Non-communicable diseases among women survivors of intimate partner violence: Critical review from a chronic stress framework

Abstract

A neurobiological framework of chronic stress proposes that the stress-response system can be functionally altered by the repeated presentation of highly stressful situations over time. These functional alterations mainly affect brain processing and include the dysregulation of the hypothalamic-pituitary-adrenal axis and associated processes. In the present critical review, we translate these results to inform the clinical presentation of women survivors of intimate partner violence (IPV). We approach IPV as a scenario of chronic stress where women are repetitively exposed to threat and coping behaviours that progressively shape their neurobiological response to stress. The changes at the central and peripheral levels in turn correlate with the phenotypes of non-communicable diseases. The reviewed studies clarify the extent of the impact of IPV on women's health in large (N>10,000) population-based designs, and provide observations on experimental neuroendocrine, immune, neurocognitive and neuroimaging research linking alterations of the stress-response system and disease. This evidence supports the prevention of violence against women as a fundamental action to reduce the prevalence of non-communicable diseases.

Collateral Effects of COVID-19 Stay-at-Home Orders on Violence Against Women in the United States, January 2019 to December 2020

“…Fourth, within speci c jurisdictions, where stay-at-home orders and other NPRM strategies varied substantially across cities or counties, research is needed to understand the impacts of local risk-mitigation strategies on VAW, overall and again by markers of vulnerability. Fifth, the nding from this analysis of increased rates of non-lethal VAW at the height of COVID-19 NPRM efforts imply subsequent elevated rates of populationlevel disease conditions, such as poor mental health, poor sexual and reproductive health, cardiovascular conditions, and years of potential life lost (48), as the risks of these conditions are heightened with exposure to violence against women (49)(50)(51). Importantly, the health impacts of elevated partner and non-partner violence during the COVID-19 pandemic are likely to be experienced disproportionately by women and likely by women of color speci cally, possibly increasing gender and racial health disparities associated with exposure to IPV (48, 52).…”

Collateral effects of COVID-19 stay-at-home orders on violence against women in the United States, January 2019 to December 2020

“…Fourth, within specific jurisdictions, where stay-at-home orders and other NPRM strategies varied substantially across cities or counties, research is needed to understand the impacts of local risk-mitigation strategies on VAW, overall and again by markers of vulnerability. Fifth, the finding from this analysis of increased rates of non-lethal VAW at the height of COVID-19 NPRM efforts imply subsequent elevated rates of population-level disease conditions, such as poor mental health, poor sexual and reproductive health, cardiovascular conditions, and years of potential life lost [ 53 ], as the risks of these conditions are heightened with exposure to violence against women [ 54 – 56 ]. Importantly, the health impacts of elevated partner and non-partner violence during the COVID-19 pandemic are likely to be experienced disproportionately by women and likely by women of color specifically, possibly increasing gender and racial health disparities associated with exposure to IPV [ 53 , 57 ].…”

Blunted neurobiological reactivity and attentional bias to threat underlie stress-related disorders in women survivors of intimate partner violence

“…For instance, increased evening plasma cortisol levels were observed in survivors while they still cohabitated with the perpetrators (Pico-Alfonso, Garcia-Linares, Celda-Navarro, Herbert, & Martinez, 2004), whereas decreased morning cortisol levels have been reported among women survivors 4 to 24 months after leaving the violent relationship (Seedat, Stein, Kennedy, & Hauger, 2003). The direction of the change on resting HPA does not only depend on the timing of the exposure, as both hyper- and hypoactivity long after the termination of the chronic stress exposure have been noted (Goldberg et al, 2021; Yim & Kofman, 2019). In addition, the specific mental health symptoms that survivors present may also be relevant for the interpretation of HPA axis results (Basu, Levendosky, & Lonstein, 2013; Garcia et al, 2020; Pinto, Correia-Santos, Costa-Leite, Levendosky, & Jongenelen, 2016).…”