Experience of sexual abuse in childhood and abortion in adolescence and early adulthood

Carrying an unintended pregnancy to term and long-term maternal psychological distress: Findings from the Dutch prospective Amsterdam Born Children and their Development study

BACKGROUND

Given the estimated high rate of unintended pregnancies, it is important to investigate long-term effects on psychological distress in women carrying an unintended pregnancy to term. However, research into associations between unintended pregnancies carried to term and psychological distress postpartum is mixed, and especially, evidence on long-term associations is scarce.

OBJECTIVE

To examine whether carrying an unintended pregnancy to term is associated with maternal psychological distress later in life, up to 12 years postpartum.

DESIGN

This study is based on the population-based birth cohort study 'Amsterdam Born Children and their Development' study, which included pregnant people in 2003 (n = 7784) and followed them up until 12 years postpartum.

METHODS

Unintended pregnancy was measured as a multidimensional construct, based on self-reported data around 16 weeks gestation on pregnancy mistiming, unwantedness and unhappiness. Symptoms of maternal psychological distress were assessed around 3 months, 5 years and 12 years postpartum using multiple questionnaires measuring symptoms of depression, anxiety and stress. Multiple structural equation modelling models were analysed, examining the associations between dimensions of unintended pregnancy and maternal psychological distress per time point, while controlling for important co-occurring risks.

RESULTS

Pregnancy mistiming and unhappiness were significant predictors of more maternal psychological distress around 3 months postpartum. Around 5 years postpartum, only pregnancy mistiming was positively associated with maternal psychological distress. Dimensions of unintended pregnancy were no longer associated with maternal psychological distress around 12 years postpartum. Strikingly, antenatal psychological distress was a much stronger predictor of maternal psychological distress than pregnancy intention dimensions.

CONCLUSION

Those who carried a more unintended pregnancy to term reported more symptoms of psychological distress at 3 months and 5 years postpartum. People carrying an unintended pregnancy to term may benefit from extra support, not because of the pregnancy intentions per se, but because they may be related to antenatal psychological distress.

Resilience among secondary school students in South-Western Nigeria; association with abuse and neglect

INTRODUCTION

Resilience, which aids coping and adjustment, prevents the development of mental health issues for individuals exposed to adversities. Abuse and neglect are some of the adversities that affect the health of adolescents. This study examined the relationship between abuse, neglect and resilience of adolescents.

METHODS

The study adopted a cross-sectional design among 522 secondary school adolescents using interviewer-administered semi-structured questionnaires. Information on socio-demographics, abuse, neglect and resilience were elicited. Associations were tested with significance set at 5%.

RESULTS

The mean age of respondents was 15.9 ± 1.5, 301 (57.7%) were females and 144 (27.6%) were from polygamous homes. Two hundred and forty-three (46.4%) had high resilience, 141 (27.0%) moderate resilience and 138 (26.6%) had low resilience. Psychological, physical and sexual abuse were reported among 238 (45.7%), 168 (32.1%) and 45 (8.6%) adolescents, respectively, while 71 (13.6%) and 134 (25.8%) experienced psychological and physical neglect, respectively. Adolescents who experienced physical abuse and sexual abuse were about 2 and 2.5 times less likely, respectively, to have high resilience than those who did not experience physical and sexual abuse.

CONCLUSION

Abuse and neglect negatively influence resilience of adolescents. Interventions targeted at reducing abuse and neglect should be incorporated in adolescent health protocols to increase their resilience.

Long-term incidence and recurrence of common mental disorders after abortion. A Dutch prospective cohort study

In a previous study (Van Ditzhuijzen et al., 2017) we investigated the incidence and recurrence of mental disorders 2.5 to 3 years post-abortion. The aim of the current study was to extend these findings with longer term follow up data, up until 5-6 years post-abortion. We compared data of women who had had an abortion of the Dutch Abortion and Mental Health Study (DAMHS) to women who did not have an abortion from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2) (N_total = 2227). We used 1-to-1 matching on background confounding variables and measured post-abortion incidence and recurrence of common DSM-IV mental disorders (mood, anxiety, and substance use disorders) using the Composite International Diagnostic Interview (CIDI) version 3.0. After matching on confounding variables, abortion did not increase the likelihood that women had incident or recurrent mental disorders in the 5-6 years post-abortion (any incident mental disorder: OR = 3.66, p = .16; any recurrent mental disorder: OR = 0.22, p = .47). We found no evidence that experiencing an abortion increases the risk on new or recurrent mental disorders on the longer term.

Cost Effectiveness of a School Readiness Intervention for Foster Children

OBJECTIVE

Many young children in foster care suffer from emotional and behavior problems due to neglect and abuse. These problems can lead to difficulties in school, and functioning in school is linked to long-term health and development. Early intervention to reduce emotional and behavioral issues can help children successfully transition to school, which can improve long-term outcomes. However, communities need information on relative costs and benefits associated with programs to make informed choices. The objective of this study was to assess cost effectiveness, over 12 months, of the Kids in Transition to School (KITS) intervention compared to usual services available to children in a foster care control group (FCC).

