Factors That Influence Battered Women to Leave Their Abusive Relationships

Transcription

1 Violence and Victims, Volume 21, Number 2, April 2006 Factors That Influence Battered Women to Leave Their Abusive Relationships Jennifer K. Koepsell, MS Mary A. Kernic, PhD, MPH Victoria L. Holt, PhD, MPH University of Washington Seattle This study examines factors associated with leaving an abusive relationship, including relationship characteristics, external support, and health status of the abused subjects. The subjects included 448 Seattle women whose abuse resulted in police involvement or filing for a civil protection order against their male partner. Women were followed longitudinally for 9 months. Stepwise logistic regression analyses assessed factors independently predictive of leave taking. Predictors of leaving the abusive relationship were young age, leaving the relationship previously, and having a protection order, an abuse-related physician visit, and a high score of psychological vulnerability to abuse. Seeking but not receiving external support was negatively associated with leave taking. Keywords: domestic violence; intimate partner violence; leave taking; abusive relationship In 2002 the National Center for Injury Prevention and Control prioritized evaluation of the efficacy and effectiveness of interventions and policies for preventing intimate partner violence (IPV), sexual violence, and child maltreatment (NCIPC, 2002). A firm knowledge base regarding characteristics that influence a victim of IPV to leave an abusive relationship is essential to the development of effective intervention strategies, yet few studies have attempted to quantitatively describe factors associated with a woman s decision to leave an abusive relationship. Most prior research has focused on characteristics of the victim to the exclusion of other important factors, such as abuser characteristics, the nature of the abusive relationship, and external support that the victim might have received. Previous analytic studies have found that low relationship commitment and economic independence are the most consistent predictors of women terminating abusive relationships (Anderson & Saunders, 2003; Frisch & Mackenzie, 1991; Gelles, 1976; Hilbert & Hilbert, 1984; Johnson, 1992; Rusbult & Martz, 1995; Snyder & Scheer, 1981; Strube, 1988). Mixed results have been presented for additional factors, including the frequency and severity of abuse, the presence of children and potential child abuse, and women s age, race, and level of education (Anderson & Saunders, 2003; Ellsberg, Winkvist, Peña, & Stenlund, 2006 Springer Publishing Company 131

2 132 Koepsell et al. 2001; Frisch & MacKenzie, 1991; Gelles, 1976; Herbert, Silver, & Ellard, 1991; Hilbert & Hilbert, 1984, 1997; Jacobson, Gottman, Gortner, Berns, & Shortt, 1996; Johnson, 1992; Pagelow, 1981; Rounsaville, 1978; Rusbult & Martz, 1995; Strube, 1988; Truman-Schram, Cann, Calhoun, & Van Wallendael, 2000). Comparison of results across analytic studies has been made difficult by variability in the definition of leaving, by the inclusion of different characteristics in the analyses, and by differences in composition of the populations being studied. Descriptive studies have noted that characteristics such as available social support and use of resources are among factors that assist women in leaving abusive relationships, emphasizing the importance of considering external factors when examining predictors of leave taking (Davis, 2002; O Campo, McDonnell, Gielen, Burke, & Chen, 2002; Ulrich, 1991, 1993; Wolf, Ly, Hobart, & Kernic, 2003). Furthermore, descriptive studies highlight the importance of recognizing that terminating an abusive relationship is a complex process that often consists of several stages and multiple attempts at leaving. Studies that have quantitatively evaluated factors related to leave taking often have not taken into account potential confounding variables. Furthermore, these studies are limited by their cross-sectional nature and by use of nonrepresentative study populations, frequently, abused women in temporary shelters. The current study built upon previous research by examining a variety of factors in association with leaving an abusive relationship, including characteristics of the abuser and abusive relationship, availability of external support, and emotional and physical health status of the abused subjects. Our sample comprised women who had a police-involved domestic violence incident or sought court intervention for their abuse, and therefore it is likely to be more representative of all abused women than is a sample of women who sought refuge in a shelter. Finally, the longitudinal nature of the study provides information about how women who make a permanent break from their abuser may differ from those who leave only temporarily. METHODS Study Population The subjects were female victims of IPV in Seattle, Washington, who participated in the Women s Wellness Study (WWS), which is described by Wolf, Holt, Kernic, and Rivara (2000). Briefly, the study population consisted of Seattle-resident women 18 years old or older who experienced abuse by a former or current male partner that resulted in the filing of an incident report by the Seattle Police Department or the subject s filing of a civil protection order with King County, Washington, Superior Court between October 15, 1997, and December 31, Since the original study for which these data were collected was designed to evaluate the effectiveness of civil protection orders, stratified random sampling has been performed based on police history of IPV and protection order status. Data Collection The incident of abuse that led to the police response or the filing of a protection order constituted the index incident. Women participated in a structured telephone baseline interview (81.2%) or self-administered mail-in baseline interview (18.8%) a median of 7 weeks after the index incident, and again roughly 4.8 and 9.4 months subsequent to the index incident. Of the 448 subjects who participated in the baseline interview, 397 (88.6%)

