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Original research
Experiences of physical and emotional intimate partner violence during the COVID-19 pandemic: a comparison of prepandemic and pandemic data in a longitudinal study of Australian mothers
  1. Kelly M FitzPatrick1,
  2. Stephanie J Brown1,2,
  3. Kelsey Hegarty3,4,
  4. Fiona K Mensah1,2,
  5. Deirdre Gartland1,2
  1. 1 Intergenerational Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
  2. 2 Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
  3. 3 Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
  4. 4 The Royal Women's Hospital, Parkville, Victoria, Australia
  1. Correspondence to Dr Kelly M FitzPatrick; kelly.fitzpatrick{at}mcri.edu.au

Abstract

Objective There is a lack of longitudinal population-based research comparing women’s experiences of intimate partner violence (IPV) prior to and during the COVID-19 pandemic. Using data from the Mothers’ and Young People’s Study, the prevalence of physical and emotional IPV in the first year of the pandemic is compared with earlier waves of data.

Design A prospective pregnancy cohort of first-time mothers in Melbourne, Australia was followed up over the first decade of motherhood, with a quick response study conducted during the COVID-19 pandemic. 422 women completed the primary exposure measure (IPV; Composite Abuse Scale) in the 1st, 4th and 10th year postpartum and the additional pandemic survey (June 2020–April 2021).

Outcome measures Depressive symptoms; anxiety symptoms; IPV disclosure to a doctor, friends or family, or someone else.

Results Maternal report of emotional IPV alone was higher during the pandemic (14.4%, 95% CI 11.4% to 18.2%) than in the 10th (9.5%, 95% CI 7.0% to 12.7%), 4th (9.2%, 95% CI 6.8% to 12.4%) and 1st year after the birth of their first child (5.9%, 95% CI 4.0% to 8.6%). Conversely, physical IPV was lowest during the pandemic (3.1%, 95% CI 1.8% to 5.0%). Of women experiencing IPV during the pandemic: 29.7% were reporting IPV for the first time, 52.7% reported concurrent depressive symptoms and just 6.8% had told their doctor.

Conclusions Findings suggest that the spike in IPV-related crime statistics following the onset of the pandemic (typically incidents of physical violence) is the tip of the iceberg for women’s IPV experiences. There is a need to increase the capacity of health practitioners to recognise emotional as well as physical IPV, and IPV ought to be considered where women present with mental health problems.

  • MENTAL HEALTH
  • COVID-19
  • Primary Care

Data availability statement

Data are available on reasonable request. Further information about the Mother’s and Young People’s Study can be obtained from the LifeCourse website (https://lifecourse.melbournechildrens.com). The data are not open access. Requests for collaboration can be sent to SJB (stephanie.brown@mcri.edu.au) and will be considered by the Mother’s and Young People’s Study investigative team.

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STRENGTHS AND LIMITATIONS OF THIS STUDY

  • Strengths of this study include recruitment of a community cohort of first-time mothers in early pregnancy, the longitudinal design, and repeated measurement of the 12-month period prevalence of physical and emotional intimate partner violence (IPV).

  • Embedded follow-up of a subsample of women during the first year of the COVID-19 pandemic provided the capacity to compare women’s experiences during the pandemic with prepandemic data.

  • A relatively small proportion (n=520, 34.5%) of the original cohort participated in the COVID-19 substudy, and the analytic sample for this study comprised 422 women (28.0%) who completed the measure of IPV at all four time points.

  • Selective participation in the COVID substudy is likely to have biased prevalence estimates for IPV and mental health problems downwards.

