Intimate partner violence (IPV) severity has a statistically significant association with depression symptom severity among pregnant women and new mothers living in poor neighborhoods in Cape Town, South Africa, according to a cohort study published the week in PLOS Medicine. The study, conducted by Alexander C. Tsai at Massachusetts General Hospital, Boston, and colleagues at Stellenbosch University, South Africa and the University of California at Los Angeles, shows that IPV and depression in this setting have a bidirectional association: IPV was associated with increased risk of future depression, and depression was associated with increased risk of future victimization.
Few if any prior studies on the association between IPV and depression have been conducted in sub-Saharan Africa, where the rates of IPV against women are among the highest in the world. In this population-based prospective cohort study, Tsai and colleagues analyzed longitudinal data collected during a cluster-randomized trial that involved more than 1,200 women living in townships near Cape Town. In a regression model adjusting for several potential confounders, lagged IPV intensity had a statistically significant association with depression symptom severity (regression coefficient b = 1.04; 95% CI, 0.61-1.47). Notably, this association was bidirectional-- lagged depression symptom severity was also associated with intimate partner violence (b = 0.054; 95% CI, 0.030-0.079). This finding suggests that combination interventions addressing both violence and mental health may be needed to interrupt the cycle.
Assessment of IPV was limited, particularly as participants were not asked about sexual violence. Nonetheless, the results underscore the importance of IPV in mental health among women in this group. The authors state, "It is possible that combined interventions, such as a broad-based package of services (e.g., case management, crisis services, legal aid, transitional housing, and childcare support) plus cognitive-behavioral therapy may be effective in interrupting the cycle of IPV and depression, but the effectiveness of such a multi-component approach is as of yet unknown."
This study was funded by U.S. National Institutes of Health (NIH) R01AA017104 and supported by R24AA022919, P30MH058107 (Center for HIV Identification, Prevention, and Treatment Services), P30AI028697 (UCLA Center for AIDS Research), and UL1TR000124 (National Center for Advancing Translational Science through the UCLA Clinical and Translational Science Institute). The authors also acknowledge salary support through K23MH096620 (ACT) and the National Research Foundation of South Africa (MT). MT is a lead investigator with the Centre of Excellence in Human Development, University of Witwatersrand, South Africa. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
ACT is a Consulting Editor, and MT an Academic Editor, for PLOS Medicine. ACT is also an Academic Editor for PLOS ONE. The other authors have declared that no competing interests exist.
Tsai AC, Tomlinson M, Comulada WS, Rotheram-Borus MJ (2016) Intimate Partner Violence and Depression Symptom Severity among South African Women during Pregnancy and Postpartum: Population-Based Prospective Cohort Study. PLoS Med 13(1): e1001943. doi:10.1371/journal.pmed.1001943
Massachusetts General Hospital, MGH Global Health, Boston, Massachusetts, United States of America
Harvard Center for Population and Development Studies, Cambridge, Massachusetts, United States of America
Mbarara University of Science and Technology, Mbarara, Uganda
Stellenbosch University, Stellenbosch, South Africa
Center for HIV Identification, Prevention and Treatment Services, University of California at Los Angeles, Los Angeles, California, United States of America
Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California, United States of America
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