Intimate partner violence (IPV) is a public health crisis across the globe, and one particular act of IPV, non-fatal strangulation, warrants serious attention. Non-fatal strangulation is a risk factor for intimate partner homicide (IPH) and can create long-term negative mental and physical health consequences. In this meta-analysis, we sought to examine factors associated with non-fatal strangulation victimization among women to help inform education and assessment efforts. Using database searches and Boolean search terms, a total of 16 studies met the inclusion criteria. A total of 16 factors that were found in at least two unique studies were examined. The strongest associated factors included physical IPV victimization, physical injury, IPH, and sexual IPV victimization. Other significant associated factors included lower education, anxiety symptoms, perceived risk of harm, post-traumatic stress symptoms, depressive symptoms, stalking victimization, and identifying as a Black woman. Experiencing childhood trauma, the length of the relationship, age, substance use, and identifying as Hispanic were not significantly related to strangulation victimization by an intimate partner. Education and assessment implications are discussed.
ArayaR.LewisG.RojasG.FritschR. (2003). Education and income: Which is more important for mental health?. Journal of Epidemiology & Community Health, 57(7), 501–505.
2.
BendlinM.SheridanL. (2019). Nonfatal strangulation in a sample of domestically violent stalkers: The importance of recognizing coercively controlling behaviors. Criminal Justice and Behavior, 46(11), 1528–1541. https://doi.org/10.1177/0093854819843973
3.
*BendlinM.SheridanL. (2021). Risk factors for severe violence in intimate partner stalking situations: An analysis of police records. Journal of Interpersonal Violence, 36(17–18), 7895–7916. https://doi.org/10.1177/0886260519847776
4.
BerginA.BerkowitzR. (2012). Domestic violence in military families: Non-fatal strangulation. Maryland Medicine, 13(3), 19–29.
BorensteinM.HedgesL. V.HigginsJ. P. T.RothsteinH. R. (2009). Introduction to meta-analysis. John Wiley.
7.
BorensteinM.HedgesL. V.HigginsJ. P. T.RothensteinH. R. (2010). A basic introduction to fixed-effect and random-effects models for meta-analysis. Research Synthesis Methods, 1(2), 97–111. https://doi.org/10.1002/0470870168
8.
BradyP. Q.FansherA. K.ZedakerS. B. (2022). How victims of strangulation survived: Enhancing the admissibility of victim statements to the police when survivors are reluctant to cooperate. Violence Against Women, 28(5), 1098–1123.
9.
BradyP. Q.ZedakerS. B.McKayK.ScottD. (2023). The darker the skin, the greater the disparity? Why a reliance on visible injuries fosters health, legal, and racial disparities in domestic violence complaints involving strangulation. Journal of Interpersonal Violence, 38(11–12), 7602–7629.
10.
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.
*CampbellJ. C.WebsterD.Koziol-McLainJ.BlockC.CampbellD.CurryM. A.GaryF.GlassN.McFarlaneJ.SachsC.SharpsP.UlrichY.WiltS. A.ManganelloJ.XuX.SchollenbergerJ.FryeV.LaughonK. (2003). Risk factors for femicide in abusive relationships: Results from a multisite case control study. American Journal of Public Health, 93(7), 1089–1097. https://doi.org/10.2105/AJPH.93.7.1089
13.
CampbellJ. C.WebsterD. W.GlassN. (2009). The danger assessment: Validation of a lethality risk assessment instrument for intimate partner femicide. Journal of Interpersonal Violence, 24(4), 653–674.
14.
CannonL. M.BaileyJ. M.ErnstS. D.St IvanyA.BevilacquaK. G.ScheimanL.Munro-KramerM. L. (2020). Examining trends in non-fatal strangulation among sexual assault survivors seeking Sexual Assault Nurse Examiner care from 2002 to 2017. International Journal of Gynaecological Obstetrics, 49(1), 106–107. https://doi.org/10.1002/ijgo.13058
15.
CardN. A. (2012). Applied meta-analysis for social science research. Guilford Press.
16.
CummingG. (2012). Understanding the new statistics: Effect sizes, confidence intervals, and meta-analysis. Routledge.
17.
