Intimate partner violence and depressive symptoms in women: Cognitive schemas as moderators and mediators

https://doi.org/10.1016/j.brat.2006.07.006Get rights and content

Abstract

In this study the role of cognitive schemas as moderators and mediators between intimate partner violence and depressive symptoms was examined. The sample consisted of 312 women who had suffered an abusive relationship. Participants completed measures of physical, psychological and sexual abuse, maladaptive cognitive schemas (disconnection and rejection, autonomy, and other-directedness), and depression. The evidence for a moderation effect was low and mainly restricted to schemas of the impaired autonomy domain. In contrast, the results supported mediational models in which violence was associated to the cognitive schemas, and these in turn were associated to depressive symptoms. Mediation was partial, with the schemas of the disconnection and rejection domain explaining most of the association between violence and depression. Finally, several explanations for these findings are examined, and their implications for the concept and measure of the cognitive schemas are discussed.

Introduction

Over the past decades, several studies have revealed the link between intimate partner violence and depressive problems in women (e.g., Barnett, 2001; Follingstad, Brennan, Hause, Polek, & Rutledge, 1991). However, women differ in the severity and magnitude of their emotional responses to the abuse and some women are able to be resilient despite exposure to such extreme stress (O’Neill & Kerig, 2000). The present study is focused on the role that cognitive schemas play in the relationship between intimate partner violence and depression.

Cognitive diathesis-stress models of depression propose that depression is more likely to result from an interaction between adverse circumstances and intrinsic cognitive characteristics that increase the risk for depressive mood (Abramson, Alloy, & Metalsky, 1989; Beck, Rush, Shaw, & Emery, 1979). Although most of the research in the area has focused on attributional style as a cognitive diathesis (Abramson et al., 1989), other cognitive variables, such as perceived self-competence, self-complexity, and problem solving orientation, have also been proposed to buffer the impact of negative events (e.g., Steinberg, Pineles, Gardner, & Mineka, 2003; Tram & Cole, 2000).

A number of studies have examined cognitive factors that could moderate the effects of violence on women's psychological adjustment. O’Neill and Kerig (2000) investigated the role of cognitive attributions about the experience of battering as a potential source of resilience. In their study, high attributions of self-blame and low perceived self-control increased the relationship between physical violence and psychological maladjustment. Parker-Corell and Markus (2004) found that the attributional style was an independent factor that, along with battering, predicted trauma symptoms and depression. However, they did not examine the effect of the interaction between violence and attributional style. Last, variables related to self-worth and self-concept have also been proposed as potential buffers between abuse and psychological adjustment with mixed results. For instance, in a study with female patients of primary care centers self-esteem moderated the effect of abuse on mental health (Carlson, McNutt, Choi, & Rose, 2002). Arias, Lyons, and Street (1997) found that relationship efficacy was protective for women who were not in psychologically abusive relationships against depression but not for women in violent relationships. And Steinberg et al. (2003) failed to confirm a buffering effect of high self-complexity for depression among abused women.

Cognitive schemas represent another cognitive variable that could moderate the consequences of intimate partner violence on women's depressive symptoms. Cognitive schemas consist of organized elements of past behaviors and experiences that form a relatively cohesive and persistent body of knowledge and guide subsequent appraisals (Segal, 1988). Young (1999) proposed the existence of 16 maladaptive schemas, which are hypothetically developed during childhood and elaborated throughout one's lifetime. According to Young's schema theory, these schemas often form the core of the individual's self-concept and define his/her vision of the world.

Young (1999) grouped these schemas within five domains or broad categories. Three of these domains could play a significant role when a woman copes with an abusive relation, because they refer to cognitive contents that have often been identified as relevant in intervention with victims (e.g., Dutton, 1992). The domain of Disconnection and Rejection includes schemas (e.g., abuse and defectiveness) that involve the expectation that one's needs for security, acceptance, and respect will not be fulfilled in a predictable way. The schemas within the domain of Impaired Autonomy and Performance (e.g., dependence and failure) consist of expectations about oneself and the environment that interfere with one's perceived capacity to separate, survive, function independently, or perform successfully. Last, the schemas within the domain of Other-directedness (self-sacrifice and subjugation) consist of an extreme focus on the desires of others, at the expense of one's own needs.

According to cognitive diathesis-stress models, when schemas are dysfunctional, women become vulnerable to negative psychological outcomes (Dutton, Burghart, Perrin, Chrestman, & Halle, 1994; Ponce, Williams, & Allen, 2004). Thus, those women who endorse the above maladaptive schemas could appraisal more negatively the meaning of intimate partner violence experiences than women who do not think in such dysfunctional way. For instance, schemas into the disconnection and rejection domain could lead victims to appraisal that they are the cause of the maltreatment and that abuse is unavoidable, whereas victims who endorse schemas into the impaired autonomy domain would experience a high dependence of their abusive partner and would think that they lack the necessary personal resources to solve the situation or to live independently. Thinking in this way could in turn increase the risk of depression development.

