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Barriers and Facilitators of Disclosing Domestic Violence to the UK Health Service

• Original Article
• Open access
• Published: 04 January 2021
• Volume 37 , pages 533–543, ( 2022 )

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• Rebecca L. Heron   ORCID: orcid.org/0000-0001-7438-5669 2 , 3   nAff1 ,
• Maarten C. Eisma 2 &
• Kevin Browne 3  

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A Correction to this article was published on 07 June 2021

This article has been updated

Domestic violence victims frequently visit health care facilities yet rarely disclose, so it is important to understand what factors are barriers and facilitators of disclosure. UK-based qualitative investigations into barriers and facilitators of disclosure in health care settings have suffered from a limited focus on ethnic minority women. Therefore, the aim of this study was to explore victims’ perceptions and experiences of disclosing to health care services and to identify barriers and facilitators of disclosure within an ethnically diverse UK sample. Semi-structured interviews were administered among 29 British (8 ethnic minority) female victims. Content analysis demonstrated that barriers to disclosure were; emotional (e.g., fear, embarrassment/shame and self-blame), physical (e.g., partner’s physical presence, controlling behavior, and manipulation of professionals) and organizational (e.g., appropriateness of setting and time for disclosure). Additional problems for ethnic minority women were language difficulties and religious practices. Facilitators to disclosure were interpersonal relations, safety, and validation from health care professionals. Barriers and facilitators of disclosure in health care services are diverse and some are specific to minority ethnic groups. Health care professionals should receive awareness and skills training to establish a positive, validating, and safe environment for victim disclosure.

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Domestic violence is a serious worldwide societal and public health issue (World Health Organization 2013 ). According to the Department of Health ( 2017 ), one in four women and one in six men in England and Wales will suffer domestic violence in some form. From March 2013, the UK definition of domestic violence is: “ 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 ” (Home Office, Cross-Government definition of domestic violence: a consultation, September 2012 , p19).

Domestic violence has negative health outcomes for both male and female victims (Chibber et al. 2016 ; Hester et al. 2015 ). However, female victims of domestic violence (compared to male victims) experience more frequent and serious injuries (World Health Organization, 2013 ) and are found to be more at risk of repeated abuse (Walby et al. 2015 ). Therefore, this study will focus exclusively on female victims of intimate partner violence.

Female victims of domestic violence compared to their non-abused counterparts have been found to visit the health care service much more frequently (Rivara et al. 2007 ). Victims suffer adverse and long-term physical and psychological health problems (Garcia-Moreno et al. 2013 ).

When female abuse victims disclose to a professional, they can be directed to specialist services where they can develop a safety plan and can receive more information about resources for abuse victims. Health care professionals can provide referrals or links to services such as advocacy and housing support, which can further benefit victims helping them to become independent, thereby improving their functioning and health, and limiting or stopping abuse (McFarlane et al. 2014 ; Spangaro et al., 2016b ; for a review: Sprague et al. 2017 ). Despite the severe consequences of domestic violence, and benefits of disclosure, research shows that most victims choose not to disclose their experiences of abuse in formal and informal relationships (Evans and Feder 2014 ).

Within professional services, many victims’ first or only point of contact is the health service (Othman et al. 2014 ). Previous research has shown that 45% of domestic violence victims who were killed by their abusive partners presented to a hospital 2 years prior to their death (Rivielo 2010 ). Victims of domestic abuse have a higher prevalence of using the health service than non-abused women (García-Moreno et al., 2015 ). As such, the health service has a unique potential to respond to domestic violence (Othman et al. 2014 ).

To use this potential, health care professionals are advised to conduct routine screening for domestic violence within the UK (National Institute for Health and Care Excellence 2014 ) and national and international guidelines have been developed on how health care professionals should respond to victims of domestic violence (National Institute for Health and Care Excellence 2014 ; World Health Organisation 2013 ).

Previous studies however have shown that despite these guidelines, doctors and nurses rarely ask about intimate partner violence and often fail to identify the signs of domestic abuse (Correa et al. 2020 ; McGarry and Nairn 2015 ). Health care professionals’ hesitancy to ask about domestic abuse (Sundborg et al. 2017 ) has resulted in them providing inadequate care (Bradbury-Jones and Broadhurst 2015 ). In the UK, qualitative studies among mental health professionals showed that many did not feel competent or confident to respond to domestic violence in their practice (Rose et al. 2011 ) and health care professionals felt incapable and uncomfortable discussing domestic abuse (Taylor et al. 2013 ). These findings are complemented by other studies showing that only a small number of domestic violence victims are identified (Chapman and Monk 2015 ). Health care professionals may thus not be adequately responding to domestic violence victims. Inadequate responses by health care professionals may be explained by a lack of knowledge due to a lack of formal training (Rose et al. 2011 ) or receiving too little training on how to respond to domestic violence (Rimmer 2017 ). In part as a consequence, actions recommended in guidelines were not routinely carried out (Ramsay et al. 2012 ). Not surprisingly then, that domestic violence victims have reported low levels of satisfaction with the response received from the health care service to their disclosures (Trevillion et al. 2014 ).

In addition to organizational barriers, female domestic violence victims may also experience many personal barriers to disclosure, for example, fear, shame and embarrassment about abuse (Katiti et al. 2016 ), self-blame (Othman et al. 2014 ), and economic dependence on the abusive partner (Shanko et al. 2013 ). Furthermore, for ethnic minority victims, research has shown that they experience additional barriers to disclosing including problems with language and communication (Femi-Ajao et al. 2020 ) and fear of deportation due to their immigration status (Canadian Council for Refugees 2016 ).

In addition to the barriers that women perceive they are also likely to experience facilitators, which help them to disclose. For example, the quality of the relationship with the health care professional, such as listening ability, trust, and empathy have been found to help victims’ disclosures (Spangaro et al. 2016a ). Other facilitators for disclosure include the women being asked about abuse but not pressured into disclosing (Spangaro et al. 2016a ).

The Present Study

Despite a growing interest in the topic, studies on domestic violence disclosure in the UK have predominantly focused on health care services employees (Hinsliff-Smith and McGarry 2017 ; Feder et al. 2009 ; McGarry 2016 ), and less attention has been devoted to understanding domestic violence victims’ experiences. To gain insight into victims’ perspectives on disclosure, qualitative research can be instrumental as it can provide an in-depth, holistic understanding of personal experiences and perspectives (Polit and Beck 2010 ). In the UK, there have been only a few qualitative studies of victim experiences of disclosure in health settings (e.g., Keeling and Fisher 2015 ; Salmon et al. 2015 ). Additionally, there have been even fewer UK studies exploring ethnic minority victim experiences of disclosing (Femi-Ajao et al. 2020 ) and several scholars have highlighted the importance of gaining a better understanding of domestic violence among ethnic minorities (Follingstad et al. 2012 ; Lacey et al. 2013 ). Therefore, we aimed to conduct a study within the UK exploring victims’ experiences of disclosing to the health care service and we included both women from both ethnic majority and ethnic minority backgrounds in our qualitative study. Thereby we aimed to get a representative picture of the types of barriers and facilitators female victims experience when disclosing domestic violence to professionals working in the UK health care service (i.e., persons with a health-related qualification working in a health care setting).

Participants

Twenty-nine females participated in this study and were recruited from a domestic violence support organization based in the East Midlands of England. In order to obtain a heterogeneous and diverse sample of women who experienced domestic violence, participants were recruited through three different women’s refuges (one of which was a Black and Ethnic Minority women’s refuge) and a community domestic violence support service. Women who had experienced intimate partner abuse were identified by the managers of the refuges and the community domestic violence support service. The managers asked these women if they wanted to participate in the study, and they were explicitly instructed by the researchers not to use persuasion or emotional coercion to promote study involvement.

In total, 36 females were approached and 29 females (81%) agreed to take part. Fifteen women were approached in the women’s refuges, of which 12 women agreed to participate (80%), and 21 women were approached through a community domestic violence support service, of which 17 agreed to participate (81%). Reasons for not participating included not being able to obtain childcare, work or study commitments, and relocating to another safe address.

All of the women who participated identified themselves as having experienced physical and/or emotional abuse within the last 12 months from a male partner. The duration of violence was between 12 months and 33 years ( M  = 4.89 years, SD  = 5.86). The women varied in age, ethnicity and life experience. They were aged between 21 and 49 years ( M  = 26.7, SD  = 6.46). Twenty-one (72%) of the participants were White British, four (14%) of the participants were Black Caribbean, two (7%) of the participants were Mixed Race, one (3%) participant was Black British African, and one (3%) participant was British Pakistani. Finally, three (10%) of the participants had married their partners and 26 (90%) had not.

Ethical Considerations

The World Health Organization ( 1999 ) highlights the importance of ethics when researching violence against women. It advocates that women’s identities should be protected through confidentiality and women should be made to feel safe. This study abided by such ethics. Formal ethical approval was obtained from a School of Medicine ethical review board. Participants were informed about key aspects of the study (e.g. anonymity, data handling, voluntariness) and provided written informed consent. Measures were taken to maintain the women’s safety, e.g., all interviews were conducted within a private setting, women’s names were anonymized and any identifiable information was changed during transcription. Additionally, the researchers also liaised with the refuge/service providers to ensure that further support was made available to women after the interview should they need it.

Study Design

This study used a qualitative approach. One-on-one semi-structured interviews were used rather than other qualitative methods (e.g., focus groups) as this would allow more detail as participants could speak more freely and provide more insight into their personal thoughts and feelings (Knodel 1993 ).

Data Collection

The interviewer contacted participants by telephone to arrange an appropriate time for the interview. Each woman when telephoned was asked if it was safe to talk. Interviews were conducted in a counselling room either at the refuge or at a community support office. The primary author conducted all the interviews. Most of the interview sessions lasted between one hour and one hour and a half. The interview schedule covered a range of topics, enquiring about the victim’s disclosure to a social worker, police, friend/relative and health care service. However, the focus of this study was on victims’ experiences of disclosure within the health care service. Among other things, we asked victims what their personal experiences of disclosure in health care settings are, whether they experienced barriers in disclosing to the health care service, and if they could provide any suggestions for how the health care service could make it easier for victims to disclose (See Online Supplement A for the full interview).