3 Leaving Abusive Relationships 133 completed the 5-month follow-up interview, and 362 (80.8%) completed the 9-month follow-up interview. Outcome Variables The primary outcome of interest for this study was whether the subject reported having recently left the abusive relationship. Specifically, a subject was considered as having left the relationship if either the subject reported not being involved with the abuser at the index incident, but had been within the previous month, or the subject reported having left the relationship between the index incident and the baseline interview. The comparison group of nonleavers was those women who reported being involved with their abuser at the time of the index incident but did not leave between the incident and the baseline interview. Subjects who left the relationship more than 1 month prior to the index incident were excluded from the analysis, because data on the predictors of interest collected at the baseline interview related to the time around the index incident. Additionally, women who had no history of abuse in the year prior to the index incident and who left prior to this incident were excluded to ensure that we examined factors predictive of leaving among women with a preexisting history of abuse. A secondary analysis was conducted to ensure that all exposure data preceded the termination of the abusive relationship. Sample size was somewhat compromised for this subanalysis, in that it compared only those women who left between the index incident and the baseline interview to women who did not leave the abusive relationship. A second subanalysis was conducted to examine whether similar factors predicted making a more permanent break from the abusive partner relative to not having left. This analysis compared the subset of women who left their abuser and did not return within 9 months of follow-up with the subset of women who did not leave their abuser during the 9 months. Predictive Variables Demographics. Demographic characteristics of the study subjects and abusers examined included age, race, education, employment, and the subject s household income in the previous year. Information collected about the subject s children included number of minor children and whether there were any police-reported allegations of child abuse and neglect for any child in the household. External Support. Subjects were asked whether they had received, attempted and not received, or not attempted to receive a variety of community services in the year before the index incident. Domestic violence services included emergency shelter, domestic violence support groups, advocacy, counseling, and other informational resources. Legal assistance was defined as help with civil action, advocacy assistance with a protection order or other police charge, crime victim s compensation, family support, paternity action, or child protection. Public or private assistance included Aid to Families with Dependent Children (AFDC), food stamps, General Assistance-Unemployable (GA-U) program, Social Security, food bank usage, employment assistance or unemployment compensation, housing, utility or transportation assistance, and educational assistance. Counseling included private counseling, Alcoholics Anonymous, and other support groups. Relationship Characteristics. Relationship characteristics that were examined included duration of relationship, legal status of relationship with the abuser (ever married vs. never married), number of times the subject tried to leave the relationship prior to the

