Family
Advocacy
Research
Digests

RESEARCH REVIEWCURRENT RESEARCH FOR FAMILY ADVOCACY PROGRAMS • Volume 2, Issue 2 • Summer 2017
In This Issue
We present the fourth edition of Research Review (RR), a publication of the Joining Forces Joining Families group. RR consists of summaries of research of interest to family advocacy, medical, andsocial service providers. These summaries consist of topics that provide tips for providers, issues notcommonly encountered in family maltreatment, and innovations for research and practice. Amongthe child maltreatment articles are resilience in abused young children, three on child physical abuse,current information on infant colic, and educational neglect in children. Summaries on intimate
partner violence (IPV) include relationships between animal abuse and IPV, conflicts in relationships
and some strategies to de-escalate conflict, mortality and medical problems in abused women, andthe complex needs of dysfunctional families.
C HILD MALTREATMENT

Guidelines for Assessment of Suspected Physical Abuse of a Child
The physical abuse of children can be difficult for casereview committees and child protective services (CPS) to
substantiate. Thorough assessment is essential for the welfareof the child. If an injury exists, they will attempt to determine
whether the injuries were intentional (such as a result ofharsh discipline) or unintentional (such as from an accident).
If abuse is suspected, they will try to determine its severity
and frequency.
An interdisciplinary approach is essential to collecting
information bearing on the events of the case. The following
are steps that will help assure a good assessment of suspected
physical abuse of a child: (1) history of alleged circumstancesof the injury; (2) examination of the child fully unclothed;(3) diagnostic workup and need for medical intervention;

CONTENTS

Guidelines for Assessment of Suspected Physical Abuse of a Child......... 1
Resilience and Competency in Children from High-Risk
Environments .......................................................................................... 2
Many Factors are Associated with Fatal and Near-Fatal Child PhysicalAbuse......................................................................................................... 3
Supporting Parents Contending with Prolonged Crying .in Infants: What
to Do About Colic?.................................................................................. 4
What is Educational Neglect? Differences for Children andAdolescents............................................................................................... 5
Complex Needs of Families Related to Intimate Partner Violence, Mental
Health, and Substance Abuse................................................................. 5(4) manage acute medical problems; (5) notify CPS and law
enforcement as mandated by the state; (6) hospitalize thechild if needed; (7) have social work perform an extensivesocial evaluation; and (8) consider forensic workup or referto organization that specializes in child abuse cases.
These guidelines are intended for evaluation by medical
staff when they are unsure of how to evaluate an injured or
child that presents with vague symptoms. The guidelines may
also assist social service personnel about how to evaluate an
injured child or one with vague symptoms.

Reference

Berkowitz, C.D. (2017). Physical abuse of children. New England Journal of Medicine; 376 (17): 1659–1666.

Reasons for the End of an Intimate Relationship........................................ 6
Five Strategies to De-escalate Conflict.......................................................... 6
Are there Effective Interventions for Adult Survivors of Adverse
Childhood Experiences?......................................................................... 7
Abuse in Childhood Results in Higher Adult Mortality Rates for
Women than for Men.............................................................................. 7
Adverse Health Effects of Intimate Partner Violence Victimization........ 8
Animal Abuse is Often Linked to Intimate Partner Violence.................... 8

CHILD MALTREATMENT

Resilience and Competency in Children
from High-Risk Environments
Research on children raised in high-risk environments
usually focuses on negative outcomes and their associatedrisk factors. However, a study of children who survive these
exposures relatively unscathed can yield data on factors that
contribute to adaptive functioning. Resilience is a term thatis frequently encountered in recent psychosocial literature. It
defies a consistent definition, but in general it is considered
the ability to positively adapt following adversity and emerge
at previous or improved levels of functioning.
Child resilience was studied in 943 families participating in the Longitudinal Studies of Child Abuse and Neglect(LONGSCAN), a consortium of five sites in the U.S. prospectively studying antecedents and outcomes of child maltreatment (Runyan, et al. 1998). Data were collected longitudinallyof children at ages four and six and from their caregivers,
mostly from high-risk environments. Participants included
some families already reported for child maltreatment. Someof the high-risk characteristics of families were low income
or socioeconomic problems such as poverty and community
violence.
Children’s functioning was assessed in behavioral, social,and developmental domains. Demographics were collected,
and caregivers were assessed for depression. Resiliency was
operationalized as competency based on the child’s performance on standardized measures. Many children facing
adversity fared well. The major finding was that 48% of thechildren appeared resilient. Children were less likely to havebeen maltreated or to have depressed caregivers. They werealso more likely to come from smaller households with fewer
children in the home and to have an employed caregiver.
These variables were considered as social capital.
However, a majority of children did not fare so well.
Child maltreatment and caregiver depression were strongly
associated with poor outcomes. These findings can allow
caregivers and providers to recognize the complexity of development — children are often resilient. Healthcare providers and those working in family services may enhance childresilience in high-risk environments by effectively treating
depressed caregivers and supporting their efforts to gain
employment.

