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Abstract

Family violence, including child sexual abuse (CSA), is a significant public health problem in the United States. It is particularly difficult to assess family violence and CSA among South Asians because it is often hidden due to cultural and familial stigma. A web-based survey was administered to a convenience sample (n = 368) of South Asian adults in the US. One-fourth (25.2 %) of the sample reported CSA; 13.8 % reported abuse involving exposure; 21.5 % reported abuse involving touching; 4.5 % reported attempted sexual intercourse; and 3.5 % reported forced sexual intercourse. Adjusted odds ratios found that participants who reported any relationship violence were significantly more likely to have experienced CSA (OR 2.28; 95 % CI 1.26–4.13); and suicide attempt was significantly associated with CSA (OR 3.96; 95 % CI 1.27–12.3). The findings presented in this formative study will assist in guiding future studies and interventions for South Asians in the United States.
ORIGINAL PAPER
Family Violence and Child Sexual Abuse Among South Asians
in the US
Hillary A. Robertson
1
Nitasha Chaudhary Nagaraj
2
Amita N. Vyas
2
ÓSpringer Science+Business Media New York 2015
Abstract Family violence, including child sexual abuse
(CSA), is a significant public health problem in the United
States. It is particularly difficult to assess family violence
and CSA among South Asians because it is often hidden
due to cultural and familial stigma. A web-based survey
was administered to a convenience sample (n =368) of
South Asian adults in the US. One-fourth (25.2 %) of the
sample reported CSA; 13.8 % reported abuse involving
exposure; 21.5 % reported abuse involving touching;
4.5 % reported attempted sexual intercourse; and 3.5 %
reported forced sexual intercourse. Adjusted odds ratios
found that participants who reported any relationship vio-
lence were significantly more likely to have experienced
CSA (OR 2.28; 95 % CI 1.26–4.13); and suicide attempt
was significantly associated with CSA (OR 3.96; 95 % CI
1.27–12.3). The findings presented in this formative study
will assist in guiding future studies and interventions for
South Asians in the United States.
Keywords Child sexual abuse Family violence South
Asian health Mental health
Introduction
Family violence in South Asian countries has received
increased media attention in the last few years [1,2]. There
are many reasons why family violence in particular merits
focus. In contrast to other forms of violence (i.e. gang
violence, violent crime, or war), family violence, which
includes child maltreatment, domestic violence, and elder
abuse, [3] presupposes a relationship between those in-
volved [4]. There is much controversy in defining family
violence and whether it should include physical and sexual
violence, and while an exact definition of family violence
is controversial, understanding the major components are
central to understanding and quantifying the degree to
which family violence occurs [4]. The present study fo-
cuses on several types of family violence including rela-
tionship violence, witnessing parental violence, and child
sexual abuse (CSA), which may be experienced outside the
family context.
As more research is underway to better understand the
complex factors surrounding family violence and CSA in
South Asia, it is important to explore the extent to which
violence extends beyond geographic boundaries and afflicts
South Asian children and families living in the United
States. First, the exposure to violence and CSA in one’s
family of origin is alleged to increase the risk of per-
petuating violence and CSA, and therefore immigrant
families from high-prevalence countries may be at in-
creased risk [5,6]. Second, family violence and child abuse
are of significant public health concern in the US. In 2013,
the Administration on Children, Youth and Families re-
ported that an estimated 679,000 children in the United
States were victims of child maltreatment [7].
There are over 3.4 million South Asians living in the
US, comprising of individuals with family origins from
&Hillary A. Robertson
robertson.227@osu.edu
1
College of Social Work, The Ohio State University, 1947
College Road, 325Q Stillman Hall, Columbus, OH 43210,
USA
2
Department of Prevention and Community Health, The
George Washington University, Washington, DC, USA
123
J Immigrant Minority Health
DOI 10.1007/s10903-015-0227-8
Afghanistan, Bangladesh, Bhutan, India, the Maldives,
Pakistan and Sri Lanka [8]. Although the South Asian
population in the US has increased significantly in the last
several decades, there has been limited data and research
on family violence in these immigrant communities and no
published quantitative studies on CSA specifically. Several
challenges to this type of research exist including the
‘healthy and wealthy/model minority stereotype’’ for this
minority group [9]. The model minority stereotype posits
that persons from South Asian countries are most often
perceived to achieve higher degrees of income and
education, and lower levels of crime rates and family in-
stability. This ‘‘myth’’ has been a driving force behind the
paucity of health-focused studies of South Asians in the US
[9,10]. Family violence and CSA are highly stigmatized
issues and are often left undetected or unaddressed within
families and communities [5,6]. Therefore, it is more than
plausible that family violence and CSA found within South
Asian countries exists globally within South Asian
families.
