Abstract
The aim of the study was to explore the pathways by which childhood sexual abuse (CSA), psychological and physical intimate partner violence (IPV) during pregnancy, and other covariates relate to each other and to posttraumatic stress disorder (PTSD) symptoms in the postpartum period. The sample comprised 456 women who gave birth at a maternity service for high-risk pregnancies in Rio de Janeiro, Brazil, interviewed at 6–8 weeks after birth. A path analysis was carried out to explore the postulated pathways between exposures and outcome. Trauma History Questionnaire, Conflict Tactics Scales and Posttraumatic Stress Disorder Checklist were used to assess information about exposures of main interest and outcome. The link between CSA and PTSD symptoms was mediated by history of trauma, psychiatric history, psychological IPV, and fear of childbirth during pregnancy. Physical IPV was directly associated with postnatal PTSD symptoms, whereas psychological IPV connection seemed to be partially mediated by physical abuse and fear of childbirth during pregnancy. The role of CSA, IPV, and other psychosocial characteristics on the occurrence of PTSD symptoms following childbirth as well as the intricate network of these events should be acknowledged in clinic and intervention approaches.
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Alder J, Fink N, Bitzer J, Hösli I, Holzgreve W (2007) Depression and anxiety during pregnancy: a risk factor for obstetric, fetal and neonatal outcome? A critical review of the literature. J Matern-Fetal Neo M 20:189–209. doi:10.1080/14767050701209560
Aliyu MH, Jolly PE, Ehiri JE, Salihu HM (2005) High parity and adverse birth outcomes: exploring the maze. Birth 32:45–59. doi:10.1111/j.0730-7659.2005.00344.x
Andersen LB, Melvaer LB, Videbech P, Lamont RF, Joergensen JS (2012) Risk factors for developing post-traumatic stress disorder following childbirth: a systematic review. Acta Obstet Gyn Scan 91:1261–1272. doi:10.1111/j.1600-0412.2012.01476.x
Andrews G, Corry J, Slade T, Issakidis C, Swanston H (2004) Child sexual abuse. In: Ezzati M, Lopez AD, Rodgers A, Murray CJL (eds) Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors, vol 2. WHO, Geneva, pp 1851–1940
Angelakis S, Nixon RDV (2015) The comorbidity of PTSD and MDD: implications for clinical practice and future research. Behav Chang 32:1–25. doi:10.1017/bec.2014.26
APA (American Psychiatry Association) (2000) Diagnostic and statistical manual for mental disorders, 4th edn revised. American Psychiatric Press, Washington
Apgar V (1953) A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg 32:260–267. doi:10.1213/ANE.0b013e31829bdc5c
Ayers S, Joseph S, McKenzie-McHarg K, Slade P, Wijma K (2008) Post-traumatic stress disorder following childbirth: current issues and recommendations for future research. J Psychosom Obst Gyn 29:240–250. doi:10.1080/01674820802034631
Ayers S, Harris R, Sawyer A, Parfitt Y, Ford E (2009) Posttraumatic stress disorder after childbirth: analysis of symptom presentation and sampling. J Affect Disorders 119:200–204. doi:10.1016/j.jad.2009.02.029
Banyard VL, Williams LM, Siegel JA (2001) The long-term mental health consequences of child sexual abuse: an exploratory study of the impact of multiple traumas in a sample of women. J Trauma Stress 14:697–715. doi:10.1023/A:1013085904337
Banyard VL, Williams LM, Siegel JA (2002) Retraumatization among adult women sexually abused in childhood: exploratory analyses in a prospective study. J Child Sex Abuse 11:19–48. doi:10.1300/J070v11n03_02
Berger W, Mendlowicz MV, Souza WF, Figueira I (2004) Semantic equivalence of the Portuguese version of the post-traumatic stress disorder checklist—civilian version (PCL-C) for the screening of post-traumatic stress disorder. Rev Psiquiatr Rio Gd Sul 26:167–175. doi:10.1590/S0101-81082004000200006
