Original article| Volume 24, ISSUE 4, e425-e434, July 2014

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Social Support and Employment Status Modify the Effect of Intimate Partner Violence on Depression Symptom Severity in Women: Results from the 2006 Behavioral Risk Factor Surveillance System Survey

  • Nathalie Dougé
    MD Program, Pennsylvania State University College of Medicine, Hershey, PA
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  • Erik B. Lehman
    Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
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  • Jennifer S. McCall-Hosenfeld
    Correspondence to: Jennifer S. McCall-Hosenfeld, MD, MSc, Departments of Medicine and Public Health Sciences, Pennsylvania State University College of Medicine, 500 University Drive, Mailcode: A210, Hershey, PA 17033. Phone: 717-531-8161; fax: 717-531-0151.
    Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania

    Department of Medicine, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
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      Depression and intimate partner violence (IPV) are significant health issues for U.S. women. Interaction effects between IPV and other psychosocial factors on the severity of depressive symptoms have not been fully explored. This study assessed effect modification, that is, how IPV interacts with sociodemographics, psychosocial factors and health risk behaviors, on the severity of depressive symptoms in women.


      We utilized cross-sectional data from female respondents (n = 16,106) of the 2006 Behavioral Risk Factors Surveillance Survey. Sociodemographics, psychosocial variables, and health risk behaviors determined to be significantly associated with depression were tested for interaction effects with IPV. Weighted ordinal logistic regression and predicted probabilities illustrated the effect of IPV status on depressive symptom severity, stratified by interaction effects.


      Recent and lifetime IPV exposure were associated with more severe depressive symptoms compared with no IPV exposure. IPV history interacted with employment status and social support on the severity of depressive symptoms in women. Overall, any IPV exposure was associated with more severe depressive symptoms among women with low social support and unemployment, although the effect of recent (versus lifetime) IPV was most pronounced among women with high social support or employed women.


      Social support and employment status interact with IPV on the severity of depressive symptoms in women. Therefore, social support or workplace interventions designed to improve depressive symptoms should examine IPV history.
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        • American Psychiatric Association
        Diagnostic and statistical manual of mental disorders (4th ed., text rev.).
        Author, Washington, DC2000
        • Ansara D.L.
        • Hindin M.J.
        Psychosocial consequences of intimate partner violence for women and men in Canada.
        Journal of Interpersonal Violence. 2011; 26: 1628-1645
        • Black M.C.
        • Basile K.C.
        • Breiding M.J.
        • Smith S.G.
        • Walters M.L.
        • Merrick M.T.
        • et al.
        The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 Summary Report.
        National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA2011
        • Blasco-Ros C.
        • Sanchez-Lorente S.
        • Martinez M.
        Recovery from depressive symptoms, state anxiety and post-traumatic stress disorder in women exposed to physical and psychological, but not to psychological intimate partner violence alone: A longitudinal study.
        BMC Psychiatry. 2010; 10: 98
        • Bonomi A.E.
        • Anderson M.L.
        • Reid R.J.
        • Rivara F.P.
        • Carrell D.
        • Thompson R.S.
        Medical and psychosocial diagnoses in women with a history of intimate partner violence.
        Archives of Internal Medicine. 2009; 169: 1692-1697
        • Breiding M.J.
        • Black M.C.
        • Ryan G.W.
        Chronic disease and health risk behaviors associated with intimate partner violence-18 U.S. states/territories, 2005.
        Annals of Epidemiology. 2008; 18: 538-544
        • Breslau J.
        • Kendler K.S.
        • Su M.
        • Gaxiola-Aguilar S.
        • Kessler R.C.
        Lifetime risk and persistence of psychiatric disorder across ethnic groups in the United States.
        Psychological Medicine. 2005; 35: 317-327
        • Campbell J.C.
        • Kub J.
        • Belknap R.A.
        • Templin T.
        Predictors of depression in battered women.
        Violence Against Women. 1997; 3: 271-293
        • Campbell J.C.
        • Soeken K.L.
        Women’s responses to battering over time: An analysis of change.
        Journal of Interpersonal Violence. 1999; 14: 21-40
        • Campbell R.
        • Sullivan C.M.
        • Davidson W.S.
        Women who use domestic violence shelters: Changes in depression over time.
        Psychology of Women Quarterly. 1995; 19: 237-255
        • Carbone-Lopez K.
        • Kruttschnitt C.
        • Macmillan R.
        Patterns of intimate partner violence and their associations with physical health, psychological distress, and substance use.
        Public Health Reports. 2006; 121: 382-392
      1. Centers for Disease Control and Prevention (n.d.). Intimate partner violence: Definitions. Available from: Accessed June 12, 2011.

