Domestic violence in mature women in the United Kingdom A review of the literature

Abstract

Domestic violence (DV) impacts considerably on the long-term health and emotional wellbeing of affected individuals. Although the literature offers some insight into the p and nature of domestic abuse amongst the mature population in the UK, at present there is little obtainable data concerning DV in mature women specifically. This gap in knowledge is increasingly being recognised as a major shortfall in knowledge and understanding in society, especially for those responsible for the support and care of victims.

Although the research in this area is limited, the work already done to date suggests that matured women’s experiences of DV are markedly different from those experienced by younger people and that these differences have not been sufficiently acknowledged. For example, mature women have different barriers that stop them reporting abuse, such as physical limitations due to older age. As the ageing population in the UK increases, national policy initiatives have started to recognise DV as a national issue for mature women. It is essential that healthcare professionals are able to identify DV and understand the exact experiences and needs of mature women that are affected by DV in order to prevent future incidents and better empower women in violent relationships.

The aim of this literature review therefore is threefold: (a) to present a complete review of the impact of DV on matured women mainly within the framework of health, (b) to explore particular barriers in recognizing and reporting DV and (c) to emphasize the gaps in our awareness and understanding from a policy and care provision viewpoint. A systematic approach to a review of the literature was used to identify key literature and available evidence relating to DV among mature women.

Introduction

The Department of Health (2000) has defined DV as “a continuum of behaviour ranging from verbal abuse, through coercion and bullying, controlling behaviour, physical and sexual attack, to rape and even killing.”DV can take many forms. The most common of these include physical, sexual, verbal and financial abuse (Women’s Aid, 2007). Physical abuse typically involves any kind of physical harm such as pushing, kicking or the use of a weapon against another individual. Sexual abuse includes using force or threats to pressure a partner into unwanted sexual acts, whilst verbal abuse includes more psychological elements such as persistently attacking a partner’s self esteem through name calling. Financial abuse usually involves withholding money from a partner or forcibly taking over a partner’s assets or financial accounts (Women’s Aid, 2007).

In 2012, 1.2 million women suffered from DV (Home Office, 2013). However, fewer than 1 in 4 individuals who suffer from DV will report this (Home Office, 2013) and therefore the estimation of DV in the UK is likely to be grossly underestimated. Thirty-one percent of the funding to DV charities from local authorities was cut between 2010/11 to 2011/12, a reduction from ?7.8 million to ?5.4 million (data obtained using Freedom of Information Act requests by the False Economy project, and analysed by the research team). The National Violence against Women Survey (NVAWS) states that about 1.5 million women are raped or physically assaulted by an intimate partner yearly (Tjaden & Thoennes, 2000). The Bureau of Justice Statistics Crime Data Brief, which measured only physical assaults, concluded that “there were 691,710 nonfatal violent victimizations committed by current or former spouses, boyfriends, or girlfriends against victims during 2001(Rennison, and Planty, 2003). Of these cases, 85% were against women (Rennison and Planty, 2003). The NVAWS also found that 22.1% of women surveyed, compared to 7.4 percent of men, and reported being physically assaulted by a current or former partner in their lifetime (Rennison and Planty, 2003).

In the United Kingdom, national policy has started to identify DV as a concern for mature women. Subsequently, the Government has put policies in place so that healthcare and social professionals are able to identify cases of DV. For example, funding of nearly ?40 million has been allocated to specialist support services and help-lines until 2015 and the piloting of a domestic violence disclosure scheme that gives individuals the right to ask about any violent criminal offences carried out by a new partner (Home Office, 2013). An estimated 27,900 women have had to be turned away by the first refuge service that they approached in the last year because there was no space, according to new figures from Women’s Aid (2012). These figures demonstrate that services are under some strain to deal with the large amount of DV cases in the UK.

Prolonged episodes of DV can result in the development of mental health problems such as depression, panic attacks and mental breakdown (Roberts et al., 1998; Astbury et al., 2000). . Women often find it difficult and challenging to communicate about the psychological abuse they suffer during DV and often prefer to suffer in silence than complain about it (Home Office, 2013). This may have resulted in creating a barrier to finding data on mature victims of domestic violence. Abused women are three and a half times more likely to be suicidal than non-abused women (Golding, 1999). Furthermore, the World Health Organization (WHO, 2005) indicates that domestic violence puts women at risk from a range of negative health outcomes such as physical injury, mental health problems, sexually transmitted diseases, including HIV and AIDS, unwanted pregnancies, depression, Post-Traumatic Stress Disorder, emotional distress, fatigue, sleeping and eating disorders and general fear.

