Maternal-child dyads of functioning: the intergenerational impact of violence against women on children

Mediators and moderator of the effects of early exposure to intimate partner violence on children's mental health

Childhood intimate partner violence (IPV) exposure increases the likelihood of internalizing and externalizing problems. There is substantial variability in children's outcomes following IPV exposure, but the reasons behind this are unclear, particularly among preschool-age children. The current study aimed to examine the direct and indirect effects of IPV on preschoolers' mental health through parent factors (parenting and parental depression), exploring child temperament as a potential moderator of the relation between IPV and child outcomes. Participants were 186 children (85 girls) and their parents living in the United States. Data were initially collected when children were age three, with follow-up at ages four and six. Both parents' baseline IPV perpetration had adverse effects on child outcomes. Mothers' IPV was associated with greater paternal depression, paternal overractivity, and maternal laxness, whereas fathers' IPV was associated with more paternal overreactivity. Only paternal depression mediated the effect of mothers' IPV on child outcomes. Parenting did not mediate nor did child temperament moderate the relation between IPV and child outcomes. Results shed insight into the need to address parental mental health in families experiencing IPV and underline the need for a further exploration of individual- and family-level mechanisms of adjustment following IPV exposure.

Association between Maternal Anxiety and Children's Problem Behaviors: A Systematic Review and Meta-Analysis

Although numerous studies have found that maternal anxiety is a risk factor for the development of children's problem behaviors, and there is a possible role of genes in the association between the two. And anxious mothers caring for their children can also affect the development of children's problem behaviors. However, there is also considerable evidence from studies that refute this view. This study used a meta-analysis to explore the relationship between maternal anxiety and preschool children's problem behaviors. Through literature retrieval and selection, in terms of the criteria for inclusion in the meta-analysis, 88 independent effect sizes (34 studies, 295,032 participants) were picked out as meta-analysis units. The test for heterogeneity illustrated that there was significant heterogeneity in 88 independent effect sizes, while the random effects model was an appropriate model for the subsequent meta-analysis. The publication bias test indicated that the impact of publication bias was modest but the major findings remained valid. In addition, in terms of the tentative review analysis and research hypotheses, the random effects model was used as a meta-analysis model. The research revealed that maternal anxiety was significantly positively correlated with preschool children's internalizing problem behaviors, externalizing problem behaviors, and overall problem behaviors. The moderating effect analysis showed that region and gender of the child affected the relationship between maternal anxiety and children's internalizing problem behaviors and externalizing problem behaviors, and region, child's age and gender, mother's age, and education level affected maternal anxiety and preschool children's problems behavioral relationship. Hence, these results affirmed the role of maternal anxiety and emphasized the need to pay attention to the demographic characteristics and cultural background of the subjects during the research process and consider the generalizability of the conclusions under different circumstances.

Eight-year trajectories of behavior problems and resilience in children exposed to early-life intimate partner violence: The overlapping and distinct effects of individual factors, maternal characteristics, and early intervention

Childhood exposure to intimate partner violence (IPV) can have lasting effects on well-being. Children also display resilience following IPV exposure. Yet, little research has prospectively followed changes in both maladaptive and adaptive outcomes in children who experience IPV in early life. The goal of the current study was to investigate how child factors (irritability), trauma history (severity of IPV exposure), maternal factors (mental health, parenting), and early intervention relate to trajectories of behavior problems (internalizing and externalizing problems) and resilience (prosocial behavior, emotion regulation), over 8 years. One hundred twenty mother-child dyads participated in a community-based randomized controlled trial of an intervention for IPV-exposed children and their mothers. Families completed follow-up assessments 6-8 months (N = 71) and 6-8 years (N = 68) later. Although intention-to-treat analyses did not reveal significant intervention effects, per-protocol analyses suggested that participants receiving an effective dose (eight sessions) of the treatment had fewer internalizing problems over time. Child irritability and maternal parenting were associated with both behavior problems and resilience. Maternal mental health was uniquely associated with child behavior problems, whereas maternal positive parenting was uniquely associated with child resilience. Results support the need for a dyadic perspective on child adjustment following IPV exposure.

