Internet-provided cognitive behaviour therapy of posttraumatic stress symptoms following childbirth-a randomized controlled trial.
Nieminen Katri,Berg Ida,Frankenstein Katri,Viita Lina,Larsson Kamilla,Persson Ulrika,Spånberger Loviisa,Wretman Anna,Silfvernagel Kristin,Andersson Gerhard,Wijma Klaas
Cognitive behaviour therapy
The aim of this study was to analyse the effects of trauma-focused guided Internet-based cognitive behaviour therapy for relieving posttraumatic stress disorder (PTSD) symptoms following childbirth, a problem that about 3% women encounter postpartum. Following inclusion, 56 traumatized women were randomized to either treatment or to a waiting list control group. Primary outcome measures were the Traumatic Event Scale (TES) and Impact of Event Scale-Reversed (IES-R). Secondary measures were Beck depression inventory II, Patient Health Questionnaire (PHQ-9), Beck Anxiety Inventory, Quality Of Life Inventory and the EuroQol 5 Dimensions. The treatment was guided by a clinician and lasted eight weeks and comprised eight modules of written text. The between-group effect size (ES) was d = .82 (p < .0001) for the IES-R. The ES for the TES was small (d = .36) and not statistically significant (p = .09). A small between-group ES (d = .20; p = .02) was found for the PHQ-9. The results from pre- to post-treatment showed large within-group ESs for PTSD symptoms in the treatment group both on the TES (d = 1.42) and the IES-R (d = 1.30), but smaller ESs in the control group from inclusion to after deferred treatment (TES, d = .80; IES-R d = .45). In both groups, the treatment had positive effects on comorbid depression and anxiety, and in the treatment group also on quality of life. The results need to be verified in larger trials. Further studies are also needed to examine long-term effects.
Longitudinal trajectories of post-traumatic stress disorder (PTSD) after birth and associated risk factors.
Dikmen-Yildiz Pelin,Ayers Susan,Phillips Louise
Journal of affective disorders
BACKGROUND:Although longitudinal trajectories of post-traumatic stress disorder (PTSD) are well-established in general trauma populations, very little is known about the trajectories of birth-related PTSD. This study aimed to identify trajectories of birth-related PTSD; determine factors associated with each trajectory; and identify women more likely to develop birth-related PTSD. METHOD:226 women who had traumatic childbirth according to DSM-IV criterion A were drawn from a community sample of 950 women. Measures were taken of PTSD, affective symptoms, fear of childbirth and social support in pregnancy, 4-6 weeks and 6-months postpartum. Information on some obstetric and psychosocial factors were also prospectively obtained. RESULTS:Four trajectories were identified: resilience (61.9%), recovery (18.5%), chronic-PTSD (13.7%) and delayed-PTSD (5.8%). Resilience was consistently distinguished from other PTSD trajectories by less affective symptoms at 4-6 weeks postpartum. Poor satisfaction with health professionals was associated with chronic-PTSD and delayed-PTSD. When affective symptoms at 4-6 weeks postpartum were removed from the model, less social support and higher fear of childbirth 4-6 weeks after birth predicted chronic and recovery trajectories; whereas experience of further trauma and low levels of satisfaction with health professionals were predictive of chronic-PTSD and delayed-PTSD, compared to resilience. Additional variables associated with different trajectories included antenatal affective symptoms, caesarean-section, preterm birth and receiving professional help. LIMITATIONS:Use of self-report measures, use of DSM-IV criteria for PTSD diagnosis, and no follow-up beyond six months are the main limitations of this study. CONCLUSION:Identified factors may inform preventive and treatment interventions for women with traumatic birth experiences.
[State of knowledge of post-natal post-traumatic stress disorder].
Benzakour Lamyae,Epiney Manuella,Girard Elodie
Revue medicale suisse
In this article, a synthesis of data from the literature on postpartum post-traumatic stress disorder (PTSD) related to childbirth is presented, knowing that the psychological suffering in this period of life is frequently associated with a certain taboo. The criteria to diagnose psychotraumatism, as well as postpartum PTSD just after the birth are here recalled as well as the importance of evaluating the subjective experience of the mother wich is a central issue. The clinical specificity and key symptoms of postpartum PTSD are described along with the risk and protective factors. In the light of scientific knowledge in the field of psychotraumatology, we present the prevention strategies of this disorder that can be applied, but which remain to be evaluated and tailored to this specific context.
Bio-socio-demographic factors associated with post-traumatic stress disorder in a sample of postpartum Brazilian women.
Zambaldi Carla Fonseca,Cantilino Amaury,Sougey Everton Botelho
Archives of women's mental health
Post-traumatic stress disorder (PTSD) is common among women. In the postpartum period, the prevalence is between 1% and 6%. The present study investigated PTSD in a sample of 400 Brazilian women between 2 and 26 weeks postpartum using the Mini-International Neuropsychiatric Interview and found a frequency of 5.3%. The factors associated with the occurrence of PTSD were low purchasing power, a history of psychiatric disorders, clinical disease, and the infant having experienced some complication.
Posttraumatic stress disorder and depression among new mothers at 8 months later of the 2008 Sichuan earthquake in China.
Qu Zhiyong,Wang Xiaohua,Tian Donghua,Zhao You,Zhang Qin,He Huan,Zhang Xiulan,Xu Fan,Guo Suran
Archives of women's mental health
On May 12, 2008, a magnitude 8.0 earthquake struck China's southwestern Sichuan province. Recent studies have identified mental health problems among the survivors, but little is known about the impact of the Sichuan earthquake on the mental health of new mothers in the area. The main objective was to assess the impact of the Sichuan earthquake on the posttraumatic stress disorders (PTSD) and depression of new mothers. A total of 317 new mothers were interviewed in the hospital from January 2009 to March 2009. Symptoms of PTSD were measured using the impact of event scale-revised, and symptoms of postpartum depression were measured using the Center for Epidemiologic Studies Depression scale. The prevalence rates of PTSD and postpartum depression were 19.9% and 29.0%, respectively. Women with high earthquake exposure had higher risks of PTSD (odds ratio (OR), 5.91; 95% confidence interval (CI), 1.75-19.97; P < 0.001) and postpartum depression (OR, 7.28; 95% CI, 2.51-21.08; P < 0.001) than women without earthquake experience. In addition, women with low monthly family income and farm workers had a higher risk of having PTSD; women who were unemployed or with lower monthly family income and poor sleep had a higher risk of having depression. Earthquake experience increased the risks of having PTSD and depression among new mothers at 8 months later of the earthquake.
