Technology-Based Mental Interventions for Domestic Violence in COVID-19

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1		Zhaohui Su	--	1928	2022-04-11 12:01:19	\|
2	Adjust the reference format	Lindsay Dong	-34 word(s)	1894	2022-04-12 04:02:14	\|

This entry is adapted from the peer-reviewed paper 10.3390/ijerph19074286

Domestic violence is a threat to human dignity and public health. Mounting evidence shows that domestic violence erodes personal and public health, spawning issues such as lifelong mental health challenges. To further compound the situation, COVID-19 and societies’ poor response to the pandemic have not only worsened the domestic violence crisis but also disrupted mental health services for domestic violence victims. While technology-based health solutions can overcome physical constraints posed by the pandemic and offer timely support to address domestic violence victims’ mental health issues.

domestic violence mental health COVID-19 technology-based interventions

1. Introduction

Domestic violence erodes humanity and global solidarity. Domestic violence or violence against women can be understood as “any act of gender-based violence that results in, or is likely to result in, physical, sexual, or mental harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life” ^[1]. It is important to note that domestic violence can happen to both men and women, especially for people who face pronounced disadvantages, such as racial/ethnic or sexual minorities ^[2]^[3]^[4]. That said, to avoid issues such as overgeneration and in light of the high prevalence of domestic violence among women compared to men ^[3]. Research conducted by the World Health Organization shows that approximately one in every three women aged 15–49 years is or will become a domestic violence victim ^[5]. Situations might be considerably worse in low- and middle-income countries ^[6]. In Colombia, for instance, analyzing data from 2001 to 2009, researchers found that, on average, 54,440 women per year, 149 per day, 6 per hour, or 1 woman every 10 min suffer from sexual violence ^[7]. These dire statistics could result in grim public health consequences. Mounting evidence shows that domestic violence could exert severe and oftentimes lifelong damage to personal and public health, ranging from anxiety, depression, insomnia, and post-traumatic stress disorders (PTSD) to suicide ^[8]^[9]^[10]^[11].

COVID-19, along with its resultant crises, has further compounded the situation. A research on 751 women in Tunisia, for instance, shows that reported violence against women rose from 4.4% to 14.8% amid an early COVID-19 lockdown ^[12]. Worrisome trends have also been confirmed in countries such as the United States (U.S.); data from 36 police and 66 sheriff’s departments across the country show that amid the pandemic, domestic violence cases are on the rise as people retreat to shelters ^[13]. Analyzing 4618 police reports from the Chicago Police Department, researchers further found that during pandemic lockdowns, domestic violence cases were 64% more likely to happen at residential locations compared to other places ^[14]. To make situations even more complex, unintended consequences of the COVID-19 pandemic have also been seen in the disruption of healthcare services for domestic violence victims. Ranging from the need for COVID-19 testing and tracing, infections, hospitalizations, and treatments to deaths, the pandemic has forced many nations to allocate most, if not all, resources to address medical emergencies associated with COVID-19, effectively leaving many non-COVID-19-related medical needs, such as mental health services for domestic violence victims, in limbo ^[15]. By interviewing health departments across the U.S., researchers further found that at least 220 departments had either temporarily or permanently cancelled their non-COVID-related public health services, directly causing a spike in reports of abuses ^[16].

One way to lessen the impact of COVID-19 and its subsequent medical resource crises on vulnerable populations, such as domestic violence victims, is via finding of alternative health solutions, such as technology-based interventions, that can be accessed virtually without relying on strained healthcare resources. Technology-based interventions can be understood as “the use of technology to design, develop, and/or deliver health promotion contents and strategies that aim to induce or improve positive physical or psychological health outcomes” in victims ^[17]. Previous evidence shows that compared to other low-scale or low-intensity in-person solutions (e.g., single counseling sessions with a physician), technology-based mental health interventions perform similarly or even better in improving domestic violence victims’ health outcomes ^[18]^[19]^[20]^[21]^[22]. However, although useful insights are available, little is known about the state-of-the-art development of technology-based mental health interventions for domestic violence victims amid the pandemic.

2. Technology-Based Mental Interventions for Domestic Violence in COVID-19

2.1. Benefits of Technology-Based Interventions

COVID-19 and the ensuing avalanche of crises, ranging from healthcare delivery issues to medical resource shortages, have further exacerbated the challenges faced by domestic violence victims ^[23]. However, not all hope is lost; compared to in-person solutions, technology-based interventions can be delivered remotely and virtually, effectively bypassing some of the most debilitating barriers introduced by COVID-19 ^[17]^[24]. Although COVID-19 has worsened the scale and severity of domestic violence ^[13]^[25]^[26]^[27], as seen across the pandemic continuum, due to limitations such as physical distancing mandates and lockdown measures, many in-person interventions that were available to domestic violence victims may have been adversely interrupted (e.g., service suspension) ^[28]^[29]^[30]. This, along with the fact that technology-based interventions could offer some victims much-needed anonymity and convenience ^[23], makes technology-based mental health interventions of particular importance amid the pandemic.

