The Role of Race,Social Support,Empowerment,and Posttraumatic Cognitions in Survivors of Intimate Partner Violence Symptoms of Posttraumatic Stress Disorder
Restricted accessResearch articleFirst published online February, 2025
The Role of Race,Social Support,Empowerment,and Posttraumatic Cognitions in Survivors of Intimate Partner Violence Symptoms of Posttraumatic Stress Disorder
Black women experience more frequent and severe intimate partner violence (IPV), but there are mixed findings on their posttraumatic stress disorder (PTSD) symptom severity. This may be explained by cultural-salient factors which are associated with fewer posttraumatic cognitions. We hypothesized an indirect effect of race on PTSD symptoms via social support, empowerment, and posttraumatic cognitions, serially. Path analysis revealed Black women reported increased social support, which was associated with higher levels of empowerment, which was associated with lower levels of posttraumatic cognitions. Decreased posttraumatic cognitions were associated with less severe PTSD symptoms. Results increase understanding of culturally-salient factors that may impact PTSD symptoms in Black women.
AbramsJ. A.MaxwellM.PopeM.BelgraveF. Z. (2014). Carrying the world with the grace of a lady and the grit of a warrior: Deepening our understanding of the “Strong Black Woman” schema. Psychology of Women Quarterly, 38(4), 503–518. https://doi-org.ezproxy.uakron.edu:2443/10.1177/0361684314541418
Banks-WallaceJ.ParksL. (2004). It’s all sacred: African American women’s perspectives on spirituality. Issues in Mental Health Nursing, 25, 25–45. https://doi.org/10.1080/01612840490249028-22
4.
Beauboeuf-LafontantT. (2007). You have to show strength: An exploration of gender, race, and depression. Gender & Society, 21(1), 28–51. https://doi.org/10.1177/0891243206294108
5.
BlackM. C. (2011). Intimate partner violence and adverse health consequences. American Journal of Lifestyle Medicine, 5(5), 428–439. https://doi.org/10.1177/1559827611410265
6.
BlakeD. D.WeathersF. W.NagyL. M.KaloupekD. G.GusmanF. D.CharneyD. S.KeaneT. M. (1995). The development of a clinician-administered PTSD scale. Journal of Traumatic Stress, 8, 75–90. https://doi.org/10.1002/jts.2490080106
7.
BoschE.FerrerV. A. (2003). Mujeres maltratadas: Análisis de características sociodemográficas, de la relación de pareja y del maltrato [Battered women: Analysis of sociodemographic characteristics, couple’s relationship and abuse]. Intervención Psicosocial, 12, 325–344.
8.
BreidingM. J.ChenJ.BlackM. C. (2014). Intimate partner violence in the United States – 2010.National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.
9.
BronderE. C.SpeightS. L.WitherspoonK. M.ThomasA. J. (2014). John Henryism, depression, and perceived social support in Black women. The Journal of Black Psychology, 40(2), 115–137. https://doi.org/10.1177/0095798412474466
10.
Brooks HollidayS.DubowitzT.HaasA.Ghosh-DastidarB.DeSantisA.TroxelW. M. (2020). The association between discrimination and PTSD in African Americans: Exploring the role of gender. Ethnicity & Health, 25(5), 717–731. https://doi.org/10.1080/13557858.2018.1444150
11.
CarterR. T.ForsythJ. (2010). Reactions to racial discrimination: Emotional stress and help-seeking behaviors. Psychological Trauma: Theory, Research, Practice, and Policy, 2(3), 183–191. https://doi.org/10.1037/a0020102
12.
CattaneoL. B.GoodmanL. A. (2015). What is empowerment anyway? A model for domestic violence practice, research, and evaluation. Psychology of Violence, 5, 84. https://doi.org/10.1037/a0035137
13.
CokerA. L.DavisK. E.AriasI.DesaiS.SandersonM.BrandtH. M.SmithP. H. (2002). Physical and mental health effects of intimate partner violence for men and women. American Journal of Preventive Medicine, 23, 260–268. https://doi.org/10.1016/S0749-3797(02)00514-7
14.
