A recent study, led by Noor Ani Ahmad, Head of the Centre for Family Research for the Ministry of Health in Malaysia, examines the relationship between intimate partner violence (IPV) and postnatal depression. The results of the study, published in BMJ Open, show that Malaysian women exposed to IPV and emotional violence are 2-4 times as likely to develop postnatal depression.
“Emotional violence has a negative impact on the emotional and mental health of women in the postpartum period and often contributes to physical or sexual violence,” the researchers write.
According to the World Health Organization (WHO), 13% of women experience mental health challenges during the postpartum period. Up to 32% of women in Malaysia may experience postpartum depression. Postpartum depression has been associated with a number of factors including age, socioeconomic status, marital conflict, partner’s use of alcohol, and stressful life events. IPV, which involves physical, sexual, or emotional abuse by a significant other, has also been associated with postpartum depression.
“While depression at any time in a woman’s life is devastating, depression during the perinatal, antenatal and postnatal periods is of special importance and is a public health concern due to its detrimental effects on women, families and their children,” the researchers write.
In the current study, the authors sought to determine the prevalence of postnatal depression in Malaysia and its relationship with IPV and other risk factors. The researchers conducted a nation-wide study, interviewing 5727 women who sought medical care at government primary care clinics and were 6-16 weeks postpartum. Women completed the Edinburgh Postnatal Depression Scale to assess postnatal depression, and also completed an interview with a trained nurse using the WHO Women’s Health and Life Events Questionnaire.
Results show that 4.4% of women in the sample met criteria for probable postnatal depression, which is a much lower estimate than previous studies. Of the sample, 3.3% of women reported ever experiencing physical and sexual IPV. Almost 1/3 women (30.2%) reported experiencing controlling behavior by a partner and 3.7% reported emotional violence from a partner.
Women who experienced physical or sexual IPV were over twice as likely to meet criteria for postnatal depression compared women with no experience of IPV. Women who were exposed to emotional violence were almost four times as likely to experience probable postpartum depression.
The authors summarize, “the psychological effects of emotional violence on PND [postnatal depression] was more prominent than those of IPV.” Unplanned pregnancy, lack of family support, partner alcohol consumption, and lower household income were also associated with postnatal depression.
“As in many Asian countries, women in Malaysia are primarily expected to care for children and manage household chores, as prescribed by traditional gender roles, regardless of whether they are working,” the study authors add.
“These cultural norms may assign an inferior status to women and lead to misconceptions that may cause women to blame themselves, minimize abuse and prevent them from seeking help when abuse occurs. Perpetrators may manipulate cultural practices or religious teachings to make it seem as if it supports IPV.”
The authors recommend that pregnancy care and postnatal programs address issues related to both postpartum depression and IPV. Healthcare providers should be trained in assessing for IPV and having confidential conversations about this issue with their patients. Referrals to resources and counseling, as well as discussions about IPV in premarital courses, are also recommended by the authors.
Ahmad, N. A., Silim, U. A., Rosman, A., Mohamed, M., Chan, Y. Y., Kasim, N. M., … Aris, T. (2018). Postnatal depression and intimate partner violence: A nationwide clinic-based cross-sectional study in Malaysia. BMJ Open, 8(5), e020649. doi:10.1136/bmjopen-2017-020649 (Link)