Consistency and Inconsistency of Young Women’s Reporting of Intimate Partner Violence in a Population-Based Study

Abstract

We examined reporting of lifetime intimate partner violence (IPV) among 7,917 young women who completed two surveys, 12 months apart. At the first survey, 32% reported a history of IPV with a current or former partner. Of these, one third of women did not report IPV 12 months later (inconsistently reported IPV). Compared with women who consistently reported a history of IPV, women who inconsistently reported a history of IPV were less likely to report suicidal ideation, self-harm, illicit drug use, and smoking at the 12-month follow-up. A deeper understanding of what influences young women’s reporting of IPV is needed.

Keywords

young women intimate partner violence population-based study mental health

Intimate partner violence (IPV) is a complex set of behaviors within an intimate relationship and may include physical and emotional abuse, sexual violence, or manipulative and controlling behaviors that inflict harm (Garcia-Moreno et al., 2012). While there is considerable variation regarding what constitutes IPV among individuals, communities, and cultures, it is well-established that IPV can have a devastating impact on women’s lives. Women exposed to IPV have a higher risk of poor physical, reproductive, and psychological health, including physical injuries, sexually transmitted infections, and depression (World Health Organization, 2013).

While much of the research focuses on the experiences of women in adult relationships, early adulthood (18–25 years) is a key period for the development and formation of intimate relationships and increased vulnerability to IPV (Cui et al., 2013; Johnson et al., 2015). In Australia, it is estimated that 13% of young women aged 16–24 years have experienced violence in their intimate relationships in their lifetime (Harris et al., 2015). Data from the United States suggest that a larger problem exists, with up to 27% of young women aged 18–23 reporting violence from a partner (Halpern et al., 2009). However, the definition and measurement of IPV varies considerably across studies, limiting the comparability of prevalence rates reported within the literature (Devries et al., 2013). In addition, there is limited population-based research that examines young women’s reports of violence over time.

Measuring IPV among young women over time may be particularly challenging. In early adulthood, young women are developing their expectations about relationships amid increasing exposure to violence, which may greatly influence how they report violence over time. Young women may normalize or minimize violence to avoid stigma and blame from others (Eckstein, 2016; Ellsberg et al., 2001; Relyea & Ullman, 2015) and to justify the perceived “strength” of intimacy in the relationship (Hlavka, 2014; Vezina & Hébert, 2007). There is also evidence to suggest that controlling behaviors are more likely to be normalized by young people. In a recent Australian survey, young people aged 18–24 years were less likely to recognize harassment and controlling behaviors as a serious problem in relationships compared with older adults (Harris et al., 2015). The greater emphasis on physical forms of violence in many social and cultural contexts may mean that other behaviors are not as easily recognized as violence (Fanslow & Robinson, 2010). Thus, the type of violence experienced may play an important role in young women’s disclosure of violence (Catallozzi et al., 2011).

Although several studies have examined the factors associated with disclosure of IPV (Sylaska & Edwards, 2014), little is known about how consistently young women report IPV over time. Much of the research on inconsistent reporting of violence comes from studies with adults recalling childhood sexual abuse (Aalsma et al., 2002; Langeland, Smit et al., 2015; McKinney et al., 2009). These studies suggest that inconsistent reporting of abuse is common, and multiple assessments of abuse over time are needed to identify abuse (McKinney et al., 2009).

Inconsistent reporting may occur over time as part of the adjustment process to the violence. Some may report abuse several years after the initial experience when they have had time to process the trauma (McKinney et al., 2009). Others, who have previously reported abuse, may wish to put the abuse “behind them” and may decide not to report it at a later time. The psychological impact of IPV, therefore, may be an important factor associated with women’s reporting of IPV over time. Symptoms of depression and anxiety are both risk factors for, and consequences of, IPV (Trevillion et al., 2012; Vezina & Hébert, 2007) and may influence the consistency of women’s reporting of IPV over time.

The social stigma can also elicit shame and may deter people from re-reporting their experiences of IPV. Fear of stigmatization is often reported in studies with women who have experienced IPV (Ellsberg et al., 2001; Evans et al., 2016). Similarly, people’s reactions (positive and negative) to women’s disclosure of IPV can influence psychological well-being (Relyea & Ullman, 2015; Sylaska & Edwards, 2014) and may also affect the consistency of women’s reporting over time. Disclosure of violence, therefore, can be a dynamic process that changes over time in response to a range of individual, relational, situational, and social factors (Sylaska & Edwards, 2014). Longitudinal research is essential to understand how reporting of IPV changes over the life course (Foshee et al., 2004) and whether inconsistent reporting is associated with poor health and well-being.

