Background During the perinatal period, risk of depression and anxiety (D&A) increases. As in other crisis events, the COVID-19 pandemic, imposed social distancing measures, diminished social support and changes in perinatal healthcare provision which heightened this risk. This study aimed to examine how changes in social and healthcare provider support during the pandemic affected coping strategies and depression and anxiety symptoms (D&As) among perinatal women. Methods A cross-sectional international study included 7,368 pregnant and postpartum women up to six months postpartum from 12 countries (Albania, Brazil, Bulgaria, Chile, Cyprus, Greece, Israel, Malta, Portugal, Spain, Turkey, and the United Kingdom). Between June and October 2020, women answered an online survey regarding D&As (measured by the Edinburgh Postnatal Depression Scale and Generalized Anxiety Disorder-7), level of social and healthcare providers’ support, changes to these types of support and coping strategies. Results Main findings show that 24.6% of women had symptoms of depression and 20.2% of anxiety. Higher levels of D&A were associated with lower social and provider support, negative changes to social support and use of negative internal coping strategies. Positive coping strategies mediated the relationship between increased social and provider support and decreased D&As, while negative coping strategies mediated the relationship between negative changes to social support and increased D&As. Conclusion Social and provider support can promote coping strategies and reduce emotional distress. Healthcare providers should screen perinatal women for D&A, discuss ways to improve their coping strategies and social support as a preventive measure, and offer initial emotional well-being support.

OBJECTIVE/BACKGROUND:Unmet needs in perinatal mental healthcare are an important public health issue particularly in the context of a stressful life event such as the COVID-19 pandemic but data on the extent of this problem are needed. AIM:The aim of this study is to determine the (1) proportion of women with clinically significant symptoms of perinatal depression, anxiety or comorbid symptoms of depression and anxiety, receiving mental healthcare overall and by country and (2) factors associated with receiving mental healthcare. METHOD:Women in the perinatal period (pregnancy or up to 6 months postpartum) participating in the Riseup-PPD-COVID-19 cross-sectional study, reported on sociodemographic, social support health-related factors, and COVID-19 related factors, and on symptoms of depression (Edinburgh Postnatal Depression Scale [EPDS]) and anxiety (Generalised Anxiety Disorder [GAD-7]) using self-report questionnaires. Clinically significant symptoms were defined as EPDS ≥ 13 for depression and GAD-7 ≥ 10 for anxiety. Mental healthcare was defined as self-reported current mental health treatment. RESULTS:Of the 11 809 participants from 12 countries included in the analysis, 4 379 (37.1%) reported clinically significant symptoms of depression (n = 1 228; 10.4%; EPDS ≥ 13 and GAD-7 ⟨ 10), anxiety (n = 848; 7.2%; GAD-7 ≥ 10 and EPDS ⟨ 13) or comorbid symptoms of depression and anxiety (n = 2 303; 19.5%; EPDS ≥ 13 and GAD-7 ≥ 10). Most women with clinically significant symptoms of depression, anxiety, or comorbid symptoms of depression and anxiety were not receiving mental healthcare (89.0%). Variation in the proportion of women with clinically significant symptoms of depression and/or anxiety reporting mental healthcare was high (4.7% in Turkey to 21.6% in Brazil). Women in the postpartum (vs. pregnancy) were less likely (OR 0.72; 95% CI 0.59-0.88), whereas women with previous mental health problems (vs. no previous mental health problems) (OR 5.56; 95% CI 4.41-7.01), were more likely to receive mental healthcare. CONCLUSION:There are high unmet needs in mental healthcare for women with clinically significant symptoms of perinatal depression and/or anxiety across countries during the COVID-19 pandemic. Studies beyond the COVID-19 pandemic and covering the whole range of mental health problems in the perinatal period are warranted to understand the gaps in perinatal mental healthcare.

Community social work (CSW) is often regarded as a practice with a variety of intervention models. The objectives of the present article are to examine CSW's philosophical and theoretical roots and to bridge the gap in the literature regarding the theoretical and philosophical origins of CSW and to conceptualize these theoretical bases as a paradigm with ontological, epistemological, axiological, and methodological aspects. The ontology of the proposed CSW paradigm relies on ecological theory, critical theory, and community psychology. The paradigm's epistemology relies on the basic assumption that community members are autonomous subjective human beings with important and valid knowledge who make decisions concerning their lives. Axiologically, the most prominent value of the paradigm is participation, from which other central values derive. The paradigm's methodology derives from its three abovementioned components. The conceptualization of a CSW paradigm provides a theoretical foundation for community interventions and refining the goals of these interventions. The paradigm can be used as a pedagogical and identity-building tool with students and social workers who focus on CSW.

