Domestic violence, psychological distress, and physical illness among New Zealand women: Results from a community-based study

Abstract

This study aimed to measure the prevalence of psychological distress and physical illness among women in New Zealand, and to identify the risk factors for psychological distress and health, with specific reference to domestic violence. A survey was carried out among a community sample of 961 women aged 19-90 years. Among all women surveyed, 25% were classified as experiencing psychological distress at the time of interview, 22% were classified as experiencing severe symptoms of physical illness, and 17% reported domestic violence by a family member at some point in their lives. Among those women who had experienced domestic violence, the perception that their life was in serious danger and the impact of the violence on their life each contributed significantly to variability in psychological distress (22% variance accounted). An estimated 12% of all cases of psychological distress and 7% of all cases of serious physical illness were attributable to domestic violence. The study underscores the need to improve policy for mental and physical health screening and care for abused women within health services in New Zealand. Domestic violence is increasingly becoming recognized as a worldwide public health problem that presents serious implications for the psychological and physical health of women and children. Despite the fact that population-based research is lacking, the available data suggests that between 20% and 50% of women in most countries have been abused at some point in their lives (Heise, Raikes, Watts, & Zwi, 1994). Domestic violence has been indicated as a significant risk factor for a diverse range of health conditions, including but not limited to, low birth weight (Bullock & McFarlane, 1989), gynecological disorders (Schei & Bakketeig, 1989; Stewart & Stotland, 1993), injuries and mortality (Grisso, Schwarz, Miles, & Holmes, 1996), and sexually transmitted diseases (Handwerker, 1993). Indeed, preliminary research suggests a host of medical conditions may be associated with domestic abuse (see Fischbach & Herbert, 1997; Gerlock, 1999). The impact of domestic violence on women's mental health has also been well documented (Koss, 1990). Battering may be the single most important factor in predicting suicidality in women (Stark & Flitcraft, 1996), and women exposed to domestic violence within an intimate relationship typically exhibit a wide variety of symptoms of psychological distress, including depression and anxiety, high avoidance or arousal, and substance abuse or addiction (Hill, 1995). In combination with the concomitant cognitive disturbances (Gondolf, 1998; Roberts, Williams, Lawrence, & Raphael, 1998), these psychological symptoms often meet criteria for diagnosis of posttraumatic stress disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (1994). A limitation of existing data on the risk of mental and physical illness following domestic violence is that the majority of studies have been conducted on convenience samples of women seeking help for mental health problems related to their abuse (Sorenson & Saftlas, 1994). Given that prior data is drawn from samples of women who have sought help, it is possible that that the findings are not representative of those who do not seek help, either for domestic violence, or general physical and mental health problems. The existing studies that have surveyed population-based samples have focused exclusively on specific populations, such as Nicaraguan (Ellsberg, 1997) and American Indian (Norton & Manson, 1995) women. Thus, data on the impact of domestic violence among women in the general population is lacking. Further rationale for sampling a broader cross-section of the population may be drawn from the fact that gender differences are consistently found in epidemiological studies of psychiatric disorders. A primary example is depression. …

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