IPV/PMADS

INTIMATE PARTNER VIOLENCE & ITS IMPACT ON PERINATAL MOOD & ANXIETY DISORDERS

Introduction

• Focus on the definition and relevance of intimate partner violence (IPV).

• Emphasizes the impact of IPV on perinatal mood and anxiety disorders.

Definition of Intimate Partner Violence (IPV)

• Intimate Partner Violence:

  • Behaviors used by a person to control their partner.

  • Abuse or aggression that occurs in close relationships, which can include intimate partners, roommates, or adult relatives.

  • May involve emotional abuse and threats against children.

  • Source: CDC, 2019.

Characteristics of IPV

• Intentional violent or controlling behavior:

  • Occurs among both current and former spouses or dating partners.

  • Does not require sexual intimacy.

  • Exists on a continuum, from a single episode of violence with lasting effects to chronic severe incidents occurring over many years.

  • Source: CDC, 2019.

Victims of IPV

Risk Factors

• Survivors come from diverse backgrounds:

  • All age groups.

  • Various religious, ethnic/racial groups.

  • Different socioeconomic statuses and educational levels.

  • All sexual orientations and gender identities.

Statistical Overview

• Nearly 1 in 5 women and 1 in 7 men report severe physical violence from an intimate partner in their lifetime.

• Approximately 1 in 5 women and 1 in 12 men have experienced contact sexual violence by an intimate partner.

• 10% of women and 2% of men report being stalked by an intimate partner.

• Over 43 million women and 38 million men have encountered psychological aggression from an intimate partner in their lifetime.

  • Source: CDC, 2019.

Physical and lethal effects

• 41% of female IPV survivors and 14% of male survivors sustain some form of physical injury related to IPV.

• 16% of homicide victims are killed by an intimate partner (approximately 1 in 6).

• Arizona's IPV firearm homicide rate is 45% above the national average; Pima County exhibits higher rates than Maricopa County in IPV firearm homicides.

Economic Impact

• The cost of IPV throughout a victim's lifetime:

  • Estimated at $103,767 for women and $23,414 for men.

• Total estimated economic cost of IPV is $3.6 trillion, encompassing medical care, mental health services, lost productivity, and criminal justice expenses.

  • Source: CDC, 2019.

Socio-Demographic Considerations

• Indigenous women, such as those from Native American and Alaska Native communities, report significantly high rates of violence: 84% have experienced violence, including 56% from sexual violence.

  • Source: NIH, 2016.

The Nature of Control and Abuse in Relationships

Power & Control

• Abuse fundamentally centers on exerting control over others, with different forms including:

  • Physical violence.

  • Sexual violence.

  • Threats of violence.

  • Reproductive coercion and psychological/emotional abuse:

  • Progressive isolation and intimidation.

  • Economic abuse that hampers victim separation.

  • All these behaviors are often reinforced by societal norms and peer behavior.

Recognizing the Pattern of Violence

• Abuse often escalates without intervention:

  • Physical: Ranges from pushing to homicide.

  • Verbal: From name-calling to victim suicide.

  • Sexual: Involves unwanted touching to rape.

Impact of IPV on Mental Health

Short- and Long-Term Health Problems

• Women experiencing IPV face severe psychological consequences:

  • Depression, anxiety, eating disorders, psychosis, suicidal ideation, and attempts.

Violence During Pregnancy

• 4-8% of women report violence during pregnancy, often derived from intentions aimed at the unborn child.

  • Risk factors include:

  • Young maternal age/adolescence.

  • Unintended pregnancy.

  • Delayed prenatal care.

  • Negative health behaviors (smoking, substance use).

  • Lack of social support.

  • STIs/HIV/AIDS.

Maternal and Fetal Complications

• Abuse during pregnancy leads to various complications:

  • Miscarriage.

  • Preterm labor (linked to stress, assaults, and STIs).

  • Nutritionally deficient maternal diet and inadequate pre-natal care.

  • Low infant birth weight.

• Chaotic lifestyles resulting from IPV can also contribute to increased maternal and fetal risks including:

  • Housing problems, sleep deprivation, substance abuse (including nicotine), and neglect of maternal self-care.

  • Maternal stress responses cause physiological changes such as high blood pressure and reduced blood flow to the uterus and fetus.

Postpartum Risks

• Increased risk of postpartum depression due to:

  • Physical injuries and lack of adequate rest/nutrition.

  • Disruption of maternal-infant bonding, increasing risk of harm to the infant.

IPV Among Teens

• Teens also experience IPV; about 1 in 11 female and 1 in 15 male teens reported physical dating violence in the past year.

• 26% of women and 15% of men experience IPV for the first time before the age of 18.

• Youth victims of violence are more likely to:

  • Exhibit symptoms of depression and anxiety.

  • Engage in unhealthy behaviors such as substance use or exhibit antisocial behaviors.

Reasons for Staying in Violent Relationships

• Victims often stay for multiple reasons:

  • Emotional and financial dependence.

  • Believing they can help their partner change.

  • Fear of escalating violence if they leave.

  • Lack of support systems and tolerable living conditions.

• Key Insight: Leaving abusive relationships often involves multiple attempts, highlighting the need for survivor-centered safety planning.

Adverse Childhood Experiences (ACEs)

• ACEs significantly impact future violence victimization and perpetration, as well as lifelong health.

  • Linked to risky health behaviors, chronic health conditions, low life potential, and early death.

The ACEs Study

• Conducted by Kaiser Permanente (1995-1997), this study involved over 17,000 individuals who underwent physical exams and confidential surveys regarding childhood experiences and current health status.

• Categories of Adverse Experiences:

  • Abuse: Physical, sexual, emotional.

  • Neglect: Emotional, physical.

  • Household Challenges: Substance abuse, separation/divorce, mental illness, violence, and incarceration within the home.

ACEs Score

• A cumulative measure of childhood trauma affecting long-term health outcomes.

• Each ACE type is equally weighted; an increasing number of ACEs corresponds with higher health risks.

Addressing ACEs

• Interventions:

  • Home visitation for pregnant women and families with newborns.

  • Parenting training and support programs.

  • Counseling for mental health and substance abuse.

  • Providing social support and economic stability for low-income families.

Perinatal Mood & Anxiety Disorders (PMADs)

• PMADs encompass a range of disorders, including:

  • Depression, anxiety disorders, obsessive-compulsive disorder, and post-traumatic stress disorder.

• Associated with serious public health concerns including adverse effects on the fetus and risk of postpartum psychopathology.

Prevalence of PMADs

• PMADs are the leading complication during pregnancy and childbirth:

  • Affect approximately 20% of women prenatally and 15-20% postpartum.

Risk Factors for PMADs

• Personal and family history of behavioral disorders, traumatic experiences, and low educational attainment heighten risk.

• Specific pregnancy and childbirth experiences (e.g., difficult labor) further contribute to increased probabilities of developing PMADs.

Untreated PMADs

• Consequences of untreated PMADs extend to the mother and infant, leading to:

  • Emotional changes after childbirth (75-80% report some distress).

  • Long-term issues such as parenting inadequacies and child attachment issues.

Screening and Intervention for PMADs

• Screening Tools:

  • Edinburgh Postnatal Depression Scale (EPDS).

  • Generalized Anxiety Disorder Scale (GAD-7).

  • Patient Health Questionnaire (PHQ-9).

Community Resources

• Local and national organizations (e.g., Tucson Postpartum Depression Coalition, Postpartum Support International) provide support, active resources, and therapeutic referrals for PMADs and IPV.