629700 research-article2016
ISP0010.1177/0020764016629700International Journal of Social PsychiatryKamimura et al.
E CAMDEN SCHIZOPH
Original Article
Intimate partner violence–related experiences and mental health among college students in Japan, Singapore, South Korea and Taiwan
International Journal of Social Psychiatry 1–9 © The Author(s) 2016 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0020764016629700 isp.sagepub.com
Akiko Kamimura1, Maziar M Nourian2, Nushean Assasnik3 and Kathy Franchek-Roa4
Abstract Background: Intimate partner violence (IPV) is a significant public health threat that contributes to a wide range of mental and physical health problems for victims. Aims: The purpose of this study was to examine IPV-related experiences and mental health outcomes among college students in Japan, Singapore, South Korea and Taiwan. Methods: The data were obtained from the Inter-University Consortium for Political and Social Research (ICPSR), the International Dating Violence Study (IDVS) 2001–2006 (ICPSR 29583; N = 981; Japan n = 207; Singapore n = 260; South Korea n = 256; Taiwan n = 258). Results: Co-experience of physical IPV victimization and perpetration was associated with borderline personality traits and posttraumatic stress disorder (PTSD), but not with depression. Childhood sexual abuse, gender hostility and violence socialization were significant predictors of borderline personality traits, depression and PTSD. While country and gender variations in mental health are noted, there are two specific populations that may need special attention for mental health interventions: Taiwanese women especially for borderline personality traits and PTSD, and Japanese men especially for depression. Conclusion: IPV victimization and perpetration, childhood sexual abuse, gender hostility and violence socialization have a significant impact on the mental health of college students in Japan, Singapore, South Korea and Taiwan. Since IPV and mental health are significant public health issues, research on IPV and mental health consequences of IPV victimization and perpetration in these countries should be further expanded in order to better understand the interventions that will be effective in treating victims, perpetrators and victim/perpetrators of IPV. Keywords Depression, borderline personality disorder, posttraumatic stress disorders, intimate partner violence, college students, Asia
Introduction Intimate partner violence (IPV) is a significant public health threat that contributes to a wide range of mental and physical health problems for victims (Ellsberg, Jansen, Heise, Watts, & Garcia-Moreno, 2008). IPV includes physical, sexual and/or psychological harm inflicted by a current or former intimate partner, such as a dating partner, fiancée or spouse (Center for Disease Control and Prevention, 2015), and these types of behaviors are used to gain power and control over a partner (United States Department of Justice, 2015). Worldwide, the lifetime prevalence of physical IPV among female victims varies from 15% to 71% (Garcia-Moreno, Jansen, Ellsberg, Heise, & Watts, 2006). This study focused on IPV and mental health among four Asian countries, Japan, Singapore, South Korea and
Taiwan, which were examined in the International Dating Violence Study (IDVS) and have a comparable sample size. The IDVS examined IPV among college students in 32 countries. The World Health Organization (WHO) 1Department
of Sociology, University of Utah, Salt Lake City, UT, USA of Medicine, University of Utah, Salt Lake City, UT, USA 3Health Society and Policy Program, University of Utah, Salt Lake City, UT, USA 4Department of Pediatrics, University of Utah, Salt Lake City, UT, USA 2School
Corresponding author: Akiko Kamimura, Department of Sociology, University of Utah, 380 S 1530 E, Salt Lake City, UT 84112, USA. Email: [email protected]
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multi-country study found that the lifetime prevalence of female IPV victimization in Japan is 12.9% GarciaMoreno, Jansen, Ellsberg, Heise, & Watts, 2006). Other studies have found that the lifetime prevalence of female IPV victimization in Singapore is 18% (Chan, Straus, Brownridge, Tiwari, & Leung, 2008), in South Korea is 28% (Chan et al., 2008) and in Taiwan is 19% (Shen, 2009). One study in South Korea found that women are more likely to report verbal IPV perpetration and victimization (28.2% victimization, 26.7% perpetration) than men (24.4% victimization, 25.3% perpetration), while men are more likely to report physical IPV perpetration (5.1%) than women (3.4%) (Lee, Stefani, & Park, 2014). In Japan, IPV victimization of women is associated with tobacco use and alcohol abuse (Yoshihama, Horrocks, & Bybee, 2010). In South Korea, female IPV victimization is associated with depression which has been found to increase the risk of further incidences of IPV (Kim & Lee, 2013). As in other studies, being a victim of child abuse is a predictor of being a victim of IPV in South Korea (Gover, Park, Tomsich, & Jennings, 2011; Jennings et al., 2014). In Taiwan, a survey of college students found that 19% of the participants had experienced IPV victimization and 11% of the participants had experienced both IPV victimization and child abuse (Shen, 2009). Experiencing both IPV and child abuse was associated with trauma symptoms and behavioral problems in young adulthood (Shen, 2009). There are very few studies on IPV in Singapore. One study which surveyed female victims of IPV found that the percentage of female victims who sought help for IPV increased between 1992 (20.6%) and 2002 (50.9%) (Foo & Seow, 2005). This could indicate an increased awareness of IPV-related services in this country. Borderline