Introduction

In May 2020, the United Nations launched a campaign to raise awareness of the disproportionate impacts of lockdowns on women, including the increasing incidence of intimate partner violence (IPV), described as the ‘shadow pandemic’.1 Lockdown measures were enacted by governments to limit the risk and rate of COVID-19 infection in the community. In Melbourne, Australia this involved the longest period of cumulative lockdown measures globally, totalling 263 days including 111 consecutive days between July and October 2020.2 The highest level of restrictions included widespread school and business closures with just four approved reasons for leaving the home (essential shopping, 1 hour of daily exercise, care or caregiving and authorised work or education), movement limited to 5 km from home and an overnight curfew (21:00 to 5:00). These measures were largely effective in limiting disease transmission in the first two years of the pandemic.3 However, while Australia has experienced relatively low mortality per capita from COVID-19,4 the social implications of extended lockdowns have included high levels of underemployment or unemployment, financial stress, increased alcohol consumption and high levels of poor mental health.5

The longer-term impacts of the COVID-19 pandemic on families will take time to uncover, however, many parents reported that the extra caregiving responsibilities and additional family, financial and health stresses associated with the pandemic were challenging.6 Women typically shoulder the greater share of caregiving, and research suggests that the pandemic had a greater impact on women in this respect, especially mothers.1 7 Some families reported a strengthening of relationships, however, increases in conflict, strained relationships and mental health problems among parents and young people were also common.8–10 In a cohort of families experiencing social adversity, family resilience was associated with better mental health for both mother and child during the pandemic, while conversely financial and family stress were associated with poorer mental health.11 Early pandemic data from population-based studies revealed high levels of depression, anxiety and alcohol and substance use among both parents and adolescents.12 13

The increased prevalence of mental health problems coincided with an overwhelmed healthcare system, a shift from face-to-face care to telehealth services, and concerns about contracting COVID-19 from services.14 In Australia, most general practitioners, psychologists and psychiatrists operate from private practices, with fees partially subsidised by the government. The financial impacts of the pandemic contributed to Australian parents postponing their medical and mental health care.9 10 Long-standing issues in private practices such as long wait times, fees well above the government subsidy and practices not taking new referrals15 worsened with the onset of the pandemic.16 17 Despite women having frequent contact with primary healthcare services (around six times per year for women of childbearing age),18 19 very few women experiencing IPV and/or mental health problems discuss these issues with health professionals.20 Many women face barriers to accessing services including financial constraints and lack of transportation, with added barriers to disclosing IPV such as concerns about confidentiality, normalisation of their experiences or choosing not to share them and fear of their partner.21–23 Periods of stay-at-home orders provided significant additional barriers to accessing services and clinicians, as well as support from friends or family.24

Social isolation during the pandemic, in particular confinement to the home, potentially increased the risks for women experiencing IPV.25 Qualitative research found that for women living with an abusive partner, home isolation further exacerbated or enabled their partner’s controlling and restrictive behaviours, while women who were separated from or not living with their partner felt safer.26 Some impacts of the pandemic amplified risk factors for men’s use of partner violence, including career and life stress, depressive symptoms and alcohol use.27 The most recent Personal Safety Survey (PSS), an Australian cross-sectional population-based survey was conducted between March 2021 and May 2022. The prevalence of both physical and emotional IPV across Australia and within Victoria was lower than the previous wave in 2016.28 This is in contrast with other pandemic data from crime statistics and emergency, health and support services. For example, Australian media outlets reported a 75% increase in google searches related to IPV and a greater number of calls to IPV helplines.29 Police data from Melbourne showed a 9% increase in IPV reports in 2020, however, the data did not rise and fall in line with the level of restrictions.30 International reports also showed a greater volume of calls to support lines and police reports related to IPV.31 A meta-analysis of 37 estimates from 18 studies across 7 countries reporting on crime or police data concluded that stay-at-home orders were associated with an increase in IPV.32 The majority of estimates (29/37) showed an increase in IPV during the pandemic, while the remaining 8/37 estimates indicated a decrease in IPV. As has been widely noted,30 32 such data underestimate the true prevalence of IPV as only a small proportion of women experiencing IPV have contact with police.

