Toronto, ON, March 6, 2023 – Pregnant and postpartum people with schizophrenia have a more than three-fold increase in the risk of an emergency department visit for interpersonal violence and are more likely to self-report experiencing abuse in the pregnancy, compared to their peers without schizophrenia, according to a new study.
The research, led by Women’s College Hospital and ICES, found that about 1 in every 33 pregnant and postpartum individuals with schizophrenia experienced an emergency department (ED) visit for interpersonal violence, which can include physical, sexual, and/or emotional abuse by someone known to them such as a family member, intimate partner, or acquaintance, or by an unknown assailant.
While research outside of pregnancy has estimated that 20.7% of women with schizophrenia experience physical or sexual violence—a much greater risk than those without serious mental illness—less is known about these women’s experiences of violence during the pregnancy and the postpartum period. Violence during this period is a particular concern as it can affect not only the pregnant or postpartum person, but also the developing fetus or infant.
“We found a three-fold increased risk of an ED visit for interpersonal violence among pregnant and postpartum individuals with schizophrenia, which is concerning. On a positive note, 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, a fourth-year psychiatry resident at the University of Toronto. “This suggests there are many opportunities for healthcare providers to intervene and prevent harm to these patients and their children.”
Researchers used data from ICES, a non-profit research institute in Ontario, and included all people aged 15-49 who gave birth from 2004 to 2018. 4470 patients with schizophrenia and 1,798,175 without schizophrenia were compared.
The study, published in CMAJ, found that:
- About 3.1% of pregnant and postpartum individuals with schizophrenia had an ED visit for interpersonal violence perinatally, versus 0.4% of those without schizophrenia. This risk was similar during pregnancy and in the first year postpartum.
- Pregnant people with schizophrenia were equally likely to be screened for (74.3% vs. 73.8%), but more likely to self-report (10.2% vs. 2.4%), interpersonal violence.
- Among pregnant people who were screened and did not disclose interpersonal violence in pregnancy, schizophrenia was still associated with a 6-fold increase in the risk of experiencing an ED visit for interpersonal violence in pregnancy or postpartum.
These results are consistent with previous research suggesting that women with psychiatric disorders may under-disclose their concerns. There is some worry that if they disclose any social issues to physicians, such as interpersonal violence, there could be negative consequences (such as child apprehension or violent retaliation from the perpetrator). This could lead to false negative responses for interpersonal violence during screening.
“Our findings highlight the importance of completing interpersonal violence screening in a careful and sensitive manner,” says senior author Simone Vigod, senior scientist and head of the department of psychiatry at Women’s College Hospital and senior adjunct scientist at ICES. “We would encourage any healthcare professionals who have contact with this patient population to review best practice guidelines and facilitate appropriate violence screening and interventions.”
The study, “Risk of interpersonal violence during and after pregnancy among people with schizophrenia: a population-based cohort study” was published in CMAJ.
ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: @ICESOntario
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