J Fam Viol (2016) 31:721–734
DOI 10.1007/s10896-016-9827-x
ORIGINAL ARTICLE
Depression Among Mexican Women: The Impact of Nonviolent
Coercive Control, Intimate Partner Violence
and Employment Status
Elizabeth C. Terrazas-Carrillo 1 & Paula T. McWhirter 2 & Kayla M. Martel 2
Published online: 26 May 2016
# Springer Science+Business Media New York 2016
Abstract There is significant empirical evidence
documenting the link between intimate partner violence
(IPV) and incidence of depression symptoms. This study explores the impact of intimate partner violence, nonviolent
spousal coercive control, and women’s employment status
on the incidence of depression symptoms in a sample of
Mexican women. Results from regression models suggest different types of abusive relationships have differential impacts
on incidence of depression. Specifically, a woman’s employment status contributed to the risk of depression in the context
of prevalent nonviolent spousal controlling behaviors. On the
other hand, employment status did not contribute to the risk of
developing depression symptoms when women were in relationships where physical violence was not coupled with controlling behaviors. Results of the study are discussed in the
context of the Mexican culture, as well as implications for the
treatment of IPV among Mexican women.
Keywords Intimate partner violence . Nonviolent coercive
control . Abusive relationships . Depression symptoms .
Mexican women
The incidence of intimate partner violence (IPV) among women in the world is estimated to range between 13 and72 %
(García-Moreno et al. 2006). The World Health Organization
(WHO) reported industrialized countries tend to have lower
rates of IPV compared to non-industrialized and newlyindustrialized countries, indicating that this social problem is
found consistently across cultural settings and countries
(García-Moreno et al. 2006). On the other hand, recent multicountry research has found that depression disorders are the
second leading cause of disease burden among women between
the ages of 15 and 44 years (Ribeiro et al. 2008). Indeed, depression and IPV are linked, as there is abundant evidence that
IPV is consistently associated with depression across the world
(Breiding et al. 2008; Beydoun et al. 2012; Chowdhary and
Patel 2008; Devries et al. 2013a; Ellsberg et al. 2008; Loxton
et al. 2006; Nduna et al. 2010; Salazar et al. 2009; Zlotnick et al.
2006). In addition, multiple studies have linked the experience
of IPV to increased risk of suicide among women in different
cultures and settings (Beydoun et al. 2012; Borges et al. 2007;
Devries et al. 2011; Maselko and Patel 2008; Mogga et al.
2006; Naved and Akhtar 2008; Pillai et al. 2008; Vizcarra
et al. 2004). However, most of the research exploring the relationship of IPV to depression is conducted in North American
and European settings. This study seeks to increase knowledge
of the protective and risk factors for depression among women
who experience abusive relationships in a nationally representative sample from Mexico.
Depression and Intimate Partner Violence
* Elizabeth C. Terrazas-Carrillo
elizabeth.terrazas@tamiu.edu
1
Department of Psychology and Communication, Texas A&M
International University, 5601 University Drive, Laredo,
TX 78045, USA
2
The University of Oklahoma, Norman, USA
Depression is a common mental disorder with greater severity
and persistence than normal mood variations or sadness
(Beckham 2000; Cuijpers et al. 2012). It is a serious, recurrent,
and debilitating mental disorder that impacts most individuals
at some point in life by means of personal experience or a
loved one. Characteristics of depression include persistent
sad or depressed mood, changes in appetite and body weight,
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sleep disturbances, difficulty thinking or concentrating, diminished interest in activities, feelings of hopelessness or worthlessness, and often thoughts of death or suicide (WHO 2008;
APA 2013). Depression is a life-long condition in which periods of wellness and illness alternate intermittently, despite
being highly treatable. It is estimated that fewer than 50 % of
individuals receive treatment globally and this percentage
varies, being lower than 30 % in some regions and even lower
than 10 % in others (WHO 2008). Significantly, depression
and associated symptoms are consistently linked to intimate
partner violence (Bonomi et al. 2009; Devries et al. 2011;
Deyessa et al. 2009; Ellsberg et al. 2008; Flanagan et al.
2015). Numerous studies across cultures have found that
IPV is consistently associated with depression and suicidal
behaviors in women in both high- and low-income areas
around the world (Borges et al. 2007; Devries et al. 2013b;
García-Moreno et al. 2006; Maselko and Patel 2008; Mogga
et al. 2006; Naved and Akhtar 2008; Pillai et al. 2008;
Vizcarra et al. 2004).
Researchers hypothesize that traumatic stress is the main
trigger for development of depression and depressive symptoms among victims of IPV (Costello et al. 2008; Devries et al.
2013a). Experiencing a traumatic event has been associated
with increased stress and subsequent development of depression and suicidality (Hyde et al. 2008; Kendler et al. 2001).
Data from a recent meta-analysis of studies conducted primarily in highly developed countries provided support for the
IPV-depression relationship, as women experiencing IPV
were more likely to develop depression compared to women
who had never experienced IPV (Beydoun et al. 2012).
