July – December 2017 Research Update

I would like to apologise for the delay in posting this, I have spent the last six months trying to finish my thesis so have not had time to keep up to date with the blog. I will try and make posts more regular from now. I have gathered the research published in July – December last year and posted it here for you.

Grief, traumatic stress, and posttraumatic growth in women who have experienced pregnancy loss.

Krosch, Daniel Jay; Shakespeare-Finch, Jane.


Objective: Pregnancy loss is common and can be devastating for those who experience it. However, a historical focus on negative outcomes, and grief in particular, has rendered an incomplete portrait of both the gravity of the loss, and the potential for growth in its wake. Consistent with contemporary models of growth following bereavement, this study explored the occurrence of posttraumatic growth following pregnancy loss and further assessed the role of core belief disruptions and common loss context factors across perinatal grief, posttraumatic stress symptoms, and posttraumatic growth. Method: Women who had experienced a miscarriage or stillbirth (N = 328) were recruited through perinatal loss support groups and completed an online survey that assessed core belief disruption, perinatal grief, posttraumatic stress symptoms, posttraumatic growth, loss context factors, and demographics. Hypotheses were tested via hierarchical multiple regression. Results: All hypotheses were supported. Specifically, (a) moderate levels of posttraumatic growth were reported; (b) core belief disruptions predicted perinatal grief, posttraumatic stress symptoms, and posttraumatic growth; and (c) perinatal grief predicted posttraumatic stress symptoms and growth. Conclusion: Findings suggest that pregnancy loss can be a traumatic event, that core belief disruptions play a significant role in posttrauma outcomes, and that other factors may contribute to grief, posttraumatic stress symptoms, and posttraumatic growth following pregnancy loss that warrant further research (e.g., rumination). Despite potential methodological and sampling limitations, the use of validated measures to assess posttraumatic growth in a large sample represents a robust attempt to quantify the occurrence of posttrauma change following pregnancy loss.


Posttraumatic stress in mothers related to giving birth prematurely: A mixed research synthesis.

Beck, Cheryl Tatano; Harrison, Lisa

Journal of the American Psychiatric Nurses Association, Vol 23(4), Jul, 2017. pp. 241-257.


Background: Globally the preterm birth rate for 184 countries in 2010 was 11.1%. Preterm births can be a traumatic experience for mothers. Objective: This article provides a mixed research synthesis of the quantitative and qualitative studies on posttraumatic stress in mothers who have given birth prematurely. Design: Narrative synthesis was the mixed research synthesis approach used. Results: Included in this narrative synthesis were quantitative prevalence studies (n = 19), quantitative intervention studies (n = 6), and qualitative studies (n = 5). Prevalence rates ranged from 14% to 79%. Four of the intervention studies had significant results and two did not. Qualitative data synthesis revealed five themes: (a) shocked and horrified, (b) consuming guilt, (c) pervasive anxiety and hypervigilance, (d) intrusive thoughts, and (e) numbing and avoiding reminders. Conclusions: Women’s traumatic experiences of preterm birth are clearly important issues for psychiatric nurses to address.


Reducing intrusive traumatic memories after emergency caesarean section: A proof-of-principle randomized controlled study.

Horsch, Antje; Vial, Yvan; Favrod, Céline; Harari, Mathilde Morisod; Blackwell, Simon E., Watson, Peter.; Iyadurai, Lalitha.; Bonsall, Michael B.; Holmes, Emily A

Behaviour Research and Therapy, Vol 94, Jul, 2017. pp. 36-47.


Preventative psychological interventions to aid women after traumatic childbirth are needed. This proof-of-principle randomized controlled study evaluated whether the number of intrusive traumatic memories mothers experience after emergency caesarean section (ECS) could be reduced by a brief cognitive intervention. 56 women after ECS were randomized to one of two parallel groups in a 1:1 ratio: intervention (usual care plus cognitive task procedure) or control (usual care). The intervention group engaged in a visuospatial task (computer-game ‘Tetris’ via a handheld gaming device) for 15 min within six hours following their ECS. The primary outcome was the number of intrusive traumatic memories related to the ECS recorded in a diary for the week post-ECS. As predicted, compared with controls, the intervention group reported fewer intrusive traumatic memories (M = 4.77, SD = 10.71 vs. M = 9.22, SD = 10.69, d = 0.647 [95% CI: 0.106, 1.182]) over 1 week (intention-to-treat analyses, primary outcome). There was a trend towards reduced acute stress re-experiencing symptoms (d = 0.503 [95% CI: −0.032, 1.033]) after 1 week (intention-to-treat analyses). Times series analysis on daily intrusions data confirmed the predicted difference between groups. 72% of women rated the intervention ‘rather’ to ‘extremely’ acceptable. This represents a first step in the development of an early (and potentially universal) intervention to prevent postnatal posttraumatic stress symptoms that may benefit both mother and child.


Maternal mind-mindedness as a linking mechanism between childbirth-related posttraumatic stress symptoms and parenting stress.

Camisasca E, Procaccia R, Miragoli S, Valtolina G, Di Blasio P.

Health Care Women Int. 2017 Jul;38(6):593-612. doi: 10.1080/07399332.2017.1296840.


The researchers of this study have two aims. The first aim is to verify whether posttraumatic stress (PTS) symptoms, evaluated at 87 hours and at 3 months postpartum, are associated with maternal mind-mindedness (MM) and parenting stress, measured at 17 months postpartum. The second aim is to investigate, at 17 months, the predictive effects of PTS symptoms on the dimensions of parenting stress and to explore whether MM mediates these associations. Forty-one mother-infant dyads participated in the study. The results show that at 17 months, hyper-arousal symptoms predicted both MM and parenting stress. MM was a linking mechanism between maternal PTS symptoms and parenting stress.


Post-traumatic stress disorder in parturients delivering by caesarean section and the implication of anaesthesia: a prospective cohort study.

Lopez U, Meyer M, Loures V, Iselin-Chaves I, Epiney M, Kern C, Haller G.

Health Qual Life Outcomes. 2017 2;15(1):118. doi: 10.1186/s12955-017-0692-y.



Post-traumatic stress disorder (PTSD) occurs in 1-7% of women following childbirth. While having a caesarean section (C-section) is known to be a significant risk factor for postpartum PTSD, it is currently unknown whether coexisting anaesthesia-related factors are also associated to the disorder. The aim of this study was to assess anaesthesia-linked factors in the development of acute postpartumPTSD.


We performed a prospective cohort study on women having a C-section in a tertiary hospital in Switzerland. Patients were followed up six weeks postpartum. Patient and procedure characteristics, past morbidity or traumatic events, psychosocial status and stressful perinatal events were measured. Outcome was divided into two categories: full PTSD disease and PTSD profile. This was based on the number of DSM-IV criteria of the Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) present. The PTSD Checklist Scale and the Clinician Administered PTSD Scale were used for measurement.


Of the 280 patients included, 217 (77.5%) answered the questionnaires and 175 (62.5%) answered to an additional phone interview. Twenty (9.2%) had a PTSD profile and six (2.7%) a PTSD. When a full predictive model of risk factors for PTSD profile was built using logistic regression, maternal prepartum and intrapartum complications, anaesthetic complications and dissociative experiences during C-section were found to be the significant predictors for PTSD profile.


This is the first study to show in parturients having a C-section that an anaesthesia complication is an independent risk factor for postpartum PTSD and PTSD profile development, in addition to known perinatal and maternal risk factors.


The presence of anxiety, depression and stress in women and their partners during pregnancies following perinatal loss: A meta-analysis.

Hunter A; Tussis L; MacBeth A

Journal Of Affective Disorders [J Affect Disord] 2017 Jul 11; Vol. 223, pp. 153-164.


Background: Research indicates perinatal loss is associated with anxiety, depression and stress in women and partners during subsequent pregnancies. However, there are no robust estimates of anxiety, depression and stress for this group. We meta-analytically estimated rates of anxiety, depression and stress in pregnant women and their partners during pregnancies after previous perinatal loss METHODS: Databases (Medline, PsychInfo, Embase, Cinahl Plus) and grey literature were searched from 1995 through to May 2016. Search terms included: depression, anxiety, or stress with perinatal loss (miscarry*, perinatal death, spontaneous abortion, fetal death, stillbirth, intrauterine death, TOPFA) and subsequent pregnancy. Case-controlled, English-language studies using validated measures of anxiety, depression or stress in women or partners during pregnancy following perinatal loss were included. Data for effect sizes, study and demographic data were extracted.
Results: We identified nineteen studies representing n = 5114 women with previous loss; n = 30,272 controls; n = 106 partners with previous perinatal loss; and n = 91 control men. Random effects modelling demonstrated significant effects of perinatal loss on anxiety (d = 0.69, 95% CI = 0.41-0.97) and depression (d = 0.22, 95% CI = 0.15-0.30) in women; but no effect on stress (d = – 0.002, 95% CI = – 0.0639 to 0.0605).
Limitations: This study was limited by the quality of available studies, underpowered moderator analyses and an inability to examine additional covariates. Insufficient data were available to generate reliable effects for psychological distress in partners.
Conclusions: Our findings confirm elevated anxiety and depression levels during pregnancies following perinatal loss. Further research on predictors of distress in women and their partners is required.


Narrative Exposure Therapy to Address Intimate Partner Violence-Related PTSD in Parenting and Pregnant Adolescents.

Volpe EM, Quinn CR, Resch K, Sommers MS, Wieling E, Cerulli C.

Fam Community Health. 2017 Jul/Sep;40(3):258-277. doi: 10.1097/FCH.0000000000000072.


Pregnant and parenting adolescents experience high rates of intimate partner violence (IPV) and its sequelae posttraumatic stress disorder (PTSD) and depression. Narrative exposure therapy (NET) is an innovative intervention that has demonstrated strong preliminary evidence in improving mental health. The specific aims of this article are 3-fold: (1) provide a brief background about IPV-related PTSD and depression among pregnant and parenting adolescents; (2) describe NET’s theoretical principles, its therapeutic process, and provide a review of existing evidence; and (3) discuss NET as a potential treatment to address the mental health burden among adolescents experiencing IPV-related PTSD and depression.


Post-traumatic stress symptoms in Swedish obstetricians and midwives after severe obstetric events: a cross-sectional retrospective survey.

Wahlberg Å, Andreen Sachs M, Johannesson K, Hallberg G, Jonsson M, Skoog Svanberg A, Högberg U.

BJOG. 2017 Jul;124(8):1264-1271. doi: 10.1111/1471-0528.14259.



To examine post-traumatic stress reactions among obstetricians and midwives, experiences of support and professional consequences after severe events in the labour ward.


