Pregnancy was once considered to be a “protected time” for women, but now research is revealing how pregnant and newly delivered moms are at risk for depression, violence and worse.
By Stephanie Soucheray
A new study from researchers at NC State University shows just how harmful domestic abuse can be for pregnant and postpartum women.
In a survey of 100 women who responded to ads posted in YMCAs, yoga studios and doctors’ offices, 70 percent reported experiencing abuse (physical, emotion or sexual) from their partner in pregnancy, while 61 percent had symptoms of perinatal mood disorders. Forty-seven reported symptoms at “clinical” levels, which means symptoms were of moderate severity, meaning psychiatric medications, counseling or a combination of both would be recommended.
The paper, titled “Intimate partner abuse before and during pregnancy as risk factors for postpartum mental health problems,” is published online in the open-access journal BMC Pregnancy and Childbirth.
“This response is pretty alarming,” said Sarah Desmarais, one of the lead authors of the paper and an assistant professor of psychology at N.C. State. “Eighty-four percent of participants said they experienced intimate-partner abuse before they got pregnant.
“Pregnancy is usually seen as a respite in abusive relationships, but this survey offers another take.”
Desmarais said that any abuse was associated with higher rates of perinatal mood disorders, and that certain types of abuse were associated with different mental health disorders. Physical abuse, for example, was correlated with post-traumatic stress disorder, while sexual abuse was linked to depression. Marital status, education and poor socioeconomic levels all were correlated with higher rates of abuse.
Fifty years ago, doctors thought that pregnancy and the postpartum period were protected times, when elevated levels of estrogen defended against depression. Now depression, anxiety, obsessive-compulsive disorder and post-traumatic stress disorder are known to be among the most common afflictions of the perinatal period. Many estimates suggest that 20 percent of women will experience a perinatal mood disorder in her lifetime.
Dramatic hormonal fluctuations in the gestational and postpartum period play a role, but clinicians have long hypothesized that social and environmental stressors can prime some women for perinatal mood disorders.
“We found that women who suffered previous abuse were much more likely to experience a perinatal mood disorder,” said Desmarais, who noted that the closer the abuse was to the pregnancy, the more likely the woman suffered from a mood disorder.
“I think that [postpartum depression] is linked with all kinds of abuse and trauma in the relationship,” said Edith Gettes, a psychiatrist specializing in women’s mood disorders who practices at the UNC Center for Women’s Mood Disorders. “It certainly seems they are at a higher risk for PPD.”
Although abuse is highly correlated to postpartum mood disorders, women are not currently screened for abuse at their six-week postpartum check-up, when tests like the Edinburgh Postnatal Depression Scale help providers screen for depression and anxiety. Gettes said she currently asks her patients if they feel supported by their partner or in their home, but doesn’t explicitly ask about abuse.
Desmarais said one of the goals of her study was to push for better and more thorough screening of pregnant and postpartum women, and to open up the definition of “abuse.”
“We included psychological and sexual abuse, and that could mean being coerced into a sexual situation you don’t want,” she said.
Desmarais also said the women who participated in the study answered an advertisement to participate in a wellness survey; neither postpartum mood disorders nor domestic abuse were mentioned in the fliers.
“This was not a clinically based population at high risk for abuse or perinatal mood disorders,” she said. “That’s what’s really surprising.”
Last month, state attorney general Roy Cooper announced that there were 108 North Carolinians killed in acts of domestic violence in 2013. That’s 14 fewer than in 2012.
Guilford County had the most domestic violence killings, with 11.
States and counties keep track of domestic-violence murders, but abuse is notoriously hard to monitor, said Dana Mangum, interim executive director of the North Carolina Coalition Against Domestic Violence. Many incidents are underreported, and Desmarais’ study included a broad definition of abuse, not just physical violence.
Moreover, Mangum said her coalition does not track the number of pregnant women seeking services in the state.
But she said that there is a push for more health care providers to screen for domestic abuse during the perinatal period.
“The Affordable Care Act has a mandate for health care professionals to do domestic-abuse screening,” said Mangum. “That’s a huge open door to address this issue through health care providers.”