Children require more health care when their mothers are victims of domestic violence

Children whose mothers have a history of abuse by intimate partners have higher health care needs than children whose mothers have no history of abuse, according to a study conducted at Group Health, a Seattle-based health plan.

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 Group Health Center for Health Studies, Harborview Injury Prevention and Research Center (HIPRC), and Seattle Children's Hospital Research Institute conducted the study, which appeared in the December 2007 issue of the journal Pediatrics.

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

Rivara is a researcher with HIPRC and Children's. The principal investigator for the study is Robert S. Thompson, MD, senior investigator at Group Health Center for Health Studies.

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 the information regarding their lifetime history with IPV. The study defines IPV as both physical abuse (slapping, hitting, forced sex) and nonphysical abuse (threats, and chronic disparaging remarks or controlling behavior.) The 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 of mothers with IPV, 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 becoming perpetrators of violence.

In 2006, the Group Health study team 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 mother's exposure to IPV and their 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,” he added.

The researchers found:

• Health care utilization and health care costs were higher in most categories of care for children whose mother had a history of IPV, with significantly higher levels of mental health costs and services, primary care visits, primary care costs, and laboratory costs. Overall, the annual costs of health care were 11 percent higher than those for children of mothers without IPV.

• Children of mothers with a history of IPV that ended before the child was born had significantly greater utilization of mental health, primary care, specialty care, and pharmacy services. Health care costs were 24 percent higher for children in this group compared to children whose mothers had experienced no IPV 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 as 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 IPV.

The authors recommend that health care 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.