Special Edition: Junior Clinical Research (2023), Vol. 3 No. S2 https://doi.org/10.47488/dhrp.v3iS2.98 DHR Proceedings ǀ http://dhrproceedings.org 87 2023, Vol. 2 No. S2 87-92 COMMENTARY Psychological Effect of Domestic Abuse on Children During COVID Lilian Sustayta1,2, Odalis Rodriguez1,2, Genesis Garza1,2 , Mia Leal1,3, Sammi Arafat1,3, Evelyn Sanchez1,4, Keina Nunez1,4, Alexxa Garcia1,5, Emily Chavez1,5, Rebecca Lerma1,6, Gabriela Perez1,6 1 3rdAnnual Junior Clinical Research Internship, South Texas Academy for Education & Training in Research, DHR Health Institute for Research and Development 2 Economedes High School, Edinburg, TX 3 McAllen Memorial High School, McAllen ,TX 4 Mercedes High School, Mercedes, TX 5 Mercedes Early College High School, Mercedes, TX 6 Zapata High School, Zapata, TX Received: November 2, 2023 Accepted for publication: November 3, 2023 Published: November 16, 2023 Introduction The COVID-19 pandemic has had a detrimental impact on the lives of many children, particularly within their own homes. This influence has been predominantly negative, leading to various challenges such as isolation and domestic problems within households. The limitations imposed as a response to the pandemic resulted in children being confined to dysfunctional environments, thereby exacerbating the prevalence of abuse.1 Domestic abuse, commonly known as "domestic violence," encompasses a range of behaviors aimed at establishing and maintaining control and power over another person. This abuse can manifest in various forms, including physical, sexual, emotional, economic, and psychological actions or threats against an individual. Such actions may include tactics intended to instill fear, intimidation, manipulation, injury, humiliation, blame, or wound the victim.2 Domestic abuse has various effects on people, including increased anxiety, depression, eating disorders, and sleep issues. Children who experience domestic abuse may feel hopeless, unmotivated, and struggle to express their emotions. Our study is aiming to show the increase in domestic abuse during and post COVID-19. Childhood Significance During childhood, one's personality and behavior is in its most important stage of development. Children suffering from an unhealthy relationship are shown to have difficulty building relationships with others.3 When parents neglect their children, children can be exposed to social and emotional consequences. When adolescents are treated with neglect and do not receive proper care, they will be exposed to mental illnesses such as depression, anxiety, and suicidal behaviors.3 Active skills are in the most important process of development. Experiencing abuse and violence has an immense influence on one's mental development. Violence affects the physical, mental, and social health of an individual. Children are required to have a stable and safe environment for proper mental development. The occurrence of domestic violence disrupts the balance of the family system and members of the family suffer the consequences.3 Domestic Abuse Incidence During the Pandemic According to the National Commission on COVID-19 and criminal justice reports, domestic Special Edition: Junior Clinical Research (2023), Vol. 3 No. S2 https://doi.org/10.47488/dhrp.v3iS2.98 DHR Proceedings ǀ http://dhrproceedings.org 88 2023, Vol. 2 No. S2 87-92 abuse increased by 8.1 % due to the lockdown orders that were established in 2020.4 Reports done by the National Commission on COVID-19 and Criminal Justice show that, out of 18 studies, 12 in the United States and 6 in other countries, the rate of domestic abuse increased by 7.9% over all and increased by 8.1% in the United States.4 Data was collected from logs, police calls, emergency lines, and health records, along with other administrative logs. Reasons for the domestic abuse increase were financial issues, substance abuse and wrong coping mechanisms.4 Studies done by the US Davis Health, show that fewer reports of child abuse during COVID-19 pandemic which may lead to believe abuse reports were missed during distance learning.5 Their studies indicate that although there may have been a rise in domestic abuse though it was not reported. Julia Magana said that since the world shut down it caused adults to feel stressed and isolated which set up the rise of domestic abuse.5 Magana teamed up with colleagues from Pediatric Emergency Care Applied Research Network (PECARN) to conduct a study that was published in the Journal of the American Academy of Pediatrics that consisted of over 1.5 million emergency department encounters at nine children's hospitals.5 They conducted their study by identifying abuse in three methods: child physical abuse diagnoses among all ages, age-restricted high-risk injury, or age- restricted skeletal survey completion. The primary outcomes were encounter rates per day and clinical severity before and during the COVID-19 pandemic. Across the three methods used, they identified about 10,000 relevant encounters. The rate for physical abuse diagnoses overall, per day, decreased by 19% during the time of the pandemic. The decrease was seen in children aged 2-13 years old, but less for young children under two years old and older children over 13. For age-restricted high-risk injury encounters, diagnosis declined by 10% during the pandemic. Of note, this reduction was in low severity abuse cases and not in severe abuse. Finally, there was no decrease in total collection of skeletal survey numbers, though there was a reduction in low severity encounters identified by this method with no change in high severity.5 The World Health Organization states that a third of children have experienced violence, which is approximately 55 million children who are abused or were abused(6). During the COVID-19 pandemic, there were a total of 616 reports of domestic violence (sexual and physical) with ages ranging from 5 to 9 and 14 to 18 with two deaths related to the violence. Most cases were