Abstract

Background: It is well known that mother–child relationships may be affected by maternal psychological disorders, but, at present, few experimental studies have investigated the negative impact of postpartum post-traumatic stress disorder (PTSD) symptoms on child behaviour using the Still Face paradigm. Objective: The aim of this exploratory work is to investigate whether postpartumstress symptoms may affect mother–child relationships. The underlying hypothesis is that the persistence of postpartum stress symptoms may have anegative outcome on the mother’s tuning with the child. Methods: A sample of 19 pregnant women (mean age = 31.31; SD = 4.50) attended the four phases o fthe research, from the seventh month of pregnancy. Maternal personalitycharacteristics were assessed by MMPI-2. The Perinatal PTSD Questionnairewas used to assess PTSD symptoms two days and two months after delivery. Three months after childbirth the dyads attended the Still Face paradigm. Results: Data have shown that the persistence of PTSD symptoms has adifferent effect on early mother–child interactions than those of mothers whohave not had postpartum stress symptoms. Conclusion: These data allow us to hypothesise that there are some baseline difficulties in women with PTSD symptoms in producing a positive interactive engagement, not only in relationto the break of interaction caused by the Still episode. Keywords: childbirth; PTSD; postpartum disorder; mother–child relationships;
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
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  
... All studies were RCTs, apart from one case series study (67). The earliest study was published in 2002 (57), and six out of 12 papers were published in the recent 5 years (60-63, 65, 66). ...
... 1. Exposure therapy-four studies examined two forms of expressive writing therapy, one by Horsch et al. (60) which asked women to write for 15 min per day for three consecutive days at 3 months postpartum, and another by (57)(58)(59) which instructed women to write for 15-20 min two times a day, at 3 days after giving birth. 2. TFCBT-two studies investigated a cognitive behavioral program respectively; one was delivered through the internet (63), another was an individual manual-based traumafocused CBT program delivered by trained clinical psychology graduate students or social workers (65, 66). 3. EMDR-one case series reporting using EMDR with women who had severe fear of childbirth due to earlier trauma birth experience (67); and 4. Any other trauma-focused psychological therapies which did not fit the above categories-four interventions met this definition. ...
... The earliest intervention was the "Tetris" intervention, which was delivered to women within 6 h after an EmCS (61). A few other interventions, such as the expressive writing and debriefing (57)(58)(59)64) were delivered between 1-3 days after the women had given birth. One CBT intervention was given to women 1-2 weeks after they have given birth to a preterm infant (65,66). ...
Article
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Background: Approximately 3% of women in community samples develop posttraumatic stress disorder (PTSD) after childbirth. Higher prevalence rates are reported for high risk samples. Postpartum PTSD can adversely affect women's wellbeing, mother-infant relationships and child development. This study aims to examine the effectiveness of trauma-focused psychological interventions (TFPT), for postnatal women. Methods: We conducted a systematic review and meta-analysis including all clinical trials which reported post-traumatic stress symptoms for both the intervention and control groups or at least two time-points, pre- and post-intervention. We searched four databases: CENTRAL, MEDLINE, PsycINFO, and OpenGrey. Screening of search results, data extraction, and risk of bias assessment were undertaken independently by two reviewers. Results: Eleven studies, reported in 12 papers, involving 2,677 postnatal women were included. All were RCTs, bar one case series. Interventions varied in modality, duration and intensity, and included exposure therapy, trauma-focused cognitive behavioral therapy, eye movement desensitization and reprocessing and other psychological approaches. Participants had experienced uncomplicated births, emergency cesarean sections and/or preterm births. Results suggest that TFPT are effective for reducing PTSD symptoms in the short term (up to 3 months postpartum [4 RCTs, n = 301, SMD = −0.50, 95% CI = −0.73 to −0.27]), and medium term (i.e., 3–6 months postpartum [2 RCTs, n = 174, SMD = −1.87, 95% CI = −2.60 to −1.13]). However, there is no robust evidence to suggest whether TFPT can also improve women's recovery from clinically significant PTSD symptoms. Conclusion: Further larger studies, distinguishing between low and high risk groups, and with adequate follow-up, are needed to establish which TFPT are most effective and acceptable for treating postnatal PTSD.
