We can't lose sight of the pandemic's hidden crisis: domestic abuse, says AMA President

“The situations created by the COVID-19 pandemic have taken many of the support systems that we have come to rely on out of play,” says Patrice A. Harris, head of the American Medical Association.
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By Patrice A. Harris, MD, MA

COVID-19 has disrupted our lives on a scale we haven’t faced for generations. The need to contain the spread of the virus by limiting our contact with others – sometimes even with members of our immediate family – has in some cases created situations that increase the risk of intimate partner violence, child abuse and neglect, and elder abuse.

Unfortunately, COVID-19’s full impact on our nation’s health won’t be known for several more months, and possibly years. But concerning trends have already emerged.

As a psychiatrist who specializes in the mental health of children and adolescents, and in the impact of trauma on children and adults, I know that the likelihood of child abuse rises in tandem with stress. Losing a job, facing a health crisis, grieving the loss of a relative or friend – these and other stressors can increase the risk of domestic abuse.

The fact that schools are closed compounds the risk to children, since child welfare agencies routinely rely on teachers, guidance counselors and other school officials to report potential cases of child abuse and neglect.

At the same time, it is likely that well-child visits to pediatricians and other types of routine care are not taking place at the usual pace, which removes another source of monitoring. Physicians are legally and ethically bound to report suspected instances of child abuse, but may not have the opportunity to identify such cases in the current crisis.

The Centers for Disease Control and Prevention tells us that at least one in 7 children are abused or neglected in a given year – and that the problem is likely greater than that due to under-reporting. The consequences extend beyond physical injuries such as burns and broken bones to emotional and psychological damage that some victims carry with them through adulthood.

Patrice A. Harris, MD, MA, a psychiatrist from Atlanta, became the 174th president of the American Medical Association in June 2019.American Medical Association

Our response to COVID-19 must recognize the lasting impact of adverse childhood experiences, or ACEs, that may result. Experiencing physical, emotional or sexual abuse in childhood – or witnessing dysfunction in the home, such as violence against another family member or economic insecurity – is firmly linked to serious health problems later in life. These problems include risky behaviors like smoking or substance abuse, chronic diseases such diabetes and cardiovascular disorders, depression, and even premature death.

Intimate-partner violence is equally concerning. The CDC estimates that roughly one in every four women, and nearly one in 10 men, have experienced sexual violence, physical violence or stalking during their lifetime. Federal crime data shows that nearly half of all women murdered in the U.S. are killed by a current or former intimate partner.

Sadly, elder abuse remains an ongoing concern, with both physical and emotional consequences. Its victims are often reluctant to report abuse to a third party when it is inflicted by a caregiver on whom they depend.

Seniors, already at higher risk from the coronavirus, are more isolated than ever in this pandemic as senior centers shut down, friends and relatives are prevented from visiting, and the home health care system is stretched to the breaking point. Heightened awareness of potential elder abuse is needed to guard against physical and emotional damage in an environment that seniors have never seen.

The situations created by the COVID-19 pandemic have taken many of the support systems that we have come to rely on out of play. Churches are closed, and many community-based organizations and park districts are idle. With typical support systems now fractured, we must remember that important resources are available and are tailored to the current crisis, including:

Agencies and organizations at the national, state and local levels are working tirelessly to limit the spread of COVID-19, broaden the scope and scale of testing, treat those who have fallen ill, and help individuals, small businesses and the nation as a whole overcome the massive disruption the pandemic continues to cause.

As this situation evolves in the weeks and months ahead, it is my hope that all of us emerge stronger and more vigilant, with greater awareness of the potential for abuse and harm that others face.

Patrice A. Harris, MD, MA, a psychiatrist from Atlanta, became the 174th president of the American Medical Association in June 2019, and the organization’s first African-American woman to hold this position. Dr. Harris has diverse experience as a private practicing physician, public health administrator, patient advocate and medical society lobbyist. A recognized expert in children’s mental health and childhood trauma, Dr. Harris has led efforts on both local and national levels to integrate public health, behavioral health and primary care services with supports for employment, housing and education. She is an adjunct assistant professor in the Emory Department of Psychiatry and Behavioral Sciences, and an adjunct clinical assistant professor in psychiatry and behavioral sciences at Morehouse School of Medicine.