Women who suffer gender-based violence have a much higher-than-average lifetime risk of substance abuse disorders and other mental health disorders, according to a study in this week’s Journal of the American Medical Association.

The study included women who had suffered gender-based violence such as sexual assault, rape, intimate partner violence and stalking, Medical News Today reports. The study of 4,451 women conducted in Australia found a total of 1,218 women, 27.4 percent, reported experiencing at least one type of gender-based violence. Among women exposed to one type of gender-based violence, 23 percent reported a substance abuse disorder at some time in their lives.

Among women who had experienced exposure to three or four forms of gender-based violence, 47.1 percent had a lifetime substance abuse disorder, a more than 5-fold increased risk compared with women who did not suffer gender-based violence. Overall, 89.4 percent of these women reported some type of mental disorder, 11 times the rate of women who did not experience gender-based violence.