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One goal of this paper is to present an integrated tripartite model of violence, with a focus on structural violence within an oppression paradigm. Using qualitative and quantitative data from 27 women (70% African American and 30% European American) who participated in a national substance abuse treatment demonstration program, we describe a model of violence in which structural violence is presented within a transactional relationship with interpersonal, and intrapersonal violence. We suggest that the effects of structural, interpersonal, and intrapersonal violence are magnified when race and poverty are considered. The second goal of the paper is to present a preliminary test of the new model of violence. Results indicated that different levels and types of violence are interrelated. Implications of these findings for empowering solutions are suggested.

SUMMARYThe objective of the study was to determine the prevalence of depressive symptoms in African American medical clinic patients age 50 and older and to describe the presentation of depressive symptoms in this sample. Consecutive, consenting, African American patients age 50 and older in active treatment at a University Hospital medical clinic were screened for the presence of depressive symptoms with the Center for Epidemiologic Studies Depression Scale (CES-D). Thirty-two per cent of the 66 patients comprising the sample had scores of 16 or higher on the CES-D. Based upon a clinical interview using the DSM-111-R checklist, 11% (seven patients) had affective disorders and were referred for psychiatric evaluation. Although 33% ( N = 22) of the sample reported that they had 8 years or less of formal education, 62% (N=41) were found to have a current reading level of seventh grade or less. These data demonstrate that the levels of depressive symptoms among medically ill, African American medical clinic patients with two or more medical illnesses are higher than reported for medical clinic samples composed of white Americans or of mixed racial subjects. Unless current reading levels are assessed, functional illiteracy and the patient's inability to provide informed consent based upon reading material may be missed.

The authors examine the narratives of 24 substance-addicted welfare recipients to understand how their neighborhoods provide a particular context for substance abuse, violence, and social isolation. The authors also examine the relationships among substance abuse, violence, and social isolation. Overall, these narratives indicate that place of residence influences one’s social networks and exposure to drugs, which subsequently influence women’s experiences with substance abuse and domestic violence. The authors suggest a cohesive framework for understanding women’s experiences, that of structural violence as experienced through neighborhood living conditions, which fosters social isolation and vulnerability to long-term drug use and domestic violence.