Archives of Psychiatric Nursing xxx (2016) xxx–xxx

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Archives of Psychiatric Nursing

journal homepage: www.elsevier.com/locate/apnu

Domestic Violence Against Women In Turkey: A Systematic Review And

Meta Analysis
Neslihan Keser Özcan ⁎, Sevil Günaydın, Elif Tuğçe Çitil
Faculty of Health Science, Istanbul University, İstanbul, Turkey

a b s t r a c t

Aim: This study was performed to determine the prevalence of and risk factors for domestic violence against
women in Turkey.
Background: The data about domestic violence against women point out a serious problem all around the world
along with including cultural differences.
Design: The prevalence of domestic violence against women was determined through a meta-analysis, and the
risk factors were determined through a systematic review. A systematic search of eight electronic databases
was conducted. In this study, 34 primary studies that were published between January 2000 and January 2015
were examined.
Results: The highest prevalence belonged to verbal violence followed by physical, emotional, economic, and sex-
ual violence. Despite different questioning methods, it was determined that 22 risk factors were most commonly
examined in the studies, and these risk factors were summed up under three separate categories: socio demo-
graphical characteristics, well-being related characteristics and marriage related characteristics. It is of further in-
terest that the most commonly examined characteristics were socio demographic characteristics.
Conclusion: Just as throughout the world, domestic violence is a common problem in Turkey.
Relevance to clinical practice: Nurses and midwives should focus not only on women's disorders but also on
the difficulties the patient faces in regard to being a family. It presents valid evidence to produce policies on
violence prevention.
© 2016 Elsevier Inc. All rights reserved.

Although violence is a concept that varies according to time and
socio cultural structure, it is one of the subjects that draw the most at-
tention in recent years (Senol & Yildiz, 2013). Whereas until up to half
a century ago domestic violence against women (DVAW) was not a sub-
ject that drew international attention or caused concern, the situation
has changed after the 80s with women's rights groups stressing vio-
lence of every kind (Ellsberg & Heise, 2005). DVAW is an important pub-
lic health problem and an important threat to human rights (Ellsberg &
Heise, 2005; WHO, 2014).
The United Nations defines violence against women as any act of
gender-based violence that results in, or is likely to result in, physical,
sexual or mental harm or suffering to women, including threats of
such acts, coercion or arbitrary deprivation of liberty, whether occurring
in public or in private life (WHO, 2014).
Role of funding source: This research received no specific grant from any funding
agency in the public, commercial, or not-for-profit sectors.
Conflict of interest: The authors declare no conflict of interest.
⁎ Correspondence Author: Neslihan Keser Özcan, R.N., PhD., Assoc. Prof, Faculty of
Health Science, Istanbul University, Demirkapı Cad. Karabal Sok. Bakırköy Ruh ve Sinir
Hastalıkları Hastanesi Bahçesi 34740, Bakırköy, İstanbul, Turkey.
E-mail addresses: neslihan_keser@hotmail.com (N.K. Özcan),
svlgunaydin@hotmail.com (S. Günaydın), midwifeelif23@gmail.com (E.T. Çitil).
DVAW is a widespread phenomenon in every culture across the
world regardless of geography, economic development level or educa-
tional level (Guler, Tel, & Tuncay, 2005). According to data from the
WHO, 35% of all women have been subjected to physical and/or sexual
violence by their spouses or others (WHO, 2014). According to the re-
sults of the Turkey Demographic and Health Survey (TDHS) in 2013,
13.3% of women believed that their husband has right to violence to-
ward themselves when acting any of the the following situations:
(1) if she burns the food; (2) if she argues with him (3) if she refuses
to have sex with him; and (4) if she neglects the children (Hacettepe
University Institute of Population Studies, 2014).
The Turkey DVAW Research Report (2015) states that 43.9% of
women were subjected to emotional violence, 35.5% were subjected
to physical violence, 30% were subjected to economical violence, and
12% were subjected to sexual violence (Hacettepe University Institute
of Population Studies, 2015). Senol and Yildiz (2013) conducted an im-
portant study on the subject, which encompassed different cities in
Turkey and included a large sample (N = 7002); this study reported a
DVAW rate of 28.8%. Other risk factors are considered included age, ed-
ucation level, economic and the employment status, place and region of
residence, religious affiliation, use of alcohol, chat chewing, family histo-
ry of violence in the international studies (Capaldi et al., 2012,
Semahegn & Mengistie, 2015, Trinh et al., 2016).

http://dx.doi.org/10.1016/j.apnu.2016.04.013
0883-9417/© 2016 Elsevier Inc. All rights reserved.

