title: Lifetime co-occurrence of violence victimisation and symptoms of psychological ill health: a cross-sectional study of Swedish male and female clinical and population samples.
abstract: BACKGROUND
  Lifetime co-occurrence of violence victimisation is common. A large proportion of victims report being exposed to multiple forms of violence (physical, sexual, emotional violence) and/or violence by multiple kinds of perpetrators (family members, intimate partners, acquaintances/strangers). Yet much research focuses on only one kind of victimisation. The aim of this study was to investigate the association between symptoms of psychological ill health, and A) exposure to multiple forms of violence, and B) violence by multiple perpetrators.
  
  
  METHODS
  Secondary analysis of cross-sectional data previously collected for prevalence studies on interpersonal violence in Sweden was used. Respondents were recruited at hospital clinics (women n = 2439, men n = 1767) and at random from the general population (women n = 1168, men n = 2924). Multinomial regression analysis was used to estimate associations between exposure to violence and symptoms of psychological ill health.
  
  
  RESULTS
  Among both men and women and in both clinical and population samples, exposure to multiple forms of violence as well as violence by multiple perpetrators were more strongly associated with symptoms of psychological ill health than reporting one form of violence or violence by one perpetrator. For example, in the female population sample, victims reporting all three forms of violence were four times more likely to report many symptoms of psychological ill health compared to those reporting only one form of violence (adj OR: 3.8, 95 % CI 1.6-8.8). In the male clinical sample, victims reporting two or three kind of perpetrators were three times more likely to report many symptoms of psychological ill health than those reporting violence by one perpetrator (adj OR 3.3 95 % CI 1.9-5.9).
  
  
  CONCLUSIONS
  The strong association found between lifetime co-occurrence of violence victimisation and symptoms of psychological ill-health is important to consider in both research and clinic work. If only the effect of one form of violence or violence by one kind of perpetrator is considered this may lead to a misinterpretation of the association between violence and psychological ill health. When the effect of unmeasured traumata is ignored, the full burden of violence experienced by victims may be underestimated.
  
  
  CONCLUSIONS
  Different kinds of victimisation can work interactively, making exposure to multiple forms of violence as well as violence by multiple perpetrators more strongly associated with symptoms of psychological ill health than any one kind of victimisation alone.
authors.affiliation: Department of Acute Internal Medicine and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden. Johanna.simmons@liu.se.
authors.forename: Johanna
authors.initials: J
authors.lastname: Simmons
authors.affiliation: Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden. Barbro.wijma@liu.se.
authors.forename: Barbro
authors.initials: B
authors.lastname: Wijma
authors.affiliation: Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden. Katarina.swahnberg@lnu.se.|Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden. Katarina.swahnberg@lnu.se.
authors.forename: Katarina
authors.initials: K
authors.lastname: Swahnberg
mesh_terms: D000328:Adult; D058445:Bullying; D019548:Crime Victims / Q000523:psychology*; D057237:Criminals / Q000145:classification; D003430:Cross-Sectional Studies; D017579:Domestic Violence; D005190:Family; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D001523:Mental Disorders / Q000209:etiology*; D008603:Mental Health; D008875:Middle Aged; D016017:Odds Ratio; D012742:Sex Offenses / Q000523:psychology*; D012747:Sexual Partners; D013548:Sweden / Q000453:epidemiology; D014754:Violence / Q000145:classification / Q000523:psychology*