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Abstract
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The 2002 World Report on Violence and Health provided the foundation for global recognition of violence as a health issue. Since then, knowledge of the health consequences of exposure to violence has proliferated, with evidence linking exposure to child abuse and neglect and other adverse childhood experiences (ACEs) with many of the leading causes of death and increasing evidence of the effects of intimate partner violence (IPV) on chronic physical and mental health problems.
Policy and guideline changes have paralleled this emerging knowledge with varied success. The importance of recognising, responding to, and preventing ACEs throughout health and other systems has increased, driven in part by championship from agencies like the Centers for Disease Control and Prevention. Other calls, like WHO recommendations for health-care provision for women who have experienced IPV or sexual violence have had more mixed results. For example, despite guidelines advocating for routine enquiry (screening) for IPV within health-care settings, IPV screening rates remain low (eg, 8·5% within primary care settings) and the rates of successful identification of IPV are even lower. Given that 27% of women globally will experience IPV in their lifetime, health-care systems are missing opportunities to respond to this important issue.
Currently recognition of how proposed health-care responses to ACEs and IPV could be integrated is limited. In this issue, Shabeer Syed and colleagues present a study exploring how ACEs and IPV may co-occur, using linked electronic health records to assess the prevalence of family adversity and its associations with indicators of IPV. They developed a population-based birth cohort of almost 130 000 children and parents and linked information from mother-child pairs and mother-father-child triads with data from general practices, emergency departments, outpatient visits, hospital admissions, and mortality records. They assessed 33 clinical indicators of family adversity, then estimated the probability of IPV associated with each adversity. Although overall recording of IPV in the clinical records was low (an estimated 2·1%, 95% UI -0·13 to 6·0, of the sample), the prevalence of family adversity was high, with 41·2% having a record of any family adversity between 1 year before and 2 years after birth of the index child. The authors found that all family adversities were significantly associated with IPV, and that the probability of IPV increased with the number of family adversities experienced (eg, 4·4 per 100 children and parents among those with one adversity, 15·1 per 100 children and parents among those with three or more adversities). The authors then reinforce and extend our knowledge of health consequences associated with IPV by comparing the prevalence of parental mental and physical health problems among families with and without IPV.
Language: en |