Domestic violence is defined as “any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence, or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality. This can encompass psychological, physical, sexual, financial, and emotional abuse” (Domestic abuse Act, England and Wales, 2021).
Experiencing domestic violence is associated with several poor mental health outcomes, including suicidal behaviour (Chandan et al., 2020; McManus et al., 2022). Previous research on experiencing domestic violence and suicidal behaviour has been conducted on survey data. For example, the Adult Psychiatric Morbidity Survey showed that 50% of people who self-harmed with suicidal intentions had experienced intimate partner violence (McManus et al., 2022).
The current study used national administrative data from the UK to investigate the differences in characteristics of women who died by suicide who had experienced domestic violence and those who had not (Turnbull et al, 2025).
Experiencing domestic violence is associated with several poor mental health outcomes including suicidal behaviour.
Methods
The study used data from the National Confidential Inquiry into Suicide and Safety which includes records of women who died by suicide under the care of UK mental health services between 2015 and 2021.
Univariable logistic regressions were used to investigate whether characteristics of women who died by suicide, compared to a reference characteristic (a characteristic that is considered to have no negative impact or to be a default), were predictive of having history of domestic violence. The same models were run with adjustment for age.
Multivariable logistic regressions were used to investigate the link between the characteristics, domestic violence and death by suicide.
Results
Between 2015 and 2021, 3,908 women died by suicide within 12 months of contact with UK mental health services. Of those, 26% had a history of domestic abuse.
Women who died by suicide and had a history of domestic abuse were more likely than their counterparts to:
- be younger, unmarried, living alone and unemployed
- die by self-poisoning
- have experienced adverse life events in the previous three months
- have histories of self-harm, violence perpetration and drug/alcohol misuse
- have a diagnosis of personality disorder, alcohol and drug dependence and PTSD
- have missed the last contact with services in the previous month
- be receiving psychological treatment.
Women who died by suicide and had a history of domestic abuse were less likely than their counterparts to:
- be engaging with crisis resolution home treatment services
- have first contact with services within the previous 12 months
- have had last contact with services within 7 days of their death.
Women who died by suicide and had a history of domestic abuse were more likely to have missed the last contact with services in the previous month.
Conclusions
Over a quarter of women under the care of UK mental health services who died by suicide had experienced physical and sexual domestic abuse.
Experiences of unemployment and adverse life events, PTSD, self-harm, perpetration of violence and substance misuse were all higher in women who died and had experienced domestic violence than those who had not experience violence.
The women who had experienced domestic violence also had different interactions with services; being more likely to miss contact and less likely to be under certain interventions, such as crisis resolution or psychological therapies.
Unemployment, adverse life events, PTSD, self-harm, perpetration of violence and substance misuse were higher in women who had experienced domestic violence prior to dying by suicide.
Strengths and limitations
A notable strength of this study is that it used national administrative data and records instead of survey data, which increases the sample and makes the findings more representative of the general population of the UK.
With regards to the limitations, one weakness of the study is that domestic violence history and other patient details were collected through a standard questionnaire by the supervising clinician (e.g., consultant psychiatrist). This questionnaire asked about sexual and physical forms of abuse only, therefore, psychological, emotional and financial abuse were not included, even though they form a part of domestic violence. As such, this study is limited to only some forms of domestic abuse. Further, the question being asked by a clinician may limit disclosure in some instances, in comparison to anonymous self-reporting in surveys.
Death by suicide was ascertained through national mortality data from public statistics bodies in the UK nations, however, the cause of death being decided by a coroner as suicide is subject to validity concerns. The intention behind an episode of self-harm is only truly known to the individual and people can die following an episode of self-harm without suicidal intentions or following substance use where the overdose was an accident not intentional self-poisoning.
Domestic violence history and other patient details were collected by clinicians in a mental health service, which might limit disclosure in comparison to anonymous self-report.
Implications for practice
Mental health and social care implications
Women in this study who experienced domestic violence were more likely to be unemployed and experience financial strain, therefore social care support to develop independence and get into the workforce might disrupt the suicidal trajectory. An understanding that those service-users who experienced violence are also more likely to be perpetrators has an implication that interventions need to be holistic and consider relationships and families and not just individuals. For example, family therapy available through local authorities (e.g., councils) can help to address the causes of violence within the relationship or the family unit. The finding that women who die by suicide who experienced domestic abuse are more likely to have a history of substance misuse, identifies the need for substance abuse support across a range of mental health services, as the sample was not restricted to addiction clinics.
The findings around services point to the importance of availability of services and interventions, and suggests that a level of proactivity could be exercised by health and social care services to ensure that service-users remain under care, without missing appointments, and are provided with treatment plans.
Research implications
This study identified many significant relationships in a national sample from administrative data, and future research should study these relationships in more depths to investigate mechanisms, for example, by evaluating mediation models. The relationships between characteristics and odds of domestic abuse and suicide identified in this research are correlational and not causal. One factor considered when thinking about cause-effect relationships is whether a relationship is free of confounders. As such, future studies could investigate the significant relationships between the characteristics, domestic abuse and suicide identified in this study, while adjusting for relevant confounders based on other literature.
Further, many of the significant correlational relationships identified here could be bidirectional, therefore statistical methods, such as the direction-of-causation structural equation models could be applied in the future to further elucidate the significant directions of effects.
Social care support for women experiencing domestic violence to develop independence and get into the workforce might disrupt the suicidal trajectory.
Statement of interests
No conflict of interest.
Links
Primary paper
Turnbull, P., Hunt, I. M., Woodhouse, T., Monk, H., Kapur, N., & Appleby, L. (2025). Domestic violence and suicide in women under the care of mental health services in the UK, 2015–2021: a national observational study. The Lancet Regional Health–Europe, 55.
Other references
Chandan, J. S., Thomas, T., Bradbury-Jones, C., Russell, R., Bandyopadhyay, S., Nirantharakumar, K., & Taylor, J. (2020). Female survivors of intimate partner violence and risk of depression, anxiety and serious mental illness. The British Journal of Psychiatry, 217(4), 562-567.
Domestic abuse Act (England and Wales) 2021 c17. Accessed July 5, 2024.
McManus, S., Walby, S., Barbosa, E. C., Appleby, L., Brugha, T., Bebbington, P. E., … & Knipe, D. (2022). Intimate partner violence, suicidality, and self-harm: a probability sample survey of the general population in England. The Lancet Psychiatry, 9(7), 574-583.
