The Mediating Effect of Psychological Status on Women's Decision to Disclose Partner Violence

Abstract

Purpose The purpose of the study was to investigate the mediating effect of psychological health status on women's decision to disclose their exposure to partner violence. Methods: Data for this cross-sectional study was collected from women working in a higher educational institution. Data about partner violence, psychological health, and decision to disclose the violence experience were collected. Path analysis was used to meet the study aim. Results: Major results revealed that women's psychological health status influenced their decision to disclose violence and psychological status worked as a mediating factor between experiences of psychological violence and decision to disclose partner violence. Conclusions: Employment, education, self-esteem, and lack of economic suffering were protective factors against the development of psychological problems in women. Disclosure of violence is considered a coping strategy that prevents progression of more psychological health problems and enables women to continue in their life. It is recommended to enhance women's disclosure of violence which, consequently, enables them to get support and advice. Further, employers need to be encouraged to provide protective tools such as proper security measures to safeguard their employees. Finally, it is recommended to use standardized screening tools as part of the assessment protocol in health care settings.

Keywords

disclosure of violence mediator path analysis psychological status working women

Introduction

Partner violence has become a significant concern for employers worldwide. Its significance stems from two main sources. First, it is an extension of violence faced by women at home, indicating that partner violence breaks home boundaries into work and affects women's work quality (Al-Modallal et al., 2016). Second, dealing with victimized employees puts extra burden on the employers in terms of maintaining flexible work schedule, providing information about resources of help, and providing referral and counseling services (Swanberg & Macke, 2006). Such factors burden the employer, and in the meantime, provide the basis for researchers to investigate this problem to better understand its dimensions and set solutions to avoid negative consequences on the victim and the employer as well.

Different factors were revealed explaining the growing phenomenon of partner violence in the Jordanian society including working and nonworking women. First, women's passive response to spousal violence is one of these factors (Al-Badaynedh, 2012). Second, women mainly don’t choose to seek help from others to manage violence experience for the sake of keeping self-dignity and positive self-image. Those who may choose to disclose violence do so to express feelings and discomfort rather than to look for solutions to the problem (Al-Modallal et al., 2016). Third, tolerance of violence in order to prevent divorce (Al-Badaynedh, 2012) is another reported factor associated with partner violence in the Jordanian community. Further information about factors associated with the occurrence of partner violence in the Jordanian society can be allocated in a related investigation (Al-Modallal et al., 2015).

Violence against women, especially partner violence, is greatly associated with disturbances in women's psychological health status. Related literature supports this relationship (Dokkedahl et al., 2019; Edwards et al., 2015; Eriksen et al., 2021). For instance, posttraumatic stress symptoms in college women were related to severity of violence they experienced (β = .19, p < .05) (Edwards et al., 2015). In addition, levels of depression, anxiety (Al-Modallal, 2012a), intentional self-harm, drug-related disorders, and mood-related disorders (Beydoun et al., 2017) and suicidal ideation (Bandara et al., 2022) were higher among women reporting partner violence compared to their counterparts.

Focusing on Jordanian women, an increasing number of studies indicated presence of a significant relationship between partner violence and women's psychological well-being. Examples of psychological health problems associated with partner violence as reported by Jordanian women include depressive symptoms, stress, anxiety, and low self-esteem (Al-Modallal, 2012a; Al-Modallal et al., 2010, 2012). Effect of psychological well-being on women's personal health and family are summarized in the same studies.

Disclosure of violence is a means of helping victims express their experience of violence. This expression may extend from just disclosing the violence experience (Al-Modallal, 2017) to providing detailed information about violence such as the relationship with the perpetrator, type of violence, frequency of violence, and severity of violence (Al-Modallal et al., 2015). In a related study, Al-Modallal (2017) provided reasons for women's lack of disclosing violence to others. Among these reasons are women's intentions “to keep the family unit intact” and their “use of patience with the spouse as a means to help him [the spouse] gradually quit violence.” In the meantime, when working women were screened for their choice of disclosing violence to others, 40% of them (nurses) admitted that they use this strategy to unveil violence (Al-Modallal et al., 2016). However, it was speculated that women disclosed violence just to express feelings rather than to find solutions for their unpleasant violence experience.

