Academic literature on the topic 'Psychologically abused women – Mental health'

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Journal articles on the topic "Psychologically abused women – Mental health"

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Cloitre, Marylene, Lisa R. Cohen, and Polly Scarvalone. "Understanding Revictimization Among Childhood Sexual Abuse Survivors: An Interpersonal Schema Approach." Journal of Cognitive Psychotherapy 16, no. 1 (2002): 91–111. http://dx.doi.org/10.1891/jcop.16.1.91.63698.

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Revictimization among women with a history of childhood sexual abuse was investigated within the context of a developmental model of interpersonal schemas. Data from the Interpersonal Schema Questionnaire (ISQ) revealed contrasting schema characteristics among sexually revictimized women (those sexually abused in childhood and sexually assaulted in adulthood) (n = 26), compared to those only abused in childhood (n = 18), and those never abused or assaulted (n = 25). Both revictimized women and never victimized women significantly generalized their predominant parental schemas to current relationships and differed only in the content of the schemas. The generalized parental schema of revictimized women viewed others as hostile and controlling while that of never victimized women viewed others as warm and noncontrolling. Women who had only been abused in childhood held schemas of parents as hostile but not controlling and did not generalize from parental to current schemas. The tendency to generalize observed in the first two groups suggest that “repetition compulsion” is not limited to those who were traumatized and are psychologically distressed. In this article, reasons for the absence of generalization among the childhood abuse only group are explored and implications for the treatment of childhood trauma survivors are discussed.
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Matud, M. Pilar. "Domestic Abuse and Children's Health in the Canary Islands, Spain." European Psychologist 12, no. 1 (2007): 45–53. http://dx.doi.org/10.1027/1016-9040.12.1.45.

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This study analyzed the association between domestic partner abuse and children's health. The sample consisted of 420 abused women with at least one child, for a total of 406 female children and 504 male children in 420 households. The women reported that one or more of their children had psychological problems in 27.4% of the cases, 13.6% reported physical health problems, and 7.6% reported both psychological and physical health problems. Externalizing problems were reported most frequently (in 11.7% of the children), while internalizing problems were reported in 5.6% of the children. A greater percentage of children with psychological and physical health problems was found in families in which the abusive partner was also abusive toward the children. We found better mental health in children whose mothers did not abuse them. Women whose children did not exhibit physical or mental health problems were younger, had suffered fewer years of abuse, and had fewer children than the women whose children exhibited health problems.
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Mittal, Mona, Kathryn Resch, Corey Nichols-Hadeed, et al. "Examining Associations Between Strangulation and Depressive Symptoms in Women With Intimate Partner Violence Histories." Violence and Victims 33, no. 6 (2018): 1072–87. http://dx.doi.org/10.1891/0886-6708.33.6.1072.

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Intimate partner violence (IPV) is associated with poor mental health outcomes among women. Studies on IPV and mental health show that experiencing more than one type of IPV often enhances women’s depression or depressive symptoms. However, most of these studies conceptualize IPV as physical, psychological, or sexual violence. Little is known about specific experiences of severe IPV, such as strangulation, that put victims at greater risk of lethality and serious injury and their association with women’s depression. This study examined associations between IPV, strangulation, and depression among women using secondary data collected for a randomized clinical trial testing an integrated HIV–IPV prevention intervention for abused women. Women were recruited from healthcare service delivery organizations, Department of Health and Human Services, and family court. Women (n = 175) completed assessments on IPV, strangulation, mental health, social support, and self-esteem. The majority reported strangulation (n = 103) and depressive symptoms (n = 101). Women who experienced strangulation also reported more severe physical (p < .001), sexual (p < .001), and psychological (p < .001) abuse. However, in multivariate logistic regression with sociodemographics, violence variables, and strangulation, none of these variables were associated with a higher risk for depressive symptoms. Social support had a protective effect on depressive symptoms. Findings suggest strangulation is prevalent among abused women seeking services, warranting screening, assessment, and referral in these settings.
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Testa, Maria, Brenda A. Miller, William R. Downs, and Denise Panek. "The Moderating Impact of Social Support Following Childhood Sexual Abuse." Violence and Victims 7, no. 2 (1992): 173–86. http://dx.doi.org/10.1891/0886-6708.7.2.173.

