Growing recognition of experiences of domestic violence (EDV) in childhood and the associated trauma has led to the explicit acknowledgement of children as victim-survivors of domestic violence (including intimate partner violence between caregivers) in their own right Reference Sawyer and McFarlane1 and is now well-recognised as a distinct type of child maltreatment. Reference Mathews, Pacella, Scott, Finkelhor, Meinck and Higgins2 Despite increasing awareness and understanding of the victimisation of children through EDV, little attention has been given to the associated health outcomes later in life. Among studies that have examined the adverse health outcomes associated with childhood EDV, many have relied on measures that only capture incidents of physical domestic violence. Reference Agrawal, Lei, Shah, Bui, Halfon and Schickedanz3–Reference McLaughlin, Basu, Walsh, Slopen, Sumner and Koenen6 The focus on physical violence does not give sufficient consideration to non-physical forms of violence, even though they are common and harmful. These non-physical forms of domestic violence are often referred to as coercive control (a course of conduct aimed at dominating and controlling another through an imbalance of power and fear), a core underpinning of EDV that does not require physical violence to be present. 7 New legislation has been introduced in multiple Australian states and territories that prohibit coercive control, which includes diverse types of physical, sexual and psychological violence, economic coercion, surveillance and other forms of abuse within a domestic relationship. 8,9
Qualitative interviews with children show that they are capable of recognising and articulating experiences of coercive control, Reference Lapierre, Sazgar and Cardeal10 including the persistence of coercive behaviours such as manipulation, control of time, movements and activities, and undermining of the relationship with their other parent beyond the point of parental separation. Reference Thiara and Humphreys11 Recent systematic review evidence has shown that coercive control in childhood is associated with numerous adverse child wellbeing outcomes including emotional and behavioural problems, social and relational difficulties and poorer physical health, independently of other forms of EDV. Reference Xyrakis, Aquilina, McNiece, Tran, Waddell and Suomi12 Given that many studies that examine the health outcomes associated with childhood EDV fail to capture experiences of coercive control, which encompasses diverse forms of violence including financial, sexual, relational or financial for example, the true extent of the attributable harm is likely underestimated.
In a landmark study of mother-child victim-survivors, Katz Reference Katz13 provided empirical evidence of how children are directly harmed by non-physical forms of domestic violence and the way it can profoundly impact them. The study by Katz demonstrated that children can experience harm in the absence of physical forms of domestic violence. Importantly, unlike physical violence, coercive control by a parent – through acts such as surveillance, isolation and economic abuse – can persist long after a relationship has ended and is often perpetrated through the weaponisation of children, particularly through the family courts. Reference Wilde, Sheeran and Douglas14 Perpetrators’ tactics can also include manipulating children into sharing information about the protective parent’s whereabouts, undermining the child’s attachment bond with their protective parent Reference Lapierre, Sazgar and Cardeal10,Reference Thiara and Humphreys11 and withholding financial support such as child support payments. Reference Cook, Byrt, Edwards and Burgin15 Domestically violent parents are also more likely to engage in emotionally and physically abusive or neglectful behaviours towards their children. Reference Heward-Belle16 These experiences can lead to chronic stress, hypervigilance, poor sleep, lower educational attainment and altered neuro-development. Reference Doroudchi, Zarenezhad, Hosseininezhad, Malekpour, Ehsaei and Kaboodkhani17,Reference Tomoda, Nishitani, Takiguchi, Fujisawa, Sugiyama and Teicher18 Compounding children’s EDV are common feelings of being powerless, having no agency over their own lives and not being taken seriously or being involved in decision-making post-separation. Reference Noble-Carr, Moore and McArthur19
