(WITHDRAWN) What Is the Effect of a History of Sexual Victimization on Depression Rates in Currently Pregnant Women: A Propensity Score Analysis

Background: Pregnancy is often regarded as a time filled with excitement and expectation. However, for women who are survivors of sexual victimization, pregnancy can be rife with antepartum depression (APD). APD among survivors is a public health crisis that requires increased attention. The aim of this study is to apply a propensity score method to approximate the effect of sexual victimization on rates of depression in women currently pregnant (i.e. APD), by comparing the rate of APD between pregnant survivors of sexual victimization and the matched control group (pregnant, but not a survivor of sexual victimization). These propensity score methods ensure treatment (i.e. a lifetime history of sexual victimization) effects are estimated after balancing the potential confounders (i.e. plausible alternative explanations) by creating exchangeable exposed and non-exposed groups.

Methods: This study analyzed data from Add Health, a longitudinal and nationally-representative study, and included respondents who were pregnant in 2008 (n=634). The pregnant violence-exposed cohort (n=130), included pregnant women who experienced sexual victimization, while the pregnant non-violence exposed cohort (n=504) included pregnant women without such history. In total, 31 covariates were used in a logistic regression to estimate the propensity score. These included: socioeconomic status, self-esteem, past depression, childhood demographics (i.e. neighborhood safety, parental involvement, and parental death). Missing data were addressed using multiple imputation by chained equations. The matched sample was used to conduct a linear regression to determine whether the exposure to sexual victimization predicted APD in women who experienced a lifetime history of sexual victimization. All cases in the sample were retained in the comparison using full matching. Balance among the covariates was assessed using the standardized difference in means (i.e. d-type effect size) using a cutoff score of .10 and variance ratios close to 1.00 or between .5 and 2.00.

Findings: After propensity score matching, women with past histories of sexual victimization had significantly higher rates of APD (p<.01) in comparison to their non-violence exposed counterparts. Further survivors of sexual victimization were significantly more likely to be of black racial identity (p<0.03), have a history of childhood depression (p<0.01), have low self-esteem (p<0.03), experience the death of a mother during childhood (p<0.01), and live in an unsafe neighborhood as a child (p<0.01).

Conclusions/Implications: Findings from this study suggest that a history of sexual victimization increases the probability of experiencing depression during pregnancy. Results call for improved screening for a trauma history during pregnancy and the need for effective interventions to serve survivors during the perinatal period.