Violence against women by their intimate partner and common mental disorders☆
Introduction
Violence against women encompasses a broad range of kinds of abuse with geographical and cultural features (Watts & Zimmerman, 2002). The WHO multi-country study on women's health and domestic violence (Garcia-Moreno, Jansen, Ellsberg, Heise, & Watts, 2006) corroborates the variation in prevalence between and within countries and found high rates of violence committed against women by their intimate partners (hereafter called simply “violence”).
Violence against women is not only a manifestation of gender inequality, but also serves to perpetuate injustice against women. According to Watts and Zimmerman (2002), in some cases, aggressors deliberately use violence as a means of subordination, as in the case of an intimate partner who demonstrates and reinforces his position of greater power, while also being head of the household or family.
The coexistence of psychological, physical and sexual violence among women abused by their intimate partner is high. Studies around the world have shown rates of physical violence perpetrated by intimate male partners occurring at least once in a lifetime varying from 10% to 56%. Between 10% and 30% of the women in these studies also reported that they had experienced sexual violence (Heise and Garcia-Moreno, 2002, Kumar et al., 2005, Watts and Zimmerman, 2002). Ellsberg (1997) found that 94% of the women who were experiencing physical violence also reported verbal insults and humiliations, while 36% were commonly forced to have sex while being beaten.
In Brazil, research conducted nationally among women aged 15 years and older has shown that 43% stated they had been subject to violence committed by a man in their lifetime, with a third reporting some form of physical violence, 13% sexual and 27% psychological (Venturi, Recamán, & Oliveira, 2004). This study also revealed that husbands, ex-husbands, boyfriends and ex-boyfriends were the principal aggressors, varying from 88% of the instigators of punches and pushes to 79% of the perpetrators of forced sexual relations.
Many authors (Ellsberg et al., 1999, Kumar et al., 2005, Nicolaidis et al., 2004, Ruiz-Perez and Plazaola-Castano, 2005) point out diverse threats to women's mental health caused by violence. The World Health Organization (WHO, 2000) considers violence to be the principal gender-related cause of depression among women. It also gives rise to anxiety and increased use of tranquilizers and antidepressants (Ruiz-Perez & Plazaola-Castaño, 2005). Long-lasting mental suffering is part of “battered women syndrome” (McCauley et al., 1995), this being a major predictive factor of visits to the doctor and increased use of general health services.
For Ruiz-Perez and Plazaola-Castaño (2005), different kinds of abuse could have different effects on women's mental health. In their study, carried out in public family practices in Spain, women reporting sexual plus psychological violence were more likely to have increased use of alcohol, while those who experienced physical plus psychological violence reported worse self-perceived health than women who had not been abused or who reported other types of violence. Furthermore, higher levels of severity, intensity and duration of the aggression imply in greater impact on women's mental health. Also, effects of violence seem to last, possibly remaining for many years after the event (Ellsberg et al., 1999, Ruiz-Perez and Plazaola-Castano, 2005).
The majority of studies on the association between violence and mental health have been performed on non-representative samples of women, usually convenience samples of women presenting to general internal medicine clinics (Nicolaidis et al., 2004) or to public family practices (Ruiz-Perez & Plazaola-Castaño, 2005). Since this information is based on women who have sought help, it surely does not present a full picture of female victims of violence (Ellsberg et al., 1999) and anxiety or depression within the population. Furthermore, most studies have only considered physical or sexual violence (Kumar et al., 2005, Nicolaidis et al., 2004), having neglected psychological violence.
This paper contributes to the existing literature by investigating the association between psychological, physical and sexual violence committed against women by their intimate partners and common mental disorders in a population-based survey carried out in Brazil as part of the WHO multi-country study on women's health and domestic violence (Garcia-Moreno et al., 2006).
Section snippets
Study design and sampling
The WHO multi-country study on women's health and domestic violence compared 15 sites in 10 countries, including Brazil. In most of the larger countries, the study obtained data from two contrasting settings: the capital (or a large city) and one representative region with both rural and urban characteristics. Full details of the study are reported elsewhere (Garcia-Moreno et al., 2006).
In Brazil, a population-based household survey was carried out among women aged 15–49 years, between 2000 and
Results
Intimate partner violence was calculated for all the women who met the condition of ever having had an intimate partner in their life: 940 women in São Paulo and 1188 in the Zona da Mata of Pernambuco.
Demographic and socioeconomic characteristics, forms of violence and the prevalence of mental disorders were statistically different among ever-partnered women interviewed in São Paulo and in the Zona da Mata of Pernambuco (Table 1). Women from Zona da Mata of Pernambuco were younger, less
Discussion
This is the first population-based study on the association between intimate partner violence and mental health in Brazil. It adds to the existing body of research and confirms that violence by an intimate partner, experienced by 50.7% of women in this country, is associated with common mental disorders as assessed by the SRQ-20.
The prevalence of common mental disorders among women interviewed in the Zona da Mata of Pernambuco from the present study was 40.2%, consistent with the 44.2% found in
Acknowledgement
We are greatly indebted to the women of São Paulo and Zona da Mata of Pernambuco who participated in the study, and without whom this research would not have been possible.
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This study was produced from the research data of the “WHO Multi-Country Study on Women's Health and Domestic Violence against women” coordinated and funded by the World Health Organization and supported by grants from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq, Brazil) and the Brazilian Ministry of Health/National STD/AIDS Programme.