Associations between intimate partner violence profiles and mental health among low-income, urban pregnant adolescents

Jordan L Thomas, Jessica B Lewis, Isabel Martinez, Shayna D Cunningham, Moiuri Siddique, Jonathan N Tobin, Jeannette R Ickovics, Jordan L Thomas, Jessica B Lewis, Isabel Martinez, Shayna D Cunningham, Moiuri Siddique, Jonathan N Tobin, Jeannette R Ickovics

Abstract

Background: Intimate partner violence (IPV) during pregnancy is associated with adverse maternal and child health outcomes, including poor mental health. Previous IPV research has largely focused on women's victimization experiences; however, evidence suggests young women may be more likely to engage in bilateral violence (report both victimization and perpetration) or perpetrate IPV (unilateral perpetration) during pregnancy than to report being victimized (unilateral victimization). This study examined prevalence of unilateral victimization, unilateral perpetration, and bilateral violence, and the association between these IPV profiles and mental health outcomes during pregnancy among young, low-income adolescents.

Methods: Survey data were collected from 930 adolescents (14-21 years; 95.4% Black and Latina) from fourteen Community Health Centers and hospitals in New York City during second and third trimester of pregnancy. Multivariable regression models tested the association between IPV profiles and prenatal depression, anxiety, and distress, adjusting for known predictors of psychological morbidity.

Results: Thirty-eight percent of adolescents experienced IPV during their third trimester of pregnancy. Of these, 13% were solely victims, 35% were solely perpetrators, and 52% were engaged in bilateral violence. All women with violent IPV profiles had significantly higher odds of having depression and anxiety compared to individuals reporting no IPV. Adolescents experiencing bilateral violence had nearly 4-fold higher odds of depression (OR = 3.52, 95% CI: 2.43, 5.09) and a nearly 5-fold increased likelihood of anxiety (OR = 4.98, 95% CI: 3.29, 7.55). Unilateral victims and unilateral perpetrators were also at risk for adverse mental health outcomes, with risk of depression and anxiety two- to three-fold higher, compared to pregnant adolescents who report no IPV. Prenatal distress was higher among adolescents who experienced bilateral violence (OR = 2.84, 95% CI: 1.94, 4.16) and those who were unilateral victims (OR = 2.21, 95% CI: 1.19, 4.12).

Conclusions: All violent IPV profiles were associated with adverse mental health outcomes among pregnant adolescents, with bilateral violence having the most detrimental associations. Comprehensive IPV screening for both victimization and perpetration experiences during pregnancy is warranted. Clinical and community prevention efforts should target pregnant adolescents and their partners to reduce their vulnerability to violence and its adverse consequences.

Trial registration: ClinicalTrials.gov, NCT00628771 . Registered 29 February 2008.

Keywords: Adolescents; Bilateral violence; Depression; Intimate partner violence; Mental health; Pregnancy.

Conflict of interest statement

Ethics approval and consent to participate

This study was approved by Yale University (26962), and Clinical Directors Network (004–06), Bronx Lebanon Hospital Center (05 08 08 02), Biomedical Research Alliance of New York (08–02-242(HHC)-202), Brookdale University Hospital and Medical Center (07–18), Brooklyn Hospital Center (624), Columbia University Medical Center (IRB-AAAD1707), Flushing Hospital (08/07–1), Lutheran Medical Center (53), and Public Health Solutions (032607). All participants provided written informed consent. The IRBs for 12 of the 14 study sites waived the parental informed consent requirement for participants aged 14–17, because the study was low risk and participants were independently consenting to their own prenatal care per New York State law. Thus, these IRBs considered these participants mature minors, able to independently provide informed consent for this study. Two of the 14 study sites’ local IRBs required parental consent. For those participants, both parental informed consent and minor assent was obtained.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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