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Assisted dying bill: Safeguards against domestic abuse and coercion must be strengthened

One in four women and one in seven men in England and Wales have experienced domestic abuse. Coercive and controlling behaviours are core to domestic abuse. They result in loss of autonomy and independence and are intended to isolate and reduce self-worth. Such behaviours are common but hard for health professionals to detect.

If passed, the Terminally Ill Adults (End of Life) Bill will allow people who are terminally ill and expected to die within six months to request assistance to end their lives. VISION researchers Gene Feder, Elizabeth (Lizzie) Cook and Sally McManus have written an opinion published in The BMJ that calls for safeguards in the bill need to be strengthened to prevent coercion in the context of domestic abuse.

Assisted dying requires a careful consideration of the risks posed by domestic abuse and coercion. The current bill does not fully tackle specific safeguarding concerns for patients experiencing domestic abuse which can include economic, emotional, physical, and other forms of abuse from a partner or other family member. To safeguard against domestic abuse and associated coercion, Gene, Lizzie and Sally propose a set of principles that should be part of the UK bill.

  1. For doctors responding to any request for assisted dying, training must be extensive, specialist, in person, and backed up by referral pathways.  Independent domestic abuse advocates, with expertise in recognising coercive control, could contribute to assessment of assisted dying requests. 
  2. Commitments to confidentiality and data security must not obscure assisted dying decisions and the contexts in which they occur. The bill must ensure transparency.
  3. The bill must establish accountability. Transparent data about each stage of the approval process would also enable monitoring and regular scrutiny of the processes and outcomes of assisted dying legislation.
  4. Lawmakers must resist expansion. Dementia and mental health conditions are now being considered for eligibility. These are conditions prevalent in survivors of domestic abuse. The UK bill should include clauses that limit any expansion of scope to other conditions and situations.

To read the opinion piece: Safeguards against domestic abuse and coercion in the assisted dying bill must be strengthened

To cite: BMJ 2025;390:r1914

For further information, please contact Gene at gene.feder@bristol.ac.uk

Arms industry as a commercial determinant of health

Experts are urging the medical profession to confront the global arms industry as the UK and other NATO nations dramatically increase defence spending to counter growing global aggressions, one under-recognised aspect of security debates is the role of the arms industry. And as London prepares to host the world’s largest arms fair, Defence and Security Equipment International, health professionals must do more to resist the arms industry’s influence on government agendas and its damaging effects on human and planetary health.

Looking critically across this landscape, the BMJ has produced a new series examining the role of the arms trade in health and calling for more scrutiny of its health-harming activities and its unhealthy relationship with governments.

In the series, two VISION researchers, Professor Mark Bellis of Liverpool John Moores University and Professor Gene Feder from University of Bristol, with colleagues, lay out the direct and wider harms of arms and show how weapons manufacturers use commercial strategies to subvert public health agendas and shape discourse around security and violence.

They argue that, like the tobacco, alcohol, and fossil fuel industries, the arms industry should be seen as a commercial determinant of health, where corporate practices matter as much as products when considering how industries can harm health.

These practices include marketing, lobbying, funding of think tanks and universities, and forging close relationships with governments, which the industry uses to shape public policy and regulatory environments in its favour while deflecting responsibility for its contribution to perpetuating conflict, injuries, and death.

Mark, Gene and colleagues’ analyses suggest that examining these industry dynamics can help uncover both direct and systemic health harms and inform how health considerations should feature alongside defence and profit.

They acknowledge that this is a conceptual shift but say “it is also a call to action for health professionals including researchers, policy makers, and civil society to advocate for a reorientation away from design, distribution, and deployment for profit and towards global priorities of health, human rights, and peace.”

To access the entire BMJ Series : Arms industry as a commercial determinant of health | The BMJ

To access the analyses by Mark, Gene and their colleagues:

For further information, please contact Mark at m.a.bellis@ljmu.ac.uk

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What is tech abuse and how can we tackle it?

