Most social workers are familiar with the concerns arising from post partum depression. It has been linked to weakened bonding and possibly disrupted attachment between mother and infant. Newly published research done in Vancouver, B.C. alerts us to the problem as much broader and having some significant links to intimate partner violence (IPV). Much of the past research has focused on the role of physical aggression, but this research by Susan Desmarais and her colleagues reminds us that the nature of IPV is much broader and each form has impacts upon women and their post partum mental health.
In their paper, published in the journal Pregnancy and Childbirth emphasizes that IPV incudes actual, attempted or threatened harm that can have an impact or detract from the victims well being across several domains – physical, psychological, sexual, economic and spiritual.
The authors also note that dear of abuse has both physical and psychological consequences on the pregnant mother. Abuse, whether it occurs or is feared, raises cortical steroid levels in mothers which can have negative outcomes for mother and child.
Post partum mental health concerns are more than just depression. Social workers must broaden their view to understand that the risks also include anxiety, obsessive compulsive disorder (OCD), and posttraumatic stress disorder along with psychosis.
These researchers studied 100 women to conclude that women who experienced IPV (both during and before pregnancy) reported a statistically significant higher rate of post partum mental health problems. Physical assault during pregnancy appeared to have the greatest impact on post partum mental health and was associated with depression, OCD and PTSD. Psychological aggression during pregnancy was associated with symptoms of stress and PTSD. Sexual coercion both before and during pregnancy was associated with symptoms of OCD.
These findings have significant concern for child protection workers. It is vital that women be given an opportunity to talk about all forms of abuse that occurred both during the pregnancy as well as the periods leading up to it. In addition, workers must be careful to look for problems beyond depression.
Other research has shown, as acute mental health concerns grow in significance, it impacts the ability of the mother to care for the emotional and physical needs of the child. When we look beyond just the care of the child to understand why the mother is neglecting her child, we may often find various forms of IPV at the root of the behavior. If we do not properly investigate and intervene, then the mother is at increased risk of more intensive mental health concerns which may also lead to substance abuse as a means of managing the mental health concerns.
The good news is that mental health problems are treatable and the need to remove the child from the care of the mother is low. However, safety has to be created for both mother and child which means that the IPV needs to be uncovered. This is tricky, but it is our challenge.