The association between life satisfaction, emotional support, and perceived health among women who experienced intimate Partner violence (IPV) – 2007 behavioral risk factor surveillance system RESEARCH ARTICLE Open Access The association between life satisfaction, emotional support, and perceived health among women who experienced intimate Partner violence (IPV) – 2007 behavioral risk factor surveillance system Vivian Hui* and Rose Eva Constantino Abstract Background: Intimate partner violence (IPV) is a pressing phenomenon whose consequences are associated with severe physical and mental health outcomes. Every minute, around 24 people in the United States are raped, physically injured, or emotionally abused by their intimate partner. Although having experienced IPV is not modifiable, emotional support is a protective factor to prevent victims from committing suicide. The psychological state of IPV victims is critical in post-traumatic events and this is evidenced in numerous qualitative interviews. Therefore, the objective of this study is to explore the association between IPV with emotional support, life satisfaction, and perceived health status in the United States. Methods: This study analyzed the data from the 2007 Behavioral Risk Factor Surveillance System. Univariate analyses, multivariable logistic regression analyses, and ordinal logistic regression analyses were used to estimate the adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs) for factors associated with IPV. Analyses were conducted using SPSS version 25. Results: The analyses show that there is a strong association between IPV experience and emotional support (AOR: 1.810; 95% CI = 1.626–2.015). Participants who had either physical violence or unwanted sex with an intimate partner in the past 12 months have 2.28 higher odds to receive less emotional support and 2.05 higher odds to perceive poor life satisfaction. Also, participants who reported experiencing IPV were associated with (AOR: 3.12; 95% CI =2.68–3.62) times the odds of having ≥6 days more mentally unhealthy days in a month. For perceived health outcomes, people who had been threatened with violence by a sex partner have 1.74 (95% CI =1.54–1.96) times the odds of having poor perceived general health status. IPV survivors have 3.12 (95% CI =2.68–3.62) times the odds of having ≥6 days more mentally unhealthy days in a month. Conclusions: People reported with any IPV experience are more likely to receive less emotional support, perceive dissatisfaction in life, and poor health outcomes. This study shows the need for policies centered on the development of interventions that focus on mental health for those who have experienced IPV. Keywords: Life satisfaction, Emotional, Perceived health, Intimate partner violence © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. * Correspondence: vivianhui.care@gmail.com Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA Hui and Constantino BMC Public Health (2021) 21:641 https://doi.org/10.1186/s12889-021-10665-4 http://crossmark.crossref.org/dialog/?doi=10.1186/s12889-021-10665-4&domain=pdf http://orcid.org/0000-0003-1966-6139 http://creativecommons.org/licenses/by/4.0/ http://creativecommons.org/publicdomain/zero/1.0/ mailto:vivianhui.care@gmail.com Background Intimate partner violence (IPV), includes physical vio- lence, sexual violence, unwanted sex, and psychological aggression by an intimate partner [1], which is a multi- dimensional phenomenon with consequences of severe social, emotional, and cognitive impairment [2]. Nearly 30% of the women have experienced IPV and reported a significant impact on their daily functioning [3]. Such experiences include physical, sexual, emotional abuse, and threats. These exposures had a graded relationship with serious consequences on the victim’s physical and mental health [4]. The prevalence of IPV and its seque- lae have profound health consequences, economic bur- den, and public health significance. IPV is attributed to an array of multidimensional health outcomes. Women are three times more likely to be exposed to domestic violence compared to men [5] and are most likely to suffer poor physical and mental health ranging from hypertension, diabetes [6], and higher rates of HIV/AIDS infection [7]. A growing litera- ture suggests that IPV can impede psychosocial develop- ment and trigger behavioral and mental health problems. Traumatic experiences like IPV can also affect emotional and psychological development, increasing vulnerability to mental health problems such as sleep disturbances [8], major depression, anxiety, posttrau- matic stress disorder (PTSD) [9–11], and suicide at- tempts [12]. Also, borderline, narcissistic, and antisocial personality disorders are common among IPV perpetra- tors [13]. Therefore, the health consequences of IPV are far-reaching and multifaceted. The physiologic and psychosocial consequences of IPV are also notable. Greater exposure to IPV is associated with higher household out-of-pocket medical costs and a financial burden to society. According to the Centres for Disease Control (CDC), the estimated annual cost of IPV is over 8 billion arise from