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Identification of violence in the home: pediatric and parental reports
B D Kerker1, S M Horwitz, J M Leventhal
1Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Conn 06520-8034, USA.
Insights
Pediatricians detect significantly less domestic violence and child abuse than parents report. Direct questioning by physicians about domestic violence and harsh discipline is recommended to improve identification rates.
Area of Science:
- Pediatric Health
- Family Medicine
- Public Health
Background:
- Domestic violence and harsh discipline are significant concerns in child welfare.
- Pediatricians play a crucial role in identifying and addressing these issues.
- Discrepancies exist between parental self-reports and physician detection of these problems.
Purpose of the Study:
- To compare domestic violence and child abuse rates reported by mothers versus those identified by physicians.
- To examine the association between domestic violence and harsh discipline practices.
- To evaluate the effectiveness of pediatricians in detecting these sensitive issues.
Main Methods:
- Community-based study involving pediatric practices in Connecticut.
- Interviews conducted with parents and pediatricians.
- Utilized Child Behavior Checklist and in-person interviews for data collection.
Main Results:
- Mothers reported domestic violence in 4.2% of cases, while pediatricians detected it in only 0.3%.
- Mothers reported harsh discipline (hitting with a mark) in 21.6% of cases, compared to 0.5% identified by physicians.
- Mothers reporting domestic violence were more likely to report harsh discipline.
Conclusions:
- Parental reports significantly exceed physician detection rates for both domestic violence and harsh discipline.
- Pediatricians should implement direct questioning strategies to elicit accurate information on domestic violence and harsh discipline.
- Improving physician inquiry methods can enhance the identification and intervention for at-risk families.
Objectives:
To compare the rates of domestic violence reported by mothers with those identified by physicians, to compare the rates of harsh discipline practices reported by mothers with the rates of abuse identified by physicians, and to examine the relationship between reported domestic violence and harsh discipline practices.
Designs:
Interviews with parents and pediatricians to compare pediatric detection of domestic violence and child abuse with parental reports of domestic violence and harsh discipline practices.
Setting:
Community-based pediatric practices in the 13-town greater New Haven, Conn, area.
Participants:
Of the 23 practices invited, 19 agreed to participate. Of the 2,006 parents of eligible 4- to 8-year-olds asked to participate, 1,886 (94%) completed the Child Behavior' Checklist. Of those invited into the interview portion, 1,148 (83%) completed the 90-minute in-person interview.
Main Outcome Measures:
Percentages of cases of domestic violence identified by pediatricians and reported by mothers. Percentages of cases of child abuse detected by pediatricians and percentages of mothers reporting that they have hit their children and left a mark.
Results:
Pediatricians detected domestic violence in 0.3% of the cases, but parents reported domestic violence in 4.2% kappa= 0.106 [95% confidence interval, -0.007 to 0.219]). Pediatricians identified physical abuse of children in 0.5% of the cases, while mothers reported hitting their children and leaving a mark in 21.6% (kappa = 0.003 [95% confidence interval, -0.018 to 0.024]). Mothers reporting domestic violence were significantly more likely to report hitting hard enough to leave a mark (relative risk, 1.6 ([95% confidence interval, 1.09-2.38]) compared with those not reporting domestic violence. Physicians identifying domestic violence were not significantly more likely to report child abuse than those not identifying domestic violence.
Conclusions:
Parents report more cases of violence than pediatricians detect. Pediatricians should ask parents directly about domestic violence and harsh discipline.