Comparative study between intimate partner violence victims younger than 65 years old and older than 65 years old.

COMPARATIVE STUDY BETWEEN INTIMATE PARTNER VIOLENCE VICTIMS YOUNGER THAN 65 YEARS OLD AND OLDER THAN 65 YEARS OLD Ana Margarida Valente da Costa Pereira Artigo de Investigação Médica Mestrado Integrado em Medicina Porto, 2014 2 Ana Margarida Valente da Costa Pereira 6º ano do Mestrado Integrado em Medicina Área: Medicina Legal [email protected] COMPARATIVE STUDY BETWEEN INTIMATE PARTNER VIOLENCE VICTIMS YOUNGER THAN 65 YEARS OLD AND OLDER THAN 65 YEARS OLD Artigo de Investigação Médica de Candidatura ao grau de Mestre em Medicina submetida ao Instituto de Ciências Biomédicas de Abel Salazar da Universidade do Porto. Orientadora: Teresa Maria Salgado de Magalhães Doutorada com agregação Prof. Catedrática convidada (ICBAS) Co-orientadora: Dina Filipa Ferreira de Almeida Mestre em Ciências Forenses Assistente convidada (ICBAS) 3 RESUMO A Violência nas Relações de Intimidade (VRI) pode variar nas suas características de acordo com o grupo etário das vítimas. As vítimas mais idosas são menos estudadas, mas à medida que este grupo aumenta em número, torna-se cada vez mais importante adquirir conhecimento sobre ele, dadas as suas particularidades. O objectivo deste estudo é contribuir para um melhor conhecimento das características da VRI feminina, particularmente no que concerne às vitimas portuguesas idosas, comparando grupos de vítimas adultas e idosas. Foi realizado um estudo retrospectivo randomizado, seleccionando 200 casos de vítimas femininas de VRI examinadas nos serviços de medicina forense do Porto e comparando 2 grupos etários – menos de 65 anos e 65 anos ou mais. As mulheres mais jovens estão mais sujeitas a: (a) sofrer abuso psicológico mais severo; (b) serem vítimas de comportamentos violentos infligidos por abusador sob influência de álcool e/ou drogas; (c) ter mais ideação suicida; (d) procurar mais frequentemente acolhimento temporário; (e) acreditarem que eventualmente haverá uma diminuição do abuso e que possuem a capacidade de alterar o curso dos eventos. As mulheres mais velhas estão mais sujeitas a: (a) terem sofrido abuso por períodos de tempo mais longos; (b) consumirem mais medicamentos; (c) terem sido abusadas pelo pai durante a infância e adolescência; (d) recorrerem mais aos serviços de urgência; (e) sofrerem mais exploração económica; (f) sofrerem mais abuso sexual; (g) acreditarem que o abuso vai manter-se. Concluiu-se que as vítimas mais jovens estão sob maior risco de serem vítimas de recorrências violentas (e possível homicídio) pelo alegado abusador. As mulheres mais velhas estão expostas a um tipo de abuso algo diferente, facto que influencia a abordagem dos seus casos particulares. PALAVRAS-CHAVE Vítima; Violência; Abuso; Mulher; Violência nas relações de intimidade; Violência doméstica; Abuso de idosos 4 ABSTRACT Intimate Partner Violence (IPV) may vary in its characteristics according to the victims’ group age. Elderly victims are the less studied, but as this group increases in number it becomes ever more important to develop knowledge about it as this age group has specific particularities. The goal of this study is to contribute to a better knowledge regarding the characteristics of female IPV, namely concerning senior Portuguese victims, comparing adult and elderly victims’ groups. We performed a retrospective randomized study, selecting 200 cases of female IPV victims that have been examined in the forensic medical services of Porto - Portugal, comparing two age groups: younger than 65 years-old and 65 or older. Younger women are more prone to: (a) suffer more severe psychological abuse; (b) be victims of violent behavior inflicted by an abuser under the influence of alcohol and/or drugs; (c) have more suicidal thoughts; (d) more often seek temporary shelter; (e) commonly believe that there would eventually be a decrease of abuse and that they possessed the ability to change the course of events. Older women are more prone to: (a) have suffered abuse for longer periods of time; (b) take more prescription drugs; (c) have