Public Health, Environmental and Occupational Health, Health (social science), Social Sciences, Gender Studies
47
Scopus Publications
Scopus Publications
Technology-facilitated sexual violence against women and its health impact: a mixed-methods systematic review Vivian Benítez-Hidalgo, Guadalupe Pastor-Moreno, Isabel Ruiz-Pérez, Sua Amaya-Santos BMC Public Health, 2026 Technology-facilitated sexual violence (TFSV) is a significant public health issue, profoundly impacting women’s health. This systematic review aimed to synthesize evidence on the association between TFSV and mental and physical health in women aged 16 years and older. Following PRISMA guidelines, a systematic search was conducted across seven databases (CINAHL, Embase, PubMed, PsycINFO, Web of Science Core Collection, Scopus, and Sociological Abstracts) up to May 2025. The protocol was pre-registered in PROSPERO (CRD420251053409). Data synthesis was conducted using a mixed-methods approach, specifically a convergent segregated design, in which quantitative and qualitative evidence were analyzed separately and later integrated during the interpretation phase to provide a comprehensive understanding of TFSV’s impact. Across 21 studies (17 quantitative, 3 qualitative and 1 mixed-methods) from 11 countries, quantitative research consistently linked TFSV exposure to depression, anxiety, post traumatic stress disorder (PTSD), stress, and negative feelings or perceptions about one’s own body, capturing the prevalence and magnitude of these outcomes. Most quantitative studies were cross-sectional, limiting insight into long-term effects, and reported effect sizes were generally small to moderate. This review additionally highlighting that very few studies isolated the unique effect of TFSV from co-occurring forms of violence. Qualitative studies complemented these findings by detailing the enduring emotional and relational consequences of TFSV, including shame, guilt, loss of control, social isolation, and difficulties in intimate relationships, as well as coping strategies such as social support, activism, and selective digital withdrawal. This review provides evidence that TFSV is significantly associated with adverse mental health outcomes, challenging the misconception that it is less severe than offline violence. It underscores the need for clearer analytical approaches to isolate TFSV from other forms of violence and highlights critical gaps in research on physical health impacts. Evidence on physical health outcomes was scarce, with few studies reporting small associations with somatic symptoms, medication use, or general health, underscoring a critical gap in the literature. This evidence should inform public health responses, policy, and support services to address this pervasive form of structural violence.
Drug-Facilitated Sexual Assault Pornography and Sexual Violence While Partying: Cross-Sectional Study Pablo Prego-Meleiro, Guadalupe Pastor-Moreno, Irantzu Recalde-Esnoz, Luis Sordo Jmir Public Health and Surveillance, 2026 Background Drug-facilitated sexual assaults (DFSAs) in youth partying contexts represent a growing public health concern, affecting approximately half of women and 1 in 4 men. These assaults often occur in environments where alcohol and other psychoactive substances are consumed, leading to impaired consent and increased vulnerability. At the same time, young people are increasingly exposed to pornography, often using it as a primary source of sexual information. However, pornography can disseminate misleading or harmful messages about sexuality and consent. Of particular concern is a subtype of pornographic material (hereafter referred to as DFSA pornography) that depicts nonconsensual sexual acts involving individuals who are asleep, unconscious, or under the influence of psychoactive substances, including alcohol and other drugs. Objective This study aimed to examine the prevalence of DFSA pornography consumption among young adults in Spain and analyze its association with self-reported DFSA perpetration and victimization in party settings. Methods A cross-sectional online survey (computer-assisted web interviewing) was conducted among individuals aged 18 to 35 years residing in Spain. Participants (N=1601; n=1534, 95.8% valid responses) were recruited from a certified online panel using quota sampling stratified by sex, age group, and region to ensure national representativeness. The questionnaire was adapted from the Sexual Experiences Survey–Short Form Victimization and the Spanish Macro-Survey on Violence Against Women. It assessed DFSA perpetration and victimization in partying contexts under the influence of alcohol or drugs. A specific variable, DFSA pornography, was created to measure intentional viewing of explicit sexual content depicting unconscious or intoxicated individuals. Additional sociodemographic variables included sex, age, educational level, sexual orientation, political ideology, nationality, and socioeconomic level. Descriptive, bivariate, and binary logistic regression analyses were performed, estimating associations between DFSA experiences and both general and DFSA pornography consumption. Results Among respondents (800/1593, 50.2% female participants; mean age 27.0, SD 5.1 years), 78.4% (1233/1572) identified as heterosexual, and 52% (825/1587) held a university degree. Overall, 66.6% (1013/1521) reported consuming pornography in the previous year, with higher prevalence among male participants (638/753, 84.7%) than among female participants (370/762, 48.6%). DFSA pornography consumption was reported by 22.2% (167/753) of male participants and 11.3% (86/762) of female participants, and increased with overall pornography use frequency. Multivariate logistic regression indicated that DFSA perpetration (adjusted odds ratio 3.78, 95% CI 1.72-8.28; P<.001) and victimization (adjusted odds ratio 1.86, 95% CI 1.24-2.78; P=.003) were associated with DFSA pornography consumption. Conclusions The findings reveal an association between exposure to DFSA pornography and both DFSA perpetration and victimization among young people in Spain. These results underscore the need for comprehensive sexual education that critically addresses pornography as a source of misinformation, emphasizing accurate understanding of consent and substance-impaired sexual activity. Public health strategies should integrate media literacy and consent education to mitigate the normalization of sexual violence depicted in pornography.
