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Mental ill health in structural pathways to women's experiences of intimate partner violence.
PLoS One. 2017; 12(4):e0175240.Plos

Abstract

BACKGROUND

Depression, post-traumatic stress disorder (PTSD), and binge drinking are among mental health effects of child abuse and intimate partner violence (IPV) experiences among women. Emerging data show the potential mediating role of mental ill health in the relationship of child abuse and IPV. There is evidence that PTSD, depression and alcohol abuse are comorbid common mental disorders and that a bidirectional relationship exists between depression and IPV in some settings. Furthermore, the temporal direction in the relationship of alcohol abuse and women's IPV experiences from different studies is unclear. We undertook a study with women from the general population to investigate the associations of child abuse, mental ill health and IPV; and describe the underlying pathways between them.

METHODS

Data is from a household survey employing a multi-stage random sampling approach with 511 women from Gauteng, South Africa. IPV was measured using the WHO Multi-country Study on Women's Health and Domestic Violence Questionnaire. Child abuse was measured using a short form of the Childhood Trauma Questionnaire. Depression was measured using the Centre for Epidemiologic Studies Depression Scale (CESD). PTSD symptoms were measured using the Harvard Trauma Questionnaire. Binge drinking was measured using the Alcohol Use Disorders Identification Test (AUDIT) scale. All data analyses were conducted in Stata 13. Regression modelling was used to test the association between variables. Structural equation modelling with full information maximum likelihood estimation accounting for missing data was done to analyse the underlying pathways between variables.

RESULTS

Fifty percent of women experienced IPV in their lifetime and 18% experienced IPV in the 12 months before the survey. Twenty three percent of women were depressed, 14% binge drank and 11.6% had PTSD symptoms. Eighty six percent of women had experienced some form of child abuse. Sociodemographic factors associated with recent IPV in multivariate models were younger age and foreign nationality. Depression, PTSD and binge drinking mediated the relationship of child abuse and recent IPV. Depression, PTSD and binge drinking were also effects of recent IPV. Other factors associated with recent IPV experience included relationship control, having a partner who regularly consumed alcohol and experiencing other life traumatic experiences.

CONCLUSION

Mental ill health plays a mediating role in the relationship of child abuse and recent IPV experiences among women. Conversely, IPV also negatively affects women's mental health. Interventions to reducing the incidence of IPV could help alleviate the burden of mental ill health among women and vice versa. Effective integration of mental health services in primary health care, detection of symptoms, brief interventions and strengthened referral mechanisms for sustained community-based care are necessary in responding to victims of intimate partner violence. Response for abused children needs to take similar approaches and reduce the long-term mental health effects associated with violent exposures.

Authors+Show Affiliations

Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa. School of Public Health, University of Witwatersrand, Johannesburg, South Africa.School of Public Health, University of Witwatersrand, Johannesburg, South Africa.Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa. School of Public Health, University of Witwatersrand, Johannesburg, South Africa.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28384241

Citation

Machisa, Mercilene T., et al. "Mental Ill Health in Structural Pathways to Women's Experiences of Intimate Partner Violence." PloS One, vol. 12, no. 4, 2017, pp. e0175240.
Machisa MT, Christofides N, Jewkes R. Mental ill health in structural pathways to women's experiences of intimate partner violence. PLoS One. 2017;12(4):e0175240.
Machisa, M. T., Christofides, N., & Jewkes, R. (2017). Mental ill health in structural pathways to women's experiences of intimate partner violence. PloS One, 12(4), e0175240. https://doi.org/10.1371/journal.pone.0175240
Machisa MT, Christofides N, Jewkes R. Mental Ill Health in Structural Pathways to Women's Experiences of Intimate Partner Violence. PLoS One. 2017;12(4):e0175240. PubMed PMID: 28384241.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mental ill health in structural pathways to women's experiences of intimate partner violence. AU - Machisa,Mercilene T, AU - Christofides,Nicola, AU - Jewkes,Rachel, Y1 - 2017/04/06/ PY - 2016/09/01/received PY - 2017/03/22/accepted PY - 2017/4/7/entrez PY - 2017/4/7/pubmed PY - 2017/9/8/medline SP - e0175240 EP - e0175240 JF - PloS one JO - PLoS One VL - 12 IS - 4 N2 - BACKGROUND: Depression, post-traumatic stress disorder (PTSD), and binge drinking are among mental health effects of child abuse and intimate partner violence (IPV) experiences among women. Emerging data show the potential mediating role of mental ill health in the relationship of child abuse and IPV. There is evidence that PTSD, depression and alcohol abuse are comorbid common mental disorders and that a bidirectional relationship exists between depression and IPV in some settings. Furthermore, the temporal direction in the relationship of alcohol abuse and women's IPV experiences from different studies is unclear. We undertook a study with women from the general population to investigate the associations of child abuse, mental ill health and IPV; and describe the underlying pathways between them. METHODS: Data is from a household survey employing a multi-stage random sampling approach with 511 women from Gauteng, South Africa. IPV was measured using the WHO Multi-country Study on Women's Health and Domestic Violence Questionnaire. Child abuse was measured using a short form of the Childhood Trauma Questionnaire. Depression was measured using the Centre for Epidemiologic Studies Depression Scale (CESD). PTSD symptoms were measured using the Harvard Trauma Questionnaire. Binge drinking was measured using the Alcohol Use Disorders Identification Test (AUDIT) scale. All data analyses were conducted in Stata 13. Regression modelling was used to test the association between variables. Structural equation modelling with full information maximum likelihood estimation accounting for missing data was done to analyse the underlying pathways between variables. RESULTS: Fifty percent of women experienced IPV in their lifetime and 18% experienced IPV in the 12 months before the survey. Twenty three percent of women were depressed, 14% binge drank and 11.6% had PTSD symptoms. Eighty six percent of women had experienced some form of child abuse. Sociodemographic factors associated with recent IPV in multivariate models were younger age and foreign nationality. Depression, PTSD and binge drinking mediated the relationship of child abuse and recent IPV. Depression, PTSD and binge drinking were also effects of recent IPV. Other factors associated with recent IPV experience included relationship control, having a partner who regularly consumed alcohol and experiencing other life traumatic experiences. CONCLUSION: Mental ill health plays a mediating role in the relationship of child abuse and recent IPV experiences among women. Conversely, IPV also negatively affects women's mental health. Interventions to reducing the incidence of IPV could help alleviate the burden of mental ill health among women and vice versa. Effective integration of mental health services in primary health care, detection of symptoms, brief interventions and strengthened referral mechanisms for sustained community-based care are necessary in responding to victims of intimate partner violence. Response for abused children needs to take similar approaches and reduce the long-term mental health effects associated with violent exposures. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/28384241/Mental_ill_health_in_structural_pathways_to_women's_experiences_of_intimate_partner_violence_ L2 - https://dx.plos.org/10.1371/journal.pone.0175240 DB - PRIME DP - Unbound Medicine ER -