Cross-sectional online survey from January 7 to March 10, 2014.


Members of the Swedish Society of Obstetrics and Gynaecology and the Swedish Association of Midwives.


Potentially traumatic events were defined as: the child died or was severely injured during delivery; maternal near-miss; maternal mortality; and other events such as violence or threat. The validated Screen Questionnaire Posttraumatic Stress Disorder (SQ-PTSD), based on DSM-IV (1994) 4th edition, was used to assess partial post-traumatic stress disorder (PTSD) and probable PTSD.


Partial or probable PTSD.


The response rate was 47% for obstetricians (n = 706) and 40% (n = 1459) for midwives. Eighty-four percent of the obstetricians and 71% of the midwives reported experiencing at least one severe event on the delivery ward. Fifteen percent of both professions reported symptoms indicative of partial PTSD, whereas 7% of the obstetricians and 5% of the midwives indicated symptoms fulfilling PTSD criteria. Having experienced emotions of guilt or perceived insufficient support from friends predicted a higher risk of suffering from partial or probable PTSD. Obstetricians and midwives with partial PTSD symptoms chose to change their work to outpatient care significantly more often than colleagues without these symptoms.


A substantial proportion of obstetricians and midwives reported symptoms of partial or probable PTSD after severe traumatic events experienced on the labour ward. Support and resilience training could avoid suffering and consequences for professional carers.


Understanding and Promoting Birth Satisfaction in New Mothers.

Hinic K;

MCN. The American Journal Of Maternal Child Nursing [MCN Am J Matern Child Nurs] 2017 Jul/Aug; Vol. 42 (4), pp. 210-215.


Purpose: The purpose of this study was to examine the impact of select maternal psychosocial and experiential factors on birth satisfaction of new mothers during early postpartum.
Study Design and Methods: This is a descriptive correlational study exploring the relationships among birth satisfaction, breastfeeding self-efficacy, and perceived stress in 107 new mothers in the first 4 days postpartum. Instruments used included the Birth Satisfaction Scale-Revised, the Perceived Stress Scale, the Breastfeeding Self-Efficacy Scale-Short Form, and a researcher-generated demographic form. Quantitative analysis included descriptive statistics, correlation, one-way Analysis of Variance, and multiple linear regression.
Results: Birth satisfaction was negatively correlated with perceived stress (r = -.299, p < .05) and positively correlated with feeling prepared for birth (rho = .243, p < .05) and breastfeeding self-efficacy (r = .226, p < .05). The predictive model for birth satisfaction was significant (R = .204, F [6, 99] = 4.225, p = .001), explaining approximately 20.4% of variance in birth satisfaction in the sample.
Clinical Implications: Stress reduction and management, establishment of realistic expectations for labor and birth, and promotion of togetherness with newborn immediately after birth are nursing priorities to promote birth satisfaction.


Traumatic Experience, Polytraumatization, and Perinatal Depression in a Diverse Sample of Adolescent Mothers.

Killian-Farrell C, Rizo CF, Lombardi BM, Meltzer-Brody S, Bledsoe SE.

J Interpers Violence. 2017 Aug 1


This study examines the prevalence of trauma subtypes, polytraumatization, and perinatal depression (PND) in a diverse sample of adolescent mothers to help inform PND prevention, screening, and treatment efforts. We conducted a secondary analysis of a sample ( N = 210) of adolescent mothers aged 14 to 20 years from a prospective longitudinal study of PND. Participants were recruited from a county-based, public health prenatal clinic, and data were collected in the prenatal and postpartum periods. In this sample, 81% of adolescent mothers reported at least one trauma experience and 75% reported lifetime experience of intimate partner violence (IPV). The most prevalent trauma types among adolescent mothers reporting PND were sexual trauma prior to age 13 (11.9%), loss of a caregiver or sibling (28.3%), emotional adversity (17.1%), and polytraumatization (43%). Trauma is alarmingly prevalent among adolescent mothers. Results suggest standards of care for adolescent mothers should include screening adolescent mothers for trauma history and provision of appropriate referrals for IPV. Findings support the need for trauma-informed treatment in perinatal public health clinics to decrease potential health risks to both mother and baby.


Facilitators and barriers to disclosure of postpartum mood disorder symptoms to a healthcare provider.

Prevatt, Betty-Shannon; Desmarais, Sarah L.

Maternal and Child Health Journal, Aug 1, 2017.


Objectives This study explored perceived barriers and facilitators to disclosure of postpartum mood disorder (PPMD) symptoms to healthcare professionals among a community-based sample. Methods A sample of predominantly white, middle class, partnered, adult women from an urban area in the southeast United States (n = 211) within 3 years postpartum participated in an online survey including the Perceived Barriers to Treatment Scale, the Maternity Social Support Scale, the Depression, Anxiety and Stress Scales-21, and items querying PPMD disclosure. Perceived barriers were operationalized as factors, from the patient’s perspective, that impede or reduce the likelihood of discussing her postpartum mood symptoms with a healthcare provider. Analyses examined: (1) characteristics associated with perceived barriers; (2) characteristics associated with perceived social support; and (3) characteristics, perceived barriers, and perceived social support as predictors of disclosure. Results Over half of the sample reported PPMD symptoms, but one in five did not disclose to a healthcare provider. Approximately half of women reported at least one barrier that made help-seeking ‘extremely difficult’ or ‘impossible.’ Over one-third indicated they had less than adequate social support. Social support and stress, but not barriers, were associated with disclosure in multivariable models. Conclusions for Practice Many women experiencing clinically-significant levels of distress did not disclose their symptoms of PPMD. Beyond universal screening, efforts to promote PPMD disclosure and help-seeking should target mothers’ social support networks.


Cumulative trauma and partner conflict predict post‐traumatic stress disorder in postpartum African‐American women.

Hauff, Nancy J; Fry‐McComish, Judith; Chiodo, Lisa M

Journal of Clinical Nursing, Vol 26(15-16), Aug, 2017. pp. 2372-2383.


Aim and objective: To describe relationships between cumulative trauma, partner conflict and post‐traumatic stress in African‐American postpartum women. Background: Cumulative trauma exposure estimates for women in the USA range from 51–69%. During pregnancy, most trauma research has focused on physical injury to the mother. Post‐traumatic stress disorder (PTSD) is associated with trauma and more prevalent in African‐American women than women of other groups. Knowledge about both the rate and impact of cumulative trauma on pregnancy may contribute to our understanding of women seeking prenatal care, and disparities in infant morbidity and mortality. Design: This retrospective, correlational, cross‐sectional study took place on postpartum units of two Detroit hospitals. Participants were 150 African‐American women aged between 18–45 who had given birth. Methods: Mothers completed the Cumulative Trauma Scale, Conflict Tactics Scale, Clinician Administered Post‐traumatic Stress Scale, Edinburgh Postnatal Depression Scale and a Demographic Data form. Descriptive statistics, correlations and multiple regressions were used for data analysis. Results: All participants reported at least one traumatic event in their lifetime. Cumulative trauma and partner conflict predicted PTSD, with the trauma of a life‐threatening event for a loved one reported by 60% of the sample. Nearly, one‐fourth of the women screened were at risk for PTSD. Increased cumulative trauma, increased partner conflict and lower level of education were related to higher rates of PTSD symptoms. Conclusion: Both cumulative trauma and partner conflict in the past year predict PTSD. Reasoning was used most often for partner conflict resolution. Relevance to Clinical Practice: The results of this study offer additional knowledge regarding relationships between cumulative trauma, partner conflict and PTSD in African‐American women. Healthcare providers need to be sensitive to patient life‐threatening events, personal failures, abuse and other types of trauma. Current evidence supports the need to assess for post‐traumatic stress symptoms during pregnancy.


Impact of psychological grief counseling on the severity of post-traumatic stress symptoms in mothers after stillbirths.

Navidian, Ali; Saravani, Zahra; Shakiba, Mansour

Issues in Mental Health Nursing, Vol 38(8), Aug, 2017. pp. 650-654.


Planned support and interventions are necessary in the care and support of women who have experienced stillbirth. The present study was conducted to determine the effect of psychological grief counseling on the symptom severity of post-traumatic stress disorder (PTSD) in mothers after stillbirths. This interventional study is semi-experimental. The study was conducted on 100 women who had recently had stillbirths. Eligible samples were selected and randomly divided into the two groups of intervention and control. The data collection tool was the PPQ, which was completed as a pre-test and post-test in both groups. The intervention group received four sessions of psychological grief counseling over two weeks, and the control group received only routine postnatal care. PTSD severity was evaluated in both groups at the end of the fourth week after the final session. The results showed that there was a statistically significant difference in the mean score of the severity of the PTSD symptoms in both groups after the intervention (P = 0.0001), which means that psychological grief counseling led to the reduction of PTSD severity in mothers. Given the positive impact of psychological grief counseling on reducing the severity of PTSD, integration of intensive psychological interventions in the maternity care system seems essential for faster transition of grief stages and for the prevention of severe cases of PTSD.


The feeling of discomfort during vaginal examination, history of abuse and sexual abuse and post-traumatic stress disorder in women.

Güneş, GizemKaraçam, Zekiye

Journal of Clinical Nursing. Aug2017, Vol. 26 Issue 15/16, p2362-2371.


Aims and objectives To examine the feeling of discomfort during vaginal examinations, history of abuse and sexual abuse and post-traumatic stress disorder in women to determine the correlation between these variables. Background Women who have experienced abuse or sexual abuse may feel more discomfort during vaginal examinations and may perceive a sensation similar to what they experienced during sexual abuse. Design Cross-sectional. Methods This study included 320 women receiving a vaginal examination. The data were collected using a questionnaire composed of items related to descriptive characteristics, vaginal examinations and violence, a visual analogue scale of discomfort, and the Post-Traumatic Stress Disorder Scale-civilian version. Results The mean score for the feeling of discomfort during vaginal examinations was 3·92 ± 3·34; 26·3% of the women described discomfort. Thirty-eight (12%) of the 320 women had experienced emotional violence, 25 (8%) had experienced physical violence, and 25 (8%) had been forced into sexual intercourse by their spouses. Of the women, 64·7% suffered from post-traumatic stress disorder, and physical, emotional and sexual violence were found to increase the possibility of this disorder. Exposure to emotional violence increased the possibility of discomfort during vaginal examinations by 4·5 ( OR = 4·482; 95% CI = 1·421-14·134). Post-traumatic stress disorder ( OR = 1·038; 95% CI = 1·009-1·066) was found to increase the possibility of discomfort during vaginal examinations; however, as the number of live births increases, women reported a reduction in their discomfort with vaginal examinations. Conclusion This study revealed a positive correlation between discomfort during vaginal examinations and emotional violence and post-traumatic stress disorder but a negative correlation between discomfort during vaginal examinations and the number of live births. In addition, having a history of abuse and sexual abuse was found to increase post-traumatic stress disorder. Relevance to clinical practice Considering these findings during vaginal examinations may help change women’s experiences for the positive and reduce the trauma, this procedure may cause.


