Kylee Trevillion

Experiences of domestic violence and mental disorders: a systematic review and meta-analysis.

Background Little is known about the extent to which being a victim of domestic violence is associated with different mental disorders in men and women. We aimed to estimate the prevalence and odds of being a victim of domestic violence by diagnostic category and sex. Methods Study design: Systematic review and meta-analysis. Data Sources: Eighteen biomedical and social sciences databases (including MEDLINE, EMBASE, PsycINFO); journal hand searches; scrutiny of references and citation tracking of included articles; expert recommendations, and an update of a systematic review on victimisation and mental disorder. Inclusion criteria: observational and intervention studies reporting prevalence or odds of being a victim of domestic violence in men and women (aged ≥16 years), using validated diagnostic measures of mental disorder. Procedure: Data were extracted and study quality independently appraised by two reviewers. Analysis: Random effects meta-analyses were used to pool estimates of prevalence and odds. Results Forty-one studies were included. There is a higher risk of experiencing adult lifetime partner violence among women with depressive disorders (OR 2.77 (95% CI 1.96–3.92), anxiety disorders (OR 4.08 (95% CI 2.39–6.97), and PTSD (OR 7.34 95% CI 4.50–11.98), compared to women without mental disorders. Insufficient data were available to calculate pooled odds for other mental disorders, family violence (i.e. violence perpetrated by a non-partner), or violence experienced by men. Individual studies reported increased odds for women and men for all diagnostic categories, including psychoses, with a higher prevalence reported for women. Few longitudinal studies were found so the direction of causality could not be investigated. Conclusions There is a high prevalence and increased likelihood of being a victim of domestic violence in men and women across all diagnostic categories, compared to people without disorders. Longitudinal studies are needed to identify pathways to being a victim of domestic violence to optimise healthcare responses.

Domestic violence and severe psychiatric disorders: prevalence and interventions

BACKGROUND The lifetime prevalence of domestic violence in women is 20-25%. There is increasing recognition of the increased vulnerability of psychiatric populations to domestic violence. We therefore aimed to review studies on the prevalence of, and the evidence for the effectiveness of interventions in, psychiatric patients experiencing domestic violence. METHOD Literature search using Medline, PsycINFO and EMBASE applying the following inclusion criteria: English-language papers, data provided on the prevalence of or interventions for domestic violence, adults in contact with mental health services. RESULTS Reported lifetime prevalence of severe domestic violence among psychiatric in-patients ranged from 30% to 60%. Lower rates are reported for men when prevalence is reported by gender. No controlled studies were identified. Low rates of detection of domestic violence occur in routine clinical practice and there is some evidence that, when routine enquiry is introduced into services, detection rates improve, but identification of domestic violence is rarely used in treatment planning. There is a lack of evidence on the effectiveness of routine enquiry in terms of morbidity and mortality, and there have been no studies investigating specific domestic violence interventions for psychiatric patients. CONCLUSIONS There is a high prevalence of domestic violence in psychiatric populations but the extent of the increased risk in psychiatric patients compared with other populations is not clear because of the limitations of the methodology used in the studies identified. There is also very limited evidence on how to address domestic violence with respect to the identification and provision of evidence-based interventions in mental health services.

Barriers and facilitators of disclosures of domestic violence by mental health service users: qualitative study

