Australia
Australian Institute of Health and Welfare, Understanding Family, Domestic and Sexual Violence (FDSV): Factors associated with FDSV’ (2024)
This resource draws information from a variety of statistical reports and studies (see report for references).
Mental health issues (including mental illness and other manifestations, such as high psychological distress due to a stressor) can be a risk factor for the perpetration and/or victimisation of FDSV and an outcome of FDSV.
Perpetrators may use a victim-survivor's mental health issues to control them and prevent them from seeking help. For example, a perpetrator may dismiss a victim-survivor's reports of violence as being related to the victim-survivor having a mental health episode and victim-survivors may be led to believe their mental health issues caused or provoked the violence.
Mental health issues that have been associated with family violence perpetrators include PTSD, depression, suicidal ideation, and personality disorders.
A mixed-model study involving online surveys and qualitative interviews with around 560 people (mostly males) who had used intimate partner and/or sexual violence against women found that:
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more than 1 in 2 (51%) screened positive for PTSD
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just under 1 in 3 met the core criteria for anxiety (30%) or depression (29%)
People with depression are over-represented among perpetrators of intimate partner homicide. However another study found that depression should be considered in the context of co-occuring risk factors for intimate partner homicide.
In 2022-23, of the around 80,400 specialist homelessness services clients aged 10 and over who have experienced family and domestic violence:
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about 4 in 10 (42%) also had a current mental health issue
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about 1 in 10 (12%) had problematic drug and/or alcohol use
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around 7,600 (9.4%) had both of the additional selected vulnerabilities
Australia’s National Research Organisation for Women’s Safety. Violence against women and mental health- Research Synthesis (ANROWS Insights, 04/2020). Sydney: ANROWS.
This paper provides a synthesis of evidence on violence against women and mental health, examining the way that mental health intersects with trauma, complex trauma, disability, coercive control, access to justice and parenting. This paper is not intended to be a comprehensive literature review—it focuses on ANROWS research and other research, while also drawing on recent grey literature for further supporting evidence. Some of the key issues identified include:
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For women experiencing violence, mental health problems can overlap with trauma, complex trauma and disability, making simple diagnoses and treatment difficult.
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Mental ill health can be a compounding factor, a barrier, an outcome and a tool used by perpetrators of violence against women.
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Access to justice can be impacted at the intersection of mental health and violence against women, because the criminal justice system is not designed to accommodate trauma.
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The co-occurrence of violence against women and mental health concerns can have parenting impacts, damaging the mother–child relationship and impacting the child’s mental health.
Douglas, Heather, ‘Domestic and Family Violence, Mental Health and Well-Being, and Legal Engagement’ (2018) Psychiatry, Psychology and Law 25(3): 341-356 doi: 10.1080/13218719.2017.1396865
This article draws from interviews with a group of diverse women who have engaged with the legal system after experiencing domestic and family violence (DFV). The study sought to investigate how women’s experiences of legal processes ‘affected their mental health and well-being’ (p 1). Almost all the women experienced some type of mental health issue directly attributable to DFV (p 5). Many women engaged preventative measures prior to attending court, including pre-court counselling, contacting mental health practitioners, and taking prescribed medication (p 2). Other women self-medicated and avoided seeking help fearing that proof of mental health concerns may lead to negative court outcomes (p 2). Many women highlighted attending court (pp 5-6), having to face the perpetrator in court (pp 6-8), and giving evidence (pp 8-9) as negatively affecting their mental health (p 10). A number of suggestions are made for improving women’s experiences in court, including:
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minimising the frequency with which victims are required to attend court (p 10);
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allowing women to give evidence remotely (p 10);
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minimising contact between the victim and abuser, through ensuring there are safe waiting spaces (p 10), and staggering attendance and departure times of the parties (p 11);
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providing effective training to court personnel regarding the dynamics of DFV (p 11); and
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ensuring cross-examination, and legal proceedings in general, are not misused by the abuser (p 11).
