Psychological Distress Indicators Among Pregnant Women Reporting Intimate Partner Violence in Primary Care: Implications for Trauma-Informed Antenatal Care in Nigeria

Background: Intimate partner violence (IPV) during pregnancy is a significant public health concern in low-resource settings. Primary care antenatal clinics are often the first point of contact for pregnant women and provide important opportunities to identify both violence and related psychological distress. This study examined the prevalence of IPV during pregnancy, the reporting of psychological distress indicators (low self-esteem, sleep disturbance, and suicidal ideation) among women reporting IPV, and the association between IPV and timing of antenatal care (ANC) initiation in a low-resource primary care setting in Nigeria. Methods: We analyzed cross-sectional data from 463 pregnant women receiving routine antenatal care at a primary health center in Abuja, Nigeria (February–July 2024). IPV during the index pregnancy was assessed via an interviewer-administered survey. Psychological distress indicators were measured using single-item self-report questions assessing perceived self-esteem, sleep disturbance, and suicidal thoughts attributed to violence. Multivariable logistic regression models examined associations between IPV and late ANC initiation (>12 weeks’ gestation), adjusting for sociodemographic and partner-related characteristics. Additional analyses examined the associations between late ANC initiation and perceived psychological distress indicators among women reporting IPV. Results: IPV during the index pregnancy was reported by 68.7% of participants. Among women reporting IPV, high proportions also reported psychological distress indicators, including low self-esteem (77.1%), sleep disturbance (67.3%), and suicidal thoughts (approximately one-third). Women reporting IPV had significantly lower odds of delayed ANC initiation (aOR = 0.37; 95% CI: 0.19–0.69). Individual psychological indicators were not independently associated with ANC timing after adjustment. Conclusions: Although women reporting IPV were more likely to initiate ANC early, they frequently also reported psychological distress indicators, highlighting routine ANC visits as important opportunities for trauma-informed identification, assessment, and referral.