increasing health ex- penses, and decreasing productivity [14]. Moreover, the health care cost burden usually sustains for at least 3 years after the exposure to IPV until the victims recover from the trauma and resume their work [15]. Import- antly, however, the economic burden of IPV is underes- timated since the previous research mostly focused only on inpatient or referral data. Research on IPV has thoroughly addressed its negative consequences. However, this line of inquiry can hardly display how adversity can also positively transform IPV survivors, and thus a comprehensive picture of recovery is absent [16]. Some studies reveal that some survivors can develop better adaptation, positive thinking, and emotional and social recovery despite experiencing trau- matic situations [17, 18]. Evidence has shown that the availability of social and emotional support is essential to mental and behavioral health in women who have experienced IPV [19, 20]. Adequate actual- and perceived support can act as a buffer against the development of PTSD in trauma-exposed victims [21, 22]. The psychological state of IPV survivors is critical in post-traumatic events and this is evidenced in numerous qualitative interviews [23]. Yet, there is a paucity of representa- tive studies to compare the perceived life satisfaction, emotional support, and health status among IPV in the current state of the science. In the absence of such knowledge, the development of effective inter- vention strategies and treatment protocol to address such deficiencies in IPV will likely remain problematic. Methods 2007 Behavioral Risk Factor Surveillance System (BRFSS) survey was analyzed to assess the association between IPV and the outcomes of perceived emotional support, life satisfaction, and health status among women aged 18 years and over in the United States [24]. BRFSS is a state-based, cross-sectional survey, collected via telephone. Though 13 years have passed since the data was collected, this survey in 2007 contains the most recent module on IPV that covered across states in the United States. Participants were asked based on the questions from the core component, and some from the optional mod- ules [24]. BRFSS selects individuals randomly by dialing household telephone numbers and interviews only one participant per household [24]. To evaluate the primary independent variable, for the current study, the optional Intimate Partner Violence Module was used. This op- tional module has been applied to the states of Hawaii, Virginia, and West Virginia, and therefore the analysis depicted only three states where the IPV module was included. Measures Our data were obtained from the 2007 BRFSS self- reported survey, which is the latest BRFSS study that included an IPV module. IPV is measured by the follow- ing questions: Intimate partner violence (IPV) “Has an intimate partner ever threatened you with physical violence? This includes threatening to hit, slap, push, kick, or hurt you in any way.” “Has an intimate partner ever attempted physical violence against you? This includes times when they tried to hit, slap, push, kick, or otherwise hurt you, but they were not able to.” Hui and Constantino BMC Public Health (2021) 21:641 Page 2 of 8 “Has an intimate partner ever hit, slapped, pushed, kicked, or hurt you in any way?” “In the past 12 months, have you experienced any physical violence or had unwanted sex with an in- timate partner?” The first three questions do not have a specific time- frame for the IPV experience, while the last question about unwanted sex is constrained with any experi- ences that occurred in the past 12 months. The follow- ing variables were used to correlate the association with IPV. Emotional support is measured with the following question ‘How often do you get the social and emo- tional support you need?’ and participants responded with an ordinal level of measurement, ranging from “al- ways”, “usually”, “sometimes”, “rarely”, “never”, “don’t know”, “not sure”, and “refused”. We collapsed the re- sponses from five to three levels, using only “always”, “sometimes” and “rarely” for a better fit with our analysis. Life satisfaction is measured with the following ques- tion ‘In general, how satisfied are you with your life?’ Participants responded from “very satisfied”, “satisfied”, “dissatisfied”, “very dissatisfied”, “don’t know”, “not sure”, and “refused”. We collapsed the responses from four to two levels, as “satisfied” and “dissatisfied” as a dichotom- ous variable. Perceived general health status is measured with the following question ‘Would you say that in general, your health status is?’ The response options were “excellent”, “very good”, “good”, “fair”, and “poor” Perceived physical health, mental health, and poor health are measured by the following questions with the response options “__number of days”, “none”, “don’t know/not sure”, or “refused”. The items measured in days were classified as “none”, “1–5 days” or “6 days or more” in a month. ‘Now thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good? ‘Now thinking about your mental health, which in- cludes stress, depression, and problems with emo- tions, for how many days during the past 30 days was your mental health not good?’ ‘During the past 30 days, for about how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recre- ation?’ Additional covariates considered were race, edu- cation, employment, income, and age. Analysis The frequency and demographic variables were described by univariate analyses, while the association between perceived emotional support, life satisfaction, unhealthy days, sociodemographic factors, and IPV were conducted by bivariate analyses with chi-square tests for nominal data. Multivariable logistic regression analyses were applied to predict the adjusted odds ratios (ORs) and 95% confidence interval (CIs). Ordinal logistic regression analysis was initially used to examine the rela- tionship of IPV variables to each of the ordinally scaled variables. Since the proportional odds assumption is not satisfied, the continuation ratio approach was used to obtain the ORs and CIs for each transition of the choices in the variable. Data analysis excluded those missing data or recorded as “don’t’ know/not sure” With the large sample size in the dataset, and the IPV module is not compulsory for participants, it is anticipated that the missing data are at random. We used hot deck imput- ation to address the missing variables, which calculated the average score on an identified outcome variable by matching the score of other variables in the sample (i.e., donor variables). We used participants’ gender, educa- tion level, and race as the donor variables. Hot deck im- putation provides less bias compared to mean imputation and is deemed as a better overall solution than the listwise deletion [25]. Statistical significance is indicated by a 2-sided p-value of <.05. Race, education, and employment were used as covariates for all dependent variables, while income and age were added exclusively for perceived health outcomes including physical, mental, and poor health. Analyses were con- ducted using SPSS version 25. Results Demographics showed a sample size of n = 19,102 with the mean age of 48.32 for those with IPV experience, while 53.87 is the mean age for those without any IPV experience. 3240 (16.9%) participants indicated an IPV experience in their lifetime. Women (n = 11,665; 61%) comprised the majority of the sample. The sample in- cluded white (n = 13,490; 78.6%) and non-white persons (n = 3681; 21.4%). Majority of the participants graduated from high school or had some high school education (n = 7650; 41.1%), followed by college or more (n = 6339; 33.2%), and college 1–3 years (n = 5089; 26.7%) as shown in Table 1. Logistic regression analysis (Table 2) shows a signifi- cantly higher odds ratio to explain the association between IPV experience, received emotional support, and perceived life satisfaction. Table 3 shows that per- sons who had been threatened with violence by their partner have 1.81 (95% CI = 1.626–2.015) times the odds of rarely receiving emotional support compared to Hui and Constantino BMC Public Health (2021) 21:641 Page 3 of 8 persons who had not been threatened with violence by their partner. Simultaneously, people who had either physical violence or unwanted sex from a partner have 2.28 (95% CI =1.99–2.62) times the odds of rarely receiv- ing emotional support compared to persons who have not. In terms of life satisfaction, persons who have been threatened with violence have 1.834 (95% CI =1.658– 2.027) times the odds compared to persons who have not been threatened with violence. Moreover, persons who had experienced either physical violence or Table 1 Descriptive statistics on demographics and IPV from states of Hawaii, Virginia, and West Virginia: 2007 BRFSS, United States Any Yes IPV (Count/%) No Total X2 or T-test Statistics Race White 2348 (13.7%) 11,142 (64.9%) 13,490 (78.6%) Non-White 478 (2.8%) 3203 (18.7%) 3681 (21.4%) P < 0.001 Age (years) Mean +/− SD 48.32 ± 14.468 53.87 ± 16.825 52.93 ± 16.58 P < 0.001 Marital status P < 0.001 Married 1405 (7.4%) 9865 (51.7%) 12,170 (59.1%) Divorced/Widowed 1119 (5.9%) 3538 (18.6%) 4657 (24.4%) Single 707 (3.7%) 2429 (12.7%) 3136 (16.5%) Highest education attained P < 0.001 High school grad or less 1207 (6.3%) 6443 (33.8%) 7650 (41.1%) College 1–3 years 1006 (5.3%) 4083 (21.4%) 5089 (26.7%) College or more 1024 (5.4%) 5315 (27.9%) 6339 (33.2%) Employment status P < 0.001 Employed 1982 (10.4%) 9047 (47.4%) 11,029 (57.8%) Unemployed 823 (4.3%) 2596 (13.6%) 3419 (17.9%) Retired 428 (2.2%) 4193 (22%) 4621 (24.2%) Annual income P < 0.001 Less than $35,000 1379 (7.9%) 5148 (29.7%) 6527 (37.6%) $35,000 - < $75,000 981 (5.7%) 5139 (29.6%) 6120 (35.3%) $75,000 or more 659 (3.8%) 4050 (23.3%) 4709 (27.1%) SD standard deviation Table 2 Logistic regression between IPV and emotional support, life satisfaction and perceived health from states of Hawaii, Virginia, and West Virginia: 2007 BRFSS, United States ^Emotional Support ^Life Satisfaction ^General Health **Physical Health **Mental Health **Poor Health Sometimes or rarely Rarely Dissatisfied Good, fair, poor Fair, poor poor ≥ 1 day(s) ≥ 6 days ≥ 1 day(s) ≥ 6 days ≥ 1 day(s) ≥ 6 days IPV (threatened) 1.77 a CI:1.17–1.34b 