Intimate Partner Violence as a Risk Factor for Postpartum Depression Among Canadian Women in the Maternity Experience Survey

doi:10.1016/j.annepidem.2010.05.011

Annals of Epidemiology

Volume 20, Issue 8, August 2010, Pages 575-583

https://doi.org/10.1016/j.annepidem.2010.05.011 Get rights and content

Purpose

Intimate partner violence is a worldwide public health concern that predominantly affects women of reproductive age. The purpose of this study was to evaluate the effect of exposure to intimate partner violence before, during, or after pregnancy on postpartum depression in a nationally representative sample of Canadian women.

Methods

A cross-sectional analysis was performed with the use of data from the Maternity Experience Survey conducted by Statistics Canada in 2006. A population-based sample of 8542 women 15 years and older who delivered singleton live births was selected from all Canadian provinces and territories; of those, 6421 completed a computer-assisted telephone interview. Recent experiences with and threats of physical or sexual violence by an intimate partner were examined in relation to postpartum depression assessed through the Edinburgh Postpartum Depression Scale.

Results

The prevalence of postpartum depression was 7.5% (95% confidence interval, 6.8−8.2). Controlling for confounders, odds of postpartum depression were significantly greater among women who reported partner violence in the past two years as opposed to those who did not (adjusted odds ratio, 1.61; 95% confidence interval, 1.06−2.45).

Conclusions

Intimate partner violence is positively associated with postpartum depression among Canadian women. Implications for healthcare practice are discussed.

Introduction

Stressful events and situations are environmental exposures that can decrease host resistance and increase host susceptibility to a wide range of physical and mental health problems. Intimate partner violence is a worldwide public health concern and a chronic stressor that predominantly affects women of reproductive age (1). Stress has been previously conceptualized as an imbalance between environmental demands and individual resources 2, 3, 4, 5. Such an imbalance can enhance stress perception and maladaptive emotional response, leading either directly or indirectly to adverse health outcomes (6).

The Centers for Disease Control and Prevention (CDC) defines intimate partner violence as “physical violence, sexual violence, threats of physical/sexual violence, and psychological/emotional abuse perpetrated by a current or former spouse, common-law spouse, non-marital dating partners, or boyfriends/girlfriends of the same or opposite sex” (1). Violence perpetrated by an intimate partner has been linked with numerous health sequelae; these include injury 7, 8, disability 9, 10, chronic pain 7, 8, 10, 11, 12, arthritis (10), headaches or migraine 10, 12, gastrointestinal signs 7, 8, 10, sexually transmitted infections 7, 8, 12, 13, substance use and abuse 7, 14, social dysfunction 7, 8, insomnia 7, 8, posttraumatic stress disorder 11, 15, 16, 17, 18, anxiety 7, 8, suicidal thoughts 12, 19, 20, and depression 11, 21, 22, 23, 24, 25, 26, 27.

According to the World Health Organization, depression is the leading cause of disability worldwide among people aged 5 years and older; furthermore, the lifetime prevalence of a major depressive disorder is considerably higher among women (25%) compared with men (10%) (28). Risk factors for depression include substance abuse, chronic physical illness, stressful life events, social isolation, a history of physical or sexual abuse, and a family history of depression (28). Recently, Daniels (25) referred to the association between intimate partner violence and depression as a deadly comorbidity because of the established risk of homicide and suicide in the presence of both conditions.

The association between intimate partner violence and depression has rarely been examined in the context of pregnancy and the postpartum period. The few recent studies were either limited in sample size, used convenience sampling, or did not adjust for important confounders 22, 29, 30, 31, 32, 33. Postpartum depression affects 8% to 20% of women and is a severe mood disorder that mainly occurs in the first four weeks after delivery; it can hamper care-giving and mother−child bonding and may also trigger self-harm in some women (34). Although hormonal factors have been shown to influence the risk of postpartum depression, the etiology of this condition appears to be multifactorial. Sociobehavioral factors that have been linked with postpartum depression include personal and family history of mood disorders, young age, unmarried status, low socioeconomic status, stressful situation during pregnancy, low social support, unplanned pregnancy, use of cigarettes, alcohol and illicit drugs, and poor relationship with an intimate partner (35); the latter risk factor implies that intimate partner violence may promote or exacerbate postpartum depression. The body of research often failed to specifically measure intimate partner violence; therefore, in many cases, poor relationships with partners may actually represent intimate partner violence.