In this article, we examine consistent and inconsistent reporting of IPV among a large, population-based sample of young Australian women (aged 18–25 years) using two waves of survey data from the same women measured 12 months apart. To examine whether types of abuse were associated with women’s reporting of IPV, we compared the abuse reported among women who consistently and inconsistently reported a history of IPV. To assess the association between women’s history of IPV and physical and psychological well-being, we also compared the “inconsistent” and “consistent” reporters of lifetime IPV on these outcomes. Finally, we examined whether there were any differences in the physical and psychological health of women reporting a history of IPV (consistently and inconsistently) relative to women who reported no history of IPV.

Method

Background

The Australian Longitudinal Study on Women’s Health (ALSWH) is a national, population-based study focusing on the biological, psychological, social, and economic factors relevant to women’s health (Dobson et al., 2015; Lee et al., 2005). In 2012–2013, ALSWH recruited a cohort of young women aged 18–23. Women were eligible if they were born in the years 1989–1995, lived in Australia, had a valid Medicare number (the universal national health insurance scheme), and if they consented to linking survey data with administrative records on health care. Participants were recruited through conventional means (e.g., magazine advertising) and online social media (e.g., Facebook). Participating women have completed online surveys annually about their physical health and mental health, health service use, and also major life events and experiences including IPV (Loxton et al., 2015; Mishra et al., 2014). Further details of the survey methodology are published elsewhere (Loxton et al., 2018).

Participants

A total of 17,012 women responded to Survey 1 in 2012–2013 and, of these, 11,345 (66.7%) responded to Survey 2 in 2014, and 8,961 (52.7%) responded to Survey 3 in 2015. Due to the distribution and design of Survey 1, only a subset of women completed all questions relating to IPV, such that Survey 1 responses were not directly comparable with those collected at subsequent surveys. Therefore, this study focuses on the 7,917 women who responded to both Survey 2 and Survey 3 to enable an examination of the changes in women’s responses between surveys conducted only 12 months apart.

Ethical Approval

In the initial online survey, participants indicated their consent to participate in the ALSWH study by completing the survey, consenting to data linkage, and providing their personal details, which were validated by the Australian Department of Human Services. This method of consent was approved by the Australian Department of Health, the Australian Department of Human Services, and both the University of Queensland (UQ) and the University of Newcastle (UoN) Human Research Ethics Committees (HREC). Participants are informed at each survey that researchers will be comparing their information with that collected in earlier surveys. At each wave, participants are offered the chance to win multiple prizes on completion of their survey. This was deemed necessary after consultations with women in the target age group in the planning phase of the study. Each prize draw has been approved by both UoN and UQ HRECs as appropriate compensation for participation. Participants have been informed that participation is voluntary and they are free to discontinue involvement at any time.

Measures

Intimate Partner Violence

At Surveys 2 and 3, women were first asked, “Have you ever had a partner or spouse?” Women who answered, “Yes,” were then asked to complete an abbreviated version of the Community Composite Abuse Scale (CCAS; Loxton et al., 2013), which is derived from Hegarty’s Composite Abuse Scale (CAS; Hegarty et al., 1999). The abbreviated CCAS (ACCAS) asks about experiences of violence from current or past partners including 12 items covering emotional abuse and physical and sexual violence and harassment. Response options for each item are in the last 12 months, more than 12 months ago, or never. The items included in the ACCAS are shown in Table 2.

The original CCAS has small to moderate correlations with other measures of abuse (e.g., Have you ever been in a violent relationship? r = .20), relationship stress (r = .36), and physical (r = −.16) and mental health (r = −.23), and has demonstrated validity in a community sample of young Australian women (Loxton et al., 2013). Although the original CCAS had four subscales of abuse (emotional, physical and sexual violence, and harassment), exploratory factor analysis with our data (with original category outcomes collapsed to 0 = never and 1 = ever) showed that only two factors were evident for the ACCAS (results not shown). These factors were labeled “combined emotional abuse, sexual violence and harassment” and “physical violence.” Based on our data, the ACCAS had high internal consistency overall (Cronbach’s α = .88 at Survey 2) and also for the combined emotional abuse, sexual violence, and harassment subscale (Cronbach’s α = .83) and the physical violence subscale (Cronbach’s α = .78).

