651624 JIVXXX10.1177/0886260516651624Journal of Interpersonal ViolenceRefaeli et al. research-article2016 Article Personal and Environmental Predictors of Depression Among Victims of Intimate Partner Violence: Comparison of Immigrant and Israeli-Born Women Journal of Interpersonal Violence 2019, Vol. 34(7) 1487–1511 © The Author(s) 2016 Article reuse guidelines: sagepub.com/journals-permissions https://doi.org/10.1177/0886260516651624 DOI: 10.1177/0886260516651624 journals.sagepub.com/home/jiv Tehila Refaeli, PhD,1 Drorit Levy, PhD,1 Anat Ben-Porat, PhD,1 Rachel Dekel, PhD,1 and Haya Itzhaky, PhD1 Abstract 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 1Bar-Ilan University, Ramat-Gan, Israel Corresponding Author: Tehila Refaeli, Bar-Ilan University, Ramat-Gan 52900, Israel. Email: tehilarefaeli@gmail.com 1488 Journal of Interpersonal Violence 34(7) true for women who receive services for prevention of violence in the community. Keywords intimate partner violence, depression, immigration, shelters, sense of mastery, social support, ecological model and cultural contexts Introduction Violence against women by their intimate partners is a widespread, universal phenomenon in modern as well as traditional societies. There has been growing recognition of intimate partner violence (IPV) as a social problem throughout the world, and research has been conducted in an attempt to identify the consequences of violence for the victims. To date, studies have focused on mental health consequences of IPV in general and depression in particular (Golding, 1999). In addition, attempts have been made to identify the factors that make some women who experienced IPV vulnerable to depression, and the findings of these studies indicate that immigration can be identified as a risk factor for depression (Stockman, Hayashi, & Campbell, 2015; Wong, Tiwari, Fong, Humphreys, & Bullock, 2011). The present study was based on the ecological theory, which has been adopted in previous research on IPV (Dutton, 1985; Heise, 1998). According to this perspective, IPV occurs within various diverse environments, where the individual simultaneously affects those environments and is influenced by them (Dutton, 1985; Heise, 1998). However, the ecological theory has not yet been used to explore the association of experiencing IPV and immigration with depression. The present study examined whether immigrant women from the Former Soviet Union (FSU) who experience IPV have specific characteristics that distinguish them from Israeli-born Jewish women with regard to depression and predictors of depression. We focused on three ecological systems that can provide a basis for predicting depression among women in the context of immigration: The microsystem includes characteristics of the environment in which violence occurs — the frequency of violence, and the women’s immigration status. The ontogenic system refers to personal resources, which were represented by the women’s sense of mastery. The mesosystem, which refers to the women’s external environment, was represented by the women’s social support and their use of services. Previous studies have examined the contributions of each of these systems to depression. However, they examined each system separately among groups of IPV victims from different cultures, and mainly among those who receive community services. The unique contribution of the present study lies in the combination of factors Refaeli et al. 1489 from different ecological systems, and the integration of these factors into one model to provide a comprehensive picture of the predictors of depression among IPV victims. In addition, the present study focused on women in shelters, who are the most vulnerable group of IPV victims (Alsaker, Kristoffersen, Moen, & Baste, 2011). Depression Among Women Who Are Victims of Violence Depression is mainly expressed in loss of mood reactivity, or lack of interest and pleasure in life (American Psychiatric Association, 1994). Many studies have found a high frequency of depression among women who are victims of violence (Bargai, Ben-Shakhar, & Shalev, 2007; Martinez-Torteya, Bogat, von Eye, Levendosky, & Davidson, 2009; Rodriguez et al., 2008). Bargai and colleagues (2007) found that of 101 women who stayed in shelters for victims of IPV in Israel, 40% had major depression. Predictors of Depression Among Women Who Are Victims of Violence The microsystem Type and frequency of violence. Previous studies have distinguished between physical violence, that is, bodily harm, and emotional abuse, that is, aspects such as isolating the women, preventing access to resources, and verbal threats (Eisikovits, Winstok, & Fishman, 2004; Golding, 1999; Matud, 2005). It was assumed that when the frequency and severity of violence were greater, women would report higher levels of depression. In addition, a metaanalysis conducted by Golding (1999) presented 18 studies which found that the severity and duration of violence was related to depression. In addition, relationships have been found between the severity of violence and emotional distress (Chandra, Satyanarayana, & Carey, 2009; Matud, 2005). This might be attributed to the increased likelihood that women who experience physical and sexual abuse will also experience emotional abuse (Sullivan, McPartland, Armeli, Jaquier, & Tennen, 2012). Therefore, these women might experience cumulative damage resulting from exposure to different types of violence. However, the differences in the results regarding the frequency of various types of violence and depression among different ethnic groups have not yet been examined. Immigration and violence. Immigration is defined as a situation of multiple stressors (Ding et al., 2011; Foster, 2001). Individuals and families experience multiple stressors relating to immigration, including language barriers, 1490 Journal of Interpersonal Violence 34(7) problems with employment and integration into the indigenous society, and emotional distress derived from the separation from familiar people and places (Borges et al., 2009; Remennick, 2005; Taler, 1998). These cumulative stressors increase the risk of frequent IPV (Hadas, Markovitzky, & Sarid, 2008). Raj and Silverman (2002) argued that the proportion of immigrant women who are victims of IPV is higher than their proportion in the total population. Contrary to this argument, in a literature review on immigration and IPV throughout the world, Menjivar and Salcido (2002) argued that in developed countries, immigrant women do not experience more violence than indigenous women. However, the literature has revealed that certain characteristics of IPV are more prevalent among immigrant women than among all women who experience violence. Research findings have revealed that immigrant women frequently experience social isolation (Menjivar & Salcido, 2002), because they have broken off their social and family relationships, and because the violent men prevent them from establishing new relationships (Abraham, 2000). The theoretical discussion above points to possible differences between immigrants and nonimmigrants in the prevalence and characteristics of IPV. However, only a few studies have compared these two populations. This gap in the literature is addressed in the current study. In Israel, the largest group of immigrants is from the FSU (Lissitsa & Peres, 2000), and these immigrants constitute about 16% of the general population (Almagor-Lotan, 2009; Israel Central Bureau of Statistics, 2011). Various testimonies have revealed that immigrant women from the FSU in Israel are at high risk of experiencing IPV (Grynbaum, Biderman, Levy, & Petasne-Weinstock, 2001). For example, data from the Israel Police Force and the welfare services indicate that 18% of the women staying in shelters in 2009 were born in the FSU. Data also indicate that immigrants from the FSU constitute 55% of the immigrants under the care of violence prevention