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Different childhood adversities lead to different health inequalities

Even experiencing just one type of adverse childhood experience (ACE) increases the risks of poor health outcomes in adulthood, including health-harming behaviours, poor sexual and mental health, and crime and violence.

Among people experiencing one type of ACE, this study examined which ACEs were most strongly related to each type of health harms, using a combined study sample of 20,556 18–69 years living in England and Wales. The research team, including VISION researcher Mark Bellis, found that sexual abuse in childhood strongly predicted subsequent obesity. Sexual abuse also showed the biggest increase in later cannabis use. Household alcohol problems in childhood was the ACE most strongly associated with violence and incarceration in adulthood.

Toxic stress can arise from ACEs such as physical and sexual abuse, but other more prevalent ACEs, for example verbal abuse and parental separation, may also contribute substantively to poorer life course health.

For further information, please see: Comparing relationships between single types of adverse childhood experiences and health-related outcomes: a combined primary data study of eight cross-sectional surveys in England and Wales | BMJ Open

Or contact Mark Bellis at M.A.Bellis@ljmu.ac.uk

Photo by Adam McCoid on Unsplash

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

Tech-facilitated abuse and the ‘new normal’

by Dr Leonie Tanczer, Associate Professor, University College London, and Co-Investigator, UKPRP VISION

The growth of digital technologies in our lives creates new habits, practices, and expectations. We need better public awareness and debate about the “new normal” we are experiencing in a society where the misuse of digital technologies has become widespread.

I don’t know about you, but there used to be a time when I was excited and thrilled by technology. I remember how ecstatic I was when I got my first mobile – and, later, my first smartphone. How unbelievably neat it felt “browsing” the web to research a school assignment. And how empowering and beneficial I once perceived platforms such as Twitter.

That’s sadly no longer how I think and feel. And I must confess, I’ve become quite pessimistic.

You can blame my dreary outlook on living through my 20s in a world where digital innovations became entrenched in daily life and now constantly demand our attention. Alternatively, you may say that my perspective has changed since I started to study technology-facilitated domestic violence (tech abuse). My interest in tech abuse emerged in 2018 when I set out to examine how smart, Internet-connected devices – such as Amazon’s Ring Doorbell or the Google Home smart speaker – impacted domestic abuse victims and survivors. It should have been only a short, six-month research project, but it developed a life of its own. Since then, my research focus and team have steadily grown and we are researching tech abuse as part of the VISION project. As the research grows, so has the scale and awareness of tech abuse.

Tech can exacerbate societal problems

I never fully bought into the narrative that tech can solve all societal ills. If anything, my research on tech abuse has shown how the misuse of digital technologies can exacerbate societal problems. The boundaries have started to blur around what is and isn’t acceptable online and where one can draw the line around what may or may not be abusive when handling digital tech.

Tech abuse is the misuse of “everyday” digital systems to alter, amplify, and accelerate coercive and controlling behaviour in the context of intimate partner violence (IPV). Tech abuse is a major concern because it offers perpetrators of domestic abuse new and powerful tools to monitor and harass. And let’s be clear: domestic abuse is an epidemic. It is widespread (approximately 1 in 5 UK adults aged 16 years and over had experienced domestic abuse since the age of 16 years); harmful (it impacts victims’/survivors’ mental, emotional, physical, social and financial wellbeing); as well as gendered and deadly ( Homicide Index data for the year ending March 2019 to the year ending March 2021 show that 72.1% of victims of domestic homicide were female).

To date, our research group has investigated numerous angles related to this expanding abuse form, from usability tests of digital devices and the analyses of legal tools to tech abuse’s interconnection with mental health. We have been outspoken about shortcomings in policy debates and the wider cybersecurity sector and collaborated with and been informed by the efforts of key stakeholders that represent the voice and lived experience of victims and survivors, as well as those working with perpetrators.

What is “normal” and “acceptable”?

The functionalities and abilities many digital services offer (and for which consumers actively pay!) create a slippery slope towards their misuse. For example, I am all up for the remote control of my heater from my UCL office, the sharing of geolocation data whilst in an Uber, and the exchange of streaming service passwords with family and friends. I mean as a white, privileged, tech-savvy woman in a consensual partnership and with supportive colleagues and friends, these features frequently benefit me.

But, what if they don’t? What if I wasn’t the legal owner and account holder of the systems I use? What if I had to think of the inferences corporations and governments will make based on my data profile? And what if it were down to my coercive partner to control the temperature, to know my whereabouts, and to set up/maintain my Netflix or email account?

