Evaluation of Psychological Symptoms in Terms of Childhood Traumas, Spirituality, and Conflict Tactics in Sheltered Battered Women

ABSTRACT

Aim and Objectives

The aim of this study was to evaluate psychological symptoms in terms of childhood traumas, spirituality and conflict styles in women victims of violence staying in women's shelters.

Background

Violence against women is a major public health problem. Spiritual values and practices are especially important for women to cope with the negative effects of violence.

Materials and Methods

The study was conducted in women's shelters in two provinces of the Ministry of Family and Social Policies in Türkiye. The sample consisted of 92 women who had been subjected to violence and stayed in a women's shelter for at least 15 days. The data were collected using the “Brief Symptom Inventory”, “Conflict Tactic Scale”, “Spiritual Well‐Being Scale (SWBS)”, “Childhood Abuse Experiences Scale Short Form”, and “Introductory Information Form” created by the researcher, and the data obtained were evaluated in SPSS 22.0 program. Frequency, percentage, Pearson Product Moment correlation analysis, t‐test, one‐way analysis of variance (ANOVA) were used in the evaluation of the data. In all statistical analyses, p < 0.05 was accepted as the significance level.

Results

It was found that 64.1% of the women in the study had at least one psychiatric diagnosis and major depression was in the first place (32.2%). According to the mean scores of the Brief Symptom Inventory, the relationships between all subdimensions except the somatization subdimension and the mean scores of the SWBS were found to be inversely significant at p < 0.05 significance level. According to the mean scores of the SWBS, the relationships between all subdimensions except the transcendence subdimension and the mean scores of the Conflict Methods Scale were found to be inversely significant at the p < 0.05 level of significance.

Conclusion

According to the findings obtained from the study, it has been concluded that women should be encouraged to support them in order to be able to cope with the mental problems experienced in the psychiatric sense and to realize their spiritual beliefs and practices.

1. Introduction

Violence is defined as an action or restriction applied with the aim of harming an individual, and therefore being mistreated by using force. Violence is a social problem that can exist in every aspect of our lives. We can be exposed to violence and even be subjected to violence in both our domestic and non‐familial lives (Alkan, Özar, and Ünver ²⁰²¹; Prime Ministry General Directorate on the Status of Women, 2015; Parliamentary Research Commission Report, ²⁰⁰⁶).

According to the definition of WHO, violence against women is defined as “any behavior that is based on gender, that hurts and harms women, that has the possibility of resulting in physical, sexual or psychological damage, that causes pressure on women in public or private life and arbitrary restriction of their freedoms”. Domestic violence against women plays an important role in marital life for many years (World Health Organization ²⁰⁰²; General Directorate on the Status of Women ²⁰¹⁵; Büyükbodur, Uğurlu, and Pamuk ²⁰²²). Especially physical violence against women is one of the most common types of violence that affects the largest number of people in the world compared to other types of violence (Crespo, Arinero, and Soberón ²⁰²¹; Büyükbodur, Uğurlu, and Pamuk ²⁰²²).

There are many types of violence against women, including physical, sexual, psychological/emotional, and economic violence (Han et al. 2019).

Violence poses a serious threat to women's health in terms of mental health problems as well as physical health problems. Psychological and behavioral problems such as depression, excessive alcohol use, panic level anxiety, suicidal behavior, unwanted pregnancies and sexually transmitted diseases have been reported in women who have been exposed to violence (Crespo, Arinero, and Soberón ²⁰²¹, Büyükbodur, Uğurlu, and Pamuk ²⁰²²).

Women's shelters, where women who are victims of violence against women, which is considered a crime, continue their lives with their children, are of great importance. Removing women and their children from the environment of violence, ensuring their safety and supporting them for their future lives are among the primary goals of women's guest houses (Çoban 2013).

In many studies, it has been determined that spiritual belief values and practices are significantly effective in alleviating the negative effects of violence experienced by women, making plans for the future periods of their lives and holding on to life more (Humphreys et al. 1999; Humphreys ²⁰⁰⁰; İzmirli ²⁰¹³).

Conflict methods and childhood trauma experiences are addressed to determine the status of witnessing, being exposed to, and perpetrating violence during childhood in individuals who are victims of violence. Women stated that their mental problems decreased when they used their spiritual values as coping skills to cope with the negative effects of their experiences of violence (Büyükbodur, Uğurlu, and Pamuk ²⁰²²). This study was conducted to examine the levels of mental distress, spiritual values, childhood abuse experiences, and conflict methods in women victims of violence living in women's shelters due to the violence they experienced from their spouses/families/environment.

2. Methods

2.1. Type of Research

This descriptive study was conducted between December 2017 and April 2018 to evaluate the mental problems, spirituality, conflict styles, and childhood traumas of women who have been subjected to violence in women's shelters. This research is derived from a master's thesis. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) was used to report the study (Figure 1).

FIGURE 1.

STROBE flow chart. STROBE, Strengthening the Reporting of Observational Studies in Epidemiology. [Colour figure can be viewed at wileyonlinelibrary.com]

2.2. Location and Characteristics of the Research

The study was conducted in women's shelters in two provinces in Türkiye affiliated to the Ministry of Family, Labor and Social Services. The study group consisted of women who had been subjected to violence, stayed in the shelters for at least 15 days and agreed to participate in the study. Data collection tools were applied by the researcher by face‐to‐face interviews with women in women's shelters and ŞÖNİM (Violence Prevention and Monitoring Center).

