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BackgroundDomestic violence and abuse (DVA) is common and damaging to health. UK national guidance advocates a multi-agency response to DVA, and domestic homicide reviews consistently recommend improved information-sharing between agencies. Identification of patients experiencing DVA in general practice may come from external information shared with the practice, such as police incident reports and multi-agency risk assessment conference (MARAC) reports. The aim of this study was to explore the views of general practitioners (GPs) and the police about sharing reports about DVA with GPs.MethodsQualitative semi-structured interviews were conducted with GPs, police staff and a partnership manager. Participants were located across England and Wales. Thematic analysis was undertaken.ResultsInterviews were conducted with 23 GPs, six police staff and one former partnership manager. Experiences of information-sharing with GPs about DVA varied. Participants described the relevance and value of external reports to GPs to help address the health consequences of DVA and safeguard patients. They balanced competing priorities when managing this information in the electronic medical record, namely visibility to GPs versus the risk of unintended disclosure to patients. GPs also spoke of the judgements they made about exploring DVA with patients based on external reports, which varied between abusive and non-abusive adults and children. Some felt constrained by short general practice consultations. Some police and GPs reflected on a loss of control when information about DVA was shared between agencies, and the risk of unintended consequences. Both police and GPs highlighted the importance of clear information and a shared understanding about responsibility for action.ConclusionGPs regarded external reports about DVA as relevant to their role, but safely recording this information in the electronic medical record and using it to support patients required complex judgements. Both GPs and police staff emphasised the importance of clarity of information and responsibility for action when information was shared between agencies about patients affected by DVA.

One in five children in the UK are affected by domestic violence and abuse. However, primary care clinicians (GPs and nurses) struggle to effectively identify and support children and young people living in homes where it is present. The IRIS+ (Enhanced Identification and Referral to Improve Safety) training and advocacy support intervention aimed to improve how clinicians respond to children and young people affected by domestic violence and abuse. IRIS+ training was delivered as part of a feasibility study to four general practices in an urban area in England (UK). Our mixed method design included interviews and questionnaires about the IRIS+ intervention with general practice patients, including children and young people as well as with clinicians and advocacy service providers. We collected the number of identifications and referrals by clinicians of children experiencing domestic violence and abuse through a retrospective search of medical and agency records 10 months after the intervention. Forty‐nine children exposed to domestic violence and abuse were recorded in medical records. Thirty‐five children were referred to a specialist domestic violence and abuse support service over a period of 10 months. Of these, 22 received direct or indirect support. The qualitative findings indicated that children benefitted from being referred by clinicians to the service. However, several barriers at the patient and professional level prevented children and young people from being identified and supported. Some of these barriers can be addressed through modifications to professional training and guidance, but others require systematic and structural changes to the way health and social care services work with children affected by domestic violence and abuse.

The COVID-19 pandemic, and associated social restrictions, have amplified women’s experiences of domestic abuse (DA). In usual times, female DA survivors reach out to those around them (friends, family members, neighbors, and colleagues) for support. Accessing of both professional and informal support by survivors has increased during the pandemic. Informal supporters are often deeply invested and immersed in situations of DA because of the closeness of relationships. The accounts of informal supporters are rarely sought, yet these are people who may have a considerable awareness of what is happening. The aim of this study was to explore how the pandemic had impacted people’s assessment of abusive situations and their ability to provide informal support. This paper reports a secondary analysis of qualitative data collected in 2020 in England. The data were gathered in 18 in-depth interviews with people who knew a female friend, relative, neighbor, or colleague who had experienced DA. The age range of participants was 25–69 years, three were men and fifteen were women. A reflexive thematic analysis was carried out. Findings indicated: (i) the pandemic had changed people’s ability to read situations and assess risk (ii) perpetrators were exploiting the pandemic to further abuse (iii) within the context of the pandemic there was additional challenge to offering support (iv) informal supporters found creative ways to remain in-touch and to continue offering support. Further research with informal supporters is needed to ascertain how best to support and equip people, without imposing an impossible burden.

