Summary: Pregnant women and new mothers with schizophrenia are three times more likely to visit the emergency room as a result of being victims of interpersonal violence, a new study finds.
source: CMJ
Pregnant and postpartum women with schizophrenia have a more than threefold increased risk of an emergency room visit for interpersonal violence compared to those without schizophrenia, according to a new study in CMJ.
Interpersonal violence can include physical, sexual, and psychological abuse by a family member, intimate partner, acquaintance, or stranger.
“Although we found a threefold increased risk for people with schizophrenia, we also found that the majority of people, both with and without schizophrenia, are screened for interpersonal violence during pregnancy,” says lead author Kelly Leslie, fourth year resident in psychiatry at the University of Toronto. “This suggests that there are many opportunities for healthcare providers to intervene and prevent harm to these patients and their children.”
About 1 in 5 (20.7%) women with schizophrenia experienced physical or sexual abuse in their lifetime, about 9 times the risk for those without a serious mental illness. However, little is known about their risk during the perinatal period.
Led by researchers from ICES and Women’s College Hospital, the study included more than 1.8 million pregnant people aged 15-49, of whom 4,470 had been diagnosed with schizophrenia. People with schizophrenia were more likely to live in a lower-income neighborhood, to have other psychiatric and chronic illnesses, and to have had an emergency department (ED) visit for interpersonal violence in the 2 years before their pregnancy.
Key Findings:
- Overall, 3.1% of people with schizophrenia had an emergency room visit for interpersonal violence during pregnancy and the first year after giving birth, compared to 0.4% of those without schizophrenia.
- Pregnant individuals with schizophrenia were equally likely to be screened for (74.3% vs. 73.8%), yet more likely to self-report (10.2% vs. 2.4%), interpersonal violence.
- Among the study participants who were screened and I was not revealed interpersonal violence during pregnancy, schizophrenia was associated with a sixfold increase in the risk of experiencing an emergency visit for interpersonal violence both during pregnancy and postpartum.
The study suggests that “routine screening for violence in prenatal care settings is an important opportunity for intervention to prevent severe physical, psychological and social harm to these patients and their children,” writes Simone Vigod, MD, chief of psychiatry, Women’s Hospital in college and a professor at the Temerty School of Medicine, University of Toronto, with co-authors.
For this research news on interpersonal violence and schizophrenia
Author: Kim Barnhardt
source: CMJ
Contact: Kim Barnhardt – CMAJ
Image: Image is in the public domain
Original research: Closed access.
“Risk of interpersonal violence during and after pregnancy among people with schizophrenia: a population-based cohort study” by Simone Vigod et al. CMJ
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Summary
Risk of interpersonal violence during and after pregnancy among people with schizophrenia: a population-based cohort study
Background: Schizophrenia is associated with an increased risk of experiencing interpersonal violence. Little is known about the risk specifically during pregnancy.
Methods: This population-based cohort study included all individuals (aged 15–49 years) identified as female on their health records who had a singleton birth in Ontario, Canada, between 2004 and 2018. We compared those with and without schizophrenia regarding the risk of an emergency department (ED) visit for interpersonal violence during pregnancy or within 1 year postpartum. We adjusted relative risks (RRs) for demographics, history of substance use disorder before pregnancy, and history of interpersonal violence. In a subcohort analysis, we used linked clinical registry data to assess interpersonal violence screening and self-reported interpersonal violence during pregnancy.
Results: We included 1,802,645 pregnant women, 4470 of whom had a diagnosis of schizophrenia. Overall, 137 (3.1%) of those with schizophrenia had a perinatal ED visit for interpersonal violence, compared with 7598 (0.4%) of those without schizophrenia, for a RR of 6.88 (95% CI [CI] 5.66–8.37) and an adjusted RR of 3.44 (95% CI 2.86–4.15). Results were similar when calculated separately for the period of pregnancy (adjusted RR 3.47, 95% CI 2.68–4.51) and the first year postpartum (adjusted RR 3.45, 95% CI 2.75–4 ,33). Pregnant people with schizophrenia were equally likely to be screened for interpersonal violence (74.3% vs 73.8%; adjusted RR 0.99, 95% CI 0.95–1.04) but were more likely to report it alone (10.2% vs 2.4%; adjusted RR 3.38, 95% CI 2.61–4.38), compared with those without schizophrenia. Among patients who did not self-report interpersonal violence, schizophrenia was associated with an increased risk of a perinatal ED visit for interpersonal violence (4.0% vs 0.4%; adjusted RR 6.28, 95% CI 3.94– 10.00).
Interpretation: Pregnancy and postpartum are periods of higher risk of interpersonal violence among people with schizophrenia compared to those without schizophrenia. Pregnancy is a key period for implementing violence prevention strategies in this population.