Domestic violence in pregnancy is linked to depression and childhood behavioural problems, suggests new research published today in BJOG: An International Journal of Obstetrics and Gynaecology.
Domestic violence has significant health consequences and it is estimated that around 24% of women have suffered from it. In particular, abuse during pregnancy can increase the risk of complications such as pre-term labour, reduced birth weight, miscarriage and fetal death.
This study looked at the long term impact of antenatal domestic violence on maternal psychiatric morbidity and child behaviour.
The study involved 13,617 women. Antenatal domestic violence was assessed at 18 weeks gestation. Participants were asked two questions on whether their partner had been emotionally cruel and/or physically hurt them since the start of the pregnancy. Similar questions were used to identify postnatal domestic violence at 2, 8, 21 and 33 months.
Maternal depressive symptoms were assessed at the same time as antenatal and postnatal domestic violence using the Edinburgh Postnatal Depression Scale (EPDS).
The results estimated that 6% of women experienced emotional cruelty, 2% reported physical cruelty and a total of 7% reported emotional and/or physical violence at 18 weeks gestation.
After the child has been born, rates increased to 14% of women experiencing domestic violence at 33 months.
Antenatal domestic violence was found to be linked to high levels of antenatal and postnatal depressive symptoms.
At 18 weeks gestation 15% of women had an EPDS score of ≥13, which means high levels of depressive symptoms. Of those who had experienced antenatal domestic violence 44% of women had probable depression compared with 12% of women who had not experienced antenatal domestic violence.
In addition, 25% of women who had experienced antenatal violence experienced probable depression at 8 weeks postnatally, compared with 10% of women who had no experience of antenatal domestic violence.
A strong link was found between antenatal violence and violence post-birth: 71% of women who experienced antenatal domestic violence pregnancy also experienced violence postnatally.
The study also found that women who had experienced antenatal violence were more likely to have children with behavioural problems.
Child behavioural problems were recorded at 42 months of age looking at factors such as hyperactivity, emotion, and conduct problems.
Antenatal violence was more commonly reported in the mothers of children with behavioural problems at 42 months (11%) compared with mothers with children with no problems (7%).
Louise Howard, Professor in Women’s Mental Health, from the Health Services and Population Research Department, Institute of Psychiatry, King’s College London and senior author of the paper said:
“This strong link between antenatal and postnatal violence should help health workers identify future problems. Pregnancy is a time when women will come into frequent contact with health professionals and therefore are more likely to talk about domestic violence being suffered and psychiatric symptoms.”
Professor Philip Steer, BJOG editor-in-chief added:
“This is an important study as it highlights the issue of domestic violence which was also highlighted in the recent UK confidential enquiry into maternal deaths.
“Antenatal domestic violence has been shown to lead to various other problems such as postnatal violence, depression and child behavioural problems. It is therefore essential that more is done to help women at an early stage and provide them with the support they need to ensure the future health of the baby.”
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Please include a link to the paper in online coverage: http://dx.doi.org/10.1111/j.1471-0528.2011.03040.x
The Freephone 24 Hour National Domestic Violence Helpline - 0808 2000 247 - is run in partnership between Women's Aid and Refuge and is for women experiencing domestic violence, their family, friends, colleagues and others calling on their behalf.
Flach C, Leese M, Heron J, Evans J, Feder G, Sharp D, Howard L. Antenatal domestic violence, maternal mental health and subsequent child behaviour: a cohort study. BJOG 2011; DOI: 10.1111/j.1471-0528.2011.03040.x.