Postpartum Posttraumatic Stress Disorder Symptoms Research Articles

Psychological Outcomes Associated with Severe Placenta Accreta Spectrum Disorder with Cesarean Hysterectomy: A Retrospective Survey Study

This retrospective survey study assesses rates of postpartum depression (PPD) and postpartum post-traumatic stress disorder (PTSD) in patients with prior hysterectomy for severe placenta accreta spectrum. 50% of patients met the Edinburgh Postnatal Depression Scale threshold for PPD, and 35% met the Post-traumatic Stress Disorder Checklist-5 (PCL-5) threshold for PTSD. Patients who underwent a delayed hysterectomy were more likely to report symptoms of PTSD (75% vs. 8%, p<0.01) and had higher median PCL-5 scores than an immediate hysterectomy (51 [IQR 16,61]) vs. 11 [IQR 2,21], p=0.01). Larger, prospective studies are needed to confirm these findings and determine standardized interventions for patients at high risk of psychological sequelae.

Associations Between Child Maltreatment Types and Pre- and Post-Partum Posttraumatic Stress Disorder Symptoms: A Brief Report

Objective: To foster resilience through reducing posttraumatic stress disorder (PTSD) symptoms in pregnant mothers with child maltreatment (CM) histories, it is important to understand factors impacting their well-being. This study explored whether CM predicted the severity of PTSD symptoms and symptom clusters during pregnancy and change in symptoms from pregnancy (Time 1; T1) to 3 months postpartum (Time 2; T2).
 Methods: 88 pregnant women (aged 18 to 29) completed surveys on CM exposure, adult interpersonal trauma experiences, and PTSD symptoms at T1; 58 participated at T2.
 Results: Stepwise regressions were conducted with the covariates age, family status, and adult interpersonal traumas. When accounting for all CM types, only neglect remained associated with overall PTSD symptoms (Ft1(1, 71) = 28.93, p < .001) and for each of the PTSD symptom clusters (ps < .01). Physical abuse remained associated with the alterations in cognition and mood cluster. No CM types were associated with changes in PTSD symptoms from T1 to T2.
 Implications: In future research, the implications of neglect for pregnant mothers should be explored in depth. Perinatal care should be trauma-informed, including assessing for CM histories, to foster greater resilience by reducing perinatal PTSD symptoms.

Past Traumatic Life Events, Postpartum PTSD, and the Role of Labor Support.

The aim of this study was to investigate the association of postpartum post-traumatic stress disorder (PP-PTSD) symptoms and subjective rates of traumatic birth experience with past traumatic life events (physical and sexual assault, child abuse, perinatal loss, previous traumatic birth experience, and the cumulative traumatic experience). A sample of Russian women (n = 2579) who gave birth within the previous 12 months, filled in a web-based survey, where they reported demographic and obstetric characteristics and past traumatic experiences, evaluated their birth experience (0 = not traumatic, 10 = extremely traumatic), and completed the City Birth Trauma Scale (CBiTS). We found that PP-PTSD symptoms were higher among women who previously experienced physical (F = 22.02, p < 0.001) and sexual (F = 15.98, p < 0.001) assault and child abuse (F = 69.25, p < 0.001), with only associations with child abuse (F = 21.14, p < 0.001) remaining significant for subjective rates of traumatic birth experience. Perinatal loss and previous traumatic birth showed moderate but inconsistent effects. Support during labor did not have a buffering effect for participants with past traumatic experiences but showed a universally protective effect against PP-PTSD. Trauma-informed practices and allowing women to have a supportive birth team of choice during childbirth are promising avenues to minimize the incidence of PP-PTSD and improve the childbirth experience for all women.

Assessment of Postpartum Posttraumatic Stress Disorder Symptoms Secondary to Childbirth at Delivery and 10 Weeks Postpartum

Childbirth is recognized as a potential traumatic event and can lead to postpartum posttraumatic stress disorder (PTSD).1 Postpartum PTSD may carry significant morbidity with negative ramifications on parent-infant bonding, marital relationships, comorbid psychiatric illnesses, and future reproductive decisions.1 Emergency cesarean section, medical complications of mother or baby, high subjective distress, and presence of dissociation are risk factors with the highest predictive values for postpartum PTSD.2 However, as deliveries without medical complications can also be perceived as traumatic, identifying women at risk for postpartum PTSD remains a challenge. The current study aimed to evaluate the feasibility of assessing the presence of trauma at delivery and progression of symptoms at 10 weeks.

