stronger links to adult mental health than physical violence

Globally, it is estimated that almost one third of women aged 15-49 years have been subjected to physical or sexual violence by an intimate partner (WHO, 2024). Though estimates are more limited, research suggests that between 3.4% and 20.3% of men have experienced physical domestic violence (Kolbe & Büttner, 2020).

Children are frequently caught in the crossfire: one recent meta-analysis found that 16.5% of children had witnessed physical domestic and family violence, with estimates from individual studies ranging from 3.6% to 57.0% (Whitten et al., 2024). Unsurprisingly, witnessing domestic violence during childhood has been linked to adverse mental (Vu et al., 2016) and physical health outcomes (Holmes et al., 2022), as well as a range of other psychosocial outcomes, including educational performance, social abilities, and delinquency (Artz et al., 2014; Doroudchi et al., 2023).

However, often when we think about domestic violence, we’re thinking almost exclusively about physical forms of violence, and the aforementioned studies, reviews, and reports do the exact same. Non-physical forms of domestic violence have been completely underrepresented in studies and in policies. Coercive control behaviours, which aim to dominate and control a partner through actions and behaviours that create fear and an imbalance of power, make up a core component of non-physical forms of domestic violence. Critically, unlike physical violence, these behaviours can often persist even after the breakdown of the relationship and can even be enacted by weaponising and directly harming children (often through custody cases in court).

While there has been a growing body of research which does consider non-physical forms of domestic violence, few studies have examined the independent impact of different forms of domestic violence on health outcomes. This blog summarises a recent cross-sectional study conducted by Blake et al. (2025) that aimed to examine the independent impact of four types of domestic violence in childhood, including coercive control behaviours, on the risk of mental health disorders and health risk behaviours among Australian adults.

Almost one third of women and up to 20% of men experience domestic violence globally. Children are frequently caught in the crossfire.

Methods

The Australian Child Maltreatment Study (ACMS; Haslam et al., 2023) is a nationally representative cross-sectional study of Australian adults. Random digit dialling of mobile phone numbers was used to recruit 8,503 Australians who were all aged 16 years or older and spoke sufficient English to complete a telephone interview. The sample was compared to the Australian population (based on census data), and prevalences and model coefficients were adjusted for any differences.

Childhood maltreatment was assessed via self-reports. Alongside other forms of child maltreatment, four types of domestic violence were captured:

1. Physical violence,
2. Threats of serious harm
3. Damage of property or pets
4. Intimidation or controlling behaviours.

Four mental health disorders were assessed via structured clinical interviews:

• generalised anxiety disorder (GAD),
• post-traumatic stress disorder (PTSD), and
• alcohol use disorder (AUD; mild, moderate, and severe), all within the past 12-months,
• as well as lifetime major depressive disorder (MDD).

The presence of six health risk behaviours within the past 12-months were assessed via self-reports, including:

• cigarette smoking,
• binge drinking,
• cannabis dependence,
• obesity,
• self-harm, and
• suicide attempts were assessed via self-reports.

Lifetime self-harm and suicide attempts were also assessed.

Results

All four mental disorders and all six health risk behaviours were more common among participants that had experienced any domestic violence. GAD, PTSD, MDD, self-harm, and suicide attempts were more common among women exposed to any domestic violence. AUD, smoking, binge drinking, and cannabis dependence were more common among men. Table 1 (below) gives an overview of all findings.

Overall, exposure to intimidation or control and damage to property or pets during childhood were found to be independently associated with the odds of mental health disorders and health risk behaviours in adulthood, even after accounting for exposure to other forms of domestic violence and childhood maltreatment.

Compared to individuals who had not been exposed to intimidation or control behaviours during childhood, individuals that had been exposed had:

• More than 2 times the odds of PTSD (adjusted odds ratio [aOR] = 2·30 [95% CI 1·77 to 2·98]);
• More than 1.6 times the odds of GAD (1·65 [1·36 to 1·99]) and cannabis use (1·64 [1·07 to 2·51]);
• Approximately 1.5 times the odds of self-harm (1·49 [1·07 to 2·07]);
• More than 1.2 times the odds of MDD (1·22 [1·04 to 1·43]);
• 17% lower odds of smoking (0·83 [0·70 to 0·99]).

Furthermore, compared to individuals who had not been exposed to damage to property or pets during childhood, individuals that had been exposed had:

• More than 1.7 times the odds of severe AUD (aOR = 1·76 [1·36 to 2·27]);
• Approximately 1.5 times the odds of PTSD (1·49 [1·15 to 1·94]);
• Approximately 1.2 to 1.4 times the odds of smoking (1·36 [1·17 to 1·59]), MDD (1·29 [1·11 to 1·50]), and binge drinking (1·24 [1·03 to 1·50]);
• 19% lower odds of obesity (0·81 [0·70 to 0·93]).

In contrast, with few gender-specific exceptions, exposure to physical violence and threats of serious harm during childhood were not associated with the assessed mental disorders or health risk behaviours during adulthood after other forms of childhood maltreatment were accounted for.