Chronic stress and trauma during childhood significantly increases the risk of mental disorders (e.g. post-traumatic stress disorder (PTSD) and depressive and anxiety disorders) and health risk behaviours (e.g. suicide, substance use and obesity) across the lifespan. Reference De Bellis and Zisk20 In the context of non-physical childhood EDV, few studies examine these health outcomes and even fewer examine them in adulthood. In a US population-based cohort study of adolescents, maternally-reported childhood EDV was associated with higher odds of substance use in adolescence. Reference James, Donnelly, Brooks-Gunn and McLanahan21 In an Australian data-linkage study, early childhood police-recorded EDV was associated with a three-fold increase in the odds of a mental-health related hospitalisation (including for alcohol use) prior to the age of 18. Reference Orr, Fisher, Preen, Glauert and O’Donnell22 In terms of adult outcomes, a Swedish population-based study found that self-reported childhood EDV was associated with a significant increase in PTSD, anxiety, depression and suicide in early adulthood. Reference Cater, Miller, Howell and Graham-Bermann23 Although these studies incorporate non-physical forms of EDV, albeit to varying degrees, none examined the independent influence of each form of EDV on health outcomes. Generating evidence of the harms associated with coercive control and other forms of non-physical forms of EDV in childhood is vital for ensuring that children are adequately protected and supported both during the parental relationship and beyond separation. Screening measures of post-separation EDV have been criticised for failing to detect non-physical EDV such as coercive and controlling behaviours, which can inadvertently place children at continued risk of physical and/or psychological harm. Reference Shorey and Baladram24
The nuances, subtleties and context-specific nature of coercive control can make it difficult to detect by external observers compared to more overt forms of EDV, and hinder the provision of protection, support and therapeutic intervention for these children. In Australia, a 2021 survey conducted of a nationally representative sample found the national prevalence of childhood EDV among people aged 16 and over is 39.6%. Reference Mathews, Pacella, Scott, Finkelhor, Meinck and Higgins2 Additional analyses of these data from the Australian Child Maltreatment Study (ACMS) have shown intimidation and control (reflecting coercive and controlling behaviours) is experienced more frequently, over a longer period of time, and at older ages, than other forms of domestic violence like physical violence, threats of serious physical harm and damage to property (details available from the author on request). In addition, this subsequent analysis found that intimidation and control presented the strongest risk for experiencing other types of child maltreatment, particularly for emotional abuse, independently of physical domestic violence. There is a need to understand the associations between the different forms of childhood EDV and long-term mental and physical health outcomes to identify areas and opportunities to support recovery and disrupt poor health trajectories for children who experience domestic violence. This paper utilised data from the ACMS, to quantify the outcomes associated with childhood EDV. Specifically, we aim to examine associations between four different forms of childhood EDV (physical violence, serious threats of harm, damage to property or harm to pets and intimidation or control) and four mental health disorders (PTSD, generalised anxiety disorder (GAD), major depressive disorder (MDD) and alcohol use disorder (AUD)), and six physical health risk behaviours (suicide, self-harm, binge drinking, obesity, smoking and cannabis dependence) in adulthood.
Method
Australian Child Maltreatment Study (ACMS)
Data were drawn from the ACMS, a nationally representative cross-sectional study of Australians who provided detailed information about their current health and current social circumstances and their experiences of maltreatment and other adversities in childhood. Extensive information about the study design is published elsewhere. Reference Haslam, Lawrence, Mathews, Higgins, Hunt and Scott25 Briefly, 8503 Australian residents aged 16 years and over across five, 10-year age groups (16–24, 35–44, 45–54, 55–64, 65 years or more) were recruited via random digit dialling of mobile phone numbers, following an advance text message inviting them to take part. The response rate for eligible candidates contacted was 14.0%, and all participants provided informed verbal consent. Trained interviewers formally recorded participants consent and collected data by computer-assisted telephone interview. Participants were stratified by age to include an over-sample of young people aged 16 to 24 years (n = 3500) and 1000 participants in five successive 10-year age groups thereafter. The demographic profile of ACMS participants was compared with the 2016 Australian census. With respect to gender, Indigenous identity, region and remoteness category of residence, and marital status, the sample was representative of the Australian population. There was some overrepresentation of participants who were born and whose parents were born in Australia, lived in areas of higher socio-economic status, had tertiary qualifications, or had higher income. Population weights were calculated to adjust for these minor differences. Reference Haslam, Lawrence, Mathews, Higgins, Hunt and Scott25 The study was approved by the Queensland University of Technology (QUT) Human Ethics Board (approval number 1900000477).
