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Resources addressing intimate partner violence (IPV) play a role in shaping how physicians conceptualize and perform their roles in caring for affected patients. This study combines environmental scanning with critical discourse analysis (CDA) to parse how roles of physicians were represented in 28 education materials and policy documents about IPV, taking the Canadian training milieu as an example. We developed a cyclical model of three core physician roles in addressing IPV—learning about IPV, identifying patients experiencing IPV, and responding to patients' disclosures of IPV. The construction of these physician roles is suggestive of an ongoing process of medicalization of IPV. [ABSTRACT FROM AUTHOR]

Maternal exposure to childhood maltreatment (CM) is associated with offspring behavioral problems; however, little work has examined these associations longitudinally across child development. This study examined the effects of maternal history of CM on trajectories of child internalizing and externalizing behavior measured from toddlerhood to preschool, and the role of maternal depressive symptoms and parenting behavior as potential mediators. Participants included 115 mother–child dyads recruited from a hospital maternity ward. Maternal CM was measured at 3-months postpartum. At 18, 36, and 60 months, maternal depressive symptoms and child behavior were assessed via maternal report and parenting behavior was assessed through direct observation. Findings indicated that children of mothers exposed to CM demonstrated poorer trajectories of problem behavior across early childhood. Maternal depressive symptoms mediated the relation between CM and children's internalizing problems. Findings highlight the importance of screening for maternal depressive symptoms and early intervention for maternal and child mental health. [ABSTRACT FROM AUTHOR]

Aims: To identify factors that influenced: (1) integration of an intimate partner violence intervention into the Nurse‐Family Partnership programme and (2) utilization of the intervention with fidelity to the clinical pathway by nurses in their home visits. Design: A qualitative descriptive study embedded in the intervention arm (n = 7 sites) of a 15‐site cluster randomized clinical trial to evaluate the intimate partner violence intervention. Methods: Semi‐structured interviews (n = 13) were conducted with supervisors. Nurses at the seven sites shared their experiences in focus groups conducted at two time points (n = 14 focus groups, 12 months after baseline and following collection of client trial data). Qualitative data were generated between May 2012 and September 2016, with this post hoc analysis completed in 2021. Focus group data were analysed using a rapid qualitative analysis technique. Conventional content analysis was used to categorize data from the supervisor interviews. Results: Integration was negatively impacted by: (1) a lack of centralized programme support and (2) competing programme demands. At the practice level, multiple factors related to supervisor capacity, preservation of the nurse–client relationship and nurse, client and intervention attributes influenced nurses' capacity to address intimate partner violence with fidelity to the clinical pathway. A lack of privacy in home visits was the most common barrier to addressing clients' experiences of violence. The need for increased time for nurses to develop clinical expertise prior to the evaluation of the intervention was also identified. Conclusion: Before implementing an intimate partner violence intervention, home visitation programmes need to attend to site readiness, provide support to supervisors to facilitate implementation, and provide nurses with time to develop the expertise and clinical judgement required to use a complex intervention whilst also respecting clients' agency to determine when and how they will respond to the violence in their relationships.ImpactWhat problem did the study address?Given the positive impacts that participating in the Nurse‐Family Partnership intimate partner violence education had on nurse home visitors' attitudes and confidence to address this type of violence experienced by first‐time mothers, it was important to understand what factors contributed to the low fidelity of intervention implementation in practice, a factor that may help to explain the lack of client‐level impacts on maternal outcomes.What were the main findings?Implementation of an intimate partner violence intervention in a nurse home visiting programme was influenced by contextual factors at both programme and practice levels. At the practice level, a lack of privacy in the home limited nurses' capacity to use the intervention. Supervisors were identified as having an important role to support nurses develop the expertise to use the intervention. Nurses also consistently balanced the intervention requirements to address intimate partner violence with an understanding of the complexity of this type of violence in young women's lives and respect for clients' agency to determine when and how they will respond to the violence in their relationships.Where and on whom will the research have an impact?These findings will be of interest to: (1) researchers developing and evaluating complex nursing interventions to address intimate partner violence in home visitation programmes and (2) stakeholders leading the implementation of novel innovations in the Nurse‐Family Partnership programme. [ABSTRACT FROM AUTHOR]

