Depression and anxiety symptoms among Nepali women: a dose–response analysis of emotional abuse and coercive control

PURPOSE: This study investigates how different forms and intensities of intimate partner violence (IPV)-particularly emotional abuse and coercive control control-are associated with symptoms of depression and anxiety among women in Nepal. METHODS: We analyzed the 2022 Nepal Demographic and Health Survey, focusing on 4377 ever-partnered women aged 15-49 years. IPV was categorised into four domains: physical, sexual, emotional, and coercive control. Depression and anxiety were assessed using Nepali versions of the PHQ-9 and GAD-7. Multivariable logistic regression and marginal effects models were applied to estimate associations and explore dose-response patterns. RESULTS: Emotional IPV (aOR = 3.8) and coercive control (aOR = 1.8) were independently associated with moderate-to-severe depressive symptoms. Similar associations were observed for anxiety (emotional IPV aOR = 2.9; coercive control aOR = 1.6). Male partner alcohol use independently increased the risk of both IPV and common mental disorders (CMDs). Predicted probabilities of CMD symptoms were 5.45% with neither IPV nor alcohol use, 7.82% with alcohol use only, 11.64% with IPV only, and 17.95% with both exposures. Marginal effects analysis showed a clear dose-response pattern: each additional act of emotional, physical, or sexual IPV significantly increased CMD risk. CONCLUSION: Psychological IPV-including emotional abuse and coercive control-has a strong, cumulative effect on women's mental health and remains underrecognized in clinical protocol and public health policies. Male partner alcohol use further amplifies this risk. Integrated IPV-mental health-alcohol interventions, grounded in syndemic and trauma-informed frameworks, are urgently needed in Nepal's primary health care systems.