Children's exposure to intimate partner violence: an overview

"I Have to Make Sure She Is Not Sad": Children's Perceptions of Their Mothers' Experiences in Shelters for Battered Women

A qualitative study examined children's subjective perception of their mother's situation during their stay in shelters for battered women (SBW). Thirty-two children, aged 7-12 years, who were staying with their mothers in SBWs participated in this study. Thematic analysis revealed the following two core themes: children's perceptions and insights, and feelings that were related to their perceptions. The findings are discussed in light of the concepts of exposure to IPV as a lived trauma, and re-exposure to violence in new contexts, and the role of the relationship with the abused mother in shaping the child's well-being.

Association and disparities of food insecurity and exposure to violence: analysis of the National Survey of Children's Health

CONTEXT

Lack of access to food is a significant concern for child well-being, and it creates many health disparities and adverse social outcomes. Food insecurity and its many associated risk factors increase parental stress, which are strongly correlated with an increased risk of child abuse and maltreatment. Research now identifies being witness to domestic abuse as a form of child maltreatment, and exposure to violence in the community has been shown to result in similar long-term impacts.

OBJECTIVES

Given the potential for lifelong adverse effects from experiencing adverse childhood events involving violence and food insecurity, our primary objective was to assess the relationship between the two and disparities among demographic factors.

METHODS

We conducted an observational study utilizing data from the National Survey of Children's Health (NSCH) 2016-2021. The NSCH is a United States nationally representative survey completed by primary caregivers of one child per home aged 0-17 years. We determined population estimates (n=216,799; n=83,424,126) and rates of children experiencing food insecurity and parent-reported exposure to violence. We then constructed logistic regression models to assess associations, through odds ratios (ORs), between food security and exposure to violence including demographic factors.

RESULTS

Among the sample, 5.42 % of children experienced low food security and 7.4 % were exposed to violence. The odds of exposure to violence are 5.19 times greater for children with low food security compared to food-secure children (95 % confidence interval [CI]: 4.48-6.02). Indigenous and Black children were 7.8 and 6.81 times more likely to experience or witness violence when food insecure compared to food secure White children, respectively (95 % CI: 3.18-19.13, 5.24-8.86 respectively).

CONCLUSIONS

Food insecurity was associated with increased odds of children experiencing and/or witnessing violence compared to those who were food secure. The interaction between exposure to violence and food insecurity also disproportionately impacts children with specific demographic factors, notably race/ethnicity including multiracial, Indigenous, and Black children. By developing and adapting strategies to improve food security, it is possible to indirectly reduce the rates of childhood exposure to violence and the long-term impacts that result.

Service evaluation of an independent domestic violence advocate post in a children's hospital

Domestic violence and abuse (DVA) has detrimental effects on the health and well-being of children and young people exposed to it, whether they witness or experience it. The introduction of independent domestic violence advocates in UK hospitals has enhanced the safety of victims of DVA. In 2020-2021 an independent domestic violence advocate post was piloted at a children's hospital for one year, the advocate's role being to train hospital staff and support women who had experienced DVA. A service evaluation showed that the training and support provided by the independent domestic violence advocate had benefits for women, children and staff. It also confirmed that the commissioning of services for children exposed to DVA is often underfunded and overshadowed by the provision of support to adults.

Witnessing family violence and adolescent cyberbullying perpetration: A longitudinal moderated mediation model involving anger dysregulation and teacher support

BACKGROUND

Family violence has been shown to be associated with traditional adolescent bullying perpetration. However, few studies have considered the association between witnessing family violence and adolescent bullying perpetration in cyberspace.

OBJECTIVE

The present study aimed to reveal the mechanism explaining the association between witnessing family violence and adolescent cyberbullying perpetration by testing the mediating effect of anger dysregulation and the moderating effect of teacher support.

PARTICIPANTS AND SETTING

Participants were 751 Chinese adolescents (Mage at Time 1 = 13.25) who completed the measures of witnessing family violence, anger dysregulation, cyberbullying perpetration, and teacher support at three time points over the year.

METHODS

Structural equation modeling was used to assess the direct and indirect effects of witnessing family violence on adolescent cyberbullying perpetration through anger dysregulation as a mediator and perceived teacher support as a moderator.

RESULTS

The results showed that witnessing family violence at baseline positively predicted adolescent cyberbullying perpetration at T3, and anger dysregulation at T2 partially mediated this association. The positive relation between witnessing family violence and later anger dysregulation was stronger for adolescents who perceived higher levels of teacher support.

CONCLUSIONS

Witnessing family violence could increase the risk for adolescent cyberbullying perpetration, with anger dysregulation mediating this association. The protective effect of perceived teacher support weakens as the levels of witnessing family violence increase. These findings offer insight into the connection between witnessing family violence and adolescent bullying perpetration in the digital age, emphasizing the importance of promoting programs to prevent intrafamilial violence.

Early adolescent development in the face of violence: A systematic review running

BACKGROUND

Exposure to violence has severe and lasting effects on development. Despite the body of research examining childhood exposures to violence and victimization, developmental outcomes during early adolescence are poorly understood.

OBJECTIVE

To synthesize existing research on the effects of violence exposure on early adolescent development (youth 9-14 years old) and highlight areas for future research.

METHOD

We conducted a systematic search of PubMed, CINAHL, Web of Science, Scopus, and EMBASE for articles published between 2012 and 2023. Included articles focused on violence exposure related to experiencing or observing community violence, witnessing domestic violence and/or being the victim of chronic physical abuse.

RESULTS

Twenty-eight articles spanning four developmental domains were included: behavioral, biological, neurological, and social development. Behaviorally, violence exposure posed significant effects on both internalizing and externalizing symptoms. Biologically, violence exposure was strongly associated with advanced epigenetic age, accelerated puberty, and insomnia. Neurologically, violence exposure had significant associations with both structural and functional differences in the developing brain. Socially, violence exposure was related to poor school engagement, peer aggression, and low social support.

CONCLUSION

This systematic review highlights varying effects of violence exposure on early adolescent development. The gaps presented should be addressed and implemented into clinical practice via evidence-based policies and procedures to ensure successful transition to adulthood.

Interventions that prevent or respond to intimate partner violence against women and violence against children: a systematic review

Efforts to prevent or respond to intimate partner violence (IPV) and violence against children (VAC) are still disparate worldwide, despite increasing evidence of intersections across these forms of violence. We conducted a systematic review to explore interventions that prevent or respond to IPV and VAC by parents or caregivers, aiming to identify common intervention components and mechanisms that lead to a reduction in IPV and VAC. 30 unique interventions from 16 countries were identified, with 20 targeting both IPV and VAC. Key mechanisms for reducing IPV and VAC in primary prevention interventions included improved communication, conflict resolution, reflection on harmful gender norms, and awareness of the adverse consequences of IPV and VAC on children. Therapeutic programmes for women and children who were exposed to IPV facilitated engagement with IPV-related trauma, increased awareness of the effects of IPV, and promoted avoidance of unhealthy relationships. Evidence gaps in low-income and middle-income countries involved adolescent interventions, post-abuse interventions for women and children, and interventions addressing both prevention and response to IPV and VAC. Our findings strengthen evidence in support of efforts to address IPV and VAC through coordinated prevention and response programmes. However, response interventions for both IPV and VAC are rare and predominantly implemented in high-income countries. Although therapeutic programmes for parents, caregivers, and children in high-income countries are promising, their feasibility in low-income and middle-income countries remains uncertain. Despite this uncertainty, there is potential to improve the use of health services to address IPV and VAC together.

Witnessing inter-parental violence in childhood and help-seeking behaviours in violence against women in Peru

BACKGROUND

Violence against women (VAW) severely impacts their physical and mental health. In some cultures, women can normalize certain types of violence if they were linked to home models in childhood and, eventually, do not seek for help in adulthood. We aimed to determine, in Peruvian women, (1) the association between witnessing violence in their family of origin and VAW experienced in adulthood, (2) the extent to which women who have experienced VAW seek some help, and (3) identify VAW prevalence by Peruvian region.

