Cultural adaptation of the danger assessment for thailand and prospective associations with repeat severe physical intimate partner violence: a prospective cohort study

Intimate partner violence (IPV) is a pervasive public health problem in Thailand, yet no culturally adapted, Thai-language risk assessment tool has been available to guide survivor safety planning. This study culturally adapted the Danger Assessment (DA) for the Thai context (DA-Thailand) and collected initial prospective evidence on associations between DA-Thailand indicators and repeat severe physical IPV. In Phase 1, the DA was adapted through a rigorous cross-cultural adaptation process grounded in an established equivalence framework, including forward and back translation, a three-round Delphi consensus process with 27 Thai IPV experts and survivors, literature synthesis, and interdisciplinary expert review. In Phase 2, a prospective cohort of Thai women aged 18 years and older ( N = 279) who screened positive for current IPV completed online baseline assessments, including the DA-Thailand, Patient Health Questionnaire-9, International Trauma Questionnaire, and culturally specific social-ecological items; 184 (65.9%) completed a 6-month follow-up. To identify all possible risk factors, bivariate logistic regression was used to estimate associations between baseline DA-Thailand indicators and repeat severe physical violence at follow-up, stratified by age group (under 20 vs. 20 years and older). The DA-Thailand comprised 30 main items and 18 conditional sub-items (48 questions total), retaining nine original DA items, modifying nine items for cultural relevance, and adding 21 new Thailand-specific items/sub-items. Endorsement of lethality-related indicators was high, and depression (79.6%), posttraumatic stress disorder (41.2%), and complex posttraumatic stress disorder (30.8%) were prevalent. Culturally grounded barriers to help-seeking, including attribution of abuse to karma (58.1%), were commonly endorsed, and 90.3% of participants had never accessed formal violence services. Partner financial problems was the only indicator statistically significantly associated with repeat severe physical IPV in both age groups (OR = 5.54, 95% CI [1.50–20.47] among women under 20; OR = 2.69, 95% CI [1.28–5.62] among women aged 20 and older). Escalation in violence severity/frequency, strangulation, and extreme jealousy showed elevated odds in the same direction in both groups, but their 95% confidence intervals included 1.0. Additional age-specific patterns emerged in exploratory stratified analyses and are reported as hypothesis-generating. The DA-Thailand is the first Danger Assessment adaptation developed for a Southeast Asian setting and provides Thai clinicians and advocates with a structured, survivor-centred means of surfacing danger indicators that routine practice currently does not ask about. Given that nine in ten participants had never reached a formal violence service, the instrument’s immediate public health value lies in everyday clinical contact points rather than specialist services. Findings underscore the need to integrate trauma-informed mental health screening with culturally responsive safety planning in Thailand, and support external validation before the instrument is embedded in decisions affecting access to services.