Family Violence Patterns Change During Pandemic

Tara Haelle

October 10, 2021

Among adolescents treated for injuries caused by family-member violence, the proportion of incidents that involved illegal drugs or weapons more than doubled during the pandemic, and incidents that involved alcohol nearly doubled, according to data presented October 10 at the American Academy of Pediatrics 2021 National Conference.

"The COVID-19 pandemic amplified risk factors known to increase family interpersonal violence, such as increased need for parental supervision, parental stress, financial hardship, poor mental health, and isolation," said investigator Mattea Miller, an MD candidate at the Johns Hopkins University School of Medicine in Baltimore.

To examine the issue, she and her colleagues "sought to characterize the prevalence and circumstances of adolescent injuries resulting from family interpersonal violence," Miller told Medscape Medical News.

Their retrospective analysis involved children 10 to 15 years of age seen before or during the pandemic in the emergency department at Johns Hopkins Children's Center for injuries that resulted from a violent incident with a family member.

Of the 819 incidents of violence-related injuries seen during the study period — the prepandemic ran from January 1, 2019 to March 29, 2020, and the pandemic period ran from March 30, 2020, the date a stay-at-home order was first issued in Maryland, to December 31, 2020 — 448 (54.7%) involved a family member. The proportion of such injuries was similar before and during the pandemic (54.6% vs 54.9%; P = .99).

Most (83.9%) of these incidents occurred at home, 76.6% involved a parent or guardian, and 66.7% involved the youth being transported to the hospital by police.

To see that amount of violence in adolescents was unexpected.

It is surprising that families accounted for such a high level of violence involving adolescents, said Christopher S. Greeley, MD, MS, chief of the division of public health pediatrics at Texas Children's Hospital and professor of pediatrics at Baylor College of Medicine in Houston, who was not involved in the research.

"The most common source of child physical abuse in younger children — infants and toddlers — are parents," who account for about 75% of cases, "but to see that amount of violence in adolescents was unexpected," he told Medscape Medical News.

Patients in the study cohort were more likely to be Black than the hospital's overall emergency-department population (84.4% vs 60.0%), and more likely to be covered by public insurance (71.2% vs 60.0%).

In the study cohort, 54.0% of the patients were female.

"We were surprised to see that 8% of visits did not have a referral to a social worker" —92% of patients in the study cohort received a social work consult during their visit to the emergency department — and that number "did not vary during the COVID-19 pandemic," Miller said. The pandemic exacerbated the types of stresses that social workers can help address, so "this potentially represents a gap in care that is important to address," she added.

Increase in Use of Alcohol, Drugs, Weapons

The most significant increases from the prepandemic period to the pandemic period were in incidents that involved alcohol (10.0% vs 18.8%; P ≤ .001), illegal drugs (6.5% vs 14.9%; P ≤ .001), and weapons, most often a knife (10.7% vs 23.8%; P ≤ .001).

"An obvious potential explanation for the increase in alcohol, drug, and weapons [involvement] would be the mental health impact of the pandemic in conjunction with the economic stressors that some families may be feeling," Greeley said. Teachers are the most common reporters of child abuse, so it's possible that reports of violence decreased when schools switched to remote learning. But with most schools back to in-person learning, data have not yet shown a surge in reporting, he noted.

The "epidemiology of family violence may be impacted by increased time at home, disruptions in school and family routines, exacerbations in mental health conditions, and financial stresses common during the pandemic," said senior study investigator Leticia Ryan, MD, MPH, director of research in pediatrics at Johns Hopkins Medicine.

And research has shown increases in the use of alcohol and illegal drugs during the pandemic, she noted.

"As we transition to postpandemic life, it will be important to identify at-risk adolescents and families and provide supports," Ryan told Medscape Medical News. "The emergency department is an appropriate setting to intervene with youth who have experienced family violence and initiate preventive strategies to avoid future violence."

Among the strategies to identify and intervene for at-risk patients is the CRAFFT substance use screening tool. And "case management, involvement of child protection services, and linkage with relevant support services may all be appropriate, depending on circumstances," Miller added.

"Exposure to family violence at a young age increases the likelihood that a child will be exposed to additional violence or become a perpetrator of violence in the future, continuing a cycle of violence," Miller explained. "Given that studies of adolescent violence often focus on peer violence, a better understanding of the epidemiology of violence-related injuries resulting from family violence is needed to better inform the development of more comprehensive prevention strategies."

This study did not note any external funding. Miller, Greeley, and Ryan have disclosed no relevant financial relationships .

American Academy of Pediatrics (AAP) 2021 National Conference. Presented October 10, 2021.

Tara Haelle is a Dallas-based science and medical journalist.

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