Another meta-analysis found that female victims of IPV had
a mean prevalence of depression of 47.6 %, which is significantly higher than rates found in the general population
(Golding 1999). Although there is a clear relationship between
depression and IPV, the causal directional impact of these
variables is less clear. There are studies arguing IPV leads to
depression (Beydoun et al. 2012; Golding 1999; Ortiz-Gomez
et al. 2014), while other studies indicate that existing depression may predispose individuals to become involved with
partners that will be more likely to perpetrate IPV (Devries
et al. 2013b; Lehrer et al. 2006; Khalifeh and Dean 2010;
McPherson et al. 2007).
On the other hand, research on IPV in the past 20 years has
strived to explore typologies of violence, arguing that not all
violence is equal (Johnson 1995; Stark 2006). For example,
representative studies in the U.S. have found the violence reported tends to be mild in severity and it is characterized by
similar perpetration rates by males and females (Johnson and
Leone 2005). This type of violence is identified as Common
Couple Violence (CCV), and has been characterized as gender
symmetric and resulting in mild consequences to mental and
physical health of the victim (Johnson 1995). However, studies
including samples from clinical settings and domestic violence
J Fam Viol (2016) 31:721–734
shelters have consistently reported the majority of the victims
they serve are women whom exhibit significant negative consequences to their mental and physical health due to severe IPV
(Lawson 2012). Research with domestic shelter victims found
that their partners exhibited a significant pattern of coercion and
control that was not found in nationally representative studies
(Dobash et al. 1992; Stark 2006). Coercive control (CC) has
been defined as a pattern in which the abusive partner asserts
power over the victim through use of threats, intimidation, withholding resources, and violence (Dutton and Goodman 2005;
Johnson 2006; 1995; Johnson and Leone 2005; Pence and
Paymar 1986; Stark 2006; Tanha et al. 2009). Johnson (1995)
characterized this type of violence as Intimate Terrorism (IT),
and it has been characterized as gender asymmetric and
resulting in significant impairments to mental and physical
health. Indeed, Dutton and Goodman (2005) assert that “exposure to coercive acts means exposure to threats of harm, including those that would be considered traumatic stressors such as
threats of harm to self or others” (p. 752). Although the research
in this area is limited and has been conducted primarily in
highly industrialized societies like the United States, Canada,
Australia, and European countries, some studies have found
that women in coercive controlling relationships exhibited adverse mental and physical health problems including depression, anxiety, sleep problems, and persistent headaches
(Dutton et al. 1999; Dutton et al. 1997; Dutton et al. 2005a).
Through ethnographic research with women in the United
States, Dutton et al. (2005b) found that coercive controlling
relationships are characterized by specific demands by the partner, who then may threaten the victim and engage in surveillance to ensure compliance with demands. However, there is
limited empirical understanding of the concept of nonviolent
coercion and control in a relationship in newly or low development countries, as most IPV research has focused on violent
and aggressive behaviors perpetrated in the context of a coercive relationship (Dutton et al. 2005a). To date, the literature
available suggests it is possible all types of IPV and depression
may independently share common risk factors; however, ethical
concerns prevent researchers from engaging in experimental
manipulation of these independent variables. Thus, correlational research seems most appropriate in this context.
Intimate Partner Violence Across Cultures
Intimate partner violence (IPV) is the most common form of
violence experienced by women in the world, as it reported by
15 − 71 % of women during their lifetime, and can occur in the
form of physical, sexual, or emotional/psychological abuse by
an intimate partner (Heise and García-Moreno 2002; GarcíaMoreno et al. 2006). Although both men and women can
experience and perpetrate IPV, there is limited research on
the physical and psychological sequelae of IPV on men
J Fam Viol (2016) 31:721–734
(Archer 2000; Straus 2005). Most cross-cultural studies conducted to date focus on the impact of IPV on women because
violence against women occurs at a higher rate than violence
against men (Devries et al. 2013b; García-Moreno et al. 2006;
Tjaden and Thoennes 2000).
Additionally, data from several studies suggested a dose–
response effect with violence. In other words, when violence
becomes increasingly persistent and severe, the impact on the
victim’s physical and mental health increases as well (Campbell
2002; Lehrer et al. 2006). Research has documented the association of high severity of abuse with poorer mental and physical health, quality of life, and higher levels of depression,
PTSD, and substance abuse across highly developed countries
like the U.S. and Canada (Dutton et al. 2005b; Golding 1999;
Straus et al. 2009; Wathen and MacMillan 2003; Wuest et al.
2010). A study by Hegarty et al. (2013) found that women
experiencing co-occurring physical, sexual, and psychological
abuse had poorer mental health and quality of life compared to
women who only experienced one type of partner violence.
IPV has also been linked to significant increases in negative
health outcomes, including broken bones, traumatic brain injury, sexual dysfunction, chronic pain syndromes, cardiovascular
disease, obesity, and gastrointestinal disorders, sexually transmitted infections, and unplanned pregnancies (Black 2011;
Breiding et al. 2008; Crofford 2007; Wathen and MacMillan
2003). Indeed, there are multiple short- and long-term negative
health effects of IPV and in extreme cases, experiencing IPV
may result in death either by the victim’s suicide or homicide by
intimate partner (Campbell 2002; Stöckl et al. 2013). In fact, a
multi-country study sponsored by the WHO found that victims
of IPV are more likely to engage in suicidal ideation and attempts (Coker et al. 2002; Devries et al. 2011; Heise and
García-Moreno 2002; Roberts et al. 2003; Warshaw et al.
