Abstract
Background: Evidence suggests an increased risk of domestic violence perpetration by people with mental disorders versus people without mental disorders. However most of this research has not investigated i) recent, versus lifetime, domestic violence, ii) mediators of observed associations between mental disorders and domestic violence, or accounted for potential confounders, or iii) how individuals who perpetrate domestic violence understand their behaviour.Aims: i) To investigate the association between mental disorders and past year domestic violence perpetration, ii) To explore mediating variables on the causal pathway between mental disorders and past year domestic violence perpetration, while controlling for known confounders, iii) To describe the sociodemographic and victimisation characteristics of individuals who report perpetrating domestic violence and iv) To understand the influence of mental disorders, substance misuse and childhood trauma on domestic violence perpetration from the perspective of men who perpetrate intimate partner violence (IPV).
Methods: First, I conducted an aggregate systematic review and meta-analysis to investigate the prevalence and odds of past year domestic violence perpetration among individuals with mental disorders. Analyses were conducted separately for IPV and adult family violence (AFV) and disaggregated by mental disorder. Second, I conducted an individual participant data (IPD) meta-mediation analysis using nationally representative general population surveys conducted in high-income countries to investigate potential mediators on the causal pathway between mental disorders and past year IPV perpetration, while also accounting for known confounding variables. Analyses were conducted separately by mental disorder and by sex. Due to a lack of data, analyses could not be conducted with respect to mental disorders and past year AFV perpetration. Third, I analysed the 2014 Adult Psychiatric Morbidity Survey (APMS), reporting the characteristics of individuals who reported lifetime IPV perpetration and the prevalence and odds of lifetime IPV perpetration among individuals with mental disorders. Due to a lack of data, analyses could not be replicated for past year IPV perpetration. Finally, I conducted a secondary qualitative analysis of interview data from men taking part in an RCT of a pilot domestic violence perpetrator programme (DVPP) for abusive men, investigating their understanding of the reasons for their abuse.
Results: The aggregate systematic review and meta-analysis (n=26 studies) found an increased prevalence and odds of any past year IPV perpetration among those with depression and PTSD versus those without these disorders. There were limited data on the prevalence and odds of IPV perpetration among people with other mental disorders, a lack of data disaggregated by type of IPV perpetration (e.g. physical, sexual, and psychological), and little data on mental disorder and AFV perpetration. The IPD meta-mediation analysis identified that there was an increase in past year physical IPV perpetration among both men and women with depression (around 4% and 7% respectively). Analyses also identified that IPV victimisation mediated the association between depression and past year physical IPV perpetration among women. No mediating effect of alcohol misuse on the association between depression and past year physical IPV perpetration was identified for either men or women. The 2014 APMS analysis similarly identified increased odds of lifetime IPV perpetration among individuals with mental disorders compared to without, and a high level of reported victimisation among individuals who reported lifetime IPV perpetration. The qualitative study found that although several men reported previous experience of mental health problems and mental health service use, they did not attribute their abusive behaviour to their mental health. However, some men drew links between their experiences of childhood trauma and their use of abusive behaviours, and men who had historically misused alcohol perceived an association between this and their perpetration of abuse.
Conclusions: Findings demonstrate that depression is associated with increased risk of past year IPV perpetration, though individuals who perpetrate IPV may not perceive an association between their mental health and their abusive behaviour. There is a high level of victimisation among individuals who report IPV perpetration, particularly women. Among women, IPV victimisation may mediate the association between depression and IPV perpetration.
Clinicians and mental health care workers who encounter women with depression who disclose perpetrating IPV should be aware that the risk of IPV victimisation may be high. Interventions aimed at reducing the risk of IPV victimisation may also reduce the risk of IPV perpetration, particularly among women. However, there was a dearth of literature on the association between other mental disorders and IPV perpetration, and between mental disorders and AFV perpetration. Future research should collect sex-disaggregated data on a range of mental disorders, on multiple types of IPV perpetration, and on covariates known to be associated with mental disorders and IPV perpetration, in order to investigate whether the associations identified in this thesis extend to other mental disorders and types of IPV. Longitudinal data with more consistent methods of data collection across studies and more consistent collection of data on the full range of IPV perpetration behaviours, including physical, psychological, sexual of IPV perpetration, are needed. Future research should also endeavour to collect data on AFV perpetration.
| Date of Award | 1 Feb 2022 |
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| Original language | English |
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| Supervisor | Sian Oram (Supervisor), Sabine Landau (Supervisor) & Louise Howard (Supervisor) |