been abused by their fathers during childhood and adolescence; (d) more often seek emergency health services; (e) suffer greater economic exploitation; (f) suffer greater sexual abuse; (g) belief that the abuse will be continue unabated. We concluded that the younger victims stand a greater risk of being the victims of violent relapses (and possible homicide) by the alleged abuser. Older women are exposed to a somewhat different type of violence, a fact which affects how their particular situations must be addressed. KEYWORDS Victim; Violence; Abuse; Female; Intimate partner violence; Domestic violence; Elderly abuse 5 INTRODUCTION Intimate partner violence (IPV) includes acts of physical and/or sexual aggression, emotional abuse and other controlling behaviors perpetrated by the victim’s current or past spouse/partner, boy/girlfriend or parent of a common child, regardless of the age, gender, familial tie or cohabitation arrangement at the time. The violence generally occurs due, among others, to the victim's dependency (e.g. emotional, psychological, economical) on the abuser, and thus, the abuser's dominant position in the relationship. IPV occurs in all countries, cultures, religions and socioeconomical groups. It is a serious public health problem and a violation of human rights (1,2,3). More frequently, the violence is perpetrated by a man against a woman. In fact, this is one of the most common forms of violence against women; though, of course, the reverse is possible (4). In spite of this fact, it is not strictly a question of gender that determines the path of violence, but rather the perceived power of the abuser. This form of violence can manifest in a variety of ways, which often coexist and evolve over time: physical, emotional/psychological or sexual abuse, economic exploitation, etc. In a multinational study carried out by World Health Organization (WHO) (3), 24.097 women from 10 different countries were interviewed; the prevalence of lifetime physical and/or sexual violence by an intimate partner was 15% to 71%, and for emotional violence was 20% to 75%. IPV risk factors include the characteristics of the victim and the abuser, and of sociocultural, economic and religious standards (2). Among the individual characteristics of the abuser, alcohol and history of abuse in their direct family appear to be common traits. Other factors include younger age, physical and/or mental disorder, substance dependence, immature and impulsive personality, poor education, low income, unemployment or a stressful professional life, and past deviant behaviors (2,4). Regarding the common traits of victims, vulnerability related to age and necessity, social isolation, history of abuse in their direct family, physical and/or mental disorder, substance dependence, poor education, and economic, physical and/or emotional dependence on the abuser. The sociocultural standards of each community often explain the reason for the silence of the victim and their families and friends; in frequent cases, the aggressor's practices still being accepted and relatively legitimated (2). A series of factors indicate whether the victim is in immediate danger of enduring a violent relapse and/or homicide against them (1): (a) increase in the frequency/severity of aggression; (b) threats of homicide or of suicide of the abuser; (c) 6 stalking of the victim; (d) threat of use or recent use of firearms or other potential fatal arms (e.g. stab instruments); (e) social isolation of the victim; (f) victim’s perception of homicide risk; (g) recent separation or report of the abuse; (h) and pregnancy. The victim frequently remains in the relationship despite acknowledging the abuser’s behavior as wrong and abusive, continuously submitting themselves to the aggression. This outcome stems from a fear of the abuser fulfilling their threats, and/or the possible economical and social losses from the denunciation of their partner. Shame and a lack of social and familial support are very realistic possibilities for a victim that speaks out against their partner. In the decision of whether a victim should complain