2009). Thus, the significant and adverse consequences of IPV
underscore the importance of a thorough understanding risk
and protective factors associated with IPV.
Multiple ideas exist regarding societal, cultural, and
individual-level explanations of partner violence. For example, Archer (2006) focused on the idea that cultural variables
have the most significance in understanding the societal prevalence of IPV. He analyzed different cultural factors across 16
different nations and found that violence was more prevalent
within collectivist countries (e.g., Negy et al. 2013).
Moreover, while culture plays a role in the origins of IPV
within the individual, it also impacts the style of abuse and
the way in which an individual will handle the abuse
(Yoshioka and Choi 2005). Clearly, the cultural influences
on IPV are complex, yet much of the large-scale research
concerning IPV has been conducted in highly developed
countries. Johnson and Ferraro (2000) relay the importance
of maintaining an awareness of ethnocentrism, or the tendency
to impose Western ideas in understanding relationship dynamics in other cultures. Thus, exploring risk factors and profiles
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of IPV in other countries provides information about whether
existing theories of this phenomenon hold consistent in different cultural settings (Terrazas-Carrillo and McWhirter 2015).
A greater understanding of cultural contexts will help establish effective interventions for victims of IPV and the sequelae
of traumatic stress, depression, and suicide attempts.
The Mexican Context
Mexico is a country with high human development according
to recent Human Development Reports (UNDP, 2013). It has
the second largest economy in Latin America and has maintained economic and financial stability in spite of the slowdown
of the U.S. and European economies (World Bank 2015).
However, Mexico is a country of contrasts and wide racial
and ethnic diversity, with people experiencing affluence and
poverty, long and healthy life as well as violence (UNDP
2014). In spite of advances in health, education, and income,
inequality is widespread in Mexico (UNDP 2014). Thus, experiences of Mexican men and women are shaped by demographic, geographical, and cultural factors (Zabludovsky 2001). In
spite of these differences, studies across demographic and socioeconomic strata have consistently found that the Mexican
culture often pressures women to get married and have children
(Brumley 2013; Ruiz Castro 2012; Zabludovsky 2001).
Although gender roles are constantly evolving in Mexico,
women continue to be seen as primarily mothers and wives
expected to place their family’s needs before their own.
(Zabludovsky 2001). Indeed, the family is very important in
Mexican culture (Flake and Forste 2006; Galanti 2003;
Ingoldsby 1991). Familismo, also known as concepto de la
familia, values putting the needs of the family before individual
needs (Coohey 2001). Within familismo, loyalty, solidarity, cooperation, and maintaining the wellbeing of the family are important in both the immediate and extended family (Ayón et al.
2010; Guilamo-Ramos 2009; Marin and Marin 1991).
Although the larger culture permeates society’s views of
gender roles, the experiences of IPV among Mexican women
may vary as a result of differences in demographic,
geographical, and socioeconomic status. For example, Agoff
et al. (2005) observed that Mexican women they interviewed
in the impoverished and mostly rural state of Chiapas felt that
partner violence was justified if inflicted because they had
deviated from social norms regarding their relationships, their
manner of dressing, and availability to engage in sexual intercourse. On the other hand, a study of women from the urban
city of Durango found that leaving home without asking permission, jealousy, defending their children, and bad housekeeping were reasons that licensed their husbands to engage
in partner violence (Alvarado-Zaldívar et al. 1998). These
studies suggest that men and women’s gender roles are not
perceived as equal, and neither is their decision-making power
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in their relationships. Indeed, Coleman and Straus (1990) have
found that violence is most prevalent in relationships where
decision-making is non-egalitarian (e.g. the female or male is
dominant in making most of the decisions, but decisions are
not made together). Therefore, decision-making may also
have an effect on the likelihood of experiencing partner violence given predominant gender roles in Mexico (Flake and
Forste 2006). Overall, understanding the dynamics of a culture’s gender roles and values is significant in understanding
the context of IPV in Mexico.
The research exploring IPV’s relationship to depression
and other negative outcomes in Mexico is sparse and limited
by methodological shortcomings (Díaz-Olavarrieta et al.
2002; Díaz-Olavarrieta and Sotelo 1996; Hijar-Medina et al.
1997; Ramírez-Rodríguez and Uribe-Vázquez 1993). For example, a retrospective study of women who sought services
from domestic violence shelters in a suburban neighborhood
in Mexico City between 1989 and 1991 found that one out of
every nine women served had attempted suicide (Valdez and
Juárez 1998; Valdez and Shrader 1992). In addition, a recent
study among recovering drug users in Mexico found that living in domestically violent situations was one of the major risk
factors for developing depression and suicidal thoughts
among this population (Ortiz-Gomez et al. 2014).