personality traits, posttraumatic stress disorder (PTSD) and depression are common adverse mental health consequences of IPV victimization and/or perpetration. Borderline personality traits are associated with IPV but vary differently for men and women. Borderline personality traits are related to both perpetration and victimization among men while only related to victimization among women (Maneta, Cohen, Schulz, & Waldinger, 2013). Borderline personality traits increase the risk of developing PTSD among female victims of IPV (Kuijpers, van der Knaap, Winkel, Pemberton, & Baldry, 2011). Wolford-Clevenger et al. (2015) found an association between being a male perpetrator of IPV and having a diagnosis of depression and borderline personality disorder. PTSD is a consequence and risk factor of IPV victimization and perpetration (Kuijpers, van der Knaap, & Winkel, 2012). It has been shown that treating PTSD and depressive symptoms can reduce recurrent IPV among female victims (Iverson et al., 2011). Treating borderline personality traits may also have an impact on IPV victims.
In addition to IPV, the following individual experiences are often considered factors that mediate the association between IPV and mental health and include substance abuse (Connelly, Hazen, Baker-Ericzen, Landsverk, & Horwitz, 2013; Evans & Shapiro, 2011; Hellmuth, Gordon, Moore, & Stuart, 2014; Illangasekare, Burke, Chander, & Gielen, 2013), history of childhood sexual abuse (Devries et al., 2011; Ouellet-Morin et al., 2015), childhood neglect (Nikulina, Widom, & Czaja, 2011), gender hostility (Filson, Ulloa, Runfola, & Hokoda, 2010) and violence socialization (Jeyaseelan et al., 2004). Yet, the association between IPV-related experiences and mental health has not been fully examined in many areas of the world, including Asia. While previous studies have examined IPV-related experiences and mental health in Japan, South Korea and Taiwan (but not in Singapore to the best of our knowledge), the comprehensive information about IPV-related experiences and mental health is still lacking in these countries. Thus, the purpose of this study was to examine IPV-related experiences and mental health outcomes among college students in Japan, Singapore, South Korea and Taiwan. This study contributes to the increased knowledge about mental health issues related to IPV and other violence-related experiences among college students that will aid the development of intervention programs for IPV, borderline personality disorder, depression and PTSD.
Methods Data The data were obtained from the Inter-University Consortium for Political and Social Research (ICPSR), the IDVS 2001–2006 (ICPSR 29583). The data were collected from college students at 68 universities in 32 countries by the members of an IDVS research consortium. The detailed information of the entire study, including data collection procedures, is available at http://pubpages.unh.edu/~mas2/. This study analyzed the data from the IDVS data set. In addition, the US data were included to provide a comparison between the four countries. The original collector of the data, ICPSR, and the relevant funding agency bear no responsibility for the use of the data or for interpretations or inferences based upon such uses.
Samples Japan sample. The Japan sample includes 207 participants from one university (men, n = 99; women, n = 108). More than 60% of the participants (men, n = 62, 62.6%; women, n = 71, 65.7%) had ever had an intimate partner. There were four different types of relationships: dating (n = 108, 81.2%), engaged (n = 15, 11.3%), married (n = 4, 3.0%) and cohabitating (n = 6, 4.5%) (percentages are based on the participants who had ever partnered). Two of the participants
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Kamimura et al. (both women) reported that they had a same sex partner. The mean age of the participants was 20.3 years (standard deviation (SD) = 1.1 years). Singapore sample. The Singapore sample includes 260 participants from one university (men, n = 83; women, n = 177). More than 80% of the participants (men, n = 67, 80.7%; women, n = 149, 84.2%) had ever had an intimate partner. There were four different types of relationships: dating (n = 162, 75.0%), engaged (n = 16, 7.4%), married (n = 34, 15.7%) and cohabitating (n = 4, 1.9%) (percentages are based on the participants who had ever partnered). Six of the participants (three men and three women) had a same sex partner. The mean age of the participants was 24.7 years (SD = 3.7 years). South Korea sample. The South Korea sample includes 256 participants from one university (men, n = 93; women, n = 163). More than 80% of the male participants (n = 77, 82.8%) and 70% of female participants (n = 113, 69.3%) had ever had an intimate partner. There were four different types of relationships: dating (n = 174, 91.6%), engaged (n = 5, 2.6%), married (n = 10, 5.3%) and cohabitating (n = 1, 0.5%) (percentages are based on the participants who had ever partnered). One of the male participants had a same sex partner. The mean age of the participants was 24.3 years (SD = 3.8 years). Taiwan sample. The Taiwan sample includes 258 participants from one university (men, n = 73; women, n = 185). More than 50% of the male participants (n = 39, 53.4%) and 60% of female participants (n = 123, 66.5%) had ever had an intimate partner. There were four different types of relationships: dating (n = 152, 93.8%), engaged (n = 0), married (n = 1, 0.6%) and cohabitating (n = 9, 5.6%) (percentages are based on the participants who had ever partnered). Eleven of the participants (two men and nine women) had a same sex partner. The mean age of the participants was 20.1 years (SD = 1.8 years).
