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Part One: Sociodemographic Characteristics of Domestic Violence Victims
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Gender
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Female
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Age
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Specify
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Marital status
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Married
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Divorced
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Single
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Widow
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Not mentioned/documented
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Years of marriage
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≤ 5 years
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6–20
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≥ 21
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Not documented/not mentioned
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Presence of kids
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Yes
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No
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Not documented
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Not applicable
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Number of children
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None
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1–3 children
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4–6 children
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≥ 7
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Not applicable
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Not documented
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Employment status
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Student
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Unemployed (stay home)
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Governmental employee
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Private sector employee
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Others
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Not documented
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Educational level
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Illiterate
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Primary/intermediate
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High school
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Diploma
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College/postgraduate
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Mode of living
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Rented apartment
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Rented villa
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Owned apartment
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Owned villa
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Other
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Not mentioned/documented
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Financial dependency
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Yes
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No
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Not mentioned
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Type of support
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No support
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Original family
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Extended family
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Friendships
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Other
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Not applicable
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Not documented
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Does the victim suffer from any kind of disability?
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Yes
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No
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Not documented
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Does the victim suffer violence from multiple people?
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Yes
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No
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Not documented
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Part Two: Demographic and Behavioral Characteristics of Perpetrators of Violence
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Perpetrator
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Husband
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Brother
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Sister
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Father
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Mother
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Multiple people
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Other
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Not documented
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Documented
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Age of perpetrator
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Specify
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Not documented
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Not mentioned
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Drug abuse of the perpetrator
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None
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Smoking
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Recreational drugs
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Alcohol
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Amphetamine
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Not documented
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Combined
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Type of violence
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Physical
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Emotional
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Sexual
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Verbal
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Physical, verbal
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Combined (physical, sexual, emotional)
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Other
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Not documented
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Educational level of the perpetrator
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Illiterate
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Primary/intermediate
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High school
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Diploma
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College/postgraduate
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Not documented
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Employment status of the perpetrator
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Unemployed
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Employed
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Retired
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Not mentioned
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Not documented
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Part Three: Psychiatric Diagnosis and Service Interventions for the Victims
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Previous psychiatric diagnosis of the victim
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No
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Yes
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Specify, if yes
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Not mentioned
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Diagnosis at presentation of the victim
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No
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Yes
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Specify
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Not mentioned
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Suicide assessment of the victim
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None
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Ideation
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Attempt
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Death wishes
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Not mentioned
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Drug abuse of the victim
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None
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Smoking
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Recreational drugs
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Not mentioned
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Type of service provided (You can choose multiple answers)
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Admission for protection
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Psychiatry OPD follow-up
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Psychology OPD follow-up
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Social service follow-up
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Family Therapy clinic
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No intervention
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Medication
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Not documented
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Psychotropic medication (You can choose multiple answers)
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None
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Antidepressant
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Antipsychotic
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Benzodiazepine
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Not documented
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Medical history (You can choose multiple answers)
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None
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Not mentioned
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Specify
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Others
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Part Four: Victim’s Knowledge and Ways to Get Help
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Is the violence still ongoing?
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Yes
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No
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Not documented
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Do you know where to go for help?
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Yes
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No
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Not documented
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Where do you get help from? (multiple answers)
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None
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Police
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Hospital
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Family
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Friends
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Other
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What was the most helpful way to stop the violence? (multiple answers)
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None
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Failing legal complaint
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Involved family members
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Health facility intervention
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Other
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Health facility intervention (multiple answers)
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None
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Psychiatry
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Psychology
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Family therapy
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Family dispute clinic
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Other
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From where did the victim hear about the domestic violence team services in NGH (multiple answers)
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Not heard about it
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Media
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Advice from another physician
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Official referrals from other
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Team services
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Friends/family
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