... Similarly, Horsch et al. (2016) found that standard expressive writing reduced symptoms of posttraumatic stress and depression in mothers of very preterm infants. Other studies have examined the effect of writing about labour and birth: a series of studies by Di Blasio and colleagues found that women who wrote expressively about labour and birth the first week after birth had fewer symptoms of posttraumatic stress 2 or 3 months postpartum (Di Blasio & Ionio, 2002;Di Blasio et al., 2009;Di Blasio et al., 2015). Another study using a variation of expressive writing called a 'making sense' intervention (where mothers wrote about their labour and birth on one occasion in the first week postpartum) found women had fewer symptoms of depression and posttraumatic stress 3 months later than those who did not write (Di Blasio et al., 2015). ...
... The results of HABiT are inconsistent with previous studies with postpartum women, where all the published research to date has found positive benefits of expressive writing (Barry & Singer, 2001;Horsch et al., 2016; Blasio & Ionio, 2002;Di Blasio et al., 2009;Di Blasio et al, 2015;Di Blasio et al., 2015). A few of these studies sampled high-risk women who are likely to be distressed i.e. women with babies born preterm or in NICU (Barry & Singer, 2001;Horsch et al., 2016), whereas HABiT used systematic sampling to try to get a representative, normative cohort. ...
... Timing of the intervention is also likely to be important, as the demands of caring for a new baby may make it difficult for women to find time to write regularly without distractions, especially in the early postpartum period. In previous studies women either wrote in the first week, often whilst they were still in hospital (Di Blasio & Ionio, 2002;Di Blasio et al., 2009;Di Blasio et al., 2015;Di Blasio et al., 2015), or after 3 months postpartum (Barry & Singer, 2001;Horsch et al., 2016). In HABiT women were recruited at 4-6 weeks postpartum and asked to complete the writing task 6-12 weeks postpartum, which may have been a factor in the low uptake and adherence. ...
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Pregnancy, birth and adjusting to a new baby is a potentially stressful time that can negatively affect the health of women. There is some evidence that expressive writing can have positive effects on psychological and physical health, particularly during stressful periods. The current study aimed to evaluate whether expressive writing would improve women’s postpartum health. A randomized controlled trial was conducted with three conditions: expressive writing (n = 188), a control writing task (n = 213), or normal care (n = 163). Measures of psychological health, physical health and quality of life were measured at baseline (6–12 weeks postpartum), 1 and 6 months later. Ratings of stress were taken before and after the expressive writing task. Intent-to-treat analyses showed no significant differences between women in the expressive writing, control writing and normal care groups on measures of physical health, anxiety, depression, mood or quality of life at 1 and 6 months. Uptake and adherence to the writing tasks was low. However, women in the expressive writing group rated their stress as significantly reduced after completing the task. Cost analysis suggest women who did expressive writing had the lowest costs in terms of healthcare service use and lowest cost per unit of improvement in quality of life. Results suggest expressive writing is not effective as a universal intervention for all women 6–12 weeks postpartum. Future research should examine expressive writing as a targeted intervention for women in high-risk groups, such as those with mild or moderate depression, and further examine cost-effectiveness. Clinical trial registration number ISRCTN58399513 www.isrctn.com Electronic supplementary material The online version of this article (10.1007/s10865-018-9970-3) contains supplementary material, which is available to authorized users.
... However, most studies are restricted in some way, which limits how far the results can be generalised to postpartum women in general and to a range of health outcomes including physical health. Studies so far have either used expressive writing with mothers whose babies were in a Neonatal Intensive Care Unit (NICU) [15,16], or they have primarily examined post-traumatic stress symptoms in mothers who were asked to write specifically about labour and delivery in the first week postpartum [17][18][19][20]. Some of these studies also used a variation on the expressive writing paradigm [15,20]. ...
