Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Domestic Violence and Perinatal Mental Disorders: A Systematic Review and Meta-Analysis

Domestic Violence and Perinatal Mental Disorders: A Systematic Review and Meta-Analysis Background: Domestic violence in the perinatal period is associated with adverse obstetric outcomes, but evidence is limited on its association with perinatal mental disorders. We aimed to estimate the prevalence and odds of having experienced domestic violence among women with antenatal and postnatal mental disorders (depression and anxiety disorders including post-traumatic stress disorder [PTSD], eating disorders, and psychoses). Methods and Findings: We conducted a systematic review and meta-analysis (PROSPERO reference CRD42012002048). Data sources included searches of electronic databases (to 15 February 2013), hand searches, citation tracking, update of a review on victimisation and mental disorder, and expert recommendations. Included studies were peer-reviewed experimental or observational studies that reported on women aged 16 y or older, that assessed the prevalence and/or odds of having experienced domestic violence, and that assessed symptoms of perinatal mental disorder using a validated instrument. Two reviewers screened 1,125 full-text papers, extracted data, and independently appraised study quality. Odds ratios were pooled using meta-analysis. Sixty-seven papers were included. Pooled estimates from longitudinal studies suggest a 3-fold increase in the odds of high levels of depressive symptoms in the postnatal period after having experienced partner violence during pregnancy (odds ratio 3.1, 95% CI 2.7–3.6). Increased odds of having experienced domestic violence among women with high levels of depressive, anxiety, and PTSD symptoms in the antenatal and postnatal periods were consistently reported in cross-sectional studies. No studies were identified on eating disorders or puerperal psychosis. Analyses were limited because of study heterogeneity and lack of data on baseline symptoms, preventing clear findings on causal directionality. Conclusions: High levels of symptoms of perinatal depression, anxiety, and PTSD are significantly associated with having experienced domestic violence. High-quality evidence is now needed on how maternity and mental health services should address domestic violence and improve health outcomes for women and their infants in the perinatal period. Please see later in the article for the Editors’ Summary. Citation: Howard LM, Oram S, Galley H, Trevillion K, Feder G (2013) Domestic Violence and Perinatal Mental Disorders: A Systematic Review and Meta- Analysis. PLoS Med 10(5): e1001452. doi:10.1371/journal.pmed.1001452 Academic Editor: Alexander C. Tsai, Massachusetts General Hospital, United States of America Received December 3, 2012; Accepted April 10, 2013; Published May 28, 2013 Copyright:  2013 Howard et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: LMH, SO, KT, and GF receive support from the NIHR Programme Grants for Applied Research scheme (RP-PG-0108-10084). LMH also receives salary support from the National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG-0108-10084). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. Competing Interests: LMH and GF are members of the WHO Guideline Development Group on Policy and Practice Guidelines for responding to Violence Against Women and the NICE/SCIE Guideline Development Group on Preventing and Reducing Domestic Violence. LMH has also been appointed as chair of the NICE guideline update on antenatal and postnatal mental health. The other authors declare no completing interests exist. Abbreviations: OR, odds ratio; PAF, population attributable fraction; PTSD, post-traumatic stress disorder. * E-mail: louise.howard@kcl.ac.uk [10]. Risk factors for most perinatal mental disorders are Introduction generally similar to those for mental disorders outside the Perinatal mental disorders are among the commonest health perinatal period and include a family and personal history of problems associated with pregnancy and the postpartum period. mental disorders [11,12]. Antenatal disorders (including depression and anxiety disorders, Previous research has found an association between mental eating disorders, and psychoses) are associated with adverse disorder and being a victim of domestic violence (i.e., intimate effects on the fetus including low birth weight and pre-term partner violence and/or violence perpetrated by another family delivery [1–3], perinatal and infant death [4–6], and postnatal member) that is not diagnostically specific; associations have been psychopathology [7–9], with the last associated with subsequent found for common mental disorders, eating disorders, and behavioural/emotional problems in the child and adolescent psychosis and domestic violence in non-perinatal populations PLOS Medicine | www.plosmedicine.org 1 May 2013 | Volume 10 | Issue 5 | e1001452 Domestic Violence and Perinatal Mental Disorders Figure 1. Flow diagram of screened and included papers. doi:10.1371/journal.pmed.1001452.g001 PLOS Medicine | www.plosmedicine.org 2 May 2013 | Volume 10 | Issue 5 | e1001452 Domestic Violence and Perinatal Mental Disorders studies, equating to approximately 152,000 to 324,000 pregnant Box 1 women experiencing abuse each year in the US [15,16], in low- Biomedical databases: Academic Search Complete, BNI and middle-income countries the prevalence can be higher [17]. (British Nursing Index), CINAHL (Cumulative Index to There is strong evidence that domestic violence increases the Nursing and Allied Health Literature), Cochrane, Embase, risk of low birth weight, and growing evidence of an association HMIC (Health Management Information Consortium), with pre-term labour, miscarriage, fetal death [18], and Medline, Maternity and Infant Care, PsycINFO, Science subsequent child behavioural problems [19]; domestic violence Direct, Web of Science (including SCI, SSCI, A&HCI, CPCI-S, can also be a cause of maternal death [20–22]. The recent UK CPCI-SSH). Confidential Enquiry into Maternal Deaths highlighted that Social sciences databases: Applied Social Sciences domestic-violence-related deaths were perpetrated by both in- Index and Abstracts, International Bibliography of the laws and partners [22]. Social Sciences, JSTOR, Sociological Abstracts. Recent reviews have indicated a possible association between Theses and dissertations: DART-Europe E-Theses Portal, perinatal mental disorder and having experienced domestic EThOS, Networked Digital Library of Theses and Disserta- violence, but these reviews have the following limitations: they tions identified only a limited number of relevant studies (,10); they focused predominantly on depression and not the full range of [13,14]. The prevalence of domestic violence during pregnancy in antenatal and postnatal mental disorders; they did not disaggre- high-income settings ranges from 4% to 8% in the majority of gate findings according to whether violence was reported during Table 1. Summary of included studies (n = 67). Longitudinal Studies Cross Sectional Studies Characteristic (n = 16) (n = 56) Total (n = 67) Diagnosis Depression 16 45 56 Anxiety 1 4 5 PTSD 0 4 4 Psychological distress 0 10 10 Recency of violence Lifetime 7 25 31 Past year 5 22 25 During pregnancy 5 19 22 Perpetrator of violence Partner or spouse 16 56 67 Family member 1 8 9 Type of violence Physical 5 18 21 Psychological 3 15 17 Sexual 2 6 8 Physical, sexual, or psychological (combined) 10 41 48 Setting Clinical only 1 34 34 Non-clinical only 6 22 26 Clinical and non-clinical 9 0 9 Region North America 4 21 22 Central America 0 0 0 South America 2 7 9 Europe 2 6 7 Middle East 1 3 4 Africa 0 1 1 Asia 6 13 19 Australasia 1 5 5 Categories are not mutually exclusive, and row totals may therefore add to more than 67. Studies may contribute both longitudinal and cross-sectional data; column totals may therefore be less than the sum of the longitudinal and cross-sectional data columns. doi:10.1371/journal.pmed.1001452.t001 PLOS Medicine | www.plosmedicine.org 3 May 2013 | Volume 10 | Issue 5 | e1001452 Domestic Violence and Perinatal Mental Disorders PLOS Medicine | www.plosmedicine.org 4 May 2013 | Volume 10 | Issue 5 | e1001452 Table 2. Summary of findings from cross-sectional studies. Lifetime Domestic Violence Past-Year Domestic Violence Domestic Violence during Pregnancy Disorder Individual ORs Individual ORs Individual ORs Where Pooled Where Pooled Where Pooled OR Could Not OR Could Not OR Could Not Median Prevalence Pooled OR Be Calculated Median Prevalence Pooled OR Be Calculated Median Prevalence Pooled OR Be Calculated Disorder in the antenatal period Depression 38.9% (IQR 35.2%–51.3%, 3.0 (95% CI 2.3–4.0, n/a 29.9% (IQR 21.8%–45.1%, 2.8 (95% CI 1.5–5.3, n/a 14.4% (IQR 13.2%– 5.0 (95% CI 4.0–6.2, I n/a 2 2 range 15.2%–72.2%) I 51.1%) [41,44,57,66,68,69, range 4.8%–46.1%) I 75.3%) 25.7%, range 8.6%– 23.7%) [41,44,57,66,68,69,82, 82,84,96,97,103] [49,52,62,63,67,71,91,96] [52,62,67,91,96] 88.4%) [19,52,57,67,79,83,96] 84,92,96,97,99,103] [19,44,52,57,67,79,96] Anxiety 29.8% (IQR 28.8%–53.1%, — Ali et al. [41] (OR—— — ——— range 28.8%–53.1%) [41,68,99] 0.5, 95% CI 0.2– 1.4); Jundt et al. [68] (OR 2.1, 95% CI 1.1–4.0) PTSD — — Mezey et al. [82] — — Seng et al. [95] — — Seng et al. [95] (OR 6.4, 95% CI (OR 4.6, 95% CI (OR 6.0, 95% CI 1.7–26.4) 2.5–8.5) 1.4–29.2) Disorder in the postnatal period Depression 28.5% (IQR 23.7%–36.3%, 2.9 (95% CI 1.8–4.8, n/a 26.7% (IQR 20.1%–45.9%. 2.8 (95% CI 1.7–4.6, n/a — 4.4 (95% CI 2.9–6.5, I n/a 2 2 range 8.9%–83.6%) I 77.6%) [42,50,51, range 5.7%–97.9%) I 79.2%) 22.4%) [38,75,89] [39,42,50,51,64,89] 64,81,89] [42,43,46,47,49,56,65,100] [42,46,47,56,100] Anxiety — — DeKlyen et al.—— — ——— [50] (OR 5.6, 95% CI 3.2–9.7) PTSD — — — — — Cerulli et al. [47]——— (OR 4.6, 95% CI 1.1–18.4) n/a, not applicable. doi:10.1371/journal.pmed.1001452.t002 Domestic Violence and Perinatal Mental Disorders Figure 2. Meta-analysis of the association between antenatal depression and any lifetime domestic violence (cross-sectional studies). ES, effect size. doi:10.1371/journal.pmed.1001452.g002 pregnancy, during the past year, or over the lifetime; and they Methods did not restrict their analyses to studies that used diagnostic or Search Strategy validated screening instruments to assess mental disorder [23– This review followed MOOSE and PRISMA guidelines (see 26]. Our systematic review aimed to address these limitations Text S1), and the protocol (see Text S2) is registered with the to providemorerobustestimates of thefollowing:(a) the PROSPERO database of systematic reviews (http://www.crd. prevalence of having experienced domestic violence (lifetime, york.ac.uk/prospero; registration number CRD42011001281) past year, and during pregnancy) among women with [27,28]. The search strategy comprised an electronic search of antenataland postnatalmentaldisorders (depression and bibliographic databases, an update of a recent systematic review anxiety disorders including post-traumatic stress disorder on the victimisation of people with mental disorders [29], hand [PTSD], eating disorders, and psychoses including puerperal searches of three key journals (Trauma Violence and Abuse, Journal of psychosis), (b) the odds of having experienced domestic Traumatic Stress, and Violence Against Women), backwards and violence (lifetime, past year, and during pregnancy) among forwards citation tracking, and expert recommendations. Medical women with antenatal and postnatal mental disorders Subject Headings (MeSH) and text words were used to search 18 (depression and anxiety disorders, eating disorders, and electronic databases, from their dates of inception up to 31 March psychoses including puerperal psychosis), and (c) the odds of 2011 (see Box 1 for the list of databases searched). Additional incident antenatal and postnatal mental disorders subsequent searches of Medline, Embase, and PsycINFO, and hand searches to having experienced domestic violence and the odds of of Trauma Violence and Abuse, Journal of Traumatic Stress, and Violence experiencing domestic violence in women with pre-existing Against Women, were conducted for the period 1 January 2011 to 15 antenatal or postnatal disorders. PLOS Medicine | www.plosmedicine.org 5 May 2013 | Volume 10 | Issue 5 | e1001452 Domestic Violence and Perinatal Mental Disorders Figure 3. Meta-analysis of the association between antenatal depression and any past year partner violence (cross-sectional studies). ES, effect size. doi:10.1371/journal.pmed.1001452.g003 February 2013. Terms for domestic violence were adapted from Data Extraction and Quality Appraisal Cochrane protocols and peer-reviewed literature reviews, and Two reviewers (S. O. and K. T.) screened the downloaded titles terms for mental disorders were adapted from NICE guidelines and abstracts against the inclusion criteria; if it was unclear [30–32]. The search strategy for Medline, Embase, and PsycINFO whether a reference met the inclusion criteria, it was taken forward is shown in Text S3. When updating the victimisation review, we to the next stage of screening. Two reviewers (S. O. and K. T.) used the author’s original search terms to search databases from assessed the full texts of potentially eligible studies. If studies September 2007 (the upper limit of the original review) to 31 collected data on the prevalence and/or odds of domestic violence March 2011. No language restrictions were used. but did not report it, authors were contacted for further information. Selection Criteria Data from included papers were extracted into an electronic Studies were eligible for inclusion if they (a) included women database by two reviewers (S. O. and H. G.). Extracted data who were 16 y or older and were assessed as having a perinatal included details of the study design, sample characteristics, mental disorder using a validated diagnostic instrument or measures of mental disorder and domestic violence, and the screening instrument; (b) presented the results of peer-reviewed prevalence and odds of domestic violence victimisation. Details on research based on experimental studies (e.g., randomised con- the type of violence and chronicity of mental disorders were trolled trials, non-randomised controlled trials, parallel group extracted where reported. studies), before-and-after studies, interrupted time series studies, The quality of included studies was independently appraised by cohort studies, case-control studies, or cross-sectional studies; and two reviewers (S. O. and H. G.) using criteria adapted from (c) measured the prevalence or odds of having experienced validated tools [33]. Reviewers compared scores and resolved domestic violence during the lifetime, during the past year, (i.e., disagreements before allocating a final appraisal score. The quality 12 mo prior to interview regardless of whether this was in the appraisal checklist (see Text S4) included items assessing study antenatal or postnatal period), or during pregnancy. When we selection and measurement biases; studies were categorised as high identified multiple eligible papers from the same study, only the quality if they scored $50% on questions pertaining to selection paper reporting the largest sample size was included. bias. PLOS Medicine | www.plosmedicine.org 6 May 2013 | Volume 10 | Issue 5 | e1001452 Domestic Violence and Perinatal Mental Disorders Figure 4. Meta-analysis of the association between antenatal depression and partner violence during pregnancy (cross-sectional studies). ES, effect size. doi:10.1371/journal.pmed.1001452.g004 Pooled unadjusted OR estimates (with corresponding 95% Data Analysis confidence intervals) were calculated using random effects meta- Prevalence, odds ratios (ORs), and 95% confidence intervals of analysis if data were available from three or more studies. We having experienced domestic violence were calculated by type of examined the influence of individual studies on summary effect perinatal mental disorder. If a study measured one disorder only estimates by conducting influence analyses, which compute (e.g., depression), the control group for the calculation of ORs was summary estimates omitting one study at a time. We aimed to women without that disorder. If a study measured multiple assess the risk of small study bias with funnel plots (see Figure disorders (e.g., depression and anxiety), the control group was S1) [34]. Because of the small number of eligible studies, women without those disorders. This reduced the risk of control statistical tests for funnel plot asymmetry were not appropriate, groups including women with mental disorders, and improved andwewereconfinedtovisual inspection of the plots. consistency where studies contributed data for several mental Heterogeneity among studies was estimated using the I statistic. disorders. Prevalence and unadjusted ORs were also calculated Pooled population attributable fraction (PAF) estimates were separately by period of violence experienced (lifetime, past year, calculated using data from longitudinal studies, based on meta- and during pregnancy). We report prevalence estimates and analysis-derived summary relative risks. All analyses were ORs for having experienced ‘‘any violence’’ (i.e., any physical, sexual, or psychological violence). There were limited disaggre- conducted in Stata 11 [35]. Only studies that assessed mental disorders using either gated data providing the prevalence and odds of having experienced physical, sexual, and psychological violence sepa- validated diagnostic instruments or validated screening instru- ments with the recommended cutoff scores were included in rately; these are reported in Table S1 (cross-sectional studies) and Table S2 (longitudinal studies).When analysing longitudinal median prevalence and pooled OR calculations. Studies that data, we examined both the association between recent used the Patient Health Questionnaire were excluded from experiences of domestic violenceatbaselineand mental these calculations because of the low sensitivity and specificity of disorder identified at follow-up, and the association between the Patient Health Questionnaire in perinatal populations [36]. mental disorder at baseline and domestic violence experienced Where sufficient data were available, pooled ORs were also during the follow-up period. calculated that included only studies that used the Edinburgh PLOS Medicine | www.plosmedicine.org 7 May 2013 | Volume 10 | Issue 5 | e1001452 Domestic Violence and Perinatal Mental Disorders Figure 5. Meta-analysis of the association between postnatal depression and any lifetime partner violence (cross-sectional studies). ES, effect size. doi:10.1371/journal.pmed.1001452.g005 Postnatal Depression Scale to measure probable depression sensitivity analyses did not materially affect pooled ORs. Pooled (highlevelsofdepressivesymptoms), asthis instrumentisthe ORs calculated using only studies that used the Edinburgh most widely used internationally and has been validated in 32 Postnatal Depression Scale were also not materially different to languages [37]. the pooled ORs calculated using all eligible studies, unless otherwise stated. Results Findings from Cross-Sectional Data The study selection process is presented in Figure 1. The As shown in Table 2, median prevalence and pooled ORs literature search yielded 30,563 unique references, of which showed that women with probable depression in the antenatal 29,469 were excluded following title and abstract screening. Of the period reported a high prevalence and increased odds of having 1,184 references that met, or potentially met, the inclusion criteria, experienced intimate partner violence during the lifetime (OR 3.0, 59 could not be located. Thus, 1,125 full papers were retrieved 95% CI 2.3–4.0, I 51.1%), during the past year (OR 2.8, 95% CI and assessed. Of these, 67 papers were included in the review 2 1.5–5.3, I 75.3%), and during pregnancy (OR 5.0, 95% CI 4.0– following full-text screening; 55 were identified from searches of 2 6.2, I 23.7%) (see also Figures 2–4). The heterogeneity for having electronic databases, two from citation tracking, three from hand experienced intimate partner violence during the lifetime was searching, and seven from expert recommendations. substantially reduced when omitting two studies that used the Hospital Anxiety and Depression Scale (OR 3.3, 95% CI 2.7–4.0, Key Features of Included Studies I 11.2%). Median prevalence and pooled ORs also showed that A summary of included studies is shown in Table 1 [19,38– women with probable depression in the postnatal period reported 103]. Individual details of all included studies, including a high prevalence and increased odds of having experienced outcomes and quality appraisal scores, are reported by disorder intimate partner violence during the lifetime (OR 2.9, 95% CI in Table S1 (cross-sectional data) and Table S2 (longitudinal 1.8–4.8, I 77.6%), during the past year (OR 2.8, 95% CI 1.7–4.6, 2 2 data). Forty studies were categorised as high quality. Unless I 79.2%), and during pregnancy (OR 4.4, 95% CI 2.9–6.5, I otherwise stated, the omission of individual studies during 22.4%) (see also Figures 5–7). PLOS Medicine | www.plosmedicine.org 8 May 2013 | Volume 10 | Issue 5 | e1001452 Domestic Violence and Perinatal Mental Disorders Figure 6. Meta-analysis of the association between postnatal depression and any past year partner violence (cross-sectional studies). ES, effect size. doi:10.1371/journal.pmed.1001452.g006 Two studies measured experiences of family violence (includ- postpartum (OR 1.4, 95% CI 1.0–2.1) [50], compared to women ing violence from a partner) among women with probable with no anxiety [41]. Studies suggested that women with probable depression in the antenatal period, reporting prevalence PTSD in the antenatal period had an increased risk of having estimates of 35.2% and 38.9% [66,99]. ORs could be calculated experienced intimate partner violence during the lifetime (OR 6.4, for only one study, which reported an increased odds of ever 95% CI 1.7–26.4) [82], during the past year (OR 4.6, 95% CI having experienced domestic violence (including from a partner) 2.5–8.5) [92,95], and during pregnancy 6.0 (95% CI 1.4–29.2) among women with probable depression in the antenatal period [92,95]. Only one study measured experiences of intimate partner (OR 2.6, 95% CI 1.3–5.2) [66]. One study measured violence among women with PTSD in the postnatal period: experiences of domestic violence (including violence from a Cerulli and colleagues reported increased odds of having partner) among women with probable depression in the experienced past-year intimate partner violence among women postnatal period and found increased odds of having experi- with PTSD (OR 4.6, 95% CI 1.1–18.4) and a prevalence of 41.2% enced past-year violence compared to women without probable [47]. depression (OR 2.9, 95% CI 1.5–5.7) [74]. One study measured having ever experienced domestic violence Data were limited on the prevalence and odds of having (including violence from a partner) among women with and experienced domestic violence among women with probable without probable anxiety in the antenatal period [41]. The study, anxiety disorder or PTSD in either the antenatal or postnatal conducted in Pakistan, found no significant difference in the odds period. The prevalence of having experienced intimate partner of having ever experienced violence between women with and violence during the lifetime was reported by two studies to be without probable anxiety (OR 0.5, 95% CI 0.2–1.4); this lack of 27.8% and 29.8% among women with probable anxiety in the difference may be due to the very high levels of violence reported antenatal period [68,99], and by one study to be 27.6% for women among women both with probable anxiety (76.4%) and without with diagnosed anxiety disorder in the postnatal period [50]. (86.0%) [41]. No studies measured violence perpetrated by family Individual studies reported non-significant increases in the odds of members among women with probable or diagnosed PTSD in the having experienced lifetime partner violence among women with antenatal or postnatal period. probable anxiety in the antenatal period (OR 2.9, 95% CI 0.9–8.4) No studies were found for other disorders in the antenatal or [68] and among women with anxiety disorder at 12 mo postnatal period. PLOS Medicine | www.plosmedicine.org 9 May 2013 | Volume 10 | Issue 5 | e1001452 Domestic Violence and Perinatal Mental Disorders Figure 7. Meta-analysis of the association between postnatal depression and partner violence during pregnancy (cross-sectional studies). ES, effect size. doi:10.1371/journal.pmed.1001452.g007 Findings from Longitudinal Data Discussion Longitudinal data were collected by 16 studies. Twelve studies Main Findings assessed the association between antenatal violence and later This systematic review and meta-analysis found that high levels of probable depression. Pooled ORs found increased odds of symptoms of all types of perinatal mental disorders included in probable postnatal depression among women who reported at studies to date (i.e., antenatal and postnatal anxiety, depression, and baseline having ever experienced intimate partner violence (OR PTSD) were associated with having experienced domestic violence, 2.9, 95% CI 2.0–4.0, I 0.0%) and among women who reported at although causality cannot be inferred. Pooled estimates from cross- baseline having experienced intimate partner violence during sectional studies show that women with probable depression in the pregnancy (OR 3.1, 95% CI 2.7–3.6, I 0.0%) (see also Figures 8 antenatal and postnatal periods have 3- to 5-fold increased and 9). Neither estimate could be adjusted for antenatal depression unadjusted odds of having experienced domestic violence over the because of a lack of data. The pooled PAF estimate for probable adulthood lifetime, during the past year, and during pregnancy, depression during the postnatal period following experiences of with correspondingly high prevalence estimates. intimate partner violence during pregnancy was 12.7% (95% CI Meta-analysis of data from longitudinal studies suggests that 11.8%–13.6%). women who experience domestic violence during pregnancy have Five studies assessed the association between probable 3-fold increased unadjusted odds of probable depression in the antenatal depression and later experiences of intimate partner postnatal period. The pooled PAF of 12.7% (95% CI 11.8%– violence. Pooled ORs could not be calculated because of 13.6%) calculated from these studies suggests that, if the insufficient data, but individual studies reported that the odds of association between domestic violence during pregnancy and having experienced intimate partner violence during or up to a postnatal depression are causal, experiences of domestic violence year after pregnancy were between two and five times higher during pregnancy may contribute to the burden of postnatal among women with probable depression in the antenatal period mental disorder, and underlines the importance of domestic compared to women without probable depression (not adjusted violence as a public health problem. Individual longitudinal studies for baseline violence). One cohort study reported increased odds also suggest that women with probable depression in the antenatal of lifetime intimate partner violence reported at 4 mo postpar- period have 3- to 5-fold increased odds of experiencing domestic tum among women who had probable antenatal anxiety at violence during or up to a year after pregnancy. Although baseline (OR 1.7, 95% CI 1.1–2.7); no longitudinal data were causality cannot be inferred, these findings suggest that a two-way available for other disorders. PLOS Medicine | www.plosmedicine.org 10 May 2013 | Volume 10 | Issue 5 | e1001452 Domestic Violence and Perinatal Mental Disorders Figure 8. Meta-analysis of the association between any lifetime partner violence and postnatal depression (cohort studies). ES, effect size. doi:10.1371/journal.pmed.1001452.g008 association between experiences of domestic violence and prob- Most studies were carried out in high-income settings; findings able depression in the antenatal and postnatal periods is likely, in were similar in low-income settings, but one study also reported which symptoms of depression may increase women’s vulnerability that the odds of psychological distress associated with having to domestic violence, and having experienced domestic violence experienced domestic violence was higher if the baby was a girl can increase the odds of probable depression in the antenatal and rather than a boy [86]. Risks are therefore likely to be modified by postnatal period. Insufficient data were available for other the cultural context of the pregnancy and postpartum period; this perinatal mental disorders to draw conclusions about the direction may be particularly the case where parents or parents-in-law play of causality for associations. a major role in the postpartum period [22]. To our knowledge, this systematic review is the first to search for studies reporting on the prevalence and odds of having experi- Strengths and Limitations enced domestic violence across the full range of antenatal and Strengths of this review include restricting primary studies to postnatal mental disorders. There are fewer studies on domestic those that used diagnostic instruments or validated screening violence and probable anxiety disorders than depression, but the instruments with their recommended cutoff scores to assess mental review found, for the first time, consistent evidence of a high disorders. The comprehensive search strategy over multiple prevalence and increased odds of having experienced domestic databases enabled the identification and synthesis of a large violence among women with anxiety and PTSD in the antenatal number of studies of several diagnostic categories, including and postnatal periods. We did not find any studies reporting the depression, anxiety disorders, and PTSD. The review highlights relationship between having experienced domestic violence and critical gaps in the literature, including few longitudinal studies, eating disorders or psychotic disorders, including puerperal few studies reporting on violence perpetrated by family members, psychosis, despite studies outside the perinatal period reporting and no studies investigating the possible relationship between an increased odds of having experienced domestic violence in domestic violence and puerperal psychosis. women with eating disorders [14], and anecdotal reports of There was high heterogeneity in pooled estimates of the domestic violence associated with puerperal psychosis [104]. association between having experienced past-year intimate partner Further research is clearly needed for these diagnostic categories. violence and probable depression in both the antenatal and PLOS Medicine | www.plosmedicine.org 11 May 2013 | Volume 10 | Issue 5 | e1001452 Domestic Violence and Perinatal Mental Disorders Figure 