Mental Health Implications of Elder Abuse and Domestic Violence

By Indu, Pankajakshan | Indian Journal of Psychological Medicine, November-December 2018 | Go to article overview

Mental Health Implications of Elder Abuse and Domestic Violence


Indu, Pankajakshan, Indian Journal of Psychological Medicine


Byline: Pankajakshan. Indu

Elder abuse and domestic violence (DV) are major social issues, which are often ignored. Families are expected to develop emotional bonding between their members and be the source of support for them. However, often families witness scenes of violence either between couples or between parents and their offspring. DV can be defined narrowly as intimate partner violence (IPV) with the focus primarily on younger women. Elder abuse refers to abuse of elderly by multiple types of abusers, some of whom are domestic partners and children.

The global population is aging rapidly, and so is the Indian population. According to the 2011 Census, the proportion of elderly people constitutes 8.6% of the total population and is expected to reach 20% by 2050. Increasing longevity is associated with increased morbidity, leading to a rise in the dependent older population.[1] Being physically, socially, and economically dependent adds to the risk of exposure to abuse. The HelpAge India, in a survey conducted in persons age 60 years and older, found that nearly one-fourth (25%) were victims of elder abuse. Disrespect, verbal abuse, and neglect were the most common forms of psychological abuse (∼50%), whereas beating or slapping was reported by 12%. The abusers were most commonly sons (52%) and daughters-in-law (34%).[2] Elder abuse can result in not only physical morbidity but also more psychological distress and morbidity, including depressive and anxiety disorders. On the contrary, psychiatric morbidities such as depression can be a risk factor for elder abuse.[3]

A hospital-based study by Patel et al ., published in this issue, has looked at the prevalence and predictors of abuse in elderly patients with depression. According to the study, the prevalence of abuse was 24%, of which psychological abuse was more common (50%) than physical abuse (4%). Abuse was reported by about 54% of those with severe depression. The perpetrators were mostly daughters-in-law and sons. Illiteracy and severe depression were found to be the risk factors for elder abuse.[4] The bidirectional relationship between depression and elder abuse is also discussed. This highlights the need for longitudinal studies to assess whether depression leads to elder abuse or vice versa.

Violence against women is a human rights abuse and a public health issue with substantial consequences for women's physical, mental, sexual, and reproductive health. The World Health Organization's multicountry study on women's health and DV against women found the lifetime prevalence of DV to vary from 15% to 71%.[5] In a study conducted by the Indian Clinical Epidemiology Network to assess DV in Indian women, 40% reported experiencing 'any violence' during their marriage. DV was significantly associated with increased risk of poor mental health in these women.[6]

Two articles assessing DV in an Indian setting are included in this issue. Nadda et al ., in a community-based, cross-sectional study conducted in Haryana, assessed the prevalence and characteristics of DV and injuries because of DV among married women. Almost one-third of the sample had ever experienced DV, whereas around 30% currently experienced DV. A comparison between rural and urban areas revealed that all types of DV, except sexual violence, were significantly more in the rural area. …

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