centers, and 22% of the complaints relating to IPV were lodged to the police by immigrant women from the FSU (Almagor-Lotan, 2009; Mizrahi, 2012). One explanation for this phenomenon is that the Russian Commonwealth countries are characterized by a patriarchal culture, in which women are expected to submit to their husbands and deny family problems (Kagan & Shafer, 2001). In patriarchal societies, violence is a result of the men’s need to control their wives by any means necessary, and to display their control even when the women have submitted to them (M. P. Johnson, 1995). However, the implications of these patriarchal traditions among immigrants who arrived in Israel from the FSU for the characteristics and consequences of IPV have not been explored to date. In addition to the possible implications of immigration at the level of interpersonal relationships (the microsystem), several studies around the Refaeli et al. 1491 world have examined immigration as a risk factor for emotional distress, and have revealed differences between immigrants and veterans with regard to emotional distress. The immigrants experienced higher emotional distress than did members of the indigenous population who had similar characteristics (Frankenberg, Kupper, Wagner, & Bongard, 2013; Lee, Park, Hwang, Im, & Ahn, 2014). Moreover, a relationship has been found between IPV and depression among immigrant women (Kagan & Shafer, 2001; Newcomb & Carmona, 2004; Wong et al., 2011). Therefore, the present study also examined the role of immigration as a variable that moderates the contribution of the rest of the research variables described below to the women’s emotional distress. The ontogenic system: Sense of mastery. Sense of mastery refers to the perceived control of individuals over their future, their appreciation of cause– effect relationships, and their perceived ability to cope with life stressors (Hobfoll & Walfisch, 1984; Pearlin & Schooler, 1978). Mastery has sometimes been referred to as agency in the literature (Lehavot, Walters, & Simoni, 2009). IPV is perceived as a situation in which women experience recurring lack of mastery, and often have difficulty assessing the triggers for IPV (Walker, 2009). As a result, they develop learned helplessness, which inhibits their desire to leave the violent relationship (Walker, 2009). The relationship between immigration and impaired sense of mastery is based on the perspective of immigration as a stress situation that can undermine a person’s confidence in everything that is familiar. However, as far as we know, no studies have compared the sense of mastery among immigrants versus indigenous residents. A study conducted among 600 immigrants from the FSU five years after their arrival in Israel revealed that a low sense of mastery is one predictor of emotional distress among immigrants in general, and that the predictive power of emotional distress is especially high among immigrant women (C. Lerner, Kertes, & Zilber, 2005). The lower sense of mastery as a consequence of experiencing IPV might be an important predictor of higher depression levels. Previous studies conducted among women who have experienced IPV have revealed a low sense of mastery being associated with depression (Bargai et al., 2007; McGuigan & Middlemiss, 2005; Rodriguez et al., 2008). Specifically, Bargai and her colleagues found that the lower the sense of mastery reported by women, the stronger the relationship between the experience of violence and depression. In addition, studies focusing on immigrant populations have revealed a relationship between low mastery and depression (Chou, 2009; C. Lerner et al., 2005; Nicholson, Miller, Schwertz, & Sorokin, 2013). The existing literature has examined the implications of both immigration and IPV for a low sense 1492 Journal of Interpersonal Violence 34(7) of mastery separately, in addition to examining the relationships between a low sense of mastery and high depression. Based on the literature, we examined the role of immigration as a moderator to determine whether the correlation between lower sense of mastery and higher depression is stronger among the immigrant groups who have experienced the multiple stressors of both immigration and IPV. The mesosystem Social support and use of services. Studies have revealed that women who are victims of violence receive little social support, and many of them are socially isolated (El-Bassel, Gilbert, Rajah, Foleno, & Frye, 2001; Rodriguez et al., 2008; Theran, Sullivan, Bogat, & Stewart, 2006). The main reason for this is that as part of the cycle of violence, the violent partners isolate the women and prevent them from contacting their families and friends. The literature indicates that immigrant women who are victims of violence have limited social support, both due to their immigration and due to the characteristics of violence among that population (Han & Resurrecoon, 2008; Raj & Silverman, 2003). It has also been found that the prevalence and severity of IPV are higher among immigrant women with low levels of social support (Liao, 2006). Another potential source of support for immigrant and Israeli-born Jewish women who are victims of IPV may be social services. Findings have revealed that these women use various services, particularly legal services and social services, to deal with the problem of violence (Hutchison & Hirschel, 1998; Zanville & Cattaneo, 2012). However, immigrant women face more barriers which prevent them from using these services, including language barriers (Raj & Silverman, 2002). In Israel, language can be a significant barrier for women from the FSU who are seeking help, because only a few social services have Russian-speaking workers (Almagor-Lotan, 2009). In addition, immigrants from the FSU harbor suspicion of formal government services and institutions, which is related, among other factors, to the negative perspective of the government in their countries of origin (Gorbatov, 2010). This suspicion can prevent them from seeking help even when they are aware that the services exist. Although the theoretical literature has claimed that the barriers preventing immigrant women from receiving different kind of support, no studies have examined differences in levels of both formal and informal support among immigrant versus nonimmigrant women staying in shelters, nor have the potential differences in the implications for women’s psychological distress been addressed. The presented study attempted to fill this gap. Research has revealed a correlation between high levels of social support and low depression among women who are victims of violence in general and Refaeli et al. 1493 among immigrant women in particular (Beeble, Bybee, Sullivan, & Adams, 2009; Coker et al., 2002; McGuigan & Middlemiss, 2005; Wong et al., 2011). The results of these studies indicate that woman who have experienced IPV and have limited support tend to experience higher levels of psychological distress. Because immigrant women experience the double stress of immigration and violence, in the present study, we examined the moderating effect of immigration, whether there are differences in the relationship between support and emotional distress among immigrant women versus Israeli-born Jewish women. However, owing to the lack of research on the relationship between use of social services and depression among women who are victims of violence, we examined this issue in the present study. In light of the above literature review, we examined the contribution of immigration and IPV to depression. In addition, we examined whether there are differences in the predictors of depression among immigrant women from the FSU versus Israeli-born Jewish women. The predictors examined in this study included variables in the microsystem (frequency of violence), the ontogenetic system (sense of mastery), and the mesosystem (social support and use of services). Specifically, the following research goals were formulated: 1. 