Journal of Interpersonal Violence

Journal ofetInterpersonal
10.1177/0886260505282564
Zlotnick al. / Intimate V
Partner
iolence
V iolence
Volume 21 Number 2
February 2006 262-275
© 2006 Sage Publications

Intimate Partner 10.1177/0886260505282564

http://jiv.sagepub.com
hosted at
Violence and Long-Term http://online.sagepub.com

Psychosocial Functioning
in a National Sample
of American Women
Caron Zlotnick
Brown University School of Medicine Hospital
Dawn M. Johnson
Summa-Kent State Center for the Treatment
and Study of Traumatic Stress
Robert Kohn
Brown University School of Medicine Hospital

Using a nationally representative sample of American married or cohabiting

women, this prospective study examined women who reported or denied inti-
mate partner violence (IPV) at wave 1 and compared them on a range of
psychosocial outcomes at a 5-year follow-up. This study also examined the
rate of divorce or separation during the 5-year interval among women who
reported IPV at wave 1 and explored whether certain predictors were related to
ending an abusive relationship with an intimate partner during the period.
Women with IPV at wave 1, compared to women without IPV, were signifi-
cantly more likely to experience a greater degree of depressive symptoms and
functional impairment and less self-esteem and life satisfaction at the 5-year
follow-up. Also, nearly half of the women in an abusive relationship left the
relationship within the period. Leaving the abusive relationship was associated
with lower individual income and more social support at wave 1.

Keywords: partner violence; national sample; psychosocial outcomes; pro-

spective study

A burgeoning body of literature has demonstrated that at least 1 in 4 mar-

ried women in North America during their lifetime will have been the
victim of partner violence (Jones et al., 1999; Ratner, 1993) and that these
women frequently suffer from a range of mental and physical health difficul-
ties as a result of the violence (see Campbell, 2002, for review). Although the

262

Downloaded from jiv.sagepub.com at UNIV OF RHODE ISLAND LIBRARY on April 7, 2015

 Zlotnick et al. / Intimate Partner Violence 263

sequelae are well documented, most of this research has focused on the
immediate effects of the violence on abused women’s health. Of the handful
of existing studies that have used longitudinal prospective designs to exam-
ine the effects of intimate partner violence (IPV) over time, findings suggest
that abused women have significant reductions in their levels of depression
or anxiety over time (Campbell & Soeken, 1999; Mertin & Mohr, 2001;
Sutherland, Bybee, & Sullivan, 1998). Yet abused women continue to report
greater ongoing use of somatic and psychiatric care than do nonabused
women during a 5-year period (Bergman & Brismar, 1991), and a substantial
number of abused women experience continued posttraumatic symptoms
during a 1-year interval, despite an overall improvement in symptoms
(Mertin & Mohr, 2001). A follow-up study that examined which subgroup of
women with IPV were more vulnerable to depressive symptoms during a 6-
month period following a shelter stay found that women who remained in the
abusive relationship were more likely to have moderate to severe levels of
depressive symptoms compared to those abused women who left their
spouse or partner (Campbell, Sullivan, & Davidson, 1995). However, a study
that investigated battered women’s responses to abuse during a period of 3 ½
years found that women who reported being free of abuse during the follow-
up period still had levels of self-esteem that were below norms of self-esteem
as established for the selected measure (Campbell & Soeken, 1999). Another
study that assessed battered women 14 ½ months after they had exited from a
shelter also found that even after ending the abusive relationship, these
women had physical and mental difficulties (Sutherland et al., 1998). Thus,
in general, existing research suggests that the effects of IPV on the health of
women are likely to be long term. Unfortunately, studies in this area have
been limited by a lack of control groups (Campbell & Soeken, 1999; Camp-
bell et al., 1995; Mertin & Mohr, 2001; Sutherland et al., 1998) and the use of
select samples of abused women, such as women in shelters (Campbell et al.,
1995; Mertin & Mohr, 2001; Sutherland et al., 1998) or emergency rooms
(Bergman & Brismar, 1991), which restricts the generalizability of these
findings.
Many battered women leave the abusive relationship. Research suggests
that 38% to 43% of women with IPV separate or divorce after a 2-year
follow-up (Jacobson, Gottman, Gortner, Berns, & Shortt, 1996; Okun,
1986). Overall, findings from studies on factors related to leaving an abusive
relationship have been equivocal. The most consistent predictors of leaving

Authors’ Note: Funding for National Survey of Families and Households (NSFH) wave 1 and
NSFH wave 2 was provided by the Center for Population Research of the National Institute of
Child Health and Human Development (Grant HD 21009). Funding for NSFH wave 2 was also
provided by the National Institute on Aging (Grant AG10266).

