The Impacts of Intimate Partner Violence on Postpartum Depression: An Updated Meta-Analysis

Background and Purpose: Intimate partner violence (IPV) is a significant public health concern globally, with severe adverse effects on women's health. The COVID-19 pandemic has been found to exacerbate the prevalence and severity of IPV. While IPV is a well-established risk factor for postpartum depression (PPD), the varying impacts of different IPV subtypes, exposure timeframes, and regional income levels on PPD remain unclear. Identifying these impacts can inform healthcare providers and help them conduct comprehensive IPV screening. This updated meta-analysis aims to estimate the impacts of overall IPV and its subtypes (physical, psychological, and sexual) on PPD, while examining the potentially varied impacts of IPV exposure time and regional income levels.

Methods: To identify original quantitative or mixed-method studies reporting on the impacts of IPV on PPD, this study conducted a systematic search across six databases (four in English and two in Chinese). The analysis included 76 studies with a total sample size of 388,966. Two critical appraisal checklists developed by the Joanna Briggs Institute were used to assess study quality. Odds ratios were synthesized using a random-effects model, and heterogeneity was assessed using I² and 𝜏² statistics. Sensitivity analyses were conducted to ensure the robustness and reliability of the findings. Subgroup analyses and meta-regression were used to explore sources of heterogeneity, including sample characteristics, method characteristics, IPV types, and evaluation time. Publication bias was also assessed by Begg’s and Egger’s tests and corrected using the trim and fill method.

Results: The study's findings suggested that IPV, and its subtypes had significant impacts on PPD. Overall IPV had the highest effect size (OR = 2.50), followed by physical (OR = 2.31), psychological (OR = 2.22), and sexual (OR = 1.75) IPV. Sensitivity analyses confirmed the robustness of the meta-analysis findings. Subgroup analyses revealed that overall IPV had a significantly higher impact on PPD in low- and middle-income regions (OR = 3.01) than in high-income regions (OR = 1.92), and IPV during pregnancy had a greater impact on PPD (OR = 2.73) than lifetime IPV (OR = 2.24). The study's meta-regression analysis showed that the quality of the included studies could explain part of the heterogeneity. Adjusted effect sizes were estimated for the impact of overall, psychological, and sexual IPV on PPD using the trim and fill method to account for publication bias.

Implications and Implications: The findings of this study emphasize the importance of supporting women who are at risk of physical IPV, especially during pregnancy, to reduce the risk of PPD. Additionally, the impact of overall IPV on PPD was found to be higher in middle- and low-income regions than in high-income regions, highlighting the importance of supporting women who are vulnerable to IPV in these regions. This study advocates for timely and effective screening of IPV exposure among women to identify those at high risk and provide practical and targeted interventions to prevent them from suffering from PPD. However, caution is needed when interpreting the results due to the high heterogeneity of the studies included in this meta-analysis.