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Gram P, Andersen CG, Petersen KS, Frederiksen MS, Thomsen LLH, Overgaard C. Identifying psychosocial vulnerabilities in pregnancy: A mixed-method systematic review of the knowledge base of antenatal conversational psychosocial assessment tools. Midwifery 2024; 136:104066. [PMID: 38905861 DOI: 10.1016/j.midw.2024.104066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 06/03/2024] [Accepted: 06/11/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Early identification of psychosocial vulnerability among expectant parents through psychosocial assessment is increasingly recommended within maternity care. For routine antenatal assessment, a strong recognition exists regarding conversational assessment tools. However, the knowledge base of conversational tools is limited, inhibiting their clinical use. OBJECTIVE Synthesising existing knowledge pertaining to antenatal conversational psychosocial assessment tools, including identifying characteristics, acceptability, performance, effectiveness and unintended consequences. DESIGN Mixed-method systematic review based on searches in CINAHL, PubMed, Embase, PsycINFO, Cochrane and Scopus. 20 out of 5394 studies were included and synthesised with a convergent integrated approach using a thematic analysis strategy. FINDINGS We identified seven antenatal psychosocial assessment tools that partially or completely utilised a conversational approach. Women's acceptability was high, and tools were generally found to support person-centred communication and the parent-health care professional relationship. Evidence regarding effectiveness and performance of conversational tools was limited. Unintended consequences were found, including some women having negative experiences related to assessment of intimate partner violence, lack of preparation and lack of relevance. High acceptability was reported by health care professionals who considered the tools as valuable and enhancing of identification of vulnerability. Unintended consequences, including lack of time and competencies as well as discomfort when assessment is very sensitive, were reported. CONCLUSIONS Evidence regarding conversational tools' effectiveness and performance is limited. More is known about the acceptability of conversational tools, which is generally highly acceptable among women and health care professionals. Some unintended consequences of the use of included conversational tools were identified.
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Affiliation(s)
- Pernille Gram
- Department of Health Science and Technology, Aalborg University, Selma Lagerløfs Vej 249, Gistrup 9260, Denmark; Center for General Practice, Aalborg University, Selma Lagerløfs Vej 249, Gistrup 9260, Denmark.
| | - Clara Graugaard Andersen
- Department of Health Science and Technology, Aalborg University, Selma Lagerløfs Vej 249, Gistrup 9260, Denmark; Research Team of Women, Children, Youth and Families Health, Unit of Health Promotion, Department of Public Health, University of Southern Denmark, Esbjerg Ø 6705, Denmark
| | - Kirsten Schultz Petersen
- Department of Health Science and Technology, Aalborg University, Selma Lagerløfs Vej 249, Gistrup 9260, Denmark
| | - Marianne Stistrup Frederiksen
- Research Team of Women, Children, Youth and Families Health, Unit of Health Promotion, Department of Public Health, University of Southern Denmark, Esbjerg Ø 6705, Denmark
| | - Louise Lund Holm Thomsen
- Research Team of Women, Children, Youth and Families Health, Unit of Health Promotion, Department of Public Health, University of Southern Denmark, Esbjerg Ø 6705, Denmark
| | - Charlotte Overgaard
- Research Team of Women, Children, Youth and Families Health, Unit of Health Promotion, Department of Public Health, University of Southern Denmark, Esbjerg Ø 6705, Denmark
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Scott SE, Laubacher C, Chang J, Miller E, Bocinski SG, Ragavan MI. Perinatal Economic Abuse: Experiences, Impacts, and Needed Resources. J Womens Health (Larchmt) 2024. [PMID: 39037010 DOI: 10.1089/jwh.2024.0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
Introduction: Economic abuse is one form of intimate partner violence (IPV) intended to control a survivor's ability to make, save, or spend money to gain power over them. Perinatal people may be more vulnerable to economic abuse due to changes in employment and finances. This study's aims were to explore how economic abuse manifests among pregnant and parenting survivors and how best to support pregnant and parenting survivors of economic abuse. Methods: We conducted virtual semistructured interviews with IPV survivors and IPV advocates. Participants were recruited through an online recruitment registry, national IPV organizations, and local domestic violence agencies. Interview audiorecordings were transcribed. We used a deductive-inductive thematic analysis approach. Two research team members individually coded each transcript and met to resolve discrepancies in coding. Results: We completed interviews with 18 advocates and 20 survivors. Participants described experiences of financial control, exploitation, and employment sabotage. Partners leveraged the criminal-legal, child welfare, and health care systems and cultural norms about pregnancy, including those related to gender and religion to financially harm survivors. Advocates described how economic abuse impacts marginalized survivors. Dream resources described include cash assistance, healthy relationship and financial education, and employer policies. Discussion: Survivors and advocates reported a variety of experiences with economic abuse during the perinatal period. Future interventions should focus on providing unrestricted cash transfers to survivors, developing education on economic abuse, and creating supportive policies in health care and employment settings. This study highlights the ways that economic abuse specifically impacts perinatal survivors and their children.
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Affiliation(s)
- Sarah E Scott
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Callie Laubacher
- Division of General Academic Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Judy Chang
- Department of Obstetrics, Gynecology, & Reproductive Sciences, and Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Maya I Ragavan
- Division of General Academic Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Zivin K, Zhong C, Rodríguez-Putnam A, Spring E, Cai Q, Miller A, Johns L, Kalesnikava VA, Courant A, Mezuk B. Suicide Mortality During the Perinatal Period. JAMA Netw Open 2024; 7:e2418887. [PMID: 38935375 PMCID: PMC11211960 DOI: 10.1001/jamanetworkopen.2024.18887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/25/2024] [Indexed: 06/28/2024] Open
Abstract
Importance The US has the highest maternal mortality rate among developed countries. The Centers for Disease Control and Prevention deems nearly all of these deaths preventable, especially those attributable to mental health conditions. Coordination between US health care and social service systems could help further characterize circumstances and risks associated with perinatal suicide mortality. Objective To examine contextual and individual precipitating circumstances and risks associated with perinatal suicide. Design, Setting, and Participants This cross-sectional observational study used a convergent mixed methods design to explore factors contributing to maternal suicides and deaths of undetermined intent (hereinafter, undetermined deaths) identified in National Violent Death Reporting System (NVDRS) data for January 1, 2003, to December 31, 2021. Analyses included decedents who were aged 10 to 50 years and pregnant or post partum at death (collectively, the perinatal group) and demographically matched female decedents who were not pregnant or recently pregnant (nonperinatal group) at death. Analyses were performed between December 2022 and December 2023. Exposures Pregnancy status at death (perinatal or nonperinatal). Main Outcomes and Measures The main outcomes included contributing circumstances associated with suicides and undetermined deaths cited in coroner, medical examiner, or law enforcement case narratives. The study examined quantitative differences between groups using a matched analysis and characterized key themes of salient suicide circumstances using qualitative content analysis. Results This study included 1150 perinatal decedents identified in the NVDRS: 456 (39.6%) were pregnant at death, 203 (17.7%) were pregnant within 42 days of death, and 491 (42.7%) were pregnant within 43 to 365 days before death, yielding 694 postpartum decedents. The nonperinatal comparison group included 17 655 female decedents aged 10 to 50 years. The mean (SD) age was 29.1 (7.4) years for perinatal decedents and 35.8 (10.8) years for nonperinatal decedents. Compared with matched nonperinatal decedents, perinatal decedents had higher odds of the following identified contributing circumstances: intimate partner problems (IPPs) (odds ratio [OR], 1.45 [95% CI, 1.23-1.72]), recent argument (OR, 1.33 [95% CI, 1.09-1.61]), depressed mood (OR, 1.39 [95% CI, 1.19-1.63]), substance abuse or other abuse (OR, 1.21 [95% CI, 1.03-1.42]), physical health problems (OR, 1.37 [95% CI, 1.09-1.72]), and death of a family member or friend (OR, 1.47 [95% CI, 1.06-2.02]). The findings of the qualitative analysis emphasized the importance of mental health and identified 128 decedents (12.4%) with postpartum depression. Conclusions and Relevance This study provides insights into complex factors surrounding maternal suicide, and it highlights opportunities for further research to understand long-term consequences of perinatal mental health. These findings also underscore the need for targeted evidence-based interventions and effective policies targeting mental health, substance use, and IPPs to prevent maternal suicide and enhance maternal health outcomes.
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Affiliation(s)
- Kara Zivin
- Department of Psychiatry, Michigan Medicine, Ann Arbor
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Chuwen Zhong
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
| | | | - Emma Spring
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
| | - Qingyi Cai
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
| | - Alyson Miller
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
| | - Lily Johns
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
| | | | - Anna Courant
- Department of Psychiatry, Michigan Medicine, Ann Arbor
| | - Briana Mezuk
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
- Research Center for Group Dynamics, Institute for Social Research, University of Michigan, Ann Arbor
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Keegan G, Hoofnagle M, Chor J, Hampton D, Cone J, Khan A, Rowell S, Plackett T, Benjamin A, Bhardwaj N, Rogers SO, Zakrison TL, Cirone JM. State-Level Analysis of Intimate Partner Violence, Abortion Access, and Peripartum Homicide: Call for Screening and Violence Interventions for Pregnant Patients. J Am Coll Surg 2024; 238:880-888. [PMID: 38329176 DOI: 10.1097/xcs.0000000000001019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND Despite representing 4% of the global population, the US has the fifth highest number of intentional homicides in the world. Peripartum people represent a unique and vulnerable subset of homicide victims. This study aimed to understand the risk factors for peripartum homicide. STUDY DESIGN We used data from the 2018 to 2020 National Violent Death Reporting System to compare homicide rates of peripartum and nonperipartum people capable of becoming pregnant (12 to 50 years of age). Peripartum was defined as currently pregnant or within 1-year postpartum. We additionally compared state-level peripartum homicide rates between states categorized as restrictive, neutral, or protective of abortion. Pearson's chi-square and Wilcoxon rank-sum tests were used. RESULTS There were 496 peripartum compared with 8,644 nonperipartum homicide victims. The peripartum group was younger (27.4 ± 71 vs 33.0 ± 9.6, p < 0.001). Intimate partner violence causing the homicide was more common in the peripartum group (39.9% vs 26.4%, p < 0.001). Firearms were used in 63.4% of homicides among the peripartum group compared with 49.5% in the comparison (p < 0.001). A significant difference was observed in peripartum homicide between states based on policies regarding abortion access (protective 0.37, neutral 0.45, restrictive 0.64; p < 0.01); the same trend was not seen with male homicides. CONCLUSIONS Compared with nonperipartum peers, peripartum people are at increased risk for homicide due to intimate partner violence, specifically due to firearm violence. Increasing rates of peripartum homicide occur in states with policies that are restrictive to abortion access. There is a dire need for universal screening and interventions for peripartum patients. Research and policies to reduce violence against pregnant people must also consider the important role that abortion access plays in protecting safety.
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Affiliation(s)
- Grace Keegan
- From the University of Chicago, Chicago, IL (Keegan, Chor, Hampton, Khan, Rowell, Plackett, Benjamin, Bhardwaj, Rogers, Zakrison)
| | | | - Julie Chor
- From the University of Chicago, Chicago, IL (Keegan, Chor, Hampton, Khan, Rowell, Plackett, Benjamin, Bhardwaj, Rogers, Zakrison)
| | - David Hampton
- From the University of Chicago, Chicago, IL (Keegan, Chor, Hampton, Khan, Rowell, Plackett, Benjamin, Bhardwaj, Rogers, Zakrison)
| | - Jennifer Cone
- From the University of Chicago, Chicago, IL (Keegan, Chor, Hampton, Khan, Rowell, Plackett, Benjamin, Bhardwaj, Rogers, Zakrison)
- Washington University, St Louis, MO (Hoofnagle)
- Carolinas Medical Center, Charlotte, NC (Cirone)
| | - Abid Khan
- From the University of Chicago, Chicago, IL (Keegan, Chor, Hampton, Khan, Rowell, Plackett, Benjamin, Bhardwaj, Rogers, Zakrison)
| | - Susan Rowell
- From the University of Chicago, Chicago, IL (Keegan, Chor, Hampton, Khan, Rowell, Plackett, Benjamin, Bhardwaj, Rogers, Zakrison)
| | - Timothy Plackett
- From the University of Chicago, Chicago, IL (Keegan, Chor, Hampton, Khan, Rowell, Plackett, Benjamin, Bhardwaj, Rogers, Zakrison)
| | - Andrew Benjamin
- From the University of Chicago, Chicago, IL (Keegan, Chor, Hampton, Khan, Rowell, Plackett, Benjamin, Bhardwaj, Rogers, Zakrison)
| | - Neha Bhardwaj
- From the University of Chicago, Chicago, IL (Keegan, Chor, Hampton, Khan, Rowell, Plackett, Benjamin, Bhardwaj, Rogers, Zakrison)
| | - Selwyn O Rogers
- From the University of Chicago, Chicago, IL (Keegan, Chor, Hampton, Khan, Rowell, Plackett, Benjamin, Bhardwaj, Rogers, Zakrison)
| | - Tanya L Zakrison
- From the University of Chicago, Chicago, IL (Keegan, Chor, Hampton, Khan, Rowell, Plackett, Benjamin, Bhardwaj, Rogers, Zakrison)
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Haddad DN, Kaufman EJ. Invited Commentary: Implications of Social Policy for Injury. J Am Coll Surg 2024; 238:888-889. [PMID: 38329111 DOI: 10.1097/xcs.0000000000000946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
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Jacobs B, Testa A. Functional Disabilities and Food Insufficiency During Pregnancy: Results from the Pregnancy Risk Assessment Monitoring System. J Womens Health (Larchmt) 2024; 33:178-186. [PMID: 37843931 DOI: 10.1089/jwh.2023.0237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023] Open
Abstract
Background: Disability is a well-documented risk factor for food insecurity. However, prior literature has overlooked the possible connection between disability and food insecurity during the antenatal period. This study extends previous research by examining the relationship between those with any functional disabilities and food insufficiency during pregnancy among a sample of mothers. Methods: Data are from the Pregnancy Risk Assessment Monitoring System, 2019-2020 (N = 9084). The relationship between the number of self-reported functional disabilities and food insufficiency is examined using modified multivariable Poisson regression. Results: After adjusting for control variables, the results reveal that those with any functional disability have a significantly higher risk of food insufficiency during pregnancy (risk ratio [RR] = 1.464, 95% confidence interval [CI] = 1.201-1.785). Findings reveal that all types of functional disability are associated with a higher risk of food insufficiency, including difficulty seeing, difficulty hearing, difficulty walking, difficulty remembering, difficulty with self-care, and difficulty communicating. Finally, the findings revealed that respondents with two functional disabilities (RR = 1.473, 95% CI = 1.153-1.882) and three or more functional disabilities (RR = 1.974, 95% CI = 1.534-2.541) are significantly more likely to report food insufficiency compared with respondents with no disabilities. Conclusions: There is a significant positive association between reporting functional disabilities and food insufficiency. Expanding current public health programs, educating health care professionals, and implementing effective screening guidelines directed at pregnant women with disabilities may reduce the prevalence of food insufficiency and promote greater health equity.