Study Problem

Disclosure of violence is useful and important to women, families, and community institutions. For women, disclosure of violence is the means by which the experience of violence is uncovered and therefore provision of safety, support, and rehabilitation services becomes possible. Following these services, women's physical and psychological well-being become less vulnerable to deterioration and illnesses. For the families, their knowledge of partner violence against a female in the family (via disclosure of violence) encourages them to provide social and financial support to the woman. Such intervention makes resolution of the problem plausible and helps keeping the family unit intact. Presence of social and financial support is important for women especially when we know that women usually prefer not to disclose violence because they are financially dependent on the spouse (Al-Modallal, 2017). Finally, at the community level, services of sheltering, legal assistance, and counseling services would not be possible and efficient unless disclosure of violence becomes a behavior adopted by victimized women. Women's lack of shelter for self and family was among the reasons they reported for not disclosing partner violence (Al-Modallal, 2017). Generally speaking, personal efforts and community services cannot be offered unless disclosure of the violence experience becomes a permissible behavior by victimized women.

Working women differ from nonworking women in some characteristics which in turn influence their priorities. As reported earlier, there are reasons behind women's lack of disclosing partner violence to others. These reasons were exclusive to nonworking women (Al-Modallal, 2017). Because we believe that working women have certain characteristics and priorities (different from nonworking women) that govern their decisions to report violence, we attempted to conduct this study (reason 1).

As previously reported, abused women suffered from psychological health problems as a result of violence. They also lacked the tendency to disclose the experience of violence to family and friends because they lacked receiving psychological support from them (Al-Modallal, 2012b). Considering their psychological status as an important factor determining their decision to disclose violence, we attempted to conduct this study (reason 2). Figure 1 represents the relationship between factors as examined in this study.

Figure 1.

The relationship between factors as examined in the study.

This study was developed to identify: (1) the prevalence of partner violence among a sample of working women, (2) frequency of women's disclosure of partner violence to family, friends, and colleagues, and (3) whether women's psychological health status acts as a mediating factor between their violence experience and decision to disclose violence to family, friends, or colleagues.

Methods

Participants

Approval for the study was obtained from the Hashemite University prior to data collection. Data for this study was collected from women working in one higher educational institution in Jordan. Women working in academia and administrative positions were included in the study. Inclusion criteria for the study included women with the following characteristics: (1) married/ever married adult women, (2) full-time employees, (3) working in academic or administrative positions, and (4) holding the Jordanian nationality. Married/ever married women were included because we attempted to collect data about partner violence. The “partner” in the participants’ culture is limited to the husband or fiancé. Jordanian employees were only included because we aimed at discussing the results of the current study considering the context of Jordanian culture, norms, and customs.

Data Collection

Employed women were approached in their offices. They were informed about the study purpose and type of required data. Because all participants were employees in an academic institution, they were acquainted with research and its requirements. In other words, we did not face problems informing them about the study and getting their approval to participate in the study. Despite this, information about the study was provided to all participants according to the study protocol.

After obtaining women's approval to participate in the study, they were handed the questionnaire to complete. Some of them completed the questionnaire immediately as it was handed to them. Others preferred not to do so and completed the questionnaires alone upon their time schedule. In both ways, the participants were informed about the contact information of the Principal Investigator (PI) in case they had questions. Those who completed the questionnaires immediately gave them to the PI who, in turn, put them in sealed envelopes. On the other hand, participants who completed the questionnaires alone were approached later in the same day or same week to get the questionnaires which also were put in sealed envelopes.

Ethical Considerations

To maintain confidentiality of information, all participants were informed to provide anonymous data. They were asked not to provide their names, employee ID, field of specialty, name of college or department where they work, or name of the building where their offices are located. All completed questionnaires were kept in similar sealed envelopes and kept with the PI. Finally, all questionnaires were then numbered and variables were coded for data entry and analysis.

Measures

According to the study purpose, we attempted to collect data about partner violence, indicators of psychological problems, and reasons behind disclosing partner violence. Measures used to collect data are summarized below.

Women's experiences of partner violence were measured using items of the Massachusetts Mother's Survey (Allard et al., 1997) which represent physical and psychological violence. Examples of the items include whether the woman was “hit, slapped, or kicked”, “stopped from seeing friends or family,” and “told that she was worthless or called names”. Each question was rated on a “yes-no” scale. The total score was obtained by adding up participants’ responses to all items. The higher the score of the Massachusetts Mother's Survey the higher the exposure to partner violence. The tool recorded high Cronbach's alpha of 0.90 in this study.

Psychological health problems were examined in our participants by asking them to indicate whether they had complaints of a number of symptoms associated with five different psychological problems. These problems were: depression, anxiety, stress, posttraumatic stress disorder (PTSD), and low self-esteem. A brief description about the tools used to assess these psychological problems is provided below.

