Children are highly exposed to physical violence between parents : A preliminary report emphasizing the need for intervention

© 2015 The Authors; Tabriz University of Medical Sciences This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Children are highly exposed to physical violence between parents: A preliminary report emphasizing the need for intervention

Domestic violence remains a serious health care problem worldwide.The only national survey of domestic violence against women in Iran conducted by The Women's Center for Presidential Advisory, The Interior Ministry and The Ministry of Higher Education in 2004, reports that more than 80.0% of married women experience various type of abuse by their husbands during the past 12 months and almost three fourth experience physical violence lifetime. 1Violence affects children not only if they are the direct victim but also when they have a close relationship to the victim. 2indings of national surveys demonstrated that 30 to more than 40.0% of abused women responding in surveys stated that their children had witnessed the violence events. 3Another study reports that more than 40.0% of all domestic violence events had children in the household at the time, and almost all of them (95.0%)hear and become aware of it. 4khari A, et al, J Anal Res Clin Med, 2015, 3(1): 51-6.doi: 10.15171/jarcm.2015.008,http://journals.tbzmed.ac.ir/JARCMDomestic violence is still common all around the world and children are directly or indirectly victimized.This study investigates the exposure of children to interparental physical violence.
Data were collected from a sample of randomly selected university students.Information was collected on any experience of exposure to violence between parents, the type, frequency and duration of violent acts.
From a total of 177 students, 31.5% of females and 46.6% of males have experienced interparental violence (IPV), and most of them (66.7%)directly witnessed it.The intimate violence was by fathers in 62.3%.The most frequent types were slamming a door and slapping (20.3%).Almost 40.0% of violent experiences began during pre-school age of the child, and a same number were still experiencing such events.Rate was higher reported by males and less educated parents.Males had a higher odds ratio (OR) of exposure to physical violence, as well as violence by fathers only.
This report emphasizes the high rate of children witnessing violence between their parents.Beside proper and in time intervention to reduce the psychological harm in these children, educational programs to increase social skills and problem-solving methods will improve the quality of relations within families.

Physical Violence
A number of estimates about the extent of children's exposure to interparental violence (IPV) have been made in recent years.A report for UNICEF (United Nations Children's Fund) estimated that between 133 million and 275 million children around the world witness repeated domestic violence.The latest survey from Iran reported that 22.8% of school-age children experienced at least one violent event between their parents. 5Children's exposure to domestic violence has been increasingly recognized as a form of child abuse and consequences are not different from maltreated children. 7[9][10] Authors mostly prefer using the terms "child exposes to violence" than "child witnesses to violence" as it describes the experience of seeing, hearing and observing the results and even living in fear more comprehensively.Most researchers agree that exposure to domestic violence occurs when children see, hear, and are directly involved in (i.e., intervening to stop, being forced to spy on a parent), or get aware of the outcome of physical or sexual assaults that occur between their parents. 11Even though many parents try to protect their children from the ongoing violence, research suggests that children in violent homes commonly hear, see or even get involved in such events 6 and parents frequently underestimate it. 12espite the major religious believes in Iran, domestic violence is common.There is still a serious need for epidemiologic data from different regions of the country depicting the current situation.Such publications will expectantly emphasize the importance of intervention in this filed for policy makers of health care system.This report focuses on exposure of children to physical violence between parents that seems to be more manifest by others compared to sexual or emotional abuse. 13The aim of this study was to explore the frequency and nature of inter-parental physical violence witnessed by university students during their childhood.Possible relation to socio-demographic characteristics of the family was also evaluated.This cross-sectional study was carried out on students from Humanity and Social Sciences Faculty of Tabriz University, Iran.The sample size was estimated to be at least 167 based on the previous report on physical violence against women (0.70) and a Confidence interval (CI) of 95%.A total of 180 students from North West region of Iran were randomly selected from the list of students.
Selected students were invited to a session where the research assistant explained the research purpose and procedures and emphasized the voluntary and anonymous nature of the research.Students were also informed about their right to refuse or discontinue participation at any time.Informed consent was then obtained from all.Self-report questionnaire was completed by 177 students at the same session, and administration averaged 15 min in length.
The questionnaire "Exposure to interparental physical violence" collects information on various aspects of exposure to physical violence between parents and is designed by Vameghi et al. 5 The original instrument consists of 30 questions including demographic data (age, gender, level of education, …), family status (parent's age, educational level, employment status, marital age and current marital status, having step father/mother, number of siblings, …) and information about family violence (exposure to inter-parental physical violence, the parent committing the physical violence toward the other, the way of exposure (witnessed, hear voices, noticed aftermath, …), types of violent behaviors (biting, clawing and pulling hair, prohibition of having food, beating up, prison, making him/her to leave home, slamming the door, pushing or pulling, punching, slapping], the first and the last time of exposure, number of episodes).
Moreover; an additional 12-item question including various types of violence was adopted from the Domestic Violence Scale structured by Qazitabatabaei and Mohseni Tabrizi 1 This final and modified questionnaire was sent to three experts in the field of family violence to examine scale's cultural relevance and content validity that was estimated to be highly reliable (α = 0.76).
Data were analyzed by SPSS for Windows software (version 11.5, SPSS Inc., Chicago, IL, USA).Data are reported as mean ± standard deviation (SD) or mean (percentage).Cronbach's alpha (α) was calculated to reveal coefficient of internal consistency of the structured questionnaire.Chi-square test was used to compare differences between groups and Phi, Cramer's V as well as odds ratio (OR) is reported where appropriate.

