According to a recent review published in the Annals of Internal Medicine, it is estimated that nearly 31% of women and 26% of men report experiencing some form of intimate partner violence (IPV) in their lifetime. While these numbers are alarmingly high, the authors point out that these estimates probably underestimate the actual rates because underreporting of IPV is relatively common.
Among pregnant women the prevalence of IPV is high. In a recent community-based study of first time mothers in Canada, it was estimated that approximately 30% of women reported one or more episodes of interpersonal violence. In a similar study carried out in Australia, it was found that about 40% of women reporting depressive symptoms also reported IPV. In this study, researchers estimated that women exposed to emotional abuse alone had a 2.72-fold increased risk of postpartum depression (PPD), whereas women exposed to physical abuse had a 3.94-fold increased risk of PPD.
Less is known about the association between IPV during pregnancy and suicidal ideation. A recent study reports on the prevalence and predictors of suicidal ideation among low-income pregnant women receiving prenatal care at a university obstetrical clinic in Baltimore. This was a cross-sectional analysis of 166 women assessed between 24 and 28 weeks of gestation using the Edinburgh Postnatal Depression Scale (EPDS) and the Abuse Assessment Screen (AAS).
The prevalence of suicidal ideation was 22.89 %. Suicidal ideation was more commonly reported in women with depressive symptomatology (OR?=?17.04; 95 % CI 2.10–38.27) and in women experiencing IPV (OR?=?9.37; 95 % CI 3.41–25.75). The authors noted that the prevalence of antenatal suicidal ideation was higher here than in other population-based samples but hypothesized that this higher rate was due to the fact that this sample was predominantly single, low-income, and 19% of the women had experienced IPV during pregnancy.
Given the strong association of antenatal suicidal ideation, depressive symptomatology, and IPV, health care providers are urged to identify women exposed to IPV so that antenatal care can be tailored to best support optimal maternal and neonatal outcomes.
There are many different tools which can be used to identify women experiencing IPV (reviewed here). Most of these screening tools are easy to administer and consist of only a few questions. (Copies of most of these screening tools can be found at this website on IPV from the Centers for Disease Control and Prevention.) Another resource is Intimate Partner Violence During Pregnancy, a Guide for Clinicians.
Ruta Nonacs, MD PhD
Alhusen JL, Frohman N, Purcell G. Intimate partner violence and suicidal ideation in pregnant women. Arch Womens Ment Health. 2015 Aug;18(4):573-8.