Onset of common mental disorders and suicidal behavior following women¿s first exposure to gender based violence: a retrospective, population-based study

Rees, Susan; Steel, Zachary; Creamer, Mark; Teesson, Maree; Bryant, Richard A.; McFarlane, Alexander C.; Mills, Katherine L.; Slade, Tim; Carragher, Natacha; O’Donnell, Meaghan; Forbes, David; Silove, Derrick

doi:10.1186/preaccept-2017783131130080

Cited by 9 publications

(10 citation statements)

References 26 publications

(49 reference statements)

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“…The estimated association was relatively large in magnitude: the experience of IPV was associated with a difference in depression symptom severity that was comparable to the treatment effects observed in short-term randomized-controlled trials of psychotherapy interventions for peripartum depression [ 69 , 70 ]. Our findings are consistent with what has been shown in longitudinal studies conducted among women in high-income countries [ 23 , 67 , 71 ], plausible in light of what is generally known about the adverse psychological impacts of stressful life events and traumatic stressors [ 13 – 17 ], and robust to alternative specifications and potential confounding by time-invariant factors. Taken together, our findings have important policy and programmatic implications for women’s health in sub-Saharan Africa.…”

Section: Discussionsupporting

confidence: 91%

Intimate Partner Violence and Depression Symptom Severity among South African Women during Pregnancy and Postpartum: Population-Based Prospective Cohort Study

et al. 2016

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BackgroundViolence against women by intimate partners remains unacceptably common worldwide. The evidence base for the assumed psychological impacts of intimate partner violence (IPV) is derived primarily from studies conducted in high-income countries. A recently published systematic review identified 13 studies linking IPV to incident depression, none of which were conducted in sub-Saharan Africa. To address this gap in the literature, we analyzed longitudinal data collected during the course of a 3-y cluster-randomized trial with the aim of estimating the association between IPV and depression symptom severity.Methods and FindingsWe conducted a secondary analysis of population-based, longitudinal data collected from 1,238 pregnant women during a 3-y cluster-randomized trial of a home visiting intervention in Cape Town, South Africa. Surveys were conducted at baseline, 6 mo, 18 mo, and 36 mo (85% retention). The primary explanatory variable of interest was exposure to four types of physical IPV in the past year. Depression symptom severity was measured using the Xhosa version of the ten-item Edinburgh Postnatal Depression Scale. In a pooled cross-sectional multivariable regression model adjusting for potentially confounding time-fixed and time-varying covariates, lagged IPV intensity had a statistically significant association with depression symptom severity (regression coefficient b = 1.04; 95% CI, 0.61–1.47), with estimates from a quantile regression model showing greater adverse impacts at the upper end of the conditional depression distribution. Fitting a fixed effects regression model accounting for all time-invariant confounding (e.g., history of childhood sexual abuse) yielded similar findings (b = 1.54; 95% CI, 1.13–1.96). The magnitudes of the coefficients indicated that a one–standard-deviation increase in IPV intensity was associated with a 12.3% relative increase in depression symptom severity over the same time period. The most important limitations of our study include exposure assessment that lacked measurement of sexual violence, which could have caused us to underestimate the severity of exposure; the extended latency period in the lagged analysis, which could have caused us to underestimate the strength of the association; and outcome assessment that was limited to the use of a screening instrument for depression symptom severity.ConclusionsIn this secondary analysis of data from a population-based, 3-y cluster-randomized controlled trial, IPV had a statistically significant association with depression symptom severity. The estimated associations were relatively large in magnitude, consistent with findings from high-income countries, and robust to potential confounding by time-invariant factors. Intensive health sector responses to reduce IPV and improve women’s mental health should be explored.

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Section: Discussionsupporting

confidence: 91%

Intimate Partner Violence and Depression Symptom Severity among South African Women during Pregnancy and Postpartum: Population-Based Prospective Cohort Study

et al. 2016

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“…Onset analyses corroborated these findings by revealing persistent effects of first GBV during childhood on mood/anxiety and SUD incidence over the lifecourse. Analyses also revealed strong immediate effects of first GBV at any age period on incidence of mood/anxiety and SUDs at that same age period, which is consistent with Australian studies showing a strong immediate effect of GBV on mental disorder incidence, particularly PTSD (Rees et al, 2014). The effect of first GBV exposure on both mood/anxiety and SUD onset generally remained significant but waned in magnitude by middle adulthood, when risk for disorder onset had largely passed.…”

Section: Discussionsupporting

confidence: 83%

“…GBV can occur in many forms, and has been broadly defined as including physical and sexual violence against women, as well as stalking (Rees et al, 2011). Using this definition, Australian studies have demonstrated strong associations between GBV and lifetime mental disorder and associated disability (Rees et al, 2011) as well as suicidal behavior (Rees et al, 2014). Although US studies have examined specific types of GBV [e.g., intimate partner violence (IPV)] in relation to selected negative health outcomes (Afifi et al, 2009), no US studies have examined associations between this broad GBV construct and a wide range of mood/anxiety and substance use disorders (SUDs).…”

