Psychological Violence During Pregnancy Linked To Postnatal Depression Risk

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Main Category: Depression
Also Included In: Pregnancy / Obstetrics;  Mental Health;  Psychology / Psychiatry
Article Date: 06 Sep 2010 - 12:00 PDT

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Psychological violence by an intimate partner during pregnancy, independent of physical violence, has been linked to a higher risk of developing postnatal depression, also known as postpartum depression, according to an article published in the medical journal The Lancet. As most social policies focus on the treatment and prevention of physical violence, this study has important policy implications, the authors explain.

The study was carried out by Dr Ana Bernarda Ludermir, Universidade Federal de Pernambuco, Recife, Brazil, and team.

This prospective cohort study took place in Recife, Pernambuco, Brazil, between July 2005 and December 2006. It involved 1,133 pregnant women, aged between 18 and 49 years who were in their third trimester of pregnancy. All the women were attending primary health-care clinics. Dr. Bernarda and team interviewed the women during their pregnancy and after delivery. Partner violence during pregnancy was assessed with a validated questionnaire - the Edinburgh postnatal depression scale was used to gauge levels of postnatal depression.

Complete data for all variables that were included in the analysis were obtained from 1,045 of the 1,133 women. 26% of them developed postnatal depression; a total of 270 women. Psychological violence (28%) was the most common form of partner violence, the researchers reported.

There was a clear link between psychological violence frequency and postnatal depression occurrence. Although this link was reduced after adjustment, the risk of developing postnatal depression among the women who reported the highest psychological violence frequency was more than double those who reported no psychological violence (even after adjustment).

The authors wrote:

We recorded a clear positive association between the frequency of psychological violence during pregnancy and the occurrence of postnatal depression, even after adjustments. As in previous studies, psychological violence was much more common than was physical or sexual violence. About 10% of the burden of postnatal depression could be attributed to partner violence during pregnancy, with most attributable to psychological violence, which was the most common form of violence in our study.

(Conclusion): Partner violence is increasingly becoming recognised as an important public health problem worldwide. However, psychological violence is often not identified because of the emphasis placed on the detection of physical and sexual violence. Prenatal care could provide an opportunity for improved detection by health-care professionals, but the precise role of health providers in identification of partner violence against women needs further elucidation. Interventions that might prevent psychological violence, or help to treat the consequences of such violence, should reduce the substantial burden of postnatal depression that affects mothers, children, and the health system as a whole.

Dr Rachel Jewkes, Gender and Health Research Unit, Medical Research Council, Pretoria, South Africa, in a linked comment, wrote:

Emotional abuse has not been part of many screening recommendations to identify women who experience abuse during prenatal care, such as those from the American Congress of Obstetricians and Gynecologists. However, there is mounting evidence that guidelines should include questions about emotional abuse, as well as physical and sexual abuse. Prevention of all forms of intimate partner violence is very important for improving women's health, particularly their mental health.

"Violence against women by their intimate partner during pregnancy and postnatal depression: a prospective cohort study"
Dr Ana Bernarda Ludermir PhD, Prof Glyn Lewis PhD, Sandra Alves Valongueiro PhD, Thália Velho Barreto de Araújo PhD, Prof Ricardo Araya
The Lancet, Early Online Publication, 6 September 2010
doi:10.1016/S0140-6736(10)60887-2

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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