METHOD

Randomized controlled trial of 192 children in foster care entering kindergarten who were randomized to KITS (n = 102) or FCC (n = 90). KITS includes school readiness groups and parent training over 4 months. Main outcomes were days free from internalizing symptoms (IFD), days free from externalizing behavior (EFD), intervention costs, public agency costs, and incremental cost effectiveness.

RESULTS

KITS significantly increased IFD and EFD compared to FCC. Average total cost of the intervention was $932 per family. The intervention did not significantly impact usual services. Average incremental cost effectiveness was $64 per IFD and $63 per EFD.

CONCLUSIONS

The cost of KITS is comparable to, or less than, similar programs, and the intervention is likely to provide significant emotional and behavioral benefits and improvements in school readiness for young children in foster care.

Correlates of Common Mental Disorders Among Dutch Women Who Have Had an Abortion: A Longitudinal Cohort Study

CONTEXT

Credible research has not found any evidence that abortion causes mental disorders. It is not known, however, whether abortion-specific risk indicators and other variables are associated with the incidence or recurrence of mental disorders after abortion.

METHODS

As part of a prospective cohort study conducted in the Netherlands, 325 women were interviewed between April 2010 and January 2011, between 20 and 40 days after having an abortion; 264 were followed up an average of 2.7 years later. Associations between selected baseline variables and postabortion incident or recurrent mental disorders among the 199 women at risk were investigated using bivariate and multivariate logistic regression analyses.

RESULTS

Thirty-two percent of women at risk of an incident or recurrent mental disorder experienced one after the abortion. In multivariate analyses, no abortion-related variables (e.g., history of multiple abortions, second-trimester abortion, preabortion decision difficulty or uncertainty, and postabortion negative emotions) were associated with experience of any postabortion incident or recurrent mental disorders. The outcome was positively associated with having conceived within an unstable relationship (odds ratio, 3.0), number of negative life events in the past year (1.4) and having a history of mental disorders (2.4).

CONCLUSIONS

Correlates of postabortion mental disorders were variables that have been identified as general risk factors for mental disorders, which supports the idea that abortion does not pose specific risks to future mental health. Future research should investigate in what way unstable relationships, adverse life events and psychiatric history affect postabortion mental health.

Incarceration and exposure to internally displaced persons camps associated with reproductive rights abuses among sex workers in northern Uganda

BACKGROUND

While female sex workers (FSWs) face a high burden of violence and criminalisation, coupled with low access to safe, non-coercive care, little is known about such experiences among FSWs in conflict-affected settings, particularly as they relate to sexual and reproductive health (SRH) and rights. We explored factors associated with lifetime abortions among FSWs in northern Uganda; and separately modelled the independent effect of lifetime exposures to incarceration and living in internally displaced persons (IDP) camps on coerced and unsafe abortions.

METHODS

Analyses are based on a community-based cross-sectional research project in Gulu District, northern Uganda (2011-2012) with The AIDS Support Organization (TASO) Gulu, FSWs, and other community organisations. We conducted questionnaires, sex worker/community-led outreach to sex work venues, and voluntary HIV testing by TASO.

RESULTS

Of 400 FSWs, 62 had ever accessed an abortion. In a multivariable model, gendered violence, both childhood mistreatment/or abuse at home [adjusted odds ratio (AOR) 1.96; 95% confidence interval (95% CI) 0.99-3.90] and workplace violence by clients (AOR 3.57; 95% CI 1.31-9.72) were linked to increased experiences of abortion. Lifetime exposure to incarceration retained an independent effect on increased odds of coerced abortion (AOR 5.16; 95% CI 1.39-19.11), and living in IDP camps was positively associated with unsafe abortion (AOR 4.71; 95% CI 1.42-15.61).

DISCUSSION AND CONCLUSIONS

These results suggest a critical need for removal of legal and social barriers to realising the SRH rights of all women, and ensuring safe, voluntary access to reproductive choice for marginalised and criminalised populations of FSWs.

Trajectories of psychopathology and risky behaviors associated with childhood abuse and neglect in low-income urban African American girls

The current study examined patterns of psychopathology, drug and alcohol use, and sexual behavior associated with childhood abuse and neglect in a high-risk sample of low-income African American girls seeking mental health treatment. Participants (N=177) were African American girls recruited from mental health clinics serving low-income communities in Chicago, IL and followed over six waves of data collection (T1-T6) reflecting early (mean age 14) to late (mean age 17) adolescence. Child abuse and neglect history was determined from adolescent and caregiver reports. Latent curve modeling examined patterns of internalizing and externalizing psychopathology, drug and alcohol use, sexual experience, and risky sexual behavior reported by girls and associations with reported child abuse and neglect. Overall, these trajectories indicated a decrease in internalizing and externalizing symptoms, stability of drug and alcohol use, and an increase in sexual experience and risky sexual behaviors over time. Child abuse and neglect was associated with increased internalizing symptoms and sexual experience at baseline and with externalizing symptoms and risky sexual behavior both at baseline and the final point. Child abuse and neglect was not significantly associated with alcohol or drug use. This study adds to the literature on the long-term consequences of child abuse and neglect by demonstrating patterns of psychopathology and risky behavior that persist over time in a high-risk group of girls with self or parent reported histories of abuse and neglect. Interventions that address externalizing problems and health risk behaviors may be of particular importance for this population.

