Vulnerable and without protection: Lifetime experiences of abuse and its influence on mental ill health
Affiliation(s)
Department of Care Science, Faculty of Health and Society, Malm? Uni-versity, Malm?, Sweden; Advance Nurse in Psychiatric and Mental Health care (APNs), Faculty of Health and Society, Malm? University, Malm?, Sweden; Registered Nurse (RN), Malm? University, Faculty of Health and Society, Malm?, Sweden . Department of Criminology, Faculty of Health and Society, Malm? Uni-versity, Malm?, Sweden . Department of Care Science, Faculty of Health and Society, Malm? Uni-versity, Malm?, Sweden; Registered Nurse (RN), Malm? University, Faculty of Health and Society, Malm?, Sweden .
Department of Care Science, Faculty of Health and Society, Malm? Uni-versity, Malm?, Sweden; Advance Nurse in Psychiatric and Mental Health care (APNs), Faculty of Health and Society, Malm? University, Malm?, Sweden; Registered Nurse (RN), Malm? University, Faculty of Health and Society, Malm?, Sweden . Department of Criminology, Faculty of Health and Society, Malm? Uni-versity, Malm?, Sweden . Department of Care Science, Faculty of Health and Society, Malm? Uni-versity, Malm?, Sweden; Registered Nurse (RN), Malm? University, Faculty of Health and Society, Malm?, Sweden .
ABSTRACT
Violence against women is a major global public health issue, and experiencing violence has substantial consequences for the lives of abused women. This study aims to illustrate experiences of abuse and its influence on mental ill health among women seeking general psychiatric care. Ten women seeking general psychiatric care in southern Sweden participated in a qualitative interview study. Content analysis resulted in four categories: Living in fear that persistently influences the substance of life, living with the sense of being worthless, living with a constant question about who you are and living between hope and despair. The theme evolving from the analysis was: Being vulnerable and without protection in a frightful reality that limits one’s possibilities of living and being the person one wishes to be. The results showed that the women described their mental ill health not only in terms of depression, anxiety and suicidal ideation and self-harm, but also in relation to feelings of hope and despair, fear, worthlessness and living with a constant question about who they are. The abuse reduces freedom of action, and leads to feelings of insecurity, of not having any boundaries, isolation, and self-contempt and a need to escape. This study provides knowledge of abused women self-reported mental ill health in relation to abuse.
Cite this paper
Örmon, K. , Torstensson-Levander, M. , Sunnqvist, C. and Bahtsevani, C. (2014) Vulnerable and without protection: Lifetime experiences of abuse and its influence on mental ill health. Open Journal of Nursing, 4, 34-41. doi: 10.4236/ojn.2014.41006.
Örmon, K. , Torstensson-Levander, M. , Sunnqvist, C. and Bahtsevani, C. (2014) Vulnerable and without protection: Lifetime experiences of abuse and its influence on mental ill health. Open Journal of Nursing, 4, 34-41. doi: 10.4236/ojn.2014.41006.
References
[1] Watts, C. and Zimmerman, C. (2002) Violence against women: Global scope and magnitude. The Lancet, 359, 1232-1237. http://dx.doi.org/10.1016/S0140-6736(02)08221-1 [2] Heise, L., Ellsberg, M. and Gottemoeller, M. (1999) Ending violence against women. Johns Hopkins University School of Public Health, Center for Communications Programs, Baltimore. [3] Tjaden, P. and Thoennes, N. (2000) Full report of the prevalence, incidence, and consequences of violence against women. Findings from the national violence against women survey, Department of Justice. [4] Krug, E.G., Mercy, J.A., Dahlberg, L.L. and Zwi, A.B. (2002) The world report on violence and health. The Lancet, 360, 1083-1088.