Downloaded from jiv.sagepub.com at UNIV OF RHODE ISLAND LIBRARY on April 7, 2015

264 Journal of Interpersonal Violence

are material resources (e.g., employment or income) and social psychologi-

cal factors (e.g., social support, commitment to the relationship; see Ander-
son & Saunders, 2003, for a review). Similar to the literature on the effects of
IPV, few studies have prospectively examined which factors are related to
leaving an abusive relationship. Also, most samples in these prospective
studies have been composed of women in shelters (Dalto, 1983; Okun, 1986;
Synder & Scheer, 1981) or have involved specific groups of women, such as
college women (Truman-Schram, Cann, Calhoun, & Vanwallendael, 2000)
or couples recruited through advertisements (Jacobson et al., 1996).
To our knowledge, this study will be the first to prospectively examine the
5-year psychosocial outcomes of women who initially reported IPV and
those who denied IPV with a spouse or live-in partner at wave 1 in a nation-
ally representative sample of women. In addition, this study will examine the
rate of divorce or separation during the 5-year interval among women who
reported IPV at wave 1. More specifically, this study will compare these
abused and nonabused women on level of depressive symptoms, self-esteem,
life satisfaction, functional impairment, social support, child behavioral
problems, and alcohol use at a 5-year follow-up period using data from the
first and second waves of the National Survey of Families and Households
(NSFH; Sweet & Bumpass, 1996; Sweet, Bumpass, & Call, 1988). Also, this
study will determine the rate of divorce or separation during a 5-year interval
among women who reported IPV within the past year at wave 1. Further, this
study will explore whether certain predictors are related to ending an abusive
relationship with an intimate partner during a 5-year period. The factors
selected for this study are those that have been empirically associated with
leaving an abusive partner (i.e., age, race, personal income, depressive symp-
toms, social support, and degree of IPV; see Anderson & Saunders, 2003).

Method

Data from the current study are from the primary respondents of the first
and second waves of the NSFH. The first wave of the NSFH used a probabil-
ity sample of 13,017 noninstitutional U.S. respondents who represented the
population aged 19 and older (1987-1988). A total of 10,005 of those respon-
dents were reinterviewed 5 years later in wave 2 (1992-1994). A full descrip-
tion of the purpose, method, and sampling frame of waves 1 and 2 of the
NSFH has been provided elsewhere (Sweet & Bumpass, 1996; Sweet et al.,
1988). The current study is a follow-up to previous research with the NSFH
that found a relationship between IPV and severity of depressive symptoms
at wave 1 (Zlotnick, Kohn, Peterson, & Pearlstein, 1998). Using a subgroup

Downloaded from jiv.sagepub.com at UNIV OF RHODE ISLAND LIBRARY on April 7, 2015

 Zlotnick et al. / Intimate Partner Violence 265

of 3,173 married or cohabiting women from wave 1 who completed ques-

tions about physical victimization in intimate relationships and were reinter-
viewed at wave 2, this study compared the 5-year outcome of women who
reported various degrees of interpersonal victimization at wave 1 (n = 148) to
those who denied interpersonal victimization. The total sample size for this
report varies because of incomplete data on some measures. The sample
sizes for individual analyses are reported in Table 1.

Measures
The NSFH questionnaires were developed by a University of Wisconsin
team. Many measures were slightly modified or shortened in an effort to
maximize the number of concepts assessed within the NSFH. A full descrip-
tion of all measures included in the NSFH has been provided elsewhere
(Sweet & Bumpass, 1996; Sweet et al., 1988). A description of the scales
employed in the current research follows.

