Identification of Violence in the Home

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Abstract
Objectives To compare the rates of domestic violence reported by mothers with those identified by physicians, to compare the rates of harsh discipline practices reported by mothers with the rates of abuse identified by physicians, and to examine the relationship between reported domestic violence and harsh discipline practices. Design Interviews with parents and pediatricians to compare pediatric detection of domestic violence and child abuse with parental reports of domestic violence and harsh discipline practices. Setting Community-based pediatric practices in the 13-town greater New Haven, Conn, area. Participants Of the 23 practices invited, 19 agreed to participate. Of the 2006 parents of eligible 4- to 8-year-olds asked to participate, 1886 (94%) completed the Child Behavior Checklist. Of those invited into the interview portion, 1148 (83%) completed the 90-minute in-person interview. Main Outcome Measures Percentages of cases of domestic violence identified by pediatricians and reported by mothers. Percentages of cases of child abuse detected by pediatricians and percentages of mothers reporting that they have hit their children and left a mark. Results Pediatricians detected domestic violence in 0.3% of the cases, but parents reported domestic violence in 4.2% (κ=0.106 [95% confidence interval, −0.007 to 0.219]). Pediatricians identified physical abuse of children in 0.5% of the cases, while mothers reported hitting their children and leaving a mark in 21.6% (κ=0.003 [95% confidence interval, −0.018 to 0.024]). Mothers reporting domestic violence were significantly more likely to report hitting hard enough to leave a mark (relative risk, 1.6 ([95% confidence interval, 1.09-2.38]) compared with those not reporting domestic violence. Physicians identifying domestic violence were not significantly more likely to report child abuse than those not identifying domestic violence. Conclusions Parents report more cases of violence than pediatricians detect. Pediatricians should ask parents directly about domestic violence and harsh discipline.