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Osório FL, Borges MM. Posttraumatic stress disorder prevalence and childbirth: update meta-analysis after the introduction of the DSM-5 and COVID-19 pandemic. Arch Womens Ment Health 2024; 27:337-357. [PMID: 38265513 DOI: 10.1007/s00737-024-01423-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024]
Abstract
PURPOSE Meta-analyses were previously performed to estimate PTSD prevalence in the postpartum period. Significant events that could impact this outcome occurred in the last decade, such as the publication of the DSM-5 in 2013 and the COVID-19 pandemic in 2020. This systematic literature review with a meta-analysis addressed studies published after 2014 to estimate PTSD prevalence after childbirth. METHOD The methodological guidelines recommended by PRISMA were followed. The meta-analysis estimate was the proportion of PTSD cases. The restricted maximum likelihood (REML) was the method adopted for estimation in addition to multilevel random effect models. Subgroup analyses were performed to assess the impact of interest variables. RESULTS The estimated prevalence was 0.10 (95%CI: 0.8-0.13; I2 = 98.5%). No significant differences were found regarding the introduction of the DSM-5 (p = 0.73) or COVID-19 (p = 0.97), but instead, between low- and middle-income countries, e.g., the Middle East presents a higher prevalence (p < 0.01) than European countries. CONCLUSIONS There is a potential increase in PTSD prevalence rates after childbirth in the last decade not associated with the pandemic or the current diagnostic classification. Most studies showed a methodological fragility that must be overcome to understand this phenomenon better and support preventive actions and treatment for puerperal women.
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Affiliation(s)
- Flávia L Osório
- Medical School of Ribeirão Preto. São Paulo University, Avenida Dos Bandeirantes, 3900, Ribeirão Preto, SP, 14048-900, Brazil.
- National Institute of Science and Technology (INCT-TM, CNPq), Brasília, Brazil.
| | - Maira Morena Borges
- Medical School of Ribeirão Preto. São Paulo University, Avenida Dos Bandeirantes, 3900, Ribeirão Preto, SP, 14048-900, Brazil
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Zeng F, John WCM, Sun X, Wang Y. COVID-19-associated impact and post-traumatic stress symptoms 39 days after pandemic in a sample of home-quarantined Chinese college students: the mediating effecting of past stressful events, psychological resilience, and social support. BMC Psychiatry 2023; 23:379. [PMID: 37254082 DOI: 10.1186/s12888-023-04906-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/26/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND During the COVID-19 outbreak, most Chinese college students were home-quarantined to prevent the spread of the virus. COVID-19-associated impact has been shown to be a risk factor for the development of post-traumatic symptoms disorder (PTSD). However, little is known about the psychological processes that mediate this association. This study investigated the association between COVID-19-associated impact and PTSD and examined whether past stressful events, psychological resilience, and social support have mediating effects on this association. METHODS The 12,397 valid responses from 31cities in China via an online survey assessed PTSD symptoms, past stressful events, psychological resilience, social support and social-demographic variables. AMOS was used to test the hypotheses of mediating effects. RESULTS On the 39th day of the declared COVID-19 epidemic in China, 6.75% of the surveyed sample showed PTSD symptoms. A positive mediating effect of past stressful events was found between COVID-19-associated impact and PTSD, whereas psychological resilience and social support had negative mediating effects. The fit indices for the path model were found to be significant (β = 0.28, p < 0.001), COVID-19-associated impact indirectly affects the risk of PTSD through mediating pathways (past stressful events → psychological resilience → social support) on PTSD. CONCLUSIONS Attention should be paid to the effects of past stressful events of Chinese college students who were home-quarantined during the COVID-19 epidemic, and strategies should also be implemented to improve social support and develop psychological resilience. TRIAL REGISTRATION The study was approved by the ethics committee of the Southwest Minzu University.
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Affiliation(s)
- Fanmin Zeng
- Mental Health Education Centre of Southwest Minzu University, Chengdu, China.
