Intimate partner violence: estimating the prevalence of partner-inflicted psychological maltreatment experienced by female workers in a tertiary healthcare facility in southwestern Nigeria

Abstract

Background

Intimate partner violence (IPV) is a global health problem that involves harmful, aggressive, and potentially life-threatening abuse against a partner in an intimate relationship. IPV may involve physical, verbal, psychological, or emotional abuse with an intercalating pattern of occurrence. Females are primarily victims of IPV, with men as perpetrators in most cases. Female healthcare workers also suffer from IPV, much like the general women population. However, most previous studies only focused on IPV in the general women population without particular focus on female workers in the healthcare sector.

Methods

Our study employed a cross-sectional design using a semi-structured self-administered questionnaire involving 282 female healthcare workers. The survey focused on various forms of IPV, including psychological, verbal, and domineering/isolation abuses. Data was entered using SPSS version 23, and univariate and bivariate analyses were done using STATA 14. Informed consent and ethical approval were obtained.

Results

Our respondents were mostly Yorubas (93.3%) and Christians (95.7%), primarily nurses (42.2%) and administrative officers (33.3%). Findings indicate a high prevalence of psychological abuse, with 74.1% of participants reporting mild to severe forms. Psychological abuse was the most common, followed by verbal and domineering/isolation abuses. Mild abuse is the most common form across all abuse types. Nurses suffered from IPV the most. There was a significant association between marital status and increased susceptibility to various forms of IPV.

Conclusion

The prevalence of IPV, particularly psychological maltreatment among female healthcare workers, underscores the critical need for comprehensive intervention strategies. These strategies should include workplace policies and societal efforts aimed at reducing IPV and supporting victims.

Introduction

Intimate partner violence (IPV) is a subject of global public health significance, with adverse effects that occur across all races, societies, and socioeconomic strata [1]. The Centre for Disease Control and Prevention (CDC) defines IPV as “abuse or aggressive behaviour that occurs in a romantic relationship” [1]. Intimate partners include previous and current spouses and dating partners. The World Health Organization defines IPV as any behaviour in a romantic relationship that causes physical, sexual and psychological abuse, including coercion and controlling behaviours [2]. Even though both males and females suffer from IPV, women suffer more disproportionately with an average worldwide occurrence rate of 27% in women aged 15–49 years compared to 17% prevalence in men². WHO estimated the global prevalence of IPV to be 30%, while a multi-national study shows the prevalence of IPV ranges between 15 and 58%, expressing the heterogeneity of occurrence across many countries [3]. The prevalence rate in Africa is 37%, while one in every four Nigerian women suffers from IPV [4].

IPV occurs in several forms, either in isolation or combined, including physical, emotional, psychological, financial, and sexual abuses, controlling behaviour, and coercion [5, 6]. Psychological abuse is estimated to be the common type of IPV, which typically involves the use of non-physical methods to control, intimate, or harm an intimate partner [7, 8]. These tactics often involve abuses such as manipulation, gaslighting, isolation, threats, use of demeaning words, and instilling fear in a partner [5, 8, 9].

While many women commonly report psychological violence, there are no standard measures of such abuses because of the subjectivity, personal and cultural context of interpretation of abuse [10]. Studies have documented challenges in corroborating reported cases of psychological abuse because of the lack of physical evidence of violence, which is a strong point in cases of physical abuse [11]. Thus, many cases of this type of partner abuse often go unreported, therefore downplaying the adverse effects of this type of violence. Short-term effects such as depression, anxiety, and post-traumatic stress disorder (PTSD) have been reported, and long-term side effects such as increased chances of children of abused partners experiencing abuse in intimate relationships later in life [11].

Verbal abuse is another common type of abuse which may be closely related to psychological abuse; however, this type of abuse involves the use of words in manners aimed at demeaning the victim [11, 12]. These abuses can be in the form of insults, threats, name-calling, or toxic criticism, which leaves a scar on the victim’s psyche [12, 13]. Such abuses may be aimed at provoking the victim, which may eventually lead to verbal or physical retaliation. One of the challenges of verbal abuse is its invisibility, which limits the ability of victims to seek help; societal dismissal of such abuses as mere words has also been documented as a barrier to seeking help [10]. Studies show that verbal abuse has adverse consequences, much like physical abuse, predisposing victims to adverse effects like those experienced in psychological abuse, as discussed earlier [11, 14, 15].