Participants’ responses to the interview questions were written down manually on paper during the interview and interviews were not audio recorded. The organization whereby the women were recruited, did not give permission for the women’s voices to be recorded, due to some of the women expressing discomfort with being recorded. Rubin and Rubin ( 1995 ) support that in some cases audio-recordings are not appropriate and so for this study we decided to only write the women’s responses to ensure that participants felt as comfortable as possible to openly discuss their experiences. In order to ensure rigour when writing responses, the interviewer took pauses between questions, so that she could adequately write down the participants’ answers. To ensure that writing down of participants’ answers did not affect her ability to establish rapport with the participant, she avoided jargon in the interview and made eye contact or provided verbal reassurance when appropriate, for example, if a participant became upset. After the interview, participants were provided with a copy of the interview transcript (in note form) and were asked to provide feedback if they felt it had not accurately reflected what they had said. None of the participants indicated that any changes needed to be made to the transcripts. At the end of the interview participants were verbally debriefed and thanked for participating.

Data Analysis

Interviews were entered into a qualitative data analysis software, Nvivo 9 (QSR International, Cambridge, MA) and a content qualitative analysis approach was used to organize the data (Bowling 1997 ). This approach was deemed by the researchers to be appropriate as it is frequently employed to answer similar research questions. For example, content analysis has been used to answer questions such as “what reasons do people have or not have for not using a service?” (Ayres 2007 ). Content analysis is increasingly used in health research and as an approach has various advantages, for example, it allows data to be analysed qualitatively whilst still allowing for data to be quantified (Grbich 2007 ). Content analysis follows two main approaches to coding and analysing data (manifest and latent coding). “Manifest content refers to those elements that are physically present and countable while latent content refers to an interpretive reading of the symbolism underlying the physically presented data” (Berg 2004 , p. 229). As recommended by Berg ( 2004 ), this study combined the approaches of manifest and latent coding.

Content analysis is a stepwise analytical process (Graneheim and Lundman 2004 ). The first step involved the primary researcher reading each of the transcripts and exploring the latent content and the overall tone of the transcripts. The researcher marked the passages that referred to victims’ experiences and perceptions of disclosing to the health care service. The researcher then reread the transcripts and the manifest content approach was applied as certain words or phrases were noted and assigned to specific codes. The content analysis was partly deductive (top-down) as predefined categories were applied to textual units but also it was inductive as themes emerged from the textual data.

The pre-defined categories were: 1) barriers and 2) facilitators of disclosing to the health care service. After the primary researcher had coded the passages into meaningful categories (of subsets of barriers and facilitators of disclosure), a second researcher was approached to read the transcripts and to do the same to promote credibility of the analyses. Both researchers independently read the transcripts and came up with their own codes; the second researcher reviewed the primary researcher’s codes against theirs and they agreed on the final codes together. Disagreements in coding were discussed and consensus was reached before deciding on the final codes.

Quotations were selected to support each of the categories and after discussions with the second researcher some of the categories were divided into sub-categories. Frequencies for each code were calculated and therefore each participant who was found to support a specific category of barriers and facilitators was tallied within that category. This allowed for the researchers to see how many participants overall had identified with a similar theme.

Nearly all of the 29 female domestic violence victims in the sample ( n  = 28, 97%) stated that they felt that all women should be routinely asked by their GP if they are experiencing domestic abuse. However, only 13 (45%) of the women actually disclosed to a health care professional (who was either a doctor (eight), a nurse (two) or a midwife (three)). Only two of the women reported disclosing to two health care professionals for example, a midwife and a doctor and only one woman reported disclosing to all three (nurse, doctor and midwife). Sixteen (55%) women stated that they felt that there were not enough leaflets on domestic violence in their GP’s surgeries and 14 (48%) participants stated that they felt that emotional abuse and physical abuse were treated differently by professionals, with emotional abuse being viewed as less serious. Most importantly, about two thirds (66%) of the participants stated that they preferred disclosing to a woman.

Barriers of Disclosing to the Health Care Service

Three main categories or themes were found regarding the reasons why women find it difficult disclosing to the health care service. These categories included emotional barriers (69%), partner-related barriers (38%) and organisational barriers (38%). These categories or themes were followed by sub-categories representing subthemes (see Table 1 ).

Emotional barriers

Over two-thirds of the women ( n  = 20; 69%) of the sample reported experiencing one or more emotions that acted as barriers for disclosing to the health care service. Women stated that they felt ‘ fear ’ (59%), ‘ embarrassment and shame’ (31%) and ‘ self-blame ’ (14%). Participant 17 highlights this point as she describes how, when wanting to disclose the abuse, she felt “blinded” by her “emotions”.

More than half of the women ( n  = 17; 59%) stated that fear had impacted on their decision to not disclose to the health care service. This fear was divided into three types, ‘fear that victims would lose their children’, ‘fear that a victim’s partner would find out’, and ‘fear that victims would not be believed’.

A third of the women ( n  = 10; 34%) expressed not disclosing to the health care service as a result of fearing professionals becoming involved and removing their children . Participant 13 stated her reason for not disclosing was that she was “scared they would take the kids.” Participant 14 mentioned that the health care service involving other professionals such as social services, leading to their children being taken away was her “biggest fear” which prevented her from telling her GP.

Over a third of the women ( n  = 11; 38%) stated their reasons for not disclosing were that they feared that their partner would find out and that the abuse would escalate . Participant 22 stated that her reasons for not disclosing were that she feared that her partner would find out and that this would “cause more trouble than it’s worth… resulting in more violence”. Participant 1 also confirmed the same fear stating that she was “scared” that her partner would find out if she disclosed, as she would “get it again, like hit.”

Two women (7%) expressed a fear that they would not be believed and so this further acted as a barrier to them disclosing to the health care service. The two women illustrated this: “Concerned about speaking to people because I thought they wouldn’t believe me and that was my biggest worry” (Participant 21). “Scared…I’d be made out to be a liar…he used to say they won’t believe you” (Participant 5).

Embarrassment and Shame

Nearly a third of the women ( n  = 9; 31%) also expressed feeling embarrassment or shame about disclosing abuse to the healthcare service; eight (28%) communicated that they felt embarrassed, and five (17%) women reported feeling shame. Participant 7 illustrates how these feelings made it difficult for her to disclose: “I felt dirty, I suppose, and embarrassed…I was ashamed.” Participant 29 also stated that her feelings of being “embarrassed and ashamed” prevented her from disclosing at first to her doctor.

Four women (14%) mentioned that self-blame further prevented them from disclosing, as they felt that they were to blame for the abuse and were therefore reluctant to disclose. Participant 7 illustrates this as she stated how she had “sometimes thought it was her fault”. Participant 2 also demonstrates feeling self-blame: “I remember thinking that I was overreacting and you blame yourself.”

Partner-related barriers

Over a third of the women ( n  = 11; 38%) also reported perceiving the perpetrator as a physical barrier which prevented them from disclosing. Three sub-categories were identified under this main theme: ‘ partner’s physical presence’ (34%), ‘ partner’s controlling behaviour ’ (10%) and ‘ partner’s manipulation of professionals’ (3%).

Partner’s Physical Presence

A third of the women ( n  = 10; 34%) felt that they could not disclose as a result of their partner being physically present in appointments. They stated that often their partners would escort them to their appointments and sit in with them making it very difficult for them to disclose. This is highlighted by Participant 19 who describes her experience of visiting the hospital with her partner: “When I went to hospital he came with me. I lied about my cause of injury... he was with me the whole time… nurse didn’t give me option of going in by myself… all my fingers were cut open … I said to them I jump started car and car door skimmed off fingers... they never questioned it.” Participant 15 also states her disappointment about not being given the opportunity to be seen on her own and this prevented her from disclosing: “When seeing doctor… he came with me... I should be seen on my own... it’s impossible when he’s sat right there.” Finally, Participant 2 further highlights the problem with women not being seen on their own and health care professionals not being sensitive to the fact that some women may not wish for their personal information to be discussed in front of their partners: “Started going into files in front of him… should be asked if it’s ok to talk about this”.

Partner’s Controlling Behaviour

The second sub-category identified was that of women feeling that they could not disclose as a result of their partners’ controlling behaviour. Women stated that their partners would often make it difficult for them to leave the house to disclose, or would keep a record of where they were and so they found it challenging to seek help. Three women (10%) had experiences of finding it difficult to leave the house without their partner knowing, which prevented them from disclosing: “Difficult to get out... had to go when he went to work” (Participant 15), “Wasn’t allowed to leave the house or go anywhere” (Participant 22).

Partner’s Manipulation of Professionals

The final sub-category was that of victims feeling that they could not disclose abuse as a result of their partner manipulating professionals who work with the family. One woman (3%) stated: “He talked himself out of it, even to the pediatrician. He can burst into tears and look pathetic at the switch of a light. One minute he can be crying and then when this person gets out the door he is as hard as nails… manipulative of professionals and even educated professionals such as doctors would be fooled.”

Organizational barriers

Nearly a third of the women ( n  = 9; 31%) reported experiencing organizational barriers which had prevented them from disclosing to the health care service, namely “ appropriateness of setting” (24%) and “ time for disclosure. ” (14%).

Appropriateness of Setting

The perceptions that the health care service was not an appropriate place to disclose abuse was held by nearly a quarter of the women ( n  = 7; 24%). This is demonstrated by Participant 12 who states that domestic violence is a “taboo subject” and how when initially visiting her doctors she “wasn’t sure if it was the right place to disclose abuse.” Participant 20 further highlights this also as she states her uncertainties of not knowing if the GP surgery is an appropriate place to discuss abuse “not the place or the time to discuss such things… well that’s not true, but not much GP can do and didn’t think it was the right place to go.” In addition to this, Participant 15 stated that they did not feel “comfortable disclosing to GP” and Participant 27 stated “didn’t think I could, I wasn’t aware of it”.

Time for Disclosure

Four of the women (14%) reported that there was not enough time to disclose within the health care setting. Participant 12 illustrates this as she stated that her reasons for not disclosing the abuse to the doctor were that she “didn’t think her GP would have time.”

Facilitators in Disclosing to the Health Care Service

Three main categories or themes were identified as facilitators which help women to disclose, namely ‘interpersonal relations’ (52%), ‘ safety ’ (28%) and ‘ validation (14%) ’.

Interpersonal relations

More than half of the women ( n  = 15; 52% of the sample) in this study communicated that having a positive relationship with the health care professional made them feel more at ease and able to disclose. Interpersonal relations was divided into three sub-categories: ‘ listening skills’, ‘trust’ and ‘ empathy’ .

