Journal of Nursing Education

Major Article 

Influence of Intimate Partner Violence and Depression on Undergraduate Nursing Students: A Literature Review

Andrea K. Garner, PhD, DNP, RN; Daniel J. Sheridan, PhD, RN, FAAN

Abstract

Background:

Intimate partner violence (IPV) and dating violence is a significant problem among college-age students. IPV has an associative outcome of depression and lower academic performance, but it is unknown how it relates to undergraduate nursing students.

Method:

Two literature searches were performed for IPV and depression from a combination of 87 databases including EBSCO, Proquest, Nursing at OVID, Medline, PubMed, CINAHL, PsycARTICLES, JSTOR, SAGE journals, and Google Scholar.

Results:

Initial results yielded 24,675 research studies on IPV, dating violence, and depression. Forty-eight level-three studies were identified using the John Hopkins School of Nursing evidence-based practice model, including 42 nonexperimental studies, three meta-syntheses, and three governmental studies.

Conclusion:

Relevant data on the prevalence rates of IPV and depression among nursing students are lacking. IPV and dating violence among college students places them at a higher risk for failure and poor academic performance. [J Nurs Educ. 2017;56(7):397–403.]

Abstract

Background:

Intimate partner violence (IPV) and dating violence is a significant problem among college-age students. IPV has an associative outcome of depression and lower academic performance, but it is unknown how it relates to undergraduate nursing students.

Method:

Two literature searches were performed for IPV and depression from a combination of 87 databases including EBSCO, Proquest, Nursing at OVID, Medline, PubMed, CINAHL, PsycARTICLES, JSTOR, SAGE journals, and Google Scholar.

Results:

Initial results yielded 24,675 research studies on IPV, dating violence, and depression. Forty-eight level-three studies were identified using the John Hopkins School of Nursing evidence-based practice model, including 42 nonexperimental studies, three meta-syntheses, and three governmental studies.

Conclusion:

Relevant data on the prevalence rates of IPV and depression among nursing students are lacking. IPV and dating violence among college students places them at a higher risk for failure and poor academic performance. [J Nurs Educ. 2017;56(7):397–403.]

Intimate partner violence (IPV) has long been recognized internationally and in the United States as a serious, preventable public health issue. The Centers for Disease Control and Prevention (CDC, 2016, para. 1) describes IPV to include “physical violence, sexual violence, stalking and psychological aggression (including coercive acts) by a current or former intimate partner.” Recent reports through the media about IPV on college campuses have highlighted the dangers of dating violence. An accretion of research over the past 2 decades has provided evidence of the prevalence of IPV among adolescent and college-age students (Karakurt, Keiley, & Posada, 2013; Kaukinen, 2014). IPV is most often called dating violence or relational aggression when it occurs in the teenage or adolescent population (CDC, 2015). Relational aggression is a set of behaviors used by the perpetrator to harm the victim through affecting relationships, sense of belonging, social status, or reputation (Dahlen, Czar, Prather, & Dyess, 2013). College student ages predominately range between the late teenage years through young adulthood. Dating violence and abuse occur in more than half (57%) of college students (Knowledge Networks, 2011), and 43% of dating college women report physical, sexual, and psychological abuse (Shorey, Stuart, & Cornelius, 2011). Three in 10 women in the United States disclosed suffering from IPV, which negatively impacted their level of daily functioning (Black et al., 2011).

The undergraduate nursing student population is mainly composed of college-aged students and is at risk for IPV or dating violence. Risk factors during nursing school include stress, tension within personal relationships, financial insecurity related to work limitations, and lowered self-esteem from rigorous academic requirements (Capaldi, Knoble, Shortt, & Kim, 2012). Translating IPV and dating violence data to the nursing population means one in three nursing students may be a victim of IPV. It is unknown whether nursing students have the same prevalence rates of IPV as other college students in the United States. IPV and dating violence may have a direct effect on a nursing students' ability to be successful in school. It may also affect their interactions, referrals, and nursing care of patients in the health care setting.

