Population Data Science, Swansea University Medical School, Swansea, United Kingdom.
Centre for Child & Family Justice Research, Sociology, Bowland College, Lancaster University, Lancaster, United Kingdom.
J Med Internet Res. 2023 May 24;25:e42375. doi: 10.2196/42375.
Domestic violence and abuse (DVA) has a detrimental impact on the health and well-being of children and families but is commonly underreported, with an estimated prevalence of 5.5% in England and Wales in 2020. DVA is more common in groups considered vulnerable, including those involved in public law family court proceedings; however, there is a lack of evidence regarding risk factors for DVA among those involved in the family justice system.
This study examines risk factors for DVA within a cohort of mothers involved in public law family court proceedings in Wales and a matched general population comparison group.
We linked family justice data from the Children and Family Court Advisory and Support Service (Cafcass Cymru [Wales]) to demographic and electronic health records within the Secure Anonymised Information Linkage (SAIL) Databank. We constructed 2 study cohorts: mothers involved in public law family court proceedings (2011-2019) and a general population group of mothers not involved in public law family court proceedings, matched on key demographics (age and deprivation). We used published clinical codes to identify mothers with exposure to DVA documented in their primary care records and who therefore reported DVA to their general practitioner. Multiple logistic regression analyses were used to examine risk factors for primary care-recorded DVA.
Mothers involved in public law family court proceedings were 8 times more likely to have had exposure to DVA documented in their primary care records than the general population group (adjusted odds ratio [AOR] 8.0, 95% CI 6.6-9.7). Within the cohort of mothers involved in public law family court proceedings, risk factors for DVA with the greatest effect sizes included living in sparsely populated areas (AOR 3.9, 95% CI 2.8-5.5), assault-related emergency department attendances (AOR 2.2, 95% CI 1.5-3.1), and mental health conditions (AOR 1.7, 95% CI 1.3-2.2). An 8-fold increased risk of DVA emphasizes increased vulnerabilities for individuals involved in public law family court proceedings.
Previously reported DVA risk factors do not necessarily apply to this group of women. The additional risk factors identified in this study could be considered for inclusion in national guidelines. The evidence that living in sparsely populated areas and assault-related emergency department attendances are associated with increased risk of DVA could be used to inform policy and practice interventions targeting prevention as well as tailored support services for those with exposure to DVA. However, further work should also explore other sources of DVA, such as that recorded in secondary health care, family, and criminal justice records, to understand the true scale of the problem.
家庭暴力和虐待（DVA）对儿童和家庭的健康和幸福有不利影响，但通常报告不足，据估计 2020 年英格兰和威尔士的患病率为 5.5%。DVA 在被认为易受伤害的群体中更为常见，包括参与公共法律家庭法庭程序的群体；然而，对于参与家庭司法系统的群体，关于 DVA 的风险因素的证据不足。
本研究调查了威尔士参与公共法律家庭法庭程序的母亲群体中的 DVA 风险因素，并与一般人群比较组进行了比较。
我们将儿童和家庭法院咨询和支持服务（Cafcass Cymru[威尔士]）的家庭司法数据与 Secure Anonymised Information Linkage（SAIL）数据库中的人口统计学和电子健康记录进行了链接。我们构建了两个研究队列：2011-2019 年参与公共法律家庭法庭程序的母亲和未参与公共法律家庭法庭程序的一般人群母亲群体，根据关键人口统计学因素（年龄和贫困程度）进行匹配。我们使用已发表的临床代码来确定在初级保健记录中记录有 DVA 暴露的母亲，这些母亲因此向他们的全科医生报告了 DVA。使用多变量逻辑回归分析来检查初级保健记录中 DVA 的风险因素。
与一般人群组相比，参与公共法律家庭法庭程序的母亲在初级保健记录中记录有 DVA 的可能性高 8 倍（调整后的优势比[OR]8.0，95%CI 6.6-9.7）。在参与公共法律家庭法庭程序的母亲队列中，DVA 的风险因素中影响最大的是居住在人口稀少的地区（OR 3.9，95%CI 2.8-5.5）、与袭击相关的急诊就诊（OR 2.2，95%CI 1.5-3.1）和心理健康状况（OR 1.7，95%CI 1.3-2.2）。DVA 风险增加 8 倍强调了参与公共法律家庭法庭程序的个人的脆弱性增加。
以前报告的 DVA 风险因素不一定适用于这组女性。本研究确定的其他风险因素可考虑纳入国家指南。证据表明，居住在人口稀少的地区和与袭击相关的急诊就诊与 DVA 风险增加有关，这可以为预防政策和实践干预措施以及针对暴露于 DVA 的人的量身定制的支持服务提供信息。然而，还需要进一步的工作来探索其他来源的 DVA，例如在二级卫生保健、家庭和刑事司法记录中记录的 DVA，以了解问题的真实规模。
