The Association Between Violence Against Women and the Consumption of Addictive Substances in Mexico and the Role of Depression as a Mediator

In Mexico, 4 out of every 10 women aged 15 or older have been exposed to some violence in the last year. Violence has been linked to adverse mental health outcomes, such as depression and higher rates of substance use among women. This study is based on the "self-medication" model, proposing that women turn to addictive substances as a coping mechanism following experiences of violence. The main aim was to examine the role of depression as a potential mediator in the association between the health consequences of violence and tobacco and alcohol consumption. We analyzed data from four Mexican nationally representative surveys for 2000, 2006, 2012, and 2018. First, we used different regression models to assess the associations between the health consequences of violence and tobacco and alcohol consumption. Subsequently, for the mediation, we used causal mediation analysis in STATA 18 (StataCorp LLC, College Station, TX, USA), based on the potential outcomes framework and bootstrapping to assess confidence intervals and uncertainty of the estimations. We found that the health consequences of violence are associated with increased tobacco and alcohol consumption in both adults and adolescents. Adolescents with health consequences of violence had 2.4 times the odds of binge. No significant association was found among adults. Depression mediated the association between health consequences of violence and tobacco consumption, but its role as a mediator in alcohol consumption was inconclusive in adults. Mediation analysis suggests the directionality and magnitude of causal pathways, facilitating the selection of possible intervention or prevention strategies. Our findings provide valuable insights suggesting intersecting dynamics of violence, mental health, and substance use among Mexican women, emphasizing the need for holistic approaches. Comprehensively studying these phenomena provides us with relevant information to mitigate the adverse impact of violence and promote the well-being of women in Mexico.