INTRODUCTION
Intimate Partner Violence (IPV) is defined as any physical, psychological, or sexual harm occurring within an intimate relationship, whether married, unmarried, or cohabiting.1 The Global Burden of Disease study reported that, in 2018, approximately 27% of women aged 15 to 49 who had partners experienced some form of violence within the past year.2 In Latin America, the prevalence of IPV varies from one country to another, with rates ranging from 14% in Brazil to as high as 50% in Bolivia.3 In Peru, it is estimated that around 40.1% of women of childbearing age have suffered some form of violence from their partners.4 Given these statistics, and the fact that the majority of victims are women of childbearing age, gender-based violence and IPV are considered global public health issues, with significant societal repercussions due to human rights violations.5
Possible risk factors for IPV include age, low educational attainment, tolerance of violent behavior, and substance use.6,7 Substance abuse, such as alcohol consumption and the use of various drugs, has been identified as a significant factor associated with intimate partner violence, both during episodes of violence and as a chronic pattern.8,9
However, little research has been conducted on the impact of substance use on the recurrence of violent acts in intimate relationships, and there is limited evidence on the recurrence of IPV. Physiological aspects may explain how substance abuse mediates both IPV and potential recidivism among offenders,10 or the victim’s tolerance for receiving violent treatment. Nonetheless, a more direct examination of the relationship between substance use and both new and repeat cases of IPV is warranted.
Hence, this study was undertaken to investigate the relationship between substance use (alcohol and drugs) and recidivism in cases of intimate partner violence. Establishing such a connection could provide additional support for the effective regulation of the sale and distribution of alcoholic beverages, shed light on the proportion of recurrences in IPV cases, and contribute to the Sustainable Development Goals outlined by the United.11
METHODS
Ethical Considerations
This study was conducted using publicly available information from the National Observatory of Violence, as previously mentioned. The research team ensured that the data did not contain any identifying information about the victims or perpetrators. Because the data was anonymized and accessible to the general public, this study did not require approval from any institutional ethics committee.
Study Design and Data Sources
This is an analytical cross-sectional observational study that utilizes data from a secondary source. The data was obtained from the Ministry of Women and Vulnerable Populations (MIMP) through the National AURORA Program for the prevention and eradication of violence within family groups. This program collects information from reports and records submitted to the Women’s Emergency Center (CEM), which are present in all departments across Peru. Both the Peruvian National Police and the Public Ministry contribute information from the received complaints to the CEM.
Data Extraction and Cleaning
Victims of violence who report violent incidents complete a standardized registration form (Supplement 1) established by the AURORA program. This form is consistent throughout the national territory, and each CEM has trained personnel for accurate form completion. The data is available to the general public on the National Observatory of Violence’s website (https://www.mimp.gob.pe/omep/estadisticas-atencion-a-la-violencia.php) and is accessible in .sav format for IBM SPSS software. The data was downloaded and transformed for use with the STATA statistical package, where variables and their categories were recoded. Data was also cleaned based on the selection criteria detailed below.
Participants and Variables
Data from the year 2022 was obtained, and all records from that period were considered. The study included adult female victims from Peru, aged 20 to 59, whose partner or ex-partner was male. Victims of economic violence were excluded, as were those without the variables of interest (alcohol consumption and information on the recurrence of violent acts) (Figure 1). The study considered variables for both the victim and the perpetrator, including age, area of residence, marital status, educational level, employment status, alcohol or drug use during the last violent incident, and frequent alcohol or drug use (these were the independent variables of interest). For the victim, additional variables considered included pregnancy status, having children, ethnicity, disability status, specific relationship with the perpetrator, type of perceived violence, a history of previous violent incidents by the same perpetrator (dependent variable), family or friend connections, and whether the victim had filed a judicial complaint with the relevant authorities.
