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Causal Pathways Between the Acute Experience of Violence During Pregnancy and Fetal Intrauterine Growth Restriction: A Cohort Study

Introduction: Violence during pregnancy (VDP) is a prevalent global issue with dire consequences for the mother and the developing fetus. These consequences include prematurity, low birthweight, and intrauterine growth restriction (IUGR), but its pathways remain elusive. This study investigated the causal pathways between VDP and IUGR using mediation analysis. Methods: A prospective population-based birth cohort was followed from the beginning of the third gestational trimester to the second year of life. IUGR was defined by the Kramer index, and information on VDP was collected using the WHO-Violence Against Women (WHO VAW) questionnaire. Cases were considered positive only when no other life episodes were reported. Ten different mediators were analyzed as possible pathways based on previous research. Path analysis was conducted to evaluate these relationships. Results: The path analysis model included 755 dyads and presented an adequate fit. Violence during pregnancy showed a direct effect (β = -0.195, p = 0.041) and a total effect (β = -0.276, p = 0.003) on IUGR. Violence was associated with gestational depression or anxiety, tobacco and alcohol consumption, changes in blood pressure, and the need for emergency care, but these did not constitute mediators of its effect on IUGR. The sum of the indirect effects, however, showed a significant association with IUGR (β = -0.081, p = 0.011). Conclusion: The acute experience of violence during pregnancy was associated with IUGR, primarily via a direct pathway. An indirect effect was also present but not mediated through the variables analyzed in this study. The robust strength of these associations underscores the negative health consequences of violence against women for the succeeding generation.

Impacts of childbirth on anxiety, disability, and depression: Results from a Brazilian cohort

Conditions such as violence, drug abuse, sexual satisfaction, anxiety, depression, and disability interfere with a healthy pregnancy and can also account for maternal morbidity. The instrument WOICE was built by WHO to measure it. We applied WOICE in a prospective cohort of 125 pregnant women, using a before-after approach, during the third trimester of pregnancy, and after 42 until 90 days of childbirth. 60% had anxiety during pregnancy, decreasing to 48.8% after delivery (p = 0.07), and depression scores decreased from 7.56 to 5.80 (p = 0.014). Disability affected 62.4% and 56, respectively. 9.6% used drugs during pregnancy, reducing to 4.0% after delivery (RR 0.69, IC 0.49 - 0.69).

Intimate Partner Violence and Women With Disabilities: The Role of Speech-Language Pathologists

This article is a call to action for speech-language pathologists to address the overlooked problem of intimate partner violence (IPV) among women with communication disorders (CDs). The article aims to heighten awareness of the higher rates of IPV in women with disabilities compared to those without, and to identify types of CDs that can result from IPV. The article provides background on CDs and IPV and delineates the role speech-language pathologists can play in identifying abuse and assisting patients to disclose IPV. Practice recommendations are provided, including enhanced IPV assessment for women with CDs, best practices for intervention emphasizing a trauma-informed approach, and the importance of collaboration and appropriate referrals.

Supporting female survivors of intimate partner violence with disabilities: Recommendations for social workers in the emergency department

Intimate partner violence (IPV) is a pervasive problem with grave consequences. Women with disabilities are among the most vulnerable groups disproportionately affected, with higher IPV rates than either women without disabilities or men with disabilities. The emergency department (ED) in particular affords a gateway into health services for female survivors of IPV, placing ED social workers in a prime position to observe potential signs of IPV and connect survivors to further assistance. This article explores the critical role ED social workers can fill in addressing the needs of female survivors of IPV with disabilities. We begin by providing background on the characteristics of IPV among women with disabilities, followed by a discussion of the opportunities and challenges inherent to assessing and intervening with survivors. We conclude by outlining recommendations for working with female survivors of IPV with disabilities in EDs, using our previous research on the topic as a guide.

Intimate Partner Violence Among Men With Disabilities: The Role of Health Care Providers

Men with disabilities experience higher rates of interpersonal violence (IPV) than either women or men without disabilities, yet research exploring this problem is limited. This retrospective descriptive study examines the clinical files of male survivors of IPV with disabilities who received services from the Secret Garden, a disability-specific nonresidential IPV program located in New York City. These data inform the role health care providers may fill in helping address IPV against men with disabilities. Abuse history, medical and mental health service utilization, and the channels through which men accessed IPV assistance were areas of focus for analysis. Data were analyzed descriptively and outcomes reported as frequencies and percentages. Results indicate that more than half of study participants were abused by an intimate partner (66.2%) and nearly two-thirds described an act of physical abuse as the most serious type of abuse perpetrated (71.7%). Nearly half (40.8%) had previous contact with medical providers due to abuse. The high prevalence of physical abuse in this sample has critical physical and mental health implications, and could further exacerbate already precarious health statuses. While nearly half reported previous contact with health care providers due to abuse, only 15.8% were referred for IPV assistance by a health care provider, indicating a missed opportunity to identify signs of abuse and direct survivors to additional resources.

Intimate partner violence and pregnancy: epidemiology and impact

Intimate partner violence is a significant public health problem in our society, affecting women disproportionately. Intimate partner violence takes many forms, including physical violence, sexual violence, stalking, and psychological aggression. While the scope of intimate partner violence is not fully documented, nearly 40% of women in the United States are victims of sexual violence in their lifetimes and 20% are victims of physical intimate partner violence. Other forms of intimate partner violence are likely particularly underreported. Intimate partner violence has a substantial impact on a woman's physical and mental health. Physical disorders include the direct consequences of injuries sustained after physical violence, such as fractures, lacerations and head trauma, sexually transmitted infections and unintended pregnancies as a consequence of sexual violence, and various pain disorders. Mental health impacts include an increased risk of depression, anxiety, posttraumatic stress disorder, and suicide. These adverse health effects are amplified in pregnancy, with an increased risk of pregnancy outcomes such as preterm birth, low birthweight, and small for gestational age. In many US localities, suicide and homicide are leading causes of pregnancy-associated mortality. We herein review the issues noted previously in greater depth and introduce the basic principles of intimate partner violence prevention. We separately address current recommendations for intimate partner violence screening and the evidence surrounding effectiveness of intimate partner violence interventions.

Intimate Partner Violence and Adverse Health Consequences

Nearly 1 in 4 women and 1 in 13 men experience intimate partner violence (IPV) at some time in their life. Victims of IPV suffer significant negative health consequences because of the physical, sexual, and emotional abuse they have experienced. Elevated risks have been observed for a wide range of adverse health outcomes. Research has substantially improved our understanding of the physiology that underlies the association between violence victimization and an array of adverse health outcomes. Given the high prevalence of IPV and the associated medical consequences and costs of IPV, it is critical to address this public health problem. IPV prevention and intervention can substantially decrease the public health burden of IPV and greatly improve the health of patients being seen in the medical system. Primary care and family physicians are in an ideal position to diagnose victims of IPV and provide the victims and their families the appropriate care that is needed. However, to accomplish this goal, there remains an urgent need to integrate information on IPV into medical and health care curricula, and to train future physicians and other health care providers about the pervasiveness of IPV and the far-reaching implications for patient health.