The authors have declared that no competing interests exist.
Conceived and designed the experiments: GK SLH KD MH. Analyzed the data: GK. Contributed reagents/materials/analysis tools: GK SLH MH. Wrote the paper: GK SLH MH KD.
General population surveys have seldom examined violence as a multidimensional concept and in relation to an array of mental disorders.
Data from the South East London Community Health Study was used to examine the prevalence, overlap and distribution of proximal witnessed, victimised and perpetrated violence and their association with current mental disorders. We further investigated the cumulative effect of lifetime exposure to violence on current mental disorders. Unadjusted and adjusted (for confounders and violence) models were examined.
In the last twelve months, 7.4% reported witnessing violence, 6.3% victimisation and 3.2% perpetration of violence. There was a significant overlap across violence types, with some shared correlates across the groups such as being younger and male. Witnessing violence in the past year was associated with current common mental disorders (CMD) and post-traumatic stress disorder (PTSD) symptoms. Proximal perpetration was associated with current CMD, PTSD symptoms and past 12 months drug use; whereas proximal victimisation was associated with lifetime and past 12 months drug use. Lifetime exposure to two or more types of violence was associated with increased risk for all mental health outcomes, suggesting a cumulative effect.
Exposure to violence needs to be examined in a multi-faceted manner: i) as discrete distal and proximal events, which may have distinct patterns of association with mental health and ii) as a concept with different but overlapping dimensions, thus also accounting for possible cumulative effects.
Violence is a multi-dimensional phenomenon that can be experienced as a victim, witness and perpetrator. Examining its prevalence and associations is necessary to understand violence occurrence
Existing general population research has been hampered by several limitations. Studies have seldom examined multiple dimensions of violence in the same sample, despite evidence indicating a co-occurrence across victimisation and perpetration
In the present study, we examine the prevalence, inter-relationships and associations of different ETV types in a diverse urban population sample: the South East London Community Health (SELCoH) study. On a local level, our sample was similar to the 2011 UK Census data for the boroughs we examined with regards to demographic and socioeconomic indicators. On a national level, the study catchment area has a higher level of deprivation and a level of violence significantly above England's average
The aims of this analysis were as follows: 1) to estimate the prevalence of proximal witnessing, victimisation and perpetration; and examine their overlap and distribution by socio-demographic and socioeconomic characteristics; 2) to examine the unadjusted and adjusted associations between proximal types of violence and current mental disorders; 3) to examine the cumulative effect of lifetime exposure to violence on current mental health. We hypothesised that witnessed violence and victimisation would be more prevalent than perpetration. We further expected to find an overlap between the different categories of violence and therefore some shared correlates across violence. We anticipated that all categories of violence would have an association with common mental disorders (CMD) and that there would be an interaction with gender, such that women exposed to violence would show a higher prevalence for CMD. We expected to find that lifetime ETV would be associated with current mental disorders, with the association increasing when more than one type has been experienced.
The South East London Community Health (SELCoH) study is an urban, population cross-sectional survey, which aimed to examine psychiatric and physical morbidity in the London boroughs of Southwark and Lambeth. Data were collected between 2008 and 2010. Private households were selected from the Small User Postcode Address File (PAF), using a stratified random sampling approach. Households that were non-residential, shared, vacant or receiving more than 50 item of mail per day were excluded. All adult residents aged 16 year and over, were invited to participate in the survey. A total of 1698 adults from 1075 households were recruited, achieving a within household participation rate of 71.9% and household participation rate of 51.9%. Trained interviewers conducted face to face interviews using a computer assisted interview schedule. All participants were compensated for their time with 15GBP. For detailed information on SELCoH study methods, refer to Hatch
The SELCoH study received full ethical approval from the King's College London research ethics committee for non-clinical research populations (reference CREC/07/08-152). Written consent was obtained from all participants in the study.
