If You Can’t Say Something Nice: A Latent Profile Analysis of Social Reactions to Intimate Partner Violence Disclosure and Associations With Mental Health Symptoms

Abstract

The social reactions that victims receive when disclosing intimate partner violence (IPV) have important implications for recovery and well-being. Women from the community (n = 172) reported IPV, reactions to IPV disclosure, and mental health symptoms in individual interviews. Latent profile analyses revealed three subgroups of victims with varied experiences of reactions. The group characterized by high negative/low positive reactions reported the highest depression and posttraumatic stress disorder (PTSD) symptom severity; symptom severity was high regardless of IPV severity. However, symptoms were only severe at high IPV severity among individuals classified into groups characterized by high positive reactions, and by low negative and low positive reactions.

Keywords

intimate partner violence social reactions IPV disclosure depression PTSD

Extensive research has shown that intimate partner violence (IPV) is linked to numerous indicators of poor health functioning, including depression and posttraumatic stress disorder (PTSD; J. C. Campbell, 2002; Coker, Davis, et al., 2002; Ellsberg, Jansen, Heise, Watts, & Garcia-Moreno, 2008; Golding, 1999). As a result, researchers have aimed to identify modifiable factors associated with IPV experiences that may attenuate these outcomes. One such factor that has garnered considerable attention is disclosure of IPV (see Sylaska & Edwards, 2014, for a review), including the social reactions that victims receive when they disclose (Ahrens, 2006; Edwards, Dardis, Sylaska, & Gidycz, 2015; Goodkind, Gillum, Bybee, & Sullivan, 2003; Ullman, 2000). Research has shown that different types of social reactions can either improve or hinder the recovery process; however, most relevant research has taken a variable-centered approach to understand this process, which focuses on the extent to which negative and positive reactions independently predict well-being. Given that the overwhelming majority of victims receive a mix of both negative and positive social reactions (Trotter & Allen, 2009; Uchino, Holt-Lunstad, Smith, & Bloor, 2004), research on disclosure can be extended by employing a person-centered analytic approach to identify: (a) subgroups of victims classified by patterns of shared experiences of positive and negative reactions to disclosure, (b) how these subgroups’ profiles of reactions directly relate to mental health outcomes, and (c) the extent to which these profiles modulate the associations between IPV severity and mental health outcomes.

Social Reactions to Disclosure

Most research on IPV disclosure has focused on investigating predictors and outcomes of choosing to disclose versus not to disclose (Sylaska & Edwards, 2014). Results of these studies have shown that there are a multitude of individual and situational factors that increase the likelihood of IPV disclosure. Although most women do disclose to at least one person, they are more likely to do so if IPV is frequent and severe, another person witnesses the IPV, or if they feel less shame and fear related to IPV (Sylaska & Edwards, 2014).

Women who choose to disclose may experience a broad range of social reactions. These reactions may be verbal or nonverbal and can be characterized generally into two categories: positive and negative (Ullman, 1996b, 2000). Positive reactions are broadly defined as reactions that are helpful or supportive to the victim and may be characterized by emotional support (e.g., believing the victim, validating feelings) or instrumental support (e.g., helping the victim seek counseling or medical services). Conversely, negative reactions are unsupportive and may include blaming the victim, minimizing the experience, or disbelieving.

Social psychological research highlights the benefits of the self-disclosure process. Receiving responsive, positive reactions ensures that the other individual is attentive to one’s needs, wants, and goals (Berg, 1987; Greene, Derlega, & Mathews, 2006; Laurenceau, Barrett, & Pietromonaco, 1998; Reis & Shaver, 1988), and increases the discloser’s well-being (Chaudoir & Fisher, 2010; Greene et al., 2006). In fact, the Disclosure Processes Model (DPM) posits that social support is one of three distinct processes that explains when and why interpersonal disclosure can be beneficial (Chaudoir & Fisher, 2010). These effects have been demonstrated in a variety of domains (e.g., sexual orientation, abortion; Major et al., 1990; Rosario, Schrimshaw, & Hunter, 2009). In addition, experimental research has shown that women who disclosed a personal secret experienced better physical health at an 8-week follow-up, but only if they received accepting reactions (Rodriguez & Kelly, 2006).