A study conducted in Mexico City by de Castro and
colleagues (2015) found that women with children younger than
5 years who experience IPV are at a significantly higher risk for
post-natal depression; this risk is exacerbated when coupled
with low socioeconomic status, low social support, and a history
of depression. However, many of these studies have limited
representativeness and low generalizability due to small sample
sizes, which make interpretation and comparisons across studies
difficult and inappropriate. A notable exception is the study by
de Castro et al. (2014), which used a probabilistic representative
sample of women with at least one child aged 5 years or younger
who participated in the Encuesta Nacional de Salud y Nutricion
(National Survey of Health and Nutrition) in 2012. The authors
found that women who reported experiences of IPV presented
the highest risk of post-natal depression, which was increased by
lack of other resources such as social support, food security, and
access to healthcare (de Castro et al. 2014). However, this study
had the limitation of only including women who had children
younger than 5 years of age. Thus, a greater understanding of
the cultural context may illuminate risk factors for women
experiencing IPV in Mexico and aid in modifying treatment
approaches to fit particular needs.
J Fam Viol (2016) 31:721–734
results in the literature have led to questions concerning whether employment is beneficial or detrimental to women that experience IPV. Some studies across different countries have
shown positive outcomes on women’s status from employment, while others have shown that IPV increases when
women’s access to financial resources increases (Bott et al.
2005; Heise and García-Moreno 2002; Koenig et al. 2003;
Schuler et al. 2013). However, many abusive partners engage
in coercive controlling behaviors that directly and indirectly
hinder women’s attempts to acquire and maintain a job
(Adams et al. 2008; Swanberg and Logan 2005). In coercive
controlling relationships, partners may exert demands on the
victim and then engage in surveillance or threatening behaviors
in order to ensure compliance (Dutton, Goodman, & Schmidt,
2006). On the other hand, research with women in the U.S. and
Canada found that relationships solely characterized by IPV but
not CC are characterized by poor problem-solving and emotional regulation skills associated with escalating arguments
that end in violence (Johnson 1995; Johnson and Ferraro 2000).
Women involved in relationships where a CC is present
may be at risk of increased vulnerability if they are to enter
the workforce. On the other hand, a study including a large
sample of Mexican women found that women who experience
IPV without coercive controlling behaviors may find economic independence to be a protective factor (Terrazas-Carrillo &
McWhirter, 2015). For instance, data from a nationally representative sample in Mexico found that women engaged in paid
employment outside the home were less likely to report depression symptoms than their homemaker counterparts (Lara
et al. 1993; Valdez and Juárez 1998). However, this study
included all women irrespective of whether they had experienced IPV. Therefore, variations in abusive experiences, gender roles, and cultural values can impact the array of health
outcomes that may result from these experiences, including
depression (Davies et al. 2015; Hegarty et al. 2013).
Researchers postulate that the relationship between IPV and
a woman’s employment status is extremely complex and dependent upon the individual factors, family, culture, and local
and global economic conditions (Chronister and McWhirter
2006). It is our hope to contribute to the body of knowledge
that will help in understanding women’s experience of IPV in
relation to employment and depression.
Method
Sample
The Relationship of Employment to IPV
and Depression
A growing body of research is committed to exploring the
impact of IPV on women’s economic status. Inconclusive
Participants included Mexican women (n = 13,053) 15 years
of age or older who identified as married or cohabiting with
a partner at the time of the interview. Data for this research
were collected by the Instituto Nacional de Estadística,
Geografía e Informática (Mexican National Institute for
J Fam Viol (2016) 31:721–734
Statistics, Geography, and Informatics) as part of their
National Survey on Household Relationship Dynamics
(Encuesta Nacional sobre la Dinámica de las Relaciones de
los Hogares [ENDIREH]) in 2011. The sampling strategy
used was stratified and probabilistic by using demographic
and cartographic information from the 2002 National
Household Registry obtained through data collected during
the 2000 National Census in Mexico (INEGI 2011a). The
primary sampling units included an estimated 160 to 300
households within a geographic area, which were then stratified by state, population size, and urban status (rural, urban,
suburb) to provide a representative sample of the Mexican
population. In each of the selected households, all women
over 15 years of age, currently living with a partner were
interviewed in person by field workers trained by INEGI for
data collection (Instituto Nacional de Estadística, Geografía e
Informática 2011b).
Hypotheses
Given results from studies suggesting an IPV dose–response
effect on mental health (Campbell 2002), the first hypothesis
proposes there are significant differences in levels of experienced depressive symptoms between mild and severe IPV.
Since the literature suggests coercive controlling behaviors
have as a main goal to establish pervasive dominance on the
victim’s life (Stark 2006), it is likely that a woman employed
outside the home may be subjected to higher levels of surveillance and intimidation from her partner to ensure compliance
with his demands. This increase in threatening behaviors is
likely to be experienced as a traumatic stressor even in the
absence of IPV (Dutton and Goodman 2005). On the other
hand, it is plausible that employment would no longer be the
main traumatic stressor for women in relationships characterized by both CC and IPV. Therefore, the second hypothesis
proposes that a woman’s employment status may be a predictor
of depression in the context of a coercive controlling relationship but may not be a predictor of depression in the context of a
violent relationship characterized by both IPV and CC.
Measurement
The ENDIREH surveyed a variety of contexts where women
may experience violence, specifically school, work, and home.
All married or cohabiting women 15 years of age and over
answered questions on topics including: Household
sociodemographic characteristics, experiences at work and
school, family of origin dynamics, characteristics of couple relationship dynamics, tensions and conflicts, intimate partner violence, decision-making, financial and social resources, personal liberty, gender role ideology, and household division of labor.
