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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 8  |  Issue : 1  |  Page : 39-45

Histories of intimate partner violence among women in short-stay shelter homes: Implications for psychosocial interventions


Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

Date of Submission15-Jan-2022
Date of Decision14-Mar-2022
Date of Acceptance21-Mar-2022
Date of Web Publication30-May-2022

Correspondence Address:
Ms. K S Shilpa
Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru - 560 029, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjp.tjp_5_22

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  Abstract 


Introduction: Among all kinds of violence that is experienced by women, Intimate Partner Violence (IPV) has been found to be the most common type. This can take the form of physical, sexual, financial, and emotional violence.
Aim: The aim of the study was to examine the histories of IPV among women in short-stay shelter homes.
Materials and Methods: The sample consisted of 30 married women from three shelter homes in Bengaluru (mean age = 32.43 years). A socio-demographic data sheet (SDS), a semi-structured interview schedule and three visual analog scales (VAS) were used to obtain data related to IPV. Descriptive statistics was used to analyze data obtained on the SDS and VAS. Thematic analysis was used to analyze the qualitative data obtained.
Results: Results indicated that 96.70% of the women experienced a combination of emotional and physical violence from their spouses. Financial violence was reported by 70% and sexual violence by 36.60%. On the VASs, the severity of IPV was rated as 8.5, perceived danger from the spouse was rated as 7.5, and perceived social support was rated as 3.9.
Conclusions: Results revealed a high prevalence of IPV, severe degree of IPV, and the women perceived significant danger from their spouses and poor social support from significant others. This indicates the need for adequate psychosocial intervention to address IPV and its consequences.

Keywords: Intimate partner violence, shelter homes, trauma-informed care, women


How to cite this article:
Shilpa K S, Suman L N. Histories of intimate partner violence among women in short-stay shelter homes: Implications for psychosocial interventions. Telangana J Psychiatry 2022;8:39-45

How to cite this URL:
Shilpa K S, Suman L N. Histories of intimate partner violence among women in short-stay shelter homes: Implications for psychosocial interventions. Telangana J Psychiatry [serial online] 2022 [cited 2022 Jun 30];8:39-45. Available from: https://tjpipstsb.org/text.asp?2022/8/1/39/346240




  Introduction Top


Violence against women has continued to be a pressing concern across cultures, religions, class, and ethnicity. Intimate partner violence (IPV) is the most common form of violence experienced by women. This can take the form of physical, sexual, financial, and emotional violence. The global prevalence of physical and/or sexual IPV among all ever-partnered women is 30%. In India, the prevalence is 29% which is very close to the global prevalence of IPV.[1] The lifetime and current prevalence of violence in South India was found to be 32.2% and 22.4%, respectively.[2]

An intimate partner is a person with whom one has a close personal relationship characterized by emotional connectedness, ongoing physical contact and/or sexual behavior, identity as a couple, knowledge, and familiarity about each other's lives. IPV lies on a continuum that can include a single episode of violence to on-going battering. Many studies have revealed that staying with an abusive partner has a significant influence on a woman's physical and mental health. IPV has been linked with various health effects, both short term and long term. The physical consequences include contracting sexually transmitted infections, such as HIV infection, chronic pains, physical injuries, gynecological problems, cardiovascular issues, and sometimes even death.[3] Women with experience of IPV are thrice more likely to meet the criteria for posttraumatic stress disorder (PTSD), often linked with depression. It also impacts a woman's ability to cope and results in trauma-related consequences such as self-harm, dissociation, somatization, and social withdrawal.[4],[5]

Some of the factors are very unique to the Indian context with respect to IPV include cultural practice of dowry, significant influence of husband's family, subservient role of women in the family, and the patriarchal society which reinforces male entitlement.[6]

When women can no longer endure the abuse, they seek security and care in shelter homes.[7] Physical abuse has been found to be strongly linked with poor mental health outcomes among women and it has also been highlighted as a significant reason for women seeking safety in shelter homes.[8]

Apart from basic survival needs, the shelter homes also need to cater to psychosocial needs of the women. Understanding the histories of IPV among women in shelter homes is crucial to address and plan a comprehensive psychosocial intervention for them.[7] The present study aimed to obtain and examine the histories of IPV among women in short-stay shelter homes (SSSH). The present study reports results obtained from qualitative data which were part of a larger study titled “IPV: Trauma coping self-efficacy, resilience, and hopefulness among women in SSSH.”


