Erika Lichter 1,2 Cynthia Mervis 1,2 Kim Haggan 2 1 University of Southern Maine

1. Intimate partner violence, social support and postpartum depression: An analysis of Maine PRAMS data Erika Lichter1,2 Cynthia Mervis1,2 Kim Haggan2 1University of Southern Maine 2Maine Center for Disease Control and Prevention

2. Postpartum Depression Definition: Depression within one year of giving birth Prevalence: • 7%-39% of women experience PPD • 2000 PRAMS data from 7 states: • 7.1% Severe • >50% Low to Moderate Symptoms: • Sadness • Lack of energy • Trouble concentrating • Anxiety • Feelings of guilt or worthlessness • Affects well-being and interferes with daily functioning

3. Postpartum Depression: Consequence and Causes • Effects: • Parenting ability • Delays in child development • Women’s health • Multiple possible causes • Hormonal • Prior depression • Stress • Intimate partner violence • Inadequate social support

4. Intimate partner violence and pregnancy • Each year 1.5 million women are physically or sexually assaulted by their intimate partners • 4%-26% prior to pregnancy • 1%-17% during pregnancy • 2001 PRAMS • 20 states • 4.9% prior to pregnancy • 3.8% during pregnancy • Depression and other mental health problems are a consequence of intimate partner violence

5. Social Support • Social support is protective for women experiencing IPV • Lack of social support associated with postpartum depression • Few studies consider how the two contribute to women’s experience of PPD

6. Research Questions 1. Are women who experienced intimate partner violence before or during pregnancy at greater risk for postpartum depression? • Are women who experienced IPV less likely to identify sources of informal social support postpartum? • Are women who experienced IPV less likely to be connected to formal social support (home visits)? • Does social support moderate the relationship between IPV and depression?

7. Informal Social Support Intimate Partner Violence Postpartum Depression Formal Social Support

8. Methods • Maine Pregnancy Risk Assessment Monitoring System (PRAMS) 2000-2003 • Average response rate for Maine: 76% (75%-77%) • Sample size: 4189

9. Measures Intimate partner violence: “During the 12 months before you got pregnant… OR “During your most recent pregnancy... …did your husband or partner push, hit, slap, kick, choke, or physically hurt you in any other way?” Formal and Informal Social Support Since the birth of your new baby: 1. “…who would help you if a problem came up?” 2. “…did any of the following people visit you in your home?”

10. Formal Social Support for Postpartum Women in Maine • Public Health Nurse/Community Health Nurse • Identified health needs (post c-section, breastfeeding) • Healthy Families/Parents as Teachers/Parents as Teachers Too • available to all first time parents • Early Head Start • Nurse from hospital • Social services case worker • Doula • Lactation Consultants

11. Measures (cont.) Depression “In the months after your delivery, would you say that you were…. -Not at all depressed -A little depressed -Moderately depressed -Very depressed -Very depressed and needed help

12. Analytic Methods • Descriptive statistics • IPV Social Support • Logistic Regression • IPV + Social Support Depression • Multinomial Logistic Regression • Outcomes: No Depression vs. Slight Depression No Depression vs. Moderate/Severe • Confounders: age, income, education, marital status, 1st birth, pregnancy intendedness • SUDAAN/SAS

13. Postpartum Women in Maine: Sample Demographics

14. Sample Demographics

15. Postpartum Depression

16. Intimate Partner Violence Prior to and During Pregnancy

17. Inadequate Social Support

18. Is intimate partner violence related to having no informal social support? Married Adjusted for age, education, income, 1st live birth *p<.05

19. Is intimate partner violence related to having no formal social support? 1st Live Birth IPV Adjusted for age, education and income *p<.05

20. What factors are associated with postpartum depression? Adjusted for age, education, income, previous live birth, marital status *p<.05

21. Does informal social support moderate the relationship between IPV and postpartum depression?

22. Does formal social support moderate the relationship between IPV and postpartum depression?

23. Summary • Intimate partner violence before or during pregnancy is associated with depression in the months following delivery • Women in violent relationships during pregnancy are less able to identify people they can turn to for help • However, many women experiencing IPV are connected to health and social services that could provide support and counseling for abuse and postpartum depression • A lack of informal social support is highly correlated with postpartum depression • It is unclear whether formal supports are adequately addressing postpartum depression.

24. Limitations • Cross-sectional data • Self-report • No information on violence after pregnancy and depression before pregnancy • Other sources of formal support not assessed

25. Implications • Providers should be aware of the prevalence of intimate partner abuse among pregnant women • Screening for IPV and depression should be included in prenatal and postpartum health care • Pre-natal care visits could assess women’s informal social support networks and help women connect with others informally • Providers of postpartum maternal and child support should be aware that they may be visiting homes where there is violence • Home visitors need to be prepared to screen for and address violence and depression in the postpartum women

26. Questions/Comments Erika Lichter Maine CDC/University of Southern Maine erika.lichter@maine.gov (207) 725-4826