... The HABiT results are inconsistent with previous research in obstetric samples where all the published studies to date have found some positive benefit [15][16][17][18][19][20]. There are a number of possible reasons for this inconsistency; studies differed by country, writing instructions, when the intervention was offered, sampling, and outcome measures. ...
... Cultural differences are possible since the HABiT study was conducted in England, whereas previous studies were conducted in Italy [17][18][19][20], Switzerland [16] and the USA [15]. What women were asked to write about and for how long also varied across studies. ...
Article
Full-text available
Background: Pregnancy, birth and adjusting to a new baby is a potentially stressful time that can negatively affect women's mental and physical health. Expressive writing, where people write about a stressful event for at least 15 min on three consecutive days, has been associated with improved health in some groups but it is not clear whether it is feasible and acceptable for use with postpartum women. This study therefore examined the feasibility and acceptability of expressive writing for postpartum women as part of a randomised controlled trial (RCT). Methods: The Health After Birth Trial (HABiT) was an RCT evaluating expressive writing for postpartum women which included measures of feasibility and acceptability. At 6 to 12 weeks after birth 854 women were randomised to expressive writing, a control writing task or normal care, and outcome measures of health were measured at baseline, one month later and six months later. Feasibility was measured by recruitment, attrition, and adherence to the intervention. Quantitative and qualitative measures of acceptability of the materials and the task were completed six months after the intervention. Results: Recruitment was low (10.7% of those invited to participate) and the recruited sample was from a restricted sociodemographic range. Attrition was high, increased as the study progressed (35.8% at baseline, 57.5% at one month, and 68.1% at six months) and was higher in the writing groups than in the normal care group. Women complied with instructions to write expressively or not, but adherence to the instruction to write for 15 min per day for three days was low (Expressive writing: 29.3%; Control writing: 23.5%). Acceptability measures showed that women who wrote expressively rated the materials/task both more positively and more negatively than those in the control writing group, and qualitative comments revealed that women enjoyed the writing and/or found it helpful even when it was upsetting. Conclusions: The feasibility of offering expressive writing as a universal self-help intervention to all postpartum women 6 to 12 weeks after birth in the HABiT trial was low, but the expressive writing intervention was acceptable to the majority of women who completed it. Trial registration: ISRCTN58399513, 10/09/2013.
... PTSD, depression, anxiety and stress are the most prominent psychological responses that may occur during pregnancy and have been hotspots in research. EW is associated with effectively alleviating depression, stress and easing the symptoms of PTSD (Barry and Singer, 2001;Di Blasio and Ionio, 2002;Di Blasio and Camisasca, 2015;Di Blasio and Ionio, 2009;Di Blasio and Miragoli, 2015). Nevertheless, some studies have failed to find significant benefits in psychological well-being improvement (Ayers and Crawley, 2018;Frederiksen and O'Toole, 2017;Horsch and Tolsa, 2016;Panagopoulou and Montgomery, 2009). ...
... The remaining 681 records were screened on the basis of article titles and abstracts, and 663 were excluded. After reviewing the remaining 18 full-text articles for eligibility, 8 studies were ultimately included (Barry and Singer, 2001;Di Blasio and Ionio, 2002;Di Blasio and Camisasca, 2015;Di Blasio and Ionio, 2009;Di Blasio and Miragoli, 2015;Frederiksen and O'Toole, 2017;Horsch and Tolsa, 2016;Panagopoulou and Montgomery, 2009). A flow chart of the study selection is displayed in Fig. 1. ...
