Intimate Partner Violence and Barriers To Mental Health Care for Ethnically Diverse Populations of Women

“Intimate partner violence (IPV) has a profound effect on women’s mental health (Golding, 1999; Johnson et al., 2007), and frequently extends to other outcomes including quality of life, social and occupational functioning, and physical health (Hedtke et al., 2008).”

“Moreover, many ethnic minority women face prejudice and discrimination based on their ethnic group and may suffer a ‘‘double stigma’’ as they confront mental health problems as well (Gary, 2005).”

“…psychiatric disorders such as posttraumatic stress disorder (PTSD), depression, and substance abuse, which are often a consequence of partner abuse (Campbell & Lewandowski, 1997; Golding, 1999; Martin et al., 2008), but can also be antecedent to involvement in violent or negative relationships…”

“Females of minority ethnic groups are more likely than non-Latina whites to use emergency services as well (Chow et al., 2003).”

“A 1998 study showed that African Americans, much like other ethnic groups, are more likely than Whites to live in deep poverty, which includes about 14% of Black families and only 3.5% of White families (Snowden, 2001).”

“In a separate study, nearly 58% of Caucasian women reported prior use of mental health services while only 36% and 11% of African American and Latina women, respectively, used services provided by mental health clinics (Alvidrez, 1999).”

“In addition, actively directing women toward the correct mental health care channels could identify many women affected by IPV who would otherwise be dismissed (Coker, 2003; Plichta, 2007).”

“This framework (Figure 2) categorizes barriers into those resulting from (1) the patient, (2) the provider, and (3) the health care system/ community (Rodriguez et al., 1996).”

“Finally, survivors with a higher frequency of abusive incidents are 2 to 4 times more likely to experience PTSD, depression, and substance abuse than are singly victimized women (Hedtke et al., 2008).”

“In a study of Latina, IPV survivors, patients appeared less likely than non-Latina Whites or Blacks to use social and health services partly due to low acculturation (Lipsky et al., 2006).”

“Cultural competency, the ability to function as a professional with effective and congruent cultural beliefs, behaviors, and attitudes for each client (Rodriguez et al., 2008), is crucial when dealing with IPV.”

“The underutilization of mental health services among women affected by IPV is even more pronounced among minority women, who are less likely than white women to seek help from various formal and informal sources, with Latinas being the least likely to seek help (Kaukinen, 2004; Lipsky & Caetano 2007; West et al., 1998…”

“…mental health services among women affected by IPV is even more pronounced among minority women, who are less likely than white women to seek help from various formal and informal sources, with Latinas being the least likely to seek help (Kaukinen, 2004; Lipsky & Caetano 2007; West et al., 1998).”

“One of the more apparent barriers to easily accessible mental health care services is a limit or lack of financial resources (Prins, Verhaak, Bansing, & Van Der Meer, 2008; Davis et al., 2008).”

“In a recent study, 36% of low-income, urban African American female patients who visited the ED reported being survivors of IPV (Houry et al., 2006).”

“Greater severity of physical IPV is associated with an increase in PTSD symptoms for female survivors (Woods, 2000).”

“In another 2004 investigation, it was found that African Americans were less likely than their Caucasian counterparts to turn to mental health care services due to a cultural emphasis on ‘‘self-reliance’’ (El-Khoury et al., 2004).”

“In another study, participants reported that they were ‘‘trying to protect [their abusive partners]’’ and did not tell peers because they might threaten and/or never forgive them (Petersen et al., 2004).”

“From a clinical standpoint, overcoming staff resistance and gaining administrative support in integrating mental health care into general practice is a challenge that, if overcome, would contribute significantly to increasing access and reducing unmet need for mental health services (Plichta, 2007).”

“Additionally, in a sample 150 African American women, use of community services such as shelters and support groups for IPV-affected participants was as low as 1%–9% (Mitchell et al., 2006).”

