- Email: [email protected]
The psychological consequences of violence against people with disabilities
Accepted Manuscript The Psychological Consequences of Violence against People with Disabilities Robert S. Dembo, MA, Monika Mitra, PhD, Michael McKee, MD, MPH PII:
S1936-6574(18)30007-4
DOI:
10.1016/j.dhjo.2018.01.006
Reference:
DHJO 676
To appear in:
Disability and Health Journal
Received Date: 5 September 2017 Revised Date:
2 January 2018
Accepted Date: 20 January 2018
Please cite this article as: Dembo RS, Mitra M, McKee M, The Psychological Consequences of Violence against People with Disabilities, Disability and Health Journal (2018), doi: 10.1016/j.dhjo.2018.01.006. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
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The Psychological Consequences of Violence against People with Disabilities
Monika Mitra, PhDb Michael McKee, MD, MPHc
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Word count, abstract: 250 Word count, manuscript: 3,998 References: 40 Tables: 5
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Robert S. Dembo, MA*a
*a. Address correspondence to: Robert Dembo, Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA 02453. Phone: 781-739-8415; Email: [email protected] b. Monika Mitra, Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA 02453. Phone: 781-7363807; Email: [email protected]
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c. Michael McKee, Department of Family Medicine, University of Michigan Medical School, 1018 Fuller St., Ann Arbor, MI 48104. Phone: 734-998-7120; Email: [email protected]
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Disclosures: Funding from the Lurie Institute for Disability Policy and the Brandeis University Provost Research Award supported this study.
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Conflicts: The authors report no conflicts of interest.
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The Psychological Consequences of Violence against People with Disabilities
Abstract
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Background: People with disabilities experience mental health disparities and higher rates of violence compared to people without disabilities. Few studies have examined the psychological consequences of violence against people with disabilities, and whether they differ from those experienced by people without disabilities.
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Objective: This study compared psychological consequences of violence among men and women with and without disabilities.
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Methods: We analyzed data from the 2008-2014 waves of the National Crime Victimization Survey. Multiple logistic regressions were estimated to compare the psychological impact of violent crime on respondents without disabilities to those with disabilities, who comprised roughly 20% of the sample (n=8,070). We stratified by gender to compare the effects of violence experienced by men and women.
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Results: Men with disabilities were more likely than men without disabilities to report severe distress (AOR=2.07, p<0.001), anxiety (1.79, p<0.001), depression (2.32, p<0.001), and anxiety and depression (2.34; p<0.001), but were less likely to experience each outcome compared to women with disabilities. Men with disabilities had similar odds of adverse psychological outcomes compared to women without disabilities. Women with disabilities had higher odds of severe distress following violence compared to men without disabilities (3.90, p<0.001) or women without disabilities (1.86, p<0.001). Similarly, women with disabilities had higher odds of anxiety, depression, and anxiety and depression compared to men and women without disabilities.
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Conclusions: Women with disabilities are at higher risk of negative psychological consequences resulting from violence compared to other gender-disability groups. Men with disabilities also experience worse outcomes relative to men without disabilities.
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Keywords: disability; mental health; violence; gender
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Introduction People with disabilities experience higher rates of violence than people without disabilities.1,2 The disparity in violence victimization is experienced broadly; both men and
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women, as well as children and adults with disabilities are substantially more likely to
experience violent crime than their counterparts without disabilities.1-4 In addition to being at a higher risk of violence generally, people with disabilities experience increased rates of many
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different types of violent crimes, including intimate partner violence,4 sexual violence,3 and assault.5
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People with disabilities are a heterogenous population with diverse lived experiences, which include histories of violence victimization. For example, research on gender differences in violence indicates that women with disabilities are more likely to be victims of violence than men.4 There is also variation across disability type. Previous research has found that people with
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intellectual disabilities face higher incidence of violence and physical maltreatment than people with other disabilities6 and people with multiple disabilities are at a higher risk than individuals with one disability.5,6 Victimization also varies by age. Children and adolescents with disabilities
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experience a substantially higher prevalence of violence than adults.5 Violence victimization has wide-ranging consequences for individuals and
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communities, and is receiving increased scrutiny as an important public health problem.7 Similarly, the documentation of mental health disparities in the population has received attention from public health researchers in recent years,8 as has the issue of health disparities among people with disabilities.9,10 Despite the growth of these literatures, there has been limited research focusing on the role of violence as a social determinant of mental health disparities between people with and without disabilities. This gap in the literature is noteworthy given that
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people with disabilities experience violence at higher rates1,2 than people without disabilities, as well as previous findings that disability is significantly correlated with psychological problems, such as anxiety and depression.11
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Previous research examining violence against people with disabilities has tended to focus on quantifying the prevalence of violence and analyzing crime trends over time.1,2,12,13 Other studies have explored details of the violent incidents, including analyses of victim-
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offender relationships and self-defense behaviors.3,14,15 Another line of research has documented adverse psychological consequences associated with violence victimization in the general
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population.15,16 The few studies that have examined the psychological consequences of violence against people with disabilities have either focused on specific disability subgroups or particular types of violence. For example, Sherer, Snyder, and Fisher17 found that college students with disabilities who were victims of violence were more likely to experience depressive symptoms
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and stress than students without disabilities. Roswell, Clare, and Murphy18 documented greater levels of distress and behavioral symptoms among people with severe intellectual disabilities who had experienced abuse.
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Our study builds on previous research by using nationally representative data on crime victimization. In this study, we examined the extent to which violence victimization is associated
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with mental health disparities between people with and without disabilities. We do this by comparing the psychological consequences of violence experienced by adults with disabilities in the U.S., and compare findings to the psychological outcomes reported by adults without disabilities. We also stratified our analyses to explore the differential effects of violence by gender.
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Methods Data We analyzed data from the National Crime Victimization Survey19 (NCVS) from 2008
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through 2014. All analyses took place in 2017. Administered by the Bureau of Justice Statistics, the NCVS collects data on the prevalence and characteristics of criminal victimization from a nationally representative sample of U.S. households. Sample respondents are asked screening
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questions to determine whether they were victims of crime in the previous six months.
Respondents who experienced a victimization are then interviewed about the type of crime
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committed, characteristics of the perpetrator, use of weapons, injuries suffered, and other consequences of the incident. The concatenated files, upon which our analysis is based, are composed only of respondents who were victims of crime. The NCVS target population is noninstitutionalized individuals in the U.S. aged 12 years and older. Because the focus of our study
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is on adults with disabilities, we restricted our analysis to respondents aged 18 years and older. We pooled cross-sections from 2008 to 2014 to obtain a sufficient sample size of people with disabilities. The study sample of adult victims of violent crime includes 8,070 respondents.
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Additional details about the methodology, sampling procedures, and response rate for the NCVS are described elsewhere.20 The study analyzed public, secondary, de-identified data and was
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considered exempt from the authors’ IRB. Measures
Violent crime. Research on psychological consequences of crime has primarily
examined the impact of personal violence rather than less personal types of crime, such as property damage or theft.21,22 We aim to extend this literature and therefore refined the sample to focus on respondents who had experienced violent crime. The Bureau of Justice Statistics has
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categorized violent crime as sexual violence, including cases of completed and attempted rape, sexual assaults with or without injuries, and unwanted sexual contact; robbery, including completed or attempted robbery, with or without injuries; non-sexual assault, including
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completed aggravated or attempted assault, with or without injuries, with or without a weapon, or simple assault completed with injuries; and verbal threats of rape, sexual assault, or
crime, like purse snatching and pocket-picking.23
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assault.20,23 Based on this typology, we exclude cases of property crime and nonviolent personal
The consequences of violent crime may be dependent upon the type of violence that is
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inflicted.24 Thus, we controlled for the type of violent crime in the models. In some cases, people experience multiple criminal incidents in a short period of time. The NCVS identifies a “series victimization” if a respondent experienced six or more similar crimes within a six-month period.25 We included a dichotomous variable to control for whether the crime was part of a
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series victimization (one of at least six incidents) or not (one of fewer than six incidents). Victim-Offender Relationship. We accounted for the possible influence of victimoffender relationship on psychological outcomes by including a categorical variable that
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measures how each respondent knew their offender: intimate partner, such as a spouse, boyfriend, girlfriend, or ex-partner; relative, such as a parent, child, or sibling; known other, such
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as a friend, neighbor, or colleague; or a stranger. Disability. Beginning in 2008, the NCVS has administered disability screening
questions that are used in the American Community Survey.5 Respondents were identified as having a disability if they reported that they: were deaf or had serious difficulty hearing; were blind or had serious difficulty seeing even when wearing glasses; had a physical disability, defined as a condition that substantially limited one or more basic activities such as walking,
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climbing stairs, reaching, lifting, or carrying; had a self-care or independent living limitation, defined as a condition that caused difficulty with dressing, bathing, or getting around inside the home, or a condition that caused difficulty with going outside the home alone to shop or visit a
learning, remembering, or concentrating.5
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doctor’s office; or had a cognitive disability, defined as a condition that caused difficulty with
Sociodemographic characteristics. We controlled for sociodemographic
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characteristics, including respondents’ age (measured as a continuous variable, 18 to 90);
education (less than high school degree, high school degree, some college, college degree, and
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advanced degree); marital status (married, widowed, divorced or separated, and single, never married); employment status (employed and not employed); and race and ethnicity (nonHispanic white, non-Hispanic Black, Hispanic, and other race/ethnicity). “Other” race/ethnicity included Native American and Alaskan, Asian, Hawaiian, Pacific Islander, and people who were
regression models.
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mixed-race. We rescaled the age variable by dividing it by 10 for ease of interpretation in the
Dependent variables. The NCVS respondents were asked several questions about the
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aftermath of the violent incident, including about the mental health impact. We explore four psychological consequences: (1) severe distress, a dichotomous variable based on a question
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which asked about respondents’ level of distress following the crime (none, mild, moderate, or severe); (2) anxiety for a month or more after the crime (yes or no); (3) depression for a month or more after the crime (yes or no); and (4) a summative measure of whether respondents experienced both anxiety and depression. Due to the skip pattern in the survey, only those respondents (n=4,021) who reported experiencing moderate or severe distress, or those who
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indicated that the crime created social problems with family, friends, or work, were asked about their anxiety and depression. Statistical Analysis
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Data analyses were conducted in Stata 14 (StataCorp, College Station, TX) with
procedures to account for the NCVS’s complex survey design, including use of sample weights, adjustments for stratification, and the use of Taylor series linearization to estimate variances. In
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most cases, the responses provided by respondents refer to the most recent violent incident, which occurred in the previous six months. As noted above, we controlled for whether an
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incident was a series crime. In about 4% of cases, however, respondents reported multiple incidents but could not recall details to distinguish the most recent incident from the others in the series. We account for these cases by including a series-adjusted victimization weight in the analysis.25 Analyses were conducted on complete cases only.