Evaluating SinergiAPS, an intervention based on patient feedback to improve patient safety in primary care: a cluster randomized trial Maria Antònia Fiol-deRoque, José María Valderas, María Jesús Serrano-Ripoll, Montserrat Gens-Barbarà, Francisco Martín-Luján, Encarna Sánchez-Freire, Juan José Montaño, Sofía Mira-Martínez, Guadalupe Pastor-Moreno, Rocío Zamanillo-Campos, Pau Riera-Serra, Ignacio Ricci-Cabello BMC Medicine, 2025 BACKGROUND: Patient safety, defined by the WHO as the absence of preventable harm, is a critical component of healthcare quality and poses a significant challenge globally. This study aimed to evaluate the effectiveness of SinergiAPS, a patient-centred audit and feedback intervention, in improving patient safety in primary healthcare (PHC) centres. METHODS: We conducted a 12-month cluster randomized controlled, multicentre trial. Fifty-nine PHC centres (1053 PHC professionals) in Spain were recruited and randomly allocated (1:1) to usual care or SinergiAPS intervention. The SinergiAPS intervention comprised: a bespoke feedback report with results from audits of patient safety based on the Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) questionnaire, administered to 75 patients/centre; a set of educational materials, and a structured template to record safety improvement plans. The primary outcome (at the PHC professional level) was patient safety culture (Medical Office Survey on Patient Safety Culture (MOSPSC) questionnaire). Secondary outcomes (at the centre level) were patient-reported safety (six PREOS-PC scales), and rate of avoidable hospital admissions. After a 12-month follow-up, we conducted 15 semi-structured interviews with PHC professionals to explore their perceptions of the intervention. RESULTS: During the 12-month follow-up, 10 of the 30 centres in the intervention group held action plan team meetings and eight registered 57 safety improvement action plans. The plans aimed to improve patient activation, address treatment-related incidents, enhance communication between patients and providers, and strengthen patient safety culture. At 12 months, no significant differences were observed in MOSPSC mean score (intervention: 3.60 [95% CI 3.55 to 3.64] vs. control: 3.64 [3.60 to 3.68]). Similarly, no differences were observed in the secondary outcomes, with both groups experiencing a decline in patient-reported safety and avoidable hospital admissions. The qualitative interviews evidenced that the onset of the COVID-19 pandemic 6-9 weeks after initiating the follow-up period severely limited PHC's capacity of developing and implementing safety improvement action plans, despite high levels of acceptability and perceived utility of the SinergiAPS intervention. CONCLUSIONS: In the context of the health emergency caused by the COVID-19 pandemic, SinergiAPS did not improve patient safety in Spanish PHC centres. TRIAL REGISTRATION: ClinicalTrials.gov (NCT03837912).