Physical abuse is the most visible and reported form of abuse because of the glaring evidence of such abuse on victims [16, 17]. It involves the use of physical force to intimidate, harm, and control a partner. This type of abuse often coexists with other types of IPV, such as psychological and verbal abuse [17]. Physical abuse ranges from mild forms, such as slapping or smacking, to severe forms, such as kicking, choking, or using objects to inflict injuries. Immediate consequences of physical abuse can be life-threatening in cases of severe abuse, such as head injuries. A study found that one of the most common instances of women’s presentation to the emergency unit was due to injuries inflicted by an intimate partner [18]. In some African contexts, mild physical abuse of women by their husbands is considered acceptable as a means of correcting wives [4]. Thus, physical abuses may cascade into severe forms and may be unreported due to threats, fear of retaliation, barriers in accessing support services, and the stigmatisation that often follows reporting, especially in low and middle-income countries like Nigeria.

In recent years, there has been particular attention to intimate partner violence on the international scene, with many countries following suit with recognition of IPV as a significant public health and human rights issue [4]. The Istanbul Convention of 2014 provides a comprehensive framework for preventing and seeking redress for victims of partner violence. In Nigeria, the Violence Against Persons Prohibition (VAPP) Act 2015 provides a legal framework prohibiting all forms of violence, including IPV [19]. Nigeria has also ratified several international conventions that prohibit gender-based violence, such as the Convention on the Elimination of All Forms of Discrimination Against Women, International Covenant on Civil and Political Rights and International Covenant on Economic, Social, and Cultural Rights [20, 21]. In addition, there are also state laws prohibiting violence against women²¹. Healthcare workers are important stakeholders in these efforts, especially female healthcare workers who play major roles in advocacy and interventions for women who suffer intimate abuse [22].

Studies have shown that female healthcare workers also suffer intimate violence despite their social and professional achievements [23, 24]. Most of the previous studies conducted in Nigeria focused on the prevalence, pattern, and risk factors of IPV among the female gender generally. In contrast, only very few studies have been done to evaluate the prevalence of IPV among female health workers despite the global trends in this regard. Psychological abuse is even less studied compared to other easily accessed forms of abuse, such as physical abuse. Psychological abuse is closely linked to verbal abuse and domineering and isolation of an intimate partner. A previous study among Nigerian nurses documented a prevalence rate of 58.7%, which is quite comparable to the prevalence rate among the general women population. Female healthcare workers experience multiple stressors, often combining stressful professional roles, traditional gender expectations at home, and partners who may feel threatened by their socioeconomic independence [25, 26]. Thus, our study seeks to evaluate the prevalence of partner-inflicted psychological maltreatment experienced by female healthcare workers in a tertiary hospital in Nigeria by evaluating their exposures to the various levels and intersecting forms of psychological, dominance/isolation, and emotional/verbal abuse.

Methodology

This cross-sectional study assessed the prevalence of partner-inflicted psychological maltreatment among female workers at a tertiary healthcare facility in Ondo State, Southwest Nigeria. Ondo State, with an estimated population of 3,460,877 (National Population Census, 2006), borders Ekiti to the north, Kogi to the northeast, Edo to the east, Delta to the southeast, Ogun to the southwest, and Osun to the northwest.

A sample size of 300 was calculated using the formula

.

Where: Z = 1.96 (95% confidence),

p = 0.234 (prevalence of psychological workplace violence in a similar Nigerian setting [27].

q = 1-p = 0.766, and d = 0.05.

We employed a multi-stage sampling technique. The facility comprised two directorates: a clinical directorate (23 departments) and an administrative directorate (11 departments). In each directorate, 10 departments were randomly selected by ballot (20 total). Within each chosen department, 15 female staff members were systematically sampled based on departmental rosters, yielding 150 participants per directorate and a total of 300 participants. The interval of participant selection in each department was determined based on the number of eligible participants in the department per the number of participants to be selected in each department [15]. Non-consenting or ineligible staff were replaced by the next eligible worker on the respective departmental roster.

Eligible participants were female staff who were present and consented during the 12-week data collection period. Exclusion criteria included absence due to illness, inability to read or write, and refusal to consent. Data were gathered via a pre-tested, self-administered 58-item questionnaire adapted from the Psychological Maltreatment of Women Inventory (PMWI), which measures psychological, dominance/isolation and emotional/verbal abuses experienced over the preceding six months [28]. Prior to data collection with the instrument, the adapted and pre-tested instrument underwent reliability testing, yielding a Cronbach’s alpha of 0.88.