or remain silent, emotional and economical dependence are of particular significance (2). This type of violence has a negative effect on the victim's health at several levels. Depression and post-traumatic stress disorder are the most prevalent diseases when considering the mental health of victims. Other problems such as alcohol and drug abuse are also commonly found. IPV-related mortality is of homicide committed by the abuser, and victim suicide. Until recently, elderly IPV victims were less studied even though this type of violence does exist and constitute a large problem in this age group. With the average age of the population steadily increasing, this group of victims will also increase, thus more research is needed as this age group has specific particularities. The goal of this study is to contribute to a better knowledge regarding the characteristics of female IPV, namely concerning senior Portuguese victims, comparing adult and elderly victims’ groups, including characteristics of victims and abusers, and the specific characteristics of abuse episodes. MATERIAL AND METHODS Inclusion criteria were: (a) being allegedly victim of IPV; (b) with 18 years old or more; (c) female; (d) examined in the North Branch (Porto) of the National Institute of Legal Medicine and Forensic Sciences of Portugal; (e) between 2012 and 2013. We performed a retrospective randomized study, selecting 200 cases of female IPV victims and comparing two age groups: younger than 65 years-old (G1 – n=100) and 65 or older (G2 – n=100). This sample represents 8% of the total of female victims of IPV examined at the same place and time period (n=2478). The primary information source was a 5-part questionnaire performed specifically for the study, concerning information about the victim, the alleged abuser, any children, and detailed description of the episodes of violence. The secondary 7 information source was the forensic medical report, concerning information about injuries and permanent consequences. Excel 2003 was employed as the database software, and SPSS 15 for Windows for statistical analysis. The Mann-Whitney test was used to compare all the variables between the two groups; in this study, a significance level of 5% was considered to be significant. RESULTS 1. Characterization of the victim Most victims were Portuguese (n=195, 97.5%) and Caucasian (n=196, 98%). The mean age was 38.2 years old in G1 (Min=19; Max=64, SD=9.809) and 71.2 in G2 (Min=65; Max=88, SD=5.015). There was a greater number of single women in G1 (25%) than married, and a greater number of married women in G2 (84%) than single (p=0.000). In terms of education level, 16% in G2 were unschooled, and 72% attending school for at least 4 years; G2 women were more educated, with no illiteracy, and 55% having studied for longer than 4 years (p=0.000). Concerning professional activity, G2 women were either retired (85%) or housewives (10%), while relevant number of the G1 subjects were unemployed (34%) - p=0.002. Only a minority claimed to be economically dependent on the alleged abuser, both in G1 (12%) and in G2 (3%) - p=0.000. Psychiatric disorder was more prevalent in G2 (63%) than in G1 (46%), without statistical significance (p=0.053). However, suicidal ideation was more frequent in G1 (18%) than in G2 (1%) - p=0.000; the same was verified regarding suicidal attempts: 13% in G1 and 7% in G2 (p=0.196). There were only 7 cases (2 in G1, and 5 in G2) of debilitating physical illness (p=0.774). G1 women were more isolated, both in social (35%) and familial levels (21%), than the G2 ones (4% and 4%, respectively) - p=0.000. In terms of substance abuse, 4% of the women in each group reported alcohol consumption; 46% in G2 reported prescription drugs consumption, with no cases in G1 - p=0.000. Regarding the history of abuse in childhood and adolescence, 41 women referred this experience – 12% in G1 and 29% in G2 (p=0.002). The most common types of abuse were physical (60% in G1, and 37.9% in G2 – p=1.000) and psychological (58% in G1, and 89.7% in G2 – p=1.000); there were also 3 cases in G1 (25%) of sexual abuse, with no cases in G2 (p=0.083). Most frequently, the alleged abuser was the father - 6 cases (50%) in G1, and 26 (89.7%) in G2. Other abusers 8 were found to be the mother (30% in G1 – n=4, and 24.1% in G2 – n=7), another family member (20% in G1 - n=2, and 51.7% in G2 - n=15), and another known person (20% in G1 - n=2) - p=0.000. 