Abuse Has Broader Health Impact Than Formerly Thought

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Researchers report elevated risks between intimate partner violence or childhood sexual abuse and certain health conditions, including major depressive disorder, maternal miscarriage for partners, and alcohol misuse and self-harm among children, in a recent global review and meta-analysis of evidence.

One in every three women who have ever been in a relationship has experienced intimate partner violence in their lives, while approximately 20% of young women and 10% of young men have experienced some kind of childhood sexual abuse. However, research into the health consequences of intimate partner violence and childhood sexual abuse has been minimal.

The authors reported a moderate relationship between intimate partner violence and an increased risk of major depressive disorders (63%), as well as an increased chance of maternal abortion and miscarriage (35%). Childhood sexual abuse was shown to be moderately associated with an increased risk of alcohol use and an increased risk of self-harm (45% and 35%, respectively).

Urgent Need for Prevention and Support

Funnel plots for meta-analysis of the association between intimate partner violence against women and five health outcomes
Funnel plots for meta-analysis of the association between intimate partner violence against women and five health outcomes identified through the systematic review of the literature. These modified funnel plots show the residuals of the reported mean relative risk (RR) relative to 0, the null value on the x-axis, and the residuals of the standard error, as estimated from both the reported standard error and gamma, relative to 0 on the y-axis. The light blue vertical interval corresponds to the 95% uncertainty interval (UI) incorporating between-study heterogeneity; the dark blue vertical interval corresponds to the 95% UI without between-study heterogeneity; the dots are each included observation; the red Xs are outliers observations; the gray dotted line reflects the null log(RR) of 0 (equivalent to a null RR of 1); the blue vertical line is the mean log(RR) for intimate partner violence and the outcome of interest; the red vertical line is the burden of proof function at the 5th quantile for these harmful risk-outcome associations. Credit: Nature Medicine (2023). DOI: 10.1038/s41591-023-02629-5.

The authors indicate these findings are larger in magnitude and more extensive than previously suggested.

“This comprehensive study marks a significant step in understanding the profound health impacts of intimate partner violence against women and childhood sexual abuse. Our findings reveal not only the alarming associations these forms of violence have with conditions like major depressive disorder, miscarriage, alcohol use disorders, and self-harm, but also underscore the urgent need for robust preventive measures and support systems,”

said senior co-lead author Dr. Joht Singh Chandan, Clinical Associate Professor in Public Health at the University of Birmingham.

“While we’ve shed light on these critical health issues, our research also highlights the gaps in current knowledge and the necessity for continued investigation to fully grasp the extensive consequences of such violence. It’s imperative that we use these insights to inform policy, health care, and community interventions, ensuring a safer and healthier future for individuals affected by these pervasive forms of violence,”

added professor Emmanuela Gakidou from the Institute of Health Metrics and Evaluation at the University of Washington and senior co-lead author of the paper.

Broader Health Outcomes Perspective

The study represents a watershed moment in how scholars see the socioeconomic and health costs of intimate partner violence (IPV). Previously, the studies focused solely on IPV’s link to HIV and depression, significantly underestimating its broader impact. This study adds to our understanding by demonstrating IPV’s substantial influence on a broader spectrum of negative health outcomes.

“This new perspective is crucial in elevating IPV as a public health imperative in the global sphere, hopefully igniting both political and scientific momentum towards effective prevention and intervention strategies,”

said Dr. Nicholas Metheny, Assistant Professor in the School of Nursing and Health Studies at the University of Miami.

Emmanuella Gakidou and colleagues identified the existing literature on intimate partner violence and childhood sexual abuse and its related health impacts by searching through papers published in seven databases. They examined almost 4,000 studies, 229 of which matched the inclusion criteria.

Not Causal Proof

They used the burden of proof method, which is a way to estimate the conservative measure of the increased or decreased risk of a certain health outcome after exposure to a harmful or protective risk factor, to look at how strong the evidence was that intimate partner violence and/or childhood sexual abuse were linked to health outcomes.

Additional potential health effects were initially identified during the study, including a link between maternal hypertensive disorders and intimate partner violence, as well as a link between smoking and childhood sexual abuse. The study concluded, however, that due to a lack of evidence, these could not be included in the meta-analysis.

The authors emphasize that the studies are observational and cannot prove causality and that their conclusions are limited due to the small number of studies that investigate these associations. They claim that their study shows the wide-ranging health effects of intimate partner violence and childhood sexual abuse, but they underline the need for more research to bolster the evidence foundation.

Abstract

The health impacts of intimate partner violence against women and childhood sexual abuse are not fully understood. Here we conducted a systematic review by comprehensively searching seven electronic databases for literature on intimate partner violence-associated and childhood sexual abuse-associated health effects. Following the burden of proof methodology, we evaluated the evidence strength linking intimate partner violence and/or childhood sexual abuse to health outcomes supported by at least three studies. Results indicated a moderate association of intimate partner violence with major depressive disorder and with maternal abortion and miscarriage (63% and 35% increased risk, respectively). HIV/AIDS, anxiety disorders and self-harm exhibited weak associations with intimate partner violence. Fifteen outcomes were evaluated for their relationship to childhood sexual abuse, which was shown to be moderately associated with alcohol use disorders and with self-harm (45% and 35% increased risk, respectively). Associations between childhood sexual abuse and 11 additional health outcomes, such as asthma and type 2 diabetes mellitus, were found to be weak. Although our understanding remains limited by data scarcity, these health impacts are larger in magnitude and more extensive than previously reported. Renewed efforts on violence prevention and evidence-based approaches that promote healing and ensure access to care are necessary.

Reference:
  1. Spencer, C.N., Khalil, M., Herbert, M. et al. Health effects associated with exposure to intimate partner violence against women and childhood sexual abuse: a burden of proof study. Nat Med (2023). Doi: 10.1038/s41591-023-02629-5