Present research examined the effects of four forms of domestic violence (physical, psychological, economic and sexual violence) on psychological well-being of conveniently selected 100 violence survivor women (n= 25 for each form). Age range of the sample was 18-50 years and was selected from the Dar-ul-amaans (shelter homes) of Multan and Bhawalpur cities of Punjab, Pakistan. Research was a mixed method survey research design and as first step Urdu translated version of California Psychological Inventory’s subscale of Well-being (Wb) (1) was used to assess the psychological well-being of these violence survivor women followed by the semi-structured interview; to explore demographic factors in provoking domestic violence and major psychological problems faced by survivor women. Results of One Way Analysis of Variance (ANOVA) revealed that the survivors of sexual and physical violence had most impaired psychological well-being as compared to other types of domestic violence survivors (quantitative analysis). The case history reports on the basis of semi structured interviews and previous history record (available in Dar-ul-amaan’s records and consultant psychologist’s files) showed that family and socio-economic factors played a significant role in provoking various types of domestic violence and major psychological problems faced by the surviors were poor self-concept, low self-esteem, feelings of powerlessness, helplessness, worthlessness, hopelessness, sleep problems, anhedonia, post-traumatic stress disorder and depression (qualitative analysis).

Keywords: domestic violence, psychological well-being, survivor women

Violence against women is becoming a very critical issue, especially domestic violence. Public health practitioners of developing countries over the years had been deeply concern with trying to study and mitigate the impact of this on female survivors. It is defined as a gender based violence that results in, or is likely to result in, physical, sexual or mental harm /suffering to women, including threat of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life.^1,2 Domestic violence is a global issue and commonly used to describe the “women abuse” those who suffer at the hands of their male partner, because wife abused by husband is the most common form of violence against women (e.g. wife beating, burning of women, acid throwing)³⁻⁶ and according to the American Medical Association domestic violence is perceived as a pattern of physical, sexual and/or psychological abuse by a person with whom the survivor had an intimate relationship.⁷⁻¹⁰ Domestic violence is also considered as an important cause of mortality and morbidity of women in every country where these associations have been studied.² It is considered as an important cause of intentional injuries in women, which consequently reduce women’s confidence by decreasing their desire to participate fully in life.¹¹⁻¹⁴ It occurs in almost all social and economic classes, races and religions in multiple patterns/trends however, not a single society could be declared free of this notion.¹⁵

One’s social setup plays vital role in the promotion of domestic violence; as historically our society encourages men to be more powerful and aggressive and at the same time encouraging women to be submissive and weak. It has a long standing history in all national, ethnic and class boundaries. Walker’s¹⁶ research indicates that the tradition of domestic violence blended with religious believes and legal rights holding. This means further that men are responsible for the needs of their wives and children, and making it their duty to discipline whose views are seen as disobedient. As domestic violence is a well-known problem today, different psychologists and sociologists define it according to their cultural perspectives. Domestic violence is an act expressed by husband towards his wife in the form of physical, sexual, emotional, or economic to which, the wife denies to consent and it is directly or indirectly conditioned by the traditions, laws, and attitudes prevalent in the living society, and it is done in order to gain the power on other partner.^17,18

In Pakistani society, domestic violence is a private matter, as it occurs in the family setup, and therefore not an appropriate focus for its assessment, proper intervention or policy changes resides in the cultural boundaries.¹⁹ Male dominance is frequently considered as a main cause of the domestic violence in general²⁰ and co-modification in this regard eventually prone seventy percent to ninety percent of Pakistani women to violence on daily basis.²¹

Domestic violence has many reasons or causes, but mostly socialization,²² economic dependency on male,²³ inflexible norms and values,²⁴ poverty and illiteracy are those profound psychological and social factors, who contribute largely in the occurrence of domestic violence.²⁵

