Violence against people with intellectual disabilities is a broad, highly complex issue that generates debate when it is addressed [8]. This is understandable when we consider that violence encompasses various factors that increase the vulnerability of victims, among them age. Age as a social marker suggests a global tendency for adolescents and young people to be vulnerable to interpersonal violence, which is one of the main causes of premature death, injury and disability among this demographic group [9]. It is estimated that more than 200,000 deaths occur each year among the 10–29 age group, with homicides ranking fourth among the causes of death [9, 10]. Added to this is the susceptibility to acts of violence against young people and children, especially people with disabilities, who are around 70% more likely to be abused than other people [10].
Therefore, children and young people with disabilities face higher rates of abuse, including sexual abuse, compared to their peers without disabilities. A meta-analysis containing 16,831,324 children cites that those with disabilities had a high overall prevalence of violence (31.7%), with a probability of occurrence 2.08 times higher than in children without any type of disability(10). This is corroborated by the data in the table, which shows a high incidence of sexual violence among people between the ages of 10 and 19, but it should be borne in mind that there were a significant number of cases described as “ignored” or “blank” in relation to age and schooling, which makes it difficult to accurately state the age group most affected, as well as the schooling of the victims, which can lead to a distortion of reality.
Researchers say that incompleteness (filling in fields such as “ignored” or left “blank”) when filling in compulsory notification forms causes damage to the proper planning of actions and measures to tackle diseases and illnesses, requiring constant training for notifiers and that these failures occur frequently in various types of illnesses and diseases, being justified by haste in filling in the document or by the notifier not considering that data as relevant at the time of care or consultation [11]. However, it is clear that people with low levels of education are more prone to interpersonal violence and often have less knowledge about the health services and protection they are entitled to.
With regard to the sex of the victim, it can be seen that for all types of violence, the proportion of female notifications was higher than the proportion of male notifications. In view of this, it is worth pointing out that gender inequality is one of the main social problems today. The creation and strengthening of patriarchy as a dominant social structure plays a fundamental role in this dynamic, since it privileges men over women, based on norms and practices associated with gender performance. These norms have been internalized and reproduced throughout history, influencing the perception of masculinity and femininity, in order to justify the acts of violence that become necessary to maintain or recover the socially established gender boundaries, providing the maintenance of male privileges [12]. It is also worth noting that in this study, heterosexual people appear to have been more victims of violence than those of other orientations. However, it is necessary to reflect that machismo is a structural phenomenon throughout the world, especially in Latin American countries, which can lead many people to self-declare as heterosexual in order to avoid exposure and judgment, even by health professionals [13].
With regard to marital status, although the prevalent situation in the data presented is single, the high number of victims in a consensual/married union is also relevant. Women with intellectual disabilities are more vulnerable to partner violence and other forms of abuse than women without comorbidities. Specifically, in the context of sexual violence, these women face various barriers related to sex education, including lack of knowledge, limited access to health care and social isolation and, as a result, are at greater risk of sexual violence [12, 13].
More violence against people with brown or black skin signals an important feature of structural racism in society, marked by social inequalities, serious insults and denial of the pain and suffering of black people(14). Its effects are felt in various conditions of intersectionality between race/color and health, such as in cases of violence. The findings indicate that black and/or brown people are more vulnerable to violence, as in other studies that have sought to establish epidemiological profiles of this problem in Brazil [14, 15]. It should be noted that the Brazilian Institute.
of Geography and Statistics (IBGE) considers brown people to be those with phenotypic traits of miscegenation between white and black people, black and indigenous people and indigenous people with white people, usually having a less dark skin color. Black people, on the other hand, are those with darker skin, with little or no phenotypic traits of miscegenation between people with different skin colors. Despite Brazil’s great miscegenation, there is a higher concentration of brown and black people in the north and northeast of the country [15].
The type of relationship between the perpetrator and the victim varies from case to case, and can include family members, friends, acquaintances or even strangers. One risk characteristic, which is not necessarily linked to the dynamic between the victim and the aggressor, is the constant need for victims to receive help from the perpetrators with activities of daily living, such as getting out of bed and eating, for example [16, 17].
A study carried out in Spain with 260 people with intellectual disabilities found that 59.2% of the sample had suffered physical or verbal abuse or neglect from their caregiver [16], although the link or degree of kinship referred to as “Caregiver” in the table of characteristics of perpetrators is not the most prevalent in the characteristics of perpetrators, the role of caregiver can be taken on by a family member or another person with direct social ties, such as friends or acquaintances. Thus, the main caregivers of people with intellectual disabilities are, for the most part, these same individuals with the closest social ties. Consequently, when an aggressor is also the caregiver, the harmful effect of the abuse is intensified by the victim’s dependence [17, 18]. An interesting piece of information in this study would be to investigate whether there were conflicting relationships between those involved (victim and aggressor), but the notification form did not contain this type of information.