The three types of violence were defined by reports of one or more events within each of the following categories: 1) witnessed violence was determined by asking participants if they had: seen something violent happen to someone (e.g. attacked or beaten) or seen someone killed within the last 12 months; 2) victimisation was reported as having experienced within the last 12 months being attacked, mugged, robbed, or been the victim of a serious crime; injured you with a weapon – gun, knife, stick, etc. and hit you, bit you, slapped you, kicked you, or forced you to have sex against your wishes; 3) perpetrated violence was indicated by participants reporting whether or not they had in the last 12 months: attacked or robbed someone; injured someone with a weapon – gun, knife, stick etc. and hit, bit, slapped, or kicked another person
Six measures of participants' current mental health were included. The presence of CMD was established through a structured interview (the Revised Clinical Interview Schedule (CIS-R)
A number of socio-demographic and socioeconomic factors were included to describe the distribution of ETV. Age was considered in 10 years interval, after examining the distribution of the data: 16 to 24 years; 25 to 34 years; 35 to 44 years; 45 to 54 years; 55 to 64 years and 65 years and over. Ethnicity categories were determined by self-identification into one of the following groups: White British, Black Caribbean, Black African, Black Other, Indian, Pakistani, Bangladeshi, Chinese or Other. The Black Other, Indian, Pakistani, Bangladeshi, Chinese or Other categories were collapsed for analysis due to small numbers within these groups
The highest level of educational attainment was reported as one of the following four categories: no qualifications; qualifications up to GCSE or ordinary level; qualifications up to advanced level; and degree or above. Employment status was reported as one of the following: full time; part time/casual; student; unemployed; sick/disabled; retired; and looking after kids. To improve distribution, information was re-categorised into the following categories: 1) employed (including full time, part time and casual); 2) students; 3) unemployed and 4) other (temporary sick or permanent sick/disabled, retired or looking after the home with children). Household income (i.e. gross yearly income from all sources before deductions for income and National Insurance) was presented as a categorical variable in the survey questionnaire, therefore participants self-identified with one of the following categories: £0 to £5,475; £5,476 to £12,097; £12,098 to £20,753; £20,754 to £31,494; and £31,495 and over.
STATA 11
Type of exposure to violence | Witnessed | Victimised | Perpetrated | ||||
n | 147 | 120 | 64 | ||||
% (95% CI) | 7.4 (6.13–8.68) | 6.3 (5.12–7.44) | 3.2 (2.42–4.02) | ||||
Characteristics | n (%) | % (95% CI) | p-value | % (95% CI) | p-value | % (95% CI) | p-value |
