Depression is highly correlated with domestic violence. Physical, emotional, and sexual abuse experienced or observed can traumatize mental wellbeing; for this reason, it is not surprising that high rates of depression or depressive symptoms are documented in the victim, perpetrator, and witness of abuse. When treating depression, therefore, it is necessary to provide an integrated, comprehensive approach that considers the potential for family violence.
Depression and the Victim
Victims of domestic violence experience harm beyond that of the actual battering. Abused and battered women are significantly more likely than non-victims to suffer from major depression, alcohol and substance abuse, generalized anxiety, posttraumatic stress disorder, and obsessive-compulsive disorder. The trauma-related effects are intensified when the abuser is someone the victim depends on, loves, or trusts.
Depression is a significant mental health problem for women because of its prevalence, persistence, recurrence, and interference with well-being and performance of everyday activities. Women classified as depressed are six to seven times more likely to have experienced severe partner abuse than women who are not classified as depressed (Hegarty et al. 2005). High levels of abuse increase risk for depression and anxiety over the life span. Conversely, a decrease in actual or threatened abuse among victims of domestic violence is associated with a lowered prevalence of depression (Kernic et al. 2003).
It is essential that professionals providing care to at risk populations recognize the mounting evidence associating depression with domestic violence. Appropriate therapeutic and precautionary intervention should then be made available to prevent potentially life-threatening situations. Doctors should be alert to the serious possibility of partner abuse whenever they are treating a patient with depressive symptoms. Time and patience need to be dedicated to probing the patient’s social context to identify the cause of the depression or depressive symptoms rather than just prescribing psychoactive medications that merely mitigate symptoms or obscure the root causes. Furthermore, treating only the symptoms of depression experienced by a victim of abuse reinforces the belief that the fault, and therefore the fix, is within the victim instead of within the abusive situation.
Failure to recognize the underlying social context for depressive symptoms can lead to increased risk of injury and deepening depression for the victim. Prescribing sedatives, tranquilizers, or antidepressants for a woman who is in a dangerously abusive or battering situation can dull the reflexes and senses she needs to protect herself (Fischbach and Herbert 1997). She must be fully alert to take safety precautions for herself and her children and, if necessary, to make and carry out an escape plan to get to a safe shelter.
High rates of depressive symptoms are found also in specific populations at risk for family and partner violence, such as the elderly, same-sex partners, adolescents in dating relationships, pregnant women, and children in abusive homes. The elderly may be at increased risk for depressive symptoms because of declining financial resources or deteriorating health, but when compounded with violence, abuse, or neglect from caregivers or family members, elderly persons consistently show severe signs of depression and anxiety (Dyer et al. 2000). Homosexual couples often are at increased risk for depression due to internalized homophobia and reactions to other social pressures; this stress may contribute to the depressive context in same-sex intimate partner violence (Goglucci 1999). Adolescents involved with an abusive partner report increased levels of depressed mood, substance use, antisocial behavior, and, in females, suicidal behavior (Roberts et al. 2003). Similarly, pregnant women are at risk for increased violence during pregnancy: It is estimated that one in five women will be abused during pregnancy (Weiss 2005). Being victimized while pregnant is associated with depression during pregnancy as well as severe postpartum depression (Jasinski 2004).
Recognizing that depression can be both a cause and a result of domestic violence should encourage the victims to make changes in their living arrangements that will lead to improvements in their sense of health and mental well-being. As a cause of violence, the despondency of a depressed victim may provoke the batterer, which can trigger further mistreatment. This in turn can result in deepening the victim’s depression, leading to a paralyzing inability to make lifesaving choices that would preserve her physical and emotional well-being.
Depression and the Batterer
Perpetrators of domestic violence also often exhibit high rates of depression and depressive symptoms. Interviews with the partners of patients who are seen in emergency rooms for signs and symptoms of abuse have shown that risk factors for perpetrating intimate partner violence include current depression, as well as race, living with a partner, and substance abuse (Lipsky et al. 2005). The majority of abusers surveyed by Stith et al. (2004) reported depression, alcoholism, or drug addiction at the time of committing an abusive act. Understanding that the abusers often show high levels of depression may be useful to health care professionals in identifying perpetrators of domestic violence, especially in primary care or emergency room settings.
