Intimate Partner Violence Victims Seeking a Temporary Restraining Order: Social Support and Resilience Attenuating Psychological Distress.

584352 research-article2015

JIVXXX10.1177/0886260515584352Journal of Interpersonal ViolenceJose and Novaco

Article

Intimate Partner Violence Victims Seeking a Temporary Restraining Order: Social Support and Resilience Attenuating Psychological Distress

Journal of Interpersonal Violence 1–25 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0886260515584352 jiv.sagepub.com

Rupa Jose1 and Raymond W. Novaco1

Abstract Social support has been found in many studies to be a protective factor for those exposed to intimate partner violence (IPV), but personal resilience has received far less attention. The present study concerns 136 female IPV victims seeking a temporary restraining order (TRO) from a Family Justice Center (FJC). The relationships between IPV victimization, social support, resilience, and psychological distress were examined. Hierarchical regressions found that both perceived social support and self-reported resilience were inversely associated with distress symptoms. Higher social support was associated with lower trauma symptoms, controlling for abuse history, demographics, and resilience. Higher resilience was associated with lower mood symptoms and lower perceived stress, controlling for abuse history, demographics, and social support. No significant associations were recorded for anger symptoms. These findings suggest that fostering resilience can have important health benefits for IPV victims, above and beyond the well-known

1University

of California, Irvine, USA

Corresponding Author: Raymond W. Novaco, Department of Psychology and Social Behavior, University of California, Irvine, 4201 Social and Behavioral Sciences Gateway, Irvine, CA 92697, USA. Email: [email protected]

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Journal of Interpersonal Violence

benefits of social support. Ways that resilience might be cultivated in this population and other implications for practice are discussed. Keywords IPV, domestic violence, social support, resilience, restraining order Intimate partner violent (IPV) relationships are far from rare occurrences. In the United States, 34.6% of serious violent crimes (i.e., rape, sexual assault, robbery, and aggravated assault), 65.4% of simple assaults, and 39% of homicides involving women were committed by an intimate partner (National Crime Victimization Survey estimates from 2002 to 2011 and 2010, respectively; Catalano, 2013). These statistics align with the 30% lifetime prevalence rate for IPV worldwide (World Health Organization [WHO], 2013). United States rates of IPV vary by type, with ranges of 13.8% to 20.4% for physical abuse, 27.5% to 34% for sexual abuse or coercion, and 12.1% to 22.7% for psychological abuse (Basile, 2002; Coker, Smith, McKeown, & King, 2000; Thompson et al., 2006; Tjaden & Thoennes, 2000). The seriousness and pervasiveness of IPV has led researchers to focus on the predictors and outcomes of abusive relationships, giving attention to the psychosocial factors that affect victims’ well-being. This study examines whether the social support resources and personal resilience of IPV victims seeking a temporary restraining order (TRO) at a Family Justice Center (FJC) affects their levels of psychological distress. FJCs, pioneered in 2002 in San Diego (cf. Gwinn, Strack, Adams, Lovelace, & Norman, 2007), formally began with a U.S. Presidential Initiative in 2004.1 They are community-based facilities that enable domestic violence victims to access a range of services at a single location through the collaboration of multiple local agencies. There are descriptive accounts of such facilities and clientele (Gwinn et al., 2007; Hoyle & Palmer, 2014; Murray et al., 2014), but we know of no quantitative study on the abuse experiences and psychological distress of FJC clients, and no prior study that has assessed both their social support and resilience. Most IPV studies have been based on shelter or broad-based community samples, which fail to capture the many women seeking legal protections against their abuser. The 1994 Violence Against Women Act (VAWA) moved partner violence from home to court with government sanctioned services for victims and penalties for abusers (Clark, Biddle, & Martin, 2002). Despite controversy about the effectiveness of protective orders (e.g., Benitez, McNiel, & Binder, 2010; McFarlane et al., 2004), they are regularly used by victims of partner


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violence. A study of 227,941 active restraining orders in California in 2003 found that more than 90% served IPV victims (Sorenson & Shen, 2005). Social support and resilience may affect the mental health of abused women through a dyadic interdependence, and conceptual links between social support and resiliency encourage their conjoint study. Both have been found to lessen the impact of IPV on mental health. We address these points sequentially on a FJC sample of IPV victims seeking a TRO.

