age being between 31 and 40 years, physical victimization, and sexual victimization were factors associated with domestic violence. Depression, spending more time in close contact, job losses, financial insecurity, lockdowns, addiction (alcohol or drugs), control of wealth in the family, technology, and quarantine were factors considered as risk factors for domestic violence. This review will serve as a “call to action” to address this crisis effectively by coming together since this crisis is the global aspect. This is a shadow pandemic growing during this COVID-19 crisis and a global collective effort is needed to prevent it. The life of women and children moves from their needs to their rights during this pandemic. It is essential to undertake urgent actions to intervene in it.

Using an analysis of primary documents and secondary sources, the problem of domestic violence against women in Sri Lanka is surveyed from the perspectives of public health, as well as human and legal rights. The limited Sri Lankan literature on the measurements, context and prevalence of such violence, as well as legislation for its prevention, is reviewed. Responses to the problem by the government and non-government organisations are described. These include using international organisations, forums and conventions to further the human rights dimensions of the problem, the establishment of support services and domestic legal reforms to accord greater protection to women. While The Prevention of Domestic Violence Act 2005 gave legislative recognition to the problem and put into place some welcome reforms, it lacked a comprehensive response to the problem. It is argued that health service providers need to be trained to be aware of domestic violence as the potential cause of physical injuries and mental conditions and that the medical record should document the circumstances and nature of domestic violence. Hospital outpatient departments should offer counselling, referrals to crisis centres and shelters, and should collect sex disaggregated data on domestic assaults. Finally, primary health care workers can both support women in dealing with domestic violence as well as performing a sentinel role in prevention. Specific and comprehensive public policy on violence against women must be developed to allow the health sector to play its role within a context of inter-sectoral collaboration.

This article critically explores accounts of how men attending domestic violence perpetrator programs (DVPP) used the “time out” strategy. Findings are drawn from 71 semi-structured interviews with 44 men attending DVPPs and 27 female partners or ex-partners of men in DVPPs. We describe three ways in which the technique was used: first, as intended, to interrupt potential physical violence; second, through the effective adaption of the time-out rules by victim-survivors; and finally, misappropriation by some men to continue and extend their controlling behaviors. Policy and practice lessons are drawn from the findings through connecting broader and deeper measurements of what success means when working with domestic violence perpetrators to the ways in which the time-out technique was used.

The current descriptive study seeks to broaden empirical understanding about women charged with intimate partner violence by comparing a sample of women in a domestic violence diversion program (N = 78) to a matched sample of men (N = 78) in the same program on measurements of general risk factors, attitudes toward using violence, and readiness to change. Findings indicate that the women charged with intimate partner violence are a heterogeneous group, endorse risk factors that show an elevated likelihood they will continue to use violence, demonstrate a high level of tolerance for using violence in their relationship, and may be highly amenable to treatment opportunities. Implications for practice and future research are addressed.

Children who live in households where domestic violence is occurring have been variously described in the literature over time as silent witnesses, witnesses, a cohort who is “exposed” to the violence, and more recently, as individual victim survivors and active agents in their own right, each with their own lived experience of violence. Research methodologies in this arena have shifted from adult-focused measurements of the impacts of domestic violence on children to more qualitative attempts to understand the experience from the child’s perspective. In doing so, there have been notions of giving “voice to the voiceless” and doing no further harm through a desire to protect children from exposure. However, the relational framing of children’s voices and recognition and enabling of children’s agency is less evolved in research and professional interventions. A study undertaken in Australia researched with a primary care population of 23 children and 18 mothers, children’s experiences of safety and resiliency in the context of domestic violence. The findings of the research were realized using qualitative research methods with children and the analytical framing of hermeneutical phenomenology, ethics of care and in particular dialogical ethics, to draw practical understanding and application in health care settings. This article aims to demonstrate how the analytical methodology chosen was applied in the research process and reveals the elements required for children to experience agency in navigating their relationships in an unsafe world, while learning about themselves. It draws upon understandings of the child’s relational context and introduces a model of children’s agency, which may have applicability for domestic violence policy and practice settings.

Objective To examine the association among six forms of violence and their levels among Peruvian university students from a public University in Peru´s Junin region.Materials and Methods A cross-sectional study of students of both sexes from the Faculty of Education. Sampling comprised 961 voluntary students (629 females and 332 males) studying in the education faculty from the National University of Center of Perú. Data were collected in the period July-December 2019 using the Domestic Violence Measurements Scale (VIFJ4), which assessed six forms of violence (physical, psychological, sexual, social, patrimonial, and gender). These variables were assessed through three levels of violence (mild, moderate, and severe).Results All student felt violence in their six forms. A higher percentage of violence was found in females than males. According severe level the forms of violence were ordered as follow: physical > psychological > patrimonial > social > gender. For moderate level: social > sexual > physical > gender > patrimonial > psychological, and mild level: psychological > patrimonial > gender > social > physical > sexual.Conclusion It was confirmed that there are different forms of violence and their levels in both males and females. This knowledge will serve as a basis for the development and implementation of educational programs that help university students to establish adequate behavior and mental health.

What happens when family caregivers experience violence and abuse from the older person for whom they care? Although this issue has received little global attention, it is relevant to researchers, practitioners, and policy makers working across the intersecting fields of older age care and medicine, adult protection and safeguarding, and domestic and intimate partner violence. To date, these fields have generated diverse explanations of violence and abuse in older age illness and how best to respond to it. This article reports the findings of a systematic literature review of 18 quantitative, qualitative, and mixed-methods studies that investigated violent and abusive behavior by older people toward their family caregivers. The review identified three central themes in the literature: (1) There are inconsistent definitions and measurements used in research about harmful, violent, and abusive behavior toward family caregivers. (2) Violent and abusive behavior toward caregivers is a sensitive and hidden topic that poses practical and methodological challenges for researchers. (3) There is some evidence to suggest that people who were violent and abusive in their earlier life—or who had a poor relationship with their family member in the past—are more likely to continue to experience violence and abusive behavior in later life. There were two central ways in which violence and abuse were conceptualized and investigated: as a “symptom of illness” or as an “act of abuse” and we present a visual map of the relationship between these two conceptualizations drawn from our analysis of the literature. We conclude by discussing the implications of the findings and recommend future directions for practice, research, and policy to support affected families.

