Intimate Partner Violence Before and During Pregnancy

Abstract

Although research examining intimate partner violence (IPV) has expanded in recent years, there has been relatively little examination of the related demographic and psychosocial factors, as well as mental health outcomes, for IPV before and during pregnancy, especially in a Mexican American population. The current study provides a snapshot of the occurrence of IPV in a community sample of low-income, perinatal Mexican American women (n = 320). Results indicated that 13.1% of the women reported IPV before pregnancy and 11.3% reported IPV during pregnancy. For both IPV before and during pregnancy, women born in the United States were more likely to report IPV than foreign-born women. For IPV before pregnancy, women who were not in a serious romantic relationship or reported a history of childhood trauma were also more likely to report IPV. For IPV during pregnancy, women who reported higher general stress and lower social support were also more likely to report IPV. Finally, the current study provided strong evidence that a history of IPV predicted elevated postpartum depressive symptoms, above and beyond the impact of prenatal depressive symptoms. This study brings greater awareness to a complex and harmful situation in an understudied population. Results are discussed in terms of the relation between demographic and psychosocial risk for IPV before and during pregnancy, acculturation, and postpartum depressive symptoms, as well as the implications for the development of future prevention and intervention programs.

Keywords

interpersonal violence pregnancy Latinas postpartum depression

Intimate partner violence (IPV) is a widespread, prevalent, and serious public health issue. Definitions of IPV include physical, sexual, emotional, and/or psychological abuse and threats of harm (Centers for Disease Control and Prevention [CDC], 2009), as well as financial abuse, controlling behavior, and coercion between current and former spouses and dating partners (Stark, 2007). Estimates suggest that approximately 1.5 million women in the United States experience IPV every year, with one in four women experiencing violence from a male partner at some point during her life (Tjaden & Thoennes, 2000). In 2007, IPV was linked to 2,340 deaths in the United States (CDC, 2009).

Although research examining IPV has expanded in recent years, there has been little examination of demographic and psychosocial factors related to IPV before pregnancy and IPV during pregnancy, particularly in Mexican American women. In addition, few studies have examined the relation between a history of IPV and postpartum depressive symptoms in a community sample of Mexican American women. The aims of the present study were to (a) examine the prevalence and descriptive characteristics of IPV both before and during pregnancy; (b) investigate the relation between demographic, general psychosocial factors, and culture-specific psychosocial factors and IPV before and during pregnancy; and (c) examine the relation between a history of IPV and postpartum depressive symptoms.

IPV Before and During Pregnancy

Although IPV occurring at any time in a person’s life can be disturbing and destructive, IPV during pregnancy presents a particularly unique concern because both the woman and her unborn child are negatively affected (S. L. Martin, Harris-Britt, Li, Moracco, Kupper, & Campbell, 2004). In the United States, prevalence rates of IPV during pregnancy in general population samples have been reported to be 0.9% to 20.1%, with most studies finding a range between 3.9% and 8.3% (Peterson et al., 1997). The current study focuses on IPV among Latinas, the largest minority group in the United States, and specifically on women of Mexican origin who represent the largest subgroup (63.0%; U.S. Census Bureau, 2011). Previous research has reported the prevalence of IPV during pregnancy among Latinas in the United States to be 6.2% to 19.0% (K. R. Martin & Garcia, 2011; Mattson & Rodriguez, 1999; Yost, Bloom, McIntire, & Leveno, 2005).

In comparing prevalence rates of IPV before and during pregnancy, results are mixed. In a large sample of pregnant women in Mexico, Castro, Peek-Asa, and Ruiz (2003) found no significant difference in rates of IPV before and during pregnancy (24.4% of the sample reported any type of IPV [physical, emotional, or sexual] before pregnancy and 24.5% reported any type of IPV during pregnancy). Others have found small declines in rates of IPV with pregnancy onset. For example, K. R. Martin and Garcia (2011) found that rates of physical IPV and emotional IPV decreased with pregnancy onset (11%-10% and 22%-19%, respectively) in Latina women living in Los Angeles, California.

IPV and Related Demographic and Psychosocial Factors

Demographic and general psychosocial risk factors for IPV in general population samples include lower socioeconomic status, lower education levels, and unemployment (Capaldi, Knoble, Shortt, & Kim, 2012; CDC, 2009; S. L. Martin et al., 2004; S. L. Martin, Mackie, Kupper, Buescher, & Moracco, 2001; Taylor & Nabors, 2009). Each of these factors is more prevalent in Mexican Americans as compared with Anglos, suggesting that Mexican Americans are at elevated risk of IPV (U.S. Census Bureau, 2003). In addition, younger age, a history of childhood trauma, lower levels of social support, and higher levels of stress have been linked to higher levels of IPV (Capaldi et al., 2012; Castro et al., 2003; K. R. Martin & Garcia, 2011; S. L. Martin et al., 2004; Taylor & Nabors, 2009). Finally, reports of IPV are higher for women who are not married or in a serious romantic relationship (K. R. Martin & Garcia, 2011).