  Materials and Methods Top


Objectives

The objective is to examine the (i) nature of IPV, (ii) consequences of IPV, and (iii) perceived social support.

Research design

A single group, mixed-method, cross-sectional research design was adopted for the purpose of this study. The study was carried out between 2017 and 2018.

Sampling and sample

The sample consisted of 30 married women from three different shelter homes in Bengaluru. Purposive sampling was used to recruit the sample. Inclusion criteria were experience of any form of IPV, married women and women who could speak Kannada or English. Exclusion criteria were women below 18 years of age, psychosis, intellectual disability, serious physical illness, and those who did not provide written informed consent.

Tools

Socio-demographic data sheet

Part A: This section obtained details of the participants such as name, age, educational qualification, socio-economic status, duration of marriage, employment history, religion, spoken languages, and details about family members. Part B of the socio-demographic data sheet obtained details about the spouse such as age, education, occupation, income, and substance use, if any. Part C obtained details of the children, if any, such as their age, education, health status, and living arrangement.

Semi-structured interview schedule

Part A: A semi-structured interview schedule (SSIS) was developed by the investigator using a topic guide to obtain information about the following: (i) nature of IPV, (ii) reasons for IPV, (iii) severity of IPV, (iv) perceived danger from the spouse, (v) disclosure of IPV, (vi) help received from others, (vii) decisions about marriage, (viii) pathways to shelter, and (ix) perceived social support.

The development of SSIS involved an exhaustive review of articles related to IPV among women and interviews with women with experiences of IPV in the routine clinical setting. Subsequently, a preliminary SSIS was developed. This preliminary SSIS was pilot-tested on two participants who met the inclusion and exclusion criteria for the study, and modifications were incorporated based on the findings. The modified SSIS was used in the main study.

Part B: Three visual analog scales (VAS) were used to measure (i) severity of IPV, (ii) perceived danger from spouse before coming to the shelter home, and (iii) perceived social support outside the shelter home. VAS is a horizontal line, 100 mm in length, anchored by word descriptors at each end, and the participants mark on it the point that they feel represents their perception. The word descriptors at each end for severity of IPV were high severity and low severity, for perceived danger from spouse, it was high perceived danger and low perceived danger, for perceived social support outside the shelter home, it was high perceived social support and low perceived social support.

Description of the setting

The study was conducted at three SSSH for women in Bengaluru. These shelter homes work closely with helplines for distressed women run by the state government and the city police department.

Procedure

Permission to conduct the study was obtained from the Institute Ethics Committee and the administrative authorities of the shelter homes. Participants were met individually, and written informed consent was obtained after explaining the nature of the study. The sessions were conducted with the participants individually in a room that ensured privacy and took about 45–60 min to complete. The interviews were recorded verbatim by the investigator who made detailed notes of the responses.

Data analysis

Data were analyzed using descriptive statistics such as frequencies, mean and standard deviation for examining the socio-demographic profile of the participants, their spouses and their children. Descriptive statistics was also used to analyze the IPV profile and data from the VASs. Thematic analysis was used to analyze the data obtained from the interviews.[9] Significant units of meaning were derived by coding the expressed words and phrases used by the participants. Data were further analyzed by comparison and refined. A main set of themes by grouping similar subthemes with similar meanings were established.


