Special Edition: Junior Clinical Research (2023), Vol. 3 No. S2 https://doi.org/10.47488/dhrp.v3iS2.87 DHR Proceedings ǀ http://dhrproceedings.org 33 2023, Vol. 2 No. S2 33-39 COMMENTARY The Long-Term Impacts of Domestic Abuse on Hispanics in their Teens Nick A. Costilla1,2, Mireya J. Eligio1,2, Hector Jalomo1,3, Debra L. M. Limon1,3, Leyla A. Medrano1,2, Valeria J. Muniz1,3, Mariah Perez1,3, Isabelle L. Perez1,3, Melissa Sosa1,2, Heidi A. Vazquez1,2, Savannah S. Villarreal1,2 1 3rdAnnual Junior Clinical Research Internship, South Texas Academy for Education & Training in Research, DHR Health Institute for Research and Development 2 Los Fresnos High School, Los Fresnos, TX 3 San Benito High School, San Benito, TX Received: June 29, 2023 Accepted for publication: September 26, 2023 Published: November 16, 2023 Introduction Domestic violence/abuse affects an estimated 10 million people every year, yet it is one of the least reported incidents.1 Domestic abuse includes maltreatment economically, sexually, physically, emotionally, and psychologically.1 Although awareness for victims of domestic abuse has been on the rise, awareness in the Hispanic community has been at a constant low. In the Hispanic community, cultural and religious practices create a greater challenge for people who want to reach out about the abuse they are experiencing. Machismo and familismo are two examples of cultural standards that prevent many from reaching out and reporting abusive situations.2 Studies also show that lower education levels correlate to a higher risk of domestic violence.2 Additionally, witnessing and experiencing abuse in childhood has been associated with becoming a perpetrator of domestic violence.1 Awareness, education, and self-help has been shown to be an effective countermeasure for domestic abuse; therefore, knowledge on the long-term impacts of domestic abuse is important to disseminate among Hispanic teens. Factors Leading to Domestic Abuse Hispanics reported higher rates of intimate partner violence. A majority of Hispanics have suffered partner violence (58%). In contrast 52% of African American and 37% of Caucasians have had this experience.3 Many social, cultural, and external factors can lead to increased risks of witnessing domestic abuse in a Hispanic household.4 This can include the socioeconomic status of both wife and husband, normalized cultural aspects such as the practice of “machismo,” or recurring substance abuse. Socioeconomic Status and Stress The socioeconomic status of the head of household, especially if it is a male of low socioeconomic level, can lead to an increased risk of domestic abuse.3 This can include measures of income, education, or type of employment. An unemployed father will show a higher propensity for domestic abuse and can result in stress upon their families.5 Hispanic households in which the wife and children are economically dependent on an abusive father can present a difficult situation to escape from. The status of residency or citizenship can also influence outcomes. Many recently arrived Hispanics in the United States show lower levels of acculturation, meaning they are reluctant to adopt the United States’ ways of living. This can bring stress to the family as economic and social marginalization diminishes their initial optimism about moving to the United States. Immigrant wives will show great reluctance in reporting cases of domestic abuse out of fear of deportation or from facing language obstacles. Special Edition: Junior Clinical Research (2023), Vol. 3 No. S2 https://doi.org/10.47488/dhrp.v3iS2.87 DHR Proceedings ǀ http://dhrproceedings.org 34 2023, Vol. 2 No. S2 33-39 Machismo and Modesty The wife and husband in a Hispanic family have distinct roles and expected attitudes that influence their behaviors. Typically, the father of the family is prone to following the expectations of a “machismo” culture, which can include both positive and negative traits.6 On a positive note, “machismo” encourages the role of a protector and leader of the family, having the father take the responsibility of providing financial strength and support. However, the toxic aspects of “machismo” can force a Hispanic father to feel the need to prove his “manhood,” especially in the presence of other men. This can lead to alcohol dependence, abuse geared toward their wife and children, and a lack of sufficient emotional expression.6 As for the mothers in Hispanic families, there is a large trend of “modesty” in communication that can diminish their ability to report cases of personal experience with domestic abuse. Leading male figures in the Hispanic family are usually trusted most with ultimate decision-making. Additionally, Catholic beliefs and the want to maintain social respectability will make the wife more reluctant to report cases of domestic abuse.6 In the context of recent immigrants, there are many actions towards the preservation of cultural traditions from their home country, also known as, la crianza que nos han dado - “The upbringing/legacy that they have given us”.7 This can make it more difficult to acknowledge and escape abusive relationships, particularly when immigrants stray from divorce