Although IPV during pregnancy may be significantly different than IPV occurring at other times, few studies examine differential correlates of IPV before and during pregnancy (Burch & Gallup, 2004). Of those that have, demographic factors (race, education level, age, poverty status) predicted higher risk of IPV before and during pregnancy similarly in general population samples (Burch & Gallup, 2004; S. L. Martin et al., 2001). No known studies have examined psychosocial factors associated with IPV before pregnancy and IPV during pregnancy in a community sample of Mexican American women.

Cultural Factors and IPV

Because immigrants face many challenges as they try to adjust to life in a new country, such as language barriers, discrimination, immigration concerns, and obtaining quality employment, education, and health care, previous research has posited that Latino immigrants may experience worse mental health outcomes, as compared with U.S.-born Latinos. Contrary to hypotheses, Latino immigrants typically exhibit similar, or even better, mental health outcomes than non-U.S.-born Latinos (Burnam, Hough, Karno, Escobar & Telles, 1987; Ortega, Rosenheck, Alegria, & Desai, 2000). Known as the “immigrant paradox,” it has been theorized that maintenance of cultural traditions promotes better mental health by minimizing exposure to stressors associated with acculturation to new cultural norms and expectations (Cuevas, Sabina, & Bell, 2012). Building on prior work, research has begun to examine how relevant cultural factors relate to IPV in Mexican (foreign-born) and Mexican American (U.S.-born) women. One of these factors, acculturation, is defined as the process of adaptation that occurs when culturally distinct groups or individuals of a society come into contact with another culture (Berry & Kim, 1988). The process may include the gradual incorporation of language, beliefs, values, and behaviors of the dominant society. Previous studies have approached the measurement of acculturation in various ways, including assessments of country of birth, language preference, cultural values, Anglo and Mexican orientation, and cultural stress (Gonzales, Knight, Morgan-Lopez, Saenz, & Sirolli, 2002).

The evidence linking acculturation and IPV is mixed. For example, Jasinski (1998) found that U.S.-born Mexican American and Puerto Rican American husbands were three times more likely to assault their wives than foreign-born husbands. Caetano, Ramisetty-Mikler, Caetano Vaeth, and Harris (2007) found significant positive relations between acculturation (measured with a multidimensional scale that assessed language preference, peer associations, and cultural values), cultural stress, and IPV (Caetano et al., 2007). In contrast, Kaufman Kantor, Jasinski, and Aldarondo (1994) found no relation between English language preference and IPV, but they did find higher rates of IPV when the romantic partner was born in the United States. Ramirez (2007) also found no relation between acculturation (measured with a combination of birthplace, country of residence, citizenship, and language preference) and IPV in Mexican American college students. One explanation for these inconsistent findings may be related to inconsistencies in the measurement of acculturation, including studies that combine multiple indicators, including demographic markers (e.g., place of birth, years in the United States) that do not directly capture dimensions of culture change associated with acculturation (e.g., language, values, behaviors). It is possible, for example, to live in the United States for several years without experiencing significant change on these dimensions. Given the conflicting results, further research that disentangles distinct cultural variables linked to acculturation may shed light on any potential relation between culture-specific factors, acculturation, and IPV in Mexican American women. The current study examines demographic variables (country of birth, spouse/partner country of birth, age of immigration, years living in the United States), dimensions of cultural orientation (language preference, Anglo and Mexican orientation), and cultural stress as independent predictors of IPV.

