Interrupted time series and non-linear regression analyses to evaluate the impact of the three consecutive COVID-19 national lockdowns on the general practice referrals of women experiencing domestic violence and abuse in England and Wales

Background: We evaluated the impact of three successive COVID-19 national lockdowns in England and Wales on the referrals from general practice (GP) to the Identification and Referral to Improve Safety domestic violence and abuse (DVA) services.

Methods: Anonymised data on daily referrals, interrupted-time series and non-linear regression quantified the impact of the three national lockdowns over 2020 and 2021 comparing analogous periods in the 2 years before and after, reporting incidence rate ratios, 95% CIs and p values. Time spent at home and workplace visits over the lockdown periods were quantified as proxies for the stringency of the different lockdowns.

Results: The first national lockdown in early 2020 led to a reduced number of referrals to DVA services (32%, 95% CI 16% to 45%). Over the second and the third lockdown, there was a possible increase in the number of referrals: 29%, 95% CI −4% to 73% and 12%, 95% CI −10% to 39%, respectively. The first national lockdown was more stringent (58% decline in workplace visits; 22% increase in time spent at home) than the second (34% decline in workplace visits; 14% increase in time spent at home) or the third (18% decline in workplace visits; 18% increase in time spent at home).

Conclusions: Increased freedom of movement alongside easier access to GP services during the two latter, less stringent, lockdowns compared with the first, stringent, lockdown could have contributed to the different trends in referrals. We highlight that ensuring access to primary care and adequate and continuing provision of specialist support for people experiencing DVA is important during national emergencies.