Emotional Abuse Leaves the Deepest Mental Health Mark on Women in Mozambique

In the crowded neighborhoods of Maputo and the rural villages of northern Mozambique, millions of women live with violence that rarely leaves visible scars. A new analysis of nationally representative survey data now offers one of the clearest pictures yet of how that hidden burden translates into psychological suffering. Drawing on the 2022–2023 Mozambique Demographic and Health Survey, researchers examined the relationship between intimate partner violence and common mental disorders among 2,790 women of reproductive age who were married or living with a partner. The findings, published in PLOS Mental Health, suggest that emotional abuse may be the single most damaging form of partner violence when it comes to women’s mental health, and that the psychological toll of violence lingers long after the abuse itself has stopped.

The study, led by Bernard Afriyie Owusu and Benedict Weobong, focused on common mental disorders, a category that encompasses depression and anxiety, the two conditions that dominate the mental health burden in low- and middle-income countries. Rather than treating these conditions separately, the researchers constructed a composite outcome: a woman was classified as having a common mental disorder if she met standardized thresholds for probable depression, probable anxiety, or both. This approach reflects the clinical reality that depressive and anxious symptoms frequently overlap and co-occur, particularly in populations exposed to chronic stressors such as poverty, food insecurity, and violence within the home.

The numbers reveal a substantial and previously underappreciated burden. Probable depression was detected in 8.6 percent of the women surveyed, with a 95 percent confidence interval of 7.1 to 10.5 percent, while probable anxiety affected 10.7 percent, with a confidence interval of 8.7 to 12.9 percent. Taken together, 13.5 percent of partnered women carried a probable common mental disorder, and 5.8 percent reported symptoms of both depression and anxiety simultaneously. Behind each of these percentages stands a woman navigating daily life while carrying a psychological weight that, in many cases, has never been recognized or treated by any health service.

Violence within intimate relationships proved disturbingly common in the same population. Emotional violence was the most prevalent form, experienced by 16.1 percent of women, followed by physical violence at 12.0 percent and sexual violence at 4.0 percent. Crucially, the researchers did not simply ask whether violence had ever occurred. They stratified exposure into three categories: never, in the past, or recently. This temporal distinction matters enormously for understanding how violence affects the mind, because it allows researchers to separate the acute psychological impact of ongoing abuse from the longer-term consequences of violence experienced years earlier.

When the researchers ran weighted binary logistic regression models in STATA 18/MP, adjusting for a range of potential confounders, the association between recent violence and mental illness emerged with striking clarity. Women who had experienced any form of intimate partner violence recently had roughly double the odds of a common mental disorder compared with women who had never experienced violence, with an adjusted odds ratio of 2.05 and a confidence interval of 1.36 to 3.09. Women whose exposure to violence was in the past also showed elevated odds, at 1.40, though this estimate crossed the line of statistical significance with a confidence interval of 0.80 to 2.44. The pattern suggests that recent abuse drives much of the mental health burden, while past violence may leave a residual, if harder to measure, imprint on psychological wellbeing.

The most consequential finding, however, concerned the type of violence rather than its timing. After adjustment, emotional intimate partner violence remained independently associated with common mental disorders, carrying an adjusted odds ratio of 2.34 with a confidence interval of 1.6 to 3.4. Physical violence, by contrast, showed a weaker and statistically nonsignificant association, with an odds ratio of 1.21 and a confidence interval spanning 0.73 to 2.03, and sexual violence similarly failed to reach significance at an odds ratio of 1.67 with a confidence interval of 0.83 to 3.35. This hierarchy challenges a common intuition that physical harm is the most psychologically destructive form of abuse. Words that demean, isolate, threaten, and control, it appears, may cut deeper than blows, perhaps because emotional abuse tends to be chronic, erodes a woman’s sense of self-worth over months and years, and often operates in the absence of any external evidence that would prompt intervention by family, neighbors, or authorities.

The analysis also surfaced findings about socioeconomic factors that complicate any simple narrative linking poverty alone to mental illness. Higher household wealth was strongly protective, with women in wealthier households showing an adjusted odds ratio of 0.34, and a confidence interval of 0.13 to 0.88, for common mental disorders compared with the poorest women. Economic resources, the data suggest, buffer against psychological distress, whether by reducing the everyday stressors that accumulate into anxiety and depression or by expanding access to coping strategies and social support. Yet one counterintuitive result stood out: women who reported joint household decision-making with their partners had higher odds of common mental disorders, at an adjusted odds ratio of 1.84 with a confidence interval of 1.08 to 3.15. The authors of the study do not overinterpret this association, but it serves as a reminder that survey cross-sections can conceal complex dynamics, and that measures intended to capture women’s empowerment may sometimes correlate with circumstances, such as employment outside the home or exposure to conflicting family expectations, that carry their own psychological costs.

Perhaps the most theoretically intriguing result involves the interaction between marital status and violence. The researchers found evidence that the effect of intimate partner violence on mental health varies depending on a woman’s marital situation, providing partial empirical support for intersectionality theory, the framework holding that social identities and disadvantages do not operate independently but combine and interact to shape individual outcomes. In practical terms, this means that the mental health consequences of abuse cannot be understood by looking at violence in isolation. A widow, a woman in a polygamous union, and a woman in a first monogamous marriage may experience and internalize the same form of abuse in profoundly different ways, shaped by the social position each occupies within Mozambican society.

For policymakers and public health practitioners, the implications are direct. Mozambique, like many countries in sub-Saharan Africa, faces a severe shortage of mental health professionals, and common mental disorders routinely go undiagnosed in primary care settings. The study’s authors argue that their findings underscore the need for regular mental health support for women and for targeted campaigns against intimate partner violence, with particular emphasis on emotional abuse, which is both the most prevalent form of violence in this population and the form most strongly linked to psychological illness. Screening women who present with depression or anxiety for violence at home, and conversely offering psychological support to women identified as victims of abuse, could create two entry points into a system of care that currently reaches only a small fraction of those in need.

The research also carries a broader message for the global conversation on violence against women. International attention and funding have historically concentrated on physical and sexual violence, the forms most visible to medical systems and easiest to document in forensic settings. This study from Mozambique adds to a growing body of evidence that emotional violence, precisely because it is pervasive, normalized, and invisible, may constitute the largest mental health threat within intimate relationships. As demographic and health surveys across the region continue to collect standardized data on both violence and mental health, researchers will be able to test whether the pattern observed in Mozambique holds elsewhere. For now, the message for the roughly one in seven partnered Mozambican women living with a probable common mental disorder is sobering but clear: the violence that harms them most may be the kind no one else can see.

Subject of Research: The association between intimate partner violence and common mental disorders among partnered women in Mozambique

Article Title: Intimate partner violence and common mental disorders among women in Mozambique: Evidence from the 2022-2023 Mozambique Demographic and Health Survey

Article References: Owusu, B. A., & Weobong, B. (2026). Intimate partner violence and common mental disorders among women in Mozambique: Evidence from the 2022-2023 Mozambique Demographic and Health Survey. PLOS Mental Health, 3(10), e0000660. https://doi.org/10.1371/journal.pmen.0000660

Image Credits: AI Generated

DOI: 10.1371/journal.pmen.0000660

Keywords: intimate partner violence, common mental disorders, depression, anxiety, Mozambique, Demographic and Health Survey, emotional abuse, women's mental health, public health, intersectionality, logistic regression, sub-Saharan Africa