Theoretical bases

Some psychological theories also strive to investigate the causes and reasons behind the act of domestic violence but no single theory would fully explain domestic violence against women, since is it is multi-factorial. According to psychoanalytical theory sexual and instinctive drives known as the libido which derives its energy from the Eros basically motivates human behaviors. In case of repression of such libidinal urges aggression or abusive behaviour emerged.²⁶ Theory of learned helplessness demonstrated that repeated violence diminishes the women’s motivation to respond by lowering her self-esteem, she becomes passive and she put down her attempt to free herself from a battering relationship.¹⁶ Social learning theory revealed that humans learn behaviours by observing them in others, therefore men who observed their parents physically attacking each other were almost three times more likely to have hit their own wives.²⁷⁻²⁹ Power based theory affirmed that the present day marital violence by men towards their wives is an attempt to established or maintain power over the wife when her behaviour becomes unacceptable to the men.^30,31 Frustration aggression theory declared that frustrating experiences acts as instigators of violent behaviour, heightening the drive level and thereby presumably sparking aggressive behaviour.³² According to gender schema theory violence against women has been emerging from inequalities between men and women and this imbalance of power results from the emergence of gender roles ascribed to men and women from birth with gender discrimination.33Domestic violence has a very devastating effect on psychological functioning of female survivors of gender based violence. survivors with distressing psychological functioning mostly report problems like hypertension, lack of concentration, lack of interest, have poor self-concept, low self-esteem, feelings of powerlessness, depression, sleep problems, post-traumatic stress disorder, and obsessive compulsive disorder.³⁴⁻³⁶ I. It is very difficult to assess the extent of the problem in our society which is likely due to the strength of notion of the privacy/secrecy of the family, and lack of reported data on this issue, but this has been quite evolving and increasingly becoming visible in our society. Moreover, slapping, hitting, punching, kicking, and pushing are hardly considered as violence. There have been various comprehensive studies done on domestic violence with reference to Pakistani society.⁴⁻⁴¹

Rationale of the study

The review of the relevant literature suggests that domestic violence is a very serious social problem and it impairS the mental and physical health of the women survivors of domestic violence.^34,35 The situation of domestic violence against women in Pakistan is far from clear but what is clear is that it is an issue and not much is being done to prevent it either by the government or nongovernmental organizations (NGOs). In Pakistan this problem was investigated for a large number of times, but almost all the research studies investigate the types and impact of domestic violence on the well-being of battered women and children^4,25,40 but they did not compare them to see the differences in impact on the psychological well-being of the abused women in comparison to each other. Only few studies were conducted on the sexual violence with the aim to investigate the causes and reasons behind this and their after effects on the social life of the abused person who survived the incident.⁴¹ To be able to address the issue properly it is important to have baseline data about its prevalence and reasons behind violence against women.⁴² So far, no psychological research had been carried out especially to check the devastating effects of sexual violence on the psychological well-being of the battered women who survive this devastating experience in Pakistan. In sexual violence, in fact, vulnerability is the key factor. It is a cultural phenomenon that most of women show hesitation to talk about the sexual violence; this has impaired both mental and physical well-being of sexually abused women.⁷ Today the issue of sexual violence has gain huge importance all over the world. This research has been planned to explore the type of domestic violence that impairs the psychological well-being of the abused women at most level and the profound demographic variables in provoking domestic violence.

Objectives of the Study

Specific objectives of the study are listed below:

1. To examine how different types of domestic violence (physical, sexual, psychological and economic violence) impair the psychological well-being of the abuse survivors.
2. To identify the main causes of high prevalence rate of domestic violence in Pakistani society.

Hypotheses

In order to achieve the above objectives following hypotheses have been formulated:

1. Survivors of sexual violence would have most impaired psychological well-being in comparison with survivors of economic and psychological violence.
2. Economic violence would have the least debilitating impact on psychological well-being in comparison with physical, sexual, and psychological violence.

