Archives

More adults showing signs of drug dependence in England

VISION co-Deputy Director, Professor Sally McManus, has published an article for The Conversation, Drug use is changing in England – with more adults showing signs of dependence. Written with Sarah Morris from the National Centre for Social Research, the article is based on their research using the Adult Psychiatric Morbidity Survey (APMS) 2023-2024 with colleagues.

The APMS is the longest running mental health survey series in the world and provides a picture of how mental health is changing across England. The national study includes people from across English society, not just those that currently use NHS services or have in the past. A random sample of approximately 7,000 adults aged 16 to 100 living in England were asked questions about their mental health, whether they used any of a range of illicit drugs, and if they had experienced signs of dependence, such as symptoms of withdrawal or increased tolerance.

Findings

  • Drug use may be more widespread
  • Non-medical use of prescription opioids may be more widespread
  • In the 16- to 24-year-old age group, the signs of drug dependence were similarly common in men and women which is a noticeable shift from past APMS findings
  • Cannabis dependence is rising
  • There appears to be a lack of specialist support as about one adult in every five who showed signs of drug dependence reported they’d ever received support or treatment for drug use

For further information: Please contact Sally at sally.mcmanus@citystgeorges.ac.uk

Photograph from Adobe Photo Stock subscription

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

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

Illustration from Adobe Stock subscription

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

Photograph from Age Without Limits image library.

Workplace violence and fear of workplace violence: An assessment of prevalence in the UK by industrial sector

Workplace violence is a significant problem with underexamined productivity effects. In a global survey, just under 1 in 5 workers reported exposure to psychological violence and harassment at work, and 1 in 10 reported exposure to physical violence during their working-lives. In the United Kingdom (UK), the Health and Safety Executive (the regulator for workplace health and safety) found 1% of all adults of working age, in the 12 months prior, experienced a physical assault or threat of assault at work.

Workplace violence covers a broad range of adverse social interactions and behaviours committed by or towards employees. It includes encounters between colleagues and between workers and service users. It can also include incidents of domestic abuse experienced at work, with abusers known to pursue victims in the workplace.

Direct and indirect exposure to violent acts or threats of violence at work can be anticipated to lead to anxiety and fear of further victimization. Workplace violence, especially when persistent, may cause psychological disorders including common mental disorders (CMD) of generalized anxiety and depression.

VISION researchers Dr Vanessa Gash (City St George’s University of London) and Dr Niels Blom (University of Manchester) used the United Kingdom Household Panel Study, a nationally representative survey with mental health indicators to examine the prevalence of violence and fear of violence by sector and the effect of violence on common mental disorders (CMD) risk. They also supplemented the analyses with the views of those with lived experience.

Their study, Workplace violence and fear of violence: an assessment of prevalence across industrial sectors and its mental health effects, examined variance in the prevalence of workplace violence and fear of violence in the UK by industrial sector and determined the mental health effects thereof using longitudinal data.

Results showed that a high prevalence of workplace violence and fear of workplace violence was found in multiple different UK industrial sectors – >1 in 10 workers were exposed to violence in the last 12 months in 30% of sectors and >1 in 20 workers were exposed in 70% of sectors. Workers employed in public administration and facilities had the highest risks of workplace violence. The second highest sector was health, residential care, and social work. Workplace violence increased CMD risk as did fear of violence at work. Also, the effect of violence and fear of violence on CMD remained when the researchers investigated CMD one year later. 

Recommendation

The researchers recommend better recognition of the extent to which workplace violence is experienced across multiple sectors and call for better systems wide interventions to mitigate the associated harms.

To download: Workplace violence and fear of violence: an assessment of prevalence across industrial sectors and its mental health effects

To cite: Gash, V, Blom, N. ‘Workplace violence and fear of violence: an assessment of prevalence across industrial sectors and its mental health effects’. Scandinavian Journal of Work, Environment & Health. https://doi.org/10.5271/sjweh.4230

For further information, please contact Vanessa at vanessa.gash.1@citystgeorges.ac.uk

Illustrations from Geisa D’Avo and copyright owned by UKPRP VISION research consortium

Multiple adverse childhood experiences and mental and physical health outcomes in adulthood: New systematic review protocol assessing causality

Research suggests that adverse childhood experiences can have a lasting influence on children’s development that result in poorer health outcomes in adulthood. Like other exposure-outcome relationships, however, there is uncertainty about the extent to which the relationship between adverse childhood experiences and health is causal or attributable to other factors.

