Associations of Violence Against Women With Comorbid Symptoms of Depression and Anxiety Among Left-Behind Women in Rural China: Cross-Sectional Study
Abstract BackgroundViolence against women (VAW) is a major public health and human rights concern with profound mental health consequences. However, the association between specific VAW forms and mental health, particularly among left-behind women in rural China, remains uncle...
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JMIR Publications
2025-08-01
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| Series: | JMIR Public Health and Surveillance |
| Online Access: | https://publichealth.jmir.org/2025/1/e72064 |
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| author | Leying Hou Zeyu Luo Weidi Sun Jiayao Ying Jing Wu Shiyi Shan Wen Liu Peige Song |
| author_facet | Leying Hou Zeyu Luo Weidi Sun Jiayao Ying Jing Wu Shiyi Shan Wen Liu Peige Song |
| author_sort | Leying Hou |
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Abstract
BackgroundViolence against women (VAW) is a major public health and human rights concern with profound mental health consequences. However, the association between specific VAW forms and mental health, particularly among left-behind women in rural China, remains unclear.
ObjectiveThis study aimed to identify the associations of VAW with depression, anxiety, and comorbid symptoms and to explore the potential roles of resilience and social support.
MethodsThe cross-sectional survey was conducted in Y City, Henan Province, China, in July 2023. A multistage stratified random sampling method was used to recruit left-behind women, resulting in a final sample of 1503 participants. Data on participants and their VAW were collected through a face-to-face questionnaire survey. The forms of VAW assessed were nonpartner violence (NPV) and intimate partner violence (IPV; including remote IPV). Depressive symptoms were evaluated using the 10-item Center for Epidemiological Studies Depression Scale, while anxiety symptoms were assessed with the Generalized Anxiety Disorder-7. The comorbid symptoms of depression and anxiety (CDA) were ascertained as the simultaneous presence of depressive and anxiety symptoms. A multivariable logistic regression model was used to estimate the odds ratio and 95% CIs. A 4-way decomposition analysis was conducted to test the mediation roles and interactions of resilience and social support between VAW and mental health outcomes. Population attributable fractions and pathway-specific population attributable fractions were calculated to estimate the burden of mental health outcomes attributable to VAW.
ResultsLifetime VAW (adjusted odds ratio [aOR] 1.84, 95% CI 1.32‐2.54) was associated with an increased risk of CDA. Women who were exposed to lifetime IPV (aOR 1.84, 95% CI 1.32‐2.56), remote IPV (aOR 2.79, 95% CI 1.60‐4.74), and NPV (aOR 2.63, 95% CI 1.58‐4.26) had an increased likelihood of reporting CDA. Similar associations could also be found for depressive symptoms and anxiety symptoms. In the 4-way decomposition analysis for VAW and CDA, mediation effects of low resilience and social support were statistically significant (PP
ConclusionsLifetime VAW, including IPV (and remote IPV) and NPV, shows significant associations with CDA and depressive and anxiety symptoms among rural left-behind women in China. The associations are partly mediated by low resilience and social support. Targeted strategies, including efforts to reduce violence against rural left-behind women, enhance their resilience and strengthen their social support networks, are urgently needed. |
| format | Article |
| id | doaj-art-6f680699c36340ff8bccf686482efd90 |
| institution | Kabale University |
| issn | 2369-2960 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | JMIR Publications |
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| series | JMIR Public Health and Surveillance |
