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Domestic violence from a health perspective: Impact on mental health

Domestic violence from a health perspective: Impact on mental health. Agnes Tiwari RN, PhD Department of Nursing Studies The University of Hong Kong. Impact on mental health. Intimate partner violence (IPV). Domestic Violence. Survivor of abuse.

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Domestic violence from a health perspective: Impact on mental health

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  1. Domestic violence from a health perspective: Impact on mental health Agnes Tiwari RN, PhD Department of Nursing Studies The University of Hong Kong

  2. Impact on mental health Intimate partner violence (IPV) Domestic Violence Survivor of abuse

  3. Depression and post-traumatic stress disorder (PTSD) • Often comorbid • Are the most prevalent mental health sequelae of IPV Campbell 2002

  4. In a meta-analysis… • Depression among abused women was 47.6% (lifetime rates of 18.6% in the general population) (18 studies) • PTSD = 63.8% (11 studies) • A dose-response relationship = severity or duration of IPV associated with the prevalence or severity of depression/PTSD Golding 1999

  5. The link between IPV and depression/PTSD • A biochemical explanation: IPV Neurophysiologic changes Psychiatric disorders Mellman & Bell 1997

  6. The link between IPV and depression/PTSD • A biochemical explanation: IPV-related stress Breakdown of neurotransmitter system Depressive symptoms (e.g. loss of interest/ low self-esteem/irritability) Matsakis 1996

  7. The link between IPV and depression/PTSD • A biochemical explanation: Prolonged stress Over-functioning of the adrenals PTSD symptoms (e.g. numbing/hyperarousal) Matsakis 1996

  8. The link between IPV and depression/PTSD • Abused women as psychologically normal individuals: Need to consider their mental health consequences In the context of ongoing partner assault Their survival depends on their adopting extreme ways of thinking, feeling and acting Stark & Flitcraft 1996; May et al. 2003

  9. Abused women’s mental health consequences in the context of ongoing partner assault Mixed with anger and hostility IPV Grief (loss of love) Depression Loss and grief theory Kubler-Ross 2005

  10. Abused women’s mental health consequences in the context of ongoing partner assault Too afraid to express their anger Anger turned inwards Depression Abouzeid 1998

  11. Abused women’s survival depends on their adopting extreme ways of thinking, feeling and acting Use numbing or emotional shutdown so as to concentrate on assessing the danger and figure out how to escape Matsakis 1996

  12. Impact of IPV on Chinese women’s mental health: some possibilities • Feelings of shame and stigma • Family shame not to be shared with outsiders • Use of ren (endurance) as a way of coping • Use of yuan (predestination) to explain the failed relationship, ward off guilt and find hope for the future Yick et al 2003; Tang 2008; Tiwari et al 2001; Lee 1995

  13. Impact of IPV on Chinese women’s mental health: some research findings Depression IPV Tang 1997; Leung et al 2002; Tiwari et al 2008; Guo et al 2003

  14. IPV – mental health association found in… • Studies of Chinese women in which psychological abuse predominates • Husbands’ verbal abuse (but not their physical abuse) was related to the women’s depression • Psychologically abused only women (but not physically and/or sexually abused women) were at a higher risk of postnatal depression and thinking about harming themselves Tang 1997; Tiwari et al 2008

  15. Effects of psychological abuse on Chinese women’s mental health Consistent with Western studies Straus et al 1989; Pico-Alfonso 2005

  16. Different forms of psychological abuse may have different effects on abused women Restriction Ridicule Jealousy Threats of divorce Damage to property

  17. Attacks her sense of self-esteem Destroys her ability to feel good about herself Causing her to feel helpless and worthless Shatters her sense of hope Leads to depression Ridicule as a form of psychological abuse Follingstad 1990; Sackett & Saunders 1999

  18. Ridicule is also considered the worst form of psychological abuse for Chinese women Depression Ridicule Leung et al 1999; Chan 2005; Tiwari et al 2005

  19. Types of shame in Chinese cultural beliefs Failing to carry out her duty Can kiu (shameful feeling) Not a virtuous wife Diu lian (lose face) Unable to meet her husband’s needs Xiu kiu (harm him because of her failing) Feeling of having a stain on her face Xiu chi (strongest shameful feeling) Varying degrees of debilitating effect on the woman Bedford & Hwang 2003

  20. In a shame-oriented Chinese society • Shame may be used as a coercive tactic by an intimate partner to control women Chan et al 2009

  21. What do we know about PTSD in Chinese abused women?

  22. IPV: Impact on mental healthFuture research in Chinese populations Need to: • conduct longitudinal studies to find out if there is a progression from non-physical to physical abuse and how this may affect mental health • recognise that IPV is not a unitary phenomenon • take into account the context, motive, controlling tactics and responses • address methodological differences in IPV research studies • investigate the occurrence of PTSD among Chinese abused women and implement culturally appropriate interventions

  23. Thank you

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