4 134 Koepsell et al. index incident, whether the subject ever lived with the abuser, and the abuser s history of alcohol or drug abuse as reported by the subject. Several covariates were used to measure differences between the subject and abuser including age difference, race difference, religious difference, education difference, and employment difference. Abuse Characteristics. The type and severity of abuse during the previous year were measured using the revised Conflicts Tactics Scale (CTS2) (Straus, Hamby, Boney-McCoy, & Sugarman, 1996). All items of the CTS2 were included for physical abuse (12 items) and psychological abuse (eight items) scales. A shortened sexual abuse scale (two items) was used to lessen the emotional burden to subjects caused by questions that would unnecessarily capture explicit details about sexual abuse events. Women s psychological vulnerability to partner violence was measured with the Women s Experience with Battering (WEB) scale (Smith, Earp, & DeVellis, 1995). The WEB provides a subject s threat appraisal of violence by the partner, and a high score indicates greater psychological vulnerability to potential abuse. Additional characteristics of abuse measured included duration of physical abuse, duration of psychological abuse, whether the subject had a temporary protection order at the time of the baseline interview, and whether the police were called in the previous year as a result of domestic violence. The subject s history of injuries included the presence and type of any injury sustained in the previous year as a result of abuse, and whether the victim had visited a physician as a result of her abuse in the previous year. Additional characteristics of the abuser included whether the abuser had ever been arrested for any crime, and whether the abuser had been arrested specifically for domestic violence against the subject. Health. Subject alcohol abuse in the previous year was measured using the Normal Eye-opener Tolerance (NET) scale (Russell et al., 1994). A positive score of 1 or more on this three-item scale was used as a dichotomous indicator of problem drinking. Illegal drug use in the previous year was measured with a single question about illicit drug use. Symptomatic depression was measured by the Center for Epidemiologic Studies Depression Scale (CES-D), a 20-item self-report scale designed to measure depressive symptomatology in the general population (Radloff, 1977). The subject s physical health was measured using her standardized continuous score on the physical health component of the Short Form-12 Health Survey (SF-12), where a lower score indicates poorer health (Ware, Kosinski, & Keller, 1995). Analysis Bivariate differences in predictive factors between women who did and did not leave their abusive partners were tested using chi-square tests with p.05 denoting significant differences. Fisher s exact test was used when a 2 2 matrix had expected cell sizes of fewer than five subjects; t tests were used to examine statistically significant differences between study groups for all continuous covariates. Multivariate analysis consisted of several steps. First, backwards stepwise logistic regression models were run for each of the separate domains of predictors (i.e., demographics, external support, relationship characteristics, abuse characteristics, and health measures) to determine independent predictors within each domain. A p-value of.10 was used as the criterion for removal and a p-value of.05 as criterion for entry of a covariate into the model. Next, each of the covariates that was retained in the separate domain-specific models was included in a final stepwise model using the same entry and removal criteria to determine the independent predictors of leave taking across all domains. All analyses were conducted using Stata versions 7 and 8 (Stata, 2001, 2003).

5 Leaving Abusive Relationships 135 RESULTS Demographics Both subjects who did and who did not leave their abusive relationship were similar with respect to age, race, education, employment, income, number of minor children, and abuse history of children (Table 1). The abusers of subjects who left their relationship were more likely to be unemployed. External Support Similar proportions of women who did and did not leave their relationship had received private counseling or gone to a support group in the previous year (Table 2). Women who left the relationship were significantly more likely to have successfully accessed services from domestic violence agencies or other public or private assistance. Women who did not leave were more likely to have attempted unsuccessfully to access these services than were women who left their abusive relationship. Relationship Distributions of race, education, and employment differences between subjects and their abusers did not differ by leave taking status (Table 3). Additionally, no study group differences were found in relationship duration or history of cohabitation. Women who left were more likely to have left before, and their abusers were more likely to have a current substance abuse problem. Abuse Women who left their abusive relationships had different abuse histories than women who did not leave their abusive relationships (Table 4). Women who left experienced a longer duration of psychological abuse, were more likely to have experienced severe physical, sexual, or psychological abuse, and scored higher for psychological vulnerability to abuse as measured by the WEB. Women who left were also more likely to have acquired a protection order before the baseline interview. Although the study groups did not differ on history of injury in the previous year, women who left their abusers were more likely than those who did not to have an abuse-related physician visit in the previous year. Finally, women who left were less likely to have a previous domestic violence arrest history with their abuser. Health Women who left their abusive relationships were less likely to be problem drinkers, were more likely to be depressed at the baseline interview, and had somewhat poorer physical health than women who did not leave their abusive relationships (Table 5). Use of illegal drugs in the previous year was comparable between the study groups. Multivariate Analysis In the domain-specific stepwise regression models, age and suspect s employment status were significant predictors in the demographic domain; use of domestic violence services and other public or private assistance in the external support domain; number of times the