2. 3. To examine differences in depression and in the above-mentioned personal and environmental variables that predict depression among Israeli-born Jewish women versus women who immigrated to Israel from the FSU. To examine the power of personal and environmental variables to predict depression among women who are victims of IPV. To examine the moderating role of immigration in the association between background variables, personal and environmental variables and depression. Method Participants The sample consisted of 505 women who were referred to 12 shelters for victims of IPV in Israel. A total of 1,409 IPV survivors applied to Israeli shelters between September 2009 and April 2014. After removing women with cognitive impairments or pathological conditions as well as women who left the shelter within 7 days of arrival from the sample, data were collected from 526 women, a response rate of 68.97%. Twenty-one participants were excluded from the research sample because they had responded to less than 40% of the items in the questionnaire. Thus, the final sample included 505 1494 Journal of Interpersonal Violence 34(7) Table 1. Distribution of Background Variables by Country of Birth and t Tests. All Women (n = 274) Age No. of childrena Years of education 35.65 (9.44) 2.50 (1.55) 12.22 (2.51) Israeli-Born (n = 149) Immigrants (n = 125) 37.13 (10.53) 33.75 (7.42) 2.67 (1.41) 2.28 (1.68) 12.39 (2.47) 12.03 (2.56) t 2.89** 1.97 1.14 df 255 244 265 aCalculated for mothers (N = 246). **p < .01. participants. One hundred forty-nine of the participants were Jewish (29.5%), 154 were Arab (30.5%), 125 had immigrated from the FSU (24.8%), and 77 had immigrated from Ethiopia (15.2%). The present article will focus on comparing the Israeli-born Jewish women with women who immigrated to Israel from the FSU (henceforth, the immigrants). Table 1 presents the background characteristics of the research population, and the results of t tests for independent samples. The age range of the women was between 20 and 75 years; more than half of them were aged 35 and below. As shown in Table 1, the Israeli-born Jewish women were significantly older than the immigrant women. About 95% of the women had children. The number of children ranged from one to 14; the mode was one child (29.2%). As can be seen in the table, there were no differences between the two groups of participants with regard to the number of children. Similarly, no difference between the groups was found in years of education, where the average number of years was more than 12 (the minimum required for a high school diploma in Israel). In addition, we used the chi-square test to examine differences in marital status and employment. Among both groups of participants, the largest percentage was married (56.8% of the Israeli-born Jewish women, and 35.8% of the immigrant women). A high percentage of the immigrant women were separated (30.1% compared with 17.8% of the Israeli-born Jewish women). Accordingly, a significant difference was found between the marital status of the Israeli-born participants versus the immigrants: χ2(3) = 12.35, p = .01. No difference was found between the groups with regard to employment during the year preceding their arrival at the shelter: χ2(1) = 0.62, p = n.s. In both groups, about half of the women had not worked during the year prior to their arrival at the shelter. Procedure The research was conducted by social workers at the shelters. A self-report questionnaire in Hebrew and Russian was distributed to the participants, who Refaeli et al. 1495 were asked to complete the questionnaire within three weeks of their arrival at the shelter. All of the women signed informed consent forms stating that refusal to participate would not affect their stay at the shelter. Completed questionnaires were returned in sealed envelopes, and participants were ensured of anonymity. The study was conducted according to the ethical guidelines of the authors’ university and was approved by the ethical committees of the university and the Ministry of Welfare and Social Services. Measures Demographic questionnaire. The questionnaire included data on the women’s background characteristics: year of birth, origin, marital status, number of children, years of education, and employment status. Frequency of violence. The questionnaire was developed by Eisikovits et al. (2004), which measures different types and frequencies of violence: verbal aggression (e.g., insulting), psychological/emotional abuse (e.g., limitation of contact with family and friends), physical assault (e.g., breaking things), and sexual assault (forced intercourse). For each of these items, the women were asked to rank the frequency of abuse in their relationship with their partner on a scale ranging from 1 (one-time) to 4 (daily). Factor analysis yielded two main factors that explained 44.83% of the variance in the data: physical assault and threats (seven items, Cronbach’s α = .82) and emotional abuse (5 items, Cronbach’s α = .69). The overall Cronbach’s alpha reliability of the instrument used in this study was .83. Personal Variables Sense of mastery. The questionnaire was developed by Pearlin and Schooler (1978) and translated into Hebrew by Hobfoll and Walfisch (1984). The questionnaire examines feelings of control over the environment and the future, and includes seven items (e.g., “What happens to me in the future mostly depends on me”). Participants were asked to rate the extent to which they agree with each item, on a 5-point scale ranging from 1 (strongly disagree) to 5 (strongly agree). One score was derived by calculating the mean of the scores on all items: the higher the score, the greater the participant’s sense of mastery. In the present study, Item 2 was mistakenly omitted from the questionnaire. In an early study, Hobfoll, Nadler, and Leiberman (1986) reported a Cronbach’s alpha reliability of .78 for the Hebrew version of the questionnaire. The Cronbach’s alpha reliability of the questionnaire used in the present study was .74. 1496 Journal of Interpersonal Violence 34(7) Environmental Variables Social support. The questionnaire used in the present study was originally developed by Karlsson, Sjöström, and Sullivan (1995), and adapted by Soskolne and Manor (2010). It contained six statements which measure the participants’ perceptions of emotional, financial, and informational support (e.g., “How often is someone available to you during a crisis to offer advice, information or guidance?”). Responses were based on a 5-point Likert-type scale ranging from 1 (never) to 5 (all the time). Soskolne and Manor reported a Cronbach’s alpha reliability of .89, and the reliability of the instrument used in the current study was .85. Use of services. The questionnaire was developed for the present study. Participants were asked to report on the extent to which they used 14 different services listed in the questionnaire. Responses were based on a 4-point scale ranging from 1 (not at all) to 4 (continuously). The general measure was the average frequency of use of different services. The general Cronbach’s alpha reliability of the questionnaire was .84. The Dependent Variable Depression. We used a scale that measures depression based on the Brief Symptom Inventory (BSI), which examines psychiatric disorders (Derogatis, 1992). The questionnaire consisted of a list of six problems. Participants were asked to indicate the extent to which they had experienced each of the problems (e.g., “no hope for the future”) on a 5-point scale ranging from 0 (not at all) to 4 (to a great extent). The Cronbach’s alpha internal reliability of the scale used in a previous study was .80 (Wang et al., 2010). Norms for the general population were constructed for the BSI. The average norm in Israel for the depression subscale was M = 0.70, SD = 0.69 (Gilbar & Ben-Zur, 2002). In a study conducted among immigrants from different countries, the average on the depression scale was .94 (Aroian, Patsdaughter, Levin, & Gianan, 1995). Data Analysis First, t tests and analyses of variance (ANOVAs) were conducted to examine the differences between the Israeli-born and immigrant women. Afterwards, Pearson’s correlations were conducted to verify the relationship between the variables and depression. A four-step hierarchical regression was conducted in accordance with ecological theory to examine the contribution of the variables from the different systems to predicting depression. 