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Violence and Postpartum Depression
About one-third of women throughout the world will experience physical and/or sexual violence at some point in their lives. Violence against women occurs in conflict, post-conflict, and non-conflict areas. A meta-analysis reviewing research on the association of violence and postpartum depression showed that violence against women increases the incidence of postpartum depression. It is important to note that the research reviewed only looked at violence experienced by women from male perpetrators, but did not consider violence inflicted on men or women by women. Further, violence against women was defined as “any act of gender-based violence that results in, or is likely to result in, physical, sexual, or psychological harm or suffering to women,”. Psychological and cultural factors associated with increased incidence of postpartum depression include family history of depression, stressful life events during early puberty or pregnancy, anxiety or depression during pregnancy, and low social support. Violence against women is a chronic stressor, so depression may occur when someone is no longer able to respond to the violence (Wu).

Intimate Partner Violence
Intimate partner violence is a specific form of violence that is estimated to be experienced by 35% of women in the United States. Meta-analysis of relevant research shows that women who had experienced intimate partner violence had 1.5-2 times increased risk of elevated depressive symptoms and postpartum depression, and 9-28% of all types of depression in women, including postpartum, was attributable to experiencing domestic violence at some point in their life. A review of emerging research shows an association of intimate partner violence with depressive symptoms in mothers during the 12 months after giving birth, and this remains true even if adjusted for previous depression.

Substance Abuse
A literature review of 5 relevant studies showed that substance-use is associated with increased incidence of postpartum depression. This is comparable to the high rates of comorbid depression seen in the general population of substance-using women. The substance-using participants in the studies discussed in the in the review article all presented with socio-demographic factors that are well associated with depression, and the one study that did not show an increase in incidence of postpartum depression among substance-using women was the only study where the socio-demographic variables were the same for the substance-using group of women and the comparison group. It is unclear whether it is the substance abuse or the impact of other social structures increasing the risk of postpartum depression among substance-using women. Regardless of whether substance use is directly or indirectly associated with incidence of postpartum depression, there are important consequences for health services providers. Another study of the literature review demonstrated that perinatal substance use increases the use of perinatal mental health services, for example, women with cocaine addiction were more likely to access outpatient mental health care during early postpartum period.

Trauma History
The literature review further reports that all but one out of eight studies examined showed significant associations between trauma history and incidence of postpartum depression, but there have been mixed results about the relative significance of different types of trauma on postpartum depression. There are studies that suggest that women with a history of physical violence report postpartum depression, but other studies show that only emotional abuse is associated with postpartum depression. This has important consequences for helping individuals suffering, because empowerment treatment, which is used as a therapy for women suffering from emotional abuse, has shown to be an effective means of reducing symptoms of postpartum depression for women that have experienced emotional abuse during pregnancy.

Chronic Illness
Depressive symptoms have been associated with some chronic illnesses, but there are other factors, such as social stigma, that may correlate the illness with depression. Hormonal changes due to pregnancy may improve or worsen these symptoms, and the effect may change after delivery. Such hormonal changes on chronic illness may affect maternal mental health. One in four studies reviewed found a significant increase in postpartum depression incidence, but only women with multiple chronic health problems were associated with higher rates of postpartum depression compared to women with just a single chronic health illness. Women with multiple chronic health problems in developing countries, where there is limited access to care compared to developed countries, were associated with increased levels of psychological stress in the postpartum period. Psychological stress is a factor positively correlated with incidence of postpartum depression.

Prevention
Many women do not seek medical services for treatment of postpartum depression, and do not receive support or assistance from family and friends. Failing to treat postpartum depression can lead to infanticide, maternal death, and suicide. Hotline for counseling services and organizations for abused women are two possible services available for women to receive support. Additionally, the American Academy of Pediatrics requires that the primary care clinician proactively screen expecting mothers, and monitor new mothers’ health.