Intimate Partner Violence and Psychological Distress: Opportunities for Prevention and Early Intervention Among Emerging Adult Women

Intimate partner violence (IPV) is most prevalent among emerging adult women, who represent a priority population for IPV prevention and early intervention. Understanding risk and protective factors for IPV and psychological distress among emerging adults is critical as this knowledge and appropriate interventions can help prevent adverse outcomes later. In a well-designed study, Shen and Kusunoki examined the bidirectional association between IPV (psychological only or any physical violence) and psychological distress (depression, stress, loneliness, and self-esteem) in a sample of 726 partnered women aged 18–19 years followed for >2 years.¹ Results indicated that past IPV was associated with greater baseline depression, stress, loneliness, and lower self-esteem, whereas psychological distress at baseline was associated with risk of future IPV, particularly psychological violence. This finding remained, even after adjusting for IPV history and a variety of covariates. Notably, having a higher high school grade point average (GPA) was associated with a lower likelihood of all measures of baseline psychological distress and a lower likelihood of subsequent psychological and physical violence.

This study of emerging adult women¹ has several methodological strengths, including its longitudinal design, in-person assessment of IPV history and baseline psychological distress, continuous (weekly) measurement of subsequent IPV throughout the study period (online or by telephone), and adjustment for sociodemographic characteristics, adolescent sexual experiences and pregnancy, relationship type, and high participation and retention rates. Unfortunately, this study did not include sexual violence or sexual coercion, a frequent component of IPV for young women that is associated with psychological distress,² limiting our ability to more fully understand the relationship between different types of IPV and psychological health. Furthermore, substance use and substance use disorders, which frequently co-occur with IPV, were not assessed. It will be important to include these conditions in future studies of IPV and psychological distress among emerging adults. Nevertheless, results from this innovative study are consistent with a bidirectional association between IPV and psychological distress and suggest that psychological violence may be independently associated with poor health.^3–5

Prior research has shown that IPV contributes to the onset and exacerbation of psychiatric disorders, and that psychiatric disorders and psychological distress can contribute to increased vulnerability to IPV.^5,6 The bidirectional association between IPV and psychological distress found in the study by Shen and Kusunoki¹ is consistent with a recent study⁷ that used electronic health record data from a large health care organization to examine changes in medical and psychiatric conditions and health care utilization before and after a diagnosis of sexual assault. This study found that women with a history of psychiatric disorders were more likely to experience sexual assault, whereas sexual assault was, in turn, associated with increased risk for psychiatric disorders. Although the mechanisms underlying the reciprocal relationship between psychological health and trauma need to be better understood, it is possible that early trauma such as adverse childhood experiences and/or social determinants of health (e.g., poverty) may be underlying causes and contribute to both psychological distress and increased risk of IPV in emerging adulthood.

Clinicians and health care settings (including adult and pediatric primary care and reproductive health, as well as student health centers) are well positioned to screen for and, more importantly, address IPV.⁷ Unfortunately, as noted by Shen and Kusunoki,¹ despite multiple national guidelines and U.S. Preventive Services Task Force (USPSTF) recommendations for routine screening and counseling for IPV among reproductive-aged women,⁸ rates of systematic screening for IPV in health care settings are low.

We agree with Shen and Kusunoki's recommendation to improve intervention protocols in health care and suggest consideration of some additional options.¹ One approach to addressing the problem of low IPV screening rates is to adopt “universal education,” which has a growing evidence base, particularly in reproductive and adolescent health settings. For example, CUEs (confidentiality, universal education and empowerment, support) is a card-based intervention that creates opportunities to routinely discuss relationship health, mental health issues, and potentially abusive behaviors, educate and inquire about IPV, and tailor discussions and possible harm reduction interventions to each person's circumstances. Research has shown that this type of intervention is well liked by young people, increases knowledge of IPV resources, and ultimately can help women to leave abusive relationships.^9–11 This approach has the distinct benefit of delivering a lot of information and resources even if the person is not ready to disclose IPV. A limitation of the universal education approach, in contrast to routine screening, is that disclosures of IPV or psychological distress may not be documented in the medical record. The advantage of visible documentation is that it provides important information for other clinicians and can facilitate opportunities for coordination of care. However, the universal education approach could appeal to multiple types of educators (e.g., peer educators, teachers, and school nurses) across settings (e.g., classrooms and student health centers) as a complement to approaches in clinical settings to get emerging adult women thinking about the importance of relationship health and safety.

Shen and Kusunoki's findings that emerging adult women with a higher GPA were at lower risk for both psychological distress and IPV¹ highlight the importance of protective factors and prevention-focused efforts that link emotional well-being to academic performance. School-based educational efforts, as well as those in health care settings, that include information and resources about IPV and psychological health for both young women and men are an important opportunity for doing this. Future research studies are needed to continue to identify and test new ways to meet the needs of emerging adults to better prevent IPV, reduce psychological distress, and improve current and future well-being.

Author Disclosure Statement

No competing financial interests exist.