Gender and violence against people with severe mental illness

Prevalence and Characteristics of People with Disabilities Among Abused Victims in Saudi Arabia

BACKGROUND

Abuse is an ongoing public health issue that results in increased morbidity and mortality rates. Abuse against individuals with disabilities is a pervasive and deeply concerning issue, often compounded by factors of vulnerability and dependence. The majority of disabled individuals experience abuse, with the majority enduring it repeatedly. Identifying the problem is the first step towards preventing abuse. This study aimed to identify the prevalence of people with disabilities among abused victims and the victim's associated risk factors in Saudi Arabia.

METHODS

This cross-sectional study obtained data from the National Family Safety Registry. All registered children and adults between April 2017 and December 2022 from 93 centers across 13 regions of Saudi Arabia were included. Logistic regression models were used to determine the association between independent variables and victim-related risk factors such as the onset of abuse complications, the victim being an adult or child, the victim's gender, and whether they had been previously abused.

RESULTS

Individuals with disabilities comprise 1.4% (n = 199) of all reported cases of abuse (n = 14,004), and the trend of violence against people with disabilities has decreased during the 6-year study period. Of the abused people with disabilities, 72.4% were children, 57.8% were males, 45.2% were previously abused, and 65.3% had complications from the abuse. Caregiver type, perpetrator gender, perpetrator age, and previous abuse status were significant factors.

CONCLUSIONS

This study highlights the disability prevalence among reported abuse cases and evaluates victim's risk factors in Saudi Arabia, which demonstrates an urgency for targeted intervention and support. People with disabilities constitute a vulnerable demographic who require increased support and resources. Comprehensive data collection can be utilized for effective violence prevention strategies. Further research should explore qualitative methods and survey the rates of abuse among people with disabilities in the community to gain deeper insights.

Cross-lagged relationships between exposure to intimate partner violence, depressive symptoms and suicidal thoughts among adolescent and young married women

BACKGROUND

High rates of depression and suicidal ideation are found in women experiencing intimate partner violence (IPV), but their temporal relationship is unclear. This study explores the bidirectional causality between IPV victimization, depressive symptoms, and suicidal thoughts among adolescent and young married women in India.

METHODS

Data sourced from the UDAYA longitudinal survey in India, comprising 3,965 women aged 15-22. Employing Pearson's correlation coefficient, we analyzed the relationship between variables. Additionally, a two-wave cross-lagged autoregressive panel model explored the bidirectional link between IPV, depressive symptoms, and suicidal ideation.

RESULTS

Approximately 25 % and 45 % of the participants reported some form of partner violence at baseline and at follow-up after three years, respectively. Exposure to IPV at baseline was significantly associated with depressive symptoms at follow-up [β = 0.10, p < 0.001], and the association between depressive symptoms at baseline and IPV at follow-up was statistically not significant [β = -0.02, 95 % CI: -0.06-0.02]. Similarly, exposure to IPV at baseline was significantly associated with suicidal thoughts at follow-up [β = 0.24, p < 0.001], and the association between suicidal thoughts at baseline and IPV at follow-up was statistically not significant [β = 0.003, 95 % CI: -0.001-006].

CONCLUSIONS

The findings suggest that exposure to IPV is consistently and strongly associated with depressive symptoms and suicidal thoughts in adolescent and young married women. However, the reciprocal relationships did not hold true in this study, implying that reducing IPV during adolescence could potentially minimize the prevalence of depressive symptoms and suicidal thoughts during young adulthood.

Psychological complications of the children exposed to domestic violence: a systematic review

Background

Domestic violence (DV) is one of the major concerning health problems worldwide, and individuals who experienced domestic violence, may suffer physical or psychological consequences.

Main body

Children as a major part of the family and society are usually involved in familial challenging events such as domestic violence, and suffer several major complications. This review aimed to explore the psychological consequences of child exposure to domestic violence. A systematic search in four databases yielded 18 peer-reviewed original studies that met the inclusion criteria. Selected studies highlighted the psychological consequences of domestic violence in witnessing and exposed children. The findings of the present study revealed that children exposed to DV suffer various psychological, mental, and behavioral complications which may be short and long-lasting, and moderate or severe. Children exposed to domestic violence may show declined educational performance and social abilities. Internalization problems, depression, post-traumatic stress disorders symptoms, and externalization symptoms such as aggressive behaviors and even lower levels of IQ are of most important reported complications of domestic violence in children. Educational programs for parents as well as trained school caregivers and health policy-makers can diminish and prevent the complications of domestic violence in children.

Conclusion

Considering the importance of children mental hygiene, health policymakers should consider facilities to screen and detect children with signs of maltreatment and exposed to domestic violence. In this regard, trained teachers or school counselors will be helpful, as social supports and therapies may be more effective by early detection affairs.

Adverse outcomes associated with recorded victimization in mental health electronic records during the first UK COVID-19 lockdown

PURPOSE

The impact of COVID-19 pandemic policies on vulnerable groups such as people with mental health problems who experience violence remains unknown. This study aimed to investigate the prevalence of victimization recorded in mental healthcare records during the first UK lockdown, and associations with subsequent adverse outcomes.

METHODS

Using a large mental healthcare database, we identified all adult patients receiving services between 16.12.2019 and 15.06.2020 and extracted records of victimisation between 16.03.2020 and 15.06.2020 (first UK COVID-19 lockdown). We investigated adverse outcomes including acute care, emergency department referrals and all-cause mortality in the year following the lockdown (16.06.2020- 01.11.2021). Multivariable Cox regressions models were constructed, adjusting for socio-demographic, socioeconomic, clinical, and service use factors.

RESULTS

Of 21,037 adults receiving mental healthcare over the observation period, 3,610 (17.2%) had victimisation mentioned between 16.03.2020 and 15.06.2020 (first UK COVID-19 lockdown). Service users with mentions of victimisation in their records had an elevated risk for all outcomes: acute care (adjusted HR: 2.1; 95%CI 1.9-2.3, p < 0.001), emergency department referrals (aHR: 2.0; 95%CI 1.8-2.2; p < 0.001), and all-cause mortality (aHR: 1.5; 95%CI 1.1-1.9; p = 0.003), when compared to service users with no recorded victimisation. We did not observe a statistically significant interaction with gender; however, after adjusting for possible confounders, men had slightly higher hazard ratios for all-cause mortality and emergency department referrals than women.

CONCLUSION

Patients with documented victimisation during the first UK lockdown were at increased risk for acute care, emergency department referrals and all-cause mortality. Further research is needed into mediating mechanisms.

Spectrum of intimate partner violence in patients with psychiatric illness-From victimization to perpetration

PURPOSE

Persons with psychiatric illness are vulnerable to be the victims of intimate partner violence (IPV) and at risk of perpetrating IPV.

OBJECTIVES

To estimate the prevalence and association of IPV in patients with psychiatric disorders, both as victims and as perpetrators.

METHODOLOGY

We conducted a questionnaire based, cross-sectional study using systematic random sampling at psychiatric Outpatient Department (OPD) in a tertiary care hospital, in Haryana, India. A total of 500 participants diagnosed with psychiatric disorder were assessed using Operational WHO Criteria for IPV Victimization assessment and IPV Perpetration Assessment scale by Rhodes et al.

RESULTS

The prevalence of IPV victimization was 16% during the last year and 26% during lifetime. IPV victimization was found significantly more in females (especially sexual), young and unemployed participants, during the initial 10 years of marriage and 10 years of the illness. Sexual IPV was the most common. The prevalence of IPV perpetration by the participants was 6% during last year and 10.6% in lifetime. Perpetrators were more likely to be males of higher age (40-50 years), unemployed, having lower income, belonging to joint family, and residing in rural areas. Diagnosis of a psychiatric illness, especially psychosis increased chances of perpetration. As the duration of illness increased, prevalence of IPV perpetration increased.

CONCLUSION

Intimate partner violence among persons with psychiatric disorders is common and they are more vulnerable to being victims of IPV, rather than perpetrating IPV. Vulnerability and risk factors for IPV should be taken into account and optimized strategies should be devised for prevention.

Association Between Intimate Partner Violence and Suicidal Ideation Among Female and Male Adults in South Korea: A Nationally Representative Longitudinal Study

This study sought to assess the prevalence of intimate partner violence (IPV) victimization and to examine the sex-stratified associations between IPV and suicidal ideation in South Korea. This study used nationally representative longitudinal survey data from 2011 to 2020 of the Korean Welfare Panel Study of 9732 married adults at baseline. Participants were annually asked about IPV experiences of verbal abuse, physical threat, or physical assault over the past year in 2011-2019. Suicidal ideation in the past year was assessed in the following year 2012-2020 of IPV experiences. Using multilevel logistic regression models, we examined the associations between IPV and suicidal ideation among married adults. The prevalence of verbal abuse, physical threat, and physical assault was respectively 19.8%, 3.0%, and 1.4% in females (n = 5056); and 18.8%, 2.7%, and 1.0% in males (n = 4676). After adjusting for potential confounders (e.g., lifetime suicidal ideation and random effects of individuals and households) in the same year when participants had IPV experiences, all types of IPV experiences were statistically associated with suicidal ideation in the following year among both females and males, except for physical threat among males. We found a statistically significant association between physical threat and suicidal ideation among females (adjusted odds ratio: 2.22, 95% confidence interval: 1.62, 3.04), whereas no association was observed among males. Our findings suggest that public health interventions related to suicidal behaviors that can be attributable to experiencing IPV are necessary among both females and males in South Korea.

