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BACKGROUND: Depression is one of the most common morbidities of the postnatal period. It has been associated with adverse outcomes for women, children, the wider family and society as a whole. Treatment is with psychosocial interventions or antidepressant medication, or both. The aim of this review is to evaluate the effectiveness of different antidepressants and to compare their effectiveness with placebo, treatment as usual or other forms of treatment. This is an update of a review last published in 2014. OBJECTIVES: To assess the effectiveness and safety of antidepressant drugs in comparison with any other treatment (psychological, psychosocial, or pharmacological), placebo, or treatment as usual for postnatal depression. SEARCH METHODS: We searched Cochrane Common Mental Disorders's Specialized Register, CENTRAL, MEDLINE, Embase and PsycINFO in May 2020. We also searched international trials registries and contacted experts in the field. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of women with depression during the first 12 months postpartum that compared antidepressant treatment (alone or in combination with another treatment) with any other treatment, placebo or treatment as usual. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data from the study reports. We requested missing information from study authors wherever possible. We sought data to allow an intention-to-treat analysis. Where we identified sufficient comparable studies we pooled data and conducted random-effects meta-analyses. MAIN RESULTS: We identified 11 RCTs (1016 women), the majority of which were from English-speaking, high-income countries; two were from middle-income countries. Women were recruited from a mix of community-based, primary care, maternity and outpatient settings. Most studies used selective serotonin reuptake inhibitors (SSRIs), with treatment duration ranging from 4 to 12 weeks. Meta-analysis showed that there may be a benefit of SSRIs over placebo in response (55% versus 43%; pooled risk ratio (RR) 1.27, 95% confidence interval (CI) 0.97 to 1.66); remission (42% versus 27%; RR 1.54, 95% CI 0.99 to 2.41); and reduced depressive symptoms (standardised mean difference (SMD) -0.30, 95% CI -0.55 to -0.05; 4 studies, 251 women), at 5 to 12 weeks' follow-up. We were unable to conduct meta-analysis for adverse events due to variation in the reporting of this between studies. There was no evidence of a difference between acceptability of SSRI and placebo (27% versus 27%; RR 1.10, 95% CI 0.74 to 1.64; 4 studies; 233 women). The certainty of all the evidence for SSRIs was low or very low due to the small number of included studies and a number of potential sources of bias, including high rates of attrition. There was insufficient evidence to assess the efficacy of SSRIs compared with other classes of antidepressants and of antidepressants compared with other pharmacological interventions, complementary medicines, psychological and psychosocial interventions or treatment as usual. A substantial proportion of women experienced adverse effects but there was no evidence of differences in the number of adverse effects between treatment groups in any of the studies. Data on effects on children, including breastfed infants, parenting, and the wider family were limited, although no adverse effects were noted. AUTHORS' CONCLUSIONS: There remains limited evidence regarding the effectiveness and safety of antidepressants in the management of postnatal depression, particularly for those with more severe depression. We found low-certainty evidence that SSRI antidepressants may be more effective in treating postnatal depression than placebo as measured by response and remission rates. However, the low certainty of the evidence suggests that further research is very likely to have an important impact on our effect estimate. There is a continued imperative to better understand whether, and for whom, antidepressants or other treatments are more effective for postnatal depression, and whether some antidepressants are more effective or better tolerated than others. In clinical practice, the findings of this review need to be contextualised by the extensive broader literature on antidepressants in the general population and perinatal clinical guidance, to inform an individualised risk-benefit clinical decision. Future RCTs should focus on larger samples, longer follow-up, comparisons with alternative treatment modalities and inclusion of child and parenting outcomes.
