Temporal Relationship Between Intimate Partner Violence and Postpartum Depression in a Sample of Low Income Women

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 São 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.     

The relationship between intimate partner violence and probable depression among adolescent girls and young women in Lilongwe,Malawi

ABSTRACT

This analysis estimates prevalence of intimate partner violence (IPV) and its association with probable depression among adolescent girls and young women (AGYW) in Lilongwe, Malawi, and whether partner’s controlling behaviour modifies this relationship. Baseline data was utilised from the Girl Power-Malawi study of 1000 15–24-year-old AGYW in Lilongwe. Emotional, physical, and sexual IPV experiences with a current or recent partner were measured using the modified Conflict Tactics Scale. Probable depression was measured by scoring ≥10 on the Centre for Epidemiologic Studies-Short Depression Scale (CES-D-10). Generalised linear models with log-link and binomial distribution estimated prevalence ratios (PR) and 95% confidence intervals (CI) for the association between IPV types and probable depression. Partner’s controlling behaviour was examined as an effect modifier. Participants’ mean age was 19.2 years, with 70% never-married. IPV prevalence varied for emotional (59%), physical (36%), sexual (46%), and all forms (20%). Prevalence of probable depression was 47%. AGYW who experienced each IPV type had a higher prevalence of probable depression: physical (PR:1.54, CI:1.28–1.86), sexual (1.46, CI:1.21–1.75), emotional (1.37, CI:1.14–1.64), all forms (1.72, CI:1.41–2.09). IPV and probable depression were prevalent and strongly associated, especially among AGYW reporting controlling behaviour. Interventions addressing IPV and controlling behaviour may positively impact depression among AGYW.     

The Syndemic Effects of Intimate Partner Violence, HIV/AIDS, and Substance Abuse on Depression among Low-Income Urban Women

Intimate partner violence (IPV), HIV/AIDS, and substance use are epidemics among low-income urban women that have been described together as the “SAVA syndemic” because of their co-occurring nature. This study examines the synergistic or “syndemic” effect of these three health issues on depression among urban women and evaluates social support as a protective factor that might reduce depressive symptoms associated with the Substance Abuse, Violence, and AIDS (SAVA) syndemic. Data from 445 urban women were collected through in-person interviews. All women were over the age of 18, not pregnant, English speaking, and reported having a main partner in the past year. Twenty-five percent had experienced all three factors of the SAVA syndemic (were HIV-positive, had experienced IPV in the past year, and had used cocaine or heroin in their lifetime). HIV-positive status, hard drug use, IPV, and low levels of social support were all individually associated with greater depressive symptoms. When controlling for demographics and other SAVA factors, IPV and hard drug use in the past 30 days remained associated with depressive symptoms, as did low social support. However, social support did not modify the effect of the SAVA factors on depression. Compared to women who experienced no SAVA factors, women who had experienced all three factors were 6.77 times more likely to have depressive symptoms. These findings confirm that IPV is significantly associated with depressive symptoms and that the syndemic impact of IPV, substance use, and HIV could have even more extreme effects on depression outcomes.     

An Exploratory Analysis of Intimate Partner Violence and Postpartum Depression in an Impoverished Urban Population

Research on the relationship between intimate partner violence (IPV) and postpartum depression (PPD) is limited. Numerous antecedents and consequences of both IPV and PPD are noted in the literature; however, understanding the mechanisms by which intimate partner violence impacts the postpartum mood are not clearly understood. This study utilized retrospective chart reviews from a pediatric/perinatal social work outreach program to explore urban minority women experiences with IPV and depression both during pregnancy and after. Findings do not suggest a direct relationship between IPV and PPD; however, there was a high co-occurrence of prenatal depression and PPD. The severity of IPV appears to influence the occurrence and acuity of prenatal depression suggesting an indirect relationship. Implications for health and social work practitioners are discussed.     

