Associations between Different Types of Intimate Partner Violence and Post-Traumatic Stress Disorder Among Women Who Use Drugs and Alcohol in Central Asia

Background and Purpose: Extant literature has demonstrated that women with a history of intimate partner violence are two to three times more likely to experience post-traumatic stress disorder (PTSD), and that there are differential associations between types of IPV exposures (e.g. physical, sexual, psychological IPV) and risk of PTSD. However, similar research examining the association between different types of IPV and PTSD among women who use drugs or alcohol is limited. This is critical as research shows multiple links between IPV, PTSD, and drug and alcohol use, with women with a history of substance use being more likely to report both IPV and PTSD. Moreover, there has been even more limited research examining IPV and PTSD among women who use drugs and alcohol in Central Asia; a region experiencing an ongoing injection drug use epidemic and multi-level barriers to IPV, addiction, and mental health services. This paper examines the association between different types of IPV and PTSD among a sample of women in Kyrgyzstan, Central Asia.

Methods: We conducted a pilot IPV prevention intervention study with 213 women who reported using drugs or engaging in hazardous alcohol use, recruited from community-based harm reduction organizations in Kyrgyzstan between 2013-2016. Data reported here are from the baseline assessment; participants completed a computer-assisted survey that captured socio-demographics, lifetime and recent (past three months) IPV using an adapted version of the CTS-2, and PTSD (past month) using the PCL-C. Bivariate and multivariate logistic regression analyses were used to examine the association between different types of IPV and PTSD, adjusting for age, marital status, primary education, transactional sex history, and history of illicit drug use.

Results: Ninety one percent (n=200) and 65% (n=139) of participants reported some lifetime and recent IPV, respectively. Sixty-five percent of the sample reported PTSD symptoms in past month. Multi-variable logistic regressions demonstrated that different types of recent IPV was significantly associated with experiencing PTSD symptoms including physical IPV (aOR: 3.24, 95% CIs: 1.15 - 9.14), injurious IPV (aOR: 2.71, 95% CIs: 1.10 - 6.65), and the combined IPV variable (aOR: 4.95, 95% CIs: 1.16 - 21.15) were significant. However, recent sexual IPV, verbal IPV, psychological IPV, and deprivation of resources as well as any lifetime IPV were not significantly associated with PTSD.

Conclusions and Implications: Findings indicated a very high prevalence of lifetime and recent exposure of IPV as well as high rates of PTSD symptoms reported in the past month among this sample of women who use drugs and alcohol in Central Asia. The significant associations between different types of IPV and PTSD symptoms underscore the need for more research to understand the mechanisms linking IPV and PTSD. These findings point to the need for trauma-informed interventions that address different types of IPV along with PTSD, and enhanced capacity to respond to the intersecting needs of substance use, violence, and mental health.