To mitigate immortality time bias, Reference Lévesque, Hanley, Kezouh and Suissa19 the same index date was assigned to the corresponding unexposed patient.
PRIM AND SERIOUS CODE
The index date for individuals in the exposed group was taken to be the first inserted Read code relating to IPV exposure once a patient was eligible to take part in the study or, alternatively, the study start date for patients with a previous record of IPV (prevalent cases). During this period, women over the age of 18 years who had documented exposure to IPV, noted through Read codes by their General Practitioner (GP), were deemed to be our exposed group. The study period was set between 1 January 1995 and 1 December 2017. Therefore, we aimed to explore this association by using primary care records derived from The Health Improvement Network (THIN) database. As well as shedding new light on the relationship between IPV and anxiety/SMI, it is also important to quantify the extent of this burden to enable planning of targeted mental health services in the UK for this group at risk. So far there has not been a UK-based cohort study assessing the relationship between IPV and anxiety, depression and SMI.
Reference Pietrzak, Goldstein, Southwick and Grant14 A separate more recent review Reference Khalifeh, Oram, Osborn, Howard and Johnson15 exploring the prevalence of experiencing domestic violence within the past year in groups of patients with severe mental illness, reported a prevalence of domestic violence exposure between 15 and 22%.īecause of the prevalence of IPV, there appears to be an association between mental health burden and exposure to IPV. An alternative review Reference Trevillion, Oram, Feder and Howard12 compiling case–control and cross-sectional data highlighted just one study investigating the relationship between IPV and bipolar disorder, which appear to be linked. Reference Suglia, Duarte and Sandel13 We identified no cohort studies that investigated the relationship between IPV and subsequent diagnosis of serious mental illness (SMI), including schizophrenia, bipolar disorder, mania and other forms of non-affective psychoses. Only one cohort study set in the USA ascertained a positive relationship between IPV and subsequent diagnosis of generalised anxiety disorder. When depression was explored as both a dependent and independent variable, a positive correlation remained. Although there are challenges in discerning the temporality of this relationship, this association appeared to be bidirectional. None of these 13 studies were set in the UK. Reference Reingle Gonzalez, Jetelina, Olague and Wondrack8– Reference Trevillion, Oram, Feder and Howard12 In a recent review of all cohorts exploring the impact of IPV on female survivors' physical and mental health, Reference Bacchus, Ranganathan, Watts and Devries4 13 of these studies explored the relationship between IPV and depression. Reference Delara7 Previous systematic reviews of observational studies have identified associations between being a survivor of IPV with depression, suicide, post-traumatic stress disorder and prenatal depressive symptoms. The pathway that leads to this association is complex, with there likely being biochemical, psychological and environmental risk factors that predispose survivors of abuse to go on to develop poor mental health outcomes.
Reference La Flair, Bradshaw, Storr, Green, Alvanzo and Crum6 There is a strong relationship between being a survivor of IPV and poor mental health outcomes. Reference Black, Basile, Breidling, Smith, Walters and Merrick3, Reference Bacchus, Ranganathan, Watts and Devries4 For example, survivors of IPV undertake more harmful lifestyle choices such as smoking Reference Crane, Hawes and Weinberger5 and excessive alcohol use. Reference Garcia-Moreno, Jansen, Ellsberg, Heise and Watts1, 2 Being a survivor of IPV is associated with a wide range of poor health outcomes. Intimate partner violence (IPV), seen as a violation of human rights, remains a prevalent global public health issue affecting as many as one in three women.
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