Case vignettes: clinical realities

Preethi, a 29-year-old from Punjab, visited a Melbourne mental health service with panic disorder, insomnia and suicidality. Newly married and recently migrated, she felt isolated and controlled by her husband and mother-in-law. Both demanded more dowry and barred her from contacting her family, as a method of coercive additional payment. Following her suicide attempt, her husband threatened to withdraw her spousal visa sponsorship. Without family support or access to money, Preethi felt trapped and fearful.

Priya, 33, presented to an emergency department with injuries attributed to a ‘fall’. Over multiple visits, clinicians noted inconsistencies and escalating depressive symptoms. Eventually, she disclosed being assaulted after refusing to request money from her parents to buy her husband a house. She was on a temporary visa with no Medicare and caring for a young child. Her legitimate fear of deportation and child removal prevented her from disclosing the full extent of her abuse.

These anonymised composites are drawn from clinical settings and reflect recurring patterns. Many affected women do not use the language of ‘dowry abuse’, but describe coercion, fear, humiliation and financial exploitation. The key features and patterns of this abuse are:

1. (a) multiple perpetrators – intimate partner or extended family paradigm;

2. (b) regime of harassment, humiliation, surveillance and neglect;

3. (c) imprisonment in the home;

4. (d) domestic servitude;

5. (e) demands for gifts in the context of a marriage.

The mental health consequences of dowry abuse and the serious risk to life it poses demand attention.

Factors contributing to dowry abuse and mental health harm

Dowry abuse is a serious form of family violence, rooted in gender inequality and power dynamics that favour the groom over the bride. An Australian National Survey (2020) found that social norms, patriarchy and a sense of entitlement perpetuated by societal norms all play a role. ^{Reference O’Connor and Lee3} The expectation of receiving dowry often escalates into coercion, threatening the emotional and physical well-being of those involved. Family dynamics also play a part in escalating the severity of dowry abuse. Mothers-in-law were the most common family members reported as having made coercive demands for dowry. In the context of migration, the bride’s visa status may depend on dowry payment, leading to a ‘contract marriage’. In these circumstances, a woman’s failure to meet these demands can lead to her abandonment in a foreign country or her deception into returning her to her home country, which is a form of exit trafficking. ^{Reference Anitha, Roy and Yalamarty4} Even when women comply with demands to pay dowry, some are abandoned in their home country after marriage and their dowry confiscated. The Indian government, rather than seeking to protect these women, issued a warning leaflet to anyone contemplating marriage to a non-resident Indian. ⁵

Migration adds another layer of complexity. Migration is known potentially to lead to acculturative stress. A newly migrated bride, particularly one with language barriers and encountering coercive demands for money and gifts, faces increased risk of acculturative stress; the presence of social support is a crucial factor in preventing acculturative stress. This lack of support, in addition to coercive demands with or without physical violence, predisposes the dowry abuse victim to anxiety, depression, loneliness and suicidality. ^{Reference Schwartz, Unger, Zamboanga and Szapocznik6} Systemic structures and migration policies further disadvantage the immigrant bride. In contrast to this, the groom’s visa status and his authority as a sponsor enhance his entitlement and can exacerbate abuse.

Psychiatric implications

While there is a lack of systematic research, there is evidence linking dowry abuse with serious mental health outcomes. A population-based study conducted in India examined the association between socioeconomic, gender and health factors and common mental disorders among rural women, surveying a total of 5703 participants. The respondents were asked questions related to gender-based violence. Specifically, one question regarding the husband’s reaction to dowry asked: ‘How would you describe the reaction of your husband’s family to the cash, gifts, jewellery and other items you brought at the time of your marriage?’ The responses were divided into either ‘satisfied’ or ‘unsatisfied’. A significant association was found between dowry-related dissatisfaction by husbands and first-episode anxiety, depression and suicidality. ^{Reference Shidhaye and Patel7}

In Australia, there is evidence suggesting that migrant married women suffer higher rates of associated post-traumatic stress disorder in cases of dowry abuse. ^{Reference O’Connor and Lee3} Dowry abuse added to the acculturative stress of the newly migrated victims, and this in turn adversely impacted their mental health and contributed to panic attacks, anxiety, fear, suicidality and isolation from support networks. ^{Reference O’Connor and Lee3}

Identification and response

There are barriers to victims of dowry abuse seeking help. Shame and embarrassment, lack of culturally competent services, language barriers, lack of knowledge of systems, a weak immigration status and financial precarity all play a role. ^{Reference O’Connor and Lee3} All these factors also exacerbate psychological harm. When faced with a young South Asian married woman with mental health presentations or suicidality, clinicians need to adopt a high index of suspicion. Using the Cultural Formulation Interview format, ⁸ we recommend adopting the patient’s terms and phrases. We present below some key questions (adapted from the Cultural Formulation Interview).