Listening Skills

Over a third of the women ( n  = 11; 38%) expressed that being listened to by their health care professional helped them to disclose. Participants 19 and 28 demonstrate this sub-theme. Participant 19 described how after relocating to flee her partner, her new doctor was not as helpful as her previous doctor as he did not take the time out to listen to her: “this doctor was not good at all… this doctor wants you to come in and go straight back out… don’t feel like I can talk to him at all… don’t feel like he wants to listen… doctor before listened and was helpful.” This therefore illustrates how important it is for victims’ disclosure to feel like they are being listened to. Participant 28 further illustrates this as she reflected on her experiences of visiting the GP’s surgery and not feeling listened to, she advised that GP’s “sit there and listen rather than trying to get you in and out”.

Six (21%) of the women stated that trusting the health care professional helped them with their disclosure. Some of the women reported knowing their doctors for a long time and they stated this helped them when disclosing. Participants 6 and 17 both illustrate this: “He’s been my doctor for a long time so I trust him… if someone changed my midwife… I wouldn’t be able to talk to new ones… need to build trust… find it hard to open up with new people” (Participant 6). “I have known my doctor since I was young, so I trusted him… important that he stayed professional and didn’t tell any of my family members” (Participant 17).

Three women (10%) also reported that empathy from the health care professional was another important factor which could aid disclosure. For instance, participant 14 stated that when disclosing to her doctor; the doctor had been “empathetic” in his response “trying to understand how I was feeling, which helped.” Furthermore, it was shown that victims want to feel understood. Participant 17 highlights this as she stated “I think it’s easier talking to people who have actually been through it themselves as they can understand the situation easier… you need a health care professional who will be empathic.”

Over a quarter of the women ( n  = 8; 28%) stated that safety was important when disclosing abuse to a health care professional. Within this main category of safety, two sub-categories were present. The first sub-category was that of ‘ privacy and confidentiality’ and the second sub-category was that of ‘ home visits’ .

Privacy and Confidentiality

A quarter of the sample ( n  = 7; 24%) communicated that privacy and confidentiality were also important factors, which could aid the disclosure of their abuse. Participant 8 illustrates this as she stated when disclosing having “no concerns” as a result of her knowing that the disclosure “was confidential.” Further to this Participant 16 illustrates the importance of women being able to disclose safely, she explained “victims need to know that everything is confidential” and she described her experiences in which she “shared the same doctor as her partner” and so she feared the “possibility” that he would “find out” if she disclosed. However, Participant 16 reported that if she had still been in contact with her “midwife” she would have disclosed to her as her midwife only came to visit her in isolation and so she could be sure that the disclosure would be confidential. This suggests that women should be made aware that disclosures will be kept confidential, especially in cases where they may share the same health care professional.

Home Visits

Two women (7%) also communicated that home visits by health care professionals would have been helpful when disclosing as they had not always felt safe leaving the house to attend a meeting in a health care setting. This point is demonstrated by one participant who reported suffering from panic attacks, which prevented her from leaving her home. “I was scared to leave home… doctor won’t come out to you... did tell doctor I’m scared of coming out and doctor did not offer a home visit” (Participant 8). In addition to this, Participant 12 also stated that she had felt “too paranoid to go out” and had felt “low”. “I was very depressed.” This participant described how it was “difficult” for her to “see the doctor” as she could not get past the receptionist “she’ll give appointments when she wants to… would have been better for the doctor to come to my house. I would have been able to talk then.” Thus, this suggested that disclosures could be increased by women when it is safe to do so being visited in their own home.

Four of the women (14%) reported that the health care professionals validation of abuse was also very important for aiding their disclosures. Participant 11 illustrates this as she states that she had previously “normalised” the abuse. She described how when telling her doctor, the doctor was able to confirm that “emotional abuse was just as bad as physical…he told me it was still abuse.” This point was further illustrated by Participant 17 who stated that although she was asked by her midwife if she had been experiencing domestic violence, she had not recognised that emotional abuse could be classified as a form of abuse and so she explained that she tolerated the abuse for some time: “just learnt to live with it… I felt like it was normal as it was more mental abuse.” Participant 17 however, stated that she would have benefitted from her midwife educating her and explaining that domestic violence involved other forms of abuse other than just “physical” violence.

Findings from Ethnic Minority Women

Other notable findings of this study were that unique barriers were found for disclosure in the ethnic minority women. However, no unique themes were found for the white majority women. Three of the eight ethnic minority women explained that lack of language proficiency hindered them in disclosing. Interestingly, five of the ethnic minority women specifically expressed that prior to telling anyone about the abuse they had turned to religion/prayer first as a way of help-seeking.

The primary aim of this study was to understand the barriers and facilitators faced by women from ethnic majorities and minorities within the UK when disclosing domestic violence to the health care service. Three major themes emerged for barriers of disclosure: ‘Emotional barriers’, ‘Partner-related barriers’ and ‘Organisational barriers’.

Emotional barriers were most prevalent, with 69% of the sample stating that they had experienced one or more emotions that had prevented them from disclosing abuse to the health care service. This finding aligns with previous research demonstrating that negative emotions, such as fear, embarrassment, and shame, contribute to victims’ reasons for not disclosing abuse to the health care service. This has been previously found in other qualitative studies (e.g., Vranda et al. 2018 ) and also in a large-scale survey of Australian abused women, in which 21% noted that embarrassment and shame acted as a barrier to them disclosing domestic abuse to their GP (Hegarty and Taft 2001 ). In light of these findings, health care professionals - when disclosed to - should convey that they believe victims, reassure them and acknowledge that their decision to disclose was likely to have been ‘difficult’ and ‘frightening’. To reduce embarrassment and shame it is further recommended that health care professionals respond empathically and non-judgmentally to (potential) victims and they should undergo specialized training, which would prepare them for this. It should be noted though that attempts to introduce domestic violence specific training into the curricula of professional programs have been challenging, due to staff resistance (Valpied et al. 2017 ). An alternative may be to offer an option to disclose via the computer, which may be preferred for victims who feel embarrassed or ashamed (Chang et al. 2012 ).

Partner-related barriers for disclosure included partners’ controlling behaviours; victims’ partners would prevent them from leaving the house or insist on attending appointments. This finding was corroborated in another qualitative study in the UK, whereby domestic violence victims reported that their partners’ made it difficult for them to disclose, as they would attend their appointments with them (Rose et al. 2011 ). Uniquely, one person in our study reported that the perpetrator emotionally manipulated healthcare staff, which further reduced the chance of the victim disclosing. It is important that professionals are educated about the perpetrators ways of preventing disclosure. Whenever possible, women should be seen alone.

Two ‘organisational barriers’ were identified. Women communicated concerns about there not being sufficient time to disclose abuse and were also worried that the health care setting would not be an appropriate environment to discuss abuse. This finding corroborated results from Narula, Agarwal and McCarthy’s (Narula et al. 2012 ) qualitative research among Canadian abuse victims. Women in their study felt that it was inappropriate to disclose abuse to the family doctors. By contrast, 97% of women in this study stated that they felt that all women should be routinely asked by their GP if they are experiencing domestic abuse. To tackle this issue, WHO ( 2002 ) emphasise the importance of increasing knowledge among health service professionals and clients that domestic abuse is a medical problem.

This knowledge can be gained using multiple methods. First, health care professionals should make an effort to display information on the topic. In our study only (45%) of the women felt that there were ‘enough’ leaflets displayed in GPs’ surgeries. In line with this idea, Bolin and Elliott ( 1996 ) demonstrated the importance of providing information to patients’ as this increased their disclosure. In their study, two groups of doctor’s attended training for how to respond to domestic violence disclosures. The first group of doctors were assigned to wear buttons that read, “It’s okay to talk to me about family violence and abuse” and the other group of doctors wore no button. The doctors who wore the button managed to elicit significantly more conversations about abuse, despite them both having the same training and the doctors who wore the buttons also had an increase in patients’ disclosures. These results highlight the importance of environmental cues and ensuring that victims are made to feel comfortable to disclose. Second, health care professionals should ideally receive training to understand the impact of domestic violence on health and to train them to proactively ask about domestic violence. This is not yet standard practice, but could play a key role in improving disclosure as victims need to be given the opportunity to initiate support (Kataoka and Imazeki 2018 ). A recent study by Baird et al. ( 2018 ) found that a brief training (1-day workshop) improved the knowledge and preparedness of midwives and nurses to conduct routine enquiry and respond to women’s disclosures of domestic abuse. Such training may be even more effective if health care professionals can observe and model good practice. Engaging in case analysis, role play, obtaining feedback and having in-depth discussions, whilst making the training experiential and interactive has been found to be particularly effective in previous studies with health care professionals (Torres Vitolas et al. 2010 ).

Facilitators of disclosure in the health care service identified in this study fell under three major themes: ‘interpersonal relations, ‘safety’ and ‘validation’. The theme category of ‘interpersonal relations’ arose as a result of 52% victims in this study stating that they were able to disclose if they trusted the health professional. This corroborated other research, indicating that trust aided domestic violence disclosure to health care professionals (Eddy et al. 2008 ). One way of health care professionals establishing trust is for them to provide follow-up appointments with their patients, as continuity of care may help victims to gain more trust and is likely to facilitate later disclosure (Narula et al. 2012 ). This is particularly important since studies in the past have found that health care professionals have had difficulty establishing rapport with victims and they have noted that this has been a barrier to the disclosure process (Williams et al. 2017 ).

Over a quarter (28%) of female victims in this study suggested that safety and confidentiality was key in helping victims to disclose. Additionally, two women in this study expressed the need for health care professionals to provide home visits. Home visits may be an effective way to reach victims who feel too scared to present to health care service (Davidov et al. 2018 ). However, it is accompanied by safety concerns which need to be taken into account (Eddy et al. 2008 ). Telehealth services could offer another solution as it allows victims to access support from their own homes. This may be particularly useful for victims whose partners control their physical whereabouts. A recent qualitative study showed preliminary evidence that online interventions can be an effective way to reach out to domestic violence victims (Tarzia et al. 2018 ).