Exposure to physical violence
From the total of 180 selected students, 177 answered the questionnaire properly.The mean age of the participants was 20.97 (1.77) years ranging between 18 and 34 years.
From the total of 177, 39.0% students (n = 69) were exposed to inter-parental physical violence including 31.5% of females and 46.6% of males.Characteristics of these students and their parents are described and compared to students with no experience of parental violence are described in table 1.

Related factors
Significant relationships were found between Phi and Cramer's V value = 0.234, P = 0.023).
This study is the first report on exposure of children to IPV from North West of Iran reporting that almost 40.0% of children report some kind of interparental physical violence, mostly beginning during their teenage years.This violence was related to a lower educational level of parents and was mostly committed by the fathers.
Results of studies about IPV are strongly dependent not only on the characteristics of study sample (e.g.age, gender...) but also cultural rules and system of the law.The pattern of IPV may also change during time.This also explains the need for and importance of repetitive studies in different regions.Such researches will provide a map for intergenerational transmission of violence 14 or hopefully any success in preventing this process for policy makers as well.
Exposure to physical violence between parents is universal and all of the available results are in agreement that at least one-third of children all around the world are exposed to IPV while they were growing up [15][16][17][18][19] and confirmed a high level of exposure.However; the current study indicated a higher rate than the past research in Iranian population. 5This difference may be explained by the different age of participants.The samples in study of Vameghi et al. 5 were school-age students where participants in the current study are selected from graduate students who are elder and have a longer life experience.In addition, elder students, entering their adulthood, may report IPV easier.A code of secrecy is often enforced, so the abuse is not revealed to those outside the family.Children are taught not to tell about the abuse, and may be threatened with punishment if they do tell. 20egardless of the rate of exposure to IPV, pattern of these violent acts were similar to previous reports and revealed fathers to be more assaultive than mothers. 5,18,21This might be influenced by a less harmful and dangerous acts from mothers in part.The most common reported forms of physical violence were slapping, slamming door, pushing/pulling, punching and beating up which was similar to many other reports 18,22 and most of the students had been directly witnessed to these acts.
Another remarkable finding of the current study is that two-thirds of exposed children experienced IPV as early as their teenage and the vulnerable time of growing up.High rate of the last exposure to IPV in university age (39.1%) substantiates a long-term exposure to IPV and indicates that these families have no attempt to reduce the violence and may have no source of help to discover secure, valuable and functional problem solving ways.This is influenced by Iranian culture where families keep secrets from the outside world.
The most important limitation of this study is that it was not population based, and characteristics of the study population restrict generalization of the results.However, nature of the concept limited our choices in selecting the study population and results are still noteworthy and include a large proportion of our population.We also tried to increase the validity of the results using open-ended questions and/or several choices of answers.
In conclusion, this study revealed that a high rate of children is exposed to physical violence between parents in North West of Iran, mostly beginning in their teenage and lasting for several years.This study emphasizes the importance of the topic and the need for educational interventions to increase social skills and problem-solving methods.

Authors have no conflict of interest.
This study was supported by Research Center of Psychiatry and Behavioral Sciences (RCPBS), Tabriz University of Medical Sciences.

Table 1 . Demographic characteristics of students exposed to IPV
* Correlation is significant at the 0.01 level; NS: Not significant; IPV: Interparental violence