This study aimed to analyse the role of governmental responses to the coronavirus disease 2019 (COVID-19) outbreak, measured by the Containment and Health Index (CHI), on symptoms of anxiety and depression during pregnancy and postpartum, while considering the countries’ Inequality-adjusted Human Development Index (IHDI) and individual factors such as age, gravidity, and exposure to COVID-19. A cross-sectional study using baseline data from the Riseup-PPD-COVID-19 observational prospective international study (ClinicalTrials.gov: NCT04595123) was carried out between June and October 2020 in 12 countries (Albania, Brazil, Bulgaria, Chile, Cyprus, Greece, Israel, Malta, Portugal, Spain, Turkey, and the United Kingdom). Participants were 7645 pregnant women or mothers in the postpartum period—with an infant aged up to 6 months—who completed the Edinburgh Postnatal Depression Scale (EPDS) or the Generalised Anxiety Disorder Assessment (GAD-7) during pregnancy or the postpartum period. The overall prevalence of clinically significant depression symptoms (EPDS ≥ 13) was 30%, ranging from 20,5% in Cyprus to 44,3% in Brazil. The prevalence of clinically significant anxiety symptoms (GAD-7 ≥ 10) was 23,6% (ranging from 14,2% in Israel and Turkey to 39,5% in Brazil). Higher symptoms of anxiety or depression were observed in multigravida exposed to COVID-19 or living in countries with a higher number of deaths due to COVID-19. Furthermore, multigravida from countries with lower IHDI or CHI had higher symptoms of anxiety and depression. Perinatal mental health is context-dependent, with women from more disadvantaged countries at higher risk for poor mental health. Implementing more restrictive measures seems to be a protective factor for mental health, at least in the initial phase of the COVID-19.

People struggling with poverty and social exclusion constitute the principal population targeted by social services around the world. To deal with this social problem, many intervention plans have been developed. In Israel, the 'Otzma' Centre programme was adopted in 2007 by the Ministry of Welfare and Social Affairs. The programme's goals are reducing clients' economic distress and social exclusion through various social work methods, with the core principle being the population's participation. The current qualitative study focused on a community programme for reducing poverty and exclusion. It was based on semi-structured in-depth interviews with thirteen women and two men aged thirty-five to fifty-eight years who participated in the programme. The study had two central goals: (i) understanding clients' experience of living in poverty and (ii) understanding clients' perceptions of the contribution of a community programme to their lives. Research findings included participants' most salient perceptions: namely, the multidimensional experience of dealing with poverty, becoming knowledgeable about their rights and the change process in terms of economic, personal and family issues. A finding that stood out in its absence concerned partnership and participation. The study enriches the literature regarding community intervention programmes, which aim to reduce poverty and exclusion. Practical and theoretical considerations are discussed. People who deal with poverty and social exclusion are the main target population of social services in Israel. In an era when the state of Israel stands in the un-flattering position at the head of the Organisation for Economic Co-operation and Development scale of poverty and inequality, the government need to address this issue is urgent. In 2007, The Ministry of Welfare and Social Affairs has adopted 'Otzma' Centre programme, a large-scale programme aimed to reduce poverty and social exclusion. The programme is currently operating in 108 localities, encompassing individual, group and community social work interventions. It is based on the principles of partnership with the programme's participants and promoting their participation. This study focuses on the experiences and perceptions of participants in two 'Otzma' community programmes aimed to reduce poverty and exclusion. The study is qualitative and based on semi-structured interviews with fifteen clients who struggle with poverty. The choice to focus on the point of view of the customers is not arbitrary. Beside the fact that as social workers our main interest is the welfare of clients, the client-centred orientation of the programmes explored, implies that they cannot be properly evaluated without participants' perspective.

