Forgone healthcare and intimate partner violence: a study in six European urban centres

Background: Victims of intimate partner violence (IPV) are known to refrain from seeking care when in need. Whether the impact on forgone care differs according to the victim-perpetrator role remains unexplored. We aimed to describe the relation between past-year IPV and forgone healthcare according to victims, perpetrators or both (bidirectional). Methods: Adult men and women (n=3496, aged 18-64), randomly sampled from the general population of Athens, Porto, London, Budapest, Östersund and Stuttgart were assessed using a common questionnaire. IPV was ascertained with the Revised-Conflict-Tactics-Scales. The association between IPV and forgone healthcare (“Have you been in need of a certain care service in the past year, but did not seek any help?”), sociodemographics (sex, age, education, city) and health factors (self-assessed health, public or private healthcare sector use), in victims, perpetrators and both was estimated using adjusted logistic regression odds ratios (AOR, 95% confidence intervals). Results: Forgone healthcare ranged from 12.6% (Budapest) to 22.4% (Stuttgart) and was associated with bidirectional involvement in IPV (AOR, 95%CI= 1.37, 1.05-1.78). A lower educational level was associated with forgone care in multivariate models fitted for victims of and for bidirectional involvement in IPV. A fair/poor self-assessed health (contrasting to a good/very good/excellent health) was significantly associated with forgone care in victims (AOR, 95%CI=2.61, 1.96-3.47), in bidirectional IPV (AOR, 95%CI=2.94, 2.27-3.82) and for perpetrators (AOR, 95%CI=2.58, 1.96-3.40). Conclusion: Beside the known barriers identified for inequalities and access to healthcare, the role of IPV in forgone healthcare should be considered.