The impact of psychological abuse by an intimate partner on the mental health of pregnant women

BJOG-An International Journal of Obstetrics and Gynaecology. 115(3): 377-384. 2008.
Tiwari A.F.Y., Chan E.K.L., Fong D.Y.T., Leung W.C., Brownridge D.A., Lam H., Wong B., Lam C.M., Chan F., Chan A., Cheung K.B. and Ho P.C.

Abstract

OBJECTIVE:
The objective of this first population-based study in Hong Kong was to assess the impact of psychological abuse by an intimate partner on the mental health of pregnant women.

DESIGN:
Survey.

SETTING:
Antenatal clinics in seven public hospitals in Hong Kong.

POPULATION:
Three thousand two hundred and forty-five pregnant women.

METHODS:
The Abuse Assessment Screen (AAS) and demographic questionnaires were administered face-to-face at 32-36 weeks of gestation. At 1 week postpartum, the AAS, Edinburgh Postnatal Depression Scale and SF-12 Health Survey were administered by telephone.
MAIN OUTCOME MEASURES:
Intimate partner violence, postnatal depression and health-related quality of life.

RESULTS:
Two hundred and ninety six (9.1%) of the participants reported abuse by an intimate partner in the past year. Of those abused, 216 (73%) reported psychological abuse only and 80 (27%) reported physical and/or sexual abuse. Forty six (57.5%) in the physical and/or sexual abuse group also reported psychological abuse. Women in the psychological abuse only group had a higher risk of postnatal depression compared with nonabused women (adjusted OR: 1.84, 95% CI: 1.12-3.02). They were also at a higher risk of thinking about harming themselves (adjusted OR: 3.50, 95% CI: 1.49-8.20) and had significantly poorer mental health-related quality of life (P < 0.001). The higher risks of postnatal depression and thinking of harming themselves were not observed in the physical and/or sexual abuse group although significantly poorer mental health-related quality of life (P < 0.001) was observed.

CONCLUSIONS:
Psychological abuse by an intimate partner against pregnant women has a negative impact on their mental health postdelivery. Furthermore, psychological abuse in the absence of physical and/or sexual abuse can have a detrimental effect on the mental health of abused women. The findings underscore the importance of screening pregnant women for abuse by an intimate partner and the need for developing, implementing and evaluating interventions to address psychological abuse.

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