The Influence of Substance Use,Mental Health Symptoms,and Intimate Partner Violence (IPV) Severity on Treatment Utilization Among Women Who Experience IPV

Abstract

Women who experience intimate partner violence (IPV; versus those who have not) are less likely to engage in treatment and more likely to encounter barriers to treatment. There is inadequate research regarding the effects of substance use, mental health symptoms, and IPV severity on mental health and substance use treatment utilization and barriers to treatment utilization among women who experience IPV. The goal of the present study was to describe substance use and mental health treatment utilization and to examine the extent to which substance use disorder (SUD), mental health symptoms, and IPV severity influence treatment utilization and barriers to treatment utilization among women experiencing IPV. Participants were 275 adult women experiencing IPV and who used any amount of alcohol or drugs in the past three months recruited from the community. A total of 54.5% of women engaged in treatment for substance use and/or mental health in the past 30 days. Receiving substance use treatment was associated with greater odds of having a SUD (OR = 2.30, p = .01). Receiving mental health treatment was associated with greater post-traumatic stress disorder (PTSD; b = 5.04, p = .002) and depressive symptom severity (b = 6.45, p < .001). Receiving combined substance use and mental health treatment was associated with more severe PTSD symptoms (b = 5.32, p = .03) and IPV-related injury (b = 5.14, p = .04). PTSD symptom severity was correlated with confidentiality concerns (r = .40, p = .02), and depressive symptom severity was correlated with attitudinal barriers (r = .40, p = .02). Psychological IPV severity was associated with attitudinal (r = .45, p = .01) and partner-related barriers (r = .35, p = .04). Utilizing treatment is associated with greater mental health severity, suggesting that either greater mental health symptom severity is associated with women seeking treatment and/or that treatment is not effectively reducing symptoms. Results highlight the importance of assessing psychological IPV and mental health symptoms to understand for whom barriers to treatment utilization are most relevant.

Keywords

intimate partner violence substance use mental health treatment utilization treatment barriers

Introduction

Intimate partner violence (IPV), which refers to physical, sexual, and/or psychological abuse from a romantic or intimate partner, is a significant public health concern. One in two women in the United States experiences IPV in their lifetime (Leemis et al., 2022), and IPV is associated with negative outcomes, including substance use concerns and mental health symptoms (Cafferky et al., 2018; Khalifeh et al., 2016; Makaroun et al., 2020; Sullivan et al., 2009). Women who experience IPV tend to underutilize available substance use and mental health treatment options and encounter numerous barriers when seeking services (Rodriguez et al., 2009; Simmons et al., 2015). While it is well-established that substance use, mental health symptoms, and IPV severity influence one another, there is inadequate research regarding the rates at which women who experience IPV access treatment, and the effects of substance use, mental health symptoms, and IPV severity on substance use and mental health treatment utilization (Pallatino et al., 2021). To address this gap, the goal of the present study was to describe substance use and mental health treatment utilization and to examine the extent to which substance use disorder (SUD), mental health symptoms, and IPV severity influence treatment utilization and barriers to treatment utilization among women experiencing IPV.

Women who experience IPV (compared to those who don’t experience IPV) are at increased risk for SUD and mental health symptoms. They have a greater likelihood of using alcohol and/or drugs (i.e., 90.1% have used alcohol and 82.1% have used drugs; Sullivan et al., 2009) or developing a SUD compared to women who never experienced IPV. In a 2024 nationally representative sample, 33% of adults diagnosed with a mental health disorder had a co-occurring SUD (Substance Abuse and Mental Health Services Administration, 2025). Globally, post-traumatic stress disorder (PTSD) and depression are the most common and prevalent mental health sequelae associated with experiencing IPV compared to women who have never experienced IPV (Johnson et al., 2020; Lagdon et al., 2014; Spencer et al., 2019). Women who experience IPV are at a three to five times increased risk for PTSD and major depressive disorder (Beydoun et al., 2012; Golding, 1999; Spencer et al., 2019) relative to women who have not experienced IPV. While there is limited research examining the rate at which substance use, mental health, and IPV co-occur, post-traumatic stress related to IPV experiences has been found to influence substance use (Sullivan et al., 2009). Furthermore, among women with a co-occurring substance use and mental health disorder in substance use treatment, 59% reported experiencing IPV in their lifetime upon admission (Lipsky et al., 2010). Despite these heightened rates of substance use and mental health concerns, treatments tend to be underutilized among women who experience IPV.

Rates of treatment utilization by women who experience IPV vary, likely due to the low rates at which IPV is disclosed to professionals and inconsistency in how agencies record requests for treatment and history of IPV (Satyen et al., 2019). In the United States, 23% of adults received any kind of mental health treatment, 6.7% of adults received substance use care, and 14.5% of individuals diagnosed with both SUD and a mental health disorder received concurrent treatment in 2024 (Substance Abuse and Mental Health Services Administration, 2025). U.S. women who experience IPV report seeking treatment for substance use or mental health significantly more frequently than women who never experienced IPV (Makaroun et al., 2020), however, rates of substance use and mental health treatment utilization decrease over time after women stop experiencing IPV (Bonomi et al., 2009). Furthermore, among women who experience IPV, more severe physical abuse is associated with greater likelihood of using mental health resources (Sabri et al., 2013). However, experiencing IPV also more than doubles women’s odds of reporting unmet need for mental health treatment (i.e., 19% of women who experience IPV report needing but not receiving mental health treatment compared to 8% of women who never experienced IPV; Lipsky & Caetano, 2007) and experiencing IPV has shown to interfere with the completion of substance use treatment and recovery from SUDs (Ogden et al., 2022). Current IPV victimization is associated with 25% decreased odds of completing substance use treatment (Lipsky et al., 2010). Moreover, individuals who had (versus had not) experienced IPV were 40% less likely to remain abstinent from substances at a 12-month follow-up assessment (Reed et al., 2015). Treatments that concurrently address substance use and mental health concerns for women experiencing IPV have been found to be effective for women who experience IPV; yet little is known about rates at which women engage in such treatments. Engaging in co-occurring trauma and substance use treatment has been found to reduce substance use more substantially for women who have (versus have not) experienced IPV (Fowler & Faulkner, 2011), and these effects have been found to last over time and to be associated with increased self-confidence among women who experience IPV (Bennett & O’Brien, 2007). The higher rates of co-occurring substance use and mental health disorders among women who experience IPV address the need to develop interventions and treatment options that address the specific occurrence of disorders (Weaver et al., 2015). These findings highlight the influence of IPV on substance use and/or mental health treatment utilization.

