Assessment of Childbirth-Related PTSD: Psychometric Properties of the German Version of the City Birth Trauma Scale

Abstract

Background: About 3–4% of women in community samples suffer from childbirth-related posttraumatic stress disorder (PTSD). Surprisingly, the recently developed City Birth Trauma Scale (City BiTS) was the first diagnostic tool for childbirth-related PTSD covering DSM-5 criteria for PTSD. Since no questionnaire on childbirth-related PTSD is available in German, we aimed to validate a German translation of the City BiTS and to provide information on its psychometric properties.Methods: A community sample of 1,072 mothers completed an online survey, which included questions on sociodemographic and obstetric characteristics, the German version of the City BiTS, the Impact of Event Scale-Revised (IES-R), the PTSD Checklist for DSM-5 (PCL-5), Edinburgh Postnatal Depression Scale (EPDS), and the anxiety subscale of the Depression, Anxiety, and Stress Scale (DASS-Anxiety).Results: Exploratory factor analysis (EFA) on a random split-half sample confirmed the previously reported two-factorial structure of the City BiTS. The factors “Childbirth-related symptoms” and “General symptoms” explained about 53%, 52% of variance. Internal consistency was good to excellent for the subscales and the total scale (Cronbach's Alpha = 0.89−0.92). In a confirmatory factor analysis (CFA) in the holdout sample the two-factorial solution reached the best model fit out of three models. Correlation analyses showed convergent validity of the City BiTS (total scale and subscales) with the IES-R and PCL-5 and divergent validity with the EPDS and the DASS-Anxiety.Limitations: Data were acquired in a community sample and prevalence rates might not be representative for mothers of high-risk groups, e.g., after preterm birth.Conclusions: The German version of the City BiTS is the first German questionnaire which allows to assess symptoms of childbirth-related PTSD according to DSM-5 criteria. Besides an improvement in clinical routine it will help to make data on prevalence of childbirth-related PTSD internationally comparable. In addition, this work provides a basis to assess childbirth-related PTSD in studies conducted with a longitudinal study design or in high-risk samples.

The Impact of Mode of Birth on Childbirth-Related Post Traumatic Stress Symptoms beyond 6 Months Postpartum: An Integrative Review

“…Six studies differentiated between vaginal birth, operative vaginal birth and CS [ 37 , 38 , 58 , 59 , 60 , 61 ], whereas three studies differentiated between vaginal birth, elective caesarean section (elective CS) and emergency CS [ 62 , 63 , 64 ]. Eleven studies distinguished between vaginal birth, operative vaginal birth, elective CS and emergency CS [ 18 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 ]. The two qualitative studies described women’s experiences after vaginal birth and CS [ 1 , 9 ].…”

“…Some were based on the DSM-IV criteria, including the Posttraumatic Diagnostic Scale (PDS) [ 9 , 22 , 38 , 57 , 59 ], PTSD Symptom Scale—self report (PSS-SR) [ 4 , 18 , 68 ], Traumatic Event Scale (TES) [ 36 , 60 , 61 , 66 ], Impact of Event Scale (IES) [ 36 , 58 , 67 ], Posttraumatic Stress Disorder Checklist (PCL) [ 65 ], Post-traumatic checklist scale (PCLS) [ 56 ], and Primary Care PTSD Screen (PC-PTSD-IV) [ 70 ]. The City Birth Trauma Scale (CityBits) [ 62 , 64 , 67 , 69 , 74 ], PTSD-short scale [ 54 ] and Perinatal PTSD Questionnaire (PPQ) [ 37 , 55 , 73 , 75 ] were based on the DSM-V criteria.…”

“…Five studies administered the questionnaires during an interview with assistance from a healthcare professional [ 4 , 9 , 54 , 58 , 62 ], while 20 studies administered self-report questionnaires sent by postal mail, e-mail or online survey [ 18 , 22 , 36 , 37 , 38 , 55 , 56 , 58 , 59 , 60 , 61 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 73 , 75 ].…”

Preferences and Barriers to Counseling for and Treatment of Intimate Partner Violence, Depression, Anxiety, and Posttraumatic Stress Disorder Among Postpartum Women: Study Protocol of the Cross-Sectional Study INVITE

“…The City Birth Trauma Scale [City BiTS; ( 102 , 103 )] is used to assess childbirth-related PTSD symptoms and consists of 22 questions, which map onto DSM-5 diagnostic criteria and therefore measure re-experiencing or avoidance of the traumatic event, negative cognitions and mood, and hyperarousal. Symptoms are rated according to frequency over the last week and scored on a scale ranging from 0 (“not at all”) to 3 (“5 or more times”).…”

“…Distress, disability, and potential physical causes are rated as yes/no/maybe. Cronbach’s α for the total German scale is high [α = 0.92; ( 103 )]. In addition to the City BiTS, women were asked to indicate how traumatic they found their recent and potential earlier births on a scale from 0 (not at all traumatic) to 10 (very traumatic).…”