Data entry was performed in IBM SPSS Statistics version 23, and analyses were conducted in STATA 14. Categorical variables were reported as frequencies and percentages, while continuous variables were summarised by median and interquartile range. Bivariate analyses examined associations between abuse categories and socio-demographic variables such as age, ethnicity, religion, occupation, and years of professional practice.

To evaluate the severity of abuse, responses to the questionnaire were scored. The instrument utilised a 5-point Likert scale and comprised the full 58-item PMWI scale along with two subscales: a 26-item dominance/isolation subscale and a 23-item emotional/verbal subscale. The minimum obtainable scores for the full PMWI scale, dominance/isolation subscale, and emotional/verbal subscale were 58, 26, and 23, respectively, while the maximum scores were 290, 130, and 115, respectively.

Scores were interpreted to classify the severity of abuse. A score equal to the minimum possible value was categorised as “No Abuse.” The range between the minimum and maximum scores for each scale was divided into three equal percentiles. Based on the cumulative score, responses falling within the lower, middle, and upper percentiles were graded as “Mild Abuse,” “Moderate Abuse,” and “Severe Abuse,” respectively.

Ethical approvalwas obtained from the Federal Medical Center, Owo, Ethics and Research Committee (Ref. FMC/OW/380/VL.CXXXVI/169). All participants gave informed verbal and written consent, and strict confidentiality was maintained by de-identifying survey data.

Results

The results of our study’s data analyses were described and interpreted at univariate and bivariate levels. Data collection for the study was done using a self-administered questionnaire, entered and collated using International Business Machine Statistical Package for Social Sciences SPSS (IBM SPSS Statistics) software version 23, and subsequently analysed using STATA 14.

Univariate analysis conducted yielded the presentation of descriptive results of all the relevant outcomes and independent variables, with the aim of providing background information about the characteristics of the study’s respondents. Variables analysed included age, religion, ethnicity, marital status, occupation and years of professional work.

Three hundred healthcare workers from the selected tertiary health facility were recruited to participate in the study. There was a 94% response rate, with only 282 participants completing the study. Others did not fill out the survey and were excused on account of incompleteness. The median age and IQR of the respondents were 38 years, IQR 27–44.

The sociodemographic characteristics of our respondents are shown in Table 1. The participants were primarily (56.7%) older adults (36–55 years), predominantly Christians (95.7%) and Yoruba (93.3%), mostly married (68.8%), and primarily working in nursing (42.2%) or administrative roles (33.3%). More than half of the participants had worked for over 10 years (51.1%).

Table 1.

Socio-demographic characteristics

Demographics variable		Frequency (N = 282)	%
Age range (years)	< 18 18–35 36–55 56–65	3 117 160 2	1.1 41.5 56.7 0.7
Religion	Christianity Islam	270 12	95.7 4.3
Ethnicity*	Yoruba Igbo Hausa Others	263 11 1 7	93.3 3.9 0.4 2.5
Marital status*	Single Married Others	76 194 12	27.0 68.8 4.3
Department/occupation	Nursing Medicine Administration Medical Records Medical Laboratory Pharmacy Health Assistant	119 27 94 21 3 6 12	42.2 9.6 33.3 7.4 1.1 2.1 4.3
Years in work	< 1 year 1–5 years 5–10 years > 10 years	61 45 32 144	21.6 16.0 11.3 51.1

*Percentages may not sum to exactly 100% due to rounding

The data in Table 2 show that mild abuse was the most common form across all abuse types. In the Dominance/Isolation subtype, 65.2% reported mild abuse, while in the Emotional/Verbal Abuse subtype, 55.0% reported no abuse, but 42.2% experienced mild abuse. Generally, in the Psychological Abuse assessment based on the PMWI scale, 74.1% reported mild abuse. Severe abuse is rare, with only 1.1% reporting it across all categories. No abuse is most common in the emotional/verbal category (55.0%).

Table 2.

Levels of abuse

	Psychological (N = 282)*	Dominance/isolation (N = 282)*	Emotional/verbal (N = 282)*
No abuse	58 (20.6%)	85 (30.1%)	155 (55.0%)
Mild abuse	209 (74.1%)	184 (65.2%)	119 (42.2%)
Moderate abuse	12 (4.3%)	10 (3.5%)	5 (1.8%)
Severe abuse	3 (1.1%)	3 (1.1%)	3 (1.1%)

*Percentages may not sum to exactly 100% due to rounding

The mean distribution of scores for items on the scale is shown in Fig. 1. The provided mean scores for the 58 responses on the PMWI scale range between 1.11 and 1.60. The highest mean score is for item 8 (“My partner said something unkind to me”), which has a mean of 1.60, while the lowest mean score is for item 41 (“My partner restricted my use of the car”), with a mean of 1.11. Items with higher mean scores (above 1.40) generally reflect verbal and emotional abuse, such as:

Fig. 1.

