JMIR Publications

ABSTRACT

Background:

Violence against women (VAW) is a severe risk factor for mental health. However, the association between specific VAW form and mental health, particularly among left-behind women in rural China, remains underexplored. The roles of resilience and social support in this association also remain unclear.

Objective:

This study aimed to identify the association of VAW with depressive, anxiety and comorbid symptoms, and to explore the potential roles of resilience and social support.

Methods:

The cross-sectional survey was conducted in Y City, Henan Province, China, in July 2023. A multi-stage stratified random sampling method was used to recruit left-behind women. Data on participants and their VAW were collected through a face-to-face questionnaire survey. The forms of VAW assessed were non-partner violence (NPV) and intimate partner violence (IPV), which also contained remote-IPV. Depressive symptoms were assessed by the 10-item Center for Epidemiological Studies Depression Scale and anxiety symptoms were assessed by Generalized Anxiety Disorder-7. The comorbid symptoms of depression and anxiety (CDA) were ascertained as the simultaneous presence of depressive and anxiety symptoms. Multivariable logistic regression model was employed to estimate odds ratio (OR) and 95% confidence interval (CI) of these mental health outcomes with VAW and its forms. A four-way decomposition analysis was conducted to test for mediation roles and interactions of resilience and social support between VAW and mental health outcomes. Population attributable fraction (PAF) and pathway-specific population attributable fraction (PS-PAF) were calculated to demonstrate the burden of mental health outcomes attributable to VAW.

Results:

Among 1,503 rural left-behind women included, participants’ median age was 52.0 (IQR: 43.0-57.0) years. Lifetime VAW (aOR:1.84, 95%CI: 1.32-2.54, P<0.001) was associated with an increased risk of CDA. Women who were exposed to lifetime IPV (aOR:1.84, 95%CI: 1.32-2.56, P<0.001), remote-IPV (aOR:2.79, 95%CI: 1.60-4.74, P<0.001), NPV (aOR:2.63, 95%CI: 1.58-4.26, P<0.001) had increased likelihood of reporting CDA. Similar associations could also be found for depressive symptoms and anxiety symptoms. In the four-way decomposition analysis for VAW and CDA, mediation effects of low resilience and social support were statistically significant (P<0.05), whereas none of the interactions reached significance (P>0.05). The pure mediation proportion was 28.2% of the low resilience and 18.6% of the social support between VAW and CDA. A total of 20.8% (95%CI: 18.2-23.4%) of CDA cases, 15.1% (95%CI:12.9%-17.3%) of depressive symptoms cases, and 22.7% (95%CI:20.1%-25.3%) of anxiety symptoms cases were attributable to VAW. Among these, low resilience accounted for 7.2% (95% CI: 4.7-10.5%) and low social support accounted for 4.7% (95% CI: 1.6-7.6%) of CDA cases as mediators.

Conclusions:

Lifetime VAW and its forms (IPV [including remote-IPV] and NPV), show higher rates of mental health issues, including CDA as well as depressive and anxiety symptoms among rural left-behind women. The associations are partly mediated by low resilience and social support. These findings emphasize the strategies targeting on VAW to improve mental health. Providing care services to better improve resilience and social support is crucial for rural left-behind women.