Sian Oram

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.

Characteristics of trafficked adults and children with severe mental illness: a historical cohort study

BACKGROUND Evidence regarding the mental health needs of trafficked people is limited; however, prevalence of depression and post-traumatic stress disorder is high among trafficked people who are in contact with shelter services. We aimed to investigate the sociodemographic and clinical characteristics of trafficked people with severe mental illness. METHODS We did a historical cohort study of trafficked people in contact with secondary mental health services in South London, UK, between Jan 1, 2006, and July 31, 2012. We searched and retrieved comprehensive clinical electronic health records for over 200 000 patients from the Case Register Interactive Search database to identify trafficked patients. A matched cohort of non-trafficked adults was generated by simple computer-generated random selection of potential controls for each case within the parameters of matching criteria. We extracted data on sociodemographic and clinical characteristics and abuse history, and used multiple imputation to deal with missing data. We fitted logistic regression models to compare trafficked and non-trafficked patients. FINDINGS We identified 133 trafficked patients, including 37 children. 78 (81%) of 96 adults and 25 (68%) of 37 children were female. 19 (51%) of 37 children were trafficked for sexual exploitation. Among both adults and children, the most commonly recorded diagnoses were post-traumatic stress disorder, severe stress, or adjustment disorder (27 adults [28%] and ten children [27%]) and affective disorders (33 adults [34%] and ten children [27%]). Records documented childhood physical or sexual abuse among trafficked adults (41 [43%]) and children (28 [76%]), and adulthood abuse among trafficked adults (58 [60%]). Trafficked adults were more likely to be compulsorily admitted as a psychiatric inpatient than non-trafficked adults (adjusted odds ratio 7·61, 95% CI 2·18-26·60; p=0·002) and had longer admissions (1·48, 1·01-2·15; p=0·045). No association was found between trafficking status and either adverse pathway into care (adjusted odds ratio 0·91, 95% CI 0·40-2·05; p=0·82) or substance misuse problems (0·55, 0·27-1·17; p=0·12). INTERPRETATION Severe mental illness in trafficked people is associated with longer admissions and high levels of abuse before and after trafficking. Evidence is needed on the effectiveness of interventions to promote recovery for this vulnerable group. FUNDING Department of Health Policy Research Programme.

Human trafficking and health: a cross-sectional survey of NHS professionals' contact with victims of human trafficking.

Objectives (1) To estimate the proportion of National Health Service (NHS) professionals who have come into contact with trafficked people and (2) to measure NHS professionals’ knowledge and confidence to respond to human trafficking. Design A cross-sectional survey. Setting Face-to-face mandatory child protection and/or vulnerable adults training sessions at 10 secondary healthcare provider organisations in England, and meetings of the UK College of Emergency Medicine. Participants 782/892 (84.4%) NHS professionals participated, including from emergency medicine, maternity, mental health, paediatrics and other clinical disciplines. Measures Self-completed questionnaire developed by an expert panel. Questionnaire asks about prior training and contact with potential victims of trafficking, perceived and actual human trafficking knowledge, confidence in responding to human trafficking, and interest in future human trafficking training. Results 13% participants reported previous contact with a patient they knew or suspected of having been trafficked; among maternity services professionals this was 20.4%. However, 86.8% (n=679) reported lacking knowledge of what questions to ask to identify potential victims and 78.3% (n=613) reported that they had insufficient training to assist trafficked people. 71% (n=556), 67.5% (n=528) and 53.4% (n=418) lacked confidence in making appropriate referrals for men, women and children, respectively, who had been trafficked. 95.3% (n=746) of respondents were unaware of the scale of human trafficking in the UK, and 76.5% (n=598) were unaware that calling the police could put patients in more danger. Psychometric analysis showed that subscales measuring perceived knowledge, actual knowledge and confidence to respond to human trafficking demonstrated good internal consistency (Cronbachs αs 0.93, 0.63 and 0.64, respectively) and internal correlations. Conclusions NHS professionals working in secondary care are in contact with potential victims of human trafficking, but lack knowledge and confidence in how to respond appropriately. Training is needed, particularly for maternity staff, on how to identify and respond to victims’ needs, including through making safe referrals.

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.

Violence against women and mental health.

Violence against women is widely recognised as a violation of human rights and a public health problem. In this Series paper, we argue that violence against women is also a prominent public mental health problem, and that mental health professionals should be identifying, preventing, and responding to violence against women more effectively. The most common forms of violence against women are domestic abuse and sexual violence, and victimisation is associated with an increased risk of mental disorder. Despite clinical guidance on the role of mental health professionals in identifying violence against women and responding appropriately, poor identification persists and can lead to non-engagement with services and poor response to treatment. We highlight that little research has been done on how to improve identification and treatment of victims and perpetrators in contact with mental health services, but that mental health services could play a major role in primary and secondary prevention of violence against women.

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.