Interpersonal Victimization
Questions regarding IPV between partners in both waves of the NSFH
were asked of individuals who were married or cohabiting at the time they
were interviewed. To measure physical victimization perpetrated by an inti-
mate partner, both waves of the NSFH survey included two self-enumerated
questions about the respondents’ experiences of physical victimization in
their intimate relationship during the past year. These questions were pre-
sented in the context of disagreements and conflicts between partners and the
ways in which such conflicts were resolved. The first question was, “During
the past year, how many fights with your partner resulted in HIM/HER hit-
ting, shoving, or throwing things at YOU?” The second questioned queried
the severity of the violence reported in the first question: “Have YOU ever
been cut, bruised, or seriously injured in a fight with your partner?” These
questions were coded on a frequency scale (none, once, twice, three, four or
more times) and were recoded as two sets of categorical variables: one deter-
mining the occurrence of IPV and the second describing the degree or sever-
ity of IPV (i.e., IPV without injury, IPV with injury). These are the same pro-
cedures used in previous research with the NSFH (Zlotnick et al., 1998).

Wave 2 Psychological Outcomes

Depression. The NSFH used an abbreviated version of the Center for

Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977), which has
been used in previous research (Ross & Mirowski, 1988). The CES-D has

Downloaded from jiv.sagepub.com at UNIV OF RHODE ISLAND LIBRARY on April 7, 2015

266 Journal of Interpersonal Violence

Table 1
Weighted Mean Scores for Wave 2 Outcome Measures
as a Function of Interpersonal Victimization at Wave 1
Intimate Partner Violence No Intimate Partner Violence
Outcome M SE M SE
a
Depression * 25.01 1.88 14.50 0.50
Child behavior problemsb 36.77 1.08 34.09 0.23
Life satisfactionc* 4.81 0.10 5.41 0.01
Self-esteemd* 6.52 0.21 5.92 0.06
Functional impairmente* 1.27 0.04 1.24 0.01
Alcohol usef 1.45 0.19 0.87 0.06
Social supportg 2.60 0.04 2.57 0.03

Note: Different ns are a result of missing values.

a. n = 3,104.
b. n = 1,209.
c. n = 3,117.
d. n = 3,098. Higher scores reflect greater disturbance in self-esteem.
e. n = 3,098.
f. n = 2,905.
g. n = 3,083.
*p < .01.

well-established reliability and validity (Radloff, 1977). The modified CES-

D is a 12-item self-report survey scored on a scale ranging from 0 to 7 indi-
cating the number of days each symptom was experienced in the past week.
The total score reflects a sum of the 12 items, where scores can range from 0
to 84. The modified CES-D demonstrated excellent reliability in the current
study (Cronbach’s α = .93).

Child behavior problems. All respondents with more than one child chose
one child (i.e., focus child) when answering specific questions about their
child’s behavior. The NSFH assessed parent report of behavior problems in
their focus children with 27 items from the National Longitudinal Survey of
Youth Behavior Problems Index (Zill, 1990). These items were primarily
taken from Achenbach’s (1978) Child Behavior Checklist and assess both
internalizing and externalizing behaviors during the past 3 months (e.g., sud-
den changes in mood, cheating or telling lies, disobedient at home,
impulsivity, fear and anxiety). Child behavior problems were assessed sepa-
rately for children ages 3 to 4 and 5 to 17. As few women in the current sam-
ple had focus children between 3 and 4, child maladjustment is only assessed
for children ages 5 to 17. Each item is rated on a 3-point scale ranging from

Downloaded from jiv.sagepub.com at UNIV OF RHODE ISLAND LIBRARY on April 7, 2015

 Zlotnick et al. / Intimate Partner Violence 267

not true to often true. Individual items are summed so that higher scores
reflect more child behavior problems. Scores can range from 27 to 81. These
items demonstrated sound reliability in the current study (Cronbach’s α =
.80).

Life satisfaction. Life satisfaction was assessed with 11 items from the
Institute for Social Research at Michigan Quality of Life Surveys. These
items have respondents rate their degree of satisfaction in different life
domains (e.g., home, finances, friendships, health) on a 7-point scale ranging
from 1 (very dissatisfied) to 7 (very satisfied). The mean of participants’
responses across the 11 questions was used to reflect global life-satisfaction,
with higher scores reflecting higher degrees of satisfaction. Overall scores
can range from 1 to 7. This scale demonstrated sound reliability in the current
study (Cronbach’s α = .83).

