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| EDITORIAL |
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| Year : 2018 | Volume
: 23
| Issue : 1 | Page : 2-3 |
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Domestic violence and mental health
Rajesh Sagar, Gagan Hans
Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| Date of Web Publication | 2-Nov-2018 |
Correspondence Address:
Rajesh Sagar
Department of Psychiatry, All India Institute of Medical Sciences, New Delhi - 110 029
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0971-8990.244924
How to cite this article:
Sagar R, Hans G. Domestic violence and mental health. J Mental Health Hum Behav 2018;23:2-3 |
Domestic violence can be broadly defined as any behavior that is violent, abusive, or threatening in nature among adults who are relatives or partners/ex-partners. Domestic violence is a major human right and public health problem which can have physical as well as mental health-related adverse effects.
Although the domestic violence may be perpetrated by either sex, the women are invariably the victims in the majority of the cases, especially in the more conservative societies. The reasons for this are manifold, and there is sufficient literature to suggest this observation.[1] Although of late and particularly in the urban and semi-urban areas, there have been reports of reversal of this trend although the number of such cases is still very less as compared to the cases where females are the victims. The perpetrators are usually the husband or the in-laws in vast majority of the cases. This is particularly true in case of the intimate partner violence where the domestic violence occurs between the current and ex-partners and is this is generally viewed as a gender issue cutting across the societies globally.[2]
Although a number of other terms have been used to describe the phenomenon of domestic violence, the underlying theme of power dynamics is always reflected in the description. The World Health Organization (WHO) has defined intimate partner violence as “any behavior within an intimate relationship which causes physical, psychological, or sexual harm to those in the relationship; it includes physical aggression, psychological abuse, forced intercourse, and other forms of sexual coercion, as well as other controlling behaviors.”[3] This broad definition includes a myriad of behaviors which comes under the definition of domestic violence and this has been one of the inherent difficulties in research as well as one of the major criticisms of the definition.
This broad definition also affects the comparability of the research carried out globally and one of the major reasons for such variability of the results. Ultimately, the prevalence rates will depend on the definition used for measuring the magnitude of the problem. Despite all these difficulties, there is no denying the fact that the problem is one of the enormous magnitudes and may exhibit iceberg phenomenon where only the tip of the cases may be reported while the majority of the cases may go unreported, especially in the developing countries where the plight of the females is generally poor.
The National Crime Records Bureau has reported that cases of domestic violence are the most prevalent form of the crime against women in India. The prevalence rates of the domestic violence in India have been estimated to be in the range of 18%–70% by various studies.[4],[5] As far as the rates of the physical violence are concerned, 21%–48% of married women have reportedly suffered from physical abuse at the hands of the husband and in-laws.[5] The data on the sexual violence against married women are very sparse. It is partially because of the cultural factors which make it difficult to assess, but some studies report a prevalence rate between 15% and 20%.[5]
This gross variation in the rates across the country can be attributed to the methodological issues as discussed above. The WHO multicountry study on the extent of the physical and sexual intimate partner violence against women in 15 sites in 10 countries has yielded a lifetime prevalence of physical and sexual violence between 15% and 71% suggesting that the cultural and regional differences account for varying rates of the domestic violence globally.[6]
It goes without saying that this violence has a significant negative impact on the physical, emotional, and mental well-being of the female population. The problem has a sociocultural extension in its association with various evil practices such as dowry, child marriage, and normalization of the violence against women. It has been well documented that demands for dowry are what forms basis for violence against women in a number of the cases.[7] The perceived failure of performing one's duties as the female of the house is also seen as a cause in some cases.[7] The perpetual cycle of violence is also fueled by some other factors such as low socioeconomic status, less wages, poor living conditions, having a number of children, ongoing pregnancy, alcohol, and other substances abuse.
The domestic violence has an adverse impact on the physical health of the females, is associated with low birth weight, pregnancy complications, and also impacts the overall well-being of the mother and children. The association between the mental health and domestic violence is usually bidirectional, and it is associated with some mental health outcomes such as depression, posttraumatic stress disorder (PTSD), suicidality, substance abuse, and exacerbation of the psychotic symptoms.[8]
There is sufficient evidence in the literature which has established this bidirectional nature of mental health issues and domestic violence. A review of the international literature found high prevalence rates of intimate partner violence among men and women across all the diagnostic categories of the mental disorders. The prevalence of intimate partner violence was found to be 45.6% among patients suffering from depressive disorders, 27.6% in anxiety disorders, and 61% for PTSD.[9] The same review also found that there was a high likelihood of experiencing intimate partner violence in women with mental illness as compared to the women who do not have any mental health problems.