Directly relevant to the current study, research also has shown that reactions to IPV disclosure are predictive of mental health outcomes, including depression and PTSD symptoms (Edwards et al., 2015; Levendosky et al., 2004; Schackner, Weiss, Edwards, & Sullivan, 2017; Stansell & Jennings, 2010). Specifically, recent research has demonstrated that positive reactions are related to victims’ perceived control over recovery which, in turn, are related to fewer PTSD symptoms (Ullman & Peter-Hagene, 2014), as well as lower depressive symptoms and decreased psychological distress (R. Campbell, Ahrens, Sefl, Wasco, & Barnes, 2001; Levendosky et al., 2004). Conversely, negative social reactions to assault disclosure have been associated with increased severity of depression and PTSD symptoms across studies (Edwards et al., 2015; Mitchell & Hodson, 1983; Moe, 2007; Ullman & Filipas, 2001; Ullman, Townsend, Filipas, & Starzynski, 2007), as well as problem drinking and general psychological distress (Borja, Callahan, & Long, 2006; Relyea & Ullman, 2015; Ullman, Starzynski, Long, Mason, & Long, 2008). Such reactions reinforced feelings of self-blame and acted as a barrier to future disclosure opportunities that may have resulted in support (Ahrens, 2006; Moe, 2007) and have been linked to a lower quality of life among women experiencing IPV (Goodkind et al., 2003).

Although most relevant research has aimed to understand the independent effects of negative and positive reactions to IPV disclosure, research suggests that the majority of victims who disclose receive a combination of both negative and positive reactions (e.g., Goodkind et al., 2003; Ingram, Betz, Mindes, Schmitt, & Smith, 2001; Uchino et al., 2004; Ullman, 1999). For example, Trotter and Allen (2009) found that 78% of victims who disclosed IPV received mixed reactions. However, such combinations of reactions have rarely been studied (Trotter & Allen, 2009; Uchino et al., 2004). Although some research has evaluated the prevalence of both negative and positive reactions (Moe, 2007; Turell & Herrmann, 2008) and has generally found that positive reactions are more common (Goodkind et al., 2003; Mitchell & Hodson, 1983), it is unclear how the simultaneous presence of both negative and positive reactions relates to mental health. Limited research suggests that receiving no social reactions results in better mental health outcomes than receiving negative reactions (R. Campbell et al., 2001), but additional research is needed to more effectively understand specific combinations of reactions and their consequences for victims’ well-being.

IPV Severity

Although most of the research described above emphasizes the direct effects of social reactions to disclosure on well-being, it is necessary to consider these associations within the broader context of victims’ IPV experiences. In addition to the effects of social reactions to disclosure on mental health symptoms, IPV severity is also a key predictor of increased depression and PTSD symptom severity (Sales, Baum, & Shore, 1984; Ullman & Filipas, 2001; Ullman et al., 2007).

In addition, social support in general has been shown to alleviate the effects of IPV severity on mental health outcomes (Coker, Smith, et al., 2002; Coker, Watkins, Smith, & Brandt, 2003). Although research often highlights the buffering effects of social support, studies also have shown that social undermining has independent, negative effects on mental health (e.g., Cranford, 2004; Heaney & Israel, 1997), which accentuates the importance of considering negative and positive social interactions in tandem. Consistent with this line of work, the associations between IPV and mental health may depend on the patterns of social reactions that women receive to disclosure. Specifically, patterns characterized by low negative social reactions and high positive reactions may buffer the effects of IPV, and patterns characterized by high negative and low positive reactions may exacerbate these effects.

Overview of Current Study

The first goal of this study is to understand the distribution of negative and positive social reactions to IPV disclosure that victims receive. To this end, latent profile analyses will be utilized to identify subgroups of women with similar profiles of reactions. Swartout, Swartout, and White (2011) propose that person-centered analytic approaches are lacking in research on violence against women, yet their use can greatly complement traditional analytic techniques. Research has shown that there is immense heterogeneity in victims’ experiences of IPV and sexual assault (Macy, Nurius, & Norris, 2007; Swartout et al., 2011). Thus, identifying profiles of these reactions is an important step toward understanding the broader context of women’s IPV experiences that impact well-being.

Another aim of the current research is to evaluate the associations between subgroup membership (i.e., latent profiles) and current mental health symptoms. Consistent with the variable-centered approaches within the IPV disclosure literature, we hypothesize that groups characterized by higher negative relative to positive social reactions will report more severe depression and PTSD symptoms. Given that the profile identification step is exploratory, we are not hypothesizing specific outcomes for each potential profile of social reactions.