http://dx.doi.org/10.1016/S0140-6736(02)11133-0 [5] Ellsberg, M., Jansen, H.A.F.M., Heise, L., Watts, C.H. and Garcia-Moreno, C. (2008) Intimate partner violence and women’s physical and mental health in the WHO multi-country study on women’s health and domestic violence: An observational study. The Lancet, 371, 1165-1172. http://dx.doi.org/10.1016/S0140-6736(08)60522-X [6] World Health Organization (2010) Child maltreatment, Fact sheet N°150.
http://www.who.int/mediacentre/factsheets/fs150/en/index.html [7] Afifi, T.O. (2012) The relationship between child maltreatment and Axis I mental disorders: A summary of the published literature from 2006 to 2010. Open Journal of Psychiatry, 2, 21-32.
http://www.SciRP.org/journal/ojpsych/ [8] Ellsberg, M. and Heise, L. (2005) Researching Violence against women: A practical guide for researchers and activist. World Health Organization, Washington DC. [9] Friedman, S.H. and Loue, S. (2007) Incidence and prevalence of intimate partner violence by and against women with severe mental illness. Journal of Women’s Health/ The Official Publication of the Society for the Advancement of Women’s Health, 16, 471-480. [10] Kelmendi, K. (2013) Violence against Women: Methodological and Ethical Issues. Psychology, 4, 559-565.
http://dx.doi.org/10.4236/psych.2013.47080 [11] Campbell, J.C. (2002) Health consequences of intimate partner violence. The Lancet, 359, 1331-1336.
http://dx.doi.org/10.1016/S0140-6736(02)08336-8 [12] Coker, A. (2006) Preventing intimate partner violence, how we will rise to this challenge. American Journal of Preventive Medicine, 30, 528-529.
http://dx.doi.org/10.1016/j.amepre.2006.03.002 [13] Howard, L.M., Trevillion, K. and Agnew-Davies, R. (2010) Domestic violence and mental health. International Review of Psychiatry, 22, 525-534. [14] Choudhary, E., Smith, M. and Bossarte, R.M. (2012) Depression, anxiety, and symptom profiles among female and male victims of sexual violence. American Journal of Men’s Health, 6, 28-36.
http://dx.doi.org/10.1177/1557988311414045 [15] Dillon, G., Hussain, R., Loxton, D. and Rahman, S. (2013) Mental and physical health and intimate partner violence against women: A review of the literature. International Journal of Family Medicine, 2013, 313909.
http://www.hindawi.com/journals/ijfm/2013/313909/abs/ [16] Stefansson, C. (2006) Chapter 5.5: Major public health problems—Mental ill-health. Scandinavian Journal of Public Health, 34, 87-103.
http://dx.doi.org/10.1080/14034950600677105 [17] Howard, L.M., Trevillion, K., Khalifeh, H., Woodall, A., Agnew-Davies, R. and Feder, G. (2010) Domestic violence and severe psychiatric disorders: Prevalence and interventions. Psychological Medicine, 40, 881-893.
http://dx.doi.org/10.1017/S0033291709991589 [18] Alhabib, S., Nur, U. and Jones, R. (2010) Domestic violence against Women: Systematic review of prevalence studies. Journal of Family Violence, 25, 369-382.
http://dx.doi.org/10.1007/s10896-009-9298-4 [19] Bengtsson-Tops, A., Markstrom, U. and Lewin, B. (2005) The prevalence of abuse in Swedish female psychiatric users, the perpetrators and places where abuse occurred. Nordic Journal of Psychiatry, 59,504-510.
http://dx.doi.org/10.1080/08039480500360732 [20] Oram, S., Trevillion, K., Feder, G. and Howard, L.M. (2013) Prevalence of experiences of domestic violence among psychiatric patients: A systematic review. British Journal of Psychiatry, 202, 94-99.
http://dx.doi.org/10.1192/bjp.bp.112.109934 [21] The Swedish Society of Nursing and the Swedish Association of Psychiatric and Mental Health Nurses (2012) Competence description for registered nurses specializing in psychiatric care. [22] Carretta, C.M. (2008) Domestic Violence, A worldwide exploration. Journal of Psychosocial Nursing and Mental health services, 46, 26-35.