Depression is an associative outcome of IPV and dating violence (Beydoun, Beydoun, Kaufman, Lo, & Zonderman, 2012; Devries et al., 2013; Dillon, Hussain, Loxton, & Rahman, 2013; Teitelman, Ratcliffe, McDonald, Brawner, & Sullivan, 2011). Concerns about increasing violence on college campuses have led to questions regarding the mental health of college students. Stressors related to changes in life events (e.g., moving away from home, adjustment to college, personal divorce) have been strongly correlated with major depression (Dobson & Dozois, 2008). Depression among college students in general is high and reportedly affects from 27% to 33% of the population (American College Health Association [ACHA], 2014; Gruttadaro & Crudo, 2012).

Among college students in general, depression has been linked to lower academic performance and attrition (Douce & Keeling, 2014; Jordan, Combs, & Smith, 2014; Kann et al., 2014; Kokkinos & Kipritsi, 2012; Smith, Park, Ireland, Elwyn, & Thornberry, 2013). In the most recent study from the ACHA (2014), 32.6% of college students reported it was difficult to function in the prior 12 months because of feelings of depression. When asked about factors affecting their academic performance, 13.5% of students reported depression had negatively affected them (ACHA, 2014). Changes in academic performance were defined to include (a) receiving a lower grade on an examination/project/course, (b) receiving an incomplete grade, (c) dropping a course, or (d) experiencing a significant disruption on a thesis, dissertation, research, or practicum. It is unknown whether the prevalence rates among nursing student is similar or dissimilar to the college population.

The demand for RNs continues to grow as the Baby Boomer generation requires additional health care needs. The U.S. Bureau of Labor Statistics (2012) has predicted 1.2 million new RN positions will be needed to fill the need for health care services in 2020. Hence, there is an increasing demand for nursing programs to produce qualified graduates to enter the workforce. According to the American Association of Colleges of Nursing (AACN, 2014), baccalaureate nursing program admissions for 2012–2013 were 276,946 but graduations were only 91,280. The inability for nursing programs to successfully retain students translates into a continued shortage of RNs in the United States.

Nursing program administrators have concentrated retaining students and increasing graduates by selecting higher quality applicants and increasing admissions to their programs. Although this intervention may be appropriate for increasing graduates, it does not address the reasons for the high rates of attrition. Factors contributing to attrition may be related to minority status, financial stressors, behavioral factors, and academic struggles (Beauvais, Stewart, DeNisco, & Beauvais, 2014; Pitt, Powis, Levett-Jones, & Hunter, 2012; Williams, 2010), although some nursing leaders cite the causes as an amalgamation of a poor-quality applicant pool and an increasingly more difficult nursing licensure examination (Jeffreys, 2012).

Although there is validity in these larger, system-wide influences on retention rates, there are serious and potentially deadly relationship-related influences in the nursing students' personal life or behind the closed doors of the student's home that can negatively affect the student's ability to stay or succeed in school. Improving our understanding of how psychological abuse affects nursing students may provide valuable insight in creating interventions that improve retention rates. Furthermore, recognizing IPV and dating violence and its associated outcomes will enhance the nursing students' learning and ability to educate and identify IPV and dating violence within the general population.

IPV and depression among U.S. nursing students has received little research attention; thus, it is not known to what degree IPV-related depression influences the retention of undergraduate nursing students through their graduation. U.S. and international studies have demonstrated a relationship between experiencing IPV and the associative outcome of depression in the adolescent and college-age population (Teitelman et al., 2011; Wang, Nansel, & Iannotti, 2011). Therefore, a literature review was conducted to explore the relationship between IPV, depression, and academic success of undergraduate nursing students in the United States.

Method

Two electronic literature searches were performed for IPV and depression. The initial search was limited to research articles published from 2010–2015 in English and was cross-linked with the terms nursing student, college student, partner violence, dating violence, and adolescent. Publications were reviewed from a combination of 87 databases, including EBSCO, Proquest® (16 databases), Nursing at OVID®, MEDLINE®, PubMed®, CINAHL®, PsycARTICLES®, JSTOR®, SAGE journals, and Google Scholar. In addition, reference lists were reviewed to identify additional relevant studies. Peer-reviewed publications focusing on IPV were also searched independently for relevant research. Unpublished research was excluded from the review.