Please cite this article as: Özcan, N.K., et al., Domestic Violence Against Women In Turkey: A Systematic Review And Meta Analysis, Archives of
Psychiatric Nursing (2016), http://dx.doi.org/10.1016/j.apnu.2016.04.013
2 N.K. Özcan et al. / Archives of Psychiatric Nursing xxx (2016) xxx–xxx
This study was performed with the goal of examining the data ob-
tained from studies published on DVAW in Turkey and obtaining the
prevalence values for types of violence.
Additionally, answers on the following: 1. DWAV types and preva-
lence, 2. characteristics of women subjected to violence, 3. characteris-
tics of aggressor, 4. the results of violence, and 5. coping methods used
after violence are, will be sought in this study.
METHODS
The study was performed as a retrospective scan of studies pub-
lished on the subject. For this reason, searches through the Istanbul Uni-
versity internet Web on databases such as PubMed, Science Direct,
Medline, PsychINFO, Ovid, EBSCO, CINAHL Plus, and Cochrane Library
with keywords such as violence, aggression, women, domestic violence,
intimate violence, and Turkey were performed, and 34 studies that
complied with the inclusion criteria that we could reach the full text
of from among 110 studies published in national and international
journals between January 2000 and January 2015 were included in the
evaluation (Fig. 1). Two studies performed on the same sample showing
different violence rates (Ergocmen, Yuksel-Kaptanoglu, & Jansen, 2013;
Yuksel-Kaptanoglu, Turkyilmaz, & Heise, 2012) and two studies per-
formed on the same sample showing the same violence rates with one
focused on the reasons and the other on the results (Oyekçin, Yetim, &
Sahin, 2012; Sahin, Yetim, & Oyekcin, 2012) were included in our
study, with only one of the pairs being taken into consideration in the
meta analysis.
The inclusion criteria for the studies were as follows: 1. being pub-
lished in a peer reviewed national/international journal between Janu-
ary 2000 and January 2015, 2. being conducted in Turkey, 3. being
original and quantitative, 4. the sample consisting of women between
the ages of 15 and 59, 5. giving a prevalence value for any type of
DVAW,6. not being performed in a sample with a specific limitation
(physical or mental problems requiring treatment, cases that were in
the legal process, pregnant women, infertile women, only women
who were exposed to violence), and 7. the sample consisting only of
women. For meta analysis, the study giving only the prevalence value
of DVAW during marriage was added to these criteria.
Conducting the Study
To evaluate the quality of the studies, 12 of the evaluation criteria
suggested by (Polit and Beck 2009) were used. All of the studies were
evaluated with regard to the goal of the study, definitions of the con-
cepts, research questions, sample sufficiency, the appropriateness in
the writing of materials, method and results, and the inclusion of sug-
gestions and limitations by two researchers according to these 12
criteria, and checked by a third researcher. The highest score for the
studies was 12 while the lowest was 7.
Data Analysis
Meta analysis was used for DVAW prevalence. The random
effects model was used for this goal through the Comprehensive
Meta-Analysis (Version 3.3.070) software. This method gives a more
accurate and strong prediction of effect size. The random effects
model weighs studies with the inverse of the intra study variance of
each primary study, and accounts for inter study variance a well as
intra study variance. For this reason, the random effects model is more
appropriate for meta analysis in the presence of heterogeneity. Intra
study heterogeneity was evaluated using Cochran Q and I2 statistics.
The Q statistic was given by χ 2 and p values; and the I 2 statistic was
given in percentages. A larger value of I 2 shows more heterogeneous
studies. (25, 50, and 75% for the I2 statistic are indicators of low, medi-
um, and high heterogeneity, respectively). In the comparison of two
Please cite this article as: Özcan, N.K., et al., Domestic Violence Against Women In Turkey: A Systematic Review And Meta Analysis, Archives of
Psychiatric Nursing (2016), http://dx.doi.org/10.1016/j.apnu.2016.04.013
groups with regard to frequency, the Q statistic was used (Borenstein,
Hedges, Higgins, & Rothstein, 2013).
RESULTS
Characteristics Regarding Study Methods
The Publishing Date and Study Design
Most studies on the subject belonged to the year 2010 (6), followed
by 2004 and 2007 (1). All of the studies were retrospective, descriptive,
and cross sectional studies examining violence phenomena. A total of
21 studies were published in English, and 13 studies were published
in Turkish.
Characteristics of the Sample
Thirty-four primary studies were included in this study
(Fig. 1). While the samples of 21 studies consisted of only
married women (Alaman & Yildiz, 2014; Akar, Aksakal,
Demirel, Durukan, & Ozkan, 2010; Akyuz, Sahiner, & Bakir, 2008;
Bener, Sahin, & Sokmen, 2010; Bulucu & Cakıl, 2013; Efe & Ayaz, 2010;
Gokler et al., 2014; Erci & Ergin, 2005; Ergin, Bayram, Alper, Selimoglu,
& Bilgel, 2005; Guler et al., 2005; Izmirli, Sonmez, & Sezik, 2014;
Karacam, Calışır, Dundar, Altuntaş, & Avci, 2006; Kelleci, Golbasi,
Erbaş, & Tugut, 2009; Kocacik & Dogan, 2006; Mayda & Akkus, 2004;
Oyekçin et al., 2012; Ozyurt & Deveci, 2010; Sahin et al., 2010, 2012;
Tokuc, Ekuklu, & Avcioglu, 2010), 13 studies included single women as
well (Civi, Kutlu, & Marakoglu, 2008; Elmali, Erten, Zincir, Ozen, &
Balci, 2011; Ergocmen et al., 2013; Gokkaya, 2011; Gokulu, Uluocak, &
Bilir, 2014; Hidiroglu, Topuzoglu, Ay, & Karavus, 2006; Kocacik &
Caglayandereli, 2009; Kocacik, Kutlar, & Erselcan, 2007; Nacar, Baykan,
Poyrazoglu, & Cetinkaya, 2009; Nur, 2012; Oyekçin et al., 2012; Ozcan,
Bilgin, Tulek, & Boyacioglu, 2014; Selek, Vural, & Cakmak, 2012).
When examined with regard to sample size, it was seen that the
sample sizes of seven studies was equal to or below 200 while the sam-
ple sizes of 27 were above 200 (Table 1).
The Questionnaires and Scales Used/The Period in Which Violence Occurred
While questionnaires prepared by the researchers were used in 27 of
the studies (Akyuz et al., 2008; Bener et al., 2010; Bulucu & Cakıl, 2013;
Civi et al., 2008; Elmali et al., 2011; Gokler et al., 2014; Erci & Ergin,
2005; Ergin et al., 2005; Gokkaya, 2011; Gokulu et al., 2014; Guler
et al., 2005; Hidiroglu et al., 2006; Izmirli et al., 2014; Karacam et al.,
2006; Kocacik & Caglayandereli, 2009; Kocacik & Dogan, 2006; Kelleci
et al., 2009; Kocacik et al., 2007; Mayda & Akkus, 2004; Nacar et al.,
2009; Oyekçin et al., 2012; Ozcan et al., 2014; Ozyurt & Deveci, 2010;
Sahin et al., 2010, 2012; Selek et al., 2012; Tanriverdi & Sipkin, 2008),
a questionnaire consisting of questions recommended by WHO for
DVAW was used in seven (Akar et al., 2010; Alaman & Yildiz, 2014;
Efe & Ayaz, 2010; Ergocmen et al., 2013; Nur, 2012; Tokuc et al., 2010;
Yuksel-Kaptanoglu et al., 2012). Apart from the questionnaires prepared
by the researchers, various questionnaires were used additionally in 8 of
the studies. The Abuse Assesment Screen Questionnaire was used in two
studies (Ergin et al., 2005; Sahin et al., 2012), the Marriage Happiness
Scale was used in one (Civi et al., 2008), the Marriage Happiness Scale
and Scale of Perceived Social Support were used together in one
(Oyekçin et al., 2012), the Scale of Domestic Violence was used in one
(Akyuz et al., 2008), the General Health Questionaire was used in one
(Kelleci et al., 2009), the Beck Depression Inventory was used in one
(Ozyurt & Deveci, 2010), and the Rosenberg Self Respect Scale and the
Childhood Period Trauma Question Form were used together in one
(Sahin et al., 2010).
The presence of violence was questioned throughout marriage in 23
studies, in the past year in one study, throughout life in six studies, both
throughout marriage and throughout life in one study, throughout mar-
riage and in the past year in two studies, and throughout marriage, life
and in the past year in one study (Table 1).
 N.K. Özcan et al. / Archives of Psychiatric Nursing xxx (2016) xxx–xxx 3

