The Relationship Between Intimate Partner Violence and Mental Health Outcomes Among Afghan Refugees Residing in Torbat Jam Camp, Iran

The Relationship Between Intimate Partner Violence and Mental Health Outcomes Among Afghan Refugees Residing in Torbat Jam Camp, Iran | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Relationship Between Intimate Partner Violence and Mental Health Outcomes Among Afghan Refugees Residing in Torbat Jam Camp, Iran Masoumeh Abbasi Shavazi, Mohammad Ali MorowatiSharifabad, Mohammad Rahimian, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8418499/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 12 You are reading this latest preprint version Abstract Background With the rising global population of refugees and migrants—especially women—intimate partner violence (IPV) has emerged as a pressing concern. Studies indicate that nearly one in three women worldwide face IPV, a phenomenon linked to serious health outcomes such as anxiety and depression. These mental health conditions may not only result from IPV but may also increase vulnerability to it. This research explores the frequency of IPV and associated psychological disorders among Afghan refugee women living in the Torbat Jam camp in Iran. Method A cross-sectional design was employed in this study, utilizing simple random sampling to evaluate both mental health status—using the DASS-21 scale—and the incidence of intimate partner violence, measured through the Haj Yahya Violence Against Women Questionnaire, among married Afghan refugee women residing in Iran's Torbat Jam camp. Results Out of 226 surveyed women (aged 17 to 68, with an average of 19.3 years living in Iran), approximately 15% were pregnant. Most participants were homemakers, and 65% reported having experienced intimate partner violence, with psychological abuse being the most prevalent form. A significant correlation was found between IPV and mental health indicators, including stress, anxiety, and depression, collectively accounting for 45% of the variance observed in IPV incidence. Conclusions Ensuring the mental well-being and safety of refugee women against intimate partner violence is an essential pillar of effective humanitarian assistance and public health planning. Interventions must prioritize both prevention and psychological support to mitigate the dual burden of IPV and mental distress in this vulnerable population. intimate partner violence refugee mental health disorder Introduction The global refugee population continues to rise, with Afghans making up the second largest group after Syrians. Iran ranks as the third largest host country for refugees worldwide, currently housing approximately 2.5 million Afghans(Dadras et al., 2021 ; Delkhosh et al., 2019 ). Torbat Jam Foreign Refugee Camp of Iran, located 120 km from Mashhad city, was established in 1994 and has accepted, accommodated and provided services to about 5000 Afghan refugees( Torbet Jam guest city for foreign immigrants , 2023) In Iran, the government oversees refugee operations through the Ministries of Interior, Health, and Education, with a focus on national security. Iran collaborates with the UNHCR and other UN agencies such as WFPA and UNODC. National NGOs and international organizations operate under the guidance of the Bureau of Aliens and Foreign Immigrants Affairs (BAFIA). The UNHCR funds NGOs like MAHAK and HAMI to provide health services. Immigrants face challenges in healthcare due to insurance issues, treatment delays, cultural differences, and language barriers. Afghan refugees registered with the UNHCR receive health benefits, including vaccinations, similar to those available to Iranian citizens. Since 2010, the UNHCR and the Ministry of Health have provided services like vaccinations, antenatal care, and family planning in 15 settlements and 30 urban areas. UNHCR support includes constructing health centers, compensating health personnel, offering training, and supplying medicine(Roozbeh et al., 2018 ). Mental disorders are common among Afghan refugees in Iran, especially among women(Rahimitabar et al., 2023 ). A notable number of Afghan immigrants and refugees suffer from psychological disorders. Based on recent reports, about one-third of Afghans in Iran suffer from psychiatric problems. Considerably, focusing Afghan refugees in camps showed 88.5% of Afghan refugees had mental disorders. Considering different components of mental health, revealed the prevalence of depression in 22.1%, anxiety in 39.3%, psychosomatic problem in 48.9%, and social dysfunction in 80.1% of them. In addition to consequences of war as a major determinant for mental disorders especially posttraumatic stress disorder in this population, lower ages at migration time, unemployment status, higher number of households, and history of chronic diseases were other indicators of mental diseases(Roozbeh et al., 2018 ) Mental health issues raise the likelihood of committing intimate partner violence(Taft et al., 2009 ). Intimate partner violence (IPV) includes physical, sexual, or psychological harm such as physical aggression, sexual coercion, psychological abuse, and controlling behaviors and is a major public health problem(Committee, 2015 ; Dalal et al., 2022 ) The negative impact of IPV on victims' physical and mental health continues to affect their well-being even after the violence has ceased(Encinas et al., 2010 ). Intimate partner violence is associated with poor mental health, and women who already have depression are more prone to experiencing IPV.(Johnson et al., 2010 ; Sugg, 2015 ). It has lasting impacts on the victims' physical, sexual-reproductive, and mental health, frequently arising from gender norms that emphasize male dominance and female submission(Dalal et al., 2022 ; Shai et al., 2019 ). IPV victimization often leads to poor mental health and can also cause symptoms like depression, which may discourage victims from seeking help(Critelli & Yalim, 2021 ; Meinhart et al., 2021 ) Intimate partner violence is a significant cause of injury in women, leading to a range of physical and psychosocial issues, in addition to being a violation of women's human rights(Hyder et al., 2007 ). US research found that different patterns of violence experienced by women were linked to positive screens for depression. But limited research has focused on the simultaneous occurrence of intimate partner violence and its association with mental health issues. Furthermore, even fewer studies have explored the impact of experiences of IPV on mental health (Sipsma et