Risk factors in pregnancy for post‐traumatic stress and depression after childbirth

Abstract

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.

The aetiology of post-traumatic stress following childbirth: a meta-analysis and theoretical framework

“…Evidence broadly confirms the associations between the factors outlined above and postpartum PTSD (Cigoli, Gilli, & Saita, 2006;Cohen, Ansara, Schei, Stuckless, & Stewart, 2004;Creedy, Shochet, & Horsfall, 2000;Czarnocka & Slade, 2000;LevWiesel, Chen, Daphna-Tekoah, & Hod, 2009;Soderquist, Wijma, Thorbert, & Wijmad, 2009;Soderquist, Wijma, & Wijma, 2002;Wijma, Soderquist, & Wijma, 1997). Very few studies have looked at the interaction between vulnerability and risk factors.…”

Aetiological relationships between factors associated with postnatal traumatic symptoms among Japanese primiparas and multiparas: A longitudinal study

“…However, whether objective birth experience is related to postnatal traumatic symptoms is a matter of debate (Czarnocka and Slade, 2000;Garthus-Niegel et al, 2013;Söderquist et al, 2006;Söderquist et al, 2002). Söderquist et al (2009) reported that most women who exhibited traumatic stress symptoms delivered babies without any obstetric intervention. Instrumental delivery or emergency Caesarean section is the final phase of their long delivery process: negative feelings may have existed before the intervention (Söderquist et al, 2009;Söderquist et al, 2002).…”

“…Söderquist et al (2009) reported that most women who exhibited traumatic stress symptoms delivered babies without any obstetric intervention. Instrumental delivery or emergency Caesarean section is the final phase of their long delivery process: negative feelings may have existed before the intervention (Söderquist et al, 2009;Söderquist et al, 2002). Thus stress symptomatology is more likely to be derived from sources other than the mode of delivery.…”

“…Nevertheless, a variety of factors have been reported in previous studies. They include (a) factors existing prior to the current pregnancy (preexisting factors) such as younger age, new motherhood, low socioeconomic status, history of mental disorders, personality characteristics (e.g., trait anxiety) and previous traumatic experience(s) (e.g., history of sexual abuse and poor attachment to partner) (Czarnocka and Slade, 2000;Olde et al, 2006;Söderquist et al, 2009;Söderquist et al, 2002), (b) psychological factors during the current pregnancy (pregnancy-related factors) such as psychological distress (e.g., antenatal fear of childbirth) and perceived lower social support from family and healthcare professionals (Fairbrother and Woody, 2007;Söderquist et al, 2009;, and (c) factors related to the present birth (birth-related factors) including obstetric interventions such as emergency Caesarean section, instrumental and induced delivery (Czarnocka and Slade, 2000;Ryding et al, 1998), negative birth experience and pain during labour (Creedy et al, 2000;Furuta et al, 2014;Söderquist et al, 2002). Although these three categories may contribute to the development of postnatal traumatic symptoms, their aetiological relationships remain unknown.…”

Transtornos psiquiátricos no pós-parto

“…O DSM-IV define evento traumático como um "evento catastrófico envolvendo morte ou lesão real ou ameaçada, ou ameaça à integridade física de si mesma, sendo caracterizada por intenso medo, impotência ou horror" 99 . Assim, advoga-se que partos em que a mulher vivencia situações como dor intensa e prolongada, procedimentos obstétricos de urgência, experiência de ter sido humilhada pela equipe médica, medo de morte ou morte do feto ou recém-nascido, percepção de anomalia congênita no bebê, entre outras, podem ser considerados fatores traumáticos que eventualmente podem desencadear o TEPT 100 .…”