Domestic violence against women during coronavirus (COVID-19) pandemic lockdown in Egypt: a cross-sectional study

BACKGROUND

While it is necessary to limit the spread of the coronavirus (COVID-19) pandemic, efforts including social isolation, restricted travel, and school closures are anticipated to raise the probability of domestic violence (DV). This study aimed to estimate the prevalence, pattern, risk factors, and physical health outcomes of domestic violence against women during the COVID-19 pandemic.

METHODS

A cross-sectional study was conducted using a convenient sample. The data collection tool was based on Sect. 11 of the Egyptian Demographic Health Survey, 2014, which is designed to measure domestic violence. We used a Google form-designed questionnaire and distributed the link to social media platforms from May 2020 to June 2020 till the collection of the required sample of 388 completed questionnaires.

RESULTS

The prevalence of every form of DV was 31%. Emotional violence was the most prevalent (43.5%) followed by physical (38.9%) and sexual violence (17.5%). About 10.5% of women reported suffering from all types of violence. The husband was the most common perpetrator of DV. The determinants of ever experiencing any form of DV were low education level of women (OR = 7.3, 95% CI 2.8-18.8), unemployment (OR = 2.31, 95% CI 4-3.5), husband's use of alcohol or substance (OR = 14.4, 95% CI 4.1-50.2), and insufficient income (OR = 2.01, 95% CI 2-3.2). The most common health consequences of DV were injuries such as cuts, bruises, and aches.

CONCLUSIONS

The prevalence of ever experiencing any form of DV was 31% which is considered high. Emotional violence was the most common whereas sexual violence was the least common. Identifying the risk factors of DV would support the development and implementation of preventive and screening programs for early identification and offering social support to the victims. Policies should be adopted for the early detection and protection of women suffering from violent behaviors. Access to adequate prompt support and health-care services is crucial in order to decrease the consequences of violence. It is necessary to implement alcohol or drug abuse interventions, preventive measures, and screening programs in families to reduce DV.

Evaluating the Relationship Between Intimate Partner Violence-Related Training and Mental Health Professionals' Assessment of Relationship Problems

Intimate partner violence (IPV) is a serious public health problem associated with increased risk of developing mental health conditions. Assessment of IPV in mental health settings is important for appropriate treatment planning and referral; however, lack of training in how to identify and respond to IPV presents a significant barrier to assessment. To address this issue, the World Health Organization (WHO) advanced a series of evidence-based recommendations for IPV-related training programs. This study examines the relationship between mental health professionals' experiences of IPV-related training, including the degree to which their training resembles WHO training recommendations, and their accuracy in correctly identifying relationship problems. Participants were psychologists and psychiatrists (N = 321) from 24 countries who agreed to participate in an online survey in French, Japanese, or Spanish. They responded to questions regarding their IPV-related training (i.e., components and hours of training) and rated the presence or absence of clinically significant relationship problems and maltreatment (RPM) and mental disorders across four case vignettes. Participants who received IPV-related training, and whose training was more recent and more closely resembled WHO training recommendations, were more likely than those without training to accurately identify RPM when it was present. Clinicians regardless of IPV-related training were equally likely to misclassify normative couple issues as clinically significant RPM. Findings suggest that IPV-related training assists clinicians in making more accurate assessments of patients presenting with clinically significant relationship problems, including IPV. These data inform recommendations for IPV-related training programs and suggest that training should be repeated, multicomponent, and include experiential training exercises, and guidelines for distinguishing normative relationship problems from clinically significant RPM.

Detection of Domestic Violence and Abuse by Community Mental Health Teams Using the BRAVE Intervention: A Multicenter, Cluster Randomized Controlled Trial

Despite increased prevalence of domestic violence and abuse (DVA), victimization through DVA often remains undetected in mental health care. To estimate the effectiveness of a system provider level training intervention by comparing the detection and referral rates of DVA of intervention community mental health (CMH) teams with rates in control CMH teams. We also aimed to determine whether improvements in knowledge, skills and attitudes to DVA were greater in clinicians working in intervention CMH teams than those working in control teams. We conducted a cluster randomized controlled trial in two urban areas of the Netherlands. Detection and referral rates were assessed at baseline and at 6 and 12 months after the start of the intervention. DVA knowledge, skills and attitudes were assessed using a survey at baseline and at 6 and 12 months after start of the intervention. Electronic patient files were used to identify detected and referred cases of DVA. Outcomes were compared between the intervention and control teams using a generalized linear mixed model. During the 12-month follow-up, detection and referral rates did not differ between the intervention and control teams. However, improvements in knowledge, skills and attitude during that follow-up period were greater in intervention teams than in control teams: β 3.21 (95% CI 1.18-4.60). Our trial showed that a training program on DVA knowledge and skills in CMH teams can increase knowledge and attitude towards DVA. However, our intervention does not appear to increase the detection or referral rates of DVA in patients with a severe mental illness. A low detection rate of DVA remains a major problem. Interventions with more obligatory elements and a focus on improving communication between CMH teams and DVA services are recommended.

Mental Illness as a Vulnerability for Sexual Assault: A Retrospective Study of 7,455 Sexual Assault Forensic Medical Examinations

BACKGROUND

Persons with severe mental illness (MI) are at a high risk of becoming victims of sexual assault (SA). Vulnerability for SA with any type of MI is unknown. This study aimed to identify the prevalence of preexisting MI and other significant factors in patients reporting preexisting MI at the time of their SA medical forensic examinations (SAMFEs).

METHOD

A retrospective SAMFE chart review of patients ( N = 7,455) from 2010 to 2020 was conducted. Sexual assault nurse examiners completed SAMFEs. Inclusion criteria included (a) aged 14 years and older, (b) completed SAMFE with SA kit evidence collection, and (c) reported to law enforcement (restricted cases not included). Descriptive statistics and chi-square analyses were completed.

FINDINGS

It was found that 46.7% of study participants reported preexisting MI and/or current use of psychotropic medications, more than double the MI prevalence rates in the general population. MI in patients seen for SAMFE was associated with prior history of SA, medical health problems, and physical or mental impairment. In addition, patients with MI reported more violent SAs with increased anogenital and nonanogenital injuries.

DISCUSSION

The high prevalence rate of any MI in patients seen for SAMFE indicates MI in varying severity is a significant vulnerability for SA. The association of preexisting MI with a history of SA, health problems, and physical or mental impairment expands understanding of associated MI factors. These findings support the development of interventions by healthcare providers and stakeholders to address SA vulnerabilities in individuals with MI.

Mental illness concordance between hospital clinical records and mentions in domestic violence police narratives: Data linkage study (Preprint)

Background

To better understand domestic violence, data sources from multiple sectors such as police, justice, health, and welfare are needed. Linking police data to data collections from other agencies could provide unique insights and promote an all-of-government response to domestic violence. The New South Wales Police Force attends domestic violence events and records information in the form of both structured data and a free-text narrative, with the latter shown to be a rich source of information on the mental health status of persons of interest (POIs) and victims, abuse types, and sustained injuries.

Objective

This study aims to examine the concordance (ie, matching) between mental illness mentions extracted from the police’s event narratives and mental health diagnoses from hospital and emergency department records.

Methods

We applied a rule-based text mining method on 416,441 domestic violence police event narratives between December 2005 and January 2016 to identify mental illness mentions for POIs and victims. Using different window periods (1, 3, 6, and 12 months) before and after a domestic violence event, we linked the extracted mental illness mentions of victims and POIs to clinical records from the Emergency Department Data Collection and the Admitted Patient Data Collection in New South Wales, Australia using a unique identifier for each individual in the same cohort.

Results

Using a 2-year window period (ie, 12 months before and after the domestic violence event), less than 1% (3020/416,441, 0.73%) of events had a mental illness mention and also a corresponding hospital record. About 16% of domestic violence events for both POIs (382/2395, 15.95%) and victims (101/631, 16.01%) had an agreement between hospital records and police narrative mentions of mental illness. A total of 51,025/416,441 (12.25%) events for POIs and 14,802/416,441 (3.55%) events for victims had mental illness mentions in their narratives but no hospital record. Only 841 events for POIs and 919 events for victims had a documented hospital record within 48 hours of the domestic violence event.

