Does Empowerment Mediate the Association Between Intimate Partner Violence (IPV) and Mental Health? An Analysis Across Multiple Forms of IPV

Abstract

This study explores the extent to which self-reported empowerment mediates the association between intimate partner violence (IPV) victimization and mental health symptomatology. Four forms of IPV—severe, harassment, psychological, and technology-facilitated IPV—and two mental health symptomatologies—depression and posttraumatic stress disorder—are examined. Data were collected from women who sought help from domestic violence service agencies in a U.S. Southwestern state. Results showed that all forms of IPV had both significant direct and indirect effects on mental health symptoms through empowerment, indicating that IPV is associated with increased mental health symptoms by, in part, diminishing one's empowerment levels. The findings underscore the importance of empowering survivors in the practice process.

Keywords

empowerment power and control intimate partner violence mental health domestic violence

Intimate partner violence (IPV) is a pervasive problem in the United States and can lead to significant mental health consequences (Messing et al., 2023; White et al., 2024). In addition to physical and sexual violence, IPV involves controlling tactics that undermine survivors’ sense of agency and autonomy (Pence & Paymar, 1993; Smith et al., 1995; Stark, 2007). As such, empowerment is a guiding theory among practitioners who intervene with IPV survivors (Edmond et al., 2019). However, limited research has examined whether empowerment mediates the association between various forms of IPV and mental health symptomatology. A better understanding of the impact of empowerment on survivors’ mental health may strengthen interventions and practice strategies with survivors of IPV. This study, therefore, investigates whether empowerment mediates the association between IPV and mental health symptomatology among a sample of women recruited from IPV programs and shelters (N = 377) in one Southwestern state. Four forms of IPV (severe, harassment, psychological, and technology-facilitated IPV) and two mental health outcomes (depression and posttraumatic stress disorder [PTSD] symptoms) are examined.

IPV and Mental Health

IPV, encompassing abusive behaviors and controlling tactics, such as physical violence, sexual violence, psychological abuse, stalking and harassment, coercion, and technology-facilitated abuse, is a traumatic exposure that can result in adverse mental health outcomes (Jiwatram-Negrón et al., 2024; Messing et al., 2023; Okuda et al., 2011; Smith et al., 2017; White et al., 2024). Specifically, IPV victimization increases women's risk of depression, PTSD, and anxiety (White et al., 2024). For example, a study by Sullivan et al. (2018) found that 89% of women who accessed domestic violence shelter services met the criteria for risk of clinical depression. Using longitudinal research designs, prior research has also found that women exposed to IPV are about 2–3 times more likely to develop symptoms of depression compared to women not exposed to IPV (Chandan et al., 2020; Chuang et al., 2012).

Similarly, research has consistently found an association between IPV and PTSD. A meta-analysis of 201 studies indicated that being exposed to various forms of IPV increases the likelihood of PTSD, with the pooled odds ratio for the association between IPV and PTSD ranging from 2.15 for sexual IPV to 2.66 for psychological IPV (White et al., 2024). Focusing on coercive control, a type of abuse aimed at belittling, isolating, and stripping a person of their rights to safety, dignity, and respect (Stark, 2007), a meta-analysis of 45 studies found that exposure to coercive control is associated with PTSD (Lohmann et al., 2024). IPV has a consistently observed mental health impact on survivors, making it important to examine factors that have the potential to mitigate these adverse effects.

Protective Factors Buffering the Adverse Impact of IPV

Research suggests that social support and adaptive coping, which refers to using positive, constructive methods to handle stress and emotion, may help mitigate the adverse effects of IPV (Lilly & Graham-Bermann, 2010; Mengo et al., 2021). Problem-focused coping, a type of adaptive coping that involves seeking help and applying problem-solving techniques, has been shown to mitigate the negative effects of police-involved IPV incidents on women's mental health (Mengo et al., 2021). In another study of women residing in domestic violence shelters who reported frequent IPV exposure, those who more frequently utilized emotion-focused coping strategies (e.g., positive reevaluation, exercising self-control) experienced a reduced impact of IPV exposure on PTSD symptoms compared to those who used such coping strategies less often (Lilly & Graham-Bermann, 2010).

Social support, which refers to the tangible and intangible resources available to people through interpersonal networks, may also serve to mitigate the detrimental effects of traumatic exposures such as IPV (Kocot & Goodman, 2003; Ogbe et al., 2020; Wachter et al., 2021 , 2022). In a sample of young women who experienced IPV, seeking more social support was found to moderate the association between IPV and psychological distress (Fortin et al., 2012). In another study, social support was the most important variable in predicting physical and mental health outcomes; survivors with higher levels of social support reported better physical and mental health and lower levels of psychological distress than those who reported less social support (Kamimura et al., 2013).