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We focused our analysis on the psychological consequences of violent crime by gender and disability status. Specifically, we estimated unadjusted logistic regressions to model group differences in respondents’ odds of reporting severe distress, anxiety, depression, and anxiety
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and depression. We then estimated multiple logistic regressions to examine the associations between gender and disability status and psychological consequences while controlling for
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potential confounding variables. Each model results in three comparisons between the four disability-gender groups, all of whom experienced violence (with one as the reference category). This increases the probability Type I errors. Thus, along with conventional p-values, we present the p-value associated with the Bonferroni-corrected alpha (p<.0167). Below, Tables 1 and 2 present descriptive statistics for all covariates and dependent variables, stratified by disability and gender. We indicate significant pairwise differences based
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on chi-squared tests. Tables 3 and 4 display the odds of experiencing the four psychological outcomes for men and women with disabilities compared to the other three groups, controlling for covariates. Each cell of Tables 3 and 4 represents a different regression, with alternating
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reference groups or dependent variables, so we do not include results for covariates in the
interest of space. However, to illustrate the effects of sociodemographic and crime characteristics we include Table 5, which provides parameter estimates for all covariates for models with men
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without disabilities as the reference. Results of all covariates for the other models are available
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upon request.
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Results Nearly 20%, or 1,581 individuals, reported having a disability among the 8,070 respondents. Among people with disabilities, men were more likely to be deaf or hard of hearing
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and women were more likely to have self-care or independent living limitations. On average, people with disabilities had lower levels of education than people without disabilities. Both men and women with disabilities were less likely to be Hispanic, married, or employed than men and
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women without disabilities, respectively. On average, men and women with disabilities were about 8 years older than their counterparts without disabilities.
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[Table 1]
The characteristics of violent incidents differed between people with and without disabilities. Men with disabilities were more likely to be robbed but were less likely to be threatened than men without disabilities. A higher percentage of women with disabilities
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experienced sexual violence compared to women without disabilities. Men with disabilities were more likely to experience violence by a relative, and men and women with disabilities were both more likely to have been victimized by someone who was known, like a neighbor or colleague,
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compared to respondents of the same gender without disabilities. Higher percentages of men and women with disabilities experienced severe distress, anxiety, depression, and anxiety and
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depression than men and women without disabilities, respectively (Table 2). [Table 2]
The first set of logistic regressions compared men with disabilities to the other three
groups. Controlling for sociodemographic and crime characteristics, men with disabilities had higher odds of reporting severe distress (AOR: 2.07, p<0.001), anxiety (1.79, p<0.001), depression (2.32, p<0.001), and anxiety and depression (2.34, p<0.001) resulting from violent
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crime compared to men without disabilities. On the other hand, men with disabilities had significantly lower odds of severe distress (0.53, p<0.001) or anxiety (0.57, p<0.01) compared to women with disabilities. Compared to women with disabilities, the odds of depression (AOR:
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0.69) or anxiety and depression (AOR: 0.71) were also significantly lower among men with disabilities at the p<0.05 level, but not at the Bonferroni-adjusted significance level. There were
the four outcomes. [Table 3]
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no statistical differences between men with disabilities and women without disabilities for any of
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Next, we compared women with disabilities to the other three groups (Table 4). Comparisons between women and men with disabilities were presented in Table 3, so were omitted from Table 4. Women with disabilities had significantly higher odds of each of the adverse psychological outcomes resulting from violent crime compared to men or women
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without disabilities. All comparisons between women with disabilities and men and women without disabilities were significant at the p<0.001 level except for the odds of anxiety compared to women without disabilities (p<0.01). Men without disabilities were less likely to report poor
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psychological outcomes compared to the three other groups (all p<0.001; comparison to women
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without disabilities not shown).
[Table 4]
We found a number of associations between respondents’ sociodemographic
characteristics and their mental health following violent incidents (Table 5). Non-Hispanic black respondents had higher odds of experiencing severe distress (AOR: 1.33) and depression (1.34, both p<0.05), and Hispanic individuals had higher odds of depression (AOR: 1.36) and anxiety and depression (1.44; both p<0.05) compared to whites. Age was also positively associated with
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severe distress (1.16, p<0.001), anxiety (1.08, p<0.05), depression (1.13, p<0.01) and anxiety and depression (1.14, p<0.001). Respondents who were employed were less likely to report severe distress (0.75, p<0.01) or anxiety (0.83, p<0.05) compared to those who were
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unemployed. Individuals who were widowed (AOR: 1.61) or divorced or separated (AOR: 1.27) had increased odds of anxiety and depression compared to married respondents (both p<0.05). Respondents who were divorced or separated were also more likely to experience severe distress
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following a violent crime compared to those who were married (1.34, p<0.01).
Mental health outcomes also differed by the type of crime committed. The
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psychological consequences of sexual violence were more adverse – across all four outcomes – than those of non-sexual assault or verbal threats of violence (all p<0.01 or p<0.001), but were not statistically different from the psychological consequences following robbery. Individuals who had experienced a series victimization had significantly higher odds of each of the four
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mental health outcomes than those who did not experience a series crime (all p<0.001). Finally, individuals who experienced partner violence were more likely to experience anxiety (AOR: 1:49, p<0.05) and anxiety and depression (1.44, p<0.05) compared to people who were
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victimized by a relative. Respondents who were victimized by a stranger or someone who was known (but not a relative or partner) were also less likely to experience severe distress (both
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p<0.001), depression (both p<0.001), or anxiety and depression (p<0.001 and p<0.01 respectively) compared to people who experienced violence by a relative. [Table 5]
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Discussion Violence prevention is recognized as an important public health goal,7 however the risk of victimization is unequally distributed. Previous studies have found that people with
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disabilities experience violence at substantially higher rates than people without disabilities.2,3,6 This literature has drawn attention to important criminal justice and public health issues relating to the safety and human rights of people with disabilities. This study builds on previous research
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by using a nationally representative sample to analyze differences in psychological consequences between men and women with and without disabilities who were victims of violent crime.
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Our findings are consistent with previous research on the poor psychological consequences related to violence against people in the general population.26 We extend these findings in two ways. First, we provide evidence of differential psychological consequences of violence between people with and without disabilities. Women with disabilities were
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significantly more likely to report poor mental health after a violent incident than people without disabilities regardless of gender. Men with disabilities also had higher odds of experiencing psychological consequences than men without disabilities. People with disabilities, in general,
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are at higher risk of poor mental health, due in part to social adversity, lack of social support, and inaccessible health care.9,27 Thus, it is possible that the increased prevalence of violence
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victimization against people with disabilities contributes to the higher rates of mental disorders observed in previous studies. Our findings warrant additional research into the role of violence as a social determinant of disability-related mental health disparities. Second, this study contributes to the body of evidence regarding gender differences in
the psychological consequences of violence. Most research about gender differences in the effects of violence has found women to be more vulnerable to adverse psychological
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repercussions.16,26 However, other studies have found that men and women experience similar outcomes when characteristics of the crime and victims’ histories of violence are considered.28 Rather than drawing conclusions about “feminine vulnerability,” Romito and Grassi29 propose
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the concept of “situational vulnerability,” which contextualizes the crime and the victim who experienced it. Our findings support this idea by including disability as an additional possible source of vulnerability.
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Women in the general population may be more likely than men to experience adverse psychological outcomes due to greater severity or repeated incidents of violence.30 However,
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when comparing people by disability status, people with disabilities also face a heightened level of “situational vulnerability,” experiencing a greater prevalence of serious violence victimization.5 Our findings that men with disabilities and women without disabilities have similar odds of poor psychological outcomes suggests that intervention strategies should account
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for multiple points of vulnerability, including, but not exclusive to, gender. Future research on the health effects of violence can examine the unique risks faced by people with disabilities, and how these challenges intersect with membership in other identity groups.
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While people with disabilities may be more vulnerable to violence and have less access to health care, which together may contribute to worse mental health1,9, they may also have
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heightened exposure to risk factors associated with poor psychological well-being. For example, people with disabilities in the sample had lower levels of education (Table 1), and we found that higher educational attainment was related to better mental health (Table 5). Given previous research on the socioeconomic-health gradient31, it is important for future investigations to consider the how lower levels of education among people with disabilities may contribute to health disparities, and to examine the buffering mechanisms that education provides for coping
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with traumatic experiences, like violence. We also found that people with disabilities were married and employed at lower rates (Table 1), and both marriage and employment predicted better mental health outcomes following violence (Table 5). Both employment32 and marriage33
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have been found to be health-promoting, likely because social relationships are positively
correlated and well-being.34 Of course, the linkage between marriage and coworker relationships and positive mental health is contingent on such relationships being nonviolent.
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This study has several implications for violence prevention and interventions for people with disabilities. First, interventions should be tailored to account for the risk factors to which
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people with disabilities are disproportionately exposed. For example, given previous evidence that social support is protective against poor mental health associated with violence35, interventionists should concentrate on increasing support for people with disabilities who experience violence, perhaps targeting people who are not married or employed. Educational
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attainment has also been hypothesized to be an important buffer against psychological distress because it facilitates help-seeking behaviors.36 People with disabilities face interpersonal and structural barriers to seeking help37, which may have the dual effect of increasing their
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vulnerability to violence while exacerbating poor mental health consequences. Thus, violence prevention efforts can focus on removing barriers to help-seeking, particularly among people
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with disabilities with lower educational attainment. The Centers for Disease Control and Prevention has argued for the wider application of
epidemiological methods in violence prevention strategies,38 however, the disproportionate risks and adverse outcomes experienced by people with disabilities have not been fully accounted for in public health violence interventions.3 Researchers and officials can include disability questions in surveillance activities to ensure that the public health goals of violence reduction
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extend to people with disabilities. In addition to identifying risk factors, additional focus should be paid to the protective factors that facilitate psychological healing and resiliency among people with disabilities. These objectives require the full and equal inclusion of people with disabilities,
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not only as research subjects, but also as participants in violence prevention and intervention programs.
This study’s results also suggest the need for health care providers and agencies that
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serve people with disabilities to include items about victimization and mental health during
screenings and assessments. However, once providers or organizations serving violence victims
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identify the psychological needs of people with disabilities, attention should turn toward the ease of accessing mental health and trauma specialists. People with disabilities face both structural, socioeconomic, and stigma-related barriers to health care,9,10 so it is crucial that mental health providers and violence prevention organizations offer accessible therapeutic services.