Antenatal depressive symptoms and subjective birth experience in association with postpartum depressive symptoms and acute stress reaction in mothers and fathers: A longitudinal path analysis.

Baumeler, LuziaGürber, SusanneGrob, AlexanderSurbek, DanielStadlmayr, Werner

European Journal of Obstetrics & Gynecology & Reproductive Biology. Aug2017, Vol. 215, p68-74. 7p.


Objectives: Postpartum depressive symptoms (PDS) and acute stress reactions (ASR) after childbirth are frequently documented in mothers, but research is scarce in fathers. In a longitudinal path analysis, the interplay of depressive symptoms in pregnancy and the subjective childbirth experience of mothers and fathers are examined with regard to the development of PDS and ASR postpartum. Study Design: One hundred eighty nine expectant couples were recruited between August 2006 and September 2009. They completed the Edinburgh Postnatal Depression Scale (EPDS) in the last trimester of pregnancy. In the first week postpartum, they answered the Salmon’s Item List (subjective birth experience), and four weeks after birth the EPDS and the Impact of Event Scale – revised (IES-r). The data were evaluated in a longitudinal path analysis.Results: Compared with fathers, mothers reported more depressive symptoms (pregnancy: p<0.001; postpartum: p<0.001), higher ASR (p<0.001), and lower ‘positive birth experience’ (p<0.001). The association between depressive symptoms in mothers and fathers was not significant during pregnancy (r=0.107, p>0.10), but moderately correlated four weeks after birth (r=0.387, p<0.001). Depressive symptoms during pregnancy and a negative subjective birth experience were independently predictive of PDS and ASR after childbirth in mothers and fathers controlling for age, mode of delivery, parity, epidural anaesthesia, infant gender and birth weight. Antenatal depressive symptoms were related to subjective childbirth experience only in fathers.Conclusion: Parental prenatal depressive symptoms and subjective birth experience are important predictors of postnatal psychological adjustment in mothers and fathers.


What about me? The loss of self through the experience of traumatic childbirth.

Byrne V, Egan J, Mac Neela P, Sarma K.

Midwifery. 2017 Aug;51:1-11. doi: 10.1016/j.midw.2017.04.017.



birth trauma has become an increasingly recognised maternal mental health issue and has important implications for both mother and infant. The importance of subjective birth experience in the development of birth trauma has been identified and may mediate the lack of theoretical consistency in this area. The current study aims to explore the subjective experience of birth trauma among first time mothers in Ireland. It aims to separate the potential effects of peripartum depression (PPD) from this in limiting this qualitative investigation to women who reported birth trauma, without PPD.


mixed methods: Quantitative methods facilitated the recruitment of participants, the selection of a homogenous sample and addressed previous methodological flaws in birth trauma research. Interpretative Phenomenological Analysis (IPA) was used to explore the subjective experience of traumatic childbirth.


seven, first- time mothers who reported a traumatic childbirth, without significant symptoms of PPD participated.


screening measures of birth trauma and PPD were completed by participants. A semi-structured interview was then conducted with each participant about their childbirth experience. Interviews were transcribed and analysed using IPA. The primary superordinate theme recounted how the identity and individuality of women is ignored and discounted, throughout the process of childbirth. Identity is challenged and altered as a result of women’s incompatibility with the maternity system.


this study supports the existence of birth trauma in an Irish context and highlights the subjective experience of women as central to the development of birth trauma.


acknowledgement and inclusion of the mother as an individual throughout the process of childbirth may be protective in limiting the experience of birth trauma.


Impact of Psychological Grief Counseling on the Severity of Post-Traumatic Stress Symptoms in Mothers after Stillbirths.

Navidian A1, Saravani Z2, Shakiba M3.

Issues Ment Health Nurs. 2017 Aug;38(8):650-654.


Planned support and interventions are necessary in the care and support of women who have experienced stillbirth. The present study was conducted to determine the effect of psychological grief counseling on the symptom severity of post-traumatic stress disorder (PTSD) in mothers after stillbirths. This interventional study is semi-experimental. The study was conducted on 100 women who had recently had stillbirths. Eligible samples were selected and randomly divided into the two groups of intervention and control. The data collection tool was the PPQ,1 which was completed as a pre-test and post-test in both groups. The intervention group received four sessions of psychological grief counseling over two weeks, and the control group received only routine postnatal care. PTSD severity was evaluated in both groups at the end of the fourth week after the final session. The results showed that there was a statistically significant difference in the mean score of the severity of the PTSD symptoms in both groups after the intervention (P = 0.0001), which means that psychological grief counseling led to the reduction of PTSD severity in mothers. Given the positive impact of psychological grief counseling on reducing the severity of PTSD, integration of intensive psychological interventions in the maternity care system seems essential for faster transition of grief stages and for the prevention of severe cases of PTSD.


Post traumatic stress disorder post childbirth versus postnatal depression: a guide for midwives.

Bromley, PhilippaHollins Martin, Caroline J; Patterson, Jenny

British Journal of Midwifery. Aug2017, Vol. 25 Issue 8, p484-490. 7p.


Post traumatic stress disorder-post childbirth (PTSD-PC) is a powerful pathophysiological reaction that occurs in response to experiencing a traumatic birth and affects between 1–6% of women. Regardless of its trigger, PTSD-PC causes significant impairment to women’s social interactions, ability to work, and daily life. A key symptom of PTSD-PC is re-experiencing the birth in the form of nightmares, flashbacks, continual replay, intrusive thoughts, and images. When these symptoms persist beyond 1 month, a diagnosis of PTSD-PC should be considered. In awareness that there are additional mental health problems that a childbearing woman could encounter, the authors have elected to focus on two of the more commonly experienced diagnoses; specifically PTSD and postnatal depression (PND). It is important for midwives to be able to differentiate between PTSD-PC and PND, because diagnoses and treatments differ. Generally, PND is treated with antidepressants and cognitive behavioural therapy (CBT), while PTSD is treated with eye movement desensitisation and reprocessing (EMDR) therapy or emotional freedom technique (EFT). There is potential for a women to develop a dual diagnosis, with partner and family also affected. Clarity surrounding the differences between PND and PTSD are key to accessing appropriate diagnosis, referral, and treatment.


Preventing traumatic childbirth experiences: 2192 women’s perceptions and views.

Hollander MH1, van Hastenberg E2, van Dillen J2, van Pampus MG3, de Miranda E4, Stramrood CAI5.

Arch Womens Ment Health. 2017 Aug;20(4):515-523.


The purpose of this study is to explore and quantify perceptions and experiences of women with a traumatic childbirth experience in order to identify areas for prevention and to help midwives and obstetricians improve woman-centered care. A retrospective survey was conducted online among 2192 women with a self-reported traumatic childbirth experience. Women were recruited in March 2016 through social media, including specific parent support groups. They filled out a 35-item questionnaire of which the most important items were (1) self-reported attributions of the trauma and how they believe the traumatic experience could have been prevented (2) by the caregivers or (3) by themselves. The responses most frequently given were (1) Lack and/or loss of control (54.6%), Fear for baby’s health/life (49.9%), and High intensity of pain/physical discomfort (47.4%); (2) Communicate/explain (39.1%), Listen to me (more) (36.9%), and Support me (more/better) emotionally/practically (29.8%); and (3) Nothing (37.0%), Ask for (26.9%), or Refuse (16.5%) certain interventions. Primiparous participants chose High intensity of pain/physical discomfort, Long duration of delivery, and Discrepancy between expectations and reality more often and Fear for own health/life, A bad outcome, and Delivery went too fast less often than multiparous participants. Women attribute their traumatic childbirth experience primarily to lack and/or loss of control, issues of communication, and practical/emotional support. They believe that in many cases, their trauma could have been reduced or prevented by better communication and support by their caregiver or if they themselves had asked for or refused interventions.


The effects of trauma on perinatal depression: Examining trajectories of depression from pregnancy through 24 months postpartum in an at-risk population.

Grekin R, Brock RL, O’Hara MW.

J Affect Disord. 2017 Aug 15;218:269-276. doi: 10.1016/j.jad.2017.04.051



Research suggests that trauma exposure is associated with perinatal depression; however, little is known about the nature of the relation between trauma history and trajectory of depression, as well as the predictive power of trauma history beyond other risk factors. Additionally, more research is needed in at-risk samples that are likely to experience severe traumatic exposure.


Secondary data analysis was conducted using demographic and depression data from the Healthy Start and Empowerment Family Support programs in Des Moines, Iowa. Hierarchical linear modeling was used to examine trajectories of perinatal depressive symptoms, from pregnancy to 24 months postpartum, and clarify whether trauma exposure, relationship status, and substance use uniquely contribute to trajectories of symptoms over time.


On average, depressive symptoms decreased from pregnancy to 24 months postpartum; however, trajectories varied across women. Single relationship status, substance use, and trauma history were each predictors of higher depression levels at several points in time across the observed perinatal period. Single relationship status was also associated with decline in depressive symptoms followed by a rebound of symptoms at 22 months postpartum.


These data were not collected for research purposes and thus did not undergo the rigorous data collection strategies typically implemented in an established research study.


History of trauma, substance use and single relationship status represent unique risk factors for perinatal depression. For single women, depressive symptoms rebound late in the postpartum period. Single women are at greater risk for substance use and traumatic exposure and represent a sample with cumulative risk. Eliciting social support may be an important intervention for women presenting with these risk factors.


There is more to perinatal mental health care than depression: Public health nurses reported engagement and competence in perinatal mental health care.

Higgins A; Downes C; Carroll M; Gill A; Monahan M

Journal Of Clinical Nursing [J Clin Nurs] 2017 Aug 03.


Aims and Objectives: To explore public health nurses’ engagement, competence and education needs in relation to perinatal mental health care in Ireland.
Background: It is estimated that 15%-25% of women will experience a mental health problem during or postpregnancy, either as a new problem or a reoccurrence of a pre-existing problem. Public health nurses, or their equivalent, are ideally positioned to support women’s mental health and improve health outcomes for the woman and baby, yet little is known about their role and engagement with mental health issues, other than with postnatal depression. The objectives of the study were to identify public health nurses’ knowledge, skills and current practices in perinatal mental health and establish their education needs.
Design: The research used a descriptive design.
Method: A total of 186 public health nurses completed an anonymous, online survey, designed by the research team.
Results: While public health nurses are positive about their role in supporting women’s mental health, they lack the knowledge and skills to address all aspects of mental health, including opening a discussion with women on more sensitive or complex issues, such as trauma and psychosis and providing information to women. Those who received education reported statistically significant higher knowledge and confidence scores than those without.
Conclusion: Public health nurses lack the knowledge and skills required to provide comprehensive perinatal mental health care to women. Future education programmes need to move beyond postnatal depression and address the range of mental health problems that may impact on women in the perinatal period.