Mothers' AdvocateS In the Community (MOSAIC)- non-professional mentor support to reduce intimate partner violence and depression in mothers: a cluster randomised trial in primary care

Background  

Effective interventions to increase safety and wellbeing of mothers experiencing intimate partner violence (IPV) are scarce. As much attention is focussed on professional intervention, this study aimed to determine the effectiveness of non-professional mentor support in reducing IPV and depression among pregnant and recent mothers experiencing, or at risk of IPV.     

The long-term effects of intimate partner violence on adolescent mothers' depressive symptoms

Adolescent mothers are at high risk of experiencing intimate partner violence (IPV) which may increase their likelihood of depressive symptoms in adulthood, yet little is known about the long-term effects of IPV on adolescent mothers' trajectories of depressive symptoms. The study reported here uses prospective data spanning 14 years from a study of 229 adolescent mothers from Washington State, USA to evaluate the effects of adolescent exposure to IPV on the trajectories of depressive symptoms over time, as well as the likelihood of depressive symptoms at age 28 years. After controlling for levels of economic insecurity, the results indicate that adolescent IPV and an early vulnerability to depression were significantly related to the intercept, but not the slope of the adult depressive symptom trajectories. Both cumulative and concurrent IPV predicted the likelihood of depressive symptoms at age 28 years. Follow-up analyses indicate that adolescent IPV is associated with greater levels of adult IPV, and that women who report both adolescent and adult IPV have the highest mean levels of depressive symptoms. These findings suggest that exposure to IPV in adolescence may alter the life course of young women, increasing their risk for continuing exposure to intimate partner violence in adulthood and its concomitant negative mental health effects. Efforts aimed at prevention and early intervention in IPV among adolescent mothers are important components of the clinical care of young mothers.     

Prevalence and Associated Factors of Intimate Partner Violence Among Pregnant Women Attending Kisumu District Hospital, Kenya

To determine prevalence and factors associated with intimate partner violence (IPV) among pregnant women seeking antenatal care. This was a cross-sectional study conducted at Kisumu District Hospital, Kenya amongst randomly selected pregnant women. A structured questionnaire was used to collect data. Participants self-reported about their own IPV experience (lifetime, 12 months prior to and during index pregnancy) and associated risk factors. Data were analyzed using Epi-info. The mean age of the 300 participants was 23.7 years. One hundred and ten (37 %) of them experienced at least one form of IPV during pregnancy. Psychological violence was the most common (29 %), followed by sexual (12 %), and then physical (10 %). Women who experienced IPV during pregnancy were more likely to have witnessed maternal abuse in childhood (aOR 2.27, 95 % CI = 1.05–4.89), been in a polygamous union (aOR 2.48, 95 % CI = 1.06–5.8), been multiparous (aOR 1.94, 95 % CI = 1.01–3.32) or had a partner who drank alcohol (aOR 2.32, 95 % CI = 1.21–4.45). Having a partner who attained tertiary education was protective against IPV (aOR 0.37, 95 % CI = 0.16–0.83). We found no association between HIV status and IPV. IPV is common among women seeking antenatal care at Kisumu District Hospital. Health care providers should be alerted to the possibility of IPV during pregnancy in women who witnessed maternal abuse in childhood, are multiparous, polygamous, have a partner who drinks alcohol or has low level education. Screening for IPV, support and referral is urgently needed to help reduce the burden experienced by pregnant women and their unborn babies.     

Depression and Social Support Among Women Living with the Substance Abuse,Violence, and HIV/AIDS Syndemic: A Qualitative Exploration

