The Impact of Intimate Partner Violence on the Mental and Physical Health of Sexual and Gender Minorities: A Comprehensive Review of Quantitative Research

doi:10.21203/rs.3.rs-3407911/v1

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Systematic Review

The Impact of Intimate Partner Violence on the Mental and Physical Health of Sexual and Gender Minorities: A Comprehensive Review of Quantitative Research

https://doi.org/10.21203/rs.3.rs-3407911/v1

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Purpose

The aim of this review is to investigate the mental and physical health outcomes of Intimate Partner Violence (IPV) victimization among Sexual and Gender Minority (SGM) individuals. This study adopts an intersectional lens to address an existing gap in research concerning IPV outcomes among SGM populations.

Methods

A systematic review was conducted through PubMed, APA PsycInfo and APA PsycNet utilizing specific keywords. Inclusion criteria included peer-reviewed publications from the last 10 years, and quantitative studies specifically assessing IPV outcomes among SGM individuals. A total of 23 studies meeting these criteria were included in the review.

Results

Our results show significant associations between IPV victimization and adverse health and mental health outcomes, including posttraumatic stress disorder, depression, anxiety, suicidal ideation and attempts, substance use, and risky sexual behaviors among SGM individuals.

Conclusions

IPV victimization poses unique mental and physical health risks for SGM populations. Our findings highlight the need for comprehensive, tailored intervention and prevention efforts that consider the intersectionality of multiple minoritized identities in the context of IPV victimization.

Psychology

Intimate Partner Violence

Sexual Orientation

Gender Identity

Adverse outcomes

Intimate Partner Violence (IPV), as defined by the Centers for Disease Control and Prevention (CDC) encompasses various forms of abuse and aggression within romantic relationships and presents a significant and pervasive global public health concern (CDC, 2021; Garcia-Moreno et al., 2006). IPV manifests as episodes of violence perpetrated by current or former partners, including spouses, dating partners, or intimate partners (CDC, 2021). This violence encompasses a broad spectrum of aggressive behaviors, such as physical violence, sexual violence, stalking, financial exploitation, and psychological abuse (i.e., intense criticism, coercive control, and verbal harassment) (CDC, 2021).

Extensive research has illuminated the impact of IPV victimization on millions of individuals annually, transcending demographic categories such as age, gender, race, ethnicity, socioeconomic status (SES), sexual orientation, and nationality (Devries et al., 2013). However, scant attention has been given to understanding the adverse consequences of IPV victimization among individuals with Sexual and Gender Minority (SGM) identities. Therefore, this study seeks to investigate the adverse outcomes of IPV victimization among individuals who identify as SGM. Our aim is to address the existing gap in SGM research concerning exposure to interpersonal violence and to contribute to the development of gender-inclusive interventions for SGM populations in future studies.

Violence Exposure Among Sexual and Gender Minorities

The National Institute of Health (NIH) broadly defines Sexual and Gender Minority populations as individuals identifying as lesbian, gay, bisexual, asexual, transgender, two-spirit, queer, intersex, those with same-sex or same-gender attractions or behaviors, those who do not self-identify with any labels but whose sexual orientation, gender identity or expression, or reproductive development is characterized by non-binary constructs of sexual orientation, gender, or sex assigned at birth (NIH, 2023).

Previous research has shown that SGM individuals experience higher rates of lifetime victimization, including peer and sibling victimization, childhood maltreatment, and sexual violence when compared to their non-SGM counterparts (Mitchell et al., 2023) as well as face similar or elevated risks of IPV and other forms of interpersonal violence throughout their lives (Balsam et al., 2005; Edwards et al., 2015; Goldberg & Meyer, 2013; Pantalone et al., 2020). Furthermore, studies indicate that polyvictimization—exposure to multiple forms of victimization across various domains and at the intersection of multiple minoritized identities—strongly predicts mental and somatic health outcomes, surpassing the impact of single measures of victimization (Finkelhor et al., 2007; Sterzing et al., 2019). Thus, an intersectionality approach is imperative for comprehending IPV outcomes, especially among SGM populations. Intersectionality, in this context, denotes how multiple identities (e.g., race, ethnicity, sexual orientation, and gender identity) interact with different systems of oppression, culminating in unique experiences (Collins, 1998).

While IPV research has historically concentrated on cisgender heterosexual women, recent studies have embraced an intersectional perspective to explore how various minority identities intersect with systems of oppression concerning IPV. These studies have identified differences in IPV outcomes based on immigration status, cultural background, and socioeconomic factors (Sabina et al., 2014; Silva-Martínez, 2017). However, much of the work still remains confined to the experiences of cisgender women, with SGM individuals still largely overlooked. Thus, it is crucial to account for the distinctive stressors potentially associated with IPV among SGM individuals, as suggested by Meyer's (2003) minority stress theory.

Meyer (2003) posits that minority stressors can be defined as stressors that (1) add to the daily stress experienced by the general population, necessitating adaptation by individuals with stigmatized identities; (2) are chronic and rooted in the complex interplay between minoritized identities and systems of oppression; and (3) are socially constructed, stemming from structural processes beyond individual control (Meyer, 2003). In addition to experiencing IPV, SGM individuals often contend with additional stressors that merit consideration when examining the consequences of victimization. These stressors encompass discrimination, victimization due to minority status, internalized stigma, transphobia or homophobia, and identity concealment (Meyer, 2003).

While recent studies have predominantly assessed the prevalence of IPV perpetration and victimization among SGM individuals, an urgent need remains to identify the specific adverse impacts of IPV exposure within SGM populations. Existing research primarily focuses on either sexual or gender identities, overlooking the role played by multiple minoritized and intersecting identities in the context of IPV victimization. The current review aims to adopt an intersectional lens to explore the mental and physical health consequences of IPV victimization among SGM individuals, and to synthesize the existing literature in the field to date.

Data Source and Search Strategy

The current systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement (Page et al., 2021). Two reviewers (MR and AN) conducted a systematic search through PubMed, APA PsycInfo and APA PsycNet. The following keywords were applied: Intimate Partner Violence OR IPV OR Domestic Violence or Partner Abuse* AND Sexual Minorities OR Gender Minorities OR Sexual Gender Minorities OR SGM OR LGBT OR LGBTQ.

