Nevertheless, the pooled effect sizes for a range of community-wide mental health interventions are impressive. What about prevention? Largescale interventions aimed at improving mental health in general and reducing aggressive behaviour in particular seem ambitious. Training about violence should be included in routine multiagency teaching on child protection. Simplistic assumptions about why women get into and remain in violent situations must be discarded-life for these families is seldom simple. Sensitive questions about unacceptable behaviour at home may help children and parents to reveal distressing situations. They do not need a detailed knowledge of family law, 8 but they do need to know when and how to seek expert help and how to avoid making matters worse. Health visitors, school nurses, and community midwives are well placed to prevent, identify, and intervene when domestic violence affects children or partners. Next, all health professionals should be more aware of domestic violence in clinical practice. The same may be true for other forms of violence in the family. What can be done about it? Many of the causes of violence are beyond the reach of health professionals, but in the case of child abuse acknowledgement by professionals and society that child abuse happened and was unacceptable was the first step towards protecting children. A genetic predisposition to violent behaviour may make a small contribution. These complex sequences and associations are probably mediated through a mixture of stress, poor parenting, low self esteem, shame, and self blame. The history of violence between partners often begins with fights and assaults on dates. Conduct disorder and antisocial behaviour, even at the age of 7, are powerful predictors of violent behaviour towards partners in adolescence and early adult life. 6 If the mother changes address often or enters a refuge to escape her violent partner, social isolation and loss of friends add to the children’s insecurity.Įxposure to violence in the home is linked to juvenile crime. Affected children often have other problems, such as involvement in endemic street and playground violence, bullying in school, educational failure, and exclusion from or dropping out of school, and an increased incidence of attention deficit hyperactivity disorder. The impact on children depends on the intensity and frequency of the violence more than their gender or age, but the presenting features are as varied as in adults. Conversely, in 60% of cases where children have been abused the mother will also have been a victim. Children in violent households are three to nine times more likely to be injured and abused, either directly or while trying to protect their parent. Women are more likely to be injured than men in domestic incidents, but men are not necessarily the initial aggressors.Īdult victims of repeated violence suffer physical injuries a range of emotional and psychological problems, including self harm, eating disorders, post traumatic stress disorder, suicide and somatic complaints such as irritable bowel syndrome. It may involve abuse, accusation, and innuendo deprivation of freedom or physical or sexual assault. Violence between adult partners occurs in all social classes, all ethnic groups and cultures, all age groups, in disabled people as well as able bodied, and in both homosexual and heterosexual relationships. Several forms of violence and abuse may occur in the same family children, parents and their partners, and older family members may be victims or perpetrators and may switch roles at different times. 3Įstimates of how many people experience violence in the family depend on definition, circumstances, and the method of inquiry, 1 but even the lowest figures show that this is a common and serious problem. 1 Violence in the family includes “any act or omission committed within the framework of the family by one of its members that undermines the life, the bodily or psychological integrity, or liberty of another member of the same family or that seriously harms the development of his or her personality.” 2 Separating the causes and effects of domestic violence from those of poor parenting, poverty, homelessness, substance abuse, and violent neighbours and schools is a tough research challenge. Physical violence in the family probably blights the lives of more people than all genetic disorders put together, yet research on the issue has struggled to achieve scientific legitimacy.
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