Of the 7,917 women who responded to Surveys 2 and 3, we excluded women who first reported IPV at Survey 3 (n = 865; 10.9%) because we were interested in inconsistent changes in reporting of IPV between the surveys. A smaller group of women who had missing data on the ACCAS (n = 112; 1.4%) were also excluded, leaving data from 6,940 women available for analysis. We then created a transition variable to capture the variation in women’s self-reporting of lifetime IPV between Survey 2 and Survey 3. The original response options were dichotomized to ever or never, and then a variable with three mutually exclusive categories was created:

IPV reported at Survey 2 and Survey 3 (Consistent)

IPV reported at Survey 2 but not re-reported at Survey 3 (Inconsistent)

No IPV reported at Surveys 2 or 3 (None)

Sociodemographic Variables (Survey 2 and Survey 3)

Information included age (in years); area of residence based on an index of distance to the nearest urban center (urban vs. rural); highest level of education (less than Year 12, Year 12 or equivalent, certificate/diploma, or university degree); current relationship status (partner vs. no partner); ability to manage on income (easy/not too bad, difficult some of the time, or difficult all of time/impossible), and number of pregnancies (≥1 vs. none).

Health-Related Variables (Survey 2 and Survey 3)

Women were asked to rate their general health (excellent/very good, good, fair/poor) using an item from the 36-item Short Form Health Survey (SF-36; Ware & Sherbourne, 1992). They were also asked about smoking (never vs. ever), alcohol consumption (non-drinker vs. current drinker; National Health and Medical Research Council, 2009), and illicit drug use (never vs. ever).

Psychological Distress (Survey 2 and Survey 3)

Symptoms of distress in the past 4 weeks were assessed using the validated Kessler 10 (K-10) scale (Kessler et al., 2003). The 10-item scale measures symptoms on a 5-point scale (1 = none of the time to 5 = all of the time). The scale has a theoretical range from 10–50, and lower scores indicate better functioning (classified as “low distress”) while scores of 22 and above suggest moderate to severe depression and/or anxiety (classified as “moderate-high distress”; Slade et al., 2011). The K-10 scale has high internal consistency as demonstrated in a general population sample of adults (Cronbach’s α = .93; Kessler et al., 2003) and also in our larger sample of young women (Survey 1 Cronbach’s α = .92; Survey 2 Cronbach’s α = .93; Rowlands et al., 2016). The K-10 is able to distinguish between people with, and without, serious mental health conditions (Kessler et al., 2003) and is widely used as a measure of distress in several international health surveys (Furukawa et al., 2003; Kessler et al., 2002) and in general medical settings (Kessler et al., 2002).

Perceived Stress (Survey 2 and Survey 3)

Women’s level of perceived stress over the last 12 months in specific areas of their life, including study, relationships, and their own health, was measured using the Perceived Stress Questionnaire for Young Women (Bell & Lee, 2002). The responses are used to derive an overall mean stress score (0 = no stress to 4 = extreme stress). The Perceived Stress Questionnaire is correlated with other psychological and physical health measures and has moderate internal reliability with Cronbach’s α being .75 (Bell & Lee, 2003).

Suicidal Ideation and Self-Harm (Survey 2 and Survey 3)

Women were asked about suicidal ideation (“Have you been feeling that life is not worth living?”) and self-harm (“Have you deliberately hurt yourself or done anything you knew would harm you?”), with responses categorized as ever or never.

Statistical Analyses

We examined differences in sociodemographic characteristics at Survey 2 among women who had, and had not, ever experienced IPV (excluding those who first reported IPV at Survey 3) using chi-square tests. For women who reported a history of IPV at Survey 2, chi-square tests were used to examine the differences in the types of IPV reported at Survey 2 among women who subsequently consistently or inconsistently reported a history of IPV at Survey 3.

We compared the physical and mental health of women who inconsistently reported a history of IPV with the health of women who consistently reported a history of IPV using bivariate logistic regression. The physical and psychological variables were entered together in the model and were simultaneously adjusted for sociodemographic variables at Survey 2 (age, marital status, education, ability to manage on income, area of residence, ever pregnant).

We repeated these analyses at Survey 3 to examine women’s physical and psychological health 12 months later. The physical and psychological variables were entered together in the model and were adjusted for sociodemographic, physical, and psychological variables at Survey 2 (age, marital status, education, ability to manage on income, area of residence, children, general health, smoking, alcohol use, illicit drug use, psychological distress, suicidal ideation, and self-harm). To examine whether the results differed according to the type of violence experienced, we repeated the Survey 3 analyses for a subset of women who only reported a history of physical violence at Survey 2.

