Doctoral Thesis: Long-Term Health Problems for Victims of Violence

The doctoral thesis of the University of Tartu, which studied interpersonal violence, revealed that while physical violence is predominant among men, women are more likely to be exposed to several forms of violence at the same time. The research also analysed how violence can have long-term, sometimes lifelong negative health effects.

“Interpersonal violence is very common in Estonia. More than 50 percent of women and more than 60 percent of men had been exposed to at least one form of interpersonal violence during their lifetime,” said the author of the study, Hedda Lippus-Metsaots, who recently defend her doctoral dissertation at the Institute of Clinical Medicine of the University of Tartu.

According to the author, it is important to study violence because it is a very culturally specific phenomenon. For example, the extent of violence and the factors that are associated with it vary from society to society.

Interpersonal violence

Among the various forms of violence, the dissertation focused on interpersonal violence, which in turn is divided into intimate partner violence and community violence. Thus, interpersonal violence includes not only violence between partners, but also violence committed by a friend, co-worker, or fellow citizen, for example.

The dissertation differs from previous approaches in its broader focus. “We examined different forms of violence not restricted by who the perpetrator was. The study also includes a comparison between men and women, as both responded to the questionnaire,” explains the author.

The research was based on the NorVold Abuse Questionnaire developed in Scandinavia, which included questions regarding mental, physical and sexual violence. This questionnaire had been already previously translated into Estonian, and it contains specific descriptions of violent situations.

The researcher emphasised that she did not have to change the questionnaire: “we kept the instrument as accurate as possible so that we could compare our results with other countries where this questionnaire has been used. In addition to the loss of comparability, the change would have meant that it would no longer have been a validated questionnaire.”

The researcher added that the sample of the population-based survey included enough people from different age groups so the results are generalizable to the entire population. For both women and men, the questionnaire was sent to around 5,000 people, about half of whom responded, which was the expected result.

Different experiences of violence among women and men
The concept of polyvictimization was central to the doctoral thesis. “This means that the victim experiences more than one type of violence during their lifetime. Previous research has shown that this is more common than previously thought,” explained Lippus-Metsaots.

In the past, violence has often been studied more narrowly, focusing for example on sexual violence between intimate partners. “In this case, the focus is on one specific experience of violence, although in fact the person may have been exposed to one or more forms of violence as a child. In addition, they may have been exposed to violence at work, for example,” the investigator discussed.

It turned out that the patterns of violence men and women had been exposed to were different. “Among women, it stood out that they had been exposed to several different types of violence. Compared to men, there were more women who had been exposed to emotional, physical, and sexual violence. There were more men who had been exposed to only physical violence,” Lippus-Metsaots said.

Differences between men and women were particularly pronounced in the case of sexual violence. “In the case of men, 0.6 percent of the respondents had been exposed to sexual violence as a child, among women it was 5.8 percent. As adults, one percent of men and 4.2 percent of women had been exposed to sexual violence,” explained the author.

The researcher added that 0.7 per cent of men and 2.7 per cent of women had been exposed to all three forms of violence included in the work, i.e., mental, physical and sexual violence as children. As adults, the same number was 0.2 percent for men and 1.4 percent for women.

If we only look at physical violence, it was twice as common among men. “Previous research suggests that men are significantly more likely than women to experience random acts of physical violence, such as bullying at school. Parents also punish boys more physically. As adults, men tend to get into random physical conflicts,” Lippus-Metsaots commented.

In the case of women, the author emphasised that the violence they are exposed to is often systematic: “It has been shown in studies of intimate partner violence that women are more often exposed to all three forms of violence. In addition, there can be economic violence.”

Although both men and women can be exposed to violence, the researcher said it was important to understand that the patterns of violence they are exposed to are different: “As a result of this, health effects are also different, which in turn explains why there are more support services for women.”

Long-term health effects of violence
It is commonly understood that a health effect means a physical injury. According to the researcher, this viewpoint is too narrow because the health effects can be long-term and hidden. “If someone had been exposed to violence as a child, it was associated with experiencing either one form of violence or polyvictimization later in life. This was significant for both sexes,” said the soon-to-be doctor.

In addition, women who had been exposed to sexual violence were found to be more likely to smoke and use alcohol and drugs. The results also showed a higher incidence of contraception non-use, having intercourse for money or other material benefits, and being diagnosed with sexually transmitted diseases.

Hedda Lippus-Metsaots defended her doctoral dissertation “Interpersonal Violence in Estonia: Prevalence, Impact on Health and Health Behaviour” on 25 August at the University of Tartu.

The translation of this article from Estonian Public Broadcasting science news portal Novaator was funded by the European Regional Development Fund through Estonian Research Council.