Results

The initial literature search (2010 to 2015) found more than 24,675 research studies on IPV, dating violence, and depression. The IPV and dating violence search resulted in 3,517 articles from all the databases; however, many were duplicates. The acronym IPV along with the complete phrase were also differentiated. International research was excluded. Adolescent and teen were terms used to find research relevant to the college population. Research related to stalking and psychological abuse was included in the IPV numbers. Using the search criteria, no studies linking IPV to nursing students were found; therefore, the literature review was expanded with no date limitations for the same search terms. Only one study on prelicensure nursing students was found (Attala, Oetker, & McSweeney, 1995). The literature on depression yielded 21,158 studies fitting the search criteria. Limiting the search to depression and partner violence excluded research relevant to postpartum and international cultural differences. International studies were included for studies on depression and nursing students. No studies were found linking depression in nursing students, depression and violence in college students, or depression and dating violence. However, during this aspect of the literature review, additional search terms emerged relevant to this literature review. Teen and adolescent were used interchangeably and romantic conflict was used to describe dating violence in several studies. Stalking and psychological abuse were common forms of violence related to IPV for this population and were included.

The Johns Hopkins School of Nursing evidence-based practice model and guidelines (Newhouse, Dearholt, Poe, Pugh, & White, 2007) were used to determine type and quality of evidence found in each study. Forty-eight level-three studies were identified in the literature review, whereas no level-one, -two, -four, or -five types of literature were found (Table A; available in the online version of this article). These 48 studies were sorted by the authors into three identifiable themes.

Evidence Quality and Synthesis of Findings

Table A:

Evidence Quality and Synthesis of Findings

Themes

The first theme emerging from the studies was the impact of adolescent dating practices. Research within this theme included (a) violence during childhood, (b) the role of the media on adolescent development, and (c) understanding common relationship practices. The second theme identified prevalence of depression and IPV among nursing students. The last theme emerging from the evidence was the associated outcomes of IPV, including (a) academic performance, (b) depression, (c) loss of power and control, and (d) economic abuse.

Impact of Adolescent Dating Practices. The World Health Organization (2016) defined adolescence as the “period in human growth and development that occurs after childhood and before adulthood, from ages 10 to 19” (para. 1). Dating is challenging at all ages; however, adolescents navigate dating practices by knowledge obtained from parents, peers, and the media. Negative influences from any of these sources can affect how adolescents view what is socially acceptable in dating relationships. These insights affect the adolescent as they develop into young adulthood.

Violence during childhood. Victimization during early childhood and adolescent years of physical, sexual, psychological, or stalking within the context of the family increases the risk in adulthood of either being a victim (Babcock & DePrince, 2013; Bracken, Messing, Campbell, La Flair, & Kub, 2010; Garrido & Taussig, 2013; Kaukinen, 2014; Lohman, Neppl, Senia, & Schofiled, 2013) or a perpetrator (Jouriles, Mueller, Rosenfield, McDonald, & Dodson, 2012; Leisring, 2013). Threats and emotional or verbal abuse are subtle but effective forms of violence not often recognized as such by teenagers, adolescents, teachers, parents, or health care providers.

Failure to recognize violence experienced by children can lead to substance abuse, depression or anxiety, adjustment difficulties, and poor academic performance (Dahlen et al., 2013; Kendra, Bell, & Guimond, 2012; Littleton, 2014). Exposure to violence during childhood also plays a role in becoming a risk factor for both victimization and perpetration as an adolescent (Babcock & DePrince, 2013; CDC, 2014; Lohman, Neppl, Senia, & Schofield, 2013; Ménard & Pincus, 2012). The exposure to violence from either what the child witnessed in the home or being a victim of abuse both negatively affected the adolescent's development into adulthood (Dahlen et al., 2013). There is strong evidence linking exposure to violence or witnessing violence at home to an increased risk of being victimized (Jennings, Park, Tomsich, Gover, & Akers, 2011; Karakurt et al., 2013; Leisring, 2013; Vagi et al., 2013).

