Testing a cognitive model to predict posttraumatic stress disorder following childbirth

Abstract

BackgroundOne third of women describes their childbirth as traumatic and between 0.8 and 6.9% goes on to develop posttraumatic stress disorder (PTSD). The cognitive model of PTSD has been shown to be applicable to a range of trauma samples. However, childbirth is qualitatively different to other trauma types and special consideration needs to be taken when applying it to this population. Previous studies have investigated some cognitive variables in isolation but no study has so far looked at all the key processes described in the cognitive model. This study therefore aimed to investigate whether theoretically-derived variables of the cognitive model explain unique variance in postnatal PTSD symptoms when key demographic, obstetric and clinical risk factors are controlled for.MethodOne-hundred and fifty-seven women who were between 1 and 12 months post-partum (M = 6.5 months) completed validated questionnaires assessing PTSD and depressive symptoms, childbirth experience, postnatal social support, trauma memory, peritraumatic processing, negative appraisals, dysfunctional cognitive and behavioural strategies and obstetric as well as demographic risk factors in an online survey.ResultsA PTSD screening questionnaire suggested that 5.7% of the sample might fulfil diagnostic criteria for PTSD. Overall, risk factors alone predicted 43% of variance in PTSD symptoms and cognitive behavioural factors alone predicted 72.7%. A final model including both risk factors and cognitive behavioural factors explained 73.7% of the variance in PTSD symptoms, 37.1% of which was unique variance predicted by cognitive factors.ConclusionsAll variables derived from Ehlers and Clark’s cognitive model significantly explained variance in PTSD symptoms following childbirth, even when clinical, demographic and obstetric were controlled for. Our findings suggest that the CBT model is applicable and useful as a way of understanding and informing the treatment of PTSD following childbirth.

The risk factors for postpartum posttraumatic stress disorder and depression

“…Obstetric intervention during childbirth has been found to increase the rates of PTSD among postpartum women. 23,24 In this study, continuous urinary catheterization during childbirth was associated with high CityBiTS scores. Notably, a strikingly similar association was found in another study, 25 Gynaecologists 26 has not cited clear supporting evidence, it recommends intermittent catheterization during the first stage of birth and its complete discontinuation during the second stage.…”

Posttraumatic stress disorder following childbirth

“…88 Perinatal care represents an area where there is clear potential to prevent or minimise posttraumatic stress reactions, as a considerable proportion of postpartum PTSD may be preventable if appropriate care and support is provided during labour and childbirth. 89 Given that perceived safety during childbirth appears to be a particularly important predictor of PTSD following childbirth, 90 sensitive and supportive management of events during the labour process may contribute to the woman's sense of control and positively influence their appraisals of these events. It is crucial that health care staff provide the labouring woman and her partner with as much information and choice as possible and that they are sensitive to the fact that even routine procedures during labour may be stressful and cause anxiety.…”

“…92 Indeed, recent studies suggest that increasing psychological mindedness of the maternity service through specific perinatal mental health training may lead to a decrease in the onset of postpartum PTSD symptoms in the cared for women. 93 To date, evidence-based interventions for women after traumatic childbirth are lacking, 94 particularly early interventions that could improve longer term outcomes for both the mother and the child. 95 A recent meta-analysis of trauma-focused psychological therapies (TFPT) for PTSD following childbirth found evidence for the effectiveness of TFPTs for reducing PTSD symptoms in the short term (up to three months postpartum) and medium term (three to six months postpartum).…”

Maternal posttraumatic stress disorder during the perinatal period and child outcomes: A systematic review

“…Evidence suggests that other factors might also be important, such as the baby's gender, level of social support following childbirth, history of mental health problems, and stressful life events (Creedy, Shochet, & Horsfall, 2000;Ford & Ayers, 2011;Grekin & O'Hara, 2014;Soderquist, Wijma, & Wijma, 2006;Tamaki, Murata, & Okano, 1997). In addition, cognitive behavioral factors, such as the nature of the trauma memory, negative cognitive appraisals, and safety behaviors may also contribute to the development of PTSD following childbirth (Ford, Ayers, & Bradley, 2010;King, McKenzie-McHarg, & Horsch, 2017;Vossbeck-Elsebusch, Freisfeld, & Ehring, 2014).…”