While seeking substance use and mental health treatment, women who experience IPV encounter several barriers (Overstreet & Quinn, 2013; Phillips et al., 2021; Simmons et al., 2015). In other populations, barriers to treatment have been characterized as attitudinal, structural, and confidentiality concerns (Haeny et al., 2021; Priester et al., 2016; Verissimo & Grella, 2017). Attitudinal barriers are individual beliefs and feelings, and concerns about the opinions of others, which can include experiencing stigma around seeking treatment for substance use and mental health concerns. Structural barriers are logistical or practical restrictions, which can include not being able to afford treatment or not having transportation. Confidentiality concerns include worries that personal information (e.g., information between the individual and treatment provider) will not be kept private (Haeny et al., 2021; Verissimo & Grella, 2017). Despite these barriers having been examined in other populations (e.g., individuals who use substances), a significant limitation of the literature is that they have not been examined among women who experience IPV, regardless of the significant barriers they encounter when seeking substance use or mental health treatment (Robinson et al., 2021). Additional barriers unique to women who experience IPV are related to their partner. These may include fear of the partner’s reactions or anticipating controlling behaviors (Phillips et al., 2021), such as partners using IPV survivors’ mental health diagnoses to threaten or harm them in legal cases or restricting their ability to make use of treatment (Simmons et al., 2015). Understanding barriers to treatment utilization among women who experience IPV can inform efforts to reduce those barriers and therefore, increase rates of utilization.

It is well-established that women who experience IPV have high rates of co-occurring substance use and mental health disorders (Cyrus et al., 2021; Spencer et al., 2019), and that substance use, mental health symptoms (e.g., PTSD and depression), and IPV severity influence one another. However, there is inadequate research regarding the rates at which women who experience IPV access substance use and mental health treatment. Additionally, there is insufficient literature regarding the effects of substance use, mental health symptoms, and IPV severity on mental health and substance use treatment utilization (Pallatino et al., 2021) and barriers to treatment utilization among women who experience IPV. To address these gaps, the purpose of this study is to describe substance use and mental health treatment utilization and barriers to substance use and mental health treatment among women who experience IPV, and to examine the extent to which SUD (i.e., DSM-IV-TR alcohol or drug abuse or dependence), mental health symptoms, and IPV severity influence women’s substance use and mental health treatment utilization and barriers to utilizing substance use and mental health treatment.

Methods

Participants

These data were collected from 275 adult women from a larger study aiming to examine the daily dynamics of PTSD symptoms, sexual risk behavior, and substance use among women experiencing IPV (Sullivan et al., 2020). Recruitment materials were posted in the community in English and Spanish in: (1) community buildings (e.g., grocery stores, libraries, pizza shops, targeting specific neighborhoods and community health clinics that represented diverse racial/ethnic groups); (2) city buses; and (3) websites (e.g., Craigslist, Facebook). Participants had experienced physical IPV by their male romantic partner in the past 3 months and had used any amount of alcohol or drugs during that time. Additional eligibility criteria included: (1) ongoing contact with their partner (saw partner a minimum of twice a week and did not exceed 2 weeks without contact during the past month); (2) English or Spanish speaking, (3) identify as Black, White, or Latina race/ethnicity (because the parent study was stratified to allow for tests of moderation). Exclusion criteria were psychiatric instability based on self-reported inpatient psychiatric hospitalization in the past year (due to concerns regarding management of acute risk) or residence in a shelter or group living environment (because such living environments may place limitations on the use of alcohol or drugs, relevant to primary aims of the parent study). Seven women were removed from the sample due to inconsistency between screening criteria and information reported at baseline. Thus, the final sample comprised 275 participants. Eligibility was determined via a phone screen based on women’s self-report. Participant demographic characteristics are summarized in Table 1.

Table 1.

Descriptive Information on Demographics and Study Variables of Interest.

Construct	M (SD)	Range	n (%)
Substance use and mental health
Past 30-day alcohol use			227 (82.5)
Past 30-day drug use			152 (55.3)
Past 30-day alcohol and drug use			123 (44.7)
Substance use disorder			73 (26.5)
PTSD symptom severity	19.18 (11.81)	0–51
Clinically significant impairment in functioning due to PTSD symptoms			216 (78.5)
Probable PTSD			95 (34.5)
Depressive symptom severity	22.93 (10.77)	0–60
Probable depression			209 (76.0)
Age	37.10 (12.41)	18–69
Racial/ethnic background
Black/African American			121 (44.0)
White			73 (26.5)
Hispanic/Latina			74 (26.9)
Multiracial			5 (1.8)
Unknown/Other			2 (0.7)
Years of education completed	12.30 (1.97)	6–20
Yearly household income below FPL			147 (53.5)
Employment status
Employed full-time			33 (12.0)
Employed part-time			71 (25.8)
Unemployed			158 (57.4)
Not in labor force (e.g., student)			13 (4.7)
Relationship status
Never married			218 (79.3)
Married			46 (16.7)
Separated or divorced			11 (4.0)
Cohabitation			185 (67.3)
Relationship length (in years)	7.30 (7.26)	0.5–50

Note. PTSD = post-traumatic stress disorder; FPL = federal poverty level.

Procedure

Participants completed (1) a baseline interview, (2) 30 days of four times daily data collection, and (3) a follow-up interview. The current study uses only data collected during the baseline interview. The baseline interview was administered by a trained female research assistant or postdoctoral fellow in a private office. Informed consent was obtained, and the interview was administered in either English or Spanish using computer-assisted self-report measures. Women were compensated up to $325 for the baseline interview, daily data collection, follow-up interview, and bonus payments. A resource brochure distributed at the end of the interview provided information on services in the area including IPV victimization support, mental health, substance use, employment, housing, financial assistance, etc. The research assistant offered support with referrals and also offered to complete a safety plan unique to the participant’s situation at the end of the baseline interview.

Measures

Substance Abuse/Dependence

The Structured Clinical Interview for DSM-IV (SCID-I; First et al., 2016) was used to establish current DSM-IV-TR alcohol abuse and/or dependence and drug abuse and/or dependence diagnosis. The SCID-I is a semi-structured assessment for psychiatric disorders. The interview was administered by research assistants or postdoctoral fellows trained by the principal investigator. All data were reviewed by a doctoral-level clinical psychologist, and diagnoses were further discussed in meetings. For the purpose of the present study, we refer to alcohol abuse and/or dependence and drug abuse and/or dependence as SUD.

PTSD Symptom Severity

The Post Traumatic Stress Diagnostic Scale (PDS; Foa et al., 1997) measures DSM-IV-TR PTSD symptom severity. The PDS assessed past 30-day PTSD symptoms related to IPV victimization by a current male partner. Symptom severity items assess the frequency of each symptom on a 4-point scale ranging from 0 (not at all, or only one time) to 3 (5 or more times a week, or almost always). Items are summed to create a total symptom severity score, with higher scores indicating more severe symptoms (Cronbach’s α = .92). Probable PTSD was determined based on endorsement of at least one Criterion A event (i.e., participants were instructed to consider IPV as the referent traumatic event), endorsement of at least one re-experiencing symptom, three avoidance/numbing symptoms, two hyperarousal symptoms, symptom duration of at least 1 month, and impairment in at least two areas of functioning, in line with DSM-IV-TR diagnostic rules (American Psychiatric Association, 2000).

