There is a significant body of research to show that experiences of physical and sexual abuse in childhood are common among adults with mental disorders, with prevalence estimates ranging from 25 to 57 % (Subica 2013; Álvarez et al. 2011; Bebbington et al. 2011; Mueser et al. 2004). Experiences of both sexual and non-sexual childhood abuse are found to increase an individual’s risk of developing adult mental disorders (Hillberg et al. 2011; McLaughlin et al. 2010; Norman et al. 2012). For example, childhood emotional abuse and neglect are shown to be associated with increased anxiety, depression and PTSD in adulthood (Spertus et al. 2003), and childhood maltreatment is associated with elevated odds of adult mood, anxiety and drug misuse disorders (odds ratios = 2.1–4.1) (Scott et al. 2012). Experiences of childhood abuse are also prevalent among female mental health service users, with recent estimates indicating a prevalence of between 25 % and 60 % (Meade et al. 2009; Cusack et al. 2006; Gearon et al. 2003; Goodman et al. 1997, 2001).

Data on the association between child abuse and perinatal mental disorders is limited (Leeners et al. 2006). However, there is some evidence to suggest that women’s experience of childhood physical and sexual abuse is associated with an increased risk of perinatal common mental disorders (Records and Rice 2009; Roberts et al. 2004; Ansara et al. 2005; Ferri et al. 2007; Buist and Janson 2001). A US study of 357 primiparous women found that those with experiences of childhood sexual abuse reported significantly higher depressive symptoms (Benedict et al. 1999). These women were also found to report higher levels of abuse before and during pregnancy, compared to women without experiences of child abuse (Benedict et al. 1999). A study of 44 pregnant women found that sexual abuse and emotional neglect in childhood were associated with symptoms of depression and anxiety in pregnancy, and emotional neglect and physical abuse predicted poorer maternal outcomes at one year post-partum (Lang et al. 2006).

Recent research indicates that the trauma associated with child abuse may be associated with adverse birth outcomes among pregnant adult women. For example, a prospective study of 839 nulliparous women in the USA found that current PTSD subsequent to child abuse was strongly associated with lower birth weight and shorter gestation (Seng et al. 2011). Women with experiences of childhood abuse are more likely to engage in risky health behaviours during pregnancy, such as smoking and substance misuse, which can also lead to adverse birth outcomes (Chung et al. 2010). A growing body of evidence indicates that child abuse is associated with disruptions in hypothalamic-pituitary-adrenal (HPA) axis functioning in adulthood (Heim et al. 2003), and these disruptions may result in vulnerabilities for the development of adult mental disorders (Heim et al. 2000). Recent findings indicate that changes in HPA axis functioning subsequent to child abuse may have trans-generational effects, with children of abused mothers displaying similar neuroendocrine profiles (Brand et al. 2010). A recent study of 126 mothers with a history of major mood disorder examined the effects of maternal childhood sexual and physical abuse on maternal and infant salivary cortisol levels following a laboratory stressor paradigm. The study found that maternal child abuse was associated with steeper declines in cortisol levels in mothers and lower baseline cortisol levels in infants (Brand et al. 2010). The study found that current life stress and co-morbid PTSD were important moderators of the child abuse-HPA axis relationship. The impact of abuse is also seen to extend to child-rearing practices, and women with histories of abuse are found to report poorer parent-child relationship quality compared to women without a history of abuse (Roberts et al. 2004).

Childhood abuse has also been shown to increase a woman’s risk of subsequent re-victimisation (Read et al. 2005), including domestic violence victimisation as an adult (Chen and White 2004; Miller et al. 2011). Indeed, analysis of data from a New Zealand birth cohort of over 1,000 young adults found that exposure to inter-parental violence in childhood, including witnessing and experiencing abuse, increases a woman’s risk of experiencing partner violence in adulthood (Fergusson et al. 2008). These findings are pertinent as evidence suggests that multiple victimisation experiences increase a woman’s risk of developing mental disorders (Rees et al. 2011).

