Protocol for a randomised controlled trial of a web-based healthy relationship tool and safety decision aid for women experiencing domestic violence (I-DECIDE)

BACKGROUND: Domestic violence is a serious problem affecting the health and wellbeing of women globally. Interventions in health care settings have primarily focused on screening and referral, however, women often may not disclose abuse to health practitioners. The internet offers a confidential space in which women can assess the health of their relationships and make a plan for safety and wellbeing for themselves and their children. This randomised controlled trial is testing the effectiveness of a web-based healthy relationship tool and safety decision aid (I-DECIDE). Based broadly on the IRIS trial in the United States, it has been adapted for the Australian context where it is conducted entirely online and uses the Psychosocial Readiness Model as the basis for the intervention. METHODS/DESIGN: In this two arm, pragmatic randomised controlled trial, women who have experienced abuse or fear of a partner in the previous 6 months will be computer randomised to receive either the I-DECIDE website or a comparator website (basic relationship and safety advice). The intervention includes self-directed reflection exercises on their relationship, danger level, priority setting, and results in an individualised, tailored action plan. Primary self-reported outcomes are: self-efficacy (General Self-Efficacy Scale) immediately after completion, 6 and 12 months post-baseline; and depressive symptoms (Centre for Epidemiologic Studies Depression Scale, Revised, 6 and 12 months post-baseline). Secondary outcomes include mean number of helpful actions for safety and wellbeing, mean level of fear of partner and cost-effectiveness. DISCUSSION: This fully-automated trial will evaluate a web-based self-information, self-reflection and self-management tool for domestic violence. We hypothesise that the improvement in self-efficacy and mental health will be mediated by increased perceived support and awareness encouraging positive change. If shown to be effective, I-DECIDE could be easily incorporated into the community sector and health care settings, providing an alternative to formal services for women not ready or able to acknowledge abuse and access specialised services. TRIAL REGISTRATION: Trial registered on 15(th) December 2014 with the Australian New Zealand Clinical Trials Registry ACTRN12614001306606.

The relationship between exposure to violence and anger in Thai adolescents

Youth violence is a serious public health problem in Thailand, and yet is poorly understood and is thought to vary considerably between metropolitan and rural areas. This article reports the findings of a cross-sectional study involving 1,170 technical college students who completed self-report questionnaires assessing the frequency of violent acts, antisocial behavior, and angry emotion. There were no differences in self-reported violent activities between metropolitan and rural participants, but those attending colleges in the metropolitan areas reported more acts involving weapons. Scores on the measure of anger expression predicted physical and verbal assault, specifically punching and name calling, suggesting that the implementation of interventions which help students to improve control over anger may be a useful violence prevention approach.

The relationship between suicide and violence in schizophrenia: analysis of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) dataset

Background

Suicide and violence often co-occur in the general population as well as in mentally ill individuals. Few studies, however, have assessed whether these suicidal behaviors are predictive of violence risk in mental illness.

Aims

The aim of this study is to investigate whether suicidal behaviors, including suicidal ideation, threats, and attempts, are significantly associated with increased violence risk in individuals with schizophrenia.

Method

Data for these analyses were obtained from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) trial, a randomized controlled trial of antipsychotic medication in 1460 adults with schizophrenia. Univariate Cox regression analyses were used to calculate hazard ratios (HRs) for suicidal ideation, threats, and attempts. Multivariate analyses were conducted to adjust for common confounding factors, including: age, alcohol or drug misuse, major depression, antisocial personality disorder, depression, hostility, positive symptom, and poor impulse control scores. Tests of discrimination, calibration, and reclassification assessed the incremental predictive validity of suicidal behaviors for the prediction of violence risk.

Results

Suicidal threats and attempts were significantly associated with violence in both males and females with schizophrenia with little change following adjustment for common confounders. Only suicidal threats, however, were associated with a significant increase in incremental validity beyond age, diagnosis with a comorbid substance use disorder, and recent violent behavior.

