the comprehensive study on domestic violence ( dv ) conducted by the world health organization ( who ) indicated that dv has probably always been part of the individual experience of women , and it results in physical , sexual , or mental injury or suffering ( 1 ) .
domestic violence is observed in many countries and it can be a public health problem ( 2 ) .
it consists of physical , sexual ( forcing undesired sexual behavior by one person upon another ) , economic ( having control over the other partner 's access to economic resources ) , and psychological ( actions aimed to dominate and manipulate the partner ) aspects caused by many factors ( 3 , 4 ) . violence against a woman results in her isolation .
victims can be of any ethnicity , age , level of education , or income level .
some of the factors that have been associated with domestic violence in iran include women s education , prior experience of dv , illicit sexual relations , and age difference .
there is a significant positive relationship between women s economic situation and psychological , physical , and social violence . in order to promote preventive strategies for the consequences of dv ,
it is essential to identify the potential risk factors for it ( 5 , 6 ) .
women are subjected to domestic violence significantly more often than men ; this is true for all societies , and it is a universal , trans - historical , and trans - cultural problem as old as human history ( 7 ) .
domestic violence is one of the causes of disability and death in women , and it is related to the status of women who live in a culture that considers males to be the dominant sex and that victimizes females .
women , who have children , suffer from a lower level dv ( 8) . who has defined dv as behavior within an intimate relationship that causes the physical , sexual , or psychological abuse of women ( 9 ) . women who are abused often have a range of physical health problems , including being rundown , aching all over , having headaches , increased hypertension , chronic fatigue , and gastrointestinal problems .
these health problems dramatically reduce their ability to cope with the violence they experience ( 10 ) .
these health problems result in chronic physical diseases , and reduced practice of healthy actions and healthy lifestyle choices ( 11 ) .
economic problems are the most common cause of dv and studies have shown a significant relationship between low socioeconomic levels and a higher risk of violence ( 12 ) . while there is a great deal of information about the social implications of dv , its impact must be taken into consideration and society must be informed about this critical issue ( 13 ) .
this study aimed to evaluate the types of dv against women who were referred to the legal medical organization of iran , located in urmia , iran , in 2012 .
a total of 300 women who were referred to the legal medical organization of iran because of dv , participated in this cross - sectional study .
the sample size was calculated based on the prevalence of dv in iran with an absolute precision of 0.05 and a confidence level ( ci ) of 95% .
the study was powered at 80% with a two - sided 5% to achieve a statistical significance on a moderate standardized effect size of 0.4 .
required data were collected through face - to - face interviews using a structured questionnaire .
the questionnaire contained 32 questions about all types of dv that the participants experienced , and their personal and family information was collected .
the research team initially developed the questionnaire after an extensive review of the relevant literature to achieve good content validity .
its reliability with internal consistency was confirmed ; the cronbach s alpha calculation was 0.85 and the test - retest reliability was 0.88 . all of the collected data were considered to be confidential and were handled only by the researchers .
the study was approved by the ethics committee and written informed consent was obtained from all of the participants .
basic descriptive statistics were presented using mean (  sd ) for quantitative variables and n ( % ) for qualitative variables . to determine the association between dv and demographic variables , student s independent
t - test and one - way analysis of variance ( anova ) were used .
the database was exported to spss for windows ( version 16 ; spss inc . , chicago , il , usa ) and analysis was performed .
the prevalence of different forms of dv for each phrase was computed with 95% ci . a probability level of p < 0.05 was determined as statistically significant .
in the present study , the mean age of the 300 female participants was 29.20 (  7.52 ) .
inclusion criteria consisted of the place of residence , either in the city of urmia , iran or in rural areas , and being married .
277 ( 92.3% ) lived in the city of urmia and 23 ( 7.7% ) lived in rural areas .
moreover , 24 women ( 8% ) had consanguineous marriages before their marriage and 33 ( 11% ) had a history of previous marriages . as indicated in table 1 , differences were found in the level of education of the men and women and the women s family .
furthermore , 47 women ( 15.7% ) and 167 men ( 55.7% ) had a steady job . different forms of violence were commitment against women 4.98 (  0.33 ) times per month ( based on their self - reported statements ) .
the mean age of marriage was 21.5 (  6.51 ) years ( max : 40 and minnutes : 12 years ) and the mean age gap between a wife and a husband was 6.1 (  0.31 ) years .
in addition , 31 couples ( 10.3% ) had married to resolve tribal and familial disputes .
of the men , 57 ( 19% ) had been previously married and 38 ( 12.7% ) had more than one wife . in 11 cases ( 3.7% ) , the women were older than the men .
furthermore , 230 couples ( 73.7% ) had children , and 38 women ( 12.7% ) were forced to marry ( based on their self - reported statements ) . in 218 cases ( 72.7% ) ,
both the men and the women desired to get married , in 59 cases ( 19.7% ) the men desired to get married , and in 20 cases ( 6.7% ) the women desired to get married .