2. Characterization of the alleged abuser In the majority of cases, the alleged abuser was Portuguese (n=193, 96.5%). The mean age was 40 years old in G1 (Min=22; Max=63; SD=9.574), and 71 years old in G2 (Min=50; Max=96; SD=7.715) - p=0.000. In G1, 28% had 4 years of schooling, 25% had 5-6 years, and 22% had 7-9 years. In G2, only 3% had no education, and 75% had some primary schooling; in both groups, only a minority had attended secondary school (11%) or higher level education (10%) - p=0.000. Professionally, 32% of G1 subjects were unemployed, and 20% worked in protection services, security, personal or domestic services or similar; 84% (n=84) of G2 were retired (p=0.001). The alleged abuser was regularly reported to use substances (n=141, 70.5%) without a statistically significant difference between the groups (p=0.135). The substance in question was alcohol in 85 cases (60.3%), and abuse drugs in 24 (17%) - p=0.150. History of previous violent behavior against the victim associated to alcohol consumption was reported (38% in G1, and 23% in G2 - p=0.015), as well as drug abuse consumption (13% in G1, and 1% in G 2 - p=0.000). Past deviant behaviors were reported in 46% of the cases in G1, and in 15% in G2 (p=0.000). In G1, most were physical integrity offenses (n=9, 19.5%), domestic violence and/or physical abuse of children (n=12, 26%), and other violent behaviors (n= 24, 42.3%). In G2, there were 7 cases (46.7%) of physical integrity offenses and 9 (60%) of domestic violence (p=0.000). The victim reported a psychiatric disorder of the alleged abuser in 17% of the cases in G1, and 18% in G2 (p=0.815). A history of abuse in childhood or adolescence was reported in 14 cases: 10% in G1, and 4% in G2 (p=0.000). All suffered physical violence and 50% suffered psychological abuse. The alleged abuser was the father in 50% of cases (n=5) in G1, and in 75% (n=3) in G2. The mother was found to be the abuser in 60% (n=6) in G1, and in 50% (n=2) in G2 (p=0.000). G2 victims did not answer in 79% of the cases. Younger abusers (involved in G1 cases) had more often been exposed to domestic violence (39%) than older ones (28%) - p=0.000. Both were mostly exposed to physical (n=56, 83.6%) and psychological (n=67, 100%) violence (p=0.060). Many women in both groups did not know the answer to this question (n=86, 44.5%). 9 3. Demographic Characterization of Eventual Children There were more children living with the couple in G1 (68%) than in G2 (23%) - p=0.000. Younger couples (G1) had 1 child in 35% of the cases, 2 in 31%, and 4 in 2%, while the older couples (G2) had 1 child in 22% of cases and 4 in 1%.- p=0.000. In G1 the majority of children were under 18 years (n=151, 92.6%), and all children were over 18 years in G2 (n=15, 93.75%). 4. Characterization of violence in the family In most cases, the victim and the alleged abuser were married (59% in G1, and 87% in G2) or in cohabitation (39% in G1, and 6% in G2) - p=0.000. At the time of forensic medical examination, the majority of the couples were cohabitating (78% and 90% for G1 and G2, respectively). The cohabitation period in G1 was under a year in 11% of cases, between 1-5 years in 17%, 6-10 in 9%, 11-15 in 18%, 16-20 in 8%, 2125 in 5%, 26-30 in 3%, 31-35 in 1% and over 35 years in 5%; in G2 was under a year in 1% of cases, between 1-5 years in 5%, 6-10 in 2%, 11-15 in 3%, 16-20 in 4%, 21-25 in 3%, 26-30 in 1%, 31-35 in 9% and over 35 years in 68% - p=0.000. There were more separated and divorced couples in G1 (25%) than in G2 (7%) - p=0.002. Separation by the victim’s will, within the last 12 months, was found in 20% of cases in G 1, and 1% in G2 (p=0.000). Only in 2 cases (1 from each group) had the victim required a separation to begin another intimate relationship. Regarding the start of the abuse, no difference