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social sciences
Systematic Review
Domestic Violence Victimization Risk Assessment in Children
and Adolescents: A Systematic Review
Daniela Rita Ribeiro Cunha 1,2, *, Maria Emília Leitão 1,2
1
2
3
*
and Ana Isabel Sani 1,2,3, *
Faculty of Human and Social Sciences, Fernando Pessoa University, Praça 9 de Abril, 349,
4249-004 Porto, Portugal; 38098@ufp.edu.pt
Observatory Permanent Violence and Crime (OPVC), FP-I3ID, Fernando Pessoa University,
4249-004 Porto, Portugal
Research Center on Child Studies (CIEC), University of Minho, 4710-057 Braga, Portugal
Correspondence: danielacunha.psicologia@gmail.com (D.R.R.C.); anasani@ufp.edu.pt (A.I.S.)
Abstract: Background: Risk assessment is the process of collecting information towards the goal of
protecting the physical and psychological integrity of the victim, taking into account factors associated
with violence to assess the severity of violence, protect victims, and prevent recidivism. This type of
risk assessment is commonly used in situations of domestic violence and needs to be adjusted for
the contexts of child and adolescent victimization. Objective: Resources and standardized criteria to
guide a child-centered domestic violence victimization risk assessment are lacking. This systematic
review aimed to evaluate the instruments, risk factors and outcomes identified in the literature
for situations of domestic violence involving children. Methods: Following the PRISMA protocol,
313 articles from the EBSCO, Web of Science and PubMed databases were screened and 13 were
identified for analysis. Results: An analysis of the characteristics of some instruments created to
assess the impact of domestic violence involving children shows that caregivers’ risk factors are
strong predictors of child abuse, highlighting the interrelationship with other factors, as well as
warning about the cumulative risk, including child homicide. Conclusions: The literature confirms
the importance of family system factors regarding the risk of the mistreatment of children in situations
of domestic violence. Risk assessment must cater to the needs and specificities of individual children.
Citation: Cunha, Daniela Rita Ribeiro,
Maria Emília Leitão, and Ana Isabel
Keywords: children; adolescent; victim of domestic violence; risk assessment
Sani. 2024. Domestic Violence
Victimization Risk Assessment in
Children and Adolescents: A
Systematic Review. Social Sciences 13:
1. Introduction
259. https://doi.org/10.3390/
While the assessment of the problems associated with experiencing domestic violence
continues to evolve, there is still a lack of specific responses aimed at predicting and managing the risk for children and adolescents who are victims of this phenomenon (Fitz-Gibbon
et al. 2019). This systematic review is the culmination of works that enumerate multiple
factors in the risk assessment of victimization in children and adolescents who are victims
of domestic violence, guided by defined criteria. Additionally, this systematic review aims
to gather foundational information, identify factors and systems, and strengthen procedures in response to the need for a clear child-centered assessment scheme for children
victimized by domestic violence.
Domestic violence is defined as any type of violence, attempt or physical threat that is
perpetrated by an individual, whether female or male, against a person with whom they
maintain or have maintained an intimate relationship (Baldry 2003; Sani and Benavente
2021). This definition includes all existing types of violence, such as physical, psychological,
emotional, sexual, economic, and stalking. A close relationship between the aggressor and
the victim is an increased risk factor for more frequent and severe violence, with a greater
probability of occurrence when they cohabit or maintain frequent contact (Almeida and
Soeiro 2010; Baldry 2003; Jongenelen et al. 2020).
socsci13050259
Academic Editor: Nigel Parton
Received: 18 March 2024
Revised: 7 May 2024
Accepted: 9 May 2024
Published: 11 May 2024
Copyright: © 2024 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons
Attribution (CC BY) license (https://
creativecommons.org/licenses/by/
4.0/).
Soc. Sci. 2024, 13, 259. https://doi.org/10.3390/socsci13050259
https://www.mdpi.com/journal/socsci
Soc. Sci. 2024, 13, 259
2 of 22
Domestic violence against children occurs when a child, directly or indirectly, witnesses situations of violence between parents or parental figures (Sani 2018); however,
this does not always translate into situations of child abuse (Shlonsky and Friend 2007).
Domestic violence against children and child abuse can occur together or be a consequence
of one another. For example, according to Ferreira et al. (2019), domestic violence is associated with patriarchal and adult-centered contexts, which emphasize the power of the
man/adult over the child, leading to violent relationships between parents and children.
On the other hand, child abuse can occur when severe forms of domestic violence trigger
negative emotional activation and emotional dysregulation in parents, which, in turn, can
contribute to the occurrence of disruptive parenting practices, increasing the likelihood of
the child experiencing abuse (Ferreira et al. 2019).
The World Health Organization [WHO] (2022) defines child abuse as the “perpetration
of physical, sexual and psychological/emotional violence and neglect of infants, children
and adolescents aged 0–17 years by parents, caregivers and other authority figures, most
often in the home but also in settings such as schools and orphanages” (p. 2). Research on
children’s exposure to domestic violence confirms the negative impact of this experience
on their overall adjustment (Sani 2020), with signs and symptoms manifesting through
emotional, cognitive, physiological, behavioral, and social problems of different severity,
in the short, medium or long term (Almeida et al. 2022; Artz et al. 2014). Over time, it has
been proven that victimization due to exposure to domestic violence is a risk factor for the
development of internalizing and/or externalizing problems (Malta et al. 2019; Sani 2006),
such as depressive symptoms (Lv and Li 2023; Sá et al. 2009; Ximenes et al. 2009), a lack of
self-control, impulsive behaviors (Barboza and Dominguez 2017; Pesce 2009) or substance
use (Maia and Barreto 2012; Malta et al. 2019). For example, internalizing problems can
develop up to 10 years after experiencing violence (Vu et al. 2016).
A child exposed to situations of domestic violence experiences various concurrent
forms of victimization (Shlonsky and Friend 2007) and their impacts are identifiable markers
of their exposure (Sani 2019). A child in the context of domestic violence is more likely to
be exposed to, or be the direct target of, additional forms of victimization (Hanson et al.
2006; Malta et al. 2019; Sani et al. 2021). However, there is limited recognition of the impact
of violence on children’s well-being, with an urgent need to consider the impact of violence
on children (Sani 2019).
The literature emphasizes the importance of considering the variability in risks and
each child’s individual response to violence in the family context (Fitz-Gibbon et al. 2019).
The age at which violence is observed may have varying impacts on the likelihood of
future perpetration or victimization (Bazargan-Hejazi et al. 2014). Furthermore, studies
show that understanding the variability in children’s adjustment requires considering
parental cognition, emotions and behaviors (Chiesa et al. 2018). For example, children’s
emotional and behavioral dysregulation after exposure to violence may vary depending on
the intensity of affection provided by the parents, as well as their strategies during marital
conflict and its resolution (Bonache et al. 2019). Moreover, the type of marital conflict may
also impact children’s adaptation to how they perceive violence (Grych and Fincham 1990).
Addressing the issue of child abuse extends beyond merely discussing safety and
protection concerning the individuals who perpetrate such violence. For a comprehensive
assessment and intervention to take place, it is imperative to consider the child’s developmental stage and the factors associated with domestic violence, while acknowledging the
potential risk of long-term damage (Shlonsky and Friend 2007).