Inclusion and Exclusion Criteria

The following inclusion criteria were applied to select the articles: (a) in the English language, (b) published in peer-reviewed journals between 2013 and 2023, (c) quantitative studies, and (d) focused on the assessment of the outcomes of Intimate Partner Violence among SGM individuals.

The studies that did not match the inclusion criteria above were excluded. In addition, the following exclusion criteria were applied: (a) studies about IPV in which the methods or results did not differentiate between IPV among SGM and cisgender, heterosexual individuals, (b) studies that assessed the outcomes of IPV as a joint factor with other stressors (e.g., the COVID-19 pandemic, Childhood Maltreatment, Peer Victimization, Bullying, etc.), (c) studies that assessed IPV’s outcomes among SGM individuals but did not differentiate between perpetration- and victimization-related outcomes, and (d) studies that explored the differences in outcomes between SGM and cisgender heterosexuals and the sample size did not include at least 50% of SGM.

Data Extraction Process

Overall, the search resulted in 10,454 articles, which were imported into Covidence Software. Of these, 123 papers were selected for full-text review after the title and abstract screening process, and 23 papers remained applicable to the criteria and were included in the systematic review. Any disagreement regarding the data extraction stage was discussed between the reviewers to obtain a unanimous agreement. See the Flowchart (Fig. 1) of the selection procedure.

Twenty-three studies were included in the current systematic review. Eighteen studies were conducted in the United States. Two studies were conducted in China, one in England, one in Peru, and one in Guatemala. The majority of the studies were published in the last 5 years. Five were published in 2021, four each year in 2019, 2020, and 2022, three in 2023, three in 2017, one in years 2013, 2015, and 2016, and none in 2014. The combined sample size of the twenty-three studies is N = 15,424.

Sociodemographic Characteristics

Sexual Identity

Studies explored IPV prevalence and outcomes across diverse sexual identities. Such identities included heterosexuals/straight (Bukowski et al., 2019; Henry et al., 2021; Passaro et al., 2020; Scheer & Mereish, 2021; Taber et al., 2023; Xu et al., 2022), bisexuals/same-gender loving (Beymer et al., 2017; Davis et al., 2022; Edwards et al., 2021; Goldberg-Looney et al., 2016; Henry et al., 2021; Miltz et al., 2019; Passaro et al., 2020; Reisner et al., 2013; Reuter et al., 2017; Scheer & Mereish, 2021; Taber et al., 2023; Whitton et al., 2019; Wirtz et al., 2022; Woulfe & Goodman, 2020; Xavier Hall et al., 2022; Xu et al., 2022), gay/homosexuals/men who have sex with men (Beymer et al., 2017; Braksmajer et al., 2020; Davis et al., 2022; Edwards et al., 2021; Goldberg-Looney et al., 2016; Henry et al., 2021; Miltz et al., 2019; Reisner et al., 2013; Reuter et al., 2017; Scheer & Mereish, 2021; Stults et al., 2015; Taber et al., 2023; Whitton et al., 2019; Wirtz et al., 2022; Woulfe & Goodman, 2020; Xavier Hall et al., 2022; Xu et al., 2022; Zhu et al., 2021), lesbians (Goldberg-Looney et al., 2016; Henry et al., 2021; Reisner et al., 2013; Reuter et al., 2017; Scheer & Mereish, 2021; Taber et al., 2023; Whitton et al., 2019; Woulfe & Goodman, 2020), and queer/pansexual/asexual/demisexual/other non-heterosexual orientation (Beymer et al., 2017; Edwards et al., 2021; Goldberg-Looney et al., 2016; Henry et al., 2021; Reisner et al., 2013; Reuter et al., 2017; Scheer & Mereish, 2021; Taber et al., 2023; Whitton et al., 2019; Woulfe & Goodman, 2020; Xavier Hall et al., 2022; Xu et al., 2022).

Gender Identity

Studies explored IPV prevalence and outcomes across diverse gender identities. Such identities included transgender men and transgender women (Becerra et al., 2021; Bukowski et al., 2019; Edwards et al., 2021; Henry et al., 2021; McDowell et al., 2019; Passaro et al., 2020; Peitzmeier et al., 2021; Reuter et al., 2017; Scheer & Mereish, 2021; Taber et al., 2023; Whitton et al., 2019; Woulfe & Goodman, 2020; Xu et al., 2022), cisgender individuals (Bukowski et al., 2019; Edwards et al., 2021; Goldberg-Looney et al., 2016; Peitzmeier et al., 2021; Reisner et al., 2013; Reuter et al., 2017; Scheer & Mereish, 2021; Whitton et al., 2019; Woulfe & Goodman, 2020; Xavier Hall et al., 2022), and non-binary/genderqueer/gender fluid/gender nonconforming/agender/two-spirt/other non-cisgender identity (Edwards et al., 2021; Henry et al., 2021; Peitzmeier et al., 2021; Scheer & Mereish, 2021; Taber et al., 2023; Xavier Hall et al., 2022).

IPV type & assessment

Studies included in this systematic review assessed different types of IPV, including sexual (Becerra et al., 2021; Beymer et al., 2017; Braksmajer et al., 2020; Davis et al., 2022; Edwards et al., 2021; Goldberg-Looney et al., 2016; Henry et al., 2021; McDowell et al., 2019; Miltz et al., 2019; Passaro et al., 2020; Peitzmeier et al., 2021; Reisner et al., 2013; Reuter et al., 2017; Stults et al., 2015; Whitton et al., 2019; Wirtz et al., 2022; Woulfe & Goodman, 2020; Xavier Hall et al., 2022; Xu et al., 2022; Zhu et al., 2021), physical (Becerra et al., 2021; Beymer et al., 2017; Braksmajer et al., 2020; Bukowski et al., 2019; Davis et al., 2022; Goldberg-Looney et al., 2016; Henry et al., 2021; McDowell et al., 2019; Miltz et al., 2019; Passaro et al., 2020; Peitzmeier et al., 2021; Reisner et al., 2013; Reuter et al., 2017; Scheer & Mereish, 2021; Stults et al., 2015; Whitton et al., 2019; Wirtz et al., 2022; Woulfe & Goodman, 2020; Xavier Hall et al., 2022; Xu et al., 2022; Zhu et al., 2021), and psychological, emotional, verbal, controlling and/or monitoring (Becerra et al., 2021; Beymer et al., 2017; Braksmajer et al., 2020; Davis et al., 2022; Goldberg-Looney et al., 2016; Henry et al., 2021; Miltz et al., 2019; Passaro et al., 2020; Reuter et al., 2017; Scheer & Mereish, 2021; Stults et al., 2015; Wirtz et al., 2022; Woulfe & Goodman, 2020; Xavier Hall et al., 2022; Xu et al., 2022; Zhu et al., 2021). Interestingly, only a few studies assessed minority-specific IPV, including identity-abuse (Scheer & Mereish, 2021; Taber et al., 2023; Woulfe & Goodman, 2020) and transgender-specific IPV (McDowell et al., 2019; Peitzmeier et al., 2021; Xu et al., 2022).

