Childbirth Related Post-Traumatic Stress Disorder and Childbirth Trauma: A Systematic Review of Available Primary Antenatal Intervention.

High burden of subthreshold DSM-5 post-traumatic stress disorder in U.S. military veterans.

Research has demonstrated that veterans with a history of traumatic brain injury (TBI) may experience persistent symptoms following injury. These symptoms are frequently maintained or exacerbated by psychiatric symptoms, including posttraumatic stress disorder (PTSD). Studies suggest that decreasing PTSD symptoms may also reduce postconcussive symptoms. This study examined whether (a) PTSD and postconcussive symptoms decreased over the course of residential PTSD/TBI treatment and (b) a reduction in PTSD symptoms was associated with a reduction in postconcussive symptoms. Twenty-eight veterans who met diagnostic criteria for PTSD and had a history of TBI were included in the study. Veterans received 8 weeks of treatment in a residential PTSD/TBI program and completed self-report measures of PTSD and postconcussive symptoms at pre- and posttreatment. Results indicated that PTSD and postconcussive symptoms significantly decreased over the course of treatment. Furthermore, the decreases in PTSD and postconcussive symptoms were significantly positively related. The reduction in PTSD symptoms is positively associated with a reduction in postconcussive symptoms following residential treatment in a PTSD/TBI program. These findings suggest that PTSD and postconcussive symptoms are interdependent and mutually influence one another.

Post-traumatic stress disorder (PTSD) symptoms are prevalent in both civilian and military service members. As the number of smartphone-based applications (apps) grows rapidly in health care, apps are also increasingly used to help individuals with subthreshold PTSD or full PTSD. Yet, if the apps are self-managed, the feasibility and efficacy of such interventions are still rather unclear in these two populations with PTSD symptoms. Hence, the present meta-analysis set out to evaluate the effect of self-management smartphone-based apps on PTSD and depressive symptoms in populations with subthreshold PTSD or full PTSD. Studies were included if they conducted randomized controlled trials or pre-post comparisons. Six studies (n = 2 randomized controlled trials) were identified for meta-analysis. In pre-post comparisons, N = 209 participants were included in the analyses. In randomized controlled trials, N = 87 participants received smartphone-based self-management interventions and N = 82 participants were in waitlist control conditions. Meta-analysis for pre-post comparisons concluded an effect of g = 0.55 (p < 0.001) regarding the overall reduction in PTSD symptoms (n = 6) and g = 0.45 (p < 0.001) for reduction in depressive symptoms (n = 5). Yet, in randomized controlled trials, no significant difference was found between app-based treatment and waitlist control groups (g = 0.09, p = 0.574). The duration of the interventions did not significantly influence the results. Overall, despite positive pre-post effects, current results indicate that smartphone-apps for PTSD patients are not significantly more effective than waitlist control conditions. Nevertheless, a combined smartphone and standard therapy approach may be a fruitful field for future research.

Treatment of traumatic birth experience with postpartum early eye movement desensitization and reprocessing therapy: a randomized clinical trial.

BackgroundLarge-scale earthquakes are associated with high and persistent rates of post-traumatic stress disorder (PTSD), depression, and anxiety. Although Eye Movement Desensitization and Reprocessing (EMDR) and Cognitive Behavioral Therapy (CBT) are both guideline-recommended treatments for PTSD, direct randomized comparisons—particularly in post-disaster settings and via remote delivery—remain limited.MethodsIn this randomized, controlled, parallel-group trial (ClinicalTrials.gov Identifier: NCT06758362), 89 adult survivors of the 2023 Kahramanmaraş earthquakes in Türkiye who met DSM-5 criteria for PTSD were assigned to 12 sessions of remotely delivered EMDR (n = 30), CBT (n = 30), or a wait-list control group (n = 29). PTSD severity was the primary outcome, with depression, anxiety, and emotion regulation as secondary outcomes. Assessments were conducted at baseline, mid-treatment, and post-treatment. Analyses followed an intention-to-treat framework using mixed-effects models.ResultsBoth EMDR and CBT produced large reductions in PTSD symptoms compared with the control condition (Cohen’s d ≈ 1.9), alongside moderate-to-large improvements in depression (d ≈ 1.4) and anxiety (d ≈ 1.3). Symptom improvement was evident by mid-treatment and increased through post-treatment. Direct comparisons between EMDR and CBT yielded overlapping confidence intervals, indicating comparable overall efficacy. However, EMDR showed a tendency toward greater reduction in core PTSD symptoms, whereas CBT demonstrated relatively stronger effects on depressive symptoms. Improvements in emotion regulation were observed in both treatment groups but did not reach statistical significance.DiscussionThe findings suggest that both EMDR and CBT are highly effective when delivered remotely in the aftermath of a large-scale natural disaster. Differential response patterns likely reflect distinct therapeutic mechanisms—direct trauma memory processing in EMDR versus cognitive restructuring and behavioral activation in CBT—highlighting their potential complementarity rather than superiority of one approach over the other. The absence of spontaneous improvement in the control group underscores the necessity of structured psychological intervention following earthquake exposure.ConclusionRemotely delivered EMDR and CBT are feasible, effective, and clinically valuable interventions for earthquake-related PTSD. Their comparable efficacy and partially distinct symptom profiles support flexible, needs-based integration of both treatments within disaster mental-health systems.Clinical Trial Registrationhttps://clinicaltrials.gov/study/NCT06758362, identifier NCT06758362.