al., 2015 ). Refugee settings may intensify the risk of intimate partner violence, while simultaneously limiting women's access to support services(Hyder et al., 2007 ). Refugee women facing unique trauma and poverty-related factors have been largely overlooked in high-income country studies of IPV, despite the increased risk of higher IPV prevalence and associated mental health risks (Rees et al., 2019 ). Immigrants often find themselves suspended between two cultural contexts, belonging fully to neither their country of origin nor the host nation. This duality creates emotional tension as they navigate the contrasting norms and expectations of both environments(Njie-Carr et al., 2021 ). In many refugee camps, including those in Iran, the absence of a structured reporting system contributes to ongoing uncertainty regarding how to appropriately respond to cases of intimate partner violence(Hyder et al., 2007 ). This study aims to examine the prevalence of IPV among Afghan women residing in the Torbat Jam refugee camp in Iran and to explore its association with their mental health status Methods This cross-sectional study involved 226 married women living with their husbands in the Torbat Jam camp. Participants were selected through simple random sampling, informed by methodologies used in previous research. This study examined the relationship between intimate partner violence (IPV) and mental health, including depression, anxiety, and stress. The Persian version of the DASS-21 was employed to assess levels of depression, anxiety, and stress. Originally developed by Lovibond and Lovibond in 1995, the DASS-21 is a widely validated instrument designed to measure symptoms across these three domains. It comprises 21 items—seven for each subscale—based on the tripartite model of emotional distress. The scale is concise and applicable to both clinical and non-clinical populations, demonstrating consistent psychometric properties across all three dimensions(Bibi et al., 2020 ; Osman et al., 2012 ). Items are scored on a 4-point Likert scale (0 = did not apply to me at all to 3 = applied to me very much/most of the time), and then multiplied by 2. Higher scores indicate greater depression, anxiety, and stress intensity(Škegro et al., 2021 ). The Haj-Yahia's Violence against Women questionnaire, used to assess IPV, comprises 32 items across four factors: psychological (items 1–16), physical (items 17–27), sexual (items 28–30), and economic (items 31–32) abuse. Employing a dichotomous scale (0 = never, 1 = at least once), the questionnaire measures abuse frequency. Cumulative scores categorize psychological abuse as "never," "mild," "moderate," or "severe," while physical, sexual, and economic abuse are categorized as "never" or "at least once"(Haj-Yahia, 1999 ). The data were analyzed using SPSS version 24, employing Chi-square tests, Pearson correlation coefficients, and linear regression analyses to examine the relationships among variables and identify significant predictors. Result There were 226 participants in total, with ages ranging from 17 to 68 years and an average age of 34±9 years. Their spouses had an average age of 38.7±9 years. Among the participants, 34 women (15%) were pregnant. A significant portion, 25.2%, were illiterate, while only 8% had higher education qualifications. In comparison, 16.4% of their husbands were illiterate, and 11.5% had university education. The vast majority, 95.6%, were housewives, with only 10 individuals working outside the home. On average, participants had been married for 15 years, with marriage durations ranging from 1 to 54 years, and each participant had an average of 3 children. The length of residence in Iran varied from 1 to 50 years, with an average of 19.1 years (Table 1) . Table 1: Frequency distribution and mean demographic indicators of study participants Varible(number (%)) Number of participants Average of age Number of children Years of residence in Iran Age difference with spouse 226 34.0 ±9.2 3.2 ±1.9 19.1 ± 5.9 4.6 ±0.8 Job Housewife employed 216(95.6) 10 (4.4) Educate level Illiterate Primary school Guidance school Highschool Diploma Academic education 57 (25.2) 52 (23.0) 36 (15,9) 20 (8.8) 43 (19.0) 18 (8) The study results reveal that 65% of participants experienced at least one form of psychological, physical, sexual, or economic violence in the past two months. Psychological violence was the most frequently reported type (Table 2). Table 2. Experiencing violence in the last two months Variable (number (%)) Yes No Any type of IPV 147(65) 79(35) Emotional IPV 140(61.9) 86(38.1) Physical IPV 64(28.3) 162 (71.7) Sexual IPV 40(17.7) 186(82.3) Economical IPV 50(22.1) 176(77.9) More than 33% of participants reported experiencing at least one psychological disorder. Specifically, 43% exhibited some level of depression, with over 17% classified as having severe or very severe depression. Additionally, approximately 52% of participants reported experiencing anxiety, while more than 62% indicated they had not experienced stress during the previous week (Table 3). Table 3. Results on DASS-21 Variable (number (%)) Depression Anxiety Stress M ± se 9.9±0.6 9.4±0.5 12.8±0.6 Range min-max 0-40 0-36 0-38 Normal 129(57.1) 110(48.7) 142(62.8) Mild 29(12.8) 10(4.4) 22(29.7) Moderate 28(12.4) 52(23.0) 31(13.7) Severe 18(8.0) 20(8.8) 24(10.6) extremely severe 22(9.7) 34(15.0) 7(3.1) These findings indicate that mental health disorders significantly contribute to the occurrence of intimate partner violence, explaining approximately 45% of its variance. Notably, for each incremental increase in the severity of violence, the prevalence of depression rose by 2.2%, underscoring a direct and measurable relationship between psychological well-being and exposure to violence (Table 4). Table 4: Linear regression coefficients for IPV on mental disorder Model Unstandardized Coefficients Standardized Coefficients t Sig. B Std. Error Beta 1 (Constant) 31.023 1.191 26.038 .000 Depression 2.227 .749 .299 2.975 .003 Anxiety .575 .641 .085 .897 .371 Stress .882 .939 .103 .940 .348 R=.454 R 2 =.205 Adj.R 2 =.194 a. Dependent Variable: IPV Discussion This study, which explored the relationship between intimate partner violence (IPV) and mental health among Afghan refugee women in Iran, found that 65% of participants had experienced at least one form of psychological, physical, sexual, or economic violence within the past two months, with psychological violence being the most prevalent. In contrast, Shinwari (Shinwari et al., 2022 ) reported that 55.54% of Afghan women had been subjected to physical, emotional, or sexual violence by their intimate partners, with physical violence being the most common (50.52%). The observed discrepancy in the predominant type of violence may be attributed more to the distinct living conditions within refugee camps than to methodological differences. Moreover, the prevalence reported in this study was lower than that documented by Delkhosh et al. (Delkhosh et al., 2019 ) among Afghan refugee women in the Semnan camp, which may reflect variations in study design and sampling approaches. In the present study, approximately 44% of participants demonstrated symptoms of mental disorders, including depression (43%), anxiety (51%, with 23% experiencing severe or very severe symptoms), and stress (37%). These prevalence rates fall within the range reported for Afghan refugees in Shiraz (Kalafi et al.) and those residing in the Dalaki camp in Bushehr province (Azizi et al.; Mohammadian et al.)