The moderating effects of social norms and attitudes on the relationship between intimate partner violence and depressive symptoms among women in two provinces of Nepal.

PURPOSE: Intimate partner violence (IPV) is often associated with increased depressive symptoms. However, considerable variability exists in this relationship, from null findings to large effect estimates, likely due, in part, to differences in attitudes (thoughts and beliefs), descriptive norms (perceptions of what behaviors occur in a community), and injunctive norms (perceptions of what behaviors are acceptable in a community). In this study, we test the effect of individual- and community-level attitudes and norms on the IPV-depressive symptoms relationship.

METHODS

The sample included 976 married women in 30 communities in Nepal. We measured depressive symptoms with the Patient Health Questionnaire and IPV with items adapted from the Revised Conflict Tactics Scale. We used generalized linear models to test seven moderators: individual-level attitudes (gender-inequitability and acceptability of husband abuse), an individual-level descriptive norms scale, and community-level proxies of injunctive norms (aggregated attitudes) and descriptive norms (aggregated IPV prevalence and descriptive norms scale).

RESULTS

Descriptive norms significantly moderated the IPV-depressive symptoms relationship at both the individual and community level. The differences in depressive symptoms between women who did and did not experience IPV were stronger where violence was perceived to be less widespread. Individual-level attitudes and community-level injunctive norms proxies were not found to be significant moderators.

CONCLUSION

Where IPV is less prevalent (or perceived as such), experiencing IPV may increase depressive symptoms, as the experience deviates from the prevailing norm. Research should continue to refine norms measurement and explore individual and contextual factors that impact the likelihood of negative mental health outcomes to inform prevention and response interventions.