The Role of Empowerment

Traditional IPV theories, such as the Power and Control Wheel (Pence & Paymar, 1993) and the coercive control model (Stark, 2007), view IPV as involving the use of controlling tactics aimed at eroding survivors’ sense of control and agency. Distinct from discrete, episodic assaultive behavior, IPV is conceptualized as an enduring condition wherein survivors’ behaviors, views of self, and beliefs in their ability to enact control over their lives are constantly shaped by abuse, shame, and isolation (Smith et al., 1995). In response, IPV interventions have historically emphasized empowerment. As a complex concept encompassing values, theory, and practice, empowerment incorporates two fundamental assumptions. First, individuals hold great positive change potential, although they may be hindered by society's inability to meet their needs (Gutierrez, 1990). Second, individuals can be empowered by cultivating their strengths and developing problem-solving, interpersonal, coping, and life skills to achieve their goals (Cattaneo & Chapman, 2010; Johnson et al., 2005; Worell & Remer, 2002).

Practitioners who work with survivors of IPV and sexual assault identify empowerment as the most frequently utilized practice approach (Edmond et al., 2019). More than nine-tenths of participating practitioners reported using empowerment as a guiding theory in their work, and almost four-fifths reported using empowerment as an intervention modality (Edmond et al., 2019). Empowerment practices, including prioritizing survivor decision-making; increasing survivor choices through resource mobilization, skill-building, and system advocacy; and working in an egalitarian, collaborative, helping relationship, are essential for restoring survivors’ power and dignity (Goodman et al., 2016; Gutierrez, 1990; Kulkarni, 2019). The emphasis on survivor decision-making, choice, and the egalitarian relationship as part of empowerment practices is recognized as one of the core tenets of trauma-informed care and has been applied in work with IPV survivors (Cattaneo & Goodman, 2015; Chu et al., 2024; Goodman et al., 2016; Kulkarni, 2019; Oram et al., 2022).

There is also evidence indicating that personal empowerment may alleviate negative mental health outcomes experienced by IPV survivors. For example, among a national sample of women veterans who reported past-year psychological IPV, there was a negative association between empowerment and later PTSD symptoms among those who reported psychological IPV (Dardis et al., 2018). Empowerment was also found to moderate the association between IPV frequency and PTSD at low and moderate levels of violence in a sample of women recruited from a domestic violence shelter (Perez et al., 2012). Wright et al. (2010) identified empowerment as an important factor in explaining differences in psychological distress reported by a sample of African American and White women survivors of IPV. Specifically, although African American women reported experiencing more frequent and severe IPV than White women in the sample, they presented fewer PTSD and depression symptoms along with higher levels of empowerment; analyses suggested that empowerment was protective and served as a mediator in the association between race and psychological distress (Wright et al., 2010).

Current Study

Extant literature has demonstrated that IPV is detrimental to survivors’ mental health (Jiwatram-Negrón et al., 2024; Messing et al., 2023) and that empowerment is associated with fewer negative mental health outcomes among IPV survivors (Dardis et al., 2018; Perez et al., 2012; Wright et al., 2010). However, the association between various forms of IPV—particularly harassment and technology-facilitated IPV—and mental health outcomes remains less understood. This study investigates the direct effects of IPV victimization (severe IPV, harassment, psychological abuse, and technology-facilitated IPV) on mental health symptomatology, specifically depression and PTSD. Severe IPV is defined as including severe physical violence, sexual violence, and controlling behaviors (Hegarty et al., 1999; Hegarty & Valpied, 2013). Harassment is conceptualized as unwanted behaviors that cause discomfort and/or intimidation (Hegarty et al., 1999; Hegarty & Valpied, 2013). Psychological abuse is defined as psychological vulnerability and loss of control resulting from experiences of abuse (Smith et al., 1995). Technology-facilitated IPV refers to humiliation, monitoring, harassment, and violent threats carried out through technology (Brown et al., 2018; Jiwatram-Negrón et al., 2024).

This study also examines the indirect effects of IPV victimization on mental health symptomatology via empowerment. The research hypotheses are (a) IPV is negatively associated with empowerment, (b) empowerment is negatively associated with mental health symptomatology, and (c) empowerment partially mediates the associations between IPV and mental health symptomatology. This study adds to the literature by investigating the pathways through which IPV affects survivors’ mental health while considering various forms of IPV. IPV deprives survivors of their sense of control and independence by fostering fear and dependance (Smith et al., 1995). Therefore, developing a more nuanced understanding of the pathways governing the associations between IPV, empowerment, and mental health has the potential to impact intervention with IPV survivors.

Method

The current analysis draws on baseline data (N = 377) collected during a multiyear study that examined the effectiveness of myPlan (www.myplanapp.org), an online safety decision aid (Glass et al., 2017 , 2022). Participant recruitment occurred between April 2016 and August 2018 at 16 domestic violence service agencies, such as shelters and agencies providing supportive services and case management, in one U.S. Southwestern state. Researchers offered the myPlan intervention and study as a part of intake procedures, in common areas, and during client group meetings. To be eligible for the study, women must: (a) be 18 years or older, (b) be comfortable using a computer or tablet, (c) be English speaking/literate, (d) have reported intimate partner abuse in the past 6 months, and (e) have safe access to an email account. If an individual did not have a safe email account and wanted to participate, a research assistant helped the participant create a new account.