1. (a) ‘Are there any kinds of stresses that make your [problem] worse, such as difficulties with money, or family problems?’

2. (b) ‘When did you get married? Was it an arranged marriage?’

3. (c) ‘Do you feel pressured by your partner or in-laws to provide money or gifts?’

4. (d) ‘How would you describe your husband’s or in-laws’ reaction to the dowry you gave?’

5. (e) ‘Has your partner threatened your immigration status or pressured you using your visa situation?’

6. (f) ‘Have you been threatened with being sent back to your country against your will or threatened with abandonment?’

7. (g) ‘Are you fearful that something bad may happen to you or your child if you don’t meet his family’s demands for a payment of dowry?’

If dowry abuse is suspected, clinicians should undertake comprehensive risk assessments focusing on suicidality, fear, threats to life, social isolation and risk of abandonment, and exit trafficking.

A safety plan should be made in collaboration with the individual – identification of safe contacts, secure storage of documents, access to emergency funds and arrangements for child safety and helpful telephone numbers, e.g. police. Inter-agency collaboration is often required, including referral to family violence services, legal advocacy groups, culturally specific women’s services or child protection services. To combat social isolation, contact with culturally specific women’s non-governmental organisations can promote safety and mental well-being. Ongoing care, including trauma-informed, culturally sensitive counselling, is essential. Documentation should clearly articulate the relationship between dowry demands and mental health symptoms; this will support the victim during any future legal proceedings or immigration implications. Coordination with primary care providers will better provide support and care.

Legal and policy implications

In India, the Dowry Prohibition Act prohibits the giving or receipt of dowry. Although this was a pioneering step, the legislation has failed to deliver its promise to prohibit dowry as a practice, due to weak enforcement. It is therefore imperative that other jurisdictions take steps to make dowry a prohibited practice and limit dowry abuse.

In Australia, dowry is considered synonymous with gift-giving and is considered a private family matter, not subject to legislation. However, the frequency of complaints associated with dowry demands, including violence, extortion and coercion, prompted a response from the Australian government. In 2018, the Australian Senate referred the practice of dowry and the incidence of dowry abuse to its Legal and Constitutional Affairs References Committee for inquiry, and prepared a report. ^{Reference O’Connor and Lee3} The report made multiple recommendations: for example, the introduction of a ‘women at risk visa’ and the insertion of dowry abuse in the Family Law Act 2025. As a result, the Family Law Act 2025 includes a definition of dowry abuse under economic abuse. ⁹ The ‘women at risk visa’ recommendation has not been implemented.

On the contrary, in the UK there is currently no statutory definition of ‘dowry abuse’ and the practice of giving or receiving a dowry is not prohibited. In addition, there is also no definition of ‘honour’-based abuse that could capture ‘dowry abuse’ within its scope. ^{Reference Anitha, Roy and Yalamarty4}

As a first step, the UK should consider adopting legislative reform similar to that in Australia. In addition, the UK and Australia should amend their migration laws to recognise a ‘woman-at-risk’ visa, which provides a woman facing dowry abuse with a critical pathway to safety. Furthermore, governments need to fund public education and raise awareness of dowry abuse and its serious physical and mental health consequences.

In addition, recognising trans-national abandonment as a form of family violence will protect women and allow victims to seek out public services without risking their visa status.

Public health and prevention

Dowry abuse represents a largely hidden form of family violence associated with significant yet under-recognised mental health consequences. In host countries such as Australia and the UK, it has relevance as a transnational issue with implications for public health systems. Policy and legislative frameworks in these settings intersect with health-sector responses. Education and training for mental health practitioners will save lives. Further research may assist in clarifying mental health impacts and informing clinical and preventive frameworks.