Health Impacts of Violent Victimization on Women and their Children
4. Synthesis and Conclusions
4.1 Summary of evidence
4.1.1 IPV and its impact on women & children’s health
- IPV remains a significant cause of death and injury among Canadian women, with certain groups, in particular Aboriginal women, experiencing more, and more severe forms of, violence.
- Other physical health problems associated with IPV exposure include chronic pain, disability, fibromyalgia, gastrointestinal disorders, irritable bowel syndrome, sleep disorders and general reductions in physical functioning/health-related life quality. Recent analyses indicate that IPV may be associated with cardiac disease.
- In terms of women’s reproductive health, IPV is associated with gynaecological disorders, infertility, pelvic inflammatory disease, pregnancy complications/miscarriage, sexual dysfunction, sexually transmitted diseases, including HIV/AIDS, unsafe abortion, and unwanted pregnancy.
- IPV during pregnancy is associated with femicide, and causing direct harm to the fetus, which can result in pre-term birth or injury and low birth weight.
- Adverse outcomes that result from witnessing IPV in childhood include an increased risk of psychological, social, emotional and behavioral problems including mood and anxiety disorders, and drug abuse and school-related problems in children and adolescents.
- IPV is consistently associated with high rates of depression, anxiety disorders (especially PTSD), protracted disabling sleep disorders, phobias and panic disorder, psychosomatic disorders, and suicidal behaviour and self-harm, eating disorders, substance dependence, antisocial personality disorders, and nonaffective psychosis.
- For Aboriginal women with abuse histories, rates of these conditions, especially depression, may be higher, though Aboriginal women exposed to violence self-rate their health at the same levels as do non-Aboriginal women.
- IPV exposure is associated with health risk behaviours, including alcohol and drug abuse, smoking, unsafe sexual behaviour and physical inactivity
4.1.2 Sexual assault of women
- Most sexual assaults do not result in physical injury however when they do, they may impact reproductive health, including pregnancy and gynaecological complications (vaginal bleeding or infection, fibroids, decreased sexual desire, genital irritation, pain during intercourse, chronic pelvic pain and urinary tract infections), along with sexually transmitted diseases, including HIV infection.
- The mental health consequences of sexual assault mirror those outlined above for IPV, with depression and anxiety, especially PTSD, being most strongly associated with this kind of victimization. Stigmatization may lead to increased rates of suicidal behaviour.
4.1.3 Child sexual abuse
- Exposure to CSA is associated with impairment in a broad range of domains, including mental health, physical health, education, criminal behaviour and interpersonal functioning.
- Sexual abuse of girls is associated with both short- and long-term negative effects on mental health, depending on the severity, persistence, and presence of risk and protective factors, both genetic and environmental.
- CSA is a non-specific risk factor for both internalizing and externalizing disorders in girls and adult women; it is associated with neurobiological dysregulation in both child- and adulthood including alterations in the hypothalamic-pituitary-adrenal (HPA) axis, the sympathetic nervous system and more recently, the immune system.
- CSA has mental health impacts into adulthood. Among adult women, there is strong evidence of significant associations between CSA and depression, PTSD, panic disorder, drug and alcohol dependence and suicide attempts.
4.1.4 Multiple forms of child maltreatment/adverse childhood experiences
- Exposure to multiple forms of child maltreatment results in short-term emotional harm, manifested by such behaviours as bed-wetting, nightmares and social withdrawal.
- Longer-term consequences can include:
- physical health impairment, including chronic obstructive pulmonary disease (COPD), ischemic heart disease (IHD), liver disease, sexually transmitted diseases (STDs), fetal death, and unintended and adolescent pregnancies.
- mental health impairment including depression, suicide attempts, sleep disorders, and health-related quality of life.
- health risk behaviours including alcoholism and alcohol abuse, illicit drug use, risk for intimate partner violence, multiple sexual partners, smoking and early initiation of smoking, and early initiation of sexual activity.
- physical health impairment, including chronic obstructive pulmonary disease (COPD), ischemic heart disease (IHD), liver disease, sexually transmitted diseases (STDs), fetal death, and unintended and adolescent pregnancies.
4.2 Conclusions
There is growing evidence of the strong links between violence against women and children and significant physical and mental health impairment, and risky health behaviours. These are prevalent among children, youth and adults victimized during childhood and/or adulthood. Certain groups, for example Canada’s Aboriginal women, are at increased risk of more, and more severe, violence, and potentially more significant health impacts.
While physical injuries and death form an important sub-set of the health impacts of violence, the more prevalent consequences are longer-term mental health problems, which in turn contribute to health risks as well as increasing the likelihood of being a violent offender or being re-victimized at a later point in time. As well, newer research points to the longer term chronic diseases associated with violent victimization, including gastrointestinal disorders, chronic pain, and cardiac disease.
The present report focused on the burden of suffering of several forms of violence victimization of women and children, in particular the prevalence, incidence and risk factors for these kinds of violence, and their physical and mental health consequences. The report did not endeavour to summarize the literature on health and other (e.g., social service, justice) interventions for these kinds of abuse – i.e., what can be done to prevent them in the first place, or to prevent recurrence or impairment after exposure.
Briefly, while more is known in some intervention areas (i.e., child maltreatment, see MacMillan et al., 2009b), little evidence exists for interventions in others (e.g., IPV, see Wathen & MacMillan, 2003; Ramsay et al., 2009). A full review of interventions is beyond the scope of this report.
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