Dyadic Interdependence: Victim and Abuser Victims of abuse are often tied to their abuser for financial (D. K. Anderson & Saunders, 2003; Kim & Gray, 2008) and emotional support (Barnett, 2001; Fanslow & Elizabeth, 2011). For example, in a study of 206 low-income women, 35% reported receiving emotional support and 57% reported receiving rent money, transportation, medical insurance, housing, and other incidentals from their abuser (Bell, Goodman, & Dutton, 2007). Multiple forms of dependency present in intimate partner relationships make them difficult to terminate. Even after obtaining an emergency order, a woman’s emotional attachment to her abuser was the key factor in not pursuing a 1-year restraining order (Zoellner et al., 2000). Despite limiting victims’ support from others, an abuser may be an integral, at times supportive member of the victim’s resource network. Abusers limit support by curtailing their partner’s access to resources and by thwarting efforts to gain financial and emotional supports. In the realm of employment, abusers interfere with or undermine their partner’s work, resulting in high job turnover, unemployment, and welfare dependence (Tolman & Raphael, 2000). A qualitative study of employed IPV victims showed that almost half of the women who disclosed the abuse to their employer resigned, due to safety concerns, emotional distress, or being forced to leave (Swanberg & Logan, 2005). Regarding social relationships, abusers often monitor with whom or how often their partners contact others—in extreme cases, resulting in victim social isolation (e.g., Farris & Fenaughty, 2002; Mitchell & Hodson, 1983). Social network studies find that abused women have fewer social contacts compared with non-abused women (Coohey, 2007; Katerndahl, Burge, Ferrer, Becho, & Wood, 2013), as abusers control to whom their partners have access. For undocumented Hispanic IPV women, partner control, combined with fears of deportation, can greatly limit formal and informal networks (Reina, Maldonado, & Lohman, 2013). The relationship between abuser and victim tends to be characterized by enmeshment—“controlling and constraining interaction patterns that inhibit individual psychological autonomy” (Barber & Buehler, 1996, p. 434). For


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IPV victims, enmeshment underscores the unhealthy bond between partners that metaphorically ensnares the victim, making leaving difficult. The bond formed fluctuates in support and control, introducing variability across IPV relationships. Not all abusers try to control their partner’s resources (Tolman & Raphael, 2000), not all who try to control are successful (Swanberg & Logan, 2005), and not all victims respond to abuse tactics in the same way— some cope using passive strategies, others use active strategies (Ruiz-Perez, Mata-Pariente, & Plazaola-Castano, 2006). Thus, examining the supports available to IPV victims should be done in conjunction with their personal resilience.

Linking Resilience and Social Support Resilience is inferred when individuals who must contend with adverse, threatening circumstances nevertheless adapt and achieve successful outcomes. First identified among youth with challenging life circumstances, continuing research attests to the importance of resilience across the life span (e.g., Bonanno, 2005). Most studies of adult resilience focus on contextual adversities such as natural disasters or terrorism (e.g., Seery, Holman, & Silver, 2010), but there are a few studies on resilience concerning adult victims of IPV, some interfaced with social support. In a shelter study of Hispanic women, those with more emotional or informational supports had higher resilience, compared to those with fewer supports (Schultz, Roditti, & Gillette, 2009). When asked to identify what promoted resilience, social support was a recurrent theme among South Asian IPV victims (Ahmad, Rai, Petrovic, Erickson, & Stewart, 2013; Shanthakumari, Chandra, Riazantseva, & Stewart, 2013), attributing their resilience to support given or received from other women, support they received from males or other family members, or support that resulted from rebuilding their relationships. Research on other IPV victim populations confirms the utility of social supports in helping abused women establish feelings of resilience (e.g., Davis, 2002; Oke, 2008). Given that resilience is an internal “personal resource” and social support is a largely external “social resource,” both should be explored in tandem (Ford-Gilboe et al., 2009). Masten and Wright (2009) assert that resilience is a non-static, dynamic state. Decades of work on childhood resilience indicates that resilient children garner support from caregivers (parents, grandparents), siblings, teachers, and peers (Werner, 2012). Adults likewise acquire support from family, friends, and coworkers. Although resilience arises from supportive relationships, it has other sources, such as intellectual functioning, secure attachment, and success in coping with challenges (Herrman et al., 2011). Thus, having social support does not ensure resilience. Downloaded from jiv.sagepub.com at UNIV OF NEW ORLEANS on May 28, 2015

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Mental Health, Social Support, and Resilience The impact of IPV has often been studied with regard to posttraumatic stress disorder (PTSD) and depression. The Beydoun, Beydoun, Kaufman, Lo, and Zonderman (2012) meta-analysis found that battered women are 2 to 3 times more likely to be diagnosed with Major Depressive Disorder, and up to 28% of women with depressive symptoms report experiencing IPV over their lifetime. International estimates indicate that IPV exposed women have nearly twice the risk for depression, versus their non-abused counterparts (WHO, 2013). For PTSD, prevalence estimates vary with sampling. Golding’s (1999) meta-analysis found a prevalence of 63.8% across 11 studies. For shelter populations, PTSD rates are high, ranging from 40% to 84% (Jones, Hughes, & Unterstaller, 2001). IPV has a medium effect size in associations with PTSD and physical or psychological aggression (Taft, Watkins, Stafford, Street, & Monson, 2011). Other adverse outcomes studied include physical health impairments, suicide, substance use, and anxiety (e.g., Dutton et al., 2006; WHO, 2013; Zlotnick, Johnson, & Kohn, 2006). Anger has been studied in predicting revictimization (Kuijpers, van der Knaap, & Winkel, 2012). Social support and resilience mitigate the impact of abuse on short-term and long-term mental health. In the Ozer, Best, Lipsey, & Weiss’ (2008) meta-analysis, lower perceived support post-trauma predicted higher current and future PTSD symptoms. Specific to IPV, women with higher social support were less likely to experience anxiety, PTSD, depression, suicidal ideation, and “poor” mental health, compared with their low or moderately supported counterparts, controlling for abuse history or other risk factors (Coker et al., 2002; Mburia-Mwalili, Clements-Nolle, Lee, Shadley, & Yang, 2010). Higher baseline social support for IPV survivors is related to lower depression and a stepper decline in depression over a 2-year period (Beeble, Bybee, Sullivan, & Adams, 2009). A study of more than 10,000 IPV women in Spain (Escribà-Agüir et al., 2010) found that those with larger friend or family networks had less psychological distress and psychotropic drug use and better self-reported health than did women with smaller networks. Victim advocate support has been found to result in positive mental health for IPV women (cf. Shorey, Tirone, & Stuart, 2014). In the Sullivan and Bybee (1999) intervention study, single abused women who received postshelter advocacy reported better quality of life, more social support, and less abuse than did women in the non-advocate group 2 years after the intervention—although group differences diminished by 3 years (Bybee & Sullivan, 2005). Similarly, in a more recent advocacy intervention study, based on a community outreach initiative, women who received counseling and support from an advocate were less likely to report depression, PTSD symptoms, and