Statistical Analysis
An initial analysis was conducted to describe and summarize each variable. Relative and absolute frequencies were used for categorical variables, while measures of central tendency (mean or median) with their respective measures of dispersion (standard deviation or interquartile ranges) were employed for numerical variables. To assess the difference in proportions between the recidivism group and new cases, the Pearson chi-square test was applied, or alternatively, Fisher’s exact test when appropriate. To evaluate the association between alcohol consumption and recidivism, generalized linear models of the binomial family with a logit link function were utilized. This model yields odds ratios (ORc) as results. An adjusted model was also applied, incorporating variables with a p-value less than 0.20 in the bivariate model, and adjusted odds ratios (ORa) were reported. All analyses were deemed significant when a p-value < 0.05 was achieved, and both ORc and ORa were presented with their respective 95% confidence intervals (CI 95%). The statistical software package STATA v.17 (STATA Corp, Texas, USA) was used for these analyses.
RESULTS
A total of 65,290 cases of intimate partner violence were analyzed, with 93.70% (n = 61,174) of these cases being instances of recidivism by the same perpetrator. Among the most representative characteristics of the victims, the following stand out: age between 30 to 39 years (n = 23,477, 35.06%), single marital status (n = 52,290, 80.09%), not pregnant (n = 63,430, 97.15%), and completion of high school or technical education (n = 35,634, 54.58%). As for the characteristics of the aggressors, the following are notable: age group between 30 to 39 years (n = 23,173, 35.49%), secondary education or technical background (n = 39,162, 60.62%), and having a job or occupation at the time of the aggression (n = 56,736, 87.39%) (Table 1).
Regarding the characteristics of the violent acts, there was a partner relationship in 55.44% (n = 36,194) of the cases, in 60.81% (n = 19,704) of cases, there was cohabitation between the victim and the perpetrator, physical violence was the most common type of violence at 49.17% (n = 32,106), in 29.54% of cases, the aggressor had a history of frequent alcohol consumption (n = 19,285), and only 6.11% had a history of frequent drug use (n = 3,988) (Table 2).
In the bivariate analysis, it was found that alcohol consumption by the aggressor was associated with the recurrence of violent acts with an ORc = 2.20 (95% CI: 2.02 – 2.39, p < 0.001), and drug use also had an association with an ORc = 1.89 (95% CI: 1.59 – 2.24, p < 0.001). In the adjusted analysis, an association was also found with frequent alcohol consumption by the aggressor, with an ORa = 2.24 (95% CI: 2.06 – 2.44, p < 0.001), and with frequent drug use, with an ORa = 2.33 (95% CI: 1.95 – 2.77, p < 0.001) (Table 3).
DISCUSSION
The results of this research reveal that over 90% of the documented cases of violence at CEM are instances of recurrence caused by the same perpetrator. This is a significant figure that underscores the need to direct preventive strategies toward couples who have already had a history of any type of violence. It is also crucial to strengthen and implement suitable programs for the early detection of new cases. A compilation of data indicates that among aggressors, 68% are rearrested within 3 years, and 50% return to prison.12 A systematic review mentions that the recidivism rate can vary between 14% and 45% among the countries from which the figures were obtained.13 Therefore, it is essential not to underestimate cases of recurrence and to properly monitor victims who have previously reported an incident of violence.
While we found a higher frequency of recidivism in cases of psychological violence (49.1% in recidivism cases versus 33.19% in new cases), this is consistent with previously identified evidence.14 Recidivism may lead to more severe aggression, as evidenced by the fact that feminicides (the most extreme form of violence against women) are often preceded by a prior act of violence by the same aggressor or feminicide.15,16 With this premise in mind, the recurrence of IPV becomes even more significant, and reporting the initial act of violence by the victim should be encouraged.
Previous evidence suggests that despite court orders, incarcerations, or restrictions imposed on aggressors, they have a high likelihood of repeating acts of violence, regardless of variables such as substance use or the type of violence exerted.17 Continuous monitoring services and therapy for those incarcerated and prosecuted for a history of aggression and violence could likely reduce the recurrence rate,18 particularly given that a substantial portion of the cases recorded in the present results are instances of recidivism.