Furthermore, in the realm of risk assessment for victimization caused by domestic
violence, a contentious issue arises when an adult victim and a child victim co-exist in a
violent environment. The risk assessment cannot be guided by the same parameters in such
cases. An adult victim and a child possess distinct needs and characteristics concerning risk.
Although these situations may be connected, there are distinct factors to observe (Jenney
et al. 2014; Stanley and Humphreys 2014), resulting in insurmountable failure when there
Soc. Sci. 2024, 13, 259
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is a clear disregard for the immediate need to conduct a risk assessment oriented towards
the child.
With an increased awareness of the problem of domestic violence and the negative
impact on victims, both in childhood and adulthood, there have been calls for decisive
action. The recognition of the devastating impact that domestic violence has on children,
directly or indirectly, has laid a strong foundation for heightening governmental awareness
of the problem (Skivenes and Stenberg 2015).
Several authors refer to child victimization by domestic violence as a pervasive issue
that impacts modern society. It is reported to occur in 60% of households where such
incidents are identified (Hamby et al. 2010; Morais-Gonçalves et al. 2018; Sani 2019). In
terms of child abuse, Stoltenborgh et al. (2015) found that it is a global and prevalent
problem, affecting millions of children. In 1993, in the United States of America (USA),
child protection service agencies submitted approximately 2 million reports regarding
alleged child abuse and neglect for evaluation (Camasso and Jagannathan 2000). According
to Baird and Wagner (2000), the number of abuse and neglect allegations in the USA
dramatically increased over the last two decades of the 20th century. Consequently, most
child protection services were pressured to respond effectively to the issue, leading to legal
action in most states, media exposure due to child fatalities, and growing concerns about
the responsibility of professionals and services. This has spurred the desire to discover new
strategies and resources to address the phenomenon. Damashek et al. (2014), in a study
based on a documentary analysis of files from the Child Death Review Board in Oklahoma
from 2000 to 2003, examined child fatalities due to inadequate caregiver supervision. They
noted that approximately 30 to 50% of these victims or their families had previously been
flagged to child protection services, whether through a report, investigation or otherwise.
Risk assessments and interventions have increasingly been used for the mitigation
and eradication of domestic violence victimization (Baird and Wagner 2000; Sani and Lopes
2018). Risk assessment guides teams in making critical decisions within limited timeframes
for child protection in healthcare services (Baird and Wagner 2000; Kearney et al. 2023),
e.g., identifying, at an early stage, families at high risk of child maltreatment (Bisagno
et al. 2023; van der Put et al. 2017). Predicting the onset of abuse can be better achieved
through an actuarial assessment (using criteria and structured measures) than through
clinical assessment (Baird and Wagner 2000; van der Put et al. 2017). The appropriate and
prompt execution of interventions, considering risks, will be crucial to the prevention of
recidivism (Morais-Gonçalves et al. 2018).
2. Risk Assessment: From Conceptualization to the Relevance of a Guided Practice
Risk assessment for domestic violence victimization is a process of collecting information towards the identification of signs and indications of violence, as well as protective
factors. The aim is to prevent the recurrence or escalation of violence (Almeida and Soeiro
2010; Morais-Gonçalves et al. 2018). “Risk” can be defined as the likelihood of a violent
act occurring, i.e., the prediction of a negative event. Violent acts vary, depending on the
perpetrator’s motivation, their relationship with the victim or the nature of the violence
enacted. Risk is multifaceted and, for this reason, the nature, severity, frequency, duration,
and imminence of any form of future violence must be considered (Morais-Gonçalves et al.
2018). Risk factors can be static, when they cannot be modified through intervention, or
dynamic, when they can be modified through intervention, resulting in changes in the
level of risk (Antunes et al. 2020; Morais-Gonçalves et al. 2018). Protective factors such
as the individual characteristics of the subjects, their interpersonal relationships, or the
meanings constructed in relation to the experience must also be taken into account, as they
can contribute to risk reduction (Sani and Pereira 2020).
When assessing risk, it is essential to first determine whether the child is in immediate
danger, as this is the only way to prevent more serious harm from occurring. To address
these immediate needs, various domestic violence victimization risk assessment instruments have been developed (Navarro-Pérez et al. 2023; van der Put et al. 2017; Vial et al.
Soc. Sci. 2024, 13, 259
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2020b). Domestic violence victimization risk assessment can and should include risk management, i.e., in addition to evaluating the risk factors present, technicians must identify
and determine the most appropriate risk management strategies, taking into account the
needs and specificities of the victim and the type of violence experienced (Almeida and
Soeiro 2010; van der Put et al. 2017). Most existing tools are generally designed to predict
the risk of immediate harm or the risk of the recurrence of mistreatment (Shlonsky and
Friend 2007).
Ideally, risk management should help minimize factors that contribute to undesirable
outcomes (e.g., harm to children), whether they originate from parents or child welfare
workers (Gambrill and Shlonsky 2001). The assessment should focus on aspects relating to
the family context. For instance, maternal depression is a significant factor associated with
child abuse. This mental health condition is prevalent in situations of domestic violence,
and its evaluation can predict child vulnerability (Vial et al. 2020b). In addition to the
context, the individual characteristics of the child, such as their gender, age, perceptions
and interpretations of violence, play a moderating role in the relationship between exposure
to domestic violence and the child’s adjustment (Soares and Sani 2016). It is also crucial to
recognize that children may react differently to similar forms of violence (Shlonsky and
Friend 2007).
Services targeting domestic violence have primarily focused on adult victims, aiming
to ensure their protection and safety (Stanley and Humphreys 2014), often overlooking child
victims. These procedures are generally justified by the notion that protecting the adult
victim also ensures the safety of the child (Sani and Pereira 2020). However, it is important
to recognize that children may have different needs to adult victims (Øverlien 2011; Stanley
et al. 2012). Therefore, there is an urgent need for differentiated risk assessment, depending
on whether the focus is on adult or child victims of domestic violence.
Vial et al. (2020b) argue that not all critical aspects are considered in the immediate
domestic violence victimization risk assessment. These include emotional abuse, situations
where caregivers cannot protect the child from harm inflicted by third parties, and instances
where a caregiver’s psychiatric disorder poses a threat to the child (Sani and Lopes 2019). In
Portugal, the risk arises merely from the child’s exposure to domestic violence, necessitating
the assessment of the child as a legally recognized victim (Law no. 57/2021) (Portugal 2021).
Child maltreatment is not assessed merely by inquiring whether the child was physically
or emotionally abused during a domestic violence episode (Shlonsky and Friend 2007).
Observable behavior in a child does not transparently reflect what the child is feeling, as
internal symptoms such as anxiety cannot be detected solely through external behavior
(Costa and Sani 2007). Context observations, such as those made during home visits, are
important for assessing child abuse risks but are somewhat limited and need improvement
(van der Stouwe et al. 2023). This improvement could include the addition of specific
detection indicators, which could be incorporated into more structured observation grids.
Therefore, this systematic review aims to answer the following research questions:
(i) What instruments for domestic violence victimization risk assessment have been considered in situations involving children? (ii) What risk factors associated with domestic
violence victimization have been identified in situations involving children? and (iii) What
consequences/impacts have been observed in child victims of domestic violence?
3. Method
3.1. Search Information
The systematic review presented (PROSPERO register CRD42024526694) includes
studies assessing the risk and implications of victimization due to domestic violence in
children and adolescents.