The aim of this systematic review is to better understand the nature and extent of the evidence available to infer a causal relationship between adverse childhood experiences and health outcomes in adulthood.

A comprehensive search for articles will be conducted in four databases (Medline, CINAHL, PsycInfo and Web of Science) and Google Scholar. The team, led by Dr Lisa Jones of Liverpool John Moores University, and includes VISION researchers Professor Mark Bellis and Professor Sally McManus, will review studies published since 2014:

  • of adults aged 16 years or over with exposure to adverse childhood experiences before age 16 years from general population samples;
  • that report measures across multiple categories of childhood adversity, including both direct and indirect types; and
  • report outcomes related to disease morbidity and mortality.

To download the protocol: Interpreting evidence on the association between multiple adverse childhood experiences and mental and physical health outcomes in adulthood: protocol for a systematic review assessing causality

To cite: Jones L, Bellis MA, Butler N, et al. Interpreting evidence on the association between multiple adverse childhood experiences and mental and physical health outcomes in adulthood: protocol for a systematic review assessing causality. BMJ Open 2025;15:e091865.  doi: 10.1136/bmjopen-2024-091865

For further information, please contact Lisa at l.jones1@ljmu.ac.uk

Illustration from Adobe Photo Stock subscription

VISION Policy Briefing: Domestic violence and abuse and mental and physical health

Domestic violence and abuse (DVA) is prevalent within the United Kingdom (UK) and has severe and long-lasting physical and mental health consequences. An estimated 2.3 million adults in England and Wales (4.8%) experienced domestic abuse in the past 12 months. More women than men experience DVA, and women experience more repeated abuse, more physical, sexual, and emotional violence and coercive control, more injuries, and greater fear.

We, in the VISION research consortium, investigate how DVA is related to health. This policy briefing summarises evidence from five of our recent publications. We highlight the key recommendation resulting from across the research and discuss the key findings and evidence demonstrating the prevalence of DVA and the need for a cross-government approach to violence prevention.

Key Recommendation

A cross-government approach to preventing violence needs to include health services, alongside justice, welfare, education and other sectors. An effective and safe NHS response to survivors of domestic violence needs to be implemented. That response, embedded in training for healthcare professionals and referral to appropriate services, stretches from identification of survivors to initial support, to addressing the mental health and other sequelae of violence. Currently, the response is sporadic and patchy, with many Integrated Care Boards (ICBs) not commissioning necessary services. Integrated commissioning, as recommended in the NICE guidelines, could help bridge silos and sectors. 

Key findings

  • Domestic violence and abuse (DVA) affects the physical and mental health of victim-survivors.
  • About half of people who attempted suicide in the past year had experienced violence from a partner at some point in their life, and one in four experienced violence from a partner in the preceding year 
  • The type of intimate partner relationship and the type of violence and abuse affects the nature and level of physical and mental health consequences. 
  • People who use violence against their partners also tend to have worse mental health, and mental health services present an opportunity for intervention with this group. 

To download the paper: VISION Policy Briefing: Domestic violence and abuse and mental and physical health

To cite: Blom, N., Davies, E., Hashemi, L., Obolenskaya, P., Bhavsar, V., & McManus, S. (2025). VISION Policy Briefing: Domestic violence and abuse and mental and physical health. City St George’s, University of London. https://doi.org/10.25383/city.28653212.v3

For further information, please contact Niels at niels.blom@manchester.ac.uk

Adverse childhood experiences in firstborns associated with poor mental health of siblings

Adverse childhood experiences (ACEs) often affect multiple children within families, yet studies tend to focus on the health outcomes of individual children, underestimating the needs of affected families. First author Dr Shabeer Syed (UCL Great Ormond Street Institute of Child Health), VISION Director and Professor Gene Feder, and colleagues aimed to examine the association between firstborns exposed to ACEs between 1 year before and 2 years after birth (the first 1000 days) and the risks of mental health problems, mental health-related health-care contacts, and all-cause hospital admissions in multiple children from the same mother, compared to firstborns without ACEs.