Article
Expressive writing (EW) is a common psychological intervention that aims to improve the mental health of traumatized individuals. Pregnancy is considered an anxious or traumatic experience for some women, and any crisis in relation to pregnancy is closely associated with their psychological well-being. Post-traumatic stress disorder (PTSD), depression, anxiety and stress are the most prominent emotional and psychological responses that may occur during the process. However, the effects of EW in mediating women's PTSD, depression, anxiety and stress related to pregnancy remain uncertain, and no qualified meta-analysis has assessed such effects. The aim of this study was to assess the effectiveness of EW as a psychological intervention for women. Five databases, including PubMed, EMBASE, Cochrane, Web of Science and PsycINFO, were searched from inception to September 2019 for eligible studies. Finally, a total of 929 participants from 8 randomized controlled trial (RCT) studies were included. A pooled analysis demonstrated that EW was an efficient therapy for decreasing PTSD. However, the results showed that the EW intervention was not associated with the expected effects on anxiety and stress symptoms. The efficacy of EW for depression was inconclusive. More RCTs are necessary to verify the effectiveness of EW for depression. Studies concentrating on EW's effects on physical symptoms are necessary, and researchers should create an EW intervention group, neutral writing group and no writing group to examine the true effects of EW. Future research should examine whether longer, more frequent, and more targeted writing interventions would result in different conclusions.
... Over the past two decades, research has shown that keeping an expressive writing journal about a traumatic or stressful event has a significant effect on promoting mental and physical health and reducing stress levels (Kadivar et al., 2015). Expressive writing (EW) is an effective approach in reducing the postpartum depressive symptomatology (Di Blasio et al., 2009;Di Blasio and Ionio, 2002;Di Blasio et al., 2015). The value of EW language interventions is demonstrated in the findings (Di Blasio et al., 2015;Elmir et al., 2010), where the perceptual evaluation of negative emotions has explained a variety of adverse experiences and mental health problems. ...
Article
Objective This qualitative study examines the linguistic features associated with postpartum depression. Methods In this longitudinal online study, 53 mothers completed self-report questionnaires assessing symptoms of postpartum depression and an expressive writing exercise about their pregnancy and birth. Mothers were randomly divided into two groups (intervention and control groups). Linguistic Inquiry and Word Count [LIWC] was used to examine the written data for depression and no depression groups. Results The overall use of words varied depending on the severity of depressive symptoms. Negative emotions and introspective terms were associated with depression and lower use of first-person plural pronouns but not singular pronouns. Additionally, the groups of individuals with depression showed a positive correlation between depressive symptoms and words referring to friends, leisure activities, the body, breastfeeding, exercise, and eating attitudes. Conclusion In addition to self-disclosure, word analysis and appropriate categorization could be useful for perinatal symptomatology in pregnant women, and interestingly also a meaningful tool that can be taught and used as a preventive care measure among pregnant and postpartum women.
... Les interventions variaient en termes de modalités, de durée et d'intensité, et comprenaient des thérapies d'exposition par écriture (Di Blasio et al., 2015;Di Blasio, Ionio, & Confalonieri, 2009;Di Blasio & Ionio, 2002;Horsch et al., 2016), des thérapies cognitivo-comportementales axées sur le traumatisme (Nieminen et al., 2016;R. Shaw et al., 2013R. ...