Risk of Depressive Symptoms Associated with Morbidity in Postpartum Women in Rural Bangladesh.
Surkan Pamela J,Sakyi Kwame S,Christian Parul,Mehra Sucheta,Labrique Alain,Ali Hasmot,Ullah Barkat,Wu Lee,Klemm Rolf,Rashid Mahbubur,West Keith P,Strobino Donna M
Maternal and child health journal
Objectives Depression following pregnancy is common, but its extent and association with maternal morbidity in the first 6 months postpartum have not been well described in low resource settings such as rural Bangladesh. Methods We used data from a population-based, community trial of approximately 39,000 married rural Bangladeshi women aged 13-44 between 2001 and 2007 to examine the relation between women's reported morbidity symptoms from childbirth to 3 months postpartum, and subsequent depressive symptoms assessed at 6 months postpartum. We calculated crude and adjusted risk ratios for depressive symptoms following women's reports of reproductive, urinary, neurologic, nutrition and other illness measures constructed based on symptomatic reporting. Results In models adjusted for sociodemographic factors and co-morbidities, all postpartum illnesses were associated with an increased relative risk [RR, with 95% confidence intervals (CI) excluding 1] of depressive symptoms by 6 months postpartum. These morbidities included uterine prolapse (RR 1.20, 95% CI 1.04-1.39), urinary tract infection (RR 1.24, 95% CI 1.11-1.38), stress related incontinence (SRI) (RR 1.49, 95% 1.33-1.67), simultaneous SRI and continuously dripping urine (RR 1.60-2.96), headache [RR 1.20 (95% CI 1.12-1.28)], convulsions (RR 1.67, 95%CI 1.36-2.06), night blindness (RR 1.33, 95% CI 1.19-1.49), anemia (RR 1.38, 95% CI 1.31-1.46), pneumonia (RR 1.24, 95% CI 1.12-1.37), gastroenteritis (RR 1.24, 95% CI 1.17-1.31) and hepatobiliary disease (RR 2.10, 96% CI 1.69-2.60). Conclusions for Practice Illnesses during the first three postpartum months were risk factors for depressive symptoms, with the strongest associations noted for convulsions and hepatobiliary disease. Symptoms of depression may be of particular concern among women suffering from physical illnesses. CLINICAL TRIAL REGISTRATION:ClinicalTrials.gov NCT0019882.
Changes in PTSD symptomatology and mental health during pregnancy and postpartum.
Onoye Jane M,Shafer Leigh Anne,Goebert Deborah A,Morland Leslie A,Matsu Courtenay R,Hamagami Fumiaki
Archives of women's mental health
Changes in mental health symptoms throughout pregnancy and postpartum may impact a woman's experience and adjustment during an important time. However, few studies have investigated these changes throughout the perinatal period, particularly changes in posttraumatic stress disorder (PTSD) symptoms. The purpose of this study was to examine longitudinal changes in PTSD, depression, and anxiety symptomatology during pregnancy and postpartum. Pregnant women of ethnically diverse backgrounds receiving services for prenatal care at an outpatient obstetric-gynecology clinic or private physicians' office were assessed by interview on symptoms of PTSD, depression, anxiety, and general stress up to four times, including their first, second, and third trimester, and postpartum visits. Overall, during pregnancy there was a declining trend of PTSD symptoms. For anxiety, there was no overall significant change over time; however, anxiety symptoms were individually variable in the rate of change. For both depression and general stress symptoms, there was a declining trend, which was also variable in the individual rate of change among women during their pregnancy. Visual and post hoc analyses also suggest a possible peak in PTSD symptoms in the weeks prior to delivery. While most mental health symptoms may generally decrease during pregnancy, given the individual variability among women in the rate of change in symptoms, screening and monitoring of symptom fluctuations throughout the course of pregnancy may be needed. Further studies are needed to examine potential spiking of symptoms in the perinatal period.
[Predictors of postpartum post-traumatic stress disorder in primiparous mothers].
Montmasson H,Bertrand P,Perrotin F,El-Hage W
Journal de gynecologie, obstetrique et biologie de la reproduction
OBJECTIVES:Identify the potential predictors of postpartum post-traumatic stress disorder (PTSD) in primiparous mothers. MATERIALS AND METHODS:This longitudinal prospective study evaluated the prevalence of obstetric complications and psychiatric disorders (anxiety, depression, psychic dissociation, PTSD, personality) in the immediate postpartum and after 3-6 months. RESULTS:Among 456 hospitalized primiparous mothers, 314 were recruited and 212 followed-up prospectively. The prevalence of PTSD symptoms was high and stable through the postpartum (12.7% versus 13.6%). Significant risk factors were associated with postpartum PTSD: social isolation, celibacy or divorce (OR=6.6; P<0.02), history of abortion (OR=6.2; P<0.01) or of infertility (OR=10.4; P<0.007), too long subjective length of labour (OR=3.5; P<0.03), mothers' perceptions of obstetric complications (OR=18.5; P<0.003), high anxiety level at the maternity hospital (OR=3.9; P<0.03), PTSD symptoms after childbirth (OR=6.7; P<0.01) and dependent personality disorder (OR=23.2; P<0.001). CONCLUSION:Subjective experience of childbirth, history of obstetric complications, social isolation and dependent personality disorder and high level of stress-anxiety after childbirth are significant predictive factors of postpartum PTSD (3-6 months). The early identification of these factors should lead to early therapeutic intervention in the mothers at risk of PTSD.
