Connections between family violence and violence in the public sphere in Afghanistan

The study addresses whether and how prolonged exposure to violence in the public sphere in Afghanistan is associated with family (domestic) violence. Afghanistan has faced decades of war, suicide attacks, and instability, with high civilian casualties and widespread displacement. Concurrently, rates of family violence are high, affecting women and children in particular, and contributing to significant mental health burdens (PTSD, depression, anxiety, suicidality). Prior work suggests cumulative and intertwined effects between public and domestic violence, with trauma symptoms (e.g., affect dysregulation, hyperarousal) contributing to aggression within families, disrupted judicial systems fostering impunity, and intergenerational transmission of trauma. The purpose of this study is to examine the co-occurrence of public and family violence among Kabul residents (both counseling clients and non-clients), assess impacts on functioning and suicidality, and inform psychodynamic, culturally attuned psychosocial services (e.g., Value-Based Counseling) suitable for conflict settings.

Cited literature documents high levels of domestic and gender-based violence in Afghanistan, with significant proportions of women experiencing intimate partner violence and children exposed to physical violence at home. Studies from Afghanistan and other conflict regions (Palestine, Rwanda, Uganda) show positive associations between exposure to political conflict/war and increased family violence, often mediated by PTSD and related symptoms among caregivers. Intergenerational trauma is noted, where parental trauma and adverse childhood experiences predict children’s trauma symptoms and later violence. Mental health and psychosocial interventions in conflict-affected LMICs show efficacy in reducing psychological distress and improving functioning; however, access barriers (stigma, resources) persist. Community- and technology-based interventions (e.g., e-Health, group counseling) in Afghanistan demonstrate promise in improving awareness, reducing stigma, and supporting survivors. These findings justify examining the linkage between public-sphere violence and family violence and tailoring scalable, culturally congruent psychosocial care.

Design: Cross-sectional mixed-methods survey conducted in Kabul in 2019 using convenience sampling. Settings/participants: N=299 Afghan adults. Three recruitment streams: 99 clients from face-to-face counseling services, 99 clients from an online counseling platform (surveyed before receiving counseling), and 101 non-client Kabul residents approached by community-trusted counselors in neighborhoods. Inclusion criteria: clients (excluding active psychosis) and non-clients aged ≥18 and resident in Kabul ≥1 year. Measures: A 10-item structured interview developed from 15 years of MHPSS work assessed two domains: (1) experiencing/witnessing violence in the public sphere; (2) family violence (victimization/perpetration). Six items used 5-point Likert scales for intensity/occurrence and impact on family relationships; four items were open-ended for qualitative insights. Additional instruments: Global Assessment of Functioning (GAF; 0–100) rated by counselors; MINI suicidality module for ideation/behaviors/self-harm; sociodemographics (gender, age, ethnicity, education, income). Accumulated violence score computed from items Q5 (public-sphere violence) and Q7–Q9 (family violence). Analysis: Descriptive statistics (frequencies, means, SDs). Group comparisons (clients vs non-clients) via Mann–Whitney U; sociodemographic associations via Chi-square, Kruskal–Wallis, and Mann–Whitney U; age via independent t-test. Associations examined using Spearman’s rho. Significance thresholds p<0.05, 0.01, 0.001 (two-tailed). Qualitative content analysis of open-ended responses identified thematic categories and frequencies.