The search was expanded to studies published in all languages across three databases,
as recommended (Donato and Donato 2019). Based on the theme and research area, we
selected the following databases: EBSCO, Web of Science, and PubMed. EBSCO includes
major reference citation indices such as Scopus and subject indices like APA PsycInfo
Soc. Sci. 2024, 13, 259
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to assess relevance and quality. Moreover, Web of Science is recognized as an excellent
platform that offers bibliographic research databases to support scientific and academic
research. Additionally, we included PubMed due to the presence of articles discussing
the victimization of children and adolescents through domestic violence, which may have
otherwise been overlooked in our research.
The search was limited to studies published between 2000 and 2022 in academic and
peer-reviewed journals.
3.2. Search Terms
The search terms and expressions, adapted for each of the databases, were as follows:
EBSCO: TI (“risk factors” OR “risk assessment” OR “risk management” OR scales
OR check-list OR instruments) AND AB (“child victims” OR “child protection” OR child
OR “adolescent victims” OR adolescence OR “child protection” OR “child welfare”) AND
AB (“family violence” OR “domestic violence” OR “intimate partner violence” OR “family abuse”);
Web of Science: ((TI = (“risk factors” OR “risk assessment” OR “risk management” OR
scales OR check-list OR instruments)) AND AB = (“child victims” OR “child protection” OR
child OR “adolescent victims” OR adolescence OR “child protection” OR “child welfare”))
AND AB = (“family violence” OR “domestic violence” OR “intimate partner violence” OR
“family abuse”); and
PubMed: ((“risk factors”[Title] OR “risk assessment”[Title] OR “risk management”[Title]
OR scales[Title] OR check-list[Title] OR instruments[Title]) AND (“child victims”[Title/Abstract]
OR “child protection”[Title/Abstract] OR child[Title/Abstract] OR “adolescent victims”[Title/
Abstract] OR adolescence[Title/Abstract] OR “child welfare”[Title/Abstract] OR)) AND (“family violence”[Title/Abstract] OR “domestic violence”[Title/Abstract] OR “intimate partner
violence”[Title/Abstract] OR “family abuse”[Title/Abstract]).
3.3. Study Selection Criteria
The selection of studies was based on the following inclusion criteria: (a) samples
involving children and adolescents under 18 years of age; (b) victims of domestic violence;
(c) studies employing quantitative methods; and (d) scientific articles published in peerreviewed journals. Correspondingly, the exclusion criteria were as follows: (a) adult
samples; (b) victims of crimes other than domestic violence; (c) qualitative or theoretical
studies; (d) systematic reviews and meta-analyses; and (e) books and/or book chapters.
Figure 1 describes the selection process of studies included in this systematic review.
The search carried out in three databases yielded a total of 313 articles, published between
2000 and 2022. After excluding 96 duplicates, 217 articles remained for an analysis of
their title and abstract. Of these, 185 articles were excluded based on the criteria. Finally,
32 articles were eligible for full-text reading, and of these, 18 were excluded. One additional
study was not included due to inaccessibility. Ultimately, a total of 13 articles were included
in the final study.
The quality of the articles (cf. Table 1) was analyzed using the Prisma Checklist
2020 (Page et al. 2021), adapted to the purposes of this study, and 13 analysis topics were
considered [(1) title; (2) abstract; (3) rationale; (4) objectives; (5) protocol; (6) eligibility
criteria; (7) information sources; (8) inclusion/exclusion criteria; (9) data collection process;
(10) study design; (11) main measures; (12) summary of main results; and (13) conclusion
and study limitations]. After applying this checklist, articles were evaluated on to a
Likert-type scale in which 0 (not reported/not specified) indicated that the article lacked
information on the topic, 1 (unclear/reported to some extent) suggested that the authors
provided some information on the subject, and 2 (adequately done) showed that the article
presented the topic exhaustively, with a complete methodological explanation.
Soc. Sci. 2024, 13, x FOR PEER REVIEW
Soc. Sci. 2024, 13, 259
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Figure 1.
1. Flowchart
Flowchart of
of the
the Systematic
Systematic Review
Review Process.
Process.
Figure
The quality
authorsof
ofthe
thisarticles
systematic
review
independently
analyzed
each article
using2020
the
The
(cf. Table
1) was
analyzed using
the Prisma
Checklist
same
checklist,
and
then
combined
their
analyses
to
obtain
the
final
values
presented
(Page et al. 2021), adapted to the purposes of this study, and 13 analysis topics were
in Table 1. Subsequently, to verify inter-rater agreement, Cohen’s Kappa coefficient was
considered [(1) title; (2) abstract; (3) rationale; (4) objectives; (5) protocol; (6) eligibility
calculated, resulting in a concordance value of 95%, indicating a high level of agreement
criteria; (7) information sources; (8) inclusion/exclusion criteria; (9) data collection process;
(Landis and Koch 1977).
(10) study design; (11) main measures; (12) summary of main results; and (13) conclusion
and study limitations]. After applying this checklist, articles were evaluated on to a Likerttype scale in which 0 (not reported/not specified) indicated that the article lacked
information on the topic, 1 (unclear/reported to some extent) suggested that the authors
provided some information on the subject, and 2 (adequately done) showed that the article
presented the topic exhaustively, with a complete methodological explanation.
The authors of this systematic review independently analyzed each article using the
same checklist, and then combined their analyses to obtain the final values presented in
Table 1. Subsequently, to verify inter-rater agreement, Cohen’s Kappa coefficient was
calculated, resulting in a concordance value of 95%, indicating a high level of agreement
(Landis and Koch 1977).
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Table 1. Analysis of the quality of selected articles using the adapted Prisma Checklist 2020 (Page
et al. 2021).
Articles
1
2
3
4
5
6
7
8
9
10
11
12
13
Total
Berens et al. (2019)
2
2
1
2
2
2
2
1
1
2
2
2
2
23
High
Bonfim et al. (2011)
2
2
2
2
2
2
2
1
2
2
2
2
2
25
High
Craig et al. (2021)
2
2
2
2
2
2
2
2
2
2
2
2
2
26
High
Diamond and Muller (2004)
1
2
2
2
2
2
2
2
2
2
2
2
2
25
High
Erolin et al. (2014)
1
2
2
2
2
2
2
1
2
2
2
2
2
24
High
Flander et al. (2009)
1
2
2
1
2
1
2
1
2
2
1
2
2
21
Average
Miyamoto et al. (2017)
2
2
1
1
2
2
2
2
2
2
2
2
2
24
High
Olszowy et al. (2013)
1
2
2
2
2
1
2
2
2
2
2
2
2
24
High
Reif and Jaffe (2021)
1
2
2
2
2
2
2
2
2
2
2
2
2
25
High
Sičić and Mužinić (2007)
0
2
2
1
1
1
2
2
2
1
2
2
1
19
Average
Sidebotham and Heron (2006)
2
2
2
2
2
2
2
2
2
2
2
2
2
26
High
Terelak et al. (2019)
1
2
2
2
2
2
2
2
2
2
2
2
1
24
High
Vial et al. (2020a)
1
2
2
2
1
1
2
2
2
1
2
2
2
22
High
Grades: 0—not reported/not specified; 1—unclear/reported to some extent; 2—adequately done.
4. Results
In the following, studies with lower adapted Prisma scores should be viewed with
more caution compared to studies with higher scores, which are methodologically robust.
