Hostname: page-component-5d59c44645-7l5rh Total loading time: 0 Render date: 2024-02-23T03:32:45.868Z Has data issue: false hasContentIssue false

Domestic violence and severe psychiatric disorders: prevalence and interventions

Published online by Cambridge University Press:  06 November 2009

L. M. Howard*
Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK
K. Trevillion
Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK
H. Khalifeh
University College London, Department of Mental Health Sciences, Royal Free Hospital School of Medicine, London, UK
A. Woodall
Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK
R. Agnew-Davies
Institute of Primary Care and Public Health, London South Bank University, UK
G. Feder
Academic Unit of Primary Health Care, University of Bristol, UK
*Address for correspondence: Dr L. M. Howard, Section of Women's Mental Health, Health Service and Population Research Department, PO31 Institute of Psychiatry, King's College London, De Crespigny Park, LondonSE5 8AF, UK. (Email:



The lifetime prevalence of domestic violence in women is 20–25%. There is increasing recognition of the increased vulnerability of psychiatric populations to domestic violence. We therefore aimed to review studies on the prevalence of, and the evidence for the effectiveness of interventions in, psychiatric patients experiencing domestic violence.


Literature search using Medline, PsycINFO and EMBASE applying the following inclusion criteria: English-language papers, data provided on the prevalence of or interventions for domestic violence, adults in contact with mental health services.


Reported lifetime prevalence of severe domestic violence among psychiatric in-patients ranged from 30% to 60%. Lower rates are reported for men when prevalence is reported by gender. No controlled studies were identified. Low rates of detection of domestic violence occur in routine clinical practice and there is some evidence that, when routine enquiry is introduced into services, detection rates improve, but identification of domestic violence is rarely used in treatment planning. There is a lack of evidence on the effectiveness of routine enquiry in terms of morbidity and mortality, and there have been no studies investigating specific domestic violence interventions for psychiatric patients.


There is a high prevalence of domestic violence in psychiatric populations but the extent of the increased risk in psychiatric patients compared with other populations is not clear because of the limitations of the methodology used in the studies identified. There is also very limited evidence on how to address domestic violence with respect to the identification and provision of evidence-based interventions in mental health services.

