Background: Interpersonal violence continues to affect health long after violence has ended. This analysis investigated stress, support, and health behaviors as mediators potentially explaining persistent health impacts of violence. Methods: Using a cross-sectional analysis of 12,594 women "Wellness, Health & You" (WHY) participants, authors measured violence as intimate partner violence (IPV), sexual assaults (SA), and childhood abuse (CA) by recency (current, past as an adult, or child) and number of violence forms. Current health-related quality of life (HR-QOL) was defined using the most recent survey as physical and mental health limiting usual activities for at least 4 days in the past 30 days. Adjusted prevalence rate ratios (aPRRs) for violence and HR-QOL were obtained using multiple variable log binomial regression where each mediator was included in separate models with demographic attributes. Results: In this sample of middle-aged women, half (n = 6307) had ever experienced violence (38.3% IPV, 12.9% SA, and 24.6% CA) and 19.9% reported multiple forms. IPV, SA, and CA were each associated with poorer current HR-QOL, yet, WHY participants experiencing all three forms had a sixfold increased rate of poor mental HR-QOL (Model 1: aPRRs = 6.23 [95% confidence interval, 95% CI: 4.87-7.97]) versus no violence. Stress was the mediator associated with the greatest change in aPRRs (-34.7%; Model 2: aPRR = 4.07 [95% CI: 3.13-5.30]). When all mediators were included (Model 5: aPRR = 3.01 [95% CI: 2.29-3.96]), partial mediation was observed, evidenced by nonoverlapping CIs between Models 1 and 5. Conclusions: Of relevance for interventions are findings that current health impacts of past violence may be mitigated through reducing current stress.
Keywords: childhood abuse; health care; health-related quality of life; intervention; intimate partner violence; mental health; physical health; sexual assaults.