The objective of this study was to determine the factors associated with adolescent perceptions of four types of domestic violence in Honduras during the COVID-19 pandemic. Considering that the pandemic contributed to a wide range of negative consequences for the mental health of children and adolescents, a critical need was established to explore this issue in an environment previously reported as problematic (4).
Social distancing, sheltering at home, restricted travel, and the closing of community foundations may have increased the risk of family violence. So, places like France and Brazil reported an increase in reported cases of domestic violence; in the United States, agencies across the country also reported an increase. Demonstrating that children were at greater risk of abuse or neglect when living in a home where domestic violence occurs repeatedly (8).
Violence, (particularly sexual violence and bullying), can sometimes come in the context of severe parental upbringing, socioeconomic and other serious problems, which together constitute mental health risks. Where some of the main determinants of mental health in adolescents are the quality of their home life and peer relationships (9).
Honduras could not be the exception, according to the Observatory of Violence, coordinated by the UNAH and the General Directorate of Forensic Medicine (DGMF), 3821 children were evaluated for different types of injuries. Sexual crimes were the most common aggressions, followed by interpersonal physical injuries. Cases of minors abused by their father, mother or caregiver totaled 462, in addition, 118 girls were assaulted by their intimate partner in 2021 (10). This is very important, since adolescents in Honduras represent 22.7% of the total population and have a fertility rate of 102 for every 100,000 live births. Twenty-two percent of adolescents in this age range have ever been pregnant, either because they are mothers (17%) or because they were pregnant for the first time (4%) (11). Future studies should include these variables.
A study in six European cities, which analyzed more than 1500 adolescents, reported that 321 of them had suffered physical or sexual violence before the age of 15 years, 155 adolescents claim to have witnessed abuse and/or violence (12). Our results report that verbal violence predominated in our adolescents, contrary to what is shown in the European study. Children exposed to intimate partner violence (IPV) are at increased risk of being abused and neglected, being more likely to develop adverse health, behavioral, psychological, and social disorders later in life. Identifying IPV, therefore, may be one of the most effective means of preventing child abuse and identifying caregivers and children who may need treatment and/or therapy (13). In a context quite like ours, the Women's Emergency Centers, of the Ministry of Women and Vulnerable Populations, in Peru (2019) attended 55565 cases of violence (to girls, boys and adolescents), with 45.38% being psychological violence; 29.93% physical violence; 22.25% sexual violence; and 0.66% economic violence (14).
In the face of all this, Honduran adolescents share similar situations that make them vulnerable to violence, according to the National Demographic and Health Survey/Multiple Indicator Cluster Survey (ENDESA/MICS2019), 63% of children aged 1 to 14 years are raised under violent methods of discipline, either physical or psychological (15).
We also found in this study that educational level was associated with verbal and physical violence; those with a lower educational level had a higher perception of violence. This has been reported in other research, where those who had a lower educational level suffered more situations of violence, in addition, the level of parental education was significantly correlated with exposure to family violence, so that parents who reported higher levels of education had lower levels of family violence (16). Huecker reported that among the risk factors for domestic and family violence: individual, relationship, community, and social problems, show an inverse relationship between education and domestic violence. Lower educational levels correlate with a higher probability of domestic violence (17).
Adolescents studied who had consumed alcohol in the past six months had twice the perception of verbal violence in their household. Globally, the prevalence of binge drinking episodes among adolescents aged 15–19 years was 13.6% in 2016; the highest risk was among males (18). The COVID-19 pandemic similarly affected alcohol and illicit drug use among male and female adolescents. For both genders, of those who used illicit drugs, more than 40% reported an increase in use after the pandemic (19). Beserra et al. in their research on school violence suffered and practiced and its association with the use of alcohol and other drugs among adolescents aged 12 to 18 years, observed a significant association between violence suffered and the age group of 12 to 14 years; male sex and the degree of schooling in elementary school were also associated (20). Alcohol consumption at this stage of life can disrupt healthy growth, increasing the risk of related disorders in the future; knowing that in 2016 approximately 38% of the population aged 15 to 19 years had consumed alcohol in the previous year and 19% claimed episodic heavy drinking (21).
The Latin American and Caribbean study, which included 26 countries and analyzed 55248 adolescents aged 13–15 years, estimated that for Honduras 16% had alcohol use: one of the lowest percentages in the region (22). In Taiwan, a total of 681970 adults from the National Health Insurance Research Database from 2002–2013 were analyzed, finding that substance use disorders were significantly associated with higher odds of child abuse perpetration, especially physical abuse (23). Our data show low alcohol consumption in adolescents, but a high level of intrafamily violence, in addition, national data show female predominance.
