The missed pandemic: Intimate partner violence in female mental-health-care-users during the COVID-19 pandemic

Adverse childhood experiences (ACEs)and interpersonal violence (IPV) in mentally ill women are often neglected andneed to be reviewed in light of the suggested increase in IPV during theCOVID-19 pandemic.We investigated the prevalence ofACEs and IPV in women living with severe mental illness (SMI) attending anoutpatient psychiatry service at a public hospital in KwaZulu-Natal, SouthAfrica, during the COVID-19 pandemic. We also describedthe association of ACEs with later IPV.A written survey comprising socio-demographic and clinical questionnaire, WHO Adverse Childhood ExperiencesInternational Questionnaire (ACE-IQ) for ACEs and the Women abuse screeningtool (WAST) for IPV, was completed by the 154 women with SMI.141 (91.6%) participants scoredpositive for ACEs and 104 (67.5%) had experienced three or more ACEs. The mostprevalent forms of ACEs were emotionalneglect 72 (46.8%), one or no parents, parental separation, or divorce 104(67.5%), contact sexual abuse 67 (43.5%) and witnessing a household membertreated violently 67 (43.5%). Sixty-one (46.6%) participants reported IPV withscores 13 (indicative of abuse). On logistic regression,experience of three ormore ACEs was significantly associated with IPV in adulthood (aOR 3.3, 95% CI:1.2-9.6).Thehigh prevalence of IPV and association of IPV with cumulative ACEs reflectfirstly the hidden epidemic of domestic violence and secondly the vulnerabilityof those with ACEs to become victims of abuse later which is often missed in the care of women with SMI.