IPV was assessed using different measures, ranging from validated questionnaires to “yes/no” questions about ever having experienced IPV victimization. Measures included the standard and short-form of the Conflict Tactics Scale (CTS; Straus & Douglas, 2004; Straus et al., 1996) (Goldberg-Looney et al., 2016; Henry et al., 2021; Scheer & Mereish, 2021; Woulfe & Goodman, 2020) the Psychological Maltreatment of Women Inventory (Tolman, 1999)^,(Scheer & Mereish, 2021; Woulfe & Goodman, 2020), the Sexual and Gender Minority Conflict Tactics Scale (SGM-CTS2; Dyar et al., 2021)^,(Edwards et al., 2021), the HIV risk Assessment for Sexual Partnerships (H-RASP; Swann et al. 2018)(Reuter et al., 2017; Whitton et al., 2019), the IPV-GBM scale (Braksmajer et al., 2020; Stephenson & Finneran, 2013; Zhu et al., 2021), the WHO-multi country study on women’s health questionnaire (Garcia-Moreno et al., 2006; Peitzmeier et al., 2021), the Identity Abuse Scale (Scheer & Mereish, 2021; Scheer et al., 2019; Taber et al., 2023; Woulfe & Goodman, 2020), the Transgender-Specific Intimate Partner Violence Scale (T-IPV) (Peitzmeier et al., 2021; Taber et al., 2023), and “yes/no” questions assessing whether an individual had ever experienced IPV (e.g., lifetime, 6 months, past year) (Becerra et al., 2021; Beymer et al., 2017; Bukowski et al., 2019; Davis et al., 2022; McDowell et al., 2019; Miltz et al., 2019; Passaro et al., 2020; Peitzmeier et al., 2021; Reisner et al., 2013; Stults et al., 2015; Wirtz et al., 2022; Xavier Hall et al., 2022; Xu et al., 2022).

IPV-Related Outcomes

Mental Health Outcomes

Posttraumatic Stress Disorder (PTSD)

IPV victimization was significantly associated with PTSD in five studies. For instance, Taber et al. (2023) found that experiencing either form of identity-specific IPV was associated with a significantly higher score on the Posttraumatic Stress Disorder Checklist (PCL-6) (Han et al., 2016) (p < .001) and that 1) the total and direct relationship of transgender-related IPV with PTSD and 2) the total and direct relationship between identity abuse with PTSD were significant based on 95% CI. In addition, Stults et al. (2015) found that in a sample of Young Men Who Have Sex with Men, lifetime IPV victimization was significantly correlated with PTSD symptoms (r = .23, p < .001). McDowell et al. (2019) found that lifetime IPV victimization (referent = no IPV; aOR = 3.08; 95% CI = 1.26‚7.53; p = .001) was significantly associated with increased odds of PTSD. Peitzmeier et al. (2021) found that in a sample of transgender women, lifetime transgender-specific IPV was significantly associated with a 50% increased risk of PTSD (APR = 1.50, 95% CI = 1.31,1.72). Woulfe & Goodman (2020) found that identity abuse accounted for an additional 1% of the variance in PTSD symptoms after controlling for other forms of IPV and demographic variables (r = .11, p < .001) and that similarly, past year identity abuse exposure contributed to 1% additional variance in PTSD symptoms after controlling for other forms of IPV exposure and demographic variables (r = .12, p < .001). In addition, the authors found that the semi partial correlation between identity abuse and symptoms of PTSD (SR² = .13; p < .001) as well as physical abuse and symptoms of PTSD (SR² = .15; p < .001) were both significant (Woulfe & Goodman, 2020).

Depression

IPV victimization was significantly associated with depression in twelve studies. Taber et al. (2023) found that experiencing either form of identity-specific IPV was significantly associated with higher scores on the PHQ-9 measure (PHQ-9)(Kroenke et al., 2001) (p < .001). In addition, the authors found that the total and direct relationships between transgender-related IPV and depression and between identity abuse and depression were significant based on 95% CI (Taber et al. 2023). Woulfe & Goodman (2020) found that identity abuse exposure accounted for an additional 1% of the variance in depression scores after controlling for other forms of IPV and demographic variables (r = .10, p < .001). In addition, the authors found that the semi-partial correlation between identity abuse and symptoms of depression (SR² = .13; p < .001) as well as physical abuse and symptoms of depression (SR² = .13; p < .001) were both significant (Woulfe & Goodman, 2020). Furthermore, Stults et al. (2015) found that lifetime IPV victimization was significantly correlated with depression symptoms (r = .23, p < .001) in a sample of Men Who Have Sex with Men. Reuter et al. (2017) found that, at a 4-year follow-up, physical IPV victimization predicted higher levels of depression (t = 2.42, p = .20) one year later. Bukowski et al. (2019) found a 36% increased likelihood (IRR = 1.36, 95% CI = 1.23,1.50) of reporting higher depressive symptoms among those who reported past-year experiences of IPV among Black Transgender Women. Additionally, Henry et al. (2021) found that IPV-related psychological abuse (r = .245, p = .05), sexual abuse (r = .227, p = .05), and assault with injury (r = .270, p = .05) were significantly associated with depression among a sample of transgender and gender nonconforming adults. Wirtz et al. (2022) found that, when controlling for other potential cofounders, recent IPV victimization was associated with increased depressive symptomatology (Ref: no IPV; adjPrR: 2.36; 95%CI: 1.61‚3.47) among Black Gay and Bisexual men. Miltz et al. (2019) found that depressive symptomatology was approximately three times higher in men who reported IPV victimization (lifetime or prior year), (OR = 2.57 95%CI = 1.71,3.86) and (OR = 2.93 95%CI = 1.71,3.86), respectively, among a sample of gay, bisexual, and other Men Who Have Sex With Men. Finally, Davis et al. (2022) found that any form of lifetime IPV (OR = 2.42, 95% CI = 1.40,4.18), recent physical or sexual IPV (OR = 3.25, 95% CI = 1.34,7.87), recent emotional IPV (OR = 5.14, 95% = 2.35,11.27), and experiencing multiple forms of recent IPV (OR = 3.83, 95% CI = 1.54,9.47) were all significantly associated (p < .001) with depression in a sample of Men Who Have Sex With Men. In addition, the authors also found that MSM living with HIV who experienced any form of lifetime IPV had significantly higher odds of experiencing depression (OR = 2.02, 95% CI = 1.02,3.99) compared to those who had not (Davis et al., 2022).

