Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
Soc Psychiatry Psychiatr Epidemiol. 2021 Dec;56(12):2217-2226. doi: 10.1007/s00127-021-02044-6. Epub 2021 Mar 9.
BACKGROUND: Intimate partner violence (IPV) is highly prevalent globally and associated with adverse mental health outcomes among women. In IPV-endemic contexts like Bangladesh, previous research has found no association between low levels of IPV and depression. Although IPV and attitudes justifying IPV against women are highly prevalent in this context, nothing is known about how related contextual norms affect associations between individual-level IPV exposure and depression. The present study examines if village-level IPV norms, characterized using village-level (Level 2) prevalence of a) IPV-justifying attitudes (injunctive norms) and b) physical IPV (descriptive norms), modifies the individual-level (Level 1) associations between the severity of recent IPV and major depressive episode (MDE) among women in rural Bangladesh. METHODS: Data were drawn from a nationally-representative sample consisting of 3290 women from 77 villages. Multilevel models tested cross-level interactions between village-level IPV norms and recently experienced individual-level IPV on the association with past 30-day MDE. RESULTS: The prevalence of IPV was 44.4% (range: 9.6-76.2% across villages) and attitudes justifying IPV ranged from 1.6% to 49.8% across villages. The prevalence of MDE was 16.8%. The risk of MDE at low levels of IPV severity (versus none) was greater in villages with the least tolerant attitudes toward IPV compared to villages where IPV was more normative, e.g., interaction RR = 1.42 (95% CI: 0.64, 3.15) for low physical IPV frequency and injunctive norms. CONCLUSIONS: The association between IPV and depression may be modified by contextual-level IPV norms, whereby it is exacerbated in low-normative contexts.
背景:亲密伴侣暴力(IPV)在全球范围内普遍存在,与女性的不良心理健康后果有关。在孟加拉国等 IPV 流行的环境中,先前的研究发现,低水平的 IPV 与抑郁之间没有关联。尽管在这种情况下,针对妇女的 IPV 和为其辩护的态度非常普遍,但人们对相关的背景规范如何影响个人层面的 IPV 暴露与抑郁之间的关联一无所知。本研究考察了村庄层面的 IPV 规范(使用村庄层面的(第 2 水平)a)为 IPV 辩护的态度(规范性规范)和 b)身体暴力(描述性规范)的流行程度)是否会改变农村孟加拉国妇女最近经历的个人层面 IPV 严重程度与主要抑郁发作(MDE)之间的个体层面(第 1 水平)关联。
方法:数据来自一个全国代表性样本,包括来自 77 个村庄的 3290 名妇女。多水平模型测试了村庄层面的 IPV 规范与最近经历的个体层面 IPV 之间的交叉水平相互作用与过去 30 天 MDE 的关联。
结果:IPV 的流行率为 44.4%(村庄间范围为 9.6-76.2%),为 IPV 辩护的态度范围从村庄间的 1.6%到 49.8%。MDE 的流行率为 16.8%。与 IPV 更规范的村庄相比,在对 IPV 最不宽容的村庄中,低水平 IPV 严重程度(与没有 IPV 相比)的 MDE 风险更高,例如,低身体 IPV 频率和规范性规范的交互 RR = 1.42(95%CI:0.64,3.15)。
结论:IPV 和抑郁之间的关联可能会被背景层面的 IPV 规范所改变,在低规范的情况下会加剧这种关联。
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