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fear than did their control (non-advocate) counterparts 1 year later (DePrince, Labus, Belknap, Buckingham, & Gover, 2012). Higher resilience among IPV victims has also been found to be associated with lower symptom levels. Humphreys (2003), reported that IPV women with higher resilience scores had fewer and less intense symptoms of distress (repeated thoughts, impulses, depression, or anxiety) than did victims with lower resilience scores. Studies of Hispanic and Canadian IPV victims indicate a significant inverse relationship between resilience and psychological disturbance (i.e., tension, anger, depression, confusion, and fatigue) and a significant positive relationship between resilience and mental health functioning (Ford-Gilboe et al., 2009; Schultz et al., 2009). Among women who had left their abusive partners, those symptomatic for PTSD had significantly lower levels of self-reported resilience (K. M. Anderson, Renner, & Danis, 2012).

Current Study We located no published research on social support and resilience as potential distress-mitigating agents for IPV women seeking a TRO—the objective of the present study. Abuse was measured as a factor score of five types: physical abuse with a weapon, physical abuse without a weapon, sexual abuse, threats of physical harm, and verbal threats. Mental health problems were represented by four symptom categories: PTSD, depression or anxiety, perceived stress, and anger. Based on previous studies of IPV victims, we hypothesize that higher levels of social support and resilience will be associated with lower levels of mental health problems. Women seeking a TRO are an understudied subset of IPV victims. Our work builds on that of McFarlane et al. (2004) and Zoellner et al. (2000) to better understand the strengths and needs of IPV victims who pursue legal protections.

Method Setting Participants were recruited from a police department affiliated non-profit FJC in southern California that provides legal assistance and other services to victims of domestic violence, child abuse, and elder abuse. The facility is also connected with several local shelters, which can provide van transport to and from the FJC. One FJC service is that IPV victims can consult with an on-site court clerk to file for a TRO and, if granted, receive their TRO within the day.


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For convenience and privacy, our study interviews were conducted at the facility in a private room. If children were present, the interview took place in the children’s play room, ensuring that mothers had a clear view of their children at all times.

Sample Study eligibility required that participants be female, above age 18, and in the process of applying for a TRO against a male romantic partner for IPV. The study sample was 136 women. From April 2012 to June 2013, a total of 175 eligible women entered the facility. Of these, 39 were not included in our study sample for the following reasons: staff absence or miscommunication (n = 6), staff judgment that the interview should not proceed due to the clients’ emotional distress (n = 2), the client’s refusal due to emotional distress (n = 1), the clients’ refusal for other reasons (i.e., unidentified reason and job interview; n = 2), clients’ early exit from the facility (n = 6), and interviewer unavailability (n = 22). Of those that the project team approached, only 3 women declined participation (97.8% participation rate). Demographic information was collected by facility staff and by six project interviewers. Due to time constraints and staff limitations, data accrued by facility staff varied in terms of completeness; there were no missing values for project interviewer data. Participants’ mean age was 32.02 years (SD = 8.47; n = 128). Thirty-one (22.79%) reported having completed high school, technical or trade school, college (or some college), or a post-graduate degree. Most women self-identified as “Hispanic/Latina” (61.75%), followed by “European/ White” (19.85%), “African American/Caribbean” (5.15%), “Asian” (2.21%), “Other” (1.47%), and “Middle Eastern” (0.74%); 12 women had no recorded ethnicity. One fourth (25.74%) of the interviews were conducted in Spanish. TROs were received by 87.5% of participants (n = 135).

Procedure Daily telephone contact informed the research team about whether there was an eligible participant at the facility and her spoken language. Once informed, an interviewer (English or Spanish) was sent to the site to administer a 30- to 35-min interview. So as to not interrupt the flow of services received, we interviewed each woman in a private room, while she was waiting to hear about her TRO status. Informed consent was obtained at the outset of the interview, making clear the study’s purpose and voluntariness; breaks occurred whenever requested by the participant. All participants received a


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compensatory gift card of US$20. Either before or after the interview, the woman’s facility ID number was collected to match project interviewer data with staff-collected data. To protect participant privacy, all data were deidentified, and sequential case numbers were assigned to each interview.