Fig. 1. Flow chart to illustrate results of search strategy.

Nature of DVAW and Related Characteristics
Type of DVAW and Prevalence
The type of violence most commonly examined in the studies was
physical (21), followed by general (any violence regardless of type)
(20), sexual (18), emotional (12), verbal (10), and economic (9) vio-
lence, respectively. The violence rates in the studies were given in
Table 1. Since different types of violence were focused on in each
study, separate meta analyses were performed for each type of violence.
Additionally, studies that give yearly prevalence and lifelong prevalence
were shown in Table 1 without being included in the meta analysis. The
meta analyses only include studies that give the prevalence of violence
throughout marriage.
As a result of the heterogeneity evaluation of 20 studies for general
violence, the Q statistic was found to be 1572.774 (sd = 19), and the
I 2 statistic was found to be 98.792 (p b 0.001). Both statistics show
that the studies were heterogeneous. The prevalence of general violence
was determined to be 57.2% (95% CI 47.6–66.2%). (Table 2). For verbal
violence the Q statistic of 10 studies was found to be 304.0559 (sd =
9), and the I 2 statistic was found to be 97.040 (p b 0.001). The preva-
lence of verbal violence was found to be 43.5% (95% CI 35.1–52.3%)
(Table 3). For emotional violence the Q statistic of 12 studies was

Please cite this article as: Özcan, N.K., et al., Domestic Violence Against Women In Turkey: A Systematic Review And Meta Analysis, Archives of
Psychiatric Nursing (2016), http://dx.doi.org/10.1016/j.apnu.2016.04.013
4 N.K. Özcan et al. / Archives of Psychiatric Nursing xxx (2016) xxx–xxx

Table 1
Summary of Primary Studies Examining DVAW in Turkey.

Authors Sample City location General Physical Emotional Verbal Sexual Economical Controlling
violence (%) violence (%) violence (%) violence (%) violence (%) violence (%) behaviors (%)

1. Mayda & Akkus, 2004 116 Duzce 84.51 41.41 25.91 8.61 77.61
PHC 50.92
2. Guler et al., 2005 162 Sivas 40.71 59.71 21.41 47.41
HV
3. Ergin et al., 2005 1010 Bursa 32.61 34.11 15.81 8.21
PHC
4. Erci & Ergin, 2005 495 Erzurum 10.11 21.61
PHC
5. Karacam et al., 2006 291 Aydın 27.81 14.41 23.01 9.21
PHC
6. Kocacik & Dogan, 2006 583 Sivas 52.01 38.31 53.81 7.91
HV
7. Hidiroglu et al., 2006 146 Istanbul 40.41
PHC
8. Kocacik et al., 2007 695 Adiyaman 801 891 621 51
Sivas
Denizli
Kırklareli
PHC
9. Civi et al., 2008 405 Konya 20.72
PHC
10. Tanriverdi & Sipkin, 2008 366 Canakkale 80.91 43.41 681 56.81 471
PHC
11. Akyuz et al., 2008 250 Ankara 761
P
12. Kelleci et al., 2009 591 Sivas 64.1 311 58.4 1a 14.91 23.41
PHC
13. Kocacik & Caglayandereli, 2009 593 Denizli 52.51 15.01 51.81 11.01
HV
14. Nacar et al., 2009 355 Kayseri 49.91 26.51 23.11 32.41 4.51 12.71
PHC
15. Tokuc et al., 2010 288 Edirne 34.03 931a 21.73
HV
16. Akar et al., 2010 1178 Ankara 77.91 29.91 39.71 31.31 60.41 59.61
PHC 8.23 15.93
17. Ozyurt & Deveci, 2010 225 Manisa 32.91 64.81 66.21 14.81
PHC
18. Sahin et al., 2010 750 Aydın/Edirne/Kocaeli/Manisa/Malatya 89.1 29.61 17.81 48.21 3.21
HV
19. Bener et al., 2010 1524 Ankara 33.71 51.51 14.41 0.51
PHC
20. Efe & Ayaz, 2010 370 Ankara 1001
PHC 54.6⁎
38.4⁎⁎
7⁎⁎⁎
21. Elmali et al., 2011 285 Kayseri 27.72 12.72 82.32 5.12
PHC
22. Gokkaya, 2011 154 Sivas 9.12 51.32 4.52 13.62
WP
23. Yuksel-Kaptanoglu et al., 2012 12.795 All cities 15.13b
HV
24. Oyekçin et al., 2012 306 Edirne 61.41 30.41 54.61 6.31 19.31
PHC
25. Sahin et al., 2012 306 Edirne 61.41 30.41 54.61 6.31 19.31
P
26. Nur, 2012 1844 Sivas 34. 21 10.32 6.82
HV 5.73 3.73
27. Selek et al., 2012 96 Urfa 22.71 18.1 181 181 461
WP
28. Bulucu & Cakıl, 2013 193 Kırsehir 64.71
HV
29. Ergocmen et al., 2013 12.795 All cities 362
HV
30. Gokulu et al., 2014 400 Canakkale 54.62 55.72 50.82 51.22
PHC
31. Alaman & Yildiz, 2014 200 Malatya 411 501a 531
P
32. Izmirli et al., 2014 260 Isparta 67.71 42.31 46.51a 14.61 33.11 39.61
PHC
33. Ozcan et al., 2014 1200 Istanbul 24.72 64.42 44.12c
S 15.32b
34. Gokler et al., 2014 800 Eskisehir 391 9.81 26.81 38.41 6.91 18.11
PHC

