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Family Violence Across the Lifespan: an Introduction Third Edition Pdf

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J Fam Violence. Author manuscript; available in PMC 2015 Oct i.

Published in last edited form as:

PMCID: PMC4193378

NIHMSID: NIHMS622820

Touch of Intimate Partner Violence on Women'due south Mental Health

Gunnur Karakurt

Example Western Reserve University, Department of Family Medicine and Community Wellness

Douglas Smith

Texas Tech University, Section of Community, Family, and Addiction Services

Jason Whiting

Texas Tech University, Department of Community, Family, and Addiction Services

Abstract

This study aimed to explore the mental health needs of women residing in domestic violence shelters; more specifically, nosotros aimed to identify commonalities and differences amid their mental health needs. For this purpose, qualitative and quantitative data was nerveless from 35 women from a Midwestern domestic violence shelter. Hierarchical clustering was applied to quantitative data, and the analysis indicated a three-cluster solution. Data from the qualitative analysis as well supported the differentiation of women into 3 distinct groups, which were interpreted as: (A) gear up to change, (B) focused on negative symptoms, and (C) focused on feelings of guilt and self-arraign.

Keywords: Mental wellness, intimate partner violence, cluster analysis, women

Violence against women is a prevalent problem around the world (Garcia-Moreno, Heise, Jassen, Ellsberg, & Watts, 2005). It has a profound and negative impact on women's ability to live happy and productive lives (Kilpatrick, 2004). Tearing acts against women include rape, incest, physical violence, and emotional abuse (Barnett, Miller-Perrin & Perrin, 2011). While both men and women are victimized, prevalence rates of violence against women are college (Johnson, 2008). Furthermore, as compared to men, women are more likely to be terrorized, injured, or killed past violence, regardless of their ethnicity, race, or socio-economic status (Johnson, 2008; Kellerman & Mercy, 1992).

Also referred to as domestic violence or spousal corruption, Intimate Partner Violence (IPV) results in exorbitant physical, emotional, and economical costs, and death is not an uncommon result (WHO World Report on Violence and Health, 2002). According to a literature review by Campbell (2002), injurious physical and mental health sequelae of Intimate Partner Violence (IPV) include injury or death, chronic hurting, gastrointestinal and gynecological problems, low, and post-traumatic stress disorder (PTSD). Many women also suffer rape and violence during pregnancy, causing harm to both mothers and children.

Intimate partner violence (IPV) has numerous mental health consequences for women (Golding, 1999; Kilpatrick & Acierno, 2003; Krug, Dahlberg, Mercy, Zwi, & Lozano, 2002; National Centre for Injury Prevention in Control, 2003; Schnurr & Green, 2004). These consequences include depression, anxiety, post-traumatic stress disorder (PTSD), substance abuse, and low self-esteem (Afifi, MacMillan, Cox, Asmundson, Stein, & Sareen, 2009; Bonomi, Anderson, Rivara, Carrell, & Thompson, 2009; Kilpatrick 2004; Logan, Cole, Shannon, & Walker, 2006; Straus & Smith, 1990). In social club to diminish the effects of IPV, it is important to understand these consequences and develop treatment modalities that improve serve women experiencing IPV. There is abundant literature on the mental health consequences of IPV. Most of these studies investigate the prevalence of mental health problems among women with a history of intimate partner violence or focus on a unmarried mental health problem (Arboleda-Florez & Wade, 2001; Dienemann, Boyle, Resnick, Wiederhorn, & Campbell, 2000; Kernic, Holt, Stoner, Wolf & Rivara, 2003).

In dissimilarity, we aim to identify the symptoms that are seen together amidst different groups of women. More specifically, the aim of this study is to investigate the self-identified mental health needs of women in domestic violence shelters, and explore the commonalities and differences among these needs. For this purpose, we have collected quantitative and qualitative data on the cocky-reported mental wellness needs of women residing in a domestic violence shelter through checklists and interviews. After, nosotros practical cluster analysis to the quantitative data to place groups of women that are like to each other in terms of their mental wellness needs. Finally, nosotros used content analysis on the data obtained from the interviews to delineate the common mental health needs identified in each cluster.