Measures Criterion variables Trauma. The Primary Care PTSD Screen (PC-PTSD; Prins et al., 2003) measures trauma symptoms in the past month. Minor modifications were made to the original 4-item scale to ensure linguistic clarity. A “yes” or “no” response scale (coded as 1 or 0) indicated whether participants ever experienced a life event that was “frightening, horrible, or very upsetting.” If “yes” was endorsed, they were asked if that event led to nightmares, avoidance, vigilance, or numbness. A “positive” screen score of “3” or “4” indicates probable PTSD. The PC-PTSD screen has been validated against the Posttraumatic Stress Disorder Checklist (PCL; Weathers, Litz, Herman, Huska, & Keane, 1993) and the Clinician-Administered Scale for PTSD (CAPS; Blake et al., 1995) and found to act as a comparable measure of probable PTSD, with good test–retest reliability (r = .83; Prins et al., 2003). It has been used to assess PTSD likelihood in previous IPV studies (e.g., Kimerling, Alvarez, Pavao, Kaminski, & Baumrind, 2007). Mood symptoms. Two items were used from the 4-item Patient Health Questionnaire (PHQ-4; Lowe et al., 2010) to assess mood symptoms over the last 2 weeks (sample α = .70). Specifically, participants were asked the extent they felt “down, depressed, or hopeless” and felt “nervous, anxious, or ‘on edge.’” Response categories included 0 = “not at all,” 1 = “sometimes,” and 2 = “a lot.” Due to the high comorbidity between depression and anxiety, with 50% of all adult primary care visitors receiving a comorbid diagnosis (Hirschfeld, 2001), a sum variable, termed “mood symptoms,” was used in analysis. The full PHQ-4 has good validity and internal reliability (i.e., α = .85; Kroenke, Spitzer, Williams, & Löwe, 2009). Stress. The 4-item Perceived Stress Scale (PSS-4; Cohen, Kamarck, & Mermelstein, 1983) was used to determine functioning within the past month (sample α = .79). Participants reported the extent that they felt “unable to control the important things” in life, “unsure of [their] ability to handle [their] personal problems,” “things were not going [their] way,” and that they “had too many difficulties” to manage. A 3-point scale was used (0 = “none of the time,” 1 = “sometimes,” and 2 = “a lot”) to simplify reporting for our study


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participants in the FJC context. Other studies on IPV have used the PSS-4 to assess stress among victims, but with a 5-point scale (e.g., Rodriguez et al., 2008). Anger. The Dimensions of Anger Reactions (DAR; Novaco, 1975) is a 7-item self-report scale (sample α = .86). Sample items are, “when I do get angry, I get really mad,” “when I get angry, I stay angry,” “my anger interferes with my ability to get my work done,” and “my anger has a bad effect on my health.” All items are rated from 0 “not at all” to 4 “very much.” The present study instrument is a revised version of the original screening tool, with the response scaling shortened to a 5-point rating. The DAR has been found to be a valid anger screen for trauma-exposed individuals, both military (e.g., Forbes et al. 2004; Novaco, Swanson, Gonzalez, Gahm, & Reger, 2012) and civilian (e.g., Kunst, Winkel, & Bogaerts, 2011). Background variables Age, ethnicity, and employment. Age was self-reported in years. Ethnicity was recoded as non-Hispanic = 0 and Hispanic = 1, due to a preponderance of Latina participants. Employment was coded for “currently employed” (“no” = 0 and “yes” = 1). Marital status. Participants self-identified as one of five pre-specified categories: single, married, cohabitating, separated, or divorced. Because married and cohabitating women are likely to share resources and be more accessible to their abuser, we combined those married or cohabitating (coded as a “1”) and single, separated, or divorced persons (coded as “0”). Abuse. A factor score representing abuse experiences was generated in STATA, using 5 of 6 items measuring abuse frequency. Participants were asked how often they had experienced the following types of abuse in the last 6 months: physical abuse without a weapon, physical abuse with a weapon, sexual abuse, verbal threats to harm or kill, physical threats (e.g., throwing objects), and emotional abuse. As emotional abuse was nearly universal in our sample (98.5% reported emotional abuse), it is a non-discriminating item and was therefore excluded from the factor score. The root mean square error of approximation or (RMSEA), which indexes the combined item fit, was “good” at .027. Internal consistency across items was “satisfactory” (α = .68). For analyses and interpretation, the continuous factor score was converted into a quantile ordinal variable, evenly splitting the factor score into five numerical categories. Values ranged from “1” = no or low levels of abuse to “5” = high levels of abuse, with incremental increases in abuse frequency between “2” and “4.” Downloaded from jiv.sagepub.com at UNIV OF NEW ORLEANS on May 28, 2015

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Social support. Using the 13-item Medical Outcomes Study index (MOS; Sherbourne & Stewart, 1991), social support was assessed by (a) the count of supportive persons, and (b) the level of perceived support. For the count of supportive persons, participants were asked the “number of close friends and close relatives” they could go to for emotional support if needed. For the total level of perceived support, ratings of 12 emotional and instrumental support items were aggregated. Example items are “someone who shows you love and affection” and “someone to prepare your meals if you were unable to do it yourself.” Items were rated on a 5-point scale (0 = “none of the time” to 4 = “all of the time”). The summary index of the 12 items (range = 0-48) for the study sample had a high internal consistency (α = .94). Resilience. The 10-item Connor-Davidson Resilience Scale (CD-RISC; Connor & Davidson, 2003) was used. The CD-RISC has high reliability (α = .89; Connor & Davidson, 2003) and established validity (Campbell-Sills & Stein, 2007). Example items are “I can deal with whatever comes” and “dealing with stress can strengthen me,” rated as 0 “not true at all” to 4 “true nearly all the time.” The total resilience score used for analysis was the 10-item sum (sample α = .87). For one item, average scores were imputed for 79 cases.