The majority (84.6%) of studies included in this review had a high score (Table 1).
4.1. Instruments for Assessing the Impact of Domestic Violence
Two studies included in this systematic review evaluated, respectively, the structure
and validity of the Parent–Child Conflict Tactics Scale (CTSPC) (Bonfim et al. 2011) and the
Childhood Psychosocial Adversity Scale (CPAS) (Berens et al. 2019).
The results of the exploratory and confirmatory factor analysis regarding the structure
of the CTSPC revealed that the items may behave differently from that proposed in the
original scale. This has been confirmed by international studies carried out with this
same scale, e.g., in the exploratory factor analysis, factor 1 incorporated items linked to
the degree of violence and related to physical abuse, whereas factor 2 included items
related to a medium degree of violence, encompassing items of corporal punishment
and violence considered disciplinary; factor 3 showed lower correlations and is more
associated with non-violent conflict resolution tactics (Bonfim et al. 2011). In relation to the
confirmatory factor analysis, factor 1, termed non-disciplinary abuse in the original scale,
included items from the scales of physical abuse, corporal punishment and psychological
aggression, whereas factor 2, originally termed disciplinary abuse, included corporal
punishment and psychological aggression items, also incorporating an item referred to as
Soc. Sci. 2024, 13, 259
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physical mistreatment; factor 3 was defined as the use of non-violent disciplinary tactics
and included only items from the non-violent discipline scale. No items that, if removed,
could significantly improve the internal consistency of the scale were found (Bonfim et al.
2011). Considering the differences in how the factors were grouped, not only in this study,
but in other international studies where the factors were organized differently from the
original study, the authors state that domestic violence against children can be interpreted
and evaluated in different ways (Bonfim et al. 2011).
As for the validity of the CPAS scale, which measures cumulative risk and is designed
to predict the levels of early childhood cognitive development (ECD), the results arrived
at a final three-factor model with subscales relating to harsh discipline and abuse, neglect
and caregivers’ emotional unavailability. Additionally, the final exploratory factor analysis
obtained caregiver-focused items measuring depression, social isolation, intimate partner violence, physical violence, verbal abuse, family conflict, economic and community
environment, family economic stress, and community adversity (Berens et al. 2019).
Berens et al. (2019) correlated the results obtained in the administration of this scale
with the Edinburgh Postnatal Depression Scale (EPDS) and the Multidimensional Scale
of Perceived Social Support (MSPSS). As expected, the results effectively demonstrated
that physical violence perpetrated by an intimate partner, verbal abuse and family conflict
were significantly correlated with maternal depression. The subscales related to prevention,
punishment, restriction, economic and family stress were significantly correlated with the
score obtained on the CPAS scale, revealing that severe parental discipline towards children
has a negative impact on cognitive development in early childhood (Berens et al. 2019).
The greater the cumulative psychosocial risk in early (48–60 months) childhood (high
CPAS scores), the greater the impact on child development (raw IQ scores); however, this
was not confirmed for other age groups (Berens et al. 2019).
4.2. Parental Problems and/or Psychopathology as a Risk Factor for the Occurrence of Child Abuse
The majority of studies considered focus on the risk factors related to parental problems
that reveal associations with the occurrence of child maltreatment and the emergence of
problems in the short and long term (Diamond and Muller 2004; Erolin et al. 2014; Flander
et al. 2009; Sičić and Mužinić 2007; Sidebotham and Heron 2006; Vial et al. 2020a). Parents
with low academic performance and a history of childhood abuse and psychiatric illness
were two to five times more likely to have their children reported to child protection services
than the reference population (Sidebotham and Heron 2006). The impact of poverty on
child abuse appears to be a mediated by the socioeconomic history of the parents. Maternal
work appears to reduce risk, but not when other social and parental factors are considered.
Sidebotham and Heron (2006) found that a negative social network increases the risk of
registration with child protective services. Family characteristics, such as single parents,
restructured families, parents who do not recognize positive attributes and describe their
children in a negative way and/or who have premature children, also have a higher risk of
being flagged in child protection services (Sidebotham and Heron 2006).
The incidence of child abuse in families with parental behavioral disorders showed a
statistically significant difference between groups in terms of exposure to different types
of emotional, physical, and sexual abuse or neglect. Participants who reported behavioral
disorders in one of their parental figures were relatively more exposed to this abuse.
However, no statistically significant differences were found between the types of abuse
suffered when considering the presence of mental disorders in the parents (Flander et al.
2009). Furthermore, the results demonstrated that in relation to feelings of social and family
loneliness, participants who reported the presence of disorders in at least one of their
parents felt lonelier than participants who did not report mental disorders in their parents.
This difference was not found in relation to feelings of loneliness with regard to love. These
results align with previous studies showing that mental illness and parental alcoholism
represent risk factors for different forms of child abuse (Flander et al. 2009).
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Vial et al. (2020a), in a multidimensional network study, evaluated the interrelationship
of risk factors associated with child abuse, both for children referred to child protection
services (high risk) and those referred to community services (low risk). The factors were
positively correlated in both networks, but were stronger in the high-risk sample than in the
low-risk sample. Children referred to protection services were older, had a greater number
of risk factors, had a higher risk of maltreatment in the future, and had immediate risk
indicators, including factors associated with a history of domestic violence, a problematic
relationship between caregivers, and experience of family conflict. The results of the
study highlighted the strong interrelationships with other static risk factors, including
those associated with a history of child abuse, domestic violence, and caregiver neglect.
Confirming what is already known about transgenerational violence, these studies also
showed the possibility of an exponential increase in the risk of child abuse in the presence
of extra risk factors (Vial et al. 2020a).
Erolin et al. (2014) sought to understand the causes and effects of post-traumatic
stress disorder (PTSD) in children and their families. Almost 60% of their sample reported
symptoms of PTSD (DSM-V diagnostic criteria), of which around 90% had been exposed
to situations of violence. Furthermore, of the children exposed to situations of violence,
65.5% reported continuous interparental violence, highlighting that the child’s exposure to
family violence throughout their lives, along with exposure to violence in the community,
increases the risk of developing PTSD or other disorders. These risks were higher still for
females exposed to violence within the home (Erolin et al. 2014).
In a study of the long-term impact of witnessing domestic violence (Diamond and
Muller 2004), the most common form of violence perpetrated by one spouse towards the
other was psychological violence, encompassing behaviors such as speaking in a hostile
manner, ridiculing in general, and ridiculing feelings. Regardless of whether the perpetrator was the mother or father, the most common forms of physical violence were slaps,
kicks, pushing and throwing objects. The degree of association with children’s internalizing behaviors was relatively higher when their exposure to violence was characterized
as ‘bigger’ (and vice versa). Furthermore, the development of psychopathology, including worsened symptoms of PTSD following exposure to physical and/or psychological
violence, is significant, especially when perpetrated by the maternal figure (Diamond
and Muller 2004). The impact on the development of PTSD symptoms and internalizing
problems was greater when perpetrated by the father figure, but when the perpetrator
was the mother figure, there tended to be greater externalizing symptoms. Finally, the
results suggest that witnessing physical, verbal and psychological violence of a less violent
nature has a long-term impact (Diamond and Muller 2004). However, victimization does
not always lead to PTSD, for instance, in cases of sexual harassment, where adjustment
disorder may occur (Marcos et al. 2023).