References

Dubowitz, H., Thompson, R., Proctor, L., Metzger, R., Black, M.,
English D., … Magder L. (2016). Adversity, maltreatment,
and resilience in young children. Academic Pediatrics; 16(3):233–239.
Runyan, D.K., Curtis, P.A., Hunter, W. M., Black, M. M., Kotch,
J. B., Bangdiwala, S., & Dubowitz, H. (1998). LONGSCAN:
A consortium for longitudinal studies of maltreatment andthe life course of children. Aggression and Violence Behavior;3(3): 275–285.

Resilience…defies a consistent definition, but in general it is considered the ability topositively adapt following adversity and emerge at previous or improved levels of functioning.

JOINING FORCES
Joining Families

RESEARCH REVIEW
Editor-in-Chief
James E. McCarroll, PhD
e-mail to James.McCarroll.ctr@usuhs.mil(301) 377-9479
Joining Forces Joining Families—Research Review is a
publication of the Family Violence and Trauma Project,
Center for the Study of Traumatic Stress, Departmentof Psychiatry, Uniformed Services University, Bethesda,
Maryland 20814, and the U.S. Army Installation
Management Command, Fort Sam Houston, TX 78234.

2 • RESEARCH REVIEW | Joining Forces/Joining Families

Editorial Advisor
LTC Ricky J. Martinez. PhD, MSC, USA
Family Advocacy Program Manager
Installation Management Command
Department of the Army
Editorial Consultant
Joshua C. Morganstein, MD
Captain, U.S. Public Health Service
Scientist, Center for the Study of Traumatic Stress
Department of Psychiatry, Uniformed Services University

Summer 2017

C HILD MALTREATMENT

Many Factors are Associated with Fatal and
Near-Fatal Child Physical Abuse
Identifying and responding to known child maltreatment risk factors can prevent harm to children. However, risk
factors are many and none alone can predict future abuse. In
cases of physical abuse resulting in death or near death, it iseven more important to learn which risk factors can be identified early and can result in a preventive intervention.
A research team conducted a retrospective review ofa series of 20 cases of children less than four years of age
who were victims of fatal (10 cases) and near-fatal physicalabuse (10 cases) (Pierce et al., 2017a). Near-fatal abuse wasdefined as an injury that places a child in a serious or criticalcondition. The median age of the children was 7.5 months,
range 1–32 months. The fatally abused children were generally younger than the near-fatally abused children, medianages of 5 and 13.5 months, respectively. Of physically abusedchildren less than one year old, eight were fatalities and fivewere near-fatalities.
Traumatic brain injury was the cause of the fatal or nearfatal event in 19/20 cases that presented for hospital care.
An altered mental status of the child was observed due toshaking and punching or slamming the child. Ninety percent
of cases had traumatic brain injuries, 80% had bruising, and
35% had fractures. The children had a male caregiver in 70%
of cases. Nine out of 14 cases had prior medical documentation. Atypical bruising was the most common physical exam
finding prior to the fatal or near-fatal event. All of the children with prior bruising subsequently had traumatic brain
injury, of which four died. Three types of bruising occurred:(1) bruises on non-mobile infants, (2) uncommon location
for bruising such as on the ears, buttocks, or eyes, and (3) patterned bruising consistent with inflicted injury. The authors
noted that bruising, unlike fractures, rarely requires medical
attention and may be often overlooked by medical and otherprofessionals such as law enforcement personnel. Overlooking such injuries can send the child back to an unsafe environment and is a missed opportunity to provide additionalsafety assessment, family preventive measures, or other safety
interventions.
A trauma history was given in only four of the 19 casesthat presented for hospital care despite the presence ofmultiple injuries to body systems. Histories were presented

