PERCEPTION OF STRESS AMONG WOMEN IN THE MUNICIPALITY OF VITÓRIA, BRAZIL, ACCORDING TO EXPERIENCES OF VIOLENCE

PERCEPCIÓN DE ESTRÉS ENTRE MUJERES DEL MUNICIPIO DE VITÓRIA SEGÚN VIVENCIAS DE VIOLENCIA

ABSTRACT

Objective:   to verify the association between perceived stress and experiences of sexual violence in childhood and intimate partner violence throughout life and during the Covid-19 pandemic.

Method:   this is a population-based cross-sectional study conducted in Vitória, Espírito Santo, Brazil, from January to May 2022, with 1,086 women aged 18 years or older who had or had had an intimate partner in the last 24 months. Perceived stress was assessed using the short version of the Perceived Stress Scale with descriptions by absolute and relative frequencies, mean, standard deviation, and bivariate tests using ANOVA and Student’s t-test. The association was verified by simple and multiple linear regression, considering p<0.20 and maintenance when p<0.05, performed in Stata 17.0.

Results:   the perception of stress was associated with victimization of two (β = 4.90; 95%CI: 3.65-6.15) and three (β = 3.83; 95%CI: 2.51-5.15) types of violence throughout life, while women who experienced one (β = 2.68; 95%CI: 1.30-4.06) or two (β = 3.60; 95%CI: 1.64-5.56) types of intimate partner violence during the Covid-19 pandemic had a higher perception of stress.

Conclusion:   there is an association between the perception of stress and exposure to intimate partner violence throughout life and during the Covid-19 pandemic. The findings are fundamental to understanding intimate partner violence as an important stress-generating exposure among women.

DESCRIPTORS:
Violence; Violence against women; Intimate partner violence; Psychological stress; Subjective stress

RESUMO

Objetivo:   Verificar a associação entre a percepção de estresse e as experiências de violência sexual na infância e violência por parceiro íntimo, ao longo da vida e durante a pandemia de Covid-19.

Método:  estudo transversal de base populacional, realizado em Vitória, no Espírito Santo, Brasil, de janeiro a maio de 2022, com 1.086 mulheres de 18 anos ou mais, que tinham ou tiveram parceiro íntimo nos últimos 24 meses. A percepção de estresse foi avaliada pela versão curta da Escala de Estresse Percebido com descrição por frequências absolutas, relativas, média, desvio padrão e testes bivariados por ANOVA e t de Student, sendo a associação verificada por regressão linear simples e múltipla, considerando p<0,20 e manutenção quando p<0,05, realizadas no Stata 17.0.

Resultados:  A percepção de estresse associou-se à vitimização de dois (β = 4,90; IC95%: 3,65-6,15) e três (β = 3,83; IC95%: 2,51-5,15) tipos de violência ao longo da vida, já durante a pandemia de Covid-19, as mulheres que experienciaram um (β = 2,68; IC95%: 1,30-4,06) ou dois (β = 3,60; IC95%: 1,64-5,56) tipos de violência por parceiro íntimo tiveram maior percepção de estresse.

Conclusão:  Há associação entre a percepção de estresse com a exposição a violência perpetrada pelo parceiro íntimo durante a vida e no período da pandemia de COVID-19. Os achados são fundamentais para compreender a violência perpetrada pelo parceiro íntimo, como uma importante exposição geradora de estresse entre as mulheres.

DESCRITORES:
Violência; Violência contra a mulher; Violência por parceiro íntimo; Estresse psicológico; Estresse subjetivo

RESUMEN

Objetivo:   verificar la asociación entre el estrés percibido y las experiencias de violencia sexual en la infancia y violencia de pareja a lo largo de la vida, así como durante la pandemia de Covid-19.

Método:   se realizó un estudio transversal poblacional en Vitória, Espírito Santo, Brasil, de enero a mayo de 2022, con 1086 mujeres de 18 años o más que tuvieron o tuvieron pareja en los últimos 24 meses. El estrés percibido se evaluó mediante la versión abreviada de la Escala de Estrés Percibido, con descripciones mediante frecuencias absolutas y relativas, media, desviación estándar y pruebas bivariados mediante ANOVA y la prueba t de Student. La asociación se verificó mediante regresión lineal simple y múltiple, considerando un valor de p < 0,20 y manteniéndose cuando p < 0,05, realizada en Stata 17.0.