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Affiliation(s)
| | - Alexander Testa
- Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
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Oliver C, Puiras E, Sharma V, Mazmanian D. Careful considerations for the treatment of posttraumatic stress disorder during and following pregnancy. Expert Rev Neurother 2024; 24:159-170. [PMID: 38196397 DOI: 10.1080/14737175.2024.2303430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 01/05/2024] [Indexed: 01/11/2024]
Abstract
INTRODUCTION The focus on perinatal mental health has expanded recently, though there is less research on post-traumatic stress disorder (PTSD). Therefore, a review of the literature was undertaken and coupled with expert clinical insights to discuss current clinical practice recommendations for PTSD in the perinatal period. AREAS COVERED This review covers considerations for the assessment, prevention, and treatment of PTSD during the perinatal period. Within these sections, evidence-based and promising practices are outlined. Extra attention is afforded to treatment, which includes considerations from both psychotherapeutic and psychopharmacological perspectives. This review closes with coverage of three important and related areas of consideration, including bereavement, intimate partner violence, and childhood sexual abuse. EXPERT OPINION Psychotherapeutic interventions for PTSD during pregnancy are limited, and no strong recommendations can be supported at this time while evidence points toward the effectiveness of cognitive behavioral therapies and eye movement desensitization therapy as first-line treatments postpartum though research evidence is also limited. Research on psychopharmacological interventions is similarly scarce, though selective serotonin reuptake inhibitors may be beneficial. Clinicians should also be mindful of additional considerations that may be needed for the treatment of PTSD in the context of bereavement, intimate partner violence, and history of sexual violence.
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Affiliation(s)
- Casey Oliver
- Department of Psychology, Lakehead University, Thunder Bay, Ontario, Canada
| | - Erika Puiras
- Department of Psychology, Lakehead University, Thunder Bay, Ontario, Canada
| | - Verinder Sharma
- Department of Psychiatry, Western University, London, Ontario, Canada
- Department of Obstetrics & Gynecology, Western University, London, Ontario, Canada
- Parkwood Institute Mental Health, St. Joseph's Health Care, London, Ontario, Canada
| | - Dwight Mazmanian
- Department of Psychology, Lakehead University, Thunder Bay, Ontario, Canada
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Sureau Y, Moro MR, Radjack R. Resources and Obstacles of a Maternity Staff Facing Intimate Partner Violence during Pregnancy-A Qualitative Study. Healthcare (Basel) 2023; 11:2782. [PMID: 37893856 PMCID: PMC10606075 DOI: 10.3390/healthcare11202782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/30/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
INTRODUCTION Intimate partner violence occurring during pregnancy has a similar prevalence as usual obstetrical disorders that are routinely screened for. Referenced publications insist on the importance of adequate screening, but the proper course of action has yet to be defined. AIM OF STUDY We qualitatively explored the different resources and concepts that emerge from the discourse of maternity staff across professions. MATERIAL AND METHODS We led a semi structured interview with professionals, which included following their involvement with preselected patients. Nine professionals provided a sample of 19 interviews. The data was analysed using IPA methodology. Results We highlight the investigative importance of navigating the patient's initial demand or lack thereof and the baby's importance within, while identifying mechanisms of maternal disqualification. Creating an atmosphere prone to patient empowerment was the final theme to emerge from the study as the most beneficial tactic both in the short and long term. CONCLUSIONS HCPs need to enable patients' trust on a personal and an institutional level, as well as empowering the patient in the moment and respecting their values and choices. HCPs also convey the stability of the institution that has become a reference of refuge and assistance for patients from their pregnancy onwards.
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Affiliation(s)
- Yam Sureau
- APHP, Hôpital Cochin, Maison de Solenn, 75014 Paris, France; (M.-R.M.); (R.R.)
- Faculté de Médecine, Université de Paris Cité, 75000 Paris, France
- GHU Paris Psychiatrie et Neurosciences, CPBB, 75014 Paris, France
| | - Marie-Rose Moro
- APHP, Hôpital Cochin, Maison de Solenn, 75014 Paris, France; (M.-R.M.); (R.R.)
- Le Laboratoire Psychologie Clinique, Psychopathologie Psychanalyse (PCPP), Université de Paris, 92100 Boulogne-Billancourt, France
- UVSQ, Inserm, CESP, Team DevPsy, Université Paris-Saclay, 94807 Villejuif, France
| | - Rahmeth Radjack
- APHP, Hôpital Cochin, Maison de Solenn, 75014 Paris, France; (M.-R.M.); (R.R.)
- Le Laboratoire Psychologie Clinique, Psychopathologie Psychanalyse (PCPP), Université de Paris, 92100 Boulogne-Billancourt, France
- UVSQ, Inserm, CESP, Team DevPsy, Université Paris-Saclay, 94807 Villejuif, France
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Utaile MM, Ahmed AA, Yalew AW. Intimate Partner Violence During Pregnancy and Maternal Morbidity in South Ethiopia: A Cohort Study. J Multidiscip Healthc 2023; 16:2577-2592. [PMID: 37667800 PMCID: PMC10475281 DOI: 10.2147/jmdh.s421208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/18/2023] [Indexed: 09/06/2023] Open
Abstract
Purpose Intimate partner violence during pregnancy is a universal public health problem. However, its link with maternal morbidity is not well understood in Ethiopia. Thus, the study assessed its effect on maternal morbidity during delivery and postpartum in South Ethiopia. Methods A prospective cohort study was conducted among 1535 pregnant women. Pregnant women with intimate partner violence during pregnancy were enrolled as the "exposed group", and pregnant women without intimate partner violence were registered as the "unexposed group". A total of 711 exposed and 774 unexposed women were included in the analysis of this study. Data were collected using an interviewer-administered questionnaire. Data entry and analysis were done in STATA Version 14. A generalized linear model with a log link function using the binreg command was applied to examine the effect of intimate partner violence on maternal morbidity. Results The level of maternal morbidity during delivery and postpartum was higher among women with intimate partner violence than women without intimate partner violence (34.0% vs 26.6%). After adjusting for confounders, women with intimate partner violence during pregnancy were more likely to experience maternal morbidity than women without intimate partner violence (aRR=4.45; 95% CI: 3.15, 6.28). Psychological violence was also identified as a risk factor for maternal morbidity (aRR=2.17; 95% CI: 1.76, 2.67). Likewise, women with physical violence were more likely to experience maternal morbidity than those without physical violence (aRR=1.31; 95% CI: 1.12, 1.53). Conclusion The current study demonstrated a higher level of maternal morbidity among women with intimate partner violence. Psychological violence, physical violence, and intimate partner violence during pregnancy were found to increase the risk of maternal morbidity. Strengthening the prevention and prompt management of intimate partner violence during pregnancy may significantly reduce the incidence of maternal morbidity.
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Affiliation(s)
- Mesfin Mamo Utaile
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ahmed Ali Ahmed
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alemayehu Worku Yalew
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Wong SC, Do PH, Eisner M, Hughes C, Valdebenito S, Murray AL. An Umbrella Review of the Literature on Perinatal Domestic Violence: Prevalence, Risk Factors, Possible Outcomes and Interventions. TRAUMA, VIOLENCE & ABUSE 2023; 24:1712-1726. [PMID: 35343325 DOI: 10.1177/15248380221080455] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Perinatal domestic violence (P-DV) is a common form of violence experienced by women and is associated with adverse impacts on their own physical and mental health and that of their offspring. Illuminating the risk factors for, potential effects of, and promising interventions to reduce P-DV is essential for informing policies to tackle P-DV and mitigate its negative impacts. This umbrella review of recent high-quality systematic reviews and meta-analyses of worldwide research on P-DV provides a systematic synthesis of current knowledge relating to the prevalence, risk factors for, possible outcomes of and interventions to reduce and prevent P-DV. 13 reviews identified through systematic searches of computerised databases, manual search and expert consultation met our inclusion criteria (i.e. English systematic reviews and/or meta-analyses that were from recent 10 years, focused on women exposed to P-DV, assessed risk factors, possible outcomes and/or interventions, and were of fair to high methodological quality). Our results suggest that while there is a growing understanding of risk factors and possible outcomes of P-DV, this knowledge has thus far not been translated well into effective interventions. P-DV intervention programmes that have been subject to rigorous evaluation are mostly relatively narrow in scope and could benefit from targeting a wider range of maternal and child wellbeing outcomes, and perpetrator, relationship and community risk factors. The overall quality of the evidence syntheses in this field is reasonable; however, future studies should involve multiple reviewers at all key stages of systematic reviews and meta-analyses to help enhance reliability.
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Affiliation(s)
- Siu-Ching Wong
- Department of Psychology, University of Edinburgh
- Centre for Family Research, University of Cambridge
| | - Phuc Huyen Do
- School of Public Health and Social Work, Queensland University of Technology
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Grünebaum A, Chervenak J, Pollet SL, Katz A, Chervenak FA. The exciting potential for ChatGPT in obstetrics and gynecology. Am J Obstet Gynecol 2023; 228:696-705. [PMID: 36924907 DOI: 10.1016/j.ajog.2023.03.009] [Citation(s) in RCA: 78] [Impact Index Per Article: 78.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/02/2023] [Accepted: 03/02/2023] [Indexed: 03/17/2023]
Abstract
Natural language processing-the branch of artificial intelligence concerned with the interaction between computers and human language-has advanced markedly in recent years with the introduction of sophisticated deep-learning models. Improved performance in natural language processing tasks, such as text and speech processing, have fueled impressive demonstrations of these models' capabilities. Perhaps no demonstration has been more impactful to date than the introduction of the publicly available online chatbot ChatGPT in November 2022 by OpenAI, which is based on a natural language processing model known as a Generative Pretrained Transformer. Through a series of questions posed by the authors about obstetrics and gynecology to ChatGPT as prompts, we evaluated the model's ability to handle clinical-related queries. Its answers demonstrated that in its current form, ChatGPT can be valuable for users who want preliminary information about virtually any topic in the field. Because its educational role is still being defined, we must recognize its limitations. Although answers were generally eloquent, informed, and lacked a significant degree of mistakes or misinformation, we also observed evidence of its weaknesses. A significant drawback is that the data on which the model has been trained are apparently not readily updated. The specific model that was assessed here, seems to not reliably (if at all) source data from after 2021. Users of ChatGPT who expect data to be more up to date need to be aware of this drawback. An inability to cite sources or to truly understand what the user is asking suggests that it has the capability to mislead. Responsible use of models like ChatGPT will be important for ensuring that they work to help but not harm users seeking information on obstetrics and gynecology.
