Table 1 Policy summary

Background

Exposure to GBV is one of the world’s most prevalent and pervasive human rights abuses, resulting in severe consequences for individuals’ health and well-being. Yet the impacts of exposure to physical, sexual or psychological GBV are still not well understood. Here we draw upon a systematic review to evaluate the associations between GBV and health outcomes that have been described in peer-reviewed journals. In a Burden of Proof meta-analysis, we estimated the magnitude of the distinct associations between exposure to physical, sexual and psychological GBV—including but not limited to IPV—and eight health outcomes and evaluated the strength of the evidence underpinning these associations.

Main findings and limitations

We evaluated the associations between physical, sexual or psychological GBV and six, eight and four health outcomes, respectively. Each of the risk–outcome pairs we investigated was supported by at least three studies. The associations between sexual violence and STIs excluding HIV/AIDS, maternal abortion and miscarriage, and major depressive disorder received moderate (three-star) ratings. Exposure to this type of violence was found to increase the risk for each of these conditions by at least 104%, 100% and 50%, respectively. Significant associations were also found between sexual violence and HIV/AIDS, anxiety disorders and drug use disorders, but the evidence was rated as weak (one-star rating). Associations between physical GBV and drug use disorders and HIV/AIDS received two-star ratings, classified as moderately weak; and one-star ratings were assessed for the relationship of physical GBV to five other outcomes (alcohol use disorders, major depressive disorder, anxiety disorders, STIs, and maternal abortion and miscarriage). Exposure to psychological GBV was associated with major depressive disorder (one-star rating), but no evidence of association was found with self-harm, maternal abortion and miscarriage, or drug use disorders. Similarly, insufficient evidence of a significant association was found between physical GBV and self-harm.

The primary limitations of this study are related to model parameters and data availability. Definitions of violence exposure differed between studies, mainly in relation to recall timing and survey methodologies used to evaluate exposure. To the extent possible, bias covariates were created and included in the model to account for study-level differences. Physical, sexual and psychological GBV exposure was evaluated as a dichotomous risk, which did not allow us to consider differences in frequency and severity. It is important that future research includes dose–response analyses for a better understanding of the health effects of exposure to GBV. Also, despite a literature search and the use of the most recently available data, this study does not capture the full breadth of the health burden associated with violence since several health outcomes identified were not included in our analysis due to insufficient data.

Policy implications

This review emphasizes the long-lasting negative health consequences of experiencing GBV and the importance of timely, comprehensive data on associations between GBV and health outcomes, continuing to expand the landscape of evidence on GBV’s health consequences beyond IPV against women. In particular, this analysis showed that the existing data landscape systematically overlooks GBV victimization as a health risk factor for men. While women are disproportionately exposed to GBV compared with men and, as such, experience a correspondingly disproportionate proportion of GBV’s health toll, GBV perpetrated against men must not be overlooked in future research, policy or programming. The analysis also showed that there is a clear paucity of data on the health effects of psychological GBV compared with data on physical or sexual GBV, leaving a substantial need for strategies to better detect, address and understand psychological GBV as a policy and research priority. It is essential to amplify actions and commitment from global to regional, national and community-based strategies for prevention, recovery and justice for individuals, groups or couples, also interrupting the intergenerational cycles of violence. Investing in multi-sectoral interventions, such as improved GBV screening and referral to trauma-informed care, can make an important difference by prioritizing safety, patient autonomy, shared decision-making and empowerment.