Sample Review
Domestic Violence

Intimate partner violence, maternal stress, nativity, and risk for maternal maltreatment of young children. Catherine A Taylor, Neil B Guterman, Shawna J Lee, Paul J Rathouz. Am J Public Health 2009;99:175-183. (from New Orleans, LA and Chicago, IL)

Review from Summer 2009 issue

This study sought to evaluate the association between intimate partner violence (IPV), maternal risk factors such as stressors, and major depression and maternal child maltreatment. The primary aim of the study was to determine if there was a unique relationship between IPV and child maltreatment when controlling for these other risk factors. The study sample involved mothers selected from families participating in the Fragile Families and Child Well-Being Study (FFCWS) which has been collecting data from 20 large US cities since 1998.

Mothers included in the present report had participated in wave three of the FFCWS and had also completed an add-on module, the In-Home Longitudinal Study of Pre-School Aged Children. Only mothers with a current partner (79%) were included in the IPV study. Individuals were selected who had three-year-old children at the time of the in-home interviews, which had been conducted from 2001 to 2004 (n=2,508).

Maternal child maltreatment was determined by maternal responses to multiple questions that focused on maternal psychological aggression, such as shouting and yelling; physical aggression, such as shaking and hitting with an object; neglect, such as leaving the child alone or being too drunk or high to care for the child; and spanking. The mother was also asked to quantify the frequency with which the behavior occurred.

Questions related to IPV focused on the mother as a victim, not as a perpetrator of IPV. The seven specific items included such things as being slapped or kicked or being pressured to have sexual intercourse. Responses were categorized as never, sometimes, or always. Three other potentially confounding variables were also examined, such as maternal parenting stress, major depression, and having considered an abortion, thought to be a proxy for an unwanted pregnancy.

Forty percent of the mothers in this study had experienced IPV. Mothers who had experienced IPV were significantly more likely to use psychological and physical aggression against their children, spank their children, and have at least one instance of neglect toward their children than those mothers who had not experienced IPV. When a regression analysis was conducted adjusting for all covariates, IPV and parenting stress were statistically associated with psychological and physical aggression, neglect, and spanking. Maternal depression was associated only with spanking.

The authors conclude that their findings do not support a simple model linking maternal IPV victimization and child maltreatment. Instead, they speculate that IPV is probably reciprocal where both partners act as assailants, but they acknowledge that male-perpetrated IPV increases the risk of partner injury. Although they queried only about maternal child maltreatment, they correctly opine that child maltreatment was likely perpetrated by both parents. Their study did not inquire about these other issues. Other methodological limitations, including desirability and recall bias, were also readily acknowledged.

The authors endorse a public health approach to addressing IPV and child maltreatment and the relationship between these two adverse childhood experiences. They recommend incorporating IPV-related programs into the child welfare system and providing parallel training in IPV and child maltreatment for all professionals dealing with child maltreatment, such as teachers and clinicians. Although they also promote home visitation, they acknowledge that the data on the benefits of home visitation show limited efficacy in the face of IPV.

    Reviewed by Carol D. Berkowitz M.D.

Reviewer’s Note:
Enhanced home visitation programs need to consider how to address IPV more effectively. Data would suggest that IPV perpetrator programs need to be implemented to actually impact on violence within the home.