2.3. Population and Sample of the Study

The research was conducted in three women's shelters in two provinces in Türkiye. The total number of women staying in women's shelters in one province was 185 and the number of children was 123, and the total number of women staying in women's shelters in the other province was 25 and the number of children was 16. A total of 210 women and 139 children stayed in women's shelters in two provinces.

The sample of the research is based on convenience sampling. Since women's shelters are also considered as initial reception units, women who stay for 1 day and leave are not considered as staying in the shelter. Out of the total number of 210 women, 126 women met the criterion of staying at least 15 days. Among these women, 6 could not be interviewed because they were foreign nationals, 9 because they were working during working hours, 8 because they were out on leave during the interview hours for reasons such as going to the doctor, finding a job, meeting with relatives, 2 because they were hearing and speech impaired, 4 because they refused to be interviewed, and 5 because they checked out the day before the day of the interview. As a result, a total of 92 women constituted the study sample. As a result of the power analysis using the GPower 3.1 program, it was found that 88 people were sufficient for the 0.95 power of the study. In this context, the adequacy of the 92 people included in the study to represent the study is high.

2.3.1. Inclusion Criteria for the Study Group

• Accepting to participate in the research

• Having stayed in a women's shelter for at least 15 days (since the symptoms of sudden distress due to violence should decrease Humphreys ²⁰⁰⁰).

2.3.2. Study Group Exclusion Criteria

Women with any diagnosis (neurologists, psychiatrists, and other specialists) for the following health problems were not included in the study.

• Women with severe mental retardation,

• Women with psychotic symptoms and impaired judgment of reality,

• Women without insight due to psychiatric disorder,

• Women with impaired cognitive functioning.

2.4. Data Collection Tools

In the study, “Introductory Information Form” was used to collect sociodemographic and violence‐related data, “Brief Symptom Inventory” (BSI) was used to determine mental problems, “Conflict Tactic Scale” (CTS) and “Childhood Abuse Experiences Scale Short Form” (CAES‐SF) were used to determine the extent and frequency of violence, and “Spiritual Well‐Being Scale” (SWBS) was used to determine the effect of spiritual values on mental problems after violence.

2.4.1. Introductory Information Form

The descriptive information form was developed by the researcher (Crespo, Arinero, and Soberón ²⁰²¹; Büyükbodur, Uğurlu, and Pamuk ²⁰²²). The form includes 35 semi‐structured questions about women's sociodemographic characteristics, family life, exposure to violence, perceptions of violence, initiatives they have taken after exposure to violence, and their perceptions of women's shelters.

2.4.2. Brief Symptom Inventory

The Turkish validity and reliability of the BSI was performed by Şahin and Durak in 1994 with three separate studies. It is a multidimensional symptom screening scale developed to identify some psychological symptoms that may occur in various medical and medical diseases. The BSI is composed of 53 items selected from the 90‐item Symptom Screening List (SCL‐90‐R). It is a Likert‐type scale and the items are graded between 0 and 4 values corresponding to “not at all” and “very much”. Higher total scores indicate an increase in the mental symptoms of the individual. The scale has 9 subscales. These are “Somatization”, “Obsessive‐compulsive disorder”, “Interpersonal sensitivity”, “Depression”, “Anxiety disorder”, “Hostility”, “Phobic anxiety”, “Paranoid ideation”, and “Psychoticism” subscales, respectively. Cronbach Alpha internal consistency coefficients obtained from the total score of the scale vary between 0.96 and 0.95 (Şahin‐Hisli and Batıgün ²⁰²²).

2.4.3. Conflict Tactics Scale

The CTS was developed by Straus in 1979. The original scale includes three scales (“negotiation”, “verbal/psychological violence”, and “physical violence”) and 18 items in total. The translation of the CTS into Turkish was made by Arslan (2002). Different forms have also been developed for different purposes. In this study, the “psychological violence” and “physical violence” scales of the CTS were used in the “witnessing father's violence against mother” form, the “exposure to psychological/physical violence by parents/parental form”, and the “self‐on‐ others form” to assess the psychological and physical violence methods used to cope with interpersonal conflicts (Straus 2007; Arslan ²⁰⁰²). The response options of the items vary between 0 and 6 values corresponding to “never/0” and “more than 40”. Cronbach's Alpha values for the psychological and physical violence scales of the EMS are between 0.77 and 0.99.

2.4.4. Spiritual Well‐Being Scale

The Turkish validity and reliability study of the scale developed by Ekşi and Kardaş (2017) was conducted. The scale consists of 29 items in total. It is a 5‐point Likert‐type scale and the rating of the items is structured as (1 = Not at all suitable for me, 2 = Not suitable for me, 3 = Somewhat suitable for me, 4 = Quite suitable for me, 5 = Completely suitable for me). The scale consists of three factors. There are 15 items in the first factor and 7 items each in the second and third factors. The scale items in each factor were analyzed and the subdimensions were named accordingly. The items in the first factor were categorized as “Transcendence”, the items in the second factor as “Harmony with Nature”, and the items in the third factor as “Anomie”. In addition, the total Cronbach Alpha value of the scale was calculated as 0.88 (Ekşi and Kardaş 2017).

2.4.5. Childhood Abuse Experiences Scale Short Form

The CAES‐SF was adapted into Turkish by Kaya (2014), and it was found to have sufficient validity and reliability. The CAES‐SF consists of 28 items. It is a 5‐point Likert‐type scale and the items are graded as 1 = Strongly disagree, 2 = Disagree, 3 = Somewhat agree, 4 = Agree, 5 = Strongly agree. The highest score that can be obtained from the scale is 125 and the lowest score is 25. The ESAS‐SF consists of five subdimensions. These are “physical abuse”, “sexual abuse”, “emotional abuse”, “physical neglect”, and “emotional neglect” (Kaya 2014).