Furthermore, 14% of victims in this study communicated valuing health care professionals who validated their abuse experiences. Reisenhofer and Seibold ( 2013 ) similarly found in an Australian sample that victims in their study valued validation from the health care professional, as this helped them to understand that they were being abused and also the seriousness of their abuse. Notably, some of our participants particularly appreciated it when a health care professional confirmed that emotional abuse is also abuse. These findings suggest that health care professionals should be trained to validate victims’ experiences, especially when these victims disclose non-physical forms of abuse. It is also recommended as part of training health care professionals that personal attitudes are reflected upon with regard to the different types of abuse, and to ensure that they recognize that all forms are unacceptable.

Finally, this study also highlighted some additional problems for black and ethnic minority victims as they sometimes experienced communication and language difficulties. This finding is in line with existing research in a systematic review of four qualitative studies in the UK, which found language and interpretation also acted as barriers to disclosure in ethnic minority victims (Femi-Ajao et al. 2020 ). Possibly, in our study the barriers of language and communication may have resulted in the majority (five) of the eight ethnic minority women turning to religion first. This has not yet been found in other studies with ethnic minority domestic violence victims. However, in another study with sexual assault victims, ethnic minority women, specifically African American victims of sexual violence, were found to use religious coping more than other ethnicities (Ahrens et al. 2010 ). Additionally, it has been observed in other studies with ethnic minority victims of domestic violence in the UK, that collaboration with faith-based organizations is key to aiding disclosure (Femi-Ajao 2018 ). Therefore, it would be interesting to research further the problems and barriers which ethnic minority women may experience when disclosing domestic abuse and how different cultures may deal with disclosure differently. It could be that interventions with domestic violence for ethnic minority women may be better implemented in religious organizations. In some cases, the provision of language support and interpreters with knowledge of the associated culture (link workers) may further help disclosure from ethnic minority victims to professionals (Reina et al. 2014 ).

This study had a number of limitations. First, it was conducted among adult female victims of domestic violence in only one geographical area of the UK. Future research is required to explore victims’ views on barriers and facilitators of disclosure in other areas of the UK, and in other countries, to see if the themes identified in this study generalize to other populations. Second, this study included women who had already disclosed domestic violence (although not necessarily always to the health care service). Therefore, it is possible that the barriers and facilitators experienced by the women in this study are different to those experienced by victims who do not disclose. Third, whilst the qualitative method of interviewing was useful in gaining in-depth information, it is susceptible to social desirability bias. For example, women may have provided answers to the researcher, which were not totally accurate due to wanting to please the researcher by telling them what they perceived the researcher wanted to hear. Future research may include larger scale quantitative studies, which may be less susceptible to such biases. Relatedly, the percentages of women indicating experiencing certain barriers or facilitators may differ if questionnaires specifying potential barriers and facilitators were used, and should thus be interpreted with caution. An additional limitation of this research was that it grouped together all health care professionals and so it did not explore if there were differences between disclosing to a GP versus a health visitor for instance, as has been researched in previous studies (Bacchus et al. 2002 ).

Notwithstanding these limitations, this qualitative study contributed to the literature on domestic violence by further elucidating the complex set of barriers and facilitators experienced by British female domestic violence victims when disclosing abuse to health care professionals. This study also highlighted some problems of ethnic minority victims of domestic violence that require further research. This study thereby contributes to the knowledge base that is needed for health care services to become better equipped to facilitate disclosure by domestic violence victims, helping more women to access support and become free from victimization.

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07 june 2021.

A Correction to this paper has been published: https://doi.org/10.1007/s10896-021-00281-6

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Heron, R.L., Eisma, M.C. & Browne, K. Barriers and Facilitators of Disclosing Domestic Violence to the UK Health Service. J Fam Viol 37 , 533–543 (2022). https://doi.org/10.1007/s10896-020-00236-3

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The most interesting literature reviews are often written as arguments (again, as mentioned at the beginning of the page, this is discipline-specific and doesn’t work for all situations). Often, the literature review is where you can establish your research as filling a particular gap or as relevant in a particular way. You have some chance to do this in your introduction in an article, but the literature review section gives a more extended opportunity to establish the conversation in the way you would like your readers to see it. You can choose the intellectual lineage you would like to be part of and whose definitions matter most to your thinking (mostly humanities-specific, but this goes for sciences as well). In addressing these points, you argue for your place in the conversation, which tends to make the lit review more compelling than a simple reporting of other sources.

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• 1 University of Geneva, Switzerland

The final, formatted version of the article will be published soon.

Rabies and snakebite envenoming are two zoonotic neglected tropical diseases (NTDs) transmitted to humans by animal bites, causing each year around 179,000 deaths and are most prevalent in Asia and Africa. Improving geographical accessibility to treatment is crucial in reducing the time from bite to treatment. This mini review aims to identify and synthesize recent studies on the consequences of distance and travel time on the victims of these diseases in African countries, in order to discuss potential joint approaches for health system strengthening targeting both diseases. A literature review was conducted separately for each disease using Pubmed, Google Scholar, and snowball searching. Eligible studies, published between 2017 and 2022, had to discuss any aspect linked to geographical accessibility to treatments for either disease in Africa.Twenty-two articles (8 on snakebite and 14 on rabies) were eligible for data extraction. No study targeted both diseases. Identified consequences of low accessibility to treatment were classified into 6 categories: 1) Delay to treatment; 2) Outcome; 3) Financial impacts; 4) Underreporting; 5) Compliance to treatment, and 6) Visits to traditional healers.Geographical access to treatment significantly influences the burden of rabies and snakebite in Africa. In line with WHO's call for integrating approaches among NTDs, there are opportunities to model disease hotspots, assess population coverage, and optimize geographic access to care for both diseases, possibly jointly. This could enhance the management of these NTDs and contribute to achieving the global snakebite and rabies roadmaps by 2030.

Keywords: Rabies, Snakebite, Neglected Tropical Desease, Africa, accessibility

Received: 08 Oct 2023; Accepted: 15 May 2024.

Copyright: © 2024 Faust and Ray. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Nicolas Ray, University of Geneva, Geneva, 1211, Geneva, Switzerland

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Alice Munro, Canadian author who mastered the short story, dead at 92

Munro, who won the nobel prize in 2013, acclaimed for blending ordinary lives with extraordinary themes.

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Alice Munro, a Canadian author who was revered worldwide as master of the short story and one of few women to win the Nobel Prize in Literature, has died at the age of 92.

Her publisher said she died at her home in Port Hope, Ont., on Monday evening.

"Alice Munro is a national treasure — a writer of enormous depth, empathy, and humanity whose work is read, admired, and cherished by readers throughout Canada and around the world," read a statement from Kristin Cochrane, CEO of McClelland & Stewart, which is owned by Penguin Random House Canada.

"Alice's writing inspired countless writers too, and her work leaves an indelible mark on our literary landscape."

Munro wrote more than a dozen acclaimed collections over the course of her career, seamlessly blending ordinary people with extraordinary themes — womanhood, restlessness, aging — to develop complex characters with the nuance, depth and clarity most writers can only find in the wider confines of a novel.

In honouring her with the Nobel Prize in Literature in 2013, the Swedish Academy hailed Munro as "master of the contemporary short story," affirming what her peers, critics and readers had proclaimed for years.

• Canadian authors remember the late Alice Munro — and the literary legacy she leaves behind
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"Alice Munro was one of the world's greatest storytellers. Her short stories about life, friendship, and human connection left an indelible mark on readers. A proud Canadian, she leaves behind a remarkable legacy," read a statement from Prime Minister Justin Trudeau on Tuesday.

"On behalf of the Government of Canada, I offer my condolences to Mrs. Munro's family, friends, and many fans. Her creativity, compassion, and gift for writing will remain an inspiration for generations."

Early years in small-town Ontario

Munro was born Alice Laidlaw in Wingham, Ont., on July 10, 1931. The eldest child of Robert and Anne Laidlaw, she was raised on what she described as a " collapsing enterprise of a fox and mink farm " in the throes of the Great Depression.

An avid reader by 11, Munro was drawn to the work of literary legends Lucy Maud Montgomery and Charles Dickens. She began "making up stories in her mind" after discovering the works of Alfred Tennyson, according to her official Nobel biography.

Alice Munro on the craft of writing

As the eldest child, Munro took on most of the domestic roles in the household after her mother, who had been a schoolteacher, was diagnosed with Parkinson's disease. Though only 12 or 13, Munro said the work gave her "a sense of responsibility, purpose, being important. It didn't bother me at all."

Despite the family challenges, she began writing short stories when she was a teenager. She graduated valedictorian of her high school class in 1949 with a two-year scholarship to the University of Western Ontario in London.

Her first published story, The Dimensions of a Shadow , appeared in Western's undergraduate creative writing magazine, Folio, in the spring of 1950 . Two more pieces followed, with all three receiving praise for their exploration of the lives of girls and women.

It was there that she met and began dating honours history student James Munro. She also noticed Gerald Fremlin, an older student and another contributor to Folio.  Laidlaw and Munro married at her parents' home in Wingham on Dec. 29, 1951. The following year, James gave his wife a typewriter as a 21st birthday present.

The Munros had three daughters — Sheila, Catherine and Jenny — in the early years of their marriage. (Catherine died the same day she was born.) Munro left university when the scholarship money ran out and the family eventually settled in West Vancouver's Dundarave neighbourhood.

• 92 things to know about master short story writer Alice Munro
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The monotony of the girls' early years was reflected in 1978's The Moons of Jupiter , which described "wives yawning, napping, visiting, drinking coffee, and folding diapers; husbands coming home at night from the city across the water."

"We had become a cartoon couple, more middle-aged in our twenties than we would be in middle age," she wrote.

5 coolest things Alice Munro told CBC about her writing

Devotion to the short story.

Munro later said she devoted her career to the short story medium — regarded by many as notoriously difficult and by others as inferior to the novel — because the demands of marriage and motherhood didn't allow her the time to complete longer works.

In 1963, the Munros moved to Victoria and opened Munro's Books on Yates Street. Munro credits the bookstore, which made a "marvellous" $175 on its first day and is still flourishing, as helping her overcome the writer's block she experienced from her mid-20s to her mid-30s: "The writing ceased to be this all-important thing that I had to prove myself with. The pressure came off."

"Just as she would shape Munro's, Munro's would shape Alice," the shop wrote in a tribute to its founder. "Jim enjoyed recounting his wife's urge to write something better than the 'crappy books' that sold alongside the store's more palatable titles."

Alice Munro remembered at the beloved Victoria book store she co-founded

Munro's first collection of stories, Dance of the Happy Shades , was published in 1968 — two years after she gave birth to her fourth daughter, Andrea. The anthology drew attention from other Canadian literary giants such as Margaret Atwood and earned her comparisons to the famed Russian short story writer Anton Chekhov.