Depressive Symptom Severity

The Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977) is a 20-item scale that measures depressive symptom severity. Items assessed how often participants have experienced symptoms in the past 30 days on a 4-point scale ranging from 0 (rarely or none of the time) to 4 (most or all of the time [on average, 5–7 days a week]). Items were summed to create a total score, with higher scores indicating more severe symptoms, and a cutoff score of 16 (Lewinsohn et al., 1997) or greater indicating probable depression (Cronbach’s α = .78).

Intimate Partner Violence

Psychological IPV

The Psychological Maltreatment of Women Inventory (PMWI-S; Tolman, 1999) is a 14-item scale that assesses psychological victimization from an intimate partner. The PMWI-S assesses dominance/isolation (7 items that assessed the power, control, and isolation) and emotional/verbal (7 items that assessed verbal abuse) victimization in the past 30 days on a 5-point scale ranging from 1 (never) to 5 (very frequently). Items were summed to create a total score, with higher scores indicating more severe psychological victimization (Cronbach’s α = .91).

Physical IPV and Injury

The Revised Conflict Tactics Scale (CTS-2; Straus et al., 1996) assessed physical assault (12 items that assessed physical victimization by a partner) and injury (6 items that assessed physical injuries that required medical attention) by their intimate partner in the past 30 days. Consistent with scoring recommendations by Straus et al. (2003), responses that were a range were recorded to the midpoint (0 = never or not in the past year, 1 = once, 2 = twice, 4 = 3–5 times, 8 = 6–10 times, 15 = 11–20 times, 25 = more than 20 times). Items were summed to create total subscale scores, with higher scores indicating more severe victimization and injury (Cronbach’s α = .92) and IPV-related injury (Cronbach’s α = .74).

Sexual IPV

The Sexual Experiences Survey (SES; Koss & Oros, 1982) is a 13-item scale that assesses women’s experiences of sexual victimization. Items were modified to assess sexual victimization by an intimate partner, as the original SES was designed to assess women’s experiences by any man (Weiss et al., 2017). Responses were modified to match the CTS-2 response options and scoring systems. Items were summed to create a total score, with higher scores indicating experiencing more severe victimization (Cronbach’s α = .92).

Treatment Utilization

Types of substance use and mental health treatment received in the past 30 days were assessed using 15 questions from the National Survey on Drug Use and Health (NSDUH; U.S. Department of Health and Human Services, 2008). Types of treatment included detoxification, meetings (e.g., Narcotics Anonymous or Alcoholics Anonymous), self-help groups or services for alcohol or drug use, individual outpatient treatment, and group outpatient treatment. Participants indicated whether they engaged in treatment to address mental health, substance use, or both simultaneously. Responses across items were collapsed to create two variables. The first represents whether participants accessed any mental health or substance use treatment (0 = no treatment, 1 = any mental health or substance use treatment). The second represents whether treatment was received to address mental health and/or substance use (0 = no treatment, 1 = treatment for mental health, 2 = treatment for substance use, and 3 = treatment for both mental health and substance use (i.e., simultaneous treatment).

Barriers to Treatment

Barriers to utilizing substance use and mental health treatment were assessed using 24 questions (12 regarding substance use, 12 regarding mental health). Participants were asked whether there has been a time in the past 30 days that they have needed treatment for substance use and/or mental health but did not engage in it (see Supplemental Material). If they answered affirmatively, they were administered questions regarding the following barriers: attitudinal (3 items; e.g., “getting help might cause negative opinion of you”), structural (4 items; e.g., “you couldn’t afford the cost”), partner-related (4 items; e.g., “your partner would think you are having an affair”), and confidentiality (1 item; i.e., “concerned information might not be kept confidential”), consistent with previous literature (Haeny et al., 2021). Questions assessing attitudinal, structural, and confidentiality barriers were drawn from the NSDUH (U.S. Department of Health and Human Services, 2008). Questions assessing partner barriers were developed specifically for this study based on extant research and the PI’s over 20 years of clinical and research experience with women who experience IPV in various IPV, substance use, and mental health settings. Items assessed participants’ agreement that each item represents a barrier to treatment on a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree). Items were summed to create a total subscale score, with higher scores indicating greater experiences of attitudinal (Cronbach’s α = .70), structural (Cronbach’s α = .81), partner (Cronbach’s α = .89), and confidentiality barriers to utilizing substance use and/or mental health treatment.

Demographic and Relationship Characteristics

Participants self-reported age, race and ethnicity, education, yearly household income, employment status, cohabitation with partner, and relationship length. Yearly income was converted into a dichotomous variable reflecting whether the participant’s yearly income fell above (coded as 0) or below (coded as 1) the federal poverty level based on the year of data collection and number of people supported by that income.

Data Analysis Plan

Frequencies and percentages were used to describe categorical variables. Means and standard deviations were used to describe continuous variables. Regression analyses were used to examine the association between treatment utilization and likelihood of having a SUD diagnosis (i.e., logistic regression) and between treatment utilization and mental health symptom severity and IPV severity (i.e., linear regression). Pearson product–moment correlations between two continuous variables and point-biserial correlations between continuous and categorical variables were used to examine the associations between barriers to treatment utilization and SUD, mental health symptom severity, and IPV severity (Figure 1).

Figure 1.

Percentage of participants with probable SUD diagnosis by substance use and/or mental health treatment utilization.

Results

Of the total sample, 82.5% (n = 227) used alcohol, 55.3% (n = 152) used drugs and 44.7% (n = 123) used both alcohol and drugs in the past 30 days. According to the SCID-I, 26.5% (n = 73) met criteria for a SUD. Based on applying DSM-IV-TR diagnostic rules to PDS items (American Psychiatric Association, 2000; Foa et al., 1997), 34.5% (n = 95) reported probable PTSD and regardless of probable PTSD diagnosis, 78.5% (n = 216) of individuals who experienced clinically significant impairment in functioning due to symptoms. Based on a cutoff score of 16 or greater on the CES-D (Lewinsohn et al., 1997; Radloff, 1977), 76.0% (n = 209) reported probable depression. Further descriptive statistics are presented in Table 1.

Treatment Utilization

In total, 54.5% (n = 150) of women engaged in treatment for substance use and/or mental health symptoms; 44.7% (n = 123) engaged in substance use treatment, 29.8% (n = 82) engaged in mental health treatment, and 11.3% (n = 31) of women engaged in simultaneous treatment for both substance use and mental health symptoms; of note, women could report engaging in multiple types of treatment and treatment groups are not mutually exclusive. See Table 2 for utilization of each treatment type.

Table 2.

Types of Substance Use, and Mental Health Treatment Engaged in and Barriers to Treatment Utilization.

