“Intimate partner violence against women: Psychopathological consequences for mother and child survivors”

Abstract

Background

this study analyses psychopathological symptomatology and post-traumatic stress disorder (PTSD) in victims of intimate partner violence against women (IPVAW) and examines the presence of school, behavioural and emotional problems in their children.

Objectives

The aim of the study was to (1) analyse psychopathological symptomatology and PTSD in women survivors of IPVAW, in comparison to women unexposed; (2) analyse the connection between the experience of this type of violence and the presence of psychopathological symptomatology and PTSD; (3) examine the presence of school, behavioural and emotional problems in the children of women survivors of IPVAW compared to the children of unexposed women; and to (4) examine the relationship between psychopathological symptomatology in women survivors of IPVAW and the presence of school, behavioural and emotional problems in their children.

Design

A cross-sectional comparative study. Participants were recruited through Women’s Care Institutions (experimental group) and schools (control group).

Method

The sample included 29 women survivors of IPVAW and 30 non-exposed women, along with their respective children (n = 60). Maternal psychopathology was assessed with the SCL-90-R and ITQ; violence exposure with the CAS-R-SF; and children’s behavioural, emotional and school outcomes with the BASC-3.

Results

Women survivors of IPVAW and their children present significantly more psychopathological symptoms compared to women and children unexposed to this violence. Furthermore, a relationship was found between the symptomatology in mothers and school, behavioural and emotional problems of their children.

Conclusion

IPVAW has a broad psychopathological impact on both survivors and their children. This study shows the importance of specifically working on psychological intervention with both.

Plain Language Summary

This study examines how violence against women by their intimate partners affects their mental health and the well-being of their children. A group of women who had experienced this type of violence was compared with another group who had not, along with their respective children. The results show that women who have been victims of intimate partner violence experience more psychological problems, such as anxiety, depression, and symptoms related to post-traumatic stress. Their children also show more difficulties compared to other children, particularly in school performance, behavior, and emotional adjustment. The study also found a relationship between the mothers’ psychological state and their children’s difficulties. In other words, the greater the emotional distress experienced by the mother, the more likely it is that children will have problems at school or show behavioral and emotional issues. Overall, the findings suggest that intimate partner violence not only directly affects the women who experience it but also has a significant impact on their children, even if the children are not directly exposed to the violence. For this reason, the study highlights the importance of providing psychological support to both mothers and their children, in order to reduce the negative effects of these experiences and promote recovery and well-being.

Introduction

According to the United Nations General Assembly, gender-based violence, or Intimate Partner Violence against Women (IPVAW) is defined as “any act of gender-based violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life”. ¹ The scope of this problem is such that regulations have been created in which the children of women victims are also included as IPVAW victims. ² To this end, the type of violence they are exposed to is taken into account, and with this an awareness arose in society and at scientific level of the need to assess the sequelae of these minors. ³ This study was conducted in Spain, where it is estimated that around 800,000 children are victims of this type of violence. ⁴

Thus, despite growing attention being paid to women survivors of IPVAW, there are still fundamental aspects that are scarcely being considered and which greatly impact the lives of the children who witness this type of violence in their family sphere. ⁵ Some women suffer IPVAW even during pregnancy,^6–8 and from that point onward, it can continue, having short- and long-term consequences which pose short- and long-term threats to the physical and mental well-being of women and their children.^9,10

In relation to women, studies have been carried out on how suffering violence by a partner or ex partner gives rise to physical problems, including heart disease, chronic pain, gastrointestinal disorders, central nervous system conditions, respiratory problems and difficulties in regulating immune response.^11–15 In addition to this physical consequences, women survivors also show cerebral and neuropsychological alterations, which appears to develop as a result of this type of violence.^16–25

Several studies have reported that these women also face a greater risk of suffering mental health-related problems such as depression, anxiety, sleep alterations, thoughts of self-harm and personality disorders.^{12,15,17,26–30} Specifically, there is increasing recognition of post-traumatic stress disorder assessment in women survivors of IPV, given it is one of the most prevalent mental disorders in this population.^31,32

Furthermore, in reference to minors, witnessing of IPVAW and/or living in a violent environment may result in psychopathological and neuropsychological sequelae, something that is gradually becoming the subject of study by researchers. It seems that, independently of degree of exposure to IPVAW, all children exposed are affected in psychopathological terms.^33,34 Among the consequences most frequently reported are depression, anxiety, behavioural problems and other disorders.^35–51 Lastly, a highly important variable in the lives of children is that related to academic performance. Recent studies suggest that being a survivor of intimate partner violence against women poses a risk to academic achievement,^52–54 with positive school adjustment observed in only 40% of these minors. ⁵⁵ This vulnerability could be due to the fact that the exposure of children to IPVAW is related to fewer empathetic abilities, problems in concentration, greater problems in completing their school tasks, and lower levels of social skills and emotional regulation,^56,57 while there is currently a lack of in-depth knowledge is regarding how the psychopathological sequelae of mothers is related to the impact of the consequences of this type of violence on the mental health and academic performance of their children.

