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Posttraumatic stress after childbirth
Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
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: urn:nbn:se:liu:diva-26671Local ID: 11238ISBN: 91-7373-203-6 (print)OAI: oai:DiVA.org:liu-26671DiVA: diva2:247220
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
List of papers
1. Posttraumatic stress disorder after childbirth: a cross sectional study
Open this publication in new window or tab >>Posttraumatic stress disorder after childbirth: a cross sectional study
1997 (English)In: Journal of Anxiety Disorders, ISSN 0887-6185, E-ISSN 1873-7897, Vol. 11, no 6, 587-597 p.Article in journal (Refereed) Published
Abstract [en]

The prevalence of having a posttraumatic stress disorder (PTSD) profile after childbirth and women's cognitive appraisal of the childbirth were studied cross sectionally in an unselected sample of all women who had given birth over a 1-year period in Linköping, Sweden. The PTSD profile was assessed by means of Traumatic Event Scale (TES), which is based on diagnostic criteria from Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV; American Psychiatric Association, 1994). The women's cognitive appraisal of the childbirth was measured by means of the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ). Twenty-eight women (1.7%) of 1640 met criteria for a PTSD profile related to the recent delivery. A PTSD profile was related to a history of having received psychiatric/psychological counseling, a negative cognitive appraisal of the past delivery, mulliparity, and rating the contact with delivery staff in negative terms.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-81621 (URN)10.1016/S0887-6185(97)00041-8 (DOI)
Available from: 2012-09-19 Created: 2012-09-19 Last updated: 2017-12-07Bibliographically approved
2. Traumatic stress after childbirth: the role of obstetric variables
Open this publication in new window or tab >>Traumatic stress after childbirth: the role of obstetric variables
2002 (English)In: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, Vol. 23, no 1, 31-39 p.Article in journal (Refereed) Published
Abstract [en]

In a sample of 1550 recently delivered women, traumatic stress after childbirth was studied in relation to obstetric variables.

A post-traumatic stress disorder (PTSD) symptom profile and traumatic stress symptoms were assessed by means of the Traumatic Event Scale (TES) Obstetric data comprised delivery mode, duration of the second stage of labor (the time from cervical dilation of 10 cm to partus) and the use of analgesia/anesthesia.

Traumatic stress symptoms and having a PTSD symptom profile were both significantly related to the experience of an emergency cesarean section or an instrumental vaginal delivery It is of clinical importance, however that most women with a PTSD symptom profile were found in the normal vaginal delivery group (NVD) This implies that a normal vaginal delivery can be experienced as traumatic, lust as an emergency cesarian section is not necessarily traumatic Traumatic stress symptoms were neither substantially correlated to the duration of the second stage of labor, nor to the use of analgesia/anesthesia.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26588 (URN)10.3109/01674820209093413 (DOI)11153 (Local ID)11153 (Archive number)11153 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-19Bibliographically approved
3. Traumatic stress in late pregnancy
Open this publication in new window or tab >>Traumatic stress in late pregnancy
2004 (English)In: Journal of Anxiety Disorders, ISSN 0887-6185, E-ISSN 1873-7897, Vol. 18, no 2, 127-142 p.Article in journal (Refereed) Published
Abstract [en]

Traumatic stress has traditionally been studied in the aftermath of traumatic events. In contrast, this study aimed to explore if traumatic stress can occur before an event that is perceived as threatening or feared. Traumatic stress, as related to the forthcoming delivery, was studied in 1224 women. Background data and psychological characteristics were assessed in early pregnancy and traumatic stress and fear of childbirth in late pregnancy. Of all subjects, 2.3% met all DSM-IV criteria for posttraumatic stress disorder (PTSD) and 5.8% fulfilled criteria B, C, and D in late pregnancy. Traumatic stress and fear of childbirth correlated significantly. High trait anxiety, depressive symptomatology, psychological/psychiatric counseling related to childbirth, and self-reported psychological problems, measured in early pregnancy, were risk factors for traumatic stress and fear of childbirth in late pregnancy. Results suggest the occurrence of “pre”traumatic stress (i.e., a threatening forthcoming event provoking symptoms similar to those after a traumatic event).

Keyword
Anxiety, Depression, Fear of childbirth, Pregnancy, Traumatic stress
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-45794 (URN)10.1016/S0887-6185(02)00242-6 (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-13Bibliographically approved
4. Risk factors in pregnancy for post-traumatic stress and depression after childbirth
Open this publication in new window or tab >>Risk factors in pregnancy for post-traumatic stress and depression after childbirth
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.

Keyword
Depression, postpartum, post-traumatic stress, pregnancy, risk factors
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-17520 (URN)10.1111/j.1471-0528.2008.02083.x (DOI)
Available from: 2009-03-28 Created: 2009-03-27 Last updated: 2012-09-19Bibliographically approved
5. The longitudinal course of post-traumatic stress after childbirth
Open this publication in new window or tab >>The longitudinal course of post-traumatic stress after childbirth
2006 (English)In: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, Vol. 27, no 2, 113-119 p.Article in journal (Refereed) Published
Abstract [en]

Post-traumatic stress was assessed in early and late pregnancy, and 1, 4, 7, and 11 months postpartum by means of questionnaires among 1224 women. Thirty-seven women (3%) had post-traumatic stress (meeting criteria B, C, and D for PTSD) at least once within 1–11 months postpartum. In pregnancy, depression, severe fear of childbirth, ‘pre’-traumatic stress, previous counseling related to pregnancy/childbirth, and self-reported previous psychological problems were associated with an increased risk of having post-traumatic stress within 1–11 months postpartum. Sum-scores of post-traumatic stress did not decrease over time among women who at least once had post-traumatic stress (criteria B, C, and D) within 1–11 months postpartum. Women with post-traumatic stress also showed a decrease in perceived social support over time postpartum.

Keyword
Post-traumatic stress, longitudinal course, depression, risk factors, pregnancy, postpartum
National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-35630 (URN)10.1080/01674820600712172 (DOI)28018 (Local ID)28018 (Archive number)28018 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2012-09-19Bibliographically approved

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