Objective. To find out the level of stressfulness of inside family isolation in Russia; coping with the negative effects of a pandemic, fear and isolation. Background. The situation of a health threat causes unexpected stress enhancing the fear of getting infected, uncertainty, anxiety. The coronavirus disease outbreak has introduced special demands: to lockdown not to get infected. But it also “triggers” adaptive coping behavior. It`s suggested that situation-adequate coping, as well as close relationships based on support, reduce the effects of coronavirus threat. Domestic violence and its effects (physical abuse, mental illness, PTSD) negatively affect family relationships, maybe as deadly as the coronavirus, require immediate prevention. Study design. A mini-longitudinal empirical study was conducted online at the beginning (27.03.2020—12.04.2020) (N1=248) and in the second half of lockdown (28.04.2020—03.05.2020) (N2=310). The role of stressors in changing family relationships has been correlated with the impact of catching COVID-19 threat and self-isolation on the psychological state of family members. Participants. 558 volunteers aged 18—87, including 425 women and 117 men; the majority of them (66%) have their own family — 369 are married/in a relationship; work. Measurements. A questionnaire created by the authors on the basis of international projects assessing impact of stress and self-isolation on family relationships, standardized anxiety and depression scales; coping scales. Results. Negative outcomes of the threat of infection and isolation are reduced if coping is adequate, emotional support from family members, and their views on the necessary daily changes are consistent. Stress levels are higher in single people. Having a partner is important for ways of coping choice. Conclusions. Stress generating from the threat of catching virus/COVID-19 experienced by people during lockdown in close/family relationships is normative as long as they use coping strategies, adequate to the situation (acceptance, positive reappraisal) with a low frequency of choosing less adequate strategies.

The objective of this study was to assess the prevalence of domestic violence in ever-married women in India and analyze the relationship between domestic violence and use of female sterilization as contraception. We analyzed data from the National Family Health Survey 2005–2006 (NFHS3). The Domestic Violence Module of the survey included abuse experiences and reproductive health outcomes of ever-married women aged 15 to 49 years ( n = 69,704). The main outcome of interest was female sterilization and domestic violence experience was the main independent variable. Covariates in our multivariate regression models were guided by the socioecological model for domestic abuse. We estimated a reference linear probability model for the dichotomous outcome. We also employed an instrumental variables procedure to strengthen causal inference under such potential sources of bias as measurement error in reporting domestic violence and omitted variables. The reference model showed an increase of 2.1 percentage points ( p < .001) in the probability of female sterilization associated with exposure to domestic violence. After correcting the estimate for the measurement error and omitted variable bias, we found that domestic violence was associated with an increase in female sterilization by 6.4 percentage points ( p < .001), which is 18% higher than the rate of sterilization among non-victims. In conclusion, our findings imply that domestic violence may lead abuse victims to opt for female sterilization as contraception. Domestic violence is a significant obstacle to efficient contraceptive use. Programs directed toward violence prevention should work conjointly with family planning programs in India.

This article addresses recent debates relating to the measurement of domestic violence, and in particular the ‘domestic violent crime’ framework proposed by Sylvia Walby and colleagues. We argue for the utility of coercive control as a framework for measurement of domestic violence, and highlight what we see as misrepresentation of this concept in the work of Walby and colleagues. We also point to the limitations of traditional crime codes in capturing the range of abuse suffered by victims of coercive control, and question whether measuring physical assault is any more straightforward in sample surveys than measuring non-violent forms of coercion. We conclude by calling for greater attention to qualitative narratives and practice-based knowledge to ensure that measurement frameworks reflect the lived experiences of victim-survivors.

AbstractWhat are the causes and consequences of systematic measurement error in violence measures drawn from media-based conflict event data? More specifically, how valid are such event data for geocoding and capturing election violence? This study examines sub-national variation in election violence and uses original data from domestic election monitor surveys as a comparison to widely used sources of event data. The authors show that conventional data under-report events throughout the election cycle, particularly in sparsely populated areas and outside anticipated violence hotspots. Moreover, systematic measurement error of media-based event data for measuring election violence can generate significant relationships where none exist, and can result in different effect magnitudes. The article suggests areas for future research and indicates ways in which existing work on election violence may have been affected by systematic measurement error.

Domestic violence (DV) represents a significant public health concern in the United States, including among Latinx populations. Despite the negative consequences associated with experiencing DV, research has shown that Latinx DV survivors may be less likely than others to utilize important services. One potential barrier is cultural competence (CC) in the provision of services specific to Latinx survivors among DV organizations. Thus, a beneficial addition to the field of DV service provision for such survivors is a better understanding and measurement of CC for this unique population. The exploratory, cross-sectional study herein presents the development and evaluation of a novel instrument for measuring the CC of DV organizations. Exploratory factor analysis was used on a purposive sample of 76 organizations in North Carolina who completed a comprehensive survey on their characteristics, practices, norms, and values. Psychometric results found best support for a 29-item, 4-factor bifactor model with both a general CC factor as well as three sub-factors. The general scale was named “General Cultural Competence,” while the three sub-scales were named “Organizational Values and Procedures,” “Latinx Knowledge and Inclusion,” and “Latinx DV Knowledge.” The final measure also demonstrated convergent validity with key organizational characteristics. Overall, higher CC scores were associated with organizations having more DV services in Spanish, a higher percentage of staff attending CC training, a higher percentage of staff attending Latinx service provision training, and a medium or greater presence in the Latinx community, and a moderate or stronger relationship with the Latinx community. The development of this measure is particularly useful in addressing knowledge gaps regarding the measurement of CC for Latinx DV services. Implications have importance for both the measurement of organizational CC and the scope of the measure’s associations with organizational, provider, and client outcomes.

