Impact of Intimate Partner Violence on Infant Temperament

Abstract

Intimate partner violence (IPV) during the first year postpartum is common in Bangladesh, and many infants are exposed to hostile and aggressive environment. The aim of the current study was to investigate how IPV (physical, emotional, and sexual) impacts on the mother’s perception of her infant’s temperament 6 to 8 months postpartum, and whether maternal depressive symptom at 6 to 8 months postpartum is a mediator in this association. A total of 656 rural Bangladeshi women and their children 6 to 8 months postpartum were included in this study. Data were collected by structured interviews. The women were asked about physical, sexual, and emotional IPV; depressive symptoms (Edinburgh Postnatal Depressive Symptoms [EPDS]); and their perception of infant temperament assessed by the Infant Characteristic Questionnaire (ICQ). Descriptive analyses were conducted for prevalence of IPV and maternal depressive symptoms. Mediation analysis was conducted with a series of linear regressions with types of IPV as independent variables, ICQ including its subscales as dependent variables and maternal depressive symptoms as potential mediator. All the analyses were adjusted for the woman’s and her husband’s ages and number of children of the couple. Nearly 90% of the mothers reported some kind of IPV at 6 to 8 months postpartum. All types of IPV were directly associated with the mother’s perception of her infant as unadaptable. Maternal depressive symptom was a mediating factor between physical IPV and the ICQ subscales fussy-difficult and unpredictable. In addition, depressive symptoms mediated between sexual and emotional IPV, and the mother’s perception of the infant as unpredictable. The results showed that IPV influenced how mothers perceived their infant’s temperament. It is important that health care professionals at maternal and child health services enquire about IPV with possibilities to refer the family or the mother and infant for appropriate support.

Keywords

domestic violence infants exposed to domestic violence mental health and violence infant temperament

Introduction

Intimate partner violence (IPV) is a public health issue worldwide that affects families on daily basis (Harper, Ogbonnaya, & McCllough, 2016), and research suggests that pregnancy and the months after birth are periods of increased risk for IPV (Griffin Burke, Lee, & O’Campo, 2008). IPV includes acts of physical aggression, forced intercourse, and other forms of sexual coercion, psychological abuse, and controlling behaviors (World Health Organization [WHO], 2002). Although IPV is pervasive across countries and cultures (Urke & Mittelmark, 2015), certain communities experience higher rates of IPV than others (Krahné, Bieneck, & Möller, 2005). A large study (Garcia-Moreno, Jansen, Ellsberg, Heise, & Watts, 2006) conducted by the WHO in 15 sites in 10 countries reported a lifetime prevalence of physical or sexual IPV or both varied between 15% and 71%. The authors of the WHO multi-country study explain this wide variation in prevalence rates due to differences in the respondents’ willingness to acknowledge their experiences, which may differ by age-group, geographic settings, and cultural contexts. Also, the prevalence of IPV might be higher in more traditional, rural settings compared with industrialized, urban settings where women might have more options to leave abusive relationships. In general, men who were more controlling were found to be more abusive toward their partners. Notably, the prevalence rates differed by the types of violence. In three of the 15 sites, sexual IPV was more prevalent than physical IPV. In Bangladesh, among rural women, the prevalence of ever experiencing physical IPV was reported to be 42% and sexual IPV 50% (Garcia-Moreno et al., 2006). Risk factors for IPV are young age (18-24 years) of mothers, having children less than 5 years of age, low economic status, and low education (Halpern, Spiggs, Martin, & Kupper, 2009; Sharps, Laughon, & Giangrande, 2007).

Increased health problems, both physical and psychological, such as injury, chronic pain, gastrointestinal and gynecological symptoms, depression, and posttraumatic stress disorders (PTSD) in abused women are documented in various settings (Campbell, 2002). Systematic reviews on the associations between IPV and mental disorders conclude increased likelihood of experiencing adult lifetime partner violence by women with mental disorders (Trevillion, Oram, Feder, & Howard, 2012), and women who are exposed to IPV demonstrate high levels of depressive, anxiety, and PTSD symptoms during the postpartum period (Howard, Oram, Galley, Trevillion, & Feder, 2013). In a previous study (Kabir, Nasreen, & Edhborg, 2014), the authors found women who experienced physical IPV were almost 3 times more likely to suffer from maternal depression.

