Intimate partner abuse and suicidality: A systematic review
Highlights
► 37 articles were reviewed, giving a comprehensive understanding of this topic ► Found a strong association between Intimate Partner Abuse and suicidality ► Factors leading to increased risk of suicidality in this group were identified
Introduction
Intimate partner abuse (IPA)1 can be defined as any “incident of threatening behaviour, violence or abuse (psychological, physical, sexual, financial or emotional) between adults who are or have been intimate partners, regardless of gender or sexuality” (Department of Health, 2000). This definition communicates the multifaceted nature of intimate partner abuse, illustrating the challenges and difficulties of conducting research in this area. However, it is worth noting that this is a relatively recent definition, and much early research in this area was carried out with the assumptions that intimate partner abuse was synonymous with only physical abuse, with female victims and male perpetrators (e.g. Back, Post, & D'Arcy, 1982). Although knowledge and understanding of intimate partner abuse has progressed significantly, the complexity of intimate partner abuse often results in researchers selecting different aspects to focus on.
IPA is a widespread issue, with 1 in 4 women experiencing IPA over their lifetimes and between 6 and 10% of women suffering IPA in any given year (Council of Europe, 2002). It has further been shown that among some “high risk” samples, such as psychiatric, clinical, and student populations, the prevalence rates are higher still, with 1 in 3 women reporting that they are currently experiencing IPA, or they have experienced it in the past (Sansone, Chu, & Wiederman, 2007a). IPA is recognised as being a major public health problem. Screening for IPA in healthcare settings is endorsed by numerous health professional organisations in the United States (Waalen, Goodwin, Spitz, Petersen, & Saltzman, 2000), and although there is not currently a screening policy in the UK, the Department of Health (2000) recommends that health professionals should consider routine enquiry of female patients for a history of IPA.
Researchers have highlighted the varied and often severe consequences of IPA. Studies have shown relationships between IPA and physical injuries, disabilities, homicide, sexual assaults, complications of pregnancy, alcohol and drug abuse, economic losses, employment status, depression, and suicide (Abbott et al., 1995, Campbell et al., 1996, ⁎Ellsberg et al., 2008, Tolman and Wang, 2005, Waller et al., 1996). Researchers have increasingly found that victims of IPA are at risk of a variety of psychological problems, finding particularly high rates of post-traumatic stress disorder (Golding, 1999) and also of depression (Gleason, 1993). Some samples show clinically significant levels of depression (Cascardi & O'Leary, 1992) whilst others have found accompanying suicidal ideation and suicide attempts (Bergman & Brismar, 1991).
A number of studies have demonstrated an association between IPA victimisation and suicidality, which is defined here as suicidal ideation and/or suicidal behaviour. People who experience IPA are more likely to attempt suicide than those without such history, with an estimated 35% to 40% making a suicide attempt at some point during or after the termination of an abusive relationship (Reviere et al., 2007). Indeed, a number of studies demonstrate a higher prevalence of suicide attempts among those with histories of IPA compared to those with no such history (Seedat, Stein, & Forde, 2005). Additionally, 20% of people who have experienced IPA make multiple suicide attempts compared to 8% of people with no history of abuse (Stark & Flitcraft, 1995).
However, despite this awareness of an association, it is a largely under-researched area, and among the existing research there is a large degree of variability in the focus and methods employed, making direct comparisons problematic. Some literature reviews have highlighted a relationship between IPA and suicidality, such as Golding (1999) meta-analytic review of IPA as a risk factor for mental disorders, and Martin, Macy, Sullivan, and Magee (2007) review of the role of IPA in pregnancy-associated violent deaths. However, no systematic review has been carried out which concentrates solely on the relationship between IPA and suicidality. Given the diversity of research in this area, the clear clinical implications, and the importance of advancing knowledge and understanding in this area, a review that focuses on this relationship is overdue. Therefore, this systematic review was carried out in order to determine and clarify the relationship between IPA and suicidality.
Section snippets
Selection of studies
A literature review of the three main psychological and medical databases was conducted: Psychinfo (1887—March 2011), Medline (1966—March 2011), and Web of Knowledge (1981—March 2011). Key word searches using the following terms were employed: (i) suicid* and domestic or partner and violen* or abuse; (ii) self-harm and domestic or partner and violen* or abuse; (iii) self-injur* and domestic or partner and violen* or abuse; (iv) parasuicid* and domestic or partner and violen* or abuse; (v)
Cross-sectional studies
The majority of the studies (n = 23) were cross-sectional (see Table 1). Thirteen of these studies were conducted with general population samples, with two of these studies recruiting participants from IPA shelters (⁎Weaver et al., 2007, ⁎Wingood et al., 2000). All of these studies were conducted out with the UK, with the majority (n = 7) being carried out in the USA. Only two of these studies utilised a sample including both sexes (⁎Afifi et al., 2009, ⁎Calder et al., 2010), with the others using
Discussion
With only one exception (Back et al., 1982), all of the studies found an association between IPA and suicidality. Importantly, this relationship held irrespective of method, sample and measurement of IPA and suicidality. Consequently, the degree of consistency in findings across these studies confirms a strong relationship between IPA and suicidality.
All of the studies made a significant contribution to our understanding of the relationship between IPA and suicidality. Some key findings had
Conclusion
Despite the variability among the studies, the consistency of the findings serves to demonstrate the strong relationship between IPA and suicidality. The studies reviewed have made a significant contribution to our understanding of this relationship, and taken together, their findings show the importance of continuing to develop this understanding and exploring the relationship between IPA and suicidality in greater depth.
Declaration of interest
The authors have declared none.
Acknowledgements
This research is funded by the Economic and Social Research Council.
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Indicates those studies that were included in the systematic review.