Drug use in the last 6 months in the Honduran adolescents analyzed showed seven times the perception of sexual violence in the home. Martínez-Mota et al, in a meta-analysis with 10843 adolescents of both sexes, found that three types of early life adversity were associated with cannabis abuse/dependence: physical abuse, sexual abuse and presence of violence. Sexual and physical abuse were critical factors affecting vulnerability to cannabis use in adolescence (24). Also, Scheidell et al. in the United States of America associated exposure to any type of abuse or neglect and specific types of domestic dysfunction (parental incarceration, excessive alcohol consumption, exposure to violence) with cannabis and cocaine use in adolescents (25). By 2019 Beharie et al. established that witnessing violence had stronger effects on adolescent substance use (26). Humphreys et al. report that during the COVID-19 pandemic, substance use may have increased violent behavior within the family (27).
In South America, a study of Brazilian adolescents reported that domestic violence against adolescents is related to family interactions, the use of psychoactive substances and violence in the school environment (28). Another research in Brazil conducted in 871 students attending public schools, reported that 15.3% had already consumed some type of drug, 13.2% claimed to have already consumed marijuana, 3.3% cocaine and 0.1% crack; 65.3% claimed to have drunk alcohol abusively in a short space of time (67.4% boys and 63.3% girls) (29). In Colombia in 2015, a sample of 500 adolescents from 20 public educational institutions was studied, finding verbal violence (66.5%) followed by physical (32.0%) and exclusion (30.6%); an association was also found between being a victim and presenting some disability, verbal aggression at home and drug use (30). Fernandes et al. in India reported that adverse childhood experiences (ACE), such as abuse and domestic violence, are strongly associated with substance abuse, most commonly tobacco, in male adolescents and young adults (31).
In our study, the fact that the father, mother or siblings of the adolescents had suffered one or more episodes of violence was more frequent among those who suffered verbal, psychological and physical violence, but not sexual violence. Hildebrand et al, in their study conducted in one of the municipalities of São Paulo over two years, found that 63% of the children or adolescents (assisted in specialized services) suffered more than one form of violence, with psychological violence being the most frequent, followed by neglect or abandonment, sexual violence and physical violence. The main aggressors were both parents (50.9%) or only one of them (30%) (32). According to Fegert et al, the increased risk of child maltreatment and dysfunction in the home did not diminish immediately after the pandemic, as several triggers will last for some time, such as economic pressure and parental mental health problems. Thus, the sequelae of the pandemic-associated increase in child and adolescent maltreatment may last a lifetime (33).
Fernandez Gonzalez et al, in a study on the impact of domestic violence (DV) on women and their children, found that about 80–90% of the children had witnessed abuse suffered by the mother in the home, 55.9% of the children in the emergency shelter and 62.2% of those in the medium-long stay shelter had been direct victims of abuse. The type of abuse suffered by the children was predominantly psychological, followed by physical abuse or both (34). This study did not find a difference between sexes with respect to the perception of intrafamily violence among adolescents; this finding is similar to that reported by Ruiz Hernández et. al. in their study conducted in a Cuban municipality among adolescents, in which they did not find a difference in the perception of violence according to sex (35).
We did not investigate the relationship between dating violence in adolescents, however, according to a study involving 6 countries and with a sample of 1008 high school students aged 13 to 16 years, reported that the overall prevalence of dating violence (DV) victimization was significantly higher among girls, equal to the prevalence of exposure to psychological violence involving control and/or fear, among those who reported that their parents had unpaid work, had lower average social support from a close friend, higher acceptability of violence, and lower problem-solving skills. Girls who had experienced childhood abuse were 69% more likely to have experienced dating violence than girls without childhood abuse (36). Adolescents exposed to family violence show a greater vulnerability to decreased physical, mental and social well-being, although many show positive well-being and development despite experiencing this adversity (37, 38), so we must continue this line of research in the country, to deepen the subject, address it from its roots, try to find more factors that are associated, conduct much larger samples and establish measures to protect adolescents.
LIMITATIONS
Among our limitations in the study are not being able to extrapolate the data to the totality of adolescents in the surveyed departments, because the main objective was not to be able to infer the data, but to find associations with the four main variables. Also, we do not have data from the second most populated department in the country, Cortes, and we do not have data from the department of Gracias a Dios, due to difficult geographic access. In addition, being a secondary data study, we did not have all the variables we would have liked to have, so both limitations show us the need for further research, so that programs can be generated to support this adolescent population, which is in the process of inserting itself into society, and that traumatic events such as these could mark their psychosocial development in the future.