CHAMPAIGN, Ill. — New mothers who are in abusive relationships are three times more likely to have suicidal thoughts, a new study suggests. Conducted with women in Brazil, the study is among a growing body of research to establish a link between suicidality and intimate partner violence among postpartum women in low- or middle-income countries.
More than 700 women between the ages of 16 and 44 participated in the research. Recruited as prenatal patients at 10 public health care clinics in Sao Paolo, the women were interviewed in their homes up to one year after giving birth.
Women in the study were asked if they had experienced specific acts of emotional, psychological and physical violence by a current or former male partner after giving birth and the frequency at which these acts occurred. More than 24 percent of women in the sample reported that they had experienced abuse from their partner, according to the study, published in the Journal of Women’s Health.
Across the full sample, 28 percent of the new mothers met the diagnostic criteria for postpartum depression, and 89 percent of women who had postpartum depression reported thoughts of suicide. Of the women who reported suicidal thoughts, more than 70 percent said they had experienced abusive behaviors from their partners.
“Women who experienced postpartum abuse had a threefold greater risk of suicidal thoughts,” said University of Illinois social work professor Karen M. Tabb Dina, the study’s lead author.
The researchers found that the prevalence of suicidal ideation across the full sample was 4 percent, a rate very similar to that of postpartum women in the U.S., at 3.2 percent.
Tabb Dina and her co-authors examined the influence of a variety of sociodemographic variables, including women’s age, education, income, levels of social support, past psychiatric treatment and whether the pregnancy was planned.
Even after adjusting for postpartum depression and past psychiatric treatment, the association between suicidal ideation and domestic violence remained significant, Tabb Dina said.
“The findings indicated that intimate partner violence was closely associated with and contributed greatly to women’s thoughts of suicide, despite the effects of other factors,” Tabb Dina said.
Women’s risk of experiencing violence from their partners escalated across the year after childbirth, from just over 21 percent at six to nine months after delivery to more than 31 percent by their baby’s first birthday, the researchers found.
Women who experience abuse during the postpartum period are at greater risks for a variety of mental health problems, including depression, anxiety, post-traumatic stress disorder and suicide attempts, research has shown. These women also are more likely to feel less prepared for motherhood and to have difficulty bonding with their infants.
Violence in the home has substantial repercussions for children’s mental health and development as well, the researchers wrote. Exposure to violence is a traumatic stressor that can cause children to have problems with aggressive or regressive behaviors, and difficulty with mother-child attachment and emotional regulation.
Offspring of mothers who attempt suicide also are at greater risk of suicidal thoughts and attempts, research has shown.
Brazil’s maternal mortality rate is high – at 69 deaths per 100,000 women, according to statistics published by the World Health Organization in January 2015.
However, the number of suicides among women of reproductive age in Brazil is difficult to estimate because deaths in rural areas are underreported and causes of death are sometimes attributed to other factors, the researchers wrote.
Socioeconomically, the women in the current study who reported suicidal ideation and those who did not differed significantly: About two-thirds of the women who reported suicidal thoughts were living in extreme poverty, surviving on household incomes of less than $350 a month.
Despite the prevalence of domestic violence during the perinatal period and its repercussions for women and children, few researchers have explored linkages among suicidal ideation, domestic violence and maternal mortality rates, particularly in less affluent countries like Brazil, the researchers wrote.
“Although intimate partner violence and suicidal ideation during the postpartum period are significant public health problems, comprehensive practice guidelines to address intimate partner violence and its impact on new mothers and their infants’ mental health are not yet established,” Tabb Dina said.
Co-authors of the study were social work professor Teresa Ostler, alumna Erin Vanderwater and graduate student Yang Wang, all of Illinois; Miriam Valdovinos, University of Connecticut; Dr. Ramanpreet Toor, University of Washington; and Dr. Alexandre Faisal-Cury, Dr. Hsiang Huang and Paulo Rossi Menezes, all of the University of Sao Paulo.