Determinants and health sequelae of intimate partner violence and abuse in young adult relationships: a mixed methods study

Intimate partner violence and abuse (IPVA) is any behaviour within an intimate relationship that causes physical, psychological, or sexual harm to those in the relationship. IPVA is a violation of human rights with enormous economic, and social costs, and is increasingly recognised as a major public health problem. A survey from 2016 estimated that 3.8 million English and Welsh women and 1.7 million men 16-59 years old have experienced IPVA at some point in their lives. Six percent of female and three percent of male respondents reported an experience of IPVA in the past year alone.
Research has shown that children of parents who are abusive toward each other, are more likely to experience IPVA in their own intimate adult relationships, and have long-term mental and physical health problems such as depression, substance abuse and obesity. But existing studies have been small and have not had a lot of information on important factors such as socio-economic status or abuse in childhood. In addition, most studies have been restricted to women (not men) and have focused on IPVA victimisation (not perpetration). Finally, most studies have collected information on measures mental and physical health using questionnaires as opposed to actually measuring them, which is a lot more accurate.
Research has also shown that not all people exposed to IPVA, either parental or in their own relationships, have mental and/or physical health problems. But we still don't know whether things like gender, a history of abuse in childhood, or whether people experienced IPVA victimization, perpetration or both affects their chances of mental and physical health problems. This is important because this knowledge can help to identify groups of people who may benefit most from interventions to prevent future health problems.
As part of our project we plan to investigate these questions using information that we have already collected as part of the Avon Longitudinal Study of Parents and Children (ALSPAC) study. ALSPAC recruited pregnant women in 1990-1992 and has been following them and their children for the last 25 years, collecting information on a wide range of measures of mental and physical health, as well economic and social factors. The offspring are now 25 years-old and have recently participated in an ALSPAC study clinical assessment which included detailed assessment of mental health and heart health. At the age of 22, some 3,500 ALSPAC offspring answered a questionnaire about the occurrence, frequency and impact of physical, sexual and emotional IPVA in their intimate relationships as well as about IPVA between their parents. We will use this information together with the detailed information collected on both parents and their offspring over 25 years to investigate the mental and physical health of young adults exposed to IPVA and to identify groups who are at particularly high risk of problems.
As detailed as it may be, this type of data cannot fully capture the complex and inter-related effects of IPVA and what it means for mental and heart health. We will therefore also conduct interviews with approximately 30 young adults (aged 18-22) to explore their own IPVA experiences, and the factors that they feel have made their own health better or worse. The two types of analyses will complement each other and provide an unprecedented detailed investigation of the causes and health consequences of IPVA in young adults.

Intimate partner violence and abuse (IPVA) is any behaviour within an intimate relationship that causes physical, psychological, or sexual harm to those in the relationship. Evidence of associations between IPVA and adverse mental and physical ill health is increasing, yet little is known about IPVA in young adult relationships specifically, particularly in the UK. Current studies have small sample sizes, and limited measurement of potential confounders and effect modifiers such as childhood abuse. Most studies have been restricted to women, and focused on victimisation (not perpetration). Finally, very few studies have directly measured mental and physical health and there remain considerable gaps in our understanding of inter-generational transmission of IPVA. Identifying groups who are particularly vulnerable to IPVA adverse health sequelae can inform secondary prevention efforts and requires epidemiologic research. But quantitative results cannot fully capture the complexity of social factors that contribute to ameliorating and/or amplifying relationships between IPVA and health. We will therefore use a mixed-methods approach. We will analyse longitudinal and prospectively collected data from the UK Avon Longitudinal Study of Parents and Children cohort to study: i) life course patterns of IPVA across two generations ii) the relationship between IPVA in young adult relationships with mental health and cardiovascular health, including iii) factors that amplify and ameliorate associations between IPVA and health outcomes. We will integrate this quantitative work with a qualitative study to understand young adults' own meaning and narratives of IPVA experiences, and the factors that they perceive as exacerbating or mitigating its adverse effects. Integrating the two approaches will enable triangulation of findings, to inform policy and the design of public health and clinical interventions for people exposed to IPVA in adolescent and early adult relationships.

We envisage that the proposed work will have impact on: the scientific community, policy makers and health care providers, people who have experienced IPVA and the wider public, and the workforce through the development of skills and research capacity of co-applicants and appointed researchers.

Impact on the scientific community will include generating finding of relevance and interest to psychologists and psychiatrists interested in developmental traumatology, and/or the impacts of violence within the family. The outputs of the proposed project will also be of interest to the growing number of researchers in psychology, health and epidemiology who are interested in the intersection of mental and physical health.

An NIHR public health research funded evidence synthesis (IMPROVE), combining longitudinal studies with trials of interventions for children exposed to IPVA, has highlighted the weakness of longitudinal studies to date, not least because of the narrow range of risk and protective factors measured at baseline. This hampers the development of therapeutic or psycho-educational interventions for children exposed to IPVA. Our proposed study will inform new interventions by detecting factors that amplify and ameliorate mental and physical health effects of IPVA.

Our findings will therefore impact on the IPVA prevention agenda, currently a key element of government policy, by enabling a focus on particularly vulnerable groups in secondary prevention efforts. Our work will therefore have impact on practitioners in health, IPVA, child welfare and education and policy makers. Further downstream, this will have impact on children and adults exposed to IPVA.

Our proposal is also concordant with the Chief Medical Officer's 2012 annual report (2013), entitled Our Children Deserve Better, which focuses on the health and wellbeing of children and young people emphasizing a life course approach and early intervention. Finally, our proposed work is aligned with the recently published joint agency report (2017; https://www.justiceinspectorates.gov.uk/hmicfrs/publications/multi-agency-response-to-children-living-with-domestic-abuse/) on the multi-agency response to children living with domestic abuse. The report calls for a national public service initiative to raise awareness of IPVA and for better strategies for prevention. It also highlights that IPVA is a widespread public health issue that needs a long-term strategy to reduce its prevalence.

The aggregate annual cost of domestic violence to the UK in 2008 including medical and social services, lost economic output and emotional costs, was £15.7 billion (Walby 2009). The cost of medical services alone was £1.7 billion. Interventions to improve the public health and clinical response to IPVA can be highly cost-effective but need to be built on a platform of robust epidemiological analysis and understanding of the needs of children and young people exposed to abuse.

Finally, the proposal will positively impact on the skills of the researchers involved in this work by providing quantitative researchers with the opportunity to be involved in a qualitative study and vice versa. Coapplicants have a strong track record of promoting the career development of early career researchers and will continue to do so through this work.