  Results Top


The socio-demographic profile is given in [Table 1]. More than half of the participants were young adults and were educated up to secondary level. Despite low level of education being a hinderance, more than half of the participants were employed in semi-skilled jobs and more than half of the participants belonged to lower socio-economic background. Similar to the participants, the spouses were young adults, and half of the spouses were educated up to secondary level. More than three-fourths of the spouses were employed in skilled or semi-skilled jobs. More than three-fourths of the spouses consumed alcohol in high quantities that could be categorized as harmful use of alcohol. More than three-fourths of the women had children who were mostly early adolescents, and more than three-fourths had children who were living with them in the shelter home.
Table 1: Sociodemographic characteristics of the participants, their spouses and their children

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Nature and severity of intimate partner violence

Details related to IPV are given in [Table 2]. More than three-fourths of the women experienced a combination of physical and emotional abuse. Financial violence was reported by more than half the participants and sexual violence by less than half the participants. More than half the participants experienced IPV on a daily basis indicating that violence was a common occurrence in their household. Examples of IPV are given in [Table 3] in the form of excerpts from the interviews. As indicated in [Table 3], the women felt overpowered by their spouses and suffered injuries due to IPV. Results obtained on the three VASs are given in [Table 4]. The severity of violence as measured on the VAS indicates that the women experienced severe IPV from their husbands.
Table 2: Main theme and subthemes obtained in the interviews

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Table 3: Illustrative quotes from participants' interviews related to their experiences of intimate partner violence

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Table 4: Range and mean scores on the three Visual Analog Scales

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Reasons for intimate partner violence

Alcohol abuse was the most common reason for perpetration of IPV with more than three-fourths of the participants reporting it. Based on the description provided by the participants, some of the spouses might also have delusional disorder. Three-fourths of the women also cited their spouses' personality to be another reason for the IPV such as being short-tempered, manipulative, unstable mood, and being suspicious. These descriptions indicate probable personality disorder in the spouse. Extra marital involvement (EMI) in the spouse was another reason for IPV where more than half of the women reported that they were aware of the EMI in their husbands. The influence of the spouse's family of origin (FOO) on the couple's family is unique to the Indian context. Finally, the financial problem was another reason that less than half the women reported. The excerpts of the interviews indicate that the spouses manifested uncontrolled anger/aggressiveness, suspiciousness were inconsiderate and manipulative.

Perceived danger from the spouse before coming to the shelter

More than three-fourths of the women reported perceiving significant danger from their spouses before coming to the shelter home. More than three-fourths of the women feared the control exerted by their spouses in all areas of their lives and also the kind of interactions they had with their spouses which would eventually end in the spouses abusing them. On VAS, the women perceived significant danger from their spouse before coming to the shelter home. The excerpts indicate that the women feared getting killed and wanted a place where they could feel safe.

Disclosure of violence, help received, and pathways to shelter

More than half the women chose to talk about the abuse to their FOO, especially their parents and siblings. Disclosure was also made to their friends and neighbors, and the police. Those who disclosed to the police, initially reported violence over helpline numbers and were then redirected to seek police or legal help. On the VAS, the women perceived low levels of social support from significant people in their lives. Initially, they received help for their survival such as shelter, food, and money for daily expenses. Some of them had their emotional needs met where they felt validated found a space to ventilate when they approached their social circle. Women who did not receive any help were blamed for triggering IPV, and the people whom they approached for help normalized the experience of IPV. The excerpts indicate that the women wanted long-term solutions and felt that the support they received from their family and friends was temporary.

Decisions regarding marriage

More than half of the women wanted to terminate the relationship through separation or divorce. Others either wanted to reconcile or were ambivalent about their decision. Women who were ambivalent often recollected the positive memories of their marital life and sometimes blamed themselves for not being very understanding on certain occasions. In contrast, they also felt betrayed and memories of the abuse stopped them from going back. Excerpts indicate that the women who wanted to separate felt that their situation would never change if they continued to stay with their spouses.