Table 1. Summary of findings

Note. Blank boxes indicate no significant association observed. Mental disorders and HRBs are captured within the past 12-months unless otherwise stated. Key: AUD=Alcohol Use Disorder; MDD=Major Depressive Disorder; T=Total; M=Male; F=Female; ↑ = Increased risk; ↓ = Decreased risk.

Exposure to intimidation or control and damage to property or pets during childhood were more strongly associated with mental health disorders and engagement with health risk behaviours in adulthood compared to exposure to physical violence and serious threats.

Conclusions

This is one of the first studies to examine independent associations between different types of domestic violence exposure and adult health outcomes.

This study found that exposure to intimidation or control and damage to property or pets are more strongly associated with mental disorders and health risk behaviours in adulthood, over and above the effects of physical violence, threats of serious harm, and other types of childhood maltreatment.

These findings emphasise a growing need to consistently acknowledge non-physical forms of domestic violence as harmful to children across research, clinical practice, criminal law, and policy.

Coercive control behaviours, which aim to create fear and an imbalance of power, have a key impact on the physical and mental health of those exposed, which continues into adulthood.

Strengths and limitations

This study used a large representative sample of Australian adults to examine the link between childhood domestic violence exposure and adverse health outcomes in adulthood. The sample was compared to the Australian population (based on census data), and prevalences and model coefficients are adjusted for any differences. Valid and reliable measures of childhood maltreatment, mental disorder, and health risk behaviours were used, and procedures and statistical analysis were described in detail, enabling replication.

However, there are some limitations that must be considered:

• Firstly, as noted by the authors, the use of a cross-sectional design limits the ability to establish causality. Retrospective reports of childhood trauma could be affected by several biases, including forgetting and misremembering, stigma, and subjective beliefs. Additionally, research suggests that individuals with a mental health problem are more likely to recall negative experiences (negative recall bias; Coleman et al., 2024). Given this is one of the first studies to distinguish between physical and non-physical forms of domestic violence, these limitations can be addressed by future prospective longitudinal studies with children and adolescents.
• Childhood maltreatment was assessed using the Juvenile Victimisation Questionnaire (JVQ)–R2: adapted version (ACMS). Participants could answer ‘yes’, ‘no’, ‘I don’t know’, or ‘prefer not to say’ on each of the 17 items. Responses of ‘I don’t know’ and ‘prefer not to say’ were counted as not having experienced the event. Participants responding to the items in this way often have experienced such events, but are choosing to not respond as such, often due to fear and stigma. Given that these individuals are included in the unexposed group, the estimates in this study may be underestimates.
• Furthermore, the authors acknowledge that for participants that indicated they had been exposed to childhood maltreatment, follow-up questions were conducted to obtain information about the frequency, age of onset, and age of cessation of the event. However, this information was not utilised in the current models. Further research could examine whether there are critical periods of exposure which infer greater long-term impact on health outcomes.
• Finally, while the sample is representative of the population of Australia (including accurate representation of Aboriginal and Torres Strait Islanders), the generalisability of these findings to other populations, especially those from low- and middle-income countries is questionable. Replication is therefore needed.

Retrospective reports of childhood trauma could be affected by several biases, including forgetting and misremembering.

Implications for practice 

As noted by the authors, the impact of childhood domestic violence exposure has:

traditionally been conceptualised through a predominantly physical violence framework.

These findings suggest that non-physical forms of domestic violence are equally, if not more, important to both short- and long-term health problems, with several key implications across research, clinical practice, and policy.

For researchers

(Especially those investigating childhood adversities, trauma, and/or violence).

Hopefully hearing about this study and its findings has highlighted the importance of also asking about exposure to non-physical forms of domestic violence – I know this will be a consideration in my own research moving forward. More research (as usual) is also needed. Replication using longitudinal prospective designs would avoid the biases of retrospective reporting and improve our ability to draw causal conclusion regarding the effect of domestic violence exposure on health in later life. Additionally, replication in other countries should be a priority, particularly low- and middle-income and non-Western countries; this would enable the examination of potential cross-cultural differences and ensure that children and young people living in these countries are appropriately represented in the evidence base.

For clinicians

Identifying and documenting instances of non-physical forms of domestic violence and coercive control would help to ensure that children are receiving appropriate support. Changes in social information processing, changes in emotion processing, and accelerated biological ageing have been identified as potential transdiagnostic mechanisms linking childhood trauma exposure (specifically threat, rather than deprivation, events) to a range of mental health problems, while higher levels of social support, particularly from caregivers, has been identified as a possible transdiagnostic protective factor following trauma exposure (McLaughlin et al., 2020). Interventions that address these potential transdiagnostic mechanisms may be beneficial in comprehensively addressing the impact of childhood maltreatment.