The construct of “psychopathology” is differently operationalised depending on the population studied. In women survivors of IPVAW, psychopathological symptomatology refers to clinically significant scores across the nine symptomatic dimensions of the SCL-90-R (somatisation, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, phobic anxiety, hostility, paranoid ideation and psychoticism), as well as to PTSD symptom clusters assessed by the ITQ. In children, the impact of IPVAW exposure is conceptualised in terms of school difficulties and deficits in personal adjustment, given the developmental context in which these consequences emerge.

Thus, the aims of this research paper were:

• • Hypothesis 1:

Women survivors of IPVAW are expected to show psychopathological symptomatology and PTSD, with statistically significant differences compared to unexposed women.

• • Hypothesis 2:

The experience of violence suffered by women survivors of IPVAW is expected to be related to the presence of psychopathological symptomatology and PTSD.

• • Hypothesis 3:

Children of women survivors of IPVAW are hypothesised to present school, behavioural and emotional problems, with significant differences compared to children of unexposed women.

• • Hypothesis 4:

A significant relationship is expected between the psychopathological symptomatology of women survivors and the presence of school, behavioural and emotional problems in their children.

Method

This study has a cross-sectional comparative design. This design was selected because it allows the simultaneous comparison of two naturally occurring groups at a single point in time without experimental manipulation. Furthermore, the instruments used were chosen to operationalise the psychopathological outcomes in a standardised way.

The IPVAW survivor group was recruited through Women’s Care Institutions located in Spain, which provided access to clinically well-defined samples of women with exposure to IPVAW and their children. These are specialised social and psychological care services for victims of IPVAW, operating within the regional public health and social services network. In contrast, the control group was recruited through state-funded primary schools in the same geographical area, following a convenience sampling approach. The overall research project was conducted between October 2021 and October 2024, with the data collection phase between April 2022 and October 2023, a period of approximately 18 months. The reporting of this study conforms to the STROBE statement for observational research ⁵⁸ ; the corresponding STROBE checklist is provided as supplemental material.

The present investigation was conducted in accordance with the ethical principles outlines in the Declaration of Helsinki. Written informed consent was obtained from all participants and their legal guardians in the case of children. Data were treated confidentially and anonymously.

Participants

The sample size was determined prior to the data collection as part of the initial planning of the study. A total of 59 women and their corresponding children (n=60) participated in the study. Regarding the women, a total of 29 belonged to the survivors of intimate partner violence against women group (IPVAWW), with the remaining 30 women belonging to the unexposed women group (CGW). The inclusion criteria for the women in the experimental group were: (1) being an adult woman; (2) being a survivor of IPVAW, and (3) having at least one child between 7 and 11 years old. The children exposed to IPVAW (experimental group) were: (1) being between 7 and 11 years old; (2) being the children of a woman survivor of IPVAW, and (3) having enough ability to read and fluency in Spanish. In the experimental group, the mean period of victimization was 3 years. The exclusion criteria included: (1) presence of a severe neurodevelopmental disorder that would preclude valid assessment; (2) insufficient reading competence in Spanish to understand instrument instructions, and (3) being in active psychological or psychiatric treatment at the time of assessment.

The average age of the women survivors was 37.43 (SD = 3.68) and for the unexposed group it was 43.93 (SD = 5.47). Regarding the minors, a total of 60 children aged from 7 to 11 participated, of which 30 were sons and daughters of women survivors of intimate partner violence against women (IPVAWW), with the remaining 30 being the children of unexposed women (CGCH). The children of the survivors group comprised 16 girls (53.3%) and 14 boys (45.7%), and the unexposed group contained 17 boys (56.7%) and 13 girls (43.3%). The average age of the survivors group was 9.70 (SD = 1.31) and that of the unexposed group was 10.03 (SD = 1.29).

Within the IPVAWW group, a total of 75.9% (n = 22) were separated or lived with new partners, 55.2% (n = 16) came from rural areas and 44.8% (n = 13) from urban areas. In terms of level of studies, 9 mothers had a university degree (31%), 11 post-16 education or professional training qualification (37.9%) and 7 were educated to secondary school level (24.1%). Regarding work, 12 (41.4%) were unemployed, 12 (41.4%) had stable employment, and the rest had temporary employment (17.2%; n = 5). And in relation to the group of women unexposed to intimate partner violence against women (CGW), the majority were married (80%; n = 24) and the remaining 6 (20%) were separated and/or cohabited with new partners. 56.7% (n = 17) came from the urban environment and 43.3% (n = 13) from rural areas. In terms of level of studies, 17 mothers had a university degree (56.7%), 10 post-16 education or professional training qualification (33.4%) and 2 were educated to secondary school level (6.7%). Regarding work, 12 (6.7%) were unemployed, 12 (80%) had stable employment, and the rest had temporary employment (13.3%; n = 4).