Hegarty, Kelsey, et al, ‘Association between Depression and Abuse by Partners of Women Attending General Practice: Descriptive, Cross Sectional Survey’ (2004) 328(7440) The BMJ 621.
This article reports on a survey of female patients within a general practice setting in Australia, which sought to investigate the connection between depression and physical, emotional, and sexual abuse of women by partners or former partners. The researchers surveyed1257 female patients of 30 general practitioners in Victoria between August and December 2000. The authors found that 18.0% of women were scored as currently probably depressed and 24% as having experienced some type of abuse in the past 12 months, while 37% had ever experienced some form of abuse while in an adult intimate relationship. Of women who were probably depressed, more were likely to have experienced some form of abuse as a child and also were more likely to have experienced partner abuse.
Heward-Belle, S., Azam Ali, P., Marotta, J., Hager, D., Rogers, M., and Stevenson, L. (2024) ‘Judicial actors’ understanding of the mental health impacts of intimate partner violence: A scoping review’, Trauma Violence Abuse online first, doi: 10.1177/15248380241244494
Abstract: In this research review (reviewing studies from 2000-2023 and including 27 articles) the researchers identified the following themes: judicial professionals were lacking knowledge about awareness of IPV survivors’ experiences, understanding of perpetrator tactics and risk factors, understanding of survivor reluctance to disclose mental health issues caused by the IPV, and overall lack of training and guidance.
Holden, Libby, et al, ‘Mental Health: Findings from the Australian Longitudinal Study on Women’s Health’ (Final Report, Women’s Health Australia, May 2013).
This report draws on data from The Australian Longitudinal Study on Women’s Health (examining data on about 5,766 Australian women). See pp76-83. Key finding from this examination include:
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‘Women in their 20s and 30s who report Intimate Partner Violence (IPV) experience a subsequent decrease in mental health.
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Women in their 20s and 30s who report IPV experience poorer mental health prior to IPV, suggesting an inter-connected relationship; that is, IPV affects mental health status and likewise mental health affects IPV.
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An analysis of data from women in the mid-aged cohort (born 1946-51) found that after the cessation of IPV, women experience an improvement in mental health. However, even after 12 years, their mental health is significantly poorer than that of women who have never lived with IPV’ (at 83).
Ogbo, Felix Akpojene, John Eastwood, Alexandra Hendry, Bin Jalaludin, Kingsley E Agho, Bryanne Barnett and Andrew Page, ‘Determinants of Antenatal Depression and Postnatal Depression in Australia’ (2018) 18(49) BMC Psychiatry (online).
This article considers the causes of antenatal and postnatal depression in Australia. The results of the study indicate that a history of intimate partner violence, both physical and psychological, is associated with depressive symptoms (p 3). Further, IPV was one of the ‘strongest risk factors for antenatal depressive symptoms’ (p 5).
Orr K., Sheeran N., and Douglas H. (2023) ‘The psychological impact on mothers who have experienced domestic violence when navigating the family court system: a scoping review’, Psychiatry, Psychology and Law, 1-28 doi: 10.1080/13218719.2023.2214927
The aim of this scoping review was to synthesise the literature to identify what the psychological impacts of family court processes were on mothers who had experienced DFV. Twenty-five articles met inclusion criteria with four themes capturing the findings: Perpetrators using the system as a mode of coercive control; Secondary victimisation as a result of interacting with the system; Required to relive their abuse; and Long-term psychological consequences of having engaged with the system. Key findings were that perpetrators manipulated the system to perpetrate further abuse and continue/reassert their control. Secondary re-victimisation was common, with poor knowledge of DFV and limited understanding of coercive control tactics and how these were employed by perpetrators by legal professionals identified as contributing factors. This review suggests that mothers who engage with the family court system experience a range of short- and long-term psychological impacts and corut processes facilitate ongoing abuse by the perpetrator.