Child abuse, both physical and sexual, has been linked
to many psychological conditions [11]. The devastating
effects of these experiences are typically seen well into
adulthood. A study conducted by McCauley et al. [12]
found that many of the associations between child abuse
and physical symptoms, psychological problems, and
substance abuse issues were as strong as the associations
for patients experiencing current abuse. Further, in a study
conducted by Sugaya et al. [13], other childhood adversi-
ties and psychiatric comorbidities, including suicide idea-
tion and suicide attempt, were all independently and
significantly associated with CSA. Dube et al. [14] found
that witnessing maternal violence during childhood in-
creased the likelihood of early initiation of illicit drug use
by 1.6-fold. Adolescent exposure to parental intimate
partner violence was found to be associated with anxiety,
depression, and substance abuse [15]. Furthermore, family
of origin violence, including CSA, has been found to pre-
dict both marital and dating violence [5,6,11,16]. The
consequences of family violence and CSA are devastating
and there is clearly a need for increased efforts to prevent
and mitigate these experiences among children living in the
United States.
Researchers have suggested that it is particularly diffi-
cult to determine the prevalence of family violence and
CSA among South Asian communities due to pervasive
cultural norms including patriarchal ideology and tradi-
tional family and gender norms [5,6,11,16,17]. Family
violence is highly stigmatized amongst the South Asian
population living in-country and abroad. The South Asian
culture is a patriarchal social system that places girls and
women in subordinate positions relative to men [5,18].
Particular to sexuality, gendered roles in the South Asian
context put girls and women at a much larger risk for
violence and sexually-related diseases [19]. Specifically
looking at CSA, a study conducted in Great Britain found
that disclosure of CSA among South Asian women was
often impeded by lack of basic knowledge of CSA; lack of
awareness surrounding the existence of the CSA services;
fear of public exposure due to disclosure of CSA; fear of
culturally insensitive responses from professionals; and
other cultural factors such as izzat [honor/respect], haya
[modesty], and sharam [shame/embarrassment]) [19,20].
Furthermore, previous research has found that the up-
bringing and personality of Asian Indians are partly shaped
by the influence of extended adult family members, and
they are expected to depend on their parents, grandparents,
other siblings, and aunts and uncles throughout their
lifespan [21]. This familial norm is often a significant
barrier for disclosure of family violence and CSA within
families [5,6].
A history of CSA places an individual at increased risk
of suicide in childhood, adolescence, and adulthood [22].
When compared with never-abused patients, childhood-
only abused patients were nearly four times more likely to
report attempted suicide [12]. Although research linking
CSA and subsequent suicide has not focused specifically on
South Asians, studies have revealed high rates of attempted
and successful suicide among South Asians across the
world [23,24]. A study conducted in the United Kingdom
(UK) found that the rate of attempted suicide among South
Asian women ages 18–24 was three times higher than the
rate of attempted suicide among their white counterparts
[25].
Intimate partner violence has been found to be associ-
ated with increased sexual health concerns, poor physical
health, depression, anxiety, and suicidal ideation among
South Asian women living in the US [26,27]. Furthermore,
a history of CSA is associated with an increased risk of
intimate partner violence and adult sexual re-victimization
[28,29]. Raj et al. found a high prevalence of IPV (40.8 %)
among immigrant South Asian women living in the US.
Fergusson et al. found that adults who have experienced
CSA have greater sexual vulnerability during adolescence
and higher rates of sexual victimization after the age of 16
[26].
One landmark quantitative national study examined the
prevalence of child abuse in India and found that about half
of India’s children reported experiencing some form of
CSA, and the majority never reported the abuse [30]. This
2007 study was conducted by India’s Ministry of Women
and Child Development and also noted that CSA in India
begins as early as 5 years and can include a myriad of
sexual crimes. Twenty-two percent of respondents indi-
cated severe (defined as sexual assault, fondling, exposure,
or child pornography) sexual abuse and 69 % of all Indian
J Immigrant Minority Health
123
children were found to be victims of physical, mental, or
emotional abuse. Of the 12,447 children interviewed one-
on-one, the study found that it was usually family members
(89 %) who perpetrate such crimes [30]. Despite what is
known in South Asian countries, there is virtually no re-
search on this highly stigmatized, public health issue
among the growing population of South Asians in the US.
To that extent, a quantitative survey of South Asian adults
living in the US was conducted to better understand the
relationships between family violence, mental health, and
CSA. The study was reviewed and approved by The Ge-
orge Washington University Institutional Review Board
(IRB # 080920).
Methods
Sample and Procedures
This study recruited a convenience sample of 425 South
Asians living in the United States. Eligibility criteria in-
cluded English-proficient male and female adults 18 years
of age and older who self-identify their origin as South
Asian regardless of where they were born. Study par-
ticipants were not remunerated for participation.
The project team collaborated with 58 local and national
South Asian organizations with social media and/or listserv
capabilities. These organizations spanned a variety of do-
mains including religious, cultural, professional asso-
ciations, and non-profits. Between June and July 2013,
organizations disseminated a web-based survey elec-
tronically to its members via email listservs and social
media sites and did not provide the research team contact
information for their individual members. Given the uni-
verse of email lists and databases, including overlap of
individuals on multiple lists, a valid response rate could not
be calculated.
People of Indian decent represent the largest percent of
the US. South Asian population, and therefore, the majority
of organizations and listservs (approximately 80 %) fo-
cused on this subgroup [8]. Significant efforts were made to
reach out to all non-Indian focused South Asian organi-
zations for data collection.
Instruments and Measures
Data were collected via an 82-item quantitative survey.