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Depression Symptoms Scale The year 2013 was the first time
ENDIREH asked questions to assess the most common symptoms of depression. The complete list of questions is listed on
Table 1. Possible answers to these questions were “Yes” and
“No.” The Depression Scale was created by adding one point
for each affirmative answer to these questions. The
Cronbach’s alpha for this scale was .70.
Sociodemographic Variables The ENDIREH asks interviewees “How old are you today?” and “What is your higher
level of education?” to assess age and level of education. In
addition, women interviewed answered the following questions to gather information about children and the age at which
women dated, married, and had their first child: “In total, how
many live children have you birthed?” “How old were you
when you had your first child?” “How many live children
does your husband have with other women?” “How old were
you when you started dating your current husband or partner?” and “How old were you when you married your husband or started living together with your partner?” The
ENDIREH also assessed a woman’s employment status by
asking “Do you currently work?” A “Yes” answer was coded
as “1” and a “No” answer was coded as “0.”
Intimate Partner Violence Scale The ENDIREH asks questions regarding specific IPV tactics generally defined as abusive according to national and international standards. Women
are asked to rate the frequency of such tactics occurring in the
context of intimate partner relationships, which can be “several times,” “a few times,” “one time,” or “never.” The questions included in this scale are included on Table 2. The Abuse
scale was created by adding 3 points when participants respond “several times,” 2 points when they answered “a few
times,” 1 point when they answered “one time,” and 0 points
when they answered “never.” Thus, higher scores on the scale
indicate high frequency of abuse, and experiencing more types
Table 1
Depression symptom scale questions
Because of your problems with your husband or partner, have you. . .
Experienced loss or increase of appetite?
Experienced problems with your nerves?*
Experienced apprehension, worry, or fear?
Experienced sadness or depression?
Experienced insomnia?
Had thoughts of ending your life?
Tried to end your life?
* In Spanish, the expression problemas de nervios alludes to symptoms of
anxiety, including difficulty breathing, concentrating, and racing
thoughts. Note. Questions translated from the Spanish version of the
ENDIREH questionnaire. ENDIREH = Encuesta Nacional sobre la
Dinámica de las Relaciones en los Hogares
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Table 2 Intimate partner
violence scale questions
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Since you started your relationship with your spouse or parner, has he . . .
Shamed you, belittled you, or humiliated you? Has told you you are ugly or compared you to other women?
Ignored you, not taken you into consideration, or has not given you love?
Has told you you are cheating on him?
Has made you feel afraid?
Has threatened you with leaving, hurting you, taking your children, or ask you to leave your home?
Has locked you up, has prohibited you to leave or receive visitors?
Has turned your children or family against you?
Has watched you or spied on you?
Has threatened you with a weapon (knife, pocket knife, gun, or rifle)?
Has threatened you with killing you, killing himself, or kill your children?
Has destroyed, thrown away, or hidden your things?
Has stopped talking to you?
Has become angry because you don’t do household chores, because meals are not ready or they are not
prepared the way he likes it or he thinks you did not fulfill your obligations?
Has argued about how you spend money?
Even if he has money he has not given you money for household expenses?
Has not given you money or has threatened with not giving you money?
Has taken possession of your money or real estate (properties, etc.)?
Has prohibited you from working or attending school?
Has pushed you or pulled your hair?
Has tied you down?
Has kicked you?
Has thrown an object at you?
Has beaten you with his hands or an object?
Has tried to choke you or suffocate you?
Has hurt you with a knife or pocket knife?
Has shot at you with a gun?
Has demanded to have sexual intercourse even if you did not want to?
When you engage in sexual intercourse, has made you do things you do not like?
Has used his physical strength to make you have sexual intercourse?
Note. Questions translated from the Spanish version of the ENDIREH questionnaire. ENDIREH = Encuesta
Nacional sobre la Dinámica de las Relaciones en los Hogares
of abuse such as physical, sexual, and emotional. Cronbach’s
alpha for this scale was .916.
Coercive Control Scale Questions used to create this scale
come from the section on the ENDIREH asking about
who holds decision-making power in the relationship.
Women were asked to answer who makes decisions in
each instance, and the potential answers were “Only the
woman interviewed,” “Only the husband or partner,”
“Both,” “Another person,” and “Not applicable.” All
questions included on this scale are listed on Table 3.
The scale was created by adding one point for each
“Only husband or partner,” and zero points for all other
answers. Thus, higher scores on this scale would indicate
higher levels of coercive control displayed by the husband. Cronbach’s alpha for this scale was .93.
Gender Role Attitudes Scale This scale assesses whether the
women interviewed endorse egalitarian gender role expectations. Women answered questions regarding gender role attitudes with “Yes,” and “No” answers. One point was added
when the interviewees endorsed statements related to more
egalitarian gender roles and zero points were added when
interviewees endorsed statements related to less egalitarian
attitudes. Therefore, higher scores on this scale represent more
egalitarian attitudes about gender role expectations. A complete list of the questions included on this scale is listed on
Table 4. Cronbach’s alpha for this scale was .98.