IPV and Postpartum Depressive Symptoms

Postpartum depressive symptoms are one of the most common mental health problems associated with a history of IPV in the general population (Beydoun, Beydoun, Kaufman, Lo, & Zonderman, 2012). Independent of a history of IPV, the prevalence of postpartum depressive symptoms among Latina women living in the United States is estimated to be between 42.6% and 59.0% (Heilemann, Frutos, Lee, & Kury, 2004; Kuo et al., 2004; Martinez-Schallmoser, Telleen, & Macmullen, 2003; Valentine, Rodriguez, Lapeyrouse, & Zhang, 2011). Although a great deal has been learned about the relation between a history of IPV and postpartum depressive symptoms in the general population, few studies have examined the relation in a community sample of Mexican American women. Rodríguez and colleagues (2010) found that lifetime IPV-exposed Latinas reported significantly more postpartum depression than non-IPV-exposed Latinas (Rodríguez et al., 2010). However, this study did not control for reports of prenatal depression in the prediction of postpartum depression. Valentine and colleagues (2011) found that recent IPV exposure (IPV defined using three questions and within the preceding 12 months) was significantly related to postpartum depression among U.S. Latinas in a general clinic population living in Los Angeles, California. Based on the limited studies examining the relation between a history of IPV and postpartum depressive symptoms in Mexican American women, additional research with a more comprehensive measure of IPV may increase our understanding of the role of a history of IPV in postpartum mental health.

Present Study

The current study examines demographic and psychosocial correlates of IPV before and during pregnancy, as well as the relation between a history of IPV and postpartum depressive symptoms in a unique, low-income, community sample of Mexican American pregnant women. It was hypothesized that this sample would have higher rates of IPV both before pregnancy and during pregnancy than found in studies with general population samples due to the multiple risk factors for IPV that are more prevalent in Mexican Americans as compared with Anglos. It was also hypothesized that multiple demographic and general psychosocial correlates of IPV before pregnancy and during pregnancy would be evident, including a history of childhood trauma, not being in a serious romantic relationship, lower social support, and higher stress. Due to the low-income nature of the sample, restricted variability may limit the prediction of lower socioeconomic status, lower education levels, and unemployment to IPV. Due to the limited and mixed results found in previous research, the relation between culturally linked psychosocial factors and IPV was regarded as exploratory. It was further hypothesized that a history of IPV would predict elevated postpartum depressive symptoms even after controlling for prenatal depressive symptoms.

Method

Participants

Data were collected as part of a larger study of postpartum adjustment among a community sample of 324 low-income Mexican American women. Eligibility criteria included the participant’s (a) age of 18 years or older, (b) Spanish or English fluency, (c) self-identification as Mexican or Mexican American, and (d) low-income status (income eligibility for Medicaid, or self-reported family income below US$25,000). Four participants’ romantic partners were present during the prenatal interview, therefore, these participants were not administered items regarding IPV (total study n = 320). A 15-week postpartum interview was completed by 300 (93.8%) of the participants. See Table 1 for demographic information. Approval to conduct this study was obtained from the Arizona State University Institutional Review Board (IRB) and the Maricopa Integrated Health System IRB. Data collection procedures were compliant with IRB provisions and standards.

Table 1.

Demographic Characteristics, General Psychosocial Factors, and Culturally Linked Psychosocial Factors of Study Participants (n = 320).

Categorical Variables	n (%)
Participant country of birth
United States	43 (13.4)
Mexico/other	277 (86.6)
Marital status
Married/living together	247 (77.2)
Single/separated/divorced	73 (22.8)
Spouse/dating partner country birth
United States	57 (20.4)
Mexico/other	222 (79.6)
Annual income
<US$15,000	190 (60.9)
US$15,000-US$30,000	93 (29.8)
>US$30,000	29 (9.1)
Employment status
Full- or part-time employment	52 (16.3)
Not employed	268 (83.8)
Language of interview
English	61 (19.1)
Spanish	259 (80.9)
Continuous Variables	M (SD)
Education	10.16 (3.21)
Age (range: 18-42)	27.86 (6.48)
Age moved to United States (range: 0-35)	15.76 (7.78)
Years living in United States (range: 0-32)	11.91 (5.98)
General perceived stress	4.73 (2.97)
Economic hardship^a	2.80 (1.23)
Cultural stress	6.49 (8.13)
Social support	51.05 (15.59)
Childhood trauma	4.75 (7.46)
Anglo orientation	2.57 (0.98)
Mexican orientation	4.26 (0.60)
Prenatal depressive symptoms	6.11 (5.53)
Postpartum depressive symptoms	3.27 (3.97)

Nonstandardized results.

Measures

Demographics

Participants provided information regarding their country of birth (1 = U.S.-born, 2 = foreign-born), language preference for interview (1 = English, 2 = Spanish), educational background, current marital status (1 = married/living together, 2 = single/separated/divorced), employment status (1 = employed full- or part-time, 2 = not employed), age, and income (1 = <US$15,001, 2 = US$15,001-30,000, 3 = greater than US$30,000), and their spouse/dating partner’s country of birth (1 = U.S.-born, 2 = foreign-born). Women born outside of the United States provided the number of years they lived in the United States and the age at which they moved to the United States.