Depression, anxiety, and stress were assessed using the short version of the Depression, Anxiety, Stress Scale (DASS-21). The DASS-21 is a brief self-report measure composed of 21 items categorized into three subscales: depression, anxiety, and stress. It is the short version of the DASS (Lovibond & Lovibond, 1995), which has 42 items composing three subscales (depression, anxiety, and stress). The DASS-21 addresses current experiences of depression, anxiety, and stress in individuals. It is an abbreviated scale that distinguishes between depression, anxiety, and stress among the participants (Antony et al., 1998). Every seven items of the DASS-21 represent one subscale. The three subscales were used for the current study. Examples of items included in the depression, anxiety, and stress subscales are “I felt that life was meaningless,” “I was aware of dryness of my mouth,” and “I felt I was rather touchy,” respectively.

Items within each subscale are rated on a 4-point Likert-type scale ranging from 0 = “did not apply to me at all” to 3 = “applied to me very much, or most of the time.” Scores for all items within each subscale included in the DASS-21 are added. The final score for each subscale ranges between 0 and 21. Scores are doubled to match the scores of the original DASS scale that has 42 items. The higher the score of each subscale, the greater the experience of depression, anxiety, or stress, accordingly.

The DASS-21 was reliable in 49 nonclinical volunteers and 258 patients with mental disorders, including panic disorder, obsessive-compulsive disorder, social phobia, specific phobia, and major depressive disorder. Cronbach's alpha for the depression, anxiety, and stress subscales were 0.94, 0.87, and 0.91, respectively (Antony et al., 1998). Concurrent validity of the DASS-21 was supported by moderate to high correlations between the DASS-21 subscales and the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), and the State-Trait Anxiety Inventory-Trait Version (STAI-T) (Antony et al., 1998). Cronbach's alpha of the depression, anxiety, and stress subscales in this study were 0.94, 0.92, and 0.90, respectively.

PTSD associated with women's identification of violence experience (as most severe or distressing experience of violence) was assessed using a set of symptoms adopted from a previous study (Brush, 2003). Diagnostic categories of the PTSD including reliving the trauma, avoidance or numbing, and increased arousal or hypervigilance are included in the items suggesting the PTSD symptoms. Two items from the PTSD scale were not used in this study because they were not culturally and religiously acceptable by our participants. These items were: “drink to get drunk” and “drink to get high to manage pain.” Cronbach's alpha for the PTSD scale in our sample was 0.91.

Self-esteem was measured using the 10-items Rosenberg Self-Esteem scale (RSE; Rosenberg, 1965). Five of the ten items were positively stated indicating positive self-esteem and five items were stated indicating negative self-esteem. All items of the RSE were rated on a four-point rating scale ranging from 0 = “strongly disagree” to 3 = “strongly agree.” Before calculating the total self-esteem score, the 5 negatively stated items were reverse scored. The total score was calculated by adding up responses of the 10 items. The RSE scale was used in a study targeting Jordanian women and was found valid and reliable (Al-Modallal et al., 2012). The reported Cronbach's alpha for the RSE scale in this study was 0.79.

Disclosure of partner violence experience was assessed using items adopted from a previous study (Swanberg et al., 2006). These items were derived from open-ended questions asked to obtain women's opt to disclose violence experience. Each item expresses a reason behind a woman's decision to disclose violence. Examples of these items are: “need to talk/vent,” “need help/advice/support,” and “explain emotional instability.” Women were asked to respond to the items using either “yes” or “no” options. A woman's positive (yes) response to any of the questions indicated that she discloses violence to others. Further, a (no) response indicated that she prefers non-disclosure of violence to others.

Statistical Analysis

Data were analyzed using descriptive and inferential statistics. Descriptive statistics were used to meet the first and second objectives of the study. Inferential statistics including path analysis was used to study the mediating effect of psychological health problems (including women's reports of depression, anxiety, stress, PTSD, and low self-esteem) between women's experience of partner violence and their decision to disclose violence. As suggested when using path analysis and based on Figure 1 provided for the study, in the first regression model, psychological health (represented by depression, anxiety, stress, PTSD, low self-esteem) was the dependent variable and in the second regression model, psychological health was among the independent variables (in addition to partner violence) as “disclosure of violence” was the dependent variable. Significance level of 0.05 was set for the study.