METHODS

Cross-sectional study of secondary data obtained from the 2019 National Demographic and Family Health Survey (ENDES). The outcome was VAW (psychological, physical and sexual violence), whereas the exposure was witnessing violence in the home of origin. Help-seeking behavior was a secondary outcome, for which VAW was the exposure. Prevalence ratios (PR) were estimated to assess both associations, unadjusted and adjusted for covariates (aPR).

RESULTS

Data from 14,256 women aged 15 to 49 years were analysed. 51.5% reported having experienced VAW and 43.8% witnessed violence in the home of origin during childhood. Witnessing inter-parental violence in childhood was associated with psychological violence aPR = 1.25 (95% CI: 1.17-1.33), physical aPR = 1.52 (95% CI: 1.38-1.67), and sexual aPR = 1.99 (95% CI: 1.57-2.52). Women who have experienced both types of violence (physical and sexual) were more likely to help-seeking (aPR = 1.30, 95% CI: 1.14-1.50) than women suffering only one type of violence.

CONCLUSION

Women who reported having witnessed home violence in their childhood are more likely to experience Violence Against Women (VAW) by their current partner. Physical and sexual violence with a current partner was more associated with witnessing inter-parental violence in childhood, and when physical and sexual violence jointly occurred women were more help-seeking. The southern region of Peru is identified as an area of high vulnerability for women. It is crucial to promote educative and community-based programs aimed at the prevention and early recognition of VAW.

What Does Child Protective Services Investigate as Neglect? A Population-Based Study

Most child protective services (CPS) investigations involve allegations of neglect. Broad and vague definitions have led to concerns that CPS-investigated neglect is driven by poverty-based material hardship. In a representative sample of 295 neglect investigations in California in 2017, structured data and narrative text fields were used to characterize the types of neglect and concurrent parental risk factors investigated by CPS and to assess the rate and nature of investigated physical neglect, defined as inadequate food, housing, or hygiene. The most common types of neglect were inadequate supervision (44%) and failure to protect (29%), followed by physical neglect (14%). Common risk factors identified in neglect investigations were parental substance use (41%), domestic violence (21%), mental illness (18%), and co-reported physical or sexual abuse (29%). Nearly all investigations of physical neglect (99%) included concerns related to substance use, domestic violence, mental illness, co-reported abuse or an additional neglect allegation (i.e., abandonment). Given concerns identified in neglect investigations, economic supports are likely insufficient without an array of behavioral-health supports.

Feasibility of a reconfigured domestic violence and abuse training and support intervention responding to affected women, men, children and young people through primary care

BACKGROUND

Identification in UK general practice of women affected by domestic violence and abuse (DVA) is increasing, but men and children/young people (CYP) are rarely identified and referred for specialist support. To address this gap, we collaborated with IRISi (UK social enterprise) to strengthen elements of the IRIS + intervention which included the identification of men, direct engagement with CYP, and improved guidance on responding to information received from other agencies. IRIS + was an adaptation of the national IRIS (Identification and Referral to Improve Safety) model focused on the needs of women victim-survivors of DVA. Without diminishing the responses to women, IRIS + also responded to the needs of men experiencing or perpetrating DVA, and CYP living with DVA and/or experiencing it in their own relationships. Our study tested the feasibility of the adapted IRIS + intervention in England and Wales between 2019-21.

METHODS

We used mixed method analysis to triangulate data from various sources (pre/post intervention questionnaires with primary care clinicians; data extracted from medical records and DVA agencies; semi-structured interviews with clinicians, service providers and referred adults and children) to assess the feasibility and acceptability of the IRIS + intervention.

RESULTS

The rate of referral for women doubled (21.6/year/practice) from the rate (9.29/year/practice) in the original IRIS trial. The intervention also enabled identification and direct referral of CYP (15% of total referrals) and men (mostly survivors, 10% of total referrals). Despite an increase in self-reported clinician preparedness to respond to all patient groups, the intervention generated a low number of men perpetrator referrals (2% of all referrals). GPs were the principal patient referrers. Over two-thirds of referred women and CYP and almost half of all referred men were directly supported by the service. Many CYP also received IRIS + support indirectly, via the referred parents. Men and CYP supported by IRIS + reported improved physical and mental health, wellbeing, and confidence.

CONCLUSIONS

Although the study showed acceptability and feasibility, there remains uncertainty about the effectiveness, cost-effectiveness, and scalability of IRIS + . Building on the success of this feasibility study, the next step should be trialling the effectiveness of IRIS + implementation to inform service implementation decisions.

Mothers' experiences of emotional abuse from an intimate partner and its associations with children's developmental outcomes at 5 years

BACKGROUND

Intimate partner violence (IPV) is associated with an increased risk of poorer child development. Existing research has focused on physical abuse with less known about the associations with emotional IPV.

OBJECTIVE

To describe the period prevalence of mother's experiences of emotional IPV during children's preschool years and associations with child mental, physical, social, and cognitive development.

METHODS

Secondary analysis of control group data (n = 194) from an Australian randomised trial (right@home), which recruited pregnant women experiencing social adversity from antenatal clinics in 2013-14. Women reported emotional abuse (Composite Abuse Scale) at child ages 3-5 years. Measures of child development at 5 years included: Strengths and Difficulties Questionnaire, Social Skills Improvement System, Pediatric Quality of Life Inventory, Clinical Evaluation of Language Fundamentals, School Entry Alphabetic and Phonological Awareness Readiness Test, NIH executive function subtests, sleep and health. The prevalence of emotional IPV from 3 to 5 years was estimated. Regression models compared developmental outcomes according to emotional IPV exposure, adjusted for child age, child gender, and maternal education. Missing data were accounted for using multiple imputation.

RESULTS

From 3-5 years, emotional IPV was experienced by 57% of women. Emotional IPV exposure was consistently associated with poorer child developmental outcomes. Differences were most apparent for SDQ internalising (mean difference 1.2, 95% CI 0.2 to 2.1) and externalising difficulties (1.2, 95% CI -0.1 to 2.4).

CONCLUSIONS

Emotional IPV was highly prevalent amongst families experiencing social adversity. Developing acceptable and effective identification processes and interventions that prioritise families experiencing co-occurring social adversities should be a public health priority.

Examining Cases of Child Physical Abuse Evaluations to Identify Opportunities to Improve Intimate Partner Violence Screening in Pediatric Emergency Departments

The association between child maltreatment and intimate partner violence (IPV) is well supported. Universal IPV screening has been recommended by the American Academy of Pediatrics and the United States Preventative Task Force, and many children's hospitals have established screening protocols. However, the yield and best screening method in families undergoing a child physical abuse (PA) evaluation have not been fully explored. To determine if there is a discrepancy in IPV disclosures between universal IPV screening completed during pediatric emergency department (PED) triage ("triage screening") and IPV screening by a social worker ("social work screening") in families of children who were evaluated for PA. Caregivers of children who presented to an urban tertiary PED and underwent an evaluation for PA via a child abuse pediatrics consult. A retrospective chart review was completed. Data collection included: caregiver responses to both triage screening and social work screening, interview setting details and participants, the child's injuries, and details of the family's reported IPV experiences. Our study (N = 329) revealed that social work screening produced significantly more positive IPV disclosures than triage screening (14.0% vs. 4.3%, p < .001). Additionally, non-IPV violence concerns were identified in 35.7% (n = 5) of the positive triage screens, whereas social work screens had none. These results highlight the benefits of IPV screening by social work in high-risk scenarios, such as child PA evaluations, regardless of universal IPV screening results. Exploring differences between the two screening methods can inform decisions about screening protocols to improve IPV identification in high-risk populations.

Validation of the Swedish version of the safe environment for every kid (SEEK) parent screening questionnaire

BACKGROUND

Psychosocial risk factors in the home may impair children's health and development and increase the risk of maltreatment. The Safe Environment for Every Kid (SEEK) model was developed to provide pediatric primary care professionals with a structured way to identify common psychosocial problems. The SEEK model includes use of the Parent Screening Questionnaire (SEEK-PSQ) at routine preventive child health visits, discussion with parents about their responses and, when indicated, referral to relevant services. The SEEK-PSQ has not previously been available in Swedish. The aim of the present study was to evaluate the psychometric properties of an adapted Swedish version of the SEEK-PSQ (PSQ-S).