Blumenshine P, Egerter S, Barclay CJ, Cubbin C, Braveman PA (2010) Socioeconomic disparities in adverse birth outcomes: a systematic review. Am J Prev Med 39:263–272. doi:10.1016/j.amepre.2010.05.012
Breslau N, Davis GC, Andreski P (1995) Risk factors for PTSD-related traumatic events: a prospective analysis. Am J Psychiat 152:529–535. doi:10.1176/ajp.152.4.529
Briere J, Jordan CE (2004) Violence against women: outcome complexity and implications for assessment and treatment. J Interpers Violence 19:1252–1276. doi:10.1177/0886260504269682
Brown TA (2015) Confirmatory factor analysis for applied research, 2nd edn. The Guilford Press, New York
Butler AC (2013) Child sexual assault: risk factors for girls. Child Abuse Neglect 37:643–652. doi:10.1016/j.chiabu.2013.06.009
Cerulli C, Talbot NL, Tang W, Chaudron LH (2011) Co-occurring intimate partner violence and mental health diagnoses in perinatal women. J Women’s Health 20:1797–1803. doi:10.1089/jwh.2010.2201
Chen LP et al (2010) Sexual abuse and lifetime diagnosis of psychiatric disorders: systematic review and meta-analysis. Mayo Clin Proc 85:618–629. doi:10.4065/mcp.2009.0583
Cohen MM, Ansara D, Schei B, Stuckless N, Stewart DE (2004) Posttraumatic stress disorder after pregnancy, labor, and delivery. J Women’s Health 13:315–324. doi:10.1089/154099904323016473
Coker AL, Smith PH, McKeown RE, King MJ (2000) Frequency and correlates of intimate partner violence by type: physical, sexual, and psychological battering. Am J Public Health 90:553–559. doi:10.2105/ajph.90.4.553
Dawson DA, Grant BF, Chou SP, Stinson FS (2007) The impact of partner alcohol problems on women’s physical and mental health. J Stud Alcohol Drugs 68:66–75. doi:10.15288/jsad.2007.68.66
Debell F, Fear N, Head M, Batt-Rawden S, Greenberg N, Wessely S, Goodwin L (2014) A systematic review of the comorbidity between PTSD and alcohol misuse. Soc Psych Psych Epid 49:1401–1425. doi:10.1007/s00127-014-0855-7
DeJonghe ES, Bogat GA, Levendosky AA, von Eye A (2008) Women survivors of intimate partner violence and post-traumatic stress disorder: prediction and prevention. J Postgrad Med 54:294–300. doi:10.4103/0022-3859.41435
Desmarais S, Pritchard A, Lowder E, Janssen P (2014) Intimate partner abuse before and during pregnancy as risk factors for postpartum mental health problems. BMC Pregnancy Childbirth 14:132. doi:10.1186/1471-2393-14-132
Dutton MA (2009) Pathways linking intimate partner violence and posttraumatic disorder. Trauma Violence Abuse 10:211–224. doi:10.1177/1524838009334451
Fiszman A, Cabizuca M, Lanfredi C, Figueira I (2005) The cross-cultural adaptation to Portuguese of the trauma history questionnaire to identify traumatic experiences. Rev Bras Psiquiatr 27:63–66. doi:10.1590/S1516-44462005000100014
Foran HM, O’Leary KD (2008) Alcohol and intimate partner violence: a meta-analytic review. Clin Psychol Rev 28:1222–1234. doi:10.1016/j.cpr.2008.05.001
Green BL (1996) Trauma history questionnaire. In: Stamm BH, Varra EM (eds) Measurement of stress, trauma and adaptation. Sidran Press, Lutherville, MD
Grekin R, O’Hara MW (2014) Prevalence and risk factors of postpartum posttraumatic stress disorder: a meta-analysis. Clin Psychol Rev 34:389–401. doi:10.1016/j.cpr.2014.05.003
Hasselmann MH, Lopes CS, Reichenheim ME (1998) Measurement reliability in a study on family violence and severe acute malnutrition. Rev Saude Publ 32:437–446. doi:10.1590/S0034-89101998000500006
Havens JR, Simmons LA, Shannon LM, Hansen WF (2009) Factors associated with substance use during pregnancy: results from a national sample. Drug Alcohol Depen 99:89–95. doi:10.1016/j.drugalcdep.2008.07.010
Heimstad R, Dahloe R, Laache I, Skogvoll E, Schei B (2006) Fear of childbirth and history of abuse: implications for pregnancy and delivery. Acta Obstet Gyn Scan 85:435–440. doi:10.1080/00016340500432507
Hillberg T, Hamilton-Giachritsis C, q (2011) Review of meta-analyses on the association between child sexual abuse and adult mental health difficulties: a systematic approach. Trauma Violence Abuse 12:38–49. doi:10.1177/1524838010386812
