Women and men who have suffered abuse by an intimate partner are twice as likely to self-harm


Published in The Lancet Psychiatry, a new study is the first to show that intimate partner violence (IPV) is strongly associated with self-harm and suicidality in both men and women, and across all ages in England.

While IPV is a recognized risk factor for psychiatric disorders, there had previously been little evidence on IPV and self-harm and suicidality.

Led by the Violence and Society Centre at City, University of London, in collaboration with the University of Manchester, University of Leicester, University College London, and the University of Bristol, the study was an analysis of results from the Adult Psychiatric Morbidity Survey (APMS) conducted face to face with over 7,000 adults, in 2014/5.

A nationally representative cross-section of households in England were interviewed, capturing information on gender, age, socioeconomic status, ethnicity and regional location.

Study participants were asked about experience of physical violence and sexual, economic, and emotional abuse from a current or former partner, and about suicidal thoughts, suicide attempts, and self-harm.

The study found that 27 percent of women and 15 percent of men had experienced IPV at some point in their life, confirming that women are far more likely than men to experience violence from a partner. People with experience of IPV were more likely to live in more deprived neighborhoods and to have also experienced many other adversities in their lives.

However, the associations between IPV and self-harm and suicidality remained strong even when these other factors were adjusted for.

After adjusting for experience of other adversities, as well as demographic and socioeconomic factors, the study found that people who had ever experienced IPV in their lives, compared to those who had not, had in the previous year:

  • over twice the risk of self-harming without suicidal intent
  • almost twice the risk of having suicidal thoughts
  • almost three times the risk of attempting suicide

If any IPV had been experienced within the previous year, then the risks were even higher.

Particularly elevated rates of self-harm, suicidal thoughts, and suicide attempts were found in those who were ever subjected to sexual and emotional IPV, those who ever experienced physical injury from IPV, and those who had experienced multiple forms of IPV, which indicates that the more types of IPV someone is exposed to, the higher the risk they are of self-harm and suicidality.

Sally McManus, Senior Lecturer in Health in the Violence and Society Centre and the School of Health Sciences, City, University of London, and first author of the study, said, “There is a high likelihood that someone presenting to services in suicidal distress is a victim of intimate partner violence (IPV). Health, social care, and welfare professionals need to ask people who have self-harmed or are at risk of suicide if they are experiencing IPV, and professionals should be prepared – and supported – to act accordingly.”

Dr. Estela Barbosa, Senior Research Fellow in the Violence and Society Centre, City, University of London, and a co-author, said, “Intimate partner violence is common in England, especially among women. The gender gap was widest for sexual IPV, which was about ten times more common in women than men, and this IPV type was associated with particularly high odds of self-harm and suicidality.”

Dr. Duleeka Knipe, Population Health Sciences at Bristol Medical School, University of Bristol, Bristol, and co-author, said, “Strategies for violence reduction should form part of individual-level suicide risk assessment and safety planning, and they should feature in national suicide prevention strategies. Interventions designed to reduce the prevalence and duration of IPV might protect and improve the lives of people at risk of self-harm and suicide.”

Effectiveness of Treatments for Adverse Effects of Intimate Partner Violence
Intimate Partner Violence (IPV) is a public health problem. It entails aggressive and violent, physical, sexual, verbal, and psychological acts by an intimate partner (Breiding et al., 2014; CDC, 2019). One in four women has reported experiencing partner violence at some point in their lifetime (Breiding et al., 2014; CDC, 2019). Over a third of women (36.4%) experience psychological aggression and about 41% of female survivors experience some form of physical injury during their lifetime (NISVS, 2012). Acute injuries including bruises, fractures, sensory damage, and internal injury, in addition to long term ailments such as muscle-skeletal issues and metabolic issues, are significantly more common among the victims of IPV than non-victims (Krug et al., 2002; Kilpatrick et al., 2003; Karakurt et al., 2017; Liu et al., 2020).

Mental health problems are also highly prevalent among the victims of IPV (Karakurt et al., 2014; Oram et al., 2017). Victims frequently report experiencing a broad range of Post-Traumatic Stress Disorder symptoms (Schnurr and Green, 2004; Afifi et al., 2009; World Health Organization, 2013; Akyazi et al., 2018). Past research also reports the association between IPV and an increased likelihood of clinical depression and suicide attempts (Mapayi et al., 2012; Akyazi et al., 2018). Comorbidities of multiple mental health issues are also common such as depression, anxiety, and PTSD among IPV victims (Schnurr and Green, 2004; World Health Organization, 2013). IPV also affects victims economically due to challenges in finding employment lost productive days, and difficulty in accessing the available resources adding to their stressors (Ford-Gilboe et al., 2009).

Researchers and clinicians developed numerous treatment programs to improve the wellbeing of victims. Initially, local shelters were provided these programs to prevent further violence and improve safety (Berk et al., 1986). Researchers found these shelter-based interventions to be beneficial for the victims in improving their current situation (Clevenger and Roe-Sepowitz, 2009). In addition, advocacy services in shelters play an important role in victims’ life satisfaction by helping them to navigate community resources (Sullivan and Bybee, 1999).

Treatment programs vary in their goals, structures, and main approach as well as delivery methods such as the domestic violence shelters, community mental health agencies, and hospitals. These programs draw from a multitude of therapy models such as cognitive-behavioral therapy (CBT), mindfulness, motivational interviewing, and expressive writing. Treatment modalities based on the CBT approach focuses on changing cognitive distortions in addressing the potential issues (Butler et al., 2006), motivational approaches focus on building intrinsic motivation to change behaviors (Rollnick and Miller, 1995), stress management approaches focus on improving coping skills to deal with stressors (Nam et al., 2020) and mindfulness-based approaches focus on improved awareness to reduce depressive and anxiety symptoms (Evans et al., 2008; Piet and Hougaard, 2011).

Additionally, patients who discuss, share, and write their traumatic experiences and intrusive memories are found to have better mental health outcomes and a greater reduction in PTSD, perceived stress, and depressive symptoms (Brewin et al., 2010). Furthermore, victims receiving psychoeducational materials and advocacy interventions report higher scores with their mood and behavior, lower depressive symptoms, and more social support (Tiwari et al., 2010).

The psychosocial wellbeing of survivors is multi-faceted, and many outcomes including mental and physical health, social support, and self-efficacy are critical to the wellbeing of a survivor. However, although many different interventions exist to treat survivors of IPV, less is known about the effectiveness of these interventions. Prior systematic reviews and meta-analysis focused on the screening of IPV (Nelson et al., 2012; O’Doherty et al., 2014) or the effects of IPV on specific populations, such as pregnant women (Hill et al., 2016) and women who suffer from substance abuse (Devries et al., 2014). These studies do not specifically explore multiple critical outcomes on the psycho-social wellbeing of the victims of IPV. For this purpose, we performed a systematic review and meta-analysis to investigate the effectiveness of interventions designed to improve the psycho-social wellbeing of survivor victims and their related comorbidities.

reference link: https://www.frontiersin.org/articles/10.3389/fpsyg.2022.793021/full

Original Research: Open access.
Intimate partner violence, suicidality, and self-harm: a probability sample survey of the general population in England” by Sally McManus et al. The Lancet


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