Elsevier

Child Abuse & Neglect

Volume 23, Issue 9, September 1999, Pages 845-853
Child Abuse & Neglect

Original Articles
Stressed parents with infants: reassessing physical abuse risk factors

https://doi.org/10.1016/S0145-2134(99)00063-0Get rights and content

Abstract

Objective: This study aimed to examine the relationship between a range of potentially adverse psychosocial and demographic characteristics identified in the immediate postpartum period and child physical abuse potential at 7 months.

Method: Data collected as part of a randomized controlled trial of a nurse home visiting programme for vulnerable families with newborns was used. Women (181) were recruited in the immediate postpartum period. At 7 months, 151 participants were available for evaluation. Potential for child physical abuse was assessed using the Child Abuse Potential (CAP) Inventory.

Results: Significant risk indicators identified by univariate analysis were financial stress, elevated Edinburgh Postnatal Depression Scale (EPDS) scores, education level less than 10 years, concern regarding the provision of housing, and domestic violence characterized by verbal and social abuse. There was no association between child abuse potential and sole parenthood, poverty, young maternal age, history of childhood abuse, or psychiatric history. Two variables were found to be of independent significance using a logistic regression model; elevated EPDS and perceived difficulty “making ends meet.”

Conclusions: The findings indicate that perceived stress relating to finances, accommodation and relationships in the immediate postpartum period are associated with heightened child physical abuse potential at 7 months. Elevated EPDS in the early postpartum period is also a risk indicator. The outcome of this study suggests that perinatal assessment of child abuse risk is possible and simple and is related to perceived stressors at the time surrounding delivery. This is independent of a range of demographic variables traditionally thought to predict high risk.

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.

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    This study was funded by a grant to Susan Cadzow from the Royal Children’s Hospital Foundation and Golden Casket Australia.

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