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CDA 10-029 – HSR&D Study

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CDA 10-029
Intimate Partner Violence, Health, and Health Care Among Female Veterans
Katherine M. Iverson PhD MA BA
VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA
Boston, MA
Funding Period: January 2012 - December 2016

BACKGROUND/RATIONALE:
Female VA patients report experiences of intimate partner violence (IPV) at alarmingly high rates. Physical, sexual, and psychological forms of abuse result in serious, complex, and costly public health problems. Because of its relevance for the care and health outcomes of women Veterans, this work aimed to inform best practices for IPV detection and treatment services within VA. VAMCs can respond to the public health threat of IPV by developing and implementing protocols to identify women affected by IPV, training staff to make appropriate referrals, and investing in cost-effective hospital-based services to improve women's health, health care receipt, and satisfaction with VA care. The overarching goal of this CDA is to develop, evaluate, and implement health services interventions and inform policies to efficiently and effectively address IPV among women Veterans.

OBJECTIVE(S):
1) Survey female VA patients in VISN 1 to evaluate the clinical utility of a brief IPV victimization screening tool for use with this population and estimate rates of past-year IPV experiences (Study 1). 2) Acquire key stakeholders' (VA providers and female VA patients) perspectives and recommendations to inform the development of IPV screening and response programming within the VA (Study 2). 3) Develop a brief IPV screening training for VA providers (Study 3). 4) Survey national sample of female Veterans to assess their preferences for IPV-related brief counseling (Study 4). The findings from these studies inform the implementation of IPV screening and response procedures in VA.

METHODS:
For objective 1, two regional mail surveys were conducted. Objective 2 was achieved through a mixed-methods project including interviews with VA primary care providers and focus groups with female VA patients. Objective 3 was achieved by soliciting feedback from key stakeholders (e.g., VA providers, relevant policy makers, and IPV experts). Objective 4 was achieved through a national online survey of female Veterans.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
Findings from these studies inform implementation of feasible, acceptable, and effective methods and procedures for intervening with women VA patients affected by IPV. VHA has adopted the E-HITS screening instrument that was evaluated within these projects as a recommended tool to facilitate IPV detection among female VA patients. The implementation of IPV screening and response procedures into VA care will likely lead to increased detection of IPV among female VA patients and may also lead to improvements in women's health, safety, and satisfaction with VA care.

PUBLICATIONS:

Journal Articles

  1. Iverson KM, Dardis CM, Cowlishaw S, Webermann AR, Shayani DR, Dichter ME, Mitchell KS, Mattocks KM, Gerber MR, Portnoy GR. Effects of Intimate Partner Violence During COVID-19 and Pandemic-Related Stress on the Mental and Physical Health of Women Veterans. Journal of general internal medicine. 2022 Sep 1; 37(Suppl 3):724-733.
  2. Vogt D, Borowski S, Maguen S, Blosnich JR, Hoffmire CA, Bernhard PA, Iverson KM, Schneiderman A. Strengths and vulnerabilities: Comparing post-9/11 U.S. veterans' and non-veterans' perceptions of health and broader well-being. SSM - population health. 2022 Sep 1; 19:101201.
  3. Thompson-Hollands J, Rando AA, Stoycos SA, Meis LA, Iverson KM. Family Involvement in PTSD Treatment: Perspectives from a Nationwide Sample of Veterans Health Administration Clinicians. Administration and policy in mental health. 2022 Nov 1; 49(6):1019-1030.
  4. Cowlishaw S, Freijah I, Kartal D, Sbisa A, Mulligan A, Notarianni M, Couineau AL, Forbes D, O'Donnell M, Phelps A, Iverson KM, Heber A, O'Dwyer C, Smith P, Hosseiny F. Intimate Partner Violence (IPV) in Military and Veteran Populations: A Systematic Review of Population-Based Surveys and Population Screening Studies. International journal of environmental research and public health. 2022 Jul 21; 19(14).
  5. Mahoney CT, Shayani DR, Iverson KM. Longing for sleep after violence: The impact of PTSD symptoms, avoidance, and pain on insomnia among female veterans. Psychiatry Research. 2022 Jul 1; 313:114641.
  6. Webermann AR, Dardis CM, Iverson KM. The role of general self-efficacy in intimate partner violence and symptoms of posttraumatic stress disorder among women veterans. Journal of traumatic stress. 2022 Jun 1; 35(3):868-878.
  7. Portnoy GA, Iverson KM, Haskell SG, Czarnogorski M, Gerber MR. A Multisite Quality Improvement Initiative to Enhance the Adoption of Screening Practices for Intimate Partner Violence Into Routine Primary Care for Women Veterans. Public health reports (Washington, D.C. : 1974). 2021 Jan 1; 136(1):52-60.
  8. Portnoy GA, Colon R, Gross GM, Adams LJ, Bastian LA, Iverson KM. Patient and provider barriers, facilitators, and implementation preferences of intimate partner violence perpetration screening. BMC health services research. 2020 Aug 13; 20(1):746.
  9. Sienkiewicz ME, Amalathas A, Iverson KM, Smith BN, Mitchell KS. Examining the Association between Trauma Exposure and Work-Related Outcomes in Women Veterans. International journal of environmental research and public health. 2020 Jun 25; 17(12).
  10. Mahoney CT, Iverson KM. The Roles of Alcohol Use Severity and Posttraumatic Stress Disorder Symptoms as Risk Factors for Women's Intimate Partner Violence Experiences. Journal of women's health (2002). 2020 Jun 1; 29(6):827-836.
  11. Williston SK, Bramande EA, Vogt DS, Iverson KM, Fox AB. An Examination of the Roles of Mental Health Literacy, Treatment-Seeking Stigma, and Perceived Need for Care in Female Veterans' Service Use. Psychiatric services (Washington, D.C.). 2020 Feb 1; 71(2):144-150.
  12. Iverson KM, Dardis CM, Grillo AR, Galovski TE, Pogoda TK. Associations between traumatic brain injury from intimate partner violence and future psychosocial health risks in women. Comprehensive psychiatry. 2019 Jul 1; 92:13-21.
  13. Huston JC, Grillo AR, Iverson KM, Mitchell KS, VA Boston Healthcare System. Associations between disordered eating and intimate partner violence mediated by depression and posttraumatic stress disorder symptoms in a female veteran sample. General hospital psychiatry. 2019 May 1; 58:77-82.
  14. Amara JH, Stolzmann KL, Iverson KM, Pogoda TK. Predictors of Employment Status in Male and Female Post-9/11 Veterans Evaluated for Traumatic Brain Injury. The Journal of head trauma rehabilitation. 2019 Jan 1; 34(1):11-20.
  15. Suri P, Stolzmann K, Iverson KM, Williams R, Meterko M, Yan K, Gormley K, Pogoda TK. Associations Between Traumatic Brain Injury History and Future Headache Severity in Veterans: A Longitudinal Study. Archives of physical medicine and rehabilitation. 2017 Nov 1; 98(11):2118-2125.e1.
  16. Iverson KM, Sayer NA, Meterko M, Stolzmann K, Suri P, Gormley K, Nealon Seibert M, Yan K, Pogoda TK. Intimate Partner Violence Among Female OEF/OIF/OND Veterans Who Were Evaluated for Traumatic Brain Injury in the Veterans Health Administration: A Preliminary Investigation. Journal of interpersonal violence. 2020 Jul 1; 35(13-14):2422-2445.
  17. Iverson KM, Dardis CM, Pogoda TK. Traumatic brain injury and PTSD symptoms as a consequence of intimate partner violence. Comprehensive psychiatry. 2017 Apr 1; 74:80-87.
  18. Dardis CM, Shipherd JC, Iverson KM. Intimate partner violence among women veterans by sexual orientation. Women & health. 2017 Aug 1; 57(7):775-791.
  19. Dichter ME, Wagner C, Goldberg EB, Iverson KM. Intimate Partner Violence Detection and Care in the Veterans Health Administration: Patient and Provider Perspectives. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2015 Sep 1; 25(5):555-60.
