The role of intimate partner violence and other health-related social factors on postpartum common mental disorders: a survey-based structural equation modeling analysis

BMC Public Health

Gustavo Lobato³  Claudia Souza Lopes¹  Claudia Leite Moraes²  Michael Eduardo Reichenheim¹ 

[1] Department of Epidemiology, Institute of Social Medicine (IMS), Rio de Janeiro State University (UERJ), Rua São Francisco Xavier 524, 7° andar, Rio de Janeiro, RJ 20550-013, Brazil;Family Health Master Program, Estácio de Sá University, Rua Riachuelo, 27, Rio de Janeiro, RJ 20230-010, Brazil;Fernandes Figueira Institute, Oswaldo Cruz Foundation (FIOCRUZ), Avenida Rui Barbosa, 716 – 3° Andar, Rio de Janeiro, RJ 22250-020, Brazil

关键词: Structural equation model;    Mental health;    Postpartum common mental disorder;    Social determinants of health;    Intimate partner violence;   

Others  :  1131455
DOI  :  10.1186/1471-2458-14-427

 received in 2013-07-28, accepted in 2014-04-15,  发布年份 2014

【 摘 要 】

Background

Although studies suggest the relevance of intimate partner violence (IPV) and other health-related social characteristics as risk factors for postpartum mental health, literature lacks evidence about how these are effectively connected. This study thus aims to explore how socio-economic position, maternal age, household and marital arrangements, general stressors, alcohol misuse and illicit drug abuse, and especially psychological and physical IPV relate in a framework leading to postpartum common mental disorder (CMD).

Methods

The study was carried out in five primary health care units of Rio de Janeiro, Brazil, and included 810 randomly selected mothers of children up to five postpartum months waiting for pediatric visits. The postulated pathways between exposures and outcome were based on literature evidence and were further examined using structural equation models.

Results

Direct pathways to postpartum CMD arose from a latent variable depicting socio-economic position, a general stressors score, and both IPV variables. Notably, the effect of psychological IPV on postpartum CMD ran partly through physical IPV. The effect of teenage pregnancy, conjugal instability and maternal burden apparently happens solely through substance use, be it alcohol misuse, illicit drug abuse or both in tandem. Moreover, the effect of the latter on CMD seems to be entirely mediated through both types of IPV.

Conclusion

Although the theoretical model underlying the analysis still requires in-depth detailing, results of this study may have shed some light on the role of both psychological and physical IPV as part of an intricate network of events leading to postpartum CMD. Health initiatives may want to make use of this knowledge when designing preventive and intervention approaches.