Analytic Plan The protective capacities of social support and resiliency were tested using ordinary least squares (OLS) regressions in a series of models with our mental health criteria. We first controlled for covariates (age, ethnicity, marital status, and employment), then entered abuse, and then introduced our hypothesized protectors of social support and resilience. As social support is a more inclusive concept than resilience, the count of supportive persons and the total level of perceived support were entered first, followed by resilience. This regression building approach best assesses the unique contribution of resilience. Regression assumptions were examined using residual plots and were deemed acceptable for inferential purposes. Variance inflation factors (VIF) never exceeded a value of “2” across all regression models.

Results Descriptive Results Summary statistics for background, abuse, social support, and resilience variables are presented in Table 1. Approximately half the sample was married or cohabitating, one third were employed, and a substantial majority was


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Jose and Novaco Table 1. Study Variables. Variable Age Ethnicity (1 = Hispanic or Latina) Current employment (1 = yes) Marital status (1 = married or cohabitating) Abuse experiences score Social supporta Count of close friends and relatives Total perceived support Resiliencyb PTSDc Score of “3” or “4” Mood symptomsd Depression Not at all Sometimes A lot Anxiety Not at all Sometimes A lot Perceived stresse Angerf

Percent(%)

M (SD)

67.74 33.59 49.07

32.02 (8.47) 2.96 (1.45) 5.13 (6.95) 29.64 (12.52) 27.62 (7.20)

59.56

14.18 50.00 35.82

16.42 42.54 41.04

3.90 (1.40) 5.74 (5.51)

Note. A score of “3” or “4” indicates probable PTSD on the PC-PTSD (Prins et al., 2003). PTSD = posttraumatic stress disorder; PC-PTSD = primary care-posttraumatic stress disorder. aSocial support assessed using the 13-item Medical Outcomes Survey (Sherbourne & Stewart, 1991). bResilience assessed using the 10-item Connor-Davidson Resilience Scale (CD-RISC; Connor & Davidson, 2003). cPTSD symptoms assessed using the Primary Care PTSD Screen (PC-PTSD; Prins et al., 2003). dMood symptoms assessed using select items from the 4-item Patient Health Questionnaire (PHQ-4; Lowe et al., 2010). ePerceived stress assessed using the 4-item Perceived Stress Scale (PSS-4; Cohen, Kamarck, & Mermelstein, 1983). fAnger assessed using the 7-item Dimensions of Anger Reactions (DAR; Novaco, 1975).

Hispanic. Regarding abuse severity in the previous 6 months, 107 (78.7%) had experienced physical abuse without a weapon, 32 (23.5%) physical abuse with a weapon, 46 (33.8%) sexual abuse, and 90 (66.2%) were threatened to be killed or physically harmed. For the abuse frequency factor score (M =


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2.96, SD = 1.45), the percentages for levels “1” to “5” were as follows: 23.53%, 16.91%, 19.85%, 19.85%, and 19.85%. Twenty-eight (20.6%) of the women were pregnant during the period of their abuse. For psychological distress, nearly 60% of participants screened positive for PTSD, and 35% to 40% experienced depressed mood or anxiety “a lot.” Perceived stress was moderate, with the average item rating corresponding to “sometimes,” comparable with the findings of Rodriguez et al. (2008). Anger scores were low, with 18 participants reporting no anger reactions. On social support counts, only a handful of participants (n = 4) reported no friends or relatives to give support. Item ratings of perceived support (M = 29.64) were similarly positive with at least 55% of participants reporting they had someone to count on if they needed to talk, someone to show them love and affection, someone they could confide in about themselves or their problems, and someone to love or make them feel wanted “most of the time” or “all of the time.” The least endorsed support items were having someone to “take you to the doctor if you needed it,” “get together with for relaxation,” “do things with to help get your mind off things,” and someone to “prepare your meals if your unable to do it yourself”—30% or more said they did not have the aforementioned supports or only had them “a little of the time.” Resilience item ratings were relatively high. At least 60% of participants indicated that they can adapt to change, deal with whatever comes, bounce back after illness or hardship, achieve despite obstacles, think of themselves as a strong person, and can handle unpleasant feelings “often” or “nearly all the time.” Two resilience items—“I try to see the humorous side of problems” and “dealing with stress can strengthen me”—were the least endorsed, with about 20% of participants reporting “not true” or “rarely true” for those items. Correlations between study variables are in Table 2. Support count was moderately related to perceived support, and, to a lesser degree, with resilience, but it was generally not related to our stress variables. Perceived support was related to resilience and employment and inversely related to perceived stress and to mood and trauma symptoms. Resilience was inversely related to perceived stress, mood symptoms, and anger.

