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



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.

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  1. 1.

    Krug E, Dahlberg LL, Mercy JA, Zwi AB, Lozano R (2002) World report on violence and health. World Health Organization, Geneva

    Google Scholar 

  2. 2.

    Devries KM, Mak JY, Garcia-Moreno C, Petzold M, Child JC, Falder G, Lim S, Bacchus LJ, Engell RE, Rosenfeld L, Pallitto C, Vos T, Abrahams N, Watts CH (2013) Global health. The global prevalence of intimate partner violence against women. Science 340(6140):1527–1528.

    Article  PubMed  CAS  Google Scholar 

  3. 3.

    Watts C, Zimmerman C (2002) Violence against women: global scope and magnitude. Lancet 359(9313):1232–1237.

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Garcia-Moreno C, Jansen HA, Ellsberg M, Heise L, Watts CH (2006) Prevalence of intimate partner violence: findings from the WHO multi-country study on women’s health and domestic violence. Lancet 368(9543):1260–1269.

    Article  PubMed  Google Scholar 

  5. 5.

    Ellsberg M, Jansen HA, Heise L, Watts CH, Garcia-Moreno C (2008) Intimate partner violence and women’s physical and mental health in the WHO multi-country study on women’s health and domestic violence: an observational study. Lancet 371(9619):1165–1172.

    Article  Google Scholar 

  6. 6.

    WHO (2013) Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and nonpartner sexual violence. World Health Organization, Geneva

    Google Scholar 

  7. 7.

    Garcia-Moreno C, Jansen H, Ellsberg M, Heise L, Watts C (2005) WHO multi-country study on women’s health and domestic violence against women. World Health Organization, Geneva

    Google Scholar 

  8. 8.

    Ellsberg M, Arango DJ, Morton M, Gennari F, Kiplesund S, Contreras M, Watts C (2015) Prevention of violence against women and girls: what does the evidence say? Lancet 385(9977):1555–1566.

    Article  Google Scholar 

  9. 9.

    WHO (2010) Preventing intimate partner and sexual violence against women: taking action and generating evidence. World Health Organization/London School of Hygiene and Tropical Medicine, Geneva

    Google Scholar 

  10. 10.

    Cleary Bradley RP, Gottman JM (2012) Reducing situational violence in low-income couples by fostering healthy relationships. J Marital Fam Therapy 38(Suppl 1):187–198.

    Article  Google Scholar 

  11. 11.

    WHO (2016) Global plan of action to strengthen the role of the health system within a national multisectoral response to address interpersonal violence, in particular against women and girls, and against children. World Health Organization Geneva, Switzerland

    Google Scholar 

  12. 12.

    Black MC, Basile KC, Breiding MJ, Smith SG, Walters ML, Merrick MT, Chen J, Stevens MR (2010) The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 Summary Report. Center for Disease Control and Prevention, Atlanta

    Google Scholar 

  13. 13.

    Straus MA, Mickey EL (2012) Reliability, validity, and prevalence of partner violence measured by the conflict tactics scales in male-dominant nations. Aggress Violent Behav 17(5):463–474

    Article  Google Scholar 

  14. 14.

    Capaldi DM, Knoble NB, Shortt JW, Kim HK (2012) A systematic review of risk factors for intimate partner violence. Partn Abuse 3(2):231–280.

    Article  Google Scholar 

  15. 15.

    Hindin MJ, Kishor S, Ansara DL (2008) Intimate partner violence among couples in 10 DHS Countries: Predictors and Health Outcomes. DHS Analytical Studies No. 18. Macro International Inc., Calverton, Maryland

  16. 16.

    Kessler RC, Üstün TB (2008) The WHO World Mental Health Surveys: global perspectives on the epidemiology of mental disorders, vol 6. Cambridge University Press, New York

    Google Scholar 

  17. 17.

    Garcia-Moreno C, Jansen H, Ellsberg M, Heise L, Watts C (2005) WHO Multi-country study on women’s health and domestic violence against women: Initial results on prevalence, health outcomes and women’s responses. World Health Organization, Geneva

    Google Scholar 

  18. 18.