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Limitations
The NCVS sample does not cover people who are living in institutions, excluding a substantial proportion of people with disabilities. In addition, the telephone-administered
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component of the survey may have, in effect, excluded many people who are deaf or hard of hearing, and possibly people with cognitive disabilities who may require assistance with an
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interview. Therefore, the survey is not representative of people with disabilities in the United States. In addition, previous research on gender and mental health suggests that men may be less likely to report accurately about their mental health due to social desirability and gender norms.39 If this is the case, the results may overestimate gender differences. Our models did not account for respondents’ type of disability. We found that controlling for disability type resulted in evidence of concerning levels of multicollinearity, with condition numbers greater than 100.40
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Future research should consider the distribution of mental health morbidity across different types of disabilities, as some people with disabilities may be more vulnerable than others. The number of valid responses varied somewhat across measures due to the skip pattern
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in the NCVS. Variation is indicated in the notes under the tables of results. However, the
interpretation of the results should be based on the specific subsample of respondents to whom survey questions were fielded. For example, only respondents who reported moderate or severe
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distress were asked about depression or anxiety. It is possible that some respondents who reported low levels of distress may have experienced anxiety or depression as well.
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Unfortunately, the NCVS does not capture these cases.23 In addition, the NCVS does not include some potentially confounding variables in its public-use files. For instance, we were unable to control for respondents’ state of residence, which may be associated with variation in rates of violence. We were also unable to control for health insurance status because only respondents
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who reported injuries from violence are asked about insurance coverage. Health insurance coverage may affect reports of psychological symptoms. Based on the questions in the NCVS, we cannot account for the temporal order of
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disability and violence. In some cases, violence may have caused respondents’ disabilities. Finally, the violence measures included in the NCVS do not include disability-related violence,
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such as the denial of personal assistance services, medication manipulation, or destruction of assistive technology. Future studies should examine the impact of these types of abuse on a representative sample of persons with disabilities.
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Conclusions Despite these limitations, this study contributes to the growing body of research about violence against people with disabilities. Results of this study emphasize the high risk of
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psychological consequences related to violence victimization, and suggest that people with disabilities are particularly vulnerable to adverse psychological outcomes. These findings
support the need to include disability status in future research about violence and mental health
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and ensure the accessibility of psychological and violence intervention services.
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18. Rowsell AC, Clare IC, Murphy GH. The psychological impact of abuse on men and women with severe intellectual disabilities. J Appl Res Intellect Disabil. 2013; 26(4): 257-270.
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19. United States Department of Justice. Office of Justice Programs. Bureau of Justice Statistics. National Crime Victimization Survey, concatenated file, 1992-2014. ICPSR36143-v1. Ann Arbor, MI: Inter-university Consortium for Political and Social Research; 2016-03-01. https://doi.org/10.3886/ICPSR36143.v1.
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20. Truman JL, Langton L. Criminal victimization, 2014 (NCJ 248973). Washington, DC: US Department of Justice; 2015. 21. Ruback RB, Clark VA, Warner C. Why are crime victims at risk of being victimized again? Substance use, depression, and offending as mediators of the victimization– revictimization link. J Interpers Violence. 2014; 29(1): 157-185. 22. Cornaglia F, Feldman NE, Leigh A. Crime and mental well-being. J Hum Resour. 2014; 49(1): 110-140. 23. Bureau of Justice Statistics. National Crime Victimization Survey technical documentation (NCJ 247252). Washington, DC: US Department of Justice; 2014.
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24. Sternberg KJ, Baradaran LP, Abbott CB, Lamb ME, Guterman E. Type of violence, age, and gender differences in the effects of family violence on children’s behavior problems: A mega-analysis. Dev Rev. 2006; 26(1): 89-112.
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25. Shook-Sa B, Couzens GL, Berzofsky M. User’s guide to the National Crime Victimization Survey (NCVS) direct variance estimation. Research Triangle Park, NC: RTI International; 2015. 26. Coker, AL, Davis KE, Arias I, et al. Physical and mental health effects of intimate partner violence for men and women. Am J Prev Med. 2002; 23(4): 260-268.
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27. Egede, LE. Major depression in individuals with chronic medical disorders: Prevalence, correlates and association with health resource utilization, lost productivity and functional disability. Gen Hosp Psychiatry. 2007; 29(5): 409-416.
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28. Pimlott-Kubiak S, Cortina LM. Gender, victimization, and outcomes: Reconceptualizing risk. J Consult Clin Psychol. 2003; 71(3): 528-539. 29. Romito P, Grassi M. Does violence affect one gender more than the other? The mental health impact of violence among male and female university students. Soc Sci Med. 2007; 65(6): 1222-1234.
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30. Brownridge DA. Partner violence against women with disabilities: Prevalence, risk, and explanations. Violence against women. 2006; 12(9): 805-822. 31. Adler NE, Boyce T, Chesney MA, et al. Socioeconomic status and health: The challenge of the gradient. American psychologist. 1994; 49(1), 15-24.
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32. Paul KI, Moser K. Unemployment impairs mental health: Meta-analyses. Journal of Vocational behavior. 2009; 74(3), 264-282.
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33. Simon RW. Revisiting the relationships among gender, marital status, and mental health. American journal of sociology. 2002; 107(4), 1065-1096. 34. House JS, Landis KR, Umberson D. Social relationships and health. Science. 1998; 241(4865), 540-545. 35. Coker AL, Smith PH, Thompson MP, McKeown RE, Bethea L, Davis KE. Social support protects against the negative effects of partner violence on mental health. Journal of women's health & gender-based medicine. 2002; 11(5), 465-476. 36. Gulliver A, Griffiths KM, Christensen H. Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC psychiatry. 2010; 10(1), 20
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37. Barrett, BJ, Pierre MS. Variations in women’s help seeking in response to intimate partner violence: Findings from a Canadian population-based study. Violence against women. 2011; 17(1), 47-70. 38. Dahlberg LL, Mercy JA. History of violence as a public health issue. Atlanta, GA: Centers for Disease Control and Prevention; 2009. Retrieved from https://www.cdc.gov/violenceprevention/pdf/history_violence-a.pdf.
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39. Sigmon ST, Pells JJ, Boulard NE, et al. Gender differences in self-reports of depression: The response bias hypothesis revisited. Sex Roles. 2005; 53(5): 401-411.
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40. Belsley, DA, Kuh E, Welsch RE. Regression diagnostics: Identifying influential data and sources of collinearity. Hoboken, NJ: John Wiley & Sons; 1980.
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The Psychological Consequences of Violence against People with Disabilities
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Tables
Significant Pairwise Differences (p<.05)*
-
a
-
-
50.5 (46.4, 54.6)
56.0 (51.5, 60.5)
-
-
Cognitive disability
57.8 (53.5, 62.0)
57.1 (52.8, 61.3)
-
-
Self-care/independent living limitation||
34.7 (30.4, 39.3)
45.0 (41.2. 49.0)
-
-
a
Education Less than HS
25.9 (21.8, 30.5)
20.9 (18.0, 24.1)
13.9 (12.3, 15.6)
16.0 (14.1, 18.0)
b, c
HS degree
33.5 (29.1 38.2)
27.1 (22.4, 32.2)
29.1 (26.8, 31.5)
25.5 (23.5, 27.6)
d
Some college
28.8 (24.7, 33.3)
39.1 (33.9, 44.6)
35.7 (32.9, 38.5)
36.7 (34.6, 38.8)
a, b
College degree
8.5 (6.3, 11.3)
7.9 (5.8, 10.6)
16.3 (14.6, 18.2)
15.2 (13.6, 17.1)
b, c
Advanced degree
3.3 (2.0, 5.4)
5.0 (3.5, 7.2)
5.1 (4.3, 6.1)
6.6 (5.5, 8.0)
Physical disability
§
Race/Ethnicity
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16.9 (13.1, 21.4)
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Women without Disabilities (n=3,238)
13.1 (10.6, 16.0)
‡
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Blind or difficulty seeing
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Table 1: Demographic Characteristics by Disability Status and Gender, % (95% CI) Men with Women with Men without Disabilities Disabilities Disabilities (n=704) (n=877) (n=3,251) † Disability Deaf or hard of hearing 20.7 (17.3, 24.5) 14.4 (11.6, 17.7) -
White, non-Hispanic
65.3 (60.5, 70.0)
66.3 (62.7, 70.6)
65.1 (62.8, 67.3)
62.7 (60.0, 65.4)
Black, non-Hispanic
15.7 (12.0, 20.3)
14.2 (11.5, 17.5)
13.1 (11.5, 14.8)
17.0 (15.0, 19.2)
d
Hispanic
11.2 (8.7, 14.2)
10.0 (7.6, 13.1)
15.5 (13.8, 17.4)
14.0 (12.4, 15.7)
b, c
Other¶
7.9 (5.6, 11.1)
9.5 (6.7, 13.4)
6.4 (5.3, 7.6)
6.3 (5.2, 7.5)
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42.9 (41.4, 44.3)
35.8 (35.1, 36.5)
Married Married
29.3 (25.4, 33.5)
25.1 (21.7, 29.0)
41.7 (39.4, 44.1)
34.4 (32.0, 36.9)
b, c, d
Widowed
6.0 (4.3, 8.3)
8.4 (6.4, 10.9)
3.2 (2.5, 4.1)
4.2 (3.3, 5.3)
b, c
Divorced or separated
36.7 (31.8, 41.8)
42.1 (37.9, 46.4)
19.9 (18.2, 21.7)
26.8 (24.9, 28.9)
b, c, d
Single, never married
28.1 (23.7, 32.8)
24.4 (20.5, 28.8)
35.3 (32.8, 37.8)
34.6 (32.3, 36.9)
b, c
29.6 (25.5, 34.0)
24.7 (20.4, 30.0)
72.3 (70.2, 74.4)
61.7 (59.7, 63.7)
b, c, d