Results
Women in this subsample of the ENDIREH had a mean age of
47.39, and a mean education of 3.82, which means that on
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Table 3
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Coercive control scale questions
Who decides, most of the time, in your home or your relationship. . .
If you can work or study?
If you can go outside the home?
What to do with the money you earn or he gives you?
If you can buy things for yourself?
If you can participate in the social or political life in your community?
How you spend or save money?
What you let your children do?
Whether you move to another home or another city?
When you have sexual intercourse?
If you use birth control?
Who should use birth control?
How many children you want?
Note. Questions translated from the Spanish version of the ENDIREH
questionnaire. ENDIREH = Encuesta Nacional sobre la Dinámica de las
Relaciones en los Hogares
average, women interviewed had completed middle school.
Since employment was measured as a dichotomous variable,
the mean of .42 is interpreted as 42 % of the women surveyed
by ENDIREH were employed outside the home. In addition,
women interviewed had an average of 2.34 children, and a reported mean age of 20.91 at the time their first child was born.
The mean number of children their husbands fathered with other
women was 3.33. On average, women in the sample started
dating their current spouse or partner at age 20.81 and married
their current spouse or partner at a mean age of 22.52. The mean
score for the Depression scale was 1.62, and it was 5.39 for the
Table 4 Gender role attitudes
scale
Gender Role Attitudes Scale. The mean score for the Coercive
Control Scale was 1.92, and the mean score for the Intimate
Partner Violence Scale was 4.61 (See Table 5 for descriptive
statistics).
Before testing the first hypothesis, a factor analysis of the
items used to create the Intimate Partner Violence Scale was
conducted in order to determine whether different items on the
scale loaded on different IPV severity levels. The 30 items of the
Intimate Partner Violence Scale were subjected to principal components analysis (PCA) using SPSS version 22. Prior to
performing PCA the suitability of data for factor analysis was
assessed. The Kaiser-Meyer-Oklin value was .86, exceeding the
recommended value of .6 (Kaiser 1970) and the Bartlett’s Test of
Sphericity (Bartlett 1954) reached statistical significance,
supporting the factorability of the correlation matrix. Principal
components analysis revealed the presence of 8 components
with eigenvalues exceeding 1. However, an inspection of the
screeplot revealed a clear break after the second component
and it was decided to retain 2 components for further investigation (Tabachnick and Fidell 2001). To aid in the interpretation of
these two components, Varimax rotation was performed. The
rotated solution revealed the presence of a simple structure, with
both components showing a number of strong loadings and all
variables loading substantially on only one component (See
Table 6). The two component solution explained a total of
22.9 % of the variance, with Component 1 contributing 11.7 %
and Component 2 contributing 11.18 %. Component 1 items
seemed to allude to mild forms of IPV, while Component 2 items
were indicative of more severe forms of IPV (See Table 6).
Once the factor structure of the Intimate Partner Violence
Scale was determined, the first hypothesis was tested by
I will read to you some phrases, please tell me “yes” when you agree and “no” when you disagree. . .
A wife should obey her husband or partner in everything he orders*
A woman has the right to choose her friends
A man should be responsible for all family expenses*
A woman has the same ability as a man to earn money
It is a woman’s obligation to have sexual intercourse with her husband or partner*
A woman is free to choose whether she wants to work
A man has the right to beat up his wife*
Caring for children should be shared by husband and wife
Parents have the right to spank their children*
If there is beating up or maltreatment in the household, it is a family matter and should not be discussed*
Women and men have the same rights to choose what they want
Women and men have the same freedoms
Women have the right to defend themselves and denounce any maltreatment or aggression
Women have the right to live a life free of violence
Women have a right to choose how many children they want
* Indicates less egalitarian gender role attitudes
Note. Questions translated from the Spanish version of the ENDIREH questionnaire. ENDIREH = Encuesta
Nacional sobre la Dinámica de las Relaciones en los Hogares
728
J Fam Viol (2016) 31:721–734
Table 5 Descriptive statistics
Predictor
Mean
Standard deviation
Age
Education level
47.39
3.82
13.77
1.62
Woman’s Employment Status
.42
.49
Number of birthed children
Age when first child born
2.34
20.91
2.70
6.73
Number of children husband fathered with other women
3.33
16.78
Age when started dating current husband or partner
Age at marriage or partnering
20.81
22.52
10.01
9.60
Depression scale
1.62
3.81
Gender role attitudes scale
Intimate partner violence scale
5.39
4.61
1.39
9.44
Coercive control scale
1.92
4.04
performing an independent samples t-test assuming unequal
variances given the differences in the groups’ sample sizes,
was conducted to compare depression scores for Severe and
Mild IPV. There was a significant difference (p < .05) in
Table 6
depression scores for Mild IPV (Mean = 1.14, SD = .577) and
Severe IPV (Mean = 1.03, SD = .271). See Table 7 for details of
this difference. In other words, there is support for the first
hypothesis regarding significant differences on depression
Varimax rotation of two factor solution for intimate partner viiolence scale items
Component 1:
Mild IPV
Since you started your relationship with your spouse or parner, has he . . .
Shamed you, belittled you, or humiliated you? (Has told you you are ugly or compared you to other women)?
