Wentao Huang
Fan Zhang
Xibin Sun5
Yutao Lan- 1Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- 2Department of Nursing, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- 3School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
- 4Department of Emergency Medicine, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
- 5School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
Aim: This study proposes investigating the risk and protective factors of intimate partner (IP) psychological violence and psychological distress to better promote psychological wellbeing for nurses and health outcomes for patients.
Design: A cross-sectional study.
Method: This cross-sectional study was carried out chiefly in Guangdong, Hunan, and Shaanxi provinces, in the east, central, and west of the Chinese economic areas, respectively. It was conducted in October 2021 using convenience sampling. A total of 843 nurses were eligible for the final analysis. Single-factor linear regression models were used to identify potential factors associated with IP psychological violence and psychological distress. In addition, the structural equation model was used to explore the role of personality traits and social support in the association between IP psychological violence and psychological distress.
Results: The predictors for the score of IP psychological violence among nurses were participants' married status, contact frequency with a partner, perceived past-year psychological and physical violence experience, the alcohol consumption of partners, and personality traits and social support of partners. Moreover, the alcohol consumption of participants, the past-year experience of IP psychological violence, the score of psychological violence, personality traits, social support, and the personality traits of partners were associated factors affecting the psychological distress of nurses. In the structural model, the personality trait of partners had a direct pathway to psychological violence and social support. The results demonstrated that psychological violence significantly increased psychological distress.
Conclusion: Personality traits and social support are essential factors influencing the relationship between IP psychological violence and psychological distress.
Impact: The findings of this study emphasize the possibility and importance of identification and intervention for reducing IP psychological violence based on personality traits and social support.
1. Introduction
Nurses are an essential part of the healthcare system and strongly contribute to better patient outcomes. Therefore, factors that affect the quality of care from nurses should be studied, including professional competence and psychological state. However, a high prevalence of adverse psychological conditions among staff nurses has been reported in the past years. Studies revealed that more than 92.3% of nurses (Feng et al., 2018) reported the presence of psychological distress and 38.5% (Huang et al., 2021) had moderate-severe psychological distress. These results may be attributed to multiple stressors, including work overload, nurse-patient, and work-family conflicts (Hao et al., 2015; López-López et al., 2019). Such conflicts and violence from an intimate partner or family can significantly affect the psychological wellbeing of nurses. Those conflicts have been demonstrated to increase depressive symptoms and burnout among nurses by destroying the psychological capital of survivors (Hao et al., 2015), seriously affecting their physical and mental health, and further reducing their efficiency at work (MacGregor et al., 2022). Trauma from intimate partner violence (IPV) may compound the challenge for patient healthcare, thereby reducing the quality of care and resulting in higher medical risks. Nurses serve as care and intervention providers for the victims who suffer from IPV. However, there is evidence that health professionals are also experiencing a high prevalence of IPV (Carmona-Torres et al., 2017, 2018, 2019; McLindon et al., 2018). Health professionals, especially nurses, are more vulnerable to IPV and have barriers to seeking support compared with the general population (Dheensa et al., 2022). However, nurse experiences of IPV have been ignored because the subjects in most studies are pregnant women or LGBT people (Chisholm et al., 2017; Lutgendorf, 2019; Swan et al., 2021) rather than nurses or face violence in the workplace (Liu et al., 2019). Therefore, considering the above, it is important to determine the prevalence of IPV among nurses, and having a better understanding of the risk and protective factors of IPV could promote better psychological wellbeing for nurses and health outcomes for patients.
2. Background
2.1. Types, prevalence, and consequences of IPV
Intimate partner violence is referred to as behavior and includes various forms of physical, sexual, and psychological violence by a current or former intimate partner (Garcia-Moreno et al., 2006; Chisholm et al., 2017). It constitutes a major global problem as many people, especially women, are affected throughout the world, and it was estimated that 27% (uncertainty interval: 23–31%) and 13% (10–16%) of women aged 15–49 years have experienced lifetime and past-year IPV, respectively (Sardinha et al., 2022). Although the prevalence of IPV is relatively low in East Asia [19% (11–32%) and 8% (3–17%) for lifetime and past-year IPV] (Sardinha et al., 2022), a meta-analysis found a high prevalence of IPV [7.7% (95% CI: 5.6–10.1%)] among pregnant women in China, which was the highest reported number in Asia (Wang et al., 2017). IPV may contribute to a series of physical and mental traumas and sequelae (Sugg, 2015), constituting an essential determinant of the mental health of an individual. Moreover, it is well-established that IPV is associated with a higher incidence of anxiety, depression, psychological distress, suicide attempts, and severe mental illness (Devries et al., 2013; Sugg, 2015; Chandan et al., 2020). The association between IPV and adverse psychological wellbeing is bidirectional (Shen and Kusunoki, 2019). Thus, women who reported psychological distress are at a higher risk of suffering psychological violence (Oram et al., 2019; Keynejad et al., 2020). However, the prevalence of psychological violence, also known as cold violence, is increasing, which is even higher than physical violence and sexual violence (Dokkedahl et al., 2019; Gibbs et al., 2020; Chen and Chan, 2021; Occean et al., 2021). A study conducted in rural areas of China reported that 26.58, 7.66, and 3.20% of women have experienced psychological, physical, and sexual violence from an intimate partner (Hou et al., 2018). Psychological violence can be perpetrated in various forms, including threats, verbal abuse, accusations, and/or manipulation. Although it has a high prevalence, harm from psychological violence is often invisible and neglected (Arriaga and Schkeryantz, 2015). Compared to physical violence and sexual violence, victims of psychological violence are at a higher risk of depression (Tiwari et al., 2008). Additionally, psychological violence can have long-term effects on the self-esteem and identity of women, making the injury linger and hard to recover from Matheson et al. (2015).