A randomized clinical trial of in-person vs. home-based telemedicine delivery of Prolonged Exposure for PTSD in military sexual trauma survivors

Background: Paediatric illness, injury and medical procedures are potentially traumatic experiences with a range of possible negative psychosocial consequences. To prevent psychosocial impairment and improve medical adherence, evidence-based psychotherapy should be offered if indicated. Eye movement desensitization and reprocessing (EMDR) has been found to reduce symptoms of posttraumatic stress disorder (PTSD) in adults. The evidence for the use with children is promising. Furthermore, recent studies indicate its effectiveness for the treatment of other psychological symptomatology. However, the effectiveness of EMDR in children with subthreshold PTSD after medically related trauma has not yet been investigated. Objective: Investigating the short-term effectiveness of EMDR on posttraumatic stress, anxiety, depression and sleep problems in children with subthreshold PTSD after hospitalization through a randomized controlled trial (RCT). Method: Following baseline screening of 420 children from various Dutch hospitals, 74 children (4–15 years old) with medically related subthreshold PTSD were randomized to EMDR (n = 37) or care-as-usual (CAU; n = 37). Follow-up assessment took place after M = 9.7 weeks. Generalized Estimating Equation (GEE) analyses were performed to examine the effectiveness of EMDR compared to CAU. Results: Children in both groups improved significantly over time on all outcomes. However, the EMDR group improved significantly more as to child-reported symptoms of blood-injection-injury (BII) phobia and depression, and child-, and parent-reported sleep problems of the child. There was no superior effect of EMDR compared to CAU on subthreshold PTSD symptom reduction. Conclusions: EMDR did not perform better than CAU in reducing PTSD symptoms in a paediatric sample of children with subthreshold PTSD after hospitalization. However, the study results indicate that EMDR might be superior in reducing symptoms of blood-injection-injury phobia, depression and sleep problems.

The relevance of post-traumatic stress disorder (PTSD) symptoms to outcomes of cognitive behavioural therapy (CBT) for chronic pain is unclear. This study examines whether (a) traumatic exposure or the severity of PTSD symptoms at pre-treatment predicts the outcomes (pain intensity/interference), (b) participation in this treatment is associated with reduced PTSD symptoms and (c) any observed changes in PTSD symptoms are mediated by changes in psychological mechanisms that have been shown to be of importance to PTSD and chronic pain. Participants were 159 chronic pain patients who were consecutively admitted for a multidisciplinary, group-based CBT program at the Pain Rehabilitation Unit at Skåne University Hospital. A self-report measure of traumatic exposure and PTSD symptoms was administered before and after treatment, and at a 12-month follow-up, along with measures of depression, anxiety, pain intensity, pain interference, psychological inflexibility, life control and kinesiophobia. Traumatic exposure and PTSD symptom severity did not predict pain intensity or interference at 12-month follow-up. There were no overall significant changes in PTSD symptom severity at post-treatment or follow-up, but 24.6% of the participants showed potential clinically significant change at follow-up. Psychological inflexibility mediated the changes that occurred in PTSD symptoms during treatment. Neither traumatic exposure nor baseline symptoms of PTSD predicted the treatment outcomes examined here. Despite improvements in both comorbid depression and anxiety, participation in this pain-focused CBT program was not associated with improvements in comorbid PTSD. To the extent that changes in PTSD symptoms did occur, these were mediated by changes in psychological inflexibility during treatment. Pain-focused CBT programs yield clinically meaningful improvements in pain and comorbid symptoms of depression and anxiety, but may have little effect on comorbid PTSD. This raises the issue of whether current pain-focused CBT programs can be modified to improve outcomes for comorbid conditions, perhaps by better targeting of psychological flexibility, and/or whether separate treatment of PTSD may be associated with improved pain outcomes.

