Because children often witness spousal abuse, pediatricians have two reasons to routinely screen their patients’ mothers or other caregivers for signs of such physical and emotional domestic violence, a study from the Johns Hopkins Children’s Center suggests.

Brief screening is not only a step to protecting a spouse or a partner, it also can reduce the very real collateral health risks experienced by children who see or hear such abuse, the investigators say. Children who live in homes where spousal abuse occurs are at high risk of being abused themselves, according to the American Academy of Pediatrics.

“Abuse of one parent by their partner is not a private adult matter, but is very much a public health problem that affects children’s health and wellbeing,” says Megan Bair-Merritt, M.D. M.S.C.E., a Hopkins pediatrician who led the study. “And prior studies show that spousal abuse can eventually escalate into child abuse.”

In a report on the study published online in the Journal of Pediatrics, the researchers say nearly one-fourth of 133 women screened during their visit to the primary pediatric clinic at Hopkins Children’s reported being abused by their partners.

Among the 30 women who reported abuse by their spouses or partners, more than half (17) said at least one child in the home saw or heard the abuse, researchers found.

“Although our study did not directly examine the effects of seeing or hearing domestic abuse on children, many previous studies have shown that those who do are at high risk for depression, anxiety, aggression, poor school performance and risky behaviors,” Bair-Merritt says.

Children exposed to domestic violence are also more likely to skip scheduled immunizations or get immunized later, according to another study led by Bair-Merritt.

Of the 30 women reporting violence, 28 said they were abused physically, while two said they were intimidated by their partner (psychological abuse). Physical abuse ranged from shoving and pushing to having a gun or a knife used against them.

“Our findings speak loud and clear,” Bair-Merritt says. “Domestic violence happens often and children witness it, so it should be on every pediatrician’s radar.”

Screening for domestic violence can be done quickly in every pediatrician’s office, often in a matter of minutes, by asking a woman to answer three to five questions either verbally or in writing, investigators say. Past research suggests many women prefer the privacy of a written questionnaire to face-to-face interviews, but literacy can be a problem in certain settings, researchers warn. All 133 women in the study were asked to fill out two sets of questionnaires: one with questions focusing on emotional abuse (only 5 percent of women reported abuse on this survey), the other one with questions focusing on physical abuse (21 percent of women reported abuse on this survey). The first screening tool included questions like “I feel programmed to react a certain way to my partner” or “I feel ashamed of the things my partner does to me.” The other questionnaire posed such questions as, “Over the last 12 months, how many times did you partner grab, push or shove you?” or “Over the last 12 months, how many times did your partner threaten you with a knife or gun?”

The findings highlight the importance of combining questions that capture both physical and emotional abuse, researchers say, adding that pediatricians should be especially alert to depression and signs of emotional abuse in parents, because they are frequently harbingers of physical violence.

The researchers say, ideally, all parents should be screened but there are signs that require special attention, including frequently missed appointments, signs of depression in the child and/or parent or caregiver and recurring symptoms in children for which no physical cause is found, such as unexplained headaches or stomach aches.

Senior investigator on the study: Tina Cheng, M.D. M.P.H., director of pediatrics and adolescent medicine at Hopkins Children’s.

Other Hopkins investigators in the study: Jacky Jennings, Ph.D. M.P.H., also of the Johns Hopkins Bloomberg School of Public Health; Kristen Eaker, P.N.P., Judith Levsky Truman, P.N.P., and Sun Min Park, P.N.P.

Source: Johns Hopkins Medicine