Papalia N., Simmons M., Trood M., McEwan T. and Spivak B. (2024) ‘Police-reported family violence victimisation or perpetration and mental health-related emergency department presentations: an Australia data-linkage study’, BMC Public Health 24, 131 doi: 10.1186/212889-023-17570-y
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Method: Demographics, prior police involvement, and individual and relationship vulnerabilities were provided by Victoria Police for 1520 affected family members (i.e. primary victims) and 1470 respondents (i.e. persons alleged to have perpetrated family violence) from family violence reports in 2016-17. Emergency mental health presentations 22-30 months post family-violence report were determined through linkage with the Victorian Emergency Minimum Dataset and compared to statewide presentations.
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Results: Emergency mental health presentations during follow-up were identified in 14.3% of the family violence sample, with 1.9% presenting for self-harm. Mental health presentation rates per 1,000 people were markedly higher among affected family members and respondents of both sexes and all ages than in the general population, except for male affected family members aged 45+. Adjusting for age and sex, the mental health presentation rate was 6 and 11 times higher among affected family members and respondents respectively, than in the general population. Individual vulnerabilities were more closely related to risk of emergency mental health presentations than relationship characteristics.
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Conclusion: Police-recorded family violence is associated with increased mental health-related emergency department presentations over the short-to-medium term.
Purdie Nola, Pat Dudgeon and Roz Walker, eds. Working together: Aboriginal and Torres Strait islander mental health and Well-being Principles and Practice, 2nd edition (2014, Telethon Kids).
This book includes chapters on a wide range of issues associated with Aboriginal and Torres Strait Islander mental health. The editors identify that the purpose of the book is to provide an appropriate resource for a range of health professionals who work with Aboriginal and Torres Strait Islander people, including Aboriginal and Torres Strait Islander health workers, counsellors, and other staff of Indigenous health services. Chapter 1 ’Australian Aboriginal and Torres Strait Islander Mental Health: An Overview’ by Robert Parker provides a good summary of relevant issues, see especially from p5-7. See also chapter 10 ‘Trauma, Transgenerational Transfer and Effects on Community Well-being’ by Judy Atkinson et al.
Szalacha, Laura A. Hughes, Tonda L., McNair, Ruth and Loxton, Deborah.(2017) ‘Mental health, sexual identity, and interpersonal violence: Findings from the Australian Longitudinal Women’s Health Study’, BMC Women's Health 17(94) (online)
This study investigates the linkages between interpersonal violence, mental health, and sexual identity (pp2-3). The results indicate that:
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Compared to exclusively heterosexual women, mainly heterosexual and bisexual women were significantly more likely to report physical, sexual and emotional abuse (p4)
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Mainly heterosexual and lesbian women were more likely to report severe physical abuse (p4)
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Mainly heterosexual women were more than three times as likely to have been in a violent relationship in the past three years (p4)
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All sexual minorities were two to three times as likely to have experienced harassment (p4)
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Bisexual women reported significantly higher levels of depression and scored lower on mental health than did exclusively heterosexual women (pp6-7)
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Interpersonal violence strongly predicted poorer mental health for lesbian and bisexual women (p6)
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Mental health indicators were similar for exclusively heterosexual and sexual minority women who did not report interpersonal violence (pp6-7)
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Experiencing multiple types of interpersonal violence was the strongest predictor of stress, anxiety and depression (p6)
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Interpersonal violence is a signficant contributor to mental health disparities for women, particularly for those belonging to sexual minorities (pp7-8)
This report is focussed on health outcomes associated with intimate partner violence. This paper presents a helpful review of relevant literature about the relationship between poor mental health and the experience of violence. It notes that previous literature has found that (at 20):
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‘Shock, fear and feeling numb are common psychological responses to intimate partner violence. However, the mental health effects persist long after a violent episode.
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Middle-aged women are significantly more likely to experience anxiety and depression.
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The effects of violence can persist for many years. Women who have experienced violence in the past have lower rates of mental health problems than women reporting current intimate partner violence, but significantly higher rates than those who have never experienced this type of violence.
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Women reporting intimate partner violence are more likely to use medication for depression and anxiety.
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Some other psychiatric disorders (namely phobias, somatisation and dissociative disorders) are more common in women reporting intimate partner violence than those not affected.’ (references omitted).