Maternal depressive symptoms are common after childbirth, and socially disadvantaged populations tend to have higher prevalence rates of postpartum depression (PPD) than wealthy populations (Rahman, Iqbal, & Harrington, 2003). Examples of symptoms of PPD include depressive mood, decreased interests in activities, fatigue, loss of energy, and inability to concentrate (American Psychiatric Association, 2013). PPD is known to impact the development of the child at every stage from infancy to young adulthood, including behavior problems, depression, and other mental problems (Reck et al., 2004). During infancy, maternal depressive symptoms could have negative effect on the bonding process (Moehler et al., 2006), early mother–infant interaction (Edhborg, Hogg, Nasreen, & Kabir, 2013), and cognitive, socioemotional and motor development (Murry & Cooper, 1997). Maternal depressive symptoms have also been associated with difficult infant temperament, particularly infant’s negative emotionality and irritability (Edhborg, Seimyr, Lundh, & Widström, 2000; Murray & Cooper, 1997).

Maternal experience of IPV has also been associated with adverse outcomes for the infant, such as physiological and emotional dysregulation (Griffin Burke et al., 2008; Zou, Zhang, Cao, & Zhang, 2015), increased distress (DeJonghe, Bogat, Levendosky, von Eye, & Davidson, 2005), poor socioemotional development (Ahls-Dunn & Huth-Bocks, 2014), and behavioral (Evan, Davies, & DiLillo, 2008) and adjustment problems (Chan & Yeung, 2009). In addition, in families where the mother is abused, the children face an increased risk of being abused or neglected or both (Hazen, Connely, Kelleher, Landsverk, & Barth, 2004).

Temperament refers to differences in an infant’s expressions of arousal and emotion, and describes the infant’s ability to self-regulate and to interact with the environment (Medoff-Cooper, 1995). Although infant temperament is biologically based and relatively stable over time, it can be modulated by environmental factors, such as parental responses. According to Chess and Thomas (1984), temperament is a child’s particular reaction to how her demands and expectations are met by the environment. The biological processes of temperament appear to be shared across cultures, but outcomes vary depending on cultural values and the child’s experiences in life (Rothbart, 2007). Griffin Burke et al. (2008) reported mother’s experience of IPV to be associated with an increased likelihood of difficult temperament of the infant at the age of 1 year. Zou et al. (2015) demonstrated that infants of abused mothers performed poorly compared to those of non-abused mothers in the temperament dimensions rhythmicity, approach/withdrawal, mood, distractibility and persistence. However, after adjusting for maternal depressive symptoms, only distractibility was significant (Zou et al., 2015). Thus, infants are not protected from the negative effects of IPV as some may believe (Ahls-Dunn & Huth-Bocks, 2014). The effect of IPV at such young age is differentially related to the characteristics of the mother, for example, her mental health. Also the infant’s characteristics, such as emotion or self-regulation, may moderate the ways IPV influences the infant (Enlow, Blood, & Egeland, 2013), as well as infant temperament (Griffin Burke et al., 2008).

Although the health consequences of IPV for women and older children witnessing IPV have received much attention, less is known about the effects of exposure of the mother to IPV on her child’s infancy (Griffin Burke et al., 2008). Because both maternal experiences of IPV and depressive symptoms are associated with negative outcomes for infants, it is important to get a clear understanding of how maternal depressive symptoms influence the association between IPV and the infant’s temperament. Thus, the aim of the current study was to investigate whether IPV (physical-, emotional-, and sexual violence) impacts on the mother’s perception of her infant’s temperament 6 to 8 months postpartum, and whether maternal depressive symptom at 6 to 8 months postpartum is a mediator in this association.

