Health Care Use of Children Whose Female Caregivers Have Intimate Partner Violence Histories

Abstract

To determine whether prior exposure to intimate partner violence (IPV) is associated with children's subsequent emergency department (ED) visits and hospitalizations. Design: Retrospective cohort study. Setting: The National Survey of Child and Adolescent Well-Being, a nationally representative sample of children reported to Child Protective Services between 1999 and 2000. Participants: Families of children reported to Child Protective Services who were assessed through comprehensive caregiver interviews at baseline and 18 and 36 months. Main Exposure: Severe or minor IPV, as measured by the Conflict Tactics Scale 1. Main Outcome Measures: Number of ED visits or hospitalizations from baseline to the 18-month assessment (interval 1, n=2689) and from the 18-month to the 36month assessment (interval 2, n=2546). Results: Compared with children whose female caregivers reported no IPV at baseline, children whose female caregivers disclosed severe IPV at baseline had significantly higher rates of ED visits over both subsequent intervals (interval 1, incidence rate ratio [IRR], 2.0; 95% confidence interval [CI], 1.3-2.9; interval 2, IRR, 1.9; 95% CI, 1.2-3.0). In contrast, rates of hospitalizations were lower in the second interval for children whose female caregivers disclosed minor IPV as compared with no IPV at baseline (IRR, 0.2; 95% CI, 0.1-0.6). Conclusions: Further research is required to elucidate the complex relationship between IPV and child health care use. Such an understanding will facilitate identification of sites within the health care system where effective interventions for children exposed to IPV, and their caregivers, might be located.

Violência física entre parceiros íntimos: um obstáculo ao início do acompanhamento da criança em unidades básicas de saúde do Rio de Janeiro, Brasil?

“…A primeira é que as associações encontradas podem estar subestimadas, uma vez que o cenário estudado deixou de contemplar as mães que não frequentam qualquer serviço de atenção à saúde da criança, as que frequentam de forma preferencial serviços de emergência pediátrica e aquelas referidas às unidades de maior complexidade. Como evidências anteriores apontam maiores probabilidades de ocorrência de violência física entre parceiros ín-timos entre essas mulheres 13,31 , se elas tivessem sido incluídas no trabalho poderiam ter contribuído para aumentar a força de associação entre a exposição e o desfecho. Novos estudos de base populacional e menos restritivos talvez permitam lançar mais luz a essa questão.…”

Relating intimate partner violence to heath‐care utilisation and injuries among Pacific children in Auckland: The Pacific Islands Families Study

“…Previous studies have often failed to adequately consider confounding 6 . Similar to Bair‐Merritt and colleagues, 7 we adjust for child's sex, age, and mother's age, education, ethnicity, depression, drug usage, alcohol dependence, and household income. Additionally, physical punishment of the child, years lived in New Zealand, smoking status, employment status and household numbers are all potential associates of injury and were included.…”

“…Children in households where parents engage in IPV are at higher risk for a wide range of emotional and behavioural problems, including anxiety, depression, poor school performance, low self‐esteem, conduct disorder and nightmares 1,6–10 . Intentional or unintentional maltreatment, poor parenting, negative household environments and the poor mental health of parents have all been opined as likely explanations for these problems 6,11,12 .…”

“…Research on the impact of exposure to IPV on children's health service use is complex, sensitive and has yet to be fully characterised 6 . Moreover, there is surprisingly little evidence relating children's risk of injury in households where IPV occurs 6,7 …”

“…In a nationally representative retrospective cohort study of US children reported to child protective services, children of mothers reporting severe physical IPV had significantly higher rates of emergency department (ED) visits compared with those children not exposed to maternal IPV, whereas children of mothers reporting minor physical IPV had ED visit rates similar to the non‐exposed group 7 . In contrast, mothers reporting severe physical IPV had hospitalisation rates that were no different to those children not exposed to maternal IPV, whereas children of mothers reporting minor physical IPV had lower rates of hospitalisations than children not exposed to maternal IPV 7 . A cross‐sectional study of these same children also demonstrated that exposure of the mother to current severe IPV was associated with more frequent ED presentations of children, but current moderate, past severe and past moderate IPV were not associated with ED presentations 11 .…”