Childhood experiences of domestic violence (EDV) and other types of child maltreatment
The Juvenile Victimisation Questionnaire (JVQ)–R2: adapted version (Australian Child Maltreatment Study) was used to capture self-reported experiences of five types of child maltreatment (EDV, emotional abuse, neglect, physical abuse and sexual abuse). Reference Mathews, Meinck, Erskine, Tran, Lee and Kellard26 The JVQ–R2 was specifically adapted for use in the ACMS and underwent a rigorous development process with the ACMS investigators, an external expert panel, cognitive testing and then pilot testing in a random sample of 100 Australian adults. Reference Mathews, Meinck, Erskine, Tran, Lee and Kellard26 Four of the 17 items assessed EDV (perpetrated by one parentFootnote a against another parent) in childhood, capturing physical violence, threats of serious harm, damage of property or pets and intimidation or control (full item wording is shown in Supplementary Table 1 available at https://doi.org/10.1192/bjp.2025.10362). Respondents could answer ‘Yes’, ‘No’, ‘I don’t know’ or refuse to answer, whereby ‘Yes’ was counted as having experienced that item, and ‘No’, ‘I don’t know’ or refusal-to-answer responses were categorised as not having experienced it. For respondents who answered ‘Yes’ to an item, follow-up questions were asked to obtain details about the frequency (discrete numbers), age at onset and age at cessation of the EDV.
Mental disorders
The Mini International Neuropsychiatric Interview (MINI), version 7.0.2, was used to establish diagnoses of GAD (current), PTSD (current), AUD (current; mild, moderate and severe) and MDD (lifetime) according to the DSM-5 criteria. The MINI is a short, structured diagnostic instrument that is valid and reliable. Reference Lecrubier, Sheehan, Hergueta and Weiller27,Reference Sheehan, Lecrubier, Sheehan, Amorim, Janavs and Weiller28 It is administered by trained lay interviewers and is widely used in epidemiological surveys of mental health.
Health risk behaviours
Health risk behaviours included: cigarette smoking in the past 12 months, binge drinking (having six or more drinks for men or five or more drinks for women in a single session at least weekly over the past 12 months), cannabis dependence (Cannabis Severity of Dependence Scale (SDS) score of 3 or more), Reference Martin, Copeland, Gates and Gilmour29 obesity (body mass index >30 kg/m2 based on self-reported height and weight), self-harm (answering yes to the question ‘during the past 12 months have you deliberately harmed or injured yourself, without intending to end your own life?’), and suicide attempt (answering yes to the question ‘during the past 12 months, have you attempted suicide?’). In addition, lifetime self-harm and lifetime suicide attempt were also assessed. Except for the Cannabis Severity of Dependence Scale (SDS) item, these items were drawn from the 2007 Australian National Survey of Mental Health and Wellbeing Reference Slade, Johnston, Oakley Browne, Andrews and Whiteford30 and the National Adolescent Mental Health Surveys (NAMHS). Reference Erskine, Maravilla, Wado, Wahdi, Loi and Fine31
Covariates
Socioeconomic disadvantage was based on postcode of residence and quintiles of the Index of Relative Socio-economic Disadvantage (IRSD) one of the Socio- Economic Indexes for Areas (SEIFA). 32 Financial hardship during childhood was assessed by asking ‘How often did your family experience economic hardship such as finding it difficult to provide food, medical care, or other basic necessities?’ People were considered to have experienced childhood financial hardship if their response was ‘somewhat often’ or ‘very often’. Current financial strain was assessed by asking: ‘In the past 12 months, has there been a time when your household could not meet essential expenses?’ Participants were considered to be experiencing current financial strain if their response was ‘Yes’.
Statistical analysis
All analyses were conducted using RStudio version 4.3.2 for Windows. 33 Consistent with previous analyses using ACMS data, we conducted all analyses using data weighted by gender, age group, Indigenous status, country of birth, highest educational level, and residential socioeconomic status. Population weights, benchmarked to national census data, were applied using the Survey package in R for Windows. Reference Lumley34 Survey-weighted prevalence and 95% confidence intervals (CIs) of mental disorders and health risk behaviours were calculated for those with and without childhood EDV, and for each of the four forms of EDV for the full sample, and for men and women separately. Survey-weighted logistic regression models were then used to examine the associations between each of the four forms of childhood EDV and each mental disorder and health risk behaviour. Each model was fitted with two levels of adjustment for other factors. The partially adjusted model accounted for age group, gender, each other form of childhood EDV and four other child maltreatment types. The fully adjusted model also accounted for socioeconomic disadvantage, financial hardship during childhood and current financial strain. In addition, a separate sensitivity analysis was undertaken to examine the associations between lifetime self-harm and lifetime suicide attempt.