Background

Depression

One of the predominant adverse furnishings of violence confronting women is an increased likelihood of clinical depression (Anderson, Saudners, Yoshihama, Bybee, & Sulivan, 2003; Arboleda-Florez & Wage, 2001; Dienemann, Boyle, Resnick, Wiederhorn & Campbell, 2000). Depression negatively impacts sleep and causes alarming changes in appetite, energy level, and the ability to function. Depression tin can somewhen lead to suicidal ideation or suicide attempts. Straus and Smith (1990) found female person victims of severe male battering were four times more likely than non-victimized women to be depressed and/or endeavor suicide.

Several studies have demonstrated the office of violence on clinical depression. Kernic, Holt, Stoner, Wolf, and Rivara (2003) conducted a longitudinal study on depression in battered women and establish severity of depression decreased once abuse ceased. Coolidge and Anderson (2002) compared the personality profiles of three groups of women and classified them equally follows: Grouping A: multiple calumniating relationships; Grouping B: one calumniating relationship; and Group C: no abusive relationship. Using the Diagnostic and Statistical Manual of Mental Disorders, ivthursday revision (DSM-4-TR; APA, 2000), the mental health profiles of these three groups of women were scored. Results showed women in Grouping A had significantly college prevalence rates and more severe levels of psychopathology, with the almost prevalent Axis I disorders being PTSD (36%) and Depression (17%), and the most prevalent Axis 2 disorder being Dependent Personality Disorder (21%). Women in Group B had college rates and levels of psychopathology when compared to the command group (Group C). These findings as well demonstrated dilapidated women are not necessarily a homogenous group, and they may have a diverseness of mental health bug depending on the type of violence they experience.

Mail service-traumatic Stress Disorder

PTSD is another usually reported mental wellness issue for women who feel IPV. A study by Mertin and Mohr (2001) suggested 40 to 60% of female victims suffer from PTSD. The evolution of PTSD involves exposure to traumatic stressors (violence), followed by fearfulness for one's safety and a sense of helplessness to control the situation. Some of the common symptoms of PTSD include: re-experiencing the event via flashbacks and nightmares, avoidance of reminders of the event, emotional numbing and increased concrete arousal (e.thousand., heightened startle response, difficulties sleeping; American Psychiatric Clan, 1994). The development of PTSD is particularly likely for victims of sexual attack (Kilpatrick, 2004). Some victims of violence have a number of PTSD symptoms, but practise not meet full diagnostic criteria for a formal diagnosis of PTSD. This suggests there is an increased variability of trauma and anxiety in women who have been victimized past violence compared to those who have not (Stein, Walker, & Forde, 1997). Besides, the extent to which female person victims develop PTSD or other anxiety disorders depends on the extent and severity of the exposure to corruption (Follette, Polunsy, Bechtle, & Naugle, 1996).

Substance Abuse

Female survivors of IPV are more likely to abuse drugs and alcohol. They receive prescriptions for more drugs and become dependent on drugs more often than non-victimized women. Fowler (2007) examined a sample of 102 women in a domestic violence shelter and found over 2-thirds of women scored in the moderate to high category for risk of substance corruption. In add-on, almost threescore% of the women were alcohol dependent, and 55% were drug dependent. In a report conducted with 71 domestic violence shelters for women in N Carolina, 47% percent of the shelters reported 26 to 50% of the women in their shelter had substance abuse problems, and 24% reported more than 50% of their clients had substance abuse problems (Martin et al., 2008). Other studies have replicated findings showing elevated levels of alcohol use among victims of IPV (Danielson, Moffitt, Caspi, & Silva, 1998; Watson et al., 1997). In add-on, more frequent victimizations are linked to a greater likelihood of substance apply in women (Logan et al., 2006). Golding (1999) conducted a meta-analytic review of intimate partner violence every bit a risk gene for mental disorders. This written report did non observe any links relating temporality of substance abuse to intimate partner violence. Nonetheless, in later years, more research identified substance use as a crucial risk factor both for victimization and perpetration of IPV (Caetano et al., 2000, Caetano et al., 2001, Chase et al., 2003, Coker, Smith, McKeown, & King, 2000, Cunradi et al., 2002, and White and Chen, 2002). Findings predominantly indicated 2-thirds of women in substance corruption treatment programs reported IPV victimization in the pretreatment yr (Drapkin et al., 2005, Lipsky, 2010 and Najavits et al., 2004).