Conclusions

Our findings suggest that current surveillance systems used to report on domestic violence may be enhanced by accessing rich information (ie, mental illness) contained in police text narratives, made available for both POIs and victims through the application of text mining. Additional insights can be gained by linkage to other health and welfare data collections.

'Modelling social exclusion in a diagnostically-mixed sample of people with severe mental illness'

BACKGROUND

Social inclusion is an important indicator of recovery in individuals with severe mental illness. The Social Inclusion Questionnaire User Experience (SInQUE) is a new measure of social inclusion for mental health service users which assesses five domains (consumption, production, access to services, social integration and civil engagement). It has good psychometric properties and is acceptable to service users and mental health professionals. It is not clear whether individuals with different diagnostic conditions experience a similar reduction in social inclusion.

AIMS

(1) Investigate whether current social inclusion differs between diagnostic groups (people with schizophrenia/other psychotic disorders, common mental disorder or personality disorder); (2) Identify factors associated with lower social inclusion; (3) Examine associations between social inclusion and stigma, quality of life and loneliness.

METHOD

Mental health service users with psychotic disorder, personality disorder or common mental disorder, living in the community, completed the SInQUE, alongside other validated outcome measures. Multiple regression investigated associations.

RESULTS

About 192 service users (55% with psychotic disorder; 26% with common mental disorder; 19% with personality disorder). Current social inclusion did not vary according to diagnosis, except for the sub-domain of productivity, where individuals with personality disorder were more socially included than the other two groups. Lower social inclusion was associated with older age (p = .008), lack of higher education (p < .001), more previous admissions (p = .005), severity of current symptoms and greater experienced stigma (p = .006) and anticipated stigma (p = .035). Greater social inclusion was associated with better quality of life (p < .001) and less loneliness (p < .001).

CONCLUSIONS

Barriers to social inclusion in individuals with severe mental health problems include factors related to the illness, such as symptom severity and external factors, such as stigma and discrimination. Social inclusion is a recovery goal and should be routinely assessed. Increasing people's social inclusion benefits service users in terms of improved mental health, better quality of life and reduced loneliness.

Emergency department use for mental and substance use disorders: descriptive analysis of population-based, linked administrative data in British Columbia, Canada

OBJECTIVES

Information on emergency department (ED) visits for mental and substance use disorders (MSUDs) is important for planning services but has not been explored in British Columbia (BC), Canada. We describe all MSUD ED visits for people ages 15 and older in the province of BC in 2017/2018 and document trends in MSUD ED visits between 2007/2008 and 2017/2018 by disorder group.

DESIGN

Population-based linked administrative data comprised of ED records and physician billings capturing all MSUD ED visits in BC.

SETTING

BC is Canada's westernmost province with a population of approximately 5 million. Permanent residents receive first-dollar coverage for all medically necessary services provided by licensed physicians or in hospitals, including ED services.

POPULATION

All people age >15 with MSUD ED visits during the study period.

MEASURES

All claims with a service location in the ED or corresponding to fee items billed only in the ED were examined alongside ED visits reported through a national reporting system. Patient characteristics (sex/gender, age, location of residence, income, treated disorders and comorbidities) and previous outpatient service use for all ED visits by visit diagnosis are also described.

RESULTS

A total of 72 363 people made 134 063 visits to the ED in 2017/2018 for needs related to MSUD. MSUD ED visits have increased since 2010, particularly visits for substance use and anxiety disorders. People with more frequent visits were more likely to be male, on public prescription drug plans for income assistance, prescribed psychiatric medications, and living in lower-income neighbourhoods. They used more community-based primary care and psychiatry services and had lower continuity of primary care.

CONCLUSIONS

MSUD ED visits are substantial and growing in BC. Findings underscore a need to strengthen and target community healthcare services and adequately resource and support EDs to manage growing patient populations.

Intimate Partner Violence Among Persons With Mental Health-Related Disabilities in Canada

This study examined the elevated risk of intimate partner violence (IPV) among persons with mental health-related disabilities (MH-RD) and the extent to which known risk factors accounted for this phenomenon. Data were drawn from a nationally representative sample of 33,127 Canadians collected in 2014 as part of Statistics Canada's General Social Survey. Results showed that respondents with MH-RD had more than three-fold increased odds of both overall and severe IPV victimization. Although females were more likely to possess a MH-RD, males and females with MH-RD reported similarly elevated odds of IPV victimization. Risk factors that contributed to a significant reduction in elevated odds of IPV for respondents with MH-RD were child maltreatment (CM), respondents' nonprescription drug abuse, and perpetrators' jealous, monitoring, and socially isolating behaviors. The inability to test additional risk factors and bidirectionality in the relationship between MH-RD and IPV may have contributed to the failure to fully account for these respondents' elevated odds of IPV. Future research is needed to understand the complex mechanisms contributing to the elevated risk of IPV and enhance prevention and intervention strategies for this underresearched and underserved vulnerable population.

Prevalence of adult sexual abuse in men with mental illness: Bayesian meta-analysis

BACKGROUND

Sexual abuse is a broad category of traumatic experiences that includes rape and any unwanted sexual contact with a body part or foreign object, whether penetrative, oral or otherwise. Although patients with mental illness have a higher risk of becoming victims of sexual abuse in adulthood, few studies investigate the proportion of male victims in this population. Their underrepresentation in research is a barrier to understanding the negative outcomes associated with sexual abuse in men.

AIMS

We estimated the prevalence of recent (past year) and adulthood sexual abuse perpetrated by any perpetrator and separately by intimate partners in males diagnosed with a mental illness.

METHOD

To model the prevalences and heterogeneity arising from reports, we used Bayesian multilevel models. Prevalences were estimated for mixed-diagnosis, substance misuse, intellectual disability and post-traumatic stress disorder samples, and studies reporting specifically on intimate partner violence. This review was registered through PROSPERO (CRD42020169299).

RESULTS

Estimated adult sexual abuse was 5.3% (95% Credibility Interval 1.6-12.8%) for past-year abuse and 14.1% (95% Credibility Interval 7.3-22.4%) for abuse in adulthood. There was considerable heterogeneity of prevalence between studies and diagnosis groups.

CONCLUSIONS

Our analyses show that the prevalence of sexual abuse of males diagnosed with a mental illness was much higher than for men in the general population. This has important implications regarding the proportion of undetected or untreated sexually abused men in clinical practice.

Intimate Partner Violence and Depression in Women in China

Intimate partner violence (IPV) is recognized as a major public health and social problem globally, with consequences for the individual, family, and society. But there is relatively little research on IPV in China. The aim of this study was to estimate the prevalence of different types of violence among women and to determine the risk factors and the association with depression. A cross-sectional study among women who had ever been in a relationship was conducted in six provinces across the three regions of China from July to September 2018 using a self-completion questionnaire developed for the study. The provincial capital and one rural county were purposively selected in each province. Questionnaires were distributed in hospitals and public places. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to measure depression. Data for 2,987 women were analyzed. The prevalence of psychological, physical, and sexual violence was 77.7%, 40.2%, and 11%, respectively: 52% had experienced two or three types of violence in their life. After adjustment, risk factors for all-type IPV were low occupational status, having one child or more, living in western provinces, having an income lower than partner's, and economic pressure. The prevalence of depression was 65.8% in women who experienced psychological violence, 69.5% for physical violence, and 75.8% for sexual violence. For psychological, physical, and sexual violence, the odds ratio for depression were 2.57 (95% confidence interval [CI] = [2.15, 3.07]), 2.07 [1.76, 2.43], and 2.26 [1.73, 2.95], respectively, after controlling for age, occupation, education attainment, and residence. There is a clear need to raise awareness about IPV and to develop approaches for prevention and management. The new Domestic Violence Law represents a step in the right direction.

