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Ikram N, Frost A, LeMasters K, Hagaman A, Baranov V, Gallis J, Sikander S, Scherer E, Maselko J. Adverse childhood experiences and implications of perceived stress, anxiety and cortisol among women in Pakistan: a cross-sectional study. BMJ Open 2022; 12:e052280. [PMID: 35428618 PMCID: PMC9014037 DOI: 10.1136/bmjopen-2021-052280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Adverse childhood experiences (ACEs) are linked to poor maternal mental health. The goal of this study is to examine the associations between ACEs and multiple manifestations of stress (including perceived stress, anxiety and cortisol) among mothers in rural Pakistan. DESIGN This study used a cross-sectional design. Mothers were originally recruited during their third trimester of pregnancy and followed until 36 months post partum. Cortisol was collected at 12 months post partum, and self-report data were collected at 36 months post partum. SETTING All participants reside in rural villages in Rawalpindi, Pakistan. The measures were administered at home visits by field interviewers. PARTICIPANTS Data were collected from 889 mothers. All mothers in the sample provided data on ACEs and perceived stress, 623 provided data on anxiety and 90 provided hair cortisol. PRIMARY AND SECONDARY OUTCOMES MEASURES ACEs were captured retrospectively using an adapted version of the ACE International Questionnaire, and represented as a continuous variable and subdomains (neglect, home violence, family psychological distress, community violence). Primary outcomes included perceived stress measured with the Cohen Perceived Stress Scale (PSS) and anxiety measured with the Generalised Anxiety Disorder-7 scale (GAD-7). Hair-derived cortisol was included as a secondary outcome. Generalised linear models with cluster-robust SEs were used to estimate associations between ACEs and the outcome variables. RESULTS All models featured positive associations between ACE items and PSS. The continuous total ACE score (B=0.4; 95% CI 0.0 to 0.8) was associated with higher anxiety symptoms on the GAD-7. Home violence (B=6.7; 95% CI 2.7 to 10.8) and community violence (B=7.5; 95% CI 1.4 to 13.6) were associated with increased hair cortisol production. CONCLUSIONS All four ACE domains were associated with elevated levels of perceived stress, anxiety and cortisol, with varying precision and strength of estimates, indicating that the type of ACE has a differential impact. This study informed our understanding of the differential impact of specific ACEs on perceived stress, anxiety and hypothalamic pituitary adrenal-axis functioning, providing implications for future clinical intervention and research development.
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Affiliation(s)
- Naira Ikram
- Department of Program II, Duke University, Durham, North Carolina, USA
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Allison Frost
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Katherine LeMasters
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ashley Hagaman
- Department of Social and Behavioral Sciences, Yale University, New Haven, Connecticut, USA
| | - Victoria Baranov
- Department of Economics, University of Melbourne, Melbourne, Victoria, Australia
| | - John Gallis
- Department of Biostatistics & Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Siham Sikander
- Department of Public Health, Human Development Research Foundation, Islamabad, Pakistan
| | - Elissa Scherer
- RTI International, Research Triangle Park, North Carolina, USA
| | - Joanna Maselko
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
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Dawson DN, Volpe VV, Laurent HK. Synergistic Effects of Psychological Intimate Partner Violence Exposure and Gender Discrimination on Postnatal Mental Health Trajectories. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP8907-NP8932. [PMID: 31057035 DOI: 10.1177/0886260519844274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
While the literature examining physical intimate partner violence (IPV) is extensive, the impact of psychological IPV on mental health during high-risk times such as the period following childbirth is not well understood. The current study examined associations between psychological IPV and the course and severity of women's postnatal mental health symptoms (depression, anxiety, and trauma symptoms). Both main effects of psychological IPV exposure and possible exacerbation by broader social victimization (i.e., gender discrimination) were considered. Participants were 76 mothers from a larger longitudinal study, who completed self-report measures of IPV, gender discrimination, and affective symptoms at 3, 6, 12, and 18 months postnatal. Hierarchical linear modeling revealed a main effect of psychological IPV on the course of trauma symptoms only. As hypothesized, gender discrimination moderated the effect of psychological IPV on all symptom trajectories in a synergistic manner. At moderate to high levels of gender discrimination only, psychological IPV predicted higher affective symptom severity and an escalating course of postnatal anxiety symptoms. These findings underscore the importance of expanding current conceptualizations of IPV impacts to incorporate relevant aspects of individuals' social-ecological context. Future directions and implications for prevention and intervention are discussed.
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St Ivany A, Schminkey DL, Munro-Kramer ML. Acquired Brain Injuries and Intimate Partner Violence: A Situational Analysis of Help Seeking Barriers in Rural Northern New England. Glob Qual Nurs Res 2021; 8:23333936211008163. [PMID: 33912624 PMCID: PMC8047928 DOI: 10.1177/23333936211008163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 03/12/2021] [Accepted: 03/18/2021] [Indexed: 11/10/2022] Open
Abstract
Nurses care for women experiencing non-fatal strangulation and acquired brain injuries whether or not it is disclosed. Situational analysis was used to analyze 23 interviews from Northern New England with survivors, healthcare workers, and violence/legal advocates to explore overlapping relationships between violence, acquired brain injuries, non-fatal strangulation, and seeking care. Findings included the concepts of paying social consequences and the normalization of violence. Non-fatal strangulation was described as increasingly related to violence and other areas. Repetitive acquired brain injuries can impair functioning needed to address violence and healthcare providers and advocates are generally unaware of the impact of acquired brain injuries. A lack of resources, training, and tools for acquired brain injury screening were barriers in recognizing and responding to it, causing hidden symptoms. This study adds to the literature examining intimate partner violence in rural areas; specifically intimate partner violence-related acquired brain injuries in rural areas.
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Santas G, Santas F, Eryurt MA. Domestic Violence and Healthcare Utilization in Turkey. SOCIAL WORK IN PUBLIC HEALTH 2020; 35:125-136. [PMID: 32268847 DOI: 10.1080/19371918.2020.1749748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This study aims to analyze the prevalence of domestic violence, the level, and determinants of healthcare utilization of women exposed to violence and the satisfaction from the behaviors of health personnel. The data source of this study is the 2014 Research on Domestic Violence against Women in Turkey which was carried out with Hacettepe University Institute of Population Studies and Ministry of Family and Social Policies in Turkey. The research has a nationally representative sample of 7462 women aged 15-59. Logistic regression analysis was performed to determine the effect of the basic characteristics of women on receiving healthcare due to violence. In this study, the rate of women receiving healthcare was 63%. Women who were unemployed have no health insurance, live in low wealth level, in rural areas, and the Eastern region had used healthcare services at a lower level.
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Affiliation(s)
- Gulcan Santas
- Faculty of Economics & Administrative Science Department of Health Management Yozgat, Yozgat Bozok University, Yozgat, Turkey
| | - Fatih Santas
- Institute of Population Studies, Hacettepe University, Ankara, Turkey
| | - Mehmet Ali Eryurt
- Institute of Population Studies, Hacettepe University, Ankara, Turkey
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Abstract
PURPOSE The aim of this study was to characterize nursing care provided by the research nurses from the Baby Behavioral Educational Enhancement of Pregnancy (Baby BEEP) study as they delivered a telephone social support intervention to low-income, pregnant women in the Midwestern United States. STUDY DESIGN AND METHODS This was a descriptive qualitative study that used Peplau's Theory of Interpersonal Relations to frame and interpret the analysis. RESULTS Research nurses from the Baby BEEP study found a novel way to reach a vulnerable population through weekly telephone interactions. Acting in several of Peplau's nursing roles, the care they provided led to a remarkable retention rate and therapeutic nurse-patient relationships. The Baby BEEP study demonstrated the provision of a well-received psychosocial support intervention that can be used to help underserved women throughout pregnancy. CLINICAL IMPLICATIONS Telenursing care provided to low-income, rural women was well received and reflected the principles in Peplau's Theory of Interpersonal Relations. Nurses may use this type of nursing care to support women who are difficult to reach and typically experience low levels of support. This article describes the nursing care provided by the Baby BEEP nurses and provides a model for future, novel approaches to social support in a vulnerable and difficult-to-reach population.