Existing population-based research reporting changes in the prevalence of IPV has predominantly relied on women’s retrospective report of their experiences prior to the onset of the pandemic.33 Such research has shown both increases and decreases in the overall prevalence of IPV, as well as in different types of IPV since the onset of the pandemic.28 34–36 Australian data showed an increase in the prevalence of IPV in the first year of the pandemic, with many women retrospectively reporting that they had not experienced IPV previously.24

A systematic review identified just two studies with IPV measured prior to and during the pandemic,36 while a rapid review of literature published in the first year of the pandemic did not identify any longitudinal studies.37 An early pandemic study by Steinhoff et al 38 of young adults in Switzerland (N=786, 58% women) examined physical violence against household members at four time points prior to and one during the pandemic. Steinhoff et al 38 reported that young men’s use of violence increased over the lockdown period. Given participants were aged around 22 years, with just 1 in 10 living with a partner (9.8%), very little of this violence was IPV. A further limitation is that different approaches were used prior to and during the pandemic. Six items from the Conflict Tactics Scales39 were used to measure violence in dating relationships prior to the pandemic (2018) and were then subsequently used to assess violence against any household member during the pandemic. Chiaramonte et al 40 recruited 406 women in the USA who had sought help for IPV and were experiencing housing insecurity. Interviews about physical, emotional, sexual and economic abuse were conducted at four 6-month intervals using an investigator-adapted version of the Composite Abuse Scale (CAS) and the revised Scale of Economic Abuse.41 The mean score for all types of IPV decreased from baseline to the onset of the pandemic, after which no significant differences were observed, suggesting the pandemic may have disrupted the decrease in IPV. The authors noted that results are unlikely to be generalisable due to the specific context of participants (ie, housing insecurity and connection with services).

To clarify these conflicting findings, evidence using repeated measurement of IPV prior to and during the pandemic is urgently needed to shape health and social care responses post pandemic and to prepare for future events. The present study draws on data from an Australian prospective cohort of 1507 first-time mothers and their first-born children followed up over 18 years, spanning the pandemic (the Mothers’ and Young Peoples’ Study, MYPS).42 A fast response COVID-19 substudy was conducted between mid-2020 and early-2021. A standardised measure of physical and emotional IPV was included in prepandemic follow ups (1, 4 and 10 years post first birth) and in the pandemic sub study (14–17 years post birth). In the present study, these longitudinal data have been used to (1) establish the prevalence of IPV at four time points prior to and during the pandemic; (2) estimate the proportion of women experiencing IPV who reported depressive or anxiety symptoms prior to and during the pandemic and (3) estimate the proportion of women experiencing IPV who disclosed these experiences to others prior to and during the pandemic. We hypothesised that there would be an increase in the prevalence of IPV during the first year of the pandemic, and that a greater proportion of women experiencing IPV during the pandemic would report clinically significant depressive or anxiety symptoms compared with prepandemic time points. We also expected to identify less disclosure of IPV experiences to doctors, friends or family during the pandemic.

Methods

Study design and participants

Women registered to give birth to their first child were recruited through six public hospitals in Melbourne, Australia between 2003 and 2005. Hospital staff identified eligible women (≥18 years, nulliparous, ≤24 weeks gestation, English language proficiency) and mailed invitations including study information, plain language statement, consent form, baseline questionnaire and a reply-paid envelope. Participants were followed up at 1, 4 and 10 years postpartum. A COVID-19 substudy was conducted between June 2020 and April 2021 where participants completed surveys through REDCap. Further study details have been described elsewhere. 42 43

Patient and public involvement

A small pilot group of women provided feedback on draft questionnaires and study procedures prior to study commencement and at each wave of follow-up. Participants are kept informed of study results via a study e-newsletter and a study website. Participant advisory groups have been established to support ongoing follow-up of the cohort. These mother and young people advisory groups are contributing to the design of follow-up procedures and will be involved in future reporting and dissemination of research findings.

Study measures

Experiences of IPV and disclosure

The 18-item CAS44 was included in all four waves of follow-up. Women were asked to report on experiences with a current or former partner in the previous 12 months (0 ‘never’ to 5 ‘daily’). The CAS has demonstrated validity for assessing the prevalence of IPV.44 Recommended scale cut-points were used to identify: physical abuse ≥1 points (eg, ‘threw me’), emotional abuse ≥3 points (eg, ‘blamed me for causing their violent behaviour’, ‘tried to convince my friends, family or children that I was crazy’) and physical and emotional abuse.45 Immediately following the CAS, women were asked ‘Have you told anyone about the above experiences?’. Response options included telling their local doctor/general practitioner, a family member, friend, someone else, or not telling anyone.

