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PACEs Research Corner — September 2023, Part 1

 

[Editor's note: Dr. Harise Stein at Stanford University edits a web site — abuseresearch.info — that focuses on the effects of abuse, and includes research articles on PACEs. Every month, she posts the summaries of the abstracts and links to research articles that address only ACEs, PCEs and PACEs. Thank you, Harise!! — Rafael Maravilla]

Child Abuse

Egge MK.
Medical Child Abuse: A Review by Subspecialty. Adv Pediatr. 2023;70(1):59-80. PMID: 37422298
“Medical child abuse (MCA), formerly called Munchausen syndrome by proxy, occurs when a caregiver, usually the mother, falsifies or exaggerates symptoms resulting in harm to a child through inappropriate medical care. MCA is underrecognized, underreported, and results in significant morbidity and mortality. Pediatrics subspecialists should consider MCA when unusual disease presentations do not respond to traditional treatments. This article reviews the more common diagnoses encountered in MCA cases by specialty.”

Canty KW, DeRidder CA.
Burns in Children: Accidental or Inflicted? Adv Pediatr. 2023 Aug;70(1):45-57. PMID: 37422297
“Abusive burns are associated with increased morbidity and mortality compared with accidental burns. A comprehensive history is essential to distinguish between accidental and abusive burns and should always include questions regarding the child’s developmental capabilities. Determination of the mechanism of injury requires a multidisciplinary investigation such as a scene investigation by a social worker and/or law enforcement. When abusive burns are suspected, consideration of concurrent injury is important, and depending on the child’s age, it may require evaluation for occult fractures, intracranial injury, and intraabdominal injury.”

Gasteratos K, McCarthy M, Chatziathanasiou D, et al.
A Systematic Review of Pediatric Nonaccidental Burns: Protecting the Children Through Knowledge, Vigilance, and Prevention. Ann Plast Surg. 2023 Jun 1;90(6):551-558. PMID: 37157138
In this research review, the most common mechanism for pediatric nonaccidental burns was scalds via forced immersion. Complications included wound infection and sepsis, requiring systemic antibiotics or intensive care.

Evans S, Farnell DJJ, Carson-Stevens A, Kemp A.
Survey of practices for documenting evidence of bruises from physical abuse during child protection proceedings. BMJ paediatrics open. 2023;7(1). PMID: 37491132
From a survey of British child protection committees with an 84% response rate, “paediatricians always or usually record bruise size (87%), site (96%), shape (68%) and colour (77%); 22% stated that they 'always' used a ranking system for likelihood of abuse; 35% 'sometimes' estimated the size of the bruise. Results showed that paediatric bruise reporting is inconsistent and incomplete for some fields compared with national guidance.”

Crumm CE, Brown ECB, Vora SB, et al.
The Impact of an Emergency Department Bruising Pathway on Disparities in Child Abuse Evaluation. Pediatr Emerg Care. 2023 Aug 1;39(8):580-585. PMID: 37391189
Using data pre and post establishing an ED child bruising protocol, children without private insurance were at higher risk of a CPS and law enforcement report before the protocol was in place. “A standardized clinical pathway for identification and evaluation of high-risk bruising may help to decrease socioeconomic disparities in reporting high-risk bruising.”

Attridge MM, Heffernan ME, Bendelow A, et al.
Adverse childhood experiences, child behavioral health needs, and family characteristics associated with the presence of a firearm in the home. Injury epidemiology. 2023;10(Suppl 1):35. PMID: 37488578
From a survey of Chicago parents, 22.0% reported having a firearm in the home.  Children with 2+ ACEs, compared to 0 ACEs, were 5.16 times more likely to live in a home with a firearm, and children who had used behavioral health services were 2.10 times more likely. “These findings are particularly important in the context of injury prevention…and could inform future public health interventions and targeted safe storage messaging.”

