Relationship between domestic violence and postnatal depression among pregnant Chinese women

The status of intimate partner violence against pregnant women in contemporary China: a scoping review

PURPOSE

This review explored the status of publications on intimate partner violence (IPV) against pregnant women in contemporary China.

METHODS

The PubMed, Cochrane Library, Embase, CINAHL, and PsycInfo databases were searched using the terms "IPV," "pregnant woman," "Chinese," and synonyms in English, along with related keywords for Chinese publications. All literature pertaining to IPV during pregnancy, conducted in China, and published between 1987 and September 2023 was included.

RESULTS

A total of 37 articles from 30 studies were selected. The prevalence of IPV during pregnancy ranged from 2.5% to 31.3%, with psychological violence being the most common form. Frequently identified risk factors included unintended pregnancy, poor family economic conditions, male partners engaging in health risk behaviors, poor employment status of women or their partners, low education levels among women, physical or mental health issues, strained couple relationships, and in-law conflicts. IPV during pregnancy primarily led to mental health problems for the victims and could result in adverse obstetric outcomes, as well as negative effects on the temperament and development of the offspring. Victims in China demonstrated a low willingness to seek help from professionals. Furthermore, relevant research in mainland China is scarce, with a limited number of studies and non-standardized research methodologies.

CONCLUSION

Future research should investigate IPV in pregnancy from various perspectives, identify factors unique to IPV during pregnancy, and focus on high-risk groups. Considering the conditions in China, there is a pressing need to increase public awareness of IPV and to investigate interventions aimed at addressing this issue.

Obstetric violence in southwestern Turkey: Risk factors and its relationship to postpartum depression

This study was conducted to determine the relationship between violence, risk factors, and depression at the end of pregnancy. The sample of this descriptive and cross-sectional study consisted of 426 women for normal postpartum monitoring during the six-month period and living in southwestern Turkey of the study. About 5.6% of the women who participated in the study were exposed to obstetric violence. 5.2% of them were intimate partner violence before pregnancy. 79.1% (n = 24), 29.1%, and 25% of them were subjected to physical, sexual, and economic violence, respectively. In addition, 7.5% of women were exposed to verbal obstetric violence. It was found that the postpartum depression scores of the women who had been subjected to violence from their husbands before pregnancy were high.

Domestic Violence Against Women During the COVID-19 Pandemic and Its Relationship to Demographic and Family Factors: A Cross-Sectional Study in Iran

BACKGROUND

During the COVID-19 pandemic, we have witnessed increased complaints from third parties about violent conditions through social media. This study aimed to determine the prevalence of domestic violence (DV) against women following exposure to the COVID-19 pandemic and its relevance to some related factors.

MATERIALS AND METHODS

This study was conducted from July 2020 to May 2021 on married women of Babol, Iran. Eligible women entered into the study in a multi-stage cluster random sampling method. Data collection tools included demographic and family data, questionnaire HITS (Hurt, Insult, Threaten and Scream). Relationships were estimated using the Univariate and multivariate regression models.  Results: The mean age of 488 women and their spouses was 34.62 ± 9.14 and 38.74 ± 9.07, respectively. Of the total female participants, 37 (7.6%), 68 (13.9%), and 21 (4.3%) were victims of total violence, verbal abuse, and physical violence, respectively. Ninety-five women (19.5) had a history of coronavirus infection. Women who were satisfied with their income and husbands were university educated, their chances of DV were reduced by 72% (95% CI (0.09-0.85), OR = 0.28) and 67% (95% CI (0.11-0.92), OR = 0.33) respectively. Drug abuse by husbands increased the likelihood of DV by up to 4 times (OR = 4.00), and more contact with their husbands at home due to home quarantine was more than twice as likely to have DV (OR = 2.64).  Conclusion: Since the level of domestic violence was lower than before the coronavirus pandemic, it seems that most Iranian women were more under the support of their husbands during the coronavirus pandemic to endure the fear and panic caused by the pandemic. Women whose husbands had a university education and sufficient income had less domestic violence.

The association between paternal childcare involvement and postpartum depression and anxiety among Chinese women-a path model analysis

Depression and anxiety are among the most common morbidities during the perinatal period. Very few studies have been conducted to examine the association between paternal childcare involvement and postpartum depression (PPD) and anxiety (PPA) in East Asian cultures. This study aims to examine the association between fathers' involvement in childcare and mothers' mental health and explores the potential mediating effects of the mother and child's health among a national sample of Chinese women. This is a cross-sectional, self-administered online survey of maternal women (N = 778) within 1 year after childbirth in China. The questionnaire comprised of sociodemographics, fathers' childcare involvement, child and mother's physical health, and mothers' postpartum mental health status. A path analysis model was constructed to examine the correlation between paternal childcare involvement and maternal depression and anxiety within 1-year postpartum. The mediating effect of the mother and child's physical health was also explored in the model. Paternal involvement in childcare was significantly associated with lower PPD (β =  - .36, p < 0.001) and PPA (β =  - .29, p < 0.001) levels of mothers after covariates were adjusted. Furthermore, women's physical health partially mediated the association between paternal involvement and PPD, and child's health partially mediated the association between paternal involvement and PPA and PPD. Our findings emphasize the essential role of father's childcare involvement and the need to promote culturally tailored intervention programs, which may improve the mental health status among Chinese postpartum mothers.

Perceived stress and associated factors among pregnant women during COVID-19 pandemic period in Northwest Ethiopia, 2020: a cross-sectional study

OBJECTIVE

This study aimed to determine the prevalence and associated factors of perceived stress among pregnant women during the COVID-19 pandemic period in Northwest Ethiopia.

METHOD

A cross-sectional study.

SETTING

University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia.

PARTICIPANTS

A total of 415 pregnant women were recruited by using a systematic random sampling technique from 28 April 2020 to 12 June 2020.

MEASUREMENT

The required data were collected through face-to-face interviews. The Perceived Stress Scale was used to assess perceived stress. The Edinburgh Postnatal Depression Scale and Oslo Social Support Scale 3 were used for associated factors. The data were analysed by using SPSS V.20. We also included sociodemographic, obstetrical and gynaecology, substance use and intimate partner-related factors. Logistic regression analysis was used to identify associated factors with perceived stress. Bivariate and multivariable logistic regression analyses were used to identify the effect of each independent variable with the outcome variable. A p value of less than 0.05 was considered to be statistically significant.

RESULTS

A total of 415 pregnant women participated in the study with response rate of 98.57%. The prevalence of perceived stress is found to be 13.7% (95% CI=10.4% to 17.1%). According to the multivariable logistic regression result, being a student (adjusted OR (AOR)=9.67, 95% CI=2.739 to 34.183), being at the first and third trimesters of gestational age (AOR=3.56, 95% CI=1.065 to 11.885; AOR=4.80, 95% CI=1.851 to 14.479, respectively), and having antenatal depression (AOR=3.51, 95% CI=1.628 to 7.563) were factors positively associated with perceived stress.

