What are the health factors associated with domestic violence amongst women victims and the role of public organisations

What are the health factors associated with domestic violence amongst women victims and the role of public organisations?
A review of the literature
631825194945
Keerat Bhogal
1597504
University of Birmingham
School of Social Policy
BA Social Policy (Health and Social Care)
Undergraduate Dissertation
March 2018

Word Count: 9,075
Acknowledgements
I would like to take this opportunity to thank my supervisor Clare Harewood for her generous support, advice and guidance that I needed to complete this dissertation effectively. Your exceptional assistance, comments and feedback have helped me throughout the course of writing this dissertation. Without any of this, I know the completion of this dissertation would not have been achievable.
Abstract
It has been well recognized that domestic violence is a common cause of serious health issues amongst women victims. The main purpose of carrying out this study is to ascertain the manner in which violence can be linked to adverse psychological and physical health outcomes, as well as how the role of public organisations can be supportive in predicting violence in women who are the victims of the abuse. This study offers a methodical approach to conducting the negative factors associated towards violence and women’s psychological and physical health. This is that literature is gathered through written works and measured studies off others, and involves analysing the literature from articles, journals and books. American studies were used in this research and is relevant to shed light on the topic of what health factors women go through with domestic violence. Specifically, themes were identified from the different studies to examine exactly the potential health factors. Identifying themes furthermore involved understanding which studies have ideas that contribute the most to those themes. Moving forward, it is ultimately suggested that domestic violence amongst women is a public health issue, which is leading on to increasingly becoming more of a psychological and physical health phenomenon. From accumulating all the literature, it therefore comes to conclude that domestic violence amongst women victims is in fact a produced health phenomenon. Therefore, there is an increased need for developing services for women victims. Public organisations can take considerable favour in responding effectually towards devising strategies like screening, which could improve domestic violence and health outcomes in women victims. Although, arguably it could be put into debate that a lot more needs to be thought into an organisation to positively support the women.

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Contents
Abbreviations…………………………………………………………………………………

Introduction……………………………………………………………………………………

Methodology…………………………………………………………………………………..

Findings Chapters…………………………………………………………………………….

Psychological Themes……………………………………………………………………

Introduction…………………………………………………………………………………………..

Post- Traumatic Stress Disorder…………………………………………………………….

Depression…………………………………………………………………………………………….

Suicide……………………………………………………………………………………………………

Summary………………………………………………………………………………………………..

Physical Themes………………………………………………………………………………..

Introduction……………………………………………………………………………………………..

Long and short- term health problems…………………………………………………………

Summary…………………………………………………………………………………………………..

Public Organisation Themes………………………………………………………………….

Introduction……………………………………………………………………………………………..

Support and Concerns………………………………………………………………………………..

Screening………………………………………………………………………………………………….

Summary…………………………………………………………………………………………………..

Discussion and Conclusion……………………………………………………………………..

Appendix………………………………………………………………………………………………

Appendix A……………………………………………………………………………………………….
List of Abbreviations
(“DVA”)…………………………………………………………….Domestic Violence Abuse
(“NHS”)…………………………………………………………….National Health Service
(“PTSD”)……………………………………………………………Post Traumatic Stress Disorder
(“NSC”)……………………………………………………………..National Screening Committee
(“WHO”)…………………………………………………………….World Health Organisation
Introduction
The following chapter will provide ideas that will focus strongly upon what will be considered in this dissertation in helping to answer the following question of study, “what are the health factors associated with domestic violence amongst women victims and the role of public organisations.” This chapter will seek to draw attention to domestic violence as a public health phenomenon, specifically drawing awareness towards women. Reflection will also extensively be demonstrated on what will be included in each of the chapters, which will then follow on from why domestic violence and women’s health impacts were both of importance to study for this dissertation.
It has been well established that domestic violence is a serious threat for many women who are huge victims of abuse. Various researchers similarly have been able to draw attention towards violence being a serious threat, yet also more extensively, recognise it as being a vital public health concern. The United Nations is one example that contributed to a rational understanding, providing that it is likely to result in, physical, sexual or mental harm or suffering to women, including threats of such acts, as well as coercion or arbitrary deprivation of liberty (The United Nations, 1993). In addition to this, it is worth considering that due to the reasoning of threats, domestic violence is becoming not just a produced phenomenon, but rather increasingly more of a public health concern, that may give rise to both psychological and physical health consequences (Stewart and Robinson, 1998). Additionally, there were studies that applied amongst domestic violence and women victims in depression, post- traumatic stress disorder, suicidal ideation and long and short-term health problems, that all formed as themes in the findings chapter. It is hoped that this present study furthermore, will settle to provide insights into acknowledging these common themes, yet also seek to understand specifically that women suffer from more long-term health problems caused by domestic violence (Alejo, 2014). In addition, to further symptoms that may be drawn from the themes that will be discussed in the findings chapter.
As noted, domestic violence is a prominent public health problem, thus involves further consideration and study to convey exactly what the health factors are of women victims who go through violence from an abusive spouse. According to Domestic Violence UK (2018), it is escalated that violence against women can reach truly life- threatening levels. In addition, it is worth noting that because of the violence and its effects, it can cause women to suffer from clinical depression and anxiety (Domestic Violence UK, 2018). Interestingly, the concept of health in violence lies as a chief focus in this study. This is primarily due to the reasoning behind domestic violence being an immense health factor in women victims, which is leading on to being highly problematic today. It is with these ranges of health factors in mind however, which firstly makes it an interesting area of study and secondly, helps to integrate both the psychological and physical factors, in order of acquiring more of an insight into understanding the phenomenology of health problems and violence towards women victims.