Andresen S.
Testimonies about child sexual abuse in the family. Challenges of addressing the private sphere. Child Abuse Negl. 2023;144:106352. PMID: 37478733
From a German independent inquiry on child sexual abuse within families, and analyzing 870 survivors’ testimonies, 47% named fathers and stepfathers as perpetrators, 9% named the mother or stepmother, and 11 % biological siblings. In addition, there were mentions of extended family members, and multiple family members either acting as co-perpetrators or accomplices. Characteristics of the abuse included “1. The planned and violent approach of the perpetrators, either through explicit threats and physical attacks or through manipulative strategies; 2. The abuse of dependency relationships through affection and tenderness or their targeted withdrawal; 3. The involvement and entanglement of family members and the family environment through relationships with the perpetrator; 4. The lack of contact persons for affected children, adolescents, and adults, as well as frequent lack of help when they confided in someone.”

Attrash-Najjar A, Tener D, Katz C.
"One Day It Will Be Over, and You Will See Other Landscapes. . . You Are Not Alone": Adult Survivors' Messages to Children Undergoing Child Sexual Abuse. J Interpers Violence. 2023:8862605231178496. PMID: 37431742
“371 written testimonies were provided to the Israeli Independent Public Inquiry on CSA…Although survivors were from diverse backgrounds, their messages to abused children were consistent…The results revealed five main messages emphasized by survivors to children experiencing CSA: (a) transferring the responsibility and guilt from children to perpetrators and society; (b) turning toward the light and continuing on; (c) disclosure is essential; (d) a happy life is possible; and (e) together we can survive…the survivors' desire to be there for the children emphasized the urgent need to promote the perception of survivors as key stakeholders in the field of child abuse and to integrate their experiences and perceptions into the formal and informal systems for children.”

Weisbrot DM, Carlson GA, Ettinger AB, et al.
Psychiatric Characteristics of Students Who Make Threats Toward Others at School. J Am Acad Child Adolesc Psychiatry. 2023;62(7):764-76. PMID: 36608740
Of 157 consecutive school-referred youths in grades K-12 between 1998 and 2019, “Mean age of referred students was 13.37 years; 88.5% were male, 79.7% White, 11.6% Hispanic, 10.1% Black, and 2.5% Asian. Of students, 51.6% were receiving special education services. Verbal threat was made by 80%, and 29.3% brought a weapon to school. History included being bullied in 43.4%, traumatic family events in 52.2%, physical abuse in 5.1%, sexual abuse in 5.7%, and verbal abuse in 36.3%. Frequently encountered psychiatric diagnoses were attention-deficit/hyperactivity, learning, depressive, anxiety, and autism spectrum disorders, usually in combinations. History of medication treatment was reported in 50.3% and psychotherapeutic interventions in 36.3%. Recommendations to return the student to their prior schools were made for 63.1%. Recommendations for psychotherapy were made for 79.9%, medication for 88.5%, and both for 70.1%. Therapeutic school setting or psychiatric hospitalization was more likely recommended (with statistical significance) with a prior threat history (odds ratio [OR] 5.47), paranoid symptoms (OR 5.72), autism spectrum disorders (OR 3.45), mood disorder (OR 5.71), personality disorder (OR 9.47), or with psychotherapy recommendation (OR 4.84).”

McGuier EA, Campbell KA, Byrne KA, Shepard LD, Keeshin BR.
Traumatic stress symptoms and PTSD risk in children served by Children's Advocacy Centers. Frontiers in psychiatry. 2023;14:1202085. PMID: 37457766
Of 2,350 children screened for PTSD symptoms at children’s advocacy centers (CACs) in a single state, 45.5% exhibited symptoms suggestive of PTSD. Brief interventions were delivered to 66% of children, and most were referred to evidence-based trauma treatment (53.1%) or community mental health services (39.0%).  “Many children served by CACs are likely to meet criteria for PTSD at their initial visit…Use of structured screening/referral protocols may improve early identification and treatment access for children experiencing PTSD symptoms.”

Poljak Lukek S, Pate T, Gostečnik C.
Physical Violence and Scapegoating Within the Family: An Exploration of Biblical Texts and Contemporary Psychology. Journal of religion and health. 2023;62(4):2638-55. PMID: 37170016
Authors discuss the biblical background of the concept of scapegoating, “and highlight two basic dynamics of violence against children in the family: when the child is the ‘scapegoat’ for unresolved tensions in the family and when the child becomes the ‘sacrifice’ or victim of the dysregulated emotional response of his or her parents.”