Review Article
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Agar, K, Read, J (2002). What happens when people disclose sexual or physical abuse to staff at a community mental health centre? International Journal of Mental Health Nursing 11, 7079.Google Scholar
Agar, K, Read, J, Bush, J (2002). Identification of abuse histories in a community mental health centre: the end for policies and training. Journal of Mental Health 11, 533543.Google Scholar
Bacchus, L, Mezey, G, Bewley, S (2008). Women's perceptions and experiences of routine enquiry for domestic violence in a maternity service. International Journal of Obstetrics and Gynaecology 109, 916.Google Scholar
Barnhill, LR, Squires, MF, Gibson, G (1982). Clinical approaches to family violence: II. The epidemiology of violence in a CMHC setting: a violence epidemic? Family Therapy Collections 3, 2133.Google Scholar
Bengtsson-Tops, A, Markstrom, U, Lewin, B (2005). The prevalence of abuse in Swedish female psychiatric users, the perpetrators and places where abuse occurred. International Journal of Psychiatry 59, 504–410.Google Scholar
Bengtsson-Tops, A, Tops, A (2007). Self-reported consequences and needs for support associated with abuse in female users of psychiatric care. International Journal of Mental Health Nursing 16, 3543.Google Scholar
Briere, J, Jordan, CE (2004). Violence against women: outcome complexity and implications for assessment and treatment. Journal of Interpersonal Violence 19, 12521276.Google Scholar
Briere, J, Woo, R, McRae, B, Foltz, J, Sitzman, R (1997). Lifetime victimization history, demographics, and clinical status in female psychiatric emergency room patients. Journal of Nervous and Mental Disease 185, 95101.Google Scholar
Bryer, BJ, Nelson, AB, Miller, BJ, Krol, AP (1987). Childhood sexual and physical abuse as factors in adult psychiatric illness. American Journal of Psychiatry 144, 14261430.Google Scholar
Campbell, JC (2002). Health consequences of intimate partner violence. Lancet 359, 13311336.Google Scholar
Cann, K, Withnell, S, Shakesphere, J, Doll, H, Thomas, J (2001). Domestic violence: a comparative survey of levels of detection, knowledge and attitudes in healthcare workers. Public Health 115, 8995.Google Scholar
Carlile, JB (1991). Spouse assault on mentally disordered wives. Canadian Journal of Psychiatry 36, 265269.Google Scholar
Carmen, E, Rieker, PP, Mills, T (1984). Victims of violence and psychiatric illness. American Journal of Psychiatry 141, 378383.Google Scholar
Cascardi, M, Mueser, KT, DeGiralomo, J, Murrin, M (1996). Physical aggression against psychiatric inpatients by family members and partners. Psychiatric Services 47, 531533.Google Scholar
Chandra, P, Deepthivarma, S, Carey, M, Carey, KB, Shalinianant, M (2003). A cry from the darkness: women with severe mental illness in India reveal their experiences of sexual coercion. Psychiatry 66, 323334.Google Scholar
Choe, JY, Teplin, LA, Abram, KM (2008). Perpetration of violence, violent victimization, and severe mental illness: balancing public health concerns. Psychiatric Services 59, 153164.Google Scholar
Currier, GW, Barthauer, LM, Begier, E, Bruce, ML (1996). Training and experience of psychiatric residents in identifying domestic violence. Psychiatric Services 47, 529530.Google Scholar
Cusack, KJ, Frueh, BC, Brady, K (2004). Trauma history screening in a community mental health center. Psychiatric Services 55, 157162.Google Scholar
Cusack, KJ, Grubaugh, AL, Knapp, RG, Frueh, BC (2006). Unrecognized trauma and PTSD among public mental health consumers with chronic and severe mental illness. Community Mental Health Journal 42, 487500.Google Scholar
Cusack, KJ, Wells, CB, Gurbaugh, AL, Hiers, TG, Frueh, CB (2007). An update on the South Carolina Trauma Initiative. Psychiatric Services 58, 708710.Google Scholar
Dalsbo, TK, Johme, T, Smedslund, G, Steiro, A, Winsvold, A (2006). Cognitive behavioural therapy for men who physically abuse their female partner (Protocol). Cochrane Database of Systematic Reviews 2006. Issue 2. Art. No: CD006048. doi:10.1002/14651858.CD006048.Google Scholar