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Antidepressivos/uso terapêutico , Depressão Pós-Parto/tratamento farmacológico , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Adolescente , Adulto , Antidepressivos/efeitos adversos , Viés , Feminino , Humanos , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Placebos/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Resultado do Tratamento , Adulto JovemRESUMO
PURPOSE: There is disregard in the scientific literature for the evaluation of psychiatric in-patient care as rated directly by patients. In this context, we aimed to explore satisfaction of people treated in mental health in-patient facilities. The project was a part of the Young Psychiatrist Program by the Association for the Improvement of Mental Health Programmes. METHODS: This is an international multicentre cross-sectional study conducted in 25 hospitals across 11 countries. The research team at each study site approached a consecutive target sample of 30 discharged patients to measure their satisfaction using the five-item study-specific questionnaire. Individual and institution level correlates of 'low satisfaction' were examined by comparisons of binary and multivariate associations in multilevel regression models. RESULTS: A final study sample consisted of 673 participants. Total satisfaction scores were highly skewed towards the upper end of the scale, with a median total score of 44 (interquartile range 38-48) out of 50. After taking clustering into account, the only independent correlates of low satisfaction were schizophrenia diagnosis and low psychiatrist to patient ratio. CONCLUSION: Further studies on patients' satisfaction should additionally pay attention to treatment expectations formed by the previous experience of treatment, service-related knowledge, stigma and patients' disempowerment, and power imbalance.
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Hospitais Psiquiátricos , Transtornos Mentais/terapia , Satisfação do Paciente/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Internacionalidade , Masculino , Pessoa de Meia-Idade , Análise Multinível , Alta do Paciente , Inquéritos e QuestionáriosRESUMO
People with severe mental illness (SMI) have high prevalence of lifetime victimization, but little is known about the extent and risk of recent domestic/sexual violence. The objective was to synthesize evidence on prevalence, odds, and risk factors for recent violence against people with SMI, with a focus on domestic and sexual violence. Relevant studies were identified through literature searches in Medline, Psychinf, Embase (for studies published in 2010-2015), and through existing systematic reviews (for studies published in 2000-2014). The review included 30 studies (with 16 140 SMI participants), including six on domestic violence and 11 on sexual violence. Prevalence of recent domestic violence ranged from 15-22% among women and from 4-10% among men/mixed samples; with little evidence on risk compared with the general population. Median prevalence of sexual violence was 9.9% (IQR = 5.9-18.1%) in women and 3.1% (IQR = 2.5-6.7%) in men; with 6-fold higher odds of victimization compared with the general population. There was little evidence on risk factors for domestic or sexual violence. In conclusion, people with SMI have a high prevalence of recent domestic and sexual violence, but little is known about risk factors for these violence types, or extent of domestic violence victimization compared to the general population.
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Violência Doméstica/estatística & dados numéricos , Pessoas Mentalmente Doentes/estatística & dados numéricos , Delitos Sexuais/estatística & dados numéricos , Adulto , HumanosRESUMO
PURPOSE: To investigate the association between childhood maltreatment and adulthood domestic and sexual violence victimisation among people with severe mental illness (SMI), and to explore this association in terms of gender differences and potential mediators. METHOD: A cross-sectional survey of 318 people living in the community who were receiving care from Community Mental Health Teams. Associations were assessed using logistic regression of multiply imputed data. RESULTS: 63 % (95 % CI 55-71 %) of men and 71 % (95 % CI 63-79 %) of women reported childhood maltreatment, 46 % (95 % CI 37-54 %) of men and 67 % (95 % CI 59-76 %) of women reported adulthood domestic violence victimisation, and 22 % (95 % CI 15-28 %)of men and 62 % (95 % CI 53-70 %)of women reported adulthood sexual violence victimisation. Men and women with SMI who reported experiences of childhood maltreatment were two to five times more likely to report domestic and sexual violence victimisation in adulthood after adjusting for confounders. The associations held for each of emotional, physical and sexual childhood abuse. CONCLUSION: People with severe mental illness have high prevalence of experiences of childhood maltreatment and adulthood domestic and sexual violence victimisation. Childhood maltreatment appears to be an independent risk factor for adulthood victimisation among men and women with SMI.