or separation. Impacts of Direct and Indirect Abuse Domestic abuse is a behavioral pattern where an individual tends to overpower or control another individual within a relationship with emotionally and physically harmful trends.8 Therefore, there can be different types of domestic abuse, indirect and direct. Direct domestic abuse includes physical and/or sexual assault, while indirect abuse may include witnessing abuse and/or being neglected.9 Individuals who experience any type of abuse, both direct and indirect, are more susceptible to depressive disorders. In a case study looking at the association of gender differences and on-set depression, about 5.7% of the individuals met the criteria for diagnosed depression by the age of 18.10 Within this study, 26% experienced direct abuse, and 13.2% experienced indirect abuse. Moreover, data analysis have shown that children that live in a household with domestic violence are more susceptible to experiencing physical, sexual, and emotional abuse later on in their life.11 Domestic violence can to lead to posttraumatic stress disorder, substance abuse, and more difficulty with relationships.12 In addition, there are some physical impacts on domestic abuse victims, such as having difficulty eating, sleeping, and physical complaints such as headaches. Victims also tend to lose interest in social activities, school, and tend to have lower self-esteem. Mental health can also be impacted with some reporting anxiety, depression, and posttraumatic stress disorder. This has also caused an influx of domestic violence victims who struggle academically, drop out of school, and/or turn to delinquency. Stigmatization & Generational Trauma Stigmatization involves categorizing a trait or characteristic as undesirable and associating negative beliefs or attitudes towards the persons or group that express that trait. The weight of stigma is carried by those experiencing and discussing difficult topics, including domestic violence and mental health. Approximately 95% of all residents of the Rio Grande Valley are Hispanic and it is known that ethnic minorities have a higher propensity to associate personal stigma with mental health disorders and domestic violence and therefore, may choose not to seek help or treatment.13,14 This is due to the fear of being perceived as being crazy or weak and can lead teenagers to feel incapable of expressing their psychological struggles. Other reasons for hesitation to receive treatment in the Hispanic community are language barriers, fear of deportation, and financial struggles.15 Furthermore, it is shown in studies that Hispanic children who come into contact with domestic violence are more likely to endure poor health.16 This kind of domestic abuse can be extremely traumatic and can have long-term effects on a child’s life. Some forms of domestic abuse experiences would be witnessing and enduring physical abuse or going through emotional abuse. This could lead to normalizing the idea of domestic abuse and creating an idea that it is acceptable in a family and/or relationship dynamic.17 The Hispanic community is one of the most underrepresented cultures when it comes to mental health and receiving help. Statistically, approximately 33% of Hispanics receive treatment compared to the national average of 43 %.18 This is due to the stigma Special Edition: Junior Clinical Research (2023), Vol. 3 No. S2 https://doi.org/10.47488/dhrp.v3iS2.87 DHR Proceedings ǀ http://dhrproceedings.org 35 2023, Vol. 2 No. S2 33-39 that Hispanics, especially men, have towards mental health. Mental Health Research has shown the general population is less likely to suffer from mental health disorders than victims of domestic abuse.19. Psychological, physical, and sexual violence are the three most experienced abuse in teens.12 Abuse in adolescents results in cognitive, emotional, biological-based, and behavioral responses. Generalized anxiety disorder (GAD) is a common mental disorder that can arise after domestic abuse. Teens are more prone to show a decline in social activities, self-esteem, and avoidance compared to common GAD symptoms. Another common mental disorder that results from domestic abuse is depression. It is a mental illness that affects the way we feel negatively and involves feelings of sadness, hopelessness, worthlessness, and emptiness. If left untreated, depression can lead to a high risk of suicidal ideations and substance addictions.20. In Hispanic adolescents from 12-17 years old, major depressive order episodes have increased from 12.6% to 15.1% in 2015-2018.15 Suicide is the 3rd leading cause of death in the Hispanic community between the ages of 10-24 and in men 25-34.21. Studies show 15-71% of women have experienced domestic abuse in the form of physical or sexual abuse.22 In the year 2019, it was reported that Hispanic teenagers in high school had reported feelings of sadness and hopelessness for more than 1 daily occurrence, which showed drastic increases from the statistics that were previously recorded in 2017.23 Post-traumatic Stress Disorder (PTSD) can also be a result of domestic abuse. The likelihood of PTSD increases after a domestic abuse event, though