For women who expressed interest in the study, researchers provided access to an iPad or desktop computer to review study-related content. Research assistants were available to answer questions, assist participants with navigating the online platform, read the survey aloud upon request, and provide online safety planning information. Women who were not eligible or declined to participate in the study were able to access myPlan without participating in the research study. The survey took an average of 60 min to complete, and women received a $20 gift card for participating. The study was reviewed and approved by the Institutional Review Board at Arizona State University.

Measures

Empowerment. The Personal Progress Scale-Revised (PPS-R; Johnson et al., 2005) was used to assess levels of empowerment, conceptualized as the extent to which women are enabled to access skills and resources to cope with stress and trauma. The instrument has 28 items (e.g., “I have equal relationships with important others in my life”) with response options ranging from 1 (“almost never”) to 7 (“almost always”). Items that indicate lower levels of empowerment were reverse-coded. A mean score was calculated, with a higher score indicating higher levels of empowerment. The scale has previously demonstrated good psychometric properties (Johnson et al., 2005) and has good internal reliability with the current sample (α = .88).

Mental Health

Depression. The Center for Epidemiologic Studies Depression Scale Revised (CESD-R; Eaton et al., 2004) was used to assess depression. The scale has 20 items (e.g., “I felt depressed”) with response options ranging from 0 (“not at all or less than 1 day”) to 3 (“nearly every day for 2 weeks”). The items were summed up and ranged between 0 and 60, with a score of 16 or higher indicating clinical significance (Eaton et al., 2004). The scale showed good psychometric properties (Naughton & Wiklund, 1993) and internal reliability with the current sample (α = .94).

PTSD. The PTSD Checklist-Civilian Version (PCL-C; US Department of Veteran Affairs, 2012) was used for assessing PTSD symptoms among survivors. The instrument comprises 17 items (e.g., “Repeated, disturbing memories, thoughts, or images of a stressful experience from the past”) with response options ranging from 1 (“not at all”) to 5 (“extremely”). The items were summed to create a composite score, with a score of 30 or more indicating the presence of PTSD (US Department of Veteran Affairs, 2012). This instrument is considered a good screening instrument for PTSD (Conybeare et al., 2012) and showed good internal consistency with the current sample (α = .95).

IPV

Severe IPV. The Severe Combined Abuse subscale in the Composite Abuse Scale (CAS; Hegarty et al., 1999; Hegarty & Valpied, 2013) was used to assess severe physical and sexual violence as well as controlling behaviors. This subscale comprises eight items, including those addressing sexual violence (e.g., “Forced to have sex”), isolation (e.g., “Locked me in the bedroom”), dominance (e.g., “Refused to let me work outside the home”), economic abuse (e.g., “Took my wallet and left me stranded”), and physical violence (e.g., “used a knife or gun or other weapon”). Response options ranged from 0 (“never”) to 5 (“daily”), and items were summed up to create a composite score (range: 0 to 40). The Severe Combined Abuse subscale showed good internal consistency within this sample (α = .83).

IPV harassment. Harassment, defined as unwanted behaviors that cause discomfort and/or intimidation, was assessed using the Harassment subscale in the CAS (Hegarty et al., 1999; Hegarty & Valpied, 2013). This subscale includes four items (e.g., “Harassed me at work,” “Followed me,” “Hung around outside my house”) with response options ranging from 0 (“never”) to 5 (“daily”). The sum score of the four items, ranging from 0 to 20, was used in the current study. The instrument demonstrated good psychometric properties, and the Harassment subscale showed acceptable internal consistency in the study sample (α = .78).

Psychological abuse. The Women's Experiences with Battering Scale (WEB) was used to measure psychological vulnerability and loss of control resulting from experiences of abuse (Smith et al., 1995). The 10-item instrument measures experiences of shame, control, and unsafety (e.g., “I feel ashamed of the things he does to me,” “he makes me feel unsafe in my own home”). Response options ranged from 1 (“agree strongly”) to 6 (“disagree strongly”). Items were reverse-coded and summed to calculate a composite score, with higher scores indicating higher levels of psychological vulnerability. The scale demonstrated good internal reliability within the current sample (α = 0.91).