Mother-Child Bond through Feeding: A Prospective Study including Neuroticism, Pregnancy Worries and Post-Traumatic Symptomatology.

Post-traumatic stress disorder (PTSD) is a common postpartum problem and influences maternal bonding with the infant. However, the relationship between this disorder, maternal personality, and the infant's emotional state during feeding is not clear. The aim of the present study was to explore the contribution of neuroticism on the infant's emotional state during feeding, by attending to the mediating role of postpartum PTSD (P-PTSD) symptoms and the moderating role of worries during pregnancy. A prospective design study was developed with 120 women with a low pregnancy risk. They responded to a questionnaire assessing maternal personality (first trimester), worries during pregnancy (third trimester), P-PTSD symptoms, and mother-baby bonding (4 months postpartum). The results showed a positive association among neuroticism, infant irritability during feeding, and P-PTSD symptoms, suggesting the latter plays a mediating role in the relationship between neuroticism and infant irritability (B = 0.102, standard error (SE) = 0.03, 95% coefficient interval (CI) [0.038, 0.176]). Excessive worries, related to coping with infant care, played a moderating role between neuroticism and P-PTSD symptoms (B = 0.413, SE = 0.084, p = 0.006, 95% CI [0.245, 0.581]). This relationship was interfered with by depressive symptoms in the first trimester (covariate) (B = 1.820, SE = 0.420, p = 0.016, ci [2.314, 0.251]). This study contributes to a better understanding of the role of neuroticism as an influential factor in the occurrence of P-PTSD symptoms, and in the impairment of infant bonding during feeding. Paying attention to these factors may favor the development of psychological support programs for mothers, with the aim of strengthening the bond with their child.

PAST TRAUMATIC LIFE EVENTS AND POSTPARTUM PTSD

Postpartum post-traumatic stress disorder (PP-PTSD) can be conceptualised both as the fi rst-time onset disorder related solely to childbirth in the absence of prior PTSD symptoms or any predisposing factors as well as a pre-existing PTSD after previous traumatic events that is reactivated by childbirth. Accordingly, convincing evidence indicates that past traumatic experience is a signifi cant risk factor for developing PP-PTSD. The aim of this study was to investigate the association of postpartum posttraumatic stress disorder (PP-PTSD) symptoms and subjective rates of traumatic birth experience with past traumatic life events, namely physical and sexual assault, child abuse, and the cumulative traumatic experience. Furthermore, we investigated the effects of previous traumatic birth experience on subsequent childbirth and risk of PP-PTSD. A sample of Russian women (n= ) who gave birth within the previous  months, fi lled in a web-based survey, where they reported demographic and obstetric characteristics, past traumatic experiences, evaluated their birth experience (-not traumatic, -extremely traumatic) and completed the Edinburgh Postnatal Depression Scale (EPDS) and the City Birth Trauma Scale (CBiTS). We found that PP-PTSD symptoms were higher among women who previously experienced physical (F=., p&lt;.) and sexual (F=.,p&lt;.) assault and child abuse (F=.,p&lt;.), with only associations with child abuse (F=.,p&lt;.) remaining signifi cant for subjective rates of traumatic birth experience. After adjustment for covariates the cumulative traumatic experiences were signifi cantly associated with both PP-PTSD symptoms (B=.,p&lt;.) and the subjective rates of traumatic birth experience (B=.,p&lt;.). PP-PTSD symptoms were lowest for those who had already given birth previously and that experience had not been traumatic; they were, on average, more than . points higher for those who gave birth for the fi rst time in the present study, and, fi nally, the highest scores were among the participants whose previous birth experience was also traumatic (F=., p&lt;.). Trauma awareness training for midwives, obstetricians and other caregivers working with women during perinatal period is essential and trauma-informed practices during childbirth are warranted for prevention of PP-PTSD.

A paradoxical role of childbirth-related posttraumatic stress disorder (PTSD) symptoms in the association between personality factors and mother-infant bonding: A cross-sectional study.

