Doctors urged to screen women for domestic abuse

By Monte Morin, Los Angeles Times

January 21, 2013, 8:02 p.m.

 

Asking standard questions of female patients of childbearing age shows a 'moderate net benefit' and little risk, a federal advisory panel says.

Women of childbearing age should undergo screening for domestic violence and other forms of abuse while visiting their doctor or clinic, according to a recommendation published online Monday by an influential panel of medical experts that advises the federal government.

 

That recommendation, published in the Annals of Internal Medicine, marks a significant change from 2004 when the U.S. Preventive Services Task Force found insufficient evidence to support screenings for so-called intimate partner violence, or IPV.

 

Now, citing new evidence, the task force said that screening women for IPV with a list of standard questions showed a "moderate net benefit," while the risks associated with disclosing abuse were small.

"The bottom line is that more research is needed on how primary-care clinicians can effectively screen and protect all populations, including older and vulnerable adults, middle-aged women, men and children from abuse and violence," said Dr. David Grossman, a Seattle pediatrician and task force member.

The guidelines apply only to women aged 14 to 46 who do not show obvious signs of physical or sexual abuse that would otherwise prompt questions from healthcare providers. Though the report acknowledged that women of childbearing age were not the only people who suffered abuse at the hands of former or current intimate partners, evidence was still insufficient to recommend broader screenings, the authors said.If abuse is confirmed, physicians should provide patients with, or refer them to, intervention services, the panel said. Such services include counseling, home visits, information cards, community service referrals and mentor programs.

 

In a separate draft statement addressing child maltreatment, task force members said there wasn't enough evidence to recommend how clinicians could prevent abuse among children who lacked obvious symptoms.

 

Intimate partner violence includes physical violence, sexual abuse, psychological abuse, stalking and reproductive coercion — intimidation that increases the risk of unplanned pregnancy. The Centers for Disease Control and Preventionestimates that nearly 31% of women and 26% of men have experienced IPV in their lifetimes. Immediate health consequences include injury, death, sexually transmitted diseases, unintended pregnancy, psychological distress and premature births.

 

Screening for domestic violence is recommended by the American Congress of Obstetricians and Gynecologists for women of all ages. Other organizations, such as the American Medical Assn., encourage physicians to inquire about abuse in all patients as part of medical history, but do not recommend a specific screening format or list of questions.

 

Monday's recommendation by the task force could possibly steer organizations toward adopting a more standardized protocol, according to some healthcare providers.

 

"This is very significant," said Eric Ferrero, a Planned Parenthood spokesman who was not involved in the study. "It's just good practice to know a patient's health history, and we have been conducting screenings for a number of years. Hopefully, with this recommendation, it will be done more broadly."

In the case of Planned Parenthood, which treats about 3 million patients in 800 facilities, IPV screenings were sometimes the first time that patients spoke of or even acknowledged abuse, Ferrero said. "We know, at least anecdotally, that this first discussion has led some women to leave an abusive relationship."

 

The task force recommendation was based on a review of dozens of studies and interviews with more than 30,000 people. Screenings were conducted several ways. Some women were questioned face to face by their healthcare provider and others performed self-screenings, answering questions on either a computer or a printed questionnaire.

monte.morin@latimes.com

Study: Child abuse bigger threat than SIDS

4,600 children hospitalized with serious injuries 

By Frederik Joelving

updated 2/6/2012 10:14:15 AM ET

MSNBC: Nearly 4,600 U.S. children were hospitalized with broken bones, traumatic brain injury and other serious damage caused by physical abuse in 2006, according to a new report.


Babies younger than one were the most common victims, with 58 cases per 100,000 infants. That makes serious abuse a bigger threat to infant safety than SIDS, or sudden infant death syndrome, researchers say in the report.

"There is a national campaign to prevent SIDS," said Dr. John Leventhal of Yale University, who led the new study. "We need a national campaign related to child abuse where every parent is reminded that kids can get injured."

The new study, published Monday in the journal Pediatrics, is the first broad U.S. estimate of serious injuries due to child abuse.

Based on data from the 2006 Kids' Inpatient Database, the last such numbers available, Leventhal's team found that six out of every 100,000 children under 18 were hospitalized with injuries ranging from burns to wounds to brain injuries and bone fractures.

The children spent an average of one week in the hospital; 300 of them died.

The rate of abuse was highest among children under one, particularly if they were covered by Medicaid, the government's health insurance for the poor. One out of every 752 of those infants landed in the hospital due to maltreatment.

"Medicaid is just a marker of poverty, and poverty leads to stress," said Leventhal, who is the medical director of the Yale-New Haven Children's Hospital Child Abuse Program.

