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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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Bystander experiences of domestic violence and abuse during COVID

VISION researchers Alex Walker, Bryony Perry, Emma R Barton, Lara Snowdon and Mark Bellis surveyed people in Wales about their experiences of being a bystander to domestic violence and abuse (DVA) during the COVID-19 pandemic, with their colleagues at University of Exeter, Public Health Wales, and University of Durham.

This research provides a unique perspective on DVA during a global pandemic, and therefore offers important new evidence that can contribute to DVA prevention during public health emergencies. 

Globally, professionals voiced concern over the COVID-19 restrictions exacerbating conditions for DVA to occur. Yet evidence suggests this also increased opportunities for bystanders to become aware of DVA and take action against it. This mixed methods study consists of a quantitative online survey and follow-up interviews with survey respondents. Conducted in Wales, UK, during a national lockdown in 2021, this article reports on the experiences of 186 bystanders to DVA during the pandemic.

The researchers found that while public health restrictions exacerbated DVA, they also increased the opportunity for bystanders to become aware of DVA, and to take prosocial action. Results support the bystander situational model whereby respondents have to become aware of the behaviour, recognise it as a problem, feel that they possess the correct skills, and have confidence in their skills, before they will take action.

Having received bystander training was a significant predictor variable in bystanders taking action against DVA; this is an important finding that should be utilised to upskill general members of the community.

For further information please see: Bystander experiences of domestic violence and abuse during the COVID-19 pandemic in: Journal of Gender-Based Violence – Ahead of print (bristoluniversitypressdigital.com)

Or contact Lara at lara.snowdon@wales.nhs.uk  

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COVID-19 adaptations to a training and support programme to improve primary care response to domestic abuse

Dr Estela Capelas Barbosa, VISION Deputy Director has recently published, COVID-19 adaptations to a training and support programme to improve primary care response to domestic abuse: a mixed methods rapid study in the BMC Primary Care journal, with Lucy Downes, IRIS Network Director.

Increased incidence and/or reporting of domestic abuse (DA) occurred during the COVID-19 pandemic. As a result of the lockdowns across the UK, services providing support to victims had to adapt and consider adding methods of remote outreach to their programmes.

Identification and Referral to Improve Safety (IRIS) is a programme to improve the response to domestic abuse in general practice, providing training for general practice teams and support for patients affected by DA. The COVID-19 pandemic required those running the programme to adapt to online training and remote support.

Estela and Lucy employed a mixed methods rapid approach to this research in order to gather evidence around the relevance, desirability and acceptability of IRIS operating remotely. Quantitative IRIS referral data were triangulated with data from surveys and interviews. They found that the adaptation to online training and support of IRIS was acceptable and desirable.

This study contributes to practice by asserting the desirability and acceptability of training clinicians to be able to identify, ask about DA and refer to the IRIS programme during telephone/online consultations. The findings from this study may be of interest to (public) health commissioners when making commissioning decisions to improve the general practice response to domestic abuse.

For further information please see: COVID-19 adaptations to a training and support programme to improve primary care response to domestic abuse: a mixed methods rapid study | BMC Primary Care (springer.com)

Or contact Dr Estela Capelas Barbosa at e.capelasbarbosa@bristol.ac.uk

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Training GPs remotely during COVID-19: Lessons learned

There may have been a rise in domestic abuse during the COVID-19 pandemic. At the same time general practice adopted remote working, which extended to training and education being delivered online.

IRIS (Identification and Referral to Improve Safety) is an example of an evidence-based UK healthcare training support and referral programme, focusing on DVA, which transitioned to remote delivery during the pandemic.

To understand the adaptations and impact of remote DVA training in IRIS-trained general practices a group of researchers – including VISION members Estela Barbosa and Gene Feder – explored the perspectives of those delivering and receiving training. 

It was found that remote DVA training in UK general practice widened access to learners. However, it may have reduced learner engagement compared with face-to-face training. DVA training is integral to the partnership between general practice and specialist DVA services, and reduced engagement risks weakening this partnership.

The researchers recommend a hybrid DVA training model for general practice, including remote information delivery alongside a structured face-to-face element. This has broader relevance for other specialist services providing training and education in primary care.

For further information please see: Adapting domestic abuse training to remote delivery during the COVID-19 pandemic: perspectives from general practice and support services | British Journal of General Practice (bjgp.org)

Or contact Estela Barbosa Capelas at estela.barbosa@city.ac.uk

Disclosing domestic violence on Reddit during the pandemic

Domestic violence (DV) is a huge social issue and during the COVID-19 pandemic, DV and intimate partner violence (IPV) increased. Frequently imposed quarantine increased contact between perpetrators and victims, potentially leading to underlying increases in the occurrence of violence at home.

Social media sites such as Reddit represent an alternative outlet for disclosing experiences of violence where healthcare access has been limited. This study analysed seven violence-related subreddits to investigate different violence patterns from January 2018 to February 2022, developing a new perspective and methodology for violence research. Specifically, we collected violence-related texts from Reddit using keyword searching and identified six major types of violence with supervised machine learning classifiers: DV, IPV, physical violence, sexual violence, emotional violence, and nonspecific violence or others. Among IPV-related posts, the number with COVID-related keywords was highest in the middle-pandemic phase.

The findings highlight the importance of the role of social media as a platform for disclosing and describing experiences of violence and support the role of social media site monitoring as a means of informative surveillance for help-providing authorities and violence research groups.

For further information please see: Characterizing the Differences in Descriptions of Violence on Reddit During the COVID-19 Pandemic – Lifang Li, Lilly Neubauer, Robert Stewart, Angus Roberts, 2023 (sagepub.com)

Or contact Lifang at lifang.li@kcl.ac.uk or Angus at angus.roberts@kcl.ac.uk

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Remote GP contact limits domestic violence care

General Practice has a central role in identifying and supporting those affected by DVA. Pandemic associated changes in UK primary care included remote initial contacts with primary care and predominantly remote consulting.

This paper explores general practice’s adaptation to DVA care during the COVID-19 pandemic. We found that the disruption caused by pandemic restrictions revealed how team dynamics and interactions before, during and after clinical consultations contribute to identifying and supporting patients experiencing DVA. Remote assessment complicates access to and delivery of DVA care.

This has implications for all primary and secondary care settings, within the NHS and internationally, which are vital to consider in both practice and policy.

For further information please see: General practice wide adaptations to support patients affected by DVA during the COVID-19 pandemic: a rapid qualitative study | BMC Primary Care | Full Text (biomedcentral.com)

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