BACKGROUND Mental health service users are at high risk of domestic violence but this is often not detected by mental health services. AIMS To explore the facilitators and barriers to disclosure of domestic violence from a service user and professional perspective. METHOD A qualitative study in a socioeconomically deprived south London borough, UK, with 18 mental health service users and 20 mental health professionals. Purposive sampling of community mental health service users and mental healthcare professionals was used to recruit participants for individual interviews. Thematic analysis was used to determine dominant and subthemes. These were transformed into conceptual maps with accompanying illustrative quotations. RESULTS Service users described barriers to disclosure of domestic violence to professionals including: fear of the consequences, including fear of Social Services involvement and consequent child protection proceedings, fear that disclosure would not be believed, and fear that disclosure would lead to further violence; the hidden nature of the violence; actions of the perpetrator; and feelings of shame. The main themes for professionals concerned role boundaries, competency and confidence. Service users and professionals reported that the medical diagnostic and treatment model with its emphasis on symptoms could act as a barrier to enquiry and disclosure. Both groups reported that enquiry and disclosure were facilitated by a supportive and trusting relationship between the individual and professional. CONCLUSIONS Mental health services are not currently conducive to the disclosure of domestic violence. Training of professionals in how to address domestic violence to increase their confidence and expertise is recommended.

Domestic violence and mental health

There are clear gender differences in the experience of domestic violence and associated mental health outcomes. There is also increasing evidence of chronic, severe and often long-term adverse mental health effects for victims. This paper explores these gender differences and the evidence on how mental health care services should respond to domestic violence. The authors argue that any strategy to reduce the burden of womens mental health problems should include efforts to identify, prevent or reduce violence against women.

Prevalence of experiences of domestic violence among psychiatric patients: systematic review

BACKGROUND Domestic violence has been linked with many mental disorders, including anxiety, depression, post-traumatic stress disorder, eating disorders and psychosis. AIMS To estimate the prevalence (adult lifetime and past year) of different types of domestic violence experienced by men and women receiving psychiatric treatment. METHOD In a systematic review, a search of 18 electronic databases was supplemented by hand searching, citation tracking and updating a recent systematic review of criminal victimisation in psychiatric populations. Two reviewers independently extracted data and appraised study quality. RESULTS Forty-two studies were included. The median prevalence of lifetime partner violence reported in high-quality papers was 30% (interquartile range (IQR) 26-39) among female in-patients and 33% (IQR 21-53) among female out-patients. Among male patients, one high-quality study reported a lifetime prevalence of 32% across mixed psychiatric settings. No study included a control group. CONCLUSIONS Psychiatric patients experience a high prevalence of domestic violence but there is limited information on family (non-partner) domestic violence, the prevalence of emotional abuse and the extent of risk compared with non-psychiatric controls.

Prevalence and risk of experiences of intimate partner violence among people with eating disorders: A systematic review

OBJECTIVES To estimate the prevalence and risk of lifetime and past year intimate partner violence (IPV) among males and females with eating disorders. METHODS Systematic review. We searched 15 electronic databases, supplemented by hand searching, citation tracking, updating a review on victimisation and mental disorder and expert recommendations. RESULTS Eight papers were included, involving 6775 females and 4857 males. Individual studies reported that eating disorders are associated with a high prevalence and increased odds of lifetime IPV among both males and females. Evidence is lacking on eating disorder and past year IPV, on whether associations between eating disorder and IPV vary by type of IPV, and temporality. DISCUSSION More research is needed to investigate the strength and nature of the association between eating disorders and IPV, including with regards to the direction of causality between eating disorders and IPV, and whether associations are mediated by childhood abuse.

Human Trafficking and Health: A Survey of Male and Female Survivors in England

OBJECTIVES To investigate physical and mental health and experiences of violence among male and female trafficking survivors in a high-income country. METHODS Our data were derived from a cross-sectional survey of 150 men and women in England who were in contact with posttrafficking support services. Interviews took place over 18 months, from June 2013 to December 2014. RESULTS Participants had been trafficked for sexual exploitation (29%), domestic servitude (29.3%), and labor exploitation (40.4%). Sixty-six percent of women reported forced sex during trafficking, including 95% of those trafficked for sexual exploitation and 54% of those trafficked for domestic servitude. Twenty-one percent of men and 24% of women reported ongoing injuries, and 8% of men and 23% of women reported diagnosed sexually transmitted infections. Finally, 78% of women and 40% of men reported high levels of depression, anxiety, or posttraumatic stress disorder symptoms. CONCLUSIONS Psychological interventions to support the recovery of this highly vulnerable population are urgently needed.