Measures All measures used in the IDVS have been tested for validity and reliability and have been used widely in many countries (Straus, 2004; Straus, Hamby, Boney-McCoy, & Sugarman, 1999). IPV was measured using the revised Conflict Tactics Scale (CTS2) (Straus, Hamby, BoneyMcCoy, & Sugarman, 1996). The CTS has been used widely not only in the United States but also in many other countries (Straus, 2008). The CTS measures both perpetration and victimization of IPV. Physical IPV (physical assault) items included incidents such as kicked, pushed or shoved, or used a knife or gun by a partner or self. In this study, the lifetime (ever) prevalence of victimization and perpetration of physical IPV was used for analysis.
Borderline personality was measured in two aspects, instability and self-harm, using nine items. The example to measure instability (five items in total) is ‘I change suddenly from being one kind of person to another’. The example to measure self-harm (four items in total) includes ‘I have had thoughts of cutting or burning myself’. Symptoms of depression, individual characteristics and experience, and couple relationship items were asked = strongly disagree, using a 4-point Likert scale (1 4 = strongly agree). Some of the items are reversely coded. This study used the scoring method based on the theoretical maximum score, which was scaled from 0 to 100. There were eight items to measure depression (e.g. ‘I have thought about killing myself’ and ‘I feel sad quite often’). PTSD was measured using eight items (four items related to avoidance/arousal and four items related to re-experiencing). The examples of the PTSD items include ‘I’ve been terrified by things that have happened to me’ (avoidance/arousal) and ‘I have bad dreams about terrible things that happened to me’ (re-experiencing). Statements measuring substance abuse included alcohol use (four items, for example, ‘I sometimes drink enough to feel really high or drunk’ and other drug use (four items, for example, ‘I worry that I have a drug problem’). Childhood sexual abuse history included sexual abuse by an adult family or non-family member or a child family or non-family member. The IDVS did not include other forms of childhood abuse or neglect such as physical and emotional abuse or witnessing IPV. Statements measuring childhood sexual abuse included the following: (1) ‘An adult or child family or non-family made me look at or touch their private parts (sex organs), or looked at or touched mine’; and (2) ‘An adult or child family or nonfamily had sex with me (vaginal, anal or oral)’. The violence approval measure has three subtopics: (1) family violence (four items, for example, ‘It is sometimes necessary to discipline a child with a good, hard spanking’), (2) male violence (three items, for example, ‘A man should not walk away from a physical fight with another man’) and (3) sexual aggression (three items, for example, ‘A woman who has been raped probably asked for it’). History of childhood neglect was measured by eight items in four areas: cognitive needs, supervisory needs, emotional needs and physical needs. The examples of the items include ‘My parents did not help me to do my best in school’ (cognitive needs), ‘My parents did not care if I got into trouble in school’ (supervisory needs), ‘My parents did not comfort me when I was upset’ (emotional needs) and ‘My parents did not keep me clean’ (physical needs). Gender hostility combined hostility to men (five items) and hostility to women (five items). The examples of the items include ‘Men/women are rude’ and ‘Men/women irritate me a lot’. The violence socialization scale included two parts: violence socialization with family (five items, for example, ‘When I was a kid, I saw my mother or father
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Table 1. Lifetime prevalence of victimization and perpetration of physical IPV. Total (N = 981)
Japan, men Japan, Singapore, Singapore, South Korea, South Korea, Taiwan, (n = 99) women men (n = 83) women men (n = 93) women men (n = 108) (n = 177) (n = 163) (n = 73)
Victim and perpetrator 188 (26.8) 23 (37.1) 16 (22.5) 6 (9.0) Victim, not perpetrator 16 (2.3) 0 0 5 (7.5) Perpetrator, not victim 63 (9.0) 2 (3.2) 5 (7.0) 3 (4.5)
38 (25.5) 2 (1.3) 13 (8.7)
21 (27.3) 3 (3.9) 6 (7.8)
36 (31.9) 2 (1.8) 13 (11.5)
Taiwan, women (n = 185)
9 (23.1) 39 (31.7) 0 4 (3.3) 1 (2.6) 20 (16.3)
IPV: intimate partner violence. Values are given as n (%).