Howard LM, Oram S, Galley H, Trevillion K, Feder G (2013) Domestic violence and perinatal mental disorders: a systematic review and meta-analysis. PLoS Med 10:e1001452. doi:10.1371/journal.pmed.1001452
Jahanfar S, Janssen PA, Howard LM, Dowswell T (2013) Interventions for preventing or reducing domestic violence against pregnant women. Cochrane Db Syst Rev 2:CD009414. doi:10.1002/14651858.CD009414.pub2
Karam EG et al (2014) Cumulative traumas and risk thresholds: 12-month PTSD in the World Mental Health (WMH) surveys. Depress Anxiety 31:130–142. doi:10.1002/da.22169
Kline RB (2015) Principles and practice of structural equation modeling, 4th edn. The Guilford Press, London
Kramer MS (1987) Determinants of low birth weight: methodological assessment and meta-analysis. B World Health Organ 65:663–737
Leeners B, Richter-Appelt H, Imthurn B, Rath W (2006) Influence of childhood sexual abuse on pregnancy, delivery, and the early postpartum period in adult women. J Psychosom Res 61:139–151. doi:10.1016/j.jpsychores.2005.11.006
Lev-Wiesel R, Daphna-Tekoah S, Hallak M (2009) Childhood sexual abuse as a predictor of birth-related posttraumatic stress and postpartum posttraumatic stress. Child Abuse Neglect 33:877–887. doi:10.1016/j.chiabu.2009.05.004
Lukasse M, Vangen S, Oian P, Schei B (2011) Fear of childbirth, women’s preference for cesarean section and childhood abuse: a longitudinal study. Acta Obstet Gyn Scan 90:33–40. doi:10.1111/j.1600-0412.2010.01024.x
Masur J, Monteiro MG (1983) Validation of the "CAGE" alcoholism screening test in a Brazilian psychiatric inpatient hospital setting. Rev Bras Pesqui Med 16:215–218
Mayfield D, McLeod G, Hall P (1974) The CAGE questionnaire: validation of a new alcoholism screening instrument. Am J Psychiat 131:1121–1123. doi:10.1176/appi.ajp.131.10.1121
McKenzie-McHarg K et al (2015) Post-traumatic stress disorder following childbirth: an update of current issues and recommendations for future research. J Reprod Infant Psyc 33:219–237. doi:10.1080/02646838.2015.1031646
Messman-Moore TL, Long PJ (2000) Child sexual abuse and revictimization in the form of adult sexual abuse, adult physical abuse, and adult psychological maltreatment. J Interpers Violence 15:489–502. doi:10.1177/088626000015005003
Ministério da Saúde (2012) Resolução n°. 466 de 12 de dezembro de 2012. Diretrizes e Normas Regulamentadoras de Pesquisas Envolvendo Seres Humanos. Diário Oficial da União
Moraes CL, Reichenheim ME (2002a) Cross-cultural measurement equivalence of the revised conflict tactics scales (CTS2) Portuguese version used to identify violence within couples. Cad Saude Publica 18:783–796. doi:10.1590/S0102-311X2002000300027
Moraes CL, Reichenheim ME (2002b) Domestic violence during pregnancy in Rio de Janeiro. Brazil Int J Gynaecol Obstet 79:269–277. doi:10.1016/S0020-7292(02)00250-3
Moraes CL, Hasselmann MH, Reichenheim ME (2002) Portuguese-language cross-cultural adaptation of the revised conflict tactics scales (CTS2), an instrument used to identify violence in couples. Cad Saude Publica 18:163–176. doi:10.1590/S0102-311X2002000100017
Moraes CL, Viellas EF, Reichenheim ME (2005) Assessing alcohol misuse during pregnancy: evaluating psychometric properties of the CAGE, T-ACE and TWEAK in a Brazilian setting. J Stud Alcohol 66:165–173. doi:10.15288/jsa.2005.66.165
Moraes CL, Tavares da Silva TS, Reichenheim ME, Azevedo GL, Dias Oliveira AS, Braga JU (2011) Physical violence between intimate partners during pregnancy and postpartum: a prediction model for use in primary health care facilities. Paediatr Perinat Ep 25:478–486. doi:10.1111/j.1365-3016.2011.01208.x
Muthén LK, Muthén BO (1998-2015) Mplus user’s guide, 7th edn. Muthén & Muthén, Los Angeles, CA
National Center for PTSD (2012) Using the PTSD Checklist (PCL). http://www.ptsd.va.gov/professional/pages/assessments/ptsd-checklist.asp