Last year, a study from four U.S. states showed a clear spike in abusive brain injuries following the financial crash in late 2007, a finding researchers chalked up to the added pressure on parents.

Mom's hug revives baby that was pronounced dead
In that study, too, toddlers appeared to be at higher risk. That led researchers to suggest the maltreatment might have been triggered by crying.

If a caretaker shakes a baby violently to make him or her stop crying, they can cause "shaken baby syndrome," in which the brain bumps up against the skull and starts bleeding.

Leventhal said babies may also be more vulnerable that older kids.

"The most serious injuries tend to be in the younger kids," he told Reuters Health.

Home birth advocate dies in childbirth
The researchers estimate that the hospitalizations cost about $73.8 million in 2006, although that's only a fraction of the overall cost of abuse to society.

"This is a serious problem that affects young children," said Leventhal, whose team is now examining more recent data to refine the findings. "We need to figure out a way to help parents do better."

Copyright 2012 Thomson Reuters.

CDC: Child abuse and neglect cost the United States $124 billion

For Immediate Release: February 1, 2012
Contact :CDC Division of News and Electronic Media
(404) 639-3286

Rivals cost of other high profile public health problems

The total lifetime estimated financial costs associated with just one year of confirmed cases of child maltreatment (physical abuse, sexual abuse, psychological abuse and neglect) is approximately $124 billion, according to a report released by the Centers for Disease Control and Prevention, published in Child Abuse and Neglect, The International Journal.

This study looked at confirmed child maltreatment cases, 1,740 fatal and 579,000 non–fatal, for a 12–month period. The lifetime cost for each victim of child maltreatment who lived was $210,012, which is comparable to other costly health conditions, such as stroke with a lifetime cost per person estimated at $159,846 or type 2 diabetes, which is estimated between $181,000 and $253,000.  The costs of each death due to child maltreatment are even higher.

“No child should ever be the victim of abuse or neglect – nor do they have to be.  The human and financial costs can be prevented through prevention of child maltreatment,” said Linda C. Degutis, Dr.P.H., M.S.N., director of CDC′s National Center for Injury Prevention and Control.

Child maltreatment has been shown to have many negative effects on survivors, including poorer health, social and emotional difficulties, and decreased economic productivity.  This CDC study found these negative effects over a survivor′s lifetime generate many costs that impact the nation′s health care, education, criminal justice and welfare systems. 
Key findings:

• The estimated average lifetime cost per victim of nonfatal child maltreatment includes:
• $32,648 in childhood health care costs
• $10,530 in adult medical costs
• $144,360 in productivity losses
• $7,728 in child welfare costs
• $6,747 in criminal justice costs
• $7,999 in special education costs

• The estimated average lifetime cost per death includes:
• $14,100 in medical costs
• $1,258,800 in productivity losses

Child maltreatment can also be linked to many emotional, behavioral, and physical health problems. Associated emotional and behavioral problems include aggression, conduct disorder, delinquency, antisocial behavior, substance abuse, intimate partner violence, teenage pregnancy, anxiety, depression, and suicide.
Past research suggests that child maltreatment is a complicated problem, and so its solutions cannot be simple. An individual parent or caregiver′s behavior is influenced by a range inter–related factors such as how they were raised, their parenting skills, the level of stress in their life, and the living conditions in their community.  Because of this complexity, it is critical to invest in effective strategies that touch on all sectors of society. 

“Federal, state, and local public health agencies as well as policymakers must advance the awareness of the lifetime economic impact of child maltreatment and take immediate action with the same momentum and intensity dedicated to other high profile public health problems –in order to save lives, protect the public′s health, and save money,” said Dr. Degutis.

Several programs have demonstrated reductions in child maltreatment and have great potential to reduce the human and economic toll on our society.  Several examples of effective programs include:

• Nurse–Family Partnership, an evidence–based community health program. Partners a registered nurse with a first–time mother during pregnancy and continues through the child′s second birthday.   http://www.nursefamilypartnership.org/
• Early Start, provides coordinated, family–centered system of services:  http://www.dds.ca.gov/earlystart/ California′s response to federal legislation providing early intervention services to infant and toddlers with disabilities and their families.
• Triple P, a multilevel parenting and family support system: http://www.triplep–america.com/ Aims to prevent severe emotional and behavioral disturbances in children by promoting positive and nurturing relationships between parent and child.

The article, "The economic burden of child maltreatment in the United States and implications for prevention," is available at http://www.sciencedirect.com/science/journal/aip/01452134.

CDC′s Injury Center works to prevent injuries and violence and their adverse health consequences.  For more information on public health child maltreatment prevention activities and research, please visit http://www.cdc.gov/ViolencePrevention/childmaltreatment.

