By Sue Thompson, Research Fellow, City University London
Research on PTSD in pregnancy and after birth is increasing and new studies are being published all the time. This year, several new studies focusing on risk factors for PTSD have been published and this blog provides a brief overview of some of these.
Maternal factors feature consistently in the research, and recent publications demonstrate this. For example, Shaban et al (2013) investigated PTSD in a sample of 600 Iranian women. Prevalence of PTSD was 17.2% at 6 to 8 weeks postpartum. Mothers with a history of neuropsychiatric conditions were at increased risk of PTSD, with moderate/severely depressed women around five times more likely to experience PTSD than non-depressed counterparts. Interestingly, PTSD rates were 2.86 times higher in working women than in home makers.
Perhaps surprisingly, Shaban et al did not find any effects related to birth mode, stillbirth, analgesia, complications of pregnancy or delivery or maternal coping. This is in contrast to many other studies, including Rowlands & Redshaw (2012) who looked at the role of mode of birth in PTSD-like symptoms in 5,332 women in the UK. They found that, in general, women reported most adverse physical and psychological symptoms at 10 days postpartum, with an improvement in health over the next three months. However, women who had undergone emergency caesarean section or forceps delivery were more likely to report symptoms of PTSD at one and three months respectively. Similarly, Boorman et al (2013), studied the effect of a traumatic birthing experience on the emotional well-being of 890 new mothers in Australia and found that mode of birth, particularly emergency caesarean section, increased the risk of perceiving traumatic birth in the early post-partum period. They also considered the degree to which women reported traumatic birth experiences in the context of DSM-IV criteria for traumatic events. Women experiencing either one or both DSM-IV criteria were more likely to meet the criteria for depression (measured by the Edinburgh Postnatal Depression Scale and The Depression Anxiety and Stress Scale 21) in the early postpartum period. Both Boorman et al (2013) and Shaban et al (2013) also found that pre-existing depression was associated with birth-related traumatic event reporting – although this effect was, to some extent, dependent upon the depression measure used.
Inevitably, there are methodological differences across these studies, particularly in relation to the measurement of PTSD, depression and anxiety, making direct comparisons difficult. Furthermore, there may be cultural differences that render results subject to particular peculiarities of the specific populations to which they refer. That said, the ability to consider predictors of postpartum PTSD is a useful starting point for the development of diagnostic measures and treatment plans designed to protect the health of new mothers.