Domestic Violence and Perinatal Mental Disorders: A Systematic Review and Meta-Analysis

BackgroundDomestic violence in the perinatal period is associated with adverse obstetric outcomes, but evidence is limited on its association with perinatal mental disorders. We aimed to estimate the prevalence and odds of having experienced domestic violence among women with antenatal and postnatal mental disorders (depression and anxiety disorders including post-traumatic stress disorder [PTSD], eating disorders, and psychoses).Methods and FindingsWe conducted a systematic review and meta-analysis (PROSPERO reference CRD42012002048). Data sources included searches of electronic databases (to 15 February 2013), hand searches, citation tracking, update of a review on victimisation and mental disorder, and expert recommendations. Included studies were peer-reviewed experimental or observational studies that reported on women aged 16 y or older, that assessed the prevalence and/or odds of having experienced domestic violence, and that assessed symptoms of perinatal mental disorder using a validated instrument. Two reviewers screened 1,125 full-text papers, extracted data, and independently appraised study quality. Odds ratios were pooled using meta-analysis.Sixty-seven papers were included. Pooled estimates from longitudinal studies suggest a 3-fold increase in the odds of high levels of depressive symptoms in the postnatal period after having experienced partner violence during pregnancy (odds ratio 3.1, 95% CI 2.7–3.6). Increased odds of having experienced domestic violence among women with high levels of depressive, anxiety, and PTSD symptoms in the antenatal and postnatal periods were consistently reported in cross-sectional studies. No studies were identified on eating disorders or puerperal psychosis. Analyses were limited because of study heterogeneity and lack of data on baseline symptoms, preventing clear findings on causal directionality.ConclusionsHigh levels of symptoms of perinatal depression, anxiety, and PTSD are significantly associated with having experienced domestic violence. High-quality evidence is now needed on how maternity and mental health services should address domestic violence and improve health outcomes for women and their infants in the perinatal period.Please see later in the article for the Editors' Summary【背景】围产期家庭暴力与不良产科结局密切相关，但目前关于其与围产期精神障碍的关联证据仍较为有限。本研究旨在评估产前及产后精神障碍（包括抑郁障碍、焦虑障碍、创伤后应激障碍（PTSD）、进食障碍及精神病性障碍）患者中曾遭受家庭暴力的患病率与风险比。 【研究方法与结果】本研究开展了系统综述与meta分析（系统综述注册平台PROSPERO注册号：CRD42012002048）。数据来源涵盖截至2013年2月15日的电子数据库检索、手工检索、引文追踪、针对被害与精神障碍相关综述的更新，以及专家推荐文献。纳入研究需为经同行评议的实验或观察性研究，研究对象为16岁及以上女性，需评估曾遭受家庭暴力的患病率和/或风险比，并采用经过验证的工具评估围产期精神障碍症状。两名研究者独立筛选1125篇全文文献、提取数据并评估研究质量。采用meta分析合并风险比数据。最终纳入67篇文献。纵向研究的合并分析结果显示，孕期遭受伴侣暴力后，产后出现重度抑郁症状的风险增加3倍（合并比值比OR=3.1，95%置信区间CI：2.7~3.6）。横断面研究一致报道，产前及产后存在重度抑郁、焦虑及PTSD症状的女性，曾遭受家庭暴力的风险显著升高。目前尚未检索到针对进食障碍或产褥期精神病的相关研究。由于研究间异质性较高且缺乏基线症状数据，本分析难以明确因果关联方向，存在一定局限性。 【结论】围产期抑郁、焦虑及PTSD的重度症状与曾遭受家庭暴力存在显著关联。目前亟需高质量研究，以明确产科及精神卫生服务应如何应对家庭暴力问题，改善围产期女性及其婴儿的健康结局。详见本文后文的编辑摘要。