Background Primary care needs to respond effectively to patients experiencing or perpetrating domestic violence and abuse (DVA) and their children, but there is uncertainty about the value of integrated programmes. The aim of the study was to develop and test the feasibility of an integrated primary care system-level training and support intervention, called IRIS+ (Enhanced Identification and Referral to Improve Safety), for all patients affected by DVA. IRIS+ was an adaptation of the original IRIS (Identification and Referral to Improve Safety) model designed to reach female survivors of DVA. Methods Observation of training; pre/post intervention questionnaires with clinicians and patients; data extracted from medical records and DVA agency; semi-structured interviews with clinicians, service providers and referred adults and children. Data collection took place between May 2017 and April 2018. Mixed method analysis was undertaken to triangulate data from various sources to assess the feasibility and acceptability of the intervention. Results Clinicians and service providers believed that the IRIS+ intervention had filled a service gap and was a valuable resource in identifying and referring women, men and children affected by DVA. Despite increased levels of preparedness reported by clinicians after training in managing the complexity of DVA in their practice, the intervention proved to be insufficient to catalyse identification and specialist referral of men and direct identification and referral (without their non-abusive parents) of children and young people. The study also revealed that reports provided to general practice by other agencies are important sources of information about adult and children patients affected by DVA. However, in the absence of guidance about how to use this information in patient care, there are uncertainties and variation in practice. Conclusions The study demonstrates that the IRIS+ intervention is not feasible in the form and timeframe we evaluated. Further adaptation is required to achieve identification and referral of men and children in primary care: an enhanced focus on engagement with men, direct engagement with children, and improved guidance and training on responding to reports of DVA received from other agencies.

Following lockdowns in countries around the world, reports emerged of a ‘surge’ or ‘spikes’ in the number of domestic violence and abuse cases. It is critical to contextualise this: more men are not starting to be abusive or violent; rather, the patterns of abuse are becoming more frequent. Spiking and surging make us think in terms of more one-off incidents but it is more likely that the pattern of abuse that is already there is increasing in terms of frequency and type because both parties remain together at all times. Amid such a crisis, it is imperative that we continue to see the dynamics of domestic violence and abuse as both a pattern of abusive behaviours and a product of gendered social and cultural norms, rather than a reaction to a specific factor or event, such as COVID-19.

Background Domestic violence and abuse is a violation of human rights which damages the health and wellbeing of victims, their families and their friends. There has been less research on the experiences and support needs of male victims than those of women. Historically research on men’s experiences has not focused on what constitutes effective, needs-led service provision. The aim of this paper was to conduct an integrated mixed methods synthesis of systematic review evidence on the topic of help-seeking by male victims of domestic violence and abuse. Methods An integrated mixed methods synthesis approach was taken to enhance our understanding of the complex phenomenon of help seeking by, and service provision to male victims. This process also identifies gaps in the evidence. Using previously identified systematic review data; mixed methods data from four primary-level service evaluation studies, along with expert and patient consultation were used to develop research propositions. Primary-level qualitative interview and survey data from 12 studies of men experiences were mapped onto the propositions to support them. Results Fourteen propositions were composed. Seven propositions were supported or at least partly supported by the qualitative data. These supported propositions were used to make recommendations for policy and practice particularly concerning service preferences of male victims. The remaining seven propositions were not specifically supported by the qualitative data. These unsupported propositions were used to develop research recommendations concerning the need to further understand the potential blurred boundaries of victim–perpetrator, hybrid perpetrator-victim experiences, men who are/have been victims of childhood sexual abuse and determining the level of risk for men. They also highlight the need to produce better guidance for the response of the police & the criminal justice system. Finally, they highlight the need to produce the most appropriate service for men in terms of access, linkage, substance/alcohol abuse, mental health, sexuality, and race. Conclusion Integrated mixed-methods synthesis of systematic review evidence is a relatively novel approach. This approach can lead to recommendations for policy and practice as well as highlighting gaps in the research agenda as shown in this example.

