ArticlesPrevalence and risk of violence against adults with disabilities: a systematic review and meta-analysis of observational studies
Introduction
Roughly 15% of adults worldwide have a disability.1 This prevalence is predicted to increase because of ageing populations, the increased risk of disability in elderly people, and the worldwide rise in chronic diseases such as cancer, diabetes, cardiovascular disease, and mental illnesses.2, 3 Approaches to disability increasingly emphasise environmental and social factors, with recognition that “disability results from the interaction between persons with impairments and attitudinal and environmental barriers that hinders their full and effective participation in society on an equal basis with others”.4 Protection of the rights of individuals with disabilities, and enablement of their full participation in society has become a major global priority, underpinned by the UN Convention on the Rights of Persons with Disabilities.4 To support action on this priority, the World Report on Disability1 gathered evidence about the magnitude of disability worldwide, its effect on well-being, and how the barriers faced by individuals with disability can be overcome.
About half a million adults die every year because of interpersonal violence;3 millions more suffer non-fatal violence and the resulting health and socio-occupational consequences. People with disabilities seem to be at an increased risk of interpersonal violence1 because of several factors: exclusion from education and employment, the need for personal assistance with daily living, reduced physical and emotional defences, communication barriers that hamper the reporting of violence, societal stigma, and discrimination.5, 6 Furthermore, rising numbers of media reports emphasise cases of physical violence, sexual abuse, and hate crime inflicted on individuals with disabilities in homes, institutions, communities, and other settings.7, 8, 9, 10 However, whether this increase indicates a rising prevalence of violence against individuals with disabilities, more consistent reporting to authorities, or greater media coverage than previously is unclear.
Although an increasing amount of research has been done to quantify violence against individuals with disabilities, study methods and the definitions of disability and violence vary widely, and no quantitative syntheses of this evidence have been done. Understanding of the magnitude of violence against affected groups is the first step in the public health approach to violence prevention.11 This step is a basic prerequisite to understand risk and protective factors, develop and rigorously assess interventions, and implement effective programmes to prevent violence. Thus, to support the World Report on Disability, we did a systematic review and meta-analysis of studies of violence against adults with disability. We aimed to identify the characteristics and coverage of research for the prevalence and risk of violence against adults with disabilities; assess the quality of this research; and synthesise evidence on the prevalence and risk of violence against adults with disabilities to identify knowledge gaps and research priorities.
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Search strategy and selection criteria
We searched Medline, PsycINFO, CINAHL, International Bibliography of the Social Sciences, ASSIA, ERIC, Sociological Abstracts, Cochrane Library, Embase, National Criminal Justice Reference System Abstracts Database, Social Care Online, and Social Sciences Citation Index to identify primary research studies published between Jan 1, 1990, and Aug 17, 2010, that reported prevalence estimates of violence against adults (mainly aged ≥18 years) with disabilities, or the risk of violence in disabled
Results
Of 10 663 abstracts, we identified 26 studies13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38 that were eligible for inclusion (figure 1, appendix). 22 studies used a cross-sectional design, but four20, 31, 34, 37 were cohort studies. 14 studies provided data for the prevalence of violence in a sample of individuals with disabilities only, whereas the remaining 12 measured violence in individuals with and without disabilities. Across 24
Discussion
Findings from this systematic review and meta-analysis show that violence is a major problem in adults with disabilities, who are at an increased risk of violence compared with non-disabled adults. Prevalence estimates of any (physical, sexual, or intimate partner) recent violence were highest in individuals with mental illnesses and lowest in those with non-specific impairments. The small number of studies and wide variation in sample and study characteristics mean a great deal of uncertainty
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