Definitions of variables

1. The definitions of the domestic violence as developed from the report published by Family Violence Professional Educational Taskforce43 suggest that in Pakistan four types of domestic violence occurred (physical, sexual, psychological and economic).
2. Physical violence refers to any intentional behaviour involving use of force against the body of another person which risks physical injury, hitting, harm or pain, punching, kicking, slapping, burning, twisting of the body parts, attacking with objects, breaking bones and murder attempts.
3. Sexual violence can be defined as any unwanted and forced sexual intimacy towards other individual; forced unwanted method of intercourse, denying partner’s sexuality, or any other unwanted sexual activity.
4. Psychological violence as the destruction of person’s self-esteem, humiliation, possessiveness, interrogation, constant criticism and make one feel inferior.
5. Economic violence occurred where the man totally controls all financial resources which involves controlling the other person’s (women) earned money; its availability and restricting her from participating in decisions about how money should be spent by denying woman’s access to her own funds.

The purposive convenience sampling technique was used in present study and 100 violence (n = 25, for each form i.e., physical, psychological, economic and sexual violence) survivor women were selected from the Dar-ul-amaans of Multan and Bhawalpur cities of Punjab Pakistan. The age range of the sample was 18-50 years (M = 34) and were identified with the help of women activist lawyer, and Dar-ul-amaan’s administration. Majority of the sample belonged to lower middle and lower socio economic status. As inclusion criteria only those women were made part of study that had legal pursuits going on in courts regarding domestic violence and were staying in Dar-ul-amaan upon court orders. Keeping in view the APA ethical consideration and fragile nature of study NOC from their lawyers and Dar-ul-amaan administration were also sought. All the willing sample confirmed their participation in study by informed consent commitment.

Well-being scale (Wb scale of CPI): Considering the objectives of the research, Urdu translated version of California Psychological Inventory’s (CPI) subscale Wb (1) was selected to explore out the level of psychological well-being of the survivors of four types of domestic violence. Wb scale comprises of 38 (6 true, 32 false) items. It was dichotomous scale having 0-1 response categories. “True” responses were scored as “1”, whereas, “False” responses were scored as “0”. High scores in the scale represent high psychological well-being vice versa. The reliability estimates of the instruments showed high value of co-efficient alpha α=.86.

The ethical considerations were kept in mind before the data collection of the present study and verbal informed consent was taken from all the respondents by assuring respondents that all information provided would be kept confidential. 22 women refused to participate in the study and were replaced by other women residing in the next Dar-ul-amaans who fulfilled the criteria.

The data collection instrument was based on the main objective of the study i.e., to measure the psychological well being along with that a socio-demographic sheet containing the data of participants was maintained including age of respondent/husband, age at marriage, duration of marriage, number of pregnancies, occupation (husband and responded own if any), type of house or ownership of house and monthly household income. Semi-structured in depth interviews (40-50 minutes) were carried out with each survivor woman individually. All of the women were inquired about the details of their lives, in-depth explanations about the nature of domestic violence which they had experienced and to report whether the abusers were their husbands or any other family members (in-laws). They were also inquired about the present state of their psychological health and these complaints were verified by the record files saved at Dar-ul-amaan’s (shelter homes) office staff and consultant psychologists. The interviews were recorded with paper and pencil (with the consent of interviewees and Dar-ul-amaan’s administration) and later on were used for the qualitative analysis, whereas the scores on psychological well-being scale were used for quantitative analysis.

The present research had been completed in two parts. Part I deals with the quantitative analysis (with the help of SPSS 21), in order to find out which types of domestic violence impaired the psychological well-being of abused women most severely. Part II deals with the qualitative analysis, in order to explore those profound demographic variables which act as provoking factors of domestic violence.

Part-I (quantitative analyses)

The data of 100 survivors women of four types of domestic violence (physical, sexual, psychological and economical violence) were analyzed on the scores of Wb scale of the survivor women in order to explore the type of domestic violence which impaired the psychological well-being most severely (Figure 1). The significant difference between the psychological well-being of survivors of four types of domestic violence was also calculated (Table 1). Findings in figure 1 indicated that four types (physical, sexual, psychological and economical violence) of domestic violence, particularly physical and sexual violence had devastating effects on the psychological well-being of survivor women than psychological and economic violence. Table 1 indicates the mean difference and standard deviation between the scores of four types of domestic violence (physical, psychological, sexual and economic violence) on CPI’s subscale Wb. The analysis of variance indicates a significant difference in terms of impact of different types of domestic violence on survivor’s psychological well being {F (3, 96) =25.63, ***p < .000).

