Women who experience gender-based violence have higher incidence of anxiety, substance use disorders

Violence against women is a major public health concern, contributing to high levels of illness and death worldwide, according to background information in the article. "In the United States, 17 percent of women report rape or attempted rape and more than one-fifth of women report intimate partner violence (IPV), stalking, or both. There is mounting evidence that each of these forms of gender-based violence (GBV) is associated with mental disorder among women, although methodological shortcomings of existing studies constrain the inferences that can be drawn," the authors write.

Susan Rees, Ph.D., of the University of New South Wales, Sydney, New South Wales, Australia, and colleagues assessed the association of a composite index of GBV (rape, sexual abuse, IPV, and stalking) with a range of lifetime mental disorders, including indices of severity and co-existing illnesses. The researchers analyzed data from the Australian National Mental Health and Well-being Survey of 2007, which included 4,451 women (65 percent response rate), ages 16 to 85 years. Diagnostic criteria from the World Health Organization's World Mental Health Survey Initiative was used to assess lifetime prevalence of any mental disorder, anxiety, mood disorder, substance use disorder, and posttraumatic stress disorder (PTSD).

The researchers found that the lifetime prevalence for any mental disorder was 37.8 percent. A total of 1,218 women (27.4 percent) reported experiencing at least 1 of the types of GBV assessed in this study. The lifetime prevalence rates were 14.7 percent for sexual assault, 10 percent for stalking, 8.1 percent for rape, and 7.8 percent for IPV. Women who had been exposed to 1 form of GBV reported a high rate of lifetime mood disorder (weighted, 30.7 percent), lifetime anxiety disorder (38.5 percent), lifetime substance use disorder (23.0 percent), lifetime PTSD (15.2 percent), and any lifetime mental disorder (57.3 percent).

"The association was particularly strong for exposure to 3 to 4 types of GBV (lifetime anxiety disorders: weighted, 77.3 percent; lifetime mood disorder: 52.5 percent; lifetime substance use disorder: 47.1 percent; lifetime PTSD: 56.2 percent; and any lifetime mental disorder: 89.4 percent). Women exposed to a single GBV reported increased rates of suicide attempts (weighted, 6.6 percent), with the highest rate of suicide attempts for those who reported exposure to 3 to 4 types of GBV (34.7 percent)" the authors write.

The researchers also found that gender-based violence was associated with more severe current mental disorder, higher rates of 3 or more lifetime disorders, physical disability, mental disability, impaired quality of life, an increase in disability days, and overall disability.

"Our data underline the observation that mental health disorder in women who have experienced GBV tends to be more severe and associated with comorbidity, characteristics that require expert and comprehensive approaches to treatment. Therefore, there is a need to ensure that expert mental health care is a central component of GBV programs. Similarly, psychiatric services need to be better equipped to assist women with mental health disorders who have experienced GBV," the authors write.

"In general, renewed impetus is needed to develop an evidence base for prevention and clinical interventions that reflect a comprehensive view of GBV and its association with wide-ranging mental and psychosocial disabilities among women."

More information: JAMA. 2011;306[5]:513-521

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