CONCLUSION

The prevalence of perceived stress among pregnant people was relatively high. This study recommends that all pregnant people should be screened and treated for perceived stress particularly during the first and third trimesters. Emphasis should be given to early detection and treatment of antenatal depression. Pregnant students must be strongly evaluated and intervened for perceived stress.

Towards Universal Screening for Postpartum Depression in China: Lessons Learned from a Comprehensive Prevention Programme in Shenzhen

PURPOSE

This study was conducted to assess the real-world efficacy of a universal programme for the prevention of postpartum depression (PPD) in Shenzhen. Given the lack of evidence on routine PPD screening and intervention in China, it sought to provide insights for programme planning and implementation, particularly in relation to achievement of the targets set by the first national guidelines for PPD prevention and treatment.

METHODS

Using routine health information system data, the PPD screening, referral and intervention rates for 2015-2019 were calculated and compared to the programmes targets. Trends of variables were tested by using trend χ².

RESULTS

The programme screened 137,761 to 178,857 women for PPD every year with the coverage among all postpartum women increased steadily from 71.1% to 82. 5% (χ² = 10145.251, p < 0.001). The PPD-positive rate maintained between 4.06% and 4.89%. However, although referral messages were given to an increased percentage of PPD-positive women (χ² = 1090.908, p < 0.001), the intervention rate (i.e., referral uptake) were far lower than the programme target of 80%.

CONCLUSIONS

This study demonstrated high efficacy of Shenzhen's comprehensive PPD prevention programme initiated in 2013. The resultant rise in the screening rate among all postpartum women, together with a high referral rate of those screened positive, have contributed to the city's relatively low PPD prevalence. PPD screening and intervention should be included as part of basic public health services to ensure universal coverage and specific strategies should be adopted to ensure referral uptake.

Intimate Partner Violence and Perinatal Post-Traumatic Stress and Depression Symptoms: A Systematic Review of Findings in Longitudinal Studies

The link between maternal violence exposure and adverse obstetric outcomes is well-documented, but less is understood about the relationship between intimate partner violence (IPV) exposure and perinatal post-traumatic stress symptoms(PTSS) and depression in women around the world. A systematic review was conducted to synthesize empirical literature on the associations between IPV (e.g., before pregnancy, during pregnancy, postpartum) and post-traumatic stress and depression symptoms in the perinatal period. This review acknowledged the effects of IPV exposure timing, timing of assessment, and IPV subtypes. Forty-seven longitudinal studies met inclusion criteria and were reviewed to determine the effects of IPV exposure on perinatal mental health. Findings suggested a strong relationship between IPV exposure and perinatal mental health. Results were more consistent between perinatal mental health and IPV sustained close to or during the perinatal period than for lifetime IPV exposure. In general, physical, sexual, and psychological IPV were independently associated with perinatal depression and PTSS. Findings underscore the importance of theoretically driven research and the development of treatment protocols for women worldwide.

Additional evidence on prevalence and predictors of postpartum depression in China: A study of 300,000 puerperal women covered by a community-based routine screening programme

BACKGROUND

Previous studies on the prevalence and predictors of postpartum depression (PPD) in China were mostly hospital-based with relatively small study samples. Basing on a routine screening programme, this study assessed the prevalence and factors associated with PPD at community level.

METHODS

A cross-sectional study was conducted with all the women who delivered in a hospital and were screened for depression during routine postpartum home visits in Shenzhen between 2015 August and 2017 April. The Edinburgh Postnatal Depression Scale was used as the screening tool with a cut-off score of 10. Predictors of PPD were determined by Chi-square test and stepwise logistic regression.

RESULTS

Approximately 300,000 puerperal women were included in the study with a PPD prevalence of 4.3%. Prenatal anxiety and depression were associated with 4.55 and 3.80 times of PPD risk, respectively. Stressful life events, family history of mental illness, poor economic status, low Apgar scores and birth defects of the infants, bottle and mixed feeding, as well as living with parents-in-low after childbirth were related to moderate risk. Higher gravidity and parity, larger gestation age, prenatal education, and living with the women's own parents were associated with lower risk.

LIMITATIONS

The large sample size might have suggested statistically significant differences which were not practical.

CONCLUSIONS

The prevalence of PPD at community level is significantly lower than the rates detected within hospitals. Prenatal anxiety and depression are the most important predictors of PPD. Integrating depression screening into routine postpartum home visits facilitates achievement of universal coverage.

Association between intimate partner violence and prenatal anxiety and depression in pregnant women: a cross-sectional survey during the COVID-19 epidemic in Shenzhen, China

OBJECTIVES

Intimate partner violence (IPV) against women remains a major global public health problem with harmful consequences for individuals and society. People's lifestyles have been greatly affected by the COVID-19 pandemic. This study investigated the prevalence of and relationship between IPV and anxiety and depression in pregnant Chinese women during the pandemic.

DESIGN

Cross-sectional study.

SETTING

This investigation was conducted in Shenzhen City, Guangdong Province, China from 15 September to 15 December 2020.

PARTICIPANTS

A total of 3434 pregnant women were screened with the Abuse Assessment Screen Questionnaire to evaluate IPV and General Anxiety Disorder and Patient Health Questionnaire to evaluate symptoms of anxiety and depression, respectively. Pregnant women with perinatal health records at Shenzhen District Maternity and Child Healthcare Hospitals who consented to participate were enrolled. Women with psychotic disorders such as schizophrenia, mania or substance dependence and pregnant women who refused to participate were excluded. Data were analysed with the χ² test and by logistic regression analysis.

RESULTS

The prevalence of IPV among pregnant women was 2.2%. Mental violence was the most common type of violence (2.2%), followed by physical (0.6%) and sexual (0.7%) violence. The prevalence of anxiety and depression symptoms was 9.8% and 6.9%, respectively. After adjusting for covariates, there was a statistically significant association between IPV and prenatal anxiety (OR=4.207, 95% CI: 2.469 to 7.166) and depression (OR=3.864, 95% CI: 2.095 to 7.125).

CONCLUSIONS

IPV increased the risk of prenatal anxiety and depression in pregnant women in China during the COVID-19 pandemic. Efforts should be made by the government and civil society to promote long-lasting antenatal interventions to ensure the safety and protect the mental health of pregnant women.

Landscaping the evidence of intimate partner violence and postpartum depression: a systematic review

OBJECTIVE

To assess the evidence of the association between exposure to intimate partner violence (IPV) and postpartum depression. IPV during pregnancy can have immediate and long-term physical and mental health consequences for the family. Therefore, it has been hypothesised that IPV may affect the risk of developing postpartum depression.

METHODS

A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, Global Health Library, Scopus and Google scholar were searched for published studies without restrictions on language, time or study design (up to May 2020). Studies were included if they assessed postpartum depression using the Edinburg Postnatal Depression Scale (cut-off≥10), among women who had been exposed to IPV (emotional, physical and/or sexual abuse). The quality of studies was judged according to the Newcastle-Ottawa scale.