9. Meta-analysis of the association between any partner violence during pregnancy and postnatal depression (cohort studies). doi:10.1371/journal.pmed.1001452.g009 postnatal periods among cross-sectional studies, and there were cannot draw firm conclusions about whether the observed insufficient studies to analyse the reasons for the higher association between domestic violence and probable perinatal heterogeneity using meta-regression. Visual inspection of the data, depression is causal. As the calculation of the pooled PAF (the however, suggests that heterogeneity may be due to variation in proportion of probable mental disorder potentially ascribable to the timing of recruitment, e.g., for women recruited in the last exposure to intimate partner violence) is based on an assumption trimester, proportionally more of the ‘‘past year’’ reference period of causality, the PAF estimate should be treated with particular includes the time they were pregnant than for women recruited in caution. Further high-quality longitudinal studies, including the first trimester. Similarly, proportionally more of the ‘‘past linked database studies, should be conducted to explore the year’’ reference period includes the period of pregnancy for nature of the association between domestic violence and women recruited in the early postpartum period than women perinatal mental disorder. Future research should also collect recruited at 9–12 mo postpartum. This variation could be relevant and report data on all types of violence (i.e., physical, sexual, because the prevalence of domestic violence can be lower during and psychological violence); the majority (48/67) of the studies pregnancy [16,17] and because the association between domestic included in this review reported on physical violence—either violence and depression may vary as a function of when the alone or in combination with other forms of violence—and violence occurred. fewer than half reported prevalence and ORs disaggregated by Insufficient characterisation of participants in the primary type of violence. studies meant we were unable to assess the role of individual risk factors, such as social class. The lack of consistency in the type of Implications data collected by the primary studies meant we were also unable to Domestic violence during pregnancy is associated with risks adjust estimates for potential confounders (e.g., history of to the fetus, child, and mother [18–22]. Our finding that depression or childhood abuse). In addition, most of the womenwithhighlevelsofsymptomsofarangeofperinatal longitudinal studies did not provide data on baseline levels of mental disorders have a high prevalence and increased odds of symptoms or domestic violence, preventing clear interpretation on having experienced domestic violence both over the lifetime incident depression after domestic violence and vice versa. Thus, and during pregnancy highlights the importance of health although having experienced domestic violence was strongly and professionals identifying and responding to domestic violence consistently associated with probable antenatal and postnatal among women attending antenatal and mental health services. depression in both longitudinal and cross-sectional studies, we The World Health Organization and some international PLOS Medicine | www.plosmedicine.org 12 May 2013 | Volume 10 | Issue 5 | e1001452 Domestic Violence and Perinatal Mental Disorders guidelines recommend identification of domestic violence and Text S1 PRISMA checklist of items to include when mental disorders in women attending antenatal care and reporting a systematic review or meta-analysis. mental health care [105–107]. However, a recent Cochrane (DOC) review found little data on whether screening and other Text S2 Systematic review protocol. interventions improve outcomes for women experiencing (DOC) domestic violence in the perinatal period [108]. Further data Text S3 Search terms for Medline, Embase, and PsycINFO. is therefore needed on how maternity and mental health (DOC) services should best identify women with a history or current experience of domestic violence, respond appropriately and Text S4 Critical appraisal checklist for included stud- safely, and thus improve health outcomes for women and their ies. infants in the perinatal period. (DOC) Supporting Information Acknowledgments Figure S1 Funnel plots to assess publication bias. We gratefully acknowledge Professor Michael Dewey (King’s College (DOC) London’s Institute of Psychiatry) for his advice regarding statistical analysis. Table S1 Characteristics and reported outcomes of Author Contributions cross-sectional analyses of included studies. (DOCX) Conceived and designed the experiments: LMH GF. Analyzed the data: SO HG KT. Wrote the first draft of the manuscript: LMH SO. Table S2 Characteristics and reported outcomes of Contributed to the writing of the manuscript: LMH SO HG KT GF. longitudinal analyses of included studies. ICMJE criteria for authorship read and met: LMH SO HG KT GF. Agree (DOCX) with manuscript results and conclusions: LMH SO HG KT GF. References 1. Grote NK, Bridge JA, Gavin AR, Melville JL, Iyengar S, et al. (2010) A meta- 19. Flach C, Leese M, Heron J, Evans J, Feder G, et al. (2011) Antenatal domestic analysis of depression during pregnancy and the risk of preterm birth, low birth violence, maternal mental health and subsequent child behaviour: a cohort weight and intrauterine growth restriction. Arch Gen Psychiatry 67: 1012– study. BJOG 118: 1383–1391. 20. Boy A, Salihu HM (2004) Intimate partner violence and birth outcomes: a 2. Howard LM (2005) Fertility and pregnancy in women with psychotic disorders. systematic review. Int J Fertil Womens Med 49: 159–164. Eur J Obstet Gynecol Reprod Biol 119: 3–10. 21. Murphy CC, Schei B, Myhr TL, Du Mont J (2001) Abuse: a risk factor for low 3. Micali N, Simonoff E, Treasure J (2007) Risk of major adverse perinatal birth weight? A systematic review and meta-analysis. CMAJ 164: 1567–1572. outcomes in women with eating disorders. Br J Psychiatry 190: 255–259. 22. Lewis G (2007) Confidential enquiry into maternal and child health: saving 4. Howard LM, Kirkwood G, Latinovic R (2007) Sudden infant death syndrome mothers’ lives. London: Centre for Maternal and Child Enquiries. and maternal depression. J Clin Psychiatry 68: 1279–1283. 23. Beydoun H, Beydoun MA, Kaufman JS, Lo B, Zonderman AB (2012) Intimate 5. Webb R, Abel K, Pickles A, Appelby L (2005) Mortality in offspring of parents partner violence against adult women and its association with major depressive with psychotic disorders: a critical review and meta-analysis. Am J Psych 162: disorder, depressive symptoms and postpartum depression: a systematic review 1045–1056. and meta-analysis. Soc Sci Med 75: 959–975. 6. Webb RT, Abel KM, Pickles AR, Appelby L, King-Hele SA, et al. (2006) 24. Lancaster CA, Gold KJ, Flynn HA, Yoo H, Marcus SM, et al. (2010) Risk Mortality risk among offspring of psychiatric inpatients: a population-based factors for depressive symptoms during pregnancy: a systematic review. follow-up to early adulthood. Am J Psych 163: 2170–2177. Am J Obstet Gynecol: 5–14. 7. Bick D, Howard LM (2010) When should women be screened for postnatal 25. Wu Q, Chen HL, Xu XJ (2012) Violence as a risk factor for postpartum depression? Expert Rev Neurother 10: 151–154. depression in mothers: a meta-analysis. Arch Womens Ment Health 15: 107– 8. Milgrom J, Gemmill AW, Bilszta JL, Hayes B, Barnet B, et al. (2008) Antenatal 114. risk factors for postnatal depression: a large prospective study. J Affect Disord 26. Fisher J, Cabral de Mello C, Patel V, Rahman A, Tran T, et al. (2012) 108: 147–157. Prevalence and determinants of common perinatal mental disorders in women 9. Howard LM, Goss C, Leese M, Appleby L, Thornicroft G (2004) The in low and low middle income countries: a systematic review. Bull World psychosocial outcome of pregnancy in women with psychotic disorders. Health Organ 90: 139–149. Schizophr Res 71: 49–60. 27. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, et al. (2000) Meta- 10. Goodman SH, Rouse MH, Connell AM, Broth MR, Hall CM, et al. (2011) analysis of observational studies in epidemiology: a proposal for reporting. Maternal depression and child psychopathology: a meta-analytic review. Clin Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. Child Fam Psychol Rev 14: 1–27. JAMA 283: 2008–2012. 28. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items 11. O’Hara MW, Swain AM (1996) Rates and risks of postpartum depression—a meta-analysis. Int Rev Psychiatry 8: 37–54. for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 12. Leight KL, Fitelson EM, Weston CA, Wisner KL (2010) Childbirth and mental 6: e1000097. doi:10.1371/journal.pmed.1000097 disorders. Int Rev Psychiatry 22: 453–471. 29. Maniglio R (2009) Severe mental illness and criminal victimization: a 13. Howard LM, Trevillion K, Agnew-Davies R (2010) Domestic violence and systematic review. Acta Psychiatr Scand 119: 180–191. mental health. Int Rev Psychiatry 22: 525–534. 30. Friedman SH, Loue S (2007) Incidence and prevalence of intimate partner violence by and against women with severe mental illness. J Womens Health 14. Trevillion K, Oram S, Feder G, Howard LM (2012) Experiences of domestic (Larchmt) 16: 471–480. violence and mental disorders: a systematic review and meta-analysis. PLoS ONE 7: e51740. doi:10.1371/journal.pone.0051740 31. National Institute for Health and Clinical Excellence (2008) The guidelines 15. Gazmararian JA, Lazorick S, Spitz AM, Ballard TJ, Saltzman LE, et al. (1996) manual. London: National Institute for Health and Clinical Excellence. Prevalence of violence against pregnant women. JAMA 275: 1915– 32. Ramsay J, Carter Y, Davidson L, Dunne D, Eldridge S, et al. (2009) Advocacy 1920. interventions to reduce or eliminate violence and promote the physical and psychosocial well-being of women who experience intimate partner abuse. 16. Gazmararian JA, Petersen R, Spitz AM, Goodwin MM, Saltzman LE, et al. Cochrane Database Syst Rev 2009: CD005043. doi:005010.001002/ (2000) Violence and reproductive health: current knowledge and future research directions. Matern Child Health J 4: 7984. 14651858.CD14005043.pub14651852 17. Devries KM, Kishor S, Johnson H, Sto¨ckl H, Bacchus LJ, et al. (2010) Intimate 33. Critical Appraisal Skills Programme (2006) Appraising the evidence. Available: partner violence during pregnancy: analysis of prevalence data from 19 http://www.casp-uk.net/find-appraise-act/appraising-the-evidence/. Accessed countries. Reprod Health Matters 18: 158–170. 22 April 2012. 34. Cochrane Collaboration (2002) The Cochrane Collaboration open learning 18. Feder G, Ramsay J, Dunne D, Rose M, Arsene C, et al. (2009) How far does material: publication bias. Available: http://www.cochrane-net.org/ screening women for domestic (partner) violence in different health-care openlearning/html/mod15-3.htm. Accessed 12 April 2013. settings meet criteria for a screening programme? Systematic reviews of nine UK National Screening Committee critieria. Health Technol Assess 13: iii–iv, 35. StataCorp (2009) Stata statistical software: release 11. College Station (Texas): xi–xiii, 1–113, 137–347. StataCorp. PLOS Medicine | www.plosmedicine.org 13 May 2013 | Volume 10 | Issue 5 | e1001452 Domestic Violence and Perinatal Mental Disorders 36. Smith MV, Gotman N, Lin H, Yonkers KA (2010) Do the PHQ-8 and the 64. Ho-Yen SD, Bondevik GT, Eberhard-Gran M, Bjorvatin B (2007) Factors PHQ-2 accurately screen for depressive disorders in a sample of pregnant associated with depressive symptoms among postnatal women in Nepal. Acta women? Gen Hosp Psychiatry 32: 544–548. Obstet Gynecol Scand 86: 291–297. 37. Gibson J, McKenzie-McHarg K, Shakespeare J, Price J, Gray R (2009) A 65. Husain N, Bevc I, Husain M, Chaudhury IB, Atif N, et al. (2006) Prevalence systematic review of studies validating the Edinburgh Postnatal Depression and social correlates of postnatal depression in a low income country. Arch Scale in antepartum and postpartum women. Acta Psychiatr Scand 119: 350– Womens Ment Health 9: 197–202. 364. 66. Imran N, Haider II (2010) Screening of antenatal depression in Pakistan: risk 38. Abbaszadeh A, Kermani FP, Safizadeh H, Nakhee N (2011) Violence during factors and effects on obstetric and neonatal outcomes. Asia Pac Psychiatry 2: pregnancy and postpartum depression. Pak J Med Sci Q 27: 177–181. 26–32. 39. Ahmed HM, Alalaf SK, Al-Tawil NG (2012) Screening for postpartum 67. Jesse DE, Walcott-McQuigg J, Mariella A, Swanson MS (2005) Risks and depression using Kurdish version of Edinburgh postnatal depression scale. Arch protective factors associated with symptoms of depression in low-income Gynecol Obstet 285: 1249–1255. African American and Caucasian women during pregnancy. J Midwifery 40. Ali NS, Ali BS, Azam IS (2009) Postpartum anxiety and depression in peri- Womens Health 50: 405–410. urban communities of Karachi, Pakistan: a quasi-experimental study. BMC 68. Jundt K, Haertl K, Knobbe A, Kaestner R, Friese K, et al. (2009) Pregnant Public Health 9: 384. women after physical and sexual abuse in Germany. Gynecol Obstet Invest 68: 41. Ali NS, Azam IS, Ali BS, Tabbusum G, Moin SS (2012) Frequency and 82–87. associated factors for anxiety and depression in pregnant women: a hospital- 69. Karac¸am Z, Anc¸el G (2009) Depression, anxiety and influencing factors in based cross-sectional study. ScientificWorldJournal 2012: 653098. pregnancy: a study in a Turkish population. Midwifery 25: 344–356. 42. Ammerman RI, Putnam FW, Altaye M, Chen L, Holleb LJ, et al. (2009) 70. Karmaliani R, Asad N, Bann CM, Moss N, McClure EM, et al. (2009) Changes in depressive symptoms in first time mothers in home visitation. Child Prevalence of anxiety, depression and associated factors among pregnant Abuse Negl 33: 127–138. women of Hyderabad, Pakistan. Int J Soc Psychiatry 55: 414–424. 43. Beydoun HA, Al-Sahab B, Beydoun MA, Tamim H (2010) Intimate partner 71. Kiely M, El-Mohandes AA, El-Khorazaty M, Gantz MG (2010) An integrated violence as a risk factor for postpartum depression among Canadian women in intervention to reduce intimate partner violence in pregnancy: a randomized the Maternity Experience Survey. Ann Epidemiol 20: 575–583. trial. Obstet Gynecol 115: 273–283. 44. Brown SJ, McDonald EA, Krastev AH (2008) Fear of an intimate partner and 72. Kim H, Mandell M, Crandall C, Kuskowski M, Dieperink B, et al. (2006) women’s health in early pregnancy: findings from the maternal health study. Antenatal psychiatric illness and adequacy of prenatal care in an ethnically Birth 35: 293–302. diverse inner-city obstetric population. Arch Womens Ment Health 9: 103– 45. Budhathoki N, Dahal M, Bhusal S, Ojha H, Pandey S, et al. (2012) Violence against women by their husband and postpartum depression. J Nepal Health 73. Kornfeld BD, Bair-Merritt MH, Frosch E, Solomon BS (2012) Postpartum Res Counc 10: 176–180. depression and intimate partner violence in urban mothers: co-occurrence and 46. Certain HE, Mueller M, Jagodzinski T, Fleming M (2008) Domestic abuse child healthcare utilization. J Pediatr 161: 348–353. during the previous year in a sample of postpartum women. J Obstet Gynecol 74. Leung WC, Kung F, Lam J, Leung TW, Ho PC (2002) Domestic violence and Neonatal Nurs 37: 35–41. postnatal depression in a Chinese community. Int J Gynaecol Obstet 79: 159– 47. Cerulli C, Talbot NL, Tang W, Chaudron LH (2011) Co-occurring intimate partner violence and mental health diagnoses in perinatal women. J Womens 75. Lobato G, Moraes CL, Dias AS, Reichenheim ME (2011) Alcohol misuse Health (Larchmt) 20: 1797–1803. among partners: a potential effect modifier in the relationship between physical 48. Crempien RC, Rojas G, Cumsille P, Oda MC (2011) Domestic violence during intimate partner violence and postpartum depression. Soc Psychiat Epidemiol pregnancy and mental health: exploratory study in primary health centers in 47: 427–438. Penalolen. ISRN Obstet Gynecol 2011: 265817. 