Witnessed | 147(8.74) | NA | 24.9 (17.58–32.35) | 13.7 (8.01–19.31) | |||
Victimised | 120 (7.13) | 29.4 (20.79–38.05) | NA | 19.4 (12.26–.52) | |||
Perpetrated | 64 (3.81) | 31.2 (19.72–42.69) | 37.9 (25.43–50.32) | NA | |||
16–24 | 356 (20.97) | 18.9 (14.41–23.33) | <0.001 | 14.3 (10.73–17.90) | <0.001 | 10.1 (6.94–13.20) | <0.001 |
25–34 | 404 (23.79) | 9.6 (6.71–12.48) | 6.3 (3.82–8.85) | 3.3 (1.50–5.07) | |||
35–44 | 336 (19.79) | 4.7 (2.36–7.08) | 4.5 (2.28–6.66) | 1.7 (0.43–2.99) | |||
45–54 | 264 (15.55) | 4.7 (2.12–7.21) | 5.3 (2.54–7.99) | 1.7 (0.19–3.29) | |||
55–64 | 163 (9.60) | 2.3 (−0.27–4.91) | 4.6 (1.00–8.26) | 1.2 (−0.05–3.01) | |||
65+ | 175 (10.31) | 1.3 (−0.17–2.76) | 1.3 (−0.14–2.73) | - | |||
Female | 959 (56.48) | 6.1 (4.55–7.77) | <0.01 | 5.4 (3.96–6.87) | <0.03 | 2.7 (1.73–3.66) | 0.07 |
Male | 739 (43.52) | 10.0 (7.89–12.11) | 8.0 (6.11–9.93) | 4.3 (2.83–5.74) | |||
White | 1,051 (61.97) | 6.4 (4.81–7.96) | 0.11 | 6.6 (5.09–8.13) | 0.18 | 3.4 (2.32–4.39) | 0.69 |
Black Caribbean | 143 (8.43) | 8.1 (3.11–13.11) | 9.1 (4.13–13.98) | 3.1 (0.37–5.74) | |||
Black African | 234 (13.80) | 11.0 (7.24–14.85) | 5.4 (2.61–8.28) | 3.9 (1.53–6.26) | |||
Other | 268 (15.80) | 8.3 (5.24–11.35) | 3.9 (1.73–6.16) | 2.2 (0.54–3.80) | |||
UK born | 1,010 (60.77) | 7.5 (5.78–9.20) | 0.08 | 7.4 (5.74–8.98) | 0.06 | 3.9 (2.82–5.14) | <0.05 |
0–4 years | 137 (8.24) | 9.7 (5.02–14.40) | 7.6 (3.44–11.74) | 2.2 (0.80–4.39) | |||
5–10 years | 178 (10.71) | 11.2 (6.38–16.05) | 3.2 (0.65–5.81) | 2.3 (0.64–4.44) | |||
11+ years | 337 (20.28) | 5.3 (2.95–7.67) | 4.3 (2.09–6.61) | 1.3 (0.25–2.40) | |||
£0–£5,475 | 139 (9.68) | 9.7 (4.69–14.72) | 0.21 | 7.9 (3.09–12.66) | 0.36 | 3.3 (1.67–5.93) | 0.51 |
£5,476–£12,097 | 212 (14.76) | 9.3 (5.45–13.21) | 5.9 (2.92–8.83) | 3.9 (1.50–6.39) | |||
£12,098–£20,753 | 203 (14.14) | 5.7 (2.77–8.55) | 5.8 (2.41–9.18) | 2.5 (0.06–4.32) | |||
£20,754–£31,494 | 179 (12.47) | 4.8 (1.79–7.85) | 9.0 (4.67–13.41) | 3.3 (1.01–5.58) | |||
£31,495 and over | 703 (48.96) | 6.5 (4.66–8.32) | 5.1 (3.49–6.64) | 2.1 (1.02–3.15) | |||
No qualifications | 228 (13.58) | 4.7 (2.29–7.15) | <0.01 | 3.3 (1.04–5.62) | <0.001 | 3.2 (1.27–5.16) | <0.001 |
GCSE | 332 (19.77) | 8.4 (5.51–11.24) | 9.7 (6.61–12.81) | 4.9 (2.76–7.04) | |||
A-level's | 426 (25.37) | 10.8 (7.57–14.06) | 9.6 (6.69–12.58) | 5.4 (3.22–7.62) | |||
Degree or above | 693 (41.27) | 6.1 (4.34–7.91) | 4.0 (2.60–5.41) | 1.2 (0.39–1.96) | |||
Employed | 921 (54.53) | 5.9 (4.44–7.49) | <0.001 | 5.4 (3.89–6.87) | <0.001 | 2.0 (1.11–2.99) | <0.001 |
Students | 247 (14.62) | 21.7 (15.91–27.53) | 13.8 (9.44–18.12) | 10.6 (6.72–14.53) | |||
Unemployed | 170 (10.07) | 11.5 (6.52–16.49) | 10.2 (5.44–14.89) | 5.4 (2.09–8.79) | |||
Other | 351 (20.78) | 2.2 (0.70–3.61) | 3.3 (1.47–5.05) | 1.1 (0.21–1.99) |
witnessed, victimised and perpetrated categories are overlapping.