Risk factors for chronic post-traumatic stress disorder development one year after vaginal delivery: a prospective, observational study.

Sentilhes L, Maillard F, Brun S, Madar H, Merlot B, Goffinet F, Deneux-Tharaux C.

Sci Rep. 2017 Aug 18;7(1):8724. doi: 10.1038/s41598-017-09314-x.


Our study aimed to assess the prevalence of post-traumatic stress disorder (PTSD) after childbirth one year after vaginal delivery and to identify characteristics of women and deliveries associated with it. Questionnaires were mailed a year after delivery to 1103 women with prospectively collected delivery and postpartum data, including a question on day 2 assessing their experience of childbirth. PTSD was assessed a year later by the Impact of Event and Traumatic Event Scales; 22 women (4.2%, 95%CI 2.7-6.3%) met the PTSD diagnostic criteria and 30 (5.7%; 95%CI 3.9-8.0%) PTSD profile criteria. Factors associated with higher risk of PTSD profile were previous abortion(aOR 3.6, 95%CI 1.4-9.3), previous postpartum hemorrhage (Aor 5.3, 95%CI 1.3-21.4), and postpartum hemoglobin <9 g/dl (aOR 2.7, 95%CI 1.0-7.5). Among 56 women (10.3%) reporting bad childbirth memories at day 2 postpartum, 11 (21.1%) met PTSD diagnosis and 11 (21.1%) PTSD profile criteria a year later, compared with 11 (2.4%) (P < 0.001) and 18 (3.8%) (P < 0.001), respectively, of the 489 (87.7%) women with good memories. PTSD is not rare at one year after vaginal delivery in a low-risk population. A simple question at day 2 post partum may identify women most at risk of PTSD and help determine if early intervention is needed.


Grief, Bereavement, and Traumatic Stress as Natural Results of Reproductive Losses.

Abi-Hashem, Naji; Div, M.

Issues in Law & Medicine. Fall2017, Vol. 32 Issue 2, p245-254. 10p.


The article focuses on the influence reproductive losses has on traumatic stress, grief, and bereavement. It presents definitions of terminology such as grief, loss, and reproductive losses, and assigns meanings to reproduction and pregnancy. It considers the cultural roots on opposing views concerning how to deal with reproductive losses. It talks about signs and symptoms of grief and trauma, and the phases and steps used in successful grief counseling processes.



Isosävi S, Diab SY, Kangaslampi S, Qouta S, Kankaanpää S, Puura K, Punamäki RL.

Infant Ment Health J. 2017 Sep;38(5):617-633. doi: 10.1002/imhj.21658.


We examined how diverse and cumulated traumatic experiences predicted maternal prenatal mental health and infant stress regulation in war conditions and whether maternal mental health mediated the association between trauma and infant stress regulation. Participants were 511 Palestinian mothers from the Gaza Strip who reported exposure to current war trauma (WT), past childhood emotional (CEA) and physical abuse, socioeconomic status (SES), prenatal mental health problems (posttraumatic stress disorder and depression symptoms), and perceived stress during their secondtrimester of pregnancy as well as infant stress regulation at 4 months. While all trauma types were associated with high levels of prenatal symptoms, CEA had the most wide-ranging effects and was uniquely associated with depression symptoms. Concerning infant stress regulation, mothers’ CEA predicted negative affectivity, but only among mothers with low WT. Against hypothesis, the effects of maternal trauma on infant stress regulation were not mediated by mental health symptoms. Mothers’ higher SES was associated with better infant stress regulation whereas infant prematurity and male sex predisposed for difficulties. Our findings suggest that maternal childhood abuse, especially CEA, should be a central treatment target among war-exposed families. Cumulated psychosocial stressors might increase the risk for transgenerational problems.


Trauma exposure and post-traumatic stress disorder in a cohort of pregnant Peruvian women.

Levey EJ, Gelaye B, Koenen K, Zhong QY, Basu A, Rondon MB, Sanchez S, Henderson DC, Williams MA.

Arch Womens Ment Health. 2017 Sep 13. doi: 10.1007/s00737-017-0776-z


Women have a higher prevalence of post-traumatic stress disorder (PTSD) than men, with a peak during the reproductive years. PTSDduring pregnancy adversely impacts maternal and infant health outcomes. The objectives of this study were to estimate the prevalence of antepartum PTSD symptoms in a population of pregnant Peruvian women and to examine the impact of number of traumatic events and type of trauma experienced. The Traumatic Events Questionnaire was used to collect data about traumatic exposures. The Post-traumatic StressDisorder Checklist-Civilian Version (PCL-C) was used to assess PTSD. Multivariable logistic regression procedures were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). Three thousand three hundred seventy-two pregnant women were interviewed. Of the 2920 who reported experiencing one or more traumatic events, 41.8% met criteria for PTSD (PCL-C score ≥ 26). A quarter of participants had experienced four or more traumas, and 60.5% of those women had PTSD. Interpersonal trauma was most strongly associated with PTSD (aOR, 3.20; 95% CI, 2.74-3.74), followed by unspeakable trauma (aOR, 2.87; 95% CI, 2.35-3.50), and structural trauma (aOR, 1.39; 95% CI, 1.15-1.67). These findings indicate the high prevalence of PTSD during pregnancy in the Peruvian population, which is relevant to other countries suffering from terrorism, war, or high rates of violence. This underscores the importance of screening for PTSD in pregnancy.


The influence of acculturation on traumatic stress following childbirth among Hispanic adolescents.

Anderson, Cheryl;  Strickland, Sarah.

Hispanic Health Care International, Vol 15(3), Sep, 2017. pp. 99-106.


Introduction: Many studies have explored the role of acculturation on health outcomes; however, no studies to date have examined relationships between acculturation and the traumatic stress of childbirth among Hispanic adolescents. Method: A convenience sample of 66 Hispanic adolescents 13 to 19 years of age completed the Acculturation Rating Scale for Mexican Americans–II (ARSMA-II), a demographic sheet, birth appraisal scale, and the Impact of Event Scale within 72 hours of birth. Results: Significant associations were found between the ARSMA-II subscales and acculturation proxy variables, excluding language; however, only the Mexican Orientation Subscale and generation proxy variable influenced the birth experience. The study findings showed that Hispanic adolescents reporting a more traumatic childbirth identified closer with the Mexican culture and reported fewer family generations residing in the United States. Conclusion: As an overlooked area of research, our findings support the need for additional research related to the traumatic stress of birth among Hispanic adolescents. Using multiple acculturation measurements, including the ARSMA-II, with larger, more diverse samples of adolescents, equally balanced between all categories of acculturation and placement within the five-tier generation matrix, can provide some insightful information and directed health care.


Partners of nulliparous women with severe fear of childbirth: A longitudinal study of psychological well-being.

Ryding EL; Read S; Rouhe H; Halmesmäki E; Salmela-Aro K; Toivanen R; Tokola M; Saisto T

Birth (Berkeley, Calif.) [Birth] 2017 Sep 11.


Background: Little is known about the psychological status of partners of women with severe fear of childbirth (FOC). In this longitudinal study from Helsinki University Central Hospital, we investigated FOC, depression, and posttraumatic stress in the partners of women with severe FOC, and possible effects of group psychoeducation and mode of birth.
Methods: During pregnancy, 250 partners of nulliparous women with severe FOC participated, 93 in the intervention group and 157 in the control group. At 3 months postpartum, 52 partners in the intervention group and 93 in the control group participated. Both the partners and the childbearing women filled in the Wijma Delivery Expectancy/Experience Questionnaire and the Edinburgh Postnatal Depression Scale mid-pregnancy as well as 3 months postpartum, when they also filled in the Traumatic Event Scale.
Results: Partners of women with severe FOC reported less antenatal and postnatal FOC and fewer depressive symptoms than the childbearing women. No partner reached the threshold of severe FOC. No partner reported a possible posttraumatic stress disorder. Group psychoeducation with relaxation was not associated with better or worse psychological well-being of the partners. An emergency cesarean delivery was associated with a more fearful delivery experience in the partners.
Conclusion: Partners of nulliparous women with severe FOC neither seem to suffer from severe FOC nor reported posttraumatic stress symptoms after childbirth. They reported better psychological well-being than the mothers both during pregnancy and after delivery. An unexpected cesarean may be a negative experience even for partners of childbearing women.


Validating the psychometric characteristics of the perinatal posttraumatic stress disorder questionnaire (ppq) in a Chinese context.

Zhang, Jun; Zhang, Di; Gan, Quan; Wang, Qiaoling; Fan, Nian; Zhang, Rong; Song, Yayun

Archives of Psychiatric Nursing, Sep 28, 2017.


BACKGROUND: Perinatal posttraumatic stress disorder (PPTSD) is a common stress-induced mental disorder worldwide. The Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ) is an excellent questionnaire that measures the symptoms of PPTSD, but has not been translated into Chinese yet. OBJECTIVES: The aims of this study were to develop a translated Chinese version of the (PPQ) and validate the psychometric characteristics of the PPQ in a Chinese context. METHODS: After translation, back-translation, and expert discussion, 280 mothers at 1 to 18months postpartum filled out the questionnaires through the Internet. Then the reliability and validity of the translated questionnaire were tested. RESULTS: The Chinese version of PPQ (PPQ-C) was composed of 14 items. Cronbach’s ± coefficient was 0.84, test-retest reliability was 0.88, and the content validity was 0.99. Exploratory factor analysis extracted three factors (representing ‘arousal’, ‘avoidance’ and ‘intrusion’) accounted for 53.30% of the variance. The established 3 factors model was well fitted with the collected data (Ç2=76.40, p<0.05). IMPLICATIONS FOR PRACTICE: The PPQ-C is a short, reliable, and valid instrument that measures the symptoms of PPTSD, and it is recommend for clinical screening. IMPLICATIONS FOR RESEARCH: Further research could involve diverse participants, as well as better adapt the PPQ-C to Chinese culture.


Does maternal parenting stress mediate the association between postpartum PTS symptoms and children’s internalizing and externalizing problems? A longitudinal perspective.

Di Blasio, Paola; Miragoli, Sarah; Ionio, Chiara; Milani, Luca

Child & Youth Care Forum, Vol 46(5), Oct, 2017. pp. 685-701.


