Research Update – February & March 2019

The role of trauma and partner support in perinatal depression and parenting stress: An Australian pregnancy cohort study.

Int J Soc Psychiatry. 2019 Mar 27:20764019838307. doi: 10.1177/0020764019838307. [Epub ahead of print]

Galbally M1,2,3Watson SJ1,2Boyce P4Lewis AJ1.

Abstract

BACKGROUND:

Improving our understanding of the relationship between maternal depression and parenting stress is likely to lie in the range of additional factors that are associated with vulnerability to depression and also to parenting stress.

OBJECTIVES:

To examine the role of trauma and partner support, in understanding the relationship between perinatal depression and parenting stress.

METHODS:

This study utilises data from 246 women in a pregnancy cohort study that followed women from early pregnancy until their infant was 12 months. Included were both women with a diagnosis of depression and those without depression. The measures included Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Edinburgh Postnatal Depression Scale, Childhood Trauma Questionnaire, Social Support Effectiveness Questionnaire and the Parenting Stress Index.

RESULTS:

We found women with depression were more likely to report a history of childhood trauma. Depressive symptoms were positively associated with parenting stress while partner support was negatively associated with parenting stress. The protective role of partner support for parenting distress was observed in those with no history of childhood abuse and low depressive symptoms, but not in those with a trauma history and high depressive symptoms.

CONCLUSIONS:

These findings highlight the importance of early trauma in understanding the protective role of support on the relationship between parenting and depression. These findings can inform future studies and the refinement of future interventions aimed at both perinatal depression and parenting.

KEYWORDS:

Depression; childhood trauma; parenting; partner support

https://www.ncbi.nlm.nih.gov/pubmed/30915877

 

Lived Traumatic Childbirth Experiences of Newly Delivered Mothers Admitted to the Postpartum Ward: a Phenomenological Study.

J Caring Sci. 2019 Mar 1;8(1):23-31. doi: 10.15171/jcs.2019.004. eCollection 2019 Mar.

Abdollahpour S1Motaghi Z2.

Abstract

Introduction: Childbirth is a stressful event in every woman’s life, leading to traumatic deliveries in half of the cases. This study aimed at describing mothers’ lived experiences which make them perceive their childbirth as traumatic. Methods: In this descriptive phenomenological study, based on the DSM-V-A criteria, 32 mothers who had perceptions of a traumatic event during their labor and delivery were explored through semi-structured interviews, and the collected data were analyzed using the Colaizzi’s method. Results: Four main themes could be extracted from the experiences of the mothers. The first theme was sensational and emotional experiences followed by clinical experiences, legal experiences and human dignity, and environmental experiences. The sensational and emotional experiences included four main categories (anxiety, fear, sorrow, anger). The theme of clinical experiences included two main categories (avoidable and unavoidable childbirth complications). The theme of legal experiences and human dignity included two main categories (non-observance of the charter of patient rights, and non-observance of human rights). The theme of environmental experiences also included two main categories (lack of proper supervision and management). Conclusion: To prevent traumatic childbirth and its negative effects, different psychological aspects of childbirth need to be identified.

KEYWORDS:

Physiological; Traumatic childbirth; lived experiences; phenomenological study

https://www.ncbi.nlm.nih.gov/pubmed/30915310

 

The German W-DEQ version B-Factor structure and prediction of posttraumatic stress symptoms six weeks and one year after childbirth.

Health Care Women Int. 2019 Mar 22:1-16. doi: 10.1080/07399332.2019.1583230. [Epub ahead of print]

König J1.

Abstract

The Wijma Delivery Expectancy/Experience Questionnaire is a frequently used measure in the context of childbirth. There are two versions with identical items for use during pregnancy (version A, fear of childbirth) and postpartum (version B, subjective experience) respectively. The original authors report that the measure is unidimensional, but since, very different factor structures have been found with different language versions. In this study, I tested the previously found factor structures in a sample of 338 German new mothers with confirmatory factor analysis. As none showed an adequate fit, I conducted an exploratory factor analysis, which yielded six factors with satisfactory internal consistencies.

https://www.ncbi.nlm.nih.gov/pubmed/30901296

 

A Pilot Study of Oxytocin in Low-Income Women With a Low Birth-Weight Infant: Is Oxytocin Related to Posttraumatic Stress?