DavisS. M. (2019). When Sistahs support Sistahs: A process of supportive communication about racial microaggressions among Black women. Communication Monographs, 86(2), 133–157. https://doi.org/10.1080/03637751.2018.1548769
15.
DavisS. M.AfifiT. D. (2019). The strong black woman collective theory: Determining the prosocial functions of strength regulation in groups of Black women friends. Journal of Communication, 69(1), 1–25. https://doi.org/10.1093/joc/jqy065
16.
DavisS. M.HighA. C. (2017). Widening the gap: Support gaps in same race versus different race female friendship dyads. Journal of Social and Personal Relationships, 36(1), 187–213. https://doi.org/10.1177/0265407517722245
DowneyR. G.KingC. V. (1998). Missing data in Likert ratings: A comparison of replacement methods. Journal of General Psychology, 125, 175–191. https://doi.org/10.1080/00221309809595542
19.
DunmoreE.ClarkD. M.EhlersA. (1997). Cognitive factors in persistent versus recovered post-traumatic stress disorder after physical or sexual assault: A pilot study. Behavioural and Cognitive Psychotherapy, 25(2), 147–159. https://doi.org/10.1017/S135246580001835X
EhringT.EhlersA.GlucksmanE. (2008). Do cognitive models help in predicting the severity of posttraumatic stress disorder, phobia, and depression after motor vehicle accidents? A prospective longitudinal study. Journal of Consulting and Clinical Psychology, 76, 219–230. https://doi.org/10.1037/0022-006X.76.2.219
22.
ErvingC. L.ThomasC. S.FrazierC. (2019). Is the Black-White mental health paradox consistent across gender and psychiatric disorders?American Journal of Epidemiology, 188(2), 314–322. https://doi.org/10.1093/aje/kwy224
23.
FlickerS. M.CerulliC.ZhaoX.TangW.WattsA.XiaY.TalbotN. L. (2011). Concomitant forms of abuse and help-seeking behavior among White, African American, and Latina women who experience intimate partner violence. Violence Against Women, 17(8), 1067–1085. https://doi.org/10.1177/1077801211414846
24.
FoaE. B.EhlersA.ClarkD. M.TolinD. F.OrsilloS. M. (1999). The posttraumatic cognitions inventory (PTCI): Development and validation. Psychological Assessment, 11, 303–314. https://doi.org/10.1037/1040-3590.11.3.303
25.
FoaE. B.RothbaumB. O. (1998). Treating the trauma of rape: Cognitive-behavioral therapy for PTSD. Guilford Press.
26.
GalanoM. M.HunterE. C.HowellK. H.MillerL. E.Graham-BermannS. A. (2013). Predicting shelter residence in women experiencing recent intimate partner violence. Violence Against Women, 19(4), 518–535. https://doi.org/10.1177/1077801213487056
27.
Gayer-AndersonC.MorganC. (2013). Social networks, support and early psychosis: A systematic review. Epidemiology & Psychiatric Sciences, 22, 131–146. https://doi.org/10.1017/S2045796012000406
28.
GillumT. L. (2008). The benefits of a culturally specific intimate partner violence intervention for African American survivors. Violence Against Women, 14(8), 917–943. https://doi.org/10.1177/1077801208321982
29.
Graham-BermannS. A.Miller-GraffL. (2015). Community-based intervention for women exposed to intimate partner violence: A randomized control trial. Journal of Family Psychology, 29, 537–547. https://doi.org/10.1037/fam0000091
30.
GuayS.BilletteV.MarchandA. (2006). Exploring the links between posttraumatic stress disorder and social support: Processes and potential research avenues. Journal of Traumatic Stress: Official Publication of the International Society for Traumatic Stress Studies, 19, 327–338. https://doi.org/10.1002/jts.20124
31.
HayesA. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Guilford Press.
32.
