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Prevalence of gender violence: studies of four kinds of abuse in five Nordic countries
Linköping University, Department of Molecular and Clinical Medicine. Linköping University, Faculty of Health Sciences.
2003 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background

Abuse against women causes much suffering for the individual and is a major public health problem. The general aims of the present studies were I. to validate the NorVold Abuse Questionnaire (NorAQ) in a randomised population sample, and 2. to estimate the prevalence of emotional, physical and sexual abuse and abuse in the health care system by means of NorAQ in seven Nordic gynaecology and one Swedish population sample.

Methods

In the validation study, data were collected in two steps. (I) NorAQ was sent to a random sample of 1923 women in Östergötland. (2) A subsample of 64 women filled in the NorAQ for a second time and were interviewed. The interview had open questions about abuse and was considered our gold standard. In the prevalence studies, NorAQ was sent to 6729 women visiting seven departments of gynaecology in Denmark (1), Finland (1), Iceland (1), Norway (1) and Sweden (3). The main outcome measures were prevalence rates of emotional, physical, and sexual abuse and abuse in the health care system, current suffering from abuse and cmmmmication of a history of abuse to the gynaecologist.

Findings

The 13 questions in NorAQ concerning experiences of abuse had satisfactory validity and reliability. The response rate was 67-85% at the clinics and 61% in the Swedish population sample. In general the participants did not feel uncomfortable when answering NorAQ. We found differences in lifetime prevalence of the four kinds of abuse as defined by NorAQ among the Nordic cmmtries: emotional abuse 19-37%; physical abuse 38-66%; sexual abuse 17-33%; abuse in the health care system 13-28%. In Sweden, the lifetime prevalence of abuse was in clinical and population samples: emotional abuse 17-21 %; physical abuse 32-38%; sexual abuse 16-17%; abuse in the health care system 14-20%. There were generally no differences in prevalence rates of abuse among the four Swedish samples, except for abuse in the health care system, which was more commonly reported in the clinical sample of Linköping than in the population sample of Östergötland. Not all abused women reported current suffering from the abusive experience. To estimate prevalence of such abuse that causes current suffering is a new approach. Childhood experiences of emotional, physical and/or sexual abuse were associated with adult experiences of abuse in the health care system. Yet two thirds of women who felt abused in the health care system as adult had no history of earlier abuse. Most women had not talked to the gynaecologist about their experiences of abuse at their latest visit to the clinic.

Conclusion

The questions about abuse in NorAQ had good validity and reliability. We found high prevalences of all four kinds of abuse. Prevalence estimates are highly sensitive to methodology issues and must be related to a specified definition of abuse. Prevalence of abuse causing current suffering was considerably lower than the mere occurrence rates for all fom kinds of abuse. In general, women had not discussed a background of abuse with the gynaecologist at their latest visit to the clinic. Experiences of emotional, physical and/or sexual abuse in childhood were associated with adult abuse in the health care system. Yet the majority of our cases were not victims of childhood abuse. Both findings call for attention and further exploration.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 2003. , 75 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 794
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-26670Local ID: 11236ISBN: 91-7373-486-1 (print)OAI: oai:DiVA.org:liu-26670DiVA: diva2:247219
Public defence
2003-06-04, Aulan, Hälsans Hus, Hälsouniversitet, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-10-10Bibliographically approved
List of papers
1. The NorVold Abuse Questionnaire (NorAQ): validation of new measures of emotional, physical, and sexual abuse, and abuse in the health care system among women
Open this publication in new window or tab >>The NorVold Abuse Questionnaire (NorAQ): validation of new measures of emotional, physical, and sexual abuse, and abuse in the health care system among women
2003 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 13, no 4, 361-366 p.Article in journal (Refereed) Published
Abstract [en]

Background: In the literature about abuse, large variations in prevalence rates exist. Validated research instruments are scarce and are needed urgently. Our aim was to validate the 13 questions concerning the experiences of abuse among women in the NorVold Abuse Questionnaire against an interview and two validated questionnaires.

Method: Data collection was in two parts. i) The NorVold Abuse Questionnaire was sent to a random sample of 2000 women in Östergötland. ii) A subsample of 64 women was interviewed, and filled in the Conflict Tactic Scale, the Sexual Abuse Questionnaire, and the NorVold Abuse Questionnaire for a second time. The interview had open questions about abuse and was considered our gold standard.

Results: The response rate was 61%. The abuse variables in The NorVold Abuse Questionnaire showed good test–retest reliability (84–95%). Specificity was 98% for all kinds of abuse except physical (85%). Sensitivity ranged from 75% (emotional) to 96% (physical). The likelihood ratio ranged from 38 to 43 for all kinds of abuse except physical (likelihood ratio 6). NorAQ performed better against the interview than against the Sexual Abuse Questionnaire and equally against the Conflict Tactic Scale. High lifetime prevalence rates of abuse were found: emotional 21.4%; physical 36.4%; sexual 16.9%; abuse in the health care 15.6%. Prevalence rates of abuse dropped considerably when a criterion of current suffering was added.

Conclusions: The abuse variables in NorAQ have good reliability and validity.