Figure 1 Graphical representation of impact of physical, sexual, psychological and economic violence on Participant’s psychological well being (N = 100).

Part-II (qualitative analyses)

After doing the quantitative analysis, data was further analysed qualitatively to find out those profound demographic variables which provoke the occurrence of domestic violence. The qualitative data was obtained through semi-structured in-depth interviews with the survivor women of four types of domestic violence, and available previous history of these survivors’ in Dar-ul-Aman. The Case study method of qualitative analysis was done to find out how the demographic variable provokes the occurrence of these four types of domestic violence, as well as to explore out those major psychological problems, which were mostly faced by the survivor women after experiencing the domestic violence. The results of qualitative analysis revealed that, the profound demographic variables which played a crucial role in provoking the prevalence rate of four types of domestic violence are: parental death (8.5%), social setup (17.9%), disobeying (35.8%), and arguing with in-laws (20.7%), infertility, (22.8%), financial reasons (19.8%), not having a son (18.8%) and husband being addicted to drugs (53%), dowry issues (15.6%), poverty (23%) and illiteracy (12.7%). The findings also revealed that the major psychological problems faced by the survivor women after experiencing the domestic violence are; poor self-concept, low self-esteem, feelings of powerlessness, helplessness, worthlessness, hopelessness, sleep problems, anhedonia, depression and post-traumatic stress disorder.

The present study aimed at exploring the effects of four types of domestic violence (physical, sexual, psychological, and economic violence) on the psychological well-being of survivor women and also intended to explore the profound demographic variables of domestic violence. The study data were analyzed both quantitatively and qualitatively.

The findings of quantitative analysis showed that the survivor women sexual violence had most impaired psychological well-being than physical, psychological and economic violence as the bar graph shows low scores of physical and sexual violence survivor women. This supported our both hypotheses that the survivors of sexual and physical violence had the most impaired psychological well-being and the survivors of economic violence had the least impaired psychological well-being (Table 1) (Figure 1). Our findings are consistent with the results of previous empirical research⁴⁴ that physical and sexual abuse has been linked to later development of psychological disorders and drug abuse. The results of ANOVA of the four types of domestic violence and scores on psychological well-being scale revealed significant difference in terms of impact of four types of domestic violence on survivors’ psychological well-being (Table 1). These findings are also in line with the findings of another study which concluded that¹⁵ that among women who reported receiving beatings by their husbands (80.0%) and had experienced such violence from their in-laws (57.5%) majority were feeling stressed by the conflict with their husbands (98.5% of the women) and with their in-laws (97.3%). Empirical evidence also yield that⁸ economic dependency of women on the man gave an edge to the independent party to sabotage the dependent economic right which in-turns create dispute and conflicts and leads toward the abusive kinds of domestic violence. On the basis of the results of quantitative analysis, the qualitative analysis was done on all cases of four types of domestic violence to explore those profound demographic variables which provoked its occurrence, as well as to explore those major psychological problems which were reported by the survivor women after experiencing the domestic violence. The results of qualitative analysis showed that some profound demographic variables which played crucial role in provoking the prevalence rate of four types of domestic violence are; parental death, social setup, poverty and illiteracy.

The findings revealed that parental death was one of the profound demographic variables which have devastating effects on the physical, emotional, behavioral and psychological development of survivors and they often feel that they are now alone in the world and there is no strong back up for self-protection from violence and abuse of husbands and in-laws. These results are in line with the result of Tremblay and Israel’s,⁴⁵ which states that the parentless girls experience more psychological problems and adjustment difficulties than girls with alive parents. Society contributed largely in escalating the incidence rate of domestic violence by propaganda of old inflexible tradition and norms. These findings are in line with Centroamericana’s⁴⁶ findings, which revealed that society enhanced the severity of the domestic violence by adopting a non-serious attitude towards it. According to our recent study, it is not only the husband but also the in-laws who commit violence against women which is also proved in the previous research literature.⁴⁷ In Pakistan a joint or extended family system is the common practice where the husband and his wife live with his parents, sisters and brothers in one household. The wife is placed in a submissive position where she faces harassment from the whole family.^47,48

