Association between depression and abuse by partners of women attending general practice: descriptive, cross sectional survey
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《英国医生杂志》
1 Department of General Practice, University of Melbourne, Vic 3053, Australia, 2 Centre for the Study of Mothers' and Children's Health, La Trobe University, Melbourne, Vic 3053, Australia
Correspondence to: K Hegarty k.hegarty@unimelb.edu.au
Abstract
Women experience depression about twice as much as men.1 This difference may be accounted for by women experiencing greater poverty, differing social roles and sex discrimination, more negative life events, and violence and abuse.1 A meta-analysis on the prevalence of mental health problems among women with a history of violence from a partner found that compared with women who had not been abused just under a half of the abused women had clinical depression.2 Data on this subject are limited in the primary care setting.3 4 We therefore explored the association between depression and different types of abuse by a partner in women attending general practice.
Methods
We approached 39 eligible general practitioners. Five of these had moved practice and four refused to participate, giving a response rate of 77%. Participants differed from the Australian general practitioner population in that more were female (18, 60%), worked part time (13/27, 48%), and had graduated recently (17, 59%).
Overall, 133 (7.0%) female patients had previously attended and 141 of 1896 patients aged 16-50 years were excluded because they were accompanied by a partner (62), were too ill (31), had comprehension or motor problems (22), were non-English speakers (16), or had difficulty seeing or hearing (10). Overall, 1257 (77.5%) eligible women completed the questionnaire, 66 (4.1%) were missed, and 299 (18.4%) refused. Most of the 1257 patients attended for themselves (868, 69.1%) and 1210 (96.3%) had been in an adult intimate relationship (table 1). When we compared the quintile percentages of index of relative socioeconomic disadvantage, fewer women were represented with the combination of low income, limited training, and unskilled occupations.
Table 1 Characteristics of women attending general practice who had ever been in an intimate relationship as an adult compared with females in Australian population
Prevalence
Depression
On a general question about depression, 543 of 1227 (44.3%) women reported ever experiencing depression lasting more than two weeks. Most (417, 76.8%) had ever told a general practitioner about that depression, of which two thirds (273, 65.5%) had told the participating general practitioner. For current mood (last week), 218 of 1213 (17.9%) women scored as probably depressed on the Beck depression inventory or Edinburgh postnatal depression scale.
Abuse by partner
One third (437/1173, 37.3%) of participants who had ever been in an adult intimate relationship stated that they had ever experienced some form of abuse. One third of these (142/417, 34%) had ever told a general practitioner about that abuse, of which one third (49/140, 35%) had told the participating general practitioner, and one in five (81/411, 20%) had ever been asked by a general practitioner. One quarter (277/1147, 24.1%) of participants scored as having experienced some type of abuse on the composite abuse scale in the past 12 months of a current or previous relationship. Severe combined abuse was experienced by 8.8% (101) of women, physical and emotional abuse or harassment by 5.7% (65), physical abuse alone by 7.1% (82), and emotional abuse or harassment alone by 2.5% (29).
Association with depression
Compared with women who were not depressed, those who scored in the probably depressed range were more likely to be unmarried, on a pension or low income, receiving benefits, unemployed, or to have had a poorer education (table 2). Probably depressed women were much more likely to have experienced some form of abuse (physical, emotional, or sexual) as a child (odds ratio 3.0, 95% confidence interval 2.1 to 4.2), and this remained significant (2.0, 1.3 to 2.9) when adjusted for sociodemographic variables, physical health (SF-36), and intimate partner abuse as an adult. Furthermore, probably depressed women were more likely to have experienced partner abuse, particularly severe combined abuse (8.0, 4.8 to 13.0) and physical and emotional abuse or harassment (8.1, 4.4 to 15.0; table 2). Even when these values were adjusted for all other variables, multidimensional measures of partner abuse remained highly associated with probable depression, with the magnitude of the effect being large (table 2).