Utilizing Text Mining, Data Linkage and Deep Learning in Police and Health Records to Predict Future Offenses in Family and Domestic Violence

Family and Domestic violence (FDV) is a global problem with significant social, economic, and health consequences for victims including increased health care costs, mental trauma, and social stigmatization. In Australia, the estimated annual cost of FDV is $22 billion, with one woman being murdered by a current or former partner every week. Despite this, tools that can predict future FDV based on the features of the person of interest (POI) and victim are lacking. The New South Wales Police Force attends thousands of FDV events each year and records details as fixed fields (e.g., demographic information for individuals involved in the event) and as text narratives which describe abuse types, victim injuries, threats, including the mental health status for POIs and victims. This information within the narratives is mostly untapped for research and reporting purposes. After applying a text mining methodology to extract information from 492,393 FDV event narratives (abuse types, victim injuries, mental illness mentions), we linked these characteristics with the respective fixed fields and with actual mental health diagnoses obtained from the NSW Ministry of Health for the same cohort to form a comprehensive FDV dataset. These data were input into five deep learning models (MLP, LSTM, Bi-LSTM, Bi-GRU, BERT) to predict three FDV offense types ("hands-on," "hands-off," "Apprehended Domestic Violence Order (ADVO) breach"). The transformer model with BERT embeddings returned the best performance (69.00% accuracy; 66.76% ROC) for "ADVO breach" in a multilabel classification setup while the binary classification setup generated similar results. "Hands-off" offenses proved the hardest offense type to predict (60.72% accuracy; 57.86% ROC using BERT) but showed potential to improve with fine-tuning of binary classification setups. "Hands-on" offenses benefitted least from the contextual information gained through BERT embeddings in which MLP with categorical embeddings outperformed it in three out of four metrics (65.95% accuracy; 78.03% F1-score; 70.00% precision). The encouraging results indicate that future FDV offenses can be predicted using deep learning on a large corpus of police and health data. Incorporating additional data sources will likely increase the performance which can assist those working on FDV and law enforcement to improve outcomes and better manage FDV events.

The Contingent Effect of Guardianship on Victimization: An Examination of People With and Without Mental Health Problems

Mixed effects of guardianship on victimization have been found in the literature. It is possible that these divergent findings have emerged because research has not recognized how the need for guardianship may shape the results. That is, individuals who are not suitable targets (i.e., individuals without mental health problems-those who are not perceived as vulnerable or incapable of defending themselves) do not need guardianship, resulting in null findings for the protective effects of guardianship on victimization. We examine the possibility that mental health problems and guardianship interact to produce victimization in the Life Opportunities Survey, a nationally representative survey of individuals in the United Kingdom (N = 27,516). Logistic regression analyses support our hypothesis that the effects of guardianship on victimization, which is measured as violence or the threat of violence against an individual, are contingent on the presence of mental health problems (i.e., any emotional or psychological health condition). The risk of victimization for those with mental health problems who had guardianship was substantially lower than for those with mental health problems who lacked guardianship (11.5% vs. 17%, respectively). We discuss this finding in light of routine activities theory and crime prevention for people with mental health problems.

Empowerment of nurses' knowledge and skills on violence against women with mental illness: A randomized controlled trail

BACKGROUND

Nurses play a key role in identifying and supporting women with abusive experiences. However, research that evaluated the effectiveness of educational interventions on violence against women is sparse from India.

AIM

To evaluate the effectiveness of a training program in improving nurses' knowledge and skills related to the identification and management of abused Women with Mental Illness (WMI).

METHODS

A randomized controlled trial design was adopted for the present study. A total of 68 nurses were randomly assigned to either the experimental or control group (34 in each group). The experimental group was provided eight interactive sessions based on a Nursing Module on abuse among women with mental illness. The assessments were done in both groups at baseline, after the intervention, at three months and six months. The data was collected using a self-rated questionnaire and case vignettes.

RESULTS

The mean knowledge score increased significantly in the experimental group after the intervention from 12.26 (SD, 2.03) to 23.60 (SD,1.24) and sustained at three months (23.07 ± 0.94) and six months (23.13 ± 1.61). Similarly, there were significant differences in nurses' skills after the training program (t = 13.17, p < 0.001) and at different time points of assessment (p < 0.001).

CONCLUSIONS

Results showed that training had a positive impact on nurses' knowledge and skills related to violence against women with mental illness. Therefore, it is necessary to provide continuous training on this issue to help nurses in providing holistic care to this vulnerable population.

Predictors of sexual violence among female students in higher education institutions in Ethiopia: A systematic review and meta-analysis

Background

Sexual violence is a profound social and public health problem in Ethiopia. Female students in institutions of higher education are highly vulnerable to sexual violence. Different studies conducted on sexual violence at higher education institutions lack consistency and inclusiveness. Thus, this systematic review and meta-analysis were conducted to estimate the lifetime and twelve-month prevalence, and predictors of sexual violence among female students in institutions of higher education in Ethiopia.

Methods

This study used a systematic review and meta-analysis of studies conducted from January 1, 2000, to June 1, 2020, in Ethiopia. This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases including PubMed, Cochrane Library, Hinari, Google Scholar, CINAHL, and Global Health were searched using relevant search terms. Meta-analysis was performed using STATA 14 software. The I² statistics and Egger’s test were used to assess heterogeneity and publication bias, respectively. Forest plots were used to present the prevalence and odds ratio (OR) with a 95% confidence interval (CI).

Results

This systematic review and meta-analysis included 10 studies, 5790 study participants. The pooled lifetime and twelve-month prevalence of sexual violence among female students in Ethiopia was 49.4% (95%CI: 37.87, 60.96) and 36.02% (95%CI: 26.42, 45.62) respectively. Rural residence (OR = 2.13;95%CI: 1.33, 3.42), alcohol drinking (OR = 2.03; 95%CI: 1.44, 2.87), and ever had a boyfriend (OR = 2.07; 95%CI: 1.32, 3.62) were factors associated with sexual violence.

Conclusions

The lifetime prevalence of sexual violence among female students in institutions of higher education in Ethiopia was high. Place of residence, alcohol drinking, and ever had a boyfriend were statistically significant factors of sexual violence. Life skill training and law enforcement are needed to control alcohol consumption. Additionally, more focused interventions should be done in rural settings.

Registration

This systematic review has been registered in the International Prospective Registry of Systematic Review (PROSPERO) with a specific registration number CRD42020155894.

Early maladaptive schemas and intimate partner violence victimization and perpetration: A systematic review and meta-analysis

Young's early maladaptive schemas represent a possible pathway between childhood adversity and Intimate Partner Violence (IPV). The aim of this review was to synthesize the evidence on early maladaptive schemas and IPV. PubMed, PsycInfo, and CINAHL databases were searched, in compliance with PRISMA, to identify peer reviewed studies that reported on the relationship between schema or schema domain scores and IPV victimization or perpetration. Based on nine included studies, meta-analyses indicated that IPV victimization showed a moderate association with the Disconnection and Rejection and Impaired Autonomy domains, and a small association with Other-Directedness. The Mistrust Abuse and Vulnerability to Harm schemas were moderately correlated with victimization. Mistrust Abuse was also implicated in perpetration but insufficient data were available for meta-analysis. The evidence suggests that being a victim of IPV is associated with an expectation that one's needs for love and safety will not be met and doubt regarding one's capacity to handle responsibilities or succeed in life.

Intimate Partner Violence, Anxiety, and Depression in Women with Sexually Transmitted Infections—A Hospital-based Case Control Study

Background:

Sexually transmitted infections (STIs) have complex relationship with mental health and intimate partner violence (IPV) causing community health concern among adolescents and young adults. Women encounter behavioral, psychological, and reproductive health consequences of violence affecting across their lifespan.

Aim:

To determine IPV anxiety and depression in women with STIs.

Methods and materials:

It is a hospital-based cross-sectional study. A total of 115 consecutive females between 18 and 45 years of age who attended STI clinic were enrolled. Sociodemographic details were collected by semi-structured pro forma. IPV was assessed by World Health Organization violence against women instrument; Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale were applied to assess severity of anxiety and depression.

Results:

Mean age of subjects was 31.21 ± 9.08 years. About 55% of the patients had history of IPV. Psychiatric comorbidities noted in 66% of patients. The odds of IPV were more with history of child abuse, suicidal ideation, and substance abuse in husband.

Conclusion:

IPV, anxiety, and depression in STI are in the primitive stage of validation due to associated stigma and lack of awareness. It is high time to divulge dormant triggering factors to protect vulnerable population. Current research should focus on education and women empowerment to prevent STI and mental health issues.

Surveillance of Domestic Violence Using Text Mining Outputs From Australian Police Records

In Australia, domestic violence reports are mostly based on data from the police, courts, hospitals, and ad hoc surveys. However, gaps exist in reporting information such as victim injuries, mental health status and abuse types. The police record details of domestic violence events as structured information (e.g., gender, postcode, ethnicity), but also in text narratives describing other details such as injuries, substance use, and mental health status. However, the voluminous nature of the narratives has prevented their use for surveillance purposes. We used a validated text mining methodology on 492,393 police-attended domestic violence event narratives from 2005 to 2016 to extract mental health mentions on persons of interest (POIs) (individuals suspected/charged with a domestic violence offense) and victims, abuse types, and victim injuries. A significant increase was observed in events that recorded an injury type (28.3% in 2005 to 35.6% in 2016). The pattern of injury and abuse types differed between male and female victims with male victims more likely to be punched and to experience cuts and bleeding and female victims more likely to be grabbed and pushed and have bruises. The four most common mental illnesses (alcohol abuse, bipolar disorder, depression schizophrenia) were the same in male and female POIs. An increase from 5.0% in 2005 to 24.3% in 2016 was observed in the proportion of events with a reported mental illness with an increase between 2005 and 2016 in depression among female victims. These findings demonstrate that extracting information from police narratives can provide novel insights into domestic violence patterns including confounding factors (e.g., mental illness) and thus enable policy responses to address this significant public health problem.