Method

Sample and Setting

The current study used data from a longitudinal study, “Risk Factors and Consequences of Maternal Perinatal Depressive and Anxiety Symptoms: A Community Based Study in Bangladesh.” In that study, data were collected during the third trimester of the pregnancy (baseline), at birth, 2 to 3 months, and 6 to 8 months postpartum (Nasreen, 2011). The sample was selected from a pregnancy register maintained by a local nongovernment organization in the study area. Inclusion criteria were residence in the study area and length of pregnancy of at least 7 months. Considering an attrition rate of 20%, the sample size calculation yielded a sample size of 720 women. Thus, women who fulfilled the inclusion criteria were enrolled consecutively at the baseline and the recruitment stopped till the required sample size was reached. At 6 to 8 months postpartum, 656 mothers and their 6 to 8 months old infants remained in the follow-up study. The current study used data from baseline (sociodemographic) and from the follow-up at 6 to 8 months postpartum. Sixty-four women (approximately 8%) were lost from baseline to the follow-up 6 to 8 months due to maternal death at birth (n = 2), neonatal and infant death (n = 17), stillbirth (n = 25), intrauterine death (n = 1), multiple birth (n = 3), outmigration from the study area (n = 12), and dropouts (n = 4).

The respondents were living in rural parts of Mymensingh district in Bangladesh, which is located 120 km north of Dhaka, the capital of Bangladesh. Mymensingh district has a population of about 4 million and is predominantly agricultural (Bangladesh Bureau of Statistics, 2016). In the current study, 94% of the women were involved in unpaid domestic work and childcare.

Procedure

Data for the longitudinal study were collected from July 2008 to August 2009 through structured interviews by trained female interviewers at the respondents’ house, in privacy. Because majority of the respondents were illiterate or had little education, detailed information about the study and about the women’s right to refuse participation or terminate the interview at any point was verbally provided before beginning the interview.

Data Collection

Sociodemographic data were collected at the baseline which included the woman’s age, her husband’s age and number of children of the couple.

Intimate partner violence was assessed 6 to 8 months postpartum by the instrument used by the WHO in a multi-country study, including Bangladesh (Garcia-Moreno et al., 2006). This instrument included questions about physical, sexual, and emotional violence by intimate partner, scored yes or no. For a total score of IPV, the scores of the three types of IPV were added together.

Physical violence by the husband included six items, scored yes (1) or no (0): (1) slapped or thrown object at her, (2) pushed or shoved to the ground, (3) punched or hit, (4) kicked, dragged, or beaten up, (5) burned on purpose, and (6) threatened to use weapon to hurt. No act of physical violence was scored 0, and act of physical violence was scored 1 to 6. The women were asked about physical violence since childbirth up to present time (6-8 months postpartum).

Sexual violence was assessed by three items about forced sex by the husband since childbirth to present time (6-8 months postpartum) and scored yes (1) or no (0). These were (1) sexual intercourse against her will, (2) sexual intercourse because she was afraid of what the husband might do in case of refusal, and (3) forced to do something sexual that she found degrading or humiliating. No act of sexual violence was scored 0, and act of sexual violence was scored 1 to 3.

Emotional violence was assessed by seven items indicating controlling behavior by the husband, since childbirth up to present time (6-8 months), scoring yes (1) or no (0). The women were asked whether her husband (1) tried to keep her from seeing friends, (2) restricted contact with her family, (3) insisted on knowing her whereabouts, (4) ignored and treated her indifferently, (5) got angry due to jealousy, (6) was suspicious about her fidelity, and (7) expected to be asked permission before seeking health care for herself. No act of emotional violence was scored 0 and one or more acts of emotional violence were scored 1 to 7.

Maternal depressive symptoms were assessed by The Edinburgh Postnatal Depressive Symptoms (EPDS) (Cox, Holden, & Sagovsky, 1987) at 6 to 8 months postpartum. The EPDS includes 10 items, scored on a 4-point scale (0-3), and rates the intensity of depressive symptoms during the previous 7 days. Higher score indicated more depressive symptoms. The EPDS is widely used and validated in many countries. It has been validated in Bangladesh, with a sensitivity of 89%, specificity of 89%, positive predicted value of 40%, and negative predictive value of 99%, using 9/10 as the cutoff score (Gausia, Fisher, Algin, & Oosthuizen, 2007). This cutoff score was used in the current study. Cronbach’s alpha of the scale was .75 at 6 to 8 months postpartum.