Background: Mental disorders during the perinatal period are a significant health concern, especially during a pandemic, in which healthcare provision is highly demanding, and governmental measures to prevent infection influence the population’s daily living. This study aimed to analyse the role of governmental responses to the coronavirus disease 2019 (COVID-19) outbreak, measured by the Containment and Health Index (CHI), on symptoms of anxiety and depression during pregnancy and postpartum, while considering the countries’ Inequality-adjusted Human Development Index (IHDI) and individual factors such as age, gravidity, and exposure to COVID-19.Methods: This study analysed women who completed the Edinburgh Postnatal Depression Scale (EPDS) or the Generalised Anxiety Disorder Assessment (GAD-7) during pregnancy or the postpartum period (n = 7,645) from 12 countries of the Research Innovation and Sustainable Pan-European Network in Peripartum Depression Disorder, task force COVID-19 (Riseup-PPD-COVID-19) observational prospective study.Findings: The overall prevalence of clinically significant depression symptoms (EPDS ≥ 13) was 30%, ranging from 20·5% in Cyprus to 44·3% in Brazil. The prevalence of clinically significant anxiety symptoms (GAD-7 ≥ ten) was 23·6% (ranging from 14·2% in Israel and Turkey to 39·5% in Brazil). Higher symptoms of anxiety or depression were observed in multigravida exposed to COVID-19 or living in countries with a higher number of deaths due to COVID-19. Furthermore, multigravida from countries with lower IHDI or CHI had higher symptoms of anxiety and depression.Interpretation: Perinatal mental health is context-dependent. Women from more disadvantaged countries are at higher risk for poor mental health. The implementation of more restrictive measures seem to be a protective factor for mental health.Funding Information: This article is based upon work from COST Action CA18138 "Research Innovation and Sustainable Pan European Network in Peripartum Depression Disorder" (Riseup-PPD), supported by COST (European Cooperation in Science and Technology; https://www.cost.eu/); also, by the Spanish Ministry of Health, the Institute of Health Carlos III, and the European Regional Development Fund «Una manera de hacer Europa» by the Prevention and Health Promotion Research Network ‘redIAPP’ (RD16/0007). Raquel Costa is supported by the FSE and FCT under an individual Post-Doctoral Grant SFRH/BPD/117597/2016. Rena Bina and Drorit Levy received funding from the Bar-Ilan Dangoor Centre for Personalized Medicine, Israel. Ana Mesquita is supported from the Portuguese Foundation for Science and Technology (FCT) and from EU through the European Social Fund and from the Human Potential Operational Program - IF/00750/2015. Ana Osório received financial support from CAPES/Proex no. 0653/2018 and CAPES/PrInt grant no. 88887.310343/2018-00. Vera Mateus received financial support from CAPES/PrInt grant no. 88887.583508/2020-00. Carmen Cadarso-Suárez and Carla Díaz-Louzao are supported by the Ministry of Economy and Competitiveness (Spain), and by the European Regional Development Fund (ERDF) under the project MTM2017-83513-R, and also under the project ED431C 2020/20, financed by the Competitive Research Unit Consolidation 2020 Programme of the Galician Regional Authority (Xunta de Galicia). CAW is funded by the UK’s National Institute for Health Research (NIHR) as an Academic Clinical Lecturer. Declaration of Interests: All authors declare no conflicts of interest.Ethics Approval Statement: This protocol and the template informed consent forms were reviewed and approved by the followings Ethics Committees: Bedër University College, Albania (Ethics protocol: 145); Sofia University “St. Kliment Ohridski”, Bulgaria (Ethics protocol approved 21th June 2020); Cyprus National Bioethics Committee (Ethics protocol: EEBK ΕΠ 2020.01.126); France (EThics approval: Ref. N°: 20.11.16.46440 / CPP2020–11-100b / 2020- A02289–30); American College of Greece (Ethics protocol: #202005207); Bar Ilan University School of Social Work, Israel (Ethics approval 062001); University of Malta (Ethics protocol: FRECMDS_1920_179); University of Minho, Portugal (Ethics Protocol: CEICVS 045/2020); Andalusian Ministry of Health, Spain (Ethics Protocol: 1257- N-20); Kırklareli University, Turkey (Ethics protocol: 35523585–199-E.8606); King’s College London, the United Kingdom (Ethics protocol: ID 19747); National University of Entre Ríos, Argentina (Ethics Protocol: CD 610/09); Mackenzie Presbyterian University, Brazil (Ethics Protocol: 31155120.7.0000.0084); Universidad de Concepcion, Chile (Ethics Protocol: CEC 13/2020 and CEBB 704–2020). Informed consent were obtained via online from all the participants, and the confidentiality of all the information provided was ensured.