Implications for Public Health
The consumption of substances and acts of violence, in general, are often related, although their specific relationship in IPV is controversial. Both chronic substance use and substance abuse need to be addressed from a public health perspective. On the other hand, recurrence in cases of IPV represents a significant proportion of the presented results. From a preventive standpoint, proper monitoring of both aggressors and victims, adequate treatment or therapy,19–21 follow-up of violence cases,22 and education about gender violence prevention from an early age,23 could be useful strategies to prevent both new and recurrent cases on a national level.
In Peru, the CEM and the AURORA program were established to address the increasing cases of violence that occur daily in the country.24 However, cases of violence have been on the rise over the past five years.25 Therefore, efforts should be combined, and the strategies provided by CEM should be integrated and complemented with collaborative work with the Ministry of Health, which could also help develop appropriate strategies for alcohol consumption control.
While it could be argued that more cases are being reported due to improved surveillance, these cases should receive proper follow-up from the moment they are first recorded. IPV and alcohol consumption continue to be areas of limited understanding, and when the recurrence of IPV is added to the equation, the role of alcohol consumption becomes even more significant.
Strengths and Limitations
The analyses presented are based on records of reported incidents of perceived violence at the national level, providing a level of representativeness across the country. This information can be extrapolated to all individuals who have reported an incident of IPV. Additionally, it’s crucial to note that these are two interrelated issues, substance use, and IPV, thus offering insights into two public health problems in Peru. Another significant strength is that the information is derived from a national entity under one of the ministries of the Government of Peru, giving the collected data validity and generalizability.
Among the limitations, the most important one is working with a secondary database, which limits the ability to collect additional variables that might be of interest. Although a suitable design would be required, including variables such as the aggressor’s criminal history, prior mental health problems, and psychiatric care. Another notable limitation is selection bias since it involves working with the records of victims who reported the violent incident. Victims who choose not to report may have an even higher rate of violence recurrence, or they may be intimidated by the violence when the aggressor is under the influence of substances. Additionally, there may be information bias, as the data is collected through self-reporting by the victim. Consequently, this information can be subject to various sources of bias, such as forgetting information or avoiding answering certain questions.
Despite these limitations, this study highlights a significant relationship between two variables in a population where there is a high tolerance for gender-based violence, a high incidence of IPV, substance use, and, above all, the need to implement appropriate strategies. Generating evidence for the proper management of these issues is essential. A more comprehensive and structured approach is required to address IPV, not only to identify risk factors but also to evaluate government and national entity proposals and strategies. Generating evidence through research in this field is crucial, and it is an area that can gain greater prominence in the academic arena.
CONCLUSION
Based on the presented results, it can be concluded that there is a relationship between substance use and the risk of recurrence in cases of intimate partner violence. Despite controlling for various potentially confounding variables and the mentioned limitations, a significant relationship was found, underscoring the need for an appropriate approach to both situations. National entities play a crucial role, and it is essential for research in this area to continue.
Authors’ contributions
E M-M: Data Cleaning, Writing - Initial Draft, Writing - Revision and Editing of the Final Version.
L A R: Conceptualization, Research, Methodology, Data Cleaning, Formal Analysis, Writing - Initial Draft, Writing - Revision and Editing of the Final Version.
M K G-T: Data Cleaning, Writing - Initial Draft, Writing - Revision and Editing of the Final Version.
M L M-A: Data Cleaning, Writing - Initial Draft, Writing - Revision and Editing of the Final Version.
V R-L: Conceptualization, Research, Methodology, Data Cleaning, Formal Analysis, Writing - Initial Draft, Writing - Revision and Editing of the Final Version.
Conflict of Interest
No author declares any conflict of interest.
Funding
None