relationship affects the form and severity of GBV, with a focus on cases reported at the One Stop Crisis Center

(OSCC) in Sarawak General Hospital. A total of 139 adult victims were surveyed between March 2021 and

March 2023 using the World Health Organization's Violence Against Women Instrument (VAWI), which

measures psychological, physical, and sexual violence. The analysis revealed that the relationship with the

perpetrator significantly influenced the severity and type of violence experienced. Victims of intrafamilial

violence were more likely to report experiencing only one form of abuse, whereas those subjected to IPV were

more often exposed to multiple forms of violence. Although the demographic factors such as age, marital status,

and education level showed some associations with the patterns of abuse, the perpetrator relationship remained

the strongest predictor in this study. In fact, these findings highlight the importance of addressing GBV within

both intimate and familial contexts. Understanding the dynamics of different relationships can inform more

approximately 27 percent of women aged between 15 and 49 have experienced physical and/or sexual violence

by an intimate partner at least once in their lifetime [3], [4]. The COVID-19 pandemic further exacerbated this

issue, as lockdowns and economic instability contributed to a sharp rise in domestic violence cases. The

widespread nature of this violence, occurring behind closed doors and across social classes, led the United

Nations to describe it as a “shadow pandemic” [5]. This hidden crisis highlighted the importance of addressing

not only the prevalence of violence but also the social, relational, and structural factors that place certain

individuals at heightened risk.

Existing research highlights that GBV can take various forms, including psychological, physical, and sexual

abuse. These experiences are not uniform; they are often shaped by the nature of the relationship between the

victim and the perpetrator. While intimate partner violence (IPV) has received substantial attention in public

they cohabit or not, and applies to both heterosexual and same-sex relationships. In contrast, Malaysia’s

Domestic Violence Act [8] extends the definition of DV to include violence perpetrated by any member of the

household, such as parents, children, or siblings [9], [10]. This broader category, referred to in the literature as

intrafamilial violence (IFV), stems from structural power imbalances and may emerge at any point across the

life course [11], [12]. Some scholars view IPV as a subcategory of IFV. However, this study treats them as

analytically distinct in order to explore how the source of abuse, whether a partner or a family member, relates

to the form and frequency of violence experienced [13].

This research is grounded in the social-ecological model (SEM), which provides a holistic framework for

analyzing the multilayered factors that contribute to GBV. According to the SEM, violence does not occur in

isolation but is shaped by interacting factors at the individual, relational, community, and societal levels. At the

possessiveness, increasing the risk of repeated and escalating abuse. In contrast, violence within families may

result from caregiving stress, generational conflicts, or traditional hierarchies. For example, elder abuse or sibling

violence can reflect deeper structural and emotional tensions within families [6], [11], [12]. Marital status can

also serve as a proxy for relational complexity, with those in formal or long-term relationships often facing

greater challenges in leaving abusive situations due to shared responsibilities, legal ties, or social expectations

[15], [16], [17].

At the societal level, broader cultural beliefs, social norms, and legal frameworks play a defining role in how

GBV is recognized, reported, and addressed. In Malaysia, cultural ideals such as family honor and filial

obedience may discourage victims from disclosing abuse, particularly when the perpetrator is a family member.

Additionally, traditional gender roles and expectations related to caregiving and submission can normalize

the perpetrator is an intimate partner or a family member, particularly in the Malaysian context.

To address this gap, the present study investigates how different perpetrator relationships and victim

characteristics shape the patterns and severity of GBV reported at the One Stop Crisis Center (OSCC) in Sarawak

General Hospital (SGH). Specifically, this study examines the associations between demographic factors (age,

gender, marital status, and education), the type of perpetrator (IPV versus IFV), and the number of abuse forms

experienced as measured by the VAWI. By applying the social-ecological framework, this research aims to offer

a deeper understanding of the layered risks and protective factors that influence GBV outcomes. The findings

are intended to inform targeted interventions and policy responses that support victims and promote long-term

resilience within communities in Sarawak.

to data collection. Ethical approval for the study was granted by the Malaysian Medical Research and Ethics

Committee (MREC), under reference number NMRR-20-1437-54831.

