Children's well-being another casualty of recession: Researchers see marked increase in abusive head trauma cases during economic downturn

Rachel P. Berger, MD, MPH., and colleagues from Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center (UPMC) became concerned when, in 2008, there were more deaths from head injuries due to abuse (shaken baby syndrome) at their hospital than from non-inflicted brain injury.

"To think that more children died from abusive head trauma than from any other type of brain injury that year is really remarkable and highly concerning," said Dr. Berger, a child abuse specialist and researcher in the Child Advocacy Center at Children's Hospital of Pittsburgh of UPMC.

The findings were so striking that Dr. Berger and her colleagues wondered whether this was a local phenomenon or if hospitals in other parts of the country were seeing similar increases. Dr. Berger teamed up with researchers from three other children's hospitals to determine whether the number of abusive head trauma cases had increased since the start of the recession and whether any increase was related to higher unemployment.

Researchers collected demographic and clinical data for all cases of unequivocal abusive head trauma before the recession (Jan. 1, 2004, through Nov. 30, 2007) and cases during the recession (Dec. 1, 2007, through Dec. 31, 2009).

They collected data on 511 cases of abusive head trauma in Pittsburgh, Cincinnati, Seattle and Columbus, Ohio, which had occurred during this six-year time period. Of these children, 63 percent had injuries that were severe enough that they were admitted to a pediatric intensive care unit, and 16 percent of the children died as a result of their abusive head trauma. In addition, one-third of children were older than 1 year.

There was a significant increase in the number of abusive head trauma cases during the recession, and all sites saw the increase, although the differences were most striking in Seattle and Pittsburgh, Dr. Berger said.

Researchers could not link the increase in abuse cases to higher unemployment rates. Dr. Berger noted that almost 90 percent of the children with abusive head trauma were receiving Medicaid at the time of their injury even in the years before the start of the recession. As a result, in this group of children, unemployment rates may not be a good measure of the effect of the recession; it is likely that the unemployment rates were high even before the recession started.

Researchers are continuing to look for an explanation for the increase, such as a decrease in social services. This type of decrease might result in an increase in family stress, which is a known risk factor for abuse, Dr. Berger said.

Regardless of the reason, the increase in abusive head trauma is very concerning and highlights the need for increased prevention efforts during times of economic hardship, Dr. Berger said. In addition, because a large percentage of the children throughout the six-year study period were older than 1 year of age, there may be a need to expand primary prevention programs, which currently focus almost exclusively on the parents of newborns, she added.