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Health issues that arise after domestic violence experiences

People with mental disorders more likely to have experienced domestic violence, says a recent study, "Experiences of Domestic Violence and Mental Disorders: A Systematic Review and Meta-Analysis," published December 26, 2012 in the journal PLoS One. Little is known about the extent to which being a victim of domestic violence is associated with different mental disorders in men and women. So the researchers aimed to estimate the prevalence and odds of being a victim of domestic violence by diagnostic category and sex.

Health issues that arise after domestic violence experiences.
Anne Hart, photography.

It turns out that men and women with mental health disorders, across all diagnoses, are more likely to have experienced domestic violence than the general population, according to new research from King's College London's Institute of Psychiatry, in collaboration with the University of Bristol. Previous studies into the link between domestic violence and mental health problems have mainly focused on depression.

In this study, funded by the National Institute for Health Research (NIHR) and published December 26, 2012 in PLoS One, researchers reviewed data from 41 studies worldwide. Compared to women without mental health problems, women with depressive disorders were around 2 and a ½ times more likely to have experienced domestic violence over their adult lifetime (prevalence estimate 45.8%); women with anxiety disorders were over 3 and a ½ times more likely (prevalence estimate 27.6%); and women with post-traumatic stress disorder (PTSD) were around 7 times more likely (prevalence estimate 61.0%).

Women with other disorders including obsessive compulsive disorder (OCD), eating disorders, common mental health problems, schizophrenia and bipolar disorder were also at an increased risk of domestic violence compared to women without mental health problems

'Men with all types of mental disorders were also at an increased risk of domestic violence. However, prevalence estimates for men were lower than those for women, indicating that it is less common for men to be victims of repeated severe domestic violence.

This is the first study to look at a wide range of mental health problems in both male and female victims. And in another study by different researchers, results showed that people with mental disorders are more likely to have experienced domestic violence in their relationships. The question is whether domestic violence led to mental health problems or do people already experience mental health issues more often get into relationships where they experience domestic violence.

One question readers may ask is whether people marry or move in together in domestic relationships at the level of their self-esteem of the particular moment, such as when there's no place else to go or there's no way to be financially independent without the significant other...or whether it's an emotional dependence rather than strictly a financial situation. For example, are people with mental issues convinced no one else will partner/marry with them or whether they deserve someone with a different set of values or past history?

It's more common for women to be victims of repeated severe intimate violence

Professor Louise Howard, senior author of the study from King's College London (King's Institute of Psychiatry), says, according to a December 26, 2012 news release, People with mental disorders more likely to have experienced domestic violence, "In this study, we found that both men and women with mental health problems are at an increased risk of domestic violence. The evidence suggests that there are two things happening: domestic violence can often lead to victims developing mental health problems, and people with mental health problems are more likely to experience domestic violence."

This study is part of PROVIDE, a 5-year research program on domestic violence funded by NIHR. Professor Gene Feder, co-author of the study from the University of Bristol's School of Social and Community Medicine and chief investigator of PROVIDE says: "We hope this review will draw attention to the mental health needs of survivors of domestic violence and remind general practitioners and mental health teams that experience of domestic violence may lie behind the presentation of mental health problems."

Internationally, the lifetime prevalence of physical and/or sexual partner violence among women ranges from 15-71%

In the UK, the2010/11 British Crime Survey reported that 27% of women and 17% of men had experienced partner abuse during their lifetime, with women experiencing more repeated and severe violence than men. From March 2013, the UK Home Office will be amending its definition of domestic violence to include 16 and 17 year olds, and will be defined as "any incident or pattern of incidents of controlling, coercive or threatening behavior, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality. This can encompass, but is not limited to, psychological, physical, sexual, financial or emotional abuse."

Professor Howard concludes, according to the December 26, 2012 news release, People with mental disorders more likely to have experienced domestic violence, "Mental health professionals need to be aware of the link between domestic violence and mental health problems, and ensure that their patients are safe from domestic violence and are treated for the mental health impact of such abuse."

Why are mandatory arrests in domestic cases leading to early death in the victims (not the perpetrators) from causes related to heart disease or other chronic health conditions?

Could it be a type of broken-heart syndrome from emotional sadness at not having succeeded in a loving marriage or relationship, alienation, or fear of being victimized again in another relationship, being stalked, or being hurt? After all, if a person thinks of himself or herself as the victim, how can that person stay happy come rain or shine, poverty or employment, or other reasons most people say makes them happy, including close family ties? The saying goes happy wife, happy life, even if the husband is the victim, but in the new study, on more occasions, the wife is the victim and dies earlier, not the person arrested for doing the domestic violence deed.

