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Abstract

Background
Domestic abuse (DA) is a public health problem with wide-ranging impacts for victim-survivors and services responding to it. The purpose of the current study was to explore relationships between victim-survivors’ experiences of abuse, additional needs/vulnerabilities and sociodemographic characteristics, and physical and mental health outcomes and health care help-seeking behaviours following DA.

Methods
Secondary analysis was conducted using Women’s Aid Federation of England’s (Women’s Aid) case management and outcomes measurement system, On Track, the largest national dataset on DA. To understand the relationship between abuse types (physical, sexual, emotional, financial, coercive control, technology-facilitated abuse (tech abuse) and threats to kill), needs/vulnerabilities (disability; offending, drug and alcohol-related support needs; pregnancy, recourse to public funds and accessing by-and-for services) and health outcomes (perpetrator caused harm to or loss of unborn child, attempted strangulation, self-harm (disclosed), feeling depressed or suicidal, injury requiring GP treatment and injury requiring Accident and Emergency (A&E) treatment), we used a series of logistic regression models, controlling for potentially confounding variables (including accommodation status, sexual orientation and ethnicity). Stakeholders from Women’s Aid and five other third sector organisations input into the study design and interpretation of results.

Results
Ninety-six percent of victim-survivors accessing DA services (n = 77,785) were female. Almost half (41.24%) had felt depressed/suicidal, while 5.59% disclosed having self-harmed. Almost one quarter (23.41%) had suffered a strangulation attempt, and 2.54% had suffered harm to or loss of their unborn child caused by the perpetrator. Just under 10% had an injury requiring A&E treatment and slightly less (7.33%) had an injury requiring GP treatment. Associations with the type of abuse varied by health outcome, for example physical abuse followed by threats to kill were most strongly associated with attempted strangulation and injuries requiring GP and A&E treatment, whilst tech abuse was most strongly associated with self-harm and feeling depressed/suicidal. Vulnerabilities/needs were more consistently associated with health outcomes, with those with a disability; drug, alcohol or offending support needs, or living in temporary/unstable accommodation more likely to experience negative outcomes across the board, and almost all needs/vulnerabilities being associated with adverse mental health outcomes (with the exception of pregnancy and accessing specialist by-and-for services, which appeared to have a protective effect).

Conclusions
Our findings highlight the almost inevitable harms to mental health for victim-survivors of DA, the dangers of non-physical types of abuse such as threats to kill and tech abuse and the heightened risk of attempted strangulation. These findings have particularly important and timely implications for the training of health care professionals. Alongside improvements in health care settings, health care professionals, specialist support workers, researchers and policymakers must continue to explore more integrative and collaborative ways of working to further improve the response to DA and intervene before irreversible damage is done.

Publication Type:	Article
Additional Information:	This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Publisher Keywords:	Domestic abuse, health, help-seeking, mental health, specialist services, vulnerability
Subjects:	H Social Sciences > H Social Sciences (General) R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Departments:	School of Policy & Global Affairs School of Policy & Global Affairs > Violence and Society Centre
SWORD Depositor:	Symplectic Administrator

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