Infant Characteristic Questionnaire (ICQ) (Bates, Freeland, & Lounsbury, 1979) was used to measure the mothers’ perceptions of infant temperament, 6 to 8 months postpartum. The ICQ comprises of 24 items describing infant behavior. The mothers rank each item on a 7-point scale, indicating the level of difficulty in dealing with the described behavior. The higher the score, the more difficult the mother perceived the infant to be. The items are grouped in four subscales: fussy-difficult (nine items), unadaptable (five items), dull (four items), and unpredictable (six items). The subscale fussy-difficult concerns how often the infant is fussy, in general how fussy, how easily upset, when upset how easy to sooth, general mood, changeable mood, and overall how difficult the infant is perceived to be (Cronbach’s alpha: .79). The subscale unadaptable is about the infant’s responses to new things such as the first bath, new places, new persons, and disruptions and changes in life (Cronbach’s alpha: .73). The subscale dull concerns the infant’s sociability, for example, how active the infant is, smiles, enjoys playing little games and how excited the infant becomes when people play or talk with him or her (Cronbach’s alpha: .56). The fourth subscale unpredictable is about how difficult or easy it is for the mother to know what is bothering the infant and to predict when the infant is hungry, wants to sleep, or needs a change of diaper/cleaning (Cronbach’s alpha: .45).

Data Analyses

Data analyses were conducted using SPSS version 23. Descriptive analyses were done to report sample descriptions and prevalence of IPV (physical, sexual, and emotional violence) and maternal depressive symptoms.

Based on the four-step method to assess mediation suggested by Baron and Kenny (1986), a series of linear regressions were conducted to examine whether maternal depressive symptoms mediated the relationship between IPV (independent variable) and the mother’s perception of the infant’s temperament (dependent variable). In the first step, the relationship between different types of IPV and the mother’s perceptions of the infant temperament (ICQ) and its subscales was tested (Path C) (Figure 1). In the second step, the relationship between different types of IPV and the potential mediator, maternal depressive symptoms, was tested (Path A). In the third step, the relationship between the potential mediator, that is, maternal depressive symptoms, and the mother’s perceptions of the infant temperament was tested (Path B). Finally, in the fourth step, different types of IPV (independent variables) and maternal depressive symptoms (EPDS score) as potential mediators were entered simultaneously in a linear regression as predictors of the mother’s perceptions of the infant temperament (ICQ and its subscales) (Path C′). All the regression models were adjusted for the woman’s age, her husband’s age, and number of children of the couple.

Figure 1.

Mediation model depicting maternal depressive symptoms as mediator in the relationship between intimate partner violence experienced by the mother and her perception of her infant’s temperament.

The following conditions are required to establish mediation: The coefficients of the first step should be significant (Path C) as well as the coefficients of the second and third steps (Paths A and B). The significance levels of the coefficients of the independent variables (all types of IPV) in the fourth step (Path C′) are either less significant (partial mediation) or nonsignificant (full mediation) compared with that in the first step (Path C). A p value of <.05 was accepted for statistical significance.

Results

The Sample

Of the 656 mothers included in the current study, 89% reported experiencing IPV when their infants were 6 to 8 months old. Experience of physical IPV was reported by 52%, sexual by 65%, and emotional by 84 % of the respondents. Thirty-two percent of the women experienced depressive symptoms during the same period (Table 1).

Table 1.

Description of the Sample (N = 656).

Background characteristics	N = 656
Mother’s age in years [M (SD)]	24.7 (6.06)
Min-Max	14-45
Father’s age in years [M (SD)]	32.9 (8.26)
Min -Max	17-70
Number of children [M (SD)]	2.0 (1.87)
Min-Max	1-11
Depressive symptoms 6-8 months postpartum as measured by EPDS [M (SD)]	7.36 (3.44)
Min-Max score	2-22
<10 on the EPDS	68.4%
≥10 on the EPDS	31.6%
IPV 6-8 months postpartum (Total IPV)	89.3%
Physical IPV	52.4%
Sexual IPV	65.1%
Emotional IPV	83.7%

Note. EPDS = Edinburgh postnatal depressive symptoms; IPV = intimate partner violence.