Dutton, M (1992). Empowering and Healing the Battered Woman: A Model for Assessment and Intervention. Springer: New York.Google Scholar
Ehrensaft, MK, Moffitt, TE, Caspi, A (2006). Is domestic violence followed by an increased risk of psychiatric disorders among women but not among men? A longitudinal cohort study. American Journal of Psychiatry 163, 885892.Google Scholar
Eilenberg, J, Thompson Fullilove, M, Goldman, GR, Mellman, L (1996). Quality and use of trauma histories obtained from psychiatric outpatients through mandated inquiry. Psychiatric Services 47, 165169.Google Scholar
Feder, G, Ramsay, J, Dunne, D, Rose, M, Arsene, C, Norman, R, Kuntze, S, Spencer, A, Bacchus, L, Hague, G, Warburton, A, Taket, A (2009). How far does screening women for domestic (partner) violence in different health-care settings meet the UK National Screening Committee criteria for a screening programme? Systematic reviews of nine UK National Screening Committee criteria. Health Technology Assessment 13, 1347.Google Scholar
Feder, GS, Hutson, M, Ramsay, J, Taket, AR (2006). Women exposed to intimate partner violence. Expectations and experiences when they encounter health-care professionals: a meta-analysis of qualitative studies. Annals of Internal Medicine 166, 2237.Google Scholar
Friedman, SH, Loue, S (2007). Incidence and prevalence of intimate partner violence by and against women with severe mental illness. Journal of Women's Health 16, 471480.Google Scholar
Frueh, BC, Knapp, GR, Cusack, JK, Grubaugh, LA, Sauvageot, AJ, Cousins, CV, Yim, E, Robins, SC, Monnier, J, Hiers, GT (2005). Patients' reports of traumatic or harmful experiences within the psychiatric setting. Psychiatric Services 56, 11231133.Google Scholar
Garcia-Moreno, C (2009). Intimate-partner violence and fetal loss. Lancet 373, 278279.Google Scholar
Garcia-Moreno, C, Jansen, HA, Ellsberg, M, Heise, L, Watts, C (2006). Prevalence of intimate partner violence: findings from the WHO multi-country study on women's health and domestic violence. Lancet 368, 12601269.Google Scholar
Golding, MJ (1999). Intimate partner violence as a risk factor for mental disorders: a meta-analysis. Journal of Family Violence 14, 99132.Google Scholar
Goodman, LA, Dutton, MA, Harris, M (1995). Episodically homeless women with serious mental illness: prevalence of physical and sexual assault. American Journal of Orthopsychiatry 65, 468478.Google Scholar
Goodman, LA, Rosenberg, SD, Mueser, KT, Drake, RE (1997). Physical and sexual assault history in women with serious mental illness: prevalence, correlates, treatment, and future research directions. Schizophrenia Bulletin 23, 685696.Google Scholar
Goodman, LA, Thompson, KM, Weinfurt, K, Corl, S, Acker, P, Mueser, K, Rosenberg, S (1999). Reliability of reports of violent victimization and posttraumatic stress disorder among men and women with serious mental illness. Journal of Traumatic Stress 12, 587599.Google Scholar
Grubaugh, AL, Frueh, BC (2006). Intimate partner violence victimization among adults with severe mental illness: results of a cross-sectional study. Journal of Clinical Psychiatry 67, 14721473.Google Scholar
Hager, D (2006). Domestic violence and mental illness/substance abuse. A survey of 39 refuges. Homeworks Trust, New Zealand ( Scholar
Herman, JL (1986). Histories of violence in an outpatient population: an exploratory study. American Journal of Orthopsychiatry 56, 137141.Google Scholar
Heru, AM, Stuart, GL, Rainey, S, Eyre, J, Recupero, PR (2006). Prevalence and severity of intimate partner violence and associations with family functioning and alcohol abuse in psychiatric inpatients with suicidal intent. Journal of Clinical Psychiatry 67, 2329.Google Scholar
Hoffman, BF, Toner, BB (1988). The prevalence of spousal abuse in psychiatric in-patients: a preliminary study. Canadian Journal of Community Mental Health 7, 5360.Google Scholar
Home Office (2008). Crime in England and Wales 2007/08. Findings from the British Crime Survey and police recorded crime. Home Office Statistical Bulletin. Home Office UK ( Scholar
Howard, L (in press). Gender and reproductive health. In Principles of Social Psychiatry (ed. Bhugra, D. and Morgan, C.). Wiley-Blackwell UK.Google Scholar
