Health-related Costs and Mental Health Service Use among Victims of Intimate Partner Violence in Finland

Intimate partner violence (IPV) is negatively associated with physical and mental health, as well as overall well-being among victims, their children, and families as a whole. This leads to a burden on society due to the escalating costs of healthcare, social services and criminal justice resources. However, only limited evidence is available concerning what are the underlying factors relating to the main cost drivers of healthcare among IPV victims. The primary aim of the work described in this thesis was to identify the burden of IPV within the healthcare system by estimating direct health-related costs and examining patterns of mental health service use among IPV victims, based on individual-level linked register data in Finland. The study utilizes nationwide population-survey data. This thesis adopts a healthcare perspective and can be seen as a starting point for a public health approach to preventing IPV. Estimating the burden of IPV in monetary terms, as well as identifying risk factors for adverse health consequences, is crucial for early intervention and improved clinical responses for those susceptible to IPV. The findings of the work described also contribute to reducing the risk of future victimization. The first article examines the association between exposure to violence, quality of life (QoL) and psychological distress utilizing national population-survey data. The second article estimates the attributable healthcare costs of IPV victims. The third article explores patterns of mental health service utilization before and after the initial identification of IPV victims, across both primary and secondary healthcare settings. The second and third articles utilized data based on police reports linked with two nationwide health registers. The fourth article examines pattens of mental health service use between IPV and non-partner violence or unidentified perpetrator violence using two nationwide health registers linked with data on shelters for domestic violence. The first study found that IPV victims have higher psychological distress and lower quality of life compared to individuals who did not report exposure to IPV during the previous year. The second study revealed that adverse health consequences persist and are associated with higher health costs for five years after the initial identification of IPV. The third study suggested that, over the two-year period before and after an initial IPV report, mental health service utilization was consistently higher among those exposed to revictimization compared with those who experienced a single, isolated IPV event. The fourth study also indicated that mental health service utilization was consistently higher among IPV victims than among those exposed to non-partner violence or to violence with missing partner information. Individuals with lower socioeconomic status (SES) and those with previous mental health diagnoses were more likely to experience IPV. Overall, these studies provide population-level evidence on health service use among IPV victims based on register data. Notably, each data source appears to represent somewhat different populations, with some overlaps. There were distinct patterns of mental health service use among women and men before and after the initial IPV identification. Understanding the characteristics of IPV victims, such as social vulnerability and patterns of service use, is useful for professionals in improving clinical responses to IPV. These findings should be addressed in policy-making through early identification of IPV, provision of trauma-specific support, and the development of integrated services across healthcare, social services and law enforcement. This would facilitate informed decision-making on resource allocation to reduce the adverse health consequences of IPV. Future studies should consider both protective and risk factors of IPV that may have long-term effects on children and families. Incorporating additional data sources, such as information on the use of lower-threshold mental health services, could lead to a more comprehensive understanding of service users and improve long-term outcomes.