Original ArticlesStressed parents with infants: reassessing physical abuse risk factors☆
Introduction
THE CONCEPT OF screening for families at risk of child abuse has been explored extensively Appleton 1997, Browne and Herbert 1997, Lealman et al 1983, Leventhal et al 1989, Wilson et al 1996. As in any screening method for a condition with low incidence, the main problem in practical terms is the high false positive rate. Screening for families at heightened risk of child abuse nevertheless has potential benefit in that effective intervention can be targeted at groups who are more vulnerable to parenting difficulties rather than individuals labeled as potential child abusers. There are encouraging indications in the literature that prevention programmes aimed at selected “at risk” families can reduce physical abuse and neglect Olds et al 1997, Olds et al 1986, Olds et al 1995, and improve a range of other outcomes for children, mothers and families Armstrong et al 1999, Johnson et al 1993, Olds et al 1994.
An expansive range of sociodemographic variables are traditionally considered to incur enhanced risk of physical abuse. There has emerged from the literature no strong single risk determinant, but rather a series of broadly defined markers. Among those most frequently cited are young maternal age, poverty, sole parenthood, “social isolation,” parental substance abuse, psychiatric illness, and history of childhood abuse Burrell et al 1994, Chaffin and Hollenberg 1996, Connelly and Straus 1992, Dubowitz et al 1987, Emerick et al 1986, Haskett et al 1994, Kinard 1996. However, taken as a whole the literature provides conflicting evidence in this regard Connelly and Straus 1992, Coohey 1996, Haskett et al 1994, Leventhal et al 1989, Stier et al 1993.
The purpose of the present study was to examine the relationship between a range of potentially adverse family characteristics identified in the immediate postpartum period and child abuse potential at infant age 7 months in a vulnerable parent population. The peripartum period is ideal for identification of families at risk as it allows commencement of preventative measures prior to discharge from hospital and establishment of a trusting relationship with the family. Child abuse potential was assessed when the infant was 7 months of age. The rationale for this was that the risk of severe physical abuse is highest throughout the first year of life Merten et al 1983, Sato et al 1989, and at around 7 months of age standard community services tend to diminish in this country.
Section snippets
Subjects
The present study used data collected as part of the Family C.A.R.E. Project, a randomized controlled trial of a nurse home visiting program for “at risk” families with newborns (Armstrong et al., 1999). The subjects were recruited from a major urban tertiary referral hospital. Between January 11, 1996 and September 9, 1996, 1,070 women were admitted to the public (non fee paying) postnatal wards following the birth of a live infant. Of these 1,008 were offered the opportunity to consent to
Results
The attrition rate during the first 7 months of the longitudinal study was 16%, leaving a total of 151 mothers available to complete the CAP Inventory when their infants reached 7 months of age. The total study group obtained higher scores on the CAP Inventory (M = 116, SD = 88) than documented normative data (M = 91, SD = 75) (Milner, 1986). Using the published cut-off score of 215, 23 (15.3%) of the subjects were classified as having an elevated CAP Inventory score and thus increased abuse
Discussion
This study suggests that for a socially and economically disadvantaged population of families with newborns the best predictors in the immediate postpartum period of child physical abuse potential at 7 months are stress factors. Financial stress, independent of income level, and maternal distress as measured by a postnatal depression screening tool have proved to be the most powerful predictors of child physical abuse potential in this vulnerable population, outweighing other characteristics
Conclusions
This project supports the hypothesis that the best predictors of child physical abuse potential during infancy are perceived family stressors; financial, partnership, and maternal. These findings have implications for all professionals involved in the care of infants and their families, particularly those involved in child abuse preventative services. Improved awareness of psychosocial risk factors should lead to more effective screening and thus help target allocation of resources and funds to
Acknowledgements
The authors wish to thank David Firman from the Health Information Office, Queensland Health for advice on statistical methods.
References (37)
Establishing the validity and reliability of clinical practice guidelines used to identify families requiring increased health visitor support
Public Health
(1997)- et al.
Onset of physical abuse and neglect: Psychiatric, substance abuse and social risk factors from prospective community data
Child Abuse & Neglect
(1996) - et al.
Mother’s age and risk for physical abuse
Child Abuse & Neglect
(1992) Child maltreatment: Testing the social isolation hypothesis
Child Abuse & Neglect
(1996)- et al.
Psychiatric diagnoses of self-reported child abusers
Child Abuse & Neglect
(1993) - et al.
Identification during the postpartum period of infants who are at high risk of child maltreatment
The Journal of Pediatrics
(1989) - et al.
The role of parental stress in physically abusive families
Child Abuse & Neglect
(1991) - et al.
A randomized controlled trial of nurse home visiting to vulnerable families with newborns
Journal of Paediatrics and Child Health
(1999) - Boyce, P., Stubbs, J., & Todd, A. (1993). The Edinburgh Postnatal Depression Scale: Validation for an Australian...
- Browne, K., & Herbert, M. (1997). Predicting and preventing child maltreatment. In Preventing family violence (pp....
Predicting child abuse potential across family types
Child Abuse & Neglect
Inflicted and noninflicted injuries: Differences in child and familial characteristics
American Journal of Orthopsychiatry
Risk factors for traumatic infant death in Oregon, 1973 to 1982
Pediatrics
Links between early post-partum mood and post-natal depression
British Journal of Psychiatry
Individual differences in risk of child abuse by adolescent mothers: Assessment in the perinatal period
Journal of Child Psychology and Psychiatry
Community mothers’ programmeRandomised controlled trial of non-professional intervention in parenting
British Medical Journal
Cited by (117)
Paid Family Leave and Mental Health in the U.S.: A Quasi-Experimental Study of State Policies
2021, American Journal of Preventive MedicineCitation Excerpt :The prevalence of postpartum depression in men, although less well characterized, is estimated at 8%–10%.10,11 Postnatal mental health disorders have also been associated with poor health outcomes in children of affected parents from infancy through adolescence,5,12–14 including poorer cognitive, behavioral, and emotional development, and higher incidence of neglect or abuse.15–23 Possible mechanisms include decreased parental attention, breastfeeding, and preventive healthcare visits.18,24–26
Perinatal mental health and risk of child maltreatment: A systematic review and meta-analysis
2019, Child Abuse and NeglectMindfulness and trauma symptoms predict child abuse potential in risk-exposed, men and women during pregnancy
2019, Child Abuse and NeglectExperiences of Somali and Oromo youth in the child protection system
2017, Children and Youth Services Review
- ☆
This study was funded by a grant to Susan Cadzow from the Royal Children’s Hospital Foundation and Golden Casket Australia.