Intimate partner violence health and social support Findings

Intimate partner violence, health and social support: Findings over the long term Dr Deborah Loxton ALSWH Deputy Director Jennifer Powers & Karly Furber

Overview • Background: Australian Longitudinal Study on Women’s Health • Aims & data • Cross sectional and sequential cross sectional analyses • Time since intimate partner violence occurred • Impact of social support • Limitations & strengths • Future plans

University of Newcastle Co-Director Professor Julie Byles Deputy Director Dr Deborah Loxton Statisticians Ms Jenny Powers Ms Xenia Dolja-Gore Data Manager Mrs Anna Graves Data Assistants Mr Ashutosh Kabra Executive Officer Mrs Lyn Adamson Research/ Communications Mrs Catherine Chojenta Research Assistant Ms Jenny Helman Administrative Officer Mrs Melanie Moonen Project Assistants Ms Laura Croger Ms Nicola Evans Ms Jane Rich Ms Megan Wilson University of Queensland Director Professor Annette Dobson Deputy Director Dr Jayne Lucke Research Fellows Dr Leigh Tooth Dr Janneke Berecki Data Manager Mr David Fitzgerald Research Project Manager Ms Megan Ferguson Administrative Officer Ms Leonie Gemmell Research Assistants / Statisticians Mr Sam Brilleman Ms Melissa Johnstone Ms Danielle Herbert Mr Richard Hockey Ms Melanie Spallek Ms Melanie Watson

ALSWH • Longitudinal cohort study of the health and well-being of Australian women • Designed to run for at least 20 years (1996 - 2015+) • Funded by Australian Government Department of Health & Ageing

Aim and purpose To determine the social, psychological, physical and environmental factors which determine good health, and those which cause ill-health, in women throughout adult life. To contribute to the development of policy and practice in key areas for women’s health.

Method • Over 40, 000 women • Mailed survey • Sampled randomly from Medicare Australia (national insurance) database • Systematic over-sampling in rural/remote areas Note: Medicare Australia provides health insurance for all permanent residents in Australia

The Australian Longitudinal Study on Women’s Health ALSWH Cohorts 1921 -26 Cohort Aged 70 -75 in 1996 now aged 83 -88 1973 -78 Cohort Aged 18 -23 in 1996 now aged 31 -36 1946 -51 Cohort Aged 45 -50 in 1996 now aged 58 -63

Design 1996 1973 -78 cohort 1946 -51 cohort 1921 -26 cohort Survey 18 -23 45 -50 (N=13 716) 70 -75 S 1 73 -78 S 2 76 -81 S 3 79 -84 S 4 82 -87 S 5 1998 47 -52 (N=12 338) 1999 2000 22 -27 2001 50 -55 (N=11 200) 2002 2003 25 -30 2004 53 -58 (N=10 905) 2005 2006 28 -33 2007 56 -61 (10 638) 2008 2009 31 -36

ALSWH data • Quantitative – Validated scales (eg SF-36, CES-D) – ALSWH questions • Qualitative – ‘Have we missed anything? ’ – 10 440 comments from 5871 participants (Surveys 1 to 4 of 1946 -51 cohort)

ALSWH 1973 -78 cohort Results: • Miscarriage • Vaginal discharge • STI • Poor physical and mental health Work in progress: • CAS validation • Longitudinal analysis of health and IPV onset • Longitudinal analysis of type of abuse and health outcomes Taft A, Watson L & Lee C. Violence against young Australian women and association with reproductive events: A cross sectional analysis of a national population sample. Australian and New Zealand Journal of Public Health , 2004; 28(4): 324 -329.

ALSWH results: 1946 -51 cohort • • • Surgical menopause, cervical cancer Inadequate Pap testing High levels of symptoms, chronic conditions Depression, anxiety High use of health services Poor physical and mental health Loxton D, Powers J, Schofield M, Hussain R, Hosking S. Inadequate cervical cancer screening among mid-aged Australian women who have experienced partner violence. Preventive Medicine, 2009, 48 (2), 184 -188. Loxton D, Schofield M, Hussain R & Mishra G. History of domestic violence and physical health in mid-life. Violence Against Women, 2006; 12(8): 715 -731. Loxton D, Schofield M & Hussain R. Psychological health in midlife among women who have ever lived with a violent partner or spouse. Journal of Interpersonal Violence, 2006; 21(8): 1092 -1107. Loxton D, Schofield M & Hussain R. History of domestic violence and health service use among mid-aged Australian women. Australian and New Zealand Journal of Public Health, 2004; 28(4): 383 -388.