Ivanov I, Weber E, Javorsky E.
Fentanyl in an Infant: Taking Our Breath Away. Cureus. 2023;15(5):e39216. PMID: 37378194
“Pediatric respiratory failure carries a wide differential diagnosis. Toxic ingestion should remain on the differential even at very young ages. There have been increasing reports of fentanyl overdoses among adults; this should be considered for accidental pediatric ingestion, especially considering its high potential for mortality.”  Authors detail a case report of a 9-month-old who responded to numerous doses of IV naloxone, with labs later positive for fentanyl and cocaine.  Ingestions can be seen in child abuse, but also neglect.

De Champlain A, Tremblay-Perreault A, Hébert M.
Gender Differences in Behavioral Problems in Child Victims of Sexual Abuse: Contribution of Self-Blame. J Child Sex Abus. 2023;32(5):536-53. PMID: 36861736
“Self-blame following the abuse has been identified as a predictor of negative outcomes in adult survivors.”  In this study of 1066 sexually abused children aged 6-12 years and their non-offending parent, “parents' self-blame was associated with a higher level of self-blame in the child which, in turn, was linked to more child internalizing and externalizing behavior problems…These findings underscore the importance of considering self-blame in interventions.”

Macorano E, Gentile M, Stellacci G, et al.
'Compressed Baby Head': A New 'Abusive Head Trauma' Entity? Children (Basel, Switzerland). 2023;10(6). PMID: 37371236
Authors detail an infant case report of unusual head trauma injuries caused by child abuse, and propose a new entity “compressed baby head” that should be included in the context of Abusive Head Trauma.

Adult Manifestations of Child Abuse

Swedo EA, Aslam MV, Dahlberg LL, et al.
Prevalence of Adverse Childhood Experiences Among U.S. Adults - Behavioral Risk Factor Surveillance System, 2011-2020.
MMWR Morb Mortal Wkly Rep. 2023;72(26):707-15. PMID: 37384554
From a CDC report of all 50 states and the District of Columbia, “Overall, 63.9% of U.S. adults reported at least one ACE, and 17.3% reported four or more ACEs. Experiencing four or more ACEs was most common among females (19.2%), adults aged 25-34 years (25.2%), non-Hispanic American Indian or Alaska Native adults (32.4%), non-Hispanic multiracial adults (31.5%), adults with less than a high school education (20.5%), and those who were unemployed (25.8%) or unable to work (28.8%). Prevalence of experiencing four or more ACEs varied substantially across jurisdictions, from 11.9% (New Jersey) to 22.7% (Oregon).”

Bhutta ZA, Bhavnani S, Betancourt TS, Tomlinson M, Patel V.
Adverse childhood experiences and lifelong health. Nat Med. 2023;29(7):1639-48. PMID: 37464047
“In this Review, we discuss the key mechanisms linking ACEs to health outcomes and consider promising strategies to prevent and mitigate their effects, highlighting evidence from programs in low-income and middle-income countries. Finally, we emphasize the need for early recognition of ACEs and delivery of packages of interventions spanning key sectors such as health, education, women's empowerment, and social protection.”

Ditzer J, Wong EY, Modi RN, Behnke M, Gross JJ, Talmon A.
Child maltreatment and alexithymia: A meta-analysis. Psychol Bull. 2023 May-Jun;149(5-6):311-329. PMID: 37261746
From a research review that combined 36,141 participants, alexithymia, difficulty identifying and describing one's emotions, was associated with childhood maltreatment, especially emotional abuse and emotional/physical neglect.

Kisely S, Siskind D, Scott JG, Najman JM.
Self-reported child maltreatment and cardiometabolic risk in 30-year-old adults. Intern Med J. 2023 Jul;53(7):1121-1130. PMID: 35607779
Of 1689 adults born in a major metropolitan maternity hospital in Australia and followed up 30 years later, “One-fifth reported maltreatment (n = 362), most commonly emotional neglect (n = 175), followed by emotional abuse (n = 128), physical neglect (n = 123), sexual (n = 121) and physical abuse (n = 116)…On adjusted analyses, there were significant associations for child maltreatment, particularly neglect or emotional abuse, and one or more of the following outcomes: obesity, the total cholesterol/high-density lipoprotein cholesterol ratio, and HDL levels.”

