Introduction
Intimate partner violence (IPV) is a serious public health issue that primarily affects 25% of women, which accounted for 20% of all violent crimes in the United States [
1,
2]. It can negatively impact IPV survivors and their families physically, psychologically, and financially. IPV is associated with a myriad of poor physical and mental health outcomes, such as hypertension, diabetes [
3], HIV/AIDS [
4], cardiovascular diseases [
5], post-traumatic stress disorder, anxiety, and suicidal ideation [
6], which are potentially devastating.
Specifically, in the state of Pennsylvania, 37.1% of women and 30.4% of men, experience either physical, sexual, or psychological violence in their lifetime [
7]. IPV survivors often experience negative physical, and emotional impacts, such as acute illnesses like respiratory and urinary tract problems, and chronic disorders like migraines and gastrointestinal diseases [
8]. It has been found that women who have experienced IPV are more likely to have poor health such as overweight, substance abuse and eating disorders [
9]. In addition to physical health, IPV survivors often report negative mental health outcomes. McManus et al., [
10] found that 50% of those who had attempted suicide in the past year had experienced IPV, and 31–84% of IPV survivors had posttraumatic stress disorder [
11].
Besides IPV survivors suffering from poor health outcomes, the current state of IPV help-seeking is also challenging. Kanougiya et al. analyzed two national surveys of IPV from 2005 to 2006 and 2015–2016, found that the incidence of physical and emotional IPV increased between the two surveys, however formal or informal help-seeking had declined [
12]. According to recent single-day statistics retrieved in 2020, due to lockdown and quarantine policy during the COVID-19 pandemic, only an estimated 2,574 survivors had sought help from the state violence prevention programs, in which 198 (7.6%) help-seeking requests went unmet due to inadequate resources provided [
13]. However, compared to previous years, the incidence of IPV increased by more than 1.8 times during COVID-19, with sexual and physical violence rising sharply [
14].. The most common sources of help-seeking for IPV survivors come from informal resources such as family or friends, rather than formal resources such as police or medical professionals [
15]. Less than 10% of IPV survivors exposed to severe forms of violence reported receiving formal help services [
16]. It could be related to fear of embarrassment, stigma, concern about receiving accusations, distrust of the justice system or insufficient resources to seek help from IPV [
17]. Therefore, exploring the association between IPV experience, help-seeking experiences, and psychological state is necessary to inform local and state-wide policy tailor-made for the IPV population.
Previous research has examined the negative mental health outcomes of IPV survivors through qualitative and quantitative studies, including representative national surveys. Gilbert et al., [
18] used National Intimate Partner Violence Survey (NISVS) data from 2010 to 2012 with (
N = 411,742) to investigate IPV and health condition among U.S. adults. Their results showed a correlation between the intensity of IPV experienced and a subsequent deterioration in mental health status. Cho et al., [
9] analyzed the relationship between physical health outcomes and IPV using the NISVS, with no in-depth exploration of mental health conditions. Similarly, Alroy et al., [
19] used New York City Community Health Survey data to analyze the prevalence of IPV, health status and behaviors, which found that adults who had experienced psychosocial IPV had a higher prevalence of not getting the treatment they needed for their mental health problems and perceived poorer health status. However, these studies were cross-sectional surveys and there was no causal analysis between IPV and psychological condition. Hui et al., [
20] has examined that IPV survivors of sexual violence experience have higher odds of receiving less emotional support and poor health outcomes based on the 2007 Behavioral Risk Factor Surveillance System (BRFSS) survey. Edwards et al., [
21] also explored the association between psychological distress and IPV from the same cohort of the BRFSS survey, and found that 15.4% of women with IPV who reported experiences of physical and sexual behavior suffered serious psychological distress. Given that BRFSS removed IPV and psychological distress modules after 2007, there is a paucity of national or locally representative studies to explore further the association between psychological distress and help-seeking experiences among people with IPV experiences in the past decade. Without addressing this knowledge gap, developing evidence-based community support to address such deficiencies among the IPV population will likely remain uncertain. Therefore, the overarching goal of this study is to explore the association between psychological distress, abusive experiences, and help-seeking among people with IPV based on the 2015 Allegheny County Health Survey.
Discussion
The World Health Organization [
32], the World Psychiatric Association [
33], and the U.S. Centers for Disease Control (CDC) [
34] have identified IPV as a major target for prevention and intervention due to its high prevalence and significant negative impacts. Because psychological distress can be a sequela of IPV, this is a critical issue for mental health professionals [
35]. This study analyzed the relationship between abusive experiences among people with IPV and psychological distress using data from the 2015/16 ACHS with
N = 8,012 participants. The study reported that the experiences of violence were significantly associated with feelings of psychological stress among survivors, such as hopelessness, restlessness or fidgeting, worthlessness and that everything was an effort.