http://dx.doi.org/10.3928/02793695-20080301-02 [23] Sundborg, E.M., Saleh-Stattin, N., Wändell, P. and Törnkvist, L. (2012) Nurses’ preparedness to care for women exposed to intimate partner violence: A quantitative study in primary health care. BioMed Central Nursing, 10, 1.
http://www.biomedcentral.com/1472-6955/11/1/ [24] Berg, B. (2008) Qualitative research for the social sciences. Pearson Education, Upper Saddle River. [25] Nilsson, G., Bengtsson-Tops, A.B. and Persson, L. (2005) Childhood abuse in Swedish female users of psychiatric services. Journal of Psychiatric and Mental Health Nursing, 12, 365-371.
http://dx.doi.org/10.1111/j.1365-2850.2005.00848.x [26] Sunnqvist, C., Westrin, A. and Traskman-Bendz, L. (2008) Suicide attempters: Biological stressmarkers and adverse life events. European Archives of Psychiatry and Clinical Neuroscience, 258, 456-462.
http://dx.doi.org/10.1007/s00406-008-0819-6 [27] Becker, K.D., Stuewig, J. and McCloskey, L.A. (2010) Traumatic stress symptoms of women exposed to different forms of childhood victimization and intimate partner violence. Journal of Interpersonal Violence, 25, 1699-1715. http://dx.doi.org/10.1177/0886260509354578 [28] Chou, K.L. (2012) Childhood sexual abuse and psychiatric disorders in middle-aged and older adults: Evidence from the 2007 adult psychiatric morbidity survey. The Journal of Clinical Psychiatry, 73, 1365-1371.
http://dx.doi.org/10.4088/JCP.12m07946 [29] Cerdá, M., DiGangi, J., Galea, S. and Koenen, K. (2012) Epidemiologic research on interpersonal violence and common psychiatric disorders: Where do we go from here? Depression and Anxiety, 29, 359-385.
http://dx.doi.org/10.1002/da.21947 [30] Bengtsson-Tops, A. andTops, D. (2007) Self-reported consequences and needs for support associated with abuse in female users of psychiatric care. International Journal of Mental Health Nursing, 16, 35-43.
http://dx.doi.org/10.1111/j.1447-0349.2006.00442.x [31] Lundgren, E., Heimer, G., Westerstrand, J. and Kalliokoski, A.M. (2001) Slagen Dam—Mäns våld mot kvinnor i jämställda Sverige—En omfångsundersökning. Fritzes Offentligapublikationer, Stockholm. [32] Scheffer-Lindgren, M. and Renck, B. (2008) It is still so deep-seated, the fear’: Psychological stress reactions as consequences of intimate partner violence. Journal of Psychiatric and Mental Health Nursing, 15, 219-228.
http://dx.doi.org/10.1111/j.1365-2850.2007.01215.x [33] Devries, K., Watts, C., Yoshihama, M., Kiss, L., Schraiber, L.B., Deyessa, N., Heise, L., Durand, J., Mbwambo, J., Jansen, H., Berhane, Y., Ellsberg, M. and Garcia-Moreno, C. (2011) Violence against women is strongly associated with suicide attempts: Evidence from the WHO multi-country study on women’s health and domestic violence against women. Social Science & Medicine, 73, 79-86.
http://dx.doi.org/10.1016/j.socscimed.2011.05.006 [34] Graneheim, U.H. and Lundman, B. (2004) Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today, 24, 105-112.
http://dx.doi.org/10.1016/j.nedt.2003.10.001
[1] Watts, C. and Zimmerman, C. (2002) Violence against women: Global scope and magnitude. The Lancet, 359, 1232-1237. http://dx.doi.org/10.1016/S0140-6736(02)08221-1 [2] Heise, L., Ellsberg, M. and Gottemoeller, M. (1999) Ending violence against women. Johns Hopkins University School of Public Health, Center for Communications Programs, Baltimore. [3] Tjaden, P. and Thoennes, N. (2000) Full report of the prevalence, incidence, and consequences of violence against women. Findings from the national violence against women survey, Department of Justice. [4] Krug, E.G., Mercy, J.A., Dahlberg, L.L. and Zwi, A.B. (2002) The world report on violence and health. The Lancet, 360, 1083-1088.
