HKU Bulletin October 2008 (Vol. 10 No. 1)

Pregnancy Blues Linked to Abuse New survey shows that psychological abuse can lead to post-natal depression A survey, conducted in seven obstetrics and gynaecology units across Hong Kong, reveals that pregnant women, who are abused by their partners, are more likely to report post-natal depressive symptoms. They are also more likely to suffer poorer mental health than non-abused women. The study, published in the British Journal of Obstetrics & Gynaecology , questioned 3,245 women between 32 and 36 weeks of pregnancy. The results showed that 9.1 per cent of them said they were abused by their partners. Of those, 76 per cent claimed the abuse was psychological. Only 27 per cent reported physical and/or sexual abuse – and of these 57.5 per cent said they were also victims of psychological abuse. Assistant Dean of the Medical Faculty and Associate Professor of the Department of Nursing Studies, Agnes Tiwari led the survey. She said: “After ten years of working on this complex problem, we are now reaching a new level of understanding. “When we started, it was difficult because intimate partner abuse in Hong Kong appeared to be very different to that reported in the literature, especially amongst pregnant women. It seemed that the men didn’t beat them here, but they abused them in a worse way – the abuse was psychological. It was very difficult to recognize psychological abuse since there was no consensus. How would one define psychological abuse? For physical abuse it was very obvious.” The need to come up with a robust definition of psychological abuse for the purpose of research and clinical practice has prompted Tiwari and her team to go back to their informants: the women who identify themselves as victims of psychological abuse. Interestingly, while there may be disagreements among scholars as to what constitutes psychological abuse, these women have no difficulty identifying what it is and there is a high degree of agreement among them. The most commonly cited examples of psychological abuse are shaming in front of friends or family, put- downs regarding appearance or behaviour, and ridiculing. Listening to the voices of abused victims has helped Tiwari and her team to develop the Chinese Abuse Assessment Screen, which allows the detection of psychological as well as other forms of abuse in Chinese women. “There is a common misconception that psychological abuse is not as harmful as physical or sexual abuse. But the women in our studies said otherwise”. Pregnancy is Tiwari’s window of opportunity for reaching these women. “Not only does pregnancy bring them into contact with healthcare professionals, the trusting relationship may make them feel safe enough to disclose their abuse.” In 2002-03 Tiwari’s team offered a short but effective intervention to abused pregnant women to help them protect themselves as well as to reduce the adverse effects of abuse on their health and well-being. “We found the most useful part was listening,” she said. “Often women will say ‘you won’t believe it, even my mother doesn’t believe me’. When our nurse assured these women that their stories were taken seriously, it was a relief for them because for the first time they had not been ignored or ridiculed for revealing the abuse. Our intervention may not be the magic pill but we are giving the women something they’ve been looking for. Knowing they are not alone helps.” Now Tiwari is concentrating on primary prevention by working with expectant mums and dads. “We don’t assume that they have any problems but, basically, we think that if we support them, it helps. We know that pregnancy is a stressful time for the women but we think it is also stressful for the men. But help for these men may not be as readily available. “We are going to find out what these expectant dads need. Primary prevention is a positive place to start from because once the abuse has started, it’s hard to go back.” Tiwari and her team will also hold a Child Friendly Parenting programme, in which parents will be asked to refrain from corporal punishment, reduce their criticism of, and shouting at, the child and also increase the number of times they praise their children. “Now that may be hard for some Chinese parents,” she said. “Because they believe that if you praise your children, they will get spoiled. I think they have to find a balance. “This is a very exciting time for us because we can work with expectant parents, and we can also work with parents in the community. With a bit of help, hopefully, home will be a happier place for these parents and children.” 14 RESEARCH 15