• Sample and sociodemographics: Clients were older than non-clients (M=31.60, SD=12.08 vs M=25.43, SD=8.89), t(296)=4.510, p<0.001. No significant group differences in gender, ethnicity, or education; significant differences in marital status (p=0.007), location (p=0.006), and income (p=0.024).
• Accumulated violence: Mean accumulated violence score (from Q5, Q7–Q9) = 5.36 (SD=3.64), range 0–16 (n=264).
• Violence-sociodemographic associations: No gender differences. Family violence differed by marital status (X²=68.13, p<0.001), education (X²=76.57, p<0.001), and income (X²=43.36, p=0.009). Accumulated violence differed by income (X²=72.89, p=0.004); no differences across ethnicity or location. Public-sphere violence did not significantly differ across these sociodemographics.
• Association between public and family violence: Significant positive correlation between family violence (Q7–Q9) and public-sphere violence (Q5) in the total sample (Spearman r≈0.22, p<0.001).
• Clients vs non-clients: Clients reported greater negative impact of security situation on family life (U=8068, z=−2.82, p=0.005) and more exposure to/witnessing public-sphere violence (Q5; U=8344.5, z=−2.22, p=0.026). Non-clients reported higher overall family violence (Q7–Q9; U=5825.0, z=−2.24, p=0.025). Clients reported more domestic violence victimization (Q7; U=7629, z=−3.54, p<0.001). No significant difference in perpetration (Q8; p=0.225).
• Functioning (GAF): Overall mean GAF=69.17 (SD=16.87). No significant difference between clients and non-clients (p=0.056). Accumulated violence not significantly associated with GAF in the total sample (r=−0.109, p=0.077); in community (non-client) group, higher violence correlated with lower GAF (r=−0.23, p<0.05).
• Suicidality (MINI): Mean MINI suicidality score=1.51 (SD=1.84). Suicidality positively correlated with total violence (n=266, r=0.25, p<0.001), family violence (n=267, r=0.23, p<0.001), and public-sphere violence (n=294, r=0.22, p<0.001); negatively correlated with GAF (n=299, r=−0.32, p<0.001). Security situation’s negative impact on family life associated with lifetime suicide attempt, recent suicide plan, self-harm, and suicidal thoughts (all p<0.05 or p<0.01). Being a victim of family violence associated with suicidal thoughts (p<0.05). No significant differences in suicidality items between clients and non-clients.
• Qualitative themes: Psychological reactions included worries (n=90), anger (n=74), fear (n=73), hopelessness (n=47), negative thoughts (n=35), negative feelings (n=31), social withdrawal (n=28). Reported negative impacts on family life: family conflicts (n=60), aggressive behavior (n=36), domestic violence (n=25), worries (n=25), social withdrawal (n=23), child abuse (n=15), unemployment (n=15), migration (n=12), economic stress (n=12). Reported incidents included family violence (n=20) and multiple public-sphere events (e.g., community physical violence, explosions, suicide attacks). Common coping responses: leaving the place/home (n=76), keeping silence (n=44), aggression (n=38), talking with others (n=34), crying (n=30); relatively few healthy strategies (e.g., respectful relationships, counseling, problem-solving).

Findings demonstrate a significant positive association between exposure to public-sphere violence and family violence, consistent with prior research in conflict settings. Chronic insecurity may drive attempts to reassert control within the family, fueling aggression; trauma-related affect dysregulation and hyperarousal may precipitate violent responses. Disrupted judicial systems may further enable family violence. Both clients and non-clients showed high exposure and considerable psychosocial burden, with suicidality related to violence exposure and reduced functioning. Clients perceived greater public-sphere violence and victimization and sought counseling, suggesting help-seeking as a constructive coping strategy; non-clients reported higher overall family violence, underscoring unmet needs. The results support the importance of accessible psychosocial interventions, including online modalities, in resource-limited and mobility-constrained contexts, to mitigate cycles of violence and distress and to provide culturally congruent, psychodynamic counseling approaches (e.g., Value-Based Counseling).

Among Kabul residents, experiences of violence in the public sphere are positively correlated with family violence, placing individuals at risk as perpetrators and/or victims. Psychosocial counseling using a psychodynamic, salutogenic approach should recognize and address these intertwined dynamics without pathologizing symptoms, focusing instead on empowerment to break cycles of violence and foster agency within families and communities. Addressing service gaps through scalable, culturally adapted online and face-to-face interventions (e.g., IPSO’s Value-Based Counseling) and brief trauma-focused supports can meet substantial unmet needs. The brevity, cultural fit, and potential digitization of interventions enable broader reach via guided self-help and trained peer counselors to enhance community engagement and resilience.

The cross-sectional, correlational design precludes causal inference and identification of mediators. The 10-item survey instrument was not standardized and may not capture the full breadth of violence perpetration/victimization. Convenience sampling limits generalizability; future studies should use randomized sampling and standardized measures.