Finally, using multinomial logistic regression, we compared the physical and mental health of women at Survey 3 who consistently and inconsistently reported a history of IPV with the health of women who reported no history of IPV. All analyses were conducted using Statistical Analysis Software (SAS), version 9.4.

Results

Of the 7,917 women who responded to Survey 2 and Survey 3, 2,561 (32.3%) reported a history of IPV at Survey 2. Of the 6,940 women who met the inclusion criteria for analysis, 1,805 (26.0%) consistently reported a history of IPV at both Surveys 2 and 3 (consistent), and 756 (10.9%) reported a history of IPV at Survey 2 but did not re-report the IPV at Survey 3 (inconsistent). The remaining 4,379 (69.1%) women reported no history of IPV at either Survey 2 or Survey 3. Compared with women who reported no lifetime IPV, consistent and inconsistent reporters of lifetime IPV were more likely to be older, currently to have a partner, to have children, and to live in a rural area at Survey 2 (Table 1). They were less likely to have completed schooling to Year 12 or have a university degree and more likely to find it difficult all of the time/impossible to manage on their income.

Table 1.

Survey 2 Characteristics Among Women Who Consistently and Inconsistently Reported IPV (N = 6,940).

	Nonen = 4,379(63.1%)	Consistentn =1,805(26.0%)	Inconsistentn = 756(10.9%)	χ²	p
Variable	n (%)	n (%)	n (%)	χ²	p
Age (years)
18–19	1,610 (36.8)	477 (26.4)	232 (30.7)	70.18	<.0001
20–21	1,448 (33.1)	642 (35.6)	265 (35.1)
22–25	1,321 (30.2)	686 (38.0)	259 (34.3)
Education
<Year 12	102 (2.3)	134 (7.4)	44 (5.9)	248.15	<.0001
Year 12	1,820 (41.6)	551 (30.6)	268 (35.6)
Certificate/diploma	927 (21.2)	615 (34.1)	231 (30.7)
University	1,528 (34.9)	503 (27.9)	209 (27.8)
Area of residence
Urban	3,368 (77.8)	1,311 (73.4)	548 (72.6)	19.09	<.0001
Rural	960 (22.2)	474 (26.6)	207 (27.4)
Ability to manage on income
Easy/not bad	2,193 (50.1)	600 (33.3)	263 (35.0)	235.59	<.0001
Difficult sometimes	1,497 (34.2)	679 (37.7)	285 (37.9)
Difficult all of the time/Impossible	684 (15.6)	524 (29.1)	204 (27.1)
Relationship status
No partner	1,957 (44.7)	502 (27.8)	223 (29.7)	182.42	<.0001
Partner	2,419 (55.3)	1,301 (72.2)	529 (70.3)
Children
No	4,275 (97.7)	1,598 (88.6)	711 (94.4)	218.80	<.0001
Yes	102 (2.3)	205 (11.4)	42 (5.6)

At Survey 2, 2,561 women reported a history of IPV. Of these, the majority (n = 2,246; 87.7%) reported experiencing combined emotional abuse, sexual violence, and harassment, and around half (n = 1,361; 53.1%) reported physical violence from a partner or spouse (Table 2). Women who inconsistently reported a history of IPV were least likely to report physical abuse. For example, 43.1% of women inconsistently reporting a history of IPV had experienced physical violence compared with 57.4% of women who consistently reported a history of IPV, respectively, p < .0001.

Table 2.

Types of Abuse Reported at Survey 2 Among Women Who Consistently and Inconsistently Reported IPV.