moreover , 99 couples ( 33% ) owned a home and 150 couples ( 50% ) rented a home , and other couples lived with their family members . a history of violence during the engagement period was observed in 82 women ( 27.3% ) , and 78 women ( 26% ) had been violated by someone else in the husband s family . in 49.7% of the women and 71.3% of the men their parents emotional relationship was not satisfactory .
this was evaluated based on the question :  how was the emotional relationship between your spouse 's parents ?  methods of coping with violence in women were : crying ( 24% ) , fighting ( 7% ) , seeking refuge at her father s house ( 5% ) , and forgiveness ( 2% ) ; however , most of the women ( 62% ) did not take any action .
in addition , 251 women ( 83.7% ) were referred to the legal medical organization of iran for the first time , while others had been referred several times . as indicated in table 2 , the causes of dv varied . in 99 cases ( 33% ) , the couples had known each other before marriage . moreover ,
39 women ( 13% ) and 42 men ( 14% ) were substance abusers , and 153 men ( 51% ) were cigarette smokers .
as indicated in table 3 , most of the women had experienced physical , sexual , economic , and psychological violence .
a significant relationship was observed between type of lodging and physical ( p = 0.42 ) , economic ( p = 0.57 ) , and sexual violence ( p = 0.58 ) .
no significant relationship was found between consanguineous marriages and physical violence ( p = 0.38 ) . however , the relationship between consanguineous marriage ( p = 0.003 ) , economic violence ( p = 0.052 ) , and sexual violence was significant ( p = 0.003 ) .
the rate of physical violence was significantly higher in men without a steady occupation ( p < 0.001 ) .
nevertheless , no significant relationship was found between the men s occupation and economic ( p = 0.147 ) and sexual violence ( p = 0.48 ) .
no significant relationship was found between marriage with the purpose of resolving tribal and familial disputes and physical ( p = 0.93 ) , economic ( p = 0.96 ) , and sexual violence ( p = 0.312 ) .
our results showed that the rate of sexual violence was significantly higher in older men ( p = 0.042 ) .
no significant relationship was found between the men s age and economic ( p = 0.34 ) and physical violence ( p = 0.19 ) .
no significant relationship was found between running away from home with one s husband and physical ( p = 0.97 ) , economic ( p = 0.83 ) , and sexual violence ( p = 0.13 ) .
the rate of physical violence was higher in women without family support , but it was not statistically significant ( p = 0.25 ) .
furthermore , no significant relationship was found between family support and economic ( p = 0.67 ) and sexual violence ( 0.78 ) .
our study demonstrated that the rate of physical violence was significantly lower in women who had a blood relationship with their husband before marriage ( p = 0.012 ) .
moreover , there was no significant relationship between economic ( p = 0.36 ) and sexual violence ( p = 0.64 ) and dating before marriage .
there was no significant relationship between physical ( p = 0.21 ) and economic violence ( p = 0.178 ) and women s hijab .
a significant positive relationship was found between the husband s drug abuse and physical ( p = 0.042 ) and economic violence ( p = 0.036 ) .
however , no significant relationship was found between drug abuse and sexual violence ( p = 0.35 ) .  
a significant negative relationship was found between the husband s education and physical violence ( p = 0.001 ) .
the rate of sexual ( p = 0.21 ) and economic violence ( p = 0.07 ) was higher in women with low - educated husbands , but there was no significant relationship between these variables .
physical violence was significantly higher in low - income couples without a home ( p = 0.011 ) .
there was no significant relationship between economic ( p = 0.11 ) and sexual violence ( p = 0.21 ) and the couples living situation and income , although both types of violence were higher in those women .
the rate of sexual ( p = 0.033 ) and physical violence ( p = 0.021 ) was significantly higher in men without faith . however , no significant relationship was found between economic violence and the husband s faith ( p = 0.95 ) .
in addition , there was no significant relationship between the age at marriage and physical ( p = 0.43 ) , economic ( p = 0.45 ) , and sexual violence ( p = 0.43 ) .
this study identified the areas of health most consistently related to experiences of dv across a wide range of samples , and women with a history of experiencing dv also experienced significantly poorer functional and somatic physical health .
it appears that dv is a common health problem that results in prolonged posttraumatic physical and psychological disorders .
the present study also showed that false traditional beliefs , low educational level , lack of knowledge about women s rights , and low social support for abused women impact the continuation of complications from dv . in a study in iran on 40 battered women that were referred to the local legal medical organization , depression , anxiety , and stress were significantly higher in the abused wives as compared to the control group ( 14 ) . a higher rate of depression , anxiety , and phobias was observed in women who were abused by their husbands than in non - abused women ( 15 ) . in our study , the incidence of sexual , physical , economic , and psychological violence was high . in another study ,
the incidence of sexual and physiological violence were 22% and 32% , respectively ( 16 ) . in the study by weingourt
, the incidence of physical , sexual , and physiological violence was 32% , 23% , and 60% , respectively ( 17 ) . in the study by avdibegovic and sinanovic ,
the incidence of sexual , physical , and physiological violence was 43.5% , 63.2% , and 69.6% , respectively ( 18 ) . in this present study ,
women living in urban areas had the highest prevalence , while women in the city of urmia had the lowest .