The final goal of this study is to investigate the extent to which associations between IPV severity and mental health severity depend on profiles of social reactions to disclosure. Consistent with past research, we expect a linear relationship between IPV severity and mental health (i.e., depression and PTSD symptom severity). Without knowledge of the specific profiles that analyses will reveal, we cannot advance specific hypotheses; however, we have generated hypotheses for expected classes characterized by high versus low negative/positive reactions. In line with research that suggests social support acts as a buffering effect and that social undermining has the opposite effect (Coker, Smith, et al., 2002; Ullman, 1999), we predict that the effects of IPV severity on mental health symptoms will be attenuated among individuals classified into groups characterized by higher positive relative to negative social reactions, and exacerbated among individuals classified into groups characterized by higher negative relative to positive social reactions to disclosure.

Method

Participants

Women (N = 240) were recruited from an urban community to participate in a “Women’s Relationship Study” and completed a 2-hour interview about their relationship with their boyfriend or husband. To participate, women must have experienced physical victimization in the past 6 months perpetrated by their current male partner, as determined by responses to items from the Conflict Tactics Scale-2 (CTS-2; Straus, Hamby, & Warren, 2003) over a phone screening. Additional inclusion criteria required that participants were 18 years of age or older, currently in a relationship for at least 6 months, in contact with the partner multiple times per week without spending more than 2 full weeks apart, and had an annual income no greater than US$50,000. Data from 20 participants were removed due to failure to meet the screening criteria at the time of the study, although they met the criteria during the phone screening. Due to the focus on social reactions to IPV disclosure, data from 47 additional participants who never disclosed their IPV experiences were removed. The final sample consisted of 173 women between the ages of 18 and 58 years (M = 36.61, SD = 10.48) who had disclosed their IPV victimization to at least one person. The majority of participants (60%) were married or cohabitating, and their average relationship duration was 76.35 months (SD = 75.03). Most participants were also unemployed (66%), with a median annual income of US$9,600 and mean education level of 12.14 years (SD = 1.55). Participants’ mean number of children was 2.30 (SD = 2.13). Self-reported race/ethnicity was as follows: 66% African American, 20% White, 10% Latina, and 5% bi- or multiracial.

Procedures

Women were recruited from the community through flyers posted in establishments such as grocery stores, libraries, pizza and sandwich shops, convenience stores, primary care clinics, agencies such as the Departments of Adult Education and Employment, and nail and hair salons. Women who were interested in participating called to complete a phone screen to determine their eligibility. Eligible women were invited to participate in a 2-hr semistructured interview. All interviews were conducted face to face using computer-assisted interviewing (NOVA Research Company, 2003) by female master’s or doctoral level research associates who had undergone more than 20 hr of structured training. After the interview, participants were debriefed, compensated with US$50, and were provided with a list of community resources for domestic violence, unemployment, benefits assistance, and mental health and substance abuse treatment.

Measures

Social reaction to IPV disclosure

The social reactions to participants’ IPV disclosure were assessed with a modified version of the Social Reactions Questionnaire (SRQ; Ullman, 2000). The original measure was developed to assess the reactions that women receive when they disclose their sexual assault victimization to others; however, modifications were made to ensure that responses were appropriate for IPV (see Sullivan, Schroeder, Dudley, & Dixon, 2010, for factor analysis description). A total of 22 items represented negative social reactions (α = .89), and 17 items represented positive social reactions (α = .88). Participants reported how often they experienced each of the listed reactions in response to their IPV disclosure, with response options ranging from 0 (never) to 4 (always). They also reported to how many people they disclosed (M = 3.40, SD = 3.14). Sample items include, “Minimized the importance or seriousness of your experience” and “Listened to your feelings.”

Depression

The 20-item Center for Epidemiological Studies Depression Scale (CES-D; Radloff, 1977) was used to assess depression over the past 30 days. Participants reported how frequently they experienced depressive symptoms, with response options ranging from 1 (rarely or none of the time) to 4 (most or all of the time). Scores were summed with higher scores representing a greater severity of depressive symptoms (α = .82).

PTSD

Posttraumatic stress was assessed with the 49-item Posttraumatic Stress Diagnostic Scale (PDS; Foa, 1995) over the past 30 days. The 17 items that assessed re-experiencing, avoidance and numbing, and arousal symptoms were summed to create an index of PTSD symptom severity (α = .90).

