Emotional and economic intimate partner violence as key drivers of depression and suicidal ideation: A cross-sectional study among young women in informal settlements in South Africa.

Andrew Gibbs,Rachel Jewkes,Kristin Dunkle,Soraya Seedat

doi:10.1371/journal.pone.0194885

Abstract

Little research has assessed the impact of emotional intimate partner violence (IPV) and economic IPV on women’s mental health. Using cross-sectional data from the Stepping Stones and Creating Futures intervention trial baseline, in eThekwini Municipality, South Africa we assess three questions. First, whether emotional IPV and economic IPV make independent contributions to mental health outcomes; second what matters, severity, variety, or absolute experience? and third, are some items more important in driving mental health impacts than others? We assess associations between past 12-month emotional IPV, past 12-month economic IPV, and past week depressive symptoms and past four-week suicidal ideation. We describe the prevalence of each mental health outcome by individual items, including never/ever and frequency, and combined emotional IPV, and economic IPV, reporting depression scores and percentage of suicidal ideation and 95% confidence intervals (CI). Second, we created four-level categorical variables for combinations of emotional, economic, sexual and physical IPV, and present its frequency, and the mean/% and 95% CI for depression symptomatology and suicidal ideation. 680 women (aged 18–30) were enrolled. High levels of past year emotional IPV, economic IPV were reported. 45.3% reported clinically relevant symptoms of depression, and 30.0% past four-week suicidal ideation. All measures of emotional IPV and economic IPV showed a consistent positive correlation with CESD scores, and suicidal ideation. For all four-level categorical constructs the highest depression scores, and prevalence of suicidal ideation, were for combinations of emotional IPV or economic IPV with physical and/or sexual IPV. For depression in 17/18 combinations this was significantly different compared to women reporting no IPV. For suicidal ideation this was significant in 6/18 combinations all related to economic IPV. Emotional IPV and economic IPV have independent associations with women’s mental health, beyond physical IPV and sexual IPV, and also have distinct patterns between each other.Trial registrationNCT03022370. Registered 13 January 2017, retrospectively registered.

Highlights

A decrease in emotional intimate partner violence (IPV) is an indicator of progress for the Sustainable Development Goal 5.2
Comparatively little has been written on emotional IPV, and no consensus exists on the best practices for measuring emotional IPV, or understanding its impact on health outcomes
We argue that through looking at the health impact of emotional IPV, and economic IPV, juxtaposed with the impact of physical and sexual IPV, we can begin to answer many of the central questions in the measurement of emotional and economic IPV

Summary

Introduction

A decrease in emotional intimate partner violence (IPV) is an indicator of progress for the Sustainable Development Goal 5.2. This indicator is one of 230 indicators assessing progress on the 17 global goals established by the UN to assess development progress by 2030 [1]. The Global Burden of Disease study in 2010 excluded emotional IPV and economic IPV as potential disease burdens because of the lack of research on these constructs and their connections to health impacts [3, 4]. The lack of research on emotional IPV and economic IPV is seen in other reviews. Two recent reviews on associations between IPV and depression [6] and HIV [7], highlighted how few studies have examined the impact of emotional IPV, and they found no studies addressing economic IPV

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Conclusion