Conclusions

Suicidal threats are independently associated with violence risk in both males and females with schizophrenia, and may improve violence risk prediction.

Women exposed to intimate partner violence : expectations and experiences when they encounter health care professionals : a meta-analysis of qualitative studies

Background The appropriate response of health care professionals to intimate partner violence is still a matter of debate. This article reports a meta-analysis of qualitative studies that answers 2 questions: (1) How do women with histories of intimate partner violence perceive the responses of health care professionals? and (2) How do women with histories of intimate partner violence want their health care providers to respond to disclosures of abuse?

Methods Multiple databases were searched from their start to July 1, 2004. Searches were complemented with citation tracking and contact with researchers. Inclusion criteria included a qualitative design, women 15 years or older with experience of intimate partner violence, and English language. Two reviewers independently applied criteria and extracted data. Findings from the primary studies were combined using a qualitative meta-analysis.

Results Twenty-nine articles reporting 25 studies (847 participants) were included. The emerging constructs were largely consistent across studies and did not vary by study quality. We ordered constructs by the temporal structure of consultations with health care professionals: before the abuse is discussed, at disclosure, and the immediate and further responses of the health care professional. Key constructs included a wish from women for responses from health care professionals that were nonjudgmental, nondirective, and individually tailored, with an appreciation of the complexity of partner violence. Repeated inquiry about partner violence was seen as appropriate by women who were at later stages of an abusive relationship.

Conclusion Women’s perceptions of appropriate and inappropriate responses partly depended on the context of the consultation, their own readiness to address the issue, and the nature of the relationship between the woman and the health care professional.

Islam and political violence : Muslim diaspora and radicalism in the West

How do we engage with the pressing challenges of xenophobia, radicalism and security in the age of the "war on terror"? The widely felt sense of insecurity in the West is shared by Muslims both within and outside Western societies. Growing Islamic militancy and resulting increased security measures by Western powers have contributed to a pervasive sense among Muslims of being under attack (both physically and culturally). Islam and Political Violence brings together the current debate on the uneasy and potentially mutually destructive relationship between the Muslim world and the West and argues we are on a dangerous trajectory, strengthening dichotomous notions of the divide between the West and the Muslim world.

The relationship between childhood cruelty to animals and psychological adjustment : a Malaysian study

In Western research, cruelty to animals in childhood has been associated with comorbid conduct problems and with interpersonal violence in later life. However, there is little understanding of the etiology of cruelty to animals, and what in the child's life may require attention if the chain linking animal cruelty and later violence is to be broken. The study reported in this paper investigated the association between parent-reported cruelty to animals, and parent- and self-reported psychological strengths and weaknesses in a sample of 379 elementary school children in an Eastern context, Malaysia. No gender differences were found in relation to cruelty to animals or psychological problems, as assessed with the Strengths and Difficulties Questionnaire (SDQ). However, there were different predictors of cruelty to animals for boys and girls. Regression analyses found that for boys, parent-reported hyperactivity was a unique predictor of Malicious and Total Cruelty to animals. For girls, self-reported conduct problems was a unique predictor of Typical Cruelty to animals. Parent-reported total difficulties were associated with Typical, Malicious, and Total Cruelty to animals. We suggest that routine screening of children with an instrument such as the SDQ may help to detect those children who may need to undergo further assessment and perhaps intervention to break the chain linking childhood cruelty to animals and later conduct problems.

Islam and political violence : Muslim diaspora and radicalism in the West

How do we engage with the pressing challenges of xenophobia, radicalism and security in the age of the "war on terror"? The widely felt sense of insecurity in the West is shared by Muslims both within and outside Western societies. Growing Islamic militancy and resulting increased security measures by Western powers have contributed to a pervasive sense among Muslims of being under attack (both physically and culturally). Islam and Political Violence brings together the current debate on the uneasy and potentially mutually destructive relationship between the Muslim world and the West and argues we are on a dangerous trajectory, strengthening dichotomous notions of the divide between the West and the Muslim world.

