Wednesday, March 3, 2021

When Staying at Home Isn’t Safe: Explaining the Increase in Intimate Partner Violence and Other Abuse During the COVID-19 Pandemic

Sravya Reddy, MD
Pediatric Resident at The University of Texas at Austin Dell Medical School
Member, Texas Medical Association

How does the COVID-19 pandemic factor into potentially abusive situations?

To stop the spread of COVID-19, we have isolated ourselves into small family units to avoid catching and transmitting the virus. While saving so many from succumbing to a severe illness, socially isolating has unfortunately posed its own problems. Among those is the increased threat of harm from intimate partner violence, which includes physical violence, sexual violence, stalking, or psychological harm by a current or former partner or spouse. Potential child abuse is an increased threat as well. The impact of this virus happened so rapidly that society did not have time to think about all the consequences of social isolation before implementing it. Now those consequences are becoming clear.

Social isolation due to the pandemic is forcing victims to stay home indefinitely with their abusers. Children and adolescents also have been forced to stay at home since many school districts have made education virtual to keep everyone safe from the virus. Caregivers are also home because they are working remotely or because they are unemployed. With the increase in the number of COVID-19 cases, financial strain due to the economic downturn, and concerns of contracting the virus and potentially spreading it to family members, these are highly stressful times. Stress leads to an increase in the rate of intimate partner violence. Even those who suffer from it can begin to become abusive to other household members, thus amplifying the abuse in the household. Some abuse may go unrecognized by the victims themselves. For example, one important and less well-known type of abuse is coercive control. It’s the type of abuse that doesn’t leave a physical mark, but it’s emotional, verbal, and controlling. Victims often know that something is wrong – but can’t quite identify what it is. Coercive control can still lead to violent physical abuse, and murder. 

The way in which people report abuse has also been altered by the pandemic.

People lacking usual in-person contacts (with teachers, co-workers, or doctors) and the fact that some types of coercive abuse are less recognized lead to fewer people reporting that type of abuse. 

Child abuse often is discovered during pediatricians’ well-child visits, but the pandemic has limited those visits. Many teachers, who might also notice signs of abuse, also are not able to see their students on a daily basis. Some abuse victims visit emergency departments (EDs) in normal times, but ED visits are also down due to COVID-19.

Local police in China report that intimate partner violence has tripled in the Hubei province. The United Nations reports it also increased 30% in France as of March 2020 and increased 25% in Argentina. In the U.S. the conversation about increased intimate partner violence during these times has just now started, and we are beginning to gather data. Preliminary analysis shows police reports of intimate partner violence have increased by 18% to 27% across several U.S. cities. Individuals affected by addiction have additional stressors and cannot meet with support groups. Children and adolescents who might otherwise use school as a form of escape from addicted caregivers are no longer able to do so. Financial distress can also play a factor. According to research, the rate of violence among couples with more financial struggles is nearly three and a half times higher than couples with fewer financial concerns.

Abuse also can come from siblings. Any child or adolescent with preexisting behavioral issues is more likely to act out due to seclusion, decreased physical activity, or fewer positive distractions. This could increase risk for others in the household, especially in foster home situations. These other residents might be subject to increased sexual and physical abuse with fewer easy ways to report it. 

What can we do about this while abiding by the rules of the pandemic? How can physicians help?

Patients who are victims of intimate partner violence are encouraged to reach out to their doctor. A doctor visit may be either in person or virtual due to the safety precautions many doctors’ offices are enforcing due to COVID-19. During telehealth visits, physicians should always ask standard questions to screen for potential abuse. They can offer information to all patients, regardless of whether they suspect abuse.

People could receive more support if we were to expand access to virtual addiction counseling, increase abuse counseling, and launch more campaigns against intimate partner violence. The best solution might involve a multidisciplinary team, including psychiatrists, social workers, child abuse teams and Child Protective Services, and local school boards. 

Physicians can help in other ways, too. Doctors can focus on assessing mental health during well-child and acute clinic visits and telehealth visits. A temporary screening tool for behavioral health during the pandemic might be beneficial. Governments could consider allocating resources to telepsychiatry. Many paths can be taken to reduce the burden of mental health issues, and this is an ongoing discussion. 

How should physicians approach patients who have or may have experienced intimate partner violence?

Victims of domestic assault can always turn to their physician for guidance on next steps. In response, doctors can:

  1. Learn about local resources and have those resources available to your patients;
  2. Review safety practices, such as deleting internet browsing history or text messages; saving abuse hotline information under other listings, such as a grocery store or pharmacy listing; and creating a new, confidential email account for receiving information about resources or communicating with physicians.
  3. If the patient discloses abuse, the clinician and patient can establish signals to identify the presence of an abusive partner during telemedicine appointments.

To my fellow physicians, I suggest recognizing and talking about the issue with families.

Medical professionals take certain steps if they suspect their patient’s injuries are a result of family violence, or if the patient discloses family violence. Physicians will likely screen a patient, document their conversation with the patient, and offer support and inform the patient of the health risks of staying in an abusive environment, such as severe injuries or even death. A doctor’s priority is his or her patient’s safety, regardless of why the victim might feel forced to remain in an abusive environment. While physicians only report child and elderly abuse, they should encourage any abused patient to report her or his own case, while also understanding the complexity of the issue. 

Under no circumstance should any form of abuse be tolerated or suffered. Any intimate partner violence should be avoided, and reported if possible and safe. My hope is that with more awareness of this rising public health concern, potential victims can better deal with the threat of abuse during this stressful pandemic – and hopefully avoid it.

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