Child behavior problems improved after intimate partner violence stopped

Intimate partner violence resolution was associated with meaningful and lasting reductions in clinically significant behavioral problems in children, according to recent study results published in JAMA Pediatrics.

“Researchers across disciplines must collaborate to evaluate the effectiveness and efficacy of interventions for families living within the intersecting worlds of child maltreatment and [intimate partner violence],” the researchers wrote.

Kristine A. Campbell, MD, of the Intermountain Injury Control and Research Center in Utah, and colleagues examined data from the National Survey of Child and Adolescent Well-Being to determine the behavioral impact of resolved vs. persistent intimate partner violence (IPV) on a subset of 320 school-aged children investigated by child protective services for suspected child maltreatment. Caregivers were interviewed on average 3, 20, 36 and 81 months after the investigations. Cases in which caregivers reported no IPV at any point after the interviews were considered resolved.

According to the researchers, 44.6% of caregivers reported persistent IPV. IPV was associated with a significant reduction in internalizing problems by the last follow-up interview (–11.9%; P=.03) after controlling for covariates such as child age and ethnicity and caregiver partner status and substance use. Children living with caregivers who reported persistent IPV had persistence in internalizing behavioral problems (2.8%; P=.60).

IPV resolution was associated with an 18.5% reduction in externalizing problems — a reduction that lasted for more than 6 years (P<.05). Persistent IPV was associated with an increase in externalizing behavioral problems, but the increase was not significant (10.1%; P=.07).

The adjusted risk ratios for internalizing and externalizing behavioral problems in children living with persistent IPV vs. resolved IPV more than 6 years after an investigation by child protective services was 1.79 (95% CI, 0.91-3.52) and 1.88 (95% CI, 1.12-3.18), respectively.

In an accompanying editorial, Andrea G. Asnes, MD, MSW, and John M. Leventhal, MD, both of Yale School of Medicine, said the findings should raise awareness of the effect of IPV on children.

“These results underscore the need for all health care providers who have contact with children to recognize the harm that can occur to children who experience IPV, identify those children who experience it, and respond swiftly and effectively,” they wrote.

To do this, Asnes and Leventhal suggested three strategies that should be implemented in the primary care setting:

Clinicians should receive special training about childhood exposure to IPV and other adverse experiences.
Increase awareness among clinicians about the involvement of child protective services with families reporting IPV.
Clinicians should routinely ask families about stress and worry in the same way they would medical problems.

For more information:

Asnes AG. JAMA Pediatr. 2013;167:299-300.

Campbell KA. JAMA Pediatr. 2013;167:236-242.

Disclosure: Campbell’s work is supported by an award from the National Institute of Child Health and Human Development.