Alcohol-related domestic violence: a household survey in Brazil

Abstracts

OBJETIVO: Analisar as situações de violência domiciliar ocorridas com o agressor sob efeito do álcool. MÉTODOS: Foi realizado um levantamento domiciliar que incluiu as 108 cidades brasileiras com mais de 200 mil habitantes em 2005. A amostragem foi por conglomerados, estratificada, probabilística e autoponderada, obtida em três estágios de seleção: setores censitários, domicílios e respondentes (população entre 12-65 anos de idade). O instrumento utilizado para obtenção dos dados foi o Substance Abuse and Mental Health Services Administration, com perguntas sobre dados sociodemográficos e uso de drogas psicotrópicas. RESULTADOS: Foram pesquisados 7.939 domicílios. Em 33,5% foi relatado histórico de violência domiciliar, sendo 17,1% com agressores alcoolizados. Os tipos de violência em associação com uso de álcool mais freqüentes foram: discussões direcionadas a pessoas do domicílio (81,8%), escândalos não direcionados a alguém específico (70,9%), ameaça de agressão física (39,5%) e de quebra de objetos (38,7%), agressões físicas (27,8%), com armas (5,5%) e abuso sexual (3,2%). Mais da metade dos agressores era morador do domicílio, 88,8% deles do sexo masculino. A maioria das vítimas era do sexo feminino (63,9%); 33,9% eram esposas e 18,2% filhos. Quanto às reincidências, 14,1% dos casos perduraram por período entre um a cinco anos e em 14,3% ultrapassaram uma década. A maior parte das vítimas (86%) e dos agressores (77,9%) não procurou por ajuda em serviço de saúde e/ou delegacia. CONCLUSÕES: Além da alta proporção de domicílios brasileiros com histórico de violência com agressores alcoolizados, as agressões apresentaram várias especificidades. A baixa procura por ajuda em serviços de saúde/segurança indica a importância da detecção ativa de casos de violência domiciliar.

Violência Doméstica; Consumo de Bebidas Alcoólicas; Relações Familiares; População Urbana; Levantamentos Epidemiológicos; Brasil

ORIGINAL ARTICLES

Alcohol-related domestic violence: a household survey in Brazil

Patrones de violencia domiciliar asociada al uso de alcohol en Brasil

Arilton Martins Fonseca^I; José Carlos Fernandes Galduróz^II; Cláudia Silveira Tondowski^I; Ana Regina Noto^I

^IPrograma de Pós-Graduação do Departamento de Psicobiologia. Escola Paulista de Medicina (EPM). Universidade Federal de São Paulo (Unifesp). São Paulo, SP, Brasil

^IIDepartamento de Psicobiologia. EPM-Unifesp. São Paulo, SP, Brasil

Correspondence

ABSTRACT

OBJECTIVE: To describe situations of domestic violence committed by perpetrators under the influence of alcohol in the largest Brazilian cities.

METHODS: A household survey was carried out in the 108 Brazilian cities with more than 200,000 inhabitants in 2005. A multistage probabilistic self-weighted sample stratified in terms of conglomerate units was performed in three selection stages: census tracts, households, and respondents (population between 12 and 65 years old). The instrument to collect the data was the Substance Abuse and Mental Health Services Administration, with questions on sociodemographics and psychotropic drug abuse..

RESULTS: The survey encompassed 7,939 households. In 33.5% of them there were reports of domestic violence, 17.1% out of which involving intoxicated perpetrators. The most frequently reported types of violence associated with the use of alcohol were: arguments among the people in the household (81,8%), loud arguments not aimed at a specific person (70.9%), threats of assault (39.5%), and breaking households objects (38.7%). The respondents also reported physical assault (27.8%), physical assault with weapon (5.5%), and sexual abuse (3.2%). More than half of perpetrators lived in the household and 88.8% were male. Most of the victims were female (63.9%); 33.9% were wives and 18.2% were children. In terms of recidivism, 14.1% of the cases lasted for a period between 1 and 5 years, and in 14.3% they lasted for over a decade. Most of the victims (86%) and perpetrators (77.9%) did not look for the help of either the health services or the police.

