Intimate Partner Violence and Mental Health Effects: A Population-Based Study among Married Women in Karachi, Pakistan
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Intimate partner violence (IPV) is recognized all over the world for its association with mental health problems in women. In Pakistan, such violence occurs commonly, but detailed information on mental health effects is scarce. The purpose of this study is to focused on married couples in urban Karachi to investigate mental health effects associated with physical, sexual and psychological violence perpetrated by husbands towards wives. Disclosure rates and health care-seeking behaviour were also investigated.
This cross-sectional study involved 759 women between the ages of 25 and 60 years, selected using a multi-stage random sampling technique. The women were interviewed by trained community midwives using a structured questionnaire.
In the total population of women, mental symptoms were prevalent. Women subjected to any form of violence reported, however, considerably poorer mental health than unexposed women. A statistically significant difference for almost all of the studied health parameters persisted even after controlling for socio-demographic factors. The strongest associations were found for suicidal thoughts and physical violence (OR 4.41; 3.18–6.12), sexual abuse (OR 4.39; 3.17–6.07) and psychological abuse (OR 5.17; 3.28–8.15). The interviews revealed that only 27% of the women subjected to violence had disclosed this to anyone, in most cases to their parents.
The findings in this study highlight that the violence women have to face contributes to the development of multiple forms of psychological stress and serious mental health problems. Women’s restrictive life circumstances seriously hamper women’s empowerment. Reliable health surveillance system and health care services are needed to serve abused women. Policy initiatives focused on IPV and gender inequality in Pakistan should be initiated.
KeywordsIntimate partner violence Domestic violence Mental health effects Depression Suicidal thoughts Coping
This study was made possible by a grant from STINT (The Swedish Foundation for International Cooperation in Research and Higher Education) and by support from the Swedish Institute. This study has also been supported by the School of Nursing and the Community Health Department at Aga Khan University, Karachi, Pakistan. The Department of Social Medicine at Gothenburg University and the Department of Public Health Sciences, Division of Global Health (IHCAR), Karolinska Institute, Stockholm, Sweden gave support during the manuscript analysis and preparation.
The authors want to thank HANDS, a non-governmental organisation that supported and facilitated the data collection and allowed the use of their surveillances system. We also want to acknowledge PAWLA (Pakistan Women Lawyers' Association) and the Women’s Social Welfare Department for their strong support in the training of the data collectors. Last but not least, we want to thank the women who participated for their trust and confidence in this study.
Disclosure of interest
The authors clarify that there is no financial relationship with the organization that sponsored the research.
The first and last authors are responsible for the conception and design, acquisition of data, analysis and interpretation of data, drafting the article or revising it critically for important intellectual content and final approval of the version to be published. The second author’s contribution is the interpretation of data, revising it critically for important intellectual content and final approval of the version to be published.
- 8.Devries K, Watts C, Yoshihama M, Kiss L, Schraiber LB, Deyessa N, et al. Violence against women is strongly associated with suicide attempts: evidence from the WHO multi-country study on women's health and domestic violence against women. Social Science & Medicine.73(1):79–86.Google Scholar
- 10.Pico-Alfonso MA, Garcia-Linares MI, Celda-Navarro N, Blasco-Ros C, Echeburúa E, Martinez M. The impact of physical, psychological, and sexual intimate male partner violence on women's mental health: depressive symptoms, posttraumatic stress disorder, state anxiety, and suicide. J Womens Health. 2006;15(5):599–611.CrossRefGoogle Scholar
- 12.Antai D. Controlling behavior, power relations within intimate relationships and intimate partner physical and sexual violence against women in Nigeria. Bmc Public Health.11(1):511Google Scholar
- 16.Beeble M, Sullivan C, Bybee D. The impact of neighborhood factors on the well-being of survivors of intimate partner violence over time. American Journal of Community Psychology.47(3):287–306.Google Scholar
- 17.Calverton M. Pakistan demographic health survey 2006–7. Macro International Inc, 2007. Islamabad: Government of Pakistan; 2007.Google Scholar
- 18.Sadaquat MB. Employment situation of women in Pakistan. International Journal of Social Economics.38(2):98–113.Google Scholar
- 19.Rabbani FQF, Rizvi N. Perspectives on domestic violence: case study from Karachi, Pakistan. East Mediterr Health J [Original article]. 2008;14(2):415–26.Google Scholar
- 27.City District Government Karachi: Kolachi to Karachi. [cited 2010 1/07/10]; Available from: http://www.karachicity.gov.pk/
- 28.Health And Nutrition Development Society. Karachi; 2010 [updated 2010; cited 2010 June 5, 2010]; About HANDS. Available from: http://www.hands.org.pk/abouthands/abouthands.htm.
- 30.WHO multicountry study on women's health and life experiences questionnaire (version 9). Geneva: World Health Organisation; 2000.Google Scholar
- 34.Ali TS, Asad N, Mogren I, Krantz G. Intimate partner violence in urban Pakistan: prevalence, frequency and risk factors. Submitted to International Journal of Women Health. December, 2010.Google Scholar
- 35.Kinnear P GC. SPSS for Windows made simple. Release 10 Aberdeen. University of Aberdeen; 2001.Google Scholar
- 36.World Health Organisation. Putting women first. Ethical and safety recommendations for research on domestic violence against women. 2001 Contract No.: Document Number.Google Scholar
- 38.Incidents of violence against women in Pakistan: reported during January to June 2010. In: Pakistan Go, editor. Islamabad; 2010.Google Scholar
- 39.Association AP. Diagnostic and statistical manual of mental disorders. 4th ed. Washington: American Psychiatric; 1994.Google Scholar
- 43.Lundgren E, Heimer G, Westerstrand J, Kalliokoski A. Slagen dam. Mäns våld mot kvinnor i jämställda Sverige-en omfångsundersökning [Captured queen—men’s violence against women in equal Sweden—a prevalence study]. Umeå, Sweden: Fritzes Offentliga Publikationer. 2001.Google Scholar
- 45.Andersson N, Cockcroft A, Ansari U, Omer K, Ansari NM, Khan A. Barriers to disclosing and reporting violence among women in Pakistan: findings from a national household survey and focus group discussions. Journal of interpersonal violence.25(11):1965Google Scholar