Abuse against women, depression, and infant morbidity: a primary care cohort study in Brazil

Intergenerational consequences of violence: violence during pregnancy as a risk factor for infection in infancy

Introduction

Psychosocial stress during pregnancy has long-lasting and important consequences in the following generations, as it can affect intrauterine development. The impact on the developing immune system is notoriously important due to the associated morbidity and mortality in the first years of life. Little attention has been given to the role of violence during pregnancy (VDP), especially its impact on infant infectious morbidity.

Methods

We analyzed data from two Brazilian birth cohorts (n = 2,847) in two distinct cities (Ribeirão Preto and São Luís), collected during pregnancy and at the beginning of the second year of life. The association between VDP and infection in infancy was analyzed with structural equation modeling, using the WHO-VAW questionnaire as exposure and a latent variable for infection as the outcome.

Results

VDP was reported by 2.48% (sexual), 11.56% (physical), and 45.90% (psychological) of the mothers. The models presented an adequate fit. In the city of São Luís, VDP was significantly associated with the latent construct for infection (standardized beta = 0.182; p = 0.022), while that was not the case for the Ribeirão Preto sample (standardized beta = 0.113; p = 0.113). Further analyses showed a gradient effect for the different dimensions of the exposure, from psychological to physical and sexual violence.

Conclusion

Our results suggest an association of VDP with infant morbidity in a poorer socioeconomic setting, and highlight the importance of considering the different dimensions of intimate partner violence. These findings may have important implications for the comprehension of global health inequalities and of the effects of gender-based violence.

Association between violence and depression during pregnancy with perinatal outcomes: a moderated mediation analysis

OBJECTIVE

To assess the direct, indirect, and total effects of violence during pregnancy on perinatal outcomes, and to evaluate the effect of violence as a moderator of the mediated relationship of depression with perinatal outcomes.

METHODS

Data was collected from the prenatal study and follow-ups of the BRISA cohort, São Luís, Maranhão, Brazil. The perinatal outcomes investigated were: birth weight (BW), intrauterine growth restriction (IUGR) and gestational age (GA). Violence against women was evaluated using the World Health Organization Violence against Women instrument (Violence during pregnancy - regardless of the type of violence; Physical violence during pregnancy; Psychological violence during pregnancy). Depressive symptoms during pregnancy were evaluated as a mediating variable. Moderated mediation analysis was performed to estimate the effects of violence and depression on perinatal outcomes.

RESULTS

Three types of violence analyzed by depression had an indirect effect in BW and GA. None of the types of violence showed an association with IUGR. All types of violence analyzed showed a moderated mediation effect with BW and GA. Only among women who experienced violence were birth weight and gestational age lower the higher the values of depressive symptoms.

CONCLUSION

Violence and depression are only associated with lower BW and GA when they occur simultaneously.

Screening for intimate partner violence in the early postpartum period: Maternal and child health and social outcomes from birth to 5-years post-delivery

BACKGROUND

Intimate partner violence (IPV) during pregnancy is a substantial public health concern, yet little is known about the developmental trajectory of these women and their children after birth.

OBJECTIVE

The objective was to examine maternal and child health as well as social outcomes from birth to 5-years post-delivery associated with a positive (vs. negative) maternal IPV screen around the time of delivery.

PARTICIPANTS AND SETTING

Manitoban women giving birth to a live singleton infant from January 1, 2003 to December 31, 2006 were followed from birth to 5-years post-delivery (analytic sample: N = 40,051).

METHODS

Administrative databases from the Manitoba Centre for Health Policy provided data for the study. Descriptive statistics and logistic regression were used to examine relationships between IPV screen response around the time of birth (i.e., current, or history of, violence between parenting partners) with maternal and child health as well as social outcomes.