Kitzmann, KM, Gaylord, NK, Holt, AR, Kenny, ED (2003). Child witnesses to domestic violence: a meta-analytic review. Journal of Consulting and Clinical Psychology 71, 339352.Google Scholar
Krug, E, Mercy, J, Dahlberg, L, Zwi, A (2002). The world report on violence and health. Lancet 360, 10831088.Google Scholar
Kubany, ES, Hill, EE, Owens, JA (2003). Cognitive trauma therapy for battered women with PTSD: preliminary findings. Journal of Traumatic Stress 16, 8191.Google Scholar
Kubany, ES, Hill, EE, Owens, JA, Iannce-Spencer, C, McCaig, MA, Tremayne, KJ, Williams, PL (2004). Cognitive trauma therapy for battered women with PTSD (CTT-BW). Journal of Consulting and Clinical Psychology 72, 318.Google Scholar
Lipschitz, DS, Kaplan, ML, Sorkenn, JB, Faedda, GL, Chorney, P, Asnis, GM (1996). Prevalence and characteristics of physical and sexual abuse among psychiatric outpatients. Psychiatric Services 47, 189191.Google Scholar
Lipsky, S, Caetano, R (2007). Impact of intimate partner violence on unmet need for mental health care: results from the NSDUH. Psychiatric Services 58, 822829.Google Scholar
Lothian, J, Read, J (2002). Asking about abuse during mental health assessments: client views and experience. New Zealand Journal of Psychology 31, 98103.Google Scholar
MacMillan, LH, Wathen, CN, Jamieson, E, Boyle, M, McNutt, A-L, Worster, A, Lent, B, Webb, M (2006). Approaches to screening for intimate partner violence in health care settings: a randomized trial. Journal of the American Medical Association 296, 530536.Google Scholar
Maniglio, R (2009). Severe mental illness and criminal victimization: a systematic review. Acta Psychiatrica Scandinavica 119, 180191.Google Scholar
McHugo, GJ, Kammerer, N, Jackson, EW, Markoff, LS, Gatz, M, Larson, MJ, Mazelis, R, Hennigan, K (2005). Women, Co-occurring Disorders, and Violence Study: evaluation design and study population. Journal of Substance Abuse Treatment 28, 91107.Google Scholar
McPherson, DM, Delva, J, Cranford, AJ (2007). A longitudinal investigation of intimate partner violence among mothers with mental illness. Psychiatric Services 58, 675680.Google Scholar
Minsky-Kelly, D, Hamberger, K, Pape, AD, Wolff, M (2005). We've had training, now what? Qualitative analysis of barriers to domestic violence screening and referral in a health care setting. Journal of Interpersonal Violence 20, 12881309.Google Scholar
Mueser, KT, Rosenberg, SD, Xie, H, Jankowski, MK, Bolton, EE, Lu, W, Hamblen, JL, Rosenberg, HJ, McHugo, GJ, Wolfe, R (2008). A randomized controlled trial of cognitive-behavioral treatment for posttraumatic stress disorder in severe mental illness. Journal of Consulting and Clinical Psychology 76, 259271.Google Scholar
Najavits, LM, Sonn, J, Walsh, M, Weiss, RD (2004). Domestic violence in women with PTSD and substance abuse. Addictive Behaviors 29, 707715.Google Scholar
Neria, Y, Bromet, EJ, Carlson, GA, Naz, B (2005). Assaultive trauma and illness course in psychotic bipolar disorder: findings from the Suffolk county mental health project. Acta Psychiatrica Scandinavica 111, 380383.Google Scholar
Owens, KR (2007). Patient-centered provider behaviors and disclosure of intimate partner violence in a psychiatric emergency setting. Doctoral dissertation, University of Pittsburgh, USA.Google Scholar
Post, RD, Willett, A, Franks, R, House, R, Back, S, Weissberg, M (1980). A preliminary report on the prevalence of domestic violence among psychiatric inpatients. American Journal of Psychiatry 137, 974975.Google Scholar
Ramsay, J, Carter, Y, Davidson, L, Dunne, D, Eldridge, S, Feder, G, Hegarty, K, Rivas, C, Taft, A, Warburton, A (2009). Advocacy interventions to reduce or eliminate violence and promote the physical and psychosocial well-being of women who experience intimate partner abuse. The Cochrane Database of Systematic Reviews, 3, CD005043, doi:10.1002/14651858.CD005043.pub2.Google Scholar
Ramsay, J, Feder, G, Rivas, C, Carter, YH, Davidson, LL, Hegarty, K, Taft, A, Warburton, A (2005). Advocacy interventions to reduce or eliminate violence and promote the physical and psychosocial well-being of women who experience intimate partner abuse (Protocol). Cochrane Database of Systematic Reviews 2005. Issue 1. Art. No.: CD005043. doi:10.1002/14651858.CD005043.Google Scholar