Ignored you, not taken you into consideration, or has not given you love?
Ignored you, not taken you into consideration, or has not given you love?
Has told you you are cheating on him?
Has made you feel afraid?
Has threatened you with leaving, hurting you, taking your children, or ask you to leave your home?
Has locked you up, has prohibited you to leave or receive visitors?
Has turned your children or family against you?
Has threatened you with killing you, killing himself, or kill your children?
Has argued about how you spend money?
Even if he has money he has not given you money for household expenses?
Has not given you money or has threatened with not giving you money?
Has watched you or spied on you?
Has threatened you with a weapon (knife, pocket knife, gun, or rifle)?
Has pushed you or pulled your hair?
Has tied you down?
Has kicked you?
Has thrown an object at you?
Has beaten you with his hands or an object?
Has tried to choke you or suffocate you?
Has hurt you with a knife or pocket knife?
Has shot at you with a gun?
Has demanded to have sexual intercourse even if you did not want to?
When you engage in sexual intercourse, has made you do things you do not like?
Has used his physical strength to make you have sexual intercourse?
Component 2:
Severe IPV
.491
.469
.467
.465
.488
.327
.374
.338
.371
.480
.480
.478
.563
.357
.307
.624
.511
.390
.323
.546
.701
.669
.330
.462
.456
J Fam Viol (2016) 31:721–734
729
Table 7 Differences in
depression symptom scale scores
between mild and severe IPV
Depression symptom scale
Mild IPV (n =16,785)
Severe IPV (n = 108)
Mean
SD
Mean
SD
1.14
.577
1.03
.271
t
df
2.117*
107.3
* Indicates p < .05
symptoms between women experiencing mild versus severe
IPV.
In order to test the second hypothesis, two regression
models were conducted to predict depression. The first model
included sociodemographic variables, woman’s employment
status, gender role attitudes scale, and coercive control scale in
order to find out whether employment in a relationship characterized by nonviolent CC would be predictive of depressive
symptomology. In the first model, women’s employment status was a significant predictor of depression [t(13,052) = 4.88,
p < .001]. The overall model was statistically significant
[F(10, 9927) = 55.37, p < .001] its R2 was .05, which indicates
an estimated 5 % of the variance in depression symptoms was
explained by the predictors included in the model. The following predictors were statistically significant: age [t(13,052) = –
2.06, p < .05], number of birthed children [t(13,052) = 10.74,
p < .001], number of children husband fathered with other
women [t(13,052) = 4.15, p < .001], woman’s employment
status [t(13,052) = 4.88, p < .001], and coercive control [t(13,
052) = 19.78, p < .001]. Therefore, predictors of depression in
the context of a nonviolent controlling relationship include:
number of children a woman has birthed, number of children
the husband fathered with other women, coercive controlling
behaviors, employment outside the home, and age.
In order to test the second part of the hypothesis, another
multiple regression model included the variable intimate partner violence along with all the predictors included in Model 1
(see table 8). This model was statistically significant F(11,
9926) = 725.49, p < .001, and its R2 = .44, which indicates an
estimated 44 % of the variance in depression scores is explained
by the predictors included in the second model. Statistically
significant predictors included: gender role attitudes [t(13,
052) = –2.29, p < .05], coercive control [t(13,052) = 6.21,
p < .001], and intimate partner violence [t(13,052) = 83.81,
Table 8 Multiple regression
model
Model 1
Age
Education level
Woman’s employment status
Number of birthed children
Age when first child born
Number of children husband fathered with other women
Age when started dating current husband or partner
Age at marriage or partnering
Gender role attitudes scale
Coercive control scale
Model 2
Age
Education level
Woman’s employment status
Number of birthed children
Age when first child born
Number of children husband fathered with other women
Age when started dating current husband or partner
Age at marriage or partnering
Gender role attitudes scale
Coercive control scale
Intimate partner violence scale
* Indicates p < .05. R2 = .053 for Model 1; R2 = .445 for Model 2
β
B
SE
–.006*
–.011
–.021
–.005
.003
.023
.377*
.150*
–.010
.049
.106
–.018
.077
.014
.006
.009*
.003
–.005
–.008
.183*
.041
.007
–.012
–.003
.194
.002
.005
.006
.027
.009
–.003
.014
.050
.009
–.001
.000
.002
.003
–.048*
.045*
.264*
–.011
.006
.007
.006
–.002
.001
.006
.007
–.018
.048
.655
.002
.018
.059
.011
.004
.002
.004
.004
.021
.007
.003
730
p < .001]. The predictor intimate partner violence alone
accounted for 39 % of the variance on depression, while coercive control accounted for only .2 % of the variance on the
criterion variable. The increase of R2 from model 1 to model
2 was statistically significant [F(1, 9926) = .393, p < .001].
Therefore, the following variables predicted depression in the
context of a relationship characterized by both CC and IPV:
gender role attitudes, coercive control, and intimate partner
violence. Once IPV was included in the model, employment
status was no longer a significant predictor of depression,
supporting both parts of the second hypothesis proposed.