Background: The research carried out in the last years outlined that childbirth could be considered as a sufficient stressor for the insurgence of posttraumatic stress (PTS) symptoms with important consequences for the child care. Objectives: In a longitudinal perspective, this study focused on PTS symptoms after childbirth to understand their impact on maternal parenting stress and children’s adjustment. First, we investigated whether childbirth-related PTS symptoms, at 87 h and 3 months postpartum, were associated with parenting stress and children’s adjustment at 18 months. Second, we explored, at 18 months, the predictive effects of postpartum PTS symptoms on children’s adjustment and verified the mediational effect of parenting stress this association. Methods: Eighty-eight women participated and completed the following questionnaires: PPQ (for assessing maternal PTS symptoms at 87 h, 3 and 18 months postpartum), PSI-SF (for maternal parenting stress at 18 months) and CBCL (for children’s adjustment at 18 months). Results: Findings outlined that more PTS symptoms at 3 months are associated with greater levels of parental distress and they predicted children’s adjustment at 18 months. Moreover, maternal parenting stress explained the predictive effects of childbirth-related PTS symptoms on children’s adjustment. More precisely parental distress partially mediated the association between PTS symptoms and children’s internalizing behaviors, while the perception of the difficult child fully mediated the effects of PTS symptoms on externalizing behaviors. Conclusion: This study was consistent with the idea that women may experience childbirth-related chronic distress and child adjustment was connected to different sources of parenting stress.


A comparative prospective cohort study of women following childbirth: Mothers of low birthweight infants at risk for elevated PTSD symptoms.

Feeley, Nancy; Hayton, Barbara; Gold, Ian; Zelkowitz, Phyllis.

Journal of Psychosomatic Research, Vol 101, Oct, 2017. pp. 24-30.


A comparative, prospective cohort study compared PTSD symptoms in four groups of women at three times after childbirth: 5, 8 and 26 weeks. Two groups considered at-risk for PTSD were included (i.e., women giving birth to a LBW infant requiring NICU admission, and those who experienced an EmCB) and two low-risk groups (i.e., women who had a vaginal birth (VB) and those who had a planned caesarean birth (PCB)). This study examined four main hypotheses. We expected that: 1) at each time women in the two at-risk groups would experience greater PTSD symptoms compared to women in the low-risk groups, 2) the decrease in mean PTSD symptom levels for at-risk groups would be less than in the low-risk groups from 5 to 8, and 8 to 26 weeks postpartum, 3) the at-risk groups would have poorer maternal interactive behavior compared low-risk groups; and 4) regardless of group, women with clinically important PTSD symptom levels (e.g., scores in the clinical range) would exhibit poorer interactive behavior compared to women without; and women with co-morbidity of PTSD and depressive symptoms, would also have poorer interactive behavior. Additional exploratory analyses were conducted. Associations between PTSD symptoms and interactive behaviors were examined. The proportion of women in the clinical range in the different groups was explored. Lastly, we also investigated the proportion of women who had symptom levels in the clinical range on the self-report measure of PTSD compared to the more rigorous structured interview; and the concordance between these two measures with respect to classification of women in the clinical range.


PTSD Symptom Trajectories among Mothers Reporting Interpersonal Trauma: Protective Factors and Parenting Outcomes.

Guyon-Harris, KatherineAhlfs-Dunn, SarahHuth-Bocks, Alissa

Journal of Family Violence. Oct2017, Vol. 32 Issue 7, p657-667. 11p. 3


The childbearing years are further complicated when experiences of interpersonal trauma from childhood and/or adulthood lead to symptoms of posttraumatic stress disorder (PTSD). Maternal symptoms of PTSD over time were examined in relation to supportive adult relationships and parenting experiences. Ninety-five primarily economically disadvantaged mothers reporting exposure to childhood maltreatment and/or intimate partner violence were assessed from pregnancy through 2-years postpartum. Latent class growth analysis of PTSD symptoms indicated a 2-group model: stable low (82%) and moderate dysfunction (18%). The stable low group reported higher levels of support from romantic partners and family members, but not friends, and lower levels of parenting distress compared to the moderate dysfunction group. Results highlight individual variability in adaptation after violence exposure; current support from romantic partners and family members may have helped maintain lower PTSD symptoms for some trauma-exposed mothers. Psychological interventions aimed at reducing the impact of trauma exposure on parenting should consider promoting ongoing social support.


The trauma of birth.

Anderson CA

Health Care For Women International [Health Care Women Int] 2017 Oct; Vol. 38 (10), pp. 999-1010.


The trauma of birth is an international concern for all childbearing women globally. Since changes in 1994 to the Diagnostic Statistical Manual that included childbirth as a potentially traumatic event, several clusters of researchers, particularly representing the Scandinavian countries, the United Kingdom, and Australia, have emerged. Their research findings appear in numerous publications; yet, what is known from these studies is based on a variety of methodological designs and differing measurement tools making it difficult to draw many firm conclusions (Ayers, 2004 ; Ayers, Joseph, Mc-Kenzie-McHarg, Slade, & Wijma, 2008 ). This review offers information obtained from frequently cited, current and seminal research studies describing the trauma of birth among women of the world.


Neuroticism-related personality traits are associated with posttraumatic stress after abortion: findings from a Swedish multi-center cohort study.

Wallin Lundell I; Sundström Poromaa I; Ekselius L;Georgsson S; Frans Ö; Helström L; Högberg U; Skoog Svanberg A

BMC Women’s Health [BMC Womens Health] 2017 Oct 02; Vol. 17 (1), pp. 96


Background: Most women who choose to terminate a pregnancy cope well following an abortion, although some women experience severe psychological distress. The general interpretation in the field is that the most consistent predictor of mental disorders after induced abortion is the mental health issues that women present with prior to the abortion. We have previously demonstrated that few women develop posttraumatic stress disorder (PTSD) or posttraumatic stress symptoms (PTSS) after induced abortion. Neuroticism is one predictor of importance for PTSD, and may thus be relevant as a risk factor for the development of PTSD or PTSS after abortion. We therefore compared Neuroticism-related personality trait scores of women who developed PTSD or PTSS after abortion to those of women with no evidence of PTSD or PTSS before or after the abortion.
Methods: A Swedish multi-center cohort study including six Obstetrics and Gynecology Departments, where 1294 abortion-seeking women were included. The Screen Questionnaire-Posttraumatic Stress Disorder (SQ-PTSD) was used to evaluate PTSD and PTSS. Measurements were made at the first visit and at three and six month after the abortion. The Swedish universities Scales of Personality (SSP) was used for assessment of Neuroticism-related personality traits. Multiple logistic regression analyses were performed to investigate the risk factors for development of PTSD or PTSS post abortion.
Results: Women who developed PTSD or PTSS after the abortion had higher scores than the comparison group on several of the personality traits associated with Neuroticism, specifically Somatic Trait Anxiety, Psychic Trait Anxiety, Stress Susceptibility and Embitterment. Women who reported high, or very high, scores on Neuroticism had adjusted odds ratios for PTSD/PTSS development of 2.6 (CI 95% 1.2-5.6) and 2.9 (CI 95% 1.3-6.6), respectively.
Conclusion: High scores on Neuroticism-related personality traits influence the risk of PTSD or PTSS post abortion. This finding supports the argument that the most consistent predictor of mental disorders after abortion is pre-existing mental health status.


Factors associated with post-traumatic stress symptoms (PTSS) 4–6 weeks and 6 months after birth: A longitudinal population-based study.

Dikmen-Yildiz, Pelin; Ayers, Susan; Phillips, Louise.

Journal of Affective Disorders, Vol 221, Oct 15, 2017. pp. 238-245.


Background: Identifying factors that precipitate and maintain post-traumatic stress symptoms (PTSS) after birth is important to inform clinical and research practice; yet, prospective longitudinal studies on the predictors of PTSS are limited. This study aimed to determine the pregnancy and postpartum factors associated with PTSS at 4–6 weeks and 6-months postpartum. Method: A systematic sample of 950 pregnant women were recruited from three maternity hospitals in Turkey. Participants completed assessments of depression, anxiety, PTSS and social support in pregnancy, 4–6 weeks and 6-months postpartum. Fear of childbirth was assessed in pregnancy and 4–6 weeks after birth. Results: Regression models showed that PTSS six months after birth were associated with anxiety and PTSS in pregnancy, complications during birth, satisfaction with health professionals, fear of childbirth 4–6 weeks after birth, PTSS and depression 4–6 weeks after birth, social support 4–6 weeks after birth, traumatic events after birth, need for psychological help, and social support 6-months after birth. PTSS was highly comorbid with depression and anxiety at all-time points. The most robust predictor of PTSS at 6-months postpartum was PTSS at 4–6 weeks postpartum. Intra-partum complications were not associated with PTSS 4–6 weeks after birth. No socio-demographic variables were correlated with PTSS postpartum. Limitations: Self-report questionnaires were used to measure outcomes. This study is based on sampling from public hospitals so may not represent women treated in private hospitals. Conclusions: Associated risk factors may help to identify women at risk of PTSS after birth and to inform targeted early intervention.


Post-traumatic stress disorder symptoms in pregnant Australian Indigenous women residing in rural and remote New South Wales: A cross-sectional descriptive study.

Mah B, Weatherall L, Burrows J, Blackwell CC, Gwynn J, Wadhwa P, Lumbers ER, Smith R, Rae KM.

Aust N Z J Obstet Gynaecol. 2017 Oct;57(5):520-525. doi: 10.1111/ajo.12618.



Pregnancy can be a stressful time for many women. There is ample evidence of numerous physical and mental health inequities for Indigenous Australians. For those Indigenous women who are pregnant, it is established that there is a higher incidence of poor physical perinatal outcomes when compared with non-Indigenous Australians. However, little evidence exists that examines stressful events and post-traumatic stress disorder (PTSD) symptoms in pregnant women who are members of this community.


To quantify the rates of stressful events and PTSD symptoms in pregnant Indigenous women.


One hundred and fifty rural and remote Indigenous women were invited to complete a survey during each trimester of their pregnancy. The survey measures were the stressful life events and the Impact of Events Scale.


Extremely high rates of PTSD symptoms were reported by participants. Approximately 40% of this group exhibited PTSDsymptoms during their pregnancy with mean score 33.38 (SD = 14.37) significantly higher than a study of European victims of crisis, including terrorism attacks (20.6, SD = 18.5).


The extreme levels of PTSD symptoms found in the women participating in this study are likely to result in negative implications for both mother and infant. An urgent response must be mounted at government, health, community development and research levels to address these findings. Immediate attention needs to focus on the development of interventions to address the high levels of PTSDsymptoms that pregnant Australian Indigenous women experience.



