key: cord-0742653-m505szsi
authors: Fares-Otero, Natalia E.; Pfaltz, Monique C.; Estrada-Lorenzo, Jose-Manuel; Rodriguez-Jimenez, Roberto
title: COVID-19: The need for screening for domestic violence and related neurocognitive problems
date: 2020-08-23
journal: J Psychiatr Res
DOI: 10.1016/j.jpsychires.2020.08.015
sha: 13ef89e81f4567adbd8552c025630e97ea0682e5
doc_id: 742653
cord_uid: m505szsi

nan

During the novel coronavirus disease (COVID-19) confinement, domestic violence (DV), i.e., physical, emotional or sexual abuse by one family or household member against another, has vastly increased worldwide 1 . DV is a highly prevalent issue of public health as global estimates indicate that about 1 in 3 (35%) women have experienced either physical and/or sexual intimate partner violence, and at least 1 in 7 children has experienced abuse or neglect at home 2 . In turn, intimate partner violence affects between 8 and 25% of children per year 3 .

Measures of quarantine can protect people from contracting COVID-19 and prevent the rapid spread of the virus. However, it increases the likelihood of victims to continued exposure to DV. That is, for those exposed to DV, home is not a safe place, especially if the survivors are quarantined with the perpetrators 4 . In this context, children and women are particularly vulnerable to be exposed to DV.

In addition, the COVID-19 crisis gives rise to certain adverse experiences such as social isolation, school closures, unemployment, income insecurity or financial deprivation, while also social services are limited and resources for support and advice are reduced 5 . It is known that psychological stressors can increase the risk for DV.

Indeed, those involved in DV prior to a crisis are more likely to experience DV following the event due to increased levels of stress in the perpetrators during and after the crisis 5 .

DV can result in stress related mental disorders, e.g., depression, anxiety, and traumatic stress disorder 6, 7 , in both the victims and the perpetrators. Moreover, a large body of literature reminds us that DV is an environmental stressor which determines alterations in the development and functioning of the brain, leading to neurocognitive deficits in its victims 8 . Therefore, it could be hypothesized that individuals exposed to DV during COVID-19 confinement will be more likely to develop neurocognitive impairments than individuals not exposed to DV, and victims of DV with a pre-existing neurocognitive deficit will be more vulnerable to neurocognitive impairments than victims without a pre-existing neurocognitive deficit.

As a chronic stressor, DV has negative effects on neurobiological mechanisms altering the functioning of midbrain structures, the limbic system, corpus callosum, J o u r n a l P r e -p r o o f including altered white matter integrity in relevant regions for attention and affective control 9 and processing the trauma information (e.g., visual cortex with witnessing DV) but also key areas in emotion processing, such as the anterior cingulate cortex 10 , and several other connected regions involving the Hypothalamic-Pituitary-Adrenal axis 11 . These brain alterations may trigger altered brain reactivity to stressful life events increasing vulnerability for the development of psychopatology 12, 13 

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