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Maus-Tratos Infantis/estatística & dados numéricos , Vítimas de Crime/estatística & dados numéricos , Violência Doméstica/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Delitos Sexuais/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Prevalência , Fatores de RiscoRESUMO
BACKGROUND: People with mental illness are at increased risk of intimate partner violence (IPV) victimisation, but little is known about their risk for different forms of IPV, related health impact and help-seeking. AIMS: To estimate the odds for past-year IPV, related impact and disclosure among people with and without pre-existing chronic mental illness (CMI). METHOD: We analysed data from 23 222 adult participants in the 2010/2011 British Crime Survey using multivariate logistic regression. RESULTS: Past-year IPV was reported by 21% and 10% of women and men with CMI, respectively. The adjusted relative odds for emotional, physical and sexual IPV among women with versus without CMI were 2.8 (CI = 1.9-4.0), 2.6 (CI = 1.6-4.3) and 5.4 (CI = 2.4-11.9), respectively. People with CMI were more likely to attempt suicide as result of IPV (aOR = 5.4, CI = 2.3-12.9), less likely to seek help from informal networks (aOR = 0.5, CI = 0.3-0.8) and more likely to seek help exclusively from health professionals (aOR = 6.9, CI = 2.6-18.3). CONCLUSIONS: People with CMI are not only at increased risk of all forms of IPV, but they are more likely to suffer subsequent ill health and to disclose exclusively to health professionals. Therefore, health professionals play a key role in addressing IPV in this population.
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Violência por Parceiro Íntimo/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Adolescente , Adulto , Doença Crônica , Efeitos Psicossociais da Doença , Vítimas de Crime/psicologia , Vítimas de Crime/estatística & dados numéricos , Estudos Transversais , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Prevalência , Fatores de Risco , País de Gales/epidemiologia , Adulto JovemRESUMO
OBJECTIVES: We examined the prevalence of intimate partner violence (IPV) and its association with social deprivation in England. METHODS: We used multivariable logistic regression to investigate IPV correlates among 21 226 men and women aged 16 to 59 years in the 2008 nationally representative cross-sectional British Crime Survey. RESULTS: Lifetime IPV was reported by 23.8% of women and 11.5% of men. Physical IPV was reported by 16.8% and 7.0%, respectively; emotional-only IPV was reported by 5.8% and 4.2%, respectively. After adjustment for demographic confounders, lifetime physical IPV experienced by women was associated with social housing tenure (odds ratio [OR] = 2.3; 95% confidence interval [CI] = 2.0, 2.7), low household income (OR = 2.2; 95% CI = 1.8, 2.7), poor educational attainment (OR = 1.2; 95% CI = 1.0, 1.5), low social class (OR = 1.5; 95% CI = 0.3, 1.7), and living in a multiply deprived area (OR = 1.4; 95% CI = 1.1, 1.7). Physical IPV experienced by men and emotional IPV experienced by either gender were generally not associated with deprivation factors. CONCLUSIONS: Physical and emotional IPV are very common among adults in England. Emotional IPV prevention policies may be appropriate across the social spectrum; those for physical IPV should be particularly accessible to disadvantaged women.
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Violência Doméstica/estatística & dados numéricos , Pobreza/psicologia , Adolescente , Adulto , Fatores Etários , Estudos Transversais , Violência Doméstica/economia , Escolaridade , Inglaterra/epidemiologia , Características da Família , Feminino , Humanos , Renda/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pobreza/estatística & dados numéricos , Prevalência , Fatores Sexuais , Fatores Socioeconômicos , Cônjuges/psicologia , Cônjuges/estatística & dados numéricos , Adulto JovemRESUMO
Men and women with severe mental illness (SMI) are at significantly increased risk of violent victimisation, but the gender pattern for this has not been systematically examined. In the general population, men are at higher risk of overall and physical victimisation, whilst women are at increased risk of domestic and sexual violence. We re-examined published victimisation studies from a gender perspective, and found that, compared to the general population, women with SMI are at greater excess risk than men, leading to a narrowing in the 'gender gap'. We discuss theoretical explanations for this and implications for prevention and research.