If you know or suspect a child is being abused, contact the National Child Abuse Hotline at 1–800–4–A–CHILD or visit the Childhelp website.

2008-2011 Domestic Abuse, Health, and Consequences to Society

Compiled by M.A.S.O. ~ Massachusetts Survivors Outreach

2011 Studies

January 4 - HealthDay News  - Survey Finds Much Victimization of Children Goes Unreported – By UNH - Nearly 60 percent of 10-to-17-year-olds surveyed in a new study say they were victims of violence, abuse or crime in the past year. However, fewer than half said that authorities ever learned about what happened.

"The hidden nature of childhood victimization has multiple sources. Clearly, children and adolescents are easily intimidated by offenders and fear retaliation."

http://domestic-abuse-violence.blogspot.com/2011/04/survey-finds-much-victimization-of.html

 

 

February 23 - MedLine Plus - PTSD Risk in Women Tied to Genetics - Heavily traumatized civilian women with two copies of a specific single nucleotide polymorphism (SNP) in the ADCYAP1R1 gene were more likely to show PTSD with an odds ratio of 1.66 (95% CI 1.32 to 2.09) relative to similar women without the condition, Kessler and colleagues found.

About one-third of the 763 women in the study were diagnosed with PTSD.

Among the individual PTSD symptoms, hyperarousal was the one most strongly associated with the CC genotype.

http://domestic-abuse-violence.blogspot.com/2011/03/ptsd-risk-in-women-tied-to-genetics.html

 

February 24  - Science Daily -  Strong Link Found Between Victimization, Substance Abuse - Researchers compared victimization experiences of unwanted sexual activity, neglect, physical violence, and assault with a weapon,

Three times as many lesbians as heterosexual women reported childhood sexual abuse.

Regardless of sexual identity, women who reported two or more victimization experiences had two to four times the prevalence of alcohol dependence, drug abuse or drug dependence as women who reported no victimization, she said.

http://domestic-abuse-violence.blogspot.com/2011/03/strong-link-found-between-victimization.html

 

 

March 18 -  Medline Plus - Domestic Abuse Often Escapes Notice of ER Staff: Study - Most not identified as victims when treated in emergency department – By UPenn - Three of four domestic violence victims treated in hospital emergency departments are not identified as victims of abuse, a new study reveals. 

80% of women who reported domestic assaults to police came to an emergency department at least once during the four years after the reported assault.  Only 28% of the women were ever identified in EDs as victims of domestic violence.

http://domestic-abuse-violence.blogspot.com/2011/04/domestic-abuse-often-escapes-notice-of.html

 

 

March 31 - Moms With Tough Childhoods More Likely to Have Smaller Babies: Study - Abuse, poverty during a mother's youth is associated with heightened health risks for the next generation

http://domestic-abuse-violence.blogspot.com/2011/04/moms-with-tough-childhoods-more-likely.html

 

 

April 16 – CDC – CDC Report: Adverse Childhood Experiences Reported by Adults

Overall, 59.4% of respondents reported having had at least one ACE while 8.7% reported five or more ACEs. 

The most common ACEs were: Separated or divorced parents, Verbal abuse, Family member with depression or mental illness, Witness of domestic violence, Physical abuse, Sexual abuse.

These findings reinforce that adverse childhood experiences are common across racial/ethnic groups and states, further reinforcing the need to expand evidence-based child abuse prevention programs such as home visiting and parent education.

http://domestic-abuse-violence.blogspot.com/2011/04/cdc-report-adverse-childhood.html

April 20 - Sciencedaily.com - Biological Links Found Between Childhood Abuse and Adolescent Depression - history of physical, sexual or emotional abuse in childhood substantially increases the risk of depression in adolescence by altering a person's neuroendocrine response to stress.

http://domestic-abuse-violence.blogspot.com/2011/05/biological-links-found-between.html

April 28 - University of Southern California and Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine. - - Child Sexual Abuse Imapct - 23yo Study - Results of many analyses, both within circumscribed developmental stages and across development, indicated that sexually abused females (on average) showed deleterious sequelae across a host of  biopsychosocial domains including: earlier onsets of puberty, cognitive deficits, depression, dissociative symptoms, maladaptive sexual development, hypothalamic–pituitary–adrenal attenuation, asymmetrical stress responses, high rates of obesity, more major illnesses and healthcare utilization, dropping out of high school, persistent posttraumatic stress disorder, self-mutilation, Diagnostic and Statistical Manual of Mental Disorders diagnoses, physical and sexual revictimization, premature deliveries, teen motherhood, drug and alcohol abuse, and domestic violence. Offspring born to abused mothers were at increased risk for child maltreatment and overall maldevelopment. 

http://domestic-abuse-violence.blogspot.com/2011/04/child-sexual-abuse-imapct-23yo-study.html

May 10 - Post-Traumatic Childhood - For every soldier returning from Iraq and Afghanistan with symptoms of depression or PTSD, there are around 10 children in the United States who are traumatized by exposure to family violence, sexual abuse, neglect and assault, with consequences comparable to those of adult exposure to war-zone violence. 