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Affiliation(s)
- Amos Grünebaum
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY.
| | - Joseph Chervenak
- Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Montefiore Hospital, Bronx, NY
| | - Susan L Pollet
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY
| | - Adi Katz
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY
| | - Frank A Chervenak
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY
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DeMaria AL, Meier S, King H, Sidorowicz H, Seigfried-Spellar KC, Schwab-Reese LM. The role of community healthcare professionals in discussing sexual assault experiences during obstetrics and gynecological healthcare appointments. BMC Womens Health 2023; 23:263. [PMID: 37189119 PMCID: PMC10184971 DOI: 10.1186/s12905-023-02401-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 04/28/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Nearly half of adult women in the US report experiencing sexual assault, with almost one-fifth reporting rape. For many sexual assault survivors, healthcare professionals are the first point of contact and disclosure. This study aimed to understand how healthcare professionals working in community settings perceived their role in discussing sexual violence experiences with women during obstetrical and gynecological healthcare appointments. The secondary purpose was to compare healthcare professionals' perspectives with the patients' to determine how sexual violence conversations should occur in these environments. METHODS Data were collected in two phases. Phase 1 consisted of 6 focus groups (Sept-Dec, 2019) with women aged 18-45 (n = 22) living in Indiana who sought community-based or private healthcare for women's reproductive healthcare needs. Phase 2 included 20 key-informant interviews with non-physician healthcare professionals (i.e., NP, RN, CNM, doula, pharmacist, chiropractor) living in Indiana (September 2019-May 2020) who provided community-based women's reproductive healthcare. Focus groups and interviews were audio-recorded, transcribed, and analyzed using thematic analyses. HyperRESEARCH assisted in data management and organization. RESULTS There were three resulting themes: (1) healthcare professionals' approaches to screening for a history of sexual violence varied depending on how they ask, what setting they work in, and type of professional asking; (2) healthcare experiences can compound traumatic experiences and create distrust with survivors; and (3) sexual violence impacts patient healthcare experiences through what services they seek, how professionals may interact with them, and what professionals they are willing to utilize. CONCLUSIONS Findings offered insight into actionable and practical strategies for enhancing sexual violence screening and discussions in community-based women's reproductive health settings. The findings offer strategies to address barriers and facilitators among community healthcare professionals and the people they serve. Incorporating healthcare professional and patient experiences and preferences for violence-related discussions during obstetrical and gynecological healthcare appointments can assist in violence prevention efforts, improve patient-professional rapport, and yield better health outcomes.
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Affiliation(s)
- Andrea L DeMaria
- Department of Public Health, College of Health and Human Sciences, Purdue University, 812 West State Street, 47907, West Lafayette, IN, USA.
- Division of Consumer Science, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA.
| | - Stephanie Meier
- Division of Consumer Science, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
| | - Hannah King
- Department of Public Health, College of Health and Human Sciences, Purdue University, 812 West State Street, 47907, West Lafayette, IN, USA
| | - Haley Sidorowicz
- Department of Biological Sciences, College of Science, Purdue University, West Lafayette, IN, USA
| | - Kathryn C Seigfried-Spellar
- Department of Computer and Information Technology, Polytechnic Institute, Purdue University, West Lafayette, IN, USA
| | - Laura M Schwab-Reese
- Department of Public Health, College of Health and Human Sciences, Purdue University, 812 West State Street, 47907, West Lafayette, IN, USA
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Andreasen K, Zapata-Calvente AL, Martín-de-Las-Heras S, Bueno-Cavanillas A, Schei B, Dokkedahl S, de León de León S, Fernandez Lopez R, Oviedo-Gutiérrez A, Ankerstjerne LBS, Megías JL, Khan KS, Rasch V, Linde DS. Video Consultations and Safety App Targeting Pregnant Women Exposed to Intimate Partner Violence in Denmark and Spain: Nested Cohort Intervention Study (STOP Study). JMIR Form Res 2023; 7:e38563. [PMID: 36939835 PMCID: PMC10132014 DOI: 10.2196/38563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 10/19/2022] [Accepted: 01/04/2023] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Intimate partner violence (IPV) during pregnancy is a public health issue with wide-ranging consequences for both the mother and fetus, and interventions are needed. Therefore, the Stop Intimate Partner Violence in Pregnancy (STOP) cohort was established with the overall aim to identify pregnant women exposed to IPV through digital screening and offer women screening positive for IPV a digital supportive intervention. OBJECTIVE The aim of this study was to (1) introduce the design and profile of the STOP cohort study, (2) assess the feasibility of implementing digital IPV screening among pregnant women, and (3) assess the feasibility of implementing a digital supportive intervention targeting pregnant women exposed to IPV. METHODS Pregnant women attending antenatal care in the Region of Southern Denmark and in Andalucía, Spain were offered digital screening for IPV using validated scales (Abuse Assessment Screen and Women Abuse Screening Tool). Women who screened positive were eligible to receive a digital supportive intervention. The intervention consisted of 3-6 video consultations with an IPV counselor and a safety planning app. In Denmark, IPV counselors were antenatal care midwives trained by a psychologist specialized in IPV, whereas in Spain, the counselor was a psychologist. RESULTS Data collection started in February 2021 and was completed in October 2022. Across Denmark and Spain, a total of 19,442 pregnant women were invited for IPV screening and 16,068 women (82.65%) completed the screening. More women in Spain screened positive for exposure to IPV (350/2055, 17.03%) than in Denmark (1195/14,013, 8.53%). Among the women who screened positive, only 31.39% (485/1545) were eligible to receive the intervention with only 104 (21.4%) of these women ultimately receiving it. CONCLUSIONS Digital screening for IPV among pregnant women is feasible in an antenatal care context in Denmark and Spain; however, a digital supportive intervention during pregnancy appears to have limited feasibility as only a minor subgroup of women who screened positive for eligibility received the intervention. More research is needed on how to best support pregnant women exposed to IPV if universal IPV screening is to be implemented in antenatal care.
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Affiliation(s)
- Karen Andreasen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Gyneacology and Obstetrics, Odense University Hospital, Odense, Denmark
- Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | | | | | - Aurora Bueno-Cavanillas
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
- Center for Biomedical Research in Epidemiology and Public Health Network-Spain, University of Granada, Granada, Spain
| | - Berit Schei
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Institute of Public Health, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynaecology, Sct. Olavs University Hospital, Trondheim, Norway
| | - Sarah Dokkedahl
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | | | | | | | - Lea Bo Sønderlund Ankerstjerne
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Gyneacology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Jesús L Megías
- Brain and Behavior Research Center, University of Granada, Granada, Spain
| | - Khalid Saeed Khan
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
- Center for Biomedical Research in Epidemiology and Public Health Network-Spain, University of Granada, Granada, Spain
| | - Vibeke Rasch
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Gyneacology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Ditte S Linde
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Gyneacology and Obstetrics, Odense University Hospital, Odense, Denmark
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Ali A, Simpson JT, Tatum D, Sedhom JA, Broome J, McGrew PR, Duchesne J, Taghavi S. Traumatic Injury in Pregnancy: A Propensity Score-Matched Analysis. J Surg Res 2023; 283:1018-1025. [PMID: 36914991 DOI: 10.1016/j.jss.2022.10.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/24/2022] [Accepted: 10/29/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Trauma represents the leading cause of nonobstetrical maternal death. How in-hospital outcomes of acutely injured pregnant patients (PP) compares to that of similarly aged nonpregnant control groups (CGs) has not been described. We hypothesized that PPs suffering acute traumatic injuries would have worse outcomes compared to a matched CG. MATERIALS AND METHODS The American College of Surgeons Trauma Quality Improvement Program (TQIP) was used to identify traumatically injured females between 2017 and 2019. Propensity score matching on age, race, injury severity score , and type of trauma (blunt, penetrating, or other) was used to compare PPs and the CG. Primary outcomes were mortality, disposition, length of stay (LOS), and complications. RESULTS A total of 1078 traumatically injured pregnant females were identified. Propensity score matching resulted in 990 patients in the PP and CG cohorts. After matching, PPs were more likely to be assault victims (11% versus 6%, P < 0.001), had longer length of stay (LOS) (5 versus 3 d, P < 0.001), and were more likely to require mechanical ventilation (26% versus 16%, P < 0.001) or intensive care unit (ICU) admission (44% versus 32%, P < 0.001). PPs were more likely to proceed directly to the operating room (OR)(34% versus 15%, P < 0.001) and less likely to be discharged home from the emergency department (ED) (1% versus 12%, P < 0.001). Complications and mortality rates were similar among PPs. CONCLUSIONS After acute trauma, PPs did not have increased mortality or complications when compared to matched controls, although they were more likely to be victims of assault, directly proceed to the OR, require mechanical ventilation or ICU admission, and have longer LOSs.
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Affiliation(s)
- Ayman Ali
- Tulane University School of Medicine, Department of Surgery, New Orleans, Louisiana
| | - John T Simpson
- Tulane University School of Medicine, Department of Surgery, New Orleans, Louisiana
| | - Danielle Tatum
- Tulane University School of Medicine, Department of Surgery, New Orleans, Louisiana
| | - Jessica A Sedhom
- Tulane University School of Medicine, Department of Surgery, New Orleans, Louisiana
| | - Jacob Broome
- Tulane University School of Medicine, Department of Surgery, New Orleans, Louisiana
| | - Patrick R McGrew
- Tulane University School of Medicine, Department of Surgery, New Orleans, Louisiana
| | - Juan Duchesne
- Tulane University School of Medicine, Department of Surgery, New Orleans, Louisiana
| | - Sharven Taghavi
- Tulane University School of Medicine, Department of Surgery, New Orleans, Louisiana.
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Morris JR, Kawwass JF, Hipp HS. Physical intimate partner violence among women reporting prior fertility treatment: a survey of U.S. postpartum women. Fertil Steril 2023; 119:277-288. [PMID: 36347311 DOI: 10.1016/j.fertnstert.2022.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine the prevalence of physical intimate partner violence (IPV) among postpartum women reporting preconception fertility treatment compared with those who conceived without the use of assisted reproduction. DESIGN Retrospective cross-sectional population-based study. SETTING Not applicable. PATIENT(S) Postpartum respondents of the Centers for Disease Control Pregnancy Risk Assessment Monitoring System survey. INTERVENTION Preconception fertility treatment utilization. MAIN OUTCOME MEASURES Physical IPV. RESULTS Of the 43,999 respondents included in this analytic sample, roughly 2% reported physical IPV. Respondents reporting preconception fertility treatment (12.6%) were less likely to endorse physical IPV than those who conceived without fertility treatment exposure (odds ratio, 0.5; 95% confidence interval, 0.4-0.7). In the multivariate regression model, the odds of physical IPV were similar among postpartum women regardless of the fertility treatment exposure (adjusted odds ratio, 1.2; 95% confidence interval, 0.8-2.0). Residing in a household with an income under the federal poverty level and increased preconception stressors were predictive of reported physical IPV. There was no difference in the type of fertility treatment and report of physical IPV. Among women exposed to fertility treatment, predictors of physical IPV included self-identification of Black or Hispanic race and ethnicity as well as report of 4 or more stressors in the 12 months before the most recent delivery. CONCLUSION The use of fertility treatment did not confer greater risk of physical IPV within this postpartum population. However, there are many individuals with infertility who never present for an assessment, proceed with treatment, or are unsuccessful, thus the extent to which infertility and fertility treatment exposure is associated with physical IPV remains to be elucidated. Women reporting a greater number of stressors may be uniquely at risk despite the access and exposure to fertility treatment. The preconception period, inclusive of encounters with infertility specialists, represents a novel opportunity to screen and counsel all women for IPV.
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Affiliation(s)
- Jerrine R Morris
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco, San Francisco, California.
| | - Jennifer F Kawwass
- Division of Reproductive Endocrinology and Infertility, Emory University School of Medicine, Atlanta, Georgia
| | - Heather S Hipp
- Division of Reproductive Endocrinology and Infertility, Emory University School of Medicine, Atlanta, Georgia
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Huang C, Hill A, Miller E, Soudi A, Flick D, Buranosky R, Holland CL, Hawker L, Chang JC. "Are You Safe at Home?": Clinician's Assessments for Intimate Partner Violence at the Initial Obstetric Visit. Violence Against Women 2023; 29:185-201. [PMID: 36474434 PMCID: PMC10704346 DOI: 10.1177/10778012221142915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Few studies have empirically examined patient-clinician conversations to assess how intimate partner violence (IPV) screening is performed. Our study sought to examine audio-recorded first obstetric encounters' IPV screening conversations to describe and categorize communication approaches and explore associations with patient disclosure. We analyzed 247 patient encounters with 47 providers. IPV screening occurred in 95% of visits: 57% used direct questions, 25% used indirect questions, 17% repeated IPV screening later in the visit, 11% framed questions with a reason for asking, and 10% described IPV types. Patients disclosed IPV in 71 (28.7%) visits. There were no associations between disclosure and any categories of IPV screening.
