Mediators and Effect Modifiers of the Causal Pathway Between Child Exposure to Domestic Violence and Internalizing Behaviors Among Children and Adolescents: A Systematic Literature Review

Childhood exposure to domestic violence (DV) can lead to mental health problems including internalizing symptoms. This systematic literature review aimed to identify individual-, familial-, and community-level factors that mediate or modify the effect of DV exposure on internalizing symptoms among children and adolescents. This systematic literature review was registered with PROSPERO, registration number: CRD42019127012. MEDLINE, EMBASE, and PsycINFO were searched between 1990 and 2018 for peer-reviewed, quantitative, longitudinal studies published in English. Backreferencing and key journal hand searches were conducted. Twelve longitudinal studies were included. These investigated how factors amenable to change either mediate or modify the effect of exposure to DV on internalizing symptoms (using validated measures) in children and adolescents up to 18 years within a general population. Study quality was assessed using the Newcastle-Ottawa risk of bias tool, and a sample of studies were second reviewed by authors. One individual-level mediator was identified, namely emotional intelligence, and two effect modifiers were identified: relational victimization and participation in extracurricular activities. Familial mediators included maladaptive parenting and parenting stress, while effect modifiers included positive parenting (maternal warmth and availability) and family social support. No community-level factors were identified. All research was conducted in the United States, most focused on risk, and the majority measured outcomes in middle childhood. Nevertheless, these findings suggest that interventions provided to families exposed to intimate partner violence need to target both child and familial factors in order to successfully reduce children's internalizing symptoms.