Poverty also provokes the occurrence rate of domestic violence because when a man fails to fulfill the basic needs of his family, it creates stress and tension which is ultimately released by adopting the violent act against his family. The results of the another study⁴⁹ are consistent with our findings that most of the women experienced the domestic violence and continuously stayed in that abusive relationship just because of their dependency on their husbands in terms of money. Women’s illiterately is also an important cause of domestic violence. The findings of the present research revealed that women avoided protesting against the violent acts of their husbands because they have inadequate knowledge about their basic rights. The findings of empirical research further⁵⁰ demonstrated illiteracy as the major contributing factor in provoking the occurrence of domestic violence. Although Pakistan is a Muslim country and Islam clearly gives the teachings of taking good care of women, unfortunately misinterpretation of these religious beliefs is also found to be the major cause of domestic violence.⁵¹ The qualitative analyses of all cases of four types of domestic violence showed that the major problems faced by the survivor women after experiencing the domestic violence are poor self-concept, low self-esteem, feelings of powerlessness, helplessness, depression, sleep problems, post-traumatic stress disorder and anhedonia. The diagnostic criteria’s of all these psychological disorders which were given by American Psychiatric Association’s DSM-V⁵² also supported these findings. The results showed that the survivor women of domestic violence have poor self-concept, low self-esteem, depression, and feelings of powerlessness. These findings are consistent with the findings of previous researches,^24,25,36 which revealed that domestic violence leads to substance abuse, low self-esteem, low self-concept, depression, and feelings of powerlessness because they believe that as they are bad, so they deserved to experience the domestic violence. Another research also⁵³ found that depression in married women was associated with younger age at marriage, lack of autonomy in marriage decisions, marital rape and domestic abuse by in-laws. The findings of the present study also demonstrated that majority of the survivor women experiencing the sleep problems, post-traumatic stress disorder and anhedonia due to night mares which mostly revealed the traumatic events of their past life. Our findings are in line with the results of previous research⁸ which found out that, those women who are abused by their intimate partners developed sleep problems and anhedonia. Various studies have found a correlation of depression with certain reproductive rights, such as younger age at marriage and marital rape.^54,55 Marital rape is any unwanted intercourse or penetration (vaginal, anal, or oral) obtained by force, threat of force, or when the wife is unable to consent.⁵⁶ Commonly it is perceived that women are raped by men other than their partners but data have revealed that, over 75% of the women who have been physically or sexually abused, report abuse by their partner. About 10-20% of the women surveyed in 5 out of 10 countries believed that a woman does not have a right to refuse sex to her husband under any circumstances.⁵⁷ It is now a crime in most parts of the Western world⁵⁶ but the Pakistani law still fails to recognize marital rape as a crime.⁵⁸ Although the association of depression with autonomy to decide about contraception has not been studied in the past, it is known that the stress of an unintended pregnancy or unsafe abortion might be expected to increase the risk of onset or recurrence of serious mental ill-health.⁵⁸

In present research the findings of both quantitative and qualitative analyses showed that sexual and physical violence had more devastating effects on the psychological well-being of survivor women than economic and psychological violence. In Pakistan, women experienced domestic violence, because of the lack of awareness about their legal rights and demand, rights, and social obligations and restrictions regarding the marital relationship. Domestic violence totally distorted the psychological functioning of survivor, but despite this our society has very cold attitude towards it. Literature review also supported the fact that whenever any kind of domestic violence had occurred at home, all the people got affected by that negatively and mostly children and women face the misery most of the time.

Our research was limited to small representative sample of only two cities of Pakistan, so it is suggested that it should be replicated on a large representative sample of whole Pakistan. The qualitative analyses of the present study was focused only on the impact of profound demographic variables, while many associated variables and personal attributes such as, birth order, autonomy, confidence and possessive nature may also be researched out.

None.

None.