Violence is one of the destructive social phenomena. It is widespread in any society and has different forms of existence. The greatest attention is drawn to domestic violence, violence against family members (wives, children, elderly parents). The purpose of the research is to establish the attitude of the Dagestan peoples to spousal abuse. The object of the research is domestic violence. The subject of the research is spousal abuse. As a rule, indicators of the measurement of spousal abuse are data on the female subgroup, since it is almost always the victim. The research method is a mass standardized survey. On the basis of the research, it has been found that in the mass consciousness of the Dagestan peoples there is a negative attitude towards spousal abuse and they emphasize its inadmissibility in the family. The author's hypothesis about the key role of education as a factor influencing the family behavior of both men and women has been confirmed by the results of the research. However, the research notes the presence of inconsistency in positions: on the one hand, it emphasizes the inadmissibility of violence in the family, regardless of the circumstances, on the other hand, the focus on its application. Verification of the sociological material shows that in the male subgroup there are fewer people who oppose spousal abuse.

Background: Spouse abuse is a major human problem in various communities, which not only has legal aspects but also considerably affects family as the primary social institution. Objectives: The aim of this study was to determine the relationship between spouse abuse and obsessive-compulsive disorder (OCD) and identify the predictors of domestic violence in women visiting comprehensive urban health services centers in Birjand, Iran. Methods: In this descriptive-analytical study, 475 women visiting comprehensive urban health services centers in Birjand were selected via the cluster sampling method. Data was collected using a demographics form, Samuee’s Standard Spouse Abuse Scale, and Rabie’s Behavioral Measurement Scale for obsessive-compulsive disorder. The collected data was entered into SPSS 16 and analyzed using MannWhitney, Kruskal Wallis, and Spearman non-parametric tests. The level of significance was set at α = 5%. Results: The mean scores of OCD and domestic violence in the studied women were 9.7 ± 5.1 and 77.1 ± 27.9, respectively. Of all the participants, 86.5% had experienced mild violence, 9.3% moderate violence, and 4.2% severe spousal violence. Moreover, 42.9% of women were suffering from OCD. The mean score of violence was significantly higher in addicted women, women with OCD, and women with unemployed, loweducated, or addicted spouses (P < 0.05). Furthermore, women who had a history of family conflict or parental conflict were significantly influenced by violent, high-risk, and arrogant behaviors of the spouse. The mean score of violence was significantly correlated with some components of OCD, age of women and their spouses, and duration of marriage (P < 0.05). Obsessive-compulsive disorder was determined as a good predictor of violence against women (P < 0.05). Conclusions: It seems that numerous psychological problems of women, such as anxiety and OCD, can be attributed to family violence. On the other hand, anxiety and OCD can increase the level of incompatibility in women and make them more vulnerable to violence. Therefore, the identification of cases of violence and spouse abuse and the timely detection and treatment of OCD in women can ensure the physical, emotional, and psychological security of women in a family, and thereby contribute to the stability of the family and community and reduce social harms.

Introduction: As a social phenomenon of the present age, Divorce as one of the social phenomena of the present age has many obvious and hidden factors practical and fundamental solutions have been proposed to reduce and deal with this issue by examining and recognizing these factors in each society. This study was carried out to identify the social factors related to the demand for divorce in Yazd. Methods: The present study was conducted by survey technique. The statistical population included the couples seeking divorce referred to the judiciary of Yazd in the period of 2011-2017, the sample size of 110 people was selected by random sampling method based on Cochran's formula, a researcher-made questionnaire was used as the measurement tool whose validity was measured by Formal validity and reliability by Cronbach's alpha. Results: According to the findings, the respondents believed that the three variables of domestic violence, interference of others and the level of spouses' participation in household work had great roles in the demand for divorce. There is also a significant relationship between age and gender, and variables of domestic violence, spouse's family interference and spouse's participation in household. 18.9% of the variance of the dependent variable (Divorce) is explained by the variables of gender, education, family past. Conclusion: It is necessary to provide life skills training and free counseling to couples and families in this regard in order to prevent failed marriages and marital problems and develop strong relationships. Besides, it is necessary for the mass media to raise awareness, give information to people, and promote rational, spiritual and easy marriages.

Abstract Background This study sought to investigate if parental divorce in childhood increases the risk for depressive symptoms in pregnancy. Methods Women were recruited during their ultrasound screening in gestational week (gwk) 12. The final study sample consisted of 2,899 pregnant women. Questionnaires (including the Edinburgh Postnatal Depression Scale) were completed at three measurement points (gwk 14, 24 and 34). Prenatal depressive symptoms were defined as Edinburgh Postnatal Depression Scale score ≥ 13. Parental divorce and other stressful life events in childhood were assessed at gwk 14. Parental divorce was defined as separation of parents who were married or cohabiting. Questionnaire data was supplemented with data from Statistics Finland and the Finnish Medical Birth Register. Results Parental divorce in childhood increased the risk for depressive symptoms during pregnancy (OR 1.47; 95% CI 1.02–2.13), but the connection was no longer significant after adjusting for socioeconomic status, family conflicts and witnessing domestic violence in the childhood family (OR 0.80; 95% CI 0.54–1.18). Conclusions Parental divorce alone does not predict depressive symptoms during pregnancy.