2.5. Data Analysis

SPSS (Statistical Package for Social Sciences) version 22 was used to analyze the data. Frequency and/or percentage descriptive analyses of all measurement tools were performed. Independent samples t‐test was performed for gender and one‐way analysis of variance (ANOVA) was performed for variables with more than two groups. Pearson correlation analysis was applied to determine whether there was a relationship between the scale scores. Chi‐square analysis was used to determine whether there was a relationship between the variables. In all statistical analyses, p < 0.05 was accepted as the significance level.

2.6. Ethical Consideration

Permission was obtained from the Ministry of Family, Labor, and Social Services before starting the study. After written permission from the institutions, written permission was obtained from Gazi University Ethics Commission dated November 14, 2017 and numbered 77082166–302.08.01‐. Participation in the study was voluntary and written informed consent was obtained from the women.

3. Results

The descriptive characteristics of the women victims of violence who participated in the study are given in Table 1.

TABLE 1.

Descriptive characteristics of the women victims of violence included in the study (n = 92).

		n	%
Age	20 years and younger	5	5.4
	21–30	39	42.4
	31–40	36	39.1
	41 years and over	12	13.0
Education status	Illiterate	6	6.5
	Literate	6	6.5
	Primary school/secondary school graduate	68	73.9
	High school graduate	9	9.8
	Associate/Bachelor's degree	3	3.3
Working in a job that generates a monthly income	Yes	12	13.0
	No	80	87.0
Profession	Housewife	64	69.6
	Worker/farmer	15	16.3
	Officer	3	3.3
	Retired	3	3.3
	Self‐employment	4	4.3
	Student	3	3.3
How he perceives his economic situation	Very bad	31	33.7
	Bad	24	26.1
	Middle	31	33.7
	Good	6	6.5
Marital status	Married	58	63
	Single	34	37
How long have you been married?	1 year	10	12.2
	2 years	10	12.2
	3–5 years	22	26.8
	6–10 years	18	22.0
	11–20 years	17	20.7
	21 years and over	5	6.1
Marriage age	12–17 years old	31	37.3
	18–32 years	52	62.7
Civil marriage status	Yes	66	79.5
	No	17	20.5
Marriage procedure	Arranged marriage	30	36.1
	By agreement/love	24	28.9
	Family coercion	3	3.6
	Running away	17	20.5
	Forcibly abducted	5	6.0
	Obligation because she was pregnant by her previous boyfriend	3	3.6
	Freedom from financial depression	1	1.2
How many marriages	1	50	60.2
	2	28	33.7
	3	4	4>8
	4	1	1.2
Reason for ending/wanting to	Violence	69	75
end marriage	Disagreement/incompatibility	14	15.2
	Indifference/irresponsibility	9	9.8
How old is your spouse/ex‐ spouse/boyfriend?	20 years and younger	1	1.1
	21–30	14	16.1
	31–40	40	46.0
	41 years and over	32	36.8
Education level of your spouse/ex‐spouse/boyfriend	Illiterate	5	5.7
	Literate	4	4.6
	Primary school graduate/secondary school graduate	60	69.0
	High school graduate	15	17.2
	Bachelor's degree	3	3.4
Occupation of your spouse/ex‐ spouse/boyfriend	Worker/farmer	40	46.0
	Officer	3	3.4
	Retired	4	4.6
	Self‐employment	36	41.4
	Not working	4	4.6
Do you have children?	Yes	78	91.8
	No	7	8.2
Number of children	1	24	30.8
	2	21	26.9
	3	21	26.9
	4 and above	12	15.4
Education level of your mother	Illiterate	44	47.8
	Literate	11	12.0
	Primary school graduate/secondary school graduate	33	35.9
	High school graduate	3	3.3
	Bachelor's degree	1	1.1
Your father's education level	Illiterate	18	19.6
	Literate	13	14.1
	Primary school graduate/secondary school graduate	48	52.2
	High school graduate	11	12.0
	Bachelor's degree	2	2.2
Number of siblings	1	3	3.3
	2	6	6.5
	3	20	21.7
	4	16	17.4
	5–19	47	51.1

The characteristics of other conditions of the women victims of violence who participated in the study are given in Table 2.

TABLE 2.

Other characteristics of the women victims of violence included in the study.

		n	%
Receiving medical treatment for the violence suffered	I saw a psychiatrist for emotional violence	1	2.1
	Battering report due to physical trauma after physical violence by her family	2	4.3
Alcohol dependence in your husband or boyfriend	Yes	42	48.3
	No	45	51.7
Alcohol and substance abuse by your spouse or boyfriend	Yes	28	32.2
	No	59	67.8
Referral to a psychiatric clinic for treatment	Yes	63	68.5
	No	29	31.5
How many times he/she applied to a psychiatric clinic for treatment	1	16	25.8
	2	13	21.0
Previous psychiatric hospitalization	Yes	22	23.9
	No	70	76.1
Diagnosed psychiatric disorder	Yes	59	64.1
	No	33	35.9
Psychiatric diagnosis	Anxiety disorder	8	32.0
	Mood disorder	13	52.0
	Sleep disturbance	2	8.0
	Alcohol‐substance addiction	1	4.0
	Eating disorder	1	4.0
Suicide attempt	Yes	34	37.5
	No	58	63.5
Duration of stay in women's shelter	15 days	54	58.7
	16–31 days	14	15.3
	32–90 days	13	14.2
	91–180 days	10	11.9
How many times has he stayed at the shelter	1	36	39.1
	2	22	23.9
	3	16	17.4
	4 and above	18	19.6
How to apply to the shelter	I applied by calling the Alo 183 social support line	4	4.3
	Through a member of the police	71	77.2
	By applying to the shunam	14	15.2
	By contacting social services	3	3.3
Changes after staying in a women's shelter	No exchange	26	26.3
	Good for his psychology	34	39.1
	Fear of arguments and violence with spouse decreased	8	8.6
	Calmed down	9	9.8
	Increased self‐esteem	12	13.0
	He started making plans for the future	3	3.2