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Affiliation(s)
- Cecilia Huang
- Long Beach Memorial Family Medicine Residency Program, Long Beach, CA, USA
| | - Amber Hill
- Department of Pediatrics, CS Mott Children’s Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Abdesalam Soudi
- Department of Linguistics, University of Pittsburgh Dietrich School of Arts and Sciences, Pittsburgh, PA, USA
| | - Diane Flick
- The Primary Health Network - Behavioral Health Operations, Sharon, PA, USA
| | - Raquel Buranosky
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Cynthia L. Holland
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lynn Hawker
- Women’s Center and Shelter of Greater Pittsburgh, Pittsburgh, PA, USA
| | - Judy C. Chang
- Magee-Women’s Research Institute and Department of Obstetrics, Gynecology and Reproductive Sciences; Division of General Internal Medicine, Department of Medicine; Clinical and Translational Science Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Intimate Partner Violence and Pregnancy: Nationwide Analysis of Injury Patterns and Risk Factors. J Am Coll Surg 2023; 236:198-207. [PMID: 36519917 DOI: 10.1097/xcs.0000000000000421] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Intimate partner violence (IPV) is a significant cause of injury, and in pregnant patients (PIPV) poses a risk to both mother and fetus. Characteristics and outcomes for PIPV patients have not been well described. We hypothesize that PIPV patients have higher admission rates and mortality than non-IPV pregnant trauma (PT) patients and nonpregnant female IPV patients of childbearing age. We also hypothesize differences exist between PIPV and PT patient injury patterns, allowing for targeted IPV screening. STUDY DESIGN The Nationwide Emergency Department Sample database was queried from 2010 to 2014 to identify IPV in adult women patients by injury code E967.3. Patients were compared in 2 ways, PIPV vs PT and PIPV vs nonpregnant female IPV patients. Demographics, injury mechanisms, and National Trauma Data Standard injury diagnoses were surveyed. Primary outcomes were hospital admissions and mortality. Logistic regression was used to estimate risk factors of the outcomes of hospitalization and IPV victimization in pregnant injured patients. RESULTS There were 556 PIPV patients, 73,970 PT patients, and 56,543 nonpregnant female IPV patients. When comparing PIPV to PT, more PIPV patients had Medicaid coverage or were self-pay. Suffocation, head injuries, face/neck/scalp contusions, multiple contusions, and abrasions/friction burns were more prevalent in PIPV patients. Mortality and hospital admissions were scarce among all cohorts. Predictors of IPV victimization among injured pregnant patients include multiple injuries, head injuries, face/neck/scalp contusions, abrasions/friction burns, contusions of multiple sites, and those with Medicaid or self-pay coverage. CONCLUSIONS Among injured pregnant patients, those with multiple injuries, head injuries, contusions of the face/neck/scalp, abrasions/friction burns, and multiple contusions should undergo IPV screening. Admissions and mortality are low; therefore, prevention measures should be implemented in the emergency department to reduce repeat victimization.
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18
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Pontes NMH, Thompson S, Saffold TL, Pontes MCF. Additive interactions between sex and forced sexual intercourse victimization on depressive symptoms and suicidality: Youth risk behavior survey 2001-2017. Nurs Outlook 2022; 70:866-878. [PMID: 36396504 DOI: 10.1016/j.outlook.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/01/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Adolescents who have been forced to have sexual intercourse have higher rates of depressive symptoms and suicidality. PURPOSE This research investigated whether the association between adolescent forced sexual intercourse victimization and depressive symptoms or suicidality varies significantly by sex. METHOD This secondary analysis pooled cross-sectional data from the Youth Risk Behavior Survey 2001 through 2017 (N = 132,580) using R to estimate adjusted risk differences and additive interactions. FINDINGS Results show an extremely high prevalence of depressive symptoms and suicidality among adolescents who experience forced sexual victimization. This association is significantly higher among females for depressive symptoms, but significantly higher among males for suicide attempt or suicide attempt requiring treatment. RESULTS also showed that approximately 40% of both males and females who attempted suicide requiring treatment also had a history of forced sexual intercourse victimization. DISCUSSION These findings highlight the importance of screening for sexual victimization, depression and suicidality among adolescents.
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Affiliation(s)
- Nancy M H Pontes
- The State University of New Jersey, School of Nursing, Camden, NJ.
| | - Summer Thompson
- Health Sciences Clinical, Psychiatric and Mental Health Nurse Practitioner Program, University of California San Francisco, School of Nursing
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19
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Kemp L, Bruce T, Elcombe EL, Byrne F, Scharkie SA, Perlen SM, Goldfeld SR. Identification of families in need of support: Correlates of adverse childhood experiences in the right@home sustained nurse home visiting program. PLoS One 2022; 17:e0275423. [PMID: 36190969 PMCID: PMC9529103 DOI: 10.1371/journal.pone.0275423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 08/31/2022] [Indexed: 11/07/2022] Open
Abstract
Background Little is known about the efficacy of pregnancy screening tools using non-sensitive sociodemographic questions to identify the possible presence of as yet undiagnosed disease in individuals and later adverse childhood events disclosure. Objectives The study aims were to: 1) record the prevalence of risk disclosed by families during receipt of a sustained nurse home visiting program; and 2) explore patterns of relationships between the disclosed risks for their child having adverse experiences and the antenatal screening tool, which used non-sensitive demographic questions. Design Retrospective, observational study. Participants and methods Data about the participants in the intervention arm of the Australian right@home trial, which is scaffolded on the Maternal Early Childhood Sustained Home-visiting model, collected between 2013 and 2017 were used. Screening data from the 10-item antenatal survey of non-sensitive demographic risk factors and disclosed risks recorded by the nurse in audited case files during the subsequent 2 year intervention were examined (n = 348). Prevalence of disclosed risks for their child having adverse experiences were analysed in 2019 using multiple response frequencies. Phi correlations were conducted to test associations between screening factors and disclosed risks. Results Among the 348 intervention participants whose files were audited, 300 were noted by nurses to have disclosed risks during the intervention, with an average of four disclosures. The most prevalent maternal disclosures were depression or anxiety (57.8%). Mental health issues were the most prevalent partner and family disclosures. Screening tool questions on maternal smoking in pregnancy, not living with another adult, poverty and self-reporting anxious mood were significantly associated with a number of disclosed risks for their child having adverse experiences. Conclusions These findings suggest that a non-sensitive sociodemographic screening tool may help to identify families at higher risk for adverse childhood experiences for whom support from a sustained nurse home visiting program may be beneficial.
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Affiliation(s)
- Lynn Kemp
- School of Nursing and Midwifery, Western Sydney University, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- * E-mail:
| | - Tracey Bruce
- School of Nursing and Midwifery, Western Sydney University, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Emma L. Elcombe
- School of Nursing and Midwifery, Western Sydney University, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Fiona Byrne
- School of Nursing and Midwifery, Western Sydney University, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Sheryl A. Scharkie
- School of Nursing and Midwifery, Western Sydney University, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Susan M. Perlen
- Population Health, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Sharon R. Goldfeld
- Population Health, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Centre for Community Child Health, The Royal Children’s Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
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20
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Anguzu R, Cassidy LD, Beyer KMM, Babikako HM, Walker RJ, Dickson-Gomez J. Facilitators and barriers to routine intimate partner violence screening in antenatal care settings in Uganda. BMC Health Serv Res 2022; 22:283. [PMID: 35232438 PMCID: PMC8889632 DOI: 10.1186/s12913-022-07669-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 02/21/2022] [Indexed: 11/14/2022] Open
Abstract
Background Uganda clinical guidelines recommend routine screening of pregnant women for intimate partner violence (IPV) during antenatal care (ANC). Healthcare providers play a critical role in identifying IPV during pregnancy in ANC clinics. This study explored facilitators and barriers for IPV screening during pregnancy (perinatal IPV screening) by ANC-based healthcare workers in Uganda. Methods We conducted qualitative in-depth interviews among twenty-eight purposively selected healthcare providers in one rural and an urban-based ANC health center in Eastern and Central Uganda respectively. Barriers and facilitators to IPV screening during ANC were identified iteratively using inductive-deductive thematic analysis. Results Participants had provided ANC services for a median (IQR) duration of 4.0 (0.1–19) years. Out of 28 healthcare providers, 11 routinely screened women attending ANC clinics for IPV and 10 had received IPV-related training. Barriers to routine IPV screening included limited staffing and space resources, lack of comprehensive gender-based violence (GBV) training and provider unawareness of the extent of IPV during pregnancy. Facilitators were availability of GBV protocols and providers who were aware of IPV (or GBV) tools tended to use them to routinely screen for IPV. Healthcare workers reported the need to establish patient trust and a safe ANC clinic environment for disclosure to occur. ANC clinicians suggested creation of opportunities for triage-level screening and modification of patients’ ANC cards used to document women’s medical history. Some providers expressed concerns of safety or retaliatory abuse if perpetrating partners were to see reported abuse. Conclusions Our findings can inform efforts to strengthen GBV interventions focused on increasing routine perinatal IPV screening by ANC-based clinicians. Implementation of initiatives to increase routine perinatal IPV screening should focus on task sharing, increasing comprehensive IPV training opportunities, including raising awareness of IPV severity, trauma-informed care and building trusting patient-physician relationships. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07669-0.
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Affiliation(s)
- Ronald Anguzu
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, USA.
| | - Laura D Cassidy
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, USA
| | - Kirsten M M Beyer
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, USA
| | - Harriet M Babikako
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Makerere University College of Health Sciences, New Mulago Gate Road, Mulago, Kampala, Uganda.,Department of Child Health and Development Center, School of Medicine, Makerere University, College of Health Sciences, Mulago Hill, Hospital Complex, P.O. Box 7072, Kampala, Kampala, Uganda
| | - Rebekah J Walker
- Center for Advancing Population Sciences (CAPS), Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Julia Dickson-Gomez
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, USA
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21
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Propensity score analysis of psychological intimate partner violence and preterm birth. Sci Rep 2022; 12:2942. [PMID: 35190645 PMCID: PMC8861009 DOI: 10.1038/s41598-022-06990-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/27/2022] [Indexed: 11/08/2022] Open
Abstract
Psychological intimate partner violence (IPV), a global public health problem, affects mothers during pregnancy. We evaluated its relationship with preterm birth. We established a cohort of 779 consecutive mothers receiving antenatal care and giving birth in 15 public hospitals in Spain. Trained midwives collected IPV data using the Index of Spouse Abuse validated in the Spanish language. Preterm was defined as birth before 37 completed weeks of gestation. Gestational age was estimated by early ultrasound. With multivariate logistic regression we estimated the relative association of IPV with preterm birth as adjusted odds ratios (AOR), with 95% confidence intervals (CI). In propensity score analysis, using weighting by inverse probability of exposure to IPV, the whole sample was used for estimating the absolute difference in probability of preterm amongst offspring born to mothers with and without IPV. Socio-demographic and other pregnancy characteristics served as covariates in both analyses. Preterm occurred in 57 (7.3%) pregnancies. Psychological IPV, experienced by 151 (21%) mothers, was associated with preterm birth (11.9% vs 6.5%; AOR = 2.4; 95% CI = 1.1–5.0; p = 0.01). The absolute preterm difference in psychological IPV compared to normal was 0.08 (95% CI = 0.01–0.16; p = 0.04). The probability of preterm birth was 8% higher on average in women with psychological IPV during pregnancy. As our analysis controlled for selection bias, our findings give credence to a causal inference. Screening and management for psychological IPV during pregnancy is an important step in antenatal care to prevent preterm birth.
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22
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Zapata-Calvente AL, Megías JL, Velasco C, Caño A, Khan KS, Rubio L, Martín-de-Las-Heras S. Screening for intimate partner violence during pregnancy: a test accuracy study. Eur J Public Health 2022; 32:429-435. [PMID: 35134894 PMCID: PMC9159325 DOI: 10.1093/eurpub/ckac009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Intimate partner violence (IPV) against women is a serious health problem that affects pregnancy more frequently than other obstetric complications usually evaluated in antenatal visits. We aimed to estimate the accuracy of the Women Abuse Screening Tool-Short (WAST-Short) and the Abuse Assessment Screen (AAS) for the detection of IPV during and before pregnancy. Methods Consecutive eligible mothers in 21 public primary health antenatal care centres in Andalusia (Spain) who received antenatal care and gave birth during January 2017–March 2019, had IPV data gathered by trained midwives in the first and third pregnancy trimesters. The index tests were WAST-Short (score range 0–2; cut-off 2) and AAS (score range 0–1; cut-off 1). The reference standard was World Health Organization (WHO) IPV questionnaire. Area under receiver operating characteristics curve (AUC), sensitivity and specificity with 95% confidence intervals (CI) were estimated for test performance to capture IPV during and before pregnancy, and compared using paired samples analysis. Results According to the reference standard, 9.5% (47/495) and 19.4% (111/571) women suffered IPV during and before pregnancy, respectively. For capturing IPV during pregnancy in the third trimester, the WAST-Short (AUC 0.73, 95% CI 0.63, 0.81), performed better than AAS (AUC 0.57, 95% CI 0.47, 0.66, P = 0.0001). For capturing IPV before pregnancy in the first trimester, there was no significant difference between the WAST-Short (AUC 0.69, 95% CI 0.62, 0.74) and the AAS (AUC 0.69, 95% CI 0.62, 0.74, P = 0.99). Conclusions The WAST-Short could be useful to screen IPV during pregnancy in antenatal visits.