RESULTS

Women screening positive for IPV had increased odds of diagnosed mood/anxiety disorders, personality disorders, substance use disorders, diabetes, respiratory morbidity, and intentional/non-intentional injury hospitalizations (adjusted odds ratio [AOR] range 1.81-5.59, p < .01). Children of women screening positive for IPV had increased odds of diagnosed attention deficit-hyperactivity disorder, lower respiratory infections, and injury hospitalizations (AOR range 1.53-2.00, p < .01), child welfare organization contact (AOR = 8.84, p <  .01), and of being more developmentally vulnerable at kindergarten across domains of functioning (AOR range 1.69-1.93, p <  .01) than children of mothers screening negative for IPV.

CONCLUSION

A positive IPV screen was associated with poorer maternal and child health, increased child and family services contact, and children being more developmentally vulnerable in the 5-years after delivery.

Intimate partner violence and childhood illnesses in Cambodia: a cross-sectional study

BACKGROUND

Around a quarter of Cambodian women reported being victim to intimate partner violence (IPV) from their current partner. Children's exposure to familial IPV impacts psychosocial well-being and emerging research indicates associations with physical health.

OBJECTIVE

Investigate associations between maternal experience of IPV and common childhood illnesses in Cambodia.

DESIGN, SETTING, PARTICIPANTS

Analysis of the Cambodia Demographic and Health Survey (2000, 2005, 2014) using logistic regression, including 5025 children under 5 years of age whose mothers responded to questions about experience of emotional, physical and sexual violence by current partner.

MAIN OUTCOME MEASURES

Report of diarrhoea, acute respiratory infection (ARI) or fever, respectively, in children in the two weeks preceding the survey.

RESULTS

Children of mothers with experience of any type of IPV had estimated elevated odds of diarrhoea (adjusted OR (aOR)=1.65, 95% CI 1.39 to 1.97), estimated odds of ARI (aOR=1.78, 95% CI 1.47 to 2.16) and estimated odds of fever (aOR=1.51, 95% CI 1.31 to 1.76) compared with children of mothers without reported IPV experience. Exposure to any form of IPV corresponded to an estimated 2.65 times higher odds (95% CI 2.01 to 3.51) for reporting having both diarrhoea and ARI.

CONCLUSIONS

Our findings support the notion that children's susceptibility to diarrhoea, ARI and fever may be affected by mothers' experience of IPV, including emotional violence. Maternal and child health programmes should train healthcare professionals to identify domestic violence and children at risk, and link victims to appropriate health and legal services.

The impact of a referral card-based intervention on intimate partner violence, psychosocial health, help-seeking and safety behaviour during pregnancy and postpartum: a randomized controlled trial

Background

We aimed to investigate the impact of a referral-based intervention in a prospective cohort of women disclosing intimate partner violence (IPV) on the prevalence of violence, and associated outcomes psychosocial health, help-seeking and safety behaviour during and after pregnancy.

Methods

Women seeking antenatal care in eleven Belgian hospitals were consecutively invited from June 2010 to October 2012, to participate in a single-blind randomized controlled trial (RCT) and handed a questionnaire. Participants willing to be interviewed and reporting IPV victimisation were randomised. In the Intervention Group (IG) participants received a referral card with contact details of services providing assistance and tips to increase safety behaviour. Participants in the Control Group (CG) received a “thank you” card. Follow-up data were obtained through telephone interview at an average of 10 months after receipt of the card.

Results

At follow-up (n = 189), 66.7% (n = 126) of the participants reported IPV victimisation. Over the study-period, the prevalence of IPV victimisation decreased by 31.4% (P < 0.001), psychosocial health increased significantly (5.4/140, P < 0.001), 23.8% (n = 46/193) of the women sought formal help, 70.5% (n = 136/193) sought informal help, and 31.3% (n = 60/192) took at least one safety measure. We observed no statistically significant differences between the IG and CG, however. Adjusted for psychosocial health at baseline, the perceived helpfulness of the referral card seemed to be larger in the IG. Both the questionnaire and the interview were perceived to be significantly more helpful than the referral card itself (P < 0.001).