Construct	Substance use treatment	Mental health treatment	Simultaneous treatment
Treatment type, n (%)
Individual outpatient treatment	26 (9.5%)	32 (11.6%)	15 (5.5%)
Group outpatient treatment	27 (9.8%)	5 (1.8%)	11 (4.0%)
Meetings, self-help groups, or services for alcohol or drug use	38 (13.8%)	—	—
Detoxification	1 (0.4%)	—	—
Total treatment utilization	123 (44.7%)	82 (29.8%)	31 (11.3%)
Barriers to treatment utilization, M (SD)
Attitudinal barriers	2.71 (1.11)	2.60 (1.09)	—
Getting help might cause a negative opinion of you	2.08 (1.29)	2.06 (1.30)	—
You can handle the problem without a program	3.38 (1.44)	2.97 (1.38)	—
You wouldn’t want others to find out that you needed a program	2.65 (1.47)	2.76 (1.54)	—
Structural barriers	3.05 (1.26)	3.58 (1.02)	—
You couldn’t afford the cost	3.54 (1.61)	4.06 (1.41)	—
You wouldn’t know where to find a program	2.77 (1.70)	3.32 (1.59)	—
You would not have time	2.81 (1.52)	3.35 (1.48)	—
No transportation and/or the hours are not convenient	3.08 (1.52)	3.59 (1.33)	—
Partner barriers	2.88 (1.42)	2.98 (1.54)	—
Partner would monitor your time and account for your whereabouts	2.46 (1.45)	3.15 (1.69)	—
Partner would think you are having an affair	3.19 (1.67)	2.97 (1.71)	—
Partner would try to keep you from doing things to better yourself	3.00 (1.65)	2.79 (1.65)	—
Partner would restrict you of things that would make it easier	2.85 (1.76)	3.00 (1.81)	—
Concerned the information you gave the staff might not be kept confidential	3.00 (1.67)	2.94 (1.59)	—

Note. 54.5% (n = 150) of women received any substance use and/or mental health treatment; Barriers were assessed on a 1 (strongly disagree)–5 (strongly agree) scale.

See Table 3 for regression results. Results of logistic regression analyses examining the association between treatment utilization and SUD revealed that engaging in substance use treatment was associated with significantly greater odds of having a SUD (OR = 2.30, p = .01, 95% CI [1.27, 4.17]). Results of linear regression analyses examining the association between treatment utilization and mental health symptom and IPV severity revealed that engaging in mental health treatment (b = 5.04, SE = 1.61, p = .002, 95% CI [1.87, 8.21]) and simultaneous treatment (b = 5.32, SE = 2.39, p = .03, 95% CI [0.62, 10.02]) were associated with significantly greater PTSD symptom severity. Engaging in mental health treatment was associated with significantly greater depressive symptom severity (b = 6.45, SE = 1.45, p < .001, 95% CI [3.60, 9.30]). Finally, engaging in simultaneous treatment was associated with more severe IPV-related injury (b = 5.14, SE = 2.43, p = .04, 95% CI [0.36, 9.91]; Figure 2).

Table 3.

Regression Analyses Examining the Effect of Treatment Utilization on the Likelihood of SUD, Mental Health Symptom Severity, and IPV Severity.

Construct	b	SE	P	OR	95% CI
Outcome: SUD diagnosis
Intercept	−1.25	0.20	<.001
Substance use treatment	0.83	0.30	.01	2.30	[1.27, 4.17]
Mental health treatment	−0.48	0.33	.15	0.621	[0.32, 1.19]
Simultaneous treatment	−0.32	0.47	.50	0.73	[0.29, 1.83]
Outcome: PTSD symptom severity
Intercept		0.97	<.001
Substance use treatment	−0.01	1.54	1.00		[−3.03, 3.02]
Mental health treatment	5.04	1.61	.002		[1.87, 8.21]
Simultaneous treatment	5.32	2.39	.03		[0.62, 10.02]
Outcome: Depressive symptom severity
Intercept		0.87	<.001
Substance use treatment	−0.22	1.38	.88		[−2.94, 2.51]
Mental health treatment	6.45	1.45	<.001		[3.60, 9.30]
Simultaneous treatment	3.98	2.17	.07		[−0.28, 8.24]
Outcome: Psychological IPV
Intercept		1.00	<.001
Substance use treatment	2.33	1.60	.15		[−0.81, 5.47]
Mental health treatment	3.09	1.67	.07		[−0.20, 6.37]
Simultaneous treatment	1.17	2.48	.64		[−3.71, 6.05]
Outcome: Physical IPV
Intercept		3.11	<.001
Substance use treatment	−3.96	4.94	.42		[−13.68, 5.76]
Mental health treatment	−1.24	5.17	.81		[−11.42, 8.94]
Simultaneous treatment	15.08	7.67	.05		[−0.02, 30.17]
Outcome: Sexual IPV
Intercept		2.29	<.001
Substance use treatment	6.55	3.65	.07		[−0.63, 13.72]
Mental health treatment	−2.42	3.81	.53		[−9.91, 5.08]
Simultaneous treatment	2.44	5.64	.67		[−8.66, 13.54]
Outcome: IPV-related injury
Intercept		0.98	<.001
Substance use treatment	−1.76	1.57	.26		[−4.85, 1.32]
Mental health treatment	0.03	1.64	.99		[−3.19, 3.25]
Simultaneous treatment	5.14	2.43	.04		[0.36, 9.91]

Note. IPV = intimate partner violence; SUD = substance use disorder; PTSD = post-traumatic stress disorder.

Figure 2.

Mean mental health symptom and IPV severity scores by substance use and/or mental health treatment utilization.

Barriers to Treatment

In total, 23.3% (n = 64) of women reported that they needed treatment for a SUD and/or mental health in the preceding 30 days but did not utilize it. Of these, 35.9% (n = 23) had a SUD, 40.6% (n = 26) had a probable PTSD diagnosis, and 92.2% (n = 59) had probable depression. See Table 4 for bivariate correlations between barriers and SUD diagnosis, mental health symptom severity, and IPV severity. PTSD symptom severity was significantly positively correlated with the barrier of concerns about confidentiality (r = .40, p = .02). Depressive symptom severity was significantly positively correlated with attitudinal barriers (r = .39, p = .03). Psychological IPV severity was significantly positively correlated with attitudinal barriers (r = .45, p = .008) and partner-related barriers (r = .35, p = .04). There were no significant correlations between barriers to receiving substance use treatment and SUD diagnosis, mental health symptom severity, or IPV severity.

Table 4.

Bivariate Correlations Between SUD, Mental Health Symptoms, IPV Severity, and Treatment Barriers.

