Strong links between serious health conditions and violence or abuse - study

Professor Janet Fanslow of the Auckland University's School of Population Health. Photo: Supplied

Warning: This story contains discusses violence and abuse.

A study has found strong links between serious health conditions and violence or abuse, including years after the violence occurred, leading to calls for more funding for violence prevention and improved education for medical students.

The study, published Wednesday, found both men and women who had experienced violence were more likely to be hospitalised for a range of reasons, including cancer, respiratory illness, nervous system and digestive disorders.

The research looked at childhood sexual abuse, multiple types of intimate partner violence - physical and sexual violence, psychological and economic abuse and controlling behaviours - and physical or sexual violence by someone other than a partner.

It found women who experienced interpersonal violence and abuse were over one and a half times more likely to be hospitalised with cancer and almost three times as likely to be hospitalised for respiratory diseases than women who had not.

Men who experienced childhood sexual abuse were seven times more likely to be hospitalised for nervous system disorders compared to men who had not.

The grim statistics revealed the experience of violence was common, with 63 percent of women reporting experiences of violence, including high rates of childhood sexual abuse (21 percent), sexual violence by non-partners (9 percent), and/or multiple types of intimate partner violence (21 percent).

More than 68 percent of men interviewed reported some experience of interpersonal violence, the majority of which was non-partner physical violence, mainly perpetrated by other men.

More than 68 percent of men interviewed reported some experience of interpersonal violence, mainly perpetrated by other men. Photo: 123rf.com

The results, published in the Scandinavian Journal of Public Health, were presented in two papers seperated by gender because men and women's experiences of violence were so different, lead author Dr Janet Fanslow said.

The higher rates at which women experienced intimate partner violence, childhood sexual abuse and sexual violence meant they were "far more likely" to experience hospitalisation for multiple disorders than men, while men were more likely to experience one-off incidences of physical violence by non partners.

The researchers - from the University of Auckland and Melbourne's Murdoch Children's Research Institute - believed the studies were a world first, mapping interviews with more than 2800 people to thirty years of hospitalisation data.

Similar research had relied on people's recollections of health issues, while this study, with the participant's permission, was able to draw on more than three decades of Ministry of Health data, Fanslow said.

It also examined how the combination - and cumulation - of different experiences of violence across someone's life affected their health.

Exposure to violence, particularly repeated violence, triggered the fight or flight reflex, Fanslow said.

"That level of fear triggers a whole system around toxic stress, increased inflammatory response, increased release cortisol, all of which has physiological effects for people."

The psychological impacts of violence and abuse made it harder for people to value themselves, could cause depression, post traumatic stress disorder, social isolation and sleep problems while efforts to manage stress could lead to substance abuse and higher rates of risk taking, all of which could in turn affect physical health.

The study confirmed that for women "intimate partner violence was a form of chronic and toxic stress that adds to the national burden of disease", and bore out self-reported claims about the increased rates of illness for those experiencing multiple types of intimate partner violence.

"Exposure to interpersonal violence is actually one of the critical determinants of health in this country, particularly for women. It means we need to start doing routine inquiries to make sure we ask about people's lifetime exposure to intimate partner violence, to make sure people are safe in the moment or are getting referred to ... trauma informed care.

"If we really want to start incorporating this into our practice, we need to, have to start teaching about it in our medical and nursing schools."

The results also signalled the "need to get serious about violence prevention, because the experience of violence is a cost to our health system", Fanslow said.

The research underscored the human and financial toll, and the ripple effects beyond individuals to their families, the broader community and strained health budgets, she said.

"We know the country is struggling to pay for health services. Supporting people to have healthy relationships and doing effective violence prevention up front is going to keep people safer, help them be healthier, and save us money.

"We often regard [violence] as a one off - we think of people getting a black eye or a broken arm, and that's where we stop. But what this research is about is trying to highlight both how pervasive it is and how wide-reaching the consequences are - if you think about the health effects for individuals, for people who have cancer, respiratory disease or digestive disorders and hospitalisations, it's not just them, it's their family members and us as a wider community."

The higher rates at which women experience intimate partner violence, childhood sexual abuse and sexual violence mean they're "far more likely" to experience hospitalisation. Photo: Unsplash/ Kristina Flour

Fanslow hoped the research would help broaden the "really limited understanding" of the health consequences of chronic stress, fear and trauma on physical illness, both in the medical profession and wider society.

Researchers statistically controlled for age and ethnicity, and as ethnicity was strongly correlated to socio-economic status, that effectively controlled for the impacts of poverty, such as substandard housing, Fanslow said.

The study was the first to document how men's experience of violence was associated with increased hospitalisation for diseases.

Men who had experienced childhood sexual abuse saw increased hospitalisation for nervous system disorders and ear diseases, non-partner physical violence towards men was associated with almost twice the rates of hospitalisation for injuries (not necessarily as a result of the violence), and experiences of intimate partner violence had associations with hospitalisation for genitourinary conditions.

There was also an increase in hospitalisation for men with non-disease specific symptoms - symptoms serious enough to warrant admission, but unable to be diagnosed.

This was an example of "exactly when practitioners should consider the impact of trauma", Fanslow said.

"Violence and the effects of violence are appearing in our health systems, but we're often not recognising it, and therefore we're not responding appropriately," she said.

There was strong evidence from other research that clinicians vastly under-identified patients exposure to violence, which was exacerbated by the lack of understanding of the links between violence, trauma and abuse with life-long and seemingly unrelated health issues.

"If clinicians are aware violence could be contributing to the health problem, they could link people to appropriate support services, whether it's around immediate safety or long-term recovery and trauma-informed care," Fanslow said.

The next steps would focus on disseminating the results, taking them to policy makers and embedding the connection more strongly in medical and healthcare education, she said.

Where to get help:

Mental health

• Need to Talk? Free call or text 1737 any time to speak to a trained counsellor, for any reason.
• Lifeline: 0800 543 354 or text HELP to 4357.
• Suicide Crisis Helpline: 0508 828 865 / 0508 TAUTOKO. This is a service for people who may be thinking about suicide, or those who are concerned about family or friends.
• Depression Helpline: 0800 111 757 or text 4202.
• Samaritans: 0800 726 666.
• Youthline: 0800 376 633 or text 234 or email talk@youthline.co.nz.
• What's Up: 0800 WHATSUP / 0800 9428 787. This is free counselling for 5 to 19-year-olds.
• Asian Family Services: 0800 862 342 or text 832. Languages spoken: Mandarin, Cantonese, Korean, Vietnamese, Thai, Japanese, Hindi, Gujarati, Marathi, and English.
• Rural Support Trust Helpline: 0800 787 254.
• Healthline: 0800 611 116.
• Rainbow Youth: (09) 376 4155.
• OUTLine: 0800 688 5463.

If it is an emergency and you feel like you or someone else is at risk, call 111.

Sexual Violence

• NZ Police.
• Victim Support 0800 842 846.
• Rape Crisis: 0800 88 33 00.
• Rape Prevention Education.
• Empowerment Trust.
• HELP (Auckland): 09 623 1700, (Wellington): 04 801 6655.
• Safe to talk: 0800 044 334.
• Tautoko Tāne Male Survivors Aotearoa.
• Survivors Network of those Abused by Priests (SNAP) 022 344 0496.

Family Violence

• Women's Refuge: 0800 733 843.
• It's Not OK 0800 456 450.
• Shine: 0508 744 633.
• Victim Support: 0800 842 846.
• HELP Call 24/7 (Auckland): 09 623 1700, (Wellington): 04 801 6655.
• The National Network of Family Violence Services NZ has information on specialist family violence agencies.

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