Questions were adapted from the Centers for Disease
Control and Prevention (CDC) Adverse Childhood Expe-
riences (ACE) Study [31] and additional questions were
adapted from the Substance Abuse and Mental Health
Services Administration (SAMHSA) National Survey on
Drug Use and Health [32], the Revised Conflict Tactics
Scale [33], the Woman Abuse Screening Scale [34] and the
CDC’s Behavioral Risk Factor Surveillance System [35].
The survey took approximately 10–15 min to complete and
collected information on socio-demographics, suicide
ideation and attempt, number of lifetime sexual partners,
relationship violence and childhood experiences, including
sexual abuse and violence. Responses were downloaded
into IBM SPSS 20.0 and didn’t require manual data entry
and coding.
Demographic characteristics included gender, country of
origin, marital status, parity, education level, annual
household income, and parents’ education level. Immi-
gration status was captured with US born and citizenship
status. Suicide ideation/attempt has been documented as a
consequence of child abuse, and therefore the survey in-
cluded two questions.
Number of sexual partners was measured by asking an
open-ended question; any type of relationship violence was
captured by adapting the Revised Conflict Tactics Scale
[33] and the Woman Abuse Screening Scale [34]; wit-
nessing parental violence was measured using questions
adapted from the CDC ACE Study [31].
Questions on CSA were adapted from the CDC ACE
Study [31]. Participants were asked: ‘‘during your first
18 years of life, did an adult or older relative, family
friend, or stranger ever (1) expose themselves to you or
force you to expose yourself to them, (2) touch or fondle
your body in a sexual way, (3) have you touch their body in
a sexual way, (4) attempt to have sexual intercourse (oral,
anal, or vaginal) with you, (5) actually have sexual inter-
course (oral, anal, or vaginal) with you?’’ A ‘‘yes’’ response
to any of these five questions classified the respondent as
having experienced sexual abuse during childhood. We
created an ‘‘any sexual abuse’’ variable from a summation
of these items and dichotomized as ‘‘yes/no.’
Analysis
Quantitative data analysis was conducted on 368 par-
ticipants. A total of 425 people participated in the survey,
but only 395 met the eligibility criteria, and 27 participants
did not complete more than 15 % of the survey and were
dropped from the dataset. Univariate and bivariate analyses
were conducted to describe the study population and to
explore relationships between sociodemographic charac-
teristics, suicide ideation/attempts, and violence-related
variables. A logistic multivariate regression model for any
CSA examined relationship violence, family violence,
suicide ideation and attempt, and adjusted for gender and
US born.
J Immigrant Minority Health
123
Results
Table 1presents demographic, health, and violence related
characteristics of study participants. As shown, the mean
age of study participants is 32.9 years and participants are
predominantly female (77.7 %). The majority of par-
ticipants are of Indian origin (74.2 %); are US citizens
(90.8 %); have more than a 4-year degree (71.6 %), and
58.5 % reported an annual income over $100,000.
As shown, 21.9 % of participants reported suicide
ideation and 5.3 % attempted suicide. Twenty-four percent
reported experiencing relationship violence, and 41.2 %
reported witnessing parental violence. The average number
of sexual partners in our study sample was eight. With
respect to CSA, 25.2 % of the population reported expe-
riencing some form of childhood sexual abuse (exposure,
touching, attempted penetration, penetration). Further,
13.8 % reported that during the first 18 years of their life
an adult had exposed themselves to them or had forced the
participant to expose themselves; 21.5 % reported sexual
abuse involving touching; 4.5 % reported experiencing
attempted sexual intercourse; and 3.5 % reported experi-
encing actual sexual intercourse.
Table 2presents adjusted odds ratios from three multi-
variate logistic models for (1) witnessing parental violence,
(2) relationship violence, and (3) suicide ideation/attempt
on ‘any childhood sexual abuse’, adjusting for age, gender,
and US born as they were significant covariates in the bi-
variate analyses. Model 1 did not yield significant findings.
Model 2 found that participants reporting any relationship
violence are significantly more likely to report any CSA
(OR 2.28; 95 % CI 1.26–4.13). Model 3 found that par-
ticipants reporting suicide attempts are significantly more
likely to report CSA (OR 3.96; 95 % CI 1.27–12.3).
Discussion
Approximately one-fourth of our sample reported any
childhood sexual abuse; 41.2 % reported witnessing par-
ental violence; and 24 % reported relationship violence.
Together, these data provide preliminary evidence of sub-
stantial prevalence of family violence and CSA among
South Asians in the US. The present analysis is consistent
with previous studies whereby subsequent consequences
such as relationship violence (marital and dating) and
suicide attempts were found related to CSA [3638]. Fur-
ther, as found in other studies, violence and CSA cuts
across social class and is prevalent among high income,
high education subgroups [36], such as the current study
sample.