kick, punch or beat up their partner’ and ‘My father or mother told me to hit back if someone hit me or insulted me’) and violence socialization by non-family (three items, for example, ‘When I was a kid, I often saw kids who were not in my family get into fights and hit each other’ and ‘When I was a kid, people (adults or kids) who were not part of my family pushed, shoved or slapped me or threw things at me’).
Statistical analysis Data were analyzed using SPSS (version 22). Descriptive statistics were used to describe the distribution of the outcome and independent variables. Comparisons were conducted using Pearson’s Chi-square tests for categorical variables (if each cell had more than five respondents) and analysis of variance (ANOVA) tests for continuous variables. Multivariate regression analysis (General Linear Model) was conducted to test the association between mental health (borderline personality traits, depression and PTSD), IPV-related experiences (substance abuse, childhood sexual abuse, neglect, gender hostility and violence socialization) and demographic characteristics (age and gender). In addition, reference variables of a country (reference = Taiwan) were included to control country differences. Regression coefficients (standard errors) were used to obtain 95% confidence intervals (CIs).
Results Table 1 describes the lifetime prevalence of victimization and perpetration of physical IPV by country and gender. Overall, approximately one-fourth of the ever-partnered participants (n = 188, 26.8%) had been both a victim and perpetrator of physical IPV with a range of 6.9% (Singaporean men) to 37.1% (Japanese men). The overall prevalence of being a victim but not a perpetrator was very low (n = 16, 2.3%), with a range of 0% (Japanese men and women and Taiwanese men) to 7.5% (Singaporean men). The overall prevalence of being a perpetrator but not a victim was 9% (n = 63), with a range of 2.6% (Taiwanese men) to 16.3% (Taiwanese women). Table 2 summarizes and compares mental health and violence-related experience by gender and country. The
results of ANOVA tests were significant for all items. Taiwanese women had the highest scores for borderline personality, PTSD and gender hostility. Japanese men had the highest score for depression. South Korean men had the highest score for substance abuse and South Korean women had the highest score for childhood neglect. Taiwanese men had the highest score for childhood sexual abuse and violence socialization. Table 3 presents predictors of mental health outcomes. Physical violence victimization and perpetration were significantly related to higher scores of borderline personality and PTSD, but not to depression. Childhood sexual abuse, gender hostility and violence socialization were significantly associated with higher scores of borderline personality, depression and PTSD. Childhood neglect was significantly related to borderline personality, but not to depression and PTSD. Younger age and female gender were significantly associated with borderline personality and PTSD. Compared to Taiwanese participants, Japanese participants reported lower levels of PTSD, but higher levels of depression. Singaporean participants reported lower levels of borderline personality than Taiwanese participants. South Korean participants reported lower levels of depression and PTSD than Taiwanese participants.
Discussion This study examined IPV-related experiences and mental health among college students in Japan, Singapore, South Korea and Taiwan. There are three main findings. First, co-experience of physical IPV victimization and perpetration was associated with borderline personality traits and PTSD, but not with depression. Second, childhood sexual abuse, gender hostility and violence socialization were significant predictors of borderline personality traits, depression and PTSD. Third, while country and gender variations in mental health are noted, there are two specific populations that may need special attention for mental health interventions: Taiwanese women especially for borderline personality traits and PTSD and Japanese men especially for depression. The results of this study suggest that the co-occurrence of IPV victimization and perpetration is related to higher levels of borderline personality traits and PTSD. Overall,
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39.96 (15.00) 39.22 (16.28) 46.91 (14.43) 15.29 (13.90) 10.61 (14.14) 29.51 (13.99) 33.43 (12.01) 29.97 (16.81)
37.15 (17.16) 47.18 (18.76) 43.31 (15.87) 15.11 (12.49) 9.64 (11.94) 25.13 (12.00) 28.01 (12.36) 27.02 (16.08)
36.56 (14.53) 43.56 (15.15) 42.17 (15.28) 11.65 (11.43) 8.37 (10.88) 22.84 (13.63) 28.92 (10.65) 19.33 (15.48)
Japan, women (n = 108)
PTSD: posttraumatic stress disorder; ANOVA: analysis of variance. Values are given as mean (SD). ANOVA tests were significant for all of the items (p
ISP0010.1177/0020764016629700International Journal of Social PsychiatryKamimura et al.
