Interplay of demographic variables, birth experience, and initial reactions in the prediction of symptoms of posttraumatic stress one year after giving birth

Abstract

BackgroundThere has been increasing research on posttraumatic stress disorder (PTSD) following childbirth in the last two decades. The literature on predictors of who develops posttraumatic stress symptoms (PSS) suggests that both vulnerability and birth factors have an influence, but many studies measure predictors and outcomes simultaneously.ObjectiveIn this context, we aimed to examine indirect and direct effects of predictors of PSS, which were measured longitudinally.MethodWe assessed women within the first days (n=353), 6 weeks, and 12 months (n=183) after having given birth to a healthy infant. The first assessment included questions on demographics, pregnancy, and birth experience. The second and third assessments contained screenings for postpartum depression, PTSD, and general mental health problems, as well as assessing social support and physical well-being. We analysed our data using structural equation modelling techniques (n=277).ResultsOur final model showed good fit and was consistent with a diathesis-stress model of PSS. Women who had used antidepressant medication in the 10 years before childbirth had higher PSS at 6 weeks, independent of birth experiences. Subjective birth experience was the early predictor with the highest total effect on later PSS. Interestingly, a probable migration background also had a small but significant effect on PSS via more episiotomies. The null results for social support may have been caused by a ceiling effect.ConclusionsGiven that we measured predictors at different time points, our results lend important support to the etiological model, namely, that there is a vulnerability pathway and a stress pathway leading to PSS. PSS and other psychological measures stayed very stable between 6 weeks and 1 year postpartum, indicating that it is possible to identify women developing problems early.Highlights of the articleOur results are consistent with a diathesis-stress model: vulnerability (antidepressant use in the previous 10 years) influenced posttraumatic stress symptoms at 6 weeks and 1 year, independently of stress (birth-related variables).The strongest predictor of posttraumatic stress symptoms 1 year postpartum was posttraumatic stress symptoms 6 weeks postpartum. This means that women who develop problems could be identified during routinely offered postpartum care.Women with a probable migration background experienced more PSS 1 year after the birth, which was an indirect effect through more episiotomies and more PSS after 6 weeks.

Post‐traumatic stress disorder in the perinatal period: A concept analysis

“…The identification of these factors and the identification of PPTSD occurring in pregnancy lend to extending the term of perinatal, not postpartum, PTSD (Ayers et al., ). As these studies were primarily correlational in nature, additional longitudinal studies are required to examine the relationships between the predictors and length of time symptoms appear (König et al., ).…”

“…The APA () notes it may take up to 6 months after the trauma for symptoms to appear. Although PPTSD may occur up to one year postpartum, few studies identify symptoms of PTSD for that time period (König et al., ). This conceptualisation of PPTSD, extending beyond the intrapartum period to any event in a woman's life which could place her at risk for PPTSD, is congruent with contemporary conceptualisations of women's perinatal health, including the IPHF published by Misra et al.…”

Peritraumatic distress fully mediates the relationship between posttraumatic stress symptoms preoperative and three months postoperative in patients undergoing spine surgery

“…Results have to be treated with care. High drop-outs are unfortunate yet common in longitudinal studies, such as König et al (2016) and van Son et al (2005). We did not ask for dropout reasons and recommend to do so in future studies.…”

“…Peritrauma variables, on the other hand, could influence posttraumatic stress either directly or indirectly through posttrauma variables occurring after the trauma. Childbirth, like elective spine surgery, is a possibly traumatizing event that is highly predictable and therefore a suitable subject for research on the relevance of pre- and peritrauma risk factors in longitudinal studies (Garthus-Niegel, Von Soest, Vollrath, & Eberhard-Gran, 2013; König et al, 2016; van Son, Verkerk, van der Hart, Komproe, & Pop, 2005). While some studies (e.g.…”

“…While some studies (e.g. König et al, 2016; van Son et al, 2005) suggest both a vulnerability and a stress pathway, Garthus-Niegel et al (2013) found that subjective experiences during birth are the most relevant predictor of PTSD symptoms.…”