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How general practice can respond to violence against women and girls

Violence against women and girls (VAWG) is a global violation of human rights that damages health and wellbeing across the life course and across generations. Except in its most obvious manifestations as acute injury or distress, VAWG has been largely hidden from the awareness of health services.

At a UK national policy level, this started to change with mandatory reporting policies on female genital mutilation, the Royal College of General Practitioners (RCGP) safeguarding standards and toolkit, and the National Institute for Health and Care Excellence (NICE) domestic abuse guidelines. However, evidence-based guidance is not yet systematically implemented in clinical education and practice.

National and local VAWG prevention policies are siloed, despite the overlap of different types of VAWG, often affecting the same families, and often part of intersectional vulnerability, amplifying other sources of inequality: class, deprivation, ethnicity, gender identity, disability, and poor mental health.

VISION Director and Professor of primary care at the University of Bristol, Gene Feder, and his Bristol colleagues, argue that the role of general practice needs to be based on the evidence for effective interventions. Despite the relatively recent recognition that violence prevention and mitigation is part of health care, that evidence has grown rapidly over the past two decades. It is strongest for the training of primary care teams linked to a referral pathway to the specialist domestic abuse sector in the UK as well as post-disclosure specialist support for survivors.

Experience of domestic violence and abuse is difficult to disclose and may endanger the patient if the abuser learns of disclosure. Disclosure may be even less likely with the increase of remote and digital access to general practice. Therefore, training for all clinicians should include how to ask about abuse, including in online or telephone consultations, how to appropriately and safely respond to disclosure, and to safely document in the medical record.

Although associated with inequality, VAWG is present in all communities. Prevention and mitigation needs to be across all sectors, with investment in interventions with individuals, families, communities, and tackling structural drivers of violence. General practice must be part of this societal response.

Key messages

  • There is overlap between different types of violence often affecting the same children, families, and households.
  • Intersections of deprivation, disability, poor mental health, and racism amplifies the effect of violence and trauma, also reducing access to general practice support.
  • Violence against women and girls (VAWG) requires a team-based general practice response underpinned by trauma-informed training and referral pathways to specialist services, often in the voluntary sector.
  • Effective responses to VAWG needs to be rooted in trauma-informed care, facilitated by relational continuity and enabled by face-to-face consultations.
  • Clinician experience of violence and abuse needs to be addressed in training and support.

To download: Violence against women and girls: how can general practice respond?

To cite: Violence against women and girls: how can general practice respond? Gene Feder, Helen Cramer, Lucy Potter, Jessica Roy and Eszter Szilassy. British Journal of General Practice 2025; 75 (756): 297-299. DOI: https://doi.org/10.3399/BJGP.2025.0244

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

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Systematic review: Effectiveness of UK-based adult domestic and sexual violence support interventions and services

Recommendations

  • Further high-quality research into the effectiveness of domestic and sexual violence and abuse (DVSA) interventions and evaluations of perpetrator programmes are required, including randomised controlled studies where appropriate and ethical, to improve certainty regarding the effect estimates generated from evidence syntheses. Published protocols, adherence to reporting guidelines, such as CONSORT, STROBE and SQUIRE 2.0, and considering and accounting for confounding factors where randomisation is not feasible, will strengthen the research.
  • Developing a core outcome set via co-production with survivors, practitioners and service providers, commissioners, policy makers and researchers will increase consistency in reported outcomes and create the cohesion necessary to develop a robust evidence base to aid understanding of how effective various support services are.

In the United Kingdom, there are a range of support services and interventions for people who have experienced domestic and sexual violence and abuse (DSVA), including refuges, advocacy such as Independent Domestic Violence Advisors (IDVAs), referral, outreach, and helplines. These are often provided by the Voluntary and Community Sector (VCS), although may also be located in the public or private sector. Due to the lack of consensus on outcomes used to assess effectiveness, evidence syntheses in this field have been limited.

Dr Sophie Carlisle led a team of VISION researchers, Dr Annie Bunce, Prof Sally McManus, Dr Estela Capelas Barbosa, Prof Gene Feder, and Dr Natalia V Lewis, and Prof Matthew Prina from Kings College London. They used findings from their scoping review to identify the common reported outcomes, to direct and inform an evidence synthesis on the effectiveness of UK-based interventions and services for DSVA.

The team conducted a systematic review and, where possible, meta-analysis. They searched relevant peer reviewed and grey literature sources. The following were included: randomised controlled trials, non-randomised comparative studies, pre-post studies, and service evaluations of support interventions or services for adults who had experienced or perpetrated DSVA. The intervention typology and selection of outcomes was determined based on co-production with stakeholders from specialist DSVA organisations. The quality of the studies was assessed independently by two reviewers. Where meta-analysis was not possible, the researchers synthesized studies with vote counting based on the direction of effect.