E CAMDEN SCHIZOPH
Original Article
Intimate partner violence–related experiences and mental health among college students in Japan, Singapore, South Korea and Taiwan
International Journal of Social Psychiatry 1–9 © The Author(s) 2016 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0020764016629700 isp.sagepub.com
Akiko Kamimura1, Maziar M Nourian2, Nushean Assasnik3 and Kathy Franchek-Roa4
Abstract Background: Intimate partner violence (IPV) is a significant public health threat that contributes to a wide range of mental and physical health problems for victims. Aims: The purpose of this study was to examine IPV-related experiences and mental health outcomes among college students in Japan, Singapore, South Korea and Taiwan. Methods: The data were obtained from the Inter-University Consortium for Political and Social Research (ICPSR), the International Dating Violence Study (IDVS) 2001–2006 (ICPSR 29583; N = 981; Japan n = 207; Singapore n = 260; South Korea n = 256; Taiwan n = 258). Results: Co-experience of physical IPV victimization and perpetration was associated with borderline personality traits and posttraumatic stress disorder (PTSD), but not with depression. Childhood sexual abuse, gender hostility and violence socialization were significant predictors of borderline personality traits, depression and PTSD. While country and gender variations in mental health are noted, there are two specific populations that may need special attention for mental health interventions: Taiwanese women especially for borderline personality traits and PTSD, and Japanese men especially for depression. Conclusion: IPV victimization and perpetration, childhood sexual abuse, gender hostility and violence socialization have a significant impact on the mental health of college students in Japan, Singapore, South Korea and Taiwan. Since IPV and mental health are significant public health issues, research on IPV and mental health consequences of IPV victimization and perpetration in these countries should be further expanded in order to better understand the interventions that will be effective in treating victims, perpetrators and victim/perpetrators of IPV. Keywords Depression, borderline personality disorder, posttraumatic stress disorders, intimate partner violence, college students, Asia
Introduction Intimate partner violence (IPV) is a significant public health threat that contributes to a wide range of mental and physical health problems for victims (Ellsberg, Jansen, Heise, Watts, & Garcia-Moreno, 2008). IPV includes physical, sexual and/or psychological harm inflicted by a current or former intimate partner, such as a dating partner, fiancée or spouse (Center for Disease Control and Prevention, 2015), and these types of behaviors are used to gain power and control over a partner (United States Department of Justice, 2015). Worldwide, the lifetime prevalence of physical IPV among female victims varies from 15% to 71% (Garcia-Moreno, Jansen, Ellsberg, Heise, & Watts, 2006). This study focused on IPV and mental health among four Asian countries, Japan, Singapore, South Korea and
Taiwan, which were examined in the International Dating Violence Study (IDVS) and have a comparable sample size. The IDVS examined IPV among college students in 32 countries. The World Health Organization (WHO) 1Department
of Sociology, University of Utah, Salt Lake City, UT, USA of Medicine, University of Utah, Salt Lake City, UT, USA 3Health Society and Policy Program, University of Utah, Salt Lake City, UT, USA 4Department of Pediatrics, University of Utah, Salt Lake City, UT, USA 2School
Corresponding author: Akiko Kamimura, Department of Sociology, University of Utah, 380 S 1530 E, Salt Lake City, UT 84112, USA. Email: [email protected]
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multi-country study found that the lifetime prevalence of female IPV victimization in Japan is 12.9% GarciaMoreno, Jansen, Ellsberg, Heise, & Watts, 2006). Other studies have found that the lifetime prevalence of female IPV victimization in Singapore is 18% (Chan, Straus, Brownridge, Tiwari, & Leung, 2008), in South Korea is 28% (Chan et al., 2008) and in Taiwan is 19% (Shen, 2009). One study in South Korea found that women are more likely to report verbal IPV perpetration and victimization (28.2% victimization, 26.7% perpetration) than men (24.4% victimization, 25.3% perpetration), while men are more likely to report physical IPV perpetration (5.1%) than women (3.4%) (Lee, Stefani, & Park, 2014). In Japan, IPV victimization of women is associated with tobacco use and alcohol abuse (Yoshihama, Horrocks, & Bybee, 2010). In South Korea, female IPV victimization is associated with depression which has been found to increase the risk of further incidences of IPV (Kim & Lee, 2013). As in other studies, being a victim of child abuse is a predictor of being a victim of IPV in South Korea (Gover, Park, Tomsich, & Jennings, 2011; Jennings et al., 2014). In Taiwan, a survey of college students found that 19% of the participants had experienced IPV victimization and 11% of the participants had experienced both IPV victimization and child abuse (Shen, 2009). Experiencing both IPV and child abuse was associated with trauma symptoms and behavioral problems in young adulthood (Shen, 2009). There are very few studies on IPV in Singapore. One study which surveyed female victims of IPV found that the percentage of female victims who sought help for IPV increased between 1992 (20.6%) and 2002 (50.9%) (Foo & Seow, 2005). This could indicate an increased awareness of IPV-related services in this country. Borderline personality traits, posttraumatic stress disorder (PTSD) and depression are common adverse mental health consequences of IPV victimization and/or perpetration. Borderline personality traits are associated with IPV but vary differently for men and women. Borderline personality traits are related to both perpetration and victimization among men while only related to victimization among women (Maneta, Cohen, Schulz, & Waldinger, 2013). Borderline personality traits increase the risk of developing PTSD among female victims of IPV (Kuijpers, van der Knaap, Winkel, Pemberton, & Baldry, 2011). Wolford-Clevenger et al. (2015) found an association between being a male perpetrator of IPV and having a diagnosis of depression and borderline personality disorder. PTSD is a consequence and risk factor of IPV victimization and perpetration (Kuijpers, van der Knaap, & Winkel, 2012). It has been shown that treating PTSD and depressive symptoms can reduce recurrent IPV among female victims (Iverson et al., 2011). Treating borderline personality traits may also have an impact on IPV victims.
