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November 2, 2011

Gender-Based Violence in Women and Mental Disorders—Reply

Author Affiliations

Letters Section Editor: Jody W. Zylke, MD, Senior Editor.

Author Affiliations: School of Psychiatry, University of New South Wales, Sydney, Australia (s.j.rees@unsw.edu.au).

JAMA. 2011;306(17):1862-1863. doi:10.1001/jama.2011.1581

In Reply: The strength of the epidemiological study we reported is that it showed a robust association between GBV and a range of common lifetime mental disorders, conditions that are severe and disabling in their effect. Such epidemiological studies are not ideal for examining developmental pathways. While structural equation modeling using cross-sectional data can map complex associations involving early childhood abuse, subsequent GBV, and mental disorders, the paths that emerge can only be suggestive, given that the data are gathered at one point in time and are based on retrospective recall of the chronology of events. Longitudinal studies are the ideal method to trace the sequencing of these phenomena. Even then, the task presents formidable challenges because of the difficulties in obtaining a candid account of early abuse either from parents or children.1 In addition, in interpreting the association of childhood nonsexual abuse and GBV, it needs to be acknowledged that these types of abuse can occur concurrently in an abusive family environment. For that reason, caution needs to be exercised in inferring with a high degree of specificity the relationships between different types of abuse.