In terms of the violent relationship of women survivors of IPVAW, 13.7% (n = 4) suffered psychological violence (insults, humiliation and disqualifications), 37.8% (n = 11) psychological and physical violence, and the remaining 44.7% (n = 13) suffered psychological, physical and sexual violence. The average duration of the exposition for the group of women survivors of IPVAW was 5 years. Moreover, 51.7% (n = 15) of the women survivors had experienced suicidal thoughts or ideation, of which 31% (n = 9) had attempted suicide in recent years.

Regarding children of women survivors of IPVAW (IPVAWCH), 51.7% (n = 15) witnessed violence towards the mother and were physically or psychologically assaulted, and 41.4% (n = 12) witnessed violence but were not assaulted. 86.2% (n = 25) of mothers considered that their children could have sequelae due to having experienced the violent relationship.

Instruments

Mothers

Sociodemographic information

Semi-structured interview

An interview was conducted to gather sociodemographic information ad hoc from mothers about their children, medical history, pregnancy, academic performance, social relationships, parenting style and parental relationships. Moreover, it included specific aspects about the violence experienced and the children’s exposure to IPVAW.

CAS-R-SF The Composite Abuse Scale (CAS-R-SF) ⁵⁹ is based on the validated 30-item Composite Abuse Scale, a measure of IPV that has been used as an standard for assessing women’s self-reported experiences of abuse. ⁶⁰ The 15-item CAS-R-SF asks women to indicate on a dichotomous scale whether they have experienced or not the 15 listed experiences. If affirmative, they must rate the frequency of experiencing each of the abusive acts in the previous 12 months, on a six-point scale ranging from ‘never’ (0) to ‘daily’. ⁵ Using cut-off scores, women’s responses are categorised as ‘positive’ or ‘negative’ for exposure to four types of IPV: physical abuse, emotional abuse, harassment, and severe combined abuse. Scores can range from 0 to 75, calculated by averaging the frequency of abuse in the last 12 months and multiplying it by 15. To be considered valid, no more than 3 items can be missing. The CAS-R-SF items cover a broad range of acts consistent with the WHO (2010) definition of IPV. Various international IPV experts (academic researchers, service providers, and policymakers) have contributed to its development, based on pooled data from 6,278 English-speaking adult women gathered across five Canadian studies. ⁵⁹ The scale has been translated into eight languages and has demonstrated initial reliability and validity. ⁵⁹

ITQ The International Trauma Questionnaire (ITQ) ⁶¹ is a self-report instrument based on the International Classification of Diseases - 11th Revision (ICD-11) criteria for PTSD and complex post-traumatic stress disorder (CPTSD). Participants are instructed to describe a primary traumatic event and subsequently answer all the questions about this specific event. The ITQ has six items measuring PTSD symptoms across three clusters: “Re-experiencing in the here and now”, “Avoidance” and “Sense of Threat”. The responses to the items show the intensity of the symptoms in the past month. The ITQ also includes another six items evaluating symptoms relating to “Disturbance in Self-Organisation” (DSO). These symptoms are in turn divided into three clusters: “Affective Dysregulation”, “Negative Self-Concept” and “Disturbed Relationships”. Three further items evaluate functional impairments in the following areas: (1) relationships and social life, (2) work or ability to work, and (3) other important aspects of life such as parenting, school/college work or other important activities. All items are answered using a 0-5 Likert scale ranging from 0 (Not at all) to 4 (Extremely). PTSD and DSO symptoms fall within the range of 0 to 24 (representing the sum of the items of each subscale), and CPTSD symptom scores range from 0 to 48 (the sum of the 12 ITQ items). The symptom and functional impairment indicators were determined using a score of ≥ 2 (Moderately) on the Likert scale. ⁶¹ The ITQ scale has shown good levels of consistency.^62,63

SCL-90-R The Symptom Checklist-90-Revised (SCL-90-R) ⁶⁴ is a self-report questionnaire used to assess psychopathological symptoms and psychological problems presented in the previous two weeks in relation to the administration of the test. The SCL-90-R consists of 90 questions categorised into 9 dimensions of symptoms (depression, anxiety, phobic anxiety, hostility, obsessive-compulsive, interpersonal sensitivity, somatisation, paranoid ideation, and psychoticism dimensions), as well as three global indices of psychopathology: (1) Global Severity Index, which is the sum of all 9 subscales; the (2) Positive Symptom Distress Index and the (3) Total Positive Symptoms, which is the number of items answered affirmatively. It uses a Likert scale ranging where scores are “0” or “not at all,” “1” or “a little bit”, “2” or “moderately,” “3” or “quite a bit,” and finally, “4” or “extremely.”. The SCL-90-R shows an optimal internal consistency with Cronbach’s alpha coefficients ranging from 0.70 to 0.80^65,66 and it has been validated in different populations.^67,68