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Shannon L, Nash S, Jackson A. Examining Intimate Partner Violence and Health Factors Among Rural Appalachian Pregnant Women. JOURNAL OF INTERPERSONAL VIOLENCE 2016; 31:2622-40. [PMID: 25846757 DOI: 10.1177/0886260515579508] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Among pregnant women, intimate partner violence (IPV) is recognized as a critical risk factor in adverse health outcomes for the mother and newborn alike. This pilot study examined IPV and health for rural Appalachian pregnant women, a particularly vulnerable high-risk and high-needs group. Participants were 77 rural, Appalachian pregnant women entering a hospital-based inpatient detoxification unit primarily for Opiate Dependence. Study participants gave informed consent to a face-to-face interview and secondary data abstraction from hospital medical records. IPV was measured via questions from the National Violence Against Women Survey, the Revised Conflict Tactics Scale (CTS2), and the Psychological Maltreatment of Women Inventory (PMWI). The majority of the sample reported lifetime psychological (89.6%) and physical (64.9%) violence. A little over three fourths (75.3%) experienced IPV in the past year. Furthermore, over one third (39.0%) experienced stalking, physical, or sexual violence in the past year. Most participants (71.4%) experienced psychological abuse in the past year. IPV experiences, in conjunction with pervasive substance use, mental and physical health problems, and poverty present in rural Appalachia, culminate in a particularly high-risk and high-needs group of pregnant women. These women present unique opportunities and challenges for prevention, intervention, and treatment.
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Roush K, Kurth A. The Lived Experience of Intimate Partner Violence in the Rural Setting. J Obstet Gynecol Neonatal Nurs 2016; 45:308-19. [PMID: 27080910 DOI: 10.1016/j.jogn.2016.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2016] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To understand the lived experience of intimate partner violence (IPV) for women living in a rural setting to inform efforts to provide effective care, support, and resources. DESIGN Qualitative descriptive. SETTING Adirondack Mountain region of upstate New York. PARTICIPANTS Twelve women with recent experiences of IPV living in a rural area. METHODS In-depth interviews were conducted. RESULTS Key findings were the self-imposed isolation women engage in to manage stigma and the system-wide abuse by law enforcement and the legal system. CONCLUSION The results of this study illustrate the complex web of individual, social, cultural, economic, and political factors that create and perpetuate the problem of IPV. It is critical to eliminate IPV-related stigma, cut through isolation, and address the ongoing system-wide abuse and discrimination women face. Finally, many of the issues raised by the participants, such as discrimination, financial constraints, and problems with the legal system, originate outside the health care system. Therefore, nursing care must be provided as part of a comprehensive public health approach.
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Shneyderman Y, Kiely M. Intimate partner violence during pregnancy: victim or perpetrator? Does it make a difference? BJOG 2013; 120:1375-85. [PMID: 23786367 PMCID: PMC3775877 DOI: 10.1111/1471-0528.12357] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To differentiate between forms of intimate partner violence (IPV) (victim only, perpetrator only, or participating in reciprocal violence) and examine risk profiles and pregnancy outcomes. DESIGN Prospective. SETTING Washington, DC, July 2001 to October 2003. SAMPLE A total of 1044 high-risk African-American pregnant women who participated in a randomised controlled trial to address IPV, depression, smoking and environmental tobacco smoke exposure. METHODS Multivariable linear and logistic regression. MAIN OUTCOME MEASURES Low and very low birthweight, preterm and very preterm birth. RESULTS Five percent of women were victims only, 12% were perpetrators only, 27% participated in reciprocal violence and 55% reported no IPV. Women reporting reciprocal violence in the past year were more likely to drink, use illicit drugs and experience environmental tobacco smoke exposure and were less likely to be very happy about their pregnancies. Women reporting any type of IPV were more likely to be depressed than those reporting no IPV. Women experiencing reciprocal violence reported the highest levels of depression. Women who were victims of IPV were more likely to give birth prematurely and deliver low-birthweight and very-low-birthweight infants. CONCLUSIONS We conclude that women were at highest risk for pregnancy risk factors when they participated in reciprocal violence and so might be at higher risk for long-term consequences, but women who were victims of IPV were more likely to show proximal negative outcomes like preterm birth and low birthweight infants. Different types of interventions may be needed for these two forms of IPV.