Self-Esteem

Victims of violence are likely to experience guilt, shame, and self-blame for being abused (Lindgren & Renck, 2008; Weaver & Clum, 1995). Unfortunately, this can contribute to a brutal bicycle as victims who accept negative self-images are less probable to take steps to avoid or get out abusive relationships (Clements & Sawhney, 2000; Umberson, Anderson, Glick, & Shapiro, 1998). Further, self-esteem damage tin can occur if acquaintances or professionals arraign the victim for not preventing her abuse (Eddleson, 1998). These types of negative societal reactions are peradventure related to several of the mental wellness issues such every bit depression or feet that are common among victims of IPV.

Equally the aforementioned passages demonstrate, IPV has a wide variety of mental health consequences for women that can range from mild to severe. The aim of this paper is to explore self-identified mental wellness needs of women who are victims of severe IPV, identify mutual patterns of mental health needs for these women; and to identify groups of women that are similar to each other in terms of their mental health needs.

Method

Sample

Participants in this study were 35 women residing in a domestic violence shelter in a Midwestern boondocks. Some of these women came from smaller towns nearby that did non have domestic violence shelters. Women reported being physically and/or emotionally driveling by their husbands (34%), boyfriends (18%), ex-boyfriends (iii%), or ex-husbands (3%), and the remaining 42% did not report their relationship with the abuser. Participants were mainly referred to the shelter through constabulary services, local hospitals, other overcrowded shelters, or cocky-referral through hotlines.

The boilerplate age of the participants was 34.63 years (SD = xi.02), ranging from 18 to 54. The participants were from a range of cultural and ethnic backgrounds including European American (n = 14, xl %), African-American (n = seven, twenty%), Hispanic (n = 2, six%), Asian-American (n = 1, three%), or other ethnicities (n = 2, 6%); one quarter (n = nine) did not report their race/ethnicity. Of the 35 women, 26% (n = 9) had less than a loftier school education, 37% (north = xiii) had a loftier school degree, 14% (north = v) had some college education, three% (n =1) had a higher caste, three% (northward =1) had a Ph.D., and 17% (due north = 6) did not report their education. 50-one percent (n =18) of the women reported having children; among those women, the average number of children was two.41.

Procedures

Participants were recruited through mailbox announcements at the domestic violence shelter. Interested participants contacted the investigator to arrange a time for participating in the report. Before data collection, women were briefed almost the report and were asked to sign consent forms. After participants signed the consent forms, they completed questionnaires that covered demographic data, a mental health checklist, and their previous experiences with mental health providers. The checklist was designed for this report and included a range of issues such as assertiveness, stress, depression, anxiety, and parenting. Participants were asked to cheque whatever of the items that were causing them any difficulty. The items were non rated or ranked by the participants. Participants were too asked if there was anything else they would like to add together to the checklist. Completing the questionnaires took approximately 10 minutes. The aim of the checklist was to include a wide range of possible issues that might be experienced by the participants. The checklist was based on a local mental wellness clinic's experience on the common problems reported by their clinical population. This checklist was revised and adjusted based on give-and-take with the research team and some items were deleted to better reverberate the needs of the shelter population.

After the questionnaires were completed, clinical interviews were conducted by a Licensed Couple and Family Therapist to develop a deeper understanding of self-identified mental wellness needs. The therapist has previous experience working at non-profit institutions such as juvenile justice systems, community mental wellness services, and domestic violence shelters. She received training in cultural competency. Likewise, an AAMFT approved supervisor supervised the clinician. Throughout the interview, the therapist attempted to aid women in feeling comfortable in order to facilitate the collection of pertinent data.

The interviews were set up every bit unstructured clinical interviews to allow the participant more control over the subject thing and management of the interview. Indeed, in past enquiry, unstructured clinical interviews were found to be well-suited for gathering information (Robson, 2002). The duration of the interviews ranged from half an 60 minutes to 2 hours. The interviews started with a full general question and narrowed down depending on the response from the participants. Open-ended questions were asked to garner more details from the participant. Some examples of these questions included: "?What brings you hither?"?, and "?When did this happen?"?, followed past questions virtually the self and the human relationship: "?Practise you have children?"?, and "?How long have you been together?"?. Subsequently, the participant was asked questions regarding symptomology: "?What are the difficulties y'all are experiencing?"? The interviewer followed upwards on each difficulty by asking questions such every bit: "?How long have yous had this difficulty?"?, "?Is there whatever event that is precipitating this difficulty?,"? "?How are you lot coping with this?"?, and "?Practise yous have a support system?"?