Self-esteem. Three items from the Rosenberg Self-Esteem Scale (Rosen-

berg, 1965), which has well-established reliability and validity, were used to
assess self-esteem. Items were rated on a 5-point scale ranging from 1
(strongly agree) to 5 (strongly disagree) and were summed where higher
scores reflect greater disturbance in self-esteem. Scores could range from 3
to 15. This scale demonstrated adequate reliability in the current study
(Cronbach’s α = .67).

Functional impairment. Six items from the Katz Activities of Daily Liv-
ing Index (Katz, 1983) and the Rosow-Breslau Functional Health Scale
(Rosow & Breslau, 1966) were used to assess impairment in functioning.
These items have respondents rate the degree their physical or mental condi-
tion limits their abilities across seven domains (e.g., caring for personal
needs, household tasks, work for pay) on a 3-point scale ranging from 1
(does not limit at all) to 3 (limits a lot). Each item represents a separate
domain of impairment. The mean of these six items was used to reflect global
functional impairment, with higher scores reflecting higher levels of impair-
ment. Total scores could range from 1 to 3. This scale demonstrated sound
reliability in the current research (Cronbach’s α = .89).

Alcohol use. A modified version of the National Survey of Alcohol and

Drug Abuse questions were used to assess alcohol use. These four items
assessed alcohol use in the past 30 days and were recoded to reflect severity
of alcohol use. An adapted version of the quantity or frequency measure of
alcohol consumption commonly used in alcohol studies (Kantor & Straus,
1987) was used in the current research. The combined responses from the

Downloaded from jiv.sagepub.com at UNIV OF RHODE ISLAND LIBRARY on April 7, 2015

268 Journal of Interpersonal Violence

four NSFH items were recoded on a 6-point scale ranging from 0 (abstinent)
to 3 (high moderate use) to 5 (binge drinking). This scale demonstrated
excellent reliability in the current research (Cronbach’s α = .97).

Social support. A 25-item self-report measure that asked how many peo-
ple in the past month, not living with the respondent, had given help to the
respondent across five domains (e.g., child care, advice or emotional sup-
port, help around the house) was used to assess recent social support. To
reflect degree of social support received by the respondent, the present study
summed the number of people who assisted the respondent across domains.
This measure, which is the same measure used in research in the first wave
(Zlotnick et al., 1998), is consistent with other measures of social support
(e.g., Barrera, 1986) and demonstrated adequate reliability in the current
research (Cronbach’s α = .60).

Data Analyses
The NSFH oversampled several subgroups: Blacks and Hispanics, one-
parent families, families with stepchildren, cohabitants, and recently married
persons (Sweet et al., 1988). A weighting variable was used in all analyses to
approximate the U.S. population. All data were analyzed using the Taylor
series variance estimation method in the SUDAAN statistical package to cor-
rect the standard errors for the stratified sampling design and for the use of
the weighting variable. The NSFH self-enumerated questionnaires were
given in various sections, with some respondents correctly completing some
sections but not others. To maximize the size of the group of respondents
who reported interpersonal victimization during wave 1, all respondents who
completed at least one of the outcome measures were used in analyses. Thus,
the overall sample size varies for each analysis because of missing data. The
effect IPV at wave 1 had on participants’ self-reported levels of depression,
life satisfaction, self-esteem, functional impairment, alcohol use, and social
support and on their children’s behavioral problems at wave 2 were explored
with regression analyses with presence of IPV as an independent variable.
These analyses controlled for any demographic differences and for wave 1
differences on psychological outcomes when available and appropriate (e.g.,
depression; Zlotnick et al., 1998). To reduce chances of Type I error, a signif-
icance level of p < .01 was used for our primary analyses. Post hoc analyses
were also conducted to help interpret findings. Because of the exploratory
nature of these analyses, the significance level of p < .05 was used for all post
hoc analyses. Means and percentages that correct for the weighting variable
are provided for all descriptive data.