RESULTS

A total of 33 studies were included in the review (participants n=131 131). The majority of studies found an association between exposure to IPV and the development of signs of postpartum depression. Overall, studies measured both exposure and outcome in various ways and controlled for a vast number of different confounders. Thirty percent of the studies were set in low-income and lower-middle-income countries while the rest were set in upper-middle-income and high-income countries and the association did not differ across settings. Among the studies reporting adjusted OR (aOR) (n=26), the significant aOR ranged between 1.18 and 6.87 (95% CI 1.12 to 11.78). The majority of the studies were judged as 'good quality' (n=20/33).

CONCLUSION

We found evidence of an association between exposure to IPV and the development of signs of postpartum depression. Meta-analysis or individual patient data meta-analysis is required to quantify the magnitude of the association between IPV and postpartum depression.

PROSPERO REGISTRATION NUMBER

CRD42020209435.

Prevalence and Risk Factors Associated With Postpartum Depressive Symptoms Among Women in Vientiane Capital, Lao PDR

Postpartum depression (PPD), the onset of depressive episodes after childbirth, is the most common psychological condition following childbirth, and a global public health concern. If undiagnosed and/or untreated, postpartum depression can have negative effects on maternal and child health, however, there are few studies on the prevalence of postpartum depression in low- and middle-income countries. To contribute to filling this gap, this study examined the prevalence and risk factors associated with postpartum depressive symptoms among women after delivery in Vientiane Capital, Lao PDR. The study was a cross-sectional design, with multistage sampling used to identify women between 4 and 24 weeks after giving birth (N = 521). The Edinburgh Postnatal Depression Scale was used to identify women with postpartum depressive symptoms. Univariate and multivariate logistic regressions identified risk factors associated with postpartum depressive symptoms. The prevalence of postpartum depressive symptoms among participants was 21.3%. Associated factors were having at least 2-3 living children (AOR: 1.9, 95% CI: 1.1-3.0), experiencing mental health problems during pregnancy (AOR: 3.3, 95% CI: 1.4-7.6), experiencing conflicts with family members (AOR: 2.5, 95% CI: 1.5-4.0), the experience of intimate partner violence (AOR: 2.6, 95% CI: 1.3-5.5), and receiving moderate social support (AOR: 5.6, 95% CI: 3.2-10.0). In contexts where access to mental health specialists has severely constrained maternal and child healthcare providers at primary health care must be supported to develop the necessary skills to identify risk factors and symptoms and offer basic essential services for postpartum depressive symptom (PDS). The study identified a high proportion of mothers with postnatal depressive symptoms, highlighting the need to screen and treat mothers who present with PDS, as not doing so exposes mother and their children to a range of negative health and social outcomes. Addressing the stigma associated with mental health illness and mental health illness and domestic violence that prevents women from seeking healthcare, must also be developed, implemented, and evaluated.

Human-Animal Interaction and Perinatal Mental Health: A Narrative Review of Selected Literature and Call for Research

There is a paucity of research exploring how relationships with household pets may impact maternal mental health. We are unaware of any study to date that has examined associations between individuals' relationships with their pets and psychological adjustment in the perinatal period. Using a biobehavioral lens, this paper provides a narrative overview of the literature on perinatal mental health and human-animal interaction (HAI). We focus on the role of social relationships, stress, and stress reduction in relation to perinatal mental health; the role of HAI in perceptions of social support, stressors, and stress reduction; and gaps in empirical knowledge concerning the role of HAI in perinatal mental health. Finally, we integrate contemporary biobehavioral models of perinatal mental health and HAI (i.e., Comprehensive Model of Mental Health during the Perinatal Period and the HAI-HPA Transactional Model) to propose a new conceptual framework that depicts ways in which HAI during the perinatal period may influence maternal and child health and wellbeing. To our knowledge, this is the first paper to consider the role of HAI in biobehavioral responses and mental health during the perinatal period. We conclude with recommendations for future research and improved perinatal care.

The impact of food insecurity on mental health in Africa: A systematic review

In 2018, 676.1 million people in Africa (52.5% of the population) were moderately or severely food insecure. This exceptionally high prevalence continues to increase as Africa experiences conflict, climate change, and economic declines. When Sustainable Development Goal 2.1 set out to end hunger and ensure access to sufficient food, particularly for vulnerable populations, by 2030, food insecurity emerged as a global priority. Food insecurity has been hypothesized to negatively impact mental health, a stigmatized area of health in Africa for which care is often inaccessible. This systematic review examines existing literature on the relationship between food insecurity and mental health in Africa, where progress remains to be made on both fronts. A systematic search of seven databases (EMBASE, Web of Science, CINAHL, PsychINFO ProQuest, Medline Ovid, Scopus, and Nursing and Allied Health) was conducted. Results were limited to studies examining food insecurity and mental health, written in English and published between January 2000 and May 2020. After title, abstract, full-text review, and quality appraisal using tools from the National Heart, Lung, and Blood Institute, 64 studies remained. Findings were summarized using a narrative synthesis approach. Studies unanimously highlighted that food insecurity is associated with poor mental health. This relationship was dose-responsive and independent of the measured mental health outcome. Two highly represented groups in the literature were women around pregnancy and people affected by HIV/AIDS. Factors which mediated the relationship included age, sex, social interactions, physical health, seasonality, and rural residence. The findings suggest that the relationship is likely amplified in specific populations such as women and seniors, and interventions which target livelihood as opposed to income may be more effective. Further research is needed which compares food insecurity's effect on mental health between at-risk populations, in order to guide resource allocation and context-specific policy making.

Psychosocial risk factors for postpartum depression in Chinese women: a meta-analysis

Background

Postpartum depression (PPD) has been identified as a recognized public health problem that may adversely affect mothers, infants, and family units. Recent studies have identified risk factors for PPD in Westerners; however, societal and cultural differences between China and the West could, potentially, lead to differences in risk factors for PPD. No comprehensive study has been conducted to collect all the evidence to provide estimates of psychological and social risk factors in China. Therefore, this study aimed to quantitatively assess all studies meeting the review’s eligibility criteria and identify the psychological and social risk factors for PPD in Chinese women.

Methods

The following databases were used in the literature search from their inception until December 2020: PubMed, Embase, Foreign Medical Literature Retrieval Service (FMRS), China Science and Technology Journal Database (VIP), China National Knowledge Infrastructure (CNKI), and China Biology Medicine disc (CBM). The quality was assessed through Newcastle-Ottawa quality assessment scale. The I²statistic was used to quantify heterogeneity. We extracted data for meta-analysis and generated pooled-effect estimates from a fixed-effects model. Pooled estimates from a random-effects model were also generated if significant heterogeneity was present. Funnel plot asymmetry tests were used to check for publication bias. Statistical analysis was conducted using Review Manager version 5.3 software.

Results

From a total of 1175 identified studies, 51 were included in the analysis. Prenatal depression (OR 7.70; 95% CI 6.02–9.83) and prenatal anxiety (OR 7.07; 95% CI 4.12–12.13) were major risk factors for PPD. A poor economic foundation (OR 3.67; 95% CI 3.07–4.37) and a poor relationship between husband and wife (OR 3.56; 95% CI 2.95–4.28) were moderate risk factors. Minor risk factors included a poor relationship between mother-in-law and daughter-in-law (OR 2.89; 95% CI 2.12–3.95), a lack of social support (OR 2.57; 95% CI 2.32–2.85), unplanned pregnancy (OR 2.55; 95% CI 2.08–3.14), and poor living conditions (OR 2.44; 95% CI 1.92–3.10), mother-in-law as the caregiver (1.95; 95% CI 1.54–2.48) .