	Consistentn = 1,805	Inconsistentn = 756	χ²	p
	n (%)	n (%)	χ²	p
ACCAS items for emotional/sexual violence and harassment
My partner told me that I was ugly, stupid or crazy	1,243 (68.9)	408 (54.0)	51.63	<.0001
My partner tried to turn my family, friends or children against me	481 (26.7)	142 (18.8)	18.07	<.0001
My partner became upset if dinner/housework wasn’t done	681 (37.8)	151 (20.0)	76.57	<.0001
My partner tried to keep me from seeing or talking to my family, friends or children	799 (44.4)	221 (29.3)	50.53	<.0001
My partner refused to let me work outside the home or took my wallet and left me stranded	153 (8.5)	28 (3.7)	18.53	<.0001
My partner followed me or harassed me	535 (29.7)	145 (19.2)	29.79	<.0001
My partner harassed me over the telephone, email, Facebook or internet	924 (51.4)	309 (40.9)	23.58	<.0001
My partner forced me to take part in unwanted sexual activity	719 (39.9)	246 (32.6)	12.06	.0005
Total	1,739 (96.3)	707 (93.5)	9.91	.002
ACCAS items for physical violence
My partner blamed me for causing their violent behaviour	750 (41.7)	208 (27.6)	45.35	<.0001
My partner pushed, grabbed, shoved, shook or threw me	829 (46.0)	228 (30.2)	55.15	<.0001
My partner kicked, bit, slapped or hit me with a fist	565 (31.4)	162 (21.5)	25.76	<.0001
My partner used a knife or gun or other weapon or beat me up	83 (4.6)	16 (2.1)	8.85	.003
Total	1,035 (57.4)	326 (43.1)	43.64	<.0001

Note. ACCAS = abbreviated Community Composite Abuse Scale.

Comparisons between the consistent and inconsistent reporters of lifetime IPV showed that women who inconsistently reported a history of IPV were less likely to report psychological distress, self-harm, and illicit drug use at Survey 2 (Table 3). At Survey 3, women who inconsistently reported a history of IPV were less likely to report suicidal ideation, self-harm, illicit drug use, and smoking than women who consistently reported a history of IPV. When restricting the analyses to reports of physical violence only, women who inconsistently reported a history of IPV had better general health, were less likely to report suicidal ideation, and were somewhat less likely to report self-harm, but did not differ on psychological distress compared with women who consistently reported a history of IPV.

Table 3.

Bivariate Logistic Regression Analysis of Associations Between Women’s Physical Health, Health Behaviors, and Mental Health and Inconsistent Reporting of IPV at Survey 2 and Survey 3. (N = 6,940).

	Survey 2Any IPV	Survey 3Any IPV	Survey 3Physical IPV only
	Inconsistent (vs. consistent)	Inconsistent (vs. consistent)	Inconsistent (vs. consistent)
	OR [95% CI]^a	OR [95% CI]^b	OR [95% CI]^b
General health
Excellent/very good	1	1	1
Good	1.10 [0.90, 1.34]	0.80 [0.63, 1.00]	0.67 [0.47, 0.94]
Fair/poor	1.03 [0.79, 1.34]	0.82 [0.59, 1.12]	0.63 [0.39, 1.01]
Smoking
Never smoked	1	1	1
Ever smoked	1.01 [0.82, 1.25]	0.67 [0.50, 0.88]	0.67 [0.39, 1.16]
Alcohol
Non-drinker	1	1	1
Current drinker	0.82 [0.68, 0.99]	1.17 [0.93, 1.48]	1.35 [0.96, 1.88]
Illicit drugs
Never	1	1	1
Ever	0.77 [0.63, 0.95]	0.74 [0.50, 1.09]	0.78 [0.43, 1.44]
Psychological distress
Low distress	1	1	1
Moderate-high distress	0.80 [0.66, 0.98]	0.88 [0.70, 1.09]	1.06 [0.76, 1.48]
Suicidal ideation
No	1	1	1
Yes	0.90 [0.71, 1.14]	0.57 [0.43, 0.75]	0.43 [0.28, 0.66]
Self-harm
No	1	1	1
Yes	0.79 [0.64, 0.97]	0.67 [0.50, 0.88]	0.72 [0.47, 1.11]

Note. IPV = intimate partner violence; OR = odds ratio; CI = confidence interval.

Adjusted for all other variables and for age, education, area of residence, ability to manage on income, relationship status, and ever pregnant.

Adjusted for all other variables and for age, education, area of residence, ability to manage on income, relationship status and children and general health, smoking alcohol, illicit drugs, psychological distress, suicidal ideation, and self-harm at Survey 2.

Multinomial logistic regression analyses were used to compare the physical health, health behaviors, and mental health of the consistent and inconsistent reporters of lifetime IPV with women who reported no IPV (Table 4). Compared with women who reported no IPV, women who consistently reported a history of IPV at both surveys had higher odds of moderate-high psychological distress, suicidal ideation, and self-harm at Survey 2, and they were more likely to have ever smoked or used illicit drugs (Table 3). Similar results were found for the women who inconsistently reported a history of IPV between the surveys; however, the odds of psychological distress, suicidal ideation, self-harm, and illicit drug use were smaller compared with the women who consistently reported a history of IPV.

Table 4.

