Ethiopian battered women in shelters: The contribution of characteristics of violence, one's life events and personal and social resources to the variation of mental distress

Intimate partner violence against women is a social phenomenon that exists all over the world (United Nations general assembly, 2006). In Israel, intimate partner violence exists on a large scale and occurs in all segments of the population (Eisikovits, Winstok & Fishman, 2004). One of the populations for which a high prevalence of intimate partner violence is estimated is the Ethiopian immigrant community. Accordingly, across shelters for victims of violence, it was found that high percentage of women staying in those shelters in Israel are Ethiopian (Koch- Davidovich & Almgor-Lutan, 2012).  The literature on victims of intimate partner violence indicates that the violence affects women in many aspects of her life, one of which is mental health. The most common mental disorders in female victims of violence are post-traumatic stress and depression, as such, there are many studies dealing with the subject (Walker, 1994; Golding, 1999  Jones, Hughes & Unterstaller, 2001). However, there are not many studies that examine the unique profile of the population of female victims of violence from Ethiopia. In view of lack of studies specific to the Ethiopian profile, this work conducts a comparison study of female victims of violence in Israel, comparing Ethiopian immigrant women with Jewish women born in the country.  The study focuses on variables related to characteristics of violence and levels of post-traumatic stress and depression, in addition to variables of life events and personal and social resources of women, as detailed below.
The present study was based on the Conservation Of Resources Theory, according to which, psychological stress is generated due to loss of resources, or the threat of such loss and due to the difficulty of the individual to regain resources lost over their lifetime (Hobfoll, 1998; 2001). Taking into account the impact of immigration on a person's ability to maintain their resources, the study also used a theoretical model called The Resource-Based Model of Migrant Adaptation, according to which the psychological distress of immigrant is assessed by taking into consideration the course of life prior to and during migration in addition to the loss of resources experienced post-migration (Ryan, Dooley & Beneson, 2008). The variables of difficult life events, sense of control and ability to obtain support were selected as an expression of the immigration process and the personal and social resources of the woman post-migration. 
In order to meet the aim of the research and establish a preliminary profile of the unique characteristics of female victims of violence from Ethiopia, the differences between Ethiopian immigrant women and Israeli-born women were examined according to the variables mentioned above (characteristics of violence, levels of post-traumatic stress and depression, difficult life events, sense of control and obtaining support). The associations between the characteristics of the violence, life events and resources and psychological distress were also examined and a comparison regarding the relationships found in each group was made. The study also examined whether personal and social resources intermediated between the characteristics of the violence and life events and women's mental distress. In addition, regression analysis was conducted on the variable of post-traumatic stress.
The study population included 80 Ethiopian women and 153 women who were born in Israel, all of them residing in shelters across the country. The data was collected as part of a larger research project conducted by Dr. Anat Ben-Porat, Prof. Rachel Dekel and Prof. Haya Itzhaki of Bar Ilan University, a project that included the distribution of questionnaires to women entering shelters. The questionnaires were translated into Amharic and illiterate women were offered an interpreter. The research questionnaires included a demographic questionnaire compiled by the research team and questionnaires to examine the study variables, i.e. the severity of violence (Eisikovich et al., 2004), the sense of danger to life, PTSD (Solomon & Horesh, 2007), depression (Derogatis, 1992), life events (Solomon, 1995), sense of control (Hobfoll & Wolfish, 1984), social support (Sokolne & Manor, 2009) and family support regarding the violence.
According to the findings of the study, differences were found between the two groups in a number of variables.  The sense of danger to life was higher among Ethiopian women, while post-traumatic stress, life events and level of social support were lower in comparison to Israel-born women. In contrast, no significant differences were found in the other variables tested, i.e. frequency of violence, depression level, family support regarding violence and sense of control of life. In addition, there were no differences between the groups in the strength of the connections between the different variables and mental distress. Regarding the entire study population, many connections were found between the variables. All types of violence (physical violence, psychological violence, threats and frequency of violence in all), as well as woman's sense of danger and life events, were associated with post-traumatic stress level. However, only psychological violence has been linked to the level of depression. The sense of control of life and obtaining social support were found to be associated with levels of depression and post-traumatic stress. Personal and social resources were found to be a meditating variable between violence and mental distress. While social support was found to be a mediating variable between the frequency of violence and the level of depression, the feeling of helplessness (one of two measures of a sense of control) was found to be a mediating variable between frequency of violence and levels of both post-traumatic stress and depression. Finally, regression analysis showed that the variables that contribute to explaining the variance of post-traumatic stress are the country of origin, the frequency of violence and sense of control, in particular the feeling of helplessness as a key component of a sense of control.
The findings indicate that the population of Ethiopian-born female victims of violence differs from the population of the Israeli- born women, with regard to some of the variables tested. Some of which confirm existing knowledge in the field and some of which contradict the existing literature. The results of this study highlight the need to address Ethiopian female victims as a separate and distinct group, as well as the need to continue to explore the unique characteristics of this group so as to understand their meaning in depth. Unique qualities arising from this study stand out, for example, the background variables that indicate that, compared with Israeli –born, more of the Ethiopian women said that they were married, and defined themselves traditional or religious, and in addition the level of education of Ethiopian women was lower than those born in the country. Also prominent is the high level of the sense of danger and the low level of obtaining social support in the Ethiopian sector compared to native-born Israelis. The findings highlight the need for unique planning interventions for Ethiopian women, as of adjusting the conditions provided in shelters to address the unique cultural characteristics of women of Ethiopian origin, through building a protection plan for high-risk situations and interventions, to future planning interventions that should include targeted recruitment of men to create exit strategies from the cycle of violence to the entire family.  There should also be a strong emphasis on developing and strengthening systems of community-based social support services available for female victims of violence among the Ethiopian community in Israel.
At the same time, the findings of the study reveal that there are many characteristics common to all women victims of violence, findings that highlight the strength of emotional experience and the effects of violence on victims coming from different countries and cultures. As in previous studies, the scope of psychological stress to female victims of violence stands out, as well as the low level of women's resources (personal and social resources and material resources, measured through monthly income of women). We must continue to develop the services provided to female victims of violence, services that are specifically tailored to the needs of women. In addition to providing financial assistance and professional training for women, the care provider should undergo training in the treatment of post-traumatic distress and depression, with an emphasis on working with women's sense of Self-efficacy and building social support systems. This conclusion is true both for the women who were born in the country and for Ethiopian women, however, there needs to be a distinction drawn between the groups which takes into account sensitive cultural characteristics.  Those distinctions should not simply be based on Prejudices but should be developed through specific research knowledge, as mentioned above. 
In summary, despite its limitations, this study's importance and uniqueness are found in its focus on a specific population, of which the current research knowledge is insufficient. Consequently, the research findings open the door to professionals assisting female victims of Ethiopian origin to work in an adjusted manner and thus more effectively help Ethiopian-born women escape the cycle of violence and to improve the quality of their lives and the lives of their families. While there is no doubt that the information obtained by this study is preliminary, it does indeed highlight the need to continue to develop these preliminary findings through further research.