JaffeA. E.DiLiooD.GratzK. L.Messman-MooreT. L. (2019). Rick for revictimization following interpersonal and noninterpersonal trauma: Clarifying the role of posttraumatic stress symptoms and trauma-related cognitions. Journal of Traumatic Stress, 32, 42–55. https://doi.org/10.1002/jts.22372
33.
JohnsonD. M.DelahantyD. L.PinnaK. (2008). The cortisol awakening response as a function of PTSD severity and abuse chronicity in sheltered battered women. Journal of Anxiety Disorders, 22, 793–800. https://doi.org/10.1016/j.janxdis.2007.08.006
34.
JohnsonD. M.WorellJ.ChandlerR. K. (2005). Assessing psychological health and empowerment in women: The Personal Progress Scale Revised. Women and Health, 41, 109–129. https://doi.org/10.1300/J013v41n01_07
35.
JohnsonD. M.ZlotnickC. (2007). Utilization of mental health treatment and other services by battered women in shelters. Psychiatric Services, 58(12), 1595–1597. https://doi.org/10.1176/appi.ps.58.12.1595
36.
JohnsonD. M.ZlotnickC. (2009). HOPE For battered women with PTSD in domestic violence shelters. Professional Psychology: Research and Practice, 40(3), 234. https://doi.org/10.1037/a0012519
37.
JohnsonD. M.ZlotnickC.HoffmanL.PalmieriP. A.JohnsonN. L.HolmesS. C.CeroniT. L. (2020). A randomized controlled trial comparing HOPE treatment and present-centered therapy in women residing in shelter with PTSD from intimate partner violence. Psychology of Women Quarterly, 44(4), 539–553. https://doi.org/10.1177/0361684320953120
38.
JohnsonS. D.WilliamsS. L. L.PickardJ. G. (2016). Trauma, religion, and social support among African American women. Social Work & Christianity, 43(1), 60–73.
JonesL.HughesM.UnterstallerU. (2001). Post-traumatic stress disorder (PTSD) in victims of domestic violence: A review of the research. Trauma, Violence, & Abuse, 2, 99–119. https://doi.org/10.1177/1524838001002002001
41.
JonesM. K.LeathS.SettlesI. H.DotyD.ConnerK. (2021). Gendered racism and depression among Black women: Examining the roles of social support and identity. Cultural Diversity and Ethnic Minority Psychology. https://doi-org.ezproxy.uakron.edu:2443/10.1037/cdp0000486
42.
JonkerI. E.SijbrandijM.WolfJ. R. L. M. (2012). Toward needs profiles of shelter-based abused women. Psychology of Women Quarterly, 36(1), 38–53. https://doi.org/10.1177/0361684311413553
43.
JosephS.DalgleishT.WilliamsR.YuleW.ThrasherS.HodgkinsonP. (1997). Attitudes towards emotional expression and post-traumatic stress in survivors of the Herald of Free Enterprise disaster. British Journal of Clinical Psychology, 36, 133–138. https://doi.org/10.1177/0145445500245004
44.
KasturiranganA. (2008). Empowerment and programs designed to address domestic violence. Violence Against Women, 14, 1465–1475. https://doi.org/10.1177/1077801208325188
45.
KirkinisK.PieterseA. L.MartinC.AgiligaA.BrownellA. (2021). Racism, racial discrimination, and trauma: A systematic review of the social science literature. Ethnicity & Health, 26(3), 392–412. https://doi.org/10.1080/13557858.2018.1514453
46.
KooK. H.NguyenH. V.GilmoreA. K.BlayneyJ. A.KaysenD. L. (2014). Posttraumatic cognitions, somatization, and PTSD severity among Asian American and White college women with sexual trauma histories. Psychological Trauma: Theory, Research, Practice, and Policy, 6, 337–344. https://doi.org/10.1037/a0033830
47.
KraemerH. C.SticeE.KazdinA.OffordD.KupferD. (2001). How do risk factors work together? Mediators, moderators, and independent, overlapping, and proxy risk factors. American Journal of Psychiatry, 158, 848–856. https://doi.org/10.1176/appi.ajp.158.6.848
LópezI.HoA. (2013). Culture-bound (or culturally salient?): The role of culture in disorder. In KeithK. D. (Ed.), The encyclopedia of cross-cultural psychology. Wiley-Blackwell. https://doi.org/10.1002/9781118339893
50.