Drs Leonie Tanczer and Madeleine Janickyj of the University College London (UCL) Gender and Tech Research Lab and the VISION research consortium, developed a policy briefing, What is tech abuse and how can we tackle it?, with their colleagues at the Gender and Tech Research Lab and the UCL Policy Impact Unit.

Technology-facilitated abuse (tech abuse) refers to the deliberate (mis)use or repurposing of digital systems to coerce, harass, or abuse others. While it is most commonly associated with domestic abuse and stalking, it also occurs in professional and institutional contexts, as well as from strangers.

It is a widespread problem: in the UK, 1.4 million women experienced domestic abuse in 2023-24. In abusive intimate relationships, tech abuse can extend and intensify existing patterns of coercive control, leading to greater levels of harm. Abusers may, for example, send persistent, obscene, or threatening digital communications or track a partner’s movements via GPS or app surveillance. They may also restrict access to accounts, services, or finances.

Despite a shared understanding of tech abuse across sectors and stakeholders, a consensus remains lacking on its precise definition and scope. This definitional ambiguity hinders efforts to measure its prevalence and impact, ultimately limiting how effective prevention and intervention strategies can be.

Recommendations

Tackling tech abuse requires a whole systems approach and better measurement. Other recommendations include:

  • Enforce safety-by-design principles and mandatory abusability testing for technology products to proactively address potential misuse
  • Deepen understanding of perpetrator behaviour and motivations to inform prevention and intervention strategies
  • Leverage innovative methods, such as machine learning, to better understand and respond to tech abuse
  • Improve coordinated responses from police, frontline domestic abuse services, tech companies, and government/international bodies, backed by sufficient and sustainable funding
  • Future-proof policies and regulations, clarify responsibility, and determine accountability across different stakeholders
  • Stop the normalisation of Tech Abuse to support more victims/survivors to seek help, including through honest conversations around digital consent

To download: What is Tech Abuse and how can we tackle it?

To cite: Janickyj, M., Koukopoulos, N., Polamarasetty, A., Reed, J., & Tanczer, L. M. (2025). Policy Brief: What is Tech Abuse and how can we tackle it? Gender and Tech Research Lab, University College London.

For further information, please contact Maddy at m.janickyj@ucl.ac.uk

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Impact of verbal abuse as a child just as harmful as physical abuse

Globally, one in six children are estimated to suffer physical abuse within domestic and family relationships. As well as immediate health risks associated with the physical trauma of abuse, physical abuse can have lifelong impacts on mental and physical health and well-being. Thus, even as adults, individuals who have been physically abused as children show higher levels of anxiety and depression as well as more problematic alcohol and drug use.

As a source of toxic stress, verbal abuse, like physical abuse, may affect the neurobiological development of children, leading to immediate and long-term impacts on health and well-being. Like physical abuse, verbal abuse has also been linked with poor mental and physical health outcomes during childhood and across the life course. Increasingly, empirical evidence supports verbal abuse causing damage to child development.

For the study, Comparative relationships between physical and verbal abuse of children, life course mental well-being and trends in exposure: a multi-study secondary analysis of cross-sectional surveys in England and Wales, VISION researcher Professor Mark Bellis and his team, combined data from multiple studies measuring child abuse across England and Wales. They tested the associations with poorer mental well-being across the life course with experiencing physical abuse or verbal abuse as a child individually as well as the impact associated with combined exposure to both abuse types.

Their research showed that exposure to childhood physical or verbal abuse has similar associations with lower mental wellbeing during adulthood. In fact, results identified around a 50% increase in likelihood of low mental wellbeing related to exposure to either form of abuse. With regard to verbal abuse, children who experienced ridicule, threats or humiliation from a parent / guardian have a 64% higher chance of poor mental health as an adult. The researchers also discovered that whilst physical abuse reduces over time, verbal abuse increases.

