Intimate Partner Violence and Depression Across Women's Pregnancy Transitions

Background/Purpose: Rates of intimate partner violence (IPV) are highest during women's reproductive age and IPV occurs throughout many women's pregnancies (McFarlane, 2007). As many as 3% to 19% of pregnant women are abused (Gazmararian, et al., 1996); women experiencing IPV during pregnancy are at elevated risk for mental health problems, including unipolar depression (Jasinski, 2004). Although up to 82% of women experiencing IPV during pregnancy also experienced depression (Martin, et al., 2006), little research has been conducted to understand how women's depression symptoms may or may not change throughout pregnancy transitions (one year before pregnancy to one year postpartum). Even less research has been conducted using comparison groups of women to determine if victimized women's perinatal depression is significantly different from women who have not experienced IPV. To help address these knowledge gaps, we examined longitudinal trends in levels of depression symptoms among a sample of women who did and did not experience IPV during pregnancy.

Methods: Pregnant women (n= 76) were recruited from two low-income prenatal care clinics in the southeastern U.S. to participate in a longitudinal study of IPV changes throughout pregnancy transitions. Both women who did (n= 33) and did not (n=43) report IPV were recruited into the study. Data was collected for 6 times: (1) one year before pregnancy; (2) first through second trimesters; (3) third trimester; (4) 1-month postpartum; (5) 6-months postpartum; and (6) 12-months postpartum. IPV experiences were measured using the Conflict Tactic Scale (revised) and depressive symptoms using Center for Epidemiologic Studies Depression Scale (CES-D). We used longitudinal, multilevel analysis to estimate the effects of IPV exposure on women's depression across the six times. We defined individual women as the Level 2 unit of analysis and repeated measurements nested within each woman as the Level 1 unit.

Results: While both groups experienced some depression symptoms at all six times (M=17.19), women who experienced IPV during pregnancy experienced significantly higher levels of depressive symptoms at each time (p<.05). Women who experienced IPV during pregnancy had depression levels (M= 25.24) that peaked during the first and second trimesters, and declined thereafter. Although women who experienced IPV had depression levels that declined after the first two trimesters, their depression levels remained clinically high (CES-D>16) compared to women not abused during pregnancy. No significant difference was found in the rate of change in depression symptoms over time between women abused during pregnancy and women not abused during pregnancy (p>.05).

Conclusions and Implications: IPV during pregnancy is associated with higher levels of depression across transitions in pregnancy, particularly during the first two trimesters. When comparing depressive symptoms in women who do and do not report IPV during pregnancy, the change rate does not differ over time. However, women abused during pregnancy had depression levels that remained clinically high compared to women not abused during pregnancy. Thus, in addition to coordinated mental health screenings and interventions during early pregnancy, women abused during pregnancy need safety interventions. The timing of such interventions is important and should be continued after pregnancy.