The mental health consequences of intimate partner violence against women in Agaro Town,southwest Ethiopia

Abstract

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.

Introduction

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.

Methods

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.

Results

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).

Table 1

The association between different forms of violence and mental distress: Agaro Town, February 2007

Types violence ever experienced	Mental distress		Crude OR (95% CI)	Adjusted OR (95%* CI)
Types violence ever experienced	Yes	No	Crude OR (95% CI)	Adjusted OR (95%* CI)
Emotional abuse
Yes	82	151	2.58 (1.7, 3.8)	2.35 (1.5, 3.6)
No	48	228	1	1
Physical abuse
Yes	70	96	3.44 (2.27, 5.21)	3.48 (2.26, 5.35)
No	60	283	1	1
Sexual abuse
Yes	74	97	3.84 (2.53, 5.83)	3.80 (2.5, 5.9)
No	56	282	1	1
Any forms of violence
Yes	94	170	3.2 (2.0, 4.9)	3.0 (1.9, 4.8)
No	36	209	1	1

OR, odds ratio; CI, confidence interval

*Adjusted for age, educational status and excessive alcohol use

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).

Table 2

The association between different forms of violence and depression, Agaro town, February 2007

Types violence ever experienced	Dispression		Crude OR (95% CI)	Adjusted OR (95%* CI)
Types violence ever experienced	Yes	No	Crude OR (95% CI)	Adjusted OR (95%* CI)
Emotional abuse
Yes	26	207	2.19 (1.1, 4.2)	1.86 (0.96, 3.7)
No	15	262	1	1
Physical abuse
Yes	21	145	2.34 (1.2, 4.4)	2.17 (1.1, 4.2)
No	20	324	1	1
Sexual abuse
Yes	22	149	2.48 (1.3, 4.7)	2.26 (1.12, 4.4)
No	19	320	1	1
Any forms of violence
Yes	31	233	3.1 (1.5, 6.5)	2.8 (1.3, 5.9)
No	10	236	1	1

OR, odds ratio; CI, confidence interval

*Adjusted for age, educational status and excessive alcohol use

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).

Discussion

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

Conclusion

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.

Footnotes

Acknowledgements

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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