The dynamics between family violence, suicide, and
CSA are certainly far more complex than what has been
explored in this study. However, the present study’s find-
ings are important as multivariate analyses found sig-
nificant relationships between CSA and relationship
violence and suicide attempt. Certainly, growing up in a
household that considers violence to be an acceptable
Table 1 Demographic, health, and violence related characteristics of
study participants (N =368)
Variables Total % (n)
Mean current age (years) 32.99 (332)
Gender
Female 77.7 (286)
Male 22.3 (82)
Country of origin
India 74.2 (271)
Other 25.8 (94)
US citizen 90.8 (334)
Born in the US 55.9 (205)
Marital status
Single 44.7 (164)
Married 48.8 (179)
Other 6.5 (24)
Mean total children 1.88 (111)
Education level
Less than a 4-year degree 3.6 (13)
4-year college degree 24.9 (91)
More than a 4-year degree 71.6 (262)
Total household income
$100,000 or less 41.5 (151)
$101,000–$200,000 27.2 (99)
Over $200,000 31.3 (114)
Suicide ideation
Yes 21.9 (75)
Suicide attempt
Yes 5.3 (18)
Mean number of sexual partners 8.01 (293)
Relationship violence
Yes 24.0 (80)
Witness parental violence
Yes 41.2 (135)
Any childhood sexual abuse
Yes 25.2 (79)
Exposure
Yes 13.8 (44)
Touching
Yes 21.5 (68)
Attempted penetration (oral, anal, or vaginal)
Yes 4.5 (14)
Penetration (oral, anal, or vaginal)
Yes 3.5 (11)
J Immigrant Minority Health
123
behavior may help to normalize this type of behavior in a
child’s mind and further the cycle of violence. The findings
presented here must guide future research, policy, and
practice. Community-based organizations (CBOs), public
health professionals, educators, and clinicians should be
aware that CSA is not limited to one socioeconomic, cul-
tural, or ethnic group. These stakeholders must collaborate
to appropriately prevent and identify family violence and
CSA to ameliorate long-term consequences.
Studies such as this one ought to (1) guide increased
awareness and sensitivity among pediatricians and provi-
ders; (2) prompt public health professionals to create CSA
and violence prevention interventions that are uniquely
tailored to South Asians in the US; and (3) direct re-
searchers to undertake an extensive study to fully under-
stand the nuances associated with family violence and CSA
in these communities.
Limitations of the Study
It is important to note that there are several methodological
limitations to this study. First, this was a convenience
sample and geographic location in the country was not
assessed, and therefore generalizability to a national sam-
ple of South Asians is limited. This was a cross-sectional
sample prohibiting causal inferences and therefore the
findings are primarily descriptive in nature. Additionally,
survey methodology relied on participants’ recall and self-
report, leaving the study vulnerable to memory and will-
ingness to report on sensitive experiences. It is likely that
the reported prevalence of CSA is an underestimate due to
underreporting. The survey was developed in English only
and therefore non-English speakers were excluded and it is
unknown whether non-English speakers’ CSA experiences
are similar or different. US born South Asians in this study
were less likely to report CSA indicating that the preva-
lence of CSA among non-English speakers may in fact be
higher than English speakers, and our results may be an
underestimate. Certainly, South Asians originating from
countries other than India and low-income South Asians
are underrepresented in the sample, and therefore this
sample is biased. In addition, women who have experi-
enced CSA may be more likely to report other negative
experiences, which may explain and overestimate the
findings related to relationship violence and suicide at-
tempt. And finally, many previous studies disaggregate
findings by sex as there are often differential factors that
influence CSA among males and females. However, the
present analysis did not stratify by sex due to the small
sample size among males (n =82). Despite these limita-
tions, this study recruited a significant sample size and
provides valuable insights for future methodologically-
sound research efforts.
Conclusion
It is without question that the prevention of family violence
and CSA is of great concern to communities worldwide. In
totality, this study found substantial levels and forms of
violence, including (1) CSA; (2) relationship violence; (3)
witnessing parental violence; and (4) self-inflicted injury
i.e. suicide ideation and attempt. Further significant rela-
tionships were found between CSA and relationship vio-
lence, and CSA and suicide attempts. To date, this is the
first study to assess CSA and its relationship with other
forms of violence among South Asians in the United States.
Although the analysis was simple due to the study
methodology, this study presents compelling evidence that
family violence and CSA, and its consequences should not
Table 2 Multivariate logistic
analysis for any childhood
sexual abuse
Adjusted odds ratio (95 % CI)
Model 1 Model 2 Model 3
Age 1.00 (0.97–1.04) 1.0 (0.96–1.03) 1.00 (0.97–1.04)
Gender
Female 2.01 (0.97–4.17) 1.92 (0.92–4.0) 2.17 (1.03–4.56)*
Male Ref Ref Ref
US born
Yes 1.76 (1.0–3.11)* 1.75 (0.99–3.11) 1.82 (1.03–3.23)*
Witnessed parental violence 1.63 (0.95–2.83)
Relationship violence 2.28 (1.26–4.13)**
Suicide ideation 1.02 (0.47–1.88)
Suicide attempt 3.96 (1.27–12.3)**
*p\0.05; ** p\0.01; *** p\0.001
J Immigrant Minority Health
123
be overlooked as a public health issue and must be added to
the public health agenda focused on South Asians living in
the US.
In recent years, more research on South Asians in the
US has been conducted and yet, these studies over-
whelmingly focus on chronic disease prevention and
treatment [9,10]. The present study’s findings suggest that
family violence and CSA are important public health issues
for South Asians in the US and warrant further attention. It
is essential that interdisciplinary research occurs and cul-
turally salient primary and secondary prevention programs
are implemented.
