The Role of Social Determinants of Health in Exacerbating Depressive Symptoms in Women with IPV Victimization over Eight Years

Background/Purpose. Intimate partner violence (IPV) victimization is a pervasive public health problem with severe long-term physical and mental health consequences. Depression is one of the most well-known mental health outcomes of IPV victimization with estimates suggesting that women with IPV victimization have a two- to threefold increased risk of major depressive disorder compared to those with no IPV. Although depression has long been a target of intervention for those with IPV victimization, limited research has examined how structural factors like social determinants of health (e.g. housing instability, income, race) may contribute to depressive symptoms in women follow IPV victimization. This study follows women who have experienced intimate partner violence (IPV) victimization over an eight-year period to examine the trajectory of and structural risk factors for depressive symptoms over time.

Methods. Women (N = 118) with children participated in a randomized control trial of a treatment program for mothers who had experienced IPV victimization. Participants completed four clinical interviews over eight years: at baseline (time 1), 5-weeks after enrollment (time 2), 6-8 months after enrollment (time 3), and 8-years after enrollment (time 4). Women reported on mental health (depressive and posttraumatic stress symptoms), IPV exposure, and social determinants of health (race, income, housing instability) using standardized measures at each measurement occasion. Longitudinal multilevel modeling (MLM) was used to examine the contributions of social determinants of health to women’s depression over the eight years, controlling for severity of IPV victimization and posttraumatic stress symptoms.

Results: Over the eight years, depression symptoms decreased. Results of longitudinal multilevel modeling (MLM) showed a significant interaction between IPV severity and housing instability on depressive symptoms (b = .01, p < .01) such that over time women with more IPV and more housing instability had more depressive symptoms than those with less housing instability. Modeling also revealed a trend-level interaction between posttraumatic stress symptoms and identification as a woman of color (b = .19, p = .054), such that over the eight-years women of color with higher levels of posttraumatic stress symptoms reported more depressive symptoms than white women with the same level of posttraumatic stress symptoms.

Conclusions/Implications: Study findings suggest that social determinants of health including housing instability and differences driven by racism exacerbate depressive symptoms over time in women with IPV victimization. Although continued research is needed to identify how these structural factors lead to worsening mental health over time, intervention for women following IPV victimization must address the role of these social determinants of health in depression over time.