The Association of Post‐Separation Abuse and Coercion With Children's Health and Flourishing

AIM: The purpose of this study is to compare health outcomes and flourishing between children (age 6-17) whose mothers experience high versus low exposure to post-separation abuse and coercive control (PSA). DESIGN: Exploratory sequential mixed-methods study. METHODS: Cross-sectional survey with community-based, convenience sample of family court-involved mothers in the United States (N = 497). Independent variable measured by subscales of the Healthcare, Economic, and Legal PSA and Coercive Tactics Scale (HELP-T). Health outcomes measured by items from National Survey of Children's Health. RESULTS: Children whose mothers experience more frequent PSA face a dual burden: increased odds of unmet mental health needs coupled with increased odds of mental health diagnoses, somatic symptoms and special health care needs. Children in the high-exposure Healthcare PSA group were twice as likely (aOR: 2.01, p-value < 0.001, 95% CI: 1.4-2.9) to report stomach/intestinal problems, 2.3 times more likely (p-value < 0.001, 95% CI: 1.5-3.4) to report chronic pain including headaches in the last 12 months, 2.13 times more likely (p-value < 0.001, 95% CI: 1.4-3.8) to have ever received a diagnosis of anxiety and 2.72 times (p-value < 0.001, 95% CI: 1.60-4.63) more likely to have unmet mental health needs as compared to children in the low-exposure group. CONCLUSION: The findings from this study advance the growing body of evidence on how co-parent perpetrated PSA and coercive control harm children's health and access to healthcare. IMPACT: This study is the first to our knowledge to demonstrate the association between maternal exposure to co-parent perpetrated PSA and children's health outcomes, establishing a foundation for future intervention work to improve children's health and access to health care. PUBLIC CONTRIBUTION: Members of the public were involved in recruitment and cognitive interviewing.