  Discussion Top


The study highlights those women who seek refuge in shelter homes report significant histories of IPV. They suffer from significant physical and psychological consequences as reported by the findings of the present study. Studies in this area have also reported similar findings where women with experiences of IPV suffer from psychiatric conditions such as PTSD, depression, anxiety, anger, shame, low self-esteem, and guilt.[10],[11] To recreate stability and tackle the psychological issues, effective individual interventions are required. Coming from lower socio-economic status, these women rarely have access to psychological help. Shelter homes can be equipped with mental health professionals who can cater to their mental health concerns. Studies have indicated the need for brief interventions for women survivors of IPV.[12] Counseling approaches that focus on advocacy, empowerment, and providing a space to ventilate can help these survivors have been found to be useful in this population. In addition, interventions that focus on the women's feelings of helplessness have also been indicated in literature.[13] Training shelter home counselors in different psychological approaches in trauma-informed care along with specific training in domestic violence and allowing flexibility on the number of counseling sessions may equip the counselors to help the women survivors better.[14] The interventions that also focus on the survivor's safety as the main objective can also help women survivors.[15] Psychological interventions that add feminist practices and insights into understanding and handling domestic violence can also help these women.[16]

Apart from interventions for the victims, it is important to provide psychosocial intervention to the spouses. Screening and appropriate treatment for probable delusional disorder and personality disorder are indicated for the spouses. As in the present study, alcohol consumption and its association with perpetration of IPV have been reported in earlier studies.[17],[18] Individual-level interventions aimed to eliminate or reduce problem drinking is indicated for those spouses who indulge in violence due to alcohol consumption. Studies have indicated that perpetrators who underwent intervention programs specific to their problem drinking behavior such as standard batterer program with alcohol reduction intervention, motivational interventions, cognitive-behavioral interventions approach have found significant reduction in their violent behaviors but these effects were not sustained. More research is indicated in this area.[19] Apart from the intervention for problem drinking, spousal intervention approaches include feminist driven approaches such as the Duluth psychoeducational groups to challenge patriarchal mindset and cognitive behavior treatment to change unhelpful thoughts and behaviors and enhance functioning by improving skills.[20]

Despite the experiences of violence, some women consider reconciliation with their spouses. In such cases, marital therapy sessions are indicated. The current study also had women who reported that they wanted to reconcile with their spouses. Clinical trials have indicated that couples therapy targets the systemic level and is effective for couples with dysfunctional interaction patterns.[21] More research is indicated to highlight the empirical evidence of couple-based approaches.

There are few social and demographic characteristics that define risk groups for IPV. Women who have low levels of education, from lower socio-economic background, and those living with alcoholic spouses have found to be at higher risk for IPV. The primary prevention strategies to protect women include empowering them socially, economically, and educationally. The focus should be on improving women's status in the society and tackling the alcohol problem in the spouse, improving their financial situation and also decreasing the norms of violence.[22]

Reviewing the mental health of children by counselors is indicated since the children exposed to domestic violence early in age are at high risk for internalizing and externalizing problems along with academic and social skills problems. Providing early intervention for children exposed to violence is crucial.[23],[24]

Shelter homes are transitory places where most often women from the lower socio-economic status seek refuge. These shelter homes should aim to provide women with holistic care rather than food and shelter alone. These centers need to focus on rehabilitating the women by providing education, skill-building, and awareness generation. They should also focus on the psychosocial needs of the women by offering the required psychological interventions for the women in distress. It is also crucial to train the mental health professionals in the shelter homes to provide trauma-informed care for these women.[25]

This study has some merits and limitations. This study explored a wide range of issues related to IPV from short-stay shelter home setting. The interview data were obtained from all thirty participants who provided the researcher with rich data for analysis. The interview language was limited to Kannada and English; hence, findings cannot be generalized to women speaking other languages. The findings of the study cannot be generalized to women with intellectual disabilities, psychotic disorders, and serious physical illnesses.


  Conclusions and Implications Top


The findings from the study indicate that issues regarding violence do not end after coming to the shelter home. The women continue to require help and support with regard to their past and future. Shelter homes usually help in vocational training and also mediating legal processes. However, the findings from the study indicate the need for sensitizing the staff in shelter homes regarding psychological trauma in women and also ensure that trauma-informed interventions are provided. Interventions are also indicated for the spouse with respect to their problem drinking, probable delusional, and personality disorders. Interventions are also indicated for children who are witness to IPV.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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