Women in a prenatal care/substance abuse treatment program: links between domestic violence and mental health.

Abstract

This study examines the prevalence of violence experienced by patients enrolled in the Step by Step program, a combined prenatal care/substance abuse treatment program at the Wake County Health Department in North Carolina. In addition, potential associations between violence and sociodemographic characteristics, substance use, and mental health are investigated. All prenatal care/substance abuse treatment patients who met study eligibility criteria (N = 84) were assessed by health care providers. Descriptive statistics and bivariate analyses were used to compare victims of violence and nonvictims on a wide range of variables. Multiple linear regression analysis estimated the impact of the women's experiences of violence on their levels of mental health symptoms while controlling for confounding factors. Forty-two percent of patients had been victims of both sexual and physical violence, and 30% had been victims of physical violence alone. The combination of sexual and physical violence was significantly less common among African-American women compared with other women. No other significant differences were found between victims and nonvictims in terms of sociodemographics or substance use. Compared with nonvictims, victims of the combination of sexual and physical violence had significantly elevated levels of general psychological distress as well as elevated levels of hostility, depression, anxiety, interpersonal sensitivity, and somatization. However, no significant differences in levels of mental health symptoms were observed among women who had experienced physical violence in the absence of sexual violence. Questions concerning experiences of violence, including sexual victimization, should be incorporated into the clinical history-taking procedures of professionals working within prenatal care/substance abuse treatment programs so that effective interventions that take experiences of violence into account can be put into place for these high-risk women.