Thesis
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Contexte : L’expérience de l’accouchement, singulière et multidimensionnelle, suscite depuis quelques années un intérêt croissant de la part des cliniciens et des chercheurs. En effet, cet évènement de vie majeur a montré son impact à la fois sur la santé mentale des femmes, mais également sur ses relations. L’évaluation de cet évènement n’est pourtant que rarement réalisée en maternité, alors que jusqu’à 33% des femmes rapportent un vécu négatif de leur accouchement. De plus, les études des conséquences en post-partum de ce vécu demeurent encore peu nombreuses, et même si, un à un, certains liens ont été étudiés, les interactions réciproques entre les facteurs prénataux, le vécu de l’accouchement, l’état psychologique maternel et les relations père-mère et mère-bébé en post-partum n’ont encore jamais été investiguées. Objectifs : Ce travail a donc pour objectifs : 1) d’étudier le vécu de l’accouchement et de valider en France une échelle d’évaluation de cette expérience, 2) d’en identifier les facteurs de risque et de protection, 3) d’évaluer la santé mentale des femmes en post-partum immédiat, et 4) d’investiguer les interactions entre le vécu de l’accouchement, les facteurs prénataux et la période du post-partum, incluant l’état psychologique maternel, la relation conjugale et la relation mère-bébé. Méthode : Le recrutement de 275 femmes venant d’accoucher a été réalisé au sein de la maternité de l’hôpital de Poissy Saint-Germain-en-Laye. Toutes les participantes ont complété un formulaire de consentement et répondu à des questions socio-démographiques, médico-psychologiques et obstétricales. Elles ont également rempli des auto-questionnaires évaluant le style d’attachement maternel, le sentiment d’efficacité personnel, l’ajustement dyadique au sein du couple, l’anxiété, la dépression, la détresse péri-traumatique et le vécu de leur accouchement. Ces femmes ont été recontactées à 2 et à 6 mois du post-partum afin de remplir des auto-questionnaires sur l’évolution de leur santé mentale et de leurs relations. Quatre études, trois au design prospectif et transversal et une au design longitudinal, ont été réalisées afin de répondre à ces objectifs. Résultats : Les résultats de la première étude présentent la validation d’une échelle d’évaluation du vécu de l’accouchement (le QEVA), ainsi que les spécificités de l’évaluation au sein de notre échantillon. Notre seconde étude sur l’identification des facteurs de risque et de protection face au vécu de l’accouchement montre que la primiparité, l’anxiété-trait, un style d’attachement anxieux, le mode d’accouchement, mais surtout les facteurs subjectifs de l’accouchement, comme un faible sentiment de contrôle perçu, contribueraient à une perception plus négative de l’accouchement. Les résultats de notre troisième étude, s’intéressant aux déterminants de la santé mentale des femmes en post-partum immédiat, indiquent que l’anxiété en post-partum immédiat serait prédite par une personnalité plus anxieuse et les complications perçues pendant l’accouchement pour la femme ou le bébé. Les symptômes de dépression seraient prédits plutôt par des antécédents de dépression, un faible sentiment d’efficacité général et une moindre satisfaction dans la relation conjugale. Enfin, la détresse péri-traumatique serait surtout liée aux évènements subjectifs de l’accouchement, tels que le sentiment de contrôle perçu, les complications perçues et les émotions négatives ressenties pendant la naissance. Notre quatrième étude, présentant les résultats longitudinaux de ce travail, montre des liens significatifs entre le vécu de l’accouchement, l’état psychologique maternel en post-partum et les relations mère bébé et conjugale. Les analyses montrent que le lien entre le vécu de l’accouchement et les relations précoces mère-bébé serait médié par les symptômes de dépression chez la mère et par l’estime de soi maternelle. Conclusion : Ce travail montre l’intérêt d’étudier le vécu de l’accouchement et les différentes dimensions qui le composent, d’évaluer ses conséquences à long terme et de prendre en charge la santé mentale des femmes qui vivent mal leur accouchement, impliquant donc de nombreuses retombées cliniques et de recherche. Au niveau clinique, ce travail suggère que des mesures de prévention pourraient être proposées en amont aux femmes présentant des facteurs de risque identifiés. Des prises en charge en post-partum de type thérapies cognitives et comportementales, associées aux techniques de l’Eye Movement Desensitization and Reprocessing (EMDR) ou de réalité virtuelle pourraient être proposées aux femmes ayant un vécu traumatique de leur accouchement. Au niveau de la recherche, il conviendrait d’investiguer de manière plus qualitative le vécu de l’accouchement afin d’en capter toute sa subjectivité, mais également de poursuivre les études sur les conséquences à plus long terme, notamment sur la dyade mère-bébé, et sur l’impact d’un accouchement traumatique pour le père. Mots clés : accouchement, dépression du post-partum, stress post-traumatique, relation mère-bébé, relation conjugale
... A series of studies in Italy also found that women who wrote expressively about their labour and birth experiences in the first week after birth had fewer PTSD symptoms postpartum (Di Blasio & Ionio, 2002;Di Blasio, Ionio & Confalonieri, 2009;Di Blasio et al., 2015). ...