METHODS

This study is part of a cluster-randomised controlled trial of SEEK in the Swedish child health services. To validate the PSQ-S, parents (n = 852) with children 0-18 months of age were invited to complete a survey including the PSQ-S as well as evidence-based standardized instruments for the targeted psychosocial risk factors: economic worries, depressive symptoms, parental stress, alcohol misuse and intimate partner violence (IPV). Baseline data from 611 (72%) parents were analysed regarding sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for each risk factor.

RESULTS

As a whole, the PSQ-S had a sensitivity of 93%, specificity of 52%, PPV of 67% and NPV of 87%. For mothers and fathers combined, sensitivity was 80% for economic worries, 89% for depressive symptoms, 78% for parental stress, 47% for intimate partner violence (IPV) and 70% for alcohol misuse. Specificity was highest for IPV and alcohol misuse (91%) and lowest for depressive symptoms (64%). NPV values were high (81-99%) and PPV values were low to moderate (22-69%) for the targeted problems. Sensitivity was higher for mothers compared to fathers for economic worries, depressive symptoms and IPV. This difference was particularly evident for IPV (52% for mothers, 27% for fathers).

CONCLUSION

The SEEK-PSQ-S demonstrated good psychometric properties for identifying economic worries, depressive symptoms, parental stress and alcohol misuse but low sensitivity for IPV. The PSQ-S as a whole showed high sensitivity and NPV, indicating that most parents with or without the targeted psychosocial risk factors were correctly identified.

TRIAL REGISTRATION

ISRCTN registry, study record 14,429,952 ( https://doi.org/10.1186/ISRCTN14429952 ) Registration date 27/05/2020.

How Expert Are the Experts? Child Custody Evaluations in Situations of Domestic Violence in Italy

In recent decades, scholars and professionals have investigated the courts' treatment of mothers and children who claim that an ex-partner/father is abusive, especially in child custody proceedings. In Italy, Laws 54/2006 and 154/2013 established that joint-custody and coparenting are critical to ensure the best interest of the child. In the process of custody determination, judges can appoint an expert to assess parenting skills. The aim of this qualitative study was to investigate the knowledge, opinions, and practices of the Court-Appointed Experts (CAEs) in child custody disputes in cases involving allegations of domestic violence (DV). Semistructured face-to-face interviews were conducted with 15 CAEs; the interviews' transcripts were analyzed with qualitative content analysis. Results suggested that in the management of child custody cases, most CAEs showed: strong prejudices against women victims of DV, who were often blamed and/or secondarily victimized; adherence to controversial models (e.g., parental alienation syndrome) and characterization of mothers as "alienators"; poor knowledge of DV and relevant laws. CAEs' overlooking DV underlines the urgent need to develop and implement guidelines on child custody decision-making in the context of DV.

General practice as a place to receive help for domestic abuse during the COVID-19 pandemic: a qualitative interview study in England and Wales

BACKGROUND

General practice is an important place for patients experiencing or perpetrating domestic violence and abuse (DVA), and for their children to seek and receive help. While the incidence of DVA may have increased during the COVID- 19 pandemic, there has been a reduction in DVA identifications and referrals to specialist services from general practice. Concurrently there has been the imposition of lockdown measures and a shift to remote care in general practices in the UK.

AIM

To understand the patient perspective of seeking and receiving help for DVA in general practice during the COVID-19 pandemic. This was then compared with experiences of general practice healthcare professionals.

DESIGN AND SETTING

A qualitative interview study in seven urban general practices in England and Wales, as part of a feasibility study of IRIS+, an integrated primary care DVA system-level training and support intervention.

METHOD

Semi-structured interviews with 21 patients affected by DVA and 13 general practice healthcare professionals who had received IRIS+ training. Analysis involved a Framework approach.

RESULTS

Patients recounted positive experiences of seeking help for DVA in general practice during the pandemic. However, there have been perceived problems with the availability of general practice and a strong preference for face-to-face consultations, over remote consultations, for the opportunities of non- verbal communication. There were also concerns from healthcare professionals regarding the invisibility of children affected by DVA.

CONCLUSION

Perspectives of patients and their families affected by DVA should be prioritised in general practice service planning, including during periods of transition and change.

Australian Trends in Academic Literature Concerned With Family and Domestic Violence Perpetrators: A Bibliometric Literature Review

In this article, we used a novel hybrid approach to review literature concerned with family and domestic violence (FADV) perpetrators. Our intention was to chart the research and publication activity of authors with Australian affiliation to identify homegrown evidence related to stopping the perpetration of violence. This involved systematic searching of literature from the Scopus electronic database, utilization of VOSviewer to sort keyword co-occurrences and authorship linking for 1,494 publication records over a 30-year period, and the review of 21 articles with perpetrator focus, identified from the 50 most cited publications. We found that Australians' authoring interests in FADV, over the last three decades, with perpetrator focus were predominantly concentrated on gender, rape and sexual assault, coercive control, and child abuse. In the most cited literature, six major themes were identified: perpetrator motivations, perpetrator interventions, patterns of violence, pandemic duet, perception of blame, and cyberstalking and violence. An upward curve in Australian authoring activity in the period under review aligns with societal shifts in which FADV was once considered a private issue and has now become ubiquitous in the public domain. Our findings revealed that research into perpetrators is insufficient to promote a zero-tolerance approach to FADV. Our corresponding in-depth literature review provides valuable insights surrounding perpetrator intervention programs with the goal of more effectively addressing the emerging challenge of technology-facilitated coercive control.

Impact of the COVID-19 Pandemic On Violence Against Children: A Narrative Review

PURPOSE OF REVIEW

The goal of this paper was to explore the different ways the COVID-19 pandemic has affected violence against children (VAC).

RECENT FINDINGS

Recent research of peer-reviewed articles using operational or survey data revealed the pandemic's impact in terms of institutional responses, risk and mediating factors, changes in VAC dynamics, and a likely increase in child marriage. Findings include a decrease in institutional responses, activities, and prevention case openings; an increased incidence of interparental intimate partner violence (IPV) witnessing cases, hospital admissions for suspected Abusive Head Trauma (AHT), other pediatric injuries, and sexual violence; a change in family conflict dynamics; and an estimated increase in child marriages. It also revealed mediating factors between the relationship of the pandemic and VAC (such as parental stress and mental health symptoms), as well as risk factors observed by service providers, which include the risk of mental health symptoms of both parents and children. Post-pandemic VAC research can be improved by utilizing operational or survey data in a meaningful way to be able to derive sound intervention approaches to diminish the pandemic's impact on VAC and child marriage. We also propose for researchers to integrate child marriage into the definition of VAC.

Does Timing Matter? Associations Between Intimate Partner Violence Across the Early Life Course and Internalizing and Externalizing Behavior in Children

The association between exposure to intimate partner violence (IPV) and child behavior problems is well established. However, questions remain about whether the timing during the child's early life course matters. We used a structured life course approach to investigate associations between the timing of IPV and children's internalizing and externalizing behaviors. Participants were from the Australian Longitudinal Study on Women's Health (ALSWH), a national, randomly sampled community-based study that has surveyed women every 3 years since 1996. For this study, mothers born 1973 to 1978 (N = 2,163) provided data on their three youngest children under 13 years (N = 3,697, 48.5% female) as part of the Mothers and their Children's Health (MatCH) study in 2016/2017. Mothers indicated IPV in ALSWH using the Community Composite Abuse Scale in early (M = 0.99 years, SD = 0.88 years) and middle childhood (M = 3.98 years, SD = 0.92 years), and before birth (preconception). Mothers rated child internalizing and externalizing behavior in MatCH (child age: M = 8.15 years, SD = 2.37 years) using the Strengths and Difficulties Questionnaire. We tested critical period, sensitive period, and accumulation hypotheses by comparing the fit of nested linear regression models (separately for girls and boys). Mothers were predominantly Caucasian (>90%) and university educated (65.5%), and 41.7% reported financial stress. Most children were not exposed to IPV (68.1%). Of those who were, 55.2% were exposed at one time, 28.7% at two times, and 16.1% at all three. Accumulation was the best model for externalizing in boys and girls and for internalizing in girls. A critical period in middle childhood was identified for internalizing in boys. Overall, the duration of exposure was more important than the timing. This suggests early detection is essential in mitigating the impact of IPV on children, with particular attention needed for boys exposed to IPV in middle childhood.