Introduction: There is evidence that women with gestational diabetes are at increased risk of the common mental disorders of anxiety and depression. The COVID-19 pandemic may have exerted an additional burden on the mental health of this population. The aim of this analysis was to compare levels of symptoms of common mental disorders and experiences during the COVID-19 pandemic between pregnant and postnatal women exposed and unexposed to gestational diabetes. Methods: Cross-sectional study utilizing quantitative data from an online survey administered across 10 countries to women who were pregnant or up to 6 months postpartum from 15 June to October 31, 2020. Women self-reported gestational diabetes and completed the Edinburgh Postnatal Depression Scale and GAD-7 (Generalized Anxiety Disorder 7 items) measures. The COPE-IS (Coronavirus Perinatal Experiences-Impact Survey) tool was also administered. Complete case analyses were conducted on a sample of 7,371 women. Results: There was evidence of an association between gestational diabetes and increased levels of depression symptoms, which was robust to adjustment for age, education, and employment status. There was only evidence of an association with anxiety in postnatal women. There was also evidence that women with gestational diabetes, particularly those in the postnatal period, experienced higher levels of pandemic-related distress, although they did not experience higher levels of COVID-19 infection in this sample. Conclusions: The increased risk of common mental disorders in women with gestational diabetes underscores the importance of integrated physical and mental health care for pregnant and postnatal women both during and beyond the pandemic. Clinical Trial Registration no. NCT04595123.

Although research from a positive psychology perspective is conducted among different populations, few studies have examined the predictors of life satisfaction among young backpackers. The current study focused on young adults (ages 21–30), an age group for whom backpacking treks are a growing phenomenon, during their treks in the Far East and South America. Direct and indirect models were used to identify personal factors and environmental resources contributing to life satisfaction. After at least one month abroad, 318 young adults (M = 23.76) answered a self-report quantitative questionnaire. The findings show that personal resources, social support, and community participation were positively associated with life satisfaction, and risk-taking behaviors were negatively associated with life satisfaction. Social support and community participation partially mediated the association between risk-taking behaviors and life satisfaction and between personal resources and life satisfaction. The implications of the findings for the subjective well-being of young backpackers during their transition to adulthood include, among others, the need to help young backpackers maintain their personal and social resources as valuable assets for coping with challenges during their trips. It is also important to increase awareness of the possible wide-ranging negative effects of risk-taking behaviors during backpacking trips.

This study assessed prevalence of perinatal depression symptoms (PNDS) during the COVID-19 pandemic among Arab and Jewish women in Israel and identified COVID-19-related risk factors for PNDS, while comparing Arab and Jewish women. Sample included 730 perinatal women (604 Jewish and 126 Arab) aged 19–45 years, who filled out an online self-report questionnaire. The questionnaire assessed several areas: perinatal experiences and exposure to COVID-19, social support, and financial and emotional impact. PNDS was measured by the Edinburgh Postnatal Depression Scale (EPDS). Prevalence of PNDS (EPDS ≥ 10) in the entire study population was 40.0%. Prevalence among Arab women was significantly higher compared to Jewish women (58% vs. 36%, PV < 0.001). Higher PNDS were significantly associated with anxiety symptoms (GAD ≥ 10) (PV < 0.001), stress related to COVID-19 (PV < 0.001), adverse change in delivery of healthcare services (PV = 0.025), and unemployment (PV = 0.002). PNDS has elevated more than twofold during COVID-19 in Israel. Such high rates of PNDS may potentially negatively impact women, and fetal and child health development. This situation requires special attention from public health services and policy makers to provide support and mitigation strategies for pregnant and postpartum women in times of health crises.