Background: Adverse childhood experiences (ACEs) are associated with multimorbidity in adulthood. This link may be mediated by psychosocial and biological factors, but evidence is lacking. The current study evaluates this mediation model. Method: We analyzed data from the Canadian Longitudinal Study of Aging (N = 27 170 community participants). Participants were 45–85 years at recruitment, when allostatic load and social engagement data were collected, and 3 years older at follow-up, when ACEs and multimorbidity data were collected. Structural equation modeling was used to test for mediation in the overall sample, and in sex- and age-stratified subsamples, all analyses adjusted for concurrent lifestyle confounds. Results: In the overall sample, ACEs were associated with multimorbidity, directly, β = 0.12 (95% confidence interval 0.11–0.13) and indirectly. Regarding indirect associations, ACEs were related to social engagement, β = −0.14 (−0.16 to −0.12) and social engagement was related to multimorbidity, β = −0.10 (−0.12 to −0.08). ACEs were related to allostatic load, β = 0.04 (0.03–0.05) and allostatic load was related to multimorbidity, β = 0.16 (0.15–0.17). The model was significant for males and females and across age cohorts, with qualifications in the oldest stratum (age 75–85). Conclusions: ACEs are related to multimorbidity, directly and via social engagement and allostatic load. This is the first study to show mediated pathways between early adversity and multimorbidity in adulthood. It provides a platform for understanding multimorbidity as a lifespan dynamic informing the co-occurrence of the varied disease processes represented in multimorbidity. [ABSTRACT FROM AUTHOR]

Estimates suggest that 15% of children in the United Kingdom have been exposed to at least one form of domestic violence (DV) during their childhood, with more than 3% having witnessed an incident during the past year. This exposure increases the risk of children suffering both short‐term and long‐term impacts, including effects on their behaviour, social development, physical and mental health, educational attainment and quality of life. In addition, children living in environments where there is DV are at higher risk of maltreatment. Adult relatives and friends of the family often observe the experiences of children in situations of DV, and have the potential to shed light in a way that children and survivors may struggle to articulate, or be reluctant to acknowledge or disclose. Such accounts are largely absent from existing research, and yet bring a perspective which can broaden our understanding of the impact that DV has on children. This paper reports a secondary analysis of qualitative data collected during 21 in‐depth interviews with people across the United Kingdom who were a friend or family member of a woman experiencing DV. An inductive thematic analysis was undertaken and the themes generated were as follows: 'the context of DV: a chaotic and unpredictable home life'; 'the roles children assume within households where there is DV including: witness of, victim of and conduit of violence and abuse',; 'the impacts of DV on children'; and 'children's coping and resilience'. The implications of these findings are discussed using a basic needs model lens. [ABSTRACT FROM AUTHOR]

Objectives: To describe the development and psychometric properties of the 2014 Ontario Child Health Study Emotional Behavioural Scales (OCHS-EBS) for dimensional measurement of 7 disorders based on criteria from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).Methods: Scale items were selected by agreement among 19 child psychologists and psychiatrists rating the correspondence between item descriptions and DSM-5 symptoms. Psychometric evaluation of the item properties and parent/caregiver and youth scales came from a general population study of 10,802 children and youth aged 4 to 17 years in 6537 families. Test-retest reliability data were collected from a subsample of 280 children and their caregivers who independently completed the OCHS-EBS checklist on 2 occasions 7 to 14 days apart. Structural equation modelling was used to assess internal and external convergent and discriminant validity-the latter tested against the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID).Results: Confirmatory factor analyses exhibited adequate item fit to all scales. Except for conduct disorder and youth-assessed separation anxiety disorder, internal (Cronbach's α) and test-retest reliability (Pearson's r) for scale scores were 0.70 or above. Except for youth-assessed conduct disorder, the OCHS-EBS met criteria for internal and convergent and discriminant validity. Compared with the MINI-KID, the OCHS-EBS met criteria for external convergent and discriminant validity.Conclusions: The OCHS-EBS provide reliable and valid dimensional measurement of 7 DSM-5 disorders assessed by caregivers and youth in the general population. Part II describes use of the OCHS-EBS as a categorical (present/absent) measure of disorder. [ABSTRACT FROM AUTHOR]

