RESILIENCE AND MENTAL HEALTH OF SURVIVORS OF DOMESTIC VIOLENCE IN KAZAKHSTAN: A MIXED-METHODS INQUIRY USING THE POSITIVE DEVIANCE APPROACH

Abstract

Introduction: Domestic violence (DV) against women is a significant public health issue, with consequences that can lead to severe mental health problems, including depression and anxiety. This mixed-methods study aims to explore the association between resilience factors and mental health among Kazakhstani women-survivors of DV. Using the Positive Deviance (PD) approach, it identifies factors that help women overcome emotional, physical, and sexual abuse, and maintain psychological well-being. The study also examines how socio-demographic, resilience-related factors, and mental health conditions linked to abuse within the past 12 months, aim to identify vulnerable groups for targeted interventions. Methods: The study utilized a concurrent mixed-methods approach, employing online surveys and semi-structured in-depth interviews as data collection tools. A cross-sectional study was conducted among 193 women who experienced DV at least once in their life, representing all five main regions of Kazakhstan and three cities of national significance. Bivariate associations between the outcome variables (depression, anxiety and composite abuse scores) and independent variables were examined based on their types using appropriate statistical tests, such as the Chi-square test, Kruskal-Wallis test, Wilcoxon-Mann-Whitney test, and Spearman's rank correlation coefficient. Multivariate linear regression analyses were used for depression and anxiety as outcomes, whilemultivariate logistic regression was applied to the categorized composite abuse score. The qualitative component of the study utilized semi-structured interviews to assess a sample of 7 positive deviants, who were characterized by successful management of stigma, development of unique stress-management strategies, proactive help-seeking behaviors, and successful reintegration into society through the creation of strong relationships. Results: More than a half respondents (56.99%) did not demonstrate major signs of depression disorder, while more than two-thirds of (64.77%) of women did not show anxiety symptoms. Unemployed respondents, not seeking work due to the presence of another source of income (housewives, retired, or on leave), had significantly higher depression scores compared to employed individuals (p-value = 0.023). Women who were self-employed or unemployed but actively seeking work had significantly higher anxiety scores compared to those who were employed (p-value = 0.027).The interaction between life satisfaction and social integration (p-value = 0.006) revealed that women-survivors with higher life satisfaction were more likely to report lower depression scores, especially when they gave extreme responses to social integration. Respondents, who identified themselves as Russian, had 81% lower odds of experiencing the composite abuse in the past 12 months compared to those, who identified themselves as Kazakh (p-value=0.01). Overall life satisfaction was significantly associated with lower odds of experiencing composite abuse (OR=0.502, p-value = 0.047). Women who strongly disagreed or agreed with social integration statements had higher odds of DV (OR=2.682, p-value=0.01). Those relying on informal help sources had 185% higher odds of higher composite abuse scores (OR=2.845, p-value=0.003). Conclusion: This mixed-methods study examined the impact of resilience factors on the psychological well-being of women survivors of domestic violence in Kazakhstan. Expanding access to formal services, such as shelters and mental health support, particularly in rural areas, along with raising public awareness about DV may decrease the help-seeking barriers and help improve their mental well-being. Additionally, promoting female police presence and fostering a culture of “believe women” may provide women-survivors with a feeling of being supported and confident in seeking help without fear of blame.