Background The COVID-19 pandemic intensified women's experiences of domestic abuse. Demand for specialist support increased substantially, and UK campaigns encouraged friends, family members, neighbours, and colleagues of domestic abuse survivors to provide support informally. Research with informal supporter participants is rare, and yet, they are likely to have a good knowledge of the situation and to have substantial influence on outcomes. The aim of this research was to investigate how the pandemic impacted on informal supporters' appraisals of abusive situations and on their ability to provide assistance. Methods A qualitative study with informal supporters of female domestic abuse survivors was underway at the start of the COVID-19 pandemic. Participants were recruited in the Southwest of England using advertisements in community venues and, once social distancing and lockdown measures were introduced, recruitment was extended across England using social media advertisements. We added additional questions about the impact of the pandemic and the related social restrictions to the topic guide. 18 in-depth semi-structured interviews were conducted with three male and 15 female informal supporters (aged 25–69 years), over the telephone and using Skype. All participants gave recorded, oral informed consent. A secondary analysis of data relating specifically to the pandemic was undertaken using reflexive thematic analysis. The original study, and subsequent amendments, were granted ethics approval by the Research Ethics Committee in the School for Policy Studies at the University of Bristol. Findings The subset of participant interviews reported in this paper were held between March 30, 2020, and Sept 15, 2020. The themes generated in the analysis indicated four main findings. First, it seemed that the pandemic changed people's ability to “read” situations and to accurately assess the level of risk. Informal supporters felt greater uncertainty about whether the abuse had continued, altered, or escalated. Second, perpetrators' tactics evolved to further abuse by exploiting the pandemic. In particular, they increased surveillance and capitalised on reduced in-person contact. Third, the pandemic created a context where the capacity of informal supporters was increasingly stretched, and where safely offering support became more challenging. Finally, informal supporters demonstrated resourcefulness and creativity, for example, by forming support bubbles with survivors and finding novel ways to monitor the situation, in order to continue offering help. Interpretation In the face of uncertainty, and an incredibly challenging life-context, informal supporters of domestic abuse survivors demonstrated resilience, creativity, and innovation as they continued to offer support. The pandemic has simultaneously highlighted the importance of informal support, and the challenges in providing it. More direct research with informal supporters is crucial to determine how best to support and equip this population. Funding AXA Research Fund.

Many women who experience domestic violence (DV) seek support from friends, relatives, colleagues and neighbours. There are substantial knock-on effects for informal supporters, and they may seek help themselves. Tailored services for this group are rare, but domestic violence helplines can provide listening and signposting support. The aim of this exploratory study was to understand which informal supporters contact domestic violence helplines, and what form these calls take.Three focus groups, following a topic guide, were conducted with staff and volunteers for domestic violence helplines during autumn 2015. Discussions were digitally recorded, transcribed verbatim, and imported into NVivo10 software. Transcripts were coded line-by-line, and a thematic analysis carried out. All participants were female, aged between 22 and 54 years, with between two months’ and eight years’ experience of taking helpline calls.Findings indicate that people with broad ranging connections to a survivor call a helpline. Calls can be triggered by disclosures, abuse escalation, witnessing incidents, feeling overwhelmed, and media highlighting of DV. Informal supporters respond to survivors, and experience impacts, in differing ways, often associated with their gender and their relationship with the survivor. Frequently, they feel a sense of responsibility and a desire to rescue the survivor, often calling a helpline to reduce feelings of helplessness and to seek a ‘magic’ solution. Many people are concerned about the legitimacy of their involvement and seek reassurance about the validity of their own help-seeking. Helpline workers feel that informal supporters would benefit from opportunities to reduce isolation, have their predicament acknowledged, and learn from peers.DV helplines have an important role in helping informal supporters of survivors. The help requested is predominantly to equip and empower the informal supporter, so that they feel more adept at coping themselves and, are thus, better able to offer support to the survivor.