| | - Wong Chee Meng John
- Department of Psychological Medicine, National University Hospital & National University of Singapore, Singapore, Singapore
| | - Xueli Sun
- Mental Health Centre of West China Hospital in Sichuan University, Chengdu, China
| | - Yarong Wang
- School of Psychology, Northeast Normal University, 130024, Changchun, China
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Hoell A, Kourmpeli E, Dressing H. Work-related posttraumatic stress disorder in paramedics in comparison to data from the general population of working age. A systematic review and meta-analysis. Front Public Health 2023; 11:1151248. [PMID: 36969652 PMCID: PMC10035789 DOI: 10.3389/fpubh.2023.1151248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/17/2023] [Indexed: 03/11/2023] Open
Abstract
ObjectiveParamedics are at particularly high risk for developing posttraumatic stress disorders (PTSD). Hitherto, evidence for higher prevalence rates in paramedics compared to the general population is vague. We aimed to determine and compare 12-month prevalence of PTSD in paramedics and general population from high-income countries.MethodsWe conducted systematic review processes to identify relevant studies for inclusion. For paramedics, we searched relevant databases, reference lists, and did citation tracking. Inclusion criteria were applied according to PICO. Quality of the studies was assessed using a validated methodological rating tool. Twelve-month prevalence data from all studies were pooled using random effects model. Subgroup analyses were performed to identify sources of heterogeneity.ResultsIn total, we found 41 distinct samples with 17,045 paramedics, 55 samples with 311,547 individuals from non-exposed general population, 39 samples with 118,806 individuals from populations affected by natural disasters, and 22 samples with 99,222 individuals from populations affected by human-made disasters. Pooled 12-month prevalence estimates of PTSD were 20.0, 3.1, 15.6, and 12.0%, respectively. Prevalence estimates in paramedics varied with methodological quality and measurement instrument. Paramedics reporting distinct critical incidences had lower pooled prevalence than paramedics reporting indistinct types of exposure.ConclusionParamedics have a pooled prevalence of PTSD that is considerably higher than rates of unexposed general population and populations affected by human-made disasters. Chronic exposure to low-threshold traumatic events during daily routine work is a risk factor for developing PTSD. Strategies to ensure long working lifetime are strongly needed.
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Veronese G, Pepe A, Obaid H, Cavazzoni F, Perez J. Agency and life satisfaction in Bedouin children exposed to conditions of chronic stress and military violence: A two-wave longitudinal study in Palestine. Clin Child Psychol Psychiatry 2020; 25:242-259. [PMID: 31353934 DOI: 10.1177/1359104519864134] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Bedouin children in Palestine are at risk of developing trauma-related pathologies as a result of chronic exposure to severe political and military violence. Little is known about their coping abilities and survival skills. The aim of our study was to longitudinally test the contribution of agency to predicting life satisfaction and the power of life satisfaction to mitigate traumatic stress in a group of Bedouin children exposed to prolonged military violence in West Bank, occupied Palestinian territories. We expected that children who maintained good levels of satisfaction over the time would be less at risk of developing stress- and trauma-related syndromes and that agency would act as a predeterminant of mitigated traumatic reactions. A quantitative cross-lagged path model (CLPM) research design was implemented. One hundred forty-three Palestinian children were administered with Children's Hope Scale, Multidimensional Student Life Satisfaction Scale, Children's Impact of Event Scale, and a built ad hoc traumatic checklist. The results provided support for all the study hypotheses, suggesting that in general Bedouin children draw on a considerable range of resources in adjusting to their chronically traumatic life context. Implications for clinical work and future research are discussed.
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Affiliation(s)
- Guido Veronese
- Department of Human Sciences "R. Massa," University of Milano-Bicocca, Italy
| | - Alessandro Pepe
- Department of Human Sciences "R. Massa," University of Milano-Bicocca, Italy
| | - Hania Obaid
- Department of Human Sciences "R. Massa," University of Milano-Bicocca, Italy
| | - Federica Cavazzoni
- Department of Human Sciences "R. Massa," University of Milano-Bicocca, Italy
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Boals A, Liu K. Illusory Reports of Posttraumatic Growth in Response to a Nontraumatic Event. JOURNAL OF LOSS & TRAUMA 2019. [DOI: 10.1080/15325024.2019.1655988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Keke Liu
- University of North Texas, Denton, Texas, USA
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Zawadzki MJ, Boals A, Mathews N, Schuler K, Southard-Dobbs S, Smyth JM. The relationship between perseverative cognitions and mental health and physical health complaints among college students. COGENT PSYCHOLOGY 2018. [DOI: 10.1080/23311908.2018.1475878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
| | - Adriel Boals
- Department of Psychology, University of North Texas
| | - Nick Mathews
- Department of Psychology, University of North Texas
| | - Keke Schuler
