Domains of common mental disorders in women reporting intimate partner violence*

Objective to verify associations between the types of intimate partner violence and the domains of common mental disorders in women. Method cross-sectional study with 369 women. The information was obtained through the instruments Self-Reporting Questionnaire and Conflict Tactic Scales. To analyze the data, Pearson’s Chi-Square test, Fisher’s exact test and Odds Ratio were used. Results women who reported physical abuse with and without sequela were respectively 2.58 and 3.7 times more likely to have symptoms of anxious depressed mood. The chances of experiencing symptoms of decreased vital energy increased by 2.27 times with psychological aggression, 3.06 times with physical abuse without sequelae and 3.13 times with physical abuse with sequelae. Somatic symptoms did not show statistical association with the types of violence. The propensity to develop symptoms of depressive thoughts increased 3.11 times with psychological aggression, 6.13 times with physical aggression without sequelae, 2.47 times with sexual coercion and 7.3 times with physical aggression with sequelae. Conclusion the types of intimate partner violence are strongly associated with the domains of common mental disorders in women. This finding may contribute to more accurate interventions by health professionals to women victims of violence.

In order to better explore common mental disorders, we used the Self-Reporting Questionnaire , which subdivides the symptoms of these disorders into four domains: anxious depressive mood, somatic symptoms, decreased vital energy and depressive thoughts (11) .
Anxious depressive mood is characterized by symptoms such as nervousness, tension, worry, sadness, crying and being easily scared. People with somatic symptoms may experience headaches, insomnia, stomach discomfort, poor digestion, poor appetite, and shaking of the hands. Decreased vital energy corresponds to symptoms such as being easily fatigued, difficulties in making decisions or in having satisfaction in one's tasks, difficulty in thinking and suffering with work activities. People who feel unable to play a useful role in life, lose interest in things, feel useless and think of ending their own lives fall within the domain of depressive thoughts (11) .
Mental health risks must be seen from a gender perspective, which influences the expression of suffering between men and women (12) . Common mental disorders are more frequently present among women (1,13) . Another issue that relates to common mental disorders in women is violence (14)(15) .
Thus, the present research is justified by the importance of identifying the symptoms of domains of common mental disorders in women who report different types of intimate partner violence, since the early discovery of these disorders is essential to minimize damage to physical and mental health. With trained and sensitive professionals to identify symptoms of these domains among their clientele, it will be possible to seek ways to address this problem and empower women beaten by their partners through an effective approach (16) .
In view of this problem, the following research The data were obtained from the database of the study: "Violence, alcohol consumption and drugs in the female universe: prevalence, risk factors and mental health in 2010 showed that in the cities where this study was conducted the population of women aged 20 to 59 years was 347,414. Thus, for the calculation of the minimum sample required, the formula for infinite populations was used based on the population proportion: n= (Z α/2 ) 2 . p.q / E 2 , where Z α/2 is the point of the normal curve that corresponds to the desired confidence interval (95%); p comprises the proportion of individuals belonging to the category to be studied, for which the estimated prevalence of non-psychotic mental disorders was considered 39.4% (17) ; q is the proportion not belonging to the category (q=1-p); and E consists of the maximum error of estimate (5%). indices to verify the self-report of intimate partner violence, being used in diverse spatial and social realities, constituting as a reliable and effective instrument (19) .
The CTS-2 are subdivided into five dimensions, with two subscales each: negotiation (cognitive and emotional); psychological aggression (severe and minor); physical abuse without sequelae (severe and minor); physical abuse with sequelae (severe and minor); and sexual coercion (severe and minor) (20)(21) . The positive response to at least one item from each subscale was considered as presence of violence. The negotiation subscale was not analyzed in this study. anxious depressive mood (4 items); somatic symptoms (6 items); decreased vital energy (6 items); depressive thoughts (4 items) (11) . The positive response to at least one item from each domain was considered as presence of symptoms of a particular domain.
Thus, the predictive variables of this study were the types of intimate partner violence (psychological aggression, physical abuse without sequelae, physical abuse with sequelae and sexual coercion) in the minor and severe degrees, whereas the outcomes were the domains of common mental disorders (anxious depressive mood, somatic symptoms, decreased vital energy and depressive thoughts). All variables were analyzed at the qualitative level of measurement. Fisher's exact test, when all the presuppositions of the chi-square test were not satisfied. We used a 5% level of significance. To quantify the intensity of the association, the odds ratio and respective intervals were used with 95% confidence level.
Considering the ethical aspects, the analysis of information began after the approval of the Ethics Research Committee (opinion no. 2,379,740/2017) and all the participants signed the Informed Consent Form in two copies. Figure 1 showed that the prevalence of intimate partner violence among women interviewed was 59.10%.   Table 1 showed that women who reported having suffered physical abuse without sequelae in a miner and severe degree presented, respectively, 1.82 and 2.58 times more chances of having symptoms of anxious depressive mood, when compared with those who did not report it. Women who reported having suffered physical abuse with minor sequelae were 3.7 times more likely to have symptoms of depressed mood than those who did not report it.