Construct	Attitudinal barriers	Structural barriers	Partner barriers	Confidentiality barrier
Barriers to substance use treatment (n = 26)
SUD diagnosis	−.10	−.35	−.19	−.19
PTSD symptom severity	.06	.14	.22	.08
Depressive symptom severity	−.19	.01	−.09	.09
Psychological IPV	.07	.06	.17	.13
Physical IPV	.03	.07	.08	.14
Sexual IPV	.13	−.03	.17	−.02
Injury	.02	.16	.003	.18
Barriers to mental health treatment (n = 34)
SUD diagnosis	−.02	−.31	.07	−.08
PTSD symptom severity	.30	.17	.26	.40*
Depressive symptom severity	.39*	.12	.15	.26
Psychological IPV	.45**	.13	.35*	.18
Physical IPV	.21	.13	.14	.15
Sexual IPV	.13	−.26	.12	.02
Injury	.27	.20	.15	.05

Note. Bolded typeface indicates significance at the level p < .05. IPV = intimate partner violence; SUD = substance use disorder; PTSD = post-traumatic stress disorder.

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

Discussion

The goal of the present study was to describe substance use and mental health treatment utilization and to examine the extent to which SUD, mental health symptoms, and IPV severity influence treatment utilization and barriers to treatment utilization among women experiencing IPV. First, more than half of the participants engaged in substance use and/or mental health treatment in the preceding month. This finding adds to the existing literature highlighting varied rates of treatment utilization among women who experience IPV (Makaroun et al., 2020). Next, we found that those who engaged in substance use treatment, but not those who engaged in mental health or simultaneous treatment, were at greater odds of having a SUD. Similarly, receiving mental health or simultaneous treatment was associated with greater PTSD symptom severity, and mental health treatment was associated with greater depressive symptom severity. Given the cross-sectional nature of these data, we are not able to delineate the direction of these associations. On one hand, it may be that those who meet criteria for a SUD diagnosis or who experience more severe PTSD and depressive symptoms are more likely to seek out or be referred for treatment. On the other hand, these findings may suggest that treatment is not effectively helping to reduce symptoms or may not be fully meeting the needs of women experiencing IPV. Alternatively, it is important to note that IPV and mental health symptom severity may interact and dynamically influence one another—previous meta-analytic reviews have reported bidirectional associations between IPV and mental health, most notably depressive symptoms (Bacchus et al., 2018). Further research focusing on symptom change over the time and over the course of treatment specifically among women experiencing IPV is needed to understand the experience of women with PTSD symptoms who use substances and are seeking treatment (Myers et al., 2015) and to better understand if substance use treatment is effective for this population (Hien et al., 2004). Finally, receiving simultaneous substance use and mental health treatment was associated with greater IPV-related injury. Further research is needed to understand these findings.

Next, with respect to barriers to treatment utilization, about one-quarter of our sample reported recently needing substance use and/or mental health treatment but not receiving it. Of note, this subsample had high rates of SUD diagnosis and probable PTSD and depression, bolstering their self-perceived need for treatment. This finding may reflect difficulty of seeking treatment when experiencing symptoms of depression and awareness of what PTSD symptoms are. This rate of non-treatment receipt is relatively higher than those reported in previous literature (Lipsky & Caetano, 2007), which may reflect differences in sample characteristics. For instance, Lipsky and Caetano (2007) made use of national epidemiologic data, whereas women were recruited from the community for participation in the present study; previous work has found that community-recruited samples tend to report more frequent and more severe IPV relative to large epidemiologic or population-based studies (Langhinrichsen-Rohling et al., 2012). Among barriers to receiving substance use or mental health treatment, structural barriers (e.g., inability to afford treatment, not having health insurance) were the most frequently endorsed. Of note, over half of our sample was unemployed and had a yearly household income that was below the federal poverty line (i.e., 53.5%), and the majority of participants are from minoritized racial and ethnic groups (i.e., Black and Latina). Previous work has found that socioeconomic status is an important social determinant of health care (Stepanikova & Oates, 2017) and that members of minoritized racial and ethnic groups report greater structural barriers to receiving medical care relative to White individuals (Caraballo et al., 2022). These disparities likely reflect forms of structural racism and other group-specific challenges (e.g., fear related to applying for government assistance if family members do not have legal citizenship, which therefore influences the ability to afford treatment; Sue & Sue, 2016). Further work is needed to address specific practical barriers to make treatment more accessible.

Significant correlations were found between barriers to receiving mental health treatment and mental health and IPV severity. First, PTSD symptom severity was correlated with concerns about confidentiality. This finding may be due to negative alterations in cognitions related to trust that are common in PTSD, as posited by the cognitive model of PTSD and models of complex PTSD (Bell et al., 2019; Ehlers & Clark, 2000; Laddis, 2019). Next, depressive symptom severity was correlated with attitudinal barriers (e.g., thinking it would go away on its own or that you are strong enough to handle it by yourself). This finding adds to existing literature that highlight women’s perception of needing to be strong enough to overcome their depression themselves, and therefore, not seeking treatment (Caplan & Whittemore, 2013). Furthermore, our sample had a relatively larger proportion of Latina women, who have been found to be more likely to express concerns regarding feeling embarrassed for family members or friends to learn they are experiencing symptoms of a mental health disorder, which can negatively influence their likelihood of seeking treatment (Sue & Sue, 2016). Finally, psychological IPV severity was positively correlated with attitudinal barriers and partner-related barriers. The positive association between psychological IPV and partner-related barriers may reflect that these partner-related barriers are themselves forms of psychological IPV (i.e., preventing women from doing things to better themselves). These results also may reflect the “invisible” nature of psychological IPV relative to physical and sexual IPV, the latter of which can cause physical pain and injury (Arriaga & Schkeryantz, 2015). It is important to note that issues related to gender, power, and hegemonic masculinity are likely inextricably linked to experiences of IPV (Connell, 2016; Krivoshchekov et al., 2023; Mahmood, 2020) and subsequently, their influence on treatment utilization. “Gender transformative” approaches, which emphasize transforming gender roles, reducing harmful gender role stereotypes, and promoting gender-equitable relations to address IPV have begun to be implemented with promising results (World Health Organization, 2007); their expansion may be important to promote women’s treatment utilization and, therefore, well-being. We found no significant correlations between barriers to receiving substance use treatment and SUD diagnosis, mental health, or IPV severity. These results suggest that barriers to receiving substance use treatment do not depend upon SUD diagnosis, mental health symptom severity, and IPV severity, perhaps due to the high degree of stigma experienced by individuals in substance use treatment (Crapanzano et al., 2019; Zwick et al., 2020). Results highlight the importance of assessing psychological IPV and mental health symptoms to understand for whom barriers to treatment utilization are most relevant. In addition, it is critical for future research to identify ways to serve culturally diverse populations to increase treatment utilization and decrease barriers to accessing treatment (Cokley, 2006).