The study adopted the World Health Organization’s Violence Against Women Instrument (VAWI) as its primary

measurement tool [22]. This instrument is widely recognized for its ability to capture the prevalence and severity

of different forms of violence. It includes 13 items distributed across three domains: physical violence (6 items),

psychological violence (4 items), and sexual violence (3 items). Each item assesses specific acts of abuse

experienced by the respondent, allowing for a nuanced analysis of both the type and intensity of GBV. Although

originally designed to evaluate intimate partner violence, the VAWI’s structure enabled it to be adapted for use

in assessing both IPV and intrafamilial violence (IFV) in this study.

The nature of the relationship between the victim and the perpetrator plays a crucial role in shaping both the

experience and complexity of violence. Research has consistently shown that violence inflicted by someone

emotionally or relationally close to the victim such as a partner, spouse, or family member tends to result in more

severe psychological trauma and often includes multiple, overlapping forms of abuse. These may include

physical, emotional, sexual, and economic violence [7], [23], [24]. Such relationships are frequently

characterized by ongoing interaction, power imbalances, emotional dependency, and a foundation of trust, all of

which contribute to the persistence and escalation of harm over time [18], [24]. Victims in these situations often

face significant barriers to seeking help, including fear of retaliation, social stigma, financial dependence, and

shared caregiving responsibilities [18]. Moreover, perpetrators who are family members or intimate partners

often exert control in several aspects of a victim’s life, making the abuse more pervasive and deeply embedded

recognize abuse, resist it, or seek help, especially in environments where violence is normalized or culturally

accepted. Furthermore, lower educational attainment is frequently associated with economic dependence and

limited mobility, which can make it harder for individuals to leave abusive relationships. In contrast, higher

levels of education have been shown to empower individuals by enhancing personal agency, increasing access

to employment opportunities, and improving the ability to negotiate power dynamics within relationships [15].

These factors contribute to a lower risk of experiencing severe or repeated violence. As a result, educational

Marital status is closely linked to patterns of vulnerability in both intimate partner and domestic violence.

Empirical studies have demonstrated that individuals who are married, cohabiting, separated, or divorced face a

significantly higher risk of experiencing multiple forms of abuse compared to those who are single or never

married [15], [16], [17]. These elevated risks are often rooted in complex dynamics, including power imbalances,

further investigation was conducted to explore how the severity and specific forms of gender-based violence

(GBV) varied between intimate partner violence (IPV) and intrafamilial violence (IFV). This analysis was based

on victim responses to the Violence Against Women Instrument (VAWI) and employed Fisher’s Exact and

Pearson’s Chi-Square tests. The findings are summarized in Table 2 and reveal notable differences in the patterns

of violence reported across these two contexts. Within the domain of psychological violence, certain forms were

significantly more prevalent among IPV survivors. Specifically, verbal insults that undermined self-worth and

acts of public humiliation were reported more frequently by those who had experienced IPV (p = 0.001). On the

other hand, experiences involving intimidation or threats such as shouting, threatening harm, or using fear-based

behaviors were reported at comparable rates in both IPV and IFV cases, with no statistically significant difference.

More distinct differences emerged in the area of physical violence. IPV victims were significantly more likely

factors on the number of violence types experienced, categorized as one, two, or three forms of violence. The

model as a whole was statistically significant, as indicated by the likelihood ratio test (χ² = 30.748, df = 16, p

= .014), suggesting that the predictors, when considered together, provided meaningful differentiation across

categories of violence severity. Among the predictors included, the relationship with the perpetrator was the only

variable that reached statistical significance (χ² = 15.137, df = 2, p < .001). This underscores the central

importance of victim–perpetrator dynamics in shaping the complexity of abuse. Victims who reported violence

by intimate partners or family members were more likely to experience multiple overlapping forms of abuse.

This result aligns with prior evidence that close relational ties often amplify risks of sustained, multifaceted

violence due to emotional dependency, power asymmetries, and repeated access to the victim.