Externalizing behaviors as a result of exposure to domestic violence are common. Sičić
and Mužinić (2007) studied the impact of risk factors on self-harm behaviors in adolescents.
For adolescents who demonstrated self-mutilation behavior, approximately 20% were direct
victims of family violence, and 31% had family members with some type of dependence,
whether on alcohol or pills. Additionally, around 40% of the adolescents included in
the study demonstrated intra and interpersonal aggressive behavior as a result of sexual,
physical and psychological abuse, with physical and psychological abuse co-occurring
twice, and with all sexual abuse occurring in an intra-family context. Furthermore, 54%
of the adolescents in the study had already attempted suicide or had suicidal ideation
behaviors. Finally, 80% of the adolescents lacked love, understanding, affection and support
in the interpersonal relationships that were prevalent in the family, not having access to the
positive characteristics that a child needs to develop in an adapted and healthy way (Sičić
and Mužinić 2007).
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4.3. Contextual Issues as Risk Factors for the Occurrence of Child Victimization
Terelak et al. (2019) studied the incidence of domestic violence in children and adolescents by considering the type of community in which they reside (rural, urban and
urban–rural areas). Of the children or adolescents who suffered different forms of domestic
violence, around 50% belonged to rural and urban–rural areas, and around 66% belonged
to urban areas. The co-occurrence of three or more forms of violence in the family environment potentiated the development of the cumulative symptoms of pathological family
life, which could put the health and even the lives of victims of domestic violence at risk.
This climate of violence, concentrated in the family nucleus, affected around 14% of the
rural, 12% of the urban–rural and 24% of the urban community. Psychological violence
was predominant; physical violence was the second most common in the urban–rural
community and the third most common in the urban community (Terelak et al. 2019).
Physical violence against children and adolescents was mainly in the form of beatings,
using objects without leaving marks and/or beatings, causing bruises, and acts of pushing
or stabbing. Although found in all three communities, negligence had a greater impact
on the urban community due to the perpetration of behaviors associated with ignoring
feelings and emotions, a lack of concern for the problems of children and adolescents, and
the underestimation of children’s illnesses. Finally, economic violence and sexual assault
were perpetrated in all three types of communities (Terelak et al. 2019).
4.4. Cumulative Familial Risk and Change in Genetic Pattern in Children
The main objective of the study by Craig et al. (2021) was to examine the extent to
which the cumulative family risk and number of maltreatment experiences affect DNA
patterns, specifically the SLC6A4 gene. In more than 90% of children who suffered more
than one type of maltreatment in childhood, the index of cumulative exposure to family
risk factors revealed a significant positive association with DNA mutation patterns in
two different genes (SLC6A4 and CpGs). However, no significant correlation was found
between the number of maltreatment experiences and DNA mutation levels. However, the
DNA mutation was significantly explained by the number of experiences of maltreatment
and the characteristics of the children, i.e., the score on the cumulative family risk index
and the number of experiences of abuse were positively correlated with higher levels of
DNA mutation. Witnessing interparental violence leaves epigenetic traces that remain
even after children are removed from their caregivers and placed in foster care, suggesting
that family risk factors play a critical role in the DNA mutations that occur in children
(Craig et al. 2021).
4.5. Risk Assessment of Child Homicide
Different studies evaluated the occurrence of child homicide within violent interparental relationships by considering instances where individuals, family, and caregivers
seriously abused children, resulting in hospitalization or death, among cases investigated
by child protection services. Furthermore, the studies analyzed whether the presence of
children within the relationships increased the likelihood of child homicide (Miyamoto
et al. 2017; Olszowy et al. 2013; Reif and Jaffe 2021).
Miyamoto et al. (2017) found that children who were hospitalized or died were often
male and had a significantly younger maternal caregiver. A structured risk assessment
revealed that the families of children who had been hospitalized or who had died were
more frequently assigned to moderate and high-risk categories. Correspondingly, the group
of children who were neither hospitalized nor had died were more frequently marked
as being at low or very low risk. The authors analyzed the possible differences between
maternal and non-maternal caregivers. In relation to the former, the variables of the child
being male, the family having a moderate or high risk score, and the family having more
than three children under the age of five were significantly correlated with a higher risk.
By contrast, variables relating to maternal involvement in intimate partner violence and
the children’s enrollment in public health insurance were associated with a reduction in
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risk (Miyamoto et al. 2017). As with maternal caregivers, involvement in violence by an
intimate partner and from a non-maternal caregiver is associated with a lower probability
of serious maltreatment (Miyamoto et al. 2017). For non-maternal caregivers, variables
relating to the younger age of the caregiver, the number of children under the age of five
living in the house, and at least one biological child not living with either parent were
significantly predictive of serious child abuse.
Another study (Reif and Jaffe 2021) found no significant differences between cases
where domestic homicide occurred with or without children in the violent relationship,
with both groups having the same number of risk factors. In cases with children, there
was a higher percentage of significant risk factors associated with child custody, previous
aggression against the victim during pregnancy, and a history of domestic violence in the
current relationship. Risk assessments, risk management and safety planning revealed
no significant differences between the groups. Within the group that included children,
no statistically significant differences were found between cases where children were the
targets of violence and were not the targets of violence (Reif and Jaffe 2021).
Olszowy et al. (2013) analyzed three instruments for assessing the risk of marital
aggression to assess whether they were suitable for identifying cases with a high risk of
child homicide. They found that the level of risk was similar and was identified by the
instruments as high when children were victims of lethal violence or the target of an attempt
on their lives, as well as in cases in which children were present in the home when their
mother was the victim of homicide. Furthermore, the results revealed that if the maternal
figure was identified as being at a high risk of homicide, there was a greater likelihood
of child homicide also occurring (Olszowy et al. 2013). In general, the instruments did
not reveal significant associations with the child homicide group or the group in which
no child homicide occurred. However, both the Danger Assessment (DA) instrument’s
assessment of previous threats to hurt the child and the B-SAFER instrument’s assessment
of the aggressor’s interpersonal adjustment problems revealed significant associations with
cases in which child homicide occurred or in which there was an attempted homicide
(Olszowy et al. 2013).
Table 2 summarizes the results and main conclusions, as well as the objectives, type of
samples, and instruments used for each study selected.
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Table 2. Summary of the characteristics of the studies included in the review.
Author(s) (Year)
Berens et al. (2019)
Bonfim et al. (2011)
Craig et al. (2021)
Objective(s)
Sample
Method/Instruments
Results and Main Conclusions
Describe the development and validity
of the Childhood Psychosocial Adversity
Scale (CPAS), which measures
cumulative risk. The CAPS was
designed to predict levels of early
childhood cognitive development (ECD).
Recruited through two longitudinal birth
cohorts of mother–child dyads: PROVIDE e
Crypto. A subset was randomly selected.
Recruitment for both cohorts was performed
through visits to the homes of all pregnant
women. Participants in the development of
the instrument were recruited by inviting all
individuals who showed up for scheduled
appointments to complete the questionnaire
(capturing children aged 18, 24, 48 and/or
60 months).
Participant Selection Questionnaire;
Semi-structured interviews (n = 20,
including 10 with mothers and 10 with
field workers) and
Focus Group (n = 8, each with
10 participants);
Cognitive Interview for the Pre-Test;
Depression Scale (EPDS) and
Multidimensional Perceived Social
Support Scale (MPSS).