http://dx.doi.org/10.1016/S0140-6736(02)11133-0 [5] Ellsberg, M., Jansen, H.A.F.M., Heise, L., Watts, C.H. and Garcia-Moreno, C. (2008) Intimate partner violence and women’s physical and mental health in the WHO multi-country study on women’s health and domestic violence: An observational study. The Lancet, 371, 1165-1172. http://dx.doi.org/10.1016/S0140-6736(08)60522-X [6] World Health Organization (2010) Child maltreatment, Fact sheet N°150.
http://www.who.int/mediacentre/factsheets/fs150/en/index.html [7] Afifi, T.O. (2012) The relationship between child maltreatment and Axis I mental disorders: A summary of the published literature from 2006 to 2010. Open Journal of Psychiatry, 2, 21-32.
http://www.SciRP.org/journal/ojpsych/ [8] Ellsberg, M. and Heise, L. (2005) Researching Violence against women: A practical guide for researchers and activist. World Health Organization, Washington DC. [9] Friedman, S.H. and Loue, S. (2007) Incidence and prevalence of intimate partner violence by and against women with severe mental illness. Journal of Women’s Health/ The Official Publication of the Society for the Advancement of Women’s Health, 16, 471-480. [10] Kelmendi, K. (2013) Violence against Women: Methodological and Ethical Issues. Psychology, 4, 559-565.
http://dx.doi.org/10.4236/psych.2013.47080 [11] Campbell, J.C. (2002) Health consequences of intimate partner violence. The Lancet, 359, 1331-1336.
http://dx.doi.org/10.1016/S0140-6736(02)08336-8 [12] Coker, A. (2006) Preventing intimate partner violence, how we will rise to this challenge. American Journal of Preventive Medicine, 30, 528-529.
http://dx.doi.org/10.1016/j.amepre.2006.03.002 [13] Howard, L.M., Trevillion, K. and Agnew-Davies, R. (2010) Domestic violence and mental health. International Review of Psychiatry, 22, 525-534. [14] Choudhary, E., Smith, M. and Bossarte, R.M. (2012) Depression, anxiety, and symptom profiles among female and male victims of sexual violence. American Journal of Men’s Health, 6, 28-36.
http://dx.doi.org/10.1177/1557988311414045 [15] Dillon, G., Hussain, R., Loxton, D. and Rahman, S. (2013) Mental and physical health and intimate partner violence against women: A review of the literature. International Journal of Family Medicine, 2013, 313909.
http://www.hindawi.com/journals/ijfm/2013/313909/abs/ [16] Stefansson, C. (2006) Chapter 5.5: Major public health problems—Mental ill-health. Scandinavian Journal of Public Health, 34, 87-103.
http://dx.doi.org/10.1080/14034950600677105 [17] Howard, L.M., Trevillion, K., Khalifeh, H., Woodall, A., Agnew-Davies, R. and Feder, G. (2010) Domestic violence and severe psychiatric disorders: Prevalence and interventions. Psychological Medicine, 40, 881-893.
http://dx.doi.org/10.1017/S0033291709991589 [18] Alhabib, S., Nur, U. and Jones, R. (2010) Domestic violence against Women: Systematic review of prevalence studies. Journal of Family Violence, 25, 369-382.
http://dx.doi.org/10.1007/s10896-009-9298-4 [19] Bengtsson-Tops, A., Markstrom, U. and Lewin, B. (2005) The prevalence of abuse in Swedish female psychiatric users, the perpetrators and places where abuse occurred. Nordic Journal of Psychiatry, 59,504-510.
http://dx.doi.org/10.1080/08039480500360732 [20] Oram, S., Trevillion, K., Feder, G. and Howard, L.M. (2013) Prevalence of experiences of domestic violence among psychiatric patients: A systematic review. British Journal of Psychiatry, 202, 94-99.
