Intimate partner violence during pregnancy in relation to non-psychotic mental health disorders in Rwanda: a cross-sectional population-based study

Intimate partner violence, depression, hazardous alcohol use, and social support among people with HIV initiating HIV care in Cameroon

Intimate partner violence (IPV) has been associated with poor mental health among people with HIV (PWH) globally. Social support may be a strategy to foster mental health among PWH. Little is known about whether the relationship between IPV and mental health differs by IPV type or level of social support. Interviews were conducted with 426 PWH initiating HIV care in Cameroon. Log binomial regression analyses were used to estimate the association between four types of IPV (controlling behavior and emotional, physical, and sexual IPV) and symptoms of depression or hazardous alcohol use, separately by IPV type and level of social support. Over half (54.8%) of respondents experienced moderate/high levels of controlling behavior, 42.0% experienced emotional IPV, 28.2% experienced physical IPV and 23.7% experienced sexual IPV. Controlling behavior was associated with greater prevalence of depressive symptoms. This relationship did not vary meaningfully by level of social support (low: aPR 2.4 [95% CI 1.2, 4.9]; high: 1.7 [95% CI 1.0, 2.7]). Emotional and physical IPV were associated with greater prevalence of depressive symptoms among those with low social support (emotional IPV: aPR 1.9 [95% CI 1.0, 3.4]; physical IPV: aPR 1.8 [95% CI 1.2, 2.8]), but not among those with high social support (emotional IPV: aPR 1.0 [95% CI 0.7, 1.6]; physical IPV: aPR 1.0 [95% CI 0.6, 1.6]). Controlling behavior, emotional IPV, and physical IPV were associated with a greater prevalence of hazardous alcohol use, with moderately larger effect estimates among those with high compared to low social support. Sexual IPV was not associated with depressive symptoms or hazardous alcohol use. Services to screen and care for people experiencing IPV are urgently needed among PWH in Cameroon. Future research to identify barriers, feasibility, acceptability, and organizational readiness to integrate IPV and mental health services into HIV care settings is needed.

Interparental Coercive Control and Child and Family Outcomes: A Systematic Review

Coercive control (CC) is a core facet of intimate partner violence (IPV) and involves asserting power, dominance, and control over another person. Although the adverse impacts of childhood exposure to interparental IPV have been well documented, the outcomes of childhood exposure to interparental CC have not been systematically examined. This study aimed to address this gap by reviewing available empirical evidence on interparental CC and child and family outcomes. Articles were identified by searching electronic databases using keywords relating to CC, children and parents, and child wellbeing outcomes. The final review included 51 studies that reported on adverse outcomes pertaining to parenting and family relationships (k = 29), child internalizing and externalizing problems (k = 7), social-emotional development (k = 5), and physical/health development (k = 17). Specifically, studies reported that CC was associated with increased parental psychopathology, poorer family functioning, harsher parenting and higher levels of child abuse, strained parent-child relationships, children used as tools and co-victims of CC, increased risk of child internalizing and externalizing problems, limited socializing opportunities, increased bullying, poorer perinatal outcomes, limited access to healthcare, and increased risk of child mortality. Evidence identified CC as a unique contributor to adverse child wellbeing outcomes, independent of exposure to IPV more broadly. Results indicated that the impacts of childhood exposure to CC are complex, far reaching, and, in some cases, devastating. The limitations of the findings, as well as implications for practice, policy, and research are discussed.

Gender, Power, and Health: Measuring and Assessing Sexual Relationship Power Equity Among Young Sub-Saharan African Women and Men, a Systematic Review

Gender inequity, including low sexual relationship power (SRP), is an important determinant of intimate partner violence (IPV) and negative sexual, reproductive, and mental health. Different versions of the Sexual Relationship Power Scale (SRPS) are commonly used within youth studies to examine how gender inequities, including controlling behaviors, in heterosexual relationships impact the lives of young people in sub-Saharan Africa. This review aims to (1) describe definitions and measures of SRP within sub-Saharan African youth studies and (2) review and summarize associations between SRP equity, IPV, and sexual, reproductive, and mental health. After searching Pubmed, Ovid Med, Psych info, Web of Science, Google Scholar, and relevant research forums, 304 papers were identified, of which 29 papers based on 15 distinct studies (published 2004-2019) met our criteria for being youth-specific, conducted in sub-Saharan Africa, and including a quantitative measure of SRP. Details of each SRPS are described, including any adaptations and psychometric properties, as well as associations with IPV, sexual, reproductive, and mental health behaviors and outcomes. Results indicate that there are variations to the SRPS, and a paucity of evidence has detailed the psychometric properties of such measures within sub-Saharan African youth studies. Measures of SRP equity are associated with experiences (among women) and perpetration of (among men) IPV as numerous pathways to HIV risk; however, the evidence remains mixed. In order to address overlapping epidemics of violence against women and HIV, efforts are needed to ensure that measures, including the SRPS, are valid and reliable among highly affected populations.