Conclusions

This study demonstrated a number of psychological and social risk factors for PPD in Chinese women. The major and moderate risk factors are prenatal depression, prenatal anxiety, a poor economic foundation, and a poor relationship between husband and wife. These findings have potential implications for informing preventive efforts and modifying screening to target at-risk populations.

A community-based cross-sectional study to assess the prevalence of post-partum depression: Why are the mothers depressed?

Introduction:

Post-partum depression can have adverse long term effects. For the mother, the episode can be the precursor of chronic recurrent depression. For her children her on going depression can contribute to emotional, cognitive and interpersonal problems in their later life. In the present study, we aimed to identify the incidence of depression in post-partum period and explore the underlying etiological factors responsible for the same.

Materials and Methods:

A cross sectional study was conducted on 250 post- natal mothers covered under UHTC, Tripuri, Patiala. The data collection was done through one to one interview technique with mental evaluation done by Edinburgh Postnatal Depression Scale instrument. Based upon the results, the cases were classified either as normal or presence of psychiatric morbidity. Psychiatry referral was provided to those requiring it. Association of post-partum depression with various socio-demographic and medical correlates was then sought through statistical analysis.

Results:

Post-partum depression was observed in 82 out of 250 females (32.8%). On univariable analysis family income, illiteracy, history of depression, caesarean section, death in family, were significantly associated with post-partum depression. On multi-variable analysis, poverty, female gender of baby, domestic violence and were observed as true predictors of depression in post-partum period (p<0.05).

Conclusion:

Depression was prevalent among almost one-third of postnatal females. Poverty, Cesarean section, domestic violence and poor spousal support have been identified as major contributors towards psychiatric morbidities. Taking care of these largely modifiable risk factors can prevent development of postpartum depression.

Perinatal mental health in Ireland: A scoping review

BACKGROUND

The international literature clearly indicates that perinatal mental health issues affect many women, and can have profound negative consequences for both the mother, infant and family, and that the causes of perinatal mental health issues are multifaceted and complex.

AIM

This scoping review explores the existing research on perinatal mental health in Ireland to provide a baseline and to guide further research as well as inform the implementation of the recent policy strategies.

DESIGN

Scoping Review METHODS: We conducted a structured literature search on Science Direct, Web of Science, PubMed, PsychInfo and Scopus, using key words to search for publications up to December 2018. All publications based on empirical studies on perinatal mental health in Ireland (regardless of research design, sample size, and methods used) were included. Exclusion criteria were: study location not the Republic of Ireland; not relating to the perinatal period (pregnancy up to the first 12 months after birth); not relating to mental health; and not relating to maternal mental health, not relating to human subjects; not an empirical study; international study with generalised results. Data were mapped onto a charting form, allowing us to a) conduct a basic numerical analysis of prevalent research questions and designs, and b) to identify key themes within the data, utilising Braun and Clarke's (2006) thematic analysis.

RESULTS

The search resulted in 623 unique references. 29 publications were included in this review. Our analysis resulted in three main findings. (1) A significant number of women in Ireland are affected by perinatal mental health problems, but prevalence rates vary significantly between studies. (2) A history of mental health problems and lack of social support were identified as key risk factors. (3) The existing perinatal mental health services in Ireland are generally inadequate. We further noted a focus on quantitative approaches and a medicalisation of perinatal mental health, resulting in an absence of women's voices and their lived experiences, particularly those of women of colour, migrant women and ethnic minorities.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

We conclude that in order to further the vision of woman-centred maternity care, we need to conduct woman-centred research that puts women's subjective experiences of perinatal mental health and well-being at the centre, including those of marginalised women in an increasingly diverse Irish society.

The effect of psychosocial risk factors on postpartum depression in antenatal period: A prospective study

PURPOSE

The aim of this study was to determine the psychosocial risk factors that may increase the risk of developing postpartum depression (PPD) symptoms in the antenatal period at postpartum 6-8 weeks.

METHODS

This study was a prospective longitudinal design, in which women completed questionnaire measures both at the third trimester of pregnancy and 6-8 weeks after birth. The present study was conducted in the women's clinic of a Medical Faculty Hospital in the Central Anatolia region of Turkey between March 15 and August 15, 2019. A total of 245 pregnant women in the third trimester were included in the study. Data were collected using a sociodemographic and obstetric data collection form, Pregnancy Psychosocial Health Assessment Scale, Perceived Stress Scale, Hospital Anxiety and Depression Scale, and Edinburgh Postnatal Depression Scale.

RESULTS

Forty-four (18%) of the 245 women had scores above the cut-off point (>13) in EPDS. Being subjected to violence from husband or another male member of the family during pregnancy, having problems in marriage, depression, anxiety, and high levels of perceived stress affect the risk of developing PPD by 55% (χ² = 101.034, P < 0.001). It was observed that those who scored low on the psychosocial health scale, those who experienced unplanned pregnancy, those with pregnancy that was not wanted by the husband, those who were emotionally abused, and those who experienced a sad event in their families were more sensitive to PPD symptoms.

CONCLUSIONS

Psychosocial health, perceived stress, and psychosocial risk factors, such as depression and anxiety, during pregnancy are important determinants of postpartum depressive symptoms.

The prevalence of domestic violence and its association with family factors: a cross-sectional study among pregnant women in urban communities of Hengyang City, China

BACKGROUND

With the increased vulnerability during pregnancy, domestic violence (DV) is a serious threat to the physical and mental health of pregnant women, making it a significant issue in public health initiatives. In China, family is of great significance to pregnant women, but few scholars have focused specifically on the relationship between the family factors of pregnant women and DV. This study aimed to explore the prevalence and association between family factors and DV among women in late pregnancy, to provide evidence for the prevention of domestic violence during pregnancy.

METHODS

A cross-sectional survey was conducted from July-October, 2019 among pregnant women in urban communities of Hengyang City, Hunan Province, China. A total of 813 participants were included by a multi-staged cluster random sampling method. DV was assessed by the Abuse Assessment Screen Questionnaire (AAS). A multivariate binary logistic regression model was used to evaluate the relationship between family factors and DV.

RESULTS

Ultimately, 127 (15.62%) participants were identified as victims of DV. After adjustment, the potential risk factors of DV were tensions between their mother-in-law and other family members (OR: 2.85; 95% CI: 1.29 to 6.30 and OR: 3.30; 95% CI: 1.57 to 6.93), medium household debt (OR: 2.17; 95% CI: 1.18 to 4.00), middle and low family APGARI (OR: 2.01; 95% CI: 1.30 to 3.13 and OR: 4.01; 95% CI: 2.09 to 7.69).

CONCLUSIONS

In summary, women in late pregnancy were at higher risk of DV in the family with tensions, medium household debt and family dysfunction, which may help medical personnel intervene in cases of domestic violence against pregnant women in a reasonable and timely manner.