Ramsay, J, Richardson, J, Carter, YH, Davidson, LL, Feder, G (2002). Should health professionals screen women for domestic violence? Systematic review. British Medical Journal 325, 314.Google Scholar
Read, J, Fraser, A (1998). Abuse histories of psychiatric inpatients: to ask or not to ask? Psychiatric Services 49, 355359.Google Scholar
Read, J, Hammersley, P, Rudegeair, T (2007). Why, when and how to ask about childhood abuse. Advances in Psychiatric Treatment 13, 101110.Google Scholar
Renker, PR, Tonkin, P (2006). Women's views of prenatal violence screening: acceptability and confidentiality issues. Obstetrics and Gynecology 107, 348354.Google Scholar
Resnick, HS, Best, CL, Freedy, JR, Kilpatrick, DG, Falsetti, SA (1993). Trauma Assessment for Adults Self-Report. National Crime Victims Research and Treatment Center, Medical University of South Carolina: Charleston.Google Scholar
Richardson, J, Feder, G, Coid, J (2002). Domestic violence affects women more than men. British Medical Journal 325, 779.Google Scholar
Salyers, MP, Evans, LJ, Bond, GR, Meyer, PS (2004). Barriers to assessment and treatment of posttraumatic stress disorder and other trauma-related problems in people with severe mental illness: clinician perspectives. Community Mental Health Journal 40, 1731.Google Scholar
Silver, E, Arseneault, L, Langley, J, Caspi, A, Moffitt, TE (2005). Mental disorder and violent victimization in a total birth cohort. American Journal of Public Health 95, 20152021.Google Scholar
Steiner-Craine, L, Henson, EC, Colliver, AJ, MacLean, GD (1988). Prevalence of a history of sexual abuse among female psychiatric patients in a state hospital system. Hospital and Community Psychiatry 39, 300304.Google Scholar
Straus, AM, Hamby, LS, Boney-McCoy, S, Sugarman, BD (1996). The Revised Conflict Tactics Scales (CTS2): development and preliminary psychometric data. Journal of Family Issues 17, 283316.Google Scholar
Straus, MA (1979). Measuring intrafamily conflict and violence: the Conflict Tactics Scales. Journal of Marriage and the Family 41, 7588.Google Scholar
Taket, AC, Wathen, N, MacMillan, H (2004). Should health professionals screen all women for domestic violence? PLoS Medicine 1, 710.Google Scholar
Teplin, LA, McClelland, GM, Abram, KM, Weiner, DA (2005). Crime victimization in adults with severe mental illness. Comparison with the National Crime Victimization Survey. Archives of General Psychiatry, 62, 911921.Google Scholar
Tham, S, Ford, T, Wilkinson, D (1995). A survey of domestic violence and other forms of abuse. Journal of Mental Health 4, 317321.Google Scholar
Thomas, CR, Miller, G, Hartshorn, JC, Speck, NC, Walker, G (2005). Telepsychiatry program for rural victims of domestic violence. Telemedicine and e-Health 11, 567573.Google Scholar
Tjaden, P, Thoennes, N (2000). Extent, Nature, and Consequences of Intimate Partner Violence: Findings From the National Violence Against Women Survey. US Department of Justice: Washington, DC.Google Scholar
Vrana, S, Lauterbach, D (1994). Prevalence of traumatic events and posttraumatic psychological symptoms in a non-clinical sample of college students. Journal of Traumatic Stress 7, 298302.Google Scholar
Walby, S, Allen, J (2004). Domestic Violence, Sexual Assault and Stalking: Findings from the British Crime Survey. Home Office: London.Google Scholar
Walsh, E, Moran, P, Scott, C, McKenzie, K, Burns, T, Creed, F, Tyrer, P, Murray, RM, Fahy, T; UK700 Group (2003). Prevalence of violent victimisation in severe mental illness. British Journal of Psychiatry 183, 233238.Google Scholar
Weingourt, R (1990). Wife rape in a sample of psychiatric patients. Journal of Nursing Scholarship 22, 144147.Google Scholar
Zlotnick, C, Johnson, DM, Kohn, R (2006). Intimate partner violence and long-term psychosocial functioning in a national sample of American women. Journal of Interpersonal Violence 21, 262275.Google Scholar
Supplementary material: File

Howard supplementary material


Download Howard supplementary material(File)
File 80 KB