An exploratory analysis of intimate partner violence and postpartum depression in an impoverished urban population

Social Determinants Among Pregnant Clients With Perinatal Depression, Anxiety, Or Serious Mental Illness

To characterize co-occurring social determinants of health for clients experiencing perinatal anxiety and depression (perinatal mood and anxiety disorders) or serious mental illness (SMI) in a diverse population receiving prenatal care in a safety-net health system, we conducted a latent class analysis, using data from a social determinants screener in pregnancy for the health system's clients during 2017-20. The sample included clients with positive screens for depression or anxiety or SMI diagnoses. Prenatal clients with a positive screen for perinatal mood and anxiety disorders or SMI comprised 13-30 percent of classes, characterized by more than two co-occurring social determinants (for example, co-occurring socioeconomic and interpersonal factors). The study findings highlight the salience of social determinants among prenatal patients experiencing perinatal mood and anxiety disorder and SMI and suggest the necessity of consistent screening for both social determinants and perinatal mental health. Policies to address social determinants within and beyond health care settings are critical.

Domestic violence as a risk factor of maternal filicide

PURPOSE

This paper will investigate precursors to maternal filicide, focusing on domestic violence. While psychosis is often well described, less frequently explored are the connections between prior trauma, domestic violence, depression, and filicide. We will discuss reasons why a woman may not disclose domestic violence and suggest possible areas for intervention.

METHODS

We present a case involving domestic violence, its impact on mental health, and eventual filicide. We then present an alternative scenario of the same case where filicide is considered, but is avoided.

RESULTS

The case of the mother who experienced domestic violence and was accused and sentenced for filicide is seen in greater relief by presenting the case in an alternative scenario with effective interventions. It is clear the availability and the ability to access community supports, such as obstetric and pediatric screening, psychiatric treatment, domestic violence shelters, intimate partner violence outreach services, parenting support groups, and hospital social work case management, tragedies such as filicide can be prevented.

CONCLUSION

Traumatic early childhood experiences predispose people to a stress-response system that is more prone to inactivity and impulsivity. This can cause women in domestic violence relationships to stay, limit their options for family planning, become increasingly depressed, not seek community support, and risk impulsive action of harming their child. This risk can be mitigated by building stable relationships with their medical team, treating depression, connecting with home visitation programs, and being empowered to access contraception.

Sexual Orientation Disparities in Experiences of Male-Perpetrated Intimate Partner Violence: A Focus on the Preconception and Perinatal Period

INTRODUCTION

Compared with their heterosexual counterparts, sexual minority women (SMW), especially those with male partners, are at increased risk for intimate partner violence (IPV). IPV has been linked to a variety of adverse maternal, infant, and child health outcomes. However, to date, no research has examined SMW's experiences of IPV in the context of pregnancy. This study explored whether SMW were more likely than exclusively heterosexual women with only male sexual partners (WSM) to report a variety of forms of IPV perpetrated by their male partner before or during pregnancy.

METHODS

Data are from the National Longitudinal Study of Adolescent to Adult Health (Add Health). Our sample size ranged from 10,081 to 10,328 pregnancies, matched with their male pregnancy partner, reported by 3,828 to 3,873 women.

RESULTS

Logistic regression results indicated that compared with heterosexual-WSM, mostly heterosexual women and heterosexual-women who have sex with women (WSW) were more likely to report any IPV, mostly heterosexual women were more likely to report an IPV-related injury, and heterosexual-WSW were more likely to report sexual assault.

CONCLUSIONS

Results suggest that mostly heterosexual and heterosexual-WSW are at increased risk of experiencing multiple forms of IPV with their male pregnancy partners, highlighting the need for additional screening and prevention efforts to reduce IPV and its negative sequelae.

I'll catch you when you fall: Social safety nets and housing instability in IPV-exposed pregnant women

BACKGROUND

Intimate partner violence (IPV) has significant consequences for women's mental health, and it also compromises women's economic security and livelihood, including housing stability. There is a dearth of research, however, on protective factors in the link between housing instability and psychopathology in IPV-exposed women.

METHODS

The current study examines the protective role of social support in the association between housing instability and mental health (depression, posttraumatic stress) in a sample of pregnant, IPV-exposed women (N = 137).

