Depression and partner violence before and after childbirth

This thesis comprises studies of prevalence and indicators of depressive mood during pregnancy, two months and one year post partum as well as on studies of prevalence, and indicators of being hit by the partner in the first post partum year and disclosure of such violence. A national cohort of 4600 Swedish-speaking women were recruited to the KUB project (Kvinnors Upplevelse av Barnafödande) and consists of about 70 percent of women enrolled in early pregnancy to antenatal care during three predestined weeks. These women answered three questionnaires, the first in early pregnancy (mean gestational week 16), the second two months post partum (mean 10 weeks) and the final one year post partum (mean 12 months and 3 weeks). Depressive mood were assessed by EPDS (Edinburgh Postnatal Depression Scale), a self-report scale designed for the postnatal period assessing the intensity of depressive mood during the prior week. A positive answer to the question "During the previous year, have you been hit at anytime by your partner?" indicates partner violence. As a follow up question we asked "If you have been hit, have you told anyone?" where "Yes" indicates disclosure. We found the prevalence of depressive mood during pregnancy to be eight percent. At two months post partum the prevalence was 12 percent; among these women, half had depressive mood also during pregnancy. Three percent of the women were prospectively identified with depressive mood at all three assessments. Indicators for depressive mood were; frequency of stressful life events in the year prior to pregnancy, having a native language other than Swedish and unemployment. The prevalence of being hit during the first post partum year was two percent (52/2563). Of the women being hit, about two thirds disclose having been hit during the first postpartum year, only 3 women reported the event to police. Indicators in early pregnancy for being hit by the partner during the first year post partum were; age 24 years or younger, country of birth outside Europe, having a partner born outside Europe, being single and being unemployed. Our findings translate to, in Sweden each year, about 8000 women have depressive mood during pregnancy and about 3000 women have recurrent or sustained depressive mood during pregnancy and the year after giving birth;. Also, approximately 2000 women are being hit the first post partum year. This is an estimation based on 99 157 births in Sweden during 2003. Midwives caring for women during pregnancy and child birth have significant opportunities to deal with these two significant public health problems; findings of these indicators in early pregnancy may improve the identification of women who are symptomatic or at risk and prevent unnecessary diagnostic procedures for diffuse somatic and psychological symptoms. However, before a broad implication of the findings in this thesis can be made interventional measures must be developed and evaluated