As mother-infant bonding difficulties are potentially detrimental to child development, it is of importance to study its etiology and associated factors. Only a minority of studies have focused on the role of personality and postpartum depression and posttraumatic stress disorder (PTSD) in the etiology of bonding difficulties. The present article attempted to ascertain the association of vulnerability (Neuroticism) and resilience (Dispositional Optimism) with bonding, wherein postpartum depression and PTSD symptoms were possible mediators. There were 504 mothers of infants, 0-13 months, who were sampled cross-sectionally using social media. Respondents completed an online survey consisting of the following questionnaires: demographic details, Neuroticism (subscale of the Big Five Inventory, BFI), Dispositional Optimism (Life Orientation Test-Revised), postpartum PTSD symptoms (City Birth Trauma Scale, BiTS), postpartum depression symptoms (Edinburgh Postpartum Depression Scale, EPDS), and mother-infant bonding difficulties (Postpartum Bonding Questionnaire, PBQ). Path analysis revealed 5 significant indirect paths: Dispositional Optimism affected bonding through EPDS (β = -0.04, p = .010) and through BiTS general symptoms (β = -.02, p = .019), and BFI-Neuroticism affected bonding through EPDS (β = 0.14, p = .001), BiTS birth-related symptoms (β = -0.03, p = .013), and BiTS general symptoms (β = 0.11, p = .001). Both Dispositional Optimism and Neuroticism correlated with bonding difficulties, mediated by postpartum depression and PTSD symptoms. When all variables were measured in a single model, postpartum PTSD birth-related symptoms predicted fewer bonding difficulties while general postpartum PTSD symptoms were associated with more bonding difficulties. Taken together, these results can promote better understanding of postpartum psychopathology and mother-infant bonding to allow for better treatments. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Associations Among Postpartum Posttraumatic Stress Disorder Symptoms and COVID-19 Pandemic-Related Stressors.

IntroductionCoronavirus disease 2019 (COVID‐19) pandemic‐related stressors (eg, exposure, infection worry, self‐quarantining) can result in heightened levels of distress and symptoms of postpartum posttraumatic stress disorder (PTSD).MethodsUsing a cross‐sectional descriptive design, we collected survey data from a convenience sample of 670 postpartum persons who gave birth to a newborn during the first 6 months of the COVID‐19 pandemic in the United States. The presence of PTSD symptoms was measured using the 21‐item Birth Memories And Recall Questionnaire (BirthMARQ) and defined as an affirmative rating for each item (score of 5 to 7 on a 1 to 7 agreement scale). Symptoms counts were computed for each of the 6 BirthMARQ domains, 2 symptom clusters (intrusive; mood and cognition alterations), and the total number of symptoms. Symptom counts were analyzed using descriptive statistics. We explored associations among COVID‐19 experiences (self‐quarantine behaviors, infection worry, exposure) and counts of PTSD symptoms using negative binomial regression models while controlling for postpartum depression screening scores, neonatal intensive care unit admissions, number of weeks postpartum, race, and marital status.ResultsAlmost 99% of participants reported experiencing at least one of 21 PTSD symptoms (mean, 8.32; SD, 3.63). Exposure to COVID‐19 was associated with a 34% greater risk for experiencing intrusive symptoms, specifically, symptoms of reliving the birthing experience as if it were happening now (47% greater risk). Worry surrounding COVID‐19 infection was associated with a 26% increased risk for experiencing intrusive recall symptoms in which birth memories came up unexpectantly. COVID‐19 quarantining behaviors were not significantly related to increasing PTSD symptoms. Many of the demographic variables included were associated with increasing PTSD symptoms.DiscussionScreening perinatal persons for PTSD is critically important, especially during public health crises like the COVID‐19 pandemic. The integration of comprehensive mental health screening, including specific screening for trauma and symptoms of PTSD, across health care settings can help improve delivery of quality, patient‐centered care to postpartum persons.

Construct validity and psychometric properties of the Chinese version of the City Birth Trauma Scale.

Currently, most postpartum posttraumatic stress disorder (PTSD) screening scales used in China are general PTSD scales which are not compiled specifically for pregnant women and thus cannot reflect the unique needs of this population. This study aimed to translate the City Birth Trauma Scale (City BiTS) into Chinese and validate its psychometric characteristics in Chinese postpartum women. After translation, back-translation, and expert discussion, 596 mothers at 1 to 12 months postpartum filled out the questionnaires through the Internet. The reliability and validity of the translated questionnaire were tested. The Cronbach's α coefficient of the Chinese version of City BiTS (City BiTS-C) was 0.889, the test-retest reliability was 0.86, and the content validity was 0.93. Exploratory factor analysis extracted two factors accounted for 63.148% of the variance. The City BiTS-C had appropriate construct validity in the Chinese culture (root mean square error of approximation [RMSEA]=0.048, <0.05; χ2 /df=2.666, <3). The values of the incremental fit index (IFI) and the Tucker-Lewis coefficient (TLI) were 0.990 and 0.976, which identified that the model was a good fit for the data. The values of the comparative fit index (CFI) and the normed fit index (NFI) were 0.890 and 0.873, respectively. The City BiTS-C is a reliable and valid measure to screening and diagnosis the postpartum PTSD among new mothers who gave birth in the past year in mainland China. The City BiTS-C is a short, reliable, and valid instrument that measures the symptoms of postpartum PTSD, and it is recommend for clinical screening.

