October Research Update

Here is an update of the research that has been published in October

Post-Natal Psychopathology and Bonding with the Infant among First-Time Mothers Undergoing a Caesarian Section and Vaginal Delivery: Sense of Coherence and Social Support as Moderators.

Noyman-Veksler, G., Shirley-Herishanu-Gilutz, Kofman, O., Holchberg, G., & Shahar, G.

http://www.ncbi.nlm.nih.gov/pubmed/25325733

Objective: To investigate the protective role of sense of coherence (SOC) and perceived social support in the effect of emergency/elective Caesarian-Section on postnatal psychological symptoms and impairment in mother-infant bonding. Design: Thirty seven women delivering via an Emergency C-Section, 21 via Elective C-Section, and 38 through a vaginal delivery were assessed six weeks post-partum (Time 1) as to their PTSD and depressive symptoms, impairment in bonding, and SOC and social support. Symptoms and bonding difficulties were assessed again six weeks later (Time 2). Main and interactive effects of mode of delivery and the protective factors were examined. Main Outcome Measures: Post-natal depressive and PTSD symptoms and mother-infant bonding. Results: An emergency C-Section mode of delivery predicted an increase in PTSD symptoms in Time 2, but only among women with low levels of Time 1 social support. Time 1 SOC predicted a decrease in post-natal PTSD and depression. Conclusions: Social support might buffer against the potentially traumatic effect of an emergency C-Section. SOC appears to constitute a powerful dimension of post-natal resilience.

A Socioecological Predication Model of Posttraumatic Stress Disorder in Low-Income, High-Risk Prenatal Native Hawaiian/Pacific Islander Women

Dodgson, J. E., Oneha, M. F., & Choi, M.

http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12211/abstract

Introduction: Only recently has perinatal posttraumatic stress disorder (PTSD) been researched in any depth; however, the causes and consequences of this serious illness remain unclear. Most commonly, childbirth trauma and interpersonal violence have been reported as contributing factors. However, not all Native Hawaiian/Pacific Islander (NHPI) women who experience these events experience PTSD. The factors affecting PTSD are many and complex, intertwining individual, family, and community contexts. Using a socioecological framework, 3 levels of contextual variables were incorporated in this study (individual, family, and social/community). The purpose of this study was to determine the socioecological predictors associated with prenatal PTSD among NHPI. Methods: A case-control design was used to collect retrospective data about socioecological variables from medical record data. The sample was low-income, high-risk NHPI women receiving perinatal health care at a rural community health center in Hawaii who screened positive (n = 55) or negative (n = 91) for PTSD. Results: Hierarchical logistic regression was conducted to determine socioecological predictors of positive PTSD screening. Although the majority of women (66.4%) experienced some form of interpersonal violence, a constellation of significant predictor variables from all 3 levels of the model were identified: depression (individual level), lack of family support and family stress (family level), and violence (social/community level). Discussion: Each of the predictor variables has been identified by other researchers as significantly affecting perinatal PTSD. However, it is because these variables occur together that a more complex picture emerges, suggesting the importance of considering multiple variables in context when identifying and caring for these women. Although additional research is needed, it is possible that the significant predictor variables could be useful in identifying women who are at higher risk for PTSD in other similar populations.

Postpartum Anxiety in a Cohort of Women from the General Population: Risk Factors and Association with Depression during Last Week ofPregnancy, Postpartum Depression and Postpartum PTSD.

