Population, Policy, and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK.
Population, Policy, and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK.
Lancet Public Health. 2023 Jul;8(7):e520-e534. doi: 10.1016/S2468-2667(23)00119-6.
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.
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.
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).
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.
NIHR Policy Research Programme.
关于在医疗保健环境中出现的受亲密伴侣暴力（IPV）影响的儿童和父母的临床特征，人们知之甚少。我们使用初级和二级保健的电子健康记录（EHR），从出生前 1 年到出生后 2 年（前 1000 天），检查了家庭逆境、健康特征与儿童和父母 IPV 之间的关联。我们比较了有和没有记录的 IPV 的父母在健康问题方面的差异。
我们在英格兰建立了一个基于人群的儿童和父母队列（年龄在 14-60 岁之间），包括来自母婴对子（没有确定的父亲）和母婴父三角的 EHR。我们通过一般实践（临床实践研究数据链接 GOLD）、急诊部门、门诊、住院和死亡记录跟踪队列。家庭逆境包括 33 个临床指标，包括父母心理健康问题、父母物质滥用、不良家庭环境和高风险虐待儿童的表现。父母的健康问题包括 12 种常见的合并症，范围从糖尿病和心血管疾病到慢性疼痛或消化疾病。我们使用调整和加权逻辑回归模型来估计与每个逆境相关的每 100 名儿童和父母中 IPV 的概率（100 名儿童和父母中每 100 名儿童和父母的概率），以及与 IPV 相关的父母健康问题的时期流行率。
我们纳入了 129948 名儿童和父母，包括 95290 对母婴父三角（73.3%）和 34658 对母婴对子（26.7%），这些数据是在 2007 年 4 月 1 日至 2020 年 1 月 29 日之间收集的。据估计，129948 名儿童和父母中有 2689 名（2.1%）记录了 IPV，95290 名（95%CI 2.0-2.3）在出生前 1 年至出生后 2 年内有任何家庭逆境。所有家庭逆境都与 IPV 显著相关。大多数有 IPV 的父母和孩子在第一次 IPV 记录之前都有记录的逆境（1612 名[60.0%]的 2689 名）。无逆境的儿童和父母每 100 人中有 0.6 人发生 IPV（95%CI 0.5-0.6），有一个逆境的儿童和父母每 100 人中有 4.4 人发生 IPV，有三个或更多逆境的儿童和父母每 100 人中有 15.1 人发生 IPV。有 IPV 的母亲比没有 IPV 的母亲有更高的身体（73.4%比 63.1%，优势比[OR]1.6，95%CI 1.4-1.8）和心理健康问题（58.4%比 22.2%，OR 4.9，4.4-5.5）的患病率。有 IPV 的父亲比没有 IPV 的父亲有更高的心理健康问题（17.8%比 7.1%，OR 2.8，2.4-3.2）和相似的身体健康问题（29.6%比 32.4%，OR 0.9，0.8-1.0）的患病率。
在接受医疗保健的儿童和父母中，每五分之二有记录的父母有心理健康问题、父母物质滥用、不良家庭环境或虐待高危表现，这些都发生在出生前 1000 天内。在有家庭逆境的儿童和父母中，每 22 个中也有 1 个在 2 岁之前有记录的 IPV。初级和二级保健人员在父母或儿童出现与 IPV 相关的家庭逆境或健康问题时，应安全地询问 IPV，并做出适当的回应。
英国国家卫生研究院政策研究计划。