Post-traumatic stress disorder in the perinatal period: A concept analysis.
Vignato Julie,Georges Jane M,Bush Ruth A,Connelly Cynthia D
Journal of clinical nursing
AIMS AND OBJECTIVES:To report an analysis of the concept of perinatal post-traumatic stress disorder. BACKGROUND:Prevalence of perinatal post-traumatic stress disorder is rising in the USA, with 9% of the U.S. perinatal population diagnosed with the disorder and an additional 18% being at risk for the condition. Left untreated, adverse maternal-child outcomes result in increased morbidity, mortality and healthcare costs. DESIGN:Concept analysis via Walker and Avant's approach. METHODS:The databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Academic Search Premier and PsychINFO were searched for articles, written in English, published between 2006-2015, containing the terms perinatal and post-traumatic stress disorder. RESULTS:Perinatal post-traumatic stress disorder owns unique attributes, antecedents and outcomes when compared to post-traumatic stress disorder in other contexts, and may be defined as a disorder arising after a traumatic experience, diagnosed any time from conception to 6 months postpartum, lasting longer than 1 month, leading to specific negative maternal symptoms and poor maternal-infant outcomes. Attributes include a diagnostic time frame (conception to 6 months postpartum), harmful prior or current trauma and specific diagnostic symptomatology defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Antecedents were identified as trauma (perinatal complications and abuse), postpartum depression and previous psychiatric history. Consequences comprised adverse maternal-infant outcomes. CONCLUSIONS:Further research on perinatal post-traumatic stress disorder antecedents, attributes and outcomes in ethnically diverse populations may provide clinicians a more comprehensive framework for identifying and treating perinatal post-traumatic stress disorder. RELEVANCE TO CLINICAL PRACTICE:Nurses are encouraged to increase their awareness of perinatal post-traumatic stress disorder for early assessment and intervention, and prevention of adverse maternal-infant outcomes.
Cumulative trauma and partner conflict predict post-traumatic stress disorder in postpartum African-American women.
Hauff Nancy J,Fry-McComish Judith,Chiodo Lisa M
Journal of clinical nursing
AIM AND OBJECTIVE:To describe relationships between cumulative trauma, partner conflict and post-traumatic stress in African-American postpartum women. BACKGROUND:Cumulative trauma exposure estimates for women in the USA range from 51-69%. During pregnancy, most trauma research has focused on physical injury to the mother. Post-traumatic stress disorder (PTSD) is associated with trauma and more prevalent in African-American women than women of other groups. Knowledge about both the rate and impact of cumulative trauma on pregnancy may contribute to our understanding of women seeking prenatal care, and disparities in infant morbidity and mortality. DESIGN:This retrospective, correlational, cross-sectional study took place on postpartum units of two Detroit hospitals. Participants were 150 African-American women aged between 18-45 who had given birth. METHODS:Mothers completed the Cumulative Trauma Scale, Conflict Tactics Scale, Clinician Administered Post-traumatic Stress Scale, Edinburgh Postnatal Depression Scale and a Demographic Data form. Descriptive statistics, correlations and multiple regressions were used for data analysis. RESULTS:All participants reported at least one traumatic event in their lifetime. Cumulative trauma and partner conflict predicted PTSD, with the trauma of a life-threatening event for a loved one reported by 60% of the sample. Nearly, one-fourth of the women screened were at risk for PTSD. Increased cumulative trauma, increased partner conflict and lower level of education were related to higher rates of PTSD symptoms. CONCLUSION:Both cumulative trauma and partner conflict in the past year predict PTSD. Reasoning was used most often for partner conflict resolution. RELEVANCE TO CLINICAL PRACTICE:The results of this study offer additional knowledge regarding relationships between cumulative trauma, partner conflict and PTSD in African-American women. Healthcare providers need to be sensitive to patient life-threatening events, personal failures, abuse and other types of trauma. Current evidence supports the need to assess for post-traumatic stress symptoms during pregnancy.
The influence of postpartum PTSD on breastfeeding: A longitudinal population-based study.
Garthus-Niegel Susan,Horsch Antje,Ayers Susan,Junge-Hoffmeister Juliane,Weidner Kerstin,Eberhard-Gran Malin
Birth (Berkeley, Calif.)
BACKGROUND:In most Western countries, breastfeeding rates are lower than what is recommended by the World Health Organization. Depression has been shown to influence breastfeeding outcomes; however, there is very little research on the role of postpartum posttraumatic stress disorder (PTSD). This study examined to what extent maternal postpartum PTSD predicted breastfeeding initiation, exclusive breastfeeding during the first 6 months, and continuation up to 1 and 2 years. METHODS:The study is part of the large, population-based Akershus Birth Cohort. Data from the hospital's birth record and questionnaire data from 8 weeks and 2 years postpartum were used (n = 1480). All breastfeeding variables significantly correlated with postpartum PTSD were entered into stepwise logistic regression analyses. RESULTS:Although most mothers (97.1%) initiated breastfeeding, considerably fewer adhered to the World Health Organization's breastfeeding guidelines about exclusive breastfeeding during the first 6 months (13.4%) or continued breastfeeding for 12 or 24 months postpartum (37.7% and 4.2%, respectively). Even after adjustment for important confounding variables, maternal postpartum PTSD was significantly associated with not initiating breastfeeding (aOR 5.98 [95% CI 1.79-19.97]). Postpartum PTSD was also significantly related to not continuing breastfeeding up to 12 months, although this association did not hold after adjusting for confounding variables. CONCLUSION:Identifying women at risk of not initiating breastfeeding is crucial to prevent a negative influence on infant development and the development of the mother-infant bond. Early screening and treatment of women at risk of developing postpartum PTSD might be a way forward.
Postpartum post-traumatic stress disorder: Associated perinatal factors and quality of life.
