低收入城市孕妇青少年中亲密伴侣暴力模式与心理健康之间的关联。
Associations between intimate partner violence profiles and mental health among low-income, urban pregnant adolescents.
机构信息
Department of Psychology, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
Yale School of Public Health, New Haven, CT, USA.
出版信息
BMC Pregnancy Childbirth. 2019 Apr 26;19(1):120. doi: 10.1186/s12884-019-2256-0.
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.
背景
怀孕期间的亲密伴侣暴力（IPV）与母婴健康不良结局相关，包括心理健康不佳。先前的 IPV 研究主要集中在女性的受害经历上；然而，有证据表明，年轻女性在怀孕期间更有可能参与双边暴力（报告受害和施暴）或实施 IPV（单边施暴），而不是报告受害（单边受害）。本研究调查了怀孕期间年轻、低收入青少年中单边受害、单边施暴和双边暴力的流行情况，以及这些 IPV 特征与怀孕时心理健康结局之间的关系。
方法
从纽约市 14 家社区健康中心和医院的 930 名 14-21 岁的青少年（95.4%为黑人或拉丁裔）中收集调查数据，这些数据是在妊娠第二和第三孕期收集的。多变量回归模型检验了 IPV 特征与产前抑郁、焦虑和困扰之间的关联，同时调整了心理发病率的已知预测因素。
结果
38%的青少年在第三孕期经历过 IPV。其中，13%是单纯的受害者，35%是单纯的施暴者，52%是参与双边暴力的。所有有暴力 IPV 特征的女性与没有报告 IPV 的个体相比，抑郁和焦虑的可能性明显更高。经历双边暴力的青少年抑郁的可能性几乎高出四倍（OR=3.52，95%CI：2.43，5.09），焦虑的可能性几乎高出五倍（OR=4.98，95%CI：3.29，7.55）。单边受害者和单边施暴者也面临不良心理健康结局的风险，与没有报告 IPV 的怀孕青少年相比，他们的抑郁和焦虑风险高出两到三倍。与经历双边暴力（OR=2.84，95%CI：1.94，4.16）和单边受害（OR=2.21，95%CI：1.19，4.12）的青少年相比，产前困扰更高。
结论
所有暴力 IPV 特征都与怀孕青少年的不良心理健康结局相关，双边暴力的关联最具危害性。怀孕期间应进行全面的 IPV 筛查，包括受害和施暴经历。临床和社区预防工作应针对怀孕青少年及其伴侣，以降低他们易受暴力及其不良后果的影响。
试验注册
ClinicalTrials.gov，NCT00628771。2008 年 2 月 29 日注册。
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