The arithmetic mean and standard deviation values of the scores of the women victims of violence are given in Table 3. It was found that the mean total score of the BSI was 118.01 ± 41.63, the mean total score of the SWBS was 114.98 ± 12.59, and the mean total score of the CAES‐SF was 63.38 ± 14.32. In addition, when the mean scores of CTF were examined, it was found that the mean score of psychological violence of the father against the mother was 1.45 ± 1.24, the mean score of minor violence of the father against the mother was 1.23 ± 1.38, the mean score of severe violence of the father against the mother was 1.39 ± 1.70, the mean score of psychological violence of the father was 1.02 ± 1.17, the mean score of minor violence of the father was 0.98 ± 1.23, the mean score of the father's severe violence was 1.09 ± 1.53, the mean score of the mother's psychological violence was 0.66 ± 1.09, the mean score of the mother's minor violence was 0.62 ± 1.11, the mean score of the mother's severe violence was 0.72 ± 1.47, the mean score of the mother's psychological violence to another person was 0.30 ± 0.64, the mean score of the mother's minor violence to another person was 0.22 ± 0.59, and the mean score of the mother's severe violence to another person was 0.29 ± 0.88.

TABLE 3.

Arithmetic mean and standard deviation values of the scores of women victims of violence on the scales.

	Min	Max	Mean	SD
BSI total scale and subdimensions	7	35
Somatization	6	28	15.75	7.5
Obsessive compulsive disorder	4	20	14.18	6.01
Interpersonal sensitivity	6	30	10.21	4.39
Depression	6	30	14.82	6.72
Anxiety	5	25	13.98	6.73
Hostilite	5	22	8.34	3.88
Phobic anxiety	5	25	8.51	3.69
Paranoid thoughts	5	25	13.30	4.77
Psychotism	53	257	10.10	4.86
Total	7	35	118.01	41.63
SWBS total scale and subdimensions
Transcendence dimension	36	75	62.79	7.76
Harmony with nature	18	35	31.67	4.25
Anomie dimension	13	31	21.49	4.32
Total	73	135	114.98	12.59
CTS subdimensions
Father's psychological violence against mother	0	3	1.45	1.23
Minor violence by father against mother	0	3	1.23	1.37
Father's severe violence against mother	0	6	1.39	1.69
Psychological violence against the father himself	0	3	1.02	1.16
Minor violence against the father himself	0	3	0.98	1.23
Severe violence against the father himself	0	5	1.09	1.53
Psychological violence against the mother herself	0	3	0.66	1.09
Minor violence against the mother herself	0	3	0.62	1.10
Severe violence against the mother herself	0	6	0.72	1.47
I don't think it's a good idea	0	3	0.30	0.64
Minor violence by oneself against another	0	3	0.22	0.59
The severe violence of oneself against another	0	5	0.29	0.88
CAES‐SF total scale and subdimensions
Physical abuse	5	25	10.64	7.79
Sexual abuse	5	25	8.36	6.90
Emotional abuse	5	25	13.76	7.61
Physical neglect	5	21	14.02	3.01
Emotional neglect	5	25	16.60	6.96
Total	41	103	63.38	14.32

Abbreviations: BSI, Brief Symptom Inventory; CAES‐SF, Childhood Abuse Experiences Scale‐Short Form; CTS, Conflict Tactic Scale; SD, Standard Deviation; SWBS, Spiritual Well‐Being Scale.

The correlation values between BSI, SWBS and CTC are presented in Table 4. The relationships between somatization and father's psychological violence against mother, father's minor violence against mother, father's severe violence against mother, father's psychological violence against self, father's minor violence against self, father's severe violence against self, mother's psychological violence against self, mother's minor violence against self, mother's severe violence against self, emotional abuse and sum of childhood experiences were found significant at p < 0.05 level of significance. The relationships between obsessive‐compulsive disorder and father's psychological violence towards mother, father's minor violence towards mother, anomie dimension, physical abuse, emotional abuse, and sum of childhood experiences were found to be significant at p < 0.05 level of significance. The relationships between interpersonal sensitivity and father's psychological violence against mother, father's minor violence against mother, father's minor violence against himself, father's severe violence against himself, anomie dimension, physical abuse, emotional abuse, and sum of childhood experiences were found significant at p < 0.05 level of significance in the right direction and the relationships between spiritual sum and emotional neglect were found significant in the inverse direction. The relationships between depression and father's psychological violence against mother, father's minor violence against mother, father's severe violence against mother, father's minor violence against self, father's severe violence against self, anomie dimension, physical abuse, emotional abuse, and sum of childhood experiences were found to be significant at p < 0.05 level of significance in the right direction and the relationships between transcendence dimension, spiritual sum, and emotional neglect were found to be significant in the opposite direction.

