Investigation of pregnant women living in rural and urban areas in terms of depression, loneliness and exposure to violence

ABSTRACT INVESTIGATION OF PREGNANT WOMEN LIVING IN RURAL AND URBAN AREAS IN TERMS OF DEPRESSION, LONELINESS AND EXPOSURE TO VIOLENCE This cross-sectional study was conducted to investigate depression, loneliness and exposure to violence suffered by pregnant women living in rural and urban areas. The study comprised 600 pregnant women (28 weeks of gestational age or over) who presented to Merkez Efendi Maternity and Child Care Hospital and Celal Bayar University Hafsa Sultan Hospital between September 1, 2012 to February 28, 2013 and accepted to participate in the study. To collect the data, the socio-demographic and fertility questionnaire, the UCLA Loneliness Scale (UCLA-LS), the Beck Depression Inventory (BDI) and the Domestic Violence against Women Determination Scale (DVAWDS) were used. For the evaluation of the data, t-test the relationship between socio-demographic characteristics of the women and their depression, loneliness and violence scores, t test, ANOVA, Kruskal-Wallis test and Mann-Whitney test were used. Pearson's correlation test was used the relationship between the UCLA-LS, BDI and DVAWDS. The mean age of the women participating in the study was 28.4 ± 4.4 (min = 18, max = 42). The majority of them (43.0%) were primary school graduates. While 8.5% of them were employed, 18.7% were primiparous. Of them, 90.2% had social security, 52.8% had enough income to meet expenses, 20% lived in rural areas, 29.8% lived in slums, 22.9% were exposed to physical violence by their spouses before becoming pregnant, 8.1% were diagnosed with depression and 10.8% had another family member diagnosed with depression. Of them, 37.8% obtained 17 points or more from the BDI with a mean score of 15.9 ± 13.9 (min = 0, max = 47). Those who themselves and whose husbands were graduates of higher education achieved the lowest mean BDI scores. Those who lived in rural areas or in slums, had low income levels, stayed in the same house with five or more people, had been married for 6-10 years, got married twice or more, had a civil marriage and or had a chronic disease obtained the highest mean scores from the BDI, the difference between the groups was statistically significant. Those who gave live births three times, had a child/children, had miscarriages, wanted a male child, had unwanted pregnancy, stated that she and her husband were incompatible, were exposed to physical violence before getting pregnant, were diagnosed with depression and or had a family member diagnosed with depression had the highest mean BDI scores. When they were compared with the other groups, the difference was found to be statistically significant. There was not a statistically significant difference between the mean BDI scores in terms of maternal age, employment status of husband, social security status, age at first marriage, having miscarriages, knowing the gender of the fetus, gestational age, receiving support during pregnancy. Those who were in the age group of 18-25 years, had husbands who were high school graduates, had income less than expenses, lived in rural areas, suffered a chronic disease, had three pregnancies, had two children and stated that they were compatible with their husbands achieved higher mean UCLA loneliness scores. The difference between the groups was statistically significant. There was not a statistically significant difference between the participants' mean UCLA loneliness scores in terms of educational status of women, employment status of women, employment status of husband, social security status, type of the house they resided in, age at first marriage, the number of people in the house, length of marriage, having a civil marriage, the number of marriages, the number of live births, having abortion, having miscarriages, gender preference, knowing the gender of the fetus, having unwanted pregnancy, gestational age, receiving support during pregnancy, exposure to physical violence before pregnancy, being diagnosed with depression and / or having a family member diagnosed with depression. Of the participants' husbands, 16.3% slapped and 25.8% pushed/shoved their wives, 24.8% broke doors or windows during quarrels and 28.3% damaged something valuable for their wives. Participating women stated that their husbands started fights for trivial reasons (nearly one out of two women), criticized their behaviors (54.1%), did not chat but sulked (40.5%), blamed them when something went wrong (38.1%), insulted them when there were no other person around (19.3%) and made the major decisions without consulting them (91.7%). Approximately two out of three women (72%) stated that their husbands managed the financial affairs, whereas one out of two women stated that their husbands limited the money the spent. Nearly half of them said that (46.9%) their husbands asked them to give an account of the expenses, and 5.5% stated that their husbands forced them to have sexual intercourse even though they were not willing. The comparison of the relationship between the mean scores obtained from the DVAWDS and the sociodemographic characteristics of the participants revealed that the DVAWDS mean scores were higher in those who were illiterate, were unemployed, had no social security, lived in rural areas, stayed in slums, shared the house with five or more people, got married at the age of 22 or younger, had been married for 6-10 years, had a chronic disease and whose husbands were literate or were unemployed. The DVAWDS mean scores were higher in those who had four pregnancies, gave birth to three children, had three or more children, had miscarriages, had abortion, wanted to have a male child, had unwanted pregnancy, were at 38-42 weeks of gestation, stated that she and her husband were incompatible, were exposed to physical violence before pregnancy and were diagnosed with depression. The differences between the groups were statistically significant. There was not a statistically significant difference between the mean DVAWDS scores in terms of maternal age, knowing the gender of the fetus, receiving support during the pregnancy, having a family member diagnosed with depression. The correlation between the total scores obtained from the DVAWDS, from the BDI, and from the UCLA-LS revealed a linear positive correlation between the UCLA-LS and the BDI (r= 0.630, p= 0.000), between the DVAWDS scale and BDI (r=0.917, p=0.000) and between the DVAWDS scale and UCLA-LS (r = 0.529, p = 0.000). Key words: Violence during pregnancy, Violence against women determination scale, Depression during pregnancy, Loneliness during pregnancy