as falls, but the offenders later admitted that the stories were
fabricated to cover up physical assaults. In the absence of a
trauma history, an altered mental status of the child should
be considered suggesting abuse.
Risk factors were abstracted from a wide variety ofsources that resulted in four major groupings: social factors,
violence, criminal history of perpetrator and non-perpetrator, and protective services history (Pierce et al., 2017b). Six
risk factors were thought to be key predictors of both future
mortality (fatalities) and morbidity (near-fatalities): violent
criminal histories of a parent (all 20 cases), prior child social
services involvement (n=17), negative or hostile attitudes
about the child or the child’s siblings (n=15), caregiver mental health issues (n=8), substance abuse histories (n=8), andprior intimate partner violence (n=6). Two sets of risk factors
were present for almost all fatalities and near-fatalities: priordomestic violence and perpetrator criminal history. Moresocial risk factors were present for fatalities than for nearfatalities. This suggests that while the presence of more social
risk factors predicts fatal child physical abuse, concern shouldbe heightened when many are present.
This study reveals many common risk factors for both
fatal and near-fatal child physical abuse cases and emphasizes
the high prevalence and importance of psychosocial risk factors, particularly for fatalities. The identification of risk factors prior to severe and fatal child abuse can help providers
assess risk and work collaboratively to prevent these events.
When evaluating children with evidence of trauma, alteredmental status or atypical bruising should prompt careful andthorough evaluation for the presence of child abuse.

References

Pierce, M.C., Kaczor, K., Acker, D., Webb, T., Brenzal, A., Lorena,
D.J., & Thompson R. (2017a). History, injury, and psychosocial risk factor commonalities among cases of fatal andnear-fatal physical child abuse. Child Abuse & Neglect; 69:
263–277.
Pierce MC, Kaczor K, Acker D, Webb T, Brenzel A, Lorenz DJ,
Young A, & Thompson R. (2017b) Dataset on psychosocial
risk factors in cases of fatal and near-fatal physical childabuse. Data in Brief; 14: 107–109.

Health care providers encountering children with atypical or unexplained injuries should
conduct further assessment when (1) there is patterned bruising that is consistent withinflicted injury, and (2) an altered mental status. In the absence of a trauma history, analtered mental status of the child should be considered suggesting abuse.

http://www.CSTSonline.org

RESEARCH REVIEW | Joining Forces/Joining Families • 3

C HILD MALTREATMENT

Supporting Parents Contending with Prolonged Crying
in Infants: What to Do About Colic?
Crying is one of the many challenges that parents facewith a new baby. Intractable crying (colic) by infants is asignificant cause of various forms of child maltreatment,
particularly head trauma from shaking (Barr, 2014). The
prevalence of colic is unknown, but in a recent study of 3,006
mothers, colic was reported in 11.6% of the babies (Alexander, Zhu, Paul, & Kjerulff, 2017). Unfortunately, especially for
new parents, there is no magic answer for resolving infant
colic. Pärtty & Kalliomäki (2017) briefly reviewed the current
state of medical knowledge and research on colic in a 2017
study with the conclusion that its origin remains unresolved
and treatment options are limited.
Colic can occur in an infant less than five months of age.
It usually involves repeated and prolonged crying periods
with no obvious cause, the crying cannot be prevented or
resolved, and there is no evidence of failure to thrive, fever, or
illness (Benninga, Nurko, Faure, Hyman, Roberts, & Schechter, 2016).
What causes colic? During the first few months of life,
there are large changes in the microorganisms in the gut.
The development and activity of these microorganisms areaffected by as yet unknown changes, which can produce painthat results in crying. Breast-feeding has not been shown
to provide a protective effect and the incidence of colic issimilar among formula-fed and breast-fed infants (Pärtty &Kalliomäki, 2017).
What can you do about it? There is no single recommended intervention for colic. Research into the origins andtreatment of colic has yielded inconsistent results. Many
remedies have been suggested although published studies ofpain-relieving agents for colic are often of low to moderatequality (Biagioli, Tarasco, Oingue Moja, & Savino, 2016). The
choice of treatment is a matter to be decided between family
members and their family physician or pediatrician as theoptions are complex.
Social support of the family, particularly the mother, isassociated with lower reported infant colic. In addition, thesame is true for mothers who rated their relationship with
their partner during pregnancy as extremely happy or perfect. Positive responses by the mother on the following ques-