Technology-facilitated IPV. Technology-facilitated IPV is a form of abuse referring to the use of social media, emails, and/or technology to monitor, harass, cyberstalk, and humiliate an intimate partner (Brown et al., 2018). The research team developed a scale to assess technology-facilitated IPV experienced by survivors (Jiwatram-Negrón et al., 2024). The scale included 15 items with yes/no (1/0) response options addressing technology-facilitated humiliation (e.g., “Posted or said something to embarrass or humiliate you using social media like Instagram, Twitter, Facebook, etc.,” “Shared or threatened to share content that was supposed to be private”), technology-facilitated monitoring and harassment (e.g., “Flooded you with messages,” “Checked your internet browser history”), and technology-facilitated violent threats (e.g., “Threatened physical harm to you using technology,” “Threatened to kill you using technology”). One additional item measuring privacy invasion was included (“Looked through your cell phone without permission”) for a total of 16 items used in this analysis. The items were summed up; the possible range of scores was 0 to 16, with a higher score indicating more frequent encounters with technology-facilitated IPV. The scale demonstrated good internal consistency in the current sample (α = .89).

Sociodemographics

Participants reported their race/ethnicity, employment status (currently employed/unemployed), educational level (some college or more/high school diploma or less), marital status (ever/never married), age (in years), and number of children under age 18.

Analytic Approach

Structural equation modeling (SEM) using Mplus was conducted to examine the association between IPV, empowerment, and mental health symptomatology among women (Muthén & Muthén, 1998–2017). Four SEM models were estimated with each observed IPV variable (severe IPV, harassment, psychological abuse, technology-facilitated IPV) as the independent variable, two observed variables of mental health symptomatology (depression, PTSD) as the dependent variable, and empowerment as the mediating variable, while controlling for the effects of race/ethnicity, age, number of children, educational level, employment status, and marital status on depression and PTSD. Criteria of model fit indices often used to examine the fit of the model are chi-square statistics ( $χ^{2}$ ), comparative fit index (CFI), Tucker–Lewis index (TLI), root mean square error of approximation (RMSEA), and standardized root mean square residual (SRMR). Specifically, a good model fit was indicated by a p-value of the χ² of .05 or larger, a CFI of .90 or higher, a TLI of .90 or higher, an RMSEA of .08 or lower, and an SRMR of .08 or lower (Kline, 2015; Peugh & Feldon, 2020). The SEM estimation method was maximum likelihood parameter estimates with standard errors for the analysis. Missing data, which ranged from 0.3% to 17% across variables, were handled using full information maximum likelihood estimation, preserving all available data to most accurately produce estimates from the study sample (Acock, 2005). Bootstrapping was used to infer mediation using a specified resampling method; in our analysis, we used 1,000 iterations (Barbeau et al., 2019; Shrout & Bolger, 2002). The indirect effect was considered statistically different from 0 at the 0.05 level if the bootstrap confidence interval did not include 0 (Barbeau et al., 2019). To estimate the magnitude of the indirect effect of IPV on mental health outcomes via empowerment, the proportion of the total effect explained by empowerment was calculated by dividing the indirect effect by the total effect (Hafeman, 2009).

Results

Sample Characteristics

Table 1 presents the characteristics of the sample. This sample consists of adult women aged 18 to 66 with a mean age of 37.7 (SD = 11.0). Participants identified as White (39%), followed by Black (23%), multiracial (14%), Hispanic (12%), American Indian (7%), Asian (2%), and other (3%). The sample was predominantly unemployed (72%), never married (57%), and slightly over half had attended college (56%). About two in five women (42%) did not have any children under the age of 18, and the remaining reported having 1 to 11 children (M = 1.5, SD = 1.8). The CESD-R composite score ranged from 0 to 60 (M = 38.2, SD = 16), with 76% of the participating women scoring more than 16, suggesting clinical significance for depression. The PCL-C composite score ranged from 17 to 85 (M = 57.5, SD = 17.7), with 80% of the participants scoring more than 30, suggesting the presence of PTSD. The average score of PPS-R, measuring empowerment, ranged from 1.9 to 4.9, with a mean of 3.4 (SD = 0.6).

Table 1.

Sample Characteristics (N = 377).

Categorical variable	n	%
Race/ethnicity
White	148	39
Black	87	23
Hispanic	47	12
American Indian	25	7
Asian	6	2
Multiracial	51	14
Other	13	3
Employment status
Currently employed	101	28
Unemployed	259	72
Educational level
Some college or more	204	56
High school diploma/GED or less	160	44
Marital status
Ever married	161	43
Never married	215	57
Abusive relationship duration
Less than 2 years	114	31
2–6 years	101	28
Over 6 years	148	41
Continuous variable	M (SD)	Range
Age	37.66 (10.96)	18–66
Number of children	1.49 (1.81)	0–11
Empowerment (PPS-R)	3.41 (0.57)	1.86–4.93
Depression (CESD-R)	38.23 (16.00)	0–60
PTSD (PCL-C)	57.47 (17.70)	17–85
Severe IPV (CAS-Severe Abuse)	10.77 (8.87)	0–40
IPV harassment (CAS-Harassment)	8.76 (5.57)	0–20
Psychological abuse (WEB)	51.78 (10.37)	10–60
Technology-facilitated IPV	9.04 (4.61)	0–16

Note. IPV = intimate partner violence; PTSD = posttraumatic stress disorder; PPS-R = Personal Progress Scale-Revised; CESD-R = Center for Epidemiologic Studies Depression Scale-Revised; PCL-C = PTSD Checklist-Civilian Version; CAS = Composite Abuse Scale; WEB = Women's Experiences with Battering Scale.

