Table 2.
Strength of the evidence for the relationship between intimate partner violence against women and five health outcomes analyzed and childhood sexual abuse and 15 health outcomes analyzed
| Risk factor | Health outcome | RR (95% UI without γ) | RR (95% UI with γ) | BPRF | ROS | Star rating | Pub. bias | No. of studies | Selected bias covariates | Risk–outcome pair in GBD 2021 |
|---|---|---|---|---|---|---|---|---|---|---|
| Intimate partner violence | Major depressive disorder | 2.1 (1.86, 2.37) | 2.1 (1.55, 2.83) | 1.63 | 0.24 |  |
No | 12 | None | Y |
| Intimate partner violence | Maternal abortion and miscarriage | 2.03 (1.68, 2.46) | 2.03 (1.25, 3.31) | 1.35 | 0.15 |  |
No | 9 | Current and/or recent exposure | N |
| Intimate partner violence | HIV/AIDS | 1.58 (1.36, 1.84) | 1.58 (1.06, 2.34) | 1.13 | 0.06 |  |
No | 6 | None | Y |
| Intimate partner violence | Anxiety disorders | 2.57 (1.78, 3.72) | 2.57 (0.8, 8.25) | 0.97 | −0.02 |  |
No | 5 | Current and/or recent exposure | N |
| Intimate partner violence | Self-harm | 2.99 (1.36, 6.57) | 2.99 (0.29, 30.25) | 0.43 | −0.42 |  |
No | 4 | None | N |
| Childhood sexual abuse | Alcohol use disorders | 1.8 (1.62, 2.01) | 1.8 (1.39, 2.33) | 1.45 | 0.19 |  |
No | 10 | Unadjusted for confounding by age, sex and additional covariates; non-geographically representative study sample | Y |
| Childhood sexual abuse | Self-harm | 1.98 (1.73, 2.26) | 1.98 (1.25, 3.12) | 1.35 | 0.15 |  |
No | 16 | Case–control study design (risk of reverse causation) | N |
| Childhood sexual abuse | Major depressive disorder | 1.66 (1.51, 1.82) | 1.66 (1.13, 2.44) | 1.20 | 0.09 |  |
No | 26 | None | Y |
| Childhood sexual abuse | Anxiety disorders | 1.44 (1.3, 1.6) | 1.44 (1.13, 1.85) | 1.17 | 0.08 |  |
No | 12 | Component outcome definition (for example, PTSD); exposure measured as experience before an age <15 (for example, 11–14) | N |
| Childhood sexual abuse | Asthma | 1.25 (1.15, 1.35) | 1.25 (1.06, 1.47) | 1.09 | 0.04 |  |
No | 4 | None | N |
| Childhood sexual abuse | Type 2 diabetes mellitus | 1.11 (1.04, 1.19) | 1.11 (0.96, 1.28) | 0.98 | −0.01 |  |
No | 7 | None | N |
| Childhood sexual abuse | HIV/AIDS | 1.34 (1.12, 1.61) | 1.34 (0.87, 2.07) | 0.93 | −0.04 |  |
No | 7 | None | N |
| Childhood sexual abuse | Sexually transmitted infections excluding HIV | 1.28 (1.04, 1.57) | 1.28 (0.79, 2.08) | 0.85 | −0.08 |  |
No | 4 | None | N |
| Childhood sexual abuse | Maternal abortion and miscarriage | 1.35 (1.11, 1.66) | 1.35 (0.75, 2.44) | 0.83 | −0.09 |  |
No | 6 | None | N |
| Childhood sexual abuse | Drug use disorders | 1.95 (1.57, 2.43) | 1.95 (0.71, 5.38) | 0.83 | −0.09 |  |
No | 16 | None | N |
| Childhood sexual abuse | Conduct disorder | 3.42 (1.64, 7.14) | 3.42 (0.45, 25.7) | 0.63 | −0.23 |  |
No | 3 | Sample represents subpopulation; Unadjusted for confounding by age, sex and additional covariates; outcome is a specific drug use disorder | N |
| Childhood sexual abuse | Bulimia nervosa | 2.95 (1.45, 5.97) | 2.95 (0.37, 23.6) | 0.51 | −0.33 |  |
No | 5 | None | N |
| Childhood sexual abuse | Schizophrenia | 3.7 (1.61, 8.53) | 3.7 (0.26, 53.3) | 0.40 | −0.46 |  |
No | 5 | Confounding uncontrolled; Unadjusted for confounding by age, sex and additional covariates | N |
| Childhood sexual abuse | Ischemic heart disease | 1.32 (0.86, 2.04) | 1.32 (0.39, 4.47) | N/A | N/A | No | 3 | None | N | |
| Childhood sexual abuse | Anorexia nervosa | 2.07 (0.95, 4.51) | 2.07 (0.22, 19.76) | N/A | N/A | No | 4 | None | N |
The reported RR and its 95% uncertainty interval (UI) reflect the risk an individual who has been exposed to intimate partner violence or childhood sexual abuse has of developing the outcome of interest relative to that of someone who has not been exposed to these risk factors. Gamma (γ) is the estimated between-study heterogeneity. We report the 95% UI when not incorporating between-study heterogeneity (γ), ‘95%UI without γ’, and when accounting for between-study heterogeneity, ‘95% UI with γ.’ The BPRF is calculated for risk–outcome pairs that were found to have significant relationships at a 0.05 level of significance when not incorporating between-study heterogeneity (the lower bound of the 95% UI without γ does not cross the null RR value of one). The BPRF corresponds to the fifth quantile estimate of RR accounting for between-study heterogeneity closest to the null for each risk–outcome pair and it reflects the most conservative estimate of excess risk associated with intimate partner violence or childhood sexual abuse that is consistent with the available data. As we define intimate partner violence and childhood sexual abuse exposure as dichotomous risk factors (an individual either has been exposed or has not), the ROS is calculated as the signed value of log(BPRF) divided by two. Negative ROSs indicate that the evidence of the association is very weak and inconsistent. For ease of interpretation, we have transformed the ROS and BPRF into a star rating (0–5) with a higher rating representing a larger effect with stronger evidence. The potential existence of publication bias, which, if present, would affect the validity of the results, was tested using Egger’s regression. Included studies represent all available relevant data identified through our systematic reviews from January 1970 through January 2023. The selected bias covariates were chosen for inclusion in the model using an algorithm that systematically detects bias covariates that correspond to significant sources of bias in the observations included. If selected, the observations were adjusted to better reflect the gold standard values of the covariate. The Supplementary Information provides more information about the candidate bias covariates that were selected for in each model.