Compared to the HIS 2018 findings, domestic violence occurred more often in Belgium since the beginning of the coronavirus crisis and the persistent confinement measures even worsened this situation. In April 2020, 6 weeks after the introduction of the confinement measures, adults were 3 times more likely to report being victim of domestic violence than in 2018, and in March 2021, it was even 5 times more likely than in 2018. However, the longer reference period for reporting domestic violence between the two COVID-19 heath surveys (retrospectively in the past 6 weeks versus in the past year) may explain the increased risk of being a victim of domestic violence from 6 weeks to 1 year after the coronavirus crisis. As is the case in other studies (7, 37, 38), psychological violence was the most frequent form of domestic violence reported in our study. This type of violence can also be experienced as traumatic, but often stays unnoticed by society (2). However, psychological violence can also go hand in hand with physical violence (9, 14). In this study, most of the victims reporting physical violence (including sexual violence) also experienced psychological violence. So even though confinement is in the interest of curbing the virus transmission, it can put people in a potentially dangerous situation or even put victims more at risk (8, 14, 15, 18, 19, 32).
Social isolation among victims of domestic violence was assessed based on five subjective social isolation indicators. The main conclusion is that there is an association between being a victim of domestic violence and perceived social isolation. Victims of domestic violence indicated twice as often to have weak social support in the first 6 weeks of confinement, and still 1 year after the introduction of the confinement measures. This is in line with a study that showed that battered women perceived their social support as being weak (21). Besides, one year after the confinement victims of domestic violence also indicated almost twice as frequently being rather unsatisfied of their social contacts. Furthermore, in the beginning of the confinement, victims of domestic violence were more likely to have less confidence in health care services. In general, in the beginning of the confinement period there was a reduced accessibility to health care and social services and later there was a switchover to virtual consultations (1, 8). In normal circumstances, victims are already reluctant to seek help, so confinement could make it even more difficult for them (20). These virtual technologies can of course be useful; however, the victim cannot always use them discreetly or cannot access them because of control tactics by the perpetrator. On the other hand it may also be possible that acquiring such technologies is too expensive (14). Other explanations of this social isolation among victims is that perpetrators often disrupt the friendship ties of the victim (21) or that they use COVID-19 as a coercive control mechanism to make their victim anxious which will make them stay at home (17). Nevertheless, even though the confinement measures have been loosened over time, 1 year after their introduction victims of domestic violence feel more than twice as often lonely, both socially and emotionally, than nonvictims.
Not only does the taboo on domestic violence make it difficult for victims to report it or to seek help (9, 16), the confinement clearly creates other barriers (i.e. movement restrictions, trapped with perpetrator, reduced access to social services) as well (15). Consequently there are vulnerable people who do not get the help they need which will affect their safety, health and wellbeing (14, 37). When confinement is necessary, policy makers should take measures that are as bearable as possible for everyone (39). Therefore it is essential to provide adequate support during confinement (8, 20). In this context the United Nations evoked to prioritize support and warning systems for victims of domestic violence (17). Support can come from different areas. For example, health care and social professionals, often the first point of contact for victims, must be made aware of the increased risk of domestic violence during confinement. Training can help them recognize this problem (signs and people at risk) and anticipate in an appropriate way so that the safety of the victim is guaranteed (1, 16, 19). One should also invest in mental health care (expand and free of charge), as victims of domestic violence often have to deal with psychological problems (7, 19, 32). It is also crucial that social support systems and shelters remain accessible during confinement (12, 16). In Belgium, hotels and empty government buildings were offered to victims as an alternative for shelters (18). Of course the general population needs to be informed about the available services like hotlines, online platforms and shelters through (social) media and health and social services (16, 17). Regarding online platforms, it is important that they contain a mechanism to quickly and safely exit them so that these platforms cannot be tracked by the perpetrator (16). Still, it is important that people keep connected with family, friends and neighbors during confinement which can help to reduce social isolation among victims of domestic violence and facilitate a faster report of a concern of domestic violence (16–18). In Belgium, but also in some other European countries, the government has set up a warning system in pharmacies. The purpose of this system is that victims can alert the staff that they are in danger and need support by using a code word (12, 17–19). In addition, it is also important to focus on prevention of domestic violence by, among others, promoting gender equality (8, 9, 12, 18).
The first strength of this study is that it was conducted in the heat of the battle against the coronavirus, this goes especially for the second COVID-19 health survey (organized 6 weeks after the introduction of the confinement measures). This rapid approach could only be done by using a web survey, which was accessible by mobile phone, a tablet and computer (25). An advantage of a web survey is that it is very user-friendly and the high quality data are readily available (40, 41). Another strength of these online health surveys is the repeated cross-sectional way of data collection and the fact that sensitive topics such as domestic violence can be surveyed (2). The last strength is that domestic violence was investigated in a large convenience sample at national level among the population of 18 years and older.
However, online surveys also introduce weaknesses in the study design. For instance children, who also can be a victim of domestic violence, were not included in this study. The Ethics Committee imposed this age restriction. Other weaknesses of this study are the selection bias (e.g. the digital divide: overrepresentation of higher educated people and internet literate people), the potential healthy volunteer bias, (e.g. need for good concentration level to complete questionnaire) and misreporting since self-reported data are subject to social desirability (2, 25). Besides, the reliability of the questions on domestic violence can be affected because they were developed without pretesting due to the urgency (25). Finally, it also needs to be noted that domestic violence in the HIS 2018 was questioned differently than in the COVID-19 health surveys (with different time periods): in the former, victims of violence were asked who the perpetrator was (stranger(s), colleague(s), acquaintance(s), friend(s), (ex-) partner, parent(s), (plus) child(ren) or family member). In addition, the methodology was also different: a survey on household level where maximum 4 members were questioned by an interviewer, next to a paper questionnaire (including the more sensitive items like violence) which needed to be filled in by the members themselves (26).