Intimate Partner Violence and Perinatal Mental Health Disorders Among Postpartum Women in Indonesia: A Case-Control Study

Ana Pujianti Harahap; Aulia Amini; Evi Diliana Rospia; Catur Esty Pamungkas; Dina Lusiana Setyowati

doi:10.21070/midwiferia.v12i2.1900

Authors

Ana Pujianti Harahap Universitas Muhammadiyah Mataram, Nusa Tenggara Barat, Indonesia
Aulia Amini Department of Midwifery Professional Education, Faculty of Health Sciences, Universitas Muhammadiyah Mataram, West Nusa Tenggara, Indonesia
Evi Diliana Rospia Department of Midwifery Professional Education, Faculty of Health Sciences, Universitas Muhammadiyah Mataram, West Nusa Tenggara, Indonesia
Catur Esty Pamungkas Department of Midwifery (Bachelor Program), Faculty of Health Sciences, Universitas Muhammadiyah Mataram, West Nusa Tenggara, Indonesia
Dina Lusiana Setyowati Department of Public Health (Master Program), Faculty of Public Health, Universitas Mulawarman, Samarinda, East Kalimantan, Indonesia

DOI:

https://doi.org/10.21070/midwiferia.v12i2.1900

Keywords:

intimate partner violence, postpartum depressive symptoms, edinburgh postnatal depression scale, primary care, perinatal mental health

Abstract

Introduction Postpartum depressive symptoms affect between10% and 20% of women globally, with figures reaching up to 22% in Indonesia. Although intimate partner violence (IPV) is potential contributor, empirical data originating from Indonesian primary healthcare settings remains limited. The objective of this study was to investigate the relationship between IPV risk and EPDS-screened postpartum depressive symptoms in Mataram, Indonesia.

Methods A facility-based case-control study included 130 postpartum women (0–12 months) attending Babakan Public Health Center from February to May 2026. Participants were categorized into cases (EPDS scores >10) and controls (EPDS ≤ 10). IPV risk was assessed using the Woman Abuse Screening Tool (WAST). Correlation was analyzed using chi-square tests and binary logistic regression.

Results IPV risk was identified in 16.9% of cases and 7.7% of controls. The unadjusted bivariate association failed to reach statistical significance (OR = 2.44; 95% CI: 0.79–7.48; p = 0.109). After adjustment, the positive trend persisted but remained nonsignificant (aOR = 2.96; 95% CI: 0.87–10.08; p = 0.083), with substantial statistical imprecision. Conversely, maternal age between 20 and 35 years showed the correlation with lower adjusted odds of postpartum depressive symptoms (aOR = 0.32; 95% CI: 0.13–0.83; p = 0.019).

Conclusion Although IPV risk was more prevalent among women screening positive for postpartum depressive symptoms, the adjusted correlation was not statistically significant. Integrating IPV and depression screening into routine postnatal care may support early identification and referral. Further prospective studies are required to clarify this relationship.

References

[1] L. M. Howard and Hind Khalifeh, “Perinatal mental health: a review of progress and challenges,” World Psychiatry, 2020, doi: org/10.1002/wps.20769.

[2] T. Kourgiantakis et al., “Access to mental health and addiction services for youth and their families in Ontario: perspectives of parents, youth, and service providers,” Int. J. Ment. Health Syst., vol. 17, no. 1, p. 4, Mar. 2023, doi: 10.1186/s13033-023-00572-z.

[3] Ana Pujianti Harahap, Mateus Sakundarno Adi, Ayun Sriatmi, and Cahya Tri Purnami, “The Influence of PMH Screening Training on Postpartum Mothers on the Knowledge, Attitude, and Practice of Midwives,” Media Publ. Promosi Kesehat. Indones., vol. 8, no. 4, pp. 287–295, Apr. 2025, doi: 10.56338/mppki.v8i4.6994.

