TOWARD AN INTEGRATED APPROACH IN RESEARCH ON INTERPERSONAL VIOLENCE : Conceptual and methodological challenges

Background: There is a growing understanding that different kinds of interpersonal violence are interrelated. Many victims report experiences of cumulative violence, i.e., being subjected to more than one kind of violent behaviour (sexual, physical, emotional) and/or violence from more than one kind of perpetrator (family members, partners, acquaintances/strangers). To gain a more comprehensive understanding of what violence entails for victims, how victims can be helped and how violence can be prevented, there is a need to learn more about the co-occurrence of violence. Also, despite strong associations repeatedly being found between exposure to violence and the reporting of different kinds of ill-health, only a minority of victims have told health care professionals about their victimization. Less is known about the process of disclosing victimization to health care professionals for men than for women. Main aims: 1) Investigate the prevalence and co-occurrence of self-reported lifetime experiences of different kinds of interpersonal violence among male and female clinical and random population samples in Sweden (Study I-II). 2) Investigate whether cumulative violence is more strongly associated with self-reported symptoms off psychological ill-health than with any kind of victimization alone (Study III). 3) Develop a theoretical model concerning male victims’ process of disclosing experiences of victimization to health care professionals in Sweden (Study IV). Method: The self-reported prevalence of interpersonal violence as well as self-reported symptoms of psychological ill-health were estimated by means of secondary analyses of data collected with the NorVold Abuse Questionnaire (NorAQ). Both sexes were represented in clinical (women n=2439 men n=1767) and random population samples (women n=1168 men n=2924). Descriptive statistics as well as binary logistic regression and ordinal regression analyses were used (Study I-III). In study IV, constructivist grounded theory was used, and 12 men were interviewed concerning their experience of disclosing victimization to health care professionals. Results: A large proportion of victims (women: 47-48%, men: 29-31%) reported experiences of more than one kind of violent behaviour. Many also reported being subjected to violence by more than one kind of perpetrator (women: 33-37%, men: 22-23%). Reporting cumulative violence had a stronger association with symptoms of psychological ill-health than reporting only one kind of victimization. In study IV, the interviewed men’s own perceptions and considerations beforehand (e.g., perceived need for help and feelings of shame), as well as the dynamics during the actual health care encounter (e.g., patient-provider relationship and time constraints), were essential for understanding the process of disclosure. Also, the men’s own conformity to hegemonic constructions of masculinity and professionals’ adherence to gender norms had a strong negative influence on the men’s process of disclosure. Discussion: Experiences of cumulative violence were common. Prevalence rates of experiences of different kinds of interpersonal violence were compared to previous studies on interpersonal violence in Sweden. Large discrepancies were found between all studies, which is a symptom of methodological and conceptual difficulties within the research field. Violence is a gendered phenomenon. Differences were seen in the kind of violence men and women reported. In addition to this, the results in study IV indicate that gender affects how violence is perceived and how victims are treated by health care professionals. Conclusion: Integrated approaches in research on interpersonal violence, as well as in clinical work, are needed. If the co-occurrence of violence is ignored, it may hamper our understanding of the experiences and consequences of interpersonal violence for victims. More research is needed into what produces the differences found in prevalence rates between studies to improve the methodology. POPULA RVETENSKAPLIG SAMMANFATTNING Introduktion Att ha varit utsatt för olika typer av våld är vanligt förekommande. På senare år har det uppmärksammats att många människor som har varit utsatta för en typ av våld (exempelvis sexuellt, fysiskt, emotionellt) också har varit utsatta för en annan typ. Det är också vanligt att personer utsätts för våld i mer än en slags relation. Exempelvis kan en individ ha varit utsatt av en eller flera familjemedlemmar (vilket i den här avhandlingen innebär förälder/styvförälder eller syskon), tidigare eller nuvarande partner och/eller bekanta/främlingar. För att bättre förstå vad våld innebär för den som utsätts, hur man bäst kan hjälpa utsatta och hur man kan förhindra att våld sker, behövs en större kunskap om hur olika typer av våld och våld från olika typer av förövare hänger samman. Trots att flera rapporterar har påvisat ett starkt samband mellan att ha varit utsatt för olika typer av våld och att lida av både fysisk och psykisk ohälsa är det relativt få av dem som varit utsatta för våld som söker hjälp för detta inom sjukvården. Det finns mer forskning kring kvinnors upplevelser av att berätta om våldsutsatthet i vården än mäns.