The CPAS is a comprehensive measure of
childhood psychosocial adversity designed for
implementation and validation in global health
settings. The data confirmed its usefulness as a
research tool that assesses psychosocial risk factors
in early childhood in relation to development
among children.
Parent–Child Conflict Tactics Scale
(CTSPC).
The factor analysis in this study revealed items that
present high factor loadings in the respective scales
and others that were different from the original.
The results revealed that DV against children is
part of a phenomenon that can be interpreted and
evaluated in very different ways, with this result
proved by the differences in how the factors were
organized in this study in relation to the original or
other studies.
Saliva sample for epigenetic analysis;
Assessment of the Cumulative Family
Risk Index (CFR); Maltreatment
Classification System (MCS) to assess
individual child maltreatment
experiences and the type of
maltreatment suffered.
In children with a history of maltreatment, the
severity of family risk factors and multiple
experiences of maltreatment contributed directly to,
at least partially, explaining the level of DNA
mutation, which may be affected by a combination
of direct variables (maltreatment treatment in
childhood) and proximal factors (close family risk
factors). The strongest predictor regarding DNA
mutation was the CFR index (cumulative familial
risk index). Children’s age was also a significant
predictor of DNA mutation. This study added new
evidence of how the family environment can
become biologically embedded through epigenetic
changes, revealing that these changes remain even
after children are removed from their caregivers
and placed in foster care, suggesting that familial
risk factors play a critical role in causing DNA
mutation in children.
To study the factorial structure of the
CTSPC scales in an urban population
sample from the Brazilian Northeast.
To examine the direct effects between
cumulative familial risk and altered
DNA patterns, specifically the SLC6A4
gene, and indirect effects between
cumulative familial risk and the number
of maltreatment experiences and altered
DNA patterns and the SLC6A4 gene. To
analyze the cumulative familial risk
index in explaining DNA mutation
patterns in abused children.
1370 children from Salvador da Bahia. (53.4%
boys; n = 731 and
46.6% girls; n = 639)
Child’s age (4–7 years; M = 7.1; SD = 1.7)
Age of mothers (18–56 years; M = 32.1;
SD = 6.7).
33 Children (20 female; 13 male aged
between 8 months and 15 years: M = 8.26,
SD = 3.63), with a history of abuse recruited
from the Clinical Unit of Abuse of the IRCCS
Scientific Institute “Eugenio Medea” from
Brindisi (Italy). All participants were hosted
in an Institution by the Juvenile
Justice System.
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Table 2. Cont.
Author(s) (Year)
Diamond and Muller
(2004)
Erolin et al. (2014)
Flander et al. (2009)
Objective(s)
To examine in detail the association
between witnessing DV and
long-term psychological adjustment.
Understanding causes and effects of
post-traumatic stress disorder in
children and families in Mexico:
(a) examine individual and family
characteristics of mother-child dyads
in the presence/absence of PSTD
and
(b) potential ecological and familial
risk factors for the presence of the
disturbance.
To analyze the relationship between
the incidence of child abuse in
families and parental
behavioral disorders.
Sample
Method/Instruments
Results and Main Conclusions
351 young adults (287 women and 64 men)
between 16 and 24 years old.
Sociodemographic questionnaire;
Young Adult Self-Report (YARS), a
self-report questionnaire with 110 items
that measure emotional and behavioral
problems and 14 items that measure
socially desirable characteristics; Trauma
Symptom Checklist-40 (TSC-40), a
40-item self-report questionnaire that
assesses adult symptomatology resulting
from traumatic experiences; Record of
Maltreatment Experiences, self-report
(ROME), retrospective measure of
victimization occurring up to 17 years
of age.
Children who witnessed ‘minor’ psychological DV
demonstrated significantly less internalizing behaviors
than those who witnessed physical DV, as well as those
who witnessed ‘major’ psychological DV.
Witnessing DV of a physical or psychological nature
was correlated with higher levels of psychopathology,
including PTSD symptomatology; this was more
significant when the perpetrator of violence was the
mother, being more associated with internalizing
behaviors, both for male and female victims. When
total PTSD symptoms were analyzed, results indicated
that the father’s psychological DV towards the mother
emerged as the only significant predictor of PTSD
symptoms for male victims, while psychological abuse
perpetrated by the mother emerged as a significant
predictor of symptoms of PTSD for women.
87 mother-child dyads (50 boys and 37 girls).
Mother’s Age (24–50 years; M = 35.1;
SD = 6.6).
Child’s age (7–14 years; M = 10.2; SD = 2.1).
UCLA PTSD, assessing the exposure of
children aged 7–18 to trauma and PTSD
symptoms; Post-traumatic Stress
Diagnostic Scale (PDS), to assess
exposure to trauma and PTSD symptoms
in mothers; Composite Abuse Scale
(CAS), to assess exposure to intimate
partner violence.
58.8% of children reported at least 1 event that met
DSM-V criteria for PTSD for different episodes of
violence across their lifetime. In relation to DV, 87.4% of
children were exposed to one or more forms of violence.
The results indicate that the factor relating to the child’s
exposure to family violence throughout their life
increases the risk of developing childhood PTSD.
Children who live in environments characterized by
high levels of violence, both family and community,
were at a high risk of PTSD and/or the exacerbation of
ongoing disorders. Furthermore, cultural factors reveal
a great influence on the expression and meaning of
trauma symptoms in individuals.
4191 high school graduates from Croatian
schools (M = 18.13 years).
General questionnaire
(sociodemographic data);
Questionnaire on child abuse (Karloviÿ
2001) according to the Comprehensive
Child Maltreatment Scale for Adults
(Higgins and McCabe 2000);
Emotional and Social Loneliness Scale
(ÿubela Adoriÿ 2004).
Mental illness and parental alcoholism represent risk
factors for the occurrence of different forms of child
abuse. Participants reporting this type of disorder in at
least one parent were more exposed to physical,
emotional and sexual abuse and neglect. The study also
revealed that participants who reported that at least
one of their parents suffered from these disorders had
much more significant feelings of family loneliness
than those whose parents did not have disorders.
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Table 2. Cont.
Author(s) (Year)
Objective(s)
Miyamoto et al. (2017)
Identify individual, family and child
caregiver risk factors for serious
child abuse, resulting in
hospitalization or death, among
children and their families
investigated by Child
Protection Services.
Olszowy et al. (2013)
Examined the utility of applying
commonly used risk assessment
tools to child homicide cases to
determine whether they would be a
valuable resource in identifying
high-risk cases.
Reif and Jaffe (2021)
Sičić and Mužinić (2007)
Identify the risk of child homicide in
the context of DV.
Determine how frequently the risk
factors studied were present in
adolescents who self-harm.
Sample
Method/Instruments
Results and Main Conclusions
234 cases of children who suffered fatal or
serious non-fatal abuse (702 children and
their caregivers).
Case-control study of Child Protective
Services (CPS) Database analyzed using
the Structured Decision-Making
Risk Tool® .
Caregiver involvement in IPV, identified in research
before the index maltreatment event, was associated
with significantly lower odds of a subsequent serious
child maltreatment event. This fact can be explained by
the increased recognition and response to IPV by CPS
and law enforcement authorities over the last two
decades. The system’s response to IPV may effectively
remove the perpetrator through arrest or restraining
order, or it may mitigate the risk by requiring
participation in diversion programs or placing children
in protective custody. These responses can protect
children from the serious outcomes of maltreatment.
40 cases of domestic homicide.
Danger Assessment (DA);
Ontario Domestic Assault Risk
Assessment (ODARA);
Spousal Assault Risk
Assessment (SARA).
The results of this study did not indicate significant
differences between cases of child and non-child
homicide (adult homicide) for the three risk assessment
instruments. This result suggested that children living
with a female intimate partner may also be considered
at risk of lethality if a risk assessment indicates that the
female intimate partner is at high risk.
140 cases of domestic homicide.
Ontario Domestic Violence Death
Review Committee (DVDRC) Database
analyzed through DVDRC risk factor
coding form.
In addition to recognizing the risk that children
presented when mothers were at risk, professionals
who work with families experiencing DV must also be
aware of the increased risk posed to children when risk
factors were identified, regardless of whether or not
obvious forms of mistreatment. Identifying these
child-specific risk factors would justify timely risk
assessment, risk management, and safety planning
practices with families experiencing DV, as these
practices play a vital role in reducing their exposure to
the associated risk. to DV and the prevention of
domestic homicides.
26 adolescents who were hospitalized or
treated at the day inpatient service at the
Children’s and Youth Psychiatric Hospital.
Specially designed questionnaire
containing psychiatric, social, basic
sociodemographic characteristics and
other important characteristics of the
interviewees.
The research results showed that family dynamics,
interpersonal relationships, material circumstances and
other risk factors influenced the normal and healthy
development of an individual and that, in the absence
of the above, several disorders can develop in a
young person.
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Table 2. Cont.
Author(s) (Year)
Sidebotham and Heron
(2006)
Terelak et al. (2019)
Vial et al. (2020a)
Objective(s)
Sample
Method/Instruments
Results and Main Conclusions
Analyze the multiple factors that affect
the risk of maltreatment in young
children within a comprehensive
theoretical framework.
Of the 14,893 mothers who enrolled, taking
into account fetal or early childhood loss and
attrition, a total of 14,256 children were
followed beyond infancy.
A series of prenatal and
postnatal questionnaires.
Reported DV showed a clear association with child
maltreatment. However, the relationship did not
persist after being introduced into the logistic
regression model. This may suggest that both DV
and child maltreatment have a similar relationship
with family structures and other background
factors, and that DV should be viewed as both an
adverse outcome and a risk in itself. Although the
importance of the association between DV and
child maltreatment is not denied, this may be a
reflection of underlying risk factors common to
both, rather than a direct causal relationship.
Determine the extent of DV against
school-age children and youth in
different types of communities.
Last class of students from primary and
secondary schools in three communities in
the province of Western Pomerania, Poland.
The research concept adopted was
carried out using the audit questionnaire
interview technique, based on previous
research, to measure the social scale of
DV suffered by school-age children.
The co-occurrence of three or more forms of
violence in the family environment seemed to
reveal cumulative symptoms of a pathological
family life, putting the health and even the lives of
DV victims at risk.
Actuarial Risk Assessment Instrument
Youth Protection (ARIJ).
A cross-sample network was constructed to
examine the interrelationships between child
maltreatment risk factors in both samples. This
strongly interrelated network revealed positive
relationships between all factors that were part of
the network. Two distinct groups of factors could
be identified in this network: (1) a group of
particularly static risk factors and (2) a group of
risk factors related to DV. The risk factors “History
of DV”, “Emotionally absent caregiver” and
“Caregiver abused as a child” were the most central
risk factors.
This study explored the interrelationship
of risk factors for child maltreatment.
Children who were referred to child
protective services (high risk of
maltreatment) and children who were
referred to community services (lower risk of
maltreatment).
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5. Discussion
In order to obtain a better understanding of the victimization risk assessment of
children in situations of domestic violence, a systematic review was carried out on studies
that could guide the identification of factors, consequences and instruments able to achieve
this objective.
When assessing risk, it is essential to first assess whether the child is in immediate
danger, thereby enabling the possibility of preventing more serious damage from occurring.
Some risk assessment tools have emerged to respond to these immediate needs (NavarroPérez et al. 2023; van der Put et al. 2017; Vial et al. 2020b), but none of them are targeted
at children. Olszowy et al. (2013) analyzed the effectiveness of existing instruments for
assessing the risk of domestic violence and homicide in children exposed to this violence.
They found that certain items could predict child homicide, including those listed in the
study by Reif and Jaffe (2021), including factors associated with the parents’ inability to
establish and maintain a relationship, explaining the occurrence of a separation based
on conflict.
The existence of scales (e.g., CTSPC and CPAS) to assess the impact of domestic
violence revealed inconsistencies in the way the items are described. These inconsistencies
are explained by cultural differences in interpretation, grouping together taboo ideas
associated with social desirability, and the avoidance of conflict for fear of reprisals (Bonfim
et al. 2011). CPAS, while supporting the assessment of the prevalence of specific forms of
psychosocial risk factors, may also contribute to the identification of early intervention
priorities. However, it is necessary to consider that the social environment has a complex
relationship with biology and therefore may not accurately predict the impact of domestic
violence (Berens et al. 2019). As Fitz-Gibbon et al. (2019) point out, it is important to take
into account the variability in risks and each individual child’s response to violence in the
family context. For these reasons, and allowing for the selected convenience sample and
the small number of participants, the difference in the items compared to the original scale
is justified (Berens et al. 2019).
Other included studies focused on contextual, family and psychopathological issues
to assess the risk and impact of domestic violence on children and adolescents (Craig
et al. 2021; Diamond and Muller 2004; Erolin et al. 2014; Flander et al. 2009; Sičić and
Mužinić 2007; Sidebotham and Heron 2006; Vial et al. 2020a). These studies found that
the presence of psychiatric problems prior to pregnancy, a low parental age, low academic
performance, the socioeconomic environment of families and the prematurity of children
can all determine behaviors that influence parenting patterns, increasing the risk of mistreatment (Sidebotham and Heron 2006). This is because these factors are associated with
high levels of stress, feelings of isolation and a lack of social support (Berens et al. 2019),
and relate to the categories of dynamic and static risk factors for domestic violence. As Vial
et al. (2020a) revealed, risk factors are interrelated and, therefore, the discrepancy between
the contribution of each of them to the occurrence of domestic violence can be explained
by how certain it is that these risk factors lead to an exponential increase in child abuse.
This confirms the need to take into account the intergenerational factors associated with
domestic violence, especially parental history (Chiesa et al. 2018; Fitz-Gibbon et al. 2019;
Shlonsky and Friend 2007). Chiesa et al. (2018) showed that understanding the variability
in children’s adjustment requires considering parents’ cognitions, emotions and behaviors.
Finally, differences in the incidence of domestic violence depending on the area of residence
(e.g., rural, urban) are explained by the different ways in which it is experienced and even
recognized by third parties, but this requires further studies (Terelak et al. 2019).
Miyamoto et al. (2017) reported that domestic violence is associated with a lower probability of serious child abuse, but this result was explained by the recognition, increase in
and mobilization of responses to domestic violence by child protection systems, facilitating
the removal of the aggressor (Miyamoto et al. 2017). This does not mean that mistreatment
does not occur, but rather that more serious mistreatment tends to be more easily avoided.