Traditionally, domestic violence victims can only report their abuse in person or via hotlines, whereas with the help of technology-based interventions, women can capitalize on a wide range of digital tools and online platforms to seek help. Evidence shows that compared to in-person sessions, teleconferences are preferred by domestic violence victims, largely because they “provided a level of control and distance” ^[31]. This, in turn, can give victims greater freedom in choosing the mental health solutions that are in line with their needs and preferences. Perhaps most importantly, these technology-based interventions give some people access to mental health support who otherwise would not have the opportunity. For instance, many international health and non-profit organizations offer domestic violence victims up-to-date mental health solutions in multiple languages to help such vulnerable communities better cope with pandemic-related stress and beyond (e.g., ^[32]). This means that when needed, victims have a wide range of access to intervention materials to select from at their own discretion. When high-speed Internet is easily accessible, victims can also utilize tools including smartphone applications (apps), such as I-DECIDE, along with other apps (e.g., WhatsApp or WeChat) and health technologies (e.g., TikTok) to further care for their mental health. However, it is important to note that although seeking information and help via technology-based interventions holds great promise, Herculean tasks are also present for health officials and technologists to ensure that optimal benefits can be delivered via these health solutions. There is also reasonable doubt in terms of whether technology-based solutions can replace more intensive and interactive in-person solutions. This concern is particularly salient in light of the possibility that some people may suffer from mental issues that prevent them from using technology-based solutions, owing to reasons such as paranoiac tendencies and/or fear of technology (e.g., cyber paranoia) ^[33]^[34]^[35].

2.2. Risks Associated with Technology-Based Interventions

It is important to highlight that one of the key findings is that most interventions place the help-seeking responsibility on the victims (i.e., individual level) rather than the larger community (i.e., community level) or societal changes (i.e., social level). In other words, even though domestic violence victims may face a number of challenges above and beyond their mental health issues, they are often expected to initiate the help-seeking actions, have the knowhow to safely navigate the ever-changing technological environment, and possess the capabilities to protect themselves from potential intended and unintended harms that might occur during the process. Essentially, these expectations put the responsibilities of technologists, health officials, and government personnel squarely and simultaneously on the shoulder of the victims, potentially further worsening domestic violence victims’ mental health status, as many technological issues (e.g., cybercrimes) could be extremely difficult to tackle ^[36]^[37]^[38]. Furthermore, as technology advances, ranging from artificial intelligence to sixth-generation technologies (e.g., ^[39]), it might become increasingly difficult for domestic violence victims with poor eHealth literacy to fully understand and appreciate the content and consequences of technology-based interventions ^[40]^[41].

It is important to note that although the cybersphere could be an inclusive and interactive environment for mental health intervention development and distribution, it is often haunted by issues ranging from high dependence on basic infrastructure (e.g., broadband access) and cybercrimes (e.g., cyberbullying and cyberstalking) to social media addiction ^[42]^[43]^[44]^[45]^[46]. Studies found that privacy and security issues inherent to technological devices and platforms could influence victims’ appreciation and utilization of technology-based mental health interventions ^[45], not to mention that in cybersphere, damage related to privacy and data-handling breaches could be extremely difficult to estimate and/or contain.

Digital addiction, such as social media addiction, could also pose harm to individuals’ mental and physical health, especially vulnerable people, including young adults ^[47]. Similar to the issue of too much usage, there is also the problem of not having enough access. Partially influenced by poor availability of systematic support, high-speed Internet, and technological devices, research shows that there is a pronounced lack of representation of marginalized and underserved populations (e.g., racial minorities) in mental health technology services ^[48]. Although digital health solutions are becoming ever-increasingly available, policies that could safeguard their quality to protect the public’s rights and safety are either lax or lagging ^[49]. Furthermore, legislative hurdles may also hinder victims’ access to quality mental health services via technology-based means. As of October 2021, only twenty-three states in the U.S. have effectively signed on to the Psychology Interjurisdictional Compact (PSYPACT), an agreement that allows cross-state telepsychology services among licensed psychologists ^[50]—although promising, a far cry from the possibility of having a digital “Doctors Without Borders” system for domestic violence victims ^[23].

Greater governmental support and oversight is needed to ensure the healthy development of technology-based interventions for domestic violence victims. Considering that domestic violence victims often live with their abusers ^[51], advanced technological solutions, such as AI-enabled facial recognition, can be integrated into various interventions to ensure the content can only be accessed by the victims. Researchers could also use AI technologies, such as natural language processing, to analyze electronic health records to potentially identify victims’ susceptibility to mental health issues before such issues become chronic or permanent ^[52]^[53]. Furthermore, by studying large corpora of texts, such as Facebook/Weibo posts, natural language processing technologies could also help government and health officials identify trends, patterns, and incidents of violence and/or mental health emergencies in a timely manner ^[54]^[55]. Overall, in light of the capricious nature of COVID-19, it is imperative for government and health officials to apply useful lessons derived from researchs, such as taking a proactive and practical yet panoramic approach to developing and deploying technology-based mental health solutions to domestic violence victims, weighing both the pros and cons of such interventions prior to distribution so that optimal intended outcomes can be achieved without causing unintended harms.

Domestic violence violates the fundamentals of humanity: safety, security, agency, and, perhaps most importantly, dignity. COVID-19, along with its resultant crises, has worsened the scale, scope, and severity of domestic violence worldwide. To address the delivery and accessibility challenges caused by the pandemic and the subsequent mandates, technology-based interventions, which could overcome the abovementioned obstacles, are gaining in popularity. There needs a pronounced need for greater research endeavors to solve the issues identified. Although technology-based interventions have substantial potential to resolve domestic violence victims’ mental health issues, risks associated with such health solutions should be comprehensively acknowledged and thoroughly addressed. For instance, future research could investigate how policy-level support (e.g., increased research funding) can further enrich society’s in-depth understanding, timely development, and victim-centered delivery of technology-based mental health interventions for domestic violence victims.

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