International Prevalence of Technology-Facilitated Sexual Violence Against Women: A Systematic Review and Meta-Analysis of Observational Studies Vivian Benítez-Hidalgo, Jesús Henares-Montiel, Isabel Ruiz-Pérez, Guadalupe Pastor-Moreno Trauma Violence and Abuse, 2025 The aim of the present review was to systematically identify and examine current knowledge regarding the frequency of any form of technology-facilitated sexual violence (TFSV) perpetrated against women aged 16 years and older. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was applied when performing the present review. Observational studies reporting prevalence data for any form of TFSV against women aged 16 years and above were considered for inclusion. Four meta-analyses were conducted. One examined data pertaining to overall TFSV, while the other three each addressed a key dimension based on the type of victimization under study. Random-effects models were used to compute pooled estimate prevalences (95% CI). Included studies reported prevalence in 32 different countries at different time points, with 28,220 women being interviewed (16–97 years). A total of 1,437 potential articles were gathered from 8 databases and 17 studies were selected for analysis. Included studies exhibited a low risk of bias (12 strong methodological quality—5 medium). Rates of TFSV ranged from 2.2% to 84%. Global estimated prevalence was 30.60% (95% CI [24.08, 37.12]). The most frequently reported behaviors pertained to “digital sexual harassment” (28.54%) followed by “technology-facilitated aggression and coercion” (16.93%) and “image-based sexual abuse” (6.48%). Present findings shed light on a significant gap in understanding the experiences of adult women. The wide range of reported frequencies underscores the importance of unifying terms and standardizing measurement instruments, emphasizing the need for a cohesive approach to better comprehend and address the multifaceted nature of TFSV.
Breast Cancer Screening Rates Among Patients With Severe Mental Disorders (Schizophrenia, Bipolar Disorder, and Major Depressive Disorder). Systematic Literature Review and Meta-Analysis Carmen Aguilar‐Romero, Vivian Benítez‐Hidalgo, Isabel Ruiz‐Pérez, Sua Amaya‐Santos, Guadalupe Pastor‐Moreno Psycho Oncology, 2025 Introduction Women with severe mental disorders (SMD) experience premature mortality, with disparities in healthcare access and quality contributing to this trend. This study aimed to analyze breast cancer screening rates in women with schizophrenia, major depressive disorder, and bipolar disorder, compared to women without SMD. Methods A systematic review and meta‐analysis were conducted using PubMed, Embase, PsycINFO, Cochrane, and Web of Science databases. Studies were included if they examined women with SMD (schizophrenia, major depressive disorder, or bipolar disorder) who were within the age range eligible for participation in breast cancer screening programs, according to the guidelines in effect at the time and in the country where the study was conducted, and if they also reported screening rates. Odds ratios were calculated, and meta‐analyses were performed using random‐effects models. Results The review included 22 studies. Women with SMD showed significantly lower odds of mammography screening compared to women without SMD (pooled OR = 0.66, 95% CI: 0.65–0.80, p‐val = < 0.0001). Subgroup meta‐analyses revealed significantly reduced screening rates in women with schizophrenia (OR = 0.58, 95% CI: 0.38 – 0.88, p‐val = 0.005) and major depressive disorder (OR = 0.41, 95% CI: 0.17 – 0.97, p‐val = < 0.0001), but no significant difference for bipolar disorder. Conclusion Women with SMD, particularly schizophrenia and major depressive disorder, have lower mammography screening rates than women without a SMD diagnosis. Addressing this disparity requires targeted interventions and increased healthcare provider awareness to improve screening rates and ensure equitable access to preventive care.
Cyberbullying and Suicidal Behavior, Self-Harm, and Nonsuicidal Self-Injury: A Systematic Review of Longitudinal Studies Irene Morales-Arjona, Vivian Benítez-Hidalgo, Isabel Ruiz-Pérez, Camila Higueras-Callejón, Guadalupe Pastor-Moreno Cyberpsychology Behavior and Social Networking, 2024 Aim: Identify and systematically review cohort studies examining the association between cyberbullying (CB) and suicidal ideation, attempted suicide, self-harm, and nonsuicidal self-injury (NSSI). Methods: Systematic literature review following PRISMA guidelines. Searches for relevant literature were conducted in Scopus, Web of Science, PubMed, PsyINFO, CINAHL, Embase, and Cochrane up until July 2023. Cohort studies were included that provided information regarding the association between CB and different dimensions pertaining to self-injurious thoughts and behaviors (SITB) separately. Gathered information included data on study characteristics, sample characteristics, prevalence, and associations between CB and variables pertaining to SITB. Findings were synthesized, and grouping studies as a function of the outcome variable was analyzed. Results: A total of 19 studies were included. Suicidal ideation was analyzed in 11 studies, with the majority (n = 8) reporting statistically significant positive associations (aOR = 1.88 [1.08, 3.29], β = 0.08 to 0.47). Only a single study conducted independent analysis of attempted suicide, finding a statistically significant association (aOR 1.88 [1.08, 3.29]). Outcomes regarding the self-harm variable were equivocal, with only two out of five studies finding a statistically significant association and one of these, which conducted a gender differentiated analysis, only finding a significant association in females. Studies that considered the NSSI dimension were also inconclusive, with only a limited number of studies (n = 5) producing contradictory outcomes. Conclusion: There is a need to continue exploring the relationship between CB and different dimensions within the spectrum of SITB through longitudinal studies. It is recommended that analyses adopt a new perspective in which short-term follow-up is prioritized or individualized follow-up periods are considered, given the rapidly changing nature of suicidal tendencies. It would be interesting to analyze the frequency, persistence, or severity of CB events and broaden research to include all age ranges. Special attention should also be given to potential gender differences and possible mediators or moderators.