this finding could mean that women in urban areas have more knowledge about their rights , and more women living in cities report dv events in comparison to women in rural areas .
no similar significant difference was found . according to our findings , higher unemployment , a lower level of education , and lower socioeconomic status aggravated a person s dv status . on the other hand , based on cultural standards and lack of financial independence ,
women in rural areas face more resistance in obtaining a divorce from their traditional society . based on the findings of our study , the rate of domestic physical violence was higher in women with a lower level of education compared to more educated women
. this might be due to educated women coping more effectively with violence and having a better economic situation .
another study showed that unemployment of women is higher , whereas rural residence had a greater impact on psychological and sexual violence ( 19 ) .
our study demonstrates a significant relationship between physical violence and the husband s employment status , drug abuse , level of education , and dwelling situation .
one study demonstrated that physical violence has a significant association with the employment status , residence ( rural or urban ) , age and occupation of women , and monthly family income ( 20 ) .
showed that the rate of committing violence against women was higher in men with low income , low education , and physical and mental fatigue ( 21 ) .
bonomi et al . also observed a significant relationship between violence and low income ( 22 ) .
another research study on women showed that the rate of domestic violence is significantly correlated with factors , such as the husband s level of education , economic condition , employment , and addiction status , as well as geographical setting ( 23 ) . according to one other study , age , education , occupation , marital duration , and the husband s addiction appeared to be significant factors associated with all types of dv , and level of family income was a highly protective factor against the occurrence of violence ( 24 ) .
however , culture may have a more significant impact than geographic region . in some islamic countries
, studies showed that at least one - third of the women experience physical violence by their husbands ( 2 ) . in this present study ,
one study found a significant association between the husband s level of education and his preference for a male child , and the prevalence of dv ( 25 ) .
ghahhari et al . reported that 73.5% , 92.2% , and 49.6% of women in the general population of sari ( north of iran ) were subjected to physical , emotional , and sexual abuse , respectively , at least once during their lives .
they also reported that most of the women suffered from mild degrees of spousal abuse and an association was found between spousal abuse and the number of offspring , the husband s age , unemployment , low level of education , drug abuse , and mental disorders ( 26 ) .
pournaghash ( 2011 ) found that the prevalence of wife beating was lower only when both partners were educated ( 27 ) , which confirms our study s results that a higher level of education is associated with a decrease in dv .
the present study found a significant relationship between sexual violence and the husband s age and the lack of men s faithfulness .
it also showed a significant relationship between sexual violence and setting , age , and the educational level of women . in this study ,
economic violence was found to have a significant relationship with the husband s education level and drug abuse .
according to this study , acceptance of domestic physical violence against wives was higher among women who had experienced abuse .
it is interesting that , in another study , 23% of the women stated that their husbands had the right to commit different kinds of dv ; that study found that some socio - economic characteristics of women have a significant association with dv ( 27 ) .
for this research , we conducted a large - scale field study of 300 iranian women in urmia , iran .
our results showed that higher education , employment , and a good economic situation could help significantly reduce dv .
convincing husbands to allow their wives to participate in decision making is another important step that could help reduce the prevalence of dv .
increasing public awareness of human rights through education is a very important measure that should be taken by reliable local officials .
future studies also need to focus on the pathways to recovery from experiences of dv and how health services can play a role in rehabilitative actions .
it is clear that dv has detrimental consequences for an individual s well - being .
the findings of this study affirm that dv is a public health problem and a legal and social issue .
first , because this is a correlational study the authors can not infer cause and effect .
second , it is possible that some of the women might not have been truthful in their answers to the dv questionnaire due to cultural problems in iran .
finally , women that participated in this study were under a lot of stress , which limits the generalizability of the findings to other populations . in summary
, since the present research has merely focused on the dv problems of women who were referred to the legal medical organization of iran , additional studies are needed to examine dv in other groups of women .
 background : today , domestic violence against women is a growing epidemic that can be observed in many countries.objectives:this study was carried out to determine the types of domestic violence against women who were referred to the legal medical organization of iran in urmia , iran in 2012.materials and methods : the descriptive survey included demographic information , abuse screening , and items regarding partner involvement . 
 data was gathered using face - to - face structured interviews . 
 the study population included 300 , women 18 years of age or older , and data was collected about their demographic characteristics and the types of domestic violence they experienced . 
 spss software version 16 was used for the analyses.results:the majority of participants were in the 25  30 age group , and 83% of them were battered by their husbands in various ways . 
 no significant relationships were observed between violence and unemployment , increasing age , and home ownership.conclusions:the prevalence of abuse reported by women in this population suggests that many women that are referred to the legal medical organization of iran may have a history of abuse . 
 abused women may have different reasons for seeking a divorce . 
 if routine screening for abuse is included in counseling , health providers will have the opportunity to develop a safety plan and initiate appropriate referrals . 
1. Background
2. Objectives
3. Materials and Methods
3. 1. Ethical Issue
3. 2. Statistical Analysis
4. Results
5. Discussion