Multinomial Logistic Regression Analysis of Associations Between Women’s Physical Health, Health Behaviors, and Mental Health, and Longitudinal Reporting of IPV (N = 6,940).

	Survey 2		Survey 3
	Inconsistent (vs. none)	Consistent (vs. none)	Inconsistent (vs. none)	Consistent (vs. none)
	OR [95% CI]^a	OR [95% CI]^a	OR [95% CI]^a	OR [95% CI]^a
General health
Excellent/very good	1	1	1	1
Good	1.07 [0.89, 1.28]	0.96 [0.83, 1.10]	0.87 [0.71, 1.07]	1.09 [0.93, 1.27]
Fair/poor	0.99 [0.77, 1.26]	0.94 [0.78, 1.14]	1.01 [0.75, 1.37]	1.22 [0.97, 1.52]
Smoking
Never smoked	1	1	1	1
Ever smoked	1.64 [1.34, 2.02]	1.60 [1.37, 1.87]	0.98 [0.70, 1.38]	1.64 [1.28, 2.10]
Alcohol
Non-drinker	1	1	1	1
Current drinker	0.84 [0.71, 1.00]	1.03 [0.90, 1.18]	1.22 [0.98, 1.51]	1.01 [0.85, 1.18]
Illicit drugs
Never	1	1	1	1
Ever	1.40 [1.17, 1.69]	1.84 [1.60, 2.12]	1.03 [0.73, 1.45]	1.36 [1.05, 1.76]
Psychological distress
Low distress	1	1	1	1
Moderate-high distress	1.20 [1.00, 1.45]	1.52 [1.32, 1.75]	1.01 [0.82, 1.24]	1.16 [0.99, 1.35]
Suicidal ideation
No	1	1	1	1
Yes	1.70 [1.37, 2.10]	1.86 [1.58, 2.18]	0.84 [0.66, 1.08]	1.52 [1.25, 1.84]
Self-harm
No	1	1	1	1
Yes	1.44 [1.19, 1.74]	1.82 [1.57, 2.10]	1.09 [0.84, 1.41]	1.65 [1.36, 2.00]

Note. OR = odds ratio; CI = confidence interval.

At Survey 3, women who consistently reported a history of IPV continued to have higher odds of suicidal ideation, self-harm, illicit drug use, and smoking relative to women who reported no IPV. However, women who no longer reported a history of IPV at Survey 3 (“inconsistent” reporters) did not differ from women who reported no IPV. When restricting the analysis to women who reported physical violence (Table 5), although women who inconsistently reported a history of IPV had lower odds of suicidal ideation, they had somewhat higher odds of psychological distress and self-harm relative to women who reported no IPV. They were also more likely to have ever smoked and somewhat more likely to consume alcohol, but slightly less likely to report fair or poor general health.

Table 5.

Multinomial Logistic Regression Analysis of Associations Between Women’s Physical Health, Health Behaviors, and Mental Health, and Reporting of Physical IPV at Survey 3. (N = 5,740).

	Survey 3Physical IPV only
	Inconsistent (vs. none)	Consistent (vs. none)
	OR [95% CI]^a	OR [95% CI]^a
General health
Excellent/very good	1	1
Good	0.74 [0.54, 1.01]	1.07 [0.87, 1.31]
Fair/poor	0.84 [0.54, 1.30]	1.27 [0.96, 1.67]
Smoking
Never smoked	1	1
Ever smoked	2.62 [1.62, 4.26]	1.29 [0.95, 1.77]
Alcohol
Non-drinker	1	1
Current drinker	1.31 [0.96, 1.79]	0.97 [0.79, 1.19]
Illicit drugs
Never	1	1
Ever	1.15 [0.68, 1.95]	1.34 [0.95, 1.89]
Psychological distress
Low distress	1	1
Moderate-high distress	1.28 [0.94, 1.73]	1.18 [0.98, 1.44]
Suicidal ideation
No	1	1
Yes	0.67 [0.46, 0.97]	1.65 [1.28, 2.14]
Self-harm
No	1	1
Yes	1.23 [0.84, 1.78]	1.71 [1.35, 2.18]

IPV = intimate partner violence; OR = odds ratio; CI = confidence interval.