Maternal mental health

During the pandemic and at 10-year follow-up, maternal depressive symptoms were assessed using the 20-item Centre for Epidemiological Studies Depression Scale.46 A cut point of ≥20 was used to identify probable major depression, in line with previous studies demonstrating that this cut-point has good sensitivity and specificity for identifying depression in community samples.47 In the first-year and fourth-year following childbirth, maternal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS).48 The recommended cut-point of ≥13 was used to identify probable major depression.48 The EPDS has been shown to have good sensitivity and specificity for identifying major depression in an Australian sample of postpartum women49 and has also been validated for use in non-postnatal populations.50

During the pandemic, anxiety was measured using the Generalised Anxiety Disorder Scale-7.51 Participants reported on how often seven symptoms bothered them in the last 2 weeks (0 ‘not at all’ to 3 ‘nearly every day’). A cut-point of ≥10 was used to identify probable generalised anxiety, having demonstrated excellent reliability and validity.51 The Beck Anxiety Inventory was used to measure anxiety at 10-year follow-up, where participants reported the impact of 21 symptoms in the previous month (0 ‘not at all’ to 3 ‘severely’). The recommended cut-point of ≥16 was used to indicate the presence of clinically significant anxiety symptoms.52 53 In the first-year and fourth-year following childbirth anxiety was measured with a single item: ‘Have you experienced intense anxiety or panic attacks during the past 3 months?’. The four response options were dichotomised: ‘never’ or ‘rarely’ versus ‘occasionally’ or ‘often’.

Cohort characteristics

At enrolment (M=15 weeks gestation) women reported their date and country of birth, relationship status, highest educational qualification, employment status and annual income. Relationship status and having a healthcare concession care also were collected in subsequent follow-ups.

Statistical analyses

Data are drawn from 422 women who answered questions about IPV at 1 year, 4 years and 10 years postpartum and during the pandemic. The representativeness of this analytic sample was assessed in comparison to the original cohort at enrolment, and at 1-year, 4-year and 10-year follow-up. Univariable logistic regression was used to estimate ORs and 95% CIs for participation in relation to maternal sociodemographic characteristics, mental health and experiences of IPV.

The 12-month period prevalence of physical IPV (with or without emotional IPV) and emotional IPV alone was estimated with 95% CIs at three time points prior to the pandemic (1, 4 and 10 years after the birth of their first child) and once during the pandemic (14–17 years postbirth) (aim 1). At these four time points, we also estimated the proportion of women experiencing IPV who reported depressive or anxiety symptoms (aim 2) and disclosed their experiences of IPV to health professionals, friends and family members (aim 3).

Results

Participants

Sample retention from enrolment in early pregnancy to 1-year postpartum was 90.0% (figure 1). Following re-consent, 73.1% women participated at 4 years and 63.2% at 10 years (figure 1). Invitations to participate in the COVID-19 substudy were sent to 1098 women, however, 414 were not successful contacts (eg, email bounced, incorrect contact details, non-responsive). Thus, 684 women were known to have received an invite, with 520 (76%) participating—34.5% of the original cohort (figure 1).

Figure 1

Flow chart of participation.

Comparison of sociodemographical characteristics of the analytic sample and the full cohort are provided in online supplemental table 1. Compared with the full cohort, women in the analytic sample were less likely to be born overseas in a country where English is not the first language and more likely to be older, tertiary educated, partnered, employed or studying and on a higher income (≥$AUD60 000) in early pregnancy. They were also less likely to have a healthcare concession card (indicator of low income) in the 1st, 4th or 10th year of motherhood. Compared with the full cohort, women in the analytic sample were less likely to have experienced IPV in the year following childbirth.

Supplemental material

The sociodemographic characteristics of the analytic sample of 422 who completed the CAS at all four time points (28.0% of the original cohort) are shown in table 1. The majority (80.6%) of participants were residing in metropolitan Melbourne during the first year of the pandemic, with a further 10.7% living in regional Victoria, 6.9% living interstate and 1.9% overseas. The State of Victoria and metropolitan Melbourne specifically experienced the greatest government restrictions in response to the COVID-19 pandemic in Australia, including school and business closures and stay-at-home orders.

