England-wide study first to show link between intimate partner violence, self-harm and suicidality

A new study is the first to show that intimate partner violence (IPV) is strongly associated with self-harm and suicidality in both men and women, and across all ages in England.

While IPV is a recognised risk factor for psychiatric disorders, there had previously been little evidence on IPV and self-harm and suicidality.

Led by the Violence and Society Centre at City, University of London, in collaboration with the universities of Bristol, Manchester, Leicester and University College London, the study, published in The Lancet Psychiatry, was an analysis of results from the Adult Psychiatric Morbidity Survey (APMS) conducted face to face with over 7,000 adults, in 2014/5.

A nationally representative cross section of households in England were interviewed, capturing information on gender, age, socioeconomic status, ethnicity and regional location.

Study participants were asked about experience of physical violence and sexual, economic, and emotional abuse from a current or former partner, and about suicidal thoughts, suicide attempts, and self-harm.

The study found that 27% of women and 15% of men had experienced IPV at some point in their life, confirming that women are far more likely than men to experience violence from a partner. People with experience of IPV were more likely to live in more deprived neighbourhoods and to have also experienced many other adversities in their lives. However, the associations between IPV and self-harm and suicidality remained strong even when these other factors were adjusted for.

After adjusting for experience of other adversities, as well as demographic and socioeconomic factors, people who had ever experienced IPV in their lives, compared to those who had not, had in the previous year:

• over twice the risk of self-harming without suicidal intent
• almost twice the risk of having suicidal thoughts
• and almost three times the risk of attempting suicide

If any IPV had been experienced within the previous year, then the risks were even higher.

Particularly elevated rates of self-harm, suicidal thoughts, and suicide attempts were found in those who were ever subjected to sexual and emotional IPV, those who ever experienced physical injury from IPV, and those who had experienced multiple forms of IPV, which indicates that the more types of IPV someone is exposed to, the higher the risk they are of self-harm and suicidality.

Sally McManus, Senior Lecturer in Health in the Violence and Society Centre and the School of Health Sciences, City, University of London and first author of the study, said:

“There is a high likelihood that someone presenting to services in suicidal distress is a victim of intimate partner violence (IPV). Health, social care, and welfare professionals need to ask people who have self-harmed or are at risk of suicide if they are experiencing IPV, and professionals should be prepared – and supported – to act accordingly.”

Dr Duleeka Knipe from the Bristol Medical School: Population Health Sciences and co-author, added:

“Strategies for violence reduction should form part of individual-level suicide risk assessment and safety planning, and they should feature in national suicide prevention strategies. Interventions designed to reduce the prevalence and duration of IPV might protect and improve the lives of people at risk of self-harm and suicide.”

Dr Estela Barbosa, Senior Research Fellow in the Violence and Society Centre, City, University of London and a co-author, said:

“Intimate partner violence is common in England, especially among women. The gender gap was widest for sexual IPV, which was about ten times more common in women than men, and this IPV type was associated with particularly high odds of self-harm and suicidality.”

Paper

‘Intimate partner violence, suicidality, and self-harm: a probability sample survey of the general population in England‘ by Sally McManus, Sylvia Walby, Estela Capelas Barbosa, Louis Appleby, Traolach Brugha, Paul E Bebbington, Elizabeth A Cook, Duleeka Knipe in The Lancet Psychiatry [open access]