Domestic violence (DV) is experienced by 1 in 4 women in the United Kingdom during their lifetime, and most survivors will seek informal support from the people around them, even if they choose not to access help from professionals. Support from these relatives, friends, neighbors, and colleagues can provide a buffer against effects on the survivor’s physical health, mental health, and quality of life, and has been shown to be protective against future abuse. There has been an absence of research studying members of survivors’ networks and, in particular, investigating how the impact of DV might diffuse to affect them. A systematic literature review of reported research (either in peer-reviewed journals or in gray literature) was undertaken to explore the impacts of DV on survivor networks. Of the articles found, 24 had data relating to the topic area, though no study addressed the question directly. Framework analysis and meta-ethnography generated the following themes: physical health impacts, negative impacts on psychological well-being, direct impacts from the perpetrator, and beneficial impacts on psychological well-being. The studies in this review indicated that informal supporters may be experiencing substantial impact, including vicarious trauma and the risk of physical harm. Currently, there is little support available which is directly aimed at informal supporters of DV survivors, thus these findings have practical and policy implications, in order to acknowledge and meet their needs.

This paper presents a narrative review of empirical evidence looking at connections between poverty and DVA. The findings presented includes social survey and qualitative evidence from the UK, and elsewhere where relevant, and is drawn from more than 80 research studies. The material was collated and supplemented by further secondary analysis of data collected as part of the 2012 UK Poverty and Social Exclusion Survey. Our review suggests that women experiencing poverty in the UK are more vulnerable to DVA, and this conclusion is consistent with wider international evidence. However, while associations clearly exist between poverty and DVA vulnerability, potential causal mechanisms are poorly understood and this reflects the limitations of existing data in this area. This paper highlights the need for further research exploring financial abuse within DVA relationships and post-separation financial abuse and poverty. Caution is needed in interpreting this relationship and drawing inferences for policy and practice. DVA is endemic throughout society in rich and poor countries, and interventions targeted at specific populations (including poverty) on their own are likely to be inadequate in the absence of a wider understanding of the social drivers of violence against women associated with patriarchal norms and practices in particular contexts.

Domestic violence and abuse (DVA) can include physical, psychological, sexual, emotional or financial abuses, and is a globally widespread problem across all age groups, cultures and socioeconomic groups. Alongside the impacts of DVA experienced by survivors, there is a growing recognition that other people, who form the support network of survivors, may also be affected by the situation. Domestic violence organisations such as helplines are important third sector services supporting survivors. However, there has been little research into the impact on those providing the support. This qualitative study of domestic violence helpline workers explored their needs and well-being. We used qualitative methodology, conducting interviews with staff recruited from a selection of different helplines who all undertook direct client-focused work. The interviews used a semi-structured format and followed a topic guide covering the training received before commencing work, self-care strategies, the impact of work on their daily life and support offered by their employer. Ten helpline staff were interviewed, all female. Following analysis of the qualitative data, a number of themes emerged. Participants disclosed numerous ways in which their work challenged their well-being, including burnout, impact on personal relationships, and lack of training and support at work. Participants used some self-care strategies in order to "switch off" from work, but they also wanted clinical supervision to support them with the difficulties they experienced at work. This study suggests that helpline staff should receive more education about trauma triggers, and ongoing support to reduce the impact on their home and social life, thus improving mental well-being and job satisfaction. This work begins the debate on the well-being needs of frontline helpline workers, and whether better meeting these needs can facilitate the provision of better support.