*DaughertyJ. C.Verdejo-RománJ.Pérez-GarcíaM.Hidalgo-RuzzanteN. (2022). Structural brain alterations in female survivors of intimate partner violence. Journal of Interpersonal Violence, 37(7–8), NP4684–NP4717. https://doi.org/10.1177/0886260520959621
18.
DavisK. E.AceA.AndraM. (2000). Stalking perpetrators and psychological maltreatment of partners: Anger-jealousy, attachment insecurity, need for control, and break-up context. Violence and Victims, 15, 407–425.
19.
De BoosJ. (2019). Review article: Non-fatal strangulation: Hidden injuries, hidden risks. Emergency Medicine Australasia, 31(3), 302–308. https://doi.org/10.1111/1742-6723.13243
20.
*DobashR. E.DobashR. P.CavanaghK.Medina-ArizaJ. (2007). Lethal and nonlethal violence against an intimate female partner: Comparing male murderers to nonlethal abusers. Violence Against Women, 13(4), 329–353.
21.
DouglasH.FitzgeraldR. (2020). Women’s stories of non-fatal strangulation: Informing the criminal justice response. Criminology and Criminal Justice, 22(2), 270–286. https://doi.org/10.1177/1748895820949607
22.
DuttonM. A.GoodmanL.SchmidtR. J. (2005). Development and validation of a coercive control measure for intimate partner violence: Final technical report (Report No. 214438). Retrieved from the National Criminal Justice Reference Service website: https://www.ncjrs.gov.
23.
FischerN. L.LamisD. A.Petersen-ColemanM. N.MooreC. S.ZhangH.KaslowN. J. (2015). Mediating effects of existential and religious well-being among abused, suicidal African American women. Journal of Family Violence, 31(3), 315–323. https://doi.org/10.1007/s10896-015-9771-1
24.
GartheR. C.HidalgoM. A.HerethJ.GarofaloR.ReisnerS. L.MimiagaM. J.KuhnsL. (2018). Prevalence and risk correlates of intimate partner violence among a multisite cohort of young transgender women. LGBT health, 5(6), 333–340. https://doi.org/10.1089/lgbt.2018.0034
25.
*GlassN.LaughonK.RuttoC.BevacquaJ.CampbellJ. C. (2008). Young adult intimate partner femicide: An exploratory study. Homicide Studies, 12(2), 177–187. https://doi.org/10.1177/1088767907313303
26.
*GlassN.LaughonK.CampbellJ.BlockC. R.HansonG.SharpsP. W.TaliaferroE. (2008). Non-fatal strangulation is an important risk factor for homicide of women. The Journal of Emergency Medicine, 35(3), 329–335. https://doi.org/10.1016/j.jemermed.2007.02.065
27.
HodgesT. A.CabanillaA. S. (2011). Factors that impact help-seeking among battered Black women: Application of critical and survivor theories. Journal of Cultural Diversity, 18(4), 120–125.
28.
HoutM. (2012). Social and economic returns to college education in the United States. Annual Review of Sociology, 38, 379–400.
29.
IversonK. M.BauerM. R.ShipherdJ. C.PinelesS. L.HarringtonE. F.ResickP. A. (2013). Differential associations between partner violence and physical health symptoms among Caucasian and African American help-seeking women. Psychological Trauma: Theory, Research, Practice, and Policy, 5, 158–166. https://doi.org/10.1037/a0025912
30.
JoshiM.ThomasK. A.SorensonS. B. (2012). “I didn’t know I could turn colors”: Health problems and health care experiences of women strangled by an intimate partner. Social Work in Health Care, 51, 798–814. https://doi.org/10.1080/00981389.2012.692352
31.
KellyL. C.SpencerC. M.KeilholtzB.McAllisterP.StithS. M. (2022). Is separate the new equal? A meta-analytic review of correlates of intimate partner violence victimization for Black and White women in the United States. Family Process, 61(4), 1473–1488. https://doi.org/10.1111/famp.12754
32.
KimmesJ. G.MalloryA. B.SpencerC.BeckA. R.CafferkyB.StithS. M. (2019). A meta-analysis of risk markers for intimate partner violence in same-sex relationships. Trauma, Violence, & Abuse, 20(3), 374–384. https://doi.org/10.1177/1524838017708784
33.