1.81a CI:1.63, 2.02b 1.83 CI:1.66–2.02 1.31 CI:1.15– 1.49 1.28 CI:1.16– 1.41 1.74 CI:1.54– 1.96 1.6 a CI:1.48– 1.81 b 1.94 CI:1.72– 2.20 2.29 CI:2.07– 2.53 2.53 CI:2.25– 2.85 1.43 CI:1.26– 1.62 1.62 CI:1.40– 1.85 IPV (attempted) 1.72 CI:1.56–1.90 1.75 CI:1.57– 1.96 1.78 CI:1.6–1.97 1.30 CI:1.13– 1.48 1.30 CI:1.18– 1.44 1.57 CI:1.34– 1.78 1.5 CI:1.35– 1.67 1.84 CI:1.62– 2.10 2.16 CI:1.94– 2.40 2.40 CI:2.13– 2.71 1.38 CI:1.21– 1.57 1.57 CI:1.35– 1.83 IPV (ever violent) 1.74 CI:1.58–1.90 1.82 CI:1.63– 2.01 1.82 CI:1.66–2.01 1.25 CI:1.12– 1.42 1.28 CI:1.17– 1.41 1.73 CI:1.54– 1.95 1.60 CI:1.45– 1.77 1.86 CI:1.66– 2.10 2.27 CI:2.06– 2.51 2.60 CI:2.32– 2.92 1.41 CI:1.25– 1.60 1.61 CI:1.39– 1.86 IPV (unwanted sex) 2.00 CI:1.74–2.29 2.28 CI:1.99– 2.62 2.05 CI:1.78–2.37 1.48 CI:1.23– 1.79 1.64 CI:1.41– 1.85 1.48 CI:1.33– 1.64 1.932 CI:1.68– 2.22 2.09 CI:1.78– 2.45 3.01 CI:2.61– 3.46 3.12 CI:2.68– 3.62 1.44 CI:1.23– 1.70 1.67 CI:1.38– 2.01 *a = odds ratio (adjusted) *b = CI 95% ^=adjusted covariates (race, education, employment) ** = adjusted covariates (race, education, employment, income, age) Hui and Constantino BMC Public Health (2021) 21:641 Page 4 of 8 unwanted sex with their partner have 2.05 (95% CI = 1.78–2.37) times the odds of more dissatisfaction in life compared to people who do not have unwanted sex with a partner. As for perceived health outcomes, persons who had been threatened with violence by their sex partner have a 1.74 (95% CI =1.54–1.96) lower perceived general health status compared with persons who have not been threatened by their sex partner. On the number of unhealthy days in a month reported by participants, those who had been threatened with vio- lence by their sex partner have a 2.29 (95% CI =2.07–2.53) more mentally unhealthy days in a month compared with persons who have not been threatened with violence by their sex partner. Contemporaneously, persons who had experienced either physical violence or unwanted sex with a partner have a 3.12 (95% CI =2.68–3.62) is having at least 72 unhealthy days in a year could negatively impact performance as a parent, employee, or student. Discussion Having 6 or more “unhealthy days” in a month is a diffi- cult predicament for anyone, whether a parent, worker or student. Having at least 72 unhealthy days in a year could ruin one’s hopes of being a competent parent, worker, or student. The purpose of this study was to understand the association between IPV experience and perceived emotional support, life satisfaction, and health status. First, we examined the relationships among the variables, and then we used a regression analysis to understand the influence of the covariates (i.e., race, education, employment, income, age) towards the dependent variables (i.e., emotional support, life satisfac- tion, and perceived health status). Finally, we explored the association between IPV and the outcome variables (i.e., dependent variables) with adjusted covariates. Results indicate a strong association between partici- pants’ IPV experience and emotional support, suggesting that persons with IPV experience received less emotional Table 3 Descriptive statistics for IPV and study constructs from states of Hawaii, Virginia, and West Virginia: 2007 BRFSS, United States Any IPV (Count/%) Total X2 or T- test Statistics Yes No Emotional support P < 0.001 Always 1213 (6.4%) 8216 (43.4%) 9429 (49.8%) Sometimes 1070 (5.7%) 4426 (23.4%) 5496 (29%) Rarely 941 (5%) 3057 (16.2%) 3998 (21.2%) Life satisfaction P < 0.001 Satisfied 1069 (5.6%) 7626 (40.1%) 8695 (45.7%) Dissatisfied 2154 (11.3%) 8186 (43%) 10,340 (54.3%) General Health P < 0.001 Excellent 519 (2.7%) 2930 (15.4%) 3449 (18.1%) Good 1027 (5.4%) 5208 (27.4%) 6235 (32.8%) Fair 936 (4.9%) 5063 (26.6%) 5999 (31.5%) Poor 745 (3.9%) 2609 (13.7%) 3354 (17.6%) Physical Health P < 0.001 None 1693 (9%) 10,409 (55.1%) 12,102 (64.1%) 1–5 days 715 (3.8%) 2782 (14.7%) 3497 (18.5%) > 6 days 809 (4.3%) 2472 (13.1%) 3281 (17.4%) Mental Health P < 0.001 None 1593 (8.4%) 11,611 (61.4%) 13,204 (69.9%) 1–5 days 704 (3.7%) 2323 (12.3%) 3027 (16%) > 6 days 904 (4.8%) 1765 (9.8%) 2669 (14.1%) Poor Health P < 0.001 None 1070 (11.2%) 4418 (46.2%) 5488 (57.3%) 1–5 days 494 (5.2%) 1499 (15.7%) 1993 (20.8%) > 6 days 606 (6.3%) 1484 (15.5%) 2090 (21.8%) SD standard deviation Hui and Constantino BMC Public Health (2021) 21:641 Page 5 of 8 support. The most significant finding is that physical violence or unwanted sex with an intimate partner in the past 12 months has a 2.28 higher odds of rarely re- ceiving emotional support and 2.05 higher odds of per- ceived life dissatisfaction. This finding is similar to the conclusions made by Coker et al. (2003) [25] in a struc- tural equation model that higher emotional support af- fects the health outcomes of IPV survivors in the long run. However, our analysis from this state-wide national survey can capture more unreported IPV experiences from random selection, which demonstrates higher generalizability with larger sample size and representa- tion in different states. Our study also elicited the evi- dence that emotional support and life satisfaction varies between the different degree of IPV