Role of the media on adolescent development. Several studies have determined that the media (e.g., television, Internet, and social media) plays a role in influencing the attitudes and knowledge about dating violence (Lenhart, 2015; Rueda, Lindsay, & Williams, 2015; Yahner, Dank, Zweig, & Lachman, 2015). Girls often learn about dating from their parents and media sources, whereas boys more likely rely on information from their girlfriend (Wood, Senn, Desmarais, Park, & Verberg, 2002). Lenhart (2015) reported 75% of teenagers have a smartphone and 92% report being online daily. Technology has many benefits for gaining knowledge; however, it creates conflict within romantic relationships such as feelings of being emotionally upset, jealous, or mistrustful of the partner (Rueda et al., 2015). The easy access of free Wi-Fi coupled with anonymity has rendered cyber dating violence a common practice in this age group (Stonard, Bowen, Lawrence, & Price, 2014). Common behaviors include (a) partner monitoring via direct physical or electronic surveillance; (b) monitoring social media; and (c) denying access to a Web site through password control (Rueda et al., 2015). For intimate partner stalkers, the Internet provides a sense of safety due to (a) a lack of social constraint, (b) a lack of sensory information from the victim allowing for a bigger fantasy, (c) an increased potential for deception, and (d) an element of surprise when reality does not conform to the fantasy with the victim (Meloy, 1998). Cyber stalking or bullying includes threatening text messages, multiple e-mails, tweets, Facebook® messages, or pressure to send sexual or naked photographs—all which makes the partner feel unsafe.

Common relationship practices. The psychological abuse occurring from cyber-related violence has blurred the lines for adolescents and college-age students regarding what constitutes acceptable relationship practices. Cyber dating violence among adolescents has become a common form of abuse among adolescents, with two thirds of teenagers reporting being a victim (Yahner et al., 2015) and more than half claiming to have been a perpetrator (Jouriles et al., 2012). Psychological dating violence (including controlling behaviors, put downs and name calling, insults, yelling, and unwanted calls, texts, or visits) are common tactics. In a study of teenagers 14 to 17 years old (N = 82), 40% reported perpetrating dating violence (Mueller, Jouriles, McDonald, & Rosenfield, 2013). Similarly, Black et al. (2011) found 56% of middle school age and 44% of high school age adolescents (N = 175) considered dating violence to be acceptable in relationships. Dating violence among adolescents and college-age students has been reported as acceptable behavior (Black et al., 2011; Bonomi et al., 2012; Makin-Byrd & Azar, 2011; Mueller et al., 2013).

Occurrence of IPV and Depression Among Nursing Students

Intimate Partner Violence. Attala et al. (1995) studied the prevalence of domestic violence among prelicensure nursing students (N = 243) from four Associate Degree in Nursing (ADN) programs and four Bachelor of Science in Nursing (BSN) programs. Eight percent of the students reported physical abuse, consistent with then-national normed values, whereas psychological abuse (called nonphysical abuse in this study) was 19%, with no national normative data available. More recently, Connor, Nover, Speck, Mackey, and Tipton (2013) conducted retrospective research on doctoral (PhD and DNP) nursing students (N = 52) about their exposure to, knowledge of, and prior training related to IPV and found that 20% of the PhD and 34% of the DNP students witnessed IPV toward a family member. Although these studies cited the need for further research on how IPV affects nursing students, no follow-up studies were found in the literature.

Depression. Only one recent study was found evaluating depression in the U.S. nursing student population (Dzurec, Allchin, & Engler, 2007). Dzurec et al. (2007) studied beginning undergraduate nursing students (N = 53) to evaluate causes of increased stress levels and found that 34% of the students were at risk for depression whereas 94% stated they were either depressed or knew another student who was depressed.

In the only study that assessed depression among nursing students experiencing IPV, Attala et al. (1995) reported a depression prevalence rate of 26.1%. In the U.S. population, 1 in 20 Americans older than 12 years (7.6%) have moderate to severe depression, and women are 70% more likely to suffer from depression (Pratt & Brody, 2014).

The diminutive amount of research over IPV and depression among nursing students has left many questions regarding the prevalence of this public health problem. Future studies are also needed to determine IPV and depression among current nurses and its impact on patient outcomes. Internationally, depression and IPV among nursing students have been studied comprehensively in several countries. These studies have been excluded in this review because of variances in social and cultural norms.