Prevalence of Mental Illnesses in Domestic Violence Police Records: Text Mining Study

Background

The New South Wales Police Force (NSWPF) records details of significant numbers of domestic violence (DV) events they attend each year as both structured quantitative data and unstructured free text. Accessing information contained in the free text such as the victim’s and persons of interest (POI's) mental health status could be useful in the better management of DV events attended by the police and thus improve health, justice, and social outcomes.

Objective

The aim of this study is to present the prevalence of extracted mental illness mentions for POIs and victims in police-recorded DV events.

Methods

We applied a knowledge-driven text mining method to recognize mental illness mentions for victims and POIs from police-recorded DV events.

Results

In 416,441 police-recorded DV events with single POIs and single victims, we identified 64,587 events (15.51%) with at least one mental illness mention versus 4295 (1.03%) recorded in the structured fixed fields. Two-thirds (67,582/85,880, 78.69%) of mental illnesses were associated with POIs versus 21.30% (18,298/85,880) with victims; depression was the most common condition in both victims (2822/12,589, 22.42%) and POIs (7496/39,269, 19.01%). Mental illnesses were most common among POIs aged 0-14 years (623/1612, 38.65%) and in victims aged over 65 years (1227/22,873, 5.36%).

Conclusions

A wealth of mental illness information exists within police-recorded DV events that can be extracted using text mining. The results showed mood-related illnesses were the most common in both victims and POIs. Further investigation is required to determine the reliability of the mental illness mentions against sources of diagnostic information.

The Hidden Pandemic of Family Violence During COVID-19: Unsupervised Learning of Tweets

BACKGROUND

Family violence (including intimate partner violence/domestic violence, child abuse, and elder abuse) is a hidden pandemic happening alongside COVID-19. The rates of family violence are rising fast, and women and children are disproportionately affected and vulnerable during this time.

OBJECTIVE

This study aims to provide a large-scale analysis of public discourse on family violence and the COVID-19 pandemic on Twitter.

METHODS

We analyzed over 1 million tweets related to family violence and COVID-19 from April 12 to July 16, 2020. We used the machine learning approach Latent Dirichlet Allocation and identified salient themes, topics, and representative tweets.

RESULTS

We extracted 9 themes from 1,015,874 tweets on family violence and the COVID-19 pandemic: (1) increased vulnerability: COVID-19 and family violence (eg, rising rates, increases in hotline calls, homicide); (2) types of family violence (eg, child abuse, domestic violence, sexual abuse); (3) forms of family violence (eg, physical aggression, coercive control); (4) risk factors linked to family violence (eg, alcohol abuse, financial constraints, guns, quarantine); (5) victims of family violence (eg, the LGBTQ [lesbian, gay, bisexual, transgender, and queer or questioning] community, women, women of color, children); (6) social services for family violence (eg, hotlines, social workers, confidential services, shelters, funding); (7) law enforcement response (eg, 911 calls, police arrest, protective orders, abuse reports); (8) social movements and awareness (eg, support victims, raise awareness); and (9) domestic violence-related news (eg, Tara Reade, Melissa DeRosa).

CONCLUSIONS

This study overcomes limitations in the existing scholarship where data on the consequences of COVID-19 on family violence are lacking. We contribute to understanding family violence during the pandemic by providing surveillance via tweets. This is essential for identifying potentially useful policy programs that can offer targeted support for victims and survivors as we prepare for future outbreaks.

Pathways to aggression and violence in psychosis without longstanding antisocial behavior: A review and proposed psychosocial model for integrative clinical interventions

There is a need for a clearer understanding of the factors associated with increased risk of aggression and violence (AV) among people with psychosis and other severe mental illness (SMI) to guide effective prevention and intervention. The current article (1) reviews the literature regarding psychosocial factors associated with AV among individuals with psychosis and other SMI who do not have longstanding antisocial behaviors, (2) proposes an integrative psychosocial model of AV that can be practically applied, and (3) proposes appropriate evidence-based clinical interventions to reduce AV and facilitate recovery. We propose that increased risk for AV among people with psychosis is driven by anger, which is affected by a range of factors including victimization and situational stressors, social rejection or experiences of discrimination, anxious arousal, and hostile attribution bias related to psychosis. The cumulative effect of these systems is exacerbated by co-occurring substance misuse and increased impulsivity, particularly negative urgency. In consideration of the current psychosocial model and existing evidence-based interventions for AV in individuals with psychosis, we propose that trauma-informed interventions that integrate skills training in emotion regulation, social and interpersonal situations, cognitive restructuring and remediation, and modified prolonged exposure may demonstrate the most promise for this population.

Violence against women with mental illness and routine screening: Nurses' knowledge, confidence, barriers and learning needs

Violence against women is a major public health issue and women with mental illness (WMI) are at a double disadvantage. While nurses play a key role in identifying and responding to abused women, research is limited on this issue from India. This qualitative study was aimed to explore nurses' knowledge, confidence, and learning needs in the identification and responding to disclosure of abuse in women with mental illness. The focus group discussions were conducted among nurses (N = 21) working in psychiatry units at a tertiary care center. An interview guide with semi-structured questions was used to collect the data. Five dominant themes and fifteen sub-themes have emerged from qualitative analysis. The dominant themes include; Awareness of abuse among women with mental illness (AWMI), Experiences of recognizing and responding to abuse, Barriers for routine screening for abuse, Educational preparedness, and learning needs, and Prevention of abuse in women with mental illness. The identified barriers include personal related (personal discomfort, lack of knowledge, etc.), job related (Time consuming, not a nurse's job, lack of time, etc.) and organizational (lack of policies and administrative support, etc.). Most of the participants expressed that they lack confidence in the routine screening of women for abuse due to inadequate training. Therefore, it is critical to include a topic on domestic violence in the nursing curriculum and provide ongoing learning opportunities to the nurses through CNE programs, workshops, and conferences.

The association between neighbourhood characteristics and physical victimisation in men and women with mental disorders

BACKGROUND

How neighbourhood characteristics affect the physical safety of people with mental illness is unclear.

AIMS

To examine neighbourhood effects on physical victimisation towards people using mental health services.

METHOD

We developed and evaluated a machine-learning-derived free-text-based natural language processing (NLP) algorithm to ascertain clinical text referring to physical victimisation. This was applied to records on all patients attending National Health Service mental health services in Southeast London. Sociodemographic and clinical data, and diagnostic information on use of acute hospital care (from Hospital Episode Statistics, linked to Clinical Record Interactive Search), were collected in this group, defined as 'cases' and concurrently sampled controls. Multilevel logistic regression models estimated associations (odds ratios, ORs) between neighbourhood-level fragmentation, crime, income deprivation, and population density and physical victimisation.

RESULTS

Based on a human-rated gold standard, the NLP algorithm had a positive predictive value of 0.92 and sensitivity of 0.98 for (clinically recorded) physical victimisation. A 1 s.d. increase in neighbourhood crime was accompanied by a 7% increase in odds of physical victimisation in women and an 13% increase in men (adjusted OR (aOR) for women: 1.07, 95% CI 1.01-1.14, aOR for men: 1.13, 95% CI 1.06-1.21, P for gender interaction, 0.218). Although small, adjusted associations for neighbourhood fragmentation appeared greater in magnitude for women (aOR = 1.05, 95% CI 1.01-1.11) than men, where this association was not statistically significant (aOR = 1.00, 95% CI 0.95-1.04, P for gender interaction, 0.096). Neighbourhood income deprivation was associated with victimisation in men and women with similar magnitudes of association.

CONCLUSIONS

Neighbourhood factors influencing safety, as well as individual characteristics including gender, may be relevant to understanding pathways to physical victimisation towards people with mental illness.

The association between intimate partner violence, psychiatric morbidity amongst pregnant women and partner alcohol use in southern Nigeria

BACKGROUND

Intimate partner violence (IPV) against women is common, although prevalence and correlates amongst pregnant women in developing countries are poorly researched.

AIM

To identify the magnitude of IPV, and its relationship with psychiatric morbidity and partner alcohol use.

SETTING

This study was conducted among women receiving routine ante-natal care at a secondary level healthcare facility in southern Nigeria.

METHODS

A cross-sectional descriptive study was conducted by recruiting pregnant women (n = 395) attending the Ante-Natal Clinic of the Central Hospital, Benin-City, Edo State, Nigeria, between August 2015 and February 2016 and undertaking face-to-face interviews utilising a socio-demographic questionnaire, the Composite Abuse Scale and the 20-item Self-reporting Questionnaire.

