The impact of intimate partner violence on the trajectory of perinatal depression: a cohort study in a Chinese sample

Abstract

Aims Intimate partner violence (IPV) is an important risk factor for perinatal depression (PND). But IPV's impact on the natural prognosis of PND symptoms is not well understood. We tested two hypotheses: (1) pregnant women with IPV experiences will exhibit more severe PND symptoms than women without IPV experience; (2) IPV experience will impede the recovery prognosis of PND. We also explored the contribution of IPV to PND comparing with other risk factors. Method The sample is comprised of 813 pregnant women followed through perinatal period in Hunan, China. We assessed IPV experience using items from the Short Form of the Revised Conflict Tactics Scale (CTS2S), and PND symptoms via the Edinburgh Postnatal Depression Scale (EPSD). We conducted Linear Mixed-effects Model to compare the trajectories of PND symptoms between victims and non-victims and a multistage Generalised Estimating Equations Model to explore salient factors on the trajectory of PND symptoms. Results There were 90 participants (11.07%) who reported IPV experience in the past 12 months. With respect to physical, psychological and sexual violence, the prevalence was 4.55% (37/813), 9.23% (75/813) and 2.34% (19/813). Victims reported more severe PND symptoms (t = 5.30, p < 0.01) and slower decreasing slope of trajectories (t = 28.89, p < 0.01). The PND trajectory was associated with IPV experience (OR = 3.78; 95% CI 1.39–10.26), social support (OR = 0.93; 95% CI 0.88–0.97), positive coping strategies (OR = 0.85; 95% CI 0.80–0.91), negative coping strategies (OR = 1.25; 95% CI 1.14–1.37) and monthly income of $0.15–$298.36 (compared to no income, OR = 0.0075; 95% CI 0.00052–0.11). Conclusions The findings suggest the reported prevalence of IPV is lower in Hunan than most of the previous studies during perinatal period in other provinces of China, and IPV victimisation is associated with increased severity and slowed prognosis of PND symptoms. Future studies that screen for victimisation and establish its explicit mechanism to the poorer prognosis of PND symptoms would benefit the prevention and treatment of PND.

Intimate Partner Violence and Perinatal Post-Traumatic Stress and Depression Symptoms: A Systematic Review of Findings in Longitudinal Studies

“…IPV was often measured on a binary scale, and most frequently assessed with the Conflict Tactics Scale (CTS, 11 of 47, 23.4%; Straus et al, 1996), followed by the Abuse Assessment Screen (9 of 47, 19.1%; McFarlane et al, 1992), and the World Health Organization IPV Standardized Scale (9 of 47, 19.1%; Garcia-Moreno et al, 2006). Some studies modified instruments to include psychological IPV (e.g., Rodriquez et al, 2010) or examples of psychological violence commonly cited in the population (Hou et al, 2020; Tiwari et al, 2008). Several studies (9 of 47, 19.1%) assessed IPV with single item (e.g., Wikman et al, 2020) or via self-developed questionnaires (e.g., Flach et al, 2011; Gaillard et al, 2014).…”

“…Most studies assessed IPV in the third trimester (18 of 47, 38.3%; Budhathoki et al, 2013; Dennis & Vigod, 2013; Fisher, Tran, Tran, et al, 2013; Gaillard et al, 2014; Gausia et al, 2009; Guyon-Harris et al, 2017; Kita et al, 2016; Ludermir et al, 2010; Malta et al, 2012; Patel et al, 2002; Peltzer et al, 2018; Robertson-Blackmore et al, 2016; Rogathi et al, 2017; Schneider et al, 2018; Tho Nhi et al, 2019; Tho Tran et al, 2018; Tiwari et al, 2008; Valentine et al, 2011) or postpartum period, with assessments ranging from delivery (e.g., McMahon et al, 2011) to 36 months postpartum (Tsai et al, 2016; 19 of 47, 40.4%; Agrawal et al, 2014; Cintora & Laurent, 2020; Dawson et al, 2019; Escriba-Aguir et al, 2013; Fisher, Tran, Biggs, et al, 2013; Flanagan et al, 2015; Guyon-Harris et al, 2017; McMahon et al, 2011; Ogbonnaya et al, 2013; Okafor et al, 2018; Peltzer et al, 2018; Robertson-Blackmore et al, 2016; Schneider et al, 2018; Sumner et al, 2012; Tiwari et al, 2008; Tsai et al, 2016; Velonis et al, 2017; Woolhouse et al, 2012; Zhang et al, 2012). Some studies assessed IPV exposure in the second or third trimester (5 of 47, 10.6%; Bitew et al, 2019; Jackson et al, 2015; Katon et al, 2014; Nongrum et al, 2014; Valentine et al, 2011) or specifically focused on the second trimester of pregnancy (9 of 47, 19.2%; Fisher, Tran, Biggs, et al, 2013; Fisher, Tran, Tran, et al, 2013; Flach et al, 2011; …”

“…Regarding mental health assessment, antenatal depression was assessed up to 5 times (Hou et al, 2020), ranging from 4 weeks (Hou et al, 2020) to 41 weeks gestation (Gaillard et al, 2014). Depression was frequently assessed in the second or third trimester (22 of 47, 46.8%), with fewer studies focusing on the first trimester (6 of 47, 12.8%; Escriba-Aguir et al, 2013; Flanagan et al, 2015; Hou et al, 2020; Peltzer et al, 2018; Schneider et al, 2018; Woolhouse et al, 2012). Three studies did not report this information (3 of 47, 6.4%; Killian-Farrell et al, 2017; Paulson & Miller-Graff, 2020; Tsai et al, 2016).…”

“…Bivariate results suggested no significant differences between U.S. adolescents with and without perinatal depression based on recent IPV (Killian-Farrell et al, 2017). In China, Hou et al (2020) found that recent IPV was associated with greater severity and poorer prognosis of perinatal depression, spanning from the first trimester to 6 weeks postpartum. After adjustment, they found that IPV was associated with almost a 4-fold increased risk for depression.…”

A Possible Next Covid-19 Pandemic: The Violence Against Women and Its Psychiatric Consequences

“…Besides, VAW and IPV might increase in pregnancy/postpartum or has deleterious effects on motherinfant bonding and child outcomes (21). In a recent systematic review, Pastor-Moreno et al (22) showed a relation between psychological IPV and adverse outcomes, including premature rupture of membranes, preterm birth, urinary tract infections, and late entry into prenatal care.…”