Limitations

While the present study provides important insight, findings should be considered in the context of the following limitations. First, women who had been hospitalized or living in a group home during the past year were excluded; thus, findings do not represent treatment utilization and barriers for women who may be experiencing more severe substance use and mental health symptoms. Future research should address the rate of inpatient treatment utilization to better understand barriers that women may encounter when seeking treatment. Further, these findings may not generalize to other individuals who experience IPV, such as men or individuals in same sex romantic relationships. Second, other forms of treatment women may have utilized (e.g., prescribed medication for SUD) were not assessed. This restricts our understanding to psychosocial treatments only. Third, treatment utilization was focused on substance use and mental health resources and services, and therefore, did not reflect other support women may have received (e.g., from domestic violence service providers). Future research should expand the types of services assessed. Fourth, we did not collect information on the effectiveness of treatments, and therefore, are unable to determine whether engagement in treatment was associated with symptom reduction. Future research should examine the extent to which SUD, mental health symptom severity, and IPV severity influence treatment outcomes for this population. Fifth, only participants who endorsed needing treatment but not receiving it had the opportunity to answer questions related to barriers, leading to a small sample size for bivariate analyses and does not represent barriers that may have been experienced by women who did access treatment that could have influenced treatment retention or efficacy. Lastly, it is important to note that women who experience IPV likely face unique barriers to treatment that were not captured in the present study (e.g., stigma related to experiencing IPV, fear of retaliation if their partner accesses their treatment records; Wright et al., 2022) and may have underreported barriers to treatment utilization. Future research could employ qualitative methods to better understand the abundance of barriers specific to women who experience IPV so that strategies can be identified to mitigate those unique barriers.

Conclusions

Findings provide important insights regarding substance use and mental health treatment utilization and barriers to treatment. Findings demonstrate that there are high rates of treatment utilization among women who experience IPV, and mental health and psychological IPV symptom severity are correlated with barriers to utilizing treatment. Future research is needed to examine treatment effectiveness to further understand the varying rates of treatment among women who experience IPV, and to understand for whom barriers are most relevant in order to increase treatment utilization. In addition, this will allow for a better understanding of symptom severity and whether treatment is reducing those symptoms. Furthermore, clinical providers may benefit from screening for psychological IPV and mental health conditions to identify individuals who may be most in need of additional orientation to treatment to reduce attitudinal and confidentiality-related barriers.

Supplemental Material

sj-docx-1-jiv-10.1177_08862605261429549 – Supplemental material for The Influence of Substance Use, Mental Health Symptoms, and Intimate Partner Violence (IPV) Severity on Treatment Utilization Among Women Who Experience IPV

Supplemental material, sj-docx-1-jiv-10.1177_08862605261429549 for The Influence of Substance Use, Mental Health Symptoms, and Intimate Partner Violence (IPV) Severity on Treatment Utilization Among Women Who Experience IPV by Alexis R. Alfano, Melissa R. Schick and Tami P. Sullivan in Journal of Interpersonal Violence

Footnotes

ORCID iDs

Alexis R. Alfano

Melissa R. Schick

Tami P. Sullivan

Funding

The authors disclosed receipt of the following financial support for the research and/or authorship of this article: This work was supported by National Institute on Drug Abuse grant R01DA031275. Work by the second author was supported by the National Institute on Drug Abuse grant T32DA019426.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interests with respect to the authorship and/or publication of this article.

Supplemental Material

Supplemental material for this article is available online.

Author Biographies

Alexis R. Alfano, BS, is a second-year graduate student in the Human Services Psychology PhD program on the clinical psychology track in the Department of Psychology at the University of Maryland, Baltimore County. Her research focuses on substance use disorders, post-traumatic stress disorder, intimate partner violence, and factors associated with effective treatment options and intervention development.

Melissa R. Schick, PhD, is an assistant professor in the Department of Psychiatry at the Yale School of Medicine and the Director of the Study of Trauma, Addiction, & Recovery Lab. Her program of research focuses on mechanistic processes underlying the etiology, course, and treatment of substance use in populations characterized by trauma.

Tami P. Sullivan, PhD, is a professor in the Department of Psychiatry at the Yale University School of Medicine and the Director of Family Violence Research and Programs. Her program of research focuses on individual- and system-level factors that affect the mental and physical health of women victims of IPV. At the individual level, she focuses on advancing knowledge of IPV, post-traumatic stress, substance use, and HIV/sexual risk—as well as other co-occurring problems. At the system level, she focuses on understanding the capacity of systems (e.g., criminal justice system) to meet the unique needs of IPV-exposed women.

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). https://doi.org/10.1176/appi.books.9780890423349

Arriaga

X. B.

Schkeryantz

E. L.

(2015). Intimate relationships and personal distress: The invisible harm of psychological aggression. Personality and Social Psychology Bulletin, 41(10), 1332–1344. https://doi.org/10.1177/0146167215594123

Bacchus

L. J.

Ranganathan

Watts

Devries

(2018). Recent intimate partner violence against women and health: A systematic review and meta-analysis of cohort studies. BMJ Open, 8, Article e019995. https://doi.org/10.1136/bmjopen-2017-019995

Bell

Robinson

Katona

Fett

A. K.

Shergill

(2019). When trust is lost: The impact of interpersonal trauma on social interactions. Psychological Medicine, 49(6), 1041–1046. https://doi.org/10.1017/S0033291718001800

Bennett

O’Brien

(2007). Effects of coordinated services for drug-abusing women who are victims of intimate partner violence. Violence Against Women, 13(4), 395–411. https://doi.org/10.1177/1077801207299189

Beydoun

H. A.

Beydoun

M. A.

Kaufman

J. S.

Zondermen

A. B.

(2012). Intimate partner violence against adult women and its association with major depressive disorder, depressive symptoms and postpartum depression: A systematic review and meta-analysis. Social Science & Medicine, 75(6), 959–975. https://doi.org/10.1016/j.socscimed.2012.04.025

Bonomi

A. E.

Anderson

M. L.

Rivara

F. P.

Thompson

R. S.

(2009). Healthcare utilization and costs associated with physical and nonphysical-only intimate partner violence. Health Research and Educational Trust, 44(3), 1052–1067. https://doi.org/10.1111/j.1475-6773.2009.00955.x

Cafferky

B. M.

Mendez

Anderson

J. R.

Stith

S. M.

(2018). Substance use and intimate partner violence: A meta-analytic review. Psychology of Violence, 8(1), 110–131. https://doi.org/10.1037/vio0000074

Caplan

Whittemore

(2013). Barriers to treatment engagement for depression among Latinas. Issues in Mental Health Nursing, 34, 412–424. https://doi.org/10.3109/01612840.2012.762958

10.

Caraballo

Ndumele

C. D.

Roy

Riley

Herrin

Krumholz

H. M.

(2022). Trends in racial and ethnic disparities in barriers to timely medical care among adults in the US, 1999 to 2018. JAMA Health Forum, 3(10), 1–15. https://doi.org/10.1001/jamahealthforum.2022.3856

11.

Cokley

(2006). The impact of racialized schools and racist (mis)education on African American students’ academic identity. In Constantine

M. G.

Sue

D. W.

(Eds.), Addressing racism: Facilitating cultural competence in mental health and educational settings (pp. 127–144). John Wiley & Sons, Inc.

12.

