Domestic violence – a study reports from Iran

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Domestic violence, often known as domestic abuse or intimate partner violence (IPV), is any pattern of behaviour aimed at establishing or maintaining dominance and authority over a partner. IPV is any kind of sexual, emotional, financial, or psychological harm or threat against another person. IPV is one of the most prevalent forms of violence against women worldwide [excerpt taken from this article].

I arbore all forms of violence and in particular those directed at vulnerable individuals. Women fall easily into this category even without disability. There seems to be a different rule for women as opposed to men preordained by a male social hierarchy. It comes as no surprise a century on women continue to have less rights and equality than men.

With MS even, my experience has been that women are affected by abuse more than men, but men are not spared it. Definitely, cognitive dysfunction, disability level and age (in that order) seem to play a major role.

In a cross-sectional study from Iran using the violence against women questionnaire scores on psychological violence, economic violence, physical violence, and sexual violence were collected. In a sample of 275 married women domestic violence was ranked moderate to severe – psychological violence (53.1%), economic violence (63%), physical violence (33.6%) and sexual violence (20.4%).

Psychological violence was higher in women with more than two children (P = 0.014), women with spouse’s income less than 1190 dollars (P = 0.014), un-employed women (P = 0.023), women with educational level lower than university (P = 0.001) and women whose spouse’s education was below diploma (P = 0.045). The economic violence was significantly higher in women whose husband’s income were less than 1190 dollars (P = 0.001) and also women with lower education (P = 0.001). Physical violence was significantly higher in families that the woman was older than her husband (P = 0.004); also, the physical violence was significantly higher in women with spouse’s income less than 476 dollars (P = 0.001), women whose spouse was labourer (P = 0.001), women with low education (P = 0.001) and women whose husband’s education was low (P = 0.011). Sexual violence was higher in women older than their husband (P = 0.03), women with a lower spouse’s educational level (P = 0.024); also, the sexual violence was low in women with strong family support compared to other level of family support (P = 0.003).

In another study (much larger one) performed in New Zealand comprising of 2888 women and men, those with any disability reported significantly higher rates abuse in both genders, including physical violence and psychological and economic abuse. Women with disabilities were more likely to report experiences of sexual violence than men (range =13.5-17.1% vs 4.0%–21.2% in men). Men with intellectual disability were more likely to report physical violence than women with intellectual disability (60.5% in men and 36.0% in women). If you want to read further on this please follow the link Lifetime Prevalence of Intimate Partner Violence and Disability: Results From a Population-Based Study in New Zealand – American Journal of Preventive Medicine (ajpmonline.org).

In my opinion human rights is a low bar to meet. Why we haven’t sorted this one out yet is frankly depressing.

Abstract

BMC Womens Health. 2022 Jul 31;22(1):321.

Domestic violence experienced by women with multiple sclerosis: a study from the North-East of Iran

Elham ManouchehriVahid Ghavami Mona LarkiMorteza SaeidiRobab Latifnejad Roudsari 

Introduction: Violence against women is a significant health and legal problem and has been declared as a health priority by the World Health Organization. The most common type of violence against women is domestic violence, more prevalent against women with disabilities than other women. Multiple sclerosis (MS) is a debilitating neurological disease and has experienced sudden growth in Iran. This study aimed to investigate the prevalence of domestic violence and its various types (psychological, economic, physical, and sexual) experienced by women with MS.

Methods: In this cross-sectional study, 275 married women with MS were selected using convenience sampling. After obtaining informed consent and reviewing the inclusion and exclusion criteria, the Domestic Violence against Women Questionnaire developed by Mohseni Tabrizi et al. was completed by the participants on a self-report basis. The results were analyzed using SPSS software version 16. To analyze data, statistical tests including chi-square and Fisher exact tests for univariate analysis and logistic regression, were employed.