experience. The more severe the IPV experience (i.e., unwanted sex over the past year), the lower the emotional support received, and life satisfaction perceived. We also found that participants who reported IPV ex- perience (e.g., threatened, attempted, over violent, or un- wanted sex) reported more unhealthy days in a month, with mental health as the most significant of reasons for having “unhealthy days”. We believe that IPV experi- ences could negatively affect the mood of women, fre- quent exposure to IPV experience contributes to an unhealthy relationship with their intimate partner. With the accumulated threats and violent experience, women may hide their feelings and themselves from the external environment. Although initially surprising, these results appear somewhat consistent with the findings from the World Health Organization (WHO) multi-country sam- ple in 2003 that found women who reported IPV at least once in their lifetime also reported significantly more emotional distress, suicidal thoughts (ORs 2.9 [CIs: 2.7– 3.2]), and suicidal attempts (ORs 3.8 [CIs: 3.3–4.5]), compared to women who did not experience IPV [26]. With the widespread use of mobile phones and technology, we believed that the perceptions and forms of IPV can shift or evolve over some time (e.g., cyberbullying, sexting threat, online coercion, etc.) Given that our data is from the last decade, the measurement from using a survey might not be able to capture all kinds of IPV experience at one time. Recently, social media has become an indispensable platform to share feelings and seek help in life events, including IPV. Massive public awareness related to IPV has been aroused through Twitter via different hashtags (#metoo, #notokay, #maybehedoesnothur- tyou) [27]. During the COVID-19 pandemic in 2020, the physical IPV is exacerbated 1.8 fold higher (p = 0.01) when compared to the past 3 years 2017–2019 [28]. As social media is the only platform accessible for survivors in the lockdown, we believe that social media would be a potential avenue for providing emotional support and improving life satisfaction. Telehealth is one of the ongoing trends after the pan- demic, however, the abused women might not be able to talk with healthcare professionals virtually if they are still living with their intimate partner. Therefore, the nature of self-disclosure text and massive #hash- tags campaign on social media would provide a better way out to express negative emotions and seek sup- port among other IPV survivors. Future research should leverage the skills of text mining like senti- ment analysis, topic modeling, and network analysis to examine the emotional or informational support received by IPV victims on social media. Implications Like public health, social justice, and human rights is- sues, IPV experience is associated with less emotional support, poor life satisfaction, and poor mental health outcomes. IPV experience can linger in people’s minds after physical wounds have healed, casting a long shadow of other physical and psychological problems throughout the lifespan. Therefore, the process of growth and pain can be inextricably associated with trauma recovery [29]. To combat the effects of IPV on emotional support and life satisfaction, enhancing biobe- havioral attributes of resilience could facilitate re- appraisal and create a sense of purpose in the face of IPV, thereby improving mental health and post- traumatic growth. Resilience literature demonstrated some individuals can bounce back and develop healthy relationships after suffering from stressful events like IPV [17]. Since resilience can be replenished [30], we suggest that enhancing an IPV survivor’s sense of con- trol, coping skills, social support, and providing multiple online resources could improve resilience and reduce the threatening and traumatic effects caused by IPV. Previous evidence has shown that resiliency programs [31] including social support [32], safety planning [33], and other technology-based interventions can mitigate the far-reaching consequences of IPV [34]. Policymakers should focus on how to turn the victims to become survivors by improving their resiliency. For example, social media would be an interactive and re- sourceful platform to find IPV support groups, financial support, or shelter availability information around their neighborhood. Policymakers should provide more fund- ing for non-governmental organizations (NGOs) or vio- lence prevention advocacy groups to integrate the online resources and create a hub for IPV survivors to navigate themselves easier. Also, as victim-blaming is one of the serious online harassment when IPV victims disclose their stories, policymakers should devise policies to com- bat the victim-blaming culture and encourage empath- etic and supporting messages both on the internet and Hui and Constantino BMC Public Health (2021) 21:641 Page 6 of 8 in a real-life situation. For example, using positive #hashtags to empower victims, highlighting the survivor stories, and creating an emotional support hub for abused women. Limitations One of the limitations of this study is the lack of the use of a weighting formula