A significant amount of research has been conducted on the association between women’s experience of domestic violence and mental disorders. Evidence shows that experiences of domestic violence are closely associated with mental disorders, and a recent systematic review found that, across all diagnostic categories, women with mental disorders experience a high prevalence and increased likelihood of domestic violence compared to women without mental disorders (Trevillion et al. 2012). Median prevalence estimates for past-year partner violence among women with depressive and anxiety disorders were 35 % and 28 %, respectively. The review also identified a higher risk of domestic violence among women with depressive disorders (odds ratio (OR) 2.77), anxiety disorders (OR 4.08) and post-traumatic stress disorder (OR 7.34) (Trevillion et al. 2012). Experiences of domestic violence are also prevalent among female mental health service users, with evidence to suggest that around 30 % of female psychiatric inpatients and 33 % of female psychiatric outpatients have experienced domestic violence (Oram et al. 2013).

Domestic violence has also been found to be a strong risk factor for antenatal and postnatal depression (Howard et al. 2014). Women with perinatal mental disorders are found to report a high prevalence and increased likelihood of domestic violence over their lifetime and during pregnancy. For example, a recent systematic review reported median prevalence estimates for partner violence during pregnancy of 14 % among women with antenatal depressive disorders (Howard et al. 2013). The review found that women reporting domestic violence in pregnancy were at increased risk of experiencing antenatal (pooled OR, 3.0) and postnatal (pooled OR, 2.9) depressive symptoms (Howard et al. 2013). Experiences of domestic violence in pregnancy were also found to be associated with increased odds of anxiety and PTSD symptoms in both the antenatal and postnatal periods (Howard et al. 2013). With regard to the type of violence, a recent prospective nulliparous pregnancy cohort study of 1305 women identified increased odds for postnatal depressive symptoms among women experiencing emotional abuse alone (AOR 2.72) or physical violence (AOR 3.94) in pregnancy, after controlling for depression in pregnancy and socio-demographic characteristics (Woolhouse et al. 2012).

Domestic violence experienced in the perinatal period can result in serious adverse pregnancy outcomes and even maternal death (Huth-Bocks et al. 2002). There is some evidence to show that antenatal domestic violence is associated with low birth weight and preterm births (Shah and Shah 2010; Feder et al. 2009a). Moreover, recent findings from the 2006–2008 UK Confidential Enquiry into Maternal and Child Health found that among 261 mothers who died from any cause, 39 (12 %) had features of domestic violence and eight of these women were murdered by an intimate partner or spouse (Draycott et al. 2011).

The impact of domestic violence experienced in the perinatal period and beyond can also have adverse impacts on the physical and mental health well-being of children. A child living in a household with familial violence may also directly experience abuse. Evidence suggests that children growing up in a domestically violent situation report higher rates of psychological disturbance (McWilliams and McKiernan 1993) and are 30–60 % more likely to experience child abuse (Eddleson 1999; Hester et al. 2007; Humphreys and Thiara 2002). Several literature reviews have sought to examine the health impacts of children’s exposure to domestic violence, defined as witnessing (i.e. seeing or hearing violent exchanges between parents) and experiencing (i.e. children that are directly abused) domestic violence (Kitzmann et al. 2003; Osofsky 2003; Wolfe et al. 2003; Yount et al. 2011). For example, Wolfe et al. (2003) conducted a meta-analysis of 41 studies and found that children exposed to domestic violence experience more behavioural and psychological problems than non-exposed children (Wolfe et al. 2003; Kitzmann et al. 2003) conducted a meta-analysis of 118 studies and found that children witnessing domestic violence experienced an increased risk of psychological, emotional and behavioural problems compared to children not witnessing violence. Furthermore, they found comparable levels of psychological, emotional and behavioural disturbances among children witnessing domestic violence and physically abused children (Kitzmann et al. 2003). A more recent meta-analysis identified an association between childhood exposure to domestic violence and trauma symptoms in children (Evans et al. 2008).

Prospective data from a US representative sample of 821 parent-child dyads found that parents’ experience of domestic violence independently increased children’s risk of externalising behavioural problems (e.g. noncompliance, aggression, antisocial behaviour), after controlling for parental history of antisocial behaviour and family violence (Ehrensaft and Cohen 2012). Evidence from the UK Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort of 13,617 children and mother dyads found that antenatal domestic violence predicted future behavioural problems in children aged 42 months (OR 1.87), although this was partly mediated by maternal depression (Flach et al. 2011).

The presence of perinatal mental disorders and violence and abuse may further compound developmental problems in children. Prospective data on antenatal depression, child maltreatment (at age 11) and child psychopathology (at age 11 and 16) from 120 mother-child dyads in a UK community-based study found that children exposed only to antenatal depression or childhood maltreatment were no more at risk of developing psychopathology. However, children exposed to both antenatal depression and childhood maltreatment were at almost 12 times more likely to develop psychopathology than those not exposed (Pawlby et al. 2011).