There are a wide range of social factors thought to contribute the high occurrence of DV against women in the UK. These factors include some religious and political practices that undermine women (Walker, 1999). Factors such as financial hardship. a lack of resources, educational shortcomings, extreme alcohol consumption, high levels of jealousy, belonging to a large family and substance abuse have also all been linked with the rising risk of domestic violence (Martin et al., 1999). Furthermore, in comparison to their younger female counterparts, mature women may have a limited understanding of the term abuse as a result of their older generation (Zink et al., 2003). For example, DV may have not been considered as a criminal offence when they were growing up and feminist movements were generally unheard of.

Despite figures showing that DV against mature women is rising considerably the UK, the government is considering serious funding cuts for crime prevention programs as well as staff cutting plans including over 50, 000 job cuts in the ‘National Health Service’ (NHS) over the next 10 year period (Scripps, 2013). In light of these cuts, this research aims to study the relationship between DV and the prevention programs that have been designed to tackle this crime. In particular, a counsellors’ perspective will be adopted and the challenged that counsellors face in the light of budget constraints will also be explored. Using an extensive review of the literature, the following sections provide a brief overview of the various aspects pertaining to DV and its psychological influence. The review will conclude with a discussion of government interventions and policy recommendations.

This review will evaluate and critique the available literature pertaining to DV including an assessment of the historical evolution of DV as a general concern for mature women, theoretical explanations of DV and consideration of the significance of gender. This underpinning process will be used as a basis for examining the impact of DV against mature women (39 years old and above). It will also look at the value and effectiveness of current resources, initiatives, and support networks used to tackle DV and assist victims. This review will illustrate that DV in mature women is a complex and multifaceted subject.

Definition of Terms

For the purpose of this review, the following terms shall be defined as follows:

Domestic violence: The term domestic violence is defined as a physical type of abuse carried out by an individual directly towards their significant other previously or currently, through the use of violence. The intent of the abuse is to somewhat establish and maintain a sense of dominion and control over another person, and is depicted in a context of uneven authority or entitlement. This therefore increases the likelihood of inflicting harm to both the physical and emotional welfare of that individual.

Well-being: According to Ryan and Deci (2001), the term ‘well-being’ refers to the full spectrum of people’s emotional experiences and to their quality of life.

Mature women: Mature women would be defined as those persons aged 39 years and above.

Health: This is a state of physical and mental well-being, and thus not necessarily means the absence of symptoms, illness and morbidity (WHO, 2004b).

Quality of life: This is an ‘individuals’ understanding of his or her status in life, in relation to the culture and value system of society, viewed against their personal goals, standard, and expectations in life (The WHOQOL Group, 1995).

Qualitative Study: Qualitative studies are exploratory and are particularly well suited to social research. Cresswell (1998) defines a qualitative study as “an inquiry process of understanding a social or human problem, based on building a complex, holistic picture, formed with words, reporting detailed views of informants conducted in a natural setting.” Typical data gathering tools employed in a qualitative research design include observation, interviews, video documentaries, and focus groups.

Quantitative Study: Quantitative studies measure information in numbers using a set of pre-defined variables as the focus of the study. Using the definition given by Cresswell (1998), it “is an inquiry into a social or human problem, based on testing a theory composed of variables, measured with numbers, and analyzed with statistical procedures, in order to determine whether the predictive generalizations of the theory holds true.” Data collection methods typically include questionnaires, standardized tests and codified forms.

Scope and Objectives

The main objective of this research was to increase awareness of DV against mature women and to improve the standard and efficacy of the care that is provided to the victims. The researcher’s experience in looking after this group of victims has been challenging and may have been much improved if their experiences and needs were better understood.

This piece of research aimed to:

Carry out a literature review of DV in mature women.
Identify how the government and society in general support victims of domestic violence in recovery.
Identify the counsellor’s role while caring for victims of DV.
To provide an opportunity for mature women to speak of their experiences in order to highlight their experiences and to develop resources to support and inform mature women (Mears, 2002).
To explore the prevalence of physical and verbal abuse among the study population (Mouton at el, 2004).

This research will use a positivist approach, focusing on the dilemma a mature victim of DV often faces and the importance of the therapeutic relationship they hold with their counsellor. This approach focuses on gaining “positive” evidence from observable experience, rather than depending on intuition or assumptions on behalf of researchers. In particular, this approach believes that there are general patterns of cause-and-effect and that these can be used to predict natural phenomena such as DV.

Research Methodology

This dissertation will use review the literature and contain analysis of secondary data and the summarising of the literature’s findings on the topic of DV in mature women.

Procedure

This piece of research used a literature review to gather data on the topic of DV amongst mature women in the UK and beyond.