After her marriage ended in 1972, Munro moved back to Ontario. She reconnected with Fremlin — whom she'd shared pages with in Folio back at Western — after he deduced from an interview of hers on CBC Radio in 1974 that she was back in Ontario. The pair married and moved to Clinton, Ont., not far from her hometown in Wingham.

Fremlin, a retired geographer and cartographer, was the one to use the office in the couple's home. Munro opted to write at a tiny desk facing a window overlooking the driveway from the corner of their dining room, according to a 2013 profile . 

Alice Munro amazed by Nobel win

International recognition came after the New Yorker bought its first Munro story, Royal Beatings , in 1977. Munro nurtured a decades-long publishing relationship with the magazine, cementing the Canadian author's status with an elite group of contributors who defined the American publication's celebrated love affair with short fiction .

An unapologetic revisionist, Munro was known to keep reworking stories even after her publisher had sent them back without asking for any changes.

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In one instance , she personally paid financial penalties in order to add an entirely new story and change the voice from first to third person after the printing deadline for Who Do You Think You Are? — a collection of short stories that went on to win Munro the Governor General's Award in 1978.

Munro won a litany of literary honours over the next decades of her career, including two more Governor General's Awards, two Giller Prizes and the Man Booker International Prize. She also received an honorary degree from her alma mater, Western University — the "only such honour" she ever accepted, the school has said .

In mid-2013, shortly after the death of her second husband, Munro told the National Post that she was content with her career and "probably not going to write anymore."

She won the Nobel Prize in Literature that October, becoming the 13th woman to receive the honour.

In an interview with CBC after her Nobel win, Munro said: "I think my stories have gotten around quite remarkably for short stories, and I would really hope that this would make people see the short story as an important art, not just something that you played around with until you'd got a novel written."

Munro's last collection of work, Dear Life , was published in 2012. She introduced the final four stories in its pages, called Finale , as "autobiographical in feeling", if only partly.

"I believe they are the first and last — and the closest — things I have to say about my own life."

ABOUT THE AUTHOR

Senior Writer

Rhianna Schmunk is a senior writer for CBC News based in Vancouver. Over a decade in journalism, she has reported on subjects including criminal justice, civil litigation and climate change. You can send story tips to [email protected].

• Send confidential story tips with SecureDrop
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With files from CBC Books

Related Stories

• audio Alice Munro’s friend and editor on what made her ‘a world-class figure’
• Alice Munro wrote about life, love, sex and secrets — revisit her 2004 conversation with Eleanor Wachtel

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Exploring factors influencing domestic violence: a comprehensive study on intrafamily dynamics

Cintya lanchimba.

1 Departamento de Economía Cuantitativa, Facultad de Ciencias Escuela Politécnica Nacional, Quito, Ecuador

2 Institut de Recherche en Gestion et Economie, Université de Savoie Mont Blanc (IREGE/IAE Savoie Mont Blanc), Annecy, France

Juan Pablo Díaz-Sánchez

Franklin velasco.

3 Department of Marketing, Universidad San Francisco de Quito USFQ, Quito, Ecuador

Associated Data

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Introduction

This econometric analysis investigates the nexus between household factors and domestic violence. By considering diverse variables encompassing mood, depression, health consciousness, social media engagement, household chores, density, and religious affiliation, the study aims to comprehend the underlying dynamics influencing domestic violence.

Employing econometric techniques, this study examined a range of household-related variables for their potential associations with levels of violence within households. Data on mood, depression, health consciousness, social media usage, household chores, density, and religious affiliation were collected and subjected to rigorous statistical analysis.

The findings of this study unveil notable relationships between the aforementioned variables and levels of violence within households. Positive mood emerges as a mitigating factor, displaying a negative correlation with violence. Conversely, depression positively correlates with violence, indicating an elevated propensity for conflict. Increased health consciousness is linked with diminished violence, while engagement with social media demonstrates a moderating influence. Reduction in the time allocated to household chores corresponds with lower violence levels. Household density, however, exhibits a positive association with violence. The effects of religious affiliation on violence manifest diversely, contingent upon household position and gender.

The outcomes of this research offer critical insights for policymakers and practitioners working on formulating strategies for preventing and intervening in instances of domestic violence. The findings emphasize the importance of considering various household factors when designing effective interventions. Strategies to bolster positive mood, alleviate depression, encourage health consciousness, and regulate social media use could potentially contribute to reducing domestic violence. Additionally, the nuanced role of religious affiliation underscores the need for tailored approaches based on household dynamics, positioning, and gender.

1. Introduction

Intimate partner violence is a pervasive global issue, particularly affecting women. According to the World Health Organization ( 1 ), approximately 30% of women worldwide have experienced violence from their intimate partners. Disturbingly, recent studies indicate that circumstances such as the COVID-19 pandemic, which disrupt daily lives on a global scale, have exacerbated patterns of violence against women ( 2 – 4 ). Data from the WHO ( 1 ) regarding gender-based violence during the pandemic reveals that one in three women felt insecure within their homes due to family conflicts with their partners.

This pressing issue of intimate partner violence demands a thorough analysis from a social perspective. It is often insidious and challenging to identify, as cultural practices and the normalization of abusive behaviors, such as physical aggression and verbal abuse, persist across diverse socioeconomic backgrounds. However, all forms of violence can inflict physical and psychological harm on victims, affecting their overall well-being and interpersonal relationships WHO ( 5 ). Furthermore, households with a prevalence of domestic violence are more likely to experience child maltreatment ( 6 ).

In this context, the COVID-19 pandemic has had profound effects on individuals, families, and communities worldwide, creating a complex landscape of challenges and disruptions. Among the numerous repercussions, the pandemic has exposed and exacerbated issues of domestic violence within households. The confinement measures, economic strain, and heightened stress levels resulting from the pandemic have contributed to a volatile environment where violence can escalate. Understanding the factors that influence domestic violence during this unprecedented crisis is crucial for developing effective prevention and intervention strategies.

This article aims to explore the relationship between household factors and domestic violence within the context of the COVID-19 pandemic. By employing econometric analysis, we investigate how various factors such as mood, depression, health consciousness, social media usage, household chores, density, and religious affiliation relate to violence levels within households. These factors were selected based on their relevance to the unique circumstances and challenges presented by the pandemic.

The study builds upon existing research that has demonstrated the influence of individual and household characteristics on domestic violence. However, the specific context of the pandemic necessitates a deeper examination of these factors and their implications for violence within households. By focusing on variables that are particularly relevant in the crisis, we aim to provide a comprehensive understanding of the dynamics that contribute to intrafamily violence during the pandemic.

The findings of this study have important implications for policymakers, practitioners, and researchers involved in addressing domestic violence. By identifying the factors that either increase or mitigate violence within households, we can develop targeted interventions and support systems to effectively respond to the unique challenges posed by the pandemic. Furthermore, this research contributes to the broader literature on domestic violence by highlighting the distinct influence of household factors within the context of a global health crisis.

The structure of this paper is organized as follows. Section 2 provides a comprehensive review of the relevant literature on household violence. Section 3 presents the case study that forms the basis of this research. Section 4 outlines the methodology employed in the study. Section 5 presents the results obtained from the empirical analysis. Finally, Section 6 concludes the paper, summarizing the key findings and their implications for addressing domestic violence.

2. Literature review

2.1. violence at home.

Throughout human history, the family unit has been recognized as the fundamental building block of society. Families are comprised of individuals bound by blood or marriage, and they are ideally regarded as havens of love, care, affection, and personal growth, where individuals should feel secure and protected. Unfortunately, it is distressingly common to find alarming levels of violence, abuse, and aggression within the confines of the home ( 7 ).

Domestic violence, as defined by Tan and Haining ( 8 ), encompasses any form of violent behavior directed toward family members, regardless of their gender, resulting in physical, sexual, or psychological harm. It includes acts of threats, coercion, and the deprivation of liberty. This pervasive issue is recognized as a public health problem that affects all nations. It is important to distinguish between domestic violence (DV) and intimate partner violence (IPV), as they are related yet distinct phenomena. DV occurs within the family unit, affecting both parents and children. On the other hand, IPV refers to violent and controlling acts perpetrated by one partner against another, encompassing physical aggression (such as hitting, kicking, and beating), sexual, economic, verbal, or emotional harm ( 9 , 10 ). IPV can occur between partners who cohabit or not, and typically involves male partners exerting power and control over their female counterparts. However, it is crucial to acknowledge that there are cases where men are also victims of violence ( 11 ).

Both forms of violence, DV and IPV, take place within the home. However, when acts of violence occur in the presence of children, regardless of whether they directly experience physical harm or simply witness the violence, the consequences can be profoundly detrimental ( 12 , 13 ).

Understanding the intricacies and dynamics of domestic violence and its impact on individuals and families is of paramount importance. The consequences of such violence extend beyond the immediate victims, affecting the overall well-being and social fabric of society. Therefore, it is crucial to explore the various factors that contribute to domestic violence, including those specific to the current context of the COVID-19 pandemic, in order to inform effective prevention and intervention strategies. In the following sections, we will examine the empirical findings regarding household factors and their association with domestic violence, shedding light on the complexities and nuances of this pervasive issue.

2.2. Drivers of domestic violence

As previously discussed, the occurrence of violence within the home carries significant consequences for individuals’ lives. Consequently, gaining an understanding of the underlying factors that contribute to this violence is crucial. To this end, Table 1 provides a comprehensive summary of the most commonly identified determinants of domestic violence within the existing literature.

Determinants of domestic violence.

Adapted and improved from the classification proposed by Visaria ( 16 ).

Identifying these determinants is a vital step toward comprehending the complex nature of domestic violence. By synthesizing the findings from numerous studies, Table 1 presents a consolidated overview of the factors that have been consistently associated with domestic violence. This compilation serves as a valuable resource for researchers, practitioners, and policymakers seeking to address and mitigate the prevalence of domestic violence.

The determinants presented in Table 1 encompass various variables, including socio-economic factors, mental health indicators, interpersonal dynamics, and other relevant aspects. By examining and analyzing these determinants, researchers have made significant progress in uncovering the underlying causes and risk factors associated with domestic violence.

