Central Institute of Mental Health Mannheim (ZI), University of Heidelberg, Germany
Central Institute of Mental Health Mannheim (ZI), University of Heidelberg, Germany
Correspondence: Dr Harald Dressing, Central Institute of Mental Health Mannheim (ZI), J 5, D-68159 Mannheim, Germany. Tel: +49 6211703 732; fax: +49 6211703 760; e-mail: dressing{at}zi-mannheim.de
Declaration of interest None. Funding detailed in Acknowledgements.
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ABSTRACT |
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Aims To examine lifetime and point prevalence rates of stalking, behavioural and psychological consequences for victims, and the impact of stalking on current psychological well-being in a German community sample.
Method A postal survey was conducted with a sample randomly selected from the population of a middle-sized German city; 679 people (400 women, 279 men) responded. The survey included a stalking questionnaire and the WHO-5 well-being scale.
Results Almost 12% of the respondents (n = 78, 68 women, 10 men) reported having been stalked. A multiple regression analysis revealed a significant effect of victimisation on psychological well-being.
Conclusions This study identified a high lifetime prevalence of stalking in the community. Effects on victims' psychological health are significant, suggesting that the phenomenon deserves more attention in future community mental health research.
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INTRODUCTION |
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METHOD |
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The survey included questions on demographic variables and a 51-item self-report stalking questionnaire on the experience of harassing intrusions. Respondents who indicated any incidence of harassment were asked to answer additional questions on the nature, duration and frequency of the intrusions, their relationship to the perpetrator, possible motives of the stalker, and behavioural and psychological responses to the stalking experience. The stalking questionnaire was adapted from an instrument used by Voss & Hoffmann (2002) in an ongoing study on stalking victims. This questionnaire contains items shown to be relevant by similar studies performed in English-speaking countries. It included a list of 18 possible harassing behaviours (e.g. unwanted communications by letters, e-mails, faxes or telephone calls, as well as following, loitering nearby, invading the victim's home, damage of property and sending of unsolicited goods).
All participants - irrespective of whether a victim of harassment or not - were asked to complete the WHO-5 Well-Being Index (World Health Organization, 1998). The WHO-5 is a psychometrically sound short scale for measuring positive psychological well-being (Bech, 2004). It consists of five items assessing positive mood, vitality and general interest over the past 2 weeks. The WHO-5 has also proved a good screening instrument for the detection of depression in the general population (Henkel et al, 2003; Loewe et al, 2004). The sum score of the WHO-5 ranges from 0 to 25; a score below 13 indicates poor well-being and represents an indication for testing for depression (World Health Organization, 1998). In the present study, the internal consistency of the scale was high (Cronbach's alpha=0.90).
In addition, all respondents completed a list with six items (coded yes/no) from the study by Voss & Hoffmann (2002), reflecting difficulties in setting boundaries and distinguishing oneself from others (psychological dependency scale). Examples are: it is difficult for me to say no; it is important for me what other people think of me; I often ask others for help.
Data analysis
Our definition restricted the presence of stalking to multiple episodes of
harassment that had to be present over a minimum of 2 weeks, involved more
than one form of intrusive behaviour, and provoked fear. As a first step, the
data were summarised descriptively. Lifetime incidence was calculated as the
percentage of participants who had experienced stalking at any time. Point
prevalence of stalking was calculated by considering only those victims who
reported being stalked at present.
Victims and non-victims were compared for several characteristics using
Pearson's 2-tests for analysing categorical data, and analyses
of variance (ANOVAs) for continuous data. A multiple regression analysis was
performed to assess the relative impact of being a stalking victim on
psychological health (WHO-5) by adjusting for further relevant
characteristics. All analyses were carried out using SPSS for Windows, version
10.1.
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RESULTS |
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Incidence of stalking
In total, 78 people (11.6%; 68 women, 10 men) from this community sample
claimed to have been subjected to repeated harassment at some point during
their life that met the stalking criteria listed above. Of the stalking
victims, 87% were women, whereas 86% of the stalkers were men. Nearly all of
the female victims (91%) were stalked by a man, whereas for male victims the
proportion of male and female stalkers was about equal (44% male stalkers,
2(1)=13.9, P <0.001).