At present, many concerns that digital systems cause are addressed along the principle of informed consent, which is technically quite simple: once something happens without the awareness and approval of all parties involved, a line has been breached. But what are we doing when ensuring informed consent is impossible or doesn’t go far enough to protect someone from abuse?

More profoundly, I believe we must start to ask ourselves important questions around the “new normal” that is looming and that I don’t think we have begun to unpack: is it OK for my partner to know my email password? Is it OK for my partner to check who I’ve been texting? And is it OK for my partner to ask for nudes via text? Plus, what if we bring children into the mix? Is it OK for parents to overtly install parental control software on devices legitimately purchased and gifted to their kids? And can – and should – a 15-year-old reject?

We need a public debate

Undoubtedly, I don’t have definite answers to any of the above-posed questions. But they have been in my mind for some time, and I’d love to see them addressed. Relationships – whether with our children, parents, friends, or romantic partners – are not always pure bliss. They can be overshadowed by conflict, but in the worst case, they can be toxic and outright destructive and harmful. Our digital systems must be capable to account for this. I, thus, believe a public debate or a re-evaluation on what we should accept as ‘normal’ is urgently needed. This then may hopefully lead to safeguards put into place so that everyone – independent of their situation – can make conscious choices on tech’s impact on their lives as well as partnerships.

Photo by Luca Bravo on Unsplash

Mental health service use in perpetrators of partner violence

Perpetration of partner violence is more common in people with recent mental health service use compared to the general household population of England.

Research conducted by Dr Vishal Bhavsar, Kings College London (KCL); VISION Co-Investigator Professor Louise M. Howard, KCL; VISION Deputy Director Sally McManus, City, University of London; and Dr Katherine Saunders, KCL, has demonstrated this correlation is not affected by criminal justice involvement or by social demographics(e.g. class, education), but seems to be explained by greater exposure to childhood adversities and exposure to partner violence.

The researchers think this work highlights an important potential role for health services in responding to perpetrators of domestic abuse, especially services which provide care for people with mental health conditions. Effective strengthening of the healthcare system’s response to perpetrators of domestic abuse has the potential to reduce violence.

For further information please see: Intimate partner violence perpetration and mental health service use in England: analysis of nationally representative survey data | BJPsych Open | Cambridge Core

Or contact Dr Vishal Bhavsar at vishal.2.bhavsar@kcl.ac.uk

Photograph by 88studio / Shutterstock.com

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)

Photo by National Cancer Institute on Unsplash

Use of text mining to study Intimate Partner Violence

Computational text mining methods are proposed as a useful methodological innovation in Intimate Partner Violence (IPV) research. Text mining can offer researchers access to existing or new datasets, sourced from social media or from IPV-related organisations, that would be too large to analyse manually. This article aims to give an overview of current work applying text mining methodologies in the study of IPV, as a starting point for researchers wanting to use such methods in their own work.

A systematic review was conducted to PRISMA guidelines, searching 8 databases and identifying 22 unique studies to include in the review.

The studies cover a wide range of methodologies and outcomes. Supervised and unsupervised approaches are represented, including rule-based classification (n = 3), traditional Machine Learning (n = 8), Deep Learning (n = 6) and topic modelling (n = 4) methods. Datasets are mostly sourced from social media (n = 15), with other data being sourced from police forces (n = 3), health or social care providers (n = 3), or litigation texts (n = 1). Only a few studies commented on the ethics of computational IPV research.

Text mining methodologies offer promising data collection and analysis techniques for IPV research. However, future work in this space must consider the ethical implications of computational approaches.

For further information please see: A Systematic Literature Review of the Use of Computational Text Analysis Methods in Intimate Partner Violence Research | SpringerLink or contact Lilly Neubauer at j.neubauer@cs.ucl.ac.uk or Dr Leonie Tanczer at l.tanczer@ucl.ac.uk

Illustration: graphicwithart / Shutterstock.com

Intimate partner violence: Asking the right questions?

VISION Interim Director Gene Feder collaborated with Valeria Skafida from the University of Edinburgh and Christine Barter from the University of Central Lancashire to undertake a critical analysis of UK longitudinal and repeated cross-sectional population surveys which asked about experiences of intimate partner violence and abuse (IPVA).