Notes taken by the interviewers were used in qualitative analysis. The interviewer took the notes. The interviewer received preparation on DAP reporting formatting designed for clinicians. Specifically, DAP format stands for taking notes on Information, Assessment, and Planning. It includes both subjective and objective data well-nigh the interviewee and the therapist'southward observations. "?Data"? refers to content and process notes from the interview. "?Assessment"? refers to the therapist'southward clinical impressions, hunches, hypotheses, and rationale for the therapist's professional judgment. "?Planning"? refers to the original treatment programme and any response/revisions needed based on the nearly recent interactions with the client. Such method of clinical note taking is a commonly accepted format for documentation.

Data Analysis

Using the mental health checklist filled out by all participants, statistical cluster analysis was conducted to group individuals based on the similarities between their cocky-identified mental health needs. Hierarchical cluster assay was used to identify the number of clusters that were present in the sample. Once the number of clusters was determined, results were used to distribute the individuals into clusters. Afterwards all the clusters were identified, 1-way analyses of variance (ANOVAs) were performed to understand the distribution of several demographic and descriptive variables across clusters. The significance of the reporting frequencies of each difficulty was also assessed. For this purpose, binomial distribution was used to compute p-values based on a null model that assumes uniform distribution of all difficulties across all women. All the statistical analyses were performed with SPSS 17. Finally, in social club to understand the validity of the clusters, content analysis was conducted based on the notes from clinical interviews.

Results

According to preliminary exploratory analysis, 42% (n =xv) of women reported suicidal ideation, and 31% (n =11) reported attempting suicide at some point in their life, ranging from ii weeks to 17 years ago. For actively suicidal women, suicide assessment was conducted and necessary precautions were taken. Moreover, 34% of women (n =12) reported regularly taking various medications for their mental and physical health.

Frequencies of self-identified mental health needs are shown in Figure 1. Co-ordinate to this table, stress was the biggest concern among women who had been abused. The next line of ordinarily observed issues consisted of sadness, low, and unhappiness. Drug use was the least usually reported issue. The self-identified mental wellness needs in Effigy 1 were directly derived from the participants' responses to the checklist.

An external file that holds a picture, illustration, etc. Object name is nihms622820f1.jpg

Column graph based on means of the self-identified mental health needs of abused women

Hierarchical cluster analysis based on Ward method was used to assign individuals into groups. The variables considered in cluster analysis were the self-identified mental health needs, which were represented as dichotomous variables. Each variable represented a mental health need in the checklist, and the variables that correspond the needs reported by a participant were assigned a value of "?1"?, while those that were not reported were assigned to "?0"?.

The results of cluster analysis are shown in Figure ii. Analysis of the dendrogram and agglomeration schedule suggested an inconsistent increment in the dissimilarity measure after the combination of variables, suggesting the clustering process should be stopped i stage prior to this, at which signal a three cluster solution was plant to exist optimal. To exam the validity of the clusters, the sample was randomly divided into ii groups and the cluster analysis was repeated. Results of clustering for each of these two groups were similar to that for the entire fix of participants.

An external file that holds a picture, illustration, etc. Object name is nihms622820f2.jpg

Hierarchical cluster analysis of the mental wellness issues of women residing in a domestic violence shelter. Vertical axis shows participants, horizontal axis shows issues, a dark cell indicates that the respective participant mentioned the corresponding issue. Participants that are amassed together are shown next to each other equally indicated by the dendrogram on the left.

In society to farther exam the capability of the iii-cluster solution, discriminant function analysis was conducted to estimate membership based on the checklist. Results indicated all participants were correctly assigned to their respective group, suggesting these 3 groups were distinguishable from each other. Finally, a number of ANOVAs were performed on age, education, and income. Results indicated no significant differences between the three groups in terms of these three demographic variables.

The first group identified by cluster analysis was composed of thirteen women. As compared to the other two groups, this grouping of women reported fewer mental health problems. Among these women, stress (northward =viii, p<.01) and concrete abuse (n =6, p<.05) were the most oft and significantly reported issues. The 2nd grouping was composed of xv women who reported having problems mainly related to low (due north =xiv, p<.01), sadness (n =12, p<.01), unhappiness (n =11, p<.01), decision making (n =10, p<.01), fears (due north =9, p<.01), loneliness (n =viii, p<.01), slumber (north =8, p<.05), headaches (n =seven, p<.05), and stress (n =14, p<.01). The last grouping consisted of four women. In improver to common mental health bug reported by other women such as stress and fears, this group of women reported a wider array of bug. These problems included slumber problems (n =4, p<.01), nervousness (due north =4, p<.01), temper (n =4, p<.01), guilt (n =iii, p<.01), concentration (n =3, p<.01), and shyness (n =three, p<.01). In order to elaborate the interpretation of these three groups, qualitative analysis was used to business relationship for the data from clinical interviews.

