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Psychol Trauma. 2019 Aug 1. doi: 10.1037/tra0000501. [Epub ahead of print]

Measuring and conceptualizing PTSD following childbirth: Validation of the City Birth Trauma Scale.

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Department of Psychology, Catholic University of Croatia.
Center for Maternal and Child Health Research, City, University of London.



City Birth Trauma Scale is a recently developed scale specifically designed for evaluation of posttraumatic stress disorder (PTSD) following childbirth based on the DSM-5 criteria (Ayers, Wright, & Thornton, 2018). Previous studies showed a two-factor structure of PTSD symptoms in postpartum women; however, more complex models were not tested. This study aimed to validate the Croatian version of the City Birth Trauma Scale and determine the latent factor structure of postpartum PTSD.


In a cross-sectional study, 603 women completed online questionnaires comprising the City Birth Trauma Scale, Impact of Event Scale-Revised (IES-R), Edinburgh Postnatal Depression Scale (EPDS), and the anxiety subscale from the Depression, Anxiety, and Stress Scale (DASS-21).


Confirmatory factor analysis confirmed the bifactor model of birth-related symptoms and general symptoms had an excellent fit to the data. Both subscales and the total scale showed high internal consistency (α = .92). Convergent and divergent validity testing showed high validity, especially for birth-related symptoms. Discriminant validity was confirmed with primiparous women and women who gave birth by instrumental vaginal delivery and emergency caesarean section having significantly higher scores on birth-related symptoms, but not on general symptoms, suggesting high discriminant validity of the birth-related symptoms subscale.


The City Birth Trauma Scale is a reliable and valid measure. Both total scale score and subscale scores can be calculated. It is highly recommended for use in postpartum population. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


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