that could have re-balanced the data to reflect the population more accurately. However, the large sample size of the data set represents greater generalizability of the BRFSS to the U.S. population. We also acknowledged that the 2015 National Intimate Part- ner and sexual violence survey may capture more recent data on IPV, however, the BRFSS 2007 also captured the physical, psychological, and sexual violence and included more mental health indicators (i.e., perceived life satis- faction and perceived mental health). These indicators are important for researchers to plan mental health intervention strategies. Another limitation is that each variable measured uses a single question only. For ex- ample, emotional support is measured with the following question ‘How often do you get the social and emotional support you need?’ and participants responded with an ordinal level of measurement, ranging from “always”, “usually”, “sometimes”, “rarely”, “never”, “don’t know”, “not sure”, and “refused”. Then, we collapsed the re- sponses from five to three levels, using only “always”, “sometimes” and “rarely” for a better fit with our ana- lysis. Further, some of the questions did not include a specific timeframe to recall the IPV experience. We are concerned about missing data which may affect the interpretation of the results. The use of the dataset in this study is in BRFSS 2007, are discussed in the following way 1) the interpretation of results, 2) the analysis procedure, and 3) hot-deck imputation provides less bias compared to mean imputation and is deemed as a better overall solution than the listwise deletion [25]. Self-reported data and recall bias are other limita- tions of the study. The strength of the study is it pro- vides information on the effects of emotional support, life satisfaction, and perceived health status on IPV in the U.S. which gives guidance to future intervention studies. Conclusions In conclusion, the consequences of IPV are enormous. In this study, persons who reported having experienced IPV were more likely to receive less emotional support, more likely to perceive dissatisfaction in life, and have poor health outcomes. Mental health encompasses vari- ous aspects that may lead a person who survives IPV to develop poor mental health. These indicators of poor mental health include depression, PTSD, suicidal idea- tion, sleep disturbance, and self-esteem issues [35, 36]. The results of this study suggest the need for person- centered policies on the development of interventions that focus on mental health for people who have experi- enced IPV. Precision health intervention programs [37] could be designed to provide individualized information, educa- tion, and prevention strategies on IPV that will match diverse IPV survivors of all races, socioeconomic sta- tuses, gender, and age. Constantino and Crane (2005), found that social/emotional support intervention in women experiencing IPV is effective in improving per- ceived social/emotional support and decreasing health- care utilization. The perception of the availability of social/emotional support is significant to survivors of IPV [20]. When their perceived availability of social/ emotional support is low, survivors of IPV lose their ability to attenuate the unhealthy consequences of IPV [20]. As such, future research should concentrate on increasing emotional support, resilience, and life satisfac- tion from the online or offline intervention (e.g., social media and community support groups). Abbreviations BRFSS: Behavioral Risk Factor Surveillance System; HIV/AIDS: Human immunodeficiency virus infection and acquired immune deficiency syndrome; IPV: Intimate Partner Violence; PTSD: Post-traumatic Stress Disorder Acknowledgments We would like to thank the Center for Disease Control and Prevention for access to data. Authors’ contributions VH analyzed the data and wrote the first draft of the manuscript. RC reviewed and edited the manuscript. All authors have read and approved the manuscript. Funding No funding to be reported for this study. Availability of data and materials The original dataset for the current study is available on the Center for Disease Control and Prevention website. The datasets used and analyzed during the current study are available from the corresponding author on reasonable request. The raw dataset can be obtained from https://www.cdc. gov/brfss/annual_data/annual_2007.htm. Declarations Ethics approval and consent to participate The Institutional Review Board at the University of Pittsburgh approved this study. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Received: 26 May 2020 Accepted: 21 March 2021 References 1. Howell KH, Thurston IB, Schwartz LE, Jamison LE, Hasselle AJ. Protective factors associated with resilience in women exposed to intimate partner Hui and Constantino BMC Public Health (2021) 21:641 Page 7 of 8 https://www.cdc.gov/brfss/annual_data/annual_2007.htm https://www.cdc.gov/brfss/annual_data/annual_2007.htm violence. Psychol Violence. 2018;8(4):438–47. https://doi.org/10.1037/ vio0000147. 