Domestic Violence as a Risk Factor for Attempted Suicide in Married Women

Cross-lagged relationships between exposure to intimate partner violence, depressive symptoms and suicidal thoughts among adolescent and young married women

BACKGROUND

High rates of depression and suicidal ideation are found in women experiencing intimate partner violence (IPV), but their temporal relationship is unclear. This study explores the bidirectional causality between IPV victimization, depressive symptoms, and suicidal thoughts among adolescent and young married women in India.

METHODS

Data sourced from the UDAYA longitudinal survey in India, comprising 3,965 women aged 15-22. Employing Pearson's correlation coefficient, we analyzed the relationship between variables. Additionally, a two-wave cross-lagged autoregressive panel model explored the bidirectional link between IPV, depressive symptoms, and suicidal ideation.

RESULTS

Approximately 25 % and 45 % of the participants reported some form of partner violence at baseline and at follow-up after three years, respectively. Exposure to IPV at baseline was significantly associated with depressive symptoms at follow-up [β = 0.10, p < 0.001], and the association between depressive symptoms at baseline and IPV at follow-up was statistically not significant [β = -0.02, 95 % CI: -0.06-0.02]. Similarly, exposure to IPV at baseline was significantly associated with suicidal thoughts at follow-up [β = 0.24, p < 0.001], and the association between suicidal thoughts at baseline and IPV at follow-up was statistically not significant [β = 0.003, 95 % CI: -0.001-006].

CONCLUSIONS

The findings suggest that exposure to IPV is consistently and strongly associated with depressive symptoms and suicidal thoughts in adolescent and young married women. However, the reciprocal relationships did not hold true in this study, implying that reducing IPV during adolescence could potentially minimize the prevalence of depressive symptoms and suicidal thoughts during young adulthood.

Suicide attempts in the adult Mexican population: an analysis of sociodemographic characteristics and associated factors

OBJECTIVE

Suicide is the culmination of a process or continuum known as suicidal behavior that proceeds from ideation and planning to attempt. The objective was to estimate the prevalence of suicide attempts in the adult Mexican population and to analyze their main associated factors.

METHODS

We conducted an observational, cross-sectional, and descriptive study with information from the National Health and Nutrition Survey (2018). Self-reported lifetime suicide attempt was used in the analysis. We analyzed depression, obesity, tobacco smoking, and alcohol consumption as suicide attempt-associated factors using a multivariate logistic regression model.

RESULTS

The prevalence of adult suicide attempt was 2.0% (95%CI 1.8-2.2) and it was higher among women (2.4%; 95%CI 2.2-2.8) and young people (2.9%; 95%CI 2.4-3.4). Low education (OR=1.6; 95%CI 1.2-2.2), being single (OR=1.3; 95%CI 1.0-1.6), having obesity (OR=1.4; 95%CI 1.1-1.8), consumption of alcohol (OR=2.4; 95%CI 1.7-3.4) or tobacco smoking (OR=1.8; 95%CI 1.4-2.4), and having strong symptoms of depression (OR=10.1; 95%CI 6.2-16.3) were associated with a higher prevalence of suicide attempts.

CONCLUSION

These results help better understand suicidal behavior in Mexico and identify the factors that increase the likelihood of suicide attempts, which is essential to help reduce suicide mortality. This research is crucial for developing early interventions and prevention programs aimed at reducing suicide's public health burden.

Understanding for Prevention: Qualitative and Quantitative Analyses of Suicide Notes and Forensic Reports

Suicide risk is associated with vulnerabilities and specific life events. The study's objective was to explore the relevance of data from forensic documentation on suicide deaths to the design of person-centered preventive strategies. Descriptive and thematic analyses were conducted of forensic observations of 286 deaths by suicide, including some with suicide notes. Key findings included the influence of health-and family-related adverse events, emotional states of loss and sadness, and failures of the health system to detect and act on signs of vulnerability, as confirmed by the suicide notes. Forensic documentation provides useful information to improve the targeting of preventive campaigns.