1 = during marriage 2 = life time 3 = over the last year a = emotional + verbal violence b = pyschical + sexual violence c = verbal + sexual violence * = low level
** = moderate level *** = high level PHC = Primary Health Care Center HV = Home Visit P = Policlinic S = Scholl WP = Working place.

Please cite this article as: Özcan, N.K., et al., Domestic Violence Against Women In Turkey: A Systematic Review And Meta Analysis, Archives of
Psychiatric Nursing (2016), http://dx.doi.org/10.1016/j.apnu.2016.04.013
 N.K. Özcan et al. / Archives of Psychiatric Nursing xxx (2016) xxx–xxx 5

Table 2 Table 4
Prevalence of General Violence (95% CI) in Primary Studies. The Prevalence of Physical Violence (95% CI) in Primary Studies.

Primary studies Prevalence %95 CI Primary studies Prevalence of %95 CI

physical violence
Upper limit Lower limit Upper limit Lower limit

Mayda & Akkus, 2004 0.845 0.767 0.900 Mayda & Akkus, 2004 0.414 0.328 0.506
Guler et al., 2005 0.407 0.334 0.484 Guler et al., 2005 0.597 0.520 0.670
Ergin et al., 2005 0.326 0.298 0.356 Ergin et al., 2005 0.341 0.312 0.371
Karacam et al., 2006 0.278 0.230 0.332 Erci & Ergin, 2005 0.101 0.077 0.131
Kocacik & Dogan, 2006 0.520 0.479 0.560 Karacam et al., 2006 0.144 0.108 0.189
Tanriverdi & Sipkin, 2008 0.809 0.765 0.846 Kocacik & Dogan, 2006 0.383 0.344 0.423
Akyuz et al., 2008 0.760 0.703 0.809 Hidiroglu et al., 2006 0.404 0.328 0.485
Kelleci et al., 2009 0.640 0.600 0.678 Kocacik et al., 2007 0.800 0.769 0.828
Kocacik & Caglayandereli, 2009 0.525 0.485 0.565 Tanriverdi & Sipkin, 2008 0.434 0.384 0.485
Nacar et al., 2009 0.499 0.447 0.551 Kelleci et al., 2009 0.310 0.274 0.348
Akar et al., 2010 0.779 0.754 0.802 Kocacik & Caglayandereli, 2009 0.150 0.123 0.181
Ozyurt & Deveci, 2010 0.329 0.271 0.393 Nacar et al., 2009 0.265 0.222 0.313
Sahin et al., 2010 0.890 0.866 0.910 Akar et al., 2010 0.299 0.274 0.326
Bener et al., 2010 0.337 0.314 0.361 Ozyurt & Deveci, 2010 0.648 0.583 0.708
Efe & Ayaz, 2010 0.999 0.979 1.000 Sahin et al., 2010 0.296 0.264 0.330
Oyekçin et al., 2012 0.614 0.558 0.667 Bener et al., 2010 0.515 0.490 0.540
Nur, 2012 0.342 0.321 0.364 Oyekçin et al., 2012 0.304 0.255 0.358
Selek et al., 2012 0.227 0.154 0.321 Selek et al., 2012 0.180 0.115 0.270
Izmirli et al., 2014 0.677 0.618 0.731 Alaman & Yildiz, 2014 0.410 0.344 0.479
Gokler et al., 2014 0.390 0.357 0.424 Izmirli et al., 2014 0.423 0.364 0.484
General prevalence 0.572 0.476 0.662 Gokler et al., 2014 0.098 0.079 0.121
General prevalence 0.338 0.266 0.419

found to be 1250.984 (sd = 11), and the I 2 statistic was found to be
99.121 (p b 0.001). The prevalence of emotional violence was found to
be 33.7% (95% CI 21.7–48.1%) (Table 3). For physical violence the Q sta-
tistic of 21 studies was found to be 1237.094 (sd = 20), and the I2 sta-
tistic was found to be 98.383 (p b 0.001). The prevalence of physical
violence was found to be 33.8% (95% CI 26.6–41.9%) (Table 4). For eco-
nomic violence the Q statistic of 9 studies was found to be 803.1444
(sd = 8), and the I 2 statistic was found to be 99.004 (p b 0.001). The
prevalence of economic violence was found to be 26.8% (95% CI
15.3–42.6%). For sexual violence the Q statistic of 18 studies was
found to be 1187.777 (sd = 17), and the I 2 statistic was found to be
98.596 (p b 0.001). The prevalence of sexual violence was found to be
12.3% (95% CI 7.2–20%) (Table 5).
The Characteristics Associated With Women
Risk factors associated with women are considered in all of the 34
primary studies. While the characteristics of the women who exposed
violence were discussed in thirty-two of the studies, two studies did
not include those. Even though the factors examined in each of the stud-
ies were similar, homogeneity is impossible to mention because of the
differences in questioning methods. Additionally, while some factors
were examined in many studies, some were mentioned only in a few.
Regardless of different questioning methods, a total of 22 risk factors
were found to be examined in all of the studies, and these risk factors
Table 5
The Prevalence of Sexual and Economical Violence (95% CI) in Primary Studies.

