Our study surveyed the pattern of prevalence of various kinds of intimate partner violence among the population of female patients with schizophrenia attending the clinic. As observed in our study, there was a high prevalence of intimate partner violence (75 %) reported by participants in our sample. The rate was higher than rates reported in previous studies on domestic violence among a similar population involving psychiatric patients [16, 20]. Our findings show that women with schizophrenia in intimate relationship suffer a high degree of IPV The high rate may be partly due to the nature of the disorder which makes them vulnerable to such violence [12, 13]. The high rate was reported despite the socio-cultural barriers to disclosure in Nigeria [21]. In comparison, the rate in our study population was higher than that reported by Olayanju et al. [11].
The most prevalent form of IPV in our study was Verbal abuse. Close to three-quarter of our respondents (73 %) reported acts of abuses, insults and critical comments by intimate partners. Regrettably, verbal abuse is a major form of violence that is not often explored in surveys of intimate partner violence but constitutes a very frequent and distressing form of IPV. Verbal abuse extols a high emotional toil that negatively affects patients with schizophrenia. The importance of this form of IPV lies in the influence it has on victims because it represents attempt to control, coerce and intimidate [6, 22]. It can also be a prelude for physical violence [6]. Importantly, it has been shown that excessive critical comments impact negatively on the rate of relapse in patients with schizophrenia [23]. Sadly, not often do mental health professionals ask about this form of violence in routine clinical visits [24].
Physical abuse was reported by more than 50 % of our respondents. Physical abuse involved various acts of beatings, hitting and physical punishments as reported by of the participants and a high percentage of these physical violence resulted in injuries to victims. The high degree of physical violence observed among women with schizophrenia may lead to further social deficits that impairs their capacity and ability to negotiate their way out of dangerous and potentially violent encounters with partners [25]. The very nature of the disorder gives rise to cognitive and emotional distortions that may also make them vulnerable to violence. About a quarter (24.1 % n = 19)) of the respondent reported incidences of sexual assault with intimate partners. Sexual assault is a severe form of IPV and women with schizophrenia are at increased risk [26]. Understandably, the lower rate may be due to the cultural beliefs which usually places undue stigmatisation towards women and limits the reporting of such cases [21]. It is noteworthy that those who reported a history of sexual and physical abuse also reported verbal abuse, this seems to suggest that women who report sexual assault and physical abuse may suffer from all other forms of IPV and precipitate serious fatal consequences [4, 27]. Unfortunately, it is rare for victims with the disorder to disclose such issues and hence often go undetected by clinicians involved in their care.
Socio-demographics variables associated with IPV
In our study, we explored socio-demographic and clinical variables that were significantly associated with various forms of intimate violence. Age was the only socio-demographic variable significantly associated with two forms of intimate partner violence, verbal abuse and sexual assault. Length of relationship with partner was significantly associated with sexual assault. Those with lower duration of intimate relationship were more likely to report sexual assault. The result does suggest that relationships in which sexual assault are experienced usually are short-lived. There is a higher likelihood for IPV to be reported by those in the younger age group similar to the results of previous studies and in the general population [11, 25]. This may be due to adjustment difficulties and sense of belonging that the new status of such relationships brings. Theorists have postulated that younger women tend to be more materially dependent on their partners giving higher risk for IPV especially in patients with severe mental illness [24]. We found that Verbal abuse was significantly commoner in those who were unemployed and who were not compliant with medication. Unemployment brings strain in intimate relationships even among healthy individuals, for women with schizophrenia, being unemployed may be due to the deficit caused by the disorder apart from the socio-economic situation. It is quite important for mental health professionals to make specific enquiries in women with schizophrenia who are unemployed. This will help in instituting a comprehensive management strategy that would include social rehabilitation to help them gain some form of employment apart from the usual routine encouragement of medication adherence at clinics. However, there were no socio-demographic or clinical variable that were associated with physical abuse. It was interesting to find that numbers of years of formal education and duration of illness were not significantly associated with any form of IPV. Social interventions involving employment generation may help in reducing the burden of IPV in women with schizophrenia.
IPV and association with psychopathology
We further explored the association of psychopathology (Using BPRS) with various forms of IPV. The findings reveal than those who reported all forms of IPV had higher mean score on the BPRS in comparison to those who did not report. Notably, as several studies have shown, psychiatric symptoms worsen with victimisation, leads to increased rate of psychiatric visitations and risk of suicide [6, 12, 26, 27]. The findings in our study show that all who reported the 3 forms of IPV were significantly associated with higher psychopathology.
Interestingly, among the various forms of IPV, those who reported sexual assault were the fewest but they had a very high mean score on the BPRS. Sexual assault represents a very severe form of IPV as our study suggests. All victims who reported sexual abuse and physical abuse, also reported verbal abuse They significantly had higher psychopathology than those without IPV. Our data seems to suggest that all who experienced sexual assault and physical abuse will also experience verbal abuse. Those who experienced all forms of IPV are prone to higher psychopathology in addition to the negative consequence on the physical health such as injuries, gynaecological problems, depression of immunity and possibly untimely death apart from the psychopathological burden [6]. It also has been reported to affect maternal responsibilities to the child in Nigeria [28]. This form of IPV may complicate treatment approaches and increase relapses among women with schizophrenia.
Study limitation
The report of the participant might be susceptible to information distortion which were not independently verified. Further, though efforts were made to recruit participants without cognitive disorders clinically, this cannot be totally excluded as schizophrenia is associated with varied cognitive problems which may distort their reports. The cross-sectional study cannot be used to generalise and explore all the other factors that may be associated with psychopathology in women with schizophrenia. Much larger pool of patients and longitudinal surveys will be needed. The study criteria excluded relationships that experienced violence or dating relationships or any other relationships that ended more than a year ago and these group of women were not captured in our results thus limiting the generalisation of our results.. The small size sample of our study and the limitation to a geographical region cannot be used to predict the pattern of results for entire population of female patients with schizophrenia in Nigeria.