LILIA BLIMA SCHRAIBER
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Medicina Preventiva, Faculdade de Medicina - Docente
LIM/39 - Laboratório de Processamento de Dados Biomédicos, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/39 - Laboratório de Processamento de Dados Biomédicos, Hospital das Clínicas, Faculdade de Medicina - Líder
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- Obstacles and facilitators to primary health care offered to women experiencing domestic violence: a systematic review(2020) D'OLIVEIRA, Ana Flavia Pires Lucas; PEREIRA, Stephanie; SCHRAIBER, Lilia Blima; GRAGLIA, Cecilia Guida Vieira; AGUIAR, Janaina Marques de; SOUSA, Patricia Carvalho De; BONIN, Renata GranussoSystematic review of the literature addressing obstacles and facilitators for the care of women, in situations of domestic violence (DV) in primary health care (PHC) in Brazil. The bibliographic review found 1,048 references. The analysis encompassed 39 articles complying with the inclusion and exclusion criteria. The material was centered on representations and beliefs of practitioners. The main obstacles were related to: conceptualizing DV as a health issue, resulting into difficulties to identify the problem and managing care encounters; lack of training and teamwork; scarce intersectoral network, fear and lack of time. The facilitators were mainly: introducing a gender and human rights perspective, bonding and embracement, teamwork and multisectoral work. Despite the potential of PHC to address the issue, few studies considered perspectives of management and financing, considered as key to overcome the problems pointed out.
- Impact of exposure to intimate partner violence on children's behavior(2011) DURAND, Julia Garcia; SCHRAIBER, Lilia Blima; FRANCA-JUNIOR, Ivan; BARROS, ClaudiaOBJECTIVE: To analyze the relationship between intimate partner violence (IPV) against women and children's dysfunctional behaviors and school problems. METHODS: Population-based study part of the WHO Multicountry Study on Domestic Violence Against Women including 790 women living with their children aged five to 12 years in two different regions of Brazil: the city of Sao Paulo, Southeastern Brazil, and Zona da Mata area in the state of Pernambuco, Northeastern Brazil. Three multivariate models were developed to estimate the strength of the relationship between explanatory variables such as social and community support, stressful events of life, sociodemographic factors and ""IPV severity,"" among others, and three outcomes: number of dysfunctional behaviors; aggressive behavior; and school problems (interruption, drop out or failure). RESULTS: Exposure to severe physical and/or sexual IPV was associated to school problems, behavioral dysfunctions in general and aggressive behaviors in the univariate analysis. Exposure to severe IPV against women was associated to the occurrence of three or more dysfunctional behaviors in their children, regardless of common mental disorder, low schooling, physical IPV against maternal grandmother, social and community support in the multivariate models. Severe IPV remained associated to aggressive behavior and school problems after adjustment for other sociodemographic variables, among others. Maternal mental health status was identified as a mediating factor between IPV exposure and dysfunctional behaviors, especially aggressive behaviors. CONCLUSIONS: Severe IPV affects children's behaviors and should be addressed in health policies for school-aged children through the development of common interventions for mothers and children.
- The Link Between Community-Based Violence and Intimate Partner Violence: the Effect of Crime and Male Aggression on Intimate Partner Violence Against Women(2015) KISS, Ligia; SCHRAIBER, Lilia Blima; HOSSAIN, Mazeda; WATTS, Charlotte; ZIMMERMAN, CathyBoth intimate partner violence (IPV) and community violence are prevalent globally, and each is associated with serious health consequences. However, little is known about their potential links or the possible benefits of coordinated prevention strategies. Using aggregated data on community violence from the So Paulo State Security Department (INFOCRIM) merged with WHO multi-country study on women's health and domestic violence data, random intercept models were created to assess the effect of crime on women's probability of experiencing IPV. The association between IPV and male aggression (measured by women's reports of their partner's fights with other men) was examined using logistic regression models. We found little variation in the likelihood of male IPV perpetration related to neighborhood crime level but did find an increased likelihood of IPV experiences among women whose partners were involved in male-to-male violence. Emerging evidence on violence prevention has suggested some promising avenues for primary prevention that address common risk factors for both perpetration of IPV and male interpersonal violence. Strategies such as early identification and effective treatment of emotional disorders, alcohol abuse prevention and treatment, complex community-based interventions to change gender social norms and social marketing campaigns designed to modify social and cultural norms that support violence may work to prevent simultaneously male-on-male aggression and IPV. Future evaluations of these prevention strategies should simultaneously assess the impact of interventions on IPV and male interpersonal aggression.
- Temporal Relationship Between Intimate Partner Violence and Postpartum Depression in a Sample of Low Income Women(2013) FAISAL-CURY, Alexandre; MENEZES, Paulo Rossi; D'OLIVEIRA, Ana Flavia Pires Lucas; SCHRAIBER, Lilia Blima; LOPES, Claudia S.To estimate whether there is a temporal association between Postpartum Depression (PPD) and intimate partner violence (IPV), and to assess the potential role of social support on this relationship. A cross-sectional study was conducted between January 2006 and March 2007 with 701 low income women who received prenatal and postpartum care in primary health care units of the public sector in So Paulo, Brazil. The Self-Report Questionnaire (SRQ-20) was used to assess the presence of PPD. Structured standardized questionnaires were used to assess IPV and social support. The prevalence of PPD was estimated with a 95 % confidence interval. Crude and adjusted prevalence ratios were calculated using Poisson regression to examine the association between PPD and exposure variables. Values of p < 0.05 were considered statistically significant. The prevalence of PPD was 27.9 % (95 %CI 24.6:31.2). The prevalence of psychological IPV was 38.6 %, physical IPV 23.4 %, and sexual IPV 7.1 %. The multivariate analysis showed that PPD was strongly associated with current psychological and physical/sexual violence, after controlling for confounding factors, and less so with past (prenatal or lifetime) IPV. Presence of social support was an independent protective factor for PPD. Identifying and addressing intimate partner violence, including psychological violence, in the postpartum period should be considered as part of a comprehensive approach to caring for new mothers.
- Psychological violence against pregnant women in a prenatal care cohort: rates and associated factors in Sao Luis, Brazil(2014) RIBEIRO, Marizelia Rodrigues Costa; SILVA, Antonio Augusto Moura da; ALVES, Maria Teresa Seabra Soares de Britto e; BATISTA, Rosangela Fernandes Lucena; ROCHA, Lourdes Maria Leitao Nunes de; SCHRAIBER, Lilia Blima; MEDEIROS, Nilzangela Lima; COSTA, Danielle Cristina Silva; BETTIOL, Heloisa; BARBIERI, Marco AntonioBackground: Violence against pregnant women has been associated with gestational and perinatal disorders. Psychological violence is the type least investigated and its associated factors have been little studied. The present study was conducted in order to estimate prevalence rates and analyze the factors associated with exclusive and recurrent psychological violence in the municipality of Sao Luis, Brazil. Methods: Data regarding 982 pregnant women, aged from 14 to 45 years, interviewed in 2010 and 2011 in a prenatal cohort were used. A self-applied questionnaire was used to screen for violence. Pregnant women submitted to physical and sexual violence were excluded from the analysis of factors associated with exclusive psychological violence. Prevalence ratios and 95% confidence intervals were estimated by a Poisson regression model with a hierarchical approach at three levels. At level 1 of the theoretical-conceptual model, we analyzed demographic and socioeconomic characteristics and variables that express gender inequalities; at level 2, we analyzed social support received by the women, and at level 3, the life experiences of the pregnant women. Results: Prevalence rate of exclusive psychological violence was 41.6% and of recurrent violence was 32.6%. Exclusive psychological violence was associated with pregnant women's age of 14 to 18 years (PR: 1.32 95% CI: 1.04 - 1.70), pregnant women's schooling superior to that of her intimate partner (PR: 1.54 95% CI: 1.09 - 2.16), inadequate social affective support/positive social interaction (PR: 1.34 95% CI: 1.11 - 1.62), use of illicit drugs by the pregnant women (PR: 1.80 95% CI: 1.16 - 2.81) and having had six or more intimate partners in life (PR: 1.52 95% CI: 1.18 - 1.96). Recurrent exclusive psychological violence was associated with inadequate social affective support/positive social interaction (PR: 1.47 95% CI: 1.15 - 1.87), use of illicit drugs by the pregnant women (PR: 2,28 95% CI: 1,40 - 3,71) and having had six or more intimate partners in life (PR: 1.47 95% CI: 1.06 - 2.03). Conclusions: Psychological violence was a common phenomenon in this population of pregnant women that was associated with gender inequalities, inadequate social support and illicit drug use and should be routinely investigated during prenatal visits at health care services.
