Women who have been physically, sexually, or emotionally abused are roughly four-and-a-half times more likely to suffer from prenatal or postpartum depression than women who havent suffered such abuse, say two researchers at the Washington State University Intercollegiate College of Nursing in Spokane.


The researchers, WSU professor Michael Rice and associate professor Kathie Records, hope the findings from their three-year study will lead to a change in the standard of care for pregnant women by identifying abuse victims and improving their treatment.


We want to create a system that allows for doctors and nurses to intervene and improve treatment, says Records, who also is a registered nurse. Our major hope is that abuse will (become) a significant predictor of prenatal and postpartum depression.


The studys findings are preliminary so far, and when the researchers conclude the analysis of their data, they hope to give insights into why abuse victims are more likely to suffer from prenatal or postpartum depression. Rice and Records say it could be another two or three years before all of the data theyve collected can be analyzed.


The studys preliminary findings, however, already support the researchers theory that abuse can predict depression during or after pregnancy.


Rice and Records tracked 139 women over a three-year period, about 30 percent whom had experienced some form of abuse in their lifetime. Twenty-two percent of the women in the study suffered from postpartum depression in the second month after giving birth. Of those women, about 73 percent were classified as abused, Records says.


Rice cautions that women who suffer from postpartum depression, a normal condition that many women experience after giving birth, arent necessarily victims of abuse. Postpartum depression can include a number of symptoms, including crying, listlessness, feelings of guilt and worthlessness, or weight loss and weight gain, or having no interest in the baby.


The feeling that something isnt right or theres something wrong is a hallmark of depression, Records says. Sometimes they feel like they cant get going. It could be from fatigue, or it could be from depression.


The study also found that about 30 percent of the women who had suffered from depression earlier in their lives suffered prenatal depression, which is slightly higher than the national average of all expectant mothers, they say. Of those women in the study who suffered prenatal depression, 68 percent had suffered some form of abuse in their life, Records says.


Their research takes into account the health of the abused and non-abused women, the effects of medication usage by the women, and the relationship between any abuse suffered and the health of their babies.


The volume of data we have is amazing, Rice says. Its going to take time to go through it all.


During the study, pregnant women were monitored for their prenatal health, including prenatal depression and postpartum depression for a 10-month period that started in their third trimester. The women werent prescreened for abuse or depression.


The researchers used structured interviews and questionnaires to collect data for the study. After the initial interview, individuals were contacted two, four, six, and eight months after their babies came.


The study monitored women between the ages of 18 and 46, with a mean age of 27. It was funded through a federal grant from the National Institute of Nursing Research, a division of the National Institutes of Health.


The researchers assisted women who suffered from depression or were involved in abusive relationships or needed immediate care. Its not clear what effect, if any, that assistance had on the studys results.


It probably will (have an effect), but we havent analyzed that piece of data yet, Records says. Any person we followed up with, we indicated it in the data set.


The two researchers have been studying the relationship between abuse and pregnancy in other studies for about seven years. Their most recent study is one of the few that has followed women over time, they claim.


Rice and Records say their research is somewhat controversial because health-care professionals typically arent comfortable delving into the possibilities of abuse, especially emotional abuse, with pregnant patients.


Every patient is assessed for violence by their physicians, Records says. However, the emotional abuse piece isnt included in that. I think our study will lead to more questions for health-care providers. Its already difficult to intervene when a woman is being hit; now, if shes being verbally harassed, what do you do next?


Rice believes all forms of abuse still are a taboo subject in the health-care industry.


There is almost a natural instinct to protect that point in time because socially there is an expectation of great excitement with a baby (coming) and everybody (in the family) is happy, Rice says. The problem is that its not all great.


Nurses generally are uncomfortable asking about abuse, Records says.


Many abused women are willing to talk, and you dont have to say anything, she says. Just listen to their story. Some nurses will say, So what would you like me to do next to help you with that?


Women often dont admit to their health-care professionals that theyve been abused, the researchers say. When answering medical questionnaires about their history of abuse, about 30 percent of the abused women arent comfortable revealing their abuse, they say.


Many times they dont admit it, Records says. Embarrassment plays a role in refusing to stop it. There also is fear of additional abuse if they do say something about the abuse theyve suffered.