Mean distribution of scores for items on the scale

• Item 8: “My partner said something unkind to me” (1.60).

• Item 9: “My partner brought up something from the past to hurt me” (1.47).

• Item 1: “My partner criticised my physical appearance” (1.46).

Items with lower mean scores (below 1.20) reflect more severe and controlling behaviours, such as:

• Item 41: “My partner restricted my use of the car” (1.11).

• Item 43: “My partner did not allow me to leave the house” (1.14).

The overall distribution suggests that verbal and emotional abuse items were reported more frequently or intensely than physical control behaviours.

Summary of dominance/isolation abuse across demographic variables

The analysis of dominance/isolation abuse across various demographic variables revealed several key insights as shown in Fig. 2; Tables 3 and 4.

Fig. 2.

Dominance/isolation abuse distribution

Table 3.

Association between the Socio-demographic characteristics and dominance/isolation abuse

Dominance/Isolation abuse
Demographics variable		No abuse Freq. (%)	Mild Freq. (%)	Moderate Freq. (%)	Severe Freq. (%)	P-Value
Age range* (Years)	< 18 18–35 36–55 56–65	0(0.0) 40(14.2) 44(15.6) 1(0.4)	3(1.1) 72(25.5) 108(38.3) 1(0.4)	0(0.0) 5(1.8) 5(1.8) 0(0.0)	0(0.0) 0(0.0) 3(1.1) 0(0.0)	0.751
Religion*	Christianity Islam	82(29.1) 3(1.1)	175(62.1) 9(3.2)	10(3.6) 0(0.0)	3(1.1) 0(0.0)	0.833
Ethnicity*	Yoruba Igbo Hausa Others	80(28.4) 3(1.1) 0(0.0) 2(0.7)	174(61.7) 5(1.8) 1(0.4) 4(1.4)	7(2.5) 2(0.7) 0(0.0) 1(0.4)	2(0.7) 1(0.4) 0(0.0) 0(0.0)	0.037*
Marital status*	Single Married Others	29(10.3) 55(19.5) 1(0.4)	41(14.5) 134(47.5) 9(3.2)	4(1.4) 5(1.8 1(0.4)	2(0.7) 0(0.0) 1(0.4)	0.008*
Department/occupation*	Nursing Medicine Administration Medical Records Medical Laboratory Pharmacy Health Assistant	27(9.6) 15(5.3) 33(11.7) 4(1.4) 0(0.0) 1(0.4) 5(1.8)	89(31.6) 10(3.6) 58(20.6) 13(4.6) 3(1.1) 4(1.4) 7(2.5)	2(0.7) 2(0.7) 3(1.1) 3(1.1) 0(0.0) 0(0.0 0(0.0)	1(0.4) 0(0.0) 0(0.0) 1(0.4) 0(0.0) 1(0.4) 0(0.0)	<0.001*
Years in work*	< 1 year 1–5 years 5–10 years > 10 years	26(9.2) 10(3.6) 9(3.2) 40(14.2)	31(11.0) 34(12.1) 21(7.5) 98(34.8)	4(1.4) 1(0.4) 2(0.7) 3(1.1)	0(0.0) 0(0.0) 0(0.0) 3(1.1)	0.144

* Percentages may not sum to exactly 100% due to rounding

Table 4.

Association between the Socio-demographic characteristics and emotional/verbal abuse