The purpose of this study was to examine the effect of exposure to intimate partner violence before, during, or after pregnancy on postpartum depression in a nationally representative sample of Canadian women. It was hypothesized that women who experienced violence by their partners, husbands, or boyfriends in the two years before survey administration were more likely than their counterparts to screen positive for postpartum depression.

Section snippets

Database

The analysis of this study was determined by the Maternity Experience Survey (MES) that was sponsored by the Public Health Agency of Canada and conducted by Statistics Canada in 2006. The MES is the first nationwide survey to assess pregnancy, delivery, and postnatal experiences of mothers and their children. The survey sample was selected from the Canadian Census of Population to include women, aged ≥15 years, who had singleton live births between February 15, 2006, and May, 2006, in the

Results

The sample size for the population analyzed in this study was 6421, weighted to represent 76,508 Canadian women. On average, the MES mother scored 5.3% (95% CI, 5.2−5.4; SD, 4.4) on the EDPS. The prevalence of postpartum depression, however, was 7.5% (95% CI, 6.8−8.2). Moreover, a total of 8373 mothers (11.0%, 95% CI, 10.3−11.8) reported to have had experienced actual or threatened violence in the past 2 years. The characteristics of violence experienced by these women are displayed in Table 1.

Discussion

In this study, we evaluated the role of intimate partner violence around the time of pregnancy on postpartum depression in a nationally representative sample of Canadian women. The following key results were obtained: (i) 11% of women reported experiencing violence by a husband, boyfriend, life partner, a family member, a friend, an acquaintance or a stranger around the time of their pregnancy. (ii) Perpetrators of violence were equally likely to be a partner or a nonpartner. (iii) Women were