Results
Mental disorders
Figure 1 and Supplementary Table 2 present the reported count and prevalence (as at 2021) of each mental disorder among those with and without childhood EDV (and for each form), for the total sample and separately for men and women. All mental disorders were more common among those with any childhood EDV compared to those without. MDD was the most prevalent (any EDV: 27.0%; no EDV: 12.7%), followed by GAD (any EDV: 18.5%; no EDV: 7.2%). The prevalence of PTSD was almost four times greater in those with childhood EDV (9.6%) compared to those without (2.6%).
Estimated prevalence* of mental disorders in Australians 16 years and over by childhood experience of domestic violence. *Proportions (with 95% CIs) are weighted by age group, gender, Indigenous status, country of birth (Australia or overseas), highest educational level and residential socioeconomic status (Relative Socio-economic Advantage and Disadvantage quintiles). PTSD, post-traumatic stress disorder; GAD, generalised anxiety disorder; MDD, major depressive disorder; AUD, alcohol use disorder; mod, moderate; sev, severe.
Fig. 1 Long description
A bar graph compares the weighted proportion of mental disorders by experiences of domestic violence in childhood. The horizontal axis lists different mental disorders: PTSD, GAD, MDD, AUD_mild, AUD_mod, and AUD_sev. The vertical axis represents the weighted proportion in percent. The graph includes five groups of vertical bars for each mental disorder, representing different types of domestic violence experiences: No childhood EDV, Physical violence, Threats of serious harm, Damage to property or pets, and Intimidation or control. Each group of bars shows varying proportions for each type of domestic violence experience. The color scheme includes light blue for No childhood EDV, light teal for Physical violence, teal for Threats of serious harm, blue for Damage to property or pets, and dark blue for Intimidation or control. The graph indicates that the proportion of mental disorders tends to increase with more severe types of domestic violence experiences. Specific values for each bar are provided, showing the weighted proportion percentages for each mental disorder and type of domestic violence experience.
Women with any childhood EDV had the highest prevalenceFootnote b of PTSD, GAD, MDD, compared to women without EDV and men with and without EDV, whereas men with childhood EDV had the highest prevalence of mild, moderate and severe AUD. A notable gender difference was observed for PTSD prevalence among those with childhood EDV (women: 11.0%; men: 7.5%), but not among those without childhood EDV (women: 2.5%; men: 2.6%).
Figure 2 and Supplementary Table 3 present the odds of each mental disorder for each form of childhood EDV compared to those without. In the fully adjusted model, intimidation or control was associated with increased odds of PTSD (aOR (adjusted odds ratio) 2.30, 95% CI 1.77–2.98), GAD (aOR 1.65, 95% CI 1.36–1.99), and MDD (aOR 1.22, 95% CI 1.04–1.43). Damage to property or pets was associated with PTSD (aOR 1.49, 95% CI 1.15–1.94), MDD (aOR 1.29, 95% CI 1.11–1.50) and severe AUD (aOR 1.76, 95% CI 1.36–2.27). Neither physical violence nor threats of serious harm significantly predicted a mental disorder in adulthood. Adjusting for current and childhood financial hardship, and socioeconomic disadvantage in the fully adjusted models did not significantly attenuate associations.
Odds ratios and 95% CIs for each form of childhood experience of domestic violence (EDV) and mental disorders. Odds ratios are adjusted for other forms of EDV, age group, the other four types of child maltreatment, current financial strain, socioeconomic disadvantage and childhood economic hardship. PTSD, post-traumatic stress disorder; GAD, generalised anxiety disorder; MDD, major depressive disorder; AUD, alcohol use disorder.
