Violence Takes Mental Health Toll on Women

Women who experience any form of gender-based violence are at greater risk of mental health disorders and related dysfunction and disability, Australian researchers found.

Those who'd been through at least one form of this abuse -- which includes intimate partner violence, rape, sexual assault, or stalking -- were almost three times more likely to experience a mental health condition than those who were never victimized (OR 2.60, 95% CI 1.99 to 3.40), according to Susan Rees, PhD, of the University of New South Wales in Sydney, Australia, and colleagues.

Those who'd experienced three or four forms had an 11-fold greater risk, they reported in the Aug. 3 issue of the Journal of the American Medical Association.

The study "reveals a pattern of social disadvantage, disability, and impaired quality of life among women who have experienced gender-based violence," the researchers wrote .

Violence against women is a major public health concern, they said. Some work has shown that it may be associated with lifetime mental health disorders -- although those studies have had methodological limitations, they noted.

So to clarify the relationship, Rees and colleagues conducted a cross-sectional study based on data from the 2007 Australian National Mental Health and Well-being Survey, which had information on 4,451 women ages 16 to 85.

In the overall sample, the lifetime prevalence of any mental disorder was 37.8%; nearly a quarter of the women (24.6%) reported anxiety, 18.3% mood disorder, 13.9% a substance use disorder (a combination of abuse and dependence), and 9.8% reported posttraumatic stress disorder (PTSD).

A total of 1,218 women, or 27.4% of the sample, reported experiencing at least one type of gender-based violence. In this group, prevalence rates were highest for sexual assault, followed by stalking, then rape, and finally, physical intimate partner violence.

In multivariate analyses, the researchers found that women who had been exposed to one form of gender-based violence had a significantly higher risk of mental health disorders than those who were never exposed:

Mood disorder: OR 2.26, 95% CI 1.59 to 3.20
Anxiety disorder: OR 2.41, 95% CI 1.84 to 3.15
Substance use disorder: OR 2.65, 95% CI 1.88 to 3.74
PTSD: OR 2.82, 95% CI 2.01 to 3.95
Any mental disorder: OR 2.60, 95% CI 1.99 to 3.40

The association was particularly strong for those who experienced three to four types of violence, the researchers found:

Mood disorder: OR 3.59, 95% CI 2.31 to 5.60
Anxiety disorder: OR 10.06, 95% CI 5.85 to 17.30
Substance use disorder: OR 5.61, 95% CI 3.46 to 9.10
PTSD: OR 15.90, 95% CI 8.32 to 30.20
Any mental disorder: OR 11.00, 95% CI 5.46 to 22.17

These women were also 15 times more likely to attempt suicide than those who hadn't been victimized, the researchers said. Those who incurred one violent encounter had about a threefold increased risk of suicide.

Violence against women was also tied to more severe mental health issues, with those reporting any trauma being nearly five times more likely to have severe disorders than those who weren't abused (Or 4.60, 95% CI 2.93 to 7.22).

Victims were also more likely to report poor overall health and poor mental health (OR 4.00, 95% CI 1.82 to 8.82 and OR 7.14, 95% CI 2.87 to 17.75).

And abused women were significantly more likely to have spent at least a week out of the preceding month on disability (OR 3.14, 95% CI 2.43 to 4.05).

Rees and colleagues said the study raises questions about whether current mental health services address the disability and dysfunction associated with gender-based violence.

They concluded that although public health efforts have targeted specific forms of gender-based violence, the study "underscores the need to alter attitudes and mores that sanction violence against women at a more general level."

The study was limited by its cross-sectional design, and by its limited generalizability since the sample didn't include homeless patients, those living in institutions, and the severely mentally ill, who may have higher rates of gender-based violence, the researchers said.

-blackwomenshealth.org