Drawing on existing studies this report identifies mental health outcomes associated with intimate partner violence: attempted suicide, self-harming behaviours, depression, anxiety, eating disorders, traumatic and post-traumatic stress symptoms and other psychiatric disorders such as phobias and dissociative and somatisation disorder (involving the physical expression of psychological symptoms) (p21).
International
Agenda Alliance and the VISION Consortium (2023) Underexamined and Underreported: Suicidality and intimate partner violence: Connecting two major public Health Concerns.
Drawing on existing data (2014 Adult Psychiatric Morbidity Survey- based on large household sample of 7,000 adults 16+) This UK based report identifies:
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Suicide and intimate partner violence (IPV) are each recognised as major public health concerns; however, the links between them have been critically under-examined.
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This briefing establishes the relationship between IPV and suicidality (suicidal thoughts and suicide attempts) and self harm, setting out the ways in which women are disproportionately impacted and at greater risk of IP related suicidality.
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Women who have experienced IPV are three times more likely than women who have not experienced IPV to have made a suicide attempt in the past year.
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Women who have experienced sexual IPV are seven times more likely than those who had not experienced sexual IPV to have attempted suicide in the past year.
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Furthermore, intersecting identities and experiences associated with systemic disadvantages, including poverty, disability, and ethnicity, exacerbate risks of both suicidality and IPV
Emily Brignone, Anneliese Sorrentino, Christopher Roberts and Melissa Dichter, ‘Suicidal ideation and behaviors among women veterans with recent exposure to intimate partner violence’ (2018) 55 General Hospital Psychiatry 60-64.
Female veterans are at a disproportionately high risk for suicide and intimate partner violence (IPV) compared to female non-veterans. Suicide rates increased by 32.7% among veterans between 2005 and 2015. There is evidence that female veterans differ from non-veterans in terms of IPV-related experiences. The authors examined the US Veterans Health Administration (VHA) electronic medical records for 8427 female veterans who completed screening for past-year IPV between April 2014 and 2016. Results showed a strong connection between IPV and suicidal ideation, and self-harm behaviours among VHA female veterans.
Cations M., Keage HAD., Layer KE., Byles J. and Loxton D. (2021) ‘Impact of Historical Intimate Partner Violence on Wellbeing and Risk for Elder Abuse in Older Women’, Americal Journal of Geriatric Psychiatry 29 930-940 doi: 10.1016/j.jagp.2020.12.026
Objective: To assess the psychological impacts and risk for elder abuse associated with historical intimate partner violence (IPV) in older women.
Design: Prospective cohort study
Setting: All Australian states and territories
Participants: A total of 12,259 women aged 70-75 years at baseline participating in the Australian Longitudinal Study of Women’s Health.
Measurements: Women were asked at baseline whether they had ever been in a violent relationship with a partner and completed a comprehensive survey about their physical and psychological health every 3 years (15 years follow up).
Results: The 782 (6.4%) women who reported historical IPV recorded significantly poorer psychological wellbeing at all timepoints compared to those who did not report historical IPV, and were at higher risk for incident depression over follow up.
Discussion: Women who have experienced a violent relationship continue to experience negative effects into older age, highlighting the importance of clinical monitoring and ongoing support for surivivors as they age.
Farzan-Kashani, Julian and Christopher Murphy, ‘Anger Problems Predict Long-Term Criminal Recidivism in Partner Violent Men’ (2017) 32(23) Journal of Interpersonal Violence 3541-3555
Anger problems are not only an important correlate of IPV, but may also be an important factor underlying treatment response for IPV perpetrators. Of 132 men receiving treatment services at a community-based DV agency, those with serious anger problems had more charges for general violence offences and more ongoing problems with protection orders than did those with ‘normal’ anger levels. Further, low anger control and high anger expression predicted general violence recidivism. The results demonstrate that new intervention approaches are necessary for partner violent men with serious anger dysregulation, as a standard cognitive-behavioural treatment program may not suffice.