The results of the gender-stratified analysis can be seen in Fig. 2. Serious threats of harm, damage to property or pets, and intimidation or control were associated with a 1.54 to 2.03 increased odds of PTSD for women. Serious threats of harm were also associated with higher odds of mild AUD (aOR 1.54, 95% CI 1.06–2.24) but lower odds of severe AUD (aOR 0.57, 95% CI 0.36–0.89). For men, intimidation or control was the only form of EDV associated with PTSD, GAD and MDD (aOR 1.33–2.55). Damage to property significantly increased the odds of severe AUD (aOR 1.82, 95% CI 1.30–2.53), whereas physical violence was associated with reduced odds (aOR 0.57, 95% CI 0.36–0.89).
Health risk behaviours
Figure 3 and Supplementary Table 4 present the reported count and prevalence of each health risk behaviour among those with and without EDV (and for each form), for the total sample and separately for men and women. Health risk behaviours were generally more common among those with childhood EDV, though 95% CIs overlapped for those with and without EDV for both binge drinking and obesity. Obesity was the most prevalent (any EDV: 27.3%; no EDV: 24.6%), followed by smoking (any EDV: 21.9%; no EDV: 14.3%). The prevalence for suicide attempt was almost four times greater in those with any EDV (1.9%) compared to those with no EDV (0.5%). Women with childhood EDV had a higher prevalence of suicide attempt and self-harm, while men with childhood EDV had a higher prevalence of current smoking, cannabis dependence and binge drinking.
Estimated prevalence* of health behaviours in Australians 16 years and over by childhood experience of domestic violence. *Proportions (with 95% CIs) are weighted by age group, gender, Indigenous status, country of birth (Australia or overseas), highest educational level and residential socioeconomic status (Relative Socio-economic Advantage and Disadvantage quintile).
Figure 4 and Supplementary Table 5 present the odds of each health risk behaviour by each form of EDV. In the fully adjusted model, intimidation or control was associated with higher odds of self-harm (aOR 1.49, 95% CI 1.07–2.07) and cannabis dependence (aOR 1.64, 95% CI 1.07–2.51), but lower odds of current smoking. Damage to property or pets was associated with an increased odds of binge drinking (aOR = 1.24, 95% CI 1.03–1.50) and smoking (aOR = 1.36, 95% CI 1.17–1.59), but lower odds of obesity. Neither physical violence nor threats of serious harm were significantly associated with any health risk behaviour. No form of EDV type was significantly associated with suicide attempt. Adjusting for current and childhood financial hardship, and socioeconomic disadvantage in the fully adjusted model did not significantly attenuate associations.
Odds ratios and 95% CIs for each form of childhood experience of domestic violence (EDV) and health risk behaviours. Odds ratios are adjusted for other forms of EDV, age group, the other four types of child maltreatment, current financial strain, socioeconomic disadvantage and childhood economic hardship.
Fig. 4 Long description
Panel A: The first set of graphs shows the odds ratios for suicide attempts, self-harm, and binge drinking. The x-axis represents the odds ratio (95% CI) ranging from 0 to 4, and the y-axis lists different forms of childhood experience of domestic violence (physical violence, threats of serious harm, damage to property or pets, intimidation control). Each graph compares men and women using different colored dots and lines. Panel B: The second set of graphs displays the odds ratios for obesity, current smoker, and cannabis dependence. The x-axis again represents the odds ratio (95% CI) ranging from 0 to 4, and the y-axis lists the same forms of childhood experience of domestic violence. Similar to Panel A, each graph compares men and women using different colored dots and lines. The graphs indicate the adjusted odds ratios for each form of childhood experience of domestic violence and health risk behaviors, with men represented by red dots and lines and women by green dots and lines.
The results of the gender-stratified analysis can be seen in Fig. 4. Significant associations for women included physical violence and binge drinking (aOR 1.57, 95% CI 1.08–2.28), intimidation or control and self-harm (aOR 1.98, 95% CI 1.29–3.03) and obesity (aOR 1.31, 95% CI 1.03–1.65), and serious threats of harm and obesity (aOR 1.38, 95% CI 1.04–1.83). For men, damage to property or pets was associated with increased odds of self-harm, binge drinking and smoking (aOR 1.38–2.46) and reduced odds of obesity. Threats of serious harm increased the odds of cannabis dependence (aOR 2.47, 95% CI 1.33–4.60).
