Table 4.

Characteristics of included studies with descriptive data (n=20).

Authors, Year, Country	Objective and Hypothesis	Participants and study design	Type of violence	Measure of outcome	Main results
Studies from Justice and Police Department Records (n=6)
Barboza, et al., 2020,45 United States.	“To provide unique insights into the spatial and temporal distribution of child abuse and neglect (CAN) in relation to COVID-19 outcomes”.45p1)	Cases (n=661 pre-COVID-19; n=614 post COVID-19 onset) of CAN against children under 18 years reported to the Los Angeles Police Department (LAPD) from July 24th of 2019 to July 19th of 2020. Spatiotemporal ecological study.	CAN.	CAN in California as defined by Penal Code 273d and 270.	A decrease of 7.95% in the number of CAN reports during the COVID-19 pandemic compared to the same time period immediately preceding it.
Dapic, et al., 2020,43 Croatia.	To analyze “trends of recent data of the Ministry of Interior with practical guidelines for improved child protection during the COVID-19 pandemic”.43(p1)	Registered number of children victims of mis-demeanour crime in the family, registered number of child abuse (CA) in the family, and number of criminal offences against children in the family (n=324 in March 2020; n=502 in March 2019) Descriptive study.	CA classified as: misdemeanour crimes; criminal offense; or sexual abuse and exploitation.	CA incidents.	A decrease of 35% in CA in March 2020 compared to the same time in the preceding year. Between January-March 2019 and the same period in 2020, there was a decrease of 31% in sexual abuse and exploitation offences against children. The number of registered perpetrators of family violence against children was 28% lower in 2020 than in 2019.
McLay, 2020,46 United States.	“The COVID-19 pandemic's impacts on domestic violence (DV) with the following research questions: 1) Did DV occurring during the pandemic differ on certain variables from cases occurring on a typical day the previous year? 2) Did DV occurring after the implementation of shelter-in-place orders differ (on these same variables) from cases occurring prior to shelter-in-place orders?”46(p1)	4618 police reports on cases that occurred during the months of March 2019 and March 2020 were utilized from the Chicago Police Department (CPD). Descriptive study.	Reports involving some kind of physical or sexual violence toward a person. These offences included any kind of assault, any kind of battery, homicide, criminal sexual assault, any sex offence against an adult, and any physical or sexual offences against children.	Occurrence of DV during COVID-19 pandemic, occurrence of DV during Shelter-in-Place order, sex crime, use of weapon, arrests, presence of child victim(s), and location of offense.	The number of child victims involved in March 2019 (3.55%) was more than the number during the pandemic (2.35%). A DV case with a child victim was 67% less likely (than cases without child victims) to have occurred during the shelter-in-place order.
Musser, et al., 2021,47 United States.	To “examine rates of documented, substantiated child maltreatment resulting in foster care placement, as well as demographic correlates of child maltreatment within the foster care system, before and during the COVID-19 pandemic”.47(p1)	Data from 294,462 youth aged 0–17 years were compiled from the State Automated Child Welfare Information System (SACWIS) maintained by Florida's Safe Families Network (FSFN) from January 1, 2001 through June 30, 2020. Descriptive study.	Child maltreatment: physical abuse, sexual abuse, physical neglect, medical neglect, inadequate supervision, and emotional abuse and neglect.	Demographic and youth characteristics, child maltreatment and primary caregiver characteristics at removal.	There was a decrease of 24.08% in the number of youths placed in foster care in April, 2020 compared to April, 2019. The percentage of youth removed and placed in foster care due to DV was 42.7% greater for April, 2020 than for April, 2019 while the percentage of youth exposed to emotional neglect was lower for April, 2020 (23.6%) than for April, 2019 (27.6%).
Rapoport, et al., 2020,48 United States.	“To assess associations between the pandemic public health response and the number of allegations of CAN”.48(p1)	The number of CAN allegations received monthly by NYC's Administration for Children's Services (2020) (n=4562 March 2020, n=2806 April 2020, n=3474 May 2020). Descriptive study.	Child maltreatment.	Maltreatment allegations, stratified by reporter type (e.g., mandated reporter, education personnel, or healthcare personnel), as well as the number of Child Protective Services investigations warranting child welfare preventative services.	Fewer allegations of child maltreatment were reported than expected in March (-28.8 %, deviation: 1848, 95 % CI: [1272, 2423]), April (-51.5 %, deviation: 2976, 95 % CI: [2382, 3570]), and May 2020 (-46.0 %, deviation: 2959, 95 % CI: [2347, 3571]). Significant decreases in child maltreatment reporting were also noted for all reporter subtypes examined for March, April, and May 2020. Fewer CPS investigations warranted preventative services than expected in March 2020 (-43.5 %, deviation: 303, 95 % CI: [132, 475]).