Domestic Coercive Control and Common Mental Disorders Among Women in Informal Settlements in Mumbai, India: A Cross-Sectional Survey

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 cross-sectional 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.

Anatomy of Domestic Violence and Suicide in Kashmir

The daily timeline of news and happenings around us persistently has the depressing snippets of cases of gender based violence cases all over. This dark reality of witnessing the rising of domestic violence related cases are very concerning and signifies the regressing perception of societal psychology on the whole. This internalization has the ubiquitous nature having the layered dimensions attached to it with women facing the agonizing consequences. Domestic violence is a fairly common occurrence in most of the parts of Kashmir region mainly from husbands or family members and broken relation with in-laws, Wife abuse, marital violence, family issues, and harassment dominance of male structures. This results in bouts of 'aimlessness' prompting women to find the meaning in ending her life. In Kashmir region, those females who are victim of domestic violence suffer from unavoidable mental health issues with flashbacks and stressors filled with negative life experiences such as stressful relationships, marital discord, and family troubles, forced marriage, economic crisis and lack of personal choices. There is direct relationship between female suicide and domestic violence. Females who experience physical or/and sexual violence in their marriage are significantly more likely to have suicidal thoughts. In the above mentioned context, it becomes significant to delve into how domestic violence trigger women to commit or attempt suicide and as such the study titled 'Anatomy of Domestic Violence and suicide in Kashmir' was undertaken. The study has focused on female suicide survivors who are married women aged from 20-35 and have faced domestic violence. The purpose of the study was to examine the profile of women who have attempted suicide. The present study highlights the spectrums of domestic violence and suicide in Kashmir by focusing on a number of key sociological aspects.

Exposure to violence and the presence of suicidal and self-harm behaviour predominantly in Asian females: scoping review

Background

Exposure to violence is associated with psychological distress, mental disorders such as depression, and suicidal behaviour. Most of the studies are conducted in the West, with limited publications from Asia. Thus, we conducted a scoping review of studies investigating the association between experiences of violence and later suicidal ideation/attempts from Asia in the twenty-first century.

Results

Many studies focused on domestic violence toward women in the Southeast Asian region. Sociocultural factors such as family disputes, public shaming, dowry, lack of education opportunities, and marriage life perceptions mediated the association. Many women exposed to violence and attempted suicide suffered from mental disorders such as depression, anxiety, and post-traumatic stress. The small number of suitable studies and the possible effect of confounders on participants were limitations in the review. Future studies would have to focus on specific types of violence and ethnoreligious beliefs.

Conclusion

Women in Asia exposed to violence appear to have an increased risk of suicidal behaviour and mental disorders. The early screening of psychological distress with culturally validated tools is essential for preventing suicides in Asian victims of violence.

Technology-Based Mental Health Interventions for Domestic Violence Victims Amid COVID-19

Introduction: Domestic violence is a threat to human dignity and public health. Mounting evidence shows that domestic violence erodes personal and public health, spawning issues such as lifelong mental health challenges. To further compound the situation, COVID-19 and societies’ poor response to the pandemic have not only worsened the domestic violence crisis but also disrupted mental health services for domestic violence victims. While technology-based health solutions can overcome physical constraints posed by the pandemic and offer timely support to address domestic violence victims’ mental health issues, there is a dearth of research in the literature. To bridge the research gap, in this study, we aim to examine technology-based mental health solutions for domestic violence victims amid COVID-19. Methods: A literature review was conducted to examine solutions that domestic violence victims can utilize to safeguard and improve their mental health amid COVID-19. Databases including PubMed, PsycINFO, and Scopus were utilized for the literature search. The search was focused on four themes: domestic violence, mental health, technology-based interventions, and COVID-19. A reverse search of pertinent references was conducted in Google Scholar. The social ecological model was utilized to systematically structure the review findings. Results: The findings show that a wide array of technology-based solutions has been proposed to address mental health challenges faced by domestic violence victims amid COVID-19. However, none of these proposals is based on empirical evidence amid COVID-19. In terms of social and ecological levels of influence, most of the interventions were developed on the individual level, as opposed to the community level or social level, effectively placing the healthcare responsibility on the victims rather than government and health officials. Furthermore, most of the articles failed to address risks associated with utilizing technology-based interventions (e.g., privacy issues) or navigating the online environment (e.g., cyberstalking). Conclusion: Overall, our findings highlight the need for greater research endeavors on the research topic. Although technology-based interventions have great potential in resolving domestic violence victims’ mental health issues, risks associated with these health solutions should be comprehensively acknowledged and addressed.