IPV

IPV was assessed with a composite score combining three separate measures of physical, sexual, and psychological IPV victimization. All measures used a referent period of 6 months and referred to victimization perpetrated by their current partner. The 12-item physical assault subscale of the CTS-2 (Straus et al., 2003) was administered to assess physical IPV. Participants self-reported how many times each victimization act had occurred, with seven response options: never, once, twice, 3-5 times, 6-10 times, 10-20 times, more than 20 times in the past 6 months. Response categories presented as ranges were recoded according to the procedures suggested by Straus et al. (2003; i.e., 4 = 3-5; 8 = 6-10; 15 = 10-20; 25 = >20), and responses across the 12 items were summed such that higher scores represented great physical IPV severity (α = .90). To assess sexual IPV victimization, participants responded to the 10-item Sexual Experiences Survey (socioeconomic status [SES]; Koss & Oros, 1982), modified due to the high required reading level to improve comprehension among participants. Response options were the same as those for the CTS-2 and were recoded and summed using the same procedures described above (α = .89). Finally, psychological IPV was assessed with the 48-item Psychological Maltreatment of Women Inventory (PMWI; Tolman, 1989). Response options ranged from 1 (never) to 5 (very frequently), and responses were summed to create a total score (α = .96). To create a composite index of IPV, the scale scores for each of the three IPV measures were standardized because they were assessed on different response scales, then averaged, such that all three forms of IPV were weighted equally, and higher scores indicate greater IPV severity.

Analytic Approach

Latent profile analysis (LPA) was used to identify subgroups (i.e., classes) of participants based on their experiences of (a) negative social reactions to IPV disclosure, and (b) positive social reactions to IPV disclosure. Next, class differences for mental health outcomes (i.e., depression and PTSD symptom severity) were evaluated. Finally, moderation analyses were conducted to determine the extent to which group membership moderates the association between IPV severity and mental health symptom severity.

LPA was conducted with Mplus software and model parameters were estimated via maximum likelihood procedures (Muthén & Muthén, 2012). Analyses were conducted using Asparouhov and Muthén’s (2013) three-step approach, in which the number of distinct latent profiles are identified and modeled to predict distal outcomes (i.e., depression, PTSD symptoms) while accounting for the uncertainty in profile membership. LPA is a person-centered analytic technique utilized to detect unobserved heterogeneity in a given population and to identify meaningful subgroups based upon similarity of responses to measured variables (Nylund, Asparouhov, & Muthén, 2007). Advantages of this approach include a model-based method for estimating population characteristics derived from sample data, statistical procedures for determining the number of classes to retain, and flexible treatment of variance among classes (Magidson & Vermunt, 2001; Muthén & Muthén, 2012; Nylund et al., 2007). The two LPA indicators were standardized prior to analysis to allow for comparisons with the full sample means. Indices of model fit as well as conceptual considerations, including interpretability of classes and class sample sizes, will guide the decision regarding the number of latent profiles to retain. To evaluate model fit, models with an increasing number of profiles were estimated and compared on multiple indices. Lower values for Bayesian information criterion (BIC) and Akaike information criterion (AIC) and a higher value for log likelihood indicate better model fit; we focused on BIC which is considered to be the superior and most reliable model fit index (Nylund et al., 2007). Conceptual issues were also considered, as extant theory and interpretability are considered key criteria for determining the number of classes to be retained (Nylund et al., 2007). Following the identification of latent classes, class differences for distal outcomes were assessed using a weighting procedure to account for classification error with parameter comparisons using the Wald chi-square test (Asparouhov & Muthén, 2007).

To test whether the associations between IPV and mental health symptom severity depend on class membership (i.e., profiles of social reactions to IPV disclosure), moderation analyses were assessed using the PROCESS macro for SPSS (Hayes, 2012). Two separate models were evaluated to assess depression and PTSD severity as outcomes. Variables were standardized such that the terms “high” and “low” are relative to the full sample average.