CONCLUSIONS: In addition to the considerable number of Brazilian households with a history of violence involving intoxicated abusers, this kind of abuse has many specific characteristics. The low rate for the search for help at the health services/police stations point to the importance of actively identifying cases of domestic violence.

Descriptors: Domestic Violence. Alcohol Drinking. Family Relations. Urban Population. Health Surveys. Brazil.

RESUMEN

OBJETIVO: Analizar las situaciones de violencia domiciliar ocurridas con el agresor bajo efecto de alcohol.

MÉTODOS: Fue realizado un levantamiento domiciliar que incluyó las 108 ciudades brasileras con más de 200 mil habitantes en 2005. El muestreo fue por conglomerados, estratificado, probabilístico y autoponderado, obtenido en tres fases de selección: sectores censitarios, domicilios y respondentes (población entre 12-65 años de edad). El instrumento utilizado para obtención de los datos fue el Substance Abuse and Mental Health Services Administration, con preguntas sobre datos sociodemográficos y uso de drogas psicotrópicas.

RESULTADOS: Fueron investigados 7.939 domicilios. En 33,5% fue relatado histórico de violencia domiciliar, siendo 17,1% con agresores alcoholizados. Los tipos de violencia en asociación con uso de alcohol más frecuentes fueron: discusiones direccionadas a personas del domicilio (81,8%), escándalos no direccionados a alguien específico (70,9%), amenaza de agresión física (39,5%) y de ruptura de objetos (38,7%), agresiones físicas (27,8%), con armas (5,5%) y abuso sexual (3,2%). Más de la mitad de los agresores era morador del domicilio, 88,8% de ellos del sexo masculino. La mayoría de las víctimas era del sexo femenino (63,9%); 33,9% eran esposas y 18,2% hijos. Con relación a las reincidencias, 14,1% de los casos perduraron por período entre uno a cinco años y en 14,3% ultrapasaron una década. La mayor parte de las víctimas (86%) y de los agresores (77,9%) no procuró ayuda en servicio de salud y/o policía.

CONCLUSIONES: Además de la alta proporción de domicilios brasileros con histórico de violencia con agresores alcoholizados, las agresiones presentaron varias especificidades. La baja búsqueda de ayuda en servicios de salud/policía indica la importancia de la detección activa de casos de violencia domiciliar.

Descriptores: Violencia Doméstica. Consumo de Bebidas Alcohólicas. Relaciones Familiares. Población Urbana. Encuestas Epidemiológicas. Brasil.

INTRODUCTION

Domestic violence affects the entire world population, thus representing a serious social and public health issue.^10,13,14 The World Health Organization (WHO) considers that violence can be prevented and recommends prioritizing research in the field based on Resolution 56.24 issued during the World Health Assembly (WHA) held in 2003.

The association between domestic violence and alcohol intake has been addressed in studies carried out in countries such as the United States, United Kingdom, Australia and Switzerland. Researches carried out in North America show that from 50 to 70% of the cases of domestic violence between couples the husband had been drinking before the assault.^9,14,16,19 Another study in the U.S. looked into calls to the police because of domestic violence and found that in 86% of the cases the aggressors had been drinking on the day of the assault.³

In Latin America, in a study involving eight cities (Salvador and Rio de Janeiro, Brazil; Santiago, Chile; Cali, Colombia; San José, Costa Rica; San Salvador, El Salvador; Caracas, Venezuela), it was found that 68% of the aggressors had been drinking before assaulting their wives and partners.¹⁸ In another study carried out in five countries (Colombia, Dominican Republic, Haiti, Nicaragua and Peru), women whose partners drunk on a regular basis were from 2.6 to 9.8 times more likely to being victims of assault compared to women whose partners did not drink.⁸ In Brazil, a household survey showed that aggressors committed assaults under the influence of alcohol in 52% of the households with a history of violence.²⁰

Alcohol is consumed in almost all the regions of the world and in different cultural contexts. In Brazil, a national household survey with the population in the 12-65 age group estimated a prevalence of 74.6% of alcohol intake and 12.3% of alcohol dependence.⁴

Although there are strong associations between domestic violence and alcohol abuse, there are not many studies addressing the specific features of these associations.

