Pregnant women with schizophrenia at increased risk of interpersonal violence

Canada: Among people with schizophrenia, postpartum and pregnancy are periods of higher risk for interpersonal violence compared to those without schizophrenia, a recent study published in CMAJ (Canadian Medical Association Journal) has shown. 

The findings suggest that routine violence screening is an important opportunity in antenatal care settings for intervention to prevent social, psychological, and physical harm to these patients and their children. 

"Postpartum and pregnant people with schizophrenia are at more than threefold increase in the risk of an ED (emergency department) visit for interpersonal violence versus those without schizophrenia," the researchers wrote in their study. 

Interpersonal violence can include sexual, physical 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 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.

Reference:

Kelly Leslie, Lucy C. Barker, Hilary K. Brown, Simon Chen, Cindy-Lee Dennis, Joel G. Ray, Natasha Saunders, Clare Taylor and Simone Vigod CMAJ March 06, 2023 195 (9) E322-E329; DOI: https://doi.org/10.1503/cmaj.220689