Literature reviews on the effectiveness of interventions in preventing direct abuse, neglect and exposure to parental domestic violence among children find evidence that early home visitation programmes (i.e. Nurse-Family Partnerships and Early Start programmes) are effective in preventing direct abuse and neglect of children within low-income and high-risk families (MacMillan et al. 2009; Mikton and Butchart 2009). These programmes comprise intensive home visitation by nurses/social workers who focus on assisting women in improving their prenatal health-related behaviours: teaching parents sensitive and empathetic care of their children and improving parents’ economic self-sufficiency. In contrast, a paucity of interventions was found to exist on the prevention of children’s exposure to parental domestic violence (MacMillan et al. 2009).

There is increasing evidence within primary care settings on interventions for women experiencing domestic violence (Feder et al. 2009b). Good evidence now exists on the effectiveness of domestic violence advocacy programmes in reducing abuse, increasing safety behaviours and enhancing access to community resources among abused women in primary care settings (Feder et al. 2009b). Limited evidence exists, however, within secondary care settings. A small randomised controlled trial of trauma-focused cognitive behavioural therapy for mental health service users found significant improvements in psychiatric symptoms and trauma-related cognitions at the end of treatment (Mueser et al. 2008). This intervention comprised a 21-week group therapy programme for men and women, including components such as breathing retraining, education about post-traumatic stress disorder, cognitive restructuring, coping skills and recovery plans. Although these findings are promising, the intervention did not specifically focus on trauma as a function of domestic violence or on the risk of future victimisation which is a key risk factor in domestic violence. There has been a pilot study of domestic violence advocacy with community mental health services in the UK, and the initial findings are promising for clinical practice (Trevillion et al. 2014). This pilot study found that reciprocal training by mental healthcare professionals and domestic violence advocates and a direct referral pathway to domestic violence advocacy for abused service users resulted in significant improvements in clinical practice and service user outcomes (Trevillion et al. 2014). Mental health professionals reported significant improvements in their knowledge, attitudes and behaviours towards domestic violence, and service users reported significant reductions in their experiences of abuse as well as significant improvements in their quality of life and social inclusion (Trevillion et al. 2014). These findings suggest joint working practices between mental health and domestic violence services can effectively support both the mental health and trauma needs of psychiatric service users experiencing victim. Clinical examples of joint-agency collaborations in the UK include representatives from both sectors participating in Multi-Agency Risk Assessment Conferences (MARACs), whereby numerous statutory and voluntary services collaborate to plan individually tailored support to protect victims at high risk of harm.

It has been argued that the dominance of the medical model of mental health can have negative consequences regarding child contact and child protection proceedings for abused women labelled with mental health problems (Humphreys and Thiara 2003a). Research suggests that a significant number of women with severe mental illness – particularly schizophrenic disorders – have children removed from their custody (Hollingsworth 2004; Howard et al. 2004; White et al. 1995). In addition, many mothers experiencing domestic violence may lose sole custody of their children, when judges do not believe their children are in danger of harm by abusive fathers. This view contrasts with the evidence that 30–60 % of men who abuse their partners also abuse their children (Eddleson 1999; Hester et al. 2007; Humphreys and Thiara 2002) and shows how the justice system makes little connection between male violence and male parenting (Thiara 2010). In response to joint custody agreements, mothers are forced to continue a relationship with their abuser, and this may result in women’s relationships with their children being undermined as part of a wider strategy of abuse (Humphreys 2006; Thiara et al. 2006). Child contact arrangements can allow abusers to maintain their damaging presence on the lives of women and children and permit them to continue to abuse and stalk their partners (Burman and Chantler 2005; Thiara 2010; Walker 2009). Alarmingly, the continuing issues faced by women and children in these situations have frequently been shown to be couched in terms of ‘mother-blaming’ (Jaffe et al. 2003; Radford and Hester 2001; Thiara et al. 2006; Thiara 2010). Legal processes may also be used by abusers to continue post-separation violence, with regard to contesting women’s evidence of domestic violence, making counter-allegations of child abuse and undermining women’s mothering capabilities (Hardesty 2002; Humphreys and Thiara 2003b; Thiara 2010).