Mental disorders and intimate partner violence perpetrated by men towards women: A Swedish population-based longitudinal study

Abstract

Background

Intimate partner violence (IPV) against women is associated with a wide range of adverse outcomes. Although mental disorders have been linked to an increased risk of perpetrating IPV against women, the direction and magnitude of the association remain uncertain. In a longitudinal design, we examined the association between mental disorders and IPV perpetrated by men towards women in a population-based sample and used sibling comparisons to control for factors shared by siblings, such as genetic and early family environmental factors.

Methods and findings

Using Swedish nationwide registries, we identified men from 9 diagnostic groups over 1998–2013, with sample sizes ranging from 9,529 with autism to 88,182 with depressive disorder. We matched individuals by age and sex to general population controls (ranging from 186,017 to 1,719,318 controls), and calculated the hazard ratios of IPV against women. We also estimated the hazard ratios of IPV against women in unaffected full siblings (ranging from 4,818 to 37,885 individuals) compared with the population controls. Afterwards, we compared the hazard ratios for individuals with psychiatric diagnoses with those for siblings using the ratio of hazard ratios (RHR). In sensitivity analyses, we examined the contribution of previous IPV against women and common psychiatric comorbidities, substance use disorders and personality disorders. The average follow-up time across diagnoses ranged from 3.4 to 4.8 years. In comparison to general population controls, all psychiatric diagnoses studied except autism were associated with an increased risk of IPV against women in men, with hazard ratios ranging from 1.5 (95% CI 1.3–1.7) to 7.7 (7.2–8.3) ( p-values < 0.001). In sibling analyses, we found that men with depressive disorder, anxiety disorder, alcohol use disorder, drug use disorder, attention deficit hyperactivity disorder, and personality disorders had a higher risk of IPV against women than their unaffected siblings, with RHR values ranging from 1.7 (1.3–2.1) to 4.4 (3.7–5.2) ( p-values < 0.001). Sensitivity analyses showed higher risk of IPV against women in men when comorbid substance use disorders and personality disorders were present, compared to risk when these comorbidities were absent. In addition, increased IPV risk was also found in those without previous IPV against women. The absolute rates of IPV against women ranged from 0.1% to 2.1% across diagnoses over 3.4 to 4.8 years. Individuals with alcohol use disorders (1.7%, 1,406/82,731) and drug use disorders (2.1%, 1,216/57,901) had the highest rates. Our analyses were restricted to IPV leading to arrest, suggesting that the applicability of our results may be limited to more severe forms of IPV perpetration.

Conclusions

Our results indicate that most of the studied mental disorders are associated with an increased risk of perpetrating IPV towards women, and that substance use disorders, as principal or comorbid diagnoses, have the highest absolute and relative risks. The findings support the development of IPV risk identification and prevention services among men with substance use disorders as an approach to reduce the prevalence of IPV.

Abstract

In a longitudinal study, Fazel and colleagues investigate the risk of intimate partner violence toward women in men with mental and substance use disorders in the Swedish population.

Author summary

Why was this study done?

• Intimate partner violence (IPV) perpetrated by men towards women is a global public health challenge and is associated with a range of poor outcomes in victims.

• One of the risk factors for IPV perpetration is mental disorders, but the nature and strength of the links with these disorders is uncertain, as previous studies typically measured the presence of mental disorders and perpetration of IPV at the same time, were based on small numbers, relied on self-report measures of IPV, and did not fully consider confounding factors including genetic and early family environmental factors.

What did the researchers do and find?

• We identified men with common psychiatric disorders from a population-based sample, and compared their risk of IPV against women with that of age- and sex-matched general population controls, and also with that of their unaffected siblings to account for possible confounding familial factors.

• The absolute rate of IPV against women ranged from 0.1% for men with autism to 2.1% for men with drug use disorders. Most of the studied mental disorders were associated with a higher risk of IPV against women. The risk increase was 2 to 8 times compared with the general population and 2- to 4-fold compared with unaffected siblings.

• The highest absolute rates and relative risks for IPV perpetration were found in men with substance use disorders, and substance use comorbidity was associated with an elevated risk of IPV in other mental disorders.

What do these findings mean?

• We found that several common mental disorders are associated with increased risk of IPV against women, and the risk is further elevated when there is a comorbidity with substance use disorders.

• Prevention and intervention programs should consider prioritizing assessment and treatment of IPV perpetration among individuals with psychiatric disorders, particularly those with alcohol and drug use disorders.

• Although the relative risk of IPV against women was higher in men with mental disorders, absolute rates of IPV were low. To reduce IPV against women, other modifiable risk factors need to be addressed.