Discussion

Using a large, population-based sample of young women, this article identified the percentage of young women who consistently and inconsistently reported a history of IPV over 2 years. We also examined whether consistent and inconsistent reporters of IPV differed from each other, and also differed from women who reported no IPV, on physical and psychological health characteristics. When these young women were first asked about experiences of IPV, 32% (n = 2,561) reported a history of IPV with a current or former partner. Although this estimate of violence is considerably higher than the 13% reported in a recent Australian study (Harris et al., 2015), it is similar to the 27% prevalence reported in a large U.S. study conducted more than a decade ago (Halpern et al., 2009). The use of longitudinal, population-based data in our study and also in Halpern et al.’s (2009) may explain the similar IPV prevalence estimates.

Of the 32% of women reporting a history of IPV in this study, the majority (70%) reported IPV again when asked about it 12 months later. In 2010, the Australian government announced the first national action plan to reduce violence against women and children. Government efforts to address violence in the years prior to the initiation of this study may have increased social awareness about violence toward women, contributing to the high rates of IPV reported by these young women (Council of Australian Governments, 2011). Women’s willingness to report IPV in our study may have also been facilitated by the online survey, giving women a sense of anonymity and a safe and trusted space for women to report their experiences (Tarzia et al., 2017). Alternatively, there is also evidence to suggest that young women are less likely than older women to have feelings of shame about the violence they experience (Sylaska & Edwards, 2014). Young women who report IPV are more likely to experience and witness violence in childhood (Lundgren & Amin, 2015; Stöckl et al., 2014), and violence in future adult relationships may become normalized (Hlavka, 2014; Vezina & Hébert, 2007), thereby increasing their reporting of violence.

Women’s physical and mental health is strongly interrelated, and our research suggests that it plays an important role in women’s reporting of violence. In this study, the women who consistently reported IPV were more likely to have poor mental health at both surveys compared with women who had never reported IPV. Poor mental health is a well-known consequence of IPV (Trevillion et al., 2012) and, therefore, women who consistently reported violence may have been in current violent relationships that were negatively impacting their well-being. Alternatively, being consistent reporters of IPV, it is possible that these women had also reported their violence to family or friends. Negative social reactions following disclosure are common and may have also contributed to the poor psychological well-being among the consistent reporters (Relyea & Ullman, 2015; Sylaska & Edwards, 2014).

In contrast, the psychological health of women who inconsistently reported a history of IPV appeared to improve between the surveys, and their outcomes were not significantly different from women who reported no IPV at the follow-up survey. Coping with negative life events often involves the adoption of various strategies to adjust to the event (Lazarus & Folkman, 1987). Thus, inconsistent reporters of IPV may have been more likely to re-evaluate their past experiences to avoid stigmatization (Eckstein, 2016; Relyea & Ullman, 2015; Vezina & Hébert, 2007) and to foster more positive “narratives” about their lives. They perhaps did not feel it was personally meaningful to re-report their experiences. Women’s inconsistent reporting of violence, therefore, may be viewed as a marker of resilience and their attempts to make sense of the violence in the context of their lives, rather than an indicator of poor coping (Ungar, 2013).

The experience of physical violence, however, appeared to negatively influence women’s well-being over the 12-month period. Inconsistent reporters who experienced physical violence did not appear to have the same mental health improvements over time. Similarly, the women who consistently reported IPV in our study—who had the poorest health and well-being—were most likely to report physical forms of violence. Physical violence, therefore, appears to be associated with reductions in women’s long-term well-being regardless of whether it is reported or not. Young women who experience physical violence as a child or an adolescent are more likely to experience IPV in adulthood (Sanz-Barbero et al., 2018). The high risk of physical injuries (World Health Organization, 2013) seriously threatens a woman’s life, and may be a barrier to help-seeking, which may contribute to poor long-term mental health outcomes. The cumulative effects of physical violence across a woman’s life course may be particularly detrimental. Longitudinal research from the United States suggests that the combination of physical and psychological violence in intimate relationships in adolescence is associated with poorer health and well-being in early adulthood than psychological violence alone (Exner-Cortens et al., 2013).

In this large, population-based study of young women, we were able to examine changes in women’s reporting of IPV over a 12-month period. However, the study did have limitations. We were limited by the survey question that did not collect information about the timing of IPV. Thus, we cannot rule out the possibility that inconsistent reporting of IPV occurred because women were not currently experiencing violence. For example, women living with a perpetrator at the initial survey may not have reported the abuse at the subsequent survey if they moved out of the violent relationship. Similarly, women may have had brief, casual relationships in the year prior, and did not wish to acknowledge the relationship in which abuse occurred at the subsequent survey. For ethical reasons, however, we did not ask women to identify who the perpetrator of the violence was. At the same time, it is also possible that women did not want to recount a traumatic experience (Billoux et al., 2016; Krause et al., 2008). Researchers examining disclosure of childhood abuse in adulthood suggest that multiple inquiries about abuse are often needed, possibly due to the trauma of the childhood abuse (McKinney et al., 2009). We are unable, therefore, to determine the extent to which women’s reporting of IPV relates to situational factors (e.g., timing of violence, current experience of violence), psychosocial factors, or a combination of these factors.