It is important to note that the determinants listed in Table 1 represent recurring themes in the literature and are not an exhaustive representation of all potential factors influencing domestic violence. The complex nature of this issue necessitates ongoing research and exploration to deepen our understanding of the multifaceted dynamics at play. Thus, we categorize these factors into two groups to provide a comprehensive understanding of the issue.

Group A focuses on variables that characterize both the victim and the aggressor, which may act as potential deterrents against femicide. Previous research by Alonso-Borrego and Carrasco ( 17 ), Anderberg et al. ( 18 ), Sen ( 19 ), and Visaria ( 16 ) has highlighted the significance of factors such as age, level of education, employment status, occupation, and religious affiliation. These individual characteristics play a role in shaping the dynamics of domestic violence and can influence the likelihood of its occurrence.

Group B aims to capture risk factors that contribute to the presence of violence within the home. One prominent risk factor is overcrowding, which can lead to psychological, social, and economic problems within the family, ultimately affecting the health of its members. Research by Van de Velde et al. ( 21 ), Walker-Descartes et al. ( 23 ), Malik and Naeem ( 2 ) supports the notion that individuals experiencing such distress may resort to exerting force or violence on other family members as a means of releasing their frustration. Additionally, Goodman ( 32 ) have highlighted the increased risk of violence in households with multiple occupants, particularly in cases where individuals are confined to a single bedroom. These concepts can be further explored through variables related to health, depression, anxiety, and stress, providing valuable insights into the mechanisms underlying domestic violence.

By investigating these factors, our study enhances the existing understanding of the complex dynamics of domestic violence within the unique context of the pandemic. The COVID-19 crisis has exacerbated various stressors and challenges within households, potentially intensifying the risk of violence. Understanding the interplay between these factors and domestic violence is essential for the development of targeted interventions and support systems to mitigate violence and its consequences.

2.3. Demographic characteristics (A)

2.3.1. education level (a1).

According to Sen ( 19 ), the education level of the victim, typically women, or the head of household is a significant antecedent of domestic violence. Women’s access to and completion of secondary education play a crucial role in enhancing their capacity and control over their lives. Higher levels of education not only foster confidence and self-esteem but also empower women to seek help and resources, ultimately reducing their tolerance for domestic violence. Babu and Kar ( 33 ), Semahegn and Mengistie ( 34 ) support this perspective by demonstrating that women with lower levels of education and limited work opportunities are more vulnerable to experiencing violence.

When women assume the role of the head of the household, the likelihood of violence within the household, whether domestic or intimate partner violence, increases significantly. This has severe physical and mental health implications for both the woman and other family members, and in the worst-case scenario, it can result in the tragic loss of life ( 22 , 23 , 35 ).

Conversely, men’s economic frustration or their inability to fulfill the societal expectation of being the “head of household” is also a prominent factor contributing to the perpetration of physical and sexual violence within the home ( 36 ).The frustration arising from economic difficulties, combined with the frequent use of drugs and alcohol, exacerbates the likelihood of violent behavior.

These findings underscore the importance of addressing socio-economic disparities and promoting gender equality in preventing and combating domestic violence. By enhancing women’s access to education, improving economic opportunities, and challenging traditional gender roles, we can create a more equitable and violence-free society. Additionally, interventions targeting men’s economic empowerment and addressing substance abuse issues can play a pivotal role in reducing violence within the home.

2.3.2. Employment and occupation (A2)

Macroeconomic conditions, specifically differences in unemployment rates between men and women, have been found to impact domestic violence. Research suggests that an increase of 1% in the male unemployment rate is associated with an increase in physical violence within the home, while an increase in the female unemployment rate is linked to a reduction in violence ( 37 ).

Moreover, various studies ( 34 , 35 , 38 , 39 ) have highlighted the relationship between domestic violence and the husband’s working conditions, such as workload and job quality, as well as the income he earns. The exercise of authority within the household and the use of substances that alter behavior are also associated with domestic violence.

Within this context, economic gender-based violence is a prevalent but lesser-known form of violence compared to physical or sexual violence. It involves exerting unacceptable economic control over a partner, such as allocating limited funds for expenses or preventing them from working to maintain economic dependence. This form of violence can also manifest through excessive and unsustainable spending without consulting the partner. Economic gender-based violence is often a “silent” form of violence, making it more challenging to detect and prove ( 40 ).

Empowerment becomes a gender challenge that can lead to increased violence, as men may experience psychological stress when faced with the idea of women earning more than them ( 14 , 18 ). Lastly, Alonso-Borrego and Carrasco ( 17 ) and Tur-Prats ( 41 ) conclude that intrafamily violence decreases only when the woman’s partner is also employed, highlighting the significance of economic factors in influencing domestic violence dynamics.

Understanding the interplay between macroeconomic conditions, employment, and economic control within intimate relationships is crucial for developing effective interventions and policies aimed at reducing domestic violence. By addressing the underlying economic inequalities and promoting gender equality in both the labor market and household dynamics, we can work toward creating safer and more equitable environments that contribute to the prevention of domestic violence.

2.3.3. Religion (A3)

Religion and spiritual beliefs have been found to play a significant role in domestic violence dynamics. Certain religious interpretations and teachings can contribute to the acceptance of violence, particularly against women, as a form of submission or obedience. This phenomenon is prevalent in Middle Eastern countries, where religious texts such as the Bible and the Qur’an are often quoted to justify and perpetuate gender-based violence ( 20 ).

For example, in the book of Ephesians 5:22–24, the Bible states that wives should submit themselves to their husbands, equating the husband’s authority to that of the Lord. Similarly, the Qur’an emphasizes the importance of wives being sexually available to their husbands in all aspects of their relationship. These religious teachings can create a belief system where women are expected to endure mistreatment and forgive their abusive partners ( 15 ).

The influence of religious beliefs and practices can complicate a woman’s decision to leave an abusive relationship, particularly when marriage is considered a sacred institution. Feelings of guilt and difficulties in seeking support or ending the relationship can arise due to the belief that marriage is ordained by God ( 15 ).

It is important to note that the response of religious congregations and communities to domestic violence can vary. In some cases, if abuse is ignored or not condemned, it may perpetuate the cycle of violence and hinder efforts to support victims and hold perpetrators accountable. However, in other instances, religious organizations may provide emotional support and assistance through dedicated sessions aimed at helping all affected family members heal and address the violence ( 20 ).

Recognizing the influence of religious beliefs on domestic violence is crucial for developing comprehensive interventions and support systems that address the specific challenges faced by individuals within religious contexts. This includes promoting awareness, education, and dialog within religious communities to foster an understanding that violence is never acceptable and to facilitate a safe environment for victims to seek help and healing.

2.4. Presence of risk factor (B)

2.4.1. depression, anxiety, and stress (b1).

Within households, the occurrence of violence is unfortunately prevalent, often stemming from economic constraints, social and psychological problems, depression, and stress. These factors instill such fear in the victims that they are often hesitant to report the abuse to the authorities ( 42 ).

Notably, when women assume the role of heads of households, they experience significantly higher levels of depression compared to men ( 21 ). This study highlights that the presence of poverty, financial struggles, and the ensuing violence associated with these circumstances significantly elevate the risk of women experiencing severe health disorders, necessitating urgent prioritization of their well-being. Regrettably, in low-income countries where cases of depression are on the rise within public hospitals, the provision of adequate care becomes an insurmountable challenge ( 21 ).

These findings underscore the urgent need for comprehensive support systems and targeted interventions that address the multifaceted impact of domestic violence on individuals’ mental and physical health. Furthermore, effective policies should be implemented to alleviate economic hardships and provide accessible mental health services, particularly in low-income settings. By addressing the underlying factors contributing to violence within households and ensuring adequate care for those affected, society can take significant strides toward breaking the cycle of violence and promoting a safer and more supportive environment for individuals and families.

2.4.2. Retention tendency (B2)

Many societies, particularly in Africa, are characterized by a deeply ingrained patriarchal social structure, where men hold the belief that they have the right to exert power and control over their partners ( 31 ). This ideology of patriarchy is often reinforced by women themselves, who may adhere to traditional gender roles and view marital abuse as a norm rather than recognizing it as an act of violence. This acceptance of abuse is influenced by societal expectations and cultural norms that prioritize the preservation of marriage and the submission of women.

Within these contexts, there is often a preference for male children over female children, as males are seen as essential for carrying on the family name and lineage ( 43 ). This preference is also reflected in the distribution of property and decision-making power within households, where males are given greater rights and authority. Such gender-based inequalities perpetuate the cycle of power imbalances and contribute to the normalization of violence against women.

It is important to note that men can also be victims of domestic violence. However, societal and cultural norms have long portrayed men as strong and superior figures, making it challenging for male victims to come forward and report their abusers due to the fear of being stigmatized and rejected by society ( 16 ). The cultural expectations surrounding masculinity create barriers for men seeking help and support, further perpetuating the silence around male victimization.

These cultural dynamics underscore the complexity of domestic violence within patriarchal societies. Challenging and dismantling deeply rooted gender norms and power structures is essential for addressing domestic violence effectively. This includes promoting gender equality, empowering women, and engaging men and boys in efforts to combat violence. It also requires creating safe spaces and support systems that encourage both women and men to break the silence, seek help, and challenge the harmful societal narratives that perpetuate violence and victim-blaming.

2.4.3. Density (B3)

Moreover, the issue of overcrowding within households has emerged as another important factor influencing domestic violence. Overcrowding refers to the stress caused by the presence of a large number of individuals in a confined space, leading to a lack of control over one’s environment ( 44 ). This overcrowding can have a detrimental impact on the psychological well-being of household members, thereby negatively affecting their internal relationships.

The freedom to use spaces within the home and the ability to control interactions with others have been identified as crucial factors that contribute to satisfaction with the home environment and the way individuals relate to each other. In this regard, studies have shown that when households are crowded, and individuals lack personal space and control over their living conditions, the risk of violence may increase ( 45 ).

Furthermore, investigations conducted during periods of extensive confinement, such as the COVID-19 pandemic, have shed light on the significance of other environmental factors within homes ( 46 ). For instance, aspects like proper ventilation and adequate living space have been found to influence the overall quality of life and the health of household inhabitants.

These findings emphasize the importance of considering the physical living conditions and environmental factors within households when examining the dynamics of domestic violence. Addressing issues of overcrowding, promoting healthy and safe living environments, and ensuring access to basic amenities and resources are crucial steps in reducing the risk of violence and improving the well-being of individuals and families within their homes.