1. Ahmad I. Development of Urdu Version of California Psychological Inventory (CPI) in Pakistan. National Institute of Psychology. Quaid-e- Azam University, Islamabad. 1986.
2. World Health Organization. Violence against women. WHO Consultation. Geneva, 5-7 Feburary, Geneva. 1996:39.
3. Aurat Foundation. Annual report on Violence Against Women (VAW). A report published by Aurat Foundation. 2014.
4. Saeed B. Relations of perceived domestic violence with delinquency among boys Adolescents. Unpublished M.Sc Research report, National Institute of Psychology. Quaid-e-Azam University, Islamabad. 2001.
5. Gordon. Domestic violence.
6. Schuler M. Freedom from violence. New York: UNIFEM. 1992.
7. Berry DB. The domestic violence source book. 4th ed. Los Angeles: Lowel House. 2000.
8. Benedictis DT, Jaffe J, Segal J. Domesztic violence and abuse: Types, signs, symptoms, causes, and effects.1996.
9. Dutton MA. Critique of the "battered women syndrome" model. National electronic network against violence on women. 1996.
10. Flitcraft A. Diagnostic and treatment guidelines on domestic violence. Chicago. American Medical Association. 1992.
11. Koenig MA, Stephenson R, Ahmed S, et al. Individual and contextual determinants of domestic violence in North India. American Am J Public Health. 2006;91(1):132−138.
12. Sidibe ND, Campbell JC, Becker S. Domestic violence against women in Egypt-wife beating and health outcomes. Soc Sci Med. 2006;62(5):1260−1277.
13. Gage AJ. Women’s experience of intimate partner violence in Haiti. Soc Sci Med. 2005;61(2):343−364.
14. Anwar F. Self concept of children. Unpublished master’s thesis, Department of Applied Psychology. Lahore. 1969.
15. Ali TS, Gavino BI. Prevalence of and reasons for domestic violence among women from low socioeconomic communities of Karachi. Eastern Mediterranean Health Journal. 2007;13(6):1417−1426.
16. Walker LE. Terrifying love: Why battered women kill and how society responds. New York: Harper and Row. 1989.
17. Christopher M. Facts about domestic violence. 2000.
18. Gelles RJ. Abused wives: why do they stay? Journal of Marriage and Family.1976;38(4):659−668.
19. Fikree FF, Bhatti LI. Domestic violence and health of Pakistani women. International Journal of Gynecology and Obstetrics.1999;65 (2):195−201.
20. Heisi L. Violence against women: An integrated, ecological framework. Violence Against Women. 1998;4(3):262−290.
21. Ahmed A. Trend analysis: Human Rights Violations- 2005 & 2006. Human rights Commission Repot Intern. 2007.
22. Sheikh MA. Domestic violence against women- perspective from Pakistan. J Pak Med Assoc. 2000;50(9):312−314.
23. Fikree FF, Razzak, JA, Durocher J. Attitude of Pakistani men to domestic violence: A study from Karachi Pakistan. Journal of Men’s Health and Gender. 2005;2(1):40−58.
24. Kadir MM, Fikree FF, Khan A, et al. Do mothers-in-law matter? Family dynamics and fertility decision-making in urban squatter settlements of Karachi, Pakistan. Journal of Biological and Social Sciences. 2003;35(4):545−558.
25. Naz A. Self concept of victims of domestic violence. Unpublished M.Sc Research report, National Institute of Psychology, Quaid-e-Azam University, Islamabad. 2000.
26. Freud S. The interpretation of dreams. The Hogarth Press. London:1900.
27. Jhonson MP, Ferraro KJ. Research on domestic violence in the 1900s: making distinctions. Journal of Marriage and Family. 2000; 62(4):948−963.
28. Hughes HM. Witnessing spouse abuse and experiencing physical abuse. Journal of Family Violence. 1989;4(2):197−209.
29. Bandura A. Aggression: A social learning analysis. Eaglewood Cliffs, N.I: Prentice-Hall. 1973.
30. Carrillo R. Gender violence: A developmental and human right's issue. In UNICEF and Secretariat of State of Women's Affairs (Ed.), Fire in the home. Bangkok: Thailand. 1991.