Mother–infant bonding in the postpartum period: Assessment of the impact of pre-delivery factors in a clinical sample.

Farré-Sender, Borja; Torres, Anna; Gelabert, Estel; Andrés, Susana; Roca, Alba; Lasheras, Gracia; Valdés, Manuel; Garcia-Esteve, Lluïsa.

Archives of Women’s Mental Health, Oct 18, 2017.


This study aims to examine the extent to which a variety of pre-delivery factors (demographic, reproductive, psychological, psychiatric, and psychopathological) predict disturbances in mother–infant bonding (MIB) in the postpartum period. Two hundred fifty-one pregnant women enrolled at a public perinatal psychiatric service were assessed between the first and second trimester of pregnancy and at 6–7 weeks after delivery. During pregnancy, the psychological risk factors were assessed with the Vulnerable Personality Style Questionnaire, the Marital Adjustment Scale, the Early Trauma Inventory, and the General Health Questionnaire. To detect psychopathology, the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory were used. At the postpartum evaluation, MIB was measured by the Postpartum Bonding Questionnaire. The results of the final regression model showed that emotional abuse in childhood, family psychiatric history, previous psychiatric hospitalization, and anxiety during pregnancy were significant predictors of MIB disturbances in postpartum, explaining 10.7% of the variance. The evaluation of women’s risk factors in pregnancy is important in order to prevent MIB disturbances and thus to ensure the welfare of mothers and their babies.


Postpartum outcomes of a pilot prenatal care-based psychosocial intervention for PTSD during pregnancy.

Weinreb, Linda; Wenz-Gross, Melodie; Upshur, Carole.

Archives of Women’s Mental Health, Nov 7, 2017.


This study examines postpartum posttraumatic stress disorder (PTSD) symptoms and secondary outcomes including postpartum depression and birth outcomes for pregnant women who screened positive for PTSD and received a psychosocial education intervention compared to women with PTSD in the usual prenatal care setting. All women entering prenatal care at two federally qualified health centers were screened for symptoms of current PTSD; one site was selected randomly to have prenatal care advocates deliver eight Seeking Safety topics for women with clinical or subclinical PTSD. Women were not blind to condition. Baseline and postpartum interviews, including demographic characteristics and assessment of mental health, social support, and coping skills, were conducted. Medical record data was collected to document preterm delivery and low birth weight. Of the 149 participants at baseline, 128 (86%) participated in the postpartum interview. Intervention women, compared to controls, significantly decreased PTSD symptoms, and showed a non-significant trend for improved social support. However, depression, coping, and birth outcomes did not differ. This study suggests some initial support for the Seeking Safety intervention in prenatal care settings and requires further research to determine the best approaches to its implementation.


Trauma and traumatic stress in a sample of pregnant women.

Gelaye, Bizu; Zhong, Qiu-Yue.; Basu, Archana; Levey, Elizabeth J.; Rondon, Marta B.; Sanchez, Sixto; Koenen, Karestan C.; Henderson, David C.;Williams, Michelle A

Psychiatry Research, Vol 257, Nov, 2017. pp. 506-513.


Objective: To examine the construct validity of the 9 item Traumatic Events Questionnaire (TEQ) and to evaluate the extent to which experiences of trauma assessed using the TEQ are associated with symptoms of psychiatric disorders among 3342 pregnant women in Lima, Peru. Methods: Symptoms of depression were assessed using the Patient Health Questionnaire-9 (PHQ-9) and Edinburgh Postnatal Depression Scale (EPDS) while the PTSD Checklist-civilian (PCL-C) and Generalized Anxiety Disorder-7 (GAD-7) were used to assess symptoms of PTSD and generalized anxiety. Hierarchical logistic regression procedures were used to evaluate relations between TEQ and symptoms of psychiatric disorders. Results: The majority of participants (87.8%) experienced at least one traumatic event (mean = 2.5 events). The trauma occurrence score was moderately correlated with symptoms of PTSD (PCL-C: rho = 0.38, P-value < 0.0001), depression (EPDS: rho = 0.31, P-value < 0.0001; PHQ-9: rho = 0.20, P-value < 0.0001), and GAD (GAD-7: rho = 0.29, P-value < 0.0001). Stronger correlations were observed between the trauma intensity score with symptoms of psychiatric disorders (PCL-C: rho = 0.49, Pvalue < 0.0001; EPDS: rho = 0.36, P-value < 0.0001; PHQ-9: rho = 0.31, P-value < 0.0001; GAD-7: rho = 0.39, P-value < 0.0001). Conclusion: Given the high burden of trauma experiences and the enduring adverse consequences on maternal and child health, there is an urgent need for integrating evidence-based trauma informed care programs in obstetrical practices serving Peruvian patients.


Childhood physical and sexual abuse experiences associated with post-traumatic stress disorder among pregnant women.

Sanchez SE; Pineda O; Chaves DZ; Zhong QY; Gelaye B; Simon GE; Rondon MB; Williams MA;

Annals Of Epidemiology [Ann Epidemiol] 2017 Nov; Vol. 27 (11), pp. 716-723.e1.


Purpose: We sought to evaluate the extent to which childhood physical and/or sexual abuse history is associated with post-traumatic stress disorder (PTSD) during early pregnancy and to explore the extent to which the childhood abuse-PTSD association is mediated through, or modified by, adult experiences of intimate partner violence (IPV).
Methods: In-person interviews collected information regarding history of childhood abuse and IPV from 2,928 women aged 18-49 years old prior to 16 weeks of gestation. PTSD was assessed using the PTSD Checklist-Civilian Version. Multivariate logistic regressions were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).
Results: Compared to women with no childhood abuse, the odds of PTSD were increased 4.31-fold for those who reported physical abuse only (95% CI, 2.18-8.49), 5.33-fold for sexual abuse only (95% CI, 2.38-11.98), and 8.03-fold for those who reported physical and sexual abuse (95% CI, 4.10-15.74). Mediation analysis showed 13% of the childhood abuse-PTSD association was mediated by IPV. Furthermore, high odds of PTSD were noted among women with histories of childhood abuse and IPV compared with women who were not exposed to either (OR = 20.20; 95% CI, 8.18-49.85).
Conclusions: Childhood abuse is associated with increased odds of PTSD during early pregnancy. The odds of PTSD were particularly elevated among women with a history of childhood abuse and IPV. Efforts should be made to prevent childhood abuse and mitigate its effects on women’s mental health.


Posttraumatic Stress Disorder and Its Effects on Pregnancy and Mothering.

J Midwifery Womens Health. 2017 Nov;62(6):775-776. doi: 10.1111/jmwh.12705


Birth trauma and post-traumatic stress disorder: the importance of risk and resilience.

Ayers, Susan

Journal of Reproductive & Infant Psychology. Nov2017, Vol. 35 Issue 5, p427-430. 4p.


The author discusses the significance of risk and resilience in birth trauma and post-traumatic stress disorder (PTSD). Topics mentioned include the number of women in the European Union and the U.S. who are likely to be affected by birth trauma and PTSD every year, association of PTSD with poor coping and stress after birth, and conceptualization of resilience on two main dimensions.


Maternal psychological distress after preterm birth: Disruptive or adaptive?

Hall, Ruby A. S.; Hoffenkamp, Hannah N.; Braeken, Johan; Tooten, Anneke; Vingerhoets, Ad J. J. M.; van Bakel, Hedwig J. A.

Infant Behavior & Development, Vol 49, Nov, 2017. pp. 272-280.


Background: Maternal postpartum distress is often construed as a marker of vulnerability to poor parenting. Less is known, however, about the impact of postpartum distress on parenting an infant born prematurely. The present study investigated whether high distress levels, which are particularly prevalent in mothers of preterm born infants, necessarily affect a mother’s quality of parenting. Method: Latent Class Analysis was used to group mothers (N = 197) of term, moderately, and very preterm born infants, based on their levels of distress (depression, anxiety, and PTSD symptoms) at one month postpartum, and their quality of parenting at one and six months postpartum. Parenting quality was assessed on the basis of maternal interactive behaviors (sensitivity, intrusiveness, and withdrawal) using observations, and maternal attachment representations (balanced, disengaged, or distorted) using interviews. Results: A 5-Class model yielded the best fit to the data. The first Class (47%) of mothers was characterized by low distress levels and high-quality parenting, the second Class (20%) by low distress levels and low-quality parenting, the third Class (22%) by high distress levels and medium-quality parenting, the fourth Class (9%) by high distress levels and high-quality parenting, and finally the fifth Class (2%) by extremely high levels of distress and low-quality parenting. Conclusions: While heightened distress levels seem inherent to preterm birth, there appears to be substantial heterogeneity in mothers’ emotional responsivity. This study indicates that relatively high levels of distress after preterm birth do not necessarily place these mothers at increased risk with regard to poor parenting. Conversely, low distress levels do not necessarily indicate good-quality parenting. The results of the present study prompt a reconsideration of the association between postpartum distress and parenting quality, and challenge the notion that high levels of maternal distress always result in low-quality parenting practices.


Elevated maternal anxiety in the NICU predicts worse fine motor outcome in VLBW infants.

Greene MM; Rossman B; Meier P; Patra K;

Early Human Development [Early Hum Dev] 2017 Nov 08; Vol. 116, pp. 33-39.


Aim: The literature is sparse with respect to the impact of elevated maternal psychological distress in the neonatal intensive care unit (NICU) on later neurodevelopmental outcome in VLBW infants. The objective of this study is to examine the impact of elevated maternal distress, defined as elevated depression, anxiety and perinatal-specific post-traumatic stress, during the NICU hospitalization on VLBW infant ND outcome at 20months corrected age (CA).
Methods: This was a prospective study of 69 mothers and their VLBW infants recruited in 2011-2012. Elevated maternal distress was collected by maternal questionnaire in the NICU. Elevated depression was quantified with the Center for Epidemiological Studies-Depression Scale, anxiety with the Spielberger State-Trait Anxiety Inventory and perinatal-specific post-traumatic stress with the Modified Perinatal Posttraumatic Stress Disorder Questionnaire. VLBW infant ND outcome was assessed using the Bayley Scales of Infant & Toddler Development-III at 20months CA. Regression analyses determined the impact of elevated distress on ND outcome after adjusting for infant medical and maternal sociodemographic variables.
Results: After controlling for infant and maternal covariates, elevated maternal anxiety in the NICU predicted lower fine motor scores at 20months CA.
Conclusion: Elevated maternal anxiety in the NICU is associated with adverse ND outcome in VLBW infants in the 2nd year of life. NICU-based support services may help mothers’ quality of life and VLBW infant outcome.