BackgroundIntimate partner violence (IPV), HIV/AIDS, and substance use are described as the SAVA “syndemic” among low-income urban women because of their intersecting and synergistic presence in these women's lives. Depressive symptoms are significantly associated with these SAVA factors and although social support is potentially protective for depression, little is understood about its impact on depression associated with the SAVA syndemic.MethodsThis paper investigates how women living with SAVA experience and describe depressive symptoms, and examines how the types of social support they access impact their experiences of SAVA and depressive symptoms. Qualitative, in-depth interviews were conducted with 24 HIV-positive, low-income, urban women who experienced IPV and used cocaine or heroin in their lifetime. Interviews were analyzed based on study aims, principles of thematic content analysis, and grounded theory.ResultsWomen identified multiple SAVA factors as catalysts for depression and noted their synergistic effect on depressive symptoms, which were both a trigger for and a result of drug use. Women accessed varying sources of social support to address their SAVA factors and associated symptoms of depression, relying on informal sources for instrumental support related to IPV and formal sources for support related to HIV, drug use, and depression.ConclusionsThese findings have important implications for health providers who serve SAVA-affected women, and suggest that comprehensively addressing all SAVA factors (and IPV in particular) and improving their access to quality social support at critical times is essential to improve their mental health.     

Intimate Partner Violence and Help-Seeking Among Ethiopian Women

Although intimate partner violence (IPV) is a widespread phenomenon in Ethiopia, the relationship between help-seeking sources and IPV is not well understood. Better understanding of this relationship could play a role in preventing IPV. We used data collected in the 2016 Ethiopia Demographic and Health Survey and limited our study to women who have ever been married, aged 15 to 49 years (n?=?4469). Overall, the proportions of women who have ever experienced emotional abuse, physical, or sexual violence were 24%, 23.1%, and 10.1%. Women who sought informal help (family) were 2.42 times more likely (OR?=?2.42; CI 1.29–4.55) to have ever experienced emotional abuse than women who did not seek family help. Neither formal nor informal help-seeking significantly associated with physical or sexual violence. The results may indicate difficulties women face in seeking help and cultural and social norms that tolerate IPV as an acceptable part of family life in Ethiopia.

     

湖南省孕产妇亲密伴侣暴力发生及影响因素研究

目的 了解孕产妇在孕前和妊娠期亲密伴侣暴力(intimate partner violence,IPV)的发生情况,探索和识别影响亲密伴侣暴力发生的因素。 方法 通过湖南省某妇幼保健院产科门诊招募孕妇进行问卷调查,内容包括一般人口学特征,家庭条件,妊娠经历,社会支持和亲密伴侣暴力经历。 结果 本次回收有效问卷510份,共113例(22.2%)孕产妇有遭受亲密伴侣暴力的经历,其中68例(13.3%)是在孕前发生的亲密伴侣暴力,45例(8.8%)是在妊娠期发生亲密伴侣暴力;就暴力类型而言,精神暴力发生率最高,有97例(19.0%),其次为躯体暴力有21例(4.1%),性暴力最少,有6例(1.2%)。多因素logistic回归分析显示有不良妊娠史是孕前亲密伴侣暴力发生的危险因素(OR=2.941,95%CI:1.574~5.494),而社会支持中主观支持是妊娠期亲密伴侣暴力发生的保护因素(OR=0.803,95%CI:0.722~0.893)。 结论 孕产妇遭遇孕前和妊娠期亲密伴侣暴力将影响孕产妇及婴幼儿身心健康,在母婴保健工作中应增加对妇女精神暴力伤害及孕产妇亲密伴侣暴力发生的关注,并及早识别受害者的暴力经历,从而采取早期干预措施。     

Substance Use and Intimate Partner Violence: Clarifying the Relevance of Women’s Use and Partners’ Use

Research has shown that, when women and/or their partners are involved in substance use, women’s risk for intimate partner violence (IPV) is higher. Prior research has not examined whether substance use by both women and their partners contributes independently or interactively to women’s risk of victimization and has not identified factors moderating the effect of substance use by victim or partner. Mental health and social support are explored as moderators of the association between women’s victimization and substance use by victim or partner in a study of 590 impoverished women residing in the Los Angeles area. This study found that substance use by both the woman and her partner independently predicted IPV and that social support moderated the effect of women’s substance use. These findings clarify the relevance of substance use in the context of intimate relationships and that of social support as a buffer against IPV among impoverished women.     

