Posttraumatic Stress Disorder in New Mothers: Results from a Two-Stage U.S. National Survey

School of Nursing, University of Connecticut, Storrs, USA.
Birth (Impact Factor: 1.26). 09/2011; 38(3):216-27. DOI: 10.1111/j.1523-536X.2011.00475.x
Source: PubMed


Prevalence rates of women in community samples who screened positive for meeting the DSM-IV criteria for posttraumatic stress disorder after childbirth range from 1.7 to 9 percent. A positive screen indicates a high likelihood of this postpartum anxiety disorder. The objective of this analysis was to examine the results that focus on the posttraumatic stress disorder data obtained from a two-stage United States national survey conducted by Childbirth Connection: Listening to Mothers II (LTM II) and Listening to Mothers II Postpartum Survey (LTM II/PP).
In the LTM II study, 1,373 women completed the survey online, and 200 mothers were interviewed by telephone. The same mothers were recontacted and asked to complete a second questionnaire 6 months later and of those, 859 women completed the online survey and 44 a telephone interview. Data obtained from three instruments are reported in this article: Posttraumatic Stress Disorder Symptom Scale-Self Report (PSS-SR), Postpartum Depression Screening Scale (PDSS), and the Patient Health Questionnaire-2 (PHQ-2).
Nine percent of the sample screened positive for meeting the diagnostic criteria of posttraumatic stress disorder after childbirth as determined by responses on the PSS-SR. A total of 18 percent of women scored above the cutoff score on the PSS-SR, which indicated that they were experiencing elevated levels of posttraumatic stress symptoms. The following variables were significantly related to elevated posttraumatic stress symptoms levels: low partner support, elevated postpartum depressive symptoms, more physical problems since birth, and less health-promoting behaviors. In addition, eight variables significantly differentiated women who had elevated posttraumatic stress symptom levels from those who did not: no private health insurance, unplanned pregnancy, pressure to have an induction and epidural analgesia, planned cesarean birth, not breastfeeding as long as wanted, not exclusively breastfeeding at 1 month, and consulting with a clinician about mental well-being since birth. A stepwise multiple regression revealed that two predictor variables significantly explained 55 percent of the variance in posttraumatic stress symptom scores: depressive symptom scores on the PHQ-2 and total number of physical symptoms women were experiencing at the time they completed the LTM II/PP survey.
In this two-stage national survey the high percentage of mothers who screened positive for meeting all the DSM-IV criteria for a posttraumatic stress disorder diagnosis is a sobering statistic.