From the Mother to the Child: The Intergenerational Transmission of Experiences of Violence in Mother-Child Dyads Exposed to Intimate Partner Violence in Cameroon

Intimate partner violence (IPV) is a widespread social problem with serious consequences for the health of both women and their children. However, little is known about the combined effect of maternal childhood abuse and current exposure to IPV with respect to the psychopathological symptoms of the mother-child dyad. In a Cameroonian cultural setting, where IPV affects more than half of women, we aimed to better understand how mother's childhood abuse and current IPV co-occur to lead to psychopathological symptoms in the mother-child dyad. With the help of a non-governmental organization in Cameroon, we recruited 49 mother-child dyads exposed to IPV, along with 25 mother-child dyads who had not been exposed, and who functioned as a control group. All mothers completed a set of questionnaires, including the Revised Conflict Tactics Scale to assess IPV; the Child Trauma Questionnaire to examine their childhood trauma; the Child Behavior Checklist to assess their children's psychopathological traits; the Hospital Anxiety and Depression Scale; and the Symptom Checklist. We found that physical abuse experienced by mothers during childhood was associated with IPV in adulthood, and specifically sexual abuse, p = .001. In addition, we found that the accumulation of maternal childhood abuse and current IPV was related to anxiety and depression symptoms in mothers, all R² ≥ .18, all ps ≤ .015, as well as to externalized symptoms in children, all R² ≥ .27, all ps ≤ .017. Our results suggest the intergenerational transmission of experiences of childhood abuse and current IPV, which calls for the development of interventions and care strategies for the mother-child dyad.

Performance Management and the Police Response to Women in India

Crimes against women have critical implications, not only for victims but also for overall community health and safety. Communities entrust law enforcement agencies with the responsibility to safeguard vulnerable people through effective and efficient policing approaches that provide a safe environment. Enhancing and improving the efficiency and performance of the police is an important part of preventing and reducing crimes against women. One approach to addressing specific performance targets is to adopt a performance management strategy. This paper examines survey data from 310 police officials in northern India about one such strategy: the balanced scorecard (BSC). Our analysis illuminates police perspectives about the perceived benefits of a generalized performance management strategy such as the BSC for improving police performance in addressing crimes against women and the needs of female citizens. Our findings reveal that respondents’ assessments of all four dimensions of the balanced scorecard are associated with their degree of optimism that performance measurement can improve the police response to crimes against women.

Trauma-informed art and play therapy: Pilot study outcomes for children and mothers in domestic violence shelters in the United States and South Africa

BACKGROUND

While intimate partner violence (IPV) has well documented impact on women and children, few interventions have been tested for mothers and children in the domestic violence shelter system.

OBJECTIVE

We used mixed methods to explore effects of a pilot intervention combining trauma focused cognitive behavior therapy (TF-CBT) (verbal therapy method) with art and play therapy (non-verbal therapy methods) in New York City and Johannesburg, to compare efficacy between high and low-middle income contexts.

PARTICIPANTS AND SETTING

School-aged children and their mothers from one domestic violence shelter in each city were invited to participate.

METHODS

Children were screened for depression and post-traumatic stress disorder (PTSD). Children participated in a weekly group session lasting 1-2 hours over 12 weeks and mothers received 3 group sessions. Quantitative data comprised pre-and post-intervention child self-reports (n = 21) and mother's report (n = 16) of child depressive and PTSD symptoms. Qualitative in-depth interviews were conducted with children (n = 11) and mothers (n = 8) who completed the intervention.

RESULTS

At baseline, children showed high rates of symptoms of probable depression and probable PTSD (33 % and 66 % respectively). By endline, depressive symptoms significantly reduced (mean of 13.7-8.3,p = 0.01) and there was a non-significant trend towards PTSD improvement (40.0-34.4, p = 0.21). Children revealed the art helped them express difficult emotions and experiences with their mothers. Multiple children felt it assisted in managing challenging behaviours.

CONCLUSION

This pilot trauma-informed art and play therapy group intervention holds promise in mitigating the effects of IPV for children and mothers in domestic violence shelters.

Breaking the cycle of intergenerational abuse: A qualitative interview study of men participating in a perinatal program to reduce violence

Domestic violence and abuse in the perinatal period leads to long-term adverse outcomes for infants, including a greater risk of becoming victims or perpetrators of violence in adulthood. Examining men's beliefs about fatherhood and violence, and their motivations for engaging in programs to reduce violence, is essential to understand how interventions can impact on behavior and break intergenerational cycles of abuse. The aim of this study was to explore the experience of becoming a father in a sample of men who are taking part in a whole-family perinatal program to reduce violence-For Baby's Sake. Ten men who had engaged with For Baby's Sake were interviewed about their experiences and beliefs around fatherhood. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. Four themes were identified: making sense of violent behavior, conceptions of fatherhood, an emotional transition, and breaking the cycle. The data provide a unique insight into men's beliefs and behaviors at this transition point in their lives. This can aid the development of interventions aimed at breaking the cycle of abuse, indicating ways to harness the motivation for a new start and support men to overcome unhelpful behavior patterns.