Children

Psychopathological symptoms

The Behaviour Assessment System for Children-Third Edition

Based on the objectives of our study, the Behaviour Assessment System for Children-Third Edition/BASC-3 ⁶⁹ was used to assess the children’s psycho-emotional well-being and behavioural state. The BASC measures emotional and behavioural problems by means of clinical scales and positive behaviours in children and adolescents with adaptive scales. The BASC shows adequate reliability and validity. ⁷⁰

The primary outcome variables were: (a) maternal psychopathological symptomatology (SCL-90-R nine subscale T-scores and Global Severity Index) and PTSD severity (ITQ global score); (b) violence severity (CAS-R-SF total score); and (c) children’s outcomes (BASC-3 subscales: school problems, internalising symptoms, externalising symptoms, emotional symptoms, functional decline, and personal adjustment). The exposure variable was group membership (IPVAW survivor vs. unexposed). Potential cofounders identified a priori included maternal age, marital status, educational level, employment status, and urban/rural residence; these were not statistically controlled in the primary analyses but are described in the sample characteristics and addressed in the Limitations. No effect modifiers were pre-specified. ⁷¹

Procedure

The information for the study was provided by professionals who attend to women and children IPVAW survivors in the Women’s Care Institutions of Extremadura in Spain, which participated voluntarily in the project. The assessment of both mothers and children was carried out by the psychologists who attend to this population in the facilities of Women’s Care Institutions in Extremadura (Badajoz and Cáceres), in order for them to feel they could trust the professionals who assessed them. The assessment lasted approximately 1 hour 30 minutes.

For the unexposed group, the information for the study was disseminated through the schools and the head of the project contacted the mothers, who agreed to participate therein and gave their consent for their children to be assessed. These assessments were performed in the laboratory of Experimental Psychology of the Faculty of Education and Psychology of the University of Extremadura. In the interview with the mother, the assessor made sure that neither she nor her son or daughter had been exposed to IPVAW. Additionally, information about the children was obtained through a combination of maternal reports and evaluations conducted by the psychologists who assessed them. If, finally, it is observed in the data that the person did belong to the survivors group, the results were eliminated from the unexposed group and not taken into consideration for the study.

All of the procedures followed were in compliance with the ethical standards of the University of Extremadura (Ref.: 78/2020) and the 1964 Declaration of Helsinki and its subsequent amendments or comparable ethical standards. The requirements established by Organic Law 3/2018, of 5 December, on Personal Data Protection and guarantee of digital rights were met, guaranteeing data confidentiality and secure storage thereof. All data were collected via a code for both the minor children and their mothers, to the extent that all of the results were analysed anonymously for the two groups.

Potential sources of bias

Several potential sources of bias were identified and addressed. Information bias inherent in self-report measures was addressed by conducting assessments in safe, familiar environments with trained clinicians. Maternal-report bias in child outcome measurement is acknowledged in the limitations section. No missing data were presented beyond instrument-permitted thresholds.

Statistical analysis

The research is descriptive and the design is cross-sectional. A descriptive analysis was performed on the psychopathological symptomatology and PTSD of women survivors of IPVAWW and unexposed women (CGW), as well as school, behavioural and emotional problems of the children of women survivors and the children of the unexposed women.

Prior to conducting inferential analyses, the assumption of normality was evaluated using the Shapiro-Wilk test, which is recommended for small samples (n < 50). Given that the data violated the assumption of normality, non-parametric tests were employed. Subsequently, after confirming the use of non-parametric tests, the Mann-Whitney U test was used to analyse the existence of significant differences between the survivor group and the unexposed group of women regarding the presence of psychopathological symptomatology and PTSD, and between the survivors of IPVAW group and the unexposed group of children in relation to presence of school, behavioural and emotional problems.

Furthermore, a Spearman correlation analysis was performed to examine the existing relationship between the experience of violence and psychopathological symptomatology and PTSD in the group of women survivors of IPVAW. Finally, a correlational analysis was performed to observe the relationship between the psychopathological symptomatology of women survivors of IPVAW and the presence of school, behavioural and emotional problems in their children. The statistical significance was set at p < .05 for all analyses, in accordance with conventional standards in psychological and clinical research. Given the relatively small sample of the research, the findings should be interpreted with caution, and the risk of low generalizability is explicitly acknowledged in the Limitations section.

The Statistical Package for the Social Sciences (SPSS) version 27 for Windows was used to statistically treat the data.