31. Kalmuss D. The intergenerational transmission of marital aggression. Journal of Marriage and Family. 1984;46(1):11−19.
32. Berkowitz L. The frustration-aggression hypothesis revised. In L Berkowitz, editors. Roots of aggression: A re-examination of the frustration-aggression hypothesis. Atherton Press. New York. 1989.
33. Bem SL. Androgyny and gender schema theory: A conceptual and Empirical integration. Nebr Symp Motiv. 1984;32:179−226.
34. Goldsmith DT, Vera M. The Physical and emotional injuries of domestic violence. 2005.
35. Newton PF. Women are dreamers too-The empowerment zone for victims of domestic violence - Warning signs of DV. 2005.
36. Zahm M. What are psychological factors associated with domestic violence. 1999.
37. Khattak S, Khan A. Content analysis of honor killing news. Unpublished M.Sc Research report, National Institute of Psychology, Quaid-e-Azam University, Islamabad. 2002.
38. Satt ST. Impact of dowry on marital adjustment among couples. Unpublished M.Sc Research report, National Institute of Psychology, Quaid-e-Azam University, Islamabad. 2002.
39. Hussain S. Domestic violence: Myths and reality. Unpublished M.Phil. Dissertation, National Institute of Psychology, Quaid-e-Azam University, Islamabad 1998.
40. Kausar R, Aslam S. Depression in wives in relation to marital aggression. Pakistan Journal of Psychological Research, 1998;13(1-2): 1−11.
41. Pervez AS, Shamim P. A study on battered women. Ministry of Women's Division: Government of Pakistan, Islamabad. 1985.
42. Alvarez-Dardet C, Ashton JR. Practicing public health beyond medicine. Journal of Epidemiology and Community Health. 2004;58(7):5−33.
43. Victoria. Family Violence Professional Educational Taskforce. Federation Press;1991: 254p.
44. Mazza D, Dennerstein L, Ryan R. Physical, sexual and emotional violence against women: A general practice-based prevalence study. Med J Aust.1996;164(1):14−17.
45. Tremblay G, Israel A. Children's adjustment to parental death. 2006.
46. Centroamericana I. Domestic violence in Nicaragua. 1999.
47. Sami N, Ali TS. Psyco social consequences in secondary infertility in Karachi. J Pak Med Assoc. 2006;56(1): 19−22.
48. Irfan N, Badar A. Top ten stressors in hysterical subjects of Peshawar. Journal of Ayub Medical College Abbottabad. 2002;14(4):38−41.
49. Pixley C. Domestic violence: Love and control. 2002.
50. Sauerbrey EA. Fighting international trafficking, oppression, illiteracy and impoverishment of women. 2003.
51. Rabbani F, Qureshi F, Rizvi N. Perspectives on domestic violence: case study from Karachi, Pakistan. Eastern Mediterranean Health Journal. 2008;14(2):415−426.
52. American Psychiatric Association. Diagnostic and statistical manual of mental disorders.5th ed, New Delhi: Jaypee Brothers;2013.
53. Ali FA, Israr SM, Ali BS, et al. Association of various reproductive rights, domestic violence and marital rape with depression among Pakistani women. BMC Psychiatry. 2009;9(77).
54. Inandi T, Elci OC, Ozturk A, et al. Risk factors for depression in postnatal first year, in Eastern Turkey. International Journal of Epidemiology. 2002;31(6):1201−1207.
55. Campbell J. Health consequences of intimate partner violence. The Lancet. 2002;359(9314):1331−1336.
56. Bergen RK. New Research and Directions. The National Online Resource Center on Violence against Women. 2006.
57. García-Moreno C, Jansen HA, Ellsberg M, et al. WHO Multi-country Study on Women's Health and Domestic Violence against Women Initial results on prevalence, health outcomes and women's responses. Geneva: World Health Organization;2005.
58. Malik N. Women's protection bill is not enough. Chowk World Health Organization. Mental health aspects of women's reproductive health: A global review of the literature. Geneva: World Health Organization;2009.