In addition to IPV, the following individual experiences are often considered factors that mediate the association between IPV and mental health and include substance abuse (Connelly, Hazen, Baker-Ericzen, Landsverk, & Horwitz, 2013; Evans & Shapiro, 2011; Hellmuth, Gordon, Moore, & Stuart, 2014; Illangasekare, Burke, Chander, & Gielen, 2013), history of childhood sexual abuse (Devries et al., 2011; Ouellet-Morin et al., 2015), childhood neglect (Nikulina, Widom, & Czaja, 2011), gender hostility (Filson, Ulloa, Runfola, & Hokoda, 2010) and violence socialization (Jeyaseelan et al., 2004). Yet, the association between IPV-related experiences and mental health has not been fully examined in many areas of the world, including Asia. While previous studies have examined IPV-related experiences and mental health in Japan, South Korea and Taiwan (but not in Singapore to the best of our knowledge), the comprehensive information about IPV-related experiences and mental health is still lacking in these countries. Thus, the purpose of this study was to examine IPV-related experiences and mental health outcomes among college students in Japan, Singapore, South Korea and Taiwan. This study contributes to the increased knowledge about mental health issues related to IPV and other violence-related experiences among college students that will aid the development of intervention programs for IPV, borderline personality disorder, depression and PTSD.
Methods Data The data were obtained from the Inter-University Consortium for Political and Social Research (ICPSR), the IDVS 2001–2006 (ICPSR 29583). The data were collected from college students at 68 universities in 32 countries by the members of an IDVS research consortium. The detailed information of the entire study, including data collection procedures, is available at http://pubpages.unh.edu/~mas2/. This study analyzed the data from the IDVS data set. In addition, the US data were included to provide a comparison between the four countries. The original collector of the data, ICPSR, and the relevant funding agency bear no responsibility for the use of the data or for interpretations or inferences based upon such uses.
Samples Japan sample. The Japan sample includes 207 participants from one university (men, n = 99; women, n = 108). More than 60% of the participants (men, n = 62, 62.6%; women, n = 71, 65.7%) had ever had an intimate partner. There were four different types of relationships: dating (n = 108, 81.2%), engaged (n = 15, 11.3%), married (n = 4, 3.0%) and cohabitating (n = 6, 4.5%) (percentages are based on the participants who had ever partnered). Two of the participants
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Kamimura et al. (both women) reported that they had a same sex partner. The mean age of the participants was 20.3 years (standard deviation (SD) = 1.1 years). Singapore sample. The Singapore sample includes 260 participants from one university (men, n = 83; women, n = 177). More than 80% of the participants (men, n = 67, 80.7%; women, n = 149, 84.2%) had ever had an intimate partner. There were four different types of relationships: dating (n = 162, 75.0%), engaged (n = 16, 7.4%), married (n = 34, 15.7%) and cohabitating (n = 4, 1.9%) (percentages are based on the participants who had ever partnered). Six of the participants (three men and three women) had a same sex partner. The mean age of the participants was 24.7 years (SD = 3.7 years). South Korea sample. The South Korea sample includes 256 participants from one university (men, n = 93; women, n = 163). More than 80% of the male participants (n = 77, 82.8%) and 70% of female participants (n = 113, 69.3%) had ever had an intimate partner. There were four different types of relationships: dating (n = 174, 91.6%), engaged (n = 5, 2.6%), married (n = 10, 5.3%) and cohabitating (n = 1, 0.5%) (percentages are based on the participants who had ever partnered). One of the male participants had a same sex partner. The mean age of the participants was 24.3 years (SD = 3.8 years). Taiwan sample. The Taiwan sample includes 258 participants from one university (men, n = 73; women, n = 185). More than 50% of the male participants (n = 39, 53.4%) and 60% of female participants (n = 123, 66.5%) had ever had an intimate partner. There were four different types of relationships: dating (n = 152, 93.8%), engaged (n = 0), married (n = 1, 0.6%) and cohabitating (n = 9, 5.6%) (percentages are based on the participants who had ever partnered). Eleven of the participants (two men and nine women) had a same sex partner. The mean age of the participants was 20.1 years (SD = 1.8 years).
