Intimate Partner Abuse and Postpartum Mental Health Problems
Intimate Partner Abuse and Postpartum Mental Health Problems
Mean participant age was 32.47 years (SD = 4.97, range = 20–49) and that of their babies was 2.01 months (SD = 1.32, range = 0–5). Almost half (41.0%) already had children (biological or otherwise). The majority of respondents (71.0%) and their partners (68.4%) were Caucasian; a substantial minority were Asian (13.0% and 11.2%, respectively), which is representative of the study area. Most (96.0%) had completed high school or equivalent, and were employed (82.0%), either part-time (17.0%) or full time (65.0%). Almost two-thirds reported familial incomes of $60,000 or more (62.0%). All but five women (95.0%) were in a serious or committed relationship with the father of their new baby at the time of the interview.
Overall, almost two-thirds of women (61.0%) reported postpartum mental health symptoms that were above normal levels, with 47.0% reporting symptoms at moderate or higher levels. For stress, anxiety, depression, and obsessive-compulsive disorder, scores were above the normal range for 41.0%, 27.0%, 26.0%, and 32.0% of participants and in the clinical range for 30.0%, 20.0%, 14.0%, and 13.0% of participants, respectively. Almost one-quarter of women (22.0%) met diagnostic criteria for posttraumatic stress disorder.
The vast majority of participants reported experiencing some form of intimate partner abuse before their pregnancy (84.0%) and more than two-thirds (70.0%) reported experiencing intimate partner abuse during their pregnancy. Both before and during pregnancy, psychological aggression was most common (83.0% and 68.0%), followed by physical assault (20.0% and 12.0%) and then sexual coercion (15.0% and 12.0%). Minor abuse was more common than severe abuse in both reference periods; still, almost one-third (31.0%) of women reported severe psychological, physical and/or abuse before pregnancy, and 12.0% during pregnancy.
Table 1 shows postpartum mental health symptoms as a function of participant characteristics and prevalence of intimate partner abuse before and during pregnancy. Bivariate results revealed some differences in postpartum mental health symptoms as a function of participant characteristics. Significantly higher levels of anxiety and posttraumatic stress disorder symptoms were seen in women who had not completed their high school education compared to those who had completed at least high school. Significantly higher levels of anxiety and posttraumatic stress disorder symptoms also were seen in women whose annual household incomes were $60,000 or greater compared to those whose annual household incomes were less than $60,000. Women who were single showed significantly higher levels of stress, anxiety, depression, and posttraumatic stress disorder than women in relationships at the time of the interview. No significant differences in postpartum mental health symptoms were found as a function of age, race/ethnicity, or prior children; thus, these 3 participant characteristics will not be included as covariates in the multivariate analyses.
Bivariate comparisons also revealed that women who experienced intimate partner abuse—whether before or during pregnancy—reported significantly more postpartum mental health symptoms compared to those who did not experience intimate partner abuse. Psychological aggression before and during pregnancy was associated with postpartum stress. Psychological aggression during, but not before, pregnancy also was associated with symptoms of posttraumatic stress disorder. Physical assault and sexual coercion before pregnancy were associated with symptoms of anxiety, obsessive-compulsive disorder and posttraumatic stress disorder. Physical assault before pregnancy additionally was associated with symptoms of depression. Physical assault and sexual coercion during pregnancy both were associated symptoms of obsessive-compulsive disorder; however, physical assault during pregnancy also was associated with posttraumatic stress disorder, whereas sexual coercion during pregnancy was associated with anxiety. Even when significant differences in postpartum mental health symptoms as a function of intimate partner abuse were not observed, there was nonetheless a trend for increased symptomatology among women who reported abuse. Finally, as the number of types of abuse reported before and during pregnancy increased, so did symptoms of obsessive-compulsive disorder and posttraumatic stress disorder. Number of types of abuse reported before, but not during, pregnancy additionally was associated with increased symptoms of anxiety.
