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

Dikmen-Yildiz, P., Ayers, S. & Phillips, L. (2018). Longitudinal trajectories of post-traumatic stress disorder (PTSD) after birth and associated risk factors. Journal of Affective Disorders, 229, pp. 377-385. doi: 10.1016/j.jad.2017.12.074

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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.

Item Type: Article
Additional Information: © 2018 Elsevier B.V. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
Uncontrolled Keywords: Post-traumatic stress disorder, Trajectories, Childbirth Risk factors, Resilience, Recovery
Divisions: School of Health Sciences > Department of Midwifery
School of Health Sciences > Department of Radiography
School of Health Sciences
URI: http://openaccess.city.ac.uk/id/eprint/19244

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