Sharing reports about domestic violence and abuse with general practitioners: a qualitative interview study

BACKGROUND

Domestic violence and abuse (DVA) is common and damaging to health. UK national guidance advocates a multi-agency response to DVA, and domestic homicide reviews consistently recommend improved information-sharing between agencies. Identification of patients experiencing DVA in general practice may come from external information shared with the practice, such as police incident reports and multi-agency risk assessment conference (MARAC) reports. The aim of this study was to explore the views of general practitioners (GPs) and the police about sharing reports about DVA with GPs.

METHODS

Qualitative semi-structured interviews were conducted with GPs, police staff and a partnership manager. Participants were located across England and Wales. Thematic analysis was undertaken.

RESULTS

Interviews were conducted with 23 GPs, six police staff and one former partnership manager. Experiences of information-sharing with GPs about DVA varied. Participants described the relevance and value of external reports to GPs to help address the health consequences of DVA and safeguard patients. They balanced competing priorities when managing this information in the electronic medical record, namely visibility to GPs versus the risk of unintended disclosure to patients. GPs also spoke of the judgements they made about exploring DVA with patients based on external reports, which varied between abusive and non-abusive adults and children. Some felt constrained by short general practice consultations. Some police and GPs reflected on a loss of control when information about DVA was shared between agencies, and the risk of unintended consequences. Both police and GPs highlighted the importance of clear information and a shared understanding about responsibility for action.

CONCLUSION

GPs regarded external reports about DVA as relevant to their role, but safely recording this information in the electronic medical record and using it to support patients required complex judgements. Both GPs and police staff emphasised the importance of clarity of information and responsibility for action when information was shared between agencies about patients affected by DVA.

Exposure to interparental intimate partner violence and the development of borderline features in adolescents

BACKGROUND

Due to associated trauma, exposure to intimate partner violence (IPV) is considered a form of child maltreatment, and is associated with heightened risk for mental health problems.

OBJECTIVE

To evaluate associations between exposure to interparental IPV and the prospective development of borderline features in adolescents.

PARTICIPANTS AND SETTING

A diverse sample of 1,042 adolescents were recruited from public high schools throughout southeastern United States and followed annually for 5 years. Baseline mean age was 15.09 (SD = .79; range 13-18), and 56 % of the sample was female; 31.4 % (n = 327) were Hispanic, 29.4 % (n = 306) were White/not Hispanic, 27.9 % (n = 291) were African American, 3.6 % (n = 38) were Asian or Pacific Islander, and 7.7 % (n = 80) were mixed or another race.

METHODS

Exposure to interparental IPV and the quality of the parent-child relationship were assessed at baseline. Borderline features were assessed annually for the each of the five follow-up timepoints. Latent growth curve modeling was used to estimate the course of change of BPD features over time.

RESULTS

Consistent with expectations, and controlling for quality of parent-child relationships and sociodemographic confounds, findings demonstrated that IPV exposure related to both cross-sectional association between interparental IPV and adolescents' borderline features and change in borderline features over a 5-year period.

CONCLUSION

Adolescents who had witnessed interparental IPV were more likely to have higher levels of BPD features at baseline and to deviate from the typically observed normative decline in BPD features over the 4-year follow-up period.

Breaking the Intergenerational Cycle: Partner Violence, Child-Parent Attachment, and Children's Aggressive Behaviors

The link between exposure to violence in the home and children's later exhibition of violent behaviors is well documented in the criminological literature. To date, most research on partner violence (PV) and children's welfare has focused on adolescent outcomes. As such, we know little about how PV affects the behavior of the youngest, and perhaps most vulnerable population of children who have been exposed to PV. Our understanding of the PV-child behavior association is also limited because extant research has focused less attention on identifying risk factors that explain and modify the link between exposure to PV and children's behavior. We use data from the Fragile Families and Child Wellbeing Study, a five-wave longitudinal study of U.S.-born children (N = 2,896) and structural equation modeling (SEM), to explore the impact of PV exposure on later aggressive behaviors. We extend the literature on PV exposure and childhood aggression in three ways: (a) We focus on young children's behavioral outcomes; (b) we identify child-parent attachment as a potential moderator of the PV-childhood aggression relationship; and (c) we investigate variation in the effect of PV exposure on children's aggressive behavior by children's attachment to parents. Findings support our hypotheses that exposure to PV during first 3 years of life is associated with increased aggression at age 5 and age 9. We find that the effect of PV on aggression at age 9 is fully mediated through the parent-child attachment. Contrary to our expectations, we do not find evidence of a strong parent-child attachment moderating the impact of PV exposure on children's aggressive behavior.