【 授权许可】

   
2014 Reichenheim et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, Abraham J, Ackerman I, Aggarwal R, Ahn SY, Ali MK, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Bahalim AN, Barker-Collo S, Barrero LH, Bartels DH, Basanez MG, Baxter A, Bell ML, Benjamin EJ: Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012, 380:2197-2223.
• [2]Mari JJ, Williams P: A comparison of the validity of two psychiatric screening questionnaires (GHQ-12 and SRQ-20) in Brazil, using Relative Operating Characteristic (ROC) analysis. Psychol Med 1985, 15:651-659.
• [3]Beusenberg M, Orley J: A user’s guide to the Self reporting Questionnaire (SRQ). In WHO/MNH/PSF/94.8). Geneva: World Health Organization; 1994. http://whqlibdoc.who.int/hq/1994/WHO_MNH_PSF_94.8.pdf webcite
• [4]Steel Z, Marnane C, Iranpour C, Chey T, Jackson JW, Patel V, Silove D: The global prevalence of common mental disorders: a systematic review and meta-analysis 1980–2013. Int J Epidemiol 2014. Epud ahead of print
• [5]Goldberg D, Huxley P: Common mental disorders: A biosocial model. London: Tavistock; 1992.
• [6]Draft comprehensive mental health action plan 2013–2020: Report by the Secretariat http://apps.who.int/gb/ebwha/pdf_files/WHA66/A66_10Rev1-en.pdf webcite
• [7]Anselmi L, Barros FC, Minten GC, Gigante DP, Horta BL, Victora CG: Prevalence and early determinants of common mental disorders in the 1982 birth cohort, Pelotas, Southern Brazil. Rev Saude Publica 2008, 42(Suppl 2):26-33.
• [8]Patel V, Kirkwood BR, Pednekar S, Weiss H, Mabey D: Risk factors for common mental disorders in women. Population-based longitudinal study. Br J Psychiatry 2006, 189:547-555.
• [9]Rognmo K, Torvik FA, Roysamb E, Tambs K: Alcohol use and spousal mental distress in a population sample: the nord-trondelag health study. BMC Public Health 2013, 13:319. BioMed Central Full Text
• [10]Eaton NR, Keyes KM, Krueger RF, Balsis S, Skodol AE, Markon KE, Grant BF, Hasin DS: An invariant dimensional liability model of gender differences in mental disorder prevalence: evidence from a national sample. J Abn Psychol 2012, 121:282-288.
• [11]Kessler RC, Ormel J, Petukhova M, McLaughlin KA, Green JG, Russo LJ, Stein DJ, Zaslavsky AM, Aguilar-Gaxiola S, Alonso J, Andrade L, Benjet C, de Girolamo G, de Graaf R, Demyttenaere K, Fayyad J, Haro JM, Hu C, Karam A, Lee S, Lepine JP, Matchsinger H, Mihaescu-Pintia C, Posada-Villa J, Sagar R, Ustun TB: Development of lifetime comorbidity in the World Health Organization world mental health surveys. Arch Gen Psychiatry 2011, 68:90-100.
• [12]World Health Organization: Mental Health: New Understanding, New Hope. Geneva: WHO Press; 2001:178.
• [13]World Health Organization: Mental Health Atlas 2011. Geneva: WHO Press; 2011:82.
• [14]World Health Organization: Mental health aspects of women’s reproductive health. A global review of the literature. Geneva: WHO Press; 2009.
• [15]Ferri CP, Mitsuhiro SS, Barros MC, Chalem E, Guinsburg R, Patel V, Prince M, Laranjeira R: The impact of maternal experience of violence and common mental disorders on neonatal outcomes: a survey of adolescent mothers in Sao Paulo, Brazil. BMC Public Health 2007, 7:209. BioMed Central Full Text
• [16]Servili C, Medhin G, Hanlon C, Tomlinson M, Worku B, Baheretibeb Y, Dewey M, Alem A, Prince M: Maternal common mental disorders and infant development in Ethiopia: the P-MaMiE Birth Cohort. BMC Public Health 2010, 10:693. BioMed Central Full Text
• [17]Accortt EE, Freeman MP, Allen JJ: Women and major depressive disorder: clinical perspectives on causal pathways. J Women's Health 2008, 17:1583-1590.
• [18]Kendler KS, Prescott CA: Genes, environment, and psychopathology: understanding the causes of psychiatric and substance use disorders. New York: The Guilford Press; 2006.
• [19]Robertson E, Grace S, Wallington T, Stewart DE: Antenatal risk factors for postpartum depression: a synthesis of recent literature. Gen Hosp Psychiatry 2004, 26:289-295.
• [20]Wenzel A, Haugen EN, Jackson LC, Brendle JR: Anxiety symptoms and disorders at eight weeks postpartum. J Affect Dis 2005, 19:295-311.
• [21]Kendler KS, Gardner CO, Prescott CA: Toward a comprehensive developmental model for major depression in women. Am J Psych 2002, 159:1133-1145.
