Prevalence of Dating Partner Violence and Suicidal Ideation Among Male and Female University Students Worldwide

Ko Ling Chan, PhD; Murray A. Straus, PhD; Douglas A. Brownridge, PhD; Agnes Tiwari, PhD; W.C. Leung, MBBS

Disclosures

J Midwifery Womens Health. 2008;53(6):529-537. 

In This Article

Discussion

In the median country in this study, 30% of the students had physically assaulted a dating partner in the previous 12 months, and 26% of them had been victimized. The median rates of perpetrating sexual coercion and being a victim of sexual coercion were 20% and 24%, respectively. The rate of suicidal ideation in the median country was 32%. Although there were large differences between sites, the lowest rates of perpetrating physical assault and being a victim of physical assault were 17% and 14%, which are still substantially high. The pattern of the rates of physical assault, injury, and sexual coercion across the sites shows that India, Korea, New Zealand, Germany, Greece, Russia, the United Kingdom, the United States, and Canada have consistently high rates of assault, injury, and sexual coercion. In contrast, Israel, Australia, Belgium, Sweden, and Switzerland have assault, injury, and sexual coercion rates lower than the median rates.

The rates of perpetrating physical assault and being a victim of sexual coercion for males and females were similar, but more sites showed higher rates of males being victims of all types of physical assault by their partners. For the rates of perpetrating physical assault resulting in an injury and being a victim of an assault resulting in an injury, as well as perpetrating sexual coercion, far more sites had higher rates for males. However, more sites had higher rates of suicidal ideation for females. Male and female students were remarkably similar in the proportion who physically assaulted a partner. Thus, with respect to both minor and severe assaults, women assaulted their partners at about the same rate as did male students. Straus[3] contended that high and similar rates of male and female students who physically assaulted a partner could be explained by the cultural norms and beliefs accepting or approving violence in partner relationships. Violence approval and corporal punishment by parents may be the root causes of high rate of dating partner violence. It should be emphasized that the most important similarity is the high rate of physical violence against dating partners by both male and female students in all the universities. Even the universities that had lower rates relative to other universities, in absolute terms had a high rate of physical assault.

The present study reveals that dating partner violence, in particular perpetrating physical assault and being a victim of physical assault, is associated with an increased rate of suicidal ideation. Depression accounted for the relationship between dating violence and suicidal ideation. This finding is consistent with past studies of partner abuse and suicide that self-harm and depression were associated with the perpetration of violence.[26,27] Aggression and stress were found to be the common factors of self-harm and IPV.[4,10]

The design of this study had a number of limitations. The sampling used in the study was convenience sampling and the subjects were mainly social science students. The findings cannot be generalized to the larger populations of the included sites. Nevertheless, the study, using standardized instruments and collecting samples from 22 sites, allows a test of the correlation between dating violence and suicidal ideation. It provides evidence that the two constructs are correlated and explained by depressive symptoms. Future studies using representative samples from different sites should be carried out to further confirm the relationship.

Despite these limitations, this study has important implications for health care professionals. An awareness of the association between dating violence and suicidal ideation can lead to the design of effective preventive strategies. As a start, health care providers need to be alert to the possible coexistence of dating violence and suicidal ideation. When screening patients suspected of physical assault victimization, health care providers should also assess for signs of self-harm. Studies of common risk factors for dating violence and suicide are necessary to identify essential elements for the development of prevention and intervention programs.

Routine universal screening is regarded as a good public health preventive strategy and has been recommended in health care settings.[28] Screening and risk assessment for violence and suicide should be conducted simultaneously for early identification of these problems. In this study, the revised CTS2 was used to identify IPV. Although this scale has been widely used, the 39-item tool may not be practical for a busy clinical setting. The Abuse Assessment Screen,[29] with only 5 questions, has been used extensively in many health care settings throughout the United States and internationally,[30] and may be used to assess for IPV. Of paramount importance when assessing suspected victims of IPV is the need to ensure confidentiality and protect them from retaliation from their perpetrators. Once IPV is identified, there should be a comprehensive support and referral system to ensure patient safety.

Furthermore, screening for suicidal ideation and self-harm should also be conducted. Assessment for mental health symptoms (such as depressive and stress symptoms) and aggressive personality should be undertaken, because these factors may increase the risk of suicidal ideation. Patients may be asked to self-report on questions related to self-harm, for instance, "I'd do almost anything to keep people from leaving me, I often get hurt by things that I do, I've told others I will kill myself," and "I have had thoughts of cutting or burning myself." Suicidal ideation can be identified by asking a direct question like "Have you thought about killing yourself?" There are several short scales available to screen for depression, or health professionals can ask patients if they are feeling good or in a good mood, if they enjoy day-to-day life, or if they are feeling sad, or wondering why they bother to go on living. Positive screens require prompt referral for comprehensive diagnosis and management.

Individuals identified as at-risk for suicide or homicide (those suspected of having suicidal ideation with a history of violence, including either perpetration or victimization of IPV) should be referred to psychiatric services immediately. Proactive monitoring of the identified cases through phone calls or home visits[31] may also be considered, and psychosocial support programs should be provided to perpetrators or victims who are depressed.

Therapeutic sessions or counseling services are also recommended to safeguard or reduce the possibility of these at-risk individuals committing suicide or further perpetration of violence. Effective interventions in managing the risk of violence will not only lower the risk of recidivism, but also educate potential victims in how to recognize factors associated with the risk of violence.[32]

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