2.2. Individual, demographic, and social factors associated with intimate partner violence
Intimate partner violence is a complex crisis attributed to multiple risk factors, including sociodemographic characteristics, relationship quality, religion, and social support. The social-ecological theory reveals the complex relationship between individual risk factors (including personal and partner factors), family, community, societal level, IPV, and mental health (Tekkas Kerman and Betrus, 2020). Thus, this complexity emphasizes the interaction between the individual and society on health outcomes (Campbell et al., 2009; Mojahed et al., 2020; Tekkas Kerman and Betrus, 2020). Personality traits are well-established to be associated with aggressive behavior and may enhance or inhibit aggressive moods and actions (Bettencourt et al., 2006; Barlett and Anderson, 2012). Openness, agreeableness, and neuroticism are related to bold emotions and physical aggression30. Conscientiousness was significantly and positively correlated with the gray matter volume in the right inferior frontal gyrus, which has revealed the relationship between personality traits and emotion regulation (Chen et al., 2018). Therefore, the personality traits of a partner might likely help to predict individuals with a higher risk of IPV. Personality traits were also strongly associated with the mental health of individuals (Nouri et al., 2019; Huang et al., 2021). Individuals characterized by high neuroticism, low extraversion, and low conscientiousness are associated with a greater risk of depression (Nouri et al., 2019). Similarly, the situation has also been described among physicians (Gramstad et al., 2013) and nurses (Warbah et al., 2007). Exploring the personality traits associated with the exposure and enforcement of IPV may help identify individuals who may be at risk for IPV and subsequent mental health problems.
The demographic factors of individuals were related to the prevalence of IPV, namely, gender, education level, employment status, personalities of individuals and partners, and alcohol consumption (Jewkes, 2002; Hou et al., 2018). Although women are regarded as victims in most situations, evidence showed gender symmetry regarding minor physical violence and psychological violence (Hou et al., 2018). Some studies pointed out that education level is a crucial predictor of IPV, and a high education level seems to protect women from suffering IPV and IP psychological violence (Debono et al., 2017; Cau, 2020; Choi et al., 2021). However, another study indicated that the education level of female victims could not predict or protect against severe IPV and homicide (Carmichael et al., 2019). The link between alcohol use/abuse and partner violence is well-established (Jewkes, 2002). Alcohol consumption is always linked to violence (Miczek et al., 2015). Therefore, men who frequently consume alcohol are more likely to commit all forms of IPV against their IP. Furthermore, alcohol consumption was significantly higher before IPV and had symmetry between men and women (Murphy et al., 2005; Foran and O'Leary, 2008; Kaufmann et al., 2014). Consequently, sociodemographic and lifestyle factors have been demonstrated as critical predictors of IPV.
The occurrence of IPV can be explained by the complex interplay between individual, relationship, community, and societal factors (Tekkas Kerman and Betrus, 2020). Social support is an essential factor in this interaction. Inadequate social support from the family and society is considered a risk factor affecting IPV and depressive symptoms (Fu et al., 2021), and high social support can be protective against some of the negative impacts of IPV and mental health (Escribà-Agüir et al., 2010; Abbas et al., 2019; Choi et al., 2021; Fedina et al., 2021). Individuals with weakened neighborhood relationships were associated with higher IPV levels and were exposed to a greater risk of psychological distress and suicide risk (Fedina et al., 2021). In addition, women exposed to IPV but with an extensive family network have a 29% lesser chance of poor self-perceived health status than those in a small family network (Escribà-Agüir et al., 2010). Social support was found to mediate between marital cohesion and depression (Abbas et al., 2019), which indicated that social support might mitigate the impact of conflict in intimate relationships. Thus, establishing strategies to improve social support may reduce IPV and subsequent adverse outcomes.
However, the prevalence of IP psychological violence and predictive and protective factors on IP psychological violence and psychological distress among nurses remain unknown. Therefore, it is unclear whether the risk factors of mutual violence are similar to those of IPV perpetration or victimization.
3. Study
3.1. Objective
This study explores the determinants associated with IP psychological violence and psychological distress among nurses. It examines the role of personality traits and social support in the relationship between IP psychological violence and psychological distress. Furthermore, this study explores whether social support can reduce the risk of IP psychological violence and psychological distress after suffering IP psychological violence.
3.2. Design
This is a cross-sectional study with a descriptive and correlational design using self-reported questionnaires and data instruments.
4. Methods
4.1. Data collection
This cross-sectional study was carried out chiefly in the Guangdong, Hunan, and Shaanxi provinces, in the east, central, and west of the Chinese economic areas. Eligible nurses and nursing supervisors were recruited to complete an online survey, using the Questionnaire Star platform (Changsha Ranxing Information Technology Co. Ltd.) through WeChat software (an instant messaging software widespread use in China) or e-mails. All electronic questionnaires were sent via a private letter from the research team or the supervisor of the subject. The questionnaires were issued to all potential subjects but were not artificially selected or mandatory. Participants have been informed that the study is not being conducted by their supervisors and institutions; the data will only be used for academic research and will not affect their work. Participants were required to answer all the questions in the questionary before the submission, and no personal identification information was collected.
4.2. Participants
The potential eligible participants included in this study have the following characteristics: (1) age ≥ 18 years; (2) a registered nurse; (3) have or used to have at least one intimate partner; and (4) voluntarily consented to the survey. A total of 1,616 participants received the questionnaires initially, and 843 participants were eligible for final analysis after excluding 773 people who reported no intimate partner. The potential number of variables for this study was 39. As a result, the sample size was higher than 20 subjects per variable, which was adequate for conducting a multivariate linear regression analysis based on the statistical method study (Austin and Steyerberg, 2015).