Domestic violence and women’s health are both very important subjects to study, one reason being due to the extensive amounts of literature that highlight the challenges that women face; however what is interesting is that the challenges that are faced almost every day by women, makes it difficult to ascertain exactly whether this phenomenon of violence will gradually come to an end, particularly due to how domestic violence has been both hidden and ignored, yet not treated with the seriousness it deserves (White Ribbon Scotland, 2018). It can be argued therefore that public organisations can provide responsibility towards devising strategies, and support women victims who have experienced such abuse and health related problems. Interestingly, this study will seek to identify a clear relationship that public health organisations can have in improving women’s psychological and physical health, when being the victims of domestic violence. What is more, the ideation towards both support and concerns and screening, will be reflected on as key themes in the findings chapter, that will seek to identify exactly different services that are available in devising suitable domestic violence and health related preventative strategies. It is interesting to bear in mind that it is with a wide range of health factors in mind furthermore, that the present study will help to integrate these health factors with public health organisations, promoting both health and well-being. It is also that this study will additionally take the position that domestic violence is fundamentally a public health issue that will require for public organisations to respond to women’s health in an adaptable way. Despite public organisations already working its way around women who have been in domestic violence and ill health, it remains as an importance to ensure that a lot more work is done to integrate both the psychological and physical factors that show through domestic violence. It can be argued for example that health professionals for instance, need to push their restrictions even further, to guarantee that outcomes are successfully achieved. This lies in with the common fact that domestic violence and ill-health are still leading problems for women victims today.
Furthermore, there is an increasing need for this chapter to introduce the structure for this dissertation, ideally to reflect on what each section of the dissertation will exhibit, leading on from the introductory chapter. The methodology chapter firstly, will emphasize the chosen research methods that were used when obtaining the literature. It then follows that when literature was obtained, themes were identified to help structure the findings chapters of the dissertation. These themes further form to specifically answer the question of study, which involves around understanding the psychological and physical health impacts and the role of public organisations. Finally, moving on from the findings chapters, a discussion and conclusion will seek to justify the overall impacts on health in women, along with future directions that will reflect upon ideas or methods that could be done differently if another student or anyone was to carry out the same study. A review of the strengths and weaknesses will further engage upon what was done well when doing this study and was not done so well.
In summary, it is imperative to note before closing this chapter that the reason for wanting this current study to focus upon domestic violence and women’s health impacts was purely for the purpose of engagement across depression, post-traumatic stress disorder, suicide and short and long-term health problems. As well, it is empirically the tensions of violence that were drawn, that are continuing to grow today, that influenced the notion of thought amongst the question of study being based on the phenomenology of domestic violence and health factors, involving both psychological and physical health factors.

Methodology
The current review conforms to the specified guidelines for performing a literature review. This study specifically includes studies and articles published in English, abiding to the following criteria; (a) publications of original data presenting the risk factors for domestic violence in women (b) works that have been published between 1961 and 2018 (c) studies conducted within the United Kingdom, and relevant, generic American studies which draw light to the topic, and finally (d) publications that highlight focus on public organisations and professionals who support a women victims health.
The research questions were incorporated within this dissertation as a guide direction that will effectively help direct the literature data and searches. The following research questions were included that helped to prompt both the research and data results effectively; (a) what are the psychological health impacts of domestic violence upon women victims? (b) What are the physical health impacts of domestic violence upon women victims? (c) How supportive is the role of public organisations towards women who have experienced domestic violence and how does screening play a part to improve an organisation? A strength that was found in relation to systematically conducting literature reviews, when addressing the nature of the research questions, is that you are able to consider the research questions and topics in more depth, which allows you to consider the strengths and weaknesses. Careful consideration therefore was accredited to the research questions, ensuring that the main focus is towards the psychological and physical aspects of women’s health, in relation to Domestic Violence and the in-depth research towards the public organisation as well.

There is no method of research that is appropriate in every case (Flick, 2006). This methodology chapter will therefore, as an alternative, discuss the foundation, justification and motivation for carrying out a literature-based research study for the research title and the three research questions at hand. Additionally, this chapter will elaborate on the orderly and systemised methods that were used to help influence the key findings for this dissertation.
Literature research is advantageous in helping to prevent the incidence of ethical issues, which would arise due to the involvement of human participants (Bryman, 2012). As a result of this, ethical approval has been approved for this research (Appendix A).
Moreover, being highly driven towards the research process of a literature review for this dissertation also involved the similarity between the steps for conducting a literature review and the steps for conducting primary research, both qualitative and quantitative (Randolph, 2009). Doing a literature review would further help to define, summarise, evaluate and elucidate famous works that have been studied from either the past, the present and today. The methods that were used to help get hold of the relevant studies, journals, articles and books will be explained.
A structured approach was adopted, to help consider and finalise the source of relevant materials up for study. Following from this, preliminary sources, such as databases, within the folders were provided with main preference. The data was slowly reduced to controllable amounts to make the review and literature searches a lot more feasible and adaptable. For seeking relevant articles for study, key search terms were the main common aspect. Attention was therefore paid when it came to focus predominantly on the searched terms, to divulge into the databases that are both needed and necessary for study and maximise the results when needed to. A full table of searched terms can be found, see (Appendix B). The searched databases that were the most commonly used comprised of the following: PubMed, PsycInfo, JournalSeek, GoogleScholar and [email protected] and Routeledge.
Table 1: Searched terms
Searched Terms
Women and Domestic Violence
Women and Psychological Health Domestic Violence
Women and Physical Health Domestic Violence
Women, Domestic Violence and Suicide
Women, Domestic Violence and Depression
Women, Domestic Violence and PTSD
Women, Domestic Violence and Short and Long-Term Health
Women, Domestic Violence and Charitable Organisations
Women, Domestic Violence and Public Organisations
Table 1 displays the key terms that were searched on the following engines: PubMed, PsycInfo, JournalSeek, GoogleScholar, [email protected] and Routeledge.
The procedure for selecting inclusive studies for literature review, is what was purely based on relevance and significance to the research topic, however, is complex with several stages (Meline, 2006). Debatably, the most vital and maybe the most ignored part of determining studies that should be included, is the course of assimilating research on one certain topic. Additionally, it is an argumentative, including contrasting schools of thought to criticise study selection (Meline, 2006). An inclusion and exclusion criteria will therefore be vital, as it controls the possibility, legitimacy and validity of the literature review key findings.
Fig 1: Flowchart of the identified studies that were used in the literature review
220 articles identified through search in the data base
63 articles were excluded by title
140 articles remained after duplicates were removed
47 articles were examined
30 articles were excluded by abstract
34 full-text articles were excluded due to not meeting inclusion criteria
40 articles were included in the literature review

Studies will only be included if they report either primary outcomes of interest which include; (a) psychological health impacts of domestic violence upon women victims (b) physical health impacts of domestic violence upon women victims (c) the role and support of public organisations towards women who have experienced domestic violence and health related problems. Topic criteria will also correlate with abused women at risk, stigma associated towards visiting health care organisations and the psychological and physical health factors implicated in domestic violence and women victims.