A survey of perceived traumatic birth experiences in an Irish maternity sample – prevalence, risk factors and follow up

ObjectivesTo establish the prevalence and correlates of a subjectively traumatic birth experience in an Irish maternity sample. DesignA questionnaire routinely provided to all women prior to hospital discharge post-birth was amended for data collection for this study. Two additional questions seeking information about women's perceptions of their birth were added and analysed. Women who described their birth as traumatic and agreed to follow-up, received a City Birth Trauma Scale (Ayers et al., 2018) at subsequent follow-up (6 to 12 weeks postpartum). Demographic, obstetric, neonatal variables and factors associated with birth trauma were collected from electronic maternity records retrospectively. SettingA postnatal ward in an Irish maternity hospital which provides postnatal care for public maternity patients. ParticipantsPostpartum women (N=1154) between 1 and 5 days postpartum. Measurements & findingsParticipants completed the Edinburgh Postnatal Depression Scale (EPDS) (Cox et al., 1987) with two additional questions about birth trauma. Eighteen percent (n=209) of women reported their birth as traumatic. Factors associated with reporting birth as traumatic included a history of depression, raised EPDS scores (>12), induction of labour, combined ventouse/forceps birth, and postpartum haemorrhage. Of these 209 women, 134 went on to complete the City Birth Trauma Scale (Ayers et al., 2018). The average score was 3.84 and 6 of this sample (4%) reached the threshold for postpartum post-traumatic stress disorder (PTSD). Key conclusionsThis study identified a prevalence of 18% of women experiencing birth as traumatic and the potentially important role of a current and past history of depression, postpartum haemorrhage, induction of labour and operative vaginal birth in defining a traumatic birth experience. The majority of women were resilient to birth trauma, few developed PTSD , but a larger cohort had significant functional impairment associated with sub-clinical postpartum PTSD symptoms. Implications for practiceMaternity care providers should be aware of the risk factors for traumatic birth. Introducing a trauma–informed approach amongst midwives and maternity care providers in the postnatal period may help to detect emerging or established persisting trauma-related symptoms. For women with sub-clinical postpartum PTSD symptoms a detailed enquiry may be more effective in identifying postpartum PTSD at a later postnatal stage e.g., at six weeks postpartum. Maternity services should provide ongoing supports for women who have experienced birth trauma.

Two are better than one? The impact of lay birth companions on childbirth experiences and PTSD.

Although continuous support during childbirth is recommended by the World Health Organization (WHO) and has well-established benefits, the practice is still not routinely implemented in all maternity settings. We studied the possible effect of an additional lay companion (other than the partner) on childbirth experience and postpartum post-traumatic stress disorder (PTSD). Two hundred and forty-six women, who gave birth in maternity wards of a large tertiary health center in Israel, responded to questionnaires in person at 1–4 days (Demographic questions and the childbirth experience questionnaire) and on-line at 8–10 weeks postpartum (City Birth Trauma Scale). Obstetric data were taken from the medical files. Women who were accompanied by their partners and an additional companion were lower in birth-related PTSD symptoms (M = 1.17, SD = 2.61) than women accompanied by only their partner (M = 1.53, SD = 2.79) (F(2, 240) = 4.0, p < 0.05). Women who had a single companion (M = 1.44, SD = 2.61) showed more birth-related PTSD symptoms than women who had two or more companions (M = 1.17, SD = 2.52) (F(1, 241) = 6.4, p < 0.05). In addition, women who had a single companion were higher in general PTSD symptoms (M = 3.91, SD = 4.73) than women who had two or more companions (M = 2.31, SD = 4.29) (F(1, 241) = 4.2, p < 0.05). No differences were found in childbirth experiences of women with single or multiple companions. Allowing more than one lay companion (other than the partner) may be a simple cost-effective way of providing beneficial support in all birth settings, promoting respectful maternity care and reducing childbirth-related PTSD levels and by that future psychopathology sequela.

