Greater vigilance needed to tackle domestic abuse, says BMA

BMJ 2007; 334 doi: (Published 21 June 2007) Cite this as: BMJ 2007;334:1289
  1. Zosia Kmietowicz
  1. London

    Doctors and other health professionals need to be more vigilant for signs of domestic abuse and should know what questions to ask so that they can take quick action, says a report from the BMA. Produced by the BMA's Board of Science, it recommends that all health professionals should have training in how to deal with domestic abuse.

    The report documents the four main types of domestic abuse—physical, sexual, psychological, and financial— which all have long term effects on the victim. Health problems that result can include fractures, burns, depression, post-traumatic stress disorder, chronic pain syndrome, arthritis, problems with hearing and sight, seizures, and headaches. Stomach ulcers, heart disease, and raised blood pressure are indirect consequences.

    Gene Feder, professor of primary care research and development, at Barts and the London NHS Trust, said that research among women who had been domestically abused identified doctors as the people they would most like to talk to about their situation. With appropriate training doctors can provide effective support to victims of abuse, such as referral to expert voluntary agencies, he said. But he admitted that inappropriate questions to try to identify abuse could do more harm than good, underlying the need for training.

    Domestic abuse is common and affects all parts of society, including many vulnerable groups, such as disabled people. An estimated half a million elderly people are being abused at any one time in the United Kingdom, most of them by family members.

    As many as three in 10 women and two in 10 men have experienced domestic abuse of some form in their life, with one in 20 women having serious injury or long term heath problems, said Professor Feder.

    Although domestic abuse affects men and women, 80% of victims are women, and 30% of the abuse starts in pregnancy, says the report.

    Prevalences are not given for children because domestic abuse occurs between adults, by definition, but about 750 000 children a year witness domestic abuse and are at increased risk of mental health problems as a result.

    Vivienne Nathanson, head of BMA science and ethics, said, “The figures we provide in this report are shocking, but perhaps more alarming is that they are likely to be grossly underestimated. Domestic abuse is an unspoken scar on our society, and many individuals never report that they are victims. Sometimes this is because of social stigma or simply because they do not know who to turn to. Other times it can be because the victims are so vulnerable that they are not in a position to seek help.”

    “Doctors and other health professionals are well placed to help victims and their families, and our message to them today is: if you suspect abuse is taking place, it is important that you help your patient to discuss this.” It is also very important for doctors to realise that men can be victims too. Men are less likely to be believed, and, therefore, they tend not to seek help,” said Dr Nathanson.

    The financial effect of domestic abuse in England and Wales, in terms of criminal justice, social services, housing, and legal costs, has been estimated at £3.1bn (€4.6bn; $6.1bn) a year, with an additional £2.7bn loss to the economy.

    The report calls on the government to raise awareness of domestic abuse among the public and to develop a more structured and statutory basis for tackling domestic abuse in a similar way to the policies that exist for child protection.

    The report recommends that all health professionals should be instructed in asking appropriate questions to encourage victims to disclose their abusive experiences if they suspect it might be a problem. Also highlighted is the need to be aware of domestic abuse in minority groups, including the Asian community, where honour crimes and abuse associated with forced marriage can occur.

    The report also recommends that refuges should be more accessible to gay, bisexual, and transgender people because research shows that abuse by a partner is as common among same sex couples as it is among heterosexual couples. All schoolchildren should also be taught that it is not normal to abuse or be abused, to try to break the cycle of repeating violence and victimisation from one generation to the next.


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