Hernández-Martínez Antonio,Rodríguez-Almagro Julian,Molina-Alarcón Milagros,Infante-Torres Nuria,Donate Manzanares Miriam,Martínez-Galiano Juan Miguel
Journal of affective disorders
BACKGROUND:The relationship between obstetric variables and postpartum post-traumatic stress disorder (PTSD), and its influence on quality of life (QoL), have scarcely been studied. OBJECTIVE:Determine the prevalence of PTSD at postpartum weeks 4 and 6, and its relation with perinatal variables and quality of life METHOD: A cross-sectional study with 2990 Spanish puerperal women in Spain. Data were collected on socio-demographic and obstetric variables, and on newborns. An online ad hoc questionnaire was used, including the Perinatal Post-traumatic Stress Disorder Questionnaire (PPQ) and SF-36. The crude and adjusted odds ratios were estimated by binary logistic regression. RESULTS:10.6% (318) of the women appeared at risk for PTSD symptoms. Factors like having a respected birth plan (aOR: 0.52; 95%CI: 0.34, 0.80), using epidural analgesia (aOR: 0.64; 95%CI: 0.44, 0.92) and performing skin-to-skin contact (aOR: 0.37; 95%CI: 0.28, 0.50) were protective factors against PTSD, among others. Instrumental birth (aOR: 2.50; 95%CI: 1.70, 3.69) and caesarean section (aOR: 3.79; 95%CI: 2.43, 5.92) were found to be risk factors, among others. The area under the ROC curve in this model was 0.79 (95%CI: 0.76, 0.81). The women with PTSD presented a mean difference for QoL of -13.37 points less than those without PTSD (95%CI: -11.08, -15.65). CONCLUSIONS:The women with PTSD symptoms had a worse quality of life at postpartum weeks 4-6. Birth type, analgesia methods and humanising practices, like skin-to-skin contact and using respected birth plans, were related with presence of the postpartum PTSD risk.
The Association of Family Support After Childbirth With Posttraumatic Stress Disorder in Women With Preeclampsia.
Soltani Narges,Abedian Zahra,Mokhber Naghmeh,Esmaily Habibollah
Iranian Red Crescent medical journal
BACKGROUND:Stressful situations and life-threatening issues such as preeclampsia can lead to Post-traumatic stress disorders [PTSD]. It seems that within social supports, family support has more effect on mental health. OBJECTIVES:The aim of this study was to determine the association between family supports in the postpartum period with occurrence of post-traumatic stress disorder following preeclampsia. PATIENTS AND METHODS:In this descriptive longitudinal study, 100 women with preeclampsia admitted in government hospitals of Mashhad were selected using convenience sampling. Post-traumatic stress disorder was diagnosed by psychiatrist interview and perinatal posttraumatic stress questionnaire (PPQ) in sixth week postpartum and family support was measured by family support scale (FSS) in second and sixth weeks postpartum. Data analyzed by SPSS 16 using Spearman correlation coefficient, paired sample T-test and Kruskal-Wallis test. RESULTS:A reverse significant association was found between family support in weeks 2 and 6 (92.6 ± 22.6, 83.7 ± 21.6, respectively) and PTSD (mean score of 4.8 ± 2.5) (respectively, P = 0.010 and P =0.011). The most important variables affecting PTSD with presence of family support in weeks 2 and 6 were postpartum depression in week 6 as well as trait anxiety at the time of admission. CONCLUSIONS:The more support in weeks 2 and 6 postpartum, the less PTSD occurs. Therefore, it is suggested to health care providers who face mothers after delivery to evaluate the support received by mothers and help those with inadequate or inappropriate support.
Effect of Previous Posttraumatic Stress in the Perinatal Period.
Geller Pamela A,Stasko Emily C
Journal of obstetric, gynecologic, and neonatal nursing : JOGNN
OBJECTIVE:To review the extant literature on the effect of traumatic experiences that pre-date conception, pregnancy, and the postpartum period (perinatal period) and present a thematic overview of current issues in this relatively new area of inquiry. DATA SOURCES:Electronic databases Cochrane, CINAHL, PsychINFO, and PubMed were searched. Manual searches of reference lists supplemented the electronic search. STUDY SELECTION:Peer-reviewed articles written in English on the role of posttraumatic stress disorder during the perinatal period were included. DATA EXTRACTION:Key findings relevant to perinatal posttraumatic stress that were reported in primary sources and meta-analyses were organized according to themes, including The Role of Childbirth, Comorbidity With Depression and Anxiety, Risk Factors for Perinatal PTSD, High-Risk Health Behaviors, and Association With Adverse Health Outcomes. DATA SYNTHESIS:Across studies, antenatal posttraumatic stress disorder (PTSD) rates were estimated between 2.3% and 24%, and observed prevalence rates during the postnatal period ranged from 1% to 20%; however, many researchers failed to assess PTSD that existed before or during pregnancy, and when preexisting PTSD is a controlled variable, postpartum rates drop to 2% to 4.7%. In addition to prenatal depression and anxiety and pre-pregnancy history of psychiatric disorders, history of sexual trauma, childhood sexual abuse, intimate partner violence, and psychosocial attributes are risk factors for development or exacerbation of perinatal PTSD. CONCLUSION:Women's health care providers should evaluate for PTSD in routine mental health assessments during and after pregnancy, especially with a reported history of trauma or the presence of a mood or anxiety disorder. Such screening will allow women to receive needed treatment and referrals and mitigate the potentially negative sequelae of PTSD. Future investigators must recognize the importance of subsyndromal posttraumatic stress symptoms and individual differences in responses to trauma.
Posttraumatic stress disorder related to postpartum haemorrhage: A systematic review.