Research aims • To examine the long-term health impact of IPV over an 11 year period • To determine the changes in mental health over an 11 year period that are attributable to IPV • To determine the effects of social support on the association between mental health and IPV

Data • 1946 -51 cohort from 1996, 1998, 2001, 2004 and 2007 • Lived with a violent partner spouse • Grouped: – Living with a violent partner at each survey – Time since last experienced IPV

Intimate partner violence Age Ever experienced IPV (%) 45 -50 years 12. 9 47 -52 years 13. 9 50 -55 years 14. 4 53 -58 years 14. 7 56 -61 years 15. 0 • 10 315 women who completed Survey 5 • Adjusted for oversampling in rural/remote areas • National estimate of lifetime IPV prevalence: 23%

Characteristics: Relationship status

Characteristics: Education

Characteristics: Percentage of women able to manage on their income

Characteristics: Percentage of women who smoked tobacco

Other characteristics • No differences in age • Women who experienced IPV more likely to experience surgical menopause

Cross sectional analysis: General health • 1996 – Never IPV: 74. 6 – Ever IPV: 67. 6 • 2007 – Never IPV: 72. 7 – Ever IPV: 64. 6 SF-36 – higher scores reflect better health

Cross sectional analysis: Mental health

Health over time My health has improved enormously this year…I am fully integrated now after working through the abuse. I have only some emotional issues sometimes when something reawakens some past experience, but that's quite manageable.

Health over time Since I have made the final break with my violent husband, my depression and general outlook on life have improved dramatically.

Health over time My husband has had a violent temper throughout the thirty years of our marriage and has been serially unfaithful. I had finally had enough and left in November 2000. I have been feeling lonely, guilty and downhearted.

Other related events I left my husband in 2003. He abused me both verbally and physically…I’d say I've had more mental stress and I do drink more…My husband is still avoiding a final settlement. Financially it is very difficult…It is very emotionally stressful after coming out of a bad relationship. It took so much courage to walk out and leave a business I started. I'm 55 years and feel alone and old!

Characteristics and time since IPV: Relationship status Years since IPV

Characteristics and time since IPV: Percentage of women able to manage on their income Years since IPV

Characteristics: Percentage of women who smoke tobacco

Mental health in 2007 and time since IPV 80 70 Mental health 60 50 no IPV 12 or more 9 -11 6 -8 Years since IPV 3 -5 0 -2

Time since IPV by mental health (unadjusted)

Time since IPV by mental health (unadjusted)

Time since IPV by mental health (unadjusted)

Time since IPV by mental health (unadjusted)

Time since IPV by mental health (unadjusted)

Time since IPV by mental health (adjusted) Mental health 80 70 60 50 1111111111111111111111111111111111111111111111111111111111111111111111111111111111 22222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222 9999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999 000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000 6666666666666666666667777777777777777777778888888888888888888889999999999999999999990000000000000000000001111111111111111111112222222222222222222223333333333333333333334444444444444444444445555555555555555555556666666666666666666667 no IPV 0 -5 6 -8 9 -11 12 or more

Social support Marriage break up, very violent assault on my self, lots of court appearances, very distressing. I coped with exercise, professional counselling, my children (all adult), a new circle of friends.

Measuring social support in the ALSWH • 1998, 2004 & 2007 • MOS Social Support Scale

Mental health in 1998, 2004 & 2007 (unadjusted) 80 70 Mental health 60 50 1998 1999 2000 2001 no IPV 0 -5 2002 2003 Years since IPV 6 -8 9 -11 2004 12 or more 2005 2006 2007

Mental health adjusted for demographics 80 70 Mental health 60 50 1998 1999 2000 2001 no IPV 0 -5 2002 2003 Years since IPV 6 -8 9 -11 2004 12 or more 2005 2006 2007

Mental health adjusted for demographics & social support 80 70 Mental health 60 50 1998 1999 2000 2001 no IPV 0 -5 2002 2003 Years since IPV 6 -8 9 -11 2004 12 or more 2005 2006 2007

Limitations and strengths • • • Measure of IPV Self report Before 1996? Time Severity • National community based sample • Longitudinal data

What next? • • Other differences Social support Work with other cohorts Linked data – Medicare (national insurer) – Pharmaceutical Benefits Scheme

Summary • Women’s mental health does improve after partner violence ceases • The improvement happens over many years • Demographics impact on mental health and on improvement of mental health • Social support impacts on mental health and is a key variable in recovery from intimate partner violence

I picked up my bags and pushed the (stroller) and I started walking and I remember it was like a strength, it was like I was empowered, all of a sudden I was absolutely empowered and I’ve never looked back. Please visit our website: www. alswh. org. au