Trop Doct 2008;38:228-229
doi:10.1258/td.2008.070353
© 2008 Royal Society of Medicine Press
The mental health consequences of intimate partner violence against women in Agaro Town, southwest Ethiopia
Amare Deribew Tadegge MD MPHE
Department of Epidemiology and Biostatistics, Jimma University, P.O.Box 378, Jimma, Ethiopia
Correspondence to: Amare Deribew Tadegge, Department of Epidemiology and Biostatistics, Jimma University, PO Box 205, Jimma, Ethiopia Email: amare_deribew{at}yahoo.com
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SUMMARY
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There are very few population-based studies on the mental health
consequences of intimate partner violence (IPV) from Ethiopia.
This study was conducted among 510 ‘ever partnered’
women in Agaro Town in February 2007. Mental distress and depression
were measured using self-reporting questionnaires and Kessler's
Scales. All types of IPV (physical, sexual and emotional abuses)
were significantly associated with mental distress and depression.
Women who suffered from physical, sexual and emotional abuses
were more likely to have mental distress. We recommend using
information education communications to educate the community
and thereby preventing IPV and the mental health consequences.
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Introduction
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The health problems caused by intimate partner violence (IPV)
is diverse (physical, sexual or both) and has been associated
with a number of mental health and behavioural problems such
as depression, emotional distress, posttraumatic disorders and
suicidal behaviours in adolescents and adults.
1,2 Violence against
women is one of the reasons for the increase of mental illnesses
among women.
3 There are very few studies of the mental health
consequences of IPV from Ethiopia. The present study was conducted
in order to assess the consequences of IPV on mental health
of women in Agaro Town in southwest Ethiopia.
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Methods
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This community-based cross-sectional study was conducted in
February 2007 in Agaro Town. Agaro Town is located 480 km southwest
of Addis Ababa and 50 km west of Jimma. It has five
Kebeles (small administrative units) and has a population of 32,866.
The study population constituted sampled women of reproductive
age group who had intimate partners and who had lived in the
study area for more than six months.
The sample size was determined by the two proportion sample size formulae using Epi-Info version 3.3.2 (Center for Disease Control and Prevention, Atlanta, 2005). The assumptions for the sample size calculation were:
- the prevalence of a depressive disorder (P1) among those who had experienced violence (17.15%)
- the prevalence of depressive disorders among women who have no experience violence (7%)4
- confidence interval (CI, 95%)
- power (90%) and
- non-response rate (10%)
The total sample
size was 515. Households which contained eligible women were
selected by a systematic random sampling technique. In the selected
households, the eligible women were interviewed using a structured
questionnaire.
Violence was assessed using the Amharic version of the structured World Health Organization (WHO) domestic violence questionnaire.1,4 Mental distress and suicidal ideation were assessed using the WHO self-reporting questionnaire (SRQ-20). Depression was measured using the Kessler 10 scales,5 10 questions which contain 5-point Likert scales (1 = never, 2 = a small part of the time, 3 = some of the time, 4 = most of the times, 5 = all of the time). The Kessler-10 scales were validated in Addis Ababa. The reliability and misclassification rates of the instrument were 0.9 and 0.1, respectively. Using the cut-off point of 14, the specificity and sensitivity of the instrument to diagnose depression were 92 and 77%, respectively.6
After ethical clearance, the data was collected using face-to-face interviews by trained female students who had completed high school. Univariate and multivariate analyses were done using SPSS version-12.
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Results
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Of the 515 women who responded, 510 (99%) were interviewed.
The mean age of the respondents was 33.1 (standard deviation
[SD] = 10.9), the majority (40%) were in the 25–34 age
group.
The overall lifetime prevalence of physical, sexual and/or emotional abuse was 48%.
Using a cut-off point of six, respondents were categorized as having or not having mental distress. All forms of violence were significantly associated with mental distress. Women who suffered from physical violence were 3.5 times more likely to suffer from mental distress (odds ratio [OR] = 3.8; 95% CI: 2.2, 5.3). Sexually abused women were 3.8 times more likely to develop mental distress (OR = 3.8; 95% CI: 2.5, 5.9) (Table 1).