Exploring factors influencing domestic violence: a comprehensive study on intrafamily dynamics

Introduction

This econometric analysis investigates the nexus between household factors and domestic violence. By considering diverse variables encompassing mood, depression, health consciousness, social media engagement, household chores, density, and religious affiliation, the study aims to comprehend the underlying dynamics influencing domestic violence.

Methods

Employing econometric techniques, this study examined a range of household-related variables for their potential associations with levels of violence within households. Data on mood, depression, health consciousness, social media usage, household chores, density, and religious affiliation were collected and subjected to rigorous statistical analysis.

Results

The findings of this study unveil notable relationships between the aforementioned variables and levels of violence within households. Positive mood emerges as a mitigating factor, displaying a negative correlation with violence. Conversely, depression positively correlates with violence, indicating an elevated propensity for conflict. Increased health consciousness is linked with diminished violence, while engagement with social media demonstrates a moderating influence. Reduction in the time allocated to household chores corresponds with lower violence levels. Household density, however, exhibits a positive association with violence. The effects of religious affiliation on violence manifest diversely, contingent upon household position and gender.

Discussion

The outcomes of this research offer critical insights for policymakers and practitioners working on formulating strategies for preventing and intervening in instances of domestic violence. The findings emphasize the importance of considering various household factors when designing effective interventions. Strategies to bolster positive mood, alleviate depression, encourage health consciousness, and regulate social media use could potentially contribute to reducing domestic violence. Additionally, the nuanced role of religious affiliation underscores the need for tailored approaches based on household dynamics, positioning, and gender.

Pediatric ACEs and related life event screener (PEARLS) latent domains and child health in a safety-net primary care practice

BACKGROUND

Research examining the connections between individual adverse childhood experiences (ACEs) and how groupings of interrelated adversities are linked with subsequent health is scarce, limiting our understanding of risk during a period of rapid expansion of ACE screening in clinical practice. The study objective was to conduct a psychometric analysis to derive latent domains of ACEs and related life events and assess the association between each domain and health outcome.

METHODS

Participants (3 months-11 years) were recruited from the University of California San Francisco Benioff's Children Hospital Oakland Primary Care Clinic. Children were screened with the Pediatric ACEs and Related Life Events Screener (PEARLS) (n = 340), which assessed 17 total ACEs and related life events, including forms of abuse, household challenges, and social risks. Domains were constructed using confirmatory factor analysis and associations between the three identified domains and 14 health outcomes were assessed using multivariable linear and logistic regression models.

RESULTS

Three PEARLS domains were identified: Maltreatment (ω = 0.73, ɑ=0.87), Household Challenges (ω = 0.70, ɑ=0.82), and Social Context (ω = 0.55, ɑ=0.70). Measurement invariance was supported across both gender and screening format. All domains were associated with poorer general and behavioral health and stomachaches. Maltreatment and Social Context were additionally associated with eczema while only Social Context was associated with increased odds of reporting headaches and somatic symptoms.

CONCLUSION

In an underserved, urban west-coast pediatric population, the PEARLS found three adversity domains of Maltreatment, Household Challenges, and Social Context that all had an independent statistically significant association with poorer child health. The results provide a timely and more nuanced representation of risk that can inform clinical practice and policy using more targeted resources and interventions.

Partner Alcohol Use and Attitudes Toward Intimate Partner Violence: Independent and Synergistic Effects on Intimate Partner Violence Across 19 Low- and Middle-Income Countries

Although partner alcohol use and acceptance of intimate partner violence against women (IPVAW) are critical determinants of IPVAW, little is known about their interaction. We explored how partner alcohol use and attitudes toward IPVAW act independently and jointly at the individual and community levels to influence women's reports of experiencing IPVAW across low- and middle-income countries. We conducted secondary analyses using a pooled sample of reproductive-aged women (n = 166,621) from 19 Demographic and Health Survey datasets. We fit a series of a priori-defined mixed-effects logistic regression models of the total effects, within- and between-community effects, and contextual effects of past-year IPVAW on partner alcohol use, acceptance of IPVAW, and their multiplicative interaction. We then fit a series of models stratified by community alcohol use and acceptance of IPVAW. Partner alcohol use (odds ratio [OR] = 3.20; 95% confidence interval [CI]: [3.07, 3.33]) and women's acceptance of IPVAW (OR = 1.83; 95% CI: [1.76, 1.89]) were consistently associated with increased odds of experiencing IPVAW. Sub-multiplicative interactions were present for within-community effects (ratio of OR = 0.86; 95% CI: [0.79, 0.94]), whereas supra-multiplicative interactions were present for between-community effects (ratio of OR = 1.002; 95% CI: [1.0002, 1.005]) and contextual effects (ratio of OR = 1.003; 95% CI: [1.0007, 1.005]). The odds of IPVAW associated with partner alcohol use was greatet in communities with lower partner alcohol prevalence and lower acceptance of IPVAW. It is important to consider norms and attitudes toward IPVAW alongside alcohol use when understanding epidemiological patterns of IPVAW and potential opportunities for preventive programs and policymaking. Future studies should focus on the complex interactions, at multiple social levels, between interacting risk factors for IPVAW.

Revisiting the Co-Occurrence of Intimate Partner Violence and Child Maltreatment

Child welfare (CW) agencies are charged with ensuring children's safety; when children live with families impacted by intimate partner violence (IPV), this task can be complex. To better understand how U.S. CW agencies identify and make decisions about child maltreatment (CM) in the presence of IPV, this mixed-methods study used national data (N = 248,654) to investigate whether IPV was more likely to be documented as co-occurring with certain types of CM. This study also explored the intersection of IPV and CM using 19 semi-structured interviews with child welfare stakeholders to gain insight into the mechanisms underpinning reporting processes. Multinomial logistical regression showed that after controlling for other risk factors, children living in a household with IPV were more likely to be determined to be physically abused and emotionally maltreated than neglected, and less likely to be determined to be sexually abused than neglected, compared with children who did not live in a household with IPV. Those children were also more likely to be determined to be emotionally maltreated than physically abused, and less likely to be determined to be sexually abused than physically abused, compared with children who did not live in a household with IPV (all results, p < .0001). Qualitative results revealed IPV and children's exposure to IPV may be categorized as different types of CM by CW agencies and staff, and that this categorization can vary by agency and staff level. Participants also described challenges to addressing IPV within CW systems. Findings suggest national CW data may obscure when IPV and CM co-occur versus when a given type of CM is serving as a proxy for the presence of or children's exposure to IPV, presenting challenges to interpreting child welfare data. Recommendations are presented to improve CW data accuracy and ensure the safety of children and families impacted by IPV.

Child safety assessments during a caregiver's evaluation in emergency departments after intimate partner violence

BACKGROUND

Physical abuse of children is reported to occur in 30%-60% of homes with intimate partner violence (IPV). IPV in adult victims presenting to emergency departments (EDs) represents a critical opportunity to evaluate for child safety.

OBJECTIVES

The primary objective was to determine the frequency of child safety assessments (CSAs), defined as any documented inquiry about the presence of children in the household, when adults presented to EDs for IPV. The secondary aims were to assess (1) the impact of demographic factors, ED type, and social work (SW) involvement on the likelihood of CSAs; (2) the nature of children's exposure; and (3) the frequency of child protective services (CPS) reports.

METHODS

We performed a chart review of encounters with ICD-10-CM codes for patients aged 18-60 with IPV presenting to three EDs in Connecticut from 2017 through 2019.

