key: cord-0049150-ny31tml2
authors: Mathur, Parul; Sharma, Lavanya P; H Nanjundaswamy, Madhuri; S Chandra, Prabha
title: Training Needs of Psychiatry Residents in Handling Intimate Partner Violence (IPV) in Clinical Situations- A Survey
date: 2020-08-27
journal: Asian J Psychiatr
DOI: 10.1016/j.ajp.2020.102379
sha: 108fb832e01dae635da30bd9110b21d7ae6a0c31
doc_id: 49150
cord_uid: ny31tml2

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WHO multi-country study on women's health and domestic violence against women") (National Family Health Survey 2017) .

IPV refers to any behaviour within an intimate relationship that causes physical, psychological or sexual harm to those in the relationship ("WHO | WHO multi-country study on women's health and domestic violence against women"). IPV and mental health issues share a bidirectional relationship, where women subjected to violence seek mental health care more often than non-abused women. Also, women mental health service users are at a higher risk of experiencing IPV (Oram et al., 2013) . IPV is also associated with increased vulnerability towards developing mental health problems such as posttraumatic stress disorder (PTSD), depression, anxiety, sexual problems, suicide, self-harm, chronic pain and substance abuse (Stewart and Chandra, 2017) .

Healthcare providers are likely to be the first point of contact for women facing IPV and health settings have been considered to be the most appropriate setting to ask about IPV and provide interventions or direct victims to appropriate resources. However, there are numerous barriers both to disclosure and to the enquiry, which may be responsible for low rates of detection. The most common reasons for non-disclosure have been reported to beembarrassment, shame, fear of threats and further violence or confinement from the perpetrator; re-traumatization; hopelessness; inability to recognize violence (particularly emotional), the stigma associated with one's mental illness, and lack of privacy (Stewart and Chandra, 2017) (Vranda et al., 2018) . Mental health professionals may also be reluctant to ask about IPV and common barriers identified include personal discomfort, therapeutic nihilism, fear of offending, causing re-traumatization and time constraints (Stewart and Chandra, 2017) (Trevillion et al., 2012a) . Table 1 . Responses with more than one option marked, rendering them ambiguous, were excluded. The results indicate fairly low rates of spontaneous disclosure of IPV by women approaching mental health services as well as low rates of routine clinical assessment of IPV by residents (Table 1 ). The majority of the residents perceived difficulties in responding to IPV or asking about it and mentioned lack of knowledge, comfort, safety concerns and concerns about medicolegal issues as prominent reasons. Nearly 71% of residents reported not receiving formal training as being a barrier. Currently, training on IPV as part of clinical rotations is varied and depends on the individual consultants' emphasis on gender issues rather than it being part of the curriculum.

These findings are similar to that of a UK-based study among 131 mental health professionals (psychiatrists and psychiatric nurses) where the majority of participants (60%) felt that they lacked adequate knowledge of support services, and 27% noticed that their workplace did not have sufficient referral resources for domestic violence (Nyame et al., 2013 ).

An Australian study that assessed psychiatrists' and trainees' preparedness in dealing with IPV, found that comfort and skill levels were directly correlated with the number of hours of training they had received. The training programme included assessment techniques, safety planning, knowledge about existing resources and referral pathways (Forsdike et al., 2019) .

Based on the findings of this survey, and the available literature, we conclude that residents may benefit from training in responding to IPV in clinical settings as part of their residency program. This would include improving assessment skills, how to triage, being alert to clinical conditions that could indicate IPV, as well as training in addressing IPV once disclosed, knowledge about access to services, and ensuring safety. The World Psychiatric Association (WPA) has developed a competency-based curriculum (Stewart and Chandra, 2017) for training and describes the skills and knowledge that psychiatry trainees should have when dealing with IPV.

How formal training about IPV for psychiatry trainees improves comfort and skill as well as service user satisfaction, and how much it is sustained over time, is an important area of study.

Centre where study conducted: National Institute of Mental Health and NeuroSciences (NIMHANS) Bangalore, India J o u r n a l P r e -p r o o f

The pandemic paradox: The consequences of COVID-19 on domestic violence

WPA International Competency-Based Curriculum for Mental Health Providers on Intimate Partner Violence and Sexual Violence Against Women

Exploring Australian psychiatrists' and psychiatric trainees' knowledge, attitudes and preparedness in responding to adults experiencing domestic violence

Domestic Violence and Mental Health, 1 edition

A survey of mental health professionals' knowledge, attitudes and preparedness to respond to domestic violence

Prevalence of experiences of domestic violence among psychiatric patients: systematic review

The response of mental health services to domestic violence: a qualitative study of service users' and professionals' experiences

Experiences of Domestic Violence and Mental Disorders: A Systematic Review and Meta-Analysis

Barriers to Disclosure of Intimate Partner Violence among Female Patients Availing Services at

Tertiary Care Psychiatric Hospitals: A Qualitative Study

WHO | WHO multi-country study on women's health and domestic violence against women