As described by
Type of exposure to violence | Witnessed | Victimised | Perpetrated |
n | 147 | 120 | 64 |
% (95% CI) | 7.4 (6.13–8.68) | 6.3 (5.12–7.44) | 3.2 (2.42–4.02) |
Characteristics | Unadjusted OR (95% CI) | Unadjusted OR (95% CI) | Unadjusted OR (95% CI) |
16–24 | 1 | 1 | 1 |
25–34 | 0.46 (0.29–0.71) |
0.41 (0.24–0.68) |
0.30 (0.16–0.59) |
35–44 | 0.21 (0.12–0.39) |
0.28 (0.16–0.50) |
0.16 (0.07–0.37) |
45–54 | 0.21 (0.11–0.39) |
0.33 (0.18–0.61) |
0.16 (0.06–0.41) |
55–64 | 0.10 (0.03–0.33) |
0.29 (0.12–0.69) |
0.11 (0.02–0.49) |
65+ | 0.06 (0.02–0.18) |
0.07 (0.02–0.25) |
- |
Female | 1 | 1 | 1 |
Male | 1.70 (1.19–2.43) |
1.52 (1.04–2.23) |
1.62 (0.96–2.71) |
White | 1 | 1 | 1 |
Black Caribbean | 1.29 (0.63–2.66) | 1.40 (0.74–2.68) | 0.91 (0.35–2.37) |
Black African | 1.82 (1.14–2.91) |
0.81 (0.44–1.49) | 1.16 (0.57–2.37) |
Other | 1.33 (0.82–2.15) | 0.58 (0.31–1.09) | 0.64 (0.28–1.47) |
Born in the UK | 1 | 1 | 1 |
0–4 years | 1.33 (0.73–2.40) | 1.03 (0.55–1.96) | 0.55 (0.19–1.54) |
5–10 years | 1.56 (0.90–2.69) | 0.42 (0.18–0.99) |
0.56 (0.19–1.57) |
11years or more | 0.69 (0.41–1.17) | 0.57 (0.32–1.04) | 0.32 (0.14–0.78) |
£0–£5,475 | 1.55 (0.81–2.96) | 1.60 (0.77–3.35) | 1.59 (0.60–4.25) |
£5,476–£12,097 | 1.48 (0.86–2.56) | 1.17 (0.62–2.19) | 1.93 (0.84–4.42) |
£12,098–£20,753 | 0.86 (0.46–1.61) | 1.15 (0.57–2.32) | 1.19 (0.47–3.01) |
£20,754–£31,494 | 0.73 (0.35–1.51) | 1.86 (0.99–3.49) | 1.59 (0.65–3.91) |
£31,495 and over | 1 | 1 | 1 |
No qualifications | 0.76 (0.41–1.42) | 0.82 (0.37–1.83) | 2.79 (1.11–6.99) |
GCSE | 1.40 (0.86–2.28) | 2.57 (1.54–4.29) |
4.32 (1.91–9.78) |
A-level's | 1.85 (1.18–2.92) |
2.55 (1.56–4.17) |
4.81 (2.16–10.72) |
Degree or above | 1 | 1 | 1 |
Employed | 1 | 1 | 1 |
Students | 4.37 (2.82–6.77) |
2.81 (1.76–4.49) |
5.68 (3.03–10.67) |
Unemployed | 2.05 (1.17–3.58) |
1.99 (1.11–3.58) |
2.75 (1.25–6.07) |
Other | 0.35 (0.16–0.73) |
0.59 (0.31–1.12) | 0.53 (0.21–1.37) |
witnessed, victimised and perpetrated categories are overlapping.
*p<0.05,
**p<0.01,
***p<0.001.
Type of Exposure to Violence | No ETV |
Witnessed |
Victimised |
Perpetrated |
|
n | 1416 | 147 | 120 | 64 | |
% (95% CI) | 85.2 (83.45–86.95) | 7.4 (6.13–8.68) | 6.3 (5.12–7.44) | 3.2 (2.42–4.02) | |
Outcome | n | % (95% CI) | % (95% CI) | % (95% CI) | % (95% CI) |
Common Mental Disorder | 396 | 22.3 (19.93–24.79) | 32.7 (24.58–40.81) | 37.6 (28.28–46.95) | 44.4 (31.64–57.21) |
Personality Dysfunction | 241 | 14.8 (12.82–16.84) | 17.7 (11.07–24.37) | 22.0 (13.80–30.26) | 22.1 (11.27–32.98) |
Post Traumatic Stress Disorder | 89 | 4.8 (3.56–5.97) | 10.0 (4.21–15.85) | 11.4 (5.27–17.47) | 11.4 (3.37–19.35) |
Lifetime Drug Use | 864 | 45.4 (42.3–48.56) | 56.5 (47.41–65.55) | 64.5 (55.29–73.74) | 63.3 (50.12–75.14) |
Drug Use in last 12 months | 363 | 15.5 (13.56–17.52) | 32.3 (24.02–40.53) | 45.2 (35.92–54.58) | 47.8 (33.97–59.58) |
Hazardous Alcohol Use | 343 | 15.6 (13.60–17.74) | 29.7 (21.59–37.80) | 33.8 (25.36–42.31) | 37.0 (25.24–48.82) |
witnessed, victimised and perpetrated categories are overlapping.
this group has not been used as a reference as it includes solely participants who have said ‘no’ to all ETV types.
the reference group is all participants who have not witnessed violence in the past 12 months.
the reference group is all participants who have reported no victimisation in the past 12 months.
the reference group is all participants who have not perpetrated violence in the past 12 months.