Anxiety

IPV victimization was significantly associated with anxiety in four studies. First, Taber et al. (2023) found that experiencing any form of identity-specific IPV was associated with a significantly higher score on the General Anxiety Disorder Scale (GAD-7)(Spitzer et al., 2006) (p < .001) and that the total and direct relationships between transgender-related IPV and anxiety and between identity abuse and anxiety were all significant based on the 95% CI. In addition, Reuter et al. (2017) found that verbal IPV victimization at a 4-year study follow-up was associated with higher levels of anxiety one year later (t = 2.04, p = .044). Additionally, Henry et al. (2021) found that IPV-related psychological abuse (r = .396, p < .001), sexual abuse (r = .45, p < .001), physical abuse (r = .45, p < .001), and assault with injury (r = .46, p < .001) were significantly associated with anxiety symptoms. Davis et al. (2022) found that any form of lifetime IPV (OR = 2.10, 95% CI = 1.29, 3.40), recent physical or sexual IPV (OR = 3.16, 95% CI = 1.35,7.42), recent emotional IPV (OR = 5.08, 95% CI = 2.31,11.20), and experiencing any form of lifetime IPV (OR = 3.18, 95% CI = 1.30,7.70) were all significantly (p < .001) associated with anxiety.

Suicidal Ideation and Attempts

IPV victimization was significantly associated with suicidal ideation in two studies. First, Xu et al. (2022) found that participants who reported experiencing physical and verbal IPV in their lifetime had about three times the odds of reporting suicidal ideation (ORm1 = 2.58, 95% CI = 1.163‚5.724; ORm2 = 2.72, 95%CI = 1.334‚5.547). In addition, Becerra et al. (2021) found that suicidal thoughts (88.3% vs. 76.5%) and suicidal attempts (53.2% vs. 33.3%) were higher among participants who reported romantic/sexual partner abuse/violence.

Psychological Distress

IPV victimization was significantly associated with psychological distress in three studies. Becerra et al. (2021) found that serious psychological distress (45.3% vs. 25.5%) was higher among participants who reported romantic/sexual partner abuse/violence. In addition, Peitzmeier et al. (2021) found that lifetime transgender-specific IPV was significantly associated with a 32% increased risk of serious psychological distress (APR = 1.32, 95% CI = 1.13,1.53). Finally, Whitton et al. (2019) found that, among a sample of sexual minority youth, sexual IPV predicted higher levels of psychological distress (r = .32, p < .001).

Loneliness

IPV victimization was significantly associated with loneliness in one study. Stults et al. (2015) found that ever having experienced IPV victimization was significantly correlated with feelings of loneliness (r = .16, p < .001).

Maladaptive Coping Styles

IPV victimization was significantly associated with maladaptive coping (i.e., self-distraction, denial, venting, substance use, behavioral disengagement, and self-blame) in one study on sexual minority men. Goldberg-Looney et al. (2016) found that psychological abuse was associated with denial (r = .24, p = .05) and behavioral disengagement (r = .28, p < .001); sexual abuse with self-distraction (r = − .14, p < .001), denial (r = .25, p = .05), and behavioral disengagement (r = .48, p < .001); physical abuse with denial (r = .21, p = .05) and with behavioral disengagement (r = .40, p < .001); and that IPV victimization with injury was significantly associated with denial (r = .28, p < .001) and behavioral disengagement (r = .46, p < .001).

Physical Health Outcomes

Substance Use

IPV victimization was significantly associated with substance use in eight studies. First, Edwards et al. (2021) found that S-IPV victimization was significantly related to hazardous drinking (r = .23, p < .05) in a sample of LGBTQ + college students. In addition, Whitton et al. (2019) found that both physical and sexual IPV were associated with increased marijuana use at the subsequent study wave (ERR = 1.21,1.3) and that both physical and sexual IPV were associated with increased odds of drug use at the next wave of the study (ORs = 1.27, 1.21) in a longitudinal study on sexual minority men. Reisner et al. (2013) found that IPV was highly associated with substance misuse history for both males- and females- assigned at birth. However, for males assigned at birth, one-third of the sexual orientation (i.e., identifying as gay/lesbian) substance misuse disparity was explained by IPV (PEE = 38.91, p = .009). In addition, Xavier Hall et al. (2022) found that IPV victimization was significantly associated with alcohol problems (IRR = 1.62, 95% CI = 1.31,2.00), cannabis problems (IRR = 1.55, 95% CI = 1.18, 1.93), cocaine use (OR = 2.87, 95%CI = 1.55, 4.99), and methamphetamine use (OR = 5.21, 95% CI = 1.86,14.62) relative to those who experienced “low lifetime victimization” and after adjusting for demographic characteristics. In addition, Passaro et al. (2020) found that Men Who Have Sex With Men (MSM) or Transgender Women (TW) who reported psychological IPV victimization were more likely to meet the criteria for an Alcohol Use Disorder than participants who did not report IPV victimization (78.6% vs. 55.2% MSM, 100% vs. 62.8% TW; p < .05). Wirtz et al. (2022) found that recent IPV was associated with hazardous alcohol use (Ref: no IPV; adjPrR: 1.93; 95%CI: 1.42,2.61). Furthermore, Peitzmeier et al. (2021) found that lifetime transgender-specific IPV was significantly associated with a 21% increased risk of Alcohol Use Disorder (APR = 1.18, 95% CI = 0.98, 1.42) and a 30% increased risk of Drug Use Disorder (APR = 1.20, 95% CI = 0.97, 1.48). In addition to finding a significant association between IPV victimization and depression as reported above, Wirtz et al. (2022) also found a significant interaction between IPV and alcohol use in the relationship with depressive symptomatology. The joint effect of this interaction was a two-fold increase in the prevalence of depression symptomatology with each unit increase in alcohol use when IPV was present (joint effect: adj. PrR: 2.10, 95%CI:1.51‚2.91). There was also a significant interaction between IPV and depression symptoms in the relationship with hazardous alcohol use. The joint effect of this interaction was a 1.6-fold increase in the prevalence of hazardous alcohol use with each unit increase in depression symptoms when IPV was present (joint effect: adj. PrR: 1.56, 95%CI: 1.23‚1.96). Finally, Scheer & Mereish (2021) found that physical abuse was associated with illicit substance use among Sexual and Gender Minority Youth (SGMY) (r = .17, p < .05).

