Abuse Epidemic: How Violence Affects Health
Abuse, violence, bullying, discrimination - not only social problems; they can lead to physical, mental, sexual and reproductive health problems. In particular, partner violence is the most significant risk factor for developing diseases, disability and death among young women. Women aged 18-45 and slightly less children are the most vulnerable groups. According to data released by WHO, 30% of women in relationships worldwide report that they have been physically or sexually abused by their partner during their lives. Up to 38% of the murders of women in the world are committed by their male sex partners. We describe how different types of violence and discrimination form the basis of health problems and who and how to deal with it.
Text: Evdokia Tsvetkova
Abuse and Women's Health
WHO and other medical organizations are paying more and more attention to the problems associated with violence, because it leads to direct and indirect health consequences, poor quality of life and loss of working days. Slightly less than half of the victims of violence from a partner reported injuries - in the worst case, it led to death. Other direct consequences are unwanted pregnancy (and its possible complications or abortion) and STIs. According to the results of an analytical study of 2013, women who have been subjected to physical or sexual violence are one and a half times more likely to have sexually transmitted infections, including HPV and (in some regions) HIV and urinary tract infections. Abuse during pregnancy also increases the risk of miscarriage, stillbirth, premature birth, complications and the birth of a child with low birth weight.
However, even if there is no physical damage, this does not mean that the abuse has not left a psychological trauma. The indirect effects of domestic violence can be depression, post-traumatic stress disorder and other anxiety disorders, insomnia, eating disorders, and suicide attempts. People who have been subjected to family violence are more likely to abuse alcohol, smoke and take drugs or potent medicines. In women affected by the abuse, the likelihood of depression or alcoholism is doubled compared with others.
ABYUZ is VIOLENCE over a close person (psychological, physical, sexual, economic); bullying - aggressive prosecution of one of the team members (academic or worker) by another or others. Discrimination is a negative attitude, bias, violence, injustice and deprivation of the rights of people because of their belonging to a certain social group.
Cardiovascular diseases can also be a consequence of violence. For example, in residents of Mexico who had been subjected to physical and sexual abuse, their early manifestations were significantly more frequent than in the control group (atherosclerosis, not yet accompanied by symptoms, and thickening of one of the layers of the vascular wall). In the US, even conducted a major study on the topic - National Longitudinal Study for Adolescent to Adult. It lasted fourteen years and included 90 thousand participants. According to him, young (mean age of twenty-nine) women who suffered from an abuse in the last year had an increased risk of developing heart disease over the next thirty years. The increase in risk was small, but this was attributed, for example, to the fact that not all cases of violence were reported, and emotional abuse was not considered at all in the study. Other health effects may include chronic pain (headache, backache, abdominal pain) and gastrointestinal disorders.
The consequences of violence against children and adolescents
Abuse in relation to children and adolescents is another huge problem; it not only makes people susceptible to various diseases and addictions, but also triggers a vicious circle, contributing to abuse in the next generations. Sexual abuse, especially in childhood, at later stages of life can lead to the development of addiction (smoking, alcoholism, addiction to drugs) and to risky sexual behaviors in which the risk of infection or unwanted pregnancy is increased. In addition, it correlates with the propensity for abyus as an adult and the likelihood of becoming a victim of violence.
According to the results of the same National Longitudinal Study for Adolescent to Adult, all abused in childhood were subsequently increased the risk of developing cardiovascular diseases. By the age of majority, it had increased threefold for every seven abuze events in childhood. "Violence is a common form of preventable disaster," explained Dr. Michel Albert, a professor at the University of California at San Francisco, at the American Heart Association meeting in 2018. "Abuse is not well understood as the cause of cardiovascular diseases. Probably, the impact of violence is one of forms of toxic stress. "
In the US, every fourth woman and every seventh man was the victim of physical violence from a partner. Every fourth and every ninth was injured (every seventh and every twenty-fifth is serious) as a result of violence (including sexual) or harassment from a partner. Every seventh and every eighteenth were persecuted partner during the life, while experiencing fear for themselves or their loved ones. Only 34% of people with injuries due to abuse receive medical care. Every fifteenth child becomes a victim of physical abuse every year.
According to Albert, violence affects the brain and the autonomic nervous system. Usually, the body is able to adapt to short-term stresses, however, constant abusa does not give room for adaptation, which can lead to the development of metabolic disorders, diabetes mellitus and ischemic heart disease. Children who have been abused themselves or have witnessed violence against their mothers are more likely to suffer from hypertension, gastric ulcer and intestinal disorders, diabetes, neurological diseases, asthma, and chronic obstructive pulmonary disease.
Bulling and discrimination
Different types of discrimination and harassment also lead to multifaceted problems: these are not only psychological stress or financial consequences of inequality, but also diseases, and these are among the leading causes of death in the world. In November 2018, the results of the study were published, in which 79,000 working men and women from 18 to 65 years old took part. It turned out that bullying and violence at work were significantly associated with the risk of 5.0% and 3.1% of cardiovascular diseases in the population, and the effect depended on the “dose” of exposure. As Tianwei Xu, who led the study, noted, eliminating workplace bullying would help to avoid five percent of all cardiovascular diseases, and eradicating violence more than three percent of all cases.