Finally, in terms of policy, legislation in the UK has recognised children as victims of domestic violence in their own right since 2021 (Office of the Domestic Abuse Commisioner for England and Wales, 2023), with equivalent legislation in Australia. However, legislation hasn’t entirely translated into action. Research conducted in England and Wales in 2022 found that just 29% of domestic violence victims and survivors who asked for support for their children actually received said support (Office of the Domestic Abuse Commisioner for England and Wales, 2022). As noted by the authors:

Urgent investment is needed in the prevention of experiences of domestic violence, as well as child-centred and trauma- and family-violence- informed interventions that support children’s recovery…

While children are recognised as victims of domestic violence in their own right, the availability of support is a postcode lottery.

Statement of interests

Megan Bailey has no interests to declare.

Edited by

Laura Hemming

Links

Primary paper

Julie A. Blake, Hannah J. Thomas , Ben Mathews , David M. Lawrence , Divna M. Haslam , Daryl J. Higgins , Eva Malacova , Holly E. Erskine  and James G. Scott (2025). Childhood experiences of domestic violence and its association with mental disorders and health risk behaviours. The British Journal of Psychiatry, 1-8.

Other references

Artz, S., Jackson, M. A., Rossiter, K. R., Nijdam-Jones, A., Géczy, I., & Porteous, S. (2014). A comprehensive review of the literature on the impact of exposure to intimate partner violence for children and youth. International Journal of Child, Youth and Family Studies, 5(4), 493-587. https://doi.org/10.18357/ijcyfs54201413274

Blake, J. A., Thomas, H. J., Mathews, B., Lawrence, D. M., Haslam, D. M., Higgins, D. J., Malacova, E., Erskine, H. E., & Scott, J. G. (2025). Childhood experiences of domestic violence and its association with mental disorders and health risk behaviours. The British Journal of Psychiatry, 1-8. https://doi.org/10.1192/bjp.2025.10362

Coleman, O., Baldwin, J. R., Dalgleish, T., Rose-Clarke, K., Widom, C. S., & Danese, A. (2024). Research Review: Why do prospective and retrospective measures of maltreatment differ? A narrative review. Journal of Child Psychology and Psychiatry, 65(12), 1662-1677. https://doi.org/10.1111/jcpp.14048

Doroudchi, A., Zarenezhad, M., Hosseininezhad, H., Malekpour, A., Ehsaei, Z., Kaboodkhani, R., & Valiei, M. (2023). Psychological complications of the children exposed to domestic violence: a systematic review. Egyptian Journal of Forensic Sciences, 13(1), 26. https://doi.org/10.1186/s41935-023-00343-4

Haslam, D. M., Lawrence, D. M., Mathews, B., Higgins, D. J., Hunt, A., Scott, J. G., Dunne, M. P., Erskine, H. E., Thomas, H. J., Finkelhor, D., Pacella, R., Meinck, F., & Malacova, E. (2023). The Australian Child Maltreatment Study (ACMS), a national survey of the prevalence of child maltreatment and its correlates: methodology. Medical Journal of Australia, 218(S6), S5-S12. https://doi.org/https://doi.org/10.5694/mja2.51869

Holmes, M. R., Berg, K. A., Bender, A. E., Evans, K. E., Kobulsky, J. M., Davis, A. P., & King, J. A. (2022). The Effect of Intimate Partner Violence on Children’s Medical System Engagement and Physical Health: A Systematic Review. Journal of Family Violence, 37(8), 1221-1244. https://doi.org/10.1007/s10896-021-00291-4

Kolbe, V., & Büttner, A. (2020). Domestic Violence Against Men-Prevalence and Risk Factors. Deutsches Ärzteblatt International, 117, 534–541. https://doi.org/10.3238/arztebl.2020.0534

McLaughlin, K. A., Colich, N. L., Rodman, A. M., & Weissman, D. G. (2020). Mechanisms linking childhood trauma exposure and psychopathology: a transdiagnostic model of risk and resilience. BMC Medicine, 18, 96. https://doi.org/10.1186/s12916-020-01561-6

Office of the Domestic Abuse Commisioner for England and Wales. (2022). A Pathwork of Provision: How to Meet the Needs of Victims and Suvivors across England and Wales. Domestic Abuse Commissioner.

Office of the Domestic Abuse Commisioner for England and Wales. (2023). Children and Young People Subject to Domestic Abuse: Professionals’ Insights Briefing.

Vu, N. L., Jouriles, E. N., McDonald, R., & Rosenfield, D. (2016). Children’s exposure to intimate partner violence: a meta-analysis of longitudinal associations with child adjustment problems. Clinical Psychology Review, 46, 25-33. https://doi.org/10.1016/j.cpr.2016.04.003

Whitten, T. A.-O., Tzoumakis, S. A.-O., Green, M. J., & Dean, K. (2024). Global Prevalence of Childhood Exposure to Physical Violence within Domestic and Family Relationships in the General Population: A Systematic Review and Proportional Meta-Analysis. Trauma, Violence, & Abuse, 25(2), 1411-1430. https://doi.org/10.1177/15248380231179133

WHO. (2024). Violence against women. Retrieved 14/10/25 from https://www.who.int/news-room/fact-sheets/detail/violence-against-women

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