The flowchart that is exhibited above, shows that out of the 220 studies that were identified through the databases (PubMed, PsycInfo, JournalSeek, GoogleScholar and [email protected]), 140 studies were included after duplicates were removed. An example of this would be removing Bowen et al, (2005), from the category as his research mirrored that of Bacchus, Mezey and Bewley, (2003). From these 140 studies, 63 were excluded due to the title. For example, Koenig et al, (2003) study titled “Women’s Status and Domestic Violence in Rural Bangladesh: Individual and Community Level Effects.” This study was excluded by title as it did not meet the theme requirements since the study was directed towards women in Bangladesh, whereas the study at hand is based towards women victims. Moreover, the study focuses on the status of women, which is a theme that is not being studied, therefore was excluded from the criteria. A total of 30 articles were also excluded due to the abstract, for example, if the abstract specified the study participants to be males, etc then it would not be included in the study. Following from this amount, 47 full text articles were examined, and 34 full text articles were excluded due to not meeting the inclusion criteria highlighted above. Finally, 38 studies were included in the literature review.

Deciding to do a literature review for this dissertation, has helped lead on too many ways of analysing and criticizing articles and works off others. It was further a virtuous way of looking into domestic violence and women’s health impacts and identifying the key gaps in the literature, that would further help understand where public organisations will be in terms of support in the next few years, and how far screening will go to help support domestic violence rates.
Findings Chapters
Psychological themes
Introduction
Specifically, this chapter will seek to explore the psychological effects of domestic violence and how this can result in mental ill health, focusing specifically on three themes. Firstly, how victims of domestic violence suffer Post-Traumatic Stress Disorder (PTSD), which can prevent their daily ability to function at a normal level. Secondly, how women who have endured domestic violence experience depression and anxiety and finally, how women who have experienced domestic violence have suicidal ideation and eventually want to commit suicide. These themes will be discussed in relation to the control of public organisations.
Post-Traumatic Stress Disorder
There is a direct link between domestic violence and heightened symptoms of post traumatic stress disorder (Cathy and Ravi, 2003). Significant patterns emerge with PTSD and a woman who is a victim of domestic violence, as enduring a length of abuse can lead to such a disorder. It was by Arias and Pape, (1999) found that a staggering 88% of women victims suffer from PTSD, and in a recent survey it was also found that 12.6% screen positive for PTSD, with areas such as violence and abuse being the contributing factor (McManus & NHS Digital 2016). There are several symptoms that a women victim can experience when she has suffered domestic abuse, and such symptoms can even begin a shocking 20 years, even after an abuse has ended. In such cases, a noted percentage of women victims will suffer such symptoms of trauma (Albucher and Liberzon, 2002). It is staggering to highlight from this, that these symptoms of trauma could result in emotional and psychological ill health. Further emotional and psychological symptoms would explore a heavy stress load, had already suffered from a series of losses, or had been traumatized, that is if only feelings were kept isolated (HELPGUIDE.ORG, n.d). One could potentially understand that having these psychological symptoms will be traumatic for women who are the victims of domestic violence. Another could further advocate strategies and support from an organisation, that could all help to make that difference in improving health overall.
We can draw a clear comparison of the factors that domestic violence has on such women, by looking into a particular research that has been carried out of the psychological abuse on women. In an example study, many battered women who had experienced physical domestic violence were examined alongside non-battered women who were not victims of physical abuse (Kemp, Green, Hovanitz and Rawlings, 1995). This is an example of an American study and is of importance to this area of domestic violence and women’s health impacts. Furthermore, the results were compared amongst the two groups and it was found that those women who had PTSD had also experienced physical, sexual and verbal abuse, injuries and a high sense of threat compared to the group of women who did not experience PTSD
To help understand this psychological health impact that domestic violence has on women, it is also important to note that domestic violence does not solely mean physical abuse. A woman can also be affected psychologically by verbal abuse too, which can lead to PTSD. Relating to the same study, (Kemp, Green, Hovanitz and Rawlings, 1995) examined that 81 percent of physically abused women met the criteria for PTSD, but close by, 63 percent of verbally abused women met the standard diagnosis too.
In assessing the impact of PTSD on women, it is vital to also consider the diagnosis, especially when a woman has experienced both physical and verbal abuse. Although diagnosis, treatment and support are made available, and there is evidence to support that many women recover from PTSD, it is shocking to know a woman who seeks support from DVA services, have high level experiences of abuse, depression, anxiety and especially PTSD (Ferrari, 2014). One could potentially argue that the occurrence of these health factors, can indeed cause women to go through such symptoms for many years, even after the abusive relationship has ended, which could result in organisations seeking to support. Another could also take that the co-occurrence of PTSD can be a risk factor for very long-term issues and problems (Freedman et al, 1999) and is something where a woman would experience adverse chronic health effects and symptoms.
Such symptoms will also have a large effect on a women’s function of daily life (Freedman et al, 1999) and this is something that one will have to adjust to. Support and help however is provided towards PTSD, and where on some occasions it can be such a lengthy recovery, that it will prevent a normal life in many ways. The experiences that a woman will encounter have been previously defined in a study as ‘intimate terrorism’ (Johnson and Ferraro, 2000). This American study was used in this research to draw light towards how a women’s daily life worsens, the more she experiences such things. The study explained where men attempted to eradicate the women’s sense of self and create a ‘puppet women’ subject to their authority (Johnson and Ferraro, 2000). It was argued that some women even described not being able to go to the toilet by themselves or the humiliation of sexual control. Such daily living with second nature to an ordinary woman was then restricted or denied with a woman victim of abuse, and the study found that the impact of domestic violence and PTSD meant that a woman will be prevented from living her daily normal life, and this is even the case when the abusive relationship has ended (Johnson and Ferraro, 2000).