Results: The mean age of participants was 37.12 ± 8.48 years. Domestic violence in different forms of psychological, economic, physical, and sexual violence was present in 53.1%, 63%, 33.6%, and 20.4% of participants, respectively. Economic violence (33.8%) was the highest, and sexual violence (5.1%) was the lowest rate of severe violence among participants. There was a significant relationship between the overall rate of domestic violence and the variables including income (P = 0.013), spouse’s income (P = 0.001), participant’s job (P = 0.036) and participant’s education (P = 0.001). In logistic regression, the overall rate of domestic violence was higher in participants with education less than a diploma than in participants with a diploma (P = 0.014) and participants with a university education (P = 0.016).

Conclusion: According to the results, providing opportunities such as promoting the social status of women, fulfilling the rights of women with disabilities and debilitating diseases such as MS in society is recommended. Additionally, educating men about the negative impact of domestic violence on the current and future status of the family seems necessary. Providing counseling facilities on various forms of violence, especially domestic violence, for women with MS, is also recommended.

About the author

Neuro Doc Gnanapavan

20 comments

  • My MS is actually a RESULT of psychological abuse and living in a house of constant chaos and turmoil. I was having symptoms I couldn’t explain. After I finally left my ex husband, I was diagnosed with MS 6 months later. I still divorced him anyway. My peace and sanity wasn’t worth my declining health. I still have to deal with him from time to time because we have minor children together, but I have more control over it, because I’m in charge of when and to what extent I have to deal with him. I don’t think people understand what some women go through in marriages or divorces where the stress from it all actually triggers their MS. Maybe do a study on that? I’m sure a lot will be revealed. Especially, women who are married to police officers, like I was. It was a brutal marriage and divorce. Thank God I’m out of that after 23 years. Unfortunately, I have MS to show for all those years of just trying to keep my family together.

    • Sorry to hear what you had to go through. Life events including divorce and loss of loved ones has been reported on as a trigger for MS, the cause being the stress.

  • “Additionally, educating men about the negative impact of domestic violence on the current and future status of the family seems necessary.”

    I think this statement shines light on cultural and legal differences regarding violence against women in particular. Domestic violence is criminal. Only when there is just prosecution will there be change. Unfortunately the rights of women and men are not equitable in some societies.

    • Completely agree. This however needs to be done out of the system. The law is ill equipped to handle this. In the UK you can do this circuitously through the DOLs (Deprivation of Liberty) safeguard but it requires the GP to be onboard.

  • Abuse isn’t always physical or obviously intentional.

    As my disability has worsened my partner wants no intimacy. We now live as just house mates. My partner is also bitter that we won’t have the retirement we planned for (we are in her mid-50s). She says things like “I’m still planning to do the world tour….”. Holidays are now too much of a faff – I get dumped in a cafe while my partner hikes up to see the castle. She now books holidays with her friends as she loves to be active – hiking, tennis, climbing. I’m happy for her to do so, but it kills me inside (I loved these things to). My partner never attends hospital appointments- finds them depressing when in the waiting room with other MSers. I don’t know how much of these is intentional, but it hurts me.

    I wonder if neuros appreciate these other impacts beyond increasing disability, job loss, loss of well-loved activities, loss of the friends you did these activities with (tennis friends, scuba diving friends). Attending a local MS society to “make new friends” is a piss poor substitute. Treatments to stop (not slow) in easing disability are so desperately needed.

    • Now this does create the need for accessible holidays. It’s not that they can’t be done and some probably already exist. I can think of Snowdon (UK) for one that has the rail access.

      • NDG,

        Nice thought, but I just want to be normal. I had 35 years of health before MS reared it’s head. I loved holidays, I loved tracking across Sulawesi, I loved diving off the Philippines. MS robs you of spontaneity. Waiting in the special assistance bit of Gatwick Airport sounds great, but I have to watch normal people happily going on holiday. It’s degrading and embarrassing. If you’ve had health and fitness, and it’s taken away from you forever (and the taking doesn’t stop) you have to re-evaluate the value of your current and future life. Electric wheelchairs, nappies and help up aircraft stairs might be fine for some, but not for me. Imagine losing all the things you love doing! No amount of CBT will ever allow me to “accept” what has happened. I miss my old life too much. A quick cancer I could deal with (I’m not scared of death), but a vet wouldn’t allow an animal to have prolonged, worsening suffering – which MS serves up.