Whelan, et al., 2020,49 United States.	“To analyze the impact of COVID-19 and Stay-at-Home orders on CA, neglect and exposure to DV filings using the Oklahoma State Court Network”.49(p2)	Charges issued for CAN from 01/01/2010 through 06/30/2020 in the Oklahoma State Court Network (n=87, 100, 83, 80, 42, February to June 2002 respectively). Descriptive study.	Physical and sexual abuse, neglect, and DV.	CA categorized as physical abuse including murder, sexual abuse including indecent or lewd acts, counts of enabling or permitting abuse (by type), neglect, solicitation of a minor, DV in the presence of a minor, failure to report abuse or neglect of a minor, and failure to protect a minor.	Fewer reports of CAN were made since the beginning of the COVID-19 compared to prior. Criminal charges for CAN between February and June 2020 averaged 78.4 (SD=19.4) monthly compared to 98.0 (SD=11.5) in 2019. A reduction in filings of sexual abuse and DV in the presence of a minor of 52.9 % and 71.7 % was observed. Sexual abuse and DV in the presence of a minor both decreased in June, with actual sexual abuse cases from 21.1 to 10 (95 % CI 11.2–31.2) and actual DV from 42 to 12 (95 % CI 24.9–59.9).
Chong, et al., 2020,50 Singapore.	“To study the impact of COVID-19 on the utilization of pediatric hospital services including emergency department (ED) attendances, hospitalizations, diagnostic categories, and resource utilization in Singapore”.50(p1)	Children aged 0 - 18 years (n=58367) seen in the ED. Descriptive study.	Physical CA.	The SNOMED-Clinical Terms (SNOMED-CT) for ED diagnoses and International Statistical Classification of Diseases and Related Health Problems (ICD 10-AM) diagnostic codes for inpatient diagnoses were used. Components of the local triage system were used which are similar to the Emergency Severity Index (ESI) of Agency for Healthcare Research and Quality.	A total of 226 children were diagnosed with CA-related injuries during the study period. While the mean number remained constant at about 1 per day throughout the pandemic, these children constituted a greater proportion of children seen during lockdown (44, 0.5%) and post-lockdown (79, 0.6%) compared to pre-lockdown levels (36, 0.2%) (p < 0.001).
Holland, et al., 2021,51 United States.	“To examine changes in US ED visits for mental health conditions, suicide attempts, overdose, and violence outcomes during the COVID-19 pandemic”.51(p1)	The study includes data from the EDs (n=3119 in 2019 and 3598 in 2020). Descriptive study.	Suspected CAN (SCAN).	SCAN ED visit counts and rates.	ED visits for SCAN exhibited a more pronounced decrease than overall ED visits between March 15 and May 17, 2020 (range, 30.8%-50.7%). There was a decrease of 57% of SCAN compared to the same period in 2019 (n = 452 in 2020 vs 1052 in 2019).
Kaiser, et al., 2021,52 United States.	To compare the volume and severity of child physical abuse encounters in children's hospitals during the COVID-19 pandemic to that of previous years	The volume of CPA encounters from January 1 to August 31, 2020, was compared to that of the same timeframe in previous years (2017–2019) to understand overall trends (multiple n's for potentially overlapping CAN observations, ranging from 12-1267). Retrospective cohort study.	CPA.	Change in volume of encounters in which CPA was diagnosed, defined by using International Classification of Diseases. Secondary outcomes included markers of CPA severity: intensive care unit use, number of injuries (a higher total is more severe), injury type, hospitalization resource intensity scores for kids, and in-hospital mortality.	There was a sharp decline in the all-cause, overall volume of ED and inpatient encounters in children's hospitals in March of 2020. When comparing trends in the volume of CPA encounters in 2020 to that of previous years, a significant decline was also found (263.4 cases [95% confidence interval: 291.8 to 235.9].
