Intimate partner violence and its mental health and help seeking implications for young adults in Rwanda

Abstract

Aim: This thesis aimed to explore the magnitude of Intimate Partner Violence (IPV), its risk factors and resulting mental health effects. A further aim was to explore the barriers to care for people suffering from mental disorders as well as for people exposed to IPV. Methods: A population-based cross-sectional study was conducted, using the World Health Organization’s questionnaire for violence research. It included 477 women and 440 men aged 20-35 years. For mental disorders, we used the Mini International Neuropsychiatric Interview questionnaire. Simple and multivariable logistic regression was used to identify risk factors associated with IPV, mental disorders and barriers to care. In addition, six focus group discussions were conducted with health care professionals regularly meeting people exposed to partner violence. Results: Women were highly exposed to IPV, with a tremendous impact on women’s mental health. In spite of this, women rarely sought professional help for mental problems due to the many barriers experienced. Instead, they preferred to go to someone they knew, partly due to services not being available, accessible, acceptable and of a good quality. Further, a conflict between what the state wants to achieve in terms of gender equality and the existing culture, heavily influenced by masculinity norms, was identified. This situation exposes women to high levels of abuse and poor access to help and support services. For men, there was a different pattern as they were considerably less exposed to IPV. However, men still suffered from mental problems found to be associated with IPV but mainly due to other factors, such as poverty and exposure to traumatic episodes during the genocide. Further, men sought health care for mental problems to a much lower extent than women, possibly due to gender norms. Health care professionals also confirm that men are not seen in the health care services as victims of IPV. Conclusions: The findings in this thesis revealed that women were more exposed to IPV, with serious mental health effects compared to men, and women also faced more barriers when seeking care. Gender inequality was an important factor behind women’s poor health. Hence, the promotion of gender equality needs to be reinforced at all levels of societal organization. For both men and women, the attainment of higher levels of education, can improve the present situation. Further, interventions to decrease poverty will lower the prevalence of IPV and reduce its mental health effects. Mental health care and IPV support services need to be made available and equipped with health professionals able to handle IPV cases and mental disorders.