The evidence in relation to domestic violence and PTSD is so compelling in studies and research, where (Golding, 1999) argues that a causal relationship is present between PTSD and a woman victim of domestic abuse. Alongside this however, very little research has considered the effects of adult abuse on women’s psychological health in the United Kingdom (Cathy and Ravi, 2003), thus little knowledge is understood about the effects of PTSD on women’s health. To some extent, the small quantity of the United Kingdom knowledge base in domestic violence and mental health produces genuine concerns from women activists, campaigners and researchers that domestic violence will become medicalised and depoliticised, only if attention turns away, and such mental health problems are not considered (Mullender, 1996). Likewise, high rates in PTSD is so closely linked to domestic violence and women victims, that further UK research should therefore be carried out which concerns both psychological and physical health factors.
This factor of psychological health and PTSD is a very huge consequence of a women who suffers from domestic abuse, and an extremely long term unfortunate impact that a woman will undergo during and after her abusive relationship. This is purely driven by the biggest impact being the long duration that PTSD will have on a women’s everyday life. This suggests that PTSD and domestic violence are both strongly linked and that its effects are far reaching. Because of this, it remains focussed that there is a need for greater public health prevention, involvement, identification, and medical treatment of domestic violence and PTSD (Jones, Hughes, Unterstaller, 2001).
Depression
A further psychological health impact that will affect a woman who experiences domestic violence is depression. Depression is the most common symptom of domestic violence and is the trigger for what will later lead to PTSD. It is arguably also the most prevalent negative mental health consequence of domestic violence (Dienemann et al, 2009). This clearly shows the extent, to which depression is common towards women victims of violence, and where links to symptoms such as PTSD can start to exhibit closely.
Additionally, according to a well-known national domestic violence helpline (Women’s Aid, 2015), domestic violence can have an enormous effect on a women’s psychological health and is the main factor in the development of depression. A woman who is a victim of domestic violence can experience health symptoms such as sleep disturbances, self-harm, attempted suicide, successful suicide, eating disorders and substance misuse (Women’s Aid, 2015).
Once again, this psychological health concern has a substantial amount of compelling evidence to suggest that depression and domestic violence between women are very closely linked. Campbell et al., (1995) and Golding (1999) are two very significant researchers, who show how women that have experienced domestic violence will suffer from symptoms of depression, and shed some light on the critical role that depression plays on a woman who experiences domestic violence. Respectively, this American study is of importance to this area of domestic violence in women victims, as it correlates a percentage rate of women who have endured depressive symptoms, which would be of relevance for this study. It was found out that fourteen and seventeen studies examined the link between women who undergo domestic abuse and depression (Campbell et al., (1995) and Golding (1999). The study identified that a 47.6 percent rate of abused women had depression Golding, (1999). In comparison to this, it was found that a staggering rate of 83% of women victims had mild depression. In contrast to a study by Mooney (1993) in London, it was reported that 46 percent of women stated they were depressed. Balancing out the statistics, both 47.6 and 46 percent are very close figures. The study carried out by Mooney, (1993) suggests the element of trust and how a reason why depression is such a common symptom is because a woman is receiving abuse from a person and environment that she is supposedly meant to trust.
Back et al (1982) is a well analysed studier in drawing a comparison between women who have experienced domestic violence and those who have not. In the study, a group of women psychiatric patients were assessed. It was found that almost double the percent of depression (32 percent) was found in women who had experienced domestic violence compared to those who had not. This can also similarly relate to the study by McCauley et al (1995), which is also another piece of literature that will clearly portray the link between depression and domestic abuse with women. Equally in this study, a similar research was carried out where a group of 103 abused women were assessed next to a group of women who had not been exposed to domestic violence before. It was found that a very high 69.9 percent of women who had been abused within the past year, had a very high depression score, which compared to a lower 31.9 percent of non-abused women (McCauley et al, 1995). Therefore, it is clearly visible that the rate for depression, caused from violence is very high, and can cause complications for women to lose out on daily life. It can furthermore be supposed that difficulties can occur for treatment of medical symptoms like depression, if the boundary remains statistically high.
Bacchus, Mezey and Bewley (2003) were further studiers to examine the impact of how women who have endured domestic violence will suffer from depression. This study was carried out amongst women who had experienced domestic abuse in the home. The results showed that women scored very highly on measures of both depression and anxiety. With depression being the most common symptom for domestic abuse, it is interesting to analyse the diagnosis and medication from this study. From the results, only six women described being diagnosed with a depressive illness by a General Practitioner and from these six participants, five were prescribed antidepressants and four had received counselling alongside the antidepressant medication (Bacchus, Mezey and Bewley, 2003). A mutual view was that the anti-depressant medication was not going to solve their difficulties and issues, therefore two out of the six did not take their antidepressants due to the worry of them being addicted and dependant on the drug (Bacchus, Mezey and Bewley, 2003). As a result, with depression being such a common symptom and well-known effect of domestic abuse in women, it is surprising to see the diagnosis of this mental health issue. There is therefore room for improvement of the way GP’s can come to support and respond to such healthcare.
The experiences which a women victim who is depressed will face due to domestic abuse, goes beyond the scope of general symptoms but, depression will also influence their standard of living (Kurtz, 1989). An abused woman will lose her self-esteem, livelihood, and will have to do measures such as moving jobs and house frequently to avoid disclosure (Kurtz, 1989). This depression will change her daily life, and this is the initial beginning to PTSD. So, even when the abusive relationship has ended, post-traumatic symptoms will continue on to grow regardless. This therefore takes the paramount and recurrent symptom of psychological health impacts that domestic violence has on women, considerably how being in a lethal relationship can emotionally cause detachment and a fear of betrayal and disloyalty, which could all result in depressive symptoms and PTSD.