Abstract Background For every maternal death, 20 to 30 women are estimated to have morbidities related to pregnancy or childbirth. Much of this burden of disease is in women in low- and middle-income countries. Maternal multimorbidity can include physical, psychological and social ill-health. Limited data exist about the associations between these morbidities. In order to address all health needs that women may have when attending for maternity care, it is important to be able to identify all types of morbidities and understand how each morbidity influences other aspects of women’s health and wellbeing during pregnancy and after childbirth. Methods We systematically reviewed published literature in English, describing measurement of two or more types of maternal morbidity and/or associations between morbidities during pregnancy or after childbirth for women in low- and middle-income countries. CINAHL plus, Global Health, Medline and Web of Science databases were searched from 2007 to 2018. Outcomes were descriptions, occurrence of all maternal morbidities and associations between these morbidities. Narrative analysis was conducted. Results Included were 38 papers reporting about 36 studies (71,229 women; 60,911 during pregnancy and 10,318 after childbirth in 17 countries). Most studies (26/36) were cross-sectional surveys. Self-reported physical ill-health was documented in 26 studies, but no standardised data collection tools were used. In total, physical morbidities were included in 28 studies, psychological morbidities in 32 studies and social morbidities in 27 studies with three studies assessing associations between all three types of morbidity and 30 studies assessing associations between two types of morbidity. In four studies, clinical examination and/or basic laboratory investigations were also conducted. Associations between physical and psychological morbidities were reported in four studies and between psychological and social morbidities in six. Domestic violence increased risks of physical ill-health in two studies. Conclusions There is a lack of standardised, comprehensive and routine measurements and tools to assess the burden of maternal multimorbidity in women during pregnancy and after childbirth. Emerging data suggest significant associations between the different types of morbidity. Systematic review registration number PROSPERO CRD42018079526.

Abstract Background Coalitions are a popular mechanism for delivering community-based health promotion. The aim of this systematic review was to synthesize research that has quantitatively analyzed the association between coalition characteristics and outcomes in community-based initiatives targeting the social determinants of health. Coalition characteristics described elements of their structure or functioning, and outcomes referred to both proximal and distal community changes. Methods Authors searched six electronic databases to identify peer reviewed, published studies that analyzed the relationship between coalition characteristics and outcomes in community-based initiatives between 1980 and 2021. Studies were included if they were published in English and quantitatively analyzed the link between coalition characteristics and outcomes. Included studies were assessed for quality using the Joanna Briggs Institute analytical cross-sectional studies assessment tool. Results The search returned 10,030 unique records. After screening, 26 studies were included from six countries. Initiatives targeted drug use, health equity, nutrition, physical activity, child and youth development, crime, domestic violence, and neighbourhood improvement. Community outcomes measured included perceived effectiveness (n=10), policy, systems or environment change (n=9), and community readiness or capacity (n=7). Analyses included regression or correlation analysis (n=16) and structural equation or pathway modelling (n=10). Studies varied in quality, with a lack of data collection tool validation presenting the most prominent limitation to study quality. Statistically significant associations were noted between community outcomes and wide range of coalition characteristics, including community context, resourcing, coalition structure, member characteristics, engagement, satisfaction, group facilitation, communication, group dynamics, relationships, community partnership, and health promotion planning and implementation. Conclusion Existing literature demonstrates that coalition characteristics, including best practice health promotion planning and evaluation, influence community outcomes. The field of coalition research would benefit from more consistent description and measurement of coalition characteristics and outcomes, and efforts to evaluate coalitions in a wider range of countries around the world. Further research using empirical community outcome indicators, and methods that consider the interrelationship of variables, is warranted. Trial registration A protocol for this review was registered with PROSPERO (CRD42020205988).

Abstract Background Mental health and resilience during the COVID-19 pandemic is a challenge for all indivduals. While evidence is emerging that the COVID pandemic has affected mental health of everybody, at this point, no comparable data about the extent of the COVID-19 pandemic impact on mental health and resilience on citizens in Europe are available. We aim to fill this gap in knowledge. Methods We conducted a longitudinal study in eight European countries including 18+ year old individuals using mixed methods sampling (e.g. convenience sampling, panel data sampling). Main outcomes were depression, anxiety, post-traumatic symptoms and resilience. Depression was assessed with the PHQ-9, anxiety with the GAD-7, substance use with the Audit, resilience with the BRS and the CD-RISK, stress symptoms with the Impact of Event Scale (IES-R). We assessed as potentially influencing factors socio-demographic factors (location, age, gender, education, profession, living situation), and COVID-19 specific factors, furthermore we investigated social support, social capital, loneliness, and domestic violence and alcohol consumption (AUDIT). We analyze every measurement point, starting from the baseline data, cross-sectional and longitudinally. For the longitudinal analyses, multiple linear regression analyses, simple logistic regression analyses, and multinomial logistic regression analyses are conducted to examine resilience trajectories. Furthermore, to simultaneously control for many variables that potentially confound the relationship between a mental health and resilience, propensity score matching is applied. Results In total as of 30. April. 2,442 individuals participated (female: n = 1,582 (64.8%), male: n = 672 (27.5%), diverse: n = 5 (0.2%), missing: n = 183 (7.5%) as well as an age bias (Median=33, Mean=36.30, SD = 14,46, age range=18years-80 years. Mental health outcomes varied widely within and between countries. In this panel European and country specific data will be presented and discussed. We present the data on behalf of the COPERS consortium, other members of the consortium will be present at the discussion. Speakers/Panelists Jutta Lindert Hochschule Emden-Leer, Emden, Germany Marija Jakubauskiene Vilnius University, Vilnius, Lithuania Marija Jevtic Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia Edvaldo Begotaraj Department of Social and Developmental Psychology, Sapienza University, Rome, Italy Alessandro Morganti Politecnico di Milano, Milano, Italy Key messages To the best of our knowledge, no comparable multinational data about the impact of the COVID-19 pandemic impact on mental conditions and resilience on citizens in Europe are available. Scope and extent of mental conditions during the COVID pandemic vary; country specific most vulnerbale groups are identified.