Due to missing responses, sample sizes for employment status, educational level, marital status, and abusive relationship duration did not sum to 377. Missing data were 4.5% (n = 17) for employment status, 3.4% (n = 13) for educational level, 0.3% (n = 1) for marital status, and 3.7% (n = 14) for abusive relationship duration.

Over two-thirds of the women in this sample reported being in an abusive relationship for 2 years or more, with 28% reporting being in an abusive relationship for 2–6 years and 41% experiencing abuse for more than 6 years. Women scored quite high on psychological IPV. With a range of 10–60, this sample's mean WEB score was 51.8 (SD = 10.4). For other forms of IPV, the CAS-Severe Abuse ranged from 0 to 40, and the mean value was 10.8 (SD = 8.9). The CAS-Harassment ranged from 0 to 20, and the mean score was 8.8 (SD = 5.6). On average, women reported experiencing nine out of 16 items assessing technology-facilitated IPV (M = 9.0, SD = 4.6).

Table 2 presents the correlations between the variables of IPV, empowerment, and mental health symptomatology at the bivariate level. Empowerment was negatively associated with IPV forms (severe IPV: r = −.22, p < .001; harassment: r = −.16, p = .006; psychological abuse: r = −.18, p = .002; technology-facilitated IPV: r = −.15, p = .011) and mental health symptomatology (depression: r = −.32, p < .001; PTSD: r = −.31, p < .001). We also found significant correlations between each form of IPV victimization and mental health symptomatology (see Table 2).

Table 2.

Correlation Matrix (N = 377).

	Empowerment	Depression	PTSD	Severe IPV	IPV harassment	Psychological abuse	Technology- facilitated IPV
Empowerment (PPS-R)	1.000
Depression (CESD-R)	−0.315 p < .001	1.000
PTSD (PCL-C)	−0.305 p < .001	0.739 p < .001	1.000
Severe IPV (CAS-Severe Abuse)	−0.215 p < .001	0.369 p < .001	0.440 p < .001	1.000
IPV harassment (CAS-Harassment)	−0.159 p = .006	0.338 p < .001	0.397 p < .001	0.689 p < .001	1.000
Psychological abuse (WEB)	−0.182 p = .002	0.358 p < .001	0.446 p < .001	0.409 p < .001	0.434 p < .001	1.000
Technology-facilitated IPV	−0.152 p = .011	0.397 p < .001	0.475 p < .001	0.586 p < .001	0.614 p < .001	0.503 p < .001	1.000

The Pathways Between IPV, Empowerment, and Mental Health

Table 3 presents the fit statistics of the SEM model examining the associations between IPV victimization, empowerment, and mental health symptomatology. The SEM models demonstrated a satisfactory fit to the data for each IPV victimization model: severe IPV (CFI = .98, TFI = .90, RMSEA = .06, SRMR = .03), harassment (CFI = .97, TFI = .88, RMSEA = .07, SRMR = .03), psychological abuse (CFI = .98, TFI = .91, RMSEA = .06, SRMR = .03), and technology-facilitated IPV (CFI = .97, TFI = .88, RMSEA = .07, SRMR = .03).

Table 3.

Model Fit Statistics (N = 377).

Model	Chi-square	CFI	TLI	RMSEA	SRMR
Severe IPV	$χ^{2}$ (6) = 14.38, p = .026	.976	.903	.061	.030
IPV harassment	$χ^{2}$ (6) = 16.24, p = .013	.970	.878	.067	.031
Psychological abuse	$χ^{2}$ (6) = 14.15, p = .028	.977	.907	.060	.029
Technology-facilitated IPV	$χ^{2}$ (6) = 16.42, p = .012	.971	.883	.068	.033

Note. IPV = intimate partner violence; CFI = comparative fit index; TLI = Tucker–Lewis index; RMSEA = root mean square error of approximation; SRMR = standardized root mean squared residual.

Direct effects. Table 4 and Figures 1–4 present the results of the SEM models. As shown in Figures 1–4, all forms of IPV victimization were significantly associated with higher depression and PTSD scores. For example, a unit increase in severe IPV was associated with a 0.31 unit increase in the depression score and a 0.38 unit increase in the PTSD score (see Figure 1). Additionally, in all models, empowerment was associated with lower depression and PTSD scores (see Figures 1–4). For example, for the severe IPV model, a unit increase in the empowerment score was associated with a 0.25 unit decrease in the depression score and a 0.21 unit decrease in the PTSD score (see Figure 1).