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Affiliation(s)
| | - Jesús L Megías
- Department of Experimental Psychology, University of Granada, Granada, Spain
| | - Casilda Velasco
- Department of Nursing and Midwifery, University of Jaen, Jaen, Spain
| | - Africa Caño
- Department of Obstetrics and Gynecology, University Hospital, Granada, Spain
| | - Khalid S Khan
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Granada, Spain
| | - Leticia Rubio
- Department of Forensic Medicine, University of Malaga, Malaga, Spain
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D’Angelo DV, Bombard JM, Lee RD, Kortsmit K, Kapaya M, Fasula A. Prevalence of Experiencing Physical, Emotional, and Sexual Violence by a Current Intimate Partner during Pregnancy: Population-based Estimates from the Pregnancy Risk Assessment Monitoring System. JOURNAL OF FAMILY VIOLENCE 2022; 38:117-126. [PMID: 37205924 PMCID: PMC10193455 DOI: 10.1007/s10896-022-00356-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/09/2022] [Indexed: 05/21/2023]
Abstract
Intimate partner violence (IPV) during pregnancy presents a risk for maternal mental health problems, preterm birth, and having a low birthweight infant. We assessed the prevalence of self-reported physical, emotional, and sexual violence during pregnancy by a current partner among women with a recent live birth. We analyzed data from the 2016-2018 Pregnancy Risk Assessment Monitoring System in six states to calculate weighted prevalence estimates and 95% confidence intervals for experiences of violence by demographic characteristics, health care utilization, and selected risk factors. Overall, 5.7% of women reported any type of violence during pregnancy. Emotional violence was most prevalent (5.4%), followed by physical violence (1.5%), and sexual violence (0.9%). Among women who reported any violence, 67.6% reported one type of violence, 26.5% reported two types, and 6.0% reported three types. Reporting any violence was highest among women using marijuana or illicit substances, experiencing pre-pregnancy physical violence, reporting depression, reporting an unwanted pregnancy, and experiencing relationship problems such as getting divorced, separated, or arguing frequently with their partner. There was no difference in report of discussions with prenatal care providers by experience of violence. The majority of women did not report experiencing violence, however among those who did emotional violence was most frequently reported. Assessment for IPV is important, and health care providers can play an important role in screening. Coordinated prevention efforts to reduce the occurrence of IPV and community-wide resources are needed to ensure that pregnant women receive needed services and protection.
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Affiliation(s)
- Denise V. D’Angelo
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy. NE, Mail stop S106-10, GA 30341 Atlanta, USA
| | - Jennifer M. Bombard
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rosalyn D. Lee
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy. NE, Mail stop S106-10, GA 30341 Atlanta, USA
| | - Katherine Kortsmit
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Martha Kapaya
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amy Fasula
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Wetzel EC, Tembo T, Abrams EJ, Mazenga A, Chitani MJ, Ahmed S, Yu X, Kim MH. The relationship between intimate partner violence and HIV outcomes among pregnant women living with HIV in Malawi. Malawi Med J 2021; 33:242-252. [PMID: 35291385 PMCID: PMC8892998 DOI: 10.4314/mmj.v33i4.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background Intimate partner violence (IPV) is a global public health concern particularly in pregnancy where IPV can have negative health implications for the mother and child. Data suggest IPV disproportionately affects pregnant women living with HIV (PWLWH) compared to those without HIV. HIV-related outcomes are worse among women experiencing IPV. Despite this knowledge, there is paucity of data concerning PWLWH and IPV in Malawi, where there is a high HIV prevalence (10.6%). Objectives We aim to characterize IPV amongst PWLWH in Malawi and describe its relationship to demographic characteristics, psychosocial factors, and HIV-related outcomes. Methods This analysis used data from the VITAL Start pilot study, which is a video-based intervention targeting retention and ART adherence amongst PWLWH in Malawi. PWLWH not on ART were recruited at antenatal clinic and given study questionnaires to assess demographics, IPV, and psychosocial factors. Questionnaires were also administered at one-month follow-up to assess outcomes related to HIV. Descriptive statistics and logistic regression models were used to explore the risk factors associated with IPV. Results Thirty-nine percent of participants reported ever experiencing IPV from their current partner. The majority (53%) reporting IPV experienced more than one type of violence. IPV was associated with being married (p=0.04) and depression (p<0.0001) in the univariable analysis. For women retained at one-month, IPV was associated with reporting a missed ART dose in the past month but not with adherence measured by pill count. Conclusions A large proportion of PWLWH experienced IPV from their current partner and IPV was associated with worse self-reported ART adherence at one-month follow-up. Further evidence is needed to understand how IPV impacts PWLWH throughout postpartum and beyond. Given the detrimental impact on health outcomes among PWLWH in Malawi, additional focus on IPV is essential to identify mechanisms to prevent, screen, and manage IPV among this population.
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Affiliation(s)
- Elizabeth C Wetzel
- Baylor College of Medicine International Pediatric AIDS Initiative, Texas Children's Hospital, Houston, United States of America (USA), Baylor College of Medicine - Children's Foundation Malawi, Lilongwe, Malawi
| | - Tapiwa Tembo
- Baylor College of Medicine - Children's Foundation Malawi, Lilongwe, Malawi
| | - Elaine J Abrams
- ICAP at Columbia University, Mailman School of Public Health and Department of Pediatrics, Vagelos College of Physicians & Surgeons, Columbia University, New York, USA
| | - Alick Mazenga
- Baylor College of Medicine - Children's Foundation Malawi, Lilongwe, Malawi
| | - Mike J Chitani
- Baylor College of Medicine - Children's Foundation Malawi, Lilongwe, Malawi
| | - Saeed Ahmed
- Baylor College of Medicine International Pediatric AIDS Initiative, Texas Children's Hospital, Houston, United States of America (USA), Baylor College of Medicine - Children's Foundation Malawi, Lilongwe, Malawi
| | - Xiaoying Yu
- University of Texas Medical Branch at Galveston, Galveston, USA
| | - Maria H Kim
- Baylor College of Medicine International Pediatric AIDS Initiative, Texas Children's Hospital, Houston, United States of America (USA), Baylor College of Medicine - Children's Foundation Malawi, Lilongwe, Malawi
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Guille C, Maldonado L, Simpson AN, Newman R, King C, Cortese B, Quigley E, Dietrich N, Kerr A, Aujla R, King K, Ford D, Brady KT. A Non-Randomized Trial of In-Person Versus Text/Telephone Screening, Brief Intervention and Referral to Treatment for Pregnant and Postpartum Women. PSYCHIATRIC RESEARCH AND CLINICAL PRACTICE 2021; 3:172-183. [PMID: 36101654 PMCID: PMC9175992 DOI: 10.1176/appi.prcp.20210027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 11/30/2022] Open
Abstract
Background Systems of care that improve mental health and substance use disorder Screening, Brief Intervention and Referral to Treatment (SBIRT) for pregnant and postpartum women are needed. Aims The aim of this study is to determine if women receiving prenatal care from January 2020 to April 2021 are more likely to be screened, screen positive, be referred for treatment and attend treatment with technology facilitated SBIRT, compared to women receiving prenatal care and in-person SBIRT January 2017 to December 2019. Materials & Methods Technology facilitated SBIRT, designated Listening to Women (LTW), includes text message-based screening, phone-based brief intervention, and referral to treatment by a remote care coordinator. A total of 3535 pregnant and postpartum women were included in the quasi-experimental study and data were collected via text message and Electronic Health Record. Results In-person SBIRT was completed by 65.2% (1947/2988) of women while 98.9% (547/553) of women approached agreed to take part in LTW and 71.9% (393/547) completed SBIRT via LTW. After controlling for potentially confounding variables, women enrolled in LTW were significantly more likely to be screened (relative risk [RR]: 1.10, 95% CI 1.03-1.16), screen positive (RR 1.91, 95% CI 1.72-2.10), referred to treatment (RR 1.55, 95% CI 1.43-1.69) and receive treatment (RR 4.95, 95% CI 3.93-6.23), compared to women receiving in-person SBIRT. Black women enrolled in LTW were significantly more likely to screen positive (RR 1.65, 95% CI 1.35-2.01), be referred to treatment (RR 1.54, 95% CI 1.35-1.76) and attend treatment (RR 5.49, 95% CI 3.69-8.17), compared to Black women receiving in-person SBIRT. Discussion LTW appears to increase the proportion of pregnant and postpartum women receiving key elements of SBIRT.
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Affiliation(s)
- Constance Guille
- Department of Psychiatry and Behavioral SciencesMedical University of South CarolinaCharleston
- Department of Obstetrics and GynecologyMedical University of South CarolinaCharleston
| | - Lizmarie Maldonado
- Department of Healthcare Leadership and ManagementMedical University of South CarolinaCharleston
| | - Annie N. Simpson
- Department of Healthcare Leadership and ManagementMedical University of South CarolinaCharleston
| | - Roger Newman
- Department of Obstetrics and GynecologyMedical University of South CarolinaCharleston
| | - Courtney King
- Department of Psychiatry and Behavioral SciencesMedical University of South CarolinaCharleston
| | - Bernadette Cortese
- Department of Psychiatry and Behavioral SciencesMedical University of South CarolinaCharleston
| | - Erin Quigley
- Biomedical Informatics CenterMedical University of South CarolinaCharleston
| | - Nicole Dietrich
- Department of Psychiatry and Behavioral SciencesMedical University of South CarolinaCharleston
| | - Anna Kerr
- Department of Obstetrics and GynecologyMedical University of South CarolinaCharleston
| | - Rubin Aujla
- Department of Psychiatry and Behavioral SciencesMedical University of South CarolinaCharleston
| | - Kathryn King
- Department of PediatricsMedical University of South CarolinaCharleston
| | - Dee Ford
- Department of PulmonologyMedical University of South CarolinaCharlestonSC
| | - Kathleen T. Brady
- Department of Psychiatry and Behavioral SciencesMedical University of South CarolinaCharleston
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Di Franco M, Martines GF, Carpinteri G, Trovato G, Catalano D. Domestic violence detection amid the COVID-19 pandemic: the value of the WHO questionnaire in emergency medicine. QJM 2021; 114:637-641. [PMID: 33377948 PMCID: PMC7798581 DOI: 10.1093/qjmed/hcaa333] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/05/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Gender-based violence affects 35-45% of women worldwide, mostly coming from domestic violence. A good screening procedure in clinical practice is useful, but WHO does not advise universal screening, recommending further research. AIM (i) To report the frequency of domestic violence cases among admissions to the Emergency Room of a major Italian Hospital in 2020, including during complete 'Lockdown' period; (ii) to document acute and chronic health effects of domestic violence and (iii) to asses usefulness of the WHO screening as a tool for uncovering cases which would otherwise remain hidden. DESIGN AND METHODS A database containing all the information recorded for each of 19 160 patients in the Emergency Room was constructed by a keyword search ('violence', 'assault', 'trauma') to filter the data and retrieve cases of violence in the period between 1 January and 2 June 2020. The self-administered questionnaire of the WHO Multi-country Study on Women's Health and Domestic Violence against Women was used in women referred to the emergency room for any cause, excluding trauma. RESULTS A recent history of domestic violence was disclosed by 22.67%, after completing the WHO questionnaire. Of those not participating in the survey, diagnosis of domestic violence was only 0.6% (128/19 160). CONCLUSION Power of detection of domestic violence by the WHO questionnaire is very high, while the frequency of occurrence of these events in this population was considerable. Seemingly, it elicits the responsiveness to the topic of the volunteer interviewees. Its use should be firmly recommended, reasonably, while Covid-19 pandemic is affecting health, rights and response.
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Affiliation(s)
- M Di Franco
- From the Department of Emergency Medicine. Ospedale San Marco-Policlinico Gaspare Rodolico. School of Medicine, The University of Catania, Via Santa Sofia 78, Catania 95100, Italy
| | - G F Martines
- From the Department of Emergency Medicine. Ospedale San Marco-Policlinico Gaspare Rodolico. School of Medicine, The University of Catania, Via Santa Sofia 78, Catania 95100, Italy
| | - G Carpinteri
- From the Department of Emergency Medicine. Ospedale San Marco-Policlinico Gaspare Rodolico. School of Medicine, The University of Catania, Via Santa Sofia 78, Catania 95100, Italy
| | - G Trovato
- From the Department of Emergency Medicine. Ospedale San Marco-Policlinico Gaspare Rodolico. School of Medicine, The University of Catania, Via Santa Sofia 78, Catania 95100, Italy
- Address correspondence to G.M. Trovato, Department of Emergency Medicine, School of Medicine, Ospedale San Marco-Policlinico Gaspare Rodolico, The University of Catania, Via Santa Sofia 78, Catania 95100, Italy.
| | - D Catalano
- From the Department of Emergency Medicine. Ospedale San Marco-Policlinico Gaspare Rodolico. School of Medicine, The University of Catania, Via Santa Sofia 78, Catania 95100, Italy
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Measuring the readiness to screen and manage intimate partner violence: Cross-cultural adaptation and psychometric evaluation of the PREMIS tool for perinatal care providers. PLoS One 2021; 16:e0258943. [PMID: 34735470 PMCID: PMC8568123 DOI: 10.1371/journal.pone.0258943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/09/2021] [Indexed: 12/05/2022] Open
Abstract
Introduction Pregnancy and perinatal periods are significant risk factors of intimate partner violence (IPV), a major public health problem that could begin or intensify during these periods. Perinatal care providers have a major role in the identification and the management of IPV. This study aimed to cross-culturally adapt into French the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) tool, a reliable instrument to assess the knowledge, attitudes and preparedness to address IPV, and to evaluate its psychometric properties. Methods The PREMIS was cross-culturally adapted by conducting forward and backward translations, following international guidelines. An online cross-sectional study was conducted to assess the psychometric properties of the PREMIS-French in perinatal care providers: data completeness, factor analysis, score distribution, floor and ceiling effects, internal consistency, item-total correlations, inter-subscale correlations and test-retest reliability. Results The PREMIS was successfully translated and cross-culturally adapted to the context of metropolitan France. The results obtained from 360 perinatal care providers showed good acceptability. Exploratory factor analysis of the “Opinions” items resulted in a six-factor solution with six of the eight subscales of the original structure identified. Good internal consistency (Cronbach’s alpha ranging from 0.54 to 0.97) and good test-retest reliability (intraclass correlation coefficients ranging from 0.46 to 0.92) for the “Background” and “Opinions” subscales were found. Discussion This study provides evidence of the good psychometric properties of the PREMIS-French. This valid instrument will help to understand perinatal care providers’ barriers to IPV screening and management and will help to focus on specific lacks of knowledge for developing IPV education programs.