Regression Results Hierarchical regression models were run for each of the four outcome symptom categories: PTSD symptoms, mood symptoms, perceived stress, and anger. All baseline models included abuse, ethnicity, current employment, marital status, and age, with subsequent steps entering the count of support persons, perceived social support, and resilience (in that order). Final model



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1.00 .28** .37*** −.25** −.30*** −.23** −.13 −.11 .11 .29** .00 −.11

1.00 .18* −.10 −.27** −.21* −.31*** .11 .22* .10 −.17 −.06

2

4

1.00 −.06 1.00 −.11 .34*** −.03 .26** −.04 .16 −.04 .07 .20* .00 .16 −.20* −.11 −.10 .11 .29**

3

6

1.00 .24** 1.00 .30** .26** .02 .22* −.01 .10 −.17 −.22* .08 −.08 .09 .08

5

1.00 −.02 −.18* −.13 .10 .03

7

1.00 .25** −.05 −.16 .01

8

bResilience

9

1.00 .11 −.15 −.02

support assessed using the 13-item Medical Outcomes Survey (Sherbourne & Stewart, 1991). assessed using the 10-item Connor-Davidson Resilience Scale (CD-RISC; Connor & Davidson, 2003). cPTSD symptoms assessed using the Primary Care PTSD Screen (PC-PTSD; Prins et al., 2003). dPerceived stress assessed using the 4-item Perceived Stress Scale (PSS-4; Cohen, Kamarck, & Mermelstein, 1983). eMood symptoms assessed using select items from the 4-item Patient Health Questionnaire (PHQ-4; Lowe et al., 2010). fAnger assessed using the 7-item Dimensions of Anger Reactions (DAR; Novaco, 1975). *p < .05. **p < .01. ***p < .001.

Support perceiveda Resiliencyb Support counta Traumac Stressd Mood symptomse Angerf Marital status Age Current employment Ethnicity Abuse

aSocial

1 2 3 4 5 6 7 8 9 10 11 12

1

Table 2. Intercorrelations of Study Variables.

1.00 .17 .06

10

1.00 .03

11

1.00

12

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results for trauma, mood, and perceived stress outcomes are presented in Table 3. Regarding the steps toward that final model for the PTSD symptoms, in the baseline model, there was a strong positive relationship between abuse experiences and trauma (β = .291; p = .003) and a marginal inverse relationship for employment (β = −.159; p = .098). When support variables were entered, abuse remained significant (β = .244; p = .013) and perceived support became significant (β = −.252; p = .020). That is, adjusting for the baseline variables and the count of supportive persons available to the victims, perceived support was negatively related to trauma symptoms. That relationship remained significant after adding resilience, which was not significantly associated with trauma symptoms. For mood symptoms, when the baseline model was augmented with the supportive persons count, being married or cohabitating was marginally associated with more symptoms (β = .173; p = .084), and being employed was marginally associated with fewer symptoms (β = −.166; p = .092). In the final model, only resilience was significantly related to mood symptoms (p = .046); higher resilience was associated with lower depression and anxiety. For perceived stress, perceived support was significant on entry (β = −.253; p = .025), but once resilience was added, this association disappeared, and a significant negative relationship between resilience and stress symptoms emerged (p = .016). This suggests that there is an independent effect of resilience above and beyond what is captured by perceived social support or by counts of available supportive persons. In the baseline model for anger reactions, older women were marginally less likely to report anger following abuse (β = −.173; p = .090). The social support variables were not significant on entry. In the final model, higher resilience was related to lower anger reaction scores (β = −.267; p = .012). Although resilience was statistically significant, the full model was not, F(8, 98) = 1.72; p =.10; adjusted R2 = .052. Across the four outcome variables, the percentage of variance explained over all models ranged from roughly 5% (for anger symptoms) to 10% (for trauma).

Discussion Over the last 20 years, IPV victims increasingly have pursued legal protections against their abusers. Despite the different types of court-sanctioned legal protections sought, Stoever (2014) has argued that court protection orders should have a minimum length of 2 years to provide meaningful



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−.098 −.070 .244

−0.295 (−1.00) −0.215 (−0.72) 0.240 (2.53)*

0.016 (0.77) .081 −0.027 (−2.18)* −.241 −0.008 (−0.41) −.042 2.986 (3.55)** 2.42 (8,98)* .097

−.003 .023

β

−0.000 (−0.03) 0.066 (0.24)

b

−.133 −.118 .049

.146 .173

β

0.003 (0.17) .018 −0.008 (−0.71) −.079 −0.034 (−2.02)* −.207 2.943 (4.01)** 2.22 (8,98)* .085

−0.345 (−1.35) −0.313 (−1.21) 0.041 (0.50)

0.021 (1.43) 0.425 (1.77)†

b

Moodb

0.015 (0.89) 0.029 (0.10)

b

.091 .010

β

0.006 (0.27) .029 −0.021 (−1.65) −.185 −0.048 (−2.45)* −.252 4.954 (5.80)** 2.06 (8,98)* .074

−.064 .104 .041

Perceived Stressc

−0.194 (−0.65) 0.320 (1.06) 0.041 (0.42)

Note. Numbers in parentheses are t ratios. aPTSD symptoms assessed using the Primary Care PTSD Screen (PC-PTSD; Prins et al., 2003). bMood symptoms assessed using select items from the 4-item Patient Health Questionnaire (PHQ-4; Lowe et al., 2010). cPerceived stress assessed using the 4-item Perceived Stress Scale (PSS-4; Cohen, Kamarck, & Mermelstein, 1983). dSocial support assessed using the 13-item Medical Outcomes Survey (Sherbourne & Stewart, 1991). eResilience assessed using the 10-item Connor-Davidson Resilience Scale (CD-RISC; Connor & Davidson, 2003). †p < .10. *p < .05. **p < .01.