Zaat Tjitske R,van Steijn Minouk E,de Haan-Jebbink Jiska M,Olff Miranda,Stramrood Claire A I,van Pampus Mariëlle G
European journal of obstetrics, gynecology, and reproductive biology
In some cases childbirth leads to negative psychological responses such as posttraumatic stress disorder (PTSD). Postpartum hemorrhage (PPH) is a common and major complication of childbirth, which occasionally requires emergency hysterectomy in severe cases. Patients often describe these complications as a traumatic experience. It is unknown whether PPH is a risk factor for developing PTSD. In this systematic review we summarize the current knowledge about the association between PPH with or without emergency hysterectomy and posttraumatic stress symptoms or PTSD. If PPH is a risk factor for PTSD, this will allow adequate preventive measures with the aim to reduce the long-term effects and socioeconomic problems associated with PTSD. To conduct this review MEDLINE, EMBASE, Web of Science, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials, Cochrane Library and PsycINFO databases were searched for publications between January 1986 and October 2017. Manuscripts evaluating the association between PPH and peripartum emergency hysterectomy and PTSD or posttraumatic stress symptoms were included. Fifty-two articles met the criteria for full-text review. Seven articles were included in this review. Five studies focused on the association between PPH and PTSD and two studies evaluated the association between emergency hysterectomy and PTSD. Three studies found no association between PPH and PTSD. Two studies reported a higher risk of developing PTSD or posttraumatic stress symptoms after PPH. Two studies reported a higher risk of developing PTSD after emergency hysterectomy. Meta-analysis was not possible due to the heterogeneity of these studies. Based on the results of these studies there may be an association between PPH and PTSD. Secondly, it seems likely that an association exists between emergency postpartum hysterectomy and PTSD, but the strength of this conclusion is limited by the small amount of studies included.
Prevalence and risk factors of postpartum posttraumatic stress disorder: a meta-analysis.
Grekin Rebecca,O'Hara Michael W
Clinical psychology review
Research has demonstrated that women develop postpartum PTSD. Prevalence of postpartum PTSD has ranged from 1% to 30%, and many risk factors have been identified as predictors of postpartum PTSD. While qualitative reviews have identified patterns of risk, the lack of quantitative reviews prevents the field from identifying specific risk factors and making a single estimate of the prevalence of postpartum PTSD. The current meta-analysis investigated prevalence and risk factors of postpartum PTSD, both due to childbirth and other events, among community and targeted samples. Prevalence of postpartum PTSD in community samples was estimated to be 3.1% and in at-risk samples at 15.7%. Important risk factors in community samples included current depression, labor experiences such as interactions with medical staff, as well as a history of psychopathology. In at-risk samples, impactful risk factors included current depression and infant complications. Further research should investigate how attitudes towards pregnancy and childbirth may interact with women's experiences during delivery. Additionally, studies need to begin to evaluate possible long-term effects that these symptoms may have on women and their families.
Fear of Childbirth, Postpartum Depression, and Birth-Related Variables as Predictors of Posttraumatic Stress Disorder After Childbirth.
Çapik Ayla,Durmaz Hatice
Worldviews on evidence-based nursing
BACKGROUND:Childbirth may be a significant cause of postpartum posttraumatic stress disorder (PTSD) in women. AIMS:The objective of this study is to examine the effect of fear of childbirth, postpartum depression, and certain birth-related variables on postpartum PTSD. METHODS:This study is a cross-sectional study. The study was carried out in a maternity hospital nonstress unit between December 1, 2015, and February 29, 2016. Three hundred and one pregnant women who met the criteria for inclusion in the study made up the research sample. RESULTS:Fear of childbirth and postpartum depression significantly and positively predicted the level of posttraumatic stress after childbirth (β = 0.17, p < .01; β = 0.68, p < .001). Fear of childbirth explains 3% of the total variance in posttraumatic stress (R = .03, adjusted R = .02, F = 7.141, p < .01), while postpartum depression explains 47% of it (R = .47, adjusted R = .46, F = 196.35, p < .001). Satisfaction with the attitudes of the medical staff during childbirth, defining the childbirth experience, and the state of experiencing postpartum problems by the mother are significant predictors of postpartum posttraumatic stress (β = -0.21, p < .01; β = -0.14, p < .05; β = 0.17, p < .01). When these three variables are addressed together, they explain 14% of the total variance (R = .14, adjusted R = .13, F = 9.33, p < .001). LINKING EVIDENCE TO ACTION:Postpartum PTSD is a situation that must be carefully emphasized in terms of maternal, baby, and family health. For this reason, it is necessary to evaluate postpartum PTSD more quickly and objectively, and healthcare providers have major duties in this respect.
Correlation between Kind of Cesarean Section and Posttraumatic Stress Disorder in Greek Women.
Orovou Eirini,Dagla Maria,Iatrakis Georgios,Lykeridou Aikaterini,Tzavara Chara,Antoniou Evangelia
International journal of environmental research and public health
A birth experience with cesarean section (CS) can be a cause of the development of post-traumatic stress disorder after a cesarean (PTSD-AC) or profile PTSD, for a percentage of women. So far, there is no data on the frequency of PTSD-AC in Greece and this syndrome is often associated with other mental disorders of the postpartum period. The purpose of this research is to associate the kind of CS with PTSD-AC for Greek mothers and the combination of factors that make them less resistant to trauma. A sample of ahundred and sixty-six mothers who gave birth with emergency cesarean section (EMCS) and elective cesarean section (ELCS) at a Greek University hospital have consented to participate in the two phases of the survey, in the 2nd day postpartum and a follow-up in the 6th week postpartum. Medical/demographic data and a life events checklist (LEC-5) with Criterion A and post-traumatic stress checklist (PCL-5) were used to diagnose PTSD and PTSD Profile. Out of166 mothers enrolled, 160 replied to the follow-up (96.4%), ELCS 97 (97%) and EMCS 63 (95%). Twenty (31.7%) EMCS had PTSD and nine (14.3%) had Profile. One (1%) ELCS had PTSD and 4 (4.1%) had Profile. This survey shows a high prevalence rate of PTSD after EMCS with additional risk factors of preterm labor, inclusion in the Neonatal Intensive Care Unit (NICU), a lack of breastfeeding, and a lack of support from the partner.
