Transtorno do estresse pós-traumático após o parto e suas relações com violência sexual na infância e violência entre parceiros íntimos na gestação.

Abstract

The main objective of this thesis was to investigate the relationships between childhood sexual abuse, intimate partner violence (IPV) during pregnancy and the occurrence of posttraumatic stress disorder (PTSD) after birth. In addition, we evaluated the dimensional structure of the Post-Traumatic Stress Disorder Checklist Civilian Version (PCL-C), used to identify the symptoms of PTSD in the study population. The data used in this research originated from a cross-sectional study conducted in the Fernandes Figueira Institute, between February and July 2011. The study population consisted of women who gave birth at the institution. Interviews occurred 6 8 weeks after birth during the routine postpartum visits. The sample included 456 women (88% of those eligible). The instruments Trauma History Questionnaire (THQ) and Revised Conflict Tactics Scales (CTS2) were used to assess the occurrence of childhood sexual abuse and IPV in pregnancy, respectively. The first paper presents the evaluation of the dimensional structure of the PCL-C. The results suggested the existence of two specific factors formed by a higher-order factor and holding two residual correlations, between items 6 and 7 and items 16 and 17. These findings point to a different structure from the models of three and four factors proposed in the fourth and fifth edition, respectively, of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The second paper shows the results of the path analysis performed to evaluate the relationship between childhood sexual abuse, IPV during pregnancy and PTSD after childbirth. The findings indicated that sexual abuse during childhood is associated with postnatal PTSD symptoms both directly and indirectly, through IPV, other trauma and psychopathology, and fear of childbirth. Both physical and psychological IPV shown to be directly associated with the occurrence of PTSD. Psychological violence was also indirectly linked to PTSD, via physical violence and fear of childbirth. It is hoped that the dissemination of the results of this thesis contribute to a refinement of PTSD diagnostic criteria and to the expansion of actions to address violence against women and perinatal mental disorders in the public health area, promoting, by extension, an improvement in health care.