Mental distress and associated factors among women who experienced gender based violence and attending court in South Ethiopia: a cross-sectional study

BACKGROUND

Gender-based violence is an act that has physical, psychological, and sexual consequences for women. It is a widespread issue, particularly in developing countries, and it causes women mental distress. Despite the fact that gender-based violence has a significant impact on mental distress, there have no study in Ethiopia. As a result, the purpose of this study was to determine the prevalence and associated factors of mental distress among mothers who had experienced gender-based violence and were in court.

METHODS

A cross-sectional study was conducted on 423 samples. The data was entered into Epi-data version 3.01 and analyzed with SPSS version 21. Binary logistic regression was used, and variables with p-values less than 0.05 were considered statistically significant with regard to mental distress at the respective 95% CI.

RESULT

The prevalence of mental distress was found to be 59.6% in this study. Mental distress was associated with factors such as a lack of social support, a lack of formal education, a husband's substance use, rural residence, age greater than 33 years, and a low family income.

CONCLUSION

The prevalence of mental distress is high when compared to the majority of previous findings from other countries. Screening and managing psychological distress in women with a history of violence is preferable, and integrating psychosocial care into court services is recommended.

The prevalence of mental disorders among intimate partner violence exposed and non-exposed Rwandans: Findings from a national cross-sectional survey

Despite mounting evidence indicating an increased risk of long-term mental disorders in Rwanda's general population, little is still known about the national prevalence of mental disorders among victims of intimate partner violence (IPV) in a post-conflict setting. The aim of this study was to compare the prevalence of mental disorders among IPV exposed and non-exposed individuals in Rwanda. This was a cross-sectional study based on secondary data from the 2018 Rwanda Mental Health Survey. The sample consisted 20,381 participants selected nationwide, from 7,124 households (age range: 14-65 years), of which 3,759 Rwandans were exposed to IPV (18.4%) and 16,622 were non-exposed to IPV (81.6%). Participants were screened for IPV exposure and common mental disorders, and data was analyzed using the SPSS version 25 software. The results showed that the rate of any mental disorder was substantially higher in the group exposed to IPV than the non-exposed, at 32.4% and 11.7% respectively. These results highlight that among Rwandans diagnosed with severe mental disorders, participants with a history of IPV exposure present with increased odds of mental disorders prevalence and severity. Therefore, people seeking mental health care should also be screened for their IPV exposure and offered appropriate interventions.

Maternal Suicide Ideation and Behaviour During Pregnancy and the First Postpartum Year: A Systematic Review of Psychological and Psychosocial Risk Factors

Suicide is a leading cause of maternal death during pregnancy and up to a year after birth (perinatal period). Many psychological and psychosocial risk factors for maternal suicidal ideation and behaviour have been investigated. Despite this, there have been no attempts to systematically search the literature on these risk factors. Additionally, few studies have described how the risk factors for suicidal ideation, attempted suicides and suicide deaths differ, which is essential for the development of tools to detect and target suicidal ideation and behaviour. Seven databases were searched up to June 2021 for studies that investigated the association between suicidal ideation and/or suicidal behaviour and psychological/psychosocial risk factors in pregnant and postpartum women. The search identified 17,338 records, of which 59 were included. These 59 studies sampled a total of 49,929 participants and investigated 32 different risk factors. Associations between abuse, experienced recently or during childhood, and maternal suicide ideation, attempted suicide and death were consistently reported. Social support was found to be less associated with suicide ideation but more so with suicide attempts. Identifying women who have experienced domestic violence or childhood abuse and ensuring all women have adequate emotional and practical support during the perinatal period may help to reduce the likelihood of suicidal behaviour.

