Examining the Bi-Directional Relationship between Intimate Partner Violence and Depression: Findings from a Longitudinal Study Among Women and Men in Rural Rwanda

Background: While studies have established an IPV-depression and depression-IPV link, the temporal relationship between these experiences remains unclear. Although IPV and depression share risk factors such as child maltreatment and family violence, few studies have controlled for these factors to eliminate potential confounding. There is also a lack of information on the bidirectional relationship between depression and IPV among men. This study addresses these gaps in the literature by exploring the bidirectional association between IPV and depression.

Methods: We use data from 813 women and 807 men from the control arm of a longitudinal cohort of couples, recruited as part of a randomized evaluation of Indashyikirwa, a multi-component intervention designed to reduce IPV among men and women in rural Rwanda. To isolate the impact of IPV on risk of depression, I restrict the sample to individuals who did not report depression at baseline and examine the association of IPV at baseline with depression at 24 months, adjusting for prior experiences of IPV and childhood factors associated with both depression and IPV. I also examined the association between depression at baseline and IPV experience or perpetration at 24 months among individuals who did not report ongoing IPV at baseline.

Results: Women who experienced physical and/or sexual IPV had 90% higher odds for reporting moderate to severe symptoms of depression at 24 months. As compared to IPV, prior experience of sexual violence was a stronger predictor of depression symptoms at 24 months. Across models, among women who were not at risk for depression at baseline, women who had experienced at least one form of sexual violence in their lifetime had approximately 75-80% higher odds of reporting depression symptoms at 24 months. Among men who did not report depression symptoms at baseline, men who perpetrated physical IPV had 87% higher odds to be at risk for depression at 24 months.

Depression symptoms at baseline were also significantly associated with different forms of IPV at 24 months. Women reporting moderate to severe symptoms of depression had two times the odds of experiencing sexual IPV at 24 months as compared to women who reported none to mild symptoms of depression at baseline (ß=2.07, CI: 1.28-3.36). Similarly, women reporting symptoms of depression were more likely to experience severe physical/sexual IPV at 24 months (ß=1.93, CI: 1.19-3.15).

Among men who did not report perpetrating physical IPV at baseline, men reporting moderate to severe symptoms of depression had 91% greater odds of perpetrating physical IPV at 24 months as compared to men who reported none to mild symptoms of depression (ß=1.91, CI: 1.04-3.50). Depressive symptoms were also associated with the perpetration of severe physical and/or sexual IPV at 24 months (ß=1.92, CI: 1.05-3.50).

Conclusion: These findings highlight the need for trauma-informed IPV prevention programs that screen for mental health issues and provide referral services to improve the effectiveness of IPV prevention programs. Mental health care workers, in turn, also need to screen patients for recent experiences of IPV to reduce the future risk of IPV experience and perpetration.