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43.3 (42.7, 45.0)
Employed (Yes=1)
35.3 (34.6, 36.0)
b, c
Age (years)
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* a. men with disabilities vs. women with disabilities; b. men with disabilities vs. men without disabilities; c. women with disabilities vs. women without disabilities; d. men without disabilities vs. women without disabilities. Uncorrected chi-squared tests except comparisons by age, which are adjusted Wald chi-squared tests. † Disability percentages sum to greater than 100 because respondents can report more than one disability ‡ Physical disability refers to difficulty “walking, climbing stairs, reaching, lifting, or carrying” § Cognitive disability refers to difficulty “learning, remembering, or concentrating” || Self-care or independent living limitations refer to difficulty “dressing, bathing, or getting around inside the home” or “going outside alone to shop or visit a doctor’s office” ¶ Other race/ethnicity includes Native American and Alaskan, Asian, Hawaiian, Pacific Islander, and mixed-race
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Type of Crime Sexual
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Table 2: Type of Violence, Incident Characteristics, and Psychological Symptoms by Disability Status and Gender, % (95% CI) Women with Men without Women without Men with Disabilities Disabilities Disabilities Disabilities (n=704) (n=877) (n=3,251) (n=3,238)
Significant Pairwise Differences (p<.05)*
9.5 (7.4, 12.1)
0.7 (0.5, 1.2)
6.3 (5.4, 7.4)
a, c
Robbery
17.7 (15.3, 20.4)
12.4 (10.4, 14.8)
13.2 (11.9, 14.6)
10.1 (9.0, 11.4)
a, b
Non-sexual assault
55.1 (51.5, 58.7)
49.4 (45.4, 53.3)
55.1 (53.2, 57.0)
56.4 (54.3, 58.5)
a, c
Threat of violence
26.3 (23.1, 29.8)
28.7 (24.4, 33.6)
31.0 (29.0, 33.1)
27.1 (25.3, 29.1)
b
Intimate Partner
7.2 (5.0, 10.2)
26.1 (22.2, 30.3)
5.9 (5.0, 6.8)
26.5 (24.3, 28.9)
a, d
Relative
10.2 (7.7, 13.3)
11.6 (9.3, 14.4)
4.8 (4.0, 5.7)
10.3 (9.0, 11.8)
b, d
Known Other
36.2 (31.6, 41.1)
35.5 (31.9, 39.2)
26.1 (24.2, 28.2)
27.6 (25.5, 29.8)
b, c
Stranger
46.4 (41.1, 51.8)
26.9 (23.6, 30.5)
63.2 (6.1, 65.3)
35.5 (33.1, 38.0)
a, b, c, d
5.2 (3.7, 7.3)
3.8 (3.0, 4.7)
4.1 (3.3, 5.0)
Psychological Symptoms
3.6 (2.2, 5.8)
‡
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Distress
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Serial Victimization (Yes=1)†
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0.9 (0.4, 2.2)
16.0 (12.7, 20.0)
4.2 (3.0, 5.8)
28.9 (26.8, 31.0)
8.6 (7.4, 10.1)
a, b, c, d
Mild
23.9 (20.4, 27.9)
15.9 (12.8, 19.6)
31.9 (30.0, 34.1)
25.6 (23.5, 27.9)
a, c, d
Moderate
22.9 (19.4, 26.9)
22.4 (19.5, 25.6)
22.7 (20.8, 24.6)
30.7 (28.7, 32.7)
c, d
Severe
37.2 (32.4, 42.2)
57.5 (52.9, 61.9)
16.6 (14.9, 18.6)
35.1 (33.0, 37.2)
a, b, c, d
Anxiety
72.1 (68.0, 75.9)
84.4 (80.9, 87.4)
56.0 (52.5, 59.4)
72.9 (70.2, 75.5)
a, b, c, d
Depression
58.4 (53.4, 63.2)
72.5 (68.3, 76.4)
32.7 (29.2, 36.3)
54.5 (52.0, 59.9)
a, b, c, d
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a, b, c, d Anxiety and depression 52.3 (47.2, 57.3) 66.4 (61.8, 70.7) 27.3 (23.9, 31.0) 48.9 (46.1, 51.6) * a. men with disabilities vs. women with disabilities; b. men with disabilities vs. men without disabilities; c. women with disabilities vs. women without disabilities; d. men without disabilities vs. women without disabilities; p<0.05 † Serial victimization is defined as 6 or more similar violent incidents occurring within a 6-month period ‡ A smaller subsample (n=4021) is asked about psychological and emotional reactions to victimization. Respondents who reported moderate or severe distress, or that the crime created social problems with family, friends, or work were asked about their psychological or emotional symptoms.
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Table 3. Group Comparisons: Psychological Consequences of Violence Victimization Among Men with Disabilities‡ § || (Unadjusted and Adjusted) Men with Disabilities Compared With: Women with Disabilities Men Without Disabilities Women without Disabilities (OR) (AOR) (OR) (AOR) (OR) (AOR) † † † † 0.44*** 0.53*** 2.89*** 2.07*** 1.09 0.99 Severe Distress (.06) (.08) (.40) (.34) (.14) (.15) Anxiety¶ 0.49***† 0.57**† 2.01***† 1.79***† 1.00 0.96 (.08) (.10) (.27) (.27) (.14) (.15) Depression¶ .53***† 0.69* 2.81***† 2.32***† 1.16 1.32 (.08) (.12) (.38) (.37) (.15) (.20) Anxiety and Depression¶ .55***† 0.71* 2.82***† 2.34***† 1.14 1.22 (.08) (.12) (.41) (.39) (.15) (.18) Note: Standard errors (linearized) in parentheses *** p<0.001 ** p<0.01 * p<0.05 † Bonferroni-corrected alpha, p<.0167 ‡ Adjusted logistic regression models control for race/ethnicity, education, age, employment status, marital status type of crime, series victimization, and victim-offender relationship. § Excludes: certain cases of robbery, threatened robbery, and verbal harassment. || Excludes cases in quarters 1 and 2 of 2008 when questions were not asked. ¶ Anxiety and depression questions not asked to respondents who report no or mild distress or no social problems.
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Table 4. Group Comparisons: Psychological Consequences of Violence Victimization Among Women with Disabilities ‡ § || (Unadjusted and Adjusted) Women with Disabilities Compared With§§: Men Without Disabilities Women without Disabilities (OR) (AOR) (OR) (AOR) 6.60***† 3.90***† 2.49***† 1.86***† Severe Distress (.80) (.58) (.30) (.26) Anxiety¶ 4.20***† 3.90***† 2.01***† 1.76**† (67) (.56) (.32) (.29) ¶ † † † Depression 5.27*** 3.27*** 2.18*** 1.90***† (.75) (.27) (.27) (.56) Anxiety and Depression¶ 5.08***† 3.33***† 2.05***† 1.72***† (.76) (.57) (.26) (.24) Note: Standard errors (linearized) in parentheses *** p<0.001 ** p<0.01 * p<0.05 † Bonferroni-corrected alpha, p<.0167 ‡ Adjusted logistic regression models control for race/ethnicity, education, age, employment status, marital status type of crime, series victimization, and victim-offender relationship. § Excludes: certain cases of robbery, threatened robbery, and verbal harassment. || Excludes cases in quarters 1 and 2 of 2008 when questions were not asked. §§ Comparisons between women and men with disabilities presented in Table 3. ¶ Anxiety and depression questions not asked to respondents who report no or mild distress or no social problems.
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Table 5. Psychological Consequences of Violence Victimization (Unadjusted and Adjusted)
Hispanic Other Education# High school Some college Bachelor's degree Advanced degree Age§ Employed
2.89***† (.40) 6.60***† (.80) 2.64***† (.20)
2.07***† (0.34) 3.90***† (0.58) 2.09***† (0.18)
2.00***† (.27) 4.20***† (.67) 2.09***† (.20)
1.79***† (0.26) 3.27***† (0.56) 1.87***† (0.20)
1.33* (0.15) 1.14 (0.13) 1.10 (0.17)
OR
AOR
2.81***† (.38) 5.27***† (.75) 2.39***† (.22)
2.32***† (0.37) 3.33***† (0.57) 1.74***† (0.18)
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AOR
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Race/ethnicity‡ Black, non-Hispanic
OR
Anxiety and Depression OR AOR 2.82***† (.41) 5.08***† (.76) 2.46***† (.26)
2.35***† (0.39) 3.29***† (0.57) 1.92***† (0.21)
0.99 (0.12) 1.20 (0.16) 0.95 (0.15)
1.34* (0.19) 1.36* (0.19) 1.32 (0.25)
1.24 (0.17) 1.44* (0.20) 1.32 (0.24)
0.96 (0.11) 0.92 (0.10) 0.73* (0.11) 0.66* (0.11)
0.93 (0.13) 0.93 (0.12) 0.87 (0.14) 0.88 (0.17)
0.87 (0.11) 0.83 (0.10) 0.78 (0.12) 0.67 (0.14)
0.98 (0.13) 0.93 (0.11) 0.81 (0.13) 0.74 (0.16)
1.17*** (0.03)
1.08* (0.04)
1.13** (0.04)
1.14*** (0.04)
0.75** (0.06)
0.96 (0.09)
0.83* (0.08)
0.88 (0.08)
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AOR
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Women with disabilities
Depression
OR
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Men with disabilities
Anxiety
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Severe distress
Marital status§§ 7
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Type of crime¶ Robbery Non-sexual assault Threat Series crime
1.20 (0.22) 0.64** (0.10) 0.49*** (0.09) 1.72*** (0.26)
0.97 (0.23) 0.56** (0.12) 0.53** (0.12) 3.09*** (0.85)
Victim-offender relationship## Partner
1.37 (0.29) 1.19 (0.12) 1.11 (0.13)
1.61* (0.35) 1.27* (0.13) 1.11 (0.13)
0.69 (0.16) 0.43*** (0.09) 0.30*** (0.06) 2.24*** (0.40)
0.84 (0.18) 0.49*** (0.09) 0.40*** (0.08) 2.41*** (0.42)
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Never married
1.39 (0.31) 1.09 (0.12) 1.00 (0.12)
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Divorced or separated
1.13 (0.22) 1.34** (0.12) 1.06 (0.10)
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Widowed
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1.24 1.49* 1.30 1.44* (0.17) (0.24) (0.22) (0.21) Known other 0.62*** 1.02 0.46*** 0.64** (0.08) (0.16) (0.06) (0.10) Stranger 0.51*** 0.82 0.31*** 0.42*** (0.07) (0.11) (0.04) (0.05) Constant 0.33 1.71 1.74 0.70 Note: Standard errors (linearized) in parentheses *** p<0.001 ** p<0.01 * p<0.05 † Bonferroni-corrected alpha, p<.0167 ‡ Reference group is ‘white, non-Hispanic’. “Other” includes Native American and Alaskan, Asian, Hawaiian, Pacific Islander, and mixed-race # Reference group is ‘less than high school’ § Age was rescaled by dividing the original variable by ten §§ Reference group is ‘married’ ¶ Reference group is ‘sexual violence’ 8
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Reference group is ‘relative’
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##
9
S1936-6574(18)30007-4
DOI:
10.1016/j.dhjo.2018.01.006
Reference:
DHJO 676
To appear in:
Disability and Health Journal
Received Date: 5 September 2017 Revised Date:
2 January 2018
Accepted Date: 20 January 2018
Please cite this article as: Dembo RS, Mitra M, McKee M, The Psychological Consequences of Violence against People with Disabilities, Disability and Health Journal (2018), doi: 10.1016/j.dhjo.2018.01.006. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
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The Psychological Consequences of Violence against People with Disabilities
Monika Mitra, PhDb Michael McKee, MD, MPHc
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Word count, abstract: 250 Word count, manuscript: 3,998 References: 40 Tables: 5
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Robert S. Dembo, MA*a
*a. Address correspondence to: Robert Dembo, Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA 02453. Phone: 781-739-8415; Email: [email protected] b. Monika Mitra, Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA 02453. Phone: 781-7363807; Email: [email protected]
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c. Michael McKee, Department of Family Medicine, University of Michigan Medical School, 1018 Fuller St., Ann Arbor, MI 48104. Phone: 734-998-7120; Email: [email protected]
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Disclosures: Funding from the Lurie Institute for Disability Policy and the Brandeis University Provost Research Award supported this study.