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The role of social support in moderating the impact of childhood sexual abuse on adult psychological adjustment was examined. Subjects included 475 women, age 18-45, some of whom were currently receiving treatment, others who were not. Women in the treatment group were receiving therapy for either alcoholism, for being battered, or for mental health problems. The comparison group was drawn from two sources: a random household sample and a sample of women attending drinking driver classes. Among both groups, women who had been sexually abused exhibited more psychological symptoms and lower self-esteem compared to those who were not abused. Latency of disclosure of childhood sexual abuse had no impact on long-term consequences of the abuse for either the treatment or the comparison group. However, among women in the comparison group, those who experienced supportive reactions following disclosure of sexual abuse had fewer psychological symptoms and somewhat higher self-esteem relative to those who did not receive support. Social support had no apparent effect on the long-term adjustment of women in the treatment group. Possible explanations for this pattern and directions for future research are discussed.
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Kizilhan, Jan Ilhan, Florian Steger, and Michael Noll-Hussong. "Shame, dissociative seizures and their correlation among traumatised female Yazidi with experience of sexual violence." British Journal of Psychiatry 216, no. 3 (2020): 138–43. http://dx.doi.org/10.1192/bjp.2020.2.

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BackgroundSurvivors of Islamic State of Iraq and Syria (ISIS) captivity are at high risk of developing mental disorders such as post-traumatic stress disorder (PTSD).AimsThis study looks at the correlation between sexual abuse, shame, somatoform or bodily distress disorders, and dissociative seizures (psychogenic non-epileptic seizures).MethodThe psychological effects of traumatic events and dissociative seizure were assessed in Yazidi women who were held captive by ISIS in Northern Iraq between 2014 and 2018. These effects were examined comparing 64 women who were held captive and sexually abused by ISIS with 60 women suffering from PTSD who were not held captive and sexually abused by ISIS. Structured clinical-psychological interviews and established psychometric questionnaires were used to assess mental disorders especially dissociative seizures and somatoform disorders, and shame related to trauma.ResultsWomen who were held captive by ISIS showed a significantly higher prevalence of dissociative seizures (43.7%; P = 0.02) and somatisation disorder (38.7%; P = 0.02), as well as depressive (75.0%; P = 0.42) and anxiety disorders (62.5%; P = 0.44), than women who were not held captive and sexually abused by ISIS. Dissociative disorders were identified in 40.6% (P = 0.36) of those female Yazidi who experienced sexual violence while being held captive.ConclusionsShame in connection with sexual violence seems to play an important role in negative self-perception after rape. Dissociation not only plays an important role in unprocessed childhood trauma with feelings of shame, but also in more recent trauma experiences with shame.
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Torres, Sara, and Hae-Ra Han. "Psychological distress in non-hispanic white and hispanic abused women." Archives of Psychiatric Nursing 14, no. 1 (2000): 19–29. http://dx.doi.org/10.1016/s0883-9417(00)80005-9.

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Henning, Kris R., and Lisa M. Klesges. "Utilization of Counseling and Supportive Services by Female Victims of Domestic Abuse." Violence and Victims 17, no. 5 (2002): 623–36. http://dx.doi.org/10.1891/vivi.17.5.623.33714.

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Increasing attention to the high prevalence of domestic violence (DV) and its impact on women’s physical and mental health has resulted in expanded services for abused women. Abused women appear to underutilize the formal counseling services available in many communities, however, and further research is needed to identify factors related to service utilization. In the present study, 1,746 women assaulted by a male intimate partner were identified from a larger pool of women interviewed by Pretrial Services following the arrest of their spouse/partner on domestic abuse charges. The women were selected for the current study if they reported prior physical assaults perpetrated by the same spouse/partner listed in the instant offense. In addition to describing previous physical assaults and psychological abuse by their current spouse/partner, women were also asked whether they had ever sought “formal counseling/supportive services” to address the abuse. Consistent with the prior literature, only a minority of the victims reported prior use of these services (14.9%). Additional analyses indicated that the likelihood of having accessed services varied as a function of victim demographic factors (race, relationship to the offender, income), characteristics of the prior DV (prior injury by partner, forced sexual activity, prior psychological abuse), and whether the victim’s children witnessed the fighting. Limitations of the study and implications for service providers and the courts are discussed.
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Gorcey, M., J. M. Santiago, and F. McCall-Perez. "Psychological consequences for women sexually abused in childhood." Social Psychiatry 21, no. 3 (1986): 129–33. http://dx.doi.org/10.1007/bf00582682.