This study found that people who have IPV experience presented psychological distress such as nervousness, hopelessness, depression, and that everything was an effort. The results of this study were consistent with previous studies that IPV experiences have a direct impact on psychological distress [
36‐
38]. Studies [
39,
40] have shown that when trauma stemmed from interpersonal violence in an intimate relationship, it had a greater negative impact on a person’s mental health and may lead to post-traumatic stress symptoms as well as alterations in person’s emotion regulation, interpersonal relationships, and self-perceptions, especially when the violent behaviors were perpetrated by someone the victim trusted. Psychological problems are more prevalent in women with IPV than in the general population, with a weighted mean prevalence of depression of 48% among women experiencing IPV, compared with a lifetime prevalence of depression of 10–20% in the general population [
41]. The isolation caused by IPV could weaken individual’s self-esteem, thereby triggering a sense of worthlessness and further deepening the depressive symptoms and anxiety of IPV survivors [
41].
In this study, the specific behaviors of IPV included hitting, slapping, punching, shoving, choking, kicking, shaking, or other physical injury. This study found that when people experienced these specific physical IPV, they felt 2.76 times higher odds of presenting psychological stress of restlessness or fidgeting than those who did not have these experiences. And among those who suffered unwanted sexual behaviors, the odds of exhibiting worthlessness were 2.47 times higher relative to people who did not experience such violations. This result was consistent with the findings of Cohen et al. (2022) [
42] that identified associations between IPV experiences and psychological distress of worthlessness. The possible explanation the link between IPV and psychological distress was that fear and trauma of the abuser may amplify the psychological effects even beyond the onset of physical violence. The IPV survivors may continue to feel unworthy, helpless, or mentally stressed as this fear continues to be exposed to the abuser’s coercive control, even after the violent incident has ended. This prolonged fear and control may maintain higher levels of psychological stress in IPV survivors compared to non-abused individuals [
19]. Simultaneously, barriers to accessing mental health treatment, such as lack of health insurance, low self-esteem, and low self-efficacy, may further increase the psychological stress of people with IPV experience [
43].
This study also found that people who sought help from IPV hotline or program after IPV experience had higher levels of hopelessness and restlessness or fidgeting than those who did not seek help. One of the possible reasons for this was that IPV survivors with high psychological distress might have higher odds of seeking help to get support to reduce the negative impacts of IPV, such as lowering mental health challenges and reducing stress [
44]. Another reason could be because some feared police involvement and contacting law enforcement increased their psychological stress, anxiety, and self-blame [
45]. Or it might be caused by racial prejudice, gender discrimination, oppression or other socio-economic factors after the help has been sought [
46]. For example, a study has found that Latino adults who have experienced IPV might face additional barriers when seeking social help, including cultural, socio-economic, and legal barriers [
46]. Therefore, it is important to understand the help-seeking behaviors and experiences among survivors from different cultural backgrounds before devising a supportive and helpful help-seeking platform, especially as many IPV survivors face barriers to accessing technology. For example, utilizing an online platform that are anonymous, safe and convenient may contribute to positive help-seeking experiences [
47].
IPV is a serious public health issue and a leading cause of nonfatal injuries to people in the United States [
48]. Despite its high prevalence and serious health consequences, IPV remains largely underreported. This may be partly attributed to embarrassment and stigma barriers that deter or delay survivors from formal help-seeking. Therefore, psychiatric healthcare providers and mental health professionals should be trained to adopt an interpersonal and holistic approach that involves ethical and humane aspects and is the basis for targeted assistance to victims of violence, with a focus on strengthening and empowering people with IPV experiences, rather than only relieving the pain and treating the symptoms and illnesses resulting from the abuse suffered [
49]. After identifying IPV, they should participate in documenting the process, working as a team, referring the case to existing intersectoral networks, and ensuring the protection of legal, human, sexual, and reproductive rights, as well as the principles of non-judgment and respect for individual’s decisions, with a focus on communication and assistance [
50].
This study revealed the relationship between IPV experiences, help-seeking experiences, and psychological stress. This study’s finding that not only was IPV experience associated with psychological distress, but that help-seeking after IPV was associated with greater distress is important for future research on potential barriers to help-seeking among marginalized groups, which has been less revealed in previous studies. However, several limitations should be considered to interpret the findings of this study. First, the data was obtained from the ACHS, where the IPV modules were not compulsory to answer, thus resulting in some missing data. Due to the specificity of the psychological distress and IPV experience, we chose to delete the sample data for the missing data rather than using statistical methods for interpolation. It might have reduced statistical power by lowering the sample size available for analysis, and the results needs to be interpreted with caution. Second, uncertainty in observed causality due to lack of control for potential confounding variables. In future studies, controlling for potential confounding variables is important to isolate the effects of IPV on psychological health of victims. Thirdly, because the IPV questionnaire used by the ACHS only covered frightened IPV, physical IPV, unwanted sex and help-seeking experiences, we were not able to analyze psychological IPV, which was also very important. Furthermore, although significant associations were found between IPV and psychological distress, the summarized methods we used, the granularity changes from 5 to dichotomous variables may not fully capture the nuances or clinical levels of mental health symptoms. Finally, the cross-sectional nature of the survey data limited the analysis of temporality between IPV survivors and the psychological distress of help-seeking. As the questions assessed exposure to experiences of IPV and psychological distress, we were unable to establish a causal relationship between psychological distress and help-seeking. Further temporal measurement studies are needed to clarify the relationship between IPV experience, help-seeking and psychological distress.
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