Thus, the objective of this study was to analyze situations of domestic violence that occurred due to the influence of alcohol.

METHODS

The data used in this study were obtained from the II Levantamento Domiciliar sobre o Uso de Drogas Psicotrópicas no Brasil - 2005 (II Household Survey on Psychotropic Drugs in Brazil - 2005), no Centro Brasileiro de Informações Sobre Drogas Psicotrópicas (CEBRID - Brazilian Center for Information on Psychotropic Drugs).

The studied population was in the 12-65 age group who resided in the 108 Brazilian cities with more than 200 thousand inhabitants. The survey was carried out between August and December 2005. The information was gathered at the households through a multistage probabilistic self-weighted sample stratified in terms of conglomerate units performed in three selection stages.

In the first stage, census tracts were randomly drawn and represented geographical areas containing approximately 200 to 300 households. The census tract is the smallest study unit for socioeconomic data at the Instituto Brasileiro de Geografia e Estatística (IBGE - the Brazilian Institute of Geography and Statistics). This information was used to determine, in each city, through multivariate statistics techniques, groups of homogenous tracts called strata. The number of census tracts per city varied from one to 60 depending on the city's population size.

In the second stage, a systematic random sample was selected and was made up of 24 households per census tract. In calculating the household sample, businesses shops, hospitals, factories, hostels, hotels, among others, were not considered. In the case of buildings, each apartment was counted as a household.

In the third stage, a respondent was selected to provide information on the situations of domestic violence. The selection was random, through an independent mechanism of the interviewer, according to Kish.¹¹

The Substance Abuse and Mental Health Services Administration (SAMHSA) questionnaire was applied. This instrument was adapted and validated for the Brazilian context in 1999,

The team of interviewers for the 27 Brazilian state capitals received standardized training, aimed at making interview procedures more homogenous, in addition to providing information on applying and filling in the questionnaire.

The study was approved by the Ethics and Research Committee of the Universidade Federal de São Paulo (Registration N. 1895/06). The interviews were carried out in private with the respondent and without the presence of third parties. Respondents were informed about the goals and procedures of the study and were ensured anonymity, and informed of right to stop the interview at any time.

RESULTS

From the 9,528 households drawn, 7,939 were included in the study. The loss rate was 16.7%, of which 9.6% corresponded to refusals and 7.1% were due to safety issues of the survey team (e.g. households in drug trafficking areas).

Table 1 shows the sociodemographic characteristics of the 7,939 respondents. The distribution of interviewees in terms of sex and marital status (married/single) was similar. More than half of the respondents were age 35 and above. In terms of schooling, 28.3% were illiterate or had not finished elementary school.

Among the 7,939 households surveyed, in 2,661 (33.5%) some kind of violence was reported, out of which 1,361 (17,1%) households respondents reported the aggressors were under the influence of alcohol at the time of the assault. Among the cases of violence reported, 49.4% took place in the year prior to the survey.

Table 2 shows the various kinds of violence that took place in the households after aggressors had been drinking. The most common kinds of violence were verbal assault (scolding/argument 81.8% and loud argument 70.9%), followed by threats of: breaking objects in the household (38.7%), physical assault (39.5%), and assault with objects in the household (27.9%). Additionally, the survey also considered violent reports of assault involving weapons, sexual abuse and theft of money and objects from the household. All of the respondents reported more than one kind of violence on the same occasion.

Concerning recurrence of violence, among the households with a background in alcohol-related violence, in 14.1%, the violence lasted from one to five years, and in 6.8%, from six to ten years, and in 14.3%, they lasted more than a decade.

The characteristics of the 1,306 aggressors are shown in Table 3. The survey found a higher proportion of aggressors who lived in the surveyed household. Most aggressors were male, and belonged to the 31-59 age-group. Only 10.9% of aggressors looked for some kind of help in cutting down on alcohol intake or quitting.

Table 4 shows the characteristics of the 1,173 victims identified during the survey. The rate of women was more than two times the rate of men (63.9% versus 31.0%) and 49.5% were between 31 and 59 years of age; in 18.2% the children were the victims. Only 8.3% of the victims looked for some kind of help of the police and 3.7% resorted to the health services.