This chapter considers how gender theory and in particular a broad understanding of theories of masculinities can help in our health responses to male victims and perpetrators of domestic violence and abuse. It seeks to redress that imbalance by contributing to the wider debate about the impact of coercive control on men as both victims and perpetrators. The chapter describes the context in which men's experiences of potentially abusive behaviours takes place, before outlining different theoretical positions in relation to theories of masculinity. It outlines the methodology of the research before reporting on the qualitative data and the findings and emerging themes. The chapter looks at accounts of men, as both victims and perpetrators of domestic violence and abuse, in order to explore how they talk about restrictions on their freedom, and about control within their relationships, and the intersections with masculine identities.

PURPOSE: Military populations may experience more severe forms of domestic violence than the general population. Although mental disorders are associated with domestic violence perpetration among the general population, it is not clear whether this is the case for military populations. This review aimed to establish the prevalence and odds of domestic violence perpetration among male and female military personnel with mental disorders.METHODS: Systematic review: searches of eleven electronic databases were supplemented by hand searches, reference screening, citation tracking and expert recommendations.RESULTS: Ten studies were included; nine reporting on partner violence and one on violence against an adult family member. Median prevalence estimates were calculated for partner violence perpetration among male military personnel with post-traumatic stress disorder (PTSD); estimates on other disorders were not possible due to lack of data. 27.5 % of men with PTSD reported past year physical violence perpetration against a partner and 91.0 % reported past year psychological violence perpetration against a partner. Due to limited data, no median estimates could be calculated for female military personnel. Data from individual papers indicate increased odds of past year partner violence perpetration among male and female military personnel with depression; inconsistent findings were reported for risk of partner violence perpetration among male and female military personnel with PTSD.CONCLUSIONS: There is some evidence that mental disorders among military personnel are associated with past year domestic violence perpetration, though current data cannot confirm direction of causality. Research is needed to inform the development of interventions targeted to reduce domestic violence perpetration among military personnel.

Reflecting the higher prevalence of domestic violence and abuse experienced by women, and the recognised health impacts of such abuse, studies have focused on the responses of health-care practitioners to women in heterosexual relationships. Comparatively few studies have looked at the health impacts or help-seeking of men who may be perpetrators and/or victims of abuse within intimate relationships. In this paper we report on help seeking and the health professional's role based on a survey of 1368 men attending 16 general practices in the southwest of England and 31 interviews with a sample of survey respondents. The survey had a number of questions on experience or perpetration of behaviours which could be considered abusive, on whether respondents had ever been asked about such behaviours by health-care professionals, and on whether they had ever sought formal or informal help for such behaviours. Men were most likely to seek informal support from friends or family. The next most likely source of support was the family doctor. This paper suggests that health-care practitioners in general, and family doctors in particular, have a role in asking male patients about the experience or perpetration of domestic abuse and need training to do so effectively and safely.

AimTo evaluate a training intervention for general practice-based doctors and nurses in terms of the identification, documentation, and referral of male patients experiencing or perpetrating domestic violence and abuse (DVA) in four general practices in the south west of England.BackgroundResearch suggests that male victims and perpetrators of DVA present to primary care clinicians to seek support for their experiences. We know that the response of primary care clinicians to women patients experiencing DVA improves from training and the establishment of referral pathways to specialist DVA services.MethodThe intervention consisted of a 2-h practice-based training. Outcome measures included: a pre-post, self-reported survey of staff practice; disclosures of DVA as documented in medical records pre-post (six months) intervention; semi-structured interviews with clinicians; and practice-level contact data collected by DVA specialist agencies.ResultsResults show a significant increase in clinicians’ self-reported preparedness to meet the needs of male patients experiencing or perpetrating DVA. There was a small increase in male patients identified within the medical records (6 pre- to 17 post-intervention) but only five of those patients made contact with a specialist DVA agency identified within the referral pathway. The training increased clinicians’ confidence in responding to male patients affected by DVA. The increase in recorded identification of DVA male patients experiencing or perpetrating DVA was small and contact of those patients with a specialist DVA support service was negligible. We need to better understand male help seeking in relation to DVA, further develop interventions to increase identification of male patients experiencing or perpetrating DVA behaviours, and facilitate access to support services.