Qualitative Analysis

Data from clinical interviews were analyzed using content analysis to explore the differences betwixt three groups that were identified via cluster assay. Content analysis is a qualitative analysis method that is used to place the being of certain concepts, themes, phrases, and characters inside text. Texts can be described as any written document, conversation (formal or breezy), or incidence of communicative linguistic communication (Berelson, 1952). In content analysis, researchers aim to quantify and analyze the existence of meanings and relationships of such concepts in an objective style and so make inferences virtually the messages inside the texts (Weber, 1990). In this study, notes from unstructured clinical interviews were analyzed using content analysis to understand the psychological and emotional state of women who were physically abused by their current and previous intimate partners. Results of the qualitative analysis also confirmed the differences between the three groups identified via cluster assay.

Ready to modify

The first group was composed of thirteen women. The common characteristics of these women included their aspiration toward life. These women heavily emphasized their needs and wants from life in the clinical interviews. For example, they reported they "?want a relationship that is between equals,"? "?want not be abused,"? "?want not be controlled,"? "? want to create a amend life for myself and my kids,"? "?want to divorce,"? "?want to separate,"? "?want a life that does non have violence,"? "?practice not want my daughter to encounter me browbeaten up,"? "?practise non want my children to think it is ok to crush upwardly,"? "?desire to break the cycle,"? "?want to protect myself,"? "?want prophylactic,"? "?desire to go to school,"? "?desire to visit my family,"? "?want to bargain with my by,"? "?want a good relationship for myself,"? "?want to exist happy,"? "?want my nobility back,"? "?want my confidence back,"? "?desire my life back,"? "?do not want this happen once more,"? and "?want my daughter to feel rubber."? This grouping of women were also highly motivated and determined to make changes in their lives. Equally compared to other groups, they also reported a stronger support system such as their family, friends, co-workers and physicians.

Focused on negative symptoms

The 2nd group was composed of four women. These women talked more about their depressive symptoms such as difficulty in sleeping, feeling "?shut down"?, not taking care of themselves, feeling dislocated well-nigh the situations, feeling angry against themselves for not ending the relationship sooner, feeling unsteady, not having everyone to talk to, difficulty in communicating, and being overwhelmed with stress (due north =4). One of the main themes that emerged for this group of women was the feeling of being overwhelmed. One woman reported being overwhelmed by physical abuse, feeling distressing and unhappy that the relationship did not piece of work, and feeling unsteady. She felt like every decision she makes backfires and she was afraid to make decisions now. Another woman reported that she feels overwhelmed by the need to take care of her immature child. I woman reported that she is having a difficult fourth dimension to read and was overwhelmed and embarrassed past having to ask for help. Another adult female reported being overwhelmed by the living arrangements at the shelter. Ii women in this group reported not having anyone to talk to and feeling lone.

Focused on feelings of guilt and self arraign

The third group was composed of 15 women. These women reported more than severe mental health needs co-morbid with other mental health problems. Substance abuse was almost prevalent among these women. Furthermore, they were more likely to report having previous mental health diagnoses such every bit bipolar disorder, kleptomania, depression, anxiety problems, suicidal ideation, PTSD, disassociation, borderline personality disorder, self-esteem problems, sleeping difficulties, nightmares, and grief. This group of women reported being in an abusive human relationship for a longer menstruum of time. They were more likely to describe their experience of abuse and their abuser. They also reported feeling excessively guilty for "?calling the police,"? and described their actions as "?feels like betraying him,"? and "?leaving my husband."?

Discussion

Data on mental wellness symptoms were collected from 35 female residents of a domestic violence shelter with the primary purpose of the written report being to develop a picture show of the mental wellness needs of female victims of IPV. Not surprisingly, the women reported a range of mental wellness problems including symptoms of depression, suicidal ideation, and other symptoms of serious mental wellness diagnoses. Previous research has clearly established relationships between tearing victimization and a broad variety of negative mental health outcomes (Afifi et al., 2009; Bonomi et al., 2009; Kilpatrick 2004; Logan et al., 2006; Straus & Smith, 1990). Specifically, symptoms associated with low and trauma were the most oft reported.