Effect of Previous Posttraumatic Stress in the Perinatal Period.


Geller PA; Stasko EC

Journal Of Obstetric, Gynecologic, And Neonatal Nursing: JOGNN [J Obstet Gynecol Neonatal Nurs] 2017 Nov – Dec; Vol. 46 (6), pp. 912-922.


Objective: To review the extant literature on the effect of traumatic experiences that pre-date conception, pregnancy, and the postpartum period (perinatal period) and present a thematic overview of current issues in this relatively new area of inquiry.
Data Sources: Electronic databases Cochrane, CINAHL, PsychINFO, and PubMed were searched. Manual searches of reference lists supplemented the electronic search.
Study Selection: Peer-reviewed articles written in English on the role of posttraumatic stress disorder during the perinatal period were included.
Data Extraction: Key findings relevant to perinatal posttraumatic stress that were reported in primary sources and meta-analyses were organized according to themes, including The Role of Childbirth, Comorbidity With Depression and Anxiety, Risk Factors for Perinatal PTSD, High-Risk Health Behaviors, and Association With Adverse Health Outcomes.
Data Synthesis: Across studies, antenatal posttraumatic stress disorder (PTSD) rates were estimated between 2.3% and 24%, and observed prevalence rates during the postnatal period ranged from 1% to 20%; however, many researchers failed to assess PTSD that existed before or during pregnancy, and when preexisting PTSD is a controlled variable, postpartum rates drop to 2% to 4.7%. In addition to prenatal depression and anxiety and pre-pregnancy history of psychiatric disorders, history of sexual trauma, childhood sexual abuse, intimate partner violence, and psychosocial attributes are risk factors for development or exacerbation of perinatal PTSD.
Conclusion: Women’s health care providers should evaluate for PTSD in routine mental health assessments during and after pregnancy, especially with a reported history of trauma or the presence of a mood or anxiety disorder. Such screening will allow women to receive needed treatment and referrals and mitigate the potentially negative sequelae of PTSD. Future investigators must recognize the importance of subsyndromal posttraumatic stress symptoms and individual differences in responses to trauma.



Stigma in the context of pregnancy termination after diagnosis of fetal anomaly: associations with grief, trauma, and depression.

Hanschmidt F, Treml J, Klingner J, Stepan H, Kersting A

Arch Womens Ment Health. 2017 Dec 29. doi: 10.1007/s00737-017-0807-9.


Termination of pregnancy after diagnosis of fetal anomaly (TOPFA) is a contested issue and stigma may negatively impact affected women’s psychological reactions. This study examined the influence of perceived and internalized stigma on women’s long-term adjustment to a TOPFA. One hundred forty-eight women whose TOPFA dated back 1 to 7 years responded to self-report questionnaires. The associations between perceived stigma at the time of the TOPFA, current internalized stigma and symptoms of grief, trauma and depression were modeled using multiple linear regression. The proportion of participants reporting scores above the cutoffs on the respective scale was 17.6% for grief, 18.9% for posttraumatic stress, and 10.8% for depression. After controlling for time since the TOPFA, pre-TOPFA mental health and obstetric variables, higher levels of current internalized stigma were related to higher levels of grief, trauma, and depression. Mediation analyses suggested that the effect of perceived stigma at the time of the TOPFA on symptoms of grief and trauma was mediated by current internalized stigma, but the cross-sectional design limited causal interpretation of results. Internalized stigma is associated with long-term psychological distress following a TOPFA. Perceived stigma at the time of the TOPFA may contribute to increased trauma and grief symptomatology, but results need to be validated in longitudinal studies. Health care providers and public initiatives should aim at reducing stigma among affected women.


The influence of postpartum PTSD on breastfeeding: A longitudinal population-based study.

Garthus-Niegel S; Horsch A; Ayers S; Junge-Hoffmeister J; Weidner K; Eberhard-Gran M

Birth (Berkeley, Calif.) [Birth] 2017 Dec 18.


Background: In most Western countries, breastfeeding rates are lower than what is recommended by the World Health Organization. Depression has been shown to influence breastfeeding outcomes; however, there is very little research on the role of postpartum posttraumatic stress disorder (PTSD). This study examined to what extent maternal postpartum PTSD predicted breastfeeding initiation, exclusive breastfeeding during the first 6 months, and continuation up to 1 and 2 years.
Methods: The study is part of the large, population-based Akershus Birth Cohort. Data from the hospital’s birth record and questionnaire data from 8 weeks and 2 years postpartum were used (n = 1480). All breastfeeding variables significantly correlated with postpartum PTSD were entered into stepwise logistic regression analyses.
Results: Although most mothers (97.1%) initiated breastfeeding, considerably fewer adhered to the World Health Organization’s breastfeeding guidelines about exclusive breastfeeding during the first 6 months (13.4%) or continued breastfeeding for 12 or 24 months postpartum (37.7% and 4.2%, respectively). Even after adjustment for important confounding variables, maternal postpartum PTSD was significantly associated with not initiating breastfeeding (aOR 5.98 [95% CI 1.79-19.97]). Postpartum PTSD was also significantly related to not continuing breastfeeding up to 12 months, although this association did not hold after adjusting for confounding variables.
Conclusion: Identifying women at risk of not initiating breastfeeding is crucial to prevent a negative influence on infant development and the development of the mother-infant bond. Early screening and treatment of women at risk of developing postpartum PTSD might be a way forward.


Reproductive trauma: Psychotherapy for pregnancy loss and infertility clients from a reproductive story perspective.

Jaffe J

Psychotherapy (Chic). 2017 Dec;54(4):380-385. doi: 10.1037/pst0000125.


The reproductive story offers a unique way to conceptualize pregnancy loss and infertility. This article describes the development of the reproductive story from early childhood on, and focuses on the devastating losses when the story does not unfold as originally hoped. Regardless of the type of reproductive trauma that clients experience, the underlying psychological constructs of grief are the same. The goal is to help clients work through their grief and loss, accept that their story can be edited and rewritten, and come away with a positive new ending. This paper illustrates how to utilize the reproductive story with infertility and pregnancy loss clients in psychotherapy. Using clinical illustrations, interventions for the treatment of perinatal grief, particularly in the context of infertility, are discussed. Specific suggestions are offered to help clients rethink past ideals, cope with their current trauma, and make constructive decisions in their effort to build their future family.


Risk factors for the development of post-traumatic stress disorder and coping strategies in mothers and fathers following infant hospitalisation in the neonatal intensive care unit.

Aftyka A, Rybojad B, Rosa W, Wróbel A, Karakuła-Juchnowicz H.

J Clin Nurs. 2017 Dec;26(23-24):4436-4445. doi: 10.1111/jocn.13773.



The aim of this study was to identify the potential risk factors for the development of post-traumatic stress disorder in mothers and fathers following infant hospitalisation in the neonatal intensive care unit.


The development of neonatal intensive care units has increased the survival rate of infants. However, one of the major parental problems is post-traumatic stress disorder.


An observational study covered 125 parents (72 mothers and 53 fathers) of infants aged 3-12 months who were hospitalised in the neonatal intensive care unit during the neonatal period.


Third-referral neonatal intensive care unit. Several standardised and self-reported research tools were used to estimate the level of post-traumatic stress symptoms (Impact Event Scale-Revised), perceived stress (Perceived Stress Scale) and coping strategies (COPE Inventory). The respondents also completed a Parent and Infant Characteristic Questionnaire.


The mothers and fathers did not differ in their parental and infant characteristics. Post-traumatic stress disorder was present in 60% of the mothers and 47% of the fathers. Compared to the fathers, the mothers felt greater stress (p = .020) and presented a higher severity of post-traumatic stress disorder (p < .001). Previous miscarriages (p = .023) and the presence of chronic diseases (p = .032) were risk factors for post-traumatic stress disorder in the mothers. In the fathers, an Apgar test at 1 min after birth (p = .030) and a partner’s post-traumatic stress disorder (p = .038) were related to post-traumatic stress disorder. The mothers compared to the fathers were more likely to use strategies such as: positive reinterpretation and growth, focusing on and venting of emotions, instrumental social support, religious coping and acceptance. In the fathers, the predictors included an Apgar score at 1 min after birth, a lack of congenital anomalies in the child and mental disengagement.


Risk factors for post-traumatic stress disorder, as well as coping strategies, differ in women compare to men.


Knowledge of risk factors for post-traumatic stress disorder, specific to men and women, may help identify the parents in whom probability of the occurrence of this disorder is increased.


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

Vignato J, Georges JM, Bush RA, Connelly CD.

J Clin Nurs. 2017 Dec;26(23-24):3859-3868. doi: 10.1111/jocn.13800



To report an analysis of the concept of perinatal post-traumatic stress disorder.


Prevalence of perinatal post-traumatic stress disorder is rising in the USA, with 9% of the U.S. perinatal population diagnosed with the disorder and an additional 18% being at risk for the condition. Left untreated, adverse maternal-child outcomes result in increased morbidity, mortality and healthcare costs.


Concept analysis via Walker and Avant’s approach.


The databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Academic Search Premier and PsychINFO were searched for articles, written in English, published between 2006-2015, containing the terms perinatal and post-traumaticstress disorder.


Perinatal post-traumatic stress disorder owns unique attributes, antecedents and outcomes when compared to post-traumaticstress disorder in other contexts, and may be defined as a disorder arising after a traumatic experience, diagnosed any time from conception to 6 months postpartum, lasting longer than 1 month, leading to specific negative maternal symptoms and poor maternal-infant outcomes. Attributes include a diagnostic time frame (conception to 6 months postpartum), harmful prior or current trauma and specific diagnostic symptomatology defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Antecedents were identified as trauma(perinatal complications and abuse), postpartum depression and previous psychiatric history. Consequences comprised adverse maternal-infant outcomes.


Further research on perinatal post-traumatic stress disorder antecedents, attributes and outcomes in ethnically diverse populations may provide clinicians a more comprehensive framework for identifying and treating perinatal post-traumatic stress disorder.


Nurses are encouraged to increase their awareness of perinatal post-traumatic stress disorder for early assessment and intervention, and prevention of adverse maternal-infant outcomes


Migraine and the risk of post-traumatic stress disorder among a cohort of pregnant women.