Child maltreatment is linked to distinct neurophysiological patterns and social-emotional vulnerability. Relations among maltreatment, relative resting frontal alpha asymmetry, shyness, and psychopathology were examined prospectively. Adolescent girls (age 14-16) who experienced child maltreatment (N = 55) were compared to nonmaltreated controls (N = 25), and returned for 6- and 12-month follow-ups. Among participants exhibiting relative right frontal asymmetry, maltreated adolescents reported higher shyness than controls at Time 1. Low-stable and high-stable shyness trajectories were observed for maltreated participants. Compared to low shy, participants in high-shy trajectory reported at Time 3: higher neuroticism and generalized anxiety; and lower extraversion if they also exhibited relative right frontal asymmetry. Thus, right frontal brain activity and shyness are involved in social-emotional vulnerability of adolescents who experienced child maltreatment. [ABSTRACT FROM AUTHOR]

This study examines the association between childhood abuse and intimate relationship quality and attachment security in young adults. Data were drawn from the Ontario Child Health Study, a province-wide communitybased survey that collected baseline data in 1983 from 3,294 children (aged 4 to 16 years) and follow-up data in 2000/2001 (then aged 21 to 35 years). The sample comprised 1,885 men and women who had completed questionnaires regarding retrospective accounts of childhood abuse and current relationship status in 2000/2001. Childhood physical and sexual abuse was assessed using the short form of the Childhood Experiences of Violence Questionnaire. It was hypothesized that childhood physical and sexual abuse would be associated with adult intimate relationship functioning, adjusting for childhood family and individual factors, and that these associations would be mediated by participants' current mental health. The analysis for intimate relationship quality showed that current mental health reduced the association between physical abuse and poor relationship quality (beta 0.09 (se 0.02) to 0.08 (0.02)) and between sexual abuse and this outcome to a non-significant level ((beta 0.07 (se 0.03) to 0.05 (0.03)). The analysis for adult attachment security showed that current mental health reduced the association between physical abuse and insecure attachment to a non-significant level (OR 1.33 (95% CI 1.02-1.76) to OR 1.31 (0.98-1.76)) and between sexual abuse and this outcome (OR 1.89 (1.36-2.65) to OR 1.74 (1.19-2.52)). The importance of current mental health functioning in accounting for continuity in intimate relationship functioning from childhood to young adulthood is discussed. [ABSTRACT FROM AUTHOR]

Background: Physical punishment of children is an important public health concern. Yet, few studies have examined how physical punishment is related to other types of child maltreatment and violence across the lifespan. Therefore, the objective of the current study was to examine if harsh physical punishment (i.e., being pushed, grabbed, shoved, hit, and/or slapped without causing marks, bruises, or injury) is associated with an increased likelihood of more severe childhood maltreatment (i.e., physical abuse, emotional abuse, sexual abuse, physical neglect, emotional neglect, and exposure to intimate partner violence (IPV)) in childhood and perpetration or victimization of IPV in adulthood.Methods: Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions collected in 2004 to 2005 (n = 34,402, response rate = 86.7%), a representative United States adult sample.Results: Harsh physical punishment was associated with increased odds of childhood maltreatment, including emotional abuse, sexual abuse, physical abuse, physical neglect, emotional neglect, and exposure to IPV after adjusting for sociodemographic factors, family history of dysfunction, and other child maltreatment types (range 1.6 to 26.6). Harsh physical punishment was also related to increased odds of experiencing IPV in adulthood (range 1.4 to 1.7).Conclusions: It is important for parents and professionals working with children to be aware that pushing, grabbing, shoving, hitting, or slapping children may increase the likelihood of emotional abuse, sexual abuse, physical abuse, physical neglect, emotional neglect, and exposure to IPV in childhood and also experiencing IPV victimization and/or perpetration in later adulthood. [ABSTRACT FROM AUTHOR]

