Recent intimate partner violence against women and health: a systematic review and meta-analysis of cohort studies

Abstract

Objective: We reviewed cohort studies to determine the magnitude and temporal direction of the association between recent intimate partner violence (IPV) and a range of adverse health outcomes or health risk behaviours.

Design: Systematic review and meta-analysis.

Methods: Medline, EMBASE and PsycINFO were searched from the first record to November 2016. Recent IPV was defined as occurring up to and including the last 12 months; all health outcomes were eligible for inclusion. Results were combined using random-effects meta-analysis.

Results: 35 separate cohort studies were retrieved. Eight studies showed evidence of a positive association between recent IPV and subsequent depressive symptoms, with a pooled OR from five estimates of 1.76 (95% CI 1.26 to 2.44, I²=37.5%, p=0.172). Five studies demonstrated a positive, statistically significant relationship between depressive symptoms and subsequent IPV; the pooled OR from two studies was 1.72 (95% CI 1.28 to 2.31, I²=0.0%, p=0.752). Recent IPV was also associated with increased symptoms of subsequent postpartum depression in five studies (OR=2.19, 95% CI 1.39 to 3.45, p=0.000), although there was substantial heterogeneity. There was some evidence of a bidirectional relationship between recent IPV and hard drug use and marijuana use, although studies were limited. There was no evidence of an association between recent IPV and alcohol use or sexually transmitted infections (STIs), although there were few studies and inconsistent measurement of alcohol and STIs.

Conclusions: Exposure to violence has significant impacts. Longitudinal studies are needed to understand the temporal relationship between recent IPV and different health issues, while considering the differential effects of recent versus past exposure to IPV. Improved measurement will enable an understanding of the immediate and longer term health needs of women exposed to IPV. Healthcare providers and IPV organisations should be aware of the bidirectional relationship between recent IPV and depressive symptoms.

Prospero registration number: CRD42016033372.

Keywords: mental health; public health; substance misuse.

Figure 1

Flow of studies through review. ^aNew systematic review published in 2017 on domestic violence in pregnancy and perinatal mental health disorders identified by editorial team during the peer review of our paper. IPV, intimate partner violence.

Figure 2

Forest plot estimates of the association between intimate partner violence and depression. Woolhouse et al  estimates are based on different subsamples and are mutually exclusive. Meta-analysis with depression as the dependent variable was also undertaken excluding the Chowdhary and Patel study which removes women with baseline depressive disorder from the analysis, but it did not materially change the overall pooled estimate (OR=1.85, 95% CI 1.35 to 2.49, I²=35.1%, p=0.202).

Figure 3

Forest plot estimates of the association between intimate partner violence and alcohol use, hard drug use, marijuana use and sexually transmitted infections (STIs). Estimates from Gao et al and Testa et al are based on different subsamples and are mutually exclusive.