• [22]Yelland J, Sutherland G, Brown SJ: Postpartum anxiety, depression and social health: findings from a population-based survey of Australian women. BMC Public Health 2010, 10:771. BioMed Central Full Text
• [23]Kendler KS, Gardner CO: A longitudinal etiologic model for symptoms of anxiety and depression in women. Psychol Med 2011, 41:2035-2045.
• [24]Birmingham MC, Chou KJ, Crain EF: Screening for postpartum depression in a pediatric emergency department. Pediatr Emerg Care 2011, 27:795-800.
• [25]Moraes CL, Silva TST, Reichenheim ME, Azevedo GL, Oliveira ASD, Braga JU: Physical violence between intimate partners during pregnancy and postpartum: a prediction model for use in primary health care facilities. Paediatr Perinat Epidemiol 2011, 25:478-486.
• [26]Nayak MB, Patel V, Bond JC, Greenfield TK: Partner alcohol use, violence and women’s mental health: population-based survey in India. Br J Psychiatry 2010, 196:192-199.
• [27]Hegarty K: Domestic violence: the hidden epidemic associated with mental illness. Br J Psychiatry 2011, 198:169-170.
• [28]Romito P, Molzan Turan J, De Marchi M: The impact of current and past interpersonal violence on women’s mental health. Soc Sci Med 2005, 60:1717-1727.
• [29]Romito P, Grassi M: Does violence affect one gender more than the other? The mental health impact of violence among male and female university students. Soc Sci Med 2007, 65:1222-1234.
• [30]Ishida K, Stupp P, Melian M, Serbanescu F, Goodwin M: Exploring the associations between intimate partner violence and women’s mental health: evidence from a population-based study in Paraguay. Soc Sci Med 2010, 71:1653-1661.
• [31]Fisher J, Tran T, Duc Tran T, Dwyer T, Nguyen T, Casey GJ, Anne Simpson J, Hanieh S, Biggs BA: Prevalence and risk factors for symptoms of common mental disorders in early and late pregnancy in Vietnamese women: a prospective population-based study. J Affect Dis 2013, 146:213-219.
• [32]Varma D, Chandra PS, Thomas T, Carey MP: Intimate partner violence and sexual coercion among pregnant women in India: Relationship with depression and post-traumatic stress disorder. J Affect Dis 2007, 102:227-235.
• [33]Melo EF Jr, Cecatti JG, Pacagnella RC, Leite DF, Vulcani DE, Makuch MY: The prevalence of perinatal depression and its associated factors in two different settings in Brazil. J Affect Dis 2012, 136:1204-1208.
• [34]Sawyer A, Ayers S, Smith H: Pre- and postnatal psychological wellbeing in Africa: a systematic review. J Affect Dis 2010, 123:17-29.
• [35]Leung WC, Kung F, Lam J, Leung TW, Ho PC: Domestic violence and postnatal depression in a Chinese community. Int J Gynaecol Obstet 2002, 79:159-166.
• [36]Romito P, Pomicino L, Lucchetta C, Scrimin F, Turan JM: The relationships between physical violence, verbal abuse and women’s psychological distress during the postpartum period. J Psychosom Obstet Gynecol 2009, 30:115-121.
• [37]Cohen MM, Schei B, Ansara D, Gallop R, Stuckless N, Stewart DE: A history of personal violence and postpartum depression: is there a link? Arch Womens Ment Health 2002, 4:83-92.
• [38]Records K, Rice MJ: Lifetime physical and sexual abuse and the risk for depression symptoms in the first 8 months after birth. J Psychosom Obstet Gynecol 2009, 30:181-190.
• [39]Gomez-Beloz A, Williams MA, Sanchez SE, Lam N: Intimate partner violence and risk for depression among postpartum women in Lima, Peru. Violence Vict 2009, 24:380-398.
• [40]Ali NS, Ali BS, Azam IS: Post partum anxiety and depression in peri-urban communities of Karachi, Pakistan: a quasi-experimental study. BMC Public Health 2009, 12:384.
• [41]Ludermir AB, Schraiber LB, D’Oliveira AFPL, Ivan França-Junior I, Jansen HA: Violence against women by their intimate partner and common mental disorders. Soc Sci Med 2008, 66:1008-1018.
• [42]Tiwari A, Chan KL, Fong D, Leung WC, Brownridge DA, Lam H, Wong B, Lam CM, Chau F, Chan A, Cheung KB, Ho PC: The impact of psychological abuse by an intimate partner on the mental health of pregnant women. BJOG 2008, 115:377-384.
• [43]Reichenheim ME, Moraes CL, Oliveira ASD, Lobato G: Revisiting the dimensional structure of the Edinburgh Postnatal Depression Scale (EPDS): empirical evidence for a general factor. BMC-Med Res Methodol 2011, 11:94. BioMed Central Full Text