Depression and Domestic Violence Experiences Among Asian Women: A Systematic Review

Purpose

To determine the association of postpartum depression with domestic violence experiences among women in Asia.

Background

Postpartum depression (PPD) is an important cause of maternal morbidity as well as mortality. There is increasing evidence that domestic violence (DV) increases the risk of PPD.

Methods

We performed literature searches using the databases PUBMED, SCOPUS, Web of Science and Google Scholar, for studies published between January 2010 and May 2019. The keywords “postpartum”, “postnatal”, “depression”, and “violence” were used. Observational studies conducted within Asia, and written in the English language, were included.

Results

In the 38 studies included in this review (with 37,087 participants), the prevalence of PPD ranged between 8.2% to 70% and that of DV between 6.1% to 67.4%. There were 1.6 to 7.1 higher odds of PPD among sufferers of DV. Intimate partner violence (IPV) was the most relevant factor that women experiencing psychological abuse (which was the most prevalent form of IPV) were more at risk for, and violence/intimidation by other family members was also associated with PPD. Domestic violence increased the risk of suicidal ideation in PPD.

Discussion

The findings of the review unequivocally shows the association between domestic violence and PPD. Maternal mental health is a neglected area of healthcare in many parts of Asia. Likewise, domestic violence is a readily recognized, but inadequately addressed social issue. We recommend that healthcare workers be trained to recognize and support the women who are vulnerable to violence and depression during pregnancy and postpartum. Policies need to be developed at national and global levels to tackle these issues with utmost urgency.

Psychosocial factors correlate with fatigue among pregnant women in Jordan

PURPOSE

The study aimed to assess the correlation between fatigue and psychological factors, namely stress, social support, self-esteem, and depression among pregnant women in Jordan.

DESIGN AND METHODS

A cross-sectional design was suggested. Cluster stratified random sampling technique was adopted. Fatigue assessment scale, Rosenberg Self-Esteem Scale, Perceived Stress Scale, Multidimensional Social Support Scale, and Beck's Depression Inventory were used.

FINDINGS

A total of 580 pregnant women were included. Overall, 67.4% of the participants experienced fatigue, about 74.0% had moderate to high stress, 56.0% had moderate social support, around 89.0% had normal self-esteem, and 43.1% experienced moderate to extreme depression. Stress, self-esteem, and depression were correlated with fatigue.

PRACTICE IMPLICATIONS

This study can help develop proper psychosocial care and sustain mental health among women during pregnancy.

The association of intimate partner violence with postpartum depression in women during their first month period of giving delivery in health centers at Dessie town, 2019

BACKGROUND

Postpartum depression is a common psychiatric complaint of women following delivery and a multitude of psychosocial, maternal, newborn and husband-related factors were contributing to it. This condition has a detrimental impact on the mother-infant caregiving relationship and hastens the infant's cognitive, emotional and social development. However, a shortage of empirical evidence existed especially in developing countries including Ethiopia. Therefore, we implemented this study to determine the magnitude of postpartum depression and its correlates.

METHODS

A cross-sectional survey was implemented on 378 postnatal women in the maternal and child health clinic of Dessie health centers within 4 weeks of their delivery. Postpartum depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS). Intimate partner violence was operationalized as a psychological, physical and sexual abusive action imposed on women by their associates. We estimated the crude and adjusted odds ratio with its 95% CI using binary logistic regression to know the association and statistical significance was declared using a p-value < 0.05.

RESULTS

More than one-fourth, 102 (27%) (95% CI 22.5, 31.5) of participants were obtained to have postpartum depression. Being single from socio-demographic variables (AOR = 4.9, 95% CI 1.27, 16.74), dissatisfaction with child gender (AOR = 3.1, 95% CI 1.62, 6.69), unplanned pregnancy (AOR = 2.5, 95% CI 1.76, 7.23) and depression during current pregnancy (AOR = 3.2, 95% CI 2.81, 8.91) from pregnancy and newborn-related variables, intimate partner violence; psychological (AOR = 6.5, 95% CI 1.98, 15.85), sexual and physical violence (AOR = 3.46, 95%CI 2.34, 18.55), current husbands alcoholism (AOR = 2.2, 95% CI 1.48, 5.34) from husband/partner-related variables and current substance use (AOR = 1.8, 95% CI 1.16, 3.75) were found to have a statistically significant association with postpartum depression.

CONCLUSION

More than one-fourth of the interviewed women (27%) were found to have postpartum depression. Being single from socio-demographic variables, dissatisfaction with child gender, unplanned pregnancy, and depression during current pregnancy from pregnancy and newborn-related variables, intimate partner violence, and current husband's alcoholism from husband/partner-related variables and current substance use were the related factors. This suggests the need for integrating postpartum depression services into the existing postnatal maternal and child health services and basing intervention geared primarily to the mentioned factors above.

Association of intimate partner violence during pregnancy, prenatal depression, and adverse birth outcomes in Wuhan, China

Background

Intimate partner violence (IPV) among pregnant women constitutes a global public health problem and a potential risk factor for adverse maternal and fetal outcomes. The present study aimed to examine the associations among IPV during pregnancy, prenatal depression, and adverse birth outcomes in Wuhan, China.

Methods

A cross-sectional study was performed from April 2013 to March 2014 in Wuhan, China. Sociodemographic characteristics, IPV during pregnancy, and depressive symptoms during pregnancy were assessed in the third trimester of pregnancy. Birth outcomes were collected after delivery using medical records. Chi-square tests and logistic regression analysis were used to examine the association between IPV and prenatal depression, as well as the association between IPV combined with prenatal depression and adverse birth outcomes.

Results

After adjustment for covariates, there was a statistically significant association between IPV during pregnancy and prenatal depression (adjusted odds ratio [aOR] = 2.50, 95% confidence interval [CI]: 1.60–3.90). IPV during pregnancy (aOR = 1.67, 95% CI: 1.08–2.56) and prenatal depression (aOR = 1.72, 95% CI: 1.11–2.68) were significantly associated with adverse birth outcomes. Women experiencing psychological abuse had a significantly higher odds of prenatal depression (aOR = 2.04, 95% CI: 1.19–3.49) and of adverse birth outcomes (aOR = 2.13, 95% CI: 1.08–2.58), compared with women who did not experience IPV and prenatal depression.

Conclusions

IPV during pregnancy and prenatal depression were significantly associated with adverse birth outcomes, after adjustment for socio-demographic and behavior factors. The findings suggest that early recognition of IPV and prenatal depression during antenatal care may protect pregnant women and improve birth outcomes.

Emotional violence exerted by intimate partners and postnatal depressive symptoms among women in Vietnam: A prospective cohort study

BACKGROUND

Previous studies have shown a relation between intimate partner violence (IPV) and postpartum depression (PPD). However, these studies have primarily focused on physical and sexual violence as predictors for postpartum depression and little attention has been given to emotional violence (EV), despite emotional violence having been well reported as the most common type of violence experienced by women. This present study aimed to investigate the association between various types of emotional experience during life with present partner and postnatal depressive symptoms among women in Vietnam.