(Azizi et al., 2006 ; Kalafi et al., 2002 ; Shah.Ahmadi et al., 2005 ). Estimates of mental health conditions among Afghan refugees in Iran vary substantially, with reported prevalence ranging from 2% to 80% for depression, 4% to 86% for stress, and 20% to 88% for anxiety (Hosseini Divkolaye & Burkle, 2017 ). Such wide variation is likely attributable to differences in research methodologies, sample characteristics, and contextual factors across studies. This study's findings align with previous research (Bacchus et al(Bacchus et al., 2018 ).; Nowshad et al.(Nowshad et al., 2022 ); Ribeiro et al.(Ribeiro et al., 2020 ); Cerda-De la et al. (Cerda-De la et al., 2022 )) indicating a strong association between intimate partner violence (IPV) and depression. Specifically, the average DASS-21 score for women experiencing IPV was more than twice that of women without such experiences, mirroring findings of elevated depression and PTSD rates (Ribeiro et al.) and nearly double the prevalence of depression (Nowshad et al.) in IPV survivors. These results corroborate a significant relationship between IPV and depressive symptoms, as reported in a review of 35 cohort studies (Bacchus et al.). In this study, a significant correlation was found between the mean IPVI score and mental disorders. Furthermore, depression, anxiety, and stress emerged as predictors of violent behavior, consistent with the findings of White et al.(White et al., 2024 ). Conclusion Addressing women's mental health is crucial due to their multifaceted roles in families and society. This study highlights the cyclical relationship between violence and mental health: mental health imbalances increase both violence against women and their tolerance of it, while experiencing violence negatively impacts their mental well-being. Ensuring women's physical and mental security is vital for stable families. Refugee and migrant women are particularly vulnerable to violence and require increased support from international organizations, NGOs, and host governments. Limitations This study has several limitations. First, data were collected through self-reported questionnaires, which may be subject to recall bias and social desirability bias, particularly given the sensitive nature of intimate partner violence (IPV). Second, the cross-sectional design limits the ability to infer causal relationships between IPV and mental health outcomes. Third, cultural stigma, illiteracy, and language barriers among Afghan refugees may have influenced participants’ willingness or ability to respond accurately, despite careful ethical and methodological considerations. Finally, the study was conducted in a single refugee camp in Torbat Jam, which may limit the generalizability of the findings to other refugee populations in different contexts. Future research should employ longitudinal and mixed-method designs to explore underlying mechanisms and provide a deeper understanding of IPV and its impact on refugees’ mental health and quality of life. Declarations Ethics approval and consent to participate This study, registered under the ethical code IR.SSU.SPH.REC.1402.099, was approved by the Research Ethics Committee of Shahid Sadoughi University of Medical Sciences and conducted in accordance with the Declaration of Helsinki. All participants were fully informed about the objectives and procedures of the study, and written informed consent was obtained from each participant prior to data collection. Participation was entirely voluntary, with the option to withdraw at any stage without any consequences. The anonymity and confidentiality of all participant information were strictly maintained by the research team. Consent for publication Not applicable. Competing interests The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The authors received no financial support for the research, authorship, and/or publication of this article. 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Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 22 Apr, 2026 Reviewers agreed at journal 27 Feb, 2026 Reviews received at journal 25 Feb, 2026 Reviewers agreed at journal 25 Feb, 2026 Reviewers agreed at journal 24 Feb, 2026 Reviews received at journal 22 Feb, 2026 Reviewers agreed at journal 18 Feb, 2026 Reviewers invited by journal 18 Feb, 2026 Editor invited by journal 11 Feb, 2026 Editor assigned by journal 30 Jan, 2026 Submission checks completed at journal 29 Jan, 2026 First submitted to journal 27 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8418499","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":595140223,"identity":"d2ce7c2f-bb52-4c9f-8b40-c41e91215c4d","order_by":0,"name":"Masoumeh Abbasi Shavazi","email":"","orcid":"","institution":"Shahid Sadoughi University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Masoumeh","middleName":"Abbasi","lastName":"Shavazi","suffix":""},{"id":595140226,"identity":"bd499ba1-7ae7-4336-823b-b4804d750e4a","order_by":1,"name":"Mohammad Ali MorowatiSharifabad","email":"","orcid":"","institution":"Shahid Sadoughi University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mohammad","middleName":"Ali","lastName":"MorowatiSharifabad","suffix":""},{"id":595140229,"identity":"364d39b6-6fdd-4641-bcd7-2efd047dffc7","order_by":2,"name":"Mohammad Rahimian","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1klEQVRIiWNgGAWjYFACHoYDDAZAWv7xASApIUOCFoa0BJAWHqK0QEGOAQoXJzBvP3vw0I0CuzzdhjOfX92oseBhYD98dAM+LTJn8hIO5xgkF5sd7N1mnXMM6DCetLQb+LRIAN0D1MKcuO0w7zbjHDagFgkeM/xa+N+AtNQnbjvG88w45x8xWiTAthxO3HaGh/lxbhtRWsC2HE/cdoPNjDm3T4KHjaBf+HOMP+f8qQZqYX78OedbnRw/++FjeLUgAzYJMEmschBg/kCK6lEwCkbBKBg5AABNykgkOHzWTAAAAABJRU5ErkJggg==","orcid":"","institution":"Shahid