“You Always End up Feeling Like You’re Some Hypochondriac”: Intimate Partner Violence Survivors’ Experiences Addressing Depression and Pain

Abstract

OBJECTIVE: Little is known regarding how providers should use information about intimate partner violence (IPV) to care for depressed patients. Our objective was to explore what depressed IPV survivors believe about the relationship between abuse, mental health, and physical symptoms and to elicit their recommendations for addressing depression. DESIGN: Focus group study. PATIENTS/PARTICIPANTS: Adult, English-speaking, female, Internal Medicine clinic patients with depressive symptoms and a history of IPV. INTERVENTIONS: Thematic analysis using an inductive approach (consistent with grounded theory), at a semantic level, with an essentialist paradigm. MEASUREMENTS AND MAIN RESULTS: Twenty three women participated in 5 focus groups. Although selected because of their depression, participants often felt their greatest concerns were physical. They acknowledged that their abuse history, depression, and physical complaints compound each other. They appreciated the need for health care workers to know about their depression and IPV history to get a "full picture" of their health, but they were often hesitant to discuss such issues with providers because of their fear that such information would make providers think their symptoms were "all in their head" or would encourage providers to discount their pain. Participants discussed difficulties related to trust and control in relationships with providers and gave recommendations as to how providers can earn their trust. CONCLUSIONS: Understanding a patient's IPV history may allow providers to develop a better therapeutic relationship. To treat depression adequately, it is important for providers to reassure patients that they believe their physical symptoms; to communicate respect for patients' intelligence, experience, and complexity; and to share control.KEY WORDS: intimate partner violence; depression; pain; physical symptoms; qualitative research; physician-patient relationship.

“Guardarse Las Cosas Adentro” (Keeping Things Inside): Latina Violence Survivors’ Perceptions of Depression

“…In contrast to our findings with non-Hispanic White women, 26 who were concerned that providers would attribute physical symptoms to their mental health or abuse histories, women appeared to be grateful when providers told them that physical symptoms were caused by depression, often seeing it as a source of new information. "I, thank God, went to urgent care because my depression stopped this part of my hands from working so that I wasn't able to hold onto a gallon of milk.…”

“…This finding is in direct contrast to what we have previously reported from a focus group study of non-Hispanic White women with depressive symptoms and histories of IPV. 26 Participants in that study were often angered by suggestions that their physical symptoms were "caused" by mental health issues or abuse, and they worried that disclosing information to healthcare providers about abuse or mental health would lead providers to treat them "like hypochondriacs". Participants in the current study had an opposite response to providers attributing physical symptoms to depression.…”

Facilitators and Barriers to Disclosing Abuse Among Women With Disabilities

“…Most research on the facilitators and barriers to disclosing IPV has been conducted with survivors who have already disclosed abuse to health providers and/or sought services, such as filing a restraining order or accessing a domestic violence shelter (Chang et al, 2005;Dienemann et al, 2005;Hegarty & Taft, 2001;Macy, Nurius, Kernic, & Holt, 2005;Nicolaidis et al, 2008;Robinson & Spilsbury, 2008;Rodríguez, Sheldon, Bauer, & Pérez-Stable, 2001). Barriers and facilitators identified in the literature were generally supported in a community-based study of women with unknown abuse histories (Petersen, Moracco, Goldstein, & Clark, 2004).…”

Motivational Interviewing at the Intersections of Depression and Intimate Partner Violence among African American Women

“…Together, we conducted a series of focus groups with African American(Nicolaidis et al, 2010), White(Nicolaidis et al, 2008), and Latina(Nicolaidis et al, 2011) depressed IPV survivors. Regardless of race or ethnicity, depressed IPV survivors shared the belief that their depression, physical health, and experiences of abuse are all extremely interconnected.…”