RESULTS

Overall models for both depression and posttraumatic stress were significant (F = 6.42, p<.001; R²=16.3%; F = 15.09, p<.001; R²=31.0%, respectively). Housing instability was significantly associated with higher levels of depressed mood (β=0.20, p<.016), but not posttraumatic stress symptoms. Social support was significantly associated with lower levels of depressed mood (β=-0.17, p<.036) and posttraumatic stress (β=-0.38, p =0.001). The addition of the interaction term (housing instability*social support) resulted in a significant improvement in variance explained from the main effects model for depression (F = 4.90, p<.028, ∆R²=3.0%) and the interaction term was significant (β=-0.60, p=.029). An interaction effect of housing instability and social support on posttraumatic stress was not identified.

LIMITATIONS

Although the current study is the first to examine protective factors in the relationship between housing instability and psychopathology in IPV-exposed pregnant women, data were cross-sectional and therefore directionality and temporality cannot be inferred.

CONCLUSIONS

Results suggest that housing instability may play a greater role in women's depressed mood than in their experience of posttraumatic stress symptoms, and the presence of social support may substantially ameliorate the effect of this adversity.

Exploring the Prevalence and Correlates Associated With Intimate Partner Violence During Pregnancy in Bangladesh

Intimate partner violence (IPV) during pregnancy is known to have multiple detrimental consequences for the woman and potentially for her unborn child. However, little is known about the nature and extent of IPV during pregnancy, particularly in developing countries, which compromises efforts to address the problem. Relying on population-based data, this article examines the extent, patterns, and correlates associated with physical, sexual, and psychological IPV during pregnancy in Bangladesh. Cross-sectional survey data were collected between October 2015 and January 2016 from 426 new mothers, aged 15 to 49 years, who were in the first 6 months postpartum. IPV was assessed with a validated set of survey items. Multivariate logistic regression analyses were conducted to evaluate correlates associated with different types of IPV. Overall, 66.4% of women experienced any IPV during pregnancy. The prevalence of physical, sexual, and psychological IPV was 35.2%, 18.5%, and 65%, respectively. These forms of IPV often overlap, particularly physical and psychological IPV. Pregnant women who report limited social support and have controlling husbands are at significantly increased risk for all three types of IPV during pregnancy. Women who cling to traditional gender roles and those with low self-esteem exhibit increased risk for physical and psychological IPV during pregnancy. Psychological IPV during pregnancy is also correlated with low decision-making autonomy and childhood exposure to violence. Women whose husband's demand a dowry at marriage are at increased risk of sexual IPV during pregnancy. Results reinforce the need to conduct routine screening during pregnancy to identify women with a history of IPV and to be able to offer help and support. The findings also reinforce calls for gender equity and women's equal access to family and social resources thereby increasing women's social support networks, their self-esteem, and autonomy, and reducing their risk of IPV during pregnancy.

Prevalence and predictors of positive screening for postpartum depression in minority parturients in the South Bronx

It is reported that the rates of perinatal depressive disorders are high in ethnic minority groups from non-English speaking countries. However, very few studies have compared the prevalence of positive screening for postpartum depression (PPD) in minority communities living in an inner city. The goal of this study is to determine the prevalence and the predictors of positive screening for postpartum depression in minority parturients in the South Bronx. The study is a chart review of 314 minority parturients, Black or Hispanic, screened for postpartum depression using the Edinburgh Postnatal Depression Scale (EPDS) tool. The overall prevalence of a positive EPDS screen among Black and Hispanic women was similar, 24.04 and 18.75%, respectively. The Black immigrant cohort had comparable positive screens with 23.81 as African Americans. Hispanic women born in the USA had the least prevalence of positive screens, 7.14%, and those who moved from the Dominican Republic and Puerto Rico had a prevalence of 17.24% of positive screens. The women who immigrated from Mexico, Central America, or South America had the highest prevalence of positive screens for PPD, 32.26%. As to the socioeconomic status (SES), there was a significant increase of 27.04 vs. 13.95% (P < 0.019) in positive screens for PPD for the unemployed mothers. Overall, Black and Hispanic parturients had similar rates of positive screens for PPD. Among the Hispanic women, immigrants had higher rates of positive screens, with those from Mexico, Central, and South America as the highest. The hospital experience did not affect the rates of positive screens. Neither did the SES with one exception; those unemployed had the higher rates of positive screens.