Sadoughi University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Mohammad","middleName":"","lastName":"Rahimian","suffix":""},{"id":595140230,"identity":"46a35708-845c-4744-8cd1-26e049f8b7e8","order_by":3,"name":"Sara jambarsang","email":"","orcid":"","institution":"Shahid Sadoughi University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Sara","middleName":"","lastName":"jambarsang","suffix":""},{"id":595140231,"identity":"03105d18-5968-4e93-800c-8648e4ff8f52","order_by":4,"name":"Zohreh Nasiri","email":"","orcid":"","institution":"Torbat jam Faculty of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Zohreh","middleName":"","lastName":"Nasiri","suffix":""}],"badges":[],"createdAt":"2025-12-21 16:23:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8418499/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8418499/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103213388,"identity":"eabbd2c2-0f8e-4177-9ecb-16097c3301dc","added_by":"auto","created_at":"2026-02-23 08:57:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":485574,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8418499/v1/c696e55b-b348-4d84-83a3-4938aae4f2f0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Relationship Between Intimate Partner Violence and Mental Health Outcomes Among Afghan Refugees Residing in Torbat Jam Camp, Iran","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe global refugee population continues to rise, with Afghans making up the second largest group after Syrians. Iran ranks as the third largest host country for refugees worldwide, currently housing approximately 2.5\u0026nbsp;million Afghans(Dadras et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Delkhosh et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Torbat Jam Foreign Refugee Camp of Iran, located 120 km from Mashhad city, was established in 1994 and has accepted, accommodated and provided services to about 5000 Afghan refugees(\u003cem\u003eTorbet Jam guest city for foreign immigrants\u003c/em\u003e, 2023) In Iran, the government oversees refugee operations through the Ministries of Interior, Health, and Education, with a focus on national security. Iran collaborates with the UNHCR and other UN agencies such as WFPA and UNODC. National NGOs and international organizations operate under the guidance of the Bureau of Aliens and Foreign Immigrants Affairs (BAFIA). The UNHCR funds NGOs like MAHAK and HAMI to provide health services. Immigrants face challenges in healthcare due to insurance issues, treatment delays, cultural differences, and language barriers. Afghan refugees registered with the UNHCR receive health benefits, including vaccinations, similar to those available to Iranian citizens. Since 2010, the UNHCR and the Ministry of Health have provided services like vaccinations, antenatal care, and family planning in 15 settlements and 30 urban areas. UNHCR support includes constructing health centers, compensating health personnel, offering training, and supplying medicine(Roozbeh et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMental disorders are common among Afghan refugees in Iran, especially among women(Rahimitabar et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). A notable number of Afghan immigrants and refugees suffer from psychological disorders. Based on recent reports, about one-third of Afghans in Iran suffer from psychiatric problems. Considerably, focusing Afghan refugees in camps showed 88.5% of Afghan refugees had mental disorders. Considering different components of mental health, revealed the prevalence of depression in 22.1%, anxiety in 39.3%, psychosomatic problem in 48.9%, and social dysfunction in 80.1% of them. In addition to consequences of war as a major determinant for mental disorders especially posttraumatic stress disorder in this population, lower ages at migration time, unemployment status, higher number of households, and history of chronic diseases were other indicators of mental diseases(Roozbeh et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2018\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eMental health issues raise the likelihood of committing intimate partner violence(Taft et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). Intimate partner violence (IPV) includes physical, sexual, or psychological harm such as physical aggression, sexual coercion, psychological abuse, and controlling behaviors and is a major public health problem(Committee, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Dalal et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2022\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe negative impact of IPV on victims' physical and mental health continues to affect their well-being even after the violence has ceased(Encinas et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Intimate partner violence is associated with poor mental health, and women who already have depression are more prone to experiencing IPV.(Johnson et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Sugg, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). It has lasting impacts on the victims' physical, sexual-reproductive, and mental health, frequently arising from gender norms that emphasize male dominance and female submission(Dalal et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Shai et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). IPV victimization often leads to poor mental health and can also cause symptoms like depression, which may discourage victims from seeking help(Critelli \u0026amp; Yalim, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Meinhart et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) Intimate partner violence is a significant cause of injury in women, leading to a range of physical and psychosocial issues, in addition to being a violation of women's human rights(Hyder et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). US research found that different patterns of violence experienced by women were linked to positive screens for depression. But limited research has focused on the simultaneous occurrence of intimate partner violence and its association with mental health issues. Furthermore, even fewer studies have explored the impact of experiences of IPV on mental health (Sipsma et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRefugee settings may intensify the risk of intimate partner violence, while simultaneously limiting women's access to