4.3. Ethical consideration
Ethical approval [No. (2021)-165] was granted by the institutional review board of the First Affiliated Hospital of Guangdong Pharmaceutical University in China. All participants have been informed of the (1) research objectives and procedures; (2) potential benefits, cost, and risk; and (3) the privacy policy before they answer the questionnaire. The participants could withdraw from the survey at any time, and data were erased in this case. Completing and submitting the electronic questionnaire was considered informed consent, indicating voluntary participation in the study.
4.4. Validity and reliability
All the instruments used in this study were based on previous studies, had validated scales, and were associated with high validity. Reliability and validity tests were used to confirm validation for each scale in this study.
4.5. Measures
4.5.1. Demographic characteristics
A self-developed questionnaire was used to collect demographic variables, such as age, sex, children situation (have or not), marital status (married, unmarried, cohabit, or non-cohabit), educational levels (technical secondary school, junior college, undergraduate, or postgraduate), alcohol consumption status of participants and partners (lifetime abstainer, former drinker, < 1 time per week, and ≥1 time per week), frequency of contact (always, often, occasionally, and hardly ever), and self-reported 1-year violence experience (psychological violence, physical violence, and sexual violence).
4.5.2. Personality traits
The Chinese version of the ten-item personality inventory questionnaire (TIPI-C) was used (Li, 2013). The TIPI is a brief personality assessment scale that could quickly assess the big-five personality traits dimensions [i.e., extraversion, agreeableness, conscientiousness, emotional stability (antithesis of neuroticism), and openness], scored on a 7-point Likert-type scale, with one as “disagree strongly” and seven as “agree strongly.” Each dimension consists of two reverse items; one item represents a positive trait (e.g., extraverted and enthusiastic) and the other a negative trait (e.g., reserved and quiet). The scores for every five dimensions were summed up with two items; higher scores for each dimension, indicating each positive trait, are preferred. The Cronbach's alpha coefficient for TIPI-C used in this study was 0.733. We asked the participants to rate their scores on a big-five personality trait questionnaire for both themselves and their partners. Therefore, in this study, the personality traits of the partners were reported by the participants and not measured directly by their partners.
4.5.3. Social support
Social support was measured using the social support rating scale (SSRS) developed by Xiao (1994), which is widely used in the Chinese population. The SSRS comprises three subscales, namely, subjective support (S-SS), objective support (O-SS), and utilization of social support (U-SS). A higher score indicates that a participant perceived or received more support from family, friends, or organizations and how actively the individual utilized that support, respectively. The Cronbach's α for SSRS used in this study was 0.794.
4.5.4. Intimate partner psychological violence
Intimate partner psychological violence was assessed using the Chinese domestic cold violence scale, a seven-item instrument developed by Yan et al. (2019), which can measure the severity of psychological violence by the spouse or intimate partner. Participants were asked to report how frequently the events related to psychological violence happened (e.g., insulting, isolating, distant, and indifferent), using a 4-point scale (from 1 for never happened to four for always happened). Items were summed, and a higher score indicated more severe experiences of psychological violence. The Cronbach's alpha for the scale was considered acceptable (0.912) in the present study. To validate the effectiveness of the scale for screening IPV, the ROC-curve analysis was computed to test the classification accuracy of participants with self-reported past-year psychological, physical, and sexual violence from an intimate partner, and the results indicated a high accuracy (AUC = 0.824, 0.786, and 0.787, respectively), which showed that the scores of intimate psychological violence measured by the scale were significantly and highly correlated with self-reported past-year IPV occurrence of the participants.
4.5.5. Psychological distress
The Kessler Measure of Psychological Distress (K10) was used to measure psychological distress (Kessler et al., 2003). Participants were asked about the frequency of experiencing symptoms in the past month, such as tiredness, nervousness, and depression. Each item was rated on a 5-point Likert scale (from 1 for none of the time to five for all the time), with a higher score indicating greater severity of psychological distress. The Cronbach's α obtained in this study was 0.953.
4.6. Data analyses
Descriptive statistics were used to report the distribution of the characteristics of the participants. Single-factor linear regression models were used to identify potential factors associated with psychological violence and psychological distress. A p < 0.05 in the adjusted model was imported into the final model. Finally, a structural equation model (SEM) with a bootstrap estimate based on 1,000 bootstrap samples was used to explore the role of personality traits and social support in the association between psychological violence and psychological distress. The model fit was evaluated using fit indices of mean square error of approximation (RMSEA), comparative fit index (CFI), Tucker-Lewis index (TLI), and standardized root mean square residual (SRMR). Descriptive statistics analysis and linear regression modeling were performed using STATA version 15.0 (Stata Corp., College Station, TX, USA). In contrast, SEM analysis was performed using Amos 26.0 (Amos Development Corporation, Meadville, PA, USA). The significant level was set to α = 0.05 (two-tailed).
5. Results
5.1. Demographic characteristics of participants
Table 1 displays the demographic characteristics of participants in this study. Of the 843 nurses (mean age = 34.35 years) who were enrolled in the final analysis, 809 (96.0%) were women, 698 (82.8%) were married and cohabiting with a partner, and 659 (78.2%) were undergraduates. A total of 234 (27.8%) participants and 507 (60.1%) of their partners reported having alcohol more than one drink per week. Of the participants, 191 (22.7%) reported suffering psychological violence from their intimate partner in the past year. In addition, there were 28 (3.3%) and 10 (1.2%) participants who also experienced physical violence and sexual violence, respectively. The correlation analysis results showed that social support, psychological violence, and psychological distress were significantly associated with each other (p < 0.001, Table 2).
Table 1. Demographic characteristics, n = 843.