2.4.4. Reason for confrontation (B4)

Another form of violence that exists within households is abandonment and neglect, which manifests through a lack of protection, insufficient physical care, neglecting emotional needs, and disregarding proper nutrition and medical care ( 47 ). This definition highlights that any member of the family can be subjected to this form of violence, underscoring the significance of recognizing its various manifestations.

In this complex context, negative thoughts and emotions can arise, leading to detrimental consequences. For instance, suspicions of infidelity and feelings of jealousy can contribute to a decrease in the partner’s self-esteem, ultimately triggering intimate partner violence that inflicts physical, social, and health damages ( 32 , 48 ).

Furthermore, it is important to acknowledge the intimate connection between domestic violence and civil issues. Marital conflicts, particularly when accompanied by violence, whether physical or psychological, can lead to a profound crisis within the relationship, often resulting in divorce. Unfortunately, the process of obtaining a divorce or establishing parental arrangements can be protracted, creating additional friction and potentially exacerbating gender-based violence ( 49 ).

These dynamics underscore the complex interplay between domestic violence and broader social, emotional, and legal contexts. Understanding these interconnected factors is crucial for developing effective interventions and support systems that address the multifaceted nature of domestic violence, promote healthy relationships, and safeguard the well-being of individuals and families within the home.

Finally, despite the multitude of factors identified in the existing literature that may have an impact on gender-based violence, we have selected a subset of variables for our study based on data availability. Specifically, our analysis will concentrate on the following factors reviewed: (A3) religion, (B1) depression, health consciousness, and mood, (B2) retention tendency as reflected by household chores, and (B3) density.

The rationale behind our choice of these variables stems from their perceived significance and potential relevance to the study of domestic violence. Religion has been widely acknowledged as a social and cultural determinant that shapes beliefs, values, and gender roles within a society, which may have implications for power dynamics and relationship dynamics within households. Depression, as a psychological construct, has been frequently associated with increased vulnerability and impaired coping mechanisms, potentially contributing to the occurrence or perpetuation of domestic violence. Health consciousness and mood are additional constructs that have garnered attention in the context of interpersonal relationships. Health consciousness relates to individuals’ awareness and concern for their own well-being and that of others, which may influence their attitudes and behaviors within the household. Mood, on the other hand, reflects emotional states that can influence communication, conflict resolution, and overall dynamics within intimate relationships.

Furthermore, we have included the variable of retention tendency, as manifested through household chores. This variable is indicative of individuals’ willingness or inclination to maintain their involvement and responsibilities within the household. It is hypothesized that individuals with higher retention tendencies may exhibit a greater commitment to the relationship, which could influence the occurrence and dynamics of domestic violence. Lastly, we consider the variable of density, which captures the population density within the living environment. This variable may serve as a proxy for socio-environmental conditions, such as overcrowding or limited personal space, which can potentially contribute to stress, conflict, and interpersonal tensions within households.

By examining these selected factors, we aim to gain insights into their relationships with domestic violence and contribute to a better understanding of the complex dynamics underlying such occurrences. It is important to note that these variables represent only a subset of the broader range of factors that influence gender-based violence, and further research is warranted to explore additional dimensions and interactions within this multifaceted issue.

3. Data collection and variables

The reference population for this study is Ecuadorian habitants. Participants were invited to fill up a survey concerning COVID-19 impact on their mental health. Data collection took place between April and May 2020, exactly at the time of the mandatory lockdowns taking place. In this context governmental authorities ordered mobility restrictions as well as social distancing measures. We conduct three waves of social media invitations to participate in the study. Invitations were sent using the institutional accounts of the universities the authors of this study are affiliated. At the end, we received 2,403 answers, 50.5% females and 49.5% males. 49% of them have college degrees.

3.1. Ecuador stylized facts

Ecuador, a small developing country in South America, has a population of approximately 17 million inhabitants, with a population density of 61.85 people per square kilometer.

During the months under investigation, the Central Bank of Ecuador reported that the country’s GDP in the fourth quarter of 2020 amounted to $16,500 million. This represented a decrease of 7.2% compared to the same period in 2019, and a 5.6% decline in the first quarter of 2021 compared to the same quarter of the previous year. However, despite these declines, there was a slight growth of 0.6% in the GDP during the fourth quarter of 2020 and 0.7% in the first quarter of 2021 when compared to the previous quarter.

In mid-March, the Ecuadorian government implemented a mandatory lockdown that lasted for several weeks. By July 30, 2020, Ecuador had reported over 80,000 confirmed cases of COVID-19. The statistics on the impact of the pandemic revealed a death rate of 23.9 per 100,000 inhabitants, ranking Ecuador fourth globally behind the UK, Italy, and the USA, with rates of 63.7, 57.1, and 36.2, respectively. Additionally, Ecuador’s observed case-fatality ratio stood at 8.3%, placing it fourth globally after Italy, the UK, and Mexico, with rates of 14.5, 14, and 11.9%, respectively ( 50 ). As the lockdown measures continued, mental health issues began to emerge among the population ( 51 ).

The challenging socioeconomic conditions and the impact of the pandemic on public health have had significant repercussions in Ecuador, highlighting the need for comprehensive strategies to address both the immediate and long-term consequences on the well-being of its population.

3.2. Dependent variable

The dependent variable in this study is Domestic Violence, which is measured using a composite score derived from five items. These items were rated on a 7-point scale, ranging from 1 (never) to 7 (very frequent), to assess the frequency of intrafamily conflict and violence occurring within the respondents’ homes. The five items included the following statements: “In my house, subjects are discussed with relative calm”; “In my house, heated discussions are common but without shouting at each other”; “Anger is common in my house, and I refuse to talk to others”; “In my house, there is the threat that someone will hit or throw something”; and “In my house, family members get easily irritated.”

To evaluate the internal consistency of the measurement, Cronbach’s Alpha was calculated and found to be 0.7. This indicates good internal consistency, suggesting that the items in the scale are measuring a similar construct and can be considered reliable for assessing the level of domestic violence within the households under investigation.

3.3. Independent variables

3.3.1. mood.

The mood construct, based on Peterson and Sauber ( 52 ), is measured using three Likert scale questions. The respondents rate their agreement on a scale from strongly disagree to strongly agree. The questions included: “I am in a good mood,” “I feel happy,” and “At this moment, I feel nervous or irritable.” The Cronbach’s Alpha coefficient for this construct is 0.7757, indicating good internal consistency.

3.3.2. Depression

The depression construct, based on the manual for the Depression Anxiety Stress Scales by Lovibond S and Lovibond P, is measured by summing the results of 13 Likert scale questions. The scale ranges from strongly disagreeing to strongly agreeing. The questions include: “I feel that life is meaningless,” “I do not feel enthusiastic about anything,” “I feel downhearted and sad,” and others. The Cronbach’s Alpha coefficient for this construct is 0.9031, indicating high internal consistency.

3.3.3. Health consciousness

The health consciousness construct, based on Gould ( 53 ), is measured using four Likert scale questions. The respondents rate their agreement on a scale from strongly disagree to strongly agree. The questions include: “I’m alert to changes in my health,” “I am concerned about the health of others,” “Throughout the day, I am aware of what foods are best for my health,” and “I notice how I lose energy as the day goes by.” The Cronbach’s Alpha coefficient for this construct is 0.7, indicating acceptable internal consistency.

3.3.4. Household chores

The respondents were asked to rate their involvement in various household chores on a scale from “not at all” to “a lot.” The listed household chores include cooking, washing dishes, cleaning restrooms, doing laundry, home maintenance, and helping with children/siblings. It can serve as a proxy for Retention Tendency.

3.3.5. Density

It is measured as the number of people per bedroom, indicating the level of overcrowding within households.

3.3.6. Religion

The religion construct is measured as the sum of four Likert scale items based on Worthington et al. ( 54 ). The respondents rate their agreement on a scale from strongly disagree to strongly agree. The items include: “My religious beliefs lie behind my whole approach to life,” “It is important to me to spend periods in private religious thought and reflection,” “Religion is very important to me because it answers many questions about the meaning of life,” and “I am informed about my local religious group and have some influence in its decisions.” The Cronbach’s Alpha coefficient for this construct is 0.8703, indicating good internal consistency.

3.4. Control variables

3.4.1. social media.

The respondents were asked to indicate the number of hours they spend on social networks during a typical day. The scale ranges from “I do not review information on social networks” to “More than three hours.”

Sex is measured as a binary variable, where 1 represents female and 0 represents male.

Age refers to the age of the respondent.

3.4.4. Age of householder

Age of householder refers to the age of the individual who is the primary occupant or head of the household.

3.5. Describe statistics

Table 2 reports the means, standard deviation, and correlation matrix. Our dataset has not the presence of missing values.

Summary statistics.

* p < 0.01.

Descriptive statistics reveal that the variables in the sample exhibit a considerable degree of homogeneity, as evidenced by the means being larger than the standard deviations. Moreover, the strong correlation between Depression and mood suggests that these two variables should not be included together in the same model.

4. Methodological approach

Our empirical identification strategy comprises the following linear model:

We employed ordinary least squares (OLS) regression techniques to examine the relationship between our selected exogenous variables and household violence during the period of mandatory lockdowns. To ensure the robustness of our regression model, we conducted several diagnostic tests. Firstly, we tested for heteroscedasticity using the Breusch-Pagan test, yielding a chi-square value of 223.58 with a value of p of 0, indicating the presence of heteroscedasticity in the model. Secondly, we assessed multicollinearity using the variance inflation factor (VIF), which yielded a VIF value of 1.07, indicating no significant multicollinearity issues among the variables. Furthermore, we conducted the Ramsey Reset test to examine the presence of omitted variables in the model. The test yielded an F-statistic of 2.06 with a value of p of 0.103, suggesting no strong evidence of omitted variables. Lastly, we checked the normality of the residuals using the skewness and kurtosis tests, which yielded a chi-square value of 97.9 with a value of p of 0, indicating departure from normality in the residuals.

Hence, our analysis revealed the presence of heteroscedasticity issues and non-normality in the residuals. Consequently, it is imperative to employ an alternative estimation technique that can handle these challenges robustly. In light of these circumstances, we opted for Quantile Regression, as proposed by Koenker and Bassett ( 55 ), which allows for a comprehensive characterization of the relationship between the input variable(s) x and the dependent variable y.

