Center for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI 02906, USA; The Women's Medicine Collaborative, The Miriam Hospital, 146 W. River St., Providence, RI 02904, USA; Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Box G-BH, Providence, RI 02912, USA.
The Women's Medicine Collaborative, The Miriam Hospital, 146 W. River St., Providence, RI 02904, USA; Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Box G-BH, Providence, RI 02912, USA.
J Psychosom Res. 2023 Sep;172:111414. doi: 10.1016/j.jpsychores.2023.111414. Epub 2023 Jun 14.
Prior studies have established that childhood sexual abuse (CSA) survivors are at increased risk for anxiety during pregnancy. Less is known about the course of anxiety throughout pregnancy for CSA survivors as well as underlying mechanisms linking CSA and perinatal anxiety. We assessed change in anxiety over the course of pregnancy for CSA survivors and examined whether acceptance and awareness of pregnancy-related body changes mediated this change.
299 pregnant participants from two larger longitudinal cohort studies were grouped into CSA (n = 67), "other Maltreatment" (OM; n = 111); and "no abuse" (NA; n = 121) based on responses to the Adverse Childhood Events scale. We used a general linear mixed model with repeated measures to examine change in anxiety (Hamilton Anxiety Scale) at two time points (M = 26.2 weeks and 34.9) by abuse/maltreatment group and then examined whether group differences in anxiety were mediated by body awareness/acceptance (from Maternal Fetal Attachment Scale) using structural equation modeling.
The CSA group demonstrated higher anxiety at both gestational time-points and significantly greater increase in anxiety over gestation compared to OM and NA groups (F(1, 280) p = .046). CSA and OM groups reported significantly lower body acceptance than those without abuse/maltreatment (F(2, 287) = 3.486, p = .032). A small proportion of the total effect of CSA on change in anxiety (0.5%) was attributable to body acceptance.
Pregnant CSA survivors experienced a greater increase in anxiety over pregnancy compared to other groups. Both abuse/maltreatment groups exhibited lower body acceptance, yet this contributed little to the association between CSA and anxiety.
先前的研究已经证实，儿童期性虐待（CSA）幸存者在怀孕期间患焦虑症的风险增加。对于 CSA 幸存者在整个怀孕期间的焦虑症的病程以及将 CSA 与围产期焦虑症联系起来的潜在机制，了解较少。我们评估了 CSA 幸存者在怀孕期间焦虑症的变化情况，并检查了对与怀孕相关的身体变化的接受和认识是否会影响这种变化。
根据对不良童年经历量表的回答，将来自两个更大的纵向队列研究的 299 名孕妇分为 CSA（n=67）、“其他虐待”（OM；n=111）和“无虐待”（NA；n=121）。我们使用具有重复测量的一般线性混合模型来检查焦虑症（汉密尔顿焦虑量表）在两个时间点（M=26.2 周和 34.9 周）的变化，然后使用结构方程模型检查焦虑症的组间差异是否由身体意识/接受度（来自母婴胎儿依恋量表）来介导。
CSA 组在两个妊娠时间点的焦虑症均较高，与 OM 和 NA 组相比，妊娠期间焦虑症的增加幅度明显更大（F（1，280）p=0.046）。CSA 和 OM 组报告的身体接受度明显低于未受虐待/虐待的组（F（2，287）=3.486，p=0.032）。CSA 对焦虑变化的总影响的一小部分（0.5%）归因于身体接受度。
与其他组相比，怀孕的 CSA 幸存者在怀孕期间焦虑症的增加幅度更大。两个受虐待/虐待的组都表现出较低的身体接受度，但这对 CSA 与焦虑症之间的关联贡献不大。
