Intimate Partner Victimization and Health Risk Behaviors Among Pregnant Adolescents

Intimate partner violence and child outcomes at age 10: a pregnancy cohort

OBJECTIVE

Assess the mental health, physical health, cognitive and language development of 10-year old children in families where mothers have reported intimate partner violence (IPV) compared with children with no reported IPV exposure.

DESIGN

Prospective pregnancy cohort. Maternal report of IPV (Composite Abuse Scale) at 1, 4 and 10 years. Maternal and direct assessment of child mental health (probable psychiatric diagnosis, anxiety and emotional/behavioural difficulties), cognition (IQ and executive function), language (general, pragmatic and receptive) and physical health at 10 years.

SETTING

A subsample of 615 mother-child dyads drawn from a pregnancy cohort of 1507 nulliparous women recruited from six public hospitals in Melbourne, Australia.

RESULTS

Any IPV exposure from infancy to age 10 was associated with poorer child outcomes at age 10. Specifically, twice the odds of a probable psychiatric diagnosis, emotional/behavioural difficulties, impaired language skills (general and pragmatic), and having consulted a health professional about asthma or sleep problems. IPV exposure at age 10 associated with two to three times higher odds of all mental health outcomes, elevated blood pressure and sleep problems. Early life exposure alone (at 1 and/or 4 years) associated with three times higher odds of a general language problem and asthma at age 10.

CONCLUSION

The high prevalence of IPV and increased risk of poorer health and development among children exposed highlights the burden of ill health carried by children in families experiencing IPV. Fewer difficulties where exposure was limited to the early years builds the case for better identification, understanding and resourcing of effective early intervention.

Intimate Partner Violence and Mental Health Among Transgender/Gender Nonconforming Adults

There is significant evidence to suggest that intimate partner violence (IPV) is associated with mental health problems including anxiety and depression. However, this research has almost exclusively been conducted through heteronormative and cisgender lenses. The current study is an exploratory, quantitative analysis of the relationship between experiences of IPV and mental health among transgender/gender nonconforming (TGNC) adults. A national sample of 78 TGNC individuals completed a survey online measuring participants' experiences with IPV and depression, anxiety, and satisfaction with life. Of the sample, 72% reported at least one form of IPV victimization in their lifetime: 32% reported experiencing sexual IPV, 71% psychological IPV, 42% physical IPV, and 29% IPV assault with injury. All four types of IPV were positively associated with anxiety, and all but physical abuse was significantly associated with depression. None of the four types of IPV was associated with satisfaction with life. In a canonical correlation, IPV victimization and mental health had 31% overlapping variance, a large-sized effect. Sexual IPV and anxiety were the highest loading variables, suggesting that TGNC individuals who have experienced sexual IPV specifically tended to have higher levels of anxiety. These findings support previous qualitative, small-sample studies suggesting that IPV is a pervasive problem in the TGNC community. TGNC individuals who have experienced IPV may be at increased risk for mental health problems, and therefore, IPV history may trigger appropriate mental health screenings and referrals for this population in health care settings.

The Intergenerational Effects of Intimate Partner Violence in Pregnancy: Mediating Pathways and Implications for Prevention

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.

Associations between intimate partner violence profiles and mental health among low-income, urban pregnant adolescents

Background

Intimate partner violence (IPV) during pregnancy is associated with adverse maternal and child health outcomes, including poor mental health. Previous IPV research has largely focused on women’s victimization experiences; however, evidence suggests young women may be more likely to engage in bilateral violence (report both victimization and perpetration) or perpetrate IPV (unilateral perpetration) during pregnancy than to report being victimized (unilateral victimization). This study examined prevalence of unilateral victimization, unilateral perpetration, and bilateral violence, and the association between these IPV profiles and mental health outcomes during pregnancy among young, low-income adolescents.

Methods

Survey data were collected from 930 adolescents (14–21 years; 95.4% Black and Latina) from fourteen Community Health Centers and hospitals in New York City during second and third trimester of pregnancy. Multivariable regression models tested the association between IPV profiles and prenatal depression, anxiety, and distress, adjusting for known predictors of psychological morbidity.