A sensitivity analysis was conducted to examine associations with lifetime self-harm and suicide attempt. Intimidation or control was associated with lifetime suicide attempt (aOR 1.39, 95% CI 1.14–1.70, see Supplementary Table 6). This association remained significant for men only in the gender-stratified analysis (aOR 2.06, 95% CI 1.50–2.84).
Discussion
In this nationally representative Australian study, four forms of childhood EDV and their associations with mental disorders and health risk behaviours were examined. To the best of our knowledge, our study is the first to determine the independent associations of both physical and non-physical forms of EDV with these health outcomes. Several important findings were identified. Damage to property or pets and intimidation or control were independently associated with a significantly increased risk of a mental disorder or a health risk behaviour in adulthood. With few gender-specific exceptions, childhood EDV characterised by physical violence and threats of serious harm were not significantly associated with adverse health outcomes after accounting for damage to property or pets and intimidation or control. This finding is particularly important in the context of understanding children’s risk of harm from domestic violence which has traditionally been conceptualised through a predominantly physical violence framework. Reference Katz13,Reference Fitz-Gibbon, Maher, McCulloch and Segrave35 Notably, adjusting for current and childhood financial hardship, socioeconomic disadvantage, as well as other types of child maltreatment experienced did not significantly attenuate these associations. This suggests that the long-term mental and physical health consequences of childhood EDV are independent of socioeconomic circumstances and other experiences of childhood abuse and neglect.
Our findings build on previous research from the ACMS. In previous papers, we reported that any EDV was not significantly associated with mental disorders or health risk behaviours after adjusting for other types of child maltreatment. Reference Lawrence, Hunt, Mathews, Haslam, Malacova and Dunne36,Reference Scott, Malacova, Mathews, Haslam, Pacella and Higgins37 These studies did not differentiate between the effects of physical and non-physical forms of EDV. Research on women survivors has shown that coercive control has a greater negative impact on mental health than physical violence. Reference Lohmann, Felmingham, O’Donnell and Cowlishaw38 Studies also found that children experience the effects of coercive control in similar ways to their mothers, Reference Callaghan, Alexander, Sixsmith and Fellin39,Reference Katz40 indicating they may also be at heightened risk of long-term adverse mental health as a result of having a coercively controlling parent/caregiver. In support of these findings, our study found the strongest associations were for intimidation or control and PTSD (2.3-fold increased odds). Disaggregation of the different forms of childhood EDV enabled these significant associations to be identified.
With regard to damage to property or harm to pets, perpetrators often target items of sentimental family value, possessions that cause financial hardship when destroyed, leave visible damage to the home or compromise its security, or objects that are central to family life (e.g. televisions, furniture). Reference Weisberg41 These tactics not only present more obvious direct consequences for children, but they also serve as visible, daily reminders of the violence and lack of safety at home. Security and stability are fundamental to healthy child development. Reference Calder and Dakin42 The experience of a primary caregiver harming or killing a family pet is likely to be particularly traumatic, as children often form strong attachment bonds with animals. In some cases, these bonds may otherwise have served as protective factors against adverse mental health outcomes associated with childhood EDV, Reference Hawkins and Williams43 further compounding their risk of mental health problems. The use of animal abuse as a mechanism of fear and control in a domestic violence context is recognised as an essential legal consideration in Australia, with calls for expansions of current legal protections of animals in domestic violence cases to reflect this. Reference Kotzmann, Bagaric, Wolf and Stonebridge44
This study highlights important considerations for future domestic violence research. It is no longer appropriate to measure EDV using a physical incident framework and without inclusion of diverse forms of non-physical coercive control as a foundational component. Although research on adult victim-survivors of domestic violence has increasingly recognised coercive control as a foundational element, there is an urgent need to consistently apply this conceptualisation to research on child victim-survivors of EDV. Similar to the underappreciation of the harm arising from emotional abuse to children compared to physical and sexual abuse, Reference Norman, Byambaa, De, Butchart, Scott and Vos45 non-physical domestic and family violence has an enduring negative impact upon the health of children. We do not suggest physical violence is not harmful to children, but rather that experiences of coercive and controlling behaviours, which are often considered as not directly affecting children, do also play a critical role in shaping long-term health and wellbeing outcomes. Recent analysis of the prevalence of intimate partner violence (IPV) experiences has shown that diverse forms of such psychological IPV are very common; for example, 45.1% of ever-partnered women and 36.1% of ever-partnered men have experienced psychological IPV. Reference Mathews, Hegarty, MacMillan, Madzoska, Erskine and Pacella46 Since children are also integral to the structure and dynamics of families with currently or previously partnered adults, it is essential to address the use of children in perpetrating coercive control post-separation, a frequent and devastating occurrence that demands improvements in health, law and family court responses.