Results

Data from 229 women were used. Participants’ age ranged between 24 and 58 years old (M = 35.4; SD = 6.2). Marriage years ranged between 1 and 35 years (M = 9.97, SD = 6.2) with an average number of children of 2.5 (SD = 1.6). All women were full-time employees at the higher educational institution and their years of experience ranged between 1 and 30 years (M = 9.1, SD = 4.7). Of the participants, 99 (45.4%) women were workers in administrative positions (e.g., secretariats and clerks), 78 (35.8%) were instructors (e.g., clinical instructors and lab technicians), and the rest were faculty members (n = 41; 18.8%). A little more than half of the participants held bachelor's degree (n = 129, 56.8%) and less than the half had a total family income ranging from 701JD to 1000JD (n = 91, 41.4%).

Regarding participants’ reports (including partner violence, psychological health problems, and disclosing partner violence), their information showed that 36 (15.7%) of them experienced physical violence and 63 (27.5%) experienced psychological violence. Experiencing at least one psychological health problem (as examined in the study) was reported by nearly half of the participants (n = 113; 49.3%). Finally, those who reported at least one reason for disclosing violence were 33.1% (n = 76) of those who revealed data. Table 1 shows descriptive statistics of the continuous variables as used in this study.

Table 1.

Descriptive Data for the Continuous Variables in the Study (N = 229).

Characteristic	N	%	M	SD
Partner violence (Input)	221	96.5	0.95	2.1
Disclose violence (Outcome)	113	49.3	3.4	3.8
Mediators
Depression	206	90.0	3.5	5.1
Anxiety	208	90.8	4.0	5.2
Stress	204	89.1	6.1	4.9
Posttraumatic stress disorder	219	95.6	2.8	3.4
Self-esteem	207	90.4	21.7	5.2

Path analysis was used to test the third objective. In the first regression model, psychological health status was the dependent variable and both physical violence and psychological violence were the independent variables. The following demographic variables were controlled in the regression model to limit the confounding effect (age, marriage years, number of children, years of experience, education level, spouse's level of education, and family income). Results showed that the total regression model was significant (F = 7.07, p <.0001). Also, controlling for participants’ demographic characteristics, psychological partner violence was only significant in predicting psychological health problems in women (β = .40; p-value = 0.003) (see Table 2).

Table 2.

Model 1: Regression of Psychological Health Status on Physical and Psychological Partner Violence.

Independent variables	Correlation (r)	Sig.	Standardized coefficients (β)	p-value
Physical violence	.41	<.0001	.03	.84
Psychological violence	.51	<.0001	.40	.003
Controlled variables
Age	−.21	.08	−.12	.40
Marriage years	−.05	.27	.09	.54
Number of children	.01	.46	−.05	.59
Years of experience	−.10	.13	−.07	.57
Education level	−.09	.15	.05	.62
Spouse's education level	−.21	.007	.02	.84
Family income	−.40	<.0001	−.28	.005

F (9, 127) = 7.07; p < .0001

R² = 33%.

The second regression model was run afterwards where disclosure of violence was the dependent variable. Physical partner violence, psychological partner violence, and psychological health status were the independent variables. Demographic characteristics that were controlled in the first regression model were also controlled in the second regression model. Results indicated that the second regression model was significant (F = 6.45, p < .0001). Controlling for the demographic variables in the model, both psychological partner violence and psychological health status were significant predictors for women's disclosure of partner violence (p = 0.02). Standardized coefficients (β) for psychological partner violence and psychological health status were 0.45 and 0.26, respectively. See Table 3.

Table 3.

Model 2: Regression of Violence Disclosure on Physical Partner Violence, Psychological Partner Violence, and Psychological Health Status.

Independent variables	Correlation (r)	Sig.	Standardized coefficients (β)	p-value
Physical violence	.57	<.0001	.10	.61
Psychological violence	.63	<.0001	.45	.02
Psychological health	.54	<.0001	.26	.02
Controlled variables
Age	−.04	.39	−.06	.76
Marriage years	−.01	.47	−.22	.27
Number of children	.26	.02	.26	.07
Years of experience	−.01	.48	−.09	.64
Education level	.04	.36	.01	.95
Spouse's education level	−.13	.16	.16	.18
Family income	−.27	.01	−.06	.67

F (10, 4) = 6.45; p < .0001

R² = 54%.

Finally, since both physical violence and psychological violence had direct and indirect effects on disclosure of violence (Figure 2), standardized coefficients associated with these two variables on one hand and disclosure of violence on the other hand were calculated. After controlling for the demographic variables in the models, psychological partner violence showed the greatest total effect on disclosure of violence (β = .55), compared to physical partner violence and psychological health status. The total effect of physical partner violence, psychological partner violence, and psychological health status were summarized in Table 4.

Figure 2.

Path analysis for the relationship between factors in the study.

