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Risk factors in pregnancy for post-traumatic stress and depression after childbirth
Linköping University, Department of Welfare and Care (IVV). Linköping University, Faculty of Health Sciences.
Linköping University, Department of Molecular and Clinical Medicine. Linköping University, Faculty of Health Sciences.
Central Hospital of Kalmar, Kalmar, Sweden.
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
2009 (English)In: BJOG - An international journal of obstetrics and gynaecology, ISSN 1470-0328, Vol. 116, no 5, 672-680 p.Article in journal (Refereed) Published
Abstract [en]

Objective  The objective of this study was to find risk factors in pregnancy for post-traumatic stress and depression 1 month after childbirth. Furthermore, the relation between post-traumatic stress and depression was explored.

Design  A prospective longitudinal study.

Setting  Pregnant women in Linköping and Kalmar, Sweden.

Population  A total of 1224 women were assessed in pregnancy, week 12–20 and 32, as well as 1 month postpartum.

Methods  Post-traumatic stress and depression after delivery were assessed 1 month postpartum. Potential risk factors were assessed in early and late pregnancy. Variables measured during pregnancy were trait anxiety, depression, fear of childbirth, childbirth-related traumatic stress, stress coping capacity, social support, parity, educational level, age, gestation week, parity, educational level, civil status, previous psychological/psychiatric counselling, and previous experience of any traumatic events. Delivery mode was assessed from the medical records.

Main outcome measures  Prevalence of post-traumatic stress (criteria A, B, C, D, E, and F according to DSM-IV) and depression (Beck’s depression inventory).

Results  One month postpartum, 12 (1.3%) women had post-traumatic stress (met symptom criteria B, C, and D for post-traumatic stress disorder according to Diagnostic and statistical manual of mental disorders, 4th edition [DSM-IV]). The most important risk factors in pregnancy were depression in early pregnancy (OR = 16.3), severe fear of childbirth (OR = 6.2), and ‘pre’-traumatic stress (in view of the forthcoming delivery) in late pregnancy (OR = 12.5). The prevalence of depression was 5.6%. Post-traumatic stress and depression were positively related 1 month postpartum and were predicted by mainly the same factors.

Conclusions  Risk factors for post-traumatic stress and depression after childbirth can be assessed in early pregnancy. Post-traumatic stress and depression also seem to share the same underlying vulnerability factors.

Place, publisher, year, edition, pages
2009. Vol. 116, no 5, 672-680 p.
Keyword [en]
Depression, postpartum, post-traumatic stress, pregnancy, risk factors
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-17520DOI: 10.1111/j.1471-0528.2008.02083.xOAI: oai:DiVA.org:liu-17520DiVA: diva2:209959
Available from: 2009-03-28 Created: 2009-03-27 Last updated: 2012-09-19Bibliographically approved
In thesis
1. Posttraumatic stress after childbirth
Open this publication in new window or tab >>Posttraumatic stress after childbirth
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of the thesis was to study the occunence of posttraumatic stress after childbirth, as seen in Posttraumatic Stress Disorder (PTSD). Furthermore the studies explored potential risk factors, in pregnancy and during the delivery, for posttraumatic stress after childbirth and its longitudinal course, one to eleven months postpartum. Posttraumatic stress was also studied in comparison with the occunence of depression, in pregnancy and after childbirth.

Study 1 and 2 had a cross-sectional design and comprised 1640 consecutively delivered women in Linköping, Sweden. The variables were assessed once, using questimmaires measuring posttraumatic stress and fear of childbirth. Obstetric data were collected from the medical records.

Study 3, 4 and 5 were based on a cohort of 1224 women who were recruited in Linköping and Kalmar. Variables were assessed in early and late pregnancy. After the delivery the variables were assessed four times: 1, 4, 7, and 11 months postpartum. Measurements by means of questionnaires comprised demographic data, potential risk factors, posttraumatic stress, fear of childbirth, and depression.

Within 1-11 months after the delivery, 1-2% of the women developed posttraumatic stress. Emergency cesarean section and vaginal instrumental delivery were associated with an increased risk for posttraumatic stress postpartum.

Severe fear of childbirth, "pre"-traumatic stress (similar to posttraumatic stress but future oriented) and depression in pregnancy were associated with an increased tisk of suffedng from posttraumatic stress within 1-11 months postpartum. During that period, 24 of the 37 women with posttraumatic stress also had depression.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2002. 41 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 761
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26671 (URN)11238 (Local ID)91-7373-203-6 (ISBN)11238 (Archive number)11238 (OAI)
Public defence
2002-12-20, Berzeliussalen, Hälsouniversitetet, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-19Bibliographically approved

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Söderquist, JohanWijma, BarbroWijma, Klaas

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