The first-of-its-kind study, published in The Lancet Public Health and funded by the National Institute for Health and Care Research Policy Research Programme, found that mothers whose firstborns had experienced adverse childhood experiences had a 71% increased risk of having children (aged five -18) with mental health problems, compared to mothers whose firstborn did not experience adversity.

This translates to 12 additional children with mental health problems for every 100 mothers whose firstborn experienced adversity.

These findings underscore the pervasive risk that early adversity can have on multiple children in the family, and the importance of early identification and sustained support for vulnerable families beyond the first 1,000 days of a child’s life.

As part of the study, researchers analysed linked GP and hospital health records from 333,048 first-time mothers and their 534,904 children (firstborns and siblings) born in England between 2002 and 2018. They focused on six different forms of adverse childhood experiences in the firstborn child recorded during their first 1,000 days of life (from conception up until the age of two).

These included: child maltreatment, intimate partner violence, maternal substance misuse, maternal mental health problems, adverse family environments (e.g. homelessness), and high-risk presentations of child maltreatment (e.g. unexplained child injuries).

Over a third (37.1%) of firstborn children had at least one recorded adverse childhood experience. The most common adverse childhood experiences were living with maternal mental health problems (21.6%), followed by adverse family environments (14.5%) such as parental criminality and housing instability.

Approximately one in five (19.8%) mothers had at least one child with a recorded mental health problem between the ages of 5 and 18.

The risk of mental health problems was consistent across all siblings, regardless of birth order (firstborn vs thirdborn), in families where the firstborn experienced adverse childhood experiences.

Lead author Dr Syed said: “Whilst previous research has focused on the impact of adverse childhood experiences on individual children, our study reveals a cascading health risk that extends beyond the individual, impacting on the health of siblings as well.

“This likely stems from the continuation of adverse childhood experiences within the family. When a child or parent presents with mental health concerns, violence or other forms of adversity, it’s essential to ask about the wider family context.”

As a result of their findings, the team are also calling for further research into the impact of early health visiting and primary care support.

Co-author, Professor Feder, said: “General practice teams have a key role in identifying first-born children experiencing adverse childhood experiences and in supporting first-time parents to help reduce the impact of adverse childhood experiences on the whole family, including subsequent children.

“We need further evidence for effective interventions to reduce that impact, particularly on mental health.”

Study limitations

The researchers could not investigate adverse childhood experiences related to fathers’ mental health or substance use as healthcare data from fathers could not be linked to their children.

The study found that adverse childhood experiences in firstborns were associated with mental health outcomes in the first and subsequent children, but this does not necessarily mean that adverse childhood experiences cause mental health problems.

Additionally, electronic health-care records underestimate intimate partner violence and child maltreatment due to non-disclosure and/or detection and under-recording by clinicians.

To download the paper: Adverse childhood experiences in firstborns and mental health risk and health-care use in siblings: a population-based birth cohort study of half a million children in England – The Lancet Public Health

Or for further information, please contact Shabeer at s.syed.16@ucl.ac.uk

Illustration from Adobe Photo Stock subscription

Systems analysis of service coordination in domestic abuse, primary care and child mental health services

The impact of intimate partner violence (IPV) on parental and child mental health is well documented, as is the associated increased use of healthcare services by survivors of IPV. UK policy emphasises the importance of partnership working between health services and domestic abuse agencies, along with clear referral pathways for victims of violence and abuse and co-ordinated local responses. However, in general, current policy and guidance is focused on the response to adult victims with more limited advice as to how this should be operationalised for working with children.

With first author Dr Claire Powell (University College of London), VISION researchers Dr Olumide Adisa and Professor Gene Feder and others explored how services work together to support parents and children experiencing both parental IPV and parental or child mental health problems by drawing on the perspectives of professionals working in primary care, children and young people’s mental health services (CYPMHS), and domestic abuse services.

The team conducted a qualitative study, interviewing professionals in geographically contrasting local authority areas in England. They carried out framework analysis using a systems approach and mapping techniques to understand the service interrelationships and boundary judgements of professionals.

