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The Center for Health and Gender Equity (CHANGE) is a research and advocacy organization that seeks to integrate concern for gender equity and social justice into international health policy and practice. CHANGE staff can be reached by e-mail at change@genderhealth.org or at http://www.genderhealth.org.

Depression. Depression is becoming widely recognized as a major health problem around the world (446). The situation is particularly acute among adult women (477), who in most countries suffer depression at nearly twice the rate seen in men (97, 327, 467). Some researchers have suggested that most of the difference between the incidence of depression in women and men may be due not to biology, but rather to poverty, gender-based discrimination, and gender-based violence (13).

Women who are abused by their partners suffer more depression, anxiety, and phobias than women who have not been abused, according to studies in Australia, Nicaragua, Pakistan, and the US (74, 100, 126, 152, 376). Among women ages 15 to 49 in Nicaragua, for example, battered women were six times more likely to experience emotional distress, as measured on an international mental health scale, than were other women. Physical abuse was the single most important risk factor for emotional distress in this study, accounting for roughly 70% of mental health problems among women (126).

Sexual assault in either childhood or adulthood is also closely associated with depression and anxiety disorders (42, 53, 81, 276, 469). Most likely to lead to psychological disorders are sexual abuse occurring before age seven or eight, abuse by more than one perpetrator, abuse that includes genital or anal penetration, and abuse that is frequent or continues over a long period of time (42, 81, 320).

Post-traumatic stress disorder. Many abused women experience post-traumatic stress disorder (PTSD), an acute anxiety disorder that can occur when people go through or witness a traumatic event in which they feel overwhelming helplessness or threat of death or injury (8). The symptoms of PTSD include mentally reliving the traumatic event through flashbacks, or “flooding”; trying to avoid anything that would remind one of the trauma; becoming numb emotionally; experiencing difficulties in sleeping and concentrating; and being easily alarmed or startled.

Rape, childhood sexual abuse, and domestic violence are among the most common causes of PTSD in women (36, 42, 44, 101, 380, 400, 433, 452). The chances that a woman will develop PTSD after being raped are between 50% and 95%, according to studies in France, New Zealand, and the US (36, 41, 101). One study in the US found that the psychological effects of being raped were comparable to the effects of being tortured or kidnapped (41).

Oms/OPS, Ministerio de Salud de Perú—MINSA y CMP Flora Tristan

"No one has the right to abuse you. If you suffer violence in your home, your health is seriously affected. Consult us," a Peruvian placard states. The reverse side reminds providers to take the opportunity to talk about violence.

Women who have experienced sexual assault either in childhood or as adults are also more likely to attempt suicide than other women (148, 280, 292, 317, 381, 470). The link is strong even after controlling for such individual risk factors as women's sex, age, and education and for presence of PTSD symptoms and psychiatric disorders (104, 421).

Alcohol and drug use. Victims of partner violence and women sexually abused as children are more likely than other women to abuse alcohol and drugs, even after controlling for such other risk factors as prior use, family environment, or parental alcoholism (133, 250, 265, 291, 304, 306). In a survey among women seeking primary care, those who had been abused by their partners within the previous year were three times more likely than those not recently abused to be drinking large amounts of alcohol and four times more likely to be using drugs (291).

Do abused women try to blunt their reactions to trauma by dulling their senses with alcohol and drugs? Or are women who use alcohol and drugs more likely to live in ways that put them at greater risk of being abused by men? In the US a 2-year longitudinal study sought to answer this question (250).

The study found that women who used illicit drugs, but not those who used alcohol, were at increased risk of being assaulted over the next two years of follow-up. As expected, any past or recent history of assault was associated with increased rates of alcohol and drug use, even after controlling for prior use and other factors. These findings suggest that increased alcohol use is more of an after-the-fact coping response to victimization, whereas drug use increases risk of being victimized at the same time that victimization increases the likelihood of using drugs (250).