Exposure to Interpersonal Violence and Its Associations With Psychiatric Morbidity in a U.S. National Sample: A Gender Comparison.

Interpersonal violence is associated with numerous adverse health outcomes, including posttraumatic stress disorder (PTSD), other anxiety disorders, depression, substance abuse disorders, and other psychiatric comorbidities (Brady, Killeen, Brewerton, & Lucerini, 2000; Breslau, Davis, Andreski, & Peterson, 1991; Jordan, Campbell, & Follingstad, 2010; Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995; Resnick, Acierno, & Kilpatrick, 1997; Resnick, Kilpatrick, Dansky, Saunders, & Best, 1993; Schnurr & Jankowski, 1999). For example, a recent study documented substantial associations between four types of interpersonal violence exposure—physical assault by an intimate partner, rape, other sexual assault, and stalking—and psychopathology among a nationally representative sample of Australian women. Women exposed to one or more of these forms of interpersonal violence were 2.6 to 11 times more likely than nonexposed women to meet criteria for a mood, anxiety, or substance use disorder in their lifetime. The associations between other types of stressful life events and psychopathology were considerably smaller. Unfortunately, in studies to date, the category of interpersonal violence has often been construed narrowly, including only experiences such as physical assault by an intimate partner, rape, other sexual assault, and stalking. Thus, less is known about the mental health impact of a broad array of different types of interpersonal violence. Also, although the link between these frequently studied forms of interpersonal violence and psychiatric morbidity is well-documented among women (Basile, Arias, Desai, & Thompson, 2004; Campbell, Greeson, Bybee, & Raja, 2008; Rees et al., 2011; Smith et al., 2011), fewer studies have focused on their prevalence and mental health impact among men. This study examines gender differences in population rates of a comprehensive set of interpersonal violence exposures in a national sample of U.S. women and men and investigates gender as a moderator of the associations between interpersonal violence exposure and lifetime mental disorders and suicide attempts using a comprehensive array of diagnostic mental health outcomes. Several studies suggest that the rates of exposure to interpersonal violence vary markedly by gender. For example, women are more likely than men to be the victims of rape, sexual assault, and stalking, and men are more likely than women to be physically assaulted and threatened with a weapon (Black et al., 2011; Kessler et al., 1995; Tolin & Foa, 2006). Because of these differences in prevalence of exposure, research on health consequences associated with certain types of interpersonal violence—for example, rape, sexual assault, and intimate partner violence—has understandably tended to focus on the effects of violence perpetrated against women in isolation from the effects of violence perpetrated against men (Campbell et al., 2008). However, although these exposures are less common among men than women, sexual assault and intimate partner violence among men also represents a significant social problem in the United States (Black et al., 2011; Carbone-Lopez, Kruttschnitt, & Macmillan, 2006; Coker et al., 2002; Saunders, 2002; Tolin & Foa, 2006; Whitaker, Haileyesus, Swahn, & Saltzman, 2007). For instance, the National Intimate Partner and Sexual Violence Survey found that at least one in five U.S. men have experienced sexual violence victimization during their lifetime, and one in seven have experienced severe physical violence by an intimate partner (Black et al., 2011), and such experiences are associated with elevated mental health symptoms (Black et al., 2011; Coker et al., 2002). Although women are often overrepresented in the literature examining the impact of rape, sexual assault, and stalking, the aforementioned studies suggest that men are legitimate victims of these forms of interpersonal violence as well. This highlights the need for research to understand the scope of a broad range of interpersonal violence experiences among men, including any ways in which health effects of interpersonal violence may be similar or different for women and men. The few studies that have examined the impact of interpersonal violence by gender have resulted in inconsistent findings (Dube et al., 2005; Kessler et al., 1995; Kimerling et al., 2010). Kessler and colleagues (Kessler et al., 1995) found that although women were nine times more likely to experience rape than men, the conditional probability of PTSD associated with rape was similar for women and men. Similarly, a study of HMO members found that although men reported slightly lower levels of childhood sexual abuse than women (16% vs. 25%, respectively), the association between child sexual abuse and mental health problems was consistent across genders (Dube et al., 2005). Conversely, other findings suggest that there may be gender differences in health outcomes as a function of the specific type of interpersonal violence. For example, Kessler et al. (1995) found that women were about four times more likely to report sexual molestation in childhood than men, and the conditional probability of PTSD associated with molestation was considerably higher for women than for men. Additionally, several studies with military populations suggest that exposure to sexual violence may have more serious mental health consequences for men than for women (Kang, Dalager, Mahan, & Ishii, 2005; Shipherd, Pineles, Gradus, & Resick, 2009; Street, Gradus, Stafford, & Kelly, 2007; Vogt, Pless, King, & King, 2005). Thus, it remains unclear whether the mental health effects of specific types of interpersonal violence differ for women and men. There are theoretical reasons to expect that the associations between interpersonal violence and mental health outcomes vary for women and men. Gender differences exist in terms of risk for a variety of psychiatric conditions, including mood, anxiety, substance use disorders, eating disorders, and attempted suicide (APA, 2000; Kessler, Chiu, Demler, Merikangas, & Walters, 2005; Moscicki, 1994). Stressful life events, such as interpersonal violence exposure, are known risk factors for psychiatric problems (Bradley et al., 2008; Jordan et al., 2010; Kessler et al., 1995). Moreover, gender differences in the prevalence and types of interpersonal violence exposure, such as women’s higher risk for rape and intimate partner violence, have been theorized to account, in part, for women’s greater risk for some mental health conditions (Herman, 1992; Kimerling, Ouimette, & Weitlauf, 2007). However, despite such research and theory, gender has yet to be explicitly examined as a moderator of the association between interpersonal violence and mental health outcomes in a large population-based sample. Understanding gender differences in the prevalence of different types of interpersonal violence exposure among women and men, and determining whether gender moderates the associations between interpersonal violence and mental health outcomes, is critical for developing targeted programs aimed at preventing health problems among all interpersonal violence victims. We addressed this gap in the literature in the current report using data from a U.S. national probability sample. First, we examined gender differences in the prevalence of a wide range of interpersonal violence exposures (i.e., physical assault by an intimate partner, rape, other sexual assault, stalking, physical assault, mugging, childhood physical abuse, kidnapping, and witnessing interparental violence). Second, we investigated the associations between the nine forms of interpersonal violence and lifetime mental health diagnoses and a history of attempted suicide after rigorous adjustment for potential cofounding variables. Third, we tested gender as a moderator of the association between interpersonal violence with lifetime mental health diagnoses and a history of attempted suicide in women and men to determine whether the associations between interpersonal violence and morbidity vary by gender.