Animals as disregarded pawns in family violence : exclusionary practices of feminist based refuge policies

Commonly agreed upon is the relationship between family violenceand violence toward nonhuman animals. Workers in the field of family violence also acknowledge that women may delay leaving a violent home due to loyalty to their nonhuman counterparts, and because refuge policies often do not allow them to accompany humans into safe shelter. The recent work of Clifton Flynn has indicated the relationship between nonhuman animals and human animals to be one of responsive interaction, with theoretical analyses most often based upon Goffman’s theory of symbolic interaction. Despite literature indicating the level of harm inflicted upon nonhuman family members in violent homes, and requests from women and children that they accompany them to safe shelter, refuge policies often negate the possibility of this occurring. This article critiques the feminist ideals on which refuge policies are based, and in doing so, argues that justice is denied to nonhuman animals. Their existence in the violent home is maintained by lack of choices available to their human counterpart, and is enforced by feminist ideals, which are ironically based upon equity. Unless feminist principles are challenged, nonhuman family members will continue to be denied justice in violent families where escape is the only option to ensure safety.

Measuring the destruction of heritage and spikes of violence in Iraq

Since the invasion of 2003, Iraq has suffered an extraordinary era of both heritage destruction and devastating spikes in violence. While cases such as the 2003 attacks on the Iraq National Museum and the Iraq National Library and Archive, as well as the systematic looting of Iraq’s sensitive archaeological sites, understandably caused outrage among scholars of heritage studies across the world, little attention has been paid to the destruction of Iraq’s many significant Islamic sites – particularly during the ethno-religious sectarian violence that raged across the nation in 2006-7. This paper presents the first results of a three year project funded by the Australian Research Council which aims to empirically test the assumption that a significant relationship exists between this spike in violence and the targeting of sites of Islamic heritage (mosques, shrines, etc.). To do this, the paper will compare and contrast the information in the world’s first database of heritage destruction (created by the author) and existing measures of violence in Iraq (such as the Iraq Body Count database). This will set the precedent for studies of both heritage and violence and enable policy formation towards the minimization of heritage destruction and spikes in violence during times of conflict.

Heritage destruction and violence in Iraq : bombing mosques and ethno-religious sectarian violence, 2006-7

Since the invasion of 2003, Iraq has suffered an extraordinary era of both heritage destruction and devastating spikes in violence. While cases such as the 2003 attacks on the Iraq National Museum and the Iraq National Library and Archive, as well as the systematic looting of Iraq’s sensitive archaeological sites, understandably caused outrage among scholars of heritage studies across the world, little attention has been paid to the destruction of Iraq’s many significant Islamic sites – particularly during the ethno-religious sectarian violence that raged across the nation in 2006-7. This paper presents the first results of a three year project funded by the Australian Research Council which aims to empirically test the assumption that a significant relationship exists between this spike in violence and the targeting of sites of Islamic heritage (mosques, shrines, etc.). To do this, the paper will compare and contrast the information in the world’s first database of heritage destruction (created by the author) and existing measures of violence in Iraq (such as the Iraq Body Count database). This will set the precedent for studies of both heritage and violence and enable policy formation towards the minimization of heritage destruction and spikes in violence during times of conflict.

Culture and violence in Iraq : bombing mosques and ethno-sectarian violence, 2006

Since the invasion of 2003, Iraq has suffered an extraordinary era of both heritage destruction and devastating spikes in violence. While cases such as the 2003 attacks on the Iraq National Museum and the Iraq National Library and Archive, as well as the systematic looting of Iraq’s sensitive archaeological sites, understandably caused outrage among scholars of heritage studies across the world, little attention has been paid to the destruction of Iraq’s many significant Islamic sites – particularly during the ethno-religious sectarian violence that raged across the nation in 2006-7. This paper presents the first results of a three year project funded by the Australian Research Council which aims to empirically test the assumption that a significant relationship exists between this spike in violence and the targeting of sites of Islamic heritage (mosques, shrines, etc.). To do this, the paper will compare and contrast the information in the world’s first database of heritage destruction (created by the author) and existing measures of violence in Iraq (such as the Iraq Body Count database). This will set the precedent for studies of both heritage and violence and enable policy formation towards the minimization of heritage destruction and spikes in violence during times of conflict.

