Trajectories of Depression, Post-Traumatic Stress, and Chronic Pain Among Women Who Have Separated From an Abusive Partner: A Longitudinal Analysis

Abstract

This longitudinal study explored changes in women's health after separation from an abusive partner by characterizing the trajectories of their mental health (depression and post-traumatic stress disorder [PTSD]) and physical health (chronic pain) over a 4-year period. We examined how the severity of intimate partner violence (IPV) affected these trajectories, controlling for selected baseline factors using 5 waves of data collected from a community sample of 309 English-speaking, Canadian women. IPV severity was measured using the Index of Spouse Abuse where women were asked to consider the entire period of their partner relationship up to present at wave 1 and to rate their IPV experiences in the previous 12 months at waves 2-5. Mental health was measured using established self-report measures of depression (CESD) and PTSD (Davidson Trauma Scale), while chronic pain was measured using the Chronic Pain Grade Scale. Trajectories were estimated using MLM techniques with severity of IPV and selected co-variates (time since separation, age, financial strain) included. Our results show that women's health improved significantly over time, although significant levels of depression, PTSD symptoms and disabling chronic pain remained at the end of wave 5. Regardless of time since separation, more severe IPV was associated with higher levels of depression, PTSD, and disabling chronic pain, with IPV having a stronger effect on these health outcomes over time, suggesting cumulative effects of IPV on health. The results of this study contribute to quantifying the continuing mental and physical health burdens experienced by women after separation from an abusive partner. Increased attention to the long-term effects of violence on women's health beyond the crisis of leaving is critically needed to strengthen health and social services and better support women's recovery and healing.

Cultural collectivism, intimate partner violence, and women's mental health: An analysis of data from 151 countries

“…The presence of depression in a victim of IPV may further increase vulnerability to further IPV, creating a vicious cycle that is often difficult to break (Mazza et al, 2021 ). The traumatic effects of IPV may persist for several years even after separation from an abusive spouse or partner, leading to chronic or recurrent depression (Ford-Gilboe et al, 2023 ).…”

Structural and construct validity of the Quality of Life Scale among Canadian women with histories of intimate partner violence

“…The consequences of IPV include more than visible physical injuries, but often extend to long-term effects on women's mental and physical health, relationships, living conditions, finances, and safety for themselves and for their families. 19,[68][69][70] The ability to measure different aspects of women's life quality has the potential to yield more comprehensive and appropriate assessment, while enhancing understanding about the differential impacts of IPV on the many different facets of women's lives. Both Sullivan's QOL Scale and the WHOQOL measures tap a broad number of domains; as previously noted, each scale has evidence supporting its reliability and validity and has been used in studies of women experiencing IPV.…”

Long-Term Recovery from Intimate Partner Violence: Recovery and Hope

“…The focus of intervention studies has recently turned to long-term recovery [ 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. Women in long-term recovery have significantly different needs to their needs at the time of leaving; with pervasive health, mental health, financial, and social impacts manifesting over time [ 23 , 27 , 28 , 29 ]. Research attention has become firmly focused on determining how to measure the effectiveness of interventions to ascertain what is most helpful to women in supporting their recoveries [ 30 ].…”

“…Further in the literature, there has been a subtle but persistent question over the recovery potential of all survivors, with various authors noting that some women seem to make little or no recovery progress [ 41 , 42 , 43 , 44 , 45 , 46 ]. Other researchers have qualified their expectations for women’s recovery, noting the length of time involved [ 47 , 48 ], the many factors involved, including factors on a social rather than an individual level [ 49 ], and the influence of other barriers to recovery, such as mental health impacts [ 29 , 48 ]. In one Australian study ( n = 123), the author conceived of recovery as an ongoing experience, and noted the range of long-term impacts in the lives of survivors, claiming that “the evolving and expanding nature” of these impacts caused many participants to either criticize or consciously reject “recovery” terminology [ 43 ].…”

“…The GBV-Heal tool has included important dimensions of recovery—namely “trauma processing and self-advocacy, self-connection, relating to others, regaining hope and power” [ 52 ]. However, it does not include the following empirically derived dimensions of recovery—physical safety, financial independence and survival, stable housing, and parenting issues—which women continue to struggle with long after separation, particularly women on low-incomes [ 27 , 29 , 34 , 38 , 53 ]. For example, King and colleagues found financial issues to be a major and overlooked aspect of long-term recovery in their convenience sample of American women in long-term recovery ( n = 130) [ 40 ].…”