6 136 Koepsell et al. TABLE 1. Demographic Characteristics of Subjects and Abusers According to Whether Subject Left Within 1 Month of Index Incident Left Did Not Leave N = 243 N = 58 p Characteristics of subject n (%) n (%) Age, years (25.5) 11 (19.0) (36.6) 19 (32.8) (29.6) 17 (29.3) (8.2) 11 (19.0) Race.09 African American 47 (19.7) 16 (28.1) White 122 (51.1) 32 (56.1) Other 70 (29.3) 9 (15.8) Education.63 < High school 28 (11.5) 5 (8.6) High school/ged 60 (24.7) 13 (22.4) Some college or vocational training 117 (48.2) 27 (46.6) College graduate/advanced degree 38 (15.6) 13 (22.4) Employment.88 Full-time 113 (46.9) 26 (44.8) Part-time 31 (12.9) 6 (10.3) Student/employed student 30 (12.5) 9 (15.5) Unemployed/disabled 67 (27.8) 17 (29.3) Household income a.21 < $15, (42.0) 20 (34.5) $15,000 24, (18.9) 7 (12.1) $25,000 49, (21.0) 19 (33.8) $50, (9.1) 4 (6.9) Missing data 22 (9.1) 8 (13.8) Subjects with minor children 133 (54.7) 27 (46.6).26 No. of minor children: M (SD) b 1.78 (0.9) 1.96 (1.1).37 Potential abuse of children 20 (15.0) 5 (18.5).77 Characteristics of abuser Age a, years (13.6) 8 (13.8) (41.6) 27 (46.6) (28.8) 14 (24.1) (7.8) 9 (15.5) Missing data 20 (8.2) 0 (0.0) Race a.92 African American 82 (33.7) 20 (34.5) White 93 (38.3) 23 (40.0) Other 54 (22.2) 13 (22.4) Missing data 14 (5.8) 2 (3.5) Education a.43 < High school 55 (22.6) 7 (12.1) High school/ged 75 (30.9) 19 (32.8) Some college or vocational training 60 (24.7) 19 (32.8) College graduate/advanced degree 31 (12.8) 8 (13.8) Missing data 22 (9.1) 5 (8.6)

7 Leaving Abusive Relationships 137 TABLE 1. Continued Left Did Not Leave N = 243 N = 58 p Employment.05 Full-time 105 (45.1) 29 (50.0) Part-time 30 (12.9) 6 (10.3) Student/employed student 4 (1.7) 5 (8.6) Unemployed/disabled 94 (40.3) 18 (31.0) a Variable had > 5% missing data. b Mean calculated only among women with minor children. TABLE 2. Subject in Receipt of External Support According to Whether Subject Left Within 1 Month of Index Incident Left Did Not Leave N = 243 N = 58 p Receipt of DV services n (%) n (%).02 Yes 49 (20.3) 5 (8.8) Attempted, not received 7 (2.9) 5 (8.8) Not attempted 185 (76.8) 47 (82.5) Receipt of legal assistance.09 Yes 59 (24.6) 7 (12.3) Attempted, not received 8 (3.3) 3 (5.3) Not attempted 173 (72.1) 47 (82.5) Receipt of public or private assistance.02 Yes 90 (37.7) 14 (24.6) Attempted, not received 3 (1.3) 4 (7.0) Not attempted 146 (61.1) 39 (68.4) Receipt of counseling/support groups.96 Yes 76 (31.7) 17 (29.8) Attempted, not received 9 (3.8) 2 (3.5) Not attempted 155 (64.6) 38 (66.7)

8 138 Koepsell et al. TABLE 3. Characteristics of the Relationship According to Whether Subject Left Within 1 Month of Index Incident Left Did Not Leave N = 243 N = 58 p Age difference a n (%) n (%).01 Within 5 years 148 (60.9) 35 (60.3) Subject > 5 years older 49 (20.2) 10 (17.2) Abuser > 5 years older 26 (10.7) 13 (22.4) Missing data 20 (8.2) 0 (0.0) Race difference a.95 Same race 132 (54.3) 31 (53.5) Different race 95 (39.1) 24 (41.4) Missing data 16 (6.6) 3 (5.2) Education difference a.91 Same level 84 (34.6) 23 (40.0) Subject more educated 96 (39.5) 21 (36.2) Abuser more educated 41 (16.9) 9 (15.5) Missing data 22 (9.1) 5 (8.6) Employment difference.53 Subject full-time, abuser not 15 (6.5) 4 (6.9) Abuser full-time, subject not 91 (39.4) 27 (46.6) Other 125 (54.1) 27 (46.6) Duration of relationship.95 6 months 32 (13.2) 8 (13.8) 7 12 months 34 (14.0) 8 (13.8) months 39 (16.1) 7 (12.1) months 66 (27.2) 18 (31.0) 61+ months 72 (29.6) 17 (29.3) Relationship status at baseline.06 Ever married 73 (30.0) 25 (43.1) Never married 170 (70.0) 33 (56.9) Previous times subject left < (19.5) 31 (54.4) (29.9) 14 (24.6) (28.2) 9 (15.8) (22.4) 3 (5.3) Subjects who ever lived with abuser 209 (86.0) 51 (87.9).70 Abuser of alcohol/drug history.01 No current or former problem 46 (18.9) 19 (32.8) Current problem 135 (55.6) 18 (31.0) Past problem, no or unknown current problem 54 (22.2) 19 (32.8) Unknown 8 (3.3) 2 (3.5) a Variable had > 5% missing data.