RESULTS

Past 12-month prevalence of IPV was 24.8%, with emotional abuse being the commonest type (89.8%). Forty-six participants (11.6%) screened positive for probable psychiatric morbidity. Predictors of IPV included partner alcohol use in the past 12 months (adjusted odds ratio [aOR]: 2.67; 95% confidence interval [CI]: 1.16-6.16; p 0.02), having a psychiatric morbidity (aOR: 2.53; 95% CI: 1.27-5.04; p 0.01), being single (aOR: 2.12; 95% CI: 1.25-3.58; p 0.01) and multiparous (aOR: 2.5; 95% CI: 1.43-4.38; p 0.001).

CONCLUSION

Intimate partner violence was common amongst pregnant women in Nigeria. Identified modifiable risk factors can be targets for screening and intervention for women in these settings.

Severity of violence and quality of life of women with psychiatric disorders as compared to normal controls

BACKGROUND

Despite the fact that violence against women is a significant public health problem, there is a paucity of research into this area, and little is known about the extent to which women with psychiatric disorders are affected.

AIM

The aim of the study was to assess and compare the severity of violence and quality of life of women with psychiatric disorders and normal controls.

MATERIALS AND METHODS

Based on purposive sampling technique, a sample consisting of 120 participants was selected from in-patient (female section) and outpatient services of the Ranchi Institute of Neuro-Psychiatry and Allied Sciences and Kanke Area. Both groups were matched on sociodemographic details. Normal controls were screened using General Health Questionnaire-12. The severity of violence against women scale and the revised Conflict Tactics Scale were used to assess the severity of violence, and World Health Organization Quality of Life (WHOQOL)-BREF scale was used for the assessment of the quality of life. Scales were scored as per their test manuals. Results were tabulated and compared using appropriate statistical tests.

RESULTS

Women with psychiatric illness as well as normal controls faced various forms of symbolic violence equally. Women with psychiatric disorders faced significantly higher severity of physical assault, sexual coercion, and injury as compared to normal controls. Women with psychiatric disorders had significantly lower scores on WHOQOL BREF compared to normal participants.

CONCLUSION

Women with psychiatric disorders suffered significantly higher severity of both physical and sexual violence and had significantly worse quality of life compared to normal controls.

Cues for different diagnostic patterns of interpersonal violence in a psychiatric sample: an observational study

BACKGROUND

Interpersonal violence has increased as a health concern, especially in psychiatry practice, over the last decades. Nevertheless, most patients with stable mental disorders do not present an increased risk of violence, and mental disorder is not a necessary or sufficient cause of violent behaviours. People with mental disorders endorse more often a number of risk factors for violence that could confound this association, such as young age and male gender. The aim of this study was to investigate the effect of age, gender, and diagnosis on reported levels of interpersonal violence in a sample of people with severe mental illness.

METHODS

The sample was composed of 160 inpatients: 73 with a psychosis within the schizophrenia spectrum, 53 with a mood disorder and 34 with a personality disorder. All patients enrolled in the study were assessed for experiences of victimization and perpetration of interpersonal violence using the Karolinska Interpersonal Violence Scale interview. Demographic variables were also collected.

RESULTS

Both violence perpetration and victimization negatively correlated with age. Compared to males, females were exposed to higher degree of victimization in childhood and adulthood, whereas males were more involved in the perpetration of violence in childhood. Personality disorders were associated with higher levels of interpersonal violence, both perpetration and victimization; an interaction effect of gender and diagnosis was also observed for violence perpetration in adulthood. Distinct patterns of interpersonal violence did emerge for the diagnostic groups with mood disorder showing a victimization pattern, personality disorders a perpetration pattern and psychoses less defined patterns.

CONCLUSIONS

The main finding is that psychotic disorders, mood disorders and personality disorders have different patterns of violent experiences interacting with age and gender. This study offers a better understanding of how gender and age could affect violent behaviours. Moreover, study findings may increase the comprehension of the reason why some mental disorders, compared to others, are more associated with the risk of victimization or perpetration of violence. These patterns could have pathophysiological or pathoplastic meaning addressing clinical and diagnostic trajectories and they could interact with other intervening risk factors.

Epidemiology of Interpersonal Trauma among Women and Men Psychiatric Inpatients: A Population-Based Study

OBJECTIVE

Small clinical samples suggest that psychiatric inpatients report a lifetime history of interpersonal trauma. Since past experiences of trauma may complicate prognosis and treatment trajectories, population-level knowledge is needed about its prevalence and correlates among inpatients.

METHODS

Using health-administrative databases comprising all adult psychiatric inpatients in Ontario, Canada (2009 to 2016, n = 160,436, 49% women), we identified those who reported experiencing physical, sexual, and/or emotional trauma in their lifetime, 1 year, and 30 days preceding admission. We described the prevalence of each type of trauma, comparing women and men using modified Poisson regression, and identified individual-level characteristics associated with lifetime trauma history using multivariable logistic regression.

RESULTS

31.7% of inpatients reported experiencing trauma prior to admission. Lifetime prevalence was higher in women (39.6% vs. 24.1%; age-adjusted prevalence ratio [aPR] = 1.68; 95% CI, 1.65 to 1.71), including sexual (22.7% vs. 8.4%; aPR = 2.81; 95% CI, 2.73 to 2.89), emotional (33.3% vs. 19.4%; aPR = 1.76; 95% CI, 1.72 to 1.79), and physical trauma (24.2% vs. 14.8%; aPR = 1.68; 95% CI, 1.65 to 1.72). Factors most prominently associated with lifetime trauma were witnessing parental substance use (adjusted odds ratio [aOR] = 8.68; 95% CI, 8.39 to 8.99), female sex (aOR = 2.29; 95% CI, 2.23 to 2.35), and number of recent stressful life events (aOR = 1.62; 95% CI, 1.59 to 1.65).

CONCLUSIONS

These results suggest that trauma-informed approaches are essential to consider in the design and delivery of inpatient psychiatric services for both women and men.

Victimization of People With Severe Mental Illness Outside and Within the Mental Health Care System: Results on Prevalence and Risk Factors From a Multicenter Study

We performed a cross-sectional study using a self-reporting survey to assess lifetime violent and non-violent victimization in people with severe mental illness experienced both inside (i.e., any service providing mental health care such as psychiatric hospitals, psychosocial rehabilitative programs, or outpatient care) and outside (i.e., in the personal life of the participants) of the mental health care system. We recruited 170 participants from 20 community mental health facilities. We built logistic regression models to assess potential risk factors for victimization inside the mental health care system. Outside of the mental health care system, the most commonly reported events were theft (n=93, 54.7%), physical violence without use of a weapon (n=87, 51.2%), and sexual harassment (n=82, 50.6%). Within the mental health care system, most commonly reported incidents were theft (n=68, 40.0%), sexual assault (n=18, 10.6%), and physical violence (n=47, 27.7%) by other patients or staff. Significant risk factors for specific victimization events inside the mental health care system were psychotic disorder, victimization in childhood and youth, female gender, number of hospitalizations, and duration of illness. Findings call for increased attention to victimization of people with severe mental illness, especially within the mental health care system as such victimization events may severely impact patients' trajectories.

Intimate partner violence and depression in rural Bangladesh: Accounting for violence severity in a high prevalence setting

Intimate partner violence (IPV) against women is highly prevalent globally, and is associated with adverse health outcomes, including depression. Though women living in low- and middle-income countries (LMICs) face a larger burden of IPV, little is known about whether IPV increases the risk of depression among non-pregnant women and in contexts of high prevalence. Within the setting of rural Bangladesh, this study examined the relationship between the severity of marital IPV against women and the risk of depression. Data were drawn from a nationally-representative study focused on individual and contextual determinants of IPV among married women aged 16-37 years in rural Bangladesh, collected through a multistage, stratified sample in 77 villages in 2014 (n=3290). Multivariable log-binomial regression models were used to estimate the association between the severity of IPV (operationalized as the frequency of different acts of psychological, physical, and sexual abuse, as well as injury due to IPV) and risk of major depressive episode (MDE) using the Edinburgh Postnatal Depression Scale (EPDS). One in six women (16.8%) met the criteria for MDE. Past year IPV was endemic; psychological (77.2%) was most common, followed by sexual (58.8%) and physical (44.4%). Nearly a third of women experienced IPV-related injury. There was a positive dose-response relationship between severity of each type of IPV and MDE above the lowest level of exposure. In adjusted models, the highest levels of psychological (RR=2.27, 95% CI: 1.62, 3.17), physical (RR=2.44, 95% CI: 1.94, 3.08), and sexual (RR=1.65, 95% CI: 1.08, 2.52) IPV severity remained significantly associated with MDE, as well as experiencing IPV-related injury (RR=1.72, 95% CI: 1.23, 2.40). In rural Bangladesh, the severity of all types of marital IPV against women is strongly related to increased risk of MDE. Results suggest the limited utility of standard dichotomous IPV indicators in high prevalence settings.