Report of Intimate partner Violence
There was no statistically significant association between the types of violence and the presence of somatic symptoms among the women interviewed (Table 2).     crying and being easily scared (11) .
Sadness may be considered in some individuals as an early stage of the depressive picture, which allows to consider this as an "at risk" mental state (22) . Thus, the identification of sadness in the general population can be useful to detect subjects vulnerable to the development of mental disorders. This could help to propose goals and strategies for the early prevention of this condition (23) .
For the victim of intimate partner violence, aggression by the person with whom they are emotionally involved may generate feelings of impotence, decreased selfesteem and depression (24) .
Depressive disorders are greater in women experiencing intimate partner violence compared to non-victims. This same author describes in his study that women who suffer intimate partner violence are almost twice as likely to have problems related to mental health (25) .
Physical and verbal abuse can generate intense selfrecrimination. However, despite the suffering generated by the aggressor, women fail to see their condition as victims; instead, they tend to feed a sense of guilt for the violence suffered. As a result, these women find it difficult to love, have fun, study and look after their children (26) .
A study of 298 women who had been victims of domestic violence by a male intimate partner showed that having been threatened with a firearm, regardless of other forms of intimate partner violence, is related to symptoms of post-traumatic stress disorder in women. Approximately one quarter of the sample (24.2%) had experienced a threat with a firearm throughout their relationship and 12.5% feared their partners would use a firearm against them (27) . This fear surrounding the lives of intimate partner victims may be a preponderant factor for the emergence of common mental disorders.
A study in Sweden also showed similar results by pointing that that women who were exposed to physical and sexual violence were 3.78 times more likely to present depressive symptoms than women who had not been exposed to such violence (28) .

A survey of 775 pregnant women in São Paulo
showed that domestic violence and mental disorders were highly correlated. About 27.15% of the women interviewed had experienced domestic violence and about 38.24% of them were diagnosed with mental disorders. The main association found was between anxiety and physical violence (29) . Other research has similar results showing that 31.6% of women who had been assaulted by their partners reported experiencing at least two symptoms of depression (28) .
It has been observed that the symptoms of anxious This domain is characterized by symptoms such as headaches, insomnia, stomach discomfort, poor digestion, lack of appetite and shaking in the hands (11) .
Intimate partner violence is a common occurrence and is particularly prevalent among women. It is related to mental health problems including depression, anxiety, post-traumatic stress disorder, substance use, eating disorders and a number of psychosomatic conditions (30) .
The same disorder can manifest itself differently in different people (31) . The literature shows that intimate partner violence is strongly associated with sleep disorders and mental health (32) . Individuals with mental disorders also present the aggravation of having impaired social relationships (33) . Thus, common psychiatric disorders in victims of intimate partner violence may include somatic symptoms, anxiety, insomnia, social dysfunction and depression (34) .
Even though this study did not show statistically  (28) .