- Department of Psychology, University of North Texas
| | - Shana Southard-Dobbs
- Department of Psychology, University of North Texas
- Department of Psychological Science, Lander University, Greenwood, SC, USA
| | - Joshua M. Smyth
- Department of Biobehavioral Health, The Pennsylvania State University
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Wang M, Duan F, Wu J, Min Q, Huang Q, Luo M, He Z. Effect of cyclooxygenase‑2 inhibition on the development of post‑traumatic stress disorder in rats. Mol Med Rep 2018; 17:4925-4932. [PMID: 29393449 PMCID: PMC5865951 DOI: 10.3892/mmr.2018.8525] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 09/18/2017] [Indexed: 12/25/2022] Open
Abstract
Post‑traumatic stress disorder (PTSD) is characterized by re‑experiencing of a traumatic event, avoidance of trauma‑associated stimulation, general changes in mood and cognition, and hyper arousal symptoms. Cyclooxygenase is involved in the production of prostaglandins and thromboxanes, and its inducible form cyclooxygenase‑2(COX‑2), an important mediator of cell injury in inflammation, is primarily expressed in leukocytes and brain cells. The present study investigated the expression of COX‑2 in the hippocampi of rats with PTSD and evaluated the effect of COX‑2 inhibition on PTSD. Adult male Wistar rats were randomly divided into three groups: Control (n=20), PTSD (n=20) and intervention group (PTSD+COX‑2 inhibitor treatment, n=20). The expression of COX‑2 was detected by immunohistochemistry, reverse transcription‑quantitative polymerase chain reaction and western blotting. Terminal deoxynucleotidyl transferase mediated dUTP nick end labeling staining was used to observe the apoptosis of rat hippocampal neurons. Tumor necrosis factor α (TNF‑α), interleukin (IL)‑6 and prostaglandin E2 (PGE2) levels were analyzed by ELISA. Nitric oxide (NO) was detected using the Griess test. The behavioral and cognitive function of rats in the PTSD group was significantly decreased compared with the control group, while the behavioral and cognitive function of rats in the intervention group were improved. The COX‑2 mRNA and protein expression levels in hippocampi of rats in the PTSD group were higher than in the control and intervention group. The apoptosis of hippocampus in rats with PTSD was significantly increased compared with the control group and following treatment with COX‑2 inhibitor, apoptosis was decreased. In addition, compared with the control group and intervention group, the levels of TNF‑α, IL‑6, PGE2 and NO in hippocampi of rats were increased in the PTSD group. The present study indicated that COX‑2 may be involved in the pathogenesis of PTSD, and inhibition of its expression serves a neuroprotective role in hippocampi of PTSD rats.
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Affiliation(s)
- Mengyang Wang
- Department of Neurosurgery, Wuhan No. 1 Hospital, Wuhan, Hubei 430022, P.R. China
| | - Faliang Duan
- Department of Neurosurgery, Wuhan No. 1 Hospital, Wuhan, Hubei 430022, P.R. China
| | - Jinglei Wu
- Department of Neurosurgery, Wuhan No. 1 Hospital, Wuhan, Hubei 430022, P.R. China
| | - Qiang Min
- Department of Neurosurgery, Wuhan No. 1 Hospital, Wuhan, Hubei 430022, P.R. China
| | - Qiaochun Huang
- Department of Neurosurgery, Wuhan No. 1 Hospital, Wuhan, Hubei 430022, P.R. China
| | - Ming Luo
- Department of Neurosurgery, Wuhan No. 1 Hospital, Wuhan, Hubei 430022, P.R. China
| | - Zhuqiang He
- Department of Neurosurgery, Wuhan No. 1 Hospital, Wuhan, Hubei 430022, P.R. China
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Yildiz PD, Ayers S, Phillips L. The prevalence of posttraumatic stress disorder in pregnancy and after birth: A systematic review and meta-analysis. J Affect Disord 2017; 208:634-645. [PMID: 27865585 DOI: 10.1016/j.jad.2016.10.009] [Citation(s) in RCA: 340] [Impact Index Per Article: 48.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 10/04/2016] [Accepted: 10/16/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Previous reviews have provided preliminary insights into risk factors and possible prevalence of Post-traumatic Stress Disorder (PTSD) postpartum with no attempt to examine prenatal PTSD. This study aimed to assess the prevalence of PTSD during pregnancy and after birth, and the course of PTSD over this time. METHODS PsychINFO, PubMed, Scopus and Web of Science were searched using PTSD terms crossed with perinatal terms. Studies were included if they reported the prevalence of PTSD during pregnancy or after birth using a diagnostic measure. RESULTS 59 studies (N =24267) met inclusion criteria: 35 studies of prenatal PTSD and 28 studies of postpartum PTSD (where 4 studies provided prevalence of PTSD in pregnancy and postpartum). In community samples the mean prevalence of prenatal PTSD was 3.3% (95%, CI 2.44-4.54). The majority of postpartum studies measured PTSD in relation to childbirth with a mean prevalence of 4.0% (95%, CI 2.77-5.71) in community samples. Women in high-risk groups were at more risk of PTSD with a mean prevalence of 18.95% (95%, CI 10.62-31.43) in pregnancy and 18.5% (95%, CI 10.6-30.38) after birth. Using clinical interviews was associated with lower prevalence rates in pregnancy and higher prevalence rates postpartum. LIMITATIONS Limitations include use of stringent diagnostic criteria, wide variability of PTSD rates, and inadequacy of studies on prenatal PTSD measured in three trimesters. CONCLUSIONS PTSD is prevalent during pregnancy and after birth and may increase postpartum if not identified and treated. Assessment and treatment in maternity services is recommended.