TABLE 4.

Correlation values for the relationship between Brief Symptom Inventory, Spiritual Well‐Being Scale, and Conflict Tactic Scale.

		1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	17	18	19	20	21	22	23	24	25
1‐ Somatization	r	—
2‐OCD	r	0.382**	—
3‐KD	r	0.562**	0.647**	—
4‐Depression	r	0.549**	0.714**	0.691**	—
5‐Anxiety	r	0.709**	0.651**	0.676**	0.715**	—
6‐Hostility	r	0.472**	0.516**	0.485**	0.549**	0.674**	—
7‐Phobic anxiety	r	0.518**	0.548**	0.639**	0.584**	0.671**	0.561**	—
8‐Paranoid thoughts	r	0.444**	0.648**	0.673**	0.658**	0.528**	0.437**	0.433**	—
9‐Psychotism	r	0.500**	0.674**	0.569**	0.651**	0.680**	0.571**	0.574**	0.577**	—
10‐BSI total	r	0.753**	0.798**	0.811**	0.863**	0.891**	0.717**	0.746**	0.744**	0.799**	—
11‐Father to mother psychologically	r	0.222*	0.230*	0.232*	0.277**	0.168	0.140	0.130	0.346**	0.241*	0.271**	—
12‐Father's minor violence against mother	r	0.239*	0.236*	0.232*	0.292**	0.167	0.174	0.165	0.364**	0.248*	0.286**	0.916**	—
13‐Father's severe violence Against mother	r	0.229*	0.173	0.197	0.253*	0.107	0.146	0.105	0.336**	0.199	0.236*	0.850**	0.903**	—
14‐Father form psychological	r	0.234*	0.035	0.181	0.181	0.169	0.328**	0.181	0.255*	0.251*	0.247*	0.420**	0.387**	0.440**	—
15‐Father form minor violence	r	0.249*	0.092	0.277**	0.236*	0.215*	0.355**	0.210*	0.261*	0.263*	0.291**	0.397**	0.366**	0.420**	0.895**	—
16‐Father form severe violence	r	0.223*	0.115	0.277**	0.229*	0.173	0.355**	0.186	0.282**	0.273**	0.279**	0.433**	0.418**	0.507**	0.854**	0.870**	—
17‐Mother form psychological	r	0.249*	0.150	0.033	0.105	0.138	0.211*	,152	0.142	0.246*	0.212*	0.210*	0.264*	0.256*	0.256*	0.199	0.241*	—
18‐Mother form minor violence	r	0.334**	0.121	0.041	0.098	0.155	0.209*	0.174	0.095	0.274**	0.227*	0.190	0.267*	0.291**	0.312**	0.284**	0.311**	0.837**	—
19‐Mother form severe violence	r	0.293**	0.164	0.045	0.163	0.156	0.232*	0.154	0.175	0.248*	0.246*	0.076	0.157	0.190	0.209*	0.191	0.250*	0.843**	0.837**	—
20‐Self psychological	r	0.087	0.000	−0.046	−0.015	0.027	0.161	0.124	0.045	−0.031	0.048	−0.034	0.032	0.041	0.240*	0.189	0.118	0.117	0.226*	0.104	—
21‐Self minor violence	r	0.022	−0.055	−0.098	−0.051	0.004	0.121	0.044	−0.129	−0.057	−0.028	0.077	0.101	0.167	0.089	0.067	0.028	0.064	0.212*	0.034	0.723**	—
22‐Himself serious violence	r	0.099	0.062	−0.109	0.037	0.077	0.128	0.038	−0.063	0.044	0.056	0.171	0.188	0.201	0.068	−0.004	−0.027	0.217*	0.272**	0.081	0.635**	0.825**	—
23‐Resistivity dimension	r	−0.089	−0.050	−0.156	−0.278**	−0.166	−0.213*	−0.022	−0.076	−0.140	−0.168	−0.180	−0.191	−0.197	−0.259*	−0.282**	−0.313**	−0.054	−0.018	0.045	0.024	0.010	0.043	—
24‐Dimension of harmony with nature	r	−0.098	−0.206*	−0.181	−0.188	−0.209*	−0.236*	−0.065	−0.248*	−0.254*	−0.234*	−0.104	−0.168	−0.168	−0.107	−0.073	−0.210*	−0.209*	−0.118	−0.082	−0.116	−0.006	−0.012	0.486**	—
25‐Anomie dimension	r	0.191	0.362**	0.359**	0.448**	0.326**	0.412**	0.257*	0.315**	0.256*	0.403**	0.123	0.166	0.161	0.168	0.215*	0.243*	0.003	0.042	0.019	0.251*	0.143	0.132	−0.313**	−0.227*	—
26‐Spirutal total	r	−0.153	−0.224*	−0.281**	−0.389**	−0.284**	−0.353**	−0.124	−0.238*	−0.260*	−0.321**	−0.189	−0.231*	−0.234*	−0.253*	−0.272**	−0.347**	−0.104	−0.065	−0.006	−0.111	−0.045	−0.023	0.888**	0.715**	−0.613**
27‐Physical abuse	r	1	2	3	4	5	6	7	0.313**	0.283**	0.293**	0.390**	0.454**	0.463**	0.644**	0.596**	0.677**	0.437**	0.408**	0.366**	0.350**	0.304**	0.287**	−0.196	−0.132	0.282**
28‐ Sexual abuse	r								0.319**	0.333**	0.289**	0.273**	0.305**	0.348**	0.466**	0.420**	0.506**	0.349**	0.345**	0.383**	0.218*	0.216*	0.143	−0.274**	−0.237*	0.196
29‐Emotional abuse	r								0.325**	0.358**	0.360**	0.293**	0.327**	0.335**	0.547**	0.519**	0.509**	0.462**	0.396**	0.370**	0.310**	0.195	0.213*	−0.223*	−0.164	0.222*
31‐ Emotional neglect	r								−0.352**	−0.313**	−0.319**	−0.326**	−0.347**	−0.359**	−0.527**	−0.500**	−0.485**	−0.406**	−0.319**	−0.320**	−0.228*	−0.166	−0.174	0.273**	0.180	−0.166
32 Childhood abuse experiences total	r	0.33**	0.328**	0.330**	0.361**	0.412**	0.445**	0.603**	0.537**	0.650**	0.461**	0.446**	0.435**	0.317**	0.271**	0.227*	−0.199	−0.178	0.287**