The following key terms and words were used in various academic search engines including Web of Knowledge (http://wok.mimas.ac.uk/), Science Direct (www.sciencedirect.com) and PubMed (http://www.ncbi.nlm.nih.gov/pubmed):

Domestic violence AND mature women.
Domestic abuse AND mature women.
Domestic violence AND women.

Due to a limit in the number of articles generated using these search terms, no exclusionary criteria were applied.

Literature review

This is a secondary review research project involving an extensive literature review on the topic of DV and its impact and effects on mature women. The material for this review was obtained from peer reviewed psychological and counselling journals, which were accessed through online journal databases such as PUBMED and CINAHL. Governmental reports such as those published by the Department of Health (2000), BACP (2000), World Health Organisation (WHO, 2004) and technical reports from scientific research groups and working papers from social welfare committees were also used within the research. This review adopted the “best evidence synthesis” method proposed by Franche et al. (2005). This method involves summarizing the literature and drawing up conclusions, based on the balance of evidence.

Epidemiology and Economic Impact

Domestic violence among mature women is a pressing national problem. As a recent report from the World Health Organisation (WHO, 2004) indicates, domestic violence against mature women has increased five-fold resulting in increased depression, physical ill health, psychological effects and other mental health disorders (Scripps, 2013).

In addition to the huge impact DV has on women, there is also a large economic cost. The Centre for Mental Health (2010) has reported an annual loss to the tune of ?30.3 billion due to mental health problems suffered by abused women, with over two thirds of this amount accounting for lost productivity within the workplace. Mental ill health which may be the result of DV has been identified as the primary reason for ‘incapacity benefit payment’ and over 43% of the 2.6 million individuals presently on long-term ‘health-related benefits’ present with psychosocial behavioural disorder as their primary condition (Department of Work and Pensions, 2010). DV can also have a direct negative impact on witnesses. Hewitt (2002) claims that almost 90% of DV occurrences are witnessed either directly or indirectly by children. Furthermore, the British government have stated that women can be distressed by witnessing DV carried out against other women (Hewitt, 2002).

The literature also reveals differences in the prevalence of DV between younger and older women. For example, mature women are two to three times more likely to report minor physical attacks such as been pushed grabbed roughly and shoving than men (Tjaden & Thoennes, 1998). It has also been found that women are 7 to 14 times more likely than men to report serious physical attacks of DV that include having been strangled, threatened with weapons or use of weapons (Tjaden & Thoennes, 1998).

Barriers to Accessing Care

The literature search highlighted a number of key differences between the experiences of younger and mature women when it comes to DV. For example, unlike younger women, older women may be even less aware of the services available to those experiencing DV. For example, Scott et al. (2004) reported that there is a widespread myth among service providers and women themselves that Women’s Aid and other DV services prioritise younger women and younger women with children.

Friedman et al. (1992) have postulated that abused mature women volunteer to share their uncertainties and concern to their health practitioners the majority of the time. Those women that do not share their concerns may not do so because of pride or shame. The other reason that mature women do not disclose DV is a fear of being judged by society and this has been challenged during the research as well as shortage of theoretical clarity concerning this matter since the majority of affected women were embarrassed to put across what they are facing and this has made data collection challenging.

Zink et al. (2003) investigated the reasons for staying in an abusive relationship in women aged over 55 years. It was found that reasons could be divided into three categories: cohort effects, which included reasons such as lacking education or job skills, period effects such as rejection from help services or difficulty accessing services, and aging effects, which related to the physical limitations that their age can cause. These results suggest that although mature women experience similar barriers to leaving abusive relationships such as a lack of faith in their ability to find employment and support themselves, there are also barriers unique to mature women such as worries regarding their physical strength. Therefore, health workers and counsellors must be privy to these differences in order to improve the level of care and support that mature victims of DV receive.

Theoretical Concepts

There are a number of different theories that make be used to explain how DV comes about and what motivates its perpetrators.. For example, the social exchange theory (Emerson, 1976) offers a foundation for law enforcement and the prosecution of offenders. Furthermore, this assists in helping to explain how children who observe abuse mostly grow up to be abusers themselves. In contrast, a feminist approach may provide support for interventions targeted at supporting perpetrators to improve their behaviour and helping to empower victims. However, looking at these theories they do not appear to provide an inclusive foundation and a comprehensive approach for dealing with the various underlying outcomes or scope of DV. The more integrated ecological framework theory (see for example, Heise, 1998) is the one that appears to provide the required basis for an inclusive approach. The ecological framework theory has been used to conceptualise DV as a multi-faceted and complex phenomenon that has its foundations in a multitude of different factors including those of a situational and socio-cultural foundation (Heise, 1998). Unlike other theories, this theory is not reductionist and acknowledges that DV can be the result of many different factors.