Suicide
A further psychological area which will have an impact on an abused woman is suicide ideation and suicide attempts. Shockingly, domestic violence is the reason behind female suicide attempts in up to one quarter of women population (Criminal Research Justice, n.d.). Statistics have revealed that female victims of domestic violence are at risk of suicide than the overall population. Ultimately, 50 percent of women who have experienced physical domestic abuse have commenced in following or succeeding attempts (Criminal Research Justice, n.d.). This research is a clear indication of the way in which domestic abuse will cause the suicidal thoughts and attempts of a woman victim.
There is key research that has been undertaken which links domestic violence with suicide in women and has provided an overview of thirteen studies of suicide and domestic violence (Golding, 1999). It was found in the studies that there was a staggering rate of 17.9 percent of women who attempted suicide, among those who had been victims of intimate partner violence. In hospital wards furthermore, suicide was shown at a rate of 43 percent (Carmen et al, 1984), and with refugees this was 33 percent (West et al, 1990). These rates consequently help to portray that suicide is highly common amongst women and further provides challenges for public organisations to respond actively.
A key case which interviewed women who had been victims of domestic abuse was further studied by Cascardi et al (1991). In the study, many of the women spoke about feeling trapped and caged by the abuser’s strategies and control, and in relation to this it was argued that this is a form of entrapment that will direct a woman to suicide (Stark and Flitcraft, 1995). It is very interesting to analyse just how much of a problem suicide was at the forefront of many of these women’s minds in the interview. This goes to show exactly that suicide is a psychological effect of domestic violence, purely driven by the feeling of women being “trapped and caged,” which can cause feelings of depression and distress (Stark and Flitcraft, 1995).

Devries et al, (2011) is a further researcher, who brought together the relationship between domestic violence and suicide amongst women. Here, data was gained from the World Health Organisation (WHO) and the main focus of the study was on women’s health and domestic violence against women, to then look at the attempt of suicide, mental health status and a variety of other health variables. Results show how an occurrence of lifetime suicide attempts; lifetime suicidal ideation and thoughts were linked to domestic violence between these females (Devries et al, 2011). Interestingly yet not surprisingly, the results suggested that the most constant risk factors for suicide attempts were linked to intimate partner domestic violence at the forefront, non-partner physical violence, relationship separation and divorce (Devries et al, 2011). The fact that the highest proportion of suicide attempts resulted from women who had previously experienced domestic violence suggests that mental health policies and organisations need to mainly recognise the ongoing relationship between violence and suicidality amongst women. Additionally, training needs to be provided to health care practitioners to recognise and respond to the physical and psychological results of violence, which may limit the health problem connected to suicidal behaviour (Devries et al, 2011).

Canetto and Lester et al, (1998) had a very interesting yet shocking summary on domestic violence towards women. The authors brought forward views that cultural ideas and perceptions of gender and suicidal behaviours are mainly exposed in language and theory. Within modern, present-day westernised cultures, suicidal women and suicidal men are both understood to have opposite views when looking at rates, types, methods, precipitants and motives of suicidal behaviour (Canetto and Lester et al, 1998). This is a key opposition to the views stated in the case where suicide is widely connected to domestic violence, as in this research we have a different opinion of how women are less disposed to suicide and ideation related to it.
There is also a very huge flaw within this psychological impact which needs further improvement. This is the fact that there is currently no ‘liability for suicide’ law under where an abuser can be prosecuted for the suicide of their victim (Suicide Act 1961). This is something which needs a reform as domestic abuse is satisfied under the abuser in ‘doing an act which assists the suicide of another person’. If this cause is satisfied, then the abuser should be liable for this. Every day, a statistic of 30 women commit suicide because of domestic violence and every week, 3 women take their own lives to escape this abuse (Refuge Organisation UK, 2017). These statistics are very elevated, and an abuser should hold some responsibility as they are the factual causation of the abuse.
Summary
In summary, psychological health impacts that a woman will go through are PTSD, depression and suicide. There is an increasing amount of evidence and statistics which have risen regarding domestic violence and these psychological issues in women. This shows that it is an increasing concern, and something should be therefore done about it. If perhaps depression is diagnosed and treated efficiently by public organisations, then PTSD can be decreased, and if both are effectively taken to action by services and organisations, then there is a higher chance that suicide amongst women can be avoided altogether. Once the initial issue of psychological health problems is addressed competently and in a timely manner, then these common issues which lead to suicide as well as this cycle can be broken. Similarly, if once these psychological health problems can be addressed knowledgably, then this can result in fewer statistics towards depression and PSTD, as seen currently in literature and studies by (Golding, 1999) and Campbell et al., (1995), the results are both compelling and unpredicted.
Physical Themes
Introduction
The following chapter will entail to provide detail on the physical health effects of domestic violence within intimate relationships towards women, which will draw it’s focus predominantly on the core theme for physical ill-health and that is long and short-term physical health problems. The health effects of physical abuse can be both acute and extensive, and its long- term effect may be drastic. It is therefore important to address this in the dissertation and that these physical health effects should not be underestimated by health care providers and professionals.
Long Term and Short-Term Health Problems
Safe Lives, a funded domestic violence charity, have statistically provided the physical health impacts of domestic abuse, suggesting that one in ten victims at medium risk are reported to attend Accident and Emergency due to sustained injuries for over a year before seeking any help (Save Lives, 2015). Moreover, nearly a quarter of victims who were at high risk because of physical domestic violence, had attended Accident and Emergency prior to getting effective help. Furthermore, regardless of the short-term injuries, women of domestic violence endure long term physical health consequences as well. These health conditions, which are associated with abuse, include respiratory problems, such as asthma, bladder and kidney Infections, cardiovascular diseases, fibromyalgia, chronic pain syndromes, irritable bowel syndrome, central nervous system disorders, migraines and headaches (Black, 2011; Crofford, 2007; Lesserman and Drossman, 2007).
Campbell et al, (2002) provided background knowledge on research into intimate partner violence and physical health consequences. The researchers selected a range of physical health problems, comparing between a sample of abused women subjects and women subjects who had no experience of abuse, who equally had access to similar health care. Within this study, The Abuse Assessment Screen and the oldest domestic violence tool, categorised women who were physically and/or sexually abused and this gave a result of 210 cases (Campbell et al, 2002). Overall, domestically abused women had a high number of headaches, back pain, sexually transmitted diseases, infections, vaginal bleeding, vaginal infections, pelvic pains, painful intercourse, urinary tract infections, appetite loss, abdominal pain and digestive problems. These issues, without being treated can and will result in chronic health problems (Campbell et al, 2002), and consequently lead to very long-term health problems. It is also important to note furthermore, that domestically abused women have a 50%-70% rate of gynaecological, central nervous system and stress-related problems (Campbell et al, 2002). These results further acknowledge the notion that gynaecological, central nervous system and stress- related problems are all extremely high in levels of physical DV, thus this study currently provides us with the view that anything above 50,% is valued for support, whereas anything under could of actually been worse, although it’s still an issue.
Regardless of the rising evidence from past research that domestic violence has long-term negative health consequences for survivors, this can result in routine screening and empathy towards health care practitioners and more research is needed in this sector. Nevertheless, the evidence proving that domestic violence has long-term negative health consequences for women survivors, even after the abuse has ended, can also elaborate towards low health status, low quality of life and high use of health care services.
Furthermore, it is thus important that training and analysis are reformed or improved to work, ensuring that the long or short-term health problems are addressed accordingly. Calibration, standardisation and adjustment are very important in a research field, where even an individual interviewer effects have a thoughtful effect on the level of revelation (Ellesberg, 2001). Supposedly, Ellesberg, (2001) point, could predominantly argue the case that calibration, standardisation and adjustment can be applied towards an organisation, ensuring that domestic violence and policy has been approved, through the process of making it conform to the best standard. It is further suggested, with reference to physical health, that woman who did not know whether their partners had histories of physical abuse and long-term health problems were likewise at a higher risk of domestic abuse towards an intimate woman partner in comparison to individuals who reported that their partners did not have these experiences (Abramsky et al, 2011).