The Pew Charitable Trusts estimates that the annual cost of childhood maltreatment like this is $103.8 billion. 

Untreated, traumatized children become failing adults who populate our jails and overwhelm our human services agencies. Cutting the development of effective treatments will produce many years of increasing costs and unquantifiable human misery

http://domestic-abuse-violence.blogspot.com/2011/05/post-traumatic-childhood.html

 

May 17 ScienceDaily.com - Deprivation and Neglect Found to Age Children's Chromosomes - Study, led by researchers at Children's Hospital Boston and Tulane University, shows that early adversity even affects children's chromosomes -- prematurely shortening the chromosome tips, known as telomeres, and hastening how quickly their cells "age."

"The telomere is designed to protect the chromosome, so accelerating how early in life telomeres lose length correlates with shortened life span," says Charles Nelson, PhD, director of the Laboratories of Cognitive Neuroscience at Children's and principal investigator of BEIP. "Shortened telomeres may lead to health consequences downstream."

http://domestic-abuse-violence.blogspot.com/2011/05/deprivation-and-neglect-found-to-age.html

 

 

May 26 -  The Annapolis Chronic Fatigue and Fibromyalgia Research Center. - Abuse History More Common in Those With Pelvic Pain, CFS, and Fibromyagia  - Childhood Trauma and Risk for Chronic Fatigue Syndrome: Association With Neuroendocrine Dysfunction

http://domestic-abuse-violence.blogspot.com/2011/05/abuse-history-more-common-in-those-with.html

May 26 - Ritual Abuse and Torture-based Mind Control: Reducing and Preventing Re-contact with Abusers - The two primary forms of re-contact w/ abusers include reporting back by phone or written correspondence, and physically returning to abusers to be abused again. Perpetrators of ritual abuse and mind control attempt to coerce their victims into submission and service to the abuser group for a lifetime. Abuser methods of exerting long-term contact and control vary in relation to the level of psychological sophistication of the abusers and the size of the abusers’s criminal network.
Some abuser groups rely primarily on threats to force their victims into compliance and to prevent their victims from escaping. For some of these groups, these are empty threats. They make claims of having more power than they have. Some abuser groups have larger criminal networks and thus, more power to carry out their threats. But, they too reliably overstate their power to maximally terrorize their victims. This is not to dismiss the reality that these abusers commit murder, but it is to say that they lie and exaggerate their power. Clearly, people who systematically abuse others lie to further their own interests. Words are just one more tool of manipulation to control their victims. Everything they say should be questioned and examined for underlying motives and feasibility.
Many of these abusers also manipulate their victims’ attachment needs, that is, their basic survival needs and needs for security and love, usually beginning in early childhood. They also go to great lengths to try to make their victims believe that the victims are accomplices to the abuse, that they are as evil as their abusers themselves, and that they are unworthy and incapable of belonging anywhere but with the abusers.
Some abuser groups go a step further and manipulate their victims’ psychological capacity to form dissociated self-states in response to extreme pain and terror. I am using the term, “dissociated self-states,” here to refer to states of consciousness with some sense of self that exist out of the conscious awareness of the most-often conscious parts of the psyche, and that typify DSM-IV Dissociative Identity Disorder, and forms of Dissociative Disorder Not Otherwise Specified in which self-states exist internally, affecting the psyche from within, but never assume complete control of executive functions (e.g., purposive action).
These Machiavellian abusers systematically torture their victims for the intended purpose of coercing their victims’ psyches into forming new dissociated self-states that they then work to exploit. They “torture-hypno-condition” these self-states, that is, they use torture, hypnosis, and behavioral conditioning, to try to coerce these dissociated self-states into fulfilling functions that serve the abusers. (I thank Hans Ulrich Gresch, Ph.D., psychologist, mind control survivor, and respected colleague, for the term, “torture-hypno-conditioning,” the most succinct descriptive phrase that I have found that explains what occurs in most torture-based mind control programming; see: http://www.mind-control.psychoprobleme.de/). These abusers “program” some of these dissociated self-states to take on “reporter” and “re-contact” functions, that is, to report to the abusers on a regular basis from a distance, and to return to the abusers as directed.
In many cases, even though the survivor is working hard to break free of her or his abusers, these programmed self-states continue to report to, and return to, the abusers, often out of the conscious awareness of the most-often conscious parts of the psyche. Ongoing access allows the abusers to retaliate against their victims for attempting to break free and to escalate their abuse and programming in efforts to increase their control of their victims.

