As one of the most common forms of violence, stalking has devastating impacts on cardiovascular health, experts say.
Women who have experienced stalking were 40% more at risk of developing cardiovascular disease, according to a US study.
Restraining orders increased CVD risk even more, with occurrence 70% higher than in women who had not obtained one.
More than 66,000 women in the Nurse’s Health II study, one of the largest investigations of risk factors for chronic diseases in women, answered a comprehensive questionnaire in 2001 and were followed up for 20 years.
Enrolment in the study started in 1989 but all women who reported cardiovascular incidents before the survey were excluded from this study.
About 6% of women reported obtaining a restraining order, and more than half of those also experienced stalking.
Nearly 12% of the overall cohort reported being stalked – a quarter of whom also obtained a restraining order.
This amounted to nearly 2000 women who had experienced both stalking and obtaining a restraining order.
The study used restraining orders as an indicator of violence severity and found that women who reported both stalking and restraining orders showed the highest risk of CVD compared to women who reported neither exposure.
According to the Australian Institute of Health and Welfare, one in five women have experienced stalking since the age of 15, equating to two million women in the 2021-2022 period.
The study reported the current prevalence of stalking in the US population as one in three women.
Restraining order equivalencies vary by Australian state, but the NSW Bureau of Crime Statistics and Research reported over 100,000 apprehended violence orders (AVOs) in place in NSW alone as of October 2024.
The number of AVOs that were initiated increased by more than 30% from the 2019/20 period to the 2023/24 period.
In the study, more than 40% of all the participants also reported intimate partner violence (IPV), and nearly three in four women who experienced stalking also reported IPV.
Of women who were stalked, more than half reported a current or former spouse or significant other as the perpetrator.
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Around 15% of restraining orders were taken out against non-partners, and around 1% of women had taken out restraining orders against both a spouse and a non-partner.
Researchers explained that their results were in line with previous reports on the cardiovascular health implications of IPV but found that many women experienced stalking and obtained restraining orders against non-partners.
The cardiovascular health consequences of non-contact forms of violence such as workplace sexual harassment have previously been identified but are less studied than contact forms of violence like sexual assault, study authors noted.
Researchers believed stalking had not been previously examined specifically in relation to women’s CVD risk, despite its prevalence.
The study did not have details regarding the context of being stalked or what led to restraining orders, but they used a narrow definition of stalking similar to that used in the National Violence Against Women Survey.
Stalking in the study context was based predominantly on non-contact behaviours, for example unsolicited letters.
Non-contact forms of violence may be viewed as less severe yet are prevalent and can be chronic, researchers said, citing data which showed that stalking lasted an average of 22 months.
The average length of stalking exposure, the often-arduous nature of obtaining a restraining order, combined with the violence itself may create a substantial period during which women may feel a lack of control over their lives and fear for their safety, researchers explained.
Covariates for violence and CVD which were accounted for in the study included childhood abuse, depressive symptoms, BMI, health behaviours such as smoking, health conditions such as type two diabetes, sociodemographic factors, somatotype at age five, parental CVD history or education level and medications including menopausal hormone therapy.
The cohort had a median age of 46 at the time of completing the questionnaire and 93% were white.