A strong association between substance use disorders (SUDs) and eating disorders (EDs) in women has been established. Yet, little is known about the rates and impact of ED symptoms in women presenting to addiction treatment. The current investigation assessed the prevalence of ED symptoms and their effect on treatment outcomes in a sample of substance abusing women with co-occurring posttraumatic stress disorder (PTSD) enrolled in outpatient substance use programs. Participants were 122 women who participated in a multisite clinical trial comparing two behavioral treatments for co-occurring SUD and PTSD. The Eating Disorder Examination-self report, and measures of PTSD and SUD symptoms were administered at baseline, during treatment and at four follow-up points. Two subgroups emerged; those reporting binge eating in the 28 days prior to baseline (Binge group; n = 35) and those who reported no binge eating episodes (No Binge group; n = 87). Women in the Binge group endorsed significantly higher ED, PTSD, and depression symptoms at baseline than those in the No Binge group. Although all participants showed significant reductions in PTSD symptoms and improvements in abstinence rates during the study period, the improvements for the Binge group were significantly lower. These findings suggest that a subgroup of women with co-occurring PTSD and SUDs, who endorsed binge ED symptoms, responded differently to SUD/PTSD group treatment. Identification of ED symptoms among treatment-seeking women with SUDs may be an important element in tailoring interventions and enhancing treatment outcomes.

Trajectories of maternal symptoms of posttraumatic stress disorder predict long-term mental health of children following the Wenchuan earthquake in China: A 10-year follow-up study

To evaluate the association between trauma exposure type, number and type of DSM-5 posttraumatic stress disorder (PTSD) symptoms, and binge eating symptoms. Data were analyzed from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III: 2012-2013), which surveyed a nationally representative sample of 36,309 non-institutionalized US civilians aged 18 years and older. Trauma exposure, PTSD, and binge eating symptoms were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule, DSM-5 Version (AUDADIS-5). Three groups were compared: trauma-exposed individuals with no/low PTSD symptoms, those with subthreshold PTSD, and those with threshold PTSD. Among both men and women, zero-inflated negative binomial regression analyses demonstrated that individuals with subthreshold and threshold PTSD endorsed a greater number of binge eating symptoms than trauma-exposed individuals with no/low PTSD symptoms (unstandardized coefficient [B] range, 0.33-0.92). Relative to witnessing trauma, combat-related trauma was associated with fewer binge eating symptoms in men (B = -0.62, SE = 0.17), while child maltreatment was associated with a greater number of binge eating symptoms in women (B = 0.28, SE = 0.12). Negative cognitions and mood symptoms in particular were associated with a greater number of binge eating symptoms (B range, 0.09-0.10). Subthreshold and threshold PTSD are associated with binge eating symptoms in both men and women. Similar to drugs and alcohol, binge eating may be used as a strategy to alleviate distressing symptoms of PTSD.

Considering the adverse impact that traumatic childbirth experiences can have on parental mental well-being, studies that have investigated the potential of providing postnatal psychological support for this group of parents require evaluation. This systematic review aimed to examine the effectiveness of psychological interventions at improving the mental well-being of parents who have experienced traumatic childbirth in terms of anxiety, depression, fear of childbirth, and post-traumatic stress disorder (PTSD) symptoms. Seven electronic databases were searched from their respective inception dates up to January 2021. Only quantitative studies that reported the effects of psychological interventions on anxiety, depression, fear of childbirth, and/or PTSD symptoms in selective (at risk of traumatic childbirth experience) or indicated (self-defined childbirth experience as traumatic for any reason) populations of parents (mothers and/or fathers) were included. Eight studies were included and meta-analyses were conducted using a random-effect model. All studies were conducted on mothers only, and one study had minimal father involvement. Results showed that psychological interventions were more effective in reducing fear of childbirth and improving PTSD symptoms compared to anxiety and depression. Greater improvement in depression was reported at 3–8 weeks’ follow-up than at immediate post-intervention. Subgroup analyses showed that technology-based interventions were feasible, and indicated interventions were more effective than selective interventions. Conducting future interventions in more geographical regions, engaging and including fathers more actively, incorporating both personalized professional therapy and informal peer support, striving for flexibility and convenience, as well as addressing topics on self-doubt and coping skills can improve current interventions.

