Zhong Qiu-Yue, Wells Anne, Rondon Marta B, Williams Michelle A, Barrios Yasmin V, Sanchez Sixto E, Gelaye Bizu
Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA.
Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA.
Am J Obstet Gynecol. 2016 Oct;215(4):501.e1-8. doi: 10.1016/j.ajog.2016.04.052. Epub 2016 May 10.
Childhood abuse is a major global and public health problem associated with a myriad of adverse outcomes across the life course. Suicide is one of the leading causes of mortality during the perinatal period. However, few studies have assessed the relationship between experiences of childhood abuse and suicidal ideation in pregnancy.
We sought to examine the association between exposure to childhood abuse and suicidal ideation among pregnant women.
A cross-sectional study was conducted among 2964 pregnant women attending prenatal clinics in Lima, Peru. Childhood abuse was assessed using the Childhood Physical and Sexual Abuse Questionnaire. Depression and suicidal ideation were assessed using the Patient Health Questionnaire-9 scale. Logistic regression procedures were performed to estimate adjusted odds ratios and 95% confidence intervals adjusted for potential confounders.
Overall, the prevalence of childhood abuse in this cohort was 71.8% and antepartum suicidal ideation was 15.8%. The prevalence of antepartum suicidal ideation was higher among women who reported experiencing any childhood abuse compared to those reporting none (89.3% vs 10.7%, P < .0001). After adjusting for potential confounders, including antepartum depression and lifetime intimate partner violence, those with history of any childhood abuse had a 2.9-fold (2.90, adjusted odds ratio; 95% confidence interval, 2.12-3.97) increased odds of reporting suicidal ideation. Women who experienced both physical and sexual childhood abuse had much higher odds of suicidal ideation (adjusted odds ratio, 4.04; 95% confidence interval, 2.88-5.68). Women who experienced any childhood abuse and reported depression had 3.44-fold (3.44, adjusted odds ratio; 95% confidence interval, 1.84-6.43) increased odds of suicidal ideation compared with depressed women with no history of childhood abuse. Finally, the odds of suicidal ideation increased with increased number of childhood abuse events experienced (P value for linear trend < .001).
Maternal history of childhood abuse was associated with increased odds of antepartum suicidal ideation. It is important for clinicians to be aware of the potential increased risk of suicidal behaviors among pregnant women with a history of childhood physical and sexual abuse.
童年期受虐是一个重大的全球公共卫生问题，与一生中无数不良后果相关。自杀是围产期主要死因之一。然而，很少有研究评估童年期受虐经历与孕期自杀意念之间的关系。
我们试图研究孕妇童年期受虐经历与自杀意念之间的关联。
对秘鲁利马产前诊所的2964名孕妇进行了一项横断面研究。使用童年期身体与性虐待问卷评估童年期受虐情况。使用患者健康问卷-9量表评估抑郁和自杀意念。采用逻辑回归程序估计调整后的比值比和针对潜在混杂因素调整后的95%置信区间。
总体而言，该队列中童年期受虐的患病率为71.8%，产前自杀意念患病率为15.8%。报告有童年期受虐经历的女性产前自杀意念患病率高于无此经历者（89.3%对10.7%，P <.0001）。在对包括产前抑郁和终生亲密伴侣暴力等潜在混杂因素进行调整后，有任何童年期受虐史的女性报告自杀意念的几率增加了2.9倍（调整后的比值比为2.90；95%置信区间为2.12 - 3.97）。童年期同时遭受身体和性虐待的女性自杀意念几率更高（调整后的比值比为4.04；95%置信区间为2.88 - 5.68）。有童年期受虐经历且报告有抑郁的女性与无童年期受虐史的抑郁女性相比，自杀意念几率增加了3.44倍（调整后的比值比为3.44；95%置信区间为1.84 - 6.43）。最后，自杀意念几率随童年期受虐事件数量增加而升高（线性趋势P值<.001）。
母亲童年期受虐史与产前自杀意念几率增加相关。临床医生了解有童年期身体和性虐待史的孕妇自杀行为潜在风险增加很重要。
