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Prevalence of sexual violence victimisation amongst mental health service users

Researchers from King’s College London, Anjuli Kaul, Laura Connell-Jones, Sharli Anne Paphitis and Sian Oram (VISION researcher), have published a systematic review and meta-analyses in Social Psychiatry and Psychiatric Epidemiology which provides up-to-date estimates on the prevalence and risk of sexual violence victimisation amongst mental health service users.

This review pooled data from 26 studies encompassing a total of 197,194 participants. Sexual violence included any sexual acts, comments or advances (or attempts at said behaviours) made towards a person without their consent. Mental health service users included any person who had been in contact with a psychiatric inpatient, outpatient, community, perinatal, liaison, addiction, veteran psychiatric inpatient, or forensic mental health service.

The researchers searched 3 electronic databases (Medline, Embase, and PsychINFO) for peer-reviewed publications from their dates of inception until 18^th July 2022. There were no restrictions on the geographic location of the included studies.

Key findings

The review found that studies consistently showed a high prevalence of past year and adult lifetime (since the age of 16) sexual violence victimisation in psychiatric service users, with higher rates found in women than men. Additionally, both male and female psychiatric service users were found to have an increased risk of experiencing sexual violence compared to non-psychiatric service users. This was the case regardless of whether the study measured past year or adult lifetime sexual violence or sampled a population of inpatients, outpatients or both.

The meta-analyses revealed high levels of heterogeneity within the data, which was likely partly due to the varied instruments used across studies to measure mental health and sexual violence. Additionally, there was not enough data available to calculate the pooled odds ratio of sexual violence victimisation for male or female psychiatric service users, nor was it possible to adjust odds ratios for known confounders such as age, ethnicity, income level or substance abuse.

The findings emphasise the need for healthcare practitioners to effectively recognise and respond to sexual violence in mental health services, and the need for a comprehensive and consistent measurement framework for sexual violence to enable reliable and comparable prevalence data to be collected.

For further information please see: Prevalence and risk of sexual violence victimization among mental health service users: a systematic review and meta-analyses | Social Psychiatry and Psychiatric Epidemiology (springer.com)

Or contact Anjuli at anjuli.1.kaul@kcl.ac.uk

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A health perspective to the war in Israel and Palestine

Gene Feder, VISION Director and Professor of Primary Care at the University of Bristol, has written an opinion piece with colleagues commenting on events in Israel and Gaza from a public health and primary care perspective. Responding to the war in Israel and Palestine was published in December in the online edition of the British Journal of General Practice.

Gene and his colleagues are GPs working to further the development of family medicine in the occupied Palestinian territory, specifically in the West Bank, but with links to family medicine in Gaza through the United Nations Relief and Works Agency and through Medical Aid for Palestinians. They also have friends and family in Israel and Palestine.

They have three responses to the current crisis as informed by their work as GPs and connection to Palestinian primary care:

A plea for the protection of health care and health professionals amid the war
A plea for the preservation of public health amid war
A recognition that in the aftermath of October 7th and the invasion of Gaza, the widespread direct and vicarious trauma in Israeli and Palestinian populations will result in permanent physical and emotional damage: the former in the shape of orthopaedic, neurological, and gynaecological (as a result of rape) harm, the latter in the form of widespread anxiety, depression, and post-traumatic stress disorder which will also cascade down the generations.

Given VISION’s commitment to developing evidence on violence prevention, we will be organising roundtable meetings bringing together researchers focusing on post-conflict violence reduction. This is an opportunity for dialogue, perhaps leading to new perspectives and research including systematic assessment of sustainable post-conflict interventions as well as further joint activities.

For further information on the opinion piece, please see: Responding to the war in Israel and Palestine

Photograph by Emad El Byed on Unsplash

Webinar: Parental and child mental health and intimate partner violence

This webinar is over. 27 June 2023, 17:00 – 18:30 BST, Zoom

VISION director, Professor Gene Feder, led the webinar, Interrelationships between parental mental health, intimate partner violence and child mental health – implications for practice, with Dr Shabeer Syed and Dr Claire Powell on behalf of the NIHR Children and Families Policy Research Unit.

They presented findings from a mixed methods study that seeks to improve responses to families affected by intimate partner violence (IPV) and parents and children’s mental health problems.

Then, they presented preliminary findings on the relationship between parental IPV and a range of clinically relevant adversity and mental health-related indicators (www.acesinehrs.com) in anonymised health records from parents and children presenting to GPs, A&E and hospital admissions between one year before and five years after birth.

Their research shows that 1 in 5 (20%) families experienced IPV, although only 1 in 50 (2%) had IPV recorded in the GP record. Recording of other adverse childhood experiences (ACEs) was better, with 1 in 2 (53.4%) families having at least one recorded in the early life course. Compared to families without ACEs, families with ACEs had a higher risk of parental IPV, especially when at least one parent and child had recorded a mental health problem. Gene will discuss the implications of these findings for national guidance on supporting families experiencing IPV and mental health problems, articulating how data already within medical records can help identify those families.

For further information please see: Interrelationships between parental mental health, intimate partner violence and child mental health – implications for practice – ACAMH

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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

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Accounting for Inequalities

In this research, Dr Alexandria Innes, Senior Lecturer in International Politics and Co-Investigator within the VISION research grant, draws on a case study of gender-based violence and subsequent responses to argue that Ontological Security Studies – a sub-paradigm of International Relations that focuses on a sociology of security based on identity and social environments – have thus far failed to fully account for intersectional inequalities within social narratives of security. 

She argues that the state is incapable of providing lived experiences of security for all residents, because of inherent inequalities that underlie national identity, affecting services people have access to and the level of support they might receive from state-based agencies such as the police and social services. It is only in attending to those inequalities among the population that we can attend to the biases at the heart of the state.

Through the case study of the murder of Sarah Everard and the responses, the value and necessity of an intersectional approach to security is made clear: trauma responses that are positioned as transgressive by the patriarchal and White supremacist dominating account are used to undermine the credibility of alternative narratives of security. The state adopts a technique of dividing identity and constructing normatively oppressed identities as transgressive to consolidate the state narrative of security.

For further information please see: Accounting for inequalities: divided selves and divided states in International Relations – Alexandria Innes, 2023 (sagepub.com) or contact Andri at alexandria.innes@city.ac.uk