Substance use and mental health disorders are linked to different forms of intimate partner violence victimisation

Highlights

• We address links between mental health/substance disorders and intimate partner abuse.

• We account for experience of multiple intimate partner violence (IPV) forms.

• AUD are associated with psychological IPV victimisation; SUD with physical forms.

• Mental health disorders are associated with all forms of IPV experienced.

• Comorbid disorders increase the likelihood of psychological and physical forms of IPV.

Abstract

Background

Substance and mental health disorders convey significant health burdens and impair interpersonal relationships. We tested associations between comorbid substance and mental health disorders and different forms of intimate partner violence (IPV) experienced by young adults.

Method

Mothers (n = 6703) were recruited during pregnancy to the longitudinal Mater-University of Queensland Study of Pregnancy. Mother/offspring dyads were followed up from birth to 21 years. Offspring with complete psychiatric data at 21 years who reported having had an intimate partnership were included (n = 1781). Participants’ experiences of psychological, physical and severe combined IPV were assessed at 21 years using a summarised form of the Composite Abuse Scale. We used the Composite International Diagnostic Interview to obtain lifetime diagnoses of mental health and substance disorders. Multivariable logistic regression models of each IPV form were adjusted for individual, family and neighbourhood factors during adolescence, and for other forms of IPV.

Results

We have shown specific links between different forms of IPV experienced and individual substance and mental health disorders. Mental health disorders were related to all three forms of IPV, while alcohol disorders were linked to psychological IPV (OR_AUD = 1.86; 1.21–2.86) and illicit substance disorders to physical IPV (OR_SUD = 2.07; 1.25–3.43). The co-occurrence of related disorders was strongly linked to psychological and physical IPV.

Conclusions

Intimate partner violence was experienced by both men and women. Substance and mental health disorders were associated with specific forms of IPV victimisation, suggesting that screening IPV clients and mental health/substance disorder patients for the converse problems may be important for intervention planning.

Introduction

Intimate partner violence (IPV) is an issue of global concern, with prevalence estimates ranging between 10% and 75% depending on the country surveyed (Garcia-Moreno et al., 2006, Feder et al., 2013, Fulu et al., 2013). The World Health Organisation defines IPV as “behaviour by an intimate partner that causes physical, sexual or psychological harm” (Feder et al., 2013). Although most victims have experienced more than one type of IPV (Hegarty et al., 2004, Thompson et al., 2006, Krebs et al., 2011), the majority of evidence on victimisation to date describes physical IPV. Some studies, however, suggest that different factors may be associated with victims’ experience of each form of harm (Hegarty et al., 2004, Jonas et al., 2014). For example, being a victim of physical IPV has been associated with alcohol disorders (Fergusson et al., 2013), illicit substance use (Smith et al., 2012), mood (la Flair et al., 2012) and anxiety disorders (Schonbrun et al., 2013). As to psychological IPV, there is initial evidence that common mental disorders may be associated with higher prevalence of this form of violence (Coker et al., 2000, Hegarty et al., 2005, Thompson et al., 2006). Little is known about how these disorders link to sexual IPV victimisation (Krebs et al., 2011, Devries et al., 2014).

Identification of different forms of IPV may be important. Firstly, treatment for psychological IPV differs from that for physical or sexual forms. Secondly, identification of and intervention for psychological IPV may help prevent progression to other forms of IPV in the relationship (Krebs et al., 2011).

The associations with mental health and substance use disorders are also useful to consider. Although the World Health Organisation no longer recommends universal screening for IPV, it endorses enquiry via conditions which may contribute to or be worsened by IPV (Feder et al., 2013). In general, it appears that common mental health disorders, including alcohol and illicit substance use, may play an important role in becoming a victim of IPV. This is additionally concerning given that substance use and mental health disorders contribute substantially to the global disease burden (Whiteford et al., 2013) and are frequently comorbid with each other (Merikangas and Kalaydjian, 2007, Teesson et al., 2009). These comorbidities present additional challenges. Treatment approaches are more complex (Tiet and Mausbach, 2007, Connolly et al., 2011) and more costly (King et al., 2000), societal participation is impaired (King et al., 2000) and behavioural problems are more severe (Salom et al., 2014). These factors may also affect therapy for IPV.

Although existing literature on IPV victimisation is substantial, there are a number of shortcomings. Firstly, few studies include all three types of intimate partner violence (Coker et al., 2000, Hegarty et al., 2004, Thompson et al., 2006, Krebs et al., 2011) and none of these has examined links between IPV forms and different types of mental health disorders, meaning the links with comorbidities could not be assessed (McPherson et al., 2007, Boden et al., 2012, Fergusson et al., 2013, Schonbrun et al., 2013, Jonas et al., 2014). Secondly, gender differences need further investigation. The existing literature is heavily weighted towards female victimisation (Coker et al., 2000, Stith et al., 2004, Krebs et al., 2011, Devries et al., 2014) and many studies are drawn from treatment samples (McPherson et al., 2007, Engstrom et al., 2008). A number of national studies have however shown that men are victims, and of each type of IPV (Smith et al., 2012, Jonas et al., 2014, Kraanen et al., 2014). Factors involved in male victimisation may differ from those for women. For example, depression in men has been linked to their experience of psychological IPV, while in women depression appears related to physical partner violence (Renner et al., 2014); hence it is important to consider gender differences.

Many studies were cross-sectional and, therefore, unable to assess the role of contributing factors, since retrospective reports of these factors may be subject to recall bias (Coker et al., 2000, Vest et al., 2002, Hegarty et al., 2005, Thompson et al., 2006, Kraanen et al., 2014, Selic et al., 2014). A few longitudinal studies have emerged with mixed results. Depression has been linked (Johnson et al., 2014, Longmore et al., 2014) and not linked (Halpern et al., 2009, Fergusson et al., 2013) with physical IPV. Similarly, findings for alcohol have been positive (Fergusson et al., 2013) and negative (Johnson et al., 2014), with another line of research suggesting that observed links between these disorders and IPV experience may be explained by other factors (Boden et al., 2012). These studies have considered only physical IPV, or have included sexual IPV in their assessment, not measuring psychological IPV.

In this study, we examine the associations between alcohol, illicit substance and mental health disorders and different forms of intimate partner violence. We hypothesise that co-occurring disorders may be more strongly linked to IPV victimisation than single disorders, and that these relationships may be gender patterned, as are substance and mental health disorders. We adjust for participants’ own violent behaviour (Coker et al., 2000, Longmore et al., 2014), experience of childhood sexual abuse (Stith et al., 2004, Renner et al., 2014), observation of parental IPV (Bonomi et al., 2014), living in a neighbourhood where violence is normalised (Selic et al., 2014), and socio-economic factors such as low education (Boden et al., 2013), unemployment (Smith et al., 2012) and restricted income (Coker et al., 2000, Garcia-Moreno et al., 2006, Thompson et al., 2006, Krebs et al., 2011) which have all been related to intimate partner violence victimisation.

We add to the existing literature on IPV in a number of ways. Our study is a large population-based sample comprising both men and women for whom we have measures consistent with clinical diagnoses of alcohol, illicit substance and mental health disorders. Our data also comprise prospectively-collected measures from individuals and their family of origin to assess adolescent and early life factors which may contribute to victimisation or confound the relationships with these disorders. Lastly, we have measures of psychological, physical and sexual IPV; these were assessed early in adulthood, so that most experience of IPV will have been recent, thus reducing the potential for recall bias. In summary, we are able evaluate the relationships of alcohol, illicit substance and mental health disorders with different types of IPV victimisation, singly and in combination.