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Conflicts: The authors report no conflicts of interest.
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The Psychological Consequences of Violence against People with Disabilities
Abstract
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Background: People with disabilities experience mental health disparities and higher rates of violence compared to people without disabilities. Few studies have examined the psychological consequences of violence against people with disabilities, and whether they differ from those experienced by people without disabilities.
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Objective: This study compared psychological consequences of violence among men and women with and without disabilities.
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Methods: We analyzed data from the 2008-2014 waves of the National Crime Victimization Survey. Multiple logistic regressions were estimated to compare the psychological impact of violent crime on respondents without disabilities to those with disabilities, who comprised roughly 20% of the sample (n=8,070). We stratified by gender to compare the effects of violence experienced by men and women.
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Results: Men with disabilities were more likely than men without disabilities to report severe distress (AOR=2.07, p<0.001), anxiety (1.79, p<0.001), depression (2.32, p<0.001), and anxiety and depression (2.34; p<0.001), but were less likely to experience each outcome compared to women with disabilities. Men with disabilities had similar odds of adverse psychological outcomes compared to women without disabilities. Women with disabilities had higher odds of severe distress following violence compared to men without disabilities (3.90, p<0.001) or women without disabilities (1.86, p<0.001). Similarly, women with disabilities had higher odds of anxiety, depression, and anxiety and depression compared to men and women without disabilities.
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Conclusions: Women with disabilities are at higher risk of negative psychological consequences resulting from violence compared to other gender-disability groups. Men with disabilities also experience worse outcomes relative to men without disabilities.
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Keywords: disability; mental health; violence; gender
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Introduction People with disabilities experience higher rates of violence than people without disabilities.1,2 The disparity in violence victimization is experienced broadly; both men and
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women, as well as children and adults with disabilities are substantially more likely to
experience violent crime than their counterparts without disabilities.1-4 In addition to being at a higher risk of violence generally, people with disabilities experience increased rates of many
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different types of violent crimes, including intimate partner violence,4 sexual violence,3 and assault.5
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People with disabilities are a heterogenous population with diverse lived experiences, which include histories of violence victimization. For example, research on gender differences in violence indicates that women with disabilities are more likely to be victims of violence than men.4 There is also variation across disability type. Previous research has found that people with
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intellectual disabilities face higher incidence of violence and physical maltreatment than people with other disabilities6 and people with multiple disabilities are at a higher risk than individuals with one disability.5,6 Victimization also varies by age. Children and adolescents with disabilities
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experience a substantially higher prevalence of violence than adults.5 Violence victimization has wide-ranging consequences for individuals and
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communities, and is receiving increased scrutiny as an important public health problem.7 Similarly, the documentation of mental health disparities in the population has received attention from public health researchers in recent years,8 as has the issue of health disparities among people with disabilities.9,10 Despite the growth of these literatures, there has been limited research focusing on the role of violence as a social determinant of mental health disparities between people with and without disabilities. This gap in the literature is noteworthy given that
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people with disabilities experience violence at higher rates1,2 than people without disabilities, as well as previous findings that disability is significantly correlated with psychological problems, such as anxiety and depression.11
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Previous research examining violence against people with disabilities has tended to focus on quantifying the prevalence of violence and analyzing crime trends over time.1,2,12,13 Other studies have explored details of the violent incidents, including analyses of victim-
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offender relationships and self-defense behaviors.3,14,15 Another line of research has documented adverse psychological consequences associated with violence victimization in the general
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population.15,16 The few studies that have examined the psychological consequences of violence against people with disabilities have either focused on specific disability subgroups or particular types of violence. For example, Sherer, Snyder, and Fisher17 found that college students with disabilities who were victims of violence were more likely to experience depressive symptoms
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and stress than students without disabilities. Roswell, Clare, and Murphy18 documented greater levels of distress and behavioral symptoms among people with severe intellectual disabilities who had experienced abuse.
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Our study builds on previous research by using nationally representative data on crime victimization. In this study, we examined the extent to which violence victimization is associated
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with mental health disparities between people with and without disabilities. We do this by comparing the psychological consequences of violence experienced by adults with disabilities in the U.S., and compare findings to the psychological outcomes reported by adults without disabilities. We also stratified our analyses to explore the differential effects of violence by gender.
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Methods Data We analyzed data from the National Crime Victimization Survey19 (NCVS) from 2008
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through 2014. All analyses took place in 2017. Administered by the Bureau of Justice Statistics, the NCVS collects data on the prevalence and characteristics of criminal victimization from a nationally representative sample of U.S. households. Sample respondents are asked screening
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questions to determine whether they were victims of crime in the previous six months.
Respondents who experienced a victimization are then interviewed about the type of crime
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committed, characteristics of the perpetrator, use of weapons, injuries suffered, and other consequences of the incident. The concatenated files, upon which our analysis is based, are composed only of respondents who were victims of crime. The NCVS target population is noninstitutionalized individuals in the U.S. aged 12 years and older. Because the focus of our study
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is on adults with disabilities, we restricted our analysis to respondents aged 18 years and older. We pooled cross-sections from 2008 to 2014 to obtain a sufficient sample size of people with disabilities. The study sample of adult victims of violent crime includes 8,070 respondents.
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Additional details about the methodology, sampling procedures, and response rate for the NCVS are described elsewhere.20 The study analyzed public, secondary, de-identified data and was
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considered exempt from the authors’ IRB. Measures
Violent crime. Research on psychological consequences of crime has primarily
examined the impact of personal violence rather than less personal types of crime, such as property damage or theft.21,22 We aim to extend this literature and therefore refined the sample to focus on respondents who had experienced violent crime. The Bureau of Justice Statistics has
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categorized violent crime as sexual violence, including cases of completed and attempted rape, sexual assaults with or without injuries, and unwanted sexual contact; robbery, including completed or attempted robbery, with or without injuries; non-sexual assault, including
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completed aggravated or attempted assault, with or without injuries, with or without a weapon, or simple assault completed with injuries; and verbal threats of rape, sexual assault, or
crime, like purse snatching and pocket-picking.23
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assault.20,23 Based on this typology, we exclude cases of property crime and nonviolent personal
The consequences of violent crime may be dependent upon the type of violence that is
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inflicted.24 Thus, we controlled for the type of violent crime in the models. In some cases, people experience multiple criminal incidents in a short period of time. The NCVS identifies a “series victimization” if a respondent experienced six or more similar crimes within a six-month period.25 We included a dichotomous variable to control for whether the crime was part of a
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series victimization (one of at least six incidents) or not (one of fewer than six incidents). Victim-Offender Relationship. We accounted for the possible influence of victimoffender relationship on psychological outcomes by including a categorical variable that
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measures how each respondent knew their offender: intimate partner, such as a spouse, boyfriend, girlfriend, or ex-partner; relative, such as a parent, child, or sibling; known other, such
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as a friend, neighbor, or colleague; or a stranger. Disability. Beginning in 2008, the NCVS has administered disability screening
questions that are used in the American Community Survey.5 Respondents were identified as having a disability if they reported that they: were deaf or had serious difficulty hearing; were blind or had serious difficulty seeing even when wearing glasses; had a physical disability, defined as a condition that substantially limited one or more basic activities such as walking,
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climbing stairs, reaching, lifting, or carrying; had a self-care or independent living limitation, defined as a condition that caused difficulty with dressing, bathing, or getting around inside the home, or a condition that caused difficulty with going outside the home alone to shop or visit a
learning, remembering, or concentrating.5
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doctor’s office; or had a cognitive disability, defined as a condition that caused difficulty with
Sociodemographic characteristics. We controlled for sociodemographic
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characteristics, including respondents’ age (measured as a continuous variable, 18 to 90);
education (less than high school degree, high school degree, some college, college degree, and
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advanced degree); marital status (married, widowed, divorced or separated, and single, never married); employment status (employed and not employed); and race and ethnicity (nonHispanic white, non-Hispanic Black, Hispanic, and other race/ethnicity). “Other” race/ethnicity included Native American and Alaskan, Asian, Hawaiian, Pacific Islander, and people who were
regression models.
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mixed-race. We rescaled the age variable by dividing it by 10 for ease of interpretation in the
Dependent variables. The NCVS respondents were asked several questions about the
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aftermath of the violent incident, including about the mental health impact. We explore four psychological consequences: (1) severe distress, a dichotomous variable based on a question
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which asked about respondents’ level of distress following the crime (none, mild, moderate, or severe); (2) anxiety for a month or more after the crime (yes or no); (3) depression for a month or more after the crime (yes or no); and (4) a summative measure of whether respondents experienced both anxiety and depression. Due to the skip pattern in the survey, only those respondents (n=4,021) who reported experiencing moderate or severe distress, or those who
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indicated that the crime created social problems with family, friends, or work, were asked about their anxiety and depression. Statistical Analysis
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Data analyses were conducted in Stata 14 (StataCorp, College Station, TX) with
procedures to account for the NCVS’s complex survey design, including use of sample weights, adjustments for stratification, and the use of Taylor series linearization to estimate variances. In
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most cases, the responses provided by respondents refer to the most recent violent incident, which occurred in the previous six months. As noted above, we controlled for whether an
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incident was a series crime. In about 4% of cases, however, respondents reported multiple incidents but could not recall details to distinguish the most recent incident from the others in the series. We account for these cases by including a series-adjusted victimization weight in the analysis.25 Analyses were conducted on complete cases only.
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We focused our analysis on the psychological consequences of violent crime by gender and disability status. Specifically, we estimated unadjusted logistic regressions to model group differences in respondents’ odds of reporting severe distress, anxiety, depression, and anxiety
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and depression. We then estimated multiple logistic regressions to examine the associations between gender and disability status and psychological consequences while controlling for
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potential confounding variables. Each model results in three comparisons between the four disability-gender groups, all of whom experienced violence (with one as the reference category). This increases the probability Type I errors. Thus, along with conventional p-values, we present the p-value associated with the Bonferroni-corrected alpha (p<.0167). Below, Tables 1 and 2 present descriptive statistics for all covariates and dependent variables, stratified by disability and gender. We indicate significant pairwise differences based
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on chi-squared tests. Tables 3 and 4 display the odds of experiencing the four psychological outcomes for men and women with disabilities compared to the other three groups, controlling for covariates. Each cell of Tables 3 and 4 represents a different regression, with alternating
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reference groups or dependent variables, so we do not include results for covariates in the
interest of space. However, to illustrate the effects of sociodemographic and crime characteristics we include Table 5, which provides parameter estimates for all covariates for models with men
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without disabilities as the reference. Results of all covariates for the other models are available
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upon request.