Traumatic memories of childbirth relate to maternal postpartum posttraumatic stress disorder.
Thiel Freya,Berman Zohar,Dishy Gabriella A,Chan Sabrina J,Seth Himani,Tokala Meghan,Pitman Roger K,Dekel Sharon
Journal of anxiety disorders
The trauma memory is a crucial feature of PTSD etiology and maintenance. Nonetheless, the nature of memories associated with childbirth-related posttraumatic stress disorder (CB-PTSD) requires explication. The present study, as part of a larger project on psychological outcomes of childbirth, utilized a multi-method approach to characterize childbirth memories in relation to CB-PTSD symptoms. We here assessed 413 women who completed self-report measures pertaining to CB-PTSD, postpartum depression, and childbirth memories. Additionally, a subset of 209 women provided written childbirth narratives, analyzed using Linguistic Inquiry and Word Count software. Women endorsing CB-PTSD symptoms on the PTSD-Checklist (PCL)-5 reported more incoherent childbirth memories with more emotional and sensory details, and more frequent involuntary recall and reliving of the memory. They also indicated the childbirth experience was more central to their identity. Written narratives in those with probable CB-PTSD were characterized by less (positive) affective processes, and more cognitive processes. We infer that childbirth memories in women who endorse symptoms of CB-PTSD in the early postpartum period resemble those described in the general PTSD literature. This suggests that childbirth may be experienced as traumatic and evoke a traumatic memory, implicated in symptom endorsement. Opportunities for therapeutic interventions modifying traumatic memories of childbirth in women at risk for CB-PTSD need to be investigated. Future research examining characteristics of traumatic childbirth memories is needed to advance our understanding of this overlooked postpartum condition.
Postpartum posttraumatic stress disorder in a fetal high-risk maternity hospital in the city of Rio de Janeiro, Brazil.
Henriques Tatiana,Moraes Claudia Leite de,Reichenheim Michael E,Azevedo Gustavo Lobato de,Coutinho Evandro Silva Freire,Figueira Ivan Luiz de Vasconcellos
Cadernos de saude publica
The objectives of this study were to estimate the prevalence of postpartum posttraumatic stress disorder (PTSD) in a maternity hospital for fetal high-risk pregnancies and to identify vulnerable subgroups. This was a cross-sectional study at a fetal high-risk maternity hospital in Rio de Janeiro, Brazil, with a sample of 456 women who had given birth at this hospital. The Trauma History Questionnaire and Post-Traumatic Stress Disorder Checklist were used to screen for lifetime traumatic events and PTSD symptoms, respectively. Overall prevalence of PTSD was 9.4%. Higher PTSD prevalence was associated with three or more births, a newborn with a 1-minute Apgar score of seven or less, history of mental disorder prior to or during the index pregnancy, postpartum depression, physical or psychological intimate partner violence during the pregnancy, a history of unwanted sexual experience, and lifetime exposure to five or more traumas. Rapid diagnosis and treatment of PTSD are essential to improve the mother's quality of life and the infant's health.
Maternal posttraumatic stress disorder during the perinatal period and child outcomes: A systematic review.
Cook Natalie,Ayers Susan,Horsch Antje
Journal of affective disorders
BACKGROUND:Approximately 3.3% of women in pregnancy have posttraumatic stress disorder (PTSD) and 4% of women postpartum PTSD. The impact of maternal PTSD during the perinatal period (from conception until one year postpartum) on child outcomes has not been systematically examined. METHOD:A systematic review was conducted to synthesize and critically evaluate quantitative research investigating the association between perinatal PTSD and child outcomes. Databases EMBASE, BNI, Medline, PsycInfo and CINAHL were searched using specific inclusion and exclusion criteria. RESULTS:26 papers reporting 21 studies were identified that examined associations between perinatal PTSD and postpartum birth outcomes, child development, and mother-infant relationship. Studies reviewed were heterogeneous, with poor-to-medium scores of methodological quality. Results showed that maternal postpartum PTSD is associated with low birth weight and lower rates of breastfeeding. Evidence for an association between maternal PTSD and preterm birth, fetal growth, head circumference, mother-infant interaction, the mother-infant relationship or child development is contradictory. Associations between maternal PTSD and infant salivary cortisol levels, and eating/sleeping difficulties are based on single studies, so require replication. LIMITATIONS:Methodological weaknesses of the studies included insufficient sample size, use of invalidated measures, and limited external validity. CONCLUSION:Findings suggest that perinatal PTSD is linked with some negative child outcomes. Early screening for PTSD during the perinatal period may be advisable and onward referral for effective treatment, if appropriate. Future research using larger sample sizes, validated and reliable clinical interviews to assess PTSD, and validated measures to assess a range of child outcomes, is needed.
Beyond postpartum depression: posttraumatic stress-depressive response following childbirth.
Dekel Sharon,Ein-Dor Tsachi,Dishy Gabriella A,Mayopoulos Philip A
Archives of women's mental health
Although depression following childbirth is well recognized, much less is known about comorbid postpartum psychiatric conditions. Some women can endorse posttraumatic stress related to the childbirth experience accompanied by symptoms of depression. The objective of our study was to examine the nature of the comorbidity of symptoms of childbirth-related posttraumatic stress disorder (PTSD) and postpartum depression. We studied a sample of 685 women who were on average 3 months following childbirth and collected data about their mental health pertaining to PTSD, depression, general distress, and childbirth experience. The vast majority of women with elevated childbirth-related PTSD symptoms also endorsed elevated postpartum depression symptoms. Factor analysis revealed that symptoms of childbirth-related PTSD and postpartum depression loaded onto one single factor rather than two factors. Stepwise multi-nominal regression analysis revealed that childbirth stressors, including obstetric complications and peritraumatic distress in birth, predicted the likelihood of developing comorbid childbirth-related PTSD and postpartum depression, but not depression alone. The findings suggest that beyond postpartum depression, postpartum women suffer from a posttraumatic stress-depressive response in the wake of a traumatic childbirth experience. Increasing awareness in routine postpartum care about traumatic childbirth and its associated emotional sequela is warranted.
