Exploring the Dose-Response Relationship Between Alcohol Consumption and Harm to Others in Australia.

Intimate partner violence (IPV), including physical, sexual, and psychological abuse () has been consistently and robustly linked to substantial health concerns over the life course (). In addition to injuries like bruises, fractures, and death, physical consequences of IPV include traumatic brain injury, long-term physical disability (; ), cardiovascular disease, hypertension, gastrointestinal problems, reduced physical functioning, and overall poor quality of health (; ). Physical and sexual IPV experiences also lead to reproductive health concerns including STIs and HIV, chronic vaginal pain, and unintended pregnancy (). All forms of IPV are associated with mental health concerns including depression, anxiety, chronic stress and post-traumatic stress disorder (PTSD; ; ). IPV is linked to a range of other trauma sequalae including somatic symptoms and substance misuse (; ). Further, there is some evidence to suggest that a survivor may experience differential impacts based on the type of IPV (physical, sexual, psychological). Indeed, found that survivors of physical IPV were at higher risk of alcohol abuse, while those experiencing psychological violence had higher rates of substance misuse and depressive symptomology. They also note the increased impact of polyvictimization (e.g., physical and sexual IPV) on a number of health outcomes. IPV is closely linked to social isolation (; ) and challenges with accessing support, as well as disability due to physical or mental health conditions stemming from IPV, which furthers these impacts (). Additionally, disrupted social networks, lack of community support, and inadequate resources contribute to the overlapping physical and mental health challenges for survivors of IPV (). Indeed, alongside their IPV-induced health complaints, survivors face economic challenges, including and perhaps especially, housing insecurity (e.g., inability to pay rent/mortgage, homelessness; ). Other economic consequences of IPV include food insecurity and missing work or the inability to find and maintain employment due to physical or mental health challenges (; ). Making matters worse, poor mental and physical health (often resulting from IPV) makes survivors particularly vulnerable to revictimization, which, in turn, intensifies health impacts and contributes to chronic conditions (). As an example, PTSD has been linked to IPV revictimization among survivors who sought out shelters (). Emergency shelter, typically offered for 30 to 90 days () is primarily focused on safety and stabilization of the most vulnerable IPV survivors; that is, those with significant safety risks from abuse and housing insecurity. In one single day in 2024, over 50,000 survivors and their children were residing in IPV housing, with shelters being the most frequently provided service in nearly 2000 programs () across the United States. The emergency shelter model is used globally to house survivors and provide comprehensive services post-violence (). Shelter is more frequently used by survivors from racial and ethnic minorities, those who have experienced high levels of IPV, people who have poor mental health, and survivors living in areas with a high cost of living (; ; ). Despite IPV shelter being the primary service for many survivors across the country, relatively little is known about sheltered survivors’ health conditions and outcomes. In the last 2 decades, work by both Sullivan and colleagues (; ) and , ) identified sustained reductions in victimization over a 2-year period post shelter. Importantly, found issues linked to revictimization risk, including reduced social support, lack of resources, recent violence, and difficulty with service access. In a study of IPV shelter residents, found strong satisfaction with staff and available services, which was associated with increased hope, improved self-efficacy, and greater empowerment (). While previous scholarship indicates that shelter can be impactful at reducing revictimization risks, the health conditions and needs of residents are less known, which represents a significant gap in knowledge to inform programming and high-impact service approaches.