METHODS

A total of 1,274 pregnant women were recruited from 24 communities in the Dong Anh District, Hanoi, Vietnam. They were interviewed four times: (a) at enrolment (before week 24 of pregnancy); (b) at a gestational age of 30-34 weeks; (c) 24-48 hours after delivery; and (d) 4-12 weeks after delivery. Emotional violence and postnatal depressive symptoms were measured using a questionnaire developed by the World Health Organization (WHO) and the Edinburgh Postpartum Depression Scale (EPDS), respectively.

RESULTS

A total of 639 (50.4%) women experienced at least one type of emotional violence with their present partner, whereas 104 women (8.2%) experienced postnatal depressive symptoms. Women exposed to emotional violence were more likely to experience postnatal depressive symptoms (OR = 3.15; 95%CI: 1.17-8.51). Other statistically significant predictors of increased postnatal depressive symptoms included type of employment, lack of family support after delivery, lower level of education, husband's preference for a specific sex of child, presence of mental disorder, and depression during pregnancy.

CONCLUSIONS

Among Vietnamese women, there was a statistically significant association between exposure to emotional violence with their present partner and postpartum depression. The findings indicate an urgent need for screening for all acts of emotional violence as risk factors for postnatal depressive symptoms.

Domestic Violence as a Risk Factor for Postpartum Depression Among Ethiopian Women: Facility Based Study

BACKGROUND

Mental illness in women leads to an increased maternal morbidity and mortality. Postpartum depression accommodates various groups of depressive disorders and syndromes that occur within the first immediate year after delivery. Thus, this study aimed to assess the prevalence of postpartum depression symptoms and correlates among mothers attending public health centers of Addis Ababa, Ethiopia.

METHODS

Facility-based cross-sectional study was conducted on 618 women in their postpartum period. Simple random sampling technique was used to select three out of ten sub cities in Addis Ababa. Then, nine health centers were selected by lottery method from the three sub-cities. The number of women included from each health center was determined by proportional allocation. Study participants were enrolled by systematic random sampling. The Edinburgh Postnatal Depression Scale was used at a cutoff point >13 to detect depression. Descriptive statistics were done. The bivariate and multivariate analysis was also carried out to identify predictors of postpartum depression.

RESULTS

Significant proportion 144 (23.3%) of the women had the symptom of postpartum depression. Respondents who were the victims of domestic violence [AOR 3.1; 95% CI: 1.6-5.9], reported to have diagnosed with postpartum depression [AOR 4.41; 95% CI: 2.4-8.3], and dissatisfied with their marriage [AOR 2.9; 95% CI: 1.5-5.6] had higher odds of reporting postpartum depression symptoms.

CONCLUSION

Postpartum depression is a common mental health problem during the postnatal period. Domestic violence was positively and significantly associated with the symptom of postpartum depression. Maternity services shall consider a sector that provides health care for women who encounter violence and develop symptoms of postpartum depression.

Postnatal depression and intimate partner violence: a nationwide clinic-based cross-sectional study in Malaysia

INTRODUCTION

An estimated 13% of women in the postnatal period suffer from postnatal depression (PND) worldwide. In addition to underprivileged women, women who are exposed to violence are at higher risk of PND. This study aimed to investigate the relationship between intimate partner violence (IPV) and PND in Malaysia.

METHODS

This survey was conducted as a nationwide cross-sectional study using a cluster sampling design. Probable PND was assessed using a self-administered Edinburgh Postnatal Depression Scale (EPDS). Demographic profiles and IPV were assessed using a locally validated WHO Multicountry Study on Women's Health and Life Events Questionnaire that was administered in a face-to-face interview. An EPDS total score of 12 or more and/or a positive tendency to self-harm were used to define PND.

RESULTS

Out of 6669 women, 5727 respondents were successfully interviewed with a response rate of 85.9%. The prevalence of probable PND was 4.4% (95% CI 2.9 to 6.7). The overall prevalence of IPV was 4.9% (95% CI 3.8 to 6.4). Among the women in this group, 3.7% (95% CI 2.7 to 5.0), 2.6% (95% CI 1.9 to 3.5) and 1.2% (95% CI 0.9 to 1.7) experienced emotional, physical and sexual violence, respectively. Logistic regression analysis revealed that women who were exposed to IPV were at 2.3 times the risk for probable PND, with an adjusted OR (aOR) of 2.34 (95% CI 1.12 to 4.87). Other factors for PND were reported emotional violence (aOR 3.79, 95% CI 1.93 to 7.45), unplanned pregnancy (aOR 3.32, 95% CI 2.35 to 4.69), lack of family support during confinement (aOR 1.79, 95% CI 1.12 to 2.87), partner's use of alcohol (aOR 1.59, 95% CI 1.07 to 2.35) or being from a household with a low income (aOR 2.99; 95% CI 1.63 to 5.49).

CONCLUSIONS

Exposure to IPV was significantly associated with probable PND. Healthcare personnel should be trained to detect and manage both problems. An appropriate referral system and support should be made available.

Intimate Partner Violence during Pregnancy and Postpartum Depression in Japan: A Cross-sectional Study

Background

The impact of intimate partner violence (IPV) on postpartum depression (PPD) has been reported in various countries by many studies. However, the association between IPV and PPD in Japan has been scarce. In addition to the limited number of research on the relationship between IPV and PPD, the number of women seeking help from IPV support centers has been steadily increasing in Japan. Hence, it is of interest to explore the relationship between IPV during pregnancy and PPD in Japan.

Methods

Four-page questionnaires assessing sociodemographic characteristics, women’s personal situation during pregnancy, and PPD were mailed to participants prior to the checkup and collected at the checkup sites or mailed back to the health center. Of 9,707 eligible mothers, 6,590 responded to a questionnaire at a 3- or 4-month infant health checkup (response rate: 68%). Verbal and physical IPV from partners was assessed with two questions in the questionnaire. Logistic regression analysis was conducted. PPD was evaluated using the Edinburgh Postnatal Depression Scale (EPDS) with a cutoff score of 8/9.

Results

Partners’ verbal and physical abuse during pregnancy was significantly associated with PPD after adjusting for possible confounders. Specifically, odds ratios (ORs) of PPD for women who had been verbally abused by their partners during pregnancy at a frequency of “often” were 4.85 (95% CI, 2.23–10.55). ORs of PPD among women who had been physically abused by their partners during pregnancy at a frequency of “sometimes or often” were 7.05 (95% CI, 2.76–17.98). A positive dose-response relationship between both types of IPV and PPD was statistically significant (both p < 0.001). In addition, about 80% of physically abused women reported being verbally abused as well, indicating that these forms of IPV were highly comorbid.

Conclusion

Both verbal and physical IPV during pregnancy is associated with PPD in Japan. This is the first study investigating the impact of IPV on PPD using a large number of subjects in the country. Further study using the same participants of the current study would allow us to explore the causality between IPV during pregnancy and PPD.

Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries

Maternal depression, a non-psychotic depressive episode of mild to major severity, is one of the major contributors of pregnancy-related morbidity and mortality. Maternal depression (antepartum or post partum) has been linked to negative health-related behaviours and adverse outcomes, including psychological and developmental disturbances in infants, children, and adolescents. Despite its enormous burden, maternal depression in low-income and middle-income countries remains under-recognised and undertreated. In this Series paper, we systematically review studies that focus on the epidemiology of perinatal depression (ie, during antepartum and post-partum periods) among women residing in low-income and middle-income countries. We also summarise evidence for the association of perinatal depression with infant and childhood outcomes. This review is intended to summarise findings from the existing literature, identify important knowledge gaps, and set the research agenda for creating new generalisable knowledge pertinent to increasing our understanding of the prevalence, determinants, and infant and childhood health outcomes associated with perinatal depression. This review is also intended to set the stage for subsequent work aimed at reinforcing and accelerating investments toward providing services to manage maternal depression in low-income and middle-income countries.

Domestic violence against women as a risk factor for depressive and anxiety disorders: findings from domestic violence household survey in Tehran, Iran

Domestic violence (DV) especially intimate partner violence is a global health problem responsible for significant part of burden of diseases in women. Mental health problems such as depression and anxiety are possibly results and resulted in IPV. To investigate correlation between IPV and depression and anxiety among married women, in a household survey of married women in Tehran, Iran, at summer 2011, we recruited 615 samples with cluster sampling method and they are directly asked about experience of 23 different types of physical and non-physical IPV during marital life and last 12 months. Depression and anxiety were assessed by Beck depression inventory II (BDI) and Beck Anxiety inventory (BAI). Multinominal regression model was used to assess the independent relationship of factor on IPV. Mean (±SE) age and duration of marriage were 42.6 ± 0.9 and 22 ± 0.8, respectively. Non-physical violence and physical violence during marital life reported in 77.2 and 35.1 %. Clinically significant depression and anxiety was reported in 15.3 and 32.7 % of women, respectively. The odds ratio (95 % CI) of clinically significant depression and anxiety in DV victims were 5.8 (2.3-14.6) and 2.6 (1.6-4.3). DV as a social factor is significantly correlated factor with depression and anxiety. Comprehensive view and collaborative work to detect and address social determinants of mental illness like DV is a crucial point in mental health promotion programs.

Associations between intimate partner violence (IPV) during pregnancy, mother-to-infant bonding failure, and postnatal depressive symptoms

This study examined the associations between intimate partner violence (IPV) during pregnancy, mother-to-infant bonding failure, and postnatal depressive symptoms at 1 month postnatal. This study also examined if these relationships would be mediated by antenatal depressive symptoms. This study was a prospective cohort study that investigated effects between the third trimester of pregnancy and 1 month after childbirth. The Japanese version of the Index of Spouse Abuse (ISA), the Japanese version of the Mother-Infant Bonding Scale (MIBS), and the Japanese version of the Hospital Anxiety and Depression Scale (HADS) were used to measure IPV during pregnancy, bonding failure with infants, and depressive symptoms during pregnancy and the postnatal period respectively. Structural equation modeling (SEM) was used to find the associations between those four variables. The final path model of the SEM showed good fit with the data. IPV during pregnancy was associated with mother-to-infant bonding failure at 1 month postnatal, whereas IPV during pregnancy was not significantly associated with postnatal depressive symptoms at 1 month postnatal. In addition, this study demonstrated that the associations between IPV during pregnancy, mother-to-infant bonding failure, and postnatal depressive symptoms at 1 month postnatal were mediated by antenatal depressive symptoms. The results of this study indicated the need for interventions for IPV and psychological health care for abused pregnant women to prevent antenatal depressive symptoms in prenatal health settings. Those interventions by perinatal health professionals would help to prevent bonding failure with infants and postnatal depressive symptoms after childbirth.

Sociodemographic and clinical features of postpartum depression among Turkish women: a prospective study

BACKGROUND

Postpartum depression (PPD) is moderate to severe depression in a woman after she has given birth. Findings from several well-designed studies reflect great variability in rates, from 10 to 22%, and also in risk factors for PPD. This variability may reflect geographical location. The incidence and risk factors for PPD among Turkish women are not well documented. It is, however, important to understand the risk factors to develop preventive intervention strategies. This study aims to examine the prevalence of PPD and associated risk factors among a sample of women receiving services at a tertiary obstetrics hospital in Ankara, Turkey.

METHODS

A sample of 671 women, between 36 and 40 gestational weeks, were enrolled and screened for depressive symptomatology using the Hospital Depression Inventory. Sociodemographic and clinical data were also collected. At a subsequent postpartum evaluation, 6-8 weeks post-delivery, 540 of the 671 were screened using the Edinburgh Postnatal Depression Scale (EPDS) for PPD.

RESULTS

Eighty-three (15.4%) of the 540 women had scores above the cutoff point (>13) on the EPDS. Statistically significant correlations were found between antenatal, prenatal and postpartum depression scores (r = 0.24). Women reporting suicidal thoughts during pregnancy (OR: 6.99), history of past PPD (OR: 6.64), physical violence during pregnancy (OR: 6.20) or during the postpartum period (OR: 5.87), previous psychiatric history (OR: 4.16), depressive symptoms during pregnancy (OR: 1.70), subjectively lower level of satisfaction with the pregnancy (OR:0. 69), a history of premenstrual syndrome (PMS) (OR: 2.05), and unplanned pregnancy (OR: 1.69) had higher odds for developing PPD.

CONCLUSION

One in six mothers screened as positive for PPD. Women who had previously been diagnosed with PPD, reported suicidal thoughts during pregnancy, or had been exposed to physical violence were at especially high risk for postpartum depression. To prevent and treat postpartum depression, special attention should be paid to women reporting these characteristics.

Depressive disorder in pregnant Latin women: does intimate partner violence matter?

AIMS AND OBJECTIVES

To identify the association of antenatal depressive symptoms with intimate partner violence during the current pregnancy in Brazilian women.

BACKGROUND

Intimate partner violence is an important risk factor for antenatal depression. To the authors' knowledge, there has been no study to date that assessed the association between intimate partner violence during pregnancy and antenatal depressive symptoms among Brazilian women.

DESIGN

Cross-sectional study.

METHODS

Three hundred and fifty-eight pregnant women were enrolled in the study. The Edinburgh Postnatal Depression Scale and an adapted version of the instrument used in the World Health Organization Multi-country Study on Women's Health and Domestic Violence were used to measure antenatal depressive symptoms and psychological, physical and sexual acts of intimate partner violence during the current pregnancy respectively. Multiple logistic regression and multiple linear regression were used for data analysis.

RESULTS

The prevalence of antenatal depressive symptoms, as determined by the cut-off score of 12 in the Edinburgh Postnatal Depression Scale, was 28·2% (101). Of the participants, 63 (17·6%) reported some type of intimate partner violence during pregnancy. Among them, 60 (95·2%) reported suffering psychological violence, 23 (36·5%) physical violence and one (1·6%) sexual violence. Multiple logistic regression and multiple linear regression indicated that antenatal depressive symptoms are extremely associated with intimate partner violence during pregnancy.

CONCLUSION

Among Brazilian women, exposure to intimate partner violence during pregnancy increases the chances of experiencing antenatal depressive symptoms.