Adkins-Jackson PB, George KM, Besser LM, et al.
The structural and social determinants of Alzheimer's disease related dementias. Alzheimers Dement. 2023 Jul;19(7):3171-3185. PMID: 37074203
“Health and its associated outcomes are never individually centered but are products of exposure to certain risk factors in varying magnitude, from cells to cities, from neurons to nations…This narrative review provides a broad illustration for the potential relationships between the structural and social determinants of health and Alzheimers Disease and related dementias.”

Foti TR, Watson C, Adams SR, et al.
Associations between Adverse Childhood Experiences (ACEs) and Prenatal Mental Health and Substance Use. Int J Environ Res Public Health. 2023;20(13). PMID: 37444136

In this Kaiser Northern California study of 1084 pregnant women average age 30.8 years, “Patients with 1-2 ACEs or ≥3 ACEs (versus 0 ACEs) had higher odds of anxiety and depressive disorders, depressive symptoms, IPV, and any prenatal substance use…particularly in the context of low resilience, highlighting the importance of trauma-informed prenatal care and the need to study resilience-building interventions during pregnancy.”

Bourdon M, Antoine V, Combes U, et al.
Severe pelvic pain is associated with sexual abuse experienced during childhood and/or adolescence irrespective of the presence of endometriosis. Hum Reprod. 2023 Aug 1;38(8):1499-1508. PMID: 37308317
Of 271 women seen at a Paris pelvic pain center and who underwent surgical exploration, while there was no association between child/adolescent sexual abuse and endometriosis, there was an association with at least one severe pelvic pain symptom.

Goeckenjan M, Veta-Darkowski J, Gabrys M, et al.
Life-time experience of violence as a risk factor for symptomatic endometriosis. J Psychosom Obstet Gynaecol. 2023;44(1):2240007. PMID: 37493247
Of 118 women seen at an Endometriosis center, 34.8% reported some type of lifetime experiences of violence, which had a significant impact on the course and severity of endometriosis. Women who reported violence had a significantly higher risk for severe menstrual cramps, use of pain medication, and other medical and mental health conditions in comparison to women without life-time experiences of violence. They also had significant differences in employment status and impaired working ability. “However, only 17.1% of women recalled being asked about violence by a medical professional… highlight the importance of healthcare providers to be aware of the potential impact of violence on women's health, and routine screening for violence in medical care.”

Mposhi A, Turner JD.
How can early life adversity still exert an effect decades later? A question of timing, tissues and mechanisms. Front Immunol. 2023;14:1215544. PMID: 37457711
“Exposure to any number of stressors during the first 1000 days from conception to age 2 years is important in shaping an individual's life trajectory of health and disease…early-life exposure to a stressor reduces the capacity of the immune system to generate subsequent generations of cells…leads us to the ‘stem cell hypothesis’ whereby exposure to adversity during a sensitive period, acts through a common mechanism in all the cell types by programming the tissue resident progenitor cells… This may consequently alter the destiny of these cells, producing the lifelong ‘supply’ of functionally altered fully differentiated cells.”

Jin Y, Song D, Yan Y, Quan Z, Qing H.
The Role of Oxytocin in Early-Life-Stress-Related Neuropsychiatric Disorders. Int J Mol Sci. 2023;24(13). PMID: 37445607
“Oxytocin is a critical social regulator and anti-inflammatory hormone that modulates stress-related functions and social behaviors and alleviates diseases…we describe the history of oxytocin and its role in neural circuits and related behaviors. We then review abnormalities in the oxytocin system in early-life stress and the functions of oxytocin in treating stress-related neuropsychiatric disorders.”

Wittekind DA, Kratzsch J, Mergl R, et al.
Childhood sexual abuse is associated with higher total ghrelin serum levels in adulthood: results from a large, population-based study. Translational psychiatry. 2023;13(1):219. PMID: 37349303
Ghrelin is a hormone that leads to a feeling of being hungry.  It is synthesized in times of stress and food absence, mainly in the stomach, but also brain, small intestine and pancreas. In this large national survey of 1086 adults mean age 57.1 years, women but not men with a history of childhood sexual abuse or also with severe emotional neglect had higher ghrelin levels than those without such history.