With regard to the significant proportion of physical aggression caused by the person themselves, authors cite a possible association between intellectual disabilities and self-inflicted aggressive behavior, since self-injurious behavior is more prevalent in this population than in the general population(19–20). This behavior, regardless of whether it is observed in people with or without intellectual disabilities, is a cause for concern. It indicates suffering and a need for support, as well as being a signpost for the development of additional mental health problems, such as the risk of suicide. The cause of self-violent behavior in people with intellectual disabilities can vary, such as attempts to communicate something, or the display of anger or pain, both of which are not adequately addressed by family members or guardians. Depending on how the social circle reacts, this self-harm behavior is stimulated, leading the person to repeat it periodically [19].
Still within this sphere, as young people, people with intellectual disabilities may experience more neglect or abandonment by their social circle [20], converging to the same data presented in the.
table, which is the high rates of the type of violence “neglect and/or abandonment” being mostly provoked by the mother followed by the father. The birth of a child with a disability can trigger divorce and/or parental neglect on the part of one of the parents [21]. However, evidence indicates that children with some degree of intellectual disability tend to be abandoned by the father, while mothers report that they are the ones who are abandoned or subject to divorce by the parent [21, 22].
Furthermore, considering the maternal figure as the main caregiver, the existence of dysfunctions in family dynamics, inadequate coping strategies, and also women’s work overload not only adversely influence family dynamics, but also contribute to the deterioration of the mother’s physical, mental and social health [22, 23]. This may justify mothers’ violent impulses against their children with intellectual disabilities, especially in times of great tension or stress.
As found in a study carried out in Norway [8], in cases of sexual violence, people with intellectual disabilities are often unable to quickly identify signs of harassment or abuse, and the aggressors know this and take advantage of moments when the victim is alone, usually at home, or without possible witnesses nearby. Threats and/or forms of “bargaining” by the perpetrator prevent victims from reporting the abuse, contributing to further occurrences of the offense(8,10), as identified in this study.
The perceived ease with which people with intellectual disabilities are attacked means that perpetrators quickly move on from situations of harassment to rape. Researchers from the United Kingdom [24] highlight the importance of family members, health professionals and other professionals involved in the daily lives of people with intellectual disabilities keeping a constant eye out for changes in behavior, irritability, fear, body marks and other signs and symptoms that could indicate sexual violence. In addition, post-exposure prophylaxis protocols should be implemented quickly in cases of suspected sexual violence, such as rapid testing, updating vaccinations such as Hepatitis B, and offering medication to prevent Sexually Transmitted Infections and HIV infection [25, 26].
A scoping review carried out by Australian researchers, which aimed to identify the main strategies for preventing violence against people with intellectual disabilities, suggests that specific lines of care for people with intellectual disabilities who are victims of violence can contribute positively to reducing the problem and to secondary prevention [27]. In other words, the use of general lines of care may not help health professionals to take assertive measures for this population, especially those that guarantee human rights, a fact that was evidenced in this study, where there was a low number of referrals to social security, human rights and guardianship councils (in the case of children).
Limitations and implications for the advancement of science
This research has some limitations. These include the possibility of losing some cases due to the possible increase in late notifications of violence against people with intellectual disabilities after the collection period, given that the Notifiable Diseases Information System (SINAN) allows data to be included at any time; difficulties in inferring causality given that this is a cross-sectional study; the possibility of inconsistencies as this is secondary data from compulsory notification forms for violence; the regional nature of the facts, as there may be differences in the profiles identified in other regions of the country, given the large geographical size of Brazil and its multiculturalism, even though São Paulo is a metropolis with a very diverse population, with people from all regions of the country. However, these limitations do not compromise the findings because consolidated epidemiological data on the phenomenon is still scarce, especially in developing countries.
The study contributes to the advancement of science as it sheds light on a problem of great biopsychosocial magnitude in people with intellectual disabilities, who are highly vulnerable to violent practices. Recognizing the main characteristics of victims and perpetrators allows society and decision-makers to plan and implement violence prevention actions and policies, as well as assertive coping strategies for victims. It also expresses the need to reflect on intersectoral measures (education, health, public safety and others) to guarantee the human rights of people with intellectual disabilities and to expand the culture of peace and justice.