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

Afghanistan has endured over four decades of pervasive public violence, including war and suicide attacks, resulting in significant civilian casualties, displacement, and widespread psychosocial distress. Concurrently, family violence rates remain alarmingly high, encompassing verbal, physical, and sexual abuse, alongside economic and social control. Existing research suggests a strong link between public and domestic violence, with individuals exposed to war, particularly women and children, exhibiting increased vulnerability to family violence. This connection is attributed to factors like the loss of patriarchal support, the drug trade, poverty, instability, and disrupted judicial systems. The cumulative effect of public violence can lead to intergenerational trauma, impacting mental health across generations. While psychosocial interventions have shown promise in mitigating mental health issues in conflict-affected regions, access to these services in Afghanistan remains limited due to various factors including stigma and resource constraints. This study aims to investigate the correlation between public and family violence in Kabul, exploring the experiences of both clients of a psychosocial counseling service and community members, to better inform the development of effective mental health services within this context.

The literature extensively documents the high prevalence of both public and family violence in Afghanistan. Studies highlight the disproportionate impact on women and children, showcasing the devastating consequences of prolonged conflict. Several studies demonstrate a positive correlation between exposure to public violence and increased risk of family violence. Qualitative research has explored the lived experiences of women in conflict zones, revealing how public violence exacerbates domestic violence. The role of post-traumatic stress disorder (PTSD) in escalating aggression and lowering tolerance for frustration within families is highlighted. Additionally, the literature emphasizes the intergenerational transmission of trauma, where parental experiences of violence directly influence the likelihood of their children experiencing or perpetrating violence. The impact of disrupted judicial systems and economic hardship in fostering impunity and contributing to the perpetuation of violence is also discussed. Previous research suggests that mental health and psychosocial interventions are effective in addressing the psychological distress stemming from conflict and violence, but these interventions often face substantial barriers to implementation and access.

A cross-sectional mixed-methods survey was conducted in Kabul, Afghanistan in 2019 using a convenience sampling method due to resource limitations and security concerns. The sample comprised 299 participants: 99 clients from a face-to-face counseling center, 99 clients from an online counseling platform, and 101 non-client Kabul residents. Inclusion criteria included being a Kabul resident (at least one year for non-clients) and being aged 18 or older (excluding clients with active psychosis). A newly developed 10-item structured interview survey assessed experiences of public and family violence (using a 5-point Likert scale) and included open-ended questions. The Global Assessment of Functioning (GAF) scale measured psychological, social, and occupational functioning, while the Mini International Neuropsychiatric Interview (MINI) suicidality module assessed suicidal ideation and behavior. Sociodemographic data were also collected. Data analysis involved descriptive statistics, parametric and non-parametric statistical tests (Chi-square, Mann-Whitney U, Kruskal-Wallis, Spearman's Rho, independent t-test) to analyze potential group differences and correlations between variables. Thematic analysis was conducted on the open-ended responses to understand participants' lived experiences and coping mechanisms.

The study found a significant positive correlation between experiences of public violence and family violence (r = 0.22, p < 0.001). Clients reported significantly higher levels of negative impact of the security situation on family life, more public violence victimization, and more domestic violence victimization than non-clients. Non-clients, however, reported higher levels of family violence perpetration and witnessing overall. Both clients and non-clients reported high levels of violence and displayed significant impairment in global functioning (average GAF score of 69.17, SD = 16.87) and high rates of suicidality. Qualitative analysis revealed prominent themes of worry, anger, fear, hopelessness, negative thoughts, and social withdrawal in response to the security situation. Negative impacts on family life included increased conflicts, aggression, domestic violence, child abuse, unemployment, and economic stress. The most common coping mechanism for family violence was leaving the home, a strategy that could paradoxically expose individuals to further public violence. Significant correlations were found between suicidality and both public and family violence. Sociodemographic factors, such as marital status, education level, and income, were found to be associated with experiences of family violence, but not public violence.

The findings strongly support the interconnectedness of public and domestic violence in Afghanistan. The chronic exposure to public violence creates an environment of insecurity and loss of control, potentially leading to compensatory aggression within families. Trauma responses and the disruption of social structures likely contribute to this cycle. The higher rates of violence and distress among clients highlight the need for accessible and culturally sensitive psychosocial interventions. The high rates of suicidality among both clients and non-clients underscore the urgent need for mental health support. The qualitative data highlights the prevalence of maladaptive coping mechanisms, which further emphasize the importance of providing support and psychoeducation. The study’s limitations include the convenience sampling method and the use of a non-standardized questionnaire, calling for future research to address these issues.

This study confirms the strong positive correlation between public and family violence in Kabul, Afghanistan. The high levels of violence, distress, and suicidality in the population highlight the urgent need for accessible and culturally appropriate mental health and psychosocial support. A psychodynamic approach, focusing on empowering clients to break cycles of violence and become agents of change, is crucial for effective intervention. Future research should focus on a randomized controlled trial with a standardized questionnaire to further investigate this relationship, including exploration of mediating factors.

The study's limitations include the use of a convenience sample, which may limit the generalizability of findings. The 10-item questionnaire, while informed by 15 years of experience, was not a standardized instrument. The correlational design does not allow for the establishment of causal relationships. These limitations should be considered when interpreting the results.