Desch J, Bakour C, Mansuri F, Tran D, Schwartz S. The association between adverse childhood experiences and insomnia symptoms from adolescence to adulthood: Evidence from the Add Health study. Sleep Health. 2023 Jul 6:S2352-7218(23)00116-X. PMID: 37419708
Using data from a large national long-term study, “Of 12,039 participants, 75.3% experienced at least one adverse childhood experience (ACE) and 14.7% experienced 4 or more. We found specific ACEs, including physical abuse, emotional abuse, neglect, parental incarceration, parental alcoholism, foster home placement, and community violence were associated with experiencing insomnia symptoms throughout the entire 22-year follow-up period from adolescence to mid-adulthood, while childhood poverty was only associated with insomnia symptoms in mid-adulthood. The number of ACEs showed a dose-response association with insomnia symptoms in adolescence.”

Matsukura H, Yamaoka Y, Matsuyama Y, Kondo K, Fujiwara T.
Association between adverse childhood experiences and marital status among Japanese older adults. Child Abuse Negl. 2023;144:106340. PMID: 37467673
From a national Japanese survey of functionally independent people aged 65 and above, “Three or more ACEs showed higher risks of being widowed, divorced, or unmarried.” Psychological neglect led to higher divorce risks, and childhood poverty showed higher risks of being unmarried.

Hall K, Stafford J, Cho B.
Women Receive More Positive Reactions to Childhood Sexual Abuse Disclosure and Negative Reactions are Associated With Mental Health Symptoms in Adulthood for Men and Women. J Interpers Violence. 2023;38(15-16):8803-23. PMID: 36915216
From on online survey of 299 US adults, “Women reported disclosing to a significantly greater number of people than men, and were more likely to disclose to parents, while men were more likely to tell friends. Results revealed that women reported receiving significantly more positive responses and emotionally supportive responses to their CSA disclosures than men. Negative reactions to disclosure were positively associated with internalizing symptoms and externalizing symptoms, while both negative reactions to disclosure and perceived parental dysfunction were positively associated with substance use symptoms. Results signify a need for resources to aid individuals in supporting survivors of CSA, as reactions have the potential to impact recovery trajectory.”

Adolescents

Rau T, Mayer S, Allroggen M.
[Traumatic Experiences and Posttraumatic Stress Disorder of Adolescents in Boarding Schools]. Praxis der Kinderpsychologie und Kinderpsychiatrie. 2023;72(5):446-65. PMID: 37455576
In this article in German, authors analyze data from 155 adolescents, 70% male, who had been in boarding school for an average of 3.26 years.  69.7% reported a traumatic experience while in school, and 33.5% met criteria for PTSD.  Authors recommend screening procedures to identify traumatic experiences, and a need for further research on traumatic experiences directly related to boarding school.

Wang J, Harrer S, Zwald ML, et al.
Association of Recent Violence Encounters With Suicidal Ideation Among Adolescents With Depression. JAMA Netw Open. 2023 Mar 1;6(3):e231190. PMID: 36862413
From a large national database, among adolescents with depression, persons who experienced past-year violence encounters showed a higher rate of suicidal ideation than those who had not (27.5% vs. 13.5%). “These findings highlight the importance of identifying and accounting for past violence encounters when treating adolescents with depression to reduce risk of suicide.”

Allwood MA, Robinson JN, Kim H.
Youth Exposure to Gun, Knife, and Physical Assaults: Assessing PTSD Symptoms Across Types of Assaults, Race, Ethnicity, Sex, and Context. J Interpers Violence. 2023:8862605231185300. PMID: 37409648
“Of 910 racially and ethnically diverse adolescents and young adults from an urban commuter college in the Northeast US…Men reported significantly more physical assaults, gun victimizations, and knife victimizations than women. Black participants reported significantly more gun victimization than all other groups, and Black, White, and Asian participants reported significantly more physical assault than Latinx participants. Individuals victimized by physical assault or by gun victimization were more than twice as likely to report clinically significant PTSD symptoms…community gun victimization, which disproportionately impacts Black men, was the only context in which PTSD symptoms were highest for men compared to women…clinical practice must include…the various ways that distress might manifest among men. In addition to symptoms of PTSD, other symptoms of distress, including substance use, anger, and retaliatory aggression, should be considered.”