The coMforT study of a trauma-informed mindfulness intervention for women who have experienced domestic violence and abuse: a protocol for an intervention refinement and individually randomized parallel feasibility trial

Background

Domestic violence and abuse (DVA) is common and destructive to health. Post-traumatic stress disorder (PTSD) is a major mental health consequence of DVA. People who have experienced DVA have specific needs, arising from the repeated and complex nature of the trauma. The National Institute for Health and Care Excellence recommends more research on the effectiveness of psychological interventions for people who have experienced DVA. There is growing evidence that mindfulness-based interventions may help trauma symptoms.

Methods

Intervention refinement and randomized controlled feasibility trial. A prototype trauma-informed mindfulness-based cognitive therapy (TI-MBCT) intervention will be co-produced following qualitative interviews and consensus exercise with stakeholders. Participants in the feasibility trial will be recruited from DVA agencies in two geographical regions and randomized to receive either TI-MBCT or usual care (self-referral to the Improving Access to Psychological Therapies (IAPT) service). TI-MBCT will be delivered as a group-based eight-week program. It will not be possible to blind the participants or the assessors to the study allocation. The following factors will inform the feasibility of progressing to a fully powered trial: recruitment, retention, intervention fidelity, and the acceptability of the intervention and trial design to participants. We will also test the feasibility of measuring the following participant outcomes before and 6 months post-randomization: PTSD, dissociative symptoms, depression, anxiety, DVA re-victimization, self-compassion, and mother-reported child health. Process evaluation and economic analysis will be embedded within the feasibility trial.

Discussion

This study will lead to the development of a TI-MBCT intervention for DVA survivors with PTSD and inform the feasibility and design of a fully powered randomized controlled trial (RCT). The full trial will aim to determine the effectiveness and cost-effectiveness of a TI-MBCT intervention in improving the clinically important symptoms of PTSD in DVA survivors.

Trial registration

ISRCTN, ISRCTN64458065, Registered 11 January 2019.

The intergenerational impact of trauma and family violence on parents and their children

BACKGROUND

Children who experience Child Abuse and Neglect (CAN) are at an increased risk of becoming a victim of Intimate Partner Violence (IPV) or a perpetrator of IPV or CAN. Moreover, maltreated children are at risk for developing long-lasting trauma symptoms, which can subsequently affect their own children's lives. Understanding the mechanisms of the intergenerational transmission of violence and trauma is a prerequisite for the development of interventions.

OBJECTIVE

We examine whether the relation between historical CAN and current trauma symptoms of mothers is mediated by current IPV. Furthermore, we investigate whether current CAN mediates the relation between current maternal trauma symptoms and child Post-Traumatic Stress Disorder (PTSD) symptoms. These mechanisms are compared for mothers and fathers.

PARTICIPANTS

We have recruited 101 fathers and 360 mothers (426 children, 50% boys, mean age 7 years) through child protection services.

METHODS

Respondents completed questionnaires about IPV, (historical) CAN and trauma symptoms.

RESULTS

Structural equation models revealed that historical CAN of father and mothers was related to trauma symptoms. Only for mothers, this association was mediated by IPV. Trauma symptoms of both fathers and mothers were related to child PTSD symptoms. This effect was not mediated by current CAN.

CONCLUSION

In violent families, maternal and paternal trauma can be transmitted over generations. However, intergenerational transmission of violence is found for mothers only. When family violence is reported, professionals should take the violence into account, as well as the history of parents and trauma symptoms of all family members.

Mental health of children exposed to intimate partner violence against their mother: A longitudinal study from Brazil

BACKGROUND

Exposure to intimate partner violence (IPV) is an important adverse childhood experience, but there are few longitudinal studies in low and middle-income countries.

OBJECTIVE

To investigate the consequences of exposure to IPV for a child's mental health.

PARTICIPANTS AND SETTING

614 mother-child pairs were evaluated in a poor urban district in Recife, northeastern Brazil.

METHODS

Women were interviewed in pregnancy, postpartum and six to nine years after delivery, and asked about their experience of IPV, and the exposure of their child to violence. The Strengths and Difficulties Questionnaire (SDQ) was completed by child's mother and teacher. Ten types of child experience of IPV and the age of onset of exposure were compared with the child's behavioral profile at school age.