Intimidation or control was the only form of domestic violence that predicted mental disorders in men, with stronger effect sizes than those observed for women. Moreover, our previous research from the ACMS highlighted higher risks for boys who experience intimidation or control, finding they have six-fold odds of experiencing emotional abuse compared to three-fold odds for girls (details available from the author on request). While domestic violence is predominantly perpetrated by men, boys remain highly victimised by EDV in childhood. Boys who experience domestic violence perpetrated by their fathers/father figures face unique emotional challenges in processing the abuse as they must also simultaneously form their own sense of masculinity and identity as they develop. Reference Callaghan, Fellin, Mavrou, Alexander, Deliyianni-Kouimtzis and Sixsmith47 Further research is needed to understand gender-specific impacts of childhood EDV, mechanisms through which these experiences exert impacts, and specific support needs to prevent intergenerational perpetuation of violence perpetration and victimisation. Reference Fitz-Gibbon, Meyer, Boxall, Maher and Roberts48 Investment is needed to address the challenges of availability and access to evidence-based services following parental separation in the context of domestic violence. Reference Ridout, Fletcher, Smith-Merry, Collyer, Dalgleish and Campbell49
Our findings also underscore the importance of training and supporting clinicians to identify and document coercive control using frameworks that centre the perpetrator’s pattern of behaviour and its impact on the entire family. This approach would help to address underlying sources of distress, mitigate ongoing harm, and strengthen perpetrator accountability across systems, including family law and new criminal law frameworks for coercive control.
Strengths and limitations
Although the ACMS is a cross-sectional study that elicits retrospective accounts of childhood EDV, it is one of only a few nationally representative studies to directly ask individuals about their own accounts of domestic violence in childhood rather than parent reports or other proxy measures and to also examine the impacts of these childhood experiences on adult health outcomes. It is possible that early-life EDV may not be recalled by participants, or they may have not been aware of certain violent behaviours that had occurred. Additionally, information relating to the severity and relationship to the perpetrator/s was not ascertained within the ACMS. Lastly, the cross-sectional nature of this study limits the ability to establish causality.
Implications
This nationally representative study provides critical evidence of the long-term adverse health outcomes associated with childhood EDV. Our study found that EDV in childhood characterised by intimidation or control and property damage or harm to pets significantly increased the risk of mental disorders and health risk behaviours in adulthood, independent of physical domestic violence, other child maltreatment experiences and financial hardship. These findings emphasise the need to advance children’s rights and protections as equal victims of domestic violence through frameworks that recognise the direct harm caused by coercive control. Urgent investment is needed in the prevention of EDV, as well as child-centred and trauma- and family-violence-informed interventions that support children’s recovery and stronger legal protections to prevent children from being weaponised in post-separation coercive control.
Supplementary material
The supplementary material is available online at https://doi.org/10.1192/bjp.2025.10362
Data availability
Final data-sets will be stored on the Australian Data Archive and made available in January 2026 after an embargo period.
Author contributions
J.A.B.: conceptualisation, methodology, writing – original draft; software; validation; formal analysis; investigation; writing – review and editing; visualisation. H.J.T.: writing – review and editing. B.M.: writing – review and editing. D.M.L.: writing – review and editing. D.M.H.: writing – review and editing. D.J.H.: writing – review and editing. E.M.: writing – review and editing. H.E.E.: writing – review and editing. J.G.S.: conceptualisation, methodology; writing – review and editing; supervision.
Funding
The Australian Child Maltreatment Study (ACMS) is supported by a National Health and Medical Research Council Project Grant (APP1158750). The ACMS also receives funding and contributions from the Australian Department of the Prime Minister and Cabinet, the Department of Social Services, and the Australian Institute of Criminology.
Declaration of interest
None.
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