Up until now, there has been confusion whether the mental illness or the abuse came first and very few previous studies have been able to demonstrate the direction of the relationship.
This new study is the first of its kind in the UK to clearly show that the relationship runs both ways and the key findings were:
- those experiencing domestic abuse are nearly three times as likely to develop mental illness
- women who are experiencing domestic abuse are also nearly three times more likely to have a history of mental illness
- this is the first study to show the link between domestic abuse and serious mental illness (bipolar and schizophrenia)
- there is a huge discrepancy found between the abuse reported in GP practices and the national data, showing significant under reporting.
The study, published in the British Journal of Psychiatry, found that not only was there a higher chance of developing mental illness after experiencing domestic abuse, but those with mental illness were more likely to go on to experience further domestic abuse.
Using medical records from UK GP surgeries between 1995 and 2017, researchers have been able to build a narrative of women within the large database before and after experiencing domestic abuse.
The authors identified 18,547 women who had experienced domestic abuse, recorded by their GP.
They compared these women to a control group of 74,188 similarly aged women who had not had experience of domestic abuse recorded.
It is the first of its kind in the UK because it is a cohort study, which is a study where people are followed up over time from the point where they have experienced trauma until the point they develop mental illness.
During the final year of the study in 2017, the reported prevalence of domestic abuse was only 0.5% for women in the database.
However, the Office for National Statistics estimates this figure should be closer to in 1 in 4 women experiencing domestic abuse at any point in their lifetime.
How violence increases the risk
Women who have experienced domestic violence or abuse are at a significantly higher risk of experiencing a range of mental health conditions including post-traumatic stress disorder (PTSD), depression, anxiety, substance abuse, and thoughts of suicide.
In situations of domestic violence, an abuser’s outburst is commonly followed by remorse and apology.
But this “honeymoon” period usually ends in violence and abuse.
This cycle means women are constantly anticipating the next outburst.
Women in these situations feel they have little control, particularly when the abuse is happening in their own home.
It’s no wonder living under such physical and emotional pressure impacts on mental and physical well-being.
One review of studies found the odds of experiencing PTSD was about seven times higher for women who had been victims of domestic violence than those who had not.
The likelihood of developing depression was 2.7 times greater, anxiety four times greater, and drug and alcohol misuse six times greater.
The likelihood of having suicidal thoughts was 3.5 times greater for women who had experienced domestic violence than those who hadn’t.
An Australian study of 1,257 female patients visiting GPs found women who were depressed were 5.8 times more likely to have experienced physical, emotional or sexual abuse than women who were not depressed.
Not only is domestic violence and abuse a risk factor for psychological disorders, but women who have pre-existing mental health issues are more likely to be targets for domestic abusers.
Women who are receiving mental health services for depression, anxiety and PTSD, for instance, are at higher risk of experiencing domestic violence compared to women who do not have these disorders.
It is apparent from this study, therefore, that domestic abuse is under-recorded by GPs.
It is imperative within the public sector to use all possible opportunities to detect abuse and to ensure at risk women have the chance to receive the support they need.
The association of poor mental health (depression and anxiety) after experiencing domestic abuse in women has been shown in other countries.
However, the extent of this has not been explored in a large population within the UK, and neither has the relationship between domestic abuse and serious mental illness (schizophrenia and bipolar disorder).
Researchers found that experiencing domestic abuse led to a doubling of risk of developing anxiety, and a tripling of risk of developing depression and serious mental illness even when accounting for other factors that lead to mental illness.
It was clear at the starting point of the study that 49.5% of women who had presented to their GP with domestic abuse had already had some form of mental illness diagnosed by the GP, compared to the control group of whom 24.0% had a pre-existing diagnosis of mental illness.
After accounting for other factors that could influence the likely development of mental illness and domestic abuse, this translated in a nearly triple risk of domestic abuse survivors having had a mental illness before they were included in the study.
The authors then excluded these patients who had mental illness at the start of the study and followed up the remainder of patients to ascertain their risk of developing a new mental illness.
The research raises several important questions and recommendations. Considering how common domestic abuse is, the public mental health burden that follows such abuse is vast within the UK.
There needs to be a greater focus on the implementation of a public health approach to protect women against abuse.
For those who have experienced abuse, we need to promote the delivery and implementation of services which aim to reduce the follow-on effects of abuse on mental wellbeing.
We already know that we are poor at identifying survivors of domestic abuse.
We know there is a strong association between domestic abuse and mental illness.
We can conclude, then, that we are missing an opportunity to screen for domestic abuse in women who present with mental illness to the GP.
There is also a role for the police.
The police are more likely to encounter domestic abuse survivors than GPs, so if the police informed GPs more about domestic abuse exposure, that could be a way of improving the recording of abuse and providing an opportunity to put in place prevention strategies to prevent the onset of mental illness.
Dr. Joht Singh Chandan, Academic Clinical Fellow in Public health at the University of Birmingham and Special Detective Constable of West Midlands Police said:
“In our study, we have been able to show the significant burden of mental illness attributable to domestic abuse within the UK.
Considering how common domestic abuse is, it is important to understand how strongly the two are connected and consider whether there are possible opportunities to improve the lives of women affected by domestic abuse.
We need a clear public health approach to prevent the violence and abuse of very vulnerable women.”
Dr. Beena Rajkumar, Co-chair of the Women’s Mental Health Special Interest Group, Royal College of Psychiatrists said, “As a frontline psychiatrist working with women with severe mental illness, I am all too aware of the devastating impact domestic abuse has on mental health, and I work with survivors every day.
This study highlights the two-way relationship between abuse and mental illness, including serious mental illness, and carries a very important warning that we are missing opportunities to detect abuse that is happening all over the country today.
Screening and recording of domestic abuse needs to be a clear priority for public services so that more effective interventions for this group of vulnerable women can urgently be put in place.”
More information: Elisabeth Mahase. Women who experience domestic abuse are three times as likely to develop mental illness, BMJ 2019; 365:l4126. doi: doi.org/10.1136/bmj.l4126
Journal information: British Journal of Psychiatry , British Medical Journal (BMJ)
Provided by University of Birmingham