article 31 Citação(ões) na Scopus Association between intimate partner violence against women and HIV infection(2011) BARROS, Claudia; SCHRAIBER, Lilia Blima; FRANCA-JUNIOR, IvanOBJECTIVE: To analyze the association between intimate partner violence against women and infection or suspected infection by the human immunodeficiency virus (HIV). METHODS: A cross-sectional study was conducted, based on data from questionnaires applied face-to-face and medical records of 2,780 women aged between 15 and 49 years, cared for in Sistema Unico de Saude (Unified Health System) units of the Greater Sao Paulo area, Southeastern Brazil, in 2001-2002. Women were categorized into: users in treatment because they are ""HIV seropositive"", those ""suspected of having HIV"" and others who sought health services for different reasons. Intimate partner violence against women throughout life was categorized according to the severity and recurrence of episodes of violence. The association with the outcome was tested using the Poisson model with robust and adjusted variance for sociodemographic, sexual and reproductive variables. RESULTS: The prevalence of violence was 59.8%. Suffering repeated and severe violence was more closely associated with confirmed HIV infection (PR = 1.91). Violence independent from severity and recurrence of episodes showed greater association with suspected HIV infection (PR = 1.29). CONCLUSIONS: Intimate partner violence against women has a key role in situations of suspected and confirmed HIV infection. Thus, it is essential to include its detection, control and prevention as part of the comprehensive care provided for women's health.- Violência por parceiro íntimo no relato de mulheres e de homens usuários de unidades básicas(2017) BARROS, Claudia Renata dos Santos; SCHRAIBER, Lilia BlimaOBJECTIVE: To analyze nonfatal violence suffered and committed by adult men and women, in an intimate relationship. METHODS: The participants in the research were women aged between 15 and 49 years and men between 18 and 60 years, interviewed by face-to-face questionnaire application. The sample selection was of consecutive type, according to the order of arrival of the users. We conducted temporarily independent investigations and covered different health services to avoid couples and relationships in which the retaliation could be overvalued. To improve the comparison, we also examined reports of men and women from the same service, i.e., a service that was common to both investigations. We compared the situations suffered by women according to their reports and cross-linked the information to what men, according to their own reports, do against intimate partners or ex-partners. We also examined the cross-linked situation in reverse: the violence committed by women against their partners, according to their reports, in comparison with the violence suffered by men, also according to their reports, even if, in this case, the exam refers only to physical violence. The variables were described using mean, standard deviation, frequencies and proportions, and the hypothesis testing used was: Fisher's exact and Pearson's Chi-square tests, adopting a significance level of 5%. RESULTS: Victimization was greater among women, regardless of the type of violence, when perpetrated by intimate partner. The perception of violence was low in both genders; however, women reported more episodes of multiple recurrences of any violence and sexual abuse suffered than men acknowledged to have perpetrated. CONCLUSIONS: The study in its entirety shows significant gender differences, whether about the prevalence of violence, whether about the perception of these situations.
- Violence against women is strongly associated with suicide attempts: Evidence from the WHO multi-country study on women's health and domestic violence against women(2011) DEVRIES, Karen; WATTS, Charlotte; YOSHIHAMA, Mieko; KISS, Ligia; SCHRAIBER, Lilia Blima; DEYESSA, Negussie; HEISE, Lori; DURAND, Julia; MBWAMBO, Jessie; JANSEN, Henrica; BERHANE, Yemane; ELLSBERG, Mary; GARCIA-MORENO, ClaudiaSuicidal behaviours are one of the most important contributors to the global burden of disease among women, but little is known about prevalence and modifiable risk factors in low and middle income countries. We use data from the WHO multi-country study on women's health and domestic violence against women to examine the prevalence of suicidal thoughts and attempts, and relationships between suicide attempts and mental health status, child sexual abuse, partner violence and other variables. Population representative cross-sectional household surveys were conducted from 2000-2003 in 13 provincial (more rural) and city (urban) sites in Brazil, Ethiopia, japan, Namibia, Peru, Samoa, Serbia, Thailand and Tanzania. 20967 women aged 15-49 years participated. Prevalence of lifetime suicide attempts, lifetime suicidal thoughts, and suicidal thoughts in the past four weeks were calculated, and multivariate logistic regression models were fit to examine factors associated with suicide attempts in each site. Prevalence of lifetime suicide attempts ranged from 0.8% (Tanzania) to 12.0% (Peru city): lifetime thoughts of suicide from 7.2% (Tanzania province) to 29.0% (Peru province), and thoughts in the past four weeks from 1.9% (Serbia) to 13.6% (Peru province). 25-50% of women with suicidal thoughts in the past four weeks had also visited a health worker in that time. The most consistent risk factors for suicide attempts after adjusting for probable common mental health disorders were: intimate partner violence, non-partner physical violence, ever being divorced, separated or widowed, childhood sexual abuse and having a mother who had experienced intimate partner violence. Mental health policies and services must recognise the consistent relationship between violence and suicidality in women in low and middle income countries. Training health sector workers to recognize and respond to the consequences of violence may substantially reduce the health burden associated with suicidal behaviour.