Type of Exposure to Violence | Witnessed |
Victimised |
Perpetrated |
Outcome | OR (95% CI) | OR (95% CI) | OR (95% CI) |
Unadjusted Model | 1.60 (1.09–2.37) |
2.00 (1.32–3.03) |
2.63 (1.55–4.46) |
Model 1 |
1.68 (1.13–2.51) |
2.10(1.38–3.21) |
2.79 (1.62–4.80) |
Model 2 |
1.88 (1.19–2.98) |
1.76 (1.08–2.85) |
2.45 (1.25–4.77) |
Model 3 |
1.63 (1.02–2.60) |
1.47 (0.89–2.43) | 2.03 (1.03–3.98) |
Unadjusted Model | 1.21 (0.75–1.96) | 1.62 (0.98–2.68) | 1.61 (0.85–3.05) |
Model 1 |
1.34 (0.82–2.16) | 1.75 (1.10–2.90) |
1.78 (0.92–3.41) |
Model 2 |
1.23 (0.71–2.13) | 1.45 (0.81–2.62) | 2.09 (1.03–4.21) |
Model 3 |
1.10 (0.63–1.92) | 1.28 (0.68–2.41) | 1.89 (0.93–3.87) |
Unadjusted Model | 2.06 (1.03–4.13) |
2.39 (1.25–4.59) |
2.32 (1.02–5.29) |
Model 1 |
2.17 (1.02–4.63) |
2.47 (1.26–4.84) |
2.37 (1.00–5.62) |
Model 2 |
2.93 (1.31–6.51) |
2.41 (1.09–5.31) |
3.36 (1.24–9.06) |
Model 3 |
2.55 (1.15–5.64) |
1.62 (0.68–3.85) | 2.65 (0.90–7.81) |
Unadjusted Model | 1.51 (1.04–2.21) |
2.15 (1.42–3.26) |
1.92 (1.12–3.30) |
Model 1 |
0.95 (0.64–1.41) | 1.59 (1.03–2.47) |
1.17 (0.66–2.04) |
Model 2 |
1.76 (1.03–2.98) |
2.20 (1.19–4.05) |
2.15 (0.78–5.87) |
Model 3 |
1.49 (0.87–2.50) | 1.93 (1.02–3.63) |
1.73 (0.61–4.93) |
Unadjusted Model | 2.29 (1.55–3.40) |
4.19 (2.84–6.19) |
4.19 (2.47–7.10) |
Model 1 |
1.27 (0.84–1.93) | 2.96 (1.93–4.54) |
2.32 (1.35–4.00) |
Model 2 |
1.38 (0.87–2.21) | 3.12 (1.87–5.20) |
2.88 (1.46–5.67) |
Model 3 |
1.06 (0.62–1.79) | 2.78 (1.60–4.83) |
2.19 (1.03–4.62) |
Unadjusted Model | 2.11 (1.41–3.17) |
2.59 (1.74–3.84) |
2.88 (1.72–4.84) |
Model 1 |
1.35 (0.86–2.12) | 1.89 (1.23–2.91) |
1.84 (1.15–3.19) |
Model 2 |
1.59 (0.95–2.65) | 1.86 (1.03–3.37) |
1.39 (0.66–2.96) |
Model 3 |
1.44 (0.85–2.45) | 1.72 (0.92–3.21) | 1.07 (0.46–2.47) |
witnessed, victimised and perpetrated categories are overlapping.
the reference group is all participants who have not witnessed violence in the past 12 months.
the reference group is all participants who have reported no victimisation in the past 12 months.
the reference group is all participants who have not perpetrated violence in the past 12 months.
model adjusted for age and gender.
model adjusted for age, gender, ethnicity, employment, education, household income and migrant status.
model adjusted for all confounders and for the other two categories of violence.
