Depressive symptoms and intimate partner violence in the 12 months after childbirth

The study also found that most of the women reporting postnatal depressive symptoms first reported this at six months after birth or later.

Intimate partner violence (both physical and emotional abuse) in the perinatal period is associated with a range of physical and psychological health problems including adverse pregnancy and birth outcomes, postnatal depression, and future behavioural problems for children.

This Australian study looked at 1305 nulliparous women. They were recruited from six public hospitals between 6 and 24 weeks of gestation. Written questionnaires were completed at recruitment and at 3, 6 and 12 months postpartum.

Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) and intimate partner violence was assessed using the short version of the Composite Abuse Scale.

Information on depressive symptoms was collected at multiple time points, while data on intimate partner violence was only collected at the 12 month follow-up.

The study found that one in six women reported intimate partner violence in the year after having their first baby. Emotional violence was more common than physical violence (14% versus 8%).

Sixteen percent of women reported depressive symptoms in the 12 months postpartum, with most women first reporting depressive symptoms in the second 6 months after birth. Factors associated with postpartum depressive symptoms include: emotional abuse alone, physical abuse, depression in pregnancy and unemployment in early pregnancy.

The significant associations between intimate partner violence and depressive symptoms over the course of the first postpartum year persisted after adjusting for the known confounders of prior depression and relevant socio-demographic characteristics (maternal age, relationship status, and employment status in early pregnancy).

Dr Hannah Woolhouse of the Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute in Victoria, Australia and co-author of the paper said:

"Depression after childbirth has received a lot of attention in recent decades. Known risk factors for developing postnatal depression include a history of depression, poor partner relationships, stressful life events/social health issues, low social support, and low income. Our findings indicate that intimate partner violence is very common among women reporting postnatal depressive symptoms, and may be an important factor for health professionals to consider in managing postnatal distress.

"In both the UK and Australia, universal screening for depressive symptoms in the first few months after childbirth is now recommended as part of routine perinatal care. However we found that most of the women reporting postnatal depressive symptoms first reported this at six months postpartum or later.

"This finding has major implications for clinical practice as many women who develop depression after six months will be missed. Health professionals should regularly enquire about a woman's mental health in the 12 months after birth, rather than at one specific time point."

Professor Philip Steer, Editor of BJOG added:

"This study shows that pregnancy and the postnatal period is a good time to identify and support women who experience both depression and partner violence."

More information: Woolhouse H, Gartland D, Hegarty K, Donath S, Brown S. Depressive symptoms and intimate partner violence in the 12 months after childbirth: a prospective pregnancy cohort study. BJOG 2011; DOI: 10.1111/j.1471-0528.2011.03219.x

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