Health Impact of Suspected Interpersonal Violence Against Adults: Retrospective Cohort Study

Interpersonal violence (IV) has an extensive and profound impact on health, representing a public health concern. Different health outcomes have been identified based on the characteristics of the survivor and the abuser, their relationship, the type of violence perpetrated, and the cumulative effect of multiple violent experiences.

The main objective of this study was to estimate the likelihood of negative health outcomes, such as substance abuse, mental health, and somatic disorders, occurring in adults presenting a clinical suspicion of IV.

We performed a retrospective, observational cohort study, using secondary data from electronic health records of adult patients of the Local Health Unit of Matosinhos (ULSM). The control cohort included all patients aged between 18 and 59 years followed at ULSM between January 1, 2008, and May 9, 2024, while the violence cohort included patients within the same age range who were suspected survivors of IV within the same time period. Exposure was defined by the presence of one or more of the IV text expressions or codes in the patient's electronic health record. Data regarding violence suspicion, comorbidities, and health outcomes were obtained by conducting a text search on clinical notes, as well as ICD-9 (International Classification of Diseases, Ninth Revision) and ICD-10 (International Statistical Classification of Diseases, Tenth Revision) and International Classification of Primary Care 2 codes. The follow-up period was 10 years. To estimate the risk of developing health outcomes, we constructed a cohort model using a Cox proportional hazards model adjusted at baseline for age and sex.

The control cohort included 154,145 patients, and the violence cohort included 36,835 patients. Suspected survivors of IV had a higher hazard ratio of developing alcohol abuse (3.05, 95% CI 2.87-3.24), drug abuse (6.03, 95% CI 4.5-8.06), suicidal ideation (5.50, 95% CI 4.78-6.32), major psychiatric disorder (4.46, 95% CI 4.38-4.53), chronic pain (3.70, 95% CI 3.60-3.81), sleep disorders (3.57, 95% CI 3.46-3.68), use of antidepressants (3.57, 95% CI 3.51-3.64), use of anxiolytics (2.98, 95% CI 2.93-3.03), and eating disorder (2.72, 95% CI 2.06-3.59). Regarding somatic health conditions, suspected violence exposure was linked to a higher hazard ratio for metabolic dysfunction-associated steatotic liver disease (6.91, 95% CI 6.37-7.50), chronic immune inflammatory disorder (3.68, 95% CI 3.93-3.44), asthma (2.64, 95% CI 2.53-2.74), chronic kidney disease (2.49, 95% CI 2.39-2.59), hypercholesterolemia (2.16, 95% CI 2.12-2.20), and early heart disease (2.01, 95% CI 1.93-2.10).

Exposure to violence was linked to a higher likelihood of developing adverse events related to substance abuse, mental, and somatic health. Our findings lead to a deeper understanding of the complex burden of violence on health, uncovering new relationships between IV and health outcomes while validating those already explored.