Verbal abuse may not immediately manifest in ways that catch the attention of bystanders, clinicians, or others in supporting services with a responsibility for safeguarding children. However, as suggested here, some impacts may be no less harmful or protracted. The potential impact of verbal abuse should be better considered in policy, and parenting and child protection interventions. The potential role of childhood verbal abuse in escalating levels of poor mental health among younger age groups needs greater consideration.

Recommendation

Interventions to reduce child abuse, including physical chastisement, should consider both physical and verbal abuse and their individual and combined consequences to life course health.

To download: Comparative relationships between physical and verbal abuse of children, life course mental well-being and trends in exposure: a multi-study secondary analysis of cross-sectional surveys in England and Wales

To cite: Bellis MA, Hughes K, Ford K, et al. Comparative relationships between physical and verbal abuse of children, life course mental well-being and trends in exposure: a multi-study secondary analysis of cross-sectional surveys in England and Wales. BMJ Open 2025;15:e098412. http://doi:10.1136/bmjopen-2024-098412

For further information, please contact Mark at m.a.bellis@ljmu.ac.uk

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Violence in later life: Life course and physical and mental health trajectories

Research has demonstrated that violence is associated with worse health in older age. Most of the evidence, however, comes from cross-sectional studies. Research showing how health changes over time in people who have experienced lifetime violence is very scarce.

To address this gap, VISION researchers, led by Dr Anastasia Fadeeva with colleagues Dr Polina Obolenskaya, Dr Estela Capelas Barbosa, Professor Gene Feder and Professor Sally McManus, used seven waves of data from the English Longitudinal Study of Ageing (ELSA) collected between 2006 and 2019 (waves 3 to 9), to examine the associations between parental physical abuse in childhood and any physical or sexual violence across the life course, with the subsequent changes in depressive symptoms, the likelihood of probable depression, and long-standing limiting illness.

The team used a sample of 6171 participants aged 50 and over who answered all questions about violence exposure in wave 3 of ELSA, while information about their health was collected from wave 3 to 9.

The VISION study provides new evidence that health consequences are sustained throughout later life. Results showed that violence of different kinds predicts poorer physical and mental health in older age. Furthermore, the health disparities between victims and non-victims did not reduce over time. This was evident in both men and women.

The findings highlight the value of implementing violence prevention measures throughout the life course, not only to mitigate immediate consequences of violence and abuse but also to reduce the burden of ill health in older age. The results also underscore the need to identify modifiable risk factors such as violence in order to inform polices aiming to promote healthy ageing. More longitudinal data, including from administrative sources, are needed to further demonstrate the associations between different types of violence and health outcomes as people age.

Recommendation

Healthy aging could be improved by preventing violence across the life course. Reducing and addressing experiences of violence at a younger age could reduce the burden of – and inequalities in – poor health in later life.

To download: Violence across the life course and physical and mental health trajectories in later life: a 13-year population-based cohort study in England

To cite: Anastasia Fadeeva, Polina Obolenskaya, Estela Capelas Barbosa, Gene Feder, Sally McManus, Violence across the life course and physical and mental health trajectories in later life: a 13-year population-based cohort study in England, The Lancet Healthy Longevity, Volume 6, Issue 7, July 2025, 100738 https://doi.org/10.1093/bjc/azaf064

For further information, please contact Anastasia at anastasia.fadeeva@citystgeorges.ac.uk

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Online and offline stalking victimisation in the Crime Survey for England and Wales

Stalking is a global phenomenon described as a pattern of repeated, intrusive behaviours that cause fear, alarm, and distress in the victim/survivor. Over the past two decades, offline stalking, a repeated pattern of behaviours such as physically following a person, which causes fear and distress, has been complemented through online and digital means also known as cyberstalking. Cyberstalking includes the use of the internet, email, and/or systems such as geo-location trackers to further the perpetrators’ reach and amplify the feelings of harassment experienced by a victim/survivor. 