Mediation Analysis

Potential mediation of maternal depressive symptoms (indicated by EPDS score) in the relationship between different types of IPV (physical-, sexual- and emotional) and the mother’s perception of the infant’s temperament (indicated by ICQ score and its subscales) were analyzed with a series of linear regressions. The first step examined whether different types of IPV were associated with the mother’s perceptions of the infant’s temperament (ICQ and subscales) (Path C). Results showed that IPV in general, as well as physical and emotional IPV were significantly associated with the mother’s perception of the infant’s temperament indicated by the total score of ICQ and its subscales fussy-difficult, unadaptable, and unpredictable, but not with the subscale dull, which indicated that the mothers did not perceive their infants as less active and unsocial than other infants. Sexual IPV was significantly associated with the mother’s perception of her infant as unadaptable and unpredictable, but not as fussy-difficult and dull (Table 2).

Table 2.

Association Between Different Types of IPV and Mother’s Perception of Infant’s Temperament (Fussy-Difficult, Unadaptable, Dull, Unpredictable, and Total ICQ Score) (N = 656).

Outcome	Predictor	Model without mediator		Model with mediator^a
Outcome	Predictor	B (SE)	p	B (SE)	p
Fussy-difficult	Physical IPV	0.73 (0.23)	.002	0.44 (0.24)	.065
	Sexual IPV	0.33 (0.23)	.312	—	—
	Emotional IPV	0.40 (0.20)	.042	0.18 (0.20)	.362
	Total IPV	0.28 (0.10)	.006	0.10 (0.11)	.358
Unadaptable	Physical IPV	0.56 (0.16)	.000	0.36 (0.17)	.033
	Sexual IPV	0.73 (0.22)	.001	0.62 (0.23)	.006
	Emotional IPV	0.49 (0.14)	.000	0.42 (0.14)	.003
	Total IPV	0.32 (0.07)	.000	0.24 (0.07)	.001
Dull	Physical IPV	0.10 (0.09)	.244	—	—
	Sexual IPV	0.03 (0.12)	.805	—	—
	Emotional IPV	–0.04 (0.07)	.563	—	—
	Total IPV	0.012(0.04)	.770	—	—
Unpredictable	Physical IPV	0.40 (0.12)	.001	0.21 (0.05)	.092
	Sexual IPV	0.38 (0.17)	.025	0.26 (0.17)	.122
	Emotional IPV	0.25 (0.10)	.015	0.15 (0.10)	.136
	Total IPV	0.18 (0.05)	.001	0.11 (0.06)	.044
Total ICQ	Physical IPV	1.79 (0.46)	.000	0.87 (0.49)	.073
	Sexual IPV	1.46 (0.65)	.024	0.70 (0.64)	.280
	Emotional IPV	1.10 (0.40)	.006	0.66 (0.40)	.097
	Total IPV	0.79 (0.21)	.000	0.43 (0.21)	.043

Note. All regression analyses were adjusted for mother’s age, husband’s age, and number of children of the couple. IPV = intimate partner violence; ICQ = Infant Characteristic Questionnaire.

Mediation analysis was not conducted in case of those predictors which were not significantly associated with the outcome variable.

In the second step (Path A), maternal depressive symptoms were significantly associated with all types of IPV, that is, the total IPV (B = 0.36, SE = 0.04, p = .000), physical IPV (B = 0.94, SE = 0.10, p = .000), sexual IPV (B = 0.69, SE = 0.14, p = .000), and emotional IPV (B = 0.42, SE = 0.09, p = .000).

In the third step (Path B), maternal depressive symptoms were significantly associated with the mother’s perceptions of her infant’s temperament (Total ICQ) (B = 1.09, SE = 0.17, p = .000) as fussy-difficult (B = 0.53, SE = 0.09, p = .000), unadaptable (B = 0.26, SE = 0.06, p = .000) and unpredictable (B = 0.24, SE = 0.05, p = .000), but not dull (B = 0.07, SE = 0.03, p = .044).

In the fourth and final step (Path C′), maternal depressive symptoms was included as a potential mediator in the linear regression models in case of those variables where the conditions to test mediation were fulfilled, that is, paths A, B and C were statistically significant. Except for the trait dull, maternal depressive symptoms either partially or fully mediated the relationship between experience of IPV by a woman and her perception of her infant’s temperament (Table 2). However, experience of sexual, emotional, and total IPV indicate a tendency to directly impact the mother’s perception of her infant’s temperament as unadaptable, that is, how the infant responds to new things, such as the first bath, new places, persons, disruptions, and changes in regular activities. Complete mediation by maternal depressive symptoms is observed in the association between the mother’s perception of her infant as fussy-difficult and IPV (physical, emotional, and total); and unpredictable and IPV (physical, sexual, and emotional). In the relationship between IPV and the mother’s perception of her infant’s temperament in general indicated by ICQ score, maternal depressive symptoms show full mediation when IPV is disaggregated by types of violence (physical, sexual, and emotional) but indicates partial mediation when all types of IPV are merged into total IPV.