http://domestic-abuse-violence.blogspot.com/2011/05/ritual-abuse-and-torture-based-mind.html

June 13 - Boston.com -  Study ties bullying, domestic violence - Boys who are bullies are nearly four times as likely as non-bullies to grow up to physically or sexually abuse their female partners, a study led by researchers from the Harvard School of Public Health found.  http://domestic-abuse-violence.blogspot.com/2011/07/study-ties-bullying-domestic-violence.html

June 30 - msnbc.com -  Effects of sexual abuse last for decades, study finds  - Young girls who are the victims of sexual abuse experience physical, biological and behavioral problems that can persist for decades after, a new study shows.   http://domestic-abuse-violence.blogspot.com/2011/07/effects-of-sexual-abuse-last-for.html

June 30 - Robert Hughes Univ of Illinois - How Custody Evaluators Think about Domestic Violence - some domestic violence involves the use of extreme forms of control that forces a partner to do something she does not want to do. Johnson labeled this form of violence as "intimate terrorism."

These findings raise important questions about the degree to which domestic violence is being thoughtfully considered in custody decisions.  It is important for the legal system to develop training and policies such that custody evaluators can appropriately consider custody arrangements in domestic violence situations.  http://domestic-abuse-violence.blogspot.com/2011/07/how-custody-evaluators-think-about.html

 

July 5 - MedPage Today - When child abuse has been substantiated, a number of risk factors can predict the likelihood that abuse will be repeated if the child is returned to the care of the abuser, according to a prospective cohort study. 

When the parents or caregivers were in their teens or twenties, were survivors of abuse, and had never taken parenting classes -- the child faced a 54% risk of being harmed again, wrote Suzanne R. Dakil, MD, and colleagues from the University of Texas Southwestern Medical Center in Dallas.
Risks higher even higher -- 60% -- for children younger than 8.5 yrs who were returned to parents that had taken parenting class, the researchers reported online in the Archives of Pediatrics and Adolescent Medicine.
Because both Federal and state laws encourage keeping children in the family home if possible after abuse, it's crucial that accurate ways of predicting future risk be identified, Dakil's group stated.

44% of children were reported to child welfare authorities again after the index report.

 http://domestic-abuse-violence.blogspot.com/2011/07/risk-factors-predict-repeat-abuse.html 

 

 

TUESDAY, July 19 - (HealthDay News) -- A new study provides evidence that stress from domestic violence during pregnancy may make offspring more prone to stress as an adult.  http://domestic-abuse-violence.blogspot.com/2011/08/study-hints-at-how-stress-of-domestic.html

TUESDAY, Aug. 2 (HealthDay News) – Long Term Affects To Heath - Women who've suffered from gender-based violence are more likely to develop anxiety disorders or other mental woes, experience physical and mental disabilities, and have worse quality of life than other women, new research shows. 

In the United States, more than 20% of women have experienced intimate-partner violence, stalking or both. A full 17% have reported rape or attempted rape, according to background information in the study.

15% of women who had been subjected to one form of gender-based violence experienced (PTSD). - Subjected to 3 or more forms of gender-based violence, that number jumped to more than 56%, the investigators found.

"This study really demonstrated the extent of gender-based violence and the long-term consequences of violence against women," said Andrea Gielen, director of the Center for Injury Research and Policy at the Johns Hopkins Bloomberg School of Public Health in Baltimore. "There are huge implications for health services; this is not just a one-time treatment in the ER for a broken bone. People who treat women for any health-related issues need to think about the extent that such violence can affect women," Gielen said.

http://domestic-abuse-violence.blogspot.com/2011/08/violence-against-women-can-take.html

August 2, 2011 - HealthDay - Violence Against Women Can Take Lifelong Toll: Study - Women who've suffered from gender-based violence are more likely to develop anxiety disorders or other mental woes, experience physical and mental disabilities, and have worse quality of life than other women, new research shows.  Gender-based violence includes rape and other forms of sexual assault, intimate-partner violence (such as spouse abuse) and stalking.    http://domestic-abuse-violence.blogspot.com/2012/01/healthday-violence-against-women-can.html

Wednesday, October 26, 2011 - Reuters Health - Murder, suicide top medical deaths in pregnancy -  Expectant mothers are more likely to die from murder or suicide than several of the most common pregnancy-related medical problems, U.S. researchers have found.

http://domestic-abuse-violence.blogspot.com/2012/01/reuters-health-murder-suicide-top.html