Additionally, occurrences of domestic violence have been similarly related with past year intimate partner domestic violence, with a past of childhood sexual abuse of the woman, childhood beatings of her partner, or both constantly linked to high risk of intimate partner domestic violence, in comparison to no reports of abuse by either partner (15/15 sites for partners, all significant; 13/15 for women and both, 10 significant) (Abramsky et al, 2011). Interestingly, conclusions and results suggested that those women in relationships, where equally herself and her partner, were abused in childhood are at the highest risk of intimate partner domestic violence (Abramsky et al, 2011).

In summary, long-term and short-term problems are common amongst women who undergo domestic abuse. This can be physical injuries which are short-term but also long-term physical consequences on the health of a woman. Psychological health effects can be more difficult to treat in comparison to physical health effects, such as injuries to the face. Nevertheless, physical injuries may result in medical difficulties as the women grows older, so you can never determine if a physical health impact will be long or short term, even with recovery, scarring or long-term pain, it can always be a problem.

Public Organisation Themes
The indicated chapter will pursue to discover the methods and approaches that public organisations use to resolve the issues of domestic violence, and help support women victims that have experienced the effects, focusing specifically on two key areas. Firstly, how public organisations support women and resolve their concerns and secondly, the vitality of how screening can help recognise and improve domestic violence outcomes. These areas will then further be debated in relation to the power of public organisations.

Support and Concerns
Heretofore, what is already known on the topic of depression and domestic violence amongst women is that domestic violence is linked to psychological ill health (Bradley et al, 2002). Additionally, our knowledge has driven towards the fact that within community surveys, one in four women have experienced domestic violence and subsequently, health care practitioners will rarely ask about domestic violence, due to the hidden nature and that it is not obviously recognised in women who have significant proving injuries of domestic violence (Bradley et al, 2002). To prove this point, an anonymous survey was conducted by Bradley et al (2002) which aimed to observe exposure to violence by a partner or spouse amongst women attending a general practice and the link with participant’s demographic and personal traits. It was found in the results of the survey that only 46% of women who were victims of domestic violence reported that their doctor asked them about this. This survey was important to draw the conclusion of how public organisations do in fact support women, but there is room for improvement of the support that they give. A supportive organisation should have a percentage higher than 46%. The survey also revealed that a woman was 32 times more likely to be afraid if they did not report such violence to the organisation or doctor. However, a woman who is a victim of domestic violence should feel comfort in the organisation to disclose. We have a flaw with the role of organisations when we look at support, as not only does a doctor withhold from asking about the domestic violence, but when we look at the survey by Mooney, (1993) we can see that only a mere 17% of women informed their general practitioner regarding this. It is important to draw a comparison to accurately see if domestic violence would ever be avoided or go unnoticed by an organisation. These two surveys show us the bar on the support that a doctor can show, and a public organisation can occasionally only ever be supportive to a certain point, which can be a common area of concern.
Interestingly, Bradley et al (2002) aimed to look at the exposure towards violence with a woman partner or spouse and the link towards demographics, personal characteristics, the frequency of domestic violence reported to general practitioners and the women’s views on regular questioning in relation to domestic violence by general practitioners. Bradley et al (2002) conducted a survey involving 22 Irish General Practitioners. To conclude, of the 1692 women who previously had a sexual relationship, 651 had experienced violent behaviour by a partner, 46% of the women had been injured, and 20% of them reported that their doctor had asked about domestic violence (Bradley et al, 2002). This is very interesting to draw together the low percentage of due-diligence that takes place within an organisation or doctor’s practice. Very little doctors asked about domestic violence, even when the woman participant was injured with a long-term physical health issue. From the study we can also analyse that 77% were in favour of routine inquiry about domestic violence by their usual general practitioner. This is also a very vital statistic as it shows that a victim of domestic abuse agreed to have a routine enquiry. This statistic was also the highest percentage in the study, which clearly suggests the outcome that the woman wants that will help support her.
Screening
Ramsay et al (2002) aimed to assess the results that were found for the suitability and effectiveness of screening women who have endured domestic violence, keeping in mind the heath care setting. Ramsay et al (2002) used a systematic review of published quantitative studies and the search strategy included a total of three electronic databases – (Medline, Embase and finally CINAHL). Overall, 43-85% of women participants initiated that screening in the health care setting is acceptable. Survey results by health of professionals found two thirds of health care professionals and almost a half of emergency staff not in favour of screening. Most of the studies distinguished a very high number of abused women identified by healthcare professionals. A total of 6 studies relating to interventions gave inconsistent results based on weak study designs (Ramsay et al, 2002). There is a minute amount of evidence that suggest vital changes in outcomes, for example, low exposure to domestic violence (Ramsay et al, 2002). Screening was very suitable to determine the effectiveness in this case. The fact that healthcare profession was not in favour, and that it gave weak inconsistent results shows that this form needs updating.