Risky Sexual Behaviors

IPV victimization was significantly associated with risky sexual behaviors in six studies. First, Reuter et al. (2017) found that verbal IPV was associated with higher rates of condomless sex acts (t = 2.29, p = .029) in a sample of LGBT adults. In addition, Braksmajer et al. (2020) found that MSM experiencing emotional IPV (b = -0.74, 95% CI = 1.28, -0.20), monitoring (b = -0.07, 95% CI = 1.24, -0.14), or forced sex (b = -1.05, 95% CI = 1.93, -0.17) were less likely to take PrEP than were MSM who did not report these forms of IPV. Zhu et al. (2021) found that sexual (ORa = 2.11, 95% CI: 1.16, 3.85), control (ORa = 1.94, 95% CI: 1.00, 3.76), and emotional IPV victimization (ORa = 1.71, 95% CI: 1.02, 2.87) were positively associated with inconsistent condom use with regular partners, that controlling IPV victimization (ORa = 2.39, 95% CI:1.011, 5.66) was positively associated with inconsistent condom uses with casual partners and that any IPV victimization (ORa = 1.54, 95% CI:1.02, 2.32), and sexual IPV victimization (ORa = 2.25, 95% CI:1.30, 3.88) were positively associated with having multiple regular sexual partners. Finally, the study also found that any IPV (ORa = 1.93, 95% CI:1.33, 2.80), sexual IPV (ORa = 1.73, 95% CI:1.01, 2.96), and controlling IPV victimization (ORa = 3.21, 95% CI:1.75, 5.89), were positively associated with multiple casual sexual partners (Zhu et al., 2021). Furthermore, Beymer et al. (2017) found that IPV victimization among a sample of African-American Men Who Have Sex With Men was a consistently significant predictor of HIV infection. Approximately 20% of the individuals who reported a lifetime history of IPV tested HIV-positive compared to only 8% of individuals who did not report a history of IPV. Additionally, individuals who reported a history of IPV had 2.39 increased odds of testing HIV-positive when compared to individuals who did not report a history of IPV. Finally, individuals with a history of IPV had a factor of 3.33 greater hazard of testing HIV-positive at follow-up when compared to individuals without a history of IPV. Passaro et al. (2020) found that Men Who Have Sex with Men or Transgender Women who experienced IPV were more likely to endorse condomless receptive and anal intercourse with one or more of their last three sexual partners (94.1%) than participants reporting no IPV (68.8%, p = .03). Finally, Wirtz et al. (2022) found that recent IPV victimization was associated with a 1.4-fold increase in self-reported past 12-month STI clinical diagnosis (ref: no IPV; adjPrR: 1.44; 95%CI: 1.08‚1.92), that it was inversely associated with current PrEP use among participants with a past negative HIV test result (ref: no IPV; adjPrR: 0.65, 95%CI: 0.38‚1.10). In addition, physical IPV was independently associated with reduced PrEP use (ref: no physical IPV; adjPrR: 0.35, 95%CI: 0.13‚0.90) and lifetime IPV victimization was associated with lifetime ART medication interruptions among participants living with HIV (ref: no IPV; adjPrR: 1.59; 95%CI: 1.25‚2.01) in a sample of Black Gay and Bisexual Men.

This systematic review identified 23 studies examining the outcomes of IPV among SGM individuals, covering a broad spectrum of sexual and gender identities and evaluating diverse forms of IPV. The results revealed significant associations between IPV victimization and adverse mental health outcomes, including PTSD, depression, anxiety, suicidal ideation and suicide attempts, psychological distress, loneliness, and maladaptive coping styles. Additionally, IPV victimization was linked to negative physical health outcomes, such as substance use, risky sexual behaviors, and sexually transmitted infections. These findings underscore the multifaceted impact of IPV on the overall well-being of SGM individuals.

IPV and Mental Health

The significant association between IPV victimization and mental health outcomes among SGM individuals warrants careful consideration. Notably, the increased prevalence of PTSD among IPV survivors within this population underscores the unique stressors SGM individuals face, including societal discrimination and stigmatization (Meyer, 2003). These additional stressors may exacerbate the trauma experienced during IPV (Beiser & Hou, 2016; Kennedy & Prock, 2018; Kirkinis et al., 2021).

The consistent links between IPV victimization and depression and anxiety as well as loneliness and psychological distress in SGM communities reinforce the urgency of tailored interventions. SGM individuals experiencing IPV may encounter distinct challenges related to disclosure and seeking help, given concerns about discrimination and lack of culturally-sensitive services. For example, a significant number of IPV survivors within the SGM community refrain from seeking assistance due to concerns that service providers may downplay their experiences of abuse (Carvalho et al., 2011). Even when SGM individuals do reach out for support, they frequently encounter services that do not affirm their identities (Maccio & Doueck, 2002; Pattavina et al., 2007). Further highlighting the critical importance of early intervention and robust mental health resources and perhaps most concerning is the association between IPV victimization and suicidal ideation and attempts within SGM populations. Support structures should be attuned to the unique needs of SGM individuals, fostering an environment where disclosure of IPV and suicidal thoughts is met with understanding and immediate assistance.

The identified significance of maladaptive coping strategies in response to IPV victimization among SGM individuals underscores the pressing need for further investigation into the long-term mental health outcomes within this specific demographic. While there is a conspicuous gap in the literature regarding these long-term effects, it is well-established that maladaptive coping strategies inherently pose a substantial risk factor for the development of psychopathological conditions and adverse health outcomes (Aldao et al., 2010; Sakulsriprasert et al., 2023). Consequently, it becomes paramount for future research endeavors to explore these coping mechanisms and their potential implications in perpetuating cycles of violence and psychological distress among SGM individuals. The development of interventions geared toward cultivating adaptive coping strategies and promoting resilience is central to breaking these pernicious cycles and ultimately fostering enduring mental well-being within SGM communities.