    Heeringa S, Wells E, Hubbard F, Mneimneh Z, Chiu WT, Sampson N, Berglund P (2008) Sample designs and sampling procedures. In: RC K TÜ (ed) The WHO World Mental Health Surveys: Global perspectives on the epidemiology of mental disorders. Cambridge University Press, New York, pp 14–32

  19. 19.

    Pennell B-P, Mneimneh Z, Bowers A, Chardoul S, Well SJ, Viana M (2008) Implementation of the World Mental Health Surveys. In: Kessler RCÜT (ed) The WHO World Mental Health Surveys: global perspectives on the epidemiology of mental disorders. Cambridge University Press, New York, pp 33–57

    Google Scholar 

  20. 20.

    Straus MA, Hamby SL, Boney-McCoy S, Sugarman DB (1996) The revised conflict tactics scales (CTS2) development and preliminary psychometric data. J Fam Issues 17(3):283–316

    Article  Google Scholar 

  21. 21.

    Lee S, Tsang A, Breslau J, Aguilar-Gaxiola S, Angermeyer M, Borges G, Bromet E, Bruffaerts R, de Girolamo G, Fayyad J, Gureje O, Haro JM, Kawakami N, Levinson D, Browne MAO, Ormel J, Posada-Villa J, Williams DR, Kessler RC (2009) Mental disorders and termination of education in high-income and low- and middle-income countries: epidemiological study. Br J Psychiatry 194(5):411–417.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  22. 22.

    Hussmanns R, Mehran F, Verna V (1990) Surveys of economically active population, employment, unemployment and underemployment: An ILO manual on concepts and methods. International Labour Office, Geneva

    Google Scholar 

  23. 23.

    Straus MA (1979) Measuring intrafamily conflict and violence: the conflict tactics (CT) scales. J Marriage Fam 41(1):75–88

    Article  Google Scholar 

  24. 24.

    Kessler RC, McLaughlin KA, Green JG, Gruber MJ, Sampson NA, Zaslavsky AM, Aguilar-Gaxiola S, Alhamzawi AO, Alonso J, Angermeyer M, Benjet C, Bromet E, Chatterji S, de Girolamo G, Demyttenaere K, Fayyad J, Florescu S, Gal G, Gureje O, Haro JM, Hu CY, Karam EG, Kawakami N, Lee S, Lepine JP, Ormel J, Posada-Villa J, Sagar R, Tsang A, Ustun TB, Vassilev S, Viana MC, Williams DR (2010) Childhood adversities and adult psychopathology in the WHO World Mental Health Surveys. Br J Psychiatry 197(5):378–385.

    Article  PubMed  PubMed Central  Google Scholar 

  25. 25.

    McLaughlin KA, Greif Green J, Gruber MJ, Sampson NA, Zaslavsky AM, Kessler RC (2012) Childhood adversities and first onset of psychiatric disorders in a national sample of US adolescents. Arch Gen Psychiatry 69(11):1151–1160.

    Article  PubMed  PubMed Central  Google Scholar 

  26. 26.

    Miller E, Breslau J, Petukhova M, Fayyad J, Green JG, Kola L, Seedat S, Stein DJ, Tsang A, Viana MC, Andrade LH, Demyttenaere K, de Girolamo G, Haro JM, Hu C, Karam EG, Kovess-Masfety V, Tomov T, Kessler RC (2011) Premarital mental disorders and physical violence in marriage: cross-national study of married couples. Br J Psychiatry 199(4):330–337.

    Article  PubMed  PubMed Central  Google Scholar 

  27. 27.

    Wolter K (1985) Introduction to variance estimation. Springer, New York

    Google Scholar 

  28. 28.

    Levy PS, Lemeshow S (2013) Sampling of populations: methods and applications. Wiley, New York

    Google Scholar 

  29. 29.

    Agresti A (2002) Logistic regression. Wiley Online Library, Hoboken

    Google Scholar 

  30. 30.

    Zou KH, O’Malley AJ, Mauri L (2007) Receiver-operating characteristic analysis for evaluating diagnostic tests and predictive models. Circulation 115(5):654–657

    Article  Google Scholar 

  31. 31.

    Hanley JA, McNeil BJ (1983) A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 148(3):839–843

    Article  CAS  Google Scholar 

  32. 32.