The duration of stalking ranged from less than 1 month (17%, n=13) to 1 year and longer (24%, 19). Frequency of pursuing ranged from a few times (32%, 25), several times a month (8%, 6), several times a week (35%, 27), daily (9%, 7) to several times a day (16%, 12). The harassment was ongoing for 11 individuals (14% of the victims, 9 women and 2 men), corresponding to a point prevalence rate of 1.6%.
Relationships of stalkers and victims
In 76% (n=59) of cases the stalker was known to the victim, being
a prior intimate partner in 32% (25), an ex-partner of the current partner in
3% (2), a friend or acquaintance in 20% (16), a work colleague in 9% (7), a
client or customer in 1% (1), and a family member in 4% (3). The most frequent
motives of the stalkers, as assessed by the victims, were a desire for a
loving relationship (35%, 27), resumption of a former relationship (30%, 23),
jealousy, envy or distrust (32%, 25), revenge (27%, 21), and feeling hurt by
rejection (24%, 19) (multiple ratings were possible).
Stalking behaviours
Stalking victims reported a mean number of five different types of
harassment (s.d.=2.8). The most frequent types included unwanted telephone
calls (78%, n=61), loitering nearby (63%, 49), unwanted letters,
e-mails or faxes (50%, 39), following (38%, 30), approach via a third party
(36%, 28), standing in front of the door (33%, 26), silently hanging around
(24%, 19), leaving messages at doors (19%, 15), pursuing by car (19%, 15),
property damage (17%, 13), invading the home (15%, 12), sending unsolicited
goods (18%, 14), placing orders under the victim's name (10%, 8), and sending
offensive materials (9%, 7). Written messages contained statements of love
(50%, 39), abusive language or denouncements (47%, 37), threats (35%, 27) and
sexual content (24%, 19). Physical assaults were reported by 31%
(n=24) of victims, including physical restraint (24%, 19), beating
(12%, 9) and hitting with objects (9%, 7). Sexual harassment was reported by
42% (33) and 19% (15) had experienced sexual assaults.
Impact on the victims
A majority of victims (73%, n=57) reported that they had changed
their lifestyle in response to stalking. This involved changing their
telephone number, installing an answerphone (32%, 25), taking additional
security measures (17%, 13), changing residence (17%, 13) and changing
workplace (5%, 4). A report to the police was made by 20% of the victims, and
12% sought help from a lawyer.
Stalking victims described various physical and mental symptoms in response to stalking. These included agitation (56%, n=44), anxiety symptoms (44%, 34), sleep disturbances (41%, 32), stomach trouble (35%, 27), depression (28%, 22), headaches (14%, 11) and panic attacks (12%, 9). Aggressive thoughts against the stalker were prevalent in 31% (24) of the victims, and 39% (30) reported that they had become more suspicious of others; 18% (14) were on sick leave because of the impact of stalking. Finally, 24% (19) consulted a psychologist or a physician because of the distress experienced following the stalking.
Comparisons of stalking victims and non-victims
Although as a whole group stalking victims tended to be younger than
non-victims, an ANOVA with fixed factors gender and being
a stalking victim showed a significant interaction effect
(F1,645=4.79, P <0.03). Female victims had the
lowest mean age (38.4, s.d.=10.5), followed by female (42.6, s.d.=13.8) and
male non-victims (43.2, s.d.=13.3), whereas male victims represented the
oldest group (49.1, s.d.=16.0). Women were stalked more frequently than men
(17% v. 4%, 2(1)=29.1, P <0.001). In
contrast, people with more education (410 years) were equally affected as
those with less education (11.6% v. 11.9%,
2(1)=0.16,
NS). Individuals who reported being stalked scored higher on the psychological
dependency scale than those who did not (2.7, s.d.=1.4 v. 2.2,
s.d.=1.3, F1,666 10.8, P <0.001).
