Machisa Mercilene T, Christofides Nicola, Jewkes Rachel
Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa.
School of Public Health, University of Witwatersrand, Johannesburg, South Africa.
PLoS One. 2017 Apr 6;12(4):e0175240. doi: 10.1371/journal.pone.0175240. eCollection 2017.
Depression, post-traumatic stress disorder (PTSD), and binge drinking are among mental health effects of child abuse and intimate partner violence (IPV) experiences among women. Emerging data show the potential mediating role of mental ill health in the relationship of child abuse and IPV. There is evidence that PTSD, depression and alcohol abuse are comorbid common mental disorders and that a bidirectional relationship exists between depression and IPV in some settings. Furthermore, the temporal direction in the relationship of alcohol abuse and women's IPV experiences from different studies is unclear. We undertook a study with women from the general population to investigate the associations of child abuse, mental ill health and IPV; and describe the underlying pathways between them.
Data is from a household survey employing a multi-stage random sampling approach with 511 women from Gauteng, South Africa. IPV was measured using the WHO Multi-country Study on Women's Health and Domestic Violence Questionnaire. Child abuse was measured using a short form of the Childhood Trauma Questionnaire. Depression was measured using the Centre for Epidemiologic Studies Depression Scale (CESD). PTSD symptoms were measured using the Harvard Trauma Questionnaire. Binge drinking was measured using the Alcohol Use Disorders Identification Test (AUDIT) scale. All data analyses were conducted in Stata 13. Regression modelling was used to test the association between variables. Structural equation modelling with full information maximum likelihood estimation accounting for missing data was done to analyse the underlying pathways between variables.
Fifty percent of women experienced IPV in their lifetime and 18% experienced IPV in the 12 months before the survey. Twenty three percent of women were depressed, 14% binge drank and 11.6% had PTSD symptoms. Eighty six percent of women had experienced some form of child abuse. Sociodemographic factors associated with recent IPV in multivariate models were younger age and foreign nationality. Depression, PTSD and binge drinking mediated the relationship of child abuse and recent IPV. Depression, PTSD and binge drinking were also effects of recent IPV. Other factors associated with recent IPV experience included relationship control, having a partner who regularly consumed alcohol and experiencing other life traumatic experiences.
Mental ill health plays a mediating role in the relationship of child abuse and recent IPV experiences among women. Conversely, IPV also negatively affects women's mental health. Interventions to reducing the incidence of IPV could help alleviate the burden of mental ill health among women and vice versa. Effective integration of mental health services in primary health care, detection of symptoms, brief interventions and strengthened referral mechanisms for sustained community-based care are necessary in responding to victims of intimate partner violence. Response for abused children needs to take similar approaches and reduce the long-term mental health effects associated with violent exposures.
抑郁症、创伤后应激障碍（PTSD）和暴饮是女性遭受儿童期虐待和亲密伴侣暴力（IPV）后产生的心理健康问题。新出现的数据表明，心理健康状况不佳在儿童期虐待与亲密伴侣暴力之间的关系中可能起到中介作用。有证据表明，创伤后应激障碍、抑郁症和酒精滥用是常见的共病精神障碍，而且在某些情况下，抑郁症与亲密伴侣暴力之间存在双向关系。此外，不同研究中酒精滥用与女性亲密伴侣暴力经历之间关系的时间顺序尚不清楚。我们对来自普通人群的女性进行了一项研究，以调查儿童期虐待、心理健康状况不佳与亲密伴侣暴力之间的关联，并描述它们之间的潜在途径。
数据来自一项家庭调查，该调查采用多阶段随机抽样方法，选取了南非豪登省的511名女性。使用世界卫生组织关于妇女健康和家庭暴力的多国研究问卷来测量亲密伴侣暴力。使用儿童期创伤问卷的简表来测量儿童期虐待。使用流行病学研究中心抑郁量表（CESD）来测量抑郁症。使用哈佛创伤问卷来测量创伤后应激障碍症状。使用酒精使用障碍识别测试（AUDIT）量表来测量暴饮。所有数据分析均在Stata 13中进行。回归模型用于检验变量之间的关联。采用考虑缺失数据的全信息最大似然估计的结构方程模型来分析变量之间的潜在途径。
50%的女性一生中经历过亲密伴侣暴力，18%的女性在调查前12个月内经历过亲密伴侣暴力。23%的女性患有抑郁症，14%的女性暴饮，11.6%的女性有创伤后应激障碍症状。86%的女性经历过某种形式的儿童期虐待。多变量模型中与近期亲密伴侣暴力相关的社会人口学因素是年龄较小和外国国籍。抑郁症、创伤后应激障碍和暴饮介导了儿童期虐待与近期亲密伴侣暴力之间的关系。抑郁症、创伤后应激障碍和暴饮也是近期亲密伴侣暴力的影响结果。与近期亲密伴侣暴力经历相关的其他因素包括关系控制、有经常饮酒的伴侣以及经历其他生活创伤事件。
心理健康状况不佳在女性儿童期虐待与近期亲密伴侣暴力经历之间的关系中起中介作用。相反，亲密伴侣暴力也会对女性心理健康产生负面影响。减少亲密伴侣暴力发生率的干预措施有助于减轻女性心理健康问题的负担，反之亦然。在应对亲密伴侣暴力受害者时，有必要在初级卫生保健中有效整合心理健康服务、检测症状、进行简短干预并加强持续社区护理的转诊机制。对受虐待儿童的应对需要采取类似方法，并减少与暴力暴露相关的长期心理健康影响。
