Abstract
Women exposed to gender-based violence (GBV) experience a high rate of common mental disorders and suicidal behaviour ("mental disturbance"). Little is known however about the timing of onset of mental disturbance following first exposure to GBV amongst women with no prior mental disorder. The analysis was undertaken on the Australian National Mental Health and Wellbeing Survey dataset (N = 8841). We assessed lifetime prevalence and first onset of common mental disorder and suicidal behaviour (mental disturbance) and exposure to GBV and its first occurrence based on the Composite International Diagnostic Interview Version 3 (WMH-CIDI 3.0). We used the Kaplan-Meier method to derive cumulative incident curves for first onset mental disturbance. The two derived subgroups were women who experienced GBV without prior mental disturbance; and women never exposed to GBV stratified to match the former group on age and socio-economic status. For women with no prior mental disorder, the cumulative incidence curves showed a high incidence of all mental disturbances following first GBV, compared to women without exposure to GBV (all log rank tests <0.0001). Nearly two fifths (37%) of any lifetime mental disturbance had onset in the year following first GBV in women exposed to abuse. For these women, over half (57%) of cases of lifetime PTSD had onset in the same time interval. For GBV exposed women, half of all cases of mental disturbance (54%) and two thirds of cases of PTSD (66.9%) had onset in the five years following first abuse. In contrast, there was a low prevalence of onset of mental disturbance in the comparable imputed time to event period for women never exposed to GBV (for any mental disturbance, 1% in the first year, 12% in five years; for PTSD 3% in the first year, 7% in five years). Amongst women without prior mental disturbance, common mental disorders and suicidal behaviour have a high rate of onset in the one and five year intervals following exposure to GBV. There is a particularly high incidence of PTSD in the first year following GBV.
Highlights
Women exposed to gender-based violence (GBV) experience a high rate of common mental disorders and suicidal behaviour (“mental disturbance”)
Our findings indicate that amongst the two thirds of GBV-exposed women who have not experienced one of the designated mental disturbances prior to the abuse, a substantial portion manifested at least one of these problems within one and five years following initial exposure to abuse
In order to achieve better outcomes, specialist agencies for GBV and general mental health services need to work in closer liaison to ensure that a comprehensive approach is pursued to addressing the multifaceted nature of this problem. It is well-established that women have much higher rates of exposure to GBV than men
Summary
Women exposed to gender-based violence (GBV) experience a high rate of common mental disorders and suicidal behaviour (“mental disturbance”). Women have high rates of common mental disorders and gender-based violence (GBV), public health problems that make a major contribution to the global burden of disease. These two health problems are closely interrelated, as indicated by a growing body of populationwide studies [1,2,3]. It seems likely but yet to be demonstrated that mental disturbances follow in close temporal proximity to initial GBV exposure [1,2,9] If such a pattern can be confirmed, clinicians will be alerted to the need to monitor survivors of first GBV for onset of a range of mental disturbances in the early aftermath of the abuse. Given that first exposure to rape and sexual assault commonly occurs in childhood and adolescence, timely psychological intervention for mental disturbance following these abuses may prevent or mitigate risk of chronic mental disorder extending into later life
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