Table 4.

Total Effect of the Predictors on Partner Violence Disclosure^a.

Predictors of violence disclosure	Direct effect (β)	Indirect effect (β)	Total effect (β)
Physical violence	.10	.008	.11
Psychological violence	.45	.104	.55
Psychological health	.26	−	.26

Controlling for age, marriage years, number of children, years of experience, education level, spouse's level of education, and family income.

Discussion

There are three major findings in the study. The first finding was that women's experience of psychological partner violence determines their psychological health status and their choice to disclose violence. The second finding was that women's complaints of psychological problems played an important role in influencing their decisions to disclose partner violence. Finally, the third important finding was that women's complaints of psychological problems played a mediating effect between their experiences of psychological partner violence and making them chose to disclose violence to others. Below, we discuss our findings in light of related literature considering women's culture and customs.

Women's complaints of psychological problems are related to their experience of violence in general, and psychological violence is specific, is a finding supported previously in related studies. Internationally, a wide range of studies supported this finding in women from different cultures and backgrounds (Al-Modallal et al., 2008; Edwards et al., 2015; Glowacz et al., 2022; Umubyeyi et al., 2014) including Arab women (Al-Modallal, 2012a; Douki et al., 2003; Maziak & Asfar, 2003). In Jordan, different studies targeting women from different backgrounds supported the predictive relationship between violence and psychological health problems (Al-Modallal, 2012a; Al-Modallal et al., 2010). For example, in a comparative study of Jordanian women between those visiting Governmental health centers and those visiting the UN Relief and Works Agency's health centers, researchers reported that women's experience of partner violence predicted different psychological health problems including depression, anxiety, stress (Al-Modallal et al., 2014). Focusing exclusively on psychological violence, evidences from Jordanian studies supported the direct relationship between psychological partner violence and women's complaints of psychological health problems (Al-Modallal, 2012a).

The question raised in this context is that why psychological partner violence, rather than physical partner violence, was significant in predicting women's psychological problems. We assume presence of two reasons behind this relationship. The first reason is related to the type of questions representing psychological violence. For example, a question such as “I couldn’t seem to experience any positive feeling at all” deeply affects psychological status of the woman and makes her relive the experience once facing such questions. Nature of psychological violence questions supports the assumption that violence is recognized as a mental, rather than social or familial, issue facing women (Kumar et al., 2013). This characteristic supports our finding.

The second reason behind this relationship is that previous studies revealed that psychological violence have a more profound effect on victim's physical health compared to other types of violence (Al-Modallal, 2016). When impact of psychological violence on victims’ psychological problems was examined, evidences of significant relationships were revealed (Al-Modallal, 2012a; Al-Modallal et al., 2014). The proposed relationship between psychological partner violence and psychological health status in women could be explained by the effect of women's socioeconomic status including employment, income, and education (Nurius et al., 2003), social factors (Rioli et al., 2017) and by women being occupied with family demands (Al-Modallal, 2012a). Such findings emphasize the importance of all kinds of violence on victims’ health with great emphasis being paid on women's psychological health.

The second major finding indicated that women's complaints of psychological problems played an important role in influencing their decisions to disclose partner violence. This pathway can be discussed given that victims of violence choose to disclose violence for the sake of their job stability. In a qualitative study of mental health service users, investigators revealed that mental health service users and health professionals agreed that the major facilitator of disclosure of violence is support and trust between individuals and health professionals (Rose et al., 2011). Similar association was revealed based on results of a systematic review search (Heron & Eisma, 2021). Social support from people available in victims’ lives significantly predicts job stability (Staggs et al., 2007). The linkage between social support, disclosure of violence, and job stability indicates that the psychological health status of victims can be altered and modified in a way to influence their decision to disclose violence. Establishment of a trusting relationship and fostering social support from family, friends, and coworkers are crucial in enhancing disclosure of violence in women.

The relationship between psychological problems and disclosure of violence can also be clarified by knowing that disclosure of violence is used by victims of violence as a coping strategy (Swanberg et al., 2007). This coping strategy helps victims of violence in two ways. First, it may prevent the development of mental illnesses because of experiencing chronic psychological problems. Second, women with psychological problems disclose their experience of violence to be able to continue in their life. This occurs because women from this culture know that they are committed to the husband, family, and extended family in a way that prevents them from ending the relationship easily or quickly. Therefore, they disclose violence to cope with the experience and eventually maintain the family unit.