Using the cut-off point of 14 on the Kessler scale, respondents
were categorized as having or not having depression. After using
controlling potential confounders, women who experienced any
form of violence were 2.8 times more likely to develop depression
(OR = 2.8; 95% CI: 1.3, 5.9). The same effect was seen as a
result of both physical and sexual violence (Table
2).
Sexually abused women were three times more likely to have suicidal
ideation (OR = 3.1; 95% CI: 1.1, 8.8). Similarly, women who
experienced emotional abuse were 3.4 times more likely to commit
suicide (OR = 3.4; 95% CI: 1.1, 10.7).
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Discussion
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To improve the validity of the study, we used validated instruments
to measure violence and mental illnesses. However, there might
have been a misclassification of cases of mental distress or
depression which could have introduced a bias. The other limitation
of the study was that it did not include women from the rural
community due to a shortage of resources.
In this study, physical, sexual and/or emotional abuses were significantly related to mental distress or depression after controlling the effect of other variables. As a result of the cross-sectional nature of the study, it may not be possible to infer causality. We tried to foresee the temporal sequences of violence and mental illness, but this may not justify the inference of causality. Mental health problems, such as depression and mental distress, could be predictors of rather than outcomes of violence. However, many published reports confirm that violence against women impacts on their mental health (depression, anxiety and suicidal ideation).7–10
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Conclusion
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In conclusion, all types of IPV (physical, sexual and emotional
abuses) were significantly associated with mental distress,
suicidal ideation and/or depression. Information education communication
is needed in order to educate the community about IPV and its
mental health consequences. We recommend the screening of victims
of violence at primary health-care centres for the early diagnosis
and treatment of common mental illnesses such as depression
and suicidal ideation.
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Acknowledgements
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I am very grateful to the Research and Publication Office of
Jimma University for their sponsoring the study. Also, I thank
the Agaro Town community for providing me with the necessary
information.
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References
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- World Health Organization. Multi-Country Study on Women's Heath and Domestic Violence Against Women. Geneva: WHO, 2005
- Ellsberg M, Caldera T, Herrera A, Winkvist , Kullgren G. Domestic violence and emotional distress among Nicaraguan women. Am Psychologist 1999;54:30–6
- World Health Organization. Mental health: new understanding and new hope. World Health Report on Mental Health. Geneva: WHO, 2001
- Gossaye Y, Deyessa N, Berhane Y, et al. Women's health and life events study in rural Ethiopia. Ethiopian J Health Dev 2003;17:1–41
- Kessler RC, Andrews G, Golpe LJ, et al. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med 2002;32:959–76[Medline]
- Tesfaye M, Alem A, Henlon C. Measuring Postnatal Mental Disorders in Ethiopia: Validation of the Edinburgh Postnatal Depression Scale (epds) and Kessler k6 & k10 Scales. Masters thesis in Psychiatry, Addis Ababa University, Addis Ababa, 2007
- Pico-Alfonso MA, Garcia-Linares MI, Cedda-Navaroo N, Blasco-Ros C, Echeburra E, Martinez M. The impact of physica, psychological and sexual intimate partner violence on women's health: depressive symptoms, post traumatic syndrome, anxiety and suicide. J women Health 2006;15:599–611
- Bergman B, Brismas B. Suicide attempts by battered wives. Acta Psychiatr Scand 1991;83:380–84[Medline]
- Kaslow NJ, Thompson MP, Meadows LA, et al. Factors that mediate and moderate the link between partner abuse and suicidal behavior in African-American women. J Consult Clin Psychol 1998;66:533–40[Medline]
- Abbott J, Johnson R, Koziol-Mclain J, Lowenstein SR. Domestic violence against women: incidence and prevalence in an emergency department population. JAMA 1995;273:1763–7[Abstract/Free Full Text]
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SUMMARY
Introduction
