Intimate Partner Violence/Abuse and Depressive Symptoms among Female Health Care Workers: Longitudinal Findings

Abstract

Intimate partner violence and abuse (IPV/A) have been shown to have a major impact on mental health functioning. This study assessed the longitudinal association between recent IPV/A and depressive symptoms to identify potential targets for preventive interventions for women. Random effects models were used to examine four waves of data collected at 6-month intervals from a cohort of 1,438 female health care workers. IPV/A (e.g., sexual and physical violence, psychological abuse) in the past 5 years was associated with higher Center for Epidemiologic Studies Depression Scale (CES-D) 10 scores across four waves after adjustment for age, time, marital status, and childhood trauma. Women who reported IPV/A in the past 5 years had higher CES-D 10 scores (β, 1.31; 95% confidence interval, 0.79–1.82; p < .0001) than nonabused women. This association was generally constant with time, suggestive of a cross-sectional association across all four waves of data. Additionally, recent IPV/A was associated with change in depressive symptoms over time among the full cohort and those with CES-D 10 scores below 10 (the threshold for likely depression) at baseline. Recent IPV/A was independently associated with depressive symptoms both cross-sectionally and longitudinally. The longitudinal association was stronger among those not depressed at baseline. Implications for health care settings and workplace policies addressing IPV/A are discussed.

Introduction

Violence within the context of a romantic relationship is a national and international public health concern. Intimate partner violence and abuse (IPV/A) describes a broad range of abusive behaviors within adult relationships, including physical and/or sexual harm involving the use of force, as well as psychological abuse directed toward current or former romantic partners (Jewkes, 2002, Krantz and Garcia-Moreno, 2005). Nearly 5.3 million women in the United States are victims of IPV/A each year (Tjaden & Thoennes, 2000). The gender differences in perpetration and victimization with regard to context, severity, and differential psychological outcomes prompt the focus of the majority of extant literature to be on the female experience of IPV/A. The present study examines the association between recent IPV/A and depressive symptoms over time among female health care workers.

The negative effects of violence against women on mental health have been widely described (Bonomi et al., 2006, Campbell et al., 2002, Plichta, 2004), and research on the impact of IPV/A on interpersonal and professional relationships is growing. Depression, posttraumatic stress disorder, suicidality, and substance use are serious psychiatric consequences of IPV/A, existing as independent or comorbid conditions (Coker et al., 2002, Coker et al., 2005, Golding, 1999, Nixon et al., 2004, Pico-Alfonso et al., 2006). Depression and depressive symptoms are especially prevalent among abused women, particularly among women with histories of both IPV/A and childhood trauma (Fogarty, Fredman, Heeren, & Liebschutz, 2008). Recent research also suggests that the association between violence victimization on health and occupational outcomes (e.g., employment stability) may be partially mediated through elevated depressive symptoms (Crowne et al., 2011).

Major depression is a complex, multifactorial disorder, with a lifetime prevalence of 20% for U.S. women compared with 13% of men (Kessler, 2003). Risk factors and correlates for major depression include age, socioeconomic status (Nolen-Hoeksema, 1990, Turner and Lloyd, 1999), marital status and quality, and childhood trauma in the form of physical and/or sexual abuse (Campbell, 2002, Golding, 1999, Kendler et al., 2003, Kendler et al., 2004, Nixon et al., 2004, Widom et al., 2007). The clinical diagnosis of major depression depends on the presence of a number of potential predisposing factors, and these depressive symptoms are associated with an increased risk of first-onset major depression in adults (Horwath, Johnson, Klerman, & Weissman, 1992). Recent work suggests that depressive symptoms have a stable course over time (Minor et al., 2005, Tram and Cole, 2006); however, major depression is also particularly sensitive to recent stressful life events, including exposure to violence (Campbell et al., 2002, Golding, 1999, Nixon et al., 2004).

Although there is an ample literature attesting to the strong positive association between violence victimization and depressive symptoms, an overreliance on cross-sectional data may mask the temporality and change over time in this relationship. The association between IPV/A and depressive symptoms has not been well investigated, especially among employed women from a full range of economic and educational resources.

Most previous studies have explored the impact of IPV/A on depressive symptoms over time using clinic-based samples of women leaving the violent relationship or using shelter services (Anderson and Saunders, 2003, Kernic et al., 2003). Little is known about its effect on depressive symptoms in the broader population context. Longitudinal studies are needed to determine whether IPV/A alters the pattern of depressive symptoms over time. To fill these gaps, the current study examines the influence of recent IPV/A on change in depressive symptoms using models that account for confounders and the temporal nesting of observations. Because the presence of participants clinically depressed at baseline may bias inferences toward the null, preplanned sensitivity analyses will evaluate this association after removing participants with elevated depressive symptoms at baseline. This a priori decision to exclude prevalent cases of depression at baseline helps to clarify the temporal ordering of exposure and outcomes to better detect the longitudinal effect of IPV/A on depressive symptoms among those for whom the violence–depression relationship has not yet played out. In this study, we evaluate the hypothesis that recent IPV/A is associated with elevated depressive symptoms in a cohort of female health care workers.