Chapter
Childbirth is recognised as a significant life-changing psychological event that can lead to enhanced self-efficacy, mastery and competence. However, over the last two decades a number of studies have identified how childbirth can be a deeply distressing, traumatic event, leading to women experiencing post-traumatic stress disorder symptoms (PTSD) and associated adverse impacts on maternal, infant and family functioning. Recent evidence is also emerging on the negative implications of secondary trauma on partners and clinical providers. In this chapter we provide an overview of key issues to help understand what childbirth-related PTSD is, its prevalence and risk factors and the implications of a traumatic birth on women and others. In recognition of how potentially traumatic events have the potential to create positive outcomes, we also highlight how some women can experience posttraumatic growth following a traumatic birth. Finally we reflect on issues concerning the assessment of risk and PTSD onset, interventions to prevent and ameliorate childbirth-related PTSD as well as implications for practice.
... La possibilità di un'elaborazione emotiva tramite la narrazione rappresenta la funzione più importante svolta dal sostegno psicologico in queste situazioni. L'elaborazione narrativa anche tramite resoconto scritto delle emozioni connesse al travaglio ed al parto può avere effetti positivi sulla salute della madre (Di Blasio & Ionio, 2002). ...
... La possibilità di un'elaborazione emotiva tramite la narrazione rappresenta la funzione più importante svolta dal sostegno psicologico in queste situazioni. L'elaborazione narrativa anche tramite resoconto scritto delle emozioni connesse al travaglio ed al parto può avere effetti positivi sulla salute della madre (Di Blasio & Ionio, 2002). ...
Chapter
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Il capitolo descrive l'intervento psicologico in un reparto di area critica ospedaliera: l'unita' di Terapia Intensiva Neonatale. Il modello di intervento proposto dagli autori prevede il sostegno psicologico per i genitori dei bambini nati prematuri e ricoverati in reparto, cosi come il lavoro psicologico con gli operatori sanitari del reparto, nella convinzione che un intervento in questo settore possa essere efficace solo se aiuta a costruire una cultura di "lavoro di gruppo" nell'equipe di cura e nel reparto tutto, oltre che intervenire direttamente sull'utenza genitoriale a sostegno della relazione genitore-figlio in condizioni di ospedalizzazione e incertezza di sopravvivenza. Viene illustrato in questo senso il gruppo omogeneo monotematico condotto coi genitori e i relativi temi principali emergenti.
Article
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DISENFRANCHISED GRIEF IN POSTPARTUM WOMEN: A HEURISTIC INQUIRY INTO WOMEN’S LIVED EXPERIENCE OF LOSS OF THE DREAMED-OF BIRTH Rumyana P. Kudeva, MSW, LCSW Jeffrey Applegate, PhD The childbearing year is of upmost significance in a woman’s life, carrying inherent possibilities of empowerment and self-actualization. Most women create a vision of their “dreamed-of birth” that represents their beliefs about birth and their role in the process. However women’s expectations about birth are often subverted by the authoritative knowledge and practices of the Western maternity care system or by the unpredictable nature of the birth itself. The pregnant woman repeatedly becomes the object of the “medicalized gaze” of a technocratic medical system that places her in the passive role of “compliant patient,” being “delivered” by professionals and robbed of her inner power and embodied knowledge of giving birth. Coming out of the childbirth experience with feelings of being uncared for, silenced, and even abused can cause serious long term psychological reactions in postpartum women. Many of these women are left unacknowledged and unsupported by professionals who unwittingly contribute to the disenfranchisement of their grief. Furthermore their grief remains invisible if they continue to appear capable and productive in their lives. This phenomenological study explores how a sample of nine women whose actual birth experience violated their “dreamed-of” birth coped with associated feelings of loss and unacknowledged grief. Employing Kenneth Doka’s concept of disenfranchised loss and grief as the theoretical framework, I conducted informal conversational in-depth interviews and employed a heuristic approach in order to explore women’s lived experience of postpartum grief. From my findings, I draw specific implications for clinical social work knowledge building and practice.
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