Impact of consecutive COVID-19 lockdowns on GP referrals of women experiencing domestic abuse in England and Wales

To curb COVID-19, three periods of severe physical distancing measures (‘lockdowns’) were imposed by the Government throughout 2020 and 2021 in England and Wales: between 23 March and 1 June 2020 (68 days), 5 November 2020 and 2 December 2020 (27 days) and between 6 January and 8 March 2021 (61 days). These lockdowns resulted in societal changes, including full or part-time school and workplace closures, and reduced community mixing.

The pandemic also necessitated a change in clinical consultations in primary care, with a shift from predominantly face-to-face to mostly remote consultations (telephone, digital and video), complicating the provision of care and support, including safeguarding. The lockdowns made it harder for people to disclose domestic violence and abuse (DVA) to health professionals, as online consultations can form barriers to support.

Long and enforced lockdowns can make it harder to disclose DVA and can have a detrimental impact on DVA victim-survivors and their families. Previous studies suggest that the COVID-19 pandemic and its lockdowns have led to an increase in DVA incidence. Refuge, the organisation running the 24-hour national DVA helpline in England, reported that calls surged by 60% during 2020 compared with the previous year. There is, however, scarce evidence on the impact of consecutive lockdowns over a period of almost 2 years on referrals from primary care to DVA support services in England.

The research team, led by Dr Jasmina Panovska-Griffiths and others including VISION researchers Professor Gene Feder and Dr Estela Capelas Barbosa, evaluated the impact of the three successive national lockdowns on the referrals from general practice (GP) to the Identification and Referral to Improve Safety DVA services. Their study, Interrupted time series and non-linear regression analyses to evaluate the impact of the three consecutive COVID-19 national lockdowns on the general practice referrals of women experiencing domestic violence and abuse in England and Wales, is the first to evaluate the continual impact of the COVID-19 pandemic and the three consecutive national lockdowns in 2020 and 2021 on DVA referrals. The researchers also explored the relationship between stringency of lockdowns and number of DVA referrals.

Anonymised data on daily referrals, interrupted-time series and non-linear regression quantified the impact of the three national lockdowns over 2020 and 2021 comparing analogous periods in the 2 years before and after, reporting incidence rate ratios, 95% Confidence Intervals and p values. Time spent at home and workplace visits over the lockdown periods were quantified as proxies for the stringency of the different lockdowns.

The first national lockdown in early 2020 led to a reduced number of referrals to DVA services. Over the second and the third lockdown, there was a possible increase in the number of referrals. The first national lockdown was more stringent (58% decline in workplace visits; 22% increase in time spent at home) than the second (34% decline in workplace visits; 14% increase in time spent at home) or the third (18% decline in workplace visits; 18% increase in time spent at home).

Increased freedom of movement alongside easier access to GP services during the two latter, less stringent, lockdowns compared with the first, stringent, lockdown could have contributed to the different trends in referrals. The research team determined that ensuring access to primary care and adequate and continuing provision of specialist support for people experiencing DVA is important during national emergencies. Further research, coproduced with DVA survivors and DVA agencies, is necessary to establish and evaluate the most appropriate support during both potential future national lockdowns and other systemic closures (eg, school holidays).

Recommendation

More stringent systemic closures will lead to a reduced number of referrals to a specialist DVA programme, while more relaxed system closures may result in increased referrals. This highlights the importance of ensuring adequate access to support, such as primary care, where people can safely disclose DVA and be referred to service providers during system closures, regardless of the stringency.

For further information: Please contact Jasmina at jasmina.panovska-griffiths@queens.ox.ac.uk

To cite: Panovska-Griffiths J, Szilassy E, Downes L, Dixon S, Dowrick A, Griffiths C, Feder G, Capelas Barbosa E. Interrupted time series and non-linear regression analyses to evaluate the impact of the three consecutive COVID-19 national lockdowns on the general practice referrals of women experiencing domestic violence and abuse in England and Wales. BMJ Public Health. 2025;3:e002408. https://doi.org/10.1136/bmjph-2024-002408

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