“We wanted to see whether and how intimate partner abuse – physical, psychological and sexual – influenced postpartum mental health in women, including problems such as depression, stress, anxiety, obsessive-compulsive disorder (OCD), and PTSD,” says Dr. Sarah Desmarais, an assistant professor of psychology at NC State and lead author of a paper on the work.
The researchers interviewed 100 women from British Columbia who were largely from higher socioeconomic backgrounds and were not considered at high risk of postpartum mental health problems. The study participants were recruited to participate in a broad health and wellness study, which was not specifically focused on domestic abuse.
Sixty-one percent of the study participants reported symptoms of postpartum mental health problems within the first three months after childbirth. And 47 percent of the 100 women reported symptoms at “clinical” levels, meaning the symptoms were of at least moderate severity.
Eighty-four percent of the participants reported experiencing physical, psychological or sexual abuse at the hands of a partner prior to becoming pregnant. Seventy percent of the 100 participants reported some form of abuse by their romantic partner during pregnancy. These forms of abuse ranged from name-calling to rape and physical assault with a weapon.
“We found that women who had experienced abuse were more likely to suffer from postpartum mental health problems, and were much more likely to suffer from those problems if the abuse occurred during pregnancy,” Desmarais says. “In addition, the more types of abuse they experienced, the more severe the mental health symptoms they reported. We also found that specific types of abuse were associated with specific problems.”
The researchers found that psychological abuse – verbal and emotional abuse – was associated with stress and PTSD. Physical abuse was associated with depression, OCD and PTSD. Sexual abuse was associated with stress, depression and PTSD.
This means that some mental health problems could stem from any of the forms of abuse. For example, PTSD is associated with all three forms of abuse, but could be caused by any one of them; psychological abuse alone could lead to PTSD.
“This highlights the need for increased awareness of the prevalence of these issues, and the need for increased screening for abuse and mental health problems for pregnant women and new mothers,” Desmarais says.
“The sheer scope of the mental health problems and types of abuse that we found tells us that we need to take a broader approach to tackling these issues,” Desmarais adds. “And this is clearly not a ‘lower class’ problem – medical professionals everywhere need to pay attention.
“But to do this effectively, we need to train doctors, nurses, and hospital staff in how to identify and respond to potential problems in this area.”
The paper, “Intimate partner abuse before and during pregnancy as risk factors for postpartum mental health problems,” is published online in the open-access journal BMC Pregnancy and Childbirth. The paper was co-authored by Ashley Pritchard of Simon Fraser University; Evan Lowder, a graduate student at NC State; and Dr. Patricia Janssen of UBC. This research was supported by the British Columbia Mental Health and Addictions Research Network, the Social Sciences and Humanities Research Council of Canada, and the Michael Smith Foundation for Health Research.
Note to Editors: The study abstract follows.
“Intimate partner abuse before and during pregnancy as risk factors for postpartum mental health problems”
Authors: Sarah L. Desmarais and Evan M. Lowder, North Carolina State University; Ashley Pritchard, Simon Fraser University; and Patricia A. Janssen, University of British Columbia
Published: online April 9, 2014, BMC Pregnancy and Childbirth
Abstract: Background: Although research has established the profound effects that intimate partner abuse can have on postpartum mental health, little is known regarding how this association may change as a function of the timing and type of abuse. This study examined associations of psychological, physical and sexual abuse experienced as adults before and during pregnancy with symptoms of postpartum mental health problems in a non-clinical sample of women. Methods: English-speaking mothers aged 18 years and older in the metropolitan area of a large, Western Canadian city were recruited to participate in a study of women’s health after pregnancy. The study was advertised in hospitals, local newspapers, community venues, and relevant websites. One-hundred women completed standardized, self-report questionnaires during semi-structured interviews conducted by female research assistants at approximately 2 months postpartum. In addition to questions about their general health and well-being, participants answered questions about their experiences of intimate partner abuse and about their mental health during the postpartum period. Results: Almost two-thirds (61.0%) of women reported postpartum mental health symptoms above normal levels, with 47.0% reporting symptoms at moderate or higher levels. The majority reported some form of intimate partner abuse before pregnancy (84.0%) and more than two-thirds (70.0%), during pregnancy; however, the abuse was typically minor in nature. Multivariate models revealed that women who experienced intimate partner abuse—whether before or during pregnancy—reported higher levels of postpartum mental health problems; however, associations differed as a function of the timing and type of abuse, as well as specific mental health symptoms. Multivariate models also showed that as the number of types of intimate partner abuse experienced increased, so did the negative effects on postpartum mental health. Conclusions: Results of this study provide further evidence that intimate partner abuse is a risk factor for postpartum mental health problems. They also underscore the complex risks and needs associated with intimate partner abuse among postpartum women and support the use of integrated approaches to treating postpartum mental health problems. Future efforts should focus on the extent to which strategies designed to reduce intimate partner abuse also improve postpartum mental health and vice versus.