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Results Nearly 20%, or 1,581 individuals, reported having a disability among the 8,070 respondents. Among people with disabilities, men were more likely to be deaf or hard of hearing
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and women were more likely to have self-care or independent living limitations. On average, people with disabilities had lower levels of education than people without disabilities. Both men and women with disabilities were less likely to be Hispanic, married, or employed than men and
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women without disabilities, respectively. On average, men and women with disabilities were about 8 years older than their counterparts without disabilities.
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[Table 1]
The characteristics of violent incidents differed between people with and without disabilities. Men with disabilities were more likely to be robbed but were less likely to be threatened than men without disabilities. A higher percentage of women with disabilities
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experienced sexual violence compared to women without disabilities. Men with disabilities were more likely to experience violence by a relative, and men and women with disabilities were both more likely to have been victimized by someone who was known, like a neighbor or colleague,
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compared to respondents of the same gender without disabilities. Higher percentages of men and women with disabilities experienced severe distress, anxiety, depression, and anxiety and
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depression than men and women without disabilities, respectively (Table 2). [Table 2]
The first set of logistic regressions compared men with disabilities to the other three
groups. Controlling for sociodemographic and crime characteristics, men with disabilities had higher odds of reporting severe distress (AOR: 2.07, p<0.001), anxiety (1.79, p<0.001), depression (2.32, p<0.001), and anxiety and depression (2.34, p<0.001) resulting from violent
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crime compared to men without disabilities. On the other hand, men with disabilities had significantly lower odds of severe distress (0.53, p<0.001) or anxiety (0.57, p<0.01) compared to women with disabilities. Compared to women with disabilities, the odds of depression (AOR:
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0.69) or anxiety and depression (AOR: 0.71) were also significantly lower among men with disabilities at the p<0.05 level, but not at the Bonferroni-adjusted significance level. There were
the four outcomes. [Table 3]
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no statistical differences between men with disabilities and women without disabilities for any of
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Next, we compared women with disabilities to the other three groups (Table 4). Comparisons between women and men with disabilities were presented in Table 3, so were omitted from Table 4. Women with disabilities had significantly higher odds of each of the adverse psychological outcomes resulting from violent crime compared to men or women
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without disabilities. All comparisons between women with disabilities and men and women without disabilities were significant at the p<0.001 level except for the odds of anxiety compared to women without disabilities (p<0.01). Men without disabilities were less likely to report poor
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psychological outcomes compared to the three other groups (all p<0.001; comparison to women
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without disabilities not shown).
[Table 4]
We found a number of associations between respondents’ sociodemographic
characteristics and their mental health following violent incidents (Table 5). Non-Hispanic black respondents had higher odds of experiencing severe distress (AOR: 1.33) and depression (1.34, both p<0.05), and Hispanic individuals had higher odds of depression (AOR: 1.36) and anxiety and depression (1.44; both p<0.05) compared to whites. Age was also positively associated with
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severe distress (1.16, p<0.001), anxiety (1.08, p<0.05), depression (1.13, p<0.01) and anxiety and depression (1.14, p<0.001). Respondents who were employed were less likely to report severe distress (0.75, p<0.01) or anxiety (0.83, p<0.05) compared to those who were
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unemployed. Individuals who were widowed (AOR: 1.61) or divorced or separated (AOR: 1.27) had increased odds of anxiety and depression compared to married respondents (both p<0.05). Respondents who were divorced or separated were also more likely to experience severe distress
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following a violent crime compared to those who were married (1.34, p<0.01).
Mental health outcomes also differed by the type of crime committed. The
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psychological consequences of sexual violence were more adverse – across all four outcomes – than those of non-sexual assault or verbal threats of violence (all p<0.01 or p<0.001), but were not statistically different from the psychological consequences following robbery. Individuals who had experienced a series victimization had significantly higher odds of each of the four
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mental health outcomes than those who did not experience a series crime (all p<0.001). Finally, individuals who experienced partner violence were more likely to experience anxiety (AOR: 1:49, p<0.05) and anxiety and depression (1.44, p<0.05) compared to people who were
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victimized by a relative. Respondents who were victimized by a stranger or someone who was known (but not a relative or partner) were also less likely to experience severe distress (both
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p<0.001), depression (both p<0.001), or anxiety and depression (p<0.001 and p<0.01 respectively) compared to people who experienced violence by a relative. [Table 5]
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Discussion Violence prevention is recognized as an important public health goal,7 however the risk of victimization is unequally distributed. Previous studies have found that people with
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disabilities experience violence at substantially higher rates than people without disabilities.2,3,6 This literature has drawn attention to important criminal justice and public health issues relating to the safety and human rights of people with disabilities. This study builds on previous research
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by using a nationally representative sample to analyze differences in psychological consequences between men and women with and without disabilities who were victims of violent crime.
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Our findings are consistent with previous research on the poor psychological consequences related to violence against people in the general population.26 We extend these findings in two ways. First, we provide evidence of differential psychological consequences of violence between people with and without disabilities. Women with disabilities were
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significantly more likely to report poor mental health after a violent incident than people without disabilities regardless of gender. Men with disabilities also had higher odds of experiencing psychological consequences than men without disabilities. People with disabilities, in general,
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are at higher risk of poor mental health, due in part to social adversity, lack of social support, and inaccessible health care.9,27 Thus, it is possible that the increased prevalence of violence
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victimization against people with disabilities contributes to the higher rates of mental disorders observed in previous studies. Our findings warrant additional research into the role of violence as a social determinant of disability-related mental health disparities. Second, this study contributes to the body of evidence regarding gender differences in
the psychological consequences of violence. Most research about gender differences in the effects of violence has found women to be more vulnerable to adverse psychological
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repercussions.16,26 However, other studies have found that men and women experience similar outcomes when characteristics of the crime and victims’ histories of violence are considered.28 Rather than drawing conclusions about “feminine vulnerability,” Romito and Grassi29 propose
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the concept of “situational vulnerability,” which contextualizes the crime and the victim who experienced it. Our findings support this idea by including disability as an additional possible source of vulnerability.
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Women in the general population may be more likely than men to experience adverse psychological outcomes due to greater severity or repeated incidents of violence.30 However,
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when comparing people by disability status, people with disabilities also face a heightened level of “situational vulnerability,” experiencing a greater prevalence of serious violence victimization.5 Our findings that men with disabilities and women without disabilities have similar odds of poor psychological outcomes suggests that intervention strategies should account
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for multiple points of vulnerability, including, but not exclusive to, gender. Future research on the health effects of violence can examine the unique risks faced by people with disabilities, and how these challenges intersect with membership in other identity groups.
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While people with disabilities may be more vulnerable to violence and have less access to health care, which together may contribute to worse mental health1,9, they may also have
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heightened exposure to risk factors associated with poor psychological well-being. For example, people with disabilities in the sample had lower levels of education (Table 1), and we found that higher educational attainment was related to better mental health (Table 5). Given previous research on the socioeconomic-health gradient31, it is important for future investigations to consider the how lower levels of education among people with disabilities may contribute to health disparities, and to examine the buffering mechanisms that education provides for coping
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with traumatic experiences, like violence. We also found that people with disabilities were married and employed at lower rates (Table 1), and both marriage and employment predicted better mental health outcomes following violence (Table 5). Both employment32 and marriage33
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have been found to be health-promoting, likely because social relationships are positively
correlated and well-being.34 Of course, the linkage between marriage and coworker relationships and positive mental health is contingent on such relationships being nonviolent.
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This study has several implications for violence prevention and interventions for people with disabilities. First, interventions should be tailored to account for the risk factors to which
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people with disabilities are disproportionately exposed. For example, given previous evidence that social support is protective against poor mental health associated with violence35, interventionists should concentrate on increasing support for people with disabilities who experience violence, perhaps targeting people who are not married or employed. Educational
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attainment has also been hypothesized to be an important buffer against psychological distress because it facilitates help-seeking behaviors.36 People with disabilities face interpersonal and structural barriers to seeking help37, which may have the dual effect of increasing their
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vulnerability to violence while exacerbating poor mental health consequences. Thus, violence prevention efforts can focus on removing barriers to help-seeking, particularly among people
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with disabilities with lower educational attainment. The Centers for Disease Control and Prevention has argued for the wider application of
epidemiological methods in violence prevention strategies,38 however, the disproportionate risks and adverse outcomes experienced by people with disabilities have not been fully accounted for in public health violence interventions.3 Researchers and officials can include disability questions in surveillance activities to ensure that the public health goals of violence reduction
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extend to people with disabilities. In addition to identifying risk factors, additional focus should be paid to the protective factors that facilitate psychological healing and resiliency among people with disabilities. These objectives require the full and equal inclusion of people with disabilities,
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not only as research subjects, but also as participants in violence prevention and intervention programs.
This study’s results also suggest the need for health care providers and agencies that
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serve people with disabilities to include items about victimization and mental health during
screenings and assessments. However, once providers or organizations serving violence victims
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identify the psychological needs of people with disabilities, attention should turn toward the ease of accessing mental health and trauma specialists. People with disabilities face both structural, socioeconomic, and stigma-related barriers to health care,9,10 so it is crucial that mental health providers and violence prevention organizations offer accessible therapeutic services.
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Limitations
The NCVS sample does not cover people who are living in institutions, excluding a substantial proportion of people with disabilities. In addition, the telephone-administered
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component of the survey may have, in effect, excluded many people who are deaf or hard of hearing, and possibly people with cognitive disabilities who may require assistance with an
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interview. Therefore, the survey is not representative of people with disabilities in the United States. In addition, previous research on gender and mental health suggests that men may be less likely to report accurately about their mental health due to social desirability and gender norms.39 If this is the case, the results may overestimate gender differences. Our models did not account for respondents’ type of disability. We found that controlling for disability type resulted in evidence of concerning levels of multicollinearity, with condition numbers greater than 100.40
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Future research should consider the distribution of mental health morbidity across different types of disabilities, as some people with disabilities may be more vulnerable than others. The number of valid responses varied somewhat across measures due to the skip pattern
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in the NCVS. Variation is indicated in the notes under the tables of results. However, the
interpretation of the results should be based on the specific subsample of respondents to whom survey questions were fielded. For example, only respondents who reported moderate or severe
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distress were asked about depression or anxiety. It is possible that some respondents who reported low levels of distress may have experienced anxiety or depression as well.
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Unfortunately, the NCVS does not capture these cases.23 In addition, the NCVS does not include some potentially confounding variables in its public-use files. For instance, we were unable to control for respondents’ state of residence, which may be associated with variation in rates of violence. We were also unable to control for health insurance status because only respondents
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who reported injuries from violence are asked about insurance coverage. Health insurance coverage may affect reports of psychological symptoms. Based on the questions in the NCVS, we cannot account for the temporal order of
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disability and violence. In some cases, violence may have caused respondents’ disabilities. Finally, the violence measures included in the NCVS do not include disability-related violence,
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such as the denial of personal assistance services, medication manipulation, or destruction of assistive technology. Future studies should examine the impact of these types of abuse on a representative sample of persons with disabilities.