Postpartum PTSD and birth experience in Russian-speaking women

ObjectiveThe principal goal of this study was to examine risk factors for postpartum posttraumatic stress disorder (PTSD), such as mode of birth, obstetric violence and medical interventions during labor, in Russia. This study is also the first attempt to investigate the association between the support during labor and postpartum PTSD in a Russian sample. Research design611 Russian-speaking mothers aged 18 to 45 years (M = 31.2 + 4.5) filled in the online form, which included Edinburgh Postnatal Depression Scale, the City Birth Trauma Scale and survey on demographic characteristics and childbirth experience within one year after birth. FindingsAmong the participants 45.7% had clinically significant depressive symptoms and 15% fulfilled all the diagnostic criteria for PTSD. Postpartum PTSD symptoms were higher among women who had a cesarean vs vaginal birth (p = 0.009), women with medical interventions (p = 0.043) and women who experienced obstetric violence (p < 0.001) during childbirth. The more interventions they had and the more instances of obstetric violence they experienced, the higher were the PTSD symptoms (B = 1.03, 95% CI 0.23; 1.84, p = 0.012 and B = 5.08, 95% CI 3.80; 6.37, p < 0.001, respectively). The presence of a partner or a personal midwife/doula at birth was associated with lower rates of cesarean birth, fewer medical interventions and less obstetric violence (p < 0.017 for all). Key conclusionsPostpartum PTSD is widespread in Russia, and the problem of obstetric violence and overuse of medical interventions has a systematic nature. Increased availability of individual continuous support during labor and the development of professional midwife and doula communities might be a potential avenue to address these problems. Implications for practiceOur findings emphasize the importance of ethics in patient-doctor communication in the maternal healthcare system and the role of support during labor, which is still not widely available in Russia.

Longitudinal mediation analysis of the factors associated with trajectories of posttraumatic stress disorder symptoms among postpartum women in Northwest Ethiopia: Application of the Karlson-Holm-Breen (KHB) method.

In recent years, literatures identified childbirth as a potentially traumatic experience resulting in posttraumatic stress disorder (PTSD), with 19.7 to 45.5% of women perceiving their childbirth as traumatic. A substantial variation in PTSD symptoms has been also indicated among women who experience a traumatic childbirth. However, there has been no research that has systematically investigated these patterns and their underlying determinants in postpartum women in Ethiopia. The aim of this study was to investigate the trajectories of PTSD symptoms and mediating relationships of variables associated with it among postpartum women in Northwest Ethiopia. A total of 775 women were recruited after childbirth and were followed at the 6th, 12th and 18th week of postpartum period during October, 2020 -March, 2021. A group-based trajectory modeling and mediation analysis using KHB method were carried out using Stata version 16 software in order to determine the trajectories of PTSD symptoms and mediation percentage of each mediator on the trajectories of PTSD symptoms. Four distinct trajectories of postpartum posttraumatic stress disorder symptoms were identified. Perceived traumatic childbirth, fear of childbirth, depression, anxiety, psychological violence, higher WHODAS 2.0 total score, multigravidity, stressful life events of health risk, relational problems and income instability were found to be predictors of PTSD with recovery and chronic PTSD trajectory group membership. Depression and anxiety not only were strongly related to trajectories of PTSD symptoms directly but also mediated much of the effect of the other factors on trajectories of PTSD symptoms. In contrast, multiparity and higher mental quality of life scores were protective of belonging to the PTSD with recovery and chronic PTSD trajectory group membership. Women with symptoms of depression, anxiety, fear of childbirth and perceived traumatic childbirth were at increased risk of belonging to recovered and chronic PTSD trajectories. Postnatal screening and treatment of depression and anxiety may contribute to decrease PTSD symptoms of women in the postpartum period. Providing adequate information about birth procedures and response to mothers' needs during childbirth and training of health care providers to be mindful of factors that contribute to negative appraisals of childbirth are essential to reduce fear of childbirth and traumatic childbirth so as to prevent PTSD symptoms in the postpartum period.

