Association Between Intimate Partner Abuse and Sleep Quality Among Pregnant Women: The Mediating Role of Depressive Symptoms

We aimed to evaluate the association between intimate partner abuse (IPA) and sleep quality among pregnant women and whether depressive symptoms mediate this association. This is a cross-sectional study conducted with 428 pregnant women from Southern Brazil who attended antenatal care visits at Primary Health Care facilities. We assessed IPA (the presence of psychological, physical, or sexual violence perpetrated by intimate partner) using the World Health Organization Violence Against Women tool. Sleep quality was self-reported and classified as “very good/good” and “regular/poor/very poor.” Depressive symptoms were measured using the Patient Health Questionnaire-9. We analyzed the association between IPA and sleep quality using crude and adjusted logistic regression models. Mediation analysis was conducted to explore the direct and indirect effects of IPA on sleep quality mediated by depressive symptoms. Among the 428 pregnant women analyzed, 13.6% experienced some IPA, with the majority being psychological IPA. Nearly 25% reported poor sleep quality. IPA ( OR = 2.51; 95% CI [1.15, 5.48]) and psychological IPA ( OR = 3.63 [1.46, 9.02]) increased the odds of poor sleep quality, while no significant associations were found for physical or sexual IPA. Mediation analyses indicate that depressive symptoms, through PHQ-9 scores, were a significant mediator in this relationship, accounting for over 30% of the total effect. In conclusion, IPA was associated with poor sleep quality, partially mediated by depressive symptoms. It is crucial to implement health promotion guidelines that address violence against women, particularly during pregnancy, to mitigate depressive symptoms and improve sleep quality.