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Sileo KM, Kershaw TS, Gilliam S, Taylor E, Kommajosula A, Callands TA. Trauma Exposure and Intimate Partner Violence Among Young Pregnant Women in Liberia. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:10101-10127. [PMID: 31625468 PMCID: PMC7778451 DOI: 10.1177/0886260519881533] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Intimate partner violence (IPV) is a global threat to women's health and may be elevated among those exposed to traumatic events in post-conflict settings, such as Liberia. The purpose of this study was to examine potential mediators between lifetime exposure to traumatic events (i.e., war-related trauma, community violence) with recent experiences of IPV among 183 young, pregnant women in Monrovia, Liberia. Hypothesized mediators included mental health (depression, posttraumatic stress symptoms), insecure attachment style (anxious and avoidant attachment), and attitudes indicative of norms of violence (attitudes justifying wife beating). We tested a parallel multiple mediation model using the PROCESS method with bias-corrected and accelerated bootstrapping to test confidence intervals (CI). Results show that 45% of the sample had experienced any physical, sexual, or emotional IPV in their lifetime, and 32% in the 2 months prior to the interview. Exposure to traumatic events was positively associated with recent IPV severity (β = .40, p < .01). Taken together, depression, anxious attachment style, and justification of wife beating significantly mediated the relationship between exposure to traumatic events and experience of IPV (β = .15, 95% CI = [0.03, 0.31]). Only anxious attachment style (β = .07, 95% CI = [0.03, 0.16]) and justification of wife beating (β = .05, 95% CI = [0.01, 0.16]) were identified as individual mediators. This study reinforces pregnancy as an important window for both violence and mental health screening and intervention for young Liberian women. Furthermore, it adds to our theoretical understanding of mechanisms in which long-term exposure to traumatic events may lead to elevated rates of IPV in Liberia, and points to the need for trauma-informed counseling and multilevel gender transformative public health approaches to address violence against women.
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Affiliation(s)
- Katelyn M. Sileo
- The University of Texas at San Antonio, USA
- The Center for Interdisciplinary Research at Yale University, New Haven, CT, USA
| | - Trace S. Kershaw
- The Center for Interdisciplinary Research at Yale University, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
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Burnett C, Crowder J, Bacchus LJ, Schminkey D, Bullock L, Sharps P, Campbell J. "It Doesn't Freak Us Out the Way It Used to": An Evaluation of the Domestic Violence Enhanced Home Visitation Program to Inform Practice and Policy Screening for IPV. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP7488-NP7515. [PMID: 30741071 DOI: 10.1177/0886260519827161] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The Domestic Violence Enhanced Home Visitation (DOVE) intervention used in the Perinatal Nurse Home Visiting Intervention Enhanced With mHealth Technology (RCT: R01HD071771) is a nurse-lead evidenced-based intervention that has been shown to decrease violence overtime. This summative mixed-methods impact evaluation is intended to provide insight to enhance the DOVE IPV protocol for screening and intervention by (a) identifying which core aspects of DOVE facilitated or inhibited its success and what was most critical to optimal IPV (intimate partner violence) screening and intervention practices, (b) informing how DOVE IPV screening and intervention were influenced by the experiences of home visitor (HV), and (c) identifying policy considerations and best practice recommendations for the DOVE protocol. Participants were HVs and managers (N = 13) in rural/urban home visiting programs delivering DOVE across three states. The sample had a mean age of 48.76. Three fourths were baccalaureate-prepared nurses with an average of 10.5 years of home visiting experience. The method used in this study was one-to-one qualitative in-depth interviews with HVs. Data were interpretively analyzed using Nvivo 10 to generate three themes. Participants endorsed screening women for IPV with DOVE being the approach of choice to facilitate IPV screening and intervening with women. HVs found DOVE helped enhance their IPV knowledge, screening, and intervening capabilities while filling an existing void in this type of preparation of HV nurses. Establishing a relationship with the women before initiating screening was an important aspect in delivering DOVE as was the training, support, and increased comfort level in addressing IPV. The evidence offers an understanding of which core aspects of DOVE contributed to its success and what was most critical to optimal IPV screening and intervention practices. Furthermore, this evaluation provided multilevel insights into how best to advance home visiting practices and policies when screening and intervening with perinatal women exposed to IPV.
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Ditekemena JD, Luhata C, Mavoko HM, Siewe Fodjo JN, Nkamba DM, Van Damme W, Ebrahim SH, Noestlinger C, Colebunders R. Intimate Partners Violence against Women during a COVID-19 Lockdown Period: Results of an Online Survey in 7 Provinces of the Democratic Republic of Congo. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105108. [PMID: 34065852 PMCID: PMC8151677 DOI: 10.3390/ijerph18105108] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 04/29/2021] [Accepted: 05/07/2021] [Indexed: 11/16/2022]
Abstract
Intimate Partners’ Violence (IPV) is a public health problem with long-lasting mental and physical health consequences for victims and their families. As evidence has been increasing that COVID-19 lockdown measures may exacerbate IPV, our study sought to describe the magnitude of IPV in women and identify associated determinants. An online survey was conducted in the Democratic Republic of Congo (DRC) from 24 August to 8 September 2020. Of the 4160 respondents, 2002 eligible women were included in the data analysis. Their mean age was 36.3 (SD: 8.2). Most women (65.8%) were younger than 40 years old. Prevalence of any form of IPV was 11.7%. Being in the 30–39 and >50 years’ age groups (OR = 0.66, CI: 0.46–0.95; p = 0.026 and OR = 0.23, CI: 0.11–048; p < 0.001, respectively), living in urban setting (OR = 0.63, CI: 0.41–0.99; p = 0.047), and belonging to the middle socioeconomic class (OR = 0.48, CI: 0.29–0.79; p = 0.003) significantly decreased the odds for experiencing IPV. Lower socioeconomic status (OR = 1.84, CI: 1.04–3.24; p = 0.035) and being pregnant (OR = 1.63, CI: 1.16–2.29; p = 0.005) or uncertain of pregnancy status (OR = 2.01, CI: 1.17–3.44; p = 0.011) significantly increased the odds for reporting IPV. Additional qualitative research is needed to identify the underlying reasons and mechanisms of IPV in order to develop and implement prevention interventions.
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Affiliation(s)
- John D. Ditekemena
- Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa 834, Congo; (C.L.); (D.M.N.)
- Correspondence:
| | - Christophe Luhata
- Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa 834, Congo; (C.L.); (D.M.N.)
| | - Hypolite M. Mavoko
- Department of Tropical Medicine, Faculty of Medicine, University of Kinshasa, Kinshasa 834, Congo;
| | | | - Dalau M. Nkamba
- Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa 834, Congo; (C.L.); (D.M.N.)
- Pôle d’Épidémiologie et Biostatistique, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain (UCLouvain), 1348 Brussels, Belgium
| | - Wim Van Damme
- Department of Public Health, Institute of Tropical Medicine, 2000 Antwerp, Belgium; (W.V.D.); (C.N.)
| | - Shahul H. Ebrahim
- Technique and Technology, University of Sciences, Bamako 1805, Mali;
| | - Christiana Noestlinger
- Department of Public Health, Institute of Tropical Medicine, 2000 Antwerp, Belgium; (W.V.D.); (C.N.)
| | - Robert Colebunders
- Global Health Institute, University of Antwerp, 2000 Antwerp, Belgium; (J.N.S.F.); (R.C.)
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Roosevelt LK, Pietzmeier S, Reed R. Clinically and Culturally Competent Care for Transgender and Nonbinary People: A Challenge to Providers of Perinatal Care. J Perinat Neonatal Nurs 2021; 35:142-149. [PMID: 33900244 DOI: 10.1097/jpn.0000000000000560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Transgender and nonbinary people experience high rates of discrimination and stigma in healthcare settings, which have a deleterious effect on their health and well-being. While the preventative healthcare needs of transgender and gender nonbinary people are slowly starting to make their way into nursing curriculum, there is still a very little guidance on how to appropriately and respectfully care for this population during one of the most vulnerable interactions with the healthcare system, the perinatal period. Without exposure or education, nurses are challenged on how to provide compassionate and culturally competent care to transgender and nonbinary people. The focus of this review is to provide guidance to nurses caring for transgender and gender nonbinary people during the perinatal period. Terminology and respectful language, a discussion around the decision to parent, affirming approaches to physical examination, and care during pregnancy and the postpartum period are all discussed. By increasing the number of nurses who are trained to deliver high-quality and affirming care to transgender and nonbinary patients, challenging health inequities associated with provider discrimination can be mitigated.
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Affiliation(s)
- Lee K Roosevelt
- School of Nursing, University of Michigan, Ann Arbor, Michigan (Drs Roosevelt and Pietzmeier); and Swedish Midwifery, Seattle, Washington (Mr Reed)
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Murray AL, Kaiser D, Valdebenito S, Hughes C, Baban A, Fernando AD, Madrid B, Ward CL, Osafo J, Dunne M, Sikander S, Walker S, Van Thang V, Tomlinson M, Eisner M. The Intergenerational Effects of Intimate Partner Violence in Pregnancy: Mediating Pathways and Implications for Prevention. TRAUMA, VIOLENCE & ABUSE 2020; 21:964-976. [PMID: 30514180 DOI: 10.1177/1524838018813563] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Prenatal intimate partner violence (P-IPV) can have significant adverse impacts on both mother and fetus. Existing P-IPV interventions focus on the safety of the mother and on reducing revictimization; yet expanding these to address the adverse impact on the fetus has considerable potential for preventing long-term negative developmental outcomes. In this review, we draw together evidence on major pathways linking exposure to P-IPV and child outcomes, arguing that these pathways represent potential targets to improve P-IPV intervention efforts. Using a narrative review of 112 articles, we discuss candidate pathways linking P-IPV to child outcomes, as well as their implications for intervention. Articles were identified via key word searches of social science and medical databases and by inspection of reference lists of the most relevant articles, including recent reviews and meta-analyses. Articles were included if they addressed issues relevant to understanding the effects of P-IPV on child outcomes via six core pathways: maternal stress and mental illness, maternal-fetal attachment, maternal substance use, maternal nutritional intake, maternal antenatal health-care utilization, and infection. We also included articles relevant for linking these pathways to P-IPV interventions. We conclude that developing comprehensive P-IPV interventions that target immediate risk to the mother as well as long-term child outcomes via the candidate mediating pathways identified have significant potential to help reduce the global burden of P-IPV.
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Affiliation(s)
- Aja Louise Murray
- Institute of Criminology, University of Cambridge, Cambridge, United Kingdom
| | - Daniela Kaiser
- Institute of Criminology, University of Cambridge, Cambridge, United Kingdom
| | - Sara Valdebenito
- Institute of Criminology, University of Cambridge, Cambridge, United Kingdom
| | - Claire Hughes
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Adriana Baban
- Department of Psychology, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Asvini D Fernando
- Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka
| | - Bernadette Madrid
- Child Protection Unit, University of the Philippines, Quezon City, Philippines
| | - Catherine L Ward
- Department of Psychology and Safety and Violence Initiative, University of Cape Town, Cape Town, South Africa
| | - Joseph Osafo
- Department of Psychology, University of Ghana, Accra, Ghana
| | - Michael Dunne
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | | | - Susan Walker
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Vo Van Thang
- Faculty of Public Health, Hue University of Medicine and Pharmacy, Hue, Vietnam
| | - Mark Tomlinson
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Manuel Eisner
- Institute of Criminology, University of Cambridge, Cambridge, United Kingdom
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Noursi S, Clayton JA, Campbell J, Sharps P. The Intersection of Maternal Morbidity and Mortality and Intimate Partner Violence in the United States. CURRENT WOMENS HEALTH REVIEWS 2020. [DOI: 10.2174/1573404816999200502024742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background:
In the United States, rates of maternal morbidity and mortality (MMM) are
high compared with other high-income countries and are characterized by significant racial/ethnic
disparities. Typically, research on MMM focuses on obstetrical problems. Less research examines
the role of intimate partner violence (IPV). Maternal health, IPV, and their intersection are linked
with the impacts of social determinants of health.
