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Varying definitions and measurements of violence limit reduction strategies

Violence reduction is a United Nations (UN) sustainable development goal (SDG) and is important to both the public health and criminology fields. The collaboration between the two has the potential to create and improve prevention strategies but has been hampered by the usage of different definitions and measurements.

In this paper, VISION researchers Dr Niels Blom, Dr Anastasia Fadeeva and Dr Estela Capelas Barbosa explore the definitions and measurements of violence by the World Health Organization, UN, and Council of Europe to arrive at a harmonized framework aligned with the SDGs.

Violence and abuse are defined by these organizations as intentional actions that (are likely to) lead to harm, irrespective of physicality or legality. When recording violence and abuse, health- and justice-based administrative systems use different codes which cannot directly be translated without resorting to broad overarching categories.

The researchers propose a framework to record violence that includes individual and event identifiers, forms of violence and abuse (including physical, sexual, and psychological), harm, and individual and event characteristics.

For further information please see: Social Sciences | Free Full-Text | The Concept and Measurement of Violence and Abuse in Health and Justice Fields: Toward a Framework Aligned with the UN Sustainable Development Goals (mdpi.com)

Or contact Niels at Niels.Blom@city.ac.uk

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Webinar: Parental and child mental health and intimate partner violence

This webinar is in the past.

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

Photo by Sebastián León Prado on Unsplash

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

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

Photo by Philipp Katzenberger on Unsplash

Unlocking violence information from clinical text

Blog by Dr Lifang Li, Research Associate with UKPRP VISION, Kings College London

Clinical Record Interactive Search (CRIS)

In 2008, the Clinical Record Interactive Search (CRIS) system was launched. CRIS removes personal identifiers from the health records of the South London and Maudsley NHS Trust, making them available for use in mental health research. The platform operates under a governance framework that prioritises patient anonymity and places patients at the centre of its operations. The use of exceptionally large volumes of records with unprecedented levels of detail has the potential to revolutionise mental health research. 

The CRIS Violence application

The CRIS violence application is computer software that finds clinical text that refers to interpersonal violence, including the presence of violence, patient status (i.e. as perpetrator, witness or victim of violence) and violence type (domestic, physical and/or sexual) using Natural Language Processing (NLP). NLP uses pattern matching and statistical techniques to automatically process natural human language. It was developed by Riley Botelle, Professor Robert Stewart and their colleagues to the identification and classification of experiences of violence in narrative records, described in their 2022 paper “Can natural language processing models extract and classify instances of interpersonal violence in mental healthcare electronic records: an applied evaluative study”. Recently, after a thorough validation process, the CRIS team has started to run the violence application routinely, alongside many other NLP applications (e.g., to find suicidality, agitation, medications, anxiety) that are available for CRIS. Structured output from these, now including various violence-related variables, is saved back into the CRIS database, from where authorised health researchers can access it.  

How does it serve the researchers and clinicians?

By accurately identifying the presence of violence, different types of violence, and patient status, the application is enabling researchers to examine how experiences of violence are correlated with various mental health problems, outcomes and treatment trajectories, and how these relate to patients’ characteristics (such and age, gender, and ethnic group), and account for health inequalities.

Future work

Given the possibility that psychological abuse and economic abuse may also occur in patients and are recorded in the health record by clinicians, our work as part of the VISION consortium involves updating the current violence application to identify mentions of these, allowing us to extend the violence research possible using CRIS.

Illustration: Nina Rys / Shutterstock.com