Results

Thirty-eight percent of adolescents experienced IPV during their third trimester of pregnancy. Of these, 13% were solely victims, 35% were solely perpetrators, and 52% were engaged in bilateral violence. All women with violent IPV profiles had significantly higher odds of having depression and anxiety compared to individuals reporting no IPV. Adolescents experiencing bilateral violence had nearly 4-fold higher odds of depression (OR = 3.52, 95% CI: 2.43, 5.09) and a nearly 5-fold increased likelihood of anxiety (OR = 4.98, 95% CI: 3.29, 7.55). Unilateral victims and unilateral perpetrators were also at risk for adverse mental health outcomes, with risk of depression and anxiety two- to three-fold higher, compared to pregnant adolescents who report no IPV. Prenatal distress was higher among adolescents who experienced bilateral violence (OR = 2.84, 95% CI: 1.94, 4.16) and those who were unilateral victims (OR = 2.21, 95% CI: 1.19, 4.12).

Conclusions

All violent IPV profiles were associated with adverse mental health outcomes among pregnant adolescents, with bilateral violence having the most detrimental associations. Comprehensive IPV screening for both victimization and perpetration experiences during pregnancy is warranted. Clinical and community prevention efforts should target pregnant adolescents and their partners to reduce their vulnerability to violence and its adverse consequences.

Trial registration

ClinicalTrials.gov, NCT00628771. Registered 29 February 2008.

Predicting postpartum depression among adolescent mothers: A systematic review of risk

BACKGROUND/AIMS

Postpartum depression (PPD) is a debilitating illness with negative consequences for affected mothers and their children (e.g., poor maternal-infant attachment, deficits in children's social, emotional, and cognitive development). While it is suggested that adolescent mothers are at increased risk of PPD, there is a paucity of research exploring factors that place adolescent mothers at risk. This systematic review aims to identify risk factors associated with adolescent PPD and appraise the quality of this evidence-base.

METHOD

A systematic review was conducted in May of 2018, using PsycINFO, EMBASE, MEDLINE, ASSIA, CINAHL, MIDIRS, and ProQuest Dissertations and Theses Global database, following PRISMA guidelines. Inclusion criteria included studies from developed countries; published after 1992; using a validated measure of PPD; with onset of illness within 12 months of childbirth, but which had persisted past two-weeks postpartum; adolescent mothers < 20 years of age; and risk factor(s) that occurred prior to birth.

RESULTS

Fourteen studies were included, ranging from weak-to-strong in quality. Results suggest several risk factors implicated in the onset of adolescent PPD, including prior depression, lack of familial social support, and socio-economic hardship.

CONCLUSIONS/LIMITATIONS

Awareness of risk factors for healthcare professionals working with pregnant adolescents is of high importance to better facilitate early identification and to provide support for adolescents at risk. Future research ought to consider employing prospective longitudinal designs, along with clearly defined, timely and validated measurements of risk factors and PPD. Limitations include only studies published in English and low agreement on the included studies selection bias.

[Fertility in adolescent women and social inequalities in Mexico, 2015Fecundidade entre adolescentes e desigualdades sociais no México, 2015]

OBJECTIVE

To determine the association between teenage pregnancy and socioeconomic factors and to estimate social inequalities among adolescents in Mexico in 2015.

METHODS

A study involving women from 15 to 19 years of age was conducted using data from birth records for 2015. The fertility rate was determined and disaggregated by quintiles for each socioeconomic variable. Absolute and relative measures of inequality were estimated; negative binomial regression analysis was used to obtain risk ratios and 95% confidence intervals.

RESULTS

The fertility rate was 73.21 births per 1000 women between the ages of 15 and 19 years in Mexico. Coahuila was the state with the highest birth rate (99.3 per 1000 adolescents). A statistically significant association was found between fertility rate and the gap in access to health services, especially in quintile 5 (risk ratio [RR] = 45.68), whereas a greater association with the gap in education was found in quintile 4 (RR = 27.36). No significant differences were found in terms of the gap in access to social security.

CONCLUSIONS

Marginalization and poverty are significantly associated with teenage pregnancy and fertility rate. However, wide inequalities exist among the different social groups, making it necessary to implement actions geared towards promoting measures to improve the social, political, and economic environment.