DISCUSSION

Due to the complexity of the topic, it is possible that the cases of violence have been under-reported. Nevertheless, there was a high prevalence of households with a history of violence associated to drinking. In more than half of the cases of violence reported, the aggressor was under the influence of alcohol. The rate of violent episodes involving alcohol intake corroborates other studies carried out in Brazil and other countries.^{6,8,17,20,21,24}

The different forms of violence associated to alcohol use found in the present study have also been described in the literature. Studies have showed that episodes of domestic violence involving alcohol use tend to be more severe and increase the likelihood of co-occurrence of other forms of violence.^{7,12,19,22,23}

Based on the pharmacological model, alcohol produces disinhibition and impairs judgment, which in some situations can facilitate or justify more aggressive behaviors.^{1,7,8,10,16,24} Alterations on the levels of monoaminergic neurotransmitters such as dopamine and serotonine may also be associated with alcohol-related assaults.^2,5

However, among the many assumptions proposed to explain violence, excessive alcohol use is one of the most controversial. There is no consensus on whether this is a causal relationship or alcohol consumption is an excuse for violent behavior.¹⁵ It is likely to be a complex relationship involving several other biological, psychological and social factors.^2,5,12,17

In regard to violence recurrence, alcohol use by aggressors seems to increase the impact of violence, its consequences to family health and violence perpetuation. The belief that alcohol use makes people engage in aggressive behaviors alleviates the aggressor's feeling of guilt and increases the victim's tolerance, which may facilitate new violence episodes.¹⁵ In addition, the chronic pattern of drinking can be a major factor for aggression recurrence, which may be aggravated with alcohol dependence.^9,12,22,24

As for the characteristics of people involved, more than half of aggressors lived in the same household. It was found a higher proportion of male aggressors and female victims, of which 33.9% were their partners. Many studies on intimate partner violence have reported that most aggressors are males who engage in violent behaviors under the influence of alcohol.^3,7,9,12,24 Overall studies address the association of alcohol and intimate partner aggression but they do not take into consideration other significant family relationships, such as parent-child. It seems that children witnessing violence, in addition to their suffering, are more likely to reproduce this same violent behavior during their adult life.^2,3,9,24 Moreover, alcohol-related violence is often perpetuated throughout childhood and/or adolescence, which are key years for a healthy human development. Further studies and more specific actions targeting alcohol-related violence in the parent-child relationship are needed.

A small proportion of alcoholic aggressors (10.9%) sought help to reduce or stop alcohol use. This finding shows that dependence treatment services can help preventing violence, as suggested in other studies.^15,19,23,24 Yet again it is evident the need for preventive actions to address the overlapping issues of domestic violence and substance dependence.

In addition to the considerable prevalence of violence situations involving aggressors under the influence of alcohol in Brazilian cities, the present study showed many peculiarities common to these violent behaviors. Families should be given more support, including active search of cases, for example through the Programa Saúde da Família (Family Health Program). And given that victims usually seek help at health services or police stations, providers at these services should be more aware of that as it may be the only opportunity to intervene.^14,16 Other aspects of domestic violence associated to alcohol use should be further explored such as the amount of alcohol aggressors consumed before engaging in domestic violence and whether victims have also consumed alcohol.

REFERENCES

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ª

^b

with questions on sociodemographic data and on psychotropic drug use. Concerning domestic violence, a questionnaire on the situations of violence taking place in the household was used addressing:

²⁰ frequency, duration and kinds of violence (verbal, physical and sexual) according to WHO standards.

ª Respondents were also asked about the state of the aggressor at the time of abuse (under the influence of alcohol), characteristics of aggressors and victims (age, sex and family relationship), and search for help at the health services/police authorities. The socioeconomic class (high, middle and low) was assessed based on a standardized rating scale issued by the

Associação Brasileira de Institutos de Pesquisa de Mercado (ABIPEME - Brazilian Association of Market Research Institutes). The socioeconomic ratings were similar to the IBGE 2000 census, which ensures sample representativeness.

Publication Dates

• Publication in this collection
  04 Sept 2009
• Date of issue
  Oct 2009

History

• Reviewed
  20 Oct 2008
• Received
  05 Mar 2008
• Accepted
  28 Jan 2009