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Affiliation(s)
- Yuliya Shneyderman
- Borough of Manhattan Community College, City University of New York, New York, NY
| | - Michele Kiely
- Eunice Kennedy Shriver National Institute of Child Health and Human Development/NIH/DHHS, Rockville, MD
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Bloom TL, Bullock LFC, Parsons L. Rural pregnant women's stressors and priorities for stress reduction. Issues Ment Health Nurs 2012; 33:813-9. [PMID: 23215982 DOI: 10.3109/01612840.2012.712087] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Rural residence and maternal stress are risk factors for adverse maternal-child health outcomes across the globe, but rural women have been largely overlooked in maternal stress research. We recruited low-income, rural pregnant women for qualitative interviews to explore their stress exposures during pregnancy, reactions to stress, and priorities for stress reduction. We also used quantitative measures (Perceived Stress Scale, Center for Epidemiologic Studies of Depression Scale-Revised, Posttraumatic Stress Disorder Checklist-Civilian, Lifetime Exposure to Violence Scale) to describe stress exposures and reactions. We interviewed 24 pregnant rural women from a Midwestern US state, who were primarily young, white, partnered, and unemployed. Women's predominant stressor was financial stress, compounded by a lack of employment, transportation, and affordable housing options; extended family interdependence; small-town gossip; isolation/loneliness; and boredom. Quantitative measures revealed high levels of global perceived stress, violence exposure, and symptoms of depression and posttraumatic stress disorder among the sample. Women most commonly reported that employment and interventions to increase their employability would most effectively decrease their stress, but faced numerous barriers to education or job training. Tested maternal stress interventions to date include nurse-case management, teaching women stress management techniques, and mind-body interventions. Pregnant women's own priorities for stress-reduction intervention may differ, depending on the population under study. Our findings suggest that rural clinicians should address maternal stress, violence exposure, and mental health symptoms in prenatal care visits and that clinicians and researchers should include the voices of rural women in the conceptualization, design, implementation, and evaluation of maternal stress-reduction interventions.
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Affiliation(s)
- Tina L Bloom
- University of Missouri, Sinclair School of Nursing, Columbia, MO 65211, USA.
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Engnes K, Lidén E, Lundgren I. Women's experiences of important others in a pregnancy dominated by intimate partner violence. Scand J Caring Sci 2012; 27:643-50. [PMID: 22998026 DOI: 10.1111/j.1471-6712.2012.01073.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Being exposed to intimate partner violence (IPV) during pregnancy is a difficult and complex situation. Despite this, there are few studies describing women's own needs for help and support. AIM The aim of this study is to gain a deeper understanding of women's experiences of important others in relation to changing their life situation in a pregnancy dominated by IPV. METHODS The study has a qualitative phenomenological design. The data were collected through in-depth interviews with seven Norwegian women, who were exposed to IPV during pregnancy. FINDINGS Being pregnant and exposed to violence in relation to important others means confronting present life, life history and future life. The essence implies striving for control in an uncontrolled situation, where other people might be experienced as both a rescuer and a risk. This is further described in four constitutions: the child needs protection; my mother is always present for me; an exhausted run for help; and a reduced, but important social network. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE For women exposed to violence, pregnancy can offer an opportunity for change. Midwives play a unique role in relation to care and continuity in this phase of life, as they can support pregnant women, help to identify their needs, possibilities for action and advise them about appropriate services. Midwives can encourage and support women to find people whom they can trust and who can offer assistance. It is vital that midwives ask about the women's relationship to the baby and their social networks, especially the relationship with their mothers. Ethical considerations: During the whole study process, guidelines for research on violence against women were followed, to respect the integrity, security and confidentiality of the participants. The study is ethically approved.