Regarding our finding of the mediating effect of psychological status between women's experiences of psychological partner violence and making them chose to disclose violence to others, we suggest the following explanation for this relationship. It was reported that the negative social stigma associated with women's experience of partner violence prevents them from telling others about their experience (Al-Badaynedh, 2012; Al-Modallal et al., 2012). In addition, some psychological constraints (such as fear of consequences) may hinder victims of violence to disclose their experience to others (Al-Modallal, 2016; Rose et al., 2011). The question raised here is how do psychological problems mediate the relationship between violence and violence disclosure?

We can answer this question considering our participants and their characteristics. Our participants are working women which means that they possess different characteristics that nonworking women possess. For instance, working women by nature serve others and have connections with people in their work community. This characteristic provides them the opportunity to disclose their violence experience to others and thereafter get required support and advice (Al-Modallal et al., 2012). The social support from coworkers moderates the association between violence victimization and their psychological well-being (Holt & Espelage, 2005) and, thereafter, enhances their psychological well-being. This moderation effect influences women's, and working women's, decision to disclose violence to others.

Related literature provided examples of protective factors that inhibit the development of psychological health problems in victims of violence. Among these factors are education, employment, self-esteem, health, and absence of economic hardship (Carlson et al., 2002). Working women have such factors which makes them liable to disclose violence with no constraints. For example, the employment status of our participants is one of the major protective factors that can be considered. Employment means that the woman has adequate education, regular monthly income that covers basic needs, and health insurance benefits. For nonworking women, disclosing violence to others and asking for help may label the woman as rebellious against her husband. Such label may lead to undesirable outcomes such as divorce (Al-Badaynedh, 2012). Divorce or separation makes women encounter severely complicated issues such as finance and custody issues. Such issues are shoulder-burdening to the woman especially if she has more than one child, unemployed, or has limited source of income. In our case, the participants will not suffer the psychological consequences associated with limited finance, custody, or separation as nonworking women. Therefore, their decision to disclose violence is considered an option for them.

Conclusion

This study was the first of a kind that examines the mediation effect of psychological problems on women's decision to disclose violence to others. The ultimate outcome we assumed from this study is to influence women to disclose violence to others whether that disclosure was directed to formal or informal parties. Disclosure of violence provides women with outlets to vent about the violence and in the meantime get required social support or help. Social support, in and of itself, from family/friends, coworkers, or legal authorities may encourage women to disclose violence to others. This attribute ease intervention efforts provided to help victimized women.

Although employers were not targeted in this study, it is important to emphasize their role in preventing violence against working women. Employers are effective contributors in implementing primary prevention measures against violence. For example, they can provide means of teaching employees ways to protect themselves from being victimized while at work. Employers can also ensure utilization of proper security measures such as suitable identification system for visitors and an alarm system to access security, if needed. Although such interventions may not apply to all work settings, dissemination of violence prevention strategies would be of extreme benefit to employers and employees as well.

Relevance to Clinical Practice

Implications for this study are relevant to clinical practice and can be implemented at community levels. The focus of the implementation should be directed to victims of violence as well as health professionals encountering these victims in different health care settings. Women must be encouraged (during their encounters with health professionals) to disclose violence and possible health and psychological problems associated with this experience. Women need to be encouraged to disclose every experience of violence even when they are sure that no physical trauma is associated with such experience. This is necessary because the sensitivity of the topic may prevent them from disclosing violence experiences unless they are asked about it.

It is important for health professionals to know reasons behind women's lack of partner violence disclosure. This knowledge guides their practice. Development and adoption of standardized screening tools that are culturally sensitive is necessary in screening victims of partner violence. Such practice would limit health professionals’ lost opportunity to identify violence victims.

Victimized women can disclose violence victimization to people within the family unit or to people in the work context (Swanberg et al., 2006). Further, women have the opportunity to disclose violence experiences to health professionals during health care visits (Heron & Eisma, 2021). To invest these disclosure outlets for the sake of victims, screening for violence victimization should be implemented in health care settings as a standardized practice of care in different health care settings.

