Pregnant Women With Schizophrenia Have Threefold Risk of Interpersonal Violence

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: CMAJ

Pregnant and postpartum people with schizophrenia have a more than threefold increase in the risk of an emergency department visit for interpersonal violence, compared with those without schizophrenia, according to a new study in CMAJ.

Interpersonal violence can include physical, sexual and psychological abuse by a family member, intimate partner, acquaintance or stranger.

“Though we found a threefold increased risk for individuals 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, a fourth-year psychiatry resident at the University of Toronto. “This suggests there are many opportunities for health care providers 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 during their lifetime, about 9 times the risk for those without 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 years, of whom 4470 had been diagnosed with schizophrenia. People with schizophrenia were more likely to live in a lower-income neighbourhood, to have other psychiatric and chronic medical conditions, 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 ED visit for interpersonal violence during pregnancy and the first year postpartum, versus 0.4% of those without schizophrenia.
Pregnant individuals with schizophrenia were equally likely to be screened for (74.3% v. 73.8%), yet more likely to self-report (10.2% v. 2.4%), interpersonal violence.
Among study participants who were screened and did not disclose interpersonal violence in pregnancy, schizophrenia was associated with a sixfold increase in the risk of experiencing an ED visit for interpersonal violence in both pregnancy and postpartum.

The study suggests “that routine violence screening in antenatal care settings is an important opportunity for intervention to prevent severe physical, psychological and social harm to these patients and their children,” writes Dr. Simone Vigod, head of psychiatry, Women’s College Hospital and a professor at the Temerty Faculty of Medicine, University of Toronto, with coauthors.

Abstract

Risk of interpersonal violence during and after pregnancy among people with schizophrenia: a population-based cohort study

Background: Schizophrenia is associated with increased risk of experiencing interpersonal violence. Little is known about risk specifically around the time of pregnancy.

Methods: This population-based cohort study included all individuals (aged 15–49 yr) listed as female on their health cards who had a singleton 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 (RRs) for demographics, prepregnancy history of substance use disorder and history of interpersonal violence. In a subcohort analysis, we used linked clinical registry data to evaluate interpersonal violence screening and self-reported interpersonal violence during pregnancy.

Results: We included 1 802 645 pregnant people, 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 an RR of 6.88 (95% confidence interval [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 pregnancy (adjusted RR 3.47, 95% CI 2.68–4.51) period 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% v. 73.8%; adjusted RR 0.99, 95% CI 0.95–1.04), but more likely to self-report it (10.2% v. 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 for a perinatal ED visit for interpersonal violence (4.0% v. 0.4%; adjusted RR 6.28, 95% CI 3.94–10.00).

Interpretation: Pregnancy and postpartum are periods of higher risk for interpersonal violence among people with schizophrenia compared with those without schizophrenia. Pregnancy is a key period for implementing violence prevention strategies in this population.