Abstract Background Intimate Partner Violence is a “global pandemic”. Meanwhile, information and communication technologies (ICT), such as the internet, mobile phones, and smartphones, are spreading worldwide, including in low- and middle-income countries. We reviewed the available evidence on the use of ICT-based interventions to address intimate partner violence (IPV), evaluating the effectiveness, acceptability, and suitability of ICT for addressing different aspects of the problem (e.g., awareness, screening, prevention, treatment, mental health). Methods We conducted a systematic review, following PRISMA guidelines, using the following databases: PubMed, PsycINFO, and Web of Science. Key search terms included women, violence, domestic violence, intimate partner violence, information, communication technology, ICT, technology, email, mobile, phone, digital, ehealth, web, computer, online, and computerized. Only articles written in English were included. Results Twenty-five studies addressing screening and disclosure, IPV prevention, ICT suitability, support and women’s mental health were identified. The evidence reviewed suggests that ICT-based interventions were effective mainly in screening, disclosure, and prevention. However, there is a lack of homogeneity among the studies’ outcome measurements and the sample sizes, the control groups used (if any), the type of interventions, and the study recruitment space. Questions addressing safety, equity, and the unintended consequences of the use of ICT in IPV programming are virtually non-existent. Conclusions There is a clear need to develop women-centered ICT design when programming for IPV. Our study showed only one study that formally addressed software usability. The need for more research to address safety, equity, and the unintended consequences of the use of ICT in IPV programming is paramount. Studies addressing long term effects are also needed.

Intimate partner sexual violence (IPSV) is a prevalent phenomenon, yet an under-researched topic. Due to the complex nature of balancing love and fear, individuals who experience IPSV have unique needs and face unique barriers to seeking care. The purpose of this systematic review was to examine the literature on help-seeking and barriers to care in IPSV. Articles were identified through PubMed, CINAHL, PsycINFO, and Web of Science. Search terms included terms related to IPSV, intimate partner violence (IPV), domestic violence, sexual assault, and rape. The review was limited to the United States, and articles that were included needed to specifically measure or identify sexual violence in an intimate relationship and analyze or discuss IPSV in relation to help-seeking behaviors or barriers to care. Of the 17 articles included in this review, 13 were quantitative studies and four were qualitative studies. Various definitions and measurements of IPSV across studies included in this review make drawing broad conclusions challenging. Findings suggest that experiencing IPSV compared to experiencing nonsexual IPV (i.e., physical or psychological IPV) may increase help-seeking for medical, legal, and social services while decreasing help-seeking for informal support. Help-seeking can also reduce risk of future IPSV and decrease poor mental health outcomes. Barriers to seeking care in IPSV included social stigma, fear, and difficulty for individuals in identifying IPSV behaviors in their relationships as abuse. More inclusive research is needed among different populations including men, non-White individuals, nonheterosexual, and transgender individuals. Suggestions for research, practice, and policies are discussed.

A small but clinically significant number of people experience delayed-onset Post-traumatic stress disorder (PTSD); symptoms of trauma years after the events which are now being re-experienced. The following case report describes the use of the cognitive-behavioural treatment for PTSD with a woman experiencing flashbacks to domestic abuse endured more than 20 years ago. Mask-wearing mandated as a result of the COVID-19 pandemic triggered non-contextualised memories of life-threatening physical violence by an abuser who covered his face. She had been managing her flashbacks and intrusive thoughts with both behavioural and experiential forms of avoidance. An 18-session intervention was provided in her own home due to physical health difficulties. Treatment focused on managing hyper-arousal, reducing thought suppression, in-vivo exposure, stimulus-discrimination and re-contextualising traumatic memories. Regular outcome measurements were kept and results are presented as a single-case experimental design in ‘AB’ format (i.e. baseline period pre intervention). Symptoms of trauma fell to levels non-indicative of PTSD and speak to the evidence base for this modality, even when applied to delayed-onset difficulties in a non-traditional therapy setting. This conclusion is lent extra credence by an experimental design with good internal validity.

Background: Since the outbreak of COVID-19 pandemic, psychological distress is increased. Transdiagnostic mechanisms, including trauma, personality functioning, mentalizing and emotion regulation are considered relevant to the development and maintenance of mental health problems and therefore may play a role in individuals’ reactions to the pandemic.Aim: To identify moderating and mediating factors associated with pandemic-related distress and mental health problems in adults and families, we aim to investigate the interactions of interpersonal trauma (childhood trauma and domestic violence), psychological capacities (personality functioning, mentalizing and emotion regulation) and pandemic-related adversity on psychological distress during the COVID-19 pandemic. Furthermore, we aim to investigate behavioral and cognitive consequences of the pandemic (e.g., media consumption, vaccination status, conspiracy beliefs).Methods: Using an online-based cross-sectional and longitudinal design, we will investigate a sample of adult participants recruited via online platforms in German-speaking countries over the course of 1 year with four measurements points via self-report instruments (personality functioning: PID5BF +; mentalizing: MentS, PRFQ; emotion regulation: DERS-SF; mental health problems: PHQ-9, GAD-7; a composite pandemic-related stress score). Structural equation and multi-level modeling will be performed for data analyses.Implications: This study will provide data on the moderating and mediating effects of trauma, personality functioning and mentalizing during the pandemic in a large community sample, particularly on vulnerable groups like families. Identifying transdiagnostic mechanisms of psychopathology in the course of a pandemic crisis may provide valuable insight for the development of pre- and intervention measures for potential psychological distress during and post the pandemic.

