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Objective The objective of this study was to find risk factors in pregnancy for post-traumatic stress and depression 1 month after childbirth. Furthermore, the relation between post-traumatic stress and depression was explored.Design A prospective longitudinal study.Setting Pregnant women in Linköping and Kalmar, Sweden.Population A total of 1224 women were assessed in pregnancy, week 12-20 and 32, as well as 1 month postpartum.Methods Post-traumatic stress and depression after delivery were assessed 1 month postpartum. Potential risk factors were assessed in early and late pregnancy. Variables measured during pregnancy were trait anxiety, depression, fear of childbirth, childbirth-related traumatic stress, stress coping capacity, social support, parity, educational level, age, gestation week, parity, educational level, civil status, previous psychological/psychiatric counselling, and previous experience of any traumatic events. Delivery mode was assessed from the medical records.Main outcome measures Prevalence of post-traumatic stress (criteria A, B, C, D, E, and F according to Diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV)) and depression (Beck's depression inventory).Results One month postpartum, 12 (1.3%) women had posttraumatic stress (met symptom criteria B, C, and D for posttraumatic stress disorder according to Diagnostic and statistical manual of mental disorders, 4th edition [DSM-IV]). The most important risk factors in pregnancy were depression in early pregnancy (OR = 16.3), severe fear of childbirth (OR = 6.2), and 'pre'-traumatic stress (in view of the forthcoming delivery) in late pregnancy (OR = 12.5). The prevalence of depression was 5.6%. Post-traumatic stress and depression were positively related 1 month postpartum and were predicted by mainly the same factors.Conclusions Risk factors for post-traumatic stress and depression after childbirth can be assessed in early pregnancy. Post-traumatic stress and depression also seem to share the same underlying vulnerability factors.

In a sample of 1550 recently delivered women, traumatic stress after childbirth was studied in relation to obstetric variables. A post-traumatic stress disorder (PTSD) symptom profile and traumatic stress symptoms were assessed by means of the Traumatic Event Scale (TES). Obstetric data comprised delivery mode, duration of the second stage of labor (the time from cervical dilation of 10 cm to partus) and the use of analgesia/anesthesia. Traumatic stress symptoms and having a PTSD symptom profile were both significantly related to the experience of an emergency cesarean section or an instrumental vaginal delivery. It is of clinical importance, however, that most women with a PTSD symptom profile were found in the normal vaginal delivery group (NVD). This implies that a normal vaginal delivery can be experienced as traumatic, just as an emergency cesarian section is not necessarily traumatic. Traumatic stress symptoms were neither substantially correlated to the duration of the second stage of labor, nor to the use of analgesia/anesthesia.

Post-traumatic stress was assessed in early and late pregnancy, and 1, 4, 7, and 11 months postpartum by means of questionnaires among 1224 women. Thirty-seven women (3%) had post-traumatic stress (meeting criteria B, C, and D for PTSD) at least once within 1-11 months postpartum. In pregnancy, depression, severe fear of childbirth, 'pre'-traumatic stress, previous counseling related to pregnancy/childbirth, and self-reported previous psychological problems were associated with an increased risk of having post-traumatic stress within 1-11 months postpartum. Sum-scores of post-traumatic stress did not decrease over time among women who at least once had post-traumatic stress (criteria B, C, and D) within 1-11 months postpartum. Women with post-traumatic stress also showed a decrease in perceived social support over time postpartum.

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All patients who visited the Department of Obstetrics and Gynaecology of Linköping, Sweden over a 2-week period were sent a questionnaire about experiences of sexual/physical abuse and the Traumatic Event Scale, assessing post-traumatic stress disorder (PTSD). Of 649 patients, 26.3% showed a history of sexual or physical abuse in childhood or adulthood. Childhood and adulthood sexual abuse were experienced by 11.6% and 6.5%, respectively, childhood and adulthood physical abuse by 16.9% and 7.9%, respectively. Twenty-nine of all participants (4.5%) met PTSD criteria, according to the Diagnostic and Statistical Manual. PTSD was associated with multiple experiences of abuse. The frequency of PTSD symptoms was positively related to the amount and recency of abuse. PTSD participants reported more visits to a physician than abused non-PTSD and nonabused participants. The PTSD group reported less satisfaction than the other two groups with (a) contact with the physician and (b) the help received during visits to the clinic.

Background: Learning in simulated nursing situations with advanced manikin is considered to prepare nursing students for clinical care situations. Collaboration with classmates facilitates the learning process which is described in the literature. The study aimed to investigate whether there are factors that nursing students describe as important for learning in a simulated care situation. Method: A mixed method was used in this study. Data were collected from (n=53) nursing students. At first, a quantitative data collection consisting of questionnaires was conducted one week before the simulation exercise. Thereafter, group interviews were conducted (n=7), which became a basis for the qualitative data collection. Results: The students described that they were well prepared for the skills training. Getting support in their learning from classmates and teachers was described as significant. Conclusion: Reflection of classmates’ processing of the situation work improves the student’s individual learning during the skills education with subsequent reflection with a teacher. In order for the learning to be optimal, collaboration with other fellow students in the base group is necessary.