Prevalence and Risk Factors of Intimate Partner Violence Among Pregnant Women in Japan

Intimate partner violence (IPV) during pregnancy can result in adverse outcomes for both mothers and their infants. This cross-sectional study examined the prevalence and risk factors of IPV associated with abuse during pregnancy via a self-administered questionnaire completed by 302 healthy pregnant women. Demographic information was also collected from medical records to analyze risk factors for abuse. Of the 302 women, 48 (15.9%) were identified as experiencing IPV. The identified risk factors were age over 30, multipara, previous abortion experience, and male partner aged under 30.     

Partner violence victimization and unintended pregnancy in Latina and Asian American women: Analysis using structural equation modeling

Intimate partner violence (IPV) is a pervasive public health problem in the U.S., affecting nearly one in every three women over their lifetimes. Using structural equation modeling, we evaluated the association between IPV and unintended pregnancy, mediated by condom use and perceived spousal/partner support among Latina and Asian women. Data came from the 2002–2003 National Latino and Asian American Study (NLAAS). The analysis was restricted to married or cohabiting female respondents aged 18+ years (n = 1,595). Dependent variables included unintended pregnancy, condom use, and perceived partner support. Independent variables included physical abuse or threats by current partner and primary decision-maker. Weighted least squares was used to fit path models to data comprising dichotomous and ordinal variables. More than 13% of women reported IPV during their relationship with their partner/spouse. Abused women were twice as likely as non-abused women to have had an unintended pregnancy. This association was partially mediated by perceived partner support. Condom use had a positive, but non-significant association with unintended pregnancy, and IPV had a negative, but non-significant association with condom use. Results highlight the importance of IPV screening for minority women. Efforts to combine family planning and violence prevention services may help reduce unintended pregnancy.     

Intimate Partner Violence During Pregnancy and the First Year Postpartum in an Australian Pregnancy Cohort Study

To assess intimate partner violence (IPV) in a longitudinal cohort study during and after pregnancy, and examine social and economic factors encouraging or inhibiting violence. Nulliparous women were recruited from 6 public hospitals in Melbourne, Australia. Self-administered questionnaires included standardised measures assessing fear of an intimate partner at enrolment, 6 and 12 months postpartum; and period prevalence of physical and emotional abuse in the first 12 months postpartum. 1,507 women completed baseline data (mean gestation 15 weeks). Response fractions at 3, 6 and 12 months postpartum were 95, 93 and 90%, respectively. 5.1 and 5.4% of women reported fear in pregnancy and the first year postpartum, respectively. 17% experienced physical and/or emotional abuse in the first year postpartum. Most women who reported fear of an intimate partner in the first year after the index birth reported fear before and/or during pregnancy. Women working in early pregnancy who qualified for paid maternity leave had significantly reduced odds of reporting combined physical and emotional IPV in the first 12 months postpartum compared with women not working (Adj. OR 0.21, 95% CI 0.08–0.55). Women working but not eligible for paid leave had reduced odds compared with women not working (Adj. OR 0.49, 95% CI 0.24–1.00). Models adjusted for maternal age, relationship status, income and education level. Few first time mothers reported fear for the first time after childbirth suggesting that IPV more commonly commences prior to the first birth. Paid maternity leave may have broader social benefits beyond immediate financial benefits to women and families.     

Social Support and Employment Status Modify the Effect of Intimate Partner Violence on Depression Symptom Severity in Women: Results from the 2006 Behavioral Risk Factor Surveillance System Survey

BackgroundDepression and intimate partner violence (IPV) are significant health issues for U.S. women. Interaction effects between IPV and other psychosocial factors on the severity of depressive symptoms have not been fully explored. This study assessed effect modification, that is, how IPV interacts with sociodemographics, psychosocial factors and health risk behaviors, on the severity of depressive symptoms in women.MethodsWe utilized cross-sectional data from female respondents (n = 16,106) of the 2006 Behavioral Risk Factors Surveillance Survey. Sociodemographics, psychosocial variables, and health risk behaviors determined to be significantly associated with depression were tested for interaction effects with IPV. Weighted ordinal logistic regression and predicted probabilities illustrated the effect of IPV status on depressive symptom severity, stratified by interaction effects.ResultsRecent and lifetime IPV exposure were associated with more severe depressive symptoms compared with no IPV exposure. IPV history interacted with employment status and social support on the severity of depressive symptoms in women. Overall, any IPV exposure was associated with more severe depressive symptoms among women with low social support and unemployment, although the effect of recent (versus lifetime) IPV was most pronounced among women with high social support or employed women.ConclusionsSocial support and employment status interact with IPV on the severity of depressive symptoms in women. Therefore, social support or workplace interventions designed to improve depressive symptoms should examine IPV history.     

