Women who experience domestic violence are almost twice as likely to suffer from depression and vice versa

In June this year The World Health Organisation (WHO) published a report, which highlighted violence against women as a ‘global health problem of epidemic proportions’.

The report detailed the impact of violence on the physical and mental health of women and girls. This can range from broken bones to pregnancy-related complications, mental problems and impaired social functioning. It concluded that a staggering 1 in 3 women throughout the world would experience physical and/or sexual abuse by a partner. Thirty eight percent of all murders of women globally were reported as being committed by their partner.

They also showed that women exposed to intimate partner violence (IPV or domestic violence/abuse) are:

The WHO report that 1 in 3 women throughout the world would experience physical and/or sexual abuse by a partner

The WHO report states that 1 in 3 women worldwide will experience physical and/or sexual abuse by a partner.

Twice as likely to have alcohol-use disorders
16% more likely to have a low birth-weight baby
1.5 times more likely to acquire HIV and 1.5 times more likely to contract syphilis infection, chlamydia or gonorrhea

No surprise then to read in this report that woman who experience domestic abuse are twice as likely to experience depression. This conclusion has been further elaborated in a systematic review and random effects meta-analysis of longitudinal studies published up until February 2013 (Devries et al.). Researchers from the UK, Sweden and Australia carried out this study.

Methods

The open access review published in PLoS Medicine set out to establish links between IPV and depression by performing a comprehensive review of longitudinal studies. They addressed four major questions:

Of course men can experience domestic violence too, and this review included studies of violence against men as well.

Are people who are subjected to IPV more likely to suffer from depression?
Are people who are subjected to IPV likelier to attempt suicide?
Are people who are depressed more likely to be subjected to IPV?
Are people who attempt suicide more likely to be subjected to IPV?

Unlike many of the previous studies, they did not restrict their studies to women; attempting to find such links with male IPV victims.

They screened over 22,000 records from 20 databases for studies that addressed their criteria, resulting in a selection of 16 (17 articles) studies involving more than 36,000 participants. All of these studies included female victims; 4 also included males. The studies included were all undertaken in high- and middle-income countries.

Results

The reviewers found that women who experienced IPV were almost twice as likely to be depressed. They also found an association in the opposite direction; with depressed women being almost twice as likely to experience IPV.

The 17 scientific publications included in this study contained 55 relevant effect estimates
11 of these studies showed a statistically significant link between women who are subjected to IPV and the onset of depression
In 6 of these studies the scientists were able to show (through meta-analysis) that women who had experienced IPV were almost twice as likely to suffer from depression:
- Pooled odds ratio (OR) from six studies = 1.97 (95% CI 1.56–2.48, I2 = 50.4%, p heterogeneity = 0.073)
They also found that females who were depressed were more likely to experience IPV; meta-analysis showed that depressed women were almost twice as likely to be exposed to domestic violence
- Pooled OR from four studies = 1.93, 95% CI 1.51–2.48, I2 = 0%, p = 0.481
Women who had been subjected to IPV were also more likely to attempt suicide. This conclusion was made based on the findings of three separate studies, all of which showed a statistically significant link
Although there were fewer studies on these effects on men, there was sufficient evidence to demonstrate a clear association between IPV and the subsequent onset of depression in males

Conclusions

This research concluded:

In women, IPV was associated with incident depressive symptoms, and depressive symptoms with incident IPV. IPV was associated with incident suicide attempts.

In men, few studies were conducted, but evidence suggested IPV was associated with incident depressive symptoms. There was no clear evidence of association with suicide attempts.

Limitations

The authors themselves identified some of limitations of their own work. These included comments on their screening method (they didn’t employ double screening), they did not contact the authors of the included studies for any unpublished data and they highlighted their difficulties comparing different scales of measure.

Perhaps the most important limitation of this study is the nature of the problem they studied; considering only IPV, depression and suicide as contributing factors would always negate a whole raft of other potential contributors which can also lead to domestic violence, depression and attempting to take one’s life. As highlighted in this study, they did not consider alcohol/drug use, childhood history (including trauma, abuse and violence); as the WHO report suggest, women who experience IPV are also likely to have struggled with some if not all of these factors.

And finally…

Action to address the ‘global epidemic’ of domestic violence is urgently required to prevent depression and suicide in this vulnerable population

This study underlines the frequency and consequences of domestic violence; supporting the WHO’s report. It demonstrates clear links between IPV and depression and suicide attempts. It also shows that men also experience these effects.