Health Impacts of Violent Victimization

While the consequences of crime and experiences of victims are all different, there is growing evidence of the links between violent victimization and mental and physical health. Physical injuries and death are the most obvious consequences of violence, but there are more prevalent consequences that are increasingly being recognized. This fact sheet outlines some of these health impacts that may be faced by women and their children who suffer violent victimization.The focus is on intimate partner violence (IPV) and children witnessing violence, as this is where most of the literature is directed¹.

Health Impacts for Women²

Some of the physical health problems associated with IPV exposure include chronic pain, disability, fibromyalgia, gastrointestinal disorders, irritable bowel syndrome, sleep disorders and general reductions in physical functioning/health-related life quality. Recent analyses indicate that IPV may be associated with cardiac disease.

Mental health problems associated with IPV mirror those associated with sexual assault, and include depression, anxiety disorders (especially PTSD), protracted disabling sleep disorders, phobias and panic disorder, psychosomatic disorders, and suicidal behaviour and self-harm, eating disorders, substance dependence, antisocial personality disorders, and nonaffective psychosis.

IPV is also associated with gynaecological disorders, infertility, pelvic inflammatory disease, pregnancy complications/miscarriage, sexual dysfunction, sexually transmitted diseases, including HIV/AIDS, unsafe abortion, and unwanted pregnancy.

For female victims of sexual assault, a small proportion result in physical injury. These injuries may impact reproductive health, including pregnancy and gynaecological complications (vaginal bleeding or infection, fibroids, decreased sexual desire, genital irritation, pain during intercourse, chronic pelvic pain and urinary tract infections), along with sexually transmitted diseases, including HIV infection.

Health Impacts for Children

Children who witness IPV or are victims of child sexual abuse may be impaired in many domains, including mental health, physical health, education, criminal behaviour and interpersonal functioning.

Sexual abuse of girls is associated with both short- and long-term negative effects on mental health, depending on the severity, persistence, and presence of risk and protective factors, both genetic and environmental. These impacts can continue into adulthood, as studies show among adult women, there is strong evidence of significant associations between CSA and depression, PTSD, panic disorder, drug and alcohol dependence and suicide attempts.

CSA is a non-specific risk factor for both internalizing and externalizing disorders in girls and adult women; it is associated with neurobiological dysregulation in both child- and adulthood including alterations in the hypothalamic-pituitary-adrenal (HPA) axis, the sympathetic nervous system and more recently, the immune system.

For victims of multiple forms of child maltreatment the short term consequences can include: bed-wetting, nightmares, and social withdrawal. The longer term effects can include:

• physical health impairment, including chronic obstructive pulmonary disease (COPD), ischemic heart disease (IHD), liver disease, sexually transmitted diseases (STDs), fetal death, and unintended and adolescent pregnancies;
• mental health impairment including depression, suicide attempts, sleep disorders, and health-related quality of life; and
• health risk behaviours including alcoholism and alcohol abuse, illicit drug use, risk for intimate partner violence, multiple sexual partners, smoking and early initiation of smoking, and early initiation of sexual activity.

Sources

• AuCoin, K., Beauchamp, D. (2007). Impacts and Consequences of Victimization, GSS 2004. Juristat. Statistics Canada, Canadian Centre for Justice Statistics. Catalogue no. Catalogue no. 85-002-XIE, Vol. 27, no. 1. Accessed April 25, 2012: http://publications.gc.ca/Collection-R/Statcan/85-002-XIE/85-002-XIE2007001.pdf.
• Basile KC, Arias I, Desai S, Thompson MP. (2004). The differential association of intimate partner physical, sexual, psychological, and stalking violence and posttraumatic stress symptoms in a nationally representative sample of women. Journal of Traumatic Stress, 17(5):413-421.
• Evans SE, Davies C, DiLillo D. (2008). Exposure to domestic violence: A meta-analysis of child and adolescent outcomes. Aggressive and Violent Behavior, 13:131-40.
• Jordan CE, Campbell R, Follingstad D. (2010). Violence and women's mental health: the impact of physical, sexual, and psychological aggression. Annu Rev Clin Psychol., 6:607-28.
• Krug EG, Dahlberg LL, Mercy JA, Zwi AB, Lozano R (Eds) (2002). World Report on Violence and Health.; Geneva: World Health Organization.
• Gilbert R, Widom CS, Browne K, Fergusson D, Webb E, Janson S. (2009). Burden and consequences of child maltreatment in high-income countries. Lancet, 373:68-81.
• Kitzmann KM, Gaylord NK, Holt AR, Kenny ED. (2003). Child witnesses to domestic violence: A meta-analytic review. Journal of Consulting and Clinical Psychology, 71:339-52.
• Nunes SOV, Watanabe MAE, Morimoto HK, Moriya R, Reiche EMV. (2010). Impact of childhood sexual abuse on activation of immunological and neuroendocrine response. Aggressive & Violent Behavior, 15(6):440-5.
• Osofsky JD. (2003). Prevalence of children’s exposure to domestic violence and child maltreatment: Implications for prevention and intervention. Clinical Child and Family Psychology Review, 6:161-70.
• Public Health Agency of Canada. (2010). Canadian Incidence Study of Reported Child Abuse and Neglect – 2008: Major Findings. Ottawa.
• World Health Organization (2005). WHO multi-country study on women’s health and domestic violence against women: summary report of initial results on prevalence, health outcomes and women’s responses. Geneva: WHO.
• Adverse Childhood Experiences (ACE) Study. http://www.cdc.gov/ace/index.htm

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• ¹ This fact sheet is compiled from a Justice Canada unpublished report: Wathen, Nadine. 2012. Health Impacts of Violent Victimization on Women and Their Children. Department of Justice Canada. Unpublished report.
• ² For Aboriginal women with abuse histories, rates of these impacts, especially depression, may be higher, though Aboriginal women exposed to violence self-rate their health at the same levels as do non-Aboriginal women.