its effects can be mitigated through seeking emotional support.24 It is reported that 13-50% of youth exposed to domestic abuse qualify for PTSD diagnosis.25 Symptoms are normally defined as avoidance, arousal, and reliving the events. Symptoms are mostly dependent on the age group of the person. Adolescent symptoms include insomnia, aggressive behavior, academic challenges, and the standard response to PTSD. Coping Mechanisms It is rare to see Hispanics admit to their mental health issues, let alone seek help. Only 22 percent of Hispanic or Latin Americans have had their mental illness recorded in an institution.21 While the logical move is to find healthy strategies to move forward, many Hispanic teens tend to fall into unhealthy coping mechanisms. One of them is to suppress their feelings, especially adolescent males.26 This can be related to the previously mentioned theory of “machismo” that perpetuates the idea that Hispanic males must maintain a sense of supremacy, sexism, and restrained emotions.26 If they were to show emotion or speak up about how they feel, they are then considered weak and want to avoid disappointing their families. Hispanic female teens may suppress their emotions to avoid being labeled as “dramatic.” Another unhealthy coping mechanism is to turn to drugs and alcohol as an escape from their reality.27 The number of reported rates for Hispanic or Latino Americans was 19.4% for illicit drug and 15.7% for substance use disorder.21 Even though that’s not the route they should be taking, as they grow up, hiding all the hurt and trauma they experienced can lead to these negative coping mechanisms. Fortunately, there are also healthy coping mechanisms that teens can adopt to deal with the abuse they experienced. Teens can choose to turn the page on their life and look at it from another perspective and lean toward a more positive recovery.28 One healthy coping mechanism is setting boundaries. As adolescents age, they reach a point where they will no longer endure what they aren’t comfortable with and choose to build new, secure relationships in order to have an adequate healing process. Many will also receive the treatment for the mental health disorders that have resulted from the abuse as well as treatment for the abuse they experienced. Treatments The effects of domestic abuse on any individual can leave serious mental, physical, and emotional marks. Similarly to other conditions, treatment rather than avoidance is recommended for victims to process and handle the impact abuse has had on their life. Social workers from Mayo Clinic suggest the main treatments for victims are therapy, classes, and shelters.29 They explain how to counsel a survivor of domestic abuse by first analyzing the impact the trauma had on the victim and then by providing counseling correlating to the impact. For instance, one of the types of responses a victim may have is the avoidance response. The avoidance response is when the victim dissociates in situations or responds with neutral responses.30 This response can cause a greater cause for concern because it can lead to difficult Special Edition: Junior Clinical Research (2023), Vol. 3 No. S2 https://doi.org/10.47488/dhrp.v3iS2.87 DHR Proceedings ǀ http://dhrproceedings.org 36 2023, Vol. 2 No. S2 33-39 resolution and post-traumatic stress disorder, PTSD. Another common response is dysregulation, which refers to the inability to control emotions and display of a wide range of emotions in short periods of time. Therapists or counselors should approach avoidance and dysregulation by slowly developing a tolerance to the abusive memories in order to create a less stressful environment when reminded of them.30 Additionally, there are certain classes can help the victim by bringing awareness to the different types of abuse and how to respond in these situations. The classes can also bring light to the structure and cycle of abuse with the intention of preventing future occurrences of abuse. Individuals from the National Network to End Domestic Violence, NNEDV, have explained that victims of domestic abuse often remain in the same housing where the abuse takes place due to financial and housing situations. Thus, shelters often become a safe haven and a necessity to take the victim out of the difficult situation.31 NNEDV has recognized this urgency and created a safer community within temporary and transitional housing.31 Organizations with similar goals to treat and support victims of domestic abuse have increased awareness throughout the United States. However, the availability and accessibility for Hispanics should be examined.27 Awareness Barriers to Accessing Resources While awareness campaigns and resources are meant to help the victims abandon their violent homes, there are obstacles that the victims face in order to make use of the resources. For example, the abuser can use threats and create an ultimatum to get victims to be silent about the abuse.1 It is common for abusers to use warnings such as the threat of informing authorities about the victims' undocumented immigration. This discourages domestically abused young Hispanics from looking for essential help and resources.1 