Disclosure of domestic violence in mental health settings: A qualitative meta-synthesis

Abstract Little is known about how psychiatric services respond to service users’ experiences of domestic violence. This qualitative meta-synthesis examined the healthcare experiences and expectations of mental health service users experiencing domestic violence. Twenty-two biomedical, social science, grey literature databases and websites were searched, supplemented by citation tracking and expert recommendations. Qualitative studies which included mental health service users (aged ≥ 16 years) with experiences of domestic violence were eligible for inclusion. Two reviewers independently extracted data from included papers and assessed quality. Findings from primary studies were combined using meta-synthesis techniques. Twelve studies provided data on 140 female and four male mental health service users. Themes were generally consistent across studies. Overarching theoretical constructs included the role of professionals in identifying domestic violence and facilitating disclosures, implementing personalized care and referring appropriately. Mental health services often failed to identify and facilitate disclosures of domestic violence, and to develop responses that prioritized service users’ safety. Mental health services were reported to give little consideration to the role of domestic violence in precipitating or exacerbating mental illness and the dominance of the biomedical model and stigma of mental illness were found to inhibit effective responses. Mental health services often fail to adequately address the violence experienced by mental health service users. This meta-synthesis highlights the need for mental health services to establish appropriate strategies and responses to domestic violence to ensure optimal care of this vulnerable population.

The Response of Mental Health Services to Domestic Violence: A Qualitative Study of Service Users’ and Professionals’ Experiences

PURPOSE: Despite numerous policies advocating for routine enquiry of abuse by mental health professionals, it is not known if such enquiry is acceptable to service users and clinicians. Furthermore, limited evidence exists on clinicians’ response to domestic violence. This study aims to explore the acceptability of routine enquiry and experiences of responding to domestic violence from service user and professional perspectives. METHODS: A qualitative study design was used to conduct individual interviews with a purposive sample of community mental health service users (n = 24) and professionals (n = 25). Thematic analysis was employed to establish superordinate and subordinate themes, which were transformed into conceptual maps. RESULTS: All service users considered routine enquiry about domestic violence in mental health settings to be acceptable but a small minority of professionals did not. Service users described positive experiences of help seeking, including receiving acknowledgement for the abuse and support for their multiple needs, and negative experiences, including nonvalidating responses from clinicians following disclosure, discrimination, and an absence of support from services. Main themes for professionals included difficulties in assessment and management of domestic violence, reporting requirements, and unclear referral pathways. CONCLUSIONS: To respond to the needs of mental health service users experiencing domestic violence, services need to articulate a clear care and referral pathway.

Recent intimate partner violence among people with chronic mental illness: findings from a national cross-sectional survey

Background People with mental illness are at increased risk of intimate partner violence (IPV) victimisation, but little is known about their risk for different forms of IPV, related health impact and help-seeking. Aims To estimate the odds for past-year IPV, related impact and disclosure among people with and without pre-existing chronic mental illness (CMI). Method We analysed data from 23 222 adult participants in the 2010/2011 British Crime Survey using multivariate logistic regression. Results Past-year IPV was reported by 21% and 10% of women and men with CMI, respectively. The adjusted relative odds for emotional, physical and sexual IPV among women with versus without CMI were 2.8 (CI = 1.9–4.0), 2.6 (CI = 1.6–4.3) and 5.4 (CI = 2.4–11.9), respectively. People with CMI were more likely to attempt suicide as result of IPV (aOR = 5.4, CI = 2.3–12.9), less likely to seek help from informal networks (aOR = 0.5, CI = 0.3–0.8) and more likely to seek help exclusively from health professionals (aOR = 6.9, CI = 2.6–18.3) Conclusions People with CMI are not only at increased risk of all forms of IPV, but they are more likely to suffer subsequent ill health and to disclose exclusively to health professionals. Therefore, health professionals play a key role in addressing IPV in this population.