Disorganization Theory,Neighborhood Social Capital,and Ethnic Inequalities in Intimate Partner Violence between Arab and Jewish Women Citizens of Israel

We draw on social disorganization (SD) theory and social capital to examine the impact of neighborhood environment on the ethnic gap in intimate partner violence (IPV) between Arab and Jewish women in Israel. We linked census data on neighborhood socioeconomic status (SES) to national data we gathered in 2014–2015 on 1401 women (436 Arab, 965 Jewish) age 16–48. Women were interviewed while visiting 65 maternal and child health clinics throughout Israel. We used General Estimated Equation (GEE) multivariate logistic regression models to adjust for clinic cluster effects and estimated the contribution of neighborhood collective efficacy, problems, relative socioeconomic status (SES), bridging and linking social capital, and social support to explaining ethnic inequalities in IPV, while adjusting for women’s socioeconomic and socio-demographic characteristics. We found that any IPV is higher among Arab compared to Jewish women (odds ratio (OR) and 95% confidence intervals (CI) = 4.19 (2.72,6.42)). Collective efficacy and social group membership (bridging social capital) had no effect on the ethnic inequality in any IPV and types of IPV. Women’s active participation in social groups (linking social capital), higher social support, and living in neighborhoods with relative SES similar to the ethnic group average) had a protective effect from any IPV and physical IPV. Neighborhood problems were associated with increased any IPV and physical IPV. In the final model, the ethnic gap in IPV was reduced but not eliminated (OR (95%CI) = 3.28 (2.01, 5.35). Collective efficacy did not explain the ethnic gap in IPV, while women’s active participation (linking social capital) had a protective effect from IPV. Given the protective nature of women’s activism in this population, future research should investigate how this might be incorporated into solutions to IPV. In addition, reducing neighborhood problems, improving neighborhood SES, and increasing social support might help reduce IPV among Arab women, thus decreasing the ethnic gap in IPV.     

Housing Quality,Housing Instability,and Maternal Mental Health

Poor housing conditions and residential instability have been associated with distress among women; however, this association could be the result of other social factors related to housing, such as intimate partner violence (IPV) and economic hardship. We examined associations of housing conditions and instability with maternal depression and generalized anxiety disorder (GAD) while accounting for IPV and economic hardship in the Fragile Families and Child Wellbeing Study (N = 2,104). In the third study wave, interviewers rated indoor housing quality, including housing deterioration (e.g., peeling paint and holes in floor) and housing disarray (e.g., dark, crowded, and noisy). Mothers reported whether they had moved more than twice in the past two years, an indicator of housing instability. A screening for depression and GAD was obtained from questions derived from the Composite International Diagnostic Interview-Short Form in the second and third study waves. IPV and economic hardship were assessed through questionnaire. In this sample, 16% of women were classified as having probable depression and 5% as having probable GAD. In adjusted analyses, mothers experiencing housing disarray (odds ratio [OR], 1.3 [95% confidence interval (CI), 1.0, 1.7]) and instability (OR, 1.4 [95% CI, 1.2, 2.3]) were more likely to screen positive for depression. In addition, those experiencing housing instability were more likely to screen positive for GAD (OR 1.9 [95% CI, 1.2, 3.0]) even after adjusting for other social factors. No associations were noted between housing deterioration and maternal mental health. Similar associations were noted when incident cases of probable depression and GAD were examined. Housing instability and disarray, but not deterioration, are associated with screening positive for depression and generalized anxiety among women regardless of other social stressors present in their lives. Housing could potentially present a point of intervention to prevent mental health consequences among mothers and possibly their children.     