Table 2 Association between probable depression and abuse by partner, abuse as a child, and sociodemographic factors for women attending general practice who had ever been in an intimate relationship as an adult (n=1210). Values are numbers (percentages) unless stated otherwise
What is already known on this topic
The association between depression and partner abuse is strong for women
Limited data are available from studies in primary care
Most studies have concentrated on physical violence
What this study adds
Physical, emotional, and sexual abuse is a strong predictor of probable depression
Researchers should measure partner abuse in longitudinal and intervention depression studies
Doctors should consider partner abuse in women with depression
Discussion
Astbury J, Cabral M. Women's mental health: an evidence based review. Geneva: World Health Organization, 2000.
Golding J. Intimate partner violence as a risk factor for mental disorders: a meta-analysis. J Fam Violence 1999;14: 99-132.
Coid J, Petruckevitch A, Chung W, Richardson J, Feder G. Abusive experiences and psychiatric morbidity in women primary care attenders. Br J Psychiatry 2003;183: 332-9.
McCauley J, Kern DE, Kolodner K, Smith J. The "battering syndrome": prevalence and clinical characteristics of domestic violence in primary care internal medicine practices. Ann Intern Med 1995;123: 737-46.
Hegarty K, Bush R. Prevalence of partner abuse in women attending Australian general practice: a cross-sectional survey. Austr NZ J Public Health 2002;26: 437-42.
Katon W, Schulberg H. Epidemiology of depression in primary care. Gen Hosp Psychiatry 1992;14: 237-47.
Hegarty, KL, Sheehan M, Schonfeld C. A multidimensional definition of partner abuse: development and preliminary validation of the composite abuse scale. J Fam Violence 1999;14: 399-414.
Dowrick C. Does testing for depression influence diagnosis or management by general practitioners? Fam Pract 1995;12: 461-5.
Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh postnatal depression scale. Br J Psychiatry 1987;150: 782-6.
Boyce P, Stubbs J, Todd A. The Edinburgh postnatal depression scale: validation for an Australian sample. Austr NZ J Psychiatry 1993;27: 472-6.(Kelsey Hegarty, senior le)
Correspondence to: K Hegarty k.hegarty@unimelb.edu.au
Abstract
Women experience depression about twice as much as men.1 This difference may be accounted for by women experiencing greater poverty, differing social roles and sex discrimination, more negative life events, and violence and abuse.1 A meta-analysis on the prevalence of mental health problems among women with a history of violence from a partner found that compared with women who had not been abused just under a half of the abused women had clinical depression.2 Data on this subject are limited in the primary care setting.3 4 We therefore explored the association between depression and different types of abuse by a partner in women attending general practice.
Methods
We approached 39 eligible general practitioners. Five of these had moved practice and four refused to participate, giving a response rate of 77%. Participants differed from the Australian general practitioner population in that more were female (18, 60%), worked part time (13/27, 48%), and had graduated recently (17, 59%).
Overall, 133 (7.0%) female patients had previously attended and 141 of 1896 patients aged 16-50 years were excluded because they were accompanied by a partner (62), were too ill (31), had comprehension or motor problems (22), were non-English speakers (16), or had difficulty seeing or hearing (10). Overall, 1257 (77.5%) eligible women completed the questionnaire, 66 (4.1%) were missed, and 299 (18.4%) refused. Most of the 1257 patients attended for themselves (868, 69.1%) and 1210 (96.3%) had been in an adult intimate relationship (table 1). When we compared the quintile percentages of index of relative socioeconomic disadvantage, fewer women were represented with the combination of low income, limited training, and unskilled occupations.
Table 1 Characteristics of women attending general practice who had ever been in an intimate relationship as an adult compared with females in Australian population
Prevalence
Depression
On a general question about depression, 543 of 1227 (44.3%) women reported ever experiencing depression lasting more than two weeks. Most (417, 76.8%) had ever told a general practitioner about that depression, of which two thirds (273, 65.5%) had told the participating general practitioner. For current mood (last week), 218 of 1213 (17.9%) women scored as probably depressed on the Beck depression inventory or Edinburgh postnatal depression scale.
