It's common, which makes it even more horrifying.  One of every three women will experience abuse committed by an intimate partner, such as current or ex- husbands and boyfriends. Worldwide, almost half of all murdered females are killed by a past or present partner. And every day in America, more than three women are murdered by a man with whom they had an intimate relationship.

Often, these women have had children with the same men who beat and killed them.

Can we imagine the effect that such a violent and devastating event has on these children?  In short succession, they lose both their parents: their mother to homicide and their father to incarceration or suicide (74 percent of all murder-suicides are committed by intimate partners, and 96 percent of the time, these are women who are murdered by men).

Unfortunately, researchers in Sweden were able to follow a large group of children whose fathers killed their mothers in the very first study of its kind, published online earlier this year in The Journal of Clinical Psychiatry.

Sweden's excellent system of national registries provided quite reliable data for the study. The researchers were able to identify 494 children whose mothers were murdered by their fathers from 1973 to 2009. These children were followed via the registries for up to 37 years and compared with a population of nonbereaved matched control children on various indicators of mental health.

Results suggest considerable trauma and sad outcomes for these children, particularly if they were younger at the time of their mother's murder. Children whose fathers killed their mothers when they were under 18 years of age showed a six fold increase in hospitalization for major mental health disorder or substance use disorder or engaging in self-harm as compared to nonbereaved control children.  Those who were over the age of 18 when their fathers murdered their mothers showed a 4-fold increased risk of completed suicide. Both groups showed an increased risk of conviction for a violent crime.

There already exists research, dating back decades, on outcomes of children who lose parents to illness, accidents, suicide, and murder.  In general, increased risk of serious psychiatric problems is limited in children whose parents die accidentally or from illness. When a parent dies by homicide or suicide, however, outcomes are poorer. For instance, another Swedish study found that the suicide of one's parent increased risk of one's own death by suicide later in life.

The current study affirms what we already know: That children who lose a parent to murder at the hands of another parent need screening, referrals and potentially treatment to help them navigate the immediate circumstances of shock, grief, placement and custody, and conflict among extended family.  Many will need intervention later to help cope the longer term consequences of such loss.

There were limits to the study and results should be interpreted cautiously. The number of bereaved children was relatively small and the follow-up times for them varied widely.  Psychiatric hospitalizations were used as the main indicator of the presence of a psychiatric disorder, which means that children with mental illness who were never hospitalized for it weren't counted; if they had, outcomes would presumably be worse.

That said, this is an important initial study that I wish we wouldn't see more of.

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