"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."

SOURCE: bit.ly/GWu3Nc Journal of Pediatrics, online March 8, 2012.

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