The Economics of Vulnerability: A Longitudinal GEDSI Perspective on Domestic Violence and Mental Health

Dear Editor,

I read with great interest Rayirala and Agnihotri’s Viewpoint article “Domestic Violence in Mental Health: Therapeutic and Legal Intersections.” ¹ Contextualizing their viewpoint in India, their analysis provides essential evidence on the devastating psychosocial impacts of domestic violence (DV). That is, they rightly call for mandatory mental health screening, psychological counseling, and enhanced legal support. DV remains a pervasive global public health crisis. It is then imperative to understand that its intersection with psychiatric vulnerability is also rooted in managing problems of domesticity (οἰκονομία) or economic vulnerability, especially in gender-related cases.

Building on the authors’ emphasis on public awareness and therapeutic interventions, I argue that their framework presents an opportunity to incorporate a broader Gender Equality, Disability, and Social Inclusion dimension. Agency-related viewpoints indeed provide a first-person authority perspective wherein the survivor is highly regarded in their testimony. ² So, while it is one thing to proceed with clinical screening and legal recourse in mitigating abuse, expanding the discourse to examine the structural socio-economic traps that force women to remain in violent environments despite legal awareness is quite another.

In the Philippines, a neighboring Asian context with progressive legal frameworks such as the “Magna Carta of Women,” recent longitudinal data (2015–2025) from the Philippine Institute for Development Studies regarding Sustainable Development Goals 5 and 10 starkly contextualize these structural challenges. ³ The data reveal a persistently stagnant female labor force participation rate, driven largely by an overwhelming burden of unpaid care work, where women spend up to 13 hours a day on domestic labor. When women are economically marginalized, time-poor, and lack independent financial agency, escaping an abusive partner becomes a structural, and, left with no choices, almost an existential, impossibility. Unfortunately, this economic vulnerability compounds into a severe “triple burden” involving rural isolation, lack of formal education, and disability for women navigating the overlapping realities.

Building effective interventions against DV demands a serious realist meta-curation of the economics of vulnerability, or psycho-structural synthesis of precarious compounding conditions. ⁴ Before health systems can rely on therapeutic screening to empower survivors, we must ask in psychosexual health which “systems systematize systems” of inequities. ⁵ Mitigating DV can also proceed with shifting the focus from individualized psychological empowerment campaigns toward structural economic accountability. State institutions must strictly ensure that mandated government budgets, such as the Philippines’ 5% Gender and Development allocation, are used for outcome-based economic inclusion, housing, and financial independence, rather than mere administrative compliance.