RESULTS

The mothers reported that 372/614 (60.6%) children had been exposed to IPV. The commonest types of child exposure to IPV were "prenatally", "overheard", "eyewitnessed", and 10.0% of children were physically or verbally involved in the IPV. Mothers reported high SDQ Total Difficulties scores in 71.7% of all children exposed to IPV and teachers in 59.8%. Multivariate logistic regression analysis demonstrated the strongest association with behavioral difficulties was with exposure to IPV in the age group 1-2 years (OR 2.5 [95% CI: 1.3-4.8]).

CONCLUSION

Young children are sensitive to the age of first exposure to IPV and to the type of IPV. Interventions to reduce IPV should be targeted on vulnerable women from poor urban communities during their pregnancies and in the first two years of their child's life.

Intergenerational transmission of adverse childhood experiences via maternal depression and anxiety and moderation by child sex

Adverse childhood experiences (ACEs) of parents are associated with a variety of negative health outcomes in offspring. Little is known about the mechanisms by which ACEs are transmitted to the next generation. Given that maternal depression and anxiety are related to ACEs and negatively affect children's behaviour, these exposures may be pathways between maternal ACEs and child psychopathology. Child sex may modify these associations. Our objectives were to determine: (1) the association between ACEs and children's behaviour, (2) whether maternal symptoms of prenatal and postnatal depression and anxiety mediate the relationship between maternal ACEs and children's behaviour, and (3) whether these relationships are moderated by child sex. Pearson correlations and latent path analyses were undertaken using data from 907 children and their mothers enrolled the Alberta Pregnancy Outcomes and Nutrition study. Overall, maternal ACEs were associated with symptoms of anxiety and depression during the perinatal period, and externalizing problems in children. Furthermore, we observed indirect associations between maternal ACEs and children's internalizing and externalizing problems via maternal anxiety and depression. Sex differences were observed, with boys demonstrating greater vulnerability to the indirect effects of maternal ACEs via both anxiety and depression. Findings suggest that maternal mental health may be a mechanism by which maternal early life adversity is transmitted to children, especially boys. Further research is needed to determine if targeted interventions with women who have both high ACEs and mental health problems can prevent or ameliorate the effects of ACEs on children's behavioural psychopathology.

Exploring Kenyan Women's Perceptions of Intimate Partner Violence

Intimate partner violence (IPV) is a major public health problem and global human rights violation. Effective interventions can only be created upon conducting qualitative studies that explore the cultural context of an affected population and how they interpret the phenomenon. This qualitative study investigated Kenyan women's perceptions of IPV. Two community-based focus groups ( n = 19) were conducted with Kenyan women in Nairobi. Conventional content analysis identified seven primary themes that emerged from focus group data: snapshot of violence; poverty; cultural context; masculinity; women taking action; resources; and, prevention strategies. Themes are described and implications for further research and intervention are presented.

Preventing Peer Violence Against Children: Methods and Baseline Data of a Cluster Randomized Controlled Trial in Pakistan

Peer violence was remarkably high at baseline. Among urban public school students, 94% of 6th-grade boys and 85% of girls reported being victimized by peers in the last 4 weeks. And 85% of boys and 66% of girls reported perpetrating such violence. Boys scored worse on a number of mental health measures. A cluster RCT is underway to evaluate a well-established school-based intervention using sports and games to reduce peer violence.

Background:

Violence against and among children is a global public health problem that annually affects 50% of youth worldwide with major impacts on child development, education, and health including increased probability of major causes of morbidity and mortality in adulthood. It is also associated with the experience of and perpetration of later violence against women. The aim of this article is to describe the intervention, study design, methods, and baseline findings of a cluster randomized controlled trial underway in Pakistan to evaluate a school-based play intervention aiming to reduce peer violence and enhance mental health.

Methods:

A cluster randomized controlled design is being conducted with boys and girls in grade 6 in 40 schools in Hyderabad, Pakistan, over a period of 2 years. The Multidimensional Peer-Victimization and Peer Perpetration Scales and the Children's Depression Inventory 2 (CDI 2) are being used to measure the primary outcomes while investigator-derived scales are being used to assess domestic violence within the family. Specifics of the intervention, field logistics, ethical, and fidelity management issues employed to test the program's impact on school age youth in a volatile and politically unstable country form this report.

Baseline Results:

A total of 1,752 school-age youth were enrolled and interviewed at baseline. Over the preceding 4 weeks, 94% of the boys and 85% of the girls reported 1 or more occurrences of victimization, and 85% of the boys and 66% of the girls reported 1 or more acts of perpetration. Boys reported more depression compared with girls, as well as higher negative mood and self-esteem scores and more interpersonal and emotional problems.