Similar work was carried out in 2018 by the same team of researchers - but already in relation to the risk of developing type 2 diabetes. It turned out that bullying and violence at work increased the risk of developing this disease by 1.46 and 1.26 times, respectively.
As for discrimination, it and its consequences (for example, forced migration) lead to stress and physical and emotional exhaustion. In the United States, cardiovascular diseases are the most common among African Americans. At the same time, the study found that the expression of genes associated with arterial hypertension in African Americans depended on the discrimination to which they were subjected. According to the results of genetic analysis, the more often a person was subjected to unfair treatment, the more “worked” these genes.
Disease and risk of violence
So, discrimination and abjuz worsen health - but there is a reverse tendency, when some diseases increase the risk of violence. There is a relationship between some mental illnesses and violence: people with these diseases are more likely to be victims of family and other violence, but their risk of abusive behavior may be increased. In this case, aggression is less often associated with the disease itself (for example, when a person has delusions or hallucinations) than with the abuse of alcohol or psychoactive substances. The most important thing here is to remove the taboo from the topic of mental illness, so that people are not afraid to consult a doctor in time for help.
People with chronic illnesses, from fibromyalgia to diabetes mellitus or migraine, often face misunderstandings, inability to make a diagnosis or get treatment. Stigmatization, in addition to physical and psychological exhaustion, contributes to an increase in stress levels - which can lead to depression or manifest aggression (when they say that a person "has deteriorated"). Behavioral changes may occur due to endocrine disorders — for example, "steroid rage" in hypercorticism or emotional lability in hyperthyroidism.
In Australia, every sixth and every sixteenth were victims of physical violence from a partner. Every fourth and every sixth were victims of emotional abuse. Every sixth girl was a victim of emotional abuse at the age of less than 15 years. Every sixth was a victim of persecution. Abuse is the cause of the loss of the house 72 thousand women, 34 thousand children and 9 thousand men
Aggressive behavior is found in dementia (including Alzheimer's disease) and is due to a variety of reasons. These are frustration due to impaired memory and thinking, changes in the personality structure, depression, delirium episodes (motor stimulation with stupefaction and impaired perception of reality) or delusions (distortion of the perception of the surrounding world), impaired vision and hearing. Today, the maximum effect of treatment is the ability to somewhat slow the progression of dementia. In addition, there are behavioral strategies for employees of people caring for the patient, which can reduce the risk of aggression.
Violence as an infection
To counter violence, we need serious strategies and the participation of various organizations - from governments to the media. In 2018, in the Ethical Journal of the American Medical Association, there was a debate about whether to treat violence, including family violence, as an infectious disease - and therefore, “cure” it. One group of authors proposed to treat violence as an infection and involve the health care system in solving the problem - in fact, this system, Cure Violence, has been implemented in some US cities for fifteen years as part of an experiment, and it is quite effective.
Like the infectious process, violence has an “incubation period” (the authors compared the augus with tuberculosis - it develops slowly, and it may take years from the moment when the child becomes a victim of violence before he becomes an abuser). Violence can be “infected” - people reproduce in their own families the models of abuse, discrimination, and bullying, which they observed. Like illnesses, violence has risk factors — for example, poverty and a low level of education. The authors talk about the need for "epidemiological control" (this is a collection of statistics and the allocation of dangerous regions) and "treatment."
In Russia, every fifth woman subjected to physical violence by a partner. Only 10-30% of women suffering from domestic violence turn to the police for help.
Different organizations participate in these processes, each of which has its own role. Police and social workers (the "violence interrupters" group) identify the "disease" and prevent its spread. Created special questionnaires that allow you to calculate whether a person is subject to abuse. “Propagandists” (teachers, medical and social workers) identify risk groups and try to reduce the likelihood of violence. Doctors and other health care workers treat victims of violence, including psychological consequences, and prevent revenge from abusers.
A complex approach
Opponents of comparing violence with infection offer a different model — the toxic environment plays a major role in it, and “treatment” is based on reducing the inhibitory factors of this environment. First of all, we are talking about a low level of education, low quality of life, discrimination, alcohol abuse, tolerance of society towards violence and gender inequality. WHO considers abuze risk factors to be a faith in honor of the family and “sexual purity”, as well as weak legal sanctions for sexual abuse.
Obviously, not only the health sector has to deal with the issue of access. What is needed in medicine is called a multidisciplinary approach: the involvement of doctors (traumatologists, surgeons, therapists, cardiologists, endocrinologists, neurologists, gastroenterologists, psychiatrists), psychotherapists, social workers or private centers (such as Sisters, Anna, INGO "), representatives of the legislative, judicial and executive branches. We need to work with a "toxic environment": improving the quality of education and living standards, a favorable information atmosphere - for example, eliminating manifestations of sexism and other types of discrimination.
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