Gender Equality Index 2021: Health

Violence and power imbalances adversely affect the mental health of women and men victims (Bhui, 2018). For example, exposure to interpersonal violence heightens the risk of suicide among youth and young adults (Miranda-Mendizabal et al., 2019). Since women are more likely to face gender-based violence and power imbalances, they are also more likely to suffer from mental health problems (Oram et al., 2017). Violence is, therefore, an important contributor to gender differences in poor mental health.

The definition of gender-based violence varies, including through each country’s legal framework and the scope of action (FRA, 2014). Gender-based violence also takes many forms: domestic violence, intimate partner violence, sexual violence, forced and early marriage, ‘honour’ crimes, FGM and human trafficking. However, intimate partner and sexual violence are its most common forms worldwide (Sian Oram et al., 2017). In the EU, physical and sexual violence by a current or former partner or spouse is the most prevalent (FRA, 2014) form of gender-based violence. More than one in five women (22 %) has suffered it. Different forms of gender-based violence consistently lead to a range of mental illnesses globally, including anxiety, depression, suicide, post-traumatic stress and substance abuse (Escribà-Agüir et al., 2010; Ferrari et al., 2016; Riedl et al., 2019). FRA’s most recent Fundamental Rights Survey shows that incidents of a sexual nature, in particular, have a profound long-term psychological impact on victims – 50 % of women victims feel anxious, 49 % feel vulnerable, 39 % lose confidence and 36 % are depressed. Other effects include 35 % of women victims having difficulties sleeping and 33 % experiencing panic attacks (FRA, 2021).

Research on victims of intimate partner violence – physical, psychological and sexual – reveals the impact of abuse on the development of mental health problems. Among these are trauma and stressor-related disorders, eating and addiction disorders, insomnia, depression and suicidal tendencies (Campbell et al., 2002; Halim et al., 2018; Sarkar, 2008). Victims of intimate partner violence have a threefold increased risk of a depressive disorder and a fourfold increased risk of developing an anxiety disorder. However, post-traumatic stress disorder (PTSD) is the most common mental health problem among women victims of intimate partner violence, with risk increasing sevenfold (Chandan et al., 2019; Ferrari et al., 2016; Shen and Kusunoki, 2019). The probability of psychotropic drug use, as well as psychological distress, increases with the duration of violence over a lifetime (Bonomi et al., 2006; Ruiz-Pérez and Plazaola-Castaño, 2005). Although women are more likely to be victims of intimate partner violence, a major contributor to the mental health gender gap, men suffering such violence are similarly impacted (Sian Oram et al., 2017).

Women who have recently experienced severe episodes of violence generally experience higher levels of distress (Hegarty et al., 2013); these levels decrease in time, independently of whether or not women are offered treatment (Coker et al., 2012; Sullivan and Bybee, 1999). Some victims still experience high levels of psychological distress and trauma-related symptoms years later (Riedl et al., 2019), demonstrating the enduring effects of intimate partner violence on mental health (Campbell et al., 2002).

Health services should consider symptoms of mental illness as a potential indicator of past or current intimate partner violence or non-partner domestic violence (Ferrari et al., 2016). Several ‘risk factors’ also need to be included in any analysis of the relationship between intimate partner violence and mental health – gender, socioeconomic status, age, social and family network, previous mental health problems and abuse during childhood (Abramsky et al., 2011; Finkelhor et al., 2007; Hughes et al., 2017; Jewkes, 2002). Mental health services, therefore, need to be aware of interpersonal violence experienced and perpetrated by women and men, and to provide gender-sensitive and cross-cutting services to address it (Sian Oram et al., 2017).

Hate-motivated violence against the LGBTI community has significant and lasting consequences for individual victims. Psychological problems and a fear of going out are the two most frequently mentioned impacts of physical and sexual attacks on health and well-being – reported by 49 % and 30 %, respectively (FRA, 2020b). Trans and intersex victims of physical and sexual attacks experience a higher rate of psychological problems, including depression or anxiety (FRA, 2020b). LGBTI people are two to three times more likely to report an enduring psychological or emotional problem – suicidal thoughts and attempts, substance misuse and deliberate self-harm – than the general population (European Commission, 2017). For example, a meta-analysis revealed that lesbian and bisexual women are nearly 1.82 times more likely to attempt suicide than heterosexual women (M. King et al., 2008).

Violence and harassment at work can also result in poor mental health (Eurofound, 2015). Sexual harassment in the workplace is an often neglected form of gender-based violence, receiving inadequate organisational responses. More than one in three women are victims of it (O’Neil et al., 2018). They are likely to suffer psychological problems such as depression, anxiety and PTSD (Sojo et al., 2016). Even after the removal of the threat, victims are likely to show psychological distress years afterwards (Nielsen and Einarsen, 2012), as sexual harassment acts as a chronic stressor.

New forms of gender-based violence have emerged with digitalisation. Cyber-violence against women is rising and spreading, abetted by the anonymity afforded to aggressors, enabling them to perpetrate violence with relative impunity (Cuenca-Piqueras et al., 2020). Younger women, the main users of social media, are disproportionately affected (WHO, 2020f). Cyber-violence encompasses cyberstalking, hacking, impersonation, cyberbullying, sexual harassment and image-based sexual abuse (Faith and Fraser, 2018). Each of these can take myriad forms. For example, image-based sexual abuse incudes revenge porn, upskirting (taking secret, sexually intrusive photographs) and sexualised Photoshopping as well as sextortion and voyeurism (McGlynn et al., 2017). Increased internet activity during the COVID-19 pandemic has been accompanied by a sharp rise in cyber-violence (EIGE, 2020g; WHO, 2020f), which lowers victims’ self-esteem and exacerbates their distress when interacting with others online. Victims of cyber-violence can experience concentration problems, stress, anxiety, depression and panic attacks as a result, and can feel helpless, pessimistic about the future and unable to control their own lives (European Parliament, 2021).