2. Twamley EW, Allard CB, Thorp SR, Norman SB, Hami Cissell S, Hughes Berardi K, Grimes EM, Stein MB. Cognitive impairment and functioning in PTSD related to intimate partner violence. J Int Neuropsychol Soc. 2009; 15(6):879–87. https://doi.org/10.1017/S135561770999049X. 3. Black M, Basile K, Breiding M, Smith S, Walters M, Merrick M, et al. National Intimate Partner and Sexual Violence Survey: 2010 Summary Report 2011. 4. Campbell J, Jones AS, Dienemann J, Kub J, Schollenberger J, O'Campo P, Wynne C. Intimate partner violence and physical health consequences. Arch Intern Med. 2002;162(10):1157–63. 5. National Center for Injury Prevention and Control C for DC and P. Infographic based on data from the national intimate partner and sexual violence survey (nisvs): 2010-2012 state report. [Internet]. 2016 [cited 2020 Mar 19]. Available from: https://www.cdc.gov/violenceprevention/pdf/NISVS- infographic-2016.pdf 6. Dolezal T, McCollum D, Callahan M. Hidden Costs in Health Care: The Economic Impact of Violence and Abuse; 2009. 7. Li Y, Marshall CM, Rees HC, Nunez A, Ezeanolue EE, Ehiri JE. Intimate partner violence and HIV infection among women: a systematic review and meta- analysis. J Int AIDS Soc. 2014;17(1):18845. https://doi.org/10.7448/IAS.17.1.1 8845. 8. Pigeon WR, Cerulli C, Richards H, He H, Perlis M, Caine E. Sleep disturbances and their association with mental health among women exposed to intimate partner violence. J Women's Health. 2011;20(12):1923–9. https://doi. org/10.1089/jwh.2011.2781. 9. Golding JM. Intimate partner violence as a risk factor for mental disorders: a meta-analysis. J Fam Violence. 1999;14(2):99–132. https://doi.org/10.1023/A:1 022079418229. 10. Hathaway JE, Mucci LA, Silverman JG, Brooks DR, Mathews R, Pavlos CA. Health status and health care use of Massachusetts women reporting partner abuse. Am J Prev Med. 2000;19(4):302–7. https://doi.org/10.1016/ S0749-3797(00)00236-1. 11. Carlson BE, McNutt LA, Choi DY. Childhood and adult abuse among women in primary health care: Effects on mental health. J Interpers Violence SAGE Publications. 2003;18:924–41. 12. Devries K, Watts C, Yoshihama M, Kiss L, Schraiber LB, Deyessa N, et al. Violence against women is strongly associated with suicide attempts: evidence from the WHO multi-country study on women’s health and domestic violence against women. Soc Sci Med. 2011;73(1):79–86. https:// doi.org/10.1016/j.socscimed.2011.05.006. 13. Mauricio AM, Tein JY, Lopez FG. Borderline and antisocial personality scores as mediators between attachment and intimate partner violence. Violence Vict. 2007;22(2):139–57. https://doi.org/10.1891/088667007780477339. 14. Max W, Rice DP, Finkelstein E, Bardwell RA, Leadbetter S. The economic toll of intimate partner violence against women in the United States. Violence Vict. 2004;19(3):259–72. https://doi.org/10.1891/vivi.19.3.259.65767. 15. Fishman PA, Bonomi AE, Anderson ML, Reid RJ, Rivara FP. Changes in health care costs over time following the cessation of intimate partner violence. J Gen Intern Med. 2010;25(9):920–5. https://doi.org/10.1007/s11 606-010-1359-0. 16. Cobb AR, Tedeschi RG, Calhoun LG, Cann A. Correlates of posttraumatic growth in survivors of intimate partner violence. J Trauma Stress. 2006;19(6): 895–903. https://doi.org/10.1002/jts.20171. 17. Linley PA, Joseph S. Positive change following trauma and adversity: a review. J Trauma Stress. 2004;17(1):11–21. https://doi.org/10.1023/B:JOTS. 0000014671.27856.7e. 18. Anderson KM, Renner LM, Danis FS. Recovery: resilience and growth in the aftermath of domestic violence. Violence Against Women. 2012;18(11):1279– 99. https://doi.org/10.1177/1077801212470543. 19. Crane PA, Constantino RE. Use of the interpersonal support evaluation list (ISEL) to guide intervention development with women experiencing abuse. Issues Ment Health Nurs. 2003;24(5):523–41. https://doi.org/10.1080/0161284 0305286. 20. Constantino R, Kim Y, Crane PA. Effects of a social support intervention on health outcomes in residents of a domestic violence shelter: a pilot study. Issues Ment Health Nurs. 2005;26(6):575–90. https://doi.org/10.1080/0161284 0590959416. 21. Ozer EJ, Best SR, Lipsey TL, Weiss DS. Predictors of posttraumatic stress disorder and symptoms in adults: A meta-analysis. Psychol Bull American Psychological Association Inc. 2003;129:52–73. 22. Robinaugh DJ, Marques L, Traeger LN, Marks EH, Sung SC, Gayle Beck J, et al. Understanding the relationship of perceived social support to post- trauma cognitions and posttraumatic stress disorder. J Anxiety Disord. 2011; 25(8):1072–8. https://doi.org/10.1016/j.janxdis.2011.07.004. 23. Watt MH, Bobrow EA, Moracco KEB. Providing support to IPV victims in the emergency department: vignette-based interviews with IPV survivors and emergency department nurses. Violence Against Women. 2008;14(6):715–26. https://doi.org/10.1177/1077801208317290. 24. Prevention C for DC and. BRFSS 2007 Survey Data and Documentation [Internet]. 2007 [cited 2020 Mar 19]. Available from: https://www.cdc.gov/ brfss/annual_data/annual_2008.htm 25. Myers TA. Goodbye, Listwise deletion: presenting hot deck imputation as an easy and effective tool for handling missing data. Commun Methods Meas. 2011;5(4):297–310. https://doi.org/10.1080/19312458.2011.624490. 