Abuse by partner
One third (437/1173, 37.3%) of participants who had ever been in an adult intimate relationship stated that they had ever experienced some form of abuse. One third of these (142/417, 34%) had ever told a general practitioner about that abuse, of which one third (49/140, 35%) had told the participating general practitioner, and one in five (81/411, 20%) had ever been asked by a general practitioner. One quarter (277/1147, 24.1%) of participants scored as having experienced some type of abuse on the composite abuse scale in the past 12 months of a current or previous relationship. Severe combined abuse was experienced by 8.8% (101) of women, physical and emotional abuse or harassment by 5.7% (65), physical abuse alone by 7.1% (82), and emotional abuse or harassment alone by 2.5% (29).
Association with depression
Compared with women who were not depressed, those who scored in the probably depressed range were more likely to be unmarried, on a pension or low income, receiving benefits, unemployed, or to have had a poorer education (table 2). Probably depressed women were much more likely to have experienced some form of abuse (physical, emotional, or sexual) as a child (odds ratio 3.0, 95% confidence interval 2.1 to 4.2), and this remained significant (2.0, 1.3 to 2.9) when adjusted for sociodemographic variables, physical health (SF-36), and intimate partner abuse as an adult. Furthermore, probably depressed women were more likely to have experienced partner abuse, particularly severe combined abuse (8.0, 4.8 to 13.0) and physical and emotional abuse or harassment (8.1, 4.4 to 15.0; table 2). Even when these values were adjusted for all other variables, multidimensional measures of partner abuse remained highly associated with probable depression, with the magnitude of the effect being large (table 2).
Table 2 Association between probable depression and abuse by partner, abuse as a child, and sociodemographic factors for women attending general practice who had ever been in an intimate relationship as an adult (n=1210). Values are numbers (percentages) unless stated otherwise
What is already known on this topic
The association between depression and partner abuse is strong for women
Limited data are available from studies in primary care
Most studies have concentrated on physical violence
What this study adds
Physical, emotional, and sexual abuse is a strong predictor of probable depression
Researchers should measure partner abuse in longitudinal and intervention depression studies
Doctors should consider partner abuse in women with depression
Discussion
Astbury J, Cabral M. Women's mental health: an evidence based review. Geneva: World Health Organization, 2000.
Golding J. Intimate partner violence as a risk factor for mental disorders: a meta-analysis. J Fam Violence 1999;14: 99-132.
Coid J, Petruckevitch A, Chung W, Richardson J, Feder G. Abusive experiences and psychiatric morbidity in women primary care attenders. Br J Psychiatry 2003;183: 332-9.
McCauley J, Kern DE, Kolodner K, Smith J. The "battering syndrome": prevalence and clinical characteristics of domestic violence in primary care internal medicine practices. Ann Intern Med 1995;123: 737-46.
Hegarty K, Bush R. Prevalence of partner abuse in women attending Australian general practice: a cross-sectional survey. Austr NZ J Public Health 2002;26: 437-42.
Katon W, Schulberg H. Epidemiology of depression in primary care. Gen Hosp Psychiatry 1992;14: 237-47.
Hegarty, KL, Sheehan M, Schonfeld C. A multidimensional definition of partner abuse: development and preliminary validation of the composite abuse scale. J Fam Violence 1999;14: 399-414.
Dowrick C. Does testing for depression influence diagnosis or management by general practitioners? Fam Pract 1995;12: 461-5.
Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh postnatal depression scale. Br J Psychiatry 1987;150: 782-6.
Boyce P, Stubbs J, Todd A. The Edinburgh postnatal depression scale: validation for an Australian sample. Austr NZ J Psychiatry 1993;27: 472-6.(Kelsey Hegarty, senior le)