Risk factors of perinatal depression in women: a systematic review and meta-analysis

BACKGROUND

Perinatal depression in women is associated with high morbidity and mortality, and has attracted increasing attention. The investigation of risk factors of perinatal depression in women may contribute to the early identification of depressed or depression-prone women in clinical practice.

MATERIAL AND METHODS

A computerized systematic literature search was made in Cochrane Library, PubMed, Web of Science, and EMBASE from January 2009 to October 2021. All included articles were published in English, which evaluated factors influencing perinatal depression in women. Based on the recommendations of the Cochrane Collaboration protocols, Review Manager 5.3 was used as a statistical platform.

RESULTS

Thirty-one studies with an overall sample size of 79,043 women were included in the review. Educational level (P = 0.0001, odds ratio [OR]: 1.40, 95% CI: [1.18,1.67]), economic status of families (P = 0.0001, OR: 1.69, 95%CI: [1.29,2.22]), history of mental illness (P < 0.00001, OR: 0.29, 95% CI: [0.18, 0.47]), domestic violence (P < 0.00001, OR: 0.24, 95% CI: [0.17,0.34]), perinatal smoking or drinking (P = 0.005, OR: 0.63; 95% CI [0.45, 0.87]; P = 0.008, OR: 0.43, 95% CI, [0.23 to 0.80]; respectively), and multiparity(P = 0.0003, OR: 0.74, 95% CI: [0.63, 0.87]) were correlated with perinatal depression in women. The stability of our pooled results was verified by sensitivity analysis and publication bias was not observed based on funnel plot results.

CONCLUSION

Lower educational level, poor economic status of families, history of mental illness, domestic violence, perinatal smoking or drinking, and multiparity serve as risk factors of perinatal depression in women.

Suicidal ideation and behavior among perinatal women and their association with sleep disturbances, medical conditions, and known risk factors

OBJECTIVE

Suicide is considered one of the leading causes of maternal mortality, especially among women with postpartum depression. In the current systematic review, we conducted a qualitative data synthesis of recent studies exploring novel risk factors including sleep disturbances and medical conditions, alongside known and significant risk factors for perinatal suicidality.

EVIDENCE ACQUISITION

We conducted a systematic search of the literature according to PRISMA guidelines on PubMed, PsycNET, and Scopus databases. Search terms were "pregnancy" "OR" "postpartum" "OR" "peripartum" "OR" "perinatal" "OR" "postnatal" combined with the Boolean "AND" operator with "suicide" "OR" "suicidality" "OR" "suicidal ideation" "OR" "suicidal behavior."

EVIDENCE SYNTHESIS

The initial search yielded 1,458 records, of which 51 research reports that met inclusion criteria were analyzed. These 51 studies sampled a total of 45,942 participants. Clinically, sleep disturbance, psychopathology, and social support have been identified as dominant risk factors for suicidal behavior among pregnant and postpartum women, as well as medical conditions and aversive life events.

CONCLUSION

Monitoring sleep disturbance, depression, and perceived social support is critical given that they are significant risk factors for suicide among perinatal women. Early identification of perinatal women who may be at risk of suicide, although not depressed, is crucial.

LIMITATIONS

The use of tools designed to identify depression to identify suicidal risk, fail to identify women who are at risk but who do not suffer from depression. Other methodological limitations are the lack of longitudinal studies and the complexity of examining suicidal behavior in sample studies.

[Clinical complications during pregnancy: a systematic review of studies with pregnant Brazilian women]

The scope of this paper was to describe the main clinical complications among pregnant Brazilian women reported in the literature, identifying the most relevant exposure factors and their outcomes in maternal and child health. This is a systematic review of articles published between 2010 and 2018. Three reviews and 36 empirical articles were included; mental disorders (n=9), infectious diseases (n=9) and severe maternal morbidity (n=8) were the main clinical complications during pregnancy. In addition, four articles focused on determining the main conditions or causes of hospitalization, with a higher frequency of Urinary Tract Infection, anemia and hypertensive diseases. Maternal age at reproductive extremes, lower schooling, socioeconomic vulnerability, racial characteristics and the use of public health services were the most relevant exposure factors. Unfavorable health outcomes associated with clinical complications in pregnancy were verified in the eight articles with this profile. The frequency of pregnant women with potential life-threatening clinical complications is high in the country, highlighting the importance of primary care coverage and the implementation of interventions to reduce and prevent adverse maternal and child outcomes.