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    • "This is in the lower end of what has been reported after childbirth, where PTSD prevalence rates of 1.3–6.9% have been found [24-26]. Although the rates reported in this study could be underestimated, still only a minority of those who reported a traumatic experience did so in relation to the abortion. "
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    ABSTRACT: Induced abortion is a common medical intervention. Whether psychological sequelae might follow induced abortion has long been a subject of concern among researchers and little is known about the relationship between posttraumatic stress disorder (PTSD) and induced abortion. Thus, the aim of the study was to assess the prevalence of PTSD and posttraumatic stress symptoms (PTSS) before and at three and six months after induced abortion, and to describe the characteristics of the women who developed PTSD or PTSS after the abortion. This multi-centre cohort study included six departments of Obstetrics and Gynaecology in Sweden. The study included 1457 women who requested an induced abortion, among whom 742 women responded at the three-month follow-up and 641 women at the six-month follow-up. The Screen Questionnaire-Posttraumatic Stress Disorder (SQ-PTSD) was used for research diagnoses of PTSD and PTSS, and anxiety and depressive symptoms were evaluated by the Hospital Anxiety and Depression Scale (HADS). Measurements were made at the first visit and at three and six months after the abortion. The 95% confidence intervals for the prevalence of lifetime or ongoing PTSD and PTSS were calculated using the normal approximation. The chi-square test and the Student's t-test were used to compare data between groups. The prevalence of ongoing PTSD and PTSS before the abortion was 4.3% and 23.5%, respectively, concomitant with high levels of anxiety and depression. At three months the corresponding rates were 2.0% and 4.6%, at six months 1.9% and 6.1%, respectively. Dropouts had higher rates of PTSD and PTSS. Fifty-one women developed PTSD or PTSS during the observation period. They were young, less well educated, needed counselling, and had high levels of anxiety and depressive symptoms. During the observation period 57 women had trauma experiences, among whom 11 developed PTSD or PTSS and reported a traumatic experience in relation to the abortion. Few women developed PTSD or PTSS after the abortion. The majority did so because of trauma experiences unrelated to the induced abortion. Concomitant symptoms of depression and anxiety call for clinical alertness and support.
    BMC Women's Health 12/2013; 13(1):52. DOI:10.1186/1472-6874-13-52 · 1.50 Impact Factor
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    • "Our results also confirm previous findings linking the negative effects of traumatic childbirth on new mothers' quality of life for over 12 months (Beck 2006). An accumulation of physical postpartum health problems was found to be a significant predictor of elevated posttraumatic stress symptoms in distressed US women (Beck et al. 2011). These physical problems are often a hidden and unrecognised aspect of maternal health. "
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    ABSTRACT: We investigated the impact of pre-existing mental ill health on postpartum maternal outcomes. Women reporting childbirth trauma received counselling (Promoting Resilience in Mothers' Emotions; n = 137) or parenting support (n = 125) at birth and 6 weeks. The EuroQol Five dimensional (EQ-5D)-measured health-related quality of life at 6 weeks, 6 and 12 months. At 12 months, EQ-5D was better for women without mental health problems receiving PRIME (mean difference (MD) 0.06; 95 % confidence interval (CI) 0.02 to 0.10) or parenting support (MD 0.08; 95 % CI 0.01 to 0.14). Pre-existing mental health conditions influence quality of life in women with childbirth trauma.
    Archives of Women s Mental Health 10/2013; 16(6). DOI:10.1007/s00737-013-0384-5 · 2.16 Impact Factor
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    • "In various studies, childbirth has been recognized as a traumatic event and approximately 1.5% to 6% of women experience PTSD following childbirth (3-5). Factors like pregnancy complications, emergency caesarean, instrumental delivery, inadequate care during the labor (3, 6, 7), unwanted pregnancy, low socioeconomic status, history of infertility (8, 9), episiotomy, the severe pain experienced during the birth, postpartum complications (3, 5, 10), primiparous, preterm labor, parenting problems (3, 8, 11), cultural factors such as the importance of the baby’s gender, level of social support following childbirth (12-14), history of mental problems (3, 15) and stressor events of life (3, 16) make women susceptible to developing PTSD following childbirth. Consequences of this disorder may result in a vulnerability of the mother-infant attachment and have harmful effects on the infant’s cognitive development (9, 13, 17). "
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    ABSTRACT: Childbirth might be a traumatic event for some women. This study was conducted with the objective of investigating the prevalence of Post-Traumatic Stress Disorder (PTSD) following childbirth. The study was designed using a descriptive correlation scheme. The participants were selected from the women referred to the healthcare centers affiliated with Zahedan University of Medical Sciences, Zahedan, Iran. Personal interviews were conducted with 600 women who were 6-8 weeks postpartum and had been undergone to this center for postpartum and child care. One hundred and three (17. 2%) women had symptoms of PTSD following childbirth based on the PTSD Symptom Scale (PSS). The results of logistic regression analysis revealed a significant correlation between maternal occupation (P = 0.01), depression level (P < 0.001) and anxiety level (P < 0.001) with PTSD following childbirth. PTSD from childbirth occurs in some women. Early identification of risk factors should lead to early therapeutic intervention in the mothers at risk of PTSD.
    03/2013; 15(3):177-82. DOI:10.5812/ircmj.2312
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