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The impact of domestic abuse on healthcare professionals   

By Dr Doug Witherspoon - 27th Jan 2025

We are slowly coming around from the antiquated notion that healthcare professionals (HCPs) are invincible when it comes to mental health. Much of the focus in terms of HCPs’ health has been on burnout, and rightly so. The reasons for burnout are often rooted in the system of work. But of course, there are other factors, some of which can be less obvious.

Studies have shown that HCPs may face unique impediments when facing psychosocial problems. Traditionally, self-care has not received adequate focus during clinical training and even less so in everyday practice. And yet, the enormous stress of the role can make a person more vulnerable than the average worker.

Numerous studies have also reported an increased risk of suicide in healthcare workers compared with the general population. A recent analysis of evidence from 20 countries found suicide rates among doctors had declined, but were still significantly higher for female doctors compared with the general population. Male doctors had a higher risk of suicide when compared with other professional groups. This study by Zimmermann and colleagues, published in the BMJ, also stated that the high level of variation between studies suggested physician suicide risk was not consistent across populations. “These results call for continued efforts in research and prevention of physician deaths by suicide, particularly among female physicians and at-risk subgroups,” they reported.

Undoubtedly, the Covid-19 pandemic has also placed additional strain on HCPs’ mental health, potentially exacerbating risk factors for suicide such as depression and substance use.

A category missing from many evaluations of HCP health is that of domestic abuse. A recently published study investigated this under-researched area (Dheensa S, Doughty J, Gregory A, Occupational Medicine, Volume 74, Issue 7). The study, ‘Healthcare professionals as domestic abuse survivors: Workplace impact and support-seeking’, examined the experiences of HCPs in the UK.

Among the 192 HCP abuse survivors who responded, all abuse subtypes were common, including psychological, sexual, economic, and physical. Ninty per cent of abusers were male (ex)partners. Some 85 per cent of respondents reported that the abusers directly interfered with their work and 92 per cent stated that their work and career were affected. Almost all respondents reported mental and physical health consequences.

Just 20 per cent said their workplace had a staff policy on domestic abuse and more than 50 per cent were unsure what workplace support mechanisms were available.

A little over 50 per cent disclosed their problem at work; concerns that others would question their fitness to practice were common. Some 22 per cent of respondents said that some aspects of work, such as long hours, prevented them from seeking support outside the workplace.

The ways in which abusers directly interfered with HCPs’ work included pre-work sleep deprivation and general harassment that affected productivity and career advancement. The average number of sick days taken due to domestic abuse was 13 days each year. Colleagues and managers were the most common sources of support while less than 10 per cent sought support from occupational health services. Based on these findings from the UK, one wonders how prevalent this issue is among Irish HCPs. 

The need for support is emphasised in the study findings: “Our study highlights an immediate need for: Wider implementation of basic support, particularly related to leave options and support following sick leave; longer-term/emotional support options; support options to be codified in policy; campaigns to make healthcare professional survivors aware of available options and policies; and the exploration of tailored support interventions.”

The authors also highlight the need for improved support from occupational health, wellbeing services, and employee assistance programmes. This would benefit HCP survivors, their patients, and the workforce. The findings suggest a requirement for domestic abuse to be seen as an occupational health issue.

As always, the first step in addressing a problem is being aware it exists. There is a growing level of awareness of both domestic abuse and HCPs’ health, but clearly, there is much work to do.

Sources of information and support:

www2.hse.ie/mental-health/life-situations-events/domestic-violence-and-abuse/ and

www.practitionerhealth.ie/

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Medical Independent 28th January 2025

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