Discussion

This researcher sought to increase knowledge and understanding regarding DV against older women by allowing older women themselves to speak out about how they define domestic violence; their views about causes, reporting, interventions, and consequences for perpetrators; factors that deter or prevent help-seeking from the justice system and community agencies; and elements of outreach and intervention strategies they see as acceptable and/or desirable. Results and Conclusions: Two important constructs that emerged were Domestic Abuse (DA), which encompasses emotional, physical, and sexual abuse, and Barriers to Help-Seeking (BHS), which appears to be closely related to the experience of victimization. In addition, eleven sub-concepts emerged from the data. Seven of these, Isolation, Jealousy, Intimidation, Protecting Family, Self-Blame, Powerlessness, and Spirituality, appeared to be related to both the experience of DA and BHS. An additional four factors defined as Secrecy, Hopelessness, Concern for Abuser, and Justice were identified.

This review has highlighted that violence amongst mature women has reached endemic proportions in most parts of the world. It also finds that no ethnic, racial, or socio-economic group is resistant from DV. Nonetheless, the review emphasized considerable heterogeneity in methodologies, sampling periods, sample sizes and the population studied. In some studies, ethnicity, age, and socio-economic status were not reliably recorded, resulting in difficulties in comparisons and evaluations. However, it must be emphasised that the WHO multi-country study was a significant effort to amass globally similar statistics by the use of identical study approaches.

There were a number of key methodological issues identified in the studies included in this literature review.

A key weakness of surveys is that they may not measure the real figures of abused women, especially as some abused women will be unwilling to reveal and report DV against them. In view of problems associated with self-reports, it is likely that results are biased by both over-reporting and under-reporting (Koss, 1993).

According to Krauss (2006) DV differs from nation to nation, and occasionally within the same culture. Therefore, there are cultural factors to take into account when comparing research. For example, in Asian cultures women are brought up with the belief that family needs are superior to individual members’ needs (Rydstrom, 2003). Though women from poor countries are possibly most pre-disposed to believe that men have a right to beat their wives, it has been found that women in developing and developed countries can also be inclined to beliefs which vindicate violence against them (Fagan and Browne 1994). Furthermore, there are cultural differences in the societal view of DV. For example, the review has shown that not every woman who suffers abuse identifies themselves as ‘battered’ women (Mahoney 1991). For example, Islamic nations do not view domestic violence a major issue, despite its increasing incidence and serious consequences. Extracts from religious tracts have been improperly used to validate violence against women, although abuse may also be the result because of culture as well as religion (Douki et al. 2003). Nonetheless, power issues and gender (Caetano et al. 2000), rather than race and ethnicity (Anderson 1997), are likely to be more significant in building and preserving male supremacy and the inequality of power between wives and husbands (Harris et al. 2005). Furthermore, various ethnic groupings are frequently distorted into one single class, for example Asians (Mobell et al. 1997). Due to this, statistics collected on violence amongst minority populations are regularly inadequate, thereby preventing meaningful generalizations.

Waltermaurer (2005) argues that the choice of measuring and the practice used to establish the occurrence of domestic violence have important bearings on the occurrence rates being reported. The majority of television and film images, as well as the images in magazines, often display images of abused younger women who have children and this may give a false impression that domestic violence is not something that may occur later on in life. This literature review has found that in comparison to younger women, older women throughout their lives have been less aware of all services and treatments readily available for those going through DV. The previous Government legislated in the Crime and Security Act 2010 for the introduction of Domestic Violence Protection Notices (DVPN) and Domestic Violence Protection Orders (DVPOs). On the 30th of June 2012 the domestic violence protection notices and orders (DVPO) were introduced in West Mercia, Wiltshire and Greater Manchester through three police forces. The operations will continue for another year while the Home Office works hand in hand to assess the pilot and decide whether or not a permanent change in the law system is required.. The scheme gives victims who might or may have fled their homes the kind of support they may need. There was a gap in protection in DV before the scheme was founded in 2012. Previously, police were unable to charge perpetrators because of lack of evidence and also because the process of granting injunctions to the perpetrators took time. The (DVPO) scheme closes the gap between then and now and gives the police and the magistrate the power to protect a victim after the attack as soon as they possibly can and try to stop the perpetrator form getting in contact with the victim or returning home for up 28 days. Disclosure of being abused itself is insufficient to reduce the risk of adverse mental health outcomes for mature women who have been victims of DV unless the listener’s response to the disclosure was repeatedly supportive (Coker et al. 2002). Mature women report key characteristics of helpful encounters with health-care providers as non-judgemental, sympathetic and caring response (Gerbert et al. 1999).