This study examined the rates of syndromal and subthreshold post-traumatic stress disorder (PTSD) and PTSD symptom scores in participants with symptoms of emotional distress, subsyndromal depression, and a history of traumatic exposure. Participants had been referred to a study of an indicated depression prevention intervention using problem-solving therapy in primary care. We hypothesized that higher severity of PTSD symptom scores would predict poorer problem-solving skills. In addition, some reports have suggested that there are higher rates of PTSD in minority populations relative to Caucasians; thus we hypothesized that race would also predict problem-solving skills in these individuals. We examined the rates of traumatic exposure, syndromal, and subthreshold PTSD. In those exposed to trauma, we performed a multiple linear regression to examine the effects of PTSD symptoms, depression symptoms, race, age, and gender on social problem-solving skills. Of the 244 participants, 64 (26.2%) reported a traumatic event; 6/234 (2.6%) had syndromal PTSD, and 14/234 (6.0%) had subthreshold PTSD. By way of regression analysis, higher PTSD symptom scores predicted poorer problem-solving skills. In addition, racial status (Caucasian vs. African American) predicted problem-solving skills; Caucasians exhibited lower levels of problem-solving skills. Individuals presenting with subsyndromal depressive symptoms may also have a history of traumatic exposure, subthreshold and syndromal PTSD. Thus, screening these individuals for PTSD symptoms is important and may inform clinical management decisions because problem-solving skills are lower in those with more severe PTSD symptoms (even after adjusting for race, age, gender, and depressive symptoms).

BackgroundCanadian public safety personnel (PSP) experience high rates of mental health disorders and face many barriers to treatment. Internet-delivered cognitive behavioral therapy (ICBT) overcomes many such barriers, and is effective for treating depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms.ObjectiveThis study was designed to fill a gap in the literature regarding the use of ICBT tailored specifically for PSP. We examined the effectiveness of a tailored ICBT program for treating depression, anxiety, and PTSD symptoms among PSP in the province of Saskatchewan.MethodsWe employed a longitudinal single-group open-trial design (N=83) with outcome measures administered at screening and at 8 weeks posttreatment. Data were collected between December 5, 2019 and September 11, 2020. Primary outcomes included changes in depression, anxiety, and PTSD symptoms. Secondary outcomes included changes in functional impairment; symptoms of panic, social anxiety, and anger; as well as treatment satisfaction, working alliance, and program usage patterns.ResultsClients reported large symptom reductions on measures of depression and anxiety, as well as moderate reductions on measures of PTSD and secondary symptoms, except for social anxiety. Most clients who reported symptoms above clinical cut-offs on measures of depression, anxiety, and PTSD during screening experienced clinically significant symptom reductions. Results suggested good engagement, treatment satisfaction, and working alliance.ConclusionsTailored, transdiagnostic ICBT demonstrated promising outcomes as a treatment for depression, anxiety, and PTSD among Saskatchewan PSP and warrants further investigation.Trial RegistrationClinicaltrials.gov NCT04127032; https://www.clinicaltrials.gov/ct2/show/NCT04127032

The fear of childbirth is the feeling of fearfulness, anxiety or worry among women in relation to pregnancy and childbirth process which influence their experience of childbirth which is the subjective feeling of sadness or joyfulness regarding childbirth. The main objective of the study was to identify the relationship between fear and experience of childbirth among primiparous women. A descriptive cross-sectional study was done where non probability, purposive sampling technique was used to select a sample of 133 primiparous women attending Paropakar Maternity and Woman's Hospital having term pregnancy (37-42 weeks of gestation) without any complications and willing to participate in the study. Data were collected through interview technique. Fear of childbirth was assessed by using standard Wijma Delivery Expectancy/ Experience Questionnaire (WDEQ) and experience of childbirth was assessed by using Childbirth Experiences Questionnaire (CEQ). Data analysis was done by using descriptive statistics like frequency, mean, percentage and standard deviation and inferential statistics i.e. Pearson's correlation and chi square test in Statistical Package for Social Sciences version 16. The study revealed that fear and experience of childbirth were negatively correlated (r= -0.254). The majority of the respondents (64.7%) had a moderate level of fear of childbirth. Most of the respondents (80.5%) had a positive experience of childbirth. This study concludes that there is negative relationship between the fear of childbirth and its experience. Women having higher fear of childbirth have less positive experience of childbirth.