Results

Latent Profile Analysis: Class Identification

Prior to the primary analyses, descriptive statistics and bivariate correlations were evaluated (see Table 1). Next, latent profile analyses were conducted. Patterns across fit indices did not clearly specify one model as the best; both a two-class and three-class model fit the data (see Table 2). BIC was lowest for the two-group solution; however, differences in BIC less than three are considered negligible (Kass & Raftery, 1995), which suggests that the three-class solution fits the data equally as well. The Vuong-Lo-Mendell-Rubin likelihood ratio test (p = .105) was nonsignificant for the three-class solution indicating that two classes are sufficient and a third is not necessary; however, the parametric bootstrapped likelihood ratio test was significant (p < .001) suggesting that three classes fit better than two. We retained a three-class (see Figure 1) model based on theory and interpretability. Past research has shown that 78% of women who disclose IPV receive a mix of positive and negative reactions (Trotter & Allen, 2009); thus, we expected multiple groups reflecting this variation in reactions. In addition, approximately 84% of participants were classified into a single group in the two-group model, which limits the ability to draw meaningful conclusions about potential group differences. Class 1 is comprised of 60 women who received low negative (M = −0.84, SE = 0.15) and high positive (M = 1.35, SE = 0.26) reactions; Class 2 in comprised of 25 women who received high negative (M = 2.62, SE = 0.44) and low positive (M = −0.28, SE = 0.28) reactions; Class 3 is comprised of 88 women who received low negative (M = −0.28, SE = 0.23) and low positive (M = −0.89, SE = 0.21) reactions.

Table 1.

Descriptive Information and Correlations (N = 173).

	1	2	3	4	5
1. Negative social reactions	—
2. Positive social reactions	.15	—
3. Depression symptom severity	.22*	.04	—
4. PTSD symptom severity	.33**	.10	.71**	—
5. IPV severity	.35*	.11	.52**	.54**	—
M (SD)	16. 95 (12.11)	31.29 (9.41)	21.02 (12.05)	16.93 (10.49)	.00 (0.78)

Note. PTSD = posttraumatic stress disorder; IPV = intimate partner violence.

p < .05. **p < .01.

Table 2.

Fit Indices for Latent Classes.

	2 classes	3 classes	4 classes	5 classes
BIC	971.95	973.64	978.714	987.13
Adjusted BIC	949.78	941.97	937.55	936.47
AIC	949.87	942.11	937.72	936.68
Log likelihood	−467.94	−461.05	−455.86	−452.34
Entropy	.789	.672	.688	.758
Class sample sizes	146, 27	25, 60, 88	53, 45, 47, 18	1, 49, 64, 44, 15
VLMR LRT	p = .011	p = .105	p = .191	p = .037
BLRT	p < .001	p < .001	p = .030	p = .217

Note. BIC = Bayesian information criterion; AIC = Akaike information criterion; VLMR LRT = Vuong-Lo-Mendell-Rubin likelihood ratio test; BLRT = bootstrapped likelihood ratio test.

Figure 1.

Latent profile analysis.

Associations Between Latent Class and Mental Health Symptoms

Omnibus equality tests of means across classes showed a significant effect for depression symptom severity, χ²(2) = 6.89, p = .032. Women classified into the high negative/low positive reactions group had significantly higher depression symptom severity (M = 0.47, SE = 0.20) than women classified into the low negative/high positive group (M = −0.09, SE = .12), χ²(1) = 5.73, p = .017, and the low negative/low positive group (M = −0.10, SE = 0.11), χ²(1) = 6.31, p = .012. However, there were no significant differences in depression symptom severity between the low negative/high positive and low negative/low positive reactions groups, χ²(1) = 0.001, p = .970.

Similarly, equality tests of means across classes revealed a significant overall effect for PTSD symptom severity, χ²(2) = 21.48, p < .001. Women classified into the high negative/low positive reactions group reported significantly higher PTSD symptom severity (M = 0.74, SE = 0.19) than women in the low negative/high positive group (M = −0.03, SE = 0.12), χ²(1) = 11.39, p = .001, and the low negative/low positive group (M = −0.25, SE = 0.10), χ²(1) = 21.46, p < .001. However, there were no significant differences in PTSD symptom severity between the low negative/high positive and low negative/low positive groups, χ²(1) = 2.01, p = .156.

Moderating Effect of Latent Class

Two separate models were analyzed to assess the extent to which latent profile membership moderated the effect of IPV severity on depression and PTSD symptom severity, respectively. For this set of analyses, significance was determined through 95% bias-corrected bootstrapped confidence intervals based on 1,000 bootstrapped samples. Confidence intervals that do not contain zero are statistically significant (at p < .05).

