Abuse During Pregnancy Associated with Both Antenatal and Postnatal Depression.

Women in lower-income countries who experience intimate partner violence during pregnancy are more likely to have ante- and post-natal depression, according to a review led by a School of Public Health researcher.

The review, published in Clinical Psychology Review, was the first to assess evidence from low- and lower-middle-income countries (LLMICs) on the association between intimate partner violence (IPV) during pregnancy and multiple mental disorders during both pregnancy and the postpartum period.

“Contrary to popular belief, pregnancy in LLMICs can be associated with stressful experiences, including IPV victimization and subsequent maternal mental health disorders, including suicides and suicidal attempts and ideation,” says lead author Nafisa Halim, research assistant professor of global health. “The focus on maternal mental health is absolutely critical in the current LLMIC context where more and more women are participating in income-generating activities, making them change-agents of gender norms and, thereby, vulnerable to backlash, including IPV.”

IPV is one of the most common forms of violence perpetrated against women worldwide; while prior studies found an association between IPV during pregnancy and perinatal disorders in high-income countries, research looking into such associations in LLMICs is still emerging. Pregnant and postpartum women in LLMICs are least 50 percent more likely to develop mental health disorders than their counterparts in high-income countries; about 16 percent of pregnant and 20 percent of postpartum women experience a form of mental health disorder.

The authors developed a conceptual framework, based on prior literature, linking IPV during pregnancy and perinatal mental disorders. They then conducted a search for peer-reviewed articles from LLMICs published between 1990 and 2017; the final analysis included 24 studies from 10 LLMICs.

The review found that women who experienced IPV during pregnancy were up to four times as likely to suffer from antenatal depression and up to seven times as likely to experience postnatal depression compared to those who did not experience IPV.

Based on the analysis, the researchers proposed that interventions in antenatal care settings are important to mitigate the effects of IPV during pregnancy and the postpartum period.

“Considering the strong association between intimate partner violence and mental disorders during pregnancy, efforts should focus on development of safe and appropriate interventions,” the authors wrote.

The review also emphasized the need for future research to better identify and respond to the needs of pregnant women experiencing IPV in high-income countries as well as LLMICs.

SPH co-authors on the study were Jennifer Beard, clinical associate professor of global health, Patricia Hibberd, professor of global health, and Aldina Mesic, research assistant in community health sciences. Archana Patel, professor of pediatrics at the Indira Gandhi Government Medical College & Hospital, and David Henderson, chair of the Department of Psychiatry at the School of Medicine, also served as co-authors.

—Salma Abdalla