Results

H1. Women survivors of IPVAW will show significantly higher levels of psychopathological symptomatology and PTSD symptom severity compared to unexposed women.

Regarding the first hypothesis of the study, Table 1 shows the results relating to the means and standard deviations of the SCL-90-R and ITQ of the IPVAWW group and those women unexposed (CGW), as well as the comparison of means via the Mann-Whitney U test.

Table 1.

Comparison of means between the IPVAWW group and the unexposed group (CGW) in the SCL-90-R and ITQ tests.

​	IPVAWW (n = 29)	CGW (n = 30)	z	p
	M (SD)	M (SD)
SCL-90-R
Somatisation	79.51 (26.21)	37.83 (29.29)	-4.89	.000
Obsession-Compulsion	77.68 (32.39)	44.00 (31.44)	-4.19	.000
Interpersonal sensitivity	78.37 (30.92)	34.66 (31.07)	-4.63	.000
Depression	74.65 (28.87)	34.90 (28.68)	-4.46	.000
Anxiety	81.68 (25.12)	45.50 (30.69)	-4.64	.000
Hostility	63.68 (32.87)	21.00 (26.14)	-4.53	.000
Phobic anxiety	70.48 (37.52)	19.16 (25.43)	-4.84	.000
Paranoid ideation	78.17 (32.72)	29.16 (31.43)	-4.93	.000
Psychoticism	76.82 (31.43)	37.56 (34.22)	-4.24	.000
Global Severity Index	81.03 (28.07)	36.50 (30.60)	-4.97	.000
ITQ – Global score	12.93 (5.62)	3.43 (4.43)	-5.26	.000

In regard to the normative SCL-90-R data, the scores higher or equal to 70 are clinically significant, providing information on the psychopathological symptomatology of the person in the different sub-scales.

As shown in Table 1, IPVAWW group show clinical symptoms in somatisations, obsessions-compulsions, interpersonal sensitivity, depression, anxiety, phobic anxiety, paranoid ideation, psychoticism and in the global severity index. The lowest mean scores are in the hostility subscale, where no statistically significant scores are observed in any of the groups.

In the unexposed women (CGW) the mean scores are under 70 in all subscales and the global severity index. Furthermore, the existence of statistically significant differences is revealed in all of the subscales between both groups (all values p < .001). The scores obtained by the survivors of IPVAW are clinically significant regarding psychopathological symptomatology, reflecting the fact that these women present high levels of psychological suffering and discomfort that hinder their adaptation to their surroundings and may have a negative effect on their capacity to respond adequately to diverse everyday situations.

Psychopathological symptoms are related to experiences of bodily dysfunction, psychosomatic manifestations and neurovegetative alterations (cardiovascular, respiratory, gastrointestinal and muscular); anxiety symptoms, such as nervousness, emotional tension, inner agitation, fear and motor restlessness; obsessive thoughts linked to the experience of victimisation (“something bad will happen”), which generate intense anguish and are difficult to avoid; feelings of shame, tendency to feel inferior to others, hypersensitivity to the opinions and attitudes of others, and in general, discomfort and inhibition in interpersonal relationships; symptoms characteristic of depression, such as discouragement, hopelessness, helplessness, lack of energy, as well as self-destructive ideas; delusional thinking, suspicion and distrust of others; persistent and disproportionate fear of certain situations leading to avoidance behaviour (leaving the house alone and fear of open spaces); and symptoms typical of the psychotic spectrum, such as believing their partner may know what they are thinking and that something is wrong in their head.

Regarding the comparison of means in PTSD between the women survivors of intimate partner violence against women (IPVAWW) and unexposed women (CGW) via the ITQ test, the data show statistically significant differences between the two groups (p < .001).

The ITQ considers the presence of PTSD from scores equal to or higher than 6 (as long as at least one symptom of re-experience, avoidance and sense of current threat is endorsed). As Table 1 shows, in the two instruments we find the presence of PTSD in IPVAWW group. Specifically, 56.7% of the survivors (n = 17) report PTSD. Moreover, in the women survivors of IPVAW we confirm the presence of functional deterioration indicators associated with PTSD symptoms (re-experience, avoidance, hypervigilance and cognitive alterations, mood and behaviour related) in various spheres of psychosocial functioning (personal, social, family and work).

H3. Children of women survivors of IPVAW will present significantly higher levels of school problems, internalising symptoms, externalising symptoms, emotional symptoms and functional decline, and significantly lower personal adjustment, compared to children of unexposed women.

Regarding the second hypothesis of the study, Table 2 shows the results relating to the means and standard deviations of the BASC-3 of the children of the IPVAWW group and the unexposed group (CGCH), as well as the comparison of means via the Mann-Whitney U test.

Table 2.