was found between the groups (p=0.070). Physical abuse started during dating in 5% of cases in G1 and 14% in G2, during the first 5 years of cohabitation in 10% of cases in G1 and 22% in G2, 6-10 years of cohabitation in 10% in G1 and 1% in G2, after 10 years in 16% in G1 and 22% in G2. In 11% of cases in G1 the physical abuse started after separation, with no cases in G2. Psychological abuse started during dating in 5.2% (n=5) of cases in G1 and 18.9% (n=18) in G2, during the first 5 years of cohabitation in 72.2% (n=70) in G1 and 67.4% (n=64) in G2, 6-10 years of cohabitation in 6.2% (n=6) in G1 and 2.1% (n=2) in G2, after 10 years in 13.4% (n=13) in G1 and 11.6% (n=11) in G2; after separation in 3.1% (n=3) in G1 and in no cases in G2. Economic exploitation started during dating in 50% (n=2) of cases in G1 and in 16% (n=4) in G2, during the first 5 years of cohabitation in 50% (n=2) in G2 and 68% (n=17) in G2, and between 6-10 years of cohabitation in 12% (n=3) of cases in G2. Sexual abuse started during dating in 23.1% (n=6) of cases in G2, during the first 5 years of cohabitation in 100% (n=2) of cases in G1, and in 61.5% (n=16) in G2, 6-10 years of cohabitation in 3.8% (n=1) in G2, and after 10 years of cohabitation in 11.5% (n=3) in G2. 16 Older women sought more health services after the aggressions. A possible explanation is that more severe injuries occurred in this group, requiring medical treatment due to both more severe aggressions and higher fragility of the women. Another consideration is that the children, already adults, could rush the victim to the emergency room. The minor utilization of the temporary shelter by older women may be due to there never having existed such a service during a great part of their lives, or alternatively, it may even indicate a greater reticence to use this service. Older women may not see their problem as IPV, and consequently, do not seek these services provided to victims (18). Legal advice was perhaps not readily available from the beginning of the abusive relationship, on account of less understanding of this problem, and little access to justice services 30 years ago. The most recent aggression episode in G2 did not have witnesses, as this couple lived alone, without any children. Young children were always the witnesses (if any) of violent episodes in G1, which is consistent with the finding from another study (17). The resulting injuries were similar in the two groups, with ecchymosis/contusion being the most frequent (Table III). Lack of any injury in the older victims shows a less severe aggression in this group. The sites of injuries were consistent with the reported aggression types; injuries on the arms and forearms may be defensive. The short time of malaise suggests less severe aggressions in most cases. CONCLUSIONS Younger women are generally characterized by: (a) higher education; (b) being unemployed; (c) living more isolated; (d) being more economically dependent on the alleged abuser; (e) suffering from a more severe psychological abuse; (f) having more suicidal ideas; (g) seeking more temporary shelter; (h) believing in the eventual decrease of abuse and in their ability to change the course of events; (i) being victims of violent behaviors by an abuser under the influence of alcohol and/or drugs. There was also a higher number of separated women in the last 12 months. The couple’s children generally: (a) live with the victim and the abuser; (b) are also abused; (c) witnessed the most recent episode of physical aggression. The abusers generally: (a) are unemployed; (b) have a history of deviant behavior; (c) possess firearms. Compared to younger women, older women were found to generally: (a) be retired; (b) use more prescription drugs; (c) have more psychiatric illness (not statistically significant); (d) suffered abuse in childhood and/or youth by their father; (e) suffer abuse for a protracted period of time; (f) be more often assaulted with blunt 17 objects; (g) more often use the emergency health services; (h) receive more treatment for injuries and psychiatric treatment; (i) consider the abuse will