UC Irvine

The gender-health paradox is a well-documented and persistent epidemiological phenomenon: women outlive men, but live “sicker lives” with higher rates of chronic illness and disability over the life course than their male counterparts. Across disciplines, theories attempting to explicate this disparity have overlooked women’s disproportionate exposure to interpersonal violence, a form of trauma with lasting impact on health. Furthermore, contemporary analytic techniques that account for heterogeneity in experiences (i.e., person-centered approaches) have only recently gained momentum despite their potential for more accurately assessing the impact of violence across the lifespan. This dissertation examines whether the link between violence against women and women's overrepresentation in some of the most disabling morbidities are factors that are inextricably linked. In Chapter 2, a systematic review was conducted to identify and summarize the empirical literature on experiences of interpersonal violence and diagnosed health conditions. Only studies using person-centered approaches (i.e., latent class analyses) were considered. Results showed that person-centered approaches can illuminate the most health-hazardous combinations of violence experiences, and that women were overrepresented in these high-risk groups; however, results also showed a paucity of research explicitly testing gender differences in violence configurations, and physical health conditions were rarely examined. Chapter 3 addressed the major gaps found in Chapter 2 by examining gender-driven patterns of interpersonal violence and the context in which they occur. A multi-group latent class analysis revealed gender differences in the types of violence experienced as adversities accumulated: women experienced intimate partner and sexual violence, while men experienced more child abuse and neglect. Results from logistic regressions also showed gradient-like associations with morbidity as exposures accumulated for women. Among men, adversity profiles appeared to confer about equal risk or less risk for morbidity, suggesting that other factors may be at play in men’s disease pathology. In Chapter 4, at-risk women with complex trauma histories were centered, using pregnancy as a conceptual framework for illuminating pathways from violence exposure to adverse health. Results showed the possible intersection of violence, trauma, mental health, and substance use were consequential to pregnancy complications, potentially compounding risk for disease long-term. Qualitative analyses revealed psychological processes signaling risk and resilience. Implications for understanding the gender-health paradox and future research on gender-based health disparities more broadly are discussed.