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Vítimas de Crime/psicologia , Homens/psicologia , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Delitos Sexuais/estatística & dados numéricos , Violência/estatística & dados numéricos , Mulheres/psicologia , Violência Doméstica/psicologia , Feminino , Humanos , Masculino , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Delitos Sexuais/psicologia , Violência/psicologiaRESUMO
Perinatal mental health has become a significant focus of interest in recent years, with investment in new specialist mental health services in some high-income countries, and inpatient psychiatric mother and baby units in diverse settings. In this paper, we summarize and critically examine the epidemiology and impact of perinatal mental disorders, including emerging evidence of an increase of their prevalence in young pregnant women. Perinatal mental disorders are among the commonest morbidities of pregnancy, and make an important contribution to maternal mortality, as well as to adverse neonatal, infant and child outcomes. We then review the current evidence base on interventions, including individual level and public health ones, as well as service delivery models. Randomized controlled trials provide evidence on the effectiveness of psychological and psychosocial interventions at the individual level, though it is not yet clear which women with perinatal mental disorders also need additional support for parenting. The evidence base on psychotropic use in pregnancy is almost exclusively observational. There is little research on the full range of perinatal mental disorders, on how to improve access to treatment for women with psychosocial difficulties, and on the effectiveness of different service delivery models. We conclude with research and clinical implications, which, we argue, highlight the need for an extension of generic psychiatric services to include preconception care, and further investment into public health interventions, in addition to perinatal mental health services, potentially for women and men, to reduce maternal and child morbidity and mortality.
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BACKGROUND: Decision-making regarding antidepressant use in pregnancy is challenging, given the uncertain evidence base on the benefits and risks for women and their children. Patient decision aids (PDAs) can improve shared decision-making for complex health decisions but no evidence-based PDAs exist for antidepressant use in pregnancy. AIM: To assess the feasibility of a full-scale randomised controlled trial (RCT) to evaluate the efficacy of an electronic PDA on antidepressant use in pregnancy. DESIGN & SETTING: A UK-based pilot parallel-group RCT. METHOD: The study recruited women whose clinicians recommended an antidepressant for depression in a current or planned pregnancy, and who were uncertain about antidepressant use while pregnant. Women were recruited via clinician or self-referral, and randomised to online access to the PDA or online access to standard resource list, with primary follow-up at 4 weeks and longer-term follow-up. The primary outcome was protocol feasibility (recruitment target of 50 women and follow-up rate of 80%). Outcome measures for a future full-scale RCT included the decisional conflict scale (DCS). RESULTS: Fifty-one women were recruited with a follow-up rate of 90.2% at 4 weeks. The PDA received good overall satisfaction ratings (mean 4.2/5). Analysis of covariance (ANCOVA) indicated a small improvement in decisional conflict at 4 weeks, accounting for baseline scores (DCS regression coefficient = -3.5, 95% confidence intervals [CI = -12.6 to 5.6]). CONCLUSION: This pilot RCT for an electronic PDA on antidepressant use in pregnancy showed that the study protocol was feasible, with high rates of participant satisfaction among those randomised to the PDA.