Emotional/Verbal Abuse
Demographics Variable		No Abuse Freq. (%)	Mild Freq. (%)	Moderate Freq. (%)	Severe Freq. (%)	P-Value
Age range (years) *	< 18 18–35 36–55 56–65	1(0.4) 60(21.3) 92(32.6) 2(0.7)	2(0.7) 57(20.2) 60(21.3) 0(0.0)	0(0.0) 0(0.0) 5(1.8) 0(0.0)	0(0.0) 0(0.0) 3(1.1) 0(0.0)	0.286
Religion	Christianity Islam	147(52.1) 8(2.8)	115(40.8) 4(1.4)	5(1.8) 0(0.0)	3(1.1) 0(0.0)	0.825
Ethnicity*	Yoruba Igbo Hausa Others	145(51.4) 5(1.8) 1(0.4) 4(1.4)	111(39.4) 5(1.8) 0(0.0) 3(1.1)	5(1.8) 0(0.0) 0(0.0) 0(0.0)	2(0.7) 1(0.4) 0(0.0) 0(0.0)	0.500
Marital status*	Single Married Others	43(15.2) 109(38.7) 3(1.1)	31(11.0) 81(28.7) 7(2.5)	0(0.0) 4(1.4) 1(0.4)	2(0.7) 0(0.0) 1(0.4)	0.009*
Department/occupation*	Nursing Medicine Administration Medical Records Medical Laboratory Pharmacy Health Assistant	62(22.0) 21(7.5) 50(17.7) 11(3.9) 1(0.4) 3(1.1) 7(2.5)	55(19.5) 6(2.1) 41(14.5) 8(2.8) 2(0.7) 2(0.7) 5(1.8)	1(0.4) 0(0.0) 3(1.1) 1(0.4) 0(0.0) 0(0.0) 0(0.0)	1(0.4) 0(0.0) 0(0.0) 1(0.4 0(0.0) 1(0.4) 0(0.0)	0.058
Years in work*	< 1 year 1–5 years 5–10 years > 10 years	34(12.1) 20(7.1) 18(6.4) 83(29.4)	27(9.6) 24(8.5) 12(4.3) 56(19.9)	0(0.0) 1(0.4) 2(0.7) 2(0.7)	0(0.0) 0(0.0) 0(0.0) 3(1.1)	0.291

*Percentages may not sum to exactly 100% due to rounding

Dominance/isolation abuse showed no significant age-related differences, maintaining a consistent prevalence across all age groups, as evidenced by a p-value of 0.751. Notably, mild abuse was predominantly observed among 38.3% of the 36–55 age group participants, whereas severe abuse was uncommon, occurring among 1.1% of participants within the same age bracket.

Religious affiliation appeared to have minimal impact on the incidence of abuse, with no significant statistical differences between Christianity and Islam (p = 0.833). However, mild abuse was notably more prevalent among 62.1% of Christian participants, compared to 3.2% of Islamic participants.

Ethnic background presented significant disparities in the prevalence of abuse (p = 0.037). The Yoruba ethnicity reported the highest number of mild abuse with 61.7% prevalence, while the Hausa reported the fewest, with 0.4% prevalence.

Marital status also showed significant differences (p = 0.008), with married individuals experiencing the highest rates of mild abuse at 47.5% prevalence, more than three times the incidence of mild abuse among singles (14.5%).

In terms of occupation, significant differences were evident (p <  0.001). The Nursing department experienced the highest prevalence of mild abuse (31.6%), followed by the Administration with 20.6%. Severe abuse was most frequently reported among 1.1% of participants from the Nursing and Medical Records departments.

Lastly, the length of employment showed no significant difference in abuse rates across different work durations (p = 0.144), with mild abuse most frequently reported with a prevalence of 34.8% by those with over ten years of service.

These findings highlighted that ethnicity, marital status, and occupation significantly influence the occurrence of dominance/isolation abuse, whereas age, religion, and years of work did not exhibit considerable differences.

Summary of emotional/verbal abuse across demographic variables

The analysis of emotional/verbal abuse across different demographic variables provided insightful observations as shown in Fig. 3.

Fig. 3.

Emotional/verbal abuse distribution among demographic variables

There were no significant differences in emotional/verbal abuse across age groups, with a p-value of 0.286, suggesting a uniform distribution of this type of abuse among different ages. Interestingly, the age group of 36–55 experienced the most mild abuse (21.3%), while severe abuse is notably rare, occurring in 1.1% of participants within this same age bracket.

Regarding religious affiliation, there was no significant distinction between Christianity and Islam in terms of abuse prevalence, with a p-value of 0.825. Both religions see similar patterns, although 52.1% of Christians reported a higher number of no abuse, while 40.8% experienced mild abuse.

Ethnic differences also did not significantly influence the prevalence of emotional/verbal abuse, as indicated by a p-value of 0.500. However, individuals of Yoruba descent reported the highest instances of no abuse and mild abuse, with 51.4% and 39.4%, respectively.

Marital status significantly affected the occurrence of emotional/verbal abuse (p = 0.009), with married individuals having the highest prevalence of mild abuse (28.7%), whereas 15% of singles reported no abuse.

In the workplace, the relationship between department/occupation and abuse prevalence was nearly significant, with a p-value of 0.058. Both the Nursing and Administration departments reported 22.0% and 17.7% prevalence of no abuse respectively. Nursing also recorded a significant 19.5% prevalence of mild abuse.