Exploring the associations between intimate partner violence victimization during pregnancy and delayed entry into prenatal care: Evidence from a population-based study in Bangladesh

OBJECTIVE

Intimate partner violence (IPV) during pregnancy can have serious health consequences for mothers and newborns. The aim of the study is to explore: 1) the influence of experiencing IPV during pregnancy on delayed entry into prenatal care; and 2) whether women's decision-making autonomy and the support for traditional gender roles act to mediate or moderate the relationship between IPV and delayed entry into prenatal care.

DESIGN

cross-sectional survey. Multivariate logistic regression models were estimated that control for various socio-demographic and pregnancy related factors to assess whether women who experienced IPV during pregnancy were more likely to delay entry into prenatal care compared with women who had not experienced IPV. The influence of traditional gender roles acceptance and decision-making autonomy were examined both as independent variables and in interaction with IPV, to assess their role as potential mediators or moderators.

SETTING

Chandpur district, Bangladesh.

PARTICIPANTS

the sample comprised of 426 Bangladeshi women, aged 15-49 years. Postpartum mothers who visited vaccinations centres to receive their children's vaccinations constitute the sampling frame.

RESULTS

almost 70% of the women surveyed reported patterns consistent with delayed entry into prenatal care. Accounting for the influence of other covariates, women who experienced physical IPV during pregnancy were 2.61 times more likely (95% CI [1.33, 5.09]) to have delayed entry into prenatal care than their counterparts who did not report physical IPV. Neither sexual nor psychological IPV victimization during pregnancy was linked with late entry into prenatal care. Both gender role attitudes and levels of autonomy mediate the effect of IPV on prenatal care.

KEY CONCLUSIONS

the results suggest that the high rates of IPV in Bangladesh have effects that can compromise women's health seeking behaviour during pregnancy, putting them and their developing fetus at risk. Specifically, Bangladeshi women who experience physical IPV during pregnancy are more likely to delay or forgo prenatal care, an effect that is further magnified by cultural ideals that emphasize women's traditional roles and limit their autonomy.

IMPLICATIONS FOR PRACTICE

this study reinforces the need to detect and assist women suffering IPV, not only to offer them help and support but also to increase entry into prenatal care. Healthcare professionals involved in obstetrics and midwifery need to be aware of the risk factors of IPV during pregnancy and be able to identify women who are at risk for delayed entry into prenatal care.

Exploring the influence of psychosocial factors on exclusive breastfeeding in Bangladesh

Exclusive breastfeeding is a proven benefit for both mothers and infants and is, therefore, an important public health priority. Intimate partner violence (IPV) is regarded as one of the potential psychosocial risk factors that may negatively affect exclusive breastfeeding (EBF). This study aimed to explore the influence of psychosocial factors including IPV on EBF. Cross-sectional survey data was collected from October 2015 to January 2016 in Chandpur District of Bangladesh from 426 married women, aged 15-49 years, who had at least one child 6 months of age or younger. Multivariate logistic regression models were used in order to investigate whether women who experienced IPV after childbirth, as well as other risk factors such as postpartum depression (PPD) and childhood sexual abuse, were more likely to face difficulties with EBF compared with women who had not experienced these same risk factors. Whilst the initiation rate of breastfeeding was 99.3%, at the time of the woman's interview, the overall EBF rate had fallen to 43.7%. Based on the adjusted model, women who experienced physical IPV (AOR 0.17, 95% CI [0.07, 0.40]) and psychological IPV (AOR 0.51, 95% CI [0.26, 1.00]) after childbirth and women who reported childhood sexual abuse (AOR 0.32, 95% CI [0.13, 0.80]) and PPD (AOR 0.20, 95% CI [0.09, 0.44]) were significantly less likely to exclusively breastfeed their infants than those who had not reported these experiences. Moreover, women with an intended pregnancy and high social support exhibited a higher likelihood of EBF. Our results suggest that preventing or reducing the occurrence of physical IPV, PPD and childhood sexual abuse may improve the EBF duration. Support from family members can assist in this process.