Table 2. Descriptive and bivariate correlation analysis for social support, psychological violence, and psychological distress.
5.2. Factors affecting psychological violence
Participants who were married but not cohabiting as a couple (regression coefficients β = 1.08, 95 %CI 0.04–2.12) and contacted hardly (β = 2.88, 95% CI 1.99–3.78) reported higher IP psychological violence experiences compared with those who got married and cohabited and contacted frequently. In addition, participants whose intimate partners had more than one drink per week were at a higher risk of psychological violence (β = 0.69, 95% CI 0.10–1.29) than a lifetime abstainer. Additionally, those having experience of past-year psychological (β = 2.74, 95% CI 2.23–3.25) and physical violence (β = 2.67, 95% CI 1.56–3.78) reported significantly higher psychological violence experience. However, agreeableness, emotional stability for an intimate partner, objective support, and subjective support from social support may be protective factors against psychological violence (Table 3, Supplementary Table 1).
Table 3. Linear regression on selected associated factors for psychological violence among Chinese nurses.
5.3. Factors affecting psychological distress
Former drinkers (β = 3.90, 95% CI 0.86–6.94) and those who drink alcohol more than 1 day a week (β = 4.91, 95% CI 1.45–8.38) were experiencing higher psychological distress than lifetime abstainers. In addition, participants with a higher score on IP psychological violence were in more significant psychological distress (β = 0.41, 95% CI 0.25–0.56). The emotional stability of participants, subjective support from social support, and conscientiousness of intimate partners may be protective factors for psychological distress (β < 0, p < 0.05; Table 4, Supplementary Table 2).
Table 4. Linear regression on selected associated factors for psychological distress among nurses.
5.4. Structural equation model for the association between variables of interest
According to the abovementioned results, SEM was conducted to determine the relationship between personality traits, social support, psychological violence, and psychological distress. The obtained results provided full support for our hypothesis. Precisely, personality traits from an intimate partner may predict the occurrence and severity of psychological violence (standardized regression coefficient β′ = −0.43, p < 0.01). Nurses who have a highly agreeable, emotionally stable, and conscientious intimate partner are less likely to suffer psychological violence and therefore receive more social support (β′ = 0.30, p < 0.01). In addition, social support may be enhanced for emotionally stable participants. Thus, greater social support directly evidenced a negative association with psychological distress (β′ = −0.32, p < 0.01) and indirectly through reductions in psychological violence (Figure 1, Supplementary Table 3).
Figure 1. Structural equation model for the relationship between personality traits, social support, psychological violence, and psychological distress. A, agreeableness; ES, emotional stability; C, conscientiousness; S-SS, subjective support; O-SS, objective support; U-SS, utilization of social support. Values are standardized regression coefficients. ***p < 0.01.
6. Discussion
This cross-sectional study yielded several significant findings and revealed that the marital status of participants, contact frequency with a partner, perceived past-year psychological and physical violence experience, alcohol consumption of a partner, personality traits of a partner, and social support were predictors for the score of IP psychological violence among nurses. Moreover, the alcohol consumption of participants, the past-year experience of IP psychological violence, the score of psychological violence, personality traits, social support, and personality traits of a partner were associated factors affecting the psychological distress of nurses. In the structural model, the personality trait of a partner is directly associated with psychological violence experience and social support of participants. Psychological violence has significantly increased psychological distress. Therefore, the emotional stability of participants may be advantageous for increasing social support and reducing psychological distress. Additionally, social support affects psychological distress directly and indirectly by decreasing psychological violence. Regarding the prevalence of IP psychological violence among Chinese nurses, some studies focus on nurses and aim to reduce the risk of IP psychological violence and its mental health consequence.
The relationship between the big-five personality traits and IPV among nurses is less studied. This study provides further evidence that the personality traits of partners, especially emotional stability followed by agreeableness, may predict the occurrence of psychological violence. Partners with higher agreeableness, conscientiousness, and emotional stability were less likely to commit psychological violence and were associated with higher social support for participants. However, no association was found between extraversion, openness, and IP psychological violence. These findings were consistent with a previous study that suggested that agreeableness, conscientiousness, and emotional stability of a partner were associated with less conflict in married couples (Buss, 1991) and higher marital satisfaction (Gattis et al., 2004). The present study also partially agrees with a study that suggests that agreeableness, extraversion, and neuroticism may predict IPV severity (Yalch et al., 2020). Another nationally representative study on the adolescent population indicated that openness, extraversion, and neuroticism were risk factors associated with IPV (Ulloa et al., 2016). These inconsistencies may be attributed to the only IP psychological violence investigated in the present study. Regardless of the inconsistencies, neuroticism (emotional stability) was found to be a strong predictor of committing IPV in most studies (Buss, 1991; Ulloa et al., 2016; Yalch et al., 2020). Individuals who are more neurotic and emotionally unstable may have more aggressive emotions, be unable to control their emotions, and consequently adopt more verbal abuse, psychological violence, as well as physical violence to their IP. Low agreeableness was associated with violence in both genders and was mediated by alcohol consumption in men (Jones et al., 2020). Therefore, reducing alcohol consumption in men would significantly reduce IP psychological violence. Conscientiousness correlates with emotion regulation in a neuroanatomical basis study (Chen et al., 2018). Thus, the results showed that some personality traits are unique predictors of IP psychological violence and may help identify high-risk populations with IP psychological violence.