Discussion
Our findings provide evidence supporting the existence of
different types of violence with different defining characteristics and impacts on mental health (Johnson 1995). Based on
these results, we conclude that risk factors predicting depressive symptoms include having an abusive and controlling
partner, young age, engaging in paid employment outside
the home, and higher birth rates. Specifically, depressive
symptomology is more prevalent in relationships characterized by both controlling behaviors and physical and emotional
abuse. Our findings indicate that a woman in a nonviolent
coercive controlling relationship will have a higher risk of
depression if she is employed. However, employment is not
a risk factor for depression symptoms among women in relationships characterized by both coercive control and IPV.
Our findings suggest that women employed outside the
home who are in relationships characterized by coercive controlling behaviors may experience increases in depression
symptomology. This finding is perhaps a result of increased
partner threats and surveillance, which may be experienced as
traumatic stressors as suggested by the literature (Dutton et al.
2005a; Stark 2006). However, employment was no longer a
predictor of depressive symptomology once IPV was introduced to the model. Although unable to establish based on
the results obtained in the multiple regression models, it is
possible that the presence of IPV in a coercive controlling
relationship may become the focus of traumatic stress and
increase the likelihood of experiencing depression regardless
of employment status.
Moreover, the absence of a negative or positive impact of
employment on depression potentially suggests that seeking
employment may be a viable alternative for women in relationships where IPV is the central concern. We speculate that
while controlling behaviors have been shown to have detrimental effects for women, their nature is insidious rather than
chronically severe in relationships where physical, sexual, and
emotional abuse is absent. The impact of this insidious pattern
of behavior is perhaps underestimated, as our results show its
presence increases the risk of developing depressive
J Fam Viol (2016) 31:721–734
symptoms. However, IPV (physical, sexual, and emotional)
in the context of a controlling relationship becomes the strongest predictor of depression, which is possibly a result of a
systematic pattern of abuse.
Implications
Based on these findings, we recommend tailoring domestic violence interventions to fit the context of the woman’s situation.
Specifically, programs designed to increase battered women’s
financial stability should consider the nature of the relationship
she has with her partner. A woman involved in a controlling
relationship may become more depressed upon entering the
workforce due to the pattern of control and limitations she experiences. In this case, stress inoculation and/or other preventative interventions for depression may be indicated while phasing
in employment, due to the increased risk of depression.
However, a woman in a relationship where the central concern
is IPV may derive some benefits from seeking out employment.
Specifically, women who contribute to the family income have
more economic power, which makes them more likely to report
abuse or leave the relationship (Harris et al. 2005).
Encouraging women in abusive relationships to work outside the home may also stimulate social change by
transforming their partners’ expectations and perspectives
(Schuler et al. 2013; Vyas and Watt 2009). However, treatment
for women involved in violent relationships characterized by
coercive controlling behaviors should exercise caution in
recommending that they work outside the home due to the
increased risk of depression. Many of these women are
experiencing control and intimidation that prevents them from
making their own choices, working, and communicating with
loved ones (Tanha et al. 2009). Women in these relationships
need access to more intensive short-term services and resources, such as shelters, health resources, and mental health
interventions that address the long-lasting effects related to
living in abusive relationships. It is important that these women are provided access to counseling services that focus on the
sequelae of abusive relationships, especially PTSD, depression, anxiety, low self-esteem, and low self-efficacy
(McWhirter and Altshuler-Bard 2010; Terrazas-Carrillo and
McWhirter 2012). Future studies should further explore the
impact of gender role ideology as a protective factor of IPV.
Limitations
This study provides valuable knowledge regarding specific protective and risk factors of depression among women experiencing nonviolent CC and also CC in the context of a violent
relationship. However, some limitations should be noted. The
first limitation is related to the correlational nature of the study,
which precludes inferences regarding causality among the variables analyzed. In addition, the study represented a cross-
J Fam Viol (2016) 31:721–734
sectional view of a social and psychological phenomena that is
generally characterized by a lifetime prevalence. Although the
study included a representative sample of Mexican women
interviewed as part of ENDIREH, only a subset of cases were
analyzed in the study due to missing data. This raises the
question of whether only a particular type of respondent
answered the questions related to the variables in the study.
Nonetheless, in spite of these limitations, this study contributes
to the body of research exploring profiles of depression and its
relationship to IPV among women of different cultures.
In sum, findings from this study lend additional support to
the salience of this issue for Mexican families. Harris et al.
(2005) found that traditional familismo and traditional gender
role orientations were reported among Mexican-born women
interviewed in their study, which contributed to lower reports
of abuse. Holding these traditional views also contributed to
women being less likely to define some acts of violence as
abuse (Harris et al. 2005). Based on the findings of this study,
interventions that aim to augment women’s financial independence should include interventions that target the effect of
independence on the family. This should combine education
for women and men on the meaning of healthy relationships
and aim to broaden men’s perception of identity and value
beyond their ability to provide for their family (Ayón et al.
2010; Flake and Forste 2006; Ingoldsby 1991). Individuals
may also benefit from learning nonviolent alternatives to
reach a conclusion during conflicts and coping skills for nontraditional contexts, such as negotiation, conflict resolution,
and assertion skills (Harris et al. 2005). Taken together, these
findings contribute to our understanding of international research focusing on the effects of IPV and coercive control on
women’s mental health and life situations.
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