The review demonstrates that there appear to be benefits of UK-based advocacy and outreach services, psychological support interventions, and perpetrator programmes. However, risk of bias and methodological heterogeneity means that there is uncertainty regarding the estimated effects.

A co-produced core-outcome set is needed to develop a more robust evidence base and facilitate future research in this field. Research practices such as publishing of study protocols, following reporting guidelines and, for research where randomisation is not feasible, considering and accounting for potential confounding factors, would greatly improve the quality of research.

To download the paper: Effectiveness of UK-based support interventions and services aimed at adults who have experienced or used domestic and sexual violence and abuse: a systematic review and meta-analysis – PMC

To cite: Carlisle S, Bunce A, Prina M, McManus S, Barbosa E, Feder G, Lewis NV. Effectiveness of UK-based support interventions and services aimed at adults who have experienced or used domestic and sexual violence and abuse: a systematic review and meta-analysis. BMC Public Health. 2025 Mar 14;25(1):1003. doi: 10.1186/s12889-025-21891-5. PMID: 40087589; PMCID: PMC11908015.

For further information, please contact Sophie at sophie.carlisle4@nhs.net

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Physical health conditions and intimate partner violence: A gendered issue

Intimate partner violence (IPV) is a widespread global public health issue with serious and long-lasting consequences. While much research has focused on the mental health consequences of IPV, such as depression and PTSD, there is limited evidence on its association with physical health.

This study explored how different types and number of types of IPV are linked to specific physical health conditions, and whether these associations differ between men and women. VISION researchers Dr Ladan Hashemi, Dr Anastasia Fadeeva and Professor Sally McManus, with Nadia Khan, City St George’s UoL, examined this using data from the 2014 Adult Psychiatric Morbidity Survey.

Key findings include:

  • Women were more likely to experience IPV and a higher number of IPV types than men.
  • Women’s experience of lifetime and 12-month IPV were significantly associated with 12 and 11 different physical health conditions, respectively, while men’s experience of lifetime and 12-month IPV were significantly associated with 4 and 1 conditions, respectively.
  • Different types of IPV types were associated with different types of physical health condition, particularly among women.
  • A cumulative association between experiencing a greater number of IPV types and an increased risk of physical health conditions was evident for women but not for men.

The research concludes that IPV is a gendered issue, with stronger associations between IPV and physical health evident in this data for women than for men. This may be because women are more likely to experience more and multiple types of IPV, more frequently, and more often with injury. Healthcare systems must recognise IPV as a priority issue, ensuring support is tailored to those affected.

Recommendation

  • Healthcare systems need to address IPV as a priority health issue for the female population. Gender-informed approaches in IPV intervention strategies and healthcare provision are required. This means emphasising the development of IPV-responsive healthcare systems and comprehensive IPV curricula in medical and health training.

To download the paper: Intimate partner violence and physical health in England: Gender stratified analyses of a probability sample survey – Ladan Hashemi, Anastasia Fadeeva, Nadia Khan, Sally McManus, 2025

To cite: Hashemi L, Fadeeva A, Khan N, McManus S. Intimate partner violence and physical health in England: Gender stratified analyses of a probability sample survey. Women’s Health. 2025;21. doi:10.1177/17455057251326419

For further information, please contact Ladan at ladan.hashemi@citystgeorges.ac.uk

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Synthetic datasets enable linkage and a longitudinal understanding of experiences of violence and health impacts and consequences

Violence is a complex social problem and a public health issue, with implications for the health and social care systems, police and justice systems, as well as significant productivity losses for those who experience it. Analysing data collected by these systems can aid understanding of the problem of violence and how to respond to it. In social research, analysing administrative records together with survey data has already enabled better measurements of violence and its costs, capturing experiences of both victim-survivors and perpetrators across multiple points in time and social and economic domains.

Ideally, data from the same individuals would enable linkage and a longitudinal understanding of experiences of violence and their (health) impacts and consequences. However, most studies in violence-related research analyse data in silo due to difficulties in accessing data and concerns for the safety of those exposed. This is particularly the case for data from third sector specialist support services for victims or perpetrators of violence which has, to VISION’s knowledge, not been linked or combined with other datasets. Because these services provide person-centred trauma-informed care and there is a risk that information on their service users may be used against them in courts or by immigration authorities, direct data linkage is not possible and alternatives are needed.

With this research, VISION researchers Dr Estela Capelas Barbosa, Dr Niels Blom, and Dr Annie Bunce provide a proof-of-concept synthetic dataset by combining data from the Crime Survey for England and Wales (CSEW) and administrative data from Rape Crisis England and Wales (RCEW), pertaining to victim-survivors of sexual violence in adulthood. Intuitively, the idea was to impute missing information from one dataset by borrowing the distribution from the other.