^* p < 0.05; ^** p < 0.001.

The relationships between anxiety disorder and father's minor violence against self, anomie dimension, and emotional abuse were found to be significant at p < 0.05 level of significance in the direct direction and the relationships between harmony with nature dimension, spiritual total, and emotional neglect were found to be significant in the reverse direction. The relationships between hostility and father's psychological violence against self, father's minor violence against self, father's severe violence against self, mother's psychological violence against self, mother's minor violence against self, mother's severe violence against self, anomie dimension, physical abuse, sexual abuse, emotional abuse, and sum of childhood experiences were found significant in the right direction and the relationships between transcendence dimension, harmony with nature dimension, spiritual sum, and emotional neglect were found significant in the opposite direction at p < 0.05 level of significance.

The relationships between phobic anxiety and father's minor violence against him and anomie dimension, physical abuse, sexual abuse, emotional abuse, and sum of childhood experiences were found to be significant at p < 0.05 significance level. The relationships between paranoid thoughts and father's psychological violence against mother, father's minor violence against mother, father's severe violence against mother, father's psychological violence against self, father's minor violence against self, father's severe violence against self, anomie dimension, physical abuse, sexual abuse, emotional abuse, and sum of childhood experiences were found significant in the right direction and the relationships between emotional neglect were found significant in the opposite direction at p < 0.05 level of significance. The relationships between psychoticism and father's psychological violence against mother, father's minor violence against mother, father's psychological violence against father, father's minor violence against father, father's severe violence against father, mother's psychological violence against mother, mother's minor violence against mother, mother's severe violence against mother, anomie dimension, physical abuse, sexual abuse, emotional abuse, and sum of childhood experiences were found significant at p < 0.05 level of significance.

The relationships between BSI total score and father's psychological violence against mother, father's minor violence against mother, father's severe violence against mother, father's psychological violence against self, father's minor violence against self, father's severe violence against self, mother's psychological violence against self, mother's minor violence against self, mother's severe violence against self, anomie dimension, physical abuse, sexual abuse, emotional abuse, and sum of childhood experiences are in the right direction and the relationships between harmony with nature dimension, spiritual sum and emotional neglect are in the opposite direction p < 0.05 significance level.

The relationships between father's minor violence against mother, father's severe violence against mother and father's psychological violence against himself and spiritual total were found to be significant in the opposite direction at p < 0.05 level of significance. The relationships between father's minor violence against himself and anomie dimension were found significant in the right direction and the relationships between spiritual total were found significant in the opposite direction at p < 0.05 level of significance. The relationships between the father's severe violence against him and the anomie dimension were found significant at the p < 0.05 level of significance in the right direction and the relationships between the harmony with nature dimension and spiritual total were found significant at the p < 0.05 level of significance in the inverse direction. The relationships between the mother's psychological violence against herself and the dimension of harmony with nature were found to be significant in the opposite direction at p < 0.05 level of significance. The relationship between psychological violence of the mother against another person and spiritual total was found significant in the right direction at p < 0.05 level of significance. The relationships between father's minor violence against mother, father's severe violence against mother, father's psychological violence against self, father's minor violence against self, father's severe violence against self, mother's psychological violence against self, psychological violence of self against another person, and physical abuse, sexual abuse, emotional abuse, and childhood experiences total were found significant at p < 0.05 level of significance in the right direction and the relationships between emotional neglect were found significant at p < 0.05 level of significance in the opposite direction.

The relationships between physical abuse, total childhood abuse experiences and anomie dimension, emotional neglect and transcendence dimension were found to be significant at p < 0.05 significance level in the right direction; the relationships between sexual abuse and transcendence dimension, harmony with nature dimension, emotional abuse and transcendence dimension, anomie dimension were found to be significant in the opposite direction.

4. Discussion

The main purpose of this study is to examine the levels of mental distress, spiritual values, childhood abuse experiences, and conflict methods in women living in women's shelters due to the violence they experience from their spouses/families/environment. In this direction, the variables related to sociodemographic and violence experiences, mental distress, spiritual values, conflict methods, and childhood abuse experiences of women living in women's shelters were examined.

In line with the data obtained as a result of the literature review, although there are a sufficient number of studies on the frequency of violence against women, the psychological effects of this situation and childhood trauma experiences; it is noteworthy that there are insufficient studies evaluating the mental distress, spiritual values and conflict methods of women victims of violence staying in women's shelters (Arroyo et al. 2017).

