Research paperIntimate partner violence and mental disorders: Co-occurrence and gender differences in a large cross-sectional population based study in Spain
Introduction
Intimate Partner Violence (IPV) and Mental Disorders (MD) are important public health problems not only because of their high prevalence, but also because of their impact on health and quality of life, which poses a major challenge to health services and systems worldwide. Global estimations suggest that around one every three women (35%) in the world have suffered physical and/or sexual IPV (Devries et al., 2013b). MD affects more than 25% of the global population (Wold Health Organization, 2015), with women disproportionally more affected than men (Albert, 2015, Wold Health Organization, 2000).
Cross-sectional and longitudinal studies have consistently reported a positive association between IPV and MD (Castellvi et al., 2017, Chuang et al., 2012, Coker et al., 2002a, Desmarais et al., 2014, Devries et al., 2013a, Golding, 1999, Khalifeh et al., 2015, Lacey et al., 2015; Oram et al.; Ruiz-Perez and Plazaola-Castano, 2005). A recent systematic review concluded that IPV can have increasing adverse effects on the mental health of victims (most notably on depression, posttraumatic stress disorder, and anxiety) in comparison with those who have never experienced IPV or those experiencing other traumatic events (Lagdon et al., 2014). It has also been argued that people with serious mental illnesses may be more likely to be victims of violence themselves than the general population (Desmarais et al., 2014, Tsigebrhan et al., 2014), and a bidirectional association has been proposed (Devries et al., 2013a).
However, despite the existing literature about IPV and MD (Coker et al., 2002a, Sipsma et al., 2015), there is limited evidence about potential gender differences (Salom et al., 2015). In relation with IPV victimization, available evidence is limited by the small number of studies using representative and population-based samples to compare prevalence and correlates in women vs men. Moreover their results have limited comparability due to the use of a number of different conceptualizations of IPV, time periods examined, and geographic settings. Further, not all the studies considered emotional or psychological IPV, mainly due to difficulties in its measurement. In general, the frequency of IPV victimization is higher in women than in men. In Ukraine, 12.7% of women vs 5.8% of men suffered an aggression perpetrated by their spouse in the past year (O'Leary et al., 2008). In Rwanda, women were more exposed to physical (18.8%), sexual (17.4%) and psychological (21.4%) IPV in the past year than men (4.3%, 1.5%, and 7.3%, respectively) (Umubyeyi et al., 2014). In England, 27.8% of women experienced some form of IPV compared with 18,7% of men (Jonas et al., 2014).
In relation to mental health, there is a scarcity of epidemiological studies comparing the prevalence and correlates of MD (either overall or specific mental disorders) in men vs women. Previous studies reporting the frequency and determinants of different types of MDs studied sex as an additional determinant of MD, but did not examine sex-specific independent risk factors (Gabilondo et al., 2010, Hardt et al., 2015).
All these aspects hindered the examination of the prevalence and associated factors of co-occurring IPV and MD in men, which is even more challenging when aiming to examine specific subtypes of MD. Only recently, scientific studies examining gender differences in depression subtypes (Bogren et al., 2017) or schizophrenia (Lewine et al., 2017) are becoming available, suggesting higher rates in women than men.
Finally, although it is known that gender is a differential factor both for IPV and MD (as it is age, social support or nationality), it is less well known whether other clinical or demographic factors could be associated with IPV, MD, or both (Jonas et al., 2014).
In this study we examined the epidemiology of IPV victimization and MD in men and women living in Andalusia, a large southern region in Spain. The following three aims were proposed:
- 1.
To estimate the prevalence of IPV (overall, and physical, sexual and emotional) and of MD (overall and diagnosis-specific) in men and women.
- 2.
To examine the association between IPV and MD (overall and diagnosis-specific) in men and women.
- 3.
To identify sociodemographic and clinical characteristics associated with MD, IPV, and co-occurring IPV-MD in men and women.
Section snippets
Design and setting
We conducted a community-based cross-sectional study in Andalusia, a southern and the largest region in Spain, with more than 8.4 million inhabitants in 2016 (18% of the Spanish population) (INE, 2017). This work is part of the PISMA-ep study, a study using regionally representative data to assess mental health in people living in Andalusia. Our study is based on the full sample of the study. The study protocol is available elsewhere (Cervilla et al., 2016).
Following a multistage sampling
Response rate and sample characteristics
A total of 4507 men and women were enrolled in the study (response rate = 74%) between 2013 and 2014. Details of the sample characteristics are available elsewhere (Cervilla et al., 2016). In short, 51% (N = 2293) were female, and mean age was 43 years old (standard deviation = 15). Around eight out of ten participants (79.7%) lived in urban areas (> 10,000 inhabitants), 43% were employed, 61% were married or under a stable relationship, and almost half of them (47%) reported high education or
Discussion
In this large, population-based study, we observed that MD and IPV are strongly associated, and that 4.4% of the participants experienced co-occurring MD-IPV. IPV was associated with a wide range of mental disorders - most notably suicidal ideation, mood disorders, and post-traumatic stress. By independently modelling in men and women clinical and sociodemographic characteristics associated with IPV, MD, and co-occurring IPV-MD, we identified gender and group specific profiles.
Acknowledgements
We thank all the participants in this study for kindly completing a large number of questionnaires and forms.
Funding
This work was supported by the “Consejería de Economía, Innovación y Ciencia de la Junta de Andalucía” (10-CTS-6682).
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