Domestic and sexual violence: exploring associations with mental health

Investigation by the Principal Investigator (PI) had highlighted several evidence gaps regarding a potential association between mental disorders and domestic and sexual violence. These include a lack of evidence regarding (i) associations between experiences of sexual violence and mental disorder (Oram et al 2017); and (ii) associations between recent perpetration of domestic violence and mental disorder (Oram et al 2014). Other limitations of previous studies include (i) unrepresentative samples; (ii) small sample sizes; and (iii) lack of data collected on potential confounder and mediators.

The overall objective of this study is to improve understanding

of the associations between mental disorders and (1) experiencing sexual violence and (2) perpetrating domestic violence. To facilitate this investigation Kings College London have requested access to pseudonymised Adult Psychiatric Morbidity Survey 2014 (APMS) data. This data was received under the previous iteration of this Agreement.

The APMS report features chapters on: common mental disorders, mental health treatment and service use, post-traumatic stress disorder, psychotic disorder, autism, personality disorder, attention-deficit/hyperactivity disorder, bipolar disorder, alcohol, drugs, suicidal thoughts, suicide attempts and self-harm, and comorbidity; and contains sufficient data for King’s College London to achieve the stated purpose while also addressing the evidence gaps.

APMS 2014 data also has important strengths relative to other datasets: it uses a nationally representative sample of consenting adults living in England and Wales, has a relatively large sample size, and collects data on a wide range of variables.

KCL have already received the whole APMS dataset as there is no facility to select individual variables. As such KCL can not minimise the data requested.

The lawful basis of processing is GDPR Article 6(1)(e) ‘public interest’ and Article 9(2)(j). This research can be deemed to be in the public interest because reducing domestic and sexual violence could improve the health and wellbeing of significant proportion of the population. Outputs from the proposed analyses will provided much needed evidence on the prevalence and risk of domestic violence perpetration among people with mental disorders, and on the prevalence and risk of sexual violence victimisation among people with mental disorders.

KCL is the sole data controller who also processes the data for the purpose described in this agreement. The research project is funded by NIHR Maudsley Biomedical Research Centre, but they do not have access to or make decision regarding the data.

REFERENCES

Oram, S., H. Khalifeh and L. M. Howard (2017). "Violence against women and mental health." The Lancet Psychiatry 4(2): 159-170.

Oram, S., K. Trevillion, H. Khalifeh, G. Feder and L. Howard (2014). "Systematic review and meta-analysis of psychiatric disorder and the perpetration of partner violence." Epidemiology and psychiatric sciences 23(04): 361-376.

All organisations party to this agreement must comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract ie: employees, agents and contractors of the Data Recipient who may have access to that data).

The 2014 APMS dataset is held on behalf of NHS Digital by the UK Data Service (UKDS) (www.ukdataservice.ac.uk ) and UKDS are responsible for dissemination under direction by NHS Digital. KCL will get the whole dataset; there is no facility to select individual variables. They will be able to download the dataset from UKDS for the period specific within the DSA and they must securely destroy all local copies of the dataset when the DSA expires and notify DARS in line with standard procedures. This 2014 version of the dataset available via DARS has been redacted on Disclosure Control Procedure advice to minimise the likelihood of individuals being able to identify anyone taking part in the survey.

Under a previous iteration of this agreement KCL received the pseudonymised APMS 2014 data.

The APMS data is currently stored on a folder on a file server inside KCL Access to the APMS data is restricted to individuals who are substantively employed by KCL, all of whom have received training in data protection and confidentiality.

Under this Agreement King’s College London intend to migrate the data to UK One Drive Business. This will be done by copying the relevant files to MS One Drive for Business (given that the total size of the data is small) and then removed securely from the KCL server so that it impossible to retrieve the data from the KCL server. The dataset will be accessed from MS (UK) OneDrive for Business from designated KCL desktop computers. Access to the APMS data will continue to be restricted to individuals who are substantively employed by KCL.

Data are being processed on MS One Drive for Business.

Analysis activities include the calculation of descriptive statistics, regression analysis, and mediation analyses. Variables may be recoded to support the conduct of these analyses (including to prevent zero or small cell counts). The proposed analyses do not involve linking or matching the 2014 Adult Psychiatric Morbidity Survey with other datasets. In addition, there is no requirement to re-identify individuals from the pseudonymised data.

Outputs will include (1) a scientific paper on the prevalence and risk of domestic violence perpetration among people with mental disorders (target submission date December 2020 ); (2) a scientific paper on the prevalence and risk of sexual violence among people with mental disorder (target submission date March 2021).

Scientific papers will be submitted to peer-reviewed academic journals; targets include PLOS Medicine, The Lancet Psychiatry, the British Journal of Psychiatry, Epidemiology and Psychiatric Sciences, and Trauma Violence and Abuse.

Papers will also be submitted to academic conferences, such as the 2021 European Conference on Domestic Violence and conferences of the International Association of Women’s Mental Health and International Federation of Psychiatric Epidemiology..

Scientific papers will be published on an open-access basis where possible (i.e. where funds are available and/or where an article processing charge fee waiver is obtained). If funds/waivers are not available, a pre-print version of the article will be made available on an open-access basis from the KCL PURE repository.

Outputs will contain only aggregate level data with small numbers suppressed in line with HES Analysis Guidance

In the UK, 8.5% of women experience domestic violence each year and 2.2% experiences some form of sexual assault each year. Experiencing domestic and sexual violence is associated with a range of health problems, including injury, chronic pain, substance misuse, and mental disorder. Domestic violence is also associated with pre-term delivery, low infant birth weight, and poor child outcomes.

Domestic and sexual violence are accordingly recognised as major public health problems; reducing these forms of violence could improve the health and wellbeing of a significant proportion of the population and reduce the associated £1.7bn annual cost to the NHS.

Outputs from the proposed analyses will provide much-needed evidence on the prevalence and risk of domestic violence perpetration among people with mental disorders, and on the prevalence and risk of sexual violence victimisation among people with mental disorders.

Short-term benefits include strengthening the evidence base for future research, practice, and policy in this area, and an improved clinical awareness of the relationship between domestic and sexual violence and mental health (within 2 years of completion). Findings will be fed into the ongoing consultation on the Domestic Abuse Bill and shared with the Domestic Abuse Commissioner for England and Wales.

Longer-term benefits include the development of interventions to improve identification of domestic and sexual violence among people with mental disorders (within 5 years of completion).

The PI has a strong track record of impact in this area, with findings cited in the NICE PH50 guidelines on domestic violence, the WHO guidelines on intimate partner violence, the 2013 and 2014 reports of the Chief Medical Officer, and the Royal College of Psychiatrists domestic violence online training.

Anticipated benefits have not been yielded to date; COVID-19 has severely disrupted the analysis of these data and the write-up and dissemination of findings.

(i) Researchers have not been able to access the dataset for several months, they were able to visit KCL on an ad-hoc basis in October 2020 to continue making progress with the analysis and are now hoping to be in a position to submit papers in the next 3-6 months;

(ii) conferences have been postponed; (iii) new pressures such as the move to online teaching in semester 1 has reduced the time available April-October 2020 to work on this project.