support services(Hyder et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). Refugee women facing unique trauma and poverty-related factors have been largely overlooked in high-income country studies of IPV, despite the increased risk of higher IPV prevalence and associated mental health risks (Rees et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eImmigrants often find themselves suspended between two cultural contexts, belonging fully to neither their country of origin nor the host nation. This duality creates emotional tension as they navigate the contrasting norms and expectations of both environments(Njie-Carr et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). In many refugee camps, including those in Iran, the absence of a structured reporting system contributes to ongoing uncertainty regarding how to appropriately respond to cases of intimate partner violence(Hyder et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). This study aims to examine the prevalence of IPV among Afghan women residing in the Torbat Jam refugee camp in Iran and to explore its association with their mental health status\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis cross-sectional study involved 226 married women living with their husbands in the Torbat Jam camp. Participants were selected through simple random sampling, informed by methodologies used in previous research.\u003c/p\u003e \u003cp\u003eThis study examined the relationship between intimate partner violence (IPV) and mental health, including depression, anxiety, and stress.\u003c/p\u003e \u003cp\u003eThe Persian version of the DASS-21 was employed to assess levels of depression, anxiety, and stress. Originally developed by Lovibond and Lovibond in 1995, the DASS-21 is a widely validated instrument designed to measure symptoms across these three domains. It comprises 21 items\u0026mdash;seven for each subscale\u0026mdash;based on the tripartite model of emotional distress. The scale is concise and applicable to both clinical and non-clinical populations, demonstrating consistent psychometric properties across all three dimensions(Bibi et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Osman et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Items are scored on a 4-point Likert scale (0\u0026thinsp;=\u0026thinsp;did not apply to me at all to 3\u0026thinsp;=\u0026thinsp;applied to me very much/most of the time), and then multiplied by 2. Higher scores indicate greater depression, anxiety, and stress intensity(Škegro et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe Haj-Yahia's Violence against Women questionnaire, used to assess IPV, comprises 32 items across four factors: psychological (items 1\u0026ndash;16), physical (items 17\u0026ndash;27), sexual (items 28\u0026ndash;30), and economic (items 31\u0026ndash;32) abuse. Employing a dichotomous scale (0\u0026thinsp;=\u0026thinsp;never, 1\u0026thinsp;=\u0026thinsp;at least once), the questionnaire measures abuse frequency. Cumulative scores categorize psychological abuse as \"never,\" \"mild,\" \"moderate,\" or \"severe,\" while physical, sexual, and economic abuse are categorized as \"never\" or \"at least once\"(Haj-Yahia, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e1999\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe data were analyzed using SPSS version 24, employing Chi-square tests, Pearson correlation coefficients, and linear regression analyses to examine the relationships among variables and identify significant predictors.\u003c/p\u003e "},{"header":"Result","content":"\u003cp\u003eThere were 226 participants in total, with ages ranging from 17 to 68 years and an average age of 34\u0026plusmn;9 years. Their spouses had an average age of 38.7\u0026plusmn;9 years. Among the participants, 34 women (15%) were pregnant. A significant portion, 25.2%, were illiterate, while only 8% had higher education qualifications. In comparison, 16.4% of their husbands were illiterate, and 11.5% had university education. The vast majority, 95.6%, were housewives, with only 10 individuals working outside the home. On average, participants had been married for 15 years, with marriage durations ranging from 1 to 54 years, and each participant had an average of 3 children. The length of residence in Iran varied from 1 to 50 years, with an average of 19.1 years (Table 1)\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eTable 1: Frequency distribution and mean demographic indicators of study participants\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45.1025%;\"\u003e\n \u003cp\u003eVarible(number (%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6401%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.2574%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45.1025%;\"\u003e\n \u003cp\u003eNumber of participants\u003c/p\u003e\n \u003cp\u003eAverage of age\u003c/p\u003e\n \u003cp\u003eNumber of children\u003c/p\u003e\n \u003cp\u003eYears of residence in Iran\u003c/p\u003e\n \u003cp\u003eAge difference with spouse\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6401%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.2574%;\"\u003e\n \u003cp\u003e226\u003c/p\u003e\n \u003cp\u003e34.0 \u0026plusmn;9.2\u003c/p\u003e\n \u003cp\u003e3.2 \u0026plusmn;1.9\u003c/p\u003e\n \u003cp\u003e19.1 \u0026plusmn; 5.9\u003c/p\u003e\n \u003cp\u003e4.6 \u0026plusmn;0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45.1025%;\"\u003e\n \u003cp\u003eJob\u003c/p\u003e\n \u003cp\u003eHousewife\u003c/p\u003e\n \u003cp\u003eemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6401%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.2574%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e216(95.6)\u003c/p\u003e\n \u003cp\u003e10 (4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45.1025%;\"\u003e\n \u003cp\u003eEducate level\u003c/p\u003e\n \u003cp\u003eIlliterate\u003c/p\u003e\n \u003cp\u003ePrimary school\u003c/p\u003e\n \u003cp\u003eGuidance school\u003c/p\u003e\n \u003cp\u003eHighschool\u003c/p\u003e\n \u003cp\u003eDiploma\u003c/p\u003e\n \u003cp\u003eAcademic education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6401%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.2574%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e57 (25.2)\u003c/p\u003e\n \u003cp\u003e52 (23.0)\u003c/p\u003e\n \u003cp\u003e36 (15,9)\u003c/p\u003e\n \u003cp\u003e20 (8.8)\u003c/p\u003e\n \u003cp\u003e43 (19.0)\u003c/p\u003e\n \u003cp\u003e18 (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe study results reveal that 65% of participants experienced at least one form of psychological, physical, sexual, or economic violence in the past two months. Psychological violence was the most frequently reported type (Table 2).