[4] L. Iskandar, K. L. Braun, and A. R. Katz, “Testing the Woman Abuse Screening Tool to Identify Intimate Partner Violence in Indonesia,” J. Interpers. Violence, vol. 30, no. 7, pp. 1208–1225, Apr. 2015, doi: 10.1177/0886260514539844.

[5] L. B. S. Ankerstjerne et al., “Landscaping the evidence of intimate partner violence and postpartum depression: a systematic review.,” BMJ Open, vol. 12, no. 5, p. e051426, May 2022, doi: 10.1136/bmjopen-2021-051426.

[6] A. B. Witteveen, C. A. I. Stramrood, J. Henrichs, J. C. Flanagan, M. G. van Pampus, and M. Olff, “The oxytocinergic system in PTSD following traumatic childbirth: endogenous and exogenous oxytocin in the peripartum period,” Arch. Womens. Ment. Health, vol. 23, no. 3, pp. 317–329, Jun. 2020, doi: 10.1007/s00737-019-00994-0.

[7] S. R. Sharma, X. Gonda, P. Dome, and F. I. Tarazi, “What’s Love Got to do with it: Role of oxytocin in trauma, attachment and resilience,” Pharmacol. Ther., vol. 214, p. 107602, Oct. 2020, doi: 10.1016/j.pharmthera.2020.107602.

[8] L. Abdoli Najmi and M. Mirghafourvand, “The relationship between spousal violence, maternal functioning, depression, and anxiety among Iranian postpartum mothers: a prospective study,” BMC Psychol., vol. 12, no. 1, 2024, doi: 10.1186/s40359-024-02036-6.

[9] L. Vogel et al., “Shadows of the past – Hierarchical regression analyses on the role of childhood maltreatment experiences for postpartum depression,” J. Affect. Disord., vol. 371, pp. 82–90, Feb. 2025, doi: 10.1016/j.jad.2024.11.045.

[10] K. Markey et al., “Enablers of and Barriers to Perinatal Mental Healthcare Access and Healthcare Provision for Refugee and Asylum-Seeking Women in the WHO European Region: A Scoping Review,” Healthcare, vol. 12, no. 17, p. 1742, Sep. 2024, doi: 10.3390/healthcare12171742.

[11] WHO, Guide for integration of perinatal mental health in maternal and child health services. 2022.

[12] L. M. Tran, P. H. Nguyen, R. T. Naved, and P. Menon, “Intimate partner violence is associated with poorer maternal mental health and breastfeeding practices in Bangladesh,” Health Policy Plan., vol. 35, no. Supplement_1, pp. i19–i29, Nov. 2020, doi: 10.1093/heapol/czaa106.

[13] N. K. Fahim, A. Negida, and A. K. Fahim, “Sample Size Calculation Guide - Part 3: How to Calculate the Sample Size for an Independent Case-control Study.,” Adv. J. Emerg. Med., vol. 3, no. 2, p. e20, 2019, doi: 10.22114/AJEM.v0i0.138.

[14] X. Wang and X. Ji, “Sample Size Estimation in Clinical Research,” Chest, vol. 158, no. 1, pp. S12–S20, Jul. 2020, doi: 10.1016/j.chest.2020.03.010.

[15] F. Hou, X. Zhang, C. Cerulli, W. He, Y. Mo, and W. Gong, “The impact of intimate partner violence on the trajectory of perinatal depression: a cohort study in a Chinese sample,” Epidemiol. Psychiatr. Sci., vol. 29, p. e133, Jun. 2020, doi: 10.1017/S2045796020000463.

[16] S. A. Amer et al., “Exploring predictors and prevalence of postpartum depression among mothers: Multinational study,” BMC Public Health, vol. 24, no. 1, pp. 1–15, 2024, doi: 10.1186/s12889-024-18502-0.

[17] V. Sivarajasingam, M. Karki, E. Bagkeris, and A. El-Osta, “Exploring the Use of the WAST-Short Domestic Abuse Screening Tool in Primary Care: A Cross-Sectional Study in Northwest London,” Sage Open, vol. 15, no. 3, Jul. 2025, doi: 10.1177/21582440251374382.