4.1. Descriptive Characteristics and Experiences of Violence

According to Turkish Statistical Institute (TÜİK) data, 75% of literate women are primary school graduates. In our study, 73.9% of the women were primary school graduates, which is consistent with these data. Of the women, 69.6% were housewives, 16.3% were workers, 3.3% were civil servants, 3.3% were retired, 4.3% were self‐employed, and 3.3% were students. In Akyazı’s (2010) study, the rate of women working in a monthly income‐earning job was reported as 81%. In our study, the rate of women working in a monthly income‐generating job was found to be 87%. This finding is in parallel with Akyazı’s (2010) study. According to this result, we can say that women who do not have a financial income and who are dependent on their husbands prefer shelters more, and that women's economic dependence on their husbands may also be effective in their exposure to violence. It is seen that 51.1% of the women participating in the study have five or more siblings. This finding can be interpreted as women from large families are more exposed to domestic violence.

Among the partners of women who were subjected to intimate partner violence, 48.3% had alcohol abuse and 32.2% had alcohol and substance abuse. According to the results of the study conducted by Urhan (2013), it was determined that 54% of women who were subjected to violence had alcohol and substance abuse among their perpetrators. In another study conducted on this subject, it was found that the rate of men with alcohol and substance abuse to resort to violence was between 52% and 85%. Despite these data, it is not clear whether men's alcohol and substance abuse causes violent behavior or whether they use alcohol and substance abuse as a justification for their violent behavior. The women who participated in our study and whose husbands abused alcohol or substance abuse stated that their partners used violence against them after alcohol or substance abuse, which could reach the level of torture, whereas they were calm and did not use violence against them when alcohol or substance abuse was not present. According to our study, this result shows that alcohol or substance abuse leads to violent behavior. However, there is uncertainty about the reason that would lead these women's husbands to abuse alcohol or substances (Han et al. 2019; Crespo, Arinero, and Soberón ²⁰²¹).

According to the results of a study examining the relationship between exposure to violence and depressive symptoms of women aged 15–49 years, 32.9% of women stated that they were exposed to violence by their husbands; 64.8% of women who stated that they were exposed to violence stated that they were exposed to physical violence, 66.2% psychological violence and 14.8% sexual violence by their husbands (Cengiz and Deveci 2011). In our study, the rates of women's exposure to spousal or boyfriend violence were found to be higher compared to other studies. Especially, the rate of women exposed to sexual violence was found to be quite high in our study. The reason for this is that our study differs from community studies in that women expressed themselves without any legal or social concerns by being interviewed face‐to‐face in a trust‐enhancing environment and by conducting a systematic interview.

Exposure to violence can lead to the development of many mental disorders. Suicide attempts, depression, alcohol‐substance addiction, post‐traumatic stress disorder, aggressive behaviors, sleep disorders, eating disorders, conversion disorder, anxiety disorders, and dissociative disorders are frequently emerging mental problems in women exposed to domestic violence for a certain period (Sardinha et al. 2022). According to the findings of our study on the occurrence of mental disorders in women exposed to domestic violence, 64.1% of the women who participated in the study had at least one psychiatric diagnosis. According to the results of Akyazı’s (2010) study on mental disorders in women exposed to domestic violence staying in women's shelters, 76.3% of women victims of violence had at least one psychiatric diagnosis. We can think that exposure to domestic violence negatively affects mental health and prepares the ground for mental disorders that may occur later.

Another striking result of the violence experienced is that 37.0% of the women who participated in our study attempted suicide because they could not share the violence they experienced with anyone and could not cope with this trauma. 58.8% of these women stated that they attempted suicide once, 14.7% twice and 26.5% more than three times. It is stated that a woman who has been exposed to violence is more likely to attempt suicide than a woman who has not been exposed (Sardinha et al. 2022). Exposure to domestic violence increases the risk of self‐harm and renders the individual's coping skills inadequate.

60.9% of the women in the study had previous experience in a women's shelter. This finding shows that women leave their homes in order to try to reduce the violence they experience, but return to their homes, that is, to the environment of violence, either due to their husbands' request, their own, their children's or relatives' request, or financial difficulties. However, it is seen that leaving home does not have any preventive effect on domestic violence. Women in the process of divorce who stayed in the shelter due to violence stated that they had stayed in the shelter before to prevent their husbands' violent behavior, but that this did not work, and therefore the most effective way to avoid violence is to completely distance from the perpetrator. The reason why they prefer to stay in a women's shelter during this process is both for security and financial reasons and because they prefer a calm environment to make plans for the future.

According to the findings obtained in order to find out what has changed in the lives of the women included in the study after they started to stay in the shelter, most of the women have a positive perspective on women's shelters. The remaining negative evaluations may be related to the personal perceptions of the individual, as well as the difficulties of living together with many women, limited physical facilities, being affected by other women's stories of violence, or being affected by the behavior of women with serious psychiatric disorders.

4.2. BSI and SWBS Relationship

In the study, a statistically significant relationship was found between BSI and SWBS scores. This shows that practicing spiritual beliefs and practices and seeing them as a source of strength in coping with problems reduces symptoms of obsessive‐compulsive disorder, interpersonal sensitivity, depression, anxiety disorder, hostility, phobic anxiety, paranoid thoughts, and psychoticism in women. The women did not receive family or social support in their despair. It is thought that spiritual beliefs and practices (such as connecting to the divine power, fulfilling religious practices, living in harmony with nature, living in harmony with nature, trying to cope with difficulties with prayer and worship) contribute positively to the mental state in order to maintain mental balance, gain coping skills, increase self‐esteem and change perceptions about the traumatic situations experienced. The study conducted by Humphreys (2000) on women victims of violence staying in a shelter is consistent with our study. According to the results of the study, it was found that obsessive‐compulsive, interpersonal sensitivity, and hostility subdimension symptoms decreased in women with higher spiritual scale scores (having stronger or more frequent spiritual beliefs or practices) (Humphreys 2000).