Suicide prevention in the context of COVID-19: An Indian perspective

The ongoing COVID-19 pandemic has impacted the health and wellbeing of communities worldwide. Measures to limit transmission, have enhanced vulnerability of individuals to well identified risk factors associated with mental illness and suicide. These include a sense of loneliness, anxiety, depression, insomnia, PTSD, harmful alcohol and drug use. Given that the potential for increased rates of suicide persist, the suicide prevention agenda remains urgent and essential. The same is one of the cornerstones of resilience in a society that is facing an array of challenges due to the pandemic. In this article, we recommend few possible strategies for attenuating suicide risk amidst the COVID-19 pandemic with particular relevance to the Indian context.

Patients With Suicidal Patterns in the Emergency Room: A Clinical and Social Reflection

Background and objective Emergency physicians come across a myriad of medical afflictions resulting from suicide attempts. The Indian contribution to global suicide deaths is alarming; the social construct of India is unique, and so are the problems and challenges. This study aims to describe the social background, demographic parameters and correlate the clinical profile and outcomes of all patients presenting with an attempted or completed suicide. Materials and methods The present study is a hospital-based prospective observational study conducted by the Department of Emergency Medicine at RL Jalappa Hospital and Research Centre, a rural tertiary-care center in Karnataka, India, from June 2020 to February 2021. After stabilizing the patient, a detailed socio-demographic history was recorded. Details of the suicide attempt and findings of the clinical examination were noted. Results The final study sample consisted of 89 patients who presented to the emergency room (ER). Fifty-three patients were female, and thirty-six were males; the average age of the sample was 28.4 ± 11 years. A higher proportion of men who completed pre-university education (p= 0.0005, c2= 11.98) or had a graduate degree (p= 0.009, c2= 6.71) attempted suicide. Amongst all women who attempted suicide, 73.6% (n=39) were married at the time of the event (p= 0.0006, c2= 11.79). Poisoning (n=59) was the most common method of attempting suicide. We also observed that it was primarily men who attempted suicide when under the influence of alcohol (p= 0.006, c2= 7.57). The most common reason for attempting suicide was familial disharmony, including domestic violence. A Glasgow Coma Scale (GCS) score of 9/15 and less at the time of presentation resulted in a mortality rate of 28.6%, whereas patients with a GCS score of 10 and above had a mortality rate of 6.1% (p= 0.04, c2= 4.14). Discussion Marriage appears to be less protective for Indian women than Indian men. Poisoning was the most common method of attempted suicide in our study, followed by tablet overdose. The reason for the above could be ease of access to household poisons. Insecticides have been a preferred method in the Indian population over the years. Aluminum phosphide poisoning, a common constituent of rodenticides, is associated with a high mortality rate. However, in the West, firearm-related incidents have the highest mortality. Multiple correspondence analysis (MCA) of the National Crime Records Bureau (NCRB), India, data showed that adult males succumb majorly to romantic relations, unemployment, and failure in examinations. The use of alcohol was more in the illiterate and unskilled workers; however, high school educated persons and students used alcohol intentionally to facilitate suicide. Lower Glasgow Coma Scale values are associated with higher fatality; however, some studies found that Full Outline of Unresponsiveness (FOUR) and Acute Physiology and Chronic Health Evaluation Score (APACHE) II scores are better mortality indicators. Conclusion Besides the presentation and GCS score, cognizance of the lethality of different methods in attempting suicide provides clues in anticipating the patient's clinical course. The social patterns of suicide must be considered while designing awareness campaigns and focused outreach programs to decrease suicides. A strict policy must be made and enforced to limit the availability of household poisons.

