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The effect of intimate partner violence on women’s mental distress: a prospective cohort study of 3010 rural Indian women

Abstract

Purpose

Intimate partner violence (IPV) encompasses physical, sexual, and psychological abuse, as well as controlling behavior. Most research focuses on physical and sexual abuse, and other aspects of IPV are rarely investigated. We estimated the effect of these neglected aspects of IPV on women’s mental distress.

Methods

We used data from 3010 women living in rural tribal communities in Rajasthan, India. Women completed baseline interviews and were re-interviewed approximately 1.5 years later. We measured IPV with questions adopted from the Demographic and Health Survey’s Domestic Violence Module, which asked seven questions about physical abuse, three questions about psychological abuse, and five questions about partner controlling behavior. Mental distress was measured with the 12-item General Health Questionnaire (score range 0–12). We used Poisson regression models to estimate the relation between changes in IPV and mental distress, accounting for time-fixed characteristics of individuals using individual fixed effects.

Results

Women reported an average of 2.1 distress symptoms during baseline interviews. In models that controlled for time-varying confounding (e.g., wealth, other types of abuse), experiencing psychological abuse was associated with an increase of 0.65 distress symptoms (95% CI 0.32, 0.98), and experiencing controlling behavior was associated with an increase of 0.31 distress symptoms (95% CI 0.18, 0.44). However, experiencing physical abuse was not associated with an increase in distress symptoms (mean difference = − 0.15, 95% CI − 0.45, 0.15).

Conclusions

Psychological abuse and controlling behavior may be important drivers of the relation between IPV and women’s mental health.

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Acknowledgements

This work was carried out with financial support from the UK Government’s Department for International Development (DFID) and the International Development Research Centre (IDRC), Canada. Robin Richardson was supported by a research training grant from the National Institute of Mental Health (5-T32-MH-013043) and the Spencer Foundation (#242794). Arijit Nandi was supported by the Canada Research Chairs program. Sam Harper was partially supported by a Chercheur Boursier Junior 2 from the Fonds de la Recherche en Santé du Québec. The views expressed herein are those of the authors and do not necessarily reflect those of the funding agencies.

Author information

Correspondence to Robin Richardson.

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Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethics statement

The study received ethics approval from the Institutional Review Board of McGill University’s Faculty of Medicine and the Human Subjects Committee of the Institute for Financial Management in Chennai, India. The research was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Appendices

Appendix 1: Association between changes in counts of abuse items and mental distress, n = 3010 (Rajasthan, India, 2015–2016)

  Crude mean difference (95% CI)a Adjusted mean difference (95% CI)b
Controlling behavior 0.20 (0.15, 0.24) 0.19 (0.15, 0.24)
Psychological abuse 0.36 (0.25, 0.47) 0.35 (0.24, 0.46)
Physical abuse 0.04 (− 0.04, 0.11) 0.02 (− 0.06, 0.09)
Controlling behavior + psychological abuse 0.44 (0.34, 0.54) 0.44 (0.34, 0.53)
Controlling behavior + physical abuse 0.18 (0.11, 0.26) 0.19 (0.11, 0.26)
Psychological abuse + physical abuse 0.33 (0.22, 0.44) 0.33 (0.22, 0.44)
Controlling behavior + psychological abuse + physical abuse 0.41 (0.32, 0.51) 0.41 (0.32, 0.51)
  1. aAdjusted for other forms of abuse (e.g., physical, psychological, controlling behavior)
  2. bAdjusted for other forms of abuse (e.g., physical, psychological, controlling behavior), household wealth, number of boys in the household, number of girls in the household, and the following interaction terms: controlling behavior × psychological abuse, physical abuse × controlling behavior, physical abuse × psychological abuse, physical abuse × psychological abuse × controlling behavior

Appendix 2: Association between changes in IPV experience and changes in mental distress among women in control arm, n = 1259 (Rajasthan, India, 2015–2016)

Controlling behavior Psychological abuse Physical abuse Crude mean difference (95% CI)a Adjusted mean difference (95% CI)b
No No No 0 (Ref) 0 (Ref)
Yes No No 0.30 (0.12, 0.48) 0.32 (0.13, 0.50)
No Yes No 0.69 (0.31, 1.08) 0.68 (0.29, 1.06)
No No Yes 0.02 (− 0.39, 0.44) 0.02 (− 0.39, 0.44)
Yes Yes No 0.39 (0.17, 0.61) 0.40 (0.18, 0.62)
No Yes Yes 0.51 (0.06, 0.97) 0.51 (0.05, 0.96)
Yes No Yes 0.14 (− 0.12, 0.40) 0.14 (− 0.12, 0.40)
Yes Yes Yes 0.70 (0.49, 0.90) 0.70 (0.49, 0.90)
  1. aAdjusted for other forms of abuse (e.g., physical, psychological, controlling behavior)
  2. bAdjusted for other forms of abuse (e.g., physical, psychological, controlling behavior), household wealth, number of boys in the household, number of girls in the household, and the following interaction terms: controlling behavior × psychological abuse, physical abuse × controlling behavior, physical abuse × psychological abuse, physical abuse × psychological abuse × controlling behavior

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Richardson, R., Nandi, A., Jaswal, S. et al. The effect of intimate partner violence on women’s mental distress: a prospective cohort study of 3010 rural Indian women. Soc Psychiatry Psychiatr Epidemiol 55, 71–79 (2020). https://doi.org/10.1007/s00127-019-01735-5

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Keywords

  • Intimate partner violence
  • Controlling behavior
  • Psychological abuse
  • Mental distress
  • India