Abstract
Background
Little is known about the clinical characteristics of children and parents affected by intimate partner violence (IPV) presenting in health-care settings. We examined the associations between family adversities, health characteristics, and IPV in children and parents using linked electronic health records (EHRs) from primary and secondary care between 1 year before and 2 years after birth (the first 1000 days). We compared parental health problems in in children and parents with and without recorded IPV.
Methods
We developed a population-based birth cohort of children and parents (aged 14–60 years) in England, comprising linked EHRs from mother–child pairs (with no identified father) and mother–father–child triads. We followed the cohort across general practices (Clinical Practice Research Datalink GOLD), emergency departments, outpatient visits, hospital admissions, and mortality records. Family adversities included 33 clinical indicators of parental mental health problems, parental substance misuse, adverse family environments, and high-risk child maltreatment-related presentations. Parental health problems included 12 common comorbidities, ranging from diabetes and cardiovascular diseases to chronic pain or digestive diseases. We used adjusted and weighted logistic-regression models to estimate the probability of IPV (per 100 children and parents) associated with each adversity, and period prevalences of parental health problems associated with IPV.
Findings
We included 129 948 children and parents, comprising 95 290 (73·3%) mother–father–child triads and 34 658 (26·7%) mother–child pairs only between April 1, 2007, and Jan 29, 2020. An estimated 2689 (2·1%) of 129 948 children and parents (95% CI 2·0–2·3) had recorded IPV and 54 758 (41·2%; 41·5–42·2) had any family adversity between 1 year before and 2 years after birth. All family adversities were significantly associated with IPV. Most parents and children with IPV had recorded adversities (1612 [60·0%] of 2689) before their first IPV recording. The probability of IPV was 0·6 per 100 children and parents (95% CI 0·5–0·6) with no adversity, increasing to 4·4 per 100 children per parents (4·2–4·7) with one adversity, and up to 15·1 per 100 parents and children (13·6–16·5) with three of more adversities. Mothers with IPV had a significantly higher prevalence of both physical (73·4% vs 63·1%, odds ratio [OR] 1·6, 95% CI 1·4–1·8) and mental health problems (58·4% vs 22·2%, OR 4·9, 4·4–5·5) than mothers without IPV. Fathers with IPV had a higher prevalence of mental health problems (17·8% vs 7·1%, OR 2·8, 2·4–3·2) and similar prevalences of physical health problems than those without IPV (29·6% vs 32·4%, OR 0·9, 0·8–1·0).
Interpretation
Two in five of the children and parents presenting to health care had recorded parental mental health problems, parental substance misuse, adverse family environments, or high-risk presentations of maltreatment in the first 1000 days. One in 22 children and parents with family adversity also had recorded IPV before age 2 years. Primary and secondary care staff should safely ask about IPV when parents or children present with family adversity or health problems associated with IPV, and respond appropriately.
Little is known about the clinical characteristics of children and parents affected by intimate partner violence (IPV) presenting in health-care settings. We examined the associations between family adversities, health characteristics, and IPV in children and parents using linked electronic health records (EHRs) from primary and secondary care between 1 year before and 2 years after birth (the first 1000 days). We compared parental health problems in in children and parents with and without recorded IPV.
Methods
We developed a population-based birth cohort of children and parents (aged 14–60 years) in England, comprising linked EHRs from mother–child pairs (with no identified father) and mother–father–child triads. We followed the cohort across general practices (Clinical Practice Research Datalink GOLD), emergency departments, outpatient visits, hospital admissions, and mortality records. Family adversities included 33 clinical indicators of parental mental health problems, parental substance misuse, adverse family environments, and high-risk child maltreatment-related presentations. Parental health problems included 12 common comorbidities, ranging from diabetes and cardiovascular diseases to chronic pain or digestive diseases. We used adjusted and weighted logistic-regression models to estimate the probability of IPV (per 100 children and parents) associated with each adversity, and period prevalences of parental health problems associated with IPV.
Findings
We included 129 948 children and parents, comprising 95 290 (73·3%) mother–father–child triads and 34 658 (26·7%) mother–child pairs only between April 1, 2007, and Jan 29, 2020. An estimated 2689 (2·1%) of 129 948 children and parents (95% CI 2·0–2·3) had recorded IPV and 54 758 (41·2%; 41·5–42·2) had any family adversity between 1 year before and 2 years after birth. All family adversities were significantly associated with IPV. Most parents and children with IPV had recorded adversities (1612 [60·0%] of 2689) before their first IPV recording. The probability of IPV was 0·6 per 100 children and parents (95% CI 0·5–0·6) with no adversity, increasing to 4·4 per 100 children per parents (4·2–4·7) with one adversity, and up to 15·1 per 100 parents and children (13·6–16·5) with three of more adversities. Mothers with IPV had a significantly higher prevalence of both physical (73·4% vs 63·1%, odds ratio [OR] 1·6, 95% CI 1·4–1·8) and mental health problems (58·4% vs 22·2%, OR 4·9, 4·4–5·5) than mothers without IPV. Fathers with IPV had a higher prevalence of mental health problems (17·8% vs 7·1%, OR 2·8, 2·4–3·2) and similar prevalences of physical health problems than those without IPV (29·6% vs 32·4%, OR 0·9, 0·8–1·0).