Abstract Background A growing body of research highlights the pervasive harms of adverse childhood experiences (ACEs) on health throughout the life-course. However, findings from prior reviews and recent longitudinal studies investigating the association between types of ACEs and persistent pain have yielded inconsistent findings in the strength and direction of associations. The purpose of this review is to appraise and summarize evidence on the relationship between ACEs and persistent pain and disability outcomes in adulthood. The specific aims are (1) to determine whether there is a relationship between exposure to ACE and persistent pain and disability in adults and (2) to determine whether unique and cumulative ACEs exposures (number and type) increase the risk of developing persistent pain and disability in adulthood. Method A systematic review and meta-analysis of observational studies will be conducted. Our eligibility criteria are defined following a PECOS approach: population, adults with persistent (≥ 3 months) musculoskeletal and somatoform painful disorders exposed to single or cumulative direct ACEs alone (i.e., physical, sexual, emotional abuse or neglect) or in combination to indirect types of ACE (e.g., parental death, exposure to domestic violence) in the first 18 years of life; comparators, unexposed individuals; outcomes, measurements for persistent pain (≥ 3 months) and disability using discrete and/or continuous measures; and settings, general population, primary care. A comprehensive search of MEDLINE (Ovid) and nine other pertinent databases was conducted from inception to 29 August 2019 using a combination of key words and MeSh terms (the search will be updated prior to conducting the analyses). Pairs of reviewers will independently screen records and full text articles, and a third reviewer will be consulted in cases of disagreement. Data will be extracted using Endnote and Covidence and a meta-analysis will be conducted using Review Manager (RevMan) Version 5.3. The Scottish Intercollegiate Guidelines Network (SIGN) and the Joanna Briggs Institute (JBI) checklists will be used to assess the quality of the included studies. If heterogeneity is high, the findings will be presented in narrative form. Discussion The present review will help consolidate knowledge on persistent pain and disability by evaluating whether frequency and type of adverse childhood experiences produces the most harm. Findings may help inform practitioners and policy-makers who endeavor to prevent and/or mitigate the consequences of ACEs and promote healthy development and well-being of children, youth, and families. Systematic review registration PROSPERO CRD42020150230

