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Healthcare Needs Higher for Children of Abused Mothers

December 14, 2007

 Children whose mothers have a history of abuse by intimate partners have more healthcare needs than children whose mothers have no history of abuse, according to a study by lead author Frederick P. Rivara, MD, MPH, of Seattle Children’s Hospital Research Institute and Harborview Injury Prevention and Research Center (HIPRC).

Children whose mothers have a history of abuse by intimate partners have more healthcare needs than children whose mothers have no history of abuse, according to a study by lead author Frederick P. Rivara, MD, MPH, of Seattle Children’s Hospital Research Institute and Harborview Injury Prevention and Research Center (HIPRC).

These needs — expressed in terms of the cost of providing care and use of health services — were higher even if the abuse occurred before the children were born, the research team found. Scientists from Children’s, HIPRC and Group Health Center for Health Studies (GHCHS) conducted the study, which appeared in the December 2007 issue of Pediatrics.

“Children are the other victims when intimate partner violence (IPV) occurs in the home,” said Rivara. “This study shows that children require more health care — especially for mental health — when their mothers are victims of such violence.”

The study compared medical records and utilization data from 631 children of mothers with a history of IPV with those of 760 children whose mothers had not experienced IPV. The mothers — who participated in a randomly sampled telephone survey of Group Health female members aged 18 to 64 — provided information regarding their lifetime history with IVP. The study defines IPV as both physical abuse (slapping, hitting, forced sex) and nonphysical abuse (threats, chronic disparaging remarks or controlling behavior.) Researchers looked at 11 years of data.

Among the mothers in the study, 46.6 percent reported experiencing IPV since age 18. Among the children, the violence stopped before they were born for 21.8 percent. For 23.6 percent, the violence happened during the children’s lifetime.

Previous studies have shown that children exposed to IPV in the home have increased risk for many problems, including also being abused at home, school problems, poor health, risk-taking behavior and being violent.

In 2006, the study team previously published evidence that IPV resulted in significantly higher health utilization and costs for women. This current study is the largest ever to examine the link between a mother’s exposure to IPV and her children’s health utilization and costs. The study is also unique in that it examined a large middle-class population and one that is very representative of Seattle, said Rivara.

“Intimate partner violence harms everyone in our society, and it must be viewed as not acceptable either for women or their children,” Rivara added.

The researchers found:

  • Both healthcare utilization and healthcare costs were higher in most categories of care for children whose mother had a history of IPV. Overall, the annual costs of healthcare were 11 percent higher than those for children of mothers without IVP.
  • Children of mothers with a history of IPV that ended before the child was born had significantly greater utilization of specific types of care including mental health, primary care, specialty care and pharmacy services. These costs were 24 percent higher for children in this group, compared to children whose mothers had experienced no IVP in their lifetime.
  • Children exposed directly to IPV after birth had greater emergency department and primary care use during the IPV, and were three times more likely to use mental health services after the intimate partner violence ended. They had 16 percent higher primary care costs than did children of mothers without IVP.

The authors recommend that healthcare providers routinely screen women for IPV and provide appropriate referrals to community agencies and mental health care both for mothers and children affected.

They also state that interventions for women and their children are needed to minimize the effects of IPV in the family. “Such interventions are unlikely to be cost effective in the short term,” they write, because the victims’ increased health-care utilization seems to be higher for years after IPV stops. “Nonetheless, such services are necessary to attend appropriately and responsibly to the long-term consequences of violence,” the authors conclude.

The research was funded by the Agency for Healthcare Research and Quality, the Health Services arm of the U.S. Department of Health and Human Services.

In addition to Rivara, authors of the study included researchers from GHCHS: Melissa L. Anderson, MS; Paul Fishman, PhD; Robert J. Reid, MD, PhD; David Carrell, PhD; Robert S. Thompson, MD; and Amy E. Bonomi, PhD, MPH, now at Ohio State University.

About Seattle Children’s Research Institute

Located in downtown Seattle’s biotech corridor, Seattle Children’s Research Institute is pushing the boundaries of medical research to find cures for pediatric diseases and improve outcomes for children all over the world. Internationally recognized investigators and staff at the research institute are advancing new discoveries in cancer, genetics, immunology, pathology, infectious disease, injury prevention and bioethics, among others. As part of Seattle Children’s Hospital, the research institute brings together leading minds in pediatric research to provide patients with the best care possible. Seattle Children’s serves as the primary teaching, clinical and research site for the Department of Pediatrics at the University of Washington School of Medicine, which consistently ranks as one of the best pediatric departments in the country. For more information, visit http://www.seattlechildrens.org/research.

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