Connell

(2016). Masculinities in global perspective: Hegemony, contestation, and changing structures of power. Theory and Society, 45(4), 303–318. https://doi.org/10.1007/s11186-016-9275-x

13.

Crapanzano

K. A.

Hammarlund

Ahmad

Hunsinger

Kullar

(2019). The association between perceived stigma and substance use disorder treatment outcomes: A review. Substance Abuse and Rehabilitation, 10, 1–12. https://doi.org/10.2147/SAR.S183252

14.

Cyrus

Sanchez

Madhivanan

Lama

J. R.

Bazo

A. C.

Valencia

Leon

S. R.

Villaran

Vagenas

Sciaudone

Coudray

M. S.

Atice

F. L.

(2021). Prevalence of intimate partner violence, substance use disorders and depression among incarcerated women in Lima, Peru. International Journal of Environmental Research and Public Health, 18, Article 11134. https://doi.org/10.3390/ijerph182111134

15.

Ehlers

Clark

D. M.

(2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38(4), 319–345. https://doi.org/10.1016/S0005-7967(99)00123-0

16.

First

M. B.

Williams

J. B.

Karg

R. S.

Spitzer

R. L.

(2016). SCID-5-CV: Structured clinical interview for DSM-5 disorders: Clinician version. American Psychiatric Association Publishing.

17.

Foa

E. B.

Cashman

Jaycox

Perry

(1997). The validation of a self-report measure of posttraumatic stress disorder: The posttraumatic diagnostic scale. Psychological Assessment, 9(4), 445–451. https://doi.org/10.1037/1040-3590.9.4.445

18.

Fowler

D. N.

Faulkner

(2011). Interventions targeting substance abuse among women survivors of intimate partner abuse: A meta-analysis. Journal of Substance Abuse Treatment, 41(4), 386–398. https://doi.org/10.1016/j.jsat.2011.06.001

19.

Golding

J. M.

(1999). Intimate partner violence as a risk factor for mental disorders: A meta-analysis. Journal of Family Violence, 14(2), 99–132.

20.

Haeny

A. M.

Oluwoye

Cruz

Iheanacho

Jackson

A. B.

Fisher

Crouch

O’Malley

(2021). Drug and alcohol treatment utilization and barriers among Black, American Indian/Alaskan Native, Latine, Asian/Pacific Islander/Native Hawaiian, and White adults: Findings from NESARC-III. Journal of Substance Abuse Treatment, 131, 1–10. https://doi.org/10.1016/j.jsat.2021.108569

21.

Hien

D. A.

Cohen

L. R.

Miele

G. M.

Litt

L. C.

Capstick

(2004). Promising treatment for women with comorbid PTSD and substance use disorders. The American Journal of Psychiatry, 161(8), 1426–1432. https://doi.org/10.1176/appi.ajp.161.8.1426

22.

Johnson

D. M.

Zlotnick

Hoffman

Palmieri

P. A.

Johnson

N. L.

Holmes

S. C.

Ceroni

T. 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

23.

Khalifeh

Oram

Osborn

Howard

L. M.

Johnson

(2016). Recent physical and sexual violence against adults with severe mental illness: A systematic review and meta-analysis. International Review of Psychiatry, 28(5), 433–451. https://doi.org/10.1080/09540261.2016.1223608

24.

Koss

M. P.

Oros

C. J.

(1982). Sexual experiences survey: A research instrument investigating sexual aggression and victimization. Journal of Consulting and Clinical Psychology, 50(3), 455–457. https://doi.org/10.1037/0022-006X.50.3.455

25.

Krivoshchekov

Gulevich

Blagov

(2023). Traditional masculinity and male violence against women: A meta-analytic examination. Psychology of Men & Masculinities, 24(4), 346–364. https://doi.org/10.1037/men0000426

26.

Laddis

(2019). The disorder-specific psychological impairment in complex PTSD: A flawed working model for restoration of trust. Journal of Trauma & Dissociation, 20(1), 79–99. https://doi.org/10.1080/15299732.2018.1451804

27.

Lagdon

Armour

Stringer

(2014). Adult experience of mental health outcomes as a result of intimate partner violence victimisation: A systematic review. European Journal of Psychotraumatology, 5(1). https://doi.org/10.3402/ejpt.v5.24794

28.

Langhinrichsen-Rohling

Misra

T. A.

Selwyn

Rohling

M. L.

(2012). Rates of bidirectional versus unidirectional intimate partner violence across samples, sexual orientations, and race/ethnicities: A comprehensive review. Partner Abuse, 3(2), 199–230. https://doi.org/10.1891/1946-6560.3.2.199

29.

Leemis

R. W.

Friar

Khatiwada

Chen

M. S.

Kresnow

Smith

S. G.

Caslin

Basile

K. C.

(2022). The National Intimate Partner and Sexual Violence Survey: 2016/2017 report on intimate partner violence. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.

30.

Lewinsohn

P. M.

Seeley

J. R.

Roberts

R. E.

Allen

N. B.

(1997). Center for Epidemiologic Studies Depression Scale (CES-D) as a screening instrument for depression among community-residing older adults. Psychology and Aging, 12(2). 277–287. https://doi.org/10.1037/0882-7974.12.2.277

31.

Lipsky

Caetano

(2007). Impact of intimate partner violence on unmet need for mental health care: Results from the NSDUH. Psychiatric Services, 58(6), 822–829. https://doi.org/10.1176/ps.2007.58.6.822

32.

Lipsky

Krupski

Roy-Byrne

Lucenko

Mancuso

Huber

(2010). Effect of co-occurring disorders and intimate partner violence on substance abuse treatment outcomes. Journal of Substance Abuse Treatment, 38, 231–244. https://doi.org/10.1016/j.jsat.2009.12.005

33.

Mahmood

(2020). Violence and its impact on Women in Bangladesh. Global Journal of Arts and Social Sciences, 2(2), 1–5.

34.

Makaroun

L. K.

Brignone

Rosland

A. M.

Dichter

M. E.

(2020). Association of health conditions and health service utilization with intimate partner violence identified via routine screening among middle-aged and older women. JAMA Network Open, 3(4), 1–12. https://doi.org/10.1001/jamanetworkopen.2020.3138

35.

Myers

U. S.

Browne

K. C.

Norman

S. B.

(2015). Treatment engagement: Female survivors of intimate partner violence in treatment for PTSD and alcohol use disorder. Journal of Dual Diagnosis, 11(3–4), 238–247. https://doi.org/10.1080/15504263.2015.1113762

36.

Ogden

S. N.

Dichter

M. E.

Bazzi

A. R.

(2022). Intimate partner violence as a predictor of substance use outcomes among women: A systematic review. Addictive Behaviors, 127, Article 107214. https://doi.org/10.1016/j.addbeh.2021.107214

37.

Overstreet

N. M.

Quinn

D. M.

(2013). The intimate partner violence stigmatization model and barriers to help seeking. Basic and Applied Social Psychology, 35(1), 109–122. https://doi.org/10.1080/01973533.2012.746599

38.

