How far does screening women for domestic (partner) - NIHR Health ...

DOI: 10.3310/hta13160 Health Technology Assessment 2009; Vol. 13: No. 16
social competence ratings, whereas their mothers
reported the greatest health and emotional
difficulties. The fourth study found that there
was no significant difference in the amount of
behavioural problems demonstrated by children
who had witnessed partner violence, children who
had been abused by their parents, and children
who had experienced child abuse and witnessed
partner violence.
Three studies examined partner violence and the
impact on children’s externalising and internalising
behaviours. The first study found that, compared
with controls, survivors reported feeling more
highly stressed as parents. The amount of stress
was the most powerful predictor of children’s
behaviour problems. Children from violent families
had more internalising behaviour problems
and were more aggressive than children from
the comparison group. The second study found
that witnessing physical and verbal interparental
violence was related to the type and extent of
behaviour problems displayed by young children.
Residents of refuges showed significant levels of
externalising and internalising behaviours with
lower levels of functioning than the non-refuge
group. The third study found that, compared
with controls, children who witness abuse and
are abused themselves showed the most distress,
followed by those witnessing abuse. Preschool
children were reported to have more difficulties
in adjustment than children at school. Two studies
examined the impact of partner violence on
children’s conduct problems. The first found that
parental marital abuse was associated with conduct
problems in children who witnessed it. The second
study found that two-thirds of the child residents
of a partner violence refuge had experienced
abuse or neglect. Of 21 schoolchildren, 46% had
academic problems; of 28 preschoolers, 39%
showed developmental delays; and of 48 children
of all ages, 75% demonstrated behaviour problems.
Two studies examined partner violence and the
impact on parental aggression. The first found
that parental aggression was highly associated with
having witnessed partner violence as a child. This
association did not vary by gender or by single
or dual parent status of the family. The second
study found a significant association between
marital conflict and children’s behaviour problems.
Boys exposed to marital conflict were at risk of
being abusive in their adult relationships. One
study examined the impact of partner violence
on children’s depressive symptoms and found
that children who were physically abused by their
parents and who witnessed violence were more
likely to report depressive symptoms. Mothers of all
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groups reported more problem behaviours than the
children acknowledged. Fathers in the same study
groups were no more likely to report behavioural
problems than fathers from the control group.
Kolbo and colleagues 69 reviewed 29 studies
of the initial effects on children of witnessing
partner violence, extending a previous review
by another group. 73 Their findings indicated
that children who witness partner violence are
at risk for maladaptation in one or more of the
following domains of functioning: (1) behavioural,
(2) emotional, (3) social, (4) cognitive and (5)
physical. The case studies examining behavioural
functioning all shared a high degree of congruence
in their findings of witnesses’ undesirable
behaviour; however, 4 of the 16 correlational
studies found no significantly higher instances of
conduct problems, hyperactivity and aggression
among witnesses of abuse than among comparison
children. When only the findings from the recently
conducted studies are compared, only one study
does not find significant differences. This suggests
that the evidence of the effects of witnessing
partner violence on children’s behavioural
functioning is less equivocal than in previous
reviews. However, the reviewers do not state
whether recently conducted studies are of a higher
quality than those included in previous reviews.
Emotional functioning was assessed in 21
correlational studies and five case studies. Although
the results of the case studies were relatively
similar, 3 of the 13 correlational studies found
no significant differences between witness and
comparison groups. As a whole, these equivocal
findings are consistent with previous reviews.
However, when looking at only the most recently
conducted studies, significant differences in
emotional functioning and behavioural functioning
are consistently found between witness and
comparison groups. Thus the recent research is
unequivocal in its finding that witnessing partner
violence affects children’s emotional functioning,
although the reviewers do not comment on
whether the recent studies have a higher quality of
design or execution.
Eleven studies examined social functioning as an
outcome. Six studies documented a significant
relationship between social functioning and
witnessing partner violence; however, four of
the five recently conducted studies did not find
child witnesses to have significantly lower social
competence scores than comparison groups.
Although some children from violent homes
appear to be at increased risk of developing
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