Objective:
We sought to understand the intersection of MMM and IPV in the United States, particularly
data issues that hinder research in this area and the resulting knowledge gaps.
Methods:
We identified major articles of interest regarding maternal morbidity and mortality and
IPV in the United States and drafted a mini review based on relevant information.
Results:
Despite the prevalence of IPV during pregnancy, the intersection of maternal health and
IPV has not been widely reviewed or discussed.
Conclusion:
There are a number of limitations in surveillance activities and data collection that
underestimate the impact of IPV on MMM. Importantly, women who die by homicide or suicide—
which in many cases is linked with IPV—are not counted as pregnancy-related deaths in the United
States under the current definition. Establishing separate panels of local experts in maternal health
or maternal mortality review committees (MMRCs) that are dedicated to examining violent deaths
and use of the Maternal Mortality Review Information Application system would likely improve
data accuracy of pregnancy-associated deaths. Based on the literature reviewed and limitations of
current data, there are significant knowledge gaps on the effects of IPV and maternal health.
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Affiliation(s)
- Samia Noursi
- Office of Research on Women’s Health, National Institutes of Health (NIH), Bethesda, MD 20817, United States
| | - Janine Austin Clayton
- Office of Research on Women’s Health, National Institutes of Health (NIH), Bethesda, MD 20817, United States
| | - Jacquelyn Campbell
- School of Nursing, Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD 21205, United States
| | - Phyllis Sharps
- School of Nursing, Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD 21205, United States
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Wright JE, Heinze RK, Wright ME. Medical Neglect Allegations in the Context of Conflicted Divorce/Separation Child Custody: What Should the Health Care Provider Do? JOURNAL OF CHILD & ADOLESCENT TRAUMA 2020; 13:285-291. [PMID: 33088385 PMCID: PMC7561624 DOI: 10.1007/s40653-020-00306-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Pediatricians and child health providers face with situation in which families disagree about recommended treatments. Managing these disagreements is more challenging during periods of divorce or separation particularly when parents are in dispute over custody or medical decision-making. Parental disagreement exists along a continuum. General principles apply 1) the worse the conflict, the worse the outcome for children, 2) when conflict is combined with other factors such as separation, the outcome is often worse, and 3) the pediatrician/primary health care provider can mitigate this. This manuscript provides a review of the subject and suggestions for the practicing provider.
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Affiliation(s)
- John Esper Wright
- Department of Pediatrics, East Carolina Brody School of Medicine, Greenville, NC USA
- TEDI BEAR CAC Brody School of Medicine, East Carolina University, 2303 Executive Circle, Mail Stop 687, Greenville, NC 27834-435A USA
| | - Rachel K. Heinze
- Department of Pediatrics, University of Wisconsin School of Medicine, Madison, WI USA
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Akaba GO, Abdullahi HI. Intimate partner violence among postpartum women at a teaching hospital in Nigeria's Federal Capital City: pattern and materno-fetal outcomes. Ther Adv Reprod Health 2020; 14:2633494120928346. [PMID: 32656533 PMCID: PMC7328348 DOI: 10.1177/2633494120928346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 04/28/2020] [Indexed: 11/15/2022] Open
Abstract
Background Intimate partner violence is an important public health and human rights issue. Previous studies have considered intimate partner violence in pregnancy mainly among pregnant women attending antenatal clinics thereby missing out a few who may encounter this problem in late pregnancy or just before delivery. This study had the objective of ascertaining the prevalence, pattern of intimate partner violence, and associated materno-fetal outcomes. Method This was a cross-sectional study conducted between January 2017 and June 2017 among postpartum mothers at a Nigerian Teaching Hospital just before being discharged home. The abuse assessment score was adapted and used to interview women regarding possible intimate partner violence experiences within the past 1 year and during the pregnancy after obtaining written consent. Results Out of 349 postpartum women interviewed, 102/349 (29.2%) experienced intimate partner violence in the past 1 year, while 18/349 (5.2%) of intimate partner violence occurred in the index pregnancy. Sexual partners were the main perpetuators of intimate partner violence, 67/102 (65.7%), while 35/102 (34.3%) were by someone else other than their sexual partners. Among those abused in the current pregnancy, 10/18 (55.6%) were abused once and the remaining 8/18 (44.4%) were abused more than once. Intimate partner violence was associated with higher chances of cesarean section (p = 0.001), increased risk of lesser birth weight babies (p = 0.014), and maternal complications in pregnancy (p = 0.030). Conclusion The prevalence of intimate partner violence in pregnancy in Abuja is high with associated poor materno-fetal outcomes. Enforcing existing legislations and screening for intimate partner violence during routine antenatal care may help reduce its prevalence and ensure a positive pregnancy experience for Nigerian women.
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Affiliation(s)
- Godwin O Akaba
- Department of Obstetrics and Gynaecology, University of Abuja/University of Abuja Teaching Hospital, KM 23 Airport-Giri Road, Abuja, 900105, Nigeria
| | - Habiba I Abdullahi
- Department of Obstetrics and Gynaecology, University of Abuja/University of Abuja Teaching Hospital, Abuja, Nigeria
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Correa NP, Cain CM, Bertenthal M, Lopez KK. Women's Experiences of Being Screened for Intimate Partner Violence in the Health Care Setting. Nurs Womens Health 2020; 24:185-196. [PMID: 32380012 DOI: 10.1016/j.nwh.2020.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 02/07/2020] [Accepted: 03/01/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To qualitatively describe experiences of survivors of intimate partner violence (IPV) in being screened for IPV and to identify opportunities to improve screening and response by health care providers. DESIGN Qualitative descriptive study. SETTING/LOCAL PROBLEM Although it is recommended that nurses and other health care providers screen for IPV, a local needs assessment of IPV screening among health care practices in Houston, Texas, showed inconsistencies in IPV screening practices, a lack of understanding on how to screen for IPV, and low referral rates to IPV agencies. PARTICIPANTS Seventeen survivors of IPV from three agencies that provide services to survivors of IPV. INTERVENTION/MEASUREMENTS Three focus groups were conducted, and notes were coded and analyzed for content and themes using open coding from the observed data. The constant comparative method was used for the analysis. RESULTS Four themes emerged from the focus group data. The first three themes address concepts and dynamics of IPV that affect IPV screening and disclosure of abuse. The final theme addresses screening for IPV in health care settings. CONCLUSION Many survivors reported that they were not screened for IPV by health care professionals, and those who were screened were not screened effectively. Compassionate care is needed in these situations, and nurses and other health care providers should be aware that the responses of IPV survivors are dynamic and may change over time.
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Psychosocial Factors Associated With Postpartum Contraceptive Method Use After an Unintended Birth. Obstet Gynecol 2020; 135:821-831. [PMID: 32168207 DOI: 10.1097/aog.0000000000003745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine whether depression, intimate partner violence, and other psychosocial stressors were independently associated with effectiveness level of postpartum contraception among women who recently had an unintended birth. METHODS We analyzed cross-sectional data from PRAMS (the Pregnancy Risk Assessment Monitoring System) to identify women who had an unintended birth between 2012 and 2015. The effectiveness level of the contraceptive method was coded into one of five categories based on the postpartum contraceptive method that women were using: none, less effective (withdrawal, rhythm, condoms, or other barrier), moderately effective (pill, patch, ring, or shot), long-acting reversible contraception (LARC; intrauterine devices or implants), and sterilization (female or male sterilization). Multinomial logistic regression was used to examine whether prepregnancy depression or elevated postpartum depressive symptoms, intimate partner violence before or during pregnancy, and number of psychosocial stressors before birth were associated with effectiveness level of method (compared with no method), in models adjusted for sociodemographics, pregnancy context, and postpartum context. RESULTS Complete data were available for 56,445 (88.2%) of the 64,030 eligible women: 24.2% experienced depression; 5.3% experienced intimate partner violence; and 16.8% experienced five or more psychosocial stressors around the time of pregnancy or birth. In adjusted models, experiencing intimate partner violence and more stressors lowered women's relative risk of using sterilization, LARC, moderately effective methods, and less-effective contraceptive methods relative to no method use. Only prepregnancy depression was associated with using sterilization compared with no method use. CONCLUSIONS Experiencing intimate partner violence and having more psychosocial stressors were each independently associated with not using a postpartum contraceptive method. Standardized screening for psychosocial factors during prenatal and postpartum care should be integrated, and practices that encourage the discussion of patients' psychosocial experiences and postpartum contraception use together are warranted.
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Pastor-Moreno G, Ruiz-Pérez I, Henares-Montiel J, Petrova D. Intimate partner violence during pregnancy and risk of fetal and neonatal death: a meta-analysis with socioeconomic context indicators. Am J Obstet Gynecol 2020; 222:123-133.e5. [PMID: 31394067 DOI: 10.1016/j.ajog.2019.07.045] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/25/2019] [Accepted: 07/30/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The objective of the study was to summarize the results from observational studies examining the risk of fetal and neonatal death (perinatal death) as a function of the experience of intimate partner violence during pregnancy and examine the influence of socioeconomic context indicators on this association. DATA SOURCES Bibliographic searches were conducted in PubMed, EMBASE, CINAHL, and LILACS until March 2019. STUDY ELIGIBILITY CRITERIA We considered observational studies that provided data on the association between intimate partner violence during pregnancy and perinatal death. STUDY APPRAISAL AND SYNTHESIS METHODS Information collected included study characteristics, type, and prevalence of intimate partner violence and the reported association between intimate partner violence and perinatal death. Quality of the included studies was assessed using the Newcastle-Ottawa scale. Two reviewers independently conducted all review procedures; disagreements were resolved by a third reviewer. Meta-analyses were conducted based on the specific type of intimate partner violence (physical, psychological, sexual, unspecified) and also based on any type of intimate partner violence, considering 1 effect size per study, regardless of the type of intimate partner violence analyzed. Meta-regression analyses were performed to assess the possible effects of socioeconomic context. The proportion of deaths attributable to the exposure of intimate partner violence based on the crude data from the 3 cohort studies available also was calculated. RESULTS Seventeen studies were included. The random-effects model showed a statistically significant increase in the odds of perinatal death among women exposed to unspecified intimate partner violence (odds ratio, 3.18; 95% confidence interval, 1.88-5.38), physical intimate partner violence (odds ratio, 2.46; 95% confidence interval, 1.76-3.44), and any type of intimate partner violence during pregnancy (odds ratio, 2.89; 95% confidence interval, 2.03-4.10). Meta-regression analysis showed stronger associations in countries with higher gross domestic product (odds ratio, 1.03; 95% confidence interval, 1.02-1.04) and a higher percentage of health expenditure (odds ratio, 1.27; 95% confidence interval, 1.09-1.46). The proportion of deaths attributable to exposure to intimate partner violence in cohort studies was attributable proportion, 60%; 95% confidence interval, 15-81%. CONCLUSION Pregnant women who experience intimate partner violence during pregnancy may be about 3 times more likely to suffer perinatal death compared with women who do not experience intimate partner violence. It should be a priority to include intimate partner violence screenings or other detection strategies in pregnancy monitoring or family-planning programs because these could help avoid preventable perinatal deaths.
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Affiliation(s)
- Guadalupe Pastor-Moreno
- Biomedical Research Center in Network of Epidemiology and Public Health (CIBERESP), Madrid; Andalusian School of Public Health, Granada
| | - Isabel Ruiz-Pérez
- Biomedical Research Center in Network of Epidemiology and Public Health (CIBERESP), Madrid; Andalusian School of Public Health, Granada.
| | | | - Dafina Petrova
- Biomedical Research Center in Network of Epidemiology and Public Health (CIBERESP), Madrid; Andalusian School of Public Health, Granada; Instituto de Investigación Biosanitaria ibs.Granada, Granada
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Gómez-Fernández MA, Goberna-Tricas J, Payá-Sánchez M. El saber experiencial de las matronas de Atención Primaria en la detección de violencia de género durante el embarazo. Estudio cualitativo. ENFERMERIA CLINICA 2019; 29:344-351. [DOI: 10.1016/j.enfcli.2019.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 05/11/2019] [Accepted: 05/19/2019] [Indexed: 11/25/2022]
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Mangla K, Hoffman MC, Trumpff C, O'Grady S, Monk C. Maternal self-harm deaths: an unrecognized and preventable outcome. Am J Obstet Gynecol 2019; 221:295-303. [PMID: 30849358 DOI: 10.1016/j.ajog.2019.02.056] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/19/2019] [Accepted: 02/27/2019] [Indexed: 12/14/2022]
Abstract
Maternal mortality continues to be a public health priority in national and international communities. Maternal death rates secondary to medical illnesses such as cardiovascular disease, preeclampsia, and postpartum hemorrhage are well documented. The rates of maternal death secondary to self-harm, including suicide and overdose, have been omitted from published rates of maternal mortality, despite growing attention to the prevalence of perinatal mood disorders, estimated at up to 15% of pregnant and postpartum women in the United States. Underlying psychiatric disorder, including depression, is consistently identified as a risk factor in substance abuse and suicide. The rate of opioid-associated morbidity and mortality has recently been deemed a national crisis. Pregnancy does not protect against these risks, and the postpartum period has been identified as a particularly vulnerable time. The lack of consistent and inclusive data on self-harm deaths in the pregnancy-postpartum period is alarming. This review will identify barriers to reporting and ascertainment of maternal suicide and overdose deaths, summarize geographic-specific data available, address potential social and psychological biases that have led to neglect of the topic of maternal self-harm deaths, and suggest recommendations that incorporate the whole woman in prenatal care and thus prevention of this devastating outcome.