Pallatino

Chang

J. C.

Krans

E. E.

(2021). The intersection of intimate partner violence and substance use among women with opioid use disorder. Substance Abuse, 42(2), 197–204. https://doi.org/10.1080/08897077.2019.1671296

39.

Phillips

Lyon

Krans

E. E.

Warshaw

Chang

J. C.

Pallatino

(2021). Barriers to help-seeking among intimate partner violence survivors with opioid use disorder, International Review of Psychiatry, 33(6), 534–542. https://doi.org/10.1080/09540261.2021.1898350

40.

Priester

Browne

Iachini

Clone

DeHart

Seay

(2016). Treatment access barriers and disparities among individuals with co-occurring mental health and substance use disorders: An integrative literature review. Journal of Substance Abuse Treatment, 61, 47–59. https://doi.org/10.1016/j.jsat.2015.09.006

41.

Radloff

L. S.

(1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401. https://doi.org/10.1177/014662167700100306

42.

Reed

Myers

Novak

S. P.

Browne

F. A.

Wechsberg

W. M.

(2015). Experiences of violence and association with decreased drug abstinence among women in Cape Town, South Africa. AIDS and Behavior, 19, 192–198. https://doi.org/10.1007/s10461-014-0820-1

43.

Robinson

S. R.

Ravi

Voth Schrag

R. J.

(2021). A systematic review of barriers to formal help seeking for adult survivors of IPV in the United States, 2005–2019. Trauma, Violence, & Abuse, 22(5), 1279–1295. https://doi.org/10.1177/1524838020916254

44.

Rodriguez

Valentine

J. M.

Son

J. B.

Muhammad

(2009). Intimate partner violence and barriers to mental health care for ethnically diverse populations of women. Trauma, Violence, & Abuse, 10(4), 358–374. https://doi.org/10.1177/1524838009339756

45.

Sabri

Bolyard

Mcfadgion

Stockman

J. K.

Lucea

M. B.

Callwood

G. B.

Coverston

C. R.

Campbell

J. C.

(2013). Intimate partner violence, depression, PTSD, and use of mental health resources among ethnically diverse black women. Social Work Health Care, 52(4), 351–369. https://doi.org/10.1080/00981389.2012.745461

46.

Satyen

Rogic

A. C.

Supol

(2019). Intimate partner violence and help-seeking behaviour: A systematic review of cross-cultural differences. Journal of Immigrant and Minority Health, 21, 879–892. https://doi.org/10.1007/s10903-018-0803-9

47.

Simmons

C. A.

Lindsey

Delaney

M. J.

Whalley

Beck

J. G.

(2015). Real-world barriers to assessing and treating mental health problems with IPV survivors: A qualitative study. Journal of Interpersonal Violence, 30(12), 2067–2086. https://doi.org/10.1177/0886260514552275

48.

Spencer

Mallory

A. B.

Cafferky

B. M.

Kimmes

J. G.

Beck

A. R.

Stith

S. 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

49.

Stepanikova

Oates

G. R.

(2017). Perceived discrimination and privilege in health care: The role of socioeconomic status and race. American Journal of Preventive Medicine, 52(1), S86–S94. https://doi.org/10.1016/j.amepre.2016.09.024

50.

Straus

M. A.

Hamby

S. L.

Boney-McCoy

Sugarman

D. B.

(1996). The revised conflict tactic scales (CTS2) develop and preliminary psychometric data. Journal of Family Issues, 17(3), 283–316. https://doi.org/10.1177/019251396017003001

51.

Straus

M. A.

Hamby

S. L.

Warren

W. L.

(2003). The conflict tactic scale handbook. Western Psychological Services.

52.

Substance Abuse and Mental Health Services Administration. (2025). Key substance use and mental health indicators in the United States: Results from the 2024 National Survey on Drug Use and Health (HHS Publication No. PEP25-07-007, NSDUH Series H-60). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health/national-releases

53.

Sue

D. W.

Sue

(2016). Counseling the culturally diverse: Theory and practice. John Wiley & Sons, Inc.

54.

Sullivan

T. P.

Armeli

Tennen

Weiss

N. H.

Hansen

N. B.

(2020). Fluctuations in daily PTSD symptoms are related to proximal alcohol use: A micro-longitudinal study of women victims of intimate partner violence. The American Journal of Drug and Alcohol Abuse, 46(1), 98–108. https://doi.org/10.1080/00952990.2019.1624765

55.

Sullivan

T. P.

Cavanaugh

C. E.

Buckner

J. D.

Edmondson

(2009). Testing posttraumatic stress as a mediator of physical, sexual, and psychological intimate partner violence and substance problems among women. Journal of Traumatic Stress, 22(6), 575–584. https://doi.org/10.1002/jts.20474

56.

Tolman

R. M.

(1999). The validation of the psychological maltreatment of women inventory. Violence and Victims, 14(1), 25–37. https://doi.org/10.1891/0886-6708.14.1.25

57.

U.S. Department of Health and Human Services. (2008). National survey on drug use and health. Substance Abuse and Mental Health Services Administration. https://www.oas.samhsa.gov/nhsda.htm

58.

Verissimo

A. D. O.

Grella

C. E.

(2017). Influence of gender and race/ethnicity on perceived barriers to help-seeking for alcohol or drug problems. Journal of Substance Abuse Treatment, 75, 54–61. https://doi.org/10.1016/j.jsat.2016.12.013

59.

Weaver

T. L.

Gilbert

El-Bassel

Resnick

H. S.

Noursi

(2015). Identifying and intervening with substance-using women exposed to intimate partner violence: Phenomenology, comorbidities, and integrated approaches within primary care and other agency settings. Journal of Women’s Health, 24(1), 51–56. https://doi.org/10.1089/jwh.2014.4866

60.

Weiss

N. H.

Dixon-Gordon

K. L.

Peasant

Jaquier

Johnson

Sullivan

T. P.

(2017). A latent profile analysis of intimate partner victimization and aggression and examination of between-class differences in psychopathology symptoms and risky behaviors. Psychological Trauma: Theory, Research, Practice, and Policy, 9(3), 370. https://doi.org/10.1037/tra0000202

61.

World Health Organization. (2007). Engaging men and boys in changing gender-based inequity in health: Evidence from programme interventions. https://iris.who.int/server/api/core/bitstreams/46a5840f-c11b-4149-b2db-1ea7cd47b604/content

62.

Wright

E. N.

Anderson

Phillips

Miyamoto

(2022). Help-seeking and barriers to care in intimate partner sexual violence: A systematic review. Trauma, Violence, and Abuse, 23(5), 1510–1528. https://doi.org/10.1177/1524838021998305

63.

Zwick

Appleseth

Arndt

(2020). Stigma: How it affects the substance use disorder patient. Substance Abuse Treatment, Prevention, and Policy, 15, 1–4. https://doi.org/10.1186/s13011-020-00288-0

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