Assessing the stability of psychobiological stress reactivity during adolescence: mixed-effect modelling of cortisol responses to laboratory stressors

Abstract

Background Our team published a systematic review highlighting the lack of a comprehensive measure of health and wellbeing for postpartum women. The aim of this project was to examine the feasibility of a combination of existing measures, chosen for their coverage of key domains and psychometric rigour. The primary objective was to examine the validity and completeness of the novel outcome set within the first week (T1), 6 weeks (T2), and 12 weeks postpartum (T3). Secondary objectives were to examine concordance between patient-clinician reports of delivery complications and assess postpartum response rates. Methods Participants completed demographic and delivery details as well as completing a combination of existing PROM tools: the PQoL (Postpartum women’s Quality of life questionnaire), ICIQ-UI-SF (International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form) and 2 sexual health questions. Participants also rated the validity of these tools. Results The response rates were 69% (n=59)T1, 67% (n=57)T2 and 48% (41)T3. Complete responses at T1 55% (n=47),T2 53% (n=45)T3 44% (n=37). The median time taken to complete the survey was 7 minutes. Across the three time points ~70% (70.2% T1, 73.3% T2, 69% T3) of respondents felt that all outcomes that mattered most to them were captured. The difference between complication rates reported by patients and clinicians was 0% for neonatal and high-dependency unit admissions. Obstetric anal sphincter injury (OASI) was reported by 2 patients and 1 clinician. Postpartum haemorrhage (PPH) was reported by 4 (28%) despite electronic records recording PPH occurrence in 14 patients at T1. Conclusions A combination of tools and additional sexual health questions collected from postpartum women using an online survey across three postnatal time points appears feasible and has good validity and completeness. Patient-clinician concordance in the reporting of complication rates was high for all but PPH where patients tended to report lower rates.