Understanding Intimate Partner Violence, Sexual Abuse, and Mental Health in Non-Indigenous Rural Chiapas: Implications for Global Mental Health Practice

Abstract

Background: In Chiapas, over 70% of people live in poverty, and 51% of the population live in rural areas. This study emerges from three years of local experience providing mental healthcare in primary-care clinics in rural Chiapas. After rolling out mental-health services in 2014, Compañeros En Salud care-providers recognized intimate partner violence (IPV) and non-partner sexual abuse (SA) as significant contributors to women’s burden of mental disorders. This paper explores the scope of IPV, partner’s controlling behaviors (CB), and SA in this region, and the ways in which gender norms and roles shape experiences of violence, and emotional distress in this community. Methods: We designed a convergent-parallel mixed-methods study in one rural community of over 1200 people. Participants were selected by random and purposeful sampling to obtain quantitative and qualitative data respectively (141 surveys of women >15 years, 40 individual interviews, and participatory observation with naturally-occurring groups). To measure IPV and SA, we administered an adapted version of the National Survey on the Dynamics of Relationships at Home (ENDIREH) questionnaire, and the Patient Health Questionnaire -9 (PHQ-9) to measure depressive symptoms. Quantitative results: Lifetime prevalence of IPV was 49.7% (95% CI: 41.1–58.2%) among women 15 years and older, and 54.7% (95% CI 45.6–63.6%) among ever-partnered women. Forty-percent (95% CI 31.3–48.9%) of ever-partnered woman have experienced moderate-severe violence with high CB (HC-IPV). In addition, 14.8% (9.2–22.2%) reported moderate-severe violence with moderate CB (MC-IPV). IPV, HC-IPV, and SA were significantly associated with moderate/severe depressive symptoms, although this was not observed for MC-IPV. Qualitative results: Lived experiences varied significantly among three generations of participants and across five salient categories: a) parenting practices and experiences; b) inhabiting separate spheres; c) experiences of alcohol abuse and violence; d) experiences of IPV and SA; e) efforts to reduce alcohol abuse and IPV. Overall, participants framed their lived experience on the way adverse-childhood-experiences affected their current way of living, their compliance and traversing of gender roles and norms, and their experiences of violence and emotional distress. Mixed-methods results: In the subgroup of women who were raised after the 1980s, the prevalence of physical IPV and partner alcohol abuse were significantly lower, whereas primary school completion was significantly higher. In contrast, coffee land ownership, partner controlling behaviors, and partner/non-partner sexual abuse have not changed despite women’s positive change in opinions about gender norms. Discussion: Poverty and adverse childhood experiences considerably shape experiences of IPV, alcohol abuse, and emotional distress in people who live in this region. In addition, gender norms that constrain women to the household further hinders women’s access to social networks and harms their mental health. Mental health services at the primary care level need to be equipped to address trauma, stress-related problems and depression resulting from these adverse experiences, also impacting the development of chronic health conditions, since health providers may be the only social resource for many individuals, especially for women.