[18] W. Ashenafi, B. Mengistie, G. Egata, and Y. Berhane, “The role of intimate partner violence victimization during pregnancy on maternal postpartum depression in Eastern Ethiopia,” SAGE Open Med., vol. 9, Jan. 2021, doi: 10.1177/2050312121989493.

[19] J. L. Paulson, “Intimate Partner Violence and Perinatal Post-Traumatic Stress and Depression Symptoms: A Systematic Review of Findings in Longitudinal Studies,” Trauma, Violence, Abus., vol. 23, no. 3, pp. 733–747, Jul. 2022, doi: 10.1177/1524838020976098.

[20] E. Q. Cox, A. Stuebe, B. Pearson, K. Grewen, D. Rubinow, and S. Meltzer-Brody, “Oxytocin and HPA stress axis reactivity in postpartum women,” Psychoneuroendocrinology, vol. 55, pp. 164–172, May 2015, doi: 10.1016/j.psyneuen.2015.02.009.

[21] A. A. Levendosky et al., “The effects of IPV and mental health symptoms on HPA axis functioning during early pregnancy,” Arch. Womens. Ment. Health, vol. 27, no. 2, pp. 285–292, Apr. 2024, doi: 10.1007/s00737-023-01399-w.

[22] C. Guiguet-Auclair et al., “Validation of the French Women Abuse Screening Tool to routinely identify intimate partner violence,” Eur. J. Public Health, vol. 31, no. 5, pp. 1064–1069, Oct. 2021, doi: 10.1093/eurpub/ckab115.

[23] A. P. Harahap, M. S. Adi, A. Sriatmi, and C. T. Purnami, “Exploring perinatal mental health in Indonesia: A mixed-method study in Mataram, West Nusa Tenggara,” Narra J, vol. 4, no. 1, p. e667, Mar. 2024, doi: 10.52225/narra.v4i1.667.

[24] K. Khademi and M. H. Kaveh, “Social support as a coping resource for psychosocial conditions in postpartum period: a systematic review and logic framework,” BMC Psychol., vol. 12, no. 1, p. 301, May 2024, doi: 10.1186/s40359-024-01814-6.

[25] T. J. Borah, A. L. Murray, M. Eisner, and I. Jugl, “Developing and Validating an Experience Sampling Measure of Aggression: The Aggression-ES Scale,” J. Interpers. Violence, vol. 36, no. 11–12, pp. NP6166-NP6182, Jun. 2021, doi: 10.1177/0886260518812068.

[26] L. Luo, L. Gao, D. Li, and H. Wen, “Depression- and anxiety-associated disrupted brain structural networks revealed by probabilistic tractography in thyroid associated ophthalmopathy,” J. Affect. Disord., vol. 347, pp. 515–525, Feb. 2024, doi: 10.1016/j.jad.2023.11.089.

[27] Z. Wang, Z. Xie, Z. Zhang, W. Zhou, B. Guo, and M. Li, “Multi-platform omics sequencing dissects the atlas of plasma-derived exosomes in rats with or without depression-like behavior after traumatic spinal cord injury,” Prog. Neuro-Psychopharmacology Biol. Psychiatry, vol. 132, p. 110987, Jun. 2024, doi: 10.1016/j.pnpbp.2024.110987.

[28] X. Wei, W. Wang, Y. W. Law, and H. Zhang, “The Impacts of Intimate Partner Violence on Postpartum Depression: An Updated Meta-Analysis,” Trauma, Violence, Abus., vol. 25, no. 2, pp. 1531–1550, Apr. 2024, doi: 10.1177/15248380231188068.

[29] T. Estriplet, I. Morgan, K. Davis, J. Crear Perry, and K. Matthews, “Black Perinatal Mental Health: Prioritizing Maternal Mental Health to Optimize Infant Health and Wellness,” Front. Psychiatry, vol. 13, no. April, pp. 1–8, 2022, doi: 10.3389/fpsyt.2022.807235.