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Life & Times

Domestic violence during COVID-19: the GP role

Jeremy Gibson
British Journal of General Practice 2020; 70 (696): 340. DOI: https://doi.org/10.3399/bjgp20X710477
Jeremy Gibson
Derbyshire, and a named GP for safeguarding children in Derby city. Email:
Roles: GP
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WITHIN THEIR HOMES MANY WOMEN FACE AN ENEMY MORE TERRIFYING THAN COVID-19

Threatened by COVID-19, the world has been on lockdown. Danger and death lay without; safety is to be found alone in the isolation of the home. The UK government’s message was ‘Stay at home … Do not meet others, even friends and family.’ But within the walls of their own homes many women face an enemy more terrifying than COVID-19.

The domestic abuse charity Refuge reported a 700% increase in calls in a single day.1 The most recent findings are that ‘... demand has spiked again significantly — calls and contacts to the Helpline have risen to a weekly average increase of 66% and visits to our website ... have seen a phenomenal 950% rise compared to pre Covid-19.’ 2

In response to this surge in domestic abuse, the Home Office announced an additional 2 million pounds of funding to support helplines and online support. But this is insufficient to mitigate the long-term consequences (for many years) of increased domestic abuse during the UK’s lockdown.

Even under normal circumstances, worldwide, about 30% of women report intimate partner violence (physical, sexual, or both) in their lifetime.3 It is estimated that 1.3 million women suffered from domestic abuse in England and Wales during the year ending March 2018.4 These women are at increased risk of experiencing difficulties with activities of daily living, gastrointestinal symptoms, chronic pain, memory loss, dizziness, headaches, vaginal discharge and sexually transmitted infections, emotional distress, depression, post-traumatic stress disorder, and suicidal thoughts and attempts.5–8 As they grow into adulthood, their children are more likely to have problems with drug and alcohol use, violence, sexual risk taking, mental ill health, smoking, cancer, and cardiac and respiratory disease.9

The dynamics of domestic abuse are not straightforward.10 In some relationships situational couple violence predominates, where both partners are equally aggressive towards each other. In others, one individual makes a concerted and sustained attempt to utterly control their partner. These abusers may be motivated by obsession and jealousy or simply driven by a determination to get their own way, no matter what. This is intimate terrorism. When an abused partner, who has been worn down by weeks, months, or even years of abuse, finally hits back (violent resistance), the consequences can be deadly. Many simply want to leave but are afraid to do so. Their intimate terrorist has often convinced them they are useless and unable to fend for themselves. What happens if they are stalked and harassed, lose their job, their home, or even their children? There is always the possibility they will be murdered.

STAYING ALERT FOR INDICATORS

The lockdown will have seen a rise in every kind of domestic abuse. More violent acts will have been committed within the home. More women enduring the overwhelming fear of being trapped and abused in the very place where they should feel safe. More children will have witnessed domestic abuse and it will have been harder than ever for women to escape from such abusive relationships.

As we emerge from the current pandemic, more women and children (throughout the world) will have suffered from and be experiencing the consequences of domestic abuse than ever before. As the lockdown is eased we need to stay alert for indicators of domestic abuse in our patients, use appropriate questions to detect coercive and controlling behaviour, and be ready to assess the risk of domestic homicide (using, for example, the SafeLives DASH risk assessment).11 We should remain sensitive to their medical and mental health needs and support them as best we can.

This may include signposting them to charitable organisations, and referring children to social care and women to the Independent Domestic Violence Advocacy (IDVA) service or even the police, if we feel their life is under threat.

Footnotes

  • This article was first posted on BJGP LIFE on 28 April 2020 with a list of support organisations; https://bjgplife.com/DV1

  • © British Journal of General Practice 2020

REFERENCES

  1. 1.↵
    Refuge sees online traffic to its National Domestic Abuse Helpline website rise by 700%Refuge20209Aprhttps://www.refuge.org.uk/refuge-sees-700-increase-in-website-visits (accessed 12 Jun 2020).
  2. 2.↵
    Refuge reports further increase in demand for its National Domestic Abuse Helpline services during lockdownRefuge202027Mayhttps://www.refuge.org.uk/refuge-reports-further-increase-in-demand-for-its-national-domestic-abuse-helpline-services-during-lockdown (accessed 12 Jun 2020).
  3. 3.↵
    1. Heise LL,
    2. Ellsberg M,
    3. Gottemoeller M
    Ending violence against women (population reports, series L, 11)Baltimore, MDJohns Hopkins University School of Public Health, Center for Communications Programs1999
  4. 4.↵
    1. Home Office
    Domestic Abuse Bill 2020: factsheets2020https://www.gov.uk/government/publications/domestic-abuse-bill-2020-factsheets (accessed 12 Jun 2020).
  5. 5.↵
    1. Ellsberg M,
    2. Jansen HAFM,
    3. Heise L,
    4. et al.
    Intimate partner violence and women’s physical and mental health in the WHO multi-country study on women’s health and domestic violence: an observational studyLancet2008371961911651172
    OpenUrlCrossRefPubMed
  6. 6.
    1. Campbell JC
    Health consequences of intimate partner violenceLancet2002359931413311336
    OpenUrlCrossRefPubMed
  7. 7.
    1. Coker AL,
    2. Davis KE,
    3. Arias I,
    4. et al.
    Physical and mental health effects of intimate partner violence for men and womenAm J Prev Med2002234260268
    OpenUrlCrossRefPubMed
  8. 8.↵
    1. Kumar S,
    2. Jeyaseelan L,
    3. Suresh S,
    4. Ahuja RC
    Domestic violence and its mental health correlates in Indian womenBr J Psychiatry200518716267
    OpenUrlAbstract/FREE Full Text
  9. 9.↵
    1. Hughes K,
    2. Bellis MA,
    3. Hardcastle KA,
    4. et al.
    The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysisLancet Public Health201728e356e366
    OpenUrlCrossRefPubMed
  10. 10.↵
    1. Johnson MP
    A Typology of Domestic Violence Intimate Terrorism, Violent Resistance, and Situational Couple ViolenceBoston, MANortheastern University Press2008
  11. 11.↵
    1. SafeLives
    SafeLives Dash risk checklist for the identification of high risk cases of domestic abuse, stalking and ‘honour’-based violence2015https://safelives.org.uk/sites/default/files/resources/Dash%20for%20IDVAs%20FINAL_0.pdf (accessed 12 Jun 2020).
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British Journal of General Practice: 70 (696)
British Journal of General Practice
Vol. 70, Issue 696
July 2020
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Domestic violence during COVID-19: the GP role
Jeremy Gibson
British Journal of General Practice 2020; 70 (696): 340. DOI: 10.3399/bjgp20X710477

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Domestic violence during COVID-19: the GP role
Jeremy Gibson
British Journal of General Practice 2020; 70 (696): 340. DOI: 10.3399/bjgp20X710477
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