Violence Exposure and Disability in Colombian Female Survivors of Intimate Partner Violence: the Mediating Role of Depressive Symptoms

Abstract

Background: Violence is an important public health problem and one of the main causes of deaths worldwide. The mental health consequences of surviving intimate partner violence (IPV) include depression, anxiety and post-traumatic stress disorder. Previous studies have identified that there is a relationship between depression and level of disability in female survivors of IPV. Estimating the direct, indirect or total effect of an exposure on an outcome makes it possible to identify mediating effects between a group of variables. Detecting mediation effects is useful for identifying casual pathways that generate a final outcome and provides a rationale for designing interventions to target the mediator, which in turn positively affects the outcome. The objective was to identify the mediating role of depressive symptoms on the relationship between IPV and disability.

Methods: This was a cross-sectional study of 94 women over the age of 18 who were survivors of IPV by men. They were recruited from two public hospitals in Cali and Tuluá in southwest Colombia. An analysis of casual relationships was performed using structural equation modelling that was made up of: four exogenous observed variables (age, current relationship status [in a relationship or single], level of schooling, and history of an impairment), intermediate endogenous variables (violence and depressive symptoms), and the main endogenous variable (disability). The analyses were carried out in Stata14.2.

Results: The direct effect of IPV severity on the level of disability was not statistically significant (β=0.09; P=0.63). However, the indirect effect of IPV severity on disability mediated by depressive symptoms was (β=0.39; P<0.01). The total effect of IPV severity on the level of disability was even greater (β=0.48; P=0.01).

Conclusions: This study found a complete mediating role of depressive symptoms on the relationship between the severity of IPV and the level of disability for the female participants in this study. The results of this research contribute to defining strategies to prevent and address intimate partner violence, depressive symptoms and disability in this population.

Keywords: Análisis de ruta; Depressive symptoms; Disability; Discapacidad; Intimate partner violence; Mediación; Mediating; Path analysis; Síntomas depresivos; Violencia íntima de pareja.