One in four women and nearly one in five men will experience domestic violence in their lifetime, yet the NHS has no reliable system to identify or support them. This research addresses a critical gap: health services currently have almost no evidence on how to respond to male victims or perpetrators, and only modest evidence for interventions that improve mental health outcomes for women. It also tackles the near-total absence of research on domestic violence among men who have sex with men (MSM) attending sexual health clinics. The project runs ten linked studies across three clinical settings. In general practice, researchers will measure how many men attending primary care are victims or perpetrators, then pilot a training intervention for clinicians. In mental health services, a randomised trial will test a psychological intervention delivered by domestic violence advocates. In sexual health clinics, researchers will measure prevalence among MSM and pilot a clinician training programme. If successful, the work could give the NHS practical, cost-effective tools to identify domestic violence and respond appropriately—reducing the £23 billion annual cost to the UK economy and improving long-term physical and mental health outcomes for patients.
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Aim: To improve the response of the NHS to domestic violence (DV) through effective care for people experiencing abuse and perpetratorsMain objectives:1. measure prevalence of DV among men attending primary care2. pilot a general practice intervention to improve care for men experiencing or perpetrating DV3 & 4 evaluate a psychological intervention delivered by DV advocates to women5. estimate prevalence of DV in people with mental health disorders, and articulate their health care needs in relation to DV6. measure prevalence of DV in men who have sex with men (MSM) attending sexual health clinics and its association with sexually transmitted infection7. articulate experiences of DV and perpetration among MSM and training needs of sexual health clinic staff8. pilot a sexual health clinic intervention to improve care for MSM experiencing or perpetrating DV9. model cost-effectiveness of interventions in studies 2 & 8 with value of information analysis10. synthesize qualitative data across all studies to explore barriers/facilitators to enquiry about & response to DVBackgroundDomestic violence (DV) is threatening behaviour, violence or abuse between adults who are or have been intimate partners, regardless of gender or sexuality. Population life-time prevalence is 28% for women, 18% for men, and higher in clinical populations. Annual cost to the UK economy is £23 billion. DV causes long term damage to physical, reproductive and mental health. It is often invisible to clinicians and poorly managed, although its health consequences are a major burden on the NHS. There is virtually no research on men as victims or perpetrators of DV in the context of health services; we do not even have reliable estimates of prevalence in clinical populations. There is some evidence for effectiveness of interventions such as advocacy for women who have experienced DV, but the effects are modest, particularly for mental health outcomes. We have little evidence to guide health care policy for DV in MSM, even in services designed for this population. Research plansWorkstream I MALE PERPETRATORS AND VICTIMS ATTENDING PRIMARY CARE Study 1: Cross-sectional survey of prevalence in general practice and association with demographic characteristics and mental health statusStudy 2: pilot of educational and support intervention targeted at primary care clinicians to promote enquiry about men’s experience or perpetration of DV and improved management after disclosure. Workstream II MENTAL HEALTH Study 3: Randomised controlled trial of a psychological intervention delivered by specialist DV advocates (Psychological Advocacy Towards Healing: PATH)Study 4: Nested qualitative study in PATH to explore perceptions of advocates and clientsStudy 5: Systematic review of studies measuring DV prevalence of populations of people with mental health disorders; systematic review of interview or focus group studies of people with mental health disorders who have experienced DVWorkstream III MEN WHO HAVE SEX WITH MEN (MSM) ATTENDING SEXUAL HEALTH CLINICSStudy 6: cross sectional survey of prevalence in sexual health clinics and association with sexually transmitted infectionsStudy 7: qualitative study to explore experience of victimisation and perpetration of DV with MSM attending sexual health clinics and to identify clinician knowledge and skills deficit in relation to supporting MSM affected by DVStudy 8: pilot of educational and support intervention targeted at sexual health clinicians and advisors to promote enquiry about MSM’s DV experience or perpetration and improved management after disclosure.Workstream IV SYNTHESISStudy 9: cost-effectiveness models with data from studies 1,2,6 & 8 followed by value of information analysisStudy 10: meta-synthesis of qualitative data from studies 2, 4, 7 and 8Research team: Leading DV, applied health care research researchers in the UK and internationally, collaborating with service providers and users. Experience of synthesising and tr
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