Downloaded from jiv.sagepub.com at UNIV OF RHODE ISLAND LIBRARY on April 7, 2015

 Zlotnick et al. / Intimate Partner Violence 269

Results

Demographics
A majority (94.7%) of participants were married (n = 2,937). At wave 1,
95 (2.3%) reported interpersonal victimization without injury, and 53 (1.4%)
reported IPV with injury. Most (n = 2,599) participants were White (85.2%),
6.8% were Black, 6.6% were Hispanic, and 1.4% were of another ethnicity.
The average age of participants was 42.3 (SE = 0.4). Socioeconomic status
(SES) was determined using the occupational prestige measured by the
Socioeconomic Indexes and the 1980 Census Occupational Classification
scheme (Stevens & Cho, 1985). SES of participants ranged from 11.8 to 87.1
(M = 32.8, SE = 0.4). Demographic differences as a function of IPV were
explored. Respondents who reported IPV were significantly younger (M =
31.4, SE = 1.2) than those who did not report IPV (M = 42.8, SE = 0.4), (t[10,
n = 3,173] = 9.46, p < .0001). No significant differences were found for SES
or ethnicity.

Psychological Outcomes
When controlling for age and depression at wave 1, IPV at wave 1 signifi-
cantly related to wave 2 CES-D scores, F(1, 10, n = 3,104) = 15.18, p = .003,
β = 6.96. When controlling for age at wave 1, IPV at wave 1 significantly
related to respondents’ wave 2 scores on measures of life satisfaction, F(1,
10, n = 3,177) = 23.23, p = .0007, β = –.44; self-esteem, F(1, 10, n = 3,098) =
11.78, p = .0064, β = .70; and functional impairment, F(1, 10, n = 3,098) =
14.13, p = .0037, β = .14. Inspection of mean scores (see Table 1) demon-
strates that women who reported IPV at wave 1 reported significantly more
severe depression symptoms, lower life satisfaction, more disturbed self-
esteem, and greater functional impairment at wave 2 than did women who
denied IPV at wave 1. No significant differences were found for child behav-
ior problems, alcohol use, or social support at wave 2 (p > .01). Table 1 dis-
plays the weighted mean scores of wave 2 psychological outcomes as a
function of IPV at wave 1.

Exploratory Analyses
Because IPV at wave 1 was significantly related to multiple psychological
outcomes at wave 2, exploratory analyses were run with the subgroup of
women who reported IPV at wave 1 (n = 148) to help interpret the findings
described above. Unfortunately, because IPV was only assessed in respon-
dents who were married or cohabiting at the time of each interview, informa-

Downloaded from jiv.sagepub.com at UNIV OF RHODE ISLAND LIBRARY on April 7, 2015

270 Journal of Interpersonal Violence

tion on IPV during wave 2 is not available for all women who reported IPV at
wave 1. Given this, it was only possible to follow whether or not the women
remained with their abusive partners over time or had left their partners some
time between waves 1 and 2 and to follow IPV at wave 2 in a subgroup of
women who responded to the IPV questions at both waves. Of the women
who reported IPV at wave 1, 57.4% (n = 87) were still with their abusive part-
ner at wave 2. Of those women who remained with their abusive partner at
wave 2 and completed questions on IPV at wave 2 (n = 84), 30.6% (n = 25)
reported IPV at wave 2. Data were only available on IPV at wave 2 for 20 of
the women who left their partner. Only 1 (2.7%) reported IPV at wave 2.
To explore possible factors that may contribute to a woman leaving an
abusive partner, exploratory analyses were run with wave 1 demographic
variables and psychological variables as dependent variables. Women who
left their abusive partner between wave 1 and wave 2 were younger, t(10, n =
148) = –2.87, p = .017; had lower individual incomes, t(10, n = 148) = –2.40,
p = .04; and reported more social support at wave 1, t(10, n = 148) = 3.07, p =
.012, than did women who remained with their abusive partner over time (see
Table 2). No effects were found for degree of IPV at wave 1 for race or for
wave 1 depression (p > .05).
Exploratory analyses were run to determine if abused women who
reported IPV at wave 1 and remained with their partner at wave 2 or those
women who experienced more severe abuse (i.e., were injured) at wave 1
were driving the relationship between IPV at wave 1 and psychological out-
comes at wave 2. To achieve this, exploratory regression analyses were run
with women’s relationship status over time (remain with abuser vs. leave
abuser at wave 2) and the presence of injury at wave 1 as independent vari-
ables. These analyses also controlled for wave 1 demographic differences
(i.e., individual income and age) and wave 1 differences on psychological
outcomes when available and appropriate (i.e., depression). No significant
effects were found for relationship status over time or injury at wave 1 on
wave 2 depression, life satisfaction, functional impairment, or self-esteem
(p > .05).

