Intimate partner violence: A global mental health problem.

A recent editorial in this Journal discussed the negative impact of violence by mentally ill individuals on caregivers, families and societies at large (Keshavan and Shah, 2013). Two articles in the current issue of the Asian Journal of Psychiatry highlight the even more devastating impact of the converse: the mental health consequences of intimate partner violence (IPV), also termed domestic violence. Satyanarayana et al. (2015) constructed an indepth phenomenological study of male IPV perpetrators and female victims. Alcohol consumption and gender sanctioned attitudes among the perpetrators were closely related to violence, and were associated with mental health consequences such as depression and anxiety among the survivors and academic difficulties in children. In a descriptive study in Iran, Masoudzadeh et al. (2015) reported a high prevalence of IPV among women whose husbands were in mental health care; majority of the women studied for IPV reported emotional, physical or sexual abuse. Victims were typically unwilling to share their abuse because of religious reasons or for fear of losing their marriage. Domestic abuse affects more than a third of women worldwide, according to world health organization estimates. The global scale of this problem is evidenced by several previous papers published in this journal from diverse nations in recent years. In a large study on mothers and children from Japan, Matsuura et al. (2013) showed that violence within families is likely to result from a cascade of prior abuse experiences setting up a vicious cycle of disadvantage leading to negative mental health consequences. A study in Vhembe, South Africa showed that mental health difficulties and IPV appeared to increase HIV risk among women who had protective orders against their perpetrators (Pengpid and Peltzer, 2013). Women are not the only sufferers: male partners of seriously mentally ill western Australian women, reported high rates of psychosocial difficulties that may have contributed to IPV as well as difficulties caring for their partners in their critical period of adjustment to parenthood (Frayne et al., 2014). Clearly, the relationship between mental illness and domestic violence is bidirectional. While the attention of mental health professionals has understandably been more focused on addressing violence caused by the minority of those with mental illness, we know little about how to tackle the broader problem of emotional and physical abuse and their causal role in psychiatric and medical morbidity. Admittedly, many of the causes of IPV are social, and related to gender and cultural barriers, which require broad social change beyond the scope of mental health professional. Women often do not report injuries or distress and fail to seek care because of stigma; and fear of losing the institution of marriage. Mental health professionals often feel that it is not part of their role to investigate suspected cases of IPV. This is where there is a call for action. Routine and sensitive inquiry into possible exposure to abuse, appropriate training of health professionals in such assessments and simple interventions can go a long way in mitigating, and possibly preventing the disastrous consequences of IPV, which remains a major global mental health problem that remains unaddressed.