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Intimate partner violence during pregnancy in relation to non-psychotic mental health disorders in Rwanda: a cross-sectional population-based study
  1. Akashi Andrew Rurangirwa1,2,
  2. Ingrid Mogren3,4,
  3. Joseph Ntaganira1,
  4. Kaymarlin Govender5,
  5. Gunilla Krantz2
  1. 1 Department of Epidemiology and Biostatistics, School of Public Health, University of Rwanda, Kigali, Rwanda
  2. 2 Section of Epidemiology and Social Medicine (EPSO), Department of Public Health and Community Medicine, The Sahlgrenska Academy at University of Gothenburg, Goteborg, Sweden
  3. 3 Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
  4. 4 Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
  5. 5 Health Economics and HIV/AIDS Research Division (HEARD), Universityof KwaZulu-Natal, Durban, South Africa
  1. Correspondence to Dr Akashi Andrew Rurangirwa; rakashi{at}nursph.org

Abstract

Objectives To investigate the prevalence of non-psychotic mental health disorders (MHDs) and the association between exposure to all forms of intimate partner violence (IPV) during pregnancy and MHDs.

Design Cross-sectional population-based study conducted in the Northern Province of Rwanda and Kigali city.

Participants and settings Totally, 921 women who gave birth ≤13 months before being interviewed were included. Simple random sampling was done to select villages, households and participants. Community health workers helped to identify eligible participants and clinical psychologists, nurses or midwives conducted face-to-face interviews. The collected data were analysed using descriptive statistics and bivariable and multivariable logistic regression modelling

Results The prevalence rates of generalised anxiety disorder, suicide ideation and post-traumatic stress disorder (PTSD) were 19.7%, 10.8% and 8.0%, respectively. Exposure to the four forms of IPV during pregnancy was highly associated with the likelihood of meeting diagnostic criteria for each of the non-psychotic MHDs investigated. Physical, psychological and sexual violence, showed the strongest association with PTSD, with adjusted ORs (aORs) of 4.5, 6.2 and 6.3, respectively. Controlling behaviour had the strongest association with major depressive episode in earlier periods with an aOR of 9.2.

Conclusion IPV and MHDs should be integrated into guidelines for perinatal care. Moreover, community-based services aimed at increasing awareness and early identification of violence and MHDs should be instituted in all villages and health centres in Rwanda. Finally, healthcare providers need to be educated and trained in a consistent manner to manage the most challenging cases quickly, discreetly and efficiently.

  • mental health
  • intimate partner violence
  • intimate partner violence; pregnancy; non-psychotic mental health disorders

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors GK, IM and AAR designed the study. GK, IM, AAR and JN developed part of the study questionnaire. AAR coordinated and participated in piloting and data collection activities and performed the statistical analyses with the assistance of GK and JN. The manuscript was drafted and written by AAR with contributions from GK, IM, JN and KG.

  • Funding This study forms part of the Maternal Health Research Programme (MaTHeR) undertaken by the University of Rwanda in collaboration with the University of Gothenburg and Umeå University in Sweden. The Study was made possible by financial support from The Swedish International Development Cooperation Agency (SIDA).

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Institutional Review Board of the College of Medicine and Health Sciences, University of Rwanda and National Institute of Statistics of Rwanda (No: 0425/2014/10/NISR).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.