Interpersonal and structural contexts of intimate partner violence among female sex workers in conflict-affected northern Uganda

Intimate partner violence (IPV) is the most prevalent form of violence against women, yet remains under-researched among sex workers in sub-Saharan Africa. We explored the interpersonal and structural determinants of recent IPV among female sex workers in northern Uganda. This analysis drew on data from a community-based cross-sectional study (conducted May 2011–January 2012), involving 379 female sex workers in Gulu, northern Uganda. Using logistic regression and multivariable modeling, we examined the correlates of recent male-perpetrated physical or sexual IPV. Of 379 women with noncommercial partners, 59 percent reported having experienced recent moderate/severe physical or sexual IPV. Reporting recent client violence (adjusted odds ratio (AOR): 3.67; 95 percent confidence interval [CI]: 2.31–5.83), doing what their partner wanted (AOR: 2.46; 95 percent CI: 1.46–4.13), and forced sexual debut (AOR: 1.92; 95 percent CI: 1.20–3.05) were independently associated with moderate/severe IPV; recent police arrest and/or incarceration were/was marginally significantly associated with IPV (AOR: 2.25; 95 percent CI: 0.86–5.88, p = 0.097). Greater odds of IPV among sex workers were associated with recent workplace violence, forced sexual debut, and gendered power dynamics favoring male partner control. Programs and policies promoting the safety and health of marginalized women and addressing gender dynamics and violence are needed.     

Pacific Islands families study: intimate partner violence and postnatal depression

Aim The present study examined the association between maternal intimate partner violence (IPV) and postnatal depression (PND) 6 weeks after giving birth. Study Design Data were gathered from the Pacific Islands Families Study. Mothers of a cohort of Pacific infants born in Auckland, New Zealand during 2000 were interviewed 6 weeks after giving birth. There were 1,085 mothers cohabiting in married or de-facto partnerships who completed measures of IPV and PND at the 6-week assessment point. Results Women who were victims of physical violence were more likely to report postnatal depressive symptoms than those who were not (29.6% vs. 10.9%, OR: 3.44, 95% CI: 2.42, 4.97). The adjusted odds remained statistically significant (OR: 2.34, 95% CI: 1.52, 3.60). Conclusion Findings suggest that being the victim of physical violence more than doubles the risk of PND. The results of the study may help to develop culturally appropriate social services and policies for Pacific women.     

Violencia de pareja y depresión en mujeres que trabajan en una institución de salud de México

ObjectiveTo assess the effect of intimate partner violence on the risk of depression and depressive symptoms among adult women.MethodWe analyzed data from the Mexican Health Workers’ Cohort study (n = 470). Type and severity of intimate partner violence was ascertained between 2004 and 2011. Self-reported medical diagnosis of depression (2011) was the main outcome; depressive symptoms ascertained with the Centre for Epidemiologic Studies-Depression (CES-D) scale was the secondary outcome. Random-effects regressions were run to model the risk of depression (logistic) and depressive symptoms (linear) in relation to intimate partner violence.Results41.9% women experienced intimate partner violence at baseline. The incidence of depression was 7.2%. The risk of depression increased with any type of IPV (adjusted odds ratio [aOR] = 2.9; 95% confidence interval [95%CI]: 1.4–6.2) and with physical (aOR = 4.3; 95%CI: 1.8–10.1), psychological (aOR = 3.1; 95%CI: 1.4–6.6) and sexual (aOR = 3.1; 95%CI: 1.2–8.2) violence. Depressive symptoms (CES-D) increased slightly with physical and sexual intimate partner violence.ConclusionsIntimate partner violence was associated with a higher risk of depression in this sample of women working in a Mexican health facility. Our results indicate the need to develop infrastructure, to implement strategies of attention and counselling, and to provide a safe environment in the workplace for women who experience intimate partner violence.