Measures All measures used in the IDVS have been tested for validity and reliability and have been used widely in many countries (Straus, 2004; Straus, Hamby, Boney-McCoy, & Sugarman, 1999). IPV was measured using the revised Conflict Tactics Scale (CTS2) (Straus, Hamby, BoneyMcCoy, & Sugarman, 1996). The CTS has been used widely not only in the United States but also in many other countries (Straus, 2008). The CTS measures both perpetration and victimization of IPV. Physical IPV (physical assault) items included incidents such as kicked, pushed or shoved, or used a knife or gun by a partner or self. In this study, the lifetime (ever) prevalence of victimization and perpetration of physical IPV was used for analysis.
Borderline personality was measured in two aspects, instability and self-harm, using nine items. The example to measure instability (five items in total) is ‘I change suddenly from being one kind of person to another’. The example to measure self-harm (four items in total) includes ‘I have had thoughts of cutting or burning myself’. Symptoms of depression, individual characteristics and experience, and couple relationship items were asked = strongly disagree, using a 4-point Likert scale (1 4 = strongly agree). Some of the items are reversely coded. This study used the scoring method based on the theoretical maximum score, which was scaled from 0 to 100. There were eight items to measure depression (e.g. ‘I have thought about killing myself’ and ‘I feel sad quite often’). PTSD was measured using eight items (four items related to avoidance/arousal and four items related to re-experiencing). The examples of the PTSD items include ‘I’ve been terrified by things that have happened to me’ (avoidance/arousal) and ‘I have bad dreams about terrible things that happened to me’ (re-experiencing). Statements measuring substance abuse included alcohol use (four items, for example, ‘I sometimes drink enough to feel really high or drunk’ and other drug use (four items, for example, ‘I worry that I have a drug problem’). Childhood sexual abuse history included sexual abuse by an adult family or non-family member or a child family or non-family member. The IDVS did not include other forms of childhood abuse or neglect such as physical and emotional abuse or witnessing IPV. Statements measuring childhood sexual abuse included the following: (1) ‘An adult or child family or non-family made me look at or touch their private parts (sex organs), or looked at or touched mine’; and (2) ‘An adult or child family or nonfamily had sex with me (vaginal, anal or oral)’. The violence approval measure has three subtopics: (1) family violence (four items, for example, ‘It is sometimes necessary to discipline a child with a good, hard spanking’), (2) male violence (three items, for example, ‘A man should not walk away from a physical fight with another man’) and (3) sexual aggression (three items, for example, ‘A woman who has been raped probably asked for it’). History of childhood neglect was measured by eight items in four areas: cognitive needs, supervisory needs, emotional needs and physical needs. The examples of the items include ‘My parents did not help me to do my best in school’ (cognitive needs), ‘My parents did not care if I got into trouble in school’ (supervisory needs), ‘My parents did not comfort me when I was upset’ (emotional needs) and ‘My parents did not keep me clean’ (physical needs). Gender hostility combined hostility to men (five items) and hostility to women (five items). The examples of the items include ‘Men/women are rude’ and ‘Men/women irritate me a lot’. The violence socialization scale included two parts: violence socialization with family (five items, for example, ‘When I was a kid, I saw my mother or father
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International Journal of Social Psychiatry
Table 1. Lifetime prevalence of victimization and perpetration of physical IPV. Total (N = 981)
Japan, men Japan, Singapore, Singapore, South Korea, South Korea, Taiwan, (n = 99) women men (n = 83) women men (n = 93) women men (n = 108) (n = 177) (n = 163) (n = 73)
Victim and perpetrator 188 (26.8) 23 (37.1) 16 (22.5) 6 (9.0) Victim, not perpetrator 16 (2.3) 0 0 5 (7.5) Perpetrator, not victim 63 (9.0) 2 (3.2) 5 (7.0) 3 (4.5)
38 (25.5) 2 (1.3) 13 (8.7)
21 (27.3) 3 (3.9) 6 (7.8)
36 (31.9) 2 (1.8) 13 (11.5)
Taiwan, women (n = 185)
9 (23.1) 39 (31.7) 0 4 (3.3) 1 (2.6) 20 (16.3)
IPV: intimate partner violence. Values are given as n (%).