Discussion

The present study found that among a community sample of married or

cohabiting women, those who reported IPV compared to those who reported
no IPV were significantly more likely within a 5-year follow-up period to
experience the following: a greater degree of depressive symptoms, more
functional impairment, less self-esteem, and less life satisfaction. This study

Downloaded from jiv.sagepub.com at UNIV OF RHODE ISLAND LIBRARY on April 7, 2015

 Zlotnick et al. / Intimate Partner Violence 271

Table 2
Comparison of Women Who Left Their Abusive Partner
With Those Who Remained With Their Abusive
Partner at Wave 2 on Relevant Wave 1 Variables
Left Abuser Remained With Abuser
Variable n % n %

Intimate partner violence (IPV) with injury 29 46.81 24 31.62

Minority status 13 23.01 16 19.37

M SE M SE

Individual income* 7,841.03 1,353.22 12,661.65 1,346.27

Age* 28.99 0.74 33.20 1.67
Depression 26.71 2.16 20.82 1.55
Social support* 3.84 0.41 2.70 0.35

Note: n = 148.
*p < .05.

did not find that women who remained in the relationship over time were
more likely to experience these psychosocial difficulties. In addition, for
these women (i.e., those who remained in the relationship), the level of injury
from the abuse was not significantly related to the degree of psychosocial
dysfunction. Thus, this study, consistent with other research findings (e.g.,
Sutherland et al., 1998), suggests that women who have experienced IPV are
at risk for a range of long-term mental health concerns, irrespective of
whether or not they stay or leave the abusive relationship or their degree of
injury. Because IPV was only assessed in respondents who were married or
cohabiting at each interview period, it is not possible to attribute the ongoing
psychosocial difficulties to the IPV 5-years prior because women may have
been revictimized in the interim time frame. Also, mediating factors, such as
other forms of stress, may account for the fact that women with IPV at wave 1
continued to report problems relative to women who reported no IPV at
wave 1.
This study found that women with IPV, compared to those with no IPV,
reported comparable degrees of child behavior problems, alcohol use, and
social support at a 5-year follow-up. In our earlier study (Zlotnick et al.,
1998), we also found that victims and nonvictims of IPV reported compara-
ble levels of social support, which indicates that level of social support of
women with IPV did not decline over time. Likewise, IPV relative to no IPV
was not found to contribute significantly to long-term alcohol use and child

Downloaded from jiv.sagepub.com at UNIV OF RHODE ISLAND LIBRARY on April 7, 2015

272 Journal of Interpersonal Violence

behavior problems. Few, if any, longitudinal studies have examined whether

the presence of IPV is associated with alcohol use, although a handful of
studies have shown that IPV is associated with high-risk alcohol use (see
Miller, Wilsnack, & Cunradi, 2000, for review). Also, virtually no studies
have examined the long-term effects of IPV on children’s adjustment. A
meta-analysis found that children from homes with IPV had significantly
worse child adjustment across a range of psychosocial outcomes relative to
those without IPV, in the short term (Kitzmann, Gaylord, Holt, & Kenny,
2003). Although the current study did not assess whether the child had been
exposed to the IPV, in Kitzmann et al.’s (2003) meta-analyses, studies that
assessed child exposure to IPV were compared to those that assumed expo-
sure based on presence of IPV in the home, and it was found that this variable
did not moderate the results of the relationship between children’s psycho-
social outcomes and IPV (Kitzmann et al., 2003). Of course, future research
needs to examine whether factors such as witnessing the violence, duration
of abuse, violence toward the child, and age of child predict long-term
behavioral problems in children of mothers who experience IPV.
This study found that many abused women (43%) leave their abusive rela-
tionship within the 5-year period, a rate that is fairly consistent with other
studies using different samples and designs (e.g., Jacobson et al., 1996).
Although exploratory, the present study found that those women who left the
abusive relationship had significantly lower individual incomes and reported
more social support at wave 1 than did women who stayed with their abusive
partner over time. Degree of depression was unrelated to their decision.
Other studies have found a relationship between leaving the abusive relation-
ship and greater personal material resources (see Anderson & Saunders,
2003); however, these studies were with women at shelters or treatment seek-
ers. Also, other research shows that women who have a source of independ-
ent income, including welfare, are more likely to leave the relationship (see
Anderson & Saunders, 2003). A possible explanation for our finding is that
lower personal income predicted leaving the abusive relationship because
low-income women qualified for welfare, which increased their economic
freedom from the relationship. Regarding social support, other research has
also found that greater social support is related to leaving the relationship
(e.g., Lesser, 1990).
Several limitations of this study warrant attention. The measure of IPV
specified only three acts of violence, which may have excluded some victim-
ized women in the sample and therefore potentially accounted for our find-
ings of no group differences in some outcomes. Another possible confound
in this study is that we could not assess the effect of continued or new IPV in
the lives of all the women in our study, and revictimization or ongoing abuse