Following the procedures outlined by Hayes and Montoya (2017) for multicategorical moderators, social reactions to disclosure group membership was dummy coded such that D1 indicated membership to the high negative/low positive group, D2 indicated membership to the low negative/high positive group, and membership to the low negative/low positive group was the referent category (coded as 0 for both D1 and D2). This approach allows us to compare the high negative/low positive and low negative/high positive groups to the low negative/low positive reactions group in a single model.

First, the interaction between IPV severity and latent class membership predicting depression severity was evaluated (Table 3). The overall model was significant, F(5,167) = 15.23, p < .001; IPV, latent class membership, and their interaction explained 31.3% of the variance in depression symptom severity. The R² change due to the addition of the interaction terms was statistically significant (p = .01) indicating that the association between IPV severity and depression symptom severity is dependent on profiles of social reactions to IPV disclosure. Specifically, the link between IPV and depression severity was positive and significant for the low negative/high positive group, B(SE) = 10.70 (1.76), p < .001, bootstrapped 95% confidence interval (CI): [7.22, 14.18], and for the low negative/low positive group, B(SE) = 8.55 (1.60), p < .001, 95% CI: [5.40, 11.71]. However, as shown in Figure 2, the slope for the high negative/low positive group was not significant, B(SE) = 2.78 (1.98), p = .163, 95% CI: [–1.13, 6.69], indicating that IPV severity was not associated with depression symptom severity; depression symptom severity was high across all levels of IPV.

Table 3.

Results for Moderation Analyses.

	B (SE)	p	95% CI: [LL, UP]
Model 1: Depression symptom severity
Intercept	21.01 (1.09)	<.01**	[18.85, 23.16]
IPV	8.55 (1.60)	<.01**	[5.40, 11.71]
D1	4.25 (2.47)	.09	[−0.63, 9.13]
D2	−0.48 (1.71)	.78	[−3.85, 2.89]
D1 × IPV	−5.78 (2.54)	.02*	[−10.80, –0.75]
D2 × IPV	2.14 (2.38)	.37	[−2.55, 6.84]
R² increase due to interaction: R² = .04, F(2,167) = 4.67, p = .01*
Model 2: PTSD symptom severity
Intercept	15.60 (0.89)	<.01**	[13.85, 17.35]
IPV	6.09 (1.29)	<.01**	[3.55, 8.64]
D1	8.86 (2.00)	<.01**	[4.91, 12.80]
D2	1.36 (1.38)	.33	[−1.37, 4.08]
D1 × IPV	−4.98 (2.05)	.02*	[−9.04, –0.93]
D2 × IPV	5.18 (1.92)	<.01**	[1.39, 8.98]
R² increase due to interaction: R² = .08, F(2,166) = 11.35, p < .01**

Note. Low negative/low positive = referent group. CI = confidence interval; LL = lower limit; UP = upper limit; IPV = intimate partner violence; D1 = dummy code for high negative/low positive; D2 = dummy code for low negative/high positive; PTSD = posttraumatic stress disorder.

p < .05. **p < .01.

Figure 2.

Association between IPV severity and depression symptom severity among different profiles of social reactions to IPV disclosure.

Next, the interaction between IPV severity and latent class membership predicting PTSD symptom severity was evaluated (Table 3). The overall model was significant, F(5,166) = 22.93, p < .001; IPV, latent class membership, and their interaction explained 40.9% of the variance in PTSD symptom severity. The R² change due to the addition of the interaction terms was statistically significant (p < .01) indicating that the association between IPV and PTSD symptom severity is dependent on profiles of social reactions to IPV disclosure. Consistent with the model for depression symptom severity, the link between IPV and PTSD symptom severity was positive and significant for the low negative/high positive group, B(SE) = 11.28 (1.42), p < .001, bootstrapped 95% CI: [8.47, 14.09], and for the low negative/low positive group, B(SE) = 6.09 (1.29), p < .001, 95% CI: [3.55, 8.64]. However, as shown in Figure 3, the slope for the high negative/low positive group was not significant, B(SE) = 1.11 (1.60), p = .488, 95% CI: [–2.05, 4.27] indicating that IPV severity was not associated with PTSD symptom severity; PTSD symptom severity was high across all levels of IPV severity.

Figure 3.