The Mediating Role of Coping Style: Associations Between Intimate Partner Violence and Suicide Risks Among Chinese Wives of Men Who Have Sex With Men

The wives of men who have sex with men, known as "Tongqi" in China, have increasingly attracted public attention due to their potential risks of suicide and sexually transmitted infections and HIV. However, few studies have explored the association between intimate partner violence (IPV) and suicide risk or the mediating effect of coping style on these associations among Tongqi in China. To describe these relationships, a cross-sectional online survey was conducted in China from February 2016 to February 2017. A questionnaire, which consisted of the Revised Conflict Tactics Scales, the Simplified Coping Style Questionnaire, the Beck Scale for Suicidal Ideation, and reports of suicide attempts, was completed by 178 Chinese Tongqi. Bootstrap tests were performed to determine the mediating role of coping styles on the association between IPV and suicide risks. The median IPV score was 14 (range: 0-50), with the domain of negotiation ranking highest. The average coping style score was .37±.73; 61.2% of Tongqi have had suicidal ideation, and 11.8% had attempted suicide. IPV was significantly correlated with suicidal ideation (r^s = .19, p < .01) and suicide attempts (r^s = .29, p < .001). Participants with a negative coping style had higher suicidal ideation (r^s = -.39, p < .01) and suicide attempts (r^s = -.22, p < .01). Coping style had a full mediating effect on the association between IPV and suicidal ideation and a partial mediating effect on suicide attempts. Chinese Tongqi experienced high level of IPV and suicide risks. IPV contributed to the suicide risks of Chinese Tongqi, but these associations were mediated by coping style. Therefore, interventions to improve mental health and prevent suicide risks of Chinese Tongqi should focus on helping them develop a positive coping style to achieve the goal of Healthy China in 2030.

Prevalence and risk factors of domestic violence in women attending the National Guard Primary Health Care Centers in the Western Region, Saudi Arabia, 2018

BACKGROUND

Domestic violence (DV) is considered a public health issue in Saudi Arabia as well as a violation of a fundamental human right. DV causes many acute and chronic physical and mental health consequences. Cultural taboos and lack of awareness regarding the appropriate support services can increase the number of cases annually. The objective of the study was to assess the prevalence and risk factors of DV in women attending the National Guard Primary Health Care Clinics in the Western Region of Saudi Arabia.

METHODS

A cross-sectional study was conducted with patients attending five Primary Health Care Centers in Jeddah from August 2017 to February 2018. A convenient sampling method was used. In total, 1845 participants were invited to complete a self-report validated Arabic version of the Norvold Domestic Abuse Questionnaire (NORAQ) to determine the prevalence and risk factors of DV. All women between 18 and 65 years who met the inclusion criteria were included. The data were analyzed using SPSS (Statistical Package Social Sciences) version 24.0.

RESULTS

The lifetime prevalence of DV in the study sample was 33.24%, with psychological abuse the most prevalent (48.47%), followed by physical abuse (34.77%) and sexual abuse (16.75%). A small proportion (4.1%) suffered from all three types of abuse. Risk factors for being a victim of abuse include being single or divorced, having a postgraduate level of education, employed, and being financially independent of the husband.

CONCLUSION

DV is prevalent in Saudi Arabia. Modernization has shifted the risk factors, identifying the risk factors and victim characteristics would support the development and implementation of preventive and screening programs to facilitate the early identification of cases as well as the initiation of empowerment programs for Saudi women.

Mental health effects of domestic violence against women in Delhi: A community-based study

Background:

Domestic violence (DV) against women is an all-pervasive phenomenon considered to have serious health consequences for women. This study aimed to assess the association of DV against women with their mental health status.