The current study also revealed that social support might reduce psychological distress by decreasing IP psychological violence. Social support is a key ecological determinant for the interaction of life events and mental health outcomes (Campbell et al., 2009; Tekkas Kerman and Betrus, 2020). This study demonstrated that social support from neighborhood and family members could predict depressive symptoms and hopelessness among women who experienced IPV (Pickover et al., 2021). Social support from family members, friends, and neighbors also helps to reduce the incidence of IPV and perinatal depressive and anxiety symptoms after suffering from IPV (Navarrete et al., 2021). Additionally, social support may be conducive to the improvement of post-traumatic growth and self-identification processes, a prompt for an individual seeking favorable personal resolutions positively after experiencing trauma from IPV (Žukauskiene et al., 2021). However, it is a possible kind of social isolation that women in abusive relationships may encounter if they were in a small social network and obtained less support against IPV from the social relationship (Katerndahl et al., 2013). Therefore, an interventional strategy that helps individuals rebuild and expand social networks would be significant.
6.1. Implications and limitations
The study provides evidence of the high prevalence of IP psychological violence in Chinese nurses and identifies multiple risk factors affecting IP psychological violence at the individual, interactional, and social levels. Nurses who experienced IP psychological violence reported a higher level of psychological distress. Considering the potential risk of IP psychological violence for nurses, this study suggests that a program that identifies IP psychological violence and provides social support interventions specific to the nurse population is necessary to promote better mental health. These strategies can potentially benefit nurses who are experiencing IP psychological violence by establishing available and clear guidelines for referrals and counseling policies that are timely and effective.
However, the present study has several limitations that should be mentioned. First, the current study sample was recruited via a network using an electronic questionnaire. Individuals who experience IPV may avoid answering the questionnaire. Although potential subjects were encouraged to participate in the study by informing them of the details of the study, privacy protection, and potential benefits, sampling bias may not be avoided entirely. Moreover, to ensure a certain level of representativeness, this study was mainly done in the three provinces in China (which is one of the provinces located in the east, central, and west of the Chinese economic areas, respectively), which still could not represent all the Chinese nurses and other health professionals. Additionally, these results could not be analogized to the general population. Another limitation of the study is that this is a cross-sectional descriptive study that limits causal inference between the risk factors and the occurrence of IP psychological violence. Finally, the measures of factors of a partner (e.g., alcohol consumption and personality traits) were proxy reported by respondents rather than from direct observations or reported by partners.
7. Conclusion
The present study identified the risk factors of IP psychological violence among Chinese nurses, namely, married but live apart, low contact frequency, high alcohol consumption frequency, past-year psychological and physical violence experience, low social support and low agreeableness, and emotional stability of partner. Structural modeling indicated that the personality traits of a partner might directly predict IP psychological violence and social support and indirectly predict psychological distress through IP psychological violence. In addition, social support may reduce IP psychological violence directly and further reduce psychological distress. The findings reported herein emphasize the possibility and importance of identification and intervention for reducing IP psychological violence based on personality traits and social support.
Data availability statement
The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.
Ethics statement
The studies involving human participants were reviewed and approved by First Affiliated Hospital of Guangdong Pharmaceutical University. The patients/participants provided their written informed consent to participate in this study.
Author contributions
WH, FZ, YL, QY, XS, and YS made substantial contributions to the conception and design, or acquisition of data, or analysis and interpretation of data. WH, FZ, YL, and YS involved in drafting the manuscript or revising it critically for important intellectual content. WH, FZ, QY, XS, JH, YS, and YL given final approval of the version to be published, each author should have participated sufficiently in the work to take public responsibility for appropriate portions of the content, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All authors contributed to the article and approved the submitted version.
Acknowledgments
The authors acknowledge the participants and nurse managers for supporting this study.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
Supplementary material
The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyg.2022.1038428/full#supplementary-material
References