Counseling Clients With Postpartum Posttraumatic Stress Disorder: A Feminist-Trauma Approach

Prevalence rates, risk factors, and impact of untreated postpartum posttraumatic stress disorder (PTSD) are well documented. Despite evidence suggesting that up to one third of women experience childbirth as traumatic, treatment recommendations remain scant. Given the call for a feminist approach to trauma and postpartum depression, we highlight a feminist-trauma approach to counseling clients with symptoms of postpartum PTSD, based on anti-oppressive feminist-trauma frameworks. A case study conceptualization of a woman experiencing traumatic stress following childbirth is presented to highlight supporting research, rationale, and ethical considerations.

Prevalence, Evolution, and Predictive Factors of Symptoms of Postpartum Posttraumatic Stress Disorder in a French-Speaking Cohort.

Identifying factors that are predictive for postpartum posttraumatic stress disorder (PTSD) is important to inform clinical and research practice. Yet prospective longitudinal studies investigating symptoms of postpartum PTSD and their prevalence, evolution, comorbidities, and predictors remain limited. The aim of this study was to estimate the prevalence of women's symptoms of PTSD at different times in the postpartum period and to identify comorbidities and predictive factors in a French-speaking sample. A total of 168 women participated in this longitudinal study, which included 3 assessment points: immediate postpartum, 2 months postpartum, and 6 months postpartum. Participants filled out questionnaires regarding sociodemographic characteristics, pregnancy, and birth outcomes; subjective perceptions of birth; and symptoms of depression, anxiety, and PTSD. Among the participants, 11.7% reported having symptoms of PTSD 2 months after birth and 10.5% reported having symptoms 6 months after birth. Regarding comorbidities and associated factors, depressive symptoms, poor marital adjustment, and impaired maternal-infant bonding were significantly and positively correlated with symptoms of PTSD. Peritraumatic distress, negative perceived childbirth experience, and complications and perceived difficulties during birth were predictive factors for postpartum PTSD. More than 1 in 10 women experienced symptoms of postpartum PTSD. Health care professionals need to be aware of symptoms of postpartum PTSD, predictive factors, and comorbidities to be able to better identify women presenting those symptoms and refer them for appropriate psychological support.

Postpartum depression and postpartum post-traumatic stress disorder: prevalence and associated factors

BackgroundDespite the increased global interest from researchers in postpartum depression (PPD) and postpartum post-traumatic stress disorder (PP-PTSD), studies of PPD in China have shown a wide range of variability. Indeed, the prevalence and risk factors for PP-PTSD have received little attention in China.AimTo determine the prevalence of PPD and PP-PTSD in China, and to examine the relationships between a range of sociodemographic, pregnancy-related, and newborn-related variables, and PPD and PP-PTSD.MethodsA cross-sectional study involving 1136 women who returned to the obstetrics clinic for routine postpartum examination were enrolled. The sociodemographic, pregnancy-related, and newborn-related characteristics were collected. Social support, and PPD and PP-PTSD symptoms were measured by the Perceived Social Support Scale (PSSS), the Edinburgh Postnatal Depression Scale (EPDS), and the Perinatal Post-traumatic Stress Questionnaire (PPQ).ResultsThe prevalence rates of PPD and PP-PTSD symptoms were 23.5 and 6.1%, respectively. A multivariate model showed that the presence of PP-PTSD was the strongest risk factor for PPD symptoms and vice versa. Other risk factors for PPD included low sleep quality, low social support and newborn’s incubator admission. In terms of PP-PTSD symptoms, risk factors included the presence of PPD symptoms, non-Han ethnicity, and low social support, while having one child was a protective factor.ConclusionsThis study addressed some gaps in the literature and provided a better understanding of PPD and PP-PTSD in China, which may contribute to early detection and intervention. Attention should be paid to women who are most susceptible to PPD and/or PP-PTSD, including those with low social support, low sleep quality, newborn’s incubator admission, non-Han ethnicity, and women with siblings.

Assessment of posttraumatic stress disorder among women after childbirth using the City Birth Trauma Scale in Spain.

