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Surviving abuse at the hands of a partner is traumatic in itself, but now researchers have found the damage goes further than skin deep. A new study finds women who have experienced domestic violence are three times more likely to develop a mental illness.

The study was published in the British Journal of Psychiatry. Researchers analyzed medical records of 92,735 women in the United Kingdom between 1995 and 2017. They believe it's the first time a "cohort" study has focused on this issue, following participants over time from when they first experienced the abuse, to the development of a mental illness.

"This study highlights the two-way relationship between abuse and mental illness, including serious mental illness" says Dr. Beena Rajkumar, co-chair of the Women's Mental Health Special Interest Group at the Royal College of Psychiatrists. It also "carries a very important warning that we are missing opportunities to detect abuse that is happening all over the country today."

Of the 92,735 medical records, researchers identified 18,547 women who's general practitioner recorded their experience of domestic abuse. They compared their medical records to 74,188 similarly aged women who had not recorded an experience of domestic abuse. Researchers say the records showed experiencing domestic abuse led to a doubling of risk of developing anxiety, and tripling the risk of developing depression and serious mental illness. Those include schizophrenia and bipolar disorder.

Now, they're trying to figure out why. Lead author Dr. Joht Singh Chandan, of the University of Birmingham, says "the connection is complex between abuse and mental illness." He says one possible explanation could be factors relating to "actual neurological and inflammatory changes which can predispose people to developing mental illness". He says socioeconomic status may also play a role, as well as alcohol misuse, smoking, drugs, previous exposure to abuse as a child, and the presence of any other psychological disease.

Dr. Chandan says his experiences as both a medical doctor and a volunteer with the West Midlands police force spurred his interest in exploring the impact of domestic abuse, focusing on the "interplay between crime and health". He believes since the results show such a strong link between domestic abuse and mental illness, both doctors and emergency responders need to do more to tackle it. "We need a clear public health approach to prevent the violence and abuse of very vulnerable women", says Dr. Chandan.

The study found only 0.5% of women in the database reported experiencing domestic abuse, but the Office of National Statistics estimates about 25% of all women experience it in their lifetime. Researchers believe this shows domestic abuse may be under-recorded by doctors. Since police are more likely to encounter domestic abuse survivors than doctors, they're urging the two sides to form a partnership. They say that could be a way to improve the recording of abuse, and provide an opportunity to put prevention strategies in place to prevent the onset of mental illness.

The research team says they believe this needs to be an ongoing process, since there's the chance that even when asked, women may not report abuse the first time it happens. Dr. Rajkumar agrees, saying "screening and recording of domestic abuse needs to be a clear priority for public services so that more effective interventions for this group of vulnerable women can urgently be put in place."