Nayak MB, Patel V, Bond JC, Greenfield TK (2010) Partner alcohol use, violence and women’s mental health: population-based survey in India. Brit J Psychiat 196:192–199. doi:10.1192/bjp.bp.109.068049
NICE (2014) Domestic violence and abuse: how health services, social care and the organisations they work with can respond effectively. Public Health Guidance PH50. National Institute for Health and Care Excellence
Noll JG, Shenk CE, Putnam KT (2009) Childhood sexual abuse and adolescent pregnancy: a meta-analytic update. J Pediatr Psychol 34:366–378. doi:10.1093/jpepsy/jsn098
Olde E, van der Hart O, Kleber R, van Son M (2006) Posttraumatic stress following childbirth: a review. Clin Psychol Rev 26:1–16. doi:10.1016/j.cpr.2005.07.002
Paolucci EO, Genuis ML, Violato C (2001) A meta-analysis of the published research on the effects of child sexual abuse. J Psychol 135:17–36. doi:10.1080/00223980109603677
Passos RBF, Figueira I, Mendlowicz MV, Moraes CL, Coutinho ESF (2012) Exploratory factor analysis of the brazilian version of the post-traumatic stress disorder checklist—civilian version (PCL-C). Rev Bras Psiquiatr 34:155–161. doi:10.1590/S1516-44462012000200007
Patra J, Bakker R, Irving H, Jaddoe VWV, Malini S, Rehm J (2011) Dose–response relationship between alcohol consumption before and during pregnancy and the risks of low birthweight, preterm birth and small for gestational age (SGA)—a systematic review and meta-analyses. BJOG-Int J Obstet Gy 118:1411–1421. doi:10.1111/j.1471-0528.2011.03050.x
Reichenheim ME, Moraes CL, Szklo A, Hasselmann MH, Souza ER, Lozana JA, Figueiredo V (2006) The magnitude of intimate partner violence in Brazil: portraits from 15 capital cities and the Federal District. Cad de Saude Publica 22:425–437. doi:10.1590/S0102-311X2006000200020
Reichenheim ME, Klein R, Moraes CL (2007) Assessing the physical violence component of the revised conflict tactics scales when used in heterosexual couples: an item response theory analysis. Cad Saude Publica 23:53–62. doi:10.1590/S0102-311X2007000100007
Rouhe H, Salmela-Aro K, Halmesmäki E, Saisto T (2009) Fear of childbirth according to parity, gestational age, and obstetric history. BJOG-Int J Obstet Gy 116:67–73. doi:10.1111/j.1471-0528.2008.02002.x
Rouhe H, Salmela-Aro K, Gissler M, Halmesmäki E, Saisto T (2011) Mental health problems common in women with fear of childbirth. BJOG-Int J Obstet Gy 118:1104–1111. doi:10.1111/j.1471-0528.2011.02967.x
Russell M, Martier SS, Sokol RJ, Mudar P, Bottoms S, Jacobson S, Jacobson J (1994) Screening for pregnancy risk-drinking. Alcohol Clin Exp Res 18:1156–1161. doi:10.1111/j.1530-0277.1994.tb00097.x
Saisto T, Halmesmaki E (2003) Fear of childbirth: a neglected dilemma. Acta Obstet Gyn Scan 82:201–208. doi:10.1034/j.1600-0412.2003.00114.x
Salis KL, Salwen J, O’Leary KD (2014) The predictive utility of psychological aggression for intimate partner violence. Partner Abuse 5:83–97. doi:10.1891/1946-6560.5.1.83
Schumacher JA, Leonard KE (2005) Husbands’ and wives’ marital adjustment, verbal aggression, and physical aggression as longitudinal predictors of physical aggression in early marriage. J Consult Clin Psych 73:28–37. doi:10.1037/0022-006x.73.1.28
Schwarz G (1978) Estimating the dimension of a model. Ann Stat 6:461–464. doi:10.1214/aos/1176344136
Shah PS, Shah J (2010) violence and pregnancy and birth outcomes: a systematic review and meta-analyses. J Maternal exposure to domestic Women’s Health 19:2017–2031. doi:10.1089/jwh.2010.2051
Smart RG, Arif A, Hughes P, Medina Mora ME, Navaratnam V, Varma VK, Wadud KA (1981) Drugs use among non-student youth—WHO offset publication, no 60. World Health Organization, Geneva
Spong CY, Mercer BM, D’Alton M, Kilpatrick S, Blackwell S, Saade G (2011) Timing of indicated late-preterm and early-term birth. Obstet Gynecol 118:323–333. doi:10.1097/AOG.0b013e3182255999
