Family adversity and health characteristics associated with intimate partner violence in children and parents

Family adversity and health characteristics associated with intimate partner violence in children and parents presenting to health care: a population-based birth cohort study in England

Link to publication: https://doi.org/10.1016/S2468-2667(23)00119-6

Introduction:

Intimate partner violence (IPV) is a deeply concerning issue that affects millions of women worldwide. One in three women experiences IPV, translating to over 800 million women globally. These women endure a harrowing reality where they feel trapped, restricted, and fear losing their children.

The World Health Organization (WHO) defines IPV as any behavior causing physical, psychological, or sexual harm within intimate relationships. IPV is often linked to other family adversities and can lead to various mental and physical health problems, increased health and social care needs, and even premature death. Despite the increased healthcare needs of affected families, IPV is often overlooked in general practice, missing an opportunity to support vulnerable families.

Methods:

The researchers used a population-based birth cohort of mothers and children, linked to electronic health records (EHRs), to evaluate IPV and family adversities during the first 1000 days of a child’s life. They examined associations between different adversities and IPV and assessed the prevalence of parental physical and mental health problems among families with and without IPV.

Results:

Two in five children and parents had recorded family adversities, while 2.1% had recorded IPV during the study period.

The probability of IPV increased with the number of different family adversities, with the highest probability observed in families experiencing three or more adversities. Families with IPV had increased risks of parental physical and mental health problems compared to families without IPV.

Discussion:

The study highlights the co-occurrence of IPV with other adverse childhood experiences and emphasizes the importance of early identification and support for vulnerable families. Healthcare professionals should be trained to ask about IPV and family adversities during clinical encounters and respond appropriately to ensure the safety and well-being of affected families. Integrated think-family functions in electronic health record systems and adequate resources for health and social care professionals are essential for effective intervention and support.

Limitations:

The low prevalence of recorded IPV may underestimate the actual extent of the problem. Some parents may not disclose IPV, leading to underreporting in the electronic health records. Associations between adversities, health problems, and IPV might reflect surveillance bias rather than differences in the underlying risk of IPV. The study excluded same-sex couples, limiting the generalizability of findings to these families.

Relevant Implications:

Overall, the study provides valuable insights into the prevalence and associations of IPV and family adversities, offering important implications for early identification and support of affected families through healthcare settings. It emphasizes the need for a comprehensive and integrated approach to address the complex issue of intimate partner violence.

• Healthcare professionals in primary and secondary care settings should be vigilant in asking about IPV when families present with indicators of family adversity or associated health problems.
• A “think-family” approach is essential, involving a comprehensive review of both parents’ and children’s electronic health records to inform clinical responses to IPV effectively.
• Healthcare providers should implement integrated think-family functions in electronic health record systems, allowing clinicians to search for adversity across household records securely.
• National policies should prioritise family-centered interventions to support families experiencing adversity, offering emotional support, risk assessment, safety planning, and appropriate referrals to specialists and long-term support.
• Adequate training and resources for health and social care professionals are necessary to respond effectively to family adversities and IPV disclosures.

Dr Shabeer Syed, Clinical Psychologist & Senior Research Associate

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