  • My gay son was with his ex partner for almost ten years. The ex was aware of his MS diagnosis from the very first date. As disease progressed and he had additional MS symptoms to deal with and was unable to contribute half of everything, especially financially, mental and emotional abuse escalated to a point that as family we had to help get him out of the situation.

  • ‘Additionally, educating men about the negative impact of domestic violence on the current and future status of the family seems necessary. ‘

    It is complicated when the problems are psychological rather than physical, due to the abuser having a personality disorder, and an attempt to leave would be dangerous. The logistics of removing oneself from such a situation whilst having a low level of independence would be beyond difficult.

  • I’ve no doubt this is an issue, but it deflects from the real abuser – MS. MS has given me constant pain, loss of independence, loss of livelihood and a grim future. MS has destroyed the life I had / worked for a d has negatively impacted the lives of my husband and family. There’s always a lot of tension in the house – I get angry at my limitations, my lovely husband bottles his frustration up, my kids (teens) wonder why I’m different to all the other mums etc. I’ve never been abused by my husband, but MS creates a cauldron of frustration and anger, it takes a martyr not to explode.

  • I am far too young to be married, however, I was in hospital once on a neuro rehabilitation ward and I remember a bloke in an electronic wheelchair told me that his wife divorced him because she said, “I never agreed to be married to a man in a wheelchair“.

    Used to tell me about a female friend who has MS and who says friend would start affairs with other women, but she was afraid to confront him because he was a principal caregiver. The field after she felt she would have no one else to fall back on and would therefore have to tolerate his infidelity.

  • Thank you so much Dr. Gnanapavan for highlighting and writing about these two studies. MS and domestic abuse is a huge problem and is so understudied.

    I am really pleased the University of Leeds and University of Nottingham have two PhDs studying this issue right now – and a PostDoc will soon follow and work over two years on developing a toolkit to help health care professionals best identify it – and what avenues to follow to help the victim.

    • I wish Rachel, that I could feel more confident of the use of any ‘toolkit’ in this regard.
      HCPs, as we all know, are struggling to provide even the basics and input may not be face-to face anymore. I have had a new MS nurse since November last year and the provision from her is a phone call once every six months. Except for my medical notes anything she knows about me is from what I tell her during a 10-15min call.

      • I know exactly what you are saying, Fi. MS nurses (and HCPs) are under huge strain – and this is just one more thing to add – and a hugely complicated one involving so many groups (legal, social care, etc). But I figure it’s a start (ever the optimist here) and hopefully the more people are aware of this issue – the more it will be a talking point.

      • I wouldn’t waste time with the MS charities. Good at fund raising and producing leaflets. The MS Society always has big ambitions (Stop MS, Octopus trial), but they never deliver.

          • Kev sounds about right. The Octopus trial has gone quiet. I think the MS Society target was to get a drug/s in the final stages by 2024. I’m not a betting man, but bet you £400 (my monthly disability allowance) that they will miss the target by a few years + the drug/s won’t stop MS. I hope your heart op went well. Real doctors getting patients better. I’m green with envy.

          • I was on a call only yesterday and the people doing octupus were talking about the trial starting.

            Second op was better than first….,maybe cured at least for a while….. last cure lasted 3 years…so abit like MS?

  • I concur with everything. MS offsets the balance established in relationships. I have not figured out how get equillibrium back. But I think it might be done with both pwms and partner acknowledgement of grief, accepting new norms, fostering autonomy, and setting boubdaries. One problem I resolved was needing to be free to communicate how bad a day I had without overwhelming my spouse. A therapist suggested using a number system, ie. Today was a 1, great day. Or today was an eight, not so good. And then my spouse knows how I’m feeling without our entire conversation being about my symptoms. This has helped us.

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