*Koziol-MclainJ.WebsterD.McFarlaneJ.BlockC. R.UlrichY.GlassN.CampbellJ. C. (2006). Risk factors for femicide-suicide in abusive relationships: Results from a multisite case control study. Violence and Victims, 21(1), 3–21. https://doi.org/10.1891/0886-6708.21.1.3
34.
KroppP. R.HartS. D. (2000). The Spousal Assault Risk Assessment (SARA)guide: Reliability and validity in adult male offenders. Law and Human Behavior, 24, 101–118. https://doi.org/10.1023/A:1005430904495
35.
KwakoL. E.GlassN.CampbellJ.MelvinK. C.BarrT.GillJ. M. (2011). Traumatic brain injury in intimate partner violence: A critical review of outcomes and mechanisms. Trauma, Violence, & Abuse, 12, 115–126. https://doi.org/10.1177/1524838011404251
36.
LariciA. R.FranchiP.OcchipintiM.ContegiacomoA.del CielloA.CalandrielloL.StortoM. L.MaranoR.BonomoL. (2014). Diagnosis and management of hemoptysis. Diagnostic and Interventional Radiology, 20(4), 299–309.
37.
*LoganT. K. (2021). Examining relationship and abuse tactics associated with nonfatal strangulation experiences before and after a protective order. Violence and Gender, 8(2), 95–103. https://doi.org/10.1089/vio.2020.0012
38.
McquownC.FreyJ.SteerS.FletcherG. E.KinkopfB.FaklerM.PrulhiereV. (2016). Prevalence of strangulation in survivors of sexual assault and domestic violence. American Journal of Emergency Medicine, 34, 1281–1285. https://doi.org/10.1016/j.ajem.2016.04.029
39.
MessingJ. T.PatchM.WilsonJ. S.KelenG. D.CampbellJ. (2018). Differentiating among attempted, completed, and multiple nonfatal strangulation in women experiencing intimate partner violence. Women’s Health Issues, 28(1), 104–111.
40.
*MessingJ. T.CampbellJ. C.SniderC. (2017). Validation and adaptation of the danger assessment-5: A brief intimate partner violence risk assessment. Journal of Advanced Nursing, 73(12), 3220–3230. https://doi.org/10.1111/jan.13459
41.
*MessingJ. T.ThallerJ.BagwellM. (2014). Factors related to sexual abuse and forced sex in a sample of women experiencing police-involved intimate partner violence. Health & Social Work, 39(3), 181–191. https://doi.org/10.1093/hsw/hlu026
42.
*MittalM.ReschK.Nichols-HadeedC.Thompson StoneJ.Thevenet-MorrisonK.FaurotC.CerulliC. (2018). Examining associations between strangulation and depressive symptoms in women with intimate partner violence histories. Violence and Victims, 33(6), 1072–1087. https://doi.org/10.1891/0886-6708.33.6.1072
43.
NicolaidisC.CurryM. A.UlrichY.SharpsP.McFarlaneJ.CampbellD.GaryF.LaughonK.GlassN.CampbellJ. (2003). Could we have known?: A qualitative analysis of women who survived an attempted homicide by an intimate partner. Journal of General Internal Medicine, 18, 788–794.
44.
PatchM.AndersonJ. C.CampbellJ. C. (2018). Injuries of women surviving intimate partner strangulation and subsequent emergency health care seeking: An integrative evidence review. Journal of Emergency Nursing, 44, 384–393. https://doi.org/10.1016/j.jen.2017.12.001
45.
*PatchM.FaragY. M.AndersonJ. C.PerrinN.KelenG.CampbellJ. C. (2021). United States ED visits by adult women for nonfatal intimate partner strangulation, 2006 to 2014: Prevalence and associated characteristics. Journal of Emergency Nursing, 47(3), 437–448. https://doi.org/10.1016/j.jen.2021.01.008
46.
*PierquetL. (1997). Neuropsychological consequences of the domestic battering of women [Doctoral thesis, Wisconsin School of Professional Psychology].
47.
PritchardA. J.ReckdenwaldA.NordhamC. (2017). Nonfatal strangulation as part of domestic violence: A review of research. Trauma Violence Abuse, 18, 407–424. https://doi.org/10.1177/1524838015622439
48.
PritchardA. J.ReckdenwaldA.NordhamC.HoltonJ. (2018). Improving identification of strangulation injuries in domestic violence: Pilot data from a researcher-practitioner collaboration. Feminist Criminology, 13(2), 160–181. https://doi.org/10.1177/15570851166531
49.
