ReviewIntimate partner violence against adult women and its association with major depressive disorder, depressive symptoms and postpartum depression: A systematic review and meta-analysis
Highlights
► Systematic review and meta-analysis of intimate partner violence (IPV) as a risk factor for depression in adult women. ► Selected epidemiologic studies suggested moderate or strong positive associations between IPV and depression. ► Meta-analysis suggested two to three-fold increased risk of major depressive disorder. ► Meta-analysis suggested 1.5–2-fold increased risk of elevated depressive symptoms and postpartum depression. ► A sizable proportion (9%–28%) of depressive outcomes can be attributed to lifetime exposure to IPV.
Introduction
Intimate partner violence (IPV) against women is a major public health concern in the United States and worldwide. IPV is often described as a specific type of family or domestic violence, in which the perpetrator is a current or former intimate partner of the victim. The Centers for Disease Control and Prevention (CDC) defines IPV as “physical violence, sexual violence, threats of physical/sexual violence, and psychological/emotional abuse perpetrated by a current or former spouse, common-law spouse, non-marital dating partners, or boyfriends/girlfriends of the same or opposite sex” (Chang et al., 2005).
IPV is highly prevalent among women in the general population as well as those identified in clinical settings (Coker, Smith, & Fadden, 2005; Kramer, Lorenzon, & Mueller, 2004; Magnussen et al., 2004; Peralta & Fleming, 2003; Ross, Walther, & Epstein, 2004). Based on national surveys, 25–30% of women in the United States have reported physical and/or sexual abuse by an intimate partner during their lifetime, whereas 2–12% report physical and/or sexual IPV over the past year (Haggerty & Goodman, 2003; Lipsky, Holt, Easterling, & Critchlow, 2004). Based on clinical studies, the prevalence estimates of physical, sexual and/or emotional abuse against women are 21–55% over a lifetime and 4–44% in the past year (Breiding, Black, & Ryan, 2008; Tjaden and Thoennes, 1998a, Tjaden and Thoennes, 1998b; Tjaden & Thoennes, 2000).
IPV is associated with a wide range of short-term and long-term physical and mental health sequelae. Victims of IPV were shown to be at an increased risk for injury (Burke, Thieman, Gielen, O'Campo, & McDonnell, 2005; Campbell, 2002), disability (Coker, Smith, Bethea, King, & McKeown, 2000; Coker et al., 2005), chronic pain (Burke et al., 2005; Campbell, 2002; Koopman et al., 2005; Kramer et al., 2004), arthritis (Coker et al., 2000), headaches or migraine (Coker et al., 2000; Kramer et al., 2004), gastrointestinal signs (Burke et al., 2005; Campbell, 2002), vaginal bleeding and sexually transmitted infections (Burke et al., 2005; Campbell, 2002; Kramer et al., 2004), substance use and abuse (Campbell, 2002; Fals-Stewart & Kennedy, 2005), social dysfunction (Burke et al., 2005; Campbell, 2002), insomnia (Burke et al., 2005; Campbell, 2002), post-traumatic stress disorder (Bradley, Schwartz, & Kaslow, 2005; Koopman et al., 2005; Woods, 2005; Woods et al., 2005), anxiety (Burke et al., 2005; Campbell, 2002), depression (Al-Modallal, Peden, & Anderson, 2008; Golding, 1999) and suicidal thoughts (Kramer et al., 2004; Meadows, Kaslow, Thompson, & Jurkovic, 2005).
The salience of IPV as a risk factor for mental health problems, in general, and depression, in particular, requires further evaluation. To date, few systematic reviews of observational studies have been conducted to comprehensively evaluate the co-morbidity of IPV and depression in women (Al-Modallal et al., 2008; Golding, 1999). In addition, no recent meta-analyses have been conducted to estimate the magnitude of the association between IPV and specific types of depressive outcomes. In 1999, Golding published a meta-analysis to assess the prevalence of mental health problems among women with a history of intimate partner violence. The prevalence of mental health problems among women experiencing IPV was 47.6% in 18 studies of depression, 17.9% in 13 studies of suicidality, 63.8% in 11 studies of post-traumatic stress disorder, 18.5% in 10 studies of alcohol abuse, and 8.9% in 4 studies of drug abuse. Odds ratios (OR) representing associations of these mental health problems with IPV ranged from 3.55 to 5.62, and were generally consistent across studies (Golding, 1999). In Golding's meta-analysis, no distinction was made regarding specific types of depression; the estimated OR (95% confidence interval) for the association between IPV and depression was 3.80 (3.16–4.57) (Golding, 1999). In this systematic review and meta-analysis, we conducted a PubMed (1980–2010) search of population-based and clinical studies focusing on pregnant and non-pregnant women to summarize the extant literature and estimate the magnitude of the association between IPV and key depressive outcomes (elevated depressive symptoms (EDS) detected by various screening instruments, diagnosed major depressive disorder (MDD) and postpartum depression (PPD)).
Section snippets
Search methodology
The literature search was conducted systematically using the PubMed database by combining the keywords “depression” and “intimate partner violence.” To avoid heterogeneity in the way these concepts were defined, synonymous keywords were not included in the search. We restricted the literature search to human studies in the English-language published between 1 January 1980 and 31 December 2010. Fig. 1 shows the result of the search, inclusion and exclusion criteria and the final number of
Results
Table 1 characterizes the 37 studies included in our systematic review and meta-analysis. Although our literature search spanned publication years of 1980 until 2010, relevant studies which we finally selected were published between the years 2000 and 2010. Twenty-four of the 37 studies were conducted in the United States; 32 were cross-sectional studies while only five were prospective or retrospective cohort studies. Sample sizes ranged between 101 and 7154 surveyed participants, with about
Discussion
In this study, we conducted a systematic review and a meta-analysis of published research articles (1980–2010) that examined the relationship between IPV and various outcomes related to depression, namely MDD, EDS and PPD. Of the selected 37 studies, most had a cross-sectional population-based design, were focused on EDS as the outcome of interest and were conducted in the United States. A large number of studies found a moderate or a strong positive association between IPV and depression. This
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