Domestic violence and perinatal mental disorders: a systematic review and meta-analysis.
Domestic violence and perinatal mental disorders: a systematic review and meta-analysis.
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DOI：
10.1371/journal.pmed.1001452
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发表时间：
2013
期刊：
影响因子：
15.8
通讯作者：
Feder G
中科院分区：
文献类型：
--
作者：
Howard LM;Oram S;Galley H;Trevillion K;Feder G
Louise Howard 及其同事进行了系统回顾和荟萃分析，以估计患有产前和产后心理健康障碍的妇女遭受家庭暴力的患病率和几率。 请参阅本文后面的编辑总结 围产期家庭暴力与不良产科结局相关，但其与围产期精神障碍相关的证据有限。我们的目的是估计患有产前和产后精神障碍（抑郁症和焦虑症，包括创伤后应激障碍 [PTSD]、饮食失调和精神病）的妇女遭受家庭暴力的患病率和几率。我们进行了系统回顾和荟萃分析（PROSPERO 参考 CRD42012002048）。数据来源包括电子数据库检索（截至 2013 年 2 月 15 日）、手工检索、引文跟踪、受害和精神障碍审查更新以及专家建议。纳入的研究是同行评审的实验性或观察性研究，这些研究报告了 16 岁或以上的女性，评估了遭受家庭暴力的患病率和/或几率，并使用经过验证的仪器评估了围产期精神障碍的症状。两名审稿人筛选了 1,125 篇全文论文，提取数据并独立评价研究质量。使用荟萃分析汇总优势比。收录了六十七篇论文。纵向研究的汇总估计表明，在怀孕期间经历过伴侣暴力后，产后出现高水平抑郁症状的几率增加了 3 倍（比值比 3.1，95% CI 2.7-3.6）。横断面研究一致报告，在产前和产后期间抑郁、焦虑和创伤后应激障碍症状严重的女性遭受家庭暴力的几率增加。没有发现关于饮食失调或产后精神病的研究。由于研究异质性和缺乏基线症状数据，分析受到限制，阻碍了因果方向性的明确发现。围产期抑郁、焦虑和创伤后应激障碍（PTSD）症状的严重程度与经历过家庭暴力显着相关。现在需要高质量的证据来说明孕产妇和心理健康服务应如何解决家庭暴力并改善妇女及其婴儿在围产期的健康结果。 请参阅本文后面的编辑摘要 家庭暴力（亲密伴侣或家庭成员的身体、性或情感虐待）是一个重大的公共卫生问题，虽然在女性中更为常见，但也会影响男性。由于问题的性质，很难收集有关家庭暴力规模的准确数据，但世界卫生组织在十个国家进行的一项研究发现，15%至71%的15至49岁女性报告称，在她们生命中的某个时刻遭受过亲密伴侣的身体和/或性暴力。遭受家庭暴力的妇女存在严重的短期和长期健康问题，特别是在心理健康方面：家庭暴力的经历可能导致一系列心理健康障碍，如抑郁、精神病、饮食失调，甚至企图自杀。由于围产期心理健康障碍是孕期和产后最常见的健康问题之一，并且考虑到孕期家庭暴力发生率（之前的研究表明孕期和产后家庭暴力发生率为4%~8%），围产期心理健康障碍与经历过家庭暴力之间可能存在联系。事实上，之前的评论已经表明存在这种关联，但受到纳入研究数量较少的限制，并且仅关注抑郁症，而不是全方位的产前和产后心理健康障碍。因此，在这项研究中，研究人员系统地回顾了已发表的研究，以对患有产前和产后心理健康障碍的妇女遭受家庭暴力的患病率提供更可靠的估计。研究人员还利用荟萃分析来估计患有产前和产后心理健康障碍的妇女遭受家庭暴力的几率。研究人员搜索了多个数据库，并使用关键搜索术语手动搜索了三份相关期刊，以识别所有类型的相关研究。研究人员使用特定标准检索并评估了 1,000 多篇完整论文，其中 67 篇符合系统审查标准。研究人员评估了每项选定研究的质量，并仅纳入那些使用经过验证的诊断仪器和筛查工具来评估精神健康障碍的研究，通过荟萃分析计算汇总（组合）比值比（OR）。使用这些方法，在横断面研究（在某个时间点进行的研究）中，研究人员发现，在产前可能患有抑郁症的女性在一生中（OR = 3）、过去一年（OR = 2.8）和怀孕期间（OR = 5）遭受伴侣暴力的患病率较高，且遭受伴侣暴力的几率也较高。产后的结果相似。对于焦虑症的证据并不那么有力：研究人员发现，在产前可能患有焦虑症的女性中，经历过终生伴侣暴力的 OR 为 2.9。产后的几率较低 (OR = 1.4) 在纵向研究（一段时间内的跟踪研究）分析中，研究人员发现，在一生中经历过伴侣暴力的女性 (OR = 2.9) 和在怀孕期间经历过伴侣暴力的女性 (OR = 3.1) 中，可能患产后抑郁症的几率更高。研究人员还发现，在怀孕期间遭受伴侣暴力后，产后可能出现抑郁症的综合患病率估计为 12.7%。由于数据有限，研究人员无法计算可能的产前抑郁症与后来的伴侣暴力经历之间的关联。这些研究结果表明，患有严重围产期心理健康障碍（产前和产后焦虑、抑郁和创伤后应激障碍）症状的女性，在一生中和怀孕期间经历家庭暴力的患病率很高，而且几率也更高。然而，这些发现不能证明因果关系，未能显示出双向关联（即围产期精神健康障碍导致随后的家庭暴力），并且没有关于其他围产期精神障碍（例如饮食失调和产后精神病）的信息。纳入研究的质量差异也限制了结果，突出表明需要高质量的数据来表明孕产妇和心理健康服务如何解决家庭暴力并改善妇女及其婴儿未来的健康结果。尽管如此，这项研究强调了在接受产前和心理健康服务的妇女中识别和应对可能的家庭暴力的重要性。请通过本摘要的在线版本访问这些网站：http://dx.doi.org/10.1371/journal.pmed.1001452。世界卫生组织提供有关暴力侵害妇女行为以及怀孕期间心理健康障碍的信息和统计数据 英国皇家精神科医师学院为专业人士和患者提供有关怀孕期间心理健康障碍的信息
Louise Howard and colleagues conduct a systematic review and meta-analysis to estimate the prevalence and odds of experience of domestic violence experience among women with antenatal and postnatal mental health disorders. Please see later in the article for the Editors' Summary Domestic violence in the perinatal period is associated with adverse obstetric outcomes, but evidence is limited on its association with perinatal mental disorders. We aimed to estimate the prevalence and odds of having experienced domestic violence among women with antenatal and postnatal mental disorders (depression and anxiety disorders including post-traumatic stress disorder [PTSD], eating disorders, and psychoses). We conducted a systematic review and meta-analysis (PROSPERO reference CRD42012002048). Data sources included searches of electronic