Prevalence Rate and Risk Factors of Victimization in Adult Patients With a Psychotic Disorder: A Systematic Review and Meta-analysis

Psychotic disorders often have been linked with violence. However, studies have shown that people with a psychotic disorder are more often victim than perpetrator of violence. The objective of this meta-analysis was to review prevalence rates for different types of victimization and to identify risk factors associated with victimization. Based on a search in MEDLINE, PsycINFO, and Web of Science, 27 studies were found with samples consisting of adults with a psychotic disorder and possible victimization occurring during adulthood and data on "violent victimization," "sexual victimization," "non-violent victimization," and/or "victimization not otherwise specified." The median prevalence rate for violent victimization was 20%, for sexual victimization 20%, nonviolent victimization 19%, and for victimization not otherwise specified 19%. Victimization rates were approximately 4-6 times higher than in the general community. Meta-analyses showed the following significant risk factors: delusion (OR = 1.69), hallucinations (OR = 1.70), manic symptoms (OR = 1.66), drugs (OR = 1.90) or alcohol abuse (OR = 2.05), perpetration of a crime (OR = 4.33), unemployment (OR = 1.31), and homelessness (OR = 2.49). Other risk factors like previous victimization, impaired social functioning, personality disorder, and living in a disadvantaged neighborhood were found only in 1 or 2 studies. Based on the results, we conclude that, depending on the examined time period, 1 in 5 (assessment period ≤3 y) or 1 in 3 (assessment period entire adulthood) people with a psychotic disorder was victim of a crime. Clinical, behavioral, and sociodemographic factors were significantly associated with victimization, as well as previous victimization. Prospective research into risk factors is needed to capture causal trajectories of victimization.

Intimate Partner Violence and Psychiatric Comorbidity in Infertile Women - A Cross-Sectional Hospital Based Study

BACKGROUND AND AIM

In Asian countries, child bearing is a social obligation. Experience of infertility profoundly affects the personal well-being of women. Women with infertility are at a higher risk of anxiety, depression, and Intimate partner violence (IPV). In this background the present study was carried out to determine IPV and psychiatric comorbidity in women with infertility.

METHODS

Hundred consecutive women with primary infertility in the age group of 18 years to 45 years were included in the study. Psychiatric diagnosis was made according to DSM-5. Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HAM-D) were used to assess the severity of the anxiety and depressive symptoms. IPV was assessed using WHO violence against women instrument.

RESULTS

The mean age of the 100 women was 26.73 ± 4.23 years, duration of marriage was 7.11 ± 4.177 years and duration of infertility treatment in years was 5.56 ± 3.89. The prevalence of IPV among patients was 50% and psychiatric comorbidity was 46%. When we compared the women who experienced IPV and who did not, the prevalence of anxiety disorder and depressive disorder was high among IPV group. Anxiety, depressive scores in HAM A, HAM D were higher in IPV group compared to the other group and was statistically significant.

CONCLUSION

A significant number of women who had infertility reported IPV. This emphasizes the importance of screening for IPV in these women. It is observed that women with IPV had higher psychiatric comorbidity and may require psychotherapeutic intervention.

Automatic Extraction of Mental Health Disorders From Domestic Violence Police Narratives: Text Mining Study

BACKGROUND

Vast numbers of domestic violence (DV) incidents are attended by the New South Wales Police Force each year in New South Wales and recorded as both structured quantitative data and unstructured free text in the WebCOPS (Web-based interface for the Computerised Operational Policing System) database regarding the details of the incident, the victim, and person of interest (POI). Although the structured data are used for reporting purposes, the free text remains untapped for DV reporting and surveillance purposes.

OBJECTIVE

In this paper, we explore whether text mining can automatically identify mental health disorders from this unstructured text.

METHODS

We used a training set of 200 DV recorded events to design a knowledge-driven approach based on lexical patterns in text suggesting mental health disorders for POIs and victims.

RESULTS

The precision returned from an evaluation set of 100 DV events was 97.5% and 87.1% for mental health disorders related to POIs and victims, respectively. After applying our approach to a large-scale corpus of almost a half million DV events, we identified 77,995 events (15.83%) that mentioned mental health disorders, with 76.96% (60,032/77,995) of those linked to POIs versus 16.47% (12,852/77,995) for the victims and 6.55% (5111/77,995) for both. Depression was the most common mental health disorder mentioned in both victims (22.25%, 3269) and POIs (18.70%, 8944), followed by alcohol abuse for POIs (12.19%, 5829) and various anxiety disorders (eg, panic disorder, generalized anxiety disorder) for victims (11.66%, 1714).

CONCLUSIONS

The results suggest that text mining can automatically extract targeted information from police-recorded DV events to support further public health research into the nexus between mental health disorders and DV.

Risk of Being Subjected to Crime, Including Violent Crime, After Onset of Mental Illness: A Danish National Registry Study Using Police Data

IMPORTANCE

People with mental illness are more likely to have contact with the criminal justice system, but research to date has focused on risk of offense perpetration, while less is known about risk of being subjected to crime and violence.

OBJECTIVES

To establish the incidence of being subjected to all types of criminal offenses, and by violent crimes separately, after onset of mental illness across the full diagnostic spectrum compared with those in the population without mental illness.

DESIGN, SETTING, AND PARTICIPANTS

This investigation was a longitudinal national cohort study using register data in Denmark. Participants were a cohort of more than 2 million persons born between 1965 and 1998 and followed up from 2001 or from their 15th birthday until December 31, 2013. Analysis was undertaken from November 2016 until February 2018.

EXPOSURES

Cohort members were followed up for onset of mental illness, recorded as first contact with outpatient or inpatient mental health services. Diagnoses across the full spectrum of psychiatric diagnoses were considered separately for men and women.

MAIN OUTCOMES AND MEASURES

Incidence rate ratios (IRRs) were estimated for first subjection to crime event (any crime and violent crime) reported to police after onset of mental illness. The IRRs were adjusted for cohort member's own criminal offending, in addition to several sociodemographic factors.

RESULTS

In a total cohort of 2 058 063 (48.7% male; 51.3% female), the adjusted IRRs for being subjected to crime associated with any mental disorder were 1.49 (95% CI, 1.46-1.51) for men and 1.64 (95% CI, 1.61-1.66) for women. The IRRs were higher for being subjected to violent crime at 1.76 (95% CI, 1.72-1.80) for men and 2.72 (95% CI, 2.65-2.79) for women. The strongest associations were for persons diagnosed as having substance use disorders and personality disorders, but significant risk elevations were found across almost all diagnostic groups examined.

CONCLUSIONS AND RELEVANCE

Onset of mental illness is associated with increased risk of exposure to crime, and violent crime in particular. Elevated risk is not confined to specific diagnostic groups. Women with mental illness are especially vulnerable to being subjected to crime. Individual's own offending accounts for some but not all of the increased vulnerability to being subjected to crime.

Violence, victimization and mental health

INTRODUCTION

Violence and victimization are often viewed in black and white terms by mental health professionals, an approach which is belied by more nuanced perspectives from outside psychiatry.

METHODS

Given increasing empirical evidence of the pervasive burden of victimization in people with mental illness, authors focused on the available theories and evidences from the literature.

RESULTS

Authors summarize the theories of victimizations, the possible measures of this phenomenon and underlie the role of research to clarify the link between psychiatry, violence and victimization.

CONCLUSION

Violence and victimization need more space in the psychiatric research. This could have important implications for the lives of patients, but also for public understanding.

Improving mental health service responses to domestic violence and abuse

Domestic violence and abuse is a considerable international public health problem, which is associated with mental disorders in both women and men. Nevertheless, victimization and perpetration remain undetected by mental health services. This paper reviews the evidence on mental health service responses to domestic violence, including identifying, referring, and providing care for people experiencing or perpetrating violence. The review highlights the need for mental health services to improve rates of identification and responses to domestic violence and abuse, through the provision of specific training on domestic violence and abuse, the implementation of clear information sharing protocols and evidence-based interventions, and the establishment of care referral pathways. This review also highlights the need for further research into mental health service users who perpetrate domestic violence and abuse.

Sociodemographic, clinical and childhood correlates of adult violent victimisation in a large, national survey sample of people with psychotic disorders

PURPOSE

Our aim was to establish the 12-month prevalence of violent victimisation in a large sample of adults with psychotic disorders (N = 1825), compare this to population estimates, and examine correlates of violent victimisation.

METHODS

The Australian national psychosis survey used a two-phase design to draw a representative sample of adults aged 18-64 years with psychotic disorders. Interview questions included psychopathology, cognition, sociodemographics, substance use, criminality, and childhood and adult victimisation. Multivariable logistic regression models were used to examine the independent contributions of known risk factors, clinical profile and childhood abuse, on risk of violent victimisation. Differences between men and women were examined.