Primary studies Prevalence %95 CI

of violence
Upper limit Lower limit
Table 3
The Prevalence of Verbal and Emotional Violence (95% CI) in Primary Studies. Mayda & Akkus, 2004 0.086 0.047 0.153
Karacam et al., 2006 0.092 0.064 0.131
Primary studies Prevalence %95 CI Kocacik & Dogan, 2006 0.079 0.060 0.104
of violence Kocacik et al., 2007 0.050 0.036 0.069
Upper limit Lower limit
Tanriverdi & Sipkin, 2008 0.568 0.517 0.618
Guler et al., 2005 0.474 0.398 0.551 Kelleci et al., 2009 0.149 0.123 0.180
Erci & Ergin, 2005 0.216 0.182 0.254 Kocacik & Caglayandereli, 2009 0.110 0.087 0.138
Kocacik & Dogan, 2006 0.538 0.497 0.578 Nacar et al., 2009 0.045 0.028 0.072
Kocacik et al., 2007 0.620 0.583 0.655 Akar et al., 2010 0.313 0.287 0.340
Kocacik & Caglayandereli, 2009 0.518 0.478 0.558 Ozyurt & Deveci, 2010 0.148 0.107 0.201
Nacar et al., 2009 0.324 0.277 0.374 Sahin et al., 2010 0.032 0.022 0.047
Ozyurt & Deveci, 2010 0.662 0.598 0.721 Bener et al., 2010 0.005 0.002 0.010
Sahin et al., 2010 0.482 0.446 0.518 Oyekçin et al., 2012 0.063 0.041 0.096
Selek et al., 2012 0.180 0.115 0.270 Selek et al., 2012 0.180 0.115 0.270
Gokler et al., 2014; 0.384 0.351 0.418 Bulucu & Cakıl, 2013 0.647 0.577 0.711
General prevalence of verbal violence 0.435 0.351 0.523 Alaman & Yildiz, 2014 0.530 0.461 0.598
Mayda & Akkus, 2004 0.259 0.187 0.346 Izmirli et al., 2014 0.146 0.108 0.194
Guler et al., 2005 0.214 0.158 0.284 Gokler et al., 2014 0.069 0.053 0.089
Ergin et al., 2005 0.158 0.137 0.182 Genel prevalence of sexual violence 0.123 0.072 0.200
Karacam et al., 2006 0.230 0.185 0.282 Ergin et al., 2005 0.082 0.067 0.101
Kocacik et al., 2007 0.890 0.864 0.911 Tanriverdi & Sipkin, 2008 0.470 0.419 0.521
Tanriverdi & Sipkin, 2008 0.680 0.630 0.726 Kelleci et al., 2009 0.234 0.202 0.270
Nacar et al., 2009 0.231 0.190 0.278 Nacar et al., 2009 0.127 0.096 0.166
Akar et al., 2010 0.397 0.369 0.425 Akar et al., 2010 0.604 0.576 0.632
Sahin et al., 2010 0.178 0.152 0.207 Oyekçin et al., 2012 0.193 0.153 0.241
Bener et al., 2010 0.144 0.127 0.163 Selek et al., 2012 0.460 0.363 0.560
Oyekçin et al., 2012 0.546 0.490 0.601 Izmirli et al., 2014 0.331 0.276 0.390
Gokler et al., 2014; 0.268 0.238 0.300 Gokler et al., 2014 0.181 0.156 0.209
General prevalence of emotional violence 0.337 0.217 0.481 General prevalence of economical violence 0.268 0.153 0.426

Please cite this article as: Özcan, N.K., et al., Domestic Violence Against Women In Turkey: A Systematic Review And Meta Analysis, Archives of
Psychiatric Nursing (2016), http://dx.doi.org/10.1016/j.apnu.2016.04.013
6 N.K. Özcan et al. / Archives of Psychiatric Nursing xxx (2016) xxx–xxx

were classified under three main topics, namely socio demographic char-
acteristics, characteristics regarding marriage, and characteristics regard-
ing well-being. It is of further interest that the most commonly examined
characteristics were socio demographic characteristics (Fig. 2).
The Characteristics Associated With the Aggressor
The characteristics associated with the aggressor questioned in nine
studies all of the 34 primary studies. Nine studies questioned the iden-
tity (husband, father, male sibling…) of the aggressor (Bener et al.,
2010; Guler et al., 2005; Izmirli et al., 2014; Karacam et al., 2006;
Kocacik & Caglayandereli, 2009; Kocacik & Dogan, 2006; Kocacik et al.,
2007; Nacar et al., 2009; Sahin et al., 2010), eight studies stressed the ag-
gressor to be the partner (Bener et al., 2010; Izmirli et al., 2014; Karacam
et al., 2006; Kocacik & Caglayandereli, 2009; Kocacik & Dogan, 2006;
Kocacik et al., 2007; Nacar et al., 2009; Sahin et al., 2010), five studies
stressed the aggressor to be male siblings, male offspring, and relatives,
as well as partner (Bener et al., 2010; Karacam et al., 2006; Kocacik &
Dogan, 2006; Kocacik et al., 2007; Nacar et al., 2009), three studies
stressed the aggressor to be both the father and partner (Kocacik &
Dogan, 2006; Kocacik et al., 2007; Sahin et al., 2010).
While seven studies reported that spouses with lower educational
levels applied more violence (Akar et al., 2010; Akyuz et al., 2008; Civi
et al., 2008; Gokler et al., 2014; Ergin et al., 2005; Mayda & Akkus,
2004; Nacar et al., 2009), four studies found no relationship between
the educational status of the spouse and violence (Alaman & Yildiz,
2014; Bulucu & Cakıl, 2013; Karacam et al., 2006; Sahin et al., 2010).
Two studies reported that unemployed spouses apply more violence
(Efe & Ayaz, 2010; Nacar et al., 2009), while one study reported that
those who work in trade related businesses apply more violence
(Kocacik et al., 2007). Six studies found no relationship between the
employment status of the spouse and violence (Akar et al., 2010; Bulucu
& Cakıl, 2013; Civi et al., 2008; Karacam et al., 2006; Mayda & Akkus,
2004; Yuksel-Kaptanoglu et al., 2012).
While three studies determined that younger spouses applied more
violence (Sahin et al., 2010.
Izmirli et al., 2014; Oyekçin et al., 2012), four studies found no rela-
tionship between the age of the spouse and violence (Akar et al., 2010;
Akyuz et al., 2008; Karacam et al., 2006; Sahin et al., 2012).
Four studies found that partners who witnessed domestic violence
in their families applied more violence (Akar et al., 2010; Bulucu &
Cakıl, 2013; Oyekçin et al., 2012; Sahin et al., 2012), while two studies
found that partners with a history of violence applied more violence
(Nacar et al., 2009; Oyekçin et al., 2012).
Six studies found spouses that gambled and used tobacco and alco-
hol applied more violence (Akar et al., 2010; Gokler et al., 2014; Izmirli
et al., 2014; Karacam et al., 2006; Nacar et al., 2009; Yuksel-Kaptanoglu
et al., 2012), while one study found no relationship between those phe-
nomena (Bulucu & Cakıl, 2013).

