Pre-marital predictors of marital violence in the WHO World Mental Health (WMH) Surveys

  • Cara M. Stokes
  • Jordi Alonso
  • Laura Helena Andrade
  • Lukoye Atwoli
  • Graça Cardoso
  • Wai Tat Chiu
  • Rumyana V. Dinolova
  • Oye Gureje
  • Aimee N. Karam
  • Elie G. Karam
  • Ronald C. Kessler
  • Somnath Chatterji
  • Andrew King
  • Sing Lee
  • Zeina Mneimneh
  • Bibilola D. Oladeji
  • Maria Petukhova
  • Charlene Rapsey
  • Nancy A. Sampson
  • Kate Scott
  • Amy Street
  • Maria Carmen Viana
  • Michelle A. Williams
  • Robert M. BossarteEmail author
  • on behalf of the WHO World Mental Health Survey Collaborators
Original Paper



Intimate partner violence (IPV) is a pervasive public health problem. Existing research has focused on reports from victims and few studies have considered pre-marital factors. The main objective of this study was to identify pre-marital predictors of IPV in the current marriage using information obtained from husbands and wives.


Data from were obtained from married heterosexual couples in six countries. Potential predictors included demographic and relationship characteristics, adverse childhood experiences, dating violence, and psychiatric disorders. Reports of IPV and other characteristics from husbands and wives were considered independently and in relation to spousal reports.


Overall, 14.4% of women were victims of IPV in the current marriage. Analyses identified ten significant variables including age at first marriage (husband), education, relative number of previous marriages (wife), history of one or more categories of childhood adversity (husband or wife), history of dating violence (husband or wife), early initiation of sexual intercourse (husband or wife), and four combinations of internalizing and externalizing disorders. The final model was moderately predictive of marital violence, with the 5% of women accounting for 18.6% of all cases of marital IPV.


Results from this study advance understanding of pre-marital predictors of IPV within current marriages, including the importance of considering differences in the experiences of partners prior to marriage and may provide a foundation for more targeted primary prevention efforts.


Intimate partner violence Predictive modeling Epidemiology International Mental health 



The WHO World Mental Health Survey collaborators are Sergio Aguilar-Gaxiola, MD, Ph.D., Ali Al-Hamzawi, MD, Mohammed Salih Al-Kaisy, MD, Jordi Alonso, MD, Ph.D., Laura Helena Andrade, MD, Ph.D., Corina Benjet, Ph.D., Guilherme Borges,ScD, Evelyn J. Bromet, Ph.D., Ronny Bruffaerts, Ph.D., Brendan Bunting, Ph.D., Jose Miguel Caldas de Almeida, MD, Ph.D., Graça Cardoso, MD, Ph.D., Somnath Chatterji, MD, Alfredo H. Cia, MD, Louisa Degenhardt, Ph.D., Koen Demyttenaere, MD, Ph.D., John Fayyad, MD, Silvia Florescu, MD, Ph.D., Giovanni de Girolamo, MD, Oye Gureje, MD, DSc, FRCPsych, Josep Maria Haro, MD, Ph.D., Yanling He, MD, Hristo Hinkov, MD, Ph.D., Chi-yi Hu, MD, Ph.D., Yueqin Huang, MD, MPH, Ph.D., Peter de Jonge, Ph.D., Aimee Nasser Karam, Ph.D., Elie G. Karam, MD, Norito Kawakami, MD, DMSc, Ronald C. Kessler, Ph.D., Andrzej Kiejna, MD, Ph.D., Viviane Kovess-Masfety, MD, Ph.D., Sing Lee, MB, BS, Jean-Pierre Lepine, MD, Daphna Levinson, Ph.D., John McGrath, MD, Ph.D., Maria Elena Medina-Mora, Ph.D., Zeina Mneimneh, Ph.D., Jacek Moskalewicz, Ph.D., Fernando Navarro-Mateu, MD, Ph.D., Beth-Ellen Pennell, MA, Marina Piazza, MPH, ScD, Jose Posada-Villa, MD, Kate M. Scott, Ph.D., Tim Slade, Ph.D., Juan Carlos Stagnaro, MD, Ph.D., Dan J. Stein, FRCPC, Ph.D., Margreet ten Have, Ph.D., Yolanda Torres, MPH, Dra.HC, Maria Carmen Viana, MD, Ph.D., Harvey Whiteford, MBBS, Ph.D., David R. Williams, MPH, Ph.D., Bogdan Wojtyniak, ScD.