1497 Refaeli et al. Table 2. Differences in Depression and Personal and Environmental Resources— Israeli-Born Jewish Women Versus Immigrant Women From the Former Soviet Union. Depression Sense of mastery Social support Use of services All Women M (SD) Israeli-Born M (SD) Immigrants M (SD) t df 2.34 (1.04) 3.23 (0.98) 3.05 (1.05) 1.70 (0.59) 2.47 (0.97) 3.11 (0.99) 3.19 (1.02) 1.76 (0.59) 2.25 (1.11) 3.29 (0.95) 2.89 (1.06) 1.61 (0.59) 1.69 −1.51 2.31* 2.00* 271 266 264 261 *p < .05. Findings To examine whether there were differences between the Israeli-born and immigrant women in levels of depression, a t test for independent samples was conducted (see Table 2). As shown in the table, no significant difference between the groups was found in levels of depression. Following this finding, t tests were conducted to examine differences in levels of depression among the women in the sample versus the level found among the overall population of Israel (M = 0.70; Gilbar & Ben-Zur, 2002). The findings revealed that the level of depression among the women in the sample (M = 2.36, SD = 1.04) was significantly higher than the level among the overall population: t(272) = 26.46, p < .001. This finding remained significant when the average levels of depression among the Israeli-born Jewish women and the immigrant women were compared separately with the overall population: t(148) = 22.13, p < .001, and t(125) = 15.58, p < .001, respectively. In the next stage, to examine differences between the Israeli-born and immigrant women in variables that might predict depression, ANOVAs as well as t tests for independent samples were conducted (see Table 2). The analysis of variance conducted for differences between the two groups in types of IPV revealed a significant but weak difference between the groups in the frequency of violence: F(1, 258) = 3.47, p < .05, η2 = .026. However, post hoc Bonferroni analyses revealed no significant difference between the groups with regard to physical violence and threats: F(1, 258) = 1.58, n.s., nor was a significant difference found with regard to emotional abuse: F(1, 258) = 2.56, n.s. Table 2 presents the results of t tests conducted for independent samples to examine the differences between the groups with regard to the variables: mastery, support, and use of services. 1498 Journal of Interpersonal Violence 34(7) Table 3. Pearson’s Correlations of Background Variables, Characteristics, and Personal and Environmental Resources With Depression. All Women (n = 274) Background and violence variables Age .11 No. of children .06 Years of schooling −.02 Physical violence .16** and threats Emotional abuse .19** Personal and environmental variables Mastery −.45*** Social support −.21*** Use of services .10 Israeli-Born (n = 149) Immigrants (n = 125) .09 .18* −.09 .08 .09 −.07 .03 .27** .04 −.43*** −.32*** .11 z test −2.02** −1.55* .32*** −2.33** −.48*** −.12 .07 0.53 −1.71* *p < .05. **p < .01. ***p < .001. The t tests for independent samples revealed no significant difference between the Israeli-born and immigrant women with regard to sense of mastery. However, the immigrants from the FSU were found to have less support and use services less frequently than the Israeli-born Jewish women. Correlations of Background Variables, Personal and Environmental Variables With Depression To examine the correlations of background variables, characteristics of violence, and personal and environmental variables with depression, we conducted a series of Pearson’s correlations (see Table 3). The Pearson’s correlations revealed that most of the background variables did not correlate significantly with depression, except for a positive correlation between number of children and depression among the Israeliborn Jewish women. The frequency of violence correlated with depression, and the source of this correlation was found mainly among the immigrant women. Moreover, we found negative correlations between mastery and depression among the women in both groups. Negative correlation between social support and depression was found among the Israeli-born Jewish women. There was no significant relationship between use of services and depression. Refaeli et al. 1499 Predictors of Depression Among Women Who Are Victims of Violence To assess the overall contribution of the background variables, violence variables, and personal and environmental variables as well as the contribution of their interactions with the participants’ country of origin, we conducted hierarchical regression analysis. Only country of origin and the variables that correlated with depression were entered into the regression equation. These variables were entered in four steps. In the first step, background variables (country of origin and number of children) were entered. The violence variables (physical violence and threats, and emotional abuse) were entered in the second step. Personal and environmental variables (sense of mastery and social support) were entered in the third step, and the interactions between country of origin and frequency of violence as well as sense of mastery and social support were entered in the fourth step. As shown in Table 4, the research variables explained 29% of the variance in depression. Except for background variables, all of the sets of variables examined in the regression contributed significantly to predicting depression. The variables entered in the second step contributed 4%. In this step, emotional abuse was found to be a predictor; the more the women experienced emotional abuse, the more they reported depression. However, the variables that contributed most significantly were personal and environmental variables (sense of mastery and social support), which explained 20% of the variance in depression: High mastery and high social support were associated with lower levels of depression, and vice versa. In addition, the interaction variables entered in the fourth step explained 3% of the variance, but none of the variables was found to be a significant predictor of depression. Discussion In the present study, we examined differences in levels of depression as well as predictors of depression among immigrant women from the FSU versus Israeli-born Jewish women who are victims of IPV. The findings revealed no differences in levels of depression between the immigrant versus Israeli-born Jewish women. The lack of differences in levels of depression among immigrants versus indigenous populations is inconsistent with the results of a previous study conducted among the overall population (Frankenberg et al., 2013; Lee et al., 2014; Mirsky, 2009). The multiple demands and losses in the process of immigration might explain the previous results. However, the literature indicates that immigrants from the FSU are less inclined to report emotional distress, and they tend to express their distress through somatic 1500 Table 4. Standardized Regression (Beta) Coefficients Measuring the Contribution of the Variables to Explaining Depression. Model 1 B Model 2 β Background variables −.20 −.10 Origina No. of children .03 .05 Violence variables Physical violence Emotional abuse Personal and environmental variables Mastery Social support Interactions Physical Violence × Origin Emotional Abuse × Origin Mastery × Origin Social support × Origin F (2, 246) = 1.63 .01 R2 — ∆R2 a0 = Israeli-born, 1 = immigrants. *p < .05. **p < .01. ***p < .001. Model 3 Model 4 B β B β −.20 .02 −.10 .03 −.18 .00 −.08 .01 −.18 .00 −.09 .00 .11 .14 .12 .14 .08 .09 .15 .11 .10 .07 −.44** −.15** −.41 −.15 .16 .21* (4, 244) = 3.58** .05** .04** (6, 242) = 14.13*** .26*** .20*** B −.43*** −.16** β −.41 −.16 .09 .08 .10 .09 −.06 −.06 .10 .10 (10, 238) = 9.79*** .29* .03* Refaeli et al. 1501 symptoms (V. Lerner, Kanevsky, & Witztum, 2008). This might explain why we did not find differences between the groups when we used the questionnaire that examined psychological distress. We did find that the levels of depression among both groups of women examined in this study were significantly higher than among the overall population. These findings are consistent with the results of previous studies, which have revealed high rates of depression among women who are victims of IPV (Bargai et al., 2007; Rodriguez et al., 2008). In addition, findings have revealed no differences among women by country origin with regard to the prevalence of IPV. These findings highlight the universal nature of IPV against women of different backgrounds and origins (Clements, Sabourin, & Spiby, 2004; Plichta & Falik, 2001). The explanation for the absence of differences between the two groups of participants might derive from the fact that the shelter is the last line in the series of services provided to women who are victims of IPV, and that the women arrive at shelters after they have been exposed to extremely severe or life-threatening physical abuse (Grossman & Lundy, 2011; McFarlane, Maddoux, Nava, & Gilroy, 2014). Both immigrant and Israeli-born Jewish women who arrive at the shelters are from the most disadvantaged populations, as reflected in their background variables (e.g., high rates of unemployment). This assumption is consistent with the findings of a study that compared the characteristics of women who arrive at shelters for victims of IPV with those who receive community services for prevention of IPV (Grossman & Lundy, 2011). The study revealed that the socioeconomic status of the women who arrived at the shelter was lower, and they had lower levels of education than the women in the other group. In this vein, another study revealed that women who arrive at shelters experience more violence and more depression than women who receive services for prevention of violence in the community (McFarlane et al., 2014). Therefore, the finding that immigration status was not a moderating variable indicates that immigration from the FSU was no longer a significant characteristic that distinguished these women from the most disadvantaged social groups who arrive at shelters. The findings indicate that with regard to depression and violence as well as background characteristics, there were more similarities than differences between the two groups of women. However, the immigrant women from the FSU had fewer environmental resources than the Israeli-born Jewish women. In addition to having lower levels of social support, they used social services less than the Israeli-born women. The findings of the present research are consistent with those of other studies, which indicate that informal support from family and friends is less available for immigrant women who are 1502 Journal of Interpersonal Violence 34(7) victims of violence, than it is for women in the indigenous population (Han & Resurrecoon, 2008; Raj & Silverman, 2003). Among other factors, this can be attributed to the role of immigration in diminishing the woman’s network of close relationships. In addition, the findings of our study are consistent with results presented in the literature review, which indicate that immigrant women face obstacles in seeking assistance from various services (Abraham, 2000; Bauer, Rodriguez, Quiroga, & Flores-Ortiz, 2000; McFarlane, Soeken, Reel, Parker, & Silva, 1997). Our findings also highlight the prevailing cultural norm among immigrants from the FSU, which demands that they keep domestic problems within the family and avoid seeking help from external agencies (Crandall, Senturia, Sullivan, & Shiu-Thornton, 2005; Kagan & Shafer, 2001). These findings are noteworthy, because the low levels of support among victims of IPV can lead to dependence on the violent partner and make it difficult to leave him (Anderson & Saunders, 2003; Barnett, 2001). This is especially true of women from the FSU, who often have no family members in Israel other than their partners. Nonetheless, it is important to note that in the present study, the women in both groups received assistance from various community services before going to the shelter. This finding indicates that women who are victims of IPV used different sources of support for a long time before leaving their abusive partners (D. M. Johnson & Zlotnick, 2007; Lewis, 2002). In the second part of the study, we examined the variables that predict depression among women who are victims of IPV. The findings reveal that in keeping with ecological theory, several of the systems in the women’s environment contributed to exacerbating their depression. The first system addressed in the study was the microsystem. In that context, we examined the contribution of IPV to the women’s emotional distress. As mentioned, several studies have found that the severity and frequency of violence are related to depression among victims of IPV (Carbone-López, Kruttschnitt, & Macmillan, 2006; Golding, 1999; Newcomb & Carmona, 2004). However, the findings of the present study revealed that even though physical violence is related to depression, especially among immigrant women, it does not predict the intensity of depression when background variables are taken into account. Nonetheless, the present study’s findings highlight the contribution of emotional abuse to depression, particularly for immigrant women. These findings are important because family violence is often perceived only as physical abuse, whereas research has revealed that emotional abuse is also a significant component, and in many cases the only component of violent relationships (Eisikovits et al., 2004; Sullivan et al., 2012). In the second ecological system, the ontogenic system, we examined the contribution of mastery to the women’s emotional distress. A high sense of Refaeli et al. 1503 mastery plays an important role in enabling these women to break the cycle of violence (Patzel, 2001). This can be explained by our findings as well as by previous findings which indicate that sense of mastery can play a role in preventing the negative mental health consequences of violence (Bargai et al., 2007; McGuigan & Middlemiss, 2005; Rodriguez et al., 2008). Notably, women who believe they have control over their situation tend to experience less depression connected to passive behavior, and therefore might have the ability to leave their abusive husband. In addition, findings have revealed that women who remain in a violent relationship for an extended period have a low sense of mastery (Frisch & MacKenzie, 1991). This might lead to a vicious cycle in which women who are exposed to ongoing violence experience depression besides damage to their sense of mastery, which limits their ability to leave their abusive partners. The finding that low social support predicts high levels of depression is related to the mesosystem. This finding is in line with the results of previous studies conducted among women who are victims of IPV (e.g., Coker et al., 2002; Wong et al., 2011). As such, these findings are of great importance because they show that informal support contributes significantly to psychological distress, whereas formal support has not been found to predict depression. In the present study, we examined concrete and emotional assistance as one variable. However, Wong and colleagues (2013) found that specific intervention with IPV victims improved the depression symptoms among nonimmigrant women but did not have the same effect on the immigrant women. These