Domestic violence is a serious public health issue that affects not only the individual but also the community. In the past, this issue was regarded as a normal occurrence, but as research and observations have shown, it is an abnormal pattern of behavior. A categorization has been developed to deal with it properly, such as physical, psychological, sexual, and many more. Currently, this act has been criminalized in many places. However, some cultures and societies still condone domestic violence. There is a lack of research on this topic in some regions, including the Middle East, so a study was conducted to better understand how to deal with this issue effectively.
This study aims to specify the types of abuse women who attend the P.H.C. suffer from and its effect on their physical and mental well-being. In some communities, women tend not to report domestic abuse due to fear, embarrassment, and cultural taboos (5). Therefore, to better help those who disclosed their abuse and those who did not, a need to understand the common types of abuse and how they affect the patients in the short and long term is warranted.
The participants who were comfortable disclosing their abuse mainly consisted of married women, especially those with less than five years of married life. There are many types of abuse, each with distinctive signs and complaints, including physical, sexual, psychological, and emotional [13]. Psychological abuse is mostly overlooked, even though it might be the most dangerous due to its long-term effects and the fact that almost all other types usually accompany it. It is usually done by showing extreme affection and care to lure the victim into the relationship to cover the abusive behavior later and normalize such behavior to the victim as a form of affection [14]. The survey results indicated a significant association between women who suffered from psychological abuse and poor health, reaching 44% of those who reported it. They were also 4.3% and 3.2% more likely to develop depression and insomnia, respectively, than nonabused women. Various European studies have demonstrated that psychological abuse victims are more likely to experience posttraumatic stress disorder (PTSD), anxiety, depression, eating disorders, sleep disorders, insomnia, and psychosomatic disorders [15–18]. Additionally, as stated by Boyle A., women who are victims of domestic abuse are more likely to resort to self-harm in accordance with episodes of violence, regardless of socioeconomic status [19]. Physical abuse encompasses many forms of direct or indirect violence, including hitting, kicking, burning, grabbing, pinching, shoving, slapping, hair-pulling, biting, denying, or forcing medical care alcohol and/or drug use [20]. Unlike psychological abuse, physical abuse tends to leave marks and evidence; however, such abuse is primarily underreported due to fear of further violence or revenge from the perpetrator, followed by embarrassment and shame [21]. A contributing factor to the rate of physical violence incidence is the condoning and encouragement of this behavior in some communities as a form of male control, which is perceived as normal [22]. Approximately 19.3% of the patients who answered the survey had poorer health than nonabused patients and were more likely to agree to psychological assistance. An observational study has shown similar results of privately insured physically abused women; they demonstrated a threefold-fold higher comorbidity score, a ninefold increase in substance use, and a 2.7-fold increased rate of mental health diagnoses compared to their peers [23]. To help sexual abuse victims, the challenge of convincing the victim to recognize that behavior must be addressed. Even though the law criminalizes forcing sexual activity without consent, some women still believe that their spouses are entitled to act that way because of the marriage bond [24]. A total of 17.6% of patients who reported sexual abuse complained of poor health and were 1.82 times more likely to require psychological help. Many sexual abuse victims do not speak up due to shame and embarrassment, as disclosing marital issues is taboo in some cultures [25]. Perpetrators of sexual abuse utilize shame and humiliation to dispirit their partners while maintaining control over them [26]. As stated by the WHO, the consequences of this type of abuse are both short- and long-term, such as gynecological trauma, unintended pregnancy, depression, anxiety, drug abuse, suicide, and infanticide [27].
Moreover, it was observed that victims of DV showed a higher frequency of visiting health facilities, with approximately 70% exhibiting clinical levels of psychological distress, which is consistent with the study results [28]. Victims who had higher education levels were less likely to justify the act of violence toward them in comparison to victims with no education, and women who were officially employed were less likely to justify violence compared to their counterparts who were not employed [29]. Hence, a higher education level showed less chance of abuse, and those living in households with higher income were less likely to report poor health. Additionally, married women reported better health, while widows were more likely to report poorer health. Last, there was no association between divorcees and their health or living area.
While demonstrating the prevalence of domestic abuse in Saudi Arabia, the study also showed the consequences and impact on the victim's physical and mental well-being—moreover, the burden and expenses it will cost the health care system due to their deteriorating health. Middle Eastern culture generally and Saudi Arabia considers exposing marital relations an embarrassment and taboo. Therefore, patients would not disclose the information unless asked by a trusted health professional, which proves the need for a culture-specific screening program.
Limitations of the study
Limitations in this study concern mostly the type of questions addressed in the questionnaire and sampling bias, which can affect the generalization of the results. The sensitivity of the questions in the questionnaire is because it addresses sensitive issues concerning marital life. Fear of stigma or shame is also a limitation; even though it was addressed in the consent form, some participants may still be hesitant to answer. Additionally, some questions were not answered thoroughly, which affected the analysis results. To overcome such limitations in the future, this research can be conducted on a different population to help generalize the results. Additionally, using an online questionnaire may provide more privacy to support having more responders and complete answers.