ArticlesViolence against women by their intimate partner during pregnancy and postnatal depression: a prospective cohort study
Introduction
Violence against women is common, with the intimate male partner as the aggressor in most circumstances.1, 2, 3, 4, 5 Rates of violence perpetrated by intimate male partners during pregnancy vary worldwide from 3% in London6 to 31% in Mexico City,7 though this variation also depends on the methods of assessment. Partner violence during pregnancy affects 4–8% of pregnant women in the USA.5
Three types of partner violence are most often assessed—physical, sexual, and psychological (including verbal or emotional abuse)—and psychological violence is most frequently reported.8, 9 Few studies have examined the potential association between violence during pregnancy and postnatal depression,8, 10 which is important for women's health as well as that of their children.11 In India, Patel and colleagues10 showed that postnatal depression was more common among women who experienced marital violence during pregnancy than in those who did not. However, the study definition of partner violence did not include psychological violence, and the results were not adjusted for potential confounding factors. In a study of a Chinese community, Leung and co-workers8 also recorded an association between psychological violence and postnatal depression. However, the information about partner violence was obtained retrospectively and so is prone to recall bias.
In view of the limitations of previous studies, whether psychological violence by intimate male partners during pregnancy has an adverse effect on the mental health of women after delivery is still unclear. Longitudinal studies are needed to account for previous psychological problems. Also, women with postnatal depression are likely to retrospectively reinterpret acts as psychological violence.8
We aimed to investigate the association of postnatal depression with psychological, physical, and sexual violence against women perpetrated by their intimate partners during pregnancy. Our hypothesis was that violence, especially psychological, during pregnancy would be associated with an increase in risk of postnatal depression. We studied a population-based sample of pregnant women who were registered with publicly funded primary health care in a poor area of northeastern Brazil.
Section snippets
Participants
The study was undertaken in health district two (one of six health areas) in Recife, which is the capital of Pernambuco state in northeastern Brazil. Health district two has a population of 217 293 inhabitants,12 representing almost 15% of the total population of Recife, with a high proportion of low-income families. We enrolled all pregnant women aged 18–49 years who were in their third trimester and had registered with the primary health-care programme (family health programme, and community
Results
1133 pregnant women were eligible for inclusion in the study, of whom 1121 (99%) had completed their assessments during pregnancy. 1057 women completed the postnatal interview, which represented a high response rate of 94% of those who had completed their assessments during pregnancy. Median length of follow-up between the first and second interviews was 8·1 months (IQR 5·2–10·2). Response rate varied dependent on educational level: a higher proportion of the 64 women lost to follow-up after
Discussion
In this population-based cohort study, we identified a gradient of increasing risk of postnatal depression associated with the coexistence of different forms of intimate partner violence against women during pregnancy. The highest risk of postnatal depression was in women who reported physical or sexual violence plus psychological violence. Postnatal depression was strongly associated with psychological violence, even when it occurred without physical or sexual violence.
We recorded a clear
References (43)
- et al.
Violence against women: global scope and magnitude
Lancet
(2002) - et al.
Prevalence of intimate partner violence: findings from the WHO multi-country study on women's health and domestic violence
Lancet
(2006) - et al.
Domestic violence: prevalence in pregnant women and associations with physical and psychological health
Eur J Obstet Gynecol Reprod Biol
(2004) - et al.
Domestic violence and postnatal depression in a Chinese community
Int J Gynecol Obstet
(2002) - et al.
Violence against women by their intimate partner and common mental disorders
Soc Sci Med
(2008) - et al.
The MOS social support survey
Soc Sci Med
(1991) - et al.
Domestic violence during pregnancy in Rio de Janeiro, Brazil
Int J Gynecol Obstet
(2002) - et al.
Detection of depression in women of child-bearing age in non-western cultures: a comparison of the Edinburgh postnatal depression scale and the self-reporting questionnaire-20 in Mongolia
J Affect Disord
(2006) - et al.
Treatment of postnatal depression in low-income mothers in primary-care clinics in Santiago, Chile: a randomised controlled trial
Lancet
(2007) Dilemmas and opportunities for an appropriate health-service response to violence against women
Lancet
(2002)