  20. Iverson KM, Pogoda TK. Traumatic brain injury among women veterans: an invisible wound of intimate partner violence. Medical care. 2015 Apr 1; 53(4 Suppl 1):S112-9.
  21. Belus JM, Wanklyn SG, Iverson KM, Pukay-Martin ND, Langhinrichsen-Rohling J, Monson CM. Do anger and jealousy mediate the relationship between attachment styles and intimate violence perpetration? Partner abuse. 2014 Oct 15; 5(4):388-406.
  22. Iverson KM, McLaughlin KA, Adair KC, Monson CM. Anger-related dysregulation as a factor linking childhood physical abuse and interparental violence to intimate partner violence experiences. Violence and victims. 2014 Oct 1; 29(4):564-78.
  23. Amara J, Pogoda TK, Krengel M, Iverson KM, Baker E, Hendricks A. Determinants of utilization and cost of VHA care by OEF/OIF Veterans screened for mild traumatic brain injury. Military medicine. 2014 Sep 1; 179(9):964-72.
  24. Iverson KM, Huang K, Wells SY, Wright JD, Gerber MR, Wiltsey-Stirman S. Women veterans' preferences for intimate partner violence screening and response procedures within the Veterans Health Administration. Research in nursing & health. 2014 Aug 1; 37(4):302-11.
  25. Pogoda TK, Iverson KM, Meterko M, Baker E, Hendricks AM, Stolzmann KL, Krengel M, Charns MP, Amara J, Kimerling R, Lew HL. Concordance of clinician judgment of mild traumatic brain injury history with a diagnostic standard. Journal of rehabilitation research and development. 2014 Jun 1; 51(3):363-75.
  26. Gerber MR, Iverson KM, Dichter ME, Klap R, Latta RE. Women veterans and intimate partner violence: current state of knowledge and future directions. Journal of women's health (2002). 2014 Apr 1; 23(4):302-9.
  27. Amara J, Iverson KM, Krengel M, Pogoda TK, Hendricks A. Anticipating the traumatic brain injury-related health care needs of women veterans after the Department of Defense change in combat assignment policy. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2014 Mar 1; 24(2):e171-6.
  28. Iverson KM, Mercado R, Carpenter SL, Street AE. Intimate partner violence among women veterans: previous interpersonal violence as a risk factor. Journal of traumatic stress. 2013 Dec 1; 26(6):767-71.
  29. Iverson KM, Wells SY, Wiltsey-Stirman S, Vaughn RA, Gerber MR. VHA primary care providers’ perspectives on screening female Veterans for intimate partner violence: A preliminary assessment. Journal of family violence. 2013 Nov 15; 11(28):823-831.
  30. Iverson KM, King MW, Resick PA, Gerber MR, Kimerling R, Vogt D. Clinical utility of an intimate partner violence screening tool for female VHA patients. Journal of general internal medicine. 2013 Oct 1; 28(10):1288-93.
  31. Pogoda TK, Hendricks AM, Iverson KM, Stolzmann KL, Krengel MH, Baker E, Meterko M, Lew HL. Multisensory impairment reported by veterans with and without mild traumatic brain injury history. Journal of rehabilitation research and development. 2013 Aug 12; 49(7):971-84.
  32. Hendricks AM, Amara J, Baker E, Charns MP, Gardner JA, Iverson KM, Kimerling R, Krengel M, Meterko M, Pogoda TK, Stolzmann KL, Lew HL. Screening for mild traumatic brain injury in OEF-OIF deployed US military: an empirical assessment of VHA's experience. Brain injury. 2013 Aug 8; 27(2):125-34.
  33. Iverson KM, Dick A, McLaughlin K, Smith BN, Bell ME, Cook N, Gerber MR, Mitchell KS. Exposure to interpersonal violence and its associations with psychiatric morbidity in a U.S. national sample: A gender comparison. Psychology of violence. 2013 Jun 6; 3(3):273-287.
  34. Iverson KM, Pogoda TK, Gradus JL, Street AE. Deployment-related traumatic brain injury among Operation Enduring Freedom/Operation Iraqi Freedom veterans: associations with mental and physical health by gender. Journal of women's health (2002). 2013 Mar 1; 22(3):267-75.
  35. Iverson KM, Litwack SD, Pineles SL, Suvak MK, Vaughn RA, Resick PA. Predictors of intimate partner violence revictimization: the relative impact of distinct PTSD symptoms, dissociation, and coping strategies. Journal of traumatic stress. 2013 Feb 1; 26(1):102-10.
  36. Gobin RL, Iverson KM, Mitchell K, Vaughn R, Resick PA. The impact of childhood maltreatment on PTSD symptoms among female survivors of intimate partner violence. Violence and victims. 2013 Jan 1; 28(6):984-99.
  37. Pistorello J, Fruzzetti AE, Maclane C, Gallop R, Iverson KM. Dialectical behavior therapy (DBT) applied to college students: a randomized clinical trial. Journal of consulting and clinical psychology. 2012 Dec 1; 80(6):982-94.
  38. Iverson KM, Follette VM, Pistorello J, Fruzzetti AE. An investigation of experiential avoidance, emotion dysregulation, and distress tolerance in young adult outpatients with borderline personality disorder symptoms. Personality disorders. 2012 Oct 1; 3(4):415-22.
  39. Resick PA, Suvak MK, Johnides BD, Mitchell KS, Iverson KM. The impact of dissociation on PTSD treatment with cognitive processing therapy. Depression and anxiety. 2012 Aug 1; 29(8):718-30.
Journal Other