Resultados:   la percepción de estrés se asoció con la victimización de dos (β = 4,90; IC del 95 %: 3,65-6,15) y tres (β = 3,83; IC del 95 %: 2,51-5,15) tipos de violencia a lo largo de la vida, mientras que durante la pandemia de Covid-19, las mujeres que experimentaron uno (β = 2,68; IC del 95 %: 1,30-4,06) o dos (β = 3,60; IC del 95 %: 1,64-5,56) tipos de violencia de pareja presentaron una mayor percepción de estrés.

Conclusión:   existe una asociación entre la percepción de estrés y la exposición a la violencia de pareja a lo largo de la vida y durante la pandemia de Covid-19. Los hallazgos son fundamentales para comprender la violencia de pareja como una importante fuente de estrés en las mujeres.

DESCRIPTORES:
Violencia; Violencia contra la mujer; Violencia de pareja; Estrés psicológico; Estrés subjetivo

INTRODUCTION

The intentional use of physical force or power, whether through threat or action, directed at oneself or another person, leading to injury, psychological harm, developmental disabilities, and deprivation, constitutes what we know as violence¹. It is in this context that violence against women² can be included, especially the occurrence of violence perpetrated by an intimate partner (IPV) and childhood sexual abuse.

IPV is characterized by physical and sexual assaults, psychological abuse, and controlling behaviors against the victim, occurring within cohabitation, marriage, and any formal or informal union³. In addition to IPV, another way to experience violence is through childhood sexual abuse, characterized by acts with sexual purposes that harm the victim’s body and mind, violating fundamental rights such as freedom, respect, and dignity, according to the Statute of the Child and Adolescent⁴.

It is estimated that 641 million women worldwide have suffered IPV, with one in three women experiencing physical and/or sexual violence from a partner during their lifetime. The prevalence in Latin America is 25% over a lifetime and 8% in the last 12 months³.

Concern about violence against women increased during the Covid-19 pandemic. Stay-at-home orders exposed many women to their abusers for longer periods, resulting in 23% of women reporting that the pandemic worsened their safety at home³. Since the beginning of the pandemic, seven out of 10 women said that physical or verbal violence from their partner has become common, and six out of 10 women reported an increase in sexual harassment⁵.

Thus, IPV alone brings devastating consequences for women, such as depressive-anxious mood, decreased vital energy, somatic symptoms and depressive thoughts⁶, insomnia, nightmares, difficulty concentrating, irritability, loss of appetite, depression, anxiety, panic disorder, post-traumatic stress and substance abuse⁷.

Childhood sexual abuse triggers several changes in women’s adult lives, such as self-destructive behaviors, difficulty in gender identification, difficulty in sexual life and future relationships, suicide attempts, drug abuse, trauma, and difficulty relating to the same sex as the abuser⁶. Thus, whether in the pandemic context or during life, both the occurrence of IPV and the occurrence of childhood sexual abuse can generate consequences in adult life^3,6.

Experiences of violence can have repercussions on the victim’s health as a source of stress⁸. The experience of sexual abuse in childhood can lead to repercussions which affect psychological, physical, sexual, and social well-being which last throughout the victim’s life⁶. IPV is associated with multiple negative outcomes for the well-being of victims, constituting a stress factor among millions of women⁹. This scenario was also observed during the Covid-19 pandemic, where women who suffered IPV had a 1.4-fold increase in perceived stress³.

Stress can be a coping response to the occurrence of IPV¹⁰, just as IPV can be the source of psychological stress¹¹. A woman may deal with her emotions in different ways when she is exposed to violence, repressing or exacerbating them, and this occurs because stress is subjective, since it is a set of reactions presented by the organism in facing situations that require an effort to adapt¹². Therefore, understanding the critical nature of stress can be a challenge due to the subjectivity of stressful events¹³; what seems to occur is a bidirectional relationship between them, but in any case stress will be inevitable in the context of IPV¹⁰.

Therefore, in order to understand the repercussions of violence on health, whether due to the occurrence of intimate partner violence or even the occurrence of sexual violence in childhood, as both are events which affect women’s social, family and work life, and especially their mental health, the question arises: what is the association between the perception of stress and the experiences of violence lived by women?

In view of the above, the present study aims to verify the association between the perception of stress and experiences of sexual violence in childhood and intimate partner violence throughout life and during the Covid-19 pandemic.

METHOD

This is a cross-sectional study which used data from a study entitled “Violence against women: a population-based study in the municipality of Vitória, Espírito Santo”, which was developed and described based on the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines, as recommended. The authors state that there were no artificial intelligence tools, models, or services used in the production of this material during the preparation of this article.

The study was conducted in Vitória, the capital of the state of Espírito Santo, with a territorial extension of 93 km², composed of 79 neighborhoods, including islands and a continental part, with a population of 322,869 people, with 173,412 women in total, where 147,516 are women over 20 years old, corresponding to 53.71% of the population¹⁴ in 2021.

Data collection took place from January to May 2022, conducted by female interviewers who were properly trained. In addition to the interviewers, the study had field supervisors. Data collection took place in the participants’ homes, ensuring confidentiality and privacy, with an average duration of 50 minutes. The collected data were computed on tablets and managed with the aid of the Research Electronic Data Capture (REDCap) electronic data capture tool.

The 2010 Census of the Brazilian Institute of Geography and Statistics (IBGE) was consulted for sampling in order to select census tracts corresponding to a cadastral unit per continuous area within a region. A total of 108,515 households were selected, divided by 100. The initial sector was chosen randomly, and the other 99 subsequent sectors were selected based on a systematic selection. A total of 1,086 women were interviewed, one selected from each household, and if there was more than one woman residing in the same household, a numerical list was drawn to randomly select one of them. This entire process was performed using the R statistical software, taking into account the socioeconomic level classification.

The sample consisted of women aged 18 years or older who had or had had intimate partners in the last 24 months. Intimate partner is defined in this study as the current or former partner, boyfriend with whom the woman has sexual relations. Those who did not have the full capacity to answer the questions in the study due to intellectual or sensory deficits were considered as an exclusion criterion.

The outcome consisted of the perceived stress level, which was assessed using the short version of the Perceived Stress Scale instrument, composed of 10 items (PSS-10)¹⁵. According to Luft et al.¹⁶, the PSS-10 instrument can range its score from zero to four (0=never; 1=almost never; 2=sometimes; 3=almost always; 4=always). It is worth noting that items with positive factor loadings will have their scores inverted (0=4; 1=3; 2=2; 3=1 and 4=0), with the remaining questions having negative factor loadings, and the score will consequently consist of the direct sum without inversion of values. Thus, the total score for perceived stress is based on a continuous Likert scale ranging from 0 to 40¹⁶.

The exposure variables were composed of categorical data such as exposure to sexual violence in childhood (no/yes), while the occurrence of IPV was tracked through the application of the Violence Against Women (WHO VAW STUDY) instrument developed by the WHO¹⁷. The instrument has 13 questions about violence and each positive response represents the experience of the violent act against women¹⁷, making it possible to track the types of IPV (psychological, physical, sexual) suffered throughout life (no/yes). Furthermore, it allows tracking the number of occurrences of these types of violence throughout life (no violence, one type of violence, two types of violence, and three types of violence); and finally, the number of types of IPV (psychological, physical, and/or sexual) suffered during the Covid-19 pandemic period, as well as tracking the number of IPV occurrences during the pandemic (no violence, one type of violence, two types of violence, and three types of violence).

The control variables for this study consisted of sociodemographic and economic data, such as: age group (18 to 24; 25 to 34; 35 to 44; 45 to 59; 60 or more), race/color (white and non-white), years of formal schooling (0 to 8 years; 8 years or more), marital status (with partner; without partner), family income by quartile (1st quartile - poorest; 2nd quartile; 3rd quartile; 4th quartile - richest), whether the mother had suffered physical violence from a partner (yes and no), and the occurrence of sexual violence in childhood (yes and no).

The study project was approved by the Research Ethics Committee of the Federal University of Espírito Santo. All women were informed about the ethical aspects of the study, its objectives, its possible risks and benefits, as well as signed the informed consent form before being interviewed.

This is a cross-sectional study which used data from a study entitled “Violence against women: a population-based study in the municipality of Vitória, Espírito Santo”, which was developed and described based on the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines, as recommended. The authors state that there were no artificial intelligence tools, models, or services used in the production of this material during the preparation of this article.

The study was conducted in Vitória, the capital of the state of Espírito Santo, with a territorial extension of 93 km², composed of 79 neighborhoods, including islands and a continental part, with a population of 322,869 people, with 173,412 women in total, where 147,516 are women over 20 years old, corresponding to 53.71% of the population¹⁴ in 2021.

Data collection took place from January to May 2022, conducted by female interviewers who were properly trained. In addition to the interviewers, the study had field supervisors. Data collection took place in the participants’ homes, ensuring confidentiality and privacy, with an average duration of 50 minutes. The collected data were computed on tablets and managed with the aid of the Research Electronic Data Capture (REDCap) electronic data capture tool.

The 2010 Census of the Brazilian Institute of Geography and Statistics (IBGE) was consulted for sampling in order to select census tracts corresponding to a cadastral unit per continuous area within a region. A total of 108,515 households were selected, divided by 100. The initial sector was chosen randomly, and the other 99 subsequent sectors were selected based on a systematic selection. A total of 1,086 women were interviewed, one selected from each household, and if there was more than one woman residing in the same household, a numerical list was drawn to randomly select one of them. This entire process was performed using the R statistical software, taking into account the socioeconomic level classification.

The sample consisted of women aged 18 years or older who had or had had intimate partners in the last 24 months. Intimate partner is defined in this study as the current or former partner, boyfriend with whom the woman has sexual relations. Those who did not have the full capacity to answer the questions in the study due to intellectual or sensory deficits were considered as an exclusion criterion.

The outcome consisted of the perceived stress level, which was assessed using the short version of the Perceived Stress Scale instrument, composed of 10 items (PSS-10)¹⁵. According to Luft et al.¹⁶, the PSS-10 instrument can range its score from zero to four (0=never; 1=almost never; 2=sometimes; 3=almost always; 4=always). It is worth noting that items with positive factor loadings will have their scores inverted (0=4; 1=3; 2=2; 3=1 and 4=0), with the remaining questions having negative factor loadings, and the score will consequently consist of the direct sum without inversion of values. Thus, the total score for perceived stress is based on a continuous Likert scale ranging from 0 to 40¹⁶.

The exposure variables were composed of categorical data such as exposure to sexual violence in childhood (no/yes), while the occurrence of IPV was tracked through the application of the Violence Against Women (WHO VAW STUDY) instrument developed by the WHO¹⁷. The instrument has 13 questions about violence and each positive response represents the experience of the violent act against women¹⁷, making it possible to track the types of IPV (psychological, physical, sexual) suffered throughout life (no/yes). Furthermore, it allows tracking the number of occurrences of these types of violence throughout life (no violence, one type of violence, two types of violence, and three types of violence); and finally, the number of types of IPV (psychological, physical, and/or sexual) suffered during the Covid-19 pandemic period, as well as tracking the number of IPV occurrences during the pandemic (no violence, one type of violence, two types of violence, and three types of violence).

The control variables for this study consisted of sociodemographic and economic data, such as: age group (18 to 24; 25 to 34; 35 to 44; 45 to 59; 60 or more), race/color (white and non-white), years of formal schooling (0 to 8 years; 8 years or more), marital status (with partner; without partner), family income by quartile (1st quartile - poorest; 2nd quartile; 3rd quartile; 4th quartile - richest), whether the mother had suffered physical violence from a partner (yes and no), and the occurrence of sexual violence in childhood (yes and no).

The study project was approved by the Research Ethics Committee of the Federal University of Espírito Santo. All women were informed about the ethical aspects of the study, its objectives, its possible risks and benefits, as well as signed the informed consent form before being interviewed.

The data analysis followed the conceptual model presented in Figure 1, which was developed based on a literature review of the factors influencing women’s perception of stress. The model’s structure guided the hierarchical definition of the variables, enabling understanding of the controls and adjustments for the outcome, contributing to coherence in the analytical process.

Figure 1 -
Hierarchical conceptual model of the relationships between independent variables and the perception of stress among women.

The analyses were conducted using crude and relative frequencies and their respective 95% confidence intervals (95%CI). The mean and standard deviation (SD) were used as central tendency measures, since the stress perception scale is still continuous; data normality was verified by visualizing the histogram, skewness/kurtosis, and confirmed by the Shapiro-Francia test, showing a value of 0.14. The data coefficient was evaluated using Cronbach’s alpha scale (α), showing good internal consistency (0.80), with confirmation by McDonald’s omega (ω) of 0.80. The data were subsequently evaluated using bivariate analysis with t-tests for the mean when the independent variables were dichotomous, and analysis of variance by ANOVA of means when the independent variables had three or more categories. A p-value of 5% was considered significant in this stage. Multivariate analyses using simple and multiple linear regression were expressed by their betas (β) to verify the proposed association. The significance level for inclusion in the multivariate model for this step was 20%, and 5% for inclusion in the final model. All described steps of the analysis were performed using the Stata version 17.0 statistical software.

RESULTS

After analyzing the data in Table 1, the highest mean perceived stress scores were among women who experienced sexual violence in childhood (µ=19.72; SD=±6.98), those who experience two types of intimate partner violence throughout their lives (µ=20.03, SD=±7.43), and those who experienced two types of intimate partner violence during the Covid-19 pandemic (µ=20.04; SD=±7.04).

Table 1 -
Perception of stress based on experience of childhood sexual violence, number of instances of violence perpetrated by an intimate partner in life, and during the Covid-19 pandemic among women residing in the municipality of Vitória, ES, Brazil, 2022. (n=1086).

Variables	N (%)	Mean (sd)	P-value
Sexual violence in childhood			<0.001
No	975 (89.4)	16.0 (7.5)
Yes	115 (10.6)	19.7 (6.9)
Number of instances of intimate partner violence in life			<0.001
No type of violence	567 (52.2)	14.5 (7.2)
One type of violence	222 (20.4)	17.0 (7.4)
Two types of violence	157 (14.5)	20.0 (7.4)
Three types of violence	140 (12.9)	19.1 (6.6)
Number of instances of intimate partner violence during the pandemic			<0.001
No type of violence	856 (78.8)	15.7 (7.4)
One type of violence	125 (11.5)	18.5 (7.7)
Two types of violence	54 (5.0)	20.0 (7.0)
Three types of violence	51 (4.7)	18.9 (6.6)

According to models 1 and 2, women who suffered sexual violence in childhood presented a higher average stress level when compared to women who did not suffer sexual violence in childhood, being on average 3.71 and 3.04 points higher, respectively, than those who did not suffer violence (Table 2).

Table 2 -
Crude and adjusted analysis of the linear regression coefficient (β) of perceived stress according to sexual violence in childhood among women residing in the municipality of Vitória, ES, Brazil, 2022. (n=1086).

Variable	Model 1		Model 2		Model 3
	β	(95%CI)	β	(95%CI)	β	(95%CI)
	p-value		p-value		p-value
Sexual violence in childhood
No	Ref.		Ref.		Ref.
Yes	3.71 <0.001	(2.28-5.15)	3.04 <0.001	(1.63-4.34)	2.75 <0.001	(0.91-3.15)
Indicators
R2	2.3%		9.4%		13.7%
Root MSE	7.42		7.17		6.94
R2 adjusted	-		8.7%		13.1%

• Model 1: Crude (without adjustments); Model 2: adjusted for sociodemographic and economic factors; Model 3: Model 2 + mother has already been beaten (no; yes); β: coefficient (adjusted); CI: confidence interval.

According to Table 3, having experienced one, two, or three types of intimate partner violence throughout life was associated with perceived stress when compared to women who did not experience any type of violence. For the final model (model 4), women who experienced two types of violence showed on average 4.90 points higher perceived stress compared to women who did not experience intimate partner violence, as did those who experienced three types of IPV throughout their lives, which had on average 3.83 points higher perceived stress compared to those who did not experience IPV (p<0.05).

Table 3 -
Crude and adjusted analysis of the linear regression coefficient (β) of perceived stress according to intimate partner violence throughout life among women residing in the municipality of Vitória, ES, Brazil, 2022. (n=1086).

Variable	Model 1		Model 2		Model 3		Model 4
	β p-value	(95%CI)	β p-value	(95%CI)	β p-value	(95%CI)	β p-value	(95%CI)
Number of types of violence experienced in life by an intimate partner
No type of violence	Ref.		Ref.		Ref.		Ref.
One type of violence	2.52	(1.41-3.64)	2.10	(1.01-3.20)	2.03	(0.91-3.15)	2.02	(0.93-3.11)
	<0.001		<0.001		<0.001		<0.001
Two types of violence	5.53	(4.26-6.80)	5.13	(3.89-6.37)	4.84	(3.56-6.12)	4.90	(3.65-6.15)
	<0.001		<0.001		<0.001		<0.001
Three types of violence	4.61	(3.28-5.94)	4.16	(2.86-5.46)	3.78	(2.42-5.15)	3.83	(2.51-5.15)
	<0.001		<0.001		<0.001		<0.001
Indicators
R2	8.6%		13.7%		13.7%		14.6%
Root MSE	7.2		6.9		6.9		6.9
R2 adjusted	-		13.0%		13.1%		13.9%

• Model 1: Crude (without adjustments); Model 2: adjusted for sociodemographic and economic factors; Model 3: adjusted for Model 2 + childhood sexual violence (no; yes); Model 4: Model 3 + mother has been beaten (no; yes); ß: coefficient (adjusted); CI: confidence interval.

In the final model, Table 4 shows that women who experienced one type of violence have on average 2.68 points higher perceived stress compared to women who did not experience any IPV, as well as those who experienced two types of intimate partner violence, showing on average 3.60 points higher perceived stress when compared to women who did not experience violence during the Covid-19 pandemic.

Table 4 -
Crude and adjusted analysis of the linear regression coefficient (β) of perceived stress according to intimate partner violence during the Covid-19 pandemic among women residing in the municipality of Vitória, ES, Brazil, 2022 (n=1086).

Variable	Model 1		Model 2		Model 3		Model 4
	β p-value	(95%CI)	β p-value	(95%CI)	β p-value	(95%CI)	β p-value	(95%CI)
Number of types of intimate partner violence during the pandemic
No type of violence	Ref.		Ref.		Ref.		Ref.
One type of violence	2.83	(1.44-4.22)	2.63	(1.38-3.97)	2.74	(1.36-4.13)	2.68	(1.30-4.06)
	<0.001		<0.001		<0.001		<0.001
Two types of violence	4.32	(2.29-6.36)	3.96	(1.99-5.93)	3.79	(1.84-5.76)	3.60	(1.64-5.56)
	<0.001		<0.001		<0.001		<0.001
Three types of violence	3.19	(1.10-5.28)	2.58	(0.55-4.61)	1.98	(-0.1-4.06)	1.78	(-0.30-3.86)
	<0.001		0.013		0.062		0.093
Indicators
R2	3.2%		9.7%		10.3%		11.1%
Root MSE	7.4		7.1		7.1		7.1
R2 adjusted	-		9.1%		10.2%		10.3%

• Model 1: Crude (without adjustments); Model 2: adjusted for sociodemographic and economic factors; Model 3: adjusted for Model 2 + childhood sexual violence (no; yes); Model 4: Model 3 + mother has been beaten (no; yes); ß: coefficient (adjusted); CI: confidence interval.

DISCUSSION

The results in this study indicate that exposure to violence perpetrated by an intimate partner, both throughout life and during the Covid-19 pandemic, is associated with a greater perception of stress among residents of the municipality of Vitória in Brazil.

Women in this study who experienced sexual violence in childhood had a higher average perception of stress as adults compared to those who did not suffer this violence. Regardless of the type of violence that occurred in childhood, one of the consequences will be stress^18,19 and it is considered that stress in childhood may stem from adverse experiences lived by the child, such as restriction, abuse or neglect by the family. Thus, when this exposure is severe and chronic, it generates negative long-term consequences, whether cognitive, emotional or behavioral.

The consequences of living in violent family environments can manifest in different ways, such as psychological impairments, difficulties in social relationships, behavioral disorders, involvement in conduct which violates criminal law and a reproduction of violent intimate relationships in adulthood²⁰.

The violent context during childhood, such as sexual abuse, can perpetuate itself into adulthood; for example, women who experienced situations of violence as children have a greater chance of suffering IPV in their lives (OR: 2.2; 95%CI 1.72-2.83), as well as those who suffered sexual abuse in childhood (OR: 7.14; 95%CI 4.15-12.26)⁶. This becomes significant, as it sheds light on the chain of events that violence occurring in childhood can entail in the life of an adult woman. Thus, as shown⁶, understanding this relationship becomes relevant, since sexual abuse in childhood, especially if it occurs within the family, can compromise a woman’s health, regardless of her age.

Furthermore, our findings show that there is a greater perception of stress among those who have suffered intimate partner violence throughout their lives, which is consistent with other studies²¹. An analysis of women diagnosed with cancer shows that experiencing IPV increases their perception of stress²¹, as these victims presented significantly higher levels of depressive symptoms and stress compared to non-victim women²². Sexual violence produces impacts with diverse effects on mental health, with dysregulated responses to stress²².

In the context of Covid-19, our data demonstrate that women presented an average of 3.6 points higher in the perception of stress than women who did not suffer violence during the pandemic. A similar result was found in another study²³, which indicates that the increase in IPV is proportional to the increase in the perception of stress²³.

The context in which society was configured during the pandemic period favored social isolation, the closure of businesses, and remote work in order to reduce the virus spread. This scenario forced families to spend more time together in their homes, increasing economic tensions, health problems, and especially violence²⁴. In this scenario, measures to control the virus, whether lockdown or social isolation, were potentiating factors for the increase in IPV²⁵. Government agencies focused on combating violence evidenced an increase in violence against women, mainly due to economic stress and forced cohabitation with the aggressor²⁶. In addition, stress can be accompanied by emotions such as anxiety and irritability, difficulty concentrating, headaches, body aches, stomach aches, and sleep problems²⁷.

Therefore, there are many challenges to be faced regarding IPV in a Brazilian society which presents a historical context of naturalization in the conduct of men and women (i.e. stereotypes), which can lead to the maintenance of a culture of discrimination and violence against women. This scenario stems from a construction of society permeated by the existing culture of unequal power relations in which women are seen as inferior to a male figure, configuring abusive and sexist attitudes, which are naturalized and compromise the integrity of women in different aspects of their lives²⁸. The consequences of violence are not only devastating for women, but also for the entire family. They go beyond the violent acts and their immediate effects, resulting in generational reproduction of this violence. Furthermore, understanding these myths becomes fundamental in intervention, as carelessness, lack of intervention, and mistakes often occur based on these stereotypes²⁹.

Some limitations can be considered in the present study; firstly, the study design is cross-sectional, which prevents us from inferring causality in our findings, mainly due to the bidirectionality of stress for IPV. Following this, information bias regarding the occurrence of violence throughout life can be cited. However, the study focused on conducting the interviews in a private space without the presence of partners, only with the women and the interviewer in order to reduce this bias.

CONCLUSION

It is concluded that there is an association between the perception of stress and exposure to sexual abuse during childhood, IPV during life, and during the Covid-19 pandemic. These findings are fundamental to understanding experiences of violence as factors which contribute to the occurrence of stress among women and highlight the need for targeted interventions to address violence and support victims, as well as to work on preventing this harm.

Furthermore, the findings allow us to conclude the need to expand scientific knowledge on the subject addressed given the scarcity of studies, especially in Brazil, that study the perception of stress in women victims of IPV, as well as in those who suffered childhood sexual abuse. Studying the perception of stress in adult female victims of partner violence is essential to develop effective interventions, inform/guide public policies, as well as improve the support offered by health professionals, including providing elements which help in identifying the signs of chronic stress associated with violence, and developing integrated treatment plans. Thus, positive health and well-being outcomes for this group can be obtained.

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NOTES

• ORIGIN OF THE ARTICLE
  Extracted from the dissertation - “Percepção de estresse entre mulheres residentes no município de Vitoria e os fatores associados”, presented to the Postgraduate Program in Public Health of the Universidade Universidade Federal do Espírito Santo, in 2025.
• FUNDING INFORMATION
  Edital 09/2020 - Processo 163/2021. Fundação de Amparo à Pesquisa e Inovação do Espírito Santo (FAPES).
• APPROVAL OF ETHICS COMMITTEE IN RESEARCH
  Approved by the Research Ethics Committee of the Federal University of Espírito Santo, opinion no.4.974.080/2021.
• TRANSLATED BY
  Christopher J. Quinn.
• DATA AVAILABILITY
  Research data is available upon request to the corresponding author.

Edited by

• EDITORS
  Associated Editors: Manuela Beatriz Velho. Editor-in-chief: Gisele Cristina Manfrini.

Data availability

Research data is available upon request to the corresponding author.

Publication Dates

• Publication in this collection
  14 Sept 2026
• Date of issue
  2026

History

• Received
  17 June 2025
• Accepted
  01 Dec 2025