The vortex of violence : moving beyond the cycle and engaging clients in change

This article introduces the conceptual practice tool of ‘The Vortex of Violence’ and one suggested practice model for utilising the vortex of violence in practice with women who have experienced a domestic violence relationship. The practice tool and model are an expansion of ‘The Cycle of Violence’ that shifts the focus from explanation of the dynamics of abusive relationships to the exploration of the lived experience of women and the development of a personal/therapeutic template for healing and reclaiming of their lives.

Managing risks of violence in a youth mental health service: a service model description

There is a significant relationship between experiencing a severe mental illness, particularly psychosis, and exhibiting violent or offending behaviour. Reducing, if not preventing, the risks of violence among patients of mental health services is clinically warranted, but models to address this are limited

"Sometimes cathartic. Sometimes quite raw": Benefit and harm in an intimate partner violence trial

 Research on intimate partner violence (IPV) has increased over the past two decades, however empirical research on potential harm to participants is limited. The aim of this study was to assess whether 272 women involved in a general practice based IPV intervention trial (weave) reported more benefit or harm, whether this differed by intervention or comparison group, and what types of benefit and harm were reported. Feedback was obtained via adapted Consequences of Screening Tool, visual analogue scale and open-ended question in baseline, 6-month, 12-month and 24-month surveys (all participants), and semi-structured interviews (subset of 28 participants). Participants in both the intervention and comparison groups tended to respond positively on all quantitative items, although on a number of items, the intervention group responded even more positively. At 6 and 12 months, 51.1% and 54.7% of all participants, respectively, reported their quality of life as becoming better and over 40% of women at each time-point, indicated they felt more positive about themselves as a result of some aspect of their involvement in weave. 42% of all participants reported their home lives becoming less difficult. In qualitative analyses, positive themes identified were altruism, value, evaluation of relationship, validation, self-awareness, empowerment, positive reinforcement, catharsis, motivation to seek help, and response to the research process. Negative themes identified were short-term emotional reactions, long-term emotional reactions, recall, retraumatization and minimization. Many participants indicated short-term negative emotions had been balanced by longer-term positive benefits. Further research is needed regarding characteristics and experiences of the small minority of participants who did not report positive benefit. © 2014 Elsevier Ltd. All rights reserved.

Problem gambling and intimate partner violence : a systematic review and meta-analysis

This study provides a systematic review of the empirical evidence related to the association between problem gambling and intimate partner violence (IPV). We identified 14 available studies in the systematic search (8 for victimisation only, 4 for perpetration only and 2 for both victimisation and perpetration). Although there were some equivocal findings, we found that most of the available research suggests that there is a significant relationship between problem gambling and being a victim of IPV. There was more consistent evidence that there is a significant relationship between problem gambling and perpetration of IPV. Meta-analyses revealed that over one third of problem gamblers report being victims of physical IPV (38.1%) or perpetrators of physical IPV (36.5%) and that the prevalence of problem gambling in IPV perpetrators is 11.3%. Although the exact nature of the relationships between problem gambling and IPV is yet to be determined, the findings suggest that less than full employment and clinical anger problems are implicated in the relationship between problem gambling and IPV victimization and that younger age, less than full employment, clinical anger problems, impulsivity, and alcohol and substance use are implicated in the relationship between problem gambling and IPV perpetration. The findings highlight the need for treatment services to undertake routine screening and assessment of problem gambling, IPV, alcohol and substance use problems, and mental health issues and provide interventions designed to manage this cluster of comorbid conditions. Further research is also required to investigate the relationship between problem gambling and violence that extends into the family beyond intimate partners.