Primary Submission Category: Mental health/function
Examining social and behavioral risk factors for postpartum violence using longitudinal, population-based hospital data
Authors: Shaina Sta. Cruz, Sidra Goldman-Mellor, Alison Gemmill, Claire Margerison,
Presenting Author: Shaina Sta. Cruz*
Violence against pregnant and postpartum women is a major public health problem worldwide. Identifying critical risk factors can better inform policies and guidelines on clinical prevention, intervention, and care, and ultimately, reduce the risk of violence for pregnant and postpartum women. Most studies on predictors of violence have been cross-sectional or based on small sample sizes or self-report data, all of which impede more representative analyses of risk factors. Utilizing more comprehensive, longitudinal, population-representative datasets would help to identify and describe the populations most at-risk for violence. In this study, we used longitudinally-linked, all-payer statewide data to test risk factors for violence victimization-related ED visits during the first year postpartum over a 11-year period (2010-2021) in California. The sample comprised all women with a live-birth hospital delivery in each year from 2010-2020 (~3 million). Annual cohorts of women were followed for 12 months after their delivery hospitalizations to identify subsequent nonfatal ED visits for violent injury (defined using ICD-9/10-CM codes). Analyses included generalized linear models to test predictors, including comorbid mental health diagnoses, hospital-based care utilization, and zip code-level sociodemographic factors. Findings highlight a dose-response relationship between emergency department presentations and violence, as well as between mental health diagnoses and violence. Additionally, incidence of violent injury increased especially sharply in the presence of mood disorders, anxiety disorders, alcohol disorders, and psychotic disorders. Furthermore, excess risk varied by sociodemographic factors, namely median household income and educational attainment. Next steps are to examine the role of the healthcare system and social services in reducing pregnancy-associated violence risk. Violence against women is a multi-faceted issue that requires multi-level health equity-focused solutions and improved behavioral health response. Healthcare professionals must consider how mental illness places women at higher risk and push to integrate behavioral health processes and support services in emergency departments, hospitals, and primary care.