The World Health Organization World Mental Health (WMH) Survey Initiative is supported by the United States National Institute of Mental Health (NIMH; R01 MH070884), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the United States Public Health Service (R13-MH066849, R01-MH069864, and R01 DA016558), the Fogarty International Center (FIRCA R03-TW006481), the Pan American Health Organization, Eli Lilly and Company, Ortho-McNeil Pharmaceutical Inc., GlaxoSmithKline, and Bristol-Myers Squibb. We thank the staff of the WMH Data Collection and Data Analysis Coordination Centres for assistance with instrumentation, fieldwork, and consultation on data analysis. None of the funders had any role in the design, analysis, interpretation of results, or preparation of this paper. The views and opinions expressed in this report are those of the authors and should not be construed to represent the views of the World Health Organization, other sponsoring organizations, agencies, or governments. The São Paulo Megacity Mental Health Survey is supported by the State of São Paulo Research Foundation (FAPESP) Thematic Project Grant 03/00204-3. The Bulgarian Epidemiological Study of common mental disorders EPIBUL is supported by the Ministry of Health and the National Center for Public Health Protection. The Chinese World Mental Health Survey Initiative is supported by the Pfizer Foundation. The Lebanese Evaluation of the Burden of Ailments and Needs Of the Nation (L.E.B.A.N.O.N.) is supported by the Lebanese Ministry of Public Health, the WHO (Lebanon), National Institute of Health/Fogarty International Center (R03 TW006481-01), anonymous private donations to IDRAAC, Lebanon, and unrestricted grants from, Algorithm, AstraZeneca, Benta, Bella Pharma, Eli Lilly, Glaxo Smith Kline, Lundbeck, Novartis, OmniPharma, Pfizer, Phenicia, Servier, UPO. The Nigerian Survey of Mental Health and Wellbeing (NSMHW) is supported by the WHO (Geneva), the WHO (Nigeria), and the Federal Ministry of Health, Abuja, Nigeria. The US National Comorbidity Survey Replication (NCS-R) is supported by the National Institute of Mental Health (NIMH; U01-MH60220) with supplemental support from the National Institute of Drug Abuse (NIDA), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Robert Wood Johnson Foundation (RWJF; Grant 044708), and the John W. Alden Trust. The Brazilian Council for Scientific and Technological Development supports Dr. Laura Helena Andrade (CNPq Grant #307784/2016-9). A complete list of all within-country and cross-national WMH publications can be found at

Compliance with ethical standards

Conflict of interest

In the past 3 years, Dr. Kessler received support for his epidemiological studies from Sanofi Aventis; was a consultant for Johnson & Johnson Wellness and Prevention, Sage Pharmaceuticals, Shire, Takeda; and served on an advisory board for the Johnson & Johnson Services Inc. Lake Nona Life Project. Kessler is a co-owner of DataStat, Inc., a market research firm that carries out healthcare research. The opinions and assertions expressed herein are those of the author(s) and do not necessarily reflect the official policy or position of the Uniformed Services University or the Department of Defense.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Cara M. Stokes
    • 1
    • 2
    • 3
    • 4
  • Jordi Alonso
    • 5
    • 6
    • 7
  • Laura Helena Andrade
    • 8
  • Lukoye Atwoli
    • 9
    • 10
  • Graça Cardoso
    • 11
  • Wai Tat Chiu
    • 12
  • Rumyana V. Dinolova
    • 13
  • Oye Gureje
    • 14
  • Aimee N. Karam
    • 15
  • Elie G. Karam
    • 15
    • 16
    • 17
  • Ronald C. Kessler
    • 12
  • Somnath Chatterji
    • 18
  • Andrew King
    • 12
  • Sing Lee
    • 19
  • Zeina Mneimneh
    • 20
  • Bibilola D. Oladeji
    • 21
    • 22
  • Maria Petukhova
    • 12
  • Charlene Rapsey
    • 23
  • Nancy A. Sampson
    • 12
  • Kate Scott
    • 23
  • Amy Street
    • 24
  • Maria Carmen Viana
    • 25
  • Michelle A. Williams
    • 26
  • Robert M. Bossarte
    • 2
    • 3
    • 4
    Email author
  • on behalf of the WHO World Mental Health Survey Collaborators
  1. 1.Department of Psychiatry, Center for the Study of Traumatic StressUniformed Services University of the Health SciencesBethesdaUSA
  2. 2.Department of Behavioral Medicine and Psychiatry, School of MedicineWest Virginia UniversityMorgantownUSA
  3. 3.Injury Control Research CenterWest Virginia UniversityMorgantownUSA
  4. 4.Department of EpidemiologySchool of Public Health, West Virginia UniversityMorgantownUSA
  5. 5.Health Services Research UnitIMIM-Hospital del Mar Medical Research InstituteBarcelonaSpain
  6. 6.CIBER en Epidemiología y Salud Pública (CIBERESP)BarcelonaSpain
  7. 7.Pompeu Fabra University (UPF)BarcelonaSpain
  8. 8.Núcleo de Epidemiologia Psiquiátrica, LIM 23Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
  9. 9.Department of Mental HealthMoi University School of MedicineEldoretKenya
  10. 10.Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownRepublic of South Africa
  11. 11.Lisbon Institute of Global Mental Health and Chronic Diseases Research Center, NOVA Medical SchoolNOVA University of LisbonLisbonPortugal
  12. 12.Department of Health Care PolicyHarvard Medical SchoolBostonUSA
  13. 13.Departament of Mental HealthNational Center of Public Health and AnalysesSofiaBulgaria
  14. 14.Department of PsychiatryUniversity College HospitalIbadanNigeria
  15. 15.Institute for Development, Research, Advocacy & Applied Care (IDRAAC)BeirutLebanon
  16. 16.Department of Psychiatry and Clinical Psychology, Faculty of MedicineBalamand UniversityBeirutLebanon
  17. 17.Department of Psychiatry and Clinical PsychologySt George Hospital University Medical CenterBeirutLebanon
  18. 18.Department of Information, Evidence and ResearchWorld Health OrganizationGenevaSwitzerland
  19. 19.Department of PsychiatryChinese University of Hong KongTai PoHong Kong
  20. 20.Survey Research Center, Institute for Social ResearchUniversity of MichiganAnn ArborUSA
  21. 21.Department of Psychiatry, College of MedicineUniversity of IbadanIbadanNigeria
  22. 22.University College HospitalIbadanNigeria
  23. 23.Department of Psychological MedicineUniversity of OtagoDunedinNew Zealand
  24. 24.VA Boston Healthcare SystemBostonUSA
  25. 25.Department of Social Medicine, Postgraduate Program in Public HealthFederal University of Espírito SantoVitoriaBrazil
  26. 26.Harvard T.H. Chan School of Public HealthBostonUSA

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