title: Violence against women by their intimate partner during pregnancy and postnatal depression: a prospective cohort study.
abstract: BACKGROUND
  Partner violence against women is common during pregnancy and might have an adverse effect on the mental health of women after delivery. We aimed to investigate the association of postnatal depression with psychological, physical, and sexual violence against women by their intimate partners during pregnancy.
  
  
  METHODS
  In a prospective cohort study undertaken in Recife, northeastern Brazil, between July, 2005, and December, 2006, we enrolled pregnant women (aged 18-49 years) in their third trimester of pregnancy who were attending primary health-care clinics. The women were interviewed during pregnancy and after delivery. The form of partner violence in pregnancy was assessed with a validated questionnaire, and the Edinburgh postnatal depression scale was used to measure postnatal depression. Associations were estimated with odds ratios (ORs), adjusted for confounding factors contributing to the association between postnatal depression and intimate partner violence.
  
  
  RESULTS
  1133 pregnant women were eligible for inclusion in the study, of whom 1045 had complete data for all variables and were included in the analysis. 270 women (25.8%, 95% CI 23.2-28.6) had postnatal depression. The most common form of partner violence was psychological (294 [28.1%, 25.4-31.0]). Frequency of psychological violence during pregnancy was positively associated with occurrence of postnatal depression, and although this association was attenuated after adjustment, women reporting the highest frequency of psychological violence were more likely to have postnatal depression even after adjustment (adjusted OR 2.29, 95% CI 1.15-4.57). Women who reported physical or sexual violence in pregnancy were more likely to develop postnatal depression (OR 3.28, 2.29-4.70), but this association was substantially reduced after adjustment for psychological violence and confounding factors.
  
  
  CONCLUSIONS
  Psychological violence during pregnancy by an intimate partner is strongly associated with postnatal depression, independently of physical or sexual violence. This finding has important policy implications since most social policies focus on prevention and treatment of physical violence.
  
  
  BACKGROUND
  Departamento de Ciência e Tecnologia da Secretaria de Ciência, Tecnologia, e Insumos Estratégicos, and Conselho Nacional de Desenvolvimento Científico e Tecnológico (Brazil).
authors.affiliation: Programa de Pós-Graduação Integrado em Saúde Coletiva, Universidade Federal de Pernambuco, Hospital das Clínicas, Cidade Universitária, Recife, PE, Brazil. abl@ufpe.br
authors.forename: Ana Bernarda
authors.initials: AB
authors.lastname: Ludermir
authors.forename: Glyn
authors.initials: G
authors.lastname: Lewis
authors.forename: Sandra Alves
authors.initials: SA
authors.lastname: Valongueiro
authors.forename: Thália Velho Barreto
authors.initials: TV
authors.lastname: de Araújo
authors.forename: Ricardo
authors.initials: R
authors.lastname: Araya
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology; D001938:Brazil; D015331:Cohort Studies; D015986:Confounding Factors, Epidemiologic; D019052:Depression, Postpartum / Q000453:epidemiology* / Q000523:psychology*; D004644:Emotions; D004651:Employment; D005239:Fear / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D016017:Odds Ratio; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D011446:Prospective Studies; D012742:Sex Offenses / Q000706:statistics & numerical data; D012747:Sexual Partners / Q000523:psychology*; D012944:Social Support; D013179:Spouse Abuse / Q000523:psychology* / Q000706:statistics & numerical data; D016387:Women's Health; D055815:Young Adult