Discussion

The results indicate IPV to be commonly prevalent (89%) among rural Bangladeshi women when their infants were 6 to 8 months old. Almost one third of the mothers reported depressive symptoms at 6 to 8 months, and maternal depressive symptoms were found to be significantly associated with IPV. Women who reported IPV in the current study perceived their infant as unadaptable, indicating that their infants reacted negatively to new places, persons, disruptions and changes in routines. However, IPV did not directly impact upon the mother’s perceptions of the infant as being fussy-difficult and unpredictable, since maternal depressive symptoms were found to be mediators. The temperament trait dull, that is, the mothers’ perceptions of their infant as unsocial were neither associated with IPV nor with maternal depressive symptoms.

The high prevalence of IPV found in the current study is in agreement with findings of previous studies on IPV in South Asia and Bangladesh (Garcia-Moreno et al., 2006; Naved & Persson, 2005; Silverman, Gupta, Decker, Kapur, & Raj, 2007). Heise and Garcia-Moreno (2002) reported that 42% of Bangladeshi women aged 15 to 49 years were physically assaulted by IPV, and Naved (2013) found that every second rural Bangladeshi women were sexually abused by their husbands. A study from a community of low-income Bangladeshi and displaced ethnic Bihari mothers in Dhaka reported even higher prevalence of IPV both before and after childbirth. Of the 250 women investigated in that study, 95% experienced events of physical, sexual, psychological, or emotional violence as well as threats of violence during their marital lives (Azziz-Baumgartner et al., 2014). Women in the current study were poor, most of whom were not in paid employment and were financially dependent on their husbands which according to Garcia-Moreno et al. (2006) could hinder them from leaving an abusive relationship. Naved and Persson (2005) showed that low education of husband, low socioeconomic status, demand for dowry, and conventional views about the roles of males and females were risk factors for IPV in Bangladesh. There is growing evidence of the adverse effects of IPV on women’s mental health (Fisher, Tran, Biggs, Dang, & Nguyen, 2013). A systematic review and meta-analysis found a 1.5 to 2 fold increased risk of PPD among women exposed to IPV in comparison to women not exposed to IPV (Beydoun, Beydoun, Kaufman, & Zonderman, 2012). A study from Vietnam also found the magnitude of the association between IPV and depression increased if the women experiencing more than one form of IPV (Fisher et al., 2013).

Griffin Burke et al. (2008) reported the prevalence of IPV to increase during the first year postpartum. Their research from the United States showed that shortly after childbirth, 29% of new mothers and at 1 year postpartum nearly half (45%) of the mothers reported IPV. Thus, very young children might be witness to their mothers being beaten, screamed at, and humiliated. Women exposed to IPV in our study, specifically physical and emotional violence by their partners, perceived their infants as fussy-difficult, unadaptable and unpredictable. However, after introducing maternal depressive symptoms in the model, mother’s perception of the infant being unadaptable remains to be the only statistically significant temperament trait directly affected by IPV. This may be explained by the fact that mothers exposed to IPV transfer their own fear and anxiety to the child. Because infants are dependent upon their caretaker, risk factors that threaten their mothers’ well-being, such as IPV, also threatens the infant’s health and development. Exposure to a climate of hostility, psychological aggression or physical violence can be upsetting for an infant in need for help with behavioral and emotional regulation (Ahls-Dunn & Huth-Bocks, 2014). Moreover, a mother exposed to IPV may be unable to help her infant to regulate and interact with the environment, as many of the IPV behavior, for example, threats, insults, physical pushing, or shoving may foster psychological unavailability in the mother that hinders sensitive caregiving and could leave the infant to self-regulation. This may contribute to the negative impact of IPV on the child’s later behavioral (Harding, Morelen, Thomassin, Bradbury, & Shaffer, 2013) and socioemotional problems (Ahls-Dunn & Huth-Bocks, 2014). Another explanation could be that an infant born with an unadaptable temperamental trait might be more negatively influenced by a home exposed to IPV, which could be chaotic and threatening, compared with an infant with easier temperament and fear in infancy predicts children’s later fearfulness and low aggression (Rothbart, 2007). In addition, an unadaptable infant might be more challenging for the mother to handle than a temperamentally adaptable one.