On the other hand, Young (1999) stated that the schemas usually remain latent until they are activated by events in the environment relevant to the particular schema. Thus, an alternative possibility is that the link between abuse and depression is accounted for by the activation of maladaptive schemas, with these schemas mediating the link between abuse and depressive symptoms. In support of this hypothesis several studies have revealed that the experiences of abuse and violence may affect the victims’ cognitions, particularly when the victims experience trauma as a result of violence (e.g., Arias & Pape, 1999; Dutton, 1992; Lerner & Kennedy, 2000).

The experience of abuse could be particularly harmful for schemas related to self-worth and self-efficacy, due to the role that the interactions with others play in the development of self-representations (McCann, Sakheim, & Abrahamson, 1988). Thus, when a woman suffers prolonged experiences of physical abuse and critical comments from her intimate partner, her self-schemas could become negative (Lynch & Graham-Bermann, 2000). This hypothesis is supported by several studies showing a negative relationship between abuse and self-esteem (e.g., Barnett, 2001; Cascardi & O’Leary, 1992), and evidences that women's self-esteem increases once they have left the abusive relation (Walker, 1984).

Various studies have examined the mediational role of cognitions in the link between abuse and attitudes to the abusive relation. For instance, intimate partner abuse has been associated with particular cognitive schemas, such as low self-efficacy, that influence the decision of terminating the violent relationship (Raghavan, Swan, Snow, & Mazure, 2005). Besides, Lerner and Kennedy (2000) found that the experience of maltreatment as a child was linked to distortions in the cognitive schemas as adults, and that these schemas in turn were associated to acceptance of violence in intimate partner relationships.

The study of the cognitive mediation between abuse and mental health has been mainly restricted to sexual abuse. For instance, various studies have found that maladaptive schemas about self and others mediate the rape's effect on mental health (e.g., Koss & Figueredo, 2005; Koss, Figueredo, & Prince, 2002) and that self-blame is consistently associated with more distress among rape victims (Frazier, 2003).

Although the above studies show the importance of cognitions in the battered women’ mental health, to date, no study has directly examined whether Young's cognitive schemas mediate or moderate the influence of intimate partner abuse on depressive symptoms. This study focused on the role of three cognitive domains (disconnection and rejection, impaired autonomy, and other-focused) in the relationship between intimate partner violence and depression in women. We tested two sets of hypotheses. First, we examined whether cognitive schemas moderate the relationship between intimate partner violence and depressive symptoms. We hypothesized that the impact of abuse on women's emotional adjustment would be higher in those women who endorse dysfunctional schemas. Second, as an alternative model, we tested whether cognitive schemas mediate the association between abuse and depression. In the mediational models tested in this study, experiences of abuse were hypothesized to be linked with maladaptive schemas, which would in turn be associated with depressive symptoms. As indicators of abuse we used measures of physical, psychological, and sexual abuse.

Section snippets

Participants

Participants were taken from a sample of 1159 women of the regional council of Bizkaia, a province in northern Spain. The inclusion criteria were based on physical and/or sexual abuse suffered during the last year, and consisted of having experienced four or more acts of minor abuse, two or more severe acts, or any combination of four or more severe and minor acts during the past year of the relationship.1

Abuse characteristics and depressive symptoms

The prevalence rates for physical, sexual, and psychological abuse were 65%, 78.5%, and 93.8%, respectively. The participants reported a mean frequency of 20.58, 12.29, and 74.4 acts of physical, sexual, and psychological abuse during the past year. Regarding the frequency of severe forms of maltreatment, the prevalence rate of severe abuse (e.g., “Used threats to make me have sex”) was 25.7%, and the rate of severe physical aggression (e.g., “Choked me”) was 47.7%. The data indicated a high

Discussion

Past research has demonstrated the association between intimate partner violence and the development of depression among victims. In this study we assessed the role of cognitive schemas as moderators and mediators of this association.

Findings of the study indicated that cognitive moderation was almost restricted to the impaired autonomy domain, with the association between all types of violence and depression slightly stronger in the presence of low rather than high impaired autonomy schemas.

Acknowledgments

This research was supported by a grant from the Ministerio de Ciencia y Tecnología, Reference BSO2003-06101 (Spanish Government). The authors thank Dr. Murray A. Straus for allowing the use of the CTS2, and Dr. Kristopher Preacher for facilitating the use of the SPSS macro for Bootstrapping.

References (50)

  • L.Y. Abramson et al.

    Hopelessness depression: A theory-based subtype of depression

    Psychological Review

    (1989)
  • I. Arias et al.

    Individual and marital consequences of victimization: Moderating effects of relationship efficacy and spouse support

    Journal of Family Violence

    (1997)
  • I. Arias et al.

