Pooled analysis of the association between mental health and violence against women: evidence from five settings in the Global South

This is the final version. Available from BMJ Publishing via the DOI in this record. Data availability statement De-identified individual participant data for Stepping Stones and Creating Futures (South Africa), Sonke CHANGE Trial (South Africa), and Evaluation of the RRS-COMBAT intervention (Ghana) and oPt intervention, are available to anyone who wishes to access the data for any purpose at https://medat.samrc.ac.za/index.php/catalog/WW. De-identified individual participant data from the Indashyikirwa Couples Surveys (Rwanda) are available from the Principal Investigator of the study, Dr Kristin Dunkle: [email protected], but may require permission from the Rwandan Ministry of Gender and Family Promotion (MIGEPROF) before transfer.Objectives To describe associations between men’s poor mental health (depressive and post-traumatic stress symptomatology) and their perpetration of intimate partner violence (IPV) and non-partner sexual violence (NPSV), and women’s mental health and their experiences of IPV and NPSV in five settings in the Global South. Design A pooled analysis of data from baseline interviews with men and women participating in five violence against women and girls prevention intervention evaluations. Setting Three sub-Saharan African countries (South Africa, Ghana and Rwanda), and one Middle Eastern country, the occupied Palestinian territories. Participants 7021 men and 4525 women 18+ years old from a mix of self-selecting and randomly selected household surveys. Main outcome measures All studies measured depression symptomatology using the Centre for Epidemiological Studies-Depression, and the Harvard Trauma Scale for post-traumatic stress disorder (PTSD) symptoms among men and women. IPV and NPSV were measured using items from modified WHO women’s health and domestic violence and a UN multicountry study to assess perpetration among men, and experience among women. Findings Overall men’s poor mental health was associated with increased odds of perpetrating physical IPV and NPSV. Specifically, men who had more depressive symptoms had increased odds of reporting IPV (adjusted OR (aOR)=2.13; 95%CI 1.58 to 2.87) and NPSV (aOR=1.62; 95% CI 0.97 to 2.71) perpetration compared with those with fewer symptoms. Men reporting PTSD had higher odds of reporting IPV (aOR=1.87; 95% CI 1.44 to 2.43) and NPSV (aOR=2.13; 95% CI 1.49 to 3.05) perpetration compared with those without PTSD. Women who had experienced IPV (aOR=2.53; 95% CI 2.18 to 2.94) and NPSV (aOR=2.65; 95% CI 2.02 to 3.46) had increased odds of experiencing depressive symptoms compared with those who had not. Conclusions Interventions aimed at preventing IPV and NPSV perpetration and experience must account for the mental health of men as a risk factor, and women’s experience.Department for International DevelopmentSouth African Medical Research Counci

Pooled analysis of the association between food insecurity and violence against women: Evidence from low- and middle-income settings

This is the final version. Available from the International Society of Global Health via the DOI in this record. Data availability: De-identified individual participant data for Stepping Stones and Creating Futures (South Africa), Sonke Change trial (South Africa), and Evaluation of the COMBAT intervention (Ghana) and Afghanistan intervention, are available to anyone who wishes to access the data for any purpose at https://medat.samrc.ac.za/index.php/catalog/WW. De-identified individual participant data from the Indashyikirwa couples surveys (Rwanda) are available from the Principal Investigator of the study, Dr Kristin Dunkle: [email protected], but may require permission from the Rwandan Ministry of Gender and Family Promotion (MIGEPROF) before transfer.Background Intimate partner violence impacts relationships across the socioeconomic spectrum, nonetheless its prevalence is reported to be highest in areas that are most socio-economically deprived. Poverty has direct and indirect impacts on intimate partner violence (IPV) risk, however, one of the postulated pathways is through food insecurity. The aim of this paper is to describe the association between food insecurity (household hunger) and women’s experiences, and men’s perpetration, of intimate partner violence and non-partner sexual violence in data from Africa and Asia. Methods We conducted a pooled analysis of data from baseline interviews with men and women participating in six Violence Against Women prevention intervention evaluations and present a meta-analysis using mixed-effects Poisson regression models. Data were from South Africa (two studies), Ghana, Rwanda (two data sets), and Afghanistan and comprised interviews with 6545 adult women and 8104 adult men. We assessed food insecurity with the Household Hunger Scale. Results Overall, 27.9% of women experienced moderate food insecurity (range from 11.1% to 44.4%), while 28.8% of women reported severe food insecurity (range from 7.1 to 54.7%). Overall food insecurity was associated with an increased likelihood of women experiencing physical intimate partner violence, adjusted incidence rate ratio (aIRR) = 1.40 (95% CI = 1.23 to 1.60) for moderate food insecurity and aIRR = 1.73 (95% CI = 1.41 to 2.12) for severe food insecurity. It was also associated with an increased likelihood of men reporting perpetration of physical IPV, with aIRR = 1.24 (95% CI = 1.11 to 1.39) for moderate food insecurity and aIRR = 1.18 (95% CI = 1.02 to 1.37) for severe food insecurity. Food insecurity was not significantly associated with women’s experience of non-partner sexual violence, aIRR = 1.27 (95% CI = 0.93 to 1.74) for moderate or severe food insecurity vs none, nor men’s perpetration of non-partner sexual violence aIRR = 1.02 (95% CI = 0.90 to 1.15). Conclusions Food insecurity is associated with increased physical intimate partner violence perpetration and experience reported by men and women. It was not associated with non-partner sexual violence perpetration, although there was some evidence to suggest an elevated risk of non-partner sexual violence among food-insecure women. Prevention programming needs to embrace food insecurity as a driver of intimate partner violence perpetration, however, non-partner sexual violence prevention needs to be shaped around a separate understanding of its drivers.Department for International DevelopmentSouth African Medical Research Counci