That mothers with depressive symptoms perceived their infants as fussy-difficult and unpredictable agreed with several studies (Edhborg et al., 2000; Medoff-Cooper, 1995; Murry & Cooper, 1997). Infants of depressed mothers face a climate of negative affect, and the mother’s depressed mood may generate a negative state in the infant that disrupt the mother–infant relationship (Tronick & Reck, 2009). An infant, showing a lot of negative emotions, difficult in general and to sooth on a daily basis could in addition trigger depressive symptoms in mothers (Medoff-Cooper, 1995).

Limitations

A limitation of the current study is that the information about the infants’ temperament was reported by their mothers and not objectively observed. If these infants really were more unadaptable, fussy-difficult, or unpredictable than an average infant could not be ensured. It has been suggested that it could be a distortion in the mother’s perception of the infant’s temperament because of the mother’s depressive symptoms (Whiffen & Gotlib, 1989). However, a prospective study found that 10 days old infants showing a difficult temperament strongly predicted onset of depression eight weeks postpartum (Murray, Stanley, Hooper, King, & Fiori-Cowley, 1996). Another limitation could be that maternal depressive symptoms were self-reported and not clinically diagnosed and thus the prevalence could be overestimated or underestimated. Also IPV is self-reported, which may increase the risk of underestimation, due to recall bias and the women’s willingness to acknowledge their experiences. However, the interviews have been conducted with the women in privacy and the prevalence in this study is high, and in agreement with other studies from Bangladesh (Garcia-Moreno et al., 2006; Naved & Persson, 2005).

Conclusion

The results from the current study show that IPV is common in Bangladesh during the first postpartum year. This means that even infants are exposed to parental IPV, which can challenge the development and health of the infant. All three types of IPV, that is, physical, sexual, and emotional, were associated with the mothers’ perception of three out of four infant temperament traits—fussy-difficult, unadaptable, and unpredictable—but the mothers did not perceive their infants as dull or unsocial, 6 to 8 months postpartum. However, when maternal depressive symptoms were included as a mediator, only the trait unadaptable was directly associated with IPV. In case of the other temperamental traits, the association with IPV was mediated by maternal depressive symptoms. More research is needed to understand how IPV and maternal mental health impact a child’s first year. There is a need for health personnel to ask about IPV at maternal and child health services with possibilities to refer the family or the mother and infant to appropriate support, as well as screen for maternal depressive symptoms and offer support.

Footnotes

Acknowledgements

The authors thank members of the data collection and data management teams at the Research and Evaluation Division, BRAC in Bangladesh for their support.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The study was supported by grants from the Swedish Research Link (2007-25292-51983-33) and European Commission (BD/ASIA-Link/ASIE/2006/144-465) to Karolinska Institute and School of Public Health, BRAC University.

Author Biographies

Maigun Edhborg received her Phd in 2004 in reproductive health and perinatal care from Karolinska Institute (KI), Stockholm, Sweden. She is a senior lecturer at the Division of Nursing, Department of Neurobiology, Care Sciences and Society, KI. Her main interests are impact of perinatal maternal and paternal mental health on children and the family, child development, and pediatric nursing care.

Hashima-E-Nasreen received her PhD in 2011 in maternal perinatal depression and child development from KI, Sweden. She is an assistant professor of epidemiology at International Islamic University Malaysia, Malaysia. Her main research interests include sexual and reproductive health; HIV and AIDS; mental health; and maternal, neonatal, and child health.

Zarina Nahar Kabir received her PhD in 2001 in Epidemiologic Ageing Research from KI and is an associate professor of Public Health at KI, Stockholm, Sweden. Her main research interests include aging in low-income countries, mental health, and interpersonal violence.

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