Indian Journal of Psychological Medicine

GUEST EDITORIAL
Year
: 2018  |  Volume : 40  |  Issue : 6  |  Page : 507--508

Mental health implications of elder abuse and domestic violence


Pankajakshan Vijayanthi Indu 
 Department of Psychiatry, Government Medical College, Kozhikode, Kerala, India

Correspondence Address:
Dr. Pankajakshan Vijayanthi Indu
Department of Psychiatry, Government Medical College, Kozhikode, Kerala
India




How to cite this article:
Indu PV. Mental health implications of elder abuse and domestic violence.Indian J Psychol Med 2018;40:507-508


How to cite this URL:
Indu PV. Mental health implications of elder abuse and domestic violence. Indian J Psychol Med [serial online] 2018 [cited 2019 Jul 17 ];40:507-508
Available from: http://www.ijpm.info/text.asp?2018/40/6/507/245091


Full Text



Elder abuse and domestic violence (DV) are major social issues, which are often ignored. Families are expected to develop emotional bonding between their members and be the source of support for them. However, often families witness scenes of violence either between couples or between parents and their offspring. DV can be defined narrowly as intimate partner violence (IPV) with the focus primarily on younger women. Elder abuse refers to abuse of elderly by multiple types of abusers, some of whom are domestic partners and children.

The global population is aging rapidly, and so is the Indian population. According to the 2011 Census, the proportion of elderly people constitutes 8.6% of the total population and is expected to reach 20% by 2050. Increasing longevity is associated with increased morbidity, leading to a rise in the dependent older population.[1] Being physically, socially, and economically dependent adds to the risk of exposure to abuse. The HelpAge India, in a survey conducted in persons age 60 years and older, found that nearly one-fourth (25%) were victims of elder abuse. Disrespect, verbal abuse, and neglect were the most common forms of psychological abuse (∼50%), whereas beating or slapping was reported by 12%. The abusers were most commonly sons (52%) and daughters-in-law (34%).[2] Elder abuse can result in not only physical morbidity but also more psychological distress and morbidity, including depressive and anxiety disorders. On the contrary, psychiatric morbidities such as depression can be a risk factor for elder abuse.[3]

A hospital-based study by Patel et al., published in this issue, has looked at the prevalence and predictors of abuse in elderly patients with depression. According to the study, the prevalence of abuse was 24%, of which psychological abuse was more common (50%) than physical abuse (4%). Abuse was reported by about 54% of those with severe depression. The perpetrators were mostly daughters-in-law and sons. Illiteracy and severe depression were found to be the risk factors for elder abuse.[4] The bidirectional relationship between depression and elder abuse is also discussed. This highlights the need for longitudinal studies to assess whether depression leads to elder abuse or vice versa.

Violence against women is a human rights abuse and a public health issue with substantial consequences for women's physical, mental, sexual, and reproductive health. The World Health Organization's multicountry study on women's health and DV against women found the lifetime prevalence of DV to vary from 15% to 71%.[5] In a study conducted by the Indian Clinical Epidemiology Network to assess DV in Indian women, 40% reported experiencing “any violence” during their marriage. DV was significantly associated with increased risk of poor mental health in these women.[6]

Two articles assessing DV in an Indian setting are included in this issue. Nadda et al., in a community-based, cross-sectional study conducted in Haryana, assessed the prevalence and characteristics of DV and injuries because of DV among married women. Almost one-third of the sample had ever experienced DV, whereas around 30% currently experienced DV. A comparison between rural and urban areas revealed that all types of DV, except sexual violence, were significantly more in the rural area. More than half of the women had sustained injuries because of DV. Interestingly, the study found that women scarcely initiated violence against their husbands.[7]

In a hospital-based, cross-sectional study, Bondade et al. assessed the prevalence of IPV and psychiatric comorbidity among women age 18–45 years with primary infertility. IPV was observed in 50% and psychiatric comorbidity in 46% of the sample. IPV was found to be significantly higher in those with psychiatric comorbidity.[8] The relationship between IPV and depression is more likely to be bidirectional, whereas that between IPV, infertility, and psychiatric comorbidity is more complex and confounded by various sociodemographic and clinical variables. The role of stress—because of stressors such as IPV—in inducing neuroendocrine changes, which could, in turn, lead to infertility and psychiatric morbidity, needs further exploration.

The social evil of abuse—experienced by elderly or women—in a domestic setting has an impact on the mental health of the victims. Clinicians have to be sensitized to the need for assessing exposure to abuse in the older people and women whom they evaluate in their clinics routinely. The mental health sequelae of abuse have to be looked for and addressed in these populations. Measures have to be taken to create awareness among elderly, women, and their family members regarding the legal and social support measures available to them to address this issue.

References

1Central Statistics Office, Government of India. Elderly in India—Profile and Programmes 2016. New Delhi: Government of India; 2016.
2Elder abuse in India—2018: A HelpAge India Report—2018. Available from: https://www.helpageindia.org/wp-content/uploads/2018/06/ELDER-ABUSE-IN-INDIA-2018-A-HelpAge-India-report.pdf. [Last accessed on 2018 Oct 18].
3Dong X, Chen R, Chang E-S, Simon M. Elder abuse and psychological well-being: A systematic review and implications for research and policy—A mini review. Gerontology 2013;59:132-42.
4Patel VK, Tiwari DS, Shah VR, Patel MG, Raja HH, Patel DS. Prevalence and predictors of abuse in elderly patients with depression at a tertiary care centre in saurashtra, India. Indian J Psychol Med 2018;40:528-33.
5Garcia-Moreno C, Jansen HAFM, Ellsberg M, Heise L, Watts CH. Prevalence of intimate partner violence: Findings from the WHO multi-country study on women's health and domestic violence. Lancet 2006;368:1260-9.
6Kumar S, Jeyaseelan L, Suresh S, Ahuja RC. Domestic violence and its mental health correlates in Indian women. Br J Psychiatry 2005;187:62-7.
7Nadda A, Malik JS, Rohilla R, Chahal S, Chayal V, Arora V. Study of domestic violence among currently married females of Haryana, India. Indian J Psychol Med 2018;40:534-9.
8Bondade S, Iyengar RS, Shivakumar BK, Karthik KN. Intimate partner violence and psychiatric comorbidity in infertile women - A cross-sectional hospital based study. Indian J Psychol Med 2018;40:540-6.