Tragically, one in three American women will experience intimate partner violence (IPV) at some point in their lifetime; but perhaps one of IPV’s worst traits is its unpredictable nature.
In fact, a new study finds that not knowing what will come next can sometimes be a stronger predictor of a woman’s health outcomes than violence frequency and severity.
“We expect severity and frequency to be the major driver to patient outcomes, but in some cases it isn’t,” said David Katerndahl, M.D., professor of family and community medicine at the University of Texas (UT) Health San Antonio.
“The nonlinearity, or unpredictability, of the violence is much more of a driver.”
In a new paper, published in the journal Primary Care Companion for CNS Disorders, the research team presents a 10-item scale called the Violence Nonlinearity Dynamics scale which is designed to reliably estimate violence unpredictability.
The scale may be a useful research tool in future studies of intimate partner violence, said Katerndahl. Researchers currently face the hurdle of obtaining sufficient valid data to measure nonlinearity, he said.
The study enrolled 143 women who had recently experienced violence. The research was advertised as a family stress study at six San Antonio family medicine clinics. Non-pregnant women ages 18 to 64 were screened in exam rooms while waiting for appointments. If husbands accompanied them, they were not screened.
Participants were asked about the abusive behavior they faced and the violent environment around them. Other assessments looked at their levels of hope and coping mechanisms. These evaluations, coupled with self-reports of the women over the eight-week study period, informed development of the Violence Nonlinearity Dynamics Scale.
Family therapist Johanna Becho, M.S., L.M.F.T., interacted with the women on a weekly basis. “My role was to receive phone calls from each woman to track day-to-day events occurring in her life: the loss of a job, birth of a baby or loss of a child, and other things of that nature that can impact the dynamics of a relationship,” Becho said.
“I also helped them to process their emotions after an incident occurred,” she said. “It was very delicate dialogue, not something one shares with just anybody. It has to be with a trusted confidant, and that’s what I became over the course of the eight weeks.”
A certain level of unpredictability was actually healthier for women than having their days uniform and tightly controlled. “Women who have what we call ‘optimal nonlinearity,’ which means they have some nonlinearity but it’s not extreme, actually did better in the study in general,” Katerndahl said.
“Some spontaneity allows us to mine for solutions,” Becho said. “Whereas one woman might be open to counseling, another might be open to legal action, and another might be ready to start thinking about steps to exit the relationship. Leaving is a process.”
Participant safety was the highest priority during the study. “We were able to set up safety measures that are not typical in everyday life, at least not in the life of a woman experiencing violence,” Becho said. “For example, if a woman missed a phone call, we would place an outbound phone call to a safe number to try to reach her. Part of the study entry criteria was to provide a safe number for us to call if she couldn’t reach us.”
Enrollment also included a safety assessment.
“If a woman was in an extremely violent relationship, we just thought it was too risky for her to try to be in the study,” Katerndahl said. “If there was a gun in the house, or he previously caused her to be hospitalized because of the violence, or another situation like that was occurring, we considered it to be too risky.”
Rather, these women were referred to community resources such as the Bexar County Family Justice Center, the Battered Women’s Shelter and local community counseling.
Of the 143 participants, analysis was conducted only with the 120 women who spoke English. These women included 94 Hispanics and 80 with at least a high school education. Sixty-two reported a household income of less than $20,000 annually. The mean duration of their relationships was 13.8 years and the mean duration of violence was 9.7 years.
Source: UT Health San Antonio