RELEVANCE TO CLINICAL PRACTICE

Clinical nurses and nurses midwifes should pay attention to the particularities of Brazilian women, especially with regard to the occurrence of intimate partner violence, whose impacts on the mental health of this population are extremely significant, both during the gestational period and postpartum.

Antenatal and postnatal depression: A public health perspective

Depression is widely prevalent among women in the child-bearing age, especially during the antenatal and postnatal period. Globally, post-partum depression has been reported in almost 10% to 20% of mothers, and it can start from the moment of birth, or may result from depression evolving continuously since pregnancy. The presence of depression among women has gained a lot of attention not only because of the rising incidence or worldwide distribution, but also because of the serious negative impact on personal, family and child developmental outcomes. Realizing the importance of maternal depression on different aspects-personal, child, and familial life, there is a crucial need to design a comprehensive public health policy (including a mental health strategy), to ensure that universal psychosocial assessment in perinatal women is undertaken within the primary health care system. To conclude, depression during pregnancy and in the postnatal period is a serious public health issue, which essentially requires continuous health sector support to eventually benefit not only the woman, but also the family, the community, and health care professionals.

Perceived Social Support and Stress among Pregnant Women at Health Centers of Iran- Tabriz

INTRODUCTION

Social support is considered the interaction between the person and environment, which reduces stressors, covers the effects of stress and consequently protects individuals from the harmful effects of stressful situations. This study aimed to determine social support in pregnant women and its relationship with the rate of pregnant women's perceived stress at health centers of Tabriz in 2012-13.

METHODS

This cross-sectional study was carried out on 450 pregnant women selected through cluster sampling. Data collection tools consisted of a demographic questionnaire, interpersonal support evaluation list (ISEL) and perceived stress questionnaire (PSS) that were completed in an interview. The range of obtainable score for social support and perceived stress was 0-90 and 0-30, respectively. Descriptive and analytical statistics including Pearson and Independent t-test were used for analyzing the data.

RESULTS

The mean score of social support and perceived stress in pregnant women was 96.6 (14.6), and 11.5 (5.5), respectively .The women with favorable social support had significantly less stress than the women with unfavorable social support.

CONCLUSION

The study finding showed that the rate of social support in highly stressful women is significantly less than low-stress mothers. Therefore, considering adverse effects of the stress on pregnancy outcomes, some strategies should be designed and implemented in order to strengthen and improve the social support for pregnant women so that it can reduce the rate of pregnant women's stress.

A comparative study of the prevalence of domestic violence in women requesting a termination of pregnancy and those attending the antenatal clinic

OBJECTIVE

To compare the prevalence of domestic violence (DV) in women requesting antenatal care (ANC) and termination of pregnancy (TOP) in North East England.

DESIGN

This was a cross-sectional comparative prevalence study using self-administered questionnaires, with women selected as opportunistic samples over a concurrent period.

SETTING

The participants were screened anonymously and confidentially in the ANC and TOP clinics.

SAMPLE

Pregnant women in the first trimester requesting a TOP or ANC.

METHODS

The participants were screened for a history of DV using a modified version of the Abuse Assessment Screening tool.

MAIN OUTCOME MEASURES

Prevalence of DV between ANC and TOP populations, and any differences in the characteristics of the women, such as age, level of education, or marital status. We aimed to determine the reasons for requesting a TOP.

RESULTS

There were 507 respondents, with 233 attending ANC and 274 requesting a TOP. Of the ANC population, 219 completed the questionnaire. In the TOP population, all the questionnaires were fully or partially completed. Women requesting a TOP were six times as likely to suffer physical abuse in the current relationship (5.8 versus 0.9%; χ(2) = 10.2 (2); P < 0.05), and were five times as likely to suffer emotional abuse (9.9 versus 1.8%; χ(2) = 13.6 (2); P < 0.0001), than those attending ANC. Of the 274 women requesting a TOP, only ten mentioned DV as a contributing factor.

CONCLUSIONS

There is a higher prevalence of DV in the TOP population than in the ANC population, but very few women stated that DV influenced their request for a TOP.

Decrease in domestic violence during pregnancy: a study from Turkey

Our aim is to evaluate the prevalence of domestic violence (DV) among pregnant women and find out whether several factors were associated with DV or not. A total of 317 pregnant women applied at Sanliurfa Obstetrics Hospital and Harran University obstetrics and gynecology department outpatient clinic were interviewed using the modified form of Abuse Assessment Screen questionnaire. Several clinical and sociodemographic data were also obtained from the participants. Mean pregnancy number per woman (gravida) was 3.62 ± 0.13. 47.3% of women had experienced DV before pregnancy. However, the rate of DV exposure significantly decreased to 10.3% during pregnancy (p < .001). Participants with positive family history of DV (mother's exposure) had significantly higher DV rates (p < .001). Those who were exposed to DV, visited their parents less (p = .002). The mean body mass index of DV exposed women was significantly lower (p = .011) than non-DV exposed women. DV exposed women had fewer social interactions and their weight gain may affected by violence. Pregnancy appears to decrease DV in Sanliurfa.

The association of unwanted pregnancy and social support with depressive symptoms in pregnancy: evidence from rural Southwestern Ethiopia

BACKGROUND

Depression in pregnancy has adverse health outcomes for mothers and children. The magnitude and risk factors of maternal depression during pregnancy is less known in developing countries. This study examines the association between pregnancy intention, social support and depressive symptoms in pregnancy in Ethiopia.

METHODS

Data for this study comes from a baseline survey conducted as part of a community- based cohort study that involved 627 pregnant women from a Demographic Surveillance Site (DSS) in Southwestern Ethiopia. The Edinburgh Postnatal Depression Scale (EPDS) was used to measure depressive symptoms during pregnancy. Data on depressive symptoms, pregnancy intention, social support and other explanatory variables were gathered using an interviewer-administered structured questionnaire. The association between independent variables and depressive symptom during pregnancy was assessed using multivariable logistic regression.

RESULTS

The prevalence of depressive symptoms during pregnancy was 19.9% (95% CI, 16.8-23.1), using EPDS cut off point of 13 and above. The mean score on the EPDS was 8, ranging from 0 to 25 (SD ±5.4). Women reporting that the pregnancy was unwanted were almost twice as likely to experience depressive symptoms compared with women with a wanted pregnancy. (Adjusted Odds Ratio (AOR) = 1.96, 95% Confidence Interval (CI) 1.04-3.69) Women who reported moderate (AOR = 0.27; 95% CI 0.14-0.53) and high (AOR = 0.23, 95% CI 0.11-0.47) social support during pregnancy were significantly less likely to report depressive symptoms. Women who experienced household food insecurity and intimate partner physical violence during pregnancy were also more likely to report depressive symptoms.

CONCLUSION

About one in five pregnant women in the study area reported symptoms of depression. While unwanted pregnancy increases women's risk of depression, increased social support plays a buffering role from depression. Thus, identifying women's pregnancy intention and the extent of social support they receive during antenatal care visits is needed to provide appropriate counseling and improve women's mental health during pregnancy.

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.