Table 1

Maternal sociodemographic characteristics, experiences of depressive symptoms and IPV (n=422)

IPV prior to and during the pandemic

The 12-month period prevalence of physical and emotional IPV at each wave is shown in figure 2. The prevalence of physical and emotional IPV was greatest during the COVID-19 pandemic (17.5%; 95% CI 14.2% to 21.5%), compared with previous waves of follow-up at 10 years (14.4%; 95% CI 11.4% to 18.1%), 4 years 13.7% (95% CI 10.8% to 17.4%) and in the year following childbirth (10.2%; 95% CI 7.6% to 13.5%).

Figure 2

The 12-month period prevalence of physical and emotional IPV in each wave of follow-up (n=422). IPV, intimate partner violence.

Almost one in three women experiencing IPV during the pandemic (22/74=29.7%; 95% CI 20.4 to 41.1) had not previously reported experiences of IPV. The majority of women who reported IPV for the first time during the pandemic (n=20, 90.9%) experienced emotional IPV alone. The prevalence of emotional IPV alone was highest during the pandemic at 14.4% (95% CI 11.4% to 18.2%) compared with 9.5% (95% CI 7.0% to 12.7%) at 10 years, 9.2% (95% CI 6.8% to 12.4%) at 4 years, and 5.9% (95% CI 4.0% to 8.6%) in the year following childbirth (figure 2).

In contrast, the prevalence of physical IPV was lowest during the pandemic (3.1%, 95% CI 1.8% to 5.0%) compared with the 1st, 4th and 10th year following childbirth (4.3%, 4.5% and 5.0%, respectively) (figure 2).

Mental health and IPV prior to and during the pandemic

One in four women (25.2%) experienced depressive symptoms during the pandemic. More than half of these women (n=61, 57.5%) had not reported depressive symptoms previously. As shown in figure 3, there was a gradual increase in the proportion of women experiencing IPV who reported concurrent depressive symptoms: from 16.3% (95% CI 7.9% to 30.5%) at 1-year postpartum to 22.4% (95% CI 13.5% to 34.9%) at 4-year follow-up, 31.1% (95% CI 20.8% to 43.8%) at 10-year follow-up and 52.7% (95% CI 41.4% to 63.8%) during the pandemic.

Figure 3

The prevalence of depressive symptoms among women experiencing IPV in the first, 4th and 10th year of motherhood and during the pandemic (n=422). IPV, intimate partner violence.

Almost one in seven women (13.6%) experienced anxiety symptoms during the pandemic. More than half of these women (n=33, 57.9%) had not reported anxiety symptoms previously. The prevalence of anxiety symptoms among women experiencing IPV increased with each wave of follow-up: from 4.8% (95% CI 1.2% to 17.2%) at 1-year postpartum to 15.5% (95% CI 8.3% to 27.2%) at 4-year follow-up, 21.3% (95% CI 12.8% to 33.4%) at 10-year follow-up and 27.0% (95% CI 18.1% to 38.2%) during the pandemic (figure 4).

Figure 4

The prevalence of anxiety symptoms among women experiencing IPV in the 1st, 4th and 10th year of motherhood and during the pandemic (n=422). IPV, intimate partner violence.

Disclosure of IPV

Directly following administration of the CAS44, women were asked whether they had talked to health professionals, family or friends about their experiences (table 2). A greater proportion of women told friends or family about their experiences of IPV during the pandemic compared with prior to the pandemic (74.7% vs 60.6% at 10-year follow-up). In contrast, a smaller proportion of women had talked to a doctor about their experiences of IPV during the pandemic compared with prior to the pandemic (6.8% vs 11.5% at 10-year follow-up). Approximately one in five women reported that they had not told anyone about their experiences: 19.7% at 10-year follow-up and 21.6% during the pandemic.