4.3. CTS and SWBS Relationship

In the study, a statistically significant relationship was found between CTS and SWBS scores. Based on this finding, we can think that the individual who witnesses and is exposed to violence more in childhood gives less importance to spiritual beliefs and practices and directs his coping skills to different practices and even falls short. In this sense, we can say that women use different options instead of spiritual beliefs and practices in order to cope with violence and feel more peaceful. At the same time, it can also be thought that growing up in an environment of constant violence and being exposed to it causes women to rebel against the divine power they believe in, to move away from religious practices, to think that the values and divine power they believe in are unfair to them, to not enjoy life, to always be the wronged party in life, and therefore to move away from their spiritual values. In Humphreys' (2000) study, which is similar to our study, no significant relationship was found between the intensity of the experience of being exposed to violence, that is, the mean score of the conflict methods scale (CTS) and the mean score of the spiritual scale (SPS). This may be related to the small sample size in the study.

As can be understood from the research examples given and the comments of the women in our study, violence has a significant impact on psychopathology. Women who have been subjected to intimate partner violence are mostly women who were exposed to domestic neglect and abuse in their childhood and witnessed their father's violence against their mother. The women in the women's shelter who participated in the research either have severe mental disorders or are undiagnosed but have symptoms of mental disorders. Continued exposure to violence increases the symptoms of mental disorders, leads to divorce and increases the duration and number of women's shelter stays. According to the study, women accepted that being subjected to violence and accepting the situation is a worse situation, instead of the perception that divorce is a bad thing that they have seen from their families. For this reason, they have tried to get rid of violence by resorting to solutions such as accommodation in women's shelters and divorce from the perpetrator of violence in order to get rid of the violent behaviors they have been experiencing since the past. At the same time, a great majority of the women stated that they took refuge in their spiritual values in order to get rid of these traumatic situations and minimize their negative effects. For these women, the most important way of coping with difficulties is their beliefs and values. They stated that they found solutions in this way and that they would start a new and peaceful life with their children. In this sense, supporting the spiritual values of these women in women's shelters is of great importance in terms of reducing the significant effects of violence and increasing their coping.

5. Conclusions and Recommendations

Increased educational attainment and women's employment prevent economic dependence on their husbands. This situation was found to reduce women's exposure to spousal violence. It was found that women whose partners abused alcohol or drugs were more likely to be subjected to violence than women whose partners did not abuse alcohol or drugs. It was found that most of the women who were exposed to violence also experienced neglect and abuse during childhood. This rate was found to be significant and high in the variables of age, number of marriages, duration of marriage, psychiatric disorder and treatment status, and number of stays in shelters. In addition, giving importance to spiritual beliefs and practices and practicing these practices were found to reduce the symptoms of mental disorders in women exposed to violence. In line with these results obtained from the study, psychiatric nurses have important roles and responsibilities. In this context, women should be supported in terms of employment, psychiatric physicians and nurses specialized in psychiatry should be present in women's shelters in order for psychiatric support systems to be more professional, women should be evaluated by a single specialist in order to cope with their mental problems and privacy should be given more importance. In addition, women should be given the opportunity to express their spiritual beliefs and practices, a ground should be prepared to support women in carrying out their practices without criticizing them for these values, and the physical environment should be arranged if necessary. In the future, it may be recommended to plan studies with larger samples and even covering all women's shelters in order to reach more information about the difficulties experienced by women victims of violence, to make interventions to provide rehabilitation and to evaluate their effectiveness. It is also important to review and reorganize the legal sanctions imposed on perpetrators of violence against women.

In addition to all these, it may be recommended to plan longer‐term services to increase rehabilitation and adaptation in the community, to provide group therapies by experts if necessary, and to increase the number of women's shelters, especially for this group with low economic and educational levels, limited social support resources and high rates of mental disorders. Women also need to be supported in building or recovering their spiritual values rather than using ineffective coping methods. It is also important that children staying with their mothers in women's shelters are provided with individual support, education and rehabilitation services under the guidance of child psychiatrists. Since a limited number of women were reached, it is recommended that future studies with larger samples and even including all women's shelters should be planned. In this context, it may also be recommended to reach more information about the difficulties experienced by women victims of violence, to carry out interventions to provide rehabilitation and to evaluate their effectiveness.

5.1. Limitations of the Study

This study is limited by not forming a comparison group with women who are not in women's shelters or who have not experienced violence. The study constitutes a small sample of women who have been subjected to violence, as it includes women victims of violence who have stayed in women's shelters for at least 15 days. As a result of the literature review, the reason for the criterion that the women included in the study should have resided in the women's shelter for at least 15 days is to minimize the psychological distress findings that may occur due to coming to the women's shelter in an emergency crisis situation.

Author Contributions

Elif Güzide Emirza: Conceptualization, methodology, analysis, writing original draft, review and editing; Nermin Gürhan: Conceptualization, methodology, collect data. All authors meet the criteria for authorship, have approved the final article and that all those entitled to authorship are listed as authors.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.