Abbas, J., Aqeel, M., Abbas, J., Shaher, B., A, J., Sundas, J., et al. (2019). The moderating role of social support for marital adjustment, depression, anxiety, and stress: evidence from Pakistani working and nonworking women. J. Affect. Disord. 244, 231–238. doi: 10.1016/j.jad.2018.07.071
Arriaga, X. B., and Schkeryantz, E. L. (2015). Intimate relationships and personal distress: the invisible harm of psychological aggression. Pers. Soc. Psychol. Bull. 41, 1332–1344. doi: 10.1177/0146167215594123
Austin, P. C., and Steyerberg, E. W. (2015). The number of subjects per variable required in linear regression analyses. J. Clin. Epidemiol. 68, 627–636. doi: 10.1016/j.jclinepi.2014.12.014
Barlett, C. P., and Anderson, C. A. (2012). Direct and indirect relations between the Big 5 personality traits and aggressive and violent behavior. Pers. Individ. Dif. 52, 870–875. doi: 10.1016/j.paid.2012.01.029
Bettencourt, B. A., Talley, A., Benjamin, A. J., and Valentine, J. (2006). Personality and aggressive behavior under provoking and neutral conditions: a meta-analytic review. Psychol. Bull. 132, 751–777. doi: 10.1037/0033-2909.132.5.751
Buss, D. M. (1991). Conflict in married couples: personality predictors of anger and upset. J. Pers. 59, 663–688. doi: 10.1111/j.1467-6494.1991.tb00926.x
Campbell, R., Dworkin, E., and Cabral, G. (2009). An ecological model of the impact of sexual assault on women's mental health. Trauma Violence Abuse 10, 225–246. doi: 10.1177/1524838009334456
Carmichael, H., Steward, L., and Velopulos, C. G. (2019). It doesn't just happen to “other” people—an exploration of occupation and education level of women who die from intimate partner violence. Am. J. Surg. 218, 744–748. doi: 10.1016/j.amjsurg.2019.07.021
Carmona-Torres, J. M., Cobo-Cuenca, A. I., Recio-Andrade, B., Dios-Guerra, C., Lopez-Soto, P. J., Hidalgo-Lopezosa, P., et al. (2019). Health professionals who suffer intimate partner violence: a descriptive, multicenter, and cross-sectional study. J. Forensic Nurs. 15, 9–17. doi: 10.1097/JFN.0000000000000231
Carmona-Torres, J. M., Recio-Andrade, B., and Rodríguez-Borrego, M. A. (2017). Intimate partner violence among health professionals: distribution by autonomous communities in Spain. Rev. Esc. Enferm. 51, e03256. doi: 10.1590/s1980-220x2016049803256
Carmona-Torres, J. M., Recio-Andrade, B., and Rodríguez-Borrego, M. A. (2018). Violence committed by intimate partners of physicians, nurses and nursing assistants. Int. Nurs. Rev. 65, 441–449. doi: 10.1111/inr.12433
Cau, B. M. (2020). Area-Level normative social context and intimate partner physical violence in Mozambique. J. Interpers. Violence 35, 2754–2779. doi: 10.1177/0886260517704960
Chandan, J. S., Thomas, T., Bradbury-Jones, C., Russell, R., Bandyopadhyay, S., Nirantharakumar, K., et al. (2020). Female survivors of intimate partner violence and risk of depression, anxiety and serious mental illness. Br. J. Psychiatry 217, 562–567. doi: 10.1192/bjp.2019.124
Chen, C., Mao, Y., Luo, J., He, L., and Jiang, Q. (2018). Regional gray matter volume mediates the relationship between conscientiousness and expressive suppression. Front. Hum. Neurosci. 12, 301. doi: 10.3389/fnhum.2018.00301
Chen, M., and Chan, K. L. (2021). Characteristics of intimate partner violence in China: gender symmetry, mutuality, and associated factors. J. Interpers. Violence 36, Np6867–Np6889. doi: 10.1177/0886260518822340
Chisholm, C. A., Bullock, L., and Ferguson, J. E. J. II. (2017). Intimate partner violence and pregnancy: epidemiology and impact. Am. J. Obstet. Gynecol. 217, 141–144. doi: 10.1016/j.ajog.2017.05.042
Choi, A. W., Lo, B. C., Lo, R. T., To, P. Y., and Wong, J. Y. (2021). Intimate partner violence victimization, social support, and resilience: effects on the anxiety levels of young mothers. J. Interpers. Viol. 36, Np12299–Np12323. doi: 10.1177/0886260519888532
Debono, C., Borg Xuereb, R., Scerri, J., and Camilleri, L. (2017). Intimate partner violence: psychological and verbal abuse during pregnancy. J. Clin. Nurs. 26, 2426–2438. doi: 10.1111/jocn.13564
Devries, K. M., Mak, J. Y., Bacchus, L. J., Child, J. C., Falder, G., Petzold, M., et al. (2013). Intimate partner violence and incident depressive symptoms and suicide attempts: a systematic review of longitudinal studies. PLoS Med. 10, e1001439. doi: 10.1371/journal.pmed.1001439
Dheensa, S., McLindon, E., Spencer, C., Pereira, S., Shrestha, S., Emsley, E., et al. (2022). Healthcare professionals' own experiences of domestic violence and abuse: a meta-analysis of prevalence and systematic review of risk markers and consequences. Trauma Violence Abuse 15248380211061771. doi: 10.1177/15248380211061771
Dokkedahl, S., Kok, R. N., Murphy, S., Kristensen, T. R., Bech-Hansen, D., and Elklit, A. (2019). The psychological subtype of intimate partner violence and its effect on mental health: protocol for a systematic review and meta-analysis. Syst. Rev. 8, 198–198. doi: 10.1186/s13643-019-1118-1
Escribà-Agüir, V., Ruiz-Pérez, I., Montero-Piñar, M. I., Vives-Cases, C., Plazaola-Castaño, J., and Martín-Baena, D. (2010). Partner violence and psychological well-being: buffer or indirect effect of social support. Psychosom. Med. 72, 383–389. doi: 10.1097/PSY.0b013e3181d2f0dd
Fedina, L., Mushonga, D. R., Bessaha, M. L., Jun, H. J., Narita, Z., and DeVylder, J. (2021). Moderating effects of perceived neighborhood factors on intimate partner violence, psychological distress, and suicide risk. J. Interpers. Violence 36, 10546–10563. doi: 10.1177/0886260519884687