female victims, of which 76.7% reported abuse from family members, 23.3% was made up of males, and many were children(6). Many of the reports came from the victim’s own home, with sexual abuse coming out on top as the highest it has ever been. The most common offenders were males, including fathers, grandparents, and brothers. Self- inflicted injuries also increased during COVID-19, corresponding to 67% of the total reported cases of domestic abuse and were mostly common in females.6 The World Health Organization states that a third of children have experienced violence, which is approximately 55 million children who are abused or were abused.6 COVID caused many parents to lose their jobs, and some worked from home which caused the % of domestic violence incidence to increase 12%.3 A study shows that the first abuse incidents increased from 16% to 23% and it also shows that it's linked to the parent’s job loss.3 The statistics show that 60% of children under the age of 17 in the USA suffer some kind of domestic violence.3 Suicide Rates in Children who Experience Domestic Violence Children who experience maltreatment throughout their lifetime are more prone to dealing with mental health issues.7 Because they are more vulnerable, abuse can often lead to self-destructive behavior within their bodies such as substance abuse, impulsivity and disorders like bipolar disorder, post traumatic stress disorder, and severe cases of psychosis.7 These are common patterns seen within domestic abuse victims. Although there are some exceptions, this trauma begins to interfere with the everyday lives of these children as physical methods of relief are only the beginning, like self–harm.8 Self- harm is seen as an alternative form of pain for the psychological toll they are experiencing as these children rather indulge in this physical harm to distract them from their psychological pain and needs.9 This emotional distress comes with factors such as doubts of self-worth and suicidal tendencies. A study done with over 11,000 9-10 year olds showcases how 9.1 % of them indulge in self-harming activities including 1.3% increase in suicidal tendencies and/or attempts.10 These signs of self-destructive behavior often go unnoticed by parents as well as domestic perpetrators. As much as 88% of parents claimed to be unaware of their child’s mental health condition.10 Because there is such a high rate in self-destructing behavior without appropriate help, suicide can seem like the next step children take in order to put an end to their issues. This has increased the number of suicides within children of the age groups of 5-11 years, to the point they have Special Edition: Junior Clinical Research (2023), Vol. 3 No. S2 https://doi.org/10.47488/dhrp.v3iS2.98 DHR Proceedings ǀ http://dhrproceedings.org 89 2023, Vol. 2 No. S2 87-92 risen to become the 8th leading cause of death.11 These suicide rates can be linked back to the issue of domestic abuse, the more trauma that a child experiences, the more likely they are to seek these alternatives. It has even been studied that children who experience 7 or more household traumatic events have a 31.1% of attempting suicide.12 The increase of traumatic events continues to put the lives of children at risk. The rise in demand for child therapy since COVID Throughout the COVID-19 pandemic, the quality of people's home lives and mental health remained a mystery as it was a period of unpredictability, since most people had not yet experienced something as intense as a quarantine before. It was a crucial period, consisting of disruptive situations that were experienced by adolescents and children alike. The extent to which COVID-19 has affected kids has proven to be impactful in terms of the quarantine mandate and the closing down of schools. This resulted in a decrease of social interactions, therefore a state of vulnerability and isolation. Since the pandemic, the after effects of COVID-19 have remained in our community. People under the age of 18 have been severely affected due to the drastic amount of anxiety and depression symptoms found in the new generation in recent times causing a national need for anxiety and depression medication and treatment.13 Psychologists claim that mental health has become a world-wide phenomenon compared to that of past years before COVID-19. More than 8 in 10 (84%) psychologists who treat anxiety disorders said they have seen an increase in demand for anxiety treatment since the start of the pandemic, compared with 74% a year ago.13 Demand for treatment of depression is also up, with 72% of psychologists who treat depressive disorders saying they have seen an increase, compared with 60% in 2020.13 This data shows the lack of quality services and equitable delivery in the medical field.14 Risk factors In order to determine the best measures to take in preventing future cases of domestic abuse, it is crucial to analyze and assess the risk factors that increase the chances of such cases occurring. Risk factors are characteristics of either a parent or guardian, or the child themselves that can increase the possibility of abuse cases.15 It is important to note that risk factors are not direct causes of violence against youth, however, they can be linked to such cases.16 Risk factors fall into various categories including individual, community, social, and family. Table 1. Individual  Participation in substances such as tobacco, alcohol, and drugs  Being exposed to violence and family discord  Reduced educational levels  Being disabled or suffering from mental health issues Community  Poverty  Easy accessibility to liquor and narcotics  Lesser economic possibilities  High gang activity and drug trafficking concentrations Social  Social and gender expectations that promote a culture of violence  Health, financial, educational, and social policies that uphold economic, gender, and social disparities  Peer rejection in society Family  Drug usage or criminal activity on the