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BACKGROUND: Concerns about teratogenicity and maternal and offspring complications restrict the use of lithium during pregnancy for the treatment of mood disorders. We aimed to investigate the association between in-utero lithium exposure and risk of pregnancy complications, delivery outcomes, neonatal morbidity, and congenital malformations. METHODS: In this meta-analysis, primary data from pregnant women and their children from six international cohorts based in the community (Denmark, Sweden, and Ontario, Canada) and in clinics (the Netherlands, UK, and USA) were analysed. Pregnancies were eligible for analysis if the pregnancy resulted in a liveborn singleton between 1997 and 2015, if health-related information was available for both mother and infant, and if the mother had a mood disorder (bipolar disorder or major depressive disorder) or if she had been given lithium during pregnancy (at least two dispensations of lithium during pregnancy that were dispensed any time from 1 month before conception until the delivery, or a single lithium dispensation during pregnancy when there was at least one other lithium dispensation within 6 months before or after this date). Pregnancies during which the mother had been prescribed known teratogenic drugs were excluded. Pregnancies were grouped into a lithium-exposed group and a mood disorder reference group. The main outcome measures were pregnancy complications, delivery outcomes, neonatal readmission to hospital within 28 days of birth, and congenital malformations (major malformations and major cardiac malformations). Analyses were done at each site by use of a shared protocol. Adjusted odds ratios (aORs) and 95% CIs were calculated by use of logistic regression models, and site-specific prevalence rates and ORs were pooled by use of random-effects meta-analytical models. FINDINGS: 22â â124 eligible pregnancies were identified across the six cohorts, of which 727 pregnancies were eligible for inclusion in the lithium-exposed group (557 [77%] from register-based cohorts and 170 [23%] from clinical cohorts). Lithium exposure was not associated with any of the predefined pregnancy complications or delivery outcomes. An increased risk for neonatal readmission within 28 days of birth was seen in the lithium-exposed group compared with the reference group (pooled prevalence 27·5% [95% CI 15·8-39·1] vs 14·3% [10·4-18·2]; pooled aOR 1·62, 95% CI 1·12-2·33). Lithium exposure during the first trimester was associated with an increased risk of major malformations (pooled prevalence 7·4% [95% CI 4·0-10·7] vs 4·3% [3·7-4·8]; pooled aOR 1·71, 95% CI 1·07-2·72) but for major cardiac malformations the difference was not significant (2·1% [0·5-3·7] vs 1·6% [1·0-2·1]; pooled aOR 1·54, 95% CI 0·64-3·70). INTERPRETATION: Considering both the effect sizes and the precision of the estimates in this meta-analysis, treatment decisions for pregnant women with mood disorders must weigh the potential for increased risks of lithium during pregnancy-in particular those associated with use of lithium during the first trimester-against its effectiveness at reducing relapse. FUNDING: None.
Assuntos
Transtorno Bipolar/tratamento farmacológico , Transtorno Depressivo Maior/tratamento farmacológico , Saúde Global , Lítio/uso terapêutico , Complicações na Gravidez/tratamento farmacológico , Adulto , Estudos de Coortes , Europa (Continente) , Feminino , Humanos , Recém-Nascido , Lítio/efeitos adversos , Ontário , Gravidez , Estados UnidosAssuntos
Aborto Induzido/psicologia , Transtornos Mentais/epidemiologia , Feminino , Humanos , GravidezRESUMO
Violence against women is widely recognised as a violation of human rights and a public health problem. In this Series paper, we argue that violence against women is also a prominent public mental health problem, and that mental health professionals should be identifying, preventing, and responding to violence against women more effectively. The most common forms of violence against women are domestic abuse and sexual violence, and victimisation is associated with an increased risk of mental disorder. Despite clinical guidance on the role of mental health professionals in identifying violence against women and responding appropriately, poor identification persists and can lead to non-engagement with services and poor response to treatment. We highlight that little research has been done on how to improve identification and treatment of victims and perpetrators in contact with mental health services, but that mental health services could play a major role in primary and secondary prevention of violence against women.
