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J Affect Disord. 2018 Mar 15;229:377-385. doi: 10.1016/j.jad.2017.12.074. Epub 2018 Jan 2.

Longitudinal trajectories of post-traumatic stress disorder (PTSD) after birth and associated risk factors.

Author information

1
Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK. Electronic address: Pelin.Dikmen.1@city.ac.uk.
2
Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK. Electronic address: Susan.Ayers.1@city.ac.uk.
3
Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK. Electronic address: L.A.Phillips@city.ac.uk.

Abstract

BACKGROUND:

Although longitudinal trajectories of post-traumatic stress disorder (PTSD) are well-established in general trauma populations, very little is known about the trajectories of birth-related PTSD. This study aimed to identify trajectories of birth-related PTSD; determine factors associated with each trajectory; and identify women more likely to develop birth-related PTSD.

METHOD:

226 women who had traumatic childbirth according to DSM-IV criterion A were drawn from a community sample of 950 women. Measures were taken of PTSD, affective symptoms, fear of childbirth and social support in pregnancy, 4-6 weeks and 6-months postpartum. Information on some obstetric and psychosocial factors were also prospectively obtained.

RESULTS:

Four trajectories were identified: resilience (61.9%), recovery (18.5%), chronic-PTSD (13.7%) and delayed-PTSD (5.8%). Resilience was consistently distinguished from other PTSD trajectories by less affective symptoms at 4-6 weeks postpartum. Poor satisfaction with health professionals was associated with chronic-PTSD and delayed-PTSD. When affective symptoms at 4-6 weeks postpartum were removed from the model, less social support and higher fear of childbirth 4-6 weeks after birth predicted chronic and recovery trajectories; whereas experience of further trauma and low levels of satisfaction with health professionals were predictive of chronic-PTSD and delayed-PTSD, compared to resilience. Additional variables associated with different trajectories included antenatal affective symptoms, caesarean-section, preterm birth and receiving professional help.

LIMITATIONS:

Use of self-report measures, use of DSM-IV criteria for PTSD diagnosis, and no follow-up beyond six months are the main limitations of this study.

CONCLUSION:

Identified factors may inform preventive and treatment interventions for women with traumatic birth experiences.

KEYWORDS:

Childbirth; Post-traumatic stress disorder; Resilience, Recovery; Risk factors; Trajectories

PMID:
29331697
DOI:
10.1016/j.jad.2017.12.074
[Indexed for MEDLINE]

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