IPV

Participants responded to 14 items from the Pregnancy Risk Assessment Monitoring System (PRAMS; CDC, 2004) regarding experiences with physical abuse (4 items), sexual abuse (2 items), and emotional abuse (8 items) perpetrated by their current or former romantic partner. Seven items addressed IPV before pregnancy and 7 identical items addressed IPV during pregnancy (Cronbach’s α = .86 for the year prior to pregnancy; α = .85 during pregnancy). Example items include “In the year before you became pregnant, did your boyfriend or husband at the time push, hit, slap, kick, choke, or physically hurt you in any other way?” and “Since you became pregnant, did your husband or boyfriend force you to take part in any sexual activity when you did not want to (including touch that made you uncomfortable)?” Scores were summed separately for IPV before pregnancy and during pregnancy.

Childhood trauma

Ten items from the Emotional Abuse, Sexual Abuse, and Physical Abuse subscales from the Childhood Trauma Questionnaire–Short Form (Bernstein & Fink, 1998; current study α = .92) were used to assess childhood trauma before the age of 18 years. Scores were summed to create a total childhood trauma score.

Perceived stress

The four-item revised Perceived Stress Scale (PSS; Cohen, Kamarck, & Mermelstein, 1983; Gonzales Ramirez & Landero Hernandez, 2007; current study α = .65) assessed the degree of stress a person perceived in the past month using a 0 (never) to 4 (very often) scale. Items were summed to create a total score. Higher scores reflect higher perceived stress. The PSS is available in Spanish and has established reliability and validity in pregnant and postpartum Hispanic women (Zambrana, Scrimshaw, Collins, & Dunkel-Schetter, 1997).

Economic hardship

The 20-item Economic Hardship Scale (Barrera, Caples, & Tein, 2001; current study α = .59) assessed financial strain, inability to make ends meet, not having enough money for necessities, and economic adjustments in the past 3 months using a 1 (almost never or never) to 5 (almost always or always) scale. Scores were summed across the subscales, standardized, and then summed to create a total economic hardship score.

Cultural stress

The Immigration, Discrimination, and Language subscales of the Hispanic-Stress Inventory (HSI; Cervantes, Padilla, & Salgado de Snyder, 1991; current study α = .73) assessed culture-specific stressors in the past 3 months. These subscales examine stress that may arise due to difficulty speaking English, being accepted by those outside of the Hispanic culture, and factors related to immigration status. Participants answered 16 questions using a 5-point scale (not at all stressed to extremely stressed). The items were summed to create a total score, with higher scores indicating higher cultural stress.

Social support

The 17-item Medical Outcome Study Social Support scale (Sherbourne & Stewart, 1991; current study α = .96) assessed participant’s current emotional/informational, tangible, affectionate, and positive social support using a 1 (never) to 5 (all of the time) scale. Items were summed to create a total score. Higher scores reflect greater social support.

Anglo and Mexican orientation

Women responded to the 30-item Acculturation Rating Scale for Mexican Americans II (ARSMA-II; Cuéllar, Arnold, & Maldonado, 1995). The ARSMA-II assesses current assimilation and integration through two subscales, the Mexican Orientation Scale and the Anglo Orientation Scale. Questions required a yes or no response. Items were summed to create a total Mexican orientation score (α = .86) and an Anglo orientation score (α = .93). Higher scores reflect higher Mexican and Anglo orientation.

Depressive symptoms

Maternal depressive symptoms were measured prenatally (α = .86) and at 15 weeks postpartum (α = .85), with the 10-item Edinburgh Postnatal Depressive Symptoms Scale (EPDS; Cox, Holden, & Sagovsky, 1987). The EPDS has good reliability (Boyd, Le, & Somberg, 2005) and has been validated in Spanish-speaking samples (Beck & Gable, 2005). Questions assessed depressive symptoms over the past week using a 0 (not at all, never) to 3 (as much as you always do, most of the time) scale. Item scores were summed, with higher scores indicating higher depressive symptoms.

Procedure

Prospective participants were identified at two county-operated prenatal care clinics in Maricopa County, Arizona. In this region, approximately 30% of the population is Hispanic (U.S. Census Bureau, 2013). Eligible pregnant women were invited to participate by a female, bilingual interviewer. Informed consent and prenatal data were obtained between gestational weeks 23 and 39 (M = 35.37, SD = 2.50) in the participants’ homes. Whenever possible, women were interviewed in a private room. Postnatal data were collected over the telephone at 15 weeks postpartum. To accommodate literacy concerns, structured interviews were administered verbally by female interviewers in the participant’s language of choice. Participants held visual aids with verbal and graphic descriptions of item response formats. Participants were paid US$50 for the prenatal interview and US$10 for the 15-week postpartum interview.

