Women’s experiences of economic coercion and depressive symptoms in Matlab, Bangladesh

Abstract

Prior studies of the association between intimate partner violence (IPV) and depressive symptoms have typically excluded economic coercion (EC), a prevalent form of IPV worldwide. Here, we used structural equation models (SEM) to estimate the association of EC with depressive symptoms, with and without adjustment for physical/psychological/sexual IPV, among women in rural Matlab, Bangladesh. Data were collected from cross-sectional surveys with married women 15-49 years, conducted between November 2018 and January 2019. Prior-week depressive symptoms were measured using the 10-item Centre for Epidemiologic Studies Depression short-form. Lifetime EC was assessed using a bi-dimensional, 36-item scale developed in Matlab. Lifetime physical/sexual/psychological IPV was assessed using the 20-item WHO Domestic Violence module. Covariates were age, age at marriage, and schooling; partner’s schooling; and household wealth. Among 929 women, lifetime experience of EC ranged from 41.9% (control over access to work, schooling, and training) to 50.0% (control over use/maintenance of economic resources), while any lifetime physical/psychological/sexual IPV was 89.5%. Coercion involving the use and maintenance of economic resources had a significant, adjusted association with depressive symptoms (standardized coefficient = 0.491, p<0.001, R 2 =0.221). The standardized association of any physical/psychological/sexual IPV with depressive symptoms, adjusted for covariates and cluster sampling, was 0.346 (p <0.001, R 2 =0.143). When further adjusted for the two measures of EC, the association was attenuated and non-significant (0.049, p = 0.817). These findings suggest that EC is prevalent, significantly associated with depressive symptoms, and attenuates the association of other forms of IPV with depressive symptoms. Addressing EC with other forms of IPV may be necessary to reduce depressive symptoms in exposed women.

Economic abuse and its associations with symptoms of common mental disorders among women in a cross-sectional survey in informal settlements in Mumbai, India

“…The literature supports these findings for depression [50,72], anxiety [25,34,88], and suicidal thoughts [89], which have been linked in Indian studies with marital disharmony, domestic violence, harassment by husbands and in-laws, and dowry disputes [90,91]. Recent work in Bangladesh suggests that economic abuse may account for at least some of the observed associations of other forms of violence with depressive symptoms [50], and it is important that surveys include questions to identify it [29]. Financial stress can lead to a 'hostile environment' and psychological distress, and further hamper women's selfefficacy and capability for independence.…”

“…The large odds ratios illustrated the fact that economic abuse is part of a broader pattern of domestic violence. Our study suggests that economic abuse co-occurred with physical, sexual, and emotional violence, contributing substantially to the totality of violence described recently in rural Bangladesh [ 29 , 50 ]. Of the 1106 women who reported economic abuse, 51% had also suffered emotional, 13% sexual violence and 33% physical violence.…”

“…With increasing exposure to a range of forms of economic abuse, these figures increased linearly to a cumulative doubling of risk. The literature supports these findings for depression [50,72], anxiety [25,34,88], and suicidal thoughts [89], which have been linked in Indian studies with marital disharmony, domestic violence, harassment by husbands and in-laws, and dowry disputes [90,91]. Recent work in Bangladesh suggests that economic abuse may account for at least some of the observed associations of other forms of violence with depressive symptoms [50], and it is important that surveys include questions to identify it [29].…”

“…Three aspects of economic abuse of women have gained attention in recent years: the need to measure it [ 16 ], the need to understand its prevalence [ 16 , 53 ], and the need to understand its effects on women’s mental health [ 17 , 50 ]. There have been few studies of the association between economic abuse and common mental disorder, and none in India [ 34 ].…”

“…Women who escape such relationships are often impoverished, and economic abuse may continue even after they have left. Economic and interpersonal relationship difficulties are associated with the development of depression and anxiety, and suicidal ideation [5,[44][45][46][47][48][49][50]. Women who experience economic abuse may suffer similar mental health consequences to those caused by violent abuse, although the link between economic abuse and common mental disorders has not been well identified [17,25,51,52].…”