RESULTS

CSAs were completed in 179/277 encounters (78.9%) and were more likely to be completed in encounters with SW involvement than without (162/171 [94.7%] vs. 17/56 [30.3%], p < 0.001). A total of 143 children lived in the home at the time of the incident; of the 107 children for whom the nature of exposure was known, 10 (9.3%) were physically involved and 26 (24.2%) were direct witnesses to the violence. CPS reports were made in 52.4% of the encounters in which children lived in the home.

CONCLUSIONS

CSAs were omitted in one-fifth of encounters for IPV. Given the high prevalence of children involved in IPV episodes, ED encounters for IPV represent an opportunity to improve the safety of children.

Intimate partner violence against ever-partnered women in Europe: Prevalence and associated factors-Results from the violence against women EU-wide survey

Study questions

To describe the prevalence of physical, sexual, and psychological intimate partner violence (IPV) against women in the European Union (EU) and to search for their determinants among demographic, socioeconomic, health-related factors, and partner characteristics.

Methods

Observational study. Data from the violence against women survey, the first study conducted in the EU, which simultaneously measured all dimensions of IPV and many characteristics. The EU Agency for Fundamental Rights randomly conducted face-to-face interviews among the 28 countries with 42,002 women aged 18-74 who resided in the survey country and spoke the language. IPV is defined by a positive answer to at least one question about physical, sexual, or psychological violence perpetrated by a current or ex-partner.

Findings

Among the 40,357 women having already been in a relationship, 51.7% (51.2-52.2) reported having been victims of violence in their lifetime. The prevalence of physical, sexual, and psychological IPV was, respectively, 20.0% (19.6-20.4), 8.4% (8.2-8.7), and 48.5% (48.1-49.0). Women, who were younger, employed, had highly qualified work, had at least one immigrant parent, lived in an urban setting, were unmarried, separated, divorced, widowed, childless, cohabited with a partner, and others over the age of 18, had worse self-perceived health, or a history of violence before the age of 15 were more likely to report IPV. It was the same when their partners had a lower level of education, no work, were home staying, earned less than they did, were involved in 10 years of relationship, were frequently drunk, or were violent otherwise.

Major implication

The lifetime prevalence of reported IPV among women in Europe is high and likely underestimated. The results emphasize the importance of a comprehensive definition of IPV and partners' characteristics. They highlight socioeconomic differences and poorer health status for victims of IPV.

Correlates of co-occurring physical child punishment and physical intimate partner violence in Colombia, Mexico and Peru

Background

Violent discipline of children and intimate partner violence (IPV) against women are global public health and human rights problems. To address calls for more evidence on intersections, this study aimed to expand knowledge about correlates of physical child punishment, physical IPV against women and their co-occurrence (both) in the same household. 

Methods

Using national, population-based survey datasets from Colombia, Mexico and Peru, multinomial logistic regressions examined correlates of three mutually exclusive patterns of violence in the household: physical child punishment (only), physical IPV ever (only) and co-occurrence (both), each compared with no violence, after adjusting for other factors. Logistic regression was used to analyse odds ratios of physical child punishment in households affected by IPV past year and before past year compared with never, after adjusting for other factors.

Results

In all countries, adjusted odds ratios (aOR) of co-occurrence were significantly higher among women with lower education, more than one child, a child aged 2–5, a partner who tried to socially isolate her, and a history of childhood violence (caregiver violence and/or IPV exposure). They were significantly lower among women who reported collaborative partnerships (joint decision-making and/or shared chores). Co-occurrence was also significantly correlated with a history of child marriage/early motherhood in Colombia and Mexico, partner’s excess drinking in Mexico and Peru, agreement that physical child punishment was necessary in Peru and partner’s history of childhood violence in Colombia and Mexico. Evidence of shared risk factors was strongest for social isolation and caregiver histories of childhood violence and of shared protective factors for collaborative partnership dynamics. In all countries, associations between physical child punishment and physical IPV remained significant after adjusting for other factors, suggesting that correlations could not be explained by shared risk factors alone.

Conclusions

These findings are consistent with several theories relevant for violence prevention: 1) more collaborative, gender equitable partnerships may protect both children and women from violence; 2) violence between intimate partners may ‘spill over’ into violence against children (as correlations could not be explained by shared risk factors alone); and 3) there appears to be strong evidence of intergenerational transmission of violence.

Child Maltreatment and Intimate Partner Violence in Mental Health Settings

Intimate partner violence (IPV) and child maltreatment (physical, emotional, sexual abuse, neglect, and children's exposure to IPV) are two of the most common types of family violence; they are associated with a broad range of health consequences. We summarize evidence addressing the need for safe and culturally-informed clinical responses to child maltreatment and IPV, focusing on mental health settings. This considers clinical features of child maltreatment and IPV; applications of rights-based and trauma- and violence-informed care; how to ask about potential experiences of violence; safe responses to disclosures; assessment and interventions that include referral networks and resources developed in partnership with multidisciplinary and community actors; and the need for policy and practice frameworks, appropriate training and continuing professional development provisions and resources for mental health providers. Principles for a common approach to recognizing and safely responding to child maltreatment and IPV are discussed, recognizing the needs in well-resourced and scarce resource settings, and for marginalized groups in any setting.

Child Welfare Reform: A Scoping Review

While there have been ongoing calls to reform child welfare so that it better meets children's and families' needs, to date there have been no comprehensive summaries of child welfare reform strategies. For this systematic scoping review, we summarized authors' recommendations for improving child welfare. We conducted a systematic search (2010 to 2021) and included published reviews that addressed authors' recommendations for improving child welfare for children, youth, and families coming into contact with child welfare in high-income countries. A total of 4758 records was identified by the systematic search, 685 full-text articles were screened for eligibility, and 433 reviews were found to be eligible for this scoping review. Reviews were theoretically divided, with some review authors recommending reform efforts at the macro level (e.g., addressing poverty) and others recommending reform efforts at the practice level (e.g., implementing evidence-based parenting programs). Reform efforts across socioecological levels were summarized in this scoping review. An important next step is to formulate what policy solutions are likely to lead to the greatest improvement in safety and well-being for children and families involved in child welfare.

Are Children Harmed by Being Locked up at Home? The Impact of Isolation during the COVID-19 Pandemic on the Phenomenon of Domestic Violence

The phenomenon of violence against children is a very complex one. There are many types of child abuse, and they are culturally dependent to a significant degree. Although studies show that children generally only suffer from mild COVID-19 infection, some social restrictions introduced during the pandemic, such as home isolation, may have many severe consequences on the population's mental health. Studies on this topic suggest that violence against children increased during lockdown due to the COVID-10 pandemic. This narrative review summarizes this available literature on the subject and discusses the different forms of violence against children, their cultural aspects, the impact of the COVID-19 pandemic on the phenomenon of violence, the long-term consequences of the above, and forms of assistance for abused minors.

Relative Wellbeing of Women Maltreated as Children

This study explores and analyzes how adult women in Sweden exposed to childhood maltreatment describe wellbeing, by using a thematic analysis of 22 semi-structured interviews with women maltreated as children. The results show that wellbeing was described as relative to both social norms and the childhood experiences and constituted four dimensions: Material and/or economic; Social and relational;Emotional; and Physical and/or mental. This study concludes that it is important to consider the relative and multiple ways wellbeing can be experienced and understood and to problematize norms of wellbeing, acknowledging the various ways people appraise their lives.

Development and Psychometric Assessment of a Questionnaire for the Detection of Invisible Violence against Women

BACKGROUND

Invisible violence against women (IVAW) can be understood as the set of attitudes, behaviors, and subtle beliefs that men use to subordinate women and that are culturally accepted. These behaviors can be a risk factor for intimate partner violence (IPV), so it is important to design tools that allow us to detect it early. The aim of this study was to design and psychometrically assess a questionnaire for the detection of invisible violence against women (Q-IVAW).

METHODOLOGY

A descriptive cross-sectional methodological study carried out in three phases: (1) development of the initial version; (2) pilot study (N = 51); and (3) final validation study (N = 990). The tool's reliability, validity, and legibility were assessed. To assess reliability, the internal consistency (Cronbach's α) was analyzed. The validity assessment included an analysis of content, criterion, and construct validity.

