Pathways Linking Intimate Partner Violence and Postpartum Depression Among Jewish and Arab Women in Israel.

Intimate partner violence (IPV) is a major risk factor for postpartum depression (PPD), with 9% to 28% of PPD cases reporting IPV at some point in their lives. Yet little is known about how these phenomena are associated. We asked, "What direct and indirect pathways link IPV to PPD in women belonging to different ethnic-national groups in Israel?" We recruited a stratified sample of Jewish and Arab women, 18 to 48 years old and 6 months postpartum, during their visits to maternal and child health clinics. We computed path analyses to identify both direct and indirect predictors linking IPV frequency and PPD in a stratified sample of Jewish (n = 807) and Arab (n = 248) women. The overall rate of PPD was estimated at 10.3%, whereas the rate of IPV for the total sample was 36%. We identified a direct link between IPV and PPD. IPV also appeared to have an equivalent, indirect effect on PPD via greater chronic stress and reduced social support. IPV was greater and social support was lower for Arab women, who also reported higher PPD, independent of sociodemographic differences between ethnic groups (i.e., education, occupation). Of note, an unplanned pregnancy appeared to increase the risk of both IPV and PPD. Our findings suggest that complex pathways link IPV to PPD and that indirect effects of IPV are equivalent to its direct effects on postpartum women. These findings contribute to a growing international body of research showing the significant effects of IPV on health and well-being. The factors we identified as directly and indirectly associated with PPD might inform interventions to identify and treat PPD.

Postpartum depression among Arab and Jewish women in Israel: Ethnic inequalities and risk factors.

OBJECTIVE: The aim of the current study was to compare the prevalence of, and risk factors for postpartum depression (PPD) among Jewish and Arab women in Israel. DESIGN: Data were obtained from a study on 'Family Relations and Violence' conducted in Israel in 2014-2015 using a multilayered nationwide representative sample of mothers who were interviewed face to face using a structured questionnaire in each woman's native language (Arabic / Hebrew) 6 weeks to 6 months postpartum. SETTING: 63 Maternal and Child Health (MCH) clinics from five geographical districts. PARTICIPANTS: Jewish (N = 853) and Arab (N = 275) women aged 16-48 who were 6 weeks to 6 months postpartum. MEASUREMENTS: PPD was measured by the Edinburgh Postnatal Depression Scale with a cutoff of ≥10. We examined a range of risk factors using multivariate logistic regression analysis and Generalized Estimating Equations (GEE) for the total sample, then separately for each ethnic group. RESULTS: For the total sample (n = 1128). Prevalence of PPD was 10.3%. Prevalence among Arab women was significantly higher compared to Jewish women (20.8% vs 7%, respectively). In the multivariable analysis, chronic stress, low social support, and unwanted pregnancy were major risk factors for PPD for Arab women. Among Jewish women the risk factors for PPD included chronic stress, low level of education, and intimate partner violence. CONCLUSIONS: Our findings indicate ethnic inequalities in the prevalence of, and risk factors for PPD in Israel that should be considered in health planning and policymaking. IMPLICATIONS FOR PRACTICE: Maternal health care nurses and other professionals should be aware of these inequalities and provide culturally sensitive health care services and programs to protect women in these population groups from PPD.