In conclusion, the associations between IPV victimization and adverse mental health outcomes among SGM individuals emphasize the pressing need for culturally-sensitive and inclusive interventions, as emphasized by previous research as well (Murray et al., 2007; Rollè et al., 2018). Recognizing the specific challenges faced by SGM survivors of IPV and tailoring support accordingly is crucial in mitigating the detrimental impact on mental health. Furthermore, addressing the intersection of IPV and mental health within SGM communities is essential to promote well-being, resilience, and recovery among marginalized populations.

IPV and Physical Health

This systematic review underscores that IPV victimization's impact extends beyond mental health to encompass physical health concerns within SGM communities. Substance use, particularly in response to IPV exposure, has been well-documented (Afifi et al., 2012; Cafferky et al., 2018). It is important to note that the relationship between IPV victimization and perpetration and substance use is exacerbated among SGM individuals due to the unique stressors they face (Meyer, 2003). Some SGM individuals may turn to substances as a coping mechanism to manage the trauma and distress associated with IPV victimization (Augsburger & Elbert, 2017; Ben-Zur & Zeidner, 2009). Recognizing this, interventions should not only address these harmful coping mechanisms but also equip individuals with healthier ones. Psychotherapy and psychoeducation programs tailored to address the unique experiences of those with minoritized identities could be invaluable in helping SGM survivors of IPV navigate their emotional responses and develop adaptive coping strategies. Such an approach can address the immediate health risks associated with substance use and promote long-term well-being and resilience within this vulnerable population.

In addition to substance use, the current study found risky sexual behaviors to be related to IPV victimization. These behaviors, including condomless sex, significantly increases the risk for HIV and STIs and are important to consider (Goesling et al., 2014). Interestingly, this study also found a significant association between PrEP use and IPV, particularly related to specific types of IPV, such as coercive control and emotional IPV. As shown in our study, STIs represent a critical aspect of the IPV-physical health nexus. IPV can increase the risk of STIs due to forced or non-consensual sexual activity, lack of control over sexual health decisions, or limited access to preventive measures. Recognizing this association emphasizes the importance of comprehensive sexual health support for SGM individuals experiencing IPV.

Healthcare providers should be equipped to address both the immediate health consequences and the broader implications of IPV on sexual health, ensuring that individuals receive appropriate care and resources. Furthermore, healthcare providers and clinics testing for HIV or STIs should start screening for IPV victimization, as many studies have found a significant relationship between both. This integrated approach can better support SGM individuals experiencing IPV, ensuring they receive not only appropriate sexual health care but also the necessary resources and interventions to address the broader implications of IPV on their well-being.

Strengths and Limitations

The strengths of this systematic review lie in its comprehensive and rigorous approach to synthesizing existing research on IPV among SGM populations. The inclusion of a wide range of peer-reviewed studies from various disciplines and the systematic screening and data extraction processes enhance the review's credibility and reliability. Additionally, the review's focus on both mental and physical health outcomes provides a holistic understanding of the impact of IPV on SGM individuals. By highlighting associations between IPV victimization and adverse health outcomes, this study offers valuable insights that can inform future research and interventions aimed at addressing the unique needs of SGM individuals experiencing IPV. Lastly, the discussion of limitations and future research directions underscores the study's commitment to advancing knowledge and advocacy in this critical area of study.

Despite the many strengths of this systematic review, some limitations are also worth considering. One notable limitation of the systematic review is the substantial heterogeneity among the included studies in terms of sample characteristics, geographical location, and measurement tools. This diversity makes it challenging to draw universally applicable conclusions, and caution should be exercised when generalizing the findings to all SGM populations. Further, the majority of studies in the review employed cross-sectional designs, which limit the ability to establish causal relationships between IPV victimization and the observed outcomes. Longitudinal research is needed to better understand the temporal dynamics and long-term effects of IPV on the mental and physical health of SGM individuals. A notable gap in the literature is the limited representation of transgender, non-binary, and other gender-nonconforming individuals. Future research should prioritize including these populations to gain a more comprehensive understanding of IPV experiences and outcomes within the broader SGM spectrum. Lastly, the included studies predominantly focused on Western contexts, potentially overlooking the unique experiences and cultural factors influencing IPV among SGM individuals in non-Western regions.

Implications and Future Research Directions

The findings of this systematic review have significant implications for both research and practice. They unveil the impactful relationship between IPV and the mental and physical health of SGM individuals. Our findings emphasize the pressing need for integrated interventions that address both the mental and physical dimensions of health. It is clear that the trauma resulting from IPV can manifest in various ways, from PTSD and depression to substance use and risky sexual behaviors. To effectively support SGM survivors of IPV, it is imperative to recognize the interconnectedness of these outcomes and tailor interventions accordingly. Healthcare providers, social workers, and policymakers should be aware of the elevated risk of IPV-related physical and mental health consequences among SGM individuals, and services should be adapted to be inclusive and sensitive to their unique needs. Secondly, this review highlights the importance of comprehensive IPV screening protocols in healthcare settings to identify and support victims early on. Thirdly, our findings underscore the importance of adopting an intersectional lens, considering the diverse identities and stressors within the SGM community. Moving forward, targeted, evidence-based interventions and ongoing research are vital to ensuring the well-being and safety of SGM individuals, addressing the unique challenges they face, and promoting resilience within this vulnerable population.

Moving forward, further research is warranted to delve deeper into the nuances of IPV within SGM communities. Longitudinal studies should be conducted to explore the causal relationships between IPV and health outcomes, shedding light on the mechanisms and pathways through which IPV exerts its negative effects. Additionally, qualitative research can help in capturing the lived experiences of SGM individuals, providing a richer understanding of the unique challenges they face and the resilience strategies they employ. Furthermore, interventions targeting IPV prevention and support among SGM populations should be rigorously evaluated for their effectiveness, considering both individual and structural factors.

Moreover, it is essential to take an intersectionality approach that considers not only sexual orientation and gender identity but also acknowledges the role that race and ethnicity play in exacerbating differences in IPV risk and adverse outcomes. Future research should thoroughly examine how these intersecting factors interact and influence IPV experiences within SGM that also identify as racial/ethnic minorities ensuring that interventions are sensitive to these nuances. Finally, as the landscape of gender and sexual identities continues to evolve, research must remain inclusive and adaptive to capture the experiences of emerging SGM groups, ensuring that the most vulnerable are not left invisible or underserved.