Materials and Methods:

This community-based, cross-sectional study was carried out among 827 ever married women from Delhi selected through cluster sampling followed by systematic random sampling. Data were collected using structured and in-depth questionnaires. Mental health status was estimated using self-reporting questionnaire 20.

Results:

The prevalence of psychological, physical, sexual, physical, or sexual violence and any form of violence was very high. A quarter of the women (25.3%) reported unhealthy mental status (>8 score) in the past 4 weeks. Women who had experienced DV showed poor mental health status and more suicidal tendencies when compared with women who had not experienced violence.

Conclusion:

DV has significant effect on women's mental health underscoring the need to develop public health interventions.

Experience of Domestic Violence and Psychological Morbidity in Spouses of Alcohol-Dependent Males

BACKGROUND

Prevalence of both domestic violence (DV) and alcohol use is reported to be high in Kerala. The prevalence of DV and psychological morbidity in spouses of alcohol-dependent males has not been studied objectively.

METHODS

This cross-sectional study was undertaken to study the occurrence of DV and psychological morbidity-major depressive disorder (MDD), anxiety disorders, and adjustment disorders-in spouses of alcohol-dependent males attending the de-addiction center of a tertiary care hospital in South India. Sixty consecutive cases, aged 18-55 years, were recruited after getting informed consent. They were assessed using Domestic Violence Questionnaire (DVQ), Mini International Neuropsychiatric Interview Schedule, and a questionnaire to assess adjustment disorder. The association of DV with psychological morbidities was also studied.

RESULTS

DV was reported by 41 (68.3%, 95% confidence interval [CI] = 55.0-79.7) cases. At least one psychiatric morbidity was observed in 51 (85.0%, 95% CI = 72.9-92.5) cases-MDD in 15 (25.0%, 95% CI = 15.1-38.1), anxiety disorders in 6 (10%, 95% CI = 4.1-21.2), and adjustment disorder in 32 (53.3%, 95% CI = 40.1-66.1) cases each. No statistically significant association was observed between DV and any of the psychiatric disorders. However, DVQ scores showed significant correlation with years of marriage (Pearson's r = 0.268, P < 0.05) and with stressful life events over the past 1 year (Pearson's r = 0.424, P < 0.05).

CONCLUSIONS

High rates of DV and psychological morbidity were seen in spouses of alcohol-dependent males.

Multiplicative Effects of Social and Psychological Risk Factors on College Students' Suicidal Behaviors

Less is known about the multiplicative effects of social and psychological risk and protective factors of suicidality on college campuses. The current study aimed to investigate the multiplicative effects of social (identifying oneself as gay/lesbian, financial difficulty, violence victimization, and religiosity) and psychological (anxiety, depression, problem alcohol use, drug use) and risk/protective factors on suicidal behaviors among college students in the United States. Using a cross-sectional design, the Healthy Mind Study (HMS; 2016–2017), is a national online survey of college students in the United States. Social (identifying oneself as gay/lesbian, violence victimization, financial difficulty, and religiosity) and psychological (anxiety, depression, problem alcohol use, and drug use) risk/protective factors were assessed among 27,961 individuals. Three aspects of suicidality, including ideation, plan, and attempt, were also assessed. Logistic regression models were used for data analysis. Financial difficulty, violence victimization, identifying oneself as gay/lesbian, anxiety, depression, and drug use increased, while religiosity reduced the odds of suicidal behaviors. Multiplicative effects were found between the following social and psychological risk factors: (1) financial difficulty and anxiety; (2) financial difficulty and depression; (3) depression and drug use; (4) problem alcohol use and drug use; and (5) depression and problem alcohol use. There is a considerable overlap in the social and psychological processes, such as financial stress, mood disorders, and substance use problems, on risk of suicide in college students. As social and psychological risk factors do not operate independently, comprehensive suicidal risk evaluations that simultaneously address multiple social and psychological risk factors may be superior to programs that only address a single risk factor.