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Affiliation(s)
- Kimberly Mangla
- Department of Psychiatry, Columbia University Medical Center, New York, NY.
| | - M Camille Hoffman
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine/Denver Health and Hospital Authority, Denver, Colorado
| | - Caroline Trumpff
- Division of Behavioral Medicine, Department of Psychiatry, Columbia University Medical Center, New York, NY
| | - Sinclaire O'Grady
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY; Division of Behavioral Medicine, Department of Psychiatry, Columbia University Medical Center, New York, NY
| | - Catherine Monk
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY; Division of Behavioral Medicine, Department of Psychiatry, Columbia University Medical Center, New York, NY; Department of Obstetrics and Gynecology, University of Colorado School of Medicine/Denver Health and Hospital Authority, Denver, Colorado; New York State Psychiatric Institute, New York, NY
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Martin-de-las-Heras S, Velasco C, Luna-del-Castillo JDD, Khan KS. Maternal outcomes associated to psychological and physical intimate partner violence during pregnancy: A cohort study and multivariate analysis. PLoS One 2019; 14:e0218255. [PMID: 31194820 PMCID: PMC6564538 DOI: 10.1371/journal.pone.0218255] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 05/29/2019] [Indexed: 11/19/2022] Open
Abstract
Intimate partner violence (IPV) is a public health problem that affects millions of women worldwide and can occur during both pregnancy and the perinatal period. We aimed to evaluate if the experience of psychological and physical intimate partner violence (IPV) adversely affects pregnancy outcomes. We established a cohort of 779 consecutive mothers receiving antenatal care including ultrasound and giving birth in 15 public hospitals, drawn using cluster sampling of all obstetric services in Andalusia, Spain (February-June 2010). Trained midwives gathered IPV data using the Index of Spouse Abuse validated in the Spanish language (score ranges: 0-100, higher scores reflect more severe IPV; cut-offs: physical IPV = 10, psychological IPV = 25). Socio-demographic data, including lack of kin support, maternal outcomes, and hospitalization were collected. Multivariate logistic regression estimated adjusted odds ratios (AOR), with 95% confidence intervals (CI), of the relationship between psychological and physical IPV and maternal outcomes, controlling for socio-demographic characteristics. Response rate was 92.2%. Psychological IPV, reported by 21.0% (n = 151), was associated significantly with urinary tract infection (127 (23%) vs 56 (37%); AOR = 1.9; 95%CI = 1.2-3.0), vaginal infection (30 (5%) vs 20 (13%); AOR = 2.4; 95%CI = 1.2-4.7) and spontaneous preterm labour (32 (6%) vs 19 (13%); AOR = 2.2; 95%CI = 1.1-4.5). Physical IPV, reported by 3.6% (n = 26), was associated with antenatal hospitalizations (134 (19%) vs 11 (42%); AOR = 2.6; 95%CI = 1.0-7.1). Lack of kin support was associated with spontaneous preterm labour (AOR = 4.7; 95%CI = 1.7-12.8). Mothers with IPV have higher odds of complications. Obstetricians, gynaecologists and midwives should act as active screeners, particularly of the undervalued psychological IPV, to reduce or remedy its effects.
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Affiliation(s)
| | - Casilda Velasco
- Department of Nursing and Midwifery, University of Jaen, Jaen, Spain
| | | | - Khalid S. Khan
- Women’s Health Research Unit, Queen Mary University of London, London, United Kingdom
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Cizmeli C, Lobel M, Harland KK, Saftlas A. Stability and Change in Types of Intimate Partner Violence Across Pre-pregnancy, Pregnancy, and the Postpartum Period. ACTA ACUST UNITED AC 2018; 5:153-169. [PMID: 30505877 DOI: 10.1080/23293691.2018.1490084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Computer-assisted telephone interviews were conducted after childbirth with 2,709 female residents of Iowa to examine experience of intimate partner violence (IPV) across pre-pregnancy, pregnancy, and postpartum. IPV was most prevalent during the postpartum period, followed by pre-pregnancy, and pregnancy. Violence in one period increased the likelihood of violence in subsequent periods. Latent Transition Analysis revealed three classes of women: those who experienced No IPV, Predominantly Sexual IPV, or Physical IPV Only. Change in IPV type across time was associated with whether women had intended, and whether their partners wanted, the pregnancy and with marital status. Findings suggest a continuity of violence for childbearing women who experience IPV prior to conception and have numerous implications for clinicians, researchers, and policymakers.
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Affiliation(s)
| | - Marci Lobel
- Stony Brook University, Department of Psychology, Stony Brook, NY 11794-2500
| | - Karisa K Harland
- University of Iowa, Department of Emergency Medicine, Iowa City, IA 52242
| | - Audrey Saftlas
- University of Iowa, Department of Epidemiology, Iowa City, IA 52242
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Long AJ, Golfar A, Olson DM. Screening in the Prenatal Period for Intimate Partner Violence and History of Abuse: A Survey of Edmonton Obstetrician/Gynaecologists. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 41:38-45. [PMID: 30585166 DOI: 10.1016/j.jogc.2018.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/29/2018] [Accepted: 05/01/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study sought to understand how obstetrician gynaecologists (OB/GYNs) in Edmonton, Alberta screen prenatal patients for intimate partner violence (IPV). It also aimed to explore attitudes, beliefs, and perceptions regarding IPV and identify barriers to screening for IPV. Institutional protocols, resources, and support available to clinicians and patients were also reviewed. METHODS All Royal College of Physicians and Surgeons of Canada-certified OB/GYNs practicing general obstetrics in Edmonton were identified and were mailed letters and electronic questionnaires with two follow-up letters or emails at 2-week intervals. Personal and clinical practice demographic information was collected. Physicians' perceptions, screening practices, and barriers to screening were identified. Responses were collected, stored, and analyzed using a secure online database, Research Electronic Data Capture Database; all responses were completely anonymous. RESULTS Of 58 physicians surveyed, 49 completed questionnaires (84% response rate). A total of 33% of respondents either never or rarely screened women for IPV during prenatal visits, 69% either never or rarely screened for childhood abuse, 94% did not have a screening protocol, and 77% did not have written materials to provide to patients. Multiple barriers were identified. A total of 94% of OB/GYNs believed that they were inadequately screening for IPV. CONCLUSION Screening of pregnant women for IPV and a history of abuse is suboptimal. There are multiple barriers (cultural, societal, economic, and institutional) that prevent women from being screened for IPV and receiving appropriate support services.
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Affiliation(s)
- Alicia J Long
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB.
| | - Atoosa Golfar
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - David M Olson
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB; Department of Pediatrics, University of Alberta, Edmonton, AB; Department of Physiology, University of Alberta, Edmonton, AB
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Kataoka Y, Imazeki M. Experiences of being screened for intimate partner violence during pregnancy: a qualitative study of women in Japan. BMC WOMENS HEALTH 2018; 18:75. [PMID: 29843686 PMCID: PMC5975515 DOI: 10.1186/s12905-018-0566-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 05/16/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Intimate partner violence (IPV) is physical, sexual or psychological violence by a current or former intimate partner. IPV threatens women's health, and during pregnancy women are more vulnerable to violence. Therefore, IPV screening has been recommended during antenatal care; however, health care providers have expressed concern about the negative impact on women and therefore have been reluctant in conducting IPV screening. Consequently our objective was to investigate pregnant women's experiences of reading and completing an IPV screening questionnaire. METHODS Semi-structured interviews were conducted with postpartum women who had received IPV screening during pregnancy to investigate their experiences using the IVP Violence Against Women Screen (VAWS). Qualitative data were analyzed based on content analysis. RESULTS A total of 43 women participated in this study. There were eight (18.6%) women positive for IPV screening during pregnancy. Content analysis for all participants revealed three themes: necessity, acceptability and optimality. 'Necessity' referred to benefits for women from IPV screening, and was supported by three categories: 'redefining the relationship', 'promoting IPV awareness' and 'opportunity to initiate support'. 'Acceptability' of IPV screening was also supported by three categories: 'comfortable', 'quickly completed' and 'difficulty'. 'Optimality' meant IPV screening during pregnancy was appropriate timing for women who had been screened as either positive or negative. CONCLUSIONS The majority of women, including women experiencing IPV, had positive responses to IPV screening during pregnancy. Future diffusion of IPV screening requires safe environments for IPV screening and improved awareness of health care providers towards IPV.
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Abbott PW, Gumusoglu SB, Bittle J, Beversdorf DQ, Stevens HE. Prenatal stress and genetic risk: How prenatal stress interacts with genetics to alter risk for psychiatric illness. Psychoneuroendocrinology 2018; 90:9-21. [PMID: 29407514 DOI: 10.1016/j.psyneuen.2018.01.019] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 01/20/2018] [Accepted: 01/21/2018] [Indexed: 02/07/2023]
Abstract
Risk for neuropsychiatric disorders is complex and includes an individual's internal genetic endowment and their environmental experiences and exposures. Embryonic development captures a particularly complex period, in which genetic and environmental factors can interact to contribute to risk. These environmental factors are incorporated differently into the embryonic brain than postnatal one. Here, we comprehensively review the human and animal model literature for studies that assess the interaction between genetic risks and one particular environmental exposure with strong and complex associations with neuropsychiatric outcomes-prenatal maternal stress. Gene-environment interaction has been demonstrated for stress occurring during childhood, adolescence, and adulthood. Additional work demonstrates that prenatal stress risk may be similarly complex. Animal model studies have begun to address some underlying mechanisms, including particular maternal or fetal genetic susceptibilities that interact with stress exposure and those that do not. More specifically, the genetic underpinnings of serotonin and dopamine signaling and stress physiology mechanisms have been shown to be particularly relevant to social, attentional, and internalizing behavioral changes, while other genetic factors have not, including some growth factor and hormone-related genes. Interactions have reflected both the diathesis-stress and differential susceptibility models. Maternal genetic factors have received less attention than those in offspring, but strongly modulate impacts of prenatal stress. Priorities for future research are investigating maternal response to distinct forms of stress and developing whole-genome methods to examine the contributions of genetic variants of both mothers and offspring, particularly including genes involved in neurodevelopment. This is a burgeoning field of research that will ultimately contribute not only to a broad understanding of psychiatric pathophysiology but also to efforts for personalized medicine.
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Affiliation(s)
- Parker W Abbott
- Department of Psychiatry, University of Iowa Carver College of Medicine, 1310 PBDB, 169 Newton Rd., Iowa City, IA, 52246, USA.
| | - Serena B Gumusoglu
- Department of Psychiatry, University of Iowa Carver College of Medicine, 1310 PBDB, 169 Newton Rd., Iowa City, IA, 52246, USA; Interdisciplinary Graduate Program in Neuroscience, University of Iowa, 356 Medical Research Center, Iowa City, IA, 52242, USA.
| | - Jada Bittle
- Department of Psychiatry, University of Iowa Carver College of Medicine, 1310 PBDB, 169 Newton Rd., Iowa City, IA, 52246, USA; Interdisciplinary Graduate Program in Neuroscience, University of Iowa, 356 Medical Research Center, Iowa City, IA, 52242, USA.
| | - David Q Beversdorf
- Interdisciplinary Neuroscience Program, Interdisciplinary Intercampus Research Program, Thompson Center for Autism and Neurodevelopment Disorders, Departments of Radiology, Neurology and Psychological Sciences, University of Missouri, Columbia, MO, USA.
| | - Hanna E Stevens
- Department of Psychiatry, University of Iowa Carver College of Medicine, 1310 PBDB, 169 Newton Rd., Iowa City, IA, 52246, USA; Interdisciplinary Graduate Program in Neuroscience, University of Iowa, 356 Medical Research Center, Iowa City, IA, 52242, USA; Iowa Neuroscience Institute, University of Iowa Carver College of Medicine, 2312 PBDB, 169 Newton Rd., Iowa City, IA, 52246, USA.
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46
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Intimate partner violence and pregnancy: epidemiology and impact. Am J Obstet Gynecol 2017; 217:141-144. [PMID: 28551446 DOI: 10.1016/j.ajog.2017.05.042] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/09/2017] [Accepted: 05/17/2017] [Indexed: 11/21/2022]
Abstract
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.
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