RESULTS

The EFA revealed that the Q-IVAW was comprised of five factors that explained 55.85% of the total variance found. The Q-IVAW showed very high reliability (α = 0.937), excellent content validity, and good construct validity. The criterion validity analysis showed a moderate correlation between A-IPVAW and Q-IVAW (r = 0.30; p < 0.001).

CONCLUSION

The psychometric assessment of the Q-IVAW yielded good results, which could support the tool's ability to assess how often women are subjected to inviable violent behaviors by their partners.

Conceptualizing Physicians' Roles in Addressing Intimate Partner Violence: A Critical Discourse Analysis of Resources for Canadian Physicians

Resources addressing intimate partner violence (IPV) play a role in shaping how physicians conceptualize and perform their roles in caring for affected patients. This study combines environmental scanning with critical discourse analysis (CDA) to parse how roles of physicians were represented in 28 education materials and policy documents about IPV, taking the Canadian training milieu as an example. We developed a cyclical model of three core physician roles in addressing IPV-learning about IPV, identifying patients experiencing IPV, and responding to patients' disclosures of IPV. The construction of these physician roles is suggestive of an ongoing process of medicalization of IPV.

Prevalence and Social Inequality in Experiences of Domestic Abuse Among Mothers of Young Children: A Study Using National Survey Data from Scotland

Domestic abuse is a pernicious societal issue that has both short- and long-term consequences for those who are victimized. Research points to motherhood being linked to women's victimization, with pregnancy being a particular point of risk. Across UK jurisdictions, new legislation aims to extend the criminalization of domestic abuse to include coercive control. Less clear is the relationship between mothers' victimization of different "types" of abuse and other factors such as age, socioeconomic status, and level of education. The article makes an original contribution to knowledge by addressing these limitations of the existing literature. Using nationally representative data from a Scottish longitudinal survey (N = 3,633) into children's development this article investigates the social stratification of mothers' exposure to different types of abuse, including coercive control, physical abuse, and threats. Overall, 14% of mothers report experiencing any type of domestic abuse since the birth of the study child (age 6), of which 7% experienced physical abuse. Compared to mothers in the highest income households, mothers in the lowest income quintile were far more likely to experience any form of abuse (Logistic Regression, OR = 3.55), more likely to have experienced more types of abuse and to have experienced these more often (OR = 5.54). Age had a protective effect, with mothers aged 20 or younger at most risk of abuse (OR = 2.60 compared to mothers aged 40+). Interaction effects between age and income suggested that an intersectional lens may help explain the cumulative layers of difficulty which young mothers on low incomes may find themselves in when it comes to abusive partners. The pattern of social stratification remained the same when comparing different types of abuse. Mothers of boys were more likely to experience abuse, and to experience more types of abuse, more often. We reflect on how these findings could inform existing policy interventions.

"I Want My Mum to Know That I Am a Good Guy …": A Thematic Analysis of the Accounts of Adolescents Who Exhibit Child-to-Parent Violence in the United Kingdom

This qualitative study explores child-to-parent violence (CPV) in the United Kingdom based on the accounts of adolescents who exhibit this type of family violence. The key areas of interest concern the familial relationships and contexts within which adolescents are embedded, and their perceptions about their emotional states and how these interplay with CPV. Eight participants were recruited in total from a community sample from two different intervention programs aiming to tackle CPV in England. Methods included participant-observation, face-to-face interviews, and handwritten interviews; all data were analyzed thematically. Results suggest that CPV is linked with adverse childhood experiences (ACEs), unsatisfactory relationships with parents, perceived emotional rejection from parents, and emotional dysregulation in young people. In this study, violent behavior was directed not only against mothers but in all cases against siblings and stepfathers. The findings address the complexity of the subject and the need for tailored, evidence-based interventions in the field of CPV.

Mothering in the Context of Violence: Indigenous and Non-Indigenous Mothers' Experiences in Regional Settings in Australia

Domestic and family violence (DFV) disproportionately affects women and children in Australia and globally. On average, one in three women experiences DFV during adulthood and the majority of these women identify as mothers. The prevalence of DFV is higher for Indigenous women and their experiences disproportionately range at the more severe end of physical abuse. For women affected by DFV, mothering during and post this type of victimization is complicated by strategic entrapment, undermining of the mother-child relationship, and threats of harm directed at children and mothers. While a substantial body of literature has examined the experiences of mothers affected by DFV more broadly, research on the experiences of Indigenous mothers affected by DFV remains scarce. Research evidence is further limited when trying to understand the specific constraints experienced by mothers affected by DFV in regional settings. This article examines the experiences of Indigenous and non-Indigenous mothers affected by DFV in regional Queensland, Australia. Data derived from 17 qualitative face-to-face interviews are used to explore the lived experiences of these mothers. Findings identify the immediate and long-term effects of DFV on mothers and children, including similarities and differences in women's experiences of mothering in the context of DFV, experiences of entrapment in an abusive relationship, experiences of post-separation abuse, strategies used to mitigate its impact on children, and surviving as a female-headed single-parent household in regional settings. While mothers in this study shared a number of similar experiences, regionality, the risk of cultural disconnectedness, and socio-structural marginalization disproportionately affected Indigenous mothers in this study. Findings raise key implications for supporting mothers and children's safety and recovery, access to safe and sustainable housing in regional towns, and the empowerment of Indigenous women to overcome the lasting effects of colonization and disproportionate experiences of disadvantage.

Prevalence of childhood exposure to intimate partner violence in low-income and lower-middle-income countries: a systematic review

OBJECTIVE

To determine the proportion of children in low-income and lower-middle-income countries exposed to intimate partner violence (IPV).

DESIGN

Systematic review.

DATA SOURCES

PubMed, CINAHL, ERIC, PsycINFO, Web of Science, WHO Global Index Medicus, and Violence and Abuse Abstracts, hand searching of specialised journals from inception until 19 May 2019.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Primary quantitative studies that included a measure of self-reported exposure to IPV prior to age 18 and were conducted in low-income and lower-middle-income countries.

DATA EXTRACTION AND SYNTHESIS

Data were screened, extracted and appraised by two independent reviewers. The prevalence estimates were pooled using a random-effects model. Outcomes included lifetime and past-year prevalence of childhood exposure to IPV. Meta-regression was used to explore heterogeneity. Publication bias was assessed using a funnel plot and Egger's regression test. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed.

RESULTS

Sixty-two studies with a total of 231 512 participants were included. Eighty-five lifetime prevalence estimates and 6 estimates of past-year prevalence were available for synthesis. The average lifetime prevalence of childhood exposure to IPV was 29% (95% CI 26% to 31%). The average past-year prevalence in children was 35% (95% CI 21% to 48%). The lifetime prevalence disaggregated by WHO regions ranged from 21% to 34%. There were no statistical differences in prevalence estimates between samples of men and women.

CONCLUSION

Almost one-third of children in low-income and lower-middle-income countries have been exposed to IPV in their lifetime. There was large heterogeneity between estimates that was not explained by available study and sample characteristics. Our findings indicate that children's exposure to IPV in low-income and lower-middle-income countries is common and widespread; prevention of this major public health exposure should be a priority.

PROSPERO REGISTRATION NUMBER

CRD42019119698.

KODY, an all-of-family response to co-occurring substance use and domestic violence: protocol for a quasi-experimental intervention trial

Background

The co-occurrence of domestic violence with alcohol and other drugs significantly increases the severity of abuse and violence experienced by family members. Longitudinal studies indicate that substance use is one of few predictors of men’s continued use of, or desistance from, violence. Recent developments in men’s behaviour change programs have focused on men’s attitudes and behaviour towards their children, and the exploration of interventions that address the needs of all family members. However, the research evidence is limited on the most effective elements of men’s behaviour change programs in promoting the safety and wellbeing of child and women victim survivors.