Outcomes Associated With Dating Violence

Academic Performance. Time constraints, financial burdens, and stress have long been known to contribute to academic failure. However, only recently have researchers in fields outside of nursing explored the link between academic failure and IPV and dating violence, finding undergraduate students who report IPV and dating violence are at a greater risk for academic disengagement, skipping classes, and ultimately failure or withdrawal from school (Dahlen et al., 2013; Eaton et al., 2012; Hammig & Jozkowski, 2013; Jordan et al., 2014; Kann et al., 2014; Mason & Smithey, 2012; Smith et al., 2013). Jordan et al. (2014) found when the victimization occurred precollege, students entered college with lower grade point averages. Other scholars have suggested that poor academic performance places a student at a greater risk of perpetrating IPV and dating violence (Lohman et al., 2013; Mason & Smithey, 2012). Academic difficulties from the precollege age to the emerging adulthood years have positively predicted psychological violence in college-age students. Academic demands and expectations are also a contributing stressor to perpetrating IPV. Mason and Smithey (2012) found that 79% of students admitted to psychologically abusing their partner and 20% had used sexual coercion.

High academic achievement can inversely affect future IPV and dating violence. Smith et al. (2013) found that students achieving higher grade point averages in school were less likely to instigate IPV and dating violence as young adults. This study suggests higher academic achievement during the precollege years may be a protective mechanism against IPV and dating violence.

Depression. Depression is one of the most predominant mental health consequences associated with IPV in the general precollege, college, and adult populations (Amanor-Boadu et al., 2011; Beydoun et al., 2012; Dahlen et al., 2013; Devries et al., 2013; Suvak, Goodman, Taft, & Dutton, 2013; Vaeth, Ramisetty-Mikler, & Caetano, 2010). Although data support the higher probability of suffering from depression as an adult is linked to being abused as a child (Dahlen et al., 2013; Kendra et al., 2012; Littleton, 2014), the focus of this literature review is on the college-age population. Therefore, studies on children and adults were excluded from this review. Only four studies were found addressing the direct relationship between IPV and depression among the precollege-age and college-age student populations.

In the precollege population, depression has been positively identified as an outcome of IPV and dating violence (Teitelman et al., 2011; Wang et al., 2011). Teitelman et al., (2011) found that 97% of female adolescents from an urban setting (N = 102) reported experiencing some form of IPV (i.e., physical abuse, emotional or psychological, threatening behavior) and more than half (54%) reported symptoms of depression. Wang et al. (2011) studied precollege-age boys and girls (N = 7,313) and measured physical abuse, verbal abuse, relational abuse, and cyber abuse. The addition of cyber abuse was important because this is a common form of psychological abuse in this age group. Students who were cyber bullied demonstrated the largest reported rates of depression, compared with other forms of abuse. As these precollege students entered college, the data remained consistent with regard to depression and IPV and dating violence.

In the general college population, increased rates of depression have been reported among students experiencing IPV and relational aggression and victimization (Amanor-Boadu et al., 2011; Dahlen et al., 2013). Dahlen et al. (2013) found that students who perpetrated IPV were more likely to report higher levels of depression. In contrast, Amanor-Boadu et al. (2011) state perpetrating violence did not predict depression in college students; however, victims of violence scored 19% higher on a checklist measuring depression than nonvictims. Whether the depression occurs as a precursor or an outcome is not clear in these studies; however, IPV and dating violence was positively correlated with depression.

Three systematic published reviews found a positive relationship between IPV and depression. Beydoun et al. (2012) reviewed 37 research studies on women and found that all demonstrated evidence of a direct association between depression and IPV. Dillon et al. (2013) reviewed 75 studies on the mental and physical health consequences of IPV in women. Of the 42 studies measuring depression, only one study insinuated there was no increase in depression for women experiencing IPV. The authors of that study acknowledged that their subjects had high baseline levels of depression, so a significant effect may not have been able to be determined. Finally, Devries et al. (2013) reviewed 16 studies and found an increase in depression and suicide among women experiencing IPV.