Results

Data Analyses

Three sets of analyses were performed. First, the prevalence of IPV before and during pregnancy was evaluated. Second, multivariate analyses were performed to examine related demographic and psychosocial factors of IPV before and during pregnancy. Third, regression analyses were conducted to predict postpartum depressive symptoms from IPV, controlling for prenatal depressive symptoms.

Prevalence of Pregnancy-Related IPV

Of the 320 participants, 15.9% (n = 51) reported IPV before pregnancy and/or during pregnancy. A total of 13.1% (n = 42) of the participants reported IPV before pregnancy, with 5.9% (n = 19) reporting physical abuse, 12.2% (n = 39) emotional abuse, and 1.9% (n = 6) sexual abuse. Among women reporting IPV before pregnancy, the average number of items endorsed was 2.67 (SD = 1.82). A total of 11.3% (n = 36) of the participants reported experiencing IPV during pregnancy, with 3.4% (n = 11) reporting physical abuse, 10.9% (n = 35) emotional abuse, and 1.5% (n = 5) sexual abuse. Among women reporting IPV during pregnancy, the average number of items endorsed was 2.42 (SD = 1.86). IPV before pregnancy and IPV during pregnancy were significantly positively correlated (r = .55). Finally, 8.4% (n = 27) of the participants reported IPV both before pregnancy and during pregnancy.

For women who reported IPV at both time points, there was not a statistically significant difference in mean IPV scores across time, IPV before pregnancy M = 2.85, SD = 1.81, IPV during pregnancy M = 2.52, SD = 1.97; t(26) = 1.16, p >.05. When separated based on physical abuse, emotional abuse, and sexual abuse, each form of abuse was statistically and significantly correlated across time (rs ranging from .40 to .72). No statistically significant differences were noted in the prevalence of physical, emotional, or sexual abuse across time (physical abuse before pregnancy M = 0.70, SD = 0.95, during pregnancy M = 0.56, SD = 0.89; emotional abuse before pregnancy M = 2.00, SD = 1.11, during pregnancy M = 1.81, SD = 1.11; sexual abuse before pregnancy M = 0.15, SD = 0.36, during pregnancy M = 0.15, SD = 0.36; all ps < .05).

Demographic and Psychosocial Correlates of IPV

Tables 2 and 3 display correlations among IPV, demographic characteristics, and psychosocial factors. IPV before and during pregnancy were higher in single/separated/divorced women and U.S.-born women, and were positively correlated with prenatal depressive symptoms, childhood trauma, perceived stress, and economic hardship, and negatively correlated with social support. IPV before pregnancy was positively correlated with cultural stress, and IPV during pregnancy was positively correlated with Anglo orientation.

Table 2.

Zero-Order Correlations Among IPV and Demographic Variables.

Variable	1	2	3	4	5	6	7	8	9	10	11
1. IPV before pregnancy	—
2. IPV during pregnancy	.65**	—
3. Country of birth^a	−.15**	−.22**	—
4. RP country birth^a	−.06	−.11^†	.30**	—
5. Language^b	−.08	−.09	.65**	.45**	—
6. Employment^c	.01	.07	−.05	−.05	−.09	—
7. Education	−.05	.04	−.19**	−.22**	−.24**	.10	—
8. Age	−.05	−.07	.33**	.36**	.39**	.05	−.26**	—
9. Annual income	−.11^†	−.04	.01	−.10	−.07	.12*	.25**	.05	—
10. Marital status^d	.30**	.28**	−.16**	−.01	−.17**	.14*	−.01	−.15**	−.17**	—
11. Age moved to United States^e	−.03	−.02	—	.32**	.44**	−.03	−.18**	.62**	−.06	−.21**	—
12. Years living in United States^e	.04	.02	—	−.11	−.29**	.06	−.05	.14*	.05	.14*	−.57**

Note. IPV = intimate partner violence; RP = romantic partner.

U.S.-born = 1; foreign-born = 2.

English = 1; Spanish = 2.

Full/part-time employment = 1; not employed = 2.

Married/living together = 1; single/separated/divorced = 2.

Only those participants not born in the United States (n = 287) reported the age in which they moved to the United States and the number of years living in the United States.

†

p < .10. *p < .05. **p < .01.

Table 3.

Zero-Order Correlations Among IPV, Depressive Symptoms, and General and Culturally Specific Psychosocial Factors.