De Sousa D, Paradis A, Fernet M, Couture S, Fortin A.
"I felt imprisoned": A qualitative exploration of controlling behaviors in adolescent and emerging adult dating relationships. J Adolesc. 2023;95(5):907-21. PMID: 37005707
First dating relationships can elicit intense emotions that youth may attempt to alleviate by using control tactics that negatively impact the quality of their relationship and their partner's well-being.” Interviews with 39 Canadian adolescents “revealed three categories of control tactics, including isolation, domination, and emotional manipulation…Educational programs can help …youth in identifying unhealthy relationship dynamics and providing them with tools to either safely end the relationship or communicate their concerns with their partner.”

Diedrick M, Clements-Nolle K, Anderson M, Yang W.
Adverse childhood experiences and clustering of high-risk behaviors among high school students. Public Health. 2023;221:39-45. PMID: 37393751
A random sample of Nevada high school students were evaluated for high-risk behavioral domains including (1) violence behaviors, (2) suicidal indicators, (3) non-suicidal self-injury, (4) substance use, (5) high-risk sexual behaviors, (6) poor diet, (7) physical inactivity, and (8) high screen time. “More than 40% of the sampled students reported high-risk behaviors across two or more domains. There was a strong, graded relationship between cumulative ACE score and the count of high-risk behavior domains.”

Larson N, Mason SM, Bruening M, et al.
Adverse childhood experiences and food insecurity in emerging adulthood. Public health nutrition. 2023:1-29. PMID: 37431646
From a survey of 1518 secondary school students in Minneapolis/St. Paul, “The adjusted prevalence of food insecurity was 45·3 % among emerging adults who reported three or more ACE compared with 23·6 % among those with one or two ACE and 15·5 % among those with no ACE…childhood experiences of emotional abuse and substance use by a household member were associated with the largest prevalence differences in food insecurity.”

Li Q, Song S, Xiang G, Fu Z, Zhou Z, Chen H.
The inferior frontal gyrus spontaneous activity mediates the association of early life adversity with self-control ability in late adolescents. Psychophysiology. 2023;60(8):e14291. PMID: 36951595
In a brain scan study of self-control in 538 Chinese adolescents, “Family unpredictability rather than family harshness of early life adversity was negatively correlated with self-control ability.”

Wittenberg MF, Fitzgerald S, Pluhar E.
Depressive symptomatology in pregnant adolescents. Curr Opin Pediatr. 2023;35(4):415-22. PMID: 36988280
“The prevalence of depressive symptoms is higher among pregnant adolescents relative to nonpregnant adolescents and pregnant adults. Clinicians should screen all pregnant adolescents for depressive symptoms at least once during pregnancy if not more frequently, with additional attention to pregnant adolescents who meet one or more risk factors for prenatal depressive symptoms.” Risk factors include “adolescents who report lower levels of income, have a previous history of depression, childhood maltreatment, recent abuse, and/or chronic exposure to racial/ethnic discrimination.”

van der Venne P, Mürner-Lavanchy I, Höper S, et al.
Physiological response to pain in female adolescents with nonsuicidal self-injury as a function of severity. J Affect Disord. 2023 Oct 15;339:64-73.  PMID: 37390927
Comparing 164 adolescents with non-suicidal self-injury (NSSI) histories to a control group, the NSSI group did not have decreased sensitivity to pain.  However, after controlling for depression, the most severe NSSI subgroup did show decreased heart rate and increased heart rate variability ( = decreased physiological arousal and improved emotion/calmness) in response to pain.