findings underscore the need to further examine the results from each of the different services separately for immigrant and nonimmigrant women. Limitations Several limitations of the study should be noted. First, it was conducted among residents of a shelter for women who are victims of IPV. Notably, women who arrive at these shelters often experience more severe physical abuse and significantly greater danger to their lives than women who are treated for IPV in community settings (Alsaker et al., 2011). In addition, studies have revealed that the women who seek help are the ones with higher psychological distress (Ford-Gilboe et al., 2015). Moreover, the transition to the shelters and the rules of the shelters might cause loss of support from family and friends and undermine the women’s sense of mastery (Glenn & Goodman, 2015). However, this study did not examine the implications of the transition to the shelter. It is important to take this into account in evaluating the implications of the findings for women who experienced IPV did not go to shelters. Furthermore, when the women’s personal resources and their 1504 Journal of Interpersonal Violence 34(7) use of services are addressed, there is a need to take into account that women in shelters have already sought help from various services before their arrival at the shelter. In addition, the immigrant women in our study succeeded in receiving support from services, and were able to arrive at the shelter while they were overcoming language barriers that they encountered in the Israeli services. It is possible that in this aspect, these women differ substantially from victims of IPV who remain in the community and do not seek help or do not succeed in finding help. In addition, the response rate of participants in the present sample amounted to about 70% of the women. This was mainly due to the fact that many women left the shelter after short periods, and the findings apparently do not reflect their situation. Clinical and Policy Implications Although we did not find differences between the immigrant and Israeli-born Jewish women with regard to the prevalence of depression, the relationship between the severity of different types of violence and levels of depression was more significant among the immigrant women. Besides these findings, the literature indicates that immigrants from the FSU are less inclined to report emotional distress and they tend to express their distress through somatic symptoms (V. Lerner et al., 2008). Therefore, it is important to conduct a comprehensive examination of depression among immigrant women who are victims of violence by identifying somatic aspects that might be indicative of depression (e.g., fatigue, lack of appetite, or excessive appetite). This would provide a basis for offering a solution for the emotional distress of these women. In addition, it is important to examine the factors that might protect women from the consequences of IPV, with emphasis on strengthening these factors through interventions (Sullivan, 2013). In the present study, we examined the contribution of sense of mastery and social support to depression among women. These aspects can and should be reinforced through individual and group interventions while the women are staying at shelters. Research Implications As mentioned, the differences between the immigrant and Israeli-born Jewish women diminished in the setting of the shelter but might have been more significant among victims of IPV who receive services in the community. Therefore, it is important that future studies examine whether there are differences in levels of emotional distress and levels of resources among immigrant women from different countries versus nonimmigrant women who are Refaeli et al. 1505 victims of IPV and receive services in different community settings. This would create a basis for providing appropriate, culturally sensitive services to women in these situations. It should also be noted that due to the cross-sectional design of the study, the results are correlational, and cannot be used as a basis for determining causal relationships. Hence, it would be worthwhile to conduct longitudinal studies to establish causality. In addition, the study examined one ethnic group in Israel and compared it with the Israeli-born Jewish group. It is important to mention that Israel is home to other groups such as Israeli-born Arabs and Ethiopian immigrants, who belong to traditional communities, in contrast to the immigrants from the FSU who are mainly secular. These groups may differ in terms of the resources at their disposal at each of the ecological levels. The initial results from Israel have revealed differences in levels of depression as well as physical victimization among Arab versus Jewish IPV victims (Kattoura, 2013). This discrepancy highlights the need to further explore women from different communities to better assess the risk factors for experiencing violence as well as psychological distress. Acknowledgments The authors thank the women and the shelters’ staff for their collaboration. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The study was supported by the Israel Ministry of Immigrant Absorption. References Abraham, M. (2000). Isolation as a form of marital violence: The South Asian immigrant experience. Journal of Social Distress and the Homeless, 9, 221-236. doi:10.1023/A:1009460002177 Almagor-Lotan, O. (2009). Violence against women: Summary of data for 2009 and dealing with the problem from a comparative perspective. Jerusalem, Israel: Knesset Research and Information Center. (In Hebrew) Alsaker, K., Kristoffersen, K., Moen, B. E., & Baste, V. (2011). Threats and acts of intimate partner violence reported by users at Norwegian women’s shelters. Journal of Interpersonal Violence, 26, 950-970. doi:10.1177/0886260510365864 1506 Journal of Interpersonal Violence 34(7) American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author. Anderson, D. K., & Saunders, D. G. (2003). Leaving an abusive partner: An empirical review of predictors, the process of leaving, and psychological well-being. Trauma, Violence, & Abuse, 4, 163-191. doi:10.1177/1524838002250769 Aroian, K. J., Patsdaughter, C. A., Levin, A., & Gianan, M. E. (1995). Use of the Brief Symptom Inventory to assess psychological distress in three immigrant groups. International Journal of Social Psychiatry, 41, 31-46. doi:10.1177/002076409504100104 Bargai, N., Ben-Shakhar, G., & Shalev, A. Y. (2007). Posttraumatic stress disorder and depression in battered women: The mediating role of learned helplessness. Journal of Family Violence, 22, 267-275. doi:10.1007/s10896-007-9078-y Barnett, O. W. (2001). Why battered women do not leave, part 2: External inhibiting factors—Social support and internal inhibiting factors. Trauma, Violence, & Abuse, 2, 3-35. doi:10.1177/1524838001002001001 Bauer, H. M., Rodriguez, M. A., Quiroga, S. S., & Flores-Ortiz, Y. G. (2000). Barriers to health care for abused Latina and Asian immigrant women. Journal of Health Care for the Poor and Underserved, 11, 33-44. doi:10.1353/hpu.2010.0590 Beeble, M. L., Bybee, D., Sullivan, C. M., & Adams, A. E. (2009). Main, mediating, and moderating effects of social support on the well-being of survivors of intimate partner violence across 2 years. Journal of Consulting and Clinical Psychology, 77, 718-729. doi:10.1037/a0016140 Borges, G., Medina-Mora, M. E., Orozco, R., Fleiz, C., Cherpitel, C., & Breslau, J. (2009). The Mexican migration to the United States and substance use in northern Mexico. Addiction, 104, 603-611. doi:10.1111/j.1360-0443.2008.02491.x Carbone-López, K., Kruttschnitt, C., & Macmillan, R. (2006). Patterns of intimate partner violence and their associations with physical health, psychological distress, and substance use. Public Health Reports, 121, 382-392. Chandra, P. S., Satyanarayana, V. A., & Carey, M. P. (2009). Women reporting intimate partner violence in