JMIR Publications

ABSTRACT

Background:

Domestic violence and abuse (DVA) has a detrimental impact on the health and wellbeing of children and families but is commonly underreported, with an estimated prevalence of 5.5% in England and Wales in 2020. DVA is more common in vulnerable groups including those involved in public law family court proceedings, however there is a lack of evidence regarding risk factors for DVA among those involved in the family justice system.

Objective:

This study examined risk factors for DVA within a cohort of mothers involved in public law family court proceedings in Wales, and a matched general population comparison group.

Methods:

We linked family justice data from the Children and Family Court Advisory and Support Service (Cafcass Cymru) to demographic and electronic health records within the Secure Anonymised Information Linkage (SAIL) Databank. We constructed two study cohorts: mothers involved in public law family court proceedings (2011–2019) and a general population group of mothers not involved in public law family court proceedings, matched on key demographics (age and deprivation). We used published clinical (Read) codes to identify mothers with exposure to DVA documented in their primary care records, and who therefore reported DVA to their general practitioner (GP). Multiple logistic regression analyses were used to examine risk factors for primary care recorded DVA.

Results:

Mothers involved in public law family court proceedings were eight times more likely to have had exposure to DVA documented in their primary care records compared to the general population group (adjusted odds ratio (AOR) =8.0 (95% confidence interval [CI] 6.6–9.7)). Within the cohort of mothers involved in public law family court proceedings, risk factors for DVA with the greatest effect sizes included: living in sparsely populated areas AOR=3.9 (95% CI 2.8–5.5); assault-related emergency department attendances AOR=2.2 (95% CI 1.5–3.1); and mental health conditions AOR=1.7 (95% CI 1.3–2.2). An eightfold increased risk of DVA emphasises increased vulnerabilities for individuals involved in public law family court proceedings.

Conclusions:

Previously reported DVA risk factors do not necessarily apply to this group of women. Additional risk factors identified in this study could be considered for inclusion in national guidelines. The evidence that living in sparsely populated areas, and assault-related attendances, are associated with increased risk of DVA could be used to inform policy and practice interventions targeting prevention and tailored support services for victims of DVA. Further work should however also explore other sources of DVA, such as that recorded in secondary healthcare, family and criminal justice records to understand the true scale of the problem.