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Mulheres Maltratadas/psicologia , Violência Doméstica/prevenção & controle , Serviços de Saúde Mental/organização & administração , Aceitação pelo Paciente de Cuidados de Saúde , Delitos Sexuais/prevenção & controle , Violência Doméstica/psicologia , Feminino , Humanos , Transtornos Mentais/etiologia , Saúde Mental , Delitos Sexuais/psicologiaRESUMO
Decisions about the use of psychotropic medication in pregnancy are an ongoing challenge for clinicians and women with mental health problems, owing to the uncertainties around risks of the illness itself to mother and fetus/infant, effectiveness of medications in pregnancy and risks to the fetus/infant from in utero exposure or via breast milk. These consensus guidelines aim to provide pragmatic advice regarding these issues. They are divided into sections on risks of untreated illness in pregnancy; general principles of using drugs in the perinatal period; benefits and harms associated with individual drugs; and recommendations for the management of specific disorders.
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Transtornos Mentais/tratamento farmacológico , Período Pós-Parto/efeitos dos fármacos , Psicofarmacologia/normas , Psicotrópicos/uso terapêutico , Feminino , Humanos , GravidezRESUMO
BACKGROUND: Suicide in pregnant and postnatal women is an important cause of maternal death, but evidence to guide suicide prevention in this group is scarce. We aimed to compare the trend, nature, and correlates of suicide in perinatal and non-perinatal women in contact with psychiatric services. METHODS: We used 1997-2012 data from the UK National Confidential Inquiry into Suicides and Homicides by People with Mental Illness, which includes all suicides by people (age ≥10 years) who had been in contact with psychiatric services in the previous year. The study sample comprised all women who died by suicide in pregnancy or the first postnatal year (perinatal suicides), and all women in the same age range who died by suicide outside this period (non-perinatal suicides). We compared suicides among perinatal and non-perinatal women with logistic regression of multiply imputed data. FINDINGS: The study sample included 4785 women aged 16-50 years who died by suicide, of whom 98 (2%) died in the perinatal period. Of the 1485 women aged 20-35 years, 74 (4%) women died in the perinatal period. Over the course of the study, we recorded a modest downward trend in the mean number of women dying by suicide in the non-perinatal period (-2·07 per year [SD 0·96]; p=0·026), but not the perinatal period (-0·07 per year [0·37]; p=0·58). Compared with non-perinatal women, women who died by suicide in the perinatal period were more likely to have a diagnosis of depression (adjusted odds ratio [OR] 2·19 [95% CI 1·43-3·34]; p<0·001) and less likely to be receiving any active treatment (0·46 [0·24-0·89]; p=0·022) at the time of death. Women who died by suicide within versus outside the perinatal period were also more likely to be younger (crude OR -6·39 [95% CI -8·15 to -4·62]; p<0·0001) and married (4·46 [2·93-6·80]; p<0·0001), with shorter illness duration (2·93 [1·88-4·56]; p<0·001) and no history of alcohol misuse (0·47 [0·24-0·92]; p=0·027). There were no differences in service contact or treatment adherence. INTERPRETATION: In women in contact with UK psychiatric services, suicides in the perinatal period were more likely to occur in those with a depression diagnosis and no active treatment at the time of death. Assertive follow-up and treatment of perinatal women in contact with psychiatric services are needed to address suicide risk in this group. FUNDING: Healthcare Quality Improvement Partnership and National Institute for Health Research.
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Transtornos Mentais/terapia , Gestantes/psicologia , Suicídio/estatística & dados numéricos , Adolescente , Adulto , Bases de Dados Factuais , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Reino Unido , Adulto JovemRESUMO
OBJECTIVE: It has been suggested that positive psychotic symptoms reflect 'aberrant salience'. Previously we provided support for this hypothesis in first-episode schizophrenia patients, demonstrating that delusional symptoms were associated with aberrant reward processing, indexed by the Salience Attribution Test (SAT). Here we tested whether salience processing is abnormal in schizophrenia patients with long-standing treatment-refractory persistent delusions (TRS). METHOD: Eighteen medicated TRS patients and 31 healthy volunteers completed the SAT, on which participants made a speeded response to earn money in the presence of cues. Each cue comprised two visual dimensions, colour and form. Reinforcement probability varied over one of these dimensions (task-relevant), but not the other (task-irrelevant). RESULTS: Participants responded significantly faster on high-probability relative to low-probability trials, representing implicit adaptive salience; this effect was intact in TRS patients. By contrast, TRS patients were impaired on the explicit adaptive salience measure, rating high-probability stimuli less likely to be associated with reward than controls. There was little evidence for elevated aberrant salience in the TRS group. CONCLUSION: These findings do not support the hypothesis that persistent delusions are related to aberrant motivational salience processing in TRS patients. However, they do support the view that patients with schizophrenia have impaired reward learning.
