Adults with disabilities are at much greater risk of violence than adults without disabilities, according to a new meta-analysis published Online First in The Lancet. Adults with mental illness appear to be particularly vulnerable and are nearly four times as likely to be a victim of violence than adults without a disability, with an estimated one in four having experienced violence in the past year.
Although a growing amount of research suggests that people with disabilities are at an increased risk of violence, this is the first study to confirm the magnitude of this risk and the relationship with different types of disability.
"About 3% of individuals with non-specific impairments [eg, physical, mental, or emotional, or health problems that restrict activities] will have experienced violence within the past 12 months, rising to almost a quarter of people with mental illnesses. Lifetime exposure to violence, and the proportions of individuals with disability who are directly threatened with violence or otherwise live in fear of becoming a victim, are likely to be substantially higher than our estimate", explains Mark Bellis from Liverpool John Moores University, Liverpool, UK, who led the study.
Here, the investigators report the results of a systematic review and meta-analysis of research on violence against disabled adults within the last year. They analysed 26 studies including over 21,500 individuals with disabilities from Australia, Canada, New Zealand, Taiwan, UK, USA, and South Africa.
They found that the prevalence of any recent violence (physical, sexual, or intimate partner) was high in both adults with mental illnesses (24.3%) and in those with intellectual impairments (6.1%).
They estimated that disabled adults are 1.5 times more likely to be a victim of violence than those without a disability, whilst those with a mental illness are at nearly four times the risk of experiencing violence.
About 15% of adults worldwide have a disability and this is predicted to rise because of the impact of an ageing population and a global increase in chronic diseases.
The authors acknowledge that the study was limited by methodological weaknesses including gaps in the types of disability and violence examined and because the research was almost entirely limited to high-income countries: "Fundamental prevalence and risk data are absent for most regions of the world, particularly low-income and middle-income countries (where 80% of the world's disabled live)."
They conclude: "Understanding the magnitude of violence against affected groups is the first step in the public health approach to violence prevention…Our review shows that the crucial precursor to worldwide action being taken to address violence against people with disability is largely absent. To begin to address these gaps in the evidence, high quality epidemiological research is needed that focuses specifically on low-income and middle-income countries and on all disability types."
In an accompanying Comment, Esme Fuller-Thomson and Sarah Brennenstuhl from the University of Toronto, Toronto, Canada say: "Although more research is clearly needed…[the] review underscores the severity of violence against adults with disabilities and suggests the importance of coordination of efforts to identify and respond to 'the forgotten victims of violence'."
They call for the improved identification of victims through targeted screening of vulnerable people with disabilities including the homeless and those with a substance abuse problem, alongside improving care and support services to better accommodate for a diverse range of disabilities.
Professor Esme Fuller-Thomson, University of Toronto, Toronto, Canada.
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