        • Centers for Disease Control and Prevention (CDC)
        Costs of intimate partner violence against women in the United States.
        U.S. Department of Health and Human Services, Atlanta2003 (Available from:) (Accessed June 12, 2011)
      2. Centers for Disease Control and Prevention. (2006). Behavioral Risk Factor Surveillance System operational and user's guide. Available from: Accessed June 12, 2011.

        • Centers for Disease Control and Prevention
        Current depression among adults – United States, 2006 and 2008.
        Morbidity and Mortality Weekly Report. 2010; 59: 1229-1235
        • Coker A.L.
        • Davis K.E.
        • Arias I.
        • Desai S.
        • Sanderson M.
        • Brandt H.M.
        • et al.
        Physical and mental health effects of intimate partner violence for men and women.
        American Journal of Preventive Medicine. 2002; 23: 260-268
      3. Corporate Alliance to End Partner Violence. (2005). Workplace statistics. Available from: Accessed March 3, 2013.

        • Devries K.M.
        • Mak J.Y.
        • Bacchus L.J.
        • Child J.C.
        • Falder G.
        • Petzold M.
        • et al.
        Intimate partner violence and incident depressive symptoms and suicide attempts: A systematic review of longitudinal studies.
        PLOS Medicine. 2013; 10: e1001439
        • Dunlop D.D.
        • Song J.
        • Lyons J.S.
        • Manheim L.M.
        • Chang R.W.
        Racial/ethnic differences in rates of depression among preretirement adults.
        American Journal of Public Health. 2003; 93: 1945-1952
        • Dutton D.G.
        • Painter S.L.
        Emotional attachments in abusive relationships: A test of traumatic bonding theory.
        Violence and Victims. 1993; 8: 105-120
        • Fanslow J.L.
        • Robinson E.M.
        Help-seeking behaviors and reasons for help seeking reported by a representative sample of women victims of intimate partner violence in New Zealand.
        Journal of Interpersonal Violence. 2010; 25: 929-951
        • Fogarty C.T.
        • Fredman L.
        • Heeren T.C.
        • Liebschutz J.
        Synergistic effects of child abuse and intimate partner violence on depressive symptoms in women.
        Preventive Medicine. 2008; 46: 463-469
        • Gotlib I.H.
        • Hammen C.L.
        Psychological aspects of depression: Toward a cognitive-interpersonal integration.
        Wiley, New York1992
        • Hammen C.
        Stress and depression.
        Annual Review of Clinical Psychology. 2005; 1: 293-319
        • Hegarty K.L.
        • O'Doherty L.J.
        • Chondros P.
        • Valpied J.
        • Taft A.J.
        • Astbury J.
        • et al.
        Effect of type and severity of intimate partner violence on women's health and service use: Findings from a primary care trial of women afraid of their partners.
        Journal of Interpersonal Violence. 2013; 28: 273-294
        • Hobfoll S.E.
        Traumatic stress: A theory based on rapid loss of resources.
        Anxiety Research. 1991; 4: 187-197
        • Jenkinson C.
        • Wright L.
        • Coulter A.
        Criterion validity and reliability of the SF-36 in a population sample.
        Quality of Life Research. 1994; 3: 7-12
        • Kessler R.C.
        • Berglund P.
        • Demler O.
        • Jin R.
        • Koretz D.
        • Merikangas K.R.
        • et al.
        The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R).
        Journal of the American Medical Association. 2003; 289: 3095-3105
        • Kessler R.C.
        The effects of stressful life events on depression.
        Annual Review of Psychology. 1997; 48: 191-214
        • Korn E.L.
        • Graubard B.I.
        Analysis of health surveys. 323. John Wiley & Sons, Hoboken, NJ2011
        • Kroenke K.
        • Spitzer R.L.
        The PHQ-9: A new depression diagnostic and severity measure.
        Psychiatric Annals. 2002; 32: 1-7
        • Kroenke K.
        • Strine T.W.
        • Spitzer R.L.
        • Williams J.B.
        • Berry J.T.
        • Mokdad A.H.
        The PHQ-8 as a measure of current depression in the general population.
        Journal of Affective Disorders. 2009; 114: 163-173
      4. Latta, R. E. (2009). Struggling to define my role. Dissertation Abstracts International: Section B: Sciences and Engineering, 69, 5783.