May, Barbara A, et al, ‘Are Abused Women Mentally Ill?’(2003) 41(2) Journal of Psychosocial Nursing & Mental Health Services 21-29.
This study attempted to profile the psychological distress symptoms of community-based abused women who were participating in a larger intervention study and compare them to normative samples using the same measure (Derogatis Brief Symptom Inventory (BSI)) to better understand the effects of intimate partner violence on their mental health. The study sample (N = 50) experienced complex trauma and various psychological manifestations consistent with [cited] literature on victims/survivors of intimate partner violence; contrary to the researchers’ implicit assumption, they profiled more like the psychiatric adult female outpatients than the adult female nonpatients.
The authors note that studies have shown a hesitancy to diagnose abused women as mentally ill because the stigma of "being crazy" tends to be used to rationalize their situations, resulting in victim blaming and revictimization. They observe also that these studies may have minimized the likelihood of self-disclosure or help-seeking, and explained health care providers' reluctance to consider this diagnosis.
‘In the community of health care providers for abused women, there is a strong need to refrain from "pathologizing" or labeling victims/survivors of abuse as mentally ill. However, the BSI findings in this study do indicate symptomatology in this nonclinical, community-based sample of abused women is very high in all dimensions and in the global indexes, which suggests serious mental distress.
Abused women are fearful of being labeled as "sick" and further stigmatized by the situations for which they actively seek answers…However, mental illness, regardless of origin, must be diagnosed so it can be treated properly…Health care providers then must educate the abused women about possible benefits of diagnosis using a "social contextual advocacy-based model" … However, it is important to remember that for many women in abusive situations a diagnosis of mental illness can work against them in a court case. In particular, when children are involved, this diagnosis may be detrimental, and the women may lose custody of their children because of it.’ (pp 25-27)
Siegel, Judith P, ‘An Expanded Approach to Batterer Intervention Programs Incorporating Neuroscience Research’ (2013) 14(4) Trauma, Violence and Abuse 295.
This article reviews findings of neurobiological research that have informed the treatment of disorders that are strongly represented among perpetrators of intimate violence, such as addiction, posttraumatic stress disorder, mood, anxiety, and personality disorders. The author argues for an expanded perspective and approach that recognize the relationships among childhood trauma, emotional regulation impairment, and intimate partner violence.
Mental health issues (including mental issues and other manifestations, such as high psychological distress due to a stressor) can be a risk factor for the perpetration and/or victimisation of family, domestic and sexual violence (“FDSV”) and an outcome of FDSV.
Research demonstrates clear causal links between the experience of domestic and family violence and the development of mental health conditions in victims.
Understanding the potential difficulties, barriers and disadvantages victims suffering from mental illness may face in proceedings in domestic and family violence-related matters may assist judicial officers in: assessing and responding to the safety needs of the victim and any children or other people at risk; the treatment and support needs of the victim; and the victim’s capacity and willingness to participate in the proceedings and to otherwise assert their legal rights and protections.
For example, there is a reported hesitancy to diagnose women victims as mentally ill due to concerns that the stigma of “being crazy” may be used to rationalise the domestic and family violence they experience, resulting in possible victim blaming and revictimisation. Further, a woman medicated or receiving treatment for a mental condition caused or aggravated by violence may be reluctant to exercise her rights to protect herself and her children from further violence for fear that the perpetrator may use her mental illness to seek to deny her child residence or contact.
Domestic and family violence may directly affect a victim’s mental disposition and cognition, and confer a vulnerability to psychiatric consequences, by engendering feelings of fear, hopelessness and low self-esteem. The most common psychiatric disorders diagnosed in women victims are: depression, dysthymia (a chronic form of depression), post-traumatic stress disorder, bipolar disorder, personality disorder, psychoses, phobias, suicidal ideation, psychoactive drug dependence, anxiety, sleep and eating disorders. The incidence, severity and co-morbidity of these conditions tend to correlate with the type, extent and duration of the violence.
