Perinatal status and help-seeking for intimate partner violence

Care of the Postpartum Patient in the Emergency Department: A Systematic Review with Implications for Maternal Mortality

OBJECTIVE

Approximately one-third of maternal deaths occur postpartum. Little is known about the intersection between the postpartum period, emergency department (ED) use, and opportunities to reduce maternal mortality. The primary objectives of this systematic review are to explore the incidence of postpartum ED use, identify postpartum disease states that are evaluated in the ED, and summarize postpartum ED use by race/ethnicity and payor source.

STUDY DESIGN

We searched PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), ClinicalTrials.gov, Cochrane CENTRAL, Social Services Abstracts, and Scopus from inception to September 19, 2019. Each identified abstract was screened by two authors; the full-text manuscripts of all studies deemed to be potential candidates were then reviewed by the same two authors and included if they were full-text, peer-reviewed articles in the English language with primary patient data reporting care of a female in the ED in the postpartum period, defined as up to 1 year after the end of pregnancy.

RESULTS

A total of 620 were screened, 354 records were excluded and 266 full-text articles were reviewed. Of the 266 full-text articles, 178 were included in the systematic review; of these, 108 were case reports. Incidence of ED use by postpartum females varied from 4.8 to 12.2% in the general population. Infection was the most common reason for postpartum ED evaluation. Young females of minority race and those with public insurance were more likely than whites and those with private insurance to use the ED.

CONCLUSION

As many as 12% of postpartum women seek care in the ED. Young minority women of lower socioeconomic status are more likely to use the ED. Since approximately one-third of maternal deaths occur in the postpartum period, successful efforts to reduce maternal mortality must include ED stakeholders. This study is registered with the Systematic Review Registration (identifier: CRD42020151126).

KEY POINTS

· Up to 12% of postpartum women seek care in the ED.. · One-third of maternal deaths occur postpartum.. · Maternal mortality reduction efforts should include ED stakeholders..

Characteristics of Women Presenting at the Emergency Department Who Choose Not to Disclose Being Subjected to Intimate Partner Violence

Literature suggests that some women refrain from disclosing being subjected to intimate partner violence (IPV) upon their contact with the health care system. Such disclosure becomes critical when the violence compels women to seek urgent medical care. The purpose of the present study was to compare characteristics of women who disclose and women who do not disclose being subjected to domestic violence, when presenting at the Emergency Department (ED). In this chart review study, characteristics of 56 randomly sampled women who disclosed and 50 who did not disclose being subjected to domestic violence, when presenting at the ED in a medical center located in central-northern Israel between 2015 and 2018, were compared. It was found that women who did not disclose were more likely to be pregnant, legally defined as helpless, and dependent on others to some extent. In addition, they were more likely to be hospitalized, which may indicate a more severe injury, and were more likely to have been subjected to psychological abuse or neglect alone. A trauma informed approach should guide specific interventions with a focus on women with these characteristics in the ED, in order to facilitate their disclosure of IPV.

The Association Between Intimate Partner Violence and 30-Year Cardiovascular Disease Risk Among Young Adult Women

Intimate partner violence (IPV), the physical, sexual, psychological abuse or control by a former or current intimate partner, affects almost one third of women in the United States. IPV exposure can result in many negative outcomes including physical injury, increased stress, and depression. Currently, there is a growing body of literature examining the link between IPV victimization and poor heart health. However, there is little known on how IPV affects cardiovascular disease (CVD) risk among young adult women and what outcomes associated with IPV victimization may be increasing this risk. A secondary analysis of the National Longitudinal Study of Adolescent to Adult Health (Add Health) was conducted to examine the association between past-year IPV exposure and 30-year CVD risk score among a representative sample of young adult women in the United States. Regression analyses were run to examine the relationship between IPV and 30-year CVD risk score. The results of the bivariate analyses suggested that past-year IPV exposure may have a small but significant impact on 30-year CVD risk score; however, this finding becomes insignificant when important covariates are introduced into the model highlighting the complexity of IPV and its co-occurring phenomenon. The findings of this study reveal that 30-year CVD risk in the context of IPV victimization should continue to be examined in this population as CVD risk may continue to grow as one experiences IPV. Future research should examine possible mediating factors in this relationship as well as biological markers that may help better understand this relationship.

The impact of intimate partner violence, depressive symptoms, alcohol dependence, and perceived stress on 30-year cardiovascular disease risk among young adult women: A multiple mediation analysis

Intimate partner violence (IPV), the physical, sexual, psychological abuse or control by a former or current intimate partner, affects almost one-third of women in the United States. IPV exposure can result in many negative outcomes including physical injury, increased stress, and depression. Currently, there is a small, but, growing body of literature examining the link between IPV victimization and increased cardiovascular disease (CVD) risk among young adult women. To better prevent this negative outcome, it is imperative to understand what factors associated with IPV victimization may be increasing this risk. A secondary analysis of Wave IV of the Add Health study was conducted to examine possible factors mediating past year IPV exposure and 30-year CVD risk score including perceived stress, depressive symptoms, and alcohol dependence among a representative sample of young adult women in the United States. Multiple mediation analyses were run to examine the possible mediating factors in the relationship between IPV and CVD risk. In a multiple mediation model, the indirect effect of perceived stress became insignificant when depressive symptoms were introduced. The findings of this study reveal that 30-year CVD risk in the context of IPV victimization should continue to be examined among this population. The mediation models suggested the importance of stress and depression in the context of IPV and heart health. Screening for depression among women exposed to IPV should be considered as an important intervention point, not only to mitigate mental health issues, but to also help prevent the development of cardiovascular disease.

Help-seeking patterns among women experiencing intimate partner violence: do they forgo the criminal justice system if their adjudication wishes are not met?

Following a criminal case disposition, an intimate partner violence (IPV) victim's willingness to seek future police and prosecutorial assistance may depend on her prior experiences within the system. This longitudinal study examines the relationship between IPV victims' future help-seeking based on past experiences. We hypothesized women would return to the criminal justice system if their adjudication wishes corresponded with prosecutors' actions. Contrary to the hypothesis, results suggest women return to the criminal system and other venues even if prosecutors' actions do not correspond to their earlier stated wishes. This has important policy implications given pro-prosecution protocols that encourage adjudication regardless of a woman's participation.

Emergency medicine public health research funded by federal agencies: progress and priorities

The emergency department (ED) visit provides an opportunity to impact the health of the public throughout the entire spectrum of care, from prevention to treatment. As the federal government has a vested interest in funding research and providing programmatic opportunities that promote the health of the public, emergency medicine (EM) is prime to develop a research agenda to advance the field. EM researchers need to be aware of federal funding opportunities, which entails an understanding of the organizational structure of the federal agencies that fund medical research, and the rules and regulations governing applications for grants. Additionally, there are numerous funding streams outside of the National Institutes of Health (NIH; the primary federal health research agency). EM researchers should seek funding from agencies according to each agency's mission and aims. Finally, while funds from the Department of Health and Human Services (HHS) are an important source of support for EM research, we need to look beyond traditional sources and appeal to other agencies with a vested interest in promoting public health in EDs. EM requires a broad skill set from a multitude of medical disciplines, and conducting research in the field will require looking for funding opportunities in a variety of traditional and not so traditional places within and without the federal government. The following is the discussion of a moderated session at the 2009 Academic Emergency Medicine consensus conference that included panel discussants from the National Institutes of Mental Health, Drug Abuse, and Alcoholism and Alcohol Abuse and the Centers for Disease Control and Prevention (CDC). Further information is also provided to discuss those agencies and centers not represented.