Associations between Multiple Types of IPV and Adverse Mental Health Outcomes Among IPV Survivors

Background and Purpose: A substantial amount of research has demonstrated that women who experience intimate partner violence (IPV) are disproportionately more likely to report adverse mental health outcomes including depression, PTSD, and suicidality – neuropsychiatric disorders that lead to disability and death. However, limited studies have incorporated multiple, robust measures of violence that reflect the true range of IPV exposures that women chronically experience such as harassment, technology-facilitated abuse, and reproductive coercion, as well as emotional, physical, and sexual abuse. This is critical as a more comprehensive understanding of the relationship between IPV exposures and their relative effects on mental health could aid in improved intervention development that reduces the current burden of mental health. As such, this paper seeks to examine the association between multiple types of IPV and adverse mental health outcomes among a sample of survivors.

Methods: We used data from a web-based survey administered between 2016-2018 to 377 women seeking services to address IPV in a U.S. Southwest state. The survey included several measures to document IPV including physical abuse (CAS-Physical Abuse Sub-scale); harassment (CAS-Harassment Sub-scale); severe abuse (CAS-Severe Combined Abuse Sub-scale); psychological abuse (WEB); reproductive coercion; and technology-facilitated i) harassment, ii) monitoring, and iii) coercive threats. Mental health measures included depression (CES-D), PTSD (PTSD Checklist-PCL), and history of suicidal threats or attempts. Following descriptive and bivariate analyses, a series of multivariate regression models with multiple imputation were conducted to investigate the net association between each IPV type and each mental health outcome, controlling for socio-demographics, relationship characteristics, and self-rated health.

Results: The sample identified as primarily White (39%), unemployed (69%), never married (57%), and having endured the abusive relationship for over 6 years (39%). Sixty-two percent of the participants met the DSM-IV criteria for PTSD, 76% met the clinical criteria for depression, and 32% reported a prior suicidal attempt or threat. Adjusted multivariate analyses indicated significant and varying associations between IPV type and mental health outcomes. Specifically, significant associations were observed between reproductive coercion (β=7.28, p<.001), technology-facilitated harassment (β=9.01, p<.05), technology-facilitated coercive threats (β=6.24, p<.05), and psychological abuse (β=5.40, p<.015) and symptoms of depression, adjusting for all other IPV types and control variables. Findings also indicated significant net associations between reproductive coercion (β=8.09, p<.001), technology-facilitated harassment (β=7.37, p<.05), and psychological abuse (β=8.03, p<.001) and increased PTSD symptomology. Finally, our third model showed that psychological abuse (OR=3.45, p<.01) increased the likelihood of reporting a prior suicidal attempt or threat, adjusting for all other variables.

Conclusions and Implications: Findings suggest a need for additional research to examine the relative effects of a broader range of IPV exposures than are typically measured, on mental health outcomes. Research to understand the mechanisms that underlie the varied associations observed in this study may also serve to strengthen existing dually focused IPV and mental health service development and response. Practice implications include the need for expanded training, screening, and capacity-building of providers to identify and address co-occurring IPV and adverse mental health, especially in relationship to technology-facilitated abuse and reproductive coercion.