Physical violence can have as a consequence
symptoms of decreased vital energy through difficulty awakening, and less interest in feeding and socializing with others (35) . A study with more than 24,000 women found an association between intimate partner violence and poor health, difficulty walking and performing daily activities, memory loss, dizziness and reproductive problems (36) .
Another study with 2,091 women showed that when it comes to the pattern of intimate partner violence, psychological aggression is more frequent than physical aggression, sexual coercion or injury (34) . Rev. Latino-Am. Enfermagem 2018;26:e3099.
People who feel unable to play a useful role in life, lose interest in things, feel useless and think of ending their lives fall within this domain (11) .
In a study developed in France with 38,694 individuals, sadness was associated with psychiatric problems and suicide (22) . The risk of suicide is significantly higher among individuals with poor physical and/or mental health (33) . Another study showed that 42% of women who had experienced intimate partner violence reported suicidal ideation and 31% reported having attempted suicide at some point in their life (37) .
A recent systematic review also pointed out that women who were exposed to intimate partner violence may be at high risk of death from suicide (38) .
A study of 134 women in a city on the Gulf Coast-USA showed that 28% of the sample reported a suicide attempt and 20% reported suicidal ideation. Correlations indicated that suicidal ideation and suicide attempts were largely associated with coercive control by the partner (39) .
Psychological abuse, including the control of one's behavior, is as harmful to a woman's health as other forms of intimate partner violence. It is used by the perpetrator to gain obedience and dependence, and generates deprivation of important aspects of the women's daily life, such as economic resources, social life and the right to have a paid work (40) .
A study of 390 adult women in Pernambuco showed that the incidence of common mental disorders was 44.6% among women who reported having suffered intimate partner violence in the last 12 months and 43.4% in the last seven years. Mental disorders have remained associated with psychological violence, even in the absence of physical or sexual violence. However, when psychological violence was concomitant with physical or sexual violence, the risk of common mental disorders was even greater (41) .
Importantly, women exposed to behavioral control are more likely to present symptoms of depression (28) , which is classified by the World Health Organization as the main contributor to suicide deaths (24) (42) .
Women exposed to physical and sexual conditions of violence are also more susceptible to depressive symptoms (28) . A study of 1,049 women in Tanzania corroborates this information by showing that physical and sexual violence were associated with increased report of symptoms of poor mental health (43) .
However, since couples often do not mention issues such as sexual violence, even when they are present (26) , this contributes to the fact that women who have experienced sexual abuse are also at higher risk of suicide (44) .
A study has shown that sexual violence was associated with the greater severity of the symptoms of post-traumatic stress disorder (28) . In another study conducted in Australia with 230 adult women, more than half of the sample had experienced at least one incident of sexual violence. Most reported unwanted caresses and being forced to sex due to pressure and coercion by the partner. Another form of sexual violence found in that research was the fact that the partner refuses to use condoms when invited to do so. Women who have experienced sexual violence were more likely to be anxious, depressed, depressed or hopeless (45) .
The prevalence of anxiety and depression symptoms among these women suggests that all forms of sexual violence should be considered as a potential major factor for the suspicion of common mental disorders (45) .
Stressful life events, especially personal losses, neglect and physical, emotional or sexual abuse, increase the likelihood of mental illness by making the brain response more intense and hypersensitive to stress (31) .  (34) .
The more severe the violence, the higher the risk of psychological trauma. More severe and recent forms Santos AG, Monteiro CFS.
of violence produce more severe symptoms of trauma, especially anxiety disorders. In the case of phobic anxiety, the symptoms disappear over time, regardless of the severity of the victimization (47) . This indicates that problem solving protects people from stressful life events (31) .
Research developed in Spain with 10,171 women, a national representative sample, showed that control behavior and current physical and sexual violence were also associated with the highest probability of reporting poor emotional health results when compared to previous violence (48) .

Conclusion
The different types and intensities of intimate