9 TABLE 4. Characteristics of Abuse According to Whether Subject Left Within 1 Month of Index Incident Left Did Not Leave N = 243 N = 58 p Duration of physical abuse n (%) n (%).40 0 a 43 (17.7) 13 (22.4) 6 months 51 (21.0) 16 (27.6) 7 12 months 31 (12.8) 6 (10.3) months 28 (11.5) 3 (5.2) months 46 (18.9) 8 (13.8) 61+ months 31 (12.8) 6 (10.3) Missing data 13 (5.4) 6 (10.3) Duration of psychological abuse.05 0 a 13 (5.5) 6 (11.3) 6 months 57 (24.2) 21 (39.6) 7 12 months 27 (11.4) 7 (13.2) months 35 (14.8) 6 (11.3) months 57 (24.2) 6 (11.3) 61+ months 47 (19.9) 7 (13.2) Severity of physical abuse.03 None a 33 (13.6) 16 (27.6) Minor 55 (22.6) 12 (20.7) Severe 155 (63.8) 30 (51.7) Severity of sexual abuse <.01 None 121 (49.8) 43 (74.1) Minor 72 (29.6) 15 (25.9) Severe 50 (20.6) 0 (0.0) Severity of psychological abuse.02 None a 3 (1.2) 3 (5.2) Minor 44 (18.1) 17 (29.3) Severe 196 (80.7) 38 (65.5) Type of injury.70 None 168 (69.1) 37 (63.8) Pain 7 (2.9) 2 (3.5) Bruises/soreness/swelling 23 (9.5) 9 (15.5) Cuts/bleeding 17 (7.0) 4 (6.9) Fracture/dislocation/burns/ 28 (11.5) 6 (10.3) internal injury/loc WEB score: M (SD) 42.8 (15.0) 27.1 (17.8) <.01 Protection order at baseline 159 (65.4) 12 (20.7) <.01 Physician visit due to abuse 54 (22.2) 4 (6.9).01 Previous police call due to abuse 119 (49.0) 21 (36.2).08 Abuser arrest other than DV with subject.09 Yes 180 (74.1) 35 (60.3) No 48 (19.8) 19 (32.8) Unknown 15 (6.2) 4 (6.9) Abuser history of arrest for DV with subject.01 Yes 72 (29.6) 27 (46.6) No 171 (70.4) 31 (53.5) a Proportions of women who report no abuse differ for the duration and severity abuse variables based on data collection. Duration variables were created by asking the women directly how long their abuse had been occurring. Severity measures were calculated from the CTS, which calculates a summary score for severity depending on the presence of several specific forms of abuse.

10 140 Koepsell et al. TABLE 5. Characteristics of Subject s Health and Substance Abuse According to Whether Subject Left Within 1 Month of Index Incident Left Did Not Leave N = 243 N = 58 p n (%) n (%) Potential alcohol abuse 72 (30.5) 24 (44.4).05 Illegal drug use 49 (20.3) 11 (19.3).87 Symptomatic depression at baseline <.01 None 28 (11.5) 16 (27.6) Mild 36 (14.8) 11 (19.0) Severe 179 (73.7) 31 (53.5) Physical health score at baseline M (SD) 45.3 (11.0) 49.4 (9.4).01 woman previously left in the relationship domain; physician visits due to abuse, having a protection order, not having a history of arrest with her partner, and demonstrating psychological susceptibility to abuse in the nature of abuse domain; and the absence of problem drinking but presence of symptomatic depression were significant predictors in the mental and physical health domain. Thus, each of these covariates was retained in the final models. Following stepwise regression of the significant predictors from each domain, we found that young age and leaving the relationship previously were independent predictors of leaving the abusive relationship within a month of the index incident (Table 6). Additional predictors were a protection order at baseline, an abuse-related physician visit in the year before the index incident, and a score above the median for psychological vulnerability to abuse. Attempting unsuccessfully to access services from a domestic violence agency or other public or private assistance predicted staying in the abusive relationship, as did a previous domestic violence incident for which their abuser was arrested. Similar results were observed when the analysis was restricted to women who left between the index incident and the baseline interview, although subject s age and physician visits in the previous year were not retained in the model (data not shown). Similar results also were observed in the analysis limited to women who left and did not return to their abusers within 9 months compared to women who did not leave over the course of 9 months (Table 7). The predictors of extended leave taking were receipt of public or private assistance in the year prior to the index incident, acquiring a protection order by the time of the baseline interview, and scoring higher for psychological vulnerability to abuse. Again, unsuccessfully accessing public or private assistance and a previous arrest history for domestic violence with their abuser predicted staying in the abusive relationship. DISCUSSION Previous studies have examined how a woman s economic stability and the frequency and severity of abuse she experiences affect her likelihood of leaving her abusive partner. In our study, we hoped to consider these characteristics and their relative importance in combination with little-studied descriptors of the availability and use of external support, the nature