Seven relevant UK representative population-based surveys which asked about IPVA among adults and/or young people (16–17 years old) were identified. They critically engaged with the questionnaires to analyse the strengths and limitations of existing UK data on IPVA.

Several limitations in UK surveys were identified. Many questions still showed a bias, partly historical, towards collecting more data about physical abuse. Few surveys asked about financial abuse, abuse post-separation or through child contact, or through technologies, though improvements were under way.

Surveys still sought to count incidents of abuse, instead of enquiring about the impact of abusive behaviours on victims. Ethnicity and other demographic variables were not always adequately captured (or accessible to data users), making it difficult to explore aspects of inequality. Potentially useful comparisons within the UK were difficult to undertake given the increasingly divergent questionnaires used in different UK nations.

They discussed how future iterations of existing surveys or new surveys can improve with regards to how questions about IPVA are asked. Given that surveys across geographical contexts often suffer similar weaknesses, their findings are relevant for IPVA survey methodology beyond the UK context.

For further information please see: Asking the Right Questions? A Critical Overview of Longitudinal Survey Data on Intimate Partner Violence and Abuse Among Adults and Young People in the UK | SpringerLink

Intimate partner violence: Factor in chronic health problems

Intimate partner violence (IPV) is increasingly recognised as a contributing factor for long-term health problems; however, few studies have assessed these health outcomes using consistent and comprehensive IPV measures or representative population-based samples. Health implications of IPV against men is also relatively underexplored. Given the gendered differences in IPV exposure patterns, exploration of gender patterns in men’ and women’s IPV exposure and health outcomes is needed.

We used data from the 2019 New Zealand Family Violence Study, a cross-sectional population-based study of ~2,800 ever-partnered women and men which was conducted across 3 regions of New Zealand.

We found that women’s exposure to any lifetime IPV, as well as specific IPV types (physical, sexual, psychological, controlling behaviors, and economic abuse), was associated with increased likelihood of reporting adverse health outcomes (poor general health, recent pain or discomfort, recent health care consultation, any diagnosed physical and mental health condition). Furthermore, a cumulative pattern was observed that is women who experienced multiple IPV types were more likely to report poorer health outcomes.

Regarding men exposure to IPV, we found that while men’s exposure to IPV was associated with increased likelihood of reporting 4 of the 7 assessed poor health outcomes, specific IPV types were inconsistently associated with poor health outcomes. Experience of a higher number of IPV types among men did not show a clear stepwise association with number of health outcomes. These findings indicate that IPV against men, unlike women, does not consistently contribute to their poor health outcomes at the population level.

In sum, our findings warrant gender-appropriate clinical approaches when IPV is identified. Specifically, health care systems need to be mobilized to address IPV as a priority health issue among women. However, these findings do not warrant routine inquiry for IPV against men in clinical settings, although appropriate care is needed if IPV against men is identified.

For further information please see: Association Between Men’s Exposure to Intimate Partner Violence and Self-reported Health Outcomes in New Zealand | Global Health | JAMA Network Open | JAMA Network and Association Between Women’s Exposure to Intimate Partner Violence and Self-reported Health Outcomes in New Zealand | Intimate Partner Violence | JAMA Network Open | JAMA Network

Or contact Dr Ladan Hashemi at ladan.hashemi@city.ac.uk

Domestic violence fatality reviews: Thinking methodologically and ethically

Domestic Violence Fatality Review (DVFR) systems collect data on different aspects of gender, violence, and abuse required to form an evidence base for prevention. However, to date, there has been limited dialogue between practitioners and researchers about the ‘doing’ of DVFRs.

As DVFR systems vary by jurisdiction, we draw upon a case study of Domestic Homicide Reviews (DHRs) in England and Wales. Applying the Research Integrity Framework developed by the four Women’s Aid Federations in the UK, this article examines both the practice of DHR and how it is utilised as data in research. Informed by our situated perspectives as researchers and/or practitioners working in the field, our analysis demonstrates how undertaking DHR as a practitioner parallels collecting, accessing, and analysing data from DHRs as a researcher. Guiding principles are identified to help practitioners and researchers navigate the parallel challenges they confront and, critically, inform dialogue between practice and research.

To increase transparency and confidence, we argue that more attention should be afforded to the methodological and ethical issues inherent in both the practice of DHRs, and their utilisation as a source of data in research.

For further information please see: Parallels in Practice: Applying Principles of Research Integrity and Ethics in Domestic Violence Fatality Review (DVFR) | SpringerLink