Table 2

Proportion of women experiencing IPV who disclosed their experiences to their doctor, family, friends or others

Discussion

Our findings suggest that a greater proportion of women experienced emotional IPV during the pandemic (when their first child was aged 14–17 years), compared with the 1st, 4th and 10th year of motherhood. Around one in three women reported IPV for the first time during the pandemic, predominantly reporting emotional IPV alone. This supports Australian cross-sectional survey data showing that many women who were experiencing IPV reflected that they had not experienced IPV prior to the pandemic.24 In Australia, IPV is more common among women aged 18–34 years compared with women aged 35 and over, with the prevalence of IPV exposure decreasing as age increases.54 The mean age of participants at the time of the COVID-19 substudy was 47 (with just two participants aged under 35 years). Outside of the pandemic context, we would have anticipated lower prevalence of IPV at this stage of life compared with previous waves.54 Our findings support the contention that the pandemic context contributed to higher prevalence of emotional IPV.

Evidence of an increase in IPV during the pandemic has largely drawn on crime statistics, police reports and contact with family violence support services.30 32 We found an increase in the prevalence of emotional IPV alone. Given police responses to family violence typically result from an incident of physical violence, it is not likely that many of these experiences led to contact with police. These findings suggest that evidence from such sources may be the tip of the iceberg in terms of the prevalence of IPV. We also expect that the prevalence of IPV we observed during the pandemic to be an underestimate of the prevalence in the wider community. There is a known association between social disadvantage and IPV, including recent evidence of an association between financial stress or hardship and IPV during the pandemic.55 The women included in the analytic sample in the present study were highly educated, and women with lower income and experiences of IPV in the first year postpartum are under-represented compared with the original cohort. Men’s previous use of violence in a relationship is a predictor of IPV,27 and previous analyses of data for this cohort show that IPV in the year following childbirth is strongly associated with subsequent experiences of IPV.56

In line with qualitative evidence8 and population-based research,12 a higher proportion of women experienced depressive and anxiety symptoms during the pandemic compared with the 1st, 4th and 10th year of motherhood. Previous analyses of this cohort have shown that both physical and emotional IPV and emotional IPV alone are associated with poor mental health.56 Importantly, our findings suggest that women experiencing IPV during the pandemic (which was largely emotional IPV alone) were more likely to be experiencing depressive symptoms compared with women experiencing IPV in the first decade of motherhood. It will be important for research to determine whether the prevalence of emotional IPV and associated mental health problems remain elevated beyond the pandemic. There is also a broader need for longitudinal studies to follow-up women through to later stages of life to better understand their experiences of IPV over the life course.

As anticipated, very few women had talked to their doctor about their experiences of IPV, and one in five women had not told anyone, similar to evidence from a community sample.26 More women had spoken to friends or family about IPV during the pandemic compared with earlier waves. This is consistent with other recent research showing that friends and family were the main source of support among women experiencing IPV during the pandemic, as well as in the previous 5 years.26 These findings likely reflect continued contact with friends and family during the pandemic, while there were more significant barriers to accessing health professionals.

It is unclear why there are such stark differences between the present study and the recent PSS,28 which showed a decrease in the prevalence of emotional IPV in Victoria, Australia during the pandemic. It is possible that the pressures imposed by the pandemic on parents of adolescents (eg, remote learning and employment, social isolation of parents and adolescents, juggling work and family) may have contributed to higher prevalence of emotional IPV for women with children in this age group. It is unclear what other demographic differences may exist between the studies as this data is not yet available. Differences in data collection processes may have contributed to the disparity. The MYPS used a well-validated measure of IPV across multiple waves of data collection, which involves reporting on a range of behaviours without self-identifying these actions as harmful or violent. Women in the MYPS may have felt more comfortable reporting on IPV due to familiarity with the questions and study processes. In contrast, the PSS is a cross-sectional population-based survey, where participants are interviewed face to face or over the phone (an option added during the pandemic). Some participants may not have felt safe to talk about violence in their home with others more likely to be present compared with earlier administrations of the PSS. Participants in the PSS are also offered to opt out to questions about violence. The subsequent items are repeated for situations including lifetime, recent, partner, familial and stranger experiences of physical or sexual violence and stalking, as well as emotional abuse that caused ‘harm or fear’.28 57 This approach may have influenced prevalence as not all women recognise or name their experiences as violent or describe them as causing harm or fear.