Age (years) Marital status (1 = married or cohabitating) Currently employed (1 = yes) Ethnicity (1 = Hispanic or Latina) Abuse Social supportd Count of friends and relatives Perceived support total Resiliencye Constant F (df) Adjusted R2

Predictor Variables

Traumaa

Table 3. Final Models of Social Support and Resilience (N = 107).

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judicial oversight, safety, and threat of criminal penalties. As the number of IPV petitioners grows, it is important to understand the relationship between protection orders and the psychological needs and resources of victims. Previous research on IPV victims with legal orders examined their initial and subsequent violence exposure (McFarlane et al., 2004; Zoellner et al., 2000). We investigated their psychological distress status, finding social support and resilience to be distress-protective for women seeking a TRO from a FJC. The abuse experiences of our sample are comparable with those of other studies on women seeking protection orders. A high proportion experienced physical abuse and nearly 20% reported experiencing high to severe abuse. Our participants (67.7% Hispanic) reported varying degrees of social, financial, and personal resources. Levels of social support were relatively high. Only one third of the sample were employed, but study participants had on average five friends and relatives to support them, and more than half had someone to show them “love and affection” all the time. This suggests that many had emotionally rich family and friendship networks. Resilience or personal coping resources were also relatively high. More than 40% endorsed feeling “strong” and capable at all times. Combining these findings on support and resilience, most of our participants cannot be characterized as “social isolates” but instead as resilient, supported persons trying to overcome the abuse of partner violence. Nevertheless, a substantial number of women were in need of social support and resilience boosting. We first note that our findings on social support were uneven. Social support was measured in two ways: the count of supportive persons and perceived social support. The count of supportive persons available was unrelated to our psychological measures, whereas perceived social support was significantly related to psychological distress, controlling for background covariates. Higher perceived social support was associated with lower symptoms of trauma, mood, and perceived stress. However, on the perceived stress criterion, the effect of perceived social support was diminished once resilience was added to the model, and it was not significant for mood symptoms or anger. The protective effect obtained for social support is in accord with previous research, such as Coker et al. (2002), who found a broader range of distress protection for social support, but they did not study resilience. Regarding our unexpected null findings for the count of supportive persons, one possibility is that functional support may be countered by problematic social relationships in the support network. Negative social ties (Rook, 1984), found to bear on the psychological well-being of older adults, might be an


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important factor for IPV populations. That is a subject for future research, as well as a topic about which advocates and counselors at FJC’s, shelters, or other care provision sites, including primary care, might inquire. The person’s distress might not only be due to the behavior of the abuser, but also a product of adversities derivative of her abuse status that occur in interactions with family and friends. Resilience was the main mitigating factor for perceived stress, mood symptoms, and anger reactions, controlling for all other variables. Humphreys (2003) reported similar findings among women residing in domestic violence shelters, as did K. M. Anderson et al. (2012) for women recruited by a mailed survey, but neither of those studies used covariate controls. Keeping in mind the comment of Anderson and her colleagues that “ . . . resilience and impairment are not necessarily opposites” (p. 1294), what remains to be understood is how supported and resilient IPV victims mobilize their resources, and what impairs coping efforts.

Cultivating Resilience Our study is one of few on IPV (e.g., Ford-Gilboe et al., 2009) that have examined social support and resilience together. Segmenting the unique contributions of each, it appears that self-reported resilience, with social support in its “gestalt,” is the stronger factor for blunting psychological distress, except, in our findings, for trauma symptoms. The stronger protective effect of resilience relative to social support underscores the importance of bolstering abused women’s sense of self-efficacy in a therapeutic context (Benight & Bandura, 2004). One way to foster resiliency among IPV women is to invest in “capacitybuilding” interventions which aim to emphasize the strengths and agency of abused women (Ford-Gilboe et al., 2009). As noted, IPV women often are enmeshed with their abusers. To break this unhealthy bond, building confidence and self-efficacy through therapeutic (cognitive-behavioral therapy), interpersonal (victim advocacy), and group (empowerment) initiatives is important. Other less direct methods to cultivate resilience would be to support job training or financial assistance programs—as economic independence can be the starting point for victims to begin to realize their own potential (Tolman & Raphael, 2000). Physical health care and other forms of self-care are neglected but potentially useful avenues for cultivating resiliency. Actualizing goals in that domain would require community-wide interface with health care providers and an integrated, collaborative system of service provision stakeholders.


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Study Limitations Our use of abbreviated measures may have diluted our ability to detect associations between IPV exposure and distress indicators. There is abundant research showing a positive linear relationship between IPV exposure and mental health problems (e.g., Cerda, DiGangi, Galea, & Koenen, 2012; Coker et al., 2002), but we only found this for PC-PTSD scores. Logistics within our study setting constrained our choice of measures. Our subsequent research will be guided by the present results, including the very revealing finding that 20.6% of the women were pregnant while victimized by abuse. Women’s exposure to abuse during pregnancy is a significant public health problem (e.g., Jahanfar, Janssen, Howard, & Dowswell, 2013). Other shortcomings are that there was missing demographic data, resulting from our reliance on site staff. Agency resource limitations are common impediments when working with community organizations (Helgeson & Lepore, 1997). In addition, our study was cross-sectional, with all data collected at a single time point, prohibiting us from exploring how social supports, resilience, and abuse experiences may change in influence over time. Finally, our sample was collected at a single facility with a high success rate for TRO acquisition. It is unclear if the women who came to this facility are different from women who file for a TRO independently in family court or go to other facilities.