Association between IPV severity and PTSD symptom severity among different profiles of social reactions to IPV disclosure.

Discussion

Past research has demonstrated the relevance of IPV disclosure to victims’ recovery and well-being. Specifically, findings on social reactions to IPV disclosure suggest that negative and positive reactions independently predict mental health outcomes, yet a lack of person-centered approaches to investigating social reactions has resulted in a dearth of knowledge regarding how co-occurring, mixed, or other variations in reactions that individuals encounter predict mental health. As such, the current research fills a critical gap in the literature by providing greater contextualization to the dynamic nature of the consequences of IPV.

The results of this study revealed three distinct profiles of social reactions to IPV disclosure, which have important direct effects on victims’ mental health, and elucidate the associations between IPV severity and subsequent depression and PTSD symptom severity. The first profile that emerged was characterized by many negative reactions and few positive reactions to IPV disclosure. As expected, individuals classified into this group reported the highest levels of depression and PTSD symptom severity. Two other profiles emerged from analyses: one group characterized by low levels of negative and high levels of positive social reactions, and the other characterized by low levels of both negative and positive social reactions. Interestingly, there were no differences between these groups for mental health symptom severity. Consistent with past research (R. Campbell et al., 2001), we found that receiving strictly negative reactions resulted in more negative health outcomes than receiving few reactions of any type. Moderation hypotheses were partially supported. As predicted, the association between IPV severity and mental health severity was dependent on a woman’s profile of disclosure reactions. There was no significant relationship between IPV severity and either indicator of mental health within the high negative/low positive group; symptom severity was high at all levels of IPV severity. For the other two groups, there was a positive significant association between IPV severity and mental health. Contrary to what was hypothesized, this suggests that there was no buffering effect of positive social reactions. These results suggest that negative reactions can be so powerful that positive reactions do not buffer their effects. Limited variable-centered research also raises this possibility (Schackner et al., 2017).

Strengths, Limitations, and Future Research Directions

There were several notable strengths to this study. First, the analytic approach filled an important gap in the research by allowing for the contextualization of how different types of social reactions to IPV disclosure are experienced and operate simultaneously to predict mental health outcomes. There has been limited attention to negative and mixed social reactions in general, and even less to person-centered analyses in this domain. The sample of this study was also a strength. In addition to diversity in participants’ age and racial/ethnic background, women were recruited from the community which allows for greater generalizability of findings. Recruiting IPV victims also extends the literature on assault disclosure which largely has focused on victims of sexual assault.

Although it was not identified in this analysis, perhaps because of the sample size, it is possible that a fourth group of people who receive a mix of high negative and high positive social reactions to disclosure exists in the population of IPV victims. If this is the case, it would be important to understand how this profile of reactions predicts mental health outcomes and to delineate the nature of the association between IPV severity and mental health among group members. It is important for other studies to replicate these methods to determine the extent to which the patterns identified in the current research generalize to other samples of IPV victims.

The results from this study suggest that negative reactions are impactful, to the extent that their effects are not attenuated by positive reactions. Furthermore, individuals report severe mental health symptom severity at high IPV severity regardless of one’s profile of social reactions. However, this does not mean that people should withhold responses of empathy and support. Our finding may partially be a limitation of the data, which focus specifically on mental health outcomes. Future research should also integrate positive outcomes such as life satisfaction, posttraumatic growth, and feelings of empowerment, for which positive reactions to disclosure may have a more notable effect (Beeble, Bybee, Sullivan, & Adams, 2009; Perez, Johnson, & Wright, 2012; Prati & Pietrantoni, 2009; Song, 2012).