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Affiliation(s)
- Kristin Engnes
- Centre for Women's, Family and Child Health, Faculty of Health Sciences, Vestfold, Norway.
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Engnes K, Lidén E, Lundgren I. Experiences of being exposed to intimate partner violence during pregnancy. Int J Qual Stud Health Well-being 2012; 7:QHW-7-11199. [PMID: 22468147 PMCID: PMC3313778 DOI: 10.3402/qhw.v7i0.11199] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2012] [Indexed: 11/30/2022] Open
Abstract
In this study a phenomenological approach was used in order to enter deeply into the experience of living with violence during pregnancy. The aim of the study was to gain a deeper understanding of women's experiences of being exposed to intimate partner violence (IPV) during pregnancy. The data were collected through in-depth interviews with five Norwegian women; two during pregnancy and three after the birth. The women were between the age of 20 and 38 years. All women had received support from a professional research and treatment centre. The essential structure shows that IPV during pregnancy is characterized by difficult existential choices related to ambivalence. Existential choices mean questioning one's existence, the meaning of life as well as one's responsibility for oneself and others. Five constituents further explain the essential structure: Living in unpredictability, the violence is living in the body, losing oneself, feeling lonely and being pregnant leads to change. Future life with the child is experienced as a possibility for existential change. It is important for health professionals to recognize and support pregnant women who are exposed to violence as well as treating their bodies with care and respect.
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Affiliation(s)
- Kristin Engnes
- Centre for Women's, Family and Child Health, Faculty of Health Sciences, Vestfold, Norway
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McElroy JA, Bloom T, Moore K, Geden B, Everett K, Bullock LF. Perinatal mortality and adverse pregnancy outcomes in a low-income rural population of women who smoke. ACTA ACUST UNITED AC 2012; 94:223-9. [PMID: 22371350 DOI: 10.1002/bdra.22891] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 12/12/2011] [Accepted: 12/13/2011] [Indexed: 11/11/2022]
Abstract
We describe adverse pregnancy outcomes, including congenital anomalies, fetal, neonatal, and infant mortality among a Missouri population of low-income, rural mothers who participated in two randomized smoking cessation trials. In the Baby BEEP (BB) trial, 695 rural women were recruited from 21 WIC clinics with 650 women's pregnancy outcomes known (93.5% retention rate). Following the BB trial, 298 women who had a live infant after November 2004 were recruited again into and completed the Baby Beep for Kids (BBK) trial. Simple statistics describing the population and perinatal and postneonatal mortality rates were calculated. Of the adverse pregnancy outcomes (n = 79), 29% were spontaneous abortions of less than 20 weeks' gestation, 23% were premature births, and 49% were identified birth defects. The perinatal mortality rate was 15.9 per 1000 births (BB study) compared with 8.6 per 1000 births (state of Missouri) and 8.5 per 1000 births (United States). The postneonatal infant mortality rate was 13.4 per 1000 live births (BBK) compared with 2.1 per 1000 live births (United States). The health disparity in this population of impoverished, rural, pregnant women who smoke, particularly in regard to perinatal and infant deaths, warrants attention.
