University of Birmingham

Academics at the University of Birmingham have identified a significant association between mental illness and domestic abuse in UK women.

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. 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.”

For more information please contact:

1. Emma McKinney, Communications Manager (Health Sciences), University of Birmingham, tel: +44 (0) 121 414 6681, or contact the press office on +44 (0) 7789 921 165.
2. Olivia Clark, Public Affairs Communications Officer, Royal College of Psychiatrists, 020 3701 2540 or 07860 755896 out of hours

• The University of Birmingham is ranked amongst the world’s top 100 institutions. Its work brings people from across the world to Birmingham, including researchers, teachers and more than 6,500 international students from over 150 countries.
• Chandan et al (2019). ‘The association between IPV and mental illness’. The British Journal of Psychiatry

• Authors of this research were: University of Birmingham's College of Dental Sciences: Dr Joht Singh Chandan, Dr Tom Thomas, Dr Caroline Bradbury-Jones, Dr Rebecca Russell, Dr Krishnarajah Nirantharakumar, Professor Julie Taylor and Professor Siddhartha Bandyopadhyay, Professor of Economics and Director of the Centre of Crime, Justice and Policing The Department of Economics at the University of Birmingham.

• In this study, the researchers were only able to review the GP patient records of female domestic abuse survivors because there were too few male abuse survivors’ records available for sufficient analysis.  It is not clear as to whether this is due to a lack of recording of male abuse by clinicians or fewer men reporting abuse. The researchers, who applaud the current work undertaken by GPs to identify domestic abuse, said more public health policies are needed to ensure men feel able to come forward and seek support.

• The British Journal of Psychiatry (known as BJPsych) is a leading international psychiatric journal published on behalf of the Royal College of Psychiatrists by Cambridge University Press. It covers all branches of psychiatry, with a particular emphasis on the clinical aspects of each topic. The journal’s overriding concern is to improve the prevention, investigation, diagnosis, treatment, and care of mental illness, as well as the promotion of mental health globally.

• The Royal College of Psychiatrists is the professional medical body responsible for supporting over 18,000 psychiatrists in the UK and internationally. We set standards and promote excellence in psychiatry and mental healthcare. We lead, represent and support psychiatrists nationally and internationally to governments and other agencies. We aim to improve the outcomes of people with mental illness, and the mental health of individuals, their families and communities. We do this by working with patients, carers and other organisations interested in delivering high quality mental health services.

Authors of this research were: University of Birmingham's College of Dental Sciences: Dr Joht Singh Chandan, Dr Tom Thomas, Dr Caroline Bradbury-Jones, Dr Rebecca Russell, Dr Krishnarajah Nirantharakumar, Professor Julie Taylor and Professor Siddhartha Bandyopadhyay, Professor of Economics and Director of the Centre of Crime, Justice and Policing The Department of Economics at the University of Birmingham.

In this study, the researchers were only able to review the GP patient records of female domestic abuse survivors because there were too few male abuse survivors’ records available for sufficient analysis.  It is not clear as to whether this is due to a lack of recording of male abuse by clinicians or fewer men reporting abuse. The researchers, who applaud the current work undertaken by GPs to identify domestic abuse, said more public health policies are needed to ensure men feel able to come forward and seek support.

The British Journal of Psychiatry (known as BJPsych) is a leading international psychiatric journal published on behalf of the Royal College of Psychiatrists by Cambridge University Press. It covers all branches of psychiatry, with a particular emphasis on the clinical aspects of each topic. The journal’s overriding concern is to improve the prevention, investigation, diagnosis, treatment, and care of mental illness, as well as the promotion of mental health globally.