Fig. 2. The characteristics associated with women in primary studies. *(√) Relation questioned but not determined statistical significance. *(+) Positive correlation/significance. *(−) Neg-
ative correlation/significance.

Please cite this article as: Özcan, N.K., et al., Domestic Violence Against Women In Turkey: A Systematic Review And Meta Analysis, Archives of
Psychiatric Nursing (2016), http://dx.doi.org/10.1016/j.apnu.2016.04.013
 N.K. Özcan et al. / Archives of Psychiatric Nursing xxx (2016) xxx–xxx
The Causes of DVAW
While only 11 studies questioned the reasons for violence (Bener
et al., 2010; Efe & Ayaz, 2010; Ergin et al., 2005; Ergocmen et al., 2013;
Gokkaya, 2011; Guler et al., 2005; Kocacik & Caglayandereli, 2009;
Kocacik & Dogan, 2006; Kocacik et al., 2007; Nacar et al., 2009; Sahin
et al., 2012), all of these studies stressed certain factors regarding
males and the environment, and seven studies discussed causes related
to women such as women being weak, not fulfilling marital duties, not
listening to males, and talking too much (Bener et al., 2010; Efe & Ayaz,
2010; Ergocmen et al., 2013; Gokkaya, 2011; Kocacik et al., 2007; Nacar
et al., 2009; Sahin et al., 2012). The reason for violence was shown to be
unfavorable economic circumstances in eight studies (Bener et al.,
2010; Ergin et al., 2005; Ergocmen et al., 2013; Gokkaya, 2011; Guler
et al., 2005; Kocacik & Caglayandereli, 2009; Kocacik & Dogan, 2006;
Sahin et al., 2012), the spouse having anger management/psychological
issues in seven studies (Efe & Ayaz, 2010; Ergin et al., 2005; Ergocmen
et al., 2013; Guler et al., 2005; Kocacik & Caglayandereli, 2009; Kocacik
& Dogan, 2006; Nacar et al., 2009), causes stemming from the families
of the woman or the spouse in five studies (Ergin et al., 2005; Ergocmen
et al., 2013; Guler et al., 2005; Nacar et al., 2009; Sahin et al., 2012), al-
cohol/tobacco or gambling habits in four studies (Bener et al., 2010;
Ergin et al., 2005; Guler et al., 2005; Sahin et al., 2012), jealousy in
four studies (Ergin et al., 2005; Guler et al., 2005; Kocacik &
Caglayandereli, 2009; Sahin et al., 2012), sexual problems in three stud-
ies (Kocacik & Caglayandereli, 2009; Kocacik & Dogan, 2006; Sahin et al.,
2012), cultural differences in three studies (Gokkaya, 2011; Kocacik &
Caglayandereli, 2009; Kocacik & Dogan, 2006; Sahin et al., 2012), and
problems related to children in two studies (Ergin et al., 2005;
Ergocmen et al., 2013), while four studies stressed the lack of any reason
(Ergocmen et al., 2013; Kocacik & Caglayandereli, 2009; Kocacik &
Dogan, 2006; Kocacik et al., 2007).
The Results of DVAW
Only eight studies discussed the results of violence (Alaman & Yildiz,
2014; Civi et al., 2008; Ergin et al., 2005; Kelleci et al., 2009; Mayda &
Akkus, 2004; Ozyurt & Deveci, 2010; Sahin et al., 2012; Tokuc et al.,
2010). While two studies discussed physical results such as abrasions
and fractures (Mayda & Akkus, 2004; Tokuc et al., 2010), seven studies
discussed emotional results such as insecurity, insignificance, depres-
sion, unhappiness, and being unhappy with one's life (Alaman & Yildiz,
2014; Civi et al., 2008; Ergin et al., 2005; Kelleci et al., 2009; Ozyurt &
Deveci, 2010; Sahin et al., 2012; Tokuc et al., 2010). Five studies were
found to question suicidal thoughts/attempts (Alaman & Yildiz, 2014;
Civi et al., 2008; Ergin et al., 2005; Sahin et al., 2012).
Coping Strategies Used After DVAW
Ten studies questioned coping strategies against DVAW (Bulucu &
Cakıl, 2013; Civi et al., 2008; Elmali et al., 2011; Ergin et al., 2005;
Ergocmen et al., 2013; Karacam et al., 2006; Kocacik et al., 2007; Nacar
et al., 2009; Sahin et al., 2012; Tokuc et al., 2010). The most commonly
reported (six studies) coping strategies were acceptance and inaction
(Bulucu & Cakıl, 2013; Elmali et al., 2011; Ergin et al., 2005; Karacam
et al., 2006; Kocacik et al., 2007; Nacar et al., 2009), while six studies re-
ported leaving home (Civi et al., 2008; Elmali et al., 2011; Ergin et al.,
2005; Ergocmen et al., 2013; Nacar et al., 2009; Sahin et al., 2012), six
repoted taking help from people/institutions (Civi et al., 2008; Elmali
et al., 2011; Ergocmen et al., 2013; Karacam et al., 2006; Nacar et al.,
2009; Tokuc et al., 2010), two reported verbal or physical reaction
(Ergin et al., 2005; Kocacik et al., 2007), two reported talking to
friends/relatives (Ergin et al., 2005; Ergocmen et al., 2013), and one re-
ported crying (Bulucu & Cakıl, 2013).
DISCUSSION
In this study where other studies were systematically examined
through meta analysis, the frequency and type of DVAW, the factors
Please cite this article as: Özcan, N.K., et al., Domestic Violence Against Women In Turkey: A Systematic Review And Meta Analysis, Archives of
Psychiatric Nursing (2016), http://dx.doi.org/10.1016/j.apnu.2016.04.013
7
affecting violence, the results of violence, and the coping strategies
used by women against violence were evaluated.
Types of DVAW and Prevalence
According to the results of one literature synthesis and one field
study performed in Turkey, the prevalence of DVAW is between 13
and 78% (Guvenc, Akyuz, & Cesario, 2014; Senol & Yildiz, 2013). The
prevalence of DVAW was determined to be 57.2% in this study, which
is in a similar range with literature. Additionally, in the DVAW report
performed with 43,414 people (2015), when the rates of being exposed
to violence in any period in one's life were examined, it could be seen
that 43.9% of women underwent emotional, 35.5% underwent physical,
30% underwent economical, and 12% underwent sexual violence
(Hacettepe University Institute of Population Studies, 2015). According
to the results of our study, all types of violence were seen in similar rates
except emotional violence (33.7%), which was lower. In the present