Systematic review of healthcare interventions for reducing gender-based violence impact on the mental health of women with disabilities Guadalupe Pastor‐Moreno, Lorena Saletti‐Cuesta, Jesús Henares‐Montiel, María J. Escudero‐Carretero, Camila Higueras‐Callejón, Isabel Ruiz‐Pérez Journal of Nursing Scholarship, 2024 PurposeWomen with disabilities are more exposed to violence. The health sector has a key role in all three levels of prevention of violence against women. The objective of this paper was to review the interventions for preventing gender‐based violence and reducing its impact on the mental health of women with any form of disability.MethodRelevant studies were identified through conducting searches in PubMed, Scopus, CINAHL, PsyInfo, Social Services Abstracts, and PILOTS. Two reviewers analyzed and selected studies. A qualitative synthesis was made.Results3149 references were obtained, among which eight articles describing nine interventions from the USA and the UK. Most were intended for women with mental/intellectual disability and assessed intimate partner or sexual violence. Only one study showed high methodological quality. They were found to be particularly effective as regards improvement of the skills acquired by participants, but the results as regards improved mental health are not consistent.ConclusionOur review shows very little evidence of effective interventions. Further studies are required with higher internal validity and female sample groups with diverse disabilities.Clinical RelevanceGender‐based violence is a highly prevalent problem for women with disabilities, and in addition to being a public health challenge is a violation of human rights. Health care systems and policymakers should take a key role in all three levels of prevention of violence against women with disabilities. Interventions with longer follow‐up times are required. It is also important for interventions to be designed in consultation with people with disabilities.
Cyber sexual harassment against women and impact on health. A cross-sectional study in a representative population sample Vivian Benítez-Hidalgo, Jesús Henares-Montiel, Isabel Ruiz-Pérez, Guadalupe Pastor-Moreno Journal of Public Health United Kingdom, 2024 Background This study focuses on the frequency of cyber sexual harassment (CSH) and examines its link with five health impact indicators (self-perceived health, medication, suicidal ideation, suicide attempts and use of health services). Methods Analyzing the data provided by the 2019 Macro-survey on violence against women in Spain, two items of which refer to CSH. It was conducted in Spain on a representative sample of 9568 women aged over 16 years old. Results A total of 9.15% of the women surveyed had experienced CSH at some point in their lives. Being under 25 years old, having higher education, not being in a relationship, having no religious beliefs and having a certified disability are sociodemographic characteristics associated with a higher risk of CSH. Women who have experienced other forms of gender-based violence also show an increased risk. Female victims of CSH reported higher rates of suicidal ideation (20% versus 9.79% in non-victims of CSH) and suicidal attempts (7.20% versus 1.74% in non-victims of CSH). Conclusions These findings have significant implications for the design of preventive health polices, which should incorporate strategies to address CSH as part of the continuum of multiple interrelated forms of gender violence that affect women and girls throughout their lives.
New Patients in Treatment for Opioid Addiction in Spain Jose Pulido, Guadalupe Pastor-Moreno, Juan Miguel Guerras, María José Belza, Ana Cáceres, Lucía Cea-Soriano, Luis Sordo Substance Abuse Research and Treatment, 2023
Male and female involvement in the birth and child-rearing process Gracia Maroto‐Navarro, Guadalupe Pastor‐Moreno, Ricardo Ocaña‐Riola, Vivian Benítez‐Hidalgo, María del Mar García‐Calvente, María del Pilar Gutiérrez‐Cuadra, María T Gijón‐Sánchez, María del Río‐Lozano, Jorge Marcos‐Marcos Journal of Clinical Nursing, 2013
Motivations for adolescent pregnancy Carmen Álvarez Nieto, Guadalupe Pastor Moreno, Manuel Linares Abad, Juan Serrano Martos, Laura Rodríguez Olalla Gaceta Sanitaria, 2012