On the other hand, this can be compared to Fader et al, (2009), where the survey reported findings from two objectives, which involved: (1) identifying, appraising and synthesising research in relevance to the selected UK National Screening Committee (NSC) standards for a screening agenda in relation to domestic violence; (2) to look at whether present evidence achieves the criteria for the selected UK National Screening Committee (NCS) in regards to screening for domestic violence in within health care settings (Fader et al, 2009).
Fader et al., (2009) found that a lifetime occurrence of romantic partner violence towards female victims in the United Kingdom increased from 13% to 31% in addition to clinical populations, which was 13% to 35%. The 1-year occurrence reached from 4.2% to 6% in the general population suggesting that partner domestic violence against women is a major public health problem and as a result suitable for screening and overall intervention. This case is a good example in opposition of Ramsey et al., (2002) as here screening was the most effective form for an organisation to determine violence against women in the general population.
The HITS (Hurts, Insults, Threatens and Screams) scale that was introduced in the study by (Sherin, 1998) was favourable out of a number of short screening tools for use in health-care settings. Many women patients considered screening acceptable (range 35–99%), yet they recognised potential harms. The evidence for effectiveness of advocacy is growing, and psychological interventions may be effective, but not necessarily for women identified through screening. No trials of screening programmes measured morbidity and mortality. The acceptability of partner violence screening among health-care professionals ranged from 15% to 95%, and the NSC criterion was not mentioned.
At present there is no evidence that implements a screening programme for domestic violence against women either in health services most commonly or in specific clinical settings. Within this study, recommendations for further research involve the use of: trials of system-level interventions and of psychological and advocacy interventions; trials to test theoretically explicit interventions to help understand what works for whom, when and in what contexts; qualitative studies exploring what women want from interventions; cohort studies measuring risk factors, resilience factors and the lifetime trajectory of partner violence; and longitudinal studies measuring the long-term prognosis for survivors of partner violence (Fader et al, 2009).

In summary, pubic organisations support women and address their concerns when it comes to domestic violence, however there is room for improvement and studies show that the statistics are too low on some occasions when it comes to an effective approach to domestic violence, especially amongst GPs (Bradley et al, 2002). However, public organisations have used screening for domestic violence in women and this is a positive efficient way to get good uptake of referrals in an organisation of domestic violence support. Although some healthcare professions are not in favour of this, (Fader et al, 2009), it is still the most ideal option for a woman who is experiencing domestic abuse. The screening can be written or oral and a variety of options are available to see what is most comfortable for the victim. This is also an effective way for a system to generate statistics on abuse for women so that organisations are aware of the facts.

