Categories and health impacts of intimate partner violence in the World Health Organization (WHO) multi-country study on women’s health and domestic violence

Background
Intimate partner violence (IPV) damages health and is costly to families and society. Individuals experience different forms and combinations of IPV; better understanding of the respective health effects of these can help develop differentiated responses. This study explores the associations of different categories of IPV on women’s mental and physical health.
Methods
Using data from the World Health Organization (WHO) Multi-Country Study on Women’s Health and Domestic Violence, multilevel mixed effects logistic regression modelling was used to analyse associations between categories of abuse (physical IPV alone, psychological IPV alone, sexual IPV alone, combined physical and psychological IPV, and combined sexual with psychological and/ or physical IPV) with measures of physical and mental health, including self-reported symptoms, suicidal thoughts and attempts, and nights in hospital.
Results
Countries varied in prevalence of different categories of IPV. All categories of IPV were associated with poorer health outcomes; the two combined abuse categories were the most damaging. The most common category was combined abuse involving sexual IPV, which was associated with the poorest health, (attempted suicide OR: 10.78 [95% CI 8.37-13.89], thoughts of suicide: 8.47[7.03-10.02], memory loss 2.93[2.41-3.56]). Combined psychological and physical IPV was associated with the next poorest outcomes, (attempted suicide 5.67[4.23-7.60], thoughts of suicide 4.41[3.63-5.37], memory loss 2.33[1.88-2.87]).
Conclusions
Understanding the prevalence and health impact of different forms and categories of IPV is crucial to risk assessment, tailoring responses to individuals, and planning services. Previous analyses that focused on singular forms of IPV likely under-estimated the more harmful impacts of combined forms of abuse.