Finally, much of the previous research on social reactions to disclosure is specific to sexual assault. It is important for future research utilizing person-centered techniques to more comprehensively acknowledge the distinctions between disclosure of psychological, physical, and sexual victimization, as well as the different types of relationships between the victim, perpetrator, and the person to whom the disclosure was made. This will allow researchers and clinicians to understand how these variations specifically relate to victims’ general well-being to better inform prevention and intervention efforts and perhaps training of professionals. For instance, endorsement of rape myth beliefs commonly described in the sexual assault literature (e.g., the victim is partially to blame if she was intoxicated or wearing revealing clothing) may be particularly damaging reactions for victims who were sexually assaulted by a stranger or acquaintance. Alternatively, victims who experience primarily psychological IPV may be accused of overreacting if they don’t have physical marks to “prove” the abuse, and IPV victims who don’t leave their partners (e.g., due to fear, financial barriers, etc.) might receive reactions that suggest they “got what they deserved.” Thus, person-centered approaches that seek to empirically evaluate the effects of patterns of reactions within the broader context of victimization experiences will fill an additional research gap and ultimately inform tailored interventions. Some researchers have focused on disclosure recipients and the conditions under which they respond negatively versus positively to others’ disclosure (e.g., Beeble, Post, Bybee, & Sullivan, 2008; Latta & Goodman, 2011; Ullman, 1996a). The Disclosure Process Model posits that outcomes of one disclosure event affects subsequent disclosure processes among individuals with concealable stigmatized identities and offers insight into how targets of disclosure can maximize the discloser’s well-being (Chaudoir & Fisher, 2010). These data specifically may serve to identify targets for change among disclosure recipients that could be enhanced by future research that takes into account specific attitudes and cognitions individuals hold about different types of victimization experiences.

Clinical and Practical Implications

Consistent with previous research, the present study demonstrates the harmful effects of receiving negative social reactions to IPV disclosure, highlighting important clinical and practical implications. While research has primarily and consistently documented the utilization of informal support systems (i.e., responses from family and friends) in the disclosure of IPV, clinicians and health care providers play a significant role as well. Professionals can assist victims in identifying those in their informal networks to gain support from, engage victims in coping with previous negative reactions received from family or friends, and provide the victim’s family and friends with guidance on how to best assist women as they seek safety. Clinicians and health care providers working with women currently experiencing or with a history of IPV should be mindful of how they express support in efforts to decrease symptom severity, improve mental health outcomes, and promote recovery. However, we cannot assume willful disclosure from victims; therefore, clinical tools such as universal screening measures can be helpful in identifying victims of IPV (Houry et al., 2008; Nelson, Bougatsos, & Blazina, 2012). Such tools may assist in encouraging disclosure, and potential intervention planning before mental health symptoms develop or worsen. The prevalence of IPV and detrimental physical, emotional, and psychological consequences of abuse highlight the urgency for health care providers to offer quality care to victims.

Conclusion

The results of this study provide novel insight into the experiences of IPV victims and their mental health symptoms. Using a person-centered analytic approach, we found that women who received reactions characterized by high levels of negativity fared worse in terms of depression and PTSD symptom severity and that receiving many positive reactions did not buffer this effect. Thus, results have important implications for how social support networks can respond to disclosure in ways that mitigate mental health symptom severity. If we are to improve the reactions victims receive, we must begin to facilitate discourse on how to appropriately respond to victims of IPV that can best aid in their safety and recovery. From a systems approach, this will require change at the interpersonal level, but also the community and societal levels. Efforts are needed to promote an environmental shift away from victim blaming and toward a commitment to prevention, education, early intervention, and accountability.

Footnotes

Declaration of Conflicting Interests

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

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The research described here was supported, in part, by grants from the National Institute on Drug Abuse (R03 DA17668, T32 DA019426).

Author Biographies

Jacqueline Woerner received her PhD in social psychology from Wayne State University and is currently a postdoctoral fellow at Yale University. The goal of her research is to understand the mechanisms by which interpersonal violence victimization disrupts social functioning and predicts health risk behaviors. She is also interested in the etiology of violence perpetration, including the ways in which alcohol intoxication and normative influence facilitate aggression.

Janan Wyatt is currently a predoctoral fellow at Yale University, working toward her PhD in clinical psychology. Operating from a social justice perspective, her research efforts focus on eliminating health disparities among underserved populations, promoting efficacious services for marginalized groups, and improving multicultural competence in both research and clinical practice. She seeks to understand the impact of various factors on health risk-behaviors for justice-involved groups in efforts to improve both prevention and treatment effectiveness.

Tami P. Sullivan is associate professor and director, Family Violence Research at Yale University. Her program of research centers on individual- and system-level factors that affect the well-being of victims of intimate partner violence (IPV). At the individual level, she conducts risk and protective factor research and has expertise in applying micro-longitudinal designs to better understand victims’ daily experiences. At the system level, she focuses on understanding the capacity of systems (e.g., criminal justice system) to meet victims’ unique needs. Her research is developed and conducted collaboratively with practitioners so that findings can inform the development of interventions to be implemented in community settings.

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