Objective: Child abuse can have devastating mental health consequences. Fortunately, not all individuals exposed to child abuse will suffer from poor mental health. Understanding what factors are related to good mental health following child abuse can provide evidence to inform prevention of impairment. Our objectives were to 1) describe the prevalence of good, moderate, and poor mental health among respondents with and without a child abuse history; 2) examine the relationships between child abuse and good, moderate, and poor mental health outcomes; 3) examine the relationships between individual- and relationship-level factors and better mental health outcomes; and 4) determine if individual- and relationship-level factors moderate the relationship between child abuse and mental health.Method: Data were from the nationally representative 2012 Canadian Community Health Survey: Mental Health ( n = 23,395; household response rate = 79.8%; 18 years and older). Good, moderate, and poor mental health was assessed using current functioning and well-being, past-year mental disorders, and past-year suicidal ideation.Results: Only 56.3% of respondents with a child abuse history report good mental health compared to 72.4% of those without a child abuse history. Individual- and relationship-level factors associated with better mental health included higher education and income, physical activity, good coping skills to handle problems and daily demands, and supportive relationships that foster attachment, guidance, reliable alliance, social integration, and reassurance of worth.Conclusions: This study identifies several individual- and relationship-level factors that could be targeted for intervention strategies aimed at improving mental health outcomes following child abuse. [ABSTRACT FROM AUTHOR]

The ultimate goal of trials is to identify interventions that can benefit individuals in the future. It is crucial, therefore, that they measure outcomes that reflect the priorities and expectations of those using the interventions. We consider this issue in relation to trials of interventions for children exposed to domestic violence and abuse (DVA). To explore this, we drew on data collected as part of a larger study to consider whether the types of outcomes measured in clinical trials reflect: (1) the perceived benefit of interventions reported in qualitative evaluation studies; and (2) the views of parents, professionals and young people as to what constitutes a 'good outcome'. We found that trials most frequently evaluated changes in children's symptoms and disorders, whereas children and parents, along with practitioners, had broader concepts of success that extended beyond narrow health-focused outcomes. A number of studies measured other types of outcomes, although there was inconsistency in the types of outcomes that were measured. Based on these findings, we discuss the need to reach consensus on an expanded set of outcomes to be measured in child-focused DVA trials. This will mean that the effectiveness of interventions is judged against outcomes that are important to those who use interventions. It will also facilitate greater consistency in outcome measurement across studies, thereby enhancing the quality of evidence in this emerging field. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Messages In order to adequately assess what works to reduce the impact of domestic violence on children, researchers should: Work with stakeholders to understand which outcomes are important to them., Seek consensus about a standardised set of outcomes to be measured and reported in all trials., Ensure that the success of interventions is measured against these outcomes. [ABSTRACT FROM AUTHOR]