\u003c/p\u003e\n\u003cp\u003eTable 2. Experiencing violence in the last two months\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"574\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47.3684%;\"\u003e\n \u003cp\u003eVariable (number (%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21.0526%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 31.5789%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.3684%;\"\u003e\n \u003cp\u003eAny type of IPV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.0526%;\"\u003e\n \u003cp\u003e147(65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.5789%;\"\u003e\n \u003cp\u003e79(35)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.3684%;\"\u003e\n \u003cp\u003eEmotional IPV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.0526%;\"\u003e\n \u003cp\u003e140(61.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.5789%;\"\u003e\n \u003cp\u003e86(38.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.3684%;\"\u003e\n \u003cp\u003ePhysical IPV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.0526%;\"\u003e\n \u003cp\u003e64(28.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.5789%;\"\u003e\n \u003cp\u003e162 (71.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.3684%;\"\u003e\n \u003cp\u003eSexual IPV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.0526%;\"\u003e\n \u003cp\u003e40(17.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.5789%;\"\u003e\n \u003cp\u003e186(82.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.3684%;\"\u003e\n \u003cp\u003eEconomical IPV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.0526%;\"\u003e\n \u003cp\u003e50(22.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.5789%;\"\u003e\n \u003cp\u003e176(77.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMore than 33% of participants reported experiencing at least one psychological disorder. Specifically, 43% exhibited some level of depression, with over 17% classified as having severe or very severe depression. Additionally, approximately 52% of participants reported experiencing anxiety, while more than 62% indicated they had not experienced stress during the previous week (Table 3).\u003c/p\u003e\n\u003cp\u003eTable 3. Results on DASS-21\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 40.1544%;\"\u003e\n \u003cp\u003eVariable (number (%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.4633%;\"\u003e\n \u003cp\u003eDepression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.6911%;\"\u003e\n \u003cp\u003eAnxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.6911%;\"\u003e\n \u003cp\u003eStress\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40.1544%;\"\u003e\n \u003cp\u003eM \u0026plusmn; se\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.4633%;\"\u003e\n \u003cp\u003e9.9\u0026plusmn;0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.6911%;\"\u003e\n \u003cp\u003e9.4\u0026plusmn;0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.6911%;\"\u003e\n \u003cp\u003e12.8\u0026plusmn;0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40.1544%;\"\u003e\n \u003cp\u003eRange min-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.4633%;\"\u003e\n \u003cp\u003e0-40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.6911%;\"\u003e\n \u003cp\u003e0-36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.6911%;\"\u003e\n \u003cp\u003e0-38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40.1544%;\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.4633%;\"\u003e\n \u003cp\u003e129(57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.6911%;\"\u003e\n \u003cp\u003e110(48.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.6911%;\"\u003e\n \u003cp\u003e142(62.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40.1544%;\"\u003e\n \u003cp\u003eMild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.4633%;\"\u003e\n \u003cp\u003e29(12.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.6911%;\"\u003e\n \u003cp\u003e10(4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.6911%;\"\u003e\n \u003cp\u003e22(29.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40.1544%;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.4633%;\"\u003e\n \u003cp\u003e28(12.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.6911%;\"\u003e\n \u003cp\u003e52(23.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.6911%;\"\u003e\n \u003cp\u003e31(13.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40.1544%;\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.4633%;\"\u003e\n \u003cp\u003e18(8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.6911%;\"\u003e\n \u003cp\u003e20(8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.6911%;\"\u003e\n \u003cp\u003e24(10.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40.1544%;\"\u003e\n \u003cp\u003eextremely severe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.4633%;\"\u003e\n \u003cp\u003e22(9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.6911%;\"\u003e\n \u003cp\u003e34(15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.6911%;\"\u003e\n \u003cp\u003e7(3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eThese findings indicate that mental health disorders significantly contribute to the occurrence of intimate partner violence, explaining approximately 45% of its variance. Notably, for each incremental increase in the severity of violence, the prevalence of depression rose by 2.2%, underscoring a direct and measurable relationship between psychological well-being and exposure to violence\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e(Table 4).\u003c/p\u003e\n\u003cp\u003eTable 4: Linear regression coefficients for IPV on mental disorder\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"574\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"bottom\" style=\"width: 152px;\"\u003e\n \u003cp\u003eModel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 182px;\"\u003e\n \u003cp\u003eUnstandardized Coefficients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 100px;\"\u003e\n \u003cp\u003eStandardized Coefficients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003eSig.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003eStd. Error\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 100px;\"\u003e\n \u003cp\u003eBeta\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e(Constant)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e31.