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Prevalence and risk factors of perinatal depression among women in rural Bihar: A community-based cross-sectional study
2021, Asian Journal of Psychiatry
Perinatal depression (PND) is one of the most common mental disorders occurring during the perinatal period among women. Few studies examined prevalence and risk factors of PND from rural settings in India. This study aimed to estimate the prevalence of perinatal depression and identify social risk factors for it among women from rural Bihar.
A cross sectional study was conducted in a community setting in rural areas of Bihar. All perinatal women were screened through a door to door survey and recruited after obtaining informed consent. A semi-structured proforma was used to collect sociodemographic characteristics and family related variables. Edinburgh postnatal depression scale (EPDS) was used to screen for perinatal depression.
A total of 564 perinatal women were recruited into the study. The estimated prevalence of PND was 23.9 % (95 % CI: 20.6,27.6). Multivariate analysis showed perinatal depression was associated with physical illness in the mother, previous history of abortion, poor financial status and ill-treatment by in-laws.
Prevalence of perinatal depression among women is high in rural settings of North India. A multitude of factors ranging from physical, obstetric, economic and family related confer a high risk for PND. Comprehensive interventions are needed to address these risk factors of perinatal depression.
Screening for intimate partner violence in the early postpartum period: Maternal and child health and social outcomes from birth to 5-years post-delivery
2021, Child Abuse and Neglect
Citation Excerpt :
As well, disruption or chronic activation of the neuroendocrine system early in development (even prenatally) can alter the functional status of the developing immune system, which may have long-term physical health consequences for the developing fetus (Bergman, Sarkar, Glover, & Thomas, 2010). Second, violence during the prenatal period has been shown to be associated with maternal physical and mental health problems both during pregnancy (Chambliss, 2008; Ferri et al., 2007; Flach et al., 2011; Mahenge et al., 2013; McMahon et al., 2011) and postpartum (Beydoun et al., 2010; Flach et al., 2011; Howard et al., 2013; Janssen et al., 2003; McMahon et al., 2011). Maternal prenatal stress, anxiety, and depression have been associated with child development problems across multiple domains of functioning (Field, 2011; Hay et al., 2011; Misri et al., 2010: Santos, Matijasevich, Barros, & Barros, 2014).
Intimate partner violence (IPV) during pregnancy is a substantial public health concern, yet little is known about the developmental trajectory of these women and their children after birth.
The objective was to examine maternal and child health as well as social outcomes from birth to 5-years post-delivery associated with a positive (vs. negative) maternal IPV screen around the time of delivery.
Manitoban women giving birth to a live singleton infant from January 1, 2003 to December 31, 2006 were followed from birth to 5-years post-delivery (analytic sample: N = 40,051).
Administrative databases from the Manitoba Centre for Health Policy provided data for the study. Descriptive statistics and logistic regression were used to examine relationships between IPV screen response around the time of birth (i.e., current, or history of, violence between parenting partners) with maternal and child health as well as social outcomes.
Women screening positive for IPV had increased odds of diagnosed mood/anxiety disorders, personality disorders, substance use disorders, diabetes, respiratory morbidity, and intentional/non-intentional injury hospitalizations (adjusted odds ratio [AOR] range 1.81–5.59, p < .01). Children of women screening positive for IPV had increased odds of diagnosed attention deficit-hyperactivity disorder, lower respiratory infections, and injury hospitalizations (AOR range 1.53–2.00, p < .01), child welfare organization contact (AOR = 8.84, p < .01), and of being more developmentally vulnerable at kindergarten across domains of functioning (AOR range 1.69–1.93, p < .01) than children of mothers screening negative for IPV.
A positive IPV screen was associated with poorer maternal and child health, increased child and family services contact, and children being more developmentally vulnerable in the 5-years after delivery.
A comparative study of postpartum anxiety and depression in mothers with pre-term births in Kenya
2020, Journal of Affective Disorders Reports
Comorbid anxiety and depression and its precursors such as stress associated with neonatal care in hospital, survival of the baby, social support and maternal family dynamics are understudied in sub-Saharan Africa. We studied comorbid postpartum anxiety and depression among mothers of preterm infants receiving intensive care in newborn unit at Kenyatta National Hospital, and mothers of full-term healthy infants attending a health center in Nairobi.
A comparative cross-sectional study design was used to recruit 172 mother-infant dyads; 86 full-term mothers and 86 with pre-term deliveries. Self-reported socio-demographic questionnaire, Edinburgh Postnatal Depression Scale, Kessler's 10 and Patient Health Questionnaire-4 were used to screen for levels of depression, psychological distress and anxiety. Multivariate logistic regression was used to assess the independent predictors of comorbid depression and anxiety.
From 35.1% who screened positive for anxiety 75% (n = 45) were mothers with pre-term babies and of 43 (25%) who screened positive for comorbid depression and anxiety, 83.7% (n = 36) were mothers with pre-term babies. We found that the risk of comorbid depression and anxiety were 6 times more among the mothers with pre-term birth as compared to full term births (p = 0.002), 4.76 times more (p = 0.043) among mothers who reported IPV and 5.95 more (p < 0.001) times among mothers who reported psychological distress.