Variable	1	2	3	4	5	6	7	8	9	10
1. IPV before pregnancy	—
2. IPV during pregnancy	.65**	—
3. Prenatal dep.	.22**	.22**	—
4. Postpartum dep.	.25**	.16**	.42**	—
5. Childhood trauma	.28**	.21**	.37**	.24**	—
6. General perceived stress	.15**	.16**	.59**	.35**	.28**	—
7. Economic hardship	.12*	.12*	.34**	.33**	.23**	.37**	—
8. Cultural stress	.13*	.03	.23**	.29**	.29**	.19**	.35**	—
9. Social Support	−.15*	−.17**	−.27**	−.18**	−.24**	−.33**	−.33**	−.09	—
10. Anglo orientation	.09	.12*	.06	−.06	.04	−.02	−.15*	−.18**	.21**	—
11. Mexican orientation	−.09	−.04	−.01	.06	−.06	−.07	.08	.10^†	.03	−.38**

Note. IPV = intimate partner violence; dep. = depressive symptoms.

†

p < .10. *p < .05. **p < .01.

Multivariate Analyses

Using variables that were found to be statistically significant in correlation analyses, two multivariate hierarchical linear regression analyses were conducted: one examined IPV before pregnancy and one examined IPV during pregnancy. To address multicollinearity, a total general stress score was created by combining the standardized perceived stress and economic hardship scores. At Step 1, demographic factors were entered, and at Step 2, general and culturally linked psychosocial factors were entered (results shown in Table 4).

Table 4.

Hierarchical Linear Regression Analyses of IPV Before Pregnancy and IPV During Pregnancy.

	IPV Before Pregnancy
Predictor	R ²	F Change	β
Step 1	.11	F(3, 319) = 12.10***
Participant country of birth^a			−.12*
Marital status^b			.25***
Income			−.04
Step 2	.18	F(7, 319) = 9.40***
Childhood trauma			.21***
Total stress			.03
Cultural stress			.07
Social support			−.06
	IPV During Pregnancy
Predictor	R ²	F Change	β
Step 1	.06	F(3, 319) = 5.60***
Participant country of birth^a			−.24***
Marital status^b			−.05
Step 2	.11	F(7, 319) = 4.68***
Childhood trauma			−.01
Total stress			.14*
Social support			−.13*
Anglo orientation			.01

Note. IPV = intimate partner violence.

U.S.-born = 1; foreign-born = 2.

Married/living together = 1; single/separated/divorced = 2.

†

p < .10. *p < .05. **p < .01. ***p < .001.

For IPV before pregnancy, results indicated that women who were born in the United States, not married or living with their significant other, or reported childhood trauma were more likely to report IPV before pregnancy. IPV during pregnancy was higher among women who were born in the United States, reported higher levels of general stress, or reported lower social support.

Relation Between a History of IPV and Postpartum Depressive Symptoms

A linear regression analysis was conducted to examine the relation between IPV and postpartum depressive symptoms. To establish a more complete antenatal measure, IPV before pregnancy and IPV during pregnancy scores were summed to create a total IPV score. A history of IPV was significantly and positively related to depressive symptoms at 15 weeks postpartum, R² = .19, F(2, 299) = 35.82, p < .001, even after controlling for prenatal depressive symptoms.

Discussion

This study investigated IPV before and during pregnancy, including its prevalence, demography, related psychosocial factors, related culturally linked psychosocial factors, and connection with postpartum depressive symptoms in a sample of low-income, Mexican American women, a high-risk population that has been significantly underrepresented in the literature. In our sample, 13.1% of the women reported IPV before pregnancy and 11.3% reported IPV during pregnancy, prevalence rates consistent with prior estimates of IPV experienced by Latinas during the perinatal period (e.g., K. R. Martin & Garcia, 2011; Mattson & Rodriguez, 1999; Yost et al., 2005). Consistent with hypotheses, the rates of IPV both before pregnancy and during pregnancy were higher than found in studies with general population samples (3.9%-8.3%; Peterson et al., 1997). No differences were found in the rates of emotional, physical, or sexual abuse across time, but there was a trend for rates of physical and emotional abuse to decrease with pregnancy onset. In general, our results are consistent with prior research indicating that women who reported IPV during pregnancy also reported IPV in the year prior to pregnancy (K. R. Martin & Garcia, 2011; S. L. Martin et al., 2004; Taylor & Nabors, 2009).