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e1.191\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e26.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003eDepression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e2.227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e.749\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e.299\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e2.975\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003eAnxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e.575\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e.641\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e.085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e.897\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e.371\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003eStress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e.882\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e.939\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e.103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e.940\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e.348\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eR=.454\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e=.205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003eAdj.R\u003csup\u003e2\u003c/sup\u003e=.194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 574px;\"\u003e\n \u003cp\u003ea. Dependent Variable: IPV\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study, which explored the relationship between intimate partner violence (IPV) and mental health among Afghan refugee women in Iran, found that 65% of participants had experienced at least one form of psychological, physical, sexual, or economic violence within the past two months, with psychological violence being the most prevalent. In contrast, Shinwari (Shinwari et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) reported that 55.54% of Afghan women had been subjected to physical, emotional, or sexual violence by their intimate partners, with physical violence being the most common (50.52%). The observed discrepancy in the predominant type of violence may be attributed more to the distinct living conditions within refugee camps than to methodological differences. Moreover, the prevalence reported in this study was lower than that documented by Delkhosh et al. (Delkhosh et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) among Afghan refugee women in the Semnan camp, which may reflect variations in study design and sampling approaches.\u003c/p\u003e \u003cp\u003eIn the present study, approximately 44% of participants demonstrated symptoms of mental disorders, including depression (43%), anxiety (51%, with 23% experiencing severe or very severe symptoms), and stress (37%). These prevalence rates fall within the range reported for Afghan refugees in Shiraz (Kalafi et al.) and those residing in the Dalaki camp in Bushehr province (Azizi et al.; Mohammadian et al.)(Azizi et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Kalafi et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2002\u003c/span\u003e; Shah.Ahmadi et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). Estimates of mental health conditions among Afghan refugees in Iran vary substantially, with reported prevalence ranging from 2% to 80% for depression, 4% to 86% for stress, and 20% to 88% for anxiety (Hosseini Divkolaye \u0026amp; Burkle, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Such wide variation is likely attributable to differences in research methodologies, sample characteristics, and contextual factors across studies.\u003c/p\u003e \u003cp\u003eThis study's findings align with previous research (Bacchus et al(Bacchus et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).; Nowshad et al.(Nowshad et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2022\u003c/span\u003e); Ribeiro et al.(Ribeiro et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2020\u003c/span\u003e); Cerda-De la et al. (Cerda-De la et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2022\u003c/span\u003e)) indicating a strong association between intimate partner violence (IPV) and depression. Specifically, the average DASS-21 score for women experiencing IPV was more than twice that of women without such experiences, mirroring findings of elevated depression and PTSD rates (Ribeiro et al.) and nearly double the prevalence of depression (Nowshad et al.) in IPV survivors. These results corroborate a significant relationship between IPV and depressive symptoms, as reported in a review of 35 cohort studies (Bacchus et al.).\u003c/p\u003e \u003cp\u003eIn this study, a significant correlation was found between the mean IPVI score and mental disorders. Furthermore, depression, anxiety, and stress emerged as predictors of violent behavior, consistent with the findings of White et al.(White et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAddressing women's mental health is crucial due to their multifaceted roles in families and society. This study highlights the cyclical relationship between violence and mental health: mental health imbalances increase both violence against women and their tolerance of it, while experiencing violence negatively impacts their mental well-being. Ensuring women's physical and mental security is vital for stable families. Refugee and migrant women are particularly vulnerable to violence and require increased support from international organizations, NGOs, and host governments.\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eThis study has several limitations. First, data were collected through self-reported questionnaires, which may be subject to recall bias and social desirability bias, particularly given the sensitive nature of intimate partner violence (IPV). Second, the cross-sectional design limits the ability to infer causal relationships between IPV and mental health outcomes. Third, cultural stigma, illiteracy, and language barriers among Afghan refugees may have influenced participants\u0026rsquo; willingness or ability to respond accurately, despite careful ethical and methodological considerations. Finally, the study was conducted in a single refugee camp in Torbat Jam, which may limit the generalizability of the findings to other refugee populations in different contexts. Future research should employ longitudinal and mixed-method designs to explore underlying mechanisms and provide a deeper understanding of IPV and its impact on refugees\u0026rsquo; mental health and quality of life.