Comparison of means between the children of IPVAW and the unexposed children of the unexposed group (CGCH) in the BASC-3 test.

​	IPVAWCH (n = 30)	CGCH (n = 30)	z	p
	M (SD)	M (SD)
BASC-3
School problems	70.23 (2.99)	48.73 (7.48)	-6.58	.000
Internalising symptoms	70.87 (4.71)	46.70 (6.59)	-6.66	.000
Externalising symptoms	70.63 (4.81)	47.63 (7.73)	-6.37	.000
Emotional symptoms	71.43 (6.54)	48.13 (8.09)	-6.51	.000
Personal adjustment	28.23 (9.06)	57.17 (6.66)	-6.63	.000
Functional decline index	71.57 (2.28)	48.40 (7.67)	-6.57	.000

Regarding the normative BASC-3 data, the mean scores between 60 and 69, and between 31 and 40 are classified as at risk, and scores equal to or higher than 70 or equal to or lower than 30 are considered clinically significant. The results show clinically significant scores regarding psychopathological symptomatology in children of IPVAW in school problems (attitude towards teachers and the school) that may affect their academic performance, internalising symptoms (anxiety, tension, somatisations and social stress), externalising symptoms (attention deficit and hyperactivity) and emotional symptoms (feeling of failure and incompetence, insecurity and low self-confidence), along with a low personal adjustment that hinders adaptation to surroundings and capacity to adequately face diverse everyday situations.

Furthermore, Table 2 shows the presence of statistically significant differences between the two groups in all of the scales (p < .001).

H2. The severity of violence experienced (CAS-R-SF scores) will be positively and significantly correlated with psychopathological symptomatology and PTSD in women survivors of IPVAW.

Table 3 shows the results of the relationship between experience of violence and presence of psychopathological symptomatology and PTSD in women survivors of intimate partner violence against women (hypothesis 3).

Table 3.

Correlational analysis between experience of violence and presence of psychopathological symptomatology and PTSD in women survivors of IPVAW.

​	CAS-R-SF
SCL-90-R
Somatisation	.598**
Obsession-Compulsion	.509**
Interpersonal sensitivity	.558**
Depression	.562**
Anxiety	.571**
Hostility	.532*
Phobic anxiety	.622**
Paranoid ideation	.613**
Psychoticism	.511**
Global Severity Index	.604**
ITQ – Global score	.727**

**p < .01.

The results draw attention to significant correlations between experience of violence (CAS-R-SF) and psychopathological symptomatology (SCL-90-R) and the TEPT (ITQ) in women survivors of IPVAW. The data show a positive correlation of the violent experience suffered by women survivors with symptoms such as somatisation (r= .598; p= .000), obsession-compulsion (r = .509; p = .000), interpersonal sensitivity (r= .558; p= .000), depression (r= .562; p= .000), anxiety (r= .571; p= .000), hostility (r= .532; p= .000), phobic anxiety (r= .622; p= .000), paranoid ideation (r= .613; p= .000), psychoticism (r= .511; p= .000) and the global severity index (r= .604; p= .000). In regard to the TEPT, the results show a positive correlation with experience of violence in survivors.

The correlation analysis showed that the experiences of abuse and violence suffered by women survivors correlated significantly with high scores in PTSD (r = .727; p < .01) and a greater presence of psychopathological symptomatology. Therefore, psychological suffering and difficulties in children and women exposed to IPVAW is clear, shown through the different symptomatic dimensions of psychopathology analysed.

H4. Psychopathological symptomatology in women survivors of IPVAW will be significantly and positively correlated with school, behavioural and emotional problems in their children.

Finally, Table 4 shows the Spearman correlation coefficients between the psychopathological symptomatology of women survivors (IPVAWW) and the presence of school, behavioural and emotional problems in their children (IPVAWCH) (hypothesis 4).

Table 4.

Correlational analysis regarding the relationship between the psychopathological symptomatology of women survivors (IPVAWW) and school, behavioural and emotional problems in their children (IPVAWCH).

​	BASC-3
	School problems	Internalising symptoms	Externalising symptoms	Emotional symptoms	Personal adjustment	Functional decline index
SCL-90-R
Somatisation	.487**	.540**	.541**	.528**	-.519**	.553**
Obsession-Compulsion	.466**	.453**	.463**	.452**	-.402**	.506**
Interpersonal sensitivity	.521**	.471**	.526**	.494**	-.444**	.527**
Depression	.485**	.457**	.549**	.486**	-.457**	.516**
Anxiety	.471**	.487**	.548**	.540**	-.453**	.533**
Hostility	.523**	.509**	.596**	.495**	-.462**	.498**
Phobic anxiety	.579**	.557**	.649**	.529**	-.583**	.604**
Paranoid ideation	.529**	.500**	.606**	.545**	-.508**	.621**
Psychoticism	.513**	.462**	.520**	.503**	-.407**	.527**
Global Severity Index	.534**	.523**	.579**	.550**	-.489**	.572**

**p < .01.

The results show a positive correlation between all of the SCL-90-R and BASC-3 subscales, and a negative correlation with the level of personal adjustment on the part of the minors. The relationship is therefore shown between the psychopathological symptomatology of women survivors of IPVAW and school, internalising, externalising, and emotional and functional decline problems in their children, as well as the presence of a lower personal adjustment of the minors. Thus, exposure to IPVAW is associated with a higher likelihood of both women and children exhibiting psychopathological symptoms.