This article is concerned with the provision of intervention programs aimed at female victims/survivors of domestic abuse in the United Kingdom. Social workers, and other statutory professionals, are increasingly referring clients who have experienced abuse to these interventions, but there has been little debate about the aims and objectives of them or consideration of their effectiveness. This article includes a discussion of the key elements of the programs and criticisms of these types of interventions.

ObjectivesTo understand help-seeking by male victims of domestic violence and abuse (DVA) and their experiences of support services by systematically identifying qualitative and mixed-method studies and thematically synthesising their findings.DesignSystematic review and qualitative evidence synthesis. Searches were conducted in 12 databases and the grey literature with no language or date restrictions. Quality appraisal of the studies was carried out using the Critical Appraisal Skills Programme tool. Reviewers extracted first and second order constructs related to help-seeking, identified themes and combined them by interpretative thematic synthesis.SettingDVA experienced by male victims and defined as any incident or pattern of incidents of controlling coercive or threatening behaviour, violence or abuse among people aged 18 or over who are or have been intimate partners or family members, regardless of gender or sexuality.ParticipantsMale victims of DVA.InterventionsAny intervention which provides practical and/or psychological support to male victims of DVA including but not limited to DVA-specific services, primary healthcare and sexual health clinics.Primary and secondary outcome measuresQualitative data describing help-seeking experiences and interactions with support services of male victims of domestic violenceResultsWe included twelve studies which were published between 2006 and 2017. We grouped nine themes described over two phases (a)barriers to help-seeking: fear of disclosure, challenge to masculinity, commitment to relationship, diminished confidence/despondency and invisibility/perception of services; and (b)experiences of interventions and support: initial contact, confidentiality, appropriate professional approaches and inappropriate professional approaches.ConclusionThe recent publication of the primary studies suggests a new interest in the needs of male DVA victims. We have confirmed previously identified barriers to help-seeking by male victims of DVA and provide new insight into barriers and facilitators to service provision.PROSPERO registration numberCRD42016039999.

Programmes of research which combine related studies are commonplace, including in the field of Intimate Partner Violence (IPV). Whereas the systematic synthesis of published qualitative data is now well established, the synthesis of qualitative data that make up a programme of work is rare. A Programme of Research on Violence in Diverse.Domestic Environments (PROVIDE) is a UK NIHR funded programme. The five studies associated with PROVIDE are sited in general practice, sexual health clinics, mental health services and 3rd sector IPV agencies. Synthesising the data from across-the studies offered an opportunity to highlight variations in help-seeking strategies according to gender and sexual orientation and identify variations in help-seeking across different contexts. The approach to the synthesis was meta-ethnography. The synthesis identified 23 2nd order constructs in relation to helpseeking. Findings show gender and sexuality influences how help-seeking in different contexts is viewed. Disclosure of IPV to mental health services was rare. Women favour help-seeking from primary care which is familiar and where they are known, whilst gay men favour help-seeking from GUM clinics where there is a taken for granted acknowledgement of sexual identity. These differences suggest an intersectional approach to providing support services for IPV is needed. (C) 2016 Published by Elsevier Ltd.

This article considers how survivors of domestic violence negotiate the unreality of the world of the perpetrator to survive and the impact this has on their psychological well-being. Utilizing recent debates about coercive control and a reframing of domestic violence as a liberty crime, this article examines women’s accounts of negotiating coercion and control. It presents data collected from oral history narrative interviews with women who have experienced domestic violence, as well as incidents of abuse recounted to the author while working with abused women, and reanalyzes those accounts in light of the theory of coercive control.