Victims who have experienced abuse as children are particularly vulnerable to the impacts of cumulative trauma and re-victimisation in adulthood and thus are at higher risk of subsequent psychiatric morbidity. This may be particularly prevalent for Aboriginal and Torres Strait Islander people where, across several generations, family members may have recurring experiences of various forms of violence and related trauma that remain unacknowledged or unresolved. Pre-existing mental ill health can also influence a victim’s vulnerability to abuse as it renders the victim more susceptible to unsafe environments and abusive relationships.
Victims who have been exposed to multiple, recurrent and prolonged forms of abuse may also experience chronic stress, distress and impairment, both psychological and physical, and a diminished capacity to cope with day to day living putting them at risk of secondary stressors such as unemployment, lack of material resources, social isolation, and poverty.
Perpetrators of domestic and family violence may also experience mental illness, which may affect the nature and severity of the violence, how it is experienced by the victim, and the appropriate judicial responses.
Aboriginal and Torres Strait Islander people may have the experience of seeing spirits or hearing ancestral voices, and may therefore be at risk of being misdiagnosed or mislabelled as mentally ill when they are not in fact ill. Fear of misdiagnosis or mislabelling may be a strong barrier to help-seeking for victims and perpetrators in this context.
Mental health issues (including mental issues and other manifestations, such as high psychological distress due to a stressor) can be a risk factor for the perpetration and/or victimisation of family, domestic and sexual violence (“FDSV”) and an outcome of FDSV.
Research demonstrates clear causal links between the experience of domestic and family violence and the development of mental health conditions in victims.
Understanding the potential difficulties, barriers and disadvantages victims suffering from mental illness may face in proceedings in domestic and family violence-related matters may assist judicial officers in: assessing and responding to the safety needs of the victim and any children or other people at risk; the treatment and support needs of the victim; and the victim’s capacity and willingness to participate in the proceedings and to otherwise assert their legal rights and protections.
For example, there is a reported hesitancy to diagnose women victims as mentally ill due to concerns that the stigma of “being crazy” may be used to rationalise the domestic and family violence they experience, resulting in possible victim blaming and revictimisation. Further, a woman medicated or receiving treatment for a mental condition caused or aggravated by violence may be reluctant to exercise her rights to protect herself and her children from further violence for fear that the perpetrator may use her mental illness to seek to deny her child residence or contact.
Domestic and family violence may directly affect a victim’s mental disposition and cognition, and confer a vulnerability to psychiatric consequences, by engendering feelings of fear, hopelessness and low self-esteem. The most common psychiatric disorders diagnosed in women victims are: depression, dysthymia (a chronic form of depression), post-traumatic stress disorder, bipolar disorder, personality disorder, psychoses, phobias, suicidal ideation, psychoactive drug dependence, anxiety, sleep and eating disorders. The incidence, severity and co-morbidity of these conditions tend to correlate with the type, extent and duration of the violence.
Victims who have experienced abuse as children are particularly vulnerable to the impacts of cumulative trauma and re-victimisation in adulthood and thus are at higher risk of subsequent psychiatric morbidity. This may be particularly prevalent for Aboriginal and Torres Strait Islander people where, across several generations, family members may have recurring experiences of various forms of violence and related trauma that remain unacknowledged or unresolved. Pre-existing mental ill health can also influence a victim’s vulnerability to abuse as it renders the victim more susceptible to unsafe environments and abusive relationships.
Victims who have been exposed to multiple, recurrent and prolonged forms of abuse may also experience chronic stress, distress and impairment, both psychological and physical, and a diminished capacity to cope with day to day living putting them at risk of secondary stressors such as unemployment, lack of material resources, social isolation, and poverty.
Perpetrators of domestic and family violence may also experience mental illness, which may affect the nature and severity of the violence, how it is experienced by the victim, and the appropriate judicial responses.
Aboriginal and Torres Strait Islander people may have the experience of seeing spirits or hearing ancestral voices, and may therefore be at risk of being misdiagnosed or mislabelled as mentally ill when they are not in fact ill. Fear of misdiagnosis or mislabelling may be a strong barrier to help-seeking for victims and perpetrators in this context.