Peer-reviewed article

The Association of Post-Separation Abuse and Coercion With Children's Health and Flourishing.

Spearman KJ, Perrin N, Bethell C, Alexander KA, Hardesty J et al. · 17 Jul 2026

Abstract

Aim The purpose of this study is to compare health outcomes and flourishing between children (age 6-17) whose mothers experience high versus low exposure to post-separation abuse and coercive control (PSA). Design Exploratory sequential mixed-methods study. Methods Cross-sectional survey with community-based, convenience sample of family court-involved mothers in the United States (N = 497). Independent variable measured by subscales of the Healthcare, Economic, and Legal PSA and Coercive Tactics Scale (HELP-T). Health outcomes measured by items from National Survey of Children's Health. Results Children whose mothers experience more frequent PSA face a dual burden: increased odds of unmet mental health needs coupled with increased odds of mental health diagnoses, somatic symptoms and special health care needs. Children in the high-exposure Healthcare PSA group were twice as likely (aOR: 2.01, p-value < 0.001, 95% CI: 1.4-2.9) to report stomach/intestinal problems, 2.3 times more likely (p-value < 0.001, 95% CI: 1.5-3.4) to report chronic pain including headaches in the last 12 months, 2.13 times more likely (p-value < 0.001, 95% CI: 1.4-3.8) to have ever received a diagnosis of anxiety and 2.72 times (p-value < 0.001, 95% CI: 1.60-4.63) more likely to have unmet mental health needs as compared to children in the low-exposure group. Conclusion The findings from this study advance the growing body of evidence on how co-parent perpetrated PSA and coercive control harm children's health and access to healthcare. Impact This study is the first to our knowledge to demonstrate the association between maternal exposure to co-parent perpetrated PSA and children's health outcomes, establishing a foundation for future intervention work to improve children's health and access to health care. Public contribution Members of the public were involved in recruitment and cognitive interviewing.