Footnotes

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Hanan Al-Modallal

References

Al-Badaynedh

(2012). Violence against women in Jordan. Journal of Family Violence, 27(5), 369–379. https://doi.org/10.1007/s10896-012-9429-1

Al-Modallal

(2012a). Psychological partner violence and women’s vulnerability to depression, stress, and anxiety. International Journal of Mental Health Nursing, 21(6), 560–566. https://doi.org/10.1111/j.1447-0349.2012.00826.x

Al-Modallal

(2012b). Patterns of coping with partner violence: Experiences of refugee women in Jordan. Public Health Nursing, 29(5), 403–411. https://doi.org/10.1111/j.1525-1446.2012.01018.x

Al-Modallal

(2016). Effect of intimate partner violence on health of women of Palestinian Origin. International Nursing Review, 63(2), 259–266. https://doi.org/10.1111/inr.12239

Al-Modallal

(2017). Disclosure of spousal violence: Viewpoints from the Jordanian society. Journal of Interpersonal Violence, 32(2), 164–182. https://doi.org/10.1177/0886260515585538

Al-Modallal

Abu Zayed

Abujilban

Shehab

Atoum

(2015). Prevalence of intimate partner violence among women visiting health care centers in Palestine refugee camps in Jordan. Health Care for Women International, 36(2), 137–148. https://doi.org/10.1080/07399332.2014.948626

Al-Modallal

Abuidhail

Sowan

Al-Rawashdeh

(2010). Determinants of depressive symptoms in Jordanian working women. Journal of Psychiatric and Mental Health Nursing, 17(7), 569–576. https://doi.org/10.1111/j.1365-2850.2010.01562.x

Al-Modallal

Al-Omari

Abujilban

Mrayan

(2016). Intimate partner violence and female nurses’ employment: Disclosure and consequences. Journal of Family Violence, 31(2), 161–166. https://doi.org/10.1007/s10896-015-9755-1

Al-Modallal

Hamaideh

Mudallal

(2014). Mental health status of women in Jordan: A comparative study between attendees of governmental and UN relief and works agency’s health care centers. Issues in Mental Health Nursing, 35(5), 386–394. https://doi.org/10.3109/01612840.2013.807449

10.

Al-Modallal

Peden

Anderson

(2008). Impact of physical abuse on adulthood depressive symptoms among women. Issues in Mental Health Nursing, 29(3), 299–314. https://doi.org/10.1080/01612840701869791

11.

Al-Modallal

Sowan

Hamaideh

Peden

Al-Omari

Al-Rawashdeh

(2012). Psychological outcomes of intimate partner violence experienced by Jordanian working women. Health Care for Women International, 33(3), 217–227. https://doi.org/10.1080/07399332.2011.610532

12.

Allard

M. A.

Albelda

Colten

M. E.

Cosenza

(1997). In harm’s way? Domestic violence, AFDC receipt, and welfare reform in Massachusetts. University of Massachusetts, McCormack Institute and Center for Survey Research. http://www.mccormack.umb.edu/editor_uploads/images/centers_institutes/center_social_policy/In_Harms_Way_Domestic_Violence,_AFDC_Receipt,_and_Welfare_Reform_in_Massachusetts.pdf

13.

Antony

M. M.

Bieling

P. J.

Cox

B. J.

Enns

M. W.

Swinson

R. P.

(1998). Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychological Assessment, 10(2), 176–181. https://doi.org/10.1037/1040-3590.10.2.176

14.

Bandara

Page

Senarathna

Wijewardene

Silva

Gunnell

Knipe

Rajapakse

Zakar

(2022). Clinical and psychosocial factors associated with domestic violence among men and women in Kandy, Sri Lanka. PLOS Global Public Health, 2(4), e0000129. https://doi.org/10.1371/journal.pgph.0000129

15.

Beydoun

H. A.

Williams

Beydoun

M. A.

Eid

S. M.

Zonderman

A. B.

(2017). Relationship of physical intimate partner violence with mental health diagnoses in the nationwide emergency department sample. Journal of Women's Health, 26(2), 141–151. https://doi.org/10.1089/jwh.2016.5840

16.

Brush

L. D.

(2003). Effects of work on hitting and hurting. Violence Against Women, 9(10), 1213–1230. https://doi.org/10.1177/1077801203255848

17.

Carlson

B. E.

McNutt

Choi

D. Y.

Rose

I. M.

(2002). Intimate partner abuse and mental health: The role of social support and other protective factors. Violence Against Women, 8(6), 720–745. https://doi.org/10.1177/10778010222183251

18.

Dokkedahl

Kok

R. N.

Murphy

Kristensen

T. R.

Bech-Hansen

Elklit

(2019). The psychological subtype of intimate partner violence and its effect on mental health: protocol for a systematic review and meta-analysis. Systematic Reviews, 8(1), 1–10. https://doi.org/10.1186/s13643-019-1118-1

19.

Douki

Nacef

Belhadj

Bouasker

Ghachem

(2003). Violence against women in Arab and Islamic countries. Archives of Women's Mental Health, 6(3), 165–171. https://doi.org/10.1007/s00737-003-0170-x

20.

