Intimate partner violence and depression in rural Bangladesh: Accounting for violence severity in a high prevalence setting
Intimate partner violence and depression in rural Bangladesh: Accounting for violence severity in a high prevalence setting
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DOI：
10.1016/j.ssmph.2019.100368
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发表时间：
2019-04-01
影响因子：
4.7
通讯作者：
Bates, Lisa M.
中科院分区：
文献类型：
--
作者：
Esie, Precious;Osypuk, Theresa L.;Bates, Lisa M.
针对妇女的亲密伴侣暴力行为在全球范围内非常普遍，并与不良健康结果，包括抑郁症有关。虽然生活在低收入和中等收入国家（LMIC）的妇女面临更大的IPV负担，但人们对IPV是否会增加非孕妇和高患病率背景下的抑郁风险知之甚少。在孟加拉国农村地区，本研究探讨了婚姻IPV对妇女的严重程度和抑郁风险之间的关系。数据来自一项全国代表性研究，该研究侧重于孟加拉国农村地区16-37岁已婚妇女中IPV的个人和背景决定因素，通过2014年在77个村庄（n=3290）的多阶段分层样本收集。多变量对数二项回归模型被用来估计IPV的严重程度（操作为不同的心理，身体和性虐待行为的频率，以及由于IPV造成的伤害）和使用爱丁堡产后抑郁量表（EPDS）的重度抑郁发作（MDE）的风险之间的关联。六分之一的妇女（16.8%）符合MDE的标准。过去一年IPV是地方性的，心理（77.2%）最常见，其次是性（58.8%）和身体（44.4%）。近三分之一的女性经历过IPV相关的伤害。在最低暴露水平以上，每种类型IPV的严重程度与MDE之间存在正剂量-反应关系。在调整后的模型中，（RR=2.27，95% CI：1.62，3.17），体格检查（RR=2.44，95% CI：1.94，3.08），（RR=1.65，95% CI：1.08，2.52）IPV严重程度与MDE以及IPV相关损伤显著相关（RR=1.72，95%CI：1.23，2.40）。在孟加拉国农村，所有类型的婚姻IPV对妇女的严重程度与MDE的风险增加密切相关。结果表明，在高患病率设置的标准二分IPV指标的效用有限。
Intimate partner violence (IPV) against women is highly prevalent globally, and is associated with adverse health outcomes, including depression. Though women living in low- and middle-income countries (LMICs) face a larger burden of IPV, little is known about whether IPV increases the risk of depression among non-pregnant women and in contexts of high prevalence. Within the setting of rural Bangladesh, this study examined the relationship between the severity of marital IPV against women and the risk of depression.Data were drawn from a nationally-representative study focused on individual and contextual determinants of IPV among married women aged 16-37 years in rural Bangladesh, collected through a multistage, stratified sample in 77 villages in 2014 (n=3290). Multivariable log-binomial regression models were used to estimate the association between the severity of IPV (operationalized as the frequency of different acts of psychological, physical, and sexual abuse, as well as injury due to IPV) and risk of major depressive episode (MDE) using the Edinburgh Postnatal Depression Scale (EPDS).One in six women (16.8%) met the criteria for MDE. Past year IPV was endemic; psychological (77.2%) was most common, followed by sexual (58.8%) and physical (44.4%). Nearly a third of women experienced IPV-related injury. There was a positive dose-response relationship between severity of each type of IPV and MDE above the lowest level of exposure. In adjusted models, the highest levels of psychological (RR=2.27, 95% CI: 1.62, 3.17), physical (RR=2.44, 95% CI: 1.94, 3.08), and sexual (RR=1.65, 95% CI: 1.08, 2.52) IPV severity remained significantly associated with MDE, as well as experiencing IPV-related injury (RR=1.72, 95% CI: 1.23, 2.40).In rural Bangladesh, the severity of all types of marital IPV against women is strongly related to increased risk of MDE. Results suggest the limited utility of standard dichotomous IPV indicators in high prevalence settings.