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... There are over 3.4 million South Asians (SAs) living in the U.S., comprising of individuals with family origins from Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan, and Sri Lanka [1]. Despite high levels of education and household income, preliminary evidence indicates that South Asians living in the U.S. have experienced different forms of abuse throughout the lifespan [2]. A 2015 study of 300 SA adults in the U.S. examined family violence and found that 24% of SA adults experienced relationship violence, and 41.2% reported witnessing violence against their mother [2]. ...
... Despite high levels of education and household income, preliminary evidence indicates that South Asians living in the U.S. have experienced different forms of abuse throughout the lifespan [2]. A 2015 study of 300 SA adults in the U.S. examined family violence and found that 24% of SA adults experienced relationship violence, and 41.2% reported witnessing violence against their mother [2]. In the same study, 25.2% reported experiencing some form of childhood sexual abuse (exposure, touching, attempted penetration, penetration). ...
... In the same study, 25.2% reported experiencing some form of childhood sexual abuse (exposure, touching, attempted penetration, penetration). Further, 13.8% reported that during the first 18 years of their life an adult had exposed themselves to them or had forced the participant to expose themselves; 21.5% reported sexual abuse involving touching; 4.5% reported experiencing attempted sexual intercourse; and 3.5% reported experiencing actual sexual intercourse [2]. In addition, participants who reported any relationship violence were significantly more likely to have experienced child sexual abuse and suicide attempt [2]. ...
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The devastating effects of experiencing violence in childhood has been particularly difficult to assess among South Asians (SA) living in the U.S. due to a lack of race specific data. A cross-sectional quantitative study of 535 SA adult women living in the U.S. was conducted to better understand the relationship between childhood exposure to violence and health behaviors in adulthood. Measures included socio-demographics, exposure to violence as a child via witnessing parental violence, and experience of childhood violence, adult IPV, suicide ideation and attempt, and body esteem and subjective well-being in adulthood. Significant associations were found between childhood verbal abuse and body esteem and subjective well-being in adulthood; childhood physical abuse and subjective well-being in adulthood; and having a battered mother and subjective well-being in adulthood. To date, this is the first study to examine childhood violence and its relationship to adult IPV and health among SA women in the U.S.
... A number of community-based studies shows that the proportion of South Asian women who report experiencing some form of intimate partner violence has ranged from 21.2% to 40.8% [5][6][7][8], with most of these studies measuring physical intimate partner violence only. One study reported child sex abuse among 25.2% of South Asian adults participating in a web-based survey [9], and marital rape and issues of sexual control have been identified in South Asian immigrant communities [10]. Preliminary disaggregated analyses of gender-based violence indicators also show the prevalence of partner abuse among Asian Indians (19.5%) to be higher than Japanese (9.7%) and Chinese (9.7%) ...
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Background Sexual violence is a growing issue faced across diverse South Asian American communities under the backdrop of a distinct religious and cultural environment that intersects with the ability to prevent and manage this public health crisis. There is also growing attention on sexual violence experienced by younger or second-generation South Asian Americans, although little is known on the prevalence of this violence and its impact on health outcomes. Using data from a community-driven sexual violence survey, this study describes the experience of sexual violence and related help seeking behaviors and mental health outcomes among 18–34-year-old South Asian Americans living near the New York (NY) State region. Methods Participants were recruited via social media to participate in an anonymous survey developed in partnership with an advisory board of South Asian young adult representatives. Data was analyzed descriptively and through adjusted logistic regression models. Results Overall, responses from 335 sexual assault survivors were analyzed. Types of assault experienced included no-contact (97.6%), contact (75.2%), rape attempts (50.2%), rape (44.6%), and multiple rape (19.6%). Many reported perpetrators were South Asian (65.1%) or family members (25.1%). Only 27.6% indicated they had reported assaults to authorities or received services. In adjusted analyses, odds of help seeking were higher among participants who were older (AOR:1.10, 95%CI:1.02–1.20), were a sexual minority (lesbian, gay, bisexual) (1.98, 1.05–3.71), had a family member as the perpetrator (1.85, 1.01–3.40), had lower disclosure stigma (1.66, 1.16–2.44), and experienced depression (2.16, 1.10–4.47). Odds of depression were higher among sexual minority participants and lower among those with higher sexual assault disclosure stigma (3.27, 1.61–7.16; 0.68, 0.50–0.93). Conclusions Findings call for greater targeted policy interventions to address the prevention of sexual violence among young South Asian Americans and greater focus on improving help seeking behaviors and improving mental health outcomes among survivors.
... First-generation SA parents, raised in hierarchical family models with authoritarian parenting, expect the goals of the family to precede individual preferences. Their parenting is influenced by being raised in a patriarchal community which views corporal punishment as a form of discipline and condones domestic violence (Krishnan & Cutler, 2005;Sabri et al., 2018) and child abuse (Kanukollu & Mahalingam, 2011;Robertson et al., 2016). Thus, expression of autonomy in sexuality, adherence to religious practices and choice of career which is normative to the developmental stage in adolescence is often viewed as disobedience, disrespect of cultural values and even rebellion (Deepak, 2005). ...