The length of employment did not significantly affect abuse rates, with a p-value of 0.291. However, participants with over ten years of work experience report a 19.9% prevalence of mild abuse.

These findings highlight that marital status is a significant predictor of emotional/verbal abuse. In contrast, other factors like age, religion, ethnicity, occupation, and years of work do not show substantial differences in abuse prevalence. This suggests that interventions to prevent emotional/verbal abuse may need to be specifically tailored to address the vulnerabilities associated with marital status within the workforce.

Summary of psychological abuse on the PMWI scale across demographic variables

The examination of psychological abuse across different demographic variables in the study presented some important findings as shown in Table 5; Fig. 4.

Table 5.

Association between the Socio-demographic characteristics and psychological abuse

Psychological Abuse
Demographics Variable		No Abuse Freq. (%)	Mild Freq. (%)	Moderate Freq. (%)	Severe Freq.(%)	P-Value
Age range (years)*	< 18 18–35 36–55 56–65	0(0.0) 28(9.9) 29(10.3) 1(0.4)	3(1.1) 84(29.8) 121(42.9) 1(0.4)	0(0.0) 5(1.8) 7(2.5) 0(0.0)	0(0.0) 0(0.0) 3(1.1) 0(0.0)	0.776
Religion*	Christianity Islam	56(19.9) 2(0.7)	199(70.6) 10(3.6)	12(4.3) 0(0.0)	3(1.1) 0(0.0)	0.825
Ethnicity*	Yoruba Igbo Hausa Others	54(19.2) 2(0.7) 0(0.0) 2(0.7)	197(69.9) 7(2.5) 1(0.4) 4(1.4)	10(3.6) 1(0.4) 0(0.0) 1(0.4)	2(0.7) 1(0.4) 0(0.0) 0(0.0)	0.319
Marital status*	Single Married Others	21(7.5) 37(13.1) 0(0.0)	50(17.7) 148(52.5) 11(3.9)	3(1.1) 9((3.2) 0(0.0)	2(0.7) 0(0.0) 1(0.4)	0.013
Department/occupation*	Nursing Medicine Administration Medical Records Medical Laboratory Pharmacy Health Assistant	17(6.0) 12(4.3) 22(7.8) 2(0.7) 0(0.0) 0(0.0) 5(1.8)	97(34.4) 13(4.6) 67(23.8) 17(6.0) 3(1.1) 5(1.8) 7(2.5)	4(1.4) 2(0.7) 5(1.8) 1(0.4) 0(0.0) 0(0.0) 0(0.0)	1(0.4) 0(0.0) 0(0.0) 1(0.4) 0(0.0) 1(0.4) 0(0.0)	0.002*
Years in work*	< 1 year 1–5 years 5–10 years > 10 years	19(6.7) 8(2.8) 5(1.8) 26(9.2)	39(13.8) 34(12.1) 24(8.5) 112(39.7)	3(1.1) 3(1.1) 3(1.1) 3(1.1)	0(0.0) 0(0.0) 0(0.0) 3(1.1)	0.183

*Percentages may not sum to exactly 100% due to rounding

Fig. 4.

Psychological Abuse on the PMWI Scale across Demographic Variables

In terms of age range, the data revealed no significant variations in psychological abuse across different age groups, as indicated by a p-value of 0.776. However, the age group of 36–55 reported a 42.9% prevalence of mild abuse, while severe abuse was exceptionally rare, with a 1.1% prevalence across all age groups.

Religious affiliation showed no significant differences between Christianity and Islam in the prevalence of psychological abuse, with a p-value of 0.825. Among Christians, 19.9% reported no abuse, while 70.1% reported mild abuse.

Regarding ethnicity, there was no significant impact on the rates of psychological abuse across different ethnic groups, supported by a p-value of 0.319. The Yoruba ethnicity, however, recorded a 69.9% and 19.2% prevalence for mild abuse and no abuse, respectively.

Marital status was significantly associated with psychological abuse, as evidenced by a p-value of 0.013. Married individuals notably experienced the highest number of mild abuse cases, with 52.5% prevalence, while 7.5% of single participants more frequently encountered no abuse.

A significant difference based on occupation was observed (p = 0.002), with those in nursing experiencing 34.4% prevalence of mild abuse cases, while only 7.8% of participants in the administration department experienced no abuse.

Years in work did not significantly influence the occurrence of psychological abuse, with a p-value of 0.183. Participants with over ten years of work experience had a 39.7% prevalence of mild abuse.

