Measuring psychological abuse by intimate partners: Constructing a cross-cultural indicator for the Sustainable Development Goals

Lori Heise, Christina Pallitto, Claudia García-Moreno, Cari Jo Clark

Research output: Contribution to journalArticlepeer-review


Background: Psychological abuse within intimate relationships is linked to negative health outcomes among women and is frequently identified as more wounding than physical or sexual violence. However, there is little agreement on how to conceptualize or measure the phenomenon, a necessary foundational step to estimate the prevalence and range of psychological abuse, its interaction with physical and sexual violence, its health impacts, and progress towards global Sustainable Development Goals (SDGs). Methods: We used Latent Class Analysis (LCA), psychometric testing, and logistic regression to evaluate the construct and content validity of alternative methods for deriving a measure of psychological partner abuse, using pooled data from the first 10 countries and 15 sites of the World Health Organization Multi Country Study on Domestic Violence and Women's Health (WHO MCS). Results: Psychological abuse is highly prevalent, ranging from 12% to 58% across countries. A three-class solution was supported for coding psychological abuse: no, moderate- and high-intensity. This three-level categorization, which can be coded without LCA, demonstrates a clear graded relationship with controlling behaviors, and all measured health outcomes except physical pain. Factor analysis confirms that psychological abuse and male controlling behaviors are separate constructs as measured in the WHO MCS and the DHS and should not be combined. Conclusions: We present a simple way to code psychological abuse for cross-country comparison. Additional research is urgently needed to strengthen understanding of psychological abuse across settings and to identify an appropriate threshold for defining psychological violence for surveys globally.

Original languageEnglish (US)
Article number100377
JournalSSM - Population Health
StatePublished - Jan 1 2019
Externally publishedYes


  • Emotional abuse/violence
  • Intimate partner violence (IPV)
  • Measurement
  • Psychological abuse/violence

ASJC Scopus subject areas

  • Health(social science)
  • Health Policy
  • Public Health, Environmental and Occupational Health

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