part of parents  weak emotional connection between parents and children  Severe, inadequate or disorganized disciplinary measures  Involuntary or premature marriage Reference: Increase Risk During COVID-19 In March and April of 2020, government leaders made the decision to enforce stay-at-home and shelter-in-place orders in hopes of regulating the COVID-19 pandemic. While the initial orders worked to contain the spread of the coronavirus, these factors would lead to an increase in other adverse outcomes, such as a rise in domestic violence and child abuse cases. Because of mandated isolation as well as the economic effects of the pandemic, factors that tend to be associated with abuse cases were augmented. Such factors included rising economic instability, increased stress related to childcare and homeschooling, greater male unemployment rates, and inadequate coping mechanisms, such as increased drinking and other substance use.17 Furthermore, because of both children and adults being forced to remain in their homes, the social network of teachers, friends, neighbors, and Special Edition: Junior Clinical Research (2023), Vol. 3 No. S2 https://doi.org/10.47488/dhrp.v3iS2.98 DHR Proceedings ǀ http://dhrproceedings.org 90 2023, Vol. 2 No. S2 87-92 others who could potentially report or intervene in cases of abuse were cut off. After the imposition of stay-at-home order, cases of domestic abuse increased by 7.9 % on average in studies including both the U.S and international countries. In the U.S alone, the reports of domestic violence increased by 8.1% during the pandemic.17 Prevention Domestic abuse is a complicated issue that traces a foundation in unhealthy relationships and harmful living conditions.15. Because the problem can be characterized by having both internal and external stimuli, as well as an imbalance of power between child and perpetrator.17 Prevention works more to try and attack the problem at the root, taking systematic consideration of the risk factors associated with it. For many organizations, the goal towards prevention begins at not only an interpersonal level, but also with legal and federal actions.18 INSPIRE Concerned by the rising cases of abuse during isolation, 21 leaders of worldwide organizations, including UNICEF, UN Women, and the World Health Organization, united in 2016 under one shared goal of protecting children from violence. They signed a joint leader’s statement expressing their concern for the heightened abuse cases that were negatively impacting children. In doing so, they established their plan to work with local and federal governments as well as urging communities and the leaders of every sector to unite against the growing instances of abuse in order to achieve the unanimous objective of ending all kinds of violence and neglect towards children.18 Under the leadership of the World Health Organization, INSPIRE offers seven evidence-based strategies that have shown to be effective in preventing child abuse.18 The seven strategies are: ● Implementation and enforcement of laws; ● Norms and values; ● Safe environments; ● Parental and caregiver support; ● Income and economic strengthening; ● Response services provision and; ● Education and life skills Figure 1. Count of all CPS Reports and Percent with DV Alleged by Week and Year.19 Figure 2. Percentage of CPS Reports with DV Alleged by Season.19 Figure 3. Count of CPS Reports by Reporter Type by Month.19 Conclusion The negative effects of COVID-19 still linger in our communities today. Having been such a stressful event that occurred in people's lives, its effects were momentous on children as they became more isolated and restricted from the rest of the world compared to everyone else. Further yet, the scars left on the children were cut deeper on those who experienced domestic violence as they dealt with the abuse and the effects of COVID-19. The pressure put Special Edition: Junior Clinical Research (2023), Vol. 3 No. S2 https://doi.org/10.47488/dhrp.v3iS2.98 DHR Proceedings ǀ http://dhrproceedings.org 91 2023, Vol. 2 No. S2 87-92 on families during this time made for already precarious households to become even more unstable, making it an even more difficult environment for a child to thrive in. The traumatic scenes that some children witnessed and endured made it possible for mental issues to develop such as anxiety, depression, P.T.S.D, etc. Even after quarantine was over, domestic violence rates are still at an all time high, causing a child's development to have serious repercussions in the future, including mental health. Despite the rise in cases, organizations like INSPIRE continue to work together with local governments to create a future for children that is safe. In addition, The Family Crisis Center in the Rio Grande Valley has also helped combat this by changing the lives of many through providing intervention and prevention services to children no matter their circumstances. Acknowledgements Monica Betancourt-Garcia, MD, Program Director; Melissa Eddy, MS, Program Manager Funding Funded by DHR Health Institute for Research & Development; DHR Health; Region One ESC GEARUP College Ready, Career Set!; Region One ESC GEARUP College Now, Career Connected; Region One ESC PATHS; Region One ESC Upward Bound Math & Science; Benavides ISD; and Jubilee Academy-Brownsville References 1. Vidal S, Prince D, Connell CM, Caron CM, Kaufman JS, Tebes JK. Maltreatment, family environment, and social risk factors: Determinants of the child welfare to juvenile justice transition among maltreated children and adolescents. Child Abuse Negl. 2017.Jan;63:7-18. doi: 10.1016/j.chiabu.2016.11.013. Epub 2016 Nov 22. PMID: 27886518; PMCID: PMC5283859. 2. Øverlien C. The COVID-19 Pandemic and Its Impact on Children in Domestic Violence Refuges. Child Abuse Rev. 2020;29(4):379- 386. doi:10.1002/car.2650 3. Grzejszczak J, Gabryelska A, Gmitrowicz A, Kotlicka-Antczak M, Strzelecki D. 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