Postpartum depression and intimate partner violence in urban mothers: Co-occurrence and child healthcare utilization

Objective: To assess the prevalence, timing, and co-occurrence of positive screens for maternal postpartum depression and intimate partner violence and examine their relationships with children's healthcare utilization from birth to 2 years. Study design: Between February and March 2008, mothers bringing newborn, 2-, 4-, or 6-month-old children to an urban primary care clinic were screened for postpartum depression and intimate partner violence. A retrospective chart review abstracted demographic data, maternal responses on the postpartum depression/intimate partner violence screen at the initial and subsequent visits, and, from the child's birth to second birthday, adherence with well-child care and use of pediatric acute care and emergency department visits. Descriptive, bivariate, and multivariate analyses were conducted. Results: A total of 173 mothers completed at least one postpartum depression/intimate partner violence screening survey. Overall, 26% screened positive for postpartum depression and 7% screened positive for intimate partner violence; most positive screens occurred at the initial visit. About 60% of mothers with a positive intimate partner violence screen also had a positive postpartum depression screen. Well-child care adherence and acute care visit utilization were not associated with maternal postpartum depression/intimate partner violence screening. Children of women with a positive screen for postpartum depression had greater emergency department utilization. Conclusion: The co-occurrence of postpartum depression and intimate partner violence is high in urban mothers. Primary care providers should routinely screen for both problems in this population and recognize the importance of screening for one problem if the other problem is identified.