kick, punch or beat up their partner’ and ‘My father or mother told me to hit back if someone hit me or insulted me’) and violence socialization by non-family (three items, for example, ‘When I was a kid, I often saw kids who were not in my family get into fights and hit each other’ and ‘When I was a kid, people (adults or kids) who were not part of my family pushed, shoved or slapped me or threw things at me’).
Statistical analysis Data were analyzed using SPSS (version 22). Descriptive statistics were used to describe the distribution of the outcome and independent variables. Comparisons were conducted using Pearson’s Chi-square tests for categorical variables (if each cell had more than five respondents) and analysis of variance (ANOVA) tests for continuous variables. Multivariate regression analysis (General Linear Model) was conducted to test the association between mental health (borderline personality traits, depression and PTSD), IPV-related experiences (substance abuse, childhood sexual abuse, neglect, gender hostility and violence socialization) and demographic characteristics (age and gender). In addition, reference variables of a country (reference = Taiwan) were included to control country differences. Regression coefficients (standard errors) were used to obtain 95% confidence intervals (CIs).
Results Table 1 describes the lifetime prevalence of victimization and perpetration of physical IPV by country and gender. Overall, approximately one-fourth of the ever-partnered participants (n = 188, 26.8%) had been both a victim and perpetrator of physical IPV with a range of 6.9% (Singaporean men) to 37.1% (Japanese men). The overall prevalence of being a victim but not a perpetrator was very low (n = 16, 2.3%), with a range of 0% (Japanese men and women and Taiwanese men) to 7.5% (Singaporean men). The overall prevalence of being a perpetrator but not a victim was 9% (n = 63), with a range of 2.6% (Taiwanese men) to 16.3% (Taiwanese women). Table 2 summarizes and compares mental health and violence-related experience by gender and country. The
results of ANOVA tests were significant for all items. Taiwanese women had the highest scores for borderline personality, PTSD and gender hostility. Japanese men had the highest score for depression. South Korean men had the highest score for substance abuse and South Korean women had the highest score for childhood neglect. Taiwanese men had the highest score for childhood sexual abuse and violence socialization. Table 3 presents predictors of mental health outcomes. Physical violence victimization and perpetration were significantly related to higher scores of borderline personality and PTSD, but not to depression. Childhood sexual abuse, gender hostility and violence socialization were significantly associated with higher scores of borderline personality, depression and PTSD. Childhood neglect was significantly related to borderline personality, but not to depression and PTSD. Younger age and female gender were significantly associated with borderline personality and PTSD. Compared to Taiwanese participants, Japanese participants reported lower levels of PTSD, but higher levels of depression. Singaporean participants reported lower levels of borderline personality than Taiwanese participants. South Korean participants reported lower levels of depression and PTSD than Taiwanese participants.
Discussion This study examined IPV-related experiences and mental health among college students in Japan, Singapore, South Korea and Taiwan. There are three main findings. First, co-experience of physical IPV victimization and perpetration was associated with borderline personality traits and PTSD, but not with depression. Second, childhood sexual abuse, gender hostility and violence socialization were significant predictors of borderline personality traits, depression and PTSD. Third, while country and gender variations in mental health are noted, there are two specific populations that may need special attention for mental health interventions: Taiwanese women especially for borderline personality traits and PTSD and Japanese men especially for depression. The results of this study suggest that the co-occurrence of IPV victimization and perpetration is related to higher levels of borderline personality traits and PTSD. Overall,
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39.96 (15.00) 39.22 (16.28) 46.91 (14.43) 15.29 (13.90) 10.61 (14.14) 29.51 (13.99) 33.43 (12.01) 29.97 (16.81)
37.15 (17.16) 47.18 (18.76) 43.31 (15.87) 15.11 (12.49) 9.64 (11.94) 25.13 (12.00) 28.01 (12.36) 27.02 (16.08)
36.56 (14.53) 43.56 (15.15) 42.17 (15.28) 11.65 (11.43) 8.37 (10.88) 22.84 (13.63) 28.92 (10.65) 19.33 (15.48)
Japan, women (n = 108)
PTSD: posttraumatic stress disorder; ANOVA: analysis of variance. Values are given as mean (SD). ANOVA tests were significant for all of the items (p