Table 2 shows results of the multivariate analysis of covariance examining the effects of psychological, physical and sexual abuse before and during pregnancy (in separate models) on symptoms of stress, anxiety, depression, obsessive-compulsive disorder, and posttraumatic stress disorder, with education, annual income, and relationship status as covariates. Only the multivariate model of physical assault during pregnancy was significant (see Table 3 ). However, the corrected univariate models for both intimate partner abuse before and during pregnancy were significant for stress (F[6, 75] = 3.87, p < .05, ηp = .18; and F[6, 75] = 2.99, p < .01, ηp = .19), anxiety (F[6, 75] = 2.65, p < .01, ηp = .24; and F[6, 75] = 3.71, p < .01, ηp = .23), obsessive-compulsive disorder (F[6, 75] = 2.42, p < .05, ηp = .15; and F[6, 75] = 3.77, p < .01, ηp = .23), and posttraumatic stress disorder (F[6, 75] = 5.69, p < .001, ηp = .31; and F[6, 75] = 8.29, p < .001, ηp = .30). The corrected univariate model for intimate partner abuse during, but not before, pregnancy additionally was significant for depression (F[6, 75] = 2.60, p < .05, ηp = .17).
Table 3 shows results of the multivariate analysis of covariance models examining associations between psychological, physical and sexual abuse (yes, no) before and during pregnancy (in separate models) and symptoms of stress, anxiety, depression, obsessive-compulsive disorder, and posttraumatic stress disorder as the continuous dependent variables, with education, annual income, and relationship status as covariates. After accounting for the other types of abuse and the covariates, sexual coercion was the only type of abuse experienced before pregnancy that was associated with postpartum mental health symptoms; obsessive-compulsive disorder, specifically (see Table 3 ). In contrast, all types of intimate partner abuse experienced during pregnancy were association with postpartum mental health symptoms. Psychological aggression during pregnancy showed independent effects on stress and posttraumatic stress disorder; physical assault during pregnancy showed independent effects on symptoms of depression, obsessive-compulsive disorder and posttraumatic stress disorder; and sexual coercion during pregnancy showed independent effects on symptoms of stress, depression, and posttraumatic stress disorder (see Table 3 ).
Table 4 shows results of the multivariate analysis of covariance models examining associations between the number of types of intimate partner abuse before and during pregnancy (in separate models) and symptoms of stress, anxiety, depression, obsessive-compulsive disorder, and posttraumatic stress disorder as the continuous dependent variables, with education, annual income, and relationship status as covariates. The multivariate model for abuse during, but not before pregnancy, was significant (see Table 4 ). In terms of the specific postpartum mental health problems, univariate models indicated that symptoms of stress, obsessive-compulsive disorder and posttraumatic stress disorder increased with the number of types of abuse experienced, both before and during pregnancy (see Table 4 ).
Results
Descriptive Statistics
Mean participant age was 32.47 years (SD = 4.97, range = 20–49) and that of their babies was 2.01 months (SD = 1.32, range = 0–5). Almost half (41.0%) already had children (biological or otherwise). The majority of respondents (71.0%) and their partners (68.4%) were Caucasian; a substantial minority were Asian (13.0% and 11.2%, respectively), which is representative of the study area. Most (96.0%) had completed high school or equivalent, and were employed (82.0%), either part-time (17.0%) or full time (65.0%). Almost two-thirds reported familial incomes of $60,000 or more (62.0%). All but five women (95.0%) were in a serious or committed relationship with the father of their new baby at the time of the interview.
Overall, almost two-thirds of women (61.0%) reported postpartum mental health symptoms that were above normal levels, with 47.0% reporting symptoms at moderate or higher levels. For stress, anxiety, depression, and obsessive-compulsive disorder, scores were above the normal range for 41.0%, 27.0%, 26.0%, and 32.0% of participants and in the clinical range for 30.0%, 20.0%, 14.0%, and 13.0% of participants, respectively. Almost one-quarter of women (22.0%) met diagnostic criteria for posttraumatic stress disorder.
The vast majority of participants reported experiencing some form of intimate partner abuse before their pregnancy (84.0%) and more than two-thirds (70.0%) reported experiencing intimate partner abuse during their pregnancy. Both before and during pregnancy, psychological aggression was most common (83.0% and 68.0%), followed by physical assault (20.0% and 12.0%) and then sexual coercion (15.0% and 12.0%). Minor abuse was more common than severe abuse in both reference periods; still, almost one-third (31.0%) of women reported severe psychological, physical and/or abuse before pregnancy, and 12.0% during pregnancy.
Bivariate Analyses
Table 1 shows postpartum mental health symptoms as a function of participant characteristics and prevalence of intimate partner abuse before and during pregnancy. Bivariate results revealed some differences in postpartum mental health symptoms as a function of participant characteristics. Significantly higher levels of anxiety and posttraumatic stress disorder symptoms were seen in women who had not completed their high school education compared to those who had completed at least high school. Significantly higher levels of anxiety and posttraumatic stress disorder symptoms also were seen in women whose annual household incomes were $60,000 or greater compared to those whose annual household incomes were less than $60,000. Women who were single showed significantly higher levels of stress, anxiety, depression, and posttraumatic stress disorder than women in relationships at the time of the interview. No significant differences in postpartum mental health symptoms were found as a function of age, race/ethnicity, or prior children; thus, these 3 participant characteristics will not be included as covariates in the multivariate analyses.