study, the low rate of emotional violence found than DVAW Report.
This may have stemmed from both the verbal and emotional violence
is questioned together in the DVAW report. In a systematical review
by Alhabib, Nur, and Jones (2010), the prevalence of domestic violence
against women was between 1.9 and 70% while the prevalence of emo-
tional violence was almost 78%, the prevalence of physical violence was
almost 47%, and the prevalence of sexual violence was almost 34%. In a
study by Abrahams et al. (2014) where studies on sexual violence from
different countries were systematically examined, the rates of sexual vi-
olence varied between 3.3 and 21%. The rates of violence were found
lower in this study when compared to other studies performed on vio-
lence against women outside Turkey. This, in turn, demonstrates that vi-
olence rates may change among cultures.
The Characteristics Associated With Women
DVAW is a multi dimensional and complex phenomenon. Although
the risk factors in literature point towards phenomenon specific to the
sample culture, the most significant risk factors are related to poverty.
All risk factors are additionally within a cause effect relationship with
each other. In this case, can provide information about the prominence
of certain risk factors in the general table, but still need to be cautious
about interpreting findings. Among the woman related risk factors de-
termined in this study low educational levels (Garcia-Moreno, Jansen,
Ellsberg, Heise, & Watts, 2006; Guvenc et al., 2014; Martín-Baena,
Montero-Piñar, Escribà-Agüir, & Vives-Cases, 2015; Regueira-Diéguez,
Pérez-Rivas, Muñoz-Barús, Vázquez-Portomeñe, & Rodríguez-Calvo,
2015), low economic level (Barnawi, 2015; Begum, Donta, Nair, &
Prakasam, 2015; Dalal & Lindqvist, 2012; Martín-Baena et al., 2015;
Nasrabadi, Abbasi, & Mehrdad, 2014; Puri, Misra, & Hawkes, 2015;
Regueira-Diéguez et al., 2015), early marriage (Barnawi, 2015; Begum
et al., 2015; Bouhours & Broadhurst, 2015; Guvenc et al., 2014;
Nasrabadi et al., 2014), unwanted/unapproved marriage (Guvenc
et al., 2014), and too many people living in the house (Begum et al.,
2015) have also been reported in many other studies. On the other
hand, there are studies that do not find educational level and economic
status, which both come out as risk factors in our study, as determining
factors (Barnawi, 2015; Bouhours & Broadhurst, 2015). Again, the prob-
lems of having sexual and gynecological problems (Alhabib et al., 2010;
Barnawi, 2015) and having behavior that approves of violence as a cul-
tural characteristic (Barnawi, 2015; Begum et al., 2015) are among the
risk factors determined in this study.
The Characteristics Associated With the Aggressor
The finding that spouses who have habits such as gambling, alcohol
use, and smoking apply more violence (Barnawi, 2015; Begum et al.,
2015; Bouhours & Broadhurst, 2015; Regueira-Diéguez et al., 2015) sup-
ports our findings on the subject. Addiction is may considered as one of
8 N.K. Özcan et al. / Archives of Psychiatric Nursing xxx (2016) xxx–xxx
the effective factors on violence occurrence. Because of the destructive
effect of addiction on behavioral, economic and mental aspects,
these findings are expected. Some authors suppose that husbands
who have less power sources such as income, education, and employ-
ment or take the lower positions than their wives use violence as an in-
strument to gain power and position. Also in this study, low education
level, unemployment was found to be risk factors as in many studies
(Begum et al., 2015; Bouhours & Broadhurst, 2015; Nasrabadi et al.,
2014). In line with the results of other studies that have been identified
as the young age of husband is an other risk factors (Bouhours &
Broadhurst, 2015).
There is limited information on non-partner DVAW. Generally, the
aggressor is women's partner. A history of violence or witnessing vio-
lence is the most important risk factor for both women and their part-
ners determined in this study, and in compliance with literature,
women who undergo violence also apply more violence to their chil-
dren (Begum et al., 2015; Dalal & Lindqvist, 2012; Guvenc et al., 2014;
Martín-Baena et al., 2015; Regueira-Diéguez et al., 2015). A history of vi-
olence in the family may cause new generations to view violence as a
normal behavior pattern, making victims potential violence appliers
and carrying violence across generations.
The Causes and Results of DVAW
While studies questioning the reasons for DVAW discuss mostly
male related characteristics just like this study, it is interesting that
women perceive their natural behavior as a reason for violence some
studies. It is possible to see such perceptions from women in male dom-
inant societies (Barnawi, 2015). Among the characteristics pertaining to
men, alcohol use, having controlling behavior, the presence of psycho-
logical problems, and jealousy are risk factors reported in other studies
as well (Bouhours & Broadhurst, 2015; Dalal & Lindqvist, 2012).
It was determined that the emotional results of DVAW were more
focused on primary studies. According to the Turkey DVAW Research
report (2009) women undergo problems such as physical problems,
emotional and behavioral problems, and thoughts of suicide after vio-
lence. Similarly, other studies have found that violence causes physical
(Barnawi, 2015; Dalal & Lindqvist, 2012; Issahaku, 2015; Martín-
Baena et al., 2015; Puri et al., 2015; Regueira-Diéguez et al., 2015),
jinekolojik (Barnawi, 2015; Martín-Baena et al., 2015; Puri et al.,
2015), emotional (Al-Nuaimi, 2013; Barnawi, 2015; Devries et al.,
2013; Martín-Baena et al., 2015; Puri et al., 2015), medical and behav-
ioral problems (sleep disorders, appetite changes, headaches, etc.)
