Open JAMA Network published two studies yesterday on child abuse in France and domestic violence in Japan early in the COVID-19 pandemic, the first found that the rate of abusive head trauma (AHT) in infants almost doubled and the second showed that calls for help from domestic violence centers increased significantly.
More severe trauma, fatal
In the first to studyResearchers in Paris compared HBP rates in infants younger than 1 year referred to the Necker Hospital for Sick Children, the only pediatric neurosurgery center in the Paris metropolitan area, from January 1, 2017, to December 31, 2021.
The team defined hypertension as one or more subdural hemorrhages (brain hemorrhages) and the determination of abuse after a multidisciplinary review of a social, clinical, biological and radiological examination. Pediatric hypertension, often called “shaken baby syndrome,” is one of the most serious forms of child abuse.
“HTN is the most frequent cause of traumatic death in infants in high-income countries, and non-fatal forms are associated with serious long-term morbidity, such as neurodevelopmental impairment (microcephaly [small head size]epilepsy, motor and visual impairments, language disorders, intellectual disability, and behavioral abnormalities) leading to severe lifelong disabilities,” the researchers wrote.
Of 99 infants diagnosed with hypertension, the median age was 4 months, 65% were children, 87% had bridging vein thrombosis, 75% had retinal hemorrhages (82% in both eyes), 32% had fractures, 26% had status epilepticus [long-lasting or seizures occurring close together]24% had refractory status epilepticus, 30% had ischemic lesions [white-matter changes and brain microbleeds] on magnetic resonance imaging (MIR0=), 20% had skin lesions, 54% underwent neurosurgery, 29% were admitted to the pediatric intensive care unit, and 13% died in hospital.
The average monthly incidence of hypertension varied by year, with 1.1 cases in 2017, 1.5 in 2018, 1.6 in 2019, 1.4 in 2020 and 2.7 in 2021. In relation to 2017 a 2019, the incidence of HT remained stable in 2020 (adjusted incidence rate ratio [aIRR], 1.02) but then almost doubled in 2021 (aIRR, 1.92). Injuries also tended to be more severe in 2021, with an odds ratio (OR) for death of 9.39.
For comparison, the researchers also studied patients with hydrocephalus [fluid buildup in the brain], a condition chosen for its similarity to hypertension in the organization of care in Paris and age range (median age at diagnosis, 2 months) and because its incidence is unlikely to have been influenced by the pandemic . There was no significant difference in rates of neurosurgery for hydrocephalus between 2020 and 2021.
Unintended consequence of crashes
Risk factors for HTN, which the authors note were often observed during the pandemic, include psychosocial distress (eg, job loss), frustration intolerance, adult psychiatric disorders, partner violence, changes in lifestyle (eg, telecommuting, school, and child care). closures, lockdowns, curfews) and interruptions in social services.
“The COVID-19 pandemic and the containment and mitigation measures adopted deteriorated the psychosocial situation of adults, increased the periods of prolonged stay of parents or guardians at home with their children, and reduced the intensity of prevention programs and early detection of CAN [child abuse and neglect]”, the authors wrote.
“Although containment and mitigation measures were necessary to reduce the spread of COVID-19, they may have had unintended consequences for children’s health, such as an increase in hypertension,” they added. “These results suggest the need for clinical awareness and preventive actions.”
in a related commentEmily Brown, MD, of Seattle Children’s Hospital, said it’s important to determine why the expected rise in HBP in Paris did not occur in 2020 and why those protective factors began to fail. “By determining what policies or factors may have helped slow the expected rise in child maltreatment, we may be able to prevent further harm to children,” she wrote.
Some families, Brown noted, will continue to experience the financial fallout from the pandemic for years to come. “Furthermore, because life for families is often stressful even outside of a pandemic, once we determine which preventative measures were the most effective in reducing HBP and other forms of maltreatment over the past two years, we may want to advocate keeping them permanently. ”, she concluded.
Women reported 97% of the violence.
In Japan, a researcher at Hokkaido University in Sapporo used data from the Japan Gender and Equality Office Cabinet Office to to study domestic violence help application rates of the 47 prefectures from 2011 to 2020 to determine whether abuse had escalated during the COVID-19 pandemic.
In Japan, domestic violence includes violence perpetrated by spouses, sexual partners, or other intimate partners. The study participants, who were married or living with a partner, ranged in age from 15 to 64.
From 2011 to 2020, Japanese residents made 1,061,410 requests for help for domestic violence, 98.1% of them from women. The majority of inquiries (66%) were made through call centers, followed by on-site visits (30.0%) and other methods (4.0%). Only annual requests made to call centers increased significantly during the pandemic (65.9% in 2011 to 2019 vs. 66.5% in 2020).
Before the pandemic, annual domestic violence claim rates were 32.0 per reporting center per 1,000 people, compared to 38.0 after the onset of COVID-19. More women than men reported domestic violence in 2020 (97.2% vs. 2.8%) in 2020. While the rates of domestic violence-specific requests for assistance by sex and means of investigation have increased since 2011 in Japan, they increased considerably in 2020 (national rate). in 2020, 129,491 in 2020 vs 103,547 before).
The author said that the restrictions related to the pandemic increased the time spent at home and contributed to income instability for both the abuser and the abused.
“This increase may be associated with a variety of factors, including economic instability, increased exposure to exploitative relationships, and reduced support options,” he wrote. “Previous studies point out that COVID-19 restrictions have cultivated an environment in which perpetrators of DV [domestic violence] exhibit dominant control tendencies.