Interpretation:

Globally, prevalence of youth violence perpetration and victimization is high and associated with poor physical and emotional health. Applying a randomized controlled design to evaluate a peer violence prevention program built on a firm infrastructure and that is ready for scale-up and sustainability will make an important contribution to identifying evidence-informed interventions that can reduce youth victimization and perpetration.

What is the role of health systems in responding to domestic violence? An evidence review

Objective The aim of the present study was to review and analyse academic literature and program evaluations to identify promising evidence for health system responses to domestic violence in Australia and internationally. Methods English-language literature published between January 2005 and March 2016 was retrieved from search results using the terms ‘domestic violence’ or ‘intimate partner violence’ in different combinations with other relevant terms, resulting in 1671 documents, of which 59 were systematic reviews. Electronic databases (Medline (Ovid), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Psycinfo, Social work Abstracts, Informit, Violence and Abuse Abstracts, Family Studies Abstracts, Cochrane Library of Systematic Reviews and EMBASE) were searched and narrative analysis undertaken. Results This review details the evidence base for the following interventions by health services responding to domestic violence: first-line responses, routine screening, risk assessment and safety planning, counselling with women, mother–child interventions, responses to perpetrators, child protection notifications, training and system-level responses. Conclusions There is growing evidence for the effectiveness of health service interventions to reduce the extent of harm caused by domestic violence. What is known about the topic? Domestic violence is a significant problem globally with enormous human, social and economic costs. Although women who have experienced abuse make extensive use of healthcare services, health services have lagged behind the policing, criminal justice and other human service domains in responding to domestic violence. What does this paper add? The present comprehensive review identifies best-practice health system responses to domestic violence. What are the implications for practitioners? Health systems can play a key role in identifying and responding to domestic violence for women who often do not access other services. There is growing evidence for the effectiveness of health service interventions to reduce the extent of harm caused by domestic violence, in particular for specialist counselling, structured risk assessment and safety planning, training for first-line responses and interventions for mothers and children affected by domestic violence.

Developing and Testing of an Economic Index Tool for Abused Women With Children

Violence and poverty combine to severely compromise the safety, health, and functioning of women with major pass-through effects to their children. To reduce poverty and mitigate violence, measures are needed to assess economic status before and after intervention programs. The purpose of the study was to develop a new tool to assess women's various sources of income, to measure the degree to which the components of the tool are independent, and assess the usefulness of the tool to assess the connection of economic status and mental health functioning among abused women.

RESULTS

Using content and face validity techniques and exploratory factor analysis, the 5-item Economic Index Tool was derived that assesses formal and informal employment wages, family and government cash assistance, and child support. Concurrent and predictive validity models for both the raw and weighted scores were significant, χ² (1) = 65.02, p <.001, Nalgelkerke R² =.285 and χ² (1) = 108.44, p <.001, Nalgelkerke R² =.443, respectively. Both the raw and weighted scores were associated with increased odds of being above poverty, Odds Ratios were 1.242 and 1.306, respectively, and all p values were < 0.001. The Economic Index Tool revealed a positive connection of higher economic status and better mental health. The Economic Index Tool offers a rapid assessment of abused women's economic status that can be used to guide multifaceted intervention programs and measure program effectiveness.

Child Brides, Forced Marriage, and Partner Violence in America: Tip of an Iceberg Revealed

Forced marriage is a violation of human rights and thwarts personal safety and well-being. Child brides are at higher risk of intimate partner violence (IPV) and often are unable to effectively negotiate safe sex, leaving them vulnerable to sexually transmitted infections, including human immunodeficiency virus, and early pregnancy. The prevalence of forced marriage and child marriage in the United States is unknown. The intersection of forced marriage and child marriage and IPV is equally unknown. When 277 mothers who reported IPV to shelter or justice services were asked about a forced marriage attempt, frequency and severity of IPV, mental health status, and behavioral functioning of their child, 47 (17%) reported a forced marriage attempt with 45% of the women younger than 18 years of age at the time of the attempt. Among the 47 women, 11 (23%) reported death threats, 20 (43%) reported marriage to the person, and 28 (60%) reported a pregnancy. Women younger than 18 years reported more threats of isolation and economic deprivation associated with the attempt as well as pressure from parents to marry. Regardless of age, women experiencing a forced marriage attempt reported more intimate partner sexual abuse, somatization, and behavior problems for their children. Forced marriage attempts occurred to one in six women (17%) reporting IPV and are associated with worse functioning for mother and child. The frequent occurrence and associated effect of forced marriage attempts to maternal child functioning indicates routine assessment for a forced marriage attempt as part of comprehensive care for women reporting IPV.

