Intimate Partner Violence (IPV) is a significant public health issue that has adverse effects on both maternal and fetal health. IPV encompasses any physical, sexual, and emotional violence or coercive behaviors perpetrated against a person by a current or former intimate partner.

In a recent study from Galbally and colleagues, the authors assessed the relationship between IPV, depression, childhood trauma, and other stressful life events during pregnancy and the postpartum period. Their study included 505 participants from the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS), an Australian cohort with data collected at 4 time points during pregnancy and the postpartum period (early pregnancy, late pregnancy, 6 months postpartum, 12 months postpartum). The aim of their study was to (1) compare the prevalence of IPV between participants with and without clinical depression during pregnancy and postpartum and (2) examine the association between childhood trauma, current stressful life events, depressive symptoms, and IPV over time.

The authors found that patients with clinical depression at the time of enrollment, compared to those without depressive symptoms, reported higher rates of physical abuse during early pregnancy (4.7% vs. 1.0%) and late pregnancy (4.7% vs. 0.5%) but not during the postpartum period. 

In addition, there was an association between depressive symptoms (measured using the Edinburgh Postnatal Depression Scale) and reported IPV throughout the perinatal period after adjusting for demographic variables, childhood trauma experience, and experience of other current stressful life events. In the adjusted model, a high EPDS score (13 or greater) was associated with a 2.64-fold greater risk (95% CI: 1.72 – 4.03) of experiencing perinatal IPV. The authors also found that those with a history of moderate to severe childhood trauma were more likely to experience IPV throughout the perinatal period, but most markedly during the postpartum. Experiencing any other current stressful life event was also associated with IPV.

These findings are consistent with other studies that have shown an association between IPV and depressive symptoms during pregnancy but included the addition of important covariates, including childhood trauma and other stressful life events, as well as a diagnostic measure of depression and a repeated measures design. This study suggests that there is likely a bidirectional relationship between IPV and depression in the perinatal period, such that those with depression are at greater risk of experiencing IPV and that experiencing IPV is associated with higher levels of depressive symptoms.

There are some important limitations to this study. IPV was measured using a subset of 2 yes/no questions on the Stressful Life Events Questionnaire as opposed to a more comprehensive, dedicated questionnaire to measure IPV. The sample in this study reported overall low rates of IPV (ranging between 1 – 8%); the CDC reports that 35.6% of women experience IPV. It is unclear whether this is due to reporting bias or low prevalence in this study cohort. Further studies are needed to better understand the risk factors for and impacts of IPV on maternal mental health.

The findings of this study reaffirm the importance of trauma-informed care and IPV screening of perinatal patients, given the relationship between depression, trauma, and IPV. Based on the findings of current study, it is especially important to screen for IPV in women reporting higher levels of depression during pregnancy, and patients who endorse other types of trauma experiences in their lifetime may benefit from more in-depth screening for IPV. In addition to screening, providers should be aware of local resources for women experiencing IPV so that they can better support the unique needs of this patient population.

Mira Bajaj, MD

Galbally M, Watson S, MacMillan K, Sevar K, Howard LM.  Intimate partner violence across pregnancy and the postpartum and the relationship to depression and perinatal wellbeing: findings from a pregnancy cohort study. Arch Womens Ment Health (2024).