Bivariate comparisons also revealed that women who experienced intimate partner abuse—whether before or during pregnancy—reported significantly more postpartum mental health symptoms compared to those who did not experience intimate partner abuse. Psychological aggression before and during pregnancy was associated with postpartum stress. Psychological aggression during, but not before, pregnancy also was associated with symptoms of posttraumatic stress disorder. Physical assault and sexual coercion before pregnancy were associated with symptoms of anxiety, obsessive-compulsive disorder and posttraumatic stress disorder. Physical assault before pregnancy additionally was associated with symptoms of depression. Physical assault and sexual coercion during pregnancy both were associated symptoms of obsessive-compulsive disorder; however, physical assault during pregnancy also was associated with posttraumatic stress disorder, whereas sexual coercion during pregnancy was associated with anxiety. Even when significant differences in postpartum mental health symptoms as a function of intimate partner abuse were not observed, there was nonetheless a trend for increased symptomatology among women who reported abuse. Finally, as the number of types of abuse reported before and during pregnancy increased, so did symptoms of obsessive-compulsive disorder and posttraumatic stress disorder. Number of types of abuse reported before, but not during, pregnancy additionally was associated with increased symptoms of anxiety.
Multivariate Analyses
Table 2 shows results of the multivariate analysis of covariance examining the effects of psychological, physical and sexual abuse before and during pregnancy (in separate models) on symptoms of stress, anxiety, depression, obsessive-compulsive disorder, and posttraumatic stress disorder, with education, annual income, and relationship status as covariates. Only the multivariate model of physical assault during pregnancy was significant (see Table 3 ). However, the corrected univariate models for both intimate partner abuse before and during pregnancy were significant for stress (F[6, 75] = 3.87, p < .05, ηp = .18; and F[6, 75] = 2.99, p < .01, ηp = .19), anxiety (F[6, 75] = 2.65, p < .01, ηp = .24; and F[6, 75] = 3.71, p < .01, ηp = .23), obsessive-compulsive disorder (F[6, 75] = 2.42, p < .05, ηp = .15; and F[6, 75] = 3.77, p < .01, ηp = .23), and posttraumatic stress disorder (F[6, 75] = 5.69, p < .001, ηp = .31; and F[6, 75] = 8.29, p < .001, ηp = .30). The corrected univariate model for intimate partner abuse during, but not before, pregnancy additionally was significant for depression (F[6, 75] = 2.60, p < .05, ηp = .17).
Table 3 shows results of the multivariate analysis of covariance models examining associations between psychological, physical and sexual abuse (yes, no) before and during pregnancy (in separate models) and symptoms of stress, anxiety, depression, obsessive-compulsive disorder, and posttraumatic stress disorder as the continuous dependent variables, with education, annual income, and relationship status as covariates. After accounting for the other types of abuse and the covariates, sexual coercion was the only type of abuse experienced before pregnancy that was associated with postpartum mental health symptoms; obsessive-compulsive disorder, specifically (see Table 3 ). In contrast, all types of intimate partner abuse experienced during pregnancy were association with postpartum mental health symptoms. Psychological aggression during pregnancy showed independent effects on stress and posttraumatic stress disorder; physical assault during pregnancy showed independent effects on symptoms of depression, obsessive-compulsive disorder and posttraumatic stress disorder; and sexual coercion during pregnancy showed independent effects on symptoms of stress, depression, and posttraumatic stress disorder (see Table 3 ).
Table 4 shows results of the multivariate analysis of covariance models examining associations between the number of types of intimate partner abuse before and during pregnancy (in separate models) and symptoms of stress, anxiety, depression, obsessive-compulsive disorder, and posttraumatic stress disorder as the continuous dependent variables, with education, annual income, and relationship status as covariates. The multivariate model for abuse during, but not before pregnancy, was significant (see Table 4 ). In terms of the specific postpartum mental health problems, univariate models indicated that symptoms of stress, obsessive-compulsive disorder and posttraumatic stress disorder increased with the number of types of abuse experienced, both before and during pregnancy (see Table 4 ).