Young Mothers' and Fathers' Perceptions of Relationship Violence: A Focus Group Study

Teens and young adults who are pregnant or parenting are important targets for efforts to prevent intimate partner violence (IPV). To intervene appropriately and effectively, we need to fully understand the unique issues and contexts for IPV in this population. This focus group study examined young parents' ( N = 28) perceptions of their relationships, stressors and sources of conflict, forms of IPV, and help-seeking behaviors. We examined data using template, content, thematic, and framework analyses. Findings about relationships and violence between young parents provide valuable insights for future intervention programs designed to prevent or address IPV among teen parents.

Psychosocial Risk Factors for Perinatal Depression among Female Adolescents: A Systematic Review

Perinatal depression is a health concern among pregnant and postpartum adolescents as it may negatively impact fetal development and result in complications such as preterm delivery, low infant birth weight, and poor maternal-infant attachment. The purpose of this systematic review is to examine psychosocial risk factors for depression among adolescents during pregnancy and postpartum. A literature search was conducted from five databases from 1995 to 2016. A total of 17 studies matched the inclusion criteria. Lack of social support, perceived stress, prior history of depression, and a history of sexual or physical violence were most frequently identified as potential risk factors for perinatal depression. Additional risk factors include the adolescent's perception of her pregnancy, family criticism, self-efficacy, self-esteem, substance use, parental stress, community violence, anxiety, and African-American ethnicity. Research and clinical implications are indicated for adolescents at risk for perinatal depression.

A 20-year review of pediatric pregnant trauma from a Level I trauma center

BACKGROUND

Trauma in pregnancy remains an important but understudied public health issue. We aimed to determine the prevalence of interpersonal violence in our pregnant trauma population (including pediatric) over the last 20 years, from our Level I trauma center.

METHODS

We conducted a descriptive, retrospective chart review to identify all pregnant trauma patients between Jan 1993 and Sept 2013. Pediatric was ≤18 years of age. We evaluated demographics, mechanism of injury, injury location, disposition, and outcome data.

RESULTS

We treated 438 pregnant patients at our center over 20 years. 378 (86%) were adult and 60 (14%) were pediatric. Intentional injuries occurred in 89 (20%) patients. The pediatric pregnant patients experienced a significantly higher proportion of intentional, interpersonal violence (33% vs. 18%, p = 0.007) compared to adults. Patients presenting after intentional, interpersonal violence had a higher mortality compared to non-intentional 5% vs 1% (p = 0.019).

CONCLUSIONS

Pediatric pregnant trauma patients remain at risk of interpersonal violence, especially firearm-related injury. Screening should be instituted by obstetricians and pediatricians for primary prevention.

Intimate Partner Violence and Gestational Weight Gain in a Population-Based Sample of Perinatal Women

OBJECTIVE

To examine the effects of intimate partner violence (IPV) at varied time points in the perinatal period on inadequate and excessive gestational weight gain.

DESIGN

Retrospective cohort using population-based secondary data.

SETTING

Pregnancy Risk Assessment Monitoring System and birth certificate data from New York City and 35 states.

PARTICIPANTS

Data were obtained for 251,342 U.S. mothers who gave birth from 2004 through 2011 and completed the Pregnancy Risk Assessment Monitoring System survey 2 to 9 months after birth.

METHODS

The exposure was perinatal IPV, defined as experiencing physical abuse by a current or ex-partner in the year before or during pregnancy. Adequacy of gestational weight gain (GWG) was categorized using 2009 Institute of Medicine guidelines. Weighted descriptive statistics and multivariate logistic regression models were used.

RESULTS

Approximately 6% of participants reported perinatal IPV, 2.7% reported IPV in the year before pregnancy, 1.1% reported IPV during pregnancy only, and the remaining 2.5% reported IPV before and during pregnancy. Inadequate GWG was more prevalent among participants who experienced IPV during pregnancy and those who experienced IPV before and during pregnancy (23.3% and 23.5%, respectively) than in participants who reported no IPV (20.2%; p < .001). Participants who experienced IPV before pregnancy only were significantly more likely to have excessive GWG (p < .001). Results were attenuated in the multivariate modeling; only participants who experienced IPV before pregnancy had weakly significant odds of excessive GWG (adjusted odds ratio = 1.14, 95% CI [1.02, 1.26]).

CONCLUSION

The association between perinatal IPV and inadequate GWG was explained by confounding variables; however, women who reported perinatal IPV had greater rates of GWG outside the optimal range. Future studies are needed to determine how relevant confounding variables may affect a woman's GWG.