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Kachaeva, M., and S. Shport. "Psychological and psychiatric consequences of violence against Women." European Psychiatry 41, S1 (2017): s904. http://dx.doi.org/10.1016/j.eurpsy.2017.01.1851.

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IntroductionDomestic violence against women has increasingly been recognized nationally and internationally as a serious problem. Violence against women is a troubling phenomenon in Russia. Meanwhile domestic abuse against women often results in long-term mental health problems.ObjectivesThe main aim of the study was to find out the psychological and psychiatric consequences of violence against women and to determine the origins of crimes committed by abused females.Materials and methodsA cohort of 18 females was examined by forensic psychiatrists. All women had committed crimes of violence (murders, attempted murders). Details of background, psychiatric and offending history were extracted. Each item was assessed with the help of descriptive statistics.ResultsA research has been carried out on the basis of psychiatric and forensic psychiatric assessment of two groups of women who had a long history of violence by their husbands or partners. Clinical assessment has revealed depression, anxiety, low self-esteem, post-traumatic stress disorder, drug abuse. All women underwent forensic psychiatric assessment as they had committed serious crimes of violence. The research has revealed two types of homicides. Women of the first subgroup displayed pathological altruistic motivation of their children. Women of the second subgroup had committed homicides of their husbands and partners whose violence towards women escalated in severity.ConclusionThe research shows the necessity of domestic violence prevention by legal provisions and multidisciplinary research with participation of psychiatrists, psychologists, sociologists, human rights advocates and feminist societies.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Sapkota, Diksha, Debra Anderson, Amornrat Saito, and Kathleen Baird. "Domestic and Family Violence and its Association with Mental Health Among Pregnant Women Attending Antenatal Care in a Tertiary Hospital of Eastern Nepal." Journal of Nepal Health Research Council 19, no. 1 (2021): 115–21. http://dx.doi.org/10.33314/jnhrc.v19i1.2508.

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Background: Pregnancy has been identified as a vulnerable period for both the initiation and escalation in severity of domestic and family violence. There is a significant dearth of scholarly literature documenting the relationship of domestic and family violence with the mental health and quality of life among pregnant women of Nepal.Methods: Baseline data of 140 women enrolled in a trial of a psychosocial intervention for abused pregnant women were analysed. Face-to-face interviews were conducted using standardised scales. Prevalence of domestic and family violence and mental health conditions were estimated and inferential statistics were used to assess the association of domestic and family violence with mental health, quality of life, social support, and use of safety behaviours.Results: The lifetime prevalence of domestic and family violence was found to be 27.7% (n = 173), followed by 17.1% of women (n = 107) fearing someone in their family. Domestic and family violence in the last 12 months was significantly associated with anxiety (p = 0.001), depression (p = 0.005), quality of life (p < 0.05), and perceived social support (p = 0.001). Use of safety behaviours (p = 0.037) was significantly low among women reporting domestic and family violence in the past year as well as during the current pregnancy (p = 0.017).Conclusions: There exists a high psychological morbidity among pregnant women exposed to domestic and family violence. The findings support the need of implementing a screening and support intervention for abused women seeking antenatal services. Keywords: Association; domestic violence; mental health; observational study; prevalence
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Dissertations / Theses on the topic "Psychologically abused women – Mental health"

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Harrison, Eileen Joselyn 1940. "Facilitating disclosure in psychologically abused women." Thesis, The University of Arizona, 1998. http://hdl.handle.net/10150/291796.

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The purpose of this study was to identify from the woman's point of view what factors facilitate or inhibit disclosure of psychological abuse. Physical and psychological symptoms arise from this abuse and women are reluctant to disclose the underlying cause. This is a significant problem for every specialty in the nursing profession. A qualitative study using grounded theory was conducted with four research participants from domestic violence shelters. The results suggest contextual and behavioral factors in the disclosure process and give descriptive supporting data of related concepts. A conceptual model for the disclosure process is proposed.
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Martin, Debbie F., and University of Lethbridge Faculty of Health Sciences. "An apple a day won't keep the violence away : listening to what pregnant women living in intimate partner violence say about their health." Thesis, Lethbridge, Alta. : University of Lethbridge, School of Health Sciences, c2009, 2009. http://hdl.handle.net/10133/2514.