Interpretation
Two in five of the children and parents presenting to health care had recorded parental mental health problems, parental substance misuse, adverse family environments, or high-risk presentations of maltreatment in the first 1000 days. One in 22 children and parents with family adversity also had recorded IPV before age 2 years. Primary and secondary care staff should safely ask about IPV when parents or children present with family adversity or health problems associated with IPV, and respond appropriately.
| Original language | English |
|---|---|
| Pages (from-to) | e520-e534 |
| Number of pages | 15 |
| Journal | The Lancet Public Health |
| Volume | 8 |
| Issue number | 7 |
| Early online date | 29 Jun 2023 |
| DOIs | |
| Publication status | Published - 1 Jul 2023 |
Bibliographical note
Funding Information:This work uses data provided by patients and collected by the UK National Health Service (NHS) as part of their care and supports #DataSavesLives. We are grateful for the generosity of the patients and their families, along with the participating general practices and NHS staff, for their ongoing contribution to mental health and family violence research. This study is funded by the National Institute for Health and Care Research (NIHR) through the Children and Families Policy Research Unit (PR-PRU-1217-21301). The views expressed are those of the authors and not necessarily those of the NHS, NIHR, the Department of Health and Social Care or associated, or other Government Departments. This study was carried out as part of the CALIBER resource . 44 CALIBER, led from the UCL Institute of Health Informatics , is a research resource providing validated electronic health record phenotyping algorithms and tools for national structured data sources. This study is based on data from the CPRD obtained under licence from the UK Medicines and Healthcare products Regulatory Agency. The data is provided by patients and collected by the NHS as part of their care and support. Hospital Episodes Statistics, and Office for National Statistics copyright (2023), reused with the permission of The Health and Social Care Information Centre. All rights reserved. RG was (in part) supported by the Health Data Research UK. The salary of GF was (in part) supported by the UK Prevention Research Partnership (Violence, Health, and Society; MR-VO49879/1), an initiative funded by UK Research and Innovation Councils, the Department of Health and Social Care (England), and the UK devolved administrations, and leading health research charities. SS, RG, GF, REL, EH, CP, and JD receive funding from the NIHR Children and Families Policy Research Unit. Research was also supported in part by the NIHR Great Ormond Street Biomedical Research Centre.
Funding Information:
This work uses data provided by patients and collected by the UK National Health Service (NHS) as part of their care and supports #DataSavesLives. We are grateful for the generosity of the patients and their families, along with the participating general practices and NHS staff, for their ongoing contribution to mental health and family violence research. This study is funded by the National Institute for Health and Care Research (NIHR) through the Children and Families Policy Research Unit (PR-PRU-1217-21301). The views expressed are those of the authors and not necessarily those of the NHS, NIHR, the Department of Health and Social Care or associated, or other Government Departments. This study was carried out as part of the CALIBER resource. 44 CALIBER, led from the UCL Institute of Health Informatics, is a research resource providing validated electronic health record phenotyping algorithms and tools for national structured data sources. This study is based on data from the CPRD obtained under licence from the UK Medicines and Healthcare products Regulatory Agency. The data is provided by patients and collected by the NHS as part of their care and support. Hospital Episodes Statistics, and Office for National Statistics copyright (2023), reused with the permission of The Health and Social Care Information Centre. All rights reserved. RG was (in part) supported by the Health Data Research UK. The salary of GF was (in part) supported by the UK Prevention Research Partnership (Violence, Health, and Society; MR-VO49879/1), an initiative funded by UK Research and Innovation Councils, the Department of Health and Social Care (England), and the UK devolved administrations, and leading health research charities. SS, RG, GF, REL, EH, CP, and JD receive funding from the NIHR Children and Families Policy Research Unit. Research was also supported in part by the NIHR Great Ormond Street Biomedical Research Centre.
Publisher Copyright:
© 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
UN SDGs
This output contributes to the following UN Sustainable Development Goals (SDGs)
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SDG 16 Peace, Justice and Strong Institutions
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