Technology-facilitated harassment is increasingly common, but there is a lack of longitudinal analysis quantifying cyberstalking and its impact on victim/survivors. To address this empirical evidence-based gap, VISION researchers Drs Madeleine Janickyj and Leonie Tanczer at University College of London and Dr Niels Blom at University of Manchester, examined Crime Survey for England and Wales (CSEW) data from the years 2012 to 2020 to provide the first nationally representative look at cyberstalking over the last decade. Their paper, Online and Offline Stalking Victimisation in the Crime Survey for England and Wales: Its Predictors and Victim/Survivors’ Views on Criminalisation, assesses which demographic groups are most likely to experience it across two countries of the United Kingdom (UK; for example, England and Wales) and also explores how these experiences affect the perception of the victim/survivors.

The analysis, involving weighted and multinomial logistic regression, revealed considerable differences between online and offline stalking behaviours. Cyberstalking is not as widespread, but is increasing in prevalence faster than its offline counterpart.

The researchers also assessed the relationship between perpetrators and victim/survivors and found that less than 50 per cent of cyberstalking victim/survivors had an existing relationship with their stalker. Moreover, various demographic groups, such as females, the LGB community, and younger participants, are more likely to be stalked via both online and offline means. While females are more likely to view what happened to them as a crime, the latter two (LGB and younger participants) more often perceive these experiences as wrong but not necessarily a crime. Although these experiences increasingly affect participants, they do not alter their perception of the event in the same way, exposing that these online experiences are thought of differently from those offline.

Recommendation

To further the analyses of cyber-enabled and cyberstalking, some adjustments could be made to the existing stalking experiences that participants are asked about. One current question merges receiving cards, letters, or text messages, combining online and offline experiences. Separating this item into two questions would give more accurate data regarding cyberstalking.

To download: Online and Offline Stalking Victimisation in the Crime Survey for England and Wales: Its Predictors and Victim/Survivors’ Views on Criminalisation

To cite: Madeleine Janickyj, Niels Blom, Leonie Maria Tanczer, Online and Offline Stalking Victimisation in the Crime Survey for England and Wales: Its Predictors and Victim/Survivors’ Views on Criminalisation, The British Journal of Criminology, 2025;, azaf064, https://doi.org/10.1093/bjc/azaf064

For further information, please contact Maddy at m.janickyj@ucl.ac.uk

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Carers’ increased risk of domestic violence and poor health outcomes

The poor health of unpaid carers is well-established, and evidence also shows they experience high levels of domestic violence. However, the links between domestic violence and carers’ poor health remains overlooked. The study, Health morbidities in carers with experience of domestic violence and abuse, led by Drs Juliana Onwumere and Emilie Wildman of King’s College London along with research team member Professor Sally McManus, VISION co-Deputy Director, and others, examined this relationship using the Adult Psychiatric Morbidity Survey (APMS), a representative sample of the adult population of England.

The results show that carers are more likely to be female, older, economically inactive, and in debt than non-carers, and that carers tend to have worse mental and physical health. One in three carers reported having had experience of domestic violence. With adjustment for confounders, carers were more likely than non-carers to be victims of physical, emotional and sexual forms of violence and abuse. People with experience of both caring responsibilities and domestic violence had particularly poor mental and physical health outcomes (compared to carers and non-carers without experience of domestic violence, as well as non-carers experiencing domestic violence).  

NICE guidelines state that carers should be offered training to help them to provide care safely, including support around managing challenging behaviour from the person being cared for. However, professionals can struggle to identify and respond to carers’ experiences of domestic violence. Facilitating routine enquiry in carers is essential, particularly given that carers often delay seeking support for their own needs carers and may not readily and independently disclose their experiences of violence to professionals.

Recommendations

Efforts to incorporate inquiry into experiences of domestic violence into carers’ needs assessments, which unpaid carers are entitled to, may help facilitate identification and referral to appropriate support services.

Carers high risk of domestic violence goes largely unrecognised in UK policy and practice. This is a sensitive and hidden topic; these findings suggest that addressing carers’ poor health requires also identifying – and addressing – their experiences of domestic violence.