There is also evidence to suggest the causal association between domestic violence and mental health issues. The severity and the duration of the physical intimate violence are associated with the frequency and the severity of the depressive symptoms.[8] Similar evidence exists for PTSD which suggests that extent, severity, and duration of the abuse are directly associated with the intensity of the posttraumatic stress symptoms.[10] Furthermore, it has been observed that women who experience multiple forms of abuse and/or revictimized are at increased risk of mental disorders.[10],[11] Thus, it can be stated that the patients with mental illness are more likely to suffer domestic abuse, and at the same time, people who undergo domestic abuse are more likely to develop psychiatric conditions as well as experience acute decompensation of preexisting mental illnesses.
The exposure of the children to the domestic violence can produce a multitude of psychiatric difficulties in subsequent life. There have been reports of moderate to a strong association between the exposure to domestic violence and internalizing symptoms such as depression and anxiety and externalizing behaviors such as aggression and trauma-related symptoms in children and adolescents.[12],[13] These children are also likely to experience difficulties in other domains such as academic difficulties, high-risk sexual behaviors, and substance abuse. These children are also more likely to face other adverse environmental risk factors such as poverty, neglect, and malnutrition which further compromise their prognosis.
Although many legislative measures have been enacted to improve the plight of the women in the country, the problem of domestic violence is one of the major challenges we face particularly in the context of modernization, urbanization, and increased costs of living. The legislations such as Protection of Women from Domestic Violence Act, 2005 and the Dowry Prohibition Act, 1961 have improved the plight of the women in general, but a lot more is still desirable. These laws safeguard the rights of the women, but the desired change can only be affected by campaigns which aim at educating the masses about this social evil. The problem of domestic abuse cannot be viewed in isolation from other challenges that we face today as a nation such as poverty, unemployment, population control, and lack of basic amenities for majority of the population.
In conclusion, it can be said that domestic violence is a complex problem with its roots in multiple societal domains such as the status of women in the society, illiteracy, poverty, substance abuse, and various evil practices such as dowry and female feticide. Thus, any approach which does not target all these issues simultaneously is unlikely to yield any favorable results. All the stakeholders such as various governmental departments, law enforcement, judiciary, women and children organizations, non-governmental organizations, press, and professional bodies need to work in a coordinated and planned manner to make any visible impact and for advocacy of the rights of the women and children.
| References | |  |
| 1. | Slep AM, O'Leary SG. Parent and partner violence in families with young children: Rates, patterns, and connections. J Consult Clin Psychol 2005;73:435-44.  |
| 2. | Heise L, Ellsberg M, Gottmoeller M. A global overview of gender-based violence. Int J Gynaecol Obstet 2002;78 Suppl 1:S5-14. |
| 3. | Krug EG, Dahlberg LL, Mercy JA, Zwi AB, Lozano R, editors. World Report on Violence and Health. Geneva, Switzerland: World Health Organization; 2002. |
| 4. | Hassan F, Sadowski LS, Bangdiwala SI, Vizcarra B, Ramiro L, De Paula CS, et al. Physical intimate partner violence in Chile, Egypt, India and the Philippines. Inj Control Saf Promot 2004;11:111-6. |
| 5. | International Clinical Epidemiological Network: Domestic Violence in India. A Summary Report of a Mutlti-Site Household Survey. Washington, D.C: International Clinical Epidemiological Network: Domestic Violence in India; 2000. |
| 6. | World Health Organization. WHO Multi-Country Study on Women's Health and Domestic Violence against Women: Initial Results on Prevalence, Health Outcomes and Women's Responses. Geneva: World Health Organization; 2005. |
| 7. | Visaria L. Violence against women: A field study. Econ Polit Wkly 2000;35:1742-51. |
| 8. | Golding JM. Intimate partner violence as a risk factor for mental disorders: A meta-analysis. J Fam Violence 1999;14:99-132. |
| 9. | Trevillion K, Oram S, Feder G, Howard LM. Experiences of domestic violence and mental disorders: A systematic review and meta-analysis. PLoS One 2012;7:e51740. |
| 10. | Jones L, Hughes M, Unterstaller U. Post-traumatic stress disorder (PTSD) in victims of domestic violence. A review of the research. Trauma Violence Abuse 2001;2:99-119. |
| 11. | McFarlane J, Parker B, Soeken K, Silva C, Reel S. Safety behaviors of abused women after an intervention during pregnancy. J Obstet Gynecol Neonatal Nurs 1998;27:64-9. |
| 12. | Kitzmann KM, Gaylord NK, Holt AR, Kenny ED. Child witnesses to domestic violence: A meta-analytic review. J Consult Clin Psychol 2003;71:339-52. |
| 13. | Wolfe DA, Crooks CV, Lee V, McIntyre-Smith A, Jaffe PG. The effects of children's exposure to domestic violence: A meta-analysis and critique. Clin Child Fam Psychol Rev 2003;6:171-87. |
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