tions were also protective against infant colic: “How much of
the time is your partner warm, loving, and affectionate toward the baby?” and “How much of the time is your partner
helpful to you?” (Alexander, Zhu, Paul, & Kjerulff, 2017).
Assisting parents in finding ways to reduce the stressassociated with infant colic may reduce the incidence ofparental harm to infants. Parents should be advised that (1)colic in some babies is a normal phase of their development,(2) it is not their fault, (3) remedies do not always work, butparents should continue to seek support and not neglect thebaby, and (4) parents supporting each other is one of themost important methods of successfully getting through thisphase of the baby’s development. Finally, providers should
not minimize the parents’ frustration or their attempts toresolve colic.

References

Alexander CP, Zhu J, Paul IM, & Kjerulff KH. (2017). Fathers
make a difference: positive relationships with mother andbaby in relation to infant colic. Child: Care, Health and Development; Mar 7: doi: 10.1111/cch.12445.
Barr R. (2014). Crying as a trigger for abusive head trauma:a key to prevention. Pediatric Radiology; 44 Supplement 4:
S559-S564.
Benninga M, Nurko S, Faure S, Hyman P, Roberts SJ, & Schechter N. (2016). Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology; 150: 1443-1455.
Biagioli E, Tarasco V, Lingue C, Moja L, & Savino F. (2016).
Pain-relieving agents for infantile colic. Cochrane Database of Systematic Reviews; 16(9): doi: 10.1002/14651858.
CD009999.pub2
Pärtty A, & Kalliomäki M. (2017). Infant colic is still a mysterious disorder of the microbiota-gut-brain axis. Acta Paediatrica; 106: 528-529.

Assisting parents in finding ways to reduce the stress associated with
infant colic may reduce the incidence of parental harm to infants.

4 • RESEARCH REVIEW | Joining Forces/Joining Families

Summer 2017

C HILD MALTREATMENT

What is Educational Neglect? Differences forChildren and Adolescents
Being attentive to a child’s progress in learning and/or
attendance in school may be part of a comprehensive evaluation for child neglect. An examination of 20 years (19932013) of child educational neglect reports in the Canadianprovince of Ontario found that in very young children,
educational neglect was defined by a lack of parental involvement in learning and literacy activities such as teaching thealphabet, numbers, colors, shapes, and reading to the child.
For older children and adolescents, neglect occurs when parents fail to ensure that their children regularly attend school
and fail to promote their child’s educational success.
When investigations involving educational neglect werecompared to other types of neglect, caregivers were significantly more likely to have mental health issues and few social
supports. Educational neglect was only one component of agenerally neglectful and chaotic home environment. About
one in five investigations found that the family had run out

of money for basic necessities and in 39% of families, social
assistance was the primary source of income.
The responsibility for ensuring that young children attend
school lies with caregivers, whereas more individual responsibility is placed on adolescents to maintain school attendance
even in the face of their problems and family dysfunction.
Teachers, counselors and healthcare providers should be alert
to the failure of very young children to achieve basic literacy
and for school absence as a potential marker of neglect thatwarrants further assessment of overall child and family wellbeing.

Reference

van Wert, M., Fallon, B., Trocmé, N., & Collin-Vézina, D. (2017).
Educational neglect: Understanding 20 years of child welfare.
Child Abuse & Neglect; doi: 10.1016/j.chiabu.2017.04.034.

CHILD MALTREATMENT

Complex Needs of Families Related to Intimate Partner Violence,
Mental Health, and Substance Abuse
Families investigated by CPS for an initial child abuse
allegation, but whose reports are not substantiated, often havecomplex personal and family needs that do not go away when
the case is closed. Often, these needs are centered on mental
health, substance abuse, and intimate partner violence. These
individuals often have a wide variety of educational, clinical,
and life skills needs that can be assessed and treated.
The purpose of this study was to understand the needs
and experiences of families whose cases were unfounded inorder to develop preventive strategies. Family functioning
was assessed by use of the Family Assessment Form (FAF)
and dichotomized into those with (n=836) and without(1,172) complex needs. The FAF has 59 items making up
eight subscales scored from 1 to 5 where higher scores mean
worse functioning. Subscales measure living conditions,financial conditions, support to caregivers, caregiver-childinteractions, developmental stimulation, interactions between
caregivers, caregiver history, and caregiver personal characteristics. Complex needs were identified when the mean scoreof the FAF was 3 or higher for intimate partner violence,
mental health, or substance abuse.