Adv Neonatal Care. 2019 Mar 19. doi: 10.1097/ANC.0000000000000601. [Epub ahead of print]

Garfield L1Holditch-Davis DCarter CSMcFarlin BLSeng JSGiurgescu CWhite-Traut R.

Abstract

BACKGROUND:

Negative outcomes related to prematurity may lead to maternal distress. Mothers of premature/low birth-weight infants report increased posttraumatic stress (50%) and depressive symptoms (63%) compared with mothers of full-term infants. Low-income, minority mothers with greater posttraumatic stress and depression have an increased risk for premature/low birth-weight delivery compared with their white counterparts. Variations in the neuropeptide oxytocin are implicated in lactation, perinatal depression, and maternal behavior.

PURPOSE:

To examine the associations among posttraumatic stress, depressive symptoms, and oxytocin in a pilot sample of minority mothers with premature/low birth-weight infants in the neonatal intensive care unit (NICU).

METHODS:

This study employed a descriptive, correlational pilot design of 8 minority, low-income mothers with premature/low birth-weight infants. Participants answered questionnaires pertaining to posttraumatic stress, depression, lactation, and demographics and oxytocin was measured. This is a substudy that added oxytocin values.

RESULTS:

Four participants had elevated depressive symptoms and 5 supplied their own milk. Women who provided their own milk had lower depressive (t = 3.03, P = .023) and posttraumatic stress (t = 3.39, P = .015) symptoms compared with women not supplying their own milk. Women with elevated posttraumatic stress had higher levels of depressive symptoms (r(8) = 0.8, P = .006) and lower levels of oxytocin (r(8) = 0.77, P = .026).

IMPLICATIONS FOR PRACTICE:

These results are congruent with previous literature on providing human milk and maternal mental health. In addition, we found a possible relationship between postpartum posttraumatic stress and oxytocin in minority women with premature/low birth-weight infants. NICU nurses should encourage lactation and assess mothers for posttraumatic stress and depressive symptoms.

IMPLICATIONS FOR RESEARCH:

Research is needed to identify the biologic milieu associated with posttraumatic stress and depression in at-risk mothers.

https://www.ncbi.nlm.nih.gov/pubmed/30893095

 

Postpartum post-traumatic stress disorder: Associated perinatal factors and quality of life.

J Affect Disord. 2019 Apr 15;249:143-150. doi: 10.1016/j.jad.2019.01.042. Epub 2019 Feb 10.

Hernández-Martínez A1Rodríguez-Almagro J2Molina-Alarcón M3Infante-Torres N4Donate Manzanares M5Martínez-Galiano JM6.

Abstract

BACKGROUND:

The relationship between obstetric variables and postpartum post-traumatic stress disorder (PTSD), and its influence on quality of life (QoL), have scarcely been studied.

OBJECTIVE:

Determine the prevalence of PTSD at postpartum weeks 4 and 6, and its relation with perinatal variables and quality of life METHOD: A cross-sectional study with 2990 Spanish puerperal women in Spain. Data were collected on socio-demographic and obstetric variables, and on newborns. An online ad hoc questionnaire was used, including the Perinatal Post-traumatic Stress Disorder Questionnaire (PPQ) and SF-36. The crude and adjusted odds ratios were estimated by binary logistic regression.

RESULTS:

10.6% (318) of the women appeared at risk for PTSD symptoms. Factors like having a respected birth plan (aOR: 0.52; 95%CI: 0.34, 0.80), using epidural analgesia (aOR: 0.64; 95%CI: 0.44, 0.92) and performing skin-to-skin contact (aOR: 0.37; 95%CI: 0.28, 0.50) were protective factors against PTSD, among others. Instrumental birth (aOR: 2.50; 95%CI: 1.70, 3.69) and caesarean section (aOR: 3.79; 95%CI: 2.43, 5.92) were found to be risk factors, among others. The area under the ROC curve in this model was 0.79 (95%CI: 0.76, 0.81). The women with PTSD presented a mean difference for QoL of -13.37 points less than those without PTSD (95%CI: -11.08, -15.65).