Bridging the gaps: a global review of intersections of violence against women and violence against children

Background

The international community recognises violence against women (VAW) and violence against children (VAC) as global human rights and public health problems. Historically, research, programmes, and policies on these forms of violence followed parallel but distinct trajectories. Some have called for efforts to bridge these gaps, based in part on evidence that individuals and families often experience multiple forms of violence that may be difficult to address in isolation, and that violence in childhood elevates the risk of violence against women.

Methods

This article presents a narrative review of evidence on intersections between VAC and VAW – including sexual violence by non-partners, with an emphasis on low- and middle-income countries.

Results

We identify and review evidence for six intersections: 1) VAC and VAW have many shared risk factors. 2) Social norms often support VAW and VAC and discourage help-seeking. 3) Child maltreatment and partner violence often co-occur within the same household. 4) Both VAC and VAW can produce intergenerational effects. 5) Many forms of VAC and VAW have common and compounding consequences across the lifespan. 6) VAC and VAW intersect during adolescence, a time of heightened vulnerability to certain kinds of violence.

Conclusions

Evidence of common correlates suggests that consolidating efforts to address shared risk factors may help prevent both forms of violence. Common consequences and intergenerational effects suggest a need for more integrated early intervention. Adolescence falls between and within traditional domains of both fields and deserves greater attention. Opportunities for greater collaboration include preparing service providers to address multiple forms of violence, better coordination between services for women and for children, school-based strategies, parenting programmes, and programming for adolescent health and development. There is also a need for more coordination among researchers working on VAC and VAW as countries prepare to measure progress towards 2030 Sustainable Development Goals.

Maternal sensitivity and the empathic brain: Influences of early life maltreatment

One of the most striking characteristics of early life maltreatment (ELM) is the risk of transmission across generations, which could be linked to differences in maternal behavior. Maternal sensitivity includes appropriate and positive affective exchanges between mother and child. Mothers with a history of ELM have been found to show a lower sensitivity representing a significant risk factor for maltreating their own children. 25 mothers with and 28 mothers without sexual and/or physical childhood maltreatment (as assessed with the Childhood Experience of Care and Abuse interview) and their children participated in a standardized mother-child interaction task. Videotaped interactions were rated by two independent trained raters based on the Emotional Availability Scales. In addition, empathic capabilities were assessed with the Interpersonal Reactivity Index. High resolution structural magnetic resonance brain images of the mothers were analyzed with unbiased voxel-based morphometry and correlated with maternal sensitivity. Results indicate that mothers with ELM were less sensitive in the standardized interaction with their own child. In non-maltreated control mothers, maternal sensitivity was positively related to anterior insular grey matter volume, a region which is crucially involved in emotional empathy, while there was a positive association between maternal sensitivity and grey matter volume in parts of the cognitive empathy network such as the superior temporal sulcus and temporal pole region in mothers with ELM. These results implicate that neurostructural alterations associated with poor maternal sensitivity might be a sequelae of ELM and that mothers with ELM may try to compensate deficits in emotional empathy by recruiting brain regions involved in cognitive empathy when interacting with their child. Thus, findings suggest possible coping strategies of mother with ELM to prevent an intergenerational transmission of abuse.

Modeling the intergenerational impact of partner abuse on maternal and child function at 24 months post outreach: Implications for practice and policy

OBJECTIVE

Many women are exposed to partner violence during their lifetime which affects mental health and child development. This study revalidates an intergenerational model connecting partner violence to poor functioning for mothers and children using structural equation techniques.

METHOD

A longitudinal design collected data on 300 mother-child pairs. Comparisons between the model, tested at study entry and again at 24 months, are reported. Maternal measures included childhood experiences of abuse, partner abuse, chronic pain, and mental health. The Child Behavior Checklist measured child function.

RESULTS

Comparison of both models revealed that maternal chronic pain, maternal mental health, and child witnessing of mother's abuse remain strong predictors of child dysfunction. Maternal social support and self-efficacy are significant predictors of more positive maternal mental health with a conduit effect on child behavior.

CONCLUSION

Intimate partner violence directly impacts the victim and also has a secondary impact on the children of abuse victims.

A Risk Assessment Tool to Predict Sustained PTSD Symptoms Among Women Reporting Abuse

BACKGROUND

Nationally and worldwide, 30% or more of women are likely to have experienced intimate partner violence. Maternal mental health symptoms predict child function. When mothers have sustained posttraumatic stress disorder (PTSD), their children at are risk for growth and developmental delays and poor behavioral outcomes that may adversely affect the course of their lives. While many who experience trauma will recover without intervention, a significant proportion will experience PTSD, with negative consequences for their personal lives and the lives of their families. Early identification of those at high risk for PTSD symptoms will support early interventions to prevent PTSD and its negative consequences.