76. Ludermir A, Lewis G, Valongueiro S (2010) Violence against women by their 49. Cwikel J, Lev-Wiesel R, Al-Krenawi A (2003) The physical and psychosocial intimate partner during pregnancy and postnatal depression: a prospective health of Bedouin Arab women of the Negev area of Israel: the impact of high cohort study. Lancet 376: 903–910. fertility and pervasive domestic violence. Violence Against Women 9: 240–257. 77. Malta LA, McDonald SW, Hegadoren KM, Weller CA, Tough SC (2012) 50. DeKlyen M, Brooks-Gunn J, McLanahan S, Knab J (2006) The mental health Influence of interpersonal violence on maternal anxiety, depression, stress and of married, cohabiting and non-coresident parents with infants. Am J Public parenting morale in the early postpartum: a community based pregnancy Health 96: 1836–1841. cohort study. BMC Pregnancy Childbirth 12: 153. 51. Dennis CL, Vigod S (2013) The relationship between postpartum depression, 78. Manzolli P, Nunes MA, Schmidt MI, Ferri CP (2012) Abuse against women, domestic violence, childhood violence, and substance use: epidemiologic study depression, and infant morbidity: a primary care cohort study in Brazil. of a large community sample. Violence Against Women. In press. Am J Prev Med 43: 188–195. 52. Dunn LL, Oths KS (2004) Prenatal predictors of intimate partner abuse. 79. Martin SL, Yun L, Casanueva C, Hanis-Britt A, Kupper LL, et al. (2006) J Obstet Gynecol Neonatal Nurs 33: 54–63. Intimate partner violence and women’s depression before and during 53. Ferrari Audi CA, Segall-Correa AM, Santiago SM, Andrade MdGG, Perez- pregnancy. Violence Against Women 12: 221–239. Escamila R (2008) Violence against pregnant women: prevalence and 80. McGarry J, Kim H, Sheng XM, Egger M, Baksh L (2009) Postpartum associated factors. Rev Saude Publica 42: 877–885. depression and help-seeking behavior. J Midwifery Womens Health 54: 50–56. 54. Fisher J, Thach T, Buoi TL, Kriitmaa K, Rosenthal D, et al. (2010) Common 81. Melo EF Jr, Cecatti JG, Pacagnella RC, Leite DFB, Vulcani DE, et al. (2012) perinatal mental disorders in northern Viet Nam: community prevalence and The prevalence of perinatal depression and its associated factors in two health care use. Bull World Health Organ 88: 737–745. different settings in Brazil. J Affect Disord 136: 1204–1208. 55. Fisher J, Tran T, Duc Tran T, Dwyer T, Nguyen T, et al. (2012) Prevalence 82. Mezey G, Bacchus L, Bewley S (2005) Domestic violence, lifetime trauma and and risk factors for symptoms of common mental disorders in early and late psychological health of childbearing women. BJOG 112: 197–204. pregnancy in vietnamese women: a prospective population-based study. J Affect 83. Miszkurka M, Zunzunegui MV, Goulet L (2012) Immigrant status, antenatal Disord 146: 213–219. depressive symptoms, and frequency and source of violence: what’s the 56. Gao W, Paterson J, Abbott M, Carter S, Iusitini L (2010) Pacific Islands relationship? Arch Womens Ment Health 15: 387–396. families study: intimate partner violence and postnatal depression. J Immigr 84. Nasreen HE, Kabir ZN, Forsell Y, Edhborg M (2011) Prevalence and Minor Health 12: 242–248. associated factors of depressive and anxiety symptoms during pregnancy: a 57. Gausia K, Fisher C, Ali M, Oosthuizen J (2009) Antenatal depression and population based study in rural Bangladesh. BMC Womens Health 11: 22. suicidal ideation among rural Bangladeshi women: a community-based study. 85. Nunes MA, Camey S, Ferri CP, Manzolli P, Manenti CN, et al. (2011) Arch Womens Ment Health 12: 351–358. Violence during pregnancy and newborn outcomes: a cohort study in a 58. Gausia K, Fisher C, Ali M, Oosthuizen J (2009) Magnitude and contributory disadvantaged population in Brazil. Eur J Public Health 21: 92–97. factors of postnatal depression: a community-based cohort study from a rural 86. Patel V, Rodrigues M, DeSouza N (2002) Gender, poverty, and postnatal subdistrict of Bangladesh. Psychol Med 33: 999–1007. depression: a study of mother in Goa, India. Am J Psych 159: 43–47. 59. Gavin A, Melville JL, Rue T, Guo Y, Tabb Dina K, et al. (2011) Racial 87. Pollock JI, Manaseki-Holland S, Patel V (2009) Depression in Mongolian differences in the prevalence of antenatal depression. Gen Hosp Psychiatry 33: women over the first 2 months after childbirth: prevalence and risk factors. 87–93. J Affect Disord 116: 126–133. 60. Gomez-Beloz A, Williams MA, Sanchez SE, Lam N (2009) Intimate partner 88. Pooler J, Perry DF, Ghandour RM (2013) Prevalence and risk factors for violence and risk for depression among postpartum women in Lima, Peru. postpartum depressive symptoms among women enrolled in WIC. Matern Violence Vict 24: 380–398. Child Health J. E-pub ahead of print. 61. Groves AK, Kagee A, Maman S, Moodley D, Rouse P (2012) Associations 89. Quelopana A (2012) Violence against women and postpartum depression: the between intimate partner violence and emotional distress among pregnant experience of Chilean women. Women Health 52: 437–453. women in Durban, South Africa. J Interpers Violence 27: 1341–1356. 90. Radestad I, Ebeling M, Hildingsson I, Rubertsson C (2004) What factors in 62. Hartley M, Tomlinson M, Greco E, Comulada WS, Stewart J, et al. (2011) early pregnancy indicate that the mother will be hit by her partner during the Depressed mood in pregnancy: prevalence and correlates in two Cape Town year after childbirth? A nationwide Swedish survey. Birth 31: 84–92. peri-urban settlements. Reprod Health 89: 8–9. 63. Harvey ST, Pun PK (2007) Analysis of positive Edinburgh depression scale 91. Records K, Rice MJ (2009) Lifetime physical and sexual abuse and the risk for referrals to a consultation liaison psychiatry service in a two-year period. depression symptoms in the first 8 months after birth. J Psychosom Obstet Int J Ment Health Nurs 16: 161–167. Gynaecol 30: 181–190. PLOS Medicine | www.plosmedicine.org 14 May 2013 | Volume 10 | Issue 5 | e1001452 Domestic Violence and Perinatal Mental Disorders 92. Rodriguez MA, Heilemann MV, Fielder E, Ang A, Nevarez F, et al. (2008) 101. Zhang Y, Zou S, Cao Y (2012) Relationship between domestic violence and Intimate partner violence, depression, and PTSD among pregnant Latina postnatal depression among pregnant Chinese women. Int J Gynaecol Obstet women. Ann Fam Med 6: 44–52. 116: 26–30. 93. Romito P, Pomicino L, Lucchetta C, Scrimin F, Turan JM (2009) The 102. Dolatian M, Hesami K, Shams J, Majd HA (2010) Relationship between relationships between physical violence, verbal abuse and women’s psycholog- violence during pregnancy and postpartum depression. Iran Red Crescent ical distress during the postpartum period. J Psychosom Obstet Gynaecol 30: Med J 12: 377–383. 115–121. 103. Hayes BA, Campbell A, Buckby B, Geia LK, Egan ME (2010) The interface of 94. Saurel-Cubizolles MJ, Blondel B, Lelong N, Romito P (1997) Marital violence mental and emotional health and pregnancy in urban indigenous women: after birth. Fertil Contracept Sex 25: 159–164. research in progress. Infant Ment Health J 31: 277–290. 95. Seng JS, Low LK, Sperlich M, Ronis DL, Liberzon I (2009) Prevalence, 104. Trevillion K (2013) The identification and response of psychiatric services to trauma history, and risk for posttraumatic stress disorder among nulliparous domestic violence [PhD dissertation]. London: Instsitute of Psychiatry, King’s women in maternity care. Obstet Gynecol 114: 839–847. College London. 96. Thananowan N, Heidrich S (2008) Intimate partner violence among pregnant 105. World Health Organization, London School of Hygiene and Tropical Thai women. Violence Against Women 14: 509–527. Medicine (2010) Preventing intimate partner and sexual violence against 97. Thompson J, Canterino JC, Feld SM, Stumpf PG, Kuo Y, et al. (2000) Risk women: taking action and generating evidence. Geneva: World Health factors for domestic violence in pregnant women. Prim Care Update Ob Gyns Organization. 7: 138–141. 106. United Kingdom Department of Health (2008) Refocusing the care 98. Tiwari A, Chan KL, Fong D, Leung WC, Brownridge DA, et al. (2008) The programme approach: policy and positive practice guidance. London: impact of psychological abuse by an intimate partner on the mental health of Department of Health. 64 p. pregnant women. BJOG 115: 377–384. 107. U.S. Preventive Services Task Force, Agency for Healthcare Research and 99. Tuten M, Jones HE, Tran G, Svikis DS (2004) Partner violence impacts the Quality (2004) Screening for family and intimate partner violence. Rockville psychosocial and psychiatric status of pregnant, drug-dependent women. (Maryland): Agency for Healthcare Research and Quality. Addict Behav 29: 1029–1034. 108. Jahanfar S, Janssen PA, Howard LM, Dowswell T (2011) Interventions for 100. Woolhouse H, Gartland D, Hegarty K, Brown S (2012) Depressive symptoms preventing or reducing domestic violence against pregnant women. Cochrane and intimate partner violence in the 12 months after childbirth: a prospective Database Syst Rev 2011: CD14009414. doi:10.1002/14651858.CD14009414 pregnancy cohort study. BJOG 119: 315–323. PLOS Medicine | www.plosmedicine.org 15 May 2013 | Volume 10 | Issue 5 | e1001452 Domestic Violence and Perinatal Mental Disorders Editors’ Summary during the past year (OR = 2.8), and during pregnancy Background. Domestic violence—physical, sexual, or emo- tional abuse by an intimate partner or family member—is a (OR = 5). The results were similar for the postnatal period. major public health problem and although more common in The evidence was less robust for anxiety disorders: among women, can also affect men. Due to the nature of the women with probable anxiety in the antenatal period, the problem, it is difficult to collect accurate figures on the scale of researchers found an OR of 2.9 of having experienced domestic violence, but a study by the World Health lifetime partner violence. The odds were less in the postnatal Organization in ten countries found that 15%–71% of women period (OR = 1.4) In their analysis of longitudinal studies aged 15–49 years reported physical and/or sexual violence by (follow-up studies over a period of time), the researchers an intimate partner at some point in their lives. Women found an increased odds of probable postnatal depression experiencing domestic violence have significant short- and both among women who reported having ever experienced long-term health problems, particularly regarding their partner violence in their lifetime (OR = 2.9) and among mental health: experience of domestic violence can lead to women who reported having experienced partner violence a range of mental health disorders such as depression, during pregnancy (OR = 3.1). The researchers also found a psychosis, eating disorders, and even suicide attempts. combined prevalence estimate of 12.7% for probable depression during the postnatal period following experienc- Why Was This Study Done? As perinatal mental health es of partner violence during pregnancy. Because of limited disorders are among the commonest health problems in data, the researchers could not calculate an OR of the pregnancy and the postpartum period, and given the rate of association between probable antenatal depression and later domestic violence during pregnancy (previous studies have experiences of partner violence. suggested a domestic violence prevalence of 4%–8% during pregnancy and the postnatal period), it is plausible that there What Do These Findings Mean? These findings suggest may be a link between perinatal mental health disorders and that women with high levels of symptoms of perinatal having experienced domestic violence. Indeed, previous mental health disorders—antenatal and postnatal anxiety, reviews have suggested the existence of such an association depression, and post-traumatic stress disorder—have a high but were limited by the small number of included studies and prevalence and increased odds of having experienced focused on depression only, rather than the full range of domestic violence both over their lifetime and during antenatal and postnatal mental health disorders. So in this pregnancy. However, these findings cannot prove causality, study the researchers systematically reviewed published they fail to show a two-way association (that is, perinatal mental health disorders leading to subsequent domestic studies to provide more robust estimates of the prevalence violence), and no information on other perinatal mental of having experienced domestic violence among women with disorders, such as eating disorders and puerperal psychosis, antenatal and postnatal mental health disorders; the research- was available. The variation of the quality of the included ers also used a meta-analysis to estimate the odds (chance) of studies also limits the results, highlighting the need for high- having experienced domestic violence among women with antenatal and postnatal mental health disorders. quality data to suggest how maternity and mental health services could address domestic violence and improve health What Did the Researchers Do and Find? The researchers outcomes for women and their infants in the future. searched multiple databases and hand searched three Nevertheless, this study emphasizes the importance of relevant journals using key search terms to identify all types identifying and responding to possible domestic violence of relevant studies. Using specific criteria, the researchers among women attending antenatal and mental health retrieved and assessed over 1,000 full papers, of which 67 services. met the criteria for their systematic review. The researchers Additional Information. Please access these websites via assessed the quality of each selected study and included the online version of this summary at http://dx.doi.org/10. only those studies that used validated diagnostic instru- 1371/journal.pmed.1001452. ments and screening tools to assess mental health disorders in their calculations of the pooled (combined) odds ratio (OR) The World Health Organization provides information and through meta-analysis. statistics about violence against women and also about Using these methods, in cross-sectional studies (studies mental health disorders during pregnancy conducted at one point in time), the researchers found that The UK Royal College of Psychiatrists has information for women with probable depression in the antenatal period professionals and patients about mental health disorders reported a high prevalence and increased odds of having during pregnancy experienced partner violence during their lifetime (OR = 3), PLOS Medicine | www.plosmedicine.org 16 May 2013 | Volume 10 | Issue 5 | e1001452 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png PLoS Medicine Public Library of Science (PLoS) Journal

Domestic Violence and Perinatal Mental Disorders: A Systematic Review and Meta-Analysis

PLoS Medicine , Volume 10 (5): e1001452 – May 28, 2013

Loading next page...
 
/lp/public-library-of-science-plos-journal/domestic-violence-and-perinatal-mental-disorders-a-systematic-review-xLdEHsH6aA

References

References for this paper are not available at this time. We will be adding them shortly, thank you for your patience.