databases (to 15 February 2013), hand searches, citation tracking, update of a review on victimisation and mental disorder, and expert recommendations. Included studies were peer-reviewed experimental or observational studies that reported on women aged 16 y or older, that assessed the prevalence and/or odds of having experienced domestic violence, and that assessed symptoms of perinatal mental disorder using a validated instrument. Two reviewers screened 1,125 full-text papers, extracted data, and independently appraised study quality. Odds ratios were pooled using meta-analysis. Sixty-seven papers were included. Pooled estimates from longitudinal studies suggest a 3-fold increase in the odds of high levels of depressive symptoms in the postnatal period after having experienced partner violence during pregnancy (odds ratio 3.1, 95% CI 2.7–3.6). Increased odds of having experienced domestic violence among women with high levels of depressive, anxiety, and PTSD symptoms in the antenatal and postnatal periods were consistently reported in cross-sectional studies. No studies were identified on eating disorders or puerperal psychosis. Analyses were limited because of study heterogeneity and lack of data on baseline symptoms, preventing clear findings on causal directionality. High levels of symptoms of perinatal depression, anxiety, and PTSD are significantly associated with having experienced domestic violence. High-quality evidence is now needed on how maternity and mental health services should address domestic violence and improve health outcomes for women and their infants in the perinatal period. Please see later in the article for the Editors' Summary Domestic violence—physical, sexual, or emotional abuse by an intimate partner or family member—is a major public health problem and although more common in women, can also affect men. Due to the nature of the problem, it is difficult to collect accurate figures on the scale of domestic violence, but a study by the World Health Organization in ten countries found that 15%–71% of women aged 15–49 years reported physical and/or sexual violence by an intimate partner at some point in their lives. Women experiencing domestic violence have significant short- and long-term health problems, particularly regarding their mental health: experience of domestic violence can lead to a range of mental health disorders such as depression, psychosis, eating disorders, and even suicide attempts. As perinatal mental health disorders are among the commonest health problems in pregnancy and the postpartum period, and given the rate of domestic violence during pregnancy (previous studies have suggested a domestic violence prevalence of 4%–8% during pregnancy and the postnatal period), it is plausible that there may be a link between perinatal mental health disorders and having experienced domestic violence. Indeed, previous reviews have suggested the existence of such an association but were limited by the small number of included studies and focused on depression only, rather than the full range of antenatal and postnatal mental health disorders. So in this study the researchers systematically reviewed published studies to provide more robust estimates of the prevalence of having experienced domestic violence among women with antenatal and postnatal mental health disorders; the researchers also used a meta-analysis to estimate the odds (chance) of having experienced domestic violence among women with antenatal and postnatal mental health disorders. The researchers searched multiple databases and hand searched three relevant journals using key search terms to identify all types of relevant studies. Using specific criteria, the researchers retrieved and assessed over 1,000 full papers, of which 67 met the criteria for their systematic review. The researchers assessed the quality of each selected study and included only those studies that used validated diagnostic instruments and screening tools to assess mental health disorders in their calculations of the pooled (combined) odds ratio (OR) through meta-analysis. Using these methods, in cross-sectional studies (studies conducted at one point in time), the researchers found that women with probable depression in the antenatal period reported a high prevalence and increased odds of having experienced partner violence during their lifetime (OR = 3), during the past year (OR = 2.8), and during pregnancy (OR = 5). The results were similar for the postnatal period. The evidence was less robust for anxiety disorders: among women with probable anxiety in the antenatal period, the researchers found an OR of 2.9 of having experienced lifetime partner violence. The odds were less in the postnatal period (OR = 1.4) In their analysis of longitudinal studies (follow-up studies over a period of time), the researchers found an increased odds of probable postnatal depression both among women who reported having ever experienced partner violence in their lifetime (OR = 2.9) and among women who reported having experienced partner violence during pregnancy (OR = 3.1). The researchers also found a combined prevalence estimate of 12.7% for probable depression during the postnatal period following experiences of partner violence during pregnancy. Because of limited data, the researchers could not calculate an OR of the association between probable antenatal depression and later experiences of partner violence. These findings suggest that women with high levels of symptoms of perinatal mental health disorders—antenatal and postnatal anxiety, depression, and post-traumatic stress disorder—have a high prevalence and increased odds of having experienced domestic violence both over their lifetime and during pregnancy. However, these findings cannot prove causality, they fail to show a two-way association (that is, perinatal mental health disorders leading to subsequent domestic violence), and no information on other perinatal mental disorders, such as eating disorders and puerperal psychosis, was available. The variation of the quality of the included studies also limits the results, highlighting the need for high-quality data to suggest how maternity and mental health services could address domestic violence and improve health outcomes for women and their infants in the future. Nevertheless, this study emphasizes the importance of identifying and responding to possible domestic violence among women attending antenatal and mental health services. Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001452. The World Health Organization provides information and statistics about violence against women and also about mental health disorders during pregnancy The UK Royal College of Psychiatrists has information for professionals and patients about mental health disorders during pregnancy