Date of Award

4-2014

Degree Name

Doctor of Philosophy

Department

Interdisciplinary Health Sciences

First Advisor

Dr. Amy B. Curtis

Second Advisor

Dr. Angela M. Moe

Third Advisor

Dr. James Wiley

Abstract

Problem: Despite the wealth of research documenting the individual links between maternal depression, partner violence, and poverty, important gaps remain regarding their combined interactions, and their variation related to perinatal timing (pregnancy and postpartum). The current dissertation examined the interplay of these phenomena across perinatality.

Methods: This dissertation utilized secondary analysis of telephone survey data from a representative sample of women recruited during their postpartum hospital stay and interviewed four times over the subsequent 18 months. Linear regression was used for predictive modeling of fixed effects, and generalized estimating equation regression was used for multivariate analysis of temporal trends.

Findings: Depression and partner violence were strongly and directly related to each other regardless of maternal psychosocial condition, socioeconomic context, or time period. However, distinct trends associated with both perinatality and socioeconomic status were identified. Postpartum women displayed two peaks in depression, both marked by a history of partner violence compared to non-depressed women, but the early peak was characterized by greater depression severity and was more likely to occur among poor women compared to the later peak. Perinatality was found to be generally protective against partner abuse for women at all income levels. However, among the 5.4% assaulted during the most recent pregnancy or postpartum, poor women were more likely to experience persistent abuse throughout the entire period, while higher income women were more likely to report one of the two abuse patterns: Prenatal-reprieve (cessation during pregnancy with resumption postpartum), or Prenatal-only (onset during pregnancy with cessation postpartum). Finally, partner abuse was directly tied to both poverty and postpartum depression, but the relationship of poverty and depression was indirect, and moderated by partner abuse: Only poor women who were abused had more depression than higher-income women, but poor women who were not abused had no higher depression risk than higher-income women.

Conclusions: Women with a history of partner violence have significantly elevated risk of postpartum depression throughout the 2 years after delivery. Although perinatality is protective against abuse, poor women are more likely to experience partner violence not just before pregnancy but throughout pregnancy and postpartum compared to higher-income women.

Access Setting

Dissertation-Open Access

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