In summary, this systematic review highlights the alarming prevalence of IPV within SGM communities and its significant association with adverse physical and mental health outcomes. These findings not only demand immediate attention but also resonate as an urgent call to action. Healthcare providers, social workers, and policymakers must recognize the heightened risk of IPV-related health consequences among SGM individuals and adapt their services to be inclusive and sensitive. Comprehensive IPV screening protocols in healthcare settings are crucial for early identification and support. Furthermore, the review emphasizes the importance of considering intersectionality within SGM populations and the need for future research to explore causal relationships, capture lived experiences, evaluate interventions, and remain inclusive and adaptive in addressing emerging SGM identities. Overall, addressing IPV within SGM communities is a critical imperative to ensure the well-being and safety of these individuals.

We have no known conflict of interest to disclose.

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Table 1

Summary of Systematic Review Findings
Citation	Sample Size	Sexual orientation	Gender Identity	IPV Measures	Mental Health measures	Physical Health measures	Mental health outcomes	Physical health outcomes
Taber et al. (2023)	200	Gay, lesbian, bisexual, pansexual, queer, asexual, straight, other non-heterosexual orientation	Transgender men, transgender women, nonbinary, genderqueer, gender fluid, gender nonconforming, agender, two-spirit	Transgender-related Intimate Partner Violence scale and the Identity Abuse scale	Posttraumatic Stress Disorder Checklist (PCL-6), General Anxiety Disorder Scale (GAD-7), PHQ-9	N/A	Identity-specific IPV was associated with a higher score on depression, anxiety, and PTSD measures (p’s < .001); the total and direct relationships of transgender-related IPV and Identity Abuse with depression, anxiety, and PTSD were all significant based on 95% CI.	N/A
Edwards et al. (2021)	1,221	Bisexual, pansexual, gay, queer, questioning, demisexual, other non-heterosexual orientation	Women, men, genderqueer, gender non-conforming, nonbinary, transgender identity	Sexual and Gender Minority Conflict Tactics Scale 2 (SGM-CTS-2)	N/A	The 5-item Alcohol Use Disorders Inventory	N/A	S-IPV victimization was significantly associated with hazardous drinking (p < .05).
Woulfe & Goodman (2020)	734	Bisexual, gay, lesbian, queer, pansexual	Men, women, transgender, nonbinary	The Identity Abuse Scale, The Conflict Tactics Scale (CTS-2), The Psychological Maltreatment of Women Inventory	The PTSD Checklist Civilian Version (PCL-C), The Center for Epidemiological Studies Depression Scale Revised (CESD-R)	N/A	Identity abuse exposure accounted for an additional 1% of the variance in depression and PTSD scores (p = .05 and p < .001, respectively).	N/A
Stults et al. (2015)	528	Homosexual and heterosexual	N/A	“Yes/no” questions	The Trauma Awareness and Treatment Center (TACT) Post-traumatic Stress Questionnaire, The Beck Anxiety Inventory (BDI)	N/A	IPV victimization was significantly correlated with Loneliness, depression symptoms and PTSD (p < .001).	N/A
Reuter et al. (2017)	172	Lesbian, gay bisexual, questioning, other non-heterosexual orientation	Male, female, male-to-female transgender, female-to-male transgender	HIV-Risk Assessment of Sexual Partnerships (H-RASP)	The Brief Symptom Inventory (BSI-18)	The HIV-Assessment of Sexual Partnerships (H-RASP), “yes/no” questions about substance use	Verbal IPV was associated with high levels of anxiety symptoms one year later (p = .44), at 4-year follow-up, physical IPV predicted higher levels of depression one year later (p = .02).	Verbal IPV was associated with a higher number of condomless sex acts (p = .02).
Whitton et al. (2019)	248	Gay, lesbian, bisexual, questioning, other non-heterosexual orientation	Cisgender, male-to-female transgender, female-to-male transgender	HIV-Risk Assessment fir Sexual Partners (H-RASP)	The Brief Symptom Inventory (BSI-18)	The HIV-Assessment of Sexual Partnerships (H-RASP), “Yes/no” questions about substance use	Sexual IPV predicted higher levels of psychological distress (p < .001).	Physical and sexual IPV were associated with increased marijuana use at the subsequent study wave and with increased odds of drug use at the next study wave.
McDowell et al. (2019)	150	N/A	Masculine spectrum identity (female-to-male and/or trans-masculine), non-binary, binary	“Yes/no” Questions	PC-PTSD, The Brief Symptom Inventory (BSI-18)	N/A	Lifetime IPV (referent = no IPV; aOR = 3.08; 95% CI = 1.26–7.53; p = 0.01) was significantly associated with increased odds of PTSD.	N/A
Bukowski et al. (2019)	493	Transgender women who have sex with men	Female, transgender, or having transitioned from male to female gender	“Yes/no questions”	The Center for Epidemiologic Studies Depression (CES-D 10)	N/A	Among the study sample, there was a 36% increased likelihood of reporting higher depressive symptoms among those who reported past-year experiences of IPV.	N/A
Xu et al. (2023)	247	Homosexual, heterosexual, bisexual	Transgender women	Transgender Youth Project Questionnaire	“Yes/no” question to assess lifetime suicidal ideation	N/A	Participants who reported experiencing physical and verbal IPV had about three times the odds of reporting suicidal ideation (ORm1 = 2.58, 95% CI = 1.163–5.724; ORm2 = 2.72, 95%CI = 1.334–5.547).	N/A
Reisner et al. (2013)	2,653	Bisexual, gay, lesbian, other non-heterosexual orientation, heterosexual	Nontransgender identity	“Yes/no” questions	N/A	“Yes/no” questions about lifetime substance use	N/A	IPV was highly associated with substance misuse history for both males and females. Evidence of mediation was supported for males, with approximately one-third of the sexual-orientation (being gay/lesbian) substance misuse disparity explained by IPV
Henry et al. (2021)	78	Gay, lesbian, bisexual, queer, other non-heterosexual orientation, heterosexual	Transgender men, transgender women, gender non-conforming, another non-cisgender identity	Revised Conflict Tactics Scale Short-Form	The Hopkins Symptoms Checklist-25	N/A	Psychological abuse, sexual abuse, physical abuse, and assault with injury were significantly associated with anxiety and depression (p < .001).	N/A