According to the DSM-IV-TR, symptoms of PTSD divers strictly diagnostic criteria are clustered into one of 3 categories: increased arousal, hypervigilance, and emotional withdrawal/numbing. A number of symptoms reported by women in this study may be representative of the descriptions of diagnostic symptoms including stress, fears, nervousness, nightmares, and retention problems. Still, definitions of trauma related symptoms are often expanded to include other symptoms reported in this report including guilt, somatic complaints, substance abuse, and self-esteem bug (Carlson & Dalenberg, 2000). The findings are unsurprising given that women with a history of violent victimization are three to five times more probable to develop PTSD (Golding, 1999) and PTSD is relatively common amongst female survivors of IPV (Mertin & Mohr, 2001).

Depressive symptoms also emerged every bit a prevalent concern among the women in this study. Nigh half the sample (42%) reported suicidal ideation. The women reported many other symptoms often associated with low including sadness, unhappiness, slumber problems, confusion, atmosphere, and concentration difficulties. The high reported rates of suicidal ideation are consistent with previous inquiry (Straus & Smith, 1990), and there is a clearly established link betwixt violence victimization and depression in the research literature (Arboleda-Florez & Wade, 2001; Golding, 1999; Straus & Smith, 1990).

Perhaps the most interesting finding from the study was that women could exist classified into one of three groups: women who are ready to change (balmy mental health consequences), women focused on negative symptoms (moderate mental health consequences), and women focused on feelings of guilt and cocky-blame (severe mental health consequences). While the moderate and severe consequences groups were characterized by symptom intensity and the balmy consequences group was characterized more by motivation for change, all iii groups differed with respect to the aspects of the abuse on which they focused. The commencement group was focused on change and moving forward. The 2nd grouping was focused on the negative symptoms they were experiencing. The tertiary group was focused more on feelings of guilt and self-blame.

Trans-theoretical Model of Change

The characteristics defining each of the three groups of women have parallels to the first three of five stages of change in Prochaska's Trans-theoretical Model of Modify (Norcross, Krebs, & Prochaska, 2011). The precontemplation stage is characterized by the lack of awareness of a problem and petty or no intent to alter. While it may be unfair to characterize women from the severe symptoms grouping as lacking awareness of a problem, especially since they have taken steps to enter a shelter, it tin exist argued, based on the qualitative data, that many women are incorrectly defining the problem. This group was characterized by feelings of guilt and self-blame instead of correctly allocating responsibility for violence to the aggressor. Women in this group may be in precontemplation stage in that they may be underestimating the severity of the state of affairs by comparing themselves to others with more serious problems or they may think nothing can be done considering of demoralization by past failures ((Murphy & Maiuro, 2009; Sleutel, 1998).

According to Prochaska's Model of Change, the contemplation stage of modify is characterized by awareness of a problem(south). According to the findings of this report, women in the moderate symptom group were aware of and focused on the negative symptoms they were experiencing. Dark-brown (1997) further noted that women in contemplation stage were trying to make the conclusion for taking action to cease the violence. During the contemplation phase, women figure out how to build social and emotional support systems and explore financial options equally a preparation for change.

According to Haggerty and Goodman (2002), adult female will act for change when they perceive they volition be benefit from change (i.e., the cons of the current situation are more costly than the pros for staying in the relationship). For this reason, the contemplation stage lasts longer for most women equally these pros and cons are considered again and once more, leading to confusion. Amid the reasons that make it hard to determine are the love for the partner or the feeling that children need a father. These can outweigh the concerns most personal rubber for many women. Because of the lack of resources or referrals and the presence of such doubt, taking activeness becomes even more than difficult for women (Griffings et al, 2002, Prochaska, 2002).

Reports from women in the "?prepare for alter"? group more closely resembled descriptions of the preparation or action stages of change. Characteristics of the preparation stage include a articulate intention to make changes and potentially some small attempts at modify. According to Brown (1997), the preparation stage is characterized past the decision to change. Nevertheless, there is less research on behavioral indicators of preparation for change. Often, minor steps toward change are followed by more serious activeness. It is possible for women in pre-contemplation stage to go back to contemplation stage; however, women that are ameliorate prepared, are less likely to do and so (Anderson, 2003). Co-ordinate to Lafata (2002), action-oriented help can exist useful for the women in the grooming phase including group work, advancement, and self-talk (Lafata, 2002).

