Association between Physical Partner Violence, Posttraumatic Stress, Childhood Trauma, and Suicide Attempts in a Community Sample of Women
Seedat, Soraya, Stein, Murray B., Forde, David R., Violence and Victims
Our objective was to estimate the prevalence of intimate partner violence (IPV) and to explore its association with childhood maltreatment, substance misuse, posttraumatic stress, and suicidal behavior in a representative community sample of women. IPV was operationalized as a "physical attack or beating by a spouse, boyfriend, or live-in partner." We surveyed 637 women in Memphis, Tennessee, by telephone survey. Sixteen percent reported ever experiencing IPV by a male partner, and 75% endorsed multiple assaultive acts. Of abused women, 5.9% met current PTSD diagnostic criteria, and an additional 11.8% were assessed with subthreshold symptoms. Abused women were more likely than other women to be divorced, to have less than 13 years education, to endorse high levels of childhood victimization, to have abused drugs and alcohol, and to have attempted suicide. Twenty-three percent of IPV+ (abused) women reported a suicide attempt at some time in their lives compared with 3% of IPV- (nonabused) women (p < .0001). Further, multiple logistic regression analysis showed that childhood sexual and emotional abuse and low educational attainment were the only significant predictors of IPV. These results suggest that in women who endorse IPV, careful inquiry of past abuse, trauma-related symptoms, suicidal behavior, and drug use may be important, so that interventions can be both timely and appropriate.
Keywords: partner violence; childhood abuse; alcohol; suicide; posttraumatic stress; survey; women
Intimate partner violence (IPV) in women is known to be associated with poor health behaviors, compromised mental and physical status, and increased use of health care services (Campbell, 2002; Coker et al., 2002; Hathaway et al., 2000; Hegarty, Gunn, Chondros & Small, 2004; Lown & Vega, 2001; Nicolaidis, Curry, McFarland, & Gerrity, 2004). It has been suggested that repeated physical assault by an intimate partner may directly increase the risk of injury and chronic disease, while chronic psychological abuse may affect physical health indirectly (Coker, Smith, Bethea, King, & McKeown, 2000; Kramer, Lorenzon, & Mueller, 2004). Population-based surveys estimate that between 10% and 50% of women who have ever had an intimate male partner have suffered IPV at some time in their lives (Jewkes, Penn-Kekana, Levin, Ratsaka, & Schrieber, 2001; Watts & Zimmerman, 2002). The Commonwealth Fund's 1998 Survey of Women's Health (Plichta & Falik, 2001), a nationally representative sample of women in the US (n = 2,850), found a lifetime prevalence of 35%. In data from 8,005 women in the National Violence Against Women Survey, the lifetime prevalence of physical IPV alone was 13.3% and the strongest risk factor for IPV was physical assault as a child (Coker et al., 2002).
Not surprisingly, a growing literature suggests that women who suffer physical and sexual abuse in childhood are at an increased risk for abuse in adulthood. For example, in a population-based telephone survey, women who reported childhood physical abuse or the witnessing of interparental violence were at a four- to six-fold higher risk of physical IPV (Bensley, Van Eenwyk, & Wynkoop Simmons, 2003). In women attending primary care practices in the UK, Coid and colleagues (2001) found a significant association between childhood experiences and IPV, namely unwanted sexual intercourse (adjusted odds ratio = 3.5) and severe beatings on more than one occasion (adjusted odds ratio = 3.6). Emerging data also support an association between the number of different types of victimization experiences (physical partner violence, child sexual assault, and adult sexual assault) and trauma symptom severity (Follette, Polusny, Bechtle, & Naugle, 1996). While childhood trauma may confound the relationship between IPV and health outcomes, a recent study by McNutt, Carlson, Persaud, and Postmus (2002) found that women with recent IPV had physical symptoms and risky health behaviors that were not wholly explained by the effects of child abuse, past IPV, and economic disadvantage. …