Publisher
Public Library of Science (PLoS) Journal
Copyright
Copyright: © 2013 Howard et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: LMH, SO, KT, and GF receive support from the NIHR Programme Grants for Applied Research scheme (RP-PG-0108-10084). LMH also receives salary support from the National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG-0108-10084). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. Competing interests: LMH and GF are members of the WHO Guideline Development Group on Policy and Practice Guidelines for responding to Violence Against Women and the NICE/SCIE Guideline Development Group on Preventing and Reducing Domestic Violence. LMH has also been appointed as chair of the NICE guideline update on antenatal and postnatal mental health. The other authors declare no completing interests exist. Abbreviations: OR, odds ratio; PAF, population attributable fraction; PTSD, post-traumatic stress disorder
Subject
Research Article; Medicine; Mental health; Psychiatry; Anxiety disorders; Mood disorders
eISSN
1549-1676
DOI
10.1371/journal.pmed.1001452
Publisher site
See Article on Publisher Site

Abstract

Background: Domestic violence in the perinatal period is associated with adverse obstetric outcomes, but evidence is limited on its association with perinatal mental disorders. We aimed to estimate the prevalence and odds of having experienced domestic violence among women with antenatal and postnatal mental disorders (depression and anxiety disorders including post-traumatic stress disorder [PTSD], eating disorders, and psychoses). Methods and Findings: We conducted a systematic review and meta-analysis (PROSPERO reference CRD42012002048). Data sources included searches of electronic databases (to 15 February 2013), hand searches, citation tracking, update of a review on victimisation and mental disorder, and expert recommendations. Included studies were peer-reviewed experimental or observational studies that reported on women aged 16 y or older, that assessed the prevalence and/or odds of having experienced domestic violence, and that assessed symptoms of perinatal mental disorder using a validated instrument. Two reviewers screened 1,125 full-text papers, extracted data, and independently appraised study quality. Odds ratios were pooled using meta-analysis. Sixty-seven papers were included. Pooled estimates from longitudinal studies suggest a 3-fold increase in the odds of high levels of depressive symptoms in the postnatal period after having experienced partner violence during pregnancy (odds ratio 3.1, 95% CI 2.7–3.6). Increased odds of having experienced domestic violence among women with high levels of depressive, anxiety, and PTSD symptoms in the antenatal and postnatal periods were consistently reported in cross-sectional studies. No studies were identified on eating disorders or puerperal psychosis. Analyses were limited because of study heterogeneity and lack of data on baseline symptoms, preventing clear findings on causal directionality. Conclusions: High levels of symptoms of perinatal depression, anxiety, and PTSD are significantly associated with having experienced domestic violence. High-quality evidence is now needed on how maternity and mental health services should address domestic violence and improve health outcomes for women and their infants in the perinatal period. Please see later in the article for the Editors’ Summary. Citation: Howard LM, Oram S, Galley H, Trevillion K, Feder G (2013) Domestic Violence and Perinatal Mental Disorders: A Systematic Review and Meta- Analysis. PLoS Med 10(5): e1001452. doi:10.1371/journal.pmed.1001452 Academic Editor: Alexander C. Tsai, Massachusetts General Hospital, United States of America Received December 3, 2012; Accepted April 10, 2013; Published May 28, 2013 Copyright:  2013 Howard et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: LMH, SO, KT, and GF receive support from the NIHR Programme Grants for Applied Research scheme (RP-PG-0108-10084). LMH also receives salary support from the National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG-0108-10084). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. Competing Interests: LMH and GF are members of the WHO Guideline Development Group on Policy and Practice Guidelines for responding to Violence Against Women and the NICE/SCIE Guideline Development Group on Preventing and Reducing Domestic Violence. LMH has also been appointed as chair of the NICE guideline update on antenatal and postnatal mental health. The other authors declare no completing interests exist. Abbreviations: OR, odds ratio; PAF, population attributable fraction; PTSD, post-traumatic stress disorder. * E-mail: louise.howard@kcl.ac.uk [10]. Risk factors for most perinatal mental disorders are Introduction generally similar to those for mental disorders outside the Perinatal mental disorders are among the commonest health perinatal period and include a family and personal history of problems associated with pregnancy and the postpartum period. mental disorders [11,12]. Antenatal disorders (including depression and anxiety disorders, Previous research has found an association between mental eating disorders, and psychoses) are associated with adverse disorder and being a victim of domestic violence (i.e., intimate effects on the fetus including low birth weight and pre-term partner violence and/or violence perpetrated by another family delivery [1–3], perinatal and infant death [4–6], and postnatal member) that is not diagnostically specific; associations have been psychopathology [7–9], with the last associated with subsequent found for common mental disorders, eating disorders, and behavioural/emotional problems in the child and adolescent psychosis and domestic violence in non-perinatal populations PLOS Medicine | www.plosmedicine.org 1 May 2013 | Volume 10 | Issue 5 | e1001452 Domestic Violence and Perinatal Mental Disorders Figure 1. Flow diagram of screened and included papers. doi:10.1371/journal.pmed.1001452.g001 PLOS Medicine | www.plosmedicine.org 2 May 2013 | Volume 10 | Issue 5 | e1001452 Domestic Violence and Perinatal Mental Disorders studies, equating to approximately 152,000 to 324,000 pregnant Box 1 women experiencing abuse each year in the US [15,16], in low- Biomedical databases: Academic Search Complete, BNI and middle-income countries the prevalence can be higher [17]. (British Nursing Index), CINAHL (Cumulative Index to There is strong evidence that domestic violence increases the Nursing and Allied Health Literature), Cochrane, Embase, risk of low birth weight, and growing evidence of an association HMIC (Health Management Information Consortium), with pre-term labour, miscarriage, fetal death [18], and Medline, Maternity and Infant Care, PsycINFO, Science subsequent child behavioural problems [19]; domestic violence Direct, Web of Science (including SCI, SSCI, A&HCI, CPCI-S, can also be a cause of maternal death [20–22]. The recent UK CPCI-SSH). Confidential Enquiry into Maternal Deaths highlighted that Social sciences databases: Applied Social Sciences domestic-violence-related deaths were perpetrated by both in- Index and Abstracts, International Bibliography of the laws and partners [22]. Social Sciences, JSTOR, Sociological Abstracts. Recent reviews have indicated a possible association between Theses and dissertations: DART-Europe E-Theses Portal, perinatal mental disorder and having experienced domestic EThOS, Networked Digital Library of Theses and Disserta- violence, but these reviews have the following limitations: they tions identified only a limited number of relevant studies (,10); they focused predominantly on depression and not the full range of [13,14]. The prevalence of domestic violence during pregnancy in antenatal and postnatal mental disorders; they did not disaggre- high-income settings ranges from 4% to 8% in the majority of gate findings according to whether violence was reported during Table 1. Summary of included studies (n = 67). Longitudinal Studies Cross Sectional Studies Characteristic (n = 16) (n = 56) Total (n = 67) Diagnosis Depression 16 45 56 Anxiety 1 4 5 PTSD 0 4 4 Psychological distress 0 10 10 Recency of violence Lifetime 7 25 31 Past year 5 22 25 During pregnancy 5 19 22 Perpetrator of violence Partner or spouse 16 56 67 Family member 1 8 9 Type of violence Physical 5 18 21 Psychological 3 15 17 Sexual 2 6 8 Physical, sexual, or psychological (combined) 10 41 48 Setting Clinical only 1 34 34 Non-clinical only 6 22 26 Clinical and non-clinical 9 0 9 Region North America 4 21 22 Central America 0 0 0 South America 2 7 9 Europe 2 6 7 Middle East 1 3 4 Africa 0 1 1 Asia 6 13 19 Australasia 1 5 5 Categories are not mutually exclusive, and row totals may therefore add to more than 67. Studies may contribute both longitudinal and cross-sectional data; column totals may therefore be less than the sum of the longitudinal and cross-sectional data columns. doi:10.1371/journal.pmed.1001452.t001 PLOS Medicine | www.plosmedicine.org 3 May 2013 | Volume 10 | Issue 5 | e1001452 Domestic Violence and Perinatal Mental Disorders PLOS Medicine | www.plosmedicine.org 4 May 2013 | Volume 10 | Issue 5 | e1001452 Table 2. Summary of findings from cross-sectional studies. Lifetime Domestic Violence Past-Year Domestic Violence Domestic Violence during Pregnancy Disorder Individual ORs Individual ORs Individual ORs Where Pooled Where Pooled Where Pooled OR Could Not OR Could Not OR Could Not Median Prevalence Pooled OR Be Calculated Median Prevalence Pooled OR Be Calculated Median Prevalence Pooled OR Be Calculated Disorder in the antenatal period Depression 38.9% (IQR 35.2%–51.3%, 3.0 (95% CI 2.3–4.0, n/a 29.9% (IQR 21.8%–45.1%, 2.8 (95% CI 1.5–5.3, n/a 14.4% (IQR 13.2%– 5.0 (95% CI 4.0–6.2, I n/a 2 2 range 15.2%–72.2%) I 51.1%) [41,44,57,66,68,69, range 4.8%–46.1%) I 75.3%) 25.7%, range 8.6%– 23.7%) [41,44,57,66,68,69,82, 82,84,96,97,103] [49,52,62,63,67,71,91,96] [52,62,67,91,96] 88.4%) [19,52,57,67,79,83,96] 84,92,96,97,99,103] [19,44,52,57,67,79,96] Anxiety 29.8% (IQR 28.8%–53.1%, — Ali et al. [41] (OR—— — ——— range 28.8%–53.1%) [41,68,99] 0.5, 95% CI 0.2– 1.4); Jundt et al. [68] (OR 2.1, 95% CI 1.1–4.0) PTSD — — Mezey et al. [82] — — Seng et al. [95] — — Seng et al. [95] (OR 6.4, 95% CI (OR 4.6, 95% CI (OR 6.0, 95% CI 1.7–26.4) 2.5–8.5) 1.4–29.2) Disorder in the postnatal period Depression 28.5% (IQR 23.7%–36.3%, 2.9 (95% CI 1.8–4.8, n/a 26.7% (IQR 20.1%–45.9%. 2.8 (95% CI 1.7–4.6, n/a — 4.4 (95% CI 2.9–6.5, I n/a 2 2 range 8.9%–83.6%) I 77.6%) [42,50,51, range 5.7%–97.9%) I 79.2%) 22.4%) [38,75,89] [39,42,50,51,64,89] 64,81,89] [42,43,46,47,49,56,65,100] [42,46,47,56,100] Anxiety — — DeKlyen et al.—— — ——— [50] (OR 5.6, 95% CI 3.2–9.7) PTSD — — — — — Cerulli et al. [47]——— (OR 4.6, 95% CI 1.1–18.4) n/a, not applicable. doi:10.1371/journal.pmed.1001452.t002 Domestic Violence and Perinatal Mental Disorders Figure 2. Meta-analysis of the association between antenatal depression and any lifetime domestic violence (cross-sectional studies). ES, effect size. doi:10.1371/journal.pmed.1001452.g002 pregnancy, during the past year, or over the lifetime; and they Methods did not restrict their analyses to studies that used diagnostic or Search Strategy validated screening instruments to assess mental disorder [23– This review followed MOOSE and PRISMA guidelines (see 26]. Our systematic review aimed to address these limitations Text S1), and the protocol (see Text S2) is registered with the to providemorerobustestimates of thefollowing:(a) the PROSPERO database of systematic reviews (http://www.crd. prevalence of having experienced domestic violence (lifetime, york.ac.uk/prospero; registration number CRD42011001281) past year, and during pregnancy) among women with [27,28]. The search strategy comprised an electronic search of antenataland postnatalmentaldisorders (depression and bibliographic databases, an update of a recent systematic review anxiety disorders including post-traumatic stress disorder on the victimisation of people with mental disorders [29], hand [PTSD], eating disorders, and psychoses including puerperal searches of three key journals (Trauma Violence and Abuse, Journal of psychosis), (b) the odds of having experienced domestic Traumatic Stress, and Violence Against Women), backwards and violence (lifetime, past year, and during pregnancy) among forwards citation tracking, and expert recommendations. Medical women with antenatal and postnatal mental disorders Subject Headings (MeSH) and text words were used to search 18 (depression and anxiety disorders, eating disorders, and electronic databases, from their dates of inception up to 31 March psychoses including puerperal psychosis), and (c) the odds of 2011 (see Box 1 for the list of databases searched). Additional incident antenatal and postnatal mental disorders subsequent searches of Medline, Embase, and PsycINFO, and hand searches to having experienced domestic violence and the odds of of Trauma Violence and Abuse, Journal of Traumatic Stress, and Violence experiencing domestic violence in women with pre-existing Against Women, were conducted for the period 1 January 2011 to 15 antenatal or postnatal disorders. PLOS Medicine | www.plosmedicine.org 5 May 2013 | Volume 10 | Issue 5 | e1001452 Domestic Violence and Perinatal Mental Disorders Figure 3. Meta-analysis of the association between antenatal depression and any past year partner violence (cross-sectional studies). ES, effect size. doi:10.1371/journal.pmed.1001452.g003 February 2013. Terms for domestic violence were adapted from Data Extraction and Quality Appraisal Cochrane protocols and peer-reviewed literature reviews, and Two reviewers (S. O. and K. T.) screened the downloaded titles terms for mental disorders were adapted from NICE guidelines and abstracts against the inclusion criteria; if it was unclear [30–32]. The search strategy for Medline, Embase, and PsycINFO whether a reference met the inclusion criteria, it was taken forward is shown in Text S3. When updating the victimisation review, we to the next stage of screening. Two reviewers (S. O. and K. T.) used the author’s original search terms to search databases from assessed the full texts of potentially eligible studies. If studies September 2007 (the upper limit of the original review) to 31 collected data on the prevalence and/or odds of domestic violence March 2011. No language restrictions were used. but did not report it, authors were contacted for further information. Selection Criteria Data from included papers were extracted into an electronic Studies were eligible for inclusion if they (a) included women database by two reviewers (S. O. and H. G.). Extracted data who were 16 y or older and were assessed as having a perinatal included details of the study design, sample characteristics, mental disorder using a validated diagnostic instrument or measures of mental disorder and domestic violence, and the screening instrument; (b) presented the results of peer-reviewed prevalence and odds of domestic violence victimisation. Details on research based on experimental studies (e.g., randomised con- the type of violence and chronicity of mental disorders were trolled trials, non-randomised controlled trials, parallel group extracted where reported. studies), before-and-after studies, interrupted time series studies, The quality of included studies was independently appraised by cohort studies, case-control studies, or cross-sectional studies; and two reviewers (S. O. and H. G.) using criteria adapted from (c) measured the prevalence or odds of having experienced validated tools [33]. Reviewers compared scores and resolved domestic violence during the