Objective To measure the experience and perpetration of negative behaviour, including domestic violence and abuse (DVA), and investigate its associations with health conditions and behaviours in men attending general practice. Design Cross-sectional questionnaire-based study conducted between September 2010 and June 2011. Setting 16 general practices in the south west of England. Participants Male patients aged 18 or older, attending alone, who could read and write English. A total of 1403 of eligible patients (58%) participated in the survey and 1368 (56%) completed the questions relevant to this paper. 97% of respondents reported they were heterosexual. Main outcome measures Lifetime occurrence of negative behaviour consistent with DVA, perceived health impact of negative behaviours, associations with anxiety and depression symptoms, and cannabis use in the past 12 months and binge drinking. Results 22.7% (95% CI 20.2% to 24.9%) of men reported ever experiencing negative behaviour (feeling frightened, physically hurt, forced sex, ask permission) from a partner. All negative behaviours were associated with a twofold to threefold increased odds of anxiety and depression symptoms in men experiencing or perpetrating negative behaviours or both. 34.9% (95% CI 28.7% to 41.7%) of men who reported experiencing negative behaviour from a partner, and 30.8% (95% CI 23.7% to 37.8%) of men who perpetrated negative behaviours said they had been in a domestically violent or abusive relationship. No associations with problematic drinking were found; there was a weak association with cannabis use. Conclusions DVA is experienced or perpetrated by a large minority of men presenting to general practice, and these men were more likely to have current symptoms of depression and anxiety. Presentation of anxiety or depression to clinicians may be an indicator of male experience or perpetration of DVA victimisation.

Background Domestic violence and abuse is experienced by 25% of women and has far-reaching health consequences for survivors. Most survivors access support from people around them, which has the potential to buffer against effects on physical and mental health of survivors, and to protect against future abuse. However, little research has directly assessed how impacts of domestic violence and abuse might diffuse to affect these informal supporters. The aim of this research was exploratory, investigating the effects on health and wellbeing in people who provide informal support to survivors of domestic violence and abuse. Methods Qualitative interviews were conducted in the UK, between 2012 and 2013, with people who had, at any point during adulthood, supported a friend, relative, or colleague who was in an abusive relationship. Recruitment was via social media, radio, and flyers in community settings. Themes from a systematic review formed the basis of the topic guide, and participants gave written informed consent. Interviews were conducted face to face, by telephone, and with Skype. Transcripts were coded in NVivo (version 10), and a thematic analysis of narratives carried out: data were coded, arranged into themes by the first author, and refined in collaboration with coauthors, by the constant comparison method. The Research Ethics Committee in the School for Policy Studies at the University of Bristol approved the study. Findings 23 participants were recruited and interviewed. Five major themes emerged from the analysis: psychological impacts (including anxiety, low mood, confusion, and anger), physical health impacts, relationship impacts, practical impacts, and being at direct risk of harm from the perpetrator. Factors that mediated the impacts experienced included the supporter's sex, the closeness of the relationship between supporter and survivor, the severity of abuse experienced by the survivor, and whether the survivor had children. Interpretation The toll on informal supporters of survivors of domestic violence and abuse was multifaceted, often onerous, and frequently persistent. Scarce support is available for friends, relatives, and colleagues of survivors. These findings have practical and policy implications to recognise and meet the needs of these important informal supporters, and have informed a public health campaign across Bristol. Funding This research was conducted as part of PhD study funded by the National Institute for Health Research School for Primary Care Research, and was hosted by the University of Bristol.

'Domestic' violence is a health problem for women, and not just because of the injuries they receive. It leads to acute and chronic physical injury, miscarriage, loss of hearing or vision, physical disfigurement and often depression, alcoholism and sometimes suicide. The medical and caring professions are in the best position to act as the 'front line' in helping women who are assaulted by their partners, because most of the female population visit doctors, are visited by health visitors or use the services of midwives during their twenties and thirties, but the pervasive 'medical model' and the individualistic stance of modern medicine mitigate against this role. This article gives the first results from a survey of medical professionals - doctors, practice nurses, health visitors and midwives - in one English county. It looks at how often they are aware of seeing cases of domestic violence in their practice, what they know about it, what they would be prepared to do about it and how they see their own r...