METHODS

This paper describes the development of a tool that can predict PTSD symptoms at 8 months in mothers who are primarily of low socioeconomic status and primarily members of underrepresented groups. The tool consists of four key measures.

CONCLUSIONS

Using this tool to identify mothers at high risk for sustained PTSD and entering them into early intervention programs may protect mothers and their children from negative outcomes and promote their health and wellbeing.

Hostility Patterns: Implications for Nursing Practice

In order to present the state of the science of hostility among and across disciplines, a review of the literature was completed. The knowledge gained may influence nursing practice. Scholarly works from nursing, medical and basic sciences, psychology, sociology, education, philosophy, business, communication, and criminology were reviewed. Similar patterns in the use of the concept were discovered. The patterns revealed five themes: hostility as a health-risk factor, hostility as a factor in family relationships, hostility as a factor in perceived challenge, hostility as a factor in criminal behavior, and hostility as a factor in the workplace. Based on the knowledge gained about hostility, implications for nursing practice related to changing the hostile working environment for nurses were suggested using modeling and role-modeling nursing theory.

How do maternal PTSD and alexithymia interact to impact maternal behavior?

Maternal interpersonal violence-related post-traumatic stress disorder (IPV-PTSD) is known to be associated with impairment of a mother's capacity to participate in mutual emotion regulation during her child's first years of life. This study tested the hypothesis that maternal difficulty in identifying feelings in self and other, as an important dimension of the construct of alexithymia, together with maternal IPV-PTSD, would be negatively associated with maternal sensitivity. Maternal sensitivity to child emotional communication is a marker of maternal capacity to engage in mutual regulation of emotion and arousal. Following diagnostic interviews and administration of the Toronto Alexithymia Scale, 56 mothers and their toddlers (ages 12-42 months) were filmed during free-play and separation/novelty-exposure. Observed maternal sensitivity was coded via the CARE-Index. Maternal IPV-PTSD severity, difficulty in identifying emotions, and lower socio-economic status were all associated with less maternal sensitivity, and also with more maternal controlling and unresponsive behavior on the CARE-Index.

Risk of behaviors associated with lethal violence and functional outcomes for abused women who do and do not return to the abuser following a community-based intervention

BACKGROUND

To determine the differential risk of behaviors associated with lethal violence and functioning outcomes for abused women with children who received an intervention of shelter or justice services and return to the abuser were compared with women who did not return.

METHODS

The study was carried out using a matched-pair analysis of 152 women. Measures of risk of behaviors associated with lethal violence, type, and severity of abuse, and poor mental health symptoms were measured every 4 months for 24 months.

RESULTS

Irrespective of service used, women returning to the abuser reported significantly (p<0.001) more risk of behaviors associated with lethal violence compared to women who did not return. Additionally, severity of physical abuse was significantly higher (p<0.01) for women returning to the abuser who had been in a shelter but not for women who received a protection order. Similarly, levels of depression, posttraumatic stress disorder, and anxiety were significantly higher (p<0.01) for sheltered women who returned to the abuser but not for women using a protection order who returned.

CONCLUSIONS

Risk of behaviors associated with lethal violence increases when abused women return to live with the abuser. Abused women should be informed of the heightened risk and greater probability for poor mental health.

Problem-solving and mental health outcomes of women and children in the wake of intimate partner violence

The environmental stress of intimate partner violence is common and often results in mental health problems of depression, anxiety, and PTSD for women and behavioral dysfunctions for their children. Problem-solving skills can serve to mitigate or accentuate the environmental stress of violence and associated impact on mental health. To better understand the relationship between problem-solving skills and mental health of abused women with children, a cross-sectional predictive analysis of 285 abused women who used justice or shelter services was completed. The women were asked about social problem-solving, and mental health symptoms of depression, anxiety, and PTSD as well as behavioral functioning of their children. Higher negative problem-solving scores were associated with significantly (P < 0.001) greater odds of having clinically significant levels of PTSD, anxiety, depression, and somatization for the woman and significantly (P < 0.001) greater odds of her child having borderline or clinically significant levels of both internalizing and externalizing behaviors. A predominately negative problem-solving approach was strongly associated with poorer outcomes for both mothers and children in the aftermath of the environmental stress of abuse. Interventions addressing problem-solving ability may be beneficial in increasing abused women's abilities to navigate the daily stressors of life following abuse.