title: Mental ill health in structural pathways to women's experiences of intimate partner violence.
abstract: BACKGROUND
  Depression, post-traumatic stress disorder (PTSD), and binge drinking are among mental health effects of child abuse and intimate partner violence (IPV) experiences among women. Emerging data show the potential mediating role of mental ill health in the relationship of child abuse and IPV. There is evidence that PTSD, depression and alcohol abuse are comorbid common mental disorders and that a bidirectional relationship exists between depression and IPV in some settings. Furthermore, the temporal direction in the relationship of alcohol abuse and women's IPV experiences from different studies is unclear. We undertook a study with women from the general population to investigate the associations of child abuse, mental ill health and IPV; and describe the underlying pathways between them.
  
  
  METHODS
  Data is from a household survey employing a multi-stage random sampling approach with 511 women from Gauteng, South Africa. IPV was measured using the WHO Multi-country Study on Women's Health and Domestic Violence Questionnaire. Child abuse was measured using a short form of the Childhood Trauma Questionnaire. Depression was measured using the Centre for Epidemiologic Studies Depression Scale (CESD). PTSD symptoms were measured using the Harvard Trauma Questionnaire. Binge drinking was measured using the Alcohol Use Disorders Identification Test (AUDIT) scale. All data analyses were conducted in Stata 13. Regression modelling was used to test the association between variables. Structural equation modelling with full information maximum likelihood estimation accounting for missing data was done to analyse the underlying pathways between variables.
  
  
  RESULTS
  Fifty percent of women experienced IPV in their lifetime and 18% experienced IPV in the 12 months before the survey. Twenty three percent of women were depressed, 14% binge drank and 11.6% had PTSD symptoms. Eighty six percent of women had experienced some form of child abuse. Sociodemographic factors associated with recent IPV in multivariate models were younger age and foreign nationality. Depression, PTSD and binge drinking mediated the relationship of child abuse and recent IPV. Depression, PTSD and binge drinking were also effects of recent IPV. Other factors associated with recent IPV experience included relationship control, having a partner who regularly consumed alcohol and experiencing other life traumatic experiences.
  
  
  CONCLUSIONS
  Mental ill health plays a mediating role in the relationship of child abuse and recent IPV experiences among women. Conversely, IPV also negatively affects women's mental health. Interventions to reducing the incidence of IPV could help alleviate the burden of mental ill health among women and vice versa. Effective integration of mental health services in primary health care, detection of symptoms, brief interventions and strengthened referral mechanisms for sustained community-based care are necessary in responding to victims of intimate partner violence. Response for abused children needs to take similar approaches and reduce the long-term mental health effects associated with violent exposures.
authors.affiliation: Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa.|School of Public Health, University of Witwatersrand, Johannesburg, South Africa.
authors.forename: Mercilene T
authors.identifier: http://orcid.org/0000-0001-7275-1100
authors.initials: MT
authors.lastname: Machisa
authors.affiliation: School of Public Health, University of Witwatersrand, Johannesburg, South Africa.
authors.forename: Nicola
authors.initials: N
authors.lastname: Christofides
authors.affiliation: Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa.|School of Public Health, University of Witwatersrand, Johannesburg, South Africa.
authors.forename: Rachel
authors.initials: R
authors.lastname: Jewkes
mesh_terms: D000293:Adolescent; D000328:Adult; D017579:Domestic Violence; D005260:Female; D006801:Humans; D008603:Mental Health; D008875:Middle Aged; D018454:Spouses; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology; D055815:Young Adult