CONCLUSIONS:

The women with PTSD symptoms had a worse quality of life at postpartum weeks 4-6. Birth type, analgesia methods and humanising practices, like skin-to-skin contact and using respected birth plans, were related with presence of the postpartum PTSD risk.

Copyright © 2019. Published by Elsevier B.V.

KEYWORDS:

Associated factors; Perinatal variables; Post-traumatic stress disorder (PTSD); Postpartum; Quality of life

https://www.ncbi.nlm.nih.gov/pubmed/30772741

 

[State of knowledge of post-natal post-traumatic stress disorder].

Rev Med Suisse. 2019 Feb 6;15(637):347-350.

[Article in French; Abstract available in French from the publisher]

Benzakour L1Epiney M2Girard E1.

Abstract

In this article, a synthesis of data from the literature on postpartum post-traumatic stress disorder (PTSD) related to childbirth is presented, knowing that the psychological suffering in this period of life is frequently associated with a certain taboo. The criteria to diagnose psychotraumatism, as well as postpartum PTSD just after the birth are here recalled as well as the importance of evaluating the subjective experience of the mother wich is a central issue. The clinical specificity and key symptoms of postpartum PTSD are described along with the risk and protective factors. In the light of scientific knowledge in the field of psychotraumatology, we present the prevention strategies of this disorder that can be applied, but which remain to be evaluated and tailored to this specific context.

https://www.ncbi.nlm.nih.gov/pubmed/30724537

 

[Perinatal and postnatal treatment of traumatized parents with mental disorders: impact on parents and their children].

[Article in German]

Nervenarzt. 2019 Mar;90(3):260-266. doi: 10.1007/s00115-018-0660-8.

Klinger-König J1Grabe HJ2,3.

Abstract

BACKGROUND:

In traumatized parents with mental disorders, pregnancy and related medical examinations can lead to high emotional distress and flashbacks and increase the already tense emotional situation. Besides psychiatric burdens, parental insecurity concerning dealing with and reduced sensitivity for the child often exist. The children themselves have a higher risk of being neglected or abused and to also develop mental disorders.

OBJECTIVE:

How does interventional research take the special needs of traumatized parents with mental disorders into account? What kind of interventions predominate and what impact do they have on parents and children?

MATERIAL AND METHODS:

Publications on perinatal and postnatal interventions for traumatized and mentally disordered parents were included in the review if at least one intervention was explicitly described, a parental trauma was discussed and the impact of the intervention on the parents and children was analyzed.

RESULTS:

A total of 2 reviews and 10 interventional studies were included. Interventions were primarily based on professional educational counseling, psychoeducation, nurse home visits, individual and group therapies and inpatient mother-baby units. The interventions led to reduced psychiatric symptoms, enhanced parental sensitivity for the child’s needs, enhanced quality of nurturing and care and an improved mother-child bonding.

CONCLUSION:

Although only few studies focused on the special needs of traumatized, mentally disordered parents, the described interventions show promising effect sizes, especially in combination with several kinds of interventions. Nevertheless, an adequate integration of fathers into the therapies has so far been neglected.

KEYWORDS:

Childhood trauma; Intervention research; Mother-child bonding; Nurturing; Pregnancy

https://www.ncbi.nlm.nih.gov/pubmed/30643953

 

Trauma-informed care with women diagnosed with postpartum depression: a conceptual framework.

Soc Work Health Care. 2019 Feb;58(2):220-235. doi: 10.1080/00981389.2018.1535464. Epub 2018 Oct 22.

Polmanteer RSR1Keefe RH2Brownstein-Evans C1.