For both IPV before and during pregnancy, women born in the United States were more likely to report IPV. Surprisingly, other acculturation variables were unrelated to IPV before or during pregnancy after accounting for country of birth, marital status, and general stress. Although cultural stress and Anglo orientation were correlated with IPV before pregnancy and IPV during pregnancy, respectively, when examining multiple demographic and psychosocial factors simultaneously, these two factors may not be as salient as other factors.

Multivariate analyses indicated different patterns of correlates for IPV before and during pregnancy. Women who were single, separated, or divorced were more likely to report IPV before pregnancy, a finding consistent with previous research (K. R. Martin & Garcia, 2011). Ruiz-Pérez, Mata-Pariente, and Plazaola-Castaño (2006) reported that a majority of abused women (68%) in their sample of 400 Spanish women attempted to actively resolve the abusive situation through separation from their romantic partner, which may explain higher reports of IPV for women who are not in a romantic relationship. Women who reported childhood trauma were also more likely to report higher levels of IPV before pregnancy. Compatible with theories of the intergenerational transmission of violence, the relation between childhood trauma and IPV in adulthood has been a consistent finding over the past two decades (Capaldi et al., 2012; Castro et al., 2003). However, further research is required to understand the causal pathways linking childhood trauma to adult IPV (Castro et al., 2003). Also consistent with previous research, women who reported higher general stress or lower social support were more likely to report IPV during pregnancy (Capaldi et al., 2012). These findings are congruent with previous research showing that abusive partners often aim to isolate the victim from family and friends, making it difficult to leave the abusive situation (Cummings, Gonzalez-Guara, & Sandoval, 2013).

Our results may have implications about factors that are more or less salient during pregnancy and bring attention to the notion of pregnancy-specific stressors. For example, it has been suggested that the increased risk for IPV before pregnancy for women who are not married or not in a serious romantic relationship may be associated with unintended pregnancies (Cripe et al., 2008). Moreover, when examining multiple correlates, some factors, such as a history of childhood trauma, may not be as salient during pregnancy when evaluated in conjunction with other factors, such as increased stress or lack of social support.

Consistent with previous research, our results further suggest an elevated risk of postpartum depressive symptoms for women reporting a history of IPV. Our results extend prior risk models to demonstrate that postpartum depressive symptoms were associated with a history of IPV over and above the influence of prenatal depressive symptoms in Mexican American women. The strong relation between IPV and postpartum depressive symptoms has significant implications for subsequent chronic depression, psychological distress, and difficulties with parenting (Coker et al., 2002; Kan, Feinberg, & Solmeyer, 2012). Postpartum depressive symptoms may be an important pathway through which IPV affects children, making it crucial to bring greater awareness and support to women experiencing IPV.

Given potential adverse consequences of postpartum depression for mothers and infants, IPV prevention and intervention programs could provide an opportunity for reducing the risk of postpartum depressive symptoms. Moreover, screening for IPV during prenatal visits can assist in the identification of patients with a history of IPV who may be at a higher risk of postpartum depression and may benefit from intervention and close follow-up by health care practitioners. It has been suggested that prevention and intervention programs should focus on amelioration of known malleable risk factors (e.g., providing assistance to couples experiencing increased stress), rather than untested or less robust factors (Capaldi et al., 2012). Our results suggest that increased stress and lack of social support, are related to increased reports of IPV, and it may be beneficial to provide at-risk couples with targeted interventions during the prenatal period.

Limitations and Future Directions

There were several limitations to the study. First, a relatively small number of women reported IPV, which limited analyses that could be conducted. For example, we were unable to probe differences between women reporting chronic IPV (before and during pregnancy) and women reporting IPV either before or during pregnancy. Furthermore, two thirds of the women reported IPV both before and during pregnancy, preventing more extensive comparisons of women reporting IPV before or during pregnancy. Moreover, marginal differences in the rates of specific IPV types (i.e., emotional, physical, sexual abuse) may be related to the small sample size, or to the dichotomous measurement of the occurrence of IPV interactions, rather than the frequency or severity of incidents, as recommended by S. L. Martin and colleagues (2004). Second, although rates of reported IPV were higher in this sample than in other studies, underreporting is a possibility. Cross-cultural issues, such as embarrassment, shame, children being the priority, cultural tradition prohibiting or discouraging disclosure, fear, and inability to speak English (Crandall, George, Marion, & Davis, 2003) may impact a Latina woman’s disclosure of IPV.