To download: Health morbidities in carers with experience of domestic violence and abuse

To cite: Wildman, E.K., Dickson, H., MacManus, D. McManus, S., Kuipers, E., Onwumere, J. Health morbidities in carers with experience of domestic violence and abuse. Soc Psychiatry Psychiatr Epidemiol (2025). Https://doi.org/10.1007/s00127-025-02959-4

For further information, please contact Juliana at juliana.1.onwumere@kcl.ac.uk

For further information about APMS, contact Sally at sally.mcmanus@citystgeorges.ac.uk

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Examining the differing trends of violence between Wales and England

Violence is a public health problem, with significant individual, economic, health and social care costs. Monitoring violence trends and distribution is a key step of a public health approach to violence prevention.

Health service data in England and Wales are used to monitor temporal change in violence prevalence. However, administrative data relies on service contact and recording practices, while nationally representative surveys, such as the Crime Survey for England and Wales (CSEW), record information on violence even when services were not sought. The Office for National Statistics (ONS) uses CSEW to estimate prevalence of violent crime and changes over time, publishing these for England and Wales combined. Therefore, there is a need to examine whether trends in violence in Wales differ from trends in England, which is the aim of this report.

Dr Polina Obolenskaya led the study, Temporal trends in prevalence of violence in Wales: analysis of a national victimisation survey, with VISION colleagues Dr Anastasia Fadeeva, Emma Barton, Dr Alex Walker, Lara Snowdon and Professor Sally McManus. Using CSEW data, for years 2002–2020, they compared trends in prevalence of violence victimisation between Wales and England, for all adults and by gender.

Country-disaggregated data shows that the prevalence of violence was generally lower in Wales than in England for the first decade of the century. Analyses by gender shows further disparities between countries. Males in Wales and England and females in England experienced a decline in violence victimisation between 2002 and 2015 but there was no decline in violence for females in Wales until after 2016. This decline in violence for females in Wales differed for females in England who experienced an upturn in prevalence of violence from 2015.

Different patterns of violence in England and Wales indicate that relying on combined estimates of violence for England and Wales in strategy development and planning in Wales should be avoided. Further work is required to understand why trends differ between England and Wales, including analyses accounting for socioeconomic and demographic characteristics of each population, as well as thorough considerations of potential policy drivers.

Recommendation

Given differences in prevalence and trends in violence between Wales and England, relying on estimates based on the countries combined to inform strategic planning in Wales is problematic. Using Wales-specific estimates and trends in violence is therefore recommended.

To download: Temporal trends in prevalence of violence in Wales: analysis of a national victimisation survey

To cite: P. Obolenskaya, A. Fadeeva, E.R. Barton, A. Walker, L.C. Snowdon, S. McManus, Temporal trends in prevalence of violence in Wales: analysis of a national victimisation survey,
Public Health, Volume 245, 2025,105775, ISSN 0033-3506, https://doi.org/10.1016/j.puhe.2025.105775.

For further information, please contact Polina at polina.obolenskaya@citystgeorges.ac.uk

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Perpetrators of domestic abuse against older adults: A rapid evidence assessment

Despite increased research on issues related to aging and older age, abuse of older adults (defined as 60 or over in this study) is a neglected area of academic study. Most of the available evidence is currently found within the elder abuse field; although there is no agreed definition of elder abuse, most incorporate abuse by perpetrators outside of the family (such as carers, people in positions of trust and in some cases strangers) meaning evidence on intimate partner and family member perpetrators is subsumed within these studies. Most studies on domestic abuse have paid limited attention to older age, and in many cases restrict the focus to intimate partner violence among young adults.

PhD student, Merili Pullerits at the Violence and Society Centre at City St George’s University of London, collaborated with colleagues Hannah Bows (Durham University), who led the study, and Natalie Quinn-Walker (University of Wolverhampton), to examine the existing, published research on the demographic and health characteristics, and the offending behaviours and histories of perpetrators of domestic violence and abuse against adults aged 60 and over. 