11 Leaving Abusive Relationships 141 TABLE 6. Independent Predictors Associated With Leaving the Abusive Relationship in Multivariate Analysis Predictive Factor Adjusted OR 95% CI Subject age (ref.) , 1.0* , 1.0* , 0.9 Receipt of DV services Yes , 4.2 Attempted, not received 0.1 < 0.01, 0.5 Not attempted 1.0 (ref.) Receipt of public or private assistance Yes , 7.0** Attempted, not received , 1.1 Not attempted 1.0 (ref.) Previous times subject left None 1.0 (ref.) , , , Physician visit due to abuse , 18.6 Protection order at baseline , 22.5 Abuser history of arrest for DV with subject , 0.7 WEB score Highest quartile of vulnerability , rd quartile , nd quartile , 4.8 Lowest quartile of vulnerability 1.0 (ref.) *p <.05. **p >.05. TABLE 7. Predictive Factors Associated With Leaving for at Least 9 Months Relative to Not Leaving Predictive Factor Adjusted OR 95% CI Receipt of public or private assistance Yes , 36.7 Attempted, not received 0.01 < 0.01, 0.1 Not attempted 1.0 (ref.) Physician visit due to abuse , Protection order at baseline , 45.3 Abuser history of arrest for DV with subject , 0.5 WEB score a , 1.2 a OR for a one-unit change in the WEB score.

12 142 Koepsell et al. of the abusive relationship, and the mental and physical health of the abused woman. We found that subject s young age was the only demographic factor that significantly predicted leaving the abusive relationship. Women who left were more likely to have left several times before, have sought a protection order against their abuser, and marginally more likely to have an abuse-related physician visit in the previous year. Leave takers had a higher score of psychological vulnerability to abuse compared to women who did not leave their relationship, but were less likely to have a history of police-reported abuse, with their abuse preceding the index incident. Finally, women who did not leave were more likely to have attempted unsuccessfully to access food stamps, Social Security, or assistance with employment, transportation, or housing than were leave takers. Results were similar when comparing women who had remained out of their abusive relationship for at least 9 months to women who had not left at all during those 9 months. The few prior studies that have examined the association between a subject s age and her likelihood of leaving an abusive relationship have reported conflicting results (Ellsberg et al., 2001; Hilbert & Hilbert, 1984). In the Hilberts study of 35 residents of women s shelters in the US, multivariate analysis revealed that older women were less likely than younger women to return to their abusers upon leaving the shelter. In a more recent crosssectional population-based survey of 188 abused women in Nicaragua, Ellsberg and associates found that age was inversely associated with the rate at which women left their abusive relationship, with women under 25 years separating from their partners more quickly than older women. A subject s age is likely to be correlated to the duration of her relationship with her partner so that older women may be more emotionally invested and committed to their relationships and therefore less likely to leave. Despite the differences in age, women in our population who left their abusers had been in relationships of similar duration to those of women who did not leave, suggesting that age may also capture additional differences between the two groups. Surprisingly, we did not find other demographic characteristics to predict leaving the abusive relationship in multivariate analysis. Other studies that have examined income as a predictor of leaving have been inconsistent in their findings (Ellsberg et al., 2001; Frisch & MacKenzie, 1991; Herbert et al., 1991; Hilbert & Hilbert, 1984; Rusbult & Martz, 1995). This may be largely attributable to study design and the manner and time at which income level is ascertained. For example, the Hilberts study of shelter residents measured only the subject s income and found that women who were more financially independent were more likely to leave their abusers upon shelter departure. Conversely, in a cross-sectional study conducted by Herbert and associates, subjects with any history of abuse were recruited using public service announcements and questioned about current relationship status and total household income. Not surprisingly, women who had left their relationship reported a lower household income than those who remained with their partner and reported their combined annual income. Our study ascertained the subject s total household income, and although the association was not significant, we did see that women who left their abusers reported somewhat higher income levels. It is possible that we failed to detect an association between income and leave taking because our study subjects were more financially independent than women in the studies discussed above. Additionally, we may have failed to detect an association because household income may be an inadequate proxy for the subject s annual income. Studies that have looked at income have largely been conducted among populations of women seeking shelter, who may be struggling to the point that they cannot afford to live independently. If women in our study population were more