RESUMO
Perinatal mental disorders are common and can impact adversely both on maternal functioning and on foetal and neonatal outcomes. For the more severe disorders, such as schizophrenia, bipolar disorder and severe depression, medication may be needed during pregnancy and breastfeeding, and there is a growing but complex evidence based on the effects of psychotropic medication on the foetus and neonate. In addition, the neonatologist needs to be aware of the co-morbid problems that women with mental disorders are more likely to have as these may also impact on the neonate. Close liaison with family physicians and primary care where there are concerns about mental health is important to ensure maternal mental health is optimal for the mother and her infant.
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Saúde Mental , Neonatologia/tendências , Complicações na Gravidez/psicologia , Efeitos Tardios da Exposição Pré-Natal/psicologia , Aleitamento Materno/efeitos adversos , Feminino , Humanos , Lactente , Recém-Nascido , Doenças do Recém-Nascido/induzido quimicamente , Doenças do Recém-Nascido/epidemiologia , Lactação/efeitos dos fármacos , Lactação/fisiologia , Gravidez , Complicações na Gravidez/tratamento farmacológico , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Resultado da Gravidez/psicologia , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Psicotrópicos/uso terapêuticoAssuntos
Atitude Frente a Saúde/etnologia , Transtornos Mentais/psicologia , Violência/psicologia , Violência/estatística & dados numéricos , Área Programática de Saúde , Vítimas de Crime/estatística & dados numéricos , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Prevalência , Índice de Gravidade de DoençaRESUMO
BACKGROUND: The recent World Report on Disability highlighted violence as a leading cause of morbidity among disabled people. However, we know little about the extent to which people with disability experience different violence types, and associated health/economic costs. The recent introduction of disability measures into the England&Wales victimization survey provided an opportunity to address this gap. METHODS AND FINDINGS: Analysis of the 2009/10 British Crime Survey (BCS), a nationally representative cross-sectional survey of 44,398 adults living in residential households in England&Wales. Using multivariate logistic regression, we estimated the relative odds of being a victim of past-year violence (physical/sexual domestic or non-domestic violence) in people with disability compared to those without, after adjusting for socio-demographics, behavioural and area confounders. 1256/44398(2.4%) participants had one or more disabilities including mental illness ('mental illness') and 7781(13.9%) had one or more disabilities excluding mental illness ('non-mental disability'). Compared with the non-disabled, those with mental illness had adjusted relative odds (aOR) of 3.0(95% confidence interval (CI) 2.3-3.8) and those with non-mental disability had aOR of 1.8(95% CI: 1.5-2.2) of being a victim of past-year violence (with similar relative odds for domestic and non-domestic violence). Disabled victims were more likely to suffer mental ill health as a result of violence than non-disabled victims. The proportion of violence that could be attributed to the independent effect of disability in the general population was 7.5%(CI 5.7-9.3%), at an estimated cost of £1.51 billion. The main study limitation is the exclusion of institutionalised people with disability. CONCLUSIONS: People with disability are at increased risk of being victims of domestic and non-domestic violence, and of suffering mental ill health when victimized. The related public health and economic burden calls for an urgent assessment of the causes of this violence, and national policies on violence prevention in this vulnerable group.