November 13, 2011 - Reuters -  Early Sexual Abuse Increases Heart Risks - CHICAGO (Reuters) - Women who were repeatedly sexually abused as girls have a 62 percent higher risk of heart problems later in life compared with women who were not abused, U.S. researchers said on Sunday.

http://domestic-abuse-violence.blogspot.com/2012/01/reuters-early-sexual-abuse-increases.html

November 13, 2011 -  American Heart Association - Abused girls may have higher risk of heart disease, stroke as adults -

Study Highlights:  Women who experienced unwanted sexual activity as children or adolescents had a higher risks for heart attacks, heart disease and strokes as adults compared to women who reported no unwanted sexual activity. Severe physical abuse as children or teens also was associated with an increased risk of cardiovascular disease as adults.

http://domestic-abuse-violence.blogspot.com/2012/01/abused-girls-may-have-higher-risk-of.html

December 9, 2011 - MedLine Plus - Abuse May Alter Child's Brain Activity.  Children who are abused or exposed to family violence have changes in brain activity similar to those seen in combat veterans, a new study finds. "This underlines the importance of taking seriously the impact for a child of living in a family characterized by violence. Even if such a child is not showing overt signs of anxiety or depression, these experiences still appear to have a measurable effect at the neural level," McCrory said.

http://domestic-abuse-violence.blogspot.com/2012/01/healthday-abuse-may-alter-childs-brain.html

December 14, 2011 - Contact: CDC Division of News & Electronic Media - (404) 639-3286 - Sexual Violence, Stalking, and Intimate Partner Violence Widespread in the US - New survey finds these types of violence affect the health of millions of adults.  On average, 24 people per minute are victims of rape, physical violence, or stalking by an intimate partner in the United States, according to findings released today by the Centers for Disease Control and Prevention. Over the course of a year, that equals more than 12 million women and men. Those numbers only tell part of the story – more than 1 million women reported being raped in a year and over 6 million women and men were victims of stalking in a year, the report says. http://www.cdc.gov/media/releases/2011/p1214_sexual_violence.html

http://domestic-abuse-violence.blogspot.com/2012/01/cdc-sexual-violence-stalking-and.html

 

2010 Studies

January 25 -  MedPage Today - MEDICAL NEWS: Domestic Abuse May Affect Reproductive Freedom - In some abusive relationships, men may use strategies to force women to become pregnant, including sabotaging their birth control, researchers reported.   More than half of the women surveyed -- 53% -- reported physical or sexual partner violence.
Approximately a third of the women who reported partner violence also reported pregnancy coercion or birth control sabotage.   Altogether, the effect of both partner violence and reproductive control nearly doubled a woman's odds of unintended pregnancy (OR 1.99, 95% CI 1.11 to 3.58)

Among the reasons men would want their partners to bear children: "It ranges from things like wanting to leave a legacy, to a straightforward desire for attachment, to having absolute control over her body," Miller said.

"It's about power and control," Mays said. "It's another way of saying, 'this girl's taken, this girl's mine.'”

"Women in abusive relationships are sometimes forced to bear children as a means to keep them dependent on their partner and sometimes as a means to justify additional -- and sometimes more severe -- abuse," Bonomi said.

http://domestic-abuse-violence.blogspot.com/2011/01/medical-news-domestic-abuse-may-affect.html

Study links persistent depression to childhood abuse

Sunday, August 14, 2011
By Kate Kelland, MedLine Plus

LONDON (Reuters) - Doctors treating people for depression should delve into the childhoods of their patients before prescribing, because a history of mistreatment has a significant impact on their illness and ability to recover, scientists said Monday.

Researchers who conducted a combined analysis of 26 studies involving more than 23,000 people found that those who suffered maltreatment as children were twice as likely as those who had normal childhoods to develop persistent and recurrent depression -- one of the world's most common and costly mental illnesses.

Those who had stressful or abusive childhoods were also less likely to be helped with drug or psychological treatment, the analysis found, suggesting doctors and scientists should look for new kinds of treatments and ways of intervening earlier.

"Identifying those at risk of multiple and long-lasting depressive episodes is crucial from a public health perspective," said Andrea Danese of the Institute of Psychiatry(IoP) at King's College London, who led the study.

Danese said the study showed that prevention and early intervention measures to target childhood maltreatment could prove vital in helping prevent the major global health problem.

"Knowing that individuals with a history of maltreatment won't respond as well to treatment may also be valuable for clinicians in determining patients' prognosis," he added.

Depression is a major cause of mortality, disability, and economic burden worldwide and the World Health Organization predicts that by 2020, depression will be the second leading contributor to the global burden of disease across all ages.