This study aims to build on the existing evidence by trialling the KODY program which addresses harmful substance use by men who also perpetrate domestic violence; the safety and wellbeing of women and children; the needs of children in their own right, as well as in relationship with their mothers; and the development of an ‘all-of-family’ service response. The evaluation of these innovations, and the ramifications for policy development to support less fragmented service system responses, provide the rationale for the study.

Methods/Design

A quasi-experimental design will be used to assess the primary outcomes of improving the safety and wellbeing of mothers and children whose (ex)partners and fathers respectively participate in KODY (the trial program), when compared with ‘Caring Dads standard’ (the comparison group). Psychometric tests will be administered to fathers and mothers at baseline, post-program and at 3-month follow up. Data collection will occur over three years.

Discussion

By building the evidence base about responses to co-occurring domestic violence and substance use, this study aims to develop knowledge about improving safety outcomes for women and children, and to better understand appropriate support for children in families living at the intersection of domestic violence and substance use. It is anticipated that study findings will point to the ramifications for policy development to support less fragmented service system responses.

Trial registration

An application for registration with the Australian and New Zealand Clinical Trials Registry (https://www.anzctr.org.au/) was lodged on 20 December 2021 (Request number: 383206)—prospectively registered.

The characteristics of Australian Maternal and Child Health home visiting nurses undertaking family violence work: An interpretive description study

AIMS

To explore the family violence practice of home visiting nurses and identify the personal and professional characteristics of nurses undertaking family violence work.

DESIGN

A qualitative research design using interpretive description.

METHODS

The family violence nursing practice and characteristics of home visiting nurses in Victoria, Australia, were explored by analysing semi-structured interviews (n = 37) conducted over 4 months in 2019-2020. Twenty-five nurses and 12 nurse managers worked in urban, regional city and rural/remote settings. The data were analysed using reflexive thematic analysis.

RESULTS

We categorized the characteristics of home visiting nurses into two broad themes with sub-themes: 'Things you can learn'; and 'You just bring yourself'.

CONCLUSION

By researching the characteristics of home visiting nurses undertaking family violence work, this study has identified the personal characteristics managers should consider when recruiting nurses to this specialist role. Identifying the personal and professional skills required will improve nurses' working experience by reducing the risk of a potential skill/role mismatch. These insights may enhance the effectiveness of home visiting nurses so that the Enhanced Maternal and Child Health program contributes effectively to the support of women experiencing family violence.

IMPACT

Interviewing home visiting nurses and their managers has enabled a clearer insight into this specialist practitioner's previously unexplored work. Identifying the nurses' personal, professional, and clinical characteristics should inform the development of position roles and identify nurses who are best suited for this role. This knowledge will ensure that the Maternal and Child Health program effectively supports women experiencing family violence.

'It felt like there was always someone there for us': Supporting children affected by domestic violence and abuse who are identified by general practice

One in five children in the UK are affected by domestic violence and abuse. However, primary care clinicians (GPs and nurses) struggle to effectively identify and support children and young people living in homes where it is present. The IRIS+ (Enhanced Identification and Referral to Improve Safety) training and advocacy support intervention aimed to improve how clinicians respond to children and young people affected by domestic violence and abuse. IRIS+ training was delivered as part of a feasibility study to four general practices in an urban area in England (UK). Our mixed method design included interviews and questionnaires about the IRIS+ intervention with general practice patients, including children and young people as well as with clinicians and advocacy service providers. We collected the number of identifications and referrals by clinicians of children experiencing domestic violence and abuse through a retrospective search of medical and agency records 10 months after the intervention. Forty-nine children exposed to domestic violence and abuse were recorded in medical records. Thirty-five children were referred to a specialist domestic violence and abuse support service over a period of 10 months. Of these, 22 received direct or indirect support. The qualitative findings indicated that children benefitted from being referred by clinicians to the service. However, several barriers at the patient and professional level prevented children and young people from being identified and supported. Some of these barriers can be addressed through modifications to professional training and guidance, but others require systematic and structural changes to the way health and social care services work with children affected by domestic violence and abuse.

Suffering and Care of 0-12 Year-Old Children Exposed to Intimate Partner Violence: Making Clinical Forensic Data Talk

Children's exposure to intimate partner violence (IPV) is a widespread phenomenon that can have detrimental consequences on their health and well-being. This study examined how clinical forensic consultation data of adult victims of IPV might provide information on the potential suffering of children exposed to IPV, the duration of exposure and the knowledge of the situation by the professionals with whom those children were in contact. Data were collected from the consultation files of 112 adult victims of IPV who consulted the Violence Medical Unit at the Lausanne University Hospital (Switzerland) in 2014, and who were parents of children aged 0 through 12. Descriptive quantitative and qualitative analyses were performed. Symptoms of suffering, such as dysregulation of instinctual functions and developmental, behavioral or emotional difficulties, were reported for nearly one-third of the victims' children. Children's exposure to IPV often started around their birth and about four in 10 children had been exposed for three years or more. Health and childhood professionals were unaware of the exposure for the vast majority of the children. Clinical forensic data can be useful in providing information on the suffering and care of children exposed to IPV. Their suffering took the form of a non-specific posttraumatic symptomatology and therefore might be difficult to detect. It is necessary to make professionals and parents aware of the fact that IPV can have a harmful impact on children's health and well-being, and to encourage health professionals to consider the possibility of IPV when facing such symptoms.

Trend in 167 cases of minors witnessing violence: The role played by COVID-19 pandemic

BACKGROUND

There currently is no evidence that COVID-19 has had an impact on the rates of psychological abuses occurring when a minor witnesses interpersonal violence.

AIM

Our aim was to describe the accesses of the last four years to the Emergency Department of a tertiary hospital (Careggi University Hospital-Florence, Italy) due to this issue and then to evaluate whether the COVID-19 has had an impact on this trend.

METHODS

We collected data regarding cases of abuse in which at least a minor had reportedly witnessed the event. Medical records stored between January 1, 2018 to January 1, 2022 were analyzed, extracting sex, age and nationality of the victim; sex of the perpetrator and relationship with the victim; known previous episodes of abuse in the medical history of the victim; setting of the abuse (domestic vs. non-domestic); type of abuse (physical, psychological, sexual); whether the perpetrator was under the influence of alcohol/drugs; whether the victim was hospitalized; prognosis of the victim; number, relation with the victim and involvement in the abuse (as co-victim) of the minor(s) who witnessed the abuse.

RESULTS

A total of 167 eligible cases were registered. 69% of victims had previous episodes of abuse. The perpetrators were all known and mainly males (96%).The abuses were mainly domestic (79%). In 74% of the cases only a type of violence was perpetrated. In 12% of the cases, the minors were also victims of physical abuse. No statistically significant relationships were found between the start of the COVID-19 pandemic and the changes in the number of cases of domestic abuse (p = 0.07), physical abuse (p = 0.62), psychological abuse (p = 0.83) or sexual abuse (p = 0.88). However, during the institutional lockdown in Italy (March-May 2022) only two cases occurred - a number that did not allow period-specific statistical inference.

CONCLUSIONS

Empowering the hospital policies specifically aimed at identifying and protecting the victims of violence/witnessed violence remains a critical goal from both a public health and medico-legal point of view.

Co-occurring violent discipline of children and intimate partner violence against women in Latin America and the Caribbean: a systematic search and secondary analysis of national datasets

Introduction

Intersections between violent discipline (physical punishment and/or verbal aggression) of children and intimate partner violence (IPV) against women have received growing international attention. This study aimed to determine how many Latin American and Caribbean (LAC) countries had national data on co-occurring IPV and violent discipline in the same household, how estimates compared and whether violent discipline was significantly associated with IPV.

Methods

A systematic search (following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines) was used to identify which LAC countries had eligible, national co-occurrence data. The most recent eligible dataset in each country was obtained and reanalysed for comparability. Standardised national estimates were produced for prevalence of violent discipline, physical and/or sexual IPV and co-occurrence among ever partnered women of reproductive age living with a child aged 1–14. Bivariate analyses and logistic regressions produced levels and odds ratios (ORs) of physical punishment and verbal aggression in households affected by IPV (past year and before past year) compared with never, adjusted for sociodemographic characteristics.