Keyword
Abuse, NorAQ, Prevalence, Reliability, Validation, Women
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-46360 (URN)10.1093/eurpub/13.4.361 (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-13Bibliographically approved
2. Emotional, physical, and sexual abuse in patients visiting gynaecology clinics: a Nordic cross-sectional study
Open this publication in new window or tab >>Emotional, physical, and sexual abuse in patients visiting gynaecology clinics: a Nordic cross-sectional study
Show others...
2003 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 361, no 9375, 2107-2113 p.Article in journal (Refereed) Published
Abstract [en]

Background

Abuse against women causes much suffering for individuals and is a major concern for society. We aimed to estimate the prevalence of three types of abuse in patients visiting gynaecology clinics in five Nordic countries, and to assess the frequency with which gynaecologists identify abuse victims.

Methods

We did a cross-sectional, multicentre study of women attending five departments of gynaecology in Denmark, Finland, Iceland, Norway, and Sweden. We recruited 4729 patients; 3641 (77%) responded and were included in the study. Participants completed a postal questionnaire (norvold abuse questionnaire) confidentially. Primary outcome measures were prevalences of emotional, physical, and sexual abuse, and whether abused patients had told their gynaecologist about these experiences. We assessed differences between countries with Pearson's χ2 test.

Findings

The ranges across the five countries of lifetime prevalence were 38–66% for physical abuse, 19–37% for emotional abuse, and 17–33% for sexual abuse. Not all abused women reported current ill-effects from the abusive experience. Most women (92–98%) had not talked to their gynaecologist about their experiences of abuse at their latest clinic visit.

Interpretation

Despite prevalences of emotional, physical, and sexual abuse being high in patients visiting gynaecology clinics in the Nordic countries, most victims of abuse are not identified by their gynaecologists. This lack of discussion might increase the risk of abused patients not being treated according to their needs. Gynaecologists should always consider asking their patients about abuse.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26583 (URN)10.1016/S0140-6736(03)13719-1 (DOI)11148 (Local ID)11148 (Archive number)11148 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
3. Are sociodemographic and regional and sample factors associated with prevalence of abuse?
Open this publication in new window or tab >>Are sociodemographic and regional and sample factors associated with prevalence of abuse?
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2004 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 83, no 3, 276-288 p.Article in journal (Refereed) Published
Abstract [en]

Background.  The aims of the present study were: 1) to estimate the prevalence of emotional, physical and sexual abuse and abuse in the health care system, and 2) to study the associations between prevalence of abuse and sociodemographic and sample variables.

Methods.  This cross-sectional study used a validated postal questionnaire in four Swedish samples; patients at three gynecologic clinics with different character and in different regions (n = 2439) and women in one randomized population sample (n = 1168).

Results.  Any lifetime emotional abuse was reported by 16.8–21.4% of the women; physical abuse by 32.1–37.5%; sexual abuse by 15.9–17.0%; and abuse in the health care system by 14.0–19.7%. For 7–8% abuse had included life threats and 9–20% of all women in the study currently suffered from their experiences of abuse. Most women had not disclosed their background of abuse to the gynecologist.

There were differences in sociodemographic variables between the four samples. Generally, in the multivariate analyses we found associations between prevalence of abuse and age, educational level, civil status and occupation, but no consistent association between prevalence of abuse and sample variables.

Conclusion.  Lifetime prevalence rates of the four kinds of abuse were high in all samples as measured by the NorVold Abuse Questionnaire (NorAQ), and 1/10–1/5 women in the study suffered currently from abusive experiences. In multivariate analyses prevalence of abuse was consistently associated with sociodemographic but not to sample variables.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-22020 (URN)10.1111/j.0001-6349.2004.0222.x (DOI)1048 (Local ID)1048 (Archive number)1048 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
4. Have adults victims of abuse in the health care system been exposed to emotional, physical and/or sexual abuse as children more often than non-victims?
Open this publication in new window or tab >>Have adults victims of abuse in the health care system been exposed to emotional, physical and/or sexual abuse as children more often than non-victims?
Show others...
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Objectives: The aim of this study was to find out if there was an association between any lifetime abuse and abuse in the health care system. Furthermore we wanted to analyse if adult victims of abuse in the health care system reported exposure to emotional, physical and/or sexual abuse as children more often than non-victims did.

Design: A cross-sectional questionnaire study. Our first hypothesis was tested in the total sample, and the second one in a case-control analysis. The cases were those women who reported experiences of abuse in the health care system as adults. Exposure was defined as emotional, physical and/or sexual abuse in childhood.

Settings: Data were gathered from patients visiting three Swedish gynaecological clinics.

Sample: 2439 gynaecology patients (response rate 81%).

Method: The NorVold Abuse Questionnaire (NorAQ) sent out by post.

Main outcome measure: Associations between experiences of emotional, physical and/or sexual abuse, and abuse in the health care system; operationalised in NorAQ.

Results: A general association was found between lifetime emotional, physical and/or sexual abuse and abuse in the health care system in all three samples. Adult victims of abuse in the health care system reported emotional, physical and/or sexual abuse in childhood more often than non-victims did. These fmdings also held after adjustment for age and educational level.

Conclusions: There is a general association between lifetime experiences of abuse and abuse in the health care system. Adult victimisation in the health care system is associated with childhood exposure to emotional, physical and/or sexual abuse. These associations call for attention and need to be further investigated.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-84492 (URN)
Available from: 2012-10-10 Created: 2012-10-10 Last updated: 2013-09-03Bibliographically approved

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Swahnberg, Katarina

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