Study Implications and Future Research Resilience fundamentally proceeds from safety. Zoellner et al. (2000), in addition to their findings on attachment cited earlier, also found that women were less likely to persist with obtaining final protection orders when the abuser threatened to harm their children. When such threat has been uncovered during intake, especially when client resilience is in doubt, it would seem important for FJCs to have resources for follow-up contact and renewed support provision. Staff advocates could help the abuse victim to formulate realistic plans and coach her or him through the steps to carry them out. Women seeking assistance from a FJC are an understudied subset of IPV victims, leaving many questions unanswered. For example, how do social supports and resiliency differentially affect the mental health outcomes for women who are denied versus granted a TRO? How does the functionality of these stress-buffering factors vary among victims with different types of legal protections (criminal protective orders, civil harassment restraining order, etc.)? The present study is a first step toward a better understanding of contemporary IPV victims and their accruing legal presence.


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Acknowledgements We are thankful for the involvement of Capt. Julian Harvey, Mari Reid, Kerith Dilley, Elia Renteria, Lt. Dave Flutts, Lt. Eric Carter, Linet Meneses, Johanna Gonzalez, Dr. Valerie Jenness, Dr. Erin Kelly, and Matt Fritz-Mauer; for the interviewing done by Apryl Iris Fierro-Lua, Hayley Schleifstein, Brandon Arguelles, Alejandro Barraza, and Sarah Ottone; and for the donor support facilitated by Maria Fierro.

Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported in part by funding from the Orange County Alliance for Health Care Research (PHFE-101103) and private donors to the second author.

Note 1.

Family Justice Centers (FJCs) are “one stop shops” providing services to domestic violence victims through on-site collaboration with multiple community agencies—police investigators, district attorney staff, county social services, state-funded housing support, and legal aid (such as for undocumented immigrants), as well as links to emergency shelters, counseling, and medical services. These are non-residential facilities. A key FJC service is to facilitate receiving a temporary restraining order by providing a supportive context for making a domestic violence report to a police officer, having a consultation with an advocate, meeting with a prosecutor, and through the FJC’s link to the court system. Assistance with transportation and housing and resources for counseling (e.g., pregnancy and nutrition) are also available. The origination, advancement through legislation, and proliferation of FJCs is aptly described by Gwinn, Strack, Adams, Lovelace, and Norman (2007), who also give an illustrative case example. The National Family Justice Center Alliance formed in 2006 and their model has grown internationally, with now more than 140 centers worldwide. Elder abuse, sexual abuse, and child abuse are part of their purview.

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Author Biographies Rupa Jose is a doctoral candidate in the Department of Psychology of Social Behavior at the University of California, Irvine. Her research interests focus on identifying individual, dyadic, and contextual factors that influence trauma recovery and on the interrelationships between mental disorder, social networks, and neighborhoods. Raymond W. Novaco, PhD, is Professor of Psychology and Social Behavior at the University of California, Irvine. His major academic work concerns anger and violence, from both an assessment and treatment standpoint, especially with psychiatric populations. Stress and psychological trauma are additional interest areas.


Effects of an intervention program for female victims of intimate partner violence on psychological symptoms and perceived social support.

Informal social control and intimate partner violence.

Altered Eating Behaviors in Female Victims of Intimate Partner Violence.

Improving coordinated responses for victims of intimate partner violence: law enforcement compliance with state-mandated intimate partner violence documentation.

The effects of procedural and distributive justice on intimate partner violence victims' mental health and likelihood of future help-seeking.

Lesbian intimate partner violence.

From early dating violence to adult intimate partner violence: Continuity and sources of resilience in adulthood.

Intimate partner violence interventions.

The Social Networks of Homeless Youth Experiencing Intimate Partner Violence.

Coordinated Community Response Components for Victims of Intimate Partner Violence: A Review of the Literature.

Intimate Partner Violence and Drinking Among Victims of Adult Sexual Assault.

Is John Henryism a resilience factor in women experiencing intimate partner violence?

Health problems of partner violence victims: comparing help-seeking men to a population-based sample.

Intimate partner violence and maternal educational practice.

Gender, psychopathy factors, and intimate partner violence.

Intimate partner violence and HIV: embracing complexity.

Intimate partner violence victims as mothers: their messages and strategies for communicating with children to break the cycle of violence.

Reaching Out To Women Who Are Victims of Intimate Partner Violence.

Perceptions of options available for victims of physical intimate partner violence in northern India.

Evaluation of healthcare use trends of high-risk female intimate partner violence victims.

Intimate partner violence and mental health.

Intimate partner violence and children's memory.

Happiness among poor women victims of intimate partner violence in Nicaragua.

Disclosure experiences of sexual minority college student victims of intimate partner violence.