Downloaded from jiv.sagepub.com at UNIV OF RHODE ISLAND LIBRARY on April 7, 2015

 Zlotnick et al. / Intimate Partner Violence 273

may have explained the lack of differences in outcomes such as child behav-
ior problems. Also, the current study’s lack of attention to possible con-
founds because of stressors other than IPV also makes it difficult to attribute
the negative psychosocial outcomes found in this study exclusively to IPV.
Another limitation of this study is that many of the instruments used in this
study were broad measures of the psychosocial functioning of women and
their children that were modified or shortened. In addition, important out-
comes, such as posttraumatic stress disorder, which has been identified as
one of the primary mental health sequelae of IPV (Campbell, 2002), were not
assessed. The present study was also limited in that our sample size was too
small to identify which subgroup of women with IPV, such as those who
remained in the relationship or who were severely injured, were most at risk
for negative health consequences. More longitudinal studies with complex
designs and larger samples are needed to further our understanding of the
effects of IPV on women and their children.
Despite these limitations, this is the first study to use a longitudinal design
with a community sample of women with IPV and to examine a range of
psychosocial variables that includes child adjustment. Overall, the findings
of this study expand previous findings with selected samples of women that
IPV compromises the mental health of women in the long term.

References
Achenbach, T. M. (1978). The Child Behavior Profile: I. Boys aged 6-11. Journal of Consulting
and Clinical Psychology, 46, 478-488.
Anderson, D. K., & Saunders, D. G. (2003). Leaving an abusive partner: An empirical review of
predictors, the process of leaving, and psychological well-being. Trauma, Violence, and
Abuse, 4, 163-191.
Barrera, M. (1986). Distinctions between social support concepts, measures, and models. Jour-
nal of Community Psychology, 14, 413-441.
Bergman, B., & Brismar, B. (1991). A 5-year follow-up study of 117 battered women. American
Journal of Public Health, 81, 1486-1489.
Campbell, J. C. (2002). Health consequences of intimate partner violence. Lancet, 359, 1331-
1336.
Campbell, J. C., & Soeken, K. L. (1999). Women’s responses to battering over time. Journal of
Interpersonal Violence, 14, 21-40.
Campbell, R., Sullivan, C. M., & Davidson, W. S., II. (1995). Women who use domestic violence
shelters. Psychology of Women Quarterly, 19, 237-255.
Dalto, C. (1983). Battered women: Factors influencing whether or not former shelter residents
return to the abusive situation. Dissertation Abstracts International, 44, 1277.
Jacobson, N. S., Gottman, J. M., Gortner, E., Berns, S., & Shortt, J. W. (1996). Psychological fac-
tors in the longitudinal course of battering: When do the couples split up? When does the
abuse decrease? Violence and Victims, 11, 371-392.

