The Relationship Between Marginalization and Mental Health Symptoms in Abused Women

Thursday, 27 July 2017: 4:30 PM

Anne Koci, PhD, FNP-BC, FAAN, WHNP1
Judith M. McFarlane, DrPH1
John A. Maddoux, PhD2
(1)College of Nursing, Texas Woman's University, Houston, TX, USA
(2)Center for Research Design and Analysis, Texas Woman's University, Denton, TX, USA

Background: Globally intimate partner violence (IPV) affects 1 in 3 women (WHO, 2013). One important factor that may be associated with the increased vulnerability to abuse is marginality which brings about social isolation as well as psychological isolation of individuals. This isolation has negative consequences for emotional health (Koci, 2012; Symes, McFarlane, Nava, Gilroy, Maddoux, 2013) Anxiety, depression and PTSD are adverse mental health symptoms that increase the risk for suicide. The World Health Organization’s Sustainable Development Goal 3 is to ensure healthy lives and promote well-being for all at all ages and to reduce premature mortality from suicide.

 Purpose: The purpose of this study was to examine the link between marginalization and mental health symptoms among women with known histories of intimate partner violence.

Methods: Data utilized in this study included five-year data from a prospective seven-year study examining the clinical outcomes of women seeking support through either a safe shelter or the DA’s office for the first time following a violent relationship (n=279). Women were surveyed every four months for five years. Key measures utilized for this sub-analysis included the Koci Marginalization Index, Brief Symptom Inventory, and a PTSD screening measure.

Results: A series of multiple linear regressions were conducted to predict mental health outcomes (depression, somatization, anxiety, PTSD) from current levels of marginalization, controlling for entry levels of marginalization. Results indicated that marginalization was significantly associated with higher levels of Global Distress (Beta = .319), Depression (Beta = .349), Anxiety (Beta = .294), Somatization (Beta = .197), and PTSD symptoms (Beta = .366). Results consistently demonstrated that higher levels of marginalization were associated with higher levels of mental health symptoms.

Conclusions: Our findings revealed a positive relationship between marginality and adverse mental health outcomes of depression, anxiety, somatization, and PTSD symptoms indicating that the more marginalized woman suffers more deeply with mental health symptoms which may put her at higher risk for suicide. These findings concur with previous research (Koci, 2004) that marginality of women contributes to social isolation and deterioration of mental health. This longitudinal study in the 5th year serves as an alert to healthcare providers to the possibility of long-term abuse-related sequelae in their practice. This research contributes to the knowledge of marginality, a social determinant of health. Understanding marginality and its impact on mental health may aid in reducing mortality from suicide. Policymakers need to be cognizant of the role of marginality in females and its potential adverse impact on their mental health which may aid in the development of healthcare agendas at all levels of government.