Childbirth Narratives of Women With Posttraumatic Stress Symptoms in the Postpartum Period.
Santoro Elena,Stagni-Brenca Elisa,Olivari Maria G,Confalonieri Emanuela,Di Blasio Paola
Journal of obstetric, gynecologic, and neonatal nursing : JOGNN
OBJECTIVE:To examine cognitive, emotional, and perceptual differences in the childbirth narratives of women with high levels of posttraumatic stress symptoms (PTSS) compared with women with low levels of PTSS in the postpartum period. DESIGN:A cross-sectional design. Participants were retrospectively assigned to the high or low PTSS group on the basis of their scores on the Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ) administered at 1 week and 3 months after childbirth. SETTING:Participants' homes and Internet survey. PARTICIPANTS:Twenty-five women were included in the high PTSS group (PPQ score ≥ 12), and 25 were included in the low PTSS group (PPQ score ≤ 1). METHODS:Participants completed the PPQ and a writing task about the birth experience 1 week after birth and completed an online version of the PPQ 3 months after birth. Characteristics of the narratives were analyzed and compared between the two groups using the Linguistic Inquiry Word Count. RESULTS:Compared with participants with low levels of PTSS, participants with high levels of PTSS reported more negative emotions, including horrific images connected to labor and birth and fewer positive emotions. Participants with high levels of PTSS used more sensory and perceptual terms (tactile, visual, and auditory). In contrast, women with low levels of PTSS described more active participation during birth and used more future tense verbs. CONCLUSION:Our findings suggest the aspects that are involved in the development and maintenance of PTSS after birth and may be considered for use in clinical practice to improve quality of care and women's health during the postpartum period.
Prediction of posttraumatic stress disorder symptomatology after childbirth - A Croatian longitudinal study.
Srkalović Imširagić Azijada,Begić Dražen,Šimičević Livija,Bajić Žarko
Women and birth : journal of the Australian College of Midwives
BACKGROUND:Following childbirth, a vast number of women experience some degree of mood swings, while some experience symptoms of postpartum posttraumatic stress disorder. AIM:Using a biopsychosocial model, the primary aim of this study was to identify predictors of posttraumatic stress disorder and its symptomatology following childbirth. METHODS:This observational, longitudinal study included 372 postpartum women. In order to explore biopsychosocial predictors, participants completed several questionnaires 3-5 days after childbirth: the Impact of Events Scale Revised, the Big Five Inventory, The Edinburgh Postnatal Depression Scale, breastfeeding practice and social and demographic factors. Six to nine weeks after childbirth, participants re-completed the questionnaires regarding psychiatric symptomatology and breastfeeding practice. FINDINGS:Using a multivariate level of analysis, the predictors that increased the likelihood of postpartum posttraumatic stress disorder symptomatology at the first study phase were: emergency caesarean section (odds ratio 2.48; confidence interval 1.13-5.43) and neuroticism personality trait (odds ratio 1.12; confidence interval 1.05-1.20). The predictor that increased the likelihood of posttraumatic stress disorder symptomatology at the second study phase was the baseline Impact of Events Scale Revised score (odds ratio 12.55; confidence interval 4.06-38.81). Predictors that decreased the likelihood of symptomatology at the second study phase were life in a nuclear family (odds ratio 0.27; confidence interval 0.09-0.77) and life in a city (odds ratio 0.29; confidence interval 0.09-0.94). CONCLUSION:Biopsychosocial theory is applicable to postpartum psychiatric disorders. In addition to screening for depression amongst postpartum women, there is a need to include other postpartum psychiatric symptomatology screenings in routine practice.
Detection and Prevention of Postpartum Posttraumatic Stress Disorder: A Call to Action.
Canfield Dana,Silver Robert M
Obstetrics and gynecology
The rising maternal mortality rate has drawn increased focus to postpartum depression. However, other mental health conditions, such as birth-related postpartum traumatic stress disorder, have not garnered the same level of attention. The majority of research about postpartum posttraumatic stress disorder (PTSD) is published in journals focused on psychiatry, psychology, and nursing, where this phenomenon is well recognized. In contrast, there is a lack of awareness among most obstetricians. Consequently, few recommendations are available to guide clinical practice. This commentary will present a clinical vignette, provide background that is key to the detection of PTSD, explore available data on postpartum PTSD, and provide recommendations for recognition and prevention of this disorder.
The risk factors for postpartum posttraumatic stress disorder and depression.
Bayri Bingol Fadime,Demirgoz Bal Meltem
Perspectives in psychiatric care
PURPOSE:In this study, we examined the association between specific birth-related variables and postpartum posttraumatic stress disorder (PTSD) and depressive symptoms. DESIGN AND METHODS:In this descriptive study, data were collected using a personal information form, the City Birth Trauma Scale, and the Edinburgh Postpartum Depression Scale. FINDINGS:The findings revealed that 8.5% of participants met all the diagnostic criteria for PTSD. The risk of developing depression was 9.7 times higher among women who met all the criteria for PTSD than among those who did not meet all the criteria. PRACTICE IMPLICATIONS:During the postpartum period, at-risk mothers should be followed and screened for PTSD and depressive symptoms.