Friedman, Lauren E; Aponte, Christina; Perez Hernandez, Rigoberto; Velez, Juan Carlos; Gelaye, Bizu; Sánchez, Sixto E; Williams, Michelle A; Peterlin, B. Lee

The Journal of Headache and Pain, Vol 18, Dec, 2017. ArtID: 67


Background: Individually both migraine and post-traumatic stress disorder (PTSD) prevalence estimates are higher among women. However, there is limited data on the association of migraine and PTSD in women during pregnancy. Methods: We examined the association between migraine and PTSD among women attending prenatal clinics in Peru. Migraine was characterized using the International Classification of Headache Disorders (ICHD)-III beta criteria. PTSD was assessed using the PTSD Checklist-Civilian Version (PCL-C). Multivariable logistic regression analyses were performed to estimate odds ratios (OR) and 95% confidence intervals (CI) after adjusting for confounders. Results: Of the 2922 pregnant women included, 33.5% fulfilled criteria for any migraine (migraine 12.5%; probable migraine 21.0%) and 37.4% fulfilled PTSD criteria. Even when controlling for depression, women with any migraine had almost a 2-fold increased odds of PTSD (OR: 1.97; 95% CI: 1.64–2.37) as compared to women without migraine. Specifically, women with migraine alone (i.e. excluding probable migraine) had a 2.85-fold increased odds of PTSD (95% CI: 2.18–3.74), and women with probable migraine alone had a 1.61-fold increased odds of PTSD (95% CI: 1.30–1.99) as compared to those without migraine, even after controlling for depression. In those women with both migraine and comorbid depression, the odds of PTSD in all migraine categories were even further increased as compared to those women without migraine. Conclusion: In a cohort of pregnant women, irrespective of the presence or absence of depression, the odds of PTSD is increased in those with migraine. Our findings suggest the importance of screening for PTSD, specifically in pregnant women with migraine.


The role of sociodemographic factors in maternal psychological distress and mother-preterm infant interactions.

Gondwe KW; White-Traut R; Brandon D; Pan W; Holditch-Davis D

Research In Nursing & Health [Res Nurs Health] 2017 Dec; Vol. 40 (6), pp. 528-540.


Preterm birth has been associated with greater psychological distress and less positive mother infant interactions than were experienced by mothers of full-term infants. Maternal and infant sociodemographic factors have also shown a strong association with psychological distress and the mother-infant relationship. However, findings on their effects over time are limited. In this longitudinal analysis, we explored the relationship of maternal and infant sociodemographic variables (maternal age, maternal education, marital status, being on social assistance, maternal race, infant birth weight, and infant gender) to maternal psychological distress (depressive, posttraumatic stress, anxiety, parenting stress symptoms, and maternal worry about child’s health) through 12 months corrected age for prematurity, and on the home environment, and mother-infant interactions through 6 months corrected age for prematurity. We also explored differences related to maternal obstetrical characteristics (gestational age at birth, parity, mode of delivery, and multiple birth) and severity of infant conditions (Apgar scores, need for mechanical ventilation, and infant medical complications). Although the relationship of maternal and infant characteristics with these outcomes did not change over time, psychological distress differed based on marital status, maternal education, infant gender, and infant medical complications. Older mothers provided more a positive home environment. Mother-infant interactions differed by maternal age, being on public assistance, maternal race, infant gender, and infant medical complications. More longitudinal research is needed to better understand these effects over time in order to identify and support at-risk mothers.


Depression, anxiety, PTSD and comorbidity in perinatal women in Turkey: A longitudinal population-based study.

Dikmen-Yildiz P; Ayers S; Phillips L

Midwifery [Midwifery] 2017 Dec; Vol. 55, pp. 29-37.


Objective: (a) to assess prevalence of depression, anxiety and post-traumatic stress disorder (PTSD) and their comorbidity among women during the perinatal period (b) to examine course of those disorders from pregnancy to 6 months postpartum (c) to determine the rates of new-onset cases at 4-6 weeks and 6 months postpartum.
Design: A longitudinal population-based study in which participants completed psychosocial measures of depression, anxiety and PTSD in pregnancy (n = 950), 4-6 weeks (n = 858) and 6 months (n = 829) after birth.
Setting: A consecutive sample of pregnant women were recruited from three maternity hospitals in three cities of Turkey: Istanbul, Ankara and Izmir.
Measures: Edinburgh Postnatal Depression Scale (EPDS), Hospital Anxiety and Depression Scale (HADS), and Posttraumatic Diagnostic Scale (PDS) were used to assess depression, anxiety and PTSD, respectively.
Findings: Depression and PTSD peaked at 4-6 weeks postpartum and then fell at 6 months postpartum, whereas anxiety followed a gradually declining linear-pattern from pregnancy to 6 months postpartum. The prevalence of depression was 14.6% in pregnancy, 32.6% at 4-6 weeks and 18.5% at 6 months postpartum, respectively. The prevalence of PTSD was 5.8% in pregnancy, 11.9% at 4-6 weeks postpartum and 9.2% at 6 months postpartum. Anxiety was highest in pregnancy (29.6%) and then decreased to 24.6% 4-6 weeks after birth and to 16.2% 6 months after birth. New-onset cases were most apparent at 4-6 weeks postpartum: 24.6% for depression; 13.7% for anxiety and 8.9% for PTSD.
Key Conclusions: A relatively high prevalence of psychological disorders was identified during the perinatal period. Anxiety was most prevalent in pregnancy, and depression and PTSD were highest at 4-6 weeks postpartum. Depression was more common than anxiety 4-6 weeks and 6 months after birth and highly comorbid with anxiety throughout this period. New-onset cases were observed at both 4-6 weeks and 6 months postpartum.
Implications: High rates of affective disorders in pregnancy and after birth highlight three main points: first, it is important to have effective perinatal screening to identify women with psychological needs; second, providing early treatment to women experiencing severe psychological problems is essential to ensure psychological well-being of those women and to prevent chronicity; and finally, psychosocial screening and interventions should be offered until at least 6 months after birth to catch new-onset cases.


Stress in fathers in the perinatal period: A systematic review.

Philpott LF; Leahy-Warren P; FitzGerald S; Savage E

Midwifery [Midwifery] 2017 Dec; Vol. 55, pp. 113-127.


Background: despite the evidence that fatherhood has a long-term positive and protective effect on men’s health, there is also evidence that fatherhood in the perinatal period can be complex and demanding. Due to the potential increase in stressors in the perinatal period, there is reason to hypothesise that it is a time of increased stress for fathers. However, it is not clear how significant a problem stress is for fathers during this stage of life. This is in part, due to the fact that the available research has not been systematically reviewed.
Purpose: the purpose of this systematic review was to critically appraise the empirical evidence that examined stress in fathers in the perinatal period.
Design: systematic review.
Methods: a systematic review protocol was developed and registered with PROSPERO (Reference number: CRD42016035821). The review was guided by the PRISMA reporting process. Electronic databases Medline, CINAHL, the Cochrane Library, PsycARTICLES, PsycINFO, Psychology and Behavioural Sciences Collections were searched to identify studies that met the inclusion criteria. Studies that researched fathers in the perinatal period were included if stress was the principal focus of the research, if stress was in the title and/or aim of the study or if stress was an outcome or dependent variable. Data were extracted and presented in narrative form including tables and figures.
Findings: eighteen studies met the inclusion criteria. The findings indicate that fathers experience stress in the perinatal period, particularly at the time of birth. Stress levels were found to increase from the antenatal period to the time of birth, with a decrease in stress levels from the time of birth to the later postnatal period. There are a number of factors that contribute to stress in fathers in the perinatal period and these included negative feelings about the pregnancy, role restrictions related to becoming a father, fear of childbirth and feelings of incompetence related to infant care. The review found that stress has a negative impact on fathers, with higher stress levels contributing to mental health issues such as anxiety, depression, psychological distress and fatigue.
Key Conclusion: during the perinatal period fathers experience stress and face unique stressors that can impact negatively on their health and social relationships.


Vicarious birth trauma and posttraumatic stress disorder: Preparing and protecting student midwives.

Power, AlisonMullan, Jenny

British Journal of Midwifery. Dec 2017, Vol. 25 Issue 12, p799-802. 4p.


Post-traumatic stress disorder was first recognised in war veterans who had experienced extreme violence during military combat; however, it is now understood to be caused by a wide range of traumatic experiences, including serious accidents, abuse, natural disasters or terrorist attacks–any event in which a person fears for their life. Traumatic childbirth is also a potential cause, not only for the mother, but also for those who may witness the birth, such as midwives, student midwives, obstetricians and birth partners. This condition is termed vicarious birth trauma. This article will examine the definition of both vicarious birth trauma and post-traumatic stress disorder, and consider the evidence in relation to how these conditions affect midwives and student midwives. It will offer suggestions for personal and organisational management and support strategies, based on research findings and expert advice.


2 Responses

  1. Elizabeth Skinner at |

    Hi Rebecca
    Here is the link for my recently published article from Dec 2017
    Warm regards
    Elizabeth Skinner Sydney Australia
    PhD candidate and researcher
    Arch Womens Ment Health. 2017 Dec 19. doi: 10.1007/s00737-017-0802-1. [Epub ahead of print]

    Psychological consequences of pelvic floor trauma following vaginal birth: a qualitative study from two Australian tertiary maternity units.
    Skinner EM, Barnett B, Dietz HP.


    Vaginal birth may result in damage to the levator ani muscle (LAM) with subsequent pelvic floor dysfunction and there may be accompanying psychological problems. This study examines associations between these somatic injuries and psychological symptoms. A qualitative study using semi-structured interviews to examine the experiences of primiparous women (n = 40) with known LAM trauma was undertaken. Participants were identified from a population of 504 women retrospectively assessed by a perinatal imaging study at two obstetric units in Sydney, Australia. LAM avulsion was diagnosed by 3D/4D translabial ultrasound 3-6 months postpartum. The template consisted of open-ended questions. Main outcome measures were quality of information provided antenatally; intrapartum events; postpartum symptoms; and coping mechanisms. Thematic analysis of maternal experiences was employed to evaluate prevalence of themes. Ten statement categories were identified: (1) limited antenatal education (29/40); (2) no information provided on potential morbidities (36/40); (3) conflicting advice (35/40); (4) traumatized partners (21/40); (5) long-term sexual dysfunction/relationship issues (27/40); (6) no postnatal assessment of injuries (36/40); (7) multiple symptoms of pelvic floor dysfunction (35/40); (8) “putting up” with injuries (36/40); (9) symptoms of post-traumatic stress disorder (PTSD) (27/40); (10) dismissive staff responses (26/40). Women who sustain LAM damage after vaginal birth have reduced quality of life due to psychological and somatic morbidities. PTSD symptoms are common. Clinicians may be unaware of the severity of this damage. Women report they feel traumatized and abandoned because such morbidities were not discussed prior to birth or postpartum.

  2. Rebecca Webb at |

    Hi Elizabeth, thank you for this! I am sorry I missed it. I will make sure to schedule a tweet for it.


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