*RamosS. K. (2017). Heterosexual women experiencing intimate partner violence: Strangulation and self-perception differences in ethnic/racial groups. ProQuest Dissertations Publishing.
50.
ReckdenwaldA.ParkerK. F. (2012). Understanding the change in male and female intimate partner homicide over time: A policy-and theory-relevant investigation. Feminist Criminology, 7(3), 167–195.
51.
ReckdenwaldA.FernandezK.MandesC. L. (2019). Improving law enforcement’s response to non-fatal strangulation. Policing: An International Journal of Police Strategies and Management, 42(6), 1007–1021.
SabriB.CampbellJ. C.MessingJ. T. (2018). Intimate partner homicides in the United States, 2003–2013: A comparison of immigrants and nonimmigrant victims. Journal of Interpersonal Violence, 36(9–10), 4735–4757. https://doi.org/10.1177/0886260518792249
54.
Sato-DiLorenzoA.SharpsP. W. (2007). Dangerous intimate partner relationships and women’s mental health and health behaviors. Issues in Mental Health Nursing, 28(8), 837–848.
55.
*SmithY. (2009). Exploring psychosocial risk factors for stroke in young women exposed to domestic violence [Doctoral dissertation, Queen Margaret University].
56.
SmithD.MillsT.TaliaferroE. (2001). Frequency and relationship or reported symptomology in victims of intimate partner violence: The effect of multiple strangulation attacks. The Journal of Emergency Medicine, 21, 323–329.
57.
SorensonS. B.JoshiM.SivitzE. (2014). A systematic review of the epidemiology of nonfatal strangulation, a human rights and health concern. American Journal of Public Health, 104(11), 54–61. https://doi.org/10.2105/AJPH.2014.302191
58.
SorensonS. B.SpearD. (2018). New data on intimate partner violence and intimate relationships: Implications for gun laws and federal data collection. Preventive Medicine, 107, 103–108. https://doi.org/10.1016/j.ypmed.2018.01.005
59.
SpencerC. M.MalloryA. B.CafferkyB. M.KimmesJ. 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
60.
SpencerC. M.StithS. M. (2020). Risk factors for male perpetration and female victimization of intimate partner homicide: A meta-analysis. Trauma, Violence & Abuse, 21(3), 527–540. https://doi.org/10.1177/1524838018781101
61.
StithS. M.MilnerJ. S.FlemingM.RobichauxR. J.TravisW. J. (2016). Intimate partner physical injury risk assessment in a military sample. Psychology of Violence, 6(4), 529.
62.
StrackG. B.McClaneG. E.HawleyD. (2001). A review of 300 attempted strangulation cases: Part I: Criminal Legal Issues. Journal of Emergency Medicine, 21(3), 303–309. https://doi.org/10.1016/S0736-4679(01)00399-7
63.
ThomasK. A.JoshiM.SorensonS. B. (2014). “Do you know what it feels like to drown?”: Strangulation as coercive control in intimate relationships. Psychology of Women Quarterly, 38, 124–137. https://doi.org/10.1177/0361684313488354
64.
*ValeraE. M.DaughertyJ. C.ScottO. C.BerenbaumH. (2022). Strangulation as an acquired brain injury in intimate-partner violence and its relationship to cognitive and psychological functioning: A preliminary study. The Journal of Head Trauma Rehabilitation, 37(1), 15–23. https://doi.org/10.1097/HTR.0000000000000755
65.
VellaS. A.MillerM. M.LambertJ. E.MorganM. L. (2017). “I felt close to death”: A phenomenological study of female strangulation survivors of intimate terrorism. Journal of Feminist Family Therapy, 29(4), 171–188. https://doi.org/10.1080/08952833.2017.1370572
66.
WilburL.HigleyM.HatfieldJ.SurprenantZ.TaliaferroE.SmithD. J.PaoloA. (2001). Survey results of women who have been strangled while in an abusive relationship. Journal of Emergency Medicine, 21, 297–302. https://doi.org/10.1016/S0736-4679(01)00398-5
67.
WusuO. (2014). Predictors and implications of intimate partner violence against married female youths in Nigeria. Journal of Family Violence, 30(1), 63–74.