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Objective South Asians (SAs), a rapidly growing minority group in the United States are underrepresented in mental health research. They represent a unique sub-group of Asian immigrants in that their journey to the United States in the last 50 years was driven by the pursuit of academic and career opportunities. Our goal is to provide a topical overview of factors contributing to the mental health challenges of South Asian American (SAA) youth and to describe culturally sensitive approaches that would provide effective treatment for SAA youth and their families. Methods We conducted a review of published literature in PubMed and PsycInfo search engines using the key words South Asian immigrants, South Asian Americans, psychological, psychiatric, mental health treatment, therapy and interventions. Results The challenges faced by these highly educated families are distinctive in that there is a struggle to maintain ethnic identity based on collectivism while embracing American ideals of individualism. These opposing values along with model minority expectations put SAs at high risk for mental health concerns and acculturative family distancing. Furthermore, mental health stigma impedes help-seeking. Mental health practitioners must navigate the different value systems of the parent–child dyad without ostracizing either generation and deliver effective care. Hence, culturally adapted family therapy and community-based approaches may be particularly relevant in SA youth. Conclusion Our article outlines common family attitudes and issues pertinent to mental health in youth and discusses useful clinical approaches to dealing with SAA youth and their families.
... Manifestations of these underlying forces include myriad structural, institutional, and sociocultural barriers for South Asian women that impede progress toward alleviating domestic violence, causing them to stay in abusive relationships longer than women from some other ethnic communities. This has consequences not only for their own health and well-being but the effects often reverberate throughout the entire family and community and can persist for generations (Ahmad, Driver, McNally, & Stewart, 2009;Robertson, Nagaraj, & Vyas, 2016). ...
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South Asian women’s organizations have been established nationwide to meet the unique needs of South Asians impacted by domestic violence. Although services at these community-based agencies are primarily delivered by providers who are South Asian themselves, research into their experiences is sparse and fails to address how sharing facets of their identity affects them and their ability to care for clients. Based on a phenomenological research design, semi-structured interviews were conducted to describe the lived experience of eight South Asian therapists who were currently working at South Asian women’s organizations in the New York metropolitan area. Four essential themes emerged from the analysis: (a) disrupting the status quo, (b) navigating psychological distress, (c) examining assumptions of identity, and (d) pushing professional boundaries. The relational complexities of ethnically similar therapeutic dyads revealed deeper issues related to the inseparability of therapy and advocacy, the questioning of cultural norms, the limiting aspects of standard agency procedures, and the straining of professional boundaries.
... • Social stressors, such as acculturation stress, abuse, gender discrimination and lack of emotional support may culminate into emotional distress and symptoms ( • Depression, anxiety, PTSD, eating disorders, substance abuse and suicide (Bhugra, 2002& TummalaNarra, 2013 • Level of depression correlates with family conflict, lack of self-esteem, and a deficit in social support (Mui & Kang, 2006;Hovey, 2000;Hovey & Magana, 2002;Samuel, 2009) • Relationship Violence (Nagaraj, 2016;Robertson, Vyas & Nagaraj, 2015) Considerations when working with South Asian Women ...
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Approximately half of migrants worldwide are women and girls. Women’s experiences of migration are shaped by contextual factors, such as employment, financial resources, family structure and dynamics, sociopolitical climate, abuse and violence, and documentation status. Further, women’s responses to adapting to a new sociocultural environment often necessitates shifts in roles and positions within family and broader society. Guided by an ecological framework, this chapter provides an overview of salient factors that impact migrant women’s experiences of stress and resilience. We emphasize the dynamic interaction of multiple layers of context and development, including the influence of sociopolitical climate on mental health and access to resources (APA, 2012; Clauss-Ehlers et al., 2019). While recognizing that women have unique experiences of migration across different regions of the world, in this chapter we focus specifically on experiences of immigrant women in the USA, and provide a case illustration of how immigrant women may experience risk and protective factors.
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Sexual violence trauma counseling should be informed by the intersections of a survivor’s identity. This research focused on the social reactions experienced by survivors of sexual violence from the Indian diaspora. This study used quantitative survey research methods and correlational analysis as well as descriptive statistics to understand the social reactions that survivors received from informal supports and formal supports. Significant results, implications for counselors, and future research recommendations are discussed.
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Asian Americans are a diverse and rapidly growing group within the US population. The aim of this chapter is to demonstrate how Asian Americans may understand mental health conditions and to help mental health clinicians, educators, and researchers develop a thoughtful and flexible approach to evaluating and working with Asian American patients. This approach will involve consideration of each person’s unique health beliefs, culture, language, family, religion, narrative, genetics, pharmacological history, and relevant life experience. While cultural beliefs and research about particular issues and trends within the population will be reviewed, Asian Americans cannot be treated as a monolithic group.
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This article explores the role of socio-cultural factors in violence against women and girls, focusing on child sexual abuse (CSA) and sexual violence (SV) in British South Asian communities. Using examples from 13 in-depth interviews with survivors, the researchers examine (1) how abusers gain access to their victims, (2) family and community responses and (3) the role of cultural factors in concealing CSA/SV. The interviews demonstrate that British South Asian survivors are extremely reluctant to disclose SV/CSA due to factors that other groups of victims usually do not face, including a general taboo about discussing sex and strong cultural norms around notions of shame. These fndings are contextualized in relation to a larger study that also involved community focus groups and interviews with professionals in relevant felds. Moving forward, new culturally specifc support pathways for British South Asian victims must be developed that take account of the role that victims and their communities must play if CSA and SV are to be effectively combatted.