        • Levy P.S.
        • Lemeshow S.
        Sampling of populations: Methods and applications.
        John Wiley & Sons, New York2013
        • Lindhorst T.
        • Oxford M.
        The long-term effects of intimate partner violence on adolescent mother’s depressive symptoms.
        Social Sciences & Medicine. 2008; 66: 1322-1333
        • Lorant V.
        • Deliege D.
        • Eaton W.
        • Robert A.
        • Philippot P.
        • Ansseau M.
        Socioeconomic inequalities in depression: A meta-analysis.
        American Journal of Epidemiology. 2003; 157: 98-112
        • McClave A.K.
        • Dube S.R.
        • Strine T.W.
        • Kroenke K.
        • Caraballo R.S.
        • Mokdad A.H.
        Associations between smoking cessation and anxiety and depression among US adults.
        Addictive Behaviors. 2009; 34: 491-497
        • Mburia-Mwalili A.
        • Clements-Nolle K.
        • Lee W.
        • Shadley M.
        • Wei Y.
        Intimate partner violence and depression in a population-based sample of women: Can social support help?.
        Journal of Interpersonal Violence. 2010; 25: 2258-2278
        • Mrazek P.,
        • Haggerty R.
        Reducing the risks for mental disorders: Frontiers for preventive intervention research.
        National Academy Press, Washington, DC1994
        • Pico-Alfonso M.A.
        • Garcia-Linares M.I.
        • Celda-Navarro N.
        • Blasco-Ros C.
        • Echeburua E.
        • Martinez M.
        The impact of physical, psychological, and sexual intimate male partner violence on women's mental health: Depressive symptoms, posttraumatic stress disorder, state anxiety, and suicide.
        Journal of Women’s Health. 2006; 13: 599-611
        • Pollack K.M.
        • McKay T.
        • Cumminskey C.
        • Clinton-Sherrod A.M.
        • Lindquist C.
        • Lasater B.M.
        • et al.
        Employee assistance program services for intimate partner violence & client satisfaction with these services.
        Journal of Occupational & Environmental Medicine. 2010; 52: 819-826
        • Riolo S.A.
        • Nguyen T.A.
        • Greden J.F.
        • King C.A.
        Prevalence of depression by race/ethnicity: Findings from the National Health and Nutrition Examination Survey III.
        American Journal of Public Health. 2005; 95: 998-1000
        • Rothman K.J.
        No adjustments are needed for multiple comparisons.
        Epidemiology. 1990; 1: 43-46
        • Saltzman L.E.
        • Fanslow J.L.
        • McMahon P.M.
        • Shelley G.A.
        Intimate partner violence surveillance: Uniform definitions and recommended data elements, Version 1.0.
        National Center for Injury Prevention and Control Centers for Disease Control and Prevention, Atlanta1999
        • Sato-Dilorenzo A.
        • Sharps P.W.
        Dangerous intimate partner relationships and women’s mental health and health behaviors.
        Issues in Mental Health Nursing. 2007; 28: 837-848
        • Scarinci I.C.
        • Beech B.M.
        • Naumann W.
        • Kovach K.W.
        • Pugh L.
        • Fapohunda B.
        Depression, socioeconomic status, age, and marital status in black women: a national study.
        Ethnicity and Disease. 2002; 12: 421-428
        • Strine T.W.
        • Mokdad A.H.
        • Balluz L.S.
        • Gonzalez O.
        • Crider R.
        • Berry J.T.
        • et al.
        Depression and anxiety in the United States: Findings from the 2006 behavioral risk factor surveillance system.
        Psychiatric Services. 2008; 59: 1383-1390
        • Swanberg J.E.
        • Logan T.
        • Macke C.
        Intimate partner violence, employment, and the workplace: Consequences and future directions.
        Trauma Violence Abuse. 2005; 6: 286-312
        • Tan C.
        • Basta J.
        • Sullivan C.M.
        • Davidson W.S.
        The role of social support in the lives of women exiting domestic violence shelters: An experimental study.
        Journal of Interpersonal Violence. 1995; 10: 437-451
        • Taylor S.E.
        • Aspinwall L.G.
        Mediating and moderating processes in psychosocial stress: Appraisal, coping, resistance, and vulnerability.
        in: Kaplan H.B. Psychosocial stress: Perspectives on structure, theory, life-course, and methods. Academic Press, San Diego1996: 71-110
        • Timko C.
        • Sutkowi A.
        • Pavao J.
        • Kimerling R.
        Women’s childhood and adult adverse experiences, mental health, and binge drinking: The California Women’s Health Survey.
        Substance Abuse Treatment, Prevention, and Policy. 2008; 3: 15
        • Thompson R.S.
        • Bonomi A.E.
        • Anderson M.
        • Reid R.J.
        • Dimer J.A.
        • Carrell D.
        • et al.
        Intimate partner violence: Prevalence, types, and chronicity in adult women.
        American Journal of Preventive Medicine. 2006; 30: 447-457
      5. Updegraff, J. A., Taylor, S. E., Kemeny, M. E., & Wyatt, G. E. (2002). The positive and negative effects of HIV-infection in women with low socioeconomic resources. Personality and Social Psychology Bulletin, Vol. 28, No. 3, March 2002, 382-394.