Aims To report a study of processes used by women to disclose intimate partner violence to healthcare professionals in urban emergency department settings. Background Women seek emergency care for impairment related to intimate partner violence yet face barriers non-judgmental and supportive care. Design A two-phase sequential explanatory mixed methods study. Methods The study was conducted in Ontario, Canada (May 2006-December 2007). In a sub-analysis of quantitative data with 1182 participants, 15% of women patients reported intimate partner violence, but only 2% disclosed to a healthcare professional. To understand these results, grounded theory with 19 participants was completed. Results/findings Participants identified that the basic social problem was the violence 'being found out' by healthcare professionals while receiving care. To address this problem, women undertook a process to minimize intrusion including: deciding to seek care, evaluating the level of trust with the presenting healthcare professional, and establishing personal readiness to disclose. The trajectory of this process was different for each participant with some negotiating all phases leading to violence disclosure. The length of time it took for participants to move through each phase varied across all participants. Common to all participants was the anticipation and the actual experience of intrusion and its influence on women's willingness to disclose intimate partner violence. Conclusion The results suggest nurses may be able to facilitate disclosure of intimate partner violence through limiting intrusion. This can include assessment in a private setting, and fewer professionals who interact with the client. [ABSTRACT FROM AUTHOR]

Background: Few studies have explored the experiences of low income mothers participating in nurse home visiting programs. Our study explores and describes mothers' experiences participating in the Nurse-Family Partnership (NFP) Program, an intensive home visiting program with demonstrated effectiveness, from the time of program entry before 29 weeks gestation until their infant's first birthday. Methods: A qualitative case study approach was implemented. A purposeful sample of 18 low income, young first time mothers participating in a pilot study of the NFP program in Hamilton, Ontario, Canada partook in one to two face to face in-depth interviews exploring their experiences in the program. All interviews were digitally recorded and transcribed verbatim. Conventional content analysis procedures were used to analyze all interviews. Data collection and initial analysis were implemented concurrently. Results: The mothers participating in the NFP program were very positive about their experiences in the program. Three overarching themes emerged from the data: 1. Getting into the NFP program; 2. The NFP nurse is an expert, but also like a friend providing support; and 3. Participating in the NFP program is making me a better parent. Conclusions: Our findings provide vital information to home visiting nurses and to planners of home visiting programs about mothers' perspectives on what is important to them in their relationships with their nurses, how nurses and women are able to develop positive therapeutic relationships, and how nurses respond to mothers' unique life situations while home visiting within the NFP Program. In addition our findings offer insights into why and under what circumstances low income mothers will engage in nurse home visiting and how they expect to benefit from their participation. [ABSTRACT FROM AUTHOR]

We examined the associations between childhood physical and sexual abuse and labor force outcomes in young adults and the possible mediating effects of educational attainment, current mental health, and physical health. Data from the Ontario Child Health Study (N = 1,893), a province-wide longitudinal study were analyzed. Controlling for childhood and demographic variables, severe childhood physical abuse was significantly associated with reduced income with small mediating effects. There was a sex difference in the association between child abuse and employment. Severe childhood physical abuse was significantly associated with lower likelihood of employment only among males; mediators partially reduced this association. Further research is needed to explore the mechanisms linking exposure to child abuse and economic vulnerability in young adults. [ABSTRACT FROM AUTHOR]

The goals of the study were to examine test-retest reliability, informant agreement and convergent and discriminant validity of nine DSM-IV-TR psychiatric disorders classified by parent and youth versions of the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). Using samples drawn from the general population and child mental health outpatient clinics, 283 youth aged 9 to 18 years and their parents separately completed the MINI-KID with trained lay interviewers on two occasions 7 to 14 days apart. Test-retest reliability estimates based on kappa (κ) went from 0.33 to 0.79 across disorders, samples and informants. Parent-youth agreement on disorders was low (average κ = 0.20). Confirmatory factor analysis provided evidence supporting convergent and discriminant validity. The MINI-KID disorder classifications yielded estimates of test-retest reliability and validity comparable to other standardized diagnostic interviews in both general population and clinic samples. These findings, in addition to the brevity and low administration cost, make the MINI-KID a good candidate for use in epidemiological research and clinical practice. (PsycINFO Database Record [ABSTRACT FROM AUTHOR]