Impact of lifetime stalking on current psychological well-being
The WHO-5 Well-Being Index score of stalking victims was significantly
poorer than that of respondents without a stalking history (11.2, s.d.=6.4
v. 15.6, s.d.=5.6, F1,658=40.2, P
<0.001), resulting in an effect size d=0.77. On a categorical
level, 57% (n=44) of the victims, in contrast to 27% (157) of the
non-victims, scored in the pathological range of 12 and below
(2(1)=29.3, P <0.001).
A multiple regression analysis was conducted to identify the relative impact of lifetime incidence of stalking on current psychological well-being (WHO-5). Further variables entered into the model were age, gender, educational level and the dependency score. Results of the multiple regression analysis are summarised in Table 1. The model explained 12% (adjusted R2) of the variability in WHO-5 scores (F4,628=18.4, P <0.001). When entered simultaneously, the variables age, being stalked and psychological dependency remained highly significant predictors of psychological well-being, whereas gender and educational level did not explain further variance. Respective beta weights in Table 1 indicate that younger age, high levels of psychological dependency and being a stalking victim predict low levels of psychological well-being.
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DISCUSSION |
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Women were identified as perpetrators in only 14% of cases. This proportion closely resembles that found in other community studies (12%-13%), whereas in forensic samples the proportion of female perpetrators is known to be higher (Purcell et al, 2001). Furthermore, female victims were pursued almost exclusively by male stalkers (91%), whereas male victims were stalked by similar percentages of male and female stalkers, indicating that same-gender stalking is a predominant problem in males (Dressing et al, 2002).
Manifestations of stalking
Consistent with reviews by Spitzberg
(2002) and Sheridan et
al (2003), the present
study revealed that stalking is mainly a product of some form of prior
relationship. About 32% of the victims were pursued by prior intimate
partners, rendering the rejected stalker, who starts stalking
after the breakdown of a close relationship
(Mullen et al, 1999),
as the main problem. Sheridan et al
(2003) concluded that
ex-intimates probably comprise the largest subgroup of stalkers, which is
concordant with our results. In the present study, only 24.6% of stalking was
done by strangers, which is close to rates found in the literature. In a
meta-analysis of 50 studies, Spitzberg
(2002) found the proportion of
stalking by strangers to be 21%.
Stalkers seem to employ multiple stalking tactics. Victims in the present study experienced an average of five different methods of intimidation. A similar rate of six methods was found by Blaauw et al (2002), and Mullen et al (1999) reported that 63% of stalkers employed between three and five distinct methods. In the Australian study, victims were subjected to a mean of 2.8 stalking methods (Purcell et al, 2002). The most prevalent methods identified in our study (e.g. unwanted telephone calls, loitering nearby, following) correspond to Spitzberg's (2002) largest stalking categories of hyperintimacy and pursuit/surveillance.
Impact on the victims
Victims of stalking also run a high risk of being physically injured. In
the literature, rates of assault vary from 2.7%
(Zona et al, 1993) to
89% (Mechanic et al,
2000), with a mean rate of 33%
(Spitzberg, 2002). In the
present study, assaults involving physical restraint, beating or hitting with
objects occurred in nearly a third of cases, confirming the high risk of
experiencing violence in the context of stalking. Sexual pestering was also
frequent, and almost one in five victims had experienced sexual assaults.
