Sexual assault, domestic violence can damage long-term mental health

(Health.com) -- Women are drastically more likely to develop a mental disorder at some point in their lives if they have been the victim of rape, sexual assault, stalking, or intimate-partner violence, according to a new study in the Journal of the American Medical Association.


While the connection between these harrowing experiences and poor mental health is hardly surprising, experts say the new findings highlight just how strongly the two problems are intertwined -- and how important it is for doctors and other health-care workers to ask women about past episodes of violence, even if they happened years ago.

"When professionals are treating women with depression or mental health issues, it's best to be clued in to the fact that violence might be behind [it]," says Andrea Gielen, Sc.D., director for the Center for Injury Research and Policy at Johns Hopkins University, in Baltimore, who was not involved in the study.

Researchers in Australia analyzed health data from a nationally representative sample of Australian women between the ages of 16 and 85. Episodes of sexual assault, stalking, and other "gender-based violence" were all too common, with 27% of the group reporting at least one episode of abuse.

Fifty-seven percent of the women with a history of abuse also had a history of depression, bipolar disorder, post-traumatic stress, substance abuse, or anxiety (including panic disorder and obsessive-compulsive disorder), versus 28% of the women who had not experienced gender-based violence.

Among women who had been exposed to at least three different types of violence, the rate of mental disorders or substance abuse rose to 89%.

"The extent and strength of the association we found was surprising and very concerning," says lead author Susan Rees, Ph.D., a senior research fellow in psychiatry at the University of New South Wales, in Sydney.

Rees and her colleagues can't say for sure whether the mental health problems in the study were triggered by the violence, or whether women with preexisting mental health issues were more likely to experience violence. (They did, however, control for a range of potential mitigating factors, including socioeconomic status and a family history of psychiatric problems.)

But there is "ample evidence" that traumatic events -- especially interpersonal traumatic events, such as domestic abuse -- can trigger mental problems, Rees says.

Moreover, she adds, episodes of gender-based violence often occur very early in life, whereas mental disorders often don't surface until years later.

Rates of gender-based violence in the U.S. and Australia are comparable, so a study of this kind conducted in the U.S. would likely yield similar results, Rees says. Roughly one-fifth of women in the U.S. say they have experienced intimate-partner violence (which includes domestic abuse), stalking, or both, and 17% say they have been victims of rape or attempted rape, according to the study.

The findings drive home that violence against women is a major public health concern.

"It underscores the impact on society as more than just the immediate consequences, more than just treating women in an emergency department for a violent injury," Gielen says.

Mental health specialists and providers of women's health services should collaborate and develop a unified approach to more effectively screen and treat mental health problems in women who have experienced violence, Rees and her colleagues say.

The U.S. has already taken a promising step in this direction, Gielen says. On Monday, the U.S. Department of Health and Human Services issued new guidelines for preventive care for women that, among other things, require all new health plans to offer no-cost domestic-violence screenings to women beginning in August 2012.

"Almost every public health organization in the country recommends screening for violence, so we're in a really good situation to really move forward," Gielen says. "The big challenge, though, is to work toward what happens after screening: How do we make [screenings] maximally effective, to make sure they really help women?"

Those questions may soon be addressed in the federal Violence Against Women Act, which is up for reauthorization this year. The renewal of the law may provide opportunities for grants, community interventions, and training programs for mental health professionals, Gielen says.

"I think this study really sets up a very hopeful future for providing help to these women who really need it," she says.

Copyright Health Magazine 2010

Generational Poverty and Trauma

  NOTE: Please be aware that for the sake of creating an understanding of some of the issues that pertain to trauma survivors who have grown up in poverty, I will be making some generalized statements. It is very important to know the survivor as an individual with specific issues that may be due to growing up in a specific culture and may not necessarily meet all the characteristics of that culture.


Many of the survivors who seek shelter from domestic violence programs have grown up in generational poverty. Ruby Payne, author of “A Framework for Understanding Poverty” defines generational poverty as families who have lived in poverty for at least two generations, meaning children of parents in poverty grow up to live in poverty themselves. By contrast, families in situational poverty have fallen into poverty because of a traumatic event such as illness or divorce. She writes that families in generational poverty form their own culture with different values, habits and lifestyles from families in the middle class.

Persons who grow up in generational poverty have different values regarding money, different communication styles, and perceive the world based on their own experience. Someone who has grown up in pervasive poverty may not have had resources available with which to develop skills with which they could move out of poverty. These resources include financial means and support systems that can assist the person in moving out of poverty. Trauma also impacts the ability of a person to move out of poverty. Those skills which are necessary in order to maintain safety and survive in a culture of poverty and trauma are primary, while other developmental milestones or skills may not be nurtured and enhanced.

In the following chart I present information based on Ruby Payne’s work but also add in the component of growing up with trauma. It shows the values involved in decision making, conflict resolution, financial decision, and meeting new people and describes the world view of people who have grown up in generation poverty, middle class, wealth, and/or a culture of trauma.

Generational Poverty
Decision Making - Decisions made based on needs of entertainment and relationships


Conflict Resolution - Ability to fight or have someone who is willing to fight for you.

Money - Money is for entertainment and relationships.

World View - The world is what is locally around you.

Meeting New People - Comments are usually made about you before you are introduced to others.


Middle Class

Decision Making - Decisions are made related to work and achievement.


Conflict Resolution - Able to use words as tools to negotiate conflict.

Money - Money is for security and is saved. .

World View - The world is your own nation.

Meeting New People - You introduce yourself to others.

Wealth

Decision Making - Ramifications of the financial, social, and political connections are important to decision making.


Money - Money is for security and is usually invested.

World View - The world is international.

Meeting New People - Someone in the group formally introduces you.

Trauma

Decision Making - Decisions are based on safety


Conflict Resolution - Fight, flight or freeze

Money - The future is improbable. Much has been lost in the past and it is anticipated that loss will occur again. Spending decisions are based on anticipated loss.

World View - The world is unpredictable and limited.

Meeting New People - If I don’t trust you, I won’t talk to you unless I need something from you.



When working with someone who has experienced trauma and poverty it is important not to judge them or have the expectation that they will make decisions the same way that you would if you have not grown up in poverty or with trauma. For example, given that a person has grown up in poverty and trauma she may make a decision to spend an income tax return on entertainment or items needed at this moment rather than saving for the future. For a trauma survivor, given that so much has been lost in the past and that the victim has often felt she is living on borrowed time, saving for a future that may not occur is not considered. By imposing our values on the person we are at risk of alienating her.  It is best to recognize the difference in values and understand that as a domestic violence advocate you need to work within the values of the person for whom you are advocating.

I invite you to have discussions at your workplace that take into consideration the impact of generational poverty and trauma and work toward a greater understanding of the dynamics that occur in the decision making process and communication styles for persons who have not had the resources to be able to move beyond poverty and trauma.