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Affiliation(s)
- Pelin Dikmen Yildiz
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK.
| | - Louise Phillips
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK
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Impact of Sedation on Cognitive Function in Mechanically Ventilated Patients. Lung 2015; 194:43-52. [PMID: 26559680 DOI: 10.1007/s00408-015-9820-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 10/30/2015] [Indexed: 10/22/2022]
Abstract
The practice of sedation dosing strategy in mechanically ventilated patient has a profound effect on cognitive function. We conducted a comprehensive review of outcome of sedation on mental health function in critically ill patients on mechanical ventilation in the intensive care unit (ICU). We specifically evaluated current sedative dosing strategy and the development of delirium, post-traumatic stress disorders (PTSDs) and agitation. Based on this review, heavy dosing sedation strategy with benzodiazepines contributes to cognitive dysfunction. However, outcome for mental health dysfunction is mixed in regard to newer sedatives agents such as dexmedetomidine and propofol. Moreover, studies that examine the impact of sedatives for persistence of PTSD/delirium and its long-term cognitive and functional outcomes for post-ICU patients are frequently underpowered. Most studies suffer from low sample sizes and methodological variations. Therefore, larger randomized controlled trials are needed to properly assess the impact of sedation dosing strategy on cognitive function.
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Boals A, Ruggero C. Event centrality prospectively predicts PTSD symptoms. ANXIETY STRESS AND COPING 2015; 29:533-41. [DOI: 10.1080/10615806.2015.1080822] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Adriel Boals
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX 76203, USA
| | - Camilo Ruggero
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX 76203, USA
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Hellmuth JC, Jaquier V, Swan SC, Sullivan TP. Elucidating posttraumatic stress symptom profiles and their correlates among women experiencing bidirectional intimate partner violence. J Clin Psychol 2014; 70:1008-21. [PMID: 24752965 DOI: 10.1002/jclp.22100] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study employed latent class analysis to identify profiles of women experiencing intimate partner violence (IPV) based on the severity of posttraumatic stress disorder (PTSD) symptoms. METHOD Self-report data from a sample of 369 women experiencing bidirectional IPV was used. RESULTS A 3-class solution comprising low, moderate, and high PTSD severity profiles best fit the data. Profiles were differentially related to whether IPV victimization was considered traumatic (PTSD criterion A); whether functioning was impaired as a result of PTSD symptoms (PTSD criterion F); whether the woman met full diagnostic criteria for PTSD; depression symptom severity; and severity of psychological, physical, and sexual IPV victimization and use of IPV. An extremely high percentage of women in the high (96%) and moderate (88%) severity classes experienced functional impairment, although many did not meet full diagnostic criteria for PTSD. CONCLUSIONS Findings support the need for interventions individually tailored to one's treatment needs based on the nature of one's traumatic stressor and the impact of PTSD on daily functioning.
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Boals A, Riggs SA, Kraha A. Coping with stressful or traumatic events: what aspects of trauma reactions are associated with health outcomes? Stress Health 2013; 29:156-63. [PMID: 22888078 DOI: 10.1002/smi.2443] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 06/29/2012] [Accepted: 07/12/2012] [Indexed: 11/10/2022]
Abstract
The presence of posttraumatic stress disorder (PTSD) symptoms has been shown to be related to a number of health outcomes. In the current study, we explored which specific aspects of PTSD are most related to health measures. The associations between the specific DSM-IV-TR PTSD criteria (criteria A-F) and five indicators of health and well-being--physical health symptoms, quality of life, mental health, depression and negative affect--were examined. The sample consisted of 711 undergraduates. A non-clinical sample was recruited so there would be variability in the various criteria for PTSD. Multiple regression analyses revealed that the hyperarousal (criterion D) was the most consistent and strongest predictor of outcomes. However, the F criterion (causes significant impairment) predicted additional variance in quality of life, depression and negative affect. These results suggest that it is not just the mere frequency of trauma symptoms that affect well-being but also the disruptive capability of these symptoms. In addition, follow-up analyses indicated that hyperarousal mediated the association between the A2 criterion (traumatic response) and all five outcome measures. These results underscore the importance of the hyperarousal criterion, while also suggesting the need for increased attention to the F criterion when considering the impact of stressful events on health and well-being.