Feng, D., Su, S., Wang, L., and Liu, F. (2018). The protective role of self-esteem, perceived social support and job satisfaction against psychological distress among Chinese nurses. J. Nurs. Manag. 26, 366–372. doi: 10.1111/jonm.12523
Foran, H. M., and O'Leary, K. D. (2008). Alcohol and intimate partner violence: a meta-analytic review. Clin. Psychol. Rev. 28, 1222–1234. doi: 10.1016/j.cpr.2008.05.001
Fu, C., Wang, G., Shi, X., and Cao, F. (2021). Social support and depressive symptoms among physicians in tertiary hospitals in China: a cross-sectional study. BMC Psychiatry 21, 217. doi: 10.1186/s12888-021-03219-w
Garcia-Moreno, C., Jansen, H. A., Ellsberg, M., Heise, L., and Watts, C. H. (2006). Prevalence of intimate partner violence: findings from the WHO multi-country study on women's health and domestic violence. Lancet 368, 1260–1269. doi: 10.1016/S0140-6736(06)69523-8
Gattis, K. S., Berns, S., Simpson, L. E., and Christensen, A. (2004). Birds of a feather or strange birds? Ties among personality dimensions, similarity, and marital quality. J. Fam. Psychol. 18, 564–574. doi: 10.1037/0893-3200.18.4.564
Gibbs, A., Dunkle, K., and Jewkes, R. (2020). The prevalence, patterning and associations with depressive symptoms and self-rated health of emotional and economic intimate partner violence: a three-country population based study. J. Glob. Health 10, 010415. doi: 10.7189/jogh.10.010415
Gramstad, T. O., Gjestad, R., and Haver, B. (2013). Personality traits predict job stress, depression and anxiety among junior physicians. BMC Med. Educ. 13, 150. doi: 10.1186/1472-6920-13-150
Hao, J., Wu, D., Liu, L., Li, X., and Wu, H. (2015). Association between work-family conflict and depressive symptoms among chinese female nurses: the mediating and moderating role of psychological capital. Int. J. Environ. Res. Public Health 12, 6682–6699. doi: 10.3390/ijerph120606682
Hou, F., Cerulli, C., Wittink, M. N., Caine, E. D., and Qiu, P. (2018). Using confirmatory factor analysis to explore associated factors of intimate partner violence in a sample of Chinese rural women: a cross-sectional study. BMJ Open 8, e019465. doi: 10.1136/bmjopen-2017-019465
Huang, W., Cai, S., Zhou, Y., Huang, J., Sun, X., Su, Y., et al. (2021). Personality profiles and personal factors associated with psychological distress in Chinese nurses. Psychol. Res. Behav. Manag. 14, 1567–1579. doi: 10.2147/PRBM.S329036
Jewkes, R. (2002). Intimate partner violence: causes and prevention. Lancet 359, 1423–1429. doi: 10.1016/S0140-6736(02)08357-5
Jones, R. M., Van Den Bree, M., Zammit, S., and Taylor, P. J. (2020). The relationship between the big five personality factors, anger-hostility, and alcohol and violence in men and women: a nationally representative cohort of 15,701 young adults. J. Interpers. Violence 37, 886260520978178. doi: 10.1177/0886260520978178
Katerndahl, D., Burge, S., Ferrer, R., Becho, J., and Wood, R. (2013). Differences in social network structure and support among women in violent relationships. J. Interpers. Violence 28, 1948–1964. doi: 10.1177/0886260512469103
Kaufmann, V. G., O'Farrell, T. J., Murphy, C. M., Murphy, M. M., and Muchowski, P. (2014). Alcohol consumption and partner violence among women entering substance use disorder treatment. Psychol. Addict. Behav. 28, 313–321. doi: 10.1037/a0034971
Kessler, R. C., Barker, P. R., Colpe, L. J., Epstein, J. F., Gfroerer, J. C., Hiripi, E., et al. (2003). Screening for serious mental illness in the general population. Arch. Gen. Psychiatry 60, 184–189. doi: 10.1001/archpsyc.60.2.184
Keynejad, R. C., Hanlon, C., and Howard, L. M. (2020). Psychological interventions for common mental disorders in women experiencing intimate partner violence in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Psychiatry 7, 173–190. doi: 10.1016/S2215-0366(19)30510-3
Li, J. (2013). Psychometric properties of ten-item personality inventory in China. China J. Health Psychol. 21, 1688–1691. doi: 10.13342/j.cnki.cjhp.2013.11.008
Liu, J., Gan, Y., Jiang, H., Li, L., Dwyer, R., Lu, K., et al. (2019). Prevalence of workplace violence against healthcare workers: a systematic review and meta-analysis. Occup. Environ. Med. 76, 927–937. doi: 10.1136/oemed-2019-105849
López-López, I. M., Gómez-Urquiza, J. L., Cañadas, G. R., De la Fuente, E. I., Albendín-García, L., and Cañadas-De la Fuente, G. A. (2019). Prevalence of burnout in mental health nurses and related factors: a systematic review and meta-analysis. Int. J. Ment. Health Nurs. 28, 1032–1041. doi: 10.1111/inm.12606
Lutgendorf, M. A. (2019). Intimate partner violence and women's health. Obstet. Gynecol. 134, 470–480. doi: 10.1097/AOG.0000000000003326
MacGregor, J. C. D., Naeemzadah, N., Oliver, C. L., Javan, T., MacQuarrie, B. J., and Wathen, C. N. (2022). Women's experiences of the intersections of work and intimate partner violence: a review of qualitative research. Trauma Violence Abuse 23, 224–240. doi: 10.1177/1524838020933861
Matheson, F. I., Daoud, N., Hamilton-Wright, S., Borenstein, H., Pedersen, C., and O'Campo, P. (2015). Where did she go? The transformation of self-esteem, self-identity, and mental well-being among women who have experienced intimate partner violence. Womens Health Issues 25, 561–569. doi: 10.1016/j.whi.2015.04.006
McLindon, E., Humphreys, C., and Hegarty, K. (2018). “It happens to clinicians too”: an Australian prevalence study of intimate partner and family violence against health professionals. BMC Womens Health 18, 113. doi: 10.1186/s12905-018-0588-y
Miczek, K. A., DeBold, J. F., Hwa, L. S., Newman, E. L., and de Almeida, R. M. (2015). Alcohol and violence: neuropeptidergic modulation of monoamine systems. Ann. N. Y. Acad. Sci. 1349, 96–118. doi: 10.1111/nyas.12862