In Britain, experts say it affects at least one in 10 people at any one time and can lead to long-term sick leave, relationship breakdown or unemployment. According to a 2006 study, depression is responsible for 100 million lost working days a year in England and Wales alone at a cost of 9 billion pounds ($14.6 billion).

Danese, whose study was published in the American Journal of Psychiatry Monday, told a briefing that previous research has found that people who were maltreated as children also have biological scars from those experiences.

Around one in 10 children worldwide is exposed to maltreatment including psychological, physical or sexual abuse or neglect and as a result abnormalities can show up in biological areas that are particularly sensitive to stress, such as the brain and the immune system, he said.

These biological changes could potentially explain why depressed people with a history of maltreatment are less likely to respond well to treatment and may give clues for research aimed at finding more effective treatments, the scientists said.

"Whilst we still do not know exactly what type of treatment may improve the care of maltreated individuals, it may be that new treatments based on the biological vulnerabilities associated with childhood maltreatment could prove an exciting avenue for research," said Rudolf Uher, also of the IOP, who worked with Danese on the research.

A study published earlier this month found that childhood hardship, including suffering abuse or losing a parent or having a parent with addiction problems, also raised the risk of a range of chronic physical illnesses in later life, such as diabetes, heart disease or asthma

(Reporting by Kate Kelland, editing by Paul Casciato)

Reuters Health

(c) Copyright Thomson Reuters 2011

Risk Factors Predict Repeat Abuse

By Nancy Walsh, Staff Writer, MedPage Today

Published: July 05, 2011

Reviewed by Zalman S. Agus, MD; Emeritus Professor

University of Pennsylvania School of Medicine and

Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

When child abuse has been substantiated, a number of risk factors can predict the likelihood that abuse will be repeated if the child is returned to the care of the abuser, according to a prospective cohort study. For instance, when the parents or caregivers were in their teens or twenties, were survivors of abuse, and had never taken parenting classes -- the child faced a 54% risk of being harmed again, wrote Suzanne R. Dakil, MD, and colleagues from the University of Texas Southwestern Medical Center in Dallas. But the risk was higher even higher -- 60% -- for children younger than 8.5 years who were returned to parents that had taken parenting class, the researchers reported online in the Archives of Pediatrics and Adolescent Medicine. Because both Federal and state laws encourage keeping children in the family home if possible after abuse, it's crucial that accurate ways of predicting future risk be identified, Dakil's group stated. Previous research into risk factors for repeated abuse has been limited in its focus primarily on individual factors, rather than the interaction of many factors. To look for patterns of characteristics associated with risk of repeated abuse, Dakil and colleagues used a statistical technique known as recursive partitioning analysis, which can identify multiple variables associated with a given outcome. They identified 2,578 children in the National Survey for Child and Adolescent Well-Being who remained in the home after a report of abuse, following them for five years. Child characteristics included in the analyses were age, sex, race, and health, while caregiver characteristics included age, marital and employment status, education, and physical and emotional health. Family and environmental characteristics included stress from unemployment, poverty, or drug use, social support, and domestic violence. A total of 44% of children in the sample were reported to child welfare authorities again after the index report. Bivariate analysis determined that these repeated reports were more likely when the child was between 3 years and 10 years of age and had behavior disturbances or developmental delays. A new report also was more likely if caregivers were younger, had themselves been abused, and were limited in their employment because of health or emotional problems. A family factor associated with repeated report was income below $20,000, while active domestic violence was less likely. The finding of lower risk in the presence of domestic violence may be explained by the possibility that children in such homes are more likely to be removed or to be provided with closer support and monitoring, according to the researchers. The recursive partitioning analysis identified risk clusters beginning with the determination of whether the index case had been substantiated, and found that in unsubstantiated cases, 56% were reported a second time. Among the 1,252 substantiated index cases, 38% involved a second report. However, this rose to 86% when the caregiver had a history of abuse and was younger than 33.5 years, the child was younger than 12.5 years but showed no behavioral difficulties, and when five or more children were present in the home. A cluster of characteristics associated with low incidence of repeated abuse -- 26% -- was a substantiated index report, older age of the caregiver, no parenting classes, and non-African-American race. "The findings, which go beyond prior research via a data-driven approach to identifying risk clusters, demonstrate that some risk factors, when combined, are powerful predictors of a child's future abuse risk," wrote Dakil and colleagues. The finding that risk was still high in cases where there had been parenting classes suggests that classes may not be adequate for high-risk families, and additional support or removal might be considered, they noted. And the increased risk seen with low income and behavior difficulties signals a need for assistance in basics such as housing, employment, medical care, and behavioral services. In contrast, lower-risk families might not need these intensive services. "These findings might be useful to [child protection services] in identifying at-risk children and making evidence-based decisions regarding child placement, families' service needs, and the duration and intensity of monitoring that families require," the researchers concluded. They acknowledged that their study was limited by reliance on caseworker reports, which can be influenced by high worker turnover, and families being lost to follow-up. The authors reported no financial disclosures.