lifetime, during the past year, (i.e., disagreements before allocating a final appraisal score. The quality 12 mo prior to interview regardless of whether this was in the appraisal checklist (see Text S4) included items assessing study antenatal or postnatal period), or during pregnancy. When we selection and measurement biases; studies were categorised as high identified multiple eligible papers from the same study, only the quality if they scored $50% on questions pertaining to selection paper reporting the largest sample size was included. bias. PLOS Medicine | www.plosmedicine.org 6 May 2013 | Volume 10 | Issue 5 | e1001452 Domestic Violence and Perinatal Mental Disorders Figure 4. Meta-analysis of the association between antenatal depression and partner violence during pregnancy (cross-sectional studies). ES, effect size. doi:10.1371/journal.pmed.1001452.g004 Pooled unadjusted OR estimates (with corresponding 95% Data Analysis confidence intervals) were calculated using random effects meta- Prevalence, odds ratios (ORs), and 95% confidence intervals of analysis if data were available from three or more studies. We having experienced domestic violence were calculated by type of examined the influence of individual studies on summary effect perinatal mental disorder. If a study measured one disorder only estimates by conducting influence analyses, which compute (e.g., depression), the control group for the calculation of ORs was summary estimates omitting one study at a time. We aimed to women without that disorder. If a study measured multiple assess the risk of small study bias with funnel plots (see Figure disorders (e.g., depression and anxiety), the control group was S1) [34]. Because of the small number of eligible studies, women without those disorders. This reduced the risk of control statistical tests for funnel plot asymmetry were not appropriate, groups including women with mental disorders, and improved andwewereconfinedtovisual inspection of the plots. consistency where studies contributed data for several mental Heterogeneity among studies was estimated using the I statistic. disorders. Prevalence and unadjusted ORs were also calculated Pooled population attributable fraction (PAF) estimates were separately by period of violence experienced (lifetime, past year, calculated using data from longitudinal studies, based on meta- and during pregnancy). We report prevalence estimates and analysis-derived summary relative risks. All analyses were ORs for having experienced ‘‘any violence’’ (i.e., any physical, sexual, or psychological violence). There were limited disaggre- conducted in Stata 11 [35]. Only studies that assessed mental disorders using either gated data providing the prevalence and odds of having experienced physical, sexual, and psychological violence sepa- validated diagnostic instruments or validated screening instru- ments with the recommended cutoff scores were included in rately; these are reported in Table S1 (cross-sectional studies) and Table S2 (longitudinal studies).When analysing longitudinal median prevalence and pooled OR calculations. Studies that data, we examined both the association between recent used the Patient Health Questionnaire were excluded from experiences of domestic violenceatbaselineand mental these calculations because of the low sensitivity and specificity of disorder identified at follow-up, and the association between the Patient Health Questionnaire in perinatal populations [36]. mental disorder at baseline and domestic violence experienced Where sufficient data were available, pooled ORs were also during the follow-up period. calculated that included only studies that used the Edinburgh PLOS Medicine | www.plosmedicine.org 7 May 2013 | Volume 10 | Issue 5 | e1001452 Domestic Violence and Perinatal Mental Disorders Figure 5. Meta-analysis of the association between postnatal depression and any lifetime partner violence (cross-sectional studies). ES, effect size. doi:10.1371/journal.pmed.1001452.g005 Postnatal Depression Scale to measure probable depression sensitivity analyses did not materially affect pooled ORs. Pooled (highlevelsofdepressivesymptoms), asthis instrumentisthe ORs calculated using only studies that used the Edinburgh most widely used internationally and has been validated in 32 Postnatal Depression Scale were also not materially different to languages [37]. the pooled ORs calculated using all eligible studies, unless otherwise stated. Results Findings from Cross-Sectional Data The study selection process is presented in Figure 1. The As shown in Table 2, median prevalence and pooled ORs literature search yielded 30,563 unique references, of which showed that women with probable depression in the antenatal 29,469 were excluded following title and abstract screening. Of the period reported a high prevalence and increased odds of having 1,184 references that met, or potentially met, the inclusion criteria, experienced intimate partner violence during the lifetime (OR 3.0, 59 could not be located. Thus, 1,125 full papers were retrieved 95% CI 2.3–4.0, I 51.1%), during the past year (OR 2.8, 95% CI and assessed. Of these, 67 papers were included in the review 2 1.5–5.3, I 75.3%), and during pregnancy (OR 5.0, 95% CI 4.0– following full-text screening; 55 were identified from searches of 2 6.2, I 23.7%) (see also Figures 2–4). The heterogeneity for having electronic databases, two from citation tracking, three from hand experienced intimate partner violence during the lifetime was searching, and seven from expert recommendations. substantially reduced when omitting two studies that used the Hospital Anxiety and Depression Scale (OR 3.3, 95% CI 2.7–4.0, Key Features of Included Studies I 11.2%). Median prevalence and pooled ORs also showed that A summary of included studies is shown in Table 1 [19,38– women with probable depression in the postnatal period reported 103]. Individual details of all included studies, including a high prevalence and increased odds of having experienced outcomes and quality appraisal scores, are reported by disorder intimate partner violence during the lifetime (OR 2.9, 95% CI in Table S1 (cross-sectional data) and Table S2 (longitudinal 1.8–4.8, I 77.6%), during the past year (OR 2.8, 95% CI 1.7–4.6, 2 2 data). Forty studies were categorised as high quality. Unless I 79.2%), and during pregnancy (OR 4.4, 95% CI 2.9–6.5, I otherwise stated, the omission of individual studies during 22.4%) (see also Figures 5–7). PLOS Medicine | www.plosmedicine.org 8 May 2013 | Volume 10 | Issue 5 | e1001452 Domestic Violence and Perinatal Mental Disorders Figure 6. Meta-analysis of the association between postnatal depression and any past year partner violence (cross-sectional studies). ES, effect size. doi:10.1371/journal.pmed.1001452.g006 Two studies measured experiences of family violence (includ- postpartum (OR 1.4, 95% CI 1.0–2.1) [50], compared to women ing violence from a partner) among women with probable with no anxiety [41]. Studies suggested that women with probable depression in the antenatal period, reporting prevalence PTSD in the antenatal period had an increased risk of having estimates of 35.2% and 38.9% [66,99]. ORs could be calculated experienced intimate partner violence during the lifetime (OR 6.4, for only one study, which reported an increased odds of ever 95% CI 1.7–26.4) [82], during the past year (OR 4.6, 95% CI having experienced domestic violence (including from a partner) 2.5–8.5) [92,95], and during pregnancy 6.0 (95% CI 1.4–29.2) among women with probable depression in the antenatal period [92,95]. Only one study measured experiences of intimate partner (OR 2.6, 95% CI 1.3–5.2) [66]. One study measured violence among women with PTSD in the postnatal period: experiences of domestic violence (including violence from a Cerulli and colleagues reported increased odds of having partner) among women with probable depression in the experienced past-year intimate partner violence among women postnatal period and found increased odds of having experi- with PTSD (OR 4.6, 95% CI 1.1–18.4) and a prevalence of 41.2% enced past-year violence compared to women without probable [47]. depression (OR 2.9, 95% CI 1.5–5.7) [74]. One study measured having ever experienced domestic violence Data were limited on the prevalence and odds of having (including violence from a partner) among women with and experienced domestic violence among women with probable without probable anxiety in the antenatal period [41]. The study, anxiety disorder or PTSD in either the antenatal or postnatal conducted in Pakistan, found no significant difference in the odds period. The prevalence of having experienced intimate partner of having ever experienced violence between women with and violence during the lifetime was reported by two studies to be without probable anxiety (OR 0.5, 95% CI 0.2–1.4); this lack of 27.8% and 29.8% among women with probable anxiety in the difference may be due to the very high levels of violence reported antenatal period [68,99], and by one study to be 27.6% for women among women both with probable anxiety (76.4%) and without with diagnosed anxiety disorder in the postnatal period [50]. (86.0%) [41]. No studies measured violence perpetrated by family Individual studies reported non-significant increases in the odds of members among women with probable or diagnosed PTSD in the having experienced lifetime partner violence among women with antenatal or postnatal period. probable anxiety in the antenatal period (OR 2.9, 95% CI 0.9–8.4) No studies were found for other disorders in the antenatal or [68] and among women with anxiety disorder at 12 mo postnatal period. PLOS Medicine | www.plosmedicine.org 9 May 2013 | Volume 10 | Issue 5 | e1001452 Domestic Violence and Perinatal Mental Disorders Figure 7. Meta-analysis of the association between postnatal depression and partner violence during pregnancy (cross-sectional studies). ES, effect size. doi:10.1371/journal.pmed.1001452.g007 Findings from Longitudinal Data Discussion Longitudinal data were collected by 16 studies. Twelve studies Main Findings assessed the association between antenatal violence and later This systematic review and meta-analysis found that high levels of probable depression. Pooled ORs found increased odds of symptoms of all types of perinatal mental disorders included in probable postnatal depression among women who reported at studies to date (i.e., antenatal and postnatal anxiety, depression, and baseline having ever experienced intimate partner violence (OR PTSD) were associated with having experienced domestic violence, 2.9, 95% CI 2.0–4.0, I 0.0%) and among women who reported at although causality cannot be inferred. Pooled estimates from cross- baseline having experienced intimate partner violence during sectional studies show that women with probable depression in the pregnancy (OR 3.1, 95% CI 2.7–3.6, I 0.0%) (see also Figures 8 antenatal and postnatal periods have 3- to 5-fold increased and 9). Neither estimate could be adjusted for antenatal depression unadjusted odds of having experienced domestic violence over the because of a lack of data. The pooled PAF estimate for probable adulthood lifetime, during the past year, and during pregnancy, depression during the postnatal period following experiences of with correspondingly high prevalence estimates. intimate partner violence during pregnancy was 12.7% (95% CI Meta-analysis of data from longitudinal studies suggests that 11.8%–13.6%). women who experience domestic violence during pregnancy have Five studies assessed the association between probable 3-fold increased unadjusted odds of probable depression in the antenatal depression and later experiences of intimate partner postnatal period. The pooled PAF of 12.7% (95% CI 11.8%– violence. Pooled ORs could not be calculated because of 13.6%) calculated from these studies suggests that, if the insufficient data, but individual studies reported that the odds of association between domestic violence during pregnancy and having experienced intimate partner violence during or up to a postnatal depression are causal, experiences of domestic violence year after pregnancy were between two and five times higher during pregnancy may contribute to the burden of postnatal among women with probable depression in the antenatal period mental disorder, and underlines the importance of domestic compared to women without probable depression (not adjusted violence as a public health problem. Individual longitudinal studies for baseline violence). One cohort study reported increased odds also suggest that women with probable depression in the antenatal of lifetime intimate partner violence reported at 4 mo postpar- period have 3- to 5-fold increased odds of experiencing domestic tum among women who had probable antenatal anxiety at violence during or up to a year after pregnancy. Although baseline (OR 1.7, 95% CI 1.1–2.7); no longitudinal data were causality cannot be inferred, these findings suggest that a two-way available for other disorders. PLOS Medicine | www.plosmedicine.org 10 May 2013 | Volume 10 | Issue 5 | e1001452 Domestic Violence and Perinatal Mental Disorders Figure 8. Meta-analysis of the association between any lifetime partner violence and postnatal depression (cohort studies). ES, effect size. doi:10.1371/journal.pmed.1001452.g008 association between experiences of domestic violence and prob- Most studies were carried out in high-income settings; findings able depression in the antenatal and postnatal periods is likely, in were similar in low-income settings, but one study also reported which symptoms of depression may increase women’s vulnerability that the odds of psychological distress associated with having to domestic violence, and having experienced domestic violence experienced domestic violence was higher if the baby was a girl can increase the odds of probable depression in the antenatal and rather than a boy [86]. Risks are therefore likely to be modified by postnatal period. Insufficient data were available for other the cultural context of the pregnancy and postpartum period; this perinatal mental disorders to draw conclusions about the direction may be particularly the case where parents or parents-in-law play of causality for associations. a major role in the postpartum period [22]. To our knowledge, this systematic review is the first to search for studies reporting on the prevalence and odds of having experi- Strengths and Limitations enced domestic violence across the full range of antenatal and Strengths of this review include restricting primary studies to postnatal mental disorders. There are fewer studies on domestic those that used diagnostic instruments or validated screening violence and probable anxiety disorders than depression, but the instruments with their recommended cutoff scores to assess mental review found, for the first time, consistent evidence of a high disorders. The comprehensive search strategy over multiple prevalence and increased odds of having experienced domestic databases enabled the identification and synthesis of a large violence among women with anxiety and PTSD in the antenatal number of studies of several diagnostic categories, including and postnatal periods. We did not find any studies reporting the depression, anxiety disorders, and PTSD. The review highlights relationship between having experienced domestic violence and critical gaps in the literature, including few longitudinal studies, eating disorders or psychotic disorders, including puerperal few studies reporting on violence perpetrated by family members, psychosis, despite studies outside the perinatal period reporting and no