MalcomeM. L.FedockG.GartheR. C.GolderS.HigginsG.LoganT. K. (2019). Weathering probation and parole: The protective role of social support on Black women’s recent stressful events and depressive symptoms. The Journal of Black Psychology, 45(8), 661–688. https://doi.org/10.1177/0095798419889755
51.
MarshallL. L. (1992). Development of the severity of violence against women scales. Journal of Family Violence, 7, 103–121. https://doi.org/10.1007/BF00978700
52.
McFarlaneJ.MaddouxJ.NavaA.GilroyH. (2015). Abused women with children who are first-time users of a shelter or applicants for a protection order: Entry data of a 7-year prospective analysis. Violence Against Women, 21, 249–268. https://doi.org/10.1177/1077801214564680
ParentM. C. (2013). Handling item-level missing data: Simpler is just as good. The Counseling Psychologist, 41, 568–600. https://doi.org/10.1177/0011000012445176
56.
PascoeE. A.Smart RichmanL. (2009). Perceived discrimination and health: A meta-analytic review. Psychological Bulletin, 135(4), 531–554. https://doi.org/10.1037/a0016059
57.
PerezS.JohnsonD. M.WrightC. V. (2012). The attenuating effect of empowerment on IPV-related PTSD symptoms in battered women living in domestic violence shelters. Violence Against Women, 18, 102–117. https://doi.org/10.1177/1077801212437348
58.
PetersonN. A.LoweJ. B.AquilinoM. L.SchneiderJ. E. (2005). Linking social cohesion and gender to intrapersonal and interactional empowerment: Support and new implications for theory. Journal of Community Psychology, 33, 233–244. https://doi.org/10.1002/jcop.20047
59.
RobertsA. L.GilmanS. E.BreslauJ.BreslauN.KoenenK. C. (2011). Race/ethnic differences in exposure to traumatic events, development of post-traumatic stress disorder, and treatment-seeking for post-traumatic stress disorder in the United States. Psychological Medicine, 41(1), 71–83. https://doi-org.ezproxy.uakron.edu:2443/10.1017/S0033291710000401
60.
RobinaughD. J.MarquesL.TraegerL. N.MarksE. H.SungS. C.Gayle BeckJ.PollackM. H.SimonN. M. (2011). Understanding the relationship of perceived social support to post-trauma cognitions and posttraumatic stress disorder. Journal of Anxiety Disorders, 25(8), 1072–1078. https://doi-org.ezproxy.uakron.edu:2443/10.1016/j.janxdis.2011.07.004
61.
Samuels-DennisJ.BaileyA.KillianK.RayS. L. (2013). The mediating effects of empowerment, interpersonal conflict, and social support on the violence–PTSD process among single mothers. Canadian Journal of Community Mental Health, 32, 109–124. https://doi.org/10.7870/cjcmh-2013-009
62.
SarasonI. G.SarasonB. R.ShearinE. N.PierceG. R. (1987). A brief measure of social support: Practical and theoretical implications. Journal of Social & Personal Relationships, 4, 497–510. https://doi.org/10.1177/0265407587044007
63.
SaundersD. G. (1994). Posttraumatic stress symptom profiles of battered women: A comparison of survivors in two settings. Violence and Victims, 9(1), 31–44. https://doi.org/10.1891/0886-6708.9.1.31
64.
SchummJ. A.Briggs-PhillipsM.HobfollS. E. (2006). Cumulative interpersonal traumas and social support as risk and resiliency factors in predicting PTSD and depression among inner-city women. Journal of Traumatic Stress, 19, 825–836. https://doi.org/10.1002/jts.20159
65.
SengJ. S.LowL. M. K.SperlichM.RonisD. L.LiberzonI. (2009). Prevalence, trauma history, and risk for posttraumatic stress disorder among nulliparous women in maternity care. Obstetrics and Gynecology, 114(4), 839–847. https://doi.org/10.1097/AOG.0b013e3181b8f8a2
66.