26. Ellsberg M, Jansen HA, Heise L, Watts CH, Garcia-Moreno C. Intimate partner violence and women’s physical and mental health in the WHO multi- country study on women’s health and domestic violence: an observational study. Lancet. 2008;371(9619):1165–72. https://doi.org/10.1016/S0140-673 6(08)60522-X. 27. Purohit H, Banerjee T, Hampton A, Shalin VL, Bhandutia N, Sheth AP. Gender-based violence in 140 characters or fewer: A# BigData case study of Twitter. 2015;arXiv preprint arXiv:1503.02086. 28. Gosangi B, Park H, Thomas R, Gujrathi R, Bay CP, Raja AS, et al. Exacerbation of physical intimate Partner violence during COVID-19 lockdown. Radiology. 2020;13:202866. 29. Saakvitne KW, Tennen H, Affleck G. Exploring thriving in the context of clinical trauma theory: constructivist self development theory. J Soc Issues. 1998;54(2):279–99. https://doi.org/10.1111/j.1540-4560.1998.tb01219.x. 30. Feder A, Fred-Torres S, Southwick SM, Charney DS. The Biology of Human Resilience: Opportunities for Enhancing Resilience Across the Life Span. Biol Psychiatry Elsevier USA. 2019;86:443–53. 31. Cutuli JJ, Chaplin TM, Gillham JE, Reivich KJ, Seligman ME. Preventing co- occurring depression symptoms in adolescents with conduct problems: the Penn Resiliency Program. Ann N Y Acad Sci. 2006;1094:282–6. https://doi. org/10.1196/annals.1376.035. 32. Constantino RE, Braxter B, Ren D, Burroughs JD, Doswell WM, Wu L, et al. Comparing online with face-to-face HELPP intervention in women experiencing intimate Partner violence. Issues Ment Health Nurs. 2015;36(6): 430–8. https://doi.org/10.3109/01612840.2014.991049. 33. Ford-Gilboe M, Varcoe C, Scott-Storey K, Wuest J, Case J, Currie LM, et al. A tailored online safety and health intervention for women experiencing intimate partner violence: the iCAN plan 4 safety randomized controlled trial protocol. BMC Public Health. 2017;17(1):273. https://doi.org/10.1186/s12 889-017-4143-9. 34. Emezue C, Bloom TL. PROTOCOL: technology-based and digital interventions for intimate partner violence: a meta-analysis and systematic review. Campbell Syst Rev. 2021;17(1):17. 35. Cerulli C, Poleshuck E, Raimondi C, Veale S, Chin N. “What fresh hell is this?” victims of intimate Partner violence describe their experiences of abuse, pain, and depression. J Fam Violence. 2012;27(8):773–81. https://doi.org/10.1 007/s10896-012-9469-6. 36. Karakurt G, Smith D, Whiting J. Impact of intimate Partner violence on Women’s mental health. J Fam Violence. 2014;29(7):693–702. https://doi. org/10.1007/s10896-014-9633-2. 37. Fu MR, Kurnat-Thoma E, Starkweather A, Henderson WA, Cashion AK, Williams JK, et al. Precision health: A nursing perspective. Int J Nurs Sci Chinese Nursing Association. 2020;7:5–12. Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Hui and Constantino BMC Public Health (2021) 21:641 Page 8 of 8 https://doi.org/10.1037/vio0000147 https://doi.org/10.1037/vio0000147 https://doi.org/10.1017/S135561770999049X https://www.cdc.gov/violenceprevention/pdf/NISVS-infographic-2016.pdf https://www.cdc.gov/violenceprevention/pdf/NISVS-infographic-2016.pdf https://doi.org/10.7448/IAS.17.1.18845 https://doi.org/10.7448/IAS.17.1.18845 https://doi.org/10.1089/jwh.2011.2781 https://doi.org/10.1089/jwh.2011.2781 https://doi.org/10.1023/A:1022079418229 https://doi.org/10.1023/A:1022079418229 https://doi.org/10.1016/S0749-3797(00)00236-1 https://doi.org/10.1016/S0749-3797(00)00236-1 https://doi.org/10.1016/j.socscimed.2011.05.006 https://doi.org/10.1016/j.socscimed.2011.05.006 https://doi.org/10.1891/088667007780477339 https://doi.org/10.1891/vivi.19.3.259.65767 https://doi.org/10.1007/s11606-010-1359-0 https://doi.org/10.1007/s11606-010-1359-0 https://doi.org/10.1002/jts.20171 https://doi.org/10.1023/B:JOTS.0000014671.27856.7e https://doi.org/10.1023/B:JOTS.0000014671.27856.7e https://doi.org/10.1177/1077801212470543 https://doi.org/10.1080/01612840305286 https://doi.org/10.1080/01612840305286 https://doi.org/10.1080/01612840590959416 https://doi.org/10.1080/01612840590959416 https://doi.org/10.1016/j.janxdis.2011.07.004 https://doi.org/10.1177/1077801208317290 https://www.cdc.gov/brfss/annual_data/annual_2008.htm https://www.cdc.gov/brfss/annual_data/annual_2008.htm https://doi.org/10.1080/19312458.2011.624490 https://doi.org/10.1016/S0140-6736(08)60522-X https://doi.org/10.1016/S0140-6736(08)60522-X https://doi.org/10.1111/j.1540-4560.1998.tb01219.x https://doi.org/10.1196/annals.1376.035 https://doi.org/10.1196/annals.1376.035 https://doi.org/10.3109/01612840.2014.991049 https://doi.org/10.1186/s12889-017-4143-9 https://doi.org/10.1186/s12889-017-4143-9 https://doi.org/10.1007/s10896-012-9469-6 https://doi.org/10.1007/s10896-012-9469-6 https://doi.org/10.1007/s10896-014-9633-2 https://doi.org/10.1007/s10896-014-9633-2 Abstract Background Methods Results Conclusions Background Methods Measures Intimate partner violence (IPV) Analysis Results Discussion Implications Limitations Conclusions Abbreviations Acknowledgments Authors’ contributions Funding Availability of data and materials Declarations Ethics approval and consent to participate Consent for publication Competing interests References Publisher’s Note