Pelin Dikmen-Yildiz1, Susan Ayers2, Louise Phillips3. 1. Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK. Electronic address: Pelin.Dikmen.1@city.ac.uk. 2. Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK. Electronic address: Susan.Ayers.1@city.ac.uk. 3. Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK. Electronic address: L.A.Phillips@city.ac.uk.
Abstract
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.
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.
Authors: Claire Hughes; Sarah Foley; Rory T Devine; Andrew Ribner; Lara Kyriakou; Lucy Boddington; Emily A Holmes Journal: Arch Womens Ment Health Date: 2019-07-06 Impact factor: 3.633
Authors: Mark A van Heumen; Martine H Hollander; Maria G van Pampus; Jeroen van Dillen; Claire A I Stramrood Journal: Front Psychiatry Date: 2018-07-31 Impact factor: 4.157