In Argentina, it is estimated that around 40% of the female population are abused by their partners. A high percentage of those women develop some form of anxiety or depressive disorder. Knowledge about coping strategies used in this population is scarce.

Objective: To explore the correlation between coping strategies and the development of anxiety and depression in female victims of domestic violence.

Sample: 65 women aged 18 and older who visited a family violence support team.

Methods: A correlation study was carried out to assess the relationship between depression, anxiety and coping strategies. After giving informed consent, participants filled a

sociodemographic questionnaire, the adult coping response inventory (CRI-A) and the anxiety and mood disorder assessment module of the SCID-I.

Results: There were statistically significant differences between both groups in the use of Seeking Alternative Rewards, Avoidance and Emotional Discharge strategies, with significantly less frequent use in the PTSD and depression group. Statistically significant differences were found in the Seeking Guidance and Support and Cognitive Avoidance strategies, revealing an increased use in the PTSD and depression group.

• Gender violence; Post-traumatic stress disorder; Depression; Coping strategies

Gender-based violence is violence directed against a person or group on the basis of their gender. It is considered a violation of human rights, which makes it distinguishable from other forms of violence [1]. In this study, we approach a type of violence against women, more specifically intimate partner violence. This term includes aggressions occurring in the context of family cohabitation, ranging from intimidation to physical harm [2].

Violence against women from their partners or former partners exists in all social groups, regardless of their economic or cultural level or any other consideration.

Women who experience domestic violence are at an increased risk of suffering from different mental disorders, especially post- traumatic stress disorder, depression, and eating disorders, and are also more likely to attempt suicide [3]. Violence against women prevents them from engaging fully in the economic and social aspects of their communities with the resulting difficulty of finding a job, which in many cases perpetuates a situation of economic dependence. According to the UN [4], the lack of access to adequate housing as well as shelters for women suffering from abuse keeps victims from escaping their aggressors. Thus, the fear of becoming homeless can compel a woman to stay in an abusive relationship.

1. Informed consent (in accordance with international ethical regulations in force)
2. Sociodemographic questionnaire: This consists of a series of questions on basic sociodemographic data, such as gender, age, educational level, etc.
3. Coping Responses Inventory –Adults (CRI-A) [5]: This is a self-rated questionnaire including 48 items on a Likert scale, which assesses the use of different coping strategies and the frequency each strategy is used.
4. Anxiety and depressive disorders module of the SCID I (DSM- IV): The SCID I (Structured Clinical Interview for DSM-IV Axis I Disorders) [6], is a structured clinical interview for the diagnosis of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) Axis I mental disorders. Designed for psychiatric research, this interview can be divided in modules that correlate with the different sections of the DSM in order to administer only those that are of interest to the researcher. Its use enables researchers to determine whether the subjects being assessed meet the inclusion criteria for the different categories of mental disorder diagnosis according to the DSM-IV.
5.  

A correlation study was carried out, interviewing a total of 65 women who visited a gender/domestic violence support team. The total sample was divided in two groups based on the presence or absence of post-traumatic stress disorder and/or depression. The main coping strategies used were identified. Subsequently the association between the different coping strategies and the presence/absence of anxiety and/or depressive disorders was assessed.

As regards sociodemographic variables, there were no significant differences between the groups in any of the variables considered (age, marital status, educational level and occupation), as can be observed in the following tables (Tables 1-5).

As for the presence of PTSD and depression in the sample under study, it is worth noting, first of all, that 56.25% of the women who visited a family violence team have developed PTSD and a depressive disorder as a result of the violent relationship with their partners.

Concerning the use of specific coping strategies, the comparison between the groups showed no statistically significant differences in Logical Analysis, Positive Reappraisal, Problem Solving, Acceptance/Resignation or Approach.

Statistically significant differences were observed in the use of the Seeking Alternative Rewards (t=-2.13; df=30; p>0.05), Avoidance (t= -2.69; df=30; p>0.05) and Emotional Discharge (t=-8.09; df=30 p>0.001) strategies, with significantly lower scores in the group with PTSD and depression.

Statistically significant differences were found in the Seeking Guidance and Support (t=2.36; df=30; p< 0.05) and Cognitive Avoidance (t= 2.72.45, df=30; p< 0.01) strategies, which were more frequently used in the PTSD and depression group (Table 6). 

The results of the present study reveal that participants with PTSD and depression reported a decreased tendency to use the coping strategies of Emotional Discharge, Avoidance and Seeking Alternative Rewards compared to the control group participants. The first two above mentioned strategies have been correlated in several studies with a decrease in the severity of symptoms of both depression and anxiety, while the latter is associated with a decrease in symptoms of depression. Thus, it is possible that its infrequent use by patients with PTSD and depression is associated to an increase in such symptoms. More studies would be needed to evaluate this hypothesis and the impact of providing therapeutic interventions aimed at increasing the use of such strategies A result that is consistent with theoretical cognitive behavioral models as regards the persistence of PTSD is that patients with this condition are more likely to use Cognitive Avoidance strategies. This entails attempts to avoid thoughts and related emotional reactions that are perceived as unpleasant or painful. However, that strategy has been related in many investigations with the increase of depression and anxiety levels, so it would be of utmost interest to further explore how it relates to PTSD with a view to understanding how it can possibly contribute to the persistence of the condition. On the other hand, an increased use in the Seeking Guidance and Support strategies might be explained as an attempt to get help as a result of the awareness of suffering a mental disorder.

Knowing the coping resources used by women who are victims of gender violence might facilitate understanding of the resources associated with PTSD and depression and those which, by contrast, are not related to such conditions.

Though promising, the reported results are preliminary and must be considered carefully, since there could be some bias because of the sample size (n=65). Moreover, given the difference in the sample size in both groups, the results must be interpreted with caution.

1. UN. United Nations High Commissioner for Refugees. Sexual and Gender-Based Violence against Refugees, Returnees and Internally Displaced Persons: Guidelines for Prevention and Response. 2003.
2. Mora Chamorro H. Manual de protección a víctimas de violencia degénero. Editorial Club Universitario. 2008; 90.
3. Medina-Mora ME, Borges-Guimaraes G, Lara C, Ramos-Lira L, Zambrano J, Fleiz-Bautista C. Prevalencia de sucesos violentos y de trastorno por estrés postraumático en la población mexicana. Salud Publica Mex. 2005; 47: 8-22
4. UN. Office of the United Nations High Commissioner for Human Rights. The Right to Adequate Housing (Fact Sheet No. 21). 2010.
5. Mikulic IM, y Crespi MC. Adaptación y validación del inventario de respuestas de afrontamiento de Moos (CRI-A) para adultos. XV Anuario de Investigaciones. Universidad de Buenos Aires. 2008; 2: 305-312.
6. First M, Spitzer R, Gibbon M, Williams J. Structured Clinical Interview for DSM-IV Axis I Disorders – Patient Edition (SCID I/P, Version 2.0). Biometrics Research Department, New York State Psychiatric Institute. 1996.