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Review
, 10 (5), e1001452

Domestic Violence and Perinatal Mental Disorders: A Systematic Review and Meta-Analysis

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Review

Domestic Violence and Perinatal Mental Disorders: A Systematic Review and Meta-Analysis

Louise M Howard et al. PLoS Med.

Abstract

Background: Domestic violence in the perinatal period is associated with adverse obstetric outcomes, but evidence is limited on its association with perinatal mental disorders. We aimed to estimate the prevalence and odds of having experienced domestic violence among women with antenatal and postnatal mental disorders (depression and anxiety disorders including post-traumatic stress disorder [PTSD], eating disorders, and psychoses).

Methods and findings: We conducted a systematic review and meta-analysis (PROSPERO reference CRD42012002048). Data sources included searches of electronic databases (to 15 February 2013), hand searches, citation tracking, update of a review on victimisation and mental disorder, and expert recommendations. Included studies were peer-reviewed experimental or observational studies that reported on women aged 16 y or older, that assessed the prevalence and/or odds of having experienced domestic violence, and that assessed symptoms of perinatal mental disorder using a validated instrument. Two reviewers screened 1,125 full-text papers, extracted data, and independently appraised study quality. Odds ratios were pooled using meta-analysis. Sixty-seven papers were included. Pooled estimates from longitudinal studies suggest a 3-fold increase in the odds of high levels of depressive symptoms in the postnatal period after having experienced partner violence during pregnancy (odds ratio 3.1, 95% CI 2.7-3.6). Increased odds of having experienced domestic violence among women with high levels of depressive, anxiety, and PTSD symptoms in the antenatal and postnatal periods were consistently reported in cross-sectional studies. No studies were identified on eating disorders or puerperal psychosis. Analyses were limited because of study heterogeneity and lack of data on baseline symptoms, preventing clear findings on causal directionality.

Conclusions: High levels of symptoms of perinatal depression, anxiety, and PTSD are significantly associated with having experienced domestic violence. High-quality evidence is now needed on how maternity and mental health services should address domestic violence and improve health outcomes for women and their infants in the perinatal period.

Conflict of interest statement

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.

Figures

Figure 1
Figure 1. Flow diagram of screened and included papers.
Figure 2
Figure 2. Meta-analysis of the association between antenatal depression and any lifetime domestic violence (cross-sectional studies).
ES, effect size.
Figure 3
Figure 3. Meta-analysis of the association between antenatal depression and any past year partner violence (cross-sectional studies).
ES, effect size.
Figure 4
Figure 4. Meta-analysis of the association between antenatal depression and partner violence during pregnancy (cross-sectional studies).
ES, effect size.
Figure 5
Figure 5. Meta-analysis of the association between postnatal depression and any lifetime partner violence (cross-sectional studies).
ES, effect size.
Figure 6
Figure 6. Meta-analysis of the association between postnatal depression and any past year partner violence (cross-sectional studies).
ES, effect size.
Figure 7
Figure 7. Meta-analysis of the association between postnatal depression and partner violence during pregnancy (cross-sectional studies).
ES, effect size.
Figure 8
Figure 8. Meta-analysis of the association between any lifetime partner violence and postnatal depression (cohort studies).
ES, effect size.
Figure 9
Figure 9. Meta-analysis of the association between any partner violence during pregnancy and postnatal depression (cohort studies).

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