Association of exposure to intimate-partner physical violence and potentially traumatic war-related events with mental health in Liberia

Abstract

Liberia's wars between 1989 and 2003 resulted in hundreds of thousands of casualties and millions of victims. Gender-based violence was widespread during the conflict. Since the end of the war, however, little attention has been paid to ongoing violence against women, especially within the household. This research examines the relationships between intimate-partner physical violence, war experiences, and mental health nearly ten years after the end of the war. The study is based on a nationwide cross-sectional, multistage stratified cluster random survey of 4501 adults using structured interviews during a six-week period in November and December 2010. The main outcome measures are prevalence of intimate-partner physical violence, exposure to potentially traumatic war-related events, symptoms of Post-Traumatic Stress Disorder (PTSD) and depression. Among adult women, 37.7% (95%CI, 34.9-40.5; n = 852/2196) reported lifetime exposure to intimate-partner physical violence and 24.4% (95%CI, 22.1-26.9; n = 544/2196) reported incidence of intimate-partner physical violence over a one-year recall period. Among men, 23.2% (95%CI, 20.8-25.9, n = 475/2094) reported having severely beaten their spouse or partner over their lifetime; the incidence over the one-year recall was 12.2% (95%CI, 10.4-14.2, n = 259/2094). Among adult residents in Liberia, 10.6% (95%CI, 9.5-11.7, n = 546/4496) met the criteria for symptoms of depression, and 12.6% (95% CI, 11.5-13.9, n = 608/4496) met the criteria for symptoms of PTSD. Intimate-partner physical violence as a victim and as a perpetrator was significantly associated with exposure to potentially traumatic war-related events, especially among men. Among women, experiencing intimate-partner physical violence was associated with symptoms of PTSD and depression. Among men, perpetrating intimate-partner physical violence was associated with symptoms of PTSD and depression after adjusting for exposure to potentially traumatic war-related events. These findings suggest that intimate-partner physical violence may be a continued stressor in post-war societies that needs to be recognized and addressed as part of the reconstruction effort.