Trauma Exposure and Intimate Partner Violence Among Young Pregnant Women in Liberia

Intimate partner violence (IPV) is a global threat to women's health and may be elevated among those exposed to traumatic events in post-conflict settings, such as Liberia. The purpose of this study was to examine potential mediators between lifetime exposure to traumatic events (i.e., war-related trauma, community violence) with recent experiences of IPV among 183 young, pregnant women in Monrovia, Liberia. Hypothesized mediators included mental health (depression, posttraumatic stress symptoms), insecure attachment style (anxious and avoidant attachment), and attitudes indicative of norms of violence (attitudes justifying wife beating). We tested a parallel multiple mediation model using the PROCESS method with bias-corrected and accelerated bootstrapping to test confidence intervals (CI). Results show that 45% of the sample had experienced any physical, sexual, or emotional IPV in their lifetime, and 32% in the 2 months prior to the interview. Exposure to traumatic events was positively associated with recent IPV severity (β = .40, p < .01). Taken together, depression, anxious attachment style, and justification of wife beating significantly mediated the relationship between exposure to traumatic events and experience of IPV (β = .15, 95% CI = [0.03, 0.31]). Only anxious attachment style (β = .07, 95% CI = [0.03, 0.16]) and justification of wife beating (β = .05, 95% CI = [0.01, 0.16]) were identified as individual mediators. This study reinforces pregnancy as an important window for both violence and mental health screening and intervention for young Liberian women. Furthermore, it adds to our theoretical understanding of mechanisms in which long-term exposure to traumatic events may lead to elevated rates of IPV in Liberia, and points to the need for trauma-informed counseling and multilevel gender transformative public health approaches to address violence against women.

Understanding Mental Health in the Context of Adolescent Pregnancy and HIV in Sub-Saharan Africa: A Systematic Review Identifying a Critical Evidence Gap

Adolescent (10-19 years) mental health remains an overlooked global health issue. Rates of adolescent pregnancy within sub-Saharan Africa are some of the highest in the world and occur at the epicentre of the global HIV epidemic. Both experiencing adolescent pregnancy and living with HIV have been found to be associated with adverse mental health outcomes, when investigated separately. Poor mental health may have implications for both parent and child. The literature regarding mental health within groups experiencing both HIV and adolescent pregnancy is yet to be summarised. This systematic review sought to identify (1) the prevalence/occurrence of common mental disorder amongst adolescents who are living with HIV and have experienced pregnancy, (inclusive of adolescent fathers) in sub-Saharan Africa (2) risk and protective factors for common mental disorder among this group, and (3) interventions (prevention/treatment) for common mental disorder among this group. A systematic search of electronic databases using pre-defined search terms, supplemented by hand-searching, was undertaken in September 2020. One author and an independent researcher completed a title and abstract screening of results from the search. A full-text search of all seemingly relevant manuscripts (both quantitative and qualitative) was undertaken and data extracted using pre-determined criteria. A narrative synthesis of included studies is provided. Quality and risk of bias within included studies was assessed using the Newcastle-Ottawa scale. A systematic keyword search of databases and follow-up hand searching identified 2287 unique records. Of these, thirty-eight full-text quantitative records and seven full-text qualitative records were assessed for eligibility. No qualitative records met the eligibility criteria for inclusion within the review. One quantitative record was identified for inclusion. This study reported on depressive symptomology amongst 14 pregnant adolescents living with HIV in Kenya, identifying a prevalence of 92.9%. This included study did not meet the high methodological quality of this review. No studies were identified reporting on risk and protective factors for common mental disorder, and no studies were found identifying any specific interventions for common mental disorder for this group, either for prevention or for treatment. The limited data identified within this review provides no good quality evidence relating to the prevalence of common mental disorder among adolescents living with HIV who have experienced pregnancy in sub-Saharan Africa. No data was available relating to risk and protective factors or interventions for psychological distress amongst this group. This systematic review identifies a need for rigorous evidence regarding the mental health of pregnant and parenting adolescents living with HIV, and calls for granular interrogation of existing data to further our understanding of the needs of this group. The absence of research on this topic (both quantitative and qualitative) is a critical evidence gap, limiting evidence-based policy and programming responses, as well as regional development opportunities.