The impact on children of exposure to domestic violence and the implications for a primary care response: a systematic review and secondary analysis of qualitative evidence

Children growing up with domestic violence and abuse (DVA), even if a child is not the direct target, can experience major physical and psychological health consequences, some of which persist to adulthood. Many of these childhood problems (challenging behaviours, post-traumatic stress disorder, depression and anxiety) will present to general practitioners. This study aims to bring together evidence about how being exposed DVA affects children’s health and well-being, and the needs that result, in order to make recommendations about how primary care might address these needs with support from other specialist services. Exposure to DVA is common: 14% of children will be exposed at some point in their childhoods, and typically 3% in the past year. Much of the work that measures the impact of DVA on children is based on survey research, which neither captures the depth of experience or the voice of the children themselves. This means that strategies to help children recover may target issues that researchers feel are important, rather than those important to children. As part of a review of programmes for children exposed to DVA (IMPROVE), we found several papers reporting how DVA affects children, from the viewpoint of children and non-abusing parents. As part of a qualitative study looking at the impact on friends and relatives of survivors, we generated rich information from other concerned third parties (non-parents) about the impact on children. We wish to draw together and derive some overarching messages from this work in order to give a picture of: how children are affected by DVA; the areas of their lives that are most impacted; the most important health issues to be addressed; and the needs that could potentially be addressed by doctors and other professionals working in primary care.