continue; (j) suffer more economic exploitation and sexual abuse; (l) showed no injuries and had no witnesses in the most recent physical violent episode. The abuser, in both groups, regularly uses/abuses substances (in most cases, alcohol), was exposed to violence in his family of origin during childhood and/or youth, and does not have a psychiatric illness. Assessing these results, we may conclude that the younger woman is at higher risk of abuse and homicide. But this is not perceived by the victim, who sometimes even believes in the eventual decrease of violence. Although the older women are at less risk, we cannot assume with certainty that this fact has remained unchanged during all abusive relationships, or that it has decreased. This group may have already been culled over the years; women of this generation who were under a higher risk may have been killed by their abusive partners, or have broken off the relationship, meaning their numbers were not included in this study. There may also be older women who suffer a more severe abuse, and who are isolated (a common situation in the general population), and/or do not see their situation as being abusive. In these cases, the report may never even be made. 18 ACKNOWLEDGMENTS To Professor Teresa Magalhães, for her availability to supervise this project, suggestions and invaluable assistance. To Dr. Dina Almeida for her essential guidance, support, dedication and availability to help in every step of this project. To Dr. Fernanda Rodrigues, for allowing data collection in the Clinical Forensic services. To Dr. Diana Garganta, for her support in the statistical analysis of data. To my family, for their support and encouragement. 19 REFERENCES 1 – Grams AC, Magalhães T. Violência nas relações de intimidade. Avaliação do risco. Revista Portuguesa do Dano Corporal 2011; 22:75-98. 2 – Magalhães T. Violência e Abuso. Respostas simples para questões complexas. 1st ed. 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Cincinatti: Anderson, 1991. p. 13130 21 TABLES Table I – Types of psychological abuse G1 (n=100) % G2 (n=100) % P Insult, humiliate or defame 88 96 Depreciation 55 74 Death threats 43 49 Schedule control 43 16 Stalking, spying 30 18 Threat of aggression or to the woman’s life using a stab instrument 22 19 0.221 Controlling the victim’s physical appearance 24 10 Destruction of assets with affective value 17 7 Unfounded accusations of infidelity 6 20 Throwing objects 19 26 Controlling relationships 2 21 Isolation 8 15 Emotional abandonment 8 30 Disturbance of nocturnal sleep 8 18 22 Table II – Types of physical abuse G1 (n=100) % G2 (n=100) % Past abuse Current episode Past abuse Current episode Pushing 49 31 73 36 Punching 49 44 63 50 Slapping 51 23 61 2 Squeezing 45 28 50 28 Kicking 42 25 38 18 Hair pulling 37 24 28 19 Throwing objects 19 6 26 2 Choking 18 14 23 14 Aggression with blunt instrument 6 2 25 20 23 Table III – Types and anatomical distribution of injuries G1 n (%) G2 n (%) p Type of Injury No injury (pain) 27 (18.2) 47 (32.5) 0.108 Swelling 23 (15.5) 15 (10.4) Bruise 53 (35.8) 44 (30.6) Abrasion 32 (21.6) 19 (13.2) Anatomical distribution Cranium 8 (4.47) 4 (2.7) 0.000 Face 46 (25.7) 24 (16.2) Neck 11 (6.2) 3 (2) Thorax 9 (5.3) 11 (7.4) Abdomen 2 (1.2) 1 (0.6) Upper limb 72 (40.2) 48 (32.4) Lower limb 20 (11.2) 14 (9.5) 24 Anexo – Resumo em português Introdução A Violência nas Relações de Intimidade (VRI) inclui actos de agressão física e/ou psicológica, abuso emocional e outros comportamentos controladores perpetrados pelo conjugue actual ou passado da vítima, namorado ou progenitor de descendente em comum, independentemente da idade, género, ligação familiar ou coabitação à altura dos factos. Os factores de risco para VRI incluem características da vítima, do abusador, de ordem sociocultural, económica e/ou religiosa. Entre as características individuais do abusador, parecem ser particularmente importantes a história de VRI na família de origem e o consumo de álcool; outros factores são idade jovem, doença física e/ou mental, dependência de substâncias, personalidade imatura e impulsiva, baixas