DV Effects on Children

Brühl A, Ward CL, Lachman JM, et al.
Co-Occurrence of Intimate Partner Violence Against Mothers and Maltreatment of Their Children With Behavioral Problems in Eastern Europe. Violence Against Women. 2023:10778012231188090. PMID: 37475529
For 813 Eastern European mothers with children with behavioral problems, “IPV was reported by 64% of mothers, CM [child maltreatment] by 96%, and their co-occurrence by 63%. Mothers exposed to emotional IPV reported more physical and emotional CM.”

Gregory K, Fingarson A, Pierce MC, et al.
Examining Cases of Child Physical Abuse Evaluations to Identify Opportunities to Improve Intimate Partner Violence Screening in Pediatric Emergency Departments. J Interpers Violence. 2023 Jul 8:8862605231182379. PMID: 37421199
From a retrospective chart review at an urban pediatric ED, of 329 children who were evaluated for possible child physical abuse, caregiver responses to IPV screening revealed that social work screening produced significantly more positive IPV disclosures than initial nurse triage screening (14.0% vs. 4.3%). “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.”

Syed S, Gilbert R, Feder G, et al.
Family adversity and health characteristics associated with intimate partner violence in children and parents presenting to health care. The Lancet Public health. 2023;8(7):e520-e34. PMID: 37393091
Using large British linked databases for 129,948 children and parents, and looking at 33 possible family adversities, “All family adversities were significantly associated with IPV…The probability of IPV was 0·6 per 100 children and parents with no adversity, increasing to 4·4 with one adversity, and up to 15·1 with three or more adversities. Mothers with IPV had a significantly higher prevalence of both physical (73·4% vs 63·1%, odds ratio [OR] 1· 6) and mental health problems (58·4% vs 22·2%, OR 4·9) than mothers without IPV. Fathers with IPV had a higher prevalence of mental health problems (17·8% vs 7·1%, OR 2·8) than those without IPV.

Carneiro JF, Silva EP, da Silva GAP, Ludermir AB.
Could children exposed to intimate partner violence against their mother have more functional gastrointestinal disorders? J Pediatr (Rio J). 2023 Jun 23:S0021-7557(23)00078-5. PMID: 37356811
Of 626 mother-child pairs living in a poor urban area of Brazil, functional gastrointestinal disorders (GI symptoms without a findable cause) “were more frequent among children exposed to violence than those not exposed (OR: 1.64). Likewise, these GI symptoms were found in children who suffered four or more types of exposure (OR: 1.81), in which the exposure started in the first two years of life (OR: 1.93) and in those whose biological father was the perpetrator of the violence (OR; 1.62).

DV Mental Health

Krause-Utz A, Černáková R, Hoogenboom W, et al.
Psychological Factors Linked to Intimate Partner Violence and Childhood Maltreatment: On Dissociation as a Possible Bridge Symptom. J Interpers Violence. 2023:8862605231181377. PMID: 37431756
From a survey of 434 adults, 40% of whom were in treatment for mental health issues, “IPV was associated with dissociation [a mental process where a person disconnects from their thoughts, feelings, memories or sense of identity], which indirectly linked it to childhood maltreatment experiences, PTSD symptoms, withdrawal, and self-blame…IPV perpetration and victimization often co-occur. Dissociation may be an important bridge symptom, linking IPV to childhood maltreatment experiences, PTSD symptoms, and maladaptive coping.”

Storey JE, Pina A, Williams CS.
The Impact of Stalking and Its Predictors: Characterizing the Needs of Stalking Victims. J Interpers Violence. 2023:8862605231185303. PMID: 37482768
From an analysis of 258 stalking cases, “most prevalent impact category was psychological and substance abuse which was present for 91.5% of victims and included anxiety, depression, difficulty managing emotions, panic attacks, anger, PTSD, and suicidal ideation. The heightened need for mental health care among victims who have experienced stalking supports the importance of trauma informed practice…it is not the severity of stalking or duration that predicts stalking impact, rather the variety of stalking behaviors…when victims are impacted on multiple fronts, this may have a substantial cumulative effect on their well-being and/or may mean that they have fewer safe spaces…stalking impacted multiple other individuals such as children, family, friends, and colleagues. This finding is critical because it identifies a larger circle of individuals who can potentially be impacted by stalking in need of support services.”

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