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Affiliation(s)
- Jane A McElroy
- Family and Community Medicine Department, University of Missouri, Columbia, USA
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Bhandari S, Bullock LFC, Anderson KM, Danis FS, Sharps PW. Pregnancy and intimate partner violence: how do rural, low-income women cope? Health Care Women Int 2011; 32:833-54. [PMID: 21834721 PMCID: PMC4432839 DOI: 10.1080/07399332.2011.585532] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
We conducted 32 in-depth interviews with 20 rural, low-income, women residing in the United States who were pregnant (n = 12) or 3 months postpartum (n = 8) and had experienced intimate partner violence (IPV). Using purposive sampling and the grounded theory method, we generated a conceptual model of coping. The urge to protect the unborn baby was the primary influence for participants' decisions about separating from or permanently leaving an abusive relationship. Implications include universal screening for IPV in child-bearing women, inquiry into maternal identity development during pregnancy, and improved resource access for rural, low-income women.
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Affiliation(s)
- Shreya Bhandari
- Department of Social Work, Wright State University, Dayton, Ohio 45435-0001, USA.
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An integrated intervention to reduce intimate partner violence in pregnancy: a randomized controlled trial. Obstet Gynecol 2010; 115:273-283. [PMID: 20093899 DOI: 10.1097/aog.0b013e3181cbd482] [Citation(s) in RCA: 171] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate the efficacy of a psycho-behavioral intervention in reducing intimate partner violence recurrence during pregnancy and postpartum and in improving birth outcomes in African-American women. METHODS We conducted a randomized controlled trial for which 1,044 women were recruited. Women were randomly assigned to receive either intervention (n=521) or usual care (n=523). Individually tailored counseling sessions were adapted from evidence-based interventions for intimate partner violence and other risks. Logistic regression was used to model intimate partner violence victimization recurrence and to predict minor, severe, physical, and sexual intimate partner violence. RESULTS Women randomly assigned to the intervention group were less likely to have recurrent episodes of intimate partner violence victimization (odds ratio [OR] 0.48, 95% confidence interval [CI] 0.29-0.80). Women with minor intimate partner violence were significantly less likely to experience further episodes during pregnancy (OR 0.48, 95% CI 0.26-0.86, OR 0.53, 95% CI 0.28-0.99) and postpartum (OR 0.56, 95% CI 0.34-0.93). Numbers needed to treat were 17, 12, and 22, respectively, as compared with the usual care group. Women with severe intimate partner violence showed significantly reduced episodes postpartum (OR 0.39, 95% CI 0.18-0.82); the number needed to treat was 27. Women who experienced physical intimate partner violence showed significant reduction at the first follow-up (OR 0.49, 95% CI 0.27-0.91) and postpartum (OR 0.47, 95% CI 0.27-0.82); the numbers needed to treat were 18 and 20, respectively. Women in the intervention group had significantly fewer very preterm neonates (1.5% intervention group, 6.6% usual care group; P=.03) and an increased mean gestational age (38.2+/-3.3 intervention group, 36.9+/-5.9 usual care group; P=.016). CONCLUSION A relatively brief intervention during pregnancy had discernible effects on intimate partner violence and pregnancy outcomes. Screening for intimate partner violence as well as other psychosocial and behavioral risks and incorporating similar interventions in prenatal care is strongly recommended. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, www.clinicaltrials.gov, NCT00381823. LEVEL OF EVIDENCE I.
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Eddy T, Kilburn E, Chang C, Bullock L, Sharps P. Facilitators and barriers for implementing home visit interventions to address intimate partner violence: town and gown partnerships. Nurs Clin North Am 2008; 43:419-35, ix. [PMID: 18674673 DOI: 10.1016/j.cnur.2008.04.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pregnant women involved in violent relationships represent a population that is vulnerable for poor pregnancy and infant outcomes on several levels. This article describes the development of a "town and gown" partnership to assist pregnant women in violent relationships. Barriers and facilitating factors for research and home visitor (HV) nurse partnerships working with this vulnerable population were identified by HV participants in a qualitative focus group session. Methods used to develop and maintain the reciprocal relationship between the community (town) and academic researchers (gown) are described.
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Affiliation(s)
- Tonya Eddy
- Sinclair School of Nursing, S450, University of Missouri-Columbia, Columbia, MO 65211, USA
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