Intimate partner violence and anxiety disorders in pregnancy: the importance of vocational training of the nursing staff in facing them

Fonseca-Machado, Mariana de Oliveira; Monteiro, Juliana Cristina dos Santos; Haas, Vanderlei José; Abrão, Ana Cristina Freitas de Vilhena; Gomes-Sponholz, Flávia

doi:10.1590/0104-1169.0495.2624

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Revista Latino-Americana de Enfermagem

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Original Articles • Rev. Latino-Am. Enfermagem 23 (5) • Sep-Oct 2015 • https://doi.org/10.1590/0104-1169.0495.2624 copy

Intimate partner violence and anxiety disorders in pregnancy: the importance of vocational training of the nursing staff in facing them¹ 1 Paper extracted from doctoral dissertation "Violence during pregnancy and the mental health of women victims of their partners", presented to Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil. Supported by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), Brazil, process # 2012/06037-0.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

to identify the relationship between posttraumatic stress disorder, trait and state anxiety, and intimate partner violence during pregnancy.

Method:

observational, cross-sectional study developed with 358 pregnant women. The Posttraumatic Stress Disorder Checklist - Civilian Version was used, as well as the State-Trait Anxiety Inventory and an adapted version of the instrument used in the World Health Organization Multi-country Study on Women's Health and Domestic Violence.

Results:

after adjusting to the multiple logistic regression model, intimate partner violence, occurred during pregnancy, was associated with the indication of posttraumatic stress disorder. The adjusted multiple linear regression models showed that the victims of violence, in the current pregnancy, had higher symptom scores of trait and state anxiety than non-victims.

Conclusion:

recognizing the intimate partner violence as a clinically relevant and identifiable risk factor for the occurrence of anxiety disorders during pregnancy can be a first step in the prevention thereof.

Spouse Abuse; Anxiety; Stress Disorders, Post-Traumatic; Pregnancy; Nursing; Public Health

Variables	n	%	PTSD*	Trait anxiety Score	State anxiety Score
Variables	n	%	n	%
Age group (complete years)					State anxiety Score
	15-19	78	21.8	15	19.2	41.6	43.6
	20-29	186	52.0	33	17.7	39.0	41.7
	30-39	88	24.6	13	14.8	37.4	43.2
	40-49	6	1.6	0	0.0	34.0	41.5
Self-declared skin color
	Non-white	135	37.7	44	32.6	40.0	41.5	43.4
	White	223	62.3	17	7.6	37.8	40.9
Formal Education (years)
	1-8	121	33.8	26	21.5	42.0	40.9	44.9
	9-11	196	54.7	33	16.8	38.2	41.1
	12 or more	40	11.2	2	5.0	34.8	41.5
	Does not know	1	0.3	0	0.0	41.0	46.0
Religion
	Yes	284	79.3	52	18.3	38.8	46.0	42.3
	No	74	20.7	9	12.2	40.2	43.0
Marital status
	Cohabiting	288	80.4	49	17.0	38.7	43.0	42.0
	Has a partner, not cohabiting	45	12.6	3	6.7	39.5	42.7
	Had a partner during pregnancy, not anymore	25	7.0	9	36.0	42.8	47.2
Paid occupation
	Yes	153	42.7	24	15.7	38.7	47.2	42.4
	No	205	57.3	37	18.0	39.4	42.5
Monthly family income^† (in monthly minimum wages)
	One or less	44	12.3	12	27.3	41.0	42.5	43.1
	Two-three	199	55.6	26	13.0	38.6	42.1
	Four or more	54	15.1	9	16.7	36.0	41.9
	Does not know	61	17.0	14	22.9	41.7	43.4
Habitual smoking
	Yes	24	6.7	2	8.3	39.4	43.4	43.4
	No	334	93.3	59	17.7	39.1	42.4
Alcohol consumption
	Yes	42	11.7	9	21.4	41.7	42.4	44.9
	No	316	88.3	52	16.4	38.8	42.1
Illicit drug use
	Yes	3	0.8	0	0.0	43.0	42.1	48.0
	No	355	99.2	61	17.2	39.1	42.4
Number of pregnancies
	Primigravida	143	39.9	21	14.7	39.0	42.4	41.6
	Multigravida	215	60.1	40	18.6	39.2	43.0
Parity
	Nullipara	158	44.2	22	13.9	38.9	43.0	41.7
	Primipara	110	30.7	22	20.0	39.2	43.2
	Multipara	90	25.1	17	18.9	39.5	42.9
Living children
	Yes	198	55.3	39	19.7	39.4	42.9	43.2
	No	160	44.7	22	13.7	38.8	41.6
Planned pregnancy
	Yes	134	37.4	27	20.1	38.3	41.6	40.6
	No	224	62.6	34	15.2	39.6	43.6
IPV^‡ during pregnancy
	Yes	63	17.6	24	38.1	48.0	43.6	48.4
	No	295	82.4	37	12.5	37.2	41.2
Total	358	100	61	-	-	-

Variables	Posttraumatic stress disorder
	Yes	No	POR _crude * (CI _95.0% )	POR _adjusted (CI _95.0% )	p ^†
	n	%	n	%
Intimate partner violence					p ^†
	Yes	24	38.1	39	61.9	4.29 (2.3-7.9)	5.25 (2.5-10.9)	<0.001
	No	37	12.5	258	87.5
Marital status
	Cohabiting	49	17.0	239	83.0	0.99 (0.5-1.9)	1.02 (0.4-2.4)		0.97
	Not cohabiting	12	17.1	58	82.9
Drug use
	Yes	10	16.9	49	83.1	0.99 (0.5-2.1)	0.55 (0.2-1.5)		0.25
	No	51	17.1	248	82.9
Pregnant woman age	-	-	-	-	-	0.98 (0.9-1.0)	0.39
Family income^‡	-	-	-	-	-	0.92 (0.7-1.2)	0.49

Variables	STAI score for symptoms of trait and state anxiety*
	Beta	p ^†
	STAI-Trait
Intimate partner violence (yes=1; no=0)	0.38	p ^†	<0.001
Marital status (cohabiting=1; not cohabiting=0)	-0.01	0.83
Age	-0.14	0.01
Education	-0.18	0.001
Monthly family income^‡	-0.01	0.86
	STAI-State
Intimate partner violence (yes=1; no=0)	0.25	0.86	<0.001
Marital status (cohabiting=1; not cohabiting=0)	-0.06	0.26
Age	-0.01	0.84
Education	-0.18	0.003
Monthly family income^‡	0.05	0.39

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

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[1] Corresponding Author: Mariana de Oliveira Fonseca-Machado Universidade Federal de São Carlos. Departamento de Enfermagem Rod. Washington Luís, Km 235. Caixa Postal 676 Bairro: Monjolinho CEP: 13565-905, São Carlos, SP, Brasil E-mail: mafonseca.machado@gmail.com