534531 research-article2014

JIVXXX10.1177/0886260514534531Journal of Interpersonal ViolenceMikton and Shakespeare

Introduction

Introduction to Special Issue on Violence Against People With Disability

Journal of Interpersonal Violence 2014, Vol. 29(17) 3055­–3062 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0886260514534531 jiv.sagepub.com

Christopher Mikton1 and Tom Shakespeare2

People with disabilities make up some 15% of the world’s population (World Health Organization [WHO]/World Bank, 2011) and experience disadvantages in many domains of life. Among the factors that blight the lives of people with physical, sensory, and intellectual impairments and mental health conditions, violence plays a key role. Recent evidence synthesis has shown what has been suspected for many years: that persons with disabilities have a 50% higher chance of having suffered violence in the past year, raising to a threefold increased risk for people with mental health conditions (Hughes et al., 2012). Meanwhile children with disabilities have a threefold increased risk of having suffered violence (Jones et al., 2012). Violence against persons with disability is therefore a significant public health and human rights issue. Protection of the rights of individuals with disabilities, and enablement of their full participation in society has become a global priority, as evidenced by the United Nations (UN) Convention on the Rights of Persons With Disabilities (UN, 2006) and the 2013 High Level Meeting on Disability and Development. In 2011, the WHO/World Bank World Report on Disability was launched to galvanize action on this priority. It gathered evidence about the global scale of disability, its impact on well-being, and showed how the barriers facing individuals with disability can be overcome. Following the World Report, the WHO’s “Global disability action plan 2014-2021: Better

1World

Health Organization, Geneva, Switzerland of East Anglia, Norwich, UK

2University

Corresponding Author: Christopher Mikton, Department of Violence and Injury Prevention and Disability, Noncommunicable Diseases and Mental Health, World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland. Email: [email protected]

Downloaded from jiv.sagepub.com at East Tennessee State University on June 12, 2015

3056

Journal of Interpersonal Violence 29(17)

health for all people with disabilities” is due to be adopted during the 2014 World Health Assembly. In parallel, violence prevention has also been receiving more attention within the public health community in recent years. In 2002, the WHO published its landmark study, the World report on violence and health (Krug, Dahlberg, Mercy, Zwi, & Lozano, 2002), which established the role of public health, alongside other sectors, in understanding and preventing violence. In 2003, this report was the subject of a World Health Assembly Resolution on implementing its recommendations (World Health Assembly, 2003). In late 2014, WHO will release the first Global status report on violence prevention, which will assess what countries are doing—in terms of action plans, data collection, policies, laws, programs, and services for victims—to prevent violence and to mitigate its consequences. The intersection of the two fields of disability and violence has, however, received far less attention. To effectively address violence against persons with disability at population level on a global scale, fundamental gaps in the evidence related to all four steps of the public health approach to addressing health problems remain to be filled. The four steps are (a) defining the problem and its consequences conceptually and numerically; (b) investigating why the problem occurs by determining its risk and protective factors and causes and the factors that might be modifiable through intervention; (c) devising ways to prevent the problem by using the above information and designing, monitoring, and rigorously assessing the effectiveness of programs through outcome evaluations; and (d) scaling up effective interventions, disseminating knowledge about them, and assessing their cost and cost-effectiveness (Krug et al., 2002). Among the evidence gaps, the exact nature of violence against persons with disability requires more detailed mapping. Currently it is not clear whether the categories of violence used for non-disabled persons are also appropriate for disabled persons or whether they should be modified to better reflect specific forms and characteristics of violence relevant to person with disability. These are likely to include disability hate crimes, financial abuse, over-medication of people with mental health conditions, violence in institutions, and the greater role of dependency in perpetrator–victim relationships. There are also large gaps in knowledge about the prevalence and risk of violence against adults and children with disabilities, as highlighted in the recent systematic reviews by Jones et al. (2012) and Hughes et al. (2012). For instance, robust studies on violence against people with disability are lacking from most regions of the world, particularly from low- and middle-income countries where some 84% of the world’s population live. Furthermore, the

Downloaded from jiv.sagepub.com at East Tennessee State University on June 12, 2015

Mikton and Shakespeare

3057

methodological quality of most studies is weak, with few based on nationally representative samples, and data are lacking on specific types of disability and specific types of violence. Research has shown that violence has far-reaching and life-long consequences, both for victims’ mental and physical health and for their sociooccupational functioning, and can also lead to premature death. The long-term physical health consequences are largely due to the adoption of health risk behaviors such as smoking, excessive drinking, drug-taking, and over-eating by victims of violence (Anda et al., 2006; Brown et al., 2009; Knudsen, Heckman, Cameron, & Shonkoff, 2006; Mercy & Saul, 2009; Shonkoff, Boyce, & McEwen, 2009; Shonkoff & Garner, 2012). Little systematic research has been conducted to explore whether the consequences of violence against persons with disability are similar or perhaps still more severe. The understanding of risk and protective factors for, and causes of, violence against person with disability is rudimentary. Some of the risk factors for violence—such as poverty—have a higher prevalence in disabled than non-disabled populations. It is not always clear whether it is disability or poverty that plays the major causal role. In addition, persons with disability are often exposed to specific risk factors such as living in institutions, or being dependent on support from formal or informal care in the home. It is also often not clear from studies whether the violence led to the disability, or whether the disability was a risk factor for the violence. Longitudinal studies are required to trace causality. Finally, evidence for the effectiveness of programs to prevent violence against person with disability in the first place and to prevent its recurrence and to mitigate its consequences once it has taken place is scant. Evidence on successfully scaling up programs and evaluating their cost and cost–benefits appears to be wholly lacking. This special issue of the Journal of Interpersonal Violence will contribute to addressing some of these evidence gaps. Several of the included articles were first presented at a roundtable at the 2012 Disability Studies Association conference in Lancaster, United Kingdom, which was supported by WHO. This event aimed to raise the profile of the violence problem among disability researchers. In turn, this special issue should have the effect of drawing the attention of violence prevention researchers to the role of disability as a risk factor. The first article in this special issue, by Hahn, McCormick, Silverman, Robinson, and Koenen (2014), draws on a large, nationally representative sample from the National Epidemiologic Survey on Alcohol and Related Conditions and uses well-validated measures to focus on the risk of a specific type of violence against people with specific types of disability: the risk of

Downloaded from jiv.sagepub.com at East Tennessee State University on June 12, 2015

3058

Journal of Interpersonal Violence 29(17)

intimate partner violence (IPV) against men and women with impairments in physical and mental health in the United States. In the total sample, physical health impairments and mental health impairments were associated with higher risk of IPV victimization, compared with those without reported impairments, suggesting that IPV programs should specifically target people with such impairments. Emerson and Roulstone (2014) examined the risk—and moderators of the risk—of violent crime, hate crime, and disablist hate crime—a form of violence specific to persons with disability—in another large, nationally representative sample from a longitudinal study on the life experiences of persons with disability. They report, for instance, that the differential risk of exposure to hate crime was particularly high among disabled adults with mental health problems or cognitive impairments and that the increased risks they identify were strongly moderated by poverty status, with no increased risk for disabled adults among more wealthy respondents. Hasan, Muhaddes, Camellia, Selim, and Rashid (2014) used a mixed quantitative and qualitative design, based on a smaller sample than the two previous studies, to examine the prevalence and the physical and psychological suffering of women with disability in Bangladesh experiencing IPV, as well as their coping strategies. They found that less than half the women had sought support from formal services to minimize or avoid the recurrence of violence, but that over 80% received support from informal networks, such as family and relatives, pointing to the need to improve community knowledge of disability and IPV as a means to address violence against women with disability Using a mixed-methods approach, Astbury and Walji (2014) estimated the prevalence of violence by household members other than intimate partners against women with disabilities in Cambodia and explored its mental health impact. Compared with non-disabled women, women with disability were at a two- to fourfold increased risk of being a victim of physical, psychological, and sexual violence by household members and, among those who had suffered violence, scored higher on a measure of psychological distress. Echoing Hasan et al. (2014), in this study, not a single woman had sought help from a formal source of support, such as a non-governmental organization, counselor, or priest. Mitra and Mouradian (2014) analyzed data from the Behavioral Risk Factor Surveillance System, a large survey conducted by the U.S. Centers for Disease Control and Prevention in the United States. They show that 27.9% of people with disabilities reported lifetime IPV, as opposed to 17.7% of those without disabilities. While women with disabilities were the group who were most likely to report lifetime IPV, men with disabilities were as likely to report lifetime attempted IPV as women without disabilities. This study also

Downloaded from jiv.sagepub.com at East Tennessee State University on June 12, 2015