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This paper is an extension of a previous study which addressed cultural perceptions of first generation Asian-Indians. The current study includes second generation Asian-Indians in the U.S. (The United States of America) and compares their reactions to the first generation subjects regarding Indian magazine advertisements versus American magazine advertisements of the same product class. The results indicate that cultural perceptions of the second generation Asian-Indian are similar to cultural perceptions of first generation Asian-Indians in the earlier study. In general, both generations appear to prefer Indian advertisements more than the corresponding American advertisements. This offers opportunities for U.S. marketers to continue to develop culturally attuned advertising strategies to effectively reach the growing and affluent Asian-Indians in the U.S.
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This study investigates the relationship between South Asian immigrantwomen’s patriarchal beliefs and their perceptions of spousal abuse. Twenty-minute telephone surveys were conducted with 47 women. The survey collected information about demographic characteristics, patriarchal beliefs, ethnic identity, and abuse status. Participants were read a vignette that depicted an abusive situation and were asked whether they felt that the woman in the vignette was a victim of spousal abuse. As hypothesized, higher agreement with patriarchal social norms predicted a decreased likelihood of identifying the woman in the vignette as a victim of spousal abuse. This finding is discussed in terms of its application to violence against women educational programs in the South Asian immigrant community.
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This article describes a revised Conflict Tactics Scales (the CTS2) to measure psychological and physical attacks on a partner in a marital, cohabiting, or dating relationship; and also use of negotiation. The CTS2 has (a) additional items to enhance content validity and reliability; (b) revised wording to increase clarity and specificity; (c) better differentiation between minor and severe levels of each scale; (d) new scales to measure sexual coercion and physical injury; and (e) a new format to simplify administration and reduce response sets. Reliability ranges from .79 to .95. There is preliminary evidence of construct validity.
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Objectives: Childhood sexual abuse (CSA) has been associated with many adverse medical, psychological, behavioral and socioeconomic outcomes in adulthood. This study aims to examine the linkages between CSA and a wide range of developmental outcomes over a protracted time period to age 30. Methods: Data from over 900 members of the New Zealand birth cohort the Christchurch Health and Development Study were examined. CSA prior to age 16 was assessed at ages 18 and 21 years, in addition to: mental health, psychological wellbeing, sexual risk-taking behaviors, physical health and socioeconomic outcomes to age 30. Results: After statistical adjustment for confounding by 10 covariates spanning socio-demographic, family functioning and child factors, extent of exposure to CSA was associated with increased rates of (B, SE, p): major depression (0.426, 0.094, <.001); anxiety disorder (0.364, 0.089, <.001); suicidal ideation (0.395, 0.089, <.001); suicide attempt (1.863, 0.403, <.001); alcohol dependence (0.374, 0.118, <.002); and illicit drug dependence (0.425, 0.113, <.001). In addition, at age 30 CSA was associated with higher rates of PTSD symptoms (0.120, 0.051, .017); decreased self-esteem (-0.371, 0.181, .041); and decreased life satisfaction (-0.510, 0.189, .007). Childhood sexual abuse was also associated with decreased age of onset of sexual activity (-0.381, 0.091, <.001), increased number of sexual partners (0.175, 0.035, <.001); increased medical contacts for physical health problems (0.105, 0.023, <.001); and welfare dependence (0.310, 0.099, .002). Effect sizes (Cohen's d) for the significant outcomes from all domains ranged from .14 to .53, while the attributable risks for the mental health outcomes ranged from 5.7% to 16.6%. Conclusions: CSA is a traumatic childhood life event in which the negative consequences increase with increasing severity of abuse. CSA adversely influences a number of adult developmental outcomes that span: mental disorders, psychological wellbeing, sexual risk-taking, physical health and socioeconomic wellbeing. While the individual effect sizes for CSA typically range from small to moderate, it is clear that accumulative adverse effects on adult developmental outcomes are substantial.
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Objective: To provide clinicians with current information on prevalence, risk factors, outcomes, treatment, and prevention of child sexual abuse (CSA). To examine the best-documented examples of psychopathology attributable to CSA. Method: Computer literature searches of Medline and PSYCInfo for key words. All English-language articles published after 1989 containing empirical data pertaining to CSA were reviewed. Results: CSA constitutes approximately 10% of officially substantiated child maltreatment cases, numbering approximately 88,000 in 2000. Adjusted prevalence rates are 16.8% and 7.9% for adult women and men, respectively. Risk factors include gender, age, disabilities, and parental dysfunction. A range of symptoms and disorders has been associated with CSA, but depression in adults and sexualized behaviors in children are the best-documented outcomes. To date, cognitive-behavioral therapy (CBT) of the child and a nonoffending parent is the most effective treatment. Prevention efforts have focused on child education to increase awareness and home visitation to decrease risk factors. Conclusions: CSA is a significant risk factor for psychopathology, especially depression and substance abuse. Preliminary research indicates that CBT is effective for some symptoms, but longitudinal follow-up and large-scale "effectiveness" studies are needed. Prevention programs have promise, but evaluations to date are limited.