Overall, the large proportion of young women who reported IPV in this study suggests that young Australian women are vulnerable to violence within their intimate relationships. With the exception of women who experienced physical violence, inconsistencies in women’s reports of IPV appeared to be associated with improvements in their psychological and physical health. Better health among these women may reflect more positive ways of thinking about or dealing with IPV, and clinicians may assist women by facilitating positive conversations about how some strategies have achieved positive outcomes for women (Ungar, 2013). More research is needed regarding how health status and ways of dealing with abuse might impact reporting abuse. Because of the potential for change in women’s responses, repeated measurement of IPV in longitudinal surveys and clinical settings may capture a greater percentage of women exposed to abuse. Qualitative research could be used to examine how physical and mental health issues affect women’s experiences of IPV and to determine the causes of inconsistent reporting to questions about history of IPV. It is important to understand the many factors that are likely to influence women’s reporting of IPV in both research and clinical settings. A deeper understanding of the many issues that influence women’s reporting of IPV will improve the identification of violence.

Footnotes

Acknowledgements

The research on which this article is based was conducted as part of the Australian Longitudinal Study on Women’s Health (ALSWH), the University of Newcastle and the University of Queensland. We are grateful to the Australian Government Department of Health for funding and to the women who provided the survey data.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: I.J.R. was supported by an Australian National Health and Medical Research Council Centre for Research Excellence (grant no. APP1000986). The Australian Longitudinal Study on Women’s Health (ALSWH) is funded by the Australian Government Department of Health.

ORCID iD

Ingrid J. Rowlands

Author Biographies

Ingrid J. Rowlands, PhD, is a Research Fellow at the School of Public Health at the University of Queensland, Australia. Her primary research focus is on young women’s health, particularly the psychosocial aspects of women’s sexual and reproductive health. Her interests in sexual and reproductive health span from contraception through to pregnancy and childbirth. She has a particular interest in women’s adjustment to stressful life events.

Carl Holder, MBiostat, is a statistician at Hunter Medical Research Institute (HMRI) in the Clinical Research Design and Statistics Support (CReDITSS) unit. Coming from a teaching background, he has a passion for mathematical education. His interests focus on response inconsistencies in longitudinal, survey-based research and the challenges associated with analysis of these data.

Peta M. Forder, MBiostat MPH, is a research academic for the Priority Research Centre for Generational Health and Ageing, University of Newcastle, Australia. Her primary research focus is with the Australian Longitudinal Study on Women’s Health (ALSWH), investigating health and well-being for women across the life course. Specific research interests include intimate partner violence (IPV) and abuse, particularly for women from vulnerable circumstances, as well as the impact of adverse childhood experiences (ACE) on later life outcomes, and the interaction between IPV and ACE on children’s development.

Kelsey Hegarty is an academic general practitioner who holds the joint Chair in Family Violence Prevention at the University of Melbourne and the Royal Women’s Hospital. She leads a Centre of Research Excellence to Promote Safer Families, and she co-chairs the Melbourne Research Alliance to End Violence against Women (MAEVe). Her research includes the evidence base for interventions to prevent violence against women; educational and complex interventions around identification of domestic and family violence in primary care settings, and early intervention including the use of new technologies for men, women, and children exposed to abuse.

Annette J. Dobson, PhD, is Professor of Biostatistics and Director of the Centre for Longitudinal and Lifecourse Research in the School of Public Health at the University of Queensland, Queensland, Australia. Her interests include statistical modeling and epidemiology, especially in relation to cohort studies of women’s health and the use of record linkage for administrative data sources for health service research.

Deborah Loxton, PhD, is the deputy director and member of the Steering Committee of the ALSWH at the Priority Research Centre for Generational Health and Ageing based at the University of Newcastle, Australia. She is an experienced quantitative and qualitative researcher in women’s health, with particular interests in reproductive health, family dynamics, and the health impact of stressful life events, including the health impact of abuse, such as IPV. She has extensive experience in developing and conducting survey-based research.

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