Domestic violence and perinatal mental health

Women who have mental health disorders around the time of birth are more likely to have previously experienced domestic violence, according to a study by UK researchers published in this week's PLOS Medicine.

The researchers, led by Louise Howard from King's College London, found that high levels of symptoms of perinatal* depression, anxiety, and post-traumatic stress disorder were linked to having experienced domestic violence either during pregnancy, the past year, or over a woman's lifetime.

The researchers (also the authors of the published study) reached these conclusions by reviewing 67 relevant studies (in a systematic review) and combining the results.

They found that around 12-13% of postnatal depression (i.e. high levels of postnatal depressive symptoms) is linked with experiences of domestic violence during pregnancy. In a further analysis, the authors found that women with antenatal and postnatal depression were three times more likely to have experienced domestic violence in the past year and 5 times more likely to have experienced domestic violence when pregnant. Women with antenatal anxiety disorders were also three times more likely to have experienced domestic violence over her lifetime but this figure was less in women with postnatal anxiety disorders.

However, it is important to note that these findings cannot prove that domestic violence can cause perinatal mental health disorders or provide evidence that perinatal mental health disorders can lead to subsequent domestic violence, and there is no information on other perinatal mental disorders, such as eating disorders and puerperal psychosis.

The authors say: "Our finding that women with high levels of symptoms of a range of perinatal mental disorders have a high prevalence and increased odds of having experienced domestic violence both over the lifetime and during pregnancy highlights the importance of health professionals identifying and responding to domestic violence among women attending antenatal and mental health services."

They continue: "Further data is… needed on how maternity and mental health services should best identify women with a history or current experience of domestic violence, respond appropriately and safely, and thus improve health outcomes for women and their infants in the perinatal period."

*the perinatal period refers to the period before, during, and after pregnancy

Funding: LMH, SO, KT, and GF receive support from the NIHR Programme Grants for Applied Research scheme (RP-PG-0108-10084). LMH also receives salary support from the National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG-0108-10084). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Competing Interests: LMH and GF are members of the WHO Guideline Development Group on Policy and Practice Guidelines for responding to Violence Against Women and the NICE/SCIE Guideline Development Group on Preventing and Reducing Domestic Violence. LMH has also been appointed as chair of the NICE guideline update on antenatal and postnatal mental health. The other authors declare no completing interests exist.

Citation: Howard LM, Oram S, Galley H, Trevillion K, Feder G (2013) Domestic Violence and Perinatal Mental Disorders: A Systematic Review and Meta-Analysis. PLoS Med 10(5): e1001452. doi:10.1371/journal.pmed.1001452

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001452

Louise Pratt
PR & Communications Manager
Institute of Psychiatry
King's College London
Email: louise.a.pratt@kcl.ac.uk
Tel: (+44) 0207 848 5378
Mob: (+44) 0785 0919 020