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Affiliation(s)
- Adriel Boals
- Department of Psychology, University of North Texas, Denton, TX 76203, USA.
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Gustafsson M, Windahl J, Blomberg K. Ten years follow-up of trauma-related psychological distress in a cohort of patients with acute traumatic hand injury. Int J Orthop Trauma Nurs 2012. [DOI: 10.1016/j.ijotn.2012.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Tagay S, Repic N, Senf W. Traumafolgestörungen bei Erwachsenen, Kindern und Jugendlichen. PSYCHOTHERAPEUT 2011. [DOI: 10.1007/s00278-011-0847-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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McCanlies EC, Araia SK, Joseph PN, Mnatsakanova A, Andrew ME, Burchfiel CM, Violanti JM. C-reactive protein, interleukin-6, and posttraumatic stress disorder symptomology in urban police officers. Cytokine 2011; 55:74-8. [PMID: 21493089 DOI: 10.1016/j.cyto.2011.03.025] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 02/15/2011] [Accepted: 03/24/2011] [Indexed: 12/25/2022]
Abstract
Our aim was to examine the relationship between the level of the inflammatory markers, C-reactive protein (CRP) and interleukin-6 (IL-6), and posttraumatic stress disorder (PTSD) symptomology in a random sample of 115 police officers. CRP was measured in citrated plasma using a particle enhanced immunonepholometric assay and IL-6 was measured in serum with a solid-phase quantitative sandwich ELISA. The presence of high PTSD symptomology was defined as having an Impact of Event Scale score (IES) of ≥ 26 compared to<26 (low PTSD symptomology). 28% of the officers had high PTSD symptomology. Mean levels of CRP and IL-6 did not differ significantly between officers with high PTSD symptomology and those with low symptomology (CRP: 0.76 mg/l vs. 0.97 mg/l; IL-6: 2.03 pg/ml vs. 1.74 pg/ml). We found no association of CRP and IL-6 levels with PTSD symptomology. This study was limited by sample size and its cross-sectional study design. A lack of association may occur if either CRP or IL-6 is elevated only at the onset of PTSD symptomology, or if inflammation is related to specific key components that define PTSD. Further research examining these relationships in a larger population may be worthwhile.
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Affiliation(s)
- Erin C McCanlies
- Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV 26505, USA.
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Stramrood CAI, Huis In 't Veld EMJ, Van Pampus MG, Berger LWAR, Vingerhoets AJJM, Schultz WCMW, Van den Berg PP, Van Sonderen ELP, Paarlberg KM. Measuring posttraumatic stress following childbirth: a critical evaluation of instruments. J Psychosom Obstet Gynaecol 2010; 31:40-9. [PMID: 20146642 DOI: 10.3109/01674820903573946] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To evaluate instruments used to assess posttraumatic stress disorder (PTSD) following childbirth with both quantitative (reliability analysis and factor analysis) and qualitative (comparison of operationalization) techniques. METHODS An unselected population of 428 women completed the Traumatic Event Scale-B (TES-B) and the PTSD Symptom Scale-Self Report (PSS-SR) 2-6 months after delivery. RESULTS Assessment of internal consistency yielded similar results for the TES-B and PSS-SR (Cronbach's alpha = 0.87 and 0.82, respectively). Factor analysis revealed two rather than three DSM-IV symptom categories for both instruments: childbirth-related factors (re-experiencing/ avoidance) and symptoms of depression and anxiety (numbing/hyperarousal). Although the TES-B and the PSS-SR sum-scores show a strong relationship (Spearmans rho = 0.78), agreement between the instruments on the identification of PTSD cases is low (kappa = 0.24); discrepancy between TES-B and PSS-SR is largely due to differences in instruction to respondents, formulation of items, answer categories, and cut-off values. CONCLUSIONS Large operationalization differences between TES-B and PSS-SR have been identified, i.e., in the formulation of questions, answer categories, cut-off values and instructions to respondents. Comparison between studies using different instruments for measuring PTSD following childbirth should be done with utmost caution.
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Affiliation(s)
- Claire A I Stramrood
- Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands.
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