IntroductionThis article addresses the experience of designing and conducting life-writing workshops for a group of clients with severe mental illness; the aim of this pilot study was to begin to determine whether such writing about the self can aid in individual ‘recovery’, as that term is understood by contemporary health professionals. A considerable amount has been written about the potential of creative writing in mental health therapy; the authors of this article provide a brief summary of that literature, then of the concept of ‘recovery’ in a psychology and arts therapy context. There follows a first-hand account by one of the authors of being an arts therapy workshop facilitator in the role of a creative practitioner. This occurred in consultation with, and monitored by, experienced mental health professionals. Life-Writing as ‘Therapeutic’ Life-story or life-writing can be understood in this context as involving more than disclosure or oral expression of a subject’s ‘story’ as in psycho-therapy – life-story is understood as a written, structured narrative. In 2001, Wright and Chung published a review of the literature in which they claimed that writing therapy had been “restimulated by the development of narrative approaches” (278). Pennebaker argues that “catharsis or the venting of emotions” without “cognitive processing” has little therapeutic value and people need to “build a coherent narrative that explains some past experience” in order to benefit from writing” (Pennebaker, Telling Stories 10–11). It is claimed in the Clinical Psychology Review that life-writing has the therapeutic benefits of, for example, “striking physical health and behaviour change” (Esterling et al. 84). The reasons are still unclear, but it is possible that the cognitive and linguistic processing of problematic life-events through narrative writing may help the subject assimilate such problems (Alschuler 113–17). As Pennebaker and Seagal argue in the Journal of Clinical Psychology, the life-writing processallows one to organise and remember events in a coherent fashion while integrating thoughts and feelings ... This gives individuals a sense of predictability and control over their lives. Once an experience has structure and meaning, it would follow that the emotional effects of that experience are more manageable. (1243)It would seem reasonable to suggest that life-writing which constructs a positive recovery narrative can have a positive therapeutic effect, providing a sense of agency, connectedness and creativity, in a similar, integrating manner. Humans typically see their lives as stories. Paul Eakin stresses the link between narrative and identity in both this internal life-story and in outwardly constructed autobiography:narrative is not merely a literary form but a mode of phenomenological and cognitive self-experience, while self – the self of autobiographical discourse - does not necessarily precede its constitution in narrative. (Making Selves 100)So both a self-in-time and a socially viable identity may depend on such narrative. The term ‘dysnarrativia’ has been coined to describe the documented inability to construct self-narrative by those suffering amnesia, autism, severe child abuse or brain damage. The lack of ability to achieve narrative construction seems to be correlated with identity disorders (Eakin, Fictions in Autobiography 124). (For an overview of the current literature on creative and life-writing as therapy see Murphy & Neilsen). What is of particular relevance to university creative writing practitioners/teachers is that there is evidence, for example from Harvard psychiatrist Judith Herman and creative writing academic Vicki Linder, that life-narratives are more therapeutically effective if guided to be written according to fundamental ‘effective writing’ aesthetic conventions – such as having a regard to coherent structure in the narrative, the avoidance of cliché, practising the ‘demonstrate don’t state’ dictum, and writing in one’s own voice, for example. Defining ‘Recovery’There remains debate as to the meaning of recovery in the context of mental health service delivery, but there is agreement that recovery entails significantly more than symptom remission or functional improvement (Liberman & Kopelowicz). In a National Consensus Statement, the Substance Abuse and Mental Health Services Administration (SAMHSA) unit of the US Department of Health and Human Services in 2005 described recovery (in general terms) as being achieved by the enabling of a person with a mental illness to live meaningfully in a chosen community, while also attempting to realize individual potential. ‘Recovery’ as a central concept behind rehabilitation can be understood both as objective recovery – that is, in terms of noting a reduction in objective indicators of illness and disability (such as rates of hospital usage or unemployment) and a greater degree of social functioning – and also as subjective recovery. Subjective recovery can be ascertained by listening closely to what clients themselves have said about their own experiences. It has been pointed out (King, Lloyd & Meehan 2) that there is not always a correspondence between objective indicators of recovery and the subjective, lived experience of recovery. The experience of mental illness is not just one of symptoms and disability but equally importantly one of major challenge to sense of self. Equally, recovery from mental illness is experienced not just in terms of symptoms and disability but also as a recovery of sense of self … Recovery of sense of self and recovery with respect to symptoms and disability may not correspond. (King, Lloyd & Meehan; see also Davidson & Strauss)Symptoms of disability can persist, but a person can have a much stronger sense of self or empowerment – that is still recovery. Illness dislocates the sense of self as part of a community and of a self with skills and abilities. Restoring this sense of empowerment is an aim of arts therapy. To put it another way, recovery is a complex process by which a client with a mental illness develops a sense of identity and agency as a citizen, as distinct from identification with illness and disability and passivity as a ‘patient’. The creative arts have gone well beyond being seen as a diversion for the mentally ill. In a comprehensive UK study of creative arts projects for clients with mental illness, Helen Spandler et al. discovered strong evidence that participation in creative activity promoted a sense of purpose and meaning, and assisted in “rediscovering or rebuilding an identity within and beyond that of someone with mental health difficulties” (795). Recovery is aided by people being motivated to achieve self-confidence through mastery and competence; by learning and achieving goals. Clearly this is where arts therapy could be expected or hoped to be effective. The aim of the pilot study was not to measure ‘creativity’, but whether involvement in what is commonly understood as a creative process (life-writing) can have flow-on benefits in terms of the illness of the workshop participant. The psychologists involved, though more familiar with visual arts therapy (reasonably well-established in Australia – in 2006, the ANZAT began publishing the Australian and New Zealand Journal of Art Therapy), thought creative writing could also be valuable. Preparation for and Delivery of the Workshops I was acutely aware that I had no formal training in delivering a program to clients with mental health illness. I was counselled during several meetings with experienced psychologists and a social worker that the participants in the three workshops over two weeks would largely be people who had degrees of difficulty in living independently, and could well have perceptual problems, could misjudge signals from outside and inside the group, and be on medication that could affect their degree of engagement. Some clients could have impaired concentration and cognition, and a deficit in volition. Participants needed to be free to leave and rejoin the workshops during the afternoon sessions. Attendance might well fall as the workshops progressed. Full ethical clearance was attained though the University of Queensland medical faculty (after detailed description of the content and conduct of the proposed workshops) and consent forms prepared for participants. My original workshop ‘kit’ to be distributed to participants underwent some significant changes as I was counselled and prepared for the workshops. The major adjustment to my usual choice of material and approach was made in view of the advice that recounting traumatic events can have a negative effect on some patients – at least in the short term. For the sake of both the individuals and the group as a whole this was to be avoided. I changed my initial emphasis on encouraging participants to recount their traumatic experiences in a cathartic way (as suggested by the narrative psychology literature), to encouraging them to recount positive narratives from their lives – narratives of ‘recovery’ – as I explain in more detail below. I was also counselled that clients with mental health problems might dwell on retelling their story – their case history – rather than reflecting upon it or using their creative and imaginative ability to shape a life-story that was not a catalogue of their medical history. Some participants did demonstrate a desire to retell their medical history or narrative – including a recurring theme of the difficulty in gaining continuity with one trusted medical professional. I gently guided these participants back to fashioning a different and more creative narrative, with elements of scene creation, description and so on, by my first listening intently to and acknowledging their medical narrative for a few minutes and then suggesting we try to move beyond that. This simple strategy was largely successful; several participants commented explicitly that they were tired of having to retell their medical history to each new health professional they encountered in the hospital system, for example. My principal uncertainty was whether I should conduct the workshops at the same level of complexity that I had in the past with groups of university students or community groups. While in both of those cohorts there will often be some participants with mental health issues, for the most part this possibility does not affect the level or kind of content of material discussed in workshops. However, within this pilot group all had been diagnosed with moderate to severe mental illness, mostly schizophrenia, but also bipolar disorder and acute depression and anxiety disorders. The fact that my credentials were only as a published writer and teacher of creative writing, not as a health professional, was also a strong concern to me. But the clients readily accepted me as someone who knew the difficulty of writing well and getting published. I stressed to them that my primary aim was to teach effective creative writing as an end in itself. That it might be beneficial in health terms was secondary. It