Mandatory arrest in domestic violence call-outs causes early death in victims, says a recent study, "Increased homicide victimization of suspects arrested for domestic assault: A 23-year follow-up of the Milwaukee Domestic Violence Experiment (MilDVE)," published online December 2013 in the Journal of Experimental Criminology.

A University of Cambridge -Maryland team follows up on a landmark domestic violence arrest experiment and finds that African-American victims who had partners arrested rather than warned were twice as likely to die young in recent research. The new research from a major 'randomized' arrest experiment 23 years ago finds that domestic violence victims whose partners were arrested on misdemeanor charges – mostly without causing injury – were 64% more likely to have died early, compared to victims whose partners were warned but not removed by police.

Suspects randomly assigned to arrest died from homicide at a consistently higher rate than controls over a two-decade period, but the difference was not statistically discernible until the 22nd year after assignment. Long-term follow-up of randomized experiments is essential for detecting mortality differences that substantially affect cost–benefit analyses of criminal justice practices says the study's abstract.

Among African-American victims, arrest increased early mortality by a staggering 98% – as opposed to white victims, whose mortality was increased from arrest by just 9%.

The research also found that employed victims suffered the worst effects of their partners' arrests. Employed black victims with arrested partners suffered a death rate over four times higher than those whose partner received a warning at the scene. No such link was found in white victims.

The study's authors say that causes are currently unknown but such health impacts are consistent with chronic stress that could have been amplified by partner arrest. They call for a "robust review" of US and UK mandatory arrest policies in domestic violence cases. "It remains to be seen whether democracies can accept these facts as they are, rather than as we might wish them to be," says Professor Lawrence Sherman from Cambridge University's Institute of Criminology, according to the March 2, 2014 news release, "Mandatory arrest in domestic violence call-outs causes early death in victims." Sherman authored the study with his colleague Heather M. Harris from University of Maryland.

The findings will be announced in the US on Monday March 3, 2014 in Milwaukee and College Park, Maryland, and presented on Wednesday in London at the winter meeting of the Society of Evidence-Based Policing. Milwaukee Police Chief Edward Flynn, who supported the follow-up study, will join in the presentation and discussion of the results. The print edition of the study will be published in a forthcoming edition of the Journal of Experimental Criminology.

The vast majority of victim deaths following the Milwaukee Domestic Violence Experiment were not murders, accidents or suicides. The victims died from common causes of death such as heart disease, cancer and other internal illnesses

Previous studies have shown post-traumatic stress symptoms (PTSS) to be prevalent in victims of domestic violence, and that low but chronic PTSS has been linked to premature death from coronary heart disease and other health problems. The authors observed that the impact of seeing a partner arrested could create a traumatic event for the victim, one that raises their risk of death. An arrest may cause more trauma in concentrated black poverty areas than in white working-class neighborhoods, for reasons not yet understood.

The exact cause of these surprising results still remains a 'medical mystery,' the study's authors say. But, whatever the explanation, the harmful effects of mandatory arrest poses a challenge to policies that have "been on the books" in most US states and across the UK for decades, they say, according to the news release.

"The evidence shows that black women are dying at a much higher rate than white women from a policy that was intended to protect all victims of domestic violence, regardless of race," says Sherman, in the news release. "It is now clear that a pro-arrest policy has failed to protect victims, and that a robust review of these policies is urgently needed."

"Because all the victims had an equal chance of having their partners arrested by random assignment, there is no other likely explanation for this difference except that it was caused by seeing their partners arrested." The Milwaukee Domestic Violence Experiment took place between 1987 and 1988, with support from the National Institute of Justice, the research arm of the US Department of Justice. Sherman, who led the study from the University of Maryland, described it as "arguably the most rigorous test ever conducted of the effects of arrest."

The experiment enrolled 1,125 victims of domestic violence whose average age was 30 years. Each case was the subject of an equal probability 'lottery' of random assignment. Two-thirds of the suspects were arrested with immediate jailing. One-third received a warning at the scene with no arrest. In 2012-13, Sherman and Harris searched state and national records for the names of every one of the victims.

The record search showed that a total of 91 victims had died. Of these, 70 had been in the group whose partners were arrested, compared to 21 whose partners had been warned. This translated into 93 deaths per 1,000 victims in the arrest group, versus 57 deaths per 1000 in the warning group. For the 791 black victims (who were 70% of the sample), the rates were 98 per 1,000 for arrest, versus 50 per 1,000 for the warned group.

"These differences are too large to be due to chance," Sherman explains in the news release "They are also too large to be ignored." For more information, check out the site of the Society of Evidence Based Policing (Winter 2014 meeting). You also can follow the Society on the day of the meeting via Twitter at #SEBP2014. See the Events page for full details and for bookings. The society is made up of police officers, police staff, and research professionals who aim to make evidence based methodology part of every day policing in the UK.

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