RESULTS

Among adults with psychotic disorders, 12-month prevalence of any victimisation was 38.6% (males 37.4%, females 40.5%), and of violent victimisation was 16.4% (males 15.2%; females 18.3%). Violent victimisation was 4.8 times higher than the population rate of 3.4% (6.5 times higher for women; 3.7 times higher for men). Significant correlates of violent victimisation were established sociodemographic and behavioural risk factors predicting victimisation in the general community: younger age, residence in the most disadvantaged neighbourhoods, homelessness, lifetime alcohol abuse/dependence, and prior criminal offending. Among clinical variables, only mania and self-harm remained significant in the multivariable model. Childhood abuse was independently associated with violent victimisation.

CONCLUSIONS

Rates of violent victimisation are high for people with psychotic disorders, especially women, compared to population rates. Greater exposure to sociodemographic and behavioural risks may render them particularly vulnerable to victimisation. Social cognition as a valuable treatment target is discussed.

Childhood maltreatment and adulthood domestic and sexual violence victimisation among people with severe mental illness

PURPOSE

To investigate the association between childhood maltreatment and adulthood domestic and sexual violence victimisation among people with severe mental illness (SMI), and to explore this association in terms of gender differences and potential mediators.

METHOD

A cross-sectional survey of 318 people living in the community who were receiving care from Community Mental Health Teams. Associations were assessed using logistic regression of multiply imputed data.

RESULTS

63 % (95 % CI 55-71 %) of men and 71 % (95 % CI 63-79 %) of women reported childhood maltreatment, 46 % (95 % CI 37-54 %) of men and 67 % (95 % CI 59-76 %) of women reported adulthood domestic violence victimisation, and 22 % (95 % CI 15-28 %)of men and 62 % (95 % CI 53-70 %)of women reported adulthood sexual violence victimisation. Men and women with SMI who reported experiences of childhood maltreatment were two to five times more likely to report domestic and sexual violence victimisation in adulthood after adjusting for confounders. The associations held for each of emotional, physical and sexual childhood abuse.

CONCLUSION

People with severe mental illness have high prevalence of experiences of childhood maltreatment and adulthood domestic and sexual violence victimisation. Childhood maltreatment appears to be an independent risk factor for adulthood victimisation among men and women with SMI.

Victimisation in adults with severe mental illness: prevalence and risk factors

BACKGROUND

Patients with a severe mental illness (SMI) are more likely to experience victimisation than the general population.

AIMS

To examine the prevalence of victimisation in people with SMI, and the relationship between symptoms, treatment facility and indices of substance use/misuse and perpetration, in comparison with the general population.

METHOD

Victimisation was assessed among both randomly selected patients with SMI (n = 216) and the general population (n = 10 865).

RESULTS

Compared with the general population, a high prevalence of violent victimisation was found among the SMI group (22.7% v. 8.5%). Compared with out-patients and patients in a sheltered housing facility, in-patients were most often victimised (violent crimes: 35.3%; property crimes: 47.1%). Risk factors among the SMI group for violent victimisation included young age and disorganisation, and risk factors for property crimes included being an in-patient, disorganisation and cannabis use. The SMI group were most often assaulted by someone they knew.

CONCLUSIONS

Caregivers should be aware that patients with SMI are at risk of violent victimisation. Interventions need to be developed to reduce this vulnerability.

Risk of Criminal Victimisation in Outpatients with Common Mental Health Disorders

BACKGROUND

Crime victimisation is a serious problem in psychiatric patients. However, research has focused on patients with severe mental illness and few studies exist that address victimisation in other outpatient groups, such as patients with depression. Due to large differences in methodology of the studies that address crime victimisation, a comparison of prevalence between psychiatric diagnostic groups is hard to make. Objectives of this study were to determine and compare one-year prevalence of violent and non-violent criminal victimisation among outpatients from different diagnostic psychiatric groups and to examine prevalence differences with the general population.

METHOD

Criminal victimisation prevalence was measured in 300 outpatients living in Amsterdam, The Netherlands. Face-to-face interviews were conducted with outpatients with depressive disorder (n = 102), substance use disorder (SUD, n = 106) and severe mental illness (SMI, n = 92) using a National Crime Victimisation Survey, and compared with a matched general population sample (n = 10865).

RESULTS

Of all outpatients, 61% reported experiencing some kind of victimisation over the past year; 33% reported violent victimisation (3.5 times more than the general population) and 36% reported property crimes (1.2 times more than the general population). Outpatients with depression (67%) and SUD (76%) were victimised more often than SMI outpatients (39%). Younger age and hostile behaviour were associated with violent victimisation, while being male and living alone were associated with non-violent victimisation. Moreover, SUD was associated with both violent and non-violent victimisation.

CONCLUSION

Outpatients with depression, SUD, and SMI are at increased risk of victimisation compared to the general population. Furthermore, our results indicate that victimisation of violent and non-violent crimes is more common in outpatients with depression and SUD than in outpatients with SMI living independently in the community.

A systematic review and meta-analysis of premature mortality in bipolar affective disorder

OBJECTIVE

To review and complete meta-analysis of studies estimating standardised mortality ratios (SMRs) in bipolar affective disorder (BPAD) for all-cause and cause-specific mortalities.

METHOD

Cause-specific mortality was grouped into natural and unnatural causes. These subgroups were further divided into circulatory, respiratory, neoplastic and infectious causes, and suicide and other violent deaths. Summary SMRs were calculated using random-effects meta-analysis. Heterogeneity was examined via subgroup analysis and meta-regression.

RESULTS

Systematic searching found 31 studies meeting inclusion criteria. Summary SMR for all-cause mortality = 2.05 (95% CI 1.89-2.23), but heterogeneity was high (I(2) = 96.2%). This heterogeneity could not be accounted for by date of publication, cohort size, mid-decade of data collection, population type or geographical region. Unnatural death summary SMR = 7.42 (95% CI 6.43-8.55) and natural death = 1.64 (95% CI 1.47-1.83). Specifically, suicide SMR = 14.44 (95% CI 12.43-16.78), other violent death SMR = 3.68 (95% CI 2.77-4.90), deaths from circulatory disease = 1.73 (95% CI 1.54-1.94), respiratory disease = 2.92 (95% CI 2.00-4.23), infection = 2.25 (95% CI 1.70-3.00) and neoplasm = 1.14 (95% CI 1.10-1.21).

CONCLUSION

Despite considerable heterogeneity, all summary SMR estimates and a large majority of individual studies showed elevated mortality in BPAD compared to the general population. This was true for all causes of mortality studied.

Under the banyan tree--exclusion and inclusion of people with mental disorders in rural North India

Background

Social exclusion is both cause and consequence of mental disorders. People with mental disorders (PWMD) are among the most socially excluded in all societies yet little is known about their experiences in North India. This qualitative study aims to describe experiences of exclusion and inclusion of PWMD in two rural communities in Uttar Pradesh, India.

Methods

In-depth interviews with 20 PWMD and eight caregivers were carried out in May 2013. Interviews probed experiences of help-seeking, stigma, discrimination, exclusion, participation, agency and inclusion in their households and communities. Qualitative content analysis was used to generate codes, categories and finally 12 key themes.

Results

A continuum of exclusion was the dominant experience for participants, ranging from nuanced distancing, negative judgements and social isolation, and self-stigma to overt acts of exclusion such as ridicule, disinheritance and physical violence. Mixed in with this however, some participants described a sense of belonging, opportunity for participation and support from both family and community members.

Conclusions

These findings underline the urgent need for initiatives that increase mental health literacy, access to services and social inclusion of PWMD in North India, and highlight the possibilities of using human rights frameworks in situations of physical and economic violence. The findings also highlight the urgent need to reduce stigma and take actions in policy and at all levels in society to increase inclusion of people with mental distress and disorders.

Violent and non-violent crime against adults with severe mental illness

BACKGROUND

Little is known about the relative extent of crime against people with severe mental illness (SMI).

AIMS

To assess the prevalence and impact of crime among people with SMI compared with the general population.

METHOD

A total of 361 psychiatric patients were interviewed using the national crime survey questionnaire, and findings compared with those from 3138 general population controls participating in the contemporaneous national crime survey.

RESULTS

Past-year crime was experienced by 40% of patients v. 14% of controls (adjusted odds ratio (OR) = 2.8, 95% CI 2.0-3.8); and violent assaults by 19% of patients v. 3% of controls (adjusted OR = 5.3, 95% CI 3.1-8.8). Women with SMI had four-, ten- and four-fold increases in the odds of experiencing domestic, community and sexual violence, respectively. Victims with SMI were more likely to report psychosocial morbidity following violence than victims from the general population.

CONCLUSIONS

People with SMI are at greatly increased risk of crime and associated morbidity. Violence prevention policies should be particularly focused on people with SMI.