Enhancing women's health: A call for social work research

This article presents a critical synthesis of the social work empirical literature on women's health. In light of recent policy changes that directly affect women's health and social work, the authors conducted a literature review of recent publications (2010-2015) regarding social work and women's health nationally. Despite frequent accounts cited in the literature, there has been no comprehensive review of issues involving women's health and social work in the United States. The purpose of this review is to examine the current social work literature addressing women's health at the national (U.S.) level. This research presents a summary description of the status of the social work literature dealing with women's health, specifically 51 articles published between 2010 and 2015. Our search highlights the need for social work research to fill gaps and more fully address the needs of women across the lifespan.

Predictors of Depression Symptoms Among Low-Income Women Exposed to Perinatal Intimate Partner Violence (IPV)

Women experiencing perinatal intimate partner violence (IPV) may be at increased risk for depression. Baseline data was analyzed from 239 low-income pregnant women participating in an intervention study designed to reduce exposure to IPV. Depression risk was assessed using the Edinburgh Postnatal Depression Scale (EPDS) and IPV factors were measured with the Conflict Tactics Scale-Revised (CTS-2). Stepwise regression was conducted to identify predictors of risk for depression. Race (p = 0.028), psychological IPV (p = 0.035) and sexual IPV (p = 0.031) were strongly associated with risk for depression. Regression results indicated that women experiencing severe psychological IPV were more likely to develop depression (OR 3.16, 95 % CI 1.246, 8.013) than those experiencing severe physical or sexual IPV. Experiencing severe psychological IPV during pregnancy is strongly linked to risk for depression. Routine screening for psychological IPV may increase identification and treatment of women at high risk for depression during pregnancy.

Association between maternal intimate partner violence victimization during pregnancy and maternal abusive behavior towards infants at 4 months of age in Japan

The purpose of this study was to investigate whether maternal intimate partner violence (IPV) victimization during pregnancy is associated with abusive behavior by the mother towards infants at 4 months of age. A population-based sample of 6590 mothers with 4-month-old infants participated in this study in Japan. Abusive behavior was assessed via questionnaire and defined as frequency of shaking and smothering during the preceding month. Both verbal and physical IPV during pregnancy were assessed retrospectively. Multiple logistic regression analysis was used, adjusting for types of IPV and potential covariates, specifically postpartum depression. Maternal exposure to verbal and physical IPV during pregnancy was reported by 10.9% and 1.2% of women, respectively. In the adjusted model, women exposed to verbal IPV alone were significantly more likely to abuse offspring (odds ratio: 1.59, 95% confidence interval: 1.17-2.16) while exposure to physical IPV did not have an additive effect for abusive behavior. Maternal victimization by verbal, but not physical IPV was associated with maternal abusive behavior towards their 4-month-old infant. Screening for verbal abuse during pregnancy might be an efficient approach to identify high-risk mothers of infant abuse.

Intimate partner violence during pregnancy: maternal and neonatal outcomes

The effects of intimate partner violence (IPV) on maternal and neonatal outcomes are multifaceted and largely preventable. During pregnancy, there are many opportunities within the current health care system for screening and early intervention during routine prenatal care or during episodic care in a hospital setting. This article describes the effects of IPV on maternal health (e.g., insufficient or inconsistent prenatal care, poor nutrition, inadequate weight gain, substance use, increased prevalence of depression), as well as adverse neonatal outcomes (e.g., low birth weight [LBW]), preterm birth [PTB], and small for gestational age [SGA]) and maternal and neonatal death. Discussion of the mechanisms of action are explored and include: maternal engagement in health behaviors that are considered "risky," including smoking and alcohol and substance use, and new evidence regarding the alteration of the hypothalamic-pituitary-adrenal axis and resulting changes in hormones that may affect LBW and SGA infants and PTB. Clinical recommendations include a commitment for routine screening of IPV in all pregnant women who present for care using validated screening instruments. In addition, the provision of readily accessible prenatal care and the development of a trusting patient-provider relationship are first steps in addressing the problem of IPV in pregnancy. Early trials of targeted interventions such as a nurse-led home visitation program and the Domestic Violence Enhanced Home Visitation Program show promising results. Brief psychobehavioral interventions are also being explored. The approach of universal screening, patient engagement in prenatal care, and targeted individualized interventions has the ability to reduce the adverse effects of IPV and highlight the importance of this complex social disorder as a top priority in maternal and neonatal health.