 

Abstract

Postpartum depression (PPD) is a mental health disorder that affects approximately 20% of all new mothers. PPD frequently co-occurs with and is exacerbated by trauma, particularly for women from vulnerable populations. Trauma-informed care (TIC) is a best practice that recognizes the importance of, and takes steps to promote recovery from, trauma while preventing retraumatization. Despite its potential utility, there is limited research published on TIC, including how TIC is operationalized across practice settings. Further, despite the prevalence and negative effects of untreated PPD, to date there have been limited articles published on TIC and PPD. The purpose of this article is to provide a TIC framework for service delivery for women diagnosed with PPD including explicit strategies for how TIC should be structured across roles, settings, and systems. Implications for health practice, policy, and future research are provided.

KEYWORDS:

Perinatal health; perinatal mental health; postpartum depression; trauma; trauma-informed care

https://www.ncbi.nlm.nih.gov/pubmed/30346906

 

Childbirth as a forthcoming traumatic event: pretraumatic stress disorder during pregnancy and its psychological correlates.

J Reprod Infant Psychol. 2019 Feb;37(1):44-55. doi: 10.1080/02646838.2018.1504284. Epub 2018 Aug 10.

Goutaudier N1Bertoli C2Séjourné N2Chabrol H2.

Abstract

BACKGROUND:

Recent research has suggested that pretraumatic stress related to a forthcoming predictable traumatic event might exist and that such stress reactions would be a key, ‘but largely ignored’, aspect of the etiology of Posttraumatic Stress Disorder (PTSD). While it is now acknowledged that childbirth may lead to PTSD, less is known regarding pretraumatic reactions in pregnancy. This study aims to (a) explore the frequency of PTSD, Fear of Childbirth and tokophobia associated with the forthcoming delivery and (b) highlight associated features of pre-traumatic stress symptoms.

METHODS:

At 34 weeks’ gestation, a sample of 102 women completed questionnaires assessing anticipated labour pain, fear of childbirth, fear of pain, pretraumatic stress symptoms, perceived social support and depressive and anxiety symptoms.

RESULTS:

8.8% of women met DSM-IV-TR criteria for PTSD related to the threatening forthcoming delivery. Fear of childbirth, anticipated labour pain, anxiety, and depressive symptoms were significant predictors of pretraumatic stress intensity.

CONCLUSION:

Our results extend prior findings on postpartum PTSD by showing that fear of labour pain is a specific construct, clearly independent from the experience of general pain. Our results suggest that childbirth may be experienced as threatening and traumatic and that this traumatic impact might develop way before the delivery. As a potential traumatic continuum from pre- to posttraumatic stress might exist, further longitudinal studies assessing pre-, peri- and posttraumatic reactions is needed to provide support for this hypothesis.

KEYWORDS:

Childbirth; prepartum; pretraumatic stress; tokophobia; trauma

https://www.ncbi.nlm.nih.gov/pubmed/30095279

 

Is childbirth-induced PTSD associated with low maternal attachment?

Arch Womens Ment Health. 2019 Feb;22(1):119-122. doi: 10.1007/s00737-018-0853-y. Epub 2018 May 21.

Dekel S1,2Thiel F3Dishy G3Ashenfarb AL3.

Abstract

Few studies examined maternal attachment in childbirth-related postpartum posttraumatic stress disorder (PP-PTSD). We studied 685 postpartum women, assessing for PP-PTSD, non-childbirth PTSD, maternal attachment, pre-birth, birth, and post-birth factors. Attachment was lower in PP-PTSD than in non-childbirth PTSD and no PP-PTSD. Hierarchical regression showed that PP-PTSD predicted less maternal attachment above and beyond pre-birth psychiatric conditions, acute distress in birth, and lack of breastfeeding. Childbirth-induced posttraumatic stress may interfere with the formation of maternal attachment, warranting screening of at-risk women.

KEYWORDS:

Attachment; Bonding; Childbirth; Infant; Postpartum; Posttraumatic stress disorder; Traumatic stress

https://www.ncbi.nlm.nih.gov/pubmed/29786116

 

Trauma and fear in Australian midwives.

