Summary: Pregnant women and new mothers with schizophrenia are three times more likely to go to the emergency room because they are victims of interpersonal violence, a new study finds.
Source: CMJ extension
Pregnant and postpartum people with schizophrenia have a more than threefold risk of an emergency room visit for interpersonal violence, compared to those without schizophrenia, according to a new study in CMJ extension.
Interpersonal violence can include physical, sexual and psychological abuse by a family member, intimate partner, acquaintance or stranger.
“Although we found a tripled 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 psychiatry resident at the University of Toronto. “This suggests that there are many opportunities for healthcare professionals to intervene and prevent harm to these patients and their children.”
About 1 in 5 (20.7%) women with schizophrenia experience physical or sexual violence in their lifetime, about 9 times the risk for those without serious mental illness. However, little is known about their risk during the perinatal period.
Conducted by researchers from ICES and Women’s College Hospital, the study included more than 1.8 million pregnant women aged 15 to 49, including 4,470 diagnosed with schizophrenia. People with schizophrenia were more likely to live in a low-income neighborhood, have other chronic medical and psychiatric conditions, and have had an emergency room (ED) visit for interpersonal violence in the 2 years before 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 delivery, compared with 0.4% of those without schizophrenia.
- Pregnant individuals with schizophrenia were equally likely to be screened (74.3% vs. 73.8%), but more likely to self-report (10.2% vs. 2.4%), interpersonal violence.
- Among study participants who were screened and no revealing interpersonal violence in pregnancy, schizophrenia was associated with a sixfold increase in the risk of experiencing an emergency room visit for interpersonal violence both in pregnancy and after delivery.
The study suggests “that routine violence screening in antenatal care facilities is an important intervention opportunity to prevent serious physical, psychological and social harm to these patients and their children,” writes Dr. Simone Vigod, chief of psychiatry, Women’s College Hospital and a professor at the Temerty Faculty of Medicine, University of Toronto, with co-authors.
On this news of the research on interpersonal violence and schizophrenia
Author: Kim Barnhardt
Source: CMJ extension
Contact: Kim Barnhardt – CMAJ
Image: Image is public domain
Original research: Access closed.
“Risk of interpersonal violence during and after pregnancy among persons with schizophrenia: A population-based cohort study” by Simone Vigod et al. CMJ extension
See also
Abstract
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 particularly in the period of pregnancy.
Methods: This population-based cohort study included all individuals (ages 15-49) listed as female on their health card who had a single birth in Ontario, Canada between 2004 and 2018. We compared those with and without schizophrenia on their risk of an emergency department (ED) visit for interpersonal violence in pregnancy or within 1 year postpartum. We adjusted relative risks (RR) for demographics, prepregnancy history of substance use disorder, and history of interpersonal violence. In a subcohort analysis, we used data from the linked clinical registry 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 (confidence interval of 95% [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 first year postpartum (adjusted RR 3.45, 95% CI 2.75 -4.33). Pregnant women 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 more probability of self-reporting it (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 the postpartum period are times of increased risk for interpersonal violence among people with schizophrenia compared to those without schizophrenia. Pregnancy is a key time to implement violence prevention strategies in this population.