title: The role of intimate partner violence and other health-related social factors on postpartum common mental disorders: a survey-based structural equation modeling analysis.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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. michael@ims.uerj.br.
authors.forename: Michael Eduardo
authors.initials: ME
authors.lastname: Reichenheim
authors.forename: Claudia Leite
authors.initials: CL
authors.lastname: Moraes
authors.forename: Claudia Souza
authors.initials: CS
authors.lastname: Lopes
authors.forename: Gustavo
authors.initials: G
authors.lastname: Lobato
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000453:epidemiology / Q000523:psychology; D001938:Brazil / Q000453:epidemiology; D015897:Comorbidity; D005190:Family / Q000523:psychology; D005191:Family Characteristics; D005260:Female; D006306:Health Surveys / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D008393:Marriage / Q000523:psychology / Q000706:statistics & numerical data; D008423:Maternal Age; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology; D009035:Mothers / Q000523:psychology; D011247:Pregnancy; D011644:Puerperal Disorders / Q000453:epidemiology* / Q000523:psychology*; D012307:Risk Factors; D012747:Sexual Partners / Q000523:psychology*; D012959:Socioeconomic Factors; D013179:Spouse Abuse / Q000523:psychology / Q000706:statistics & numerical data; D013315:Stress, Psychological / Q000453:epidemiology / Q000523:psychology; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology; D014754:Violence / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult