J Fam Viol (2009) 24:193202 DOI 10.

1007/s10896-008-9220-5

ORIGINAL ARTICLE

The Incidence and Impact of Family Violence on Mental Health Among South Korean Women: Results of a National Survey
Jaeyop Kim & Sookyung Park & Clifton R. Emery

Published online: 9 January 2009 # Springer Science + Business Media, LLC 2009

Abstract This representative national survey examined incidence of husband-to-wife violence in the past year, lifetime exposure to parental violence, and the relationships between victimization experiences of family violence and mental health among South Korean women (N =1,079). The major findings were that incidence rate of husband-to-wife violence among Korean women was 29.5%, which was much higher than those of other nations, and that their experiences of physical violence by husbands in the last year and lifetime verbal abuse by parents had strong associations with the mental health of victims. The findings suggest that preventive intervention programs for male perpetrators as well as domestic violence victims with mental health problems and comprehensive interventions for Korean couples are urgently needed. In addition, parents should be educated about how to modify their childrens behavior without physical punishment or verbal abuse.

Keywords Family violence . South Korea . Domestic violence . Mental health Although Korean society has undergone dramatic social changes during the past 30 years, South Korean men remain more violent toward their family members than women (Kim and Emery 2003). This may be a residual influence of traditional culture. According to previous national surveys in South Korea, the annual incidence of husband-to-wife physical violence is between 27.9% (Kim 1998a) and 35.6% (Byun et al. 1999), which is much higher than in the United States (between 5.21% and 13.61%) (Schafer et al. 1998) and Western Europe (20.8%) (Rmkens 1997). This paper compares the rate of domestic violence in South Korea with rates in other countries and examines the relationship between Korean womens family violence victimization and mental health outcomes. Specifically, the study examines the relationship between family violence victimization and depression, stress, aggression, and self esteem in a nationally representative sample of South Korean women. Women are injured more severely and more frequently by their male intimates than by strangers (Bachman and Saltzman 1995). Previous studies indicate that for women between the ages of 15 and 44, intimate partner violence is the most significant cause of serious injury (Grisso et al. 1991). Women who experience violence by their husbands often have not only physical injuries but also mental problems and social maladjustment (Kim et al. 1999; Kim 2002). For example, women subjected to physical or sexual violence by their partners are more likely to have depression, anxiety, and posttraumatic stress disorders (PTSD) (Plicha 1996; Tolman and Rosen 2001; Cole et al. 2005). Depression rates among Korean female victims of conjugal

This study was supported by Ministry of Health and Welfare, South Korea, in 2000. J. Kim Department of Social Welfare, Yonsei University, Shinchon-Dong, Seoul, South Korea e-mail: [email protected] S. Park (*) Department of Social Welfare, Daejin University, Kyunggi-Do, Pocheon, South Korea e-mail: [email protected] C. R. Emery George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO 63130, USA e-mail: [email protected]

194

J Fam Viol (2009) 24:193202

violence have been reported from 68.5% (Hong 1997) to 83% (Byun et al. 1993), and in the United States, female victims of conjugal violence are four times as likely to suffer depression and 5.5 times more likely to attempt suicide than women in the general population (Stets and Straus 1990). Also, female domestic violence victims tend to report psychological problems such as chronic stress symptomatology (Goldberg 1982), low self-esteem and guilty conscience (Walker 1984; Hilberman 1980). Frequently, women experience more than one type of family violence. In the United States, estimates of both battering and sexual violence by same partner range from 27% to 45.9% (Campbell 1989; Campbell and Shoeken 1999). Psychological maltreatment, such as emotional violence, is both a precursor to a womans physical abuse (Tolman 1989) and may co-occur with sexual violence, especially among acquaintances (Kasian and Painter 1992). Previous research has found evidence of concurrent battering, physical assault and sexual assault by intimate partners in a community sample (Smith et al. 2002). In a longitudinal study of adolescents and college-age women, adolescents who experienced physical or sexual assault were at increased risk for revictimization and covictimization (i.e., both sexual and physical violence) (Smith et al. 2003). Women subjected to multiple types of family violence are more likely to report serious mental health problems. Shiled et al. (1990) found that women who are both sexually and physically abused by their partners, when compared with women who suffer from physical abuse only, had significantly higher scores on a number of subscales of the Brief Symptom Inventory Scale: somatization, hostility, paranoid ideation, psychoticism, and depression. Some researchers have reported that intimate partner sexual violence significantly influences mental health problems such as PTSD (Bennice et al. 2003), but others have found no difference in the likelihood of mental health problems among women sexually and physically abused by partners when compared to those suffering from physical abuse alone (Campbell 1989; Shiled and Hanneke 1983). Numerous studies have found that childhood physical and sexual abuse by a parent is important for predicting physical and sexual violence in adulthood (Gilbert et al. 1997; Irwin 1999; Weaver et al. 1997; Coker et al. 2000; Higgins and McCabe 2000; Krishnan et al. 2001; Ramos et al. 2004; Aosved and Long 2005; Feerick and Snow 2005). Child abuse has short- and long-term mental health consequences for women in adulthood. Women abused as children manifest a variety of mental health problems, such as suicide, depression, anxiety, and alcohol problems (Maker et al. 1998; Widom 1998; Miller 1993; Ramos et al. 2004). Of note, physical child abuse is a stronger predictor of depression than childhood sexual abuse (Roosa

et al. 1999). Further, abuse by parents in childhood has been linked to later aggression in adulthood (Crawford and Wright 2007) and to adult self-esteem (Shen 2008). As shown in previous studies, women who experienced one type or multiple types of violence in families are more likely to report mental health problems. However, despite recognition of the high prevalence of family violence in South Korea, little is known about how victims are affected except for a few studies of the mental health of elderly and adolescent victims (Hong 1997; Kim et al. 1998; Kim and Kim 2003). Furthermore, few studies have explored the relationships between occurrence or co-occurrence of types of violence in families and mental health among women by analyzing nationally representative Korean data. Instead, most studies related to family violence in South Korea have focused only on prevalence of violence and its correlates (Byun et al. 1993; Kim 1998a, b, 2002; Kim et al. 2000, Kim and Emery 2003). Accordingly, we investigated prevalence and the relationships between types of family violence and mental health among South Korean women. The purposes of the study were to: (1) examine the incidence of types of family violence (e.g., partner verbal, physical and sexual violence; parental verbal and physical violence), (2) to explore the co-occurrence of multiple violence experiences across relationships and (3) to examine the relationship between different types of family violence and the mental health status of Korean women. Based on previous findings in the literature, we hypothesized that verbal, physical, and sexual family violence victimization would have negative associations with victims self esteem and positive associations with victims depression, stress, and aggression.

Methods Sample and Procedure This study used data collected for the study of effects of violence against women, which was supported by the Ministry of Health and Welfare in South Korea (2000). Stratified random sampling was used to select a national sample of married women over the age of 20. To ensure the precision of estimates (a 95% confidence interval with an error range of 2.5% for proportions), we used a sample size of 1,500. Women from large and small-to-mid sized cities and rural areas were selected using probability proportional to size multi-area sampling. Of the 1,500 women sampled, we analyzed the data from the 1,079 who were currently living with their husbands. Data were collected by R.D.D. telephone interview from October 26, 1999, to March 31, 2000, by use of a structured questionnaire. Interviewers were recruited from universities

J Fam Viol (2009) 24:193202

195

nationwide from undergraduate and graduate social work programs. All received intensive training before the interviews were conducted. Hierarchical regression modeling, Chi-square and t-statistics were used to analyze the data. Measures Conjugal Violence and Parental Violence Conjugal violence was measured by yes/no scales composed of ten items regarding verbal, physical and sexual violence. The participants were asked whether they had experienced husband-to-wife violence during the past year. Verbal abuse was measured by the item my husband insulted me. Physical violence was measured by the following eight items (translated into Korean) from the Conflict Tactics Scales (CTS), Couple Form R. by Straus and Gelles (1990): i) my husband threw something at me, ii) my husband pushed me, iii) my husband slapped me, iv) my husband kicked, bit, or hit me with his fist, v) my husband hit me with something (e.g., belt, bat, golf club), vi) my husband beat me, vii) my husband choked me, and viii) my husband threatened me with or used a knife (scissors) or gun. Among these eight items, i), ii), and iii) are termed minor violence while the other five items are termed severe violence. Sexual violence was measured by the question I had sex forcefully against my will. Cronbachs alpha was .839. Parental violence was measured by nine CTS items: one verbal and eight for physical violence. The single item measuring sexual violence was omitted from the scale. The participants were asked if their father or mother had been violent with them in childhood. Cronbachs alpha statistics were .720 and .571, for fathers and mothers respectively. Mental Health Mental health was evaluated on the basis of four subcategories: depression, stress, aggression, and self-esteem. Depression was measured by three items which were selected and translated into Korean from Becks Depression Inventory (BDI 1961). The following items were felt to have strong face validity in the Korean context: i) sadness, ii) pessimism, and iii) suicidal ideation. Cronbachs alpha was .773. Stress was measured by the following four items selected, revised and translated into Korean from the Index of Clinical Stress (ICS 1991): i) I feel extremely tense, ii) I feel so stressed that Id like to hit something, iii) It is very hard for me to relax and iv) It is not easy for me to fall asleep at night. Cronbachs alpha was .843. We created a measure for the level of aggression because we were not able to identify one developed specifically for use with Korean women. We used these questions: i) When I have a quarrel with someone, I

must win, ii) If someone laughs at me, I cannot tolerate it, and iii) I have often gotten into fights with other people within the last year. Reliability for this scale was low: Cronbachs alpha was .540. This low reliability may be a consequence of trying to capture relational aggression (the first two items) and physical aggression (item 3). Self-esteem was measured by five items selected and translated into Korean from Rosenbergs Self-Esteem Scale (1979): i) I am able to do things as well as most other people, ii) I certainly feel useless at times, iii) On the whole, I am satisfied with myself, iv) At times I think I am no good at all, and v) I feel I do not have much to be proud of. Cronbachs alpha was .753.

Results Descriptive Statistics for Demographic Characteristics and Mental Health Status Table 1 presents the descriptive statistics for demographic characteristics and mental health status. The average age of participants was 42.39 years (SD=11.52 years). Some 48.1% were high school graduates, 24.2% had junior college or higher levels of education, 13.0% were middle school graduates, and 14.7% had not completed middle school. In terms of mental health, higher scores indicate higher levels of depression, stress, aggression and self-esteem. The mean scores for depression, stress, aggression, and self-

Table 1 Descriptive statistics for socio-demographic characteristics and mental health status (N =1,079) N (%)/mean (SD) Age 2029 years 3039 years 4049 years 5059 years 6069 years Over 70 years Education level Elementary education or less Middle school graduate High school graduate Junior college or more College graduate Graduation school or higher Mental health status Depression Stress Aggression Self-esteem 42.39 years 118 388 321 165 78 27 161 143 528 44 208 13 (SD=11.52 years) (10.8) (35.4) (29.3) (15.0) (7.1) (2.5) (14.7) (13.0) (48.1) ( 4.0) (19.0) (1.2)

1.71(SD=.62) 1.83(SD=.68) 2.00(SD=.60) 2.15(SD=.29)

196

J Fam Viol (2009) 24:193202

esteem were 1.71 (SD=.62), 1.83 (SD=.68), 2.00 (SD=.60) and 2.15 (SD=.29), respectively. Incidence of Past Year Partner Violence and Lifetime Parental Violence The annual incidence rates of husband to wife verbal, physical and sexual violence in the past year among South Korean women in this study were 26.4%, 29.5% and 3.7%, respectively. Sub-dividing physical violence, 29.0% of women had been subjected to minor violence and 6.7% experienced severe violence in the year before the survey. The rate of physical violence by partner was similar to previously published findings for South Korean women (27.5% by Kim (1998b) and 35.6% by Byun et al. (1999), but much higher than reported for women in other nations between 5.21% and 13.61% in the United States (Schafer et al. 1998); 15% in Canada (Canadian Center for Justice Statistics 1993); 20.8% in Western Europe (Rmkens 1997), and 21% in China (Xu et al. 2005) which has a similar culture. With the exception of Rmkens 1997, each of these studies used the Conflict Tactics Scales to measure domestic violence. Rmkens (1997) used in-depth interviews ranging in length from 1 h to 9 h. (Table 2) Almost one in three married women in South Korea experienced minor physical assault during the year, i.e., threw something (22.5%), pushed (17.0%), or slapped (13.8%), while 6.7% were experienced severe assault, i.e., kicked, bit, or hit with a fist (6.2%); hit with something (1.5%); beat up the other one (2.4%); choked (0.7%); or threatened with a knife or gun (0.9%). Rate of severe partner physical violence (6.7%), which Straus and Gelles defined as wife beating, was more than twice as high as for US women (3.2%) (Plitcha and Weisman 1995) and a little better than for women in China (6%) (Xu et al. 2005). However, our finding of a 3.7% prevalence rate of sexual violence by a partner in the past year was far below the Chinese rate of 12% (Xu et al. 2005). Given the strong likelihood of underreporting, we believe that the actual prevalence rates are even higher. Results from the Korean studies are probably most comparable with the U.S. study because both used the Conflict Tactics Scale and both used telephone interviews. Xu et al. (2005) used the Conflict Tactics scale, but conducted face to face interviews in a hospital setting, making the comparison with China more problematic. Parish et al. (2004) conducted a study of China with a stronger representative sampling design, but used a lifetime ever question on hitting (34% of their respondents reported any male to female hitting) as their measure, making comparisons with severe violence measures from Korea and China problematic.1

Lifetime prevalence rates of verbal and physical violence by parents among South Korean women were 31.3% and 23.1% (minor violence 14.2%, severe violence 14.8%), respectively. Lifetime prevalence rates of verbal and physical violence victimization by a father were 17.0% and 12.6% (minor violence 8.4%, severe violence 7.6%), respectively, and prevalence rates of verbal and physical violence victimization by a mother were 24.6% and 13.9% (mild violence 6.9%, severe violence 9.3%), respectively. (Table 3) Relationships Between Conjugal Violence and Parental Violence Table 4 presents the bivariate relationships between different forms of partner violence (verbal, physical and sexual) and lifetime parental violence (verbal and physical). Rates and counts of participants reporting violence are given for women who reported verbal, physical and sexual partner violence. Chi-square statistics indicate whether there were significant differences in rates of partner violence when the form of violence reported in the column was present versus not present. Relative risk statistics were as follows: Women who reported that they suffered from verbal abuse by their partner were more than three times more likely (R.R.=60.3/18.5=3.26) (p <0.001) to report being victimized by physical partner violence, and ten times more likely (p <0.001) to report sexual partner violence than women who didnt report verbal partner violence. Women who reported physical partner violence were three times more likely (p <0.001) to report sexual partner violence. Regarding the relationship between parental violence and partner violence, women who had experienced lifetime parental verbal abuse were 1.6 times more likely (p <0.001) to report physical violence by their partner than women who had not experienced parental verbal abuse. Women with life histories involving parental physical violence were 1.5 times more likely (p <0.001) to report physical violence by their partner than were women with no history of parental physical violence. P-values are based on chi-square statistics reported in Table 4. Type of Family Violence and Mental Health Among Women Table 5 shows the relationships between type of partner and parental violence and mental health among women. To determine if victims differed from non-victims in mental health status, we used two t-tests. Results of t-tests analyses indicated
Parish et al. (2004) actually do not report 34%, but rather that 37% of men reported any hitting of women and 31% of women reported any hitting of women. However, as their sample by design contains exactly 50% women and 50% men, the overall sample rate must be the average of the two rates.
1

J Fam Viol (2009) 24:193202 Table 2 Annual incidence of husband-to-wife physical violence in National Survey of U.S., China, and Korea Type of violence Rates of Incidences (%) U.S. 1998, 1995 (n =1599, 1,324) ANY physical violence by the husband SEVERE physical violence by the husband 5.213.6 3.2 China 2000 (n =8912) 21.0 6.0 Korea 1997 (n =1279) 27.5 7.9

197

Korea 1999 (n =1079) 29.5 6.7

that for verbal abuse by a partner, the average scores for depression (t =4.129, p <.001), stress (t =2.272, p <.05), aggression (t =3.415, p <.01) and self-esteem (t =2.662, p <.01) were significantly worse for victims than non-victims. Respondents reporting physical partner violence had significantly higher mean scores for depression (t =10.697, p <.001), stress (t =9.642, p <.001), aggression (t =7.781, p <.001) and poor self-esteem (t =2.686, p <.01) than non-victims. In contrast, there were no significant differences in the mean scores of depression, stress, aggression, and self-esteem between victims of sexual partner violence and non-victims. Women who had histories of verbal abuse by parents reported more depression (t =4.624, p <.001), stress (t = 4.526, p <.001) and aggression (t =4.998, p <.001) than non-victims but there was no significant difference in the mean self-esteem scores of victims and non-victims. Also, women who had experienced lifetime parental physical violence were more aggressive (t =3.630, p < .001) than non-victims; however, there were no significant differences in the mean scores of depression, stress, and self-esteem

between women whose parents had been or had not been physically violent with them. Hierarchical regression analyses were conducted to estimate the relative effects of the type of family violence in predicting mental health status among women with a history of family violence. In each of these analyses, age and education were entered in the first block, followed by the type of family violence in the second block. Results of these analyses are presented in Table 6. Controlling for age and education, type of family violence accounted for 9.8% of the variance in depression, 7.8% of the variance for stress, 6.7% for aggression and 0.9% for self esteem. In the regression analysis that predicted depression, partner physical violence and parental verbal abuse were significant factors. Similarly, partner physical violence and lifetime verbal abuse by parent significantly influenced stress and aggression, respectively. However, in the regression analysis predicting self-esteem, only partner verbal abuse was significant. These effect sizes fall into the medium range for depression, stress and

Table 3 The incidence of family violence among married South Korean women (n =1,079) Type of violence Husband to wife violence (In past year) N (%) Parental violence (lifetime) N (%) Total Verbal violence Insulted me Total physical violence Total minor physical violence Threw something at me Pushed me Slapped me Total severe physical violence Kicked, bit, or hit me with fist Hit me with something (e.g., belt, bat, golf club). Beat me Choked me Threatened with or used a knife(scissor) or gun Sexual violence I has sex forcefully against my will By father By mother

290 (26.4) 324 (29.5) 318 (29.0) 247 (22.5) 187 (17.0) 151 (13.8) 74(6.7) 68(6.2) 17(1.5) 26(2.4) 8 (0.7) 10(0.9) 41(3.7)

343 (31.3) 253 (23.1) 156 (14.2) 77(7.0) 60(5.5) 104(9.5) 162 (14.8) 42(3.8) 141(12.9) 21(1.9) 3(0.3) 2(0.2)

186 (17.0) 138 (12.6) 92 (8.4) 48(4.4) 29(2.6) 68(6.2) 83 (7.6) 29(2.6) 67(6.1) 14(1.3) 2(0.2) 2(0.2)

270 (24.6) 152 (13.9) 76 (6.9) 35(3.2) 35(3.2) 42(3.8) 102 (9.3) 15(1.4) 93(8.5) 9(0.8) 1(0.1) 0(0.0)

198 Chi-square

J Fam Viol (2009) 24:193202 2.196 18.365*** 1.794 175 (60.3) 32 (11.0) *p <.05, **p <.01, ***p <.001 Verbal (N =290) Physical (N =324) Sexual (N =41) 149 (18.5) 9 (1.1) 179.802*** 58.343*** 23 (7.1) 18 (2.3) 14.439*** 81 (23.6) 137 (39.9) 12 (3.5) 209 (27.7) 187 (24.8) 29 (3.8) 2.041 25.968*** .079 76 (30.0) 102 (40.3) 13 (5.1) 214 (25.4) 222 (26.3) 28 (3.3)

aggression, and into the small range for self esteem (Cohen 1992).2
Physical violence by parent Table 4 The relationship between husband-to-wife violence and parental violence among married South Korean women (N =1,079) Verbal abuse by parent Physical violence by husband Verbal abuse by husband Violence by husband (Yes)

Discussion This study explored incidence and the relationships between various types of family violence and mental health problems among South Korean women based on the results of a national survey. Results of this study showed that about one out of three Korean women had experienced physical violence at the hands of their husbands in the last year. About one in four had experienced physical violence by a parent at some point in life. Incidence rate of husband to wife physical violence among South Korean women was at least twice as high as for women in the U.S., and was 1.4 times higher than Xu et al.s (2005) rate for women in China. In addition, the incidence rate of severe physical violence, i.e., wife beating (6.7%) was also more than twice as high as that of U.S. women. These higher rates of physical violence by husbands among South Korean women were consistent with findings of previous National surveys in South Korea (Kim 1998b). We found two interesting results related to lifetime parental violence toward South Korean women. First, prevalence rate of severe physical violence was higher than that of minor physical violence. Second, prevalence rates of verbal and severe physical violence by mothers were higher than those by fathers. This may result from many Koreans traditional education and parenting experiences. Traditionally, Koreans regarded physical punishment by a parent as a means of educating or socializing children. Furthermore, South Korean mothers are much more likely to be involved in educating their children than fathers. However, additional studies are needed to explore the causes of the high incidence of maternal violence toward their daughters. Partner sexual violence was associated with partner verbal and physical violence and partner verbal abuse was also related to partner physical abuse. These patterns are consistent with previous findings (Smith et al. 2002; Smith et al. 2003). Similarly, women who were abused by parents either verbally or physically reported more physical partner violence than women who had not been abused by a parent, consistent with previous findings (Wyatt et al. 2000; Ramos et al. 2004). These results are consistent with the idea that women with a history of abuse by an intimate partner or parent have more difficulty asserting themselves with the
2 Cohen (1992) defines a large effects as a correlation of 0.50, a medium sized correlation as 0.30 and a small correlation as 0.10. Keeping in mind that the partial r-square values can be converted into partial correlation coefficients by taking the square root gives r =.31 for depression, r =.28 for stress, r =.26 for aggression, and r =.10 for self esteem.

Yes N(%)

No N(%)

Chi-square

Yes N(%)

No N(%)

Chi-square

Yes N(%)

No N(%)

Chi-square

Yes N(%)

No N(%)

J Fam Viol (2009) 24:193202 Table 5 Conjugal violence and parental violence in relation to mental health among married South Korean women (N =1,079) Depression N Violence by husband Verbal violence Yes No Physical violence Yes No Sexual abuse Yes No Violence by parent Verbal violence Yes No Physical violence Yes No Mean T Stress Mean t Aggression Mean t Self-esteem Mean t

199

290 807 324 773 41 1056

1.852 1.667 2.031 1.584 1.837 1.711

4.129***

1.913 1.801 2.143 1.699 1.969 1.825

2.272*

2.112 1.964 2.218 1.914 2.008 2.003

3.415**

2.195 2.141 2.190 2.140 2.181 2.154

2.662**

10.697***

9.642***

7.781***

2.686**

1.264

1.318

.047

.574

343 754 253 844

1.844 1.658 1.765 1.702

4.624***

1.965 1.769 1.895 1.811

4.526***

2.138 1.942 2.124 1.967

4.998***

2.179 2.144 2.156 2.155

1.764

1.421

1.701

3.630***

.082

*p <.05, **p <.01, ***p <.001

perpetrators of violence than women without a history of abuse. In fact, women who have been exposed to psychological maltreatment such as verbal abuse may tend to use submissiveness or passivity in order to self-protect. Thus, these women are more likely to be at greater risk of victimization (Aosved and Long 2005). As expected and consistent with previous findings, our results indicate that verbal abuse and physical partner violence and parental verbal abuse and physical violence

are negatively associated with all subcategories of mental health in the current study i.e., depression, stress, aggression, and self-esteem (Golding 1999; Campbell and Belknap 1997; Ramos et al. 2004). Hierarchical regression analyses showed that both physical partner violence and parental verbal abuse have significant relationships with depression, stress, and aggression. This shows that amongst types of violence by partner, physical violence was associated with the most

Table 6 Results of hierarchical regression analyses predicting mental health from history of husband-to-wife violence and violence by parent (Beta coefficient) (N =1,079) Independent variables Depression Beta Stress Beta Aggression Beta .097** .070* .008 4.156* .091** .038 .036 .198*** .033 .108** .030 .075 12.607*** .067*** Self-esteem Beta

Block 1 Age Education R2 F Block 2 Age Education Verbal violence by husband Physical violence by husband Sexual violence by husband Verbal violence by parent Physical violence by parent R2 F R2 change
#

.075* .202*** .061 35.745*** .075* .161*** .010 .283*** .005 .107** .029 .159 29.474*** .098***

.058 .241*** .075 44.639*** .058 .206*** .049 .267*** .020 .094** .013 .154 28.281*** .078***

.059 .117** .024 13.515*** .060 .109** .067* .024 .000 .061 .022 .033 5.365*** .009#

p <.10, *p <.05, **p <.01, ***p <.001

200

J Fam Viol (2009) 24:193202

serious consequences, while amongst types of violence by parents, verbal abuse appeared to have more negative influence on womens mental health. In addition, this finding suggested that the relationships between verbal or physical violence and mental health among South Korean women differ depending on who the perpetrator is. Another interesting result was that aggression among women was associated with every type of family violence except sexual partner violence. Accordingly, aggression among women who have experienced violence may be the most common mental health problem regardless of type of family violence. Also, we found that not only partner violence in the past year but also any lifetime parental violence was associated with present mental health among women in South Korea. This is consistent with previous findings that lifetime abuse is associated with elevated levels of anxiety and depression (Ramos et al. 2004). This study indicates that family violence as a whole accounted for 9.8% of the variance in depression; 7.8% of the variance in stress; 6.7% of the variance in aggression; and 0.9% of the variance in self-esteem, controlling for age and education. This indicates that every type of family violence explained more of the variance in depression than in other sub-categories of mental health. Our study has several limitations. First, because the data are cross-sectional, it is difficult to determine whether mental health symptoms are an antecedent for family violence (Ramos et al. 2004). Second, as the data were obtained by telephone survey, the rates of violence and mental health problems in this study may be underreported. Third, there may be recall bias for experiences of past abuse. Fourth, although this study focused on marital relationships among couples, it only included wives and not husbands. Data based solely on self-report can be biased, and marital interactions can be better understood when both spouses are included in a study. Finally, in this study, assessments of mental health status were somewhat limited because measurements of mental health were limited to selected items measuring depression, stress, aggression, and self-esteem rather than complete scales and because the reliability for the aggression measure was low. Despite these limitations, our results have several important implications. First, findings in the current study indicate that prevalence of physical violence by intimate partners among South Korean women seems to be much higher than in Western nations and possibly even in China (which has a similar culture). Recognizing the urgent need for intervention programs to prevent conjugal violence, well organized public efforts should be made in South Korea. In 1998, the Korean government adopted the Family Violence Prevention and Punishment Act and since then has made ongoing efforts to resolve family violence

problems. However, so far, the focus has been on improving intervention programs for female victims rather than on decreasing the incidence of family violence. The Korean government should also make efforts to enhance intervention programs for the perpetrators of conjugal violence. In addition, policymakers and practitioners should focus on developing community-based early marital conflict intervention programs that are easily accessible. For couples who have experienced marital conflict, therapy must be developed to promote better communication skills and alternative ways of conflict resolution. Second, as noted in our analysis section, physical partner violence and parental verbal abuse appear to be more likely to influence a womans mental health than other types of family violence. These results suggest that policymakers and mental health practitioners need to be aware of the critical nature of types of violence and their relationship to mental health problems among female victims. Community-based support systems should be enhanced to enable objective assessment and early appropriate treatment of female abuse victims with mental health problems. Third, prevalence of severe physical violence by parents toward their daughters was higher than minor physical violence by a parent. Further, prevalence of verbal or severe physical violence by mothers was higher than that by fathers. Considering that Korean society tends to tolerate physical punishment of children by parents, there is a need to develop parent education programs that focus on alternatives to physical punishment. Given the strength of the associations between parental verbal abuse and the mental health outcomes of the women, policy attention to programs helping parents to develop healthy communication patterns with their children should also be considered. Fourth, there were strong relationships between sexual violence, verbal abuse, and physical violence by the same partner among South Korean women. In addition, women who were the victims of parental violence were more likely to report co-occurrence of partner physical violence than women who did not report parental violence. This suggests that professional intervention programs for female victims of multiple types of violence are urgently needed. Future longitudinal studies are needed to determine whether mental health symptoms are an antecedent for family violence. Assessment tools to determine the mental health status of abused women and the creation of clinical intervention remedies would also be useful.

References
Aosved, A. C., & Long, P. J. (2005). College womens experiences of psychological maltreatment and sexual assault. Violence and Victims, 20, 577587. doi:10.1891/vivi.2005.20.5.577.

J Fam Viol (2009) 24:193202 Bachman, R., & Saltzman, L. E. (1995). Violence against woman. Estimates from the redesigned survey a national crime victimization report. NCJ-154348. Washington, DC: Bureau of Justice Statistics, U. S. Dept. of Justice. Bennice, J., Resick, P., Mechanic, M., & Astin, M. (2003). The relative effects of intimate partner physical and sexual violence on post-traumatic stress disorder symptomatology. Violence and Victims, 18, 8793. doi:10.1891/vivi.2003.18.1.87. Byun, W. S., Won, Y. A., & Choi, E. Y. (1993). A study on the countermeasures on domestic violence-focused on wife abuse. Seoul: Korean Womens Development Institute. Byun, W. S., Won, Y. A., & Chung, S. K. (1999). A study on genderconsciousness and violence against women in Korea. Seoul: Korean Womens Development Institute. Canadian Center for Justice Statistics (1993). Violence against Woman survey Highlights. Ottawa: Author. Campbell, J. C. (1989). Womens responses to sexual abuse in intimate relationships. Health Care for Women International, 10, 335346. Campbell, J. C., & Belknap, R. A. (1997). Predictors of depression in battered women. Violence Against Women , 3 , 271 294. doi:10.1177/1077801297003003004. Campbell, J. C., & Shoeken, K. L. (1999). Forced sex and intimate partner violence: Effects on womens risk and womens health. Violence against Women, 5, 10171035. Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155159. doi:10.1037/0033-2909.112.1.155. Coker, A. L., Smith, P. H., McKeown, R. E., & King, M. J. (2000). Frequency and correlates of intimate partner violence by type: Physical, sexual, and psychological battering. American Journal of Public Health, 90, 553560. doi:10.2105/ AJPH.90.4.553. Cole, J., Logan, T. K., & Shannon, L. (2005). Intimate sexual victimization among women with protective orders: Types and associations of physical and mental health problems. Violence and Victims, 20, 695715. doi:10.1891/vivi.20.6.695. Crawford, E., & Wright, M. (2007). The impact of childhood psychological maltreatment on interpersonal schemas and subsequent experiences of relationship aggression. Journal of Emotional Abuse, 7(2), 93116. doi:10.1300/J135v07n02_06. Feerick, M. M., & Snow, K. L. (2005). The relationships between childhood sexual abuse, social anxiety, and symptoms of posttraumatic stress disorder in women. Journal of Family Violence, 20, 409419. doi:10.1007/s10896-005-7802-z. Gilbert, L., El-Bassel, N., Schilling, R., & Friedman, E. (1997). Childhood abuse as a risk for partner abuse among women in methadone maintenance. The American Journal of Drug and Alcohol Abuse, 23, 581595. Goldberg, W. G. (1982). Behavioral Assessment of the physical abused. In Warner, C. G. & Brean, G. R. (Eds.), Management of physically and emotionally abused: Emergency assessment, intervention and counseling. A Capistrano Publication Press, Ltd. Golding, J. M. (1999). Intimate partner violence as a risk factors for mental disorders: A meta-analysis. Journal of Family Violence, 14, 99132. doi:10.1023/A:1022079418229. Grisso, J. A., Wishner, A. R., Schwartz, D. F., et al. (1991). A population-based study of injuries in inner-city women. American Journal of Epidemiology, 134, 5986. Higgins, D. J., & McCabe, M. P. (2000). Multi-type maltreatment the long-term adjustment of adults. Child Sexual Abuse Review, 9, 6 18. doi:10.1002/(SICI)1099-0852(200001/02)9:1<6::AIDCAR579>3.0.CO;2-W. Hilberman, E. (1980). Overview: the wife-beater s wife reconsidered. The American Journal of Psychiatry, 137, 13361347. Hong, C. H. (1997). Domestic violence and womens mental health. Silla University Journal of Womens Studies, 8, 4158.

201 Irwin, H. J. (1999). Violent and nonviolent revictimization of women abuse in childhood. Journal of Interpersonal Violence, 14, 1095 1110. doi:10.1177/088626099014010006. Kasian, M., & Painter, S. L. (1992). Frequency and severity of psychological abuse in a dating population. Journal of Interpersonal Violence, 7, 350364. doi:10.1177/088626092007003005. Kim, J. Y. (1998a). Conjugal violence in Korean elderly couples: an analysis with socio-economic status. Journal of the Korea Gerontological Society, 18(1), 170183. Kim, J. Y. (1998b). Spousal abuse and social class in Korean national family violence survey. Korean Journal of Social Welfare, 35, 133155. Kim, K. S. (2002). A case study on the characteristics of wife abusers. Journal of Family Relations, 7(2), 6587. Kim, J. Y., & Emery, C. (2003). Marital power, conflict, norm consensus, and marital violence in a nationally representative sample of Korean couples. Journal of Interpersonal Violence, 18 (2), 197219. doi:10.1177/0886260502238735. Kim, J. Y., Kim, D. B., & Choi, S. H. (1998). Stress, marital conflicts, depression, and marital power of elderly couples. Journal of the Korean Gerontological Society, 18(3), 103122. Kim, J. Y., & Kim, H. S. (2003). Conjugal violence and mental health of Korean elderly women. Journal of the Korea Gerontological Society, 23, 5165. Kim, J. Y., Yang, H., & Lee, K. Y. (1999). A study of the effectiveness of the integrated group program for battered womens depression. Korean Journal of Social Welfare, 38, 6899. Kim, S. K., Chang, K. S., Lee, H. S., Chung, K. S., Cho, A. G., & Song, I. J. (2000). Change of Korean Family and Its Coping Strategy. Seoul: Korea Institute for Health and Social Affairs. Krishnan, S. P., Hilbert, J. C., & Pase, M. (2001). An examination of intimate partner violence in rural communities: Results from a hospital emergency department study from southwest United States. Family & Community Health, 24, 114. Maker, A., Kemmelmeier, J., & Peterson, C. (1998). Long-term psychological consequences in women of witnessing parental physical conflict and experiencing abuse in childhood. Journal of Interpersonal Violence, 13, 574589. doi:10.1177/088626098013005002. Parish, W., Wang, T., Laumann, E., Pan, S., & Luo, Y. (2004). Intimate partner violence in china: national prevalence, risk factors and associated health problems. International Family Planning Perspectives, 30(4), 174181. Plicha, S. B. (1996). Violence and abuse: Implications for womens health. In M. M. Falik, & K. S. Collins (Eds.), Womens health: The commonwealth survey (pp. 237272). Baltimore: Johns Hopkins University Press. Plitcha, S. B., & Weisman, C. S. (1995). Spouse or partner abuse, use of health services, and unmet need for medical care in U.S. women. Journal of Womens Health, 4, 4554. Ramos, B. M., Carlson, B. E., & Mcnutt, L. -A. (2004). Lifetime abuse, mental health, and African American women. Journal of Family Violence, 19, 153164. doi:10.1023/B:JOFV.0000028075.94410.85. Roosa, M., Reinholtz, C., & Angeline, P. (1999). The relation of child sexual abuse and depression in young women: comparison across four ethnic groups. Journal of Abnormal Child Psychology, 21, 6576. Rmkens, R. (1997). Prevalence of wife abuse in the Netherlands: Combining quantitative and qualitative methods in survey research. Journal of Interpersonal Violence, 12, 99125. doi:10.1177/088626097012001007. Schafer, J., Caetano, R., & Clark, C. (1998). Rates of Intimate Partner Violence in the United States. American Journal of Public Health, 88(11), 17021704. doi:10.2105/AJPH.88.11.1702. Shen, A. (2008). Self-esteem of young adults experiencing interparental violence and child physical maltreatment. Journal of Interpersonal Violence, forthcoming.

202 Straus, M., & Gelles, R. (Eds.) (1990). Physical Violence in American Families. New Brunswick: Transaction Publishers. Stets, J., & Straus, M. (1990). Gender difference in reporting marital violence and its medical and psychological consequences. In M. Straus, & R. Gelles (Eds.), Physical violence in American families (pp. 151165). New Brunswick: Transaction. Tolman, R. M. (1989). The development of measure of psychological maltreatment of women by their male partners. Violence and Victims, 9, 223232. Tolman, R. M., & Rosen, D. (2001). Domestic violence in the lives of women receiving welfare. Violence Against Women, 7(2), 141158. Smith, P. H., Thornton, G. E., Devellis, R., Earp, J., & Coker, A. L. (2002). A population-based study of prevalence and distinctiveness of battering, physical assault, and sexual coercion and rape. Journal of Interpersonal Violence, 14, 548561. Smith, P. H., White, J. W., & Hollend, L. J. (2003). A longitudinal perspective on dating violence among adolescent and college-age women. American Journal of Public Health, 93, 11041110. doi:10.2105/AJPH.93.7.1104. Shiled, N. M., & Hanneke, C. R. (1983). Battered wives reactions to marital rape. In D. Finkel, R. Gelles, G. Hotaling, & M. Straus (Eds.), The dark side of families: Current family violence research (pp. 131148). Thousand Oaks, CA: Sage.

J Fam Viol (2009) 24:193202 Shiled, N. M., Resick, P. A., & Hanneke, C. R. (1990). Victims of marital rape. In R. T. Ammerman, & M. Herson (Eds.), Treatment of family violence: A sourcebook (pp. 165182). New York: John Wiley & Sons. Walker, L. (1984). The battered woman syndrome. New York: Springer. Weaver, R. I., Kilpatrick, D. G., Resnick, H. S., Best, C. L., & Saunders, B. E. (1997). An examination of physical assault and childhood victimization histories within a national probability sample of women. In G. K. Knator, & J. L. Jasnski (Eds.), Out of darkness: Contemporary perspectives on family violence (pp. 3546). Thousand Oaks, CA: Sage. Widom, C. S. (1998). Posttraumatic stress disorder in abuse and neglected children. The American Journal of Psychiatry, 156, 12231229. Wyatt, G. E., Axelrod, J., Chin, D., Carmona, J. V., & Loeb, T. B. (2000). Examining patterns of vulnerability to domestic violence among African American women. Violence against Women, 6, 495514. Xu, X., Zhu, F., OCampo, P., Koenig, M. A., Mock, V., & Campbell, J. (2005). Prevalence of and risk factors for intimate partner violence in China. American Journal of Public Health, 95, 78 85. doi:10.2105/AJPH.2003.023978.