Table 4.

Results of Path Analysis (N = 377).

	Depression				PTSD
Model	β	LCI	UCI	%	β	LCI	UCI	%
Severe IPV
Direct effects	0.306	0.198	0.404	84.76	0.379	0.289	0.463	89.39
Indirect effects	0.055	0.025	0.099	15.24	0.045	0.018	0.090	10.61
IPV harassment
Direct effects	0.280	0.188	0.366	86.69	0.352	0.257	0.435	90.49
Indirect effects	0.043	0.013	0.079	13.31	0.037	0.011	0.073	9.51
Psychological abuse
Direct effects	0.293	0.196	0.391	84.93	0.402	0.299	0.502	90.34
Indirect effects	0.052	0.018	0.100	15.07	0.043	0.014	0.084	9.66
Technology-facilitated IPV
Direct effects	0.365	0.270	0.464	89.90	0.427	0.328	0.523	92.42
Indirect effects	0.041	0.013	0.082	10.10	0.035	0.010	0.073	7.58

Note. IPV = intimate partner violence; PTSD = posttraumatic stress disorder.

Results of standardized effect were reported. Bootstrap 95% confidence intervals were reported. Covariates were controlled in all models, including race/ethnicity, age, number of children, educational level, employment status, and marital status.

Indirect effects. As shown in Table 4, significant indirect effects of IPV victimization on depression via empowerment were found for all forms of IPV: severe IPV (β = 0.06; 95% CI [0.03, 0.10]), harassment (β = 0.04; [0.01, 0.08]), psychological abuse (β = 0.05; [0.02, 0.10]), and technology-facilitated IPV (β = 0.04; [0.01, 0.09]). We also found significant indirect effects of IPV victimization on PTSD via empowerment: severe IPV (β = 0.05; [0.02, 0.09]), harassment (β = 0.04; [0.01, 0.07]), psychological abuse (β = 0.04; [0.01, 0.08]), and technology-facilitated IPV (β = 0.04; [0.01, 0.07]).

Table 4 also presents the proportions of the total effect attributable to empowerment. When predicting depression, the proportions of the total effect explained by the indirect effect ranged from 10% (technology-facilitated IPV) to 15% (severe IPV, psychological abuse), with harassment in the middle of the range (13%). When predicting PTSD, the proportions of indirect effect ranged from 8% (technology-facilitated IPV) to 11% (severe IPV), with both harassment and psychological abuse at the higher end of the range (10%).

Discussion

Built on the existing knowledge of the negative impact of IPV on survivors’ mental health, this study sought to extend the current knowledge base by investigating the extent to which IPV is associated with mental health symptomatology via empowerment while considering multiple forms of IPV. Results confirmed all study hypotheses, and some key findings emerged. First, consistent with prior research (Jiwatram-Negrón et al., 2024; Messing et al., 2023; Sullivan et al., 2018; White et al., 2024), we found high levels of depression and PTSD symptomatology among service-engaged IPV survivors and positive associations between IPV and mental health symptoms. More than three-fourths of women participating in the study met the criteria for depression, and four-fifths reported the presence of PTSD. All forms of IPV examined were positively associated with mental health symptoms while controlling for demographic variables. This finding affirms the importance of addressing mental health among IPV survivors and addressing IPV in behavioral and public health systems (Oram et al., 2022). Given the link between IPV and adverse mental health, mental health service providers should be equipped with knowledge of the signs of IPV and the dynamics of IPV and should have the skills to assess for IPV and to respond to IPV disclosures (Oram et al., 2022; Paphitis et al., 2022).

Empowerment plays a critical role in the development and amelioration of mental health symptoms among IPV survivors. As expected, IPV, regardless of its form, was associated with lower levels of empowerment, and a decrease in empowerment was associated with increased reporting of depression and PTSD symptoms. Furthermore, empowerment was found to mediate the association between IPV and mental health: IPV was associated with more depression and PTSD symptoms via a decrease in empowerment. These findings have two implications. First, the findings provide some evidence regarding the mechanism by which IPV affects survivors’ mental health. Echoing the power and control framework, our findings suggest that IPV affects survivors’ mental health by minimizing their agency, sense of control, and autonomy (Pence & Paymar, 1993; Smith et al., 1995; Stark, 2007). This finding supports theoretical conceptions, providing evidence about both the nature of IPV and the importance of assessing its psychological impacts on survivors. While IPV is often measured and quantified based on violent acts, it is equally important to understand the meaning survivors attach to their experiences of violence and abuse, as well as to assess the psychological vulnerability resulting from these experiences (Smith et al., 1995; Stark, 2007).