Discussion

The literature on psychological sequelae in women, survivors of IPVAW demonstrate negative consequences in their mental health, damaging their quality of life and relationships with their environment.^{35–41,45–51,72} Nevertheless, it is unclear whether these same variables have an impact on and relate in turn to the sequelae suffered by their children. This study examined the psychopathological consequences of IPVAW in survivors and their children. All four hypotheses were supported. The first one (H1) was confirmed: women survivors presented clinically significant and significantly higher multi-dimensional psychopathological symptomatology and PTSD severity compared to unexposed women. H2 was also confirmed: violence severity correlated positively and significantly with the psychopathological and PTSD symptomatology. H3 was confirmed: minors exposed to IPVAW showed symptomatology and school, internalising, externalising and emotional problems, as well as a lower personal adjustment, compared to unexposed children. H4 was confirmed: the maternal symptomatology was significantly and positively correlated with all child outcome domains.

H1 and H2. Psychopathological symptomatology, PTSD and the importance of violence severity in women survivors

Findings reinforce the fact that women survivors of IPVAW show more psychopathological symptomatology and PTSD-specific symptomatology compared to women who have not suffered this type of violence in their relationships. In this regard, women survivors of IPVAW presented clinically significant scores on eight of the nine SCL-90-R dimensions (somatisation, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, phobic anxiety, paranoid ideation and psychoticism) as well as on the Global Severity Index, showing a multi-dimensional psychopathological profile. Only hostility did not reach a clinical significance in either group.

In the same vein, the results of this study indicate the existence of a relationship between experience of violence suffered and psychopathological symptomatology and PTSD. This symptomatology includes somatisation, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, phobic anxiety, paranoid ideation and psychoticism. These findings show that the greater exposure to violence is related with more trauma-related symptomatology, interpersonal dysfunction, internalising difficulties, and psychotic-spectrum features. Therefore, psychological suffering of discomfort in survivors is evident, manifested through the different symptomatic dimensions of psychopathology that has been analysed. These results are consistent with those obtained in the study by Fernández-Fillol et al., ⁷³ who found that 50% of women survivors of IPVAW in the sample fulfilled the diagnostic criteria of PTSD. Similarly, Molina and Matud ⁷⁴ conducted a study with 255 women and found that experiencing psychological IPVAW significantly predicted the onset of PTSD-related symptoms. Ultimately, this is also consistent with several studies indicating that women exposed to intimate partner violence exhibit depressive symptomatology, post-traumatic stress disorder (PTSD), anxiety, suicidal ideation, self-harm, amnesia, concentration problems, substance use, medication misuse, memory loss, social skills deficits, and sleep disturbances.^{29,30,72,75–78}

H3. School, behavioural and emotional problems in children exposed to IPVAW

Children exposed to IPVAW presented clinically significant scores across all BASC-3 clinical scales and clinically significant deficits in personal adjustment, confirming H3 and demonstrating simultaneous impairment across all assessed developmental domains. Internalising symptoms (M = 70.87) were among the most elevated, consistent with high rated of anxiety, depression and somatisation documented in children exposed to IPVAW. Similar results were obtained by Jouriles et al., ⁷⁹ who performed research on 69 children under five and found a negative relationship between exposure of minors to IPVAW and school performance. Likewise, Rosser and Suriá ⁸⁰ conducted a study with 46 children exposed to IPVAW and identified academic and behavioural difficulties in most of them, aligning with the findings of the present research. Similarly, another piece of evidence of the impact of violence was demonstrated by Gustafsson et al., ⁸¹ who studied a group of child victims that showed difficulties in the school setting due to early exposure to gender-based violence. This would confirm that regardless of the age of the child, the consequences of this violence expand to the academic terrain, causing problems in their performance.^82,83

It should be taken into account that these results could be related to the parenting style of the caregivers, since in this context mothers may adopt an overprotective role toward their children, while fathers may appear more irritable and strict. ⁸⁴ Moreover, the experience of gender-based violence affects the mother–child relationship, ⁸⁵ which in turn may influence children’s adjustment problems. Similarly, the psychopathology observed in children could reflect a genetic vulnerability, as the high levels of anxiety and depression in mothers may be inherited by their children.