Section: Introductionmentioning

confidence: 99%

Lifetime prevalence of gender-based violence in US women: Associations with mood/anxiety and substance use disorders

Walsh

Keyes

Koenen

et al. 2015

Journal of Psychiatric Research

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No population-representative US study has examined how lifetime exposure to gender-based violence (GBV) is related to a broad range of mood/anxiety and substance use disorders. The current study advances the literature by examining the relative contributions of developmental timing of earliest GBV exposure and amount of lifetime GBV exposure on risk for eight mood/anxiety and ten substance use disorders. Participants were 20,089 women from wave 2 (2004–2005) of the National Epidemiologic Survey of Alcohol and Related Conditions. Women reporting lifetime GBV (25%; n = 5284) had 3.6 and 2.5 times the odds of meeting lifetime mood/anxiety and substance use disorder criteria, respectively. Number of types and number of incidents of GBV were associated with risk for both types of disorders in a dose–response fashion; when examined simultaneously, number of types of GBV was the stronger predictor of mood/anxiety and substance use disorders. Relative to those who first experienced GBV during adulthood, first exposure during childhood and adolescence was associated with increased risk for mood/anxiety and substance use disorders. One in four women reported lifetime GBV, which had pernicious effects on mood/anxiety and substance use disorders, particularly for women who had experienced multiple types of GBV. The GBV effect varied by developmental period of exposure. Prevention of GBV is critical to reducing its burden. Among those exposed to GBV, clinicians should consider assessing a range of disorders and providing integrated treatment targeting multiple outcomes.

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“…In contrast, our study had an average latency period of 12 months, which could lead some to potentially argue that the lag between exposure and outcome exceeds a reasonable latency period of response. However, in many studies in this literature, extended latency periods are not uncommon and may extend from 12 months (Heflin, Siefert, & Williams, 2005) to two years or even more (Polsky et al, 2005; Rees et al, 2014). In ancillary analyses we did not find a statistically significant interaction between food insufficiency and assessment time ( P =0.78), but the lagged association between food insufficiency and depression symptom severity did weaken in both magnitude and statistical significance with greater lag times: The association between food insufficiency at baseline and depression symptom severity at 6 months was β=0.78 ( t =4.05); between food insufficiency at 6 months and depression symptom severity at 18 months, β=0.71 ( t =3.60); and between food insufficiency at 18 months and depression symptom severity at 36 months, β=0.59 ( t =2.88).…”

Section: Discussionmentioning

confidence: 99%

Food insufficiency, depression, and the modifying role of social support: Evidence from a population-based, prospective cohort of pregnant women in peri-urban South Africa

Tsai

Tomlinson

Comulada³

et al. 2016

Social Science & Medicine

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Rationale Food insecurity has emerged as an important, and potentially modifiable, risk factor for depression. Few studies have brought longitudinal data to bear on investigating this association in sub-Saharan Africa. Objective To estimate the association between food insufficiency and depression symptom severity, and to determine the extent to which any observed associations are modified by social support. Methods and Results We conducted a secondary analysis of population-based, longitudinal data collected from 1,238 pregnant women during a three-year cluster-randomized trial of a home visiting intervention in Cape Town, South Africa. Surveys were conducted at baseline, 6 months, 18 months, and 36 months (85% retention). A validated, single-item food insufficiency measure inquired about the number of days of hunger in the past week. Depression symptom severity was measured using the Xhosa version of the 10-item Edinburgh Postnatal Depression Scale. In multivariable regression models with cluster-correlated robust estimates of variance, lagged food insufficiency had a strong and statistically significant association with depression symptom severity (β=0.70; 95% CI, 0.46-0.94), suggesting a 6.5% relative difference in depression symptom severity per day of hunger. In stratified analyses, food insufficiency had a statistically significant association with depression among women with low levels of instrumental support. Using quantile regression, we found that the adverse impacts of food insufficiency were experienced to a greater degree by women in the upper end of the conditional distribution of depression symptom severity. Estimates from fixed-effects regression and fixed-effects quantile regression, accounting for unobserved confounding by time-invariant characteristics, were similar. Conclusions Food insufficiency was associated with depression symptom severity, particularly for women in the upper end of the conditional depression distribution. Instrumental social support buffered women against the adverse impacts of food insufficiency.

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Onset of common mental disorders and suicidal behavior following women¿s first exposure to gender based violence: a retrospective, population-based study

Cited by 9 publications

References 26 publications

Intimate Partner Violence and Depression Symptom Severity among South African Women during Pregnancy and Postpartum: Population-Based Prospective Cohort Study

Intimate Partner Violence and Depression Symptom Severity among South African Women during Pregnancy and Postpartum: Population-Based Prospective Cohort Study

Lifetime prevalence of gender-based violence in US women: Associations with mood/anxiety and substance use disorders

Food insufficiency, depression, and the modifying role of social support: Evidence from a population-based, prospective cohort of pregnant women in peri-urban South Africa

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