TY - JOUR

T1 - Postpartum depression among women who have experienced intimate partner violence

T2 - A prospective cohort study at Moshi, Tanzania

AU - Rogathi, Jane J.

AU - Manongi, Rachael

AU - Mushi, Declare

AU - Rasch, Vibeke

AU - Sigalla, Geofrey N

AU - Gammeltoft, Tine

AU - Meyrowitsch, Dan W.

N1 - Copyright © 2017 Elsevier B.V. All rights reserved.

PY - 2017/8/15

Y1 - 2017/8/15

N2 - BACKGROUND: Post-partum depression (PPD) in many low-income countries, including Tanzania, is not well recognized, and the underlying predictors and causes of PPD remain unclear. Results from previous studies suggest that PPD is associated with intimate partner violence (IPV) experienced during the perinatal period. In the present study, we assessed the relationship between IPV and PPD among women attending antenatal services in Tanzania.METHODS: We conducted a prospective cohort study from March 1, 2014 to May 30, 2015, in Kilimanjaro Region, Tanzania, among pregnant women of less than 24 weeks gestation attending antenatal clinics in two primary level health facilities. Women were interviewed at four time points: 1) Socio-demographic and reproductive health characteristics were assessed at recruitment; 2) At 34 weeks gestational age we screened for depression using the Edinburgh Postpartum Depression Scale (EPDS) and self-reported IPV experiences were assessed using structured questions adopted from the WHO's Multi-country Study on Women's Health and Domestic Violence; 3) Assessment for postpartum depression using EPDS was repeated at 40 days post-partum. Data were analyzed using bivariate and multivariate analyses.RESULTS: A total of 1013 women were interviewed, of whom 304 (30.0%) reported being exposed to at least one type of IPV during their pregnancy and 122 (12.0%) had EPDS scores of 13 and more. Exposure to at least one type of IPV increased the odds of PPD more than three times (AOR=3.10; 95% CI: 2.04-4.40) as compared to those women who were not exposed to IPV during their pregnancy. Stratified analyses showed that this risk of PPD was highest among younger women (aged 18-24 years) who were exposed to physical violence (AOR=3.75; 95% CI: 1.21-11.67). Among women exposed to emotional violence, women with no previous history of depression were also at higher risk of developing postpartum depression as compared to women who were having previous history of depression (AOR=2.79; 95% CI: 1.76-4.42) and (AOR=0.89; 95% CI: 0.38-2.08).CONCLUSIONS: One out of every three pregnant women in the study population was exposed to IPV during pregnancy and these events were strongly associated with development of postpartum depression. Younger women and women with no prior history of depression were specifically prone to develop PPD when being exposed to IPV. These findings should help to inform targeted screening for PPD in the postnatal setting in Tanzania and other low-income countries in order to minimize complications suffered by mothers and their babies.

AB - BACKGROUND: Post-partum depression (PPD) in many low-income countries, including Tanzania, is not well recognized, and the underlying predictors and causes of PPD remain unclear. Results from previous studies suggest that PPD is associated with intimate partner violence (IPV) experienced during the perinatal period. In the present study, we assessed the relationship between IPV and PPD among women attending antenatal services in Tanzania.METHODS: We conducted a prospective cohort study from March 1, 2014 to May 30, 2015, in Kilimanjaro Region, Tanzania, among pregnant women of less than 24 weeks gestation attending antenatal clinics in two primary level health facilities. Women were interviewed at four time points: 1) Socio-demographic and reproductive health characteristics were assessed at recruitment; 2) At 34 weeks gestational age we screened for depression using the Edinburgh Postpartum Depression Scale (EPDS) and self-reported IPV experiences were assessed using structured questions adopted from the WHO's Multi-country Study on Women's Health and Domestic Violence; 3) Assessment for postpartum depression using EPDS was repeated at 40 days post-partum. Data were analyzed using bivariate and multivariate analyses.RESULTS: A total of 1013 women were interviewed, of whom 304 (30.0%) reported being exposed to at least one type of IPV during their pregnancy and 122 (12.0%) had EPDS scores of 13 and more. Exposure to at least one type of IPV increased the odds of PPD more than three times (AOR=3.10; 95% CI: 2.04-4.40) as compared to those women who were not exposed to IPV during their pregnancy. Stratified analyses showed that this risk of PPD was highest among younger women (aged 18-24 years) who were exposed to physical violence (AOR=3.75; 95% CI: 1.21-11.67). Among women exposed to emotional violence, women with no previous history of depression were also at higher risk of developing postpartum depression as compared to women who were having previous history of depression (AOR=2.79; 95% CI: 1.76-4.42) and (AOR=0.89; 95% CI: 0.38-2.08).CONCLUSIONS: One out of every three pregnant women in the study population was exposed to IPV during pregnancy and these events were strongly associated with development of postpartum depression. Younger women and women with no prior history of depression were specifically prone to develop PPD when being exposed to IPV. These findings should help to inform targeted screening for PPD in the postnatal setting in Tanzania and other low-income countries in order to minimize complications suffered by mothers and their babies.

KW - Adolescent

KW - Adult

KW - Depression, Postpartum

KW - Emotions

KW - Female

KW - Gestational Age

KW - Humans

KW - Intimate Partner Violence

KW - Multivariate Analysis

KW - Poverty

KW - Pregnancy

KW - Pregnancy Trimester, Third

KW - Prenatal Care

KW - Prospective Studies

KW - Psychiatric Status Rating Scales

KW - Tanzania

KW - Young Adult

KW - Journal Article

U2 - 10.1016/j.jad.2017.04.063

DO - 10.1016/j.jad.2017.04.063

M3 - Journal article

C2 - 28477502

VL - 218

SP - 238

EP - 245

JO - Journal of Affective Disorders

JF - Journal of Affective Disorders

SN - 0165-0327

ER -