title: The impact of intimate partner violence, substance use, and HIV on depressive symptoms among abused low-income urban women.
abstract: Intimate partner violence (IPV), substance use, and HIV are often co-occuring health problems affecting low-income urban women, and have been described as connected epidemics making up a "syndemic." Research suggests that each issue separately is associated with depressive symptoms, but no studies have examined the combined effect of IPV, substance use and HIV on women's depression. Interviews were conducted with 96 women recruited from community health clinics serving low-income women in an urban U.S. city. All women were over 17, not pregnant, English-speaking, without private insurance and had experienced physical IPV in the past year. Women were primarily African American (82%) and 82% were receiving income assistance. Twenty seven percent were HIV-positive, and 27% had used heroin or cocaine in the past 6 months. Based on the Centers for Epidemiological Studies Depression Scale (CES-D ), 73% were depressed. Women who experienced severe IPV in the past 6 months were compared to women who experienced no IPV or psychological IPV only in the past 6 months; those who experienced severe IPV were 5.3 times more likely to be depressed, controlling for HIV status, drug use, age, and relationship status. Women who experienced severe IPV, were HIV-positive, and used drugs (7.3% of sample) were 7.98 times as likely to be depressed as women without these characteristics. These findings confirm that severe IPV is significantly associated with depression among urban abused women. Furthermore, this research suggests that the syndemic effect of IPV, substance use, and HIV could be even more detrimental to women's mental health. Health practitioners and researchers should be aware of the combined impact of the IPV, substance use, and HIV syndemic and consider how they can address the mental health needs of urban women.
authors.affiliation: Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. sillanga@jhsph.edu
authors.forename: Samantha L
authors.initials: SL
authors.lastname: Illangasekare
authors.forename: Jessica G
authors.initials: JG
authors.lastname: Burke
authors.forename: Karen A
authors.initials: KA
authors.lastname: McDonnell
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Gielen
mesh_terms: D000328:Adult; D018585:Battered Women / Q000523:psychology*; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D007398:Interpersonal Relations; D008396:Maryland; D011203:Poverty; D012747:Sexual Partners / Q000523:psychology*; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014505:Urban Population; D014754:Violence
keywords: alcohol and drugs; domestic violence; domestic violence and cultural contexts; mental health and violence