    Psychological abuse: Implications for adjustment and commitment to leave violent partners

    Violence and Victims

    (1999)
  • O.W. Barnett

    Why battered women do not leave, Part 2. External inhibiting factors-social support and internal inhibiting factors

    Trauma, Violence and Abuse

    (2001)
  • A.T. Beck et al.

    Cognitive therapy of depression

    (1979)
  • D.P. Bernstein

    Cognitive therapy of personality disorders in patients with histories of emotional abuse or neglect

    Psychiatric Annals

    (2002)
  • J. Bowlby

    Attachment and loss: Loss, sadness, and depression

    (1980)
  • E. Calvete et al.

    Creencias y síntomas depresivos: Resultados preliminares en el desarrollo de una escala de creencias irracionales abreviada (Beliefs and depressive symptoms: Preliminary findings in the development of a brief irrational beliefs scale)

    Anales de Psicología

    (1999)
  • Calvete, E., Corral, S., & Estévez, A. (in press). Factor structure and validity of the revised conflict scales for...
  • E. Calvete et al.

    Desarrollo de un inventario para evaluar el abuso psicológico en las relaciones de pareja (Development of an inventory to assess emotional abuse in couple relationships)

    Clínica y Salud

    (2005)
  • E. Calvete et al.

    The Schema Questionnaire—short form: Structure and relationship with automatic thoughts and symptoms of affective disorders

    European Journal of Psychological Assessment

    (2005)
  • B.E. Carlson et al.

    Intimate partner abuse and mental health: The role of social support and others protective factors

    Violence Against Women

    (2002)
  • M. Cascardi et al.

    Depressive symptomatology, self-esteem, and self-blame in battered women

    Journal of Family Violence

    (1992)
  • M.A. Dutton

    Assessment and treatment of post-traumatic stress disorder among battered women

  • M.A. Dutton et al.

    Battered women's cognitive schemata

    Journal of Traumatic Stress

    (1994)
  • P.A. Frazier

    Perceived control and distress following sexual assault: A longitudinal test of a new model

    Journal of Personality and Social Psychology

    (2003)
  • P.A. Frazier et al.

    Testing moderator and mediator effects in counseling psychology research

    Journal of Counseling Psychology

    (2004)
  • E.B. Foa et al.

    Post-traumatic stress disorder following assault: Theoretic considerations and empirical findings

    Current Directions in Psychological Science

    (1995)
  • D.R. Follingstad et al.

    Factors moderating physical and psychological symptoms of battered women

    Journal of Family Violence

    (1991)
  • G. Gladstone et al.

    Depressogenic cognitive schemas enduring beliefs or mood state artifacts?

    Australian and New Zealand Journal of Psychiatry

    (2001)
  • Hayes, A.F., & Preacher, K.J. (2005). SPSS and SAS macros for bootstrapping indirect effects in multiple mediator...
  • J.L. Herman

    Complex PTSD: A syndrome in survivors of prolonged and repeated trauma

    Journal of Traumatic Stress

    (1992)
  • G.N. Holmbeck

    Toward terminological, conceptual, and statistical clarity in the study of mediators and moderators: Examples from the child-clinical and pediatric psychology literatures

    Journal of Consulting and Clinical Psychology

    (1997)
  • M.P. Koss et al.

    Cognitive mediation of rape's mental health impact: Constructive replication of a cross sectional model in longitudinal data

    Psychology of Women Quarterly

    (2005)
  • M.P. Koss et al.

    Cognitive mediation of rape's mental, physical, and social health impact: Test of four models in cross-sectional data

    Journal of Consulting and Clinical Psychology

    (2002)
  • Cited by (42)

    • Maladaptive schemas as mediators of the relationship between previous victimizations in the family and dating violence victimization in adolescents

      2018, Child Abuse and Neglect
      Citation Excerpt :

      Furthermore, daughters could be learning schemas that are present in their mothers. Previous research with female victims of intimate partner violence indicate that the experience of being a victim seems to be particularly harmful for schemas related to self-worth and feelings of being rejected and abused by others (Calvete, Estévez, & Corral, 2007). Thus, disconnection and rejection schemas could be present in abused mothers and, through the above-mentioned same-sex parent modelling mechanism, daughters could more probably learn their mothers’ schemas.

    • Core beliefs and self-schematic structure in depression

      2015, Current Opinion in Psychology
      Citation Excerpt :

      With the exception of a subsample of males who reported high Disconnection/Rejection and Other-Directedness, no significant interactions between EMS and stressors emerged in the prediction of depressive symptoms in a multiwave study of adolescents [11••]. Findings in adult samples follow a similar pattern, with some reporting no evidence of diathesis–stress interactions [20,21] and others reporting moderation only in subsamples or for specific EMS [12,22,23]. Schmidt et al. [23] suggest that the schemas of individuals with high EMS are chronically activated by a broad array of environmental events, such that these individuals are always in high distress.

    View all citing articles on Scopus
    View full text