Postpartum posttraumatic stress disorder (PP-PTSD) affects 3.1-6.3% of women after childbirth. The City Birth Trauma Scale (City-BiTS) is a questionnaire designed to evaluate and diagnose this disorder, according to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria, including the following groups of symptoms characteristic of posttraumatic stress: reexperiencing, avoidance, negative cognitions and mood, and hyperarousal. The aim of the present study was to evaluate the psychometric properties of the Spanish-language version of this questionnaire (City-BiTS-S), based on a community sample of Spanish women. A total of 207 mothers, recruited at three health centers in southern Spain, completed the City-BiTS-S questionnaire and provided sociodemographic and obstetric data. Exploratory factor analysis of the data replicated the two-factor structure reported in previous studies that explained 47.9% of the variance: Factor 1 of general symptoms and Factor 2 of birth-related symptoms. Both City-BiTS-S (Cronbach's alpha = .90) and the two factors (Cronbach's alpha for Factor 1 = 0.89; Cronbach's alpha for Factor 2 = 0.82) presented high internal consistency. Rasch analysis confirmed the unidimensionality of the two factors as valid subscales of the PP-PTSD. Results suggested reducing response options, reviewing Item 8, and rewording Item 3 in the Spanish version. The City-BiTS-S presents appropriate psychometric properties to measure symptoms of PP-PTSD. Nevertheless, further research is recommended to confirm its validity in a clinical population and in different medical approaches to the birth process. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Long-Term High Risk of Postpartum Post-Traumatic Stress Disorder (PTSD) and Associated Factors.

Postpartum post-traumatic stress disorder (PTSD) is not a specific process but can last for months and may manifest itself during any subsequent pregnancies or even become chronic. This study aimed to determine the factors associated with long-term PTSD symptoms one year after delivery. A cross-sectional study was conducted on 1301 Spanish puerperal women. Data were collected on sociodemographic, obstetric, and neonatal variables. The Perinatal Post-Traumatic Stress Disorder Questionnaire (PPQ) was administered online through midwives’ associations across Spain. Crude odds ratio (OR) and adjusted odds ratio (aOR) and their 95% confidence intervals were calculated. A PPQ score ≥ 19 (high-risk) was recorded for 13.1% (171) of the participants. Identified risk factors were not respecting a birth plan (aOR = 1.89 (95% CI 1.21–2.94)), formula-feeding of the baby at discharge (aOR = 2.50 (95% CI 1.20–5.17)), postpartum surgical intervention (aOR = 2.23 (95% CI 1.02–4.85)), hospital readmission (aOR = 3.45 (95% CI 1.21–9.84)), as well as verbal obstetric violence (aOR = 3.73 (95% CI 2.52–5.53)) and psycho-affective obstetric violence (aOR = 3.98 (95% CI 2.48–6.39)). During childbirth, some clinical practices, such as formula-feeding of the newborn at discharge or types of obstetric violence towards the mother, were associated with a higher risk of PTSD symptoms one year after delivery.

The risk factors for postpartum posttraumatic stress disorder and depression.

In this study, we examined the association between specific birth-related variables and postpartum posttraumatic stress disorder (PTSD) and depressive symptoms. In this descriptive study, data were collected using a personal information form, the City Birth Trauma Scale, and the Edinburgh Postpartum Depression Scale. 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. During the postpartum period, at-risk mothers should be followed and screened for PTSD and depressive symptoms.

The role of posttraumatic stress and depression symptoms in mother-infant bonding

BackgroundThere is some evidence posttraumatic stress disorder (PTSD) following childbirth may impact on the mother-infant bond. However, the evidence is inconsistent over whether PTSD or co-morbid depressive symptoms are primarily related to impaired bonding. This study therefore aimed to examine the relationship between PTSD symptoms, depressive symptoms and mother-infant bonding. MethodsA cross-sectional online study included 603 mothers of infants aged 1–12 months. Measures were taken of PTSD (City Birth Trauma Scale, Ayers et al., 2018) which has two subscales of birth-related PTSD symptoms and general PTSD symptoms; depression (Edinburgh Postnatal Depression Scale, Cox et al., 1987) and mother-infant bonding (Postpartum Bonding Questionnaire, Brockington et al., 2001). ResultsImpaired bonding was related to both dimensions of PTSD symptoms and depressive symptoms in bivariate analysis. Path analysis testing the model of whether depressive symptoms mediated the effect of PTSD symptoms on mother-infant bonding found a differential role of birth-related and general PTSD symptoms. Birth-related PTSD symptoms did not have any effect on bonding or depressive symptoms. In contrast, general PTSD symptoms had a direct effect on bonding and an indirect effect on bonding via depressive symptoms. LimitationsSelf-report measures of PTSD and depression symptoms were used. ConclusionsFurther research regarding different aspects of postpartum PTSD, depression and other disorders in the context of mother-infant bonding are needed. Future preventive programs should focus on diminishing symptoms of postpartum PTSD and depression so that the mother-infant bonding remains optimal.