• [44]Moraes CL, de Oliveira AS, Reichenheim ME, Lobato G: Severe physical violence between intimate partners during pregnancy: a risk factor for early cessation of exclusive breast-feeding. Public Health Nutr 2011, 14:2148-2155.
• [45]Lobato G, Moraes CL, Dias AS, Reichenheim ME: Alcohol misuse among partners: a potential effect modifier in the relationship between physical intimate partner violence and postpartum depression. Soc Psychiatry Psychiatr Epidemiol 2012, 47:427-438.
• [46]Lobato G, Brunner MA, Dias MA, Moraes CL, Reichenheim ME: Higher rates of postpartum depression among women lacking care after childbirth: clinical and epidemiological importance of missed postnatal visits. Arch Womens Ment Health 2012, 15:145-146.
• [47]Lobato G, Moraes CL, Dias AS, Reichenheim ME: Postpartum depression according to time frames and sub-groups: a survey in primary health care settings in Rio de Janeiro, Brazil. Arch Womens Ment Health 2011, 14:187-193.
• [48]Sampaio PF, Moraes CL, Reichenheim ME, Oliveira AS, Lobato G: [Birth in Baby-Friendly Hospitals in Rio de Janeiro, Brazil: a protective factor for breastfeeding?]. Cad Saude Publica 2011, 27:1349-1361.
• [49]Alexandre GC, Nadanovsky P, Moraes CL, Reichenheim M: The presence of a stepfather and child physical abuse, as reported by a sample of Brazilian mothers in Rio de Janeiro. Child Abuse Negl 2010, 34:959-966.
• [50]Alexandre GC, Nadanovsky P, Wilson M, Daly M, Moraes CL, Reichenheim M: Cues of paternal uncertainty and father to child physical abuse as reported by mothers in Rio de Janeiro, Brazil. Child Abuse Negl 2011, 35:567-573.
• [51]Bottino MN, Nadanovsky P, Moraes CL, Reichenheim ME, Lobato G: Reappraising the relationship between maternal age and postpartum depression according to the evolutionary theory: Empirical evidence from a survey in primary health services. J Affect Dis 2012, 142:219-224.
• [52]Brazilian Criterion of Economic Classification http://www.abep.org/new/Servicos/Download.aspx?id=08 webcite
• [53]Reichenheim ME, Harpham T: An intra-community profile of nutritional deficiency: a study of children under 5 years of age in a low-income community in Rio de Janeiro (Brazil). Rev Saude Publica 1990, 24:69-79.
• [54]Russell M, Martier SS, Sokol RJ, Mudar P, Bottoms S, Jacobson S, Jacobson J: Screening for pregnancy risk-drinking. Alcohol Clin Exp Res 1994, 18:1156-1161.
• [55]Moraes CL, Viellas EF, Reichenheim ME: Assessing alcohol misuse during pregnancy: evaluating psychometric properties of the CAGE, T-ACE, and TWEAK in a Brazilian setting. J Stud Alcohol 2005, 66:165-173.
• [56]Mayfield D, McLeod G, Hall P: The CAGE questionnaire: validation of a new alcoholism screening instrument. Am J Psych 1974, 131:1121-1123.
• [57]Ewing JA: Detecting alcoholism: The CAGE questionnaire. JAMA 1984, 252:1905-1907.
• [58]Masur J, Monteiro MG: Validation of the “CAGE” alcoholism screening test in a Brazilian psychiatric inpatient hospital setting. Braz J Med Biol Res 1983, 16:215-218.
• [59]Smart RG, Arif A, Hughes P, Medina Mora ME, Navaratnam V, Varma VK, Wadud KA: Drugs use among non-student youth. In. Geneva: World Health Organization; 1981.
• [60]Straus MA, Hamby SL, Boney-McCoy S, Sugarman DB: The revised Conflict Tactics Scales (CTS2): Development and preliminary psychometric data. J Fam Issues 1996, 17:283-316.
• [61]Moraes CL, Hasselmann MH, Reichenheim ME: Portuguese-language cross-cultural adaptation of the Revised Conflict Tactics Scales (CTS2), an instrument used to identify violence in couples. Cad Saude Publica 2002, 18:163-176.
• [62]Moraes CL, Reichenheim ME: Cross-cultural measurement equivalence of the Revised Conflict Tactics Scales (CTS2) Portuguese version used to identify violence within couples. Cad Saude Publica 2002, 18:783-796.
• [63]Harding TW, de Arango MV, Baltazar J, Climent CE, Ibrahim HH, Ladrido-Ignacio L, Murthy RS, Wig NN: Mental disorders in primary health care: a study of their frequency and diagnosis in four developing countries. Psychol Med 1980, 10:231-241.
• [64]Harpham T, Reichenheim ME, Oser R, Thomas E, Hamid N, Jaswal S, Ludermir A, Aidoo M: How to measure mental health in a cost-effective manner. Health Policy Plan 2003, 18:344-349.
• [65]Mari JJ, Williams P: Misclassification by psychiatric screening questionnaires. J Chron Dis 1986, 39:371-378.