Power and Control. IPV and dating violence subjugates a woman's independence through fear created by the perpetrator using tactics that isolate, degrade, and control the intimate partner (Stark, 2007). Fear results in a loss of control that prevents women from seeking assistance (Maldonado, Landenberger, & Cuevas, 2015). Long-term effects of coercive controlling behaviors by the intimate partner may alter a victim's ability to discern socially acceptable relationship practices. The inability to meet the intimate partner's expectation may prompt feelings of guilt and feelings that the abuse is justified (Maldonado et al., 2015). Although physical or psychological abuse was described by the women (Cerulli, Poleshuck, Raimondi, Veale, & Chin, 2012; Dichter, & Gelles, 2012), some women viewed the abuse as a normal part of the relationship (Maldonado et al., 2015).

Economic Abuse. Coercive control by the intimate partner is frequently in the form of economic or social abuse (Postmus, Plummer, McMahon, Murshid, & Kim, 2011). Economic abuse includes control of money, financially exploitative behaviors, and employment sabotage. Women often report that their abuser restricts, monitors, or exclusively controls the family finances (Sanders, 2015). Postmus et al. (2011) reported that 94.2% of the women they studied (N = 121) who experienced IPV over the past year also experienced some form of economic abuse. Seventy-nine percent of the women experienced exploitative behaviors (e.g., paying bills late, spending money needed to pay bills), and 78% reported employment sabotage (e.g., having them do something to prevent them from going to work or demanding they quit their job).

Discussion

The literature review revealed many insights to the problem of IPV and dating violence. Adolescents exposed to violence during childhood get a distorted understanding of relationships. Exposure to violence from abuse by a caregiver or witnessing violence in the community places the person at a higher probability for experiencing IPV and dating violence. Adolescents have learned both to use media for information gathering and to perpetuate psychological abuse, contributing to changing societal norms by distorting precollege-age and college-age students' understanding about acceptable relationship practices. Failure by adolescents to identify unacceptable social behavior perpetuates the problem into the college-age population.

Data about IPV and dating violence among nursing students have been reported in only two U.S. studies. International studies on depression have demonstrated prevalence rates at or above the national average (Chatterjee et al., 2014; Hoang, Hengudomsub, & Suppaseemanont, 2011), and the only study in the United States exploring the prevalence of IPV and depression among nursing students occurred more than 20 years ago (Attala et al., 1995). Outcomes of IPV and dating violence identified included (a) effects on academic performance, (b) development of depression, (c) loss of power and control, and (d) economic abuse. All the identified outcomes have a tremendous influence on nursing students' ability to complete their education. The outcome with the greatest influence on a nursing student completing school has not been determined. In addition, specific IPV tactics used by intimate partners in this population have not been identified. Discovery of new knowledge may reduce attrition rates by providing tools for nursing program administrators tools to identify at-risk students.

Further research is needed to determine prevalence rates in the United States for both IPV and depression among nursing students. Qualitative studies are needed to determine whether the outcomes of IPV and dating violence in the undergraduate nursing student population are consistent with findings from the general college population. Furthermore, studies targeting different types of academic nurse preparation programs are suggested to determine differences or similarities in experiences of nursing students. Among the reviewed studies, the scales used to measure depression and IPV or dating violence were inconsistent. Future studies can determine whether existing reliable and valid IPV clinical and research assessment scales developed for the general population can accurately screen for at-risk nursing students or whether new instruments need to be developed. Research is needed to explore whether experiencing IPV or depression as a nursing student affects future patient care, especially if the patient acknowledges being in an abusive relationship. Finally, research is needed to determine whether highly academic undergraduate nursing students have lower rates of IPV or depression than the research has demonstrated in the general college population.

Conclusion

IPV and dating violence have a positive associative outcome of depression and academic disengagement in the college-age student. Psychological abuse is the most common form of IPV or dating violence in the general college student population. Psychological abuse does not leave scars seen by human eyes; thus, it is often minimized or overlooked by health care providers and academic administrators. Failing to understand the myriad types of psychological abuse directed at a student by the abusive partner may negatively influence the ability to educate future nurses and identify current abuse conditions.

Prevalence rates of IPV in the undergraduate nursing student population in the United States are unknown, as is how IPV and dating violence contributes to disengagement and the student's ability to graduate from a nursing program. Despite rigorous admission requirements in nursing schools, high attrition rates are a significant concern. The inability for nursing programs to successfully retain qualified students contributes to the continued shortage of RNs and this attrition directly affects the health care community.