The significant impact of stalking is demonstrated by the high percentage of victims reporting changes in lifestyle as a response to stalking behaviour, with a rate (73%) similar to that found in other studies (Pathé & Mullen, 1997; Purcell et al, 2002). Reviews on the impact of stalking conclude that it has deleterious effects on the victims' psychological health (Spitzberg, 2002; Sheridan et al, 2003). For example, affective symptoms such as anger, irritation, anxiety, nervousness and depression were reported with a mean prevalence of 58% by Spitzberg (2002). Pathé & Mullen (1997) found that up to 83% of their stalking victims exhibited increased levels of anxiety and depression, and 37% fulfilled the criteria for post-traumatic stress disorder according to DSM-IV (American Psychiatric Association, 1994). However, all the previous studies focused on highly selected samples of victims, with a majority of victims seeking help or being registered as a victim at some kind of institution. Nevertheless, in the present community-based study victims indicated rates of psychological and somatic health complaints in reaction to the stalking that come close to those reported for selected samples, with the most prevalent symptoms being agitation (56%), anxiety (44%), sleep disturbance (41%), nausea (35%) and depression (28%). Indicative of victims' suffering is also the fact that nearly a quarter sought help from a health professional in response to stalking.
Although a wide range of age groups has been reported to be vulnerable to pursuit (Blaauw et al, 2002), a majority of studies suggest that younger persons between the age of 18 and 30 years are at the highest risk (Tjaden & Thoenness, 1997). Our results indicate, however, that this may be particularly true for female but not for male victims. Future studies with larger samples should address this aspect in more detail.
In the present study, victims had higher scores than non-victims on a psychological dependency scale. Although persons with lower levels of independence might be at greater risk of becoming victims, it is at least as plausible that the prolonged experience of having been stalked undermines self-confidence and feelings of independence. However, the cross-sectional design of this study does not allow for any causal interpretations on the direction of this association. In addition, we are aware that our assessment was based on a very simple measure. Future research should include more comprehensive standardised assessments of person-related characteristics (as in Kamphuis et al, 2003).
Stalking and impaired psychological well-being
The present study is also the first to show that the lifetime prevalence of
being a stalking victim is associated with current impaired psychological
well-being. Although the vast majority of stalking victims indicated that the
stalking episode had ended at the time of the survey, they displayed
substantially lower scores on the WHO-5 Well-Being Index than non-victims. The
percentage of victims scoring in a pathological range (57%) comes close to
that reported by Kamphuis & Emmelkamp
(2001) and Kamphuis et
al (2003), who studied a
sample of 201 female victims, with more than 50% meeting the criteria for
clinically significant pathology according to the General Health Questionnaire
(Goldberg & Hillier, 1979).
An important finding of the present study was that the substantial association
between ever having been a stalking victim and current psychological distress
held true even when a number of variables connected with psychological health
were controlled for.
Limitations
There are also some limitations of this study. A clear limitation is the
low response rate of 34%. Although the age distribution of the responders was
very similar to that of the referring population, women were somewhat
overrepresented in the responder sample, limiting the generalisability of the
results with regard to male victims. A connected limitation is the postal
nature of the survey. High refusal rates in questionnaire studies are
suspected to lead to an overestimation of prevalence rates because victims are
more motivated to participate than non-victims
(Sheridan et al,
2003). Conversely, victims may experience such a survey as more
intrusive and therefore refuse to respond, potentially leading to an
underestimation of prevalence rates
(Purcell et al,
2002). In any case, respective systematic errors cannot be ruled
out completely within the framework of a postal survey study design. Finally,
the data collection was restricted to an urban area, and generalisation to
rural areas is not warranted. Despite these potential limitations, our
prevalence rates are strikingly consistent with those from other
community-based studies (Tjaden &
Thoenness, 1997; Budd &
Mattinson, 2000; Purcell
et al, 2002), as are the identified consequences for the
victims (Kamphuis & Emmelkamp
2001; Blaauw et al,
2002; Kamphuis et al,
2003).
Summary
The present community-based study is the first of its kind in Germany and
has yielded some important information on the prevalence and impact of
stalking. It confirms findings from the few existing larger epidemiological
studies from other countries, indicating a substantial incidence of stalking
in the community. Furthermore, the significant impact of stalking on the
victims' psychological health identified suggests that the phenomenon deserves
more attention in future community mental health research.
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Clinical Implications and Limitations |
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LIMITATIONS
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ACKNOWLEDGMENTS |
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Received for publication July 12, 2004. Revision received November 18, 2004. Accepted for publication November 24, 2004.
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