India: Associations with PTSD and depressive symptoms. Archives of Women’s Mental Health, 12, 203-209. doi:10.1007/ s00737-009-0065-6 Chou, K. L. (2009). Pre-migration planning and depression among new migrants to Hong Kong: The moderating role of social support. Journal of Affective Disorders, 114, 85-93. doi:10.1016/j.jad.2008.06.005 Clements, C. M., Sabourin, C. M., & Spiby, L. (2004). Dysphoria and hopelessness following battering: The role of perceived control, coping, and self-esteem. Journal of Family Violence, 19, 25-36. doi:10.1023/B:JOFV.0000011580.63593.96 Coker, A. L., Davis, K. E., Arias, I., Desai, S., Sanderson, M., Brandt, H. M., & Smith, P. H. (2002). Physical and mental health effects of intimate partner violence for men and women. American Journal of Preventive Medicine, 23, 260268. doi:10.1016/S0749-3797(02)00514-7 Crandall, M., Senturia, K., Sullivan, M., & Shiu-Thornton, S. (2005). “No way out”: Russian-speaking women’s experiences with domestic violence. Journal of Interpersonal Violence, 20, 941-958. doi:10.1177/0886260505277679 Refaeli et al. 1507 Derogatis, L. R. (1992). The Brief Symptom Inventory (BSI) administration, scoring, and procedures manual–II. Baltimore: Clinical Psychometric Research Corporation. Ding, D., Hofstetter, C. R., Norman, G. J., Irvin, V. L., Chhay, D., & Hovell, M. F. (2011). Measuring immigration stress of first-generation female Korean immigrants in California: Psychometric evaluation of Demand of Immigration Scale. Ethnicity & Health, 16, 11-24. doi:10.1080/13557858.2010.523107 Dutton, D. G. (1985). An ecologically nested theory of male violence towards intimates. International Journal of Women’s Studies, 8, 404-413. Eisikovits, Z., Winstok, Z., & Fishman, G. (2004). The first Israeli national survey on domestic violence. Violence Against Women, 10, 729-748. doi:10.1177/1077801204265549 El-Bassel, N., Gilbert, L., Rajah, V., Foleno, A., & Frye, V. (2001). Social support among women in methadone treatment who experience partner violence: Isolation and male controlling behavior. Violence Against Women, 7, 246-274. doi:10.1177/10778010122182433 Ford-Gilboe, M., Varcoe, C., Noh, M., Wuest, J., Hammerton, J., Alhalal, E., & Burnett, C. (2015). Patterns and predictors of service use among women who have separated from an abusive partner. Journal of Family Violence, 30, 419-431. doi:10.1007/s10896-015-9688-8 Foster, R. P. (2001). When immigration is trauma: Guidelines for the individual and family clinician. American Journal of Orthopsychiatry, 71, 153-170. doi: 10.1037/0002-9432.71.2.153 Frankenberg, E., Kupper, K., Wagner, R., & Bongard, S. (2013). Immigrant youth in Germany: Psychological and sociocultural adaptation. European Psychologist, 18, 158-168. doi:10.1027/1016-9040/a000154 Frisch, M. B., & MacKenzie, C. J. (1991). A comparison of formerly and chronically battered women on cognitive and situational dimensions. Psychotherapy: Theory, Research, Practice, Training, 28, 339-344. doi:10.1037/0033-3204.28.2.339 Gilbar, O., & Ben-Zur, H. (2002). Adult Israeli community norms for the Brief Symptom Inventory (BSI). International Journal of Stress Management, 9, 1-10. doi:10.1023/A:1013097816238 Glenn, C., & Goodman, L. (2015). Living with and within the rules of domestic violence shelters: A qualitative exploration of residents’ experiences. Violence Against Women, 21, 1481-1506. doi:10.1177/1077801215596242 Golding, J. M. (1999). Intimate partner violence as a risk factor for mental disorders: A meta-analysis. Journal of Family Violence, 14, 99-132. doi:10.1023/A:1022079418229 Gorbatov, R. (2010). Survey of the pilot program for training social service workers who deal with immigrants from the former Soviet Union. Jerusalem, Israel: Department for Research, Planning & Training, Ministry of Social Services. (In Hebrew) Grossman, S. F., & Lundy, M. (2011). Characteristics of women who do and do not receive onsite shelter services from domestic violence programs. Violence Against Women, 17, 1024-1045. doi:10.1177/1077801211414169 1508 Journal of Interpersonal Violence 34(7) Grynbaum, M., Biderman, A., Levy, A., & Petasne-Weinstock, S. (2001). Domestic violence: Prevalence among women in a primary care center—A pilot study. The Israel Medical Association Journal, 3, 907-910. Retrieved from http://europepmc.org/abstract/med/11794912 Hadas, D., Markovitzky, G., & Sarid, M. (2008). Spousal violence among immigrants from the former Soviet Union—General population and welfare recipients. Journal of Family Violence, 23, 549-555. doi:10.1007/s10896-008-9166-7 Han, C. K., & Resurrecoon, B. P. (2008). Struggling alone: Gender, migration and domestic violence among Thai women in Bangkok. Asian Journal of Women’s Studies, 14(1), 34-71. Heise, L. L. (1998). Violence against women: An integrated, ecological framework. Violence Against Women, 4, 262-290. doi:10.1177/1077801298004003002 Hobfoll, S. E., Nadler, A., & Leiberman, J. (1986). Satisfaction with social support during crisis: Intimacy and self-esteem as critical determinants. Journal of Personality and Social Psychology, 51, 296-304. doi:10.1037/00223514.51.2.296 Hobfoll, S. E., & Walfisch, S. (1984). Coping with a threat to life: A longitudinal study of self-concept, social support, and psychological distress. American Journal of Community Psychology, 12, 87-100. doi:10.1007/BF00896930 Hutchison, I. W., & Hirschel, J. D. (1998). Abused women: Help-seeking strategies and police utilization. Violence Against Women, 4, 436-456. doi:10.1177/ 1077801298004004004 Israel Central Bureau of Statistics. (2011). Israel statistical yearbook 2011. Jerusalem, Israel: Central Bureau of Statistics. (In Hebrew) Johnson, D. M., & Zlotnick, C. (2007). Utilization of mental health treatment and other services by battered women in shelters. Psychiatric Services, 58, 15951597. doi:10.1176/appi.ps.58.12.1595 Johnson, M. P. (1995). Patriarchal terrorism and common couple violence: Two forms of violence against women. Journal of Marriage and the Family, 57, 283-294. doi:10.2307/353683 Kagan, H., & Shafer, K. C. (2001). Russian-speaking substance abusers in transition-New country, old problems. In S. L. A. Straussner (Ed.), Ethnocultural Factors in Substance Abuse Treatment (pp. 250-271). New York: The Guilford Press. Karlsson, J., Sjöström, L., & Sullivan, M. (1995). Swedish Obese Subjects (SOS)— An intervention study of obesity. Measuring psychosocial factors and health by means of short-form questionnaires. Results from a method study. Journal of Clinical Epidemiology, 48, 817-823. doi:10.1016/0895-4356(94)00196-W Kattoura, O. (2013). Battered women residents in shelters: A comparison between battered Arab and Jewish women in self-control, life threatening and depression (Unpublished master’s thesis). Bar-Ilan University, Israel. (In Hebrew) Lee, S. H., Park, Y. C., Hwang, J., Im, J. J., & Ahn, D. (2014). Mental health of intermarried immigrant women and their children in South Korea. Journal of Immigrant and Minority Health, 16, 77-85. doi:10.1007/s10903-012-9747-7 Refaeli et al. 1509 Lehavot, K., Walters, K. L., & Simoni, J. M. (2009). Abuse, mastery, and health among lesbian, bisexual, and two-spirit American Indian and Alaska Native women. Cultural Diversity & Ethnic Minority Psychology, 15, 275-284. doi:10.1037/a0013458 Lerner, C., Kertes, J., & Zilber, N. (2005). Immigrants from the former Soviet Union, five years post-immigration to Israel: Adaptation and risk factors for psychological distress. Psychological Medicine, 35, 1805-1814. doi:10.1017/ S0033291705005726 Lerner, V., Kanevsky, M., & Witztum, E. (2008). The influence of immigration on the mental health of those seeking psychiatric care in southern Israel: A comparison of new immigrants to veteran residents. The Israel Journal of Psychiatry and Related Sciences, 45, 291-298. Retrieved from http://www.ncbi.nlm.nih.gov/ pubmed/19439835 Lewis, S. F. (2002). An investigation of help-seeking behavior in battered women (Unpublished doctoral dissertation). West Virginia University, Morgantown. Liao, M. S. (2006). Domestic violence among Asian Indian immigrant women: Risk factors, acculturation, and intervention. Women & Therapy, 29(1-2), 23-39. doi:10.1300/J015v29n01_02 Lissitsa, S., & Peres, Y. (2000). Immigrants from the former Soviet Union in Israel: Formulating an identity and processes of integration. Israeli Sociology, 3, 7-30. (In Hebrew) Martinez-Torteya, C., Bogat, G. A., von Eye, A., Levendosky, A. A., & Davidson, W. S. (2009). Women’s appraisals of intimate partner violence stressfulness and their relationship to depressive and posttraumatic stress disorder symptoms. Violence and Victims, 24, 707-722. doi:10.1891/0886-6708.24.6.707 Matud, M. P. (2005). The psychological impact of domestic violence on Spanish women. Journal of Applied Social Psychology, 35, 2310-2322. doi:10.1111/ j.1559-1816.2005.tb02104.x McFarlane, J., Maddoux, J., Nava, A., & Gilroy, H. (2014). Abused women with children who are first-time users of a shelter or applicants for a protection order: Entry data of a 7-year prospective analysis. Violence Against Women, 21, 249268. doi:10.1177/1077801214564680 McFarlane, J., Soeken, K., Reel, S., Parker, B., & Silva, C. (1997). Resource use by abused women following an intervention program: Associated severity of abuse and reports of abuse ending. Public Health Nursing, 14, 244-250. doi:10.1111/j.1525-1446.1997.tb00297.x McGuigan, W. M., & Middlemiss, W. (2005). Sexual abuse in childhood and interpersonal violence in adulthood: A cumulative impact on depressive symptoms in women. Journal of Interpersonal Violence, 20, 1271-1287. doi:10.1177/0886260505278107 Menjivar, C., & Salcido, O. (2002). Immigrant women and domestic violence: Common experiences in different countries. Gender & Society, 16, 898-920. doi:10.1177/089124302237894 Mirsky, J. (2009). Mental health implications of migration: A review of mental health community studies on Russian-speaking immigrants in Israel. Social Psychiatry and Psychiatric Epidemiology, 44, 179-187. doi:10.1007/s00127-008-0430-1 1510 Journal of Interpersonal Violence 34(7) Mizrahi, S. (2012). Violence against women: Summary of data for 2012. Jerusalem, Israel: Knesset Research and Information Center. (In Hebrew) Newcomb, M. D., & Carmona, J. V. (2004). Adult trauma and HIV status among Latinas: Effects upon psychological adjustment and substance use. AIDS and Behavior, 8, 417-428. doi:10.1007/s10461-004-7326-1 Nicholson, L. M., Miller, A. M., Schwertz, D., & Sorokin, O. (2013). Gender differences in acculturation, stress, and salivary cortisol response among former Soviet immigrants. Journal of Immigrant and Minority Health, 15, 540-552. doi:10.1007/s10903-012-9752-x Patzel, B. (2001). Women’s use of resources in leaving abusive relationships: A naturalistic inquiry. Issues in Mental Health Nursing, 22, 729-747. doi:10.1080/01612840152712992 Pearlin, L. I., & Schooler, C. (1978). The structure of coping. Journal of Health and Social Behavior, 19, 2-21. Plichta, S. B., & Falik, M. (2001). Prevalence of violence and its implications for women’s health. Women’s Health Issues, 11, 244-258. doi:10.1016/S10493867(01)00085-8 Raj, A., & Silverman, J. (2002). Violence against immigrant women: The roles of culture, context, and legal immigrant status on intimate partner violence. Violence Against Women, 8, 367-398. doi:10.1177/10778010222183107 Raj, A., & Silverman, J. G. (2003). Immigrant South Asian women at greater risk for injury from intimate partner violence. American Journal of Public Health, 93, 435-437. doi:10.2105/AJPH.93.3.435 Remennick, L. (2005). Immigration, gender, and psychosocial adjustment: A study of 150 immigrant couples in Israel. Sex Roles, 53, 847-863. doi:10.1007/s11199005-8297-z Rodriguez, M. A., Heilemann, M. V., Fielder, E., Ang, A., Nevarez, F., & Mangione, C. M. (2008). Intimate partner violence, depression, and PTSD among pregnant Latina women. Annals of Family Medicine, 6, 44-52. doi:10.1370/afm.743 Soskolne, V., & Manor, O. (2010). Health inequalities in Israel: Explanatory factors of socio-economic inequalities in self-rated health and limiting longstanding illness. Health & Place, 16, 242-251. doi:10.1016/j.healthplace.2009.10.005 Stockman, J. K., Hayashi, H., & Campbell, J. C. (2015). Intimate partner violence and its health impact on ethnic minority women. Journal of Women’s Health, 24, 62-79. doi:10.1089/jwh.2014.4879 Sullivan, T. P. (2013). Think outside: Advancing risk and protective factor research beyond the intimate-partner-violence box. Psychology of Violence, 3, 121-125. doi:10.1037/a0032125 Sullivan, T. P., McPartland, T., Armeli, S., Jaquier, V., & Tennen, H. (2012). Is it the exception or the rule? Daily co-occurrence of physical, sexual, and psychological partner violence in a 90-day study of substance-using, community women. Psychology of Violence, 2. doi:10.1037/a0027106 Taler, Y. (1998). Integration into work of unemployed new immigrant women from single parent families. International Journal of Rehabilitation Research, 21, 195209. doi:10.1097/00004356-199806000-00007 Refaeli et al. 1511 Theran, S. A., Sullivan, C. M., Bogat, G. A., & Stewart, C. S. (2006). Abusive partners and ex-partners: Understanding the effects of relationship to the abuser on women’s well-being. Violence Against Women, 12, 950-969. doi:10.1177/ 1077801206292871 Walker, L. E. A. (2009). The battered woman syndrome (3rd ed.). New York, NY: Springer-Verlag. Wang, J., Kelly, B. C., Booth, B. M., Falck, R. S., Leukefeld, C., & Carlson, R. G. (2010). Examining factorial structure and measurement invariance of the Brief Symptom Inventory (BSI)-18 among drug users. Addictive Behaviors, 35, 23-29. doi:10.1016/j.addbeh.2009.08.003 Wong, J. Y. H., Tiwari, A., Fong, D. Y. T., Humphreys, J., & Bullock, L. (2011). Depression among women experiencing intimate partner violence in a Chinese community. Nursing Research, 60, 58-65. doi:10.1097/NNR.0b013e3182002a7c Wong, J. Y. H., Tiwari, A., Fong, D. Y. T., Yuen, K. H., Humphreys, J., & Bullock, L. (2013). Intimate partner violence, depressive symptoms, and immigration status: Does existing advocacy intervention work on abused immigrant women in the Chinese community? Journal of Interpersonal Violence, 28, 2181-2202. doi:10.1177/0886260512475311 Zanville, H. A., & Cattaneo, L. B. (2012). The nature of risk and its relationship to coping among survivors of intimate partner violence. Psychology of Violence, 2, 355-367. doi:10.1037/a0028198 Author Biographies Tehila Refaeli, PhD, is currently a postdoctoral fellow in the school of social work at the Hebrew University, and an adjunct lecturer at the School of Social Work at BarIlan University. In recent years, she has been involved in various research projects that examined violence against women and youth at risk during transition to adulthood. Drorit Levy, PhD, is a lecturer and the coordinator of community and organization development program in the School of Social Work at Bar-Ilan University. In the last decade, she has been involved in various research projects that focus on immigrant women. Anat Ben-Porat, PhD, is a lecturer in the School of Social Work at Bar-Ilan University. In the last decade, she has been involved in various studies that examined different aspects of family violence. Rachel Dekel, PhD, is the director and professor in the School of Social Work at BarIlan University, Ramat-Gan, Israel. In the last decade, she has been involved in various research projects that examined different facets of human coping with traumatic events such as, war, terror, and family violence. Haya Itzhaky, PhD, is the Head of the Graduate Committee Studies and Professor in the School of Social Work at Bar-Ilan University. In the last decades, she has been involved in various research projects that examined different phenomena in functional communities such as family violence, traditional communities, and backpackers.