Using a systematic methodology, searches were conducted in five databases: MEDLINE Complete, APA PsychInfo, CINAHL Complete, SociINDEX with Full Text, Criminal Justice Abstracts with Full Text, and Web of Science (Core Collection), resulting in 75 papers being included in the review.

Their rapid review found that much of the available evidence comes from the elder abuse field, with only a fifth of the included studies taking a specific domestic abuse perspective. Because elder abuse studies often group together all abuse types across varied relationship contexts, such studies make  becomes difficult to extract findings on domestic abuse, potentially hiding important differences. Additionally, the review found that non-intimate partners, that is (adult) children or other family members, tend to be the most frequently reported perpetrator group, although this varied according to the design and methodology of the studies. Most perpetrators tend to be male, and, where information is available, poor health, and drug and alcohol problems are often reported.

The research team concluded that more evidence is required on perpetrators of domestic violence and abuse using a broader range of data sources and research methods.

Recommendation

Evidence on those that use domestic violence and abuse on older people should be situated within the conceptual lens of domestic abuse. Policy and practice should urgently review whether existing risk assessment tools and perpetrator programmes are suitable given that a substantial proportion of domestic abuse against older adults is perpetrated by younger sons, daughters or other family members.

To download: Perpetrators of domestic abuse against older adults – a rapid evidence assessment

To cite: Hannah Bows, Merili Pullerits, Natalie Quinn-Walker, Perpetrators of domestic abuse against older adults – a rapid evidence assessment, Aggression and Violent Behavior, Volume 82, 2025, 102056, ISSN 1359-1789, https://doi.org/10.1016/j.avb.2025.102056.

For further information, please contact Hannah at hannah.bows@durham.ac.uk

Funding: This study was funded by a Home Office (Domestic Abuse Perpetrators) grant.

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Challenges for evidence syntheses on homicide in a global context

Data and evidence on violence are a few of the many core elements necessary for prevention. They inform decision-making by policy makers, provide corroboration for claims-makers, and exist as a means of empowerment for advocates and activists. However, evidence required for prevention is currently fragmented across different systems of knowledge production, creating challenges in the form of missing data.

Viewed through the sociology of quantification and knowledge production, VISION Co-Investigator Dr Elizabeth Cook, provides methodological and ethical reflections on conducting a global systematic review of sex/gender-disaggregated homicide data. In doing so, she highlights epistemological and ontological differences that risk becoming obscured in global, comparative work on violence. 

The systematic review she draws on in her critique, Conflating the map with the territory: Challenges for evidence syntheses on homicide in a global context, consisted of a four-step search strategy: electronic database searches, hand searches of statistics, ministry, and police websites, citation tracking, and email survey of statistics offices.

Studies were included if they reported prevalence data on homicide which was sex/gender-disaggregated (by victim/offender relationship, sexual aspects, and/or motivation) by both women and men. From 194 WHO-recognised countries, data were available for just under half (n = 84). However, there were pronounced differences between countries and regions regarding the availability of data.

Evidence syntheses are just one way of trying to make sense of this vast body of evidence in a transnational context. Viewed through sociological work on quantification and epistemic communities, Lizzie has provided reflections on a global systematic review to establish the prevalence of sex/gender disaggregated homicide by country, region, and globally. 

Recommendation

To avoid conflating the ‘map with the territory’ as others argue, moving towards critical knowledge synthesis as a way to build in contestation and to decenter assumptions of objectivity in the global systematic review of sex/gender-disaggregated homicide data.

To download: Conflating the map with the territory: Challenges for evidence syntheses on homicide in a global context

To cite: Cook, E. A. (2025). Conflating the map with the territory: Challenges for evidence syntheses on homicide in a global context. International Sociology, 0(0). https://doi.org/10.1177/02685809251336694

For further information, please contact Lizzie at elizabeth.cook@citystgeorges.ac.uk

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