Primary source: Archives of Pediatrics and Adolescent Medicine Source reference: Dakil S, et al "Recidivism in the child protection system: identifying children at greatest risk of reabuse among those remaining" Arch Pediatr Adolesc Med 2011; DOI:10.1001/archpediatrics.2011.129. Please go to MedPage Today for more information.

Survey Finds Much Victimization of Children Goes Unreported

Percentage of cases revealed to authorities has risen, experts say, but many remain hidden

URL of this page: http://www.nlm.nih.gov/medlineplus/news/fullstory_107309.html (*this news item will not be available after 04/04/2011)

By Randy Dotinga

Tuesday, January 4, 2011

TUESDAY, Jan. 4 (HealthDay News) -- Nearly 60 percent of 10-to-17-year-olds surveyed in a new study say they were victims of violence, abuse or crime in the past year. However, fewer than half said that authorities ever learned about what happened.
Researchers led by David Finkelhor of the University of New Hampshire surveyed youths 10 to 17 years old and parents of children up to 9 years old in 2008. More than 4,500 children were involved in the survey.

More than 58 percent of the kids said they'd been victimized in the past year, including reports of bullying. Of these, just shy of 46 percent said authorities knew of at least one of the incidents.

Authorities were more likely to know about incidents that were more serious, such as certain cases of sexual assault, kidnapping and gang or group assaults, the survey found.

"However, even emotional bullying (51.5 percent), neglect (47.8 percent) and theft (46.8 percent) were often known to authorities," the authors wrote. Kids were less likely to report assaults by peers and siblings, dating violence, sexual exposure (such as flashing) and statutory rape.

"Childhood/adolescent abuse is frequently described as a hidden problem, and victimization studies regularly have shown that much abuse goes undisclosed," the study authors wrote. "The hidden nature of childhood victimization has multiple sources. Clearly, children and adolescents are easily intimidated by offenders and fear retaliation."

The authors added that, in many cases, young people and their families choose to deal with incidents "informally," fearing the consequences of police and court involvement.

The study did find, though, that authorities are more aware of victimization than during an earlier survey, conducted in 1992.

"However, the study also shows that a considerable portion of childhood/adolescent exposure to victimization is still unknown to authorities," the authors wrote. "The study suggests that outreach needs to be particularly enhanced toward boys, Hispanics and higher-income groups. It also suggests that disclosure promotion should be directed toward episodes that involve family members and peer perpetrators."

The study is published in the January issue of Archives of Pediatrics & Adolescent Medicine.

SOURCE: Archives of Pediatrics & Adolescent Medicine, news release, Jan. 3, 2011

HealthDay

Copyright (c) 2011 HealthDay. All rights reserved.

Moms With Tough Childhoods More Likely to Have Smaller Babies: Study

Abuse, poverty during a mother's youth is associated with heightened health risks for the next generation

By Robert Preidt  (*this news item will not be available after 06/29/2011)

Thursday, March 31, 2011 

THURSDAY, March 31 (HealthDay News) -- Women who suffered abuse in childhood are at increased risk of having low birth weight babies, a new study indicates.

It also found that poverty during childhood and substance use during adolescence and pregnancy boosts the chances of having low birth weight babies, who are at increased risk for death before their first birthday and chronic health problems.

About 8 percent of babies born in the United States each year have a low birth weight -- less than 5 pounds, 8 ounces (2,500 grams).

Researchers at the University of Washington in Seattle examined data from 136 mothers who had been part of a study since childhood. They found that women who suffered emotional, physical or sexual abuse or poverty in childhood were more likely to smoke, drink or use drugs during pregnancy, which increases the risk of having a low birth weight baby.

"Our findings suggest that a mother's economic position in childhood and her experience of maltreatment during childhood have implications for her children born years later," study author Amelia Gavin, an assistant professor in the School of Social Work, said in a university news release.

"What is important about this study is that it was the mother's experience of poverty and maltreatment in childhood, not her poverty or depression or obesity in adulthood, that contributed to her infant's low birth weight," she added.

Doctors should ask prospective mothers about any childhood maltreatment and offer help to those at risk for substance abuse during pregnancy, Gavin suggested.

The study was published online recently in the Journal of Adolescent Health.

SOURCE: University of Washington, news release, March 29, 2011

HealthDay Copyright (c) 2011   HealthDay.   All rights reserved.