• [66]Mari JJ, Williams P: A validity study of a psychiatric screening questionnaire (SRQ-20) in primary care in the city of Sao Paulo. Br J Psychiatry 1986, 148:23-26.
• [67]Goldberg DP, Blackwell B: Psychiatric illness in general practice. A detailed study using a new method of case identification. Br Med J 1970, 1:439-443.
• [68]Scazufca M, Menezes PR, Vallada H, Araya R: Validity of the self reporting questionnaire-20 in epidemiological studies with older adults: results from the Sao Paulo Ageing & Health Study. Soc Psychiatry Psychiatr Epidemiol 2009, 44:247-254.
• [69]Iacoponi E, Mari JJ: Reliability and factor structure of the Portuguese version of Self-Reporting Questionnaire. Int J Soc Psychiatry 1989, 35:213-222.
• [70]Santos KO, Araujo TM, Oliveira NF: [Factor structure and internal consistency of the Self-Reporting Questionnaire (SRQ-20) in an urban population]. Cadernos de Saúe Pública 2009, 25:214-222.
• [71]Muthén LK, Muthén BO: Mplus User’s Guide. 7th edition. Los Angeles: Muthén & Muthén; 1998-2012.
• [72]Kline RB: Principles and practice of structural equation modeling. 3rd edition. London: The Guilford Press; 2011.
• [73]Brown TA: Confirmatory Factor Analysis for Applied Research. New York: The Guilford Press; 2006.
• [74]Hu L, Bentler PM: Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struct Equ Modeling 1999, 6:1-55.
• [75]Hu L, Bentler PM: Fit indices in covariance structure modeling: Sensitivity to underparameterized model misspecification. Psychol Methods 1998, 3:424-453.
• [76]Browne MW, Cudeck R: Alternative ways of assessing model fit. In Testing structural equation models. Edited by Bollen KA, Long JS. London: Sage Publications Inc; 1993:136-162.
• [77]Tucker LR, Lewis C: A reliability coefficient for maximum likelihood factor analysis. Psychometrika 1973, 38:1-10.
• [78]Schmidt MI, Duncan BB, Azevedo e Silva G, Menezes AM, Monteiro CA, Barreto SM, Chor D, Menezes PR: Chronic non-communicable diseases in Brazil: burden and current challenges. Lancet 2011, 377:1949-1961.
• [79]Reichenheim ME, Souza ER, Moraes CL, Mello Jorge MH, Silva CM, Minayo MCS: Violence and injuries in Brazil: the effect, progress made, and challenges ahead. Lancet 2011, 377:1962-1975.
• [80]Woolhouse H, Gartland D, Hegarty K, Donath S, Brown SJ: Depressive symptoms and intimate partner violence in the 12 months after childbirth: a prospective pregnancy cohort study. BJOG 2012, 119:315-323.
• [81]Feld SL, Straus MA: Escalation and desistance of wife assault in marriage. Criminology 1989, 27:141-162.
• [82]Beck CT: Predictors of postpartum depression: an update. Nurs Res 2001, 50:275-285.
• [83]O’Hara MW, Swain AM: Rates and risks of postpartum depression: a meta- analysis. Int Rev Psychiatry 1996, 8:37-54.
• [84]Xie RH, He G, Koszycki D, Walker M, Wen SW: Prenatal social support, postnatal social support, and postpartum depression. Ann Epidemiol 2009, 19:637-643.
• [85]Matt G, Vazquez C, Campbell WK: Mood-congruent recall of affectively toned stimuli: a meta-analytical review. Clin Psychol Rev 1992, 12:227-255.
• [86]Dennis CL, Creedy D: Psychosocial and psychological interventions for preventing postpartum depression. Cochrane Database Syst Rev 2013., 28CD001134
• [87]Dennis CL, Hodnett E: Psychosocial and psychological interventions for treating postpartum depression. Cochrane Database Syst Rev 2007., 17CD006116
• [88]Dennis CL, Ross LE, Herxheimer A: Oestrogens and progestins for preventing and treating postpartum depression. Cochrane Database Syst Rev 2008., 8CD001690
• [89]Yawn BP, Dietrich AJ, Wollan P, Bertram S, Graham D, Huff J, Kurland M, Madison S, Pace WD: TRIPPD: a practice-based network effectiveness study of postpartum depression screening and management. Ann Fam Med 2012, 10:320-329.
• [90]Ho SM, Heh SS, Jevitt CM, Huang LH, Fu YY, Wang LL: Effectiveness of a discharge education program in reducing the severity of postpartum depression: a randomized controlled evaluation study. Patient Educ Couns 2009, 77:68-71.
• [91]Silverman ME, Loudon H: Antenatal reports of pre-pregnancy abuse is associated with symptoms of depression in the postpartum period. Arch Womens Ment Health 2010, 13:411-415.
• [92]Wilton G, Moberg DP, Fleming MF: The effect of brief alcohol intervention on postpartum depression. MCN Am J Matern Child Nurs 2009, 34:297-302.