Key findings from the study underlined that marital status and occupation are significantly associated with psychological abuse, while other demographic factors like age, religion, ethnicity, and years of work show no substantial differences. These insights suggest the need for targeted interventions in workplace environments and marital counselling initiatives to address and mitigate psychological abuse effectively.

Discussion

Findings from our study showed that there was a high prevalence of psychological abuse, with 74.1% of respondents reporting mild to moderate form abuse. Emotional/verbal abuse (45%) and domineering/isolation (69.9%) were also noted. Our respondents were mostly married. Research shows that intimate partner violence against women occurs less in marriage compared to non-marital settings [29]. However, our study found that most women who experienced IPV were married. All forms of abuse were more common among married respondents, which directly contrasts with previous global and local studies where abuses were more common among cohabiting and dating partners [24, 30]. Societal differences influencing relationship dynamics and reporting patterns in our study population may explain this disparity.

The dominant distribution of females in the nursing department of our study location corroborates the global finding of female dominance in the nursing profession. WHO reports that women constitute about 89% of the global nursing workforce, with figures as high as 90% reported in the United States [31, 32]. This disparity is deeply rooted in the age-long societal view of the nursing profession as a caregiver role that is suited for women. Intimate partner violence was significantly high among nurses, second only to female administrative staff. A previous study documented significant levels (58%) of partner abuse among female nurses in a tertiary healthcare centre, bringing to the fore the need to address this issue among female nurses who are major stakeholders in the prevention and intervention for victims of IPV [12].

Level of domineering/isolation abuse

Domineering and isolation of partners have been reported in the literature as an insidious, often neglected form of abuse that robs the victim of autonomy and social connection. Most (65.2%) of our respondents suffered mild form of domineering/isolation abuse in intimate relationships which underscores its significance. This was corroborated by respondents who experienced controlling behaviours such as restriction of access to their cars and movement. This form of abuse silences women and prevents them from living life to their fullest potential, reduced quality of life, loneliness, and psychiatric sequelae such as depression, anxiety and post-traumatic stress disorders [11, 33–35]. It puts affected women at the risk of suffering progressive abuse as they become increasingly isolated from potential sources of help; other forms of abuse like verbal/emotional abuse can result from being silenced and obsessively controlled in an intimate relationship [8, 36]. Domineering/isolation abuse is a harbinger of other forms of abuse, which may even lead to homicide following separation from an abusive partner [8, 36]. Interestingly, studies have shown that women have controlling behaviour. However, they are less likely to victimise their partner compared to the male gender [36].

The tendency for female victims to downplay this form of abuse compared to other forms of abuse is high, especially in the African setting where excessive control of females in intimate relationships is culturally acceptable [37–39]. Studies conducted among female nurses and nursing students found abuses were also experienced by this group, pointing to a widespread occurrence regardless of profession and economic status [23, 24].

Psychological abuse

Most participants who reported psychological abuse experienced only mild abuse (74.1%), much like domineering behaviour and isolation by partners. As documented in previous literature, psychological abuse is difficult to estimate as this form of abuse is subjective when compared with other forms of abuse [3, 10]. The prevalence of 74.1% of mild psychological abuse found in our study is a pointer to the magnitude of psychological abuse suffered by women in the setting of intimate relationships. Astudy conducted in a similar setting documented a psychological abuse prevalence of 79.7%, which is similar to the finding in our study, where 79.4% of respondents had experienced varying levels of psychological abuse [40]. Another study conducted in southwestern Nigeria documented a lower prevalence of 61%, which may suggest possible intraregional differences in IPV [33].

There has been difficulty in creating standard scales to measure psychological abuse due to cultural contexts. However, psychometric analyses have increasingly been used in many studies [12, 41]. Studies correlate the occurrence of intimate partner violence against women with societies where men dominate the formal workspace, which is the case in Nigeria and many African countries [37].

Nurses in our study suffered psychological abuse compared to other female healthcare workers much like other forms of abuse, which may lead to communication lags and an increased rate of work burnout among female nurses as corroborated by a study done in a similar setting [23]. Consequently, a spill-over effect manifesting in suboptimal patient care and poor clinical outcomes may affect their work performance.