Recent physical and sexual violence against adults with severe mental illness: a systematic review and meta-analysis

Abstract People with severe mental illness (SMI) have high prevalence of lifetime victimization, but little is known about the extent and risk of recent domestic/sexual violence. The objective was to synthesize evidence on prevalence, odds, and risk factors for recent violence against people with SMI, with a focus on domestic and sexual violence. Relevant studies were identified through literature searches in Medline, Psychinf, Embase (for studies published in 2010–2015), and through existing systematic reviews (for studies published in 2000–2014). The review included 30 studies (with 16 140 SMI participants), including six on domestic violence and 11 on sexual violence. Prevalence of recent domestic violence ranged from 15–22% among women and from 4–10% among men/mixed samples; with little evidence on risk compared with the general population. Median prevalence of sexual violence was 9.9% (IQR = 5.9–18.1%) in women and 3.1% (IQR = 2.5–6.7%) in men; with 6-fold higher odds of victimization compared with the general population. There was little evidence on risk factors for domestic or sexual violence. In conclusion, people with SMI have a high prevalence of recent domestic and sexual violence, but little is known about risk factors for these violence types, or extent of domestic violence victimization compared to the general population.

Labour trafficking among men and boys in the greater mekong subregion: Exploitation, violence, occupational health risks and injuries

Background Men comprise nearly two-thirds of trafficked and forced labourers in common low-skilled labour sectors including fishing, agriculture and factory work. Yet, most evidence on human trafficking has focused on women and girls trafficked for sex work, with scant research on trafficked men and boys. Methods We analyse survey data from the largest systematic consecutive sample of trafficked people collected to date to describe the prevalence of violence, occupational health risks and injuries and associated factors. Participants were labour-trafficked men and boys using post-trafficking support services in Thailand, Cambodia and Vietnam. Findings Data are presented on 446 males aged 10–58. Men and boys were mainly trafficked for fishing (61.7%), manufacturing (19.1%) and begging (5.2%). Fishermen worked extensive hours (mean 18.8 hours/day, SD 5.9) and factory workers worked on average 11.9 hours/day (SD 2.9). 35.5% of male survivors had been injured while trafficked; 29.4% received no personal protective equipment (e.g. gloves). The most commonly reported injuries among all males were deep cuts (61.8%) and skin injuries (36.7%), injuries for which fewer than one-quarter reported receiving medical care. Six fishermen lost body parts, none of whom received medical care. Most males (80.5%) had no or very few rest breaks. One-third (37.8%) experienced severe violence. Work-related injuries were associated with severe violence (AOR 3.44, CI:1.63–7.26), being in the fishing sector, (AOR 4.12, CI:2.39–7.09) and threats (AOR 2.77, CI:1.62–4.75). Experiencing any violence was associated with threats (AOR 26.86, CI:14.0–51.23), being in the fishing sector (AOR 18.53, CI:8.74–39.28) and fluency in language of destination country (AOR 0.39, CI:0.20–0.75). Conclusion This study highlights the abuse and extreme occupational hazards suffered by trafficked men and boys. Occupational health and safety interventions are urgently needed to protect male migrant labourers working in high-risk sectors, particularly fishing.

Suitability of measurements used to assess mental health outcomes in men and women trafficked for sexual and labour exploitation: a systematic review

Trafficking is a global human rights violation with multiple and complex mental health consequences. Valid and reliable mental health assessment tools are needed to inform health-care provision. We reviewed mental health assessment tools used in research with men and women trafficked for sexual and labour exploitation. We searched nine electronic databases (PsycINFO, Ovid Medline, PubMed, Embase, Assia, the Web of Science, Global Health, Google Scholar, and Open Grey) and hand-searched the reference lists of relevant identified studies. Seven studies were included in this Review. Six of the studies screened for post-traumatic stress disorder, depression, and anxiety; one study screened for harmful use or abuse of alcohol and used a diagnostic tool to assess post-traumatic stress disorder, depression, and anxiety. Two studies included men in their sample population. Although the reported prevalence of mental health problems was high, little information was provided about the validity, reliability, and cultural appropriateness of assessment tools. Further research is needed to determine which assessment tools are culturally appropriate, valid, and reliable for trafficked people.

Informal caregiving and intimate relationships: the experiences of spouses of UK military personnel

Aim Currently, there is no research available on the experiences of spouses providing informal care to wounded, injured or sick (WIS) UK military personnel. The aim of this study was to fill this gap by investigating the relationship experiences of non-military partners caring for WIS UK military personnel. Methods Spouses of WIS military personnel (n=25) completed telephone interviews with the research team. The data were transcribed and analysed using thematic analysis. The transcripts were cross-coded and checked for inter-rater reliability. Results Six major themes were identified: (1) communication between couples, (2) adverse family environment, (3) reintegration, (4) intimacy, (5) financial uncertainty and (6) transition from partner to caregiver. Conclusions Partners caring for injured/ill military personnel appear to be at risk of experiencing personal distress caused by impaired relationship functioning, which may lead to diminished physical and mental well-being. Partners of WIS military personnel experience significant levels of distress and burden associated with caregiving in the form of arguments with the military partner, problems in reintegration and a lack of physical and emotional intimacy.