Whether or not the three groups of women identified in this study closely match the stages of change, as divers in the transtheorretical model, is perhaps less important than the clear implication that shelter-based interventions may exist less effective if a "?i size fits all"? approach is used. In a meta-assay of 39 studies, Norcross, Krebs, and Prochaska (2011) found that stage of change was a pregnant predictor of outcome in psychotherapy. Levesque, Driskell, and Prochaska (2008) reported back up for a stage of modify matched treatment arroyo for domestic violence offenders.

Violence against women is associated with various psychological functioning and emotional well-being difficulties. Many women need protection from their abuser and initiate contacts with confidential domestic violence shelters. Although shelters provide food, clothing, and protection for many, these women are likewise in demand of avenues for healthy recovery from the negative consequences of violence. In other words, a woman who was subjected to domestic abuse is not destined to a life of misery or emotional problems. Women actually do recover and alive fulfilling lives. This was besides supported by the findings of this report in that three groups of women were identified, and women in each group appeared to exist at different stages of recovery. In particular, the get-go group of women reported having an agile charge of their life, and would similar to have their life back. This group of women who are in shelter because of IPV still showed resilience and important signs of recovery from the consequences of violence.

Clinical Implications

Findings from this report can inform the clinical practice. For example, the findings suggest clinicians can inquire most the calumniating experience and its effects to appraise the stages of modify. They can explore recent events, the well-nigh severe assaults, and the strategies that have been used to end the abuse and bargain with its consequences. The description of the abuse and its consequences by the victim may vary a lot between unlike women. The clusters identified in this study, the patterns associated with these clusters, and their alignment with the stages of alter suggest at that place may be common patterns in these differences. Women who are in the precontemplation stage may deny IPV and blame themselves for the events. Those in the wistful phase, on the other hand, may acknowledge the corruption but believe it is an atypical consequence. Finally, women in the preparation stage may talk about reevaluating their violent relationships (Haggerty & Goodman, 2002).

Limitations

At that place are a number of limitations of the current report. One limitation of this study is the use of self-study. Collection of information from shelter staff and family unit members may assist identify different mental health needs for these women. Information technology is possible some of the mental health problems are under-identified by some of the participants, such as suicidal ideation and substance abuse, considering of shelter policies regarding these issues. Another limitation of this study is the pocket-sized sample size. Additionally, the findings cannot exist generalized beyond shelter populations. Future research could focus on a larger number of women from diverse locations with a wider range of experiences for a more than comprehensive understanding of the issue.

The data for the written report was collected by a single interviewer. This poses a limitation in our power to check this clinician's coding against that of other clinicians. In other words, triangulation was non applied to the qualitative data reported in this study. Another limitation of the study is that the checklist used for the study was not validated and standardized with previous research. Since the content of the notes were used as a source for the qualitative analysis and the notes were collected using DAP via only ane interviewer, the content of both the checklist and the DAP note depend on the interviewer.

Conclusion

In conclusion, these results should non be interpreted equally minimizing the touch of IPV on women. On the contrary, our findings emphasize women are not lifelong victims, and they can exist helped in various means and can be empowered to assistance themselves. 1 style of facilitating recovery is to offer counseling for these women. In fact, past research indicated therapeutic interventions demonstrate hope in helping victims of domestic violence, peculiarly in terms of reducing the intensity of PTSD symptoms (Resick & Schnicke, 1992). Many shelters have counselors on staff to offer group counseling focusing on self-esteem, parenting, and controlling, as well as individual therapy. The findings of this study revealed there are different groups of women who have different mental health needs. For quicker and healthy recovery, it could be helpful to gear treatment more than toward the needs of these women, rather than providing a general standardized treatment for all.

Acknowledgments

We would similar to thank Jackly Cavern (TTU) for her assist on an earlier version of this manuscript.

Contributor Data

Gunnur Karakurt, Case Western Reserve University, Department of Family Medicine and Community Health.

Douglas Smith, Texas Tech Academy, Department of Customs, Family unit, and Addiction Services.

Jason Whiting, Texas Tech University, Section of Community, Family, and Habit Services.

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