H4. Relationship between maternal psychopathological symptomatology and children’s outcomes

Statistically significant positive correlations were found between all SCL-90-R subscales and all BASC-3 clinical scales, and negative correlations with personal adjustment, confirming H4. The strongest associations emerged between phobic anxiety in mothers and externalising symptoms (r = .649) and functional decline (r = .604) in children, and between paranoid ideation and functional decline (r = .621). These dimensions (hypervigilance, avoidance and distrust) produce the most important disruption to the caregiving environment and to children’s functional development.

To sum up, a relationship was found between the presence of psychopathological symptomatology in mothers who were survivors of IPVAW and school, behavioural and emotional problems of their children. These results are consistent with and broaden knowledge by exploring the different domains of the children measured with the BASC-3, obtaining correlations with all the SCL-90-R scales, an instrument used to measure psychopathology in their mothers. Nevertheless, it is important to consider that other mediating factors may affect this relationship (Graf & Schechter, 2024), such as the parenting style and the quality of the parent–child bond. ⁸³

Our results therefore show a relationship and increase the probability of these two groups of survivors, mothers and children, showing psychopathological symptomatology.

Implications

Despite its limitations, this study has permitted us to identify the presence of psychopathological symptomatology in women survivors and their children, as well as underline the affectation in all aspects of the life of the minor: behavioural, emotional and school performance. These findings carry significant clinical and policy implications. First, the severity of psychopathological symptomatology observed in women survivors of IPVAW underscores the need for comprehensive, multi-dimensional psychological assessment in services attending to IPVAW survivors, going beyond evaluations focused exclusively on PTSD or depression. Second, the clinically significant impairment observed across all assessed domains in children of survivors reinforces the urgent need for routine psychological screening of children whose mothers are attending IPVAW services, as these children are a high-risk population. Third, attention should be drawn to the fact that the results of this recent study indicate the need to improve and explore psychological treatments aimed at both women and their children and, above all, a correct pre and post assessment of the sequelae at all levels to evaluate the change produced following the psychological intervention.

Limitations and future directions

The present study has several limitations that should be considered. Firstly, the sample size of the two groups is reduced, to which future research should be able to increase the sample to replicate and/or confirm these results. Also, a formal power analyses was not conducted prior to data collection, with represents a methodological limitation and future studies should calculate the required sample size based on expected effect sizes from the literature before initiating data collection. The use of non-parametric statistics was chosen to tackle the small sample limitation. In this sense, future analyses should increase sample size to do more robust statistical analyses, including multivariate approaches.

Second, the cross-sectional design of the study limits any causal inferences regarding the associations observed between variables. In this sense, it would be interesting to conduct longitudinal studies to clarify how these variables evolve over time. Third, the control group was not recruited from Women’s Care Institutions but through schools, which may introduce selection bias. In this sense, there are potential confounding factors that may influence the results of this study and were not analysed, such as social support, socioeconomic status, education or coping strategies, which should be considered in future work. Another limitation of this research is the potential for reporting bias in the data collected through self-report measures.

One of the strengths of this study is, however, that the IPVAW sample was drawn from women and children receiving attention in specialised institutions, and the protocol followed for their selection and evaluation was highly rigorous. Furthermore, another strength of this study is the selection and use of specific means for measuring PTSD and psychopathology in women.

Conclusion

This study provides evidence that IPVAW produces a clinically significant, multi-dimensional psychopathological impact in both women survivors and their children. The four hypotheses proposed were supported. These findings highlight the importance of integrated assessment and intervention strategies targeting both mothers and their children simultaneously, the implementation of multi-dimensional psychological screening tools in IPVAW services, and the need for pre- and post-intervention evaluation to monitor psychological recovery. Also, it is recommended to replicate the study with a larger sample and to include other mediating variables, such as family dynamics or social support, to obtain more generalizable results.

ORCID iD

Carlos Barbosa-Torres https://orcid.org/0000-0003-2767-1536

Ethical considerations

This study was conducted in accordance with the ethical principles of the Declaration of Helsinki and was approved by the Ethics Committee of the University of Extremadura (Ref.: 78/2020).

Consent to participate

All participating women provided written informed consent for themselves and their children prior to enrolment in the study. For minors, written informed consent was obtained from their mothers or legal guardians, and assent was obtained from the children when appropriate.

Consent for publication

All participants were informed that the data collected would be used for scientific dissemination in anonymized form. Written consent for publication was obtained from all participating mothers on behalf of themselves and their children.

Data Availability Statement

The datasets generated and analysed during the current study are not publicly available due to the sensitive nature of the information and in order to protect the privacy and safety of participants. However, anonymized data may be made available from the corresponding author upon reasonable request and subject to institutional and ethical approval.*