We found higher proportions of depression, anxiety, and general distress in mothers who delivered pre-term. Risk factors like IPV and poor mental health should be addressed in postpartum mothers regardless of full term or preterm births status, as a fundamental right.
Psychotropic medication use and intimate partner violence at 4 years postpartum: Results from an Australian pregnancy cohort study
2019, Journal of Affective Disorders
In the perinatal period, maternal mental health problems and intimate partner violence often co-occur. We aimed to examine associations between psychotropic medication use and intimate partner violence (IPV) in an Australian population-based sample.
Prospective cohort study of 1507 first-time mothers recruited in early pregnancy (mean gestation 15 weeks) from public maternity hospitals in Melbourne Australia. Follow-up questionnaires at 12 months and four years included validated measures of intimate partner violence (Composite Abuse Scale), and maternal mental health (Edinburgh Postnatal Depression Scale, SF-36). Data on use of psychotropic medications was collected using a self-report measure at four years postpartum.
At four years postpartum, almost one in eight mothers (13.9%) were taking psychotropic medication. The prevalence of psychotropic medication use in women experiencing concurrent IPV was considerably higher compared to women not experiencing IPV (25% vs 11%, Odds Ratio = 2.68, 95% CI 1.73–4.15). Women experiencing IPV were significantly more likely to be taking psychotropic medication, even after adjusting for sociodemographic factors and depressive symptoms (Adj OR = 1.86, 95% CI 1.16 to 2.96). Only 5% of women reporting IPV at four years postpartum had discussed this with a general practitioner.
Limitations include use of a self-report measure to assess psychotropic medication use, lack of data on the use of psychological counselling and/or other specialist mental health services and potential for attrition to bias results (addressed using multiple imputation).
Our findings reinforce the need for health professionals treating women for depressive symptoms to inquire about IPV and tailor responses accordingly.
Postpartum depression among Arab and Jewish women in Israel: Ethnic inequalities and risk factors
2019, Midwifery
Citation Excerpt :
Gauthreaux et al. (2017) likewise reported that women who did not want pregnancy (at the time of conception) were 1.5 times more likely to experience PPD compared to women who wanted to be pregnant. As we hypothesized, and in line with a large number of studies (Beydoun et al., 2010; Fiala et al., 2017; Gauthreaux et al., 2017; Liu et al., 2016; Mitra et al., 2015), we found that women who reported high chronic stress were 5 times more likely to develop PPD than women who reported low levels of chronic stress. This association highlights the relevance of chronic stress for developing PPD.
The aim of the current study was to compare the prevalence of, and risk factors for postpartum depression (PPD) among Jewish and Arab women in Israel.
Data were obtained from a study on 'Family Relations and Violence' conducted in Israel in 2014–2015 using a multilayered nationwide representative sample of mothers who were interviewed face to face using a structured questionnaire in each woman's native language (Arabic / Hebrew) 6 weeks to 6 months postpartum.
63 Maternal and Child Health (MCH) clinics from five geographical districts.
Jewish (N = 853) and Arab (N = 275) women aged 16–48 who were 6 weeks to 6 months postpartum.
PPD was measured by the Edinburgh Postnatal Depression Scale with a cutoff of ≥10. We examined a range of risk factors using multivariate logistic regression analysis and Generalized Estimating Equations (GEE) for the total sample, then separately for each ethnic group.
For the total sample (n = 1128). Prevalence of PPD was 10.3%. Prevalence among Arab women was significantly higher compared to Jewish women (20.8% vs 7%, respectively). In the multivariable analysis, chronic stress, low social support, and unwanted pregnancy were major risk factors for PPD for Arab women. Among Jewish women the risk factors for PPD included chronic stress, low level of education, and intimate partner violence.
Our findings indicate ethnic inequalities in the prevalence of, and risk factors for PPD in Israel that should be considered in health planning and policymaking.
Maternal health care nurses and other professionals should be aware of these inequalities and provide culturally sensitive health care services and programs to protect women in these population groups from PPD.
Perinatal Intimate Partner Violence
2018, Obstetrics and Gynecology Clinics of North America

View all citing articles on Scopus

: This research was supported in part by the intramural research program of the NIH, National Institute on Aging.

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Intimate Partner Violence as a Risk Factor for Postpartum Depression Among Canadian Women in the Maternity Experience Survey

Purpose

Methods

Results

Conclusions

Introduction

Section snippets

Database

Results

Discussion

Womens Health Issues

Early Hum Dev

Lancet

Womens Health Issues

J Subst Abuse Treat

Ann Epidemiol

Am J Prev Med

J Affective Disord

Int J Gynaecol Obstet

J Obstet Gynaecol Can

Obstet Gynecol

Int J Gynaecol Obstet

Ann Epidemiol

Am J Obstet Gynecol

J Obstet Gynecol Neonatal Nurs

Int J Gynaecol Obstet

Ann Epidemiol

Am J Prev Med

Soc Sci Med

J Midwifery Womens Health

Int J Gynaecol Obstet

Int J Gynaecol Obstet

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