Results showed that

  • The relationships between domestic abuse services, CYPMHS, and primary care were complex, involving funders and commissioners, local authority strategic groups, and wider services such as schools and children’s centres.
  • Participants consistently identified a gap in the relationship between statutory CYPMHS and domestic abuse services.
  • There were mental health service gaps were for children living with ongoing or intermittent IPV and for children and parents with needs falling below or between service thresholds.
  • There was a gap in services for users of abusive behaviour to prevent future IPV.
  • Staff perspectives revealed differing views on treating the effects of trauma, and the co-ordination and sequencing of care.

Improving the response to children and adults experiencing mental health problems in the wake of IPV requires a systems perspective to understand the barriers to service co-ordination. The findings indicate a particular need to address the gap between CYPMHS and domestic abuse services.

To download the paper: Domestic abuse, primary care and child mental health services: A systems analysis of service coordination from professionals’ perspectives – ScienceDirect

To cite the paper:  Claire Powell, Olumide Adisa, Lauren Herlitz, Shivi Bains, Sigrún Eyrúnardóttir Clark, Jessica Deighton, Shabeer Syed, Ruth Gilbert, Gene Feder, Emma Howarth, Domestic abuse, primary care and child mental health services: A systems analysis of service coordination from professionals’ perspectives, Children and Youth Services Review, Volume 169, 2025, 108076, ISSN 0190-7409, https://doi.org/10.1016/j.childyouth.2024.108076

Illustration from Adobe Photo Stock subscription

Natural Language Processing: Interrogating free text in mental healthcare records to capture experiences of violence

Violence can be categorised in a variety of ways for example physical, sexual, emotional, and domestic but all cause significant physical and mental morbidity within general populations. Individuals with a severe mental illness have been found to be significantly more likely to experience domestic, physical, and sexual violence compared to the general population. For these individuals, experiences of violence are important risk factors however, this is not routinely collected by mental health services.

In general data on all forms of violence has been inadequately available from healthcare records. This is partly due to the lack of routine enquiry by professionals at points of clinical contact, and partly because instances of violence are difficult to identify in healthcare data in the absence of specific coding systems.

A general challenge for using health records data for research is that the most valuable and granular information is frequently contained in text fields (e.g., routine case notes, clinical correspondence) rather than in pre-structured fields; this includes mentions of violence whether experienced as a victim or perpetrated. Capturing violence experiences across mental healthcare settings can be challenging because most instances are likely to be recorded as unstructured text data. Therefore, natural language processing (NLP), is increasingly in use to extract information automatically from unstructured text in electronic health records, particularly in mental healthcare, on clinical entities.

Dr Ava Mason from Kings College London and VISION researchers Professor Robert Stewart, Dr Angus Roberts, Dr Lifang Li, and Dr Vishal Bhavsar worked with colleagues to apply NLP across different clinical samples to investigate mentions of violence. They ascertained recorded violence victimisation from the records of 60,021 patients receiving care from a large south London NHS mental healthcare provider during 2019. Descriptive and regression analyses were conducted to investigate variation by age, sex, ethnic group, and diagnostic category.

Results showed that patients with a mood disorder, personality disorder, schizophrenia spectrum disorder or PTSD had a significantly increased likelihood of victimisation compared to those with other mental health diagnoses. Additionally, patients from minority ethnic groups for Black and Asian had significantly higher likelihood of recorded violence victimisation compared to White groups. Males were significantly less likely to have reported recorded violence victimisation than females.

The researchers demonstrated the successful deployment of machine learning based NLP algorithms to ascertain important entities for outcome prediction in mental healthcare. The observed distributions highlight which sex, ethnicity and diagnostic groups had more records of violence victimisation. Further development of these algorithms could usefully capture broader experiences, such as differentiating more efficiently between witnessed, perpetrated and experienced violence and broader violence experiences like emotional abuse.

To download the paper: Frontiers | Applying neural network algorithms to ascertain reported experiences of violence in routine mental healthcare records and distributions of reports by diagnosis

To cite: Mason AJC, Bhavsar V, Botelle R, Chandran D, Li L, Mascio A, Sanyal J, Kadra-Scalzo G, Roberts A, Williams M, Stewart R. Applying neural network algorithms to ascertain reported experiences of violence in routine mental healthcare records and distributions of reports by diagnosis. Frontiers in Psychiatry 2024 Sep 10. doi:103389/fpsyt.2024.1181739

Illustration from Adobe Photo Stock subscription