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study, registered under the ethical code IR.SSU.SPH.REC.1402.099, was approved by the Research Ethics Committee of Shahid Sadoughi University of Medical Sciences and conducted in accordance with the Declaration of Helsinki. All participants were fully informed about the objectives and procedures of the study, and written informed consent was obtained from each participant prior to data collection. Participation was entirely voluntary, with the option to withdraw at any stage without any consequences. The anonymity and confidentiality of all participant information were strictly maintained by the research team.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors received no financial support for the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAzizi F, Holakoie Naieni K, Rahimi A, Amiri M, Khosravizadegan F. 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Retrieved 5/23/2023 from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://atba.khorasan.ir/RContent/0003P84D-%D9%85%D8%B9%D8%B1%D9%81%DB%8C-%D9%85%D9%87%D9%85%D8%A7%D9%86%D8%B4%D9%87%D8%B1-%D8%A7%D8%AA%D8%A8%D8%A7%D8%B9-%D9%88-%D9%85%D9%87%D8%A7%D8%AC%D8%B1%DB%8C%D9%86-%D8%AE%D8%A7%D8%B1%D8%AC%DB%8C-%D8%B4%D9%87%D8%B1%D8%B3%D8%AA%D8%A7%D9%86-%D8%AA%D8%B1%D8%A8%D8%AA-%D8%AC%D8%A7%D9%85.aspx\u003c/span\u003e\u003cspan address=\"https://atba.khorasan.ir/RContent/0003P84D-%D9%85%D8%B9%D8%B1%D9%81%DB%8C-%D9%85%D9%87%D9%85%D8%A7%D9%86%D8%B4%D9%87%D8%B1-%D8%A7%D8%AA%D8%A8%D8%A7%D8%B9-%D9%88-%D9%85%D9%87%D8%A7%D8%AC%D8%B1%DB%8C%D9%86-%D8%AE%D8%A7%D8%B1%D8%AC%DB%8C-%D8%B4%D9%87%D8%B1%D8%B3%D8%AA%D8%A7%D9%86-%D8%AA%D8%B1%D8%A8%D8%AA-%D8%AC%D8%A7%D9%85.aspx\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWhite SJ, Sin J, Sweeney A, Salisbury T, Wahlich C, Montesinos Guevara CM, Gillard S, Brett E, Allwright L, Iqbal N, Khan A, Perot C, Marks J, Mantovani N. Global Prevalence and Mental Health Outcomes of Intimate Partner Violence Among Women: A Systematic Review and Meta-Analysis. Trauma Violence Abuse. 2024;25(1):494\u0026ndash;511. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/15248380231155529\u003c/span\u003e\u003cspan address=\"10.1177/15248380231155529\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"discpsy","sideBox":"Learn more about [Discover Psychology](https://www.springer.com/44202)","snPcode":"","submissionUrl":"","title":"Discover Psychology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"intimate partner violence, refugee, mental health disorder","lastPublishedDoi":"10.21203/rs.3.rs-8418499/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8418499/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eWith the rising global population of refugees and migrants\u0026mdash;especially women\u0026mdash;intimate partner violence (IPV) has emerged as a pressing concern. Studies indicate that nearly one in three women worldwide face IPV, a phenomenon linked to serious health outcomes such as anxiety and depression. These mental health conditions may not only result from IPV but may also increase vulnerability to it. This research explores the frequency of IPV and associated psychological disorders among Afghan refugee women living in the Torbat Jam camp in Iran.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eA cross-sectional design was employed in this study, utilizing simple random sampling to evaluate both mental health status\u0026mdash;using the DASS-21 scale\u0026mdash;and the incidence of intimate partner violence, measured through the Haj Yahya Violence Against Women Questionnaire, among married Afghan refugee women residing in Iran's Torbat Jam camp.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOut of 226 surveyed women (aged 17 to 68, with an average of 19.3 years living in Iran), approximately 15% were pregnant. Most participants were homemakers, and 65% reported having experienced intimate partner violence, with psychological abuse being the most prevalent form. A significant correlation was found between IPV and mental health indicators, including stress, anxiety, and depression, collectively accounting for 45% of the variance observed in IPV incidence.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eEnsuring the mental well-being and safety of refugee women against intimate partner violence is an essential pillar of effective humanitarian assistance and public health planning. Interventions must prioritize both prevention and psychological support to mitigate the dual burden of IPV and mental distress in this vulnerable population.\u003c/p\u003e","manuscriptTitle":"The Relationship Between Intimate Partner Violence and Mental Health Outcomes Among Afghan Refugees Residing in Torbat Jam Camp, Iran","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-23 08:56:57","doi":"10.21203/rs.3.rs-8418499/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-22T15:27:35+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"234583080264998191760579807541449486222","date":"2026-02-27T19:34:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-25T06:44:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"18127039260470256150682823121329490305","date":"2026-02-25T06:00:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"255730859462856004557907034142837358365","date":"2026-02-24T12:01:58+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-22T13:48:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"249003735542780256190544531745516990796","date":"2026-02-18T18:20:01+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-18T18:18:41+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-11T09:17:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-30T16:00:25+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-29T14:00:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Psychology","date":"2026-01-27T11:09:37+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"discpsy","sideBox":"Learn more about [Discover Psychology](https://www.springer.com/44202)","snPcode":"","submissionUrl":"","title":"Discover Psychology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ea71dfd4-2eaa-44b4-991a-f29fc2a7bdac","owner":[],"postedDate":"February 23rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-04-22T15:39:29+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-23 08:56:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8418499","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8418499","identity":"rs-8418499","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}