The researchers borrowed information from CSEW to impute missing data in the RCEW administrative dataset, creating a combined synthetic RCEW-CSEW dataset. Using look-alike modelling principles, they provide an innovative and cost-effective approach to exploring patterns and associations in violence-related research in a multi-sectorial setting.

Methodologically, they approached data integration as a missing data problem to create a synthetic combined dataset. Multiple imputation with chained equations were employed to collate/impute data from the two different sources. To test whether this procedure was effective, they compared regression analyses for the individual and combined synthetic datasets for a variety of variables.

Results show that the effect sizes for the combined dataset reflect those from the dataset used for imputation. The variance is higher, resulting in fewer statistically significant estimates. VISION’s approach reinforces the possibility of combining administrative with survey datasets using look-alike methods to overcome existing barriers to data linkage.

Recommendations

  • Imputing missing information from one dataset by borrowing the distribution from the other should be applicable for costing exercises as it permits micro-costing. 
  • Compared to traditional research, VISION’s proposed approach to data integration offers a cost-effective solution to breaking (data-related) silos in research.

To download the paper: Look-alike modelling in violence-related research: A missing data approach | PLOS One

To cite: Barbosa EC, Blom N, Bunce A (2025) Look-alike modelling in violence-related research: A missing data approach. PLoS ONE 20(1): e0301155. https://doi.org/10.1371/journal.pone.0301155

For further information, please contact Estela at e.capelasbarbosa@bristol.ac.uk

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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

Call for Frontiers in Sociology abstracts: Enhancing data collection and integration to Reduce health harms and inequalities linked to violence

Frontiers in Sociology is currently welcoming submissions of original research for the following research topic: Enhancing Data Collection and Integration to Reduce Health Harms and Inequalities Linked to Violence.

This edition is guest-edited by Dr Estela Capelas Barbosa (University of Bristol and the UKPRP VISION research consortium), Dr Annie Bunce (City St. George’s, UoL and the UKPRP VISION research consortium), and Katie Smith (City St. George’s, UoL / University of Bristol).

Submissions should focus on any of the following:

  • advancing measurement approaches which emphasise cross-sector harmonisation to better evaluate interventions, address health inequalities, and reduce violence
  • addressing any form of violence (e.g., physical, non-physical, technology-facilitated) and its impacts on health, social and economic well-being, and marginalised groups, considering intersections of age, gender, ethnicity, disability, and religion

Research using existing datasets or primary data (quantitative or qualitative), cross-sectoral and cross-disciplinary approaches (e.g., sociology, criminology, public health), and lived experience perspectives is encouraged.

Contributions may include conceptual reviews, methodological innovations, empirical studies and systematic reviews on themes such as health inequalities, intervention effectiveness, outcome measurement, data harmonisation, and linkage strategies.

Abstracts are due by 7th April 2025, and the deadline for manuscripts is 28th July 2025.

For details of the different article types accepted and associated costs, please follow this link https://www.frontiersin.org/journals/sociology/for-authors/publishing-fees.

For more information and to submit an abstract or manuscript, please use the “I’m interested” link below or visit the Research Topic page here https://www.frontiersin.org/research-topics/67291/enhancing-data-collection-and-integration-to-reduce-health-harms-and-inequalities-linked-to-violence. 

This special edition provides an excellent opportunity to advance knowledge in this critical area. Please do reach out and contact us if you have any questions: annie.bunce@city.ac.uk

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Positive experiences can mitigate negative effects in children with trauma

Children with traumatic experiences in their early lives have a higher risk of obesity. But as new research from VISION researcher Dr Ladan Hashemi and colleagues at University of Auckland, New Zealand, demonstrate, this risk can be reduced through positive experiences.

Their analysis of data from around 5,000 children in the Growing Up in New Zealand study revealed nine out of ten faced at least one significant source of trauma by the time they were eight years old. Multiple adverse experiences were also prevalent, with one in three children experiencing at least three traumatic events. Notably, certain traumatic experiences (including physical abuse and parental domestic violence) related more strongly to obesity than others. This highlights the strong connection between early-life adversity and physical health outcomes.

Whilst researching the associations between obesity and childhood trauma, the team also explored the protective and mitigating effects of positive experiences. They defined positive experiences as:

  • mothers interacting well with their children
  • mothers involved in social groups
  • children engaged in enriching experiences and activities such as visiting libraries or museums and participating in sports and community events
  • children living in households with routines and rules, including those regulating bedtime, screen time and mealtimes
  • children attending effective early childhood education

The findings were encouraging. Children with more positive experiences were significantly less likely to be obese by age eight. For example, those with five or six positive experiences were 60% less likely to be overweight or obese compared to children with zero or one positive experience. Even two positive experiences reduced the likelihood by a quarter.