Results

Nine countries had eligible datasets. Co-occurring physical punishment with past year IPV ranged from 1.7% (Nicaragua) to 17.5% (Bolivia); and with IPV ever from 6.0% (Nicaragua) to 21.2% (Haiti). In almost all countries, children in IPV affected households experienced significantly higher levels and ORs of physical punishment and verbal aggression, whether IPV occurred during or before the past year. Significant adjusted ORs of physical punishment ranged from 1.52 (95% CI 1.11 to 2.10) in Jamaica to 3.63 (95% CI 3.26 to 4.05) in Mexico for past year IPV; and from 1.50 (95% CI 1.23 to 1.83) in Nicaragua to 2.52 (95% CI 2.30 to 2.77) in Mexico for IPV before past year.

Conclusions

IPV is a significant risk factor for violent discipline, but few national surveys in LAC measure both. Co-occurrence merits greater attention from policymakers and researchers.

Depression in childhood: The role of children's exposure to intimate partner violence and maternal mental disorders

BACKGROUND

Intimate partner violence (IPV) is a global problem with high prevalence rates, and is linked to maternal mental disorders (MMD). Children's exposure to IPV (CEIPV) can have impacts on their physical and mental health, including depression.

OBJECTIVE

To analyze the associations between exposure to both CEIPV and MMD and depression in schoolchildren.

PARTICIPANTS AND SETTING

630 mother-child pairs were evaluated in a poor urban district in Recife, Northeast Brazil.

METHODS

A cohort study investigated the effects of IPV during pregnancy, postpartum and six to nine years after delivery. Women were asked about their experience of IPV, their own mental health, and the exposure of their child to violence. The child's mood was reported by the mother, using the Short Mood and Feelings Questionnaire (SMFQ). Ten types of CEIPV, and the age of onset of exposure, were compared with the child's subsequent risk of depression.

RESULTS

IPV was associated with MMD in 31.9% of the women at some period of time. Depressive symptoms were reported in 15.7% of school-age children. All types of CEIPV were associated with depression at school age. Multivariable analyses of exposure to IPV and MMD at different ages showed that exposure to both IPV and MMD in the first year of life had the strongest association with childhood depression (OR = 9.1; 95% CI: 2.4-33.9).

CONCLUSIONS

The frequency of CEIPV and MMD, and the high prevalence of depression at school age, shows the importance of assessing MMD and identifying exposure to IPV in pregnancy and the early years.

Intimate partner violence and child outcomes at age 10: a pregnancy cohort

OBJECTIVE

Assess the mental health, physical health, cognitive and language development of 10-year old children in families where mothers have reported intimate partner violence (IPV) compared with children with no reported IPV exposure.

DESIGN

Prospective pregnancy cohort. Maternal report of IPV (Composite Abuse Scale) at 1, 4 and 10 years. Maternal and direct assessment of child mental health (probable psychiatric diagnosis, anxiety and emotional/behavioural difficulties), cognition (IQ and executive function), language (general, pragmatic and receptive) and physical health at 10 years.

SETTING

A subsample of 615 mother-child dyads drawn from a pregnancy cohort of 1507 nulliparous women recruited from six public hospitals in Melbourne, Australia.

RESULTS

Any IPV exposure from infancy to age 10 was associated with poorer child outcomes at age 10. Specifically, twice the odds of a probable psychiatric diagnosis, emotional/behavioural difficulties, impaired language skills (general and pragmatic), and having consulted a health professional about asthma or sleep problems. IPV exposure at age 10 associated with two to three times higher odds of all mental health outcomes, elevated blood pressure and sleep problems. Early life exposure alone (at 1 and/or 4 years) associated with three times higher odds of a general language problem and asthma at age 10.

CONCLUSION

The high prevalence of IPV and increased risk of poorer health and development among children exposed highlights the burden of ill health carried by children in families experiencing IPV. Fewer difficulties where exposure was limited to the early years builds the case for better identification, understanding and resourcing of effective early intervention.

Longitudinal effects of maltreatment, intimate partner violence, and Reminiscing and Emotion Training on children's diurnal cortisol regulation

Dysregulation in children's physiological stress systems is a key process linking early adversity to poor health and psychopathology. Thus, interventions that improve children's stress physiology may help prevent deleterious health outcomes. Reminiscing and Emotion Training (RET) is a brief relational intervention designed to improve maternal caregiving support by enhancing maltreating mothers' capacity to reminisce with their young children. This study evaluated associations between maltreatment, intimate partner violence, and the RET intervention with changes in children's diurnal cortisol regulation across the 1 year following the intervention, and the extent to which improvements in maternal elaborative reminiscing differed between intervention groups and mediated change in children's physiological functioning. Participants were 237 children (aged 36 to 86 months) and their mothers. Results indicated that the RET intervention was associated with significant positive change in elaborative reminiscing, which was sustained over time. Mothers' elaboration immediately after the intervention served as a mediator of RET's effects on improvements in children's diurnal cortisol regulation (steeper diurnal slopes) from baseline to 1 year following intervention. This suggests RET is effective in facilitating physiological regulation among maltreated children.

Neurophysiological patterns associated with blunted emotional face processing and withdrawal tendencies in young children exposed to intimate partner violence

Studies linking child maltreatment to abnormal neurophysiological responses to emotional stimuli and mental health impairment have not specifically explored these patterns in young children exposed to intimate partner violence (IPV). The present study examined two neurophysiological indicators, resting-state electroencephalography and an emotion event-related potential (ERP) in 21 IPV exposed and 30 nonexposed children ages 4-6 years recruited from the community and domestic violence shelters. Frontal alpha asymmetry (FAA) was assessed while at rest. FAA is often associated with avoidant/withdrawn behavior and increased risk of IPV-related mental health conditions (e.g., depression). Additionally, the late positive potential (LPP) ERP component, reflecting motivated attention, was acquired in the context of an age-appropriate affective oddball paradigm with low probability animal pictures as targets and human facial expressions (angry, happy, neutral) as distracters. Results demonstrated that IPV-exposed children, compared with nonexposed children, exhibited lower left FAA during resting state and reduced LPPs to oddball targets and affective faces relative to neutral faces in the oddball task. Together, these results suggest neural patterns associated with a blunted response to emotional stimuli and withdrawal tendencies, respectively, in young children exposed to IPV. Implications for emotional socialization in this vulnerable population are discussed.

The co-occurrence of intimate partner violence exposure with other victimizations: A nationally representative survey of Chilean adolescents

BACKGROUND

Previous studies have found a high co-occurrence between Intimate Partner Violence exposure (IPVe) and other forms of victimization, such as physical and sexual abuse, yet little is known about this issue from community samples in Latin America or -in particular- Chile.

OBJECTIVE

To examine the prevalence, sociodemographic correlates and co-occurrence of IPVe with other youth victimizations in Chile.

PARTICIPANTS AND SETTING

A secondary data analysis of the First Poly-victimization Survey in Children and Adolescents in Chile was conducted, which had 19,684 responses from 7^th to 11^th grade students attending publicly-funded, subsidized and independent schools in urban areas across the country.

METHODS

The Juvenile Victimization Questionnaire was applied, and sociodemographic information was collected. Multiple logistic regression models were used.

RESULTS

The prevalence of lifetime IPVe was 13.0 % (95 % CI [12.4-13.6]), and 3.6 % (95 % CI [3.4-4.0]) for past-year IPVe. The factors that were positively associated with lifetime IPVe were: female, over 14 years old, indigenous ethnicity, with a disability, mother with immigrant status, living with only one parent, and attending publicly-funded and subsidized schools. Most of these associations were maintained for past-year IPVe. All victimizations studied were positively associated with lifetime and past-year IPVe. Poly-victimization, maltreatment and witnessing sibling abuse showed the strongest associations (adjusted OR > 4.0). Co-occurrence was particularly high among IPVe youth, especially for community violence (86.2 %) and any maltreatment (81.5 %) in lifetime reports.

CONCLUSIONS

An integrated approach to assessing IPVe and other forms of victimizations would enrich research and clinical practice, especially early detection of IPVe occurrences.