Swedo, et al., 2020,53 United States.	"To examine national trends in ED visits for suspected or confirmed child abuse and neglect during January 6, 2019–September 6, 2020, the period before and during the U.S. COVID-19 pandemic”.53(p2)	Visits were included if the ED provider or facility documented suspected or confirmed physical, sexual, or emotional abuse or physical or emotional neglect of a child or adolescent aged <18 years by a parent or other caregiver (n's not provided). Descriptive study.	Physical, sexual, emotional abuse, or physical/emotional neglect of a child.	Suspected or confirmed physical, sexual, or emotional abuse; or physical or emotional neglect as perpetrated by parents, caregivers, or an authorized custodian of the child. Acts of violence perpetrated by peers, siblings, or intimate partners are excluded from the CAN definition.	The total number of 2020 ED visits for CAN began decreasing to below the number of visits that occurred during the corresponding 2019 pre-pandemic period in March 15–March 22. At the same time, the proportion per 100,000 ED visits began increasing above the proportion seen during the corresponding period in 2019. During the 4-week period following the early pandemic nadir (March 29–April 25), the number of ED visits related to CAN among children and adolescents aged <18 years averaged 53% less than the number that occurred during the corresponding period in 2019 (March 31–April 27). The number of ED visits related to CAN was lower during this period in 2020, compared with visits during the corresponding period in 2019 for every age group, with the largest proportional declines in the number of visits by children aged 5–11 years (61%). The percentage of ED visits related to CAN ending in hospitalization increased significantly among children and adolescents aged <18 years, from 2.1% in 2019 to 3.2% in 2020 p<0.001).
Hamadani, et al., 2020,54 Bangladesh.	“To determine the immediate impact of COVID-19 lockdown orders on women and their families in rural Bangladesh”.54(p1)	Mothers (or female guardians) of children enrolled in the Benefits and risks of iron interventions in children were contacted by telephone to complete a questionnaire (n=2424). Interrupted time-series study design.	IPV: emotional, physical, and sexual violence.	IPV questions were based on the WHO multi-country survey tool, and specifically addressed emotional, physical, and sexual violence by the woman's husband since the last days of March 2020.	Among mothers, emotional violence (insult) was reported by 19.9% of of which 68.4% reported an increase since lockdown; humiliation was reported by 8.9%, of which 66.0% reported an increase; intimidation was reported by 13.5% of which 68.7% reported an increase; physical violence was reported by 6.5%, of which 56% reported an increase; and sexual violence was reported by 3.0%, of which 50.8% reported an increase.
Kimura, et al., 2021,55 Japan.	“To examine the relationships between changes due to COVID-19 pandemic and the development of depressive and anxiety symptoms among mothers of infants and/or preschoolers in Japan”.55(p1)	Women aged 20–49 years and had at least one young child (0–6 years; n=2286). Longitudinal prospective follow-up.	IPV: physical and emotional abuse.	Whether a respondent's husband/partner was violent towards them was assessed as follows: ‘Between March to May 2020, my husband/partner shouted at me more often’ and ‘Between March to May 2020, my husband/ partner was violent with me’. If the participant responded to both or either one with ‘yes’, we treated it as ‘yes=1’, and if the participant responded ‘no’ to both, we treated it as ‘no=0’.	54 (2.4%) participants reported an increase in partner aggression during the pandemic.
Mahmood, et al., 2021,56 Iraq.	“To assess the impact of the COVID-19 pandemic on gender-based violence by comparing the prevalence of spousal violence against women before and during the COVID-19 related lockdown periods”.56(p1)	Married women aged 18 years and older and residing in the Kurdistan Region of Iraq completed the online survey (n=346). Cross-sectional.	IPV: physical, emotional, and sexual violence.	A 30-item survey examining emotional abuse, physical violence, sexual violence, severity of injuries, and frequency of children witnessing violence.	The prevalence of any violence significantly increased from 32.1% to 38.7% during lockdown (p = .001). The prevalence of emotional abuse (29.5% to 35.0%, p = .005) and physical violence (12.7% to 17.6%, p = .002) significantly increased during lockdown. Being physically forced to have sexual intercourse significantly increased during lockdown (6.6% to 9.5%, p = .021). A higher proportion of violence occurred in front of children during the two months preceding the lockdown (13.0%) than the lockdown period (10.7%), but this difference was not statistically significant.
Malkawi, et al., 2021,57 Jordan.	To investigate “reported mental health and changes in lifestyle practices among Jordanian mothers during COVID-19 quarantine”. 57(p1)	Mothers who had at least one child between the ages of 4–18 years, mothers’ ages ranging from 20 to 60 years, living in Jordan, of any nationality, and able to read and write (n=2103). Cross-sectional.	DV.	Domestic violence was measured by question included in the lifestyle change section	An increase of 27.4% in DV at home was reported.