*p<0.05,
**p<0.01,
***p<0.001.
Lifetime drug use was reported by 46.8% of participants in the sample. Amongst individuals reporting ETV, those who have been victimised in the past year reported the highest proportion of lifetime drug use. Although the unadjusted models indicated that proximal ETV was associated with increased odds for lifetime drug use, the adjusted models indicated that this association was solely maintained for victimisation. Drug use in the past 12 months was reported by 18.1% of all participants, with the highest portion being amongst the perpetrated group. Both unadjusted and adjusted models indicated that proximal exposure to victimisation and perpetration was associated with increased odds for past 12 months drug use. The association with witnessed violence was fully attenuated after controlling for socio-demographic factors. Hazardous alcohol use was reported by 17.5% of all participants, with the highest proportion observed in the perpetrated group. Unadjusted odd ratios suggested an association between all ETV categories and hazardous alcohol use. However, the association with witnessing violence was fully attenuated after adjusting for socio-demographic factors. Similarly, adjusting for socioeconomic factors appeared to fully attenuate the association between perpetration and hazardous alcohol use in model 2. For victimisation, adjusting for violence co-occurrence attenuated the association.
We examined the interaction terms for ETV categories and gender on CMD. Our results suggested no interaction for proximal witnessing (p = 0.34, not shown), victimisation (p = 0.48, not shown), and perpetrations (p = 0.94, not shown). On further examination (
Number of ETV types | No ETV |
1 type of ETV | 2 types of ETV | 3 types of ETV | |
n | 604 | 496 | 370 | 204 | |
% (95% CI) | 37.8 (35.20–40.41) | 30.1 (27.74–32.39) | 21.3 (19.24–23.32) | 10.8 (9.34–12.35) | |
Outcome | n | % (95% CI) | % (95% CI) | % (95% CI) | % (95% CI) |
Common Mental Disorder | 396 | 15.4 (12.24–18.63) | 23.8 (19.83–27.83) | 33.4 (28.19–38.65) | 33.7 (26.79–40.69) |
Personality Dysfunction | 241 | 10.9 (0.82–13.52) | 12.9 (9.89–16.05) | 21.9 (17.16–26.56) | 24.3 (17.72–30.94) |
Post Traumatic Stress Disorder | 89 | 1.8 (0.75–2.88) | 4.4 (2.50–6.35) | 8.9 (5.79–12.10) | 14.1 (8.85–19.40) |
Lifetime Drug Use | 864 | 31.7 (27.69–35.78) | 49.5 (44.59–54.37) | 59.7 (54.31–65.18) | 68.5 (61.71–75.39) |
Drug Use in last 12 months | 363 | 10.3 (7.94–12.71) | 17.8 (14.19–21.48) | 25.1 (20.64–29.56) | 33.9 (27.18–40.71) |
Hazardous Alcohol Use | 343 | 12.2 (9.58–14.89) | 16.5 (12.96–20.00) | 24.2 (19.83–28.56) | 26.9 (20.59–33.23) |
No ETV has been used as the reference group.
Number of ETV types | No ETV |
1 type of ETV | 2 types of ETV | 3 types of ETV | |
Outcome | n | OR (95% CI) | OR (95% CI) | OR (95% CI) | OR (95% CI) |
396 | |||||
Unadjusted Model | 1 | 1.71 (1.23–2.38) |
2.75 (1.97–3.83) |
2.79 (1.89–4.12) |
|
Model 1 |
1 | 1.78 (1.28–2.54) |
3.10 (2.29–4.47) |
3.38 (2.25–5.10) |
|
Model 2 |
1 | 1.77 (1.21–2.57) |
3.04 (2.08–4.42) |
2.86 (1.82–4.49) |
|
241 | |||||
Unadjusted Model | 1 | 1.22 (0.84–1.79) | 2.29 (1.56–3.39) |
2.64 (1.68–4.16) |
|
Model 1 |
1 | 1.26 (0.86–1.84) | 2.49 (1.68–3.73) |
3.05 (1.91–4.89) |
|
Model 2 |
1 | 1.41 (0.90–2.19) | 2.93 (1.82–4.70) |
3.81 (2.19–6.61) |
|
89 | |||||
Unadjusted Model | 1 | 2.50 (1.18–5.31) |
5.31 (2.67–10.59) |
8.89 (4.23–18.71) |
|
Model 1 |
1 | 2.61 (1.22–5.56) |
6.08 (3.01–12.26) |
11.22 (5.18–24.32) |
|
Model 2 |
1 | 2.48 (0.96–6.42) | 7.27 (3.07–17.15) |
13.38 (5.13–34.90) |
|
864 | |||||
Unadjusted Model | 1 | 2.11 (1.63–2.73) |
3.19 (2.41–4.23) |
4.69 (3.28–6.71) |
|
Model 1 |
1 | 2.19 (1.69–2.87) |
3.31 (2.48–4.41) |
4.47 (3.10–6.53) |
|
Model 2 |
1 | 2.36 (1.69–3.29) |
2.75 (1.90–3.97) |
4.13 (2.62–6.48) |
|
363 | |||||
Unadjusted Model | 1 | 1.88 (1.33–2.66) |
2.91 (2.08–4.07) |
4.46 (3.04–6.55) |
|
Model 1 |
1 | 1.95 (1.37–2.77) |
2.97 (2.09–4.21) |
4.14 (2.74–6.24) |
|
Model 2 |
1 | 1.71 (1.15–2.53) |
2.53 (1.71–3.74) |
3.59 (2.22–5.83) |
|
343 | |||||
