Patterns of Women's exposure to psychological violence: A global examination of low- and middle-income countries

Cari Jo Clark; Irina Bergenfeld; Yuk Fai Cheong; Hector Najera; LynnMarie Sardinha; Claudia García-Moreno; Lori Heise

doi:10.1016/j.ssmph.2023.101500

Patterns of Women's exposure to psychological violence: A global examination of low- and middle-income countries

SSM Popul Health. 2023 Aug 29:24:101500. doi: 10.1016/j.ssmph.2023.101500. eCollection 2023 Dec.

Authors

Cari Jo Clark¹, Irina Bergenfeld¹, Yuk Fai Cheong², Hector Najera³, LynnMarie Sardinha⁴, Claudia García-Moreno⁴, Lori Heise^{5

6}

Affiliations

¹ Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
² Department of Psychology, Emory University, Atlanta, GA, USA.
³ Programme for Development Studies. National Autonomous University of Mexico PUED-UNAM, Mexico.
⁴ The UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
⁵ Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁶ Prevention Collaborative, USA.

Abstract

Introduction: Under Sustainable Development Goal 5, prevalence of intimate partner violence (IPV) is a globally reportable indicator. There is a lack of consensus on how to measure and report psychological IPV, affecting prevalence estimates and cross-country comparability. We examine similarities and differences in the patterning of women's experiences of psychological abuse in low- and middle-income countries (LMICs) to inform common cut points.

Methods: Data include 13,452 ever-partnered women from six LMICs participating in the WHO multi-country study on women's health and domestic violence against women and 306,101 from 47 LMICs participating in the Demographic and Health Surveys. A confirmatory latent class analysis (LCA) approach was applied to identify the optimal class structure using the 3 DHS and 4 WHO psychological IPV items, assessed the impact of physical and sexual IPV on class structure, and tested class generalizability across countries. We validated the three-class solution by regressing the classes on physical IPV, sexual IPV, controlling behaviors, and injury due to domestic violence. We used item response theory (IRT) methods to assess item-level characteristics of the items.

Results: Analysis confirmed the three-class structure in most countries. Addition of physical and sexual IPV did not change overall class structure or improve discrimination or homogeneity of the items. The three-class structure was invariant within most WHO-classified regions. Operationalized classes informed by the LCA resulted in prevalences of roughly 90% low-to-no class, 7% moderate-intensity class, and 3% high-intensity class. Classes showed convergent validity with all outcomes tested. IRT analysis revealed good discriminations but substantial information overlaps over a narrow range of the latent psychological violence construct.

Conclusions: This study confirms the three-class pattern but suggests some differences across countries. and regions. We suggest cut points distinguishing violent from non-violent acts and demarcating levels of severity for future study. Findings offer evidence-based guidance to rectify challenges.

Keywords: Intimate partner violence; Latent class analysis; Latent patterns; Low- and middle-income countries; Profile similarity; Psychological violence.

Grants and funding

001/WHO_/World Health Organization/International