ShortL. M.McMahonP. M.ChervinD. D.ShelleyG. A.LezinN.SloopK. S.DawkinsN. (2000). Survivors’ identification of protective factors and early warning signs for intimate partner violence. Violence Against Women, 6(3), 272–285. https://doi.org/10.1177/10778010022181840
67.
SibravaN. J.BjornssonA. S.Pérez BenítezA. C. I.MoitraE.WeisbergR. B.KellerM. B. (2019). Posttraumatic stress disorder in African American and Latinx adults: Clinical course and the role of racial and ethnic discrimination. The American Psychologist, 74(1), 101–116. https://doi.org/10.1037/amp0000339
68.
SmithS. G.ZhangX.BasileK. C.MerrickM. T.WangJ.KresnowM. J.ChenJ. (2018). The national intimate partner and sexual violence survey: 2015 data brief–updated release. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. https://www.cdc.gov/violenceprevention/pdf/2015data-brief508.pdf
69.
SouthwickS. M.VythilingamM.CharneyD. S. (2005). The psychobiology of depression and resilience to stress: Implications for prevention and treatment.
SpencerC.MalloryA. B.CafferkyB. M.KimmesG. G.BeckA. R.StithS. M. (2019). Mental health factors and intimate partner violence perpetration and victimization: A meta-analysis. Psychology of Violence, 9(1), 1–17. https://doi.org/10.1037/vio0000156
72.
StockmanJ. K.HayashiH.CampbellJ. C. (2015). Intimate partner violence and its health impact on ethnic minority women [corrected]. Journal of Women’s Health (2002), 24(1), 62–79. https://doi.org/10.1089/jwh.2014.4879
73.
TalwarP.OthmanM. K.GhanK. A.WahT. K.AmanS.YusoffN. F. M. (2017). The role of social support in mediating stress and depression. Online Journal of Health Allied Scs, 16(1), 4. Available at URL: http://www.ojhas.org/issue61/2017-1-4.html
74.
TranT. V. (1997). Exploring the equivalence of factor structure in a measure of depression between Black and White women: Measurement issues in comparative research. Research on Social Work Practice, 7(4), 500–517. https://doi.org/10.1177/104973159700700405
75.
VogtD. S.KingD. W.KingL. A. (2007). Risk pathways for PTSD. Handbook of PTSD: Science and Practice, 99–115.
76.
WeathersF. W.KeaneT. M.DavidsonJ. R. (2001). Clinician-administered PTSD scale: A review of the first ten years of research. Depression and Anxiety, 13(3), 132–156. https://doi.org/10.1002/da.1029
77.
WhitemanS. E.WitteT. K.CeroI.KramerL. B.WeathersF. W. (2020). Posttraumatic stress disorder and suicidal ideation: The moderating effect of posttraumatic cognitions. Journal of Traumatic Stress. https://doi-org.ezproxy.uakron.edu:2443/10.1002/jts.22598
78.
WilliamsD. R.MohammedS. A. (2009). Discrimination and racial disparities in health: Evidence and needed research. Journal of Behavioral Medicine, 32(1), 20–47. https://doi.org/10.1007/s10865-008-9185-0
79.
WilliamsM.JayawickremeN.SposatoR.FoaE. B. (2012). Race-specific associations between trauma cognitions and symptoms of alcohol dependence in individuals with comorbid PTSD and alcohol dependence. Addictive Behaviors, 37, 47–52. https://doi.org/10.1016/j.addbeh.2011.08.008
80.
WorellJ.RemerP. (2003). Feminist perspectives in therapy: Empowering diverse women (2nd ed.). John Wiley & Sons Inc.
81.
WrightC. V.PerezS.JohnsonD. M. (2010). The mediating role of empowerment for African American women experiencing intimate partner violence. Psychological Trauma: Theory, Research, Practice, and Policy, 2, 266–272. https://doi.org/10.1037/a0017470