Mojahed, A., Alaidarous, N., Shabta, H., Hegewald, J., and Garthus-Niegel, S. (2020). Intimate partner violence against women in the Arab countries: a systematic review of risk factors. Trauma Violence Abuse 23, 1524838020953099. doi: 10.1177/1524838020953099
Murphy, C. M., Winters, J., O'Farrell, T. J., Fals-Stewart, W., and Murphy, M. (2005). Alcohol consumption and intimate partner violence by alcoholic men: comparing violent and nonviolent conflicts. Psychol. Addict. Behav. 19, 35–42. doi: 10.1037/0893-164X.19.1.35
Navarrete, L., Nieto, L., and Lara, M. A. (2021). Intimate partner violence and perinatal depression and anxiety: social support as moderator among Mexican women. Sex. Reprod. Healthc. 27, 100569. doi: 10.1016/j.srhc.2020.100569
Nouri, F., Feizi, A., Afshar, H., Hassanzadeh Keshteli, A., and Adibi, P. (2019). How five-factor personality traits affect psychological distress and depression? Results from a large population-based study. Psychol. Stud. 64, 59–69. doi: 10.1007/s12646-018-0474-6
Occean, J. R., Thomas, N., Lim, A. C., Lovett, S. M., Michael-Asalu, A., and Salinas-Miranda, A. A. (2021). Prevalence and factors associated with intimate partner violence among women in haiti: understanding household, individual, partner, and relationship characteristics. J. Interpers. Violence 36, 11356–11384. doi: 10.1177/0886260519898443
Oram, S., Boyce, N., and Howard, L. M. (2019). Mental health and violence: opportunities for change. Lancet Psychiatry 6, 558–559. doi: 10.1016/S2215-0366(19)30186-5
Pickover, A. M., Bhimji, J., Sun, S., Evans, A., Allbaugh, L. J., Dunn, S. E., et al. (2021). Neighborhood disorder, social support, and outcomes among violence-exposed African American women. J. Interpers. Violence 36, Np3716–Np3737. doi: 10.1177/0886260518779599
Sardinha, L., Maheu-Giroux, M., Stöckl, H., Meyer, S. R., and García-Moreno, C. (2022). Global, regional, and national prevalence estimates of physical or sexual, or both, intimate partner violence against women in 2018. Lancet 399, 803–813. doi: 10.1016/S0140-6736(21)02664-7
Shen, S., and Kusunoki, Y. (2019). Intimate partner violence and psychological distress among emerging adult women: a bidirectional relationship. J. Womens Health 28, 1060–1067. doi: 10.1089/jwh.2018.7405
Sugg, N. (2015). Intimate partner violence: prevalence, health consequences, and intervention. Med. Clin. North Am. 99, 629–649. doi: 10.1016/j.mcna.2015.01.012
Swan, L. E. T., Henry, R. S., Smith, E. R., Aguayo Arelis, A., Rabago Barajas, B. V., and Perrin, P. B. (2021). Discrimination and intimate partner violence victimization and perpetration among a convenience sample of LGBT individuals in Latin America. J. Interpers. Violence 36, Np8520–Np8537. doi: 10.1177/0886260519844774
Tekkas Kerman, K., and Betrus, P. (2020). Violence against women in Turkey: a social ecological framework of determinants and prevention strategies. Trauma Violence Abuse 21, 510–526. doi: 10.1177/1524838018781104
Tiwari, A., Chan, K. L., Fong, D., Leung, W. C., Brownridge, D. A., Lam, H., et al. (2008). The impact of psychological abuse by an intimate partner on the mental health of pregnant women. BJOG 115, 377–384. doi: 10.1111/j.1471-0528.2007.01593.x
Ulloa, E. C., Hammett, J. F., O'Neal, D. N., Lydston, E. E., and Leon Aramburo, L. F. (2016). The big five personality traits and intimate partner violence: findings from a large, nationally representative sample. Violence Vict. 31, 1100–1115. doi: 10.1891/0886-6708.VV-D-15-00055
Wang, T., Liu, Y., Li, Z., Liu, K., Xu, Y., Shi, W., et al. (2017). Prevalence of intimate partner violence (IPV) during pregnancy in China: a systematic review and meta-analysis. PLoS ONE 12, e0175108. doi: 10.1371/journal.pone.0175108
Warbah, L., Sathiyaseelan, M., VijayaKumar, C., Vasantharaj, B., Russell, S., and Jacob, K. S. (2007). Psychological distress, personality, and adjustment among nursing students. Nurse Educ. Today 27, 597–601. doi: 10.1016/j.nedt.2006.09.002
Xiao, S. (1994). The theoretical basis and research application of Social Support Rating Scale. J. Clin. Psychiatry. 02, 98–100.
Yalch, M. M., Rickman, S. R. M., Good, E. W., and Levendosky, A. A. (2020). Influence of personality traits on college women's appraisals of intimate partner violence. J. Trauma Dissociation 21, 574–584. doi: 10.1080/15299732.2020.1760411
Yan, F., Li, X., and Zhang, X. (2019). Development and preliminarily psychometric evaluation of domestic cold violence scale. Chin. Gen. Pract. 22, 312–318. doi: 10.12114/j.issn.1007-9572.2018.00.273
Keywords: intimate partner violence, nurse, psychological violence, personality traits, social support, psychological distress
Citation: Huang W, Zhang F, Sun X, Yu Q, Huang J, Su Y and Lan Y (2023) Association between intimate partner psychological violence and psychological distress among nurses: The role of personality traits and social support. Front. Psychol. 13:1038428. doi: 10.3389/fpsyg.2022.1038428
Received: 08 September 2022; Accepted: 15 December 2022;
Published: 12 January 2023.
Edited by:
Luca Rollè, University of Turin, ItalyReviewed by:
Carolina Bringas Molleda, University of Extremadura, SpainSarah Gino, University of Eastern Piedmont, Italy
Copyright © 2023 Huang, Zhang, Sun, Yu, Huang, Su and Lan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Wentao Huang, 
aHVhbmd3dDEmI3gwMDA0MDtzeXN1Y2Mub3JnLmNu; Yunhui Su, eXVuaHVpc3UyMDA4JiN4MDAwNDA7MTYzLmNvbQ==; Yutao Lan, bGFueXV0YW8mI3gwMDA0MDtnZHB1LmVkdS5jbg==