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Researchers have provided evidence that living in intimate partner violence while pregnant negatively impacts the health of both the women and their unborn children. The purpose of this narrative study was twofold, first to gain understanding of the meaning of health as described by pregnant women who lived in intimate partner violence, and second to gain strategies for health care professionals. Six purposefully selected women participated in two interviews. The data were arranged under five themes: loss of body health, loss of mind health, loss of spirit health, coping with loss of body, mind and spirit health, and advice for health care professionals. The results revealed that these women’s health was negatively affected by living in intimate partner violence while pregnant. Universal screening, coalition building, further research, changes in health care policies, and changes in nursing education and practice are needed to properly address this serious health issue.<br>xi, 153 leaves ; 29 cm
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Danielson, Marci Mae. "Multiple forms of maltreatment and the effects on mental health in Hispanic and Caucasian women." CSUSB ScholarWorks, 2007. https://scholarworks.lib.csusb.edu/etd-project/3121.

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The purpose of this study was to examine the effects of multiple forms of abuse (physical, psychological, and sexual) on later psychopathology (depression, anxiety, and somatic complaints as assessed by the Hopkins Symptoms Checklist -HSCL) among two ethnic groups (non-Hispanic Caucasian and Hispanic).
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Temple, Jeff R. "Effects of Partner Violence and Psychological Abuse on Women's Mental Health Over Time." Thesis, University of North Texas, 2006. https://digital.library.unt.edu/ark:/67531/metadc5340/.

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This study examined the distinct effects of partner violence and psychological abuse on women's mental health over time. Latent growth modeling was used to examine stability and change over time, evaluating the course and consequences of each form of abuse. The size of women's social support network was examined as a mediator. The sample consisted of 835 African American, Euro-American, and Mexican American low-income women. Participants who completed Waves 1, 2, 3, and 5 were included in the study (n = 585). In general, partner violence decreased over time for all groups, while psychological abuse decreased over time for only Euro-American women. Whereas initial and prolonged exposure to psychological abuse was related to and directly impacted women's mental health, partner violence was only related to initial levels of mental health. Surprisingly, social support was only related to initial violence and distress and had no impact on the rate of change over time. These results have important implications for researchers and health care professionals. First, differences in the pattern of results were found for each ethnic group, reaffirming the notion that counselors and researchers must be sensitive to multicultural concerns in both assessment and intervention. For example, psychological abuse had a greater impact on the mental health of African American and Mexican American women than it did for Euro-American women, suggesting a shift in focus depending on the ethnicity of the client may be warranted. Second, this longitudinal study highlights the importance of future research to considerer individual differences in treating and studying victimized women. Understanding factors that contribute to individual trajectories will help counselors gain insight into the problem and in devising plans to prevent or reduce the occurrence and negative health impact of partner abuse.
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Samelius, Lotta. "Abused women : health, somatization, and posttraumatic stress /." Linköping : Univ, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-8942.

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Vallellanes, Alicia Kay, and Kelley Ferris. "Social support and mental health outcomes in battered women." CSUSB ScholarWorks, 2005. https://scholarworks.lib.csusb.edu/etd-project/2884.

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This study examined the relationship between perceived social support and negative mental health outcomes in battered women. Correlations between perceived social support and depression, anxiety, and post-traumatic stress disorder were analyzed. Perceived social support, particularly from family members, was found to be significantly related to mental health outcomes. Results indicate that agencies that work with battered women should include social support in the assessment and intervention processes. The study utilized a quantitative survey design with a sample of 120 battered women from four domestic violence agencies throughout Riverside and San Bernardino counties. Quantitative data analysis procedures, such as multivariate analysis and logistic regression, were used to further examine variables. Samples of the instruments used in the study are included.
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Bell, Holly. "The impact of counseling battered women on the mental health of counselors /." Digital version accessible at:, 1999. http://wwwlib.umi.com/cr/utexas/main.

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Ritchey, Kathleen M. "Women with a history of incest : MMPI profile constellations." Virtual Press, 1991. http://liblink.bsu.edu/uhtbin/catkey/776710.