studies investigating the possible relationship between an increased odds of having experienced domestic violence in domestic violence and puerperal psychosis. women with eating disorders [14], and anecdotal reports of There was high heterogeneity in pooled estimates of the domestic violence associated with puerperal psychosis [104]. association between having experienced past-year intimate partner Further research is clearly needed for these diagnostic categories. violence and probable depression in both the antenatal and PLOS Medicine | www.plosmedicine.org 11 May 2013 | Volume 10 | Issue 5 | e1001452 Domestic Violence and Perinatal Mental Disorders Figure 9. Meta-analysis of the association between any partner violence during pregnancy and postnatal depression (cohort studies). doi:10.1371/journal.pmed.1001452.g009 postnatal periods among cross-sectional studies, and there were cannot draw firm conclusions about whether the observed insufficient studies to analyse the reasons for the higher association between domestic violence and probable perinatal heterogeneity using meta-regression. Visual inspection of the data, depression is causal. As the calculation of the pooled PAF (the however, suggests that heterogeneity may be due to variation in proportion of probable mental disorder potentially ascribable to the timing of recruitment, e.g., for women recruited in the last exposure to intimate partner violence) is based on an assumption trimester, proportionally more of the ‘‘past year’’ reference period of causality, the PAF estimate should be treated with particular includes the time they were pregnant than for women recruited in caution. Further high-quality longitudinal studies, including the first trimester. Similarly, proportionally more of the ‘‘past linked database studies, should be conducted to explore the year’’ reference period includes the period of pregnancy for nature of the association between domestic violence and women recruited in the early postpartum period than women perinatal mental disorder. Future research should also collect recruited at 9–12 mo postpartum. This variation could be relevant and report data on all types of violence (i.e., physical, sexual, because the prevalence of domestic violence can be lower during and psychological violence); the majority (48/67) of the studies pregnancy [16,17] and because the association between domestic included in this review reported on physical violence—either violence and depression may vary as a function of when the alone or in combination with other forms of violence—and violence occurred. fewer than half reported prevalence and ORs disaggregated by Insufficient characterisation of participants in the primary type of violence. studies meant we were unable to assess the role of individual risk factors, such as social class. The lack of consistency in the type of Implications data collected by the primary studies meant we were also unable to Domestic violence during pregnancy is associated with risks adjust estimates for potential confounders (e.g., history of to the fetus, child, and mother [18–22]. Our finding that depression or childhood abuse). In addition, most of the womenwithhighlevelsofsymptomsofarangeofperinatal longitudinal studies did not provide data on baseline levels of mental disorders have a high prevalence and increased odds of symptoms or domestic violence, preventing clear interpretation on having experienced domestic violence both over the lifetime incident depression after domestic violence and vice versa. Thus, and during pregnancy highlights the importance of health although having experienced domestic violence was strongly and professionals identifying and responding to domestic violence consistently associated with probable antenatal and postnatal among women attending antenatal and mental health services. depression in both longitudinal and cross-sectional studies, we The World Health Organization and some international PLOS Medicine | www.plosmedicine.org 12 May 2013 | Volume 10 | Issue 5 | e1001452 Domestic Violence and Perinatal Mental Disorders guidelines recommend identification of domestic violence and Text S1 PRISMA checklist of items to include when mental disorders in women attending antenatal care and reporting a systematic review or meta-analysis. mental health care [105–107]. However, a recent Cochrane (DOC) review found little data on whether screening and other Text S2 Systematic review protocol. interventions improve outcomes for women experiencing (DOC) domestic violence in the perinatal period [108]. Further data Text S3 Search terms for Medline, Embase, and PsycINFO. is therefore needed on how maternity and mental health (DOC) services should best identify women with a history or current experience of domestic violence, respond appropriately and Text S4 Critical appraisal checklist for included stud- safely, and thus improve health outcomes for women and their ies. infants in the perinatal period. (DOC) Supporting Information Acknowledgments Figure S1 Funnel plots to assess publication bias. We gratefully acknowledge Professor Michael Dewey (King’s College (DOC) London’s Institute of Psychiatry) for his advice regarding statistical analysis. Table S1 Characteristics and reported outcomes of Author Contributions cross-sectional analyses of included studies. (DOCX) Conceived and designed the experiments: LMH GF. Analyzed the data: SO HG KT. Wrote the first draft of the manuscript: LMH SO. Table S2 Characteristics and reported outcomes of Contributed to the writing of the manuscript: LMH SO HG KT GF. longitudinal analyses of included studies. ICMJE criteria for authorship read and met: LMH SO HG KT GF. Agree (DOCX) with manuscript results and conclusions: LMH SO HG KT GF. References 1. Grote NK, Bridge JA, Gavin AR, Melville JL, Iyengar S, et al. (2010) A meta- 19. Flach C, Leese M, Heron J, Evans J, Feder G, et al. (2011) Antenatal domestic analysis of depression during pregnancy and the risk of preterm birth, low birth violence, maternal mental health and subsequent child behaviour: a cohort weight and intrauterine growth restriction. Arch Gen Psychiatry 67: 1012– study. BJOG 118: 1383–1391. 20. Boy A, Salihu HM (2004) Intimate partner violence and birth outcomes: a 2. Howard LM (2005) Fertility and pregnancy in women with psychotic disorders. systematic review. Int J Fertil Womens Med 49: 159–164. Eur J Obstet Gynecol Reprod Biol 119: 3–10. 21. Murphy CC, Schei B, Myhr TL, Du Mont J (2001) Abuse: a risk factor for low 3. Micali N, Simonoff E, Treasure J (2007) Risk of major adverse perinatal birth weight? A systematic review and meta-analysis. CMAJ 164: 1567–1572. outcomes in women with eating disorders. Br J Psychiatry 190: 255–259. 22. Lewis G (2007) Confidential enquiry into maternal and child health: saving 4. Howard LM, Kirkwood G, Latinovic R (2007) Sudden infant death syndrome mothers’ lives. London: Centre for Maternal and Child Enquiries. and maternal depression. J Clin Psychiatry 68: 1279–1283. 23. Beydoun H, Beydoun MA, Kaufman JS, Lo B, Zonderman AB (2012) Intimate 5. Webb R, Abel K, Pickles A, Appelby L (2005) Mortality in offspring of parents partner violence against adult women and its association with major depressive with psychotic disorders: a critical review and meta-analysis. Am J Psych 162: disorder, depressive symptoms and postpartum depression: a systematic review 1045–1056. and meta-analysis. Soc Sci Med 75: 959–975. 6. Webb RT, Abel KM, Pickles AR, Appelby L, King-Hele SA, et al. (2006) 24. Lancaster CA, Gold KJ, Flynn HA, Yoo H, Marcus SM, et al. (2010) Risk Mortality risk among offspring of psychiatric inpatients: a population-based factors for depressive symptoms during pregnancy: a systematic review. follow-up to early adulthood. Am J Psych 163: 2170–2177. Am J Obstet Gynecol: 5–14. 7. Bick D, Howard LM (2010) When should women be screened for postnatal 25. Wu Q, Chen HL, Xu XJ (2012) Violence as a risk factor for postpartum depression? Expert Rev Neurother 10: 151–154. depression in mothers: a meta-analysis. Arch Womens Ment Health 15: 107– 8. Milgrom J, Gemmill AW, Bilszta JL, Hayes B, Barnet B, et al. (2008) Antenatal 114. risk factors for postnatal depression: a large prospective study. J Affect Disord 26. Fisher J, Cabral de Mello C, Patel V, Rahman A, Tran T, et al. (2012) 108: 147–157. Prevalence and determinants of common perinatal mental disorders in women 9. Howard LM, Goss C, Leese M, Appleby L, Thornicroft G (2004) The in low and low middle income countries: a systematic review. Bull World psychosocial outcome of pregnancy in women with psychotic disorders. Health Organ 90: 139–149. Schizophr Res 71: 49–60. 27. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, et al. (2000) Meta- 10. Goodman SH, Rouse MH, Connell AM, Broth MR, Hall CM, et al. (2011) analysis of observational studies in epidemiology: a proposal for reporting. Maternal depression and child psychopathology: a meta-analytic review. Clin Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. Child Fam Psychol Rev 14: 1–27. JAMA 283: 2008–2012. 28. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items 11. O’Hara MW, Swain AM (1996) Rates and risks of postpartum depression—a meta-analysis. Int Rev Psychiatry 8: 37–54. for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 12. Leight KL, Fitelson EM, Weston CA, Wisner KL (2010) Childbirth and mental 6: e1000097. doi:10.1371/journal.pmed.1000097 disorders. Int Rev Psychiatry 22: 453–471. 29. Maniglio R (2009) Severe mental illness and criminal victimization: a 13. Howard LM, Trevillion K, Agnew-Davies R (2010) Domestic violence and systematic review. Acta Psychiatr Scand 119: 180–191. mental health. Int Rev Psychiatry 22: 525–534. 30. Friedman SH, Loue S (2007) Incidence and prevalence of intimate partner violence by and against women with severe mental illness. J Womens Health 14. Trevillion K, Oram S, Feder G, Howard LM (2012) Experiences of domestic (Larchmt) 16: 471–480. violence and mental disorders: a systematic review and meta-analysis. PLoS ONE 7: e51740. doi:10.1371/journal.pone.0051740 31. National Institute for Health and Clinical Excellence (2008) The guidelines 15. Gazmararian JA, Lazorick S, Spitz AM, Ballard TJ, Saltzman LE, et al. (1996) manual. London: National Institute for Health and Clinical Excellence. Prevalence of violence against pregnant women. JAMA 275: 1915– 32. Ramsay J, Carter Y, Davidson L, Dunne D, Eldridge S, et al. (2009) Advocacy 1920. interventions to reduce or eliminate violence and promote the physical and psychosocial well-being of women who experience intimate partner abuse. 16. Gazmararian JA, Petersen R, Spitz AM, Goodwin MM, Saltzman LE, et al. Cochrane Database Syst Rev 2009: CD005043. doi:005010.001002/ (2000) Violence and reproductive health: current knowledge and future research directions. Matern Child Health J 4: 7984. 14651858.CD14005043.pub14651852 17. Devries KM, Kishor S, Johnson H, Sto¨ckl H, Bacchus LJ, et al. (2010) Intimate 33. Critical Appraisal Skills Programme (2006) Appraising the evidence. Available: partner violence during pregnancy: analysis of prevalence data from 19 http://www.casp-uk.net/find-appraise-act/appraising-the-evidence/. Accessed countries. Reprod Health Matters 18: 158–170. 22 April 2012. 34. Cochrane Collaboration (2002) The Cochrane Collaboration open learning 18. Feder G, Ramsay J, Dunne D, Rose M, Arsene C, et al. (2009) How far does material: publication bias. Available: http://www.cochrane-net.org/ screening women for domestic (partner) violence in different health-care openlearning/html/mod15-3.htm. Accessed 12 April 2013. settings meet criteria for a screening programme? Systematic reviews of nine UK National Screening Committee critieria. Health Technol Assess 13: iii–iv, 35. StataCorp (2009) Stata statistical software: release 11. College Station (Texas): xi–xiii, 1–113, 137–347. StataCorp. PLOS Medicine | www.plosmedicine.org 13 May 2013 | Volume 10 | Issue 5 | e1001452 Domestic Violence and Perinatal Mental Disorders 36. Smith MV, Gotman N, Lin H, Yonkers KA (2010) Do the PHQ-8 and the 64. Ho-Yen SD, Bondevik GT, Eberhard-Gran M, Bjorvatin B (2007) Factors PHQ-2 accurately screen for depressive disorders in a sample of pregnant associated with depressive symptoms among postnatal women in Nepal. Acta women? Gen Hosp Psychiatry 32: 544–548. Obstet Gynecol Scand 86: 291–297. 37. Gibson J, McKenzie-McHarg K, Shakespeare J, Price J, Gray R (2009) A 65. Husain N, Bevc I, Husain M, Chaudhury IB, Atif N, et al. (2006) Prevalence systematic review of studies validating the Edinburgh Postnatal Depression and social correlates of postnatal depression in a low income country. Arch Scale in antepartum and postpartum women. Acta Psychiatr Scand 119: 350– Womens Ment Health 9: 197–202. 364. 66. Imran N, Haider II (2010) Screening of antenatal depression in Pakistan: risk 38. Abbaszadeh A, Kermani FP, Safizadeh H, Nakhee N (2011) Violence during factors and effects on obstetric and neonatal outcomes. Asia Pac Psychiatry 2: pregnancy and postpartum depression. Pak J Med Sci Q 27: 177–181. 26–32. 39. Ahmed HM, Alalaf SK, Al-Tawil NG (2012) Screening for postpartum 67. Jesse DE, Walcott-McQuigg J, Mariella A, Swanson MS (2005) Risks and depression using Kurdish version of Edinburgh postnatal depression scale. Arch protective factors associated with symptoms of depression in low-income Gynecol Obstet 285: 1249–1255. African American and Caucasian women during pregnancy. J Midwifery 40. Ali NS, Ali BS, Azam IS (2009) Postpartum anxiety and depression in peri- Womens Health 50: 405–410. urban communities of Karachi, Pakistan: a quasi-experimental study. BMC 68. Jundt K, Haertl K, Knobbe A, Kaestner R, Friese K, et al. (2009) Pregnant Public Health 9: 384. women after physical and sexual abuse in Germany. Gynecol Obstet Invest 68: 41. Ali NS, Azam IS, Ali BS, Tabbusum G, Moin SS (2012) Frequency and 82–87. associated factors for anxiety and depression in pregnant women: a hospital- 69. Karac¸am Z, Anc¸el G (2009) Depression, anxiety and influencing factors in based cross-sectional study. ScientificWorldJournal 2012: 653098. pregnancy: a study in a Turkish population. Midwifery 25: 344–356. 42. Ammerman RI, Putnam FW, Altaye M, Chen L, Holleb LJ, et al. (2009) 70. Karmaliani R, Asad N, Bann CM, Moss N, McClure EM, et al. (2009) Changes in depressive symptoms in first time mothers in home visitation. Child Prevalence of anxiety, depression and associated factors among pregnant Abuse Negl 33: 127–138. women of Hyderabad, Pakistan. Int J Soc Psychiatry 55: 414–424. 43. Beydoun HA, Al-Sahab B, Beydoun MA, Tamim H (2010) Intimate partner 71. Kiely M, El-Mohandes AA, El-Khorazaty M, Gantz MG (2010) An integrated violence as a risk factor for postpartum depression among Canadian women in intervention to reduce intimate partner violence in pregnancy: a randomized the Maternity Experience Survey. Ann Epidemiol 20: 575–583. trial. Obstet Gynecol 115: 273–283. 