Public and private organizations have kept on enhancing their contributions in fighting DV. In the United Kingdom, The Domestic Violence, Crime and Victims Act (2004) furnishes superior power to police and the courts in dealing with cases of DV and in providing security to victims. Furthermore the British government has recently issued a national domestic violence action plan which sets fourth ambitious goals:

– Reduction in the occurrence of domestic violence

– Increase in the rate that domestic violence is reported

– increase the rate of domestic violence offences that are brought to justice

– Ensure victims of domestic violence are satisfactorily protected and supported nationwide

– Reduce the number of domestic violence related homicides.

The review has shown that despite all Government initiatives towards domestic violence, healthcare agencies are still under-represented (Hague et al., 1996). It was not until the year 2000 that the Department of Health (DoH) started to take steps to implement front-line interventions from health professionals by publishing two documents known as ‘Domestic Violence: A Resource Manual for Health Care Professionals’ and ‘Principles of Conduct for Health Professionals’ (Department of Health, 2000a, 2000b). The aim of these documents was to integrate best practices recommended by the various governing bodies of differing health professionals. This documentation aims to provide guidance for healthcare professionals in their practice and daily interactions with women experiencing DV. After the publication of these documents, DV was seen for the first time as a health care issue as opposed to a mainly social care problem.

The police and the criminal justice system cannot address the issue of domestic violence alone. The cost of protection for those women who experience domestic violence is of such a scale that it should be considered a major public health issue (Department of Health, 2000a: 2).

Validity and Reliability

As most of the literature referred to in this research was phenomenological, there are some key methodological limitations. For example, phenenological research is often open to interpretation. In particular, the same words may have different meanings for different people (Beck, 1994). This may be of particular importance for the topic of DV as some women who are included as participants may report that they are abused but may not attach the same negative connotations that the researchers do. The most reliable estimates of the extent of domestic violence in England and Wales come from the Crime Survey of England and Wales (CSEW; formerly known as the British Crime Survey). The CSEW asks people about their experience as victims. Being a household survey, it picks up more crime than the official police figures, as not all crimes are reported to the police, let alone recorded by them. Two sets of figures are available from the CSEW: the first, collected from the survey’s inception in 1981, come from the results of face-to-face interviews; the second, available from 2004/05, come from confidential self-completion modules, which respondents complete in private by responding to questions on a computer. The unwillingness of respondents to reveal experience of domestic violence to an interviewer means that the first measure significantly underestimates the extent of domestic violence.

Conclusion

The high occurrence ofDV experienced by mature women suggests that doctors and other healthcare professionals working in all areas of medicine must identify and explore the potential significance of DV when considering reasons why mature women present with ill health. The issue of DV against mature women should be integrated into medical training, therapist training and also into governmental policy. Heterogeneity within the methodology of the different studies discussed in this review has highlighted the significance of developing stronger definitions to improve coherence across findings during a literature search. Future research work must try to recognize cultural differences when working with families and women of ethnic minorities.

Contrary to previous assumptions that mature women may consider DV as acceptable, results of a study found that mature women were able to identify abuse and actions seen as abusive, which demonstrates suggesting that care workers may be misinterpreting victims’ feelings. The study also demonstrates how the attitude of mature women has been altered over time, from something acceptable to something that must be dealt with.

Society must stop viewing domestic violence against mature women as a problem which only affects women, as the issue is overall a public health issue. All forms of violence against mature women are abhorrent and support for those who have been abused in any form should be readily available. We need a clear and decisive answer for calls for help from the health sector, in collaboration with women’s organizations and other related public powers. As observed by Hamberger et al. (1992), future research is essential in order to help determine the reason behind some re-occurring factors that are prevalent in contributing toward cases of DV against mature women.

A collective societal intervention is necessary to address the social determinants of DV. Counsellors, as frontline care providers, have an essential role to play in controlling the negative impacts of DV amongst mature women. Counsellors can be proactive in their approach and target vulnerable individuals and groups based on initial assessment or treatment programs. Counsellors and healthcare providers should effectively liaise with various governmental and non governmental agencies that participate in delivering individual treatment plans for mature victims of DV.By improving the coordination between these participating agencies and the women that need intervention, healthcare providers can promote greater access to and utilization of these services.

Future Work

The researcher discovered that there is not much data available on the topic of DV in mature women from previous researchers. In future the researcher will conduct research herself when qualified enough to conduct research using questionnaires and interviews to collect qualitative data.

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