“In one study, a health care provider said, ‘‘The word clinic itself scares [the patients,] especially if it’s mental, because then they say ‘I do not wish to be called crazy’’’ (Barrio et al., 2008).”

“In a 2007 survey of 2,027 women attending health care clinics in Boston, 1 in 20 women reported that partner intrusion impeded their seeking and using health care services, ultimately raising the risk of mental health conditions (McCloskey et al., 2007).”

“…stress disorder (PTSD), depression, and substance abuse, which are often a consequence of partner abuse (Campbell & Lewandowski, 1997; Golding, 1999; Martin et al., 2008), but can also be antecedent to involvement in violent or negative relationships (Briere & Jordan, 2004; McHugo et al. 2005).”

“(Latta and Goodman, 2005).”

“Community services and agencies are often some of the most common and frequent settings which IPV-affected women encounter, making it imperative that there is a wide and varied effort to establish links between health care settings and community services for IPV affected women (Petersen et al., 2001).”

“Female survivors of IPV are more likely than women not exposed to IPV to report needing mental health services (Lipsky & Caetano, 2007), and fewer than one-third of women in the general population report seeking help related to partner abuse (National Center for Injury Prevention, 2003).”

“…for ‘‘perceived need’’ and poverty, cultural differences in seeking and actually receiving mental health services persist, with Hispanic women consistently demonstrating the lowest rate of help-seeking behavior and utilization of specialty mental health services (Kimerling and Baumrind 2005).”

“…interactions between the survivor and the system, as well as the relative responses to IPV, barriers involving language and communication, cultural values, and stigmas often make seeking out any type of service challenging for those in need of help (Barrio et al., 2008; Ayalon & Alvidrez, 2007).”

“In one study of nearly 9,243 Latina and Asian American clients from San Diego County, patients with limited English proficiency were less likely to access mental health care via emergency services as opposed to outpatient services than English-proficient patients (28% of Latinas with limited English proficiency compar…”

“Physicians were less likely to screen their patients for IPV if their specialty was emergency medicine while obstetrics/gynecology physicians, female physicians, and those with IPV training within the last 12 months were found to have higher screening rates in their practices (Jaffee et al., 2005).”

“Many immigrant female IPV survivors are faced with language barriers that prevent them from gaining insight into the variety of services provided to them (O’Mahony & Donnelly, 2007).”

“cultural competence enhances the probability of accurate assessment and effective intervention in the case of abused women’’ (Campbell and Campbell 1996).”

“…stress disorder (PTSD), depression, and substance abuse, which are often a consequence of partner abuse (Campbell & Lewandowski, 1997; Golding, 1999; Martin et al., 2008), but can also be antecedent to involvement in violent or negative relationships (Briere & Jordan, 2004; McHugo et al. 2005).”

“…show LEP as a barrier to utilization, one study of Cambodian refugees reported that seeking services from medical and mental health care providers was associated with limited English-speaking proficiency, again possibly supporting the heterogeneous nature of ethnic groups (Marshall et al., 2006).”

“Despite the underutilization of mental health care services, many IPVaffected women patients still express interest in psychosocial care and treatment as reported in a study by 84% of its participants (Wong et al., 2007; Chow et al., 2003).”

“…unique barriers to utilizing healthcare, including structural, interpersonal, and cultural factors related to help-seeking (Alegría et al., 2002; Rodríguez et al., 2009), focusing recruitment entirely at traditional health sites (e.g., hospitals, healthcare institutions, academic research…”

“Another commonly cited instrumental barrier is the cost of mental health services (Davis, Ressler, Schwartz, Stephens, & Bradley, 2008; Jaycox et al., 2004; Koenen et al., 2003; Prospero & Vohra-Gupta, 2008; Rodriguez et al., 2009; Smith et al., 2002).”

“Women, especially ethnic minority women affected by intimate partner violence, also face challenges accessing mental health care (50).”