Although other variables, including gender, age group, marital status, and education level, did not yield

in this sample, these variables contribute to a comprehensive model that reflects the multifactorial nature of

gender-based violence. Excluding them would risk oversimplifying the phenomenon and ignoring established

pathways documented in previous studies.

The Nagelkerke R² value of 0.243 indicates that the predictors in the model accounted for approximately 24.3

percent of the variation in the dependent variable. This represents a moderate and meaningful level of

explanatory power within the context of social and behavioral research [32]. As noted by [33], pseudo-R² values

The present study examined how sociodemographic characteristics and perpetrator–victim relationships

influence the forms and severity of gender-based violence (GBV). Conceptualizing violence as a continuum,

from experiencing a single form of abuse to multiple, overlapping forms, our findings suggest that the victim–

characteristics alone, but is deeply rooted in the relationships people are embedded in and the broader cultural

intimate partner or a family member, emerged as the strongest and most consistent predictor of violence severity.

conditions where abuse is more easily sustained and more difficult to escape. These dynamics, documented

across the literature [21], remind us that GBV is not simply an individual experience but a relational and

structural problem that reflects the interplay of power, trust, and vulnerability in everyday life.

For intimate partner violence (IPV), the majority of cases in this study involved female victims who were ever

married. This reflects deeply entrenched gendered power hierarchies within households, where decision-making

authority and financial control often rest with male breadwinners [21]. Such dynamics can foster environments

where women have less autonomy and greater vulnerability to coercion and abuse. Interestingly, the results also

showed that women with secondary education or higher were more likely to report IPV, a pattern consistent with

findings from other studies in Malaysia [23]. Education, therefore, appears to play a complex role. On one hand,

adults, are more likely to remain in the family home, where dependence on parents or siblings can increase the

risk of family-based abuse. Such experiences often carry consequences that extend far beyond the immediate

harm. Family violence can disrupt education, limit opportunities for personal development, and create lasting

barriers to economic independence. These disruptions frequently translate into long-term disadvantages, such as

reduced income and heightened vulnerability to poverty later in life [36]. In this way, IFV is not only an

expression of power within the family but also a mechanism that perpetuates inequality across the life course,

showing how structural vulnerabilities at both the individual and relational levels intersect to shape enduring

consequences.

Age appeared to play an important role in the bivariate analysis, where the chi-square test highlighted how

vulnerabilities shift across the life course. Younger adults, many of whom still lived with family members or

remain more vulnerable within intimate partnerships due to entrenched gender norms, economic dependence,

and social expectations, while men who experience violence may face additional stigma that discourages

disclosure. These findings emphasize the need for interventions that recognize gender as a critical dimension,

not as a stand-alone risk factor but as one that interacts with relationship dynamics and societal structures to

shape how violence is experienced and reported.

Ultimately, this study shows that the victim–perpetrator relationship is the most decisive factor shaping the

patterns and severity of GBV in Sarawak. While sociodemographic factors such as age, education, and marital

status help to frame who may be at risk, their influence becomes most meaningful when viewed through the

dynamics of intimate and familial relationships. A social-ecological perspective reminds us that GBV is not an

individual problem that begins and ends with a single victim or perpetrator; it is deeply embedded within families,

but a central determinant of violence complexity. Individual characteristics such as age, marital status, and

education influence vulnerability, but their effects are best understood through their interaction with relational

contexts.

Viewed through a social-ecological lens, these findings suggest that GBV is shaped by the interplay of factors

across multiple levels, covering individual, relational, family, and societal. At the individual level, education and

age intersect with vulnerability, while at the relational level, dependence and power asymmetries create sustained

opportunities for abuse. At the societal level, entrenched gender norms, stigma, and cultural expectations

continue to silence victims and normalize violence. Effective responses therefore require multi-level strategies

that target not only victims and perpetrators but also families, communities, and institutions. Prevention and

intervention must be adapted to the relational context of violence, acknowledging that the risks posed by intimate

partners may differ fundamentally from those posed by family members.