Domestic violence and suicide in women under the care of mental health services in the UK, 2015-2021: a national observational study.

Background: There is growing evidence of a link between domestic violence and suicidality. We present the first national analysis of women with mental disorders who died by suicide having experienced domestic violence. We aim to make recommendations to improve the safety of services, particularly for women who experience domestic violence. Methods: We obtained data on women who died by suicide under the care of UK mental health services (2015-2021). We compared women who experienced domestic violence with women with no known history. Logistic regression identified associations between person and care characteristics and domestic violence. Findings: We identified 630 women who experienced domestic violence, 26% of all women with mental disorders who died by suicide. These women were younger (median age 42 vs. 47), and more often unemployed (366, 64% v. 641, 39%; p0.002). Adverse life events were common (378, 66%), most often serious financial problems (104, 23% v. 163, 10%; p < 0.001) and/or loss of job, benefits, or housing (97, 20% v. 198, 13%; p < 0.001). Many had a diagnosis of PTSD (83, 13% v. 72, 4%), self-harm (500, 83% v. 1,077, 62%), and alcohol misuse (371, 63% v. 477, 27%). They were more likely to have a history of violence as a perpetrator (124, 22% v. 87, 5%; p < 0.001). Interpretation: Many factors associated with suicide are also associated with domestic violence (e.g., unemployment, serious financial problems), suggesting intersecting disadvantages. Mental health clinicians have a responsibility to enquire about domestic violence and address its impacts as an integral part of suicide prevention. Funding: The Healthcare Quality Improvement Partnership.