13 Leaving Abusive Relationships 143 financially independent, then other factors might have been more influential in contemplating the decision to stay or leave their relationship. Contrary to most studies, we did not find the subject s employment status a significant predictor of leaving the abusive relationship (Frisch & MacKenzie, 1991; Gelles, 1976; Johnson, 1992; Rusbult & Martz, 1995; Strube & Barbour, 1983, 1984). Like income, employment is a measure of financial independence, and women employed outside the home are less reliant on their abusers, thus they may feel more confident in their ability to survive on their own. In our study, roughly half of the women were employed full-time, while many others had part-time jobs or were students. Again, our population may be representative of abused women who were more affluent than women seeking refuge in shelters, so that other factors played a larger role in determining whether the women left their relationships. Our study found that women who did not leave were more likely to have unsuccessfully attempted to access services from a domestic violence agency as well as other public or private assistance with housing, food, transportation, or other necessities than women who left. By not receiving the support they were seeking, these women failed to obtain resources comparable to those accessed by women who did leave. Additionally, they might have experienced feelings of failure that contributed to the belief that the abuse was their fault. This, in turn, might have decreased confidence in their ability to successfully leave the relationship. Although many descriptive studies have suggested that the receipt of external support through family, friends, domestic violence agencies, or other avenues facilitates the process of leaving an abusive relationship, very few analytic studies have considered these types of support. Strube and Barbour (1984) found in multivariate analysis that the number of coping strategies used, including whether women sought counseling or legal assistance in the form of filing assault charges or attaining a protection or restraining order, was a significant predictor of leave taking. However, their study population consisted of women who had all contacted a counseling unit, so, their results have limited generalizability to non-help-seeking women. In another study, comparing chronically to formerly abused women, Frisch and MacKenzie (1991) found that those women who had left their abusers were more likely to have ever sought counseling. We examined several characteristics of the abusive relationship that have not been previously studied, including differences in demographic factors between the subject and her abuser. We hypothesized that subjects who were older than their abusers, more educated, or better employed would be more able to leave due to a sense that they had greater resources, whereas subjects who were younger than their abusers, less educated, or worse employed might be more dependent on their partners and less likely to leave. Furthermore, we hypothesized that racial and religious differences between the partners might capture additional stresses in the relationship that could contribute to a woman s decision to leave. Although women who did not leave were more likely than those who left to be more than 5 years younger than their abusers, subject-abuser age differences did not remain significant in multivariate analyses. Because the abuser s information was obtained only through interviews with the subject, these variables had a fair number of missing data, which might have contributed to our failure to find additional significant associations. In multivariate analysis the number of times the subject had previously left the relationship was the only relationship characteristic significantly to predict a woman s likelihood of leaving. This confirmed findings from other studies that have examined the association between previous separations and leave taking (Ellsberg et al., 2001; Snyder & Scheer, 1981).