Second, our study underscores the importance of promoting empowerment by creating and affirming opportunities that facilitate choice and autonomy for IPV survivors. Given the finding that empowerment mediated the association between IPV and mental health symptoms, IPV services and programs should carefully examine the extent to which they empower survivors in the practice process. This may entail acknowledging survivors’ strengths and resilience; helping survivors gain knowledge of power dynamics in IPV; fostering self-efficacy, connections, and social support; and securing resources and skills that would allow survivors to achieve their personal goals (Cattaneo & Chapman, 2010). It is equally important that service providers across systems do not engage in victim-blaming when responding to an IPV disclosure and that they acknowledge survivors’ strengths and resilience, tailor services and treatment plans, and honor survivors’ needs and wants by sharing decision-making (Kulkarni, 2019; Oram et al., 2022). An empowerment-focused practice aligns with an evidence-based and survivor-defined practice approach by allowing intervention to be guided by survivors’ knowledge, expertise, and preferences—rather than fitting survivors into existing services (Davies & Lyon, 2014; Kulkarni, 2019; Messing, 2019). Empowerment-focused practice should also be trauma-informed by avoiding retraumatizing survivors at the provider level (e.g., being respectful and empathetic instead of judgmental and silencing), the team level (e.g., avoiding having survivors retell their stories), and the policy level (e.g., minimizing the use of coercive treatment, removing systematic barriers that prevent survivors from meeting their needs; Oram et al., 2022).

The finding that empowerment partially mediates the association between IPV and mental health, with different proportions of indirect effects by the forms of IPV and mental health symptomatology, is novel. As shown in Table 4, when predicting depression, the proportion of total effect explained by indirect effect was the highest for severe IPV (15.2%), followed by psychological abuse (15.1%), harassment (13.3%), and technology-facilitated IPV (10.1%). When predicting PTSD, the proportion of indirect effect was also highest for severe IPV (10.1%) and lowest for technology-facilitated IPV (7.6%), but similar for psychological abuse (9.7%) and harassment (9.5%). These findings suggest that the mechanism through which IPV is associated with survivors’ mental health varies by the form of IPV and the type of mental health symptomatology. In general, it appears that this pathway can better explain the association between IPV and mental health for severe IPV (a combination of more severe physical, sexual, and emotional abuse; see Hegarty & Valpied, 2013) and psychological abuse (operationalized as psychological vulnerability resulting from IPV; see Smith et al., 1995). These findings extend the limited literature examining the differing impacts of types of IPV on survivors’ mental health (Cheng et al., 2022; Jiwatram-Negrón et al., 2024). Different forms of IPV may have varying effects on survivors’ psychological processes, with some creating a greater sense of control and entrapment, thereby more substantially eroding individuals’ sense of agency and self-efficacy. Future research should continue to explore the differing impacts of various forms of IPV. For example, it is unclear why the (dis)empowerment pathway accounted for less of the impact of technology-facilitated abuse on survivors’ mental health, despite previous research indicating that technology-facilitated abuse can be particularly harmful to emotional well-being due to the added component of public humiliation (Jiwatram-Negrón et al., 2024; Woodlock, 2016).

Furthermore, the finding that empowerment partially mediates the association between IPV and mental health suggests that attuning to empowerment, while critically important, is not sufficient in attenuating the impact of IPV on mental health among survivors. Given that empowerment is often conceptualized as an internal function, it would be remiss to conclude that survivors simply need to feel more empowered and that practice approaches should solely focus on enhancing feelings of empowerment. This perception would overlook empowerment as a process in which individuals develop strengths and skills based on tangible resources and supports that are accessible and available to them. Future research should continue to explore other potential mechanisms through which IPV is associated with mental health. For example, race and ethnicity (which links to racism and discrimination experienced by a survivor) and income level (which links to resources and support available to a survivor) might moderate the association between IPV, empowerment, and mental health (Wright et al., 2010). Similarly, the deprivation of connections and support might be another mediator for the association between IPV and mental health (Goodman & Smyth, 2011), while increasing social support and connections may facilitate mental health (Wachter et al., 2021 , 2022).

Future research should continue to explore the role of empowerment in the relationship between IPV and mental health, with a focus on additional forms of IPV. Although a few questions about sexual violence were included in the measures of severe IPV (e.g., “Made me have sex when I didn’t want to,” “Tried to make me have sex when I didn’t want to”) and technology-facilitated IPV (e.g., “Asked you via cellphone, email, IM, text, chat, etc., to have sex or engage in sexual acts when you didn’t want to”), we did not assess sexual violence with a separate measure. Similarly, because severe IPV includes one item related to economic abuse (e.g., “Refused to let me work outside the home and/or go to class”), we did not include a separate scale for economic abuse. Given that economic abuse directly affects economic choice, opportunity, and mobility, it is crucial to further investigate how economic abuse influences empowerment and, in turn, contributes to adverse mental health outcomes. Likewise, it is important to explore how sexual violence and the deprivation of one's autonomy—such as reproductive coercion—impact empowerment and mental health.

