title: Experiencing Lifetime Domestic Violence: Associations with Mental Health and Stress among Pregnant Women in Rural Bangladesh: The MINIMat Randomized Trial.
abstract: BACKGROUND
  Experience of domestic violence has negative mental health consequences for women. The association of cumulative and specific forms of domestic violence, particularly emotional violence and controlling behavior, with common mental disorders and stress has rarely been studied in pregnant women. The aim of this study is to evaluate associations of specific and multiple forms of lifetime domestic violence and controlling behavior with distress and cortisol level during pregnancy in rural Bangladeshi women.
  
  
  RESULTS
  In this observational sub-study of larger MINIMat trial, 3504 pregnant women were interviewed using a shortened Conflict Tactic Scale about their lifetime experience of domestic violence including physical, sexual, emotional domestic violence and controlling behavior. Women's levels of emotional distress were assessed using the self-reported questionnaire (SRQ-20) developed by WHO, and levels of morning salivary cortisol were measured in a subsample (n = 1300) of women during week 28-32 of pregnancy. Regression analyses were used to estimate the associations of lifetime physical, sexual, emotional domestic violence and controlling behavior with levels of distress and cortisol during pregnancy. The prevalence of lifetime domestic violence was 57% and emotional distress was 35% in these pregnant women. All forms of domestic violence were associated with higher levels of emotional distress. Women who experienced either emotional violence or controlling behavior had the highest levels of emotional distress. There was a dose-response relationship between cumulative number of the different forms of domestic violence and women's levels of emotional distress. There was no association between women's experience of domestic violence and level of morning salivary cortisol.
  
  
  CONCLUSIONS
  Including emotional violence and controlling behavior as major types of violence in future research and health interventions is warranted. Furthermore, the extent of the negative impacts of domestic violence on pregnant women, multiple forms of violence and their cumulative effects need to be investigated.
authors.affiliation: Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden.
authors.forename: Shirin
authors.identifier: http://orcid.org/0000-0001-5396-6624
authors.initials: S
authors.lastname: Ziaei
authors.affiliation: School of Health Sciences and Human Performance, Ithaca College, Ithaca, New York, United States of America.
authors.forename: Amy Lynn
authors.initials: AL
authors.lastname: Frith
authors.affiliation: Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden.
authors.forename: Eva-Charlotte
authors.initials: EC
authors.lastname: Ekström
authors.affiliation: International Centre for Diarrhoeal Disease Research (ICDDR, B), Dhaka, Bangladesh.
authors.forename: Ruchira Tabassum
authors.initials: RT
authors.lastname: Naved
mesh_terms: D000328:Adult; D001459:Bangladesh / Q000453:epidemiology; D017579:Domestic Violence / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D011247:Pregnancy; D011263:Pregnancy Trimester, Third / Q000523:psychology*; D015995:Prevalence; D011897:Random Allocation; D012044:Regression Analysis; D012424:Rural Population / Q000706:statistics & numerical data; D057566:Self Report; D013179:Spouse Abuse / Q000523:psychology / Q000706:statistics & numerical data*; D013315:Stress, Psychological / Q000453:epidemiology*; D016387:Women's Health; D055815:Young Adult
chemical_list: D006854:Hydrocortisone