14 144 Koepsell et al. The more commonly studied characteristics of the nature of abuse and its effect on leave taking have been its frequency and severity, and findings have been inconsistent (Ellsberg et al., 2001; Frisch & MacKenzie, 1991; Gelles, 1976; Herbert et al., 1991; Hilbert & Hilbert, 1984; Hilbert, Kolia, & Van Leeuwen, 1997; Jacobson et al., 1996; Johnson, 1992; Pagelow, 1981; Rounsaville, 1978; Truman-Schram et al., 2000). It may be hypothesized that women who are more frequently and severely abused should have greater impetus to try to leave their relationship, yet some studies have found the opposite. For example, in a study of women staying in shelters, Johnson (1992) found that women more severely abused tended to return to their partners upon leaving the shelter, although the association was not adjusted for potentially confounding factors. Johnson suggested that the severity of abuse is only one of many factors that women consider in their decision to leave, and that for women with few resources and skills, they may decide that the benefits of support that the partner provides to the subject and her children may outweigh the costs of being abused. Severely abused women may also be more frightened and more isolated from accessing resources that would assist them in leaving. Other studies, however, have found a positive association between increased severity of abuse and greater likelihood of leaving. These findings have been demonstrated among shelter populations, as well as population-based samples, and have persisted after adjustment for other covariates. In our study, the characteristics of the abuse that predicted leaving were an abuse-related physician visit, a protection order at the time of the baseline interview, and a high score on the psychological vulnerability to abuse scale. These findings are unique to this study and suggest that indirect measures of abuse severity or measures of help-seeking behavior may be stronger predictors than directly questioning the subject about her abuse history. For example, a woman may not be categorized as severely abused based on her responses to the CTS questions, but we may recognize the categorization if we know that the abuse resulted in her seeking medical treatment. Additionally, an elevated score on the WEB psychological vulnerability scale may capture a more pervasive and psychologically damaging form of abuse than the subject would report through direct questioning. We also found that subjects who had a prior history of police-involved abuse incidents resulting in arrest with their partner were less likely to leave. One explanation for this finding might be a residual fear of repercussions women might have experienced after their abuser was previously arrested. Finally, very few studies have focused on the mental and physical health of the subject in association with leave taking (Frisch & MacKenzie, 1991; Hilbert et al., 1997; Rounsaville, 1978). Rounsaville studied a population of 31 abused women who had visited the emergency department or sought services at a mental health center and found that women who left were no more or less likely to be depressed than women who did not leave. The finding should be interpreted with caution for two reasons: first, many of the subjects in the study had sought counseling services, and there might not have been enough variation in depressive symptomology in the population to detect an association with leave taking. Second, the study was cross-sectional in design, therefore, it is unclear whether depression preceded or followed leave taking. Two studies conducted in shelter populations looked at the subject s history of alcohol and drug abuse and likelihood of leaving the abusive relationship and failed to find a significant association (Frisch & Mackenzie, 1991; Hilbert et al., 1997). In our study, problem drinking, symptomatic depression, and poor physical health were all significantly associated with leave taking at the bivariate level, but were not retained in multivariate analysis. Physical health and mental health are likely affected by the severity of abuse, so that after adjustment for measures of severity, the association between poor health and increased likelihood of leaving may be attenuated.

15 Leaving Abusive Relationships 145 We observed results similar to our primary analysis in the secondary analysis that compared takers of more permanent leave to those who had not left in 9 months of follow-up. However, the subject s age, receipt of services from a domestic violence agency and the previous number of times the subject had left were not retained in this analysis. Remaining independent predictors included measures of the women s reaction to the abuse they had experienced. This suggests that more than economic or health concerns, women who permanently separate from their abusers are those with unique abuse histories that lead them to seek help. That the permanent leavers had been more likely to visit their physician, to obtain a protection order, and to access forms of public or private assistance suggest that women who are able to obtain outside assistance may be more successful at leaving their relationships on a long-term basis. This study had limitations that should be noted. Most important, these women were identified and interviewed during a brief point on the continuum of the relationship with their abuser. Thus, our primary analysis focused on women who had recently left, but we may have missed capturing that same information on women who were involved with their abusers at baseline but left shortly thereafter. Furthermore, our secondary analysis focused on a subset of women who had been followed for 9 months, but because our study oversampled women with protection orders, who were likely to have left their abusers, our comparison group of women who did not leave during this period was relatively small. Ideally, we should follow a sample of women who were all involved with their partners at study initiation irrespective of their protection order status in order to compare rates of leaving over the course of several years. Additionally, although our sample was more broadly representative of IPV victims than samples drawn from battered women s shelters, it was nonetheless limited to women whose abuse was reported to the police or court system. It is important to note, however, that women with a police-involved incident of abuse did not necessarily enlist help themselves. In some instances a third party initiated the call to the police. As a result, we believe this captures a broader population than one of only women demonstrating help-seeking behavior. We also should like to study other characteristics, including women s family history of abuse and available support from friends and family, but this information was not available in the existing dataset. Finally, there were missing data for some variables, including abuser characteristics, and information about these characteristics must be interpreted with caution, because we relied on the subject s report rather than the abuser s. This study contributes several points of interest to the study of leave taking behavior in abused women. Whether a woman is able to successfully access external resources may have important implications for her likelihood of terminating the abusive relationship. Future research should focus on services offered by domestic violence agencies to examine outcomes in women who do and do not access these services, with careful attention paid to women who attempt but do not receive assistance. External measures of abuse or the women s reactions to abuse, such as obtaining a protection order, visiting a physician, or having a previous history of police-involved abuse may provide important information about the severity of abuse and the likelihood of a woman leaving her relationship. This could have important implications for programs that attempt to identify and reach out to abused women. Finally, although our study focused on a brief segment of time, future analytic studies of leave taking may address how to best study the whole continuum of an abusive relationship, in order to better describe the process of leaving in quantitative terms, and help identify factors that affect the decision to leave at different points along this continuum.

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