| spelling | doaj-art-6f680699c36340ff8bccf686482efd902025-08-20T03:41:32ZengJMIR PublicationsJMIR Public Health and Surveillance2369-29602025-08-0111e72064e7206410.2196/72064Associations of Violence Against Women With Comorbid Symptoms of Depression and Anxiety Among Left-Behind Women in Rural China: Cross-Sectional StudyLeying Houhttp://orcid.org/0009-0006-6600-6343Zeyu Luohttp://orcid.org/0009-0006-4973-1463Weidi Sunhttp://orcid.org/0000-0002-8763-3569Jiayao Yinghttp://orcid.org/0009-0004-3457-1562Jing Wuhttp://orcid.org/0009-0001-4400-0577Shiyi Shanhttp://orcid.org/0009-0004-8423-9576Wen Liuhttp://orcid.org/0000-0002-8353-8855Peige Songhttp://orcid.org/0000-0002-0196-9759 Abstract BackgroundViolence against women (VAW) is a major public health and human rights concern with profound mental health consequences. However, the association between specific VAW forms and mental health, particularly among left-behind women in rural China, remains unclear. ObjectiveThis study aimed to identify the associations of VAW with depression, anxiety, and comorbid symptoms and to explore the potential roles of resilience and social support. MethodsThe cross-sectional survey was conducted in Y City, Henan Province, China, in July 2023. A multistage stratified random sampling method was used to recruit left-behind women, resulting in a final sample of 1503 participants. Data on participants and their VAW were collected through a face-to-face questionnaire survey. The forms of VAW assessed were nonpartner violence (NPV) and intimate partner violence (IPV; including remote IPV). Depressive symptoms were evaluated using the 10-item Center for Epidemiological Studies Depression Scale, while anxiety symptoms were assessed with the Generalized Anxiety Disorder-7. The comorbid symptoms of depression and anxiety (CDA) were ascertained as the simultaneous presence of depressive and anxiety symptoms. A multivariable logistic regression model was used to estimate the odds ratio and 95% CIs. A 4-way decomposition analysis was conducted to test the mediation roles and interactions of resilience and social support between VAW and mental health outcomes. Population attributable fractions and pathway-specific population attributable fractions were calculated to estimate the burden of mental health outcomes attributable to VAW. ResultsLifetime VAW (adjusted odds ratio [aOR] 1.84, 95% CI 1.32‐2.54) was associated with an increased risk of CDA. Women who were exposed to lifetime IPV (aOR 1.84, 95% CI 1.32‐2.56), remote IPV (aOR 2.79, 95% CI 1.60‐4.74), and NPV (aOR 2.63, 95% CI 1.58‐4.26) had an increased likelihood of reporting CDA. Similar associations could also be found for depressive symptoms and anxiety symptoms. In the 4-way decomposition analysis for VAW and CDA, mediation effects of low resilience and social support were statistically significant (PP ConclusionsLifetime VAW, including IPV (and remote IPV) and NPV, shows significant associations with CDA and depressive and anxiety symptoms among rural left-behind women in China. The associations are partly mediated by low resilience and social support. Targeted strategies, including efforts to reduce violence against rural left-behind women, enhance their resilience and strengthen their social support networks, are urgently needed.https://publichealth.jmir.org/2025/1/e72064 |
| spellingShingle | Leying Hou Zeyu Luo Weidi Sun Jiayao Ying Jing Wu Shiyi Shan Wen Liu Peige Song Associations of Violence Against Women With Comorbid Symptoms of Depression and Anxiety Among Left-Behind Women in Rural China: Cross-Sectional Study JMIR Public Health and Surveillance |
| title | Associations of Violence Against Women With Comorbid Symptoms of Depression and Anxiety Among Left-Behind Women in Rural China: Cross-Sectional Study |
| title_full | Associations of Violence Against Women With Comorbid Symptoms of Depression and Anxiety Among Left-Behind Women in Rural China: Cross-Sectional Study |
| title_fullStr | Associations of Violence Against Women With Comorbid Symptoms of Depression and Anxiety Among Left-Behind Women in Rural China: Cross-Sectional Study |
| title_full_unstemmed | Associations of Violence Against Women With Comorbid Symptoms of Depression and Anxiety Among Left-Behind Women in Rural China: Cross-Sectional Study |
| title_short | Associations of Violence Against Women With Comorbid Symptoms of Depression and Anxiety Among Left-Behind Women in Rural China: Cross-Sectional Study |
| title_sort | associations of violence against women with comorbid symptoms of depression and anxiety among left behind women in rural china cross sectional study |
| url | https://publichealth.jmir.org/2025/1/e72064 |
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