StataCorp (2014) Stata statistical software: release 14. Stata Corporation, College Station (TX)
Stein A et al (2014) Effects of perinatal mental disorders on the fetus and child. Lancet 384:1800–1819. doi:10.1016/S0140-6736(14)61277-0
Straus MA, Hamby SL, Boney-McCoy S, Sugarman DB (1996) The revised conflict tactics scales (CTS2). J Fam Issues 17:283–316. doi:10.1177/019251396017003001
Sumner LA, Wong L, Schetter CD, Myers HF, Rodriguez M (2012) Predictors of posttraumatic stress disorder symptoms among low-income Latinas during pregnancy and postpartum. Psychol Trauma 4:196–203. doi:10.1037/a0023538
Szwarcwald CL, Leal MC, Gouveia GC, Souza WV (2005) Health socioeconomic inequalities in Brazil: results of the World Health Survey, 2003. Rev Bras Saude Mater Infant 5:s11–s22. doi:10.1590/S1519-38292005000500002
Taillieu TL, Brownridge DA (2010) Violence against pregnant women: prevalence, patterns, risk factors, theories, and directions for future research. Aggress Violent Beh 15:14–35. doi:10.1016/j.avb.2009.07.013
Trevillion K, Oram S, Feder G, Howard LM (2012) Experiences of domestic violence and mental disorders: a systematic review and meta-analysis. PLoS One 7:e51740. doi:10.1371/journal.pone.0051740
Turner RJ, Lloyd DA (1995) Lifetime traumas and mental health: the significance of cumulative adversity. J Health Soc Behav: 360–376 doi:10.2307/2137325
Turner HA, Finkelhor D, Ormrod R (2006) The effect of lifetime victimization on the mental health of children and adolescents. Soc Sci Med 62:13–27. doi:10.1016/j.socscimed.2005.05.030
Verreault N, Da Costa D, Marchand A, Ireland K, Banack H, Dritsa M, Khalife S (2012) PTSD following childbirth: a prospective study of incidence and risk factors in Canadian women. J Psychosom Res 73:257–263. doi:10.1016/j.jpsychores.2012.07.010
Vossbeck-Elsebusch AN, Freisfeld C, Ehring T (2014) Predictors of posttraumatic stress symptoms following childbirth. BMC Psychiatry 14:200. doi:10.1186/1471-244X-14-200
Weathers F, Litz B, Herman D, Huska J, Keane T (1993) The PTSD checklist: reliability, validity, & diagnostic utility. Annual Meeting of the Internation Society of Traumatic Stress Studies, San Antonio, TX
WHO (2000) Women’s mental health: an evidence based review. WHO Press, Geneva
WHO (2012) Understanding and addressing violence against women: intimate partner violence. World Health Organization, Geneva
WHO (2013) Responding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines. World Health Organization, Geneva
Widom CS, Czaja SJ, Dutton MA (2008) Childhood victimization and lifetime revictimization. Child Abuse Neglect 32:785–796. doi:10.1016/j.chiabu.2007.12.006
Wosu A, Gelaye B, Williams M (2015) Childhood sexual abuse and posttraumatic stress disorder among pregnant and postpartum women: review of the literature. Arch Women Ment Hlth 18:61–72. doi:10.1007/s00737-014-0482-z
Acknowledgments
This study was funded by the Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro/FAPERJ (grant no. E-26/111.161/2011). AGSO was supported by the FAPERJ (grant no. E-26/101.563/2014). MER was supported partially by the Brazilian National Research Council (grant no. 302224/2013-0).
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All procedures performed in this study were in accordance with the ethical standards of the national research committee and with the 1964 Helsinki Declaration. Informed consent was obtained from all individual participants included in the study.
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Oliveira, A.G.e.S.d., Reichenheim, M.E., Moraes, C.L. et al. Childhood sexual abuse, intimate partner violence during pregnancy, and posttraumatic stress symptoms following childbirth: a path analysis. Arch Womens Ment Health 20, 297–309 (2017). https://doi.org/10.1007/s00737-016-0705-6
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DOI: https://doi.org/10.1007/s00737-016-0705-6