Language Barriers to Accessing Resources While according to Pew Research Center, more than 20% of young Hispanics are dominantly Spanish speaking.27 This makes it important to bring attention to the language barrier the youth Hispanics could and are going through. With the majority of domestic violence awareness campaigns in the United States produced in the English language, they become ineffective for Spanish-speaking teens who cannot successfully understand the language.32 Furthermore, healthcare providers should communicate with patients in their native language whenever possible.2 While some studies show that healthcare workers may display an unconscious bias when treating non-native English speakers, there are studies that show bias is decreased once the healthcare provider was aware of the bias.32 Domestic Abuse in Hispanics Hispanics make up approximately 19% of the population in the United States. Of those Hispanics, the states with the highest Hispanic population are California, Texas, Florida, New York, and Arizona which places 3rd highest in domestic abuse in America.33 In Texas, 40% Hispanic females and 35% males have experienced some form of domestic abuse including intimate partner violence, rape, or stalking.33 Resources There are several resources available to people who are victims of domestic violence and require assistance. The Domestic Abuse Hotline is a 24/7 and multilanguage resource available to those who need help.34 There are also hundreds of shelters, online supporting research, and websites to help support survivors of abuse. The Domestic Violence Evidence Project is an online resource center that is designed to help state coalitions, local domestic violence programs, and researchers with the information needed to collaborate and combat domestic violence in their communities.35 The Project is focusing on a plan called “The Theory of Change” that describes the framework for how the work of domestic violence programs help rehabilitate and improve survivors and children of survivors with an 8- factor and 3-step plan. The 8 factors are self- sufficiency, hopefulness, social connectedness, safety, having adequate social and economic opportunities, economic stability, enhanced justice, and good physical, emotional & spiritual health. The 3-step plan consists of Program Activities, Program Outcomes, and Factors Predicting Well-being.35 Additionally, there are also multiple shelters for victims, although there are a higher number of shelters for women rather than men.36 Conclusion Reporting domestic abuse and violence has always been a struggle for victims. Taking a closer look at standards, stigmas, culture, religious beliefs, Special Edition: Junior Clinical Research (2023), Vol. 3 No. S2 https://doi.org/10.47488/dhrp.v3iS2.87 DHR Proceedings ǀ http://dhrproceedings.org 37 2023, Vol. 2 No. S2 33-39 and fears in the Hispanic and Latinx communities, we have been able to dissect the struggles Hispanics face when it comes to reaching out or seeking help. Abuse, whether direct or indirect, experienced by children in Hispanic households has both immediate and long- term effects. Domestic abuse leads to mental, emotional, and, many times, physical damage that can last a lifetime. Physical scars, PTSD, anxiety, depression, and other disorders are at an increased chance of being developed in the victim’s future. The development of abuse on oneself at a young age may cause them to reciprocate the action on others in the future, otherwise known as the cycle of abuse. Growing research suggests that exposure to abuse leads to an increased risk of abuse in future relationships as well.37 Additionally, language barriers and political fears result in a decrease in reports; however, there are many treatments and coping mechanisms available, both positive and negative. Therapy, medication, setting boundaries, have shown encouraging outcomes in victims during and after experiencing abuse. More awareness of the effects of domestic abuse on Hispanics in their teens is greatly needed to understand the issues that prevail all around us. Addressing these issues will lead to positive changes in the lives of survivors and their families. Acknowledgements Monica Betancourt-Garcia, MD, Program Director; Melissa Eddy, MS, Program Manager Funding Funded by DHR Health Institute for Research & Development; DHR Health; Region One ESC GEARUP College Ready, Career Set!; Region One ESC GEARUP College Now, Career Connected; Region One ESC PATHS; Region One ESC Upward Bound Math & Science; Benavides ISD; and Jubilee Academy-Brownsville References 1. Huecker MR, King KC, Jordan GA, Smock W. Domestic Violence. 2023 Apr 9. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 29763066. 2. Abuse in the Latinx Community. The Hotline. https://www.thehotline.org/resources/abuse- in-the-latinx-community/ 3. Cummings AM, Gonzalez-Guarda RM, Sandoval MF. Intimate Partner Violence Among Hispanics: A Review of the Literature. J Fam Violence. 2013 Feb 1;28(2):153-171. doi: 10.1007/s10896-012- 9478-5. PMID: 23606787; PMCID: PMC3627727. 4. Soler H, Vinayak P, Quadagno D. Biosocial aspects of domestic violence. 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