In the Nigerian setting, where there is poor reportage of intimate partner violence against women, the significant prevalence of IPV compared to the prevalence reported in a multicountry study underscores the need to establish a standardized protocol for reporting, protection of victimised women, and prosecution of abusers [42, 43]. Gender inequality and social acceptability of psychological abuse also fuel limited or no reportage of this form of abuse. It is easier to point to a physical scar than it is to give evidence of a demeaning encounter that affected the psyche of an individual, leaving this form of abuse insidiously taking its toll on its victims [7]. Long-term adverse effects such as depression, poor self-esteem, anxiety, PTSD, suicidal ideation, and suicide have been reported in the literature [5, 44–46].

Emotional/verbal abuse

Verbal abuse is one of the most common forms of abuse in intimate relationships documented in literature; however, our study found the level of verbal abuse to be the lowest (45%) compared to other forms of violence we surveyed [33]. Similar studies have reported a higher prevalence of verbal abuse, with a study reporting a prevalence of 98.1% while anotherreported a 66.1% prevalence, suggesting considerable variability likely influenced by study populations, definitions of violence, and methodological approaches [33, 40].

Ultimately, we found that verbal abuse is a harbinger of psychological abuse, with words intended to demean used frequently by male partners on the affected respondents. Respondents reported that their partners said demeaning things to them, which they may have interpreted as targeted against their psyche in the relationship, which was more prevalent in married female healthcare workers. Compared to other groups of participants, nursing respondents were more affected by verbal abuse, reinforcing the discussion on the magnitude of this grave issue among female nurses. Perhaps the high economic power of female nurses played a role, especially in the Nigerian context of male-dominant economic power. Studies revealed the effects of abuse in intimate relationships on children; children who were raised in such households tend to be victims and/or perpetrators of the violence later in life [47–49]. Much like other forms of abuse, depression and other psychological complications can occur. Female nurses have the closest contact with patients and greater work demands compared to other female healthcare workers, which may increase the likelihood of stress and burnout and the chances of strain in their intimate relationships [24]. Other factors, such as childhood trauma and refusal of sex, which may be due to work stress, have been associated with abuse experienced by female healthcare workers, especially nurses.

Strengths, limitations, and future research

The study employed a robust methodology and a significant sample size, enhancing the reliability of its findings regarding the prevalence of intimate partner violence (IPV) among female healthcare workers in Nigeria. It provided essential insights into psychological abuse patterns within this demographic. However, the cross-sectional design may not adequately capture the dynamic nature of IPV or its long-term impacts. Additionally, the reliance on self-reported data might lead to underreporting due to stigma or fear of reprisal. Future research should focus on longitudinal studies to assess the enduring effects of IPV on mental health and job performance. We employed univariate and bivariate analyses in our study, which limits the degree of correlation between variables. Thus, future studies should employ multivariate analysis. It is also crucial to evaluate the efficacy of targeted interventions in healthcare settings and to explore the cultural factors influencing IPV across different Nigerian communities.

Conclusion

The findings from this study underscore the significant prevalence of intimate partner violence (IPV) among female healthcare workers in a tertiary hospital in Nigeria, particularly highlighting the widespread occurrence of psychological maltreatment. Despite their professional achievements and roles in public health, female healthcare workers are not immune to the dynamics of IPV, which manifest predominantly as psychological and verbal abuses within this group. The prevalence of psychological abuse, noted as the most common form of maltreatment, calls for an urgent reevaluation of workplace policies and societal norms that currently fail to protect this vulnerable group adequately.

As healthcare professionals frequently encounter victims of IPV, understanding and addressing the violence they face is crucial for both personal well-being and professional efficacy. This study advocates for comprehensive strategies that include creating supportive workplace environments, institutionalising marital counselling initiatives, enhancing legal frameworks, and promoting cultural shifts to mitigate IPV against female healthcare workers. Ultimately, the protection and empowerment of this group are essential for them to continue their critical roles in healthcare delivery and advocacy effectively.

Author contributions

DJA drafted the research protocol, collected data, coordinated the work and reviewed the final manuscript, GOA wrote the manuscript, IAO participated in data collection and manuscript writing, PTA participated in data collection and research protocol revision. All authors reviewed and approved the final manuscript.

Funding

Nil.

Data availability

The datasets generated in this research are available upon reasonable request through the corresponding author.

Declarations

Ethics approval and consent to participate

Ethical approval was obtained from the Ethical and Research Committee of the Federal Medical Center, Owo, Ondo State, Nigeria, reference number FMC/OW/380/VL. CXXXVI/169. The study was conducted after informed consent was obtained, and compliance with the Helsinki Declaration on conducting research among human subjects was ensured.

Consent for publication

Not applicable.

Clinical trial number

Not applicable.

Competing interests

The authors declare no competing interests.