Downloaded from jiv.sagepub.com at UNIV OF RHODE ISLAND LIBRARY on April 7, 2015

274 Journal of Interpersonal Violence

Jones, A. S., Gielen, A. C., Campbell, J. C., Schollenberger, J., Dienemann, J. A., Kub, J., et al.
(1999). Annual and lifetime prevalence of partner abuse in a sample of female HMO
enrollees. Womens Health Issues, 9, 295-305.
Kantor, G. K., & Straus, M. A. (1987). The “drunken bum” theory of wife beating. Social Prob-
lems, 34, 213-230.
Katz, S. (1983). Assessing self-maintenance: Activities of daily living, mobility, and instrumen-
tal activities of daily living. Journal of the American Geriatrics Society, 31, 721-727.
Kitzmann, K. M., Gaylord, N. K., Holt, A. R., & Kenny, E. (2003). Child witnesses to domestic
violence: A meta-analytic review. Journal of Consulting and Clinical Psychology, 71, 339-
352.
Lesser, B. (1990). Attachment and situational factors influencing battered women’s return to
their mates following a shelter program: Research explorations in adult attachment. New
York: Peter Lang.
Mertin, P., & Mohr, P. (2001). A follow-up study of posttraumatic stress disorder, anxiety, and
depression in Australian victims of domestic violence. Violence and Victims, 16, 645-654.
Miller, B. A., Wilsnack, S. C., & Cunradi, C. B. (2000). Family violence and victimization:
Treatment issues for women with alcohol problems. Alcoholism: Clinical and Experimental
Research, 24, 1287-1297.
Okun, L. E. (1986). Women abuse: Facts replacing myths. Albany: State University of New York
Press.
Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general
population. Applied Psychological Measurement, 1, 385-401.
Ratner, P. A. (1993). The incidence of wife abuse and mental heath status in abused wives in
Edmonton, Alberta. Canadian Journal of Public Health, 84, 246-249.
Rosenberg, M. (1965). Society and the adolescent self-image. Princeton, NJ: Princeton Univer-
sity Press.
Rosow, I., & Breslau, N. (1966). A Guttmann health scale for the aged. Journal of Gerontology,
21, 556-559.
Ross, C. E., & Mirowski, J. (1988). Child care and emotional adjustment to wive’s employment.
Journal of Health and Social Behavior, 29, 127-138.
Snyder, D. K., & Scheer, N. S. (1981). Predicting disposition following brief residence at shelter
for battered women. American Journal of Community Psychology, 9, 559-566.
Stevens, G., & Cho, J. H. (1985). Socioeconomic indexes and the new 1980 Census Occupa-
tional Classification Scheme. Social Science Research, 14, 142-168.
Sutherland, C., Bybee, D., & Sullivan, C. (1998). The long-term effects of battering on women’s
health. Women’s Health: Research on Gender, Behavior, and Policy, 4(1), 41-70.
Sweet, J., & Bumpass, L. (1996). The National Survey of Families and Households—Waves 1
and 2: Data description and documentation. Retrieved December 12, 2002, from http://
www.ssc.wisc.edu/nsfh/home.htm
Sweet, J., Bumpass, L., & Call, V. (1988). The design and content of the National Survey of Fami-
lies and Households (Working paper NSFH-1). Madison: University of Wisconsin–
Madison.
Truman-Schram, D. M., Cann, A., Calhoun, L., & Vanwallendael, L. (2000). Leaving an abusive
dating relationship: An investment model comparison of women who stay versus women
who leave. Journal of Social and Clinical Psychology, 19, 161-183.
Zill, N. (1990). Behavior Problems Index based on parent report. Washington, DC: Child
Trends.

Downloaded from jiv.sagepub.com at UNIV OF RHODE ISLAND LIBRARY on April 7, 2015

 Zlotnick et al. / Intimate Partner Violence 275

Zlotnick, C., Kohn, R., Peterson, J., & Pearlstein, T. (1998). Partner physical victimization in a
national sample of American families: Relationship to psychological functioning,
psychosocial factors, and gender. Journal of Interpersonal Violence, 13, 156-166.

Caron Zlotnick, Ph.D., is an associate professor in the Department of Psychiatry and Human
Behavior, Brown Medical School. She is also the director of behavioral medicine research at
Women and Infants Hospital, Providence, RI. Her research focuses on early trauma, post trau-
matic stress disorder, and the mental health needs of financially disadvantaged women.

Dawn M. Johnson, Ph.D., is clinic coordinator and full-time faculty at the Summa-Kent State
Center for the Treatment and Study of Traumatic Stress. Her research has emphasized posttrau-
matic stress disorder (PTSD) and interpersonal violence. Her current interests are in the treat-
ment of battered women with PTSD.

Robert Kohn, M.D., is an associate professor in the Department of Psychiatry and Human
Behavior, Brown Medical School. He is also the director of the Cultural Psychiatry Program at
Butler Hospital, Providence, RI. His research focuses on psychiatric epidemiology and risk fac-
tors for mental illness in the community.

Downloaded from jiv.sagepub.com at UNIV OF RHODE ISLAND LIBRARY on April 7, 2015