    Smith GC, Seaman SR, Wood AM, Royston P, White IR (2014) Correcting for optimistic prediction in small data sets. Am J Epidemiol 180(3):318–324.

    Article  PubMed  PubMed Central  Google Scholar 

  33. 33.

    Efron B (1983) Estimating the error rate of a prediction rule: improvement on cross-validation. J Am Stat Assoc 78(382):316–331

    Article  Google Scholar 

  34. 34.

    Ellsberg M, Heise L, Pena R, Agurto S, Winkvist A (2001) Researching domestic violence against women: methodological and ethical considerations. Stud Fam Plann 32(1):1–16

    Article  CAS  Google Scholar 

  35. 35.

    Kishor S (2005) Violence against women: a statistical overview, challenges and gaps in data collection and methodology and approaches for overcoming them—domestic violence measurement in the demographic and health surveys: the history and the challenges. Dvision for the Advancement of Women, Geneva

    Google Scholar 

  36. 36.

    Smith MD (1994) Enhancing the quality of survey data on violence against women: a feminist approach. Gender Soc 8(1):109–127

    Article  Google Scholar 

  37. 37.

    Fulu E, Jewkes R, Roselli T, Garcia-Moreno C (2013) Prevalence of and factors associated with male perpetration of intimate partner violence: findings from the UN Multi-country cross-sectional Study on Men and Violence in Asia and the Pacific. Lancet Global Health 1(4):e187–e207.

    Article  PubMed  Google Scholar 

  38. 38.

    Heise L, Ellsberg M, Gottemoeller M (1999) Ending violence against women. Popul Rep 27(4):1

    Google Scholar 

  39. 39.

    Kuhn M, Johnson K (2013) Applied predictive modeling, vol 810. Springer, New York

    Google Scholar 

  40. 40.

    Cleary Bradley RP, Friend DJ, Gottman JM (2011) Supporting healthy relationships in low-income, violent couples: reducing conflict and strengthening relationship skills and satisfaction. J Couple Relatsh Therapy 10(2):97–116

    Article  Google Scholar 

  41. 41.

    Heise L (2011) What works to prevent partner violence? An evidence overview. STRIVE, London School of Hygiene and Tropical Medicine, London.

  42. 42.

    Gil-Gonzalez D, Vives-Cases C, Ruiz MT, Carrasco-Portino M, Alvarez-Dardet C (2008) Childhood experiences of violence in perpetrators as a risk factor of intimate partner violence: a systematic review. J Public Health 30(1):14–22.

    Article  Google Scholar 

  43. 43.

    Roberts AL, Gilman SE, Fitzmaurice G, Decker MR, Koenen KC (2010) Witness of intimate partner violence in childhood and perpetration of intimate partner violence in adulthood. Epidemiology 21(6):809–818.

    Article  PubMed  PubMed Central  Google Scholar 

  44. 44.

    Kim HK, Laurent HK, Capaldi DM, Feingold A (2008) Men’s aggression toward women: a 10-year panel study. J Marriage Fam 70(5):1169–1187.

    Article  PubMed  PubMed Central  Google Scholar 

  45. 45.

    Szklo M, Nieto J (2014) Epidemiology beyond the basics, 3rd edn. Jones and Bartlett Learning, Burlington

    Google Scholar 

  46. 46.

    Kazemian L, Farrington DP (2005) Comparing the validity of prospective, retrospective, and official onset for different offending categories. J Quant Criminol 21(2):127–147

    Article  Google Scholar 

  47. 47.

    DeKeseredy WS, Schwartz MD (1998) Measuring the extent of woman abuse in intimate heterosexual relationships: a critique of the conflict tactics scales. US Department of Justice Violence Against Women Grants Office Electronic Resources.

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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

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Correspondence to Robert M. Bossarte.

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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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Members of “The WHO World Mental Health Survey Collaborators” are listed in acknowledgement section.

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Stokes, C.M., Alonso, J., Andrade, L.H. et al. Pre-marital predictors of marital violence in the WHO World Mental Health (WMH) Surveys. Soc Psychiatry Psychiatr Epidemiol 55, 393–405 (2020).

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  • Intimate partner violence
  • Predictive modeling
  • Epidemiology
  • International
  • Mental health