Unadjusted Model | 1 | 1. 42 (0.99–2.00) | 2.29 (1.64–3.19) |
2.64 (1.78–3.92) |
|
Model 1 |
1 | 1.38 (0.97–1.97) | 2.10 (1.49–2.95) |
2.13 (1.41–3.23) |
|
Model 2 |
1 | 1.30 (0.87–1.93) | 1.92 (1.31–2.81) |
1.75 (1.10–2.78) |
model adjusted for age and gender.
model adjusted for age, gender, ethnicity, employment, education, household income and migrant status.
No ETV has been used as the reference group.
*p<0.05,
**p<0.01,
***p<0.001.
Our results are from a study, which provided rich data derived from a densely populated and diverse metropolitan area. The findings indicate violence co-occurrence in both proximal and distal exposure and the presence of some shared correlates across types, suggesting that individuals at risk of one type are at increased risk of experiencing other types of violence. Conversely, there were some distinct patterns of association with mental disorders that persisted after adjusting for potential confounders and the remaining categories of violence. This suggests that certain ETV could be associated with particular constellations of mental health symptoms. Our results further indicate that the impact of violence is long-standing, with the effect on current mental health also evident for distal ETV.
In comparison to previous general population surveys
In contrast with previous research (indicating that victimisation is more common amongst individuals who self-identify with non-white ethnicity
The relationship between ETV and mental disorders emerged as a complex one. Some distinct patterns of association emerged for proximal witnessing and perpetration with CMD and proximal witnessing with PTSD symptoms
Our results further indicate that violence requires to be examined in longitudinal fashion, where ETV prior to the last 12 months could have an independent (of proximal violence) and cumulative effect on some current mental disorders. Although previous research has been limited, existing evidence is consistent with our findings
Lastly, we found no gender effect for proximal ETV and CMD. In clinical populations, gender is known to be an important modifying factor in associations between serious mental illness and both violent victimisation and perpetration
As a result of the cross sectional nature of this study, we are unable to make causal inference with regard to the relationship between ETV and mental disorders. It is possible that some recall bias has occurred in the study as a result of lifetime ETV reports being based on participants' recollection. Despite a satisfactory within household participation rate (71.9%,
Future studies may benefit from a more detailed assessment of ETV. Our questions on violence were part of a wider survey on health, and were not detailed - they did not distinguish between different sub-types of violence (i.e. sexual victimisation), the seriousness of violence, its frequency, its context, or the relationship between victim and perpetrator. It is feasible that the above factors have a distinct, nevertheless an important effect on the prevalence of violence and its relationship with mental disorders. For example, repeat exposure to one type of violence has been associated with internalising mental disorders
Our results highlight the need to examine violence in a multidimensional manner accounting for a diverse range of violence experiences and inclusive of perpetration. Future research would benefit from a more detailed assessment of violence, where ETV is also examined as discrete distal and proximal events and as overlapping dimensions, thus accounting for their cumulative effect. Our findings suggest that there is a complex relationship between ETV and mental disorders in the general population, which warrants further investigation. More specifically, examining the needs of individuals experiencing multiple dimensions of violence and mental disorder could be invaluable in informing service development plans and initiatives to improve assessment and intervention for this group.
Gender interaction with proximal ETV types by mental health outcome.
(DOCX)