Given that the needs of survivors likely vary based on their cultural background, research should also further explore how the concept and practice of empowerment may differ when working with survivors from different social and demographic backgrounds. For example, in South and East Asian communities, in-law abuse, referring to abuse and violence perpetrated by a member of the abusive intimate partner's family, is relatively prevalent (Cheng et al., 2025; Lee & Bell-Scott, 2009; Rai & Choi, 2022). Empowerment in these communities, thus, may entail recognizing control and abuse from family and community, as well as building social support outside of existing family and community connections. Moreover, in some cases, survivors’ perceptions are not aligned with scientific evidence. For example, some research suggests that validated risk assessments of severe IPV perform better than survivors’ self-perceptions in predicting future IPV (Cheng et al., 2024; Messing, 2019). Future research should examine what practical steps practitioners can take to communicate and work around discrepancies in their perceptions and survivors’ perceptions of abuse, risk, mental health, and empowerment.

Limitations

There are several limitations to consider. First, the data are cross-sectional; thus, we could not establish the time order of IPV, empowerment, and mental health, and no causal explanations can be drawn. To avoid overinterpretation, we used the word association over cause and consequence. Readers should keep this limitation in mind when interpreting the study findings. Second, the sample consists of women recruited from domestic violence services, including shelters and agencies providing supportive services and case management, the majority of whom reported experiencing multiple forms of IPV for 2 years or more. Therefore, the findings may not be generalizable to IPV survivors who do not seek formal support or those with different relationship characteristics. Third, this study did not assess bidirectional IPV, and therefore cannot provide information on the extent to which violent resistance (e.g., IPV survivors physically fighting back) or other forms of bidirectional IPV (e.g., situational couple violence) may interact with empowerment to affect survivor mental health (Johnson, 2008). Fourth, this study is limited to testing the association between IPV and mental health via empowerment while controlling for the effects of sociodemographics on mental health symptoms. We did not test whether sociodemographics moderate the association between IPV, empowerment, and mental health. Survivors in racially/ethnically minoritized groups are more likely to experience discrimination, inequities, and systemic injustices in their day-to-day lives (Cheng et al., 2025), which may interact with feelings of disempowerment and affect mental health, warranting further investigation. Finally, data were collected through self-report surveys, and although the format offered privacy, it is possible that survivors’ responses were influenced by social desirability.

Conclusions

This study contributes to the literature by shedding light on the mechanisms through which IPV is associated with survivors’ mental health while considering different forms of IPV (severe IPV, psychological abuse, harassment, and technology-facilitated IPV) and mental health symptomatologies (depression and PTSD). The analyses demonstrate that IPV, regardless of its form, is associated with lower levels of empowerment, and IPV is associated with poor mental health via a decrease in empowerment. Consistent with the power and control framework, our findings suggest that IPV affects survivors’ mental health by diminishing their sense of control and autonomy (Pence & Paymar, 1993; Smith et al., 1995; Stark, 2007). The findings underscore the importance of empowering survivors in the practice process. Aligned with the survivor-defined approach and the trauma-informed framework, advocacy practice with IPV survivors should acknowledge survivors’ strengths, tailoring services to honoring survivors’ needs and wants, and minimizing retraumatization (Davies & Lyon, 2014; Kulkarni, 2019; Oram et al., 2022).

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This material is based on work supported by the Corporation for National & Community Service under Grant No. 18AFHAZ0010009.

ORCID iDs

Shih-Ying Cheng

Hsiu-Fen Lin

Tina Jiwatram-Negrón

Jill Theresa Messing

Author Biographies

Shih-Ying Cheng, MSW, PhD, is an assistant professor at the Jane Addams College of Social Work, University of Illinois Chicago. Her research focuses on gender-based violence, particularly severe violence, and its impact on vulnerable populations. She examines the effects of violence on survivors, their healing processes, and the implementation of evidence-based assessments and interventions. Additionally, her work explores gender-based violence among Asian immigrants to the United States, including their help-seeking behaviors and the cultural adaptation of evidence-supported interventions and assessments for this population.

Hsiu-Fen Lin, MSW, PhD, is an assistant professor at the University of Central Florida in the School of Social Work and a member of the Violence Against Women faculty cluster. Her research areas include identifying financial risk factors of intimate partner homicide, evaluating economic empowerment for survivors of IPV, creating culturally competent prevention measures, and improving screening and assessment for immigrant and non-English speaking populations.

Tina Jiwatram-Negron, MSW, PhD, is an assistant professor in the School of Social Work at Arizona State University. Her research is focused on examining and addressing IPV/GBV and associated health and mental health disparities among socially and economically marginalized populations of women domestically and internationally.

Jill Theresa Messing, MSW, PhD, is a professor in the School of Social Work and the director of the Office of Gender-Based Violence at Arizona State University. Dr Messing specializes in the development and testing of IPV risk assessments and is particularly interested in the use of risk assessment in collaborative, innovative interventions and as a strategy for reducing intimate partner homicide.

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