habilitações académicas, baixo rendimento, desemprego ou vida profissional muito intensa e antecedentes de comportamentos desviantes. Relativamente à vítima, são relevantes a vulnerabilidade relacionada com a idade e as necessidades, o isolamento social, a experiência de abuso na família de origem, dependência de substâncias, doença física e/ou mental, dependência económica, física e/ou emocional do abusador e baixas habilitações académicas. Uma série de factores indicam se a vítima está sob perigo imediato e sob risco de recidiva da violência e/ou homicídio: aumento da frequência e/ou severidade das agressões, ameaças de homicídio ou suicídio do abusador, perseguição da vítima, ameaça de uso ou uso recente de armas durante as agressões, isolamento social da vítima, percepção pela vítima de risco de homicídio, separação recente e gravidez. Mesmo quando entende como errado e abusivo o comportamento a que está sujeita, é frequente a mulher manter-se na relação e submeter-se continuadamente ao abuso. Tal é consequência do medo tanto da concretização das ameaças do abusador, como das possíveis perdas afectivas, económicas e sociais decorrentes da denúncia; da vergonha da falência da relação; e da falta de apoio social e familiar. Na decisão de denunciar o abuso, têm particular importância as dependências emocional e económica. Até recentemente, as vítimas mais velhas de VRI eram menos estudadas apesar deste tipo de violência existir e constituir um problema neste grupo etário. Com o envelhecimento da população, este grupo de vítimas irá aumentar, e assim mais investigação é necessária dadas as especificidades deste grupo. 25 Material e Métodos Os critérios de inclusão foram: (a) ser uma alegada vítima de VRI; (b) ter 18 anos ou mais; (c) ser examinada na Delegação Norte do Instituto de Medicina Legal e Ciências Forenses de Portugal; (d) entre 2012-2013. Foi realizado um estudo retrospectivo, seleccionando 200 casos de vítimas femininas de VRI e comparando dois grupos etários: idade superior a 65 anos (G1 – n=100) e 65 ou mais anos (G2 – n=100). Esta amostra representa 8% do total de vítimas femininas de VRI examinadas no mesmo local e período de tempo (n=2478). Para a recolha de dados, foi utilizado um questionário constituído por 5 partes, englobando informação relativa à vítima, informação relativa ao alegado agressor, a eventual existência de filhos e caracterização dos episódios de violência. Os processos das vítimas foram a fonte de informação. A fonte secundária de informação foi o relatório da perícia médico-legal, relativa a informação sobre as lesões e dano permanente. Para a base de dados, foi utilizado o programa informático Excel 2003, e para o tratamento estatístico o SPSS 14 para Windows. Utilizou-se o teste de Mann-Whitney nas comparações de todas as variáveis. Considerou-se um nível de significância de 5% para todas as variáveis. Resultados e discussão As mulheres mais jovens têm mais habilitações literárias, sem qualquer analfabeta neste grupo. Esta diferença reflecte as mudanças no acesso à educação que tiveram lugar no século XX, como a implementação da escolaridade obrigatória. Apesar da educação superior das mulheres mais jovens, estas tendem a ser mais dependentes economicamente, de forma estatisticamente significativa. As mulheres em G2 que não responderam a esta questão podem, eventualmente, estar a ocultar a sua dependência. Dada a menor qualificação profissional destas mulheres, é seguro afirmar que haverá maior número de dependentes em G2. As mulheres mais velhas reportaram maior consumo de substâncias, à custa de medicamentos. Uma possível explicação é a maior prevalência de doença orgânica desta faixa etária, frequentemente polimedicada. No entanto, também pode haver abuso destas substâncias, nomeadamente de ansiolíticos e analgésicos. A doença psiquiátrica foi mais prevalente em G2, porém sem significância estatística. O impacto do abuso durante um longo período de tempo tem mais impacto na saúde mental destas mulheres. A ideação suicida foi mais prevalente em G1, sugerindo que poderá haver doença psiquiátrica ainda não diagnosticada nestas vítimas.