Among children exposed to multiple adversities, positive experiences can help mitigate the negative effects of childhood trauma. However, at least four positive experiences were required to significantly counteract the impact of adverse experiences.

Recommendations

  • Traditional weight-loss programmes focused solely on changing behaviours are not enough to tackle childhood obesity. To create lasting change, children need positive social environments and life experiences as well as support to address the emotional scars of early trauma shaping their lives.
  • Fostering positive experiences is a vital part of this holistic approach. These experiences not only help protect children from the harmful effects of adversity but also promote their overall physical and mental wellbeing. This isn’t just about preventing obesity – it’s about giving children the foundation to thrive and reach their full potential.
  • Sure Start and providers of early childhood education and support for parents could help reduce the health inequalities resulting from exposure to violence.

To download the paper: Identification of positive childhood experiences with the potential to mitigate childhood unhealthy weight status in children within the context of adverse childhood experiences: a prospective cohort study | BMC Public Health

To cite: Mellar, B.M., Ghasemi, M., Gulliver, P. et al. Identification of positive childhood experiences with the potential to mitigate childhood unhealthy weight status in children within the context of adverse childhood experiences: a prospective cohort study. BMC Public Health 25, 8 (2025). https://doi.org/10.1186/s12889-024-20727-y

For further information on the research:

Or for further information, please contact Ladan at ladan.hashemi@city.ac.uk

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Adverse childhood experiences associated with childhood obesity

Adverse childhood experiences (ACEs) are potentially traumatic events or environmental factors occurring during childhood that can disrupt a child’s sense of safety, stability, and bonding. ACEs include child abuse and maltreatment, family dysfunctions, and exposure to violence outside the family. Individuals impacted by ACEs are at greater risk of developing obesity in adulthood, however, few studies have prospectively measured ACEs and obesity during childhood. Associations with the adoption of obesogenic behaviours during childhood, which directly contribute to obesity are also understudied.

VISION researcher Dr Ladan Hashemi, along with colleagues from the University of Auckland, New Zealand, examined associations between individual and cumulative ACEs, obesity, and obesogenic behaviours during childhood (up to age 8). Using data from eight waves of the Growing Up in New Zealand study—the country’s largest birth cohort study—they developed an index to measure nine ACEs: child physical and psychological abuse, witnessing domestic violence against the mother, parental separation or divorce, parental incarceration, parental substance abuse, parental mental illness, peer bullying, and experiences of ethnic discrimination.  Their research, Associations between specific and cumulative adverse childhood experiences, childhood obesity, and obesogenic behaviours, discovered that:

  • ACEs were prevalent among children in New Zealand with almost nine out of ten experiencing at least one ACE. Multiple adverse experiences were also prevalent, with one in three children experiencing at least three traumatic events.
  • Higher ACE scores and experience of each specific ACE were significantly more prevalent among those identified as Māori or Pacific, those living in food insecure households or in the most deprived areas.
  • Experience of two or more ACEs was associated with higher risk of adopting obesogenic behaviours such as excessive consumption of unhealthy foods and drinks, inadequate consumption of fruits and vegetables, inadequate sleep duration, excessive screen time, and physical inactivity. The risk increased as the number of ACEs increased.   
  • Six of nine assessed ACEs were associated with the development of childhood obesity. A dose-response pattern was observed, with obesity risk increasing as the number of ACEs increased.

Exposure to ACEs contributes to the population-level burden of childhood obesity, potentially influencing obesity outcomes through associations with unhealthy, obesogenic behaviours. The findings highlight the importance of a holistic understanding of the determinants of obesity, reinforcing calls for ACEs prevention and necessitating incorporation of ACEs-informed services into obesity reduction initiatives.

Recommendations

  • Childhood obesity reduction efforts may benefit from considering the role of ACEs. Understanding and addressing the social determinants of obesity, such as family and social environments, may be important in the context of traditional behavioural change interventions targeting nutrition, sleep, screen time, and physical activity
  • Interventions that reduce children’s exposure to violence could help reduce levels of obesity and associated ACEs
  • Violence reduction and family support should feature in the government’s Tackling Obesity strategy

To download the paper: Full article: Associations between specific and cumulative adverse childhood experiences, childhood obesity, and obesogenic behaviours

To cite: Hashemi, L., Ghasemi, M., Mellar, B., Gulliver, P., Milne, B., Langridge, F., … Swinburn, B. (2025). Associations between specific and cumulative adverse childhood experiences, childhood obesity, and obesogenic behaviours. European Journal of Psychotraumatology, 16(1). https://doi.org/10.1080/20008066.2025.2451480

Or for further information, please contact Ladan at ladan.hashemi@city.ac.uk

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