Institutional violence and quality of service in obstetrics are associated with postpartum depression

Souza, Karina Junqueira de; Rattner, Daphne; Gubert, Muriel Bauermann

doi:10.1590/S1518-8787.2017051006549

Brasil

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Artigos Originais • Rev. Saúde Pública 51 • 2017 • https://doi.org/10.1590/S1518-8787.2017051006549 linkcopy

Institutional violence and quality of service in obstetrics are associated with postpartum depression

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE To investigate the association between institutional violence in obstetrics and postpartum depression (PP depression) and the potential effect of race, age, and educational level in this outcome.

METHODS This is a cross-sectional study about the health care conditions for the maternal and child population of the Federal District, Brazil, carried out in 2011. The study has used a probabilistic sample of 432 women, whose children were aged up to three months, stratified by clusters. Indicators of institutional violence and demographic characteristics have been used in a logistic regression model to estimate the probability of occurrence of postpartum depression.

RESULTS The model has identified a high prevalence of postpartum depression, being it higher among non-white women and adolescent females, besides having a strong positive association between the several indicators of obstetric violence and postpartum depression. Positive interactions on a multiplicative scale have also been observed between: violence by negligence by health care professionals and race and age; physical violence from health care professionals and age; and, verbal violence from health care professionals and race.

CONCLUSIONS The indicators adopted to reflect institutional violence in obstetric care are positively associated with postpartum depression, which calls for a reflection on the need to make the health care protocols adequate to the precepts of the Brazilian humanization of childbirth care policies and changes in the obstetric care model.

Depression, Postpartum, epidemiology; Risk Factors; Violence; Quality of Health Care; Humanization of Assistance; Maternal-Child Health Services

Variable	Average	Standard deviation

Number of prenatal care visits	9.6	3.6
Number of prenatal care visits	n	%
Age (years)
< 20	958	9.2
≥ 20	9,510	90.8
Race
White	4,198	40.1
Non-white	6,270	59.9
Schooling
Elementary/Middle school	6,010	57.4
University	4,458	42.6
Registered in government programs^a
Yes	1,612	15.4
No	8,856	84.6
Delivery at the referred hospital
Yes	6,658	63.6
No	3,810	36.4
Type of delivery^b
Vaginal	2,774	26.5
Cesarean section	7,558	72.2
Skin-to-skin contact or breastfeeding during 1st hour
Yes	8,237	78.7
No	2,098	20.0
Companion during delivery^b
Yes	5,795	55.4
No	4,540	43.4
Rooming-in^b
Yes	9,489	90.7
No	846	8.1
Puerperal or child welfare appointment scheduled^b
Yes	8,650	82.6
No	1,686	16.2

Variable	Prevalence of postpartum depression (%)	95%CI	p*
Age (years)			< 0.00
< 20	43.3	40.1–46.5
≥ 20	15.4	14.6–16.3
Race			< 0.00
Non-white	21.5	20.5–22.6
White	12.4	11.2–13.7
Schooling			< 0.00
Elementary/Middle school	21.3	20.2–22.4
University	12.9	11.6–14.2
Place of delivery			< 0.96
SUS hospital	18.5	17.4–19.6
Non-SUS hospital	18.5	17.2–19.8
Companion during delivery			< 0.00
Yes	11.9	10.9–12.9
No	25.7	24.3–29.0
Demanded more than 1 hospital			< 0.50
Yes	18.9	17.5–20.3
No	18.3	17.3–19.3
Physical violence			< 0.00
Yes	59.0	54.7–63.1
No	15.8	15.0–16.6
Violence by negligence			< 0.00
Yes	51.8	48.0–55.5
No	15.5	14.7–16.4
Verbal violence			< 0.00
Yes	50.3	47.0–53.5
No	14.5	13.7–15.4
Violence from the institution			< 0.00
Yes	26.1	24.8–27.6
No	12.2	11.3–13.2
Violence from the health system			< 0.00
Yes	19.6	18.6–20.6
No	16.1	14.7–17.6

Variable	Crude OR	95%CI
Violence from the system	1.27	1.11–1.43
Violence in the service	2.54	2.31–2.80
Violence by negligence by HP	7.66	6.37–9.23
Physical violence by HP	5.83	4.95–6.87
Verbal violence by HP	5.93	5.14–6.87
Delivery at SUS hospital	1.00	0.90–1.10
Companion during delivery	0.39	0.30–0.34
Demanded more than 1 hospital	1.03	0.92–1.16

Variable	β	Standard error	OR	95%CI	p^a
Intercept	-2.18	0.08	0.11	-	0.00
Non-white race	0.16	0.08	1.17	1.01–1.37	0.04
Age < 20 years	1.11	0.09	3.02	2.49–3.66	0.00
Violence from the system	-0.17	0.07	0.84	0.73–0.97	0.02
Violence from services	0.03	0.07	1.34	1.16–1.56	0.00
Violence by negligence by HP	-0.81	0.43	0.44	0.19–1.04	0.06
Physical violence by HP	0.41	0.15	1.51	1.13–2.02	0.00
Verbal violence by HP	0.24	0.29	1.28	0.71–2.29	0.41
IVP by negligence * race	2.82	0.46	16.76	6.87–40.89	0.00
IVP by negligence * age	-2.30	0.28	0.10	0.03–0.15	0.00
IVP physical violence * age	1.76	0.27	5.81	3.39–9.98	0.00
IVP verbal violence * race	1.27	0.32	3.54	1.91–6.59	0.00

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[TFN1] ^a Recipients of a monthly allowance.

[TFN2] ^b 1.2% of non-response.