Shlomi Polachek,  I., Huller Harari, L., Baum, M., D Strous R.

http://doctorsonly.co.il/wp-content/uploads/2014/08/08_Postpartum-Anxiety-in.pdf

Background: In contrast to postpartum depression, postpartum anxiety receives less attention, especially in the general population. Acknowledging the phenomenon is important, as it may lead to significant distress and impair maternal functioning. Objectives: To explore the phenomenon in a cohort of women in the general population and to investigate possible associated factors. Methods: Within the first days after childbirth, women at Chaim Sheba Medical Center maternity ward were interviewed. Questionnaires included psychosocial variables, feelings and fears during pregnancyand childbirth, and the Edinburgh Postnatal Depression Scale (EPDS) (referring to the last week before delivery). A month later, subjects completed the EPDS, a modified Spielberger Anxiety Scale and the Posttraumatic Stress Diagnostic Scale via telephone. Results: 40.4% had high anxiety scores. A significant association was noted between postpartum anxiety and depression during the last week of pregnancy, postpartum depression, as well as postpartum PTSD. Anxiety scores were almost 50% higher in those who suffered from postpartum PTSD compared to those who experienced postpartum depression. Associations were also found with fear of the birth, fear of death during delivery (mother and fetus), feeling lack of control during labor and less confidence in self and medical staff. Of women who developed postpartum anxiety, 75% reported feeling anger, fear or emotional detachment during childbirth. No association was found with birth complications. Conclusions: Anxiety symptomatology appears to be a common manifestation after childbirth. It is therefore important to inquire about depression and fears during pregnancy and childbirth and subjective experience in order to anticipate postpartum anxiety symptoms, even by means of a brief screening test. The finding that postpartum PTSD was associated with the severity of postpartumanxiety may be used in the future as a potential identifier of PTSD symptoms in women with high anxiety scores.

Psychophysiology and posttraumatic stress disorder symptom profile in pregnant African-American women with trauma exposure.

Michopoulos, V., Rothbaum, A. O, Corwin, E., Bradley, B., Ressler, K. J., & Jovanovic, T.

http://link.springer.com/article/10.1007%2Fs00737-014-0467-y

While female sex is a robust risk factor for posttraumatic stress disorder (PTSD), pregnant women are an understudied population in regards to PTSD symptom expression profiles. Because circulating hormones during pregnancy affect emotionality, we assessed whether pregnant women would have increased expression of the intermediate phenotypes of hyperarousal and fear-potentiated startle (FPS) compared to non-pregnant women. We examined PTSD symptom profiles in pregnant (n = 207) and non-pregnant women (n = 370). In a second study, FPS responses were assessed in 15 pregnant and 24 non-pregnant women. All participants were recruited from the obstetrics and gynecology clinic at a public hospital serving a primarily African-American, low socioeconomic status, inner-city population. Our results indicate that overall PTSD symptoms were not different between the groups of women. However, pregnant women reported being more hypervigilant (p = 0.036) than non-pregnant women. In addition, pregnant women showed increased FPS to a safety signal compared to non-pregnant women (p = 0.024). FPS to a safety signal in pregnant women was significantly correlated with PTSD hyperarousal symptoms (r = 0.731, p < 0.001). Furthermore, discrimination between danger and safety signals was present in non-pregnant women (p = 0.008), but not in pregnant women (p = 0.895). Together, these data suggest that pregnant women show clinical and psychophysiological hyperarousal compared to non-pregnant women, and support screening for PTSD and assessment of PTSD risk in pregnant women.

Little is known about what constitutes key components of partner support during the childbirth experience. This study modified the five minute speech sample, a measure of expressed emotion (EE), for use with new parents in the immediate postpartum. A coding framework was developed to rate the speech samples on dimensions of couple support. Associations were explored between these codes and subsequent symptoms of postnatal depression and posttraumatic stress. 372 couples were recruited in the early postpartum and individually provided short speech samples. Posttraumatic stress and postnatal depression symptoms were assessed via questionnaire measures at six and thirteen weeks. Two hundred and twelve couples completed all time-points. Key elements of supportive interactions were identified and reliably categorised. Mothers’ posttraumatic stress was associated with criticisms of the partner during childbirth, general relationship criticisms and men’s perception of helplessness. Postnatal depression was associated with absence of partner empathy and any positive comments regarding the partner’s support. The content of new parents’ descriptions of labour and childbirth, their partner during labour and birth and their relationship within the immediate postpartum may have significant implications for later psychological functioning. Interventions to enhance specific supportive elements between couples during the antenatal period merit development and evaluation.