Abstract
Coercive control behaviors central to the abuse of power appear more frequent than other types of domestic violence, but little is known about its frequency, features, and consequences for women in India. We aimed to examine the prevalence of domestic coercive control and its association with physical, sexual, and emotional domestic violence in the preceding year and symptoms of depression, anxiety, and suicidal thinking. In a crosssectional survey, we interviewed 4,906 ever-married women aged 18-49 years living in urban informal settlements in Mumbai, India. We developed a 24-item scale of coercive control, assessed physical, sexual, and emotional violence using existing questions, and screened for symptoms of depression with the Patient Health Questionnaire (PHQ9), anxiety with the Generalized Anxiety Disorder (GAD7) questionnaire, and suicidal thinking with questions developed by the World Health Organization. Estimates involved univariable and multivariable logistic regression models and the prediction of marginal effects. The prevalence of domestic coercive control was 71%. In total, 23% of women reported domestic violence in the past 12 months (emotional 19%, physical 13%, sexual 4%). Adjusted models suggested that women exposed to controlling behavior had greater odds of surviving emotional (aOR 2.1; 95% CI 1.7, 2.7), physical (1.4; 1.0, 1.9), and sexual (1.8; 1.1, 3.0) domestic violence in the past 12 months; and higher odds of a positive screen for moderate or severe depression (1.7; 1.3, 2.2), anxiety (2.1; 1.3, 3.1), and suicidal thinking (1.7; 1.2, 2.3), and increased with each additional indicator of coercive control behavior. When women reported 24 indicators of coercive control, the adjusted predicted proportion with moderate or severe depressive symptoms was 60%, anxiety 42%, and suicidal thinking 17%. Inclusion of coercive control in programs to support domestic violence, would broaden our understanding of domestic abuse to resemble most victims experience and improve interventions.
Highlights
Preventing domestic violence against women is a global imperative (UN Assembly, 2000)
Our objectives were to examine (1) the prevalence of coercive control, (2) its associations with other forms of domestic violence, and (3) its relationship with depression, anxiety, and suicidal thinking.We hypothesized that coercive control would be common, that it would be associated with other forms of abuse, and that it would be a risk factor for depression, anxiety, and suicidal thinking
Our study considered coercive control as part of the spectrum of domestic violence
Summary
Preventing domestic violence against women is a global imperative (UN Assembly, 2000). Bound up with these forms of violence is controlling behaviour in which family members use threats and violence to assert power over the survivor, who suffers negative consequences for non-compliance. Coercive control involves abusers using a range of means to "hurt, humiliate, intimidate, exploit, isolate, and dominate their victims"(Stark, 2007). These include restricting or controlling movement and access to family, friends, neighbours, and broader social circles. Perpetrators often use gender norms to constrain women's mobility, time, spending, socialising, and diet. The environment reflects, entrenches, and exaggerates social and gender norms and women's subordinate position in society (Williamson, 2010), potentially to the extent that it is not perceived as abusive. Coercive control tactics are often interpreted as expressions of care, affection, and love, rather than jealousy or proprietariness (Beck & Raghavan, 2010; Dutton et al, 2006; Stark & Hester, 2019; Suarez, 1994; Wolford-Clevenger et al, 2017)
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