(Al-Nuaimi, 2013; Barnawi, 2015; Issahaku, 2015; Martín-Baena et al.,
2015) and thoughts of suicide (Devries et al., 2013; Issahaku,
2015; Puri et al., 2015). The results of DVAW in this study are similar
to literature.
Coping Strategies Used After DVAW
In this study, it was determined that acceptance was more wide-
spread with strategies of getting help from people of institutions were
also tried. According to the Turkey DVAW Research Report (2009) re-
sults the most common method used by women is taking supportive
help from people with less application to institutional help. Even if
most of the women disapprove the violence, their life extremely limited
environment and not has enough information about their rights. In ad-
dition, the number of institutions, which can apply, is insufficient in
Turkey and there is not enough information about these institutions.
Similar strategies can be found in international studies (Barnawi,
2015; Nasrabadi et al., 2014; Puri et al., 2015). Additionally reacting ver-
bally/physically (Anderson, Renner, & Bloom, 2014; Nasrabadi et al.,
2014), applying violence to offspring after violence (Nasrabadi et al.,
2014), taking help from friends/relatives (Anderson et al., 2014;
Nasrabadi et al., 2014), and taking help from institutions (Anderson
et al., 2014) are among the coping strategies in the studies.
Please cite this article as: Özcan, N.K., et al., Domestic Violence Against Women In Turkey: A Systematic Review And Meta Analysis, Archives of
Psychiatric Nursing (2016), http://dx.doi.org/10.1016/j.apnu.2016.04.013
CONCLUSION
This study shows that DVAW is an important problem in Turkey just
as it is all around the world, and the high rates of every type of violence
are striking. The study finding is in agreement with the literature and
The Turkey DVAW Research Report (2015).
It can be said that the studies on the subject increase after the year
2010, that most of the studies were performed on a sufficient sample
on women who apply for first step medical services in the Middle Ana-
tolian Region, that the types of violence examined were questioned
through questionnaires formed by researchers instead of standardized
forms, that the type of violence examined in most of the studies were
identified and questioned in a detailed manner, and that most of the
studies include only violence throughout marriage. The highest preva-
lence belonged to verbal violence followed by physical, emotional, eco-
nomic, and sexual violence, respectively. Regarding women who
undergo violence, low educational and economic level, living in rural
areas, early marriage, unwanted/unapproved marriage, dissatisfaction
with marriage, too many people living in the house, applying violence
to offspring, having a history of violence, having a history of family
violence, having sexual and gynecological problems were determined
to be significant risk factors. Spouses with low educational levels who
have a history of violence, gamble, use alcohol, and smoke were found
to resort to violence more; and women were found to identify reasons
regarding spouses or the environment as reasons for violence, discuss
the emotional results of violence more, and mostly cope with violence
by acceptance.
Nurses and midwives play unique roles in counseling and leading
the women about legal rights and coping strategies for DVAW. Through
counseling nurses and midwives will be able to create changes in atti-
tudes relating to the acceptance of violence. In addition, nurses and
midwifes should enable women who suffer from violence and promot-
ing education, policy, attitude and preventing violence.
LIMITATIONS AND STRENGTHS
This study is limited to the 34 primary studies examined. There is not
a unified identification of violence types among the studies. Besides
being identified with different terms, there are also differences in
which behaviors the types of violence include. Alongside identifications,
methodological differences (questionnaires used, sample size and con-
stitution, the period of time in which violence was questioned, variance
in related variables) are important limitations. All of the studies are fo-
cused on past experiences of individuals. The fact that people can act
prejudiced about their past experiences is also another issue to be con-
sidered. In this context, the heterogeneity of primary studies is a limita-
tion and the number of studies is considered a strong side of our study.
Despite all limitations, this study has evaluated a respectively high
number of primary studies for one country.
RELEVANCE TO CLINICAL PRACTICE
Nurses and midwives should focus not only on women's disorders
but also on the difficulties the patient faces with regards to being a par-
ent. To have information about people who perpetrate violence and
having knowledge about the victims of violence will provide diagnose
easier. It may produce politics about prevention of violence.
STATEMENT OF AUTHORSHIP
Category 1
(a) Conception and design Neslihan Keser Özcan.
(b) Acquisition of data Sevil Günaydın, Elif Tuğçe Çitil.
(c) Analysis and interpretation of data Neslihan Keser Özcan.
 N.K. Özcan et al. / Archives of Psychiatric Nursing xxx (2016) xxx–xxx
Category 2
(a) Drafting the article Neslihan Keser Özcan, Sevil Günaydın, Elif
Tuğçe Çitil.
(b) Revising it for intellectual content Neslihan Keser Özcan.
Category 3
(a) Final approval of the completed article.
Neslihan Keser Özcan, Sevil Günaydın.
Acknowledgment
We have received help in statistical service. We would like to thank
the service for improving our papers' quality.
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Please cite this article as: Özcan, N.K., et al., Domestic Violence Against Women In Turkey: A Systematic Review And Meta Analysis, Archives of
Psychiatric Nursing (2016), http://dx.doi.org/10.1016/j.apnu.2016.04.013