IPV and dating violence and depression among nursing students in the United States has incredulously received little research attention, as if nursing students somehow have immunity from these well-documented social and medical determinants affecting significant numbers of like-aged general college students (i.e., the college population who are not nursing students). Further qualitative and quantitative research of how IPV and dating violence, coupled with depression among nursing students, is needed urgently to explore its effects on students' physical and mental health and their abilities to succeed in school and achieve their professional potentials. More knowledge is needed to identify the tactics used by abusive intimate partners intentionally designed to psychologically traumatize and sabotage nursing students in their education pursuits thus placing them at high risk for failure in college. Improving our understanding of how IPV or dating violence and depression affects nursing students may provide valuable insight in creating interventions to improve the physical and emotional health of nursing students and improve retention rates.

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Evidence Quality and Synthesis of Findings

Intimate Partner Violence (IPV) and Academic Performance in Nursing Students: A Literature Review
Categorya (Level Type)Total of Sources/LevelOverall Quality RatingaSynthesis of Findings
Level 1  Experimental0
Level II  Quasi-experimental0
Level III  Nonexperimental, qualitative   Meta-synthesis   Governmental study42 3 327 with A 15 with B 0 with C 3 with A 0 with B 0 with C IPV link between academic disengagement/withdrawal-failure(Dahlen et al., 2013; Eaton et al., 2012; Hammig & Jozkowski, 2013; Jordan et al., 2014; Kann et al., 2014; Kokkinos & Kipritsi, 2012; Lohman et al., 2013; Mason & Smithey, 2012; Smith et al., 2013) Depression link between academic disinterest(Chatterjee et al., 2014; Hoang et al., 2011) Victimization increased risk of becoming victim (Backcock & (DePrince, 2013; Bracken et al., 2010; Garrido & Taussig, 2013; Jennings et al., 2011; Karakurt et al., 2013; Lohman et al., 2013) Victimization during childhood increased risk of becoming a perpetrator(Jouriles et al., 2012; Kaukinen, 2014; Leisring, 2013; Ménard & Pincus, 2012; Vagi et al., 2013) Media influences attitudes and knowledge about dating violence(Lenhart, 2015; Rueda et al., 2015; Stonard et al., 2014; Wood et al., 2002; Yahner et al., 2015) IPV influence on acceptability in relationships(Black et al., 2011; Bonomi et al., 2012; Makin-Byrd & Azar, 2011; Mueller et al., 2013) Dating violence prevalence greater than 50%(Bonomi et al., 2012; Shorey et al., 2011) IPV in student nurses and nurses(Attala et al., 1995; Bracken et al., 2010; Connor et al., 2013) IPV and outcome of loss of control(Cerulli et al., 2012; Dichter & Gelles, 2012; Maldonado et al., 2015; Postmus et al., 2011; Sanders, 2015). Depression in nursing students(Attala et al., 1995; Chatterjee et al., 2014; Dzurec et al., 2007; Hoang et al., 2011) Depression link to IPV/dating violence(Amanor-Boadu et al., 2011; Beydoun et al., 2012; Cerulli et al., 2012; Dahlen et al., 2013; Devries et al., 2013; Dillon et al., 2013; Suvak et al., 2013; Teitelman et al., 2011; Vaeth et al., 2010; Wang et al., 2011)
Levels IV and V0
Authors

Dr. Garner is Assistant Professor, Division of Health Professions, Central Methodist University, Fayette, Missouri; and Dr. Sheridan is Professor and Director, Forensic Health Care Education, Research & Intervention Program, Texas A&M College of Nursing, Bryan, Texas.

The authors thank Dr. Jean Davis for her assistance in the manuscript preparation and igniting a spirit of inquiry about nursing research. The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Andrea K. Garner, PhD, DNP, RN, Assistant Professor, Division of Health Professions, Central Methodist University, 411 Central Methodist Square, Fayette, MO 65248; e-mail: akgarner@centralmethodist.edu.

Received: December 22, 2016
Accepted: February 15, 2017

10.3928/01484834-20170619-03

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