Health outcomes of victim-survivors accessing specialist domestic abuse services: the role of abuse experience, vulnerabilities and sociodemographic characteristics

Background Domestic abuse (DA) is a public health problem with wide-ranging impacts for victim-survivors and services responding to it. The purpose of the current study was to explore relationships between victim-survivors’ experiences of abuse, additional needs/vulnerabilities and sociodemographic characteristics, and physical and mental health outcomes and health care help-seeking behaviours following DA. Methods Secondary analysis was conducted using Women’s Aid Federation of England’s (Women’s Aid) case management and outcomes measurement system, On Track, the largest national dataset on DA. To understand the relationship between abuse types (physical, sexual, emotional, financial, coercive control, technology-facilitated abuse and threats to kill), needs/vulnerabilities (disability; offending, drug and alcohol-related support needs; pregnancy, recourse to public funds and accessing by-and-for services) and health outcomes (perpetrator caused harm to or loss of unborn child, attempted strangulation, self-harm (disclosed), feeling depressed or suicidal, injury requiring GP treatment and injury requiring A&E treatment), we used a series of logistic regression models, controlling for potentially confounding variables (including accommodation status, sexual orientation and ethnicity). Stakeholders from Women’s Aid and five other third sector organisations input into the study design and interpretation of results. Results Ninety-six percent of victim-survivors accessing DA services (n = 77,785) were female. Almost half (41.24%) had felt depressed/suicidal, and a sizeable minority (23.41%) had suffered a strangulation attempt, and just under 10% had an injury requiring A&E treatment. The type of abuse that most influenced health outcomes varied by outcome, while having additional vulnerabilities or needs was strongly associated with experiencing physical and mental health harms, as well as requiring health care from a GP and/or A&E. Conclusions Our findings highlight the almost inevitable harms to mental health for victim-survivors of DA, the dangers of non-physical types of abuse such as threats to kill and technology-facilitated abuse and the heightened risk of attempted strangulation. These findings have particularly important and timely implications for the training of health care professionals. Alongside improvements in health care settings, health care professionals, specialist support workers, researchers and policymakers must continue to explore more joined-up ways of working to further improve the response to DA and intervene before irreversible damage is done.