Violence against women is significantly associated with mood, anxiety, and substance use disorders throughout the victim’s lifetime, according to a report in the Aug. 3 issue of JAMA.
Moreover, the relationship appears to be dose related, with higher rates of mental disorders seen in women who have been exposed to the most types of violence. In particular, women who have experienced three or four types of gender-based violence show a nearly 90% prevalence of mental disorders, while those who have never experienced it show only a 28% prevalence, said Susan Rees, Ph.D., of Australia’s University of New South Wales School of Psychiatry and the Center for Population Mental Health Research, Sydney, and her associates.
Four types of violence typically perpetrated against women (physical beating by an intimate partner, rape, other forms of sexual assault, and stalking) are collectively known as gender-based violence. Evidence that all of these are associated with mental disorders has been increasing. Dr. Rees and her colleagues studied the issue using data from the Australian Bureau of Statistics’ National Mental Health and Well-Being Survey.
The confidential survey, which included a representative sample of 4,451 Australian women aged 18-65 years, asked subjects whether they had ever been diagnosed as having any of four broad types of mental disorders: anxiety disorders (panic disorder, agoraphobia, social phobia, generalized anxiety disorder, or obsessive-compulsive disorder); mood disorders (major depressive episode, dysthymia, or bipolar affective disorder); substance use disorders; or posttraumatic stress disorder (PTSD).
The survey also asked specifically about the four forms of gender-based violence. The most common type of gender-based violence was sexual assault, which was reported by 14.7% of the study subjects. This was followed by stalking (reported by 10%), rape (reported by 8.1%), and physical violence by an intimate partner (reported by 7.8%).
In the entire study population, the lifetime prevalence of any mental disorder was 37.8%. The overall prevalence of anxiety disorders was 24.6%; of mood disorders, 18.3%; of substance use disorders, 13.9%; and of PTSD, 9.8%.
These rates were significantly higher in the 1,218 women who reported experiencing at least one type of gender-based violence.
The prevalence of any mental disorder was 57.3% for women who had experienced one form of gender-based violence, and 89.4% for those who experienced three or four types. In comparison, women who were never exposed to gender-based violence had only a 28% prevalence of mental disorders, the investigators said (JAMA 2011;306:513-21).
Women exposed to one type of gender-based violence had a lifetime prevalence of 30.7% for mood disorders, 38.5% for anxiety disorders, 23% for substance use disorders, and 15.2% for PTSD.
However, most women who experienced one type of gender-based violence also experienced other types during the course of their lives. For women who reported experiencing three or four types of gender-based violence, the prevalence of anxiety disorders was 77.3%, that of mood disorders was 52.5%, that of substance use disorders was 47.1%, and that of PTSD was 56.2%.
Women who had never experienced gender-based violence showed a lifetime rate of suicide attempts of 1.6%. In contrast, those who had experienced one type of violence had a suicide-attempt rate that was more than four times higher at 6.6%, and those who had experienced three to four types of violence had a suicide attempt rate more than 22 times higher, at 34.7%.
In addition to mental disorders, women who experienced gender-based violence showed an overall pattern of social disadvantage, disability, and impaired quality of life. "An important question raised by our research is whether existing services address [these] multiple domains of disability and dysfunction associated with gender-based violence," Dr. Rees and her colleagues said.
Services for victims of gender-based violence tend to be separate from mental health services, which reduces stigma but also restricts access to the full array of mental health interventions. The severity of the mental disorders and the extent of comorbidities revealed in this study "require expert and comprehensive approaches to treatment" that are not available in typical programs for gender-based violence, they noted.
Similarly, providers of psychiatric services must be equipped to assist women with mental health disorders who are found to have experienced gender-based violence. For example, such women may have difficulty attending group therapy or inpatient care that includes male patients. And personnel must be trained "in strategies to engage and interview women in a gender-sensitive manner; to build trust; and to ensure safety, privacy, and confidentiality in all interactions," they added.
This study was funded by the National Health and Medical Research Council of Australia. No conflicts of interest were reported.