Individual needs and psychosocial health among victims of intimate partner violence

Intimate partner violence (IPV) is a pervasive public health concern associated with a range of lifelong health consequences and social adversities. The overall aim of this thesis is to contribute to an improved understanding of how individual and contextual factors are related to social and psychological health among victims of intimate partner violence.

Methods: The studies are based on data from two separate data sets which were collected as part of large evaluation projects concerning interventions offered to IPV exposed women; a national survey and a cohort study. Study I has a cross-sectional design and is based on data from the Swedish National Public Health Survey, conducted between years 2004 and 2009, with a total sample of 50,350 individuals including both women and men. Studies II-IV are based on data from three separate cohorts of women exposed to IPV: (1) help seekers recruited from women’s shelters, (2) help seekers recruited from the social services, and (3) non-help seekers. Violence exposure, social situation and psychological health were assessed using self- report measures at baseline and at the 12-month follow up.

Results: The results from Study I showed that being exposed to domestic violence was associated with similar health related and social adversities among women and men. Of particular importance, suicidal behaviours were strongly linked to domestic violence victimization among both men and women. Study II explored potential differences regarding social and psychological health between two groups of women that had been exposed to IPV; women who had sought formal help and those who had not. The results showed that both groups reported similar lifetime violence exposure, psychological and social impairment, although women in the help seeking group disclosed a higher problem load regarding current social psychological health. Study III explored changes in mental health over a 12-month period among IPV exposed women in relation to childhood violence (CV) exposure and formal help seeking. The results showed that IPV exposed women with a history of CV reported poorer mental health than IPV exposed women without CV exposure. Multivariate analyses showed improvements in mental health specifically in CV exposed women. Some factors reported at baseline (e.g., sexual IPV exposure in latest violent relationship and current access to formal help) were associated with mental health improvements. In study IV, psychometric properties (i.e., concurrent validity and test-retest reliability) of the Decision Making in Abusive Relationships Interview (DIARI) were investigated. DIARI is an interview-based measure developed to collect and structure information concerning violence exposure and associated factors. Results from the inter-rater reliability tests demonstrated great variability between items. Regarding concurrent validity, DIARI demonstrated associations with self-report measures assessing mental health.

Conclusions: Violence is a multifaceted problem with a negative impact on health in the Swedish population. In line with previous research, the results in this dissertation project point towards a holistic approach, where several social and health related factors should be taken into account to support victims of violence. The DIARI could be a promising tool to collect and structure information concerning violence exposure and associated factors.

List of scientific papers

I. Dufort, M., Stenbacka, M., & Hellner Gumpert, C.H. (2014) Physical domestic violence exposure is highly associated with suicidal attempts in both women and men. Results from the national public health survey in Sweden. European Journal of Public Health, 25(3), 413-8.
https://doi.org/10.1093/eurpub/cku198

II. Dufort, M., Gumpert, C.H., & Stenbacka, M. (2013) Intimate partner violence and help seeking – a cross-sectional study of women in Sweden. BMC Public health, 21;13:866.
https://doi.org/10.1186/1471-2458-13-866

III. Dufort, M., Stenbacka, M., & Gumpert, C.H. Intimate partner violence exposure among adult women: Changes in mental health with regard to previous experience of childhood violence in a Swedish cohort study. [Manuscript]

IV. Dufort, M., Stenbacka, M., & Gumpert, C.H. Decision making in abusive relationships interview (DIARI): results from a Swedish pilot study of a structured need inventory for battered women. [Manuscript]