Women Birth. 2019 Feb;32(1):64-71. doi: 10.1016/j.wombi.2018.04.003. Epub 2018 May 16.

Toohill J1Fenwick J2Sidebotham M3Gamble J4Creedy DK5.

 

Abstract

BACKGROUND:

Relatively little is known about the extent of trauma and birth-related fear in midwives and how this might affect practice.

AIM:

(1) Determine prevalence of birth related trauma and fear in midwives and associations with midwives’ confidence to advise women during pregnancy of their birth options and to provide care in labour. (2) Describe midwives’ experiences of birth related trauma and/or fear.

METHOD:

A mixed methods design. A convenience sample of midwives (n=249) completed an anonymous online survey. Descriptive and inferential statistics were used to analyse the quantitative data. Latent content analysis was used to extrapolate meaning from the 170 midwives who wrote about their experiences of personal and/or professional trauma.

RESULTS:

The majority of midwives (93.6%) reported professional (n=199, 85.4%) and/or personal (n=97, 41.6%) traumatic birth experiences. Eight percent (n=20) reported being highly fearful of birth. Trauma was not associated with practice concerns but fear was. Midwives categorised as having ‘high fear’ reported more practice concerns (Med 23.5, n=20) than midwives with ‘low fear’ (Med 8, n=212) (U=1396, z=-3.79, p<0.001, r=0.24). Reasons for personal trauma included experiencing assault, intervention and stillbirth. Professional trauma related to both witnessing and experiencing disrespectful care and subsequently feeling complicit in the provision of poor care. Feeling unsupported in the workplace and fearing litigation intensified trauma.

CONCLUSION:

High fear was associated with lower confidence to support childbearing women. Fear and trauma in midwives warrants further investigation to better understand the impact on professional practice.

Copyright © 2018 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

KEYWORDS:

Birth; Fear; Midwives; Moral stress; Trauma

https://www.ncbi.nlm.nih.gov/pubmed/29759933

 

A feasibility study of trauma-sensitive obstetric care for low-income, ethno-racial minority pregnant abuse survivors.

J Psychosom Obstet Gynaecol. 2019 Mar;40(1):66-74. doi: 10.1080/0167482X.2017.1398727. Epub 2017 Nov 22.

Stevens NR1Lillis TA1Wagner L1Tirone V1Hobfoll SE1.

Abstract

PURPOSE:

This study evaluated the feasibility and acceptability of an integrated (psychological and obstetric) intervention for pregnant abuse survivors with posttraumatic stress symptoms (PTS) from low-income, ethno-racial minority backgrounds.

METHODS:

Trauma-sensitive obstetrics to promote control, anxiety-reduction and empowerment (TO-CARE) offers cognitive-behavioral therapy (CBT) coping skills delivered over six sessions by therapists, coupled with trauma-sensitive obstetric care from specially-trained obstetric physicians.

RESULTS:

Participants were 21 women who completed at least three sessions of CBT, totaling 51.2% of eligible participants. Participants received approximately one-third (M = 2.29; SD = 2.15) of their prenatal visits with obstetric residents trained in trauma-sensitive care. Nearly all participants (95%) reported that they benefited from the intervention. Although most participants demonstrated improvement in PTS, only four demonstrated reliable improvement, and two demonstrated reliable improvement in depression symptoms. These improvements appeared to be maintained at postpartum follow-up for two of the participants.

CONCLUSIONS:

Our findings suggest that TO-CARE was acceptable to pregnant abuse survivors and may be a promising intervention to reduce symptoms of distress. Implications of the low retention rate for the CBT (51.2%) are discussed in the context of interventions for low-income minority pregnant women. Limitations regarding feasibility of the integrated intervention are discussed.

KEYWORDS:

Pregnancy; abuse; obstetric care; posttraumatic stress; trauma-sensitive care

https://www.ncbi.nlm.nih.gov/pubmed/29164970

 

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