Half of family or parent or guardian caregivers withcomplex needs had a history of childhood abuse, almost half
had 6-8 needs, and about a quarter had 3-5 needs. Ninety
percent of caregivers without complex needs had zero to twoneeds. These findings highlight the importance of recognizing the many variations in families investigated for allegedchild maltreatment that require accurate screening andservices matched to their needs rather than a one-size-fitsall approach. Use of the FAF by social service providers is aninnovative way of formulating specific intervention goals forfamilies whether allegations of family abuse are substantiatedor not. Accomplishment of specific goals can be an important
preventive intervention at any level of family dysfunction.

Reference

Simon, J.D., & Brooks, D. (2017). Identifying families withcomplex needs after an initial child abuse investigation: A
comparison of demographics and needs related to domestic
violence, mental health, and substance use. Child Abuse &Neglect; 67: 294-304.

Families investigated by CPS often have many complex needs, often about
mental health, substance abuse, and intimate partner violence.
http://www.CSTSonline.org

RESEARCH REVIEW | Joining Forces/Joining Families • 5

IN T IMATE PARTNER VIOLENCE

Reasons for the End of an Intimate Relationship
There are many reasons for the breakup of in intimate
relationship. Breakups can be costly emotionally and financially in terms of potential legal costs, loss of income frompartner, lost time from work, alimony, child support, andother expenses. A recent study of 15,162 men and women in
the Third National Survey of Sexual Attitudes and Lifestylein Britain between 2010–2012 found a variety of reasons forbreakups. Of this sample, 10.9% of men and 14.1% of womenreported the end of a relationship during the past five years.
Of these, 706 men and 1,254 women reported at least one
reason for the breakup.
Sixteen percent of women and 4% of men reported intimate partner violence (IPV) as the reason for the breakdownof their relationship. The other most commonly reported
reasons were that they grew apart (35.6% of women and39.5% of men), arguments (30.3% and 27%, respectively),
unfaithfulness (23% and 18%), lack of respect or appreciation (24.8% and 17.1%), not sharing housework (14.4% and6.8%), money problems (11.8% and 7.3%), different interests
or nothing in common (15.7% and 13.3%), and difficulties
with sex (6.3% and 4.9%). IPV showed the greatest difference
between genders, 16% for women and 4% for men. Women

were statistically significantly more likely to end the relationship for unfaithfulness, lack of respect, money problems, notsharing housework, and IPV.
Overall, the authors found that difficulties in communication and the deterioration of the quality of the relationshipwere the predominant reported reasons for the breakups.
They suggested that promoting better communication andconflict resolution skills are important to pursue in relationship education and counseling. Suggestions for further research were for qualitative studies to assess how partnershipcharacteristics and life course events may precede the deterioration and breakup of a relationship. Additional research
could also address how couples overcome the relationshipdifficulties.

Reference

Gravningen K, Mitchell KR, Wellings K, Johnson AM, Geary
R, Jones KG … Mercer CH. (2017). Reported reasons forbreakdown of marriage and cohabitation in Britain: Findings from the Third National Survey of Sexual Attitudes
and Lifestyles (Natsal-3). PLOSONE; 12(3):e0174129. doi:
10.1371/journal.pone.0174129.

IN T IMATE PARTNER VIOLENCE

Five Strategies to De-escalate Conflict
Overheated conversations can lead to trouble. There
are many ways to calm oneself and others depending on a
person’s own preference for methods. Among these are deep
breathing, muscle relaxation, walking away, prayer, and manyothers. Keeping situations under control can avert violence,
bad feelings, and other results of failure to manage a situation. The article reviewed here offers five remedies that can beused to defuse a tense situation involving potential or actualinterpersonal conflict.
Listen. The first remedy to defuse a tense situation is tolisten, to learn why we see it differently. Discard trying todecide who is right and who is wrong. Instead, try to understand how the other person sees the situation.
Untangle intent from impact. Attempts at having a good
impact on others may not be seen the same way by them.
Similar to learning to see things differently, try to determine
how your behavior will impact others.
Allow space for feelings. Trying to reason things out may