Conclusions

Asking questions can be helpful even for types of IPV of low severity, although simply distributing a referral card may not qualify as the ideal intervention. Future interventions should be multifaceted, delineate different types of violence, controlling for measurement reactivity and designing a tailored intervention programme adjusted to the specific needs of couples experiencing IPV.

Trial registration

The trial was registered with the U.S. National Institutes of Health ClinicalTrials.gov registry on July 6, 2010 under identifier NCT01158690).

Electronic supplementary material

The online version of this article (10.1186/s12884-017-1519-x) contains supplementary material, which is available to authorized users.

Household Food Insecurity is Associated with Respiratory Infections Among 6-11-Month Old Infants in Rural Ghana

BACKGROUND

To determine the relationship between household food insecurity (HHFI) and symptoms of respiratory infections among infants in rural Ghana.

METHODS

The study was cross-sectional. The outcome variables were symptoms of respiratory infections (cough and nasal discharge) in infants. HHFI was measured using a 15-item modified U.S. Department of Agriculture (USDA) household food security module. Households were classified as food insecure if they had an affirmative answer for at least 1 item. Associations were examined using multiple logistic regression analysis. Data were collected in 32 communities located in 3 rural subdistricts in the Upper Manya Krobo district of the Eastern region of Ghana. The sample included 367 infants aged 6-11 months who attended a community-based growth monitoring session.

RESULTS

Overall, 20.5% of households reported experiencing food insecurity in the last month. Compared with infants in food secure households, infants living in food insecure households were about twice as likely to experience cough (adjusted odds ratio: 2.25, 95% confidence intervals: 1.25, 4.04) and nasal discharge (adjusted odds ratio: 1.87, 95% confidence intervals: 1.05, 3.36).

CONCLUSION

Infants living in food insecure households are at an increased risk of respiratory tract morbidity. Interventions that address HHFI might be important to improve infant health in rural Ghana.

Domestic violence and perinatal mental disorders: a systematic review and meta-analysis

BACKGROUND

Domestic violence in the perinatal period is associated with adverse obstetric outcomes, but evidence is limited on its association with perinatal mental disorders. We aimed to estimate the prevalence and odds of having experienced domestic violence among women with antenatal and postnatal mental disorders (depression and anxiety disorders including post-traumatic stress disorder [PTSD], eating disorders, and psychoses).

METHODS AND FINDINGS

We conducted a systematic review and meta-analysis (PROSPERO reference CRD42012002048). Data sources included searches of electronic databases (to 15 February 2013), hand searches, citation tracking, update of a review on victimisation and mental disorder, and expert recommendations. Included studies were peer-reviewed experimental or observational studies that reported on women aged 16 y or older, that assessed the prevalence and/or odds of having experienced domestic violence, and that assessed symptoms of perinatal mental disorder using a validated instrument. Two reviewers screened 1,125 full-text papers, extracted data, and independently appraised study quality. Odds ratios were pooled using meta-analysis. Sixty-seven papers were included. Pooled estimates from longitudinal studies suggest a 3-fold increase in the odds of high levels of depressive symptoms in the postnatal period after having experienced partner violence during pregnancy (odds ratio 3.1, 95% CI 2.7-3.6). Increased odds of having experienced domestic violence among women with high levels of depressive, anxiety, and PTSD symptoms in the antenatal and postnatal periods were consistently reported in cross-sectional studies. No studies were identified on eating disorders or puerperal psychosis. Analyses were limited because of study heterogeneity and lack of data on baseline symptoms, preventing clear findings on causal directionality.

CONCLUSIONS

High levels of symptoms of perinatal depression, anxiety, and PTSD are significantly associated with having experienced domestic violence. High-quality evidence is now needed on how maternity and mental health services should address domestic violence and improve health outcomes for women and their infants in the perinatal period.