Third, we examined many factors related to IPV but are unable to establish causal and temporal precedence between these factors and IPV before or during pregnancy. However, several of the factors can be considered to have temporal precedence to IPV before and during pregnancy due to the historical nature of the variable (e.g., country of birth, spouse/dating partner’s country of birth, language preference, educational background, age, childhood trauma, parity, number of years living in the United States, and the age women moved to the United States). Finally, other potentially important factors not measured in the study may provide insight into the incidence of IPV, including partner reports about stressors, the frequency of IPV behaviors, and other predictors of IPV such as substance use, witnessing IPV between parents, association with deviant peers, and other forms of psychopathology (Capaldi et al., 2012). It will be important for future studies to include these and other measures to develop a more complete understanding of the occurrence of IPV and related risk and protective factors during the perinatal period.

In conclusion, the current study provided a snapshot of the prevalence of IPV before and during pregnancy in a community sample of low-income, perinatal Mexican American women. The findings on prevalence rates and related demographic and general and culturally linked psychosocial factors were in support of prior research and extended our understanding of potential differences in the critical temporal contexts of before and during pregnancy. In addition, our results provide strong evidence for an elevated risk of postpartum depressive symptoms for Mexican American women experiencing IPV, bringing greater awareness to a very complex and harmful situation. Finally, results provide potential targets for IPV prevention and intervention efforts, as well as implications for future research.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by National Institute of Mental Health MH083173. Preparation of the manuscript was supported by the National Institute of Mental Health Training Grants T32 MH18387 and F31 MH869732. The views in this article do not necessarily represent those of the agency supporting this research.

Author Biographies

Corrie L. Jackson, PhD, is a postdoctoral fellow at the Prevention Research Center at Arizona State University. She received her PhD in clinical psychology from the University of Memphis. Her research examines the role of childhood, adolescent, and familial aggression and violence on psychosocial development. Her research has been funded through the National Institute of Mental Health.

Lucia Ciciolla is a doctoral candidate in the clinical psychology program at Arizona State University. Her research examines the transmission of psychopathology from parents to children, the role of early parental behavior and parent–child interactions, and the significance of the postpartum period and infancy on child psychosocial development, with a focus on low-income and high-risk families. Her research has been funded through a National Research Service Award through the National Institute of Mental Health.

Keith A. Crnic is Foundation Professor and Chair of Psychology. Crnic has held faculty positions at the University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences and Penn State University in the Department of Psychology prior to assuming his position in Psychology at Arizona State University. The focus of his research has been on the contribution of early parent-child interactions, parenting factors, and the family context to the understanding of developmental and psychological outcomes for young children.

Linda J. Luecken, PhD, is a professor of psychology at Arizona State University. She received her PhD in clinical psychology in 1998 from Duke University and completed a postdoctoral position at the University of Vermont prior to joining the faculty at Arizona State University. Her research has been funded by the National Institutes of Health (NIH), the American Heart Association, and the Maricopa County Department of Public Health.

Nancy A. Gonzales is ASU Foundation professor of psychology and director of the Prevention Research Center at Arizona State University. Her research examines cultural and contextual influences on family processes and the social, academic, and psychological development of children in low-income communities. Her research has been continually funded by the National Institutes of Health and includes a wide range of topics, such as parenting practices in diverse cultural groups; family, cultural, and community influences on child and adolescent development; strategies to promote academic success and prevent mental health and substance abuse problems among Mexican American youth; family and cultural influences on postpartum depression; and the role of acculturation in development and mental health. The ultimate aims of this work are to translate findings into community-based interventions that are effective at promoting successful adaptation and reducing health disparities for high-risk youth and families.

Dean V. Coonrod is chair of the Department of Ob/Gyn at Maricopa Integrated Health System in Phoenix and is a professor at the University of Arizona’s College of Medicine. He was recently named as chair of the executive committee of the Department of Obstetrics and Gynecology for the Phoenix campus of the medical school and also recently named as the 2013 Distinguished Health and Science Honoree of the YWCA Maricopa County. Earning his MD and MPH in 1990, he completed his residency in ob/gyn at the Phoenix Integrated Residency in Obstetrics and Gynecology (PIROG) in 1994. He actively practices as a clinician, researcher, educator, and advocate to victims of domestic violence (DV) through his community health work. Several of his key leadership roles include medical director for the Well Woman Healthcheck Program, a program that provides free cancer screening to women including breast exams, mammograms, pelvic exams, and pap tests; member of the State of Arizona’s Maternal Mortality Review Team and principal investigator on a grant that launched a hospital-wide DV advocacy program offering education and training to victims of DV as well as training of clinicians to recognize DV and offer referral services to victims. He is also interested in preconception care; he is the project director on a grant with First Things First to create an internatal clinic providing care for women between pregnancies who have experienced an adverse pregnancy outcome.

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