leave out the importance of another person’s feelings. Exploring emotions can help to explore a solution. For example,
asking, “What are you feeling?” can open up a discussion of
how to resolve the situation.
Pursuing interests rather than positions. To find thebest way forward, learn what interest each person is pursing
rather than debating positions. Learning everyone’s interestin a situation can create new options based on mutual understanding of goals.
Sidestep the triangle. When two people have whatamounts to a minor disagreement, it is usually best to try toresolve it rather than bringing in another person. However,for one that may be more serious, consulting a professional
may be the best course of action.

Reference

Garrido AM. (2016). Five simple strategies to help keep things
cool. Health Progress; July-August : 67-69.

Listen, untangle, allow space, pursue interests, sidestep the triangle.

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Summer 2017

IN T I MATE PARTNER VIOLENCE

Are there Effective Interventions for Adult Survivorsof Adverse Childhood Experiences?
Medical and scientific literature has documented the negative health effects of adverse childhood experiences (ACEs)
in children and adults. The question arises, what can be done
for an adult with such history? Cognitive-behavioral therapies (CBT), when compared to other interventions offered topatients, have the most potential for improving health problems, particularly for mental health and health-risk behaviors. In addition to CBT, other therapies have shown promise,but they have more limited evidence of effectiveness.
There are numerous issues to consider for people with
ACEs who present to primary care. Many come for a varietyof physical health problems and with different experiencesof ACEs. Providing specific interventions for each ACE does
not appear to be necessary, as research has concluded that
results of therapy are likely to generalize. Many people with

ACEs are unaware of their effects and may have limited
motivation to pursue treatment, particularly when some CBTinterventions require many sessions over months. However,research indicates that brief interventions can also show
positive outcomes. Innovative primary care for adults with ahistory of ACEs that involves a behavioral health component
may provide improved health and quality of life for thesepatients.

Reference

Korotana LM, Dobson KS, Psuch D, & Josephson T. (2016). A
review of primary care interventions to improve health outcomes in adult survivors of adverse childhood experiences.
Clinical Psychology Review; 46: 59–90.

Cognitive-behavioral therapies have the most potential for improving health problems, particularly
improving mental health and reducing health-risk behaviors, for survivors of ACEs.
IN T IMATE PARTNER VIOLENCE

Abuse in Childhood Results in Higher Adult Mortality
Rates for Women than for Men
Women who report having been victims of abuse inchildhood continue to be vulnerable to premature mortality
and should receive greater attention regarding health promotion. Adverse childhood experiences and childhood abuse
are known to have negative effects on the development andhealth of children and adults. However, the effects of abuseon adult mortality have not been investigated. In the study
reported here, a national sample (n=6,285) of the survey of
Midlife Development in the U.S. of persons aged 25–74 in
1995–1996 was analyzed for their mortality through October
2015. The original data collection included reports of childhood severe physical abuse, moderate physical abuse, andemotional abuse. At follow-up, participants were 48% men,
91% were white, and the mean age was 46.9 years. Mortality rates for men and women were compared controlling forchildhood socioeconomic status, personality traits, depression, history of major chronic diseases (cancer and heartdisease), and health behaviors (smoking and alcohol).

When comparing all women and men who had reported
histories of severe physical abuse, moderate physical abuse, or
emotional abuse during childhood, women had higher mortality rates than men. Their mortality rates were also higher
for the combined types of abuse. There was no explanation
for this finding of why the long-term effects of childhood
abuse resulted in higher mortality rates for women. Somesuggestions were vulnerability to psychiatric disorders suchas depression, negative health behaviors such as drug use, andbiologically embedded changes in body systems across thelifespan, although none of these was investigated and mortality was not calculated for specific causes of death.

Reference

Chen, E., Turiano, N.A., Mroczek, D.K., & Miller, G.E. (2016).
Association of reports of childhood abuse and all-cause
mortality rates in women. JAMA Psychiatry; 73(9): 920–927.

Women who were severely physically abused, moderately physically abused, or
emotionally abused during childhood had higher mortality rates as adults than men.
http://www.CSTSonline.org

RESEARCH REVIEW | Joining Forces/Joining Families • 7

IN T I MATE PARTNER VIOLENCE

Adverse Health Effects of Intimate Partner Violence Victimization
Victims of intimate partner violence (IPV) suffer amyriad of injuries, psychological distress, medical problems,
wasted time, and increased healthcare costs. Improving providers’ ability to manage the healthcare needs of IPV victims
can result in improved interventions. Recent improvements
in computer technology makes possible the analysis of large
volumes of data that can reveal previously unrecognizedissues, a task that once was impossible for the individual
researcher.
Data for this research was obtained from Explorys, acommercial platform that ties together millions of electronic
health records from hospitals and providers to study adverse
health effects following IPV. Analysis was limited to female
victims of IPV since they were significantly more common
than male victims. The investigation found 2,429 symptoms
identified as prevalent among IPV victims. These covereda wide variety of pathologies, but could be grouped underfour categories: acute symptoms such as injuries inflicted by
the abuser; chronic symptoms, disorders, and cardiovascular
problems; gynecological and pregnancy-related problems;and mental and behavioral health issues. The most common-ly reported diagnoses were acute injuries including bruising,head and neck injuries, and multiple skin wounds. Each of
the four categories above includes many conditions that canbe addressed medically and socially for IPV victims. For
example, cardiovascular problems can arise from repeatedphysiological arousal of the central nervous system. Gynecological and pregnancy-related problems include gynecological injuries, delays seeking prenatal care, and missed visits tothe doctor. Mental and behavioral health problems include
depression, PTSD, fear, anxiety, increased smoking, and substance abuse.
This research shows the breadth of physical and medical
issues involved in IPV. For medical providers, especially in theemergency room, the treatment of acute injuries is a unique
opportunity to address IPV and offer support to victims aswell as referrals for further evaluation and management.

Reference

Karakurt, G., Patel, V., Whiting, K., & Koyutürk, M. (2017). Mining electronic health records data: Domestic violence andadverse health effects. Journal of Family Violence; 32: 79–87.

IN T IMATE PARTNER VIOLENCE

Animal Abuse is Often Linked to Intimate Partner Violence
An important link exists between the abuse of companion
animals and intimate partner violence (IPV) against women.
In a review of 94 studies, the co-occurrence of intentional
animal abuse and IPV by male abusers was between 25–86%.
The intentional injury of a pet of women who were notvictims of IPV was 0–5%. Many abused women delay goingto a shelter because they cannot take their animals with them.
Women who reported threats or physical abuse against theiranimals were more likely to delay leaving their violent home,and many later returned out of concern for their animals.
Animal abuse by the IPV perpetrator can consist of
threats to the animal, physical abuse of the animal, and prohibiting the female victim of IPV from supplying the animal’s
basic needs such as food, water, and veterinary care. Motives
for such abuse by males include fun, desire to control, anger,
revenge, dislike of the animal, discipline based on unrealistic expectations, and jealousy. Male abusers have also usedthreats of animal abuse as a type of psychological control.
Males who abuse animals tend to talk to their pets only interms of commands or threats, and consider them non-sentient property and a life stressor.
The involvement of children in animal abuse is also
important. Children may be exposed to animal abuse in thehome and in the community. They may risk their own safety

8 • RESEARCH REVIEW | Joining Forces/Joining Families

to protect their animals. Some participate in the abuse. Children
who observe animal abuse are more likely to abuse animals.
Animal abuse by children tends to occur at an early age anddeclines significantly by ages 10–12.
Veterinarians may not know that animal abuse can be aharbinger of IPV. Studies indicate that between about 43–86%
of veterinarians do know about this link. They may be thefirst or the only professionals who have knowledge of abusive
households, but may be reluctant to report suspicions of abuse
due to lack of training and knowledge about the topic, ethical conflicts, possible adverse consequences of reporting, andprofessional confidentiality. Family advocacy and healthcare
personnel should be aware of the connections between IPV
and animal abuse and make this knowledge part of their clinical inquiries as well as with community veterinarians. Animal
abuse is a unique window into violent families and could be an
early entry for interventions that prevent later harm to humans
and animals.

ReferenceMonsalve S, Ferreira F, & Garcia R. (2017). The connection between
animal abuse and interpersonal violence: A review from the veterinary perspective. Research in Veterinary Science; 114: 18–26.

Summer 2017