Mikton and Shakespeare

3059

provides some important data about the consequences of violence against people with disability: Men with disabilities who experience IPV were more likely than other men to report symptoms of stress and/or poor mental health and behaviors that pose a risk to health. Ballan et al.’s (2014) article is a retrospective case study review of nearly 900 client files from the Secret Garden, a non-residential domestic violence disability program located in New York City. Males were excluded from the study. The majority of cases were women of color. Almost half were married and two thirds had children. Nearly half had a history of childhood physical or sexual abuse. As well as enriching our understanding of disabled women victims of violence, the authors also highlight unmet needs for mental health services, and the high rate of unemployment among this population. A study in Switzerland by Mueller-Johnson, Eisner, and Obsuth (2014) used high school survey data to look at the prevalence of, and risk factors for, sexual victimization among youth with physical disabilities (N = 360). The results show that disability was a significant predictor of sexual victimization for boys, but not for girls. More than a quarter of girls with disability had experienced contact sexual victimization, compared with 18.5% boys with disability, but the boys were nearly three times as likely to have been victims than non-disabled boys. Disabled respondents were 50% more likely to report at least one lifetime incident of contact sexual victimization than the nondisabled young people. This is one of the rare studies in the field to investigate risk factor for violence against people with disability and identified child maltreatment, harsh parenting, witnessing inter-parental violence, alcohol and drug use, violent delinquency, and internet use as the most important risk factors—apart from physical disability, which was only a risk factor for boys. The final article is from our team at the WHO Department of Violence and Injury Prevention and Disability. Mikton, Maguire, and Shakespeare (2014) set out to evaluate evidence for the effectiveness of violence prevention and victim support interventions for people with disabilities. However, only 10 studies met the inclusion criteria, all were found to be methodologically weak, and only 1 was from a low-income country. From this, we conclude that there is a lack of good quality research and infer that there may be a lack of effective preventive and supportive interventions. This may reflect the low priority placed on tackling the problem of endemic violence against disabled people, a neglect that we hope this special issue will contribute to remedying. More work is urgently required to identify prevention strategies and support measures for victims, together with research to evaluate their effectiveness. Together, the eight articles in this special issue take forward the field of violence against people with disability a few important steps. Several draw

Downloaded from jiv.sagepub.com at East Tennessee State University on June 12, 2015

3060

Journal of Interpersonal Violence 29(17)

on large nationally representative samples and use well-validated measures to estimate the prevalence and examine the risk of violence against people with, relative to people without, disability. Some begin to explore, using both quantitative and qualitative methods, the consequences of violence against people with disability, a dimension of the problem that has remained largely neglected. Others focus on specific types of violence, such as IPV or violence by household members who are not intimate partners, and specific forms of disability, such as physical disability or mental health conditions. Two articles provide data from low-income countries—Bangladesh and Cambodia— where data on the problem have, to date, been severely lacking. And one article rigorously investigates risk factors for sexual violence against people with disability. This special issue also highlights populations and themes that deserve special attention—for instance, men with disability who appear to be at particularly high risk of both IPV and sexual violence; mental health conditions and their importance as both a risk factor for, and a consequence of, violence against people with disability. Together, however, these eight articles also call attention to major remaining gaps in the literature in this field. Most focus on prevalence and risk of violence against people with disability and most are from high-income countries, chiefly the United States. A few focus on consequences, but the full-range of possible long-term consequences remain understudied. Only one addresses risk factors for violence against people with disability and only one focuses on the effectiveness of interventions to prevent and mitigate the consequences of violence against people with disability—drawing the depressing conclusion that currently there are no such interventions well supported by evidence. The editors hope that this special issue raises the profile of the problem and offers groundwork for the further research that is so badly needed. Reading these articles, it is clear that for disabled people to enjoy their human rights, action is required to tackle the violence that is among the greatest obstacles to good quality of life. At the time of writing, 144 countries have ratified the UN Convention on the Rights of Persons With Disabilities (UN, 2008). Article 16 of that Convention requires that States Parties shall take all appropriate legislative, administrative, social, educational and other measures to protect persons with disabilities, both within and outside the home, from all forms of exploitation, violence and abuse, including their gender-based aspects.

The editors hope that this special issue will assist in this urgent endeavor.

Downloaded from jiv.sagepub.com at East Tennessee State University on June 12, 2015

Mikton and Shakespeare

3061

References Anda, R. F., Felitti, V. J., Bremner, J. D., Walker, J. D., Whitfield, C., Perry, B. D., . . . Giles, W. H. (2006). The enduring effects of abuse and related adverse experiences in childhood: A convergence of evidence from neurobiology and epidemiology. European Archives of Psychiatry & Clinical Neuroscience, 256, 174-186. doi:10.1007/s00406-005-0624-4 Astbury, J., & Walji, F. (2014). The prevalence and psychological costs of household violence by family members against women with disabilities in Cambodia. Journal of Interpersonal Violence, 29, 3127-3149. Ballan, M., Freyer, M., Marti, C. N., Perkel, J., Webb, K., & Romanelli, M. (2014). Looking beyond prevalence: A demographic profile of survivors of intimate partner violence with disabilities. Journal of Interpersonal Violence, 29, 3167-3179. Brown, D. W., Anda, R. F., Tiemeier, H., Felitti, V. J., Edwards, V. J., Croft, J. B., & Giles, W. H. (2009). Adverse childhood experiences and the risk of premature mortality. American Journal of Preventive Medicine, 37, 389-396. doi:10.1016/j. amepre.2009.06.021 Emerson, E., & Roulstone, A. (2014). Developing an evidence base for violent and disablist hate crime in Britain: Findings from the Life Opportunities Survey. Journal of Interpersonal Violence, 29, 3086-3104. Hahn, J. W., McCormick, M. C., Silverman, J. G., Robinson, E. B., & Koenen, K. C. (2014). Examining the impact of disability status on intimate partner violence victimization in a population sample. Journal of Interpersonal Violence, 29, 3063-3085. Hasan, M. T., Muhaddes, T., Camellia, S., Selim, N., & Rashid, S. F. (2014). Prevalence and experiences of intimate partner violence against women with disabilities in Bangladesh: Results of a exploratory sequential mixed-method study. Journal of Interpersonal Violence, 29, 3105-3126. Hughes, K., Bellis, M. A., Jones, L., Wood, S., Bates, G., Eckley, L., . . .Officer, A. (2012). Prevalence and risk of violence against adults with disabilities: A systematic review and meta-analysis of observational studies. Lancet, 379, 1621-1629. doi:10.1016/s0140-6736(11)61851-5 Jones, L., Bellis, M. A., Wood, S., Hughes, K., McCoy, E., Eckley, L., . . .Officer, A. (2012). Prevalence and risk of violence against children with disabilities: A systematic review and meta-analysis of observational studies. Lancet, 380, 899-907. doi:10.1016/s0140-6736(12)60692-8 Knudsen, E. I., Heckman, J. J., Cameron, J. L., & Shonkoff, J. P. (2006). Economic, neurobiological, and behavioral perspectives on building America’s future workforce. Proceedings of the National Academy of Sciences of the United States of America, 103, 10155-10162. doi:10.1073/pnas.0600888103 Krug, E., Dahlberg, L., Mercy, J., Zwi, A., & Lozano, R. (2002). World report on violence and health. Geneva, Switzerland: World Health Institution. Mercy, J. A., & Saul, J. (2009). Creating a healthier future through early interventions for children. Journal of the American Medical Association, 301, 2262-2264.

Downloaded from jiv.sagepub.com at East Tennessee State University on June 12, 2015

3062

Journal of Interpersonal Violence 29(17)

Mikton, C., Maguire, H., & Shakespeare, T. (2014). A systematic review of the effectiveness of interventions to prevent and respond to violence against persons with disabilities. Journal of Interpersonal Violence, 29, 3207-3226. Mitra, M., & Mouradian, V. E. (2014). Intimate partner violence in the relationships of men with disabilities in the United States: Relative prevalence and health correlates. Journal of Interpersonal Violence, 29, 3150-3166. Mueller-Johnson, K., Eisner, M. P., & Obsuth, I. (2014). Sexual victimization of youth with a physical disability: An examination of prevalence rates, and risk and protective factors. Journal of Interpersonal Violence, 29, 3180-3206. Shonkoff, J. P., Boyce, W. T., & McEwen, B. S. (2009). Neuroscience, molecular biology, and the childhood roots of health disparities building a new framework for health promotion and disease prevention. Journal of the American Medical Association, 301, 2252-2259. Shonkoff, J. P., & Garner, A. S. (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129, E232-E246. doi:10.1542/peds.2011-2663 United Nations. (2008). Convention on the rights of persons with disabilities. Retrieved from http://www.un.org/disabilities/convention/conventionfull.shtml World Health Assembly. (2003). Implementing the recommendations of the World report on violence and health - WHA56.24. Geneva, Switzerland: World Health Organization. World Health Organization/World Bank. (2011). World report on disability. Geneva, Switzerland: World Health Organization.

Author Biographies Christopher Mikton is a Technical Officer in the Prevention of Violence Unit of the Department of Violence and Injury Prevention and Disability within the World Health Organization. He is responsible for synthesizing evidence on all aspects of violence prevention and co-managing the Global status report on violence prevention. Tom Shakespeare is a senior lecturer in medical sociology at Norwich Technical Officer in the Disability and Rehabilitation team of the World Health Organization, where he was an editor and author of the World report on disability (WHO 2011). His books include Disability rights and wrongs (Routledge, London, 2006).

Downloaded from jiv.sagepub.com at East Tennessee State University on June 12, 2015

Introduction to special issue on violence against people with disability.

Introduction to special issue on violence against people with disability. - PDF Download Free
344KB Sizes 0 Downloads 4 Views