The Influence of Mental Health Coercion on Women’s Mental Health Treatment Experiences and Symptoms

Background and Purpose: Intimate partner violence (IPV) continues to be one of the most harmful experiences disproportionately affecting women, especially women impacted by the criminal legal system. IPV includes forms of physical, emotional, economic, and sexual abuse and has many negative outcomes, including mental health concerns. An understudied form of IPV is mental health coercion in which a partner sabotages, disrupts, or prevents their partner from accessing and engaging in mental health treatment (e.g., withholding transportation to get care, accusing a partner of having an affair with provider). Mental health coercion also includes interfering with mental health medication treatment (e.g., making a partner take too much medication or withholding medication) and harmfully leveraging other systems by misrepresenting a partner’s mental health needs (e.g., making false claims about a partner’s mental health concerns to the child welfare system). We propose a conceptual model that links women’s experiences of mental health coercion to more severe symptoms of depression and anxiety, both directly and indirectly through the mediating role of mental health treatment. The guiding research question for our study is how do forms of mental health coercion directly and indirectly disrupt women’s experiences with mental health treatment and affect symptoms of depression and anxiety?

Methods: A survey was conducted with a sample of N=491 racially diverse women with histories of criminal legal system involvement in one Midwestern state and included questions to measure different forms of IPV (including types of mental health coercion), satisfaction with mental health treatment, and symptoms of depression and anxiety. We estimated a path model linking each type of mental health coercion to depression and anxiety symptom severity, specifying mental health treatment satisfaction as a mediator variable. Other forms of IPV and demographics were included as covariates. Direct and indirect effects were estimated with bootstrapped confidence intervals to further investigate our conceptual model.

Results: Factor analysis identified treatment sabotage (α=.896), medication sabotage (α=0.838), and system-linked punishment (α=.813) as distinct types of mental health coercion experiences within the sample. Path model results show that higher exposure to each form of mental health coercion is significantly associated with lower satisfaction with mental health treatment, and lower treatment satisfaction is significantly associated with more severe symptoms of depression and anxiety. We thereby find that each form of mental health coercion increases depression and anxiety severity directly and indirectly through the mediating role of feeling (un)satisfied with mental health treatment. In other words, women who experienced more mental health coercion reported worse mental health outcomes, in part because coercion reduced their satisfaction with the mental health services intended to support them.

Implications: The study focused on an understudied form of IPV: mental health coercion. We provide items that can be used in practice and research to elicit this form of IPV. Our results demonstrate how specific forms of mental health coercion negatively impact women’s experiences of mental health treatment and their anxiety and depression symptoms. We discuss implications for social work research and practice.