Becerra et al. (2021)	27,715	N/A	Transgender individuals	“Yes/no questions”	“Yes/no” questions about suicidal ideation and attempts	N/A	Suicidal thoughts (88.3% vs. 76.5%), suicidal attempts (53.2% vs. 33.3%), and serious psychological distress (45.3% vs. 25.5%) were higher among participants who reported romantic/sexual partner abuse/violence.	N/A
Braksmajer et al. (2020)	663	Men Who Have Sex With Men	N/A	IPV-GBM Scale	N/A	“Yes/no” questions about PrEP use	N/A	MSM experiencing emotional IPV, monitoring, or forced sex were less likely to take PrEP than were MSM who did not report these forms of IPV.
Zhu et al. (2021)	578	Men Who Have Sex With Men	N/A	IPV-GBM Scale	N/A	“Yes/no” questions about risky sexual behaviors	N/A	Sexual, controlling, and emotional IPV victimization were positively associated with inconsistent condom use with regular partners, controlling IPV victimization was positively associated with inconsistent condom use with casual partners, any IPV victimization was positively associated with multiple regular and casual partners.
Xavier Hall et al. (2022)	1,202	Gay, bisexual, other sexual orientations	Cisgender male and gender minorities	“Yes/no” questions	N/A	The Alcohol Use Disorder Identification Test (AUDIT), “yes/no” questions about substance use	N/A	IPV was significantly associated with substance use problems compared to groups who experienced “low victimization”.
Beymer et al. (2017)	1,974	Gay, bisexual, Men Who Have Sex With Men, men who have sex with transgender persons	N/A	“Yes/no” questions	N/A	82-item risk assessment questionnaire	N/A	Individuals who reported a history of IPV had 2.39 increased odds of testing HIV-positive and a factor of 3.33 greater hazard of testing HIV-positive at follow-up when compared to individuals who did not report a history of IPV.
Goldberg-Looney et al. (2016)	89	Gay, bisexual. Queer, other non-heterosexual orientation	Men	Revised Conflict Tactics Scale, Short-Form	The Brief COPE Scale	N/A	Sexual IPV, assault with injury, and physical PV were significant associated with maladaptive coping styles.	N/A
Passaro et al. (2020)	576	Bisexual, homosexual, heterosexual	Transgender	“Yes/no” questions	N/A	The Alcohol Use Disorder Identification Test (AUDIT-10), “yes/no” questions about substance use, “yes/no” questions about risky sexual behaviors	N/A	Psychological IPV were more likely to meet criteria for an Alcohol Use Disorder than participants who denied IPV. Those who experienced psychological IPV were more likely to endorse condomless receptive and anal intercourse with one or more of their last three sexual partners than participants reporting no IPV.
Wirtz et al. (2022)	629	Gay, same-gender loving, bisexual, other non-heterosexual orientation	N/A	“Yes/no questions”	The Patient Health Questionnaire-2 scale	3-item AUDIT-C Scale, and “yes/no” questions about risky sexual behaviors	Recent IPV was associated with increased prevalence of recent depression symptomatology (Ref: no IPV; adjPrR: 2.36; 95%CI: 1.61–3.47).	Recent IPV was associated with hazardous alcohol use, with a 1.4-fold increase in self-reported past 12-month STI clinical diagnosis, and inversely associated with current PrEP use among participants with a past negative HIV test result. Physical violence was independently associated with reduced PrEP use, and lifetime IPV victimization was associated with lifetime ART medication interruptions among participants living with HIV.
Peitzmeier et al. (2021)	661	N/A	Female or Woman, Transwoman, nonbinary, another gender identity	T-IPV, WHO multi-country study questionnaire, “Yes/no” questions,	PC-PTSD, and the Kessler-6	AUDIT-C, DAST-10, “yes/no” questions about risky sexual behaviors	Lifetime T-IPV was significantly associated with 32% increased risk of serious psychological distress and 50% increased risk of PTSD.	Lifetime T-IPV was significantly associated with a 21% increased risk of Alcohol Use Disorder and a 30% increased risk of Drug Use Disorder
Miltz et al. (2019)	436	Gay, bisexual, Men Who Have Sex With Men	N/A	“Yes/no” questions	PHQ-9	“Yes/no” questions about substance use and risky sexual behaviors.	Depressive symptom prevalence was approximately three times higher in men who reported IPV victimization (lifetime or last year) (p < .001).	Lifetime and past year measures of IPV victimization was strongly associated with sexualized drug use.
Davis et al. (2022)	374	Gay, bisexual, and other Men Who Have Sex With Men	N/A	“Yes/no” questions”	2-item Generalized Anxiety Disorder Assessment (GAD-2), and the 2-item Patient Health Questionnaire (PHQ-2)	The 11-item DSM-5 Alcohol Use Disorder (AUD) assessment	Any form of lifetime IPV, recent physical or sexual IPV, recent emotional IPV, and experiencing multiple forms of recent IPV were all significant associated with higher odds of experiencing anxiety and depression.	N/A
Scheer & Mereish (2021)	149	Lesbian, gay, bisexual, queer, other non-heterosexual orientation	Cisgender women, cisgender men, transgender women, transgender men, gender nonbinary	The Identity Abuse Scale, Conflict Tactics Scale, Short form, Psychological Maltreatment of Women Inventory	N/A	“Yes/no” questions about substance use	N/A	Physical abuse was associated with illicit substance use among SGMY (p < .05).

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The Impact of Intimate Partner Violence on the Mental and Physical Health of Sexual and Gender Minorities: A Comprehensive Review of Quantitative Research

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Abstract

Purpose

Methods

Results

Conclusions

Figures

Introduction

Violence Exposure Among Sexual and Gender Minorities

Materials and Methods

Data Source and Search Strategy

Inclusion and Exclusion Criteria

Data Extraction Process

Results

Sociodemographic Characteristics

Sexual Identity

Gender Identity

IPV type & assessment

IPV-Related Outcomes

Mental Health Outcomes

Posttraumatic Stress Disorder (PTSD)

Depression

Anxiety

Suicidal Ideation and Attempts

Psychological Distress

Loneliness

Maladaptive Coping Styles

Physical Health Outcomes

Substance Use

Risky Sexual Behaviors

Discussion

IPV and Mental Health

IPV and Physical Health

Strengths and Limitations

Implications and Future Research Directions

Conclusion

Declaration

References

Table

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