Edwards

K. M.

Dardis

C. M.

Sylaska

K. M.

Gidycz

C. A.

(2015). Informal social reactions to college women’s disclosure of intimate partner violence: Associations with psychological and relational variables. Journal of Interpersonal Violence, 30(1), 25–44. https://doi.org/10.1177/0886260514532524

21.

Eriksen

A. M. A.

Melhus

Jacobsen

B. K.

Schei

Broderstad

A.-R.

(2021). Intimate partner violence and its association with mental health problems: The importance of childhood violence – The SAMINOR 2 Questionnaire Survey. Scandinavian Journal of Public Health, 50(8), 1179–1191. https://doi.org/10.1177/14034948211024481

22.

Glowacz

Dziewa

Schmits

(2022). Intimate partner violence and mental health during lockdown of the COVID-19 pandemic. International Journal of Environmental Research and Public Health, 19(5), 1–16. https://doi.org/10.3390/ijerph19052535

23.

Heron

R. L.

Eisma

M. C.

(2021). Barriers and facilitators of disclosing domestic violence to the healthcare service: A systematic review of qualitative research. Health & Social Care in the Community, 29(3), 612–630. https://doi.org/10.1111/hsc.13282

24.

Holt

M. K.

Espelage

D. L.

(2005). Social support as a moderator between dating violence victimization and depression/anxiety among African American and Caucasian adolescents. School Psychology Review, 34(3), 309–328. https://doi.org/10.1080/02796015.2005.12086289

25.

Kumar

Nizamie

S. H.

Srivastava

(2013). Violence against women and mental health. Mental Health & Prevention, 1(1), 4–10. https://doi.org/10.1016/j.mhp.2013.06.002

26.

Lovibond

P. F.

Lovibond

S. H.

(1995). The structure of negative emotional states: Comparison of the depression anxiety stress scales (DASS) with the beck depression and anxiety inventories. Behaviour Research and Therapy, 33(3), 335–343. https://doi.org/10.1016/0005-7967(94)00075-u

27.

Maziak

Asfar

(2003). Physical abuse in low-income women in Aleppo, Syria. Health Care for Women International, 24(4), 313–326. https://doi.org/10.1080/07399330390191689

28.

Nurius

P. S.

Macy

R. J.

Bhuyan

Holt

V. L.

Kernic

M. A.

Rivara

F. P.

(2003). Contextualizing depression and physical functioning in battered women: Adding vulnerability and resources to the analysis. Journal of Interpersonal Violence, 18(12), 1411–1431. https://doi.org/10.1177/0886260503258033

29.

Rioli

Sgarbi

Moretti

Sinisi

De Fazio

Giambalvo

Ferrari

Galeazzi

G. M.

(2017). An update on intimate partner violence and mental health. Minerva Psichiatrica, 58(4), 216–233. https://doi.org/10.23736/S0391-1772.17.01943-4

30.

Rose

Trevillion

Woodall

Morgan

Feder

Howard

(2011). Barriers and facilitators of disclosures of domestic violence by mental health service users: Qualitative study. British Journal of Psychiatry, 198(3), 189–194. https://doi.org/10.1192/bjp.bp.109.072389

31.

Rosenberg

(1965). Society and the adolescent self-image. Princeton University Press.

32.

Staggs

S. L.

Long

S. M.

Mason

G. E.

Krishnan

Riger

(2007). Intimate partner violence, social support, and employment in the post-welfare reform era. Journal of Interpersonal Violence, 22(3), 345–367. https://doi.org/10.1177/0886260506295388

33.

Swanberg

J. E.

Macke

(2006). Intimate partner violence and the workplace: Consequences and disclosure. Affilia: Journal of Women and Social Work, 21(4), 391–406. https://doi.org/10.1177/0886109906292133

34.

Swanberg

J. E.

Macke

Logan

T. K.

(2006). Intimate partner violence, women, and work: Coping on the job. Violence and Victims, 21(5), 561–578. https://doi.org/10.1891/0886-6708.21.5.561

35.

Swanberg

Macke

Logan

T. K.

(2007). Working women making it work: Intimate partner violence, employment, and workplace support. Journal of Interpersonal Violence, 22(3), 292–311. https://doi.org/10.1177/0886260506295387

36.

Umubyeyi

Mogren

Ntaganira

Krantz

(2014). Intimate partner violence and its contribution to mental disorders in men and women in the post genocide Rwanda: Findings from a population based study. BMC Psychiatry, 14(1), 1–12. https://doi.org/10.1186/s12888-014-0315-7