      6. Vos, T., Astbury, J., Piers, L. S., Magnus, A., Heenan, M., Stanley, L., et al. (2006). Measuring the impact of intimate partner violence on the health of women in Victoria, Australia. Bulletin of the World Health Organization, 84, 739–744.

        • Wilhelm K.
        • Mitchell P.
        • Slade T.
        • Brownhill S.
        • Andrews G.
        Prevalence and correlates of DSM-IV major depression in an Australian national survey.
        Journal of Affective Disorders. 2003; 75: 155-162
        • Walker L.E.
        The battered woman syndrome.
        3rd ed. Springer, New York2000
      7. Yansanah, I. S. (2003) Construction and use of sample weights. In: Expert Group Meeting to review the draft Handbook on Designing of Household Sample Surveys, United Nations Secretariat Statistics Division. Available from: Accessed February 17, 2014.


      Nathalie Dougé, BS, is currently a MD candidate at the Pennsylvania State College of Medicine, Hershey. She plans on pursuing a career in Internal Medicine.


      Erik B. Lehman, MS, is a Biostatistician at the Pennsylvania State University College of Medicine.


      Jennifer S. McCall-Hosenfeld, MD, MSc, is Assistant Professor of Medicine and Public Health Sciences at the Pennsylvania State College of Medicine, Hershey. Her research focuses on primary/preventive care of women, especially rural women and survivors of intimate partner violence.