The aim of the current study was to address a gap in the literature by determining prevalence, specific types of violence, and risk factors of intimate partner violence (IPV) among Israeli born Arab women compared with Israeli born Jewish women. The following measures were compared: demographic and socioeconomic measures; measures relating to the characteristics of the violence, that is, the three types of violence (physical, emotional, and verbally threatening), sense of danger, and history of violence in childhood; family support levels; and perpetrator characteristics. The sample consisted of 154 Israeli born Arab women and 149 Israeli born Jewish women who were staying in shelters for victims of domestic violence in Israel. A comparison of the two groups revealed that the Arab women were exposed to more physical violence and received less family support than did their Jewish counterparts. The proportion of Arab perpetrators with access to weapons was higher than that of Jewish perpetrators, whereas the proportion of police complaints against Jewish perpetrators was higher than that against Arab perpetrators. Arab women were also younger, less educated, and less a part of the workforce than Jewish women. The contribution of the woman's age to the variance in levels of physical violence was negative and significant. In contrast, the contribution of her sense of danger, and various perpetrator characteristics, was positive. Moreover, the interaction between sense of danger × ethnicity contributed significantly to levels of violence. This study extends the existing knowledge about the contribution of ethnicity as one of many variables that play a role in the lives of women who are victims of domestic violence and highlights the need to develop, in particular, unique individual, community, and social interventions for Arab women in Israeli society.

BackgroundCorona Virus Disease 19 (COVID-19) is a new pandemic, declared a public health emergency by the World Health Organization, which could have negative consequences for pregnant and postpartum women. The scarce evidence published to date suggests that perinatal mental health has deteriorated since the COVID-19 outbreak. However, the few studies published so far have some limitations, such as a cross-sectional design and the omission of important factors for the understanding of perinatal mental health, including governmental restriction measures and healthcare practices implemented at the maternity hospitals. Within the Riseup-PPD COST Action, a study is underway to assess the impact of COVID-19 in perinatal mental health. The primary objectives are to (1) evaluate changes in perinatal mental health outcomes; and (2) determine the risk and protective factors for perinatal mental health during the COVID-19 pandemic. Additionally, we will compare the results between the countries participating in the study.MethodsThis is an international prospective cohort study, with a baseline and three follow-up assessments over a six-month period. It is being carried out in 11 European countries (Albania, Bulgaria, Cyprus, France, Greece, Israel, Malta, Portugal, Spain, Turkey, and the United Kingdom), Argentina, Brazil and Chile. The sample consists of adult pregnant and postpartum women (with infants up to 6months of age). The assessment includes measures on COVID-19 epidemiology and public health measures (Oxford COVID-19 Government Response Tracker dataset), Coronavirus Perinatal Experiences (COPE questionnaires), psychological distress (BSI-18), depression (EPDS), anxiety (GAD-7) and post-traumatic stress symptoms (PTSD checklist for DSM-V).DiscussionThis study will provide important information for understanding the impact of the COVID-19 pandemic on perinatal mental health and well-being, including the identification of potential risk and protective factors by implementing predictive models using machine learning techniques. The findings will help policymakers develop suitable guidelines and prevention strategies for perinatal mental health and contribute to designing tailored mental health interventions.Trial registrationClinicalTrials.gov Identifier: NCT04595123.

This study examined the existence of secondary traumatic stress (STS) and/or vicarious posttraumatic growth (VPTG) among volunteers who work at the Therapeutic Riding & Canine Institute (TRCI) in Israel. Additionally, the study examined the personal and environmental factors that contribute to these phenomena. The study was conducted among 115 adult TRCI volunteers. The findings indicated that 10.6% reported moderate to high STS, and 2.6% reported severe STS. The level of VPTG was moderate. In addition, mastery and self-esteem correlated negatively only with STS, and the interaction between self-esteem and attitudes towards animals contributed to the explained variance of STS. By contrast, the environmental factors of social support and organizational commitment correlated significantly only with VPTG. The findings highlight the importance of raising awareness of STS and VPTG and their implications for volunteers.

This study examined whether there were differences in levels of depression between Arab and Jewish Israeli female victims of intimate partner violence (IPV) and how various personal and environmental variables contributed to depression. A total of 303 women were selected. T tests were conducted, and no significant differences were revealed. Hierarchical regressions were also conducted. Background variables (violence in childhood and employment status) and psychiatric treatment contributed significantly to the variance in depression, and a negative contribution was made by personal and environmental variables (sense of mastery and social support). The interaction between ethnic origin and psychiatric treatment was also found to be significant. The discussion highlights the theoretical contribution and implications for practice in the field.

