Background
Violence
against women by intimate partners remains unacceptably common worldwide. The
evidence base for the assumed psychological impacts of intimate partner
violence (IPV) is derived primarily from studies conducted in high-income
countries. A recently published systematic review identified 13 studies linking
IPV to incident depression, none of which were conducted in sub-Saharan Africa.
To address this gap in the literature, we analyzed longitudinal data collected
during the course of a 3-y cluster-randomized trial with the aim of estimating
the association between IPV and depression symptom severity.
Methods and Findings
We
conducted a secondary analysis of population-based, longitudinal data collected
from 1,238 pregnant women during a 3-y cluster-randomized trial of a home
visiting intervention in Cape Town, South Africa. Surveys were conducted at
baseline, 6 mo, 18 mo, and 36 mo (85% retention). The primary explanatory variable
of interest was exposure to four types of physical IPV in the past year.
Depression symptom severity was measured using the Xhosa version of the
ten-item Edinburgh Postnatal Depression Scale. In a pooled cross-sectional
multivariable regression model adjusting for potentially confounding time-fixed
and time-varying covariates, lagged IPV intensity had a statistically
significant association with depression symptom severity (regression
coefficient b = 1.04; 95% CI, 0.61–1.47), with estimates from a quantile
regression model showing greater adverse impacts at the upper end of the
conditional depression distribution. Fitting a fixed effects regression model
accounting for all time-invariant confounding (e.g., history of childhood
sexual abuse) yielded similar findings (b = 1.54; 95% CI, 1.13–1.96). The
magnitudes of the coefficients indicated that a one–standard-deviation increase
in IPV intensity was associated with a 12.3% relative increase in depression
symptom severity over the same time period. The most important limitations of
our study include exposure assessment that lacked measurement of sexual
violence, which could have caused us to underestimate the severity of exposure;
the extended latency period in the lagged analysis, which could have caused us
to underestimate the strength of the association; and outcome assessment that
was limited to the use of a screening instrument for depression symptom
severity.
Conclusions
In this secondary analysis of data from a
population-based, 3-y cluster-randomized controlled trial, IPV had a
statistically significant association with depression symptom severity. The
estimated associations were relatively large in magnitude, consistent with
findings from high-income countries, and robust to potential confounding by
time-invariant factors. Intensive health sector responses to reduce IPV and
improve women’s mental health should be explored.
Below: Kernel density plots of depression symptom severity, by type
and frequency of intimate partner violence. The scale includes items inquiring about the frequency with
which a women’s current or previous intimate partner had, during the past 12
mo, (A) slapped or thrown anything at her; (B) pushed or shoved her; (C) hit
her with a fist or another object; or (D) threatened or attacked her with a
gun, knife, or other weapon.
Full article at: http://goo.gl/nm1AsI
By:
- 1Massachusetts General Hospital, MGH Global Health, Boston, Massachusetts, United States of America.
- 2Harvard Center for Population and Development Studies, Cambridge, Massachusetts, United States of America.
- 3Mbarara University of Science and Technology, Mbarara, Uganda.
- 4Stellenbosch University, Stellenbosch, South Africa.
- 5Center for HIV Identification, Prevention and Treatment Services, University of California at Los Angeles, Los Angeles, California, United States of America.
- 6Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California, United States of America.
- PLoS Med. 2016 Jan 19;13(1):e1001943. doi: 10.1371/journal.pmed.1001943. eCollection 2016.
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