http://dx.doi.org/10.1192/bjp.bp.112.109934 [21] The Swedish Society of Nursing and the Swedish Association of Psychiatric and Mental Health Nurses (2012) Competence description for registered nurses specializing in psychiatric care. [22] Carretta, C.M. (2008) Domestic Violence, A worldwide exploration. Journal of Psychosocial Nursing and Mental health services, 46, 26-35.
http://dx.doi.org/10.3928/02793695-20080301-02 [23] Sundborg, E.M., Saleh-Stattin, N., Wändell, P. and Törnkvist, L. (2012) Nurses’ preparedness to care for women exposed to intimate partner violence: A quantitative study in primary health care. BioMed Central Nursing, 10, 1.
http://www.biomedcentral.com/1472-6955/11/1/ [24] Berg, B. (2008) Qualitative research for the social sciences. Pearson Education, Upper Saddle River. [25] Nilsson, G., Bengtsson-Tops, A.B. and Persson, L. (2005) Childhood abuse in Swedish female users of psychiatric services. Journal of Psychiatric and Mental Health Nursing, 12, 365-371.
http://dx.doi.org/10.1111/j.1365-2850.2005.00848.x [26] Sunnqvist, C., Westrin, A. and Traskman-Bendz, L. (2008) Suicide attempters: Biological stressmarkers and adverse life events. European Archives of Psychiatry and Clinical Neuroscience, 258, 456-462.
http://dx.doi.org/10.1007/s00406-008-0819-6 [27] Becker, K.D., Stuewig, J. and McCloskey, L.A. (2010) Traumatic stress symptoms of women exposed to different forms of childhood victimization and intimate partner violence. Journal of Interpersonal Violence, 25, 1699-1715. http://dx.doi.org/10.1177/0886260509354578 [28] Chou, K.L. (2012) Childhood sexual abuse and psychiatric disorders in middle-aged and older adults: Evidence from the 2007 adult psychiatric morbidity survey. The Journal of Clinical Psychiatry, 73, 1365-1371.
http://dx.doi.org/10.4088/JCP.12m07946 [29] Cerdá, M., DiGangi, J., Galea, S. and Koenen, K. (2012) Epidemiologic research on interpersonal violence and common psychiatric disorders: Where do we go from here? Depression and Anxiety, 29, 359-385.
http://dx.doi.org/10.1002/da.21947 [30] Bengtsson-Tops, A. andTops, D. (2007) Self-reported consequences and needs for support associated with abuse in female users of psychiatric care. International Journal of Mental Health Nursing, 16, 35-43.
http://dx.doi.org/10.1111/j.1447-0349.2006.00442.x [31] Lundgren, E., Heimer, G., Westerstrand, J. and Kalliokoski, A.M. (2001) Slagen Dam—Mäns våld mot kvinnor i jämställda Sverige—En omfångsundersökning. Fritzes Offentligapublikationer, Stockholm. [32] Scheffer-Lindgren, M. and Renck, B. (2008) It is still so deep-seated, the fear’: Psychological stress reactions as consequences of intimate partner violence. Journal of Psychiatric and Mental Health Nursing, 15, 219-228.
http://dx.doi.org/10.1111/j.1365-2850.2007.01215.x [33] Devries, K., Watts, C., Yoshihama, M., Kiss, L., Schraiber, L.B., Deyessa, N., Heise, L., Durand, J., Mbwambo, J., Jansen, H., Berhane, Y., Ellsberg, M. and Garcia-Moreno, C. (2011) Violence against women is strongly associated with suicide attempts: Evidence from the WHO multi-country study on women’s health and domestic violence against women. Social Science & Medicine, 73, 79-86.
http://dx.doi.org/10.1016/j.socscimed.2011.05.006 [34] Graneheim, U.H. and Lundman, B. (2004) Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today, 24, 105-112.
http://dx.doi.org/10.1016/j.nedt.2003.10.001