Midwives' practices and knowledge about fear of childbirth and postpartum posttraumatic stress disorder.
de Vries Nadine E,Stramrood Claire A I,Sligter Lynn M,Sluijs Anne-Marie,van Pampus Maria G
Women and birth : journal of the Australian College of Midwives
BACKGROUND:Women suffering from fear of childbirth and postpartum posttraumatic stress disorder are often not recognised by health care professionals. AIM:To evaluate practices, knowledge and the attitudes of midwives towards women with fear of childbirth and postpartum posttraumatic stress disorder. METHODS:A cross-sectional study was performed amongst midwives who work in community practices and hospitals in the Netherlands with the use of a questionnaire purposefully designed for this research aim. FINDINGS:257 midwives participated in the study, of whom 217 completed all items in the questionnaire. Midwives were better equipped to answer knowledge questions concerning fear of childbirth than posttraumatic stress disorder (regarding symptomatology, risk factors, consequences and treatment). When tending to women with fear of childbirth or (suspected) postpartum posttraumatic stress disorder, most midwives referred to another caregiver (e.g. psychologist). Most midwives expressed a positive and compassionate attitude towards women with fear of childbirth and postpartum posttraumatic stress disorder. DISCUSSION:The majority of midwives are well informed with respect to fear of childbirth, but knowledge of important aspects of postpartum posttraumatic stress disorder is often lacking. Midwives report no crucial issues related to their attitudes towards women with fear of childbirth and posttraumatic stress disorder. Most midwives provide adequate organisation of care and support. CONCLUSION:Midwives should acquire more in depth knowledge of fear of childbirth and postpartum posttraumatic stress disorder. This can be achieved by including the two conditions in the program of midwifery education.
Development and validation of the Social Capital Assessment Tool in pregnancy for Maternal Health in Low and middle income countries (LSCAT-MH).
Agampodi Thilini C,Agampodi Suneth B,Glozier Nick,Lelwala T A,Sirisena K D P S,Siribaddana Sisira
OBJECTIVES:Social capital which implies 'features of social organisation, such as trust, norms and networks that can improve the efficiency of society by facilitating coordinated actions' is rarely assessed in relation to maternal health in low/middle-income countries (LMICs). A main reason for this research gap could be the unavailability of a specific tool to measure social capital in pregnancy. The study developed and validated an instrument to measure social capital among pregnant women. SETTING:We developed the tool based on World Bank Social Capital Assessment Tool and its adaptations identified as applicable to LMIC from an initial systematic review. The study was conducted in Anuradhapura district in the North Central Province of Sri Lanka. Validation process was conducted in urban, rural and resettled communities. PARTICIPANTS:Study participants of the cognitive validation included pregnant women from the three communities, and an expert panel including a social scientist, methodological expert, subject expert, public health officers. The psychometric validation was performed on 439 pregnant women permanently residing in the three communities. RESULTS:The 24-item Low and middle income countries Social Capital Assessment Tool for Maternal Health (LSCAT-MH) demonstrated high internal consistency (Cronbach's α=0.94). Factor analytical methods suggested a four-factor model of (1) neighbourhood networks (structural bonding), (2) domestic and neighbourhood cohesion (cognitive bonding), (3) social contribution and (4) social participation (structural bridging). Concurrent validity with antenatal mental ill health was confirmed through a negative correlation with the Edinburgh Postpartum Depression Scale. Test-retest reliability was high with intraclass correlation of 0.71 and a Pearson correlation of 0.83. CONCLUSION:The LSCAT-MH is a psychometrically valid and reliable tool to measure social capital in pregnancy. Predictive validity was not tested as the study was not a longitudinal follow-up.
The association between social capital and quality of life among a sample of Iranian pregnant women.
RezaeiNiaraki Masoumeh,Roosta Sadaf,Alimoradi Zainab,Allen Kelly-Ann,Pakpour Amir H
BMC public health
BACKGROUND:Quality of life (QoL) is a multidimensional concept that is affected by various factors. According to the literature, social capital is one of the key determinants of QoL that improves the living conditions of the entire community. This study aimed to investigate the association between social capital and QoL in pregnant women. METHODS:This cross-sectional study included 240 pregnant women with a mean age of 27.98 years who were referred to healthcare centers in Qazvin, Iran. A two-stage random sampling method was used to select the health centers and participants. Social capital, QoL, demographic and obstetric characteristics were assessed. RESULTS:The mean scores of social capital, physical and mental dimensions of quality of life were 67.43, 70.2 and 71.88 respectively. All dimensions of social capital except for family and friends' connection and tolerance of diversity had positive significant correlations with the physical and mental health dimensions of quality of life (r = 0.17 to 0.28 p < 0.05). A univariate regression model revealed that social capital had a significant association with both the physical health (B = 0.40, 95% CI: 0.19-0.61, p < 0.001) and mental health (B = 0 .44, 95% CI: 0.18-0.58, p < 0.001) dimensions of pregnant women's quality of life. In the adjusted model, each unit increase of social capital increased pregnant women's QoL in both the physical health and mental health dimensions. CONCLUSION:Social capital has a significant association with women's QoL during pregnancy. Therefore, QoL during pregnancy could be improved by considering physical, psychological and social components of their healthcare.
Social capital and fertility behaviors: a cross-sectional study in Iranian women health care workers.
Firouzbakht Mojgan,Tirgar Aram,Hajian-Tilaki Karimollah,Bakouei Fatemeh,Riahi Mohammad Esmaeil,Nikpour Maryam
BMC women's health
BACKGROUND:Fertility, in addition to the biomedical aspect, is phenomena of social, economic and demographic changes. Social network were considered for understanding fertility behaviors and changes in the levels of fertility. This study was conducted to investigate the relationship between social capital and childbirth behaviors in Iranian women employees. METHODS:This cross-sectional study was conducted in 2017 on 536 women health care workers who randomly selected from health care setting Babol/Iran. Data were collected using demographic, childbearing behavior and social capital questionnaires. The SPSS-21 software was employed to analysis the data at a significant level of 0.05. RESULTS:The results of the study showed that, there was significant relationship between number of pregnancy and social capital (P = 0.039). Furthermore, social capital has a significant relationship with the time of pregnancy (P = 0.043), the time of pregnancy in women with high social capital was observed to be relatively 30% shorter compare the women with low social capital. CONCLUSION:Social capital, as one of the important factors influencing childbirth behaviors, should be considered in population planning and policy making.