Abuse and violence can occur in many forms, including physical, psychological, financial, sexual and social, as well as neglect. In Australia, after the age of 15 years, one in six women and one in 16 men have experienced physical or sexual violence from a current or previous partner, with one in four women enduring emotional abuse by a current or previous partner.1 Child abuse and neglect have long-term impacts on health, including higher rates of diabetes, gastrointestinal problems, headaches and heart disease in adulthood, in addition to persisting mental health problems, eating disorders, obesity, and alcohol and substance abuse.2 Partner violence is the third leading risk factor for total disease burden in women aged 25–44 years, behind child abuse and neglect during childhood, and illicit drug use.1 While women are more likely to experience violence in their home from a known person, men are more likely to experience violence in a public place from a stranger.1
The most prevalent form of abuse and violence in Australia is bullying. One in four Australian children in years four to nine have been bullied, and approximately one in five Australian young people experience cyberbullying in a 12-month period.3 In a six-month period, 9.4% of Australian workers experience bullying, and one-third of these experience bullying at least weekly.4 Women are more likely to be bullied and to experience unwanted sexual advances, unfair treatment due to their gender, and to be physically assaulted or threatened by a client or patient.4
There are over 600 abuse-related hospitalisations per year for children in Australia.1 In 2017–18, there were more than 26,400 child protection notifications substantiated, with emotional abuse most commonly reported as the primary abuse type.5 Approximately 13% of Australian adults experienced physical and/or sexual abuse during childhood,6 while one in six women and one in 25 men have experienced at least one sexual assault since the age of 15.7 The rate of police-recorded sexual assaults against children aged 0–14 years is nearly twice that of people aged 15 and over.7
The prevalence of abuse of older people in Australian residential aged care is estimated to be almost 40%.8 In the Australian community as a whole, the prevalence of abuse of older people is estimated at between 2% and 14%.9 The abuse of older people can be financial, emotional, physical, sexual and/or neglect.10 Aboriginal and Torres Strait Islander peoples and people from culturally and linguistically diverse communities face additional barriers to reporting sexual assault, including communication barriers, lack of culturally appropriate services, and lack of trust in police and institutions.7
Due to the prevalence of abuse and violence in the community, it is imperative that general practitioners (GPs) understand abuse and violence-related presentations. GPs play an important role in recognising red flags that may indicate a patient is experiencing or has experienced abuse or violence. Individuals may present on one or several occasions with signs, such as recurrent injuries or unexplained bruising, that warrant further investigation. Depression is the most common presentation in Australian general practice for victims of family and domestic abuse and violence.11 Patients may also present with less specific symptoms and signs, such as mood changes, sleeping issues or substance misuse. Screening for abuse and violence should occur across the lifespan. The use of trauma-informed care is important to promote safety, empowerment and healing with patients. GPs may be called on by police to examine a person who has been physically or sexually assaulted, particularly in rural and remote areas, or may be asked by a patient for an examination following an assault. An understanding of forensic requirements, including chain of custody and writing court reports, are essential general practice skills, as well as knowing where and when to seek assistance. GPs need to be aware of their medico-legal requirements and mandatory reporting laws.