4.1. Quantile regression

While an OLS predicts the average relationship between the independent variables and the dependent variable, which can cause the estimate to be unrepresentative of the entire distribution of the dependent variable if it is not identically distributed, Quantile Regression allows estimating parts of the dependent variable. Distribution of the dependent variable and thus determine the variations of the effect produced by the exogenous variables on the endogenous variable in different quantiles ( 56 ). The Quantile Regression methodology also presents the benefit that, by providing them with a weight, the errors are minimal. Quantile Regression is defined as follows:

where: Y i is dependent variable, X i is vector of independent variables, β(ϑ): is vector of parameters to be estimated for a given quantile ϑ, e ϑ i : is random disturbance corresponding to the quantile ϑ, Q ϑ ( Y i ) is qth quantile of the conditional distribution of Y i given the known vector of regressors X i .

The Quantile Regression model provides predictions of a specific quantile of the conditional distribution of the dependent variable and is considered the generalization of the sample quantile of an independent and identically distributed random variable ( 57 ). By considering a range of quantiles, Quantile Regression offers a more nuanced understanding of the conditional distribution, making it a valuable technique for analyzing various aspects of the relationship between variables.

The estimation results are reported in Table 3 . The regressions 1 and 3 consider individuals who are not household heads, while regressions 2 and 4 involve the respondent being the household head. In regressions 5 and 6, the respondent is not the household head and is also female, whereas in regressions 7 and 8, the respondents are household heads and male. The regressions exhibit a coefficient of determination ranging between 9 and 11.

Standard errors in brackets. * p < 0.1, ** p < 0.05, *** p < 0.001.

The effects of the different variables studied on violence are presented below: Across all regressions, it can be observed that the mood of a person, which indicates whether they are in a good mood or feeling cheerful, nervous, or irritated, is statistically significant at all levels of confidence. This implies that violence decreases when the mood is good. On the other hand, depression has a positive and significant sign. This tells us that, on average, an increase of one unit in the depression, anxiety, and stress scale is associated with an increase in the measurement of conflict and intrafamily violence in a household, whether the respondent is a household head or not.

On the other hand, Health Consciousness has a negative and significant sign, indicating that violence decreases as Health Consciousness increases. However, it is noteworthy that it loses significance when the survey respondent is a woman, regardless of whether she is a household head or not.

Regarding Household chores, which refers to the time spent on household tasks, it can be observed that it is only significant and negative when the respondent is not a household head, and this significance holds even when the respondent is male. In other words, less time spent on household chores decreases violence in households where the respondent is not a household head.

The variable religion generally has a positive and significant sign in most regressions, but loses significance in regressions (1) and (5), where the respondent is not the household head and is female, respectively. This suggests that being religious would increase the levels of violence.

In general, density increases violence in the surveyed households, as indicated by a positive and significant sign. However, it is interesting to note that it is only significant again when the respondent is not a household head and is female, or when the respondent is a household head and is male.

As for the control variables, the variable Social media, which indicates the number of hours a person spends on social media, is positive and significant whether the respondent is a household head or not, and even when the respondent is male. This suggests that violence decreases with access to social media, possibly due to increased access to information. Finally, the variables sex, age of the respondent, and age of the household head were not significant.

6. Discussion

Interestingly, the prevalence and intensity of domestic violence appear to vary across different segments of society. Goodman ( 33 ) have highlighted the existence of variations in episodes of domestic violence among social strata. They have also identified several factors that act as deterrents to domestic violence, including income levels, educational attainment, employment status of the household head, household density, consumption of psychotropic substances, anxiety, and stress. These factors increase the likelihood of experiencing instances of violence within the home.

Within this context, the COVID-19 pandemic has had far-reaching implications for individuals and families worldwide, with significant impacts on various aspects of daily life, including domestic dynamics. This study explores the relationship between household factors and violence within the context of the pandemic, shedding light on the unique challenges and dynamics that have emerged during this period.

Our findings highlight the importance of considering mental well-being in the context of domestic violence during the pandemic. We observe that positive mood is associated with a decrease in violence levels within households. This suggests that maintaining good mental health and emotional well-being during times of crisis can serve as a protective factor against violence. With the increased stress and anxiety caused by the pandemic, policymakers and practitioners should prioritize mental health support and interventions to address potential escalations in violence within households.

Furthermore, our results indicate that depression exhibits a positive association with violence. As individuals grapple with the impacts of the pandemic, such as job loss, financial strain, and social isolation, the prevalence of depression may increase. This finding underscores the urgent need for accessible mental health resources and support networks to address the heightened risk of violence stemming from increased levels of depression.

The study also reveals that health consciousness plays a crucial role in reducing violence within households. As individuals become more aware of the importance of maintaining their health amidst the pandemic, violence levels decrease. This suggests that promoting health awareness and encouraging healthy lifestyle choices can serve as protective factors against domestic violence. Public health initiatives and educational campaigns aimed at fostering health-conscious behaviors should be emphasized as part of comprehensive violence prevention strategies.

Interestingly, our analysis uncovers a mitigating effect of social media usage on violence levels during the pandemic. With the increased reliance on digital platforms for communication and information sharing, access to social media may provide individuals with alternative channels for expression and support, ultimately reducing the likelihood of violence. Recognizing the potential benefits of social media, policymakers and practitioners should explore ways to leverage these platforms to disseminate violence prevention resources, provide support, and promote positive social connections within households.

Additionally, our findings highlight the role of household chores and density in shaping violence levels during the pandemic. Less time spent on household chores is associated with decreased violence, indicating that redistributing domestic responsibilities may alleviate tension and conflict within households. The COVID-19 pandemic has disrupted routines and added new challenges to household dynamics, making it essential to consider strategies that promote equitable distribution of chores and support mechanisms for individuals and families.

Moreover, the positive association between household density and violence emphasizes the impact of living conditions during the pandemic. With prolonged periods of confinement and restricted mobility, crowded living spaces may intensify conflicts and escalate violence. Policymakers should prioritize initiatives that address housing conditions, promote safe and adequate living environments, and provide resources to mitigate the negative effects of overcrowding.

In this line, our study delves into the intricate relationship between household factors and violence during the COVID-19 pandemic, primarily within our specific context. However, it is valuable to consider how our findings align or diverge when juxtaposed with research from developed countries, where economic, social, and healthcare systems are typically more advanced. In developed countries, the impact of crises, such as the pandemic, could manifest differently due to varying levels of financial stability, access to support networks, and well-established healthcare systems.

For instance, while we observe that maintaining mental well-being serves as a protective factor against violence, developed countries might have better access to mental health resources and support networks, potentially magnifying the impact of positive mental health on violence prevention ( 58 ). Similarly, the positive association between health consciousness and reduced violence levels could be influenced by different perceptions of health and well-being in developed countries, where health awareness campaigns are more prevalent ( 51 ).

The mitigating effect of social media on violence levels during the pandemic might also vary across contexts. Developed countries might have more widespread and equitable access to digital platforms, leading to a stronger impact on violence reduction through alternative channels for communication and support ( 59 ). Conversely, regions with limited digital infrastructure could experience a smaller effect.

Additionally, comparing the role of religious affiliation and its influence on violence with findings from developed countries could reveal cultural variations in the interplay between religious teachings, gender dynamics, and violence ( 60 ). While our study suggests the need for interventions promoting peaceful religious interpretations, it is crucial to examine whether similar efforts have been successful in developed nations with distinct cultural norms and religious landscapes.

In this context, this study makes a significant contribution to the field of gender-based violence research by intricately examining the intersection of diverse socio-economic and psychological factors within the backdrop of the COVID-19 pandemic. The uniqueness of this article lies in its holistic approach to comprehend domestic violence dynamics amidst a global crisis. By dissecting and analyzing how mental health, health awareness, social media utilization, household chore distribution, living space density, and religious affiliation interact to influence violence levels, this study provides a deeper and nuanced insight into the factors contributing to the manifestation and prevention of gender-based violence. Moreover, by pinpointing areas where traditional gender norms and religious beliefs might exacerbate violence, the article suggests novel avenues for research and intervention development that account for cultural and contextual complexities. Ultimately, this work not only advances the understanding of gender-based violence during a critical period but also offers practical and theoretical recommendations to inform policies and preventive actions both throughout the pandemic and in potential future crises.

In considering the limitations of our study, we acknowledge that while our findings provide crucial insights into the role of religious affiliation in shaping violence levels during the pandemic, there are certain aspects that warrant further investigation. Firstly, our analysis primarily focuses on the association between religious beliefs and violence without delving deeply into the underlying mechanisms that drive this relationship. Future research could employ qualitative methodologies to explore how specific religious doctrines and practices interact with broader cultural norms to influence gender dynamics and contribute to violence within households. Additionally, our study does not extensively address variations in religious interpretations across different communities, which could lead to distinct outcomes in terms of violence prevention efforts. To address these limitations, scholars could conduct comparative studies across religious affiliations and denominations to uncover nuanced insights into the interplay between religious teachings, cultural contexts, and violence dynamics.

Furthermore, while our study suggests that policymakers and practitioners should consider developing targeted interventions promoting peaceful religious interpretations to mitigate violence, the precise design and effectiveness of such interventions remain areas ripe for exploration. Future research could involve collaboration with religious leaders and communities to develop and test intervention strategies that align with both religious teachings and contemporary gender equality principles. This interdisciplinary approach could yield actionable insights into fostering cultural change and enhancing the role of religion in promoting non-violence within households.

In conclusion, our study provides valuable insights into the dynamics of domestic violence within households during the COVID-19 pandemic. The findings underscore the importance of addressing mental health, promoting health consciousness, leveraging social media, redistributing household chores, improving housing conditions, and considering the nuanced role of religious beliefs. By incorporating these findings into policy and intervention strategies, policymakers and practitioners can work toward preventing and mitigating domestic violence in the context of the ongoing pandemic.

Data availability statement

Author contributions.

CL played a crucial role in this research project, being responsible for the data collection, conducting the econometric analysis, contributing to the literature review, introduction, and discussion sections of the manuscript. JD-S made significant contributions to the project and assisted in the data collection process, contributed to the literature review, and provided insights in the discussion section. FV assisted with the data collection process and reviewed the article for accuracy and clarity. All authors contributed to the article and approved the submitted version.

This project receives funding from Vicerrectorado de Investigación y Proyección Social, Escuela Politécnica Nacional.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Acknowledgments

The authors acknowledge the Escuela Politécnica Nacional for this support on this project.