Postpartum depression tied to domestic violence

Mothers with postpartum depression are more likely to be in a violent relationship than moms without depression, and new mothers in abusive relationships are more likely to suffer postpartum depression, according to a new survey of women with infants. 

"I think intuitively and clinically it's not surprising that there would be an overlap between depression and intimate partner violence," said Dr. Linda Chaudron, a psychiatry professor at the University of Rochester Medical Center, who was not involved in this study. 

The results provide clinicians with some guidance for screening women who show signs of postpartum depression or a violent relationship. 

"That is a big message that we want to send, that if pediatricians have started screening for maybe one of these two and they detect one, they should be screening for the other," said Dr. Barry Solomon, a pediatrics professor at John's Hopkins Children's Center, and the lead author of the study. 

Previous research on the overlap between postpartum depression and domestic violence has typically come from researchers that focus on the mothers' health. 

But in recent years, pediatricians have increasingly adopted the practice of screening mothers for postpartum depression and domestic violence. 

 

"It's come from growing evidence that mothers who are depressed or are in a relationship with violence, there are negative effects on children," Solomon told Reuters Health. 

1 in 14 in violent relationship 

Solomon and his colleagues took advantage of the frequent visits to the pediatrician that new moms make with their babies to explore how often violence in the home and depression co-occur. 

In February, 2008 they started screening mothers with children under six months old who came to their clinic for healthy baby checkups. 

Most of the women were African American and about one third of them were teenagers. 

From the surveys that the moms filled out, the research team found that one out of four of the mothers appeared to have postpartum depression and one out of 14 was in a violent relationship. 

The moms who screened positive for domestic violence were twice as likely to have postpartum depression. 

More than 50 percent of women in violent relationships also screened positive for depression, compared to 22 percent of mothers who were not in violent relationships. 

Similarly, women with postpartum depression were four times as likely to also screen positive for violence at home. 

Four percent of women without depression and 16 percent of women with depression were in violent relationships. 

Two-way street? 

The study did not determine whether one causes the other. Chaudron said it might go both ways. 

"If you're depressed you can't as easily get out of a violent situation, and if you're in a violent relationship you're walking on eggshells and can become depressed," she told Reuters Health. 

The study, published in the Journal of Pediatrics, also found that mothers with postpartum depression were more likely to bring their children to the emergency department more frequently. 

It's not clear why, but Chaudron speculated that perhaps depressed mothers have more anxiety, which could bring them to the emergency department. 

Chaudron said she is pleased to know the pediatric community is making an effort to study and be proactive about issues centered on the mother. 

"I think that the focus is still on the health and development and well being of the child, but now we know that moms who are going through serious emotional difficulties and violence in the home affect the children. It affects the care we can give to them and their own emotional development," Solomon said. 

The challenge to getting more pediatricians to screen for postpartum depression and domestic violence is what to do if a mom needs help. 

Solomon said pediatricians need support from the adult psychiatric and social services communities so that they can offer resources if they suspect mothers are in need. 

His clinic has brought on full time social work staff to work with mothers on the spot, for instance. 

In practices that don't have such resources, they "have to reach out to their maternal health partners," he said. "We can't expect pediatricians to screen for intimate partner violence or postpartum depression without providing them resources and connections."

UK obesity: Is diet or surgery the best cure?

With one in 30 of the UK population now classed as morbidly obese, the NHS is spending increasing amounts on weight-loss stomach surgery.

 

Figures released by the NHS Information Centre last week showed there had been a 30-fold increase in bariatric surgeries in a decade - up from 261 in 2000-01 to 8,087 in 2010-11.

While some NHS trusts continue to fund such surgeries for people with life-threatening obesity, others prefer to take a different approach.

In Leeds, teenager Emma Jane Money has recently undergone a gastric bypass operation.

She lost more than two stone in weight in the two weeks after the NHS paid for her to have the surgery at the private Thornbury hospital in Sheffield.

'Potentially dangerous' The 16-year-old, who weighed more than 21st (133kg) before the operation, said she had tried to diet and exercise more but had been unable to lose weight on her own.

She told the BBC's Inside Out programme: "With constant images of ribcages and bones and bony elbows and things like that it is hard and people do get this idea in their head that this is what every person is meant to be.

"It's really hard when someone then looks at me and thinks 'they're not right, that's not normal'."

Emma said she was "excited" about losing weight.

"I will get to wear all the new fashion trends with my friends. I will get to go anywhere and I don't have to worry about people saying things or judging me."

About 1% of patients die after weight-loss operations but consultant surgeon Roger Ackroyd, who operated on Emma, said the benefits of the surgery far outweighed the risks.

"It's extreme, it's potentially dangerous but it really does work," he said.

"People come to me and say... you are spending hard-earned taxpayers' money treating people who basically all they need to do is eat less and exercise more. That's a very valid argument.

"The only thing I would say is these people such as Emma would in time go on to need a hip replacement, knee replacement, she'll go on diabetic medication, she'll go on blood pressure medication and cancer is much more common in overweight people.

"If we can invest in this type of surgery now then it saves the NHS money in the long term."

In the East Riding of Yorkshire, people with a body mass index of more than 45 are being referred to a programme where they are given a personal trainer and nutrition advice.

Mandy Bennett, from Driffield, is one of nearly 50 patients signed up to the Live Well scheme and has lost three stone.

She said: "I have been maintaining my weight for three or four months now which is a big part of it. Learning to maintain your weight is as big an issue as losing the weight."

She said that without the help of her personal trainer she would "still be sat in front of the TV eating the wrong things, getting bigger, getting more unhealthy and probably not anywhere near as happy as I am".

Dr Tim Allison, NHS East Riding of Yorkshire's director of public health, said: "We have seen the number of surgical operations drastically go down by about 80%.

"The levels of bariatric surgery had been increasing quite considerably and we didn't have the services in place to give people the opportunity to have that dedicated six to nine months of intensive diet and physical activity.

"We felt it would be far better if we could put that in place rather than simply have people go forward to surgery.

"People shouldn't be desperate to have bariatric surgery, they should be desperate to change their life around and to work to lose weight."