Objective To establish global research priorities for interpersonal violence prevention using a systematic approach. Methods Research priorities were identified in a three-round process involving two surveys. In round 1, 95 global experts in violence prevention proposed research questions to be ranked in round 2. Questions were collated and organized according to the four-step public health approach to violence prevention. In round 2, 280 international experts ranked the importance of research in the four steps, and the various substeps, of the public health approach. In round 3, 131 international experts ranked the importance of detailed research questions on the public health step awarded the highest priority in round 2. Findings In round 2, "developing, implementing and evaluating interventions" was the step of the public health approach awarded the highest priority for four of the six types of violence considered (i.e. child maltreatment, intimate partner violence, armed violence and sexual violence) but not for youth violence or elder abuse. In contrast, "scaling up interventions and evaluating their cost-effectiveness" was ranked lowest for all types of violence. In round 3, research into "developing, implementing and evaluating interventions" that addressed parenting or laws to regulate the use of firearms was awarded the highest priority. The key limitations of the study were response and attrition rates among survey respondents. However, these rates were in line with similar priority-setting exercises. Conclusion These findings suggest it is premature to scale up violence prevention interventions. Developing and evaluating smaller-scale interventions should be the funding priority. [ABSTRACT FROM AUTHOR]

BACKGROUND: Evidence-based preventive interventions are rarely final products. They have reached a stage of development that warrant public investment but require additional research and development to strengthen their effects. The Nurse-Family Partnership (NFP), a program of nurse home visiting, is grounded in findings from replicated randomized controlled trials. OBJECTIVE: Evidence-based programs require replication in accordance with the models tested in the original randomized controlled trials in order to achieve impacts comparable to those found in those trials, and yet they must be changed in order to improve their impacts, given that interventions require continuous improvement. This article provides a framework and illustrations of work our team members have developed to address this tension. METHODS: Because the NFP is delivered in communities outside of research contexts, we used quantitative and qualitative research to identify challenges with the NFP program model and its implementation, as well as promising approaches for addressing them. RESULTS: We describe a framework used to address these issues and illustrate its use in improving nurses' skills in retaining participants, reducing closely spaced subsequent pregnancies, responding to intimate partner violence, observing and promoting caregivers' care of their children, addressing parents' mental health problems, classifying families' risks and strengths as a guide for program implementation, and collaborating with indigenous health organizations to adapt and evaluate the program for their populations. We identify common challenges encountered in conducting research in practice settings and translating findings from these studies into ongoing program implementation. CONCLUSIONS: The conduct of research focused on quality improvement, model improvement, and implementation in NFP practice settings is challenging, but feasible, and holds promise for improving the impact of the NFP. [ABSTRACT FROM AUTHOR]

BACKGROUND: The use of physical punishment is controversial. Few studies have examined the relationship between physical punishment and a wide range of mental disorders in a nationally representative sample. The current research investigated the possible link between harsh physical punishment (ie., pushing, grabbing, shoving, slapping, hitting) in the absence of more severe child maltreatment (ie, physical abuse, sexual abuse, emotional abuse, physical neglect, emotional neglect, exposure to intimate partner violence) and Axis I and II mental disorders. METHODS: Data were from the National Epidemiologie Survey on Alcohol and Related Conditions collected between 2004 and 2005 (W= 34 653). The survey was conducted with a representative US adult population sample (aged >20 years). Statistical methods included logistic regression models and population-attributable fractions. RESULTS: Harsh physical punishment was associated with increased odds of mood disorders, anxiety disorders, alcohol and drug abuse/ dependence, and several personality disorders after adjusting for sociodemographic variables and family history of dysfunction (adjusted odds ratio: 1.36-2.46). Approximately 2% to 5% of Axis I disorders and 4% to 7% of Axis II disorders were attributable to harsh physical punishment. CONCLUSIONS: Harsh physical punishment in the absence of child maltreatment is associated with mood disorders, anxiety disorders, substance abuse/dependence, and personality disorders in a general population sample. These findings inform the ongoing debate around the use of physical punishment and provide evidence that harsh physical punishment independent of child maltreatment is related to mental disorders. [ABSTRACT FROM AUTHOR]