  1. Iverson KM. Routine screening for intimate partner violence in VHA: a timely opportunity. Journal of general internal medicine. 2014 Feb 1; 29(2):280.
Book Chapters

  1. Kimmerling R, Weitlauf JC, Iverson KM, Karpenko JA, Jain S. Gender Issues in PTSD. In: Friedman MJ, Kean TM, Resick PA, editors. Handbook of PTSD. 2 ed. New York, NY: The Guilford Press; 2014. Chapter 6. 313-330 p.
  2. Iverson KM, Resick PA. Cognitive processing therapy following sexual assault and other traumas. In: Posttraumatic Stress Disorder, fourth edition. 4th ed. Berlin, Germany: Springer; 2013. 419-440 p.
Conference Presentations

  1. Iverson KM, Pogoda TK. Traumatic Brain Injury Among Women Veterans: An Invisible Wound of Intimate Partner Violence. Presented at: International Society for Traumatic Stress Studies Annual Meeting; 2014 Nov 15; Miami, FL.
  2. Bartlett B, Iverson KM, Wolf E, Mitchell K. Intimate partner violence, PTSD, and disordered eating among male and female veterans. Poster session presented at: International Society for Traumatic Stress Studies Annual Symposium; 2014 Nov 7; Miami, FL.
  3. Resick PA, Iverson KM, Cunningham K. Long term follow-up of impact statement coding among women with PTSD treated with Cognitive Processing Therapy. Paper presented at: International Society for Traumatic Stress Studies Annual Symposium; 2014 Nov 7; Miami, FL.
  4. Iverson KM, King A, Resick PA, Kimerling R, Street AE, Vogt DS. Accuracy of intimate partner violence screening tool for female VHA patients: A replication and extension. Poster session presented at: International Society for Traumatic Stress Studies Annual Symposium; 2014 Nov 5; Miami, FL.
  5. Iverson KM, Pogoda TK. Intimate partner violence-related traumatic brain injury in a sample of female Veterans. Poster session presented at: Boston University Medical Campus / VA Boston Joining Forces TBI/PTSD Annual Conference; 2014 Nov 4; Boston, MA.
  6. Iverson KM, Pogoda TK. Traumatic Brain Injury Among Women Veterans: An Invisible Wound of Intimate Partner Violence. Paper presented at: VA HSR&D Enhancing Partnerships for Research and Care of Women Veterans Conference; 2014 Jul 31; Arlington, VA.
  7. Creech S, Iverson KM, Street AE. Sexual revictimization and PTSD symptoms in women Veterans presenting to primary care. Poster session presented at: VA HSR&D Enhancing Partnerships for Research and Care of Women Veterans Conference; 2014 Jul 15; Arlington, VA.
  8. Gerber M, Iverson KM, King M, Haskell S. Associations between mental health burden, smoking, and cardiovascular disease in women Veterans over age 45. Poster session presented at: VA Women's Health Research Conference; 2014 Jul 15; Arlington, VA.
  9. Gradus J, Iverson KM, Wisco B, Marx BP, Street AE. Differential associations between deployment-related TBI and suicidal ideation among female and male OEF/OIF Veterans. Poster session presented at: VA HSR&D Enhancing Partnerships for Research and Care of Women Veterans Conference; 2014 Jul 15; Arlington, VA.
  10. Iverson KM, King M, Gerber M, Kimerling R, Resick PA, Street AE, Vogt DS. Accuracy of an intimate partner violence screening tool for female VHA patients: A replication and extension. Poster session presented at: VA HSR&D Enhancing Partnerships for Research and Care of Women Veterans Conference; 2014 Jul 15; Arlington, VA.
  11. Iverson KM, Dichter MD. VA patient and provider perspectives on IPV screening and counseling procedures in VA. Paper presented at: AcademyHealth Annual Research Meeting; 2014 Jun 15; San Diego, CA.
  12. Marsiglio M, Iverson KM. Intimate Partner Violence and Mental Health symptoms among women Veterans: The role of partners' military status. Poster session presented at: VA HSR&D Enhancing Partnerships for Research and Care of Women Veterans Conference; 2014 Jun 15; Arlington, VA.
  13. Pogoda TK, Stolzmann KL, Iverson KM, Baker E, Krengel MH, Lew HL, Meterko MM. Associations between traumatic brain injury, suspected psychiatric conditions, and unemployment in returning Veterans. Poster session presented at: AcademyHealth Annual Research Meeting; 2014 Jun 10; San Diego, CA.