To examine the contribution of background variables, threat variables, and personal and community resources to participants' perceived social distance toward unauthorized migrants. Study participants were 168 Israeli citizens/longtime residents of three disadvantaged neighborhoods in Israel, who filled out self-report questionnaires. We applied a hierarchical regression model and also examined the direct and indirect contribution of the abovementioned variables to the social distance of these longtime residents toward unauthorized migrants in Israel. All participants reported high levels of social distance, irrespective of their physical proximity to the migrants. Cultural disparity was perceived as a major threat. Residents who lived in close proximity to migrants particularly expressed concern about harm to their economic well-being. Although political preference had no statistically significant direct effect on social distance, the mediation analysis revealed a complete indirect mechanism of the effect of political preference on social distance through threat perceptions. The research broadened our understanding of longtime neighborhood residents' perceived social distance toward migrants.It migrants. It also contributes to the development of knowledge, which will form the basis for intervention programs in the community

A positive sense of agency is crucial for a successful transition to adulthood. Young women at risk may struggle with a compromised sense of agency due to their backgrounds and daily challenges, potentially delaying them at the stage of emerging adulthood when they are required to become independent. The current paper looks at the development of agency through the experiences of young women at risk who successfully graduated from a National Civic Service (NCS) volunteering program. Thirty alumni of the program were interviewed about their experiences in the program. Participants described the NCS as providing them with a transformative experience, during which they gained a new sense of agency. Three themes emerged, which represent two complementary needs to become normative, and to stand out as unique: Gaining a sense of normalcy and belonging, feeling worthy through others' eyes, and gaining an internalized sense of competency. Implications of these findings for theory and practice are discussed.

This article aims to examine the contribution of personal and environmental resources to the sense of belonging to the community among postforced eviction communities. The study included 140 participants who experienced forced eviction, and ranged in age from 20 to 79 years. Slightly more than half were women (52.4%, 74). Nearly half of the participants continued living alongside their fellow community members, while others left for different communities. The participants filled out self-report questionnaires assessing their sense of belonging, social and family support, sense of mastery, and self-esteem. We used 2 complementary instruments: the stepwise regression and the mediation model. Results indicated that the level of social and family support was found to be higher in the unified communities. Lower levels of the sense of belonging were found in the split communities. The sense of mastery was found to positively contribute to the sense of belonging. The self-esteem resource was not found to contribute to the sense of belonging, whereas social and family support was found to positively contribute to the sense of belonging. The mediation model presented an interesting finding insofar that an indirect positive association was found regarding the sense of belonging via social support within different types of communities. The discussion refers to the findings and their contribution to both theory and practice.

This study focuses on a program designed to engage at-risk youth in the National Civic Service (NCS) in Israel with the goal of enabling them to better integrate into normative adult lives. This exploratory study employed a cross-sectional design and compared groups of at-risk female volunteers (N = 426) with comparison groups of not at-risk participants in the NCS (N = 456). For both of them, three sub-groups were examined at different stages of their service: the beginning, near the end, and about one year after finishing the service. In both the at-risk and comparison groups, self-esteem was higher among the alumni compared to those at earlier stages of the program. Life satisfaction was generally much lower among the at-risk group, but after service completion, both groups reported higher life satisfaction. There were no significant differences between the groups in their future perceptions. The implications of these findings for policy and practice are discussed.

This article describes the perspectives of alumni of National Civic Service (NCS) in Israel on its impact at the individual level. We compared 250 young women who were identified as youth at risk with 295 mainstream volunteers. Overall, the two groups show similar outcomes that are typical to this developmental stage of life. Yet youth at risk experience more difficulties. While NCS aims at increasing equality between groups, it seems that it is not enough to bridge the gaps between the groups. The findings imply a need for a continued intervention to accompany the at-risk alumni that would leverage the progress made during the NCS period.

In the present study, ecological theory was used as a basis for predicting depression among women who survive intimate partner violence (IPV). The predictors examined in the study derived from three ecological systems: the microsystem (background variables and frequency of the violence), the ontogenic system (personal resources), and the mesosystem (support resources). One hundred twenty-five women who immigrated from the Former Soviet Union and 149 Israeli-born Jewish women filled in questionnaires when they entered shelters for victims of IPV. The research findings indicate that background variables, including immigration, did not contribute significantly to the women’s depression. Frequency of violence contributed slightly to depression, whereas the women’s sense of mastery and social support contributed most significantly. The results highlight the need to strengthen these resources when women are in shelters, and to conduct further research to determine whether these results also hold true for women who receive services for prevention of violence in the community.