Adverse childhood experiences influence development of pain during pregnancy

Objective

To investigate the association between adverse childhood experiences (ACE) and pain with onset during pregnancy.

Design

Cross‐sectional study.

Setting

Eighteen antenatal clinics in southern Mid‐Sweden.

Sample

Of 293 women invited to participate, 232 (79%) women agreed to participate in early pregnancy and were assessed in late pregnancy.

Methods

Questionnaires were distributed in early and late pregnancy. The questionnaires sought information on socio‐demography, ACE, pain location by pain drawing and pain intensity by visual analogue scales. Distribution of pain was coded in 41 predetermined areas.

Main outcome measures

Pain in third trimester with onset during present pregnancy: intensity, location and number of pain locations.

Results

In late pregnancy, 62% of the women reported any ACE and 72% reported any pain location with onset during the present pregnancy. Among women reporting any ACE the median pain intensity was higher compared with women without such an experience (p = 0.01). The accumulated ACE displayed a positive association with the number of reported pain locations in late pregnancy (r_s = 0.19, p = 0.02). This association remained significant after adjusting for background factors in multiple regression analysis (p = 0.01). When ACE was dichotomized the prevalence of pain did not differ between women with and without ACE. The subgroup of women reporting physical abuse as a child reported a higher prevalence of sacral and pelvic pain (p = 0.0003 and p = 0.02, respectively).

Conclusions

Adverse childhood experiences were associated with higher pain intensities and larger pain distributions in late pregnancy, which are risk factors for transition to chronic pain postpartum.

The role of stress, depression, and violence on unintended pregnancy among young urban women

BACKGROUND

Unintended pregnancy (UP) is common, particularly among women exposed to violence, and it is linked to adverse maternal and child outcomes. This study investigated the potential role of current depressive symptoms, social support, and psychosocial stress in moderating the association between violence exposure and UP.

METHODS

Pregnant women, being treated at an urban Emergency Room, completed a self-reported baseline interview where pregnancy intention as well as depression symptoms, perceived stress, past and current violence, and demographic factors were evaluated.

RESULTS

Pregnant women were identified among women aged 14-40 years presenting to an urban emergency department. Women reporting sadness or planning to terminate the pregnancy were classified as having an UP. A higher number of women reported an UP if they had at least one episode of childhood sexual assault (CSA) (odds ration [OR]=1.39, 95% confidence interval [CI]: 1.03-1.87), but this association disappeared after adjusting for socioeconomic factors. Relative to women reporting an intended pregnancy, women reporting sadness or wanting to abort the pregnancy reported lower social support (mean number of friends 2.5 vs. 3.0, p=0.005), had a higher prevalence of current depressive symptoms (67% vs. 49%, OR=2.14, 95% CI: 1.72-2.66), and had higher mean levels of current perceived stress (6.9 vs. 5.6, p<0.001). At least one episode of CSA and current depressive symptoms was positively associated with the report of sadness or wanting to abort the pregnancy relative to women with no depressive symptoms and no history of CSA. In addition, high level of stress positively moderated the role of CSA and reporting sadness or wanting to abort the pregnancy.

CONCLUSION

Ongoing screening for depressive symptoms and stress among female survivors of CSA may be important in reducing the high rates of unintended pregnancy in urban communities.

Childhood adversities and subsequent risk of one or multiple abortions

Although many studies have found an association between childhood adversities and mental health disorders, few have examined whether childhood adversities are linked to having abortions. This research investigates the association between a range of childhood adversities and risk of abortion in part to identify which adversities should be considered when examining the association between abortion and subsequent mental health. Using the U.S. National Comorbidity Survey-Replication (NCS-R), we tested the association between 10 childhood adversities and risk of 0, 1, or multiple abortions among 1511 women ages 18-41. We employed multinomial logistic regression to examine the independent association between each childhood adversity and number of subsequent abortions, controlling for sociodemographic factors, total number of pregnancies, and each adversity. Women who had experienced two or more personal safety threats, one parental mental illness, or two or more parental mental illnesses while growing up were more likely subsequently to have multiple versus no abortions [Relative Risk Ratio (RRR) = 9.87, 95% CI: 2.45-39.72; OR = 2.81, 95% CI: 1.27-6.21; RRR = 5.28, 95% CI: 1.60-17.38, respectively], and multiple versus one abortion [RRR = 13.33, 95% CI: 2.48-71.68; RRR = 2.17, 95% CI: 1.03-4.56; RRR = 3.67, 95% CI: 1.15-11.76, respectively]. Women who had experienced childhood physical abuse were more likely to have one compared to no abortions [RRR = 2.00; 1.19-3.34]. These results suggest that some childhood adversities may partially explain the association between abortion and mental health. Accordingly, they should be considered in future research examining the link between abortion and mental health.