was a health professional who introduced me and briefly outlined the research aims of the workshop – including some attempt to measure qualitatively any possible benefits. It was my impression that the participants did not have a diminished sense of my usefulness because I was not a health professional. Their focus was on having the opportunity to practice creative writing and/or participate in a creative group activity. As mentioned above, I had prepared a workshop ‘kit’ for the participants of 15 pages. It contained the usual guidelines for effective writing – extracts from professional writers’ published work (including an extract from my own published work – a matter of equity, since they were allowing me to read their work), and a number of writing exercises (using description, concrete and abstract words, narrative point of view, writing in scenes, show don’t tell). The kit contained extracts from memoirs by Hugh Lunn and Bill Bryson, as well as a descriptive passage from Charles Dickens. An extract from Inga Clendinnen’s 2006 account in Agamemnon’s Kiss: selected essays of her positive interaction with fellow cancer patients (a narrative with the underlying theme of recovery) was also valuable for the participants. I stressed to the group that this material was very similar to that used with beginning writers among university students. I described the importance of life-writing as follows: Life-writing is simply telling a story from your life and perhaps musing or commenting on it at the same time. When you write a short account of something chosen from your life, you are making a pattern, using your memory, using your powers of description – you are being creative. You are being a story-teller. And story-telling is one very important thing that makes us humans different from all other animals – and it is a way in which we find a lot of meaning in our lives.My central advice in the kit was: “Just try to be as honest as you can – and to remember as well as you can … being honest and direct is both the best and the easiest way to write memoir”. The only major difference between my approach with these clients and that with a university class was in the selection of possible topics offered. In keeping with the advice of the psychologists who were experts in the theory of ‘recovery’, the topics were predominantly positive, though one or two topics gave the opportunity to recount and/or explore a negative experience if the participant wanted to do so: A time when I was able to help another personA time when I realised what really mattered in lifeA time when I overcame a major difficultyA time when I felt part of a group or teamA time when I knew what I wanted to do with my lifeA time when someone recognised a talent or quality of mineA time I did something that I was proud of A time when I learned something important to meA memorable time when I lived in a certain house or suburbA story that begins: “Looking back, I now understand that …”The group expressed satisfaction with these topics, though they had the usual writing students’ difficulty in choosing the one that best suited them. In the first two workshops we worked our way through the kit; in the third workshop, two weeks later, each participant read their own work to the group and received feedback from their peers and me. The feedback was encouraged to be positive and constructive, and the group spontaneously adopted a positive reinforcement approach, applauding each piece of writing. Workshop DynamicsThe venue for the workshops was a suburban house in the Logan area of Brisbane used as a drop-in centre for those with mental illness, and the majority of the participants would be familiar with it. It had a large, breezy deck on which a round-table configuration of seating was arranged. This veranda-type setting was sheltered enough to enable all to be heard easily and formal enough to emphasise a learning event was taking place; but it was also open enough to encourage a relaxed atmosphere. The week before the first workshop I visited the house to have lunch with a number of the participants. This gave me a sense of some of the participants’ personalities and degree of engagement, the way they related to each other, and in turn enabled them to begin to have some familiarity with me and ask questions. As a novice at working with this kind of client, I found this experience extremely valuable, especially as it suggested that a relatively high degree of communication and cognition would be possible, and it reduced the anxiety I had about pitching the workshops at an appropriate level. In the course of the first workshop, the most initially sceptical workshop participant ended up being the most engaged contributor. A highly intelligent woman, she felt it would be too upsetting to write about negative events, but ultimately wrote a very effective piece about the empowerment she gained from caring for a stray cat and locating the owner. Her narrative also expressed her realisation that the pet was partly a replacement for spending time with her son, who lived interstate. Another strong participant previously had written a book-length narrative of her years of misdiagnoses and trauma in the hospital system before coming under the care of her present health professionals. The participant who had the least literacy skills was accepted by the group as an equal and after a while contributed enthusiastically. Though he refused to sign the consent form at the outset, he asked to do so at the close of the first afternoon. The workshop was comprised of clients from two health provider organisations; at first the two groups tended to speak with those they already knew (as in any such situation in the broader community), but by the third workshop a sense of larger group identity was being manifested in their comments, as they spoke of what ‘the group’ would like in the future – such as their work being published in some form. It was clear that, as in a university setting, part of the beneficial effect of the workshops came from group and face to face interaction. It would be more difficult to have this dimension of benefit achieved via a web-based version of the workshops, though a chat room scenario would presumably go some way towards establishing a group feeling. Web-based delivery would certainly suit participants who lacked mobility or who lived in the regions. Clearly the Internet is a vital social networking tool, and an Internet-based version of the workshops could well be attempted in the future. My own previous experience of community digital storytelling workshops (Neilsen, Digital Storytelling as Life-writing) suggests that a high degree of technical proficiency can not be expected across such a cohort; but with adequate technical support, a program (the usual short, self-written script, recorded voice-over and still images scanned from the participants’ photo albums, etc) could make digital storytelling a further dimension of therapeutic life-writing for clients with mental illness. One of the most useful teaching techniques in a class room setting is the judicious use of humour – to create a sense of sharing a perspective, and simply to make material more entertaining. I tested the waters at the outset by referring to the mental health worker sitting in the background, and declaring (with some comic exaggeration) my concern that if I didn’t run the workshop well he would report adversely on me. There was general laughter and this expression of my vulnerability seemed to defuse anxiety on the part of some participants. As the workshop progressed I found I could use both humorous extracts of life-writing and ad hoc comic comments (never at the expense of a participant) as freely as in a university class. Participants made some droll comments in the overall context of encouraging one another in their contributions, both oral and written. Only one participant exhibited some temporary distress during one of the workshops. I was allowing another participant the freedom to digress from the main topic and the participant beside me displayed agitation and sharply demanded we get back to the point. I apologised and acknowledged I had not stayed as focused as I should and returned to the topic. I suspect I had a fortunate first experience of such arts therapy workshops – and that this was largely due to the voluntary nature of the study and that most of the participants brought a prior positive experience of the workshop scenario, and prior interest in creative writing, to the workshops. Outcomes A significantly positive outcome was that only one of the nine participants missed a session (through ill-health) and none left during workshops. The workshops tended to proceed longer than the three hours allotted on each occasion. Post-workshop interviews were conducted by a psychologist with the participants. Detailed data is not available yet – but there was a clear indication by almost all participants that they felt the workshops were beneficial and that they would like to participate in further workshops. All but one agreed to have their life-writing included in a newsletter produced by one of the sponsors of the workshops. The positive reception of the workshops by the participants has encouraged planning to be undertaken for a wide-ranging longitudinal study by means of a significant number of workshops in both life-writing and visual arts in more than one city, conducted by a team of health professionals and creative practitioners – this time with sophisticated measurement instruments to gauge the effectiveness of art therapy in aiding ‘recovery’. Small as the workshop group was, the pilot study seems to validate previous research in the UK and US as we have summarised above. The indications are that significant elements of recovery (in particular, feelings of enhanced agency and creativity), can be achieved by life-writing workshops that are guided by creative practitioners; and that it is the process of narrative construction within life-writing that engages with or enhances a sense of self and identity. NoteWe are indebted, in making the summary of the concept of ‘recovery’ in health science terms, to work in progress by the following research team: Robert King, Tom O'Brien and Claire Edwards (School of Medicine, University of Queensland), Margot Schofield and Patricia Fenner (School of Public Health, Latrobe University). We are also grateful for the generous assistance of both this group and Seiji Humphries from the Richmond Queensland Fellowship, in providing preparation for the workshops. ReferencesAlschuler, Mari. “Lifestories – Biography and Autobiography as Healing Tools for Adults with Mental Illness.” Journal of Poetry Therapy 11.2 (1997): 113–17.Davidson, Larry and John Strauss. “Sense of Self in Recovery from Severe Mental Illness.” British Journal of Medical Psychology 65 (1992): 31–45.Eakin, Paul. Fictions in Autobiography: Studies of the Art of Self-Invention. Princeton: Princeton UP, 1985.———. How Our Lives Become Stories: Making Selves. 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