Rodriguez, et al., 2021,58 United States.	“The goal of the first study was to determine whether parents’ economic concerns, worries, and loneliness were significantly associated with perceived increases in adverse parenting during the pandemic. In the second study, mothers participating in a longitudinal study reported on their CA risk and parenting during the pandemic”.58(p3)	Study 1: Parents of at least one child who was 12 years of age or younger (n=405). Cross-sectional. Study 2: Mothers enrolled in a prospective longitudinal study in the Southeast U.S. (n=119). Longitudinal prospective cohort.	Verbal, physical, and emotional abuse/neglect.	Emotional neglect was measured using one item from the parental neglect subscale of the Parent-Child Conflict Tactics Scale CTSPC, and CA risk was assessed via the Adult-Adolescent Parenting Inventory-2 and the Brief Child Abuse Potential Inventory.	Study 1: 20.3% of parents indicated increased use of discipline; 5.3% reported they spanked or hit more than usual; 24.9% indicated yelling/ screaming more; 30.7% indicated they had more conflicts with their children; 4.9% indicated they had to leave their children alone more; 12.6% indicated they used harsh words toward their children more often; and 26.7% indicated they had engaged in emotional neglect. Study 2: Only 3% of mothers indicated they were hitting more often (either “agree” or “strongly agree”), but 33.3% reported more yelling, 34.9% reported more conflict, and 11.9% reported speaking more harshly. 7.5% of mothers reported leaving their children alone more often, 1.8% reported more difficulty feeding their children, and 1.8% reported showing less love toward their child since the pandemic began.
Saji, et al., 2020,44 India.	“To study the social impact of post-COVID-19 lockdown in Kerala from a community perspective”.41(p1)	The study information was collected from families in total from the 14 districts of Kerala, India, during the lockdown period (n=700). Cross-sectional.	DV.	Data was collected using a pilot-tested structured questionnaire via a chain-referral procedure in which participants recruit one another, akin to snowball sampling.	The survey picked up an increase in the prevalence of DV (13.7%) during the lockdown period.
Shah, et al., 2021,41 India.	"To assess the impact of lockdown on children with ADHD, and their families”.41(p1)	Parents of children diagnosed with ADHD, who were actively following up before the lockdown, were contacted by phone (n=80). Cross-sectional.	CAN.	Questionnaire designed to assess the behavior of children with ADHD and their parents during the ongoing lockdown period.	There was an increase in shouting at (43.8%), verbal abuse (25%), and punishing the child (27.1%).
Sharma, et al., 2021,59 India.	“To find out the prevalence of DV and coping strategies among married men and women during lockdown in India”.59(p2)	Married men and women across the country (n=96). Cross-sectional.	DV (physical, emotional, sexual, verbal, and financial abuse).	DV was defined as “any act by partner or family member residing in a joint family which harms or injures or endangers the safety and well-being of the victim as defined under the protection of women from domestic violence act, 2005.” (p.2) The forms of abuse included in DV are physical, verbal, sexual, and financial abuse. The perpetrators of the DV could be the partner or other family members.	Out of 94 study participants, about 7.4% (n=7) had faced DV during lockdown. Out of these 7 participants, about 85.7% (n=6) reported increased frequency of DV during lockdown. The most common type of violence which was reported to be increased during lockdown was verbal violence (57.1%, n=4).
Tierolf, et al., 2021,60 Netherlands.	“To gain insight by a mixed-method study on what has happened during the lockdown within families who were already known to social services”.60(p1)	Families recruited before the pandemic (n=159), and families recruited during the lockdown (n=87) through child protection services including parents with children between 3 and 18 years of age, and children aged between 8 and 18 years of age. Cross-sectional.	Physical, sexual, emotional abuse/neglect, and CAN.	For measuring the violence within the families, the Revised CTSPC & Revised Conflict Tactics Scale-2 were used.	No difference was found in violence between families who participated before and after the lockdown. The level of violence is still high in most families.

Note: (S)CAN = (Suspected) Child Abuse and Neglect; CA = Child Abuse; CPA = Child Physical Abuse; CTSPC = Conflict Tactics Scale Parent-Child; DV = Domestic Violence; ED = Emergency Department; IPV = Intimate Partner Violence.