The impact of current and past interpersonal violence on women's mental health
Introduction
Violence against women and girls is widespread. Most of the perpetrators are men, well-known to the victims, such as male family members, partners, or acquaintances; however, women can also be abused by other women, such as female partners or adult daughters (Koss et al., 1994). While today the harmful consequences of violence are known and appear obvious (Resnick, Acierno, & Kilpatrick, 1997; Krug, Dahlberg, Mercy, Zwi, & Lozano, 2002), this awareness is relatively recent: for instance, until the 1960s, one psychiatric perspective was that incest was not psychologically harmful to the victims (Olafson, Corwin, & Summit, 1993).
Although a wealth of good studies on the consequences of violence on the health of women are available today (Golding, 1999; Campbell, 2002; Koss, Bailey, Yuan, Herrera, & Lichter, 2003), a number of aspects are left untreated. First, it is difficult to simultaneously take into account the different kinds of violence a woman can have experienced during her lifetime, as each of them can have an impact on her health, and the impact can also be cumulative. These experiences are often related to each other. Abuse during childhood, be it sexual, physical, psychological, or neglect, increases the risk of further victimization as an adolescent or an adult (Romito, Saurel–Cubizolles, & Crisma, 2001). Partner violence may be linked with abuse by other family members, such as in-laws or older children, especially during or after separation.
Secondly, interpersonal violence can lead to social problems that are in themselves independent risk factors for psychological distress or bad health. Domestic violence is associated with losing educational opportunities and with professional precariousness (Lloyd & Taluc, 1999; McFarlane et al., 2000; Jaspard et al., 2003). Battered women are more vulnerable to sexual harassment in the work place (Jaspard et al., 2003; Romito, Ballard, & Matton, 2004). Sexual and physical assault in adulthood, regardless of the perpetrator, increases the risk of women's poverty (Byrne, Resnick, Kilpatrick, Best, & Saunders, 1999). Studies on the social determinants of women's health and those on the impact of interpersonal or intimate partner violence on health remain separate fields of research. As a consequence, violence is seldom considered as a risk factor in the former type of studies, while potential social risk factors for women's health are seldom considered in the latter type of studies.
Thirdly, as violence by an intimate male partner is probably the single most common type of violence experienced by women, many studies are concerned with the health consequences of this kind of violence. Although partner psychological abuse is far more frequent than physical or sexual violence (Gillioz, DePuy, & Ducret, 1997; Jaspard et al., 2003), a number of recent reviews of the literature consider only the effects of physical and sexual violence (Golding, 1999; Campbell, 2002; Koss et al., 2003).
Another limitation is that older women are rarely studied. Most population studies on the prevalence of violence exclude women over 60 or 65 from their samples (Gillioz et al., 1997; Jaspard et al., 2003). This happens also in studies on the links between violence and health (for instance, Dìaz-Olavarrieta, Ellertson, Paz, de Leon, & Alarcon-Segovia, 2002). In the three recent reviews (Golding, 1999; Campbell, 2002; Koss et al., 2003), women's age is not mentioned. On the other hand, studies on elder abuse have traditionally lacked a gender approach (Phillips, 2000; Vinton, 2000).
Moreover, most of the studies on violence and health come from English-speaking countries, largely the USA, and we have little information from countries in Southern Europe.
Section snippets
Aim of the study
We conducted a cross-sectional survey among women attending six family practices in an Italian town. The aim of the study was to analyze the relationships between current and past interpersonal violence and the three indicators of current women's health—psychological distress, the use of psychoactive drugs and a subjective evaluation of health—controlling for a number of women's demographic and social characteristics. We hypothesized that women who had experienced violence (either recently or
Procedure
Ponte nelle Alpi is a small town in Northeastern Italy, in the province of Belluno, with a population of 7900 inhabitants, 3429 of them female over 18 years old. The study was carried out at the initiative of one of the six family doctors practicing in the town; all six family practices were included in the study. A detailed description of the development, implementation, and effects of the study in the community is given elsewhere (Romito, De Marchi, Molzan Turan, Ciociano Bottaretto, & Tavi,
Characteristics of the sample
Overall, 542 women were asked to participate and 444 accepted. Due to a high proportion of missing values, 18 questionnaires were discarded. Analysis was performed on 426 questionnaires, with a response rate of 78.6%.
Characteristics of the sample are displayed in Table 1. Twenty-three percent of the respondents were over 59 years of age. Almost a third had only primary education, and this was far more common among older women. Only 5.7% of the respondents were separated or divorced, a
Discussion
Women who had experienced violence in the last 12 months are more likely than other women to be psychologically distressed, to evaluate their health as bad, and to take psychoactive pills. The associations were strong with the most inclusive indicator—any type of violence by any perpetrator—and even stronger with the indicators of male partner violence. In the following discussion, we will mostly consider partner violence. We also found an association between violence in the past and current
Acknowledgments
Our thanks to the women who participated in the study; to Rosa Ciociano Bottaretto and Michela Tavi for their collaboration; to the doctors of the Associazione Medici di Medicina Generale di Ponte nelle Alpi, M. Mazzorana, R.N. De Prà, F. De Pasqual, G. Boito, and P. Dal Borgo for supporting the project.
The research was supported by funding from the City Hall of Ponte nelle Alpi, the Health Agency (ULSS) of Belluno, the Fidapa, and women's chapters of several associations (Rotary, Lyons,
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2020, The Lancet PsychiatryCitation Excerpt :Studies did not distinguish between ongoing intimate partner violence and intimate partner violence that had ended. Specifying exposure to past only, current only, and both types of intimate partner violence would enhance interpretation, since studies in HIC suggest such violence has cumulative effects on women's mental health.40 Many studies incorporated safety protocols to manage adverse mental health events, but none described procedures for responding to intimate partner violence-related risks arising during participation.