  14. Iverson KM, Pogoda TK. Intimate partner violence-related traumatic brain injury in a sample of female Veterans. Poster session presented at: AcademyHealth Annual Research Meeting; 2014 Jun 9; San Diego, CA.
  15. Meterko MM, Pogoda TK, Stolzmann KL, Iverson KM, Krengel MH, Nealon Seibert M, Sayer N, Gormley K, Baker E. Are there symptom groupings associated with mild TBI? A cluster analysis of neurobehavioral symptom data among Operation Enduring Freedom/Operation Iraqi Freedom Veterans. Poster session presented at: AcademyHealth Annual Research Meeting; 2014 Jun 9; San Diego, CA.
  16. Pogoda TK, Iverson KM. Traumatic Brain Injury Among Women Veterans: An Invisible Wound of Intimate Partner Violence. Poster session presented at: AcademyHealth Annual Research Meeting; 2014 Jun 1; San Diego, CA.
  17. Mercado RC, Wiltsey-Stirman S, Iverson KM. Impact of childhood abuse on physical and mental health and health care utilization among female Veterans. Poster session presented at: American Psychiatric Association Annual Meeting; 2014 May 15; New York, NY.
  18. Iverson KM, Latta R. Addressing intimate partner violence (IPV) among women in the Veterans Health Administration (VHA): Toward a comprehensive response. Paper presented at: U.S. Department of Health and Human Services Intimate Partner Violence Screening and Counseling Symposium; 2013 Dec 9; Bethesda, MD.
  19. Iverson KM, Mercado R, Carpenter L, Street AE. Intimate partner violence among women Veterans: Previous interpersonal trauma as a risk factor. Paper presented at: International Society for Traumatic Stress Studies Annual Symposium; 2013 Nov 15; Philadelphia, PA.
  20. Gobin R, Iverson KM, Mitchell KM, Vaughn R, Resick PA. The relative impact of previous interpersonal trauma on intimate partner violence survivors’ PTSD symptoms. Paper presented at: International Society for Traumatic Stress Studies Annual Meeting; 2012 Nov 1; Los Angeles, CA.
  21. Iverson KM, Litwack SD, Pineles SL, Suvak MK, Vaughn R, Resick PA. The role of distinct PTSD symptoms, dissociation, and coping strategies in intimate partner violence revictimization. Paper presented at: International Society for Traumatic Stress Studies Annual Meeting; 2012 Nov 1; Los Angeles, CA.
  22. Iverson KM, Pogoda TK, Gradus JL, Street AE. Do the associations between deployment-related TBI and mental and physical health conditions differ by gender among OEF/OIF veterans. Paper presented at: International Society for Traumatic Stress Studies Annual Meeting; 2012 Nov 1; Los Angeles, CA.
  23. Suvak MK, Brogan L, Iverson KM, Shiperd J. Sexual revictimization in a large sample of Marine recruits. Paper presented at: International Society for Traumatic Stress Studies Annual Meeting; 2012 Nov 1; Los Angeles, CA.
  24. Wanklyn SG, Belus G, Iverson KM. Does jealousy and anger mediate the relationship between attachment styles and intimate violence perpetration? Poster session presented at: Canadian Psychological Association Annual Meeting; 2012 Jun 14; Halifax, Nova Scotia, Canada.
  25. Gerber MR, Iverson KM, Mason Wholley C. Women Veterans and IPV: Enabling community-VA partnerships. Paper presented at: Futures Without Violence Health and Domestic Violence National Biennial Conference; 2012 Mar 30; San Francisco, CA.
  26. Iverson KM, Kimerling, R, Stolzman KL, Meterko MM, Baker E, Krengel MH, Hendricks AM, Pogoda TK. Do OEF/OIF Veterans who experience both MST and deployment-related TBI face more mental health problems that those with deployment-related TBI only? Paper presented at: International Society for Traumatic Stress Studies Annual Meeting; 2011 Nov 16; Baltimore, MD.


DRA: Health Systems, Mental, Cognitive and Behavioral Disorders
DRE: Technology Development and Assessment
Keywords: none
MeSH Terms: none

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