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

From the press release: 

Women who reported experiencing gender-based violence, such as rape, sexual assault, intimate partner violence and stalking, had an associated higher lifetime prevalence of mental health disorders, dysfunction and disability, according to a study in the August 3 issue of JAMA, a theme issue on violence and human rights.

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).

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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.

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Lifetime Prevalence of Gender-Based Violence in Women and the Relationship With Mental Disorders and Psychosocial Function
Susan Rees, Derrick Silove, Tien Chey, Lorraine Ivancic, Zachary Steel, Mark Creamer, Maree Teesson, Richard Bryant, Alexander C. McFarlane, Katherine L. Mills, Tim Slade, Natacha Carragher, Meaghan O'Donnell, David Forbes
JAMA. 2011;306(5):513-521.
doi:10.1001/jama.2011.1098 [[fee]

Context: Intimate partner physical violence, rape, sexual assault, and stalking are pervasive and co-occurring forms of gender-based violence (GBV). An association between these forms of abuse and lifetime mental disorder and psychosocial disability among women needs to be examined.

Objectives: To assess the association of GBV and mental disorder, its severity and comorbidity, and psychosocial functioning among women.

Design, Setting, and Participants: A cross-sectional study based on the Australian National Mental Health and Well-being Survey in 2007, of 4451 women (65% response rate) aged 16 to 85 years.

Main Outcome Measures: The Composite International Diagnostic Interview version 3.0 of 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). Also included were indices of lifetime trauma exposure, including GBV, sociodemographic characteristics, economic status, family history of mental disorder, social supports, general mental and physical functioning, quality of life, and overall disability.

Results: A total of 1218 women (27.4%) reported experiencing at least 1 type of GBV. For women exposed to 3 or 4 types of GBV (n = 139), the rates of mental disorders were 77.3% (odds ratio [OR], 10.06; 95% confidence interval [CI], 5.85-17.30) for anxiety disorders, 52.5% (OR, 3.59; 95% CI, 2.31-5.60) for mood disorder, 47.1% (OR, 5.61; 95% CI, 3.46-9.10) for substance use disorder, 56.2% (OR, 15.90; 95% CI, 8.32-30.20) for PTSD, 89.4% (OR, 11.00; 95% CI, 5.46-22.17) for any mental disorder, and 34.7% (OR, 14.80; 95% CI, 6.89-31.60) for suicide attempts. Gender-based violence was associated with more severe current mental disorder (OR, 4.60; 95% CI, 2.93-7.22), higher rates of 3 or more lifetime disorders (OR, 7.79; 95% CI, 6.10-9.95), physical disability (OR, 4.00; 95% CI, 1.82-8.82), mental disability (OR, 7.14; 95% CI, 2.87-17.75), impaired quality of life (OR, 2.96; 95% CI, 1.60-5.47), an increase in disability days (OR, 3.14; 95% CI, 2.43-4.05), and overall disability (OR, 2.73; 95% CI, 1.99-3.75).

Conclusion: Among a nationally representative sample of Australian women, GBV was significantly associated with mental health disorder, dysfunction, and disability.