Conclusion and Discussion
The present review was aimed at shedding some light regarding the risks associated with domestic violence towards women victims focusing on both the psychological and physical health factors and the role of public organisations in relation to these health factors. The substantial risk and negative health factors associated with domestic violence towards women indicates the influence in shaping both policy and practice. A considerable amount of research concerning domestic violence towards women focuses merely on the identification of risk factors and the long-term effects that vulnerable women can experience. Such studies take an epidemiological interpretation by focusing primarily on the psychological and physical health effects towards women who had experienced domestic violence. Interestingly, there seemed to be more research based on psychological health factors related to domestic violence towards women victims in comparison to the physical health factors related to domestic violence towards women victims (Kemp, Green, Hovanitz and Rawlings, 1995).
The present review comprised of both qualitative and quantitative studies that were included in the key findings chapter. The strengths and weaknesses of including both qualitative and quantitative studies based on the topic of health factors associated with domestic violence amongst women victims and the role of public organisations will be discussed. Qualitative methods can be advantageous as it allows researchers to look at the root of precise issues based on real life experiences, perceptions, insights and beliefs permitting a clearer picture to emerge, which will overall result in an understanding of the health factors associated with domestic violence amongst women victims. Statistical quantitative research on the other hand can be deemed as unreliable due to interpersonal and cultural factors, hence why there are inconsistent patterns and trends amongst epidemiological studies based on the psychological and physical health factors related to domestic violence towards women victims. This literature review concentrated on both qualitative and quantitative studies as means of obtaining rich data regarding the psychological and physical health factors related to domestic violence towards women and the experiences that women have endured. Therefore, for the purpose of this review, qualitative and quantitative studies relating to psychological health factors associated with domestic violence, physical health factors associated with domestic violence and the role of public organisations in supporting women who have experienced domestic violence were carefully analysed. The rich data provided through means of multidimensional studies, longitudinal studies, semi-structured interviews, purposive sampling, focus groups, multiple regression analyses, meta-analysis, multivariate logistic regression model, bivariate analysis, binominal regressions, systematic reviews and surveys provided useful perceptions and understandings into the multifaceted and the complex nature of physical and psychological health factors associated with domestic violence against women and the role of the public organisation.
Furthermore, with psychological health factors, physical health factors and public organisations being the super-ordinate themes, this study has identified and focused on a fair number of subordinate themes including Post Traumatic Stress Disorder (PTSD), depression, suicide, for the psychological super-ordinate theme, short term and long-term health problems for the physical super-ordinate theme and support, concerns and screening for the public organisations super-ordinate theme. There seems to be a characteristic emerging from domestic violence literature which is concerned with the fact that psychological health is more affected when a woman has experienced domestic violence from a romantic partner in comparison to physical health. Additionally, psychological abuse was a main forecaster of mental health problems, specifically speaking of Post- Traumatic Stress Disorder and interestingly psychological abuse forced women to leave their abusive partners, even after bearing the effects of the physical abuse. In this respect, an example of this is the study conducted by Arias and Pape (1999) who looked at the psychological and physical abuse to battered women’s psychological adjustment and the intentions to terminate their abusive relationship was examined. Sixty-eight women who had experienced domestic violence gave information on their physical and psychological abuse, psychological symptomatology, strategies for coping, the perceptions of control over partner violence and the intentions to return to their abusive partners (Arias and Pape, 1999). Multiple regression analyses further suggested that the occurrence and extremity of physical abuse was not a vital forecaster of Post-Traumatic Stress Disorder symptomatology, neither of women intending to leave their abusive spouse. However, it is believed psychological abuse was, on the other hand, a significant predictor of Post-Traumatic Stress Disorder symptomatology and purposes to permanently leave abusive partners, even after controlling for the effects of the physical abuse (Arias and Pape, 1999). In this regard, conflicting to expectations, women tend to display resentment, dislike and fear in the direction of psychological abuse and the effects of psychological abuse more than that of physical abuse (Follingstad et al, 1990). Because of this, it is shocking as to why very minute attention has been given to the occurrence and impact of psychological abuse towards women’s physical and psychological health. A small experimental interest may be the main purpose of the need to attend to the harsh consequences of physical abuse and the expectations that psychological abuse may have few, temporary, less severe and less brutal consequences than that of physical abuse. However, it is important to note that even though physical abuse is seen to be noticeable, more clear and evident to the naked eye, psychological abuse can result in long term negative effects and additionally can cause hidden diseases, such as Post-traumatic stress disorder and depression, which can be deadly if not treated appropriately. Another reason for the lack of research into psychological abuse may be due to the complications in measuring psychological abuse, which may have as a result delayed the progress of research and studies (Vitanza, Vogel and Marshall, 1995). Nevertheless, some if not much, empirical attention has been dedicated to the effects of abuse on women’s physical and psychological mental health. Aguilar and Nightingale, (1994) studies a sample of 48 battered women and 48 non-battered women to focus on the effects of physical abuse on women’s self-esteem. Battered women had low levels of self-esteem in comparison to non-battered women. Within the battered sample, psychological abuse was the only vital forecaster of low self-esteem. In addition to this, Follingstad et al (1990) found that women who had gone through psychological domestic violence more harmfully in comparison to women who had experienced physical abuse more harmfully stated distress and fear of the romantic partner, shame, low self-esteem, depression and anxiety. Furthermore, Arias, Street and Brody (1996) found that psychological abuse resulted in depression and problematic drinking, which continued subsequently after the depression was controlled. As well as this, the negative effects of women’s psychological abuse prolonged to their children where the psychological abuse resulted in emotionally negligent, neglectful and mistreating parenthood (Arias and Street, 1996). This then extended to depression and low self-esteem in the children. These reviewed studies propose that psychological abuse has a negative influence on the physical and psychological health of women. The results of the completed studies to date show the importance of examining and investigating women’s psychological alteration as well as examining the effects of physical abuse.

Very little research has considered the effects of adult abuse on women’s mental health, particularly in the United Kingdom. The relevant studies are conducted in North America but it’s relevance to domestic violence is very significant, with shedding some generic light on to the subject. To some extent, the small quantity of the United Kingdom knowledge base in domestic violence and mental health produces genuine concerns from women activists, campaigners and researchers that domestic violence will become medicalised and depoliticised if attention turns away from and does not consider women’s mental health problems (Mullender, 1996). As a future direction, more attention should be provided towards studying and researching both psychological and physical effects of domestic violence towards women in the United Kingdom on similar wavelengths, which will ensure that public organisations are successful in the programmes they run to offer support towards women who have experienced domestic violence in the United Kingdom. As well as this, more interventions can be put in place to guide policies and practices.

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Appendix A:
Ethical Review Form
Department of Social Policy and Social Work
Preliminary Ethical Approval
This form is to be completed by ALL students in the School of Social Policy who are carrying out research. The purpose of this form is to decide whether or not further ethical review and approval is required before the commencement of a given research project.

NAME:
TITLE OF PROJECT: What are the health factors associated with domestic violence amongst women victims and the role of public organisations? A review of the literature
TITLE OF PROGRAMME/MODULE: BA Social Policy (Health and Social Care)
Please answer the following questions
Will the research project involve humans as subjects of the research (with or without their knowledge or consent at the time)? No
Are the results of the research project likely to expose any person to physical or psychological harm? No
Will you have access to personal information that allows you to identify individuals, or to corporate or company confidential information? No
Does the research project present a significant risk to the environment or society? No
Are there any ethical issues raised by this research project that in your opinion require further ethical review? No
If you answer NO to ALL the above questions:
Further ethical review is not necessary but you must submit this form to your dissertation supervisor. Please note that, if subsequent to this declaration, changes are made during the study that modify any of the above NO answers to YES, you must inform your dissertation supervisor.

If you answer YES to ANY you should know:
Further ethical review is necessary and you should complete the stage 2 Ethical Review Application Form, and submit this form to your dissertation supervisor.

DECLARATION
I declare that the questions above have been answered truthfully and to the best of my knowledge and belief and that I take full responsibility for these responses. I undertake to observe ethical principles throughout the research project and to report any changes that affect the ethics of the project to my dissertation supervisor.
Signed (STUDENT): Name (PRINT): DATE: 24/11/2017
Signed (TUTOR): Name: Clare Harewood DATE: 24/11/2017

Please print a copy for your records and then email a copy to your Dissertation Tutor who will certify that it has been approved. In all cases the certified form should be included as an Appendix in the submitted version of your dissertation.

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