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Context Suicide is a leading cause of death in the United States, but identifying persons at risk is difficult. Thus, the US surgeon general has made suicide prevention a national priority. An expanding body of research suggests that childhood trauma and adverse experiences can lead to a variety of negative health outcomes, including attempted suicide among adolescents and adults.Objective To examine the relationship between the risk of suicide attempts and adverse childhood experiences and the number of such experiences (adverse childhood experiences [ACE] score).Design, Setting, and Participants A retrospective cohort study of 17 337 adult health maintenance organization members (54% female; mean [SD] age, 57 [15.3] years) who attended a primary care clinic in San Diego, Calif, within a 3-year period (1995-1997) and completed a survey about childhood abuse and household dysfunction, suicide attempts (including age at first attempt), and multiple other health-related issues.Main Outcome Measure Self-reported suicide attempts, compared by number of adverse childhood experiences, including emotional, physical, and sexual abuse; household substance abuse, mental illness, and incarceration; and parental domestic violence, separation, or divorce.Results The lifetime prevalence of having at least 1 suicide attempt was 3.8%. Adverse childhood experiences in any category increased the risk of attempted suicide 2- to 5-fold. The ACE score had a strong, graded relationship to attempted suicide during childhood/adolescence and adulthood (P<.001). Compared with persons with no such experiences (prevalence of attempted suicide, 1.1%), the adjusted odds ratio of ever attempting suicide among persons with 7 or more experiences (35.2%) was 31.1 (95% confidence interval, 20.6-47.1). Adjustment for illicit drug use, depressed affect, and self-reported alcoholism reduced the strength of the relationship between the ACE score and suicide attempts, suggesting partial mediation of the adverse childhood experience–suicide attempt relationship by these factors. The population-attributable risk fractions for 1 or more experiences were 67%, 64%, and 80% for lifetime, adult, and childhood/adolescent suicide attempts, respectively.Conclusions A powerful graded relationship exists between adverse childhood experiences and risk of attempted suicide throughout the life span. Alcoholism, depressed affect, and illicit drug use, which are strongly associated with such experiences, appear to partially mediate this relationship. Because estimates of the attributable risk fraction caused by these experiences were large, prevention of these experiences and the treatment of persons affected by them may lead to progress in suicide prevention.
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Little is known about the extent to which parental conflict and violence differentially impact on offspring mental health and substance use. Using data from a longitudinal birth cohort study this paper examines: whether offspring exposure to parental intimate partner violence (involving physical violence which may include conflicts and/or disagreements) or parental intimate partner conflict (conflicting interactions and disagreements only) are associated with offspring depression, anxiety and substance use in early adulthood (at age 21); and whether these associations are independent of maternal background, depression and anxiety and substance use. Data (n = 2,126 women and children) were taken from a large-scale Australian birth-cohort study, the Mater University of Queensland Study of Pregnancy (MUSP). IPC and IPV were measured at the 14-year follow-up. Offspring mental health outcomes – depression, anxiety and substance use were assessed at the 21-year follow-up using the Composite International Diagnostic Interview (CIDI). Offspring of women experiencing IPV at the 14-year follow-up were more likely to manifest anxiety, nicotine, alcohol and cannabis disorders by the 21-year follow-up. These associations remained after adjustment for maternal anxiety, depression, and other potential confounders. Unlike males who experience anxiety disorders after exposure to IPV, females experience depressive and alcohol use disorders. IPV predicts offspring increased levels of substance abuse and dependence in young adulthood. Gender differences suggest differential impact.
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Objectives. —To determine the prevalence of childhood physical or sexual abuse in women seen in primary care practices; to identify physical and psychologic problems associated with that abuse; and to compare the effects of childhood physical vs sexual abuse and childhood vs adult abuse.
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This study characterizes adults who report being physically abused during childhood, and examines associations of reported type and frequency of abuse with adult mental health. Data were derived from the 2000-2001 and 2004-2005 National Epidemiologic Survey on Alcohol and Related Conditions, a large cross-sectional survey of a representative sample (N = 43,093) of the U.S. population. Weighted means, frequencies, and odds ratios of sociodemographic correlates and prevalence of psychiatric disorders were computed. Logistic regression models were used to examine the strength of associations between child physical abuse and adult psychiatric disorders adjusted for sociodemographic characteristics, other childhood adversities, and comorbid psychiatric disorders. Child physical abuse was reported by 8% of the sample and was frequently accompanied by other childhood adversities. Child physical abuse was associated with significantly increased adjusted odds ratios (AORs) of a broad range of DSM-IV psychiatric disorders (AOR = 1.16-2.28), especially attention-deficit hyperactivity disorder, posttraumatic stress disorder, and bipolar disorder. A dose-response relationship was observed between frequency of abuse and several adult psychiatric disorder groups; higher frequencies of assault were significantly associated with increasing adjusted odds. The long-lasting deleterious effects of child physical abuse underscore the urgency of developing public health policies aimed at early recognition and prevention.