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Since children exposed to domestic violence are victims of different forms of victimization that occur simultaneously (Shlonsky and Friend 2007), there is a negative on
their overall development (Sani 2020). Consequently, for a detailed assessment of the
development of long-term damage and related interventions, it is necessary to take into
account the child’s level of development and the various factors associated with domestic
violence. Therefore, working on and intervening in child abuse cases is more complex than
just discussing issues of safety and protection concerning the perpetrators (Shlonsky and
Friend 2007).
The intergenerational nature of violence confirms that domestic violence has an impact on the social and emotional behaviors of adolescents (Sičić and Mužinić 2007). The
aggressive behaviors of adolescents can be explained by exposure to domestic violence,
which is the only way they know how to resolve conflicts and externalize the anger they
feel, explaining the development of internalizing and externalizing symptoms and behaviors (Sičić and Mužinić 2007). As Malta et al. (2019) and Sani (2006) have pointed out,
victimization through exposure to domestic violence is a proven risk factor for the development of internalizing and/or externalizing behavioral problems. Furthermore, long-term
symptoms in male victims exposed to psychological domestic violence are more evident
when the perpetrator is the mother, and can be better explained by the deterioration that
occurs in the mother–child relationship than by the occurrence of domestic violence per
se (Diamond and Muller 2004). The probability, severity, expression, and development of
post-traumatic stress disorder varies depending on the prevalence of ecological, family and
contextual factors, explaining the increase in symptoms and the impairment of psychosocial
functioning, especially in females (Erolin et al. 2014).
Flander et al. (2009) found that emotional and social issues occur in children who are
victims of domestic violence associated with the existence of psychopathology and parental
alcoholism. High levels of feelings of family and social loneliness, associated with high
levels of stigmatization, result in children isolating themselves from their peers, having
difficulty in establishing social relationships, and greater likelihood for suffering other
forms of victimization (Hanson et al. 2006; Malta et al. 2019; Sani et al. 2021). However,
children and adolescents exposed to different types of mistreatments can still develop
strong emotional bonds, seeking emotional support in relationships (Flander et al. 2009).
Craig et al. (2021) showed that risk factors and impacts of exposure to domestic
violence can explain the variance in DNA mutation levels. Proximal family risk factors are
associated with high levels of parental stress and variations in early-stage care, resulting in
altered neural, hormonal, cognitive and behavioral responses in children, with the degree
of impact dependent on the age at which mistreatment occurs (Craig et al. 2021).
An increase in the frequency and severity of domestic violence is associated with an
increase in the probability of child abuse, which may culminate in the death of the child.
This can be explained by attacks that occur during pregnancy, custody disputes over the
child, or jealousy, with homicide being the result of attempted or broken relationships (Reif
and Jaffe 2021).
This systematic review targeted studies that list multiple factors in the assessment
of risk in children and adolescents who are victims of domestic violence, subject to our
inclusion/exclusion criteria. Although we used three recognized databases that cover
current and high-quality articles, allowing for the broad coverage of relevant scientific
literature, we could have also included other databases to increase the number of studies
for analysis in order to obtain a broader and more robust response to the research questions.
We believe that one of the limitations of our study is the conceptual definitions surrounding
violence against children. The chosen concept of domestic violence encompassed, in several
studies, notions that could be expressed in different ways (e.g., intimate partner violence,
interparental violence, child abuse), so we opted for a comprehensive concept that involved
the victimization, whether direct or not, of the child, and which would lead to a potential
negative experience and consequences for their development. Therefore, studies that did
not consider children or that addressed child abuse but not in the family context of their
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caregivers were not included in this review. This decision was the result of many difficult
discussions between researchers, and the viewpoint of other colleagues might differ.
The choice of a more quantitative study design was, to a large extent, linked to the
search for objective measures that would validate a more structured (actuarial) assessment,
which has been identified as allowing for a better prediction of mistreatment. However,
studies with other designs can make an important contribution to the assessment of risk
and impact. The literature revealed the interrelationship of risk factors, the possibility of
them being mediated by others, and the possibility of a significant exponential increase
in this risk, thereby underscoring the importance of considering the simultaneity of these
indicators and the need for other studies that deepen these interrelations, with other
methodologies. Reviews focusing only on existing instruments that assess the risk of child
abuse can sometimes appear to be generic, but there remains a scarcity of measures focused
only on the problem of domestic violence between caregivers and involving the presence
of children. Acknowledging attempts to control for possible geographic and cultural
differences, there is still a need for transnational studies involving two or more countries;
this would allow for larger samples and comparisons that would lead to the development
of more universal instruments. It is important that such studies are carried out in the future.
In any case, this review contributes, in an integrated way, to the identification of the main
criteria that could be the basis of a child-centered risk assessment.
6. Conclusions
The study of child abuse requires the consideration of various contextual and individual risk factors and the multifactorial impact of victimization, making it more complex than
just taking into account safety and protection issues in relation to perpetrators. Domestic
violence requires a simultaneously integrated and differentiated reading. On the one hand,
multiple contextual–situational or individual factors (parents and/or child) must be integrated into the assessment, whether static (caregivers’ history of victimization) or dynamic
(families’ socioeconomic environment); these interact and impact on the consideration of
the risk. On the other hand, given the multifactorial impact of victimization by domestic
violence in the short, medium or long term, it is important to differentiate the experience
and (estimation of) risk of this victimization in children and adults.
It is imperative to break down the adult-centered approach to addressing domestic
violence to highlight the importance of conducting a child-centered assessment of the risk of
domestic violence victimization. This literature review gathers sufficient empirical evidence
such that—in situations of domestic violence among adult caregivers—the victimization of
the child is undeniable. The empirical literature supports the importance of various factors
in the life history of caregivers. It also provides a framework for instruments that identify
and measure the key elements to consider when assessing the risk posed to children in
cases of domestic violence. This underscores the need for a comprehensive assessment that
goes beyond solely evaluating the adults involved.
This systematic review confirms the intergenerational transmission of violence and
child abuse, and alerts us to the cumulative and exponential risk that can arise from a partial
assessment that is not centered on the child and which, for various reasons, disregards
their protection and their rights. It also allowed us to uncover, in addition to the material
screened and analyzed, the body of literature that has emerged on the victimization risk
assessment of children in situations of domestic violence. We consider it important to make
efforts to improve existing instruments based on the knowledge that has been gained in
recent decades and to develop more structured resources for the earlier prediction of risk,
thereby supporting child protection services in minimizing or even preventing child abuse.
Author Contributions: Conceptualization, D.R.R.C., M.E.L. and A.I.S.; methodology, D.R.R.C., M.E.L.
and A.I.S.; validation, A.I.S.; formal analysis, D.R.R.C. and M.E.L.; investigation, D.R.R.C., M.E.L.
and A.I.S.; data curation, D.R.R.C. and M.E.L.; writing—original draft preparation, D.R.R.C. and
M.E.L.; writing—review and editing, A.I.S.; supervision, A.I.S. All authors have read and agreed to
the published version of the manuscript.
Soc. Sci. 2024, 13, 259
19 of 22
Funding: This work was partially financed by national funds through the Foundation for Science
and Technology (FCT) within the framework of the Research Centre for Child Studies (CIEC) of the
University of Minho projects under the references UIDB/00317/2020 and UIDP/00317/2020.
Institutional Review Board Statement: Not applicable.
Informed Consent Statement: Not applicable.
Data Availability Statement: The data presented in this study are available upon request from the
corresponding author.
Conflicts of Interest: The authors declare no conflicts of interest.
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