Key strengths of our study include recruitment of a community cohort of nulliparous women in early pregnancy and repeated measurement of IPV and mental health outcomes using robust, standardised and well-validated instruments in four waves of data collection over a period of 14–17 years. These longitudinal data for a subsample of 422 women who completed the measure of IPV (CAS) at four time points provided rare evidence of women’s experiences of IPV and mental health prior to and during the pandemic. There are also a number of limitations to note. Due to time constraints and the context of the pandemic, a relatively small proportion of the original cohort participated in the COVID-19 substudy. Compared with the full cohort, the women in our analytic sample were more likely to have completed postsecondary qualifications, to be older and on a higher income at the time of enrolment during early pregnancy. They were also less likely to have experienced IPV or depressive symptoms in the first 12 months after the birth of the index child. These factors are all likely to have biased the prevalence estimates of IPV and mental health problems downwards. Due to the length of the study and time between surveys some women may have experienced IPV outside of the periods of measurement. The small proportion of women reporting physical IPV limited our capacity to compare women experiencing emotional IPV alone with women who were also experiencing physical IPV.

Conclusions

The relatively high prevalence of emotional IPV, including women reporting IPV for the first time and the low levels of disclosure to health services observed during the pandemic have important implications for policy and practice. There is a clear need for health services to be better equipped to support women exposed to IPV, particularly as many are also experiencing mental health problems.58 59 The majority of women had told friends or family about their experiences of IPV, providing support for a recent recommendation to improve the capacity of informal support networks to respond to IPV disclosure and assist women in connecting with appropriate services and further support.26 Flexible healthcare arrangements established during the pandemic (eg, telehealth) undoubtedly increased access for some women, however more work needs to be done for this to translate into meaningful opportunities for women to access support in relation to IPV. When women present with mental health problems, evidence-based practice for health practitioners would include always considering whether they may be experiencing IPV. There is an urgent need to enhance the capacity of health services to recognise and respond to experiences of IPV, and particularly emotional IPV, which has substantial implications for women’s mental health.

Data availability statement

Data are available on reasonable request. Further information about the Mother’s and Young People’s Study can be obtained from the LifeCourse website (https://lifecourse.melbournechildrens.com). The data are not open access. Requests for collaboration can be sent to SJB (stephanie.brown@mcri.edu.au) and will be considered by the Mother’s and Young People’s Study investigative team.

Ethics statements

Patient consent for publication

Ethics approval

Ethics approval was obtained via the research ethics committees at participating hospitals, La Trobe University (2002/38) and the Royal Children’s Hospital (27056A, 33127A, 34058A and 36189A).

Acknowledgments

This study was conducted on the lands of the Kulin nations, and we pay our respects to their Elders, past, present and emerging. We are extremely grateful to all of the women taking part in the study; to members of the Mothers’ and Young People’s Study Collaborative Group who contributed to the design of study instruments and data collection procedures for 10-year follow-up and the recent COVID-19 sub-study; and to members of the Mothers’ and Young People’s Study research team who have contributed to data collection and data management.

References

Footnotes

  • Contributors SJB (guarantor) conceived the study and developed the original study protocol. SJB, DG and KH contributed to the design of 10-year follow-up and the COVID-19 substudy. DG was involved in data collection and curation. KMF planned the analyses in collaboration with DG, SJB, FKM and KH. KMF and DG conducted analyses and KMF wrote the original draft. All authors contributed to interpretation of data, reviewed earlier versions of the manuscript and approved the final version.

  • Funding The Mothers’ and Young People’s Study (formerly the Maternal Health Study) has been supported by four project grants from the Australian National Health and Medical Research Council (NHMRC) (# 199222, #433006, #491205 and #2000842) and by Australian Rotary Health. SJB holds an NHMRC Leadership Investigator Grant (#2018144). KMF is a Stronger Futures Centre of Research Excellence (CRE) Scholar supported by a grant from the NHMRC awarded to the Stronger Futures CRE (#1198270) and the Oak Foundation (#OUSA-20-006). Research at the Murdoch Children’s Research Institute is supported by the Victorian Government’s Operational Infrastructure Support Program.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.