44. Brown SJ, McDonald EA, Krastev AH (2008) Fear of an intimate partner and 72. Kim H, Mandell M, Crandall C, Kuskowski M, Dieperink B, et al. (2006) women’s health in early pregnancy: findings from the maternal health study. Antenatal psychiatric illness and adequacy of prenatal care in an ethnically Birth 35: 293–302. diverse inner-city obstetric population. Arch Womens Ment Health 9: 103– 45. Budhathoki N, Dahal M, Bhusal S, Ojha H, Pandey S, et al. (2012) Violence against women by their husband and postpartum depression. J Nepal Health 73. Kornfeld BD, Bair-Merritt MH, Frosch E, Solomon BS (2012) Postpartum Res Counc 10: 176–180. depression and intimate partner violence in urban mothers: co-occurrence and 46. Certain HE, Mueller M, Jagodzinski T, Fleming M (2008) Domestic abuse child healthcare utilization. J Pediatr 161: 348–353. during the previous year in a sample of postpartum women. J Obstet Gynecol 74. Leung WC, Kung F, Lam J, Leung TW, Ho PC (2002) Domestic violence and Neonatal Nurs 37: 35–41. postnatal depression in a Chinese community. Int J Gynaecol Obstet 79: 159– 47. Cerulli C, Talbot NL, Tang W, Chaudron LH (2011) Co-occurring intimate partner violence and mental health diagnoses in perinatal women. J Womens 75. Lobato G, Moraes CL, Dias AS, Reichenheim ME (2011) Alcohol misuse Health (Larchmt) 20: 1797–1803. among partners: a potential effect modifier in the relationship between physical 48. Crempien RC, Rojas G, Cumsille P, Oda MC (2011) Domestic violence during intimate partner violence and postpartum depression. Soc Psychiat Epidemiol pregnancy and mental health: exploratory study in primary health centers in 47: 427–438. Penalolen. ISRN Obstet Gynecol 2011: 265817. 76. Ludermir A, Lewis G, Valongueiro S (2010) Violence against women by their 49. Cwikel J, Lev-Wiesel R, Al-Krenawi A (2003) The physical and psychosocial intimate partner during pregnancy and postnatal depression: a prospective health of Bedouin Arab women of the Negev area of Israel: the impact of high cohort study. Lancet 376: 903–910. fertility and pervasive domestic violence. Violence Against Women 9: 240–257. 77. Malta LA, McDonald SW, Hegadoren KM, Weller CA, Tough SC (2012) 50. DeKlyen M, Brooks-Gunn J, McLanahan S, Knab J (2006) The mental health Influence of interpersonal violence on maternal anxiety, depression, stress and of married, cohabiting and non-coresident parents with infants. Am J Public parenting morale in the early postpartum: a community based pregnancy Health 96: 1836–1841. cohort study. BMC Pregnancy Childbirth 12: 153. 51. Dennis CL, Vigod S (2013) The relationship between postpartum depression, 78. Manzolli P, Nunes MA, Schmidt MI, Ferri CP (2012) Abuse against women, domestic violence, childhood violence, and substance use: epidemiologic study depression, and infant morbidity: a primary care cohort study in Brazil. of a large community sample. Violence Against Women. In press. Am J Prev Med 43: 188–195. 52. Dunn LL, Oths KS (2004) Prenatal predictors of intimate partner abuse. 79. Martin SL, Yun L, Casanueva C, Hanis-Britt A, Kupper LL, et al. (2006) J Obstet Gynecol Neonatal Nurs 33: 54–63. Intimate partner violence and women’s depression before and during 53. Ferrari Audi CA, Segall-Correa AM, Santiago SM, Andrade MdGG, Perez- pregnancy. Violence Against Women 12: 221–239. Escamila R (2008) Violence against pregnant women: prevalence and 80. McGarry J, Kim H, Sheng XM, Egger M, Baksh L (2009) Postpartum associated factors. Rev Saude Publica 42: 877–885. depression and help-seeking behavior. J Midwifery Womens Health 54: 50–56. 54. Fisher J, Thach T, Buoi TL, Kriitmaa K, Rosenthal D, et al. (2010) Common 81. Melo EF Jr, Cecatti JG, Pacagnella RC, Leite DFB, Vulcani DE, et al. (2012) perinatal mental disorders in northern Viet Nam: community prevalence and The prevalence of perinatal depression and its associated factors in two health care use. Bull World Health Organ 88: 737–745. different settings in Brazil. J Affect Disord 136: 1204–1208. 55. Fisher J, Tran T, Duc Tran T, Dwyer T, Nguyen T, et al. (2012) Prevalence 82. Mezey G, Bacchus L, Bewley S (2005) Domestic violence, lifetime trauma and and risk factors for symptoms of common mental disorders in early and late psychological health of childbearing women. BJOG 112: 197–204. pregnancy in vietnamese women: a prospective population-based study. J Affect 83. Miszkurka M, Zunzunegui MV, Goulet L (2012) Immigrant status, antenatal Disord 146: 213–219. depressive symptoms, and frequency and source of violence: what’s the 56. Gao W, Paterson J, Abbott M, Carter S, Iusitini L (2010) Pacific Islands relationship? Arch Womens Ment Health 15: 387–396. families study: intimate partner violence and postnatal depression. J Immigr 84. Nasreen HE, Kabir ZN, Forsell Y, Edhborg M (2011) Prevalence and Minor Health 12: 242–248. associated factors of depressive and anxiety symptoms during pregnancy: a 57. Gausia K, Fisher C, Ali M, Oosthuizen J (2009) Antenatal depression and population based study in rural Bangladesh. BMC Womens Health 11: 22. suicidal ideation among rural Bangladeshi women: a community-based study. 85. Nunes MA, Camey S, Ferri CP, Manzolli P, Manenti CN, et al. (2011) Arch Womens Ment Health 12: 351–358. Violence during pregnancy and newborn outcomes: a cohort study in a 58. Gausia K, Fisher C, Ali M, Oosthuizen J (2009) Magnitude and contributory disadvantaged population in Brazil. Eur J Public Health 21: 92–97. factors of postnatal depression: a community-based cohort study from a rural 86. Patel V, Rodrigues M, DeSouza N (2002) Gender, poverty, and postnatal subdistrict of Bangladesh. Psychol Med 33: 999–1007. depression: a study of mother in Goa, India. Am J Psych 159: 43–47. 59. Gavin A, Melville JL, Rue T, Guo Y, Tabb Dina K, et al. (2011) Racial 87. Pollock JI, Manaseki-Holland S, Patel V (2009) Depression in Mongolian differences in the prevalence of antenatal depression. Gen Hosp Psychiatry 33: women over the first 2 months after childbirth: prevalence and risk factors. 87–93. J Affect Disord 116: 126–133. 60. Gomez-Beloz A, Williams MA, Sanchez SE, Lam N (2009) Intimate partner 88. Pooler J, Perry DF, Ghandour RM (2013) Prevalence and risk factors for violence and risk for depression among postpartum women in Lima, Peru. postpartum depressive symptoms among women enrolled in WIC. Matern Violence Vict 24: 380–398. Child Health J. E-pub ahead of print. 61. Groves AK, Kagee A, Maman S, Moodley D, Rouse P (2012) Associations 89. Quelopana A (2012) Violence against women and postpartum depression: the between intimate partner violence and emotional distress among pregnant experience of Chilean women. Women Health 52: 437–453. women in Durban, South Africa. J Interpers Violence 27: 1341–1356. 90. Radestad I, Ebeling M, Hildingsson I, Rubertsson C (2004) What factors in 62. Hartley M, Tomlinson M, Greco E, Comulada WS, Stewart J, et al. (2011) early pregnancy indicate that the mother will be hit by her partner during the Depressed mood in pregnancy: prevalence and correlates in two Cape Town year after childbirth? A nationwide Swedish survey. Birth 31: 84–92. peri-urban settlements. Reprod Health 89: 8–9. 63. Harvey ST, Pun PK (2007) Analysis of positive Edinburgh depression scale 91. Records K, Rice MJ (2009) Lifetime physical and sexual abuse and the risk for referrals to a consultation liaison psychiatry service in a two-year period. depression symptoms in the first 8 months after birth. J Psychosom Obstet Int J Ment Health Nurs 16: 161–167. Gynaecol 30: 181–190. PLOS Medicine | www.plosmedicine.org 14 May 2013 | Volume 10 | Issue 5 | e1001452 Domestic Violence and Perinatal Mental Disorders 92. Rodriguez MA, Heilemann MV, Fielder E, Ang A, Nevarez F, et al. (2008) 101. Zhang Y, Zou S, Cao Y (2012) Relationship between domestic violence and Intimate partner violence, depression, and PTSD among pregnant Latina postnatal depression among pregnant Chinese women. Int J Gynaecol Obstet women. Ann Fam Med 6: 44–52. 116: 26–30. 93. Romito P, Pomicino L, Lucchetta C, Scrimin F, Turan JM (2009) The 102. Dolatian M, Hesami K, Shams J, Majd HA (2010) Relationship between relationships between physical violence, verbal abuse and women’s psycholog- violence during pregnancy and postpartum depression. Iran Red Crescent ical distress during the postpartum period. J Psychosom Obstet Gynaecol 30: Med J 12: 377–383. 115–121. 103. Hayes BA, Campbell A, Buckby B, Geia LK, Egan ME (2010) The interface of 94. Saurel-Cubizolles MJ, Blondel B, Lelong N, Romito P (1997) Marital violence mental and emotional health and pregnancy in urban indigenous women: after birth. Fertil Contracept Sex 25: 159–164. research in progress. Infant Ment Health J 31: 277–290. 95. Seng JS, Low LK, Sperlich M, Ronis DL, Liberzon I (2009) Prevalence, 104. Trevillion K (2013) The identification and response of psychiatric services to trauma history, and risk for posttraumatic stress disorder among nulliparous domestic violence [PhD dissertation]. London: Instsitute of Psychiatry, King’s women in maternity care. Obstet Gynecol 114: 839–847. College London. 96. Thananowan N, Heidrich S (2008) Intimate partner violence among pregnant 105. World Health Organization, London School of Hygiene and Tropical Thai women. Violence Against Women 14: 509–527. Medicine (2010) Preventing intimate partner and sexual violence against 97. Thompson J, Canterino JC, Feld SM, Stumpf PG, Kuo Y, et al. (2000) Risk women: taking action and generating evidence. Geneva: World Health factors for domestic violence in pregnant women. Prim Care Update Ob Gyns Organization. 7: 138–141. 106. United Kingdom Department of Health (2008) Refocusing the care 98. Tiwari A, Chan KL, Fong D, Leung WC, Brownridge DA, et al. (2008) The programme approach: policy and positive practice guidance. London: impact of psychological abuse by an intimate partner on the mental health of Department of Health. 64 p. pregnant women. BJOG 115: 377–384. 107. U.S. Preventive Services Task Force, Agency for Healthcare Research and 99. Tuten M, Jones HE, Tran G, Svikis DS (2004) Partner violence impacts the Quality (2004) Screening for family and intimate partner violence. Rockville psychosocial and psychiatric status of pregnant, drug-dependent women. (Maryland): Agency for Healthcare Research and Quality. Addict Behav 29: 1029–1034. 108. Jahanfar S, Janssen PA, Howard LM, Dowswell T (2011) Interventions for 100. Woolhouse H, Gartland D, Hegarty K, Brown S (2012) Depressive symptoms preventing or reducing domestic violence against pregnant women. Cochrane and intimate partner violence in the 12 months after childbirth: a prospective Database Syst Rev 2011: CD14009414. doi:10.1002/14651858.CD14009414 pregnancy cohort study. BJOG 119: 315–323. PLOS Medicine | www.plosmedicine.org 15 May 2013 | Volume 10 | Issue 5 | e1001452 Domestic Violence and Perinatal Mental Disorders Editors’ Summary during the past year (OR = 2.8), and during pregnancy Background. Domestic violence—physical, sexual, or emo- tional abuse by an intimate partner or family member—is a (OR = 5). The results were similar for the postnatal period. major public health problem and although more common in The evidence was less robust for anxiety disorders: among women, can also affect men. Due to the nature of the women with probable anxiety in the antenatal period, the problem, it is difficult to collect accurate figures on the scale of researchers found an OR of 2.9 of having experienced domestic violence, but a study by the World Health lifetime partner violence. The odds were less in the postnatal Organization in ten countries found that 15%–71% of women period (OR = 1.4) In their analysis of longitudinal studies aged 15–49 years reported physical and/or sexual violence by (follow-up studies over a period of time), the researchers an intimate partner at some point in their lives. Women found an increased odds of probable postnatal depression experiencing domestic violence have significant short- and both among women who reported having ever experienced long-term health problems, particularly regarding their partner violence in their lifetime (OR = 2.9) and among mental health: experience of domestic violence can lead to women who reported having experienced partner violence a range of mental health disorders such as depression, during pregnancy (OR = 3.1). The researchers also found a psychosis, eating disorders, and even suicide attempts. combined prevalence estimate of 12.7% for probable depression during the postnatal period following experienc- Why Was This Study Done? As perinatal mental health es of partner violence during pregnancy. Because of limited disorders are among the commonest health problems in data, the researchers could not calculate an OR of the pregnancy and the postpartum period, and given the rate of association between probable antenatal depression and later domestic violence during pregnancy (previous studies have experiences of partner violence. suggested a domestic violence prevalence of 4%–8% during pregnancy and the postnatal period), it is plausible that there What Do These Findings Mean? These findings suggest may be a link between perinatal mental health disorders and that women with high levels of symptoms of perinatal having experienced domestic violence. Indeed, previous mental health disorders—antenatal and postnatal anxiety, reviews have suggested the existence of such an association depression, and post-traumatic stress disorder—have a high but were limited by the small number of included studies and prevalence and increased odds of having experienced focused on depression only, rather than the full range of domestic violence both over their lifetime and during antenatal and postnatal mental health disorders. So in this pregnancy. However, these findings cannot prove causality, study the researchers systematically reviewed published they fail to show a two-way association (that is, perinatal mental health disorders leading to subsequent domestic studies to provide more robust estimates of the prevalence violence), and no information on other perinatal mental of having experienced domestic violence among women with disorders, such as eating disorders and puerperal psychosis, antenatal and postnatal mental health disorders; the research- was available. The variation of the quality of the included ers also used a meta-analysis to estimate the odds (chance) of studies also limits the results, highlighting the need for high- having experienced domestic violence among women with antenatal and postnatal mental health disorders. quality data to suggest how maternity and mental health services could address domestic violence and improve health What Did the Researchers Do and Find? The researchers outcomes for women and their infants in the future. searched multiple databases and hand searched three Nevertheless, this study emphasizes the importance of relevant journals using key search terms to identify all types identifying and responding to possible domestic violence of relevant studies. Using specific criteria, the researchers among women attending antenatal and mental health retrieved and assessed over 1,000 full papers, of which 67 services. met the criteria for their systematic review. The researchers Additional Information. Please access these websites via assessed the quality of each selected study and included the online version of this summary at http://dx.doi.org/10. only those studies that used validated diagnostic instru- 1371/journal.pmed.1001452. ments and screening tools to assess mental health disorders in their calculations of the pooled (combined) odds ratio (OR) The World Health Organization provides information and through meta-analysis. statistics about violence against women and also about Using these methods, in cross-sectional studies (studies mental health disorders during pregnancy conducted at one point in time), the researchers found that The UK Royal College of Psychiatrists has information for women with probable depression in the antenatal period professionals and patients about mental health disorders reported a high prevalence and increased odds of having during pregnancy experienced partner violence during their lifetime (OR = 3), PLOS Medicine | www.plosmedicine.org 16 May 2013 | Volume 10 | Issue 5 | e1001452

Journal

PLoS MedicinePublic Library of Science (PLoS) Journal

Published: May 28, 2013

There are no references for this article.