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Conclusions Despite these limitations, this study contributes to the growing body of research about violence against people with disabilities. Results of this study emphasize the high risk of
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psychological consequences related to violence victimization, and suggest that people with disabilities are particularly vulnerable to adverse psychological outcomes. These findings
support the need to include disability status in future research about violence and mental health
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and ensure the accessibility of psychological and violence intervention services.
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References
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3. Mitra M, Mouradian VE, Fox, MH, Pratt C. Prevalence and characteristics of sexual violence against men with disabilities. Am J Prev Med. 2016; 50(3): 311-317.
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4. Smith DL. Disability, gender and intimate partner violence: Relationships from the behavioral risk factor surveillance system. Sex Disabil. 2008; 26(1): 15-28. 5. Harrell E. Crime against persons with disabilities, 2009–2015: Statistical tables (NCJ 250632). Washington, DC: US Department of Justice; 2017. 6. Rand MR, Harrel E. Crime against people with disabilities, 2007 (NCJ 227814). Washington, DC: US Department of Justice; 2009.
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8. Safran MA, Mays RA, Namhe Huang L, et al. Mental health disparities. Am J Public Health. 2009; 99(11): 1962-1966.
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9. Krahn GL, Klein Walker D, Correa-De-Araujo R. Persons with disabilities as an unrecognized health disparity population. Am J Public Health. 105(S2): S198-S-206. 10. Iezzoni LI. Eliminating health and health care disparities among the growing population of people with disabilities. Health Affair. 2011; 30(10): 1947-1954. 11. Kinne S, Patrick DL, Lochner Doyle D. Prevalence of secondary conditions among people with disabilities. Am J Public Health. 2004; 94(3): 443-446. 12. Goodman LA, Salyers MP, Mueser, KT, et al. Recent victimization in women and men with severe mental illness: Prevalence and correlates. J Trauma Stress. 2001; 14(4): 615632.
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13. Casteel C, Martin SL, Smith JB, Gurka KK, Kupper LL. National study of physical and sexual assault among women with disabilities. Inj Prev. 2008; 14(2): pp.87-90.
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14. Curry MA, Renker P, Hughes RB, et al. Development of measures of abuse among women with disabilities and the characteristics of their perpetrators. Violence Against Women. 2009; 15(9): 1001-1025. 15. Kaura SA, Lohman BJ. Dating violence victimization, relationship satisfaction, mental health problems, and acceptability of violence: A comparison of men and women. J Fam Violence. 2007; 22(6): 367-381.
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16. Afifi TO, MacMillan H, Cox BJ, Asmundson GJ, Stein MB, Sareen J. Mental health correlates of intimate partner violence in marital relationships in a nationally representative sample of males and females. J Interpers Violence. 2009; 24(8): 13981417. 17. Scherer HL, Snyder JA, Fisher BS. Intimate partner victimization among college students with and without disabilities: Prevalence of and relationship to emotional well-being. J Interpers Violence. 2016; 31(1): 49-80.
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18. Rowsell AC, Clare IC, Murphy GH. The psychological impact of abuse on men and women with severe intellectual disabilities. J Appl Res Intellect Disabil. 2013; 26(4): 257-270.
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19. United States Department of Justice. Office of Justice Programs. Bureau of Justice Statistics. National Crime Victimization Survey, concatenated file, 1992-2014. ICPSR36143-v1. Ann Arbor, MI: Inter-university Consortium for Political and Social Research; 2016-03-01. https://doi.org/10.3886/ICPSR36143.v1.
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20. Truman JL, Langton L. Criminal victimization, 2014 (NCJ 248973). Washington, DC: US Department of Justice; 2015. 21. Ruback RB, Clark VA, Warner C. Why are crime victims at risk of being victimized again? Substance use, depression, and offending as mediators of the victimization– revictimization link. J Interpers Violence. 2014; 29(1): 157-185. 22. Cornaglia F, Feldman NE, Leigh A. Crime and mental well-being. J Hum Resour. 2014; 49(1): 110-140. 23. Bureau of Justice Statistics. National Crime Victimization Survey technical documentation (NCJ 247252). Washington, DC: US Department of Justice; 2014.
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24. Sternberg KJ, Baradaran LP, Abbott CB, Lamb ME, Guterman E. Type of violence, age, and gender differences in the effects of family violence on children’s behavior problems: A mega-analysis. Dev Rev. 2006; 26(1): 89-112.
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25. Shook-Sa B, Couzens GL, Berzofsky M. User’s guide to the National Crime Victimization Survey (NCVS) direct variance estimation. Research Triangle Park, NC: RTI International; 2015. 26. Coker, AL, Davis KE, Arias I, et al. Physical and mental health effects of intimate partner violence for men and women. Am J Prev Med. 2002; 23(4): 260-268.
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27. Egede, LE. Major depression in individuals with chronic medical disorders: Prevalence, correlates and association with health resource utilization, lost productivity and functional disability. Gen Hosp Psychiatry. 2007; 29(5): 409-416.
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30. Brownridge DA. Partner violence against women with disabilities: Prevalence, risk, and explanations. Violence against women. 2006; 12(9): 805-822. 31. Adler NE, Boyce T, Chesney MA, et al. Socioeconomic status and health: The challenge of the gradient. American psychologist. 1994; 49(1), 15-24.
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33. Simon RW. Revisiting the relationships among gender, marital status, and mental health. American journal of sociology. 2002; 107(4), 1065-1096. 34. House JS, Landis KR, Umberson D. Social relationships and health. Science. 1998; 241(4865), 540-545. 35. Coker AL, Smith PH, Thompson MP, McKeown RE, Bethea L, Davis KE. Social support protects against the negative effects of partner violence on mental health. Journal of women's health & gender-based medicine. 2002; 11(5), 465-476. 36. Gulliver A, Griffiths KM, Christensen H. Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC psychiatry. 2010; 10(1), 20
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113.
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37. Barrett, BJ, Pierre MS. Variations in women’s help seeking in response to intimate partner violence: Findings from a Canadian population-based study. Violence against women. 2011; 17(1), 47-70. 38. Dahlberg LL, Mercy JA. History of violence as a public health issue. Atlanta, GA: Centers for Disease Control and Prevention; 2009. Retrieved from https://www.cdc.gov/violenceprevention/pdf/history_violence-a.pdf.
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39. Sigmon ST, Pells JJ, Boulard NE, et al. Gender differences in self-reports of depression: The response bias hypothesis revisited. Sex Roles. 2005; 53(5): 401-411.
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40. Belsley, DA, Kuh E, Welsch RE. Regression diagnostics: Identifying influential data and sources of collinearity. Hoboken, NJ: John Wiley & Sons; 1980.
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The Psychological Consequences of Violence against People with Disabilities
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Tables
Significant Pairwise Differences (p<.05)*
-
a
-
-
50.5 (46.4, 54.6)
56.0 (51.5, 60.5)
-
-
Cognitive disability
57.8 (53.5, 62.0)
57.1 (52.8, 61.3)
-
-
Self-care/independent living limitation||
34.7 (30.4, 39.3)
45.0 (41.2. 49.0)
-
-
a
Education Less than HS
25.9 (21.8, 30.5)
20.9 (18.0, 24.1)
13.9 (12.3, 15.6)
16.0 (14.1, 18.0)
b, c
HS degree
33.5 (29.1 38.2)
27.1 (22.4, 32.2)
29.1 (26.8, 31.5)
25.5 (23.5, 27.6)
d
Some college
28.8 (24.7, 33.3)
39.1 (33.9, 44.6)
35.7 (32.9, 38.5)
36.7 (34.6, 38.8)
a, b
College degree
8.5 (6.3, 11.3)
7.9 (5.8, 10.6)
16.3 (14.6, 18.2)
15.2 (13.6, 17.1)
b, c
Advanced degree
3.3 (2.0, 5.4)
5.0 (3.5, 7.2)
5.1 (4.3, 6.1)
6.6 (5.5, 8.0)
Physical disability
§
Race/Ethnicity
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16.9 (13.1, 21.4)
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Women without Disabilities (n=3,238)
13.1 (10.6, 16.0)
‡
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Blind or difficulty seeing
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Table 1: Demographic Characteristics by Disability Status and Gender, % (95% CI) Men with Women with Men without Disabilities Disabilities Disabilities (n=704) (n=877) (n=3,251) † Disability Deaf or hard of hearing 20.7 (17.3, 24.5) 14.4 (11.6, 17.7) -
White, non-Hispanic
65.3 (60.5, 70.0)
66.3 (62.7, 70.6)
65.1 (62.8, 67.3)
62.7 (60.0, 65.4)
Black, non-Hispanic
15.7 (12.0, 20.3)
14.2 (11.5, 17.5)
13.1 (11.5, 14.8)
17.0 (15.0, 19.2)
d
Hispanic
11.2 (8.7, 14.2)
10.0 (7.6, 13.1)
15.5 (13.8, 17.4)
14.0 (12.4, 15.7)
b, c
Other¶
7.9 (5.6, 11.1)
9.5 (6.7, 13.4)
6.4 (5.3, 7.6)
6.3 (5.2, 7.5)