Evidence indicates that depression brought on by stressful life events may also be connected to an increased risk of being a batterer, even in relationships that previously were free from physical confrontation. For example, in the period leading up to and during separation and divorce, new instances of violence, as well as increased violence, are reported (Toews 2003). In times of high stress where depressive symptoms could be expected, e.g., during natural disasters or prolonged unemployment, women are at increased risk for physical abuse from their partners (Norris 2005).
Though females are less likely than males to be perpetrators of intimate partner violence, abusing females are nonetheless also found to show high levels of depression. In Watson’s study of ten female perpetrators, 50 percent of the women had histories of major depression, post-traumatic stress disorder, or substance abuse (Watson 2001).
While some argue that the high correlation and temporal relationship of depression with domestic violence suggest a causal relationship, others are concerned that blaming depression for the violent or abusive acts reduces the batterer’s accountability. They posit that most men who batter their partners and children do not exhibit generalized violence outside of their domestic relationships, even when depressed or under stress. This suggests that partner violence is a pattern of control that includes verbal and physical abuse, threats, psychological manipulation, and sexual coercion, rather than random, isolated acts of violence caused by depression or mental illness (Adams 2003).
Depression and the Witness
Estimates of the number of children who observe domestic violence perpetrated against their mothers range from 3.3 million to 10 million children every year. This engenders grave consequences because witnessing domestic violence, like directly experiencing it, also predicts depression. There is increasing evidence that a child who is exposed to domestic violence against his or her mother is more likely to experience depression, behavior problems, and physical complaints (Wolf 2002). These children are affected in ways similar to children who are abused, revealing signs of helplessness, powerlessness, and conflicting feelings toward the perpetrator. Younger children exhibit higher emotional and psychological distress than older children, suggesting that they have not developed critical coping skills for their age. These early traumatic observations can handicap children when they need to deal with future problems, putting them at risk for depression throughout their lives.
Internalized depressive feelings of powerlessness and helplessness in child witnesses of family violence can appear in adolescence as extreme and dangerous behaviors such as drug and alcohol abuse, truancy, and sexual promiscuity (Herrera 2002). Female adolescents who witnessed battering against their mothers tend toward depression and internally destructive behaviors with an increased risk of suicide. Male adolescents are likely to exhibit depression and other psychological stresses through violent and aggressive outlets. Those who witnessed domestic violence as children continue to exhibit high levels of depressive symptoms as adults (Reinherz et al. 2003).
Observing even a threat of violence can have the same potent consequences as witnessing violent acts against another. Research examining the negative psychological impact of childhood exposure to family violence has found that observed threats of violence and current heavy drinking were the most potent predictors of depression in women. Among men, observing threats of violence predicted current heavy drinking, while directly experiencing violence predicted depression and also put the men at risk for perpetrating violent behavior in their own future relationships (Trocki and Caetano 2003).
Recognizing the intergenerational cycle of abuse and depression among victims, batterers, and witnesses means that domestic violence cannot be regarded as a private matter. Domestic violence perpetuates itself with devastating effects on individuals as well as on society.
Depression is regarded as one of the world’s leading mental health problems. In addition to impairing patient well-being, depression imposes a significant societal burden in terms of both direct costs (e.g., for treatment) and indirect costs (e.g., absenteeism, lost productivity, and increased risk for other medical illnesses). The alarming prevalence of depression among victims, perpetrators, and witnesses of domestic violence demands continuing epidemiological study to substantiate the causal relationship and to direct health professionals to examine social factors when treating the symptoms of depression. Psychoactive medication should be prescribed with care so as not to jeopardize the ability of victims of violence to protect themselves. The consequences of domestic violence are urgent public health challenges that require a strong societal commitment to providing the expertise, resources, and services to treat, intervene, and free victims from the destructive intergenerational cycles of violence and depression.
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