530: Pregnant women are inconsistent in their disclosure of physical, sexual, and emotional abuse

Our ability to recognize abuse during prenatal care is limited and underemphasized. The objective of this study was to determine if subjects report abuse consistently during the standard Clinical Prenatal Assessment (CPA) when compared with their reports during a Structured Clinical Interview for DSM-IV (SCID). We also sought to determine if diagnosis of psychiatric disorders such as depression, anxiety, and post-traumatic stress disorder (PTSD) varied by report of abuse. A clinical chart and study record review was completed for subjects ≥ 18 years old with singleton pregnancies, no major mental or physical co-morbidities and enrolled at <15 weeks gestation in a larger prospective longitudinal study. Reports of past and present physical, sexual, and emotional abuse were recorded from both the CPA and the SCID and reports of abuse were compared between the two measures. Diagnoses of depression, anxiety, and PTSD were abstracted from the SCID and subjects who reported abuse in either format were compared with subjects who did not report abuse. Sixty-four CPAs were available for review of past and present abuse and psychiatric disorder. Of these, 46 SCIDs were completed and available for review. Past sexual abuse was reported by 17% of subjects on the CPA versus 13% of subjects on the SCID (p=0.4). Four subjects who reported past sexual abuse on the CPA did not disclose it on the SCID. Past physical abuse was reported similarly between the 2 measures (14% CPA vs 13% SCID). Depression and PTSD were more common in abused subjects than non-abused (67% vs 47%, p=0.16, and 40% vs 0%, p=0.0002). Subjects did not consistently report a past history of sexual abuse in our study population. Of those who did report any abuse, the incidence of psychiatric disease was high. Healthcare providers must consider how information about abuse is ascertained to improve rapport and trust with patients prior to expecting their candid disclosure.