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42.9 (41.4, 44.3)
35.8 (35.1, 36.5)
Married Married
29.3 (25.4, 33.5)
25.1 (21.7, 29.0)
41.7 (39.4, 44.1)
34.4 (32.0, 36.9)
b, c, d
Widowed
6.0 (4.3, 8.3)
8.4 (6.4, 10.9)
3.2 (2.5, 4.1)
4.2 (3.3, 5.3)
b, c
Divorced or separated
36.7 (31.8, 41.8)
42.1 (37.9, 46.4)
19.9 (18.2, 21.7)
26.8 (24.9, 28.9)
b, c, d
Single, never married
28.1 (23.7, 32.8)
24.4 (20.5, 28.8)
35.3 (32.8, 37.8)
34.6 (32.3, 36.9)
b, c
29.6 (25.5, 34.0)
24.7 (20.4, 30.0)
72.3 (70.2, 74.4)
61.7 (59.7, 63.7)
b, c, d
SC
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43.3 (42.7, 45.0)
Employed (Yes=1)
35.3 (34.6, 36.0)
b, c
Age (years)
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* a. men with disabilities vs. women with disabilities; b. men with disabilities vs. men without disabilities; c. women with disabilities vs. women without disabilities; d. men without disabilities vs. women without disabilities. Uncorrected chi-squared tests except comparisons by age, which are adjusted Wald chi-squared tests. † Disability percentages sum to greater than 100 because respondents can report more than one disability ‡ Physical disability refers to difficulty “walking, climbing stairs, reaching, lifting, or carrying” § Cognitive disability refers to difficulty “learning, remembering, or concentrating” || Self-care or independent living limitations refer to difficulty “dressing, bathing, or getting around inside the home” or “going outside alone to shop or visit a doctor’s office” ¶ Other race/ethnicity includes Native American and Alaskan, Asian, Hawaiian, Pacific Islander, and mixed-race
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Type of Crime Sexual
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Table 2: Type of Violence, Incident Characteristics, and Psychological Symptoms by Disability Status and Gender, % (95% CI) Women with Men without Women without Men with Disabilities Disabilities Disabilities Disabilities (n=704) (n=877) (n=3,251) (n=3,238)
Significant Pairwise Differences (p<.05)*
9.5 (7.4, 12.1)
0.7 (0.5, 1.2)
6.3 (5.4, 7.4)
a, c
Robbery
17.7 (15.3, 20.4)
12.4 (10.4, 14.8)
13.2 (11.9, 14.6)
10.1 (9.0, 11.4)
a, b
Non-sexual assault
55.1 (51.5, 58.7)
49.4 (45.4, 53.3)
55.1 (53.2, 57.0)
56.4 (54.3, 58.5)
a, c
Threat of violence
26.3 (23.1, 29.8)
28.7 (24.4, 33.6)
31.0 (29.0, 33.1)
27.1 (25.3, 29.1)
b
Intimate Partner
7.2 (5.0, 10.2)
26.1 (22.2, 30.3)
5.9 (5.0, 6.8)
26.5 (24.3, 28.9)
a, d
Relative
10.2 (7.7, 13.3)
11.6 (9.3, 14.4)
4.8 (4.0, 5.7)
10.3 (9.0, 11.8)
b, d
Known Other
36.2 (31.6, 41.1)
35.5 (31.9, 39.2)
26.1 (24.2, 28.2)
27.6 (25.5, 29.8)
b, c
Stranger
46.4 (41.1, 51.8)
26.9 (23.6, 30.5)
63.2 (6.1, 65.3)
35.5 (33.1, 38.0)
a, b, c, d
5.2 (3.7, 7.3)
3.8 (3.0, 4.7)
4.1 (3.3, 5.0)
Psychological Symptoms
3.6 (2.2, 5.8)
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Serial Victimization (Yes=1)†
SC
0.9 (0.4, 2.2)
16.0 (12.7, 20.0)
4.2 (3.0, 5.8)
28.9 (26.8, 31.0)
8.6 (7.4, 10.1)
a, b, c, d
Mild
23.9 (20.4, 27.9)
15.9 (12.8, 19.6)
31.9 (30.0, 34.1)
25.6 (23.5, 27.9)
a, c, d
Moderate
22.9 (19.4, 26.9)
22.4 (19.5, 25.6)
22.7 (20.8, 24.6)
30.7 (28.7, 32.7)
c, d
Severe
37.2 (32.4, 42.2)
57.5 (52.9, 61.9)
16.6 (14.9, 18.6)
35.1 (33.0, 37.2)
a, b, c, d
Anxiety
72.1 (68.0, 75.9)
84.4 (80.9, 87.4)
56.0 (52.5, 59.4)
72.9 (70.2, 75.5)
a, b, c, d
Depression
58.4 (53.4, 63.2)
72.5 (68.3, 76.4)
32.7 (29.2, 36.3)
54.5 (52.0, 59.9)
a, b, c, d
AC C
None
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a, b, c, d Anxiety and depression 52.3 (47.2, 57.3) 66.4 (61.8, 70.7) 27.3 (23.9, 31.0) 48.9 (46.1, 51.6) * a. men with disabilities vs. women with disabilities; b. men with disabilities vs. men without disabilities; c. women with disabilities vs. women without disabilities; d. men without disabilities vs. women without disabilities; p<0.05 † Serial victimization is defined as 6 or more similar violent incidents occurring within a 6-month period ‡ A smaller subsample (n=4021) is asked about psychological and emotional reactions to victimization. Respondents who reported moderate or severe distress, or that the crime created social problems with family, friends, or work were asked about their psychological or emotional symptoms.
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Table 3. Group Comparisons: Psychological Consequences of Violence Victimization Among Men with Disabilities‡ § || (Unadjusted and Adjusted) Men with Disabilities Compared With: Women with Disabilities Men Without Disabilities Women without Disabilities (OR) (AOR) (OR) (AOR) (OR) (AOR) † † † † 0.44*** 0.53*** 2.89*** 2.07*** 1.09 0.99 Severe Distress (.06) (.08) (.40) (.34) (.14) (.15) Anxiety¶ 0.49***† 0.57**† 2.01***† 1.79***† 1.00 0.96 (.08) (.10) (.27) (.27) (.14) (.15) Depression¶ .53***† 0.69* 2.81***† 2.32***† 1.16 1.32 (.08) (.12) (.38) (.37) (.15) (.20) Anxiety and Depression¶ .55***† 0.71* 2.82***† 2.34***† 1.14 1.22 (.08) (.12) (.41) (.39) (.15) (.18) Note: Standard errors (linearized) in parentheses *** p<0.001 ** p<0.01 * p<0.05 † Bonferroni-corrected alpha, p<.0167 ‡ Adjusted logistic regression models control for race/ethnicity, education, age, employment status, marital status type of crime, series victimization, and victim-offender relationship. § Excludes: certain cases of robbery, threatened robbery, and verbal harassment. || Excludes cases in quarters 1 and 2 of 2008 when questions were not asked. ¶ Anxiety and depression questions not asked to respondents who report no or mild distress or no social problems.
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Table 4. Group Comparisons: Psychological Consequences of Violence Victimization Among Women with Disabilities ‡ § || (Unadjusted and Adjusted) Women with Disabilities Compared With§§: Men Without Disabilities Women without Disabilities (OR) (AOR) (OR) (AOR) 6.60***† 3.90***† 2.49***† 1.86***† Severe Distress (.80) (.58) (.30) (.26) Anxiety¶ 4.20***† 3.90***† 2.01***† 1.76**† (67) (.56) (.32) (.29) ¶ † † † Depression 5.27*** 3.27*** 2.18*** 1.90***† (.75) (.27) (.27) (.56) Anxiety and Depression¶ 5.08***† 3.33***† 2.05***† 1.72***† (.76) (.57) (.26) (.24) Note: Standard errors (linearized) in parentheses *** p<0.001 ** p<0.01 * p<0.05 † Bonferroni-corrected alpha, p<.0167 ‡ Adjusted logistic regression models control for race/ethnicity, education, age, employment status, marital status type of crime, series victimization, and victim-offender relationship. § Excludes: certain cases of robbery, threatened robbery, and verbal harassment. || Excludes cases in quarters 1 and 2 of 2008 when questions were not asked. §§ Comparisons between women and men with disabilities presented in Table 3. ¶ Anxiety and depression questions not asked to respondents who report no or mild distress or no social problems.
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Table 5. Psychological Consequences of Violence Victimization (Unadjusted and Adjusted)
Hispanic Other Education# High school Some college Bachelor's degree Advanced degree Age§ Employed
2.89***† (.40) 6.60***† (.80) 2.64***† (.20)
2.07***† (0.34) 3.90***† (0.58) 2.09***† (0.18)
2.00***† (.27) 4.20***† (.67) 2.09***† (.20)
1.79***† (0.26) 3.27***† (0.56) 1.87***† (0.20)
1.33* (0.15) 1.14 (0.13) 1.10 (0.17)
OR
AOR
2.81***† (.38) 5.27***† (.75) 2.39***† (.22)
2.32***† (0.37) 3.33***† (0.57) 1.74***† (0.18)
SC
AOR
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Race/ethnicity‡ Black, non-Hispanic
OR
Anxiety and Depression OR AOR 2.82***† (.41) 5.08***† (.76) 2.46***† (.26)
2.35***† (0.39) 3.29***† (0.57) 1.92***† (0.21)
0.99 (0.12) 1.20 (0.16) 0.95 (0.15)
1.34* (0.19) 1.36* (0.19) 1.32 (0.25)
1.24 (0.17) 1.44* (0.20) 1.32 (0.24)
0.96 (0.11) 0.92 (0.10) 0.73* (0.11) 0.66* (0.11)
0.93 (0.13) 0.93 (0.12) 0.87 (0.14) 0.88 (0.17)
0.87 (0.11) 0.83 (0.10) 0.78 (0.12) 0.67 (0.14)
0.98 (0.13) 0.93 (0.11) 0.81 (0.13) 0.74 (0.16)
1.17*** (0.03)
1.08* (0.04)
1.13** (0.04)
1.14*** (0.04)
0.75** (0.06)
0.96 (0.09)
0.83* (0.08)
0.88 (0.08)
TE D
Women without disabilities
AOR
EP
Women with disabilities
Depression
OR
AC C
Men with disabilities
Anxiety
RI PT
Severe distress
Marital status§§ 7
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Type of crime¶ Robbery Non-sexual assault Threat Series crime
1.20 (0.22) 0.64** (0.10) 0.49*** (0.09) 1.72*** (0.26)
0.97 (0.23) 0.56** (0.12) 0.53** (0.12) 3.09*** (0.85)
Victim-offender relationship## Partner
1.37 (0.29) 1.19 (0.12) 1.11 (0.13)
1.61* (0.35) 1.27* (0.13) 1.11 (0.13)
0.69 (0.16) 0.43*** (0.09) 0.30*** (0.06) 2.24*** (0.40)
0.84 (0.18) 0.49*** (0.09) 0.40*** (0.08) 2.41*** (0.42)
RI PT
Never married
1.39 (0.31) 1.09 (0.12) 1.00 (0.12)
SC
Divorced or separated
1.13 (0.22) 1.34** (0.12) 1.06 (0.10)
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1.24 1.49* 1.30 1.44* (0.17) (0.24) (0.22) (0.21) Known other 0.62*** 1.02 0.46*** 0.64** (0.08) (0.16) (0.06) (0.10) Stranger 0.51*** 0.82 0.31*** 0.42*** (0.07) (0.11) (0.04) (0.05) Constant 0.33 1.71 1.74 0.70 Note: Standard errors (linearized) in parentheses *** p<0.001 ** p<0.01 * p<0.05 † Bonferroni-corrected alpha, p<.0167 ‡ Reference group is ‘white, non-Hispanic’. “Other” includes Native American and Alaskan, Asian, Hawaiian, Pacific Islander, and mixed-race # Reference group is ‘less than high school’ § Age was rescaled by dividing the original variable by ten §§ Reference group is ‘married’ ¶ Reference group is ‘sexual violence’ 8
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Reference group is ‘relative’
AC C
##
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