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The current study assessed the effects of incest utilizing the Minnesota Multiphasic Personality Inventory (MMPI), an objective measure that can address such long term effects as low self esteem, isolation, depression, anxiety, suicidality, substance abuse, impaired sexual adjustment, psychosomatic concerns, and interpersonal relationship difficulties. Eighty-one women seeking counseling for issues related to an incestuous childhood, and 90 non sexually abused adult female clients completed the MMPI and a background information questionnaire.A Multivariate Analysis of Variance test comparing the mean profiles demonstrated that the incest group was more somatic, depressed, angry, anxious, and confused. A chi square analysis of two-point code type configurations found the incest group being more classified by the 48/84 and the 24/42 code types whereas the control group was more represented by the 46/64 code type. Lastly, the groups were compared by completing cluster analyses on each group's profiles. Both groups yielded an "overwhelmed" cluster that was statistically the same. Secondly, they each yielded a "normal" cluster that was similar but statistically different. Finally, the incest group yielded an "angry and confused" cluster and the control group yielded a "somatizer" cluster. Descriptions of the clusters and reasons for their differences are proposed.Differential impact was examined by comparing the incest clusters on number of abusers, use of threat or force, identity of the abuser, perceived betrayal by a non offending parent, length of time since abuse, and length of time in counseling. The only significant finding in these analyses was that the "overwhelmed" cluster had a greater number of abusers than the "angry and confused" and the "normal" clusters.The first two analyses were included in the study to validate the similarity of the present data with previous research and to demonstrate the myopic vision that results from analyzing the data in these manners. The cluster analysis allowed for the examination of the differential impact of the numerous long term sequalae. Recommendations for further research are presented as well as implications for treatment.<br>Department of Counseling Psychology and Guidance Services
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Edwards, Valerie Joan. "The risk of sexual assault and mental health problems in adult daughters of battered women /." Digital version accessible at:, 1998. http://wwwlib.umi.com/cr/utexas/main.

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Nangolo, L. H. N. "Violence against women and its mental health consequences in Namibia." Thesis, University of Limpopo, 2002. http://hdl.handle.net/10386/2046.

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Thesis ((M.A. (Clinical Psychology)) --University of the North, 2002<br>Violence against women ts a manifestation of historically unequal power relations between men and women, which has led to the domination of women by men and to the prevention of the full advancement of women. It is an old phenomenon that was kept secret, and people pretended that the problem did not exist. It wasn't until the feminist activists openly addressed the issue of inequality that included women's lack of rights and low status within marriage and society as well as battering that the taboo topic was changed into a subject extensively investigated. Extensive research on the topic now exists. As is the case in many developing countries, research on violence against women in Namibia is relatively rare. Research regarding the mental health consequences of abuse is virtually non-existent. It is to this area of research that the present study addressed itself. This study aimed at describing and determining the mental health consequences of battering to which Namibian women are subjected. The study followed both qualitative and quantitative research approaches. Qualitative research used in-depth interviews based on a semi-structured questionnaire. The measures utilized was an Abuse Disability Questionnaire (ADQ). A demographic questionnaire identifying battered women variables was also utilized. A total of 60 battered women were surveyed and all 60 women completed the questionnaires. In quantitative methods, data were analysed in terms of descriptive statistics. In qualitative methods, closely related data were grouped together under specific titles to serve as categories. The results indicated that Namibian battered women endure physical, emotional, sexual and financial abuse. The results has shown that age, education, religion, employment status and marital status do not matter. Women are still being battered. The results also indicated that Namibian battered women are indeed subjected to various negative mental health consequences.
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Books on the topic "Psychologically abused women – Mental health"

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Engel, Beverly. The emotionally abused woman: Overcoming destructive patterns and reclaiming yourself. Lowell House, 1990.

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Engel, Beverly. Encouragements for the emotionally abused woman. Lowell House, 1993.

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The emotionally abused woman: Overcoming destructive patterns and reclaiming yourself. Fawcett Columbine, 1992.

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What did I do to deserve this?: A step-by-step guidebook to move you through the abusive relationship towards a peace-filled future. Mosley Pub. Group, 2001.

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Lost voices: Women, chronic pain, and abuse. Harrington Park Press, 1995.

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Jaffe, Peter G. Children of battered women. Sage Publications, 1990.

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Jaffe, Peter G. Children of battered women: Issues in child development and intervention planning. Sage, 1989.

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Assessing woman battering in mental health services. Sage Publications, 1998.

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Chemically dependent women: Assessment and treatment. Lexington Books, 1989.

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Walking victims: Understanding and treating abused women who repeat the cycle. Learning Publications, Inc., 1997.

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Book chapters on the topic "Psychologically abused women – Mental health"

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Roychowdhury, Poulami. "The Allure and Costs of Capability." In Capable Women, Incapable States. Oxford University Press, 2020. http://dx.doi.org/10.1093/oso/9780190881894.003.0011.

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Chapter 11 analyzes the costs and benefits of women’s “capability.” On the one hand, women who tried to be “capable” became empowered in concrete ways. They gained self-confidence, feeling psychologically better than they had after experiencing abuse. Some of them experienced important forms of social mobility, acquiring stable jobs and respect from friends and neighbors. Some became members of the public sphere, able to navigate government offices, occupy public space, and lead their own organizational efforts. On the other hand, by trying to be “capable,” women also experienced real uncertainty and risks. They became overworked, overwhelmed, lonely, and physically endangered. Trying to be capable had long-term negative effects on women’s health, mental stability, and, for some, the very desire to survive.
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Thara, Rangaswamy, and Aarthi Raman. "Gender perspectives in migration." In Oxford Textbook of Migrant Psychiatry, edited by Dinesh Bhugra, Oyedeji Ayonrinde, Edgardo Juan Tolentino, Koravangattu Valsraj, and Antonio Ventriglio. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780198833741.003.0006.

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There is critical and compelling evidence to suggest that whatever form migration takes place, it is accompanied by differing levels of stress, which may fall disproportionately on women. This considerable stress may well lead to mental health problems, even though migrants may be more resilient. This chapter reviews work on gender perspectives in mental health aspects of migration. Although of great clinical and social significance, this aspect has not been well researched, especially in low- and middle-income countries. While both genders are susceptible to psychological problems, women seem to have higher rates of depression and anxiety. Young women refugees are often sexually exploited and abused. This is particularly marked in the antenatal and postnatal periods, more so if access to health care is problematic. The country of origin of the migrants, their literacy and socio-economic levels, family cohesiveness, and quality of social support need to be considered when planning interventions for this group.
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Walker, Lenore E. A., and Carlye B. Conte. "Women, Domestic Violence, and the Criminal Justice System." In Gender, Psychology, and Justice. NYU Press, 2017. http://dx.doi.org/10.18574/nyu/9781479819850.003.0003.

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This chapter describes women’s experiences of recent justice reforms intended to enhance the effectiveness of criminal justice interventions in incidents of domestic battering, specifically mandatory arrest laws and no-drop policies. Domestic violence is a form of complex trauma that is associated with poor mental and physical health outcomes. This chapter discusses how trauma-related symptoms explain women’s responses to physical, emotional, and psychological abuse as well as their ambivalent attitudes towards the justice and mental health systems. It also highlights the way racial and gender stereotypes, poverty, immigration status, and fear of social rejection constitute barriers to seeking help. Lastly, this chapter highlights the principles of a gender-responsive, trauma-informed approach to the treatment of female survivors of domestic violence.
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Milne, Alisoun. "The impact of age-related risks and inequalities on mental health in later life." In Mental Health in Later Life. Policy Press, 2020. http://dx.doi.org/10.1332/policypress/9781447305729.003.0005.

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In broad terms there are two sets of age-related risks to mental health. The first set are those arising directly from experiences and losses common to later life, including physical ill health and/or disability, being a carer, retirement, and bereavement. These are associated with impaired psychological wellbeing and heightened risk of depression, particularly amongst older people with few economic or social resources. The second set of risks arise from ageism and age discrimination